cmdhbhome.cwp.govt.nz · 9.00am – 9.10am . 2.0 Governance. 2.1 Attendance & Apologies : 2.2 Disclosure of Interests /Specific Interests . 2.3 Acronyms . 2.4 Confirmation of Public

Counties Manukau District Health Board – Hospital Advisory Committee Agenda

Counties Manukau District Health Board Hospital Advisory Committee Meeting Agenda Wednesday, 25 March 2015 at 9.00am – 12.30pm, Innovation Lab, Ko Awatea, Middlemore Hospital, Hospital Road, Otahuhu, Auckland Time Item Page No

9.00am 1.0 Welcome

9.00am – 9.10am 2.0 Governance 2.1 Attendance & Apologies 2.2 Disclosure of Interests/Specific Interests 2.3 Acronyms 2.4 Confirmation of Public Minutes (11 February 2015) 2.5 Action Item Register Public

3 4-7 8 9-15 16-17

9.10am –9.30am

9.30am – 9.40am 9.40am – 9.50am

9.50am – 10.00am 10.00am – 10.10am 10.10am – 10.20am 10.20am – 10.30am 10.30am – 10.35am 10.35am – 10.40am 10.40am – 10.45am

3.0 Director of Hospital Services Report – Phillip Balmer 3.01) Executive Summary 3.02) Balanced Scorecard 3.03) Financial Summary 3.04) Hospital Activity Overview 3.05) Actions Arising Responses 3.06) Appendix A – Scorecard Glossary 3.1 Mental Health – Tess Ahern 3.2 Women’s Health & Kidz First – Nettie Knetsch 3.3 Surgery and Ambulatory Care – Gillian Cossey 3.4 Adult Rehabilitation/ Health of Older People 3.5 Medicine, Acute Care & Clinical Support - Brad Healey 3.6 Non-Clinical Support Services – Phillip Balmer 3.7 Director of Allied Health report – Martin Chadwick 3.8 Director of Midwifery report – Thelma Thompson 3.9 Director of Nursing report – Denise Kivell

18-20 21-22 23-28 29-37 38-41 42 43-46 47-58 59-72 73-82 83-90 91-109 110-113 114-115 116 117-119

10.45am – 11.00am Morning Tea

11.00am – 11.30am

4.0 Presentation/s 4.1 Middlemore Foundation – Pam Tregonning, Executive Director

-

11.30am – 11.45am

11.45am - 12.10pm

5.0 For Discussion 5.1 Values Refresh: Patient Survey/Staff Survey – Beth Bundy, GM Human Resources & Marianne Scott, Master Planner 5.2 Diagnostic Target Performance Report/Performance Plan/ Dashboard/Project Plan & Milestones/Project Brief – Phillip Balmer

120-123 124-134

6.0 Resolution to Exclude the Public

135-136

Counties Manukau District Health Board – Hospital Advisory Committee Agenda

Time Item Page No

12.10pm – 12.20pm

12.20pm – 12.25pm 12.25pm – 12.28pm

12.28pm – 12.30pm

7.0 Confidential Items 7.1 Patient Safety Report/S&AE Report/HQSC Survey

Results – Report/Presentation –David Hughes 7.2 Risk Register/Report – David Hughes 7.3 Confirmation of Confidential Minutes (11 February

2015) 7.4 Action Item Register Confidential

137-269 270-280 281-289 290

Next Meeting: 6th May 2015, Ko Awatea Innovation Lab

3

BOARD MEMBER ATTENDANCE SCHEDULE – HAC 2015 Name

Jan 11 Feb 24 Mar Apr 6 May 17 June 29 July August 9 Sept 21 Oct Nov 2 Dec

Lee Mathias (Chair)

No

Mee

ting

No

Mee

ting

No

Mee

ting

No

Mee

ting

Wendy Lai

Arthur Anae

Colleen Brown

Sandra Alofivae

Lyn Murphy (Committee Chair)

David Collings

Kathy Maxwell

George Ngatai

Dianne Glenn

Reece Autagavaia

* Attended part meeting only

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BOARD MEMBERS’ DISCLOSURE OF INTERESTS

25 March 2015 Member Disclosure of Interest

Dr Lee Mathias, Chair • Chair Health Promotion Agency

• Deputy Chair Auckland District Health Board • Director, Pictor Limited • Director, iAC Limited • Advisory Chair, Company of Women Limited • Director, John Seabrook Holdings Limited • Chairman, Unitec • External Advisor, National Health Committee • Director, Health Innovation Hub • Director, healthAlliance Ltd • Director, healthAlliance (FPSC) Ltd • MD Lee Mathias Limited • Trustee, Lee Mathias Family Trust • Trustee, Awamoana Family Trust • Trustee, Mathias Martin Family Trust

Wendy Lai, Deputy Chair • Board member and partner at Deloitte

• Board member Te Papa Tongarewa, the Museum of New Zealand

• Chair, Ziera Shoes

Arthur Anae

• Councillor, Auckland Council • Member The John Walker ‘Find Your Field of

Dreams’ • Chairman, NZ Good Samaritan Heart Mission to

Samoa Trust

Colleen Brown • Chair, Disability Connect (Auckland Metropolitan Area)

• Member of Advisory Committee for Disability Programme Manukau Institute of Technology

• Member NZ Down Syndrome Association • Husband, Determination Referee for Department of

Building and Housing • Chair IIMuch Trust • Director, Charlie Starling Production Ltd • Member, Auckland Council Disability Advisory Panel

5

Dr Lyn Murphy • Member, International Society for Pharma-coeconomics and Outcomes Research (ISPOR).

• Member of the New Zealand Association of Clinical Research (NZACRes)

• Senior lecturer in management and leadership at Manukau Institute of Technology

• Member, ACT NZ • Director, Bizness Synergy Training Ltd • Director, Synergex Holdings Ltd • Associate Editor NZ Journal of Applied Business

Research • Member Franklin Local Board

Sandra Alofivae

• Member, Fonua Ola Board • Board Member, Pasefika Futures

David Collings

• Chair, Howick Local Board of Auckland Council • Member Auckland Council Southern Initiative

Kathy Maxwell • Director, Kathy the Chemist Ltd

• Regional Pharmacy Advisory Group, Propharma (Pharmacy Retailing (NZ) Ltd)

• Editorial Advisory Board, New Zealand Formulary • Member Pharmaceutical Society of NZ • Trustee, Maxwell Family Trust • Member Manukau Locality Leadership Group,

CMDHB • Board Member, Pharmacy Guild of New Zealand

Dianne Glenn • Member – NZ Institute of Directors

• Member – District Licensing Committee of Auckland Council

• Life Member – Business and Professional Women Franklin

• Member – UN Women Aotearoa/NZ • Vice President – Friends of Auckland Botanic

Gardens and Member of the Friends Trust • Life Member – Ambury Park Centre for Riding

Therapy Inc. • CMDHB Representative - Franklin Health

Forum/Franklin Locality Clinical Partnership • Vice President, National Council of Women of New

Zealand

George Ngatai • Arthritis NZ – Kaiwhakahaere • Chair Safer Aotearoa Family Violence Prevention

Network • Director Transitioning Out Aotearoa • Director BDO Marketing • Board Member, Manurewa Marae

6

• Conservation Volunteers New Zealand • Maori Gout Action Group • Nga Ngaru Rautahi o Aotearoa Board

Reece Autagavaia • Member, Pacific Lawyers’ Association

• Member, Labour Party • Member, Auckland Council Pacific People’s Advisory

Panel • Member, Tangata o le Moana Steering Group • Employed by Tamaki Legal • Board Member, Governance Board, Fatugatiti Aoga

Amata Preschool

7

HOSPITAL ADVISORY COMMITTEE MEMBERS’ REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 25th March 2015 Director having interest Interest in Particulars of interest Disclosure date Board Action Wendy Lai

HBL – Food & Laundry & FPSC Programme

Ms Lai declared a specific interest in regard to Deloitte providing support to HBL in the food and laundry and FPSC Programme. Deloitte has mainly been providing Oracle implementation resources to FPSC. Ms Lai is not directly involved with this work.

12 February 2014

That Ms Lai’s specific interest be noted and that the Committee agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.

Wendy Lai

Te Pou Matakana Deloitte is currently working with Te Pou Matakana (TPM) which is a subsidiary of Waipereira Trust. TPM has been awarded the contract as the Commissioner for Whaanau Ora services for North Island Maori.

7th May 2014 That Ms Lai’s specific interest be noted and that the Committee agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.

Sandra Alofivae

Board Member, Pacific Futures Board

7th May 2014 That Ms Alofivae’s specific interest be noted and that the Committee agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.

8

Glossary

ACC Accident Compensation Commission ADU Assessment and Diagnostic Unit ARDS Auckland Regional Dental Service CADS Community Alcohol, Drug and Addictions Service CAMHS Child, Adolescent Mental Health Service CNM Charge Nurse Manager CT Computerised Tomography CW&F Child, Women and Family service DNA Did not attend ESPI Elective Services Performance Indicators FSA First Specialist Assessment (outpatients) FTE Full Time Equivalent ICU Intensive Care Unit MHSG Mental Health service group MoH Ministry of Health MTD Month To Date MOSS Medical Officer Special Scale OHBC Oral health business case ORL Otorhinolaryngology (ear, nose, and throat) PACU Post-operative Acute Care Unit PHO Primary Health Organisation PoC Point of Care SCBU Special care baby unit SMO Senior Medical Officer SSU Sterile Services Unit TLA Territorial Locality Areas WIES Weighted Inlier Equivalent Separations YTD Year To Date

9

Minutes of the meeting of the Counties Manukau District Health Board

Hospital Advisory Committee Wednesday, 11 February 2015

held at the Innovation Lab, Ko Awatea, Middlemore Hospital

commencing 9.00am

COMMITTEE MEMBERS PRESENT: Dr Lee Mathias (Board Chair) Dr Lyn Murphy (Committee Chair) Ms Wendy Lai Ms Sandra Alofivae Ms Colleen Brown Ms Kathy Maxwell Mr George Ngatai Ms Dianne Glenn Anae Arthur Anae Apulu Reece Autagavaia

ALSO PRESENT: Mr Martin Chadwick (Director Allied Health)

Ms Denise Kivell (Director of Nursing). Ms Margaret White (Deputy Chief Financial Officer, Hospital Services) Dr Gloria Johnson (Chief Medical Officer) Mr Phillip Balmer (Director Hospital Services)

APOLOGIES: Apologies were received and accepted from Mr Geraint Martin, Ms Dana Ralph-Smith, Anae Arthur Anae (left early), Apulu Reece Autagavaia (arrived late).

WELCOME Ms Sandra Alofivae opened the meeting with a short prayer. 2.2 DISCLOSURE OF INTERESTS The Committee noted that Ms Colleen Brown is no longer Chair of the Early Childhood Education Taskforce for COMET and Chair of the ECE Implementation Team Auckland South and no longer a member of the Manurewa Advisory Group and the Child Advocacy Group, Manukau. 2.2 SPECIFIC INTERESTS There were no additional specific interests to note with regard to the agenda for this meeting. 2.3 ACRONYMS The acronym list was noted.

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2.4 CONFIRMATION OF PUBLIC MINUTES Confirmation of the Public Minutes of the Counties Manukau Health Hospital Advisory Committee meeting held 3 December 2014. Resolution (Moved Ms Sandra Alofivae/Seconded Ms Colleen Brown) That the public minutes of the Counties Manukau Health Hospital Advisory Committee meeting held 3 December 2014 be approved. Carried 2.5 PUBLIC ACTION ITEMS REGISTER Resolution (Moved Ms Colleen Brown/Seconded Dr Lee Mathias) Traction is being achieved on Health Literacy in regard to the National Health Targets. Mr Balmer to present to the next HAC meeting (25 March) on the overall strategy and how we are targeting localities. It was agreed that this item come off the HAC agenda and move to the Board Agenda. Resolution (Moved Ms Colleen Brown/Seconded Dr Lee Mathias) That the Public Action Items Register of the Counties Manukau Health Hospital Advisory Committee be received. Carried 3.0 DIRECTOR’S REPORT Mr Phillip Balmer took the Committee through the Director’s report (pages 19-55). • The Spinal Cord Impairment Strategy was discussed in detail. • Standardised Mortality Rate has improved due to various measures that have been put in place. • Health Round Table – CM Health sits comparatively well across all measures. • Keeping the beds open in the Medical Assessment Unit over the 2014/15 summer has shown

that come next year we will have a greater ability to future predict whether or not we will continue to keep these beds open.

• OneStaff to be upgraded and this will see greater efficiencies in staffing. Keeping an eye on pressures for staff.

• A key initiative is more concise report for ease of reading for the Board. Mr Balmer was asked to provide a breakdown of acute theatre minutes by Service for the next HAC meeting (25 March). (Anae Arthur Anae left the meeting at 10am).

11

Surgical & Ambulatory Care (pages 56-66) Ms Gillian Cossey took the Committee through this section of the Director’s report. • December was a very challenging but satisfying month. By 23 December we had achieved the

MoH target of no elective patient waiting longer than 120 days for FSA or treatment. • Elective discharges for December at 112% of the National Health Target. • No falls with major harm for the eighth month in a row. • No CLABs in December. • No SAC 3 or 4 Pressure Injuries. • Results for the six months YTD are comparative with the same period last year. Some challenges/issues identified were: • Sustaining the 120 day elective waiting times for treatment in view of the closure of four

Manukau theatres until the end of February. • Meeting the MoH target for bariatric treatment – this will require allocation of additional

theatre lists up to June 2015. The Committee noted the hard work of the staff in this service to achieve this result. Adult Rehabilitation/Health of Older People (pages 67-75) This section of the report was taken as read. Medicine, Acute Care & Clinical Support (pages 76-85) Mr Brad Healey took the Committee through this section of the Director’s report. • Presentations to EC are continuing to trend upwardly. This continues to put pressure on

services/system. • Length of Stay spiked just after Christmas and then has continued to trend downwards. • Diverium negotiations are progressing well with an answer expected in the next 5 to 10 days. • Histology turnaround time has been confirmed at 5 days. • CTI/MRI –suggestion to move to patient focussed booking in order to better meet patient needs

and improve reporting statistics. • Gastroenterology continues to have capacity issues resulting in increasing waiting lists. A

business case for additional facilities is currently being developed. Mr Healey was asked to report back to HAC at a later meeting.

• Faster Cancer Treatment - 30% below our target. Mr Healey was also asked to report back on this initiative.

Women’s Health & Kidz First (pages 86-97) Ms Nettie Knetsch took the Committee through this section of the Director’s report. • Birth numbers are stable. • Numbers are continuing to increase with women accessing LMCs. • WIES equivalent is slightly up reflecting the complexities of this district. • Tubal ligations have reduced by half with the increase in the use of long term contraception. • Obesity continues to be a concern in this district. There is a National Strategy in relation to this

and targets will be revealed over the next year. • Children with BMIs over 35 are being brought to the notice of their parents. • Ko Awatea is to run a session on how, in this age, we address the issues of obesity/behaviours. • Healthy Families to return to CPHAC.

12

Mental Health & Mental Health Risk Register (pages 98-108) Ms Tess Ahern, GM Mental Health took the Committee through this section of the Director’s report. • Regional Mental Health - working with Mother’s on a case by case basis. • Koropiko Inpatient Service – The occupancy in Koropiko has been over 100% and some service

users have been admitted to Tiaho Mai in order to assist with managing demand however, this is not satisfactory as the client groups are very different. This is an area that requires focus and further discussion to identify what is required to support the ongoing increased demand for MHSOP acute hospital care and how we work together with PHOs.

Non-Clinical Support Services (pages 109-113) This section of the report was taken as read. Director of Allied Health Report (pages 114-115) This section of the report was taken as read. Director of Nursing Report (pages 116-117) Ms Denise Kivell took the Committee through this section of the Director’s report. • New Graduate class in January. 71 graduates, 10 in Mental Health, 1 in Corrections. • Of the previous graduate class of 67, 63 remain at CM Health; 4 Maaori and 11 Pacific. Resolution (Moved Dr Lyn Murphy/Dr Lee Mathias) That the Director of Hospital Services report be received. Carried 4.0 PRESENTATIONS 4.1 Workforce Diversity Strategy (pages 118-125) Ms Beth Bundy, GM Human Resources, Ms Kim Wiseman, Building Capacity Lead and Ms Caroline Tichbon, Future Workforce Development Manager took the Committee through the presentation. A copy is available on the CMH website. • Virtual Academy Model will be the first in New Zealand. The MoH are interested and have

provided additional funding. • The spin-offs from having an increased workforce sitting within the region are numerous. • Social Bonds – there is an opportunity to do some further investigation in this area and the

Finance team are currently undertaking this work. • The Executive Leadership Team are committed to a diverse workforce. • Recruitment and Retention Strategy - any additional work will flow on from the Values &

Strategy Refresh work. • We will still need to commit to the regional activities.

13

4.2 Medication Safety Programme (pages 126-163) Mr Chip Gresham, Senior Medical Officer and his team took the Committee through the presentation. A copy is available on the CMH website. • The Medication Safety Programme is about designing systems to reduce preventable harm to

patients from medicines; promoting a culture of medication safety; making it easier to do the right thing.

• Medication Safety Assessment Tool was created in the United States and adapted by Australia. The MSSA is a tool to help assess the safety of our medicine systems and processes, identify opportunities for improvement and helps prioritise potential goals within medication safety. We will be the first hospital in New Zealand to complete the assessment.

• MSC needs to be brought onto the Electronic Pharmacy system. The Committee asked for that a copy of Mr Gresham’s updated presentation be distributed to them. 5.0 QUALITY & SAFETY 5.1 Inpatient Experience Survey Report (pages 164-167) Dr David Hughes, Clinical Director Patient Safety and Quality Assurance took the Committee through this report. Report 3 focussed on the confidence and trust that patients have in our staff and services. Overall the feedback was positive with inpatients believing that the following things make the most difference to the quality of their care and treatment – communication, being treated with compassion and dignity and, respect and confidence in care and treatment. 6.0 RESOLUTION TO EXCLUDE THE PUBLIC Resolution (Moved Dr Lee Mathias/Seconded Ms Dianne Glenn) That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General Subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

7.1 Patient Safety Report/HQSM Report

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.

[NZPH&D Act 2000 Schedule 3, S.32 (a)]

Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)]

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7.2 Risk Register Report




7.3 Minutes of HAC meeting 3 December 2014 with public excluded

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

Confirmation of Minutes For the reasons given in the previous meeting.

7.4 Action Items Register Confidential


Action Items Register For the reasons given in the previous meeting.

7.4.1 Relationship between patient safety and health and safety.




7.5 Eligibility Letter for Renal Patients

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result

Privacy The disclosure of information would not be in the public interest

15

in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.


because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)]

Carried 12.20pm Public excluded session. 12.30pm Open meeting resumed. The meeting concluded at 12.30pm. The minutes of the Counties Manukau Hospital Advisory Committee meeting held on Wednesday, 11 February 2015 be approved. (Moved /Seconded ) Chair Dr Lyn Murphy Date

Items once ticked complete and included on the Register for the next meeting, can then be removed the following month.

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Hospital Advisory Committee Meeting – Action Items Register – 25 March 2015 DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

11.6.2013 3.1 Health Literacy - all committee members to keep

health literacy front of mind about what the Board can do in this area over its next 3 years.

All committee members

This item has been transferred to Board

2.7.14 6.1 Patient Safety Report – VHIU - Mr Martin to discuss with Dr Harry Rea and report back on how many of the 2000 patients in top section of the triangle would no longer be there now due to them moving down into the ARI category.

TBC

Mr Martin

13.8.2014 3.1 Director’s Report Health & Safety Hazard Register

Pending

Mr Balmer

Copy to come to HAC when compiled by OH&S.

10.9.2014 3.0 Director’s Report – Have our vacancies increased as a percentage – has it changed; if we are carrying the same level of vacancies is the right approach outsourcing/casual overtime etc or is there another way for us to think about it.

Pending

Mr Balmer

Further work being undertaken.

10.9.2014 3.0 Director’s Report – Clinical Engineering –we have a deficit of skills in this area. Mr Martin to discuss this with the new CEO at Waikato to see it is feasible to do anything with their DHB.

Pending

Mr Martin

Mr Martin has a meeting scheduled with Mr Nigel Murray shortly and will report back to the Committee.

10.9.2014 3.0 Director’s Report – Surgery – Orthopaedics –

undertaking analysis of what the projections are going forward, knowing the unmet need is going to increase. Report back when data is available.

March Mr Balmer Working on a new model of care – deferred to March.

5.11.2014 3.0 Director’s Report Maaori & Pacific DNA action plan to be presented when finalised

March

Mr Balmer

Included in Director’s Report this month.

5.11.2014 3.1 Surgery & Ambulatory Care – Cap plan demonstration.

March Mr Balmer Deferred to March due to Dashboard issues.

5.11.2014 3.3 Medicine – copy of the Middlemore Foundation work programme to be provided to HAC.

March Mr Balmer/Mr Healey

Included on this month’s agenda

Items once ticked complete and included on the Register for the next meeting, can then be removed the following month.

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DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

3.12.2014 3.0 Director’s Report Acute Spinal Unit – spinal, burns & plastics are not classified as ‘tertiary’. Mr Martin to raise at next regional CEOs meeting and come back with a work programme.

March

Mr Martin

3.12.2014 3.0 Director’s Report Ms White to provide some data analysis on the acute surgical WIES that would show whether there has been a shift in the overall demand.

March/April

Ms White

Verbal update to come in April.

3.12.2014 3.1 Surgery & Ambulatory Services Ms Cossey to provide further information on the new training programme for Optometrists in her February report. Ms Cossey to report back when she has more information about adopting the Australian system of prioritisation for theatres.

Pending Date TBC

Ms Cossey/Mr Balmer Ms Cossey/Mr Balmer

Currently waiting for ADHB work to be completed before able to give an update.

3.12.2014 3.3 Medicine Mr Healey to provide further information on the 25 Falls causing major harm YTD.

March

Mr Healey/Mr Balmer

Included in this month’s report.

11.2.2015 3.0 Director’s Report – provide a breakdown of acute theatre minutes by service.

March Mr Balmer

11.2.2015 3.3 Medicine Report Mr Healey to report back on Gastroenterology capacity issues. Faster Cancer Treatment – 30% below our target. Mr Healey to report back on this initiative.

Date TBC March

Mr Balmer/Mr Healey Mr Balmer/Mr Healey

Included in this month’s report

HAC: 25th March 2015

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3.0 Hospital Services Report

Recommendation It is recommended that the Hospital Advisory Committee receive the Hospital Services Report covering activity in January 2015 as follows: Prepared and submitted by: Phillip Balmer, Director Hospital Services


19

Additional Acronym and abbreviations used in this report

ALOS Average Length of Stay ARHOP Adult Rehabilitation / Health of Older People Division ARRC Aged Related Residential Care ASRU Auckland Spinal Rehabilitation Unit AT&R Assessment Treatment and Rehabilitation AUT Auckland University of Technology BFHI Baby Friendly Hospital Initiative BSC Balanced Score Card CEO Chief Executive Officer CGS Community Geriatric Service CLAB Central Line Associated Bacteraemia DHB District Health Board DOSA Day of Surgery Admission DRES Delivery Redesign Elective Services DSS Decision Support Service (within Health Intelligence & Informatics Ko Awatea) EAM Enterprise Asset Management EC Emergency Care e-MR Electronic Medication Reconciliation ETT Exercise Tolerance Test FNA Free Needle Aspiration (biopsy) GP General Practitioner hA healthAlliance HBL Health Benefits Ltd HBT Home-based Team ISMP Institute for Safe Medication Practices KPI Key Performance Indicator LMC Lead Maternity Carer MAU Medical Assessment Unit (short stay areas) MECA Multi -Employer Collective Agreement MHSOP Mental Health Services Older people MIT Manukau Institute of Technology MORRSA Multidisciplinary clinic- Occupational Therapy, Physiotherapy & Nurse Specialist. MSC Manukau Super Clinic MRI Magnetic Resonance Image MRO Multi-Resistant Organisms MRSA Methicillin-resistant Staphylococcus aureus MSOP Musculoskeletal Outpatient Physiotherapy NASC Needs Assessment / Service Coordination NEQIP National Endoscopy Quality Improvement Programme


20

NNU Neonatal Unit NZNO New Zealand Nurses Organisation PER Partnership in Evaluation towards Recovery (mental health service) POAC Primary Options Acute Care PSA Public Service Association PSH Practising Sustainable Healthcare PWCC Patient/ Whaanau Centred Care RAC Referral and Appointment Centre REAMHS Research, Evaluation and Audit - Mental Health Services RIS PAC Radiology Information System / Picture Archive & Communication RMO Registered Medical Officer SACS Surgical & Ambulatory Care Services STEMI- PCI ST segment elevation myocardial infarction (STEMI) - Percutaneous coronary

interventions (PCI). SUDI Sudden Unexplained Death of Infant TADU Theatre Admission/ Discharge Unit WH Women’s Health

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3.01 Executive Summary

Activity summary a) Emergency Care (EC) presentations actual versus 2013/14 presentations

January had 671 additional presentations as compared with the previous year’s volumes. YTD there have been 2819 additional presentations as compared with last year (Ave 22/day).

b) EC presentations (discharges against contract) actual versus projected for 2014/15 - as agreed with the Funder January had 725 additional presentations as compared with the forecast volumes. YTD there have been 2064 additional presentations as compared with last year. Our 14/15 contracted volumes underestimated the increase in demand.

N.B. Presentations refer to all people entering Emergency Care, while Discharges only include those that are admitted/ treated and includes a growth assumption on last year volumes (excludes a small number of cases that leave unseen, or are transferred).

c) WIES volumes actual versus projected for 2014/15 - as agreed with the Funder January month WIES volumes (shown below) are (4%) below the funded agreement ((6%) for Acute and (12%) below for Electives). YTD WIES volumes as compared with the previous year are 1% higher (1% acute and (1%) for elective.

d) Patient discharge volumes actual versus 2013/14 patient discharge volumes. (refer over) January • WIES volumes are down by (2%). • Patient discharge volumes remain up 1% (Electives (14%) and acutes 5%) or 94 more discharges

as compared to last year (Elective s (157) and acutes 256 discharges). The reduction in Electives is in part due to the fact the four theatres were closed for upgrades from December through to the end of March. Additional volumes are being provided through outsourcing

Volumes Month YTD

Act Last Yr / Contract

Var Act Bud / Contract

Var

Emergency Care

Presentations (against last year) 8293 7622 671 63464 60645 2819

Discharges (against contract) 9,175 8,450 725 64,990 62,926 2,064

22

YTD • WIES volumes are up 1% on last year’s actuals (Electives down (11%) and Acutes no change; • Patient discharge volumes are up 2% on last year (Electives down (1%) and Acutes up 2%) or

823 discharges on last year’s actuals (Electives 63 discharges lower in the month and Acutes 886 higher). .

1.3 Financials • The Provider Arm produced a $446k deficit for the month, reporting a favourable result against

budget of $86k for January 2015. This contributes to the consolidated DHB variance of $7k favourable to budget.

• Favourable personnel costs $1.8m, reflect the planned management of vacancies and annual leave over the Christmas/New Year period. Some of these savings are offset by the need to outsource to cover key vacancies (eg Mental Health) and outsource clinical services where we are short on specialist capacity.

• The delayed uptake for healthAlliance procurement and HBL Laundry contribute to the cost pressures within the DHB. Deployment of nursing and bed projects have ensured YTD delivery to budget despite the level of acute demand (vs contract/budget).

• Note that YTD revenue includes $550k revenue for Spinal Cord Impairment (SCI) acute spines, reflecting the MOH proposal for a supplementary payment in additional to WIES. This remains at risk pending confirmation by MOH. Accrues SCI revenue reflects IDF referrals only - we have treated 13 CMH SCIs at an estimated cost of $250-300K.

• The YTD result also includes recognition of $535K IDF inflow revenue. YTD IDF inflow (other DHB patients treated by CMH) is 221 WIES favourable to budget. This equates to est $1M WIES revenue. The balance of the revenue is not recognised at this time, pending wash-up for IDF outflow (CMH patients treated in other DHBs) which cannot be confirmed until conclusion of the financial year in June 2015.

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3.02 BALANCED SCORECARD (See definitions in Appendix A)

HOSPITAL SERVICES BALANCED SCORECARD

January 2015

NOTES

* performance is against 2013/14 actual~ YTD figures not applicable, or reliant on further work to establish a data set# YTD records Baseline (2013 audit) results∆ ESPI interim results subject to change^ Ambulatory Sensitive Hospitalisation rates and targets data from MoH - rates are standardised (100% national average). Data reported March/ Sept

NATIONAL HEALTH TARGETS - hospital

month result trend Def

since Feb-14 Jan-15 Target Var Actual Target VarEmergency Care - 6 hour LOS target 95.9% 95% 0.9% 95.7% 95% 0.7% 28

% Cancer Treatment (ADHB Radiotherapy) in 4 weeks 100% 100% 0.0% 100% 100% 0.0% 30

Elective Access - discharges 103.6% 100% 3.6% 111.5% 100% 11.5%% smokers receive smokefree advice -Total 95% >95% 0% 95% >95% 0% 77

BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCES

month result trend Def

since Feb-14 Jan-15 Target Var Actual Target VarTotal Caseweight 5,722 6,074 -6% 46,609 46,330 1% 1

Acute Caseweight 4,619 4,822 -4% 36,502 35,970 1% 2

Elective Caseweight 1,103 1,252 -12% 10,107 10,360 -2% 3

Total Discharges * 6,668 6,574 1% 52,452 51,629 2% 4

Budgeted FTEs 5,462 5,740 4.8% 5,669 5,765 1.7% 6

Operating Costs ($000) 23,715 22,255 -6.6% 171,074 162,675 -5.2% 7

Personnel Costs ($000) 43,949 45,762 4.0% 309,215 314,433 1.7% 8

Financial Result Total ($000) -446 -533 87 -3,302 -3,426 124 9

Outpatient FSA Volumes* 6,624 6,928 -4% 59,074 56,894 4% 10

Outpatient Follow Up Volumes* 22,472 23,384 -4% 182,551 181,034 1% 11

Virtual FSAs (GP consult and nonpatient appointments) 203 196 4% 2,026 1,779 14% 12

Reduce clinical outsourcing ($000) 1,258 1,154 -104 9,850 8,887 -963 13

HR metrics

since July 14 Jan-15 Target Var Actual Target VarExcess Annual Leave dollars ($000) - estimated cost for excess 3,034,031$ $1,421,580 -$1,612,451 ~

Adult Rehab / Health of Older People 77,500$ $64,613 -$12,887 ~Medicine/ Acute Care and Clinical Support 825,959$ $548,437 -$277,522 ~

Surgical/ Ambulatory Care 1,193,747$ $438,374 -$755,373 ~Mental Health 216,767$ $143,934 -$72,834 ~

Kidz First/ Women's Health 720,058$ $226,223 -$493,835 ~

% Staff Annual Leave >2 years 10.7% 5.0% -5.7% 11.2% 5.0% -6.2% 14

Adult Rehab / Health of Older People 6.0% 5.0% -1.0% 6.5% 5.0% -1.5%Medicine/ Acute Care and Clinical Support 7.5% 5.0% -2.5% 9.6% 5.0% -4.6%

Surgical/ Ambulatory Care 13.6% 5.0% -8.6% 13.8% 5.0% -8.8%Mental Health 7.5% 5.0% -2.5% 8.8% 5.0% -3.8%

Kidz First/ Women's Health 15.9% 5.0% -10.9% 16.7% 5.0% -11.7%% Staff Turnover (YTD no. voluntary turnovers by average headcount) 1.2% 2.0% 0.8% 9.4% 10.0% 0.6% 15

% Sick Leave 3.1% 2.8% -0.3% 2.8% 2.8% 0.0% 16

Workplace Injury Per 1,000,000 hours 8.97 10.50 1.53 18.02 10.50 -7.52 17

Where employees report a secondary identity Maaori, Pacific and Asian have been prioritised in that order. Var VarWorkforce Diversity - Leader data 2014 workforce population workforce population 19

Maaori 7% 16% -9% 6% 16% -10%Pacific 11% 23% -12% 8% 23% -15%Asian 29% 23% 6% 28% 23% 5%

NZ European / non-specified/ other 53% 38% 15% 58% 38% 20%

Ensu

ring

Fina

ncia

l Sus

tain

abili

tyEn

ablin

g Hi

gh P

erfo

rmin

g Pe

ople

Year to date

Year to date

Average last 12 months

Jan-15 Jan-14

Year

24

IMPROVED QUALITY, SAFETY AND EXPERIENCE OF CARE

NB data reported from December 14 to align with patient safety report

Jan-15 Target Var CL Target Var% e-medication reconciliation -high risk patients within 48hrs 65% 80% -15% NA 80% #VALUE! 20

% Serious Pressure Injuries rate / 100 Patients 0.81% <3.5% 2.7% 0.6% <3.5% 3.0% 21

Falls causing major harm rate / 1,000 bed days 0.04 0.00 -0.04 0.13 0.0 -0.13 22

Rate of adverse events rate / 1,000 bed days (Jun 14) 62.76 tbc NA 23

CLAB rate / 1,000 line days 0.00 0.0 0.0 NA 0.0 #VALUE! 24

Rate of S. aureus bacteraemia rate / 1,000 bed days 0.0 0.00 NA 0.0 #VALUE! 25

Q1 14/15 Target Var baseline Target Var% Operations - all 3 parts of the Surgical Safety Checklist used # 91% 90% 1% 86% 90% -4% 26

% 75+ years assessed for the risk of falling # 94% 90% 4% 97% 90% 7% 27

% 75+ years assessed for falls risk with falls intervention plans # 94% 90% 4% 92% 90% 2% 27a

Jan-15 Target Var Actual Target Var% Radiotherapy commences in 4 weeks - National Health Target 100% 100% 0% 100% 100% 0% 30

% Chemotherapy commences in 4 weeks – National Health Target 100% 100% 0% 100% 100% 0% 31

% MRI scans completed within 6 weeks from referral - MOH IDP 44% 80% -36% 59% 80% -21% 33

% CT scans completed within 6 weeks from referral - MOH IDP 47% 90% -43% 76% 90% -14% 34

% urgent diagnostic colonoscopy within 14 days - MOH IDP 97.4% 75% 22% 72% 75% -3% 37

% diagnostic colonoscopy patients within 42 days - MOH IDP 24.7% 60% -35% 27% 60% -33% 38

% surveillance colonoscopy patients within 84 days - MOH IDP 98.9% 60% 39% 95% 60% 35% 39

% cardiac STEMI-PCI (angiography) <120mins - Northern Region 87.0% 80.0% 7% 83% 80.0% 3% 41

% Coronary Angiography within 90days - MOH IDP (1mth arrears) NA 85.0% #VALUE! NA 85.0% #VALUE!

