Hospital Advisory Committee Meeting Wednesday, 16 ... · 9.40am 3. Confirmation of Minutes 05 August 2015 9.45am 4. Action Points 9.50am 5. Provider Arm Performance Report 5.1 Scorecard

Hospital Advisory

Committee Meeting

Wednesday, 16 September 2015

9.30am

A+ Trust Room

Clinical Education Centre

Level 5

Auckland City Hospital

Grafton

He Oranga Tika Mo Te Iti Te Rahi

Healthy Communities, Quality Healthcare

Published 09 September 2015

Auckland District Health Board Hospital Advisory Committee Meeting 16 September 2015

Agenda Hospital Advisory Committee

16 September 2015

Venue: A+ Trust Room, Clinical Education Centre

Level 5, Auckland City Hospital, Grafton

Time: 9.30am

Committee Members

Judith Bassett (Chair)

Jo Agnew

Peter Aitken

Doug Armstrong

Dr Chris Chambers

Assoc Prof Anne Kolbe

Dr Lester Levy

Dr Lee Mathias

Robyn Northey

Morris Pita

Gwen Tepania-Palmer

Ian Ward

Auckland DHB Executive Leadership

Ailsa Claire Chief Executive Officer

Simon Bowen Director of Health Outcomes – ADHB/WDHB

Margaret Dotchin Chief Nursing Officer

Joanne Gibbs Director Provider Services

Naida Glavish Chief Advisor Tikanga and General Manager Māori

Health – ADHB/WDHB

Dr Debbie Holdsworth Director of Funding – ADHB/WDHB

Dr Andrew Old Chief of Strategy, Participation and Improvement

Rosalie Percival Chief Financial Officer

Linda Wakeling Chief of Intelligence and Informatics

Sue Waters Chief Health Professions Officer

Dr Margaret Wilsher Chief Medical Officer

Auckland DHB Senior Staff

Dr Vanessa Beavis Director Perioperative Services

Dr John Beca Director Surgical, Child Health

Dr Clive Bensemann Director Mental Health

Jo Brown Funding and Development Manager Hospitals

Judith Catherwood Director Long Term Conditions

Dr Mark Edwards Director Cardiac Services

Dr Sue Fleming Director Women’s Health

Mr Wayne Jones Director Surgical Services

Auxilia Nyangoni Deputy Chief Financial Officer

Tony O’Connor Director Participation and Experience

Dr Michael Shepherd Director Medical, Children’s Health

Marlene Skelton Corporate Business Manager

Dr Barry Snow Director Adult Medical

Dr Richard Sullivan Director Cancer and Blood and Deputy Chief

Medical Officer

Clare Thompson General Manager Non Clinical Support Services

Frank Tracey General Manager and Acting Director Clinical

Support Services

Michelle Webb Corporate Committee Administrator

Gilbert Wong Director Communications

(Other staff members who attend for a particular item are named at the start

of the respective minute)

Apologies Members: Lee Mathias (for late arrival)

Apologies Staff: Sue Waters.

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Agenda Please note that agenda times are estimates only

9.30am 1. Attendance and Apologies

9.35am 2. Register and Conflicts of Interest

Does any member have an interest they have not previously disclosed?

Does any member have an interest that may give rise to a conflict of interest with a matter on the agenda?

9.40am 3. Confirmation of Minutes 05 August 2015

9.45am 4. Action Points

9.50am 5. Provider Arm Performance Report

5.1 Scorecard

5.2 Overall Provider Performance including Health Target Updates

5.3 Financial and Operational Performance

10.00am 6. Directorate Updates

6.1 Mental Health Directorate

6.2 Women’s Health Directorate

6.3 Child Health Directorate

6.4 Surgical Services Directorate

6.5 Perioperative Services Directorate

6.6 Cardiovascular Directorate

6.7 Adult Medical Directorate

6.8 Cancer and Blood Directorate

6.9 Clinical Support Services

6.10 Non-Clinical Support Services

6.11 Community and Long Term Conditions Directorate

10.30am 7. Patient Experience Report

7.1 Patient Experience Reports July and August 2015

7.2 Participation and Experience Update

10.15am 8. Information Papers

8.2 Auckland Integrated Cancer Centre

10.30am 9. Resolution to Exclude the Public

Next Meeting: Wednesday, 28 October 2015 at 9.30am A+ Trust Room, Clinical Education Centre Level 5, Auckland City Hospital, Grafton

Hei Oranga Tika Mo Te Iti Me Te Rahi

Healthy Communities, Quality Healthcare

3


Attendance at Hospital Advisory Committee Meetings

Members

02

Ap

r. 1

4

14

May

. 14

25

Ju

n. 1

4

06

Au

g. 1

4

17

Se

p. 1

4

29

Oct

. 14

10

De

c. 1

4

18

Fe

b. 1

5

01

Ap

r. 1

5

13

May

. 15

24

Ju

ne

15

5 A

ug

15

16

Se

p 1

5


1 1 x 1 1 1 1 1 1 1 1 1

Joanne Agnew 1 1 1 1 1 1 1 1 x 1 1 1

Peter Aitken 1 1 1 1 1 1 1 1 1 1 1 1

Doug Armstrong

1 1 1 1 1 1 1 1 1 1 1 1

Chris Chambers

1 1 1 1 1 1 1 1 1 1 1 1

Anne Kolbe 1 1 1 x 1 1 1 1 1 1 x 1

Lester Levy x 1 1 1 1 1 1 1 1 x 1 1

Lee Mathias 1 1 1 1 x 1 1 1 1 1 1 1

Robyn Northey

1 1 1 x 1 1 1 1 1 1 1 x

Morris Pita 1 1 1 1 x 1 1 x 1 1 1 x

Gwen Tepania-Palmer

1 1 1 1 1 1 1 1 1 x 1 1

Ian Ward 1 1 1 1 1 1 1 1 1 1 1 1

Key: x = absent, # = leave of absence

1

4


Conflicts of Interest Quick Reference Guide Under the NZ Public Health and Disability Act Board members must disclose all interests, and the full

nature of the interest, as soon as practicable after the relevant facts come to his or her knowledge.

An “interest” can include, but is not limited to:

Being a party to, or deriving a financial benefit from, a transaction

Having a financial interest in another party to a transaction

Being a director, member, official, partner or trustee of another party to a transaction or a

person who will or may derive a financial benefit from it

Being the parent, child, spouse or partner of another person or party who will or may derive a

financial benefit from the transaction

Being otherwise directly or indirectly interested in the transaction

If the interest is so remote or insignificant that it cannot reasonably be regarded as likely to

influence the Board member in carrying out duties under the Act then he or she may not be

“interested in the transaction”. The Board should generally make this decision, not the individual

concerned.

Gifts and offers of hospitality or sponsorship could be perceived as influencing your activities as a

Board member and are unlikely to be appropriate in any circumstances.

When a disclosure is made the Board member concerned must not take part in any deliberation

or decision of the Board relating to the transaction, or be included in any quorum or decision, or

sign any documents related to the transaction.

The disclosure must be recorded in the minutes of the next meeting and entered into the

interests register.

The member can take part in deliberations (but not any decision) of the Board in relation to the

transaction if the majority of other members of the Board permit the member to do so.

If this occurs, the minutes of the meeting must record the permission given and the majority’s

reasons for doing so, along with what the member said during any deliberation of the Board

relating to the transaction concerned.

IMPORTANT

If in doubt – declare.

Ensure the full nature of the interest is disclosed, not just the existence of the interest.

This sheet provides summary information only - refer to clause 36, schedule 3 of the New Zealand

Public Health and Disability Act 2000 and the Crown Entities Act 2004 for further information

(available at www.legisaltion.govt.nz) and “Managing Conflicts of Interest – Guidance for Public

Entities” (www.oag.govt.nz ).

2

5


Register of Interests – Hospital Advisory Committee

Member Interest Latest

Disclosure

Judith BASSETT (Chair)

Fisher and Paykel Healthcare

Westpac Banking Corporation

Husband – Fletcher Building

Husband is a shareholder of Westpac Banking Group

Daughter is a shareholder of Westpac Banking Group

13.07.2015

Jo AGNEW Director/Shareholder 99% of GJ Agnew & Assoc. LTD

Trustee - Agnew Family Trust

Professional Teaching Fellow – School of Nursing, Auckland University

Appointed Trustee – Starship Foundation

Casual Staff Nurse – Auckland District Health Board

15.07.2015

Peter AITKEN Pharmacy Locum - Pharmacist

Shareholder/ Director, Consultant - Pharmacy Care Systems Ltd

Shareholder/ Director - Pharmacy New Lynn Medical Centre

Shareholder/Director – New Lynn 7 Day Pharmacy

Shareholder/Director – Belmont Pharmacy 2007 Ltd

15.07.2015

Doug ARMSTRONG Shareholder - Fisher and Paykel Healthcare

Shareholder - Ryman Healthcare

Trustee – Woolf Fisher Trust

Trustee- Sir Woolf Fisher Charitable Trust

Daughter is a partner – Russell McVeagh Lawyers

Member – Trans-Tasman Occupations Tribunal

Shareholder – Orion Healthcare

14.07.2015

Chris CHAMBERS Employee - ADHB

Wife is an employee - Starship Trauma Service

Clinical Senior Lecturer in Anaesthesia - Auckland Clinical School

Member – Association of Salaried Medical Specialists

Associate - Epsom Anaesthetic Group

Shareholder - Ormiston Surgical

26.01.2014

Anne KOLBE Director - Kolbe Medical Services Ltd

Senior Consultant - Communio NZ

Senior Consultant - Siggins Miller, Australia

Member - Risk and Audit Committee, Whanganui District Health Board

Chair - National Health Committee

Member - Australian Institute of Directors

Fellow by Examination – Royal Australian College of Surgeons

Vocational medical registration – Medical Council NZ

Reviewer – Australia and New Zealand Journal of Public Health

Reviewer – European Commission, Personalising Health and Care H2020-

PHC2015 – two stage

Reviewer - Injury

International Journal of Technology Assessment in Health Care

05.08.2015

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Daughter – University of Strathclyde, MSc, Forensic Science research placement,

NZ ESR

Husband:

Professor of Medicine, University of Auckland

Chair - Health Research Council of NZ, Clinical Trials Advisory Committee

Member - Australian Medical Council, Medical School Advisory Committee

Lead - Medical Specialties Advisory Committee Accreditation Team, Royal

Australian College of General Practitioners

Member - Executive Committee, International Society for Internal Medicine

Chair - RACP Re-validation Working Party

Member - RACP Governance Working Party

Lester LEVY Chairman - Waitemata District Health Board (includes Trustee Well Foundation

- ex-officio member as Waitemata DHB Chairman)

Chairman - Auckland Transport

Independent Chairman - Tonkin and Taylor Ltd (non-shareholder)

Director - Orion Health (includes Director – Orion Health Corporate Trustee Ltd)

Professor (Adjunct) of Leadership - University of Auckland Business School

Head of the New Zealand Leadership Institute – University of Auckland

Member – State Services Commission Performance Improvement Framework

Review Panel

Director and sole shareholder – Brilliant Solutions Ltd (private company)

Director and shareholder – Mentum Ltd (private company, inactive, non-

trading, holds no investments. Sole director, family trust as a shareholder)

Director and shareholder – LLC Ltd (private company, inactive, non-trading,

holds no investments. Sole director, family trust as shareholder)

Trustee – Levy Family Trust

Trustee – Brilliant Street Trust

19.02.2015

Lee MATHIAS Chair - Counties Manukau Health

Deputy Chair - Auckland District Health Board

Chair - Health Promotion Agency

Chair - Unitec

Director - Health Innovation Hub

Director - Health Alliance Limited

Director/shareholder - Pictor Limited

Director - Lee Mathias Limited

Director - John Seabrook Holdings Limited

Advisory Chair - Company of Women Limited

Trustee - Lee Mathias Family Trust

Trustee - Awamoana Family Trust

Trustee - Mathias Martin Family Trust

Director – New Zealand Health Partnerships

10.07.2015

Robyn NORTHEY Self-employed Contractor - Project management, service review, planning etc.

Board Member - Hope Foundation

Trustee - A+ Charitable Trust

Shareholder of Fisher & Paykel Healthcare

Husband – shareholder of Fisher & Paykel Healthcare

21.07.2015

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7


Husband – shareholder of Fletcher Building

Husband – Chair, Problem Gambling Foundation

Husband – Chair, Auckland District Council of Social Service

Morris PITA Member – Waitemata District Health Board

Shareholder – Turuki Pharmacy, South Auckland

Owner and operator with wife - Shea Pita & Associates Ltd

Wife is member of Northland District Health Board

Wife provides advice to Maori health organisations

13.12.2013

Gwen TEPANIA-PALMER

Board Member - Waitemata District Health Board

Board Member - Manaia PHO

Chair - Ngati Hine Health Trust

Committee Member - Te Taitokerau Whanau Ora

Committee Member - Lottery Northland Community Committee

Member - Health Quality and Safety Commission

02.04.2013

Ian WARD Board Member - NZ Blood Service

Director and Shareholder – C4 Consulting Ltd

CEO – Auckland Energy Consumer Trust

Shareholder – Vector Group

Son – Oceania Healthcare

12.07.2015

8

Auckland District Health Board Hospital Advisory Committee Meeting 05 August 2015 Page 1 of 14

Minutes

Hospital Advisory Committee Meeting

05 August 2015

Minutes of the Hospital Advisory Committee meeting held on Wednesday, 05 August 2015 in the A+ Trust Room, Clinical Education Centre, Level 5, Auckland City Hospital, Grafton commencing at 9.30am

Committee Members Present


Jo Agnew

Peter Aitken

Doug Armstrong

Dr Chris Chambers

Assoc Prof Anne Kolbe

Dr Lester Levy

Dr Lee Mathias

Gwen Tepania-Palmer

Ian Ward

Auckland DHB Executive Leadership Team Present

Ailsa Claire Chief Executive Officer

Margaret Dotchin Chief Nursing Officer

Joanne Gibbs Director Provider Services Dr Andrew Old Chief of Strategy, Participation and

Improvement

Rosalie Percival Chief Financial Officer

Linda Wakeling Chief of Intelligence and Informatics

Sue Waters Chief Health Professions Officer

Dr Margaret Wilsher Chief Medical Officer

Auckland DHB Senior Staff Present

Directors

Dr Vanessa Beavis Director Perioperative Services

Dr John Beca Director Surgical Child Health

Dr Clive Bensemann Director Mental Health

Judith Catherwood Director Community and Long Term

Conditions

Dr Mark Edwards Director Cardiac Services

Karin Drummond General Manager Women’s Health

Dr Wayne Jones Director Surgical Services

Deidre Maxwell General Manager Cancer and Blood

Dr Michael Shepherd Director Medical Child Health

Dr Barry Snow Director Adult Medical

Frank Tracey General Manager and Acting Director

Clinical Support Services

Other Auckland DHB Senior Staff

Jo Brown Funding and Development Manager

Hospitals

Marlene Skelton Corporate Business Manager

Clare Thompson General Manager Non-Clinical Support Services

Michelle Webb Corporate Committee Administrator

Gilbert Wong Director Communications

Tim Wood Funding and Development Manager,

Primary Care

(Other staff members who attend for a particular item are named at the

start of the minute for that item)

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1. APOLOGIES

The apologies of Robyn Northey and Morris Pita, and the apologies of Doug Armstrong for

lateness were accepted.

The apologies of senior staff members Dr Richard Sullivan, Director Cancer and Blood and Dr

Sue Fleming, Director Women’s Health were accepted.

