dhb non-financial monitoring framework and performance ...€¦ · web viewa narrative is also...

DHB non-financial monitoring framework and performance measures 2017/18

2017/18

DHB non-financial monitoring framework and

performance measures

Document last updated January 2018

Updates included as at January 2018:Policy priorities PP6: Improving the health status of people with severe mental illness through improved access – updates to contextual information to clarify reporting period

Updates included as at December 2017:PP26: Rising to the Challenge: The Mental Health and Addiction Service Development Plan change to deliverables reports now expected as below:

Focus Area 4 Improve outcomes for children Please report on progress against actions identified in the annual plan for improving outcomes for children. The report must include progress on the implementation of Supporting Parents Healthy Children (COPMIA).

Focus area 5 improving employment and physical health needs of people with low prevalence conditions: Please provide a progress report on actions identified in the annual plan for improving the physical and employment outcomes of people with low prevalence conditions.

Adjustment to focus area 1 and focus area 3 to remove teleconferenced based reporting requirement Updates included as at August 2017:Update to 2017/18 measures re the proportion of babies living in smoke free homes-

Improving the proportion of babies living in smoke free homes has been signalled as: a developmental System Level Measure for 2017/18 one of the measures that has transitioned from the previous Maori Health plan into the

2017/18 DHB monitoring framework a supporting measure for the new Better Public Service Targets 2 and 3.

A number of issues relating to the definition and data have been identified with this measure. As part of the development process under the System Level Measures (SLM) Framework, the Ministry will work with the sector to align definitions, data sources and data processes and finalise the

1


measure by March 2018. The final measure will be used for systematic reporting across SLM Framework, BPS targets and Maori Health Plan from 1 July 2018.

Progress on the developmental work will be shared through System Level Measures communications which will be available from the Ministry of Health and the Nationwide Service Framework Library (NSFL) websites.

In this update to the DHB performance measures for 2017/18: PP34 Improving the percentage of households who are smoke free at six weeks postnatal

has been removed, the measure currently identified DV7 is retained as this is the developmental System Level

Measure: Proportion of babies who live in a smoke-free household at six weeks post natal.

PP20 Improved management for long term conditionsMinor adjustments to remove inconsistencies and provide clarification of expected reporting

Updates included as at July 2017:SI2: Ensuring delivery of Regional Service PlansRemoval of requirement to provide a regional SUDI plan as this will now by captured through the contract requirements with the lead service provider.

PP7: Improving mental health services using wellness and transition (discharge) planningRewording to clarify requirements

PP20: Improved management for long term conditionsAdjustment to focus area 1 and focus area 3 to remove teleconferenced based reporting requirement

Updates included as at June 2017:PP20: Improved management for long term conditionsUpdates to focus area 2 diabetes services in-line with DCIP devolution from 1 July

PP23: Implementing the Healthy Ageing StrategyAdditional clarification included re deliverable 2.

PP25: Delivery of the Prime Minister’s youth mental health initiativeAdjustment to reporting time frames for initiative 1 part 1 (now six monthly)

PP28: Reducing Rheumatic feverAdjustment to definition following announcements regarding refreshed Better Public Service targets and confirmation of targets for 2017/18.

2


PP38: Delivery of response actions agreed in annual planAdjustment to include the two new health led BPS targets

Updates included as at May 2017:

PP23: now titled ‘Implementing the Healthy Ageing Strategy’Following the release of the Healthy Ageing Strategy, this measure has been reframed to focus on progress with delivery of the actions and milestones of the Healthy Ageing Strategy and support the health system to be person centred and focused on maximising healthy ageing and independence.

PP28: Reducing Rheumatic feverFollowing announcements regarding refreshed Better Public Service targets - Confirmation that this measure will continue as a DHB performance measure (targets for 2017/18 tbc).

SI1: Ambulatory sensitive hospitalisations (ASH)For the 45-64 age group DHB Annual plans include targets for the total population (the Ministry will continue to monitor and assess DHB performance for sub populations against the total population target. Performance for the 0-4 age group is a focus in the SLM improvement plan, when setting targets DHB are expected to refer to the SLM improvement plan in relation to this age group. Performance for the 0-4 age group will be assessed through the SLM improvement plan reporting.

SI2: Ensuring delivery of Regional Service PlansClarification included regarding the reporting of actions related to implementation of the Health Ageing Strategy Addition of requirement re the development of a Regional SUDI Prevention Plan to be provided to the Ministry in quarter one 2017/18 reports.

Updates included as at March 2017:

PP20: Improved management for long term conditions (CVD, Acute heart health, Diabetes, and Stroke) - Adjustment to the outline of commentary to be provided for Focus Area two – diabetes services

PP29: Improving waiting times for diagnostic services - targets now included

PP35: Reducing SUDI infant deaths Measure previously included in Maori Health plan - the requirements and reporting for this measure will be captured under a new Crown Funding Agreement variation. The Ministry has developed a new National SUDI Prevention Programme to be implemented from 1 July 2017. The SUDI performance measures from the previous Maori Health plans will be incorporated into the reporting for the regional component of the new programme via a new Crown Funding Agreement variation.

SI4: Standardised Intervention Rates (SIRs)- targets now included

OS3: Inpatient Average Length of Stay (ALOS) –ALOS targets now included

3


OS10: Improving the quality of identity data within the National Health Index (NHI) and data submitted to National Collections – addition of information re the extension of DHB data stewardship of the NHI to enrolled populations in primary care and linking to PP32

4


2017/18 DHB non-financial monitoring framework Overview of changes to the measures proposed in the DHB monitoring framework for 2017/18 compared to 2016/17 Key changes to the DHB non-financial monitoring framework for 2017/18 are outlined below with further detail provided in relation to each measure

Streamlined DHB annual plans that are directly focussed on the Minster of Health’s key expectations for each DHB are expected for 2017/18. A new confirmation and exception measure is included to capture confirmed delivery of response actions identified in the streamlined annual plan

All of the measures that were previously identified in Maori Health plans have been included as performance measures in the DHB non-financial monitoring framework for 2017/18.

In addition, a strengthened focus on equity has been included in the overarching assessment criteria for all measures.

Further information on development of the plans is available in the DHB Annual Planning Guidance on the National Service Framework Library (http://nsfl.health.govt.nz/).

DHB heath targets 2017/18

Health target Target goalShorter stays in Emergency Departments

95 percent of patients will be admitted, discharged, or transferred from an Emergency Department (ED) within six hours.

Improved access to elective surgery

The volume of elective surgery will be increased by an average of 4,000 discharges per year.

Faster cancer treatment 90 percent of patients to receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks.

Increased immunisation 95 percent of eight months olds will have their primary course of immunisation (six weeks, three months and five months immunisation events) on time.

Better help for smokers to quit 90 percent of PHO enrolled patients who smoke have been offered help to quit smoking by a health care practitioner in the last 15 months

90 percent of pregnant women who identify as smokers upon registration with a DHB-employed midwife or Lead Maternity Carer are offered brief advice and support to quit smoking

Raising healthy kids By December 2017, 95 percent of obese children identified in the Before School Check (B4SC) programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions.

Change key - changes to DHB performance measures compared to 2016/17No significant change Changes made to deliverables/expectations – yet to be confirmed 16/17 measure signalled for removal in 17/18additional deliverables included within existing measure

5


New measure included for 17/18

Overview – DHB performance measures Measure changes compared to 2016/17 LETTER OF EXPECTATIONS HS Supporting delivery of the New Zealand Health

Strategyno change

PP6 Improving the health status of people with severe mental illness through improved access

PP6 updated to include consult liaison

PP7 has been modified to include all age groups so that 95% of people have a transition plan at discharge and 95% of those who have been in the service for a year or more will have a wellness plan. The other change is requiring DHBs to undertake file audits to determine the quality of the plans and report the results. This is a direct consequence of the OAG audit findings that 4 out of 5 people in their sample did not have a collaborative plan.

PP7 Improving mental health services using wellness and transition (discharge) planning

PP8 Shorter waits for non-urgent mental health and addiction services

PP10 Oral health: Mean DMFT score at year 8 no changePP11 Children caries free at 5 years of age no changePP12 Utilisation of DHB funded dental services by

adolescents from School Year 9 up to and including 17 years

no change

PP13 Improving the number of children enrolled in DHB funded dental services

no change

PP20 Improved management for long term conditions (CVD, Acute heart health, Diabetes, and Stroke)

Update to indicator title to include reference to acute heart health, focus area 2 removal of reference to diabetes annual reviews, focus area 3 inclusion of specific sub measure titled Indicator 2: Percentage of ‘eligible Māori men in the PHO aged 35-44 years’ who have had a CVD risk recorded within the past five years. Focus area 4 inclusion of reference to ANZACS-QI. Focus area 5 Increase to target - potentially eligible stroke patients thrombolysed

PP21 Immunisation coverage at 2 years of age (IPIF Healthy Start) and 5 years of age, immunisation coverage for human papilloma virus (HPV) and influenza at age 65 years

Updated to include measure previously included in Maori Health Plan -Focus area 3: Influenza immunisation at age 65 years and over

PP22 Delivery of actions to improve system integration and SLMs

no change

PP23 Delivery of actions to improve Wrap Around Services for Older People

Implementing the Healthy Ageing Strategy

PP25 Delivery of the Prime Minister’s youth mental health initiative

Adjustment to reporting time frames for initiative 1 part 1 (now six monthly)

PP26 Rising to the Challenge: The Mental Health and Addiction Service Development Plan no change

PP27 Supporting Vulnerable Children no changePP28 Reducing Rheumatic fever Following announcements regarding refreshed Better

Public Service targets - Confirmation that this measure will continue as a DHB performance measure

6


PP29 Improving waiting times for diagnostic services Updated targets includedPP30 Part A: Faster cancer treatment

– 31 day indicator no change

Part B: Shorter waits for cancer treatment – radiotherapy and chemotherapy

Part B Removed for 17/18

PP31 Better help for smokers to quit in public hospitals (previous health target)

no change

PP32 Ethnicity Data Quality Accuracy of ethnicity reporting in PHO registers as measured by Primary Care Ethnicity Data Audit Toolkit (EDAT).

PP33 Access to Care (PHO Enrolments) Measure previously included in Maori Health plan now integrated into DHB performance measures and Annual Plan as PP33

PP34 Improving the percentage of households who are smoke free at six weeks postnatal

This measure will no longer be included for 17/18 DV7 will be retained as the key measure in this space

Measure previously included in Maori Health plan (two weeks post natal)

PP35 SUDI - this measure will be removed for 17/18 Measure previously included in Maori Health plan - the requirements and reporting for this measure will be captured under a new Crown Funding Agreement variation.The Ministry has developed a new National SUDI Prevention Programme to be implemented from 1 July 2017. The SUDI performance measures from the previous Maori Health plans will be incorporated into the reporting for the regional component of the new programme via a new Crown Funding Agreement variation.

PP36 Reduce the rate of Māori under the Mental Health Act: section 29 community treatment orders

Measure previously included in Maori Health plan now integrated into DHB performance measures and Annual Plan as PP36

PP37 Child Health (Breastfeeding) Measure previously included in Maori Health plan now integrated into DHB performance measures and Annual Plan as PP37 - Exclusive or fully breastfed at 3 months

PP38 Delivery of response actions agreed in annual plan

New confirmation and exception measure to confirm delivery of response actions to priorities identified in annual plans

SI1 Ambulatory sensitive hospitalisations (ASH) For the 45-64 age group for target setting purposes this measure is being refocused on total population (the Ministry will continue to monitor and assess DHB performance for sub populations against the total population target.DHBs are expected to refer to the SLM improvement plan for the 0-4 age group.

SI2 Ensuring delivery of Regional Service Plans Minor updatesSI3 Ensuring delivery of Service Coverage no changeSI4 Elective Services Standardised Intervention Rates Updates to target expectations

7


SI5 Delivery of Whānau ora minor updates

SI7 SLM total acute hospital bed days per capita

Reporting of the SLMs will continue to occur through PP22

SI8 SLM patient experience of care Reporting of the SLMs will continue to occur through PP22

SI9 SLM amenable mortalityReporting of the SLMs will continue to occur through PP22

SI10 Improving cervical Screening coverage Measure previously included in Maori Health plan now integrated into DHB performance measures and Annual Plan as SI10

SI11 Improving breast screening ratesMeasure previously included in Maori Health plan now integrated into DHB performance measures and Annual Plan as SI11

OS3 Inpatient length of stay updates to target expectations includedOS8 Acute readmissions to hospital This measure definition has been reviewed with a

sector technical group – final drafts of the revised measure and Q&As are available of the nsfl web site. http://nsfl.health.govt.nz/accountability/performance-and-monitoring/performance-measures

OS10 Improving the quality of identity data within the National Health Index (NHI) and data submitted to National Collections

addition of information re the extension of DHB data stewardship of the NHI to enrolled populations in primary care and linking to PP32

Output1 Output delivery against plan no change

DV 4 Improving consumer experience no change

DV5 Childhood Obesity(health target development) Live as health target – DV5 now removedDV6 SLM youth access to and utilisation of youth

appropriate health services Remains under development

DV7 SLM number of babies who live in a smoke-free household at six weeks post natal

Remains under development

8

http://nsfl.health.govt.nz/accountability/performance-and-monitoring/performance-measures



Transition mapping table - Previous Maori health plan measures Accountability

measureMeasure previously referenced in Maori health plan

PP32 Ethnicity Data Quality Accuracy of ethnicity reporting in PHO registers as measured by Primary Care Ethnicity Data Audit Toolkit (EDAT).

PP33 Access to Care (PHO Enrolments)

Percentage of Māori enrolled in PHOs

SI1 Access to Care (ASH)

Measure previously included in both Maori Health plan and Annual plan – retained as SI1 in Annual Plan. Ambulatory Sensitive Hospitalisation (ASH)

PP37 Child Health (Breastfeeding)

Measure previously included in Maori Health plan now integrated into DHB performance measures and Annual Plan as PP37 - Exclusive or fully breastfed at 3 months

SI10 Cancer Screening (Cervical)

Measure previously included in Maori Health plan now integrated into DHB performance measures and Annual Plan as SI10

SI11 Cancer Screening (Breast)

Measure previously included in Maori Health plan now integrated into DHB performance measures and Annual Plan as SI11

PP34 Improving the percentage of households who are smoke free at six weeks postnatal


Health target Immunisation (1) Measure previously included in Maori Health plan and Annual plan – retained as health target.

PP21 Immunisation (2) Measure previously included in Maori Health plan now integrated into DHB performance measures and Annual Plan. Seasonal influenza immunisation coverage rates included in PP21.

PP28 Rheumatic fever Measure previously included in both Maori Health plan and Annual plan – retained as PP28 in Annual Plan

PP13 Oral health Measure previously included in both Maori Health plan and Annual plan – retained as PP13 in Annual Plan

PP36 Reduce the rate of Māori under the Mental Health Act: section 29 community treatment orders


PP35 SUDI Measure previously included in Maori Health plan now integrated into DHB performance measures and Annual Plan as PP35

The requirements and reporting for this measure will be captured under a new Crown Funding Agreement variation.

The Ministry has developed a new National SUDI Prevention Programme to be implemented from 1 July 2017. The SUDI performance measures from the previous Maori Health plans will be incorporated into the reporting for the regional component of the new programme via a new Crown Funding Agreement variation.

9


2017/18 DHB non-financial monitoring framework (excludes health target definitions – these are provided separately)

Contents2017/18 DHB non-financial monitoring framework (excludes health target definitions – these are provided separately).................................................................................................................................9Overview of the DHB monitoring framework........................................................................................12Overview of the monitoring framework................................................................................................13Assessment Criteria/Ratings.................................................................................................................14HS: Supporting delivery of the New Zealand Health Strategy............................................................15Policy priorities PP6: Improving the health status of people with severe mental illness through improved access.....................................................................................................................................16Policy priorities PP7: Improving mental health services using wellness and transition (discharge) planning...................................................................................................................................................20Policy priorities PP8: Shorter waits for non-urgent mental health and addiction services for 0-19 year olds..................................................................................................................................................24Policy priorities PP10: Oral Health- Mean DMFT score at Year 8.......................................................28Policy priorities PP11: Children caries-free at five years of age........................................................33Policy priorities PP12: Utilisation of DHB-funded dental services by adolescents from School Year 9 up to and including age 17 years...............................................................................................38Policy priorities PP13: Improving the number of children enrolled in DHB funded dental services..................................................................................................................................................................43Policy Priorities PP20: Improved management for long term conditions (CVD, Acute heart health, Diabetes, and Stroke).............................................................................................................................49Policy Priorities PP21: Immunisation coverage (includes previous health target)..........................56Policy Priorities PP22: Improving system integration and SLMs......................................................66Policy Priorities PP23: Implementing the Healthy Ageing Strategy...................................................69Policy Priorities PP25: Prime Minister’s youth mental health project...............................................75Policy priorities PP26: Rising to the Challenge: The Mental Health and Addiction Service Development Plan...................................................................................................................................79Policy Priorities PP27: Supporting Vulnerable Children.....................................................................82Performance Dimension: ‘Achieving Government’s priorities and targets’....................................85Policy Priorities PP28: Reducing Rheumatic fever.............................................................................85Policy Priorities PP29: Improving waiting times for diagnostic services.........................................90Policy Priorities PP30: Faster cancer treatment.................................................................................94Policy Priorities PP31: Better help for smokers to quit in public hospitals (previous health target)..................................................................................................................................................................97Policy priorities PP32: Improving the quality of ethnicity data collection in PHO and NHI registers................................................................................................................................................................101Policy priorities PP33: Improving Maori enrolment in PHOs to meet the national average of 90%................................................................................................................................................................105PP35: Reducing SUDI infant deaths....................................................................................................108Note performance related to this measure (previously signalled for inclusion as a 17/18 DHB performance measure) will now be captured through a Crown Funding Agreement variation....108Policy priorities PP36: Reduce the rate of Māori under the Mental Health Act: section 29 community treatment orders...............................................................................................................109Policy priorities PP37: Improving breastfeeding rates......................................................................112Policy priorities PP38: Delivery of response actions and milestones agreed in the annual plan for each Government planning priority.....................................................................................................116Performance Dimension: Meeting service coverage requirements and Supporting sector inter-connectedness......................................................................................................................................119System Integration SI1: Ambulatory sensitive hospitalisations (ASH)...........................................119System Integration SI2: Delivery of Regional Service Plans............................................................123System Integration SI3: Ensuring delivery of Service Coverage.....................................................127

10


Performance Dimension: Meeting service coverage requirements and Supporting sector inter-connectedness......................................................................................................................................130System Integration SI4: Standardised Intervention Rates (SIRs)....................................................130Performance Dimension: Meeting service coverage requirements and Supporting sector inter-connectedness......................................................................................................................................140System Integration SI5: Delivery of Whānau Ora..............................................................................140Performance Dimension: Meeting service coverage requirements and Supporting sector inter-connectedness......................................................................................................................................144System Integration SI7: SLM total acute hospital bed days per capita...........................................144Performance Dimension: Meeting service coverage requirements and Supporting sector inter-connectedness......................................................................................................................................145System Integration SI8: SLM patient experience of care..................................................................145Performance Dimension: Meeting service coverage requirements and Supporting sector inter-connectedness......................................................................................................................................149System Integration SI9: SLM amenable mortality rate......................................................................149System Integration SI10: Improving Cervical Screening coverage.................................................150System Integration SI11: Improving breast screening rates.............................................................155Ownership OS3: Inpatient Average Length of Stay (ALOS).............................................................159Performance Dimension: Providing quality services efficiently.....................................................167Ownership OS8: Reducing Acute Readmissions to Hospital..........................................................167Ownership OS10: Improving the quality of identity data within the National Health Index (NHI) and data submitted to National Collections...............................................................................................171Performance Dimension: purchasing the right mix and level of services within acceptable financial performance...........................................................................................................................180Output 1: Mental health output Delivery against Plan.......................................................................180Developmental measures DV4: Improving patient experience........................................................183Developmental measures DV6: SLM youth access to and utilisation of youth appropriate health services..................................................................................................................................................187Detail not yet available.........................................................................................................................187Developmental measures DV7: SLM number of babies who live in a smoke-free household at six weeks post natal...................................................................................................................................187Appendix 1: NZ organised acute stroke service specifications, stroke rehabilitation service specifications and Organised Inpatient Stroke Rehabilitation Service Minimum Expectations (refer PP20)............................................................................................................................................188188

11


Overview of the DHB monitoring framework

ContextThe DHB monitoring framework was developed recognising a DHB funding and operating environment where: • DHBs have responsibility for making decisions on the mix, level and quality of health and

disability services, within the parameters of the NZ Health and Disability Strategies and nationwide minimum service coverage and safety standards.

• The Ministry of Health, as agent of the Minister of Health, defines nationwide service coverage, safety standards and the operating environment. The Minister enters into funding agreements with DHBs, containing DHB specific agreed performance targets, and may exercise reserve powers in the case of repeated performance failures.

DHB non-financial monitoring arrangements operate within wider DHB accountability arrangements including legislative requirements, obligations formalised via Crown Funding Agreements and other contractual requirements, along with formal planning documents agreed with the Minister of Health/Minister of Finance.

The measures included within the DHB non-financial monitoring framework are intended to cover a specific set of markers of DHB performance in key areas, rather than all health services or DHB activity. Views and perspectives about what is most important to monitor, measure, and report for accountability purposes change over time with changing priorities. As a result the monitoring framework is updated periodically, and the measures that populate the framework are updated annually.

Within the Ministry of Health clinical and subject area experts are involved in all aspects of the monitoring work programme including: indicator design and definition; establishment of baselines; agreement of performance expectations; data supply and performance feedback; performance management and escalation of non-performance; reporting to Ministers and publication of results.

The Ministry of Health reviews the measures within the monitoring framework as part of the development of annual DHB planning advice. Working drafts are shared with DHBs for comment and feedback. If new measures are included in the framework, these measures must: incorporate intervention logic and a performance story linking the measure to sector outcomes provide clear and transparent deliverables including clearly defined numerators and denominators

for quantitative measures, with data sources clearly identified identify the actions DHB funders can take to influence performance, and activities DHBs can put in

place that have a proven impact on the measure identify the required detail and frequency of reporting Identify clear performance expectations, including what constitutes achievement, partial

achievement and non-achievement of the measure.

The burden of reporting is also an important consideration. New measures need to be strongly justified before they are included in the framework, existing measures are generally required to be removed to make way for new measures and minimise indicator creep over time.

DHBs formally agree to deliver on the performance expectations associated with the measures in the DHB monitoring framework through DHB Annual Plans. Each individual measure owner within the Ministry of Health reviews and approves performance expectation for their measures.

DHBs provide quarterly reports to the Ministry via a web based reporting tool. DHB performance against each target or measure is assessed by the Ministry measure owner/subject expert, and performance assessment and feedback is provided directly to DHBs via the web based reporting tool.

12


Where DHBs do not meet performance expectations, based on the definitions outlined in this document, the Ministry measure owner/subject expert determines whether the DHB has:

Partially achieved i.e. some or all expected performance expectations/deliverables associated with the measure not met, however there is a an appropriate resolution plan

Not achieved i.e. the deliverable is not met and the DHB does not have an adequate resolution plan.

Where a ‘not achieved’ assessment is made, performance escalation is coordinated by DHB Relationship Managers and through formal monitoring and intervention processes where required. A monitoring and Intervention Framework is used by the Ministry to monitor and manage DHB performance, and provides for increasingly intensive levels of monitoring and, where necessary, intervention to ensure that issues relating to poor performance are addressed.

A dashboard style report is produced each quarter based on the performance assessments undertaken by the Ministry measure owner/subject. These reports summarise on one page performance for the quarter against key expectations agreed in accountability documents. The dashboards are used to report DHB performance to the Minister.

Overview of the monitoring frameworkThe current monitoring framework aims to provide the Minister with a rounded view of performance using a range of performance markers. Four dimensions are identified that reflect DHBs functions as owners, funders and providers of health and disability services. The four identified dimensions of DHB performance cover:• achieving Government’s priority goals/objectives and targets or ‘Policy priorities’ • meeting service coverage requirements and Supporting sector and inter-sector connectedness or

‘System Integration’

• providing quality services efficiently or ‘Ownership’

• purchasing the right mix and level of services within acceptable financial performance or ‘Outputs’’.

‘SLM‘ in the measure title indicates a measure is part of the ‘System Level Measures’ identified for the current year.

Code Dimension

PP Policy Priorities

SI System Integration

OP Outputs

OS Ownership

DV Developmental – Establishment of baseline (no target/performance expectation is set)

HS Progress update - highlights re delivery of the NZ Health Strategy (no target/performance expectation is set)

13


Assessment Criteria/RatingsUnless otherwise stated in the definition of the performance measure, the following performance assessment criteria will apply:

Rating Abbrev 0Criteria

Outstanding performer/sector leader

O

1. This rating indicates that the DHB achieved a level of performance considerably better than the agreed DHB and/or sector expectations.

2. This rating is applied when the DHB has met the target agreed in its Annual Plan and has achieved the target level of performance for the Maori population group, and the Pacific population group.

Note: this rating can only be applied in the fourth quarter for measures that are reported quarterly or six-monthly. Measures reported annually can receive an ‘O’ rating, irrespective of when the reporting is due.

Achieved

A

1. Deliverable demonstrates targets / expectations have been met in full.

2. In the case of deliverables with multiple requirements, all requirements are met.

3. For those measures where reporting by ethnicity is expected, this rating should only be applied when the DHB has met the target agreed in its Annual Plan and has achieved significant progress for the Maori population group, and the Pacific population group.

4. Data, or a report confirming expectations have been met, has been provided through a mechanism outside the Quarterly Reporting process, and the assessor can confirm.

Partial achievement

P

1. Target/expectation not fully met, (including not meeting expectations for Maori and Pacific population groups or other specified equity gaps) and the resolution plan satisfies the assessor that the DHB is on track to compliance.

2. A deliverable has been received, but some clarification is required.

3. In the case of deliverables with multi-requirements, where all requirements have not been met at least 50% of the requirements have been achieved, and a resolution plan satisfies the assessor that the DHB is on track to compliance for the requirements not met.

Not achieved – escalation required

N

1. The deliverable is not met.2. There is no resolution plan if deliverable indicates non-

compliance.3. A resolution plan is included, but it is significantly deficient.4. A report is provided, but it does not answer the criteria of the

performance indicator.5. There are significant gaps in delivery. 6. It cannot be confirmed that data or a report has been provided

through channels other than the quarterly process.

14


15


Performance Dimension: Progress update - highlights re delivery of the NZ Health Strategy

HS: Supporting delivery of the New Zealand Health Strategy

All DHBs made strong commitments to the New Zealand Health Strategy in their annual plans, linking local performance stories to the Strategy and its strategic themes. The following deliverable is included within DHB quarterly reporting with the intention of capturing brief snapshots of sector progress in delivery of the strategy.

Delivery of the New Zealand Health Strategy

Each DHB is asked to provide one brief example (single dot point) per strategy theme each quarter, to highlight an action, initiative or activity delivered in the quarter.

These highlights will be included on the DHB quarterly dashboards for sharing with the Minister (no performance assessment will be made).

Delivery of the NZ Health strategy – DHB highlights for the quarter

People-powered Closer to home Value and high performance One team Smart system

one brief (single dot point) example of an action, initiative or activity delivered in the quarter





16


Performance Dimension: Achieving Government’s priorities and targets

Policy priorities PP6: Improving the health status of people with severe mental illness through improved access

Summary informationTarget/performance expectation

Agreed in DHB Annual Plan

Measure type and reporting frequency

Type: Data & exception

Reporting frequency: Six-monthly

Source information for reporting provided by:

Ministry to provide data via NSFL web site http://nsfl.health.govt.nz/accountability/performance-and-monitoring and the DHB quarterly reporting website

Quarterly reporting - standard timeline applies

DHB Reports Due 20th of the month following the end of the quarter

Ministry Initial rating & feedback 8-10 working days from receiving reports

DHB Response due 5 working days from receiving initial ratings

Confirmed rating and feedback 4-5 working days from receiving DHB feedback

Link to outcomes and priority areasDelivery of this measure supports the overarching outcome for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’ and the overarching goal that all New Zealanders live well, stay well, get well.

This measure has key linkages to Government planning priorities as highlighted.

Sector outcome = applicable

Improved health and equity for all populations(population focus)

Best value for public health system resources(system focus)

Improved quality, safety and experience of care(individuals and their family focus)

2017/18 Annual planning priority Healthy Mums and Babies Better Public Service Target

Keeping Kids Healthy Better Public Service Target

Prime Minister’s Youth Mental Health Project Reducing Unintended Teenage Pregnancy Better Public Service (contributory) Target

17


Supporting Vulnerable Children Better Public Service Target

Increased Immunisation Health Target

Shorter Stays in Emergency Departments Health Target

Improved Access to Elective Surgery Health Target

Faster Cancer Treatment Health Target

Better Help for Smokers to Quit Health Target

Raising Healthy Kids Health Target

Bowel Screening

Mental Health Healthy Ageing

Living Well with Diabetes

Childhood Obesity Plan

Child Health

Disability Support Services

Primary Care Integration

Pharmacy Action Plan

Improving Quality

Information Technology

Workforce

Living Within our Means

Regional Service Plan priorities for 2017/18


Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing

Mental Health and Addictions

Hepatitis C

Major Trauma

DHBs will improve the health status of people with severe mental illness through improved access to a broad range of services.

DHBs will contribute to the Health Strategy priority of improving value and high performance by ensuring their mental health services are cost effective, results focused and have regard to the service impacts on people who are severely affected by mental illness. The DHB will provide people with better health and

18


disability services by ensuring that the range of services closes existing service gaps, and makes them easier to access.

The DHB’s range of services will be of high quality, safe, evidence based and provided in the least restrictive environment. This focus is designed to provide better outcomes for people with mental illness and increase people’s confidence and trust in the health and disability system and services.

Actions and activities are that have a proven impact on this measure:Examples of key activities undertaken to support improved access rates are: development of CAMHS services across all regions, packages of care for individuals with high and complex needs, mental health specialists at emergency departments, Kaupapa Maori services, and eating disorder services.

Integration of primary and secondary services will result in improving access to a wider range of services and impact on the referrals to specialist mental health services.

Increasing consult liaison activity is also likely to impact on access rates and is required to be reported here.

Deliverables definitions for Access and Consult Liaison

Access

Numerator:

(Data Source: Ministry of Health)The average number of people domiciled in the DHB region, seen per year rolling every three months being reported (the period is lagged by three months) for: child and youth aged 0-19, specified for each of the three categories Māori, Other, and in total adults aged 20-64, specified for each of the three categories Māori, Other, and in total older people aged 65+, specified for each of the three categories Māori, Other, and in total.Denominator: (Data Source: Ministry of Health)Projected population of the DHB region by age and ethnicity.