ESPI 2: No. patients waiting >4 mths for FSA - Elective ∆ 1 0 -1 0 0 0 42

ESPI 5: No. patients waiting >4 mths treatment - Elective ∆ 1 0 -1 0 0 0 43

Radiology - Inpatient radiology completion times <24hrs 93% 95% -2% 92% 95% -3% 35

Radiology- Emergency Care radiology completion times <2 hrs 95% 95% 0% 95% 95% 0% 36

Acute Surgery Priority Score - delay for surgery 81% 80% 1% 81% 80% 1% 44

Q2 Target Var Actual Target VarFaster Cancer Treatment - % high suspicion first cancer treatment within 62 days - MOH FCT + target by 2016 59% 85% -26% 52% 85% -33% 45

Faster Cancer Treatment - % confirmed diagnosis first cancer treatment within 31 days - MOH FCT + 90% na 90% na 46

% Radiology results reported within 24 hours 60% 75% -15% 61% 75% -14% 47

Jan-15 Target Var Actual Target VarAverage Length of Stay - Acute Inpatient - MOH IDP 2.8 2.98 0.18 2.9 2.98 0.08 50

Average Length of Stay - Acute Arranged/ Elective - MOH IDP 1.53 1.37 -0.16 1.47 1.37 -0.10 51

MMH % patients to discharge lounge or home by 1100hrs 17.4% 30% -13% 17% 30% -13%Acute Readmissions within 7 days - Total 3.4% 2.89% -0.5% 3.3% 2.89% -0.4% 52

Acute Readmissions within 28 days - Total - MOH IDP 6.6% 8% 1.0% 7.5% 8% 0.1% 53

Acute Readmissions within 28 days - 75+ years - MOH IDP 11.0% 11.85% 0.9% 11.2% 11.85% 0.6% 54

EC Presentations - 75+ year olds (5% reduction on 2013) 878 807 -71 6,682 4,842 -1840 55

% clinical summaries (meddocs) authorised <7 days of creation 68% 90% -22% 71% 90% -19% 56

% of patient outliers - not on home ward <5% 3% 5% 2.0% 4% 5% 1.0% 58

Health Quality and Safety QSM - QUARTERLY AUDIT REPORTING

Year to date

Tim

ely

Firs

t, Do

No

Harm

(Saf

ety)

Year to date

Year

Year to date

YearQUARTERLY REPORTING

Syst

em In

tegr

atio

n (E

ffec

tive)


January 2015

NOTES


25


January 2015

NOTES


Q2 Target Var Actual Target Var

% Eligible stroke patients thrombolysed - Northern Region 2.6% 6.0% -3.4% 5.0% 6.0% -1.0% 59

% DHB Mental Health Services - children/ youth (0-19years) seen by 3 weeks for non-urgent mental health - MOH IDP 70.5% 75.0% -4.5% NA 75.0% #VALUE! 48

Mental Health access rate - clients seen in last 12 months as % of population (0-19 Years) 3.26% 3.15% 0.1% NA 3.15% #VALUE! 49a

Mental Health access rate - clients seen in last 12 months as % of population (20-64 Years) 3.82% 3.15% 0.7% NA 3.15% #VALUE! 49b

Mental Health access rate - clients seen in last 12 months as % of population (64+ Years) 2.55% 2.70% -0.2% NA 2.70% #VALUE! 49c

Ambulatory Sensitive Hospitalisation rates - MOH IDP ^ See note - standardised national data 2013.140-4 years - Total 104% 101% -3% 99% 60

0-4 years - Maaori 128% 118% -10% 119%0-4 years - Pacific 136% 118% -18% 136%0-74 years - Total 120% 114% -6% 122% 60a

0-74 years- Maaori 206% 119% -87% 220%0-74 years- Pacific 184% 119% -65% 187%

Jan-15 Target Var Actual Target VarOutpatient - First Specialist : Follow-up Clinic ratio 29% 30% 1% 32% 31% -1% 61

Outpatient - DNA rates - Maaori 12% 10% -2% 12% 10% -2% 62

Outpatient - DNA rates - Pacific 9% 10% 1% 9% 10% 1% 62a

Theatre List Utilisation 101.1% 88.0% 13% 89.3% 87.4% 2% 63

Day of Surgery Admissions (DOSA) 93% 90% 3% 91% 90% 1% 65

Day Case Rate (Elective/ Arranged) 64.0% 65% -1% 63.1% 65% -2% 66

% Medical Assessment patients with LOS < 28 hours 99% 65% 34% 99% 65% 34% 68

No. Hospital bed days occupied (against forecast open beds) 19,098 21,448 12% 141,058 131,516 -7% 73

No. Length of Stay outliers (LOS >10 days)* 251 272 8% 2,001 1,933 -3% 74

Jan-15 Target Var Actual Target VarPatient Experience Survey (rated very good/ excellent) 77% 90% -13% 79% 90% -11% 75

Better Health Outcomes For All

Jan-15 Target Var Actual Target Var% Infants Exclusively Breastfed at discharge - Total 81.0% 75% 6% 80.0% 75% 5% 76

% Infants Exclusively Breastfed at discharge - Maaori 86.0% 75% 11% 81.0% 75% 6%% Infants Exclusively Breastfed at discharge - Pacific 76.0% 75% 1% 78.0% 75% 3%

% smokers receive smokefree advice - Maaori 96% >95% 1% 96% >95% 1% 77

% smokers receive smokefree advice - Pacific 95% >95% 0% 95% >95% 0%

% Women (45-60yrs)with Breastscreen in 24months - Total NA 70% #VALUE! 70.2% 70% 0% 78

% Women (45-60yrs)with Breastscreen in 24months - Maaori NA 70% #VALUE! 69.8% 70% 0%% Women (45-60yrs)with Breastscreen in 24months - Pacific NA 70% #VALUE! 73.6% 70% 4%

Equi

ty

Year to date

Year to date

Patie

nt

Wha

anau

Ef

ficie

ntSy

stem

Inte

grat

ion

(Eff

ectiv

e)

QUARTERLY REPORTINGYear

(n = 181) Year to date (n = 1148)

26

National Health Targets: All graphs demonstrate consistent performance in meeting national health targets. All targets were achieved for Quarter 1 of the 2014-15 year. SmokeFree Support for hospitalised Smokers – Target 95% are identified and offered support.

Achieved: January result 95%

Emergency Care Department – Length of Stay – Target 95% are seen and admitted or discharged within 6 hours. Achieved: January result 96%

27

Achieving the 6 hour target remains a challenge with the ongoing increase in patient volumes as shown.

Elective Discharges – Target 100% of additional agreed elective discharges are delivered to achieve Ministry of Health national annual increase of 4,000 additional elective discharges (not WiES). Achieved: January result 104%

FY2014/15 Counties Manukau National Health target is 16200 Elective Discharges. .N.B. Current target is <120 days (from 31/12/2014). The data below is from National Elective Services reporting and has some time delay, compared to internal reporting in the Balanced Scorecards. Adjusted data is provided through the month.

2104

2046

2041

2102

2012

1978

2116

2122 21

4322

06

1400

1600

1800

2000

2200

2400

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52

Pres

enta

tions

Week

Weekly EC Presentations by Calendar Year

2011 2012 2013 2014 2015 UCL

28

Report Run Date: 04/03/2015 - data subject to change

Patients given a commitment to treatment but not treated within FOUR months.

2014 01 2014 02 2014 03 2014 04 2014 05 2014 06 2014 07 2014 08 2014 09 2014 10 2014 11 2014 12 2015 01350 356 252 280 163 193 243 230 189 153 88 0 0263 240 305 267 141 227 192 143 99 68 24 0 0119 153 194 171 112 111 124 93 76 62 60 2 72296 241 302 211 123 159 184 130 93 40 12 0 12

3,625 3,202 2,957 2,947 1,851 1,952 2,355 2,125 1,754 1,638 1,041 123 638

Patients given a commitment to treatment but not treated within FIVE months.

2014 01 2014 02 2014 03 2014 04 2014 05 2014 06 2014 07 2014 08 2014 09 2014 10 2014 11 2014 12 2014 0154 57 31 33 25 7 19 41 18 16 16 0 05 5 4 19 2 2 2 3 0 2 0 0 07 10 46 61 12 23 37 12 11 9 7 1 1

24 23 23 35 16 11 25 20 17 7 7 0 0681 628 393 689 409 150 219 398 333 367 196 54 87

Patients waiting longer than FOUR months for their first specialist assessment (FSA).

2014 01 2014 02 2014 03 2014 04 2014 05 2014 06 2014 07 2014 08 2014 09 2014 10 2014 11 2014 12 2014 01737 558 483 532 374 531 639 599 479 451 179 0 0391 283 339 214 214 200 185 129 39 6 21 0 1491 373 386 234 150 158 162 111 63 51 19 0 9

1,242 1,111 831 687 655 604 682 388 314 156 76 0 177,494 6,261 5,329 4,280 3,560 3,547 3,668 2,952 2,551 2,334 1,630 50 552

Patients waiting longer than FIVE months for their first specialist assessment (FSA).

2014 01 2014 02 2014 03 2014 04 2014 05 2014 06 2014 07 2014 08 2014 09 2014 10 2014 11 2014 12 2014 0153 30 36 35 24 20 18 5 25 20 19 0 019 2 2 2 2 4 0 0 2 0 0 0 032 9 9 12 11 4 12 11 4 7 5 0 087 11 18 23 0 13 1 0 0 0 1 0 0

792 375 175 346 230 190 166 182 108 177 168 8 12National Total:

National Total:

AucklandCounties ManukauNorthlandWaitemata

Waitemata

National Total:

AucklandCounties ManukauNorthlandWaitemata

National Total:

AucklandCounties ManukauNorthland

Waitemata

Number of patients waiting more than four, five months for Treatment or an FSA

AucklandCounties ManukauNorthland

0

100

200

300

400

Regional ESPI - Treatment over 120 Days

Auckland

CountiesManukau

Northland

Waitemata

0

300

600

900

1,200

Regional ESPI - FSA over 120 Days

Auckland

CountiesManukau

Northland

Waitemata

29

3.03 FINANCIAL SUMMARY Best value for public health system resources Financial Performance

Actual Budget Variance Comparative Actual Budget Variance

$(000) $(000) $(000)Variance to Prev Mnth $(000) $(000) $(000)

Income

Government Revenue 4,202 4,247 (44) U 31,253 30,662 590 F

Patient/Consumer Sourced 733 750 (17) U 5,257 5,027 230 F

Other Income 1,337 1,672 (335) U 13,209 12,281 929 F

Funder Payments 60,945 60,816 129 F 427,268 425,713 1,555 F

Total Income 67,217 67,485 (268) U 476,987 473,682 3,304 F

Expenditure

Personnel 43,949 45,762 1,814 F 309,215 314,433 5,218 F

Outsourced Personnel 1,241 882 (360) U 8,853 6,166 (2,688) U

Outsourced Clinical 1,999 1,299 (700) U 11,285 9,901 (1,384) U

Outsourced Other 2,490 2,374 (116) U 17,476 16,649 (827) U

Clinical Supplies (excluding Depreciation) 7,832 7,443 (389) U 61,189 56,108 (5,080) U

Other Expenses 5,211 5,036 (175) U 36,814 37,303 489 FTotal Expenditure (excl Depreciation, Interest and Capital Charge) 62,722 62,796 75 F 444,832 440,559 (4,273) U

Earnings before Depreciation, Interest and Capital Charge 4,496 4,689 (193) U 32,155 33,123 (969) U

Depreciation 2,701 2,846 146 F 19,278 19,925 647 F

Interest 1,083 1,280 198 F 7,509 8,963 1,454 F

Capital Charge 1,159 1,095 (64) U 8,670 7,662 (1,008) U

Total Depreciation, Interest and Capital Charge 4,942 5,221 279 F

35,457 36,549 1,092 F

Net Surplus/(Deficit) Provider (446) (533) 86 F (3,302) (3,426) 124 F

Month Year to DateConsolidated Statement of Financial PerformanceJanuary 2015

30



Clinical

Women & Child Health (5,535) (5,798) 262 F (39,075) (39,713) 638 F

Medical & Clinical Support (16,809) (17,405) 596 F (120,071) (119,964) (107) U

ARHOP (4,401) (4,566) 164 F (31,350) (31,881) 532 F

Mental Health (5,662) (5,724) 62 F (39,413) (39,741) 328 F

Surgical & Ambulatory (14,556) (14,848) 292 F (103,722) (105,111) 1,389 F

Director of Nursing (89) (18) (71) U (127) (127) 0 F

Middlemore Central (356) (350) (6) U (2,436) (2,428) (8) U

Total Clinical (47,410) (48,709) 1,299 F (336,193) (338,965) 2,772 F

Non-ClinicalCorporate (incl Provider Arm Revenue from Funder) 52,711 53,489 (778) U 373,877 374,777 (899) U

HBL (150) 85 (235) U (1,080) (150) (930) U

Health Alliance - 472 (472) U - 2,639 (2,639) U

Facilities Services (3,914) (3,930) 16 F (27,236) (28,146) 911 F

Integrated Care (654) (805) 152 F (5,051) (5,638) 586 F

Innovations Hub & Ko Awatea (1,030) (1,134) 104 F (7,619) (7,942) 324 F

Total Non-Clinical 46,963 48,176 (1,213) U 332,891 335,539 (2,648) U

Net Surplus/(Deficit) Provider (446) (533) 86 F (3,302) (3,426) 124 F

Performance Summary by DirectorateJanuary 2015

Month Year to Date



Medical Personnel 14,016 14,729 712 F 98,260 101,668 3,408 F

Nursing Personnel 17,259 17,226 (33) U 118,614 116,958 (1,656) U

Allied Health Personnel 6,201 6,812 611 F 45,200 47,003 1,804 F

Support Personnel 2,089 2,018 (71) U 14,261 14,196 (65) U

Management/Administration Personnel 4,383 4,977 594 F 32,881 34,608 1,727 F

Total (before Outsourced Personnel) 43,949 45,762 1,814 F 309,215 314,433 5,218 F

Outsourced Medical 651 439 (212) U 4,544 3,086 (1,458) U

Outsourced Nursing 206 37 (169) U 978 265 (713) U

Outsourced Allied Health 50 70 21 F 370 492 123 F

Outsourced Support 44 38 (6) U 292 265 (27) U

Outsourced Mangement/Admin 291 298 7 F 2,669 2,058 (611) U

Total Outsourced Personnel 1,241 882 (360) U 8,853 6,166 (2,688) U

Total Personnel 45,190 46,644 1,454 F 318,068 320,598 2,530 F

Month Year to DatePersonnel Costs By Professional GroupJanuary 2015

31


FTE FTE FTEVariance to Prev Mnth FTE FTE FTE

Medical Personnel 754 785 30 F 769 790 21 F

Nursing Personnel 2,535 2,529 (6) U 2,581 2,546 (34) U

Allied Health Personnel 991 1,128 137 F 1,074 1,125 51 F

Support Personnel 472 470 (2) U 477 475 (2) U

Management/Administration Personnel 710 829 119 F 768 829 60 F

Total (before Outsourced Personnel) 5,462 5,740 279 F 5,669 5,765 96 F

Outsourced Medical 23 16 (8) U 23 16 (8) U

Outsourced Nursing 18 3 (15) U 12 3 (9) U

Outsourced Allied Health 4 5 2 F 4 5 1 F

Outsourced Support 8 7 (1) U 8 7 (1) U

Outsourced Mangement/Admin 36 37 1 F 47 36 (11) U

Total Outsourced Personnel 90 68 (21) U 95 68 (27) U

Total Personnel 5,552 5,809 257 F 5,764 5,833 69 F

Month Year to Date

FTE By Professional GroupJanuary 2015


FTE FTE FTEVariance to Prev Mnth FTE FTE FTE

Clinical

Women & Child Health 663 673 9 F 699 678 (20) U

Medical & Clinical Support 1,548 1,553 5 F 1,577 1,568 (9) U

ARHOP 594 649 55 F 630 647 17 F

Mental Health 623 684 61 F 653 684 31 F

Surgical & Ambulatory 1,332 1,383 51 F 1,372 1,384 12 F

Director of Nursing 11 13 2 F 13 13 0 F

Middlemore Central 49 48 (1) U 47 48 1 F

Total Clinical 4,821 5,003 182 F 4,990 5,022 32 F

Non-ClinicalCorporate (incl Provider Arm Revenue from Funder) 83 106 23 F 93 105 12 F

HBL - - 0 F - - 0 F

Health Alliance - - 0 F - - 0 F

Facilities Services 446 447 1 F 445 452 6 F

Integrated Care 96 113 18 F 107 113 6 F

Innovations Hub & Ko Awatea 106 140 34 F 128 140 12 F

Total Non-Clinical 730 806 76 F 774 811 37 F

Net Surplus/(Deficit) Provider 5,552 5,809 257 F 5,764 5,833 69 F

FTE by DirectorateJanuary 2015

Month Year to Date

32

Financial Performance Trends

**May14: Costs associated to additional elective volumes offset by MoH revenue $3.2m

**Jun14: ACC Levy and depreciation provisions released

33

Month Result Major variances for the Provider Arm Statement of Financial Performance (Fig. 1) follow: Revenue is $(268)k unfavourable for the month of January. The main drivers for the current month’s variance are: • Government Revenue $(44)k; CTA Nursing timing of revenue to budget $(206)k, ACC revenue

phasing reflects a $(372)k variance for the month (YTD $210k) ; Integrated care additional income for Mana Kids programmes $637k (offset by cost); No additional revenue was taken up for Acute Spines in Jan15 $(117)k; other $14k.

• Patient/Consumer Sourced $(17)k; There were no Tahitian burns patients that presented in January $(200)k, this is offset against Non-resident additional billings for the month $182k (offset by bad debts); other $1k.

• Other Income $(335)k; Interest Received is $144k above budget for the month; donation revenue delay in project uptake $(128)k; Classification Pharmac rebate $(250)k transferred to Clinical Support division; Bad debts $(143)k; Other $42.

• Funder Payments $129k; Variation in revenue phasing from Funder for contracts outside base funding ie: 20k days and localities $307k

Expenditure – Total expenditure favourable variance of $75k is driven by favourable personnel costs $1.8m, offset by outsourced personnel $(360)k, outsourced clinical and other $(816)k, clinical supplies $(389)k and other expenses $(175)k. Major variances are explained below:

• Personnel costs Favourable personnel costs $1.8m, reflects planned management of vacancies and annual leave over the Christmas/New Year period. A measure of these savings have been offset by the need to outsource to cover key vacancies (eg Mental Health) and outsource clinical services where we are short on specialist capacity. Medical Personnel costs for the month, $712k reflects existing vacancies, part offset by outsourced services, $(212)k, as well as planned annual leave taken during the holiday period. A strategy to reduce the annual leave liability >2 years has resulted in annual leave being paid out on application and approval by the appropriate General Manager. Nursing personnel costs for the month $(159)K reflects the level of clinical demand within the hospital. Year to date ward nursing costs have increased 0.3% when compared to the same period last year, despite an 4.5% increase in occupied beds for the same period. Please refer to Director of Nursing report for update on the Sustainable Nursing Workforce Strategy. Note that the Personnel cost variance above includes costs incurred in delivering additional unbudgeted revenue of $254k. • Outsourced Costs These are $(1.2)m unfavourable for January (includes personnel, clinical and other). Integrated Care is the main contributor, $(626)k. The Mana Kids Programme (Rheumatic Fever) cost overspend is offset by additional revenue from MoH. Surgical Services, $(204)k. Outsourced surgical procedures continue to maintain the MoH ESPI 120 day targets. Mental Health, $(160)k. The service employed locum medical staff due to a national shortage of psychiatrists (part offset by favourable personnel costs). Kids & Womens $(107)k. External bureau to address skill mix issues within the service.

34

Medicine, $(67)k. External bureau used to cover annual leave and increase spend in initiatives (Sleep, Gastro, Neurology). Other Non-Clinical Outsourcing, $(36)k. • Clinical Supplies $(389)k unfavourable for the month. Delayed target procurement savings across the services of $(708)k are partially offset in other cost and revenue areas. Clinical Support, $85k. Drugs usage reduction based on surgical services volumes. Surgical Services, $32k. Use of stock piled inventory on hand during January. Non-Clinical, $148K. Patient transport and lodging agreement with NTA (MoH National Transport and Accommodation) is $50k favourable to budget reflecting a reduction in the number of patients that required transport in January. Ambulance/Air Ambulances costs were favourable for the month $39k and Health Promotion costs were underspent by $46k; other $13k. Other, $54k. • Other expenses are $(175)k unfavourable for January. The main expense drivers for the

month are: Delayed target laundry procurement savings across the services of $(143)k; Other $32k

• Depreciation, Interest and Capital Charge costs are $279k favourable due to;

CMDHB level of borrowings is lower than budgeted delivering a $198k favourable interest cost variance for the month. Capital Charge unfavourable variance of $(64)k reflects the actual cost of capital charged by MoH against budget. Depreciation $146k favourable variance due to YTD adjustment of IT depreciation to budget.

Year-to-date Result The YTD result is $124k favourable to budget, with WIES tracking at 101% of base contract (Actual 46,793 WIES vs Contract 46,330 WIES). YTD key variances are detailed below. Revenue YTD is $3.3m favourable to January 2015. Positive revenue variances include:

• $85k CTA phasing of actual revenue against budget. • $210k ACC revenue above budget. • $1,011k Increase in Non-Resident billings (offset 80% by Bad Debt provision). • $1,204k Interest income received over budget (reflecting cash holdings higher than budget). • $1,555k Funder payments for contracts outside base funding, offset by expenditure. • $250k Pharmac rebate 2014/15 • $107k Gastro outsourcing funding from MoH • $442k PCT revenue (offset by pharmacy overspends) • $550k IDF inflow washup 2014/15 • $184k Bad Debt recoveries • $146k Other

YTD unfavourable revenue variances include: • $(267)k Acute Spines deferred revenue (recognised 25 spines YTD). • $(477)k Personal Health revenue variance for breast screening (offset in full in cost savings). • $(462)k Base Public Health revenue budget in Integrated Care has been recovered through

expenses YTD. • $(788)k YTD reduction in private patients revenue including Tahitian burns patients. • $(171)k MIT, AUT and Unitech training courses revenue deficit.

35

• $(279)k Donations short fall.

Expenditure YTD is $(4,3)m unfavourable to budget, representing $5.2m personnel costs and $(9.5)m other expenses. Major variances to January are: • Personnel costs $5.2m, 96FTE (excludes outsourced) – Reflects a deliberate strategy to balance

overall 2014/15 budget expectations. The favourable variance is primarily driven by a high level of vacancies (273FTE YTD) that exist across the organisation (representing 4.4% of budget FTE). This is partially offset by external outsourcing (27)FTE and internal FTE cover provided (63)FTE.

• Outsourced services $(4.9)m – $(2.7)M reflects cover provided for vacancies where required to sustain clinical services (partially offsets $5.2m favourable personnel costs); Corporate Services $(827)k including delayed HBL National Procurement Project and Food Service Regional Implementation not budgeted; Lab sendaways and surgical outsourcing services $(1.4)m.

• Clinical Supplies $(5)m – Delayed target procurement savings across the services of $(4.3)m are partially offset by savings in other cost and revenue areas. Non-clinical Patient transport and lodging $(204)k over budget YTD due to increased demand; Clinical Support drug overspend $(687)k partially funded by revenue; labs volume increases mainly in microbiology and bloods $(630)k; radiology supply variance in shunts/stents and treatment disposables $(358)k. Surgical Services are $783k favourable due to acute and elective surgical volumes and achievement of a level of procurement savings (offsetting $4.3m YTD provider arm target). Strategies are in place to reduce elective volume over production based on previous year which has lead to lower YTD clinical supply costs. The above variance includes est $1153K of clinical supply costs incurred in delivering additional unbudgeted revenue: Pharmaceutical Cancer Treatment $550k and Non Residents $303k (Calculated as 30% of additional Non-resident revenue). Spinal implants costs are estimated at $300k YTD.

• Other Expenses $489k – primarily reflects Facilities savings $768k in patient meals, repairs and maintenance and utilities; Integrated Care YTD underspend $772k (offset against unfavourable revenue); Bad debts $(810)k (offset by Non-Resident revenue); delayed target laundry procurement savings $(286)k; other $45k.

• Depreciation, Interest and Capital Charge $1m favourable YTD.

FTE - Full Time Equivalents FTE Total FTE (including outsourced) for January is 5,552 which is 257 FTE below budget and 216 below last month. The January favourable FTE variance reflects a managed level of vacancies within the organisation, together with long term vacancies in some clinical services (covered by outsourcing as appropriate). Planned annual leave taken during the Christmas/New Year period also contributes to the favourable FTE variance, particularly in management/admin, nursing and Allied Health.

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2014/15 Practising Sustainability Healthcare Programme

The approved 2014/15 DAP includes a commitment to Provider Arm target savings of $23m for FY 2014/15. This sits within a $37.7m whole of DHB savings plan.

*hA and HBL procurement savings YTD (primarily clinical supplies) reflect spend in areas monitored under the Procurement strategies. This reflects a mix of price and volume variances. These savings plans are reported in more detail in the Practising Sustainable Healthcare (PSHC) monthly report. As indicated earlier in this report, the sustained increase in clinical demand YTD has impacted target savings strategies. The savings shortfall has been offset by additional funded activity as well as management of FTE and associated resources.

Savings have been categorised as follows: Bud 14/15

Bud YTD 14/15

Act YTD 14/15

PSHC Summary $m's $m's $m's Expenditure initiatives *hA/HBL procurement savings targets (primarily clinical supplies) 8.1 4.4 3.0 Reduce surgical outsourcing (services) 4.4 2.6 1.9 Reduce Bed Day demand (clinical supplies & personnel) 2.0 1.2 0.2 Inventory & supply chain roll-out (all supplies) 0.5 0.3 0.4 Environmental sustainability initiatives 0.5 0.3

HBL Linen & Laundry savings plan 1.0 0.3 Clinical staffing skill mix realignment 1.5 0.7 1.1

Management & Admin. Review 0.9 0.5 1.6 ACC Levy 1.3 0.8 0.8 Other initiatives 1.1 0.7 0.4 Sub-total 21.4 11.6 7.2 Revenue initiatives

Additional Surgical revenue (Acute spines) 1.4 0.8 0.6 Sub-total 1.4 0.8 0.6 TOTAL PROVIDER PHSC Budget Savings plan 22.8 12.4 7.8

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Human Resources: Human Resource metrics are provided to outline performance for Annual Leave Balances, Sick Leave and Turnover rates. Below are the 13 month trend graphs to January 2015

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3.04 HOSPITAL ACTIVITY OVERVIEW Overview of the Hospital

Emergency Care presentations continue to increase with January volumes higher than July 2013 winter volumes. This is higher than the seasonal pattern of previous years. There remains wide day-to-day variation, and while the pressure reduced it is notable that: – The daily presentations per day range from 246-350. – The average was 267 presentations/ day. – 12 days were over 300 EC presentations, (compared with 28 in August). Reflecting the high use of Emergency Care, ward occupancy was also a challenge however with effective teamwork there were only two Dot Days on the 8th and 9th of September.

Middlemore Central

Hospital volumes continued to be high through early September, but receded from a winter peak in August. A winter debrief is scheduled in late October with all services to ensure the right information has been collated to allow for planning to then be initiated for next winter.

The result for the month of January 2015 reflects effective care capacity demand management (CCDM) with the lowest volume of Resourced Beds over the past 19 months, being 20 beds less than Jan-14 as well as reflecting the lowest Gap between resourced and occupied, down to an exceptional result of just two. This was assisted by the unusually high number of bed closures during the Christmas/new year period. The continued drop in the Gap reflects significant improvements in bed management. With YTD reductions in resourced beds at 232 it is anticipated that if the performance continues by year end we will have reduced resourcing to the equivalent of 432 beds or 36 beds per month.

This closer matching of resourced to occupied beds has meant we have been able to maintain closer control of nursing costs with a YTD increase of 0.3%, when compared to the prior year, despite an increase in the number of occupied beds, which are up by an average of 29 beds per month (4.5% YTD) . Both the YTD and full year forecast reflect a highly satisfactory 1% or less increase in the Cost per Resourced Bed, despite an increasing occupancy, expected to be up nearly 6% by year end.

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Hospital full days

With the close matching of resourced beds to actual occupancy we need to monitor closely whether this creates a bottleneck in ensuring faster, safer, more reliable care. One of the indexes for this is what is termed dot days when the beds are full. As you will note from the graphs below Dot Days usually occur on a Monday after the weekend when discharges are reduced and potentially patients are delayed in accessing acute surgery.

Discharge Lounge

One of the ways hospital services can ensure beds are available for acute admissions is to ensure timely discharge from the wards. This enables cleaners to prepare the rooms thoroughly before the new admission arrives and thereby also reduces the cross infection risk. We are seeing an increase in the number of patients discharged before 1100 and 1400 which makes room for the incoming patients.

Since the opening of the discharge lounge there has been increased use with medicine discharging more patients through the lounge than surgery. Despite the benefit achieved Medicine are still

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan2013/2014 2014/2015

Resourced Beds 749 744 753 731 718 680 695 705 713 713 705 725 747 750 752 736 685 699 675Occupied Beds 668 665 679 648 633 617 630 652 660 647 621 661 683 690 690 692 655 663 673Gap (Resourced less Occupied beds) 81 79 74 83 85 63 65 53 53 66 84 64 64 60 62 44 30 36 2

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Resourced vs Occupied Beds(Data from Feb 15 onwards is forecasted)

Wards Included:Medical, Surgical Services MMH, Women's Health, Kidz First, Mental Health Acute, MHSOP

Data Sources:FFARS - Nurse Cost (excl. external bureau)CapPlan - Daily average resourced beds

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discharging two thirds of their patients after 2 pm each day compared to 45% in surgery (shown in purple in the graph below). Initiatives are underway to improve discharge timeliness for Medicine.

Ward specific volumes As shown below the best performing wards in volume were wards 33E/33N followed by 34E/ 2 /32N.

As shown below, surgical areas have demonstrated significant growth in the number of patients discharged before 11am each month and an even greater increase in the number discharged before 1400, for example in January 2014 there were 444 patients discharged by 1400 with the DL and in January 2015 there were 648 patients discharged before 1400 an increase of 200;

ARHOP Critical Care Emergency Care Medical SurgicalDischarged by 11am 13 0 0 93 152Discharged by 2pm 47 8 10 866 1054Discharged after 2pm 36 13 10 1670 913Total Transfers In 96 20 18 2584 2047

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TNBC WD01-AMC

WD02-AMC WD04-ATR WD05-ATR WD06-

AMCWD07-AMC

WD08-AMC

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WD11-AMC WD24-ATR WD32N-

EHBWD33E-

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EHBColumn1 3 62 389 35 66 230 230 303 272 153 127 1 395 530 579 471 333 180

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Discharge Lounge Ward Totals (May 2014 - Jan 2015)

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Certification and quality assurance - A number of initiatives are underway to ensure the adequate and timely completion of work required to meet recommendations identified at the Certification Surveillance audit in November. A number of corrective actions relate to clinical practice evident in several areas of the hospital; these will be managed using an organisational approach. Work has also commenced on developing a robust audit tool for ensuring the compliance with those sector standards (such as medicine management, infection prevention and control) not covered by patient point-of-care audits programme.

Capturing Consumer Experience This data will be presented one month in arrears as it has been found to more accurate.

Now thinking about your whole stay in hospital overall, how would you rate the care and treatment you received?

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3.05 ACTION ARISING RESPONSES Maaori & Pacific DNA action plan update Maaori:

• On-going national work programs with the CMOs • National stocktake on innovation and action • Once the data is analysed and reviewed in this area, local areas will be targeted to accelerate

improvements Pacific:

• A process is already underway where DNA patients are followed up via Fanau Ola, with DNA information provided on a daily basis to the team

• Follow-up with the DNA patients involves phone calls and where appropriate a visit from the community teams

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3.06 Appendix A – Scorecard Glossary - in development HEALTH ADVISORY COMMITTEE SCORECARD NOTES AND DESCRIPTIONS 1 Total Case weight – DSS – This is the total MOH funded WIES for the month and year to date, from the

front page of the most recent Redbook WIES reporting. 2 Acute Case weight – DSS - This is the total ACUTE MOH funded WIES for the month and year to date, from

the front page of the most recent Redbook WIES reporting. 3

Elective Case weight –DSS - This is the total ELECTIVE MOH funded WIES for the month and year to date, from the front page of the most recent Redbook WIES reporting.

