A G E N D A - waitematadhb.govt.nz · Chair – Social Services Online Trust Board member – Rotary National Science and Technology Forum Trust 28/09/11 Sandra Coney Elected Member

HOSPITAL ADVISORY COMMITTEE (HAC) MEETING

Wednesday 31st October 2012 10.00am Note: • Public Excluded Session 10.00am to 11.00am • Open meeting from 11.00am

A G E N D A

VENUE Waitemata District Health Board Boardroom Level 1, 15 Shea Tce Takapuna

Waitemata DHB, Hospital Advisory Committee Meeting 31/10/12 i

HOSPITAL ADVISORY COMMITTEE (HAC) MEETING

31 October 2012 Venue: Waitemata DHB Boardroom, Level 1, 15 Shea Terrace, Takapuna Time: 10.00am WDHB Board Members Gwen Tepania-Palmer – Committee Chair Lester Levy – WDHB Chair Max Abbott – WDHB Deputy Chair Pat Booth – WDHB Board Member Sandra Coney – WDHB Board Member Rob Cooper – WDHB Board Member Warren Flaunty – WDHB Board Member Wendy Lai – WDHB Board Member James Le Fevre – WDHB Board Member Christine Rankin – WDHB Board Member Allison Roe – WDHB Board Member Hasan Bhally – Co-opted Member Susanna Galea – Co-opted Member Andrew Jones – Co-opted Member

WDHB Management Dale Bramley – Chief Executive Officer Rosalie Percival – Chief Financial Officer Andrew Brant – Chief Medical Officer Jocelyn Peach – Director of Nursing & Midwifery Debbie Holdsworth - Acting Chief Planning and Funding Officer Phil Barnes – Director of Allied Health Barry Vryenhoek – CEO, healthAlliance Sam Bartrum – GM Human Resources Paul Patton – Director of Communications Paul Garbett – Board Secretary

Apologies:

AGENDA DISCLOSURE OF INTERESTS • Does any member have an interest they have not previously disclosed? • Does any member have an interest that might give rise to a conflict of interest with a matter on the agenda?

PART I – Items to be considered in public meeting All recommendations / resolutions are subject to approval of the Board. TIME 10.00a.m (please note agenda item times are estimates only and that the public excluded session is from 10.00am-11.00am)

11.10am Presentation: West Auckland Hospice and Waitemata DHB and Palliative Care

1. AGENDA ORDER AND TIMING 10.00am 2. RESOLUTION TO EXCLUDE THE PUBLIC ............................................................... 1

3. CONFIRMATION OF MINUTES 11.25am 3.1 Confirmation of Minutes of Hospital Advisory Committee Meeting 19/9/12......................... 3

4. PROVIDER REPORT 11.30am 4.1 Provider Arm Performance Report .................................................................................... 13

5. CORPORATE REPORTS 12.10pm 5.1 Clinical Leaders’ Report .................................................................................................... 71 12.20pm 5.2 Human Resources Report .................................................................................................. 75

6. INFORMATION PAPERS 12.30pm 6.1 Elective Services Update .................................................................................................. 89 12.40pm 6.2 Laboratory Innovation Paper ............................................................................................. 92

Waitemata DHB, Hospital Advisory Committee Meeting 31/10/12 ii

REGISTER OF INTERESTS

Board/Committee Member

Involvements with other organisations

Last Updated

Lester Levy Professor of Leadership – University of Auckland Business School Co-Director – New Zealand Leadership Institute Deputy Chair – Health Benefits Limited Independent Chairman – Tonkin & Taylor Chair – Auckland District Health Board Chairman – Auckland Transport (commencing 1st November 2012)

28/08/12

Max Abbott – Deputy Chair

Pro Vice-Chancellor (North Shore) and Dean – Faculty of Health and Environmental Sciences, Auckland University of Technology Patron – Raeburn House Board Member – Health Workforce New Zealand Board Member - AUT Millennium Ownership Trust Chair – Social Services Online Trust Board member – Rotary National Science and Technology Forum Trust

28/09/11

Sandra Coney Elected Member and Chair Parks Committee - Auckland Council 02/05/11 Rob Cooper Board Member – Auckland District Health Board

Chief Executive - Ngati Hine Health Trust Advisory Board Member – James Henare Research Centre, University of Auckland

26/09/12

Pat Booth Consulting Editor – Fairfax Suburban Papers in Auckland 24/06/09 Warren Flaunty Member of Henderson – Massey, Rodney and Upper Harbour Local

Boards, Auckland Council Trustee - West Auckland Hospice Trustee - Waitakere Licensing Trust Shareholder - Metlifecare Shareholder - EBOS Group Shareholder – Pharmacy Brands Ltd Shareholder – Westgate Pharmacy Ltd Chair – Three Harbours Health Foundation Trustee – Trusts Community Foundation Ltd

18/07/12

James Le Fevre Medical Officer - Auckland Adults Emergency Department Research Fellow - Shorter Stays in ED National Research Project Auckland Helicopter Emergency Medical Service Doctor Member of ASMS Member – Australasian Society of Emergency Medicine, Hospital Overcrowding Subcommittee

04/04/12

Wendy Lai Partner – Deloitte Board Member – Rodney Health Link Board member - Museum of NZ Te Papa Tongarewa

09/08/10

Christine Rankin Member - Upper Harbour Local Board, Auckland Council Member - The Families Commission Director - The Transformational Leadership Company

02/02/11

Allison Roe Shareholder – Optimisewellbeing.com Founding member – Breast Health Foundation Director – Spiritus NZ Trustee – Allison Roe Trust Board member – North Shore Hospital Foundation Founder – Takapuna 2020 Community Group

28/03/11

Waitemata DHB, Hospital Advisory Committee Meeting 31/10/12 iii

Board/Committee Member

Involvements with other organisations

Last Updated

Gwen Tepania-Palmer

Chairperson- Ngatihine Health Trust, Bay of Islands Life Member – National Council Maori Nurses Alumni – Massey University MBA Director – Manaia Health PHO, Whangarei Board Member – Auckland District Health Board

18/10/12

Co-Opted Members

Hasan Bhally Member – Association of Salaried Medical Specialists (ASMS) Recipient of funding for research and advice - Pfizer Anti-Infectives Recipient of funding for research and advice - Cubist Pharmaceuticals

08/05/12

Susanna Galea Member – New Zealand Medical Association Member – Association of Salaried Medical Specialists (ASMS) Member – Medical Protection Society

10/05/12

Andrew Jones Member – Public Services Association (PSA) Chair – Physiotherapy New Zealand Ethics Committee

08/05/12

Waitemata DHB Hospital Advisory Committee Meeting 19/09/12 iv

Waitemata District Health Board Hospital Advisory Committee Member Attendance Schedule 2012

x Absent * Attended part of the meeting only # Absent on Board business ^ Leave of absence

NAME FEB APR MAY JUNE AUG SEPT OCT DEC Gwen Tepania – Palmer (Committee Chair) ü ü ü ü ü ü

Dr Lester Levy (Chair) ü ü ü x ü ü

Max Abbott (Deputy Chair) x ü ü ü ü x

Pat Booth ü ü ü ü ü ü

Sandra Coney ü ü ü ü ü ü

Rob Cooper x ü ü ü* x x

Warren Flaunty ü ü ü x x ü

Wendy Lai ü ü ü x x ü

James Le Fevre ü ü ü x ü ü

Christine Rankin ü ü ü ü ü ü

Allison Roe ü ü ü ü ü ü

Co-opted members

Hasan Bhally - - ü* ü ü ü

Susanna Galea - - ü ü ü ü

Andrew Jones - - ü ü ü ü

Waitemata DHB, Hospital Advisory Committee Meeting 31/10/12

2 RESOLUTION TO EXCLUDE THE PUBLIC Recommendation: That, in accordance with the provisions of Schedule 3, Sections 32 and 33, 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

1. Confirmation of Public Excluded Minutes – Hospital Advisory Committee Meeting of 19/09/12

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)]

Confirmation of Minutes As per resolution(s) to exclude the public from the open section of the minutes of the above meeting, in terms of the NZPH&D Act.

2. Quality 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.


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)]

3. Medication Safety Strategy Update



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)]

4. Human Resources 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.


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)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)]

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5. Nursing Workload Management



Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)]

6. Update on Legal Proceedings



Legal Professional Privilege The disclosure of information would not be in the public interest because of the greater need to maintain legal professional privilege. [Official Information Act 1982 S.9 (2) (h)]

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3.1 Confirmation of Minutes of the Hospital Advisory Committee meeting held on 19th September 2012

Recommendation: That the Minutes of the Hospital Advisory Committee meeting held on 19th September 2012 be approved.

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Minutes of the meeting of the Waitemata District Health Board

Hospital Advisory Committee

Wednesday 19 September 2012

held at Waitemata District Health Board Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 10.15a.m

PART I – Items considered in public meeting COMMITTEE MEMBERS PRESENT: Gwen Tepania-Palmer (Committee Chair)

Lester Levy (Board Chair) Pat Booth Sandra Coney Warren Flaunty

Wendy Lai James Le Fevre

Christine Rankin Allison Roe Hasan Bhally (Co-opted Member) Susanna Galea (Co-opted Member) Andrew Jones (Co-opted Member) ALSO PRESENT: Dale Bramley (Chief Executive Officer) Rosalie Percival (Chief Financial Officer) Andrew Brant (Chief Medical Officer) Debbie Holdsworth (Acting Chief Planning and Funding Officer) Jocelyn Peach (Director of Nursing & Midwifery)

Phil Barnes (Director of Allied Health) Sam Bartrum (GM Human Resources) Cath Cronin (GM Surgical and Ambulatory Services)

Linda Harun (GM Child, Women and Family Services) Gerard Lenssen (GM Service Development and Strategic Projects) Helen Wood (GM Mental Health Services) John Cullen (HOD Medical, Surgical and Ambulatory Services) Jeremy Skipworth (Clinical Director, Forensics) Penny Andrew (Clinical Lead Quality)

Paul Garbett (Board Secretary) (Staff members who attended for a particular item are named at the

start of the minute for that item.) PUBLIC AND MEDIA REPRESENTATIVES:

Lynda Williams (Auckland Womens Health Council)

APOLOGIES: Apologies were received from Max Abbott and Rob Cooper. WELCOME: The Committee Chair welcomed those present.

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DISCLOSURE OF INTERESTS There were no additions or amendments to the Interests Register. There were no identified conflicts of interest for the open part of the agenda. 1. AGENDA ORDER AND TIMING

Items were taken in the same order as listed in the agenda, with the public excluded session being held first, from 10.17a.m until 11.45a.m.

2. RESOLUTION TO EXCLUDE THE PUBLIC (agenda page 1)

Resolution (Moved Wendy Lai/Seconded Pat Booth)

That, in accordance with the provisions of Schedule 3, Sections 32 and 33, 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:




1. Confirmation of Public Excluded Minutes – Hospital Advisory Committee Meeting of 08/08/12

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]

Confirmation of Minutes

As per resolution(s) to exclude the public from the open section of the minutes of that meeting, in terms of the NZPH&D Act.

2. Quality 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)]

3. Provider Arm Performance 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]


4. Medication Safety Strategy Update

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

Privacy The disclosure of information would not be in the public interest because of the greater need to

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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]

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

5. HR Update 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)]

Negotiations

The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.[Official Information Act 1982 S.9 (2)(j)]

6. Eligibility 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]


7. Facilities 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]

Commercial Activities

The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out , without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)]

Negotiations

The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.[Official Information Act 1982 S.9 (2)(j)]

Carried 10.17a.m to 11.45a.m – public excluded session 11.45a.m – the Committee resumed in open meeting.

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3. COMMITTEE MINUTES

3.1 Confirmation of the Minutes of the Meeting of the Hospital Advisory Committee held on 8 August 2012 (agenda pages 3-12) Resolution (Moved Sandra Coney/Seconded Susanna Galea) That the minutes of the meeting of the Hospital Advisory Committee held on 8 August 2012 be approved. Carried Matters Arising No issues were raised.

4. PROVIDER ARM PERFORMANCE REPORT

4.1 Provider Arm Performance Report – July 2012 (agenda pages 13-76)

Provisional performance results for August 2012 were tabled and circulated at the meeting. Andrew Brant and Rosalie Percival introduced the report (and the August update), highlighting:

• The financial results (overall the organisation is back in surplus for August) and the work underway in the Provider Arm for each service to provide plans for ensuring expenditure will be within budget for 2012/13. Mitigation plans will be brought to Audit and Finance Committee meetings, with two Divisions to report to the October meeting and two to the November meeting.

• The very good results against health targets. • Elective surgery volumes had been low in July but had risen in August to be

104% against target at the end of August. • Inter District flows – acute inflows had increased, while acute outflows had

reduced. Matters covered in discussion and response to questions included:

• Auckland DHB IDF inflows have increased, but with the increase not coming from Waitemata DHB. The new agreement with Auckland DHB is in place for 2012/13, whereby Waitemata DHB will only fund up to a fixed cap for IDFs, so that the cost of any over-delivery will be met by Auckland DHB.

• It was noted that elective volumes are up, but elective WIES is down. • With the adverse financial result for Clinical Supplies, an issue had been the

latest version of Oracle. There had not been correct checking of invoices. The question now was how to get the right process for reconciliations in place.

• With inventory management, there was scope for substantial improvement in standardisation and classification of purchases. Good systems are available and are being assessed for the Elective Surgery Centre, but it is more difficult to introduce them where there are existing processes. John Cullen advised that currently there are surgeon specific and procedure specific sets of instruments and they are trying to rationalise that.

• Dale Bramley advised that with regard to Maori and Pacific DNAs (did not attend appointments) each Division had been allowed to select the approach

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they considered most likely to be effective, although all had included phoning patients. Results over the next few months would determine whether to continue with separate approaches by Division or whether there should be a common approach.

Surgical and Ambulatory Services Cath Cronin (General Manager, Surgical and Ambulatory Services) and John Cullen (Head of Division, Medical, Surgical and Ambulatory Services) were present for this section of the report. Matters covered included:

• Information concerning the draft IANZ audit report on Breastscreen Waitemata Northland and the corrective actions required will be brought to the next Committee meeting.

• With financial performance, the clinical supply costs are a major challenge. There seems to be a major disconnect with work done and clinical supply costs and it is important to identify why. There is no IT system or even a normal inventory to monitor. Therefore a basic personnel intensive approach will be used to address the issue, involving stock takes and assessing what is needed for each week. Work is also underway on personnel costs.

Medicine and Health of Older Peoples Services Jonathan Christiansen (Head of Department - Medical) and Tamzin Brott (Head of Division, Allied Health, Medicine and Health of Older Peoples Services) introduced this section of the report. Matters they noted included:

• Improvement in the DNA (did not attend appointments) rate. • Performance against the shorter stays in ED target for August had reached

97.1%, which was exceptional considering the heavy late winter hospital occupancy rate.

• The average turnaround time for responses to complaints for August had reduced to 14 days.

• With financial performance, the division was looking at supply chain, streamlining processes and reducing the number of people involved in ordering supplies. A savings plan for the division had been delivered to the Chief Executive.

The Board Chair expressed appreciation of the excellent results for the target of length of stay in ED at a time of increased volumes of hospital admissions. The Committee supported his suggestion that he write a letter of appreciation to acknowledge that achievement. In answer to a question, Andrew Brant confirmed that at the time emergency department services had opened at Waitakere Hospital it had been emphasised that cases of high acuity and those involving intensive care would need to transfer from Waitakere Hospital to North Shore Hospital and a number of protocols were put in place concerning transfers. The Board Chair noted that this information might need to be conveyed to the newspapers again and requested information for Board members on the number of presentations at Waitakere Hospital ED and the number of those that had been referred across to North Shore Hospital. It was noted that the oldest wards 14 and 15 had re-opened after refurbishment and looked very good and that the Kingsley Mortimer Unit refurbishment would begin in the following couple of weeks.

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Child, Women and Family Services Linda Harun (General Manager, Child, Women and Family Services), and Tim Jelleyman (HOD Medical, Child, Women and Family Services) were present for this section of the report. Linda Harun introduced two representatives from CYFS: Lui Pio and Megan Halbert, who were welcomed to the meeting. Linda Harun highlighted some key points including:

• Gynaecology elective surgery rates for August had improved, at 116% of target.

• A significant decrease in the DNA rate. At times they had been able to assist with transport issues and they are hoping to work more closely with the Waipareira Trust.

• Financial performance results had not been good; however they had a plan to resolve that and were working towards it.

• Feedback received from credentialing of paediatricians (detailed on page 46 of the agenda).

Tim Jelleyman advised that the Rangatira Ward, which had re-opened at the start of winter, had experienced good winter use and is much appreciated by families and staff. In answer to a question Tim Jelleyman advised that if there is no Resident Medical Officer cover for a shift, Senior Medical Officer cover is used. Linda Harun advised that the transition to a paperless clinical record system for Home Care for Kids (page 47 of the agenda) involves team members taking small laptops when they visit children in their homes. She would provide more information on the change, perhaps in the next report. The Committee Chair expressed concern at PHO under performance with Before School Checks (page 43 of the agenda). Linda Harun advised that this was being monitored and Debbie Holdsworth noted that there is currently an RFP to re-tender that service. The Committee Chair acknowledged Liu Pio and Megan Halberd of CYFS and said that it was good to see working relationships being demonstrated. Mental Health and Addiction Services Helen Wood (General Manager, Mental Health Services) highlighted aspects of the report including:

• Shorter waits in Emergency Department target – the Division is auditing breaches fairly intensively now, but still struggling to get to the 95% target. Audit of the previous three months showed that of 31 cases that failed to meet the target, 26% of those cases had needed to stay in ED. Only four breaches related to waiting for a bed. After hours delays remained an issue.

• The significant focus on overtime at present (detailed on page 52 of the agenda).

• Whereas the District Health Board generally has a pattern of significant winter demand, this year Mental Health had noticed an early spring influx. Occupancy had reached its highest level for the year and there had been a significant increase in referrals. More detail would be provided in the next HAC agenda.

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• Child and Youth initiatives are on track. • The visit by the Canadian and New Zealand Mental Health Commissioners to

Cultural Teams, when some of the services to Maori had been profiled. There is an increasing outreach to maraes.

• The focus on the major business cases for Taharoto and the Mason Clinic. The latter will come to the Board in December, a month later than previously hoped for.

• The courts are extending their hours, which may require an increase in resources.

• Work related to Suicide Prevention Guidelines (detailed on page 57 of the agenda). New guidelines are expected from the Ministry of Health. There are concerns about clusters of suicides and some concerns about texting.

Matters covered in discussion and response to questions included:

• With regard to assaults, the training approach has changed over the last few years, with the emphasis on de-escalation and how to respond to someone in a highly agitated state. The suggestion made at the meeting of training in the defensive techniques of Aikido could be looked at.

• The Committee Chair advised that she had received good positive feedback about the work that is being done for Maori by Mental Health, particularly marae based.

• Helen Wood advised that her work at Auckland DHB had shown both commonalities and differences in Mental Health. The first joint clinical governance workshop had been held two weeks previously. There were many things that they could collaborate on. Susanna Galea confirmed how successful and useful the joint workshop had been.

Provider Arm Support Services Phil Barnes and Rosalie Percival and were present for this section of the report. Items highlighted included:

• The cleaners had greatly appreciated the letter of thanks from the Committee Chair for their work during the norovirus outbreak and the Chief Executive thanking them personally.

• The backlog with clinical typing had improved a little but was still well behind timelines. Outsourcing has a higher cost but also produces higher productivity. Phil Barnes expected to report back regularly to the Committee on this issue.

• The collaboration project with Auckland DHB looking at telephony and call centres is making reasonable progress.

• The Finance collaboration project with Auckland DHB is proceeding well, with a number of workshops having taken place. COGNOS budget tools are being implemented at Auckland DHB. They were also looking at how collaboration could occur with master site and facilities planning.

The report was received.

5. CORPORATE REPORTS

5.1 Clinical Leaders’ Report (agenda pages 77-79)

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Andrew Brant (Chief Medical Officer), Jocelyn Peach (Director Nursing & Midwifery) and Phil Barnes (Director Allied Health) were present for this item. Phil Barnes referred to the trial of iPad/Tablet technology for Community Dieticians later this year. He noted that it is important to think laterally about ways of making community services more efficient. Jocelyn Peach highlighted the successful launch by Jean McQueen, Clinical Nurse Director of Primary Care, of a new wound care programme which supports general practice to manage complex wounds. She also noted the intake of thirty new graduate nurses starting the September 2012 programme. In answer to a question, Dale Bramley commented on the work of Awhina in assisting staff making grant applications for research. He noted that of four HDC major grants announced recently, three involved Waitemata DHB staff. There was a discussion of the positive role Awhina plays in supporting research, including the database of journal publications by staff. A request was made for a report on the Trendcare Project to the next meeting.