Interpreting Access RatesThere are at least four factors that can impact on making informed decisions regarding access rates both by DHB and nationally. These factors must be taken into consideration by all parties when negotiating targets. They are: the more recovery-focused a service, the lower the likely demand will be for services. A

point will be reached where access will stabilise at a particular rate that is likely to be unique to each DHB

the number and quality of primary ancillary mental health services (e.g. GPs, Private Counsellors, and Relationship Services) will have an impact on access rates to secondary mental health services

that there is a difference between determining serious mental illness epidemiologically, and a clinical assessment of what constitutes a serious mental illness

that only half of older peoples services are funded directly by mental health

19


Reporting required: Six monthly, for a rolling 12 months as per the table below:

Quarter For the time periodQuarter 2 Annual a quarter in arrears

Quarter 4 Annual a quarter in arrears

Consultation & Liaison ActivityFor those DHBs who can report consultation activity it should be reported here.

The criteria below have been drawn from the KPI consult liaison working group proposal that reported its work to the Ministry of Health:

Consult Function Consult Activity Activity definition

Total number of activities

Direct consult Consultation: Consumer participation

No active referral – please refer to the KPI Consult Liaison document

Indirect consult Consultation: No consumer participation

No active referral – please refer to the KPI Consult Liaison document

Total Consultation Activity

Reporting required: Six monthly, for the six month periods as per the table below:

Quarter For the time periodQuarter 2 1 Jul 17 to 31 Dec 17

Quarter 4 1 Jan 18 to 30 June 18

ExpectationsWhere the target has not been met (or in quarter two, is not on track to be met) the DHB is expected to provide commentary on reasons for the target not being met

The following achievement scale will be applied:

Rating: Definition

Outstanding performer

The DHB has met the target agreed in the Annual Plan, and has also reached or improved on the performance for the Maori population group, and the Other population group.

Achieved The DHB has met the target agreed in the Annual Plan

Partially Achieved

Applied in quarter 2 if the DHB has not met the target agreed in the Annual Plan, but is on track for achievement by year end

Not Achieved Applied in quarter 2 if the DHB has not met the target agreed in the Annual Plan, and is not on track for achievement by year end.

20


Applied in quarter 4 if the DHB has not reached the target agreed in the Annual Plan.

21



Policy priorities PP7: Improving mental health services using wellness and transition (discharge) planning.

95% of people will have a quality wellness plan or transition plan

Summary information

Target/performance expectation Reporting

Agreed in Annual Plan Type: Data & exception

Reporting frequency:

Quarterly


DHBs to provide data to Ministry

Each DHB to supply reports on DHB the rates of people with wellness and transition plans and the results of quality audits

Link to outcomes and priorities

Delivery of this measure supports the overarching outcome for the health and disability system of ‘New Zealanders living longer, and healthier and more independent lives’ and the overarching goal that all New Zealanders live well, stay well, get well.This measure has key linkages to Government planning priorities as highlighted.

Sector outcome if applicable













22



Bowel Screening




Child Health




Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

All New Zealanders live well, stay well, get well, in a system that is people-powered, provides services closer to home, is designed for value and high performance, and works as one team in a smart system

95% of people treated in mental health and addiction services for more than 3 months will have a quality wellness plan or have had a transition plan at discharge.

Delivery against this measure supports the Health Strategy strategic theme People Powered The health system plays an important role in providing people with the information they need to fully understand issues to do with health and wellness, including how to be healthy, access health services and manage their own health care. Delivery against this measure also particularly supports ‘New Zealanders to live well, stay well, get well. This measure is consistent with and links to Rising to the Challenge: The Mental Health and Addiction Service Development Plan 2012-2017. The significance of wellness (relapse prevention plans) transition/discharge planning contributing to improved outcomes for people is evidenced in the literature and is a requirement of the Health and Disability Services Standards (NZS 8135:2008). Most significantly

23


The 2016 OAG mental health audit showed that 4 out 5 of people using mental health services did not have a collaborative plan.

Actions and activities are that have a proven impact on this measure: Refer to the Ministry of Health website for information on transition/discharge plans

(http://www.health.govt.nz/publication/transition-planning-guidelines-infant-child-and-adolescent-mental-health-alcohol-and-other-drugs).

Measures:Quantity At least 95% of clients discharged will have a quality transition or wellness plan.Quality 95% of audited files meet accepted good practice

DHBs will undertake routine audits of client files against accepted good practice criteria for a wellness and transition plans that have a focus on the inclusion of wellness strategies

ReportingReporting template:

Percentage of clients with a plan

Numerator Denominator Percentage

The number of clients with a transition (discharge) plan from the community (Data Source: DHB)

Number clients discharged from the community mental health and addiction services (DHB data source DHB)

Percentage of clients with transition (discharge) plan

Number of clients in the service for a year or more with a wellness plan(Data Source: DHB)

Number of clients in the service for a year or more (Data Source: DHB)

Percentage of clients with a wellness plans

Quality of plans (The DHB is required to report the results of quality audits for both provider arm and NGO services quarterly. Including the number of eligible files and the percentage audited)

Number clients discharged from the community mental health and addiction services (Data Source: DHB)

Number of files audited (Data Source: DHB)

Percentage with a transition plan of acceptable standard

Number of clients in the service for a year or more(Data Source: DHB)

Number of files audited(Data Source: DHB)

Percentage of files audited that have a wellness plan of acceptable standard

Cohort – inclusions / exclusions• Exclude referrals that were not ‘accepted’ (e.g. rejected and cancelled referrals).• Exclude referrals that have no face-to-face (actual attendances).

24

http://www.health.govt.nz/publication/transition-planning-guidelines-infant-child-and-adolescent-mental-health-alcohol-and-other-drugs

http://www.health.govt.nz/publication/transition-planning-guidelines-infant-child-and-adolescent-mental-health-alcohol-and-other-drugs


• Include only those referrals with 3 or more face-to-face attendances (i.e. only those referrals where the client was seen 3 or more times).

Note: the Ministry will compare data sourced from PRIMHD data (Mental Health and Addiction administrative data collection from 20 DHBs and 220 NGOs) with the data provided by the DHB – where this is a discrepancy of more than 10% the DHB will be required to explain this. (Not all DHBs and NGOs are reporting this data to PRIMHD currently as the capability to collect this information was introduced in July 2016).

Exception Reports if targets are not met The DHB will be required to report what actions are being taken if the target of 95% of people

with plans is not met.

The DHB will be required to report what actions are being undertaken if the target of 95% of audited files do not meet accepted good practice

Reporting Period (Data covers a rolling twelve month period and is produced one quarter in arrears)

Reporting required: Quarterly, as per the table below:

Quarter For the time periodQuarter 1 Data to cover the 12 month period to June

Quarter 2 Data to cover the 12 month period to Sept

Quarter 3 Data to cover the 12 month period to Dec

Quarter 4 Data to cover the 12 month period to March

ExpectationsDHBs are expected to have in place a process that ensures all people have a quality transition or wellness plan.

It is expected the DHB accurately report the number of people It is expected that DHBs can demonstrate a method that ensures all clients have up-to-date

quality transition and wellness plans Where the 95% target has not been met, the DHB is expected to provide commentary/resolution

plan on what it is doing to address the performance failure.The following achievement scale will be applied:

Rating: DefinitionOutstanding performer

The DHB has met the target agreed in the Annual Plan, and has also reached the same level of performance for the Maori population group, and the non - Maori population group.

Achieved All agreed rates are met.

Partial Achievement

Some or all agreed rates are not met

Not Achieved All agreed rates are not met

25


26



Policy priorities PP8: Shorter waits for non-urgent mental health and addiction services for 0-19 year olds

Each DHB to supply reports on waiting times for mental health and addiction for 0-19 year olds

Summary informationTarget/performance expectation Reporting80% seen within 3 weeks95% seen within 8 weeks

Type: Full report

Reporting frequency: Quarterly

Source information for reporting provided by: Ministry to provide data via NSFL

Link to outcomes and prioritiesDelivery against this measure supports the health and disability system outcome of ‘New Zealanders living longer, healthier and more independent lives’. This measure will also support delivery of the Minister of Health’s priority of ‘Improving value for money’ and the overarching goal that all New Zealanders live well, stay well, get well. The measure directly links to the Prime Ministers Youth Mental Health Project and the Government’s Drivers of Crime initiative.
















Bowel Screening

Mental Health

27


Healthy Ageing



Child Health




Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Access and shorter waits are very important to patients regardless of the conditions. The waiting time concept is easily understood by the public. Earlier treatment in the progression of illness links to better outcomes as evidenced in international literature. Timeliness is also a key quality indicator in calls for improvement to the health care system. This indicator is consistent with and links to Rising to the Challenge: The Mental Health and Addiction Service Development Plan 2012-2017. This will improve provider performance in relation to the Welfare Working Group’s report and the need to address long term welfare dependency through better access to health services. A reducing waiting time indicator is also supported by the Ministry of Justice and Department of Corrections particularly in relation to access to AOD services. This target is a universal deficiency across the country and requires attention now that we can measure waiting times using PRIMHD data.

Actions and activities are that have a proven impact on this measure:Provider arm and NGO services may need to modify their triage processes to meet this target and possibly look to adopting a single point of entry process. For people who do not attend (DNA) scheduled appointments services generally have in place processes for declining the referral after 3 DNA’s. However, services could put in place processes, if they haven’t already, that improve the likelihood of a person attending their appointment e.g. reminder texts. DHB services will also need to ensure clients accepted into the service have a treatment plan that leads to appropriate timely discharge. Where there is long-term requirement for treatment and care the DHB will need to have in place Knowing the People

28


Planning or something similar to ensure long term clients are in the best possible position to manage their illness and consequently lower demand on services.

Deliverables definitionsAll DHBs are expected to reach 80% of people referred for non-urgent mental health or addiction services are seen within three weeks and 95% of people are seen within 8 weeks this year.

DHBs will be required to meet this target within three years. DHBs will need to set and agree with the Ministry individualised targets (based on data provided by the Ministry).

The wait time will be counted from the time the referral is received for a person who has not been seen for at least a year (or not at all) to the time of the first face to face contact with a mental health or addiction professional. The wait time will also be calculated for provider arm services and AOD NGOs. Where there are two referrals open for the same client the earliest referral will be counted.The wait time will exclude the following:

1. PRIMHD activity_type_codes (mental health care coordination contact) ,T24 (work opportunities programme attendances), T32 (mental health contact with family/whānau), T35 (did not attend), T37 (on leave), T43 (community support contacts), T44 (advocacy), T45 (peer support)

2. Activity_Setting_Codes WR (written), SM (text), PH (phone)

3. Referral_end_codes RI (referral declined-inability to provide services) requested) or RO (referral declined other services more appropriate) or DD (Died) or DM (did not attend following the referral)

N.B. Referrals must be entered into the information system as at the date they were received

A narrative is also required to:1. identify what processes have been put in place to reduce waiting times2. explain variances of more than 10% waiting times target

Reporting Period Reporting required: Quarterly reporting, as per the table below:

Quarter For the time periodQuarter 1

Rolling annual waiting time data will be provided from PRIMHD (3 months in arrears)

Quarter 2

Quarter 3

Quarter 4

Note: Monthly reporting may be required from DHBs where waiting times are below 70% of people being seen within 3 weeks.Baseline informationBaseline information will be provided by the Ministry according to the above definitions

Wait times: reporting mental health Alcohol and other drug wait times by adult, older child/youth services

29


Mental Health Provider Arm <= 3 weeks <8 weeksAge target (%) Achieved (%) Agreed target (%) Achieved (%)0-19 80% 95%

Addictions (Provider Arm and NGO) <= 3 weeks <8 weeksAge Target (%) Achieved (%) Target (%) Achieved (%)0-19 80% 95%

Narrative:Identify what processes have been put in place to reduce waiting times

Explain variances of more than 10% in waiting times

30



Policy priorities PP10: Oral Health- Mean DMFT score at Year 8

Summary informationTarget/performance expectation Reporting

Transitional measure not included in performance dashboard reports. It is unlikely that a standardised Electronic Oral Health Record system will be utilised by all DHBs and accessible nationally before 2017/18.

Type: Data and exception report

Reporting frequency: Annually

Source data/template for reporting provided by: Data to be supplied by DHBs, template is on NSFL

Link to outcomes and prioritiesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’ and the overarching goal that all New Zealanders live well, stay well, get well.This measure has key linkages to Government planning priorities as highlighted:







Prime Minister’s Youth Mental Health Project

Reducing Unintended Teenage Pregnancy Better Public Service (contributory) Target








Bowel Screening

Mental Health

Healthy Ageing


31



Child Health Disability Support Services



Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Delivery of this measure most strongly supports the following sector outcomes and government priorities: By decreasing the severity of dental decay experienced by children in school Year 8 (12/13-year olds), the DHB will contribute to the outcome of protecting and promoting good health and independence through providing effective publicly funded child oral health programmes (health promotion, prevention and treatments) that reduce the prevalence of oral disease in children of primary school age.This measure also provides information that allows DHBs, and the Ministry, to evaluate how health promotion programmes, and services such as the DHB Community Oral Health Service (COHS) and other child oral health providers, are influencing the oral health status of children. The data breakdowns by ethnicity and fluoridation status enable DHBs to identify and target the populations in their district where children’s oral health status is poorest. It also provides DHBs with information to support the fluoridation of water supplies, which will be important when dealing with territorial local authorities.Through the intermediate outcome, the measure contributes to the high level outcome of New Zealanders living longer, healthier and more independent lives.

Actions and activities are that have a proven impact on this measure:The following actions and activities are examples of initiatives that have a proven impact on this measure: increased enrolment of pre-school children in publicly funded child oral health programmes enables

early engagement and provides opportunities for interventions aimed at prevention of oral disease and oral health promotion, and on an overall basis, reduces the prevalence of dental decay; and

the re-investment programme increases accessibility of regular care through “hub” and mobile clinics that will be open throughout the year and operate longer hours, and as well as increasing service productivity to increase service coverage for a greater number of children during the year.

32


ContextThis measure indicates the prevalence of oral disease and severity of dental decay experienced in children at the end of their primary schooling (Year 8, 12/13-year olds). This impact indicator measures the oral health status of New Zealand’s child population for demonstrating progress towards the population priority of “improving oral health” in the New Zealand Health Strategy.Publicly funded oral health services are available to children and adolescents from birth to 17 years of age (i.e. until the 18th birthday), through DHBs’ Community Oral Health Services (COHS), DHB-funded contracts with Maori oral health providers to provide child oral health services, and DHB-funded contracts with private dentists and Maori oral health providers to provide adolescent oral health services. In 2008, the Government embarked on a reinvestment programme in child and adolescent oral health services supported by the provision of additional capital and operating funding for renewed physical facilities, increased workforce, increased service coverage and increasing the preventive focus in the service delivery model. The reinvestment programme is expected to be fully implemented by DHBs by December 2015.After school Year 8, the majority of children transfer to publicly-funded oral health services provided for adolescents by private dentists contracted by DHBs, although some DHBs continue to provide some adolescent oral health services in their COHS and hospital dental departments. Improvements in this measure will show the impact made by the reinvestment programme on the effectiveness of publicly funded child oral health services and the COHS in particular. The World Oral Health Organisation (WHO) also regularly collates this measure for inclusion in its global oral health database for cross-country comparisons.

Deliverables definitionsNumerator: (Data source: DHB via COHS and other oral health providers)Upon the commencement of dental care, at the last dental examination before the child leaves the DHB’s Community Oral Health Service, the total number of:(i) permanent teeth of children in school Year 8 (12/13-year olds) that are –

Decayed (D), Missing (due to caries, M), and Filled (F); and

(ii) children who are caries-free (decay-free).

Denominator: (Data source: DHB via COHS and other oral health providers)The total number of children who have been examined in the Year 8 (12/13-year olds) group, in the year to which the reporting relates.

Other components of this indicator:1. The data reported in the Numerator and Denominator must also be broken down by:

(i) Ethnicity, using “prioritised ethnicity” approach1 into the following (in order of assignment): Māori; Pacific (only for the seven ‘official’ Pacific DHBs); and

1 It is acknowledged that use of the “prioritised ethnicity” approach is not consistent with New Zealand’s Statistical Standard for Ethnicity; but it is considered that this approach is acceptable given that: the historical use of this approach in the long-term data series since 1990 and the standard “total response” approach will not provide an accurate picture of the number of children examined by DHBs’

Community Oral Health Service and other contracted third party providers.33

http://www.stats.govt.nz/~/media/statistics/class-stnd/ethnicity/ethnic05-statistical-standard.aspx



Other (includes Pacific children in the other DHBs that are not ‘official’ Pacific DHBs); and(ii) water fluoridation status of the school area the child attends, defined as:

fluoridated; and non-fluoridated.

2. The data for this indicator will be generated by DHBs. There is a number of technical interpretation issues associated with oral health, which are centred largely around variances in: processes for data collection amongst DHBs technologies for management of data amongst DHBs.

3. DHBs are encouraged to record data at the unit (individual child) level, using the National Health Index, but data are reported in an aggregated format and should be provided using the Ministry of Health Excel template, available on the quarterly reporting database or from the Ministry of Health’s oral health team.

4. DHBs are required to separately report the number of Decayed, Missing (due to caries), or Filled teeth (DMFT).

Reporting Period Reporting required: Annual, in the third quarter.

Quarter For the time periodQuarter 3 1 January 2017 – 31 December 2017

ExpectationsDHBs are expected to report complete, comprehensive and timely information. It is expected that all DHBs will meet the specific individually agreed targets, for this indicator, as agreed in their Annual Plans. Where the target has not been met, the DHB must provide commentary or a resolution plan that describes the DHB will do to address the performance failure. DHBs are expected to set targets for this indicator for each of the two calendar years straddled by the fiscal year that the Annual Plan pertains to.

DHBs will retain the “year 2 targets” from the outgoing fiscal year’s Annual Plan as the “year 1 targets” for the incoming fiscal year’s Annual Plan.

Each DHB’s Annual Plans should focus on the activities that the DHB will put in place to achieve the “year 2 target” – this generally allows DHBs a six-month planning window followed by a 12-month implementation window for DHBs to achieve their “year 2 targets”.

34



Rating: DefinitionOutstanding The DHB has met the targets agreed in the Annual Plan, and is more than 5%

over specified targets, and has also has also reached the same level of performance for the Other population group, and the Maori population group, and the Pacific population group (where applicable).

Achieved All targets agreed in the Annual Plan are met, within 95% - 105% of specified targetsand a resolution plan with appropriate actions is provided if the total population target is not met for the Māori population group, and the Pacific population group

Partially Achieved Some or all targets agreed in the Annual Plan are not met, but delivered results are same as, or better than, the results delivered in the prior year and/orthe DHB has not met the target/performance expectation agreed in its Annual Plan, and a resolution plan with appropriate actions is provided, including actions to deliver improved performance for the Māori population group, and the Pacific population group

Not Achieved Some or all targets agreed in the Annual Plan are not met, and actual results are worse than the results delivered in the prior year

Reporting TemplateThe Ministry of Health Excel reporting template is also located on the nationwide service framework library web site: http://www.nsfl.health.govt.nz/.

35



Policy priorities PP11: Children caries-free at five years of ageSummary information


Transitional measure included until national data collection is established (not included in performance dashboard reports)




Linkage: This measure also links to measure SI5: Delivery of Whānau Ora

Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’ and the overarching goal that all New Zealanders live well, stay well, get well.

This measure has key linkages to Government planning priorities as highlighted:
















Bowel Screening

Mental Health

Healthy Ageing

36







Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Delivery of this measure most strongly supports the following sector outcomes and government priorities: Increasing the proportion of 5-year olds who have never experienced tooth decay will show that the DHB has made an impact on the outcome of protecting and promoting good health and independence through providing effective publicly-funded child oral health programmes (health promotion, prevention and treatments) that reduce the prevalence of oral disease in children of pre-school age.The measure also provides information that allows DHBs and the Ministry to evaluate how health promotion programmes, and services such as Well Child and the Community Oral Health Service (COHS), are influencing the oral health status of children. The data itemised by ethnicity and fluoridation status enable DHBs to identify and target the populations in their district where children’s oral health status is poorest. It also provides DHBs with information to support the fluoridation of water supplies, which will be important when dealing with territorial local authorities.Through the intermediate outcome, the measure contributes to the high level outcome of New Zealanders living longer, healthier and more independent lives.



37



ContextThis measure indicates the prevalence of oral disease and experienced in children of pre-school age. This impact indicator measures the oral health of status of New Zealand’s child population for demonstrating progress towards the population priority of “improving oral health” in the New Zealand Health Strategy.Publicly funded oral health services are available to children and adolescents from birth to 17 years of age, through DHBs’ Community Oral Health Services (COHS), DHB-funded contracts with Maori oral health providers to provide child oral health services, and DHB-funded contracts with private dentists and Maori oral health providers to provide adolescent oral health services. In 2005, the Government embarked on a reinvestment programme in child and adolescent oral health services supported by the provision of additional capital and operating funding for renewed physical facilities, increased workforce, increased service coverage and increasing the preventive focus in the service delivery model. The reinvestment programme is expected to be fully implemented by DHBs around June 2014.Prior to the reinvestment programme, a majority of children enrol in COHS upon entry to primary school between ages 5 and 6. One of the areas of focus for the reinvestment programme is to increase the enrolment of pre-school children in COHS to enable early interventions to be delivered to pre-school children. Improvements in this measure will show the impact made by the reinvestment programme on the effectiveness of publicly-funded child oral health services. The World Oral Health Organisation (WHO) also regularly collates this measure for inclusion in its global oral health database for cross-country comparisons.

Deliverables definitionsNumerator: (Data source: DHB via COHS and other oral health providers)At the first examination after the child has turned five years, but before their sixth birthday, the total number of children who are caries-free (decay-free); Denominator: (Data source: DHB via COHS and other oral health providers)The total number of children who have been examined in the 5-year old age group, in the year to which the reporting relates.

Other components of this indicator:1. The data reported in the Numerator and Denominator must also be broken down by:(i) Ethnicity, using “prioritised ethnicity” approach.(ii) 2 into the following (in order of assignment):

Māori; Pacific (only for the seven ‘official’ Pacific DHBs); and Other (includes Pacific children in the other DHBs that are not ‘official’ Pacific DHBs); and

(iii) water fluoridation status of the school area the child attends, defined as: fluoridated; and non-fluoridated.






2. The data for this indicator will be generated by DHBs. There is a number of technical interpretation issues associated with oral health, which are centred largely around variances in: processes for data collection amongst DHBs technologies for management of data amongst DHBs.


4. DHBs are required to separately report the number of decayed, missing (due to caries), or filled teeth (dmft).



ExpectationsDHBs are expected to report complete, comprehensive and timely information. It is expected that all DHBs will meet the specific individually agreed targets, for this indicator, as agreed in their Annual Plans. Where the target has not been met, the DHB must provide commentary or a resolution plan that describes the DHB will do to address the performance failure. DHBs are expected to set targets for this indicator for each of the two calendar years straddled by the fiscal year that the Annual Plan pertains to.


Each DHB’s Annual Plans should focus on the activities that the DHB will put in place to achieve the “year 2 target” – this generally allows DHBs a six-month planning window followed by a 12-month implementation window for DHBs to achieve their “year 2 targets”.

39



Rating: DefinitionOutstanding The DHB has met the targets agreed in the Annual Plan, and are more than 5%

over specified targets, and has also has also reached the same level of performance for the Other population group, and the Maori population group, and the Pacific population group (where applicable).



Not Achieved Some or all expectations are not met, and actual results are worse than the results delivered in the prior year

Reporting TemplateThe Ministry of Health Excel reporting template is also located on the nationwide service framework library web site: http://www.nsfl.health.govt.nz/.

40



Policy priorities PP12: Utilisation of DHB-funded dental services by adolescents from School Year 9 up to and including age 17 years


Transitional measure included until national data collection is established (not included in performance dashboard reports)




Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy and the overarching goal that all New Zealanders live well, stay well, get well.

This measure has key linkages to Government planning priorities as highlighted:
















Bowel Screening

Mental Health

Healthy Ageing

41







Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Delivery of this measure most strongly supports the following sector outcomes and government priorities: Increasing the proportion of adolescents, in school Year 9 (13/14-year olds) up to and including 17 years of age, who have accessed DHB-funded oral health services will show that the DHB has made an impact on the outcome of protecting and promoting good health and independence by providing accessible and available publicly-funded adolescent oral health programmes. The programmes will help reduce the prevalence and severity of oral disease in adolescents.Through the intermediate outcome, the measure contributes to the high level outcome of New Zealanders living longer, healthier and more independent lives.This measure has key linkages to Government planning priorities as highlighted:

Actions and activities are that have a proven impact on this measure:The following actions and activities are examples of initiatives that have a proven impact on this measure: increasing the number of dentists contracted under the Combined Dental Agreement to provide DHB-

funded adolescent oral health services; more effective transfers of children at the end of school Year 8 by the DHB’s Community Oral Health

Service to dentists contracted under the Combined Dental Agreement to provide adolescent oral health services; and

increased promotion and follow-through of enrolments in DHB-funded adolescent oral health services.

42


43


ContextThis measure indicates the coverage of publicly funded adolescent oral health services. This output indicator provides a measure that can be used to demonstrate progress towards the population priority of “improving oral health” in the New Zealand Health Strategy.Publicly-funded oral health services are available to children and adolescents from birth to 17 years of age (i.e. until the 18th birthday), through DHBs’ Community Oral Health Services (COHS), DHB-funded contracts with Maori oral health providers to provide child oral health services, and DHB-funded contracts with private dentists and Maori oral health providers to provide adolescent oral health services. In 2005, the Government embarked on a reinvestment programme in child and adolescent oral health services supported by the provision of additional capital and operating funding for renewed physical facilities, increased workforce, increased service coverage and increasing the preventive focus in the service delivery model. The reinvestment programme is expected to be fully implemented by DHBs around June 2012.One of the areas of focus for the reinvestment programme is the reinvestment programme to increase the utilisation of publicly funded oral health services by adolescents. Improvements in this measure will show the impact made by the reinvestment programme on the service coverage of publicly funded adolescent oral health services.

Deliverables definitionsNumerator: (Data source: DHBs, via reporting from Sector Services and other DHB-contracted oral health providers.)In the year to which the reporting relates, the total number of adolescents accessing DHB-funded adolescent oral health services, defined as:(i) the unique count of adolescent patients’ completions and non-completions under the Combined

Dental Agreement; and(ii) the unique count of additional adolescent examinations with other DHB-funded dental services

(e.g. DHB Community Oral Health Services, Māori Oral Health providers and other contracted oral health providers).

To reduce duplication of effort, at the end of each quarter in the year to which the reporting relates, the Ministry will organise a data extract from Sector Services for all DHBs for claims made by dentists contracted under the Combined Dental Agreement, and provide this data for DHBs’ use in determining part (i) of the Numerator.

Denominator: (Data source: Estimates of DHB population by age, sourced from NZ Census and Statistics New Zealand’s population projections between Census)DHBs do not need to report a denominator. The Ministry will source denominator data, and advise denominator prior to DHBs’ targets being set.The denominator will be calculated as follows:

Half of the cohort aged 13 years All of the cohorts aged 14 – 17 years inclusive.

Other components of this indicator:1. The data reported in the Numerator and Denominator must also be broken down by:(i) Ethnicity, using “prioritised ethnicity” approach3 into the following (in order of assignment):

Māori; Pacific (only for the seven ‘official’ Pacific DHBs); and

3

44


Other (includes Pacific adolescents in the other DHBs that are not ‘official’ Pacific DHBs); andThe Ministry acknowledges that availability of ethnicity in the Numerator is subject to ethnicity data being available from the source systems concerned.

2. Part of the data for this indicator will be provided by the Ministry (CDA data from the Proclaim payments system) and the balance will be generated by DHBs (non-CDA data on adolescents utilising COHS services and DHB-contracted dental services not paid through Proclaim). There is a number of technical interpretation issues associated with oral health, which are centred largely around variances in: processes for data collection amongst DHBs technologies for management of data amongst DHBs.


Reporting Period Reporting required: Annual, in the fourth quarter.


ExpectationsDHBs are expected to report complete, comprehensive and timely information. It is expected that all DHBs will meet the specific individually agreed targets, for this indicator, as agreed in their Annual Plans. Where the target has not been met, the DHB must provide commentary or a resolution plan that describes the DHB will do to address the performance failure. DHBs are expected to set targets for this indicator for each of the two calendar years straddled by the fiscal year that the Annual Plan pertains.

DHBs will retain the “year 2 targets” from the outgoing fiscal year’s Annual Plan as the “year 1 targets” for the incoming fiscal year’s Annual Plan. Each DHB’s Annual Plans should focus on the activities that the DHB will put in place to achieve the “year 2 target” – this generally allows DHBs a six-month planning window followed by a 12-month implementation window for DHBs to achieve their “year 2 targets”.

On a quarterly basis, DHBs are expected to monitor their progress towards achieving the agreed targets in their Annual Plans, and put in place appropriate measures to ensure targets are achieved by the end of the year to which the reporting relates.

45



Rating: DefinitionOutstanding The DHB has met the targets agreed in the Annual Plan, and are more than

5% over specified targets, and has also has also reached the same level of performance for the Other population group, and the Maori population group, and the Pacific population group (where applicable).




Reporting Template

The Ministry of Health Excel reporting template is located on the nationwide service framework library web site NSFL homepage: http://www.nsfl.health.govt.nz/.

46



Policy priorities PP13: Improving the number of children enrolled in DHB funded dental services


Agreed in Annual Plan Type: Data and exception report



Linkages: links to SI5 Delivery of Whānau ora

Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’ and the overarching goal that all New Zealanders live well, stay well, get well.Delivery of this measure most strongly supports the following sector outcomes and government priorities: By increasing the number of pre-school children less than five years of age (0 – 4 year olds, inclusive), who have enrolled for DHB-funded oral health services and reducing the number who are overdue for their scheduled examination, the DHB will show that it has made an impact on the outcome of protecting and promoting good health and independence. The measures indicates the accessibility and availability of publicly-funded oral health programmes, which will in turn reduce the prevalence and severity of early childhood caries, and improve oral health of primary school children.The measures provide information that allows DHBs and the Ministry to evaluate how health promotion programmes, and services such as Well Child and the Community Oral Health Service (COHS), are influencing the oral health status of children and whether oral health service programmes are delivering timely oral health services to children. Through the intermediate outcome, the measure contributes to the high level outcome of New Zealanders living longer, healthier and more independent lives.