4

Total Discharges –DSS - Total number of patients discharged for the month and year to date, from the front page of the most recent Redbook reporting. There is no target/ funder agreement given for this measure, so last year’s actual is used as the target.

5 removed 6 Budgeted FTE –Finance - FFARs FTE actual and budget by month and YTD, as reported in the Provider Arm.

7 Operating Costs ($000) – Finance – FFARs actual and budget by month and YTD, as reported in the Provider

Arm. All expenditure less staff/personnel costs plus 8000-xxxxx internal allocations. 8 Personnel Costs ($000) – Finance – FFARs actual & budget by month & YTD, as reported in the Provider

Arm. 9 Financial Result – total $m (negative is contribution) – Finance – FFARs actual and budget by month and

YTD, as reported in the Provider Arm $m. 10 Outpatient FSA Volumes – DSS – The total number of outpatient type of ‘New Patient’ for the month and

year to date. There is no target/ funder agreement for this measure, so last year’s actual is used as the target.

11

Outpatient Follow Up Volumes –DSS – The total number of outpatient type of ‘Follow-up’ for the month and year to date. There is no target/ funder agreement for this measure, last year’s actual is the target.

12 Virtual FSAs –DSS – volumes of outpatient events for PUC codes M00010 Virtual Medical Firsts and S00011 Virtual Surgical Firsts against contract. To show ‘Increase from baseline by 10%’, a baseline to be provided. Currently using the contract for the year.

13

Reduce clinical outsourcing – Finance. Spend on clinical service outsource against budget

14 Accrued Annual Leave (Rate based measures of staff with high annual leave balances within the DHB) HR - Excessive leave is considered to be those employees with an annual leave balance in excess of 2 years’ worth of their current annual entitlement. Factors in FTEs. Numerator: A count of the number of employees with an excessive annual leave balance as defined above. Denominator: A count of the number of employees with an annual leave balance.

15 Staff Turnover (A rate based measure of staff turnover within the DHB) – HR – Numerator: The number of employees who cease employment due to voluntary resignation during the period. Denominator: The total headcount of employees at the beginning of the period.

16 Sick Leave (A rate based measure of paid and unpaid sick leave hours taken by employees within the DHB) –HR - Measure the proportion of DHB employees’ paid and unpaid hours that are lost to sick leave. Provides an indication of relative effectiveness in maintaining healthy staff and managing absenteeism in the DHB. Does not measure all forms of absenteeism. Numerator: The total number of paid and unpaid sick leave hours taken by DHB employees during the reporting period. Denominator: The total number of DHB paid hours during the reporting period.

17 Incidences of days lost due to staff injuries per 1,000,000 hours worked – HR Measures the proportion of DHB employees who have days lost due to workplace injuries or illness. Injuries or illness associated with the workplace contribute towards lost work hours.

18 Mandatory Training Completed < 3 months:– B Watson - HR This measure is under development 19 Workforce Diversity

– HR 20 Patient Safety e-MR within 48hrs per 100 patients –MMC Aligns with monthly patient safety report

21 Patient Safety Rate of patients with hospital acquired pressure injuries per 100 patients – MMC

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Aligns with monthly patient safety report 22 Patient Safety Rate of all falls in hospital causing major harm per 1,000 bed days. All inpatients including

satellite facilities such as Franklin Memorial –MMC Aligns with monthly patient safety report 23 Patient Safety Adverse Drug events per 1000 bed days – MMC

Aligns with monthly patient safety report 24 Patient Safety Rate of CLAB in patient that had a central line that is not related to an infection at another

site expressed as per 1000 central line days – MMC Aligns with monthly patient safety report 25 Patient Safety Rate of Staph. Aureus Bacteria infection per 1,000 bed days – MMC

Aligns with monthly patient safety report 26 Quality Safety Marker, HQSC. % Operations with all 3 Surgical Safety Checklist complete

A baseline audit completed in Q1, 2013 had CM Health at 86% –MMC 27 Patient Safety % patients 75+ years old (55+ years old for Maaori and Pacific) assessed for risk of falling –

Ko Awatea/ Regional Plan 27a Patient Safety % patients assessed for falls who have falls intervention plan – Ko Awatea/ Regional Plan

28 National Health Target. Numerator: number of patient presentations to the Emergency Department with

an Emergency Department length of stay of less than six hours from the time of presentation to the time of admission, transfer and discharge. Denominator: total number of patient presentations to the Emergency Department.

29 Seen by inpatient team <3 hours –DSS - 3 hours rule calculation is based on “If a patient is discharged from EC with a discharge description as "Admit to Ward" and the difference between EC DTTM of Arrival and IP Admit DTTM or if EC DTTM of Arrival to EC Discharge DTTM is >180 M then they fail the 3 hour rule or else they pass . 1 being fail and 0 being pass, No Triage mins logic has been included into this”

30 National Health Target: Percentage of radiotherapy patients receiving treatment within 4 weeks from date of decision to treat. Waiting time for treatment is from date of First Specialist Assessment to the beginning of treatment. The goal is that no one should wait longer than 4 weeks due to reasons of capacity constraint. Patients who wait due to clinical considerations or by their own choice are omitted

31 National Health Target: Percentage of chemotherapy patients receiving treatment within 4 weeks from date of decision to treat. Waiting time for treatment is from date of First Specialist Assessment to the beginning of treatment. The goal is that no one should wait longer than 4 weeks due to reasons of capacity constraint. Patients who wait due to clinical considerations or by their own choice are omitted

32 Medical Assessment Unit - seen by SMO within 4 hours: This measure is being developed

33 MOH Indicator of DHB Performance. 80% of accepted referrals for MRI scans will receive their scan within than 6 weeks (42 days). Overall patient event numbers (Community and Outpatient Referrals) – including planned patient events; Waiting times (Community and Outpatient Referrals) – excluding planned patient events; Monthly activity and demand (Community and Outpatient Referrals) – excluding planned patient events.

34

MOH Indicator of DHB Performance. 90% of accepted referrals for CT scans will receive their scan within than 6 weeks (42 days). Overall patient event numbers (Community and Outpatient Referrals) – including planned patient events; Waiting times (Community and Outpatient Referrals) – excluding planned patient events; Monthly activity and demand (Community and Outpatient Referrals) – excluding planned patient events.

35 Radiology - Inpatient Radiology times within 24 hours:

36 Radiology - EC radiology times <2 hours :– P Hewitt – Radiology

37 MOH Indicator of DHB Performance. 50% of people accepted for an urgent diagnostic colonoscopy will receive their procedure within two weeks (14 days)

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MOH Indicator of DHB Performance. 50% of people accepted for a diagnostic colonoscopy will receive their procedure within 6 weeks (42 days)

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MOH Indicator of DHB Performance. 50% of people waiting for a surveillance or follow-up colonoscopy will wait no longer than 12 weeks (84 days) beyond the planned date

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Laboratory - Test turnaround time (TAT) – Labs This measure is being developed

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41 Northern Region Target. Proportion of percutaneous coronary interventions (PCIs) carried out within the recommended 90 minute guideline in emergency cardiac care, specifically in the treatment of ST segment elevation myocardial infarction (STEMI). Measure is Door to Balloon, that is, from the arrival of the patient to when they receive a balloon angioplasty (inflation of balloon in a blocked coronary artery)

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Ministry of Health Elective Service Performance Indicator (ESPI). Number of patients currently waiting longer than five months (150 days) from date of referral for their First Specialist Assessment. ESPI 2.

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Ministry of Health Elective Service Performance Indicator (ESPI). Number of patients currently waiting longer than 5 months (150 days) for Treatment – elective. ESPI 5.

44

Surgical Acute Priority Score -delay for surgery. Theatre Central MMC [definition to be added]

45 Faster Cancer Treatment – MOH target The maximum target length of time taken for a patient referred with a high-suspicion of cancer (that is, person presents with clinical features typical of cancer, or has less typical signs and symptoms but the triaging clinician suspects there is a high probability of cancer), to receive their first treatment (or other management) for cancer.

46 Faster Cancer Treatment – MOH target The maximum target length of time a patient should have to wait from date of decision-to-treat to receive their first treatment (or other management) for cancer. The 31 day indicator includes all patients who receive their first cancer treatment, irrespective of how they were initially referred.

47 Radiology % radiology results reported within 24 hours [definition to be added]

48 Mental Health national target, Indicator of DHB Performance. % child/ youth seen by 3 weeks for non-urgent mental health services – 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.

49 a.b.c

Mental Health national Access rates - CMDHB domiciled unique clients seen by MH in preceding 12 months as % of population (0-19years, 20-64years and over 65 years)

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MOH, Annual Plan Indicator of DHB Performance. ALOS – Acute Inpatient – DSS ALOS for Admit type Acute Inpatients across all services.

51 MOH, Annual Plan Indicator of DHB Performance. ALOS – Elective Surgery– DSS ALOS for Admit type Elective, Arranged and Waiting List Inpatients across all services.

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Acute Readmissions within 7 days – Total – DSS

53 MOH, Annual Plan Indicator of DHB Performance. Acute Readmissions within 28 days – Total –DSS

54 MOH, Annual Plan Indicator of DHB Performance. Acute Readmissions within 28 days – 75+ years–DSS

55 Annual Plan % EC admissions – 75+ years – DSS

56 Discharge Information % transcribed clinical summaries authorised within 7 days for document created, that is, authorised to be published in Concerto and sent out to GPs and patients.

57 % patients with Goal Discharge Date (EDD/ CSD) within 24hours of admission: This measure is being developed

58 Patient outliers (patients admitted to a ward different from that which they are meant to be in. For example, a medical patient placed in a surgical ward due to the lack of beds) Numerator: patient outliers in ARHOP, Medical and Surgical adult inpatients, excluding EC/ Short Stay. Denominator: occupancy in Medical, Surgical and ARHOP services only.

59 Northern Region Health Plan Target. Eligible stroke patients, that is, only patients with ischaemic stroke.

60 MOH, Indicator of DHB Performance. Hospitalisations of children aged 0 - 4 years old resulting from diseases sensitive to prophylactic or therapeutic interventions that are deliverable in a primary health care setting. The baseline national rate is expressed as 100% and DHB performance is reported against the national rate.

60a MOH, Indicator of DHB Performance. Hospitalisations of people aged 0 - 74 years old resulting from diseases sensitive to prophylactic or therapeutic interventions that are deliverable in a primary health care setting. The baseline national rate is expressed as 100% and DHB performance is reported against the national rate.

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61 FSA/Follow up ratio – DSS – Using the OP measures from measure 4, the number of new patients divided by the number of follow-up appointments for the time period. There is no target; the previous year is the variance.

62 Outpatient DNA rates – Maaori –– DSS – All DNA’s for all hospitals for Maaori ethnicity divided by all outpatient appointments at all hospitals for Maaori ethnicity patients.

62a Outpatient DNA rates – Pacific – DSS – All DNA’s for all hospitals for Pacific ethnicity divided by all outpatient appointments at all hospitals for Pacific ethnicity patients.

63 MOH, Annual Plan Indicator of DHB Performance Theatre List Utilisation – DSS – from Report Manager Actual operating minutes vs. resourced operating minutes for all CMDHB theatres. :https://nthreports.healthcare.huarahi.health.govt.nz/Reports/Pages/SearchResults.aspx?SearchText=theatre%20utilisation&ViewMode=List

64 Theatre Session Utilisation – DSS – also from reporting manager,

65 MOH, Annual Plan Indicator of DHB Performance Day of Surgery Admissions (DOSA) – DSS – Percentage of all elective discharges (excluding day surgery) where the surgical procedures take place on the day of admission.

66 MOH, Annual Plan Indicator of DHB Performance Day Case Rate (Elective/Arranged) –DSS – Percentage of all elective discharges that have the same admission and discharge date.

67 removed 68 % MAU patients with LOS <28 hours – DSS – the time a patient spent in MSSU/SSMED during stay in EC

69 % Community NASC referrals via e-referrals and assessed within 48hours. (part of e-referral project).

This measure is being developed, 70 % patients discharged and with District Nursing / Home Help within 24hours

This measure is being developed, 71 % FSA Referrals received electronically - This is a part of Regional e-referral project.

Baseline data is currently being collected 72

Nursing Hours per patient days: MMC This measure is being developed as part of the McKesson development

73 Hospital beds occupied – DSS – number of inpatient bed days for the month and year to date. Target for month does not include Neonates and Critical Care as no forecast capacity

74 LOS outliers – DSS – count of encounters with a LOS >10 days, excluding burns, spinal, long stay psych and long stay geriatrics.

75

National HQSC MCC - patient experience survey which all DHBs are expected to implement in 2014/15.

76 MOH, Annual Plan Indicator of DHB Performance - Kidz First/ Women's Health - Infants who are exclusively breastfed upon discharge from Middlemore Baby Friendly Hospital Initiative Maternity facilities only. Excludes the three primary maternity units.

77 National health target. SmokeFree team - Percentage of identified smokers who have been identified through diagnostic coding as having received advice to quit.

https://nthreports.healthcare.huarahi.health.govt.nz/Reports/Pages/SearchResults.aspx?SearchText=theatre%20utilisation&ViewMode=List

https://nthreports.healthcare.huarahi.health.govt.nz/Reports/Pages/SearchResults.aspx?SearchText=theatre%20utilisation&ViewMode=List

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3.1 Mental Health Service Overview Mental Health is managed by Tess Ahern, General Manager, with Peter Watson Clinical Director and Anne Brebner Clinical Nurse Director. Highlights Integrated Mental Health and Addictions Leadership Group ‘Expressions of Interest’ are currently being sought for membership of the new Integrated Mental Health and Addictions Leadership Group. The group’s focus will be to provide strategic oversight for the CMH mental health and addictions system, guiding and actively supporting progress towards a system transformation that delivers a more connected, co-ordinated and integrated mental health and addictions service, as part of the broader healthcare system. The initial planning stages are underway for a co-design process that will ensure that the views of service users, their family/ whanau, and health/community partners are integral to the design and delivery of integrated MH&A services. Acute Mental Health Inpatient Unit Detailed Business Case Update (January 2015) Detailed Business Case • The Board has approved the final draft of the Detailed Business Case • The business case will go to Regional Capital and Regional Governance Groups on the 13 and 12

February 2015, respectively, for regional approval and endorsement before it is presented to the National Health Board’s Capital Investment Committee sometime in March.

Concept Design – and beyond • The final concept design report is being finalised for issue. • The final concept design will be discussed with John Crawshaw at the Ministry of Health on the

17 February 2015 to gain his support prior to business case submission to the Capital Investment Committee.

• Approval has been granted by the Deputy Chief Executive Officer for the design team to continue to preliminary design.

Decanting Plan • Decanting proposal has been accepted by the Director of Hospital. A full detailed plan is being

worked up with Facilities.

Current issues/risks: • Capital Investment Committee date for March has yet to be set by the National Health Board.

The timeframes for the implementation phase of the business case will be affected by delays in funding approval.

Looking Ahead - Tasks and milestones • Capital Investment Committee – March 2015 (TBC). Wrap up of the Detailed Business Case

phase for the project – lessons learnt report, project de-brief planned for the w/s 23 Feb • Stakeholder event on the 25 February will feedback to everyone who participated in the global

cafes, focus groups sessions and one to one sessions - staff, service users and whanau, clinical and non-clinical intersectoral partners – the final concept design.

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Acute Pathway Intake and Acute Assessment: The after-hours Consultant roster has been going well. The ability to have a dedicated Consultant Psychiatrist available at the “front of house” service has seen better quality clinical decisions, support for the Clinical -Coordinators to prioritise issues as they arise and a reduction in unnecessary admissions. The development and implementation of the draft Capacity Management tool has gone very well. This tool outlines the strategy to be taken to ensure capacity within the acute continuum. The next step is a collaboration with the NGO sector to ensure all resources are considered as part of the plan, especially when we move into the “amber” and “red zone”. The initial consultation with the relevant NGO sector managers was very positive. The ongoing development and refinement of the HCC whiteboards has seen a marked improvement in the day to day operational management of referrals. The next step is to improve our data collection to ensure we can quantify the services key performance indicators. Home Based Treatment: A six month pilot project that will see the alignment of Community Support Workers to work alongside the Home Based Treatment clinical staff will begin on 9 February. The DHB and NGO managers have worked together to develop operating protocols, a training package, support package and set of measurements to determine whether the anticipated improvements are realized. It is expected that the addition of non-clinical support will enhance the Home Based Treatment service by providing more holistic intervention plans that are more able to meet service user needs. System Integration Child and Youth The following two initiatives are examples of integration between child and adolescent mental health services and primary care settings. These initiatives are in their infancy and clinicians are adapting to capturing accurate Consult Liaison activities. School Based Mental Health Services: Targeting early intervention for vulnerable Young People who may not access CAMHS in the traditional way and supporting schools to facilitate early and seamless access to services. Pilot project in two secondary schools, Manurewa High and Aorere College - Senior Clinicians attend both of these school pastoral care MDT meetings twice weekly and provide:

• Consultation and liaison regarding young people of concern who are not known to the service. These contacts are entered into HCC as Consult Liaison so that the volume of this activity is monitored.

• Facilitate appropriate and timely referrals to into CAMHS • Facilitate a shared care approach- Learning’s from these two pilots will inform subsequent

school based services.

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The above graph indicates the outcomes following consultation and liaison input into the pilot schools over 2014. There is a need to consult and give professional advice to primary care to manage young people as well as refer to specialist mental health services.

The graph above shows the main consultation requirement from schools MDT are around managing and monitoring safety and risky young people followed by anxiety management and then managing relationships with peers or family/whanau. Turuki Health Care and Maternal Mental Health Turuki Health services include General Practice, Midwifery, Whanau Ora, Family start, Mana Kidz, Rheumatic Fever Prevention Team Baby, Mama and Pepe, Parents as first Teachers and Domestic Violence Prevention. Whirinaki CAMHS works on site with Turuki staff on a weekly basis providing consultation liaison, shared care and clinic based services to: • Mothers to be and mothers of infants/young children who are reluctant to be referred to MHS • Facilitate referrals to Maternal Mental Health, Whirinaki or Adult mental Health Services.

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The graph above is the consultation liaison outcomes from CAMHS input into Turuki Health Care Services by %. Majority of the input has been joint primary care/CAMHS face to face assessments for service users of Turuki followed by MDT referral discussion.

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SERVICE PERFORMANCE Activity summary

Comments on BSC Locum costs: Medical locum costs are $7k under target this month but over YTD however this is expected to improve as more permanent Psychiatrists commence employment. Overtime: There was an increase in overtime used in Koropiko as a result of the on-going high occupancy and acuity of patients on the ward. There was also an increase in overtime across all 3 wards in Tiaho Mai due to acuity and high occupancy. Wait times for non-urgent Mental Health 0-19years: Kotahi Ra (first) appointments were offered for all new referrals to be seen within 3 weeks during December and January - with enough slots available to accommodate predicted demand. However many whanau (unless acute/urgent) declined appointments due to family and holiday activities. MOH report data in the BSC is collected from rolling 12 months retrospect. Therefore, the positive gains will not yet be evident in this particular data set.

Volumes

ActBud /

Contract Var % var ActBud /

Contract Var % var

INPATIENT Bed daysTiaho Mai 1,521 1,370 -151 -11% 10,521 9,503 -1,018 -11%

Tamaki Oranga 513 558 45 8% 3,703 3,870 167 4%

Koropiko - MHSOP 455 395 -60 -15% 2,973 2,741 -232 -8%Service Access No. of unique CMDHB domiciled clients seen over 12 months

18,255 16,041 2,214 14% N/A N/A N/A

Note - Actual Bed days exceeding the target is shown as negative as this implies over-crowding. The budgetis 85% occupancy rate of the available beds

Mental Health Volumes (Bed days and Service Access)JANUARY '15 Year to date

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SCORECARD

Mental Health SCORECARD

January 2015


Def

Jan-15 Target Var Actual Target VarMedical staff locum Costs (in $000s) $137 $144 $7 $1,105 $1,008 97-$ Overtime costs(in $000s) $156 $86 70-$ $989 $602 387-$

Jan-15 Target Var Actual Target Var% Staff with Annual Leave > 2 years 7.5% 5.0% -2.5% 8.8% 5% -3.8% 14

% Staff Turnover 1.8% 2.0% 0.2% 10.3% 10% -0.3% 15

% Sick Leave 2.7% 2.8% 0.1% 3.5% 2.8% -0.7% 16

Workplace Injury Per 1,000,000 hours 0 10.50 10.50 22.4 10.50 -11.90 17


Jan-15 Target Var Actual Target VarNo. of Seclusion events - (Rolling 12 months in development) 157 125 -32

Jan-15 Target Var Actual Target VarShorter wait times for non urgent mental health and addiction Services (%< 3week wait)

0-19 years 70.48% 75% -4.52%20-64 years 87.79% 80% 7.79%

65+ years 88.50% 80% 8.50%overall 81.52% 80% 1.52%

Jan-15 Target Var Actual Target VarMental Health Access rate - unique clients seen by all MH services ((PRIMHD reporting services include AoD and NGO services) 12 months as a % of population

0-19 years 3.26% 3.15% 0.11% ~20-64 years 3.82% 3.15% 0.67% ~

65+ years 2.55% 2.70% -0.15% ~Readmissions within 28 days - Total 16.13% 12.00% -4.13% 13.77% 12.00% -1.77%

Jan-15 Target Var Actual Target VarOccupancy - Tiaho Mai acute mental health unit target is <85% 94.4% 85% 9.4% 85% -85.0%No of Patient LOS (Tiaho Mai inpatient) < 5 days 16 tbc tbc

Jan-15 Target Var Actual Target VarPP7-Relapse Prevention Plan - Maaori 94.5% 95.0% -0.5% 95% -95.00%PP7-Relapse Prevention Plan - Pacific 96.6% 95.0% 1.6% 95% -95.0%

BETTER HEALTH OUTCOMES FOR ALL

Jan-15 Target Var Actual Target VarAccess rate - No. CM domiciled unique clients seen by MH services (PRIMHD) 12 months as a % of population - Maori 6.33% 6.0% 0.33%

~Access rate - No. CM domiciled unique clients seen by all MH services (PRIMHD) 12 months as a % of population - Total 3.50% 3.1% 0.40%

~

Equi

ty

Year

Effic

ient

Year

Year

Patie

nt

Wha

anau

Ce

ntre

d Ca

re

Firs

t, Do

N

o Ha

rm

(Saf

ety) Year to date

Syst

em In

tegr

atio

n (E

ffect

ive)

Year to date

Tim

ely

Year to date

Ensu

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Fina

ncia

l Su

stai

nabi

lity Year to date

Enab

ling

High

Pe

rfor

min

g Pe

ople

12 month average

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FINANCIAL RESULTS: Best value for public health system resources

Actual Budget Var Var % Actual Budget Var Var %REVENUE

6 3 2 66% Government Revenue 53 24 30 126%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%

(42) 6 (48) (763)% Other Income 60 44 17 38%36 0 36 0% Funder Payments 229 0 229 0%(0) 10 (10) (104)% Total Revenue 343 67 276 409%

EXPENDITURE5,229 5,432 203 4% Staff Costs 36,312 37,701 1,389 4%

177 17 (160) (959)% Outsourced Costs 1,396 117 (1,279) (1,093)%13 17 4 23% Clinical Costs 98 122 24 20%

218 236 18 8% Infrastructure Costs 1,727 1,650 (77) (5)%25 31 7 (22)% Internal Allocations 223 219 (4) 2%

5,662 5,734 72 1% Total Expenditure 39,755 39,808 53 0%(5,662) (5,724) 62 1% Net Result (39,412) (39,741) 329 1%

FTE64 80 16 20% Medical 67 80 13 17%

324 322 (2) (1)% Nursing 324 322 (2) (1)%176 223 47 21% Allied Health 201 223 23 10%

51 58 7 12% Management/Admin 52 58 6 10%615 683 68 10% FTE Total 644 683 39 6%

STATEMENT OF FINANCIAL PERFORMANCE - MENTAL HEALTH

Month to Date Year to Date

($000's) ($000's)

Jan-15

-5,900

-5,800

-5,700

-5,600

-5,500

-5,400

-5,300

-5,200

-5,100

-5,000

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

100

200

300

400

500

600

700

800

900

Mon

thly

resu

lt $0

00's

Monthly Operating Costs

Result Budget

4,400

4,600

4,800

5,000

5,200

5,400

5,600

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

* Jun14 - outsourcing $270k unfav -locum medical staff; YTD allocation of vehicle transfer costs $170k unfav

54

Quality: Goal to improve the quality safety and experience of care SAFETY First Do No Harm Mental Health Acute 28 day Readmission rates and Use of Seclusion - Refer to BSC Timeliness; Reducing waits and delays for both those who receive and those who give care. Waiting times for non-urgent mental health and addiction Services - Refer to BSC Efficiency Avoiding Waste, including waste of equipment, supplies, ideas and energy Mental Health Acute Inpatient services – Tiaho Mai: December and the first few days of January saw a high number of bed vacancies with up to 9 beds being available on one occasion. However this rapidly changed and demand and acuity reached the point where there were no inpatient beds available and few respite options. The implementation of the Capacity Management Tool meant that as of midnight there were no occasions when Tiaho Mai was “over capacity”, despite the demand. There were 2 occasions when Tiaho Mai was over capacity during the early afternoon and one service user waited for 1 hour 40 minutes for a bed and the second for 3 hours 15 minutes.

Month YTD

Total Variance: $62 $329

Revenue: $(10) $276

Salaries & Wages: $102 $1,186

Outsourced: $182 $1,119

Clinical Supplies: $4 $24

Infra-Structure: $18 $(77)

Internal Allocations: $7 $(4)

The year end forecast is for the division to meet budget plus expected cost savings for the year.

Acute demand management costs remain high in January this has been more than off-set by the vacancies in the community. The vacancies have resulted in underspends in Allied Health of $75k for the month (YTD $461k underspend).

YTD Mainly Funding for Clinical Release and Supervision of undergraduates(YTD $83k) and Youth Forensic Specialist Community Service Funding $22k for the month, YTD $154k

Medical staff is underspent by $177k for the month (YTD $1,227k). There is a national shortage of psychiatrists and therefore locums, mainly from overseas are contracted to provide services (ref outsourced services below). Current medical vacancies for the month are 8.2FTE. Acute demand management has mainly resulted in an overspend for the month in Nursing of $(68k)(YTD $(453)k overspend). Vacancies in the community have resulted in underspends in Allied Health of $75k, 16FTE (YTD $461k underspend).

Year end Forecast variance to Budget $440

Locum Medical staff $(137)k for the month and $(1,105)k YTD off-set by the favourable variance in Medical Staff salaries $177k for the month (YTD $1,227k favourable) and Admin Clerical mainly for Child and Youth $(10)k for month and YTD $(140)k

STATEMENT OF FINANCIAL PERFORMANCE - MENTAL HEALTHJan-15

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Average Length of Stay – Tiaho Mai: There was a slight increase in average length of stay which was thought to be mainly due to the following factors: high acuity and standard medications not having the expected improvement resulting in a longer time to recovery.

Length of Stay > 35 days Tiaho Mai: 13 service users were discharged in January with a LOS ≥ 35 days and ranging from 37 days to 78 days. There were 9 service users at the end of January with a LOS ranging from 38 days to 140 days. Of the 9, 3 are still waiting for beds in Tamaki Oranga and the other 6 are still considered to be acutely unwell.

Mental Health Services for Older People (MHSOP): Occupancy in January remains high with fewer admissions and a longer length of stay. This is comparable to the data collected for the past 2 years and while the reason is not clear it is suspected that this may be socially driven due to families being away over the festive period and a reduction in other services available over the time timeframe.

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Adult Community Service: Clinician Contacts: There were a total of 17314 contacts during January. This is a slight decrease from the December contacts (18166) however this was expected due to the number of clinical staff who were supported to be on annual leave throughout the month.

Child and Youth Service: Clinician Contacts: Decrease in clinical contacts over the holiday period is expected due to drop in demand as non-essential clinicians are encouraged to take annual leave.

Effectiveness: Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit

57

Adult Community Service: 7 Day Post Discharge Contact: The percentage of clients seen within seven days of discharge from the inpatient unit was 71.79% in January, however we expect this to increase significantly once the data from early February is captured (in next month’s report). All teams are aware of the clinical requirement to see clients within this time period.

Child and Youth Service: not seen last 90 days Whanau not wanting to be seen face to face during School holiday period slowed down and teams experienced setbacks against plans to progress the reduction of clients not seen in the last 90 days. Improvement and support plans are being put in place to support clinicians who are struggling to manage demand and capacity and have become overwhelmed with caseloads that have become unmanageable.

Patient and Whanau Centred Care: Providing care that is respectful of and responsive to individual patient preferences, needs and values and ensuring that patient values guide all clinical decisions Te Rawhiti Family Group There were 13 family/whanau members at the first meeting of the year, some of whom shared their experiences of their Christmas holiday time including some of the challenges faced. Topics of discussion included: • difficulty accessing any short term respite support • how people had used some of the communication techniques from the Information Packs • Two people are attending the free Mindfulness Course at East Health that we had promoted as

a positive way of caring for their own mental health • Jeremy Stockton, Coordinator of the new Intake and Assessment Team (North), attended the

meeting. Jeremy spoke about what people could expect from the new service and also heard

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some family experiences of our acute services. After the meeting, Jeremy followed up individually with one family member about a particularly distressing family experience of our acute response.

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3.2 Kidz First & Women’s Health Service Overview Kidz First and Women’s Health is managed by Nettie Knetsch, General Manager with Dr Wendy Walker Clinical Director (Kidz First), Dr Sarah Tout Clinical Director (Women’s Health), Thelma Thompson (Director Midwifery) and Michelle Nicholson-Burr, Clinical Nurse Director. Highlights / Emerging Issues In January 2015 there were 29 less births at Middlemore and 1 more at the 3 community units. YTD we now have 5 less births than YTD 2014 so minimal change overall. However, the distribution of births continues to shift towards Middlemore with 62 more births YTD (up 1.66%) and the three Community Units down by 67 YTD (11.55%). The WIES or WIES equivalent from the 3 Community Units was up for the month. The WIES or WIES equivalent from Middlemore (secondary facility) was also up by 20 WIES. Of note, remains the increase in YTD WIES whilst the births have remained static. YTD overall WIES for secondary is 5074 – up by 212 over last year and static for the Community Units (despite an 11.55% decrease in birth numbers). This is reflecting the acuity and complexity of women both at Middlemore and women transferring from Middlemore to the Community Units following birth. Occupancy at the 3 Community Units remains high, particularly in Pukekohe (YTD 83%) and Botany (YTD 98%)as women are transferring to the Units following birth at Middlemore for postanatal care.

The trend to having more women being cared for by a self-employed LMC under the continuity of carer model is continuing with YTD January showing 68% of women booking their pregnancy care with a self-employed LMC (up from 65% last year). Kidz First Medicine /EC/ICU Inpatient WIES for the month remains very similar to last year (8 WIES up for the month but discharges down by 19). Overall, a very similar pattern to January 2014 was observed. Of note is that the presentations to Kidz First EC were up significantly again this month (227 for the month) on last year with more children being assessed and discharged within 3 hours and not requiring a short stay or inpatient admission. YTD there have been 1171 more presentations than the same period 2014.

