HOSPITAL ADVISORY COMMITTEE (HAC) MEETING · Mike Schubert – Interim Chief Executive Officer, healthAlliance Sam Bartrum – GM Human Resources ... Trustee – Allison Roe Trust

HOSPITAL ADVISORY

COMMITTEE (HAC)

MEETING

Wednesday 6th

November 2013

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 06/11/13 i

HOSPITAL ADVISORY COMMITTEE (HAC) MEETING

6th

November 2013

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

Robert Paine – Chief Financial Officer and Head of Corporate Services

Andrew Brant – Chief Medical Officer

Jocelyn Peach – Director of Nursing & Midwifery

Debbie Holdsworth – Director Funding

Phil Barnes – Director of Allied Health

Mike Schubert – Interim Chief Executive Officer, healthAlliance

Sam Bartrum – GM Human Resources

Paul Garbett – Board Secretary

Apologies: Rob Cooper (leave of absence)

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)

1. AGENDA ORDER AND TIMING

10.00am 2. RESOLUTION TO EXCLUDE THE PUBLIC ......................................................................................... 1

3. CONFIRMATION OF MINUTES

11.00am 3.1 Confirmation of Minutes of Hospital Advisory Committee Meeting 25/09/13 ............................. 2

4. ITEMS FOR CONSIDERATION AND RECOMMENDATION TO THE BOARD

5. PROVIDER REPORT

11.05am 5.1 Provider Arm Performance Report ............................................................................................. 16

6. CORPORATE REPORTS

11.55am 6.1 Clinical Leaders’ Report ............................................................................................................... 87

12.15pm 6.2 Human Resources Report ............................................................................................................ 93

Waitemata DHB, Hospital Advisory Committee Meeting 06/11/13 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

01/11/12

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 Member – Waitakere Ranges Local Board, Auckland Council 21/10/13

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 and Rodney Local Boards,

Auckland Council

Trustee - West Auckland Hospice

Trustee - Waitakere Licensing Trust

Shareholder - EBOS Group

Shareholder – Pharmacy Brands Ltd

Shareholder – Westgate Pharmacy Ltd

Chair – Three Harbours Health Foundation

Director – Trusts Community Foundation Ltd

21/10/13

James Le Fevre Registrar Auckland City Hospital

Auckland Helicopter Emergency Medical Service Doctor

Member – Australasian Society of Emergency Medicine, Hospital

Overcrowding Subcommittee

27/02/13

Wendy Lai Partner – Deloitte

Board member - Museum of NZ Te Papa Tongarewa

31/10/12

Christine Rankin Member - Upper Harbour Local Board, Auckland Council

Director - The Transformational Leadership Company

Chief Executive – Conservative Party

17/05/13

Allison Roe Member – Devonport-Takapuna Local Board, Auckland Council

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

21/10/13

Waitemata DHB, Hospital Advisory Committee Meeting 06/11/13 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

Committee Member – Lottery Northland Regional Committee

10/04/13

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 06/11/13 iv

Waitemata District Health Board

Hospital Advisory Committee Member Attendance Schedule 2013

x Absent

* Attended part of the meeting only

# Absent on Board business

^ Leave of absence

NAME FEB APR MAY JULY AUG SEPT NOV DEC

Gwen Tepania – Palmer

(Committee Chair) � � � � x �

Dr Lester Levy (Chair) � � � � � �

Max Abbott (Deputy Chair) � � � �* � �

Pat Booth � � � � � �

Sandra Coney � � � � �* �

Rob Cooper ^ � � � � ^

Warren Flaunty � � x � � �

Wendy Lai � � � � � �

James Le Fevre � x � � � x

Christine Rankin � � � � �* �

Allison Roe � � � � � �

Co-opted members

Hasan Bhally � � � � x �

Susanna Galea � � � x � �

Andrew Jones � � x x � �

Waitemata DHB, Hospital Advisory Committee Meeting 06/11/13

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 25/09/13

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







[NZPH&D Act 2000


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. HR Update Report That the public conduct of the whole or the







[NZPH&D Act 2000


Privacy



greater need to protect the privacy of




S.9 (2) (a)]

Negotiations



greater need to enable the board to carry

on, without prejudice or disadvantage,

negotiations.


S.9 (2) (j)]

4. Management of

Referrals and ESPI

That the public conduct of the whole or the







[NZPH&D Act 2000


Commercial Activities



greater need to enable the Board to carry

out, without prejudice or disadvantage,

commercial activities.


S.9 (2) (i)]

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Waitemata District Health Board, Meeting of the Hospital Advisory Committee 06/11/13

3.1 Confirmation of Minutes of the Hospital Advisory

Committee meeting held on 25th

September 2013

Recommendation:

That the Minutes of the Hospital Advisory Committee meeting held on 25

th September

2013 be approved.

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Minutes of the meeting of the Waitemata District Health Board

Hospital Advisory Committee

Wednesday 25 September 2013

held at Waitemata District Health Board Boardroom, Level 1, 15 Shea Terrace,

Takapuna, commencing at 10.19a.m

PART I – Items considered in public meeting

COMMITTEE MEMBERS PRESENT:

Gwen Tepania-Palmer (Committee Chair)

Lester Levy (Board Chair)

Max Abbott

Pat Booth

Sandra Coney

Warren Flaunty

Wendy Lai

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)

Andrew Brant (Chief Medical Officer)

Robert Paine (Chief Financial Officer and Head of Corporate Services)

Jocelyn Peach (Director of Nursing and Midwifery)

Phil Barnes (Director of Allied Health)

Sam Bartrum (General Manager, Human Resources)

Cath Cronin (GM Surgical and Ambulatory Services)

Debbie Eastwood (GM Medicine and Health of Older People Services)

John Cullen (HOD Medical and ESC Director)

Jonathan Christiansen (HOD Medical)

Tamzin Brott (HOD, Allied Health)

Jenny Parr (Associate Director of Nursing)

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) was present, except

for Item 4.1 considered at the start of the meeting.

APOLOGIES: Apologies were received from Rob Cooper (leave of absence) and James

Le Fevre.

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WELCOME: The Committee Chair acknowledged the passing of Ngati Kahu

Kaumatua Denis Hansen, a long time kaumatua and supporter of

Auckland and Waitemata DHBs. The Board’s thoughts were also with

Rob Cooper, unwell at this time.

Gwen Tepania-Palmer gave a warm welcome to all those present.

DISCLOSURE OF INTERESTS

There were no additions or amendments to the Interests Register. Lester Levy noted his

standing interest with matters related to HBL Ltd.

There were no identified conflicts of interest for the open part of the agenda.

1. AGENDA ORDER AND TIMING

Items were taken as indicated on the agenda, with Item 4.1 being considered first,

then the public excluded session (from 11.06a.m until 11.52a.m.) and then the

remainder of the open agenda.

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

Resolution (Moved Warren Flaunty/Seconded Wendy Lai)

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


Reason for passing this resolution

in relation to each item



1. Confirmation of

Public Excluded

Minutes – Hospital

Advisory Committee

Meeting of 14/08/13

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







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


deceased natural persons.[Official


S.9 (2) (a)]

4 of 98


General subject of


Reason for passing this resolution

in relation to each item



3. Medication Safety

Report








Information Act 1982.


Privacy






deceased natural persons.[Official


S.9 (2) (a)]

4. Human Resources

Update Report








Information Act 1982. [NZPH&D Act

2000 Schedule 3, S.32 (a)]

Privacy







[Official Information Act 1982 S.9

(2) (a)]

Negotiations




need to enable the board to carry

on, without prejudice or

disadvantage, negotiations.


(2)(j)]

5. Provider Arm

Performance Report








Information Act 1982. [NZPH&D Act

2000 Schedule 3, S.32 (a)]

Commercial Activities




need to enable the Board to carry

out, without prejudice or

disadvantage, commercial

activities.


S.9 (2) (i)]

Negotiations




need to enable the board to carry

on, without prejudice or

disadvantage, negotiations.


(2)(j)]

Carried

5 of 98


3. COMMITTEE MINUTES

3.1 Confirmation of the Minutes of the Meeting of the Hospital Advisory Committee

held on 14 August 2013 (agenda pages 3-15)

Resolution (Moved Pat Booth/Seconded Susanna Galea)

That the minutes of the meeting of the Hospital Advisory Committee held on 14

August 2013 be approved.

Carried

Matters Arising

No matters were raised.

4. DECISION ITEMS

4.1 Clinical Strategy Putting Theory into Practice (agenda pages 16-20)

Dr Dale Bramley and Dr Richard Bohmer (participating by teleconference) presented

their report.

Dale Bramley introduced the report, summarising the key aspects.

Richard Bohmer noted that the real issue going forward will be putting in place

groups of people and the supporting fundamentals and infrastructure to get this

work done. The first question would be who is going to do the work to assure that

each year progress is made towards the outcomes identified. The intention is to

have the clinical leadership group do much of this work at a micro system level. This

paper is signalling that this is the type of work that clinical leadership will undertake:

understanding what outcomes provide value; how these outcomes can be achieved;

and developing a strategy to achieve that. If clinical leaders are given this task they

need to be effectively supported. It is necessary for the Senior Management Team

to make sure that the clinical management group has the support to carry out this

role.

Richard Bohmer spoke of the importance of training and mentoring, with support

being given to clinicians as they grow in a new career direction. They would also

need data and measures that they had not had previously and some intelligent

information on what are the best models out in the world. The intention is to

develop an Innovation Unit surveying all approaches and models, defining preferred

care models and providing for the clinical leaders an innovation assessment and

adoption process for ideas that come forward.

Richard Bohmer also spoke of the need for an internal organisational culture and

climate that supports what is being done. There needs to be continued

development of behaviours consistent with the organisational values and the

understanding of what is not consistent with the values. There will also be a need to

look at the way services are structured and whether we have the best and most

intuitive groupings for progress with this Clinical Strategy. It will be important to

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ensure that sub units are organised to ensure that clinical leaders have clear lines of

sight over the units they are leading.

Richard Bohmer advised that this work had been started with the establishment of a

group of clinical leaders. The leadership development programme had started and

the aim is to run further with this. There had been progress on the shape of the

Innovation Group. It was intended to put together a set of short term steering

groups to oversee this stage of the process.

Matters covered in discussion and response to questions included:

• Dale Bramley advised that the word “clinical” in the context of this strategy

has a broader context than just those clinicians working in the organisation.

While the first cohort intensively focused on had been within the

organisation, the intention is to widen involvement to primary care. Richard

Bohmer commented that while the hospitals had been the convenient

starting point, they want very soon to get into the issue of how primary care

and the hospitals can work more closely together and then to look at how

we can work more closely with the community to reduce health problems.

Part of the strategy is focused on people who are patients and part on those

who are not. The strategy involves a three to five year commitment to reach

this point. The intention is to build bridges between the community end of

the DHB’s mandate and the campus end. This is difficult to achieve in the

abstract, but much easier when looking at particular needs. There are a lot

of areas where there is a need to work to more tightly connect different

components.

• There was a discussion of the potential impact that a DHB could have on

raising broader community health issues, such as the abuse of alcohol. Pat

Booth’s work in the term of the previous Board to push for compulsory

reporting of violence against children was seen as a good example of what

can be achieved.

• The Chief Executive noted that this strategy is not about which activities will

be pursued, but providing a mechanism to galvanise the organisation and

looking at organisational redesign to mobilise the organisation to achieve

the outcomes needed.

• One key element of the proposal is getting clinicians to take on leadership. A

second is the focus on outcomes and the work required to achieve them.

The Board Chair suggested this could be seen as being about overcoming

accumulated indifference; to start giving people capacity and support them

to overcome indifference.

• Some concern was expressed that there is a limit to what clinicians can do in

addressing the underlying determinants of inequality, resulting from the

structural change New Zealand has gone through.

• It was suggested that the organisation can do a better job of articulating

what is needed to meet the health needs of the community and that our

planning function needs to be of a quality that can provide guidance.

• Susanna Galea commented that she had found the approach extremely

useful. It provided a different perspective to serious problems, opening the

mind and making one think differently about how to meet the needs of the

population and the purpose of what we do.

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Resolution (Moved Max Abbott/Seconded Christine Rankin)

That it be recommended to the Board:

That the Board note this paper follows on from, and is consistent with, the earlier

papers that have been confirmed by the Board related to the organisational

purpose and values.

Carried

Resolution (Moved Pat Booth/Seconded Max Abbott)

That the Board endorse the two identified organisational priorities of:

a. Better Outcomes (for patients/ whanau/families/ staff, clinical groupings

and populations)

b. Relieving Suffering (with two subthemes related to enhanced

patient/whanau/family experience and better connections).

Carried

Resolution (Moved Wendy Lai/Seconded Allison Roe)

That the two organisational priorities should remain unchanged for the next three

years to ensure sufficient momentum is obtained and measurable results are

achieved.

Carried

Resolution (Moved Wendy Lai/Seconded Pat Booth)

That the Board note the developing work plan.

Carried

Richard Bohmer was thanked for his work on this and Dale Bramley noted that many

people are finding a lot of value from the work Richard is doing.

There was a discussion on the commitment being made to a three to five year

process and the Board Chair commented that it was important that this

commitment be there and that people realise that the strategy is not a fad.

5. PROVIDER ARM PERFORMANCE REPORT

5.1 Provider Arm Performance Report – July 2013 (agenda pages 21-90)

In addition to the July Performance Report, a brief summary report for August was

tabled and circulated at the meeting.

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Executive Summary/Overview/Scorecard

Dale Bramley introduced the report, noting that the financial performance for the

Provider Arm for July 2013 was close to target and on target for August, a very good

achievement. Health target performance had been maintained despite volumes

through the Emergency Departments being higher than ever before. He wished to

acknowledge the tremendous work done to meet the target for shorter waits in ED.

There was one day when performance had dropped to 87%, however over the last

two weeks the average had been 97% and the target achieved for the month.

In discussion of seasonal pressures, it was noted that spring had brought greater

pressures on Emergency Departments than winter for Waitemata DHB, Auckland

DHB and Counties Manukau DHB. Hasan Bhally commented that spring is certainly

the busier time for respiratory illnesses and influenza had a late peak this year. He

advised that in response clinicians had gone out of their way to see more patients.

Registrars and house officers had helped out in ED and ADU. It had been a great

team effort. The Board Chair asked the Chief Executive to work with the Division on

how best to recognise that. The Committee Chair advised that she would also send a

letter of thanks on behalf of the Committee.

Dale Bramley advised that ESPI compliance was tracking well, even against the new

four month target.

Robert Paine (Chief Financial Officer and Head of Corporate Services) summarised

the financial results and factors affecting the results shown in the August update

(circulated at the meeting) and in the July report. He noted that overall results are

still very close to budget and that given the time of year they give confidence about

the degree of control being shown in managing costs.


• With regard to the under spend in personnel costs, Robert Paine advised

that he did not think there had been a reduction in FTE, rather staffing had

not increased as much as allowed for in the budget. In answer to a question

he also advised that medical locum staff tend to be more expensive than

employed staff. Jocelyn Peach advised that for nursing to fill gaps they are

using in house locums who do not cost more than normal staff to employ.

• It was noted that the information provided did not match the Board Chair’s

information on vacancies and a request was made that the two sources of

information be correlated and a clear view of what is occurring with staff

numbers and vacancies be provided.

Resolution (Moved Alison Roe/Seconded Pat Booth)

That the Executive Summary/Overview/Scorecard be received.

Carried

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Surgical and Ambulatory Services

Cath Cronin (General Manager, Surgical and Ambulatory Services), John Cullen

(Head of Division Medical and ESC Director) and Mark Watson (Group Manager ESC)

were present for this section of the report.

Matters highlighted included:

• A separate scorecard for the ESC is still being worked on.

• With ESPI targets, the challenge is in Orthopaedics, where there is still work

to do.

• The renaming of the position Head of Division (Medical) SAS as Chief of

Surgery and Perioperative Medicine, which better described what the

position does. The position is currently being advertised, including overseas.

• Workload of staff this month, with all areas at full capacity. They remained

very focused on the patient experience and on getting value for money


• John Cullen advised that with spinal surgery there is almost unlimited

demand for surgical services and an emphasis on making sure that those

patients selected for surgery are the most appropriate ones. He did not

believe that there is a need to increase the service at the moment and he

considered that that regionally there is an over-servicing of spinal surgery.

Certainly there is a case for looking regionally at how back pain is managed

with a view to reducing surgery. It was agreed that this question be raised

with the National Health Committee.

• With regard to the last paragraph on page 43 of the agenda, Cath Cronin

advised that at the time ESC started some work was being done by Surgical

services that the Surgical and Ambulatory service was not holding the

budget for. This issue was about tracking patients and correctly

apportioning costs.

Resolution (Moved Max Abbott/Seconded Pat Booth

That the Surgical and Ambulatory Service section of the report be received.

Carried

Elective Surgery Centre

John Cullen noted that the ESC had been a little slower than anticipated in getting

numbers of operations up to where they were planned to be. This is being

addressed. He also commented that one of the cornerstones of the ESC concept had

been the development of surgeon/anaesthetist/nursing team continuity. Progress in

achieving that had been disappointing and hopefully progress would be able to be

reported in the next report.

Mark Watson highlighted:

• The conservative but safe start to operations in the ESC in July and August.

• The consolidation of nursing and administrative teams, which had

progressed well.

• The remarkably positive feedback from patients and surgeons.

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• Processes are now well tried and tested.

• Construction defects management – all defects identified have been very

minor and are being remedied.

• The first meeting of the ESC Clinical Advisory Committee is on 26

September. Clinical leadership is starting to come to the forefront.

Resolution (Moved Max Abbott/Seconded Christine Rankin)

That the Elective Surgery Centre section of the report be received.

Carried

Medicine and Health of Older Peoples Services

Debbie Eastwood (General Manager, Medicine and Health of Older Peoples

Services), Dr Jonathan Christiansen (Head of Division Medical) and Tamzin Brott

(Allied Health) were present for this section of the report.


• With regard to Ward 2, the Stroke Ward at North Shore Hospital, Jonathan

Christiansen advised that quite a lot of shuffling does take place to get

stroke patients located into that ward. They are achieving 70% at the

moment. Others are seen in the other wards by the Stroke Team.

• Waitemata DHB like Auckland DHB has a stroke audit and the results will be

brought back to the next meeting. Jonathan Christiansen advised that the

real challenge for Waitemata DHB is with those disabled by stroke and under

65 years of age, because we don’t have rehabilitation facilities for them.

• There was a discussion of the issue that with patients who have dementia

that there is no one with a role to feed them, and food can be left

untouched by them. The role of Nutrition Services is just to hand out trays.

Jocelyn Peach agreed that this is an area for improvement. Phil Barnes noted

that in the United Kingdom these gaps are covered by volunteer

programmes.

• With regard to the strategic initiative on page 54 of the agenda: “provide

LTC workforce education courses to primary health care practitioners -

ongoing”, Debbie Eastwood said that she would be discussing with Debbie

Holdsworth about where the accountability for this lies.

Debbie Eastwood, Jonathan Christiansen and Tamzin Brott were thanked.

Child, Women and Family Services

Linda Harun (General Manager, Child, Women and Family Services) presented this

section of the report. She conveyed apologies from Dr Tim Jelleyman and Dr Peter

van de Weijer.

Matters highlighted or discussed included:

• Results from the scorecard.

• “Breastfeeding Beginners Guide” referred to in the report – copies were

circulated at the meeting.

11 of 98


• After hours appointments are now being made in Oral Health, with no DNAs

for those.

• With the trial of paediatric clinics at Totara Health in New Lynn, social

workers are contacting those families who seem to have difficulty engaging

with the service or who seem to engage a lot. Home visits take place to see

what the issues are.

The Chief Executive thanked Linda and her team especially for what had been

achieved in reducing dental service arrears, a huge effort.

Mental Health and Addiction Services

Ian MacKenzie (Regional Forensics Manager and Acting General Manager, Mental

Health Services) and Alex Craig (Head of Department, Nursing) were present for this

section of the report.

Matters highlighted or updated included:

• The opening of the Connect (NGO) Facility at Silverdale (page 72 of the

agenda).

• The opening of the Equip (NGO) Facility at Koromiko House in Torbay on 2

September. Warren Flaunty congratulated Ian Mackenzie on his

presentation at the opening. Pat Booth requested to be advised of the

English translation of Koromiko.

• Perinatal Support – the Ministry of Health had confirmed new funding. The

region is in the final stages of developing a recommendation on how the

service development will be implemented. There is no simple solution and

quite a range of services are needed.

• Regional Eating Disorder Service - Review of Model of Care – as detailed on

page 74 of the agenda.


• It is correct that the model of care for eating disorders is no longer focused

on inpatient care and best practice is focused on family group therapy and

treatment based much more in the home or day care. This was quite a

shift.

• Closing of the police cells at both Orewa and Constellation Drive means

that the increased use of the cells at Waitakere Police Station will require

deeper resources to help those people held there.

• Dale Bramley distributed new pictures of the design for the Taharoto

building replacement. These were an improvement but he was still not

completely satisfied.

Ian MacKenzie and Alec Craig were thanked.

Resolution (Moved Max Abbott/Seconded Allison Roe)

That the Mental Health and Addiction Services section of the report be received.

Carried

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Provider Arm Support Services

Phil Barnes introduced the Hospital Operations section of the report. Matters he

highlighted included:

• Security – a large number of the incidents reported on page 81 of the

agenda actually involved a small number of patients.

• Phil’s role as Acting Manager of Hospital Operations is coming to an end

after 21 months. Phil outlined some of the developments that had occurred

over that period.

• The question of ascertaining what patients like and don’t like about hospital

food was raised. The Board Chair advised that the HBL indicative case for

change for Food Procurement was based on the concept that it is possible to

have a lot better service that is also more cost effective. That proposal will

come out in the next few months. The current set up means that nationally

massive investment in new kitchens is due. A lot of the savings that had

been found related to avoiding those costs. There will be a consultative

process with the HBL proposal. The Chief Executive advised that all hospital

meals are approved by dieticians and there is a robust process for hospital

food. He also mentioned that the national CEO group had been briefed on

the experience from Alberta on innovation similar to what HBL is

considering, with a key theme being getting the right mix of local and

national provision.

Phil Barnes was thanked.

The report was received.

6. CORPORATE REPORTS

6.1 Clinical Leaders’ Report (agenda pages 91-97)

Dr Andrew Brant (Chief Medical Officer), Dr Jocelyn Peach (Director Nursing and

Midwifery) and Phil Barnes (Director Allied Health and Acting GM for Hospital

Operations) presented this item.

Andrew Brant explained the information and graphs relating to Electronic Discharge

Summary Completion and Timeliness on pages 91 to 93 of the agenda.

Phil Barnes highlighted the proposed significant professional leadership changes and

consultation process concerning those. The changes are an attempt to position Allied

Health for major transformation ahead.

Jocelyn Peach highlighted:

• The review of role expectations for senior nurses in Clinical Nurse specialist roles.

• The diagram showing nursing leadership structure on page 97 of the agenda.

• Waitemata DHB participation in the national Civil Defence Emergency

Management awareness week. Dale Bramley has taken a leadership role for the

region in emergency planning.

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The Trendcare demonstration was deferred until the next meeting due to lack of time

and will be scheduled for earlier in the meeting.

The presenters were thanked.

6.2 Human Resources (agenda pages 98-103)

The report was taken as read. With regard to advertising on Kiwihealthjobs and the graph

on page 100 of the agenda, the Chief Executive noted that in July Waitemata DHB had

the most number of positions advertised there and in August was one of the top four.

Resolution (Moved Pat Booth/Seconded Wendy Lai)

That the report be received.

Carried

7. INFORMATION PAPERS

There were no information papers.

The Committee Chair thanked those present.

The meeting concluded at 1.27p.m.

SIGNED AS A CORRECT RECORD OF THE WAITEMATA DISTRICT HEALTH BOARD HOSPITAL

ADVISORY COMMITTEE MEETING OF 25 SEPTEMBER 2013

_____________________________________ CHAIR

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Actions Arising and Carried Forward from

Meetings of the Hospital Advisory Committee

as at 29th

October 2013

Meeting Agenda

Ref

Topic Person

Responsible

Expected

Report

Back

Comment

HAC

14/08/13

6.1 Trendcare – demonstration to

be arranged for Board members

Jocelyn

Peach

HAC

06/11/13

Deferred from

September

meeting

HAC

25/09/13

5.1 Emergency Department -

appropriate way to be found to

recognise the exceptional team

effort to meet the pressures

experienced in late winter/early

spring.