47









Bowel Screening

Mental Health

Healthy Ageing






Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma



48



ContextThis indicates the coverage and timeliness of publicly funded child oral health services delivered by DHBs’ Community Oral Health Services (COHS). The output indicators in this measure can be used to demonstrate progress towards the population priority of “improving oral health” in the New Zealand Health Strategy.Publicly funded oral health services are available to children and adolescents from birth to 17 years of age, through DHBs’ Community Oral Health Services (COHS), DHB-funded contracts with Maori oral health providers to provide child oral health services, and DHB-funded contracts with private dentists and Maori oral health providers to provide adolescent oral health services. In 2005, the Government embarked on a reinvestment programme in child and adolescent oral health services supported by the provision of additional capital and operating funding for renewed physical facilities, increased workforce, increased service coverage and increasing the preventive focus in the service delivery model. The reinvestment programme is expected to be fully implemented by DHBs around June 2014.One of the areas of focus for the reinvestment programme is to increase service coverage and workforce productivity to deliver more and better quality care through DHBs’ COHS. Improvements in these measures show the impact made by the programme on the coverage and timeliness of publicly-funded child oral health services. Ethnicity data in these measures also enable DHBs to identify and target the populations in their district where children’s oral health status is poorest.

Deliverables definitionsMeasure 1: Number of Pre-School Children Enrolled in DHB-funded Oral Health ServicesNumerator: (Data source: DHBs, via their Community Oral Health Services and other oral health providers.)In the year to which the reporting relates, the total number of children under five years of age, i.e. aged 0 to 4 years of age inclusive, who are enrolled with DHB-funded oral health services (DHB’s Community Oral Health Service and other DHB-contracted oral health providers such as Māori oral health providers).

Denominator: (Data source: NZ Census sourced estimates of DHB population by age)DHBs do not need to report a denominator. The Ministry will source denominator data, and advise denominator prior to DHBs’ targets being set.In the year to which the reporting relates, the total number of children under five years of age, i.e. ages 0 to 4.

Other components of this measure:1. The data reported in the Numerator and Denominator must also be broken down by:(i) Ethnicity, using “prioritised ethnicity” approach4 into the following (in order of assignment):

Māori; Pacific (only for the seven ‘official’ Pacific DHBs); and Other (includes Pacific children in the other DHBs that are not ‘official’ Pacific DHBs); and






1. The data for this indicator will be generated by DHBs. There is a number of technical interpretation issues associated with oral health. This centres largely around variances in: processes for data collection amongst DHBs technologies for management of data amongst DHBs.

2. DHBs are encouraged to record data at the unit (individual child) level, using the National Health Index, but data are reported in an aggregated format and should be provided using the Ministry of Health Excel template, available on the quarterly reporting database or from the oral health team.

Measure 2: Number of Enrolled Pre-School and Primary School Children Overdue for their Scheduled ExaminationsNumerator: (Data source: DHBs, via their Community Oral Health Services and other oral health providers.)In the year to which the reporting relates:(i) the total number of pre-school children and primary school children in total and for each school

decile who have not been examined according to their planned recall period in DHB-funded dental services (DHB’s Community Oral Health Service and other DHB-contracted oral health providers such as Māori oral health providers); and

(ii) the greatest length of time children has been waiting for their scheduled examination, and the number of children that have been waiting for that period.

Denominator: (Data source: DHBs, via their Community Oral Health Services and other oral health providers.)In the year to which the reporting relates, the total number of children enrolled in DHB-funded dental services (DHB’s Community Oral Health Service and other DHB-contracted oral health providers such as Māori oral health providers), showing separately the number of – pre-school children, and primary school children.

Data Definitionsa. Pre-school and primary school children are the children from age 0 (less than 1 year old) to the end of

school Year 8 inclusive.

Other components of this measure:1. The data reported in the Numerator and Denominator must also be broken down by:(i) Ethnicity, using “prioritised ethnicity” approach5 into the following (in order of assignment):

Maori; Pacific (only for the seven ‘official’ Pacific DHBs); and Other (includes Pacific children in the other DHBs that are not ‘official’ Pacific DHBs); and

The Ministry acknowledges that availability of ethnicity in the Numerator is subject to ethnicity data being available from the source systems concerned.

2. The data for this indicator will be generated by DHBs. There is a number of technical interpretation issues associated with oral health. This centres largely around variances in: processes for data collection amongst DHBs






technologies for management of data amongst DHBs.3. DHBs are encouraged to record data at the unit (individual child) level, using the National Health

Index, but data are reported in an aggregated format and should be provided using the Ministry of Health Excel template, available on the quarterly reporting database or from the oral health team.



ExpectationsDHBs are expected to report complete, comprehensive and timely information. It is expected that all DHBs will Annual Plans. It is expected that DHBs will meet the specific individually agreed targets s in their Annual Plans. Where the target has not been met, the DHB must provide commentary or a resolution plan that describes the DHB will do to address the performance failure.

DHBs are expected to set targets for this indicator for each of the two calendar years straddled by the fiscal year that the Annual Plan pertains to.


Each DHB’s Annual Plans should focus on the activities that the DHB will put in place to achieve the “year 2 target” – this generally allows DHBs a six-month planning window followed by a 12-month implementation window for DHBs to achieve their “year 2 targets”. The following achievement scale will be applied:

Rating: DefinitionOutstanding The DHB has met the targets agreed in the Annual Plan, and are more than

5% over specified targets, and has also has also reached the same level of performance for the Other population group, and the Maori population group, and the Pacific population group (where applicable).




51


Reporting TemplateThe Ministry of Health Excel reporting template is located on the nationwide service framework library web site: http://www.nsfl.health.govt.nz/.

52



Policy Priorities PP20: Improved management for long term conditions (CVD, Acute heart health, Diabetes, and Stroke)

Summary information

Target/performance expectation:Performance agreed in annual plan

Reporting

Type: Exception reporting


Source data/template for reporting provided by: : A reporting template will be provided on NSFL


















Bowel Screening

Mental Health

53


Healthy Ageing

Living Well with Diabetes Childhood Obesity Plan Child Health


Primary Care Integration Pharmacy Action Plan

Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Long Term Conditions Long-term conditions comprise the major health burden for New Zealand now and into the foreseeable future. This group of conditions is the leading cause of morbidity in New Zealand, and disproportionately affects Maori and Pacific peoples and people who experience mental illness and addiction. As the population ages and lifestyles change these conditions are likely to increase significantly. Cardiovascular disease, including heart attacks and strokes, are substantially preventable with lifestyle advice and treatment for those at moderate or higher risk. Diabetes is also important as a major and increasing cause of disability and premature death and is a good indicator of the responsiveness of a health service to the people in most need.Long term conditions prevention and management is tackled though the implementation of action 8 of the New Zealand Health Strategy. Action 8 states ‘Increase the effort on prevention, early intervention, rehabilitation and wellbeing for people with long-term conditions such as diabetes and cardiovascular disease, by addressing common risk behaviours such as obesity and intervening at key points across the life course’.

Deliverables definitionsThe deliverables will be formally defined in the planning package, including mechanisms for data collection and delivery expectations. Each DHB must provide narrative comment for the indicator on progress on the activities being taken to improve performance, as outlined in their Annual Plan. The

54


narrative is to include specific activities undertaken for Maori and Pacific and where relevant, people from the Indian subcontinent6.There are five Focus Areas within this policy priority.

FA1 Long Term Conditions, FA2 Diabetes services, FA3 Cardiovascular health, FA4 Acute heart services, FA5 Stroke services.

Focus Area 1 Long Term Conditions

Expectation All New Zealanders live well, stay well, get wellDeliverables:: Specific Quarterly Reporting:

Quarters 2 and 4 - Commentary on how DHB is using LTC outcomes framework http://nsfl.health.govt.nz/service-specifications/long-term-conditions-outcomes-framework

Please discuss progress, gaps and challenges.

Definitions: Actions to support long term conditions prevention and management include: Prevention through clearly outlined networks between general practice and community

organisations to maximise physical activity, nutrition, quit smoking and reduction in alcohol use.

Identification of populations at risk using risk stratification to inform systematic categorisation of people at risk in order to provide appropriate management. As well, showing evidence of proactive recall and management of at risk populations

Management of people with long term conditions through: development and/or implementation of new models of care to support people with LTCs; provision of multi-disciplinary teams including allied health and kaiawhina supporting service delivery in primary care; primary care access to specialist support where appropriate and provision of self-management support and education for people with Long Term Conditions. Support regular primary care multidisciplinary teams to undertake collaborative practice review of the 1% of people with a high level of complex problems.

Enablers demonstrating clinical governance for Long Term Conditions services and IT systems to support risk stratification, case management, shared care and or clinical information sharing (focus on collaboration enablers). As well, Show evidence of staff training and education around goal setting, motivational interviewing and shared decision-making concepts and include ongoing workforce development in primary care, and clinical governance with a named clinical lead. IT capability is to be maintained and improved including provision of audit tools and/or a dashboard reporting system.

Linkages with PP22 Delivery of actions to improve system integration, and SI01 Ambulatory sensitive (avoidable) hospital admissions.

6 The requirement to report about Pacific people applies only to those DHBs with high Pacific populations. These DHBs are: Counties Manukau, Auckland, Waitemata, Waikato, Capital & Coast, Hutt Valley and Canterbury.

55

http://nsfl.health.govt.nz/service-specifications/long-term-conditions-outcomes-framework

http://nsfl.health.govt.nz/service-specifications/long-term-conditions-outcomes-framework


Focus Area 2 Diabetes services –

Expectation People living with diabetes are regarded as leading partners in their own care within systems that ensure they can manage their own condition effectively with appropriate support.Improve or, where high, maintain the proportion of patients with good or acceptable glycaemic control. The expectation is to continue to implement actions in the Diabetes plan “Living Well with Diabetes”.

Commentary to be provided

Six-monthly reporting.Quarters 2 and 4:

Report on the progress made in self-assessing diabetes services against the Quality Standards for Diabetes Care.

Report on the HbA1c indicator (as documented below).

A template will be provided for reports. Deliverables: HbA1c

Numerator – Count of enrolled people aged 15-74 in the PHO with diabetes and the most recent HbA1c during the past 12 months of equal to or less than 64 mmol/mol; equal to or less than 80mmol/mol; equal to or less than 100mmol/mol; and greater than 100mmol/mol).Denominator - Count of enrolled people in the PHO aged 15-74 with diabetes on the Ministry of Health Virtual Diabetes Register (VDR 2016).

Data source: MOH will supply VDR, and DHBs/PHOs to provide numerator.Note: Patients coded with diabetes in the General Practice registers can be used instead of VDR once comparisons between the two have been complete, and accuracy of GP registers can be demonstrated.

Focus Area 3 Cardiovascular (CVD) health

Expectation Improve equity for priority populations to have CVD risk assessments, informed discussions and appropriate follow-up.

Improve early risk identification and risk factor management efforts for people with high and moderate cardiovascular disease risk by supporting the spread of best practice from those producing the best and most equitable health outcomes.

Commentary to be provided

Specific Quarterly Reporting:Quarters 1,2,3 and 4: - Confirmation report:

confirmation that activity and actions agreed in the Annual Plan related to CVD risk assessment are on track (where applicable, cross reference to reports provided via other measures )

a qualitative report (recovery plan including milestones to get back on track) if progress is not on track for either the quantitative targets or the activity based confirmations.

Deliverables Indicator 1: 90 percent of the eligible population will have had their cardiovascular risk assessed in the last five years. Numerator: (Data source: IPIF Programme)Count of enrolled people in the PHO within the eligible population who have had a CVD risk recorded within the last five years

Denominator: (Data source: PHO enrolment register)Count of enrolled people in the PHO who are eligible for a CVD risk assessment. The population eligible for CVDRA is as follows: Males of Maori, Pacific, or Indian sub-continent* ethnicity aged 35-74 years at the end of the

reporting period and enrolled with PHO Females of Maori, Pacific, or Indian sub-continent* ethnicity aged 45-74 years at the end of

the reporting period and enrolled with PHO Males of any other ethnicity aged 45-74 years at the end of the reporting period and

enrolled with PHO Females of any other ethnicity aged 55-74 years at the end of the reporting period and

enrolled with PHO.

56


Indicator 2: Percentage of ‘eligible Māori men in the PHO aged 35-44 years’ who have had their cardiovascular risk assessed in the past five years.Numerator and denominator are subsets of Indicator 1.

Reporting should also include a brief narrative of: Steps being taken to monitor populations with high CVD event risk in order to ensure

appropriate management. As well, showing evidence of proactive recall and management of at risk and high risk populations

Development and/or implementation of new models of care to support risk factor management; provision of multi-disciplinary teams including allied health and kaiawhina supporting service delivery in primary care; primary care access to specialist support where appropriate and provision of self-management support and education for people with cardiovascular disease (and other Long Term Conditions).

Enablers demonstrating clinical governance for CVD risk assessment and risk factor management services and IT systems to support risk stratification, case management, shared care and or clinical information sharing (focus on collaboration enablers). As well, show evidence of staff training and education around goal setting, motivational interviewing and shared decision-making concepts and include ongoing workforce development in primary care, and clinical governance with a named clinical lead. IT capability is to be maintained and improved including provision of audit tools and/or a dashboard reporting system.

Data source: CVD data provided by the Ministry

Focus Area 4 Acute heart service

Expectation To provide a nationally consistent reporting framework, all regions are required to report agreed indicators from ANZACS-QI and progress to achieving deliverables for acute heart services identified in annual plans.

Deliverable: Current agreed indicators are: 70 percent of high-risk patients will receive an angiogram within 3 days of admission. (‘Day

of Admission’ being ‘Day 0’) by ethnicity Over 95 percent of patients presenting with ACS who undergo coronary angiography have

completion of ANZACS QI ACS and Cath/PCI registry data collection within 30 days Over 95 percent of patients undergoing cardiac surgery at the five regional cardiac surgery

centres will have completion of Cardiac Surgery registry data collection with 30 days of discharge.

Data source: Data provided from ANZACS-QI and the Cardiac surgery registry Additional Commentary to be provided:

Specific Quarterly Reporting:Quarters 1 and 3: Regional teleconference-based reporting on progress to date on deliverables for acute heart

services identified in annual plans and actions and progress in quality improvement initiatives to support the improvement of agreed indicators as reported in ANZACS-QI

The minutes from the teleconferences will be recorded and uploaded as the quarterly report.Quarters 2 and 4 - Confirmation and exception report:

confirmation that activity and actions agreed in the Annual Plan are on track and indicators achieved.

a qualitative exception report (recovery plan including milestones to get back on track) if progress is not on track for either the quantitative targets or the activity and actions agreed in the Annual Plan.

Definitions: A high-risk patient can be defined by the DHBs.

57


Focus Area 5 Stroke Services

Expectation: All DHBs will provide an organised acute stroke service for their population as recommended in the NZ Clinical Guidelines for Stroke Management and include advice provided by the national and regional clinical stroke networks

Deliverable: 8 percent or more of potentially eligible stroke patients thrombolysed 24/7 80 percent of stroke patients admitted to a stroke unit or organised stroke service with

demonstrated stroke pathway 80 percent of patients admitted with acute stroke who are transferred to inpatient

rehabilitation services are transferred within 7 days of acute admission (also report % of acute stroke patients transferred to inpatient rehab)NB: when reporting against above indicators include numerators and denominators in brackets after percent

Data source : DHBs to provideAdditional Commentary to be provided:

Specific Quarterly Reporting:Quarters 1 and 3: Regional teleconference-based reporting on progress to date on deliverables for stroke

identified in the DHB annual plans The minutes from the teleconferences will be recorded and uploaded as the quarterly report.Quarters 2 and 4: - Confirmation and exception report:

confirmation that activity and actions greed in the Annual Plan are on track where there is no quantitative target associated with the measure

a qualitative exception report (recovery plan including milestones to get back on track) if progress is not on track for either the quantitative targets or the activity based confirmations.

Definitions: A potentially eligible stroke patient is one who has an ischaemic or undetermined stroke. Other strokes, such as Intracerebral hemorrhage (ICH), transient ischemic attack (TIA), or mimics are excluded.

An acute stroke patient is admitted to hospital with a primary discharge diagnosis of ischaemic, haemorrhagic, or undetermined stroke. TIA patients, stroke mimics, and patients discharged from emergency department without being recorded as a hospital admission are excluded. Care should be taken that patients transferred during their admission are only counted once even if managed at two separate institutions.

ICD10 codes included: I61 Intracerebral Haemorrhage with subcodes for site inclusive, I63 Cerebral Infarction with subcodes 163.0-163.9 inclusive, I64 Stroke, not specified as haemorrhage or infarction)

A stroke unit is defined as a discrete ward, or beds within a ward, with a dedicated specialised multi-disciplinary team (MDT) and could include acute stroke units that discharge patients to a rehabilitation service, or an integrated acute and rehabilitation unit (New Zealand National Acute Stroke Services Audit 2009).

Organised Acute Stroke Services are provided by a coordinated specialised interdisciplinary team (IDT) and consist of early and ongoing comprehensive assessments and treatment which is guided by best practice. This is reflected in the use of stroke specific protocols. The IDT meets regularly to discuss, formulate and implement patient management and optimise rehabilitation and patient function. Ideally care is provided in a geographically discrete unit, but depending on DHB size this may not always be feasible.

Minimum specific organised acute stroke service specifications and stroke rehabilitation specifications are included as Appendix 1.

58


Summary of reporting Period for FA4 and FA5 All deliverables within the measure are to be provided as follows:

Quarter For the time period

Indicator to report on

1 1 July – 30 September

Regional teleconference to discuss ACS, including discussion on ACS indicators Regional teleconference to discuss Stroke, including discussion on stroke indicators

2 1 October – 31 December

DHBs to complete template provided by the Ministry DHBs to complete template provided by the Ministry

3 1 January – 31 March

Regional teleconference to discuss ACS, including discussion on ACS indicators Regional teleconference to discuss Stroke, including discussion on stroke indicators

4 1 April – 30 June 2017

DHBs to complete template provided by the Ministry DHBs to complete template provided by the Ministry

59



Policy Priorities PP21: Immunisation coverage (includes previous health target)


At least 95 per cent of two year olds are fully immunised and coverage is maintained At least 95 percent of four year olds are fully immunised by age 5 years

and coverage is maintained At least 75 percent of girls are fully immunised for HPV - reported annually

in quarter 4 (for 2017/18 it is the 2004 birth cohort measured at 30 June 2018)

At least 75 percent of the population aged 65 years and over are immunised against influenza annually (measured at 30 September)


Type: Confirmation and exception report based on data supplied by Ministry

Reporting frequency:2-year and 5-year immunisation Quarterly

HPV immunisation Annual (quarter 4)

Influenza immunisation Annual (quarter 1)

Data Source / information for reporting provided by:

Data is supplied by the Ministry from the National Immunisation Register Data Mart and through the DHB quarterly reporting website (technical details including extract dates provided with data)

Quarterly reporting - standard timeline applies DHB Reports Due 20th of the month following the end of the quarter




Linkages: These performance measures are also System Level Measures Framework contributory measures.

60






Improved quality, safety and experience of care(individuals and their family/ focus focus)





Supporting Vulnerable Children Better Public Service Target Increased Immunisation Health Target






Bowel Screening

Mental Health

Healthy Ageing



Child Health




Improving Quality


Workforce



61



Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Link to outcomes

Delivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’, and the overarching goal that all New Zealanders live well, stay well, get well.

Delivery of this measure most strongly supports the following sector outcomes and government priorities. Improved immunisation coverage leads directly to reduced rates of vaccine-preventable disease, and consequently better health and independence for children and adults. This equates to longer and healthier lives.

The changes that are required to reach the target immunisation coverage levels for childhood measures will lead to better health services for children, because more children will be enrolled with and visiting their primary care provider on a regular basis. It will also require primary and secondary health services for children to be better co-ordinated. These actions are leading to improved implementation of the Primary Health Care Strategy, and ensuring that the primary care workforce including maternity is better equipped to address the needs of children and families.

Increasing influenza immunisation contributes to the Reducing Acute Hospital Bed Days priority. Those aged 65 years and over have the highest rates of hospital admissions for influenza-related severe acute respiratory infections (other than those aged under 5 years). The indicator also contributes to Improved health and equity for all populations; people of Māori or Pacific ethnicities are two- to five-times more likely to be admitted to hospital for influenza-related severe acute respiratory infections than other ethnicities (ESR. Influenza Surveillance in New Zealand 2015).

HPV immunisation protects against HPV-related cancers later in life, supporting New Zealanders to live longer and healthier lives. A school-based HPV immunisation programme is the preferred service delivery model for eligible children, with HPV immunisation currently being delivered primarily in school year 8. There are successful national and international experiences of school/institution-based mass immunisation programmes, achieving high coverage rates resulting in reduced inequalities (CBG Health Research 2006, Ministry of Health 2004). Planning is underway for delivering both HPV and Tdap (tetanus, diphtheria and pertussis) vaccines concurrently in school year 7 from 2018.

DHBs and schools need to work together to determine the most appropriate methods of providing follow up clinics depending upon the needs of the school and the needs of the population.

62


Focus area 1: 2-year-old and 5-year-old immunisation coverage

Deliverables definitions

Percentage of eligible children fully immunised at 2 years (24 months) of age – total DHB population, Māori and PacificImmunisation coverage for two year olds will be measured quarterly using the National Immunisation Register (NIR) Data Mart Milestone Ages report for age 24 months for the previous 3-month reporting period. The report includes all infants turning 24 months of age during the reporting period. The coverage will be reported for Total, Māori, and (where relevant) Pacific.

Fully immunised at age 2 years is defined as having received the relevant immunisations scheduled for 5 months and 15 months of age. To be measured as fully immunised, the child must have received age-appropriate doses of diphtheria, tetanus, whooping cough, polio, hepatitis B, Haemophilus influenzae type B, pneumococcal, measles, mumps and rubella vaccines. Although rotavirus is included in the National immunisation Schedule, it is not currently included in performance measures or health targets. It is anticipated that rotavirus vaccines will be included in performance measures in the future.

Percentage of eligible children fully immunised at 5 years of age – total DHB population, Māori and PacificImmunisation coverage for five year olds will be measured quarterly using the National Immunisation Register Data Mart Milestone Ages report for the previous 3-month reporting period. The report includes all infants turning 5 years of age during the reporting period. The coverage will be reported for Total, Māori, and (where relevant) Pacific.

Fully immunised at age 5 years is defined as having received the relevant immunisations scheduled for 5 months, 15 months and 4 years of age. To be measured as fully immunised, the child must have received age-appropriate doses of diphtheria, tetanus, whooping cough, polio, hepatitis B, Haemophilus influenzae type B, pneumococcal, measles, mumps and rubella vaccines.

Numerator: The numerator is the number of eligible children enrolled on the NIR who have turned the milestone age (24 months or 5 years) during the reporting period and who are recorded as fully immunised on the day that they turn the milestone age.

Denominator: The numerator is the number of eligible children enrolled on the NIR who have turned the milestone age (24 months or 5 years) during the reporting period.

For both measures, current performance reports can be accessed directly from NIR Data Mart Milestone Ages reports. The Ministry will also provide DHBs with excel and pdf versions of the NIR Data Mart coverage reports in the toolkit section of the DHB Quarterly Database each quarter.

The quarterly coverage report will be run after the weekly data update (“refresh”) of the NIR Data Mart reports after the end of the quarter; reports are generally run on the Tuesday closest to the 10 th of the month after the end of the quarter to ensure timeliness while also allowing the complete quarter's data to have been loaded on to the NIR and to have been extracted into the NIR Data Mart.

63


DHBs are expected to use these reports to provide exception qualitative report and/or use this mechanism to raise issues with the Ministry.

Reporting period

Reports are to be provided quarterly for immunisation coverage at age 2 years and 5 years.

Quarter For the time periodQuarter 1 Data to cover the period 1 July to 30

September

Quarter 2 Data to cover the period 1 October to 31 December

Quarter 3 Data to cover the period 1 January to 31 March

Quarter 4 Data to cover the period 1 April to 30 June

ExpectationsThe national target is 95 percent of two-year olds and 95 percent of five-year-olds are fully immunised for age.

Progress towards the 2-year and 5-year immunisation coverage targets will be assessed quarterly. If DHBs do not reach target coverage they are expected to provide an exception qualitative report at the end of each quarter advising how they will track towards higher coverage. If the target has been reached, only a confirmation statement is required.

The assessment requirements are set out below.

Table 1: Quarters 1, 2 & 3 assessment for 2-year-old and 5-year-old immunisation coverageRating Explanation

Achieved The DHB has reached the “Total population” immunisation coverage target for children at 2 years of age and children at 5 years of age.This score requires that the DHB has met both targets agreed in its Annual Plan and has achieved significant progress for the Māori population group, and (where relevant) the Pacific population group, for both targets.

Partially Achieved The DHB’s immunisation coverage is progressing towards the target and coverage is acceptable relative to national coverage, for both targets.

Not Achieved The DHB’s immunisation coverage has failed to substantially progress towards the target and/or coverage is unacceptable relative to national coverage for one or both targets.

64


Table 2: Quarter 4 assessment for 2-year-old and 5-year-old coverageRating Explanation

Outstanding Performer

The DHB has met the “Total population” immunisation coverage target for children at 2 years of age and children at 5 years of age and the DHB has substantially exceeded the coverage target for one or both

targets and/or the DHB has met the coverage target for one or both targets for:

o the total population, ando the Māori population group, and (where applicable)o the Pacific population.

This score requires that the DHB has met both targets agreed in its Annual Plan and has achieved significant progress for the Māori population group, and (where relevant) the Pacific population group, for both targets.

Achieved The DHB has reached the “Total population” immunisation coverage target for children at 2 years of age and children at 5 years of age.

This score requires that the DHB has met both targets agreed in its Annual Plan and has achieved significant progress for the Māori population group, and (where relevant) the Pacific population group, for both targets.

Partially Achieved The DHB’s immunisation coverage has substantially improved from the coverage at the start of the year and progress towards the target is acceptable relative to national coverage for both targets.

Not Achieved The DHB’s immunisation coverage has failed to substantially progress towards the target and/or coverage is unacceptable relative to national coverage for one or both targets.

Focus area 2: HPV coverage


Percentage of eligible girls fully immunised with HPV vaccine, total DHB population, Māori, Pacific and Other.Immunisation coverage for eligible girls will be measured annually in quarter four using the applicable NIR Data Mart report. The coverage will be reported for Total, Māori, and (where relevant) Pacific, Asian, and Other (including New Zealand European).

For 2017/18, the indicator measures coverage for girls born in 2004.

The change from a three-dose to two-dose HPV immunisation schedule for those aged under 15 years will not affect target coverage, which is based on completion of the appropriate schedule.

The HPV immunisation programme has been expanded to include boys from 1 January 2017. The current indicator measures HPV immunisation coverage for girls only. No target will be set for HPV immunisation coverage for boys until the programme is well embedded.

65


NumeratorThe number of girls born in the relevant birth cohort who have completed their HPV immunisation course as per Schedule and recorded on the NIR.

DenominatorThe eligible population is estimated from the Census population projection denominator for the relevant birth cohort. Because the population is estimated, the actual number of girls may be higher than estimated, resulting in HPV coverage rates of more than 100% in some instances.

Current performance reports can be accessed directly from NIR Data Mart. However, during the transition year following the introduction of the two-dose Gardasil 9 schedule on 1 January 2017, the number of girls who have completed immunisation may need to be calculated separately for those who have received three doses of Gardasil 4 and those who have received two doses of Gardasil 9. Coverage for the target measure will then be based on the total number of girls fully immunised including both groups. The Ministry will provide DHBs with excel and pdf versions of the coverage reports in the toolkit section of the DHB Quarterly Database at the end of quarter four.

DHBs are expected to use these reports to provide exception qualitative report and/or use this mechanism to raise issues with the Ministry.

Reporting period

For HPV immunisation, coverage is to be reported at the end of quarter four (30 June) for the birth cohort defined by the measure: coverage for the 2004 birth cohort is to be reported on 30 June 2018.

Quarter For the time periodQuarter 1

n/a

Quarter 2

n/a

Quarter 3

n/a

Quarter 4

All immunisations received by the relevant birth cohort (2004) up to 30 June 2018

ExpectationsFor 2017/18, the national target is 75 percent of girls born in 2004 are fully immunised for HPV.

Progress towards the HPV immunisation coverage target will be assessed annually as part of quarterly 4 reports.If DHBs do not reach target coverage they are expected to provide an exception qualitative report at the end of Quarter Four advising how they will track towards higher coverage. If the target has been reached, only a confirmation statement is required.

66



Table 3: Annual (quarter four) assessment for HPV immunisationRating Explanation

Outstanding Performer

The DHB has substantially exceeded the “Total population” HPV immunisation coverage target for eligible girls; and/or

The DHB has reached the HPV target for eligible girls for:o the total population, ando the Māori population group, and (where applicable)o the Pacific population.

This score requires that the DHB has met the target agreed in its Annual Plan and has achieved significant progress for the Māori population group, and (where relevant) the Pacific population group.

Achieved The DHB has reached the “Total population” HPV immunisation coverage target for eligible girls.


Partially Achieved This score requires that the DHB’s HPV immunisation coverage has substantially improved from the coverage in the previous year and progress towards the target is acceptable relative to national coverage.

Not Achieved This score requires that the DHB’s HPV immunisation coverage has failed to substantially progress towards the target and/or coverage is unacceptable relative to national coverage.

Focus area 3: Influenza immunisation at age 65 years and over

Percentage of the eligible population aged 65 years and over immunised against influenza (annual immunisation) – total DHB population, Māori and Pacific

Coverage for influenza immunisation for those aged 65 years and over will be measured using the National Immunisation Register Data Mart report. The coverage will be reported for Total, Māori, and (where relevant) Pacific and Asian.

Numerator: The numerator is the number of eligible people aged 65 years and over enrolled on the NIR who have completed at least one influenza vaccination for the given vaccination year.

Denominator: The denominator for coverage by ethnicity is sourced from Statistics New Zealand Population projections derived from the estimated resident population as at 30 June, by prioritised ethnicity, sex and DHB, from year 2014-2019 for those aged 65 years and over.

67


Age bands are determined by the age at the time of the vaccination event and based on Census estimated population for the given vaccination year.

Current performance reports can be accessed directly from NIR Data Mart. The Ministry will also provide DHBs with excel and pdf versions of the NIR Data Mart coverage reports in the toolkit section of the DHB Quarterly database at the end of quarter one.

DHBs are expected to use these reports to provide exception qualitative reports and/or use this mechanism to raise issues with the Ministry.

Reporting Period

The influenza immunisation indicator will be measured at the end of quarter 1 of the reporting year for the period 1 March to 30 September in the current calendar year (1 March 2017 to 30 September 2017 in the 2017/18 reporting year).