5.2 Human Resources (agenda pages 80-95) Sam Bartrum (Director - Human Resources) introduced the report and highlighted:

• The Customer Service Programme for Clerks and Administrators. • The new leadership development programme ‘Mobilising Nurse Leadership’. • Analysis of exit interviews – confirmed some areas that needed to be worked on

and basically reflected what people had said in the Staff Satisfaction Survey. The report was received.

7. INFORMATION PAPERS 7.1 Elective Services Update (agenda pages 96-98)

The report was received without any issues being raised.

The Committee Chair thanked those involved in the meeting. She spoke of how far the organisation had come in the previous three years The meeting concluded at 1.11p.m. SIGNED AS A CORRECT RECORD OF THE WAITEMATA DISTRICT HEALTH BOARD HOSPITAL ADVISORY COMMITTEE MEETING OF 19 SEPTEMBER 2012

______________________________________________________ CHAIR

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Actions Arising and Carried Forward from Meetings of the Hospital Advisory Committee

as at 27 September 2012

Meeting Agenda Ref

Topic Person Responsible

Expected Report Back

Comment

HAC 27/6/12 08/08/12 19/09/12

4.1 Provider Arm Performance Report: - Mental Health Blueprint II – discussion of implications to be arranged for HAC. - Information to be provided on draft IANZ report on Breastscreen Waitemata Northland and the corrective actions required. - Information to be provided on number of presentations to Waitakere Hospital ED and number of high acuity patients transferred to North Shore Hospital.

Helen Wood Cath Cronin Andrew Brant

HAC 31/10/12

HAC 19/09/12

5.1 Clinical Leaders Report : - report on Trendcare Project to be provided to the next meeting.

Jocelyn Peach

HAC 31/10/12

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Waitemata DHB Hospital Advisory Committee Meeting 31/10/12

4.1 Provider Arm Performance Report – September 2012 Recommendation: 1. That the report be received. 2. That the Committee notes the updates to the report to reflect the 2012/13 new

measures and commitments. ___________________________________________________________________________ Prepared by: Rosalie Percival (Chief Financial Officer) and Andrew Brant (Chief Medical Officer) This report summarises the Provider arm performance for September 2012.

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Provider Arm Performance Report

Table of Contents

Glossary

Executive summary

Scorecard

Health Targets

Financial Performance

Human Resources

Divisional Reports

- Surgical and Ambulatory services

- Medicine and Health of Older people services

- Child, Women and family services

- Mental Health and Addiction services

- Provider Arm support services

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Glossary ACC Accident Compensation Commission

ADU Assessment and Diagnostic Unit

ARDS Auckland Regional Dental Service

BT Business Transformation

CADS Community Alcohol, Drug and Addictions Service

CAMHS Child, Adolescent Mental Health Service

CME Continuing Medical Education

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

iFOBT Immuno Faecal Occult Blood Test

MHSG Mental Health service group

MoH Ministry of Health

MTD Month To Date

MOSS Medical Officer Special Scale

NSH North Shore Hospital

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 (method for measuring relativity between

medical and surgical discharges)

WRE Work Related Expenses

WTH Waitakere Hospital

YTD Year To Date

Information to assist with understanding the scorecard:

For each measure the green bar reflects how well we are doing against the target for the period (ie.

September 2012), the arrow reflects progress compared to last period (ie. compared to August

2012). Where the current month's result is still meeting target but performance has decreased

compared to last month, a dash is used.

The progress green bar is weighted for each measure based on the degree of concern of any short

fall in meeting the target. The analysts within each service have provided an initial estimate of the

weighting for each measure based on prior performance; however this element of the scorecard is

still work in progress for some of the measures. For example, this weighting is noticeable for Elective

Volumes where the scale is very sensitive so that any variance is deemed to be significant. If

performance is achieving or better than target, the bar will display as a solid green line.

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Executive Summary / Overview

Overall assessment

There has been a major turnaround in September with the Provider arm returning to surplus of

$146,000 for the month and reducing the year to date variance. The Provider arm delivered a

surplus of $2.044M against a budgeted surplus of $3.343M year to date (YTD) to September 2012.

The $1.299M unfavourable financial performance was primarily driven by expenditure overall being

adverse to budget by $4.478M, with $3.179M of this adverse cost being offset by additional revenue

realised. The unfavourable Provider position was fully offset by the $1.734M favourable

performance in the Funder and Governance & Admin arms. This resulted in a consolidated DHB

result favourable to budget by $485k YTD. Overall the DHB is on track to achieve the full year

planned surplus of $2M.

Additional funding relates to unbudgeted contracts (with corresponding unbudgeted costs), funding

to offset greater than budgeted cancer treatment drugs and additional interest income. Adverse

expenditure was realised in all other cost categories except infrastructure costs. Personnel cost

pressures affected all clinical staff areas as well as management and admin staff. Clinical supplies

costs were particularly high for the July and August months but are close to budget for September.

At service group level, key contributors to the Provider adverse position YTD remain Surgical &

Ambulatory services ($875k adverse) and Medicine & Health of Older People ($1.791M adverse).

These were partially offset by favourable financial results in Mental Health and Provider Support

services. Key drivers for these variances to budget are provided under the respective service sections

in this report.

A review of Provider arm 2012/13 budgets has been undertaken to ascertain the potential

underlying budget issues and in response to the significantly adverse Provider position for the first

two months of the year. Outcomes of these reviews (and ongoing reviews) will be used in preparing

year end financial forecast for the Provider arm. This will also inform the budget preparation for

2013/14. Savings initiatives to address any identified underlying budget issues will be added to the

Business Transformation programme to ensure the planned $2M surplus for the entire organisation

is achieved.

Service Delivery

Health Targets We have maintained our performance against the three health targets, better support for smokers

to quit (95.6%), elective volumes (104.4%) and shorter wait times in the emergency department

(95.9%). We have also maintained out ESPI compliance for September.

Did not attend rates Our overall performance has improved to 8.9% for September, and for Maori (16.1%) and Pacific

peoples (13.7%). Services are continuing to focus on longer term strategies to decrease the rate for

Maori and Pacific people. For example a fracture clinic is to be held at Waitakere Hospital due to the

increased DNA rates of people from Waitakere to the North Shore fracture clinic.

16 of 94


Scorecard

Health Targets Actual Target Productivity Actual Target

Better help for smokers to quit 95.6% 1 0 95.0% �� ESPI 2 - % patients waiting > 6 months for FSA 0.0% 1 0 0.0% ��

Provider Arm Elective Volumes 104.6% 1 0 100.0% �� ESPI 5 - % patients not treated within 6 months 0.0% 1 0 0.0% ��

Shorter Waits in ED 95.9% 1 0 95.0% �� Elective Surgical Day case rate % 59.0% 1 0 60.0% �

Patient Flow

Average Length of Stay - Acutes 3.80 1 0 3.50 �

Average Length of Stay - Electives 4.10 1 0 3.82 �

Quality Actual Target Discharges before 11am* 16% 1 0 20% �

Complaint Turnaround Time 18 days 1 0 14 days � Discharges during weekends 22% 1 0 20% �

Complaint Volume per 1000 occupied bed days 2.30 0 1 TBC �

Hospital acquired blood stream infections per 1000 occupied bed days 0.00 0 1 TBC � Contracts (YTD)

HDC Complaint Volume per 1000 occupied bed days 0.25 0 1 TBC � Elective WIES Volumes 4,091 1 0 4,149 �

Falls per 1000 occupied bed days 3.20 0 1 TBC � Acute WIES Volumes 13,496 1 0 12,949 �

SAC1 Reportable Event Volume per 1000 occupied bed days 0.04 0 1 TBC �

SAC2 Reportable Event Volume per 1000 occupied bed days 0.11 0 1 TBC � Non-Case weighted Discharges

Incident Volume per 1000 occupied bed days 25.00 0 1 TBC � First Specialist Assessment (FSA) 8,909 1 0 9,469 �

Subsequent Attendance (FUP) 20,664 1 0 18,700 �

Emergency presentations (admitted) 12,031 1 0 11,754 �

DNA Rates Emergency presentations (non-admitted) 11,822 1 0 15,178 �

DNAs as % of OP presentations - Total 8.9% 1 0 10.0% �

DNAs as % of OP presentations - Maori 16.1% 0 1 10.0% �

DNAs as % of OP presentations - Pacific 13.7% 1 0 10.0% �

Other Key Measures

Acute Readmission Rate within 28 days * not avail 0 1 10.2% �

* Note: this is the Ministry's quarterly result

HR Wellbeing Actual Target

Sick Leave Rate (days) * 8.5 days 1 0 7.5 days ��

Overtime Rate (%) * � 1.0% 1 0 1.0% ��

Annual Leave Balance > 75 days 65 1 0 58 ��

Turnover Rate % * 9.9% 1 0 10.0% �

Clinical Employ (FTE) 4,321 FTE 1 0 �

* 12 month rolling average � this does not include mental health services

Financial Result YTD Actual $000s Target $000s

Revenue 181,409 k 1 0 178,230 k �

Expense 179,365 k 0 1 174,887 k �

Personnel Costs 120,205 k 1 0 118,882 k �

Outsourced Services 12,887 k 0 1 10,941 k �

Clinical Supply Costs 22,726 k 0 1 20,743 k �

Non-Clinical Supply Costs 23,547 k 1 0 24,321 k �

Contribution 2,044 k 1 0 3,343 k �

Accrued FTE 5,515 FTE 1 0 5,610 FTE �

Capital Expenditure 10,973 k 0 1 17,844 k �

Waitemata DHB Monthly Performance ScorecardALL ServicesSeptember 2012

Service Delivery

Human Resources

Quality

Finance

Priority One

17 of 94


Health Targets

Better Help for Smokers to Quit

50%

60%

70%

80%

90%

100%

7 J

an

14

Ja

n2

1 J

an

28

Ja

n4

Fe

b1

1 F

eb

18

Fe

b2

5 F

eb

3 M

ar

10

Ma

r1

7 M

ar

24

Ma

r3

1 M

ar

7 A

pr

14

Ap

r2

1 A

pr

28

Ap

r5

Ma

y1

2 M

ay

19

Ma

y2

6 M

ay

2 J

un

9 J

un

16

Ju

n2

3 J

un

30

Ju

n7

Ju

l1

4 J

ul

21

Ju

l2

8 J

ul

4 A

ug

11

Au

g1

8 A

ug

25

Au

g1

Se

p8

Se

p1

5 S

ep

22

Se

p2

9 S

ep

6 O

ct1

3 O

ct2

0 O

ct2

7 O

ct3

No

v1

0 N

ov

17

No

v2

4 N

ov

1 D

ec

8 D

ec

15

De

c2

2 D

ec

29

De

c

Pe

rce

nta

ge

of

smo

kers

off

ere

d in

terv

en

tio

n

Week ending

Smoking Intervention Offered - Weekly Results

WDHB Total Target

18 of 94


Shorter Stays in Emergency Departments

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

7 J

an

14

Ja

n2

1 J

an

28

Ja

n4

Fe

b1

1 F

eb

18

Fe

b2

5 F

eb

3 M

ar

10

Ma

r1

7 M

ar

24

Ma

r3

1 M

ar

7 A

pr

14

Ap

r2

1 A

pr

28

Ap

r5

Ma

y1

2 M

ay

19

Ma

y2

6 M

ay

2 J

un

9 J

un

16

Ju

n2

3 J

un

30

Ju

n7

Ju

l1

4 J

ul

21

Ju

l2

8 J

ul

4 A

ug

11

Au

g1

8 A

ug

25

Au

g1

Se

p8

Se

p1

5 S

ep

22

Se

p2

9 S

ep

6 O

ct1

3 O

ct2

0 O

ct2

7 O

ct3

No

v1

0 N

ov

17

No

v2

4 N

ov

1 D

ec

8 D

ec

15

De

c2

2 D

ec

29

De

c

% o

f E

D p

ati

en

ts d

isch

arg

ed

wit

hin

6 h

ou

rs

Week ending

ED % 6 Hour Health Target Compliance

Target

WDHB

Emergency Department Presentations

1,000

1,200

1,400

1,600

1,800

2,000

2,200

2,400

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

Pre

sen

tati

on

s

Calendar Weeks

WDHB ED Presentations

Calendar Years from 01 Jan 2008 to 06 Oct 2012

2008 2009 2010 2011 2012 Mean from Aug 2010

19 of 94


ESPI Compliance

As of 30 September 2012, no patients were waiting greater than 180 days for their first specialist assessment

(ESPI 2) or subsequent treatment (ESPI 5):

ESPI 2 Number > 180 days ESPI 2 %

Anaesthesiology 0 0%

Cardiology 0 0% Dermatology 0 0% Diabetes 0 0% Endocrinology 0 0% Gastroenterology 0 0% General Medicine 0 0% General Surgery 0 0% Gynaecology 0 0% Haematology 0 0% Infectious Diseases 0 0% Neurology 0 0% Oncology 0 0% Orthopaedic 0 0% Otorhinolaryngology 0 0% Paediatric MED 0 0% Renal MED 0 0% Respiratory Medicine 0 0% Rheumatology 0 0% Urology 0 0% Overall 0 0%

ESPI 5 Number > 180 days ESPI 5 %

Cardiology 0 0%

General Surgery 0 0%

Gynaecology 0 0%

Orthopaedic 0 0%

Otorhinolaryngology 0 0%

Urology 0 0%

Overall 0 0%

20 of 94


Improved Access to Elective Surgery

0

1000

2000

3000

4000

5000

6000

7000

8000

9000

10000

11000

12000

13000

14000

15000

16000

Ele

ctiv

e s

urg

ica

l d

isch

arg

es

Week ending

Progress against Elective Surgery Target (2012/13)

Total Target Total Estimated

Estimated WDHB provided WDHB Provided Target

The Provider performed at 104.6% against contracted volumes in the first quarter of 2012/13. Major joint

replacement is improving and is at 89.4% of contracted volume.

Elective Performance: Zero Patients Waiting Over 6 Months

The Provider has attained ESPI compliance for September although this needs to be confirmed by the MoH later

this month. Therefore no one was waiting over six months for their FSA or elective surgery over the first quarter.

21 of 94


Financial Performance

ALL Services

CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Sep-12

Provider

($000’s)

Actual Budget Variance Actual Budget Variance Forecast Budget Variance

REVENUE

Government

and Crown

Agency

58,416 57,535 881 175,914 172,604 3,310 692,965 692,965 0

Other Income 1,669 1,875 (207) 5,495 5,626 (131) 22,533 22,533 0

Total Revenue 60,085 59,410 675 181,409 178,230 3,179 715,498 715,498 0

EXPENDITURE

Personnel

Medical 11,054 11,407 353 34,537 34,193 (344) 139,338 139,338 0

Nursing 15,092 14,793 (299) 46,007 45,244 (763) 185,052 185,052 0

Allied Health 7,554 7,693 139 23,540 23,421 (119) 96,380 96,380 0

Support 983 1,205 222 2,888 3,264 376 14,677 14,677 0

Management /

Administration4,260 4,254 (6) 13,233 12,760 (473) 52,225 52,225 0

38,942 39,352 410 120,205 118,882 (1,323) 487,672 487,672 0

Other Expenditure

Outsourced

Services4,462 3,649 (813) 12,887 10,941 (1,946) 43,792 43,792 0

Clinical Supplies 7,271 6,952 (319) 22,726 20,743 (1,983) 85,398 85,398 0

Infrastructure

& Non-Clinical

Supplies

7,913 8,107 194 23,547 24,321 774 97,636 97,636 0

19,647 18,708 (939) 59,160 56,005 (3,155) 226,826 226,826 0

Total Expenses 58,589 58,060 (529) 179,365 174,887 (4,478) 714,498 714,498 0

Contribution 1,496 1,350 146 2,044 3,343 (1,299) 1,000 1,000 0

Allocations (0) (0) 0 (0) (0) 0 0 0 0

NET RESULT 1,496 1,350 146 2,044 3,343 (1,299) 1,000 1,000 (0)

FULL YEARMONTH YEAR TO DATE


Provider

($000’s)


CONTRIBUTION

Surg & Ambulatory 915 655 260 963 1,838 (875) 4,190 4,190 0

Medical & HOPS 6,983 7,113 (130) 19,245 21,036 (1,791) 80,155 80,155 0

Child Women F. 3,256 2,977 279 8,577 8,817 (240) 35,568 35,568 0

Mental Health 3,453 3,129 324 9,627 9,016 611 33,389 33,389 0

Provider Support (13,111) (12,524) (588) (36,367) (37,363) 996 (152,302) (152,302) 0

Total Contribution 1,496 1,350 146 2,044 3,343 (1,299) 1,000 1,000 0

MONTH YEAR TO DATE FULL YEAR

CONSOLIDATED STATEMENT OF PERSONNEL by PROFESSIONAL GROUP Reporting Date Sep-12

Provider

($000’s)


FTE

Medical 644 639 (5) 612 639 27 651 651 0

Nursing 2,577 2,390 (187) 2,446 2,437 (9) 2,492 2,492 0

Allied health 1,452 1,445 (7) 1,425 1,466 40 1,508 1,508 0

Support 281 327 47 262 294 32 333 333 0

Management 783 783 (1) 770 774 4 781 781 0

Total FTE 5,737 5,584 (153) 5,515 5,610 94 5,765 5,765 0


22 of 94


Comment on Major Variances Revenue Provider arm revenue was favourable for the month ($675k) and YTD ($3.179M). Additional revenue was realised

mainly for the bowel screening project ($924k received from the Funder with matching costs), revenue to cover

cancer treatment drug costs ($478k), HPV ($84k), Smokefree project ($56k), Additional Electives ($225k),

Maternity Quality and Safety Programme ($68k), various Service Level Agreements with the funder, CEO

initiatives and additional interest income.

Expenditure Expenditure for the Provider arm was overall unfavourable for the month ($529k) and YTD ($4.478M). Key drivers

for this include:

• Expenditure associated with additional income streams noted above.

• Greater than planned personnel costs mainly in Nursing staff (due to higher than planned levels of sick leave,

increased constant observations and the impact of Norovirus in several wards in July and August, backfilling

for maternity and other leave); Medical staff (reflecting greater than planned allowances including for

additional clinics, leave cover and working without registrar support, superannuation costs, CME/WRE costs,

revaluation of staff leave balances due to payroll errors stretching back two financial years); Management &

Admin staff (includes miscoded support staff, unrealised savings expected later in the year, budget phasing

issues expected to correct by October); and Allied Health staff (driven by overspend in allowances and

overtime for Radiology, Breast screening and Anaesthetic technicians). Measures have been put in place for

replacement of vacant positions, cover for unplanned leave and use of bureau staff to manage personnel

costs down.

• Outsourced services costs were unfavourable mainly due to outsourced staff to cover vacancies and

unbudgeted outsourced ultrasounds.

• Clinical Supplies costs were adverse mainly driven by cancer treatment drugs, clinical depreciation greater

than planned, theatres overspend on treatment disposables and supplies for home based older adult services.

Costs also reflect delayed invoices for prior year supplies and miscoding issues in Surgical Services clinical

supplies.

• These were offset by favourable movements in infrastructure costs mainly due to less than planned interest

costs.

Business Transformation The approved 2012/13 DAP includes Business Transformation savings of $12M (Provider arm ($5.401M) and

Funder arm ($6.599M)). The full quarter savings target of $2.648M was achieved as summarised below:

Initiatives

Full Year Actual

$’000s

Budget

$’000s

Variance

$’000s

Cardiology Services Review 75 19 19 0

WIES Based Savings Initiative 1,000 250 250 0

Café in house 350 0 0 0

Orderly services in-house 100 18 18 0

Transcription Services - outsourcing services 500 0 125 (125)

Reviewing Contracting Service delivery 2,700 675 675 0

Pharms Reviewing & Refining costs model 2,899 725 725 0

Paediatrics SMOs - business case review 200 (175) 50 (225)

Dental Staffing - business case review 1,076 321 269 52

Inventory Management, Clinical Supplies & Outsourced 430 136 108 28

Legal expenditure review, Infrastructure costs, Patient Flow

Project, Staff Optimisation and Models of Care reviews 1,554 731 389 269

Treasury Management & Other Income Streams 1,116 22 22 0

Total 12,000 $2,648 $2,648 0

23 of 94


Human Resources

ALL Services Sick Leave

-

2.0

4.0

6.0

8.0

10.0

12.0

Se

p-2

01

0

No

v-2

01

0

Jan

-20

11

Ma

r-2

01

1

Ma

y-2

01

1

Jul-

20

11

Se

p-2

01

1

No

v-2

01

1

Jan

-20

12

Ma

r-2

01

2

Ma

y-2

01

2

Jul-

20

12

Se

p-2

01

2

Sick Leave Rate (days per fte)

Trends

The September 2012 result shows a decrease to the monthly sick leave rate, but remains at over

3.5%. The decrease in this period is in line with the annual patterns throughout winter and this

result is better than last year’s result. The annual usage has been impacted as a result of higher

usage over the recent winter period and is currently 8.5 days per employee.