Also a letter to be sent from the

Committee Chair.

Dale Bramley

/ Debbie

Eastwood

Gwen

Tepania –

Palmer

Actioned. Letter

sent to Surgical and

Ambulatory Services

Staff.

HAC

25/09/13

5.1 Information on Staff Numbers

and Vacancies – information in

July Provider Arm on vacancies

to be correlated with Board

Chair’s information and a clear

view provided on what is

occurring with staff numbers

and vacancies.

Sam Bartrum

/ Robert

Paine

Board

06/11/13

Refer this month’s

Board Financial

Performance

Report. Robert and

Sam can also speak

to at the meeting.

HAC

25/09/13

5.1 Spinal Surgery – suggestion that

there is a case for looking

regionally at how back pain is

managed with a view to

reducing surgery to be raised

with the National Health

Committee.

Cath Cronin Case being

prepared.

HAC

25/09/13

5.1 Feeding of Dementia Patients -

issue of how to avoid meals not

being eaten to be looked at.

Jocelyn

Peach

Refer to note

below.

Note (re Feeding of Dementia Patients request):

As part of the nursing quality programme there is an interdisciplinary work group currently

working on a number of issues relating to patient nutrition and hydration. The work

programme relates to

• Assessment of all patients / particularly those at risk [weighing on admission and

weekly, use of MUST assessment form]

• Planning [referral for additional dietician input for patients at risk, protected meal

times for people at risk]

• Implementation of best practice processes [minimising 'nil per mouth' processes, red

tray and patient assistance for high risk patients, staff training] and

• Evaluation [patient experience/satisfaction, staff conforming to expected standards,

interdisciplinary engagement].

Intensive focus is planned in November and December of nursing and allied health staff to

address issues arising from ward and Dietitian audit findings.

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Waitemata DHB Hospital Advisory Committee Meeting 06/11/13

5.1 Provider Arm Performance Report – September 2013

Recommendation


___________________________________________________________________________ Prepared by: Robert Paine (Chief Financial Officer and Head of Corporate Services) and Andrew Brant (Chief

Medical Officer)

This report summarises the provider arm performance for September 2013.

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Provider Arm Performance Report

Table of Contents

Glossary

Executive summary

Scorecard

Health Targets

Financial Performance

Human Resources

Divisional Reports

- Medicine and Health of Older people services

- Child, Women and family services

- Mental Health and Addiction services

- Surgical and Ambulatory services

- Elective Surgery Centre

- 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

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

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.

July 2013).

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.

18 of 98


Executive Summary / Overview

OVERALL ASSESSMENT


For the month of September, the Provider Arm incurred a surplus of $1.675M which was $153k

unfavourable to the planned surplus for the month of $1.828M. This result is attributed to

overspends in staff costs and higher than expected clinical supplies costs, partially offset by savings

due to vacancies.

The Provider arm adverse financial performance was fully offset by a favourable position in the

Funder and Governance Arms combined result ($235k favourable). As a result, the entire DHB result

was $91k favourable to budget for the month.

SERVICE DELIVERY

Health Targets are on track for smokers to quit and shorter waits in ED. Elective volumes are slightly

below target but on track YTD.

Complaint response time averages have now improved to 14 days.

A project on DNAs is being led by Cath Cronin for the whole provider arm.

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Scorecard

Health Targets Actual Target Productivity Actual Target

Better help for smokers to quit 95.7% 1 0 95.0% �� ESPI 2 - % patients waiting > 5 months for FSA 0.2% 1 0 0.0% �

Provider Arm Elective Volumes 98.2% 1 0 100.0% � ESPI 5 - % patients not treated within 5 months 0.9% 0 1 0.0% �

Shorter Waits in ED 96.5% 1 0 96.0% �

Patient Flow

Average Length of Stay - Acutes 3.81 1 0 5.00 ��

Average Length of Stay - Electives 3.89 1 0 3.50 �

Discharges during weekends 19% 1 0 20% �

Quality Actual Target

Complaint Average Response Time 14 days 1 0 14 days � Contracts (YTD)

Rate of falls with major harm 2.0 1 0 < 0.07 � Elective WIES Volumes 4,150 1 0 3,980 �

Pressure injuries grade 3&4 0.0 1 0 0 �� Acute WIES Volumes 14,271 1 0 13,278 �

DNA Rates Number Non-Case weighted Discharges

First Specialist Assessment (FSA) DNA rate - Total 408 12.1% 1 0 10.0% � First Specialist Assessment (FSA) 9,024 1 0 10,694 �

First Specialist Assessment (FSA) DNA rate - Maori 70 23.1% 0 1 10.0% � Subsequent Attendance (FUP) 20,733 1 0 20,564 �

First Specialist Assessment (FSA) DNA rate - Pacific 46 19.6% 0 1 10.0% � Emergency presentations (admitted) 16,018 1 0 16,061 �

Follow up (FU) DNA rate - Total 778 10.4% 1 0 10.0% � Emergency presentations (non-admitted) 12,617 1 0 12,328 �

Follow up (FU) DNA rate - Maori 129 23.9% 0 1 10.0% �

Follow up (FU) DNA rate - Pacific 110 20.3% 0 1 10.0% �

Other Key Measures

Acute Readmission Rate within 28 days 11.5% 1 0 9.0% �

HR Wellbeing Actual Target

Sick Leave Rate (days) * 8.2 days 1 0 7.5 days ��

Overtime Rate (%) * � 1.3% 1 0 1.0% ��

Annual Leave Balance > 75 days 63 1 0 58 �

Turnover Rate % * 9.6% 1 0 10.0% �

Clinical Employ (FTE) 4,421 FTE 1 0 �

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

Financial Result YTD Actual $000s Target $000s

Revenue 187,957 k 1 0 188,395 k �

Expense 188,876 k 1 0 189,077 k �

Personnel Costs 124,630 k 1 0 128,074 k �

Outsourced Services 14,887 k 1 0 13,598 k �

Clinical Supply Costs 24,805 k 0 1 23,291 k �

Non-Clinical Supply Costs 24,554 k 1 0 24,115 k �

Contribution -919 k 1 0 -682 k �

Capital Expenditure 8,929 k 0 1 12,451 k �

Indicator Title 85.0% 1 k 0 100.0% � Improvement against previous result

DHB performance achieving or above the target will display as a solid green line.

Actual TargetDHB Performance

Waitemata DHB Monthly Performance ScorecardALL ServicesSeptember 2013

Service Delivery

Human Resources

Finance

Priority One

How to read

Quality

20 of 98


Health Targets

Better Help For Smokers To Quit

Shorter Stays in Emergency Departments

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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 05/10/2013

2008 2009 2010 2011 2012 Mean from Aug 2010 2013

Improved Access to Elective Surgery

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

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

Ele

ctiv

e S

urg

ica

l D

isch

arg

es

Week

Progress Against Elective Surgery Target - 2013/14WDHB Provided Target Total Target Estimated WDHB Provided YTD Estimated Total YTD

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Elective Performance: Zero Patients Waiting Over 5 and Over 4 Months

Specialty Compliant Non Compliant Non

compliance %

ESPI2 10479 16 0.15%

ESPI5 3458 19 0.55%

Specialty Compliant Non Compliant Non

compliance %

ESPI2 9484 1011 9.63%

ESPI5 226 3251 93.50%

Specialty Compliant Non

Compliant

Non compliance

%

Specialty Compliant Non

Compliant

Non

compliance %

Compliant Non

Compliant

Non

compliance %

Cardiology 174 0 0.00%

Anaesthesiology 88 0 0.00% 88 0 0.00% General

Surgery

751 3 0.40%

Cardiology 1,217 0 0.00% 1052 165 15.68% Gynaecology 460 0 0.00%

Dermatology 69 0 0.00% 69 0 0.00% Orthopaedic 1033 12 1.16%

Diabetes 149 0 0.00% 142 7 4.93% Otorhinolary

ngology

655 4 0.61%

Endocrinology 165 0 0.00% 160 5 3.13% Urology 385 0 0.00%

Gastro-Enterology 1,016 0 0.00% 876 140 15.98% Total 3458 19 0.55%

General Medicine 306 0 0.00% 302 4 1.32%

General Surgery 1,441 1 0.07% 1296 146 11.27%

Gynaecology 984 0 0.00% 876 108 12.33%

Haematology 82 0 0.00% 82 0 0.00% Specialty Compliant Non

Compliant

Non compliance

%

Infectious Diseases 18 0 0.00% 18 0 0.00% Cardiology 2 172 1.16%

Neurology 32 0 0.00% 32 0 0.00% General

Surgery

33 721 4.58%

Oncology 22 0 0.00% 22 0 0.00% Gynaecology 18 442 4.07%

Orthopaedic 1,472 1 0.07% 1302 171 13.13% Orthopaedic 97 948 10.23%

Otorhinolaryngology 1,299 13 1.00% 1105 207 18.73% Otorhinolary 50 609 8.21%

Paediatric MED 1,019 1 0.10% 1006 14 1.39% Urology 26 359 7.24%

Renal Medicine 78 0 0.00% 78 0 0.00% Total 226 3251 6.95%

Respiratory Medicine 246 0 0.00% 244 2 0.82%

Rheumatology 187 0 0.00% 187 0 0.00%

Urology 589 0 0.00% 547 42 7.68%

Total 10,479 16 0.15% 9,484 1,011 10.66%

ESPI5 Summary (1% Compliance Buffer) - Compliant 4 months

Waitemata DHB: ESPI Compliance Summary Report - 5 months

Waitemata DHB: ESPI Compliance Summary Report - 4 months

ESPI2 Summary (0.4% Compliance Buffer) ESPI5 Summary (1% Compliance Buffer) - Compliant 5 months

5 months 4 months

As at September 2013 the Provider was compliant for ESPI 2 and 5 within the allowable MoH buffer

for five months waiting. This means that they obtained yellow status and no penalty trigger is

activated. The Provider will therefore be compliant within the MoH buffer for ESPI 2 and 5 for the

quarter.

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All Services

CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Sep-13

Provider

($000’s)

Actual Budget Variance Actual Budget Variance Forecast Budget Variance

REVENUE

Government and

Crown Agency 60,967 61,512 (545) 181,774 182,753 (979) 734,303 734,303 0

Other Income 2,030 1,806 224 6,182 5,642 541 21,876 21,876 0

Total Revenue 62,997 63,318 (321) 187,957 188,395 (438) 756,180 756,180 0

EXPENDITURE

Personnel

Medical 11,231 11,614 383 34,886 35,984 1,098 144,185 144,185 0

Nursing 15,473 15,851 378 48,274 49,052 778 196,632 196,632 0

Allied Health 7,971 8,128 157 24,699 25,320 621 99,828 99,828 0

Support 1,046 1,239 192 3,155 3,838 682 15,364 15,364 0

Management /

Administration4,423 4,473 50 13,616 13,880 264 54,732 54,732 0

40,144 41,304 1,160 124,630 128,074 3,444 510,740 510,740 0

Other Expenditure

Outsourced Services 4,801 4,584 (218) 14,887 13,598 (1,290) 54,537 54,537 0

Clinical Supplies 8,328 7,801 (527) 24,805 23,291 (1,515) 93,808 93,808 0

Infrastructure & Non-

Clinical Supplies8,048 7,801 (247) 24,554 24,115 (439) 96,094 96,094 0

21,177 20,185 (992) 64,246 61,003 (3,243) 244,439 244,439 0

Total Expenses 61,322 61,490 168 188,876 189,077 201 755,180 755,180 0

Contribution 1,676 1,829 (153) (919) (682) (237) 1,000 1,000 0

Allocations 0 0 0 (2) (2) 0 0 0 0

NET RESULT 1,675 1,828 (153) (917) (680) (237) 1,000 1,000 0

FULL YEARMONTH YEAR TO DATE


Provider

($000’s)


CONTRIBUTION

Surg & Ambulatory (634) (787) 154 (2,389) (2,622) 234 (12,005) (12,005) 0

Medical & HOPS 6,980 6,826 154 19,552 18,934 618 73,926 73,926 0

Child Women F. 3,272 3,359 (88) 8,883 8,987 (104) 35,986 35,986 0

Mental Health 2,894 2,804 90 8,139 7,581 557 31,692 31,692 0

Elective Surgery Centre 385 508 (123) (19) 332 (351) 6,480 6,480 0

Provider Support (11,221) (10,881) (340) (35,085) (33,894) (1,191) (135,079) (135,079) 0

Total Contribution 1,676 1,829 (153) (919) (682) (237) 1,000 1,000 0

MONTH YEAR TO DATE FULL YEAR

CONSOLIDATED STATEMENT OF PERSONNEL by PROFESSIONAL GROUP Reporting Date Sep-13

Provider


FTE

Medical 665 632 (34) 642 646 4 653 653 0

Nursing 2,557 2,552 (6) 2,479 2,599 121 2,602 2,602 0

Allied health 1,450 1,498 48 1,429 1,531 102 1,515 1,515 0

Support 273 335 62 263 336 73 336 336 0Management 762 780 18 755 796 41 779 779 0

Total FTE 5,708 5,796 88 5,568 5,909 341 5,885 5,885 0


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COMMENT ON MAJOR VARIANCES

Revenue

Year to date, Provider Arm is $438k unfavourable. Of this $1.212m relates to the shortfall of delivery

of ESC elective output offset by $232k favourable Medicine and HOPs ACC AT&R non-acute revenue,

additional $150k of car parking revenue (from increased fees and inclusion of satellite areas), $492k

of additional interest and $165k of unbudgeted mental health respite revenue which has not been

transferred to NGO providers. In addition there has been a shortfall in Non Resident revenue billing

of $483k and a delay in the transfer of paediatric volumes resulting in an unfavourable revenue

variance of $188k.

Expenditure

Expenditure for the Provider arm was overall favourable for the month ($168k) and YTD ($201).

Within this is a substantial underspend in personnel costs for the month ($1.160M) and YTD

($3.444M) arising in all divisions and staff types.

• Medical Personnel ($1098k favourable) – $968k of this stems from SMO vacancies (3.8FTE) in

SAS which are being covered by outsourced staff, high levels of leave taken in July and savings

on RMO rotation costs (due to lower theatre volumes and efficient rostering). A $225k

MedHops underspend was due to vacancies in ED ($274k, held vacant in advance of the review

of the staffing model) and a $325k underspend due to short term vacancies and tighter control

over allowances across the division. Offsetting this is a $174k overspend for SMO hyperbaric

unit costs (which will be refunded by the NHB) and a $200k provision for medical costs that may

arise later in the year

• Nursing Personnel ($778k favourable) – The difficulty in recruiting to nursing positions on the

wards has eased in comparison to prior months but has contributed to a nursing underspend of

$875k in SAS, ESC and MedHops, some of which was offset with bureau spend. In addition,

MedHops has generated a $152k savings in ED as new clinical nurse specialists are paid at

reduced rates during their training. Mental Health Services has also experienced nursing staff

cost underspends ($410k) from positions held vacant in advance of service reviews and higher

than expected annual leave. These favourable variances are partially offset by unfavourable

variance in centralised nursing savings budgets.

• Allied Health Personnel ($621k favourable) – $325k of this variance arises in the CWF division

as both Child Health and Dental delay in recruiting into some budgeted positions. Child Health

will not fill roles until they are confirmed as part of their service redesign, and Dental will hold

vacancies until their recruitment of new graduates in early 2014. Mental Health Services are 8

FTE, $252k favourable YTD but are actively recruiting to fill these vacancies. Maori Health is

$245k favourable to budget as staff costs are being recorded under admin personnel. MedHops

are $102k unfavourable due to costs in the hyperbaric service.

• Support and Admin Personnel ($946k favourable) – The bulk of the underspend in Support

staff costs relates to vacancies in orderlies and cleaning staff ($508k) which is matched by the

use of agency casual staff paid from outsourced services. Vacancies in facilities maintenance

staff contribute a further $114k to the Support staff costs underspend. The Management and

Admin underspend ($264k) was mainly in Corporate Services, clinical records and typing due to

vacancies some of which are covered by contractors (with corresponding costs in outsourced

services costs).

Non staff costs were unfavourable by $3.243M YTD. Of this $1.318M related to overspends on

outsourced staff related to: the cost of covering vacant positions budgeted in staff costs, and a net

$113k underspend on combined ESC/SAS POC budgets due to lower than planned activity.

25 of 98


The YTD $1.515M unfavourable variance in clinical supplies cost arises in all divisions and is partly

offset by a $294k underspend in ESC implant costs due to lower volumes. SAS experienced a $428k

overspend in implant costs as it carried out orthopaedic procedures impacted by the delayed

opening of ESC. The $358k clinical supplies overspend in MedHops was due to $183k of PCT drug

cost ahead of plans and $282k unbudgeted spend for client support costs incurred by ADHB due to

the delay in the Renal Phase 2 project and higher respite costs in older adults. In addition MedHops

have incurred costs earlier than anticipated for ostomy and mobility products ($103k) and higher

than planned pacemaker costs ($42k). Hospital Operations have overspent clinical supplies costs by

$193k due to higher labs ($118k) and pharmaceutical ($184k) volumes offset by $127k savings from

repatriation of the engineering service from ADHB. The clinical supplies overspend in CWF services

($394k) is due to changes in the dental recharging agreements with ADHB and CMDHB, $80k of

which is offset by additional revenue. Provider Arm services have also budgeted $290k of national

clinical supplies savings which are not expected to be achieved until later in the year.

The $439k unfavourable variance in Infrastructure costs relates to $1.108M of unmet savings from

professional services and general operating costs mitigated by other infrastructure underspends

such as a $119k underspend on electricity costs, $131k interest saving from lower debt balances

and interest rates, delayed IT spending of $226k and hotel cost savings of $257k.

26 of 98


Human Resources

All Services

Sick Leave

Trends

Following a slight decrease in August the sick leave rate has spiked upwards in September and is at

its highest since September 2011.

Highlights/risks

It will be concerning if this significant upwards trend continues particularly as we are moving into

summer and the holiday period where more staff are away on annual leave. It would be expected

that this should level off and decrease over the next few months.

Planned Actions

We will continue monitoring to assess ongoing trend with more detailed analysis by the Division to

identify any particular areas needing attention. HR Advisors to continue to support managers with

sick leave management planning where required.

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Overtime

Trends

Following a slight decrease in August, the overtime rate has increased in September to be sitting just

below 1.5%. This pattern reflects the sick leave trending for the same period. This is higher than

2012 figure but slightly less than 2011.

The annual result shows a continued trend downwards towards the target of 1%.

Highlights/risks

Overall the rates still reflect a significant improvement with a continued reducing trend. We are

however tracking slightly above rates for the same period last year which to some extent will be

influenced by the increased sick leave rates.

Planned Actions

Continued monitoring at organisational and Divisional level and support from HR to implement

targeted strategies to address any concerns identified.

Annual Leave Management (headcount)

Service AL bal AL bal AL bal AL bal

0-24 days 25-49 days 50-74 days 75+ days

01-WIMO Medical and HOPS 1277 497 120 24

01-WSAS Surgical and Ambulatory 784 287 70 15

01-WWCW Child Women & Family 805 172 24 9

01-WESC Elective Surgery Centre 53 9 4 0

01-WMHS Mental Health Services 864 291 31 9

01-WHOG Hospital Operations 420 175 14 2

01-WACP Corporate 157 68 9 4

01-WCFA Facilities and Development 16 14 1 0

Grand Total 4,376 1,513 273 63

Trends

The figures in general continue to remain fairly stable. The most significant change this month has

been an increase of about 200 in the 0-24 days leave bracket which will most likely be due to

anniversary dates falling in this period and new entitlements being credited.

28 of 98


Highlights/risks

There has been a very slight increase in the number of employees with between 25-74 days leave in

the September reporting period. While it is not significant, a continued focus is required on this

cohort to ensure a reduction in leave balances.

Planned Actions

Services will be encouraged to maximise opportunities to release employees over the summer

period, with a particular focus on those with higher leave balances.

HR to continue to support managers with leave planning across teams and to work with individuals

with high leave balances to work towards reductions.

Staff Retention

Staff Resignations within 6 months

Trends

There has been a slight decrease in August and September with the rate being static over this

period. This aligns with the annual trend of decreasing turnover.

Highlights/risks

While there have been one or two upward spikes over the past twelve months, the trend of

decreasing turnover has been sustained and ongoing over all.

Planned Actions

Continued monitoring and implementation of strategies such as exit interviews to identify any issues

or patterns that may need addressing.

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Turnover

Trends

Turnover rate has continued to decrease over the past two months to be sitting below target. It is

noted that leavers in the current month have been under reported in the system but it is not

expected that this will have had a significant impact on the current trend.

Highlights/risks

While it is positive to see reduced turnover, current trending down to 6%, if sustained, could create

a converse concern as some turnover is required to support continued organisational development

through the importing of a range of skills and knowledge.

Planned Actions

Continued monitoring and review of strategies based on trends over the next few months.

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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 Dr Jonathan

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

are Dr Hamish Hart for Medicine, Dr John Scott for Health of Older Adults, Dr Tina Crownshaw and

Dr Angela O’Brian Acting Heads for Psychiatry for the Older Adult, Dr Willem Landman for

Emergency Care, Dr Ali Jafer for Gastroenterology, Dr Rick Cutfield for Diabetes/Endocrinology, Dr

Tony Scott for Cardiology, Dr Hasan Bhally for Infection Diseases, Dr Janak De Zoysa for Renal, Dr

Megan Cornere for Respiratory, Dr Ross Henderson for Haematology, Dr Cathy Miller for Palliative,

Dr Blair Wood for Dermatology and Dr Michael Corkill for Rheumatology.

SCORECARD

HEALTH TARGETS

Smokefree

September’s organisational results show a further improvement against the ‘Better help for smokers

to quit’ health target with 98% of all identified smokers offered advice and support to quit. Just 25

of the 1087 admitted smokers were discharged without evidence that support was offered.

September’s performance was enough to secure a result of 97% for Q1.

The Medicine and Health of Older People Service achieved 95.5% for September against a target of

95%.

ELECTIVE WIES & DISCHARGES FOR CARDIOLOGY

WIES for elective cardiology procedures is under budget for September; however it is at 96% of

contract YTD.

COMPLAINTS

The number of complaints received in September was 32 for the month with a turnaround time of

22 days against a target of 14. We received 12 requests/inquiries/suggestions in the month and

these had an average response time of 11 days.

The resignation of our Quality Lead who supported our service with complaints is a significant loss,

and has impacted on our ability to consistently respond to our complaints in a timely manner. The

Quality Unit is trying to continue to support us in a more limited manner until the position is filled.

However this is not optimal at our busiest time of year in the acute hospital where the majority of

our complaints originate from.

DNAs

Our overall DNA result for First Specialist Assessments is 12% which is 2% higher than our target of

10%. Follow Up appointments are under the 10% target at 9.7%. However DNA for Maori and Pacific

people is significantly higher at an average of 23% across all appointments. The area of focus for

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Medicine & Health of Older People will be our First Specialist Assessments as this has a higher DNA

rate than follow up appointments for Maori and Pacific people. One of our key initiatives will be to

roll out patient focused booking across all the Medicine specialties. This has been done in Diabetes,

however further refinement of the patient focused processes is required within Diabetes to realise a

sustained reduction in DNA rates.

Moving the management of all outpatient appointments for medical sub specialties into the

Medicine & Health of Older People Service division has allowed the development of a full

programme of improvement to commence with staff. Starting immediately, the systems and

processes in the department are all being reviewed by the team to ensure they are fit for purpose

and enhance engagement with our patients. It is expected that this review will result in a significant

change in the way appointments are booked and managed for medical specialities. The changes will

take some time as many of the current systems and processes have been in place for a considerable

time.