2. REGISTER AND CONFLICTS OF INTEREST

Lee Mathias advised that she was no longer the Chair, iAC IP limited and had no further interest in HA (FPSC) Limited.

Associate Professor Anne Kolbe advised that James Kolbe’s association with Auckland DHB

had now concluded as his contract had now ended.

There were no declarations of conflicts of interest for any items on the open agenda.

3. CONFIRMATION OF MINUTES 24 June 2015 (Pages 8 to 20)

The Committee agreed that the minutes were accurate. There was no further discussion.

Resolution: Moved Lee Mathias / Seconded Ian Ward

That the minutes of the Hospital Advisory Committee meeting held on 24 June 2015 be

confirmed as a true and correct record.

Carried

4. ACTION POINTS (Page 21)

The Chair drew the Committee’s attention to Action Point Item 6.9, and advised that a paper

incorporating both the waitlist strategy and workforce challenges being experienced by

Clinical Support Services had been completed and was included on the Confidential Agenda

as Item 9.1.

5. PROVIDER ARM PERFORMANCE REPORT

With respect to trend information, Linda Wakeling provided context around the hand

hygiene compliance scores which were down slightly from the previous reporting period,

advising that this was due to an increased amount of data now being submitted for monthly

audits over previous months. Auckland DHB now reports hand hygiene compliance data

from all wards and departments, not just that from the national reporting wards.

The sample size of data being submitted for all monthly audits is significant each month and

therefore there is confidence that the level of compliance overall is well understood. The

areas that are outliers in performance are actively being worked on; those being Older

People’s Health and General Medicine.

With respect to performance against the 6 hour target, Joanne Gibbs advised that overall

results were presenting as positive, however it was important to note that the overall 14/15

FY target for Emergency Department performance has been missed.

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Whilst there had been good performance in the final two quarters of the previous year, this

last winter quarter 2015/2016 had been particularly challenging. A draft improvement plan

is in development. Dr Barry Snow will present it to the next HAC meeting.

Ailsa Claire suggested that the Committee might benefit from the addition of a ‘deep dive’

section in future meetings occurring after the consideration of the Scorecard item and that,

should the Committee be agreeable, the agenda would need adjusting to allow for these.

5.1 Scorecard (Pages 24 to 40)

Professor Kolbe observed that the Committee needed to understand what baseline

assumptions are being made and what the information is telling us, going on to query Falls

and Pressure injuries and how falls with serious harm are measured.

Margaret Dotchin confirmed that these are carefully measured, particularly for older people.

Auckland DHB search coding cases each month for fractures resulting from a fall, looking at

what was reported in Risk Monitor Pro as a fall without harm, and where appropriate

reclassifying the coding.

The Metro region classifies all Grades 3 and 4 pressure injuries as serious harm and reports

these to the Quality and Safety Commission as Serious Events. The same process is

completed for coded discharges as opposed to relying on self- reporting. A Serious Event

process review by the Adverse Event Review Committee reviews these events in detail to

extract information and learning to base improvements on. Other DHB’s may follow

different classification methods.

Chris Chambers queried how long the process had been going on as a result of reviews.

Advice was given that Serious Event reviews have been happening for three years and that

an increase in the number of falls with serious harm was being seen. To address this,

interventions were being tested, a module was being employed and rolled out and that this

was showing a reduction in prevalence.

Lester Levy asked if anything was being done to normalise the data, noting that the problem

might be the way comparisons in data were being made and that sometimes historical

information was not helpful.

Lee Mathias stated that Margaret Dotchin had previously commented that most patients

were aged over 70, but that in reality most were aged over 80 and therefore the element of

dementia and other complications for patients was much greater than it used to be.

Lester Levy commented that people will trip and slip regardless of age and other factors and

queried whether stronger effort around falls prevention would reduce that risk.

Margaret Dotchin responded that there was currently joint work occurring with ACC and

within the community around falls and that in her view Auckland DHB do need to continue to

focus strongly on falls prevention; emphasising that if one patient can be protected from

harm and further complication then it is a positive outcome in patient care.

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11


Professor Kolbe stated that a good step might be to focus on how to model the business

implications of falls, which would build capability in the sector. A better approach might be

in examining and finding the drivers of falls so that the implementation strategies and what

outcome they might deliver could be forecast.

Judith Bassett supported Professor Kolbe, commenting that this action would broaden the

context by including all of the consequences for Auckland DHB.

Lee Mathias expressed interest in the figures for Outpatients MRI’s which were showing

decreasing performance and asked what actions were being undertaken to address this. It

was advised that this would be addressed in the Confidential meeting during consideration of

Item 9.1.

5.2 Overall Provider Performance including Health Target Updates (Pages 41 to 49)

[Secretarial note: This item was considered in conjunction with Item 5.1].

5.3 Financial and Operational Performance Report (Pages 50 to 71)

Rosalie Percival, Chief Financial Officer spoke to the report highlighting that the overall

Provider Arm result for the month of June was $0.8M unfavourable, largely due to

outsourcing of services and nursing costs.

Additionally, this reporting period has been impacted by abnormally high clinical supply costs

related to blood products in Cancer and Blood Services and one-off repair costs for a renal

dialysis reverse osmosis unit.

In general:

FTE over the past month has reduced however there is still the need for further

reductions as the FTE budget cannot be exceeded.

The Full Year result shows that overall volumes are close to base contract volumes

The IDF wash up is approximately $9M unfavourable. Provision had been made for

this.

Infrastructure and Non-Clinical Supplies for the month contains more than one third

of the negative variance due to unique factors within the period, including high acute

volumes.

High factor costs have been analysed to determine what can be expensed versus

what should be capitalised during the end of year wash up.

The regional budget needs further consideration, as Auckland DHB seems to carry

higher costs than it needs to.

Total spend is approximately $500M. A variance of around 2% that occurs service-

by-service will therefore be material.

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The following points were covered in discussion of the report:

A variance of $9M is unacceptable and estimates aren’t being received to enable

appropriate forecasting. Discussion then took place as to the methodology applied

to the IDF wash up process.

Rosalie Percival pointed out that what led to under-delivery in the previous year may

differ to what leads to it in the current year and therefore if reviewed at different

points the results will always be disparate.

It was queried whether management were confident that a 2% variance was

acceptable, or whether it should be lower. Lester Levy asked what proportion of the

variance was controllable or uncontrollable receiving advice that 70 to 80 percent

was controllable. Factors such as Electives endeavouring to meet discharge plans at

same time as meeting volumes were critical. For provider services, the challenge

was meeting volumes versus getting the right case mix; for example at the end of

year Elective Surgery met its targets however Acute Flow did not. It was also pointed

out that WEIS and volumes were separate processes.

Jo Brown, Funding and Development Manager Hospitals advised that this year set

volumes had been put in place for Auckland and Waitemata to provide clarity. The

methodology is to roll out the volume plan weekly so that all teams at specialty level

will be aware of what the requirements are. There is joint work occurring with teams

to reconcile numbers. This is a clinical priority. Another measure being employed is

to assure that wait times are being managed on clinical priority.

The current process for looking at categories in WEIS was queried. Jo Brown

responded that having a Regional Service Review Advisory Group to look at issues

emerging on case by case basis provides the opportunity to query financial and

clinical sustainability. Service creep was a key challenge, as many staff responded to

patient presentation and prevalence as opposed to service specifications.

Jo Brown further advised that the planning process requires the IDF to be set in

November for the following year and needs to be technically 95% correct at that

point in November. Annual planning timelines allow an opportunity in February to

review the IDF figure. The main objective of the IDF planning process is to enable

provision of a clear signal to providers around scope and scale to inform their

planning.

Rosalie clarified that for Auckland DHB, the IDF numbers need to be as accurate as

possible by February, because after that it becomes impossible to change or re-

litigate, hence the decision of the current process.

Lee Mathias stated that Auckland DHB should retain tertiary services, even if they

are undertaken at another site and therefore engagement with other District Health

Boards was needed.

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Professor Kolbe considered that in relation to service specifications, the DHBs would

need to decide what services they can deliver within the funding available. She

stated that unless DHBs can determine priorities collectively, and control the

dependencies, (noting that other DHBs make this choice based on total revenue and

budget), inequalities will result. It was noted that Auckland DHB carries a significant

risk in relation to this issue. Professor Kolbe added that it was important to

understand what high volume and high impact actually cost the DHB.

Ailsa Claire stated that there is a need to define specifications for tertiary services, as

all DHBs (not just Auckland) should be responsible for these services.

Judith Bassett commented that the region needs to work collaboratively together to

address these inequalities.

That the Provider Arm Performance Report for August 2015 be received.

Resolution: Moved Lee Mathias / Seconded Jo Agnew

Carried

6. DIRECTORATE UPDATES

6.1 Mental Health Directorate (Pages 73 to 78)

Dr Clive Bensemann, Director Mental Health asked that the report be taken as read.

The following points were covered in discussion of this report:

The Directorate restructure continues to progress well, with five of the 6 Service

Clinical Directors now appointed.

The Eating Disorders Service model continues to experience delays and a briefing for

the Board is being prepared. The delays experienced have resulted in a high level of

uncertainty within the workforce. In order to determine Auckland DHB’s best course

of action, a project team is being formed to effectively progress key decisions.

Work has commenced on the Pathway for Police Referral and Assessment with a

view to assess as many people as possible in a health (rather than custodial)

environment. Limitations have been identified in the current Emergency

Department environment that need to be addressed to ensure that whatever activity

such an assessment involves it can be managed safely.

Only a small group of patients go to Police Central for health assessment, and this is

generally only when there is no other option for police.

As part of the Auckland DHB/ProCare project the Mental Health Service for Older

People are piloting the use of electronic Shared Care Plans, with staff using tablets to

work with consumers in the community setting.

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6.2 Women's Health Directorate (Pages 79 to 84)

Karin Drummond, General Manager Women’s Health asked that the report be taken as read,

highlighting that the workshop on the Wahine/Women’s Health Maternity Collaboration

Proposals is planned for 26 August 2015.

Ailsa Claire commented that the key issue for the workshop was in fact how to increase focus

on the safety of women giving birth and how to achieve those improvements that will have a

profound and positive impact on the birthing experience.

Members requested that further feedback be given to authors of the Wahine/Women’s

Health Maternity Collaborations Proposals report previously received by the Committee that

the terminology does not reflect the partnership of assisting women to give birth, and that

the language required correcting.

Other matters covered in discussion of the report included:

The DNA rates for Maori and Pacific women were of serious concern, particularly for

those with maternity related diabetes. The availability of Maori midwives visiting

these patients requires improvement and collaboration is taking place to link models

of care for in-house versus outreach services. Pregnant women with diabetes are at

high risk but it can be challenging for them to access in-house services. As a result

they do not attend appointments.

Auckland DHB are in the early stages of conversations with Ngati Whatua O Orakei to

establish a Maori Midwifery Team in the community to help reduce risk and

vulnerability.

There were two Adverse Events reported for the month; one unwitnessed fall in the

outpatient area, and one baby tested for red eye reflex.

A formal invitation is extended to the Committee for the National Women’s Health

Annual Clinical Report Presentation Day on 21 August 2015.

6.3 Child Health Directorate (Pages 85 to 93)

Dr John Beca, Director Surgical Children’s Health and Dr Michael Shepherd, Director Medical,

Children’s Health asked that the report taken as read highlighting the following:

Good progress has been made against the directorate financial savings plan.

Annual leave balances were of concern. A directorate-wide strategy has been

developed with Clinical Leaders to address this over the next Financial Year.

Introduction of the clinic ‘scrum’ process to increase utilisation of clinics has

provided increased flexibility and more effective use of space

Completion of the operating rooms refurbishment project.

The Chair thanked John and Michael for their report. There was no further discussion.

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6.4 Surgical Services Directorate (Pages 94 to 100)

Dr Wayne Jones, Director Surgical Services asked that the report be taken as read,

highlighting the following:

DNA rates are stable, with improvements in Maori and Pacific rates

The investigation review of Head and Neck Services is coming to conclusion. Next

steps will include considering the way the service is organised in ORL and

undertaking a team building exercise.

There will be a strong cost management focus in the next Financial Year, particularly

relating to annual leave balances, theatre productivity (in conjunction with pre-op

services) and to the nursing cost challenges.

Culture improvement continues to be a strong area of focus. Regular meetings have

been implemented and input has been positive. It is generally acknowledged that

there is a good clinical governance framework and a genuine desire to make it work.

ESPI compliance has deteriorated moderately to 0.59% which equates to 26 patients

in total for all services not receiving a date for surgery within 4 months.

The General Surgery ESPI 5 position is slightly down, however the service has over

delivered on IDFs where it has limited control.

Work to increase ESPI5 compliance is in progress, including redesigning the patient

pathway for spinal surgery. This involves setting up a process where those referrals

are managed by the Musculoskeletal team with input from the Pain service. This

may enable up to 30% of patients to be diverted from surgery to other types of

clinical care.

The Regional Service Review Advisory Group have prioritised regular discussion

regarding spinal services which provides an opportunity for alignment and to access

additional funding to allow redesign of the patient pathway. Demand for spinal

surgery demand has risen and patients do experience delays due to capacity

shortfalls. Dialogue between the Board Chair and Minister is currently in progress in

relation to the same potential risks in the current system

Action:

That a strategic discussion regarding surgical demand and intervention rates takes place as

part of a future Board meeting.

6.5 Perioperative Services Directorate (Pages 101 to 106)

Vanessa Beavis, Director Perioperative Services asked that the report be taken as read,


The Year End position for the Engaged Workforce indicator shows that the

directorate is 2% ahead of target for those staff with less than one year’s tenure.

Annual turnover has increased slightly to 8.8% (which is still below target).

16


Greenlane Clinical Centre was used almost to full capacity to assist with achieving

elective targets in the last reporting period.

The Starship Hospital Operating Room rebuild is now complete. Opportunities still

exist to improve patient and visitor access. Members felt that in particular

consideration should be given to providing a covered walkway between Carpark B

and Starship. In the interim, non-slip paint could be applied to prevent slips and trips

when the grounds are wet.

Action:

That improving safe access into Starship Hospital be investigated and actioned accordingly.

6.6 Cardiovascular Directorate (Pages 107 to 112)

Dr Mark Edwards, Director Cardiac Services asked that the report be taken as read,


Changes made in the Clinical leadership of Vascular services were encouraging.

Increases in cardiac service throughput for the period of June and July have reduced

with the waitlist down, however the lung transplant waitlist may put this at risk – 17

transplants have been performed this year already.

The directorate is meeting most of its targets, however there are clinical and volume

based risks pending.

Counties Manukau DHB are making changes to their Cath lab in late

August/September during which time Auckland DHB will take their patients

The Hybrid Theatre is transitioning from being new to business-as-usual.

6.7 Adult Medical Directorate (Pages 113 to 119)

Dr Barry Snow, Director Adult Medical asked that the report be taken as read, highlighting

the following:

Medication errors are up, however overall are trending downwards. Pharmacy

Technicians are now working in wards which will assist with reducing errors.

Acute flow continues to be a major issue. The increase of very sick patients being

admitted is concerning, with a 23% increase of Triage 1 and 2 compared to a similar

period last year.

Hospital occupancy rates are high, averaging 95 to 100%. A survey of regional

colleagues indicates that other DHBs are experiencing the same levels.

The directorate has achieved 105% of contract delivery in the past year.

Long Term Conditions are putting processes in place to assist with patients being

discharged more quickly.

3

17


Colonoscopy is working well and managing demand. The service is however

anticipating high bowel screening referrals due to the new screening programmes.