This period is intended to capture the time from when the seasonal influenza vaccine for that year becomes available (usually in March) until the anticipated end of the influenza season; vaccines should be administered before the peak of the winter illness season and thus 30 September represents a time when the majority of vaccines should have been delivered to ensure effective protection.

Quarter For the time periodQuarter 1 (ending 30 September) Data to cover the period 1 March to 30

September

Quarter 2 (ending 31 December) n/a

Quarter 3 (ending 31 March) n/a

Quarter 4 (ending 30 June) n/a

ExpectationsFor 2017/18, the national target is 75 percent of those aged 65 years and over receive influenza immunisation (annual immunisation).

Progress towards the influenza immunisation target will be measured annually in quarter one. If DHBs do not reach target coverage they are expected to provide an exception qualitative report at the end of quarter one advising how they will track towards higher coverage. If the target has been reached, only a confirmation statement is required. It is acknowledged that 2017/18 is a transition year for this target, having previously been a Māori health plan indicator, and performance may not reach the target in this first year.


Table 4: Annual (quarter one) assessment for influenza immunisationRating: DefinitionOutstanding performer

The DHB has substantially exceeded the “Total population” influenza immunisation

68


coverage target for those aged 65 years and over; and/or The DHB has reached the influenza immunisation coverage target for those aged

65 years and over for:o the total population, ando the Māori population group, and (where applicable)o the Pacific populationo the Asian population.


Achieved The DHB has reached the “Total population” influenza immunisation coverage target for those aged 65 years and over.

This score requires that the DHB has met the target agreed in its Annual Plan and has achieved significant progress for the Māori population group, and (where relevant) the Pacific population group

Partially Achieved

The DHB’s influenza immunisation coverage for those aged 65 years and over has substantially progressed towards the target and is acceptable relative to national coverage.

Not Achieved

The DHB’s influenza immunisation coverage for those aged 65 years and over has failed to substantially progress towards the target and/or coverage is unacceptable relative to national coverage.

69



Policy Priorities PP22: Improving system integration and SLMsSummary information

Indicator: Progress on delivery of the actions and milestones to improve integration identified in DHB Annual Plans

Measures Reporting

Target: Actions and milestones agreed in APs Type: Progress update


Source data/template for reporting provided by: Checklist of actions supplied on the quarterly reporting website

Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy and the overarching goal that all New Zealanders live well, stay well, get well.’This measure has key linkages to Government planning priorities as highlighted.
















Bowel Screening

Mental Health

Healthy Ageing

70




Child Health



Improving Quality Information Technology

Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Deliverables definitionsDHBs are expected to report on delivery of the actions and milestones to improve integration identified in Annual Plans.

Each quarter the Ministry will present checklists that summarise the system integration actions agreed in Annual plans on the quarterly reporting web site as follows:

System integration check list

DHBs are required to provide a quarterly update identifying progress made during the quarter against the actions and milestones (deliverables) in each checklist. The progress update must include:

Whether the DHB is on track meeting each deliverable by the end of quarter 4, including comment on specific actions delivered in the quarter

Where deliverables are not on track the report must include mitigation strategies and new timeframes for delivery

Where quantitative measures are reported – Reports must include baseline, target and quarterly performance progress

71


System Level Measure improvement plansDHBs are expected to provide jointly agreed (by district alliances) System Level Measure improvement plans, including improvement milestones.

ExpectationsThe assessment requirements for each quarter are set out below:

Table 1: Quarterly assessmentRating Explanation

Achieved All actions, milestones and measures related to the reporting period are on track.

Partially Achieved Some actions, milestones and measures are not on track but adequate mitigation strategies are presented.

Not Achieved Some actions, milestones and measures are not on track and adequate mitigation strategies are not presented or there are any missing deliverable components.

Reporting periodQuarter For the time period1 1 July – 30 September



4 1 April 13 – 30 June

72



Policy Priorities PP23: Implementing the Healthy Ageing StrategySummary information

Indicator: Progress on delivery of the actions and milestones of the Healthy Ageing Strategy and support the health system to be person centred and focused on maximising healthy ageing and independence

Measures ReportingType: Process Type: Progress update

Target: Actions and milestones to deliver on commitments in the annual planning documents (Annual Plans and Regional Service Plans)


Quarterly

Source data/template for reporting provided by:

Checklist of actions supplied on the quarterly reporting website

Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘All New Zealanders live well, stay well, get well, in a system that is people-powered, provides services closer to home, is designed for value and high performance, and works as one team in a smart system.’7 The five themes of the New Zealand Health Strategy are cornerstones in establishing a health sector that understands people’s needs and provides services that are integrated across sectors, emphasising investment early in life, maintaining wellness, preventing illness, and providing support for the final stages of life











7 The five themes of the New Zealand Health Strategy 2016 – people-powered, closer to home, value and high performance, one team and smart system.

73








Bowel Screening

Mental Health

Healthy Ageing Living Well with Diabetes


Child Health




Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

The Healthy Ageing Strategy 2016 sets the direction for the health and wellbeing of older people for the next ten years. Its vision is that “Older people live well, age well and have a respectful end of life in age-friendly communities.” It takes a life course approach that seeks to maximise health and wellbeing for all older people. The Strategy sets a framework whereby policies, funding, planning and service delivery:

prioritise healthy ageing and resilience into and throughout people’s older years enable high quality acute and restorative care, for effective rehabilitation, recovery and

restoration after acute events74


ensure people can live well with long-term conditions better support people with high and complex needs provide respectful end-of-life care that caters to physical, cultural and spiritual needs.

The deliverables for 2017/18 are listed below together with the theme of the New Zealand Health Strategy to which it is most closely aligned;8 and the aim of the Healthy Ageing Strategy 2016.

Deliverable Part 1: DHBs are expected to provide a progress report on:Actions and milestones to deliver on the commitment in the DHB’s 2017/18 Annual Plan to implement the Healthy Ageing Strategy (including workforce regularisation) as set out below:Note - For any DHBs where actions were not agreed in their Annual Plans, the quarter one reporting process will be used to agree actions for future quarterly reporting.

1.a Future Models of Care This expectation aligns most closely to the Care Closer to Home theme from the New Zealand Health Strategy; and the Living Well with Long-Term Conditions goal of the Healthy Ageing Strategy

• DHBs are to report progress during the quarter (in brief) to deliver on agreed action(s) and milestones.

1.b Integrated Falls and Fracture Prevention and Rehabilitation Services9 This expectation aligns most closely to the Care Closer to Home theme from the New Zealand Health Strategy; and the Ageing Well and Acute and Restorative Care goals of the Healthy Ageing Strategy.

• DHBs are to report progress during the quarter (in brief) to deliver on agreed action(s) and milestones

Using the reporting template provided:

• Report on practical (and concrete) steps taken to improve coding of falls at the point of entry to hospital with the aim to accurately capture fall related injuries.

• Report the number of older people (65 and over, or younger if identified as a falls risk) that have received these services:

in-home strength and balance retraining service Community/group strength and balance retraining service Seen by the fracture liaison service or similar fracture prevention service Prescribed bisphosphonates (or dispensed if the number prescribed is

unavailable), including 5mg/100ml zoledronic acid infusions for treatment of osteoporosis. The number should include both people who have suffered a fall-related fracture and those being treated for Osteoporosis.

1.c Action(s) to improve equity • DHBs are to report progress during the quarter (in brief) to deliver on agreed action(s)

and milestones. 8 Note that priority areas of focus are linked to one (or more) theme from the New Zealand Health Strategy and should be reflected in your reporting.9 The following measures align with the Outcomes and Best Practice Framework and ACC/DHB/HQSC injury prevention partnering agreements for falls and fracture prevention. These measures enable indicators to be developed and reported nationally to all DHBs. The measures below also report a component of the quarterly reporting requirement under the ACC/DHB partnering agreements

75


1.d. Workforce – regularisation: Actions to implement the kaiāwhina workforce action plan and regularise the home and community workforce including guaranteed hours, paid training and wages linked to training (action included under ‘workforce priority’ in Annual Plan)This expectation aligns most closely to One Team theme from the New Zealand Health Strategy; and the Living Well with Long-Term Conditions goals of the Healthy Ageing Strategy. • DHBs are to report progress during the quarter (in brief) to deliver on agreed action(s)

and milestones.

1.e Locally prioritised action(s)• DHBs are to report progress during the quarter (in brief) to deliver on one (or more)

DHB-identified action (not included above that may or may not be included in the DHB’s Annual Plan) that the DHB has prioritised locally to highlight implementation of the Healthy Ageing Strategy and that it expects to have the greatest impact on outcomes for older people locally

Deliverable Part 2: Reporting template to be provided. DHBs are expected to report volumes and measures associated the interRAI: Comprehensive Clinical Assessment in aged residential care and in home and community support settings including:

an exception report where the percentage of older people who have received long term home and community support services in the last three months who have had an interRAI Home Care or a Contact assessment and completed care plan is less than 95 percent.

older people referred for an interRAI assessment to access publicly funded services undergo the assessment and have a service allocated/declined in a timely manner.

This expectation aligns with the interRAI measure for reporting via Regional Service Plan (below) quarterly reporting and most closely to the Care Closer to Home theme from the New Zealand Health Strategy; and the Living Well with Long-Term Conditions goals of the Healthy Ageing Strategy.

Please note for reference purposes the following deliverables that will form part of the Health Aging performance story are being captured through reporting of Regional Service Planning Priorities as included in performance measure SI2.Dementia (S12)This expectation aligns most closely to Value and High Performance theme from the New Zealand Health Strategy; and the Living Well with Long-Term Conditions goals of the Healthy Ageing Strategy.

DHBs are expected to report (in brief) via the S12 measure on key actions to expand the identification, interventions, information and advice relevant to dementia to Strengthen the Implementation of the New Zealand Dementia Framework, and the actions specified in Improving the Lives of People with Dementia.

interRAI (S12)

This expectation aligns most closely to the Care Closer to Home theme from the New Zealand Health Strategy; and the Living Well with Long-Term Conditions goals of the Healthy Ageing Strategy. DHBs to report (in brief) via the S12 measure on the use interRAI assessment data to identify quality indicators and service development opportunities (including with health providers). This includes but is not limited to sharing accurate, accessible, easy to interpret and up to date aggregated data from all assessments, in an aged residential care (ARC) facility, or within a DHB, to better understand service performance and identify areas to improve quality.

76



Rating: DefinitionOutstanding The DHB reports on the following:

key actions (in brief) undertaken in the quarter to deliver on Healthy Ageing commitments agreed in its Annual Plan; and

one (or more) DHB-identified key action or actions (in the DHB’s Annual Plan or more broadly) that the DHB is currently doing to implement the Healthy Ageing Strategy; and

by exception, the interRAI: Comprehensive Clinical Assessment in aged residential care and in home and community support settings (PP23) measure (2016/17 PP23 refers), if there are departures from targets, the reasons for departures and any relevant associated remedial actions; and

significant improvements in its level of performance for the action to improve equity identified in its Annual Plan.

Achieved The DHB reports on the following: key actions (in brief) undertaken in the quarter to deliver on Healthy

Ageing commitments agreed in its Annual Plan; and one (or more) DHB-identified key action or actions (in the DHB’s Annual

Plan or more broadly) that the DHB is currently doing to implement the Healthy Ageing Strategy; and


identified action(s) to improve equity and reported any related activity to improve its level of performance as per commitments in its Annual Plan.

Partially Achieved

The DHB does not report on some of the following: key actions (in brief) undertaken in the quarter to deliver on Healthy

Ageing commitments agreed in its Annual Plan; and one (or more) DHB-identified key action or actions (in the DHB’s Annual

Plan or more broadly) that the DHB is currently doing to implement the Healthy Ageing Strategy; and


an identified action(s) to improve equity and any related activity to improve its level of performance as per commitments in its Annual Plan.

Not Achieved

The DHB does not report key actions undertaken in the quarter to deliver on Healthy Ageing commitments agreed in its Annual Plan and one or more DHB-

77


identified action or actions (in the DHB’s Annual Plan or more broadly) that the DHB is currently doing to implement the Healthy Ageing Strategy.

Reporting Period for PP23All deliverables within the measure are to be provided as follows: Quarter

For the time period

Indicator to report on

1 1 July – 30 September

Narrative reports and data where required





4 1 April – 30 June Narrative reports and data where required

Reporting TemplateThe Ministry of Health Excel reporting template is to be loaded onto the nationwide service framework library web site prior to Q1 for use in reporting on this measure: http://www.nsfl.health.govt.nz/.

78



Policy Priorities PP25: Prime Minister’s youth mental health project Summary information

Indicator: Progress update reports on actions to implement Initiatives 1, 3 and 5 of the Prime Minister’s Youth Mental Health Project

Measures Reporting

Type: Process Type: Qualitative and quantitative

Target: Provision of complete report Reporting frequency: Quarterly (six-monthly some components)

Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’, and the overarching goal that all New Zealanders live well, stay well, get well.

















Bowel Screening


79




Child Health




Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

PP25 reports on progress towards achieving three initiatives in the Prime Minister’s Youth Mental Health Project:

Initiative 1: School Based Health Services (SBHS) in decile one to three secondary schools, teen parent units and alternative education facilities

Initiative 3: Youth Primary Mental Health ((reported under PP26) Initiative 5: Improve the responsiveness of primary care to youth.

Note: Initiative 6 is reported under PP8, and Initiative 7 is reported under PP7.

Young people are often unable or reluctant to access primary care and mental health services. Often the services in their local area are geared towards treating adults or people with more acute needs. Young people may require a unique mix of social, developmental and health services, and their family GP may not have sufficient expertise to provide the full range of care needed. Young people can also feel uncomfortable discussing their issues with their usual family GP. To improve youth access to appropriate primary care services, young people need a range of sustainable youth-friendly health and social services, including:

youth specific services as appropriate for the locality, which may include youth wellness hubs/networks, School Based Health Services or Youth One Stop Shops (YOSS); and

General practice that is responsive to youth

Responsive primary care, YOSS, Youth Wellness Hubs, and other youth-friendly organisations provide young people with a wide range of services, including mental health services, in a non-judgemental and community-based environment. Youth-friendly services help young people to overcome their reluctance

80


and enable them to open up about their issues. This can lead to significant improvements in their mental health and wellbeing, while assisting with other problems they may be facing.

Changes we would expect to see:

Primary care services are more responsive to the specific needs of young people Improved youth access to appropriate services Improved integration of services for youth Improved sustainability of youth-specific services, such as YOSS.

Actions and activities that have a proven impact on this measure:DHBs are expected to use the Alliance Leadership Team and youth Service Level Alliance Teams (SLATs) to jointly develop DHB Annual Plans for the Youth Services component of the Prime Minister’s Youth Mental Health Project. From 2014/15 every District Alliance shall have a youth SLAT to implement an integrated approach to improving the health and wellbeing of young people. Youth SLATs (or equivalent) shall have a mandate to make recommendations to the Alliance Leadership Team on local youth health needs and agreed changes to service provision, while providing oversight on the implementation of actions to improve youth health across the system.

The youth SLATs should include membership from youth specific health services, Social Sector Trials (SST) where they exist, and other relevant stakeholders (including the education and social sectors) as appropriate. Where SST are operating locally, DHBs are expected to work with local SST Leads for the actions identified to improve access to youth mental health and youth AOD services.

Deliverables definitionsInitiative 1: School Based Health Services (SBHS) in decile one to three secondary schools, teen parent units and alternative education facilities.

1. Provide six monthly quantitative reports on the implementation of SBHS in quarters two and four, as per the template provided.

2. Provide quarterly narrative progress reports on actions undertaken to implement Youth Health Care in Secondary Schools: A framework for continuous quality improvement in each school (or group of schools) with SBHS.

Initiative 3: Youth Primary Mental Health

1. Provide quarterly narrative progress reports (as part of PP26 Primary Mental Health reporting) with actions undertaken in that quarter to improve and strengthen youth primary mental health (12-19 year olds with mild to moderate mental health and/or addiction issues) to achieve the following outcomes: early identification of mental health and/or addiction issues better access to timely and appropriate treatment and follow up equitable access for Maori, Pacific and low decile youth populations.

2. Provide quantitative reports using the template provided under PP26

Initiative 5: Improve the responsiveness of primary care to youth.

1. Provide quarterly narrative reports with actions undertaken in that quarter to ensure the high performance of the youth SLAT(s) (or equivalent) in your local alliancing arrangements.

2. Provide quarterly narrative reports with actions the youth SLAT has undertaken in that quarter to improve the health of the DHB’s youth population (for the 12-19 year age group at a minimum) by addressing identified gaps in responsiveness, access, service provision, clinical and financial sustainability for primary and community services for the young people, as per your SLAT(s) work programme.

81


ExpectationsRating Explanation

Achieved All actions, milestones and measures are on track.


Not Achieved Some actions, milestones and measures are not on track and adequate mitigation strategies are not presented.





82



Policy priorities PP26: Rising to the Challenge: The Mental Health and Addiction Service Development Plan

Summary informationMeasures Reporting

Type: Input Type: Full report

Target: No target – supply of information Reporting frequency: Quarterly

Source data/template for reporting provided by: Not applicable

Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’ and the overarching goal that all New Zealanders live well, stay well, get well.

















Bowel Screening



83



Child Health




Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Rising to the Challenge: The Mental Health and Addiction Service Development Plan (Rising to the Challenge) clearly articulates prioritised service developments for the next four years. The Plan aims to ensure that across the spectrum of primary, specialist treatment and support services access and responsiveness will be enhanced; integration will be strengthened while improving value for money and delivering improved outcomes for people using services.

Deliverables definitionsFocus area 1: Primary Mental Health (Note - this focus area individually identified on performance dashboard)As part of the implementation of goal six Delivering increased access for adults with high-prevalence conditions while increasing service integration and effectiveness, the Ministry monitors access to evidence-informed psychological therapies for mental health and addictions issues in primary care.

Primary mental health and addiction interventions are for people presenting with mild to moderate mental health and addiction problems. In addition to the general primary care response to the needs of people of any age, access to primary mental health interventions are funded for the following specific population groups:

1. The enrolled adult population focused on Maori, Pacific and/or low income. The expected outcome is increased access to psychological and psychosocial interventions for these at-risk groups.

84


2. Youth primary mental health services, available to all youth in the 12 to 19 year age group (regardless of PHO enrolment) who require such a service. The expected outcomes are to enable early identification of developing mental health and/or addiction issues and better access to timely and appropriate treatment and follow up.

Reporting PeriodBy the 20th of January, April, July and October each year using the Ministry quarterly reporting website.

Reporting required: Each quarter, please update the reporting template provided (refer to the DHB quarterly reporting web site and toolkit).

Reporting (also links to PP25 Youth Mental Health Project for youth)1. Provide quarterly reports on the attached template which covers the amount of service delivered

including alcohol brief interventions (numbers of adults and youth (12-19) seen by ethnicity and services accessed). Grey boxes are optional but helpful particularly if outcome data is being captured locally.

2. Narrative report on the following: Overall assessment of the services delivered and Any major achievements/successes Major issues that have affected the achievement of the contracted Services Whether services have been externally evaluated / reviewed / audited and status of

recommendations made.

Focus Area 2 District Suicide Prevention and Postvention (Note - this focus area individually identified on performance dashboard)

Suicide prevention and postvention plans were completed and agreed in mid 2015. Please report the following as result of the plan being implemented (note: this is not a comprehensive reporting requirement on every action identified in the plan):

Please select three actions from your plan to report on, and include highlights, challenges/exceptions and milestones. Please also note that when an action is completed then another action will need to be identified for reporting.

Focus Area 3 Improving Crisis response services

Reducing the demand on police for crisis support of known clients is an important interagency goal. There is a significant range in the rate of known clients referred by police crisis services. Please provide actions that have been undertaken to reduce the rate of known clients being referred by police to crisis teams and what difference have the above actions made to police referrals.

Focus Area 4 Improve outcomes for children

Please report on progress against actions identified in the annual plan for improving outcomes for children. The report must include progress on the implementation of Supporting Parents Healthy Children (COPMIA).

Focus area 5 improving employment and physical health needs of people with low prevalence conditions:

Please provide a progress report on actions identified in the annual plan for improving the physical and employment outcomes of people with low prevalence conditions.

85


Performance Dimension: ‘Achieving Government’s priorities and targets’

Policy Priorities PP27: Supporting Vulnerable ChildrenSummary information

Indicator: Progress on delivery of the actions and milestones identified in DHB Annual Plans support the implementation of the Children’s Action Plan and the Vulnerable Children Act 2014.

Measures Reporting

Type: Process Type: Progress update

Target: Actions and milestones agreed in APs Reporting frequency: Quarterly


Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders are healthier and more independent ’, and ‘the health system is cost effective and supports a productive economy’ and the overarching goal that all New Zealanders live well, stay well, get well.










Supporting Vulnerable Children Better Public Service Target Increased Immunisation Health Target






Bowel Screening

Mental Health

86


Healthy Ageing



Child Health




Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

ContextThe cross-agency Children’s Action Plan (CAP), is a key priority for the Government. The CAP sets out what will be done to protect vulnerable children who are at greatest risk of maltreatment. The CAP supports the Prime Minister’s Better Public Services (BETTER PUBLIC SERVICE) Key Result Area for Supporting Vulnerable Children, particularly the result area of reducing child assaults by 5 percent by 2017. DHBs have an important role in supporting the implementation of the CAP and BETTER PUBLIC SERVICE. The White Paper (Volumes 1 & 2) and additional information about CAP can be accessed at www.childrensactionplan.govt.nz

DHBs, through delivering on the CAP, particularly through the support they provide to Children’s Teams, and other health sector initiatives that support the prevention and early identification of child maltreatment (such as VIP programmes, health professional training and implementation of the National Child Protection Alerts System and Shaken Baby Prevention programmes), will contribute to better coordinated services and improved outcomes for vulnerable children and their families/whanau.

Deliverables definitionsDHBs are required to provide a quarterly update identifying progress made during the quarter against the actions and milestones (deliverables) committed to in their Annual Plan. The progress update must include:

87

http://www.childrensactionplan.govt.nz/


DHBs with Children’s Teams only the numbers (head count and FTE) and roles of staff participating in the children’s team, including Local Governance representation, Lead Professionals, Service Brokers, Panel members and any other role.

All DHBs the link to the online copy of the DHB’s child protection policy – Quarter 1 only exception reporting on child protection policies for funded providers: where the DHB has not yet

included the requirement for providers of children’s services to adopt a child protection policy within the provider’s funding agreement, the DHB will report actions to introduce this requirement and to support providers to implement the policy

exception reporting on safety checking: detail of individual instances where the DHB has not met the requirements for safety checking newly employed or engaged core and non-core children’s workers

the number of existing staff found working in core children’s workers roles who have been suspended under s28 of the Act (identified as having committed a specified offence), and a summary of the DHB’s subsequent employment decisions for that worker

actions or initiatives to reduce deaths and hospitalisations due to assault, neglect or maltreatment of children 0-14, including description of how initiatives are being (or will be) evaluated for success.

For additional activity the DHB must report:

Whether the DHB is on track meeting each deliverable, including comment on specific actions delivered in the quarter

Where deliverables are not on track the report must include mitigation strategies and new timeframes for delivery.

ExpectationsThe assessment requirements for each quarter are set out below:

Table 1: Quarterly assessmentRating Explanation








88


Performance Dimension: ‘Achieving Government’s priorities and targets’

Policy Priorities PP28: Reducing Rheumatic feverSummary information

Delivery of agreed acute rheumatic fever hospitalisation rates


Agreed in Annual Plan Type: progress update and exception report

Reporting frequency: quarterly

Source information for reporting provided by: Ministry sourced from NMDS

Linkages:

Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’ and the overarching goal that all New Zealanders live well, stay well, get well. This measure links to priorities as highlighted:





2017/18 Annual planning priority

Healthy Mums and Babies Better Public Service Target











Bowel Screening

Mental Health

Healthy Ageing



Child Health


89




Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Rheumatic fever prevention will continue to be a priority for the Ministry of Health and will be a secondary measure under the new Better Public Service (BPS) Result Area 3: Keeping Kids Healthy. Therefore, efforts to reach and maintain a national target of 1.4 per 100,000 will continue.

Rheumatic fever primarily affects school and intermediate-aged children and generally follows a Group A streptococcal throat infection. It is a preventable disease and can have serious consequences, such as the development of rheumatic heart disease. Rheumatic fever is unevenly distributed in New Zealand – it occurs mainly in the North Island, is strongly correlated with poor socio-economic status, and disproportionately affects Māori and Pacific people. Actions and activities that have a proven impact on this measure:In order to achieve the overall reduction in rheumatic fever, DHB target numbers and rates have also been set. The target numbers and rates for each DHB are shown in Table 1. The actions DHBs can take to improve performance are included in each DHB’s rheumatic fever prevention plan.

The DHB rheumatic fever prevention plans identify the DHB’s approach and commitment to delivering a range of actions which will contribute to achieving their rheumatic fever target. The plans cover the period to July 2022.

90


Table 1: First episode rheumatic fever hospitalisation target rates (per 100,000 total population) and by District Health Board

DHB Rate per 100,000 total population

Northland 3.5

Waitemata 0.7

Auckland 1.1

Counties Manukau 4.5

Waikato 1.2

Lakes 2.6

Bay of Plenty 1.3

Tairawhiti 2.8

Taranaki 0.3

Hawke’s Bay 1.5

MidCentral 0.6

Whanganui 1.1

Capital &Coast 1.0

Hutt Valley 1.6

Wairarapa 0.0

Southern region 0.2

New Zealand 1.4

Deliverables definitions Exception reporting for DHBs with a high incidence of rheumatic fever (Northland, Auckland, Waitemata, Counties Manukau, Waikato, Bay of Plenty, Lakes, Hawke’s Bay, Hauora Tairāwhiti, Capital & Coast, Hutt Valley) if the target indicated in table 1 above (Hospitalisation rates per 100,000 DHB total population for acute rheumatic fever) has not been reached or maintained. Rates will be output by the Ministry of Health every 6 months (Quarter 2 and quarter4) and if the target has not been reached or maintained based on these rates, the DHB will provide exception reporting. A template will be provided.

Data on acute rheumatic fever hospitalisation rates will be supplied by the Ministry.

Reporting Period Reporting required: Exception reports will be required quarterly. Due to the reliance on NMDS data (where the deadline for submission is about one month after the end of the quarter), the data used to derive the hospitalisation measure will be for one quarter in arrears.

91


ExpectationsThe following achievement scale will be applied:

Rating: DefinitionAchieved Agreed target met or hospitalisation rate below target.

An achieved rating is applied when the DHB has met the target agreed in its Annual Plan and has achieved significant progress for the Māori population group, and the Pacific population group. As 90% of hospitalisation for rheumatic fever are among Māori and Pacific populations, 'significant progress' for Māori and Pacific populations is defined as the DHB meeting the DHB target agreed in its Annual Plan.

Partially Achieved

DHB hospitalisation rate above agreed target (including not making agreed progress for Maori and Pacific population groups), and within a 95% confidence interval of agreed target.As 90% of hospitalisations for rheumatic fever are among Māori and Pacific populations, this rating is applied if the resolution plan supplied by the DHB includes actions specifically focused on improving results for the Maori and Pacific populations.

Not Achieved DHB hospitalisation rate above agreed target and outside a 95% confidence interval of agreed target









.

92










.

93



Policy Priorities PP29: Improving waiting times for diagnostic servicesSummary information

Measures Reporting

Target: Agreed target

Type: Variation from expectation

Reporting frequency: Monthly


Coronary Angiography – data to be supplied by DHBs to the National Booking Reporting System (NBRS) in accordance with national collection reporting rules

Colonoscopy – data to be supplied by DHBs either to the NBRS, or via a generic template

Computed Tomography and Magnetic Resonance Imaging - each DHB is to provide monthly data on a generic template. Templates will be due 20 days after the end of the calendar month – a copy of the templates is attached

Link to outcomes Delivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’ and the overarching goal that all New Zealanders live well, stay well, get well.

Link to priority areas of focusDelivery of this measure will support Better Sooner More Convenient Health Services for New Zealanders by ensuring people are provided more timely access to diagnostic services. Increasing delivery will improve access and reduce waiting times will increase public confidence that the health system will meet their needs.

Delivery of this measure will also support the key (strategic) planning approaches of regional collaboration and governance, and integration by encouraging DHBs to adopt a regional view of diagnostic service delivery. This requires improved integration across all clinical services, and patient pathways.







94









Improved Access to Elective Surgery Health Target Faster Cancer Treatment Health Target Better Help for Smokers to Quit Health Target


Bowel Screening Mental Health

Healthy Ageing



Child Health




Improving Quality


Workforce




Workforce

Quality

Electives Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Diagnostics are a vital step in the pathway to access appropriate treatment. Improving waiting times for diagnostics can reduce delays to a patient’s episode of care and improve DHB demand and capacity management.

95


Improving access to diagnostics will improve patient outcomes in a range of areas: Cancer pathways will be shortened with better access to a range of diagnostic modalities Emergency Department (ED) waiting times can be improved if patients have more timely access

to diagnostics Access to elective services will improve, both in relation to treatment decision-making, and also

improved use of hospital beds and resources Workforce opportunities can be explored to consider alternative and more efficient ways of

providing diagnostics

These efforts will help to promote and protect good health and independence, and contribute to the high level outcome of New Zealanders living longer, healthier and more independent lives.A multi-year programme commenced in 2012/13 and involves a staged approach being taken to improving waiting times for diagnostics (from receipt of referral to provision of diagnostic service).

Deliverables definitionsDescription:For 2017/18 the programme will involve deliverables in the following four modalities:

Coronary angiography Colonoscopy Magnetic Resonance Imaging (MRI) Computed Tomography (CT)

These procedures were identified because they are aligned with other health sector priorities, and because national or regional representative groups are established. The Ministry of Health has worked with clinical networks to establish nationally agreed expectations regarding what appropriate timeframes should be for these diagnostic modalities.

Refer to the Improving Waiting Times for Diagnostic Services Indicator Templates for more information on the deliverables, definitions and expectations.

Reporting Period Reporting required: Monthly reporting from as follows:

Elective coronary angiogram to be reported to the National Booking Reporting System (NBRS) in accordance with NBRS data dictionary reporting requirements.

CT, MRI and colonoscopy reporting templates to be submitted to the Ministry of Health within 20 days of the end of the previous month. The reporting template is emailed out by National Collections.

Performance monitoring against this measure will be undertaken quarterly via the non-financial performance monitoring framework as follows:

Quarter ResultsQuarter 1 September results

Quarter 2 December results

Quarter 3 March results

Quarter 4 June results

96


Expectations DHBs are required to collect, measure and monitor how long people are waiting for identified diagnostic procedures. Incremental improvements are required each year. Expectations for 2017/18 are:

1. Coronary angiography – 95% of accepted referrals for elective coronary angiography will receive their procedure within 3 months (90 days)

2. CT and MRI – 95% of accepted referrals for CT scans, and 90% of accepted referrals for MRI scans will receive their scan within 6 weeks (42 days).