500

550

600

650

700

750

# of Births

60

Kidz First Neonates (not including WH neonates) continues with similar discharges - only 27 up YTD January. WIES in Neonates is now stabilising in line with decreased discharges. Annual leave there was more taken across Kidz First and Women’s Health services this January than January 2014. Charge Nurses/Midwives and Team leaders have been focussing on allocating leave for those staff with high annual leave balances. Similarly, more leave was allocated to junior and senior medical staff where possible with rosters and service coverage. Sick leave was down significantly in January both across Kidz First and Women’s Health. New Born Hearing screening (quarterly target) Overall, some 97% of children are offered the New-born Hearing Screen, but only 78%- 80% complete the screening either in hospital or following discharge at a clinic. The DNA rate is too high and we are now working with the teams to see if we can extend the hours the Newborn Hearing Screeners work at the hospital sites as well as working with MoH on establishing whether we can screen in Birthing and Assessment Unit within 2 – 4hours after birth before a woman may go home or be transferred to a community unit. SERVICE PERFORMANCE Activity summary

Volumes

ActBud /


Contract Var % var

INPATIENT (WIES)Kidz First EC 59 51 8 15.7% 532 478 54 11.30%Paed Medicine 156 158 -2 -1.3% 2,050 1,886 164 8.70%Paed ICU 3 1 2 200.0% 24 22 2 9.09%NNU - Unit 271 256 15 5.9% 1,548 1,512 36 2.38%NNU Womens health 47 39 8 20.5% 291 300 -9 -3.00%Kidz First Surgical - acute 164 188 -24 -12.8% 977 1,302 -325 -24.96%Kidz First Surgical - Elective 76 61 15 24.6% 661 533 128 24.02%Total Kidz First WIES 776 754 22 2.9% 6,083 6,033 50 0.83%INPATIENT (CASES)Kidz First EC 197 212 -15 -7.1% 1,872 1,925 -53 -2.75%Paed Medicine 308 313 -5 -1.6% 3,610 3,543 67 1.89%Paed ICU 2 1 1 100.0% 18 23 -5 -21.74%NNU - Unit 67 68 -1 -1.5% 491 464 27 5.82%NNU Womens health 98 113 -15 -13.3% 720 827 -107 -12.94%Kidz First Surgical - acute 190 160 30 18.8% 1,165 1,207 -42 -3.48%Kidz First Surgical - elective 124 130 -6 -4.6% 1,018 851 167 19.62%Total Kidz First CASES 986 997 -11 -1.1% 8,894 8,840 54 0.61%EC AttendancesEC Attendances 1,850 1,623 227 14.0% 15,571 14,400 1,171 8.13%OUTPATIENTSFSA's 136 127 9 7.1% 1,158 1,171 -13 -1.11%Follow-ups 215 258 -43 -16.7% 1,780 1,838 -58 -3.16%Chart Reviews (Doc) one mo in arrear

87 93 -6 -6.5% 444 528 -84 -15.91%

Virtual FSA 33 24 9 37.5% 273 279 -6 -2.15%Total Kidz First Outpatients 471 502 -31 -6.2% 3,655 3,816 -161 -4.22%

Contract = Last year actuals

Jan-15 Year to dateKidz First Volumes (WIES and CASES)

61

Kidz First: Kidz First Medical and Surgical Activity Kidz First Medical had similar discharges to January 2014 whilst Kidz First Surgical saw a small increase in discharges in January 2015. Kidz First Neonatal Unit Activity As reported earlier, the fluctuation in WIES from month to month for Neonates is fully dependent on the number on very premature babies being discharged in the month and the WIES they attract. Following the very high WIES in August, the WIES for September stabilised. For the unit only, YTD the WIES is up by 36 and discharges are up by 27 compared to YTD 2013. Women’s Health:

Women’s Health - trend in birthing volumes YTD For the month of January there were 29 less births at MMH and 1 more at the 3 community units. Gynaecology Gynaecology WIES are up for acutes (6) but electives is down by 12 – inclusive of 3 private WIES) for the month. Discharges are up for acutes (11) but electives is down (24) for the month. YTD Gynaecology WIES is up for acutes (34) and up for discharges (20). Elective WIES is down by 68 and for discharges (35). Obstetrics Outpatients Obstetric FUs continue to decrease in line with better streamlining and co-ordination between midwifery and consultant clinics. In addition, there are many virtual FSAs that take place in the

Volumes

ActBud /


Contract Var % var

INPATIENT (WIES)WH Gynae - acute 138 132 6 5% 943 909 34 4%WH Gynae - elective 108 120 -12 -10% 883 951 -68 -7%WH Primary Unit (wies equi) 198 197 1 1% 1,343 1,349 -6 0%WH secondary 524 504 20 4% 3,742 3,513 229 7%Total Women's Health WIES 968 953 15 2% 6,911 6,722 189 3%Births/ DeliveriesTotal 598 626 -28 -4% 4,301 4,306 -5 0%INPATIENT (CASES)WH Gynae - acute 259 248 11 4% 1,720 1,700 20 1%WH Gynae - elective 104 128 -24 -19% 947 982 -35 -4%Total WH CASES 363 376 -13 -3% 2,667 2,682 -15 -1%OUTPATIENTSGynae FSA's 188 269 -81 -30% 1,549 1,826 -277 -15%Gynae Follow-ups 166 222 -56 -25% 1,568 1,728 -160 -9%Gynae Virtual 31 2 29 1450% 199 25 174 696%Nurse-led clinic 116 59 57 97% 793 552 241 44%Colposcopy 196 213 -17 -8% 1,302 1,490 -188 -13%Colposcopy HC 11 22 -11 -50% 119 155 -36 -23%Colposcopy HC in OT 0 7 -7 -100% 42 50 -8 -16%Gynae HC 34 65 -31 -48% 347 455 -108 -24%Total WH Outpatients 742 859 -117 -14% 5,919 6,281 -362 -6%

Women's HealthVolumes (WIES and CASES)Jan-15 Year to date

Contract = Last year actuals

62

Obstetric Clinics (in particular the clinics at the 3 Community Units) for which we are still setting up a process of counting this activity. Commentary on BSC Kidz First and Women’s Health

• Annual Leave accrual High annual leave taken both across Kidz First and Women’s Health. • Sick leave hours Both Kidz First and Women’s Health’s sick leave observed a decrease in sick

leave in January . This is partly due to high annual leave hours taken over Xmas and New year and during January. On average just over 4.5 FTE sick leave was reported in Kidz First and Women’s Health for January.

• Expired Appointments (all Follow-Ups) Kidz First Outpatients As mentioned in last month’s HAC report the service will be presenting options to reduce the waiting times for Expired Appointments in February 2015 as the numbers of children waiting to be seen is starting to increase again. We are working with the new GP Liaison, Dr Christine McIntosh and the ARI team to explore options for ARI for Outpatient Paediatrics.

• Caesarean Section rate The CS rate for Jan 2014 is 24.7% (year end 13/14 was 23.2%). The mix of acute and elective CS has remained the same as the previous year (66% acute and 34% electives). YTD the CS rate is 23 % - similar to YTD 2013.

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SCORECARD

January 2015

BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCESDef

Jan-15 Target Var. Actual Target Var.Gen Paeds Outpatients FSAs 136 127 7% 1,158 1,171 -1% 4

Gen Paeds Outpatients Follow Ups 215 258 -17% 1,780 1,838 -3% 5

Gen Paeds Virtual FSAs 33 24 38% 273 279 -2% 11

KF Surgical Ward discharges 213 174 22% 1,380 1,332 4%KF Surgical Ward WIES 199 158 26% 1,269 1,445 -12%KF Medical Ward + Short Stay Discharges 308 313 -2% 3,610 3,543 2%KF Medical Ward + Short Stay WIES 158 158 0% 2,052 1,886 9%

Neonatal Care Discharges - Neonatal Unit 67 68 -1% 491 464 6%Neonatal Care Discharges - WH Neonatal 98 113 -13% 720 827 -13%Neonatal Care WIES - Neonatal Unit 271 256 6% 1,548 1,512 2%Neonatal Care WIES - WH Neonatal 47 39 21% 291 300 -3%

EC Attendances <15 years 1,850 1,623 14% 15,571 14,400 8%

Jan-15 Target Var. Actual Target Var.% Staff with Annual Leave > 2 years 13.3% 5% -8.3% 13.4% 5% -8.4% 12

% Staff Turnover 0.9% 2% 1.1% 10.8% 10.0% -0.8% 13

% Sick leave 2.7% 3% 0.3% 3.6% 3.0% -0.6% 14

Workplace injury per 1,000,000 hours 0 10.50 10.50 7.00 10.50 3.50 15

Nursing Sick leave hours taken in FTEs (inc unpaid sick) - onestaff 4.27 5.79 1.52Performance reviews completed - onestaff 70% 58% 12.3%Study (both internal & external) leave taken FTE RN - onestaff 4.33 1.36 -2.97

Bi-Annual REPORTING Jan-15 Oct-14 Var. Actual Target Var.% of 12 hour shifts (Jan 2015 vs Oct 2014) next report in Jan 2015 39% 48% 9% ~


Jan-15 Target Var. Actual Target Var.Neonatal Rate of medication errors/1000 bed days 5.6 5.0 -0.61 ~ 0.00 20

Neonatal Care CLAB rate per 1000 line days 0.0 0.0 0.0 ~ 0.00 21

Emergency trolley checks (compliance with checking) 90% 100% -10% ~ 100%Hand hygiene (compliance with checking) 100% 100% 0% ~ 100%Safe sleep - audits completed (tbc) 86% 100% -14% ~Family Violence Prevention # staff trained 37 NNU TBC 128.00Health & Safety audit (Bi monthly) N/A 100% ~ 1.00Expired Planned Appointments KF outpatients 732

Jan-15 Target Var. Actual Target Var.ED 6 hour target - National Health target (Kidz First EC) 97% 95% 2% 98% 95% 3% 41

% patients waiting >4 months for FSA - Kidz First Medical 0 0 0 0

Q2 Target Var. Actual Target Var.NBHS number babies screened prior to discharge from hospital sites 80% 90% -10% ~B4SC checks meets MoH target N/A 25% #VALUE! 55% 58% -3%

Jan-15 Target Var. Actual Target Var.% transcribed clinic letters authorised >7 days of created 75.4% 75.0% 0.4% 54

Readmission Rate (KF med) within 7 days (one month in arrear) 6.5% 3.8% -2.7% 7.0% 5.9% -1.1%Readmission Rate (KF med) within 7 days (Maaori) 10.8% 0.0% -10.8% 10.6% 5.6% -5.0%Readmission Rate (KF med) within 7 days (Pacific) 4.1% 4.8% 0.7% 6.1% 5.7% -0.4%

Readmission Rate (Level 1,2, 3) within 28 days (one month in arrear ) 0.0% 9.5% 9.5% 8.0% 12.1% 4.1%Readmission Rate (all Neonates) within 28 days (one month in arrear ) 2.0% 7.0% 5.0% 6.2% 6.2% -0.0%Admission Rate Babies in the first year of life (Total) 24% 20% -4.0% 21% 21% 0.0%

Admission Rate Babies in the first year of life (Maaori) 28% 28% 0.0% 25% 25% 0.0%Admission Rate Babies in the first year of life (Pacific) 29% 28% -1.0% 28% 27% -1.0%

ALOS (raw) - Kidz First - Surgical - Surgical Floor 2.0 2.2 0.2 1.97 2.38 0.4ALOS (raw)- Kidz First Medicine - KF Wards 2.2 3.0 0.8 2.7 2.7 0.0ALOS (raw)- Kidz First Medicine - EC Short Stay (hrs) 4.2 5.0 0.9 4.7 4.8 0.1ALOS (raw) - Kidz First - Neonatal Unit discharge only 11.2 12.6 1.4 10.2 11.8 1.6ALOS (raw)- Kidz First - Neonates including WH 6.5 6.5 0.0 5.7 5.9 0.2

Year

Year to date

KIDZ FIRST SCORECARD

Year

Year to date

Firs

t, Do

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Harm

(Saf

ety)

Year to date

12 month average

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Tim

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Peop

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stem

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(Eff

ectiv

e)

QUARTERLY REPORTING - Next report in Jan 2015 for YTD Dec 2014

64

Jan-15 Target Var. Actual Target Var.Outpatient DNA - FSA 12.0% 15.5% 3.5% 9.00% 10% 1.0%Outpatient DNA - Follow up 12.0% 13.5% 1.5% 15.0% 16% 1.0%Nurse Hours per Patient Day - KF Med 7.40 6.97 -0.43 5.86 6.00 0.14Nurse Hours per Patient Day - KF Surg 6.35 5.96 -0.39 4.92 4.80 -0.12 Nurse Hours per Patient Day- Neonatal 11.77 11.38 -0.39 12.09 9.67 -2.42

Jan-15 Target Var. Actual Target Var.Patient Experience Survey results 75% 90% -15% 78% 90% -12% 74


Jan-15 Target Var. Actual Target Var.Percentage of 'eligible' inpatients are referred to AWHI 87.0% 100.0% 13.0%

Year

n = 4 Year (n = 42)

Year

Equi

tyPa

tient

W

haan

au

Cent

red

Care

Effic

ient

65

January 2015


Def

Jan-15 Target Var. Actual Target Var.Deliveries TOTAL 598 626 -28 4301 4306 -5

Deliveries at MMH 519 548 -29 3788 3726 62Deliveries at Primary birthing units 79 78 1 513 580 -67

Gynae Acute WIES 138 132 6 943 909 34 3

Gynae Elective WIES (Private) 3 0 3 31 0 31 2

Gynae Elective WIES 105 120 -15 852 951 -99 2

Gynae Acute - Discharges 259 248 11 1720 1700 20Gynae Elective - Discharges 104 128 -24 949 982 -33Maternity WIES 925 898 27 6,427 6211 216 1

Outpatient Gynae First 188 269 -81 1549 1826 -277Outpatient Gynae Follow-up 166 222 -56 1568 1728 -160Gynae nurse-led clinic 116 59 57 793 552 241Gynae SMO VFSA 31 2 29 199 25 174Obstetric Outpatient FSAs S/B Doctors 231 229 2 1850 1663 187Obstetric Outpatient F/U S/B Doctors 298 347 -49 2084 2321 -237

DHB Community Midwives Antenatal visits (two month in arrear and running total 1,310 1,552 -242 17,277 18,634 -1,357DHB Community Midwives Postnatal visits (two month in arrear and running total for the past 12 months)

1,181 1,312 -131 14,999 18,630 -3,631

Jan-15 Target Var. Actual Target Var.% Staff with Annual Leave > 2 years 18.5% 5.0% -13.5% 19.9% 5.0% -14.9% 12

% Staff Turnover 0.9% 2.0% 1.1% 9.4% 10.0% 0.6% 13

% Sick leave 2.2% 2.8% 0.6% 2.9% 2.8% -0.1% 14

Workplace injury per 1,000,000 hours 0.00 10.50 10.50 5.25 10.50 5.25 15

Sick leave hrs. taken FTEs Nursing/Midwifery inc unpaid 4.51 5.53 1.02Study leave hours taken FTEs in Nursing/Midwifery 0.99 0.1 -0.89 Orientation hours taken FTEs in Nursing / Midwifery 1.41 1.06 -0.35 Performance reviews completed per annum 80% 53% 27%

BI-ANNUAL REPORTING Jan-15 Oct-14 Var. Actual Target Var.% of 12 hour shifts (Jan 2015 vs Oct 2014) - Next reporting due in Jan 2015 23% 27%


Jan-15 Target Var. Actual Target Var.Emergency trolley checks (days checked) 89% 100% -11% naFamily Violence Prevention # staff trained N/A TBC 9.00Total Caesarean Percentage 24.7% 22.5% -2.23% 23.0% 22.6% -0.4%

Caesarean - elective number 52 56 85 391 342 49 Caesarean - acute number 96 85 11 597 631 -34

Inductions of labour % (one month in arrear) 24% 25% 1% 22% 22% 0%Inductions of labour - number compared to last year (one month in arrear) 156 156 0 825 853 28Surgical Site Infection - C-section (3 month in arrear) Qtrly - July for April , Oct for June, Jan for Oct, April for Jan 7 9 2 33 37 4

Jan-15 Target Var. Actual Target Var.ED 6 hour target - National Health target (Gynae) 98% 95% 3% 95% 95% 0% 41

ESPI 2 - No. waiting >4 months for FSA Dec 14 - Elective 0 0 0 0 0 41

ESPI 5 - No. waiting > 4 months for treatment - Elective 0 0.00 0 0.00 0 42

WOMEN'S HEALTH SCORECARD

Ensu

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Fina

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gh P

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Year to date

12 month average

Year to date

Year to date

Year

66

Jan-15 Target Var. Actual Target Var.% transcribed clinic letters authorised <7 days created 71.0% 95.0% -24% 54

Average Length of Stay Gynaecology - MMH 1.36 1.53 0.17 1.61 1.67 0.06Average Length of StayGynaecology - MSC Inpatients 0.68 0.83 0.15 0.67 0.85 0.18Average Length of Stay Obstetric (DHB Mat) (1 mo in arrear) 2.12 2.31 0.19 2.24 2.31 0.07Average Length of Stay Obstetric (Ind. Mat) (1 mo in arrear) 2.00 2.43 0.43 2.28 2.33 0.05Average Length of Stay Vaginal Deliveries overall 2.15 2.11 -0.04 2.04 1.97 -0.07

Maaori - 1st time mothers 2.24 2.96 2.52 2.15 2.56 0.41Pacific - 1st time mothers 2.65 2.84 0.19 2.67 2.46 -0.21 Complex Needs Women

CM Health Midwifery/ LMC Split at BookingClosed unit / Shared Care 30% 36% -6% 32% 35% 3%

Access Holders 70% 64% 6% 68% 65% -3%

CM Health Midwifery/LMC Split at deliveryClosed unit / Shared Care (#) 290 283 7 1,832 1,836 -4

Access Holders (#) 219 185 34 1,480 1,516 -36Access Holders with secondary procedures (#) 89 158 -69 989 943 46

Closed unit / Shared Care (%) 48% 45% 3% 43% 43% 0%Access Holders (%) 37% 30% 7% 34% 35% -1%

Access Holders with secondary procedures (%) 15% 25% -10% 23% 22% 1%

Jan-15 Target Var. Actual Target Var.FSA / FUP ratio - Gynae 1:0.88 1:1 ~ 1:1 1:1 ~DNA - Midwifery Antenatal clinics - First 15% 14% -1% 15% 14% -1%DNA - Midwifery Antenatal clinic - Follow up 16% 18% 2% 14% 15% 1%DNA - Doctor Antenatal clinics- FSA 14% 12% -2% 13% 15% 2%DNA - Doctor Antenatal clinics - Follow up 10% 12% 2% 14% 13% -1%

Outpatient DNA - Maaori (Gynae) 14% 10% -4% 15% 10% -5%Outpatient DNA - Pacific (Gynae) 17% 10% -7% 13% 10% -3%Outpatient DNA - Maaori (Obst) 18% 10% -8% 15% 10% -5%Outpatient DNA - Pacific (Obst) 13% 10% -3% 10% 10% 0%

% Resourced Occupancy (avg of 9am & 9pm) June 14YTDGynaecology Ward 91.9% 93% 1% 87% 92% 5%

Maternity Ward - Maternity (45 beds) (lodgers included) 80.6% 78% -2% 80% 78% -2%Maternity Ward - Nursery (30 beds) (lodgers included ) 85.1% 81% -4% 88% 86% -1%

Botany Maternity Unit (lodgers included) 101.3% 85% -17% 98% 94% -4%Papakura Maternity Unit (lodgers included) 89.2% 92% 3% 89% 82% -7%

Pukekohe Maternity Unit (lodgers included) 77.2% 72% -5% 83% 74% -9%

Def

Jan-15 Target Var. Actual Target Var.Nursing Hours per Patient Day (not including HCA)at MMH

NHPPD - Maternity Ward North (including nursery PD) 6.65 6.16 -0.49 6.20 5.50 -0.70 NHPPD - Maternity Ward South (including nursery PD ) 5.09 6.08 0.99 5.81 5.50 -0.31

Nursing Hours per Patient Day - Gynae 4.77 5.04 0.27 5.23 5.63 0.40

Jan-15 Target Var. Actual Target Var.Patient Experience Survey 64% 90% -26% 77% 90% -13% 74


Jan-15 Target Var. Actual Target Var.% Infants Exclusively Breastfed Discharge MMH - Total 81.0% 75% 6.0% 80.0% 75% 5.0% 75

% Infants Exclusively Breastfed Discharge MMH - Maaori 86.0% 75% 11.0% 81.0% 75% 6.0%% Infants Exclusively Breastfed Discharge MMH - Pacific 76.0% 75% 1.0% 78.0% 75% 3.0%

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Year to date

Year

n = 34 Year (n = 238)

Year to date

67



72 72 0 1% Government Revenue 495 502 (7) (1)%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%

119 113 6 5% Other Income 1,086 792 294 37%65 63 1 2% Funder Payments 454 444 10 2%

256 248 8 3% Total Revenue 2,035 1,738 297 17%

EXPENDITURE2,548 2,682 135 5% Staff Costs 18,434 18,578 145 1%

50 18 (32) (172)% Outsourced Costs 397 129 (269) (209)%139 119 (19) (16)% Clinical Costs 1,277 1,188 (89) (8)%

62 83 21 26% Infrastructure Costs 636 636 (0) (0)%(53) (23) 29 125% Internal Allocations (524) (163) 361 221%


FTE40 40 1 2% Medical 44 43 (1) (2)%

191 192 1 1% Nursing 201 196 (5) (3)%58 68 10 15% Allied Health 68 68 0 0%22 29 7 24% Management/Admin 27 29 1 4%

310 330 19 6% FTE Total 340 335 (5) (1)%

STATEMENT OF FINANCIAL PERFORMANCE - KIDZ FIRSTJan-15


($000's)($000's)

-2,900

-2,800

-2,700

-2,600

-2,500

-2,400

-2,300

-2,200

-2,100

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

100

200

300

400

500

600

700

800

900

1,000

Mon

thly

resu

lt $0

00's


Result Budget

-

500

1,000

1,500

2,000

2,500

3,000

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

68

Month YTD


Revenue: $8 $297

Salaries & Wages: $135 $145

Outsourced: $(32) $(269)

Clinical Supplies: $(19) $(89)


Internal Allocation: $29 $361

Current Month:$(17)K accrual HVT RC to purchase 1 beraphone. Notified by MoH in Late Dec 2014 that all DHBs must replace all existing NBHS equipment (11) by June 2016. We are planning to replace 4 or 5 beraphones in 2014-2015. (3-4 will be funded by funding from MoH) awaiting for a pricing information from MoH.

Year to date:in Dec 2014, We were notified that $103k for NNC inventory was incorrectly coded to a balance sheet account. The whole amount was transferred to NNC RC in Dec 2014. In addition, NNC had high admission of Level 3 babies in Dec 2014 that required high use of clinical supplies.

STATEMENT OF FINANCIAL PERFORMANCE - KIDZ FIRST

Additional costs for various projects (not budgeted) are offset against additional revenue/internal allocations from the funder, i.e. Ccrep Research, ASD, and Mana Kidz. Annual leave has been well managed over the school holiday period (end of Sept 2014/early Oct 2014, Dec 2014 and Jan 2015).Current Month:Medical - $64k - Annual Leave managementNursing- $(16)k - NNU had very high acuity in Jan 2015 with level 3 babiesAllied Health- $58k - Annual Leave Management in Jan 2015Clerical - $31k - on track; operation manager budgeted under nursing but coded to Clerical, a cost transferred for gateway administrator was changed to AH from Clerical

Year to date:Medical - $165k - AL leave management over school holidays and $(30)k ACC refund to an employee in Aug 2014.Nursing- $(124)k - Additional costs for various projects (not budgeted (5.2) FTE at $(43)k) are offset against additional revenue. High levels of sick leave and ACC leave continue within the service. Unpredictable NICU volumes (acuity and occupancy), ongoing since Sept 2013, as well as vacancies/ skill mix issues, has driven cost increases year to date.Allied Health- $52k - Additional costs for various projects (not budgeted 3.65 FTE at $18K).Clerical - $55k - on track; operation manager budgeted under nursing but coded to Clerical.

Current Month:Funder Payment: NilGovernment Revenue: ACC $0.5KOther Income: ASD $11k, CCREP $5K ,UoA $2K, Turuki & NRA $4K, donations $(17)K reversed and corrected. Year to Date:Funder Payment: NilGovernment Revenue: ACC $(7)k (code correction for ACC refund)Other Income: ASD $77k, Rheumatic Fever Research $22K, CCREP $87K , UoA $12.5k, F&P $10K, Turuki & NRA $30K, ADHB $10K, Donations $10K, mana kidz $30k, MoE equity fund $14k

Current Month:$(7)k for external bureau, $(4)K for University of Auckland, $(4)K for temp clerical accrual reversed , $(16)K for ASD - multidisplinary consultation,

Year to date:$(94)k for external bureau, $(35)K for University of Auckland, $(23)K for temp clerical, $(37)K for locum$(25)k for secondment from ADHB clinicians for Centre for Youth, $(61)K for ASD - multidisplinary consultation

Kidz First has a favourable variance for Jan 2015 of $142k driven by annual leave management in Jan 2015. Discharges for the month are similar to Jan 2014 (956 cases vs 997 Jan 2014).


Revenue for projects are recovered on a monthly basis. Additional costs for various projects (not budgeted) are offset against additional revenue.

Jan-15

$518

Current Month:Lower expenditure for printing and stationery orders in Jan 2015.

Year to date: We were notified that $28k for NNC was incorrectly coded to a balance sheet account. The whole amount was transferred to NNC RC in Dec 2014.

Year end Forecast variance to Budget

Current Month:Additional revenue for various projects (not budgeted) are offset against costs, ManaKidz $29K Year to date:Additional revenue for various projects (not budgeted) are offset against costs, ManaKidz $311K less pharmacy transactions

69


53 74 (21) 0% Government Revenue 470 520 (50) (10)%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%

15 3 13 505% Other Income 143 18 125 715%7 6 0 6% Funder Payments 46 44 2 6%

75 83 (8) (10)% Total Revenue 659 581 78 13%

EXPENDITURE2,734 2,888 154 5% Staff Costs 19,038 18,988 (50) (0)%

141 65 (75) (115)% Outsourced Costs 647 458 (189) (41)%128 117 (11) (10)% Clinical Costs 956 957 1 0%125 131 6 5% Infrastructure Costs 871 922 51 5%(7) 49 56 (115)% Internal Allocations 37 340 303 (89)%


FTE45 44 (0) (1)% Medical 45 44 (0) (1)%

248 247 (1) (0)% Nursing 251 247 (5) (2)%5 5 (1) (14)% Allied Health 6 5 (1) (27)%

48 45 (3) (8)% Management/Admin 49 45 (4) (10)%343 341 (3) (1)% FTE Total 352 341 (11) (3)%

Jan-15STATEMENT OF FINANCIAL PERFORMANCE - WOMENS HEALTH


($000's) ($000's)

-3,500

-3,000

-2,500

-2,000

-1,500

-1,000

-500

-

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

100

200

300

400

500

600

700

800

900

1,000

Mon

thly

resu

lt $0

00's


Result Budget

-

500

1,000

1,500

2,000

2,500

3,000

3,500

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

70

Month YTD


Revenue: $(8) $78

Salaries & Wages: $154 $(50)


Clinical Supplies: $(11) $1

Infra-Structure: $6 $51

Internal Allocation: $56 $303

STATEMENT OF FINANCIAL PERFORMANCE - WOMENS HEALTH

Additional costs for various projects (not budgeted) are offset against additional revenue.Current Month:Other Income: AUT student days $8K, clinic room rental $4K, Colposcopy revenue down by $(22)K, Misc Revenue $2KYear to Date:Other Income: AUT student days $46K, safe sleep $14K, clinic room rental $33K, UoA 15K and miscellaneous $23K, Colposcopy revenue down by $(60)K

Jan-15

Additional costs for various projects (not budgeted) are offset against additional revenues, i.e. Ccrep Research Annual leave was well managed over the school holiday period.Current Month:Medical- $94k - Annual management Nursing/Midwives- $299 favourable; as detailed below. - $84k Internal bureaus (11.48)FTE and $11K for OT (1)FTE due to Midwifery vacancies of 21 FTE, skill mix, high sick leave. Allied Health- $(9)K unfav costs, (3)FTE - offset by additional revenues for Breastfeeding Advocates.Clerical - $(30)K unfavourable additional costs, (1)FTE offset by additional revenues from the maternity review board. High use of casuals for MCIS roll-out and vacancies. Code for a service manager was changed from Senior nurse account to Clerical account and costs transferred, budget sits under senior nurses account

Year to Date:Medical- $290k -Annual leave managementNursing/Midwives- $(61)K unfavourable; as detailed below. - unexpected high volume and high acuity in NNC resulting in more NNC graduates on Maternity Ward.-high sick, study leave, ACC and orientationAllied Health- $(66)K unfavourable costs, (3)FTE - offset by additional revenues for Breastfeeding Advocates.Clerical - $(212)K unfavourable additional costs, (1)FTE offset by additional revenues from the maternity review board.

The division reported an favourable variance of $120k for the month driven by annual leave management in Jan 2015. WIES for Womens Health are 1% up against contract for the month. Jan 2015 deliveries are 28, births down against last year's actual (delivery numbers at MMH were down by 29 and community units up by 1).

Current Month:$(57)k for External Bureaus to offset MW / Nursing vacancies and skill mix issues$(1)k for AUT MDES (Midwifery Development) - accrual reversed after confirmation of no MDES funding claw back from Maternity Reveiw Board$(23)k unfavourable for UoA clinical services additional dutiesYear to Date:$(205)k for External Bureaus to offset MW / Nursing vacancies and skill mix issues$(7) K for locum usage$(20)k for AUT MDES (Midwifery Development) - not budgeted - proposal to be funded by Maternity Review Board.$29 k favourable for UoA clinical services due to Long term injury of UoA Faculty staff member$23K favourable for secondary Ultrasound charge

The year end forecast is for the division to meet budget. The additional target savings for Womens Health is not likely to be met. YTD the division has $194K favourable variance, however, with volumes and acuity continuing, target saving will not be net in full, balance of year. Target savings $684k.


Current Month:Additional revenue for various projects (not budgeted) are offset against costs, i.e. BFA $11K, Safe Sleep $7K, Maternity Review Board $38k, Year to Date:Additional revenue for various projects (not budgeted) are offset against costs, i.e. BFA $66K, Safe Sleep $49K, Cancer Care $24K, Maternity Review Board $216k, $47K favourable for MRI usage, $(77)K more pharmacy expenses

Current Month:investigating - awaiting for details of transfers from clinical engineering team. Year to Date:$(35)k for urgent delivery bed mattress replalcement for bodily fluid contamination at ALBU and Botany.$36k for lower ambulance usage. Less use of patient consumables in community unit.

$193

Current Month:$(10)K unfavourable for bedding and linens $16K for less printing, stationeries, office suppliers and other misc expenses

Year to Date:$36K for less printing, stationeries and office suppliers$16K no MVT/Fuel transfer (budget but no $ actual allocation)$(23)K MMF funded project expensesand less spending on other misc expenses

71

QUALITY: Goal to improve the quality safety and experience of care SAFETY First Do No Harm

• PUP/ MEWS/ PEWS For 2014/15 all areas now have a version of an Early Warning Scoring System so the Division will measure compliance with Physiological Unstable Patients (PUP) for Gynae, Maternity Early Warning System (MEWS) for Maternity Ward and Birthing and Assessment and the Paediatric Early Warning System (PEWS) for Kidz First Medical and Surgical wards. MEWS has only just been introduced and as yet has not undertaken formal audits. • Safe Sleep Training and Audit Following the training the Division has now started the pilot of the Safe Sleep Audits: Safe Sleep Audits: Mothers knowledge of Safe Sleep messages and baby sleeping position. In December 2014, through the NRA Child Health network the Regional Safe Sleep Audit tool was finalised in alignment with the Regional Safe Sleep Policy. The pilot Safe Sleep Audit was undertaken at Counties and Auckland DHBs by a Final Year Medical Student on a SUDI Elective placement. The Safe Sleep Audit was done one evening late January in Counties facilities - Maternity Ward, and Botany and Papakura Maternity facilities. We are awaiting the final report from this audit process and then a regular audit schedule will be established for monthly audits and regional reporting. • Violence Intervention Programme - Training We commenced rolling out the “Shaken Baby Prevention” programme module as part of the overall Child Protection training module in October/ November 2014. Kidz First staff members were the first ones to take part in this training. Over December and January, 37 Neonatal Staff were trained. Women’s Health staff members are scheduled to complete this module from March 2015. TIMELINESS: “Every Hour Counts” if we are to achieve quality and safety outcomes Refer to BSC

Measures Result Six Hour Target – 95% of EC presentations are seen/admitted/discharged

Paediatric Medicine: 97% - YTD 98% Gynaecology : 98 % for – YTD 95%

4 months FSA Kidz First outpatient Meeting target. 4months FSA Women’s Health Gynaecology outpatients and procedures

Meeting target.

EFFICIENCY Avoiding waste, including waste of equipment, supplies, ideas and energy Refer to BSC

Measures Result ALOS Kidz First Surgical Floor Actual YTD 1.97 vs. 2.38 for 2013/14 ALOS Kidz First Medical - - KF Wards Actual YTD 2.7 vs. 2.7 for 2013/14 ALOS Neonatal Care Actual YTD 10.2 vs. 11.8 for 2013/14

72

EFFECTIVENESS Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit.

Effective Result Menorrhagia/PID/Hyperemesis pathways Pilot underway. Good participation from GP practices

Obstetric clinics in Mangere and Otara SMO Obstetric clinic for Otara has commenced in August with positive feedback from both the women and the SMO/Registrar. Awaiting internet connection at Manager before the SMO clinic can commence

Contraception pathways Part of Maternity Project Board work stream and reporting.

EQUITY (Better outcomes for all campaign)

Equity Result B4 school checks (quarterly) In January 2015 overall coverage sits at 55% against a

target of 59%. HPV Vaccinations On track for 2014 Increase LMC access and market share at registration

YTD January 68% of women now book with an LMC (up from 65% last year).

Breast feeding at discharge from hospital (target 75%)

For January MMH: Overall = 81%, Maaori = 86%, Pacific = 76%

PATIENT and WHAANAU CENTRED CARE Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions Patient and whanau/fono centred care Result

Increased postnatal LOS for 40% of women with high needs

Overall Length of Stay (vaginal deliveries = 2.04 vs. 1.97 YTD) First Time Mothers Maaori = 2.15 vs. 2.56 YTD First Time Mothers Pacific = 2.67 vs. 2.46 YTD

Patient Satisfaction Result

Complaints / Compliments activity

January 2015: Kidz First: 0 Complaints, 2 Compliments, 0 SAC 1, 0 SAC 2 Women’s Health: 3 Complaints (2 intermediate, 1 minor), 13 Compliments, 0 SAC 1, 0 SAC2

73

3.3 Surgery and Ambulatory Care Surgical and Ambulatory Care is managed by Gillian Cossey, General Manager with Mr Wilbur Farmilo Clinical Director - Surgery, Catherine Simpson Clinical Director - Critical Care, Jacqui Wynne-Jones Clinical Nurse Director Surgery, and Annie Fogerty Clinical Nurse Director Acute & Critical Care. Divisional Overview - January January was another challenging month for the Division of Surgical and Ambulatory Care with four Manukau theatres still closed for refurbishment, acute volumes reaching 6000+ theatre minutes on two consecutive days and the on-going pressure of the 120 day elective waiting time target. As usual the SAC team was flexible and hardworking, pulling out all the reserves to ensure maximum utilisation of all available theatre capacity. The results are record breaking – 99% theatre session utilisation and 98.9% theatre list utilisation across the two sites (Middlemore and Manukau). On the busiest acute day at Middlemore, there were nine acute theatres operating, two more than normal. By month end, we were able to operate on all but one of the elective patients needed to be treated to maintain the 120 day waiting time target – an excellent result given that it was a holiday period with many staff on leave. January also achieved a financially favourable variance of $292k, giving a YTD favourable variance of $1.389 million. Improvement Highlights • No CLABs in Surgical Service in January – Ward 9 has now achieved 1392 CLAB free days. • No SAC 3 or 4 pressure injuries in January. • Significant improvement in Quality Safety Marker - Surgical Site Infection audit results - skin

preparation now sitting at 97%. • Improvement in number of patients discharged to discharge lounge or home by 100 hours –

21.7% in January, up from 17.9% in December. • Improvement in Day of Surgery Admissions (DOSA) – 93% in January up from 91% in December.