OTHER KEY MEASURES

Shorter Stays in ED

Shorter stays in ED performance for September was 97.1% for Medicine & Health of Older People

and 96.5% for the organisation for July – Sept (Q1). Achieving this result for September and Q1 was

supported by:

• Increasing orderly resources for transporting patients between ED and Radiology

• Short Stay Ward remaining open 24/7

• Use of ‘mid shift’ for ED doctors

• Charge nurse managers texting regular updates to General Managers and Operations

Managers when action and/or additional support is required

General Medicine also implemented a number of strategies over the winter and in particular

September to support the high winter volumes and ensure patients flowed appropriately through

the system and received the care they needed in a timely manner. These initiatives included:

• Cancelling elective registrar clinics on our high volume days (Monday and Tuesday) for

September

• Adding additional junior doctor support into ED/ADU on Monday and Tuesday from 4pm to

9pm

• Operations Manager working Sunday mornings over September to support patient flow and

manage weekend staffing issues as they arose, i.e. junior doctor sick leave, allocation of

workloads

• Operations Manager regularly checked the whiteboard and initiated early escalation to

Senior Medical Officers as required in the evenings

QUALITY

Falls prevention has been the weekly focus at Frontline Focus Friday and the data that has been

collected for the quarter ending 30 September shows a pleasing improvement in our results. The

organisational data shows that 94% of patients had a falls assessment completed and 76% had an

individualised care plan. This data feeds into the HQSC quarterly reporting.

The First Do No Harm regional group have employed another quality improvement specialist who is

going to help collate the falls and pressure injury data from ARRC.

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Hourly Rounding (HR) - HR was the main topic for the September Quality Day. One of the key

emphases was to reiterate the reasons for HR and why it is an important component of high quality

patient care. This discussion generated a better understanding amongst the nursing staff of why we

do hourly rounding and the importance of their ‘buy in’ to ensure it is done consistently and to a

high standard.

All specialties across Medicine & Health of Older People are working on their quality plans. Ideally

each area will identify 1 or 2 important process, structure or outcome measures that will underpin

their local continuous quality improvement work.

HUMAN RESOURCES

Our recently appointed overseas trained nurses and new graduates have almost completed their

orientation and nursing rosters are now starting to reflect safer staffing levels and an improved skill

mix across all the general medical wards. This recruitment will mean significantly less reliance on

both internal and external nursing staff to fill budgeted roster gaps, thereby improving team work

and patient care on the wards.

We now have a process in place to ensure all wards’ rosters are signed off by both the charge nurse

managers and then the Nursing Head of Department to ensure there are minimal roster gaps and

that rosters are compliant with the agreed cover model.

We are pleased to have appointed a quality improvement lead into the Infection Control Team; this

role will provide leadership within the team for our hand hygiene and surgical site infection

programs.

SERVICE DELIVERY

Cardiology achieved 93% compliance with the MoH target of 85% of elective patients receiving their

coronary angiogram within 90 days. However the total number of patients waiting has increased; we

will address this rise by increasing the number of sessions for this group of patients in the catheter

laboratory.

Colonoscopy service delivery – as noted on the scorecard we achieved 52% compliance for the

urgent colonoscopies completed within 14 days. The additional endoscopy room at Waitakere

Hospital opened in early August and we have processed an additional 174 patients through this

room to date.

ESPI COMPLIANCE

ESPI 2 & ESPI 5

All specialties are compliant with the 5 month target this month. We are continuing to work on our

outpatient processes; this work will support us to consistently achieve the 5 month target and move

towards 4 months.

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Scorecard


Better help for smokers to quit 95.5% 1 0 95.0% �� Chemotherapy waiting times - within 4 weeks 100% 1 0 100% ��

Provider Elective Volumes (Cardiology) 91.0% 1 0 100.0% � % elective coronary angiography within 90 days 93% 1 0 85% �

Shorter Waits in ED 97.1% 1 0 96.0% � % urgent diagnostic colonoscopy done within 14 days 52% 1 0 50% �

% diagnostic colonoscopy done within 42 days 45% 1 0 50% �

% surveillance colonoscopy done within 84 days 58% 1 0 50% ��

Patient Flow

Quality Actual Target Average Length of Stay - Acutes 3.64 1 0 3.50 �

Complaint Average Response Time 22 days 0 1 14 days � Average Length of Stay - Electives 3.67 1 0 3.82 ��

Rate of falls with major harm 2.00 0 1 < 0.07 � Average Length of Stay - AT&R 16.00 1 0 15.50 �

Discharges at weekends 20.9% 1 0 20.0% �

DNA Rates Number Discharges before 11am 15.4% 1 0 20.0% �

First Specialist Assessment (FSA) DNA rate - Total 140 12.1% 1 0 10.0% �

First Specialist Assessment (FSA) DNA rate - Maori 27 27.6% 0 1 10.0% � ESPI 2 - % patients waiting longer than 5 months for FSA

First Specialist Assessment (FSA) DNA rate - Pacific 20 25.3% 0 1 10.0% � Cardiology 0.0% 1 0 0.0% ��

Follow up (FU) DNA rate - Total 322 9.7% 1 0 10.0% �� Dermatology 0.0% 1 0 0.0% ��

Follow up (FU) DNA rate - Maori 45 21.4% 0 1 10.0% � Diabetes 0.0% 1 0 0.0% ��

Follow up (FU) DNA rate - Pacific 50 20.3% 0 1 10.0% � Endocrinology 0.0% 1 0 0.0% ��

Gastroenterology 0.0% 1 0 0.0% ��

Other Key Measures General Medicine 0.0% 1 0 0.0% ��

ADU - time to be seen from triage (Medicine) % Compliant to 60 minutes 49.0% 0 1 70.0% � Haematology 0.0% 1 0 0.0% ��

Acute Readmission Rate within 28 days 13.8% 0 1 9.0% � Infectious Diseases 0.0% 1 0 0.0% ��

Renal 0.0% 1 0 0.0% ��

Respiratory 0.0% 1 0 0.0% ��

Rheumatology 0.0% 1 0 0.0% ��

HR Wellbeing Actual Target ESPI 5 - % of Patients not treated within 5 months

Sick Leave Rate (days) * 8.0 days 1 0 7.5 days � Cardiology 0.0% 1 0 0.0% ��

Overtime Rate (%) * 0.6% 1 0 1.0% ��

Annual Leave Balance > 75 days 24 1 0 32 � Contracts (YTD)

Turnover Rate % * 9.7% 1 0 10.0% � Elective WIES Volumes

Clinical Employ (FTE) 1,486 FTE 1 0 � Medical (Overall) 412 1 0 441 �

* 12 month rolling average Cardiology 321 1 0 333 �

Gastroenterology 50 1 0 59 �

Acute WIES Volumes

Financial Result YTD Actual $000s Target $000s Medical (Overall) 8,305 1 0 7,468 �

Revenue 69,323 k 1 0 69,091 k �

Expense 49,771 k 1 0 50,157 k � First Specialist Assessment (FSA) 3,488 1 0 4,015 �

Personnel Costs 39,056 k 1 0 40,109 k � Subsequent Attendance (FUP) 9,432 1 0 9,856 �

Outsourced Services 1,235 k 1 0 1,164 k � Emergency presentations WTK L4 (admitted) 4,931 1 0 4,844 �

Clinical Supply Costs 7,684 k 1 0 7,327 k � Emergency presentations WTK L4 (non-admitted) 6,539 1 0 6,773 �

Non-Clinical Supply Costs 1,796 k 1 0 1,558 k � Emergency presentations NSH L5 (admitted) 11,087 1 0 11,217 �

Contribution 19,552 k 1 0 18,934 k � Emergency presentations NSH L5 (non-admitted) 6,078 1 0 5,555 �

Capital Expenditure 186 k 0 1 362 k �




Medical and Health of Older PeopleSeptember 2013

Human Resources

Quality

Finance

Priority One Service Delivery

How to readHow to readHow to read

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Strategic Initiatives

Deliverable /Action On Target

Increase monitoring and review of waiting times by ethnicity for echocardiograms and

adopt new ways of working that will improve the use of current capacity and reduce

waiting times ��

Direct access for general practitioners to specialist nurse and /or doctor advice in renal,

diabetes, gerontology, dementia and cardiology – confirm current practice and

establish baseline Q1, identify any enablers or process changes required (e.g. processes

to ensure any advice provided is captured in clinical notes) Q2, implement changes

required Q3, direct access in place for identified specialties Q4

��

The Diabetes Centre will explore the option to extend the Mind the GAP (Glucose

Awareness Project) programme once the results of the pilot are known ��

Inpatient hospital services (31 services) will have a trained and resourced smokefree

lead to provide training and support to clinical staff. These leads will be supported and

resourced by the Waitemata DHB Smokefree Team with peer support and monthly

updates

��

Refresh the ABC activity recording form (ATM – Ask, Triage, Manage) in use at

Waitemata DHB ��

Having completed a comprehensive review of the current General Medicine model of

care, redesign the model of care and staffing for General Medicine inpatient services by

September 2013 x

Implement the new model of care by February 2014 x

Continue the development and implementation of clinical pathways which will ensure

standardisation and equity of care for patients in both ED & ADU – 5 pathways to be

reviewed and/or developed by June 2014 ��

Develop a workforce strategy plan for the ED by July 2013 with sign off and initial

implementation by December 2013 x

Implement a semi acute respiratory clinic by July 2013 for winter demand and evaluate

by December 2013 x

Provide LTC workforce education courses to primary health care practitioners –

ongoing completed

Implementation of an staff on-line training tool for thrombolysis staff ��

Use the findings of the Integrated Transition of Care Project to inform development by

October 2013 of a suite of interventions to improve the discharge management

process. Commence piloting the suite of interventions by January 2014. Use participant

feedback for iterative development and re-piloting to achieve a sustainable suite of

interventions by April 2014. Pilot evaluated to determine suitability for rollout across a

range of inpatient services by 30 June 2014

��

Implement the Ministry of Health Elder Abuse Guidelines ��

Deliver secondary preventative care for fragility sufferers (through identification,

investigation and intervention) to prevent hip fractures. This will be supported by the

Minimum data set (MDS) for hip fractures. (Service Level Agreement in progress) ��

Finalise and report the findings of clinical quality audit of Māori referrals for

angiography and angioplasty by September 2013, and develop a business case to

support implementation of recommendations as appropriate ��

Review older people services and clinical pathways ��

Ongoing provider arm services reviews ��

* include a � or a �

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Key achievements for month

• The Infection Control Team’s work programme has now been signed off for this year. They are

also ready for the Health & Disability Sector Standards audit including all the necessary

policies and procedures and a draft risk register.

• The Board approved the Renal Phase 2 contractor tender recommendation

(contractor/tender price) for the clinical fit-out of community dialysis building at Apollo Drive.

• Four recliners and one specialty chair (Bionic Therapy chair) sponsored by the Look Good Feel

Good working for Women with Cancer organisation were delivered to Haematology Day Stay

Unit in September.

• The Waitemata DHB renal denervation (for refractory Hypertension) program is progressing

well with seven cases now being completed. The Renal Service continues to work

collaboratively with the Cardiology Service on the delivery of this new service.

• The New Zealand Renal Society (RSA) conference in November this year is being organised by

the Waitemata DHB senior renal nurses and technicians. The programme is now finalised and

the key note speaker is Dr John Agar from Australia who has a strong interest in home

haemodialysis.

• Since coming under the management of Waitemata DHB, the Slark Hyperbaric Unit has

undertaken elective patients for wound healing. These patients have been referred by

orthopaedic services of local DHBs. They have also provided treatment to two acute patients,

with one being a diving injury. We have also now recruited a third Senior Medical Officer to

support the on call roster (evenings and weekends). This recruitment has minimised a

significant risk in terms of sustainability of the after hours service.

• Social Workers Day was held on Wednesday 25th September with a morning tea in the staff

café at North Shore and a shared lunch at Waitakere for all social workers to celebrate.

• The Hector Trust has given approval for the purchase of 2 iPads and software to be used for

therapeutic activity by the allied health multidisciplinary team at North Shore Hospital. These

units can also be used to provide Skype tele-rehabilitation as they will be 3G capable.

• Waitemata DHB continues to be provide training opportunities for allied health students, with

the following placements currently in place: o 23 AUT year three occupational therapy students o 30 AUT year four physiotherapy students o 14 AUT year one physiotherapy students during October

• The Advanced Nurses Gerontology Symposium was held on October 4th and hosted by

Waitemata DHB.

Areas off track for month and remedial plans

• The ED workforce strategy is underway, however there has been a delay in the initial

consultation with the medical staffs union (ASMS), as they have required longer than

anticipated to review the indicative case for change and respond to us. We have also

experienced delays with rolling out the best care bundles (BCB) and now anticipate having

four rolled out by December. Some of the delay for the development of the BCB has been

the additional time to consult with other services; however this is an important component

of ensuring the bundles are appropriate.

• Whilst the recruitment of a senior nurse for the fracture liaison service has been delayed we

have now recruited a suitable nurse who will commence in October. The model of care for General Medicine will be one of the projects for the Richard Bohmer

workshop in December, however we are including Health of Older People leaders in the

discussion around how we might design our services to support frail elderly from ED through to

discharge or rehabilitation.

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Key issues/initiatives identified in coming months

• We are currently working on our summer plan which includes closing beds and reducing

nursing staff levels over this period. We will also be maximising annual leave across all areas

of the service with a focus on the non-acute services.

• We are looking at options to replace the vacant team leader for the medical bookings team

which has transferred into our service.

• We are working with NoRTH on how best to manage the over allocation of house officers

who start in November. One of the key areas of focus is using the additional resources to

improve the onerous house officer roster at North Shore for General Medicine and then for

General Surgery and Orthopaedics.

• The Needs Assessment and Service Coordination team continue to work with a high

workload and the pressure of an increasing waiting list for non-urgent household support.

The Planning and Funding team has agreed to fund an additional 4 FTE to work through the

back log. We are currently recruiting to these additional fixed term positions.

• Gastroenterology – one of the senior medical staff has agreed to do a dedicated non-urgent

gastroscopy list each week to reduce the number of longest waiting patients. We are also

working on outsourcing this group of patients.

Overview of the Stroke Service at Waitemata DHB

The stroke service is divided into acute (under General Medicine) and rehabilitation (under Health of

Older Adults). Patients with an acute stroke are admitted to either of our stroke units with one being

Ward 2 at North Shore and the other Wainamu at Waitakere Hospital. Patients remain in the stroke

unit until they are medically stable and are then either discharged or transferred to a rehabilitation

ward/unit.

VOLUME & DEMOGRAPHICS

The number of stroke patients cared for by the acute service has steadily increased by approximately

10% each year and stroke services are now caring for more than 1000 patients per year. The median

age of our stroke patients is 76 years old with 76% being 65 years or older and 36% over the age of

80.

STROKE FEATURES

Stroke is defined by the World Health Organisation as a

condition characterised by rapidly developing symptoms

lasting more than 24 hours and with no apparent cause

other than that of vascular origin. Transient ischaemic

attacks (TIAs) are defined as where these symptoms and

signs last less than 24 hours. TIAs share the same causes

as stroke and may precede a stroke.

Ischemic stroke is by far the most common. Because there

are many conditions that can mimic a stroke the Acute

Stroke Service also see a significant number of non-stroke

patients (11%).

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Average Length of Stay (LOS)

The average LOS across the two hospitals is 7.6 days however this value is skewed by a small number

of patients with very long LOS. A more meaningful summary statistic of LOS is median LOS = 5.0444.

Hospital Median LOS (days) Average LOS (days)

North Shore 4.841 7.4

Waitakere 5.873 8.6

STROKE UNIT ADMISSION

The stroke unit at NSH (Ward 2 - 10 beds) opened in July 2011 and the stroke unit at WTK (Wainamu

- 6 beds) in July 2012. Co-locating patients with stroke in a dedicated geographic area of the hospital

has been shown to save lives and reduce disability. The key factors leading to this benefit are

cumulative experience of nursing staff and a specialised and coherent multidisciplinary team.

National guidelines set by the Ministry of Health stipulate that at least 80% of all stroke patients

should be admitted to a dedicated stroke unit. Waitemata currently falls just below this target at

72%. Ischemic strokes in particular can be difficult to distinguish from other conditions that mimic

stroke and the challenge comes from ensuring ‘real strokes’ get directed to a limited number of

stroke beds.

Thrombolysis Cases Per Year

Thrombolysis ("clot busting") is specialised treatment that breaks up clots inside the blood vessel. It

is applicable only to a small proportion of patients with stroke due to a number of reasons, the chief

of which is the need to initiate treatment within 4.5 hours of symptom onset. Delayed presentation

to hospital will thus render the patient ineligible for treatment. The stroke team is currently

performing a prospective audit of all stroke cases to determine the individual patient reasons for not

receiving thrombolysis. Preliminary data based on approximately 6 months suggests that

institutional deficiencies are very rarely the cause for thrombolysis to be with-held.

CONCLUSION AND FUTURE CHALLENGES

The most important development in stroke care in the last 10 years has been the development of

the Stroke Unit concept. Waitemata DHB now has two established and effective units. It remains a

challenge to admit all eligible patients to these units because of high hospital wide bed demand and

to a lesser extent infection control issues.

Stroke thrombolysis continues to be a work-in-progress both at Waitemata and around the country.

Although our thrombolysis rates are low, clinical audit indicates that majority of eligible patients are

being appropriately managed. The necessary pathways are in place and clinical experience and

confidence are increasing. We have made contact with ADHB to discuss their review of stroke

services and will see how this might be undertaken at Waitemata. We are also planning to bring

together our wider stroke team as part of the Richard Bohmer work in 2014, so reviewing the service

prior to this would provide a useful baseline.

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Financial Results


Medical & HOPS

($000’s)


REVENUE

Government and

Crown Agency 23,030 22,879 151 68,811 68,730 81 274,484 274,484 0

Other Income 187 120 66 513 361 151 1,446 1,446 0

Total Revenue 23,217 22,999 217 69,323 69,091 232 275,930 275,930 0

EXPENDITURE

Personnel

Medical 4,170 4,235 65 13,061 13,287 226 53,273 53,273 0

Nursing 6,322 6,541 219 19,119 20,235 1,116 80,733 80,733 0

Allied Health 1,507 1,418 (89) 4,625 4,523 (103) 18,565 18,565 0

Support 1 (28) (29) 1 (81) (82) (307) (307) 0

Management /

Administration742 671 (71) 2,250 2,145 (105) 8,769 8,769 0

12,742 12,837 94 39,056 40,109 1,052 161,033 161,033 0

Other Expenditure

Outsourced

Services353 388 35 1,235 1,164 (72) 4,654 4,654 0

Clinical Supplies 2,516 2,431 (85) 7,684 7,327 (358) 30,094 30,094 0

Infrastructure &

Non-Clinical

Supplies

626 518 (107) 1,796 1,558 (238) 6,222 6,222 0

3,495 3,337 (158) 10,715 10,048 (667) 40,971 40,971 0

Total Expenditure 16,237 16,174 (63) 49,771 50,157 386 202,004 202,004 0

Contribution 6,980 6,826 154 19,552 18,934 618 73,926 73,926 0

Allocations 6,644 6,644 0 20,098 20,098 0 80,298 80,298 0

NET RESULT 335 181 154 (546) (1,164) 618 (6,372) (6,372) 0

YEAR TO DATE FULL YEARMONTH

Comment on Major Financial Variances

Financial Results

The overall result for Medicine and Health of Older People was favourable by $154k for the month

and year to date $618k favourable.

Revenue

Year to date (YTD) revenue is $232k favourable, with the main contributor being ACC revenue in

AT&R at $258k. This favourable ACC result is due to a combination of late billings from last financial

year and higher than budgeted bed day usage for ACC patients this financial year. There was a

shortfall in the community nursing ACC of $79k which is being investigated. The Slark Hyperbaric

also contributed $157k in unbudgeted revenue which fully offset the costs related to this service;

they also generated $18k revenue from ACC work.

Expenditure

Personnel costs overall are $94k favourable for September and $1,052k favourable YTD. Medical

staff costs are $226k favourable year to date and this is due to medical officer vacancies in ED and to

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a lesser extent senior medical staff vacancies in Health of Older People. The favourable result in

RMO costs is primarily due to the actual paid salary being lower than budgeted in the first quarter. A

provision of $200k has been made in medical staff costs towards the anticipated implementation

costs of the ED model of care. Nursing staff costs are under spent by $1,116k year to date, with the

main contributor being vacancies across primarily wards; this is at both North Shore and Waitakere

Hospitals. The charge nurse managers have been actively recruiting, however there have not been

sufficiently experienced nurses applying. Given this situation we have increased the number of new

graduates we have employed in the September intake.

Contracted FTE for nursing in the division was 928 FTE at the end of June against a budget for

2013/14 financial year of 1016 FTE (excluding bureau and unplanned leave FTE) therefore we

started the year with approximately 88 FTE vacancies or 8.5% of total nursing FTE. Recruitment

during the first quarter has increased contract FTE by 49 to 977 reducing the vacancies to 4% of total

nursing FTE. The opening of the Short Stay Ward to meet bed demand over the winter has

contributed $167k of additional nursing cost which is covered by corporate. Approximately 5% of our

nursing spend over the last three months has been a combination of internal and external bureau;

this has been to cover a combination of vacancies and sick leave. We expect bureau usage to

decrease significantly as newly recruited staff start and we reduce beds/FTE for summer.

FTE Staffing levels are below the agreed budget FTE for the division this month with contracted FTE

1633.81 against the budget of 1730.94. Vacancies are the main contributor to this, however this

favourable variance will not continue as newly recruited staff start with the organization.

September has been our highest month this year with a net increase of 35.30 contracted FTE across

the division.

Other Expenditure

Outsourced Services are $35k favourable for the month and $72k unfavourable YTD. External

nursing bureau costs are $262k over budget YTD, however this is offset by the favourable variance in

nursing personnel costs. There were favourable variances for both medical fee for service and

clinical services.

Clinical Supplies are unfavourable to budget $358k YTD. PCT drugs are overspent by $183k YTD of

which $173k relates to under accrued costs from the 2012/13 financial year. Overall PCT costs now

include use of these drugs in Haematology, Rheumatology and Renal. Client related costs are over

budget by $282k YTD. This is comprised of on-going costs of ADHB home haemodialysis support

which continues to incur cost due to the delay in the build of the Apollo Drive Dialysis Unit, which is

part of the Renal Phase 2 business case. Other areas of over spend include protective clothing,

dressings, monitoring equipment and catheters. These costs will be closely monitored over the next

quarter to ensure any agreed price reductions are realised and where there is volume or price

increases we will seek to mitigate these over spends.

Infrastructure and non-clinical costs are unfavourable by $238k YTD with the most significant

overspends coming from budgeted revenue which has not yet been received, and one off consulting

costs from PwC relating to work in the division on identifying savings opportunities.

Savings

Work continues on all of the initiatives built into the budget with most of the savings expected to be

generated in the second half of the year. From August 2013 the budget includes additional savings to

be achieved of $182k per month ($2m full year). Those savings are spread over personnel costs

($95k/month $1040k full year), clinical supplies ($84k /month, $923k full year) and infrastructure

($3k/month, $36 full year). Currently there are no specific plans in place to cover these savings

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however cost containment and vacancies across the services have meant the division has had a

favourable result in the first three months. All operations managers are proactively planning annual

leave across all staff categories; the target is for all staff to take at least one years leave entitlement.

Quality Improvement using GRS at Waitemata DHB

What is the Global Rating Scale?

The quality improvement framework in Endoscopy is the Global Rating Scale (GRS). The GRS was

created in the UK in 2004 and introduced in New Zealand in 2011 as a quality improvement and

assessment tool for gastrointestinal endoscopy.

It is a tool that enables centres to assess how well they provide services to patients. This requires

departments to self-assess and provide evidence against 307 measures. These measures build up to

grades of A-D for 21 categories, split in four overarching domains:

• Clinical Quality

• Quality of Patient Experience

• Workforce

• Training

To achieve a rating of C, all C and D rated measures must be met.

The diagram below represents the pyramid through which a rating for Clinical Quality and Quality of

Patient experience domains are calculated.