3. Diagnostic colonoscopy –

a. 90% of people accepted for an urgent diagnostic colonoscopy will receive their procedure within two weeks (14 calendar days, inclusive), 100% within 30 days

b. 70% of people accepted for a non urgent diagnostic colonoscopy will receive their procedure within six weeks (42 days), 100% within 90 days

Surveillance colonoscopy

c. 70% of people waiting for a surveillance colonoscopy will wait no longer than twelve weeks (84 days) beyond the planned date, 100% within 120 days

Performance Ratings for PP29: Improving waiting times for diagnostic servicesSeparate performance rating will be applied for each of the three expectation areas within this performance measure:

1. Coronary angiography (one indicator)2. Radiology (CT & MRI indicators)3. Colonoscopy (three indicators)

The following achievement scale will be applied for each of the three areas

Rating: Achieved The DHB has achieved all the waiting time indicator or indicators for the

respective diagnostic area

Partial Achievement The DHB has either:- achieved some, but not all, of the waiting time indicators for the

respective diagnostic area (for example, achieved the CT indicator but not the MRI indicator), and has provided a report that includes planned actions to lift performance; or

- achieved none of the indicators for the respective diagnostic areas, but shows improvement over the previous quarter, and has provided an adequate work-out plan to reach the target by year-end.

Not Achieved The DHB has not achieved the waiting time indicators for the respective diagnostic area, and has not demonstrated an adequate work-out plan to reach the target by year-end.

97



Policy Priorities PP30: Faster cancer treatment

Link to outcomes Delivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, ‘the health system is cost effective and supports a productive economy’ and the overarching goal that all New Zealanders live well, stay well, get well.














Faster Cancer Treatment Health Target Better Help for Smokers to Quit Health Target


Bowel Screening

Mental Health

Healthy Ageing



Child Health




98


Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Faster cancer treatment takes a pathway approach to care, to facilitate improved hospital productivity by ensuring resources are used effectively and efficiently. DHBs working towards achievement of Faster cancer treatment supports public trust in the health and disability system; and that these services can be used with confidence. Implementation of Faster cancer treatment requires existing capacity and resources to be maximised, this results in effective and efficient use of resources and supports the key planning consideration of value for money.

Implementing the overall faster cancer treatment programme supports the overarching goal of Better, Sooner, More Convenient Health Services for New Zealanders. Cancer treatment is provided across all DHBs, although not all DHBs provide all services. This requires DHBs to collaborate across boundaries to ensure services are integrated and patients receive a seamless service.

Actions to deliver improved performance in this focus area include: use of the Faster Cancer Treatment Indicators: Business Rules and Data Definitions and High

suspicion of cancer definitions (to ensure consistency of reporting improve the quality of data (volume of patients, number of tumour types, types of first treatment)

captured analysis of the data to identify areas for system and process improve along the patient pathway

and any differences in access or timeliness by ethnicity or geography. review and re-design of the coordination of treatment processes and booking processes to

ensure optimal use of capacity.This measure has key linkages to Government planning priorities as highlighted.

DeliverablesDHBs will be required to supply data monthly (within 20 days of the end of the month) via secure file transfer protocol on the length of time taken for patients to receive their first cancer treatment (or other management) from date of decision-to-treat.

The Faster cancer treatment 31 day indicator includes all patients who receive a publicly-funded first cancer treatment, irrespective of how they were initially referred.

99


Detailed information on the definitions, inclusions and process for submitting data to the Ministry of Health is outlined in Faster Cancer Treatment Indicators: Business Rules and Data Definitions (version 3.1, March 2014) available from: http://nsfl.health.govt.nz/accountability/performance-and-monitoring/business-rules-and-templates-reporting/faster-cancer.

The DHB of domicile is responsible for collecting and reporting information on their domiciled population even if it is not the DHB of:

receipt of referral service.

No further quantitative reporting is required as part of the quarterly reporting process.DHBs are required to submit a quarterly qualitative report through the quarterly reporting database outlining:

the activities being undertaken to ensure data quality and volumes delays identified along the cancer pathway and challenges with implementing Faster cancer

treatment actions taken and planned in response to the delays and challenges identified.

Reporting periodDHB achievement of the Faster cancer treatment 31 day indicator will be calculated based on six months rolling data as outlined in the table below:

Reporting quarter Achievement based on patients receiving their first cancer treatment between:

Quarter 1 1 April – 30 September

Quarter 2 1 July – 31 December

Quarter 3 1 October - 31 March

Quarter 4 1 January – 30 June

ExpectationsThe following achievement scale, which is aligned to the achievement scale for the Faster cancer treatment health target, will be applied:

Rating:

Achieved will apply where at least 85 percent of patients receive their first cancer treatment (or other management) within 31 days from date of decision-to-treat.

Partially Achieved will apply where less than 85 percent of patients receive their first cancer treatment (or other management) within 31 days from date of decision-to-treat, but the narrative comment satisfies the assessor that the DHB has a plan to improve achievement.

Not Achieved will apply where less than 85 percent of patients receive their first cancer treatment (or other management) within 31 days from date of decision-to-treat and the narrative comment does not satisfy the assessor that the DHB has a plan to improve achievement.


100


Policy Priorities PP31: Better help for smokers to quit in public hospitals (previous health target)

Summary information 95 percent of hospital patients who smoke and are seen by a health practitioner in a public hospital

are offered brief advice and support to quit smoking

Measures ReportingTarget: Target agreed in

Annual PlansType: Data & report



Hospital target data – supplied by DHBsAll reporting templates will be supplied by the Ministry.

Link to outcomes Delivery against this measure supports the health and disability system outcome of ‘New Zealanders living longer, healthier and more independent lives’ and the overarching goal that all New Zealanders live well, stay well, get well.















Better Help for Smokers to Quit Health Target Raising Healthy Kids Health Target

Bowel Screening

Mental Health

101


Healthy Ageing



Child Health




Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Achievement of this measure also supports ‘a more unified and improved health and disability system’. The measure also supports the Government’s aspirational goal of a Smokefree New Zealand by 2025. Achieving a Smokefree New Zealand will mean that: our children and grandchildren will be free from exposure to tobacco and tobacco use the prevalence of smoking across all populations will be less than 5 percent tobacco will be difficult to sell and supply.

At present, tobacco smoking places a significant burden on the health of New Zealander’s and on the New Zealand health system. Tobacco smoking is related to a number of life-threatening diseases, including cardiovascular disease, chronic obstructive pulmonary disease and lung cancer. It also increases pregnant smokers’ risk of miscarriage, premature birth and low birth weight, as well as their children’s risk of Asthma and Sudden Unexplained Death in Infants (SUDI). Stopping smoking confers immediate health benefits on all people, and is the only way to reduce smokers’ risk of developing a smoking-related disease. Providing smokers with brief advice to quit increases their chances of making a quit attempt. The chance of that quit attempt being successful is increased if medication and/or cessation support are also provided. Most medications roughly double a smoker’s chance of quitting, but using medication in conjunction with a cessation support service (such as the Quitline or an Aukati KaiPaipa service) can increase a smoker’s chance of quitting by as much as four times.

102


By ensuring that all health professionals are routinely providing their patients with advice and support to quit, DHBs are helping to ensure that people receive better health and disability services, and live longer and healthier lives. The following actions and activities are examples of initiatives that have had an impact on this measure: Mechanisms for capturing data are accessible and easy to use. Methods for referring patients to cessation support services are simple and succinct. Services are able to monitor their progress towards the target on a regular basis. Smokefree champions are in place within each ward, practice or service to provide motivation,

education and support for the target.

DeliverablesEach quarter, DHBs will be required to complete the template supplied by the Ministry (numerical and narrative sections must be completed). Local patient management systems will be used to capture the necessary data using the relevant ICD-10-AM codes (see table 1).

Table 1: Smoking related ICD-10-AM codes

Measurement of Target

ICD Code ICD Definition

Hospitalised smokers

F17.1 Mental and behavioural disorders due to use of tobacco, harmful use is assigned when a clearly documented relationship exists between a particular condition and smoking.

F17.2 Mental and behavioural disorders due to use of tobacco, dependence syndrome is assigned only when a formal diagnosis of ‘tobacco dependence syndrome’ has been made.

Z72.0 Tobacco use, current is assigned if the patient has smoked tobacco within the last month and when there is insufficient documentation available to qualify the assignment of either F17.1 or F17.2.

Advice and support

Z71.6 Counselling for tobacco use disorder is assigned in addition to a tobacco status code when a health care worker has provided either advice to quit smoking and/or cessation therapy while the patient is in hospital.- For completeness if Z71.6 coding exists in the absence of a code for

hospitalised smoker, then apply code Z72.0.

Those DHBs that do not meet the 95 percent target for the quarter must provide the Ministry with an action plan detailing how they will improve their result, and must begin reporting their results to the Ministry monthly.Eligible populationsAll adults who are: aged 15 years and over admitted to hospital either acutely or for elective procedures admitted as an inpatient; and identified as a current tobacco smoker at the time of admission (a current tobacco smoker is

someone who has smoked within the last four weeks). Explanation of termsFor the purpose of the hospital target a current smoker is someone who has smoked at all within the last four weeks. A facility is a place which may be a permanent, temporary or mobile structure, which health care users attend or are resident in, for the primary purpose of receiving health care or disability support services. This definition excludes supervised hostels, halfway houses, staff residences and rest homes where the rest home is the patient’s usual place of residence.For the purposes of data collection for the hospital target, private hospitals are excluded. Therefore, the facility type includes, but is not limited to, public hospitals, psychiatric hospitals and drug and alcohol treatment facilities.

103


Reporting periodQuarterly reports must be submitted to the Ministry by the 20th of the month following the relevant quarter.Expectations All DHBs are expected to maintain performance of 95 percent for the hospital target. The achievement scale below will be applied to each of the target areas individually every quarter. Achievement Scale

Rating Definition

Achieved The DHB has met the percentage target

Partial Achievement The DHB has not met target, but has improved on its result from the previous quarter.

Not Achieved The DHB has not met target, and its result has dropped since the previous quarter.

.

104



Policy priorities PP32: Improving the quality of ethnicity data collection in PHO and NHI registers

Summary informationIndicator Progress on implementation and maintenance of Ethnicity Data Audit Toolkit (EDAT)

Target/performance expectation

DHB has not implemented EDAT Toolkit Outline specific internal improvement processes and practices for maximising quality of

ethnicity data collection in NHI and PHO registers Outline clear strategies to ensure EDAT tool implementation by end of Quarter 2 Outline training/development for staff to ensure 100 percent are trained by Quarter 4 Provide current baseline information and target for indicator

DHB implementing EDAT Toolkit At least 95-100 percent of staff trained in EDAT toolkit by Quarter four Outline opportunities for training and education for ongoing evaluation and improvement of

ethnicity data quality Outline specific processes/strategies to monitor and maintain ongoing quality of ethnicity

data collection Provide current baseline information and target for indicator

DHB has implemented EDAT Toolkit Undertake an audit of ethnicity data collected to ensure quality is maintained Outline processes and approaches to reviewing and correcting errors identified in quality of

ethnicity data collected Provide current baseline information and target for indicator


Type: Combination data and narrative report

Reporting frequency: Six-monthly (quarters 2 and 4)


Data is sourced from CBF10 file. Information for reporting is publicly available on the Ministry of Health website http://www.health.govt.nz/our-work/primary-health-care/about-primary-health-organisations/enrolment-primary-health-organisation





Linkages: This performance measure is also linked to Tier 2 statistics available via Ministry website http://www.health.govt.nz/our-work/primary-health-care/about-primary-health-organisations/enrolment-primary-health-organisation

Each DHB/PHO must have clear documentation to enable accurate, timely and consistent collection of ethnicity data including defined processes to continually evaluate and improve the quality of ethnicity data.

10 Note this data will be sourced via the NES PHO report following the roll-out of the National Enrolment System. 105


















Bowel Screening

Mental Health

Healthy Ageing



Child Health




Workforce



106



Workforce

Quality Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Link to outcomes: Improved health and equity for all populations (population focus)

Best value for public health system resources (system focus)

Improved quality, safety and experience of care (individuals and their family/focus).

The health and disability sector has a role in providing quality ethnicity information that enables wider sector analysis of economic, social and cultural experiences of different ethnic groups within the New Zealand population. Collecting quality ethnicity data will ensure that the Government is able to track health trends by ethnicity and effectively monitor its performance to improve health outcomes and reduce health inequalities. Also by accurately recording and collecting ethnicity data, the quality of information available to DHBs/PHOs will improve and enable better service planning, funding of services for different population groups and ensure quality of services provided. The measures provide information that allows DHBs/PHOs to understand the health care needs of all ethnicities through accurate information. It also provides Mäori with quality information about their health status and enables Mäori to participate in, and contribute to, strategies for Mäori health improvement. The New Zealand Health Strategy highlights the need for better access to relevant information to improve decision making at both the health and disability sector level and at community level, enabling a greater role in decision making by communities.

Training and education in EDAT toolkit will ensure accurate reporting and collection of ethnicity to improve quality of information used for service planning, targeting and delivery of funding for priority and high needs populations.

Deliverables definitions DHBs are expected to report on delivery of the actions and milestones to improve quality of ethnicity data collection.

DHBs are required to provide six-monthly update identifying progress made against the actions and milestones (deliverables) based implementation stage of EDAT Toolkit. The progress update must include:

Whether the DHB/PHO is on track meeting each deliverable by the end of quarter 4, including comment on specific actions delivered during the six-month period

107



Where quantitative measures are reported – reports must include baseline, target and quarterly performance progress.

Reporting Period Reporting required: Six-monthly, in

Quarter For the time periodQuarter 2 Data to cover the period 1 October to 31

December

Quarter 4 Data to cover the period 1 April to 30 June

Expectations

DHBs/PHOs are expected to have in place a process that ensures quality of ethnicity data collected from clients.

It is expected the DHB/PHO accurately record ethnicity information about clients It is expected that DHBs have processes in place to ensures all clients ethnicity

information are up-to-date Provide commentary/resolution plan on what it is doing to address the performance

failure. Work continually to improve ethnicity data quality and reporting mechanisms. Have strategies for reviewing and correcting ethnicity data quality issues. Take proactive action to develop and improve internal processes in order to maximise

data quality. This activity must include:o considering the negative effect any proposed system change may have on data

quality and minimising this impacto provide appropriate training and resources to staff involved in the collection,

dissemination and storage of health informationo undertaking timely consultation with the Ministry when changes are going to be

applied.


DHB/PHO has implemented, trained staff and audited EDAT tool, has processes in place to ensure ongoing maintenance of ethnicity data quality, documented training programme for new staff with an established process for reviewing and correcting errors identified in quality of ethnicity data collected. Current baseline information and target provided.

Achieved All actions, milestones and measures related implementation stage of EDAT toolkit for the reporting period are on track. Current baseline and target provided.

Partially Achieved

Some actions, milestones and measures are not on track for the related implementation stage but adequate mitigation strategies are presented. Current baseline and/or target information not provided.

Not Achieved

Performance measures are not on track and adequate monitoring strategies are not presented or there are missing deliverable components. Current baseline and target

108


information not provided.

erformance Dimension: Achieving Government’s priorities and targets

Policy priorities PP33: Improving Maori enrolment in PHOs to meet the national average of 90%


DHBs with Maori enrolment rates less than 90% Work with their PHO/s to target those people who are not enrolled PHO/s and/or DHB/s deliver enrolment messages to those who are not enrolled through

outreach clinics and NGOsDHBs already meeting or exceeding the national average of 90%

Continue to maintain the Maori enrolment percentage


Type: Combination data and narrative report

Reporting frequency: Six monthly (quarters 2 and 4)


Data is sourced from CBF file. Information for reporting in publically available on the Ministry of Health website http://www.health.govt.nz/our -work/primary-health-care/about_primary-health-organsiation/enrolment-primary-health-organisation





Linkages: This performance measure is also linked to the Tier 1 Statistics available via Ministry websitehttp://www.health.govt.nz/our-work/primary-health-care/about-primary-health-organisation/enrolment-primary-health-organisation

Link to outcomes and priority areasDelivery of this measure supports the overarching outcome for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’.



Applicable


Applicable

Improved quality, safety and experience of care(individuals and their family/ focus focus) Applicable



109











Bowel Screening

Mental Health

Healthy Ageing



Child Health


Primary Care Integration Yes – Applicable


Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Link to outcomes: Improved health and equity for all populations (population focus) Best value for public health system resources (system focus) Improved quality, safety and experience of care (individuals and their family/focus)

110


The health and disability sector has a role in providing ethnicity information that enables wider sector analysis of economic, social and cultural experiences in different ethnic group within the New Zealand population. The measures provide information that allows DHB/PHOs to understand the health care needs of all ethnicities through accurate information. It also provides Maori with quality information about their health status and enables Maori to participate in, and contribute to, strategies for Maori health improvement. The New Zealand Health Strategy highlights the need for better access to relevant information to improve decision making at both the health and disability sector level and at community level, enabling a greater role in decision making by communities.

Deliverables definitionsDHBs are expected to report on delivery of the actions and milestones to improve the Maori enrolment rates with PHOs.

DHBs are required to provide six-monthly update identifying progress made against the actions and milestones (deliverables) in each checklist. The progress update must include:

Whether the DHB/PHO is on track meeting each deliverable by the end of quarter 4, including comment on specific actions delivered during the six-month period


Where quantitative measures are reported – reports must include baseline, target and quarterly performance progress

Reporting PeriodReporting required: Six monthly, in

Quarter For the time periodQuarter 2 1 July – 31 December

Quarter 4 `1 April – 30 June

ExpectationsDHBs/PHOs are expected to have in place a process that ensures the Maori population within their region is enrolled with a PHO.

It is expected the DHB/PHO accurately record ethnicity information about clients It is expected the DHBs have processes in place to ensure all clients ethnicity information are up-

to-date Provide commentary/resolution plan on what it is doing to address the performance failure Work continually to improve Maori enrolment rates within their region Have strategies for reviewing enrolment rates and linking those who are not enrolled with PHO.


DHB has an enrolled Maori population of 90% or above and is maintaining and increasing their enrolment rates.

Achieved DHB has enrolled Maori population of 90%

Partially Achieved

DHB has an enrolled Maori population of 80 – 90% and has activities underway to ensure enrolment messages are delivered to the un-enrolled population.

Not Achieved

DHB has enrolled Maori population > 80%

111



PP35: Reducing SUDI infant deathsNote performance related to this measure (previously signalled for inclusion as a 17/18 DHB performance measure) will now be captured through a Crown Funding Agreement variation

Summary informationThis measure was previously included in Maori Health plans - the requirements and reporting for this measure will be captured under a new Crown Funding Agreement variation.

The Ministry has developed a new National SUDI Prevention Programme to be implemented from 1 July 2017. The SUDI performance measures from the previous Maori Health plans will be incorporated into the reporting for the regional component of the new programme via a new Crown Funding Agreement variation.

112



Policy priorities PP36: Reduce the rate of Māori under the Mental Health Act: section 29 community treatment orders


DHBs will reduce the rate of Maori under the Mental Health Act (s29) by at least 10% by the end of the reporting year.


Type: Data & exception report



Data is sourced from PRIMHD databaseMinistry to provide data for reporting via NSFL web site http://nsfl.health.govt.nz/accountability/performance-and-monitoring and the DHB quarterly reporting website ( technical details including extract dates provided with data)





Linkages: This measure also links to measure SI5: Delivery of Whānau Ora

Link to outcomes and priority areasDelivery of this measure supports the overarching outcome for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and the overarching goal that all New Zealanders live well, stay well, get well.



√


√

Improved quality, safety and experience of care(individuals and their family/ focus focus) √






113

http://nsfl.health.govt.nz/accountability/performance-and-monitoring








Bowel Screening

Mental Health

Healthy Ageing



Child Health




Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Delivery against this measure particularly supports ‘New Zealanders to live well, stay well, get well. This measure is consistent with and links to Rising to the Challenge: The Mental Health and Addiction Service Development Plan 2012-2017.

Actions and activities are that have a proven impact on this measure:Activities/actions to support performance improvement on this measure include ensuring clinical reviews are completed in timely way and Kaupapa Maori services are more involved in the persons care

114


Deliverables definitionsData is sourced from PRIMHD and Statistics New Zealand population statistics. Baseline data and information can be found on the NSFL website. Current performance reports will be provided by the Ministry ahead of the reporting period via the quarterly reporting database and the nationwide service framework web site.

DHBs are required to reduce the rate of Maori under s29 of the Mental Health Act by at least 10% by the end of the reporting year

Numerator: (Data source: PRIMHD)The number of Maori under community treatment orders s29 of the Mental Health Act

Denominator: Data source: Statistics New Zealand population statistic

A qualitative report is required that identifies progress on actions to reduce Maori under compulsory treatment orders identified in the annual plan.

Reporting Period Reporting required:

Quarter For the time periodQuarter 1 (reported 20 October)

Data to cover the quarter period to June

Quarter 2 (reported 20 January)

Data to cover the quarter period to Sept

Quarter 3 (reported 20 April)

Data to cover the quarter period to Dec

Quarter 4 (reported 20 July)

Data to cover the quarter period to March

ExpectationsIdentify any specific performance issues and provide a high level resolution plan

The achievement criteria/ratings scale that will be applied:


The DHB’s rate of Maori under community treatment orders (Mental Health Act s29) is at the same rate as non-Maori

Achieved Milestones outlined in the annual plan are being reached and the rates of Maori under community treatment orders has reduced.

Partially Achieved

Milestones outlined in the annual plan are being reached and the rates of Maori under community treatment orders have not reduced

Not Achieved

Milestones outlined in the annual plan are not being reached

115



Policy priorities PP37: Improving breastfeeding ratesSummary information


Exclusive or fully breastfed at 3 months.


Type: Confirmation and exception report based on data supplied by Ministry

Narrative report/progress update



Data is sourced from the Well Child / Tamariki Ora (WCTO) dataset. Reporting on breastfeeding rates is via the six monthly publication of Well Child / Tamariki Ora (WCTO) Quality Improvement Framework Report. Baseline data and information can be found on the Ministry of Health website.





Linkages: This performance measure is also included in the Well Child / Tamariki Ora Quality Improvement Framework.






Improved quality, safety and experience of care(individuals and their family/ focus)


116













Bowel Screening

Mental Health

Healthy Ageing


Childhood Obesity Plan Child Health




Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Linkages:

117


The protection, promotion and support of breastfeeding have been identified as fundamental to achieving optimum health in New Zealand11. Breastfeeding is important for the physical health of mothers and infants12, and there is strong evidence to show that breastfeeding and appropriate infant feeding contribute to the social and emotional wellbeing of infants, mothers and families13. The Ministry of Health recommends that infants be breastfed exclusively for around the first six months of life and continue to be breastfed, along with the introduction of appropriate complementary foods, up to one year of age or beyond14.

New Zealand has a relatively high rate of exclusive breastfeeding initiation. 82.2% of New Zealand babies are exclusively breastfed on discharge from a Baby-Friendly Hospital Initiative (BFHI) accredited maternity facility15. There has, however, been little change in community breastfeeding rates over the last ten years and there remains a significant drop off in breastfeeding over early infancy. There are also significant ethnic and socio-economic differences in breastfeeding rates contributing to health inequalities, particularly for Māori and Pacific populations16.

Research shows that children who are exclusively breastfed for around six months are less likely to suffer from childhood illnesses such as respiratory tract infections, gastroenteritis and otitis media. Breastfeeding benefits the health of mother and baby, as well as reducing the risk of SUDI, asthma and childhood obesity. Nationally, breastfeeding rates for Māori infants start at a similar (although slightly lower) rate as the total population, but drop off more quickly than the total population at the three and six month time points. Breastfeeding is an important area of focus because there is significant room for improvement, and breastfeeding has wide-reaching benefits and potentially results in reduced cost for families.

Improving breastfeeding rates at three months of age addresses multiple themes in the refreshed New Zealand Health Strategy including one team (allowing a multi-disciplinary team to work together on a national strategy and implementation plan), people-powered (by understanding the needs and preferences of that consumers i.e. breastfeeding women, or those that have recently ceased breastfeeding and partnering with them to design the strategy and recommendations) and closer to home (investing in health and wellbeing early in life and focussing on children, young people, families and whanau).

Improving breastfeeding rates at three months of age supports the achievement of the following government priority: the Childhood Obesity Plan which has three focus areas—food, the environment and being active at each life stage, starting during pregnancy and early childhood.

Improving breastfeeding rates at three months of age further supports the achievement of the following Ministry objectives: the Ministry Statement of Intent 2015-19 objective to embed and expand the Maternity Quality Initiative Priority 1— Strengthening Primary Maternity Services: better coordination of national support for breastfeeding promotion and protection.

Actions and activities are that have a proven impact on this measure: Establish a mother-to-mother peer support programme, targeting Māori, Pacific and families in low

socioeconomic areas. Deliver professional development updates to GP teams, WCTO providers and LMCs around current best

practice for breastfeeding. Work with partners to develop a breastfeeding action plan that will identify enablers to improve

breastfeeding rates. Develop a communication plan to ensure that whanau with a newborn are aware of pathways to support

them with breastfeeding on their return home from hospital. Reorient current lactation support services to provision of clinics in areas of high deprivation.

Deliverables definitions:

11 National Breastfeeding Advisory Committee of New Zealand. 2009. National Strategic Plan of Action for Breastfeeding 2008–2012: National Breastfeeding

Advisory Committee of New Zealand’s advice to the Director-General of Health. Wellington. Ministry of Health. 12 WHO 2003. Global strategy for infant and young child feeding.13 Martinelli et al, 2015. The effects of frenotomy on breastfeeding. Journal of Applied Oral Science 23 (2) p153-157.14 Ministry of Health 2008. Food and Nutrition Guidelines for Healthy Infants and Toddlers (Aged 0–2): A background paper - Partially revised December 2012. Wellington: Ministry of Health.15 New Zealand Breastfeeding Alliance Report, December 2015.16 Ministry of Health. 2016. Indicators for the Well Child / Tamariki Ora Quality Improvement Framework: March 2016. Wellington: Ministry of Health.

118


Data is sourced from the Well Child / Tamariki Ora (WCTO) dataset. Reporting on breastfeeding rates is via the six monthly publication of Well Child / Tamariki Ora (WCTO) Quality Improvement Framework Report. Baseline data and information can be found on the Ministry of Health website (http://www.health.govt.nz/publication/well-child-tamariki-ora-quality-improvement-framework).

Qualitative deliverables:The qualitative report covers the following deliverables (template attached):

The DHB identifies its total population baseline performance (whether a primary care activity or PHO) and outlines progress towards achieving the target of 60% for the total population. The DHB also identifies its baseline performance for Māori, Pacific and high deprivation populations, outlining the equity gaps and progress towards closing these.

Activities described are specific, time-bound and evidence based, and are most likely to increase the baseline rate towards the target for the total population and for Māori. If the target has not been achieved (for the total population and for Māori), the DHB is expected to outline activities designed to address this. If the target has been achieved, the DHB is invited to share their successful activities.

The activities are a mixture of universal and tailored interventions. The tailored interventions are designed to promote, protect and support breastfeeding for Māori whanāu in particular. The primary aim of these tailored activities is to address equity gaps.

There is a clear intervention logic outlining how the activities listed will improve Maori and Pacific health outcomes and reduce health inequalities.

The DHB outlines how they are monitoring or evaluating against the activities identified.Numerator: Breastfeeding at three months = exclusive or fully Source: WCTO NHI dataset (http://www.health.govt.nz/publication/indicators-well-child-tamariki-ora-quality-improvement-framework-march-2016)

Denominator: Breastfeeding at three months = not null Source: WCTO NHI dataset (http://www.health.govt.nz/publication/indicators-well-child-tamariki-ora-quality-improvement-framework-march-2016)

Reporting Period


Quarter 1 Data to cover the period 1 January to 30 June

Quarter 3 Data to cover the period 1 July to 31 December

Expectations

Standard DHBs use evidence-based interventions and education to promote child, family and whānau health and wellbeing.

Indicator Infants are exclusively or fully breastfed at three months.

Target 60 percent

Rating: Definition

Outstanding performer

Consistent achievement over a consecutive 24 month period of 60% of infants (total population and Māori) are exclusively or fully breastfed at three months. Significant progress has been made towards closing equity gaps.

Achieved 60% of infants (total population and Māori) are exclusively or fully breastfed at three months within the current reporting period. Progress has been made towards closing equity gaps.

Partially The target has not been reached for either the total population or Māori. The DHB has

119


Achieved supplied a resolution plan outlining activities to meet the target for the total population and to address equity gaps.

Not Achieved The target has not been reached for either the total population or Māori.


Policy priorities PP38: Delivery of response actions and milestones agreed in the annual plan for each Government planning priority


Delivery of the response actions and milestones agreed in the Annual Plan for each Government planning priority


Type: Confirmation and exception report

Reporting frequency: BPS related components – quarterly Other components six-monthly (quarters 2 and 4)


DHB to supply confirmation and exception reports

Quarterly reporting - standard timeline applies DHB Reports Due 20th of the month following the end of the quarter (2nd and

4th quarters)




Link to outcomes and priority areasDelivery of this measure supports the overarching outcome for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and the overarching goal that all New Zealanders live well, stay well, get well. This measure has key linkages to Government planning priorities as highlighted.




Improved quality, safety and experience of care(individuals and their family/ focus)




Prime Minister’s Youth Mental Health Project Reducing Unintended Teenage Pregnancy Better Public Service (contributory) Target Supporting Vulnerable Children Better Public Service Target Increased Immunisation Health Target Shorter Stays in Emergency Departments Health Target Improved Access to Elective Surgery Health Target

120


Faster Cancer Treatment Health Target Better Help for Smokers to Quit Health Target Raising Healthy Kids Health Target Bowel Screening Mental Health Healthy Ageing Living Well with Diabetes Childhood Obesity Plan Child Health Disability Support Services Primary Care Integration Pharmacy Action Plan Improving Quality Information Technology Workforce Living Within our Means



Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Deliverables definitions:Quarterly - Actions and milestones supporting the health-led BPS targets:• Healthy Mums and Babies • Keeping Kids Healthy Each DHB is expected to provide a report either confirming all actions and milestones agreed for delivery in the period in for each priority area have been delivered or identifying a resolution plan for any actions or milestones that have not been delivered as agreed. In some cases delivery of an action or milestone may be reported through another performance measure – please provide a cross reference where this is the case.