Highlights/risks

The decrease in the use of sick leave in September 2012 is encouraging. This follows two months

where the rate was higher than anticipated which was related to the impact of the virus which

affected both Medicine and Health of Older People Services and Mental Health Services.

Planned Actions

Close monitoring of the sick leave usage rate is occurring at team level. Investigation into regional

reporting options to provide further information to managers on patterns and clusters of sick leave

by individual is continuing. Overtime

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

Se

p-2

01

0

No

v-2

01

0

Jan

-20

11

Ma

r-2

01

1

Ma

y-2

01

1

Jul-

20

11

Se

p-2

01

1

No

v-2

01

1

Jan

-20

12

Ma

r-2

01

2

Ma

y-2

01

2

Jul-

20

12

Se

p-2

01

2

Overtime Rate (% total hours)

24 of 94


Trends

The September result shows a small increase in the rate of overtime (less than 1.5%) on the previous

month. The annual result has been sustained at 1.6%.

Highlights/risks

There has been a significant improvement in overtime over the last two months and this has been

achieved at the same time as the organisation has experienced a sustained substantial use of sick

leave.

Planned Actions

Human Resources will review the results going forward at service level to identify any changes in

services which are not affected by increases in the sick leave usage rate.

Annual Leave Management

Trends:

The Annual Leave rate remains favourable; most staff are taking around 25 days annual leave per

year. The number of employees with an annual leave balance of over 75 days has remained static at

65.

Planned Actions:

Ongoing HR support and monitoring, concerning active leave management planning.

Staff Retention

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

14.00%

16.00%

Se

p-2

01

0

De

c-2

01

0

Ma

r-2

01

1

Jun

-20

11

Se

p-2

01

1

De

c-2

01

1

Ma

r-2

01

2

Jun

-20

12

Se

p-2

01

2

Voluntary Turnover Rate (% total employ)

25 of 94


Staff Resignations within 6 months

0

2

4

6

8

10

12

14

16

Se

p-2

01

0

De

c-2

01

0

Ma

r-2

01

1

Jun

-20

11

Se

p-2

01

1

De

c-2

01

1

Ma

r-2

01

2

Jun

-20

12

Se

p-2

01

2

Staff Resignations within 6 mths (headcount)

Turnover

Trends

The monthly annual turnover continued to decrease in the September period and the annual result

is currently within the target of 10%

Highlights/risks

The leavers within six months in September were spread. Each instance has been reviewed at team

level.

Planned Actions

All employees leaving within one year of service continue to be provided with an exit interview in

person, rather than electronic.

26 of 94


Surgical and Ambulatory Services

This Division provides elective and acute surgery to our community encompassing surgical specialties

such as general surgery, orthopaedics, otorhinolaryngology and urology, and includes outpatient

clinics, operating theatres and pre and post-operative wards. The service is managed by Cath

Cronin. The Head of Division Medical is John Cullen, Acting Head of Division Nursing is Kate Gilmour

and Head of Division Allied Health is Tamzin Brott.

Scorecard

Health Target Better help for smokers to quit – achieved above target again this month at 96.7% and ward staff

remain committed to achieving this target.

Over 2012/13 the Government is introducing new waiting time indicators for diagnostics. The

waiting time indicator is for 75% of accepted referrals for CT and MRI scans to receive their scan

within 6 weeks (42 days). We are currently sitting at 81% for CT and 55% for MRI.

These are not performance measures for 2012/13 but rather over the year the focus is to collect

wait-time information, support DHBs to identify valid data and set appropriate achievement levels

for introduction of the performance standard in following years.

Elective Surgery Volumes

The elective volume is showing performance to 102% for the first quarter.

ESPI Compliance

Surgical services continue to maintain 100% compliance for FSA (ESPI 2) and treatment within 6

months (ESPI 5).

November and December will be challenging months, particularly in Orthopaedics in terms of the

volume of patients requiring surgery who will have been on the waiting list for 6 months. This is a

direct result of the increased number of FSAs performed in May and June to meet ESPI compliance

and secure the MoH monetary incentive at year end. A plan is in place to manage this peak in

demand.

Waiting times are to further reduce to 5 months by 31 June 2013; work is underway to achieve this

and is evident as a target we can meet in gynaecology, ORL and urology. Work continues in

orthopaedics and general surgery.

Shorter Waits in ED Shorter waits in ED is slightly below target this month at 94.1%. This reflects only one or two

patients who did not meet the 6 hour target.

Quality Complaint turnaround time was 19 days in September (17 days for Service alone). This is a slight

improvement compared to last month’s result of 20 days.

The service continues to receive compliments for the month and a number of these compliments are

noting positive interactions, communication and a high standard of care from the team.

27 of 94


Human Resources John Cullen has been appointed as Director, Elective Surgery Centre.

Mark Watson has been appointed as Group Manager, Elective Surgery Centre.

Kay Hogan has resigned from her position as Nursing Head of Division S&AS. Kate Gilmour is acting

Nursing HOD until the role is replaced.

Sue French has been appointed in the role of Faster Cancer Tracker. This is the first role appointed

at Waitemata DHB as part as funding made available for Cancer Nurse Co-ordinators and the Faster

Cancer Treatment Initiative.

Jean Bothwell, Urology CNS won the best paper award at the New Zealand Urological Society

National Conference held in September. This is the third time Jean has won this National prize,

making her the only person in awards history to achieve this honour.

Recruitment for the intensive care unit (ICU) Outreach service expansion has seen the appointment

of four new outreach registered nurses. The expanded ICU Outreach service will provide new cover

on all afternoon shifts at both the NSH and WTH sites. New staff will complete a customised ten

week training programme with the commencement of the extended cover on the NSH site expected

in mid December. Cover at Waitakere will start in the New Year.

Service Delivery Surgical WIES is above target September YTD as planned to optimise opportunities to backfill

elective lists and allow for optimal decrease in activity over January for annual leave and to realign

theatre costs.

There has been improvement this quarter in both acute and elective length of stay (LOS). Average

length of stay for elective was 3.8 against a target of 3.9 and acute 4.2 - steadily improving

performance against 4.5 days for July.

The national BreastScreen Aotearoa (BSA) target is 70%. The NSU BSA coverage by lead provider by

ethnicity for the 24 months to 31 July 2012 for Maori was 69.5%; Pacific at 78.6%; Other at 69.9%;

and Total coverage was 70.3%. The BreastScreen Waitemata Northland (BSWN) performance target

is to achieve 70% equitable coverage and to deliver a minimum of 40,000 screens for the period 1

July 2012 to 30 June 2013.

Screening numbers for the quarter ending 30 September 2012 are set out in the table below.

Period

Maori

Pacific

Other

Total

July 391 167 2655 3213

August 345 165 2962 3472

September 352 162 2755 3269

Quarter One 1088 494 8372 9954

Equipment failure at fixed clinics; connectivity issues on mobile services; and reduced staffing levels

(MRTs) have impacted on performance targets this quarter (approximately 1000 fewer screens).

Steps are being taken to manage identified issues across the BSWN service.

28 of 94


A plan is being developed to enable the BSWN service to increase screening numbers and meet

performance targets. Achieving equity and managing workforce issues (MRT shortages) will be

priority areas of focus moving forward.

Radiology, in collaboration with Cardiology, has support from the Audit & Finance Committee for

Board approval for purchase of a ceiling mounted angiography machine to be installed in cardiology

and relocating the existing cardiology floor mounted angiography machine into the new

Interventional Radiology suite on the 1st Floor North Shore Hospital.

Area of Focus – DNA Rates DNA rates in Surgical and Ambulatory Service is on target this month and total presentations are at

10.3%. Maori DNA rates have decreased from 24.8% to 20.5%. In terms of actual numbers, there

are 99 failed appointments compared to 155 last month. Pacific Island DNA rates have increased

from 18.9% to 19.1%.

Telephone contact prior to booking appointment will continue to occur for both Maori and Pacific

Island patients while long term strategies are explored and implemented. One of the strategies to be

implemented involves relocating a fracture clinic from North Shore to Waitakere to provide services

to Waitakere domiciled patients. An analysis by clinic indicated that there is a higher DNA from

Waitakere domiciled outpatients when the fracture clinic is held at North Shore. It is anticipated

that this change will not only assist in managing waiting room capacity issues at NSH but will also

reduce the outpatient DNAs.

29 of 94


Scorecard


Better help for smokers to quit 96.7% 1 0 95.0% �� Elective Surgical Day case rate % 59.0% 1 0 60.3% �

Provider Arm Elective Volumes * 102.3% 1 0 100.0% �� Elective Day of Surgery Cancellations 1.5% 1 0 2.0% ��

Shorter Waits in ED 94.1% 1 0 95.0% � Theatre utilisation 85.0% 1 0 85.0% �

* excludes gynae % of CT scans within 6 weeks (42 days) 81.0% 1 0 75.0% �

% of MRI scans within 6 weeks (42 days) 55.0% 0 1 75.0% �

Patient Flow

Quality Actual Target Day of Surgery Admission rate (DOSA) 94.0% 1 0 92.0% ��

Complaint Turnaround Time 19 days 1 0 14 days � Average Length of Stay - Acutes 4.2 1 0 4.0 �

Complaint Volume per 1000 occupied bed days 0.63 0 1 TBC � Average Length of Stay - Electives 3.8 1 0 3.9 ��

Hospital acquired blood stream infections per 1000 occupied bed days 0.10 0 1 TBC � Discharges at weekends 9.0% 0 1 20.0% �

HDC Complaint Volume per 1000 occupied bed days 0.04 0 1 TBC � Discharges before 11am 17.3% 1 0 20.0% �

Falls per 1000 occupied bed days 0.32 0 1 TBC �

SAC1 Reportable Event Volume per 1000 occupied bed days 0.00 0 1 TBC � ESPI 2 - % patients waiting longer than 6 months for FSA

SAC2 Reportable Event Volume per 1000 occupied bed days 0.04 0 1 TBC � General Surgery 0.0% 1 0 0.0% ��

Incident Volume per 1000 occupied bed days 3.00 0 1 TBC � ORL 0.0% 1 0 0.0% ��

Orthopaedics 0.0% 1 0 0.0% ��

DNA Rates Urology 0.0% 1 0 0.0% ��

DNAs as % of OP presentations - Total 10.3% 1 0 10.0% �

DNAs as % of OP presentations - Maori 20.5% 0 1 10.0% � ESPI 5 - % of Patients not treated within 6 months

DNAs as % of OP presentations - Pacific 19.1% 0 1 10.0% � General Surgery 0.0% 1 0 0.0% ��

ORL 0.0% 1 0 0.0% ��

Orthopaedics 0.0% 1 0 0.0% ��

Urology 0.0% 1 0 0.0% ��

HR Wellbeing Actual Target Contracts (YTD)

Sick Leave Rate (days) * 7.7 days 1 0 7.5 days � Elective WIES Volumes

Overtime Rate (%) * 1.6% 1 0 1.0% �� Surgery (Overall) 3,278 1 0 3,090 �

Annual Leave Balance > 75 days 10 1 0 9 � General Surgery 1,255 1 0 1,073 �

Turnover Rate % * 9.4% 1 0 10.0% � ORL 315 1 0 297 �

Clinical Employ (FTE) 740 FTE 1 0 � Orthopaedics 1,429 1 0 1,475 �

* 12 month rolling average Urology 279 1 0 245 �

Acute WIES Volumes

Surgery (Overall) 2,990 1 0 3,000 �

Financial Result YTD Actual $000s Target $000s General Surgery 1,644 1 0 1,073 �

Revenue 36,936 k 1 0 35,583 k � Orthopaedics 1,346 1 0 1,435 �

Expense 35,974 k 0 1 33,746 k �

Personnel Costs 24,174 k 1 0 23,642 k � Non-Case weighted Discharges

Outsourced Services 2,426 k 1 0 1,510 k � First Specialist Assessment (FSA) 2,920 1 0 3,570 �

Clinical Supply Costs 7,731 k 1 0 7,093 k � Subsequent Attendance (FUP) 8,593 1 0 7,534 �


Contribution 963 k 1 0 1,838 k �

Accrued FTE 950 FTE 1 0 942 FTE �

Capital Expenditure 186 k 0 1 1,907 k �

Surgical and Ambulatory ServiceSeptember 2012

Service Delivery

Human Resources

Quality

Finance

Priority One

30 of 94


Strategic Initiatives Deliverable /Action On Target

Elective Services Patient Indicator Flow (ESPI) compliance will be

maintained each month through:

• more consistent referral management

• a redesign of booking and scheduling processes

• outsourcing options

• improved productivity.

�

Elective Surgery Centre FSA project “one stop shop” completed –

improving the quality of elective referrals from GPs

�

Continue to use the national CPAC priority scoring tool � Formalised elective agreements will be in place with private elective

providers

�

Commence building of the dedicated purpose-built elective facility

(Elective Surgery Centre) on the North Shore Hospital campus February

2012 to be completed by 2013.

�

Perform 100 Bariatric procedures in 2012/13 with a focus on Māori and

Pacific people

�

Develop and implement a training, education and resource (including a

pain education and management website) programme for patients,

primary care physicians and secondary services based on innovative,

patient specific interventions that rely on stratifying patients to individual,

group based or GP partnership models of care

�

Implement new Outpatient Service model (staffing, booking & scheduling) � * include a � or a �

Key achievements for month:

1. ESPI 2 and 5 compliant

2. Elective surgery productivity 104%

3. Review of clinical supplies commenced and Surgical Inventory Manager role interviewed

4. Two senior roles appointed for the Elective Surgery Centre

5. Planning well underway to allocate theatre schedules for NSH, WTH and ESC

6. Communication plan for all activities related to the ESC rolled out to all staff

Areas off track for month and remedial plans:

Review of the reporting of the GP Skin Lesion volumes is to be undertaken due to currently being

retrospectively reported and therefore may present a risk if volume not completed to meet

health targets

Key issues/initiatives identified in coming months • Daily monitoring of performance to targets and a financial review is underway to ensure health

targets are met and any potential risks to achieving revenue are identified and resolved.

• Project commenced to improve reporting and seek timely data on expenditure for clinical

supplies, both consumables and prosthesis to set up in time ordering, reduce cost of imprest

held in theatre and contain/reduce costs. Currently this data is not available and impacting on

work to contain monthly expenditure to budget.

31 of 94


• Surgical pathway analysis is underway to measure surgical demand/capacity and work to

maintain ESPI compliance with a target to treat patients within 4 months.

• The radiology service has developed a scorecard which will align with the Surgical and

Ambulatory division scorecard in relation to timeliness of access to diagnostics.

• Targeted workforce planning has commenced to recruit a skilled surgical workforce in

anticipation of the ESC opening in July 2013.

• Longer term strategies are being explored to reduce the Maori and Pacific DNA rates.

32 of 94


Financial Results


Surg & Ambulatory

($000’s)


REVENUE

Government

and Crown

Agency

12,378 11,789 589 36,817 35,367 1,450 141,467 141,467 0

Other Income 59 72 (13) 120 216 (97) 866 866 0

Total Revenue 12,437 11,861 576 36,936 35,583 1,353 142,333 142,333 0

EXPENDITURE

Personnel

Medical 3,527 3,694 167 11,330 11,076 (254) 44,955 44,955 0

Nursing 2,468 2,457 (11) 7,467 7,532 65 30,946 30,946 0

Allied Health 843 833 (10) 2,687 2,554 (133) 10,509 10,509 0

Support 141 165 24 446 460 14 1,991 1,991 0

Management /

Administration694 674 (20) 2,244 2,021 (224) 8,343 8,343 0

7,673 7,823 150 24,174 23,642 (531) 96,745 96,745 0

Other Expenditure

Outsourced

Services910 503 (407) 2,426 1,510 (916) 6,040 6,040 0

Clinical Supplies 2,242 2,380 138 7,731 7,093 (638) 29,355 29,355 0

Infrastructure

& Non-Clinical

Supplies

697 500 (197) 1,643 1,501 (142) 6,003 6,003 0

3,849 3,383 (466) 11,800 10,103 (1,697) 41,398 41,398 0

Total Expenditure 11,522 11,206 (316) 35,974 33,746 (2,228) 138,143 138,143 0

Contribution 915 655 260 963 1,838 (875) 4,190 4,190 0

Allocations 928 928 0 2,711 2,711 0 10,787 10,787 0

NET RESULT 1,843 1,583 260 3,674 4,549 (875) 14,977 14,977 0


Comment on Major Financial Variances The overall result for Surgical and Ambulatory Services is F$260k for Sept-12, U$875k YTD.

Revenue (F$576 for month/ F$1.353M YTD) • Additional elective activity is above revenue for the month and YTD arising from the funding of volumes over

delivered. Volumes however can only be funded to the MoH contracted volumes with Waitemata DHB. They

cannot be funded over and above the dedicated funding determined by the MoH over the entire financial

year. • Bowel Screening has $248k of unbudgeted revenue accrued to match the actual costs for the month and

$927k YTD.

• Patient revenue derived from hearing aid supplies is down ($77k) YTD – a corresponding reduction in cost of

goods shows in clinical supplies for ORL.

33 of 94


Expenditure (U$316k for month/ U$2.23M YTD)

• Bowel Screening accounts for $927k of the negative variance YTD with unbudgeted expenditure across staff,

outsourced, clinical supplies and Infrastructure costs. Costs are captured in a separate RC and revenue has

been accrued to offset this. This occurred as the Service was only introduced after the budgetary process had

closed.

• Personnel costs (F$242k for month / U$248 YTD excluding Bowel Screening)

o Medical staff YTD costs are U$220k, falling mostly in SMO account codes, partly due to superannuation

and CME/WRE costs being above budget by $171k, and the revaluation of some staff leave balances due

to payroll errors stretching back two financial years of $190k. Review underway includes job sizing

exercises to establish actual budget costs.

o Nursing costs are F$156k YTD due to vacancies and some miscoding of nursing staff into admin account

codes.

o Allied Health Staff costs are U$116k to budget YTD. The adverse variance comes from Radiology, Breast

Screening and Anaesthesia and arises from allowances and overtime above budget. Under review.

o Management and Admin staff costs are F$28k for the month in a reversal of the earlier trend, bringing

the YTD result back to U$81k YTD - $64k coming from miscoded clinical and support staff, while the

balance is a phasing effect which will resolve by the end of the financial year.

Other Direct costs (U$307k for month / U$1.05M YTD excluding Bowel Screening)

• Outsourced costs are U$473YTD made up by unbudgeted outsourced ultrasounds ($106k – offset by

equivalent revenue), $167k in outsourced nursing (under review by Director of Nursing and Operations

Manager/Nursing HOD), $100k of point of care (PoC) costs from 11/12 activity and $140k YTD of Interim Care

cost. The interim care programme criteria are being reassessed.

• Clinical Supplies unfavourable by $587k YTD, arising from miscoding, delayed invoices from the previous

financial year and shortfall in budget. A major review of inventory control systems, and procurement

processes is underway in conjunction with healthAlliance. Expenses from previous financial year.

While mentioned above it is prudent to highlight that the service will be reporting a total of a minimum $590k of

costs attributable to the 11/12 financial year within the YTD variance through to the end of the financial year,

including Staff historical leave corrections of $190k; outsourced costs including PoC fees of $130k; and clinical

supply costs of a minimum of $370k due to a Health Alliance processing hiccup.

Summary:

Theatre production continued to run above target for all services in September, with all except orthopaedics

achieving a favourable YTD volume variance in additional electives. The over delivery is expected to continue in

the 2nd quarter until Christmas. A plan will be in place to ensure production is aligned to reduce costs in the

second half of the year.

During September a detailed analysis was undertaken by the Service to identify and forecast financial risk relating

to budget variances to the end of the financial year. This exercise highlighted areas of focus for the development

of mitigation strategies. Contribution variance is expected to be U$150k for October.

34 of 94


Medicine and Health of Older Peoples Services

Service Overview This Division is responsible for the provision of emergency care, medical services and sub-specialties

(including cardiology, dermatology, diabetes, endocrinology, gastroenterology, haematology,

infectious diseases, renal, respiratory and rheumatology), and services for older people including

assessment, treatment and rehabilitation (A, T and R), mental health services, and home based

support services.

The service is managed by Debbie Eastwood with the Heads of Department Jonathan Christiansen,

Medical, Shirley Ross, Nursing and Tamzin Brott, Allied Health. The Clinical Directors are Hamish

Hart for Medicine, John Scott for Health of Older Adults, Gavin Pilkington for Psychiatry for the Older

Adult, Willem Landman for Emergency Care, Ali Jafer for Gastroenterology, Rick Cutfield for

Diabetes/Endocrinology, Tony Scott for Cardiology, Hasan Bhally for Infection Diseases, Walter Van

der Merwe for Renal, Megan Cornere for Respiratory, Ross Henderson for Haematology, Cathy Miller

for Palliative, Blair Wood for Dermatology and Michael Corkill for Rheumatology.