Challenges with DNA rates have been experienced. An update report will be provided

to a future HAC meeting.

Actions:

That a report be provided to the September HAC meeting on plans for Acute Flow and the

new model of care.

That the Director Adult Community and Long Term Conditions report back to a future HAC

meeting on PSA/Outpatient rates and challenges.

6.8 Cancer and Blood Directorate (Pages 120 to 127)

Deidre Maxwell, General Manager Cancer and Blood spoke to the report, and asked that the

report be taken as read.

The following points were covered in discussion of the report:

The new structure for clinical leadership commenced this week, with the arrival of

the new Service Clinical Director.

The directorate has a favourable Financial Year End position.

Faster Cancer Treatment remains an area of strong focus with many activities

underway, including production planning particularly in Medical Oncology and its

interface with the rest of the hospital.

The Bone Marrow Transplant capacity business case has been signed off. The

number of transplant patients waiting for longer than Ministry of Health guidelines

remains a concern. To address this issue three beds have been opened on a fixed

term basis so that these patients can access care in a timely manner. In order to

prevent this happening again the directorate is reviewing the models of care.

A new initiative to build on the provision of care for cancer patients is in progress

and is funded by the Ministry of Health. A part time lead Psychologist role will be

engaged to lead this work.

6.9 Clinical Support Services (Pages 128 to 135)

Frank Tracey, General Manager/Acting Director asked that the report be taken as read. He

advised that he supported Dr Snow’s remarks regarding current hospital pressure, and

wished to acknowledge the work of the staff over the past month and their commitment to

making things work for patients and providing the best possible care.

The following points were covered during discussion of the report:

It had been a challenging year within a broad portfolio. The Imaging service has been

under huge pressure.

18


Lab Services are on track with significant work being undertaken to refine the model

of service. Consultation has occurred on this. A key objective is to place diagnostic

services at the forefront in the patient journey/pathway to establish much stronger

links with clinical services to help improve turn-around time for results, and

therefore effect a faster diagnosis and treatment for patients.

Performance for the financial year is good, there is more work to do to ensure

sustainability without compromising quality and safety.

There is a significant amount of effort being placed on the engaged workforce and

annual leave liability matters.

6.10 Non-Clinical Support Services (Pages 136 to 144)

Clare Thompson, General Manager Non-Clinical Support Services spoke to the report.

Significant savings of 152% of target were achieved in the clinical supplies budget

across the organisation. This is an excellent result and a big achievement for

Auckland DHB. The work of the General Manager Non-Clinical Support Services and

Chief Financial Officer is to be commended and acknowledged. The directorates

have all shown good engagement and have contributed to this result.

The loading bay and docks have been a key health and safety focus, with most of the

remedial actions now complete.

Planning is in progress for the October sustainability audit.

Food practice and safety issues have been addressed through working closely with

Compass.

The Food project is moving into Phase Two of transition.

Positive work is ongoing with Compass on the new service delivery model, and

Auckland DHB is introducing Steamplicity extensively throughout the hospital.

6.11 Community and Long Term Conditions Directorate (Pages 145 to 152)

Judith Catherwood, Director Community and Long Terms Condition asked that the report be

taken as read, highlighting the following points:

The new structure is now live, current activity includes orientation for the new

Service Clinical Directors.

OPH waiting time performance and patient flow is now measured against a two day

or less waiting time target (from the previous 4 days).

An outbreak of norovirus in OPH resulted in significant bed closures to protect

patients from infection and this impacted on flow in the month of June. The

directorate is confident however that targets can be met.

3

19


The new Rapid Response services have commenced. The next step will be focussing

on home based aged residential care, and providing assistance with acute issues and

older adults.

DNA rates are high for the month and continue to present a challenge. A new action

plan has been developed to address this is progressing and is being monitored

closely.

Resolution: Moved Peter Aitken / Seconded Lee Mathias

That the directorate updates for August 2015 be received.

Carried

7. PATIENT EXPERIENCE REPORT (Pages 153 to 157)

Andrew Old, Chief of Strategy Participation and Innovation Officer spoke to the report on

behalf of Tony O’Connor, Director Participation and Experience. Andrew asked that the

report be taken as read, highlighting the following points:

This is the second of these combined reports, with the focus being on values.

Data shows a positive trend over the period of time Auckland DHB has been

surveying patients, with the ‘Excellent’ rating increasing. The database includes

responses from over 20,000 patients.

The report presents actual patient voices giving it real immediacy and added value.

A paper proposing moving to the use of a Net Promoter score will be presented to

the September HAC meeting.

Action:

That a paper proposing moving the patient survey to the use of a Net Promoter score be

presented to the September HAC meeting.

Resolution: Moved Gwen Tepania-Palmer / Seconded Doug Armstrong

That the Patient Experience report for June 2015 be received.

Carried

8. RESOLUTION TO EXCLUDE THE PUBLIC (Pages 158 to 159)

Resolution: Moved Jo Agnew / Seconded Doug Armstrong

Carried

That in accordance with the provisions of Clauses 34 and 35, Schedule 4, of the New Zealand 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:

20


General subject of

item to be considered

Reason for passing this resolution

in relation to the item

Grounds under Clause 32 for the

passing of this resolution

3. Confirmation of Confidential Minutes 24 June 2015

Confirmation of Minutes As per resolution(s) from the open section of the minutes of the meeting, in terms of the NZPH&D Act 2000.

That the public conduct of the

whole or the relevant part of the

meeting would be likely to result in

the disclosure of information

which good reason for withholding

would exist under any of sections

6, 7, or 9 (except section 9(2)(g)(i)) of

the Official Information Act 1982

[NZPH&D Act 2000]

4. Confidential Action Points

Confirmation of Action Points

As per resolution(s) from the open

section of the minutes of the

meeting, in terms of the NZPH&D

Act 2000.









[NZPH&D Act 2000]

6. Risk Register Report

Obligation of Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which is subject to an obligation of confidence [Official Information Act 1982 s9(2)(ba)]

Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 s9(2)(i)]









[NZPH&D Act 2000]

7. Quality Report (includes complaints, compliments, incident management and policies and procedures)


Privacy of Persons To protect the privacy of natural persons, including that of deceased natural persons [Official Information Act s9(2)(a)]









[NZPH&D Act 2000]

3

21


8. Quality and Standards Reviews’ Report


Negotiations To enable the Board to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations) [Official Information Act 1982 s9(2)(j)]









[NZPH&D Act 2000]

9. Discussion Papers (includes Managing MRI, CT and Ultrasound Demand at Auckland District Health Board)


Negotiations

To enable the Board to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations) [Official Information Act 1982 s9(2)(j)]










[NZPH&D Act 2000]

Carried

The meeting closed at 11.20am.

Signed as a true and correct record of the Hospital Advisory Committee meeting held on Wednesday, 05 August 2015

Chair: Date:

Judith Bassett

22

Auckland District Health Board Hospital Advisory Committee Meeting 05 August 2015

Action Points from Previous Hospital Advisory Committee Meetings

As at Wednesday, 05 August 2015

Meeting and Item

Detail of Action Designated to Action by

5 Aug 2015

Item 6.2

Women’s Health Directorate Report

That the invitation to the Board to the Annual Clinical Report Presentation day on 21 August 2015 be circulated to members by email.

M Skelton Complete

5 Aug 2015

Item 6.4

Surgical Services Directorate Report

That a strategic discussion regarding surgical

demand and intervention rates takes place as part

of a future Board meeting.

D Holdsworth 16 Sep 15

To be referred to

ADHB Board

5 Aug 2015

Item 6.5

Perioperative Services Directorate Report

That improving safe access into Starship Hospital be investigated and actioned accordingly.

S Waters 28 Oct 15

5 Aug 2015

Item 6.7

Adult Medical Directorate Report

1. That a report be provided to the September HAC meeting on plans for Acute Flow and the new model of care.

B Snow 16 Sep 15

Complete – See Item 9.1

of the Confidential

Agenda

2. That the Director Community and Long Term Conditions report back on PSA/Outpatient rates and challenges.

B Snow 28 Oct 15

5 Aug 2015

Item 7.0 Patient Experience Report

That a paper proposing moving the patient survey to the use of a Net Promoter score be presented to the September HAC meeting.

A Old,

T O’Connor

16 Sep 15

Complete – referred to 5 Aug 15 Board Agenda (also see Item 7.2

of this Agenda for

update)

24 Jun 2015

Item 5.3

Financial and Operational Performance Report

That the Committee’s appreciation for the good

work they are undertaking in managing and

improving expenditure related to personnel costs

be conveyed to the Directorates by the Chief

Financial Officer.

R Percival 5 Aug 2015

Complete

4

23

Auckland District Health Board Hospital Advisory Committee Meeting 05 August 2015

18 Feb 2015

Item 6.10

Security

GM Non-Clinical Support Services to work with the Health and Safety Committee on the organisation’s capacity to lock down in crisis situations and report back to a future meeting.

C Thompson Pending consideration

of final reviews

report by ADHB

management

17 Sep 2014

Item 6.1

Eating Disorders Service Model Redesign

That a brief presentation on the outcome of the model redesign be provided in the new year.

C Bensemann Pending MOH decision –

interim report

provided to Board 16 Sep

15

6 Aug 2013

Item 6

Ethnicity Data

Ethnicity Data/benchmarking data to be provided when the new national Cardio surgical Database is implemented

Director Provider Services

Date to be advised when determined

by MoH

24


Provider Arm Performance Report

Recommendation

That the Hospital Advisory Committee receives the Provider Arm Performance report.

Prepared by: Joanne Gibbs (Director Provider Services)

Endorsed by: Ailsa Claire (Chief Executive)

Executive Summary

The Executive Team highlight the following performance themes from the July 2015 Provider

Scorecard:

Adult Emergency Department patients with an ED stay <6 hours

We have experienced significant increases in the numbers of patients presenting

acutely this winter; and with the proportion of severely ill patients; with record

highs continuing in August in both total presentation and those admitted.

All plans for the winter have been implemented, including additional staffing in the

Emergency Department and additional beds, but these have not been sufficient to

maintain acute flow within the six hour target timeframe.

Our focus has remained on clinical safety and prioritising the most unwell patients.

ADHB will not meet the Quarter One six hourly target performance. August monthly

data (still to be validated) will report performance at approximately 91.7%.

A “deep dive” discussion paper is scheduled for today’s confidential HAC meeting

with a comprehensive plan of actions to be implemented during 2015/16. These

include initiatives to:

- see and assess patients more quickly;

- increase flexibility to meet surges in demand;

- redesign our clinical model of care and facilities to accommodate the

growing number of patients.

Elective discharges cumulative variance from target

Elective discharge volumes in adults and children’s surgery are behind plan at the

end of July and August.

There are robust plans in place across each area to increase capacity, with most

additional capacity being implemented across Quarter Two.

It is expected the required activity in all discharge categories (ADHB, IDFs and ACC)

will be delivered by the end of the year.

A “deep dive” discussion paper is proposed for the October HAC meeting to review

the production plans for 2015/16.

Falls with major harm

We continue to monitor and support all wards to strengthen their risk assessment

and interventions.

There is a multi-disciplinary monthly review of all falls with harm at organisational

level, and, as part of this, we review and identify trends and themes.

5

25


Number of reported adverse events causing harm (SAC1 and SAC2)

Falls with harm have increased recently (see note above)

Within Mental Health there have been 4 events (excluding falls); each is being

investigated appropriately within the agreed process.

All other event types are stable.

Percentage hand hygiene compliance

This continues to improve, with August performance now confirmed at 81%.

26


Auckland DHB Provider Scorecard

For July 2015

Measure Actual TargetPrev

PeriodCommentary

% AED patients seen within triage time -

triage category 2 (10 minutes)PR006 78.3% >= 80% 82.1%

Red Green % CED patients seen within triage time -

triage category 2 (10 minutes)PR008 86.4% >= 80% 87.4%

Green Green

Number of reported adverse events causing

harm (SAC 1&2)PR084 14 <= 12 12

Red Green Central line associated bacteraemia rate per

1,000 central line days PR087 0 <= 1 0

Green Green Healthcare-associated Staphylococcus

aureus bacteraemia per 1,000 bed daysPR088 0.07 <= 0.25 0.12

Green Green Healthcare-associated bloodstream

infections per 1,000 bed days - AdultPR089 1.19 <= 1.6 0.96

Green Green Healthcare-associated bloodstream

infections per 1,000 bed days - ChildPR090 1.35 <= 2.4 2.29

Green Green

Falls with major harm per 1,000 bed days PR095 0.2 <= 0.09 0.15

Red Red Healthcare-associated Clostridium difficile

infection rate per 10,000 bed days

(Quarterly)

PR143 1.59 <= 4 2.39

Green Green % Hand Hygiene Compliance PR144 80.5% >= 80% 79.1%

Red Amber Nosocomial pressure injury point

prevalence (% of in-patients) PR097 2.5% <= 6% 2.6%

Nosocomial pressure injury point

prevalence - 12 month average (% of in-

patients)

PR185 3.7% <= 6% 3.8%

Green Green

The 7 serious harm falls have

occurred in most directorates

with no cluster in single

directorates. We have alerted the

leaders within Directorates and

we are closely monitoring the

situation.

Significent increases in AED

presentations. Please refer to

detailed briefing paper.

Pat

ien

t Sa

fety

Half of these reported events are

falls with major harm which have

increased recently (see PR095

below for comment). Also 4

mental health events. Other

event types stable.

5.1

27


PR013 92.2% >= 95% 94.1%

Red Amber

(MOH-01) % CED patients with ED stay < 6

hours PR016 95.3% >= 95% 94.8%

Green Amber

% Inpatients on Older Peoples Health

waiting list for 2 calendar days or lessPR023 71.5% >= 80% 58.7%

Red Red

HT2 Elective discharges cumulative variance

from targetPR035 0.94 >= 1 0.99

Red Amber (ESPI-2) Patients waiting longer that 4

months for their FSAPR038 0% 0% 0%

Green Green (ESPI-5) Patients given a commitment to

treatment but not treated within 4 monthsPR039 0.7% 0% 0.5%

Amber Amber Cardiac Bypass Surgery Waiting List PR042 60 <= 104 70

Green Green % Accepted referrals for elective coronary

angiography treated within 3 monthsPR043 98.1% >= 90% 98.8%

Green Green % Urgent Diagnostic colonoscopy

procedures treated < 14 daysPR044 96.3% >= 75% 81.8%

Green Green % Non urgent colonoscopy procedures

treated < 42 daysPR045 98.2% >= 60% 98%

Green Green

% Outpatients & community referred MRI

completed < 6 weeksPR046 38.7% >= 85% 44%

Red Red

% Outpatients & community referred CT

completed < 6 weeksPR047 87.9% >= 95% 82.3%

Red Red

Elective day of surgery admission (DOSA)

ratePR048 64.5% >= 68% 67.8%

Red Amber

% Day Surgery Rate PR052 56% >= 70% 58.9%

Red Red Inhouse Elective WIES through theatre - per

dayPR053 136.09 >= 99 151.21

Green Green % DNA rate for outpatient appointments -

All EthnicitiesPR056 9.5% <= 9% 8.7%

Amber Green

% DNA rate for outpatient appointments -

MaoriPR057 18.4% <= 9% 15.5%

Red Red

Be

tte

r Q

ual

ity

Car

e

(MOH-01) % AED patients with ED stay < 6

hours

Ring to remind patients continues

to be the main focus of our input,

particularly in the Cardiac

Services.

This has slipped in month partly

due to the complexity of the

elective procedures undertaken,

and the need for

observations/work up on the day

prior to surgery.Work has

demonstrated some opportunity

to further improve performance.