Global Rating Scale at Waitemata DHB

The unit experienced a very slow start with GRS when we joined the pilot two years ago, however

progress in the past year has been impressive. Achieving an A rating in any category is challenging,

with most centres in the UK mostly sitting at around B and C grades. To achieve an A grade, units

must not only prove they are achieving standards, but also that there are processes in place for

monitoring these and taking remedial action where necessary.

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The Global Rating Scale is the focus of our quality improvement activity in Endoscopy. We cannot

achieve everything at once, but by addressing each measure with initiatives and change processes

we are striving to continually improve the quality of the services we provide.

Clinical Quality

All categories in the Clinical Quality domain have shown improvement, the most dramatic being

safety and quality of care. Both North Shore and Waitakere hospitals have increased their safety

rating from a D in August 2012 to an A in September 2013. This category covers a variety of

measures including our management of clinical governance, proactive review of incidents and audit

of outcomes for patients. The quality of care measure has also increased significantly, from a D to an

A. This measure covers performance indicators for the clinical team, measurement of these and

taking action if clinicians fall below desired outcomes.

Categories looking at consent, appropriateness of procedures and the communication of results

have also improved from initial D ratings to B and C.

All of the above improvements combined have led to an increase in the overall grade for Clinical

Quality from D grade to B grade. We are committed to achieving an A grade in the next 12 months.

Aug-12 Sep-13

Consent D C

Safety D A

Comfort C C

Quality D A

Appropriateness D C

Communication of results C B

Quality of Patient Experience

Most categories in quality of patient experience have improved. The only exception is timeliness.

Timeliness considers waiting times for all procedures and we are unlikely to achieve more than a C

rating until all wait times are significantly shorter.

Particularly, new booking rules have allowed us to be responsive to patient needs without affecting

waiting times. We have also improved in equality, privacy and aftercare fields. The departments

have a regular programme of requesting and acting on feedback from patients.

Aug-12 Sep-13

Equality B A

Timeliness D D

Choose D A

Privacy C C

Aftercare B B

Feedback C A

Workforce

There has also been progress made in the workforce domain, with initiatives introduced to enhance

skill mix, orientation and staff assessment. We continue to work on the documented interface with

staff. The skill mix measure includes, amongst others, measures of rostering flexibility and

completion, succession planning, recruitment practice and workforce development.

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Orientation incorporates measures for education programmes, initial orientation and using patient

feedback to contribute to development of staff.

Aug-12 Sep-13

Skill Mix C A

Orientation D A

Assessment D C

Staff cared for C C

Staff listened to C C

Training

Training measures have also improved, although not by as much as other domains. Training is

traditionally (New Zealand and UK) a challenging domain to improve in. Resource limitations and

focus on timeliness and productivity can significantly affect the ability provide anything other than

basic requirements for training. Waitemata DHB has a good reputation for providing training to

junior medical staff in Endoscopy and Gastroenterology and we continue to be committed to

improvement where possible.

Aug-12 Sep-13

Environment D D

Trainers D C

Assessment D D

Equipment D B

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Child, Women and Family Services

Service Overview

This Division is responsible for the provision of maternity, 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, e.g. births and gynaecology surgery, and

within our community, e.g. community midwifery and mobile/transportable dental clinics. The

division is managed by Linda Harun with Dr Tim Jelleyman HOD Medical CWF, Emma Farmer HOD

Midwifery; Marianne Cameron HOD Nursing, Ronelle Baker Allied Health Lead, Dr Sathananthan

Kanagaratnam Clinical Director ARDS, Dr Sue Belgrave Clinical Director Obstetrics, Dr Peter van de

Weijer Clinical Director Gynaecology and Dr Meia Schmidt-Uili Clinical Director Child Health.

Scorecard

HEALTH TARGETS

Better help for smokers to quit has been delivered to 100% of patients in this month.

Overall elective gynaecology surgery volumes are above target at 122%. Gynaecology volumes in ESC

achieved 91% in September and have since increased to 110% of target as the gynaecology service

has been able to access additional theatre times.

Overall the ED 6 hour target has shown a reduction to 94.2% this month.

Paediatrics breeches of the target are shown below for September and reflect the surges of

admissions during winter months.

A comparison of months shows that the August result was unusual and there has been a marked

improvement in September, however this requires close monitoring on a daily basis.

Reasons for breeches include the lack of an ADU for paediatrics at Waitakere and this issue will be

addressed in the new ED design.

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QUALITY

Complaint response time is 9 days.

The readmission rate remains better than target at 7.2%.

HUMAN RESOURCES

The sick leave rate has decreased slightly for the second month to 9.7 days and is tracking towards

achieving the target. Annual leave is being arranged for SMOs during the close down of theatres in

December/January.

AREA OF FOCUS – DID NOT ATTEND (DNA) RATES

The service continues to monitor DNA rates and follow up DNAs where possible. Overall, despite the

introduction of a range of initiatives, DNA rates continue to be high. Child health is continuing to

ring every Maori and Pacific family who has not attended appointments. Issues identified are being

tracked so solutions can be identified. The project being led by Cath Cronin will assist in improving

this outcome.

Service Delivery

Theatre utilisation at Waitakere continues to cause the overall gynaecology theatre utilisation rates

to be below target although a slight improvement has been seen for the month.

Breastfeeding on discharge

Exclusive breastfeeding on discharge continues to be above target at 77%.

Births

Birth volumes and maternity WIES are slightly above target for the month. Average length of stay in

maternity is on target at 2.5 days overall.

Discharges at weekends remain above target and assist the Rangatira ward to manage the inflow of

patients during weekends.

ESPI

Gynaecology ESPI 2 and 5 targets remain compliant and meet the 5 month target. Close monitoring

of these areas will continue and additional clinics will be held as the need arises.

ESPI 1

There are a small number of paediatric patients who are showing to be non-compliant this month on

the scorecard due to administrative errors (e.g. appointments that have already been held that have

not been outcomed). These have now been rectified and the service remains ESPI 2 compliant.

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Contracts

All volumes were above target this month except acute gynaecology. Elective gynaecology WIES

volume delivered in ESC is above target although the volumes are only 91% of target as more

complex cases have been delivered.

At the end of September the total volume in Rangatira ward is higher (44%) than contracted

volumes. This reflects increased demand for the service over the winter months.

Transfers from Starship Hospital and Out of Area Admissions

This month, there has been an increase in the number of children transferred from Starship ED to

Rangatira ward and an increase of out of area admissions.

At the end of September, SCBU activity is higher (8%) than contracted volumes.

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Child Rehabilitation Activity – ACC Bed Days

This month the Child Rehabilitation has delivered 96 ACC bed days. Bed days delivered year to date

are higher than average.

FSA/FU

At the end of September, paediatric FSAs are lower (29%) than contracted volumes. This reflects the

reduction in clinic availability over the winter months (where medical time has been diverted to

acute duties).

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Scorecard


Better help for smokers to quit 100.0% 1 0 95.0% �� Oral Health Arrears 9.0% 1 0 10.0% �

Provider Elective Volumes 122.3% 1 0 100.0% �� Oral Health Arrears (Maori) 10.0% 1 0 10.0% ��

- Child, Women & Family Services 136.9% 1 0 100.0% �� Oral Health New Enrolments (Preschool) 6,148 0 1 10,414 �

- Elective Surgical Centre 91.5% 1 0 100.0% � Theatre utilisation Gynaecology 81.0% 1 1 90.0% �

Shorter Waits in ED 94.2% 1 0 96.0% � Exclusive breastfeeding on discharge 77.0% 1 0 75.0% ��

Births 1,688 1 0 1,689 �

Patient Flow

Average Length of Stay - Maternity 2.5 1 0 2.5 �

Quality Actual Target Average Length of Stay - Paediatrics 2.1 1 0 2.2 ��

Complaint Average Response Time 9 days 1 0 14 days � Average Length of Stay - SCBU 9.7 1 0 7.0 �

Discharges at weekends 28.6% 1 0 20.0% �

DNA Rates Number

First Specialist Assessment (FSA) DNA rate - Total 78 9.7% 1 0 10.0% �� ESPI 2 - % patients waiting longer than 5 months for FSA

First Specialist Assessment (FSA) DNA rate - Maori 14 16.3% 0 1 10.0% � Gynaecology 0.0% 1 0 0.0% ��

First Specialist Assessment (FSA) DNA rate - Pacific 9 12.7% 1 0 10.0% � Paediatrics 0.1% 1 0 0.0% �

Follow up (FU) DNA rate - Total 128 12.4% 1 0 10.0% �

Follow up (FU) DNA rate - Maori 32 25.8% 0 1 10.0% � ESPI 5 - % of Patients not treated within 5 months

Follow up (FU) DNA rate - Pacific 18 18.8% 0 1 10.0% � Gynaecology 0.0% 1 0 0.0% ��

Other Key Measures Contracts

Acute Readmission Rate within 28 days 7.2% 1 0 10.0% � Elective WIES Volumes

Gynaecology 457 1 0 354 �

- Child, Women & Family Services 345 1 0 268 �

- Elective Surgical Centre 112 1 0 86 �

HR Wellbeing Actual Target

Sick Leave Rate (days) * 9.7 days 1 0 7.5 days �� WIES Volumes

Overtime Rate (%) * 0.2% 1 0 1.0% �� Gynaecology Acute 278 1 0 286 �

Annual Leave Balance > 75 days 9 1 0 6 � Maternity 1,788 1 0 1,632 �

Clinical Employ (FTE) 777 FTE 1 0 � Paediatrics 571 1 0 394 �

* 12 month rolling average Neonatal 482 1 0 445 �

Other Contracted Volumes

Child Rehabilitation bed days 497 1 0 456 �


Revenue 29,453 k 1 0 29,599 k � Non-Case weighted Discharges (YTD)

Expense 20,570 k 1 0 20,612 k � First Specialist Assessment (FSA) 2,497 1 0 3,157 �

Personnel Costs 16,340 k 1 0 16,900 k � Subsequent Attendance (FUP) 3,291 1 0 2,651 �

Outsourced Services 1,072 k 1 0 939 k �



Contribution 8,883 k 1 0 8,987 k �

Capital Expenditure 67 k 0 1 105 k �

Indicator Title 85.0% 1 k 0 100.0% �

Actual Target

Improvement against previous result


DHB Performance

Waitemata DHB Monthly Performance ScorecardChild Women and Family Service and Elective Surgical Centre

September 2013

Human Resources

Quality

Finance


How to read

48 of 98


STRATEGIC INITIATIVES

Deliverable /Action On

Target

Implement Child Emergency Departments and Paediatric Wards immunisation

processes improvement plan

�

Ensure all cases of acute rheumatic fever are notified to the Medical Officer of Health

within 7 days of confirmed diagnosis by June 2014

�

Continue to deliver the hospital-based Family Violence prevention and intervention

programme. For 2013/14, this will include training for mental health social workers,

Auckland Regional Dental Service and on-going DHB generic training via Learning and

Development

�

Work with maternal mental health to implement universal screening for mental health

conditions in pregnancy

�

Progress training of DHB professionals to recognise signs of maltreatment in the

following key services: Child Health, Maternity, Alcohol and Other Drugs, Mental Health,

Sexual Health and Emergency Departments

�

Sign the CYF Schedule 2 (under the Memorandum of Understanding with Child, Youth

and Family Services, Police and DHBs for interagency collaboration for child protection),

which relates to Child, Youth and Family Services funded liaison social worker positions

in all DHBs

�

Policies and reporting systems in place to recognise and report child abuse and neglect �

High level accountability in place for clinicians to routinely screen for family violence as

part of assessing the well-being and safety of children and families

�

Develop and implement a policy to support maternal/perinatal mental health services

screening of pregnant and postpartum women who access provider arm services for

antenatal and post natal care

�

Publication of Annual Maternity and Clinical Reports for 2012 is published in August

2013 and for 2013 data, in August 2014

�

Develop a system for identifying whether children presenting to Child Health Services

are engaged with early childhood education and routinely provide information to

families/whānau on the benefits of early childhood education

�



� Regional planning meetings have been held in relation to the Perinatal Infant Mental Health

funding that was announced for the provision of a regional acute facility. A recommendation

paper has been submitted to the MoH. Progressing a screening programme is contingent on

developing care pathways as part of this programme which will commence in 2014. � Ward clerks on Rangatira ward are routinely accessing the National Immunisation Register to

check the immunisation status of each child admitted. If a child’s immunisation is incomplete,

this is communicated to clinical staff to discuss immunisation status with the family and

encourage GP follow up. Opportunistic immunisation is also available. � A Rheumatic Fever protocol has been completed and implemented in Rangatira. This document

ensures that coding can be undertaken correctly and that the Rheumatic Fever Guidelines are

routinely followed . � A review of all Child Protection policies for the community child health teams is continuing. It

has been agreed that there will be one policy across all teams. � A new social work risk assessment form has been completed. This provides guidance for

49 of 98


inpatient social workers on child protection concerns. This form will be implemented by October

2013. � A paediatrician and a paediatric nurse are now working three days a week from Totara Health.

As well as providing clinic appointments to children and families closer to home, this has enabled

GPs to have direct consultation and liaison with Child Health clinicians. To date, both the nurse

and SMO have seen children in partnership with GPs and have provided advice. Information is

being developed for GPs in the wider cluster about how to access support and advice. � Planning is underway to increase the provision of paediatric outpatient services delivered from

Whanau House.


• A system for identifying children engaged with early childhood education has not been

developed as yet. In the first instance, the community child health unit manager will be liaising

with the Ministry of Education to identify resources available to families.

Other Highlights

VIP (Violence Intervention Programme) Evaluation:

Self Audit Report Feedback – Audit period October 2011 to March 2013

This report acknowledged the Waitemata VIP programme strengths and recognition of areas for

growth. Scores of 99% for Partner Abuse and 100% for Child Abuse and Neglect are a reflection of

the maturity of the programme and substantial infrastructure supporting VIP at Waitemata DHB.

Identified strengths include: strong leadership, VIP leaders across all screening services,

collaboration with community partners, well developed tools and policies and work with Waipareira

Trust on Whanau ora initiatives. With VIP now implemented across all relevant Ministry targeted

services, the focus moves to increasing reliability and quality of partner abuse and child abuse and

neglect identification and is outlined in the Audit Action Plan.

Auckland Regional Dental Service

ARDS now records the percentage of children seen within the recall time as a positive amount with

the target being 90% achieved. The overall percentage for children seen within the recall period is

now 91%. By location the results are: Central=92.6% (7.4% arrears); South=89.6% (10.4% arrears);

N/West=91.5% (8.5% arrears). The better than target result can be attributed to the hard work of all

the teams. This is the lowest overall arrears target since data collection began in October 2009.

Weekly reporting of each of the 12 teams’ results is shared across the service.

ARDS % children seen on time

76%

78%

80%

82%

84%

86%

88%

90%

92%

1-J

ul

8-J

ul

15

-Ju

l

22

-Ju

l

29

-Ju

l

5-A

ug

12

-Au

g

19

-Au

g

26

-Au

g

2-S

ep

9-S

ep

16

-Sep

23

-Sep

30

-Sep

7-O

ct

Week commencing

AR

DS

% c

hil

dre

n s

ee

n

Target

50 of 98


The process for the recruitment of new graduate Dental Therapists has commenced. Interviews with

14 students have taken place in Otago. Interviews of AUT students will take place next month.

Distribution of the new uniforms is expected to occur in February 2014 to coincide with the new

calendar year. Staff have been involved in choosing the uniform style and colour. Advice was also

taken from New Zealand Dental Council and Waitemata DHB infection control personnel. The team

are really appreciative of this improvement. It will also align the staff presentation with the new

facilities.

Women’s Health

The Women’s Health Service has completed the Visual Quality Management process in the

Waitakere maternity facility which has reduced the stock quantities and consequently will result in

savings in clinical supplies.

The midwifery community service at Waitakere has entered into a partnership with TAHA (a well

Pacific and mother and infant service) to roll out the “Tapuaki Pacific Pregnancy and Parenting

Programme”. This is a tailored and targeted pregnancy and parenting education programme for

Pacific pregnant women and their families. The pilot will start on 22 October 2013 and run for six

weeks.

Approval for Waitemata DHB to be involved in the PRINCess study has been granted through

Awhina. The study concerns the prediction of regression in *CIN 2 – a prospective multicentre trial of

conservative management of CIN 2 in women under the age of 25. The research has been approved

by the NZ Health and Disability Ethics Committee and has the support of the National Cervical

Screening programme. Currently there are 13 DHB’s involved in the study.

Rheumatic Fever Programme

The rheumatic fever throat swabbing programme is operational three days a week in all four high

risk schools within the Waitemata district.

Data as at the end of term three is:

Swabs taken 1,848

Percentage GAS school children given antibiotics 99.7%

Percentage children provided antibiotics by public health

nurse 65%

The swabbing programme will commence in Onepoto Primary (a decile 1 school in Northcote) from

the beginning of term four (14th October).

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The health promoting schools advisor and public health nurse have submitted an abstract for a

poster presentation in the Clinical Excellence Awards on the work taking place in the school

community around rheumatic fever. The title is “Say ahhhhh…. for sore throats: a multi-faceted

approach aiming to reduce the incidence of rheumatic fever in West Auckland school communities”.

Ranui Health Expo

The health promoting schools advisor and public health nurses attended the Ranui Health Expo Day,

which was an opportunity for Ranui tamariki to share their Inquiry Learning Journey from their

studies on “Kaitiakitanga of our Hauora” and their solutions on working together to reduce

commonly preventable illnesses in the community. Child and Family had a rheumatic fever

information stall with fun education activities for students and families to enjoy. There were also a

number of other community groups promoting their services. The day was extremely successful and

was highly attended by students and families. The students loved the new rheumatic fever flow

chart game and colouring in posters that the health promoting schools advisor created. The

students all had a stall with their class health topic and educated other students, families and health

organisations about what they had learnt during this term.

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Financial Results


Child Women Family

($000’s)


REVENUE

Government and

Crown Agency 9,890 9,997 (107) 29,322 29,506 (184) 118,384 118,384 0

Other Income 52 31 21 131 93 38 372 372 0

Total Revenue 9,942 10,028 (86) 29,453 29,599 (146) 118,756 118,756 0

EXPENDITURE

Personnel

Medical 1,245 1,312 67 3,786 3,922 136 15,868 15,868 0

Nursing 1,915 1,959 45 5,963 6,030 67 24,954 24,954 0

Allied Health 1,842 1,917 75 5,636 5,961 325 23,554 23,554 0

Support 21 18 (3) 64 59 (5) 252 252 0

Management /

Administration293 302 9 891 928 37 3,541 3,541 0

5,315 5,508 192 16,340 16,900 560 68,169 68,169 0

Other Expenditure

Outsourced

Services253 268 16 1,072 939 (133) 3,692 3,692 0

Clinical Supplies 549 376 (172) 1,587 1,193 (394) 4,606 4,606 0

Infrastructure &

Non-Clinical

Supplies

553 516 (37) 1,571 1,580 9 6,304 6,304 0

1,355 1,161 (194) 4,230 3,712 (518) 14,602 14,602 0

Total Expenditure 6,670 6,669 (2) 20,570 20,612 42 82,771 82,771 0

Contribution 3,272 3,359 (88) 8,883 8,987 (104) 35,986 35,986 0

Allocations 2,966 2,966 0 8,984 8,984 0 35,991 35,991 0

NET RESULT 306 393 (88) (101) 2 (104) (5) (5) 0

FULL YEARMONTH YEAR TO DATE


Contribution

The September monthly contribution was driven by revenue being short of target, particularly due

to high winter Paediatric volumes affecting Starship transfers planned. This is equally true of the

YTD position. While there are a number of overspends arising in the service, these have been

mitigated so far with careful service planning, however this may not be sustainable in the longer

term.

Revenue

Both Starship and the Rangatira Unit have operating at greater than contracted volumes YTD,

therefore no saving has been realised at this time. This reduces revenue $180k to planned levels.

Colposcopy revenue was $36k favourable to contracted revenue, but $47k unfavourable overall due

to an incorrect price being budgeted affecting the result by $83k each month for the remainder of

the year.

Maternity volumes continue to be above expected levels averaging an additional $25K per month.

Child Health ACC revenue remains in a positive position with a favourable $26K result this month.

53 of 98


Expenses

Medical

Women’s Health have been actively recruiting for two SMOs, with one due to start in January. This

has resulted in net underspend of $64K in September.

Child Health is not actively recruiting 2.5 Medical vacancies until these positions are confirmed

under the new Service design, resulting in an underspend of $28K for the month.

Over allocations of SHOs in Women’s Health increased costs $13K and Registrars in Paeds was $20K

overspent for the same reason. This position should change with the next rotation (December

2013), as the over allocation should not continue.

Nursing

Maternity and Child Health have successfully recruited into vacancies and these positions will be

filled in the coming weeks. September saw an underspend while the roles were briefly vacant.

Allied Health

Child Health Allied Health vacancies arising are only filled where clinically urgent until the roles are

confirmed under the new service design. An underspend of $34K arose in September as a result of

this delay, but this is not sustainable long term.

Recruitment of planned Dental positions has also been delayed until new graduates become

available in Jan/Feb 2014m. A total of $33K above budgeted savings was realised in September as a

result. Recruitment has begun for these positions, a total of 20 FTE are hoped to be recruited at this

time.

Management/Administration

Integrated Family Health Care Centre Reception roles have now been recruited into, several months

later than initially planned. This resulted in an underspend in the month, as it was planned to occur

several months earlier.

ARDS have administration vacancies due to the departure of a staff member and the redeployment

of others into the service. A decision on recruiting into these roles has not yet been made.

Outsourced Costs

Favourable Outsourced costs this month include ongoing under spends in Paediatric Locum costs as

a result of the over allocation of Registrars and a reduction in Waitakere On call Anaesthetists costs

as recharged from Surgical Services.

Clinical Supplies

An additional $82k a month has been assigned to be saved from Clinical Supplies, however savings

are not likely to be found in this area. Savings will need to be found in other areas to offset this.

ARDS costs to be recharged to other DHBs total $61K this month, which is unplanned expenditure.

Higher treatment volumes in ARDS are also resulting in higher than anticipated clinical supplies costs

YTD.

Infrastructure

The Data contract with Telecom has been renegotiated and actual costs of these services are now

being passed onto the user, where they were previously absorbed within the bulk data plan. This

was an unbudgeted cost so is expected to remain an overspend throughout the remainder of the

year.

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Mental Health and Addiction Services

Service Overview

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

Better help for smokers to Quit: 98%

Service remains on target.

Shorter Waits in ED: 87%

The service met its ED target for the month.

Quality Complaint response time: 14 days

The service returned to meeting target this month. A proactive focus on response times has

assisted bringing the response times back.

Seclusion in Adult Inpatient Units

During September, three people under the care of adult services had seclusion episodes which

totalled 30 hours of seclusion. Two people were secluded in Taharoto and one in Waiatarau.

This is the first use of seclusion in Waiatarau for six months; this unit continues to be a leader

locally and nationally in the reduction of seclusion use.

Human Resources Sick leave and turnover remain relatively steady. A couple of areas are having a renewed focus

on bringing down accrued annual leave. Adult services have 10 staff members with over 75 days

leave accrued and will be pursuing more proactive agreements with staff overall to reduce

leave balances. Another 35 staff members (across all services) have over 50 days accrued.

Service Delivery – Productivity Occupancy and Average length of stay:

Length of stay remains steady however all services operated at peak occupancy levels. The forensic

services waiting list has been the subject of recent media interest and Official Information Act

requests. The Mason Clinic provides the only non-acute secure hospital level of care in the

region and it is anticipated that the regional high and complex needs report will quantify

service gaps for this cohort of people. This report is currently moving through the regional sign-

off process.

Waiting Times/ Access Rates

Waiting times targets were exceeded for all services and access rates were steady. Child and Youth

have seen an improvement in access rates this year in relation to their target increase from 2.6 to

3%.