General Surgery DOSA rate was particularly height at 97.5%. • Elective discharges Health target for January at 111.5%. • Patient Flow Coordinator had an article published regarding the type of acute cases seen –

enclosed NZ Herald piece

74

Challenges/Issues

• Sustaining the 120 day elective waiting times for treatment in view of the continued closure of four Manukau theatres.

• Provision of additional theatre capacity needed to meet the Bariatric treatment target by 30 June 2015.

• Managing the high spinal workload throughout December and January, especially in ICU and Ward 11.

SERVICE PERFORMANCE Activity summary – January 2015 (Based on 71% coding for month 95% YTD) • Acute WIES 0.83% lower than contract for the month (3.38% behind contract ytd). • Electives WIES 0.73% below contract for the month but 1.94% above contract ytd. • Overall WIES 0.8% or 25 WIES lower than contract for the month and 386 WIES or 1.66% behind

contract ytd. • Compared with 13/14 financial year (seven months): Acute WIES 1.1% higher and electives

0.16% lower. Overall 0.60% higher than the corresponding period last year.

Surgical Volumes (WIES - Acute and Elective) Volumes JAN 14 Year to date

Act Bud / Contract Var % var Act

Bud / Contract Var % var

ACUTES

- Adults 1859 1858 1 0.05% 12725 12886 (161) (1.25%) - Children 170 188 (18) (9.53%) 983 1302 (319) (24.53%) Total 2029 2046 (17) (0.83%) 13708 14188 (480) (3.38%) ELECTIVES

- Adults 1021 1043 (23) (2.16%) 8463 8496 (34) (0.40%) - Children 75 61 14 23.63% 661 533 128 23.91% Total 1096 1104 (8) (0.73%) 9124 9030 94 1.04% COMBINED TOTAL

- Adults 2880 2901 (22) (0.74%) 21188 21382 (194) (0.91%) - Children 245 249 (4) (1.41%) 1644 1836 (192) (10.45%) TOTAL 3125 3150 (25) (0.80%) 22832 23218 (386) (1.66%)

Inpatient summary (Discharges) - The month and YTD activity is shown in the table below. • Acutes discharges below contracted levels by 17 patients or 0.96% (ytd 892 patients or 7.39%

lower than contract. • Elective discharges below anticipated contracted levels by 23 patients or 2.34% (ytd 451 patients

or 5.51% higher than contract). Important to note that 64 Elective discharges for the month only carry a notional WIES and therefore do not count as part of the overall WIES. The corresponding ytd figure is 946 discharges. This compares with 1066 for the seven months of the previous financial year.

• Overall monthly patient discharges are 40 below contract while ytd we are down by 441 discharges as a result of lower acute workload compared with contract for the year.

• In comparison with the seven months of last financial year acute discharges are higher by 122 patients and Electives are up 6. Overall therefore we are up 128 discharges or 0.65%.

75

• For the seven months to January 15 we subcontracted 754 Elective patients to external providers compared with our budget of 683 patients for the same period. For the corresponding period last year we had subcontracted 1161 patients. Therefore subcontracting has dropped by 407 patients or 35% over this period in comparison with the corresponding period last year.

• Substantial Elective work was done internally towards achieving target of 120 day waiting time by 31/12/2014.

• Elective base contract for the month excludes Gynae but includes additional elective work. NOTE: Adjustment has been made for uncoded Hip and knee patients operated and discharged during the month.

Surgical Volumes (Discharges - Acute and Elective) Volumes JAN 15 Year to date

Act Bud / Contract Var % var Act

Bud / Contract Var % var

ACUTES - Adults 1535 1522 13 0.87% 10022 10554 (532) (5.04%) - Children 190 220 (30) (13.63%) 1165 1526 (361) (23.64%) Total 1725 1743 (17) (0.96%) 11187 12079 (892) (7.39%) ELECTIVES

- Adults 853 896 (43) (4.82%) 7618 7297 321 4.04% - Children 124 104 20 18.97% 1019 889 130 14.64% Total 977 1000 (23) (2.34%) 8637 8186 451 5.51% COMBINED TOTAL

- Adults 2388 2418 (30) (1.24%) 17640 17850 (210) (1.18%) - Children 314 324 (10) (3.15%) 2184 2415 (231) (9.55%) TOTAL 2702 2742 (40) (1.44%) 19824 20265 (441) (2.18%)

Outpatient Summary (Visits First and follow up) for the month, and YTD • FSA's for month 14.15% above contract for the month but 10.63% higher than contract ytd. • Follow ups are 1.74% above contract for month (4.98% below contract ytd).

January 2015 Year to Date Actual Contract Variance % Actual Contract Variance % FSAs 2694 2360 334 14.15% 21448 19387 2061 10.63% Follow ups 6031 5928 103 1.74% 44179 46492 (2313) (4.98%)

76

SCORECARD

Surgical and Ambulatory Care SCORECARD

JANUARY 2015


Def

Jan-15 Target Var Actual Target VarTotal Caseweight (Provider view) 3,125 3,150 -0.8% 22,832 23,218 -1.7% 1

Elective Caseweight 1,096 1,104 -0.7% 9,124 9,030 1.0% 3

Acute Caseweight 2,029 2,046 -0.8% 13,708 14,188 -3.4% 2

Elective Surgical Discharges 977 1,000 -2.3% 8,637 8,186 5.5% 4

Outpatient FSA Volumes 2,694 2,360 14% 21,448 19,387 11% 10

Outpatient Follow Up Volumes 6,031 5,928 1.7% 44,179 46,492 -5% 11

Virtual FSAs -(GP consult and nonpatient appointments) 129 76 53 879 753 126 12

Reduce clinical outsourcing ($000) 286 138 -148 2,398 1,731 -667 13

Jan-15 Target Var Actual Target Var% Staff with Annual Leave > 2 years 13.6% 5.0% -8.6% 13.8% 5.0% -9.2% 14

% Staff Turnover 1.2% 2.0% 0.8% 8.3% 10.0% 2.7% 15

% Sick Leave 2.1% 2.8% 0.73% 2.7% 2.8% 0.0% 16

Work Place Injury per 1,000,000 hours 11.77 10.50 -1.27 11.66 10.50 -1.26 17


Jan-15 Target Var Actual Target VarHand Hygiene compliance rate (based on Gold Audit) - Ward 11 74% 80% -6% 80% 80% 3%Pressure Injuries / 100 patients 0% 0% 0% 0% 0% 0%Falls causing major harm / 1000 bed days 0% 0% 0% 0% 0% 0% 22

Severe Pressure Injury (ungradeable) per 1000 bed days 0% 0% 0% 0% 0% 0%Surgical Site Surveillance for Major joints

Anitbiotics given 0-60mins before "knife to skin" 91% 95% -4% 84% 95% -11%2 grams or more Cefazolin given 99% 100% -2% 94% 100% -6%

Appropriate skin preparation 97% 100% -3% 90% 100% -10%% Operations - all 3 parts of Surgical Safety Checklist used 89% 90% -1% 92% 90% 1%CLAB rate/ 1000 line days 0% 0% 0% 0% 0% 0% 24

Rate of S. aureus bacteraemia per 1000 bed days 0% 0% 0% 0% 0% 0% 25

VTE - number of SACS re-admissions due to VTE 3 0 -3 68 0 -20

Jan-15 Target Var Actual Target VarPre-operative Length of Stay Days (from admit to surgery) 0.60 1.00 0.40 0.44 1.0 0.56ESPI 2 No. patients waiting >150 days for FSA - Elective (Surgical Services incl Gynae) 0 0 0 0 0 0 42

ESPI 5 No. patients waiting >150 days Treatment - Elective (Surgical Services incl Gynae) 0 0 0 0 0 0 43

ESPI 2 No. patients waiting >120 days for FSA - Elective (Surgical Services incl Gynae)-Target 0 by 31/12/14 1 0 - 1 0 -ESPI 5 No. patients waiting >120 days Treatment - Elective (Surgical Services incl Gynae) -Target 0 by 31/12/14 1 0 - 1 0 -

Jan-15 Target Var Actual Target VarAverage Length of Stay - Acute Inpatient incl Burns 3.87 3.8 -0.07 3.95 3.8 -0.15 50

Average Length of Stay - Acute Inpatient excl: Burns 3.76 3.8 0.04 3.89 3.8 -0.09 Average Length of Stay - Electives 1.73 1.5 -0.23 1.37 1.5 0.14 51

Acute Readmissions within 7 days - Total 3.85 3.43 -0.42 3.62 3.43 -0.19 52

Number of patients referred to POAC 3 10 -7 50 60 -10

Jan-15 Target Var Actual Target VarTheatre list utilisation - % used MMH/MSC (MOH OS5) _Error in OS corrected 98.9% 85.0% 13.9% 89% 85% 4.0%Theatre session utilisation - % used MMH/MSC 99.0% 95.0% 4.0% 94% 95% -1%Elective Theatre turnaround times- Mins (MMH/MSC) 16.1 15 -1.1 14.7 15 0.3Elective cancellations - Day of surgery as % of all Elective (all reasons)- SACS only 9.5% 5.0% -4.5% 7.8% 5% -2.8%Day of Surgery Admissions (DOSA) 93.0% 90.0% 3.0% 91.0% 90% 1.0% 65

Day Case Rate (Elective/ Arranged) -Subspecialties in SACS only Adults/kids 64.0% 65.0% -1.0% 63.1% 65% -1.9% 66

MMH % patients discharged to discharge lounge or home by 1100hrs 21.7% 30% -8.3% 19.0% 30% -11.0%Ratio FSA/FU clinic ratio 37.6% 31% 6.6% 39.6% 31% 8.6% 61

Outpatient DNA rates - overall- Surgical Services only 8.1% 10% 2.0% 7.8% 10% 2.2% 62

Outpatient DNA rates - Maori (FSA) - Surgical Services only 11.4% 10% -1.4% 11.8% 10% -1.8% 62

Outpatient DNA rates - Pacific (FSA)- Surgical Services only 12.0% 10% -2.0% 11.5% 10% -1.5% 62

Jan-15 Target Var Actual Target VarPatient Experience Survey (n=102) 81% 92% -11% 81% 92% -11% 74


Jan-15 Target Var Actual Target Var% of hospitalised smokers receiving smokefree advice & support -Total (Surgical) 93% 95% -2.0% 95% 95% 0.0% 77

Ensu

ring F

inan

cial

Sust

aina

bilit

y

Year to date

Year to date

Year to date

12 month average

Year to date

Enab

ling H

igh

Perfo

rmin

g Peo

ple

Firs

t, Do

No

Harm

(Saf

ety)

Equi

tySy

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Inte

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ion

(Effe

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Patie

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Wha

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Year

Year to date (n=497)

Year

77

FINANCIAL: Best value for public health system resources


538 565 (27) (5)% Government Revenue 3,600 4,036 (436) (11)%0 200 (200) (100)% Patient/Consumer Sourced 387 1,175 (788) (67)%

94 125 (31) (24)% Other Income 1,596 1,424 172 12%1,043 1,035 8 1% Funder Payments 7,299 7,244 55 1%1,675 1,925 (250) (13)% Total Revenue 12,882 13,879 (997) (7)%


599 394 (204) (52)% Outsourced Costs 4,509 3,540 (969) (27)%2,747 2,779 32 1% Clinical Costs 21,338 22,121 783 4%

460 513 53 10% Infrastructure Costs 3,587 3,817 230 6%536 549 12 (2)% Internal Allocations 4,244 4,360 116 (3)%

16,231 16,773 542 3% Total Expenditure 116,604 118,989 2,386 2%14,556 14,848 292 2% Net Result 103,722 105,111 1,389 1%

FTE271 287 16 5% Medical 277 287 10 3%768 776 8 1% Nursing 776 776 (0) (0)%

99 116 18 15% Allied Health 109 116 7 6%66 67 1 2% Support 72 67 (5) (8)%

113 127 14 11% Management/Admin 123 127 4 3%1,316 1,373 56 4% FTE Total 1,357 1,373 16 1%

**April:Unpaid days accrual for the Easter period,adjusted in May.

($000's) ($000's)

STATEMENT OF FINANCIAL PERFORMANCE - SURGICAL & AMBULATORY

Month to Date Year to DateJan-15

12,500

13,000

13,500

14,000

14,500

15,000

15,500

16,000

16,500

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

1,000

2,000

3,000

4,000

5,000

6,000

Mon

thly

resu

lt $0

00's


Result Budget

10,000

10,500

11,000

11,500

12,000

12,500

13,000

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

78

Month YTD

Total Variance: $292 $1,389

Revenue: $(250) $(997)




Infra-Structure/Internal Allocati $65 $346

The favourable Variance for the month is mainly due to the use of Clinical supplies ordered and unused for December 2014 . The stock up in dec was to deal with suppliers being unable to deliver items during the Christmas and New year period. Year todate favourable variance is chiefly due to reduced Acute Workload for the first five months of the financial year coupled with savings due to better prices negotiated on expired clinical supplies contracts with suppliers.

Current Year end Forecast is for a $3M favourable variance at year end (target savings $4.1m).

Year end Forecast variance to Budget $3M favourable

Favourable for the month and year todate mainly due to savings under MRI and Pharmacy charges,Printing and Stationery and Vac suction rental charges.

Jan-15

Outsourced costs on private subcontracting $(139)k Unfavourable and ($647k) Adverse Ytd. This is chiefly due to variances on outsourcing elective patients to maintain the 120 day ESPI targets . For the month we also had a $65k unfavourable variance on external outsourced personnel costs . $42k ($210k ytd) relates to Nursing bureau costs to supplement staffing needs to ensure adequate care was provided for the patient workload on wards. A further $23k Variance (ytd 76K) related to SMO costs paid to University of Auckland due to an SMO taking up a University Appointment during the year.

STATEMENT OF FINANCIAL PERFORMANCE - SURGICAL & AMBULATORY

Government Revenue: Elective ACC Revenue was $26k un-favourable for the month. The month's revenue target was not met because the division gave priority to MoH patients to enable Acute wait times and ESPI wait times to be met. The limited Capacity for treatment coupled with the four theatre refurbishment at MSC meant that subcontacting patients to private providers had to be stepped up to meet MoH targets. Ytd there is an Adverse variance on Elective ACC revenue of ($433k). Patient/Consumer Sourced: Private patients $(200)k adverse for the month (ytd $788k) due to a reduction in acute Tahitian burns patients accessing treatment.Other Income $30k unfavourable for the month (ytd $172k Favourable mainly due to additional Revenue from Urology and Plastics as a result of SMO 's carrying out work in other Auckland DHB'sFunder Payments: Funder revenue for elective work on $6k over budget for the month, Ytd $52k favourable due to timing differences.

The Division had a favourable variance of $292k for the month . Detailed explanation for the months variance is given below. Year todate the result is 1.389M favourableMoH outputs for the month were lower than contract by 25 WIES or 0.8% . This was based on 71% coding of patient charts. There was a reduction in Acute workload of 0.83% or 17 WIES and a corresponding reduction in Electives of 0.73% (8 WIES). Inspite of the reduction in Electives the Division maintained compliance with ESPI (ie) that all patients complied with the 120 day wait times target that was sucessfully achieved by the target date of 31st December 2014

Medical $388k favourable for the MTH and $1268k fav ytd - Primarily reflects SMO vacancies due to pending job sizing issues and the benefit of leave taken exceeding leave accrued for the month. The mix of RMO's for the run and the leave transfers on rotation have had a favourable affect on the Division. Nursing $26k unfavourable for the MTH (fav $70k Ytd) - Unfavourable variance for the month represents extra internal bureau to cope with the higher workload of both Acute and Elective patientsAllied Health $162k favourable for MTH ($625k fav Ytd) - Favourable variance due to vacancies 7.5 FTE. Vacancies have not been filled as a result of the lack of skilled staff and the time lag for recruitment. Support Staff $36k favourable for the MTH and $75k fav ytd : represent vacancies 5 FTE of SSU staff in the process of being recruited and vacancies in interpreter staff. Note: that the Division holds the budget for the entire organisation providing interpreting services as and when required. The demand on the service has grown rapidly and servicing these demands has resulted in more casual interpreters being recruited to meet expectation.Management Admin $89k favourable for the MTH and $188k ytd . Months variance mainly due to Leave taken exceeding leave accrued, MSC closures for holidays and 10 FTE vacancies. Ytd favourable variance due to unfilled positions

79

QUALITY: Goal to improve the quality safety and experience of care Highlights • Surgical Services involved in Opioid collaborative at MSC site • 20 Surgical Trigger Tools chart reviews are booked to occur at the start of each month. CM

Health is the first DHB to commence the Surgical Trigger tools auditing • No SAC 3 or 4 Pressure injuries recorded again this month • No CLABS for surgical again this month, Ward 9 has now achieved 1,392 CLAB free days • Smokefree Target at 93% for Surgical Services • Number of admissions through TADU for January increased, and Increased number of patients

being discharged through the discharge lounge • 29 Controlled documents were reviewed and updated this month in Objective • Members of the surgical quality team are presenting at the PGY1 House Officers safeshop SAFETY First Do No Harm • Surgical Site Surveillance – A very productive meeting was held with Surgical Services and

Infection Control teams, to confirm the processes needed to improve the audit results for the NQSC Surgical Site Infection Improvement programme. There was clarification on how data should be entered to ensure that the auditors can collect accurate information. Wilbur Farmilo advised the Anaesthetists regarding the recording of the antibiotic and time given, and the form listing the skin prep is being altered to prevent erroneous details being recorded (e.g. with regard to Iodine). The introduction of a Perioperative Clinical Information System will ensure future accuracy of data recording and audit.

• Opioid collaborative A project team is working with the MoH on a collaborative at Manukau Surgery Centre regarding – the use of opioids and the prevention of constipation.

• Occupational Health and Safety Opioid collaborative Care is being taken with lifting and turning spinal patients - two staff member in ICU have hurt their backs from lifting. Extra orderlies are being trained up to assist the nurses.

• Wound Care A full review of wound care products has been completed and agreement reached on the most cost effective products to be used. Education posters have been designed and distributed to explain the new products.

• Perioperative Health & Safety Group (Middlemore) Audits are being completed on time and the entire group have had training.

• Surgical Services Top 5 Employee Incidents over the last quarter Risks identified for staff remain blood and body fluid incidents and musculoskeletal injuries.

80

TIMELINESS: “Every Hour Counts” if we are to achieve quality and safety outcomes” ELECTIVE WAITING TIMES – January ESPI 2: No patients will wait more than 120 days for their First Specialist Assessment (FSA) Services have done very well over the January period considering the impact the holiday period has on clinician, clinic and patient availability to have only 1 patient exceeding 120 days at the end of the month. ESPI 5: Patients given a commitment to treatment will be treated within 120 days As with the ESPI 2 result above, there has been 1 breach with a patient waiting more than 120 days for treatment at the end of January. Considering the holiday period and the impact of the closure of theatres at Manukau for renovation, this is a good result and an improvement in position compared to the previous in 13/14 year. The impact of the Manukau theatre closures will have a considerable impact on the February result with an expected 20-30 cases, across predominately ORL but also inclusive of other services, being signalled as likely to breach the 120 day requirement. Outsourcing has commenced to ensure patients receive surgery on time.

81

EFFICIENCY Avoiding waste, including waste of equipment, supplies, ideas and energy • Theatre session and list utilisation was extremely high in January. This will settle down to a

more manageable and safe level when the four Manukau theatres re-open after refurbishment. • Day of Surgery Admissions (DOSA) were also high in January - 93% against the MoH target of

90%. General Surgery has a very streamlined process for pre-operative preparation reducing the need for patients to be admitted the day before surgery. (as reflected in their DOSA result of 97.5% in January).

• TADU utilisation was high in January, with a large increase in the number of both pre-operative and post-operative patients. This is due to all 14 theatres and both procedure rooms at Middlemore being open to create capacity lost by the closure of four Manukau Theatres. The increase in the Local Anaesthetic outpatient procedures (LAOP) work in the procedure room is particularly noticeable, with all this work being brought across from Manukau Surgery Centre.

EFFECTIVENESS: Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit. • The Goal Discharge Date process is working well and is changing practice on the wards,

especially in General Surgery. The >10 days LOS inpatients are being monitored – the CNMs report weekly on these patients.

• The Interpreting Service underwent a review which reallocated FTE according to service demand. As a result, the amount of overspend in that service has reduced considerably – the January financial result showed only a small negative variance of $726.00 against budget.

• The Professional Development of Anaesthetic Technicians is going from strength to strength due to the effective work of the new role of Professional Leader. The Anaesthetic Tech educators are involved in the development of the planned Dedicated Education Unit in Theatres.

82

• The Well – Managed Pain programme being run in conjunction with Ko Awatea has shown 303 bed-days saved as a result of 101 interventions.

• The DRES programme of work is reaching its final stages. The DRES Programme Coordinator contract (Michael Wilson) ended on 31 December 2014. He is now working in the Primary & Community Team helping to roll out clinical pathways. Each service involved in DRES is continuing to work on their new pathways with a view to completing all the DRES work by 30 June 2015 (Final report to MoH due on 30 November 2015).

• On a less positive note, there is a challenge in PACU at Middlemore with regards to long stay patients - there were a total of 169 patients who stayed in PACU over the KPI of 2hours in January. This is compared to 106 patients in January 2013. This is an increase of long stays by 37%. The opening of the 14th theatre is not entirely responsible for this increase. This reflects acuity, increased new business (spines) and the status of the hospital which at the times was over 100% full in occupancy in January. There have been significant delays in getting patients back to the ward. Of the 169 patients, 21 required a Critical Care Review, resulting in the 12 patients being discharge to Critical Care Complex from PACU.

EQUITY • The demand pressures of the CM Health ageing population and the unmet need in the

community will continue to be a challenge for the provision of elective surgery. Services are constantly reviewing criteria to ensure that equity of access is not greatly compromised and that any exclusion from any service will be based on lower clinical need. Other avenues for patients to receive treatment are being actively pursued.

PATIENT AND WHAANAU CENTRED CARE: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions. • Critical care and Orthopaedics have been challenged coping with the increased volumes of

spinal patients who require a lot of resource and attention. The staff are very passionate and caring, ensuring each patient has the optimal experience possible, despite their life-changing situation.

• SAC Division is looking forward to the opportunities provided by Project Swift to enhance the patient experience (e.g. by the provision of a Patient Portal to enable patients to make their own outpatient appointments).

• Complaints/ compliments: are tracked monthly with strengths and gaps noted, analysed and acted on. Compliments numbers (72) continue to outweigh the number of complaints (27).

83

3.4 Adult Rehabilitation and Health of Older People (ARHOP) Service Overview Adult Rehabilitation and Health of Older People (ARHOP) is managed by Dana Ralph-Smith, General Manager, with Dr Peter Gow, Clinical Director and Lyn Cooper, Clinical Nurse Director (ARHOP). In addition, to support the Health of Older People contracted services, Dr Kathy Peri is Clinical Nurse Director. Highlights • Ward 23 remained closed during January with no issues arising from the closure in terms of lack

of capacity of beds across the AT&R wards. Of note Pukekohe rehab beds also remained low during January.

• In-reach service continues to provide excellent assessments of patients’ needs and as a result our rehabilitation length of stay has decreased and at times through January we have had up to 17 Acute Care for the Elderly patients, which is quite different to last year.

• The ARHOP Outpatient Reception areas for Physiotherapy, Medical and other clinics were consolidated in January. Testing, trials and planning leading up to this prevented any major issues, with the minor problems that did occur in the process of resolution. Training to give the administration team fluid capacity to provide cover will continue over the next three-four months.

SERVICE PERFORMANCE Activity summary Inpatient summary for the month and YTD activity Of note YTD spinal bed day volumes were up by 255 bed days reflecting a greater demand.

* Service commenced May 13 Outpatient Summary (Visits First and follow up) for the month Geriatrician Outpatient Clinics

NB: From January 2015 the data has been changed, instead of greater than 150,120 and 90 it is now 120, 90 and 60 days.

Volumes

ActBud /


Contract Var % var

INPATIENT AT&R 1,484 1,653 -169 -10% 13,084 13,141 -57 0%

Spinal 391 505 -114 -23% 3,066 2,811 255 9%

Stroke Rehabilitation 277 417 -140 -34% 2,377 2,337 40 2%

Acute Care for the Elderly 318 232 86 37% 2,118 2,232 -114 -5%NASC

Contacts 243 1,167 -924 -79% 6,220 7,440 -1,220 -16%

ARHOP Volumes (Bed days and Contacts)January '15 Year to date

Month Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15Added 273 232 244 125 88 94 91 78 91 92 85 79 82 93 108 68 80 80 81Seen 233 226 237 144 191 82 73 70 93 64 85 103 81 85 70 61 84 72 70Return to GP 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0Removed Other 36 57 28 37 45 15 20 25 17 17 18 11 12 11 9 8 20 5 11

TOWL 782 701 721 796 793 193 189 179 168 172 159 142 123 115 143 145 126 137 141Waiting > 120 days 149 143 116 140 149 14 10 16 21 14 12 14 9 12 17 17 16 22 27Waiting > 90 days 264 238 213 272 275 28 28 28 34 21 17 23 16 17 22 21 23 33 33

84

SCORECARD Commentary of Balanced Scorecard

Adult Rehabilitation and Health of Older People SCORECARD

January 2015


Def

Jan-15 Target Var Actual Target VarSpinal Inpatient ACC Revenue(in '000s) 133 363 -230 2,637 2,763 -125 Non-acute Rehabilitation ACC Revenue(in '000s) 130 200 -70 2,348 2,000 348

Jan-15 Target Var Actual Target Var% Staff with Annual Leave > 2 years (1) 6.0% 5.0% -1.0% 6.5% 5.0% -1.5% 14

% Staff Turnover 0.8% 2.0% 1.2% 11.8% 10.0% -1.8% 15

% Sick Leave 2.8% 2.8% 0.0% 3.0% 2.8% -0.2% 16

Workplace Injury Per 1,000,000 hours 25.55 10.50 -15.05 24.31 10.50 -13.81 17


Jan-15 Target Var Actual Target VarFalls - % of falls assessments done in first 6 hours (2) 100% 100% 0.0% 89% 88% 1.0%Falls - % of Interventions completed 87% 100% -13.0% 94% 91% 3.0%Pressure Injuries - % of assessments done in first 6 hours 95% 100% -5.0% 97% 82% 14.6%Pressure Injuries - % of interventions completed 88% 100% -12.0% 94% 87% 7.4%Reduce over ride rate of Pyxis on ATR wards decrease medication errors to 15% 16% 15% -1.0% 16% 15% -1.0%

Jan-15 Target Var Actual Target VarStroke discharges - CVD risk profile, medications and 3 month follow-up 100% 90% 10.0% 100% 90% 10.0%Proportion of referrals managed via e-referrals across all Services (ARHOP) (3) 25% 50% -25.2% 21.0% ~ ~

Access to Outpatient specialist services -volumes of Geriatric A&R Hotline Calls (4) 91 29 62 50 ~ ~

QUARTERLY REPORTINGQtr 1 Target Var Actual Target Var

% NASC referral to assessment - high complex within 5 days urgent < 24 hrs (or less), (new measure 2014/15) (5) 32% 75% -43.0% 32.4% 75% -42.6%% NASC referral to assessment - low complex clients <15 days (new measure 2014/15) (5) 80.3% 75.0% 5.3% 80.3% 75.0% 5.3%

Jan-15Jan-14 (less %) Var Actual Target Var

Reduce number of patient 75’s or older LOS > 10 days in AT&R wards by 2% (6) 46 49.00 -3 56.1 58.2 -2 51Reducing direct admissions from GPs to ATR wards by 5% 27 17.91 9 56 33.26 23% of Estimated Discharge date set following assessment 93% 75% 18% 85% 75% 10%Avoidable presentations to EC from Aged Residential Care Facilities (ARRC) 12 10 2 13.6 15.5 -1.9MMH % patients discharged to discharge lounge or home by 1100hrs 30% -30% 30% -30%Rehabilitation 7 day Readmissions rate 0.87% ~ ~ 0.67% ~Acute Readmission within 28 days - Total for Rehabilitation beds 13.0% 7.8% -5.2% 10.3% 10% 0.8% 53

QUARTERLY REPORTING Q4 Target Var Actual Target Var

% +65years with long term HBSS - comprehensive clinical assessment &care plan 76.70% 75% 2% 76.70% 75% 2%Reported one quarter in arrears

Jan-15 Target Var Actual Target VarPatient Experience Survey 100% 90% 10.0% 93% 90% 3.0%


Jan-15Jan 14 Target Var Actual Target Var

Number of Spinal Rehabilitation Outreach Clinic days - (new measure 2014/15) 2 5 -3 3.42 2.57 0.85 47

Ensu

ring

Fina

ncia

l Su

stai

nabi

lity Year to date

Enab

ling

High

Pe

rfor

min

g Pe

ople 12 month average

Firs

t, Do

No

Harm

(S

afet

y)

Year to date

Equi

ty

Year to date

Syst

em In

tegr

atio

n (E

ffect

ive)

Year to date

Effic

ient

Year to date

`

Year to date

Year to date

Patie

nt

Wha

anau

Ce

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d Ca

re n = 3 Year to date (n=16)

Tim

ely

85

1. The Division is continuing to monitor and manage high annual leave balances. Sick Leave rates also continue to be monitored and managed.

2. Falls assessments increased to 100% for the month. Clinical Nurse Director continues to follow up with wards ensuring this is a high clinical priority.

3. The Division is working with teams to identify any barriers and what we can do to increase e-referrals use. ARHOP has had a further increase in Hotline calls to Community Geriatric Services.

4. Current performance reporting on timeliness of NASC referrals to assessment for complex and non-complex clients is being developed through internal analysis. This will inform regional and national reporting requirements once agreed definitions have been developed. There will be a more detailed balance scorecard/performance measure developed for Needs Assessment and Service Coordination (NASC) to monitor performance during the Locality integration process over the next 12 months. We have continued to make good gains in Needs Assessment and Service Coordination (NASC) interRAI assessments and have commenced analysing data for service planning.

5. Implementing a Whole of System for Health of Older People 75 years and older to reduce length of stay and readmissions which has achieved good overall performance this month.

Please refer to details below for further details on the key results. Inpatient and Specialist services Middlemore Rehabilitation Services - Adult Rehabilitation and Health of Older People admitted 139 patients with 83 patients (60%) admitted acutely direct from Emergency Care. Discharges from ARHOP – Health of Older People and Rehabilitation services; Wards 4 & 5, Geriatric Rehabilitation Ward 24 and All Ages Rehabilitation Ward 23. There were 95 discharges in the month.

Ages 75years + with >10 days Length of Stay The numbers of discharges for people ages 75 years and older with a length of stay more than 10 days in Assessment Treatment and Rehabilitation (AT&R) for January 2015 is 46, a decrease from 50 for January 2014. Ages 75years + with >10 days length of stay dischargers, represent 48% of the total AT&R discharges for the month of January.

86

Outpatient and Community Services Home Health Care - Community District Nurses and Allied Health Teams – The Home Health service is available to people in their home or in a clinic setting. The Home Health teams are aligned to the Locality Clinical Partnerships and operationally report to the Locality General Managers. Home Health Care received 984 referrals; discharged 1,067 clients and completed 9,209 contacts across all bases for the month of January. Additional cars to support the Needs Assessment teams in Eastern and Manukau Localities will be leased for six months from February. Community Geriatric Service - Contacts in Aged Residential Facilities and Community – Community Geriatric Service (CGS) Contacts have decreased by four compared to January 2014. For the month of January 2015, there were 118 contacts; the average contact duration was 66 minutes. 53% of contacts were a First Contact, 33% of contacts were at a Rest Home or Private Hospital location, 70% of contacts were by a nurse and 68% were for an Assessment.

Needs Assessment and Service Coordination (NASC) – The NASC teams are now fully integrated into the localities and planning within these teams continues in each locality. A NASC dashboard has been developed and continues to be reviewed to ensure that KPIs are monitored centrally as well as at an individual locality level across all of the NASC teams. The central triage role continues to be provided through a roster system covered by Needs Assessors from each locality and training and development for this function continues. InterRAI Assessments Completed in month by Locality 2014/15

0

50

100

150

200

250

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan

2014 2015

Volume of contacts by CGS Team

DNA

Actual

87

FINANCIAL: Best value for public health system resources


358 358 0 0 Government Revenue 2,635 2,507 129 5%1 0 1 369% Patient/Consumer Sourced 2 2 0 19%

21 49 (28) (56)% Other Income 194 344 (150) (44)%141 168 (27) (16)% Funder Payments 1,329 1,177 152 13%522 576 (54) (9)% Total Revenue 4,160 4,029 131 3%


362 355 (7) (2)% Outsourced Costs 2,581 2,485 (95) (4)%509 488 (21) (4)% Clinical Costs 3,753 3,417 (336) (10)%143 132 (11) (8)% Infrastructure Costs 1,091 922 (169) (18)%

58 57 (1) 2% Internal Allocations 517 439 (79) 18%4,923 5,141 218 4% Total Expenditure 35,509 35,910 401 1%

(4,401) (4,566) 164 4% Net Result (31,350) (31,881) 532 2%

FTE 30 30 0 1% Medical 31 30 (1) (3)%

256 260 4 2% Nursing 269 261 (8) (3)%255 295 39 13% Allied Health 281 295 14 5%

47 55 8 15% Management/Admin 49 55 6 11%588 643 55 8% FTE Total 624 641 18 3%

STATEMENT OF FINANCIAL PERFORMANCE - ARHOP


($000's) ($000's)

Jan-15

-4,800

-4,700

-4,600

-4,500

-4,400

-4,300

-4,200

-4,100

-4,000

-3,900

-3,800

-3,700

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

200

400

600

800

1,000

1,200

1,400

Mon

thly

resu

lt $0

00's


Result Budget

2,000

2,500

3,000

3,500

4,000

4,500

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

88

QUALITY: Goal to improve the quality safety and experience of care SAFETY First Do No Harm Against a goal of Zero Patient Harm: • Pressure injuries: There was one pressure injuries recorded during January, which were

acquired during present admission. • Falls incidents: There were 18 recorded falls in January; this is consistent with recorded falls last

month. Of these there were six falls with harm, an increase from nil during December. • Medication errors incidents: There were two medication errors reported for January. This is a

further decrease from nine medication errors reported for December.