Scorecard Smokefree

Performance against the “Better help for smokers to quit” health target remained strong at 95.9%

for the month of September; allowing us to maintain an average of 96% for the quarter.

Electives

Provider elective volumes for cardiology were 100.4% against a target of 100% for the month of

September, while the percentage of elective coronary angiography undertaken within 90 days

currently sits at 100% against a target of 85%. With 20 working days in the month of September the

total acute cath lab volume for September is down on August, however the per day acute volume

August to September was up by 8.93%.

Complaints

Responsiveness to complaints was 23 days against a target of 14; this is up from 14 days in August.

The increased response time has been driven predominantly by the complexity of the complaints

which cross multiple departments and services and which require face-to-face meetings with all

parties in order to address complex and specific issues. MHOPs received 29 complaints for the

month of September compared to 41 in August. The majority of the overdue complaints relate to

General Medicine. A significant contribution to this delay has been the absence of the Head of

Department Medical and the Clinical Director of Medicine due to annual leave.

DNAs

The strategy of telephoning patients to remind them of their appointment has been making a

positive impact for Maori and Pacific Peoples. For the month of September we achieved 8% DNA

rate, down from 8.1% in August against a target of 10%. For Maori a slight decrease from 12.5% in

August to 12.2% in September and for Pacific people the DNA was 10.9% in September down 1%

from 11.9% in August. The target for all groups is 10%.

Shorter Stay in ED

The division achieved 96.5% against the Shorter Stay in ED target for September and 96.3% YTD. The

occupancy of the inpatient wards across both North Shore and Waitakere sites was high as a result

of increased ED presentations and subsequent admissions and this was reflected with a bed

utilisation rate of 106.98% (Trendcare).

35 of 94


Transfers from Waitakere ED to North Shore ED occur when the level of clinical care required is most

appropriately provided at North Shore Hospital. The average this calendar year is 8.64% (range =

7.28% - 9.88%) of patients initially triaged at Waitakere who have been transferred to either North

Shore or another facility such as Auckland City Hospital or Residential Aged Care.

Transfers out of WTK compared to total Triage Presentations 2012

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Jan Feb Mar Apr May Jun Jul Aug Sep

Month

Nu

mb

er

Total Triage presentations 2012

Total transfers out

To NSH

To Other

Jan Feb Mar Apr May Jun Jul Aug Sep

Total Triage presentations

2012 3266 3304 3437 3129 3409 3654 3923 3868 3625

Total transfers out 266 318 316 309 308 266 308 301 327

To NSH 202 228 228 208 208 190 224 204 228

To Other 64 90 88 101 100 76 84 97 99

% of total transfers to total

presentations 8.14% 9.62% 9.19% 9.88% 9.03% 7.28% 7.85% 7.78% 9.02%

Area of Focus – ED front of house workgroup and the training of ED frontline staff

Phase I: identify key stakeholders and front of house experts-

This has been completed and a core working group formed.

Phase II: identify, quantify and rank front of house tasks and requirements, and understand the

current patient journeys-

This is now underway: individual staff surveys regarding front of house tasks have been completed.

We are in the process of collating the information to understand front of house requirements and

create ideal patient journeys.

Phase III: will involve developing a front of house process that effectively, efficiently and

empathetically meets our patients' needs based on the outcomes of Phase II above.

36 of 94


Analysis of the feedback so far has clearly demonstrated a keen awareness and longing from all staff

to better serve our patients empathetically. It is clear that the current process is not set up to

provide enough time for our staff to do this consistently; instead other pressing tasks are prioritised.

Human Resources

Sick Leave remains stable at 8 days against a target of 7.5 Days. Turnover Rate has dropped to 11.1%

for September from 12.5% in August. This is higher than the organisation target of 10%. We continue

to have a high number of people with annual leave balances greater than 75 days, with an increase

in September to 37 from 33. This in mostly in nursing and a plan is in place to manage those within

these parameters.

Service Delivery

The overall average length of stay for acutes is 3.9 against a target of 3.5 days. This is down

slightly in August by 0.1 days. Given the acute volumes this remains a good result coming out of

the winter months with more beds being opened to meet the demand.

The length of stay for electives is now at 5.5, which is above the target of 3.92. The last two

months have both yielded waiting times higher than our typical result. We are monitoring this

area closely to ensure that this trend does not continue.

37 of 94


Scorecard


Better help for smokers to quit 95.9% 1 0 95.0% �� Chemotherapy waiting times - within 4 weeks 100% 1 0 100% ��

Provider Elective Volumes (Cardiology) 100.4% 1 0 100.0% �� % elective coronary angiography within 90 days 100% 1 0 85% ��

Shorter Waits in ED 96.5% 1 0 95.0% ��

Patient Flow

Average Length of Stay - Acutes 3.90 1 0 3.50 �

Average Length of Stay - Electives 5.50 1 0 3.82 �

Discharges at weekends 24.2% 1 0 20.0% �

Quality Actual Target Discharges before 11am 16.7% 1 0 20.0% �

Complaint Turnaround Time 23 days 0 1 14 days �

Complaint Volume per 1000 occupied bed days 1.05 0 1 TBC � ESPI 2 - % patients waiting longer than 6 months for FSA

Hospital acquired blood stream infections per 1000 occupied bed days 0.07 0 1 TBC � Cardiology 0.0% 1 0 0.0% ��

Falls per 1000 occupied bed days 2.74 0 1 TBC � Dermatology 0.0% 1 0 0.0% ��

SAC1 Reportable Event Volume per 1000 occupied bed days 0.00 0 1 TBC �� Diabetes 0.0% 1 0 0.0% ��

SAC2 Reportable Event Volume per 1000 occupied bed days 0.07 0 1 TBC � Endocrinology 0.0% 1 0 0.0% ��

Incident Volume per 1000 occupied bed days 12.30 0 1 TBC � Gastroenterology 0.0% 1 0 0.0% ��

General Medicine 0.0% 1 0 0.0% ��

DNA Rates Haematology 0.0% 1 0 0.0% ��

DNAs as % of OP presentations - Total 8.0% 1 0 10.0% � Infectious Diseases 0.0% 1 0 0.0% ��

DNAs as % of OP presentations - Maori 12.2% 1 0 10.0% � Renal 0.0% 1 0 0.0% ��

DNAs as % of OP presentations - Pacific 10.9% 1 0 10.0% � Respiratory 0.0% 1 0 0.0% ��

Rheumatology 0.0% 1 0 0.0% ��

Other Key Measures

Pressure injuries 0.14 0 1 TBC � ESPI 5 - % of Patients not treated within 6 months

Cardiology 0.0% 1 0 0.0% ��

Contracts (YTD)

Elective WIES Volumes

HR Wellbeing Actual Target Medical (Overall) 306 1 0 382 �

Sick Leave Rate (days) * 8.0 days 1 0 7.5 days �� Cardiology 257 1 0 324 �

Overtime Rate (%) * 0.9% 1 0 1.0% �� Gastroenterology 49 1 0 59 �

Annual Leave Balance > 75 days 37 1 0 32 �

Turnover Rate % * 11.1% 1 0 10.0% � Acute WIES Volumes

Clinical Employ (FTE) 1,452 FTE 1 0 � Medical (Overall) 7,816 1 0 7,382 �

* 12 month rolling average

First Specialist Assessment (FSA) 3,368 1 0 3,346 �

Subsequent Attendance (FUP) 8,995 1 0 7,588 �

Emergency presentations WTK L4 (admitted) 4,719 1 0 4,995 �

Financial Result YTD Actual $000s Target $000s Emergency presentations WTK L4 (non-admitted) 6,563 1 0 6,271 �

Revenue 67,273 k 1 0 67,178 k � Emergency presentations NSH L5 (admitted) 7,312 1 0 10,183 �

Expense 48,028 k 0 1 46,143 k � Emergency presentations NSH L5 (non-admitted) 5,259 1 0 5,483 �


Outsourced Services 1,523 k 1 0 928 k �



Contribution 19,245 k 0 1 21,036 k �

Accrued FTE 1,695 FTE 1 0 1,649 FTE �

Capital Expenditure 480 k 0 1 889 k �

Waitemata DHB Monthly Performance ScorecardMedical and Health of Older People

September 2012

Human Resources

Quality

Finance

Priority One Service Delivery

38 of 94


Strategic Initiatives

Deliverable /Action On Target

Complete a comprehensive review and redesign of the model of care and staffing for

General Medicine inpatient services �

Implement new model of care in General Medicine inpatients �

Implement rapid rounding concept to the Hospital �

Primary/secondary liaison role in place Completed

Implement further strategies to reduce high users of ED, A & Ms, GPs and St John

services �

To further ensure that clinical staff are strongly supported in their service, 20 hospital

services will have a ‘STEPS’ trained and supported smokefree educator within their

team. Eight services have been STEPS trained and the others will get underway when

the new Smokefree Manager starts.

�

Speech Language Therapists are implementing a new swallow screen which will reduce

the incidence of aspiration pneumonia as a complication of stroke �

Provision of specialist support to aged care residences (gerontology nurse specialist,

dietitian and clinical pharmacists) to better support patients in the community –

WDHB only

�

Continue the roll-out of the Integrated Transition of Care (previously Readmissions)

project to identify and focus on those with the highest likelihood of hospital

readmission, particularly those 65+ years.

�

InterRAI training for NASC completed by Dec 12 �

InterRAI benchmarking between DHBs on core quality measures is progressively

developed nationally through 2012/13 as the volumes of clients who have had an

InterRAI assessment completed increases

�

Single Point of Entry project from pilot phase to full implementation. This will provide

an integrated access point for Older Adults and Home Health Completed

Re-scope delirium work as a Rigour project – subsequent improvement work complete �

Pilot(s) for regional dementia work stream to be developed and started �

Review the memory service and work with primary care to ensure people with a

diagnosis of dementia are placed on a dementia care pathway �

Commence implementation of Dementia Day Care Services ��

Continue to work with primary care (Waitemata PHO) to develop specialist gerontology

services. �

The SSOA work plan is delivered on time and within budget �

At least 75% of DHB Needs Assessment staff will be trained and assessing older people

in the community with InterRAI by 30 June 2013 �

Implementation of dementia care pathway initiated by June 2013 �

Assess and compare readmission rates for over 65s. ��

An ICD service will have been established at North Shore Hospital to improve access for

our population Completed

We will have contributed to the National Review of Electrophysiology to determine the

appropriate role of cardiac electrophysiology in the diagnosis and management of

arrhythmias, and commenced implementation of any mandated recommendations

arising from this

�

We will have implemented a strategy to address the causes of ethnic inequalities in

cardiac revascularisation for patients with acute ST elevation myocardial infarction �

Reduce waiting times for diagnostic echocardiography �

Secondary services - weekly diabetes clinic at Waipareira Trust facility in west Auckland �

39 of 94



Continue to deliver the RACIP (Residential Aged Care Integration Programme) which

employs a team of Gerontology Nurse Specialists (GNSs) 6 in total: 3.3 FTE and two 0.5

FTE Wound Care Nurse Specialists led by the Gerontology Nurse Practitioner 0.5 FTE.

(The other half of the GNS and Nurse Practitioner role is with community dwelling

older adults)

�

Key achievements for month

Accreditation of NSH Gastroenterology service. NZ SAC Gastroenterology/RACP (Royal Australian

College of Physicians) has accredited our site for advanced training.

Smokefree - A new Smokefree Service Manager has been appointed and will commence

employment 29th October.

InterRAI training for NASC is on track to be completed by December 2012. 89% of staff will have

been trained by mid-October. InterRAI is a comprehensive standardised instrument specifically for

evaluating the needs, strength and preferences of those in chronic care in the community.

The SSOA work plan is moving forward well. Wards 14 and 15 reopened post refurbishment on the

7th September. There was a blessing of the Muriwai KMU annex on the 25th September and this is a

significant move forward for the SSOA service. The KMU ICU rebuild started on the 2nd of October

and will be completed by the 19th of December.

Implement rapid/hourly rounding concept to the Hospital – Margaret O'Sullivan is leading this for

AT&R - Ward 14 started in September; Ward 15 and Muriwai will start on 1 October. Shirley Ross is

leading this rollout for the medical wards. This is going well at Waitakere and was commenced on

medical wards at NSH on 6 August.

Cardiology Nursing

We are very pleased to advise that Adele Clayton has commenced with cardiology with two

components to her role, Implantable Cardioverter Defibrillator (ICD) and Cardiac Rehabilitation

Nurse Specialist. Alongside Adele, Jo Hewlett has accepted a six-month secondment into the NSH

cardiac rehabilitation nurse vacancy. Jo will also continue to work within both the Lakeview and CCU

Waitakere teams.

Areas off track for month and remedial plans

Commence implementation of Dementia Day Care Services – Following delays in finalising the

contract this has now been completed by the Funder for a single provider. The service will

commence on 5 November 2012. NASC will be the access point to this service.

Assess and compare readmission rates for over 65s - This is regional – we are awaiting the latest set

of figures from NDSA. Target is - readmission rates for 75+ population will reduce to 14.79%

Key issues/initiatives identified in coming months

Reduction in falls: Recommendations from the falls project are now fully implemented with Morse

Assessment forms being used across all wards. Falls stickers, alerts and whiteboard magnets are

being used to create awareness for all members of the multi-disciplinary team regarding patient falls

40 of 94


risk. The Charge Nurse Manager (CNM) and ward staff are fully engaged regarding the use of floor

line beds to prevent falls.

Nursing Leadership: Workshops facilitated by NZLI (New Zealand Leadership Institution) have been

well received with two workshops now completed. This programme of ‘mobilising nursing

leadership’ continues in October with the charge nurses, operations managers and nurse educators

focusing on moving boundaries and further developing the leadership skills in these key staff.

41 of 94


Financial Results


Medical & HOPS

($000’s)


REVENUE

Government

and Crown

Agency

22,341 22,256 85 66,798 66,769 28 267,077 267,077 0

Other Income 274 136 138 475 409 66 1,636 1,636 0

Total Revenue 22,616 22,393 223 67,273 67,178 94 268,713 268,713 0

EXPENDITURE

Personnel

Medical 3,988 4,225 237 12,639 12,662 23 51,749 51,749 0

Nursing 6,112 5,968 (144) 18,832 18,237 (595) 74,309 74,309 0

Allied Health 1,350 1,436 85 4,143 4,336 194 17,727 17,727 0

Support 0 32 32 0 88 88 385 385 0

Management /

Administration728 707 (21) 2,226 2,120 (106) 8,738 8,738 0

12,177 12,367 189 37,840 37,443 (396) 152,908 152,908 0

Other Expenditure

Outsourced

Services579 309 (270) 1,523 928 (595) 3,713 3,713 0

Clinical Supplies 2,345 2,064 (281) 6,986 6,151 (834) 25,460 25,460 0

Infrastructure

& Non-Clinical

Supplies

531 540 8 1,679 1,619 (60) 6,478 6,478 0

3,456 2,913 (542) 10,188 8,699 (1,489) 35,650 35,650 0


Contribution 6,983 7,113 (130) 19,245 21,036 (1,791) 80,155 80,155 0

Allocations 7,245 7,245 0 21,584 21,584 0 88,468 88,468 0

NET RESULT 14,228 14,358 (130) 40,829 42,620 (1,791) 168,623 168,623 0

YEAR TO DATE FULL YEARMONTH

42 of 94


Comment on Major Financial Variances

The overall result for Medicine & HOPS was unfavourable by $130k for the month and $1.79M YTD.

Revenue

There is a favourable revenue variance for the YTD of $94k. This is due to an injection of $479k from

the Funder to mitigate overspends in PCT drugs and unrecovered PCT rebates. This gain is offset by

significant unfavourable variances in ACC revenue, Cardiology electives and Disability Support

Service revenue. ACC revenue, which is under budget by $150k YTD, is an area which continues to

be problematic and significant efforts are underway to investigate ways of increasing this revenue

stream, however there are many factors at play in this area which make this a challenging target to

achieve. Cardiology elective revenue is $310k unfavourable in September due to actual production

volumes YTD being below budgeted volume. A plan is in place to bring the volumes up to budgeted

levels in quarter 2 and the revenue is expected to be recovered. Base Disability Support Services

revenue of $140k is being accrued pending the contract sign-off; this accrual was not processed in

September due to an error, which will be corrected in the October result.

Expenditure

Personnel costs overall are unfavourable to budget by $396k YTD. Nursing staff costs are overspent

by $595k YTD with the main drivers being patient volume, higher than budgeted sick leave (impacted

by Norovirus in several wards in July/August) and increased constant observations. The opening of

Short Stay Ward to meet bed demand has contributed $69k to the overspend. A strict process is now

in place for replacement of unplanned leave and the use of external bureau staff. A one off

adjustment revaluing medical staff leave balances was taken up in September for $183k.

Other Expenditure

Outsourced Services are $595k unfavourable YTD. External Nursing Bureau costs are $601k over

budget; this includes an estimated $125k of late billing relating to last financial year. Strict controls

around use of external bureau staff has significantly reduced the number of shifts booked in

September. We expect to realise the benefit of this process in the October billing period.

Clinical Supplies are unfavourable to budget $834k YTD. PCT drugs are over spent by $389k although

this cost is fully offset by the additional revenue from the Funder to the end of September. Clinical

depreciation is over budget by $123k and this is expected to increase to approximately $500k year

end. Dressings are over budget by $75k YTD with the majority of this coming from District Nursing,

and work is in progress reviewing types of product and stock levels. Ostomy and continence is over

budget by $85k YTD with increasing patient numbers and recent price increases contributing to this.

Client related costs are over budget by $69k YTD with the majority of this coming from recharges

from ADHB for Home Haemodialysis. This is expected to continue until the Renal Phase 2 Community

facility is opened. Work within the division will continue around clinical supplies, reviewing ordering

and stock levels, and key areas of overspend will be targeted.

Infrastructure and non-clinical costs are unfavourable by $60k YTD with the most significant

overspends coming from laundry $31k (which is volume related), and printing and stationery $52k.

Costs are being scrutinised, and focus put on mitigating overspends within the existing infrastructure

budget for these expenses.

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Child, Women and Family Services

This Division is responsible for the provision of obstetrics, gynaecology and paediatric medicine

services for our community and the Auckland Regional Dental Service (ARDS) for metro-Auckland.

Services are provided within our hospitals, eg births and gynaecology surgery, and within our

community, eg mobile/transportable dental clinics. The division is managed by Linda Harun with

Tim Jelleyman HOD Medical CWF, Sathananthan Kanagaratnam Clinical Director ARDS, Sue Belgrave

Clinical Director Obstetrics, Peter van de Weijer Clinical Director Gynaecology and Meia Schmidt-Uili

Clinical Director Child Health.

Scorecard

Health Targets Results for Better Help for Smokers to quit at 93.8% and shorter waits in ED at 93.5% are below

target for September. Both targets have small numbers and the percentage results are affected by a

small variance. The service continues to monitor these closely for improvement.

Gynaecology elective surgery volumes are over contract by 117.8% for the month and YTD at 113%.

The appointment of an O&G Fellow and a MOSS has significantly contributed to the ability to backfill

vacant operating lists due to SMO leave.

Quality Complaint turnaround times were longer than target due to several complex complaints. The overall

complaint volumes are showing a decrease and turnaround times are improving with no outstanding

complaints currently.

Overall DNA rates for the service are 8% which is below the target. However the rates for Maori and

Pacific have risen again this month to 19% and 17% respectively. The numbers are small and require

vigilance to maintain them at the target or below.

The overall DNA rate for Child Health has continued to decrease over the past two months. The DNA

rate for Maori children dropped significantly in August to 8% (7 children in total). During September

the rate rose to 24% (15 children in total) with the overall number of appointments scheduled

significantly lower than in August.

Child Health had a downward trend in the DNA rate for Pacific children from a high of 35%; however

the DNA rate for Asian children remains variable at around 15%. The services continue to monitor

DNA rates to improve outcomes.

Human Resources The sick leave rate has remained above the target again this month. The rate has continued to

improve slightly each month this quarter despite winter sickness rates. High sick leave has occurred

in both maternity facilities over the past month. The maternity facilities have been extremely busy

and short of staff. The main reason for the sick leave has been seasonal illness. Maternity services

have been able to recruit two full time and three casual midwives to fill some of the vacant positions

at the North Shore maternity facility.

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Service Delivery Women’s Health

Exclusive breastfeeding on discharge rates are now above target and look to meet the BFHI

requirements for achievement of target for three months prior to the audit scheduled in February

2013.

The number of births for the month was 1,783 which is 94 births above the contract for the month.