We continue to work with teams

to identify cases to be undertaken

as day case.Specialty based

discussions underway to agree

improvement plans.

MRI performance continues to

deteriorate with the large wait

list. Outsourcing started August

15 which will see an additional 40

patients per weeks scanned.

Compliance with the CT target is

on track to be achieved by

October 2015.

Hospital occupancy has impacted

on our performance in July. OPH

has been at 110% occupancy due

to larger patient numbers with

significantly greater acuity.

High levels of annual leave

impacted the throughput for

adult elective services. This was

planned and capacity aligned in

areas where no internal cover

was available.

Drop due to high volumes and

high activity. Please refer to

detailed briefing paper.

28


% DNA rate for outpatient appointments -

PacificPR058 18.9% <= 9% 17.4%

Red Red % Chemotherapy patients (Med Onc and

Haem) attending FSA within 4 weeks of

referral

PR059 100% 100% 98.8%

Green Amber % Radiation oncology patients attending

FSA within 4 weeks of referralPR064 100% 100% 99.5%

Green Amber % Cancer patients receiving

radiation/chemo therapy treatment within 4

weeks of DTT

PR070 100% 100% 100%

Green Green Average LOS for WIES funded discharges

(days)PR074 2.98 <= 3 2.81

Green Green 28 Day Readmission Rate - Total PR078 R/U <= 6% 9.2%

Grey Red Breastfeeding rate on discharge excluding

NICU admissionsPR099 R/U >= 75% 76.4%

Grey Green Mental Health - 28 Day Readmission Rate

(KPI Discharges) to Te Whetu TaweraPR119 R/U <= 10% 17%

Grey Red

Mental Health Average LOS (KPI Discharges)

- Te Whetu TaweraPR120 35.6 <= 21 26.9

Red Red % Very good and excellent ratings for

overall inpatient experiencePR154 R/U >= 90% 86.9%

Grey Red

Number of CBU Outliers - Adult PR173 321 0 371

Red Red % Patients cared for in a mixed gender

room at midday - AdultPR175 14.6% 0% 11.9%

Red Red 31/62 day target – % of non-surgical patients

seen within the 62 day targetPR181 R/U >= 85% 45.5%

Grey Red 31/62 day target – % of surgical patients

seen within the 62 day targetPR182 R/U >= 85% 88.9%

Grey Green 62 day target - % of patients treated within

the 62 day targetPR184 R/U >= 85% 65%

Grey Red

Be

tte

r Q

ual

ity

Car

e

Continued focus by Charge

Nurses.

Continued volume of General

Medical , Oncology and Acute

Surgical patients resulting in

outliers. Nurse specialists

rounding on patients on outlying

wards.

30% of discharges from TWT in

July had stays >35 days. This was

unusually high and has previously

been <30% for last eight months.

Communication with patients

about appointments continues to

be an issue. Development work is

underway linked to indicator

PRO57.

5.1

29


Mental Health % long-term clients with

relapse prevention plans in last 12 months

(6-Monthly)

PR125 91.4% >= 95% 95%

Red Green % Hospitalised smokers offered advice and

support to quitPR129 95.1% >= 95% 96%

Green Green

Amber

R/U

31/62 day target - % of surgical patients seen within the 62 day target

62 day target - % of patients treated within the 62 day target

*

PR099

Results unavailable until after the third week of the next month.

PR125 (6-Monthly)

Actual result is for the period ending June 2015. Previous period result is for period ending June 2015.

PR078, PR119

A 35 day period is required to accurately report all acute re-admissions for the previous month's discharges. (35 days = 28

days post discharge as per MoH measures plus 5 working days to allow for coding).

PR154

This measure is based on retrospective survey data, i.e. completed responses for patients discharged the previous month.

= Quarterly or 6-Monthly Measure

31/62 day target - % of non-surgical patients seen within the 62 day target

Results unavailable from NRA until after the 20th day of the next month.

= Variance from target not significant enough to report as non-compliant. This includes percentages/rates within 1% of

target, or volumes within 1 value from target.

= Result unavailable

Imp

rove

d H

eal

th S

tatu

s

This has fallen below target 95%.

Of the total 8.6% of eligible

patients without an 'up to date'

relapse prevention plan >80%

already have a plan but this

requires review. Services are

emphasising the importance of

reviewing existing plans.

30


Trend Information

% AED patients seen within triage time - triage category 2 (10 minutes) (PR006)

The percentage of Triage 2 presentations who receive treatment within Australasian College of Emergency Medicine (ACEM) time guidelines

Current Target Performance

78.26%. Significant increases in AED presentations have resulted in longer waits within the Department.

Current/Planned Improvements

There are a number of improvement projects underway and being planned. Please refer to the detailed briefing paper.

5.1

31


Number of reported adverse events causing harm (SAC 1&2) (PR084)

The number of incidents causing significant harm to patient, staff member or visitor.


Recent rise in overall reported events is mainly due to increases in Falls with Major Harm (see PR095 below) as they contribute 50% of events.


The seven serious harm falls have occurred in most Directorates with no cluster in single Directorates. We have alerted the leaders within Directorates and we are closely monitoring the situation.

Consideration of full separation these two measures to avoid double counting.

32


Falls with major harm per 1,000 bed days (PR095)

The rate of falls resulting in major harm (SAC 1 or 2) per 1000 bed days


The 7 serious harm falls have occurred in most Directorates with no cluster in single directorates. We have alerted the leaders within Directorates, and we are closely monitoring the situation.


Adult Medical has implemented a new Falls program to address their higher Falls with Major Harm rate.

On-going roll outs of concepts identified through the Falls concept ward.

Additional monitoring to isolate areas where additional work is required.

5.1

33


% AED patients seen with ED stay < 6 hours (PR013)

The amount of time a patient remains in Emergency Departments (ED) before leaving, regardless of their destination


92.24%. Drop due to high volumes and high activity of patients.


There are a number of improvement projects underway and being planned. Please refer to detailed briefing paper.

34


% Inpatients on Older Peoples Health waiting list for 2 calendar days or less (PR023)

Percentage of inpatients to Older Peoples Health on the waiting list for 2 calendar days or less


Hospital occupancy and patient acuity has impacted on our performance in July. OPH has been fully flexed for several weeks and this has impacted on our ability to meet this target. Note there has been an improvement from June performance.


Through on-going work to support patient flow we anticipate being able to restore our performance to previous levels and achieve the 2 day target for transfer.

A number of new service models have commenced including rapid response and step home beds.

We also plan to implement an electronic referral system and combined OPH and Rehab Plus waiting list management to further improve our performance and enhance flow.

5.1

35


Elective discharges cumulative variance from target (PR035)

The Actual Elective WIES funded discharges cumulative variance from target


We under-performed in July against Auckland DHB volumes and over performed in IDF volumes; the combined total results in 98% of the overall target being delivered.

High levels of annual leave impacted the throughput for adult elective services. This was planned and capacity aligned in areas where no internal cover was available.

High levels of acute presentations across the organisation have impacted on patient flow, but impact on elective discharges has been minimised.


We are expecting the position to improve and come back in line with planned performance with plans to increase capacity in the two key specialties of ophthalmology and orthopaedics after the next three months.

36


% Outpatients & community referred MRI completed < 6 weeks (PR046)

The percentage of accepted Outpatient & Community referred MRI's completed within six weeks


Target percentage continues to fall with approximately 1500 patients on the wait list.


Outsourcing to private providers commenced August 2015.

On-going training of MRI MRT’s.

Expectation of 12 hour days on GCC MRI scanner in August/September.

Repatriation of MRI scans to domicile DHB.

Continual audit of wait list.

5.1

37


% Outpatients & Community referred CT completed < 6 weeks (PR047)

The percentage of accepted Outpatient & Community referred CT's completed within six weeks.


Continues to improve and aim to achieve target by October 2015.


Audit of wait list.

Targeted booking for patients nearing 6 weeks.

Dashboard reporting being developed for booking co-ordinators.

38


Elective day of surgery admission (DOSA) rate (PR048)

The proportion of elective surgical inpatients (excluding day cases), who have their operation on the day of admission


64.5% against a target of 68%.


This has deteriorated this month partly due to the complexity of the elective procedures undertaken and the need for observations/work-up on the day prior to surgery. Recent work has demonstrated some opportunity to further improve performance.

5.1

39


% Day Surgery Rate (PR052)

The percentage of WIES funded elective surgical procedures that are day cases


59.3% against a target of 70%.


All specialities are reviewing the cases that can be operated on as day stay.

The case mix and acuity of patients has been heavier in July which has reduced the number of cases to be undertaken compared to June.

Speciality based discussions are underway to agree improvement plans.

40


% DNA rate for outpatient appointments – Maori (PR057)

The percentage of appointments booked for Maori where the patients Did Not Attend (DNA)


The increase overall in Maori DNAs is disappointing however the July DNAs for Cancer & Blood show an improvement from the June data of 0.5%. Cardiac DNAs are up slightly by just under 1% from June, but improved by 4.5% from the 20% DNA rates of April/May.


We have worked with the Clinical Director of Cancer & Blood to develop a report that includes the Clinic specialties that could potentially result in a Cancer diagnosis. This will make the ring to remind/confirm Maori patients of their future appointments a more accurate report.

We have also developed the same report for the Cardiac Services.

A specific DNA report is also generated identifying those (on the clinic specialties report) who don’t arrive at their appointment with a view to understanding their reasons for not attending.

5.1

41


% DNA rate for outpatient appointments – Pacific (PR058)

The percentage of appointments booked for Pacific People where the patients Did Not Attend (DNA).


DNA rate increased from the last month.


Communication with patients about appointments continues to be an issue. Development work underway links with PRO57.

42


Mental Health Average LOS (KPI Discharges) - Te Whetu Tawera (PR120)

The monthly average length of stay (LOS) for Mental Health Adult Acute Unit - Te Whetu Tawera (limited to discharges meeting National KPI definition for inclusion)


The high average Length of Stay (LoS) for July was influenced by:

A small group of ‘long-stayers’ being discharged: 1 x client with a length of stay of 148 days, and 3 x clients with stays of between 90 to 100 days.

An unusually high percentage of discharged clients having a LoS >35 days:

- Historically there is usually 15-20% of all current TWT inpatients with a LOS at months end of >35 days.

- During July there were 30% of discharged clients with stays >35days.

- This is the highest % in the last 8 months.


A renewed focus will be taken on review processes for this group to understand what the particular issues are.

5.1

43


Number of CBU Outliers – Adult (PR173)

The number of patients with an assigned CBU (Clinical Business Unit) that is not the CBU of the ward the patient was admitted or transferred to


Continued improvement despite high demand.


Continued volume of General Medical, Oncology and Acute Surgical patients resulting in outliers. Nurse specialists rounding on patients on outlying wards.

44


% Patients cared for in a mixed gender room at midday – Adult (PR175)

The percentage of patients cared for in a mixed gender room based on census at midday – Adult


Increase in gender mixed rooms since last month.


Daily focus at Charge Nurse Forums.

5.1

45


Mental Health % long-term clients with relapse prevention plans in last 12 months (PR125)

The proportion of Long Term Service users with an up-to-date Relapse Prevention Plan


This has fallen below target 95%. Of the total 8.6% of eligible patients without an 'up to date' relapse prevention plan >80% already have a plan but this requires review i.e. of more than 1200 eligible patients, 19 have no plan.


Services are emphasising the importance of reviewing existing plans. The nationally set target is 95% to assure a high quality ‘relapse planning’ process, but work is on-going to endeavour that all eligible patients have such plans.

46


Mental Health Provider Arm Services: SAC1&2 Suicides (PR194)

A monthly count of suicides/suspected suicides advised to MH services and meeting the definition for SAC1 or SAC2


One community suicide has occurred this month.


The community suicide will be reviewed using the nationally agreed HQSC protocols.

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47


Overall Provider Performance Report

Shorter Stays in Emergency Departments

Adult Acute Patient Flow

Target: 95 per cent of patients will be admitted, discharged or transferred from the adult emergency department within six hours.

Target Champions – Brenda Clune, Dr Barry Snow


Not met due to high numbers and activity of patients and staff shortages due to illness.

Current/ Planned Improvements

Please refer to detailed briefing paper.

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Shorter Stays in Emergency Departments – continued

Children’s Acute Patient Flow

Target: 95 per cent of patients will be admitted, discharged or transferred from the children’s emergency department within six hours.

Target Champion – Mike Shepherd


We have met the target for July despite high acute volumes and acuity.


Hospital occupancy will continue to be carefully monitored and managed over the winter period.

On-going work on streamlining the patient admission process is continuing.

49


Improved Access to Elective Surgery

Target: The volume of elective surgery will be increased by at least 4000 discharges per year nationally. DHBs have negotiated local targets taking into consideration the health needs of their communities. Collectively these targets contribute to a national increase in elective surgery discharges.

ADHB’s objective is to deliver the MoH target for elective surgical discharges (14,372).

Target Champions – Wayne Jones, Paul Browne, Tara Argent


We under performed in July against ADHB volumes, and over performed in IDF volumes however the combined total results in 98% of the overall target being delivered.

High levels of annual leave impacted the throughput for adult elective services, this was planned and capacity aligned in areas where no internal cover was available.

High acute presentations across the organisation has impacted on patient flow, but have had a minimal impact on elective discharges.


We are expecting the position to improve and come back in line with the planned performance with plans to increase capacity in the two key specialties of ophthalmology and orthopaedics over the next three months.

5.2

50


Shorter Waits for Cancer Treatment

Target: All patients, ready for treatment, wait less than four weeks for radiotherapy or chemotherapy

The policy priority is for patients who are ready to treat. It excludes patients who require other treatment prior to radiotherapy or chemotherapy, who are not fit to start treatment because of their medical condition or who choose to defer their treatment.

Target Champions – Giuseppe Sasso, Fritha Hanning, Richard Doocey, Deirdre Maxwell

Note: One patient not treated in December 2014 causing drop in percentage to 99.66%


Chemotherapy

We continue to meet the policy priority for July.

Radiation Therapy

We continue to meet the policy priority for July.


Improved weekly reporting allows us to view the numbers of patients currently on the waitlist for each tumour stream, the target booking date and the booked appointment date. This allows us to ensure compliance with the 4 week policy priority.

Weekly prioritisation meetings continue, as a means to best match patient access requirements with clinic capacity.

The transition to the new Service Clinical Director structure is facilitating service improvement discussions. There is a renewed focus on better models of care and pathways for our patients across services, with a nominated SMO lead.

51


Increased Immunisation

Target: 95 per cent of eight-month-olds will have their primary course of immunisation (six weeks, three months and five month immunisation events) on time by December 2014 and maintained to 2017. The quarterly progress result includes children who turned eight months old during the three month period of the quarter and who were fully immunised at that stage.

Target Champion – Mike Shepherd


Auckland DHB's coverage to 30 June 2015 remains 94%. Overall, this is just below the target rate of 95%. Maori is 87%; Pacific 94%; Asian 97%; Others 93% and NZE 94%.

Note: This data is provisional until confirmed by the MOH and is reported quarterly.


Six month milestone plan continues, to promote early enrolment of nominated infants, improve on-time immunisations at 3 and 5 months, and initiate prompt referral to outreach immunisation services when appropriate. Agreement reached to aim for 85% of 6 month infants fully immunised. Four month prompt initiated by PHOs to rapidly follow-up children who turn 4 months old and are overdue 3 month immunisations.