TIMELINESS: “Every Hour Counts” if we are to achieve quality and safety outcomes Waitlists - Acute Allied Health Outpatients Waitlist Activity Includes: Cardiac Rehabilitation, Physiotherapy Hyperventilation Service, Multidisciplinary Clinic, Occupational Therapist, Physiotherapist & Rheumatology Nurse Specialist (MORRSA), Musculoskeletal Outpatients (MSOP), Occupational Therapy Rheumatology, Pulmonary Rehab (Howick, Otara, Middlemore Hospital, Pukekohe), Women’s Health Gynaecology, Women’s Health Obstetric The main persistent issue with the waitlist has been Musculoskeletal Outpatients with the waitlist remaining very high at around 400 patients. Despite this the priority one patients are being seen within the desired target timeframe but the priority 2 patients are waiting up to 15 weeks to be seen. Additional resource has been pushed in to the team to get the waitlist down to within the clinical target levels. Referrals to the MSOP service have increased 37% over the past 3 years.

Month YTD


Revenue: $(54) $131



Clinical Supplies: $(21) $(336)

` Infra-Structure: $(11) $(169)

Internal Allocations: $(1) $(79)


Mainly due to Deferred Maintenance-Ward 23 $(33)K for month (YTD $(93)k overspend).

The main variances are Community Continence overspend $(12)k for the month (YTD $(83)k), Patient Consumables (Burns Garments) $1k underspend for the month (YTD overspend $(84)k) that is recoverable through the ACC pathway, Community Ostomy $(23)k overspend for the month (YTD $(68)k overspend) and Clinical Equipment Repairs and Maintenance $(1)k overspend for the month (YTD $(34)k). 2014/15 budget reflects reduced useage of clinical supplies.


The January month result reflects the personnel costs below budget for Medical,Nursing, Allied and Admin, offset partly by Clinical Costs and Infrastructure costs overspend as detailed below.

The shortfall in the month is mainly due to the under-utilisation of respite resulting in lower reimbursement against the budget.

Medical Staffing is under budget $36k for the month (YTD underspend $176k) mainly due to RMOs seniority level being less than budgeted. The closure of Ward 23 during the month for Deferred Maintenance and the recruiting of staff at a lower level in Nursing has resulted in an underspend for the month of $64k (YTD underspend of $208k). The Allied Health vacancies, 20.5FTE and recruiting staff at a lower level wherever possible has resulted in a favourable variance of $154k (YTD underspend $543k). The Admin vacancies and recruiting at lower levels has resulted in a favourable variance of $3 k for the month (YTD under spend $152k).

STATEMENT OF FINANCIAL PERFORMANCE - ARHOPJan-15

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Acute Allied Health Waitlist Activity

Note: There are only three Pulmonary Rehabilitation patients of the 75 waiting greater than 150 days, that the service has been unable to contact to confirm a follow up appointment. EFFICIENCY Avoiding waste, including waste of equipment, supplies, ideas and energy Wound Care – A meeting was held with Renal Dialysis to explore possibility of clients having their simple wounds cleaned and re-dressed while they are undergoing dialysis. All agreed to take small steps to see how it can work, starting with providing Forms On Line access to Renal Dialysis and wound care training for the Renal RNs. Needs Assessment and Services for Older People (NASC) — Now that NASC have moved into locality clusters, the next transition are to develop and implement the new locality multidisciplinary model aligned to At Risk Individual Programme. EFFECTIVENESS Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit. Acute Care for the Elderly (ACE): The focus of this initiative is to provide faster safer more reliable care for people over 85 and to prevent harm from deconditioning from prolonged inactivity. The outcomes for ACE continue at or better than the target levels. Outcomes are stable and have been sustained now over the past 12 months. The project focus has now moved to the business case and the “how-to-guide.”

Dementia Pathway Implementation (Memory Team) – The Outreach model has been developed into a briefing paper which was presented to the Clinical Advisory Network meeting in Franklin, gaining their support to continue to proof of concept with a selected GP Practice. Support has been gained form the Community Geriatric Service and Alzheimer’s Auckland to participate in the model.

Month Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15Added 490 365 389 418 513 417 502 538 380 384 284Seen 336 232 356 273 368 220 387 332 364 290 242Removed Other 114 79 44 104 67 94 94 105 112 51 87

Total on Waiting List 914 877 720 818 819 830 865 928 846 908 881Waiting > 150 days 38 33 11 10 10 17 16 31 36 51 75Waiting > 120 days 53 38 24 18 31 22 45 41 32 63 63Waiting > 90 days 71 94 84 79 65 97 62 79 94 110 113

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The Community Stroke Early Supported Discharge – The Early Supportive Discharge (ESD) remains stable at its current level. The focus for the next three months will be around completing the final elements of the project; the business case for sustainable funding and the implementation package to spread to full service. Community Geriatric Service (CGS) team – An important component of the Systems Integration/Locality development is to provide additional Geriatrician support to primary care practices and aged residential care. The CGS team provided support to five GP practices during the January. Target <100 Emergency Care presentations from residential facilities per month • January 2015 saw 102 Aged Related Residential Care (ARRC) Clients present to Emergency Care.

Of these, 10 presentations were falls related and 12 were potentially avoidable admissions. • Community Geriatric Services Hotline Contacts Total: 91 Hotline Calls. Average hotline contact

time for the month of January was 2.4 minutes for Doctors and 2.6 minutes for nurses.

The National Spinal Strategy and Counties Manukau Health Spinal Service - Focus continues on implementing the acute spinal pathway (referral and transport to acute surgical services). We have had 36 acute patients through the acute spinal service since 1 July 2014 with a continuing high number of complete cervical injuries. Not all patients admitted to acute services go on to receive rehabilitation at the Auckland Regional Spinal Unit. Progress is being made in seeking financial support for the purchase of the O-Arm with support from the Rugby Foundation looking possible. Continuing with work to establish clinical pathways for urology, psychology and tracheostomy and embed these across acute and inpatient rehabilitation services. PATIENT AND WHAANAU CENTRED CARE Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions Complaints/compliments: Complaints – There was one complaint received during January; relating to the closure of the Physiotherapy Reception Area in the Acute Allied Health Service. Compliments – There were two compliments received during the month of January,; expressing gratitude and appreciation to staff on Ward 4 and a Physiotherapist in Acute Allied Health.

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3.5 Medicine, Acute Care and Clinical Support Service Overview The Division of Medicine, Acute Care and Clinical Support service is managed by Brad Healey, General Manager, with Clinical Directors/Heads Dr Jeff Garrett (Medicine), Dr Vanessa Thornton (Emergency Care), Dr Ross Boswell (Laboratory), Dr Sally Urry (Radiology & Breastscreen), Dr Mary Christie (Histopathology) and Clinical Nurse Directors To’a Fereti and Annie Fogarty. Highlights Emergency Care: Emergency care volumes in January 2015 were 9156 presentations. This was 1.3% higher than last month and 7.6% higher than this time last year. This was the highest January on record. Average daily volumes were 295 with presentations fluctuating between 236 and 331 which is similar to winter volumes a year ago.

The EC LOS 6 hour target was successfully achieved the January % pass was 96.1%. Medicine The Medical Assessment Unit continues to function well with the key benefits of co-location with EC in a single facility providing operational efficiencies. We are currently undertaking an evaluation of Medical Assessment (being done by Ko Awatea) to review our performance and understand and quantify the benefits. Continued work on discharge templates for some conditions, (e.g. TIA, pneumonia, CHF). An analysis on General Medicine ward rounds will see from 16th February a trial of some changes to the current process. The daily number of general medicine patients with a LOS of >10 days has fallen in response to our daily round up of the patients and regular twice weekly meeting with the Charge Nurses. The plan to extend this work to include some PDSAs linking the > 10 day patients with community services through their respective localities.

200

220

240

260

280

300

320

340

Jul 2

009

Oct

200

9

Jan

2010

Apr 2

010

Jul 2

010

Oct

201

0

Jan

2011

Apr 2

011

Jul 2

011

Oct

201

1

Jan

2012

Apr 2

012

Jul 2

012

Oct

201

2

Jan

2013

Apr 2

013

Jul 2

013

Oct

201

3

Jan

2014

Apr 2

014

Jul 2

014

Oct

201

4

Jan

2015

Apr 2

015

Jul 2

015

Average Daily EC Presentations

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Renal Diaverum has now been confirmed as the preferred provider for the new incentre dialysis unit. Contract negotiations have commenced and the combined project team (Diaverum and CMDHB) established. Breastscreen Coverage levels continue to increase, in particular Maaori coverage, for 50-69 year olds is 69.8% at 31 Dec, very close to the 70% target and the highest coverage BSCM has achieved for Maaori women. We expect to achieve the national target when BSA run regular reports with the new census data applied to the denominators. Pharmacy Hospital Pharmacy Residency Programme - This new programme has commenced with 2 residents successfully recruited into the programme. The programme is designed to trial a new model for workforce development for hospital pharmacists. There was significant interest in the positions from pharmacists considering hospital pharmacy as a career. Self-Management Project - The Pharmacy service has put forward a project within the Self Management Campaign. The project aims to collaborate with primary care pharmacy to build a model to improve self-management of gout using a community pharmacy model. The project is currently in its exploratory phase. Stakeholder engagement planned to occur within the next month. We have managed to obtain some interest from potentials sites that could be used to test the proof of concept. Emerging Issues Renal - Scott Building Dialysis Unit (AMC) An options paper is complete to address space constraint issues - with the preferred option being the reduction from 20 to 14 chairs. This will have a number of impacts on capacity and staff. Renal Dialysis Capacity - Dialysis volumes continue to exceed capacity at growth rate of 5-6% pa. Over capacity volumes continue to be managed by 24 patients dialysing at the Western Campus Prefab facility, outsourcing 32 patients to Nephrocare (private facility), running evening shifts (which is suboptimal due to the shortened time for dialysis available and no medical cover) in the AMC and Rito Unit- currently at 45 patients. This means a total of 101 patients’ overcapacity. Various strategies to manage the overcapacity continue to be implemented with home dialysis volumes now at 43.7% (target 50% of all dialysis patients), transplants increasing to 27 in the last year (over double to previous year’s total) and implementing a new acute peritoneal dialysis programme. Other initiatives for home dialysis include developing a case for a new community house for patients who

93

cannot have a dialysis machine in their own home and the Auckland Kidney Society is to submit a proposal for a new house in the next month. Gastroenterology Capacity - Gastroenterology continues to have capacity issues resulting in increasing waiting lists. Productivity continues to be the highest in the region, but there is an increasing demand which is outstripping the department’s ability to meet the demand and MoH targets within current capacity. Production planning and modelling demonstrates that increased workforce and facilities are required in public as well as continued outsourcing in the new financial year. We are currently outsourcing 1000 colonoscopies up to June 2015 in order to try and meet targets and get the longest waiting patient’s procedures done. A new SMO commenced in December but unfortunately a Fellow recruited to start in January, but withdrew and the position will now have to be re-advertised. New facilities for procedures continue to be explored, with increased theatre capacity for Gastroenterology at Manukau now the most preferred option. Regionally there is considerable work being undertaken to determine the level of capacity for the region in order to prepare services to be able to undertake the Bowel Screening Programme when it is rolled out. CMDHB is involved in all aspects of this including capacity planning, CT Colonography Utilisation, Nurse Endoscopy, Preparation for National Bowel Screening, and upgrade of the regional endoscopy IT system Provation. Nationally, the MoH’s additional funding to DHBs for the “Improving Colonoscopy Waiting Times” project has completed the first quarter. The MoH will provide additional funding on a quarterly basis if a DHB has met targets set for them by the ministry. Volumes indicate that P1 and surveillance targets will be met for the next quarter funding, but P2s will again fall short. This is partly attributable to the Fellow not commencing as planned. Cardiology There have been no real changes in the wait lists for Echo, Spirometry and Holter. The review of the administrative processes and workload within the Cardiac Investigations Unit is about to commence. Good progress has been made on plans to clear the spirometry backlog using module 7 and 7a staff. The localities are happy to provide higher levels of spirometry in primary care if funding can be provided for this purpose. Respiratory Management of neuromuscular patients transitioning to adult services has become a recent issue. This group of patients require a new care model due to longer survival times. These patients have traditionally been managed through ADHB adult respiratory, but this is becoming less viable due to costs and patient volumes. Radiology MRI- The MRI waiting list continues to grow with MRI scanning not meeting the demand by approx. 75-100 patients per month. Some of this is related to the impact of reduced out-patient bookings due to public holidays in January and December, however, the longer term trend is towards increasing waiting times. The replacement of the MRI scanner at Building 58 is currently planned for April and will mean this MRI scanner is out of action for 4 weeks. At the same time the building owners wish to replace the

94

roof tiles as these are cracked and co-ordination of these activities will be a significant challenge. Facilities have appointed a Project Manager, Mua Taito to assist in this process. CT scanning - The tender responses for the alterations in EC to develop a Radiology Acute Hub have been received and are indicating a potential additional cost of $200k. This appears to be to do with the HVAC requirements for the CT scanner room. Further review of the requirements is being done to ascertain if this additional cost is necessary. The CT waiting list continues to grow with demand providing 100-150 more referrals per month than is currently delivered. As with the MRI commentary above the numbers of elective CT scans performed over the public holidays in January is less than normal, however, the longer term trend is towards increased elective waiting times. Ultrasound scanning - The ultrasound service staffing remains constrained with approx. 40% vacancy rate. The waiting times for patients have not increased significantly over the last 3mths mainly due to the additional weekend sessions. Further weekends are planned in February and March. Over the Christmas and New Year period, many of the private radiology practices reduced levels of service resulting in community midwives requesting scans from the DHB. This creates additional load that cannot always be met. Breastscreen BSA Service Delivery and Funding Model Review While there will be little or no change as a result of the service delivery review, all Lead Providers, including BSCM are likely to receive less funding from 1 July 2016 as a result of the funding model review. We have fed back our concerns to the review team on some of the conclusions drawn which we believe are based on incorrect assumptions and analysis. Patient Information The File Specification for Phase 2 of the National Patient Flow Programme of work was released to the DHBs at the end of December 2014. Following a review of the specifications it has been identified that CM Health will not be able to deliver 25 of the mandatory data elements required for Phase 2 and the other DHBs in the country are in a similar situation. An updated version of the File Specification is due to be released on 11/02/2015. The MOH Project Team has made it very clear the requirements in this final document will need to be implemented by 01/07/2015. A paper will be presented to the IS Governance Group on 09/02/2015 making the recommendation that an application for exemption be submitted following the review of the mandatory requirements in the final File Specification. Laboratory Laboratory rebuild project - Our objective is to build a world class hospital laboratory to meet the needs of Counties Manukau Health both now and into the future. We believe that we cannot run this major project from the laboratory without some dedicated project resource. Selection and deployment of this resource is an immediate concern. We have approached the overall project lead for an allocation of project costs to enable this resource to be supported.

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SERVICE PERFORMANCE Activity Summary (January)

Volumes Month YTD

Act Bud / Contract

Var Act Bud / Contract

Var

Inpatient (WIES) Adult Acute Care 342 337 5 2,648 2,348 300 Adult Medical Care 1,743 1,917 (174) 14,620 14,729 (109) Total 2,085 2,254 (169) 17,268 17,077 191 Inpatient (cases) Contract = Last year actuals

Adult Acute Care 943 942 1 6,871 6,782 89 Adult Medical Care 2,173 1,959 214 16,172 15,356 816 Total 3,116 2,901 215 23,043 22,138 905 Medicine O/P Procedural (contract) 270 426 (156) 3,046 3,746 (700) FSA’s 1,193 1,146 47 11,295 9,075 2,220 Follow up’s 2,708 2,708 0 21,746 23,690 (1,944) Emergency Care Presentations (against last year)

Discharges (against contract) 9,175 8,450 725 64,990 62,926 2,064

Breast Screening No. of screens 1,964 2,160 (196) 15,060 15,120 (60)

Inpatient Wies: The overall monthly wies result reflects a 9% decrease compared to contract and a 4% decrease compared to last year. The results for General Medicine in January showed a 12% decrease in wies compared to contract and a 6% decrease compared to last year. (Source Total Inpatient Wies for Current fiscal period – (Medical Service Book Run 2). Inpatient Cases: This month we saw 11% or 214 more cases than this time last year, with a 14% decrease in the ALOS compared to last year. General Medicine (inpatients) saw 3% or 36 cases more compared to last year and a 9% decrease in the ALOS. (Source Acute Care/Medicine Services ALOS and Cases for current fiscal period). Outpatient volumes: In January FSA’s were 4.1 % above contract and 5.2% lower than the same month last year. YTD FSA's are 24.5% higher contract and 1.5% higher than last year. YTD follow-ups are 8.2% lower than contract and 2.2 % lower than the same time last year. Education and management volumes remain significantly higher YTD (48.5 % higher than the same time last year). Procedural volumes are 19.6% higher than the same time year but 4.6% higher than contract. Emergency Care: Emergency care volumes in January 2015 were 9156 presentations. This was 1.3% higher than last month and 7.6% higher than this time last year. This was the highest January on record Average daily volumes were 295 with presentations fluctuating between 236 and 331.

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SCORECARD

January 2015


Def

Jan-15 Target Var Actual Target VarTotal Caseweight 2,102 2,214 -5% 17,447 16,853 4% 1

Elective Caseweight 25 35 -29% 256 275 -7% 2

Acute Caseweight (includes ICU) 2,076 2,178 -4.7% 17,191 16,578 4% 3

Outpatient FSA Volumes 1,597 1,903 -16.1% 18,749 17,385 8% 4

Outpatient Follow Up Volumes 5,645 10,531 -46% 80,030 80,382 -0% 5

Virtual FSAs 73 96 -24% 911 896 2% 10

Jan-15 Target Var Actual Target Var% Staff with Annual Leave > 2 years 8.9% 5.0% -3.9% 9.7% 5.0% -4.7% 11

% Staff Turnover 1.2% 2.0% 0.8% 8.5% 10.0% 1.5% 13

% Sick Leave 2.5% 2.8% 0.3% 2.8% 2.8% 0.0% 14

Workplace Injury Per 1,000,000 hours 10.50 10.50 10.50 10.50 15


Jan-15 Target Var Actual Target Var% electronic medication reconciliation completed for high risk patients within 48hrs NA 80.0% #VALUE! NA 80.0% #VALUE! 21

% Severe Pressure Injuries Per 100 Patients 3.5% 3.5% 22

No. Falls causing major harm 0.0 0 0.0 0 23

Jan-15 Target Var Actual Target Var% MRI scans completed within 6 weeks from acceptance of referral 44% 80% -36% 59% 80% -21% 34

% CT scans completed within 6 weeks from acceptance of referral 47% 90% -43% 76% 90% -14% 35

Radiology - Inpatient radiology times < 24hours 93% 95% -2% 92% 95% -3% 36

Radiology EC radiology times < 2 hours 95% 95% 0% 95% 95% 0% 37

% diagnostic colonoscopy patients receive the procedure within 14 days 97.4% 60% 37% 72.1% 60.0% 12% 38

% diagnostic colonscopy patients receive the procedure within 42 days 24.7% 60% -35% 27.3% 60.0% -33% 39

% surveillance colonscopy patients receive their procedure within 84 days of planned 99% 60% 38.9% 95.4% 60.0% 35.4% 40

% cardiac STEMI - PCI (angiography) within 120 mins - Northern Region Target 87% 80% 7.0% 83.3% 80.0% 3.3% 41

ESPI 2: No. patients waiting >5 mths for FSA - Elective ~ 0 0 NA 0 -2 42

Medical Assessment – Triage3-5 patients seen by SMO within 60 min 58 mins 60min 2 mins NA 60 #VALUE! 46

Laboratory -Test turnaround time (TAT) within 60mins average of results YTD 49

Potassium 95% 90% 5% 96% 90% 6% 50

Haemoglobin 97.7% 98% -0.3% 97.5% 98% -0.5% 51

PT/INR 99% 98% 1% 99% 98% 1% 52

Troponin 1 for EC 95% 90% 5% 93% 90% 3% 53

Histology - All - 5 working days 70% 90% -20% NA 90% #VALUE! 54

-Breast - 3 working days 100% 100% 0% NA 100% #VALUE! 55

-Non gynae FNAs - 5 working days 87% 100% -13% NA 100% #VALUE! 56

Blood Bank - antibody screen within 4 hours 90% -90% NA 90% #VALUE! 57

MicrobiologyCSF cell count <30mins 90% 90% 0% NA 90% #VALUE! 58

ESBL screens <2days 93% 95% -2% NA 95% #VALUE! 59

CDT (C. diff Toxin) <25hrs 91% 90% 1% NA 90% #VALUE! 60

UCHM (Urine Chemistry) <60mins 93% 90% 3% NA 95% #VALUE! 61

Year to date

Tim

ely

Medicine, Acute and Clinical Support Scorecard

Year to date

12 month average

Year to date

Ensu

ring

Fina

ncia

l Su

stai

nabi

lity

Enab

ling

High

Pe

rfor

min

g Pe

ople

Firs

t, Do

No

Harm

(S

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y)

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The total number of patients on the waiting list for an FSA has increased by 258 patients from last month. This was driven mainly by a significant increase in cardiology patients waiting for an appointment and a result of the lost RMO and SMO clinics in January due to vacancies. There was also a marked increase, to a lesser degree, in Diabetes FSA’s on the wait list. Other specialities showed minor changes in their FSA wait lists. All services met the 120 target in January except Haematology which showed a breach by 3 patients but in actual fact these patients were seen on time. Seen by times by Priority The following report shows the percentage compliance by priority for all FSA patients seen within medicine the last 12 months. Overall, the compliance for most services has decreased slightly with P1 and P2 referrals. P3 compliance has maintained progress gains made in previous months.

Door to Cathlab suspected Acute Coronary Syndrome < 3 days (median time) 86% 70% 16% 76% 70% 6% 63

General Medince - Seen By Time (minutes)1st Time to be seen Triage 1 & 2 patients (median time) 35.12 <30mins -5.1 NA <30mins #VALUE! 64

1st Time to be seen Triage 3 - 5 patients (median time) 93.02 <60mins -33.0 NA <60mins #VALUE! 65

2nd Time to be seen Triage 1 & 2 patients (median time) <30mins 30.0 NA <30mins #VALUE! 66

2nd Time to be seen Triage 3-5 patients (median time) 73.17 <60mins -13.2 NA <60mins #VALUE! 67

QUARTERLY REPORTING Q1 Target Var Actual Target VarFaster Cancer Treatment - % high suspicion first cancer treatment within 62 days - MOH FCT + 56.7% 85% -28% 56.8% 85% -28% 68

Faster Cancer Treatment - %confirmed diagnosis first cancer treatment within 31 days - MOH

84.6% na 90.0% na 69

% radiology results reported within 24 hours 60.0% 75% -15% 61.0% 75% -14% 70

Jan-15 Target Var Actual Target VarAverage Length of Stay - Acute 2.28 2.59 0.3 2.48 2.59 0.1 71

Average Length of Stay - Acute Arranged / Elective 2.0 1.84 -0.14 2.07 1.84 -0.2 72

Acute Readmissions within 7 days - Total 5.5% 4.3% -1.2% 4.7% 4.4% -0.3% 73

Acute Readmissions within 28 days - 75+ - MOH IDP 12.5% 13.5% 1.0% 14.0% 14% 0% 75

% transcribed clinical summaries (meddocs)authorised <7 days of creation 68% 95% 32% 71.3% 95% 28.7% 76

% of patients on home wards in General Medicine 53.1% >75% 21.9% 80

% of Outliers on non-medicine wards 2.7% 0.0% -2.7% 5% 0.0% 81

QUARTERLY REPORTING Q1 Target Var Actual Target Var% eligible stroke patients thrombolysed - Northern Region Target 2.6% 6% -3.4% 5% 6% -2% 84

Stroke patients on stroke pathway 75.0% 80% -5.0% 76% 80% -4% 85

Jan-15 Target Var Actual Target Var% Discharges from transit lounge or home by 1100hrs 7.8% 30% -22% 30% -30% 89

% MA short stay patients discharged home from Medical Assessment 48% 80% -32% 80% 90

% of patients < 28 hrs discharged from inpatient wards 11.4% <10% -1.4% <10% 93

94

Implement Home First Renal policy - (increase CAPD & HD rate) 44% 50% -6% 44% 50% -6% 95

Jan-15 Target Var Actual Target VarPatient experience Survey data (n=43) 90% -90% 90% -90%Implementation of Advance Care Planning - number of conversations 427 218 209 2,310 1308 1,002 95


Jan-15 Target Var Actual Target Var% Women with Breastscreen in last 24 months - total >70% -70.0% 70.2% >70% 0% 98

% Women with Breastscreen in last 24 months - Maaori >70% -70.0% 69.8% >70% 0% 99

% Women with Breastscreen in last 24 months - Pacific >70% -70.0% 73.6% >70% 4% 100

Tim

ely

Year

Syst

em In

tegr

atio

n (E

ffect

ive)

Effic

ient

Year

Equi

ty

Year to date

Patie

nt W

haan

au

Cent

red

Care

Year to date (n=212)

Year

Year

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Patient Information KPI 95% of transcribed clinical summaries authorised within 7 days of creation: The performance of the Medicine Division for this target is outlined below. The trend shows deterioration in the time frame within which the documents are authorised. The number of documents which have been authorised within 7 days decreased in January. This is largely due to staff being on leave and unable to authorise them within the 7 day period.

Total Number of Documents Created

No of Documents approved within 7 days

Percentage

July 2014 7669 5665 87.6% August 2014 8704 6512 88.0% September 2014 7631 5747 75.3% October 2014 6079 4288 70.5% November 2014 7081 5185 73.2% December 2014 7580 5280 69.6% January 2015 6631 4620 69.6% Transcription Turn-around Times: Staff working during the Christmas/New Year break were able to reduce the backlogs which occurred at the end of December. The situation as at 13/01/2015 is presented in the table below. Backlog (in hours) Backlog (in Jobs) Oldest Turn-around times

28/04/2014 308 6972 10 working days 12/05/2014 204 4666 8 working days 9/06/2014 188 4444 8 working days 10/07/2014 153 3375 5 working days 08/08/2014 104 2359 4 working days 09/09/2014 108 2563 5 working days 10/10/2014 81 1799 4 working days 11/11/2014 129 2883 4 working days 08/12/2014 171 4068 6 working days 13/01/2015 100 2167 5 working days 09/02/2015 124 2792 5 working days

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FINANCIAL RESULTS

Jan-15


0 0 0 0% Government Revenue 4 0 4 0%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%1 0 1 0% Other Income 2 0 2 0%0 0 0 0% Funder Payments 0 0 0 0%1 0 1 0% Total Revenue 5 0 5 0%


28 23 (6) (26)% Outsourced Costs 153 158 4 3%197 233 36 15% Clinical Costs 1,694 1,634 (60) (4)%123 122 (1) (1)% Infrastructure Costs 851 855 4 0%

86 76 (10) 14% Internal Allocations 660 595 (65) 11%3,101 3,194 92 3% Total Expenditure 21,638 21,911 272 1%

(3,101) (3,194) 93 3% Net Result (21,633) (21,911) 278 1%

FTE 53 54 1 2% Medical 54 54 (1) (1)%

208 196 (11) (6)% Nursing 204 207 3 2%0 1 1 100% Allied Health 0 1 1 100%0 1 1 100% Support 0 1 1 100%

46 51 5 10% Management/Admin 46 51 5 10%306 302 (4) (1)% FTE Total 304 313 9 3%

STATEMENT OF FINANCIAL PERFORMANCE - ACUTE CARE


($000's) ($000's)

-3,500

-3,000

-2,500

-2,000

-1,500

-1,000

-500

-

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

100

200

300

400

500

600

Mon

thly

resu

lt $0

00's


Result Budget

-

500

1,000

1,500

2,000

2,500

3,000

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

100

Jan-15Month YTD


Revenue: $1 $5


Outsourced Costs: $(6) $4

Clinical Supplies: $36 $(60)

Infra-Structure: $(1) $4


Overspends across the clinical supply codes driven by increased volumes in EC - 4% above this time last year, offset by useage of excess inventory on hand.

$65k - Admin staff - savings due mostly to delays in the recruitment of MAU ward clerks.

STATEMENT OF FINANCIAL PERFORMANCE - ACUTE CARE

Volumes in EC were 1.3% higher than last month (9,156 presentations vs last year 8,507) and 8% above this time last year. Year to date volumes are 4.5% above this time last year.

$(17)k u - 0.75fte due to go on maternity leave March, cover in place. $10k f - 1 fte RMO vac

Overspends for drugs driven by increased volumes in EC - 4% above this time last year.

The year end forecast is for the division to meet budget plus a portion of expected cost savings for the year (total expected cost savings $1.1m).

Overall the division was $93k favourable for the month and $278k favourable variance YTD.

The current month variance is driven by high annual leave taken over the new year period and savings for clinical supplies due to using up excess stock purchased in December to cover the Xmas/new year period.

Current month:-


Year to date:-

Year to date:-

$81k f - high annual leave taken over the Xmas /new year period across all employee categories

Year to date:-$110k - Medical staff - due mostly to salary variations and high annual leave taken over the July/Jan school holidays.$194k - Nursing staff - savings due mostly to delays in the recruitment of MAU nursing staff.

$21k - misc.

101


342 222 119 54% Government Revenue 2,104 1,557 547 35%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%

50 69 (19) (28)% Other Income 659 511 148 29%156 74 81 109% Funder Payments 979 521 458 88%

547 366 181 49% Total Revenue 3,742 2,589 1,153 45%

EXPENDITURE6,039 6,008 (31) (1)% Staff Costs 41,213 40,920 (294) (1)%

472 406 (67) (16)% Outsourced Costs 3,135 2,834 (301) (11)%1,349 1,364 16 1% Clinical Costs 9,453 9,572 119 1%

227 250 23 9% Infrastructure Costs 1,771 1,752 (19) (1)%676 663 (13) 2% Internal Allocations 5,043 4,573 (471) 10%

8,762 8,691 (72) (1)% Total Expenditure 60,615 59,650 (966) (2)%(8,215) (8,324) 110 1% Net Result (56,874) (57,061) 188 0%

FTE162 155 (7) (5)% Medical 161 158 (3) (2)%428 406 (22) (5)% Nursing 434 410 (24) (6)%

45 47 2 3% Allied Health 49 47 (3) (6)%39 40 1 2% Management/Admin 42 40 (1) (4)%

674 648 (27) (4)% FTE Total 686 654 (32) (5)%

STATEMENT OF FINANCIAL PERFORMANCE - MEDICINE


($000's) ($000's)

Jan-15

-8,600

-8,400

-8,200

-8,000

-7,800

-7,600

-7,400

-7,200

-7,000

-6,800

-6,600

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

800

1,600

2,400

3,200

Mon

thly

resu

lt $0

00's


Result Budget

4,600

4,800

5,000

5,200

5,400

5,600

5,800

6,000

6,200

6,400

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

102

Month YTD


Revenue: $181 $1,153

Salaries & Wages: $(31) $(294)

Current Mth:-


Current Mth:-




$(653)k - Unbudgeted positions funded externally (offset by revenue), (11.2)FTE

$699k - Vacancies 10FTE average

$230k - High annual leave taken over the Xmas / New Year period

$53k - Vacancies 6.4 FTE's

$(37k) - unfavourable kiwisaver/super/mat leave payments

$(190k) - unfavourable kiwisaver/super

$(108)k - Additional SMO/RMO duties to cover vacancies/additional clinics/etc

$(150)k - Staffing costs for additional Renal night shifts to address renal growth (8.3)FTE - after provision release

$(19)k - misc

$55k - Renal Fluids savings in CAPD Renal part offset by higher spend in Haemodialysis renal fluids

Year to date:-

$(58)k - Outsourced Neurology/sleep clinics

$64k - Savings patient consumables across various RC's in the division


Government Revenue: $442k - higher PCT revenue (Funder payment) to offset increased drug cost - see drug overspend in Allocations below$107k - Outsourced Gastro colonoscopies funded by MOH - see for offset overspend in Outsourced belowOther income: $148k - Renal Transplant recoveries 104k, Renal SMO salary recoveries and study subsidy $31k, Cancer Fast Tracker Funding $24k, lower Cardiology clinics $(11)kFunder Payments: $456k - cost recoveries for unbudgeted project positions - 6.1 FTE plus outsourced podiatrists

Year to date:-

$(92)k - Additional Nursing/Techs duties to cover renal night shift

The year end forecast is for the division to meet budget plus partial cost savings for the year (total expected cost savings $1.261m).