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Scorecard


Better help for smokers to quit 98% 1 0 95% � Patient Flow

Shorter Waits in ED 87% 1 0 80% � Average Length of Stay - Adult Acute 22 1 0 15-21 �

Average Length of Stay - CADS Detox 8 1 0 6-8 �

Bed Occupancy (midnight) - Adult Acute 92% 1 0 85% �

Bed Occupancy (midnight) - CADS Detox 108% 1 0 90% �

Bed Occupancy (midnight) - Forensics Acute&Rehab 98% 1 0 95% �

Quality Actual Target Bed Occupancy (midnight) - ID 83% 1 0 70% �

Complaint Average Response Time 14 days 1 0 14 days �

Service Access (latest available)

Seclusion MH Access Rates 0-19 years (Total) 2.70% 1 0 3.00% �

Seclusion use Forensics - episodes 14 1 0 10-14 �� MH Access Rates 0-19 years (Maori) 3.53% 1 0 3.60% �

Seclusion use Adult - episodes 3 1 0 1-5 � MH Access Rates 20-64 years (Total) 3.55% 1 0 3.50% �

MH Access Rates 20-64 years (Maori) 7.94% 1 0 7.50% �

Whanau Contacts per service user (community only) Youth Alcohol and Drug Services (0-19 years) access rates 0.27% 0 1 1.50% ��

Adults 70.4% 1 0 70.0% �

Child 100.0% 1 0 80.0% �� Waiting Times (latest available)

Youth 100.0% 1 0 80.0% �� Youth (0-19) < 3 weeks 79% 1 0 70% �

Adult (20-64) < 3 weeks 92% 1 0 80% �

Acute Readmission Rates within 28 days (reported one month behind) CADS (0-19) < 3 weeks 93% 1 0 80% �

Adults 10.0% 1 0 10.0% � CADS (20-64) < 3 weeks 97% 1 0 80% �

CADS 0.0% 1 0 5.0% �� Forensic (20-64) < 3 weeks 89% 1 0 80% �

Community Care - treatment days per service user

Adults 3.70 1 0 3-5 ��

Children 2.78 1 0 2-4 �

HR Wellbeing Actual Target Youth 2.98 1 0 2-4 ��

Sick Leave Rate (days) 8.9 days 1 0 7.5 days � CADS 2.48 1 0 2-4 ��

Overtime Rate (%) 3.2% 1 0 3.0% � Forensics 1.74 1 0 2-4 �

Annual Leave Balance > 75 days 9.00 1 0 9 �

Turnover Rate % 9.7% 1 0 10.0% �� Community Care - Preadmission community care

Clinical Employ (FTE) 1,015 FTE 1 0 � Adults 76% 1 0 75% �

* 12 month rolling average

Community Care - Post Discharge community care

Adults 80% 1 0 90% �

Financial Result YTD Actual $000s Target $000s Financial YTD Distinct Clients with open referral

Revenue 38,594 k 1 0 38,389 k � Inpatient Adults 289 1 0 269 �

Expense 30,455 k 1 0 30,807 k � Inpatient CADS 131 1 0 127 �

Personnel Costs 27,496 k 1 0 28,386 k � Inpatient Forensics 135 1 0 133 �

Outsourced Services 447 k 1 0 92 k � Outpatient Adults 3912 1 0 3767 �

Clinical Supply Costs 338 k 1 0 352 k � Outpatient Maori 164 1 0 157 �

Non-Clinical Supply Costs 2,175 k 1 0 1,977 k � Outpatient Pacific 196 1 0 177 �

Contribution 8,139 k 1 0 7,581 k � Outpatient Youth 1653 1 0 1686 �

Outpatient CADS 8029 1 0 8184 �

Capital Expenditure 43 k 1 0 36 k � Outpatient Forensics 1390 1 0 1203 �

New referrals during the month

Inpatient Adults 95 1 0 84 �

Inpatient CADS 38 1 0 41 �

Inpatient Forensics 14 1 0 8 �

Outpatient Adults 802 1 0 709 �

Outpatient Maori 13 1 0 5 �

Outpatient Pacific 26 1 0 15 �

Outpatient Youth 277 1 0 282 �

Outpatient CADS 1082 1 0 1133 �

Outpatient Forensics 190 1 0 192 �



Actual TargetDHB Perfo rmance

Waitemata DHB Monthly Performance ScorecardMental Health Service

September 2013

Human Resources

Quality

Finance


How to read

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No. Deliverable /Action – Prime Minister’s Youth Mental Health Project On

Target

1 Refine data collection systems and collect baseline data for the percentage of youth

discharged from CAMHS and Youth AOD services into primary care being provided

with follow-up care plans, and for consult-liaison sessions delivered by secondary

care to primary care, and set targets by June 2014. The impact of these practices will

be reviewed by June 2015.

�

2 Establish baseline for youth access rates to specialist alcohol and drug services and

develop plan to meet the target of 1.5%. �

3 Supporting families by developing services for children with parents with mental

illness and addictions by June 2014 and ensure access for the parents to parent

education (e.g. Triple P and Incredible Years) - ongoing. �

No. Deliverable /Action – Mental Health Service Development Plan On

Target

4 Complete a stock-take and gap analysis and develop a three year plan, based on it –

September 2013 �

5 Collect baseline data for number of consult-liaison sessions delivered by secondary

care to primary care, and set targets by June 2014 �

6 Implement the GAIHN integrated care pathway for depression �

7 Ensure links to Whānau ora are made through specific project work �

8 Establish a reporting mechanism to reflect employment status of service-users and

develop an integrated plan to increase opportunities for employment in alignment

with MSD services and welfare reforms (links to local and regional KPI work)

�

9 Meet the wait time targets for non-urgent mental health services �

10 Full implementation of Stepped Care across adult clinical services, and increased

access to talking therapies �

11 Establish an inter-agency steering group to develop a local suicide

prevention/postvention action plan

Funder

12 Contribute the mental health perspective to a Maori clinical governance structure

Not

started

13 Ongoing provider arm services reviews �

No. Deliverable /Action – Other On

Target

14 Work towards zero wait times for maternal mental health referrals from DHB

maternity services and lead maternity carers �

15 At least 200 DHB mental health and addiction service practitioners to complete CALD

cultural competency courses within the year 2013/14 �


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Deliverable /Action Prime Ministers Youth Mental Health Project

1) Data Collection

• Reviewed requirement with Information Analyst and Altered High Service Manager.

• Werry Centre to roll out Discharge Plan project which will be implemented to align with data

collection protocols.

• Regional Project re Consult-Liaison data capture is underway and being trialled by Marinoto

West.

2) Establish baseline for youth access rates to specialist alcohol and drug services and develop

plan to meet the target of 1.5%

• The 2006 Census shows that WDHB has a Child and Youth population (0 – 19) of 153,150 of

which the Youth population (12-19 years) is 62,570. Of these 8,300 were Maori, with 54,270

being “other”.

• Based on this, to meet the 1.5% target, CADS, Te Atea Marino and Tupu together with any

NGO’s providing AOD services for youths would need to achieve a number of 939 clients per

annum in that age group.

• Currently the services appear to be 182 young people below the targeted percentage.

• Initiatives such as working more closely with Primary Care, pro-active approaches to secondary

schools, reducing barriers to service access and service promotions are part of ongoing

strategies to increase the current uptake

3) Supporting Families

• Secure Beginnings Project is underway and delivering services to families in the West.

• Meeting scheduled with funder and NGO provider to discuss reconfiguration of existing family

support contract to include specific option for children of parents with mental illness (COPMI).

• Collaboration and Review workshop scheduled with Waitemata Triple P providers and

stakeholders.

Deliverable /Action – Mental Health Service Development Plan

4) Complete a stock-take and gap analysis and develop a three year plan, based on it –

September 2013 COMPLETED

7) Ensure links to Whanau ora are made through specific project work - Gains made in relation to

involvement of Whanau House and Maori Funding and Planning in WSN (Waitemata stakeholder

network) and PEG (provider executive group – all NGO CEOs and provider arm managers)

8) Establish a reporting mechanism to reflect employment status of service-users and develop an

integrated plan to increase opportunities for employment in alignment with MSD services and

welfare reforms (links to local and regional KPI work); Reporting processes in place as part of joint

NGO and Provider arm scorecard, however this area is still underreported. Two highly successful

workshop sessions with NGO employment providers, funders and GM from ADHB and WDHB to

start stocktake of services and begin to identify key areas for improvement and gaps. Stocktake of

Vote Health funded services completed and much of MSD funded services. Next step is to finalise

and develop priorities for future development.


14) Wait Times Maternal and Infant - Awaiting feedback from MoH regarding definition of ‘zero

wait times’ for Maternal Mental Health referrals from within the DHB.

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OTHER COMMENTS

12) Contribute a mental health perspective to a Maori clinical governance structure; Maori Health is

leading this - involvement from Mental Health not requested yet.

OTHER HIGHLIGHTS

Community Acute Service Opened

This service named Piri Pono was opened by the MP for Rodney District, Mark Mitchell on the 23rd

September. The first service users were admitted the following day. There has been a maximum of

three beds occupied at any one time during September and as of the 18th October all the beds were

full. There are currently four beds with a fifth becoming available when the MoH audit process is

completed. Feedback from consumers, family and staff for this service has been very positive to

date.

The Sub-acute beds at Taharoto Unit were closed a day earlier than was required, on the 27th

September 2013.

Respite Service Opened

Koromiko House (North Shore and Rodney Adult Respite) opened on the 2nd of September; there

have been a few issues in the interim for Equip (NGO) and Provider Arm services to deal with that

have involved neighbours. These issues appear to have been resolved by the Equip CEO. This

service, though only opened in September, is at times running at full seven bed capacity. Feedback

from consumers, family and staff is also positive for this service

KPI’s for Forensic Services

A national workshop was held in September to identify indicators for benchmarking use in forensic

services. From this workshop and identification of a set of candidate indicators, the national KPI

benchmarking project team have developed the technical specifications. Waitemata DHB is a key

leader in this process.

Planned developments for Auckland Regional Correctional Facility (Paremoremo)

Forensic services have been invited to contribute to workshops to support the development of the

operating model that will underpin the design process for the rebuild of Auckland East prison.

Audio Visual Links

A trial of audio visual technology for medical assessments in Forensic service interventions with

prisoners at NRCF (Ngawha prison in Northland) has started with a 4 month initial timeframe. This

trial will be actively reviewed from both mental health and corrections perspectives.

Marinoto North & Carmel Collage donation

Carmel College held a fund raising talent show and identified Marinoto North as the recipient as part

of Mental Health Awareness week. $1,650 was raised and presented to the service. We have

thanked the college for their very generous action.

Circle of Security Group Programme (Blueprint II)

The Circle of Security is a relationship based early intervention programme designed to enhance

attachment security between parents and children. Earlier this year two clinicians were funded to

train in the model to deliver a group for parents of infants. With the appropriate supervision now in

place, these clinicians are offering to run a group for not only parents accessing Marinoto West, but

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for parents of infants from the Child Health Services in West Auckland. An information day for

prospective participants is planned for early October.

Fostering Security (Blueprint II)

Fostering Security is a training programme for parents and caregivers of children with early trauma

and attachment difficulties. The programme is jointly delivered by CYF and Child Adolescent Mental

Health Service staff and aims to:

• Provide caregivers with education around basic child development, and the attachment and

physiological effects of early trauma, abuse and neglect

• Provide caregivers with practical management strategies

• Facilitate an integrated approach to caregiver support between CYF and Child Adolescent

Mental Health Service

• Establish a support group for parents and caregivers

• Give parents and caregivers confidence to manage the challenging behaviours of their

children, to develop health attachments and to sustain their placements.

The second Fostering Securities Programme has been implemented and reviewed, indicating there is

considerable enthusiasm on the part of CYF to extend the programme across the Waitemata sites. A

“Road Show” is being organised and initial conversation with Marinoto North manager re potential

facilitators has occurred. We plan to train facilitators in preparation for commencement of

programme early next year.

Service and Workforce Development Stepped Care (Blueprint II)

Developments between primary and secondary services require capacity building within specialist

services. Adult community services are stocktaking current workforce skills in Talking Therapies as

part of a project to develop a service delivery pathway on initial entry to service or following review.

This pathway will provide a structured approach to matching the level and type of therapy intensity

with outcome measures and review processes. The project will be supported by the national

workforce development centre, Te Pou, and links with other initiatives for integrating primary and

secondary care.

Supporting Recovery from Psychosis (Blueprint II)

This is a programme to increase capability of staff across Adult and Forensic services in the types of

approaches that have been found to be effective in reducing the frequency and impact of relapse for

longer term service users. The programme development and coordination is supported by a Janssen

Cilag Educational Grant for 2013. An application has been made for a further Grant for 2014.

Training involves 4x 1 day modules: engagement; cognitive behaviour therapy; collaborative

interventions in pharmacotherapy, co-existing problems and Recovery Planning; and motivational

interviewing. A first roll-out to 80 MHSG staff is underway with modules delivered by our own

clinical leadership from medical, pharmacy, nursing, allied health and consumer team. Our

expectation is that this programme will continue to rollout through 2014 and 2015 until 100% of

Adult and Forensic Services have completed.

Co-Existing problems (Blueprint II)

We have started the development of an online workforce self-assessment tool for individual and

team identification of current skill mix and training needs. This tool is in development for assessment

against the national Co Existing Problems Competency Framework but has the potential for a wide

range of future applications.

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Facilities Development

Taharoto Replacement Project

Building Consultants are working on the development of a more detailed design prior to engaging a

main construction company. Construction will start now in January 2014 and it is anticipated that

the unit will open in February 2015.

The signing of a lease with Unitec enables the remedial work to repair Mason Clinic buildings with

leaky building syndrome. The first stage will involve the building of a decant unit on the leased land

to allow service users to be housed during the course of remedial activity.

Change Programmes Progress:

Restructuring Community Mental Health Managers Roles - This process is now complete with the

new appointees starting in their roles on 30 September. Service manager roles have been

consolidated with one manager now for the North Shore, one for West Auckland and one for the

Rodney District. All of these rolls were filled by existing managers redeploying.

The new manager for the North Community Mental Health Service is Patrick Hinchey, the manager

for the West Community Mental Health Service is Apollo Taito, and Hugh O’Reilly was reconfirmed in

his role as the Rodney Community Mental Health Service Manager. Heather Stewart has chosen to

retire on 27 September after 40 years working in Mental Health. Heather was farewelled by many

of the staff that she had worked with over the years in a very positive farewell party.

Review of Administration Roles – consultation completed and staff have been informed of outcome.

Staff are currently having individual meetings to review impact and identify re-deployment

opportunities where this is sought.

Review of clinical charge nurse roles in adult mental health units – discussions are concluded.

Review of community acute services – workshops with staff held and new models being developed.

In discussion with PSA on change process.

Key Issues coming up Custody in Police Stations

The police have planned to move all people in custody from their police stations in Waitemata DHB’s

catchment area to the Waitakere Police Station from December 2013. DHB representatives have

met with Police representatives to minimise the impact of the proposed changes. The DHB Mental

Health services have supplied the police with information about the numbers of people being

assessed by mental health services in both police stations and emergency departments in the North

Shore, West Auckland and the Rodney areas.

Further joint planning work is planned between representatives from both organisations. The police

have assured us that the changes will only start in December and that many of the processes have

not yet been worked out; there was agreement for consultation about the processes when they are

in draft form. Clinicians and managers have been invited to these meetings from a range of MH

services and Emergency Departments.

There is a risk to the Organisation that higher numbers of clients will present in West Auckland to

the mental health service and may present in higher numbers to the Waitakere Hospital Emergency

Department.

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Financial Results


Mental Health Services

($000’s)


REVENUE

Government and

Crown Agency 12,683 12,674 9 38,207 38,056 152 151,712 151,712 0

Other Income 143 111 32 387 333 54 1,250 1,250 0

Total Revenue 12,826 12,785 41 38,594 38,389 206 152,963 152,963 0

EXPENDITURE

Personnel

Medical 2,200 2,072 (128) 6,171 6,397 226 25,401 25,401 0

Nursing 3,994 4,215 221 12,636 13,047 410 51,489 51,489 0

Allied Health 2,207 2,307 99 6,921 7,173 252 27,924 27,924 0

Support 57 59 3 166 176 10 714 714 0

Management /

Administration501 521 20 1,601 1,594 (8) 6,101 6,101 0

8,959 9,174 215 27,496 28,386 890 111,630 111,630 0

Other Expenditure

Outsourced

Services170 31 (140) 447 92 (355) 332 332 0

Clinical Supplies 115 117 3 338 352 14 1,409 1,409 0

Infrastructure &

Non-Clinical

Supplies

688 659 (29) 2,175 1,977 (198) 7,899 7,899 0

973 807 (166) 2,960 2,421 (538) 9,640 9,640 0

Total Expenditure 9,933 9,981 49 30,455 30,807 352 121,271 121,271 0

Contribution 2,894 2,804 90 8,139 7,581 557 31,692 31,692 0

Allocations 2,308 2,308 0 6,941 6,941 0 27,838 27,838 0

NET RESULT 586 496 90 1,198 640 557 3,854 3,854 0

YEAR TO DATE FULL YEARMONTH

COMMENT ON MAJOR FINANCIAL VARIANCES

Revenue

The favourable revenue result of $206k YTD is driven by $258k of unbudgeted revenue received due

to a delay in commissioning alternative services to the existing adult mental health respite and

inpatient sub-acute facilities. This revenue ceased this month as the new respite service opened

September 1st and the community alternative to sub-acute inpatient beds opened September 23rd.

An unfavourable variance of $122k YTD arising due to reallocation of Forensic demographic funding

to Capital and Coast DHB to fund five Forensic beds partially reduces the positive impact of the

additional revenue referred to above. The full year impact will be $490k adverse.

Personnel

Medical personnel expenditure is favourable by $226k YTD because of a CME (Continuing Medical

Education) adjustment ($30k), annual leave earned being less than paid ($43k) and vacancies.

Vacancy savings through the payroll are partially reduced by costs realised in outsourced services

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($82k) due to employment of a locum and payment to the University of Auckland for shared

employment arrangements.

Favourable variances for the year to date in allied ($252k) and nursing ($410k) are also mainly driven

by vacancies. Many of the vacancies relate to services which are being reviewed as part of the group

savings plan. The positive result in nursing is also to some extent attributable to improved acuity

management particularly in the Forensic inpatient units.

Other Direct Costs

The unfavourable variance in outsourced services of $355k YTD is made up of $268k unmet budget

savings and $107k of outsourced clinical staff budgeted for in personnel. These variances are

partially suppressed by an under-spend on forensic step down beds of $38k.

Notable explanations contributing to the $198k overspend on infrastructure and non-clinical

supplies are late billing ($32k), one off consultant fees ($10k), security services for watches in adult

mental health ($15k), unmet budget savings ($41k) and a negative budget ($62k) in a general

suspense account representing additional revenue which was recognised after the DAP submission

and therefore budgeted here to ensure alignment with MoH expectations.

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Surgical and Ambulatory Services

Service Overview 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, Head of Division Nursing is Kate Gilmour and

Head of Division Allied Health is Tamzin Brott.

Scorecard

Health Targets

Better help for smokers to quit is close to target at 94.9%.

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 87% for CT and 32% for MRI.

Elective Surgery Volumes

The Waitemata DHB (S&AS and ESC) elective volume has been achieved to meet MoH target for the

quarter. However it is important to note that we have a stretch target internally to meet the 30

June Health Target.

Shorter Waits in ED

Shorter waits in ED for September was just under the target at 93.4%. Please note the outcome for

the quarter. This information is being presented to each Clinical Director.

Quarter Specialty Month Breaches Compliant

Total

Discharges

% 6 Hours

Compliance

General Surgery Jul_13 13 212 225 94%

Aug_13 29 258 287 90%

Sep_13 12 192 204 94%

Q1 Total 54 662 716 92.6

Orthopaedic Jul_13 11 124 135 92%

Aug_13 19 141 160 88%

Sep_13 9 108 117 92%

Q1 Total 39 373 412 90.6

ESPI Compliance

ESPI compliance has been achieved for the first quarter within the MoH buffer. Our goal is to be

100% compliant to the 5 month treatment time by the end of the year. The surgical areas of risk are

orthopaedics and ORL. Formal reporting on ESPI I will commence at the next HAC meeting.

Quality

The service received 27 complaints in September (21 received at the same time last year) and

achieved a complaint response rate of 12 days.

Thirty five compliments were received by surgical services.

The Health and Disability Sector Standard Audit preparations are on target for the audit on 11 – 15

November 2013. Self-assessments have been completed and submitted for the auditors’ review. The

areas identified for external audit will receive an internal audit in the first week of November to

identify other improvements to be made before the final audit.

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Intensive Care/High Dependency Unit and Outreach

With the SMO recruitment completed, there has been a significant reduction in the amount of locum

work being required which is providing both cost savings and the ability to actively manage and

promote the taking of annual leave.

Outpatients Departments

Additional outpatient breast clinics have started to support the commencement of new breast

plastic surgery at Waitemata DHB.

We are working collaboratively with the urology service to establish a new way of managing patients

in clinic with possible prostate cancer who are referred for Truss biopsies. We anticipate this will

improve both the patient experience and information sharing prior to biopsy as well as reducing the

risk of complications post biopsy.

The electronic whiteboard project is progressing with a number of work stations in the department

having dual screens installed to allow constant visibility. We are awaiting some technical work to be

done by Health Alliance to allow the programme to go live.

Radiology

Initiatives to address the ultrasound wait list backlog have seen an improvement in the percentage

of patients receiving their routine scans within the target six weeks from 36% in February 2013 to

61% in September. The percentage aimed for by year end is 75% waiting no longer than 6 weeks and

the service is on track to achieve this. Ultrasound capacity shortfall at the DHB resulting from 2.0FTE

sonographer vacancies is currently supplemented by outsourcing a regular volume of GP referred

scans to a community provider. A Radiology staff representative sits on an HWNZ advisory group to

assist with developing a plan to address the nationwide sonographer shortage, as requested by the

Minister of Health.

Additional overtime and outsourced CT and MR lists funded through Elective Services team initiative

at the NHB are underway and will run through to 16 December. The initiative has already helped

reduce the CT waiting times for September, with the latest indicator level sitting at 87% of patients

receiving their scan within six weeks.

The Board has now accepted the proposal from Philips for supply and installation of a second MR

scanner. The current MR1.5 T scanner is a Philips machine and their proposal includes a

comprehensive upgrade which will extend the life of this 11 year old scanner for a further ten years.

The detailed facility design can now be finalised in preparation for resource consent application and

build tendering. The facility programme delivers a build start date of early-mid December and

commissioning of second machine in March 2014. Planning is underway to minimise the impact of

the build programme on current MR service throughput.

Urology

The One Stop nurse-led mascroscopic haematuria clinic: waiting times and patient satisfaction

practice development paper has been published in the international urological nursing journal. Sue

Osborne (Urology Nurse Practitioner) and Mr Madhusudan Koya (Clinical Director) are co-authors.

Surgical Wards

• The surgical wards continue to work on their quality plans which include the agreed quality and

safety markers falls, pressure injuries, hand hygiene and CLAB.

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• Quality study days continue which allows recommendations with corrective actions to be

implemented following audit.

• Preparation for the upcoming HDSS audit in November continues.

• Infection Control – Bare Below the Elbows continues to be a focus for the Surgical Wards. We

have identified a General Surgeon to represent the Bare Below the Elbows project for Surgery.

• Falls HOD has run education sessions focusing on fall and ward champions have been appointed

and there has been no falls with fracture in September.

• Ward participation in the patient and family satisfaction survey continues.

• Annual leave management plans have been a focus in Surgical Wards.

• The session on the Frances Report was well attended by the Surgical and Ambulatory Services

CNMs.

• We have commenced the ERAS (Enhanced Recovery after Surgery) Orthopaedic Project.

• The Negative Pressure contract has been negotiated which will be financially favourable to

Waitemata DHB.

Outpatients DNA

Our DNA rates have maintained a status quo over the last six months despite various projects and

focus. A new project is being worked up with funding specifically allocated to the project which will

be led by Cath Cronin for the provider arm to address this issue. We are currently seeking a project

person to facilitate the work with sustainable outcomes within the provider arm.

Theatres NSH and WTH

Two quality projects are underway at present, Surgical Safety Checklist, preventing

perioperative harm and Hand Hygiene. Both are quality and safety markers for Health Quality

and Safety Commission New Zealand.

Inventory scanning project at NSH is nearing completion and is expected to be fully

implemented by the end of October. This will provide efficient ordering of consumables and

stock rotation with the expected outcome of reduction in expired stock and improved

consumable stock management.