This may be due to the repatriation of the diabetes in pregnancy service from ADHB and more detail

will be identified following the three month review of the service in October.

The increase in gynaecology volumes has subsequently increased the WIES for the month to 40

additional WIES to contract.

ESPI compliance has been maintained.

ARDS

Enrolment targets are being met and work continues to reduce the arrears from 16% to 10%.

Child Health

SCBU occupancy has been high throughout the Auckland region this month. Both SCBU units have

been over capacity on several occasions.

Discharges on weekend rates remain high at 30% which reflects paediatric commitment to timely

discharge.

Area of Focus – Did not attend (DNA) rates Work is underway to reduce the DNA rate for Maori and Pacific women booked for gynaecology out

patient clinic appointments. Contact has been made with the Maori and Pacific Health services to

seek support for women to get to clinic.

ARDS is implementing a DNA strategy across the service. Rates fluctuate with peaks during the

school holiday period. Rates are higher for preschool children and particularly for Maori and Pacific

pre school children. A number of strategies have been introduced including: text reminders, calls

prior to appointments; follow up of DNAs and rescheduling within timeframe and patient focused

bookings. ARDS is changing the text reminders to request confirmation of appointments to enable

more appointments to be rescheduled when requested.

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Scorecard


Better help for smokers to quit 93.8% 1 0 95.0% � Oral Health Arrears 16.3% 1 0 10.0% �

Provider Elective Volumes 117.8% 1 0 100.0% � Oral Health New Enrolments (Preschool) 12,188 1 0 10,414 �

Shorter Waits in ED 93.5% 1 0 95.0% � Theatre utilisation Gynaecology 73.0% 0 1 90.0% �

Exclusive breastfeeding on discharge 78.9% 1 0 75.0% ��

Births 1,783 1 0 1,689 �

Patient Flow

Quality Actual Target Average Length of Stay - Maternity 2.5 1 0 2.5 �

Complaint Turnaround Time 16 days 1 0 14 days � Average Length of Stay - Paediatrics 2.2 1 0 2.2 �

Complaint Volume per 1000 occupied bed days 0.35 0 1 TBC � Average Length of Stay - SCBU 6.9 1 0 7.0 �

Hospital acquired blood stream infections per 1000 occupied bed days 0.00 0 1 TBC �� Discharges at weekends 30.3% 1 0 20.0% �

Falls per 1000 occupied bed days 0.07 0 1 TBC � Discharges before 11am 15.2% 0 1 20.0% �

SAC1 Reportable Event Volume per 1000 occupied bed days 0.04 0 1 TBC �

SAC2 Reportable Event Volume per 1000 occupied bed days 0.00 0 1 TBC � ESPI 2 - % patients waiting longer than 6 months for FSA

Incident Volume per 1000 occupied bed days 3.30 0 1 TBC � Gynaecology 0.0% 1 0 0.0% ��

Paediatrics 0.0% 1 0 0.0% ��

DNA Rates

DNAs as % of OP presentations - Total (Maternity, Gynae, Paeds) 8.8% 1 0 10.0% � ESPI 5 - % of Patients not treated within 6 months

DNAs as % of OP presentations - Maori 19.4% 0 1 10.0% � Gynaecology 0.0% 1 0 0.0% ��

DNAs as % of OP presentations - Pacific 17.1% 0 1 10.0% �

Contracts

Elective WIES Volumes

Gynaecology 438 1 0 398 �

Acute WIES Volumes

HR Wellbeing Actual Target Gynaecology 257 1 0 283 �

Sick Leave Rate (days) * 10.0 days 1 0 7.5 days �� Maternity 1,721 1 0 1,533 �

Overtime Rate (%) * 0.1% 1 0 1.0% �� Paediatrics 517 1 0 448 �

Annual Leave Balance > 75 days 8 1 0 6 �� Neonatal 404 1 0 460 �

Clinical Employ (FTE) 770 FTE 1 0 �

* 12 month rolling average Other Contracted Volumes

Child Rehabilitation bed days 597 1 0 456 �

Non-Case weighted Discharges (YTD)

Financial Result YTD Actual $000s Target $000s First Specialist Assessment (FSA) 2,660 1 0 2,771 �

Revenue 29,035 k 1 0 28,271 k � Subsequent Attendance (FUP) 2,871 1 0 2,694 �

Expense 20,458 k 1 0 19,454 k �





Contribution 8,577 k 1 0 8,817 k �



Waitemata DHB Monthly Performance ScorecardChild Women and Family Service

September 2012

Human Resources

Quality

Finance


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Deliverable /Action

On

Target

Deliver the oral health business case objectives for 2012/13 ��

Adopt Rheumatic Fever clinical pathways and current recommendations for the school

based programme

Implement consistent evidenced-based guidelines and models of care ��

Ongoing implementation of quality and safety standards for maternity services ��

All parents of paediatric patients will receive advice and support to quit smoking. ��

A plan is developed to ensure pregnant women are provided with advice and support to

quit by Lead Maternity Carers ��

Support the national process for improving the numbers of newborns enrolled with

primary care by ensuring mother’s GP recorded on birth event booking form within

WDHB facilities ��

Develop and implement a regional safe sleep strategy across primary care, pregnancy

and parenting education, and DHBs, which ensures:

• Staff who support families caring for infants receive mandatory training and

updates about prevention of SUDI and ways of communicating risks to families

• The modelling of safe sleeping practices for all infants within DHB facilities

• Safe sleeping arrangements are available for all infants after they are discharged

home

• Families are provided education and supports tailored to their level of need

about the hazards that arise in some sleeping situations

• That advice on safe strategies for night feeds and settling infants is provided

• Inclusion of Maori and Pacific cultures and values

��

Include the management of skin infections cellulitis and abscesses as part of the

healthcare provided in school based health services ��


• Nationally agreed evidence-based sore throat guidelines are being promoted to Better Sooner

More Convenient business cases as part of the child health streams of action. Consultation with

Maori Health and other providers for children across Waitemata has occurred, and the balance

of strategy between focused school-based efforts and the wider less intensive but distributed

approach to the problem is now to be established with action points. This strategy will be joined

up with ADHB.

• The WDHB safe sleeping approach has been presented at the Auckland Child Health Stakeholder

Advisory Group (CHSAG) which involves representatives from government sector agencies such

as Housing NZ and MSD. The challenge is to get the right messages to mothers and families at a

time when there is a whole raft of information to be effectively conveyed.


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Other Highlights Women’s Health Colposcopy procedures and treatments continue to over deliver against contract. Volumes are well

above the numbers for this time last year. Additional staffing and clinics are assisting in reducing the

waiting list.

Colposcopy volumes 2011/2012 2012/2013

July 349 578

August 511 543

September 466 687

Total 1326 1808

An additional outpatient newborn hearing screening clinic has commenced at Red Beach to cover

the Whangaparoa area. All the newborn hearing screening staff have now completed the new NZQA

Careerforce qualification. Waitemata DHB newborn hearing screening trainers also completed the

first contract of training screeners from another DHB - Bay of Plenty DHB. We recently met with the

National Director for Screening Services within the NHB (Jill Lane) who was very positive about the

Waitemata DHB newborn hearing screening programme. She recommended raising the visibility of

the newborn hearing screening programme within the organisation at clinical governance level as

this type of population screening has valuable health benefits.

Child Health Rangitira Ward has been recognised by Hand Hygiene New Zealand as Hand Hygiene ward of the

quarter. A profile about the ward will feature in the Quarterly News Magazine – The Clean Hands

Chronicle. The ward will also receive a prize.

There has been increased demand for neonatal cots over September and early October and at points

occupancy has been high (up to 30 babies across two 12-cot units). There has also been pressure

from the Neonatal Intensive Care Unit (NICU) at Auckland DHB to transfer babies back to a

Waitemata facility, as demand has also been high across the region. Babies have been transferred

where possible and all available options (including outlying babies in Rangatira ward) have been

utilised.

Rangatira Ward

Radio Lollipop was officially launched in Rangatira ward by Sir John Kirwan and Mary Lambie on 10

October. Volunteers are currently working in the ward on a Tuesday and Thursday evening and it is

likely that the service will be extended in the near future, as further people have indicated an

interest in joining the volunteer programme. The evening of the opening also coincided with the

volunteers working with their 100th child on the ward.

Completed activities Enduring consent has been introduced in ARDS over the past month. This has been a service project

since 2011 and has included customer feedback. The use of enduring consent will improve patient

outcome by reducing the repetition of gaining consent for all preventive work such as x-ray and will

enable diagnosis to be more accurate and timely. The new forms will have an interim evaluation at

the end of December.

Auckland-Waitemata DHBs Collaboration in Child Health

The Child Health Services at Waitemata and Auckland DHBs are committed to working

collaboratively to ensure that joint planning occurs for the development and delivery of services for

both DHB populations.

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There continues to be progress in two work streams:

1. General Paediatric & Emergency Care – the feasibility study of developing acute and general

paediatric services at North Shore Hospital has been completed and the findings have been

presented to the Executive Leadership Team. The study demonstrated that the development of

a paediatric ward at North Shore Hospital was not financially viable, as there would be a gap of

over $2 million between potential revenue and costs. Alternatives are currently being explored

in partnership with Auckland DHB.

2. Child Rehabilitation Service Development – a paper has been presented and approved by the

Waitemata DHB Board in regards to the future facility options for the Child Rehabilitation

Service. Specifically, the Board has agreed to support the development of a purpose built

rehabilitation facility on the St Leonards Road site by the Wilson Home Trust. In addition, a

current state analysis of the service is nearing completion.

Key issues/initiatives identified in coming months Planning is underway in ARDS to extend clinic hours. Analysis of a survey conducted earlier this year

recommended that it would be beneficial to offer appointments on Saturday mornings and in the

early evening of one or more week days in most areas. The results indicated that these extended

hours would ease transport issues experienced by 18% of the respondents. The majority of

respondents in the survey felt it was important for them to attend appointments with their children

and that extended hours would make this easier.

Co-location of Paediatric Services with Primary Care

A positive meeting has been held with the New Lynn cluster of General Practice providers and

agreement has been reached in principle of developing co-located and/or integrated paediatric

outpatient services at the developing Integrated Family Health Centre at New Lynn. Analysis of the

child cohort enrolled with the cluster is underway and discussions have occurred with Auckland DHB

(as approximately one-third of the enrolled population reside within the Auckland DHB catchment

area). There has been agreement that the development will occur in partnership with General

Paediatric Services at Auckland DHB.

The white paper for vulnerable children was released by MSD on 11 October and has

recommendations that require working through in terms of staff training and systems improvement.

CW&F will be undertaking this work in coming months.

Theatre Utilisation

There has been a higher than usual number of cancellations due to patients being unwell and other

clinical conditions making it unsuitable to proceed on the day. Also incidents of patients’ changing

their minds on the day and not wanting to proceed with surgery (tubal ligation).

There continue to be a number of early starts to lists which are not accounted for in the data e.g.

commencing a list 30 minutes earlier than scheduled and finishing earlier as the data is captured

from the "set" theatre time. This has been flagged a number of times but is unable to be counted as

utilisation of theatre.

The service will look to overbook operating lists to prevent this underutilisation in coming months.

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Financial Results


Child Women Family

($000’s)


REVENUE

Government

and Crown

Agency

9,906 9,371 535 28,775 28,113 661 115,000 115,000 0

Other Income 78 53 25 261 158 103 632 632 0

Total Revenue 9,983 9,424 560 29,035 28,271 764 115,632 115,632 0

EXPENDITURE

Personnel

Medical 1,434 1,153 (282) 3,984 3,455 (529) 14,093 14,093 0

Nursing 2,007 1,870 (136) 5,992 5,707 (286) 23,487 23,487 0

Allied Health 1,750 1,842 92 5,439 5,558 119 22,912 22,912 0

Support 23 19 (4) 72 54 (18) 236 236 0

Management /

Administration319 307 (12) 985 922 (63) 3,787 3,787 0

5,533 5,191 (342) 16,473 15,697 (776) 64,516 64,516 0

Other Expenditure

Outsourced

Services340 368 28 1,198 1,104 (94) 4,416 4,416 0

Clinical Supplies 405 455 50 1,292 1,356 64 5,606 5,606 0

Infrastructure

& Non-Clinical

Supplies

450 433 (17) 1,495 1,298 (198) 5,527 5,527 0

1,194 1,255 62 3,985 3,757 (228) 15,548 15,548 0


Contribution 3,256 2,977 279 8,577 8,817 (240) 35,568 35,568 0

Allocations 2,840 2,840 0 8,535 8,535 0 34,801 34,801 0

NET RESULT 6,097 5,817 279 17,112 17,352 (240) 70,369 70,369 0

FULL YEARMONTH YEAR TO DATE

Comment on Major Financial Variances Contribution The favourable contribution for the month reflects additional revenue, particularly Dental oral health business

case (OHBC) funding, gynaecology electives, additional colposcopy clinics, and new services such as Gateway.

Offsetting this is a one-off adjustment accrual to SMO annual leave valuations.

Revenue The single largest revenue adjustment is $295k in dental revenue relating to OHBC funding devolved to the DHB

from MoH. This favourable variance is at risk, as the budget for this sits elsewhere in Provider Management and

will therefore be showing an unfavourable variance for the month.

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Other favourable revenue variances include $100k for additional gynaecology electives – this does not fully reflect

the additional volumes delivered, as total elective revenue is capped but more revenue may yet be forthcoming

for this.

Expenses Medical staffing is again significantly above budget; however this is due to a one-off accrual to adjust the

valuation of SMO annual leave, totalling $292k. Without this variance there would be a $10k favourable variance

for the month.

Nursing was also above budget, again in Paediatrics and Maternity, although closing Paediatric beds is already

reducing this spend. Some one-off retirement gratuities and very high sick leave in all areas has compounded this

unfavourable variance.

Non-Personnel costs are underspent for the month, although these remain over budget for the YTD.

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Mental Health and Addiction Services

This division provides specialist community and inpatient mental health services to Waitemata

residents. It is also provides community alcohol, drug and other addiction services, and forensic

services to the northern region. The group is managed by Helen Wood with Clinical Director Murray

Patton for Mental Health and Clinical Director Forensics, Jeremy Skipworth.

Scorecard Note, the division has been reviewing the key performance indicators in the scorecard. The new

scorecard will be provided to next month’s committee meeting.

Health Targets

Shorter waits in Emergency Department 87%

The themes for “breaches” are similar to last month with multiple issues and team involvement.

Breaches almost always occur for clients presenting in the latter evening. A particular focus has been

placed on the Waitakere ED, with a Crisis staff member providing a specific service to West ED

between the hours of 1200-2000. This focus has seen a reduction in the time consumers are

spending in Waitakere ED.

Better help for smokers to quit 98%

Mental Health in-patient units continue to perform well against this target

Quality

Complaint Turnaround time 8 Days

A great achievement by the service despite some complex complaints during this period.

Human Resources

There is no change from last month, with a slight drop (0.1%) in overtime; otherwise the results

are consistent with prior months.

Service Delivery

Service Access: Remains about the same for the past months with a slight increase in access

rates compared with September.

Community care: Treatment days per service user is seeing a small increase in variation than is

usual. Some minor shift down in most areas. This may have been impacted by a reduced

number of working days compared to July and August (September has 10 weekend days and

one less working day). Seclusion rates for adults continue to remain low, which is a positive

result for the service.

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Scorecard


Better help for smokers to quit 98% 1 0 95% �� Patient Flow

Shorter Waits in ED 87% 1 0 95% � Average Length of Stay - Adult Acute 23.06 1 0 15-21 �

Average Length of Stay - CADS Detox 6.59 1 0 6-8 ��

Service Access (latest available)

MH Access Rates 0-19 years (Total) 2.60% 1 0 3.00% �

Quality Actual Target MH Access Rates 0-19 years (Maori) 3.46% 1 0 3.60% �

Complaint Turnaround Time 8 days 1 0 14 days � MH Access Rates 20-64 years (Total) 3.43% 1 0 3.50% �

Complaint Volume per 1000 occupied bed days 0.28 0 1 TBC � MH Access Rates 20-64 years (Maori) 7.47% 1 0 7.50% �

Hospital acquired blood stream infections per 1000 occupied bed days 0.00 0 1 TBC ��

Falls per 1000 occupied bed days 0.07 0 1 TBC � Community Care - treatment days per service user

SAC1 Reportable Event Volume per 1000 occupied bed days 0.00 0 1 TBC �� Adults 3.67 1 0 3-5 ��

SAC2 Reportable Event Volume per 1000 occupied bed days 0.00 0 1 TBC � Children 1.54 1 0 2-4 �

Incident Volume per 1000 occupied bed days 5.51 0 1 TBC � Youth 1.74 1 0 2-4 �

CADS 2.39 1 0 2-4 ��

Acute Readmission Rates Forensics 1.69 1 0 2-4 �

Adults 12.0% 1 0 10.0% �

CADS 0.0% 1 0 5.0% �� Community Care - Preadmission community care

Adults 76% 1 0 75% �

Community Care - Post Discharge community care

Adults 78% 1 0 90% �

HR Wellbeing Actual Target

Sick Leave Rate (days) * 9.4 days 1 0 7.5 days � Seclusion

Overtime Rate (%) * 3.8% 1 0 3.0% �� Seclusion use Forensics - hours 681 1 0 900-1100 �

Annual Leave Balance > 75 days 6 1 0 9 � Seclusion use Forensics - episodes 19 1 0 10-14 �

Turnover Rate % * 8.2% 1 0 10.0% � Seclusion use Forensics - distinct service users 10 1 0 6-10 �

Clinical Employ (FTE) 1,041 FTE 1 0 � Seclusion use Adult - hours 48 0 1 26-30 �

* 12 month rolling average Seclusion use Adult - episodes 9 0 1 1-5 �

Seclusion use Adult - distinct service users 6 1 0 1-5 �

Relapse Prevention Planning

Financial Result YTD Actual $000s Target $000s Relapse Prevention Planning - Adults 98% 1 0 95% �

Revenue 38,849 k 1 0 38,023 k � Relapse Prevention Planning - Child & Youth 96% 1 0 95% �

Expense 29,222 k 1 0 29,007 k � Relapse Prevention Planning - CADS 97% 1 0 95% �


Outsourced Services 408 k 1 0 461 k � Whanau Contacts per service user (community only)

Clinical Supply Costs 374 k 1 0 344 k � Adults 71% 0 1 �

Non-Clinical Supply Costs 2,203 k 1 0 2,234 k � CADS 22% 0 1 �

Contribution 9,627 k 1 0 9,016 k � Forensics 12% 0 1 �

Child 100% 0 1 ��

Accrued FTE 1,200 FTE 1 0 1,252 FTE � Youth 100% 0 1 ��


Waitemata DHB Monthly Performance ScorecardMental Health Service

September 2012

Human Resources

Quality

Finance


53 of 94



Deliverable /Action

On

Target

1. Agree multi-agency actions to improve early screening, detection and early

interventions of mental health and addiction issues ��

2. Increase in Family/Whanau participation across all services /agencies and support to

them (family forums) – measured through KPI reporting and participation in Family

Forums

��

3. Identify opportunities for emerging models of integrated and/or collaborative clinical

service delivery (Primary care, NGO and DHB clinical teams) Eg primary care liaison

roles

��

4. Increase flexibility of rehabilitation services through shift to new model of contracts ��

5. Performance and productivity improvements measured through regional / national

KPI benchmarking and the Te Aranga Hou (Lean Thinking) service improvement

programme in provider arm, specifically – average length of stay acute inpatient, 28

day readmission rate, inpatient HONOS score; and community treatment days ��

6. Develop a multi/interagency strategy for services for high risk children and youth, to

include transition, discharge and follow up protocols

�

7. Implement the advanced level of the Choice and Partnership Approach (CAPA) � 8. Child and Adolescent Mental Health Services (CAMHS) and Altered High will engage

in a collaboration project to increase referrals, access rates and co-existing problems

(CEP) competencies across both services

�

9. Establish Specialist Interagency Response to Conduct Problems (SIRCP) service

(Incredible Years contract)

�

10. Enhance provision of Infant Mental Health services by developing and delivering a

staff training module for infant mental health

�

11. Develop and deliver basic Eating Disorder and Co-Existing Problems core skills

training for clinical teams

�

12. Work with key stakeholders to perform a stocktake of self-management tools and

resources and ensure access is readily available to young people and their families

�

13. Adult mental health and addiction KPIs – child and youth, adult, forensic established ��

14. Develop measure for recording waiting times for psychological therapies – provide

quarterly report to Waitemata Stakeholder Network (WSN) x

15. Development and use of WSN balanced score card to include social inclusion

measures ��

16. Establish baseline and agree targets for rates of family and behaviour assessments

performed by the service per annum �� * include a �� or a ��


3. Evolving models of care with Primary care: Developing discussion and joint work with Auckland

DHB on emerging models with primary care. Part of an international learning collaborative.