Reporting Period


Quarter 1 to cover the three month period to 30 September

Quarter 3 to cover the three month period to 31 March

Six monthly - Actions and milestones supporting all priorities (including BPS targets)

121


Each DHB is expected to provide a report either confirming all actions and milestones agreed for delivery in the period in for each priority area have been delivered or identifying a resolution plan for any actions or milestones that have not been delivered as agreed. In some cases delivery of an action or milestone may be reported through another performance measure – please provide a cross reference where this is the case. Reporting Period


Quarter 2 to cover the six month period to 31 December

Quarter 4 to cover the six month period to 30 June

Expectations

Rating: DefinitionAchieved All actions and milestones identified for delivery in the period being reported have been delivered.

Partially Achieved

Some actions and milestones identified for delivery in the period being reported have been delivered, and for those actions not delivered an appropriate resolution plan is agreed.

Not Achieved One or more actions and milestones identified for delivery in the period have not been delivered and an appropriate resolution plan has not been agreed.

122


Performance Dimension: Meeting service coverage requirements and Supporting sector inter-connectedness

System Integration SI1: Ambulatory sensitive hospitalisations (ASH) ASH for zero to four-year-olds has been identified as a System Level Measure (SLM) and reporting for this age group will occur through SLM improvement plans

During 2016/17 a review of the definition and use of ASH data was undertaken to ensure that it remains a meaningful measure of system performance.

ASH data has been collected and reported in New Zealand since 2001, as a proxy measure of avoidable hospital admissions. ASH conditions are a subset of all health conditions that are believed to be relatively amenable to out-of-hospital management. ASH rates are undoubtedly impacted by the quality of primary care services, but also by high quality population health care, and the interfaces between population health, primary/community care, and secondary/hospital care.

There have been changes over time in both systems of hospital care and hospital coding practices, and the revised Ministry ASH definition takes into account these changes. The focus will continue to be incremental reduction of ASH rates as a measure of high quality health care in a community setting, but with greater emphasis on equity for all New Zealanders.


Type: Exception report

Target: Target agreed in Annual Plan Reporting frequency: quarterly

Source data/template for reporting provided by: Data supplied by Ministry (NMDS)

Linkages: Linkage: This measure also links to measure SI5: Delivery of Whānau Ora

Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, ‘the health system is cost effective and supports a productive economy’ and the overarching goal that all New Zealanders live well, stay well, get well.This measure has key linkages to Government planning priorities as highlighted.





123












Bowel Screening

Mental Health

Healthy Ageing





Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

124


Reducing ambulatory sensitive hospital admissions (ASH) reflects the Ministerial priorities of timely patient care closer to home and value for money. Improvements in community-based care can reduce avoidable hospitalisations, and free up hospital staff and resources.

Link to priority areas of focusDelivery of this measure will require improved integration of services, and contribute to a reduction in the total number of unplanned hospital admissions, a substantial proportion of which are ambulatory sensitive.

Actions and activities that have a proven impact on this measureThese actions are best identified through a “whole of system” approach that engages patients and their families, as well as community and hospital based services. A number of activities have been shown to be effective in reducing avoidable hospitalisations - they include:

1. System or institution-wide programmes to improve access to health services, especially for children and other underserved populations.

2. Comprehensive disease management programmes which are patient-focused and involve multidisciplinary teams.

3. Education and self-management programmes in association with disease management programmes.

4. Disease-specific management programmes, in particular for long-term conditions such asthma and ischaemic heart disease.

A Systematic Review that identified the effective interventions for reducing these admissions was published in 2008 by the Health Services Assessment Collaboration.17

Deliverable definitionsEach DHB is expected to provide a commentary on their latest 12 month ASH data which is available on the nationwide service framework library web site (NSFL) homepage: http://www.nsfl.health.govt.nz/. The data on this site is based on the DHB of domicile population, so all ASH admissions will be captured regardless of which hospital people are admitted to.

The DHB commentary may include additional district level data that is not captured in the national data collection and also information about local initiatives that are intended to reduce ASH admissions.

ASH per 100,000The number of ASH admissions per 100,000 population (DHB and national rates) are provided for two different age groups. These are 45 – 64 years and 0 – 4 years.

Please note that Ambulatory sensitive hospitalisations (ASH) rates for zero to four year olds is a System Level Measure. In relation to the SLM DHBs should identify a target that improves on their non-standardised baseline position (this approach also applies to the 45-64 age band target included in the Annual Plan).

Each ASH age band total population data is divided into: Māori Pacific – for the seven DHBs with the highest number of Pacific people. These are: Auckland,

Waitemata, Counties Manukau, Waikato, Capital and Coast, Hutt, and Canterbury Other

17 Basu, A., & Brinson, D. (2008). The effectiveness of interventions for reducing ambulatory sensitive hospitalisations: A Systematic Review. HSAC Report.

125


Additional information can be found on the nationwide services framework library web site www.nsfl.govt.nz including five year trend data (DHB and national), which together with the condition level data assists with interpretation at a DHB level. Denominator: The DHB population is derived from Statistics NZ Census data

Expectations For the 45-64 age group DHB Annual plans include targets for the total population (the Ministry will continue to monitor and assess DHB performance for sub populations against the total population target. Performance for the 0-4 age group is a focus in the SLM improvement plan, when setting targets DHB are expected to refer to the SLM improvement plan in relation to this age group. Performance for the 0-4 age group will be assessed through the SLM improvement plan reporting.

Additional DataAdditional condition level data is available to DHBs through the NSFL website.

Reporting Period Annual Plan and SLM Six monthly in the second and fourth quarters, (against results based on most complete previous 12 months’ data).

Assessment CriteriaThese assessments will be based on analysis of the most complete 12 months rolling data available at the time of the assessment. The following achievement scale will be applied:

Rating: Outstanding Performer(3rd quarter only)

The DHB has met all targets agreed in the Annual Plan, and has similar ASH rates for Māori, Pacific, and “Total” populations.

Achieved An achieved rating is applied when the DHB has met all the targets agreed in its Annual Plan.A realistic resolution plan is provided that demonstrates how the DHB will achieve equitable ASH rates for Maori and Pacific.

Partially Achieved The DHB has not met all of the targets agreed in its Annual Plan.A realistic resolution plan is provided that demonstrates how the DHB will achieve target ASH rates for Maori and Pacific.

Not Achieved A realistic resolution plan that demonstrates how the DHB will achieve target ASH rates for Maori and Pacific has not been provided.

126


Performance Dimension: Meeting service coverage requirements and supporting sector inter-connectedness

System Integration SI2: Delivery of Regional Service PlansSummary information

Target/performance expectation:Agreed in Regional and Annual Plans

Reporting progress report against actions in the regional implementation plan

Type: Qualitative


Source data/template for reporting provided by:Report to be provided by Shared service agency on behalf of DHBs.

Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’, and the overarching goal that all New Zealanders live well, stay well, get well.This measure has key linkages to Government planning priorities as highlighted.
















Bowel Screening

Mental Health

Healthy Ageing

127




Child Health




Improving Quality


Workforce


Regional Service Plan priorities for 2017/18Information Technology Workforce Quality Electives Stroke Cardiac Services Healthy Ageing Mental Health and Addictions Hepatitis C Major Trauma

By reporting on the regional performance measure the DHB demonstrates that they are collaborating regionally. This measure enables the formal monitoring of delivery of regional priorities and supports achieving the regional planning purpose. Regional planning objectives are to reduce clinical and financial vulnerability of services and improve service sustainability, reduce costs and improve quality, by coordinated service model development and coordinated planning of workforce and information technology. Delivery of this measure supports achieving improved system integration by linking commitments made in the Regional Service Plans (RSP) and Annual Plan (AP).

RSPs include the regional government priorities and may also include locally agreed regional priorities. The Ministry’s assessment of RSPs and quarterly reports is focussed on the government priorities. Per government priority area the regions are required to specify measures and deliverables as per the RSP guidance.

Deliverables1. A single progress report will be supplied on behalf of the region, agreed by all DHBs within that region.

The report should focus on the actions agreed by each region as detailed in its RSP implementation plan.

For each government priority18, and its associated actions, the progress report will identify:

the nominated lead DHB/person/position responsible for ensuring the action is delivered

whether actions and milestones are on track to be met or have been met

18 Regions may be requested to include specific updates on areas outside the government priorities on an as agreed basis. 128


performance against agreed measures and targets19; and

financial performance against budget associated budget associated with the action where applicable.

If actions/milestones /performance measures/financial performance are not tracking to plan a resolution plan must be in place and agreed. The resolution plan should include actions and regional decision-making processes being undertaken to agree to the resolution plan.

To streamline reporting individual DHBs will not be required to report on local actions to support regional priorities through their local DHB quarterly reports.

Please note the following the reports should be included in relation to actions supporting implementation of the Healthy Ageing Strategy:

Dementia

This expectation aligns most closely to Value and High Performance theme from the New Zealand Health Strategy; and the Living Well with Long-Term Conditions goals of the Healthy Ageing Strategy.

DHBs are expected to report (in brief) via the S12 measure on key actions to expand the identification, interventions, information and advice relevant to dementia to Strengthen the Implementation of the New Zealand Dementia Framework, and the actions specified in Improving the Lives of People with Dementia.

interRAI (S12)

This expectation aligns most closely to the Care Closer to Home theme from the New Zealand Health Strategy; and the Living Well with Long-Term Conditions goals of the Healthy Ageing Strategy.

DHBs to report (in brief) via the S12 measure on the use interRAI assessment data to identify quality indicators and service development opportunities (including with health providers). This includes but is not limited to sharing accurate, accessible, easy to interpret and up to date aggregated data from all assessments, in an aged residential care (ARC) facility, or within a DHB, to better understand service performance and identify areas to improve quality.

2. Integrated hepatitis C assessment and treatment servicesIn quarters two and four regions are expected to provide the following information in support the implementation of integrated hepatitis C assessment and treatment services:

Report six monthly broken down by quarters on the following measures:

Measures Data and Source1. Number of people diagnosed with hepatitis C

per annum (by age bands and genotype).Total number of people with a positive HCV PCR test in the DHB region (data from five reference labs provided to regional DHBs).

2. Number of HCV patients who have had a Liver Elastography Scan in the last year

(a) new patients (b) follow up (c) (by age and ethnicity).

Total number of hepatitis C Liver Elastography Scans performed annually (data from the delivery of Liver Elastography Scans in primary and secondary care).

Note: all Liver Elastography Scans are to be counted regardless of the device used

3. Number of people receiving PHARMAC funded antiviral treatment per annum (by age and ethnicity).

Total number of people prescribed antiviral treatment who have hepatitis C (data from PHARMAC provided to regional DHBs).Ministry of Health to obtain data(by age, ethnicity and medication type) and provide this to DHB regions via annual reporting in the Regional Service Plans.

19 In relation to the measures within the stroke priority area, regional indictor results are not required to be supplied as each DHB is supplying local performance data under PP20 focus area 4.

129


Quarter For the time periodQuarter 1 1 July – 30 September

Quarter 2 1 October – 31 December

Quarter 3 1 January – 31 March

Quarter 4 1 April – 30 June

ExpectationsRegional progress in the delivery of each government priority area will be assessed quarterly according to the criteria outlined below:

Achieved All health targets/deliverables/milestones have been tracking to plan;

Partially Achieved

Health targets have been achieved; some indicators/deliverables/milestones are not tracking to plan but an adequate resolution plan is in place; more clarification is required from the region.

Not Achieved One or more health targets indicators/deliverables/milestones have not been achieved; no adequate resolution plan is in place; there are delays in the implementation of the plan.

The overall report for this performance measure will get one rating based on the following criteria:

Definitions of ratings of overall regional report Achieved All regional government priorities are tracking to plan

Partially Achieved

Some priorities are not tracking to plan but an adequate resolution plan has been provided.

Not Achieved One or more priorities are not tracking to plan and resolution plan is inadequate.

130



System Integration SI3: Ensuring delivery of Service CoverageSummary information

Measures Reporting

Type: Output Type: Confirmation & exception

Target: Exceptions set out in APs Reporting frequency: Six monthly

Source data/template for reporting provided by: Not Applicable









Prime Minister’s Youth Mental Health Project Reducing Unintended Teenage Pregnancy Better Public Service (contributory) Target Supporting Vulnerable Children Better Public Service Target Increased Immunisation Health Target Shorter Stays in Emergency Departments Health Target Improved Access to Elective Surgery Health Target Faster Cancer Treatment Health Target Better Help for Smokers to Quit Health Target Raising Healthy Kids Health Target Bowel Screening Mental Health Healthy Ageing Living Well with Diabetes Childhood Obesity Plan

131


Child Health Disability Support Services Primary Care Integration Pharmacy Action Plan Improving Quality Information Technology Workforce Living Within our Means



Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

By ensuring service coverage for its population and addressing service gaps, the DHB will increase the public’s trust and confidence that the health and disability system is able to provide them the services they may need. Providing these essential health services will contribute to the high level outcome of New Zealanders living longer, healthier and more independent lives.

This measure is included as a formal mechanism for ensuring service coverage gaps are transparently managed. The DHB monitoring framework focuses on key marker services. This measure allows performance failures in those service areas that are not routinely monitored to be formally managed within the accountability framework.

Delivery of this measure will support Better Sooner More Convenient Health Services for New Zealanders by ensuring that service risks are managed and Government’s decisions about the national minimum range of services to be made available to the public are delivered.

Delivery of this measure will also support the key (strategic) planning approaches of Improved Integration and Regionalisation by encouraging DHBs to collaborate to find solutions to service coverage issues and risks, especially in relation to vulnerable services and collectively ensure service coverage is delivered.

Actions and activities that have a proven impact on this measure:Actions that support resolution of service coverage gaps and issues may include: development and implementation of a work-out plan, employment of additional staff or equipment, funding additional volumes or making service(s) available through an alternate provider/DHB, or identifying funding, contractual, or other constraints, which must be addressed before the issue can be resolved.


132


Qualitative indicatorDHBs to report providing the following information:Report progress achieved during the quarter towards resolution of exceptions to service coverage identified in the Annual Plan, and not approved as long term exceptions, and any other gaps in service coverage identified by the DHB or Ministry through:• analysis of explanatory indicators• media reporting • risk reporting• formal audit outcomes• complaints mechanisms• sector intelligence.

Reporting Period Reporting required: Six Monthly, in the second and fourth quarters

ExpectationsDHBs are expected to ensure service coverage expectations are met, and to demonstrate resolution of service coverage gaps by reporting complete, comprehensive, and timely information on the deliverable outlined above, demonstrating an appropriate resolution plan is in place for identified issues, and adequate progress is being made against the resolution plan.• A partial achievement rating will be obtained when a DHB has a service coverage gap that has not

been agreed as a formal long term exception for the period of the DAP, and an appropriate resolution plan is supplied that demonstrates the DHB is making progress towards resolution of the service coverage gap.

• An achieved rating will be obtained when all service coverage expectations have been met for the period under review.

• An outstanding performer/sector leader rating does not apply for this risk-based measure.

Exception reporting Exception reports should include progress made towards resolution of service coverage gaps, including milestones for final resolution.

133



System Integration SI4: Standardised Intervention Rates (SIRs)Summary information

Standardised Intervention Rates (SIRs) measure a DHB’s service delivery to their population relative to the service delivery in other DHBs, standardised to take account of variations in the population profiles of different DHBs. The Ministry will be monitoring DHB SIRs for cataracts, major joints, and cardiac services, including cardiac surgery, percutaneous coronary revascularization (angioplasty), and coronary angiography services.

Measures Reporting

Type: Impact Type: Exception

Target: Targets agreed in AP Reporting frequency: Annually cataracts major joints

Quarterly cardiac surgery coronary

angiography coronary angioplasty

Source data/template for reporting provided by: Data supplied by DHBs to the National Minimum Dataset, and report provided by Ministry. Reports will be loaded on Quickr. Note: While DHB reporting on cataracts and major joints is only required on an annual basis, update reports will be made available on Quickr quarterly to allow DHBs to monitor their progress.










134






Improved Access to Elective Surgery Health Target Faster Cancer Treatment Health Target



Bowel Screening

Mental Health

Healthy Ageing



Child Health




Improving Quality


Workforce




Workforce

Quality

Electives Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Link to outcomesDelivery against this measure supports the health and disability system outcome of ‘New Zealanders living longer, healthier and more independent lives’ and the primary intermediate outcome that ‘People receive better health and disability services’. An additional outcome is ‘The health and disability system and services are trusted and can be used with confidence’.

135


Elective services, including cardiac, are an important part of the health care system for the treatment, diagnosis and management of health problems. Timely access to these services is also considered a measure of the effectiveness of the health system. Elective surgery is important to New Zealanders as these are essential services to reduce pain or discomfort, and improve independence and wellbeing. This is particularly the case for surgery such as cardiac, cataract, and major joint replacement procedures. To provide elective services at appropriate rates for its population, the DHB will need to improve or maintain access to key elective procedures, and ensure people receive better and more timely access to treatment.

Improving relative access to electives will also contribute to delivery of the Government’s pledge to increase elective surgery by an average of 4,000 discharges year on year.

Meeting standardised intervention rates for a variety of types of surgery means that access is fair, and not dependent upon where a person lives. Knowing that access to services is equitable will improve the public’s trust and confidence in the public health system.

This measure will help improve people’s quality of life and help people to live longer, healthier and more independent lives.

Link to priority areas of focus

Delivery of this measure will support Better Sooner More Convenient Health Services for New Zealanders by improving or maintaining access to elective services, and ensuring people receive better and more timely access to health services, regardless of where they live.

Pathways to improve access for these conditions require seamless flow between primary and secondary care, and regional collaboration.

The following actions and activities are examples of initiatives that have a proven impact on this measure. 1. The Orthopaedic, Cataract and Cardiac Initiatives, which provided additional ring fenced funding for

joint, cataract and cardiac surgery – funding continues to be available to DHBs to support improved access to these procedures;

2. The Electives Initiative which has provided funding to improve access to a wide range of elective surgery, including cardiology inpatient treatment or diagnostics;

3. The Ambulatory Initiative which has provided funding to improve access to first specialist assessments, including cardiology, and to community referred diagnostics.

Deliverables definitionsQuantitative Indicator*Expectations

• For major joint replacement procedures, a target intervention rate of 21 per 10,000 of population will be achieved.

• For cataract procedures, a target intervention rate of 27 per 10,000 of population will be achieved.• For cardiac surgery20 a target intervention rate of 6.5 per 10,000 of population will be achieved.

DHBs with rates of 6.5 per 10,000 or above in previous years will be required to maintain this rate.• For percutaneous revascularization a target rate of at least 12.5 per 10,000 of population will be

achieved. 20 Cardiac surgery is defined as coronary artery bypass graft (CABG), and valve replacement or repair (including transcatheter aortic valve implantation, and valve sparing aortic root procedures) for patients aged 15 and over.

136


• For coronary angiography services a target rate of at least 34.7 per 10,000 of population will be achieved.

• ICD10 codes for each of the procedure groups are included in the technical specification to this document.

Qualitative IndicatorFor any procedure where the standardised intervention rate in the preceding 12 month period is significantly below the target level a report demonstrating:1. what analysis the DHB has done to review the appropriateness of its rate

AND2. whether the DHB considers the rate to be appropriate for its population21

OR3. a description of the reasons for its relative under-delivery of that procedure; and4. the actions being undertaken in the current year that will ensure the target rate is achieved.

Reporting periodFor cataracts and major joints, annually as follows:

Quarter For the time periodQuarter 1 2016/17 financial year’s results

For cardiac services, reported quarterly as follows:

Quarter For the time period*Quarter 1 2016/17 financial year’s results

Quarter 2 2017/18 quarter 1 results

Quarter 3 2017 calendar year’s results

Quarter 4 2017/18 quarter 3 results

* Due to the reliance on NMDS data (where the deadline for submission is about one month after the end of the quarter), the data used to derive this measure will be for one quarter in arrears.

ExpectationsWhat are the Ministry’s expectations of performance?Quantitative measures Standardised intervention rates not significantly below the expected level.

Qualitative measures

21 If a DHB deems the rate delivered to be appropriate then this must be supported with the analysis the DHB has done to review the appropriateness of its rate (as per 1 and 2 above). If the analysis is substantial enough to give confidence in the DHBs position, then this would be accepted, and an Achieved rating would be provided. If not, depending on the analysis provided, a Partial rating may be given. It is important to acknowledge that DHBs commit to SIRs in their annual plans. Analysis should be completed at least annually, and this should inform the rate which is agreed between the Ministry and the DHB. If a DHB considers that their SIR should be set lower than the national rate, then this analysis and discussion should be discussed with the Ministry as part of the annual planning cycle.

137


The analysis report (1 and 2 above) must cover the relationship between the secondary and primary sectors, including evidence of consultation with primary care as to the perceived level of access (does primary care have patients they consider should be able to access this procedure who cannot, or who they are no longer referring because of historic access issues, etc.). The report must also provide confirmation from the relevant service clinical director that the rate being provided is appropriate for the DHB population.

Unless the above information is provided, the Quarter One report (3 and 4 above) needs to outline actions being undertaken in the current year to achieve the required rate. Subsequent quarterly reports for cardiac services need to outline progress being made against these plans.

Baseline informationBaseline information can be found on the Electives restricted access website (Quickr). Current performance reports will be provided by the Ministry via the quarterly reporting database. Full standardised intervention rate information is available via Quickr, the restricted Electives website.

Technical Specifications –

WIES version The most current version of WIES available at the time baseline data is run. This is New Zealand WIES version tbc methodology.

Standardisation Methodology

Date is standardised by - Age (5 year age bands)- Gender (Male, Female)- Ethnicity (Maori Pacific, Other)- Deprivation Quintile (NZ Dep 2006 Quintiles)

DHB data is standardised to the total New Zealand population using indirect standardisation methodology.

Direct standardisation methodology relies on there being a number of people in all possible population groups. If these criteria are not met there is a risk of unreliable intervention rates for population groups with very low numbers. The distribution of the standard population should not be markedly different from the study populations being compared.

However many of the possible population groups within some DHBs have few or no people, and the population profiles vary markedly between DHBs. Therefore, the indirect standardisation methodology is used to develop the DHB’s intervention rates, to avoid the risk of distortion.

The national intervention rate for each population group is applied to the same population group in each DHB, for all population groups, and these numbers are summed to give an expected number of procedures.

The observed (actual) number of procedures is divided by the expected number of procedures to give a standardised discharge ratio (SDR). The national intervention rate is multiplied by the SDR to give the standardised intervention rate for the DHB

SIR = total observed discharges x national intervention rate

138


total expected discharges

= ∑ni x R∑piRi

Where:ni = the number of discharges in age, gender, ethnicity and dep group ipi = the population in age, gender, ethnicity and dep study group iRi = the national intervention rate for age, gender, ethnicity and dep group iR = the overall national intervention rate

Admission types:

• AC – Acute• AA – Arranged• AP – Private hospital elective admission• WN – Admitted from waiting list (Elective)

Principle health purchaser code:

• 13 – DHB base purchase (retired)• 20 – Overseas eligible• 34 – MOH funded purchase• 35 – DHB funded purchase

Purchase units:

All purchase units

ICD10 Codes included in the reports

To ensure no procedures are omitted from a procedure group, all relevant codes from all ICD versions are included in this list.

Type Code DescriptionCardiac Surgery 3849700 Coronary artery bypass, using 1 saphenous vein graftCardiac Surgery 3849701 Coronary artery bypass, using 2 saphenous vein graftsCardiac Surgery 3849702 Coronary artery bypass, using 3 saphenous vein graftsCardiac Surgery 3849703 Coronary artery bypass, using >= 4 saphenous vein graftsCardiac Surgery 3849704 Coronary artery bypass, using 1 other venous graftCardiac Surgery 3849705 Coronary artery bypass, using 2 other venous graftsCardiac Surgery 3849706 Coronary artery bypass, using 3 other venous graftsCardiac Surgery 3849707 Coronary artery bypass, using >= 4 other venous graftsCardiac Surgery 3850000 Coronary artery bypass, using 1 LIMA graftCardiac Surgery 3850300 Coronary artery bypass, using >= 2 LIMA graftsCardiac Surgery 3850001 Coronary artery bypass, using 1 RIMA graftCardiac Surgery 3850301 Coronary artery bypass, using >= 2 RIMA graftsCardiac Surgery 3850002 Coronary artery bypass, using 1 radial artery graftCardiac Surgery 3850302 Coronary artery bypass, using >= 2 radial artery graftsCardiac Surgery 3850003 Coronary artery bypass, using 1 epigastric artery graftCardiac Surgery 3850303 Coronary artery bypass, using >= 2 epigastric artery graftsCardiac Surgery 3850004 Coronary artery bypass, using 1 other arterial graft

139


Cardiac Surgery 3850304 Coronary artery bypass, using >= 2 other arterial graftsCardiac Surgery 9020100 Coronary artery bypass, using 1 other material graft, not elsewhere classifiedCardiac Surgery 9020101 Coronary artery bypass, using 2 other material grafts, not elsewhere classifiedCardiac Surgery 9020102 Coronary artery bypass, using 3 other material grafts, not elsewhere classifiedCardiac Surgery 9020103 Coronary artery bypass, using >=4 other material grafts, not elsewhere classifiedCardiac Surgery 3863700 Re-operation for reconstruction of occluded coronary artery graftCardiac Surgery 3845610 Open valvotomy of aortic valveCardiac Surgery 3848000 Repair of aortic valve, 1 leafletCardiac Surgery 3848100 Repair of aortic valve, 2 or more leafletsCardiac Surgery 3848300 Decalcification of aortic valve leafletCardiac Surgery 3848800 Replacement of aortic valve with mechanical prosthesisCardiac Surgery 3848801 Replacement of aortic valve with bioprosthesisCardiac Surgery 3848900 Replacement of aortic valve with homograftCardiac Surgery 3848901 Replacement of aortic valve with unstented heterograftCardiac Surgery 3845615 Other intrathoracic procedures on aortic valve without cardiopulmonary bypassCardiac Surgery 3865304 Other intrathoracic procedures on aortic valve with cardiopulmonary bypassCardiac Surgery 3848700 Open valvotomy of mitral valveCardiac Surgery 3848001 Repair of mitral valve, 1 leafletCardiac Surgery 3848101 Repair of mitral valve, >= 2 leafletsCardiac Surgery 3848501 Decalcification of mitral valveCardiac Surgery 3847500 Mitral valve annuloplastyCardiac Surgery 3847700 Mitral valve annuloplasty with ring insertionCardiac Surgery 3847702 Aortic valve annuloplasty with ring insertionCardiac Surgery 3848802 Replacement of mitral valve with mechanical prosthesisCardiac Surgery 3848803 Replacement of mitral valve with bioprosthesisCardiac Surgery 3848902 Replacement of mitral valve with homograftCardiac Surgery 3848500 Reconstruction of mitral valve annulusCardiac Surgery 3845616 Other intrathoracic procedures on mitral valve without cardiopulmonary bypassCardiac Surgery 3865305 Other intrathoracic procedures on mitral valve with cardiopulmonary bypassCardiac Surgery 3845611 Open valvotomy of tricuspid valveCardiac Surgery 3848002 Repair of tricuspid valve, 1 leafletCardiac Surgery 3848102 Repair of tricuspid valve, >=2 leafletsCardiac Surgery 3847501 Tricuspid valve annuloplastyCardiac Surgery 3847502 Aortic valve annuloplastyCardiac Surgery 3847701 Tricuspid valve annuloplasty with ring insertionCardiac Surgery 3848804 Replacement of tricuspid valve with mechanical prosthesisCardiac Surgery 3848805 Replacement of tricuspid valve with bioprosthesisCardiac Surgery 3848903 Replacement of tricuspid valve with homograftCardiac Surgery 3845617 Other intrathoracic procedures on tricuspid valve without cardiopulmonary bypassCardiac Surgery 3865306 Other intrathoracic procedures on tricuspid valve with cardiopulmonary bypassCardiac Surgery 3845601 Open valvotomy of pulmonary valveCardiac Surgery 3848806 Replacement of pulmonary valve with mechanical prosthesisCardiac Surgery 3848807 Replacement of pulmonary valve with bioprosthesisCardiac Surgery 3848904 Replacement of pulmonary valve with homograftCardiac Surgery 3848905 Replacement of pulmonary valve with unstented heterograft

Cardiac Surgery 3845618Other intrathoracic procedures on pulmonary valve without cardiopulmonary bypass

Cardiac Surgery 3865307 Other intrathoracic procedures on pulmonary valve with cardiopulmonary bypassCardiac Surgery 3849000 Reconstruction and re-implantation of subvalvular structures

Cardiac Surgery 3849300Operative management of acute infective endocarditis during heart valve procedure

Cardiac Surgery 3855000 Repair of ascending thoracic aortaCardiac Surgery 3855001 Replacement of ascending thoracic aortaCardiac Surgery 3855300 Repair of ascending thoracic aorta with aortic valve repairCardiac Surgery 3855301 Repair of ascending thoracic aorta with aortic valve replacement

140


Cardiac Surgery 3855600Repair of ascending thoracic aorta with aortic valve repair and implantation of coronary arteries

Cardiac Surgery 3855601Repair of ascending thoracic aorta with aortic valve replacement and implantation of coronary arteries

Cardiac Surgery 3855900 Repair of aortic arch and ascending thoracic aortaCardiac Surgery 3855901 Replacement of aortic arch and ascending thoracic aortaCardiac Surgery 3856200 Repair of aortic arch and ascending thoracic aorta with aortic valve repairCardiac Surgery 3856201 Repair of aortic arch and ascending thoracic aorta with aortic valve replacement

Cardiac Surgery 3856500Repair of aortic arch and ascending thoracic aorta with aortic valve repair and implantation of coronary arteries

Cardiac Surgery 3856501Repair of aortic arch and ascending thoracic aorta with aortic valve replacement and implantation of coronary arteries

Cardiac Surgery 3855302 Replacement of ascending thoracic aorta with aortic valve repairCardiac Surgery 3855303 Replacement of ascending thoracic aorta with aortic valve replacement

Cardiac Surgery 3855602Replacement of ascending thoracic aorta with aortic valve repair and implantation of coronary arteries

Cardiac Surgery 3855603Replacement of ascending thoracic aorta with aortic valve replacement and implantation of coronary arteries

Cardiac Surgery 3856202 Replacement of aortic arch and ascending thoracic aorta with aortic valve repair

Cardiac Surgery 3856203Replacement of aortic arch and ascending thoracic aorta with aortic valve replacement

Cardiac Surgery 3856502Replacement of aortic arch and ascending thoracic aorta with aortic valve repair and implantation of coronary arteries

Cardiac Surgery 3856503Replacement of aortic arch and ascending thoracic aorta with aortic valve replacement and implantation of coronary arteries

Cataract 4269800 Intracapsular extraction of crystalline lensCataract 4270200 Intracapsular extraction of crystalline lens with insertion of foldable artificial lensCataract 4270201 Intracapsular extraction of crystalline lens with insertion of other artificial lens