Focus on increasing and improving new-born enrolment processes to ensure all babies are enrolled with a GP by 3 months of age, to enable access to pre-call and recalls. New resource completed and provided to all Auckland DHB/Waitemata DHB General Practices to standardise process. Pilot underway with 4 general practices.

Monthly monitoring of practice acceptance and declines of NBE nominations by NIR, with PHOs following up with Practices as required.

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52


Maternity / PHO enrolment data-match audit completed and report finalised and released. Outcomes will inform strategies to increase new born enrolments with primary healthcare.

The antenatal (AN) video developed as a collaboration by the four Northern DHBs for use in AN clinics and child birth education classes promoting AN immunisations, on-time childhood immunisation and the value of early enrolment with GP and LMC, is completed. Released during Immunisation Week 2015 and distribution on-going.

53


Better Help for Smokers to Quit

Target:

1. 95 per cent of hospitalised patients who smoke and are seen by a health practitioner in public hospitals and 90 per cent of enrolled patients who smoke and are seen by a health practitioner in general practice are offered brief advice and support to quit smoking.

2. Within the target a specialised identified group will include progress towards 90 per cent of pregnant women (who identify as smokers at the time of confirmation of pregnancy in general practice or booking with Lead Maternity Carer) are offered advice and support to quit.

Target Champions – Stephen Child, Margaret Dotchin, Karen Stevens


Hospitalised patient target – over the past 12 months we have averaged at 96.2%. In the month of July we achieved at a lower level (95.3%) in addressing the target. This mirrors the high occupancy rates and patient turnover in July coupled with our hospital based practitioner unable to carry out on-going auditing due to sickness.

We achieved in this area in quarter four 2014-2015. The target working group has now changed from independent midwives to the work of our Auckland DHB community midwives. Carbon monoxide monitors have been purchased for the Auckland DHB midwives to help them persuade their clients who smoke to accept help to stop smoking. Our Auckland DHB pregnancy stop smoking service has a 46% success rate at 4 and 12 weeks of helping pregnant women who smoke to quit.


Hospitalised patient target – we will be concentrating on providing more nicotine replacement therapy (NRT) to more admitted patients who smoke via a campaign that includes the release of an inpatient brochure.

Education of doctors and a release of an updated Nicotine Withdrawal management policy. Evidence is showing that patients provided NRT in hospital and supplied after discharge will seek to quit.

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54


The Maternal target will be better achieved after 1st September when we commence the pregnancy purchasing voucher incentives project coupled with carbon monoxide monitor use.

55


More Heart and Diabetes Checks

Target: 90 per cent of the eligible population will have had their cardiovascular risk assessed in the last five years.

Target Champion – Jagpal Benipal


Auckland DHB has met the More Heart and Diabetes Checks – National Health Target in quarter four 2014/15. The preliminary results from the Ministry of Health shows that Auckland DHB has achieved 92.4%. Auckland DHB has consistently met this target through the 2014/15 year (refer to the graph above).


The DHB and the PHOs have agreed to implement the CVD management outcome measures approved by the District Alliance Leadership Team. Consequently the Primary Care team will report on those measures in future once implementation is completed.

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Cardiac Bypass Surgery

Target: To enable timely access to cardiac bypass surgery, the wait list should be no greater than 104. To support the national cardiac bypass intervention target, 1038 bypasses should be completed in 2014/2015. Target Champion – Dr Mark Edwards


During July the service delivered 76 eligible procedures against a plan of 72. The service has had 3 lung transplants and 3 ECMO patients. 79 new patients were added to the waiting list in July.

Despite seeing an increase in ECMO and transplant patients in the service the waitlist saw a decrease from 70 at the end of June to 60 at the end of July. This is predominately due to a lower than usual inflow of patents onto the waitlist and production numbers higher than the plan.

The service has had a total of 13 cancellations. The cancellations were primarily due to substitution of elective cases for acute work which contributes to staff unavailability the following day.

At month end, there were 7 patients waiting in hospital, 53 waiting up to 90 days and no patients waiting between 90 and 120 days.

Fortnightly teleconferencing with the MOH to update them on the service performance and production continues.

The service has remained ESPI 2 and 5 compliant.

The challenge for the service over the next few months will be managing a likely increase of patients on to the waitlist. Continuing trends predict transplant work will remain high putting acute pressure on the service. The ECMO demand is likely to continue in the shorter term which will also increase demand on CVICU beds and staffing.

The service will also be challenged with perfusion staff shortages which are contributing to an inability to schedule OR sessions. Recruitment attempts continue for perfusion staff.

57



Live cases are now being scheduled for the hybrid OR. The challenge for the service will be resourcing the hybrid room in light of perfusion and cardiac operating theatre staff limitations.

Weekend contracts to continue due to the anticipated winter inflows increasing.

Work streams progressing with a focus on ward rounds and patient pathways.

Poster to be submitted to APAC forum for the Patient Improvement Project.

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Financial Performance

Consolidated Statement of Financial Performance - July 2015

Provider Month (Jul-15) YTD (Jul-15)

$000s Actual Budget Variance Actual Budget Variance

Income

Government and Crown Agency sourced

6,653 7,692 (1,039) U 6,653 7,692 (1,039) U

Non-Government & Crown Agency Sourced

6,708 6,466 242 F 6,708 6,466 242 F

Inter-DHB & Internal Revenue

2,110 1,302 808 F 2,110 1,302 808 F

Internal Allocation DHB Provider

98,856 98,589 267 F 98,856 98,589 267 F

114,328 114,049 279 F 114,328 114,049 279 F

Expenditure

Personnel 69,433 70,913 1,479 F 69,433 70,913 1,479 F

Outsourced Personnel 2,002 1,491 (511) U 2,002 1,491 (511) U

Outsourced Clinical Services

1,974 1,894 (80) U 1,974 1,894 (80) U

Outsourced Other 3,713 3,799 86 F 3,713 3,799 86 F

Clinical Supplies 21,473 20,947 (527) U 21,473 20,947 (527) U

Infrastructure & Non-Clinical Supplies

16,488 15,360 (1,129) U 16,488 15,360 (1,129) U

Internal Allocations 561 557 (3) U 561 557 (3) U

Total Expenditure 115,644 114,960 (684) U 115,644 114,960 (684) U

Net Surplus / (Deficit) (1,316) (911) (405) U (1,316) (911) (405) U

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Consolidated Statement of Financial Performance – July 2015

Performance Summary by Directorate

By Directorate $000s Month (Jul-15) YTD (Jul-15)

Actual Budget Variance Actual Budget Variance

Adult Medical Services 1,783 1,057 726 F 1,783 1,057 726 F

Adult Community and LTC

2,571 1,913 657 F 2,571 1,913 657 F

Surgical Services 8,831 9,093 (261) U 8,831 9,093 (261) U

Women's Health & Genetics

3,260 2,978 281 F 3,260 2,978 281 F

Child Health 7,390 6,528 862 F 7,390 6,528 862 F

Cardiac Services 3,021 2,695 326 F 3,021 2,695 326 F

Clinical Support Services (2,342) (2,705) 364 F (2,342) (2,705) 364 F

Non-Clinical Support Services

(1,603) (1,658) 55 F (1,603) (1,658) 55 F

Perioperative Services (11,201) (11,057) (143) U (11,201) (11,057) (143) U

Cancer & Blood Services 2,139 2,230 (90) U 2,139 2,230 (90) U

Operational - Other 4,902 8,340 (3,438) U 4,902 8,340 (3,438) U

Mental Health & Addictions

541 (13) 554 F 541 (13) 554 F

Ancillary Services (20,608) (20,312) (296) U (20,608) (20,312) (296) U

Net Surplus / (Deficit) (1,316) (911) (405) U (1,316) (911) (405) U

Consolidated Statement of Personnel by Professional Group – July 2015

Employee Group $000s Actual Month

Budget Month

Variance Month

Actual YTD

Budget YTD

Variance YTD

Medical Personnel 26,589 26,693 104 F 26,589 26,693 104 F

Nursing Personnel 22,445 22,624 179 F 22,445 22,624 179 F

Allied Health Personnel 11,688 12,254 566 F 11,688 12,254 566 F

Support Personnel 1,436 1,628 192 F 1,436 1,628 192 F

Management/ Admin Personnel

7,276 7,714 438 F 7,276 7,714 438 F

Total (before Outsourced Personnel)

69,433 70,913 1,479 F 69,433 70,913 1,479 F

Outsourced Medical 757 765 8 F 757 765 8 F

Outsourced Nursing 279 254 (26) U 279 254 (26) U

60


Outsourced Allied Health

132 99 (33) U 132 99 (33) U

Outsourced Support 227 5 (222) U 227 5 (222) U

Outsourced Management/Admin

607 369 (238) U 607 369 (238) U

Total Outsourced Personnel

2,002 1,491 (511) U 2,002 1,491 (511) U

Total Personnel 71,435 72,404 968 F 71,435 72,404 968 F

Consolidated Statement of FTE by Professional Group – July 2015

FTE by Employee Group Actual

FTE Month

Budget FTE

Month

Variance FTE

Month

Actual FTE YTD

Budget FTE YTD

Variance FTE YTD

Medical Personnel 1,291 1,333 41 F 1,291 1,333 41 F

Nursing Personnel 3,497 3,484 (13) U 3,497 3,484 (13) U

Allied Health Personnel 1,809 1,897 88 F 1,809 1,897 88 F

Support Personnel 354 422 68 F 354 422 68 F

Management/ Admin Personnel

1,206 1,276 70 F 1,206 1,276 70 F

Total (before Outsourced Personnel)

8,158 8,413 255 F 8,158 8,413 255 F

Outsourced Medical 33 32 (1) U 33 32 (1) U

Outsourced Nursing 5 7 2 F 5 7 2 F

Outsourced Allied Health

11 3 (9) U 11 3 (9) U

Outsourced Support 64 0 (64) U 64 0 (64) U

Outsourced Management/Admin

84 5 (79) U 84 5 (79) U

Total Outsourced Personnel

197 47 (151) U 197 47 (151) U


Consolidated Statement of FTE by Directorate – July 2015

Employee FTE by Directorate Group

Actual Month

Budget Month

Variance Month

Actual YTD

Budget YTD

Variance YTD

(including Outsourced FTE)

Adult Medical Services 812 826 14 F 812 826 14 F

Adult Community and LTC 516 525 9 F 516 525 9 F

Surgical Services 807 791 (16) U 807 791 (16) U

Women's Health & Genetics 385 369 (16) U 385 369 (16) U

Child Health 1,032 1,090 57 F 1,032 1,090 57 F

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Cardiac Services 501 512 12 F 501 512 12 F

Clinical Support Services 1,448 1,453 5 F 1,448 1,453 5 F

Non-Clinical Support Services

244 244 0 F 244 244 0 F

Perioperative Services 795 829 34 F 795 829 34 F

Cancer & Blood Services 314 315 1 F 314 315 1 F

Operational - Others 0 0 0 F 0 0 0 F

Mental Health & Addictions 722 738 15 F 722 738 15 F

Ancillary Services 780 767 (13) U 780 767 (13) U


Month Result The Provider Arm result for the month is $0.4M unfavourable. This result is driven by unfavourable expenditure – primarily one off/abnormal Infrastructure and Non Clinical Supplies costs. Overall volumes are reported at 96.9% of base contract, however the latest estimate based on 100% coded gives total contract performance at 97.8% - this equates to $2.1M below contract (not recognised in the month result). Provider Arm revenue for the month is very close to budget at $0.3M (0.2%) favourable, with the key variance being particularly high retail pharmacy sales $0.3M favourable (although offset by higher costs of goods sold). Total expenditure is $0.7M (0.6%) unfavourable, with the key variances as follows:

Personnel Costs $1.5M (2.1%) favourable due to FTE 255 below budget – the FTE variance is spread widely with vacancies across all categories other than Nursing which was 13 above budget. The favourable variance is partly offset by $0.5M unfavourable Outsourced Personnel costs for contract Support and Administration staff covering vacancies.

Clinical Supplies $0.5M (2.5%) unfavourable – this variance is primarily due to the timing of planned healthAlliance procurement savings which have been phased into the budget for the full year but actual savings are expected to be weighted towards the second half of the year.

Infrastructure and Non Clinical Supplies $1.1M (7.4%) unfavourable, comprising three key variances – higher costs of goods sold for retail pharmacy $0.3M (offset by additional revenue), provision for obligations arising from sector projects $0.5M, and delay in capitalisation of operating costs for IT projects $0.2M unfavourable (timing variance only).

FTE Total FTE (including outsourced) for July were 8,355 which was 104 FTE below budget. After adjusting for the impact of Food Services staff transferring out this was an increase of 45 from the previous month – 24 of this increase is in RMOs and is a reflection of June FTE being lower than normal, with July FTE still within budget.

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2015/16 Savings Programme

The key priorities established since 2013/14 continue into 2015/16 as part of the business transformation framework to deliver services in a cost efficient and productive manner. The savings programme is in line with our strategic plan to live within our means and achieve a break even bottom line.

Key Strategies

In 15/16 the required savings to be found to close the budget gap is $26.9M mainly within the Provider Arm services. The savings are identified as being one of three key strategies; revenue growth, model of service delivery changes and cost containment.

Table 1: 15/16 Savings Target ($000s)

Cause of Change Revenue growth Model of service delivery changes Cost Containment Grand Total

Budget as usual $943 $500 $13,953 $15,396

Business transformation $1,535 $1,054 $8,883 $11,472

Grand Total $2,478 $1,554 $22,836 $26,867

Month Update

For the month of July 2015 $1.3M of savings were reported against a budget of $1.6M, resulting in an unfavourable variance of $332k. The unfavourable position is mainly related to timing around the clinical supplies procurement savings and reporting.

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Table 2: Savings Programme - July 15 YTD ($000s)

Strategy Main Category

15/16 Savings Target

July YTD Act

July YTD Bud YTD Var

Revenue growth Government & Crown Agency $1,791 $38 $105 -$67

Non-Government & Crown Agency $363 $55 $11 $44

Outsourced Services $200 $25 $16 $9

Personnel $24 $2 $2 $0

Internal Allocation $100 $0 $0 $0

Revenue growth Total $2,478 $120 $134 -$14

Model of service Clinical Supplies -$250 $0 -$21 $21

Non-Government & Crown Agency $150 $17 $0 $17

Outsourced Services $680 $0 $50 -$50

Personnel $680 $28 $28 $1

Effectiveness improvement $294 $0 $0 $0

Model of service delivery changes Total $1,554 $45 $57 -$12

Cost Containment Clinical Supplies $11,187 $116 $485 -$369

Infrastructure & Non-Clinical $196 $54 $6 $48

Internal Alloc’n DHB Provider $10 $1 $1 $0

Outsourced Services $181 $0 $7 -$7

Personnel $11,261 $1,006 $984 $23

Cost Containment Total $22,836 $1,177 $1,483 -$306

Grand Total $26,867 $1,341 $1,673 -$332

Category of Savings The main categories of savings are personnel $1,036k (77%), Clinical Supplies of $116k (9%), Revenue $110k (8%) and other $80k (6%).

64


Key Points by Service Adult Medical – Unfavourable variance $16k U.

The service achieved savings against the majority of its initiatives with a minor unfavourable variance of $16k U. This is mainly due to the under-achievement of pharmacy savings ($17k U).

Adult Community & LTC – Favourable variance $5kF.

The service exceeded its first month's target by $5k F mainly attributed to personnel savings and in particular managing staff leave, review of medical allowances and skill mix reviews.

Adult Surgical – Unfavourable variance $23k U.

The service achieved savings against the majority of its cost containment initiatives with a minor unfavourable variance of $23k U. This is mainly related to implants ($10k U) and other opex costs ($12k U).