Discussions being held with East Tamaki PHO and entering process of discussion with New Lynn

Integrated Health care (also potentially with ADHB). CADS have a goal this year to improve

collaboration with Primary care and to transfer 50% of methadone patients to primary care. In

September 1,178 patients were treated by the CADS Auckland Opiate Treatment Services (AOTS).

48% of patients had been transferred back to their general Practitioner in Primary Care on

authorisation of CADS AOTS.

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9. Incredible Years Support Service - This service is now operational with two full time staff

employed (Psychologist and Social Worker), trained and with families referred. The staff are co-

facilitating Incredible Years groups with an NGO provider as well as supporting families participating

in other groups. There remains a 0.2 FTE psychiatrist role to fill, but there is a discussion pending

with an interested candidate. Discussions with consultant are progressing.

10. Infant Mental Health Training Module – Training programme and schedule for CAMHS has been

developed. Regional planning project around Perinatal and infant mental health services started.

First task is to complete full stocktake of services in region against national guidance “healthy

Beginnings”

12. Self Management Tools and Resources for Youth and Families – Project team has been formed

which includes invited representatives from The Werry Centre, Youth line and The Kari Centre.

13. National CAMHS KPI project launched in September. WDHB is one of 6 DHBs identified to assist

with the development of the set of indicators.


16. Developing baseline data across multiple organisations for access to psychological therapies is

proving more challenging and slower than originally anticipated. Some progress is being made

however with pulling together data from Primary care, NGOs and DHB provider arm services. A plan

is also being developed to get some consistency in how psychological treatments as an intervention

are recorded in the electronic clinical record (HCC data).

Other Highlights

Ministry of Health: Consultation on Service Development Plan

The MoH launched its consultation phase (10 Oct – 2 Nov) for “The Mental Health and Addictions

Service Development Plan 2012-17”. The purpose of this plan is to set the direction for mental

health and addictions service delivery over the health sector (vote health funding only) for the next

five years. It builds on the work of Blueprint II and describes in detail the Governments expectations

about what changes are needed to build on and enhance services.

The plan outlines key priority actions for the next two to three years aimed at achieving further

system wide change and lifting “our game” in order to improve consistency, performance, better

outcomes and value for money. The four over arching themes are

1. Better use of resources / value for money ( ↑ percentage of worker time in direct face to

delivery & ↑ number of consult liaison contacts from specialist services to primary care)

2. Improving primary secondary integration (↑ access to primary care response for people with

mental health and addiction problems : ↓ waiting times to specialist services)

3. Cementing and building on gains for the most vulnerable (↓ use of seclusion, ↑ access for all

ages, ensuring robust planning for adult forensic services, ↑ access to specialist services for

youth offenders, ↑ in employment & education opportunities for people with low prevalence

conditions)

4. Intervening early in the life cycle to prevent later problems (↓ waiting times child and youth

services, ↑ access to child and youth MH services)

The plan is due to be finalised in readiness for the 2013/14 planning process. Regional processes are

established for the consultation process (15th Oct, 24 CD/GM and representative regional group to a

MoH forum on 24th Oct.). Most of the areas are already key priorities in our work plan and we have,

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or are building measures to report on them e.g. access to psychological therapies, employment and

education (WSN scorecard).

Implementing Blueprint II

We have started the process of establishing an overarching executive group responsible for building

a plan to address the eight priority areas in Blueprint II. The current WSN sponsor group will be the

basis of that group and includes Clinical Director, NGO CEO and Chair of WSN, Manager F& P, GM.

We are working on getting a primary care rep. We have invested considerable time in the past three

months in socialising the plan and aligning current work programs of WSN to it e.g. The Adult work

stream and Child and Youth work stream all have objectives related to Blueprint II. Now that the

Service Development plan is out we can start to align the two and undertake a gap analysis in

preparation for the next annual plan. We also keen to align effort with Auckland DHB services in this

area.

School Refusal Care Bundle

Marinoto West Child and Adolescent Mental Health Service (CAMHS) has worked extensively with

the Improving School Attendance Programme (ISAP - formerly Truancy Service) and the West

Auckland Principals Association to develop a School Refusal Care Bundle. Under the CAPA model,

care bundles are a systematic way of measuring and improving clinical care processes by grouping

together interventions that are more effective if given together than alone.

The School Refusal Care Bundle sets out how to assess children and when to refer them to Marinoto

or to ISAP or to other services. It also provides a platform for developing joint plans to help children

and families. The bundle has been successfully trialled and is reported on in Healthlines this month.

This work aligns to Blueprint II priority 1, 2 & 3 and Prime Ministers Youth Mental health project.

Community Alcohol and Drug Service (CADs) – Maintaining access for vulnerable populations

A specific program for CADs this year is to maintain access to services for vulnerable populations.

They have set a target of 60% of patients from Deprivation Index 5-10. Progress on this target has

been positive. 73.7 % of the patients resided in areas with a deprivation index of five or higher. This

indicates that the majority of the CADS, TUPU and Te Atea Marino patients are from economically

poor areas in the metro region. Ensuring good access to services for vulnerable populations is a key

priority in Blueprint II (BP II priority 2, 3, 7) and Ministry of Health guidance.

Pacific Shared Vision – 26th / 27th September

This event was attended by consumers and staff from Isalei/ Malaga, Vakatautua, West Fono,

Ministry of Education representatives, physical health teams, Pacific funder and families of

consumers. This particular forum focussed on eliciting from the participants their views on

improving Health & Social Services to be responsive to the needs of Pacific consumers and their

families in the Waitemata district. A highlight was the acknowledgment of the Waitemata Auckland

Pacific Frontline Network presented by the chair Maria Tavita of Tuvaluan descent. This appointment

was apt given that the Tuvalu ethnic group is represented mostly in the Waitemata region (with their

recent celebrations in Ranui). This network will link with the Soalaupule group ensuring the

recommendations from the forum will be implemented. A report of this forum is currently been

completed and will be made available to the Board in the next month. (Aligns with Blueprint II

priority 6 (Promoting Well being, reducing stigma & discrimination) & Priority 7 (providing a positive

experience of care).

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Sensory Modulation Symposium

Mental Health Services Group hosted a national opportunity to share Sensory Modulation theory

and practice. The one day symposium attracted 190 people and was designed to showcase

leadership in the field of Sensory Modulation in partnership with Te Pou and AUT. Waitemata has

been cutting edge in developing practice experts and developing tools and guidelines, particularly

within inpatient settings where Sensory Modulation is well embedded as a practice which markedly

reduces the incidence of restraint and seclusion. Presenting teams included a wide range of

disciplines, providers and consumer voices and encompassed adult, child, youth and family models

of practice. Attendance also included clinicians from older adult and general health, reflecting the

transferability of the practices. The programme represented the strong network that has been built

around developing Sensory Modulation in the last four years and the great relationships MHSG

clinicians have with regional and national partners. (Links to BP II priority 7 – providing positive

experience of care.)

Workforce Development: Growing in house initiatives.

During the past two months of constrained discretionary spending, a number of applications by staff

(non CME) to attend external and international conferences have been declined. This has caused

some disappointment by a few staff which two of the unions have picked up (APEX and PSA). We

continue to work on in house training and workforce development opportunities where possible.

CADS in partnership with HMA Consultants and Matua Raki Workforce Development Programmes

developed a four hour training course in Motivational Interviewing (MI). The course includes

interviews with key Australian, New Zealand and American researchers on MI as well as ample

examples of MI in action in patient-staff member interactions. Nine CADS and Te Atea Marino staff

generously shared their MI skills for others to observe. This applied learning is now available on the

mental health services group (MHSG) Intranet site in online chapters for all MHSG staff to use to

improve their MI skills. Online and free of charge means that participants learn at their own pace, at

a time convenient for them and is gentle on the budget. Motivational Interviewing clinical skills are

extensively internationally researched and considered best practice when professionals engage

patients in discussing behaviour life style changes, including alcohol and drug use, diet, smoking,

exercise, medication compliance, family violence, and many other difficult to change human

routines. An Occupational Therapy Symposium was hosted by Waitemata DHB on October 9th for staff from

the DHBs and NGOs in the upper North Island. Approximately 80 staff heard presentations from a

variety of practice settings and organisations on “Setting the Stage”, or how to build rapport and a

safe space when working with service users. This included discussions on OT models of intervention

and the use of therapeutic tact and disclosure with people of different ages and cultures. Feedback

has been very positive, especially on the opportunity to network with OTs from different regions to

see what initiatives they are working towards, with the opportunity to share resources and

expertise.

Key issues/initiatives identified in coming months

CAD’s involvement with Auckland and Waitakere Drug Courts The Ministry of Health has signed off a business case for WDHB Community Alcohol and Drug

Services to support the Government's Drug Court initiative. This is a five year project with eight

additional FTE for the WDHB CADs service. The business case will consist of two sections:

enhancement for the CADS offender team to continue to work with Community Probation Services

(in particular the Government's target on reducing Recidivist Drink Driving) and to perform AOD

assessments for the Henderson and Auckland District Courts for referral to the Drug Court.

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This project is spearheaded by the local Henderson Judge Lisa Tremewan and Auckland Judge Emma

Aitken.

The CADS interventions will be coordinated with the Odyssey House, Higher Ground and Salvation

Army consortium that provides the alcohol and drug rehabilitation services in the Drug Court. The

Drug Court will be opened on 1 November by Minister Collins.

Stepped Care Model for Implementing Talking Therapies

Developing capacity for talking therapies within adult community teams is a goal which will require a

systematic approach to training the right numbers of staff within a team to provide the right

numbers of skilled interventions at the right level of intensity. A Training Schema is being developed

for Adult Services based upon a Stepped Care approach to provide talking therapy training from

orientation (Step 1) through to team based training (Step 2) and individual training plans (Step 3

advanced practitioners). This work is aligned to the emerging opportunities for an integrated

stepped care response across primary care, NGO and DHB clinical teams. (Link to BP II priority 3, 4,

and 7)

Community Acute Unit

The unit is a relocation of the sub acute beds from Taharoto Unit into a community facility. Five

Requests for proposals (RFPs) were received by the due date of 17 September. All have now been

marked. Three were asked to meet with the marking group to answer more questions and this

occurred on 10 October. The panel has made a recommendation that will now be presented to the

CEO.

Taharoto Replacement Business Case

The Business Case is with the Minister for consideration. We await the final decision. The MP for

North Shore, Maggie Barry visited the unit recently and has asked for a briefing on progress with the

replacement of Taharoto.

Forensics Waiting List

The number of people on the waiting list continues to rise both in terms of numbers and acuity. The

Department of Corrections for the public prisons and Serco on behalf of the Mt Eden Correctional

Facility are so concerned about the current situation that they are routinely sending a list of

prisoners with untreated mental illness, for which they have serious concerns about being able to

maintain their safety.

The Director of Mental Health has directed the transfer of one female patient to the Canterbury

Forensic Service. This patient was a South Island resident but had been transferred by Corrections to

Auckland Women’s Prison and was receiving treatment at Mason Clinic. No protocols currently exist

about the costs of transferring people directed to another region for care. The cost of transport to

Christchurch for this patient was $7500. It is anticipated that there will be further directions to

relocate some patients. A request has been sent to the Director of Mental Health for consideration

of reimbursement to the service of these costs.

Video-conferencing with the courts

The new contract regarding the provision of this service has now been completed and is under

review by the Lawyers. The Hardware has been ordered and the installation plan developed. It is

unlikely that the project will be fully functional until the New Year.

Facilities Project

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Costing for the relocation of the Rimu Hostel to the Waitakere Hospital site and the repair of Mason

Clinic are higher than original estimates indicated. A value management meeting has occurred at

which a number of modifications were suggested for the plan of Rimu Hostel and further estimates

of repair costs requested. Recent air testing indicated that air pathogens were within safety limits.

Responsibility for advancing this project is currently with Facilities and Development.

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Financial Results


Mental Health Services

($000’s)


REVENUE

Government

and Crown

Agency

12,734 12,567 167 38,509 37,702 807 150,808 150,808 0

Other Income 113 107 6 340 320 19 1,282 1,282 0

Total Revenue 12,847 12,674 173 38,849 38,023 826 152,090 152,090 0

EXPENDITURE

Personnel

Medical 1,787 1,941 154 5,596 5,815 219 23,731 23,731 0

Nursing 3,954 3,904 (50) 12,248 11,966 (282) 48,994 48,994 0

Allied Health 2,093 2,122 29 6,717 6,503 (214) 26,817 26,817 0

Support 57 52 (5) 158 145 (13) 636 636 0

Management /

Administration485 513 28 1,518 1,538 20 6,321 6,321 0

8,376 8,531 155 26,238 25,968 (270) 106,497 106,497 0

Other Expenditure

Outsourced

Services222 154 (69) 408 461 53 1,843 1,843 0

Clinical Supplies 100 115 15 374 344 (30) 1,424 1,424 0

Infrastructure

& Non-Clinical

Supplies

696 745 49 2,203 2,234 31 8,936 8,936 0

1,018 1,014 (4) 2,984 3,039 55 12,203 12,203 0

Total Expenditure 9,394 9,545 151 29,222 29,007 (215) 118,701 118,701 0

Contribution 3,453 3,129 324 9,627 9,016 611 33,389 33,389 0

Allocations 1,922 1,922 0 5,759 5,759 0 23,232 23,232 0

NET RESULT 5,375 5,051 324 15,386 14,774 611 56,621 56,621 0

YEAR TO DATE FULL YEARMONTH

Comment on Major Financial Variances Revenue

The MHSG transferred budget to the funder to commission respite beds and a community based alternative to

adult sub-acute inpatient beds which were due to commence July 2012. There has since been a delay in fully

procuring these services, hence, revenue of $133k per month will continue to be paid to MHSG to enable existing

arrangements to continue until the new services are operational.

Other favourable revenue variances of note are a result of unbudgeted revenue relating to contracts signed after

the budget was set, revenue of $260k for the CMDHB portion of the Fresh Start contract for 2011/12 and cost

recovery of employees working in other organisations which in turn both result in a corresponding cost.

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Personnel

Medical personnel expenditure is favourable by $219k YTD due to volume related savings as a consequence of

vacancies. The volume variance is reduced by $66k as many of the vacancies are covered by locums paid for in the

account code for outsourced medical staffing.

An overspend on nursing staff of $282k YTD is apparent in the inpatient and community teams as a consequence

of overtime usage to cover sick leave, vacancies and acuity, unbudgeted maternity leave payments, redundancies

and additional costs incurred to continue staffing four adult sub-acute beds at the Taharoto unit until a

community alternative is commissioned later in the year. This last issue is completely offset by additional

revenue.

Allied Health is also unfavourable YTD by $214k due to the accrual relating to lump sum payments made to clinical

psychologists as part of the APEX agreement being approximately $50k short and because the vacancy rate is

lower than what has been assumed in the budget.

Other Direct Costs

Favourable variances of $53k and $31k YTD in Outsourced Services and Infrastructure and Non-Clinical Supplies

are partly reduced by an overspend of $30k on Clinical Supplies. The adverse variance is driven by unbudgeted

costs relating to adult respite care of $102k which is completely offset by additional revenue. These costs are

partially masked by underspends in other areas of the group such as FCT step down beds and flexi-funds.

As referred to above, a YTD overspend on outsourced medical staffing of $66k has occurred as a result of medical

vacancies. This is partially offset by underspends in other areas of the group.

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Provider Arm Support Services

These services include Corporate, Facilities, Hospital Operations, Decision Support and Provider Management.

Rosalie Percival has overall responsibility for this division with Louise Ward - Facilities, Phil Barnes - Hospital

Operations (replacing Clare Thompson in the interim), and Alim Tahir - Decision Support.

Scorecard

Human Resources The Provider Support services group performance against key Human Resources indicators (refer to Scorecard

below) is within target for all indicators except for the overtime rate which is slightly greater than the target.

Finance The Financial result for Provider Support services is $996k favourable to plan YTD, mainly attributed to a

favourable position in Corporate Services, fully offsetting unfavourable results for Hospital Operations and

Provider Management services. Decision Support and Facilities Services results were within budget.

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Scorecard

HR Wellbeing Actual Target Productivity Actual Target

Sick Leave Rate (days) * 7.3 days 1 0 7.5 days �� Clinical Typing

Overtime Rate (%) * 1.3% 1 0 1.0% �� Clinical letters turnaround time - Surgical 7 days 40% 60% 2 days �

Annual Leave Balance > 75 days 4 1 0 2 �� Clinical letters turnaround time - Medicine 6 days 53% 47% 2 days �

Turnover Rate % * 9.2% 1 0 10.0% � Clinical letters turnaround time - Child, Women and Family 10 days 0% 100% 2 days �

Clinical Employ (FTE) 317 FTE 1 0 �

* 12 month rolling average

Financial Result YTD Actual $000s Target $000s

Revenue 9,316 k 1 0 9,175 k �

Expense 45,683 k 1 0 46,538 k �





Contribution -36,367 k 1 0 -37,363 k �


Capital Expenditure 10,173 k 0 1 14,639 k �

Waitemata DHB Monthly Performance ScorecardProvider Support Services

Corporate, Hospital Operations, Facilities, Decision Support and Provider Management

September 2012

Finance

Human Resources Service Delivery

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North Shore Hospital Ward 5 refurbishment √

North Shore Hospital ESC Infrastructure x

North Shore Hospital external and internal painting √

Oral Health - 11 Community Dental Clinics, 48 Pads and 12 Transportable Dental Units x

North Shore Hospital Car Park post contract works x

North Shore Hospital Marae √

North Shore Hospital Kingsley Mortimer Unit Ward 12 upgrade √

North Shore Hospital Lift refurbishment √

North Shore Hospital Elective Surgical Centre √

We are also actively pursuing the following projects:

• North Shore Hospital Taharoto Adult Mental Health Unit redevelopment √

• Mason Clinic remedial works due to water tightness issues √

• Waitemata DHB Renal Phase II √

• North Shore Hospital MRI Phase II √

• Strategic stage business case for new ‘mini-tower’ at NSH. √

Inventory management for clinical and non-clinical supplies

Implement Fleet Management policy for fleet vehicles

Development of business cases for in-sourcing services (eg orderlies) * include a �� or a ��


• $5.8M capital returned to Corporate due to efficiencies achieved completing F&D projects

• ADHB collaboration relating to Compliance and Lease Management

• Ward 14/15 minor upgrade complete to freshen up ward area for Older Adults

• Collaboration with Facilities Management for all DHBs

• Completed Muriwai minor upgrade to accommodate 4 KMU patients

• Completion of Waste Audit and publish high level results to GMs and Executive

• Car-pooling proposal approval received by Executive for Waitakere and North Shore

hospitals

• All Building Warrant of Fitness remain up to date

• 85% completion rates for Facilities Maintenance team


• Relocation of Clinical Typists from Karaka St Units - request to extend lease from 1

September to 30 November proposed to Landlord. Investigation to relocate occupiers of

level 1, 1 Shea Tce to accommodate Clinical typists. Relocation of RiTA team from Karaka

Street Units to 1 Shea Tce is complete.

• Building Consent approvals are holding up the construction start for three fixed dental

clinics. Contact is being made daily with Council to resolve.

• NSH car park post contract works held up due to lack of mesh material in New Zealand to

complete job. Works now rescheduled to be completed by mid-October

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• ESC infrastructure contractor has lodged an Extension of Time Claim due to in-ground

services being found that had previously not been known and slow responses by consultants

to Request for Information. The Claim is approximately $24k, and the contractor is doing all

possible to make up the time lost and thereby reducing the claim.

• Whanau House is available to lease from July 2012. Funding and Planning have now

confirmed most of the users for this leased premise, and additional work is required. A

capital request is being submitted for approval in October. The work is expected to take up

to three weeks to complete.

• Phase 2 Renal Community solution design base building Heads of Agreement is being

negotiated. The Service is expecting the building to be available for patients in July 2013,

however the Developer advises design plans and resource consent will be progressed once

the Heads of agreement are executed. Consenting is expected to be 3+months. The base

building is expected to take more than 6 months to complete.

• The Radiology Service advise a paper is before the Board to approve the relocation of the

newer Cath Lab equipment. This will also require some building alterations in the new

Interventional Radiology suite to accommodate this machine.

• The addition of another MRI suite displaces Maori Health and Chaplains. A solution for

these two Services is being evaluated by building additional space on level 3 of the Tower

Block at North Shore Hospital.

Other Highlights/Issues Corporate

The WDHB/ADHB Finance Collaboration workstreams are progressing well as summarised below:

• Capital & Asset Management Planning: Work continues regarding aligning capital planning and

asset management processes as well as Capex and business case forms/templates and

preparation/approval processes between the two DHBs.

• Reporting: The working group is looking at aligning reporting to Board, HAC, and Audit & Finance

Committee as well as reporting to the business. Due to the different organisational structures

for the two DHBs, the immediate workstream will focus on aligning financial reporting.