There has been a focus on consumable savings within the department. The surgical teams have

reviewed their practice for opening consumables and are using a just in time approach. This

change in practice does not impact service delivery and has produced savings in two areas with

sutures and drapes both significantly under budget YTD. To complement this we are also

running a consumable pricing competition to heighten the awareness of the cost of everyday

items and to add an element of fun to the workplace.

Management of the acute surgical workload presents challenges due to the workload

variability. Improved engagement with all clinicians in prioritising acutes and twice daily acute

reporting has resulted in improvements which have exceeded the 22 hour target of 85% in

September.

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Scorecard

Health Targets Actual Target Productivity Number Actual Target

Better help for smokers to quit 94.9% 1 0 95.0% � Elective Day of Surgery Cancellations 2.2% 1 0 2.0% �

Provider Arm Elective Volumes - overall * 98.5% 1 0 100.0% � - Surgical and Ambulatory Services 2.2% ##### ##### 2.0% �

- Surgical and Ambulatory Services 120.9% 1 0 100.0% � - Elective Surgical Centre 0.0% 1 0 2.0% �

- Elective Surgical Centre 62.9% 0 1 100.0% � No. & % of CT scans done within 6 weeks (42 days) 598 87.0% 1 0 85.0% �

Shorter Waits in ED 93.4% 1 0 96.0% � No. & % of MRI scans done within 6 weeks (42 days) 80 32.0% 0 1 75.0% ��

* excludes gynae No. & % of US scans done within 6 weeks (42 days) 501 61.0% 0 1 75.0% �

Patient Flow

Average Length of Stay - Acutes 4.75 1 0 4.00 �

Quality Actual Target Average Length of Stay - Electives 4.14 1 0 3.90 �

Complaint Average Response Time 12 days 1 0 14 days �� - Surgical and Ambulatory Services 5.20 1 0 3.90 �

- Elective Surgical Centre 1.98 1 0 3.90 �

DNA Rates Number Discharges before 11am 16.5% 1 0 20.0% �

First Specialist Assessment (FSA) DNA rate - Total 175 13.8% 1 0 10.0% �

First Specialist Assessment (FSA) DNA rate - Maori 26 24.8% 0 1 10.0% � ESPI 2 - % patients waiting longer than 5 months for FSA

First Specialist Assessment (FSA) DNA rate - Pacific 15 19.7% 0 1 10.0% � General Surgery 0.2% 1 1 0.0% ��

Follow up (FU) DNA rate - Total 315 10.7% 1 0 10.0% � ORL 1.1% 0 1 0.0% �

Follow up (FU) DNA rate - Maori 50 26.5% 0 1 10.0% � Orthopaedics 0.0% 1 0 0.0% �

Follow up (FU) DNA rate - Pacific 39 21.1% 0 1 10.0% � Urology 0.0% 1 0 0.0% ��

Other Key Measures ESPI 5 - % of Patients not treated within 5 months

Acute Readmission Rate within 28 days 10.3% 1 0 9.0% � General Surgery 1.4% 0 1 0.0% �

% of fractured neck of femur patients to theatre within 24 hours (July 2013) 52.0% ##### ##### TBC � ORL 0.6% 0 1 0.0% �

ICU - rate of CLAB per 1000 line days 1.2 1 0 < 1 � Orthopaedics 1.6% 0 1 0.0% �

Urology 0.0% 1 0 0.0% ��

Contracts (YTD)

Elective WIES Volumes

HR Wellbeing Actual Target Surgery (Overall) 3,015 1 0 2,675 �

Sick Leave Rate (days) * 7.6 days 1 0 7.5 days � - Surgical and Ambulatory Services 2,347 1 0 1,992 �

Overtime Rate (%) * - Surgical and Ambulatory Services 1.2% 1 0 1.0% �� - Elective Surgical Centre 765 1 0 975 �

Annual Leave Balance > 75 days 15 1 0 9 � General Surgery 1,156 1 0 1,134 �

Turnover Rate % * 8.0% 1 0 10.0% � - Surgical and Ambulatory Services 924 1 0 657 �

Clinical Employ (FTE) 811 FTE 1 0 � - Elective Surgical Centre 231 0 1 477 �

* 12 month rolling average ORL 286 1 0 303 �

Orthopaedics 1,279 1 0 975 �

- Surgical and Ambulatory Services 857 1 0 766 �

- Elective Surgical Centre 422 1 0 498 �

Financial Result YTD Actual $000s Target $000s Urology 295 1 0 263 �

Revenue 34,272 k 1 0 34,045 k �

Expense 36,661 k 1 0 36,668 k � Acute WIES Volumes

Personnel Costs 25,696 k 1 0 26,785 k � Surgery (Overall) 3,115 1 0 3,262 �

Outsourced Services 1,718 k 1 0 1,131 k � General Surgery 1,661 1 0 1,713 �

Clinical Supply Costs 7,760 k 1 0 7,237 k � Orthopaedics 1,443 1 0 1,549 �


Contribution -2,389 k 1 0 -2,290 k �� Non-Case weighted Discharges

First Specialist Assessment (FSA) 3,039 1 0 3,521 �

Capital Expenditure 462 k 1 0 500 k � Subsequent Attendance (FUP) 8,010 1 0 8,057 �

Indicator Ti tle 85.0% 1 k 0 100.0% � Improvement against previous result



Waitemata DHB Monthly Performance ScorecardSurgical and Ambulatory Service and Elective Surgical Centre

September 2013

Service Delivery

Human Resources

Quality

Finance

Priority One

How to readHow to read

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A fully functioning Cancer Care Co-ordination service employing clinical nurse specialists

across all tumour streams and including Māori and Pacific navigators, Faster Cancer

Treatment tracking, and a Clinical Lead for Cancer Care, by 30 June 2014. Cancer nurse co-

ordinators will be supported to attend regional training and mentoring forums.

�

Use Faster Cancer Treatment data reported to the Ministry of Health as baseline data for

service improvements

�

Design rapid reporting and telephone communication of results of diagnostic scans and

investigations

�

Re-designed cancer multi-disciplinary meetings consistent with national standardised

processes of access, documentation, communication and care coordination, audit and

reporting in place by 30 June 2014

�

Conduct a baseline survey of cancer patient experience � Collect ethnicity data for Māori and Pacific People at the key Faster Cancer Tracking wait

time indicators as baseline data for 2014/15 interventions to reduce ethnic inequalities � Plan to deliver required elective surgical discharges for the Waitemata DHB population in

accordance with patients’ assigned priority and within the appropriate waiting time

�

Ensure plan in place to meet and maintain ESPI compliance � Monitor patient outcomes including complication rate, readmission rate and infection

rates each month by ethnicity

�

Ensure improved Maori and Pacific access to bariatric surgery � Implement electronic referrals for eight elective procedures by 30 June 2014 � Review numbers of follow ups to ensure match to clinical need with a plan to discharge

patient back to primary care

�

Audit current ultrasound utilisation and relevant back-up to better understand possibility

of incorporating both CT and CT angiogram within same appointment for TIA patients

�

Implement new Outpatient Service model (staffing, booking & scheduling) � Maintain direct access for general practitioners to a full suite of diagnostic imaging

including X-rays, ultrasounds, fluoroscopy, mammography, nuclear medicine, CT and MR

with a focus on reducing waiting times for ultrasounds (establish baseline Q1, reduction in

waiting times by 30 June 2014)

�

Electronic referral templates, developed by a working group comprised of primary and

secondary clinicians, implemented by 31 December 2013 to enhance general practitioner

access to radiology services

�

Direct referrals by general practitioners to elective booking lists will be in place for skin

lesions, vasectomy, mirena insertions and ring pessaries (WDHB) – confirm current

practice and establish baseline Q1, identify any enablers/process changes required Q2,

implement changes required Q3, direct referrals to identified booking lists in place Q4

�

The Waitemata DHB chronic pain management service will work more closely with general

practices through improved availability for telephone and email contact and by having

regular, interactive workshops which will provide a forum for specialist pain staff to share

knowledge with primary care practitioners to improve the community based

management of patients with chronic pain. The service will operate with a concept of

“partnership in pain management” between the patient, general practitioner and hospital

specialist service

�

Ensure viable elective services units within Provider Arm during 2013/14 � Ongoing provider arm services reviews �

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Key achievements for month:

ESPI compliance achieved for first quarter (within MoH buffer) Surgical Health target met for first quarter

KEY ISSUES/INITIATIVES IDENTIFIED IN COMING MONTHS

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

patients within 5 months and to sustain this in FY14.

• Work will commence in the next few months to identify the issues associated with moving to a

surgical treatment time of 4 months in December 2014.

• Daily monitoring of performance to targets and financial management continues to ensure

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

• Clinical Supplies Project continues 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.

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

• S&AS has received funding and has commenced the Enhanced Recovery After Surgery (ERAS) to

orthopaedic patients (hip/knee procedures and fractured neck of femur). Our work will be

based on the successful implantation of ERAS for Colorectal patients lead by Matthias Soop

(Colorectal Surgeon).

• Strategies are in place to contain our expenditure and to look for opportunities to contribute to

savings initiatives within the service.

• Formalisation of appropriate financial processes between S&AS and ESC.

Fractured Neck of Femur Pathway Project

In August 2013, the Fractured Neck of Femur Pathway project was initiated by S&AS following

approval from the Clinical Governance Board. The project team has representation from key areas

across the organisation, including ED, Theatres, Orthopaedics, Anaesthesiology and Gerontology.

Over the last 6 weeks, the team have been working together to agree on the key measures of

success for this project and gathering baseline data about current performance. Our current target is

to measure access to theatre from admission with 24 hours. We have seen an improvement and

currently achieve 50.8%. Best practice recommendation from local and international evidence base

supports the change in time to surgery from 24 to 48 hours with no deterioration in morbidity. This

proposal will be taken to WDHB clinical governance for further discussion and will be raised at a

national quality forum.

The next steps for the project are to integrate with the national Ministry of Health ERAS Program

and continue to build momentum, delivering improvements in both process and outcome measures

as agreed by the working and sponsor groups.

69 of 98


Cancer Care Coordination Update All CNS Cancer Coordinator roles have been recruited to cover all tumour streams and support

patients within Waitemata HDB and attending treatment at Auckland DHB.

Faster Cancer Tracking

Data sent to Ministry 20th of October, third reporting quarter. Regional analysis of this data is due 4th

November and an update will be reported once the data is available

Financial Results


Surg & Ambulatory

($000’s)


REVENUE

Government and

Crown Agency 11,014 11,252 (239) 34,032 33,870 161 133,712 133,712 0

Other Income 119 57 62 240 175 65 692 692 0

Total Revenue 11,133 11,310 (177) 34,272 34,045 227 134,404 134,404 0

EXPENDITURE

Personnel

Medical 3,579 4,024 445 11,188 12,155 968 48,441 48,441 0

Nursing 2,875 2,936 61 8,771 8,970 199 36,838 36,838 0

Allied Health 931 929 (2) 2,890 2,836 (54) 11,190 11,190 0

Support 168 184 16 511 550 40 2,196 2,196 0

Management /

Administration758 738 (20) 2,336 2,274 (62) 9,077 9,077 0

8,311 8,811 500 25,696 26,785 1,090 107,742 107,742 0

Other Expenditure

Outsourced

Services425 370 (55) 1,718 1,131 (587) 4,461 4,461 0


Infrastructure &

Non-Clinical

Supplies

495 483 (12) 1,487 1,514 27 5,863 5,863 0

3,456 3,286 (170) 10,965 9,882 (1,083) 38,667 38,667 0


Contribution (634) (787) 154 (2,389) (2,622) 234 (12,005) (12,005) 0

Allocations (88) (88) 0 (190) (190) 0 (919) (919) 0

NET RESULT (546) (699) 154 (2,199) (2,433) 234 (11,086) (11,086) 0


Commentary on First Quarter Major Financial Variances: (S&AS = Surgical & Ambulatory Services)

Revenue

The MoH revenue variance YTD is $175k favourable due to additional $271k FSA/FUP volumes done

at NSH instead of ESC in July (as budgeted in Price Volume Schedule), less ORL elective surgery

volume under plan ($96k). The YTD total excludes an additional $1.50m electives volumes delivered

but only paid to budget as agreed with the WDHB Funder, made up of General Surgery ($1.1m) and

Orthopaedics ($400k). Note that the Funder: Provider agreement for elective funding is to pay either

the actual, or YTD budgeted amount, whichever is lower. The revenue budget is set at the MoH

target level as this is the amount the WDHB Funder receives each month from MoH. However, the

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actual operational elective production volumes and relative expenses are set considerably higher

(around 11.2% or $2.0m for Q1) which explains the reason for the additional $1.50m volume, and

the fact some savings variance has accrued relating to expenditure. Note that this MoH:actual

production plan differential phases neutral by financial year end.

Expenditure

Medical personnel:

Savings in SMO & MOSS are $570k favourable to budget YTD, with $230k being generated by the

Department of Anaesthesia due to savings generated by lower capacity requirements at ESC,

allowing efficient use of the roster. As well as this saving, a large amount of leave was taken in July

creating General Ledger savings, together with a number of vacancies awaiting recruitment (3.8 FTE

SMO), most of which are being filled by outsourced medical services, which creates a negative

variance in the outsourced area. Registrar and House Officer costs also proving favourable by $400k,

due to a material saving on allowances due to higher FTE overall, lower theatre volumes and more

efficient rostering.

Nursing:

Favourable YTD position in FTE of 6.2 senior nurses and 11.0 RNs waiting to recruit, partially off-set

by 13 FTE $176k in internal bureau and $76k in external bureau nursing in wards and theatre. This

leaves a total favourable variance of $199k YTD.

Allied Health staff:

The unfavourable YTD variance of $54k is in contrast to the actual staffing situation in Allied Health,

which is 7.0 FTE favourable due to vacancies and maintaining disciplined rosters, and which would

reflect a $70k favourable dollar position. However, a $121k savings line, being part of S&AS’s $2m

share of budget savings initiatives, to which S&AS is fully committed and plans to deliver, is included

in the Allied Health set of accounts. These savings initiatives are being actively addressed in all

divisions of S&AS, and off-sets this net $54k unfavourable variance for the quarter.

Admin staff:

Similarly, the unfavourable YTD variance of $62k is created by a $67k YTD savings line in this cost

centre, with the actual planned staffing and costs on budget. S&AS is committed to achieving this

saving, and this variance is being addressed by the service as a whole and will be off-set in other

areas of S&AS such as Medical and Nurse personnel savings.

Outsourced personnel: ($486k unfavourable YTD)

Package of Care costs for surgeons of $136k doing unbudgeted work at WTH awaiting the start of

ESC (first 2 weeks of July), contribute to the variance. Breast Screening Programme have unbudgeted

outsourced doctor costs of $27k awaiting recruitment of SMOs; while a University of Auckland SMO

costing $42k is off-set by an underspend in Medical FTE. A savings initiative off-setting an unattained

Ophthalmology programme of $174k YTD sits in this area awaiting implementation of alternative

saving initiatives. Bowel Screening Programme Manager’s costs of $36k off-sets BSP management

FTE savings. Includes $77k of unfavourable bureau nursing needed to off-set RN vacancies.

Outsourced services: ($101k unfavourable YTD)

ADHB radiology costs ordered by Urology unfavourable by $50k; Breast SP outsourced screens are

$21k over budget YTD due to Northland volumes; and $31k worth of Lab sendaway tests have been

incurred compared to budget. While these extra costs have all been reconfirmed, it is hoped that

service review can help mitigate some of these costs going forward.

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Clinical supplies: ($522k unfavourable YTD)

$60k repairs re Anaesthetic equipment. Implants $428k unfavourable due to unbudgeted WTH lists

and additional NSH volumes from ESC, and mostly off-set by favourable balance in ESC. Procedure

packs $198k unfavourable YTD due to a change in ordering and accounting procedure. This is likely

to continue during the year, but under close scrutiny. Some savings initiatives are off-setting these

overspends, with a ‘price basket’ being used to ensure that embedded HBL/hA signalled savings

materialise. A point of note is that total actual YTD clinical supply costs for this year for NSH/WTH is

$7.76m compared to $7.73m last year despite considerable elective volumes being done by ESC.

However, $280k of this is ambulance costs, not paid by S&AS last year.

Summary:

The fact S&AS has been able to complete the first quarter with a small favourable variance reflects a

good start regarding the savings programme and the $888k worth of savings embedded in the first

quarter budget. However, stringent cost control measures must remain in place to ensure costs are

kept in check as elective volumes in the production plan rise over the second quarter.

S&AS and ESC Combined

Actual

Dollars

Sept

Budget

Dollar

Sept

Dollars

Variance

Sept

Actual

Dollars

YTD

Budget

Dollars

YTD

Dollars

YTD

Variance

Budget

Full Year

YTD

Actual

FTE (Avg)

YTD

Budget

FTE (Avg)

FTE

YTD

Varian

ce

(Avg)

Budget

FTE Full

Year

Government and Crown

Agency Sourced -12,824,095

-

13,431,135 -607,040 -37,533,604 -38,584,542

-

1,050,938

-

159,032,628

Patient/Consumer

Sourced -43,775 -31,961 11,814 -99,658 -97,405 2,253 -385,054

Other Income -75,322 -25,461 49,861 -139,988 -77,595 62,393 -306,739

-12,943,192

-

13,488,557 -545,365 -37,773,250 -38,759,542 -986,292

-

159,724,421

MEDICAL PERSONNEL 3,583,796 4,024,061 440,265 11,193,061 12,155,399 962,338 48,440,940 197.65 198.94 1.29 198.94

NURSING PERSONNEL 3,143,531 3,255,936 112,405 9,629,112 9,902,706 273,594 40,689,758 537.50 554.08 16.58 554.08

ALLIED HEALTH

PERSONNEL 931,201 928,877 -2,324 2,889,746 2,835,624 -54,122 11,190,061 138.73 145.80 7.07 145.80

SUPPORT PERSONNEL 167,995 184,270 16,275 512,329 550,169 37,840 2,196,002 38.51 39.78 1.27 39.78

MANAGEMENT

ADMINISTRATION

PERSONNEL 785,869 773,616 -12,253 2,459,420 2,381,823 -77,597 9,522,415 163.08 164.42 1.34 164.42

8,612,392 9,166,760 554,368 26,683,668 27,825,721 1,142,053 112,039,176 1,075.47 1,103.02 27.55 1,103.02

OUTSOURCED SERVICES 949,202 1,015,793 66,591 2,842,689 2,760,281 -82,408 11,276,402 0.00 0.00 0.00 0.00

CLINICAL SUPPLIES 3,102,039 3,002,820 -99,219 8,964,381 8,675,343 -289,038 34,908,353 0.00 0.00 0.00 0.00

INFRASTRUCTURE &

NON-CLINICAL SUPPLIES 528,165 582,137 53,972 1,690,134 1,788,506 98,372 7,024,883 0.00 0.00 0.00 0.00

4,579,406 4,600,750 21,344 13,497,204 13,224,130 -273,074 53,209,638 0.00 0.00 0.00 0.00

13,191,798 13,767,510 575,712 40,180,872 41,049,851 868,979 165,248,814 1,075.47 1,103.02 27.55 1,103.02

248,606 278,953 30,347 2,407,622 2,290,309 -117,313 5,524,393 1,075.47 1,103.02 27.55 1,103.02

The combined summary helps off-set some of the larger disparities created by the ratio of budgeted

volumes delivered between NSH and ESC theatres being different to those that have actually

occurred in the first quarter of ESC’s operation. For instance, the S&AS outsourced services YTD

variance is $587k, which reduces to $82k when combined with ESC, and clinical supplies reduces

from $522k to $289k (with much of this latter amount attributable to HBL/hA pricing initiatives yet

to materialise). The revenue figure still excludes the $1.5m elective volume delivered but not

currently funded due to the methodology adopted which only pays actual to a capped budget.

72 of 98



Service Overview

This new division provides elective surgical services to our community, working alongside the

Surgical and Ambulatory and Child, Women and Family Services. It provides general surgery,

orthopaedic surgery, gynaecology and urology. It has its own outpatient clinic, operating theatres,

CSSD and a post-operative ward. The Director of the Service is John Cullen and it is managed by

Mark Watson.

SCORECARD – SEE SURGICAL AND AMBULATORY SERVICES AND CHILD WOMEN AND

FAMILY SERVICES SCORECARDS FOR ESC MEASURES

Service Delivery A significant increase in volumes occurred in August.

Points of Interest:

• Monthly volumes – Plan in place to now increase the volumes

• Continued measured opening of facilities in a safe and controlled manner

• ESC Clinic opened – August

• Urology service to start in full at ESC in October

• Continued excellent patient feedback

• Inaugural ESC Clinical Committee meeting took place in September

• Review of the current Booking and Scheduling process

Elective Surgery Volumes

August has seen an improvement in the number (227) patients operated on in the theatres, with

September reaching 251. This still remains short of the expected volumes for the month. These

patients have been a mix of orthopaedics, general surgery, gynaecology and some minor ORL and

urology cases, to date. The table below gives a visual to the breakdown of overall patient volumes

each month so far.

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September has seen the start of three SMO locums in orthopaedic and general surgery. These

surgeons will pick up a number of unallocated sessions to improve the utilisation of the three staffed

theatres. Plans are in place to ensure there are patient volumes for these new surgeons. First locum

lists have started in the last week of September, improvements in volumes will occur in October and

onwards.

Urology Volumes

Following discussions with S&AS and the Urology Dept, it has been agreed that ESC will provide

services for intermediate urology services. This will include work such as TURP and also radical

prostatectomy. The main work will commence at the beginning of October with an initial fortnightly

all day list. This work will displace some of the expected general surgical caseload.

Additional volumes

We are currently working to an agreed (Surgical & Ambulatory/ESC) schedule with allocated

anaesthetists to each of these lists. The ability to do additional work outside these scheduled times

is restricted by the current total anaesthetic FTE. The ability to do this outside the defined schedule

will be facilitated in February with an increase in anaesthetic FTE. Alternative solutions within the

current anaesthetic FTE are being explored. This utilisation of lists outside the current schedule was

requested by the surgeons and the ability to utilise lists outside the designated sessions will help to

ensure the contracted ESC numbers are realised.

ACC

Approaches have been made by a number of orthopaedic surgeons to bring some of their ACC

patients, currently done in private, to the ESC. A list of ACC patients will be trialled within the next

few weeks.

Session Utilisation/Start & Finish Times

In order to illustrate why the patient volumes have remained lower that we had initially anticipated,

the following table shows the sessions used:

15-Jul 22-Jul 29-Jul 05-Aug 12-Aug 19-Aug 26-Aug 02-Sep 09-Sep 16-Sep 23-Sep

Sessions Allocated 26 28 31 28 26 29 32 29 25 31 26

Sessions Used 19 12 15 23 19 25 21 25 21 25 19

Of these unused sessions, the reasons behind them not being utilised is broken down below:

ESPI Compliance

We are working closely with S&AS to ensure volumes are increasing to meet expected productivity.

We have replaced some general surgery volumes with urology cases and the unit will commence

working fortnightly at ESC from September. From October, we will have most of our sessions

assigned to a surgeon and the use of the locums will help this and also provide some cover and

backfill for SMOs on leave, etc.

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Quality

The service received no complaints in August. Overall, for the first three months, the service is

receiving a significant number of compliments regarding the clinical service as well as the food

service, which has been pleasing to see and is a credit to the team, overall, who have been working

very hard to get the service up and running, whilst continuing to provide a top level of service for our

patients. There have been two complaints in September.

Surgeon/Anaesthetist Teams

Despite a slow start to the Surgeon/Anaesthetic team continuity, it is anticipated that this will

improve over the coming weeks. The overall compliance with the provided Surgeon/Anaesthetist

team list has been 33% in July and 30% in August. However, work is underway to rectify this, now

that the theatre schedules have been finalised, with fewer changes to the expected sessions.

The weekly averages of compliance for the four weeks over September were 40%, 8.33%, 30.77%

and 36.36%.

Outpatients Departments

The ESC Outpatient clinics opened at the beginning of August. These have been predominantly

Orthopaedic new and follow up patients. Overall numbers through the clinic through August have

been steady, with 34 clinics in total and 328 patients seen. In September there were 39 clinics held

and 364 patients seen.