Year to date:-

$484

$(21)k - MRI costs

Year to date:-


$196k - Cancer Care Revenue to offset unbudgeted staffing costs.

$(625)k - PCT Drugs overspend, Chemotherapy volumes 10% and Rituximab doses up 10% on 13/14 average, part offset by MOH revenue.$(21)k - Miscellaneous drug overspends

STATEMENT OF FINANCIAL PERFORMANCE - MEDICINE

The division was $110k favourable against budget for the month and $188k favourable year to date. Medicine WIES volumes was 9.1% down on contract for Jan15 and 0.7% down on contract year to date.

Current Month:-

Jan-15

Year to date:-

Other income: $(19)k- Mostly due to lower number of Cardiology clinics

Funder Payments: $64k - Salary recoveries for unbudgeted project positions, 6.1 FTE $16k - Funding for VHIU training

Government Revenue: $120k - higher PCT revenue (Funder payment) to offset increased drug cost - see drug overspend in Allocations below. This month's revenue higher due to revenue received in arrears and part offsets previous months drug overspend.

$(28)k - Outsourced Nursing bureau to cover Nursing annual leave - lower number of internal bureau available$(39)k - mainly higher spend in Outsourced sleep, Gastro and Neurology - to be adjusted down in future months

$(121)k - Outsourced Gastro colonoscopy procedures - Offset by MOH funding

$(60)k - Outsourced Nursing bureau to cover Nursing annual leave$(43)k - Outsourced Podiatry funded by 20k beddays in Revenue above

103


458 480 (22) (4)% Government Revenue 3,367 3,392 (25) (1)%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%

434 170 264 155% Other Income 1,566 1,191 375 31%16 0 16 0% Funder Payments 112 0 112 0%

908 650 258 40% Total Revenue 5,044 4,582 462 10%


341 353 12 3% Outsourced Costs 2,776 2,529 (248) (10)%2,645 2,730 85 3% Clinical Costs 20,922 19,266 (1,656) (9)%

270 291 22 7% Infrastructure Costs 1,920 2,031 111 5%(1,423) (1,564) (142) (9)% Internal Allocations (11,465) (10,982) 483 4%

6,402 6,537 135 2% Total Expenditure 46,609 45,574 (1,035) (2)%(5,493) (5,887) 394 7% Net Result (41,565) (40,992) (573) (1)%

FTE71 76 6 7% Medical 73 76 4 5%37 40 3 7% Nursing 40 40 0 1%

303 311 8 3% Allied Health 307 309 2 1%145 168 23 14% Management/Admin 158 168 10 6%556 596 40 7% FTE Total 578 593 16 3%

STATEMENT OF FINANCIAL PERFORMANCE - CLINICAL SUPPORT


($000's) ($000's)

Jan-15

-6,400

-6,200

-6,000

-5,800

-5,600

-5,400

-5,200

-5,000

-4,800

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

1,000

2,000

3,000

Mon

thly

resu

lt $0

00's


Result Budget

-

2,000

4,000

6,000

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

104

Month YTD

Total Variance: $394 $(573)

Current month:-

Revenue: $258 $462


Current Mth:-

Outsourced: $12 $(248)

Clinical Supplies: $85 $(1,656)


Internal Allocations: $(142) $483


Year to date:- Funder Payments: $112k - cost reimbursement for 2.7 FTE unbudgeted Pharmacists - SMOOTH projectOther income: $100k - ADHB Radiology service for ADHB referrals $140k - MOH funding for Radiolody Service Improvement Initiative $119k - Pharmacy timing of rebates Miscellaneous: $(9)k

Current month:-$295k - December Pharmac rebate transferred from Finance$(48)k - Breast Screen revenue down due to lower volumes over the Xmas / New year period. $16k Funder Payments: cost reimbursement for 2.7 FTE unbudgeted Pharmacists - 20k bed days project$(5)k Miscellaneous

$17k - Miscellaneous

$(16)k - Unbudgeted 2.7 fte Pharmacists funded by SMOOTH project (offset by revenue)$157k - Savings due to vacancies and high annual leave taken over the Xmas / New year period.

$387k - savings due to vacancies across the service

Year to date:-

STATEMENT OF FINANCIAL PERFORMANCE - CLINICAL SUPPORTJan-15

The division was $394k favourable for the month due mainly to the transfer of the December Pharmac rebate to Pharmacy from Finance of $295k and lower staffing costs due to high annual leave taken over the Xmas/New year period.

Year to date:-Year to date the service was $(573)k overspent due to increased demand for Labs and Radiology services.Labs is currently $(554)k unfavourable against budget with an average 8.2% increase in volumes overall with some areas experiencing up to 14% increase in volumes on this time last year.Radiology is currently $(479)k unfavourable against budget due to increase demand including an overspend of $(136)k for catheters and an overspend of $(146)k for shunts & stents driven by demand from Vascular Surgery, $(82)k overspend for outsourced PET CT scans and $(65)k overspend for outsourced MRI Scans.

Current month:-

Current month:- $77k - Drugs underspend driven by demand across the organisation & recovered through internal charging: - $39k - Central Nervous System underspend mostly driven by Surgical Services $44k - Infections underspend driven by $47k Surgical Services $(6k) - Miscellaneous overspend

The year end forecast is that the division will not achieve budget. An increase in volumes across the clinical services, particularly in Radiology and Laboratory has driven high overspends year to date. This is expected to continue for the balance of year. Target savings for the division are $1.5m.

Year end Forecast variance to Budget $(633)

Year to date:Misc savings across the division mostly for transport , printing, stationery, postage and other office expenses.

Current month:$(76k) - Drug cost recoveries - offsets drug underspend above $(63k) - Radiology MRI Cost recovery

Year to date:-$(138)k - Lab sendaway tests volumes up 8.5%$(82) - PET CT scans volumes higher than budgeted$(65) - MRI scans volumes higher than budgeted$37k - Miscellaneous

Year to date:-$(687)k - Drugs overspend driven by demand across the organisation & recovered through internal charging:- $(733)k - PCT drugs partly funded by revenue $(40)k - Infections driven by Surgical Services volumes $116k - Nutrition underspend driven by Medicine $(30)k - Miscellaneous$(247)k - Lab blood products driven by high cost patients in ICU, EC & Dialysis. Part offset by a $135k rebate.$(383)k - Lab testing kits & other clinical supplies - volumes up by 8.5% year to date$(147)k - Radiology shunts & stents - driven by vascular surgery$(136)k - Radiology Catheters - driven by vascular surgery$(75)k - Radiology Dressings - driven by increasing internal demand for Radiology Service$19k Miscellaneous

Year to date:$677k - Drug cost recoveries - offsets drug overspend above$(256)k - Radiology MRI Cost recovery$62k - Miscellaneous

105

SERVICE UNIT UPDATES Emergency Care A Clinical Nurse Specialist in EC is beginning to prepare to submit her portfolio to Nursing Council for Nurse Practitioner and the department is supporting her through this process. A further CNS is set to join the team in April 2015. The Medical Assessment Unit has welcomed nursing staff from the medical ward, who have been seconded to the unit to allow it to open 24/7 over summer. Recognising that this is necessary we have increased the summer staffing from 30 FTE to 36 FTE and reduced the winter staffing from 42 FTE to 36 FTE. However, we may require additional staff at times over winter depending on patient volumes and in particular the number of inpatients waiting for beds in the unit at 7am (to be assessed on a daily basis) Medicine We are continuing to audit the total Gen Med admissions in November 2014 to determine ward round frequency by registrar, house officer and consultant. We are also reviewing the current model of care for the Gen Med ward round, during the week – trial due to start 16th February 2015. The chief resident for medicine has developed an online survey to enable review and understanding of the registrar workload on the weekends. We will also be auditing the same weekends to try and get a picture of the Registrar workload over the weekend, which appears problematic. POAC: 14 patients from the medicine wards were discharged in January using POAC. This was out of a total of 21 eligible patients. This is compared with 27 patients in November being discharged using POAC. Cardiology Echo Wait Times There were no substantive changes in the 95th percentile wait time this month, and a slight worsening of the median wait time. The Standard Echo wait list is currently 1440 (down 21 from last month). Further modeling work continues although this proves to be challenging. Weekend clinics continue.

106

The new Sonographer position was unable to be successfully recruited to. This position has now been advertised three times over the last six months. One limitation in employing qualified Sonographers is the qualification requirements of the Medical Radiation Technologist Board (MRTB). There are currently two professional bodies which include cardiac sonography in scope of the roles their members perform. This is the MRTB and the CPRB (Clinical Physiologist Registration Board). Currently, the CPRB and MRTB are working together to co-ordinate their approach on can who perform cardiac sonography. In the first stage, the CPRB have commenced Practical Competency Assessments (PCA’s) for those who perform cardiac sonography as the only component of their role, but do not hold either DMU or QUT qualifications. This will enable overseas qualified sonographers to gain registration with the CPRB. In the second stage, the MRTB and CPRB are meeting with the aim of agreeing those who sit a PCA and register with the CPRB are also able to register with the MRTB. This should make job opportunities more attractive to overseas cardiac sonographers. In-patient Echo’s In-patient wait times were acceptable in January and referral demand remains down with most patients being scanned within 2 days of referral. CCU Telemetry/Monitoring System Replacement The Telemetry system remains operational with been no significant issues in January. Plans for the new system to be implemented in May 2015 are progressing well. The WiFi scoping and subsequent detailed design has now been completed and is being presented to the health Alliance governance board in February. A service level support agreement between health Alliance and clinical engineering has been drafted by the project manager and is in the final stages of sign off. CTCA: No further work on the development of the acute in-patient CT Coronary Angiography (CTCA) service in Radiology from July 2015. It remains on the priority initiative list for 15/16. Spirometry Good progress has been made on plans to clear the spirometry backlog using module 7 and 7a staff. And the localities are happy to provide higher levels of spirometry in primary care if funding can be provided for this purpose. Cancer Faster Cancer Treatment Health Target Performance • 56.7% commenced treatment within 62 days in January (Target 85% from July 2016). • 84.6% of eligible patients receiving treatment within 31 days of decision to treat.

Clinical communication regarding grading continues – issues exist around defining high suspicion of cancer, which is being discussed locally and regionally. Weekly performance reports are assisting pathway improvement activity. FCT Implementation group continues to oversee CMDHB’s development toward the 62-day target. This group is meeting fortnightly and has representation from across the organisation. Preparations are underway for a rapid-access lung cancer clinic model to be piloted from mid-February. Enhancing Cancer Multidisciplinary Meetings healthAlliance are continuing work on discuss data transfer issues. 10 out of 12 tumour streams utilising VC technology regularly. Cancer Coordinators Strategic plan is being finalised the development of the coordinator roles and the service as a whole over the next 3-5 years.

107

Respiratory • FSA waitlist continues to track well with no patients exceeding the incoming 120-day target. • Pressure on spirometry waitlists in CIU remains. Short-term solution to manage the backlog is

being implemented through utilising module 7 and lung function lab staff. Locality-based options are being developed as well.

Renal

• The upgraded Clinical Vision database continues to be implemented in the Renal Service, along

with an additional application for management of transplant patients, Graft Vision. • The Renal Facility Procurement project is progressing well with the project implementation team

established with the new provider, Diaverum, and contract negotiations well underway. Community and Locality engagement to commence in the Mangere/Otara locality.

• The new Acute Peritoneal Dialysis Unit will open in March. This has been delayed because of health and safety issues with the Western Campus building raised by Occupational Health and Safety and Infection Control. Work on up-grading the facility will take place in a couple of weeks and enough work to enable the clinic to open in March should be completed. Other issues with the sterile store area will be dealt with after March.

Gastroenterology • Gastroenterology continues to experience significant capacity issues. Outsourcing of

colonoscopies to private providers continues as a way to try and meet the quarterly targets set for CMDHB. We will potentially meet the P1 and surveillance targets, but not P2s again as capacity issues continue to be worked on.

• CM Health continues to participate in the regional projects being done to manage the DHBs waiting lists and prepare for implementation of the National Bowel Screening Programme in the next couple of years. The projects have been divided into work streams and include- Regional Growth, CT Colonography Utilisation, Nurse Endoscopy, Preparation for National Bowel Screening, and upgrade of the regional endoscopy IT system Provation.

Pharmacy Prescribing quality and Potential Solutions • The quality of prescribing and the gaps were identified at the audit as an ongoing area for

improvement for the hospital. There were several gaps identified with incomplete prescriptions and application of the rules within the organisation’s prescribing policy.

0

100

200

300

400

500

600

700

Respiratory FSA Waitlist Volumes

Sleep FSA >120 days

Sleep FSA >90 days

Gen Resp FSA >120 days

Gen Resp FSA >90 days

Overall FSA >120 days

Overall FSA >90 days

Overall Total W/L Sleep

Overall Total W/L Gen Resp

Overall Total W/L Service

108

Medication Safety Medication safety measures for the Patient Safety Point of Care Measures have been considered. The following measures were proposed, a decision on these has yet to be made.

1. ADR/Allergy - Has the patient been prescribed anything that has been documented on the medication chart as having an allergy/ADR to?

2. PRN Identification – Is the indication for each PRN medication documented? 3. Signature present with name, APC number – Are medicines prescribed been signed and

prescribers specimen signatures and names documented? 4. Medication Administration – Has the medicine been administered as charted? 5. Pharmacist Review of Prescription – Have all new prescribed items been reviewed and

signed by a clinical pharmacist in the last 24 hours. (Monday to Friday charts) 6. Medicines Reconciliation – Has MR been completed on high risk patients within 48 hours

of admission

The following projects are currently being undertaken by the medication safety service. • Prescribing Improvement Project • Allergy and Adverse Drug Reaction – regional collaborative project • Opioid Collaborative – the aim of this project is to improve safety with opioids • Use of Medication Safety Self Assessment tool to identify gaps

The team is presented the medication safety strategy and update to ELT and HAC in February. Laboratory • The laboratory focussed on routine service delivery during the month of January as we

endeavoured to get as many staff as possible away on annual leave. Workload was manageable with the resources we deployed. Workload growth continues to track in line with recent trends and, while January was lower in numbers than previous months it was still up considerably on previous years

Laboratory Accommodation Preliminary design has commenced and is well advanced in some areas. Histology • Cutup supervisor commenced on the 12th Jan, 2015. The vacant scientist positions have been

successfully recruited into and one commenced on 19th and one to commence on 2nd February. Histology specimen registration for January 2015 saw a 5% decrease when compared to January 2014.

• The Non Gynae Cytology numbers have increased by 50% for January 2015 when compared to January 2014. It should be noted that repatriation of Non Gynae Cytology work resumed in November 2014, and this is a contributing factor to this increase for period January comparison. However, there was an 11% increase observed when compared to previous month of December, 2014.

Microbiology : The 0.5 FTE SMO has been appointed. Due to start June 2015.

109

QUALITY: Goal to improve the quality safety and experience of care Safety (First Do No Harm) Taking a whole picture view of staff and patient safety Falls – There were 26 falls across the medicine wards in January, one more than recorded in December. The number of falls with harm/injury decreased from 5 in December to 3 in January. The number of falls for the last 2 months is similar with slightly fewer numbers of confused and disorientated patients, so there was still high numbers of ‘watches’ or use of HCA bureau across the service to watch and to keep these patients safe. The usual falls prevention measures continue ie: rounding use of watches, high/low beds, etc. January tasks related to review of completed work and planning for the 2015 year. The need for a dedicated resource, such as a clinical lead for falls, was further discussed. A review of falls that meet the inclusion criteria for Serious and Sentinel events will be completed in February. MRO’s Screening Audit – A repeat MRO Screening Audit ‘snapshot’ took place in Ward 32N again in January - which showed only 40% of patients fitting criteria for MRO screen were completed. This was 50% in December. The organisational expectation is that 85% of patients are screened on admission. One teaching session with nursing staff was undertaken by the Infection Control CNS in December and another 2 were completed in January. Compliments and complaints The Division received 29 compliments endorsing the positive patient experience in Medicine wards; these commented on the quality of care and treatment, the attitude and courtesy of staff, and communication between staff and patients and their families. There were nine complaints; four of these recorded concerns with attitude and courtesy of staff, and communication, and five recorded concerns with care and treatment. Incidents Eighty-four incidents were logged in January; this is marginally lower than in each of the previous three months, which averaged 95 incidents logged per month.

110

3.6 Non-Clinical Support Services Major High Level Issues and Activities Clinical Engineering As previously reported, difficulty remains in recruiting technical personnel exacerbating previously identified risk of growing non-compliance due to volume growth and capacity disconnect. However, effort continues in the area of recruitment – we are now looking at prospective IT personnel who may be able to adapt to a CE environment with training, and we are working towards a common inter charging rate between ADHB and ourselves, so that at least some measure of optimisation might be achieved along with potential cultural flux. Approval has been granted for a mobile workshop, which will allow more efficient allocation of techs to outliers and for the attendance to some equipment on those sites. This is a forerunner to a regional model that will benefit in particular areas like Waitemata and Northland when they are ready to adopt this idea. As raised previously, clinical network management issues will be exacerbated with current challenge of replacing RF monitoring network with Wi-Fi. Also action required in formalising who takes prime responsibility for clinical IT demands – operationally going forward. Considerable progress made on defining the problem and an additional two meetings should result in a recommendation for change with response processes. The Manager CE is now on the IT Governance Committee to ensure the committee understands all the challenges going forward with all IT investments and the Assets Manager Roy Malto will sit on the Technical Advisory Group to assist in assessing IT implications of Capex procurements. Enterprise Asset Management (EAM) Summary The Enterprise Asset Management system implementation has been divided into 3 phases based on scope focusing on the DHB services involved in the implementation. Phase 1 is further divided into 2 stages focusing on the implementation of the processes for asset management. Milestones and Tasks Stage 1 reflects initial components to be implemented to EAM • Equipment Catalogue (Rotable Items). • Supplier Catalogue. • Clinical Equipment (establish platform for loading CE Assets). • Capital Expenditure Request Management. • Procurement Interface to Oracle. The new EAM environments on CCL’s servers in Christchurch have been built and are just waiting for the Connect Health to be activated. Suppliers, locations, UMDNS codes, RC Codes have been loaded into the database. Integration design has commenced with the healthAlliance Oracle Financials team. EAM Process Implementation The following processes are slowly being implanted in coordination with the organisation requirements. 1. Work Order process. 2. Capital prioritization Plan Process – (Partial implementation). 3. CAPEX Process. 4. Disposal Process. 5. Asset Purchase Process – (Partial implementation).

111

Access to the EAM System for stage 1 has been targeted for March 1, 2015. The asset team will then communicate to the wider DHB processes and procedures as required. Food Services ELT have endorsed a 12 month extension to the current Food Services contract between WDHB, CM Health and Compass. In parallel, rollout of CM Health new contract with Compass as part of the proposed National Initiative is progressing. The public Retail Space will be redeveloped as part of a new Head Lease arrangement which will come from a procurement process. This will be led by healthAlliance and we will be working with Waikato who has a similar project. Security We are progressing with a solution for Maternity (which will be multi-level and able to be paralleled with the AMH design parameters which will have a similar trigger and alert security system). Installation of Access Control to both Maternity and the Birthing Unit is underway and further developments complementing this are being considered. A high level paper on strategy going forward will combine with outcomes from a meeting on 13th February with NZ Police to determine how the hospital can work more collaboratively on information flow and access to DVRs by their command centre on certain prompts from the hospital. Non-Clinical Support Services Non Clinical Support Capacity fully utilised with little room to move other than budget increase or reduced demand. It is expected that further improvements to discharge process will realise further efficiencies. As a result of CM Health now being a regional centre for Spine Patients, we are working closely with the ICU team, from an Orderlies perspective on assisting them with turning patients every 2 hours 24hrs and 7 days per week. 160 Cleaners have signed up to the inaugural NZQA qualification for the National Certificate in Health Disability and Aged Support Level 3, this is a great effort, we are hoping to have all candidates through at 7 unit standards by the end of March 2015. During January, all 160 cleaners cleared 3 unit standards, a really great achievement. We have additional cleaning staff on Wards 10 and 11 due to ESBL cases, isolation cleaning 18 hours 7 days a week, and this will remain in place for an eight week duration. This is being monitored daily by the Infection Control Unit. As a result of the ESBL work, there has been a 50% increase on requests from the wards for full isolation cleans on each discharge. Victorian Cleaning Standards Audit Results – Middlemore Hospital January 2015

95 96 96 93 95 95 95 96 97

10

60

Nov-14 Dec-14 Jan-15

Victorian Cleaning Standards % Across Risk Factors Middlemore Hospital

Very High areas High areas Moderate areas

112



0 0 0 0% Government Revenue 0 0 0 0%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%

24 33 (9) (27)% Other Income 270 229 41 18%0 0 0 0% Funder Payments 0 0 0 0%

24 33 (9) (27)% Total Revenue 270 229 41 18%

EXPENDITURE1,921 1,831 (91) (5)% Staff Costs 12,946 12,912 (34) (0)%

2 0 (2) 0% Outsourced Costs 21 0 (21) 0%(2) 55 56 103% Clinical Costs 228 384 156 41%

2,016 2,077 61 3% Infrastructure Costs 14,311 15,079 768 5%0 0 0 0% Internal Allocations 0 0 0 0%


FTE15 19 4 22% Allied Health 16 19 3 17%

406 402 (4) (1)% Support 404 407 3 1%25 26 1 4% Management/Admin 25 26 0 2%

446 447 1 0% FTE Total 445 452 7 1%

**Jun14: Recovery of motor vehicle lease costs

**Jun14: Recovery of motor vehicle lease costs

STATEMENT OF FINANCIAL PERFORMANCE - FACILITIES


($000's)

Jan-15

($000's)

-4,300-4,200-4,100-4,000-3,900-3,800-3,700-3,600-3,500-3,400-3,300

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

1,700

1,800

1,900

2,000

2,100

2,200

2,300

2,400

Mon

thly

resu

lt $0

00's


Result Budget

-

500

1,000

1,500

2,000

2,500

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

113

Month YTD


Revenue: $(9) $41

Salaries & Wages: $(91) $(34)




Internal Allocations: $0 $0

Clinical Supplies were favourable mainly due to Clinical Equipment R&M recoveries $53k for the month and $144k year to date - varies month to month.

STATEMENT OF FINANCIAL PERFORMANCE - FACILITIES

Total Employee Costs were $91k unfavourable for the month:Current month:-Clinical Engineering $11k - 4 FTEs vacancies to be filled.Non Clinical Support $15k - 2 FTEs vacancies to be filled.Cleaners $(81)k and Orderlies $(83)k - additional cleaning and orderly service requests for norovirus outbreaks and in ALBU and Discharge Lounge, (8.3)FTEs; High use of in-house casual pool staff to cover vacancies, annual leave, sick leave taken, and new staff training.Security officers $(18)k - high use of overtime and in-house casual pool staff to cover sick leave and annual leave taken and high penal costs for stats holidays.Maintenance Supervisors & Engineers $56k due to 7.25 FTEs vacancies in Engineering. 'In-house' casual staff are being managed within the service.

Year to date:- Unfavourable variance $(34)k YTD including high vacancies in Clinical Engineering $110k, Non Clinical Support $78k, and Maintenance Supervisors & Engineers $442k. This is offset by unfavourable variances for Cleaners $(175)k and Orderlies $(484)k due to additional cleaning and orderly service requests for norovirus outbreaks and in ALBU and Discharge Lounge, (8.3)FTEs and new staff training, and unfavourable variance for Security Officers $(34)k.

Favourable variance year to date due to rebate payments to Food Services for MSC Café.

Overall the Division was $16k favourable, $911k favourable year to date.Lower employee costs due to high vacancies and reduced cost for utilities have been the main drivers for the overall favourable variance year to date.

Jan-15

Outsourced staff costs were unfavourable due to covering vacancies in Clinical Engineering, sick leave in Engineering helpdesk and maternity leave cover in Facilities Management.


The year end forecast is for the division to meet budget plus expected cost savings for the year. An expected savings on utilities and food services will be realised balance of year.

Current month:-Infra-Structure Costs $61k favourable including Patient Meals Outsourced $54k; Cleaning Supplies $(12)k; Laundry Bedding & Linen $60k due to refund of overcharging; Security Services Outsourced $(14)k; R&M (account 5151 - 5159) $(194)k; Utilities $84k, and MV Leases, Fuel, Regn and R&M $59k.Year to date:- Favourable variance $768k YTD including Patient Meals Outsourced $300k; Laundry Bedding & Linen $69k; Security Services Outsourced $(126)k; R&M (account 5151 - 5159) $(533)k; Utilities $854k; MV Leases $75k; MV Fuel $113k; Software Maintenance Fees $(34)k, Expenses Recoveries $47k and Postage Courier Freight $(63)k.

$2,269

114

Counties Manukau District Health Board Director Allied Health Report

Recommendation It is recommended that the Combined Hospital Advisory Committee note the report from the Director Allied Health. Prepared and submitted by: Martin Chadwick Director Allied Health

Strategic Development He Pou Oranga (AH Enabling Localities Project) continues with a focus on how to better align the AH workforce to population health needs within the community. • A Master Driver Diagram constructed to track the work and associated benefits as the locality

works towards integration continues to be worked through with the Locality GMs has been completed.

• The Service Re-Design framework has been completed with good engagement from the Franklin locality and health workers. The work is now being summarised into a roadmap of work to be completed.

• Planning for the inpatient AH setting. Pragmatically this will now happen towards the end of the year to avoid unnecessary change during the winter period and will allow for appropriate engagement with operational staff and frontline staff.

• The condensed “café” style sessions for Mental Health as they are looking at the key worker role within the organisation have also been completed.

Allied Health Workforce The Sonography project continues to be progressed through the NRA with preparation for the second training cohort about to begin. As the workforce issue has been highlighted as a national issue, a national group has been bought together of which I am the national DAH representative. A report has been drafted and will be presented at the next National CEO forum. The stability of training Anaesthetic Technicians continues to be an issue and is being addressed with AUT. A successful meeting was held with AUT and has led into a broader meeting of key stakeholders to look at issues of having a sustainable workforce. Health Workforce New Zealand will be engaged for further work on this issue. Establishment of a training programme for Renal Physiologists through MIT progresses with the programme now up and running. Overall the process is now running much smoother. Work is underway with MIT to establish a programme for Clinical Engineers given that there is currently no programme in NZ. There is good support for this nationally and it is hoped to have this up and running by next year.

The balanced scorecard concept for Allied Health from a Clinical Leadership perspective has been completed with an initial cohort of professions. Focus for this year will be on imbedding the concept of Clinical Indicators.

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Health Excellence Framework The Health Excellence Framework work continues with planning for dissemination of results amongst the organisation. The decision was made at ELT that the intention is to ensure that we can demonstrate gains in all areas highlighted in the initial review. As such no application will be made this year, with a focus on submitting an application in 2016 and demonstrating the gains that have been made. Allied Health Directorate Development Work has begun on establishing a strategic intent document for the AH Directorate for the coming year. Part of this process will be a re-focusing of the Associate Directorate roles for OT and SW to be able to be a single point of accountability for the profession across practice areas and geography within the organisation. Key pieces of work within the directorate for the calendar year are to:

• Facilitate the ongoing roll-out of the He Pou Oranga Service Re-Design Framework • Launching and imbedding the Allied Health Initiative for Education and Development

(AHIED) • Undertaking a stocktake and establishing a strategic direction for Allied Health research • Working closely with our tertiary partners to improve the diversity of the AH trainees and

ultimately CMH workforce

On a personal note, an abstract submitted to the World Confederation of Physical Therapy has been accepted. The abstract is based on current doctoral work underway examining professional boundaries. Chairing of the National Directors Allied Health group commenced in the month of February. A strong presence is being planned for the APAC Forum in September. Building on the Nuffield Trust report, it is intended to hold an AH breakfast aiming to explore what “good” looks like from an AH perspective, especially from a quality standpoint, as well as from a service delivery standpoint.

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COUNTIES MANUKAU HEALTH Director of Midwifery Report

Recommendation It is recommended that the Hospital Advisory Committee note the report from the Director of Midwifery. Prepared and submitted by: Thelma Thompson, Director of Midwifery Midwifery Workforce Project Board With the Maternity Care Review Board moving into transition to business as usual the Workforce Project Board is currently reviewing the Terms of Reference and 2013-2015 work plan to reflect the current workforce and direction needed. Six employed and one self-employed graduate midwife commenced in January 2015. Recruitment is currently underway for the main intake in May 2015. MOH Maternity Quality and Safety Programme The current work plan finishes in June 2015. The Committee is currently preparing the Annual Report as required by the National Maternity Monitoring Group and planning for 2015-16. A Maternity Quality and Safety Coordinator commenced in January 2015 through to October 2015 to assist in this work as a fixed term position.

Maternity Clinical Information System (MCIS) The ‘go live’ and rollout of the new system at CM Health commenced in November 2014 using a staged approach with a small roll out involving the antenatal period for new bookings with the employed community midwives. The staff at the Medical Antenatal Clinics, Maternity Wards and Birthing and Assessment are currently undergoing training as this roll out continues with the first women’s expected date of delivery occurring in June 2015. Maternity Culture and Communications Project This project has commenced with the assistance from Ko Awatea working with the Midwife Managers and staff of the Maternity Wards and now in conjunction with the Organisational Values and Strategy Refresh project. The plan includes the following two objectives: • To have maternity workforce culture and communications that reflects the vision and values of Counties Manukau Health • Understanding and responding to the woman’s experience and needs Flu Vaccinations The planning for staff vaccinations commenced in February 2015 with the focus on Peer vaccinators being available in the different areas. Senior Midwives with dual registration, i.e. registered nurse and registered midwives registration with current Practicing certificates are becoming peer vaccinators for the Women’s Health area. The planning for availability for pregnant women to have awareness and easy access to the Flu vaccination is occurring with the Primary and Community Directorate.

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Counties Manukau District Health Board Director of Nursing, Hospital Report

___________________________________________________________________________ Recommendation It is recommended that the Hospital Advisory Committee note the report from the Director of Nursing. Prepared and submitted by: Denise Kivell Director of Nursing Nursing Strategic Issues An annual Planning Day was held with the Clinical Nurse Directors and Nurse Leaders from Primary Care on 30 January. The day was facilitated by Bev McClelland (Organisational Development Consultant) from Ko Awatea. This was a useful discussion regarding the opportunities for the future, with a focus on Project Swift, Integration and Workforce planning. The key themes were to support our Nursing workforce to be flexible and engaged in change occurring, and to recognise, celebrate and value the hard work being done. Common themes for the coming year are progressing patient experience co-design, spreading the “bright spots” and building cultural and psychological safety for teams. The Project Swift “expressions of interest process” for clinical input has resulted in 60 nurses across Counties keen to be involved in the work streams. Patient and Whaanau Centred Care (PWCC) Regional agreement for a Patient Experience Week planning continues for 23rd March 2015. The week will be a mixture of celebrating, showcasing and sharing learning on patient experience. The week will include patient stories, activities, displays, examples of co-design and learning opportunities. At the same time, new Consumer Council for Hospital and Ambulatory Care Services will be launched. Recruitment to the Consumer Council will seek volunteers with linkages across the sector. The newly appointed Chair is Rosalie Glynn, an inaugural Patient and Whaanau Centred Care Board member. Sustainable Nursing workforce Work with Middlemore Central, One-Staff, and the HR and Finance teams has strengthened the integration of reporting for nursing skill mix, redeployment, leave utilisation and bureau utilisation trends. Summary profiles for all Medical and Surgical wards are complete – giving descriptor, budget/ actual FTE and occupancy, ALOS and typical discharge volumes. The remaining areas will be confirmed in March. This information being informed by discussions with the Charge Nurse Managers, Clinical Nurse Directors and Business Managers and is aligned with the work to develop the acuity based Nursing Hours per Day as part of McKesson upgrades. This is helping to inform discussions with services and validate 2015/16 Nursing budgets models.