Women’s – Unfavourable variance $1k U.

The service exceeded savings under its model of service delivery strategy and this offset under-achievement in revenue growth and other cost containment strategies.

Children’s – Achieved budget savings of $296k.

The service achieved its budget savings of $296k and this is mainly attributed to personnel cost containment with additional savings in FTE management savings ($67k F). This has offset the revenue initiative ($67k U).

Cardiac Services – Favourable variance $3k F.

The Service exceeded the July target by $3k F. This is driven by additional savings in production planning.

Clinical Support – Unfavourable variance $27k U.

The service experienced timing delays in the reduction in clinical supplies ($42k U) and outsourcing ($29k U), but was able to mitigate some of the shortfall with additional unbudgeted income ($52k F).

Non Clinical Support – Favourable variance $54k F.

The service exceeded its target by $54k F, mainly driven by hotel services.

Cancer & Blood – Unfavourable variance of $86kU.

The service is unfavourable against budget ($86k U) due to employee ($57k U) and pharmaceutical ($21k U). There are some timing factors which will correct the shortfall in the months ahead.

Mental Health – achieved YTD Budget savings of $164k.

The service achieved its target savings of $164k mainly from personnel costs (staff turnover assumptions).

healthAlliance – Unfavourable variance of $240k U.

The unfavourable variance is due to timing of planned procurement savings which have been phased into the budget for the full year but actual savings are expected to be weighted towards the second half of the year.

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Table 3: Savings by Service – July 15 YTD ($000s)

Service Strategy

Total 15/16 Savings Target YTD Actual

YTD Budget YTD Var

Adult Community &LTC Revenue growth $24 $2 $2 $0

Cost Containment $971 $82 $77 $5

Adult Community &LTC Total $995 $84 $79 $5

Adult Medical Cost Containment $3,069 $307 $324 -$16

Adult Medical Total $3,069 $307 $324 -$16

Surgical Revenue growth $100 $0 $0 $0

Cost Containment $2,211 $61 $84 -$23

Surgical Total $2,311 $61 $84 -$23

Womens Revenue growth $687 $38 $46 -$8

Model of service delivery $50 $17 $0 $17

Cost Containment $50 -$10 $0 -$10

Womens Total $787 $45 $46 -$1

Child Health Revenue growth $800 $0 $67 -$67

Cost Containment $2,735 $296 $229 $67

Child Health Total $3,535 $296 $296 $0

Cardiac Revenue growth $600 $25 $16 $9

Model of service delivery $530 $0 $0 $0

Cost Containment $507 $19 $25 -$6

Cardiac Total $1,637 $44 $41 $3

Clinical Support Revenue growth $200 $52 $0 $52

Model of service delivery $680 $28 $57 -$29

Cost Containment $2,643 $145 $195 -$50

Clinical Support Total $3,523 $225 $252 -$27

Non Clinical Support Revenue growth $67 $3 $3 $0


Non Clinical Support Total $626 $59 $5 $54

Perioperative Model of service delivery $294 $0 $0 $0


Perioperative Total $1,265 $0 $0 $0

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Service Strategy

Total 15/16 Savings Target YTD Actual

YTD Budget YTD Var

Cancer & Blood Cost Containment $1,634 $51 $137 -$86

Cancer & Blood Total $1,634 $51 $137 -$86

Mental Health Cost Containment $1,505 $164 $164 $0

Mental Health Total $1,505 $164 $164 $0

healthAlliance Cost Containment $5,980 $5 $245 -$240

healthAlliance Total $5,980 $5 $245 -$240

Grand Total $26,867 $1,341 $1,673 -$332

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Volume Performance

1) Combined DRG and Non-DRG Activity (All DHBs)

July 2015 Year to Date

$000s $000s

Directorate Service Cont Act Var Prog % Cont Act Var Prog %

A+ Links, HOP, Rehab 4,303 4,213 (90) 97.9% 4,303 4,213 (90) 97.9%

Ambulatory Services 2,120 1,989 (131) 93.8% 2,120 1,989 (131) 93.8%

6,423 6,202 (221) 96.6% 6,423 6,202 (221) 96.6%

AED, APU, DCCM, Air

Ambulance2,003 2,054 51 102.6% 2,003 2,054 51 102.6%

Gen Med, Gastro, Resp,

Neuro, ID, Renal10,878 11,655 777 107.1% 10,878 11,655 777 107.1%

12,881 13,709 828 106.4% 12,881 13,709 828 106.4%

Surgical ServicesGen Surg, Trauma,

Ophth, GCC, PAS7,945 8,069 124 101.6% 7,945 8,069 124 101.6%

N Surg, Oral, ORL,

Transpl, Uro9,009 8,801 (208) 97.7% 9,009 8,801 (208) 97.7%

Orthopaedics Adult 4,216 3,951 (265) 93.7% 4,216 3,951 (265) 93.7%

21,170 20,821 (349) 98.3% 21,170 20,821 (349) 98.3%

8,443 7,905 (538) 93.6% 8,443 7,905 (538) 93.6%

11,441 10,866 (575) 95.0% 11,441 10,866 (575) 95.0%

Child Health & Disability 903 884 (19) 97.9% 903 884 (19) 97.9%

Medical & Community 7,454 6,391 (1,062) 85.7% 7,454 6,391 (1,062) 85.7%

Paediatric Cardiac & ICU 3,708 3,569 (139) 96.3% 3,708 3,569 (139) 96.3%

Surgical & Community 4,647 4,168 (479) 89.7% 4,647 4,168 (479) 89.7%

16,711 15,012 (1,699) 89.8% 16,711 15,012 (1,699) 89.8%

3,337 3,293 (45) 98.7% 3,337 3,293 (45) 98.7%

6,794 6,794 0 100.0% 6,794 6,794 0 100.0%

128 128 0 100.0% 128 128 0 100.0%

101 101 0 100.0% 101 101 0 100.0%

Genetics 287 352 65 122.7% 287 352 65 122.7%

Women's Health 7,021 6,605 (416) 94.1% 7,021 6,605 (416) 94.1%

7,308 6,957 (351) 95.2% 7,308 6,957 (351) 95.2%

94,738 91,788 (2,951) 96.9% 94,738 91,788 (2,951) 96.9%

Women's Health


DHB Funds

Public Health Services

Support Services

Surgical Services Total

Cancer & Blood Services

Cardiac Services

Children's Health

Children's Health Total

Adult Community & LTC Total

Grand Total

Women's Health Total

Adult Medical

Services

Adult Medical Services Total

Adult Community

& LTC

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2) Total Discharges for the YTD July 2015

Directorate Service 2015 2016 Last YTD This YTD % Change Last YTD This YTD Last YTD This YTD

A+ Links, HOP, Rehab 0 0 221 209 (5.4%) 0 0 0.0% 0.0%

Ambulatory Services 157 135 187 137 (26.7%) 170 117 90.9% 85.4%

Adult Community & LTC

Total 157 135 408 346 (15.2%) 170 117 41.7% 33.8%

AED, APU, DCCM, Air

Ambulance 964 1,065 965 1,066 10.5% 715 762 74.1% 71.5%


Neuro, ID, Renal 1,639 1,772 1,656 1,787 7.9% 262 288 15.8% 16.1%

Adult Medical Services

Total 2,603 2,837 2,621 2,853 8.9% 977 1,050 37.3% 36.8%

Cancer & Blood Total 401 442 447 464 3.8% 198 232 44.3% 50.0%

Cardiac Services Total 675 731 701 746 6.4% 188 180 26.8% 24.1%

Medical & Community 1,406 1,321 1,571 1,443 (8.1%) 884 788 56.3% 54.6%

Paediatric Cardiac & 193 214 222 230 3.6% 54 58 24.3% 25.2%

Surgical & Community 794 744 852 774 (9.2%) 413 355 48.5% 45.9%

Children's Health Total 2,393 2,279 2,645 2,447 (7.5%) 1,351 1,201 51.1% 49.1%

Gen Surg, Trauma,

Ophth, GCC, PAS 1,309 1,449 1,520 1,551 2.0% 877 807 57.7% 52.0%

N Surg, Oral, ORL,

Transpl, Uro 916 980 1,004 1,038 3.4% 427 408 42.5% 39.3%

Orthopaedics Adult 408 385 447 408 (8.7%) 83 74 18.6% 18.1%

Surgical Services Total 2,633 2,815 2,971 2,997 0.9% 1,387 1,289 46.7% 43.0%

Women's Health Total 1,808 1,777 1,869 1,856 (0.7%) 749 695 40.1% 37.4%

Grand Total 10,670 11,015 11,662 11,709 0.4% 5,020 4,764 43.0% 40.7%

Same Day as % of all

discharges

Children's Health

Surgical Services

Adult Medical Services


Cases Subject to WIES

Payment

Inpatient

All Discharges Same Day discharges

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69


3) Caseweight Activity for the YTD July 2015 (All DHBs)

Directorate Service Con Act Var Con Act Var Prog % Con Act Var Con Act Var Prog % Con Act Var Con Act Var Prog %

78 73 (6) 372 344 (28) 92.6% 9 3 (6) 43 16 (28) 36.0% 87 76 (12) 415 360 (55) 86.7%

AED, APU, DCCM,

Air Ambulance274 303 30 1,300 1,441 141 110.8% 0 0 0 0 0 0 0.0% 274 303 30 1,300 1,441 141 110.8%

Gen Med, Gastro,

Resp, Neuro, ID,

Renal

1,510 1,637 127 7,176 7,778 602 108.4% 0 0 0 0 0 0 0.0% 1,510 1,637 127 7,176 7,778 602 108.4%

1,784 1,940 156 8,476 9,219 743 108.8% 0 0 0 0 0 0 0.0% 1,784 1,940 156 8,476 9,219 743 108.8%

Gen Surg, Trauma,

Ophth, GCC, PAS690 717 27 3,277 3,405 128 103.9% 605 593 (12) 2,875 2,818 (57) 98.0% 1,295 1,310 15 6,151 6,223 72 101.2%

N Surg, Oral, ORL,

Transpl, Uro710 769 59 3,373 3,653 280 108.3% 629 559 (69) 2,987 2,658 (329) 89.0% 1,339 1,328 (10) 6,360 6,310 (50) 99.2%

Orthopaedics

Adult448 432 (16) 2,131 2,053 (78) 96.4% 335 301 (34) 1,592 1,430 (162) 89.8% 783 733 (50) 3,723 3,484 (239) 93.6%

1,848 1,917 69 8,781 9,111 330 103.8% 1,569 1,453 (115) 7,453 6,906 (547) 92.7% 3,417 3,371 (46) 16,234 16,017 (217) 98.7%

533 502 (31) 2,532 2,385 (146) 94.2% 0 0 0 0 0 0 0.0% 533 502 (31) 2,532 2,385 (146) 94.2%

1,359 1,221 (138) 6,456 5,801 (655) 89.9% 847 872 25 4,024 4,144 120 103.0% 2,206 2,093 (113) 10,480 9,945 (535) 94.9%

Medical &

Community1,065 900 (165) 5,059 4,277 (782) 84.5% 0 0 0 0 0 0 0.0% 1,065 900 (165) 5,059 4,277 (782) 84.5%

Paediatric Cardiac

& ICU459 464 5 2,181 2,205 24 101.1% 204 234 30 971 1,113 142 114.6% 663 698 35 3,152 3,318 166 105.3%

Surgical &

Community437 462 25 2,078 2,195 117 105.6% 406 300 (106) 1,927 1,426 (502) 74.0% 843 762 (81) 4,005 3,620 (385) 90.4%

1,961 1,826 (135) 9,318 8,676 (641) 93.1% 610 534 (76) 2,898 2,538 (360) 87.6% 2,571 2,360 (211) 12,216 11,215 (1,002) 91.8%

861 843 (18) 4,092 4,006 (86) 97.9% 162 139 (22) 768 663 (105) 86.3% 1,023 983 (40) 4,860 4,669 (192) 96.1%

8,424 8,322 (102) 40,027 39,544 (483) 98.8% 3,196 3,002 (194) 15,186 14,266 (920) 93.9% 11,620 11,325 (295) 55,213 53,810 (1,403) 97.5%

Excludes caseweight Provision

$000s

Adult

Medical

Services



Surgical

Services

$000s Case Weighted Volume

Women's Health Service

Grand Total

Case Weighted Volume $000s Case Weighted Volume


Cancer & Blood Service

Cardiac Service

Children's

Health


Acute Elective Total

70


Acute The year has got off to a slightly busier start than the previous year, with throughput, average WIES and surgical throughput being up on last year. Acute discharges are up 2.3% on the previous year which had not seen any growth on 2013/14.

Medical discharges are up 3% on the same month last year, as is average WIES, suggesting that the WIES is roughly the same. ALOS is slightly higher than last July.

Surgical discharges are also up 3%, but average WIES is looks only marginally higher than last year. Surgical WIES has generally stayed the same reflecting a consistent case mix over time. ALOS is lower than the same month last year.

There has been a slight drop off in birth numbers for the month.

Elective Notwithstanding the increase in acute discharges, elective activity is up by 3% on the same period last year with higher WIES cases. This may not continue with recent cancellations in August due to the winter influx of patients.

5.3

71


4) Non-DRG Activity (ALL DHBs)

July 2015 Year to Date

$000s $000s

Directorate Service Cont Act Var Prog % Cont Act Var Prog %

A+ Links, HOP, Rehab 4,303 4,213 (90) 97.9% 4,303 4,213 (90) 97.9%

Ambulatory Services 1,705 1,629 (76) 95.5% 1,705 1,629 (76) 95.5%

6,008 5,842 (166) 97.2% 6,008 5,842 (166) 97.2%

AED, APU, DCCM, Air

Ambulance703 613 (90) 87.3% 703 613 (90) 87.3%


Neuro, ID, Renal3,702 3,876 174 104.7% 3,702 3,876 174 104.7%

4,405 4,490 85 101.9% 4,405 4,490 85 101.9%

Surgical ServicesGen Surg, Trauma,

Ophth, GCC, PAS1,793 1,846 53 102.9% 1,793 1,846 53 102.9%

N Surg, Oral, ORL,

Transpl, Uro2,649 2,490 (159) 94.0% 2,649 2,490 (159) 94.0%

Orthopaedics Adult 493 467 (26) 94.7% 493 467 (26) 94.7%

4,936 4,804 (132) 97.3% 4,936 4,804 (132) 97.3%

5,911 5,520 (392) 93.4% 5,911 5,520 (392) 93.4%

961 921 (40) 95.8% 961 921 (40) 95.8%

Child Health & Disability 903 884 (19) 97.9% 903 884 (19) 97.9%

Medical & Community 2,395 2,115 (280) 88.3% 2,395 2,115 (280) 88.3%

Paediatric Cardiac & ICU 556 252 (304) 45.2% 556 252 (304) 45.2%

Surgical & Community 642 548 (94) 85.3% 642 548 (94) 85.3%

4,495 3,797 (698) 84.5% 4,495 3,797 (698) 84.5%

3,337 3,293 (45) 98.7% 3,337 3,293 (45) 98.7%

6,794 6,794 0 100.0% 6,794 6,794 0 100.0%

128 128 0 100.0% 128 128 0 100.0%

101 101 0 100.0% 101 101 0 100.0%

Genetics 287 352 65 122.7% 287 352 65 122.7%

Women's Health 2,161 1,936 (224) 89.6% 2,161 1,936 (224) 89.6%

2,447 2,288 (159) 93.5% 2,447 2,288 (159) 93.5%

39,525 37,978 (1,547) 96.1% 39,525 37,978 (1,547) 96.1%


DHB Funds


Adult Community

& LTC

Adult Community & LTC Total

Adult Medical

Services



Children's Health

Cardiac Services

Cancer & Blood Service

Women's Health Total

Public Health Service

Support Services

Women's Health

Grand Total

Cancer & Blood Services are not seeing the expected growth even with the faster cancer treatment

protocols in place. While the service is doing slightly more than last year, the contract has been set at a

5% growth rate each year which does not appear to be happening.