• Budgeting: Work is underway to implement the WDHB COGNOS Planning tool at ADHB for

2013/14 budgeting with support from WDHB Decision Support staff.

Facilities

Savings of $5.8M were realised from various facilities projects that have been completed at less than

the budgeted costs. These savings are part of the Corporate contingencies included in the 2012/13

Capital Budget approved by the Board and also include savings in the form of undrawn Crown debt.

Detailed reporting on status and progress on implementation of major facilities projects is provided

to the Audit & Finance Committee monthly.

Building importance levels for all existing buildings assessed in 2011 have been confirmed by the

Emergency Planner and a reassessment of some of the percentages to the New Building Standards is

being completed.

The leaking building syndrome at a rented property on the Hibiscus Coast that has been experienced

from the time of our occupation has been resolved. We have been notified of new owners.

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Front of House assessments have been completed to provide more food choice and a better

environment for patients, public and staff. The incumbent café operator is seeking to improve whilst

analysis is continuing. A business case will be completed on this.

Planning is underway for Staff Sustainable Transport Expos in October which will be held at both

North Shore and Waitakere Hospitals. The staff carpooling scheme will be launched at these expos

and Auckland Transport are providing significant support to these events including offering two

week public transport trial passes to staff and expert cycling information.

Several initiatives are underway to identify cost savings including the following:

• The release of Units 1-3 at Karaka Street is due by 30 November 2012, whereby existing

premises will be used to accommodate the clinical typists and reduce our overall rental by up to

$150k over the previous twelve months.

• Feasibility is being completed to assess if we are able to harness water from Lake Pupuke to use

in infrastructure services to reduce our electricity costs. Funding is being sought from the Energy

Efficiency and Conservation Authority for this.

• Waste Audit has been published to the organisation, with actions to reduce waste, sort waste

and recycle where possible.

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Hospital Operations

Asian Health Support Services

Asian Health Support Services was funded by the NDSA Auckland Regional Settlement Strategy –

Migrant Health Action Programme to develop a set of CALD learning resources for health

practitioners working with CALD clients in a mental health context. The deliverables included (i) Face

to face course materials; (ii) Online courseware for e-learning; (iii) A supplementary online resource

providing culture-specific resources for “Working with Asian Clients in Mental Health”; and (iv) A

supplementary online resource providing culture-specific resources for “Working with Middle

Eastern and African-Asian clients in Mental Health”. Deliverables (i), (ii) and (iii) have been

completed and were officially launched and made accessible to primary and secondary care

workforces working in the Auckland region on 28th September 2012.

Cleaning Services

Three wards subjected to external audit achieved an average score of 96% - an excellent

achievement for the service and the staff working in these areas. The results provide objective

evidence of the current high standards of cleaning in our hospitals.

Orderly Services

The Task-Manager software has now been implemented in all clinical areas and all orderly staff have

completed the WDHB health and safety induction programme. The service achieved a sustained

Service Level Agreement (SLA) target of more than 60% for all patient movements through ECC by

Orderlies. The previous average for patient movements in ECC when spotless was operating the

service was under 45%.

Fire Training Specialist

264 staff members have successfully completed the e-learning module and 100 staff members have

received face to face training. Improved communication with the New Zealand Fire Service (NZFS)

has been established and a partnership has been developed with NZFS for “creating safer

communities”.

Food & Nutrition Services

Improvements have been made to food preparation processes to decrease patient waiting times for

meals, particularly breakfast delivery which had caused disruption to wards and complaints from

patients.

Laboratory

A revised request form for laboratory tests has been recently issued for several tests (urea, AST, PO4

and ESR) have been removed from most test panels. Savings will be realised once the existing stock

is reduced. Based on an 80% reduction, the estimated reagent savings are $16,450 for AST and

$7,258 for PO4.

The MALDI-TOF machine which was initially provided by the supplier on trial has now been

purchased and is in routine use. Associated susceptibility hardware, the Phoenix AST, AP and

middleware have arrived and are being validated. Use of the MALDI-TOF has already reduced

turnaround times for bacterial identification. Financial savings will occur as the system is embedded

and standard work processes are modified. The MALDI-Trace instruments will arrive on 5th

November and Italian engineers will be on-site to install the new technology. Staff from other DHBs

have been invited to the launch.

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Patrick Gladding’s Theranostics Laboratory is about to enter a formal partnership with WDHB

Laboratories and Dr Gladding has already introduced a “Verigene - Nanosphere” instrument that is

now providing CYP2C19 genetic testing for Clopidogrel efficacy. This will be used to develop a

MALDI-TOF SNP test that will reduce the assay cost. Further development of molecular genetic

testing will provide an efficient on-site service that can be used as a referral site by external clients.

Protective laboratory gowns are now being replaced weekly instead of being used only once. A

decision has been made to reuse gowns for one week, unless soiled. Additional clothes pegs have

been fitted on both sites to provide individual identification of personal gowns. This should save

approximately 80% in laundry costs.

The workforce central system is now live for laboratory staff electronic rostering and timesheet. RiTA

training has been completed and all employees now have electronic timecards and schedules. The

system is now live.

The inaugural laboratory staff/Union Local Engagement Group (LEG) took place on the 26th of

September and will be a regular bi-monthly forum for improvement in workforce relations and

practices.

Maori Health Services

The Marae renovations at Waitakere Hospital are complete and the facility is now in use. The Maori

Services Manager (Tanekaha Rosieur) has resigned from the service but will be re-deployed to

another cultural position within the DHB, i.e. Maori Mental Health Services.

Pharmacy

An initial assessment of the feasibility of integrating an automated robotic dispensing machine into

the medicine supply chain with the Dispensary at North Shore Hospital is underway.

The ePrescribing Project expected Go-live date is planned for the 26th of November 2012. A contract

between CSC (the vendor) and Waitemata DHB was negotiated with hA and was signed on 31 July

2012. Medchart v.7 was installed into the TEST environment by CSC and has been thoroughly tested

for User Acceptance by the Project Team. A presentation on ePrescribing has been given to the

AT&R SMO’s.

Relocations

There is increasing awareness of the furniture recycling project which continues to make significant

contributions to the reduction in capital expenditure in this area.

Security

Most calls for assistance and “Code Orange” calls involve aggression, i.e. 29 out of 39 incidents

noted in September. These incidents included 12 attempted assaults and five assaults against staff.

In one incident a very large abusive man threatened ward staff, lit up a cigarette at the ward

entrance, and then attacked and threatened to kill security staff before he was eventually

restrained.

In response to three events in the car park with patients collapsing, security staff have completed

bystander CPR and provided basic first aid. Note: ambulances cannot access the car park building

and beds/stretchers are too long for the lifts.

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Decision Support Group

Information Management

The Oxygen Service, recently repatriated from ADHB, has been implemented in the Soprano Clinical

Information System. Prescriptions, assessments and contacts for these high risk patients are now

recorded and shared electronically, replacing a series of Excel spreadsheets.

The Decision Support Group has supported the implementation of a system to track cancer

treatment key points, as defined by the Faster Time to Cancer Treatment MoH targets.

The cancer tracking system produces a report that identifies newly diagnosed patients for tracking

and hosts a collection of essential data required for monthly MoH measures.

The data warehouse has continued to process without interruption since it was transferred back to

the DHB from healthAlliance nine months ago. There have been some issues with business rule

change adversely impacting some reports but this is being addressed with a more rigorous change

process. The cluster server to increase resilience by reducing the risk of hardware failure is about to

be ordered.

Information Systems

Go-live planning is well underway for an upgrade to the Waitemata Patient Management System

(iPM). It is scheduled for Friday the 2nd of November 2012 at 11pm to limit the impact on services

and will result in a 10 hour overnight outage. This upgrade impacts core clinical systems (which

interface iPM) in ED/ADU, Acute Theatres, Laboratory, Radiology, Inpatient Wards and Outpatient

clinics. The main systems affected are Concerto Clinical Workstation, ED & ADU Whiteboard,

Radiology, Laboratory, Pharmacy Dispensing and Patient Acuity.

Finance

Decision support staff are participating in the WDHB/ADHB collaboration workstreams and are

coordinating the implementation of the WDHB COGNOS Planning tool at ADHB for 2013/14 budgets.

Preparation of 2012/13 year end forecasting and 2013/14 budgets has started for the Provider arm.

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Financial Results


Provider Support

($000’s)


REVENUE

Government

and Crown

Agency

1,056 1,551 (495) 5,017 4,653 363 18,612 18,612 0

Other Income 1,145 1,507 (362) 4,300 4,522 (222) 18,118 18,118 0

Total Revenue 2,201 3,058 (857) 9,316 9,175 141 36,730 36,730 0

EXPENDITURE

Personnel

Medical 317 395 77 988 1,184 196 4,810 4,810 0

Nursing 551 594 43 1,468 1,802 335 7,315 7,315 0

Allied Health 1,518 1,461 (57) 4,554 4,469 (85) 18,415 18,415 0

Support 762 937 175 2,211 2,517 306 11,430 11,430 0

Management /

Administration2,034 2,053 19 6,260 6,159 (100) 25,036 25,036 0

5,183 5,440 257 15,481 16,132 651 67,006 67,006 0

Other Expenditure

Outsourced

Services2,411 2,315 (96) 7,331 6,938 (393) 27,781 27,781 0

Clinical Supplies 2,180 1,938 (242) 6,344 5,799 (545) 23,553 23,553 0

Infrastructure

& Non-Clinical

Supplies

5,539 5,890 350 16,527 17,669 1,142 70,693 70,693 0

10,130 10,142 12 30,203 30,407 204 122,026 122,026 0

Total Expenditure 15,313 15,582 269 45,683 46,538 855 189,032 189,032 0

Contribution (13,111) (12,524) (588) (36,367) (37,363) 996 (152,302) (152,302) 0

Allocations (12,935) (12,935) 0 (38,588) (38,588) 0 (157,288) (157,288) 0

NET RESULT (26,047) (25,459) (588) (74,956) (75,952) 996 (309,590) (309,590) 0


Comment on Major Financial Variances The overall result for Provider Support Services was unfavourable to plan for the month by $588k

and favourable for the full quarter by $996k.

Revenue

Less than planned Crown funding ($397k) was realised in Provider Management services. This is

primarily due to correction of prior months’ distribution of Funder to Provider arm revenue to

Provider clinical services in order to reflect volumes delivered. Revenue is on target YTD.

Expenditure

Expenditure was favourable to budget by $855k YTD, mainly attributed to personnel costs (less than

budget due to vacancies in medical, nursing and support staff) and infrastructure & non-clinical costs

(mainly favourable interest costs due to timing of debt drawings). These movements fully offset

adverse expenditure realised in outsourced costs (mainly contracted FTE vacancy being covered by

agency casual staff and casual cleaning staff costs) and clinical supplies costs (mainly inpatient

services pharmaceutical costs driven by volumes and interpreting services costs with offsetting

additional income).

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5.1 Clinical Leaders Report Recommendation That the report be received. Prepared by: Dr Andrew Brant (Chief Medical Officer), Dr Jocelyn Peach (Director Nursing & Midwifery), Phil Barnes (Director Allied Health) Glossary ADHB DAH Auckland District Health Board Director of Allied Health APC Annual Practicing Certificate AUT Auckland University of Technology HDU High Dependency Unit HPCAA Health Practitioners Competence Assurance Act ICU Intensive Care Unit SMO Senior Medical Officer 1. Medical staff Medical Annual Practising certificate The medical annual practising certificates (APC) are issued by the Medical Council and authorise the doctor to practise medicine within a scope of practice and conditions given on the certificate. It is the responsibility of the doctor to hold a current practising certificate. The certificates are issued four times a year, effective from 1 March, 1 June, 1 September and 1 December. A certificate renewal notice is sent out to the doctors six weeks and two weeks before the current certificate expires. If a doctor doesn’t hold a current practising certificate, it is an offence under the Health Practitioners Competence Assurance Act 2003. Waitemata Human Resources team runs a Medical Council report on APCs the first Monday of each month reconciling information available from the Medical Council against our payroll system. This ensures that all doctors are up to date and also provides an alert about those whose current certificates will expire within the next month. The information also gives details of those on general scope of practice as well as those with conditions on employment. The Medical Council also send a list of those whose APCs are about to expire to the Chief Medical Officer, and this is reconciled with the list from our Human Resource service. When APCs are due to expire a notification is sent to the relevant Clinical Director and General Manger of the service. This also provides information about the consequence of not having an up to date certificate. The Medical Council updates its information every week, so very close to the time of the expiry of the certificates their information may not be reflecting the exact status of all the doctors. Therefore close to the time of the expiry there is direct engagement of those doctors seemingly without certificates to ensure they are compliant. NoRTH manages on behalf of the regional DHBs the RMO APC requirements. The upcoming SMO meeting hosted by ASMS and the Executive Leadership Team in November is going to continue to focus on quality of care issues in our DHB. The meeting will first cover the new Waitemata DHB values. This will be followed by how to undertake difficult conversations with patients and their families and will be undertaken with the assistance of the Medical Practice Society, and finally work on Advance Care Planning (ACP) which will be assisted by Dr Barry Snow, the regional Clinical Lead on ACP.

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The Chief Medical Officer has been meeting directly with SMOs within the services to discuss the new DHB values. The discussions have often centred around the difference between the values derived from the profession and colleagues, and those of an organisation. The four Values have stimulated constructive conversation about issues they see within the service and the DHB, and how they as individuals may be part of building the values in the organisation. Allied Health, Technical and Scientific staff • Annual Practising Certificates: see table below.

Annual Practising Certificates

Discipline HPCAA WDHB Policy

Responsibility Support Internal Audit

External Audit

Laboratories Yes Yes Service Manager/Service Leaders

Quality Manager

Yes Annual

Yes Annual IANZ

Surgical Pathology

Yes Yes Team Leader Quality Manager

Yes Annual

Yes Annual IANZ

Radiography Yes Yes Service Manager Quality Manager

Yes Annual

Yes Annual IANZ

Pharmacy Yes Yes Service Manager Operations Manager

No No

Dietitians Yes Yes Service Manager Professional Leader

No No

Physiotherapy Yes Yes Team Leaders Professional Leader

No No

Occupational Therapy

Yes Yes Team Leaders Professional Leader

No No

Dental Therapy Yes Yes Operations Manager

Professional Leader

No No

Social Work No Yes Team Leaders Professional Leader

Yes List provided to PL by Board

Speech Language Therapy

No Yes Team Leaders Professional Leader

No No

Anaesthetic Technicians

Yes Yes Charge Anaesthetic Technician

Anaesthetic Technician Educator

No No

Renal Technicians

No Yes CNM Renal Educator

Alcohol & Drug Workers

Some Yes Professional Leader No No

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• Dietetics: The Waitemata DHB Professional Leader, Kaye Dennison, has been awarded the “NZ Award for Excellence and Outstanding Achievement in Dietetics” by her national peers. The citation for Kaye was stunning in every aspect and included the following accolades…” has worked passionately and tirelessly for patients”…”forms bridges and works across boundaries”…”huge passion for research” …”enthusiasm radiates to all around her”…”regarded as an authority in many areas of practice”… “powerful advocate for the Treaty of Waitangi”…”an innovative and stimulating educator”…” the ultimate professional with a deeply caring and compassionate nature”. The final statement was that “Kaye Dennison aims for perfection and settles for excellence”. In summary, an exemplar for our new Waitemata DHB Values.

• Pharmacy: Three top prizes at the New Zealand Pharmacists Conference were won by Waitemata DHB pharmacists.

• Allied Health General: The professional leadership team met with the Auckland DHB Director of Allied Health to discuss potential areas for collaboration and alignment of professional and operational structures across the region.

• Laboratories: Discussions around the joint appointment of a high level “researcher” between Waitemata DHB and Auckland University of Technology are well advanced. The appointee is expected to catalyse the development of clinico-commercial applications for the new Waitemata DHB testing platforms such as Maldi-TOF.

• Anaesthetic Technicians: This professional group has recently come under the auspices of the HPCAA and details have been released of the requirements for continuing professional development for registered practitioners. Waitemata DHB will need to establish a training/competency/development programme to ensure that staff members are able to continue to meet Registration Board requirements.

• Sonography: The regional Directors of Allied Health have initiated discussions with NoRTH in an attempt to address the acute shortage of qualified sonographers. There is no New Zealand training programme for these staff and the Directors of Allied Health have suggested collaboration between NoRTH, Auckland University and other potential training providers with the aim of developing and funding a regional/national fast-track training programme and credentialing framework.

• New Born Hearing Testers: Ministry of Health officials visited Waitemata DHB to review the operation of the local programme and inform us of significant quality issues in other DHBs. The visit was a useful alert to potential problems relating to instrumentation and staff training. This information will be of great value in developing and improving our programme.

• Dental Therapy: Members of the New Zealand Dental Council visited Waitemata DHB in September to discuss complaints and incidents reported to their Board in the previous year. There was unequivocal agreement that a regional peer-review audit programme would help to raise standards of practise and establish a model for New Zealand in general. The Director of Allied Health and Professional Leader proposed to develop an audit programme and auditor training regime to progress this as soon as practicable.

• Podiatry: One of New Zealand’s leading Podiatrists will soon commence employment with Waitemata DHB, primarily as a clinician in the Diabetes Service but with the intention of taking up professional leadership of Podiatry across the DHB.

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Nursing and Midwifery Staff Progress with Strategic Initiatives Leadership A group of senior nurses from Medical and Surgical Divisions are completing the third module of the leadership programme ‘Leadership at the Point of Care’ which has challenged them to consider their team leadership approach to motivate staff practice to be the best. The senior nurses in ICU/HDU have taken the challenge of expanding the ICU outreach team with registered nurse resource from the after-hours clinical coach role. Recruitment of nurses has identified some excellent staff. The training programme will prepare the team to work across the North Shore and Waitakere clinical areas by December. This will extend clinical leadership after-hours. It is planned to extend shift coordination leadership learning from November for nurses and midwives from across the provider divisions. Shift coordination is an important activity to ensure team leadership and clinical safety after-hours. These staff have had little development for the increasingly complex expectations. Fiscal responsibility There has been considerable emphasis on developing clinical leader understanding of their budgets and how they can continue to manage within allocation. This includes decisions about staff replacement, clinical equipment and consumable purchasing. Integrated service delivery to support clinical pathways Jean McQueen, Clinical Nurse Director for Primary Care, continues to work with the two practices (Kelston and West Fono) and the West Auckland district nursing team to implement the integrated wound care project. There have been some excellent achievements e.g. wound healing within six weeks where previously there had been no change for two years. Allied health engagement has assisted the patient lose weight and he remains highly motivated to improve his health. Workforce Development Nurses have submitted 380 portfolios for assessment so far this year. The DHB has a 67% compliance rate, which is one of the highest nationally. Assessors work hard to ensure that each portfolio meets the standard and staff are supported to develop from competent [65%] to proficient [26%] and expert [4%]. The focus is on moving 15% from competent to proficient which ensures a safer skill mix for patient outcome and efficiency and 6% from proficient to expert to provide clinical leadership. The Health Care Assistant development programme is progressing well. The aim is to have 120 staff through the programme by December. The focus is on enhancing capability and effectiveness. Safe Care, Highest Standard Each ward and area is challenge to have their quality boards updated by the end of October so that team commitment to quality improvement is visible and achievements can be acknowledged.

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____________________________________________________________________________________________________Waitemata DHB Hospital Advisory Committee Meeting 31/10/12

5.2 Human Resources Recommendation

That the September report be received. __________________________________________________________________________________ Prepared by: Sam Bartrum, Director - Human Resources 1. Executive Summary

This report identifies some key areas that are occurring in Human Resources for the month of September 2012.

2. Workforce Development

Scholarship Programme

Applications for the 2013 academic year scholarships are currently open (until 31 October 2012). Conversations with Hiring Managers regarding employment options for recipients finishing at the end of this year have been positive and there are a number of students who have interviews lined up for positions going forward. Kia Ora Hauora

Funding for an additional year (2012/13) for this Maori health workforce development programme has been approved as well as an indication that funding will continue past June 2013. Activity plans for the 2012/13 year have been submitted and specific dates for activities are in the process of being identified. Elective Surgical Unit

Recruitment activity in preparation for the opening of the Expression of Interest has been taking place.

3. Corporate HR

Attached below is the Exit Interview report for Quarter 1 July – 30 September 2012.