Cataract 4269801Extracapsular extraction of crystalline lens by simple aspiration (and irrigation) technique

Cataract 4270202Extracapsular extraction of crystalline lens by simple aspiration (and irrigation) technique with insertion of foldable artificial lens

Cataract 4270203Extracapsular extraction of crystalline lens by simple aspiration (and irrigation) technique with insertion of other artificial lens

Cataract 4269802Extracapsular extraction of crystalline lens by phacoemulsification and aspiration of cataract

Cataract 4270204Extracapsular extraction of crystalline lens by phacoemulsification and aspiration of cataract with insertion of foldable artificial lens

Cataract 4270205Extracapsular extraction of crystalline lens by phacoemulsification and aspiration of cataract with insertion of other artificial lens

Cataract 4269803Extracapsular extraction of crystalline lens by mechanical phacofragmentation and aspiration of cataract

Cataract 4270206Extracapsular extraction of crystalline lens by mechanical phacofragmentation and aspiration of cataract with insertion of foldable artificial lens

Cataract 4270207Extracapsular extraction of crystalline lens by mechanical phacofragmentation and aspiration of cataract with insertion of other artificial lens

Cataract 4269804 Other extracapsular extraction of crystalline lens

Cataract 4270208Other extracapsular extraction of crystalline lens with insertion of foldable artificial lens

Cataract 4270209Other extracapsular extraction of crystalline lens with insertion of other artificial lens

Cataract 4269805 Other extraction of crystalline lensCataract 4270210 Other extraction of crystalline lens with insertion of foldable artificial lensCataract 4270211 Other extraction of crystalline lens with insertion of other artificial lens

Cataract 4273101Extraction of crystalline lens by posterior chamber sclerotomy with removal of vitreous

141


Cataract 4271900 Capsulectomy of lensCataract 4271902 Mechanical fragmentation of secondary membraneCataract 4272200 Capsulectomy of lens by posterior chamber sclerotomyCataract 4273100 Capsulectomy of lens by posterior chamber sclerotomy with removal of vitreousCataract 4273400 Capsulotomy of lensCataract 4273700 Needling of posterior capsule of lensCataract 4278800 Capsulotomy of lens by laserCataract 4279102 Corticolysis of lens material by laserCataract 4271600 Removal of juvenile cataractMajor Joints 4931800 Total arthroplasty of hip, unilateralMajor Joints 4931900 Total arthroplasty of hip, bilateralMajor Joints 4932400 Revision of total arthroplasty of hipMajor Joints 4932700 Revision of total arthroplasty of hip with bone graft to acetabulumMajor Joints 4933000 Revision of total arthroplasty of hip with bone graft to femurMajor Joints 4933300 Revision of total arthroplasty of hip with bone graft to acetabulum and femurMajor Joints 4933900 Revision of total arthroplasty of hip with anatomic specific allograft to acetabulumMajor Joints 4934200 Revision of total arthroplasty of hip with anatomic specific allograft to femur

Major Joints 4934500Revision of total arthroplasty of hip with anatomic specific allograft to acetabulum and femur

Major Joints 9060700 Resurfacing of hip, unilateralMajor Joints 9060701 Resurfacing of hip, bilateralMajor Joints 4951700 Hemiarthroplasty of kneeMajor Joints 4951800 Total arthroplasty of knee, unilateralMajor Joints 4951900 Total arthroplasty of knee, bilateralMajor Joints 4952100 Total arthroplasty of knee with bone graft to femur, unilateralMajor Joints 4952101 Total arthroplasty to knee with bone graft to femur, bilateralMajor Joints 4952102 Total arthroplasty to knee with bone graft to tibia, unilateralMajor Joints 4952103 Total arthroplasty to knee with bone graft to tibia, bilateralMajor Joints 4952400 Total arthroplasty of knee with bone graft to femur and tibia, unilateralMajor Joints 4952401 Total arthroplasty of knee with bone graft to femur and tibia, bilateralMajor Joints 4953400 Total replacement arthroplasty of patellofemoral joint of kneeMajor Joints 4953000 Revision of total arthroplasty of knee with bone graft to femurMajor Joints 4953001 Revision of total arthroplasty of knee with bone graft to tibiaMajor Joints 4953300 Revision of total arthroplasty of knee with bone graft to femur and tibiaMajor Joints 4955400 Revision of total arthroplasty of knee with anatomic specific allograftMajor Joints 4953401 Total replacement arthroplasty of patellofemoral joint of kneeMajor Joints 4952700 Revision of total arthroplasty of kneeAngiography 3821500 Coronary angiographyAngiography 3821800 Coronary angiography with left heart catherisationAngiography 3821801 Coronary angiography with right heart catherisationAngiography 3821802 Coronary angiography with left and right heart catherisationAngioplasty 3530400 Percutaneous transluminal balloon angioplasty of 1 coronary arteryAngioplasty 3530500 Percutaneous transluminal balloon angioplasty of >= 2 coronary arteriesAngioplasty 3531000 Percutaneous insertion of 1 transluminal stent into single coronary arteryAngioplasty 3531001 Percutaneous insertion of >= 2 transluminal stents into single coronary arteryAngioplasty 3531002 Percutaneous insertion of >= 2 transluminal stents into multiple coronary arteriesAngioplasty 3830000 Percutaneous transluminal balloon angioplasty of 1 coronary arteryAngioplasty 3830300 Percutaneous transluminal balloon angioplasty of >= 2 coronary arteriesAngioplasty 3830600 Percutaneous insertion of 1 transluminal stent into single coronary arteryAngioplasty 3830601 Percutaneous insertion of >= 2 transluminal stents into single coronary arteryAngioplasty 3830602 Percutaneous insertion of >= 2 transluminal stents into multiple coronary arteriesAngioplasty 3830900 Percutaneous transluminal coronary rotational atherectomy [PTCRA], 1 artery

Angioplasty 3831200Percutaneous transluminal coronary rotational atherectomy [PTCRA], 1 artery with insertion 1 stent

142


Angioplasty 3831201Percutaneous transluminal coronary rotational atherectomy [PTCRA], 1 artery w insertion >= 2 stents

Angioplasty 3831500Percutaneous transluminal coronary rotational atherectomy [PTCRA], multiple arteries

Angioplasty 3831800Percutaneous transluminal coronary rotational atherectomy [PTCRA], multi arteries w insert 1 stent

Angioplasty 3831801Percutaneous transluminal coronary rotational atherectomy, multi arteries w insert >= 2 stents

143



System Integration SI5: Delivery of Whānau Ora DHBs will contribute to achieving Whānau Ora across the whole of the health system focusing on progress in five key areas - mental health, asthma, oral health, obesity and tobacco – to achieve accelerated progress towards health equity for Māori; and where appropriate collaborating with Whānau Ora non-government organisation (NGO) Commissioning Agencies to benefit the health of whānau.

Summary informationMeasures ReportingHealth priority areas

Achievement rating of the relevant DHBs performance measure within the monitoring framework for the five health priority indicators (mental health, asthma, oral health, obesity and tobacco)

Health area reporting frequency:

As per key health area reporting requirements. No additional reporting is required.

Narrative report target:

Progress since last year Narrative report reporting frequency:

Annual


Not applicable

Linkages to the following measures - P13, PP34, PP36, SI1, Raising health kids health target

Link to outcomesDelivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’, and the overarching goal that all New Zealanders live well, stay well, get well.







144










Better Help for Smokers to Quit Health Target Raising Healthy Kids Health Target

Bowel Screening







Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

In November 2015, the Whānau Ora Partnership Group agreed to a set of indicators to support Whānau Ora. These indicators are part of the Whānau Ora Outcomes Framework.

The Whānau Ora Partnership Group is a crown-iwi advisory body responsible for the strategic leadership of Whānau Ora. Chaired by the Minister for Whānau Ora, it consists of equal membership comprising six

145


representatives from the Iwi Chairs Forum (identified by the National Iwi Chairs Forum), and six Ministers representing the crown.

The Whānau Ora Partnership Group provides leadership to Whānau Ora by setting its direction and priorities and overseeing its progress and success. At a strategic level it informs complementary effort across ministerial portfolios and identifies opportunities between Iwi and the Crown to support shared development, aims and aspirations.

The five government agencies, Ministries of Health, Finance, Education, Social Development, and Economic Development have indicated some key activities underway, or planned, to progress achievement of Whānau Ora short-term outcomes.

Within those, health sector activity will need to focus on progress in five key areas that contribute to Whānau Ora - mental health, asthma, oral health, obesity and tobacco – to achieve accelerated progress towards health equity for Māori and Pacific, and Whānau Ora in the next four years.

In addition to progress in these areas, DHBs will be expected to continue work with the three Whānau Ora Commissioning Agencies across the country.

Actions and activities that have a proven impact on this measure:DHBs have a role in contributing to achieving Whānau Ora across the whole of the health system, and where appropriate collaborating with Commissioning Agencies to benefit the health of whānau.

As DHBs are required within the Annual Plan to achieve agreed annual health targets, they are best placed to use the opportunity to demonstrate, and action, system-level changes to achieve Whānau Ora and health equity.

The Ministry expects that the whole health system contributes to Whānau Ora outcomes, by providing quality accessible health services to everyone living in New Zealand.

The DHB actions/activities that demonstrate this include:1. Commitments to having a heightened focus to achieve accelerated progress towards Whānau Ora and

health equity within the five health priorities, within the respective Annual or Māori Health Plans. It is expected that within the five health priorities, DHBs will support improved outcomes for Māori individuals, and their whānau. Linkages have been included within each of the health areas within the Annual Plan guidance. This will be demonstrated through improved performance for the following indicators:

Key Area Indicator UsedMental health reduced rate of Māori committed to compulsory treatment relative to

non-Māori.Asthma reduced asthma and wheeze admission rates for Māori children (ASH

0-4 years).Oral health Increase in the number of children who are caries free at age 5.Obesity By December 2017, 95 percent of obese Māori children identified in the

Before School Check (B4SC) programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions.

Tobacco Improving the percentage of households who are smoke free at six weeks postnatal.

2. Active engagement and collaboration with Whānau Ora Commissioning Agencies. This could include a knowledge of the Whānau Ora funding and initiatives within each respective DHBs region, involving local commissioning agencies in planning, working on joint projects/commissioning together or building strong relationships with the Commissioning Agencies for the benefit of whānau.

The three established Whānau Ora Commissioning Agencies are:146


Te Pou Matakana (North Island Commissioning Agency)

Te Pūtahitanga o Te Waipounamu (South Island Commissioning Agency); and

Pasifika Futures (Commissioning Agency for Pacific families).

Performance reporting and deliverable definitionsProgress for how DHBs are achieving Whānau Ora in a measureable way will be completed in two methods.

1. Two narrative reports – end of quarter 2 and 4

DHBs are required to provide two narrative reports – a progress update at the end of quarter 2 and end of year completion report at the end of quarter 4, outlining how they are or have achieved:

supporting and/or delivering progress in the five priority health areas to support Whānau Ora, what have been the key drivers for improved performance, what challenges or obstacles have been experienced, and the impact of this progress for whānau. In addition, inclusion of a data table of annual performance (in comparison to two previous years) for the five health priority health indicators (the indicators are included in the table above).

engaging with their relevant Whānau Ora Commissioning Agency, progress made on joint collaborations or investment, how well this has been achieved, what challenges or obstacles have been experienced, and the impact of their effort for whanau.

2. Five priority health areas

The five priority health areas will also be assessed based on the achievement rating of the relevant DHBs performance measures. The indicators are included in the table above.

147



System Integration SI7: SLM total acute hospital bed days per capita

Summary informationTotal acute hospital bed days per capita is being introduced as a System Level Measure

Performance measure definition

Please refer to www.hqmnz.org.nz

System Level Measure Performance expectations and reporting

DHBs are expected to provide jointly agreed (by district alliances) System Level Measure improvement plans, including improvement milestones.

The System Level Measure improvement plans are expected to be reported through PP22 ‘Delivery of actions to improve system integration’

148

http://www.hqmnz.org.nz/



System Integration SI8: SLM patient experience of care

Patient experience of care is a being introduced as a System Level Measure. The new measure combines the previous developmental DHB hospital focused measure (DV4) with an additional section referencing primary care patient experience

Focus area 1: National inpatient survey

Summary informationImplementing a national approach to collection, measurement and use of patient experience information.

Measures ReportingTarget: Provide patient experience data

and establish baselines for future target


Quarterly


DHBs to supply data by either:- Submitting patient information to the national

survey provider (yet to be appointed) who will conduct the national patient experience survey and reporting on their behalf, or

- Providing completed national patient experience survey data to the national provider for incorporation in national reports.

Link to outcomes Delivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’ and the overarching goal that all New Zealanders live well, stay well, get well.








149





Increased Immunisation Better Health Target






Bowel Screening

Mental Health

Healthy Ageing



Child Health




Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Patient experience data is an important performance indicator, and is vital in driving service improvements. However, New Zealand does not have a consistent national approach to collection, measurement and use of patient experience information.

150


Recent international opinion has shifted from measuring patient satisfaction to measuring the broader concept of patient experience. Furthermore, studies have shown that patient / consumer experience is a good indicator of the quality of health services, with patient experience positively correlated to processes of care for prevention, disease management, and with adherence to medical advice and treatment plans. Better experience, stronger partnerships with consumers, and patient and family-centred care have been linked to improved health, clinical, financial, service and satisfaction outcomes.

The focus on local needs for quality improvement is as important as consistent data for a national perspective. The indicators must be flexible enough to allow DHBs to plan and track local service-level improvements. They must be usable in DHB performance monitoring and accountability processes focused on hospitals, but also have more general application across the system, including in primary care.

Actions to deliver improved performance in this focus area:The information gathered at local and national levels through these measures can be used to benchmark patient experience across the country and to improve services locally. The indicators are collected via surveys completed by patients, carers and family/whānau.

The aim of the national programme is to develop:- a nationally consistent model of patient experience indicators incorporating four key domains

(communication, partnership, coordination, and physical and emotional needs) supported by additional questions

- a set of questions that can be incorporated in existing local patient experience surveys- adopting pre-existing and validated tools, where possible- an approach consistent with international best practice, to allow New Zealand data to be compared

with overseas results.

Deliverables definitions1. DHBs are expected to supply patient experience data according to the detailed information provided

in the requirements document published on the HQSC web site www.hqsc.govt.nz and the nationwide service framework library web site www.nsfl.govt.nz, that includes: the national patient experience survey methodological rules (including sample size and timing) patient data extract file specification correspondence examples national reporting rules and timeframes.

2. Each quarter DHBs will supply a report via the DHB quarterly reporting process: confirming patient experience data has been supplied according to the requirements document confirming the DHB has delivered the patient experience actions and milestones identified in its

Annual Plan identifying any local survey management issues providing a resolution plan if it has not delivered to requirements or to plan for any survey

management issues identified.

Reporting Period DHBs will supply patient experience data and confirmation reports in line with the following quarters:

Quarter For the time period1 e.g.1 July – 30 September

2 e.g.1 October – 31 December

3 e.g.1 January – 31 March 151


4 e.g.1 April – 30 June

Further detail on timing of data supply is specified in the requirements document.

Quarterly survey reports at national and DHB level will be made available by the national survey provider two weeks following the end of the quarter. DHBs will be able to see other DHBs reports.

ExpectationsAll DHBs submit data for a sample group of patients on all the core survey questions. The Ministry of Health and Health Quality and Safety Commission expects that DHBs will make improvements in the quality of the data in each quarter enabling baselines to be set and future performance expectations to be developed.

DHBs are expected to include local patient experience information in their Quality Accounts.

Focus area 2: Primary care survey



System Level Measure Performance expectations and reporting in relation to both focus area 1 and 2

DHBs are expected to provide jointly agreed (by district alliances) System Level Measure improvement plans, including improvement milestones.


152




System Integration SI9: SLM amenable mortality rate

Summary informationAmenable mortality is being introduced as a system level measure.



System Level Measure Performance expectations and reporting

DHBs are expected to provide jointly agreed (by district alliances) System Level Measure improvement plans, including improvement milestones


153



Performance Dimension: Meeting service coverage requirements and Supporting sector and inter-sector connectedness

System Integration SI10: Improving Cervical Screening coverage Summary information


80% coverage for all ethnic groups (Māori, Pacific, Asian, and European/Other) and Overall


Type: Data & exceptions report



Data is sourced from NCSP DHB quarterly reports published on the NSU website.For the Q2 report data is from Q1; for the Q4 report data is from Q3.https://www.nsu.govt.nz/health-professionals/national-cervical-screening-programme/cervical-screening-coverage

Quarterly reporting - standard timeline applies DHB Reports Due 20th of the month following the end of Q2 and Q4




Linkages: This performance expectation may be a contributory System Level Measure under Amenable Mortality.

Link to outcomes and priority areasDelivery of this measure supports the overarching outcome for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and the overarching goal that all New Zealanders live well, stay well, get well.


Sector outcome

Improved health and equity for all populations(population focus) √Best value for public health system resources(system focus)







154

https://www.nsu.govt.nz/health-professionals/national-cervical-screening-programme/cervical-screening-coverage









Bowel Screening

Mental Health

Healthy Ageing



Child Health


Primary Care Integration √Pharmacy Action Plan

Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

LinkagesSector Outcomes (from the Outcomes Framework in the Ministry’s SOI)

Improved health and equity for all populations

NZ Health StrategyPeople powered

Ensuring women are informed about screening services available

155


Increasing the participation women in cervical screening, in particular priority group women22. Closer to home

Cervical screening providers are supported to provide timely, quality screening services Value and high performance

Improving screening coverage, particularly in priority group women One team

Collaborative working relationships between key stakeholders including primary and secondary care, and with screening support services providers

Smart system Using data to identify women who are missing out from screening (ie, women who are unscreened

or under-screened)

Actions and activities are that have a proven impact on this measure:1. Using data matching to identify women who are missing out from screening, and systematically inviting

them for screening.2. Using screening support services (where these are available) to provide targeted support to priority

group women in order to facilitate screening.3. Reducing barriers to screening by providing free smears to priority group women.4. Providing individual support to primary care providers to improve cervical screening systems and

processes, and improve screening rates.5. Holding regular meetings where key stakeholders work collaboratively on strategies for improving

cervical screening coverage.6. Undertaking initiatives to improve attendance by priority group women at colposcopy clinics.

Deliverables definitionsNumerator data is sourced from the NCSP Register. Quarterly DHB cervical screening coverage data is published on the NSU website.

Numerator: Cervical screening coverage by DHB

Women aged 25 – 69 years (by ethnicity) who have had a cervical sample taken in the last 3 yearshttps://www.nsu.govt.nz/health-professionals/national-cervical-screening-programme/cervical-screening-coverage

Denominator: 2013 Census estimates for each DHB

Women aged 25-69 years (by ethnicity), adjusted for hysterectomyhttps://www.nsu.govt.nz/health-professionals/national-cervical-screening-programme/cervical-screening-coverage

Quarter x, 201x/201x Cervical screening coverageDHB xx Exceptions reportingEthnic group Coverage Outline DHB activities to achieve 80% coverage if this target

has not been metMaori %

22 Priority group women are Māori, Pacific and Asian women aged 20 – 69 years, and Other women aged 30 – 69 years who are either un-screened or under-screened (ie, who haven’t had a cervical screening test in over 5 years).

156




Pacific %

Asian %

European / Other %

TOTAL %

Interpretation issues N/A

Reporting Periods Quarter Data sourceQuarter 2(For the period ending 31 December)

The data source used for Q2 reporting is DHB quarterly coverage data from Q1, as published on the NSU website.

Quarter 4(For the period ending 30 June)

The data source used for Q4 reporting is DHB quarterly coverage data from Q3, as published on the NSU website.

Expectations80% coverage

Total coverageRating DefinitionOutstanding performer >80% coverage

Achieved 80% coverage

Partially Achieved 70-80% coverage

Not Achieved <70% coverage

Māori coverageRating DefinitionOutstanding performer >80% coverage




Pacific coverageRating DefinitionOutstanding performer >80% coverage




Asian coverage

157


Rating DefinitionOutstanding performer >80% coverage




European / Other coverageRating DefinitionOutstanding performer >80% coverage




158


Performance Dimension: Meeting service coverage requirements and Supporting sector and inter-sector connectedness

System Integration SI11: Improving breast screening rates Summary information


70% coverage for all ethnic groups (Māori, Pacific and European/Other) and Overall


Type: Data & exception report



Data is sourced from BSA DHB quarterly reports published on the NSU website. Coverage is reported by ethnicity for a two year period.https://www.nsu.govt.nz/health-professionals/breastscreen-aotearoa/breast-screening-coverage





Linkages: This performance measure may be a contributory System Level Measure under Amenable Mortality.











Increased Immunisation Better Health Target

159

https://www.nsu.govt.nz/health-professionals/breastscreen-aotearoa/breast-screening-coverage







Bowel Screening

Mental Health

Healthy Ageing



Child Health




Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

LinkagesSector Outcomes (from the Outcomes Framework in the Ministry’s SOI)

Improved health and equity for all populations

NZ Health Strategy

People powered Ensuring women are informed about screening services available

160


Increasing the participation women in breast screening, in particular priority group women23. Priority women at the centre

Closer to home Breast screening providers are supported to provide timely, quality screening services

Value and high performance Improving screening coverage, particularly in priority group women.

One team Collaborative working relationships between key stakeholders including breast screening providers,

DHBs, primary care, and screening support service providers. Smart system

Using data to identify women who are not engaged in screening (i.e., women who are unscreened or under-screened)

Actions and activities that have a proven impact on this measure:7. Data matching to identify women who are not participating in screening, and systematically inviting

women. 8. Referral to screening support services to provide targeted support to priority group women to access

screening. 9. Reducing barriers to screening by providing transport to appointments for priority group women. 10. Collaboration between key stakeholders to work on strategies for improving breast screening coverage.

Deliverables definitionsNumerator data is extracted from the national BreastScreen Aotearoa database. Quarterly DHB breast screening coverage data is published on the NSU website.

Numerator: Breast screening coverage by DHB

Women aged 50 -69 years (by ethnicity) who have had a screening mammogram in the last two years. This includes women who may have turned 70 or 71 during the monitoring period.


Denominator: Denominators are derived from the 2013 census with population projections updates from Statistics New Zealand. https://www.nsu.govt.nz/health-professionals/breastscreen-aotearoa/breast-screening-coverage

Quarter x, 2017/2018 Breast Screening CoverageDHB xx Exceptions reporting Ethnic Group Coverage Outline DHB activities, including contribution to regional

coordination planning, to achieve 70% coverage if this target has not been met

Māori %

23 Priority group women are women aged 45 – 69 years who are Māori, Pacific, unscreened (never been screened or not screened for 5 years) or under-screened (groups of women whose coverage and participation rates are well below those of the total eligible population.

161




Pacific %

European /Other %

TOTAL %

Interpretation issuesN/A

Reporting Period

Reporting required:

Quarter For the time periodQuarter 2(For the period ending 31 December)

The data source used for Q2 reporting is DHB quarterly coverage data from Q1 published on the NSU website.

Quarter 4(For the period ending 30 June)

The data source used for Q4 reporting is DHB quarterly coverage data from Q3 published on the NSU website.

Expectations70% coverage

Total coverageRating: DefinitionOutstanding performer >70% coverage


Partially Achieved 65 – 70% coverage


Māori coverageRating: DefinitionOutstanding performer >70% coverage




Pacific coverageRating: DefinitionOutstanding performer >70% coverage




Performance Dimension: Providing quality services efficiently

162


Ownership OS3: Inpatient Average Length of Stay (ALOS)


Agreed in Annual Plan Type: Comprehensive measurement



Link to outcomes Delivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, ‘the health system is cost effective and supports a productive economy’ and the overarching goal that all New Zealanders live well, stay well, get well.This measure has key linkages to Government planning priorities as highlighted.
















Bowel Screening

Mental Health

Healthy Ageing



163


Child Health





Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Actions and activities that have a proven impact on this measure:The following actions and activities are examples of initiatives that have a proven impact on this measure:

Implementing programmes such as The Productive Ward – Releasing Time to Care or Optimising the Patient Journey which focus on improving ward processes and environments to help nurses and therapists spend more time on patient care, thereby improving safety and efficiency

Process mapping and/or service redesign to improve the patient journey, reduce “waste” and improve primary care’s access to services

Improving rates of day of surgery admissions (DOSA) for elective patients Improving pre-admission programmes for elective patients

Deliverables definitionsEach DHB will report against two ALOS measures – Part One: Elective surgical inpatient ALOSPart Two: Acute inpatient ALOS Both Part One and Part Two of the measure are calculated using information held in the National Minimum Data Set (NMDS), and do not require a separate DHB data submission.

Description:

164


The standardised ALOS is the ratio of ‘observed’ (actual) to ‘predicted’ ALOS, multiplied by the nationwide inpatient ALOS.

The length of stay calculation includes day case events, and joins multiple discharge events where The events have the same NHI

The events have the same DHB of Service

The prior event ends in a transfer

There is less than 24 hours between the end of one event and the start of the next event

Where multiple discharge events are joined, the admission type for the stay is the admission type of the first event. In the rest of this document:

An elective discharge is defined as a stay where the first or only event in the stay is elective

An acute discharge is defined as a stay where the first or only event in the stay is acute

Other linking criteria are included in the Appendix 1: Technical Specifications1. Elective surgical inpatient average length of stay:

Quantitative Indicator

The standardised ALOS for inpatient discharges in a surgical specialty with an elective admission type, expressed as the ratio of the observed to predicted ALOS, multiplied by the nationwide elective surgical inpatient ALOS.

The DHB observed ALOS, and the nationwide elective surgical inpatient ALOS, are both defined as the total bed days for elective surgical inpatients discharged during the 12 months to the end of the quarter, divided by the total number of discharges for elective surgical inpatients during the 12 months to the end of the quarter.

The predicted ALOS is derived by taking the nation-wide ALOS for each grouping of patient discharges, defined by DRG cluster and complexity group, multiplying this by the proportion of total discharges this group represents, and summing the result across all discharge groups. A contingency table is used to provide the ALOS across all DHBs for each DRG and complexity group. This information is then used to calculate the standardised ALOS for the casemix DRGs within each DHB.

Exclusions:• where the first event in the stay doesn't have a valid DHB of service e.g. is missing• where every event in the stay is non-casemix• where the first event in the stay is not Elective• where the purchaser of the first event in the stay is not in a set list• where the stay is Elective and no event has a surgical purchase unit (ie the purchase unit code does

not start with “S”• where the last event in the stay ended in a transfer

The purchase unit codes for the measure are included in Appendix 1: Technical Specification.

Expectations

165


DHBs will be supplied with comparative baseline data for the twelve months to September 2016 showing performance relative to other DHBs.

The suggested target is 1.47 days, which represents the 75th centile of national performance.

For any DHB that is already achieving an elective surgical inpatient 1.47 of tbc days or less in their baseline result (derived from the baseline data), a target that maintains their current performance or represents a modest improvement is suggested.

The Ministry will assume that 25 percent of the improvement towards target can be made each quarter, unless the DHB specifies otherwise.

Where the DHB is not achieving in line with the target, the DHB should provide information about any factors that are thought to be hindering achievement, and any actions being taken to gain improvements.Reporting PeriodReported quarterly. Due to the reliance on NMDS data (where the deadline for submission is about one month after the end of the quarter), the data used to derive this measure will be for one quarter in arrears.

Performance Rating for Elective ALOS measureA separate performance rating will be applied for each expectation within this performance measure, i.e. the Elective Surgical Inpatient ALOS and the Acute Inpatient ALOS expectations.

The following achievement scale will be applied for the Elective Surgical Inpatient ALOS measure:

Rating: Achieved The DHB has achieved their agreed elective surgical inpatient ALOS target

for the quarter

Partial Achievement The DHB has not achieved the agreed target for the quarter, but has demonstrated an adequate work-out plan to reach the target by year-end.

Not Achieved The agreed ALOS target for the quarter has not been achieved, and the DHB has not demonstrated an adequate work-out plan to reach the target by year-end.

2. Acute inpatient ALOS:

Quantitative Indicator The standardised ALOS for acute discharges in any medical or surgical specialty, expressed as the ratio of the observed (actual) to predicted ALOS, multiplied by the nationwide acute inpatient ALOS.

The DHB observed ALOS, and the nationwide acute inpatient ALOS, are both defined as the total bed days for acute medical or surgical inpatients discharged during the 12 months to the end of the quarter, divided by the total number of discharges for acute inpatients during the 12 months to the end of the quarter.

The predicted ALOS is derived by taking the nation-wide ALOS for each grouping of acute medical or surgical patient discharges, defined by DRG cluster and complexity group, multiplying this by the proportion of total discharges this group represents, and summing the result across all discharge groups.

Exclusions: • where the first event in the stay doesn't have a valid DHB of service e.g. is missing• where every event in the stay is non-casemix

166


• where the first event in the stay is not acute • where the purchaser of the first event in the stay is not in a set list• where the last event in the stay ended in a transfer.

ExpectationsDHBs will be supplied with comparative baseline data for the twelve months to December 2016 showing their performance relative to other DHBs.

The suggested target for 2017/18 is 2.3 days. This represents a modest reduction from the target for 2016/17.

For any DHB that is already achieving an acute inpatient ALOS of 2.3 days or less in their baseline data, a target that maintains their current performance or represents a modest improvement is suggested.

The Ministry will assume that 25 percent of the improvement towards target can be made each quarter, unless the DHB specifies otherwise.

Where the DHB is not achieving in line with the target, the DHB should provide information about any factors that are thought to be hindering achievement, and any actions being taken to make improvements.

Performance Rating for ALOS measuresA separate performance rating will be applied for each expectation within this performance measure, i.e. the Elective Surgical Inpatient ALOS and the Acute Inpatient ALOS expectations

The following achievement scale will be applied for the Acute Inpatient ALOS measure:

Rating: Achieved The DHB has achieved their agreed acute inpatient ALOS target for the

quarter


Not Achieved The agreed ALOS target for the quarter has not been achieved, and the DHB has not demonstrated an adequate work-out plan to reach the target by year-end.

167


Appendix 1: Technical Specifications

WIES version:The most current version of WIES available at the time baseline data is run. For 2015/16 this is NZ WIES version tbc.

DHB of service:Hospital agency codes are used to derive DHB of service.Where the stay has multiple events, the DHB which provides the first event will be considered to be the DHB of Service WIES recognised private facilities are excluded.

Joining Discharge Events into StaysDischarge events are considered to be part of the same stay if:

The events have the same NHI

The events have the same DHB of Service

The prior event ends in a transfer

There is less than 24 hours between the end of one event and the start of the next event

If an event starts before the end of a previous event with the same NHI, its start time is set to the end time of the prior event

If an event ends before the end of a previous event with the same NHI, its end time is set to the end time of the prior event

The quarter before the 12 month time period is also loaded to help detect long stays.