Paediatric outpatient activity is unusually low, particularly in Paediatric Cardiac which has seen a drop in

both FSA and follow up activity. Nurse clinics and general paediatric activity also seem unusually low

and should be reviewed.

72


6 Directorate Updates

Recommendation

That the Directorate Updates report, which is comprised of the following sections, be received:

6.1 Mental Health Directorate

6.2 Women’s Health Directorate

6.3 Child Health Directorate

6.4 Surgical Services Directorate

6.5 Perioperative Services Directorate

6.6 Cardiovascular Directorate

6.7 Adult Medical Directorate

6.8 Cancer and Blood Directorate

6.9 Clinical Support Services

6.10 Non-Clinical Support Services

6.11 Community and Long Term Conditions Directorate

Endorsed by: Joanne Gibbs, (Director Provider Services)

6

73


Mental Health Directorate

Speaker: Clive Bensemann, Director

Service Overview

This Directorate provides specialist community and inpatient mental health services to Auckland

residents. Our team provide a range of services at various levels: sub‐regional (adult inpatient

rehabilitation & community psychotherapy), regional (youth forensics) and supra‐regional (child and

youth acute inpatient & eating disorders). The Mental Health Directorate is led by Director: Dr Clive

Bensemann, with General Manager: Maria West, Director of Nursing: Anna Schofield and Director of

Allied Health: Mike Butcher.

Scorecard

Mental HealthJul-15 Measure Target

Medication Errors with major harm 0 0 0

Medication Errors without major harm 21 0 17

Falls with major harm 2 0 1

Nosocomial pressure injury point prevalence (% of in‐patients) 0.0% % 0.0%

Nosocomial pressure injury point prevalence ‐ 12 month average (% of in‐patients) 0.0% % 0.0%

Number of reported adverse events causing harm (SAC 1&2) 5 0 0

Seclusion. All inpatient services ‐ episodes of seclusion 1 <=7 0

Restraint. All services ‐ incidents of restraint 94 <=86 72

Mental Health Provider Arm Services: SAC1&2 Suicides 1 0

7 day Follow Up post discharge 100.0% 95% 97.4%

Mental Health ‐ 28 Day Readmission Rate (KPI Discharges) to Te Whetu Tawera R/U 10% 17.0%

Mental Health Average LOS (KPI Discharges) ‐ Te Whetu Tawera 35.6 <=21 26.9

Mental Health Average LOS (All Discharges) ‐ Child & Family Unit 9.0 <=15 10.2

Mental Health Average LOS (All Discharges) ‐ Fraser McDonald Unit 41.0 <=35 41.1

Waiting Times. Provider arm only: 0‐19Y ‐ 3W Target 83.3% 80% 83.3%




Waiting Times. Provider arm only: 65Y+ ‐ 3W Target 74.3% 80% 74.3%

Waiting Times. Provider arm only: 65Y+ ‐ 8W Target 88.7% 95% 88.7%

Actual Prev Period

Increased Patient Safety

Better Quality Care

6.1

74


Scorecard Commentary

Health Targets

95% Hospitalised smokers offered advice and support to quit

100% of hospitalised smokers have been offered advice and support to quit in the reporting period.


Buchanan Rehabilitation Centre: Medication Errors

Eight errors are attributed to BRC. The transition from blister packed medication to IPD and

administration has been completed. Three of the errors are related to blister packs for clients on

leave from the Unit and one error is related to an incident in general practice. Four errors are

relating to administration and charting. None of the medication errors resulted in harm. The Acting

Nurse Director is supporting the Unit in the transition and is closely monitoring practice and

following up with all incidents of administration error.

% Hospitalised smokers offered advice and support to quit 100.0% 95% 100.0%

% Long‐term clients with relapse prevention plans in last 12 months (6 monthly) * 91.4% 95% 95.0%

Mental Health access rate ‐ Maori 0‐19Y 4.98% % 5.12%

Mental Health access rate ‐ Maori 20‐64Y 10.36% % 10.52%

Mental Health access rate ‐ Maori 65Y+ 3.52% % 3.77%

Mental Health access rate ‐ Total 0‐19Y 2.77% 3% 2.91%

Mental Health access rate ‐ Total 20‐64Y 3.85% % 3.96%

Mental Health access rate ‐ Total 65Y+ 3.15% % 3.34%

Improved Health Status

Excess annual leave dollars ($M) $0.17 0 $0.18

% Staff with excess annual leave > 1 year 27.0% 0% 27.2%

% Staff with excess annual leave > 2 years 6.5% 0% 6.1%

% Staff with excess annual leave and insufficient plan to clear excess by the end of

financial year 100.0% 0% 97.9%

% Pre‐employment Screenings (PES) cleared before the start date 100.0% 100% 91.7%

Sick leave hours taken as a percentage of total hours worked 4.1% 3.4% 4.1%

% Voluntary turnover (annually) 10.5% 10% 9.9%

% Voluntary turnover <1 year tenure 2.6% 6% 2.7%

Amber =

R/U =

Engaged W

orkforce

Variance from target not significant enough to report as non‐compliant. This includes percentages/rates within 1% of target, or volumes

within 1 value from target. Not applicable for Engaged Workforce KRA.

Result unavailable.

Mental Health ‐ 28 Day Readmission Rate (KPI Discharges) to Te Whetu TaweraA 35 day period is required to accurately report all acute re‐admissions for the previous month's discharges. (35 days = 28 days post

discharge as per MoH measures plus 5 working days to allow for coding).

Note: * reported 6 monthly, actual value for period ending June 2015.

75


Restraint

This high monthly figure was predominantly driven by two clients (50% of all incidents). Both of

these patients had high and complex needs and have now recovered to the point of discharge from

inpatient care to the community services.

Adverse Events SAC 1&2

There was one community suicide (SAC2) and five other SAC1 & 2 events reported in this

period. Two falls with major harm, one ingestion of foreign body, two assaults (one SAC1, one

SAC2). All are being investigated and managed appropriately.

Better Quality Care

Average Length of Stay

This is high for Te Whetu Tawera and Fraser McDonald Unit this month.

Te Whetu Tawera: discharges for July included one client with an LoS of 148 days, and 3 more

between 90‐100days. Historically there has been 15‐20% of all discharges with a LOS of >35 days.

Discharges in July comprised 30% >35 days, which is the highest in the last 8 months. A renewed

focus will be taken on review processes for this group to understand what the particular issues are.

FMU Length of Stay: LOS for FMU is a locally set target based on average activity measured over

several years. It has not yet been nationally benchmarked. FMU has had a number of significantly

treatment resistant patients on clozapine or anti‐depressant trials who have required inpatient

monitoring. The availability, suitability and affordability of discharge accommodation remains an

issue and this can increase LOS for some people.

Mental Health for Older People Service: Waiting Times

Both the 3 week and 8 week target have been impacted by the unplanned leave of the full time FMU

SMO whose absence has been covered by the Community Team Consultants. This has reduced

clinician availability to do the usual number of new community assessments. Interim arrangements

are now in place providing full cover to inpatient and community services. Work continues

reviewing data and the triage process with the aim of improving efficiency and throughput of

referral management.


Relapse Planning: Note: This is updated and report six monthly to the MoH. The target was not

achieved in the 6m period to end June 2015. This has fallen below target 95%. Of the total 8.6% of

eligible patients without an 'up to date' relapse prevention plan >80% already have a plan but this

requires review. Services are emphasising the importance of reviewing existing plans.

Access: Data used by MoH for this report was incomplete for Auckland DHB due to compliance

issues with PRIMHD Reporting (now resolved). This means that the gap between actual figures and

targets would be less than these figures suggest.

6.1

76


Family Violence Screening

17 Family Violence/Care & Protection training days have been delivered to 250 MH staff in adult

community & In Patient services across the MH Directorate. 24 Family Safety Facilitators are in place

across services to provide team level resource in FV & CP interventions.

Engaged Workforce

Focused work continues on leave plans for those with > 2 years excess annual leave.

Strategic Initiatives

Deliverable/Action Status

Ensure that people are engaged at the right level of service at the right time (using resources effectively/links to stepped care)

Monitor consult liaison activity from secondary care to primary care, schools and other public agencies

Continue to implement the long term restraint/seclusion minimisation strategy

Implement actions from the Child and Youth MH&A Direction with interagency partners

Implement enhancements to Maternal Mental Health continuum

Improve social inclusion through increased access to employment

Regional MoC Eating Disorders Off Track

Contribute to development of Regional Youth Forensic pathway and MoC

Increased Patient Safety Better Quality Care Economic Sustainability Improved Health Status Engaged Workforce

Key achievements in the month Real Time Feedback

The Real Time Feedback system (Consumer feedback) is in the final stages of preparation at Kari

Centre – CAMHS. The tablet devices will be deployed into a number of specific clinical pathways to

gather service user and family feedback. The go live date was 1st September.

Areas off track and remedial plans Regional Eating Disorders Model of Care

The funder has developed a paper for the Board.

Key issues and initiatives identified in coming months

Child and Youth MH&A Direction with interagency partners

Planning is underway for the youth focus “Look Up” forum in November 2015 –.Child & Youth MH

services will participate and attend.

77


TWT Co‐Design Project

Key themes and priorities have been identified from the TWT Service User, Family and Staff

experiences. Plans have been developed to implement short, medium and long term improvements

within the TWT physical and therapeutic environment.

Financial Results

Comments on Major Financial Variances

The result for the month is a surplus of $541k against a budgeted loss of $13k, a favorable variance

of $554k.

The main driver of the result is the favorable personnel costs of $500k (including outsourced

Personnel) due to high FTE vacancies and high budget phasing in July. Outsourced Clinical Service

costs are favourable, due to a timing issue around respite invoices.

Note – the Medical FTE result of 12.9 FTE U reflects an 8.5 FTE error which will reverse in August.

The balance is the 4.4 FTE provision which was part of the original estimate of the medical

component of the overall budgeted vacancy factor, and is offset by actual vacancies in other

employee categories.

STATEMENT OF FINANCIAL PERFORMANCEMental Health & Addictions Reporting Date Jul-15

($000s) MONTH YEAR TO DATE


REVENUE

Government and Crown Agency 59 70 (10) U 59 70 (10) U

Funder to Provider Revenue 8,613 8,613 0 F 8,613 8,613 0 F

Other Income 40 29 11 F 40 29 11 F

Total Revenue 8,713 8,712 1 F 8,713 8,712 1 F

EXPENDITUREPersonnel

Personnel Costs 5,916 6,414 498 F 5,916 6,414 498 F

Outsourced Personnel 80 82 2 F 80 82 2 F

Outsourced Clinical Services 76 129 53 F 76 129 53 F

Clinical Supplies 70 65 (5) U 70 65 (5) U

Infrastructure & Non-Clinical Supplies 315 300 (15) U 315 300 (15) U

Total Expenditure 6,458 6,991 533 F 6,458 6,991 533 F

Contribution 2,255 1,721 534 F 2,255 1,721 534 F

Allocations 1,714 1,734 20 F 1,714 1,734 20 F

NET RESULT 541 (13) 554 F 541 (13) 554 F

Paid FTEMONTH (FTE) YEAR TO DATE ( FTE)


Medical 101.4 88.5 (12.9) U 101.4 88.5 (12.9) U

Nursing 294.7 301.1 6.3 F 294.7 301.1 6.3 F

Allied Health 254.0 274.6 20.7 F 254.0 274.6 20.7 F

Support 4.6 5.0 0.4 F 4.6 5.0 0.4 F

Management/Administration 57.7 61.6 3.9 F 57.7 61.6 3.9 F

Total excluding outsourced FTEs 712.3 730.7 18.4 F 712.3 730.7 18.4 F

Total :Outsourced Services 10.0 7.1 (2.9) U 10.0 7.1 (2.9) U

Total including outsourced FTEs 722.3 737.8 15.5 F 722.3 737.8 15.5 F

6.1

78


The service is actively recruiting and there has been an improvement in clinical FTE over the last 6

months, however vacancies are expected to be ongoing for short term with the mixed factors of

recruitment difficulties and resignations. We are forecasting to reach Budget FTE by year‐end.

Mental Health is favourable to budget for the month. We are working to achieve a full workforce

which will enable a reduction in excess annual leave and cost per FTE.

79


Women's Health Directorate

Speaker: Dr Sue Fleming, Director

Service Overview

The Women’s Health portfolio includes all Obstetrics and Gynaecology services plus Fertility and

Termination services. The team is contracted to provide primary, secondary and tertiary services.

The Maternal Fetal Medicine group provide quaternary services and are contracted to lead the

National Maternal Fetal Medicine network.

The Northern Hub of the National Genetic service is also under the umbrella of the Women’s

Healthcare Service Group.

Scorecard

Women's HealthJul-15 Measure Target







HT2 Elective discharges cumulative variance from target 0.98 >=1 0.93

(ESPI‐1) % Services acknowledging 90% of FSA referrals 100.0% 100.0%

(ESPI‐2) Patients waiting longer than 4 months for their FSA 0.00% 0% 0.00%

(ESPI‐5) Patients given a commitment to treatment but not treated within 4 months 0.00% 0% 0.00%

% DNA rate for outpatient appointments ‐ All Ethnicities 8.6% 9% 8.0%

% DNA rate for outpatient appointments ‐ Maori 13.0% 9% 14.0%

% DNA rate for outpatient appointments ‐ Pacific 14.0% 9% 17.0%

Elective day of surgery admission (DOSA) rate 82.2% % 85.0%

% Day Surgery Rate 50.3% % 51.1%

Inhouse Elective WIES through theatre ‐ per day 6.67 >=4.5 9.00

Number of patients discharged to Birthcare 281 TBC 235

Number of CBU outliers 2 0 1

% Very good and excellent ratings for overall inpatient experience R/U 90% 80.9%

% Very good and excellent ratings for overall outpatient experience R/U 90% 82.5%

Number of complaints received 1 TBC 7

28 Day Readmission Rate ‐ Total R/U TBC 4.9%

Average Length of Stay for WIES funded discharges (days) ‐ Acute 2.20 >=2 2.03

Average Length of Stay for WIES funded discharges (days) ‐ Elective 1.47 >=1.25 1.23

Actual Prev Period


Better Quality Care

6.2

80



Health Targets

Our elective discharge target is slightly behind target, this is in part due to SMO leave during this

month.


We have met all our targets for this month except for 3 minor medication errors that did not result

in patient harm

Better Quality Care

We continue to remain compliant with our ESPI targets.

Our high Maori and Pacific DNA rates remain a concern. We are planning to progress a broad piece

of work together with our regional partner, Waitemata DHB, to look at ways in which we can deliver

our services in a way that better aligns to the needs of these priority populations. We recognise the

need to change our current models of care and to provide more community based care where

possible.


Breastfeeding rate on discharge excluding NICU admissions R/U % 76.4%

Cervical Screening Rate (Quarterly) * 78.7% % 78.9%

NCSP DNA rates 13.0% 9% 5.0%







Number of Employees who have taken greater than 80 hours sick leave in the past 12

months R/U

118



Engaged W

orkforce

Improved Health

Status

Amber =

R/U =

Results unavailable until after the 17th day of the month.