Cullen Ward

Ward stays have fluctuated, reflecting the theatre schedule. We have had 20 + patients staying

overnight and low numbers on other nights. Weekends have proven to be challenging, however, the

allocation of an orthopaedic surgeon to do joints on Thursday from October onwards, now allows us

to staff over the weekends, which will also reduce transfers to NSH. Overall, the ward processes

remain highly successful, with excellent feedback from surgeons and patients.

Clinical Committee

The following members sit on the ESC Clinical Committee:

• Mr B Farrington (Chair)

• Mr J Cullen

• Mr J Koea

• Dr T Hunter

• Dr L Nicholson

• Mr P Van de Weijer

• M Watson

• L Virtosu

• G du Preez

The inaugural meeting took place at the end of September.

Key outcomes from the meeting:

• Chair voted

• TOR’s agreed

• A full comprehensive review of all clinical transfers

• Good discussion regarding the importance of Surgeon/Anaesthetic teams being in place

• Good feedback from the surgeons/anaesthetists back to the operational management team

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Overall a very positive meeting with good membership. The next meeting is planned for one months’

time, after which a final decision will be made over the on-going frequency.

Food Services

A particularly pleasing outcome of the ESC’s first couple of months has been the food service, which

is a major change in the way food is prepared and served within our DHB. In the table below is the

latest round of feedback from our patients.

The Board may be aware that we have a standalone food service at ESC, with waitress style service

provided for all inpatients and light refreshments served for all day patients. The inpatient food is

served from one small room on level one, Cullen Ward and requires only two staff to serve the

entire ward on busy days. The main evening meal is provided through a Steamplicity concept, which

is essentially raw food that is microwaved and cooked in its own steam. The result is a very tasty and

appetising meal that requires very little labour to prepare and serve.

This concept is being viewed by the DHB as a potential alternative to food provision within the main

site and we will look to promote this excellent product in conjunction with the CEO.

Patient Taste Meals Eaten TemperatureDinner

PresentationB +L Quality

Amount of

food

Overall

meal/beverage

service

Other

1 Very niceRoast Lamb,

Braised SteakHot

Very

SatisfiedVery Satisfied

Yes,

sufficientVery satisfied

Very happy, couldn't fault them

(FSAs), great service

2 Nice Roast Lamb YesVery

SatisfiedVery Satisfied Plenty Very satisfied Perfectly happy

3 Ok Braised Steak FineVery

Satisfied - Too much -

No complaints at all, (FSAs) very

helpful. Broccoli cooked perfectly.

4

Ricotta Tortelini

nice, Potato on

Lamb too spicy.

Roast Lamb,

Braised Steak,

Ricotta Tortell ini

Good, hotVery

SatisfiedVery Satisfied

Yes,

enoughVery satisfied (FSAs) friendly and helpful.

5 Too spicy.Roast Lamb, Herb

Rubbed ChickenGood Satisfied Satisfied Yes Not satisfied*

Service is fine, just the spicy food

lets it down

6 Tasted great. Ricotta Tortell ini GoodVery

SatisfiedVery Satisfied Heaps Very satisfied Everything good

7

Average, only

ate half,

potatoes too

spicy

Roast Lamb, Herb

Rubbed Chicken,

Brasied Steak.

FineVery

Satisfied - Yes Satisfied Girls (FSAs) are nice and cheerful.

8Yummy, all

good.

Herb Rubbed

Chicken, Roast

Lamb.

Fine, not too

hot.

Very

SatisfiedVery Satisfied Definitely Very satisfied The whole team has been great.

n=8 100% Satisfied

100%

satisfied or

very satisfied

100%

respondents

satisfied or

very satisfied

90%

satisfied*

80%

respondents

satisfied or

very satisfied

* 1 patient not satisfied due to the spiciness of the roast potato provided with the Roast Lamb and Herb Rubbed Chicken. This issue was investigated and it was

identified that the of roast potato product used for this batch of meals was spicier than the usual product. Al l patients were subsequently informed of the spice

level of these meals when dinner orders were taken. Summary

In summary, August and September have shown a gradual and controlled increase in patient

volumes. Patient safety has been paramount and we are happy that this has not been compromised

since opening. This has resulted in continued positive feedback from all patients and staff.

A sound clinical governance platform has now been initiated through our new ESC Clinical

Committee and this will provide much needed guidance and support to the ESC management team

in the running of the ESC.

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Scorecard


Provider Arm Elective Volumes - overall * 98.2% 1 0 100.0% �

- Elective Surgical Centre * 62.9% 0 1 100.0% � Patient Flow

* includes gynae Average Length of Stay - Electives 4.1 days 1 0 3.9 days �

- Elective Surgical Centre 2.0 days 1 0 3.9 days �

ESPI 2 - % patients waiting longer than 5 months for FSA

HR Wellbeing Actual Target General Surgery 0.2% 1 1 0.0% ��

Sick Leave Rate (days) * 3.4 days 1 0 7.5 days �� ORL 1.1% 0 1 0.0% �

Overtime Rate (%) * 0.9% 1 0 1.0% � Orthopaedics 0.0% 1 0 0.0% �

Annual Leave Balance > 75 days 0 1 0 2 �� Urology 0.0% 1 0 0.0% ��

Turnover Rate % * 1.9% 1 0 10.0% �

Clinical Employ (FTE) 48 FTE 1 0 0 FTE � ESPI 5 - % of Patients not treated within 5 months

* 12 month rolling average General Surgery 1.4% 0 1 0.0% �

ORL 0.6% 0 1 0.0% �

Orthopaedics 1.6% 0 1 0.0% �

Urology 0.0% 1 0 0.0% ��


Revenue 3,501 k 1 0 4,714 k � Contracts (YTD)

Expense 3,521 k 1 0 4,382 k � Elective WIES Volumes

Personnel Costs 988 k 1 0 1,040 k � Elective Surgical Centre (Overall) 765 1 0 975 �

Outsourced Services 1,125 k 1 0 1,630 k � General Surgery 231 0 1 477 �

Clinical Supply Costs 1,205 k 1 0 1,438 k � Orthopaedics 422 1 0 498 �

Non-Clinical Supply Costs 203 k 1 0 274 k � Gynaecology 112 1 0 86 �

Contribution -19 k 1 0 332 k �

Non-Case weighted Discharges

First Specialist Assessment (FSA) 276 0 1 1,158 �

Subsequent Attendance (FUP) 297 0 1 1,513 �

Improvement against previous result


Indicator Title 85.0% 1 k 0 100.0% �

Actual Target

Waitemata DHB Monthly Performance ScorecardElective Surgical Centre

September 2013

DHB Performance

Service Delivery

Human Resources

Finance

Priority One

How to readHow to read

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Implement shorter journey and productivity models of care in ESC by 30 June 2014 � Implement remuneration package in ESC by 30 June 2014 � Implement PIPMS (Peri-operative Information Process Management System) system in

ESC by 30 June 2014

�

Ensure viable elective services units within ESC during 2013/14 � Primary Care access and streamline referral process pathways to the Elective Surgery

Centre (orthopaedics) in place by 31 December 2013

�

Implementation of new model of care for elective services delivery at the new surgery

centre �


Key achievements for month:

1. All surgical specialties have now operated at ESC

2. Joint arthroplasties undertaken up to 30/09/13 - 45 TKJR & 60 THJR

3. Successfully completed laparoscopic fundoplication and laparoscopic rectopexy in general

surgery

4. Started urology on fortnightly basis- already completed uro-gynae cases

5. Completed theatre schedules in place and locums have been employed

6. The inaugural Clinical Committee meeting took place at the end of September

7. Family type culture and positive work environment

8. Continued excellent feedback from patients regarding clinical care and food services

Areas off track for month and remedial plans:

1. Overall anticipated volumes have not been met, as per the production plan 2. Surgeon and Anaesthetist teams have not been fully achieved as yet

Key issues/initiatives identified in coming months

• Daily monitoring of volumes that are booked onto our operating lists along with continued

robust financial management should go towards ensuring health targets are met and any

potential risks to achieving revenue are identified and resolved.

• Continue on with the development of the NEXUS system that will help improve both the clinical

reporting as well as providing accurate data on expenditure for clinical supplies, both

consumables and prosthesis that can then be worked in with facility and SMO’s costs to give us a

true understanding of a procedure cost within the ESC

• Collection of vital data for the Shorter Journey Project that can be fed into the NHB report

• Consolidation of current practices and look to finalise the surgeon/anaesthetist teams

• Build up further business rules for the use of spare capacity for ACC work within the ESC

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Financial Results



($000’s)


REVENUE

Government and

Crown Agency 1,810 2,179 (368) 3,502 4,714 (1,212) 25,320 25,320 0

Other Income 0 0 0 (1) 0 (1) 0 0 0

Total Revenue 1,810 2,179 (368) 3,501 4,714 (1,213) 25,320 25,320 0

EXPENDITURE

Personnel

Medical 5 0 (5) 5 0 (5) 0 0 0

Nursing 269 320 51 858 932 75 3,852 3,852 0

Allied Health

Support 0 0 0 2 0 (2) 0 0 0

Management /

Administration28 36 8 124 108 (16) 446 446 0

302 356 54 988 1,040 52 4,297 4,297 0

Other Expenditure

Outsourced

Services524 646 122 1,125 1,630 505 6,815 6,815 0

Clinical Supplies 567 570 3 1,205 1,438 233 6,566 6,566 0

Infrastructure &

Non-Clinical

Supplies

33 99 66 203 274 71 1,162 1,162 0

1,123 1,314 191 2,532 3,342 810 14,543 14,543 0


Contribution 385 508 (123) (19) 332 (351) 6,480 6,480 0

Allocations 482 482 0 1,462 1,462 0 5,856 5,856 0

NET RESULT (97) 26 (123) (1,482) (1,130) (351) 625 625 0



Overall YTD contribution = $351k unfavourable Revenue ($1.23m unfavourable)

772 of the 1,061 budgeted elective WIES have been delivered YTD. This was mostly due to a

challenge regarding SMO availability, together with patient complexity. FSA and FUPs short delivered

by ESC in first quarter by $683k (573 cf 2532), but picked up by SAS, although it has been decided

that all budgeted FSA and FUP revenue will now paid to ESC from August 2013.

Expenditure

Nursing: ($75k favourable)

Still recruiting with 5.0 nursing FTE vacancies balanced by lower volumes and capacity than

expected, and to which nursing models have been established. Volumes anticipated to meet planned

production in second quarter. Some cost savings off-set in July due to overtime in set-up and pre-

opening. Also two senior nurses charged to Admin in July and August, but now payroll has corrected.

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Admin staff: ($16k unfavourable)

2.0 FTE unbudgeted booking & scheduling staff were employed by ESC in July and August due to late

change in operational planning, but now transferred to SAS. Two senior nurses charged to admin in

error July/Aug now corrected.

Outsourced personnel: ($504k favourable YTD)

Around 70% of procedures delivered YTD compared to budget, therefore only a similar proportion of

surgeon Package of Care costs have been incurred. While anaesthetist costs are mostly fixed, the

reduced volumes have created some savings in the first quarter through phasing, although it has

been agreed the full 6 month budget (and annual budget) will ultimately be transferred to SAS.

Clinical supplies: ($233k favourable YTD)

As only around 70% of procedures delivered YTD compared to budget a lesser amount of clinical

supplies have been incurred YTD. This is particularly apparent in implants and prosthesis, where a

$293k favourable variance has accrued, which is off-set by an unfavourable variance in SAS due to

extra volumes being picked up by WTH in the first three weeks of the financial year (ESC pre-

opening). An inventory scanning system has been recently introduced in ESC which has created

some temporary accounting challenges, which hopefully will be addressed during the second

quarter.

Infrastructure: ($71k favourable YTD)

The lower throughput has assisted in keeping costs down in this area, plus some budgeted facilities

costs now being picked up via allocations. Off-setting this, it has been recognised that some first year

property and maintenance costs normally picked up in the project contract are to be a WDHB cost,

and while Facilities will pick up the budget for on-going financial years, costs incurred this year may

need to be absorbed within this favourable gap in ESC.

Summary:

While the lower theatre volumes create corresponding reductions in both revenue and direct

supplies used, there are a number of fixed costs that cannot be avoided. This creates the majority of

the $351k unfavourable first quarter variance.

It is hoped that volumes will start to reach planned levels in quarter 2, but it is doubtful if the

quarter 1 shortfall will be recouped.

A $626k embedded savings initiative commences in the budget in January 2014, so does not

influence this first quarter result, but will be a severe challenge achieving within the normal first year

demands.

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Provider Arm Support Services

These services include Corporate Services and Hospital Operations.

Corporate Services: Include offices of the CEO/CFO/CMO/DON/DAH, Corporate Finance, Operational

Finance, Information Systems and Management, Facilities and Development, Quality, HR & Awhina,

Maori Services and also includes outsourced healthAlliance services, HBL, Other affiliation costs and

financing costs. Robert Paine has overall financial responsibility for the Corporate Group.

Hospital Operations: Include Hospital Ops Management, Laboratories, Surgical Pathology,

Pharmacy, Nutrition and Food, Security, Traffic & Fleet, Asian/Pacific Health and Clinical Equipment

Pool. Phil Barnes has overall financial responsibility for the Hospital Operations Group.

Scorecard

HR Wellbeing Actual Target Productivity Actual Target

Sick Leave Rate (days) * 7.2 days 1 0 7.5 days �� Clinical Typing

Overtime Rate (%) * 1.3% 1 0 1.0% �� Clinical letters turnaround time - Surgical 1.0 days 100% 0% 2 days ��

Annual Leave Balance > 75 days 6 1 0 2 � Clinical letters turnaround time - Medicine 1.0 days 100% 0% 2 days ��

Turnover Rate % * 9.7% 1 0 10.0% �� Clinical letters turnaround time - Child, Women and Family 2.0 days 100% 0% 2 days ��

Clinical Employ (FTE) 284 FTE 1 0 �

* 12 month rolling average


Revenue 12,812 k 1 0 12,556 k �

Expense 47,898 k 1 0 46,450 k �

Personnel Costs 15,054 k 1 0 14,854 k �

Outsourced Services 9,291 k 1 0 8,642 k �



Contribution -35,085 k 1 0 -33,894 k ��

Capital Expenditure 8,171 k 0 1 11,448 k �




Waitemata DHB Monthly Performance ScorecardProvider Support Services

Corporate, Hospital Operations, Facilities, Decision Support and Provider Management

September 2013

Finance

Human Resources Service Delivery

How to read

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Specific deliverables/actions to deliver improved performance will consider: On Target

Inventory management for clinical and non-clinical supplies ��

Laboratory testing review and cost savings ��

Pharmaceutical cost savings ��

Development of the Allied Health workforce strategy ��

Infrastructure costs/contracts and energy efficiency reviews and savings ��

Implement Fleet Management policy for fleet vehicles ��

Development of business cases for in-sourcing services (e.g. orderlies) complete

Commencement of new mental health facility to replace Taharoto Unit ��

Mason Clinic remedial work ��

Transfer of renal services: Phase II ��

MRI replacement ��

* include a �� or a ��


• Mason Clinic ground lease has been executed by Waitemata DHB. Unitec have been provided

the document to execute. The size of the building has increased by at least 50%, however the

land leased remains as originally requested in February 2013.

• Renal Project is within scope and on time. The new community dialysis facility is tracking

favourably to programme. The Board approved the Contractor Tender Recommendation

(contractor and tender price) for the Clinical Fit Out of the Community Dialysis Facility at 96

Apollo Drive, Albany on 25 September 2013. Handover for clinical fit out is scheduled for 28th

October 2013; this is delayed due to the late uplift of the Developers Building Consent, weather

and tenant requesting alterations. A review of the agreement to lease documentation will

provide any reimbursement for this late delivery for the clinical fit out to commence.

Operational/Commissioning plan is well underway with established monthly key service

interface meetings. Renal Central Reverse Osmosis (RO) supplier contract is currently being re-

negotiated towards regional agreement. Phase two recruitment is underway.

• Work with healthAlliance has progressed, focused primarily on establishing the Elective Surgical

Centre and North Shore theatres supply chain and inventory systems. It has been agreed to

second Prashant Gupta from the quality team to lead the programme of work. He has worked

with Child Women and Family to establish sustainable inventory management processes. He will

be able to lead the programme of work for the DHB in consultation with the HealthAlliance

team.

• Taharoto Unit Mental Health Unit - Building consent has been received for Stage One site and infrastructure works - Detailed design is complete and a building consent has been lodged for the balance of works

being structure, envelope and fit out. - Five construction firms have been shortlisted to submit a proposal for the construction works,

with a recommendation due to go to the 12 December 2013 Board meeting for approval - Consultation with Rodney and North Shore consumer groups have met with positive feedback

on the internal and external layout of the new facility

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Corporate Services Group Highlights / Issues

Health Information Group

• Collaboration between healthAlliance and the Health Information Group in packaging software

allows objective measures to be made from a real-time digital x-ray movie. It is used by the

Speech Language Therapy Department, meets international best practice guidelines and is the

only site in Australasia. An Auckland University Masters student is about to start a research

study evaluating pre and post screening outcomes

• Electrocardiograms (ECGs) are now beaming live from the ambulance to the Emergency

Department flight deck enabling fast efficient clinical decision making

• Corporate records completed an in-depth investigation of our holdings at Crown records

Management and most are now tagged with accurate descriptions and review/disposal dates

• The Windows 7 pilot at Northland has been successful and the northern region is on track to

meet the deadline of April 2014. The deadline is challenging and will be constantly monitored to

manage risk

• Enterprise Contact Management System (ECMS) Pilot scoping and re-scaling work is

now complete and a draft Statement of Work has been completed and will be reviewed by

healthAlliance Procurement. The Steering Group approved the pilot scope.

Facilities & Development

Highlights/Issues

• Workshops have been undertaken with Clinical Services regarding Hibiscus Coast leased

premises. The recommendation is to remain in the building for a further 5 years with minimal

alterations to reception area and meeting room. A cash incentive has also been offered by the

landlord

• A new lease of premises at 17 Shea Tce to accommodate the newly formed Planning and

Funding team has been approved by the Board. The commencement date is November 2013

• 2 Lake Pupuke Drive has experienced leaks recently, a consultant review of the building has

indicated this as a leaky building. The landlord is engaged to complete the most critical

remedial works in September.

Major Capital Projects

• NSH KMU remedial works including additional bedroom spaces have commenced. The project

is staged over several months

• Renal Phase II Community solution is progressing with the concrete slab poured and walls

beginning to be constructed. The base building undertaken by the developer is due for

completion in December 2013 with the clinical fit out commencing in October

• WTH Seminar project is due to be completed in September to allow for more meeting space

• WTH Low Load Chiller project works have commenced, with the project expected to be

completed prior to December 2013.

Other

• Vacancies remain for 1 operations engineer, and the sustainability officer role.

• Recruitment has been approved for two project managers, one personal assistant and one

administration support.

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Hospital Operations

Key issues

Asian Support Services

• The Asian Health team at North Shore is currently pressured by space. Space has been identified

and allocated to Asian Health and the Facilities and Development staff are working out work

space allocations for the affected staff.

Food and Nutrition Services

• Physical space at the Waitakere kitchen needs to be reviewed given the increased growth in

volumes that is occurring.

Laboratory

• The first of several business cases, Urinalysis, has been submitted to the Capital and Asset

Management Planning committee for approval.

Relocations

• Demand for this service often exceeds supply. Resource may need to be invested in the rapidly

growing furniture and equipment recycling component of the role.

Security

Violence and aggression data from security reports (Only includes events that Waitemata DHB security have been involved with.)

Pharmacy

• The hospital pharmacy is short staffed at the moment due to parental leave. Recruitment over

the last two months for clinical pharmacists has been unsuccessful.

• Work from ESC is impacting significantly on the team of pharmacists providing a clinical service

to ESC. Patient numbers on Wards 7 and 9 have not reduced at present.

Surgical Pathology

• The service currently has only one functional tissue processor with no reliable back-up

equipment. Capex has been completed and a new Pelorus processor ordered. An issue has been

identified with the adequacy of floor cleaning in the histology technical area that is leading to a

build-up of wax and creating a hazard. This is under investigation with health and safety

representatives.

Non-Clinical Support

• Priority is given to patient movement which means very limited time available for Orderlies

other tasks eg. Removing furniture. This incurs costs (Allied Pickfords). The possibility of

employing a dedicated individual to these additional duties is under consideration.

YTD Jul Aug Sept

Verbal abuse/aggression or threats 69 19 27 23

Attempted assault 25 8 14 3

Assaults 10 6 2 2

Police involvement 18 6 4 8

Patients stopped from leaving 41 19 12 10

Patients held to administer treatment/meds 36 14 8 14

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Corporate and Operational Finance

Planning work in preparation for the 2014/15 Budget has commenced with a 2013/14 full year

forecasting exercise underway. Finalisation of the Annual Report is also close.

Financial Results


Provider Support

($000’s)


REVENUE

Government and

Crown Agency 2,541 2,531 9 7,900 7,877 24 30,690 30,690 0

Other Income 1,528 1,486 42 4,912 4,679 233 18,116 18,116 0

Total Revenue 4,069 4,017 52 12,812 12,556 256 48,806 48,806 0

EXPENDITURE

Personnel

Medical 32 (29) (61) 675 224 (451) 1,202 1,202 0

Nursing 98 (121) (219) 926 (163) (1,089) (1,235) (1,235) 0

Allied Health 1,484 1,557 74 4,627 4,828 201 18,595 18,595 0

Support 800 1,006 206 2,412 3,134 722 12,509 12,509 0

Management /

Administration2,101 2,206 104 6,414 6,831 417 26,798 26,798 0

4,515 4,619 104 15,054 14,854 (200) 57,869 57,869 0

Other Expenditure

Outsourced

Services3,076 2,881 (195) 9,291 8,642 (648) 34,583 34,583 0


Infrastructure &

Non-Clinical

Supplies

5,653 5,525 (128) 17,322 17,211 (111) 68,644 68,644 0

10,775 10,280 (496) 32,844 31,597 (1,247) 126,017 126,017 0

Total Expenditure 15,290 14,898 (391) 47,898 46,450 (1,447) 183,886 183,886 0

Contribution (11,221) (10,881) (340) (35,085) (33,894) (1,191) (135,079) (135,079) 0

Allocations (12,313) (12,313) 0 (37,298) (37,298) 0 (149,063) (149,063) 0

NET RESULT 1,092 1,431 (340) 2,213 3,404 (1,191) 13,984 13,984 0


COMMENT ON MAJOR FINANCIAL VARIANCES


The overall result for Provider Support is $340k unfavourable for month and $1,191k unfavourable

YTD.

Revenue (favourable $52k month, favourable $256k YTD)

The favourable YTD position is largely due to Car Park revenue ($141k YTD) reflecting the high

number of patients / visitors and the change in tariffs from July 2013. In addition interest receivable

is $492k favourable YTD with higher cash deposits. This is offset by a shortfall in non-resident

charging of $484k YTD.

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Expenditure (unfavourable $391k month, unfavourable $1,447k YTD)

Personnel Costs are $200k unfavourable YTD due to savings budgeted in Corporate but realised in

the other Operating Groups. In addition Support staff costs are $722k favourable YTD mainly due to

vacancies Cleaning and Orderly Services being covered by agency casual staff. Management and

Admin costs are $417k favourable YTD due to vacancies in Corporate Services and Hospital

Operations being partly offset by outsourced casual staff.

Although vacancies have contributed to underspend in all staff categories, no vacancies are

being deliberately held in front line clinical staff other than in areas under review. There is

always a persistent level of staff vacancies, caused by the normal day to day turnover of

staff. In all clinical areas vacancies are minimised where possible.

Other Direct costs are unfavourable $496k in the month and unfavourable $1,247k YTD. Included

in this is $988k YTD unfavourable variance against savings budgeted in Provider Support but realised

in the other Operating Groups. Also included are the unfavourable variance for outsourced costs for

casual Cleaning and Orderly staff in Hospital Operations ($761k unfavourable YTD). Clinical Supplies

in Hospital Operations are unfavourable $193k due to volume related costs in Laboratories and

Pharmacy. Non-clinical Supplies in Corporate Services are $464k favourable YTD primarily due to the

irregular timing of training, legal and travel costs. Electricity costs are $120k favourable YTD due to

the favourable pricing of new national contract.