Only stays which end within the 12 month time period are included.Determining Stay Information Where there is more than one discharge event in a stay, the following criteria are usedDHB of Services = the DHB that provided the first eventStart Date =; the earliest event start dateEnd Date = the latest event end dateAdmission Type = the admission type of the first discharge eventDRG = the DRG of the highest caseweight eventPCCL = the PCCL of the highest caseweight eventCaseweight = the sum of every events' caseweightLength of Stay = the sum of the duration (in hours) of every event in the stay

Calculating Length of Stay

Each discharge event's length is calculated, rounded to the closest half hour, then summed together. No adjustment is made for leave days. Non-casemix events have their length set to zero

168


Admission types: Where multiple discharge events are joined, the admission type for the stay is the admission type of the first event.

Elective surgical inpatient ALOS:

An elective discharge is defined as a stay where the first or only event in the stay has an admission type of:• AP – Private hospital elective admission• WN – Admitted from waiting list (Elective)

Acute inpatient ALOS:

An acute discharge is defined as a stay where the first or only event in the stay has an admission type of:

• AC – Acute• ZC – Acute, discontinued code

All other admission types, including arranged types, are excluded. Views from the sector are that while it is important to manage the length of stay for arranged admissions, inclusion of arranged admission type in either the acute or elective calculation can mask trends, and make the measures less useful. For this reason, arranged admissions are excluded from both calculations.

Principal health purchaser code:

The principal purchaser code for the first or only event in the stay must be in • 20 – Overseas eligible• 34 – MOH funded purchase• 35 – DHB funded purchase

Purchase units

Elective Surgical Inpatient ALOS:

S00001 General Surgery - Inpatient Services (DRGs)S05001 Anaesthesia Services (inpatient)S15001 Cardiothoracic - Inpatient Services (DRGs)S25001 Ear Nose and Throat - Inpatient Services (DRGs)S30001 Gynaecology - Inpatient Services (DRGs)S35001 Neurosurgery - Inpatient Services (DRGs)S40001 Ophthalmology - Inpatient Services (DRGs)S45001 Orthopaedics - Inpatient Services (DRGs)S55001 Paediatric Surgical Services (DRGs)S60001 Plastic & Burns - Inpatient Services (DRGs)S70001 Urology - Inpatient Services (DRGs)S75001 Vascular Surgery - Inpatient Services (DRGs)

Acute Inpatient ALOS:

All medical or surgical purchase units that are casemix included.

169


How the data is standardisedStandardisation is a process by which health delivery data is adjusted to take account of variations in the characteristics of different population or service delivery groups. This provides a basis for comparison for different populations or providers with different service mixes.

Often data is standardised by age, but data can be standardised by any characteristic that needs to be statistically controlled.

In deciding what variables to use to standardise the data, the effect of various factors such as sex, deprivation, age, ethnicity and rurality on ALOS were tested using regression methods. It was found that the only factors that had a statistically significant effect across all DRGs were admission type (acute or elective), and patient complexity and co-morbidity. Other factors have therefore been omitted from routine consideration.

ALOS is standardised to reflect differences in the type of service provision and is broken down into the following groups:

DRG cluster Patient Complexity and Comorbidity level (pccl)

The DRG cluster is the first three characters of the DRG code. The national ALOS is calculated by these groups using all DHB data for the relevant time period.

The individual DHB data is split by the same DRG cluster and pccl groupings so the record level DHB length of stay can be compared to the national DRG cluster and pccl grouping ALOS.

The data used for the ALOS calculation is:Stays - the number of inpatient stays by DHB meeting the ALOS criteria

Expressed mathematically:standardised ALOS

∑observed length of stayDHB ∑observed length of stayNational

∑ predicted length of stayDHB ∑staysNational

The predicted length of stay is calculated by creating a contingency table of DRG by Complication & Comorbidity Code.

A discharge group is defined by the combination of DRG cluster (first three characters of the DRG) and the pccl group. Standardisation by discharge group is carried out using a contingency table approach24.

The standardised ALOS adjusts for differences between the DHB observed length of stay and the predicted length of stay based on the mix of the services the DHB provides and the ALOS for each DRG cluster. This ratio is applied to the national rate to give a standardised rate.

This method of standardising means that the overall rate is not skewed by the relative proportion of data within each DHB DRG cluster group. All methods of standardisation need to be qualified in that they cannot control for or mitigate data quality or administrative practices.

241 In deciding what variables to use to standardise the data, the effect of various factors such as sex, deprivation, age, ethnicity and rurality on ALOS were tested using regression methods. It was found that the only factors that had a statistically significant effect across all DRGs were admission type (acute or elective), and patient complexity and co-morbidity. Other factors have therefore been omitted from routine consideration. .

170

X


Performance Dimension: Providing quality services efficiently

Ownership OS8: Reducing Acute Readmissions to Hospital

The readmission model currently in use is based on work carried out in 1991, with some technical adjustments made in 1995/96.

A recent assessment suggests there is a need for review and re-development of the model. This work is now in final draft form and is available for comment on the nsfl website. http://nsfl.health.govt.nz/accountability/performance-and-monitoring/performance-measures

The previous measure definition is outlined below and will be updated following final agreement of the measure revision outlined in the link above


Agreed in Annual Plan Type: Comprehensive measurement


Quarterly

Source data/template for reporting provided by: Not applicable – data from NMDS












171









Bowel Screening

Mental Health

Healthy Ageing



Child Health




Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

An unplanned acute hospital readmission may often (though not always) occur as a result of the care provided to the patient by the health system. Reducing unplanned acute admissions can therefore be interpreted as an indication of improving quality of acute care, in the hospital and/or primary care. , ensuring that people receive better health and disability services. Through the intermediate outcome that people receive better health and disability services, the measure contributes to the high level outcome of New Zealanders living longer, healthier and more independent lives while receiving better care closer to home.

Actions and activities that have a proven impact on this measure:

172


The following actions and activities are examples of initiatives that have a proven impact on this measure: Focus on effective management of long term conditions Process mapping and redesign of patient pathways, particularly to improve primary care access

to services to diagnose and treat people in the community Initiatives to improve hospital discharge processes Appropriate integration between secondary and primary services to ensure continuity of care for

patients.

Deliverables definitions Ownership 8: Acute Readmissions to Hospital is calculated from information held in the National Minimum Data Set (NMDS), and does not require a separate DHB data submission.

The following admissions are excluded: Where the admissions is non-casemix Where the admission is for palliative care Where the DHB of service is unknown

The following readmissions are excluded: Where the readmission is non-acute Where the readmission is more than 28 days from the previous admission Where the readmission is within 24 hours and has a transfer flag Where the readmission matches a list of planned readmissions Where the readmission is a statistical readmission Where any previous admission ended in patient’s death

Readmissions are grouped by the DHB of service. Where the admission and readmission occur in different DHBs, the readmission is counted toward the first DHB.

Ownership 8 provides both standardised and unstandardized acute readmission to hospital rates for each DHB. The standardised rate is calculated using a regression method, and is designed to control for differences in admissions to DHBs, i.e. ethnicity, age, complexity. The formula used to calculate it is:

Reporting PeriodReported quarterly. Due to the reliance on NMDS data (where the deadline for submission is 21 days after the end of the month of discharge), and due to the time lapse required in order to observe 28 day readmissions, this measure will operate using data that is one quarter in arrears.

ExpectationsDHBs will be supplied with comparative data on performance relative to other DHBs and suggested target ranges. There is some flexibility for DHBs to go outside suggested target ranges where DHBs can

173


demonstrate this is in the interests of wider objectives. (As well as measuring DHB performance against target for the standardised measure, the target will be converted to an unstandardised rate to facilitate DHB measurement of performance between quarters.)

Please note: This definition and expectations also apply for over 75 readmissions

DHBs are to state their year-end target. The Ministry will assume that 25 percent of the improvement towards target can be made each quarter, unless the DHB specifies otherwise.

Where the DHB is not achieving in line with target, the DHB should provide information about any factors that are thought to be hindering achievement, and any actions being taken to gain improvements.


Rating: Achieved The DHB achieves the agreed target for the quarter.


Not Achieved The agreed target for the quarter has not been achieved, and the DHB has not demonstrated an adequate work-out plan to reach the target by year-end.

For the final year-end assessment, a simple achieved/not achieved rating will apply.

174


Ownership OS10: Improving the quality of identity data within the National Health Index (NHI) and data submitted to National Collections

Summary informationImproving the quality of identity data within the National Health Index (NHI) and event data submitted to the National Collections Systems (NCS).

Measures Reporting

Type: Output Type: Comprehensive measurement

Target: Pre-Set Reporting frequency: Quarterly


Data to be supplied by DHBs as required by the Operational Policy Framework (OPF)


















Bowel Screening

Mental Health

175


Healthy Ageing



Child Health





Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

By ensuring the quality of the data it provides to the National Collections Systems, the DHB will impact the outcome of unifying and improving the health and disability system. Quality data supports good policy making, decision-making and planning. It also helps identify and address issues and improve services across the whole health and disability system through improving hospital productivity and community health. This happens through DHBs sharing their information, ensuring their population has the most up to date and accurate demographic data, and the monitoring and analysis done by the Ministry of Health and health researchers.

DHBs are the primary data stewards of the NHI as the master ‘source of truth’ patient identity system used by all health providers. Ensuring that patient identity is correctly established, confirmed and maintained means that DHBs are able to accurately identify patients, and make sure clinicians can access all relevant health information, previous history and warnings and alerts for them. This means increased patient safety, leading to the health and disability system and services being trusted and used with confidence. It also means reduced duplication and consequent reduction of time and effort spent resolving duplicates to maintain unique identifiers. Primary health care providers now have the ability to directly maintain and add records to the NHI via the National Enrolment Service. This is a significant shift in practice at the primary care level. DHBs’ data stewardship of the NHI will be extended to their enrolled populations in primary care via the Primary Health Organisation (PHO) Services Agreement and the Back to Back Agreements PHOs have with their contracted primary care providers. Monitoring of NHI quality in the enrolled populations of primary care providers under each DHB will be incorporated in the reporting DHBs receive from the Ministry.

By ensuring the quality of the data it provides to the National Collections Systems, the DHB and its contracted primary care providers will impact the outcome of unifying and improving the health and disability system. Quality data

176


supports good policy making, decision-making and planning. It also helps identify and address issues and improve services across the whole health and disability system through improving hospital productivity. This happens through DHBs sharing their information, and monitoring and analysis done by the Ministry of Health and health researchers.

Actions and activities that have a proven impact on this measure:Following are the actions and activities that have a proven impact on the indicators within this measure:

NHI

New NHI registration in error (causing duplication): Users of the NHI interface must be fully trained in search and evaluation techniques and receive regular refresher training to maintain skills and knowledge. DHBs should provide feedback to individuals involved in instances of duplication detected by monitoring. In cases where this has been produced at the primary care level, feedback should be channelled through the contracted primary care provider’s PHO. Business processes should support users in establishment, confirmation and maintenance of identity – e.g. use of forms for patients to record details. DHB subscribing Patient Management System (PMS) interfaces to the NHI must be compliant with relevant Standards and technical specifications at all times and present correct and meaningful warning and error messages.

Recording of non-specific ethnicity: Users of the NHI interface must be fully trained in ethnicity collection and recording processes as set out in the Ethnicity Data Protocols for the Health & Disability Sector. This should include use of the Ethnicity Data Audit Tool described in measure PP32 “Improving the quality of ethnicity data collection in PHO and NHI registers”. DHB’s should provide feedback to individuals involved in instances of recording non-specific values in either new registration or update of records. Business processes should support users in accurate collection and recording e.g. use of the Standard ethnicity question, follow-up with a presenting patient to obtain specific ethnicity if a referral was received with no or non-specific ethnicity. DHB subscribing Patient Management System (PMS) interfaces to the NHI must be compliant with relevant Standards and technical specifications at all times.

Address validation quality: Users of the NHI interface must be fully trained in recording patient addresses in a way which validate against the Standard. DHBs should provide feedback to individuals involved in instances of poor quality addresses where validation should have been possible. Business processes should support users in accurate collection, recording and validation of addresses. DHB subscribing Patient Management System (PMS) interfaces to the NHI must be compliant with relevant Standards and technical specifications at all times.

Invalid NHI data updates causing potential identity confusion (overlay): Users of the NHI interface must be fully trained in the process of confirming and maintaining patient identity information i.e. selection of the correct person/record and updates to existing data elements of name, DOB, gender or address. DHB’s should provide feedback to individuals involved in instances of updates to these data fields that are subsequently confirmed to be invalid. Business processes should support users in accurate collection and recording of data elements egg, seeking additional confirmation of a change in DOB. DHB subscribing Patient Management System (PMS) interfaces to the NHI must be compliant with relevant Standards and technical specifications at all times and present correct and meaningful warning and error messages.

National collections

Assessment of data reported to the NMDS. It is recommended that DHBs monitor the standard classification concepts versus the clinical statements for the specified range of diagnosis codes.

The Ministry encourages DHBs to update their business processes so that detailed information is recorded in the clinical record and is made available to enable clinical coders to extract the detailed clinical statements to improve the clarity and context of the information reported to the NMDS. Where standard classification concepts are reported to the NMDS this is an indication that the clinical record lacked detailed information. DHBs are encouraged to work with clinical staff and clinical coders to ensure the information recorded in the clinical record provides the specificity for quality clinically coded data to be reported to the NMDS.

177


Timeliness of NNPAC data: This is a new measure; however DHBs that are successful on this indicator have a data warehouse which holds data across all of their outpatient services. They will continually monitor data quality and update their records and have regular communication with other DHBs in their region.

NBRS events for exited treated patients match to NNPAC or NMDS events: DHBs that are successful on this indicator have integrated patient management systems for NBRS and outpatient and inpatient data. They use the data from both sources as part of their patient reporting and internal performance monitoring.

National Collections file load success rate: DHBs that have a high file load success rate for NMDS, NBRS, NNPAC and PRIMHD data are those organisations that have built the business rules into their extracts. They also use the same data to monitor and report within their own organisations as they report to the national collections; thus any systemic data quality issues are identified before the information is provided to the Ministry of Health.

PRIMHD data quality: PRIMHD data will be assured by a routine internal audit thus any systematic data quality issues are identified before the information is provided to the Ministry of Health.

Deliverables definitionsThis measure has three parts as set out below:

Focus area 1: Improving the quality of identity data within the NHI

Focus area 2: Improving the quality of data submitted to National Collections

Focus area 3: Improving the quality of the Programme for the Integration of Mental Health data (PRIMHD)

Focus area 1: Improving the quality of identity data within the NHIIndicator 1: New NHI registration in error (causing duplication)

Numerator: Number of new NHI registrations requiring subsequent linking by MOH per DHB per quarter. It excludes pre-allocated NHI numbers used, newborn NHI registrations and unidentified patient NHI registrations. It is cumulative across the quarter.

Denominator: Total number of new NHI registrations per DHB per quarter (excluding pre-allocated NHI numbers, newborn registrations and unidentified patient NHI registrations).

Indicator 2: Recording of non-specific ethnicity in new NHI registration

Numerator: Total number of new NHI registrations with ethnicity recorded as ‘Not Stated’ (99) or ‘Response Unidentifiable’ (97) per DHB per quarter. It excludes pre-allocated NHI numbers used and unidentified patient NHI registrations. It is cumulative across the quarter.

Denominator: Total number of new NHI registrations per DHB per quarter (excluding pre-allocated NHI numbers, and unidentified patient NHI registrations)

Indicator 3: Update of specific ethnicity value in existing NHI record with a non-specific value

Numerator: Total number of updates to any ethnicity field in an existing NHI record with a non-specific value (‘Not Stated’ [99] or ‘Response Unidentifiable’ [97]) where a specific value existed in that field, per DHB per quarter

Denominator: Total number of NHI ethnicity updates per DHB per quarter

Indicator 4: Invalid NHI data updates

Numerator: Confirmed incorrect updates

178


Denominator: Total number of queried updates

Reporting PeriodTo be reported quarterly.ExpectationsThe table below illustrates the Ministry’s expectations for each measure:

Rating

Not Achieved– Escalation Required

Partial Achievement Achieved

Outstanding Performer/ Sector

Leader

Mea

sure

1 New NHI registration in error (duplication)

SEE NOTE BELOW reA, B and C

A > 6% A>4% and <= 6% A

>2% and <= 4% A

<= 2%

B > 4% B>3% and <= 4% B

>1% and < =3% B

<=1%

C > 12% C>6% and <=12% C

>1.5% and

<= 6% C<= 1.5%

2 Recording of non-specific ethnicity in new NHI registration

Greater than 4%>2% and < or equal to 4%

>05% and < or equal to 2%

< or equal to 0.5%

3. Update of specific ethnicity value in existing NHI record with a non-specific value

Greater than 4%>2% and < or equal to 4%

>05% and < or equal to 2%

< or equal to 0.5%

4. Validated addresses excluding overseas, unknown and dot (.) in line 1

< or equal to 70%>70% and < or equal to 76%

>76% and < or equal to 85% Greater than 85%

5. Invalid NHI data updates

Still to be confirmed

NOTE: this indicator will not be measured for at least Q1 and

Q2 2014-15




179


DHB’s have been split into 3 groups for measure 1 based on volumes of new registrations (this is to take into account the effect of small numbers on percentages to better reflect actual performance)

GROUP A GROUP B GROUP C

Auckland Bay of Plenty South Canterbury

Canterbury Hawkes Bay TairawhitiCapital and Coast Hutt Valley Wairarapa

Counties Manukau Lakes West Coast

Southern Mid Central Whanganui

Waikato Nelson MarlboroughWaitemata Northland

Taranaki

DHBs must provide explanations if ratings are ‘not achieved’ or ‘partially achieved’ and submit plans for improvement and/or remediation.

Focus area 2: Improving the quality of data Submitted to National Collections DHB results from production data reported to the national collections will be the basis for the initial assessments. All DHBs can provide feedback on their performance. This will inform the Ministry about data quality activities in the DHB and it will also be taken into account when assigning the final ratings.

Description:National Collections and Reporting (Information Group, National Health Board) have developed a quarterly toolkit showing results for each DHB by measure.

Indicator 1: NBRS collection has accurate dates and links to NNPAC and NMDS.

For all Exited Treated patients in the NBRS there is an event with the same procedure date in NMDS with matching PMS Unique ID or NNPAC with matching Client System Identifier.

Numerator: Total number of records reported as Treated Exited in NBRS where an event with the same procedure date exists in NMDS or NNPAC per DHB per quarter.

Denominator: Total number of records reported as Treated Exited in NBRS per DHB per quarter.

Indicator 2: National Collections File load Success

Numerator: Number of PRIMHD, NMDS, NNPAC and NBRS records successfully submitted per DHB per quarter.

Denominator: Total number of PRIMHD, NMDS, NNPAC and NBRS records submitted per DHB per quarter.

Note: The rating for this measure will be an average of the rating across all 4 collections. A breakdown of the percentage and rating for each individual collection will be provided.

Indictor 3: Assessment of data reported to the National Minimum Data Set (NMDS)

Numerator: Number of clinical statements for specific diagnosis codes (M00 to M99, S00 to T98, U50 to Y98 (excluding M30 to M36, U739, Y920, Y9249, Y929, X59)) per DHB per quarter.

180


Denominator: Total number of specific diagnosis codes (M00 to M99, S00 to T98, U50 to Y98 (excluding M30 to M36, U739, Y920, Y9249, Y929, X59)) per DHB per quarter.

Indicator 4: Timeliness of National Non-admitted Patient (NNPAC) data

Numerator: Total number of publicly funded NNPAC events loaded into the NNPAC more than 21 days post month of discharge per DHB per quarter.

Denominator: Total number of publicly funded NNPAC events in the NNPAC per DHB per quarter.

This measure only applies to records reported for mandatory purchase units where the reporting requirements were published in the PUC Data Dictionary at the beginning of the financial year

Note: The last submitted date will be used to calculate this measure to account for instances where the Ministry are late to load the files that have been submitted.

Explanation of terms

Assessment of data reported to the NMDS

This measure refers to the distinction between the use of standard classification concepts (as per ICD-10-AM and 3MTM CodefinderTM) and clinical statements for specific diagnosis codes submitted to the NMDS. Standard classification concepts limit the usefulness of data, as they lack detail and specificity. DHBs are, therefore, encouraged to record and report clinical statements by adding detailed text extracted from the clinical record to improve the clarity and context of the information reported. This measure focuses on musculoskeletal diagnoses, injuries, poisonings and certain other consequences of external cause and external cause i.e. those in the range M00 to M99, S00 to T98 and U50 to Y98 (excluding M30 to M36, Y920, Y9249, U739, Y929, X59).

NBRS links to NNPAC and NMDS NBRS data is used to manage elective booking lists. The links between NBRS and NMDS/NNPAC provides high quality information about the surgeries that is consistent and robust, and also minimises risks of patients being accidentally exited without treatment. This ability to trace a patient’s episode across the national collections is central to developments in this area.

Timeliness of NNPAC data: Calculated as the difference between the date a record is loaded into NNPAC and the date of service reported in the record. 21 days includes weekends and public holidays. This is the timeliness requirement signed up to in the Operational Policy Framework. Further several DHBs have been deleting their whole years NNPAC data and re-submitting it within days of the end of year wash-up. This measure is to allow users to have a measure of the consistency of the data in this collection.

National Collections File Success Rate This is the success rate of NNPAC, NMDS, NBRS and PRIMHD records submitted by the DHB in the quarter. DHBs are required to

181


reach an high level to achieve compliance and this measure is to ensure that they continue to achieve a rate of 98% or above. Accurate file loading ensures that the national collections data is timely and complete.

DHBs should explain their improvement plans for where their ratings fall into the ‘not achieved’ or ‘partially achieved’ levels.

Reporting PeriodTo be reported quarterly, with a toolkit placed on the Quickplace website.

ExpectationsThe table below illustrates National Collections and Reporting’s expectations for each measure:

Rating



Outstanding Performer/ Sector

Leader

Mea

sure

1 NBRS links to NNPAC and NMDS.

Less than

95%

Greater than or equal to 95% and

less than 97 %

Greater than or equal to 97% and less than 99.5 %

Greater than or equal to 99.5%

2 National Collections File load Success

Less than

95%


less than 98 %

Greater than or equal to 98% and less than 99.5 %

Greater than or equal to 99.5%

3 Assessment of data reported to the NMDS

Less than 60%Greater than or

equal to 60% and less than 75%

Greater than or equal to 75%

N/A

4 NNPAC timeliness

Less than

85%


less than 95 %


less than 98 %

Greater than or equal to 98%

Focus area 3: Improving the quality of the Programme for the Integration of Mental Health data (PRIMHD)

Indicator 1: PRIMHD data quality

Please provide date(s) of routine data quality audits and corrective actions if any.

Dates(s) of routine audit(s) Corrective actions (if no corrective actions please indicate – NIL)

182


Explanation of termsPRIMHD data quality DHB provider arm services undertake routine audits to ensure

PRIMHD data is accurate. These routine audits will have a particular focus on Mental Health Act data.

Reporting PeriodTo be reported quarterly, a toolkit will be placed on the Quickplace website.

ExpectationsThe table below illustrates National Collections and Reporting’s expectations for each measure:

Rating



Outstanding Performer/

Sector Leader

Mea

sure

2 PRIMHD data quality

No routine audits undertaken

Routine audits undertaken but

inadequate information on

corrective actions

Routine audits with appropriate

corrective actions where required

Routine audits undertaken and

no corrective actions where

required

183


Performance Dimension: purchasing the right mix and level of services within acceptable financial performance

Output 1: Mental health output Delivery against Plan

Summary informationTarget/performance expectation:Agreed in Annual Plan (Production Plan)

Reporting

Type: Comprehensive measurement


Source data/template for reporting provided by:Ministry of health (Mental Health)

Link to outcomes Delivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’, and the overarching goal that all New Zealanders live well, stay well, get well.This measure has key linkages to Government planning priorities as highlighted.
















Bowel Screening

Mental Health

184


Healthy Ageing



Child Health




Improving Quality


Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma


DescriptionEach DHB must monitor, evaluate and report on the delivery of Mental Health Services set out in its Annual Plan Production Plan.

For Mental Health Services provided by the DHB’s provider arm, the DHB must complete the Mental Health Volumes Reporting template. This will be provided by the Ministry, and included with the main quarterly reporting template.

Reporting PeriodReported quarterly.

ExpectationsThe following achievement scale will be applied:

Rating: DefinitionAchieved Volume delivery for specialist Mental Health and Addiction services is within:

185


a) five percent variance (+/-) of planned volumes for services measured by FTE, b) five percent variance (+/-) of a clinically safe occupancy rate of 85% for inpatient services measured by available bed day, andc) actual expenditure on the delivery of programmes or places is within 5% (+/-) of the year-to-date plan.

Partial Achievement Volume delivery is outside the bounds for an ‘Achieved’ rating and the accompanying exception reporting is satisfactory.

Not Achieved Volume delivery is outside the bounds for an ‘Achieved’ rating and the accompanying exception reporting is not satisfactory.

186


Developmental measures DV4: Improving patient experience

Summary informationImplementing a national approach to collection, measurement and use of patient experience information.

Measures ReportingTarget: Provide patient experience data

and establish baselines for future target


Quarterly


DHBs to supply data by either:- Submitting patient information to the

national survey provider (yet to be appointed) who will conduct the national patient experience survey and reporting on their behalf, or

- Providing completed national patient experience survey data to the national provider for incorporation in national reports.

Link to outcomes Delivery of this measure supports the overarching outcomes for the health and disability system of ‘New Zealanders living longer, healthier and more independent lives’, and ‘the health system is cost effective and supports a productive economy’ and the overarching goal that all New Zealanders live well, stay well, get well.This measure has key linkages to Government planning priorities as highlighted.












187






Bowel Screening

Mental Health

Healthy Ageing



Child Health





Workforce




Workforce

Quality

Electives

Stroke

Cardiac Services

Healthy Ageing


Hepatitis C

Major Trauma

Patient experience data is an important performance indicator, and is vital in driving service improvements. However, New Zealand does not have a consistent national approach to collection, measurement and use of patient experience information.

Recent international opinion has shifted from measuring patient satisfaction to measuring the broader concept of patient experience. Furthermore, studies have shown that patient / consumer experience is a good indicator of the quality of health services, with patient experience positively correlated to processes of care for prevention, disease management, and with adherence to medical advice and treatment plans. Better experience, stronger partnerships with consumers, and patient and family-centred care have been linked to improved health, clinical, financial, service and satisfaction outcomes.

188


The focus on local needs for quality improvement is as important as consistent data for a national perspective. The indicators must be flexible enough to allow DHBs to plan and track local service-level improvements. They must be usable in DHB performance monitoring and accountability processes focused on hospitals, but also have more general application across the system, including in primary care.

Actions to deliver improved performance in this focus area:The information gathered at local and national levels through these measures can be used to benchmark patient experience across the country and to improve services locally. The indicators are collected via surveys completed by patients, carers and family/whānau.

The aim of the national programme is to develop:- a nationally consistent model of patient experience indicators incorporating four key domains

(communication, partnership, coordination, and physical and emotional needs) supported by additional questions

- a set of questions that can be incorporated in existing local patient experience surveys- adopting pre-existing and validated tools, where possible- an approach consistent with international best practice, to allow New Zealand data to be compared

with overseas results.

Deliverables definitionsDHBs are expected to supply patient experience data according to the detailed information provided in the requirements document published on the HQSC web site www.hqsc.govt.nz and the nationwide service framework library web site www.nsfl.govt.nz, that includes:

the national patient experience survey methodological rules (including sample size and timing) patient data extract file specification correspondence examples national reporting rules and timeframes.

Each quarter DHBs will supply a report via the DHB quarterly reporting process: confirming patient experience data has been supplied according to the requirements document confirming the DHB has delivered the patient experience actions and milestones identified in its

Annual Plan identifying any local survey management issues providing a resolution plan if it has not delivered to requirements or to plan for any survey

management issues identified.

Reporting Period DHBs will supply patient experience data and confirmation reports in line with the following quarters:

Quarter For the time period1 e.g.1 July – 30 September

2 e.g.1 October – 31 December

3 e.g.1 January – 31 March

4 e.g.1 April – 30 June

189


Further detail on timing of data supply is specified in the requirements document.

Quarterly survey reports at national and DHB level will be made available by the national survey provider two weeks following the end of the quarter. DHBs will be able to see other DHBs reports.

ExpectationsAll DHBs submit data for a sample group of patients on all the core survey questions. The Ministry of Health and Health Quality and Safety Commission expects that DHBs will make improvements in the quality of the data in each quarter enabling baselines to be set and future performance expectations to be developed.

DHBs are expected to include local patient experience information in their Quality Accounts.

Baseline information

To be established from 2014/15 and subsequent data reported.

190


Developmental measures DV6: SLM youth access to and utilisation of youth appropriate health services

Detail not yet available

Developmental measures DV7: SLM number of babies who live in a smoke-free household at six weeks post natal

Detail not yet available

191


Appendix 1: NZ organised acute stroke service specifications, stroke rehabilitation service specifications and Organised Inpatient Stroke Rehabilitation Service Minimum Expectations (refer PP20)

192


193


194


195


196


197


198


199


‘ Organised Inpatient Stroke Rehabilitation Service’Minimum Expectations

On-site availability of core stroke rehabilitation team members (Doctor, Nurse, Physiotherapist, Occupational Therapist, Speech and Language Therapist, Social Worker)

Co-location of all adult ages stroke rehabilitation beds on a single rehabilitation ward Regular inter-disciplinary meeting with documented goal setting at least once per week Written clinical guidelines for shoulder pain, continence, mood, falls, pressure injuries, dysphagia,

nutrition and aphasia available and accessible to staff Documented goal specific rehabilitation plan for each patient that is developed in conjunction with

the patient and their family Written stroke education for patients, families, and carers available on ward Pre-discharge education and training for family/carers completed and documented for each patient

prior to discharge Regular measurement and documentation of rehab intensity (i.e. time patient spends in active

rehabilitation grouped by provider – e.g. PT, SLT, RN, therapy assistant) Participation in AROC data collection in addition to regular reporting of MoH stroke KPIs Annual audit of at least one additional aspect of stroke rehabilitation services Stroke specific education for core clinical staff available (minimum 8 hours per year) Access as required to a clinical psychologist, dietician, pharmacist, and service co-ordinator/NASC

These expectations are based on the “NZ Organised Stroke Rehabilitation Service Specifications” document (in-patient and community) prepared by the National Stroke Network in December 2014. For more detail please refer to this document.

200

dhb non-financial monitoring framework and performance ...€¦ · web viewa narrative is also...

Documents