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Exit Interview Analysis Waitemata DHB Quarterly Report (1 July - 30 Sept 2012)

Report prepared for:

WDHB HAC

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INTRODUCTION In early 2011 Group Human Resources released a new Exit Interview Survey via Survey Monkey as part of the launch of the electronic exit process. This ensured that all employees voluntarily exiting the organisation were notified of the opportunity to provide feedback on their employment experience with Waitemata DHB including identifying their reasons for leaving the organisation. In July 2011 a revised version of the survey was launched; this report is based on the data gathered from this version of the survey since the commencement of the 2012/13 financial year. The initial part of the report focuses on various organisational demographics including response rate by service area, profession and reasons for leaving at a high level. The reasons for leaving have been broken into “Push” and “Pull” Factors which indicate whether they should be considered to be within the organisations sphere of influence (“Push”) or external reasons which affect the individual’s situation (“Pull”). The remainder of the report focuses on the employment experience and a number of the survey questions are aligned to the areas covered by the Staff Survey and therefore provide additional commentary on the following areas: • My Career • Teamwork • Management • Workplace Safety • Job Satisfaction The results support the findings of the Staff Survey in terms of the areas for improvement being career development, communication and engagement. This report is at organisation and service level seeks to identify points for further analysis and corrective action. It is anticipated that this report will be further refined and provided on a quarterly basis to the Executive Leadership Team. An additional retention survey is in development to be sent to employees around their 1 year service anniversary to seek information on their employment experience, which should assist in the validation of the information collected in the exit survey.

LIMITATIONS There are a number of limitations of this report which need to be noted including: • The survey is optional and therefore many employees have chosen not to participate or complete it in full • The survey can be completed anonymously and therefore individual responses can not be validated or followed up • The survey has many questions which are optional and therefore the sample size may not be significant • There are a number of questions where the option “other” is provided together with a free text box for additional information. Where appropriate I have added comment on the themes identified in the free text information.

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Length of Service The number of respondents who indicated their length of service with the organisation was small. However, it is interesting to note that the majority of respondent’s length of service was less than 5 years, which is in line with the organisations turnover by length of service. All employees with less than 1 year’s service are now being contacted by HR to facilitate a face to face exit interview. The purpose of this intervention is to identify improvements that could be made from the initial recruitment activity through their employment with the DHB to prevent turnover at such an early time in the employee life cycle. WDHB Total

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By Service Service

(Number) (%) (Number) (%) (Number) (%) (Number) (%) (Number) (%) (Number) (%) (Number) (%) (Number) (%)

Child, Women & Family 1 10.0% 2 20.0% 3 30.0% 3 30.0% 1 10.0% 0.0% 0.0% 10 100.0%

Corporate 0.0% 0.0% 1 50.0% 0.0% 0.0% 1 50.0% 0.0% 2 100.0%

Decision Support Services 0.0% 0.0% 0.0% 1 100.0% 0.0% 0.0% 0.0% 1 100.0%

Facilities & Development 1 50.0% 0.0% 0.0% 0.0% 0.0% 0.0% 1 50.0% 2 100.0%

Hospital Operations 1 16.7% 1 16.7% 0.0% 2 33.3% 0.0% 1 16.7% 1 16.7% 6 100.0%

Medicine & Health of Older People 1 14.3% 1 14.3% 0.0% 2 28.6% 1 14.3% 1 14.3% 1 14.3% 7 100.0%

Mental Health 0.0% 2 28.6% 3 42.9% 1 14.3% 1 14.3% 0.0% 0.0% 7 100.0%

Surgical & Ambulatory 1 12.5% 1 12.5% 2 25.0% 3 37.5% 1 12.5% 0.0% 0.0% 8 100.0%

Grand Total 5 11.6% 7 16.3% 9 20.9% 12 27.9% 4 9.3% 3 7.0% 3 7.0% 43 100.0%

Total20+ Years15 - 20 Years10 - 15 Years5 - 10 YearsLess than 1 Year 2 - 5 Years1 - 2 Years

By Profession Profession

(Number) (%) (Number) (%) (Number) (%) (Number) (%) (Number) (%) (Number) (%) (Number) (%) (Number) (%)

Admin/Clerical 0.0% 0.0% 1 25.0% 2 50.0% 0.0% 1 25.0% 0.0% 4 100.0%

Allied Health 1 14.3% 1 14.3% 2 28.6% 1 14.3% 0.0% 0.0% 2 28.6% 7 100.0%

Dental 2 33.3% 1 16.7% 3 50.0% 0.0% 0.0% 0.0% 0.0% 6 100.0%

Midwifery 0.0% 0.0% 0.0% 2 100.0% 0.0% 0.0% 0.0% 2 100.0%

Nursing 2 10.5% 4 21.1% 3 15.8% 6 31.6% 3 15.8% 1 5.3% 0.0% 19 100.0%

SMO 0.0% 1 50.0% 0.0% 0.0% 1 50.0% 0.0% 0.0% 2 100.0%

Other 0.0% 0.0% 0.0% 1 33.3% 0.0% 1 33.3% 1 33.3% 3 100.0%

Grand Total 5 11.6% 7 16.3% 9 20.9% 12 27.9% 4 9.3% 3 7.0% 3 7.0% 43 100.0%

Total20+ Years15 - 20 Years10 - 15 Years5 - 10 Years2 - 5 Years1 - 2 YearsLess than 1 Year

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Exit Interview Completion Rates It is to be noted that the number of employees leaving both the highest participating groups will not be significant, and these teams have easy daily access to computers as part of their roles which may explain the high response rate for these groups. The overall participation rate is considered normal where surveys are voluntary. Following the release of this report further encouragement will be provided to line managers to remind exiting employees to complete this survey.

The participation rate for Dental is significant, and suggests an engaged workforce. Further emphasis will be placed on this opportunity for areas with low participation rates including HCAs, Midwifery and SMOs.

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Primary Reason for Leaving WDHB

This chart displays the results for reasons for leaving as indicated in the Exit Survey. These responses have been colour coded to indicated whether the reasons are considered “Pull” factors (Green) which are external to the organisation, “Push” factors (Red) which are considered to be within the influence of the organisation, or Other (Orange) where we are unable to clearly identify the response provided. The chart clearly demonstrates that the majority of reasons for leaving are considered to be “Pull” factors. This is not a reason for complacency as most research suggests that reasons for leaving provided by employees completing exit surveys are not always an accurate reflection of their situation. It is important to note the percentage of people identifying “Push” factors has increased in this quarter on the results of the last financial year. Further considerations should also been paid to whether the “Other” group could have delayed their exit or whether further notice of their change in circumstances provided to the organisation and whether if this information had been provided earlier in their decision making process or post leaving the organisation whether they would have indicated a different reason for leaving. Given these normal concerns about the selected reasons for leaving, we have sought further information on the employment experience to identify further areas for improvement. Those who specified “Other” as a reason for leaving generally provided commentary that indicated either one or more of the main options for reasons for leaving was appropriate.

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Employment Experience The following charts provide a summary of the responses to questions posed to exiting employees regarding their employment experience and their perceptions of various aspects of their employment relationship. It is important to note that the majority of employees indicated a neutral to positive experience for all the questions. The particular areas where there was a more strongly negative response include: • Workload • Career development • Performance Reviews • Communication, engagement and appreciation These are all areas which were identified within the Staff Survey in 2011 and have programmes of work identified or underway to respond to these areas.

Perceptions of Working Conditions

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Perceptions of Opportunities for Development

Perceptions of Professional Relationships

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Perceptions of Team Participation & Recognition

Perceptions of Wages/Salary & Benefits

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WDHB as an Employer The following three reports provide a summary of responses to questions posed regarding the employees overall perception of Waitemata DHB as an employer, including by service. It is interesting that whilst the majority of employees consider the DHB to be an average employer most employees would recommend the organisation as a place to work. At a service level further investigation should be considered into the responses for Corporate, Surgical & Ambulatory Services, Child Women & Family Services, Facilities & Development and Hospital Operations.

Good Place to Work Rating

NB. Corporate and Facilities has 2 leaves only during this period.

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Suggested Areas for Improvement The final three charts focus on areas for improvement for the DHB. It should be noted that the suggested changes which would have maintained employment and the improved aspects of future employment mirror one another.

Ways to Encourage Respondents to remain at WDHB

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Aspects of New Job That Are Better Than WDHB Can Provide

Successes & Areas for Improvement This final chart compares employee views on what the DHB does well and could improve. It demonstrates that there is a varying experience across the DHB as many areas feature in both response such as flexible working options, provide support and training opportunities. However the areas where the responses are most varied are: • Career progression • Reward achievement

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CONCLUSION The initial data collected through the Exit Survey provides additional support for the work which is already underway or planned in the areas of: • Career planning and professional development • Succession Planning • Performance Management • Communication and Engagement • Reward and recognition The participation rate for this survey could be improved through additional prompting for completion of the survey, this is now possible through increased exit reporting. It will be important to monitor these results going forward for significant changes in the responses. The result for the rating of WDHB as an employer being considered average is disappointing and further work to enhance the employer reputation through improvements to the employee experience should have an impact on this result. Further work is planned to improve the survey to incorporate the DHB’s new values is planned for the coming financial year.

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6.1 Elective Services Update

Recommendation

That the report be received. ________________________________________________________________________________________________________________ Prepared by: Andrea Baker (Provider Arm Performance Manager) and Andrew Palmer (Senior Analyst, Hospitals Group) Endorsed by: Dr Debbie Holdsworth (Chief Planning and Funding Officer) Glossary DHB - District Health Board ESPI - Elective Services Performance Indicator which monitors waitlist performance ESPI 2 - This monitors the time people wait for their first specialist appointment (FSA). It should be no longer than 6 months from the date of their referral ESPI 5 - This monitors the time people wait to receive their elective surgery. It should be no longer than 6 months from their FSA FSA - First specialist appointment IDF - Inter District flows (Services provided by one DHB for another DHB’s population) MoH - Ministry of Health WIES - Weighted Inlier Equivalent Separation. This is the unit of measure applied to coding of

inpatient activity and allows the relative resource utilisation of an inpatient event to be compared across all inpatient events. This is also known as “caseweights”.

YTD - Year to date

1. Introduction The total value of the additional electives money (over and above baseline funding) available to Waitemata DHB is $32,673,964 for 2012/13. The aim of this report is to track performance against the plan on a monthly basis to ensure the DHB is able to access the full value of this funding. It also includes reporting against ESPI compliance to mitigate risk of financial penalty associated with non compliance. The additional electives plan is an organisational plan inclusive of both provider and IDF. As this report focuses specifically on the additional electives plan, there are differences in the values reported in the Hospital Advisory Committee provider performance report. The provider arm report reports against the total electives contract the funder has with the provider arm and is inclusive of baseline and additional elective volumes. This report covers the period ended 30 September 2012.

2. Final Month of the First Quarter 2012/13 Electives Performance 2.1 Discharge target Waitemata DHB’s discharge rate for September was 106.6%, being 104.6% for the Provider and 110.4% for IDF. The Provider Arm productivity has increased in the last two months and we are confident at this stage the Provider will meet their year end volume target. Waitemata DHB now has a capped volume contract in place with Auckland DHB which means we will not pay for over-delivery to plan. Although IDF activity has increased over the past three months we anticipate a reduction in activity over the next three months.

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2.2 Caseweight delivery While the electives target is a volumes target, the actual payment from the Ministry is based on the actual caseweights (or WIES) delivered. The provider arm budgets have assumed the full value of the plan and therefore it is important that both the discharge and caseweight plan is delivered. For September we have delivered 98.8% of our caseweight plan and are confident we will deliver to the full plan and be paid the full value of our additional electives money. 2.3 ESPI Compliance We continue to be compliant with the zero waiters beyond six months. The Ministry has requested a presentation from Waitemata DHB to the national electives forum to be held in November on how we achieved this compliance. They view our performance as a significant success story as our compliance to the new target has been sustained beyond the June 30 deadline. There are a number of DHBs who achieved the target for June 30, 2012 but have had subsequent issues with non compliance. The Ministry would like to see them learning from our experience. Work continues on achieving the new target of zero waiters beyond five months earlier than the required date of June 30, 2013. 2.4 Key intervention targets The final 11/12 intervention rate results have recently been published. Waitemata is delivering just above the required target rate and leads the ranking of the four northern region DHBs as shown in the following table.

Cataracts Major Joints Cardiac

IR

Target IR Rank IR

Target IR Rank IR

Target IR Rank WDHB 27.0 37.8 5 21.0 22.0 7 6.5 7.4 6 ADHB 27.0 35.6 6 21.0 16.3 20 6.5 5.4 16 CMDHB 27.0 38.2 4 21.0 20.7 11 6.5 6.8 10

Note the intervention rate (IR) is measured per 10,000 population and the ranking is out of the 20 DHBs. The table shows all three Auckland DHBs are heavily exceeding the required national intervention rate. Two significant achievements are exceeding both the major joint and cardiac surgery intervention rates and being the top ranked northern region DHB for both. Historically we have been the lowest ranked and this significant improvement reflects the focused work which has gone into both. We also exceeded the national overall surgical intervention rate of 308 per 10,000 and delivered 317 per 10,000 in 11/12.

3. Report Key

Achieved Target Met Not achieved < 98%

Of health target

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Sept 2012

Discharge Summary Elective Services Patient Indicators (ESPIs)

IDF Total 110.4% ESPI 2 (waiting time for First Specialist Assessment) 0.0%Provider Total 104.6%

General Surgery Inpatient services 103.8% ESPI 5 (waiting time for treatment) 0.0%ENT Inpatient Services 102.1%Gynaecology Inpatient Services 105.1%Orthopaedics Inpatient Services 93.7%Urology Inpatient Services 120.7%

Waitemata DHB Total Surgical Elective Discharges 106.6%Elective Surgical Purchase units, and Avastin and Skin Lesions reported to NMDS

Caseweight Delivery (CWD) Summary Joints

IDF Total 109.6% Knee Joint Replacements 82.6%Provider Total 98.8%

Hip Joint Replacements 99.5%Waitemata DHB Total Elective CWD 105.1%Elective Surgical, Dental and Cardiology Purchase units, and Avastin and Skin Lesions reported to NMDS Total Joints 89.4%

Overall

Elective Initiatives Report - Health Target

Waitemata DHB continued to achieve the new ESPI compliance for September 2012 being no patients waiting over six months for their FSA or elective treatment. Waitemata are now aiming towards the 30 June 2013 targets of no patents waiting over five months for their FSA and elective treatment.

Waitemata patient needs indicates that knee joint replacements make up 60% of major joint replacement demand with hip joints being approximately 40%. The provider is making steady progress is reaching the target year to date.

The provider has made excellent progress with discharge volumes. They achieved 105% in September. All specialties achieved over 100% with orthopaedics making good progress at 94%.

The IDF CWD outflow was 110%. Although the IDF outflow is higher than the contract Waitemata DHB has reached agreement with ADHB that will cap the level of funding to the agreed plan.

CWD Target reflects the Elective CWD purchased by the MOH. To meet the required surgical discharges target the Waitemata funder has contracted to provide additional Elective volumes on top of the MOH funded Elective CWD.

Surgical Elective Discharges Actual Vs Contract

0

200

400

600

800

1000

1200

1400

1600

1800

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar

Apr

May

Jun

Actual Discharge Volume Total Planned Discharge Volume

08/10/2012 Prepared by: Andrew Palmer Elective Initiatives Report 201213.xls91 of 94


6.2 Laboratory Innovation Recommendation

That the report be received.

Prepared by: Mehran Zareian, Laboratory Services Manager Endorsed by: Phil Barnes, Director Allied Health and Acting GM Hospital Operations 1. Executive Summary

This report aims to provide an insight into the way in which the Waitemata DHB Laboratory Service has developed in recent years and the strategies behind current service plans. Innovation and early-adoption are key philosophies with the aim of improving quality of patient care as an underpinning theme. This in turn will provide significant savings for Waitemata DHB and the profile of the DHB should also benefit progressively.

2. Introduction/Background

The laboratories on both sites have experienced significant workload increases over the past three years as a result of the DHB growth and expansion of services. Growth of the Waitakere Laboratory has been disproportionately high following the introduction of a 24 hour ED service and the increasing clinical expectations of rapid turnaround times to match. Local population growth and service repatriation have to some extent outstripped the capacity of the Waitemata laboratories to provide the necessary sophistication in terms of the scope and specialisation of testing offered on-site. In consequence there has been an exponential growth in “sendaway tests” mostly to Auckland DHB who hold a regional monopoly position as provider of “specialised” tests. However, new technology has become much more affordable and easier to operate, vastly increasing the potential for routine laboratories to provide faster, cheaper testing on-site. Collaboration, regionalisation and integration are the ultimate keys to delivering the best and most affordable service outcomes.

3. Risks/Issues

There is no genuine regional strategy for the Auckland regional laboratories but it is clear that the current distribution of funding and expertise may not match the needs of the greater Auckland population. Waitemata DHB laboratory strategies have been locally focussed and increasingly antagonistic to the established centralised Auckland DHB model. These conflicting approaches will need to be re-examined and resolved in the best interest of the region as a whole. Success will need to be measured in terms of patient outcomes as well as cost/efficiency benefits for patients across the entire region.

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4. Progress/Achievements/Activity

There are two major components to the laboratory’s cost/efficiency drive: a) Instrumentation. Some medical laboratory science disciplines e.g. Biochemistry and

haematology have been highly automated for many years. A typical biochemistry analyser will test in the order of a hundred samples per hour with a dozen tests or more on each sample. Innovations here have been mainly around the scope of automated testing available and increases in speed and accuracy. By contrast, clinical microbiology has remained a very labour-intensive discipline until the advent of some radical technological innovations such as MALDI-TOF (identification of microorganisms), Automated Sensitivity Testing (testing sensitivity of bacteria to antibiotics) and Urinalysis machines (scanning urine samples for bacteria, cells, casts and biochemical markers). Waitemata DHB laboratories have been early adopters of these new techniques. Other examples of automation in labour-intensive areas include request form imaging in Specimen Reception, to eliminate the need for multiple photocopying and manual filing of request forms.

b) People. Increasing automation requires constant tuning and adjustment to skill-mix ratios. As techniques previously requiring a high degree of manual skill and interpretative experience become obsolete, different skills need to be developed. It has also been important for Waitemata laboratories to develop multi-skilled staffs, reversing the trend of the last 20 years whereby laboratory scientists have tended to become more and more specialised. In particular, efficient cover for night shifts across two sites has required staff to be able to work in two or more disciplines.

Advanced techniques under development include:

• Polymerase chain reaction (PCR) methodologies. This involves the amplification and identification of DNA fragments, enabling the detection of very small amounts of protein/bacteria/virus and massively increasing the sensitivity of testing. The technique is used for the rapid identification of pathogenic microorganisms such as Chlamydia.

• Capillary electrophoresis – a technique for separating blood proteins, drugs and other large molecules to allow simultaneous analysis of a single sample for a large range of analytes.

Successful quality improvement initiatives, some of which are in progress: • A waste reduction programme • Restriction/removal of a range of routinely requested tests where cheaper and/or better

markers exist, e.g. Urea, AST, PO4, ESR. • Regional e-ordering project. Blood tests will only be able to be ordered electronically

according to clinically agreed parameters and algorithms. This is expected to reduce unnecessary testing by up to 10%.

• WTHLAB lean transformation • NSHLAB lean transformation • Investigation into automated systems for temperature monitoring of precious temperature-

labile stock (in collaboration with pharmacy).

Successful workforce development initiatives: • Regular educational on-site events • Video-conferencing across North Shore and Waitakere hospitals • Video-conference events extended nationally • Video recording of events • Externally accessed website (www.nzice.co.nz)

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http://www.nzice.co.nz


• “Grow your own” workforce philosophy • Leadership development programme • Continued Professional Development • Career Mapping projects • Systematic reinforcement and promotion of Waitemata DHB values Current research and development collaborations: • Waitemata DHB Clinicians • Waitemata DHB Pharmacy • Waitemata DHB Dietetic service • Auckland University of Technology (AUT); joint researcher appointment under discussion • Massey University • New Zealand Centre of Conservation Medicine (NZCCM/Auckland Zoo) • Innovative Genetic Diagnosis (IGENZ)* • Theranostics* • Liggins Institute * Partnerships Commercialisation/Associations: • Pro-active collaboration with Counties Manukau DHB and Auckland DHB • Molecular genetic testing (IGENZ) • Environmental testing • Veterinary testing

Testing opportunities under evaluation: • Food safety testing • Wine testing • Sports performance testing

5. Conclusion

The laboratory provides a highly efficient and quality service, by any standards of measurement, including those by external quality assessment programmes and internal monitoring of turnaround times for test results. The effective long term continuation of this service depends heavily upon bigger picture considerations for the region as a whole and these will need to be debated with regional partners without further delay. This is of particular importance given that the population of Waitemata DHB may well be underserved by its laboratory service’s limited on-site testing repertoire and limited timely/affordable access to specialised testing. Meeting our population needs requires us to be proactive in adopting new technologies and procedures as well as producing our own innovative and customised solutions.

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A G E N D A - waitematadhb.govt.nz · Chair – Social Services Online Trust Board member – Rotary National Science and Technology Forum Trust 28/09/11 Sandra Coney Elected Member