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6.1 Clinical Leaders Report

Recommendation:


Prepared by: Dr Andrew Brant (Chief Medical Officer), Phil Barnes (Director of Allied Health and Acting GM for

Hospital Operations) and Dr Jocelyn Peach (Director of Nursing and Midwifery)

Glossary

CAAG - Capacity at a Glance is a database that shows minute by minute the capacity of the wards,

emergency departments across all sites.

Trendcare - A patient acuity and workload measurement database that records the clinical needs/acuity

of patients and calculates the hours of care required to meet the needs.

Medical Staff

Quality

The Robert Francis visit stimulated much debate over lessons to be learned from his enquiry and its

meaning for our local context. In particular the visit highlighted the individual’s role and responsibility in

ensuring high quality care from what he or she sees around them and not allowing complacency in status

quo of care, and the culture needed to enable this behaviour. It also made us reflect on how robust our

mechanisms are in monitoring care.

The quality team have developed a web based quality account, which summarises quality in the DHB over

the previous year, and includes patient stories.

A new succinct quality strategy is near completion. It will form a new template for the services to develop

their own quality strategies, which a number of services are already progressing.

We are looking at the performance of the services’ morbidity and mortality reviews. These are a key

platform within the services to reflect on and improve care.

SMO

The upcoming ASMS/SMO forum will be focusing on updating developments in our clinical Information

Systems, Awhina’s progress in enhancing SMO engagement, and a focus on the role of mortality and

morbidity as a means for quality assurance and improvement in the DHB.

Dr Lesley Maher has started in ICU. This now brings the department to a full complement of SMO for the

first time since its inception.

RMO

Trends have emerged nationally and internationally which have resulted in more junior doctors than

positions available - this is a new development and a national issue. We want all New Zealand graduating

medical school students to have jobs, and in response have created additional RMO places in the upcoming

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year to accommodate first year doctors at short notice. We are taking 42 first year house surgeons.

Services are looking at best places for these extra positions to help address rosters that may benefit from

extra staff. A national taskforce has been created to look at national solutions to this issue.

Information services

We are going to be rolling out eprescribing further next year in our hospitals. The next best location is being

identified, at this stage general medicine at NSH but potentially Waitakere hospital, but it will be

dependent on the timeframe of the impending upgrade of the software.

We are looking to accelerate the introduction of electronic ordering of laboratory tests which will not only

be more efficient, but also help ensure we are not doing unnecessary tests, and able to track that all results

requested are signed off in a timely fashion.

Advance care planning

The website www.advancecareplanning.org.nz is now up and running. It provides information for patients,

family, or health care workers. It also provides for basic and level 1 training in ACP. We are undertaking two

Advance Care Planning Level 2 training programmes in November and December for up to 24 people. A

number of participants are from the residential care sector.

Allied Health, Technical and Scientific Staff

Medical Laboratory Services

A Laboratory Service Consolidation and Value Plan is under development, involving senior management,

clinical pathologists and support clinicians. The aim is to reduce operating costs by around $500k p.a. and

reduce “sendaway” test costs by $200k p.a. A key component of the plan will be the introduction of

e-ordering for laboratory requests as a tool to guide requesting clinicians and better manage demand.

Dietetics

Following a vacancy of seven months we have successfully appointed a Renal Dietitian from the UK who

commences at Waitemata DHB on the 25th November 2013. The service has recently received two

resignations and recruitment is on hold pending the outcome of the Allied Health restructure.

Pharmacy

Progress is being made with the Antimicrobial Stewardship (AMS) Programme:

• An AMS pharmacist who has spent the last three years working at the Alfred Hospital in Melbourne

commenced at Waitemata DHB on 9 September 2013.

• A multidisciplinary AMS Committee (AMSC) has been established and had an initial meeting under the

chairmanship of Dr Kerry Read.

Clinical Engineering

The Clinical Engineering team is now close to full complement for year one of the business plan, having

recruited two more highly experienced and skilled technologists from Auckland DHB. Consideration is

being given to how best to provide a 24/7 cover service for Waitemata DHB.

Allied Health Therapies

The Director of Allied Health has held preliminary discussions with regional and national colleagues to

explore means of introducing a skill mix review based on “Calderdale Framework” principles developed

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initially in the UK and introduced more recently to Australia. The Framework comprises two key

components:

1. Skill sharing: allied health practitioners qualified in one discipline take on specific tasks of another

discipline after undertaking a structured training programme. This has been shown to reduce the

number of staff/patient interactions, reduce length of stay in hospitals and reduce costs in

community service teams.

2. Delegation: Therapy Assistants are trained to undertake a large proportion of tasks currently

undertaken by qualified therapists, under the direct or indirect supervision of a qualified therapist.

Studies have shown that in some areas of practice between 30 – 50% of work carried out by

therapists can be delegated to lower grade staff. This has the potential to create significant

efficiencies and free up time for therapists to work at the top of their scope and beyond.

One of the intended outcomes of the allied health services review is the diversion of professional

leadership resources into supporting and leading innovation and transformational change. This particular

project may offer one of the best opportunities to achieve these aims.

Nursing and Midwifery

Strong Leadership and Strategic Influence

Leadership for patient and family-centred care, good patient experience, excellent clinical outcomes and

greater employee engagement. Looking to the Future

Senior Nurse Support

Part One of the reframing of the Charge Nurse Manager role has been completed and a leadership learning

programme is planned for 2014. Part Two will commence in January 2014 and include the rest of the

charge nurse managers. The process involves: completion of a survey, analysis of responses, meetings with

each person to discuss development plans and scheduling into the appropriate learning programme.

Feedback from the first group has been possible.

A similar review is underway of the nurses appointed to the Clinical Nurse Specialist and Speciality roles

across all divisions. There has been good engagement in the survey process. Analysis of feedback from the

survey and focus groups is underway. By the end of December it is anticipated there will be feedback for

the group and planned ongoing discussions on development plans in the New Year.

Work is underway with the Emergency Department to further develop the role of the Clinical Nurse

Specialist in that setting to undertake expanded practice activities in acute patient assessment, planning

and interventions. A DHB Nursing Scope of Practice Committee has been established to provide senior

professional oversight.

Nursing workload and patient acuity database [Trendcare]

The senior nurses, midwives and allied health teams are utilising the data from Trendcare to monitor the

day by day acuity of patient needs, how staff are managing the workload and what can be done to address

work pressures. Staffing is managed using an objective tool [Trendcare] and monitored closely each day.

The staffing model is set to base data identified over the past 12 months and matched to the available

budget. The managers work within the resources allocated and do what is reasonable in the circumstances.

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Waitemata DHB and 15 other private hospitals and DHBs in New Zealand [plus many in Australia and

Asia] use Trendcare which measures workload based on patient acuity and hours of care that a patient

needs at various times in their care experience. The benchmarked average nurse hours per patient day is

4.5 [NHPPD]. The managers monitor the average NHPPD daily and each month to ensure that these seem

reasonable and match the national benchmarks.

Medical AM PM N

Average NHPPD [care hours] 2.13 1.66 0.97

Patients to RN [general medical] 3.75 4.81 8.24

# Nurses/HCAs / shift 35

beds 7.59 5.9 3.33

Surgical AM PM N

Average NHPPD [care hours] 2.23 1.79 1.07

Patients to RN [surgical] 3.59 4.46 7.44

# Nurses/HCAs / shift 34

beds 9.43 7.37 4.3

Where there is sickness or gaps in the roster, the managers utilise casual staff where these are available.

Occasionally nurses are moved from other wards, at times staff work overtime or the wards work staff

short. The managers work very hard to ensure that care is not unsafe and staff not asked to manage

unreasonable workloads. This is monitored using Trendcare and the 'Care Capacity at a Glance' screen.

Staff are using the ‘Capacity at a Glance’ [CAAG] screens to review hospital workload and communicate

with the Duty Nurse Managers about their ability to manage workload.

Workforce Development for the Future

A supportive work environment and workforce development environment that liberates the talents and

skills of every nurse and midwife to help them be the best professional they can be. Looking to the Future.

Advancing Practice excellence

Investment in staff which enables us to recruit and retain high calibre staff with the appropriate balance of

knowledge, experience and caring attitude

New Graduate / Entry to Practice

New graduate recruitment for February 2014 is underway. Waitemata DHB is recruiting for the general

programme [medicine, surgical, child health, public health], mental health, and primary care including

general practice and residential aged care.

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Applications for post graduate education

Applications for funding for post graduate study in 2014 are being processed at present. Applications for

2014 appear consistent with 2013 applications. Funding is primarily from Health Workforce New Zealand

although additional funding is allocated as able.

2011

for

2012

2012

for

2013

Post Graduate Funding

Number of applications received 250 315

Number of applicants funded 207 232

Numbers funded by Division

Medicine & Health of Older People 90 93

Surgical & Ambulatory 20 38

Child Health 20 23

Mental Health 16 17

Primary Care 61 61

Quality Practice and Patient Safety

Safer clinical quality and efficiency, a culture of excellence, through evidence-based care

There was good attendance by nurses at the Robert Frances lectures two weeks ago. The nurses had been

discussing the Mid Staffs report for some months and were interested to hear the issues raised and

consider the relevance to their own work settings.

There is good engagement in the Waitemata DHB priorities framework that guides nurses and midwives

and their focus on quality and patient safety. The priorities include:

[i] Patient and Family Satisfaction / Patient Experience, activities e.g. hourly rounding, survey and

consideration of experience, bereavement care/end of life care

[ii] Patient safety & risk management priorities/reducing error and improved patient outcomes

Activities relate to Productive Ward framework

Know How we are Doing

KHWD

Well Organised Ward

WOW

Patient Status at a Glance

PSAG

Measuring outcomes and

performance

• Ward Quality Boards

• Frontline Focus Fridays

• On-line auditing

• Score boards audit data

• Care Capacity Demand

Management [CCDM]

Clean, well organised wards

• [6S project- Safety, Sort,

Simplify, Shine,

Standardise, Sustain]

• Environment & Equipment

maintenance

• Cleaning schedule & audit

Patient Information Boards -

consistent format for patient

tracking

• Trendcare

• Electronic white boards

• Care Capacity at a Glance

[CAAG]

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Focus on key processes

1 Nutrition, Hydration &

Meals

Proactive nutritional assessment. Assessment of weight. MUST

score. Protected meal-times. Feeding of patients at risk [red tray]

2 Medicines Reduced interruptions when administering medications e.g. ward

design/locked medication rooms; Pyxis; e-prescribing

Consistent medication administration practice, including

controlled drug management; reduce medication errors

3 Admissions & Planned

Discharge

Remove the rush of admission and discharge by making the

processes planned, use of the Discharge Lounge, planned

discharge

4 Shift Handovers Reduce time spent in handovers, making information more

appropriate, easier to remember and understand

5 Essentials of Patient

Care

Assistance with hygiene, activities of daily living. Mobilisation to

reduce deconditioning

Environmental cleanliness and maintenance: cleaning standards,

equipment cleanliness

6 Patient Observation Assessment and Documentation: consistent application of

Assessment, Diagnosis, Planning, Implementation and Evaluation

Improve standard of patient observations: vital signs & NEWS

accurate, appropriate action taken, Hourly Rounding, 15/60

7 Nursing Procedures Improve supporting processes so they are consistent, a better

patient experience and achieve the standards aspired to

8 Ward Round Ward rounds quicker, more consistent with clear outcome and

planning

9 Safety Focus Falls prevention [high priority], Pressure injury prevention [key

focus]. Infection Prevention & Control practice (hand hygiene,

reduced UTIs, reduced IV site/CVL infections), infection screening

and compliance. Management of cognitive impairment: delirium,

dementia, restraint minimisation, reduced seclusion

[iii] Outcomes - Robust audit and measurement of outcomes as evidence of attention to quality and

safety. Includes up to date ward/unit quality boards

[iv] Learning framework & professional development: that supports staff performance to achieve

expectations of professional practice and service delivery. Includes Professional Development &

Recognition Programme [PDRP] for nurses and Quality Leadership Programme [QLP] for midwives.

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6.2 Human Resources

Recommendation


Prepared by: Sam Bartrum (General Manager, Human Resources)

Executive Summary

This report identifies some key areas that are occurring in Human Resources for the

month of August - September 2013.

Recruitment

Actual Target

Current Employ (fte) 5417 n/a

No of Hires 132 n/a

% of Hires from Internal Referrals n/a 35%

Time to Hire 75 days 45 days

Cost per Hire $693 $750

No. Hires

(All permanent, fixed term, casual roles)

-

50

100

150

200

Sep-

12

Oct-12

Nov-12

Dec-1

2

Jan-1

3

Feb-

13

Mar-1

3

Apr-13

May-

13

Jun-1

3

Jul-1

3

Aug-13

Sep-13

Cost per Hire ($)

(this includes advertising costs, relocation costs and

Monthly Recruitment Centre Running Costs)

-

200

400

600

800

1,000

Sep-1

2

Oct-12

Nov-12

Dec-1

2

Jan-1

3

Feb-13

Mar-1

3

Apr-13

May-

13

Jun-1

3

Jul-1

3

Aug-13

Sep-

13

Cost per Hire Cost per Hire Target ($)

Time to Hire (days)

(From candidate application to hire)

-

10

20

30

40

50

60

70

80

Sep-

12

Oct-1

2

Nov-12

Dec-1

2

Jan-1

3

Feb-

13

Mar-1

3

Apr-13

May-

13

Jun-1

3

Jul-1

3

Aug-13

Sep-

13

Time to Hire (days) Time to hire Target (days)

• Cost per hire for September was $693 which is below target of $750 but up due to

relocation costs for September being up.

• Hires for September were 132.

• Time to hire was up this month due to 2x SMO hires that were over 200 days which

skewed the data

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KiwiHealthJobs

Highlights for September

• A significant increase in referrals from Taleo sources. Auckland and Midland region DHBs

have inserted a link to unsuccessful candidate emails directing candidates to KHJ for

further opportunities.

• Since February 2012 there have been 229 hires made which can be directly attributed to

KHJ.

• The average click through rate across Google Adwords & Facebook advertising was 0.7%

(the industry average is 0.02%).

At a glance – September 2013

Total number of visits: 33,606

Visits from:

- UK

- Australia

- USA

- Canada

- Ireland

2,231

1,501

1,075

461

343

Number of jobs posted:

- Clinical jobs

- Non-clinical jobs

418

305

113

Total number of hires – Feb 12 to

date from KHJ* 229

Number of Jobs advertised by month and organisation

0

10

20

30

40

50

60

70

80

90

Northla

nd

Auckla

nd

Wai

tem

ata

Countie

s Man

akau

Wai

kato

Bay o

f Ple

nty

Taira

whiti

Tara

naki

Lake

s

Whan

ganui

Haw

kes B

ay

Mid

Cent

ral

Wai

rara

pa

Capita

l and

Coast

Hutt Val

ley

Nelson M

albr

ough

Cante

rbur

y

South

Cant

erbury

Wes

t Coas

t

South

ern

NZ Blo

od

Aug-13

Sep-13

94 of 98


Internal Communications

Publications

The internal communications team produced the following publications in

September/October:

• Healthlines – monthly 12 page staff magazine available online and 1,200 hard copies

• Primary Care News – monthly magazine for Auckland GPs with contributions from

Waitemata, Auckland and Counties Manukau DHBs

• Waitemata Weekly – a weekly e-newsletter for all staff

• A Note from the CEO – a fortnightly message from Dale to all staff

• Weekly health targets update – weekly update and commentary on health targets to all

staff via email

• Maintenance of StaffNet - WDHB’s intranet - Awhina website, WDHB external website

and WDHB pages on HealthPoint

Project work

The internal communications team provided communications advice and support to the

following projects in September:

• Update ‘planning a sustainable future’ webpage on StaffNet - houses general information

and links to specific services’ sites around changes/reviews happening within services

• Design and lay up work for Annual Report 2012/2013

• Better, best brilliant health excellence awards

• Robert Francis QC visit to Waitemata DHB for two staff sessions

• The next stage of the values work

• Ongoing communications support to Waitakere Rainbow Childcare Centre

• Sub-editing and layout of various departmental leaflets/booklets

• Photography and design of Bare Below the Elbows campaign pull up banner

• Get Ready, Get Through civil defence campaign

• Mental Health Awareness Week campaign

• ACC Safety Week campaign

• Maori & Pacific Mental Health masquerade ball

• Staff Christmas dinner planning

• Christmas activity planning

Other support

The internal communications team supported the following events in September:

• Celebration of 10th anniversary of EUS at North Shore Hospital’s endoscopy suite

• September Health Heroes celebration – Heidi Joffe and Helen Cramond.

Workforce

Long Service Recognition Programme

All queries resulting from the July implementation of the Long Service Recognition catch-up

have been resolved, and a process is underway for transferring responsibility of implementing

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the ongoing programme to the service HR teams, which will happen in October. Workforce

Development will continue to provide support in terms of the data mining of eligible staff.

Health Scholarship Programme

Applications for the 2014 health scholarship programme have been received and shortlisted.

Application numbers were down overall, with very few applications particularly in Allied

Health professions. Interviews are in the process of being scheduled, with the aim of

confirming all scholarships by November.

Ngati Whatua o Orakei Partnership

Applicants for the Ngati Whatua Whakatupu Hauora scholarships have been shortlisted, and

interview times are being scheduled at present. We have a maximum of 5 scholarships

available to support health students who whakapapa to Ngati Whatua for the 2014 academic

year.

Awhina

Leader and manager development – enabling Best Leaders, Best Care

Healthcare organisations like Waitemata DHB are facing increased demand, increased patient

and family expectations for service quality and outcomes, and increased expectations of value

by both the government and the public. This evolution in the nature of the demand for health

care means that the work of health care is more complex clinically thus requiring greater

clinical understanding on behalf of those who manage and lead health care organisations

(Bohmer R, 2012).

Given the health care context and the need for great leaders and managers, the leader and

manager development programmes provided at Waitemata DHB are designed with the

following principles in mind:

• Making person-centred care happen

• Improving the quality of the patient experience

• Creating a culture for quality

• Understanding self to improve the quality of care.

Leader and manager development programmes currently available to staff are:

1. Orientation and short courses – designed for the first six months in role and covering HR

and Finance processes to meet DHB and legislative compliance requirements, culture and

values, cultural diversity and career development

2. Management Foundations – an 11 module/12 month programme for cohorts of 20 front-

line leaders/managers at a time. Modules focus on managing and leading at Waitemata,

people development, recruitment and selection, performance development and

appraisal, financial management, operational planning, quality, employment relations,

occupational health and safety, diversity and reflective learning practice.

3. Productive Leader – four courses: Personal Efficiency Programme; FAST - an applied

learning and mentoring programme for managing medium size quality improvement

projects (a Corporate Quality team programme); Write Well (an online course covering

the essentials for writing clearly); and Rapid Reading (an online self-directed learning

package)

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4. In-house coaching – to grow and retain talent across the DHB. The GROWTH Coaching

programme has three parts: (i) WDHB staff are developed to be coaches – we’ll have 30

by December 2013; (ii) the coaches coach other DHB employees; (iii) the coaches provide

coaching on a 1:1 basis for leaders leading care model re-design initiatives.

5. Clinical leadership development – in conjunction with NZ Leadership Institute and

building on the Leadership at the Point of Care programme that was provided to 75 senior

manager, doctor, nurse and allied health leaders in 2011-2012. This next phase of the

development support is being provided in conjunction with the clinical leadership work

being facilitated by Professor Richard Bohmer

6. Forums – the CEO Speaker series focusing on the future of healthcare and the Awhina

Speaker series focusing on values-based practice for providing quality care.

Two further development programmes are being scoped currently. One is for charge nurse

managers and is being developed in partnership with nurse leaders. The second focuses on

having difficult conversations (clinician to patient, colleague to colleague, performance

discussions etc) in clinical settings.

The Personal Efficiency Programme impacting productivity and regaining time to care

The Waitemata DHB priority of ‘living within our means’ requires staff to work in the most

productive way (Levy L, 2011). Since 2011 Awhina Education has provided a Personal

Efficiency Programme for staff to increase their capacity and capability to work productively

and regain time to care for patients. This programme is facilitated by a multi-disciplinary team

of in-house facilitators.

PEP is a three day programme delivered over six weeks and is a blend of classroom learning

and one-to-one coaching for each participant. It provides practical tools to manage and

prioritise workload and plan projects. More than 100 staff have completed the programme

since it commenced in 2011.

Participants and their managers report the following benefits from the programme:

• Time looking for paper, emails, documents, reports is reduced by 50%

• Improvement in reading and responding to emails and mail is up 50%

• Time to spend on key aspects of the person’s job is up by 2 hours per day

• Time saved by participants as a result of applying the tools and principles is 1 hour a day/5

hours per week

• 78% of clinical staff who have done the programme stated that there has been a

moderate or significant impact on the time they have available for patients and/or patient

related tasks, responsibilities and projects.

Follow-up surveys at six months indicate behavioural changes are sustained over time.

RMO Education – supporting junior doctors to transition into their medical careers

The revised programme for first year house officers (PGY1s) was approved by the Medical

Council of NZ in February 2013. The programme was designed around the themes of quality,

medication safety, procedural skills and interprofessional understanding. In July 2014 the

Medical Council will return to Waitemata DHB to conduct an accreditation visit. Preparation

for this accreditation visit is underway and progress reports will be provided to the Board over

coming months.

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The medication safety theme in the programme has become a substantial part of the

programme and has come to the attention of the national Medication Safety Group. This

work has been accepted as a peer reviewed paper at the Australasian Prevocational Medical

Education Conference later this year. It has also sparked a research project on doctor and

pharmacist’s attitudes to collaboration.

An improved video-conferencing unit was hired for the Waitakere site to enhance access to

teaching for doctors working at Waitakere. A member of the Medical Education and Training

Unit was present at the site at least once a month this year and sessions were run from

Waitakere every 4-6 weeks. Enhancing access to the programme at the Waitakere site can be

further developed and enhanced with more face-to-face sessions. Lunch is now available at

Waitakere as it is at North Shore which makes it easier for house officers to attend and is cost

neutral.

Agreements have been reached regionally on e-learning modules for first year house officer

orientation and there is a lot of regional consistency with career planning.

Coming up – the orientation week for first year house officers is scheduled for November 18-

22 November. This will be reported on next month.

A community of practice for clinical simulation practitioners and educators at WDHB

On Friday 11 October an inaugural clinical simulation forum was held in the new clinical

seminar room in the Simulation Centre at Waitakere Hospital. This was an initiative of the

Awhina Simulation Centre team based at Waitakere and emerged from a discussion during a

simulation conference in Wellington this year.

The forum was attended by a multi-disciplinary group of clinicians and educators from

Waitemata’s ED, ICU, SCBU and Awhina Education teams involved in clinical simulation

training.

The group shared information about their simulation programmes and discussed ways in

which they could connect and strengthen the quality of clinical simulation training – and

hence patient care in our hospitals.

Key outcomes from the forum were to establish a database for simulation resources (people

and clinical equipment), establish best practice principles for debriefs following clinical events,

develop a good practice guide for scenarios and simulation and find ways to share their

expertise and improve.

Coming up – Waitemata DHB Education Committee

In the next six weeks a Waitemata DHB Education Committee will be established. The

committee will be a pan-DHB committee and will provide a central connection for education

and learning at Waitemata. It is being established to promote quality, assist knowledge

creation and sharing across the DHB, and provide advice and guidance to the executive

leadership team to support their decision-making.

The committee comprises leaders from the following groups: medical, nursing, allied health,

general managers, clinical quality, clinical training, workforce development and human

resources, mental health, non-clinical support and Awhina Education and Learning.

The first meeting of the committee is scheduled for the beginning of December.

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Documents

HOSPITAL ADVISORY COMMITTEE (HAC) MEETING · Mike Schubert – Interim Chief Executive Officer, healthAlliance Sam Bartrum – GM Human Resources ... Trustee – Allison Roe Trust