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Overall costs per resourced beds continue to be constrained compared to the same period last year. Redeployment use is increasing and use of RN internal and external bureau staff stabilising, although overtime has been higher than last January/ February. It is thought this is associated with increase in volumes and numbers of watches required for patients with delirium and high falls risks. Sessions with Charge Nurse Managers and senior management teams have continued to champion the workforce sustainability process, with a focus on maintaining quality care, being accountable for resources, understanding budgets and associated workforce costs. The focus for the coming month is to confirm the protocol (including responsibility and accountability) for use of additional non-standard resource (external bureau, overtime, watches etc.). Work is already underway to confirm the most appropriate exception reporting for this area. Workforce The New Graduates Programme graduation was on 15th January. The graduates complete the clinical year, with a post-graduate paper and PDRP completion to a competent level. The following week saw the new cohort start their first year. A total of 79 with the largest Primary Health Care 16 Mental Health, 10 Aged Care, 1 corrections. The ethnic breakdown was 4 Maaori 11 Pacific. Emergency care celebrated their 101st New Graduate entering the New Graduate Programme since 20007.To date 90 have completed the program with 68 remaining in EC Additionally, since 2008, transition students have been working in the EC department and 25 transition students having gone on to join the New Graduate programme. Currently two CNS are preparing portfolios for Nursing Council-one in EC and one on the Patient at Risk team. The Medical Assessment Unit welcomed nursing staff seconded from Medical Wards to enable the Unit to open 24/7 over the summer. This has adjusted the summer staffing from 30FTE to 36FTE and reduced the winter staffing FTE budget. Depending on the winter patient volumes, further adjustment may be needed. The Medical Assessment Unit has supported the summer plan to close inpatient beds, by seeing and discharging patients ‘at the front door’. A period of full consultation on the plan to cease rostering 12 hour shifts in Kidz First has been completed. The Decision Document to be circulated to staff from 13 Feb 2015. To date evidence indicates the 8 hour shifts in the wards are safer and more economical. CM Health Nursing and the Pacific Unit are working with Manukau Institute of Technology supporting Bachelor Nursing Pacific students that failed State exams in December 2014. This commenced on 29 January and will run until the resit on 17 March. Advanced Nursing Certification The Advanced Nursing Certification (ANC) Committee has now been in existence for 18 months. In 2014, the committee reviewed and approved the following procedures under Expanded Scope of Practice:

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Colposcopy (Charge Nurse, Gynae), Long Acting Reversible Contraception (LARC) Insertion under local anaesthetic (CNS), Punch Biopsy (Module 7, RN) and Urodynamic Studies (CNS Urology). Additionally, under Advanced Competency Assessment are the following: Conservative Sharp Wound Debridement (CNS, Wound Care, and the District Nursing services), Arterial Blood Gas Sampling (Respiratory), PICC Line Insertion (Radiology), Enrolled Nurse - IV medication administration (Nursing) and Nipple / Areolar Micrcopigmentation and Tissue Expansion (CNS, Plastics Ambulatory Care). A pilot involving Health Care Assistants undertaking Peritoneal Dialysis Bag Exchanges Pilot (Ward 1) is currently in progress. Profile: “Patient at Risk” Team at Middlemore Hospital The Patient at Risk Team (PAR Team) provides 24/7 clinical support to patients at risk of clinical deterioration predominantly in the inpatient adult ward population and are part of the Critical Care Complex. The team was established in 2009 and consists of Clinical Resource Nurses with experience from medical, surgical and critical care backgrounds. Professional and clinical leadership of the team is provided by the Critical Care Complex Nurse Practitioner and the teams Associate Charge Nurse. The team respond to patients who trigger the adult early warning scoring system “PUP” (physiologically unstable patient) scoring system. This scoring system utilises physiological observations to be recorded and scored with a resulting graded response strategy. The team also respond to clinical emergencies (SET, MET and cardiac arrest) as part of the Medical Emergency Team (MET), they follow-up patients who have been transferred to the ward form the Critical Care Complex and also respond to calls of concern from both medical and nursing staff. In addition, they provide professional leadership and support to staff caring for these groups of patients in the acute care setting. The PAR Team activity can be seen in real time on Concerto, they are a 24/7 365 days team, they attend medical handover daily to ensure a collaborative approach to the patients at risk. In 2014 the PAR team received 3893 referrals and completed 9442 patient visits. Most patients referred to the PAR team remained on wards for their clinical management with only 7.2% requiring a higher level of care such as admission to critical care or coronary care. In 2014 the PAR team attended 63 inpatient cardiac arrests with 17.5% of those surviving to discharge. Four members of the team have completed their Masters, with prescribing rights and two are currently working on submission to Nursing Council for Nurse Practitioner Acute Care. Many of the team carry strategic portfolios such as sitting on the National outreach forum, reviewing Cardiac arrest data for CMH, Patient at Risk committee, simulation training, CM Health trigger tool group and are part of the Drug and Therapeutics Governance Group.

Middlemore Foundation

Presentation to HAC March 25 2015 Pam Tregonning Executive Director

Background

• Established in Aug 1999 by D Clarke & T Harris • Independent board and chair • 3 positional appointments from CMH • 9 independent trustees • Collaborative partnership with CMH

Raise funds for:

• Facilities • Equipment

• Projects

Facilities:

• NNU • ICU • EC • Kidz First • NBC • Ko Awatea and CTEC • ALBU • Spiritual Centre

Equipment

For example: • Ultrasounds • CT Scanners ( 2) • Bone densitometer • Lazy boys • Camera for wound management • Otoscopes • Skin meshers

Projects:

• Warm Up Manukau • Eyeglasses • Prescriptions • Wool programme • Scholarship programme • Mana ā Riki

To Date:

From 1/1/ 2000 – 1/1/ 2015

just over $43m

Foundation Issues

• Approved projects • Project details + quotes • Processing - services • Paperwork • Delays in ordering • Change of mind

Thank You

COUNTIES MANUKAU DISTRICT HEALTH BOARD

Counties Manukau Health - Our values - patient and family/whaanau survey

IntroductionAt Counties Manukau Health we take great pride in providing care that is patient and family/whaanau centred. But we know we don’t get it right all of the time, and there is plenty of room for improvement.

Our aim is to provide you, your family/whaanau and all of our communities with consistently safe, compassionate, high quality care across all our services. We need your help to do this. Please complete this confidential survey to tell us about your experience in our care.

We will use your feedback to improve the quality of care we provide to all our patients, their family/whaanau and carers. Please complete this in the language you feel most comfortable. Thank you.

About youQ1. Are you a... Please tick appropriate box

Patient

Family/whaanau member

Carer

Other (please specify)

About your experienceQ2. The best thing about my experience / my family’s/whaanau’s experience at a Counties

Manukau Health hospital or service is / was...

Q3. What I liked least about my experience at a Counties Manukau Health hospital or service is / was.

Patients

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Counties Manukau Health - Our values - patient and family/whaanau survey

Enriching our values about how our staff behaveQ4. In our hospitals and services – when our staff act in a way that you like, what do you see

and hear them doing, that they should keep doing, or do more of?

Q5. Sometimes you may have experienced staff at our hospitals and services doing things that you don’t like. If this is the case, what behaviours have you noticed that you would like to see or hear people doing less of, or not at all?

FinallyQ6. If we could change one thing to improve your experience with us, it would be...

Q7. Please give us any other views or comments you think we should know about.

Many thanks for taking part in our survey, and helping us to keep improving the quality of our care. You can follow the progress of this project on our website. http://countiesmanukau.health.nz/

The closing date for this survey is 8 May 2015

Please place your survey in the feedback box at the Main Information Desk at Middlemore Hospital or Manukau SuperClinic. Alternatively post to:

Adeline CumingsProject ManagerPrivate Bag 93311 OtahuhuAuckland 1640.

Patients

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3. Thinking about a great patient and staff experience, what are the things you see and hear staff doing, that they should keep doing, or do more of...

…with patients, families/whaanau and carers …with colleagues?

1. The compliment I would most like to hear from a patient is... 2. I’d like colleagues to describe me as the kind of person who...

Our behaviours

Counties Manukau Health - Values Graffiti BoardWe know staff at Counties Manukau Health take great pride in providing care that is patient and family/whaanau centred. We are equally passionate about making this a great place to work for you and your colleagues. But we know we don’t get it right every time.

Our ambition is to provide a consistently positive experience for our patients, their families/whaanau, our staff and for the communities we serve. So we want to get your views on how we can achieve this by Living our Values, Together. We will use your feedback to help us to develop shared values, and understand what they look like in our day to day behaviours with everyone we work with, and when we are providing the excellent care we all aspire to.

This survey is intended for all our staff, whether in direct patient care roles or supporting services. Please answer all of the questions with your views. It is strictly anonymous any answers you provide cannot be linked to you. We are collecting similar feedback from our patients and their family/whaanau to understand what matters most to them.

Please complete this in the language you feel most comfortable.


Staff

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Improving our experience5. If we could do one thing to make your experience

at work better it would be...

Which of these best describes your role or profession?

Medical

Nursing & Midwifery

Allied Health

Non -Clinical Support

Admin & Management

Other (please specify)

Which of these best describes the department you work in?

Facilities / Engineering / Non Clinical Support

Medicine & Acute Care

Surgical and Ambulatory Care

ARHOP

Kidz First/ Women’s Health

Mental Health

Middlemore Central

Ko Awatea

Primary Care & Localities

Strategic Development

Corporate

Other (Please specify)

6. If we could make one improvement for patients it would be...

4. Occasionally you may see staff doing things that don’t provide a good patient and staff experience. What are the things you see and hear staff doing, that they should do less of, or not at all...

…with patients, families/whaanau and carers …with colleagues?

Scan completed surveys to: [email protected]

or post to: Adeline Cumings Level 5, Executive Suite Galbraith Building Middlemore

The closing date for this survey is 8 May 2015

Email COMPETITION to [email protected] for your chance to be into win one of four $1100 Club Physical memberships.

Thanks for taking part. All responses are totally anonymous, but it will help us to ensure the survey is representative of the whole organisation if you can tell us the department you work in, and your role.


Staff

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Counties Manukau District Health Board Diagnostic Target Performance Report

Recommendation It is recommended that: Hospital Advisory Committee note the Diagnostic Target Performance Report. Prepared and submitted by: Brad Healey General Manager Medicine 1. Purpose The purpose of this report is to update Hospital Advisory Committee on our plans and progress to achieve the diagnostic waiting times for CT, MRI, and Colonoscopy. Included within this report is a document that highlights for each DHB January 2015 performance for diagnostics – The theme that emerges from this report is that many DHBs are struggling to achieve performance within the required time frames. In addition we provide the project plan to achieve Faster Cancer Treatment Times.

Progress Report National Health Targets Achieve by 010715

Tentative Not Achieve by 010715

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PP29 : Improving Waiting Times for Diagnostic Services RADIOLOGY: Computed Tomography (CT): 90% of accepted referrals for CT scans will receive their scan within six weeks (42 days) at 1 July 2015

Performance at December 2014: 75% - please see Graph, over Current Wait List: 933 Patients. Oldest Referrals: November 2014

Activity Risks and Constraints Mitigations Production Planning • Production planning tool is in place and planning underway to operationalize

this in CT • SPMO providing a model to advise level of activity required to meet current

and future demand Demand Review • Demand review has been undertaken to identify variation between Counties

Manukau referring clinicians. This did not reveal any significant outliers. However this data is also being reviewed in Medicine

• A further piece of work is being undertaken by Decision Support to link referrals to DRGs.

Capacity • The CT scanner in Emergency Department for Acute scans will be installed

and running early July 2015. This will increase capacity to meet acute demand and separate the majority of acute work from elective scans, enabling a smoother process and access for elective workflow.

• Saturday sessions. Some MRTs have volunteered to run Saturday sessions and these will commence in late March 2015. However this is on a voluntary basis.

• We will further increase CT capacity by continuing the Building 58 CT scanner from July 2015 which we had otherwise planned to close. This will mitigate the need to outsource in order to help us achieve the target.

Process Mapping • All Radiology processes have been mapped over the last two years and

actions to mitigate “waste” taken..

CT procedure mix. The Radiology service has also been focussed on assisting to meet the Colonoscopy and Faster Cancer Treatment targets. CT Colonography is a time-intensive procedure compared to other diagnostic scans and it has been difficult to balance the demand. MRT Workforce (for CT) Over last 3-4 months we have lost experienced CT trained MRT staff to parental leave and work overseas.

The production planning tool and demand modelling, combined with greater capacity steps as outlined here will mitigate. Work is underway to recruit and rebuild the team. Training however takes 10-12 weeks minimum for an MRT to be able to perform CT without supervision. As a result some evening lists have not been running, thereby reducing capacity. We will be recruiting to staff this additional capacity over the next three months.

Overall status for achievement

at 1 July 2015:



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PP29 : Improving Waiting Times for Diagnostic Services RADIOLOGY: Magnetic Resonance Imaging (MRI ): 80% of accepted referrals for CT scans will receive their scan within six weeks (42 days) at 1 July 2015

Performance at December 2014: 65% - please see Graph below Current Wait List: 706 Patients.

Oldest Referrals: November 2014 Activity Risks and Constraints Mitigations

Production Planning • Production planning tool is in place and will be implemented for MRI when CT

completed. Demand Review • Demand review has been undertaken to identify variation between Counties

Manukau referring clinicians. This did not reveal any significant outliers. • A further piece of work is being undertaken by Decision Support to link

referrals to DRGs. However this data is also being reviewed by Medicine Capacity • Building 58 MRI scanner replacement. The current 1.5 T MR scanner is old

and its inability to produce adequate images for certain areas of the body inhibits its flexibility. Introducing the 3T MRI scanner will improve flexibility and therefore capacity. It will be operational in May 2015.

• Outsourcing to TRG at Ormiston Hospital for obese patients and to Ascot Radiology for Breast scans and biopsies. Once the new MRI scanner is operational at Building 58, the Breast scans and biopsies will be brought back from Ascot Radiology

• We plan to increase capacity in 2015/16 by undertaking evening sessions Building 58.

• Production modelling is currently being undertaken which will inform us on how many MRI procedures may need to be outsourced in order to achieve the target.

Process Mapping (as above for CT)

MRT Workforce (for MRI) Over last 6 months we have lost two experienced MRI trained MRT staff. The team is small (6.4 FTE) so the impact has been significant with a reduction in evening sessions over the latter part of 2014.

With the gap partially mitigated evening lists are now running but the ability to perform routine weekend work is very limited. Recruitment continues with haste however there is a national shortage of trained MRI MRTs.

Overall status for achievement

at 1 July 2015:

0%

20%

40%

60%

80%

100%

120%

Dec

-12

Jan-

13Fe

b-13

Mar

-13

Apr

-13

May

-13

Jun-

13Ju

l-13

Aug

-13

Sep

-13

Oct

-13

Nov

-13

Dec

-13

Jan-

14Fe

b-14

Mar

-14

Apr

-14

May

-14

Jun-

14Ju

l-14

Aug

-14

Sep

-14

Oct

-14

Nov

-14

Dec

-14

Perc

enta

ge

Month

Target: 95% of accepted referrals for scans receive their scan within 6 weeks (42 days)

CT

MRI

Ultrasound

X-ray

Target



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PP29 : Improving Waiting Times for Diagnostic Services COLONOSCOPY Diagnostic Colonoscopy:

a. 75% of people accepted for an urgent diagnostic colonoscopy will receive their procedure within two weeks (14 days) Performance at February 2015, 93.3%

b. 60% of people accepted for a diagnostic colonoscopy will receive their procedure within six weeks (42 days) Performance at February 2015, 27.9%

Surveillance Colonoscopy c. 60% of people waiting for a surveillance colonoscopy will wait no longer than twelve weeks (84 days) beyond the planned date

Performance at February 2015, 93.2% Activity Risks and Constraints Mitigations

Internal Capacity • Internal capacity that was to come on stream November 2014 and did

not eventuate, has now been enabled as follows with the associated production planning:

o An additional 2 lists at Manukau Health Park from 1 April 2015 and a further 2 planned from 01 July 2015.

o Providing as may additional lists in-house as possible i.e. SMOs working 120% of capacity to provide extra lists. This includes providing lists on a Saturday

o A Gastroenterology Fellow currently working as a registrar in CCU can do supervised lists Saturday

o It is expected further offers for Saturday lists will be received o General Surgeons are providing set lists on a Wednesday at

Manukau Health Park from April 2015 when Plastics vacate Room 25.

o Recruit for a (second) Fellow in Gastro as a substitute for an additional SMO (until we recruit an SMO who we anticipate being in-post January 2016

Service has been focussed on outsourcing the “long waiting” patients i.e. those waiting more than 42 days. This waiting list continues to grow and the outsourcing has made little impact on achieving the 62 Day target although appropriately clinically. Utilisation of operating room capacity will be subject to workforce availability for SMOs and nurses. Fellow who was supposed to start December 2014, did not eventuate

Hence the Service has refocussed its strategy with initiatives listed as “Activity” Interviewing for replacement Fellow who could start April 2015 – and other initiatives as per “Activity”

Overall status for achievement of 62- Day target at 1 July

2015:



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Activity Risks and Constraints Mitigations Outsourced Capacity • 1,000 colonoscopies in total currently being outsourced (Ormiston and

McMurray Road). • Outsourcing mainly longest waiting patients and managing the under-

42 day patients in-house. • Close monitoring and adjustment to lists. Process Improvement • Review of booking processes to be undertaken to create a more

responsive system i.e. book additional lists more quickly and remove patients from list (as appropriate) more quickly

Clinical Review of Surveillance and First Colonoscopy • To determine if patients can wait longer or be delayed further to

enable focus on others under 42 days. • Contacting the long wait patients to determine if they still need or

want to have their colonoscopy.

Production planning has indicated we need to outsource an additional 300 procedures (alongside the internal initiatives) to ensure we meet the 1 July 2015 Target.

We will be outsourcing to Ormiston, McMurray and Auckland Endoscopy. The final volume to be outsourced will be determined by week to week volumes achieved.

Insert Graphs (Pauline)

201,501.00

201501 201501 201501January January January January January January January January January January January January

2015 2015 2015 2015 2015 2015 2015 2015 2015 2015 2015 2015Coronary

Angiography CT Scan 201501 MRI Scan UrgentColonoscopy

Non-urgentColonoscopy

SurveillanceColonoscopy

Waiting orCatheterised

Within 90 Days

Total Waitingand

Catheterised% Within 90

Days

Waiting orScannedWithin 42

DaysCT Waiting

and Scanned% Within 42

Days

Waiting orScannedWithin 42

DaysMRI Waitingand Scanned

% Within 42Days

Waiting andScoped Within

14 DaysTotal Waitingand Scoped

% Within 14Days



% Within 42Days



% Within 84Days

Auckland 134 136 98.5% 709 1,202 59.0% 477 977 48.8% 8 8 100.0% 233 238 97.9% 141 142 99.3% AucklandBay of Plenty 62 68 91.2% 507 585 86.7% 242 289 83.7% 45 95 47.4% 234 569 41.1% 93 787 11.8% Bay of PlentyCanterbury 118 120 98.3% 1,110 1,179 94.1% 519 710 73.1% 19 20 95.0% 211 333 63.4% 348 573 60.7% CanterburyCapital and Coast 104 106 98.1% 532 670 79.4% 233 592 39.4% 12 15 80.0% 140 204 68.6% 94 105 89.5% Capital and CoastCounties Manukau 56 56 100.0% 626 1,338 46.8% 397 905 43.9% 39 40 97.5% 320 1,294 24.7% 237 240 98.8% Counties ManukauHawkes Bay 46 49 93.9% 365 428 85.3% 210 386 54.4% 22 27 81.5% 54 190 28.4% 78 163 47.9% Hawkes BayHutt Valley - - - 241 258 93.4% 171 318 53.8% 8 9 88.9% 120 203 59.1% 134 134 100.0% Hutt ValleyLakes - - - 350 484 72.3% 174 428 40.7% 12 17 70.6% 85 193 44.0% 31 86 36.0% LakesMidCentral 50 52 96.2% 331 352 94.0% 229 229 100.0% 6 6 100.0% 119 125 95.2% 80 110 72.7% MidCentralNelson Marlborough 86 93 92.5% 222 597 37.2% 143 528 27.1% 16 19 84.2% 104 314 33.1% 13 187 7.0% Nelson MarlboroughNorthland - - - 251 278 90.3% 147 523 28.1% 19 56 33.9% 76 927 8.2% 68 152 44.7% NorthlandSouth Canterbury - - - 292 314 93.0% 137 177 77.4% 13 14 92.9% 38 127 29.9% 50 125 40.0% South CanterburySouthern 85 86 98.8% 549 881 62.3% 425 1,200 35.4% 14 20 70.0% 120 165 72.7% 79 88 89.8% SouthernTairawhiti - - - 128 143 89.5% 53 76 69.7% 2 4 50.0% 46 93 49.5% 27 30 90.0% TairawhitiTaranaki 44 44 100.0% 173 244 70.9% 83 203 40.9% 12 14 85.7% 97 262 37.0% 18 19 94.7% TaranakiWaikato 142 151 94.0% 419 520 80.6% 253 1,137 22.3% 18 43 41.9% 163 604 27.0% 71 155 45.8% WaikatoWairarapa - - - - - - - - - 21 23 91.3% 22 48 45.8% 21 25 84.0% WairarapaWaitemata 86 86 100.0% 627 731 85.8% 338 748 45.2% 42 59 71.2% 369 837 44.1% 270 498 54.2% WaitemataWest Coast - - - 109 109 100.0% 51 58 87.9% 7 9 77.8% 39 55 70.9% 17 33 51.5% West CoastWhanganui - - - 144 166 86.7% 70 101 69.3% 8 13 61.5% 44 120 36.7% 25 51 49.0% Whanganui

National Total: 1,013 1,047 96.8% 7,685 10,479 73.3% 4,352 9,585 45.4% 343 511 67.1% 2,634 6,901 38.2% 1,895 3,703 51.2% National Total

Percentage of patients receiving diagnostics within required timeframes

Patients waiting at the end of the month and exited during the month for January 2015

NOTES

BOX 3: Indicator TriggersThe indicator will be Green if:

1. The DHB percentage result is at or above the level identified in Box 1

The indicator will be Red if:

1. The DHB percentage result is below the level identified in Box 1; or2. The DHB has not supplied data; or the DHB data is incomplete

This is a Policy Priority

1. Data was provided by DHBs for the first time in July 2012 2. This was a Development Indicator until June 2014. 3. The information is being shared to continue to improve accuracy and understanding of the data report and to improve data quality4. The data will remain variable as DHBs work to understand reporting requirements and improve data collection5. Please advise of any concerns you have about the quality of data you have supplied6. Please ensure that if this data is shared, these caveats are included.

BOX 1: Indicator Levels BOX 2: CalculationIn the 2014/15 financial year the following waiting time indicators apply :Coronary Angiography: 90% of people accepted for elective angiography receive their procedure within three months (90 days)Computed Tomography (CT): 90% of people accepted for a CT scan receive their scan within six weeks (42 days)Magnetic Resonance Imaging (MRI): 80% of people accepted for an MRI scan receive their scan within six weeks (42 days)Urgent Colonoscopy: 75% of people accepted for an urgent colonoscopy receive their procedure within two weeks (14 days)Non-urgent Colonoscopy: 60% of people accepted for a non urgent colonoscopy receive their procedure within six weeks (42 days)Surveillance Colonoscopy: 60% of people accepted for a surveillance colonoscopy whose procedure is due prior to or within the month of reporting receive their procedure within 12 weeks (84 days)

Numerator: People who received the diagnostic within the identified timeframe and People waiting for the diagnostic at the end of the period who have waited less than the indicated timeframe

Denominator:

BOX 4: Data source:

Angiography data is supplied by DHBs to the National Booking Reporting System (NBRS), and extracted monthly

CT and MRI data is supplied by DHBs on a spreadsheet report each monthColonoscopy data for most DHBs is supplied on a spreadsheet report each month. Four DHBs are reporting colonoscopy via NBRS

People who received the diagnostic and people waiting for the diagnostic at the end of the period

Report Run Date: 03 March 2015

BOX 5: Previous Indicator LevelsThe following waiting time indicators applied while this was a Developmental Indicator:

BOX 6: Data requirements:

Developmental Indicator Policy Priority2012/13 2013/14 2014/15

Coronary Angiography 85% within 90 days 85% within 90 days 90% within 90 daysCT Scan 75% within 42 days 85% within 42 days 90% within 42 daysMRI Scan 75% within 42 days 75% within 42 days 80% within 42 daysUrgent Colonoscopy 50% within 14 days 50% within 14 days 75% within 14 daysNon-urgent Colonoscopy 50% within 42 days 50% within 42 days 60% within 42 daysSurveillance Colonoscopy 50% within 84 days 50% within 84 days 60% within 84 days

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Responsibility Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-171

1.1 Refined performance reporting 1.1.1 Weekly new patient & time to FSA report1.1.2 Monthly FCT performance report

1.2 Tumour stream pathway mapping and improvements1.2.1 Initial pathway maps development1.2.2 Detailed pathway maps development:

GynaeLower GIUrologyUpper GILung

1.2.3 Analysis of potential improvements1.2.4 Targeted pathway improvements

1.3 Individual case audits1.3.1 Analysis of patient journeys Ongoing

1.4 Lung Cancer Pathway Pilot1.4.1 Pilot development1.4.2 Pilot Implementation1.4.3 Pilot Evaluation

1.5 Potential pre-referral investigations- primary care1.5.1 Identify tumour stream(s) to target1.5.2 Primary Care engagement/communicaton1.5.2 Pilot development1.5.3 Pilot Implementation1.5.4 Pilot Evaluation

2 Service Quality Development2.1 Standardisation of Radiology tests

2.1.1 Regional Pilot Implementation2.1.2 Regional Pilot Evaluation

2.2 Development of Cancer Nurse Coordinator role2.2.1 Strategic plan development2.2.2 Detailed workplan development2.2.3 Workplan implementation

3 Capacity and capability Development3.1 Developing FCT Implementation Group

3.1.1 Group implmentation/forming3.1.2 Two-weekly tumour stream activity feedback Ongoing

3.2 Gastroenterology service development 3.2.1 Business case development & approval3.2.2 Implementation

3.3 CM Health-based Medical Oncology service (estimated)3.3.1 Regional Strategic Plan development3.3.2 Decision re local service provision (in principle)3.3.3 Planning for service requirements3.3.4 Facility and service model development3.3.5 Potential Service initiation

4 Regional Service Development4.1 Regional FCT Steering group

4.1.1 Group formation and TOR developed4.1.2 Monthly meeting - regional and local issues

4.2 Linked pathway development4.2.1 Pathway mapping4.2.2 Improvements identified4.2.3 Implementation of pathway improvements

5 Education and communication5.1 Benchmarking and Service design

Identify top 3-5 performing DHBs and visit themImplement improvements

5.2 Secondary care cancer services 4.1.1 Education and engagement

5.3 Primary/community 4.2.1 FCT Target education

5.4 Ministry of Health4.3.1 Quarterly reporting (data and narrative)

4.3.2 MOH FCT Roadshow visit

4.3.3 FCT National Forum

2014-15 2015-16 2016-17

Faster Cancer Tests and Treatment - Implementation Plan

Q4 Q1 Q2 Q3 Q4Q3

Process/Service Development

Q3 Q4 Q1 Q2Key Activity

FCT Project Team, Tumour Stream Clinical Leads, Service Managers, Cancer Coordinators

Tumour Stream Clinical staff

Lung Tumour Stream, Regional Cancer Network

FCT Project Group, Tumour streams, Primary Care

FCT Project Team, Decision Support

Radiology, Regional Cancer Network

Cancer Nurse Coordinators

FCT and Cancer Steering Groups

Gastro Tumour Stream

ELT, Cancer Steering Group

Regional Cancer Network, Richard Small, Wilbur FarmiloRegional Cancer Network, FCT Project Team

FCT Group

FCT Project Team

Service Manager Cancer

FCT Project Team

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131

Project Charter

Project Overview

Project Name: Faster Cancer Times (FCT)

Project Summary: The MoH has set a new indicator target of 62 days for 85% of cancer patients. The target requires eligible patients to commence treatment within 62 days of initial referral. Eligible patients are to be graded as high suspicion and seen at FSA (First Specialist Appointment) within 2 weeks of referral.

Project Manager Nick Price Project Sponsor Brad Healey Business Department Department of Medicine Doc Version No. 3

Project Approval

Sponsor Date Project Manager Date Print

Print

Sign

Sign

Project Details

1. Background/problem statement

The MoH has set a target of 62 days for at least 85% of cancer patients from initial referral to commencement of treatment by July 1st, 2016 and then increasing to 90% of patients by July 1st, 2017. The initial data from the Clinical Cancer Tracker puts CMDHB at 59% for Q2 (October –December 2014). A directive from the CMDHB CEO is to achieve the initial MoH target by June 30th, 2015.

2. Goal/ Objective The goal of the project is to bring all five tumour streams identified in order Gynaecology, Lower GI, Upper GI, Urology and Lung to meet the Ministry of Health targets by 30th June, 2015.

3. Project scope (specify boundaries not deliverables)

In scope: • Eligible for treatment in NZ. • Pathway beings inside NZ public health system • Graded as high suspicion of cancer and having a need to be seen within 2 weeks. • Cancer diagnosed in public health system • Pathway via outpatient setting (including where there is an initial acute

presentation) • Received treatment for metastatic cancer with unknown primary. • Under care of adult services and 16 years or older • Received publicly funded first treatment

Out of Scope: • Not eligible for treatment in NZ • Pathway beings outside NZ public health system • Graded with not having a high suspicion of cancer • Graded as not needing to be seen within 2 weeks • Having a confirmed cancer diagnosis at referral • Cancer diagnosed via screening programme (e.g. breast, cervical)

Strategic Programme Management Office

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• Cancer diagnosed privately • Pathway entered via acute presentation with no subsequent outpatient referral • Recurrent cancer (irrespective of timeframe) • Metastatic cancer with known primary • Not under care of adult services and/or 16 years or older • Received non-publicly funded first treatment (including private)

4. Expected benefits • The organisation will achieve the 85% target 12 months ahead of Ministry of Health schedule and improve cancer treatment for all patients owing to initial and ongoing improvements to the patient journey.

5. Benefit measurement Description Measure (days)

Date and Current Actual

Date and Target Expected Impact

Outcome Metrics

Manage date of referral receipted to date of first FSA

Average length of delay <14 days with low (?) variability

March 2nd, 2015

April 30th, 90% within 14 days

90% of patients remain on target for 62 day indicator.

Reduce/maintain date of FSA to date of MDM to within 14 days

Average length of delay <14 days

March 2nd, 2015

April 30th, 90% within 14 days,

90% of patients remain on target for 62 day indictor.

Process Metrics Record dates of pathway milestones

Record dates of all failed patients in the Q2 period

March 2nd, 2015

March 16th, 2015

To create a patient database highlighting where milestones were not achieved.

6. Outline project deliverables

Deliverables / Products/ PDSA Cycle By whom Estimate due

date 1 Creation of tumour stream value stream process

map Nick Price March 16th, 2015

2 Creation of patient database highlighting milestone “breaches” and reasons Nick Price March 16th, 2015

3 Proposal of first set of changes to the various tumour stream processes

Project Team,

Tumour streams

March 23rd, 2015

4 Develop prioritised plan for effecting approved changes (process, people, systems)

Project Team March 30th, 2015

5

Commence roll out changes (phased)

Project Team,

Tumour streams

March 30th, 2015

6 Record reason why milestone breach occurred Nick Price March 30th, 2015

7 Creation of “breach” database to review common issues amongst all tumour streams and specific issues to just 1-2 tumour streams

Nick Price March 30th, 2015

8 Monitor enhanced tumour stream processes TBC

9 Complete rollout of changes TBC May 1st, 2015

10 Document new state by tumour stream Project Manager May 15th, 2015

7. Estimated Project Budget

Resource Unit Cost Proportion/FTE Start Date End Date Totals Project Manager $85,000 0.5 March 2nd,

2015 April 30th, 2015 $7,000

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Project Mentor March 2nd,

2015 April 30th, 2015

Overall Total Budget $10,000 est

2014-15 $10,000 est

8. Where will the funding come from?

• BAU of current departments project manager and mentor currently work in.

9. Issues (including constraints)

• Short timeframe to complete work and implement initiatives within 4 month period • Lack of current process map of patient journey through tumour streams. • Lack of consistent automated system to record patient information. • Resource constraint as both project members have BAU work to complete as part of

their current roles.

10. Risks • Lack of definitive criteria around “high risk” patients and inclusion in 62 day indicator means some patients may be missed from inclusion.

• Low volume of patients will led to wide variability in results making measuring of outcomes after initiatives difficult.

• Breaches due to clinical considerations/ patient choice is @ 14% • Lack of clinical engagement due to small proportion of patients. • Delays due to process design such as scheduled MDM meetings (held weekly) • Diagnostic delays due to system capacity mainly identified in laboratory and

Radiology. • Limited time/resource to coordinate and work with services to drive system change.

Work to date is occurring within business as usual resourcing. • Manual data collection systems, complicated by multi-DHB involvement. • Reliance on regional services to meet target treatments dates especially with some

treatment only provided at ADHB.

11. Interrelated projects

• Current clinical cancer pathway tracker collecting patient data for the 31 day indicator target.

• Northern Regional Alliance project working within the Lung Tumour stream for streamlining and improving the patient journey.

• Project Swift within CMDHB to improve current manual tracking except for Lung Tumour stream using Engima’s Predict database tool.

12. Major Stakeholders Name Title

Geraint Martin CEO, CM Health

Phillip Balmer Director Hospital Services

Brad Healey General Manager, Medicine

Wilbur Farmilo Clinical Director of Surgery

Richard Small Service Manager, Medicine

Anne-Marie Wilkins Lead Cancer Co-ordinator

13. Project Approach Create a value stream process map (VSM) for the five tumour streams lower GI, Gynaecology (first two) then Upper GI and Urology, Breast and Lung. Analyse VSM Develop of “future state” process model enhanced as required by ‘stream’. Prioritise and approve model elements Rollout agreed changes Develop reporting mechanism Create a patient database of all patients who failed the 62 day indicator during Q2. Record dates of the following for each patient:

• Date Referral received (starting point) • Date referral graded • Date Pre FSA Diagnostics performed and type of test • Date of First Specialist Appointment (FSA)

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• Date of Post FSA Diagnostics performed and type of test • Date of Multi-Disciplinary meeting (MDM) and planned meeting times of the

MDM • Date of MDM Diagnostics performed and type of test. • Date of Pre Treatment (Rx) assessment • Date Treatment commences (end point)

Review database for common issues amongst all five tumour streams and specific issues for 1-2 tumour streams.

14. Project Team Nick Price (Project Manager) Bill Lewis (Project Mentor) Brad Healey (General Manager) Richard Small (Service Manager) Anne-Marie Wilkins (Lead Cancer Coordinator) Stephanie Easthope (Ko Awatea Faculty Manager) Richard Steele

15. Reporting line Nick Price to Richard Small to Brad Healey

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Counties Manukau District Health Board Hospital Advisory Committee Meeting – 25 March 2015

6.0 Resolution to Exclude the Public Resolution: That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000 the public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General Subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

7.1 Patient Safety Report




7.2 Risk Register That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.



7.3 Minutes of HAC meeting 11 February 2015 with public excluded


Confirmation of Minutes For the reasons given in the previous meeting.

7.4 Action Items Register Confidential

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under

Action Items Register For the reasons given in the previous meeting.

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section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]