Number of Employees who have taken greater than 80 hours sick leave in the past 12 months

Breastfeeding rate on discharge excluding NICU admissions

Results unavailable until after the 20th day of the next month.

A 35 day period is required to accurately report all acute re‐admissions for the previous month's discharges. (35 days = 28 days post


Note: * reported quarterly, actual value for period ending March 2015.



Result unavailable.

% Very good and excellent ratings for overall inpatient experience

% Very good and excellent ratings for overall outpatient experience

These measures are based on retrospective survey data, i .e. completed responses for patients discharged or treated the previous month.

28 Day Readmission Rate ‐ Total

81


Work has commenced in our high risk clinics to reduce the time women have to spend attending a

clinic appointment. There has been long waits to be seen previously in this service and a green belt

project has been implemented to enable a more efficient model of care that provides more timely

care.


The DNA rate for the National Cervical screening programme has increased however as this service is

provided in the community, this is not within our control to manage or to clearly understand the

reason why there has been an increase in DNAs for this month.

Engaged Workforce

In line with our leave planning project our Charge Nurses are working with all of their direct reports

to develop leave plans and to track this within our newly developed leave planning tool. We have

identified that there is a small number of staff who have a high excess leave balance, but do not

have the capacity to take their leave due to part time staff requiring many months on leave to

reduce their balance. We are currently working with HR to review how this can be appropriately

managed whilst also sustaining our service demands.


Women’s Health strategic initiatives as outlined below continue on track.

The Women’s Health Collaboration work is in the process of developing a regional maternity

strategic document following feedback from the recently held Board workshop.

We continue to see excellent results with the WAU acute flow project and have had no 6 hour

breeches in AED as a result of these changes.


Maternity Strategy establishes clear regional pathways for pregnant women

Regional SGA guideline completed

Regional induction of labour pathway completed

Diabetes pathway‐under development

On track

Women have appropriate access to primary birthing options (tied to Maternity Collaboration)

Normal birthing pathway‐under development

Increasing primary birthing options‐ under development

Progressing new time frames to be established

Secondary maternity services are delivered in an optimal and sustainable manner (tied to Maternity Collaboration)

Progressing

new time frames to be established

6.2

82


Maternity services are better aligned meet the needs of pregnant women, including vulnerable women (tied to Maternity Collaboration)

Progressing

new time frames to be established

Recovery after Obstetric Surgery ( EROS) On track

Referral pathways for women with common gynaecology problems are agreed.

Abnormal uterine bleeding‐ completed

Urogynaecology pathway‐ completed

Completed

Women’s Health Assessment Unit acute flow project

Redesign‐completed

Evaluation and refinement‐underway

On track

Development of Women’s Health Management Operating System and Clinical Governance framework aligned with new leadership structure

On track

Completed for L2

On track for L3

Support staff and monitor staffing

Defining models of care‐ completed

Consultation with unions‐ completed

Reviewing leave process –underway

On track

Faster cancer pathways development plan

Stage 1‐ mapping

Stage 2‐ implementation

Stage 1 completed

Stage 2

commenced

Epsom Day Unit redevelopment

Redesigning model of care‐ underway

Rebranding of EDU‐ conceptual stage

Facilities redevelopment‐ early stage planning

On track


Key achievements in the month

Favourable monthly financial position

Cultural Diversity training completed for our senior leadership team

83


Commenced management strengthening programme for all our level 4 leaders, to allow for on‐

going mentorship

SMO after‐ hours remuneration review undertaken and in negotiation

Completion of Annual Clinical Report document and published on the National Women’s website

Areas off track and remedial plans

Midwifery and Nursing FTE remains over budget, the service continues to be challenged to maintain

staffing levels within budgeted FTE. With the development of more robust ward based scorecards

and daily MOS meetings as well as the implementation of Trendcare in early September; we

anticipate this information will inform the true drivers of our variance.


Annual Clinical report presentation day on 21 August 2015

Directorate Annual Planning afternoon on 24 August 205

Maternity Services Workshop with HAC on 26 August 2015

Risk register update

Availability of caesarean section theatre after hours:

In 2013 during a RANZCOG training audit of Women’s Health the review committee noted that we

did not meet standards with respect to availability of after‐hours theatre access for caesarean

section. The standard used by RANZCOG was: “1 theatre per 4000 deliveries or part thereof be

available at all times and staffed to deal with obstetric emergencies, in line with international

standards.” With around 7500 births occurring each year this is a standard that was not being met

and this risk was therefore captured on the risk register.

It is worth noting the following:

Although there is only one designated WH after hour’s theatre the service has shared access

to an acute theatre on Level 8

The standard adopted by RANZCOG is not evidenced but adopted from NHS guidelines (also

not evidenced)

The physical theatre facilities are available for after‐hours use they are not staffed

When an additional theatre is required theatre staff and surgical staff come in from home

Since the risk was escalated to the risk register considerable work has been done to assess the degree of risk access to one fully staffed theatre possess to patient care.

A retrospective audit of 120 cases of category 1 caesarean section from 2013 was performed. The audit criteria used was that 100% of RANZCOG Category 1 Caesarean Sections should have a Decision‐to‐delivery interval (DDI) of ≤30 minutes. This audit was not limited to after‐hours CS only.

Findings: The % of cases with DDI ≤30 minutes= 58.18%. This did not meet standard but was an improvement over previous audit finding (31% (2011), 41% (2008), 32.6% (2007)). Further sub‐analysis suggested that the greatest contributor to delay, for cases that did not meet the 30 minute target was from decision to deliver to arrival in theatre. It was not able to be determined the contribution that theatre availability contributed to the delay.

6.2

84


Prospective audit: A prospective audit of category 1 CS was undertaken in 2014/15. Of the 28 cases on which data was collected over a 6 month period; 23 gained timely access to L9 operating theatre, an additional theatre was opened on level 9 for 1 case, and 3 cases needed to occur on level 8. In only two cases was delay identified. In one the spinal anaesthetic failed and in the other the anaesthetist was not immediately available.

Further audit: A further retrospective audit was undertaken to determine whether there was any downstream

impact on lower acuity CS or gynaecological care. This audit mid 2015 of category 2 CS’s and

gynaecology surgery demonstrated:

80% of category 2 CS were meeting expected time frame of 60 minutes DDI

60% of acuity gynaecology cases were meeting a 60 min decision to surgery timeframe

This suggests that caesarean sections are being appropriately prioritized over gynaecological

surgery. This is achieved at the cost of access for gynaecological patients.

Summary of current risk:

Although we do not currently meet stated RANZCOG standards with respect to the number of

dedicated afterhours CS theatres per 4000 births we appear to be achieving timely access for the

most acute cases (category 1 CS) by use of level 8 theatres in combination with our dedicated level 9

theatre. This is occurring at the expense of delays in access to less acute CS and to a greater extent,

our acute gynaecological cases. Where delay does occur it appears to be influenced factors beyond

the availability of theatre such as following standard emergency procedures (calling a code) and

availability of clinical staff.

Next steps:

The limitation to achieving decision to theatre times for our maternity and gynaecological cases is

not just the availability of a staffed dedicated operating theatre. At the present time our senior

medical staff are employed on an on‐call not on‐site model. Their availability is also likely to be an

important factor in delay to delivering timely care.

We are exploring transitioning to longer onsite hours for our SMO staff. Theatre availability should

be staged to align with obstetrician on‐site presence.

In the meantime the lack of a second theatre should remain on the risk register.

85


Financial Results


The result for the month was $281k F from budgetary timing for Personnel cost, and under‐spend on

Labs costs.

CWD volumes for the month were 96% of contract and Specialist Neonates are at 71% YTD.

Gynaecology acute WIES are on 98% of contract for the month. Both of these equate to $237k of

revenue below contract (not recognised in the Provider arm result).

Total discharges from the Directorate YTD are 1.7% lower than the same period last year.

July 15: Year to date financial analysis:

1 Revenue $16k U YTD. a. MoH non‐Devolved Contracts $17k U of which $10k U due to our reduction of the

income from MQSP (Maternity Quality and Safety Programme) based on Funder advance notice that the budgeted programme funding will be changed.

STATEMENT OF FINANCIAL PERFORMANCEWomens Health Services Reporting Date Jul-15



REVENUE



Other Income 170 170 (1) U 170 170 (1) U

Total Revenue 7,646 7,662 (16) U 7,646 7,662 (16) U



Outsourced Personnel 78 72 (6) U 78 72 (6) U

Outsourced Clinical Services (19) 11 29 F (19) 11 29 F


Infrastructure & Non-Clinical Supplies 91 102 11 F 91 102 11 F


Contribution 3,924 3,693 230 F 3,924 3,693 230 F

Allocations 664 715 51 F 664 715 51 F

NET RESULT 3,260 2,978 281 F 3,260 2,978 281 F



Medical 64.5 66.5 2.0 F 64.5 66.5 2.0 F

Midwives & Nursing 260.5 240.4 (20.1) U 260.5 240.4 (20.1) U

Allied Health 19.3 20.3 1.0 F 19.3 20.3 1.0 F

Support 0.0 0.0 0.0 F 0.0 0.0 0.0 F


Other 0.0 0.0 0.0 F 0.0 0.0 0.0 F

Total excluding outsourced FTEs 380.3 366.8 (13.6) U 380.3 366.8 (13.6) U


Total including outsourced FTEs 384.9 369.3 (15.5) U 384.9 369.3 (15.5) U

6.2

86


2 Expenses Expenditure is $297k Fav; major variances are: a. Personnel $230k Fav. Due to budgetary phasing and the fact of many doctors taking

annual leave in the month, amounting to $163k. Their leave also explains the Gynecology FSA appointments being 196 (47%) below contract.

b. Allocations $51k F. Labs costs are $50k Favorable; this is expected to be temporary, i.e. due to budget timing.

87


Child Health Directorate

Speaker: Dr John Beca, Surgical Child Health Director and Dr Michael Shepherd, Medical Child Health Director

Service Overview

The Child Health Directorate is a dedicated paediatric healthcare service provider and major

teaching centre. This Directorate provides family centred care to children and young people

throughout New Zealand and the South Pacific. Care is provided for children up to their 15th

birthday, with certain specialised services beyond this age range.

A comprehensive range of services are provided within the two directorate portfolios:

Surgical Child Health (Director, Dr John Beca)

Paediatric and Congenital Cardiac Services, Paediatric Surgery, Paediatric ORL, Paediatric

Orthopaedics, Paediatric Intensive Care, Neonatal Intensive Care, Neurosurgery, Consult

Liaison.

Medical Child Health (Director, Dr Michael Shepherd)

General Paediatrics, Te Puaruruhau, Paediatric Haematology/Oncology, Paediatric Medical

Specialties (Dermatology, Developmental, Endocrinology, Gastroenterology, Immunology,

Infectious Diseases, Metabolic, Neurology, Chronic Pain, Palliative Care, Renal, Respiratory,

Rheumatology), Children's ED, Safekids and Community Paediatric Services (including Child

Health and Disability, Family Information Service, Family Options, Audiology, Paediatric

Homecare and Rheumatic Fever Prevention)

The leadership team members are: Dr Michael Shepherd, Director, Dr John Beca, Director, Emma

Maddren, General Manager, Sarah Little, Nurse Director, Linda Haultain, Allied Health Director.

Scorecard

Children's HealthJul-15 Measure Target

Central line associated bacteraemia rate per 1,000 central line days 0 <=1 0







Actual Prev Period


6.3

88


(MOH‐01) % CED patients with ED stay < 6 hours 95.3% 95% 94.8%








Elective day of surgery admission (DOSA) rate 47.3% TBC 54.8%

% Day Surgery Rate 60.4% >52% 61.2%

Inhouse Elective WIES through theatre ‐ per day 25.99 TBC 30.79




28 Day Readmission Rate ‐ Total R/U 10% 9.4%

% Adjusted theatre utilisation 81.3% 80% 80.5%

Average Length of Stay for WIES funded discharges (days) ‐ Acute 3.9 4.2 4.1

Average Length of Stay for WIES funded discharges (days) ‐ Elective 1.1 <1.5 1.1

Immunisation at 8 months 95.0% 5% 94.0%










Engaged W

orkforce

Better Quality Care

Improved

Health

Status

Amber =

R/U =





Result unavailable.





89



Health Targets

Shorter stays in ED

Performance against the target was 95.3% for July. The number of presentations reduced during

July, largely due to the school holidays.

The Acute Flow Steering Group is addressing systemic issues to optimise flow throughout Starship and

refocusing efforts on the patient experience. During July there was continued focus on a more active

presence from the surgical teams in CED and direct medical admissions. The Flow Coordinator roles

continued through July to further support flow across Starship.

Immunisation of 8 month olds

Auckland DHB achieved the target for July with 95% coverage (Maori 91%, Pacific 94%). There was

an increase for Maori (5%) and no change for Pacific in the July period.

Access to elective surgery

Elective surgery performance continues to be actively managed to maintain 120 day compliance

and elective discharges. ESPI 8 (use of a nationally approved prioritisation tool) was introduced in

July 2015 and work has begun in Paediatric ORL to achieve compliance on this target. The

prioritisation tool is being trialled by the surgical team and banding, overrides and thresholds will

be agreed once all surgeons are using the tool.

ESPI ‐1 (acknowledgement of referral) 100% compliant.

ESPI‐2 (Time to FSA) 100% complaint.

ESPI‐5 – (Time to Surgery) 1.58% non‐compliant, 11 cases breached (9 Paed Ortho and 2 Paed

Surg) contributing factors include spinal surgery capacity, acute demand and annual leave.

Mitigations include additional funded and re‐allocated theatre sessions and planned Saturday lists.

Elective discharges are at 65% of target for the month of July. Pead ORL and paed surgery were

most impacted. This resulted from a combination of few Auckland DHB patients on the surgical

waitlist, acute activity and case mix. Plans are in place to mitigate the discharge position through

August to October.


There were no Central Line Associated Bacteraemia (CLAB) events in July. It has been 338 days since

the last CLAB event.

Medication errors for July increased to 35, all were minor in nature and no patient harm resulted.

There were no adverse events (SAC 1) in the Child Health Directorate during July.

Better Quality Care

Patient and family complaints

There were 5 new complaints received in July. The key themes identified within the complaints

were communication, attitude and courtesy. Where possible direct (face to face or telephone)

contact is being made with family who have expressed concerns about the care provided for their

child to discuss concerns and agree the best means of addressing these.

6.3

90


DNA rates

Patient access and DNA rates are an important area of focus for the Child Health Directorate. The

overall DNA rate increased to 11% in July. DNA rates for Maori increased to 20% and Pacific rates

increased from 17% to 18%.

A project was initiated in August 2014 to address DNA rates in services with the highest rates. This

work links to the Maori and Pacific DNA initiative and is being led by Allied Health Director, Linda

Haultain. The current focus is on paediatric respiratory, paediatric general surgery and general

paediatrics with an emphasis on high risk children and families within these services.

The whanau ora assessment tool will be used for all children admitted with bronchiectasis and a

comprehensive discharge plan developed. If children being treated as outpatients are identified as

being at risk of not attending appointments they will participate in a whanau ora assessment.

Phase one of the project is to develop a clear pathway for the appropriate recording and

management of children who were not brought to clinic. DNA will be re‐conceptualised as Was Not

Brought (WNB) so the issues associated with child welfare, and children’s needs in respect to

attending medical appointments are at the centre of practice.

During July the project focused on the following:

Weekly review of patients due to attend clinic who have a previous history of DNA. Calls are

made to encourage, remind and support parents to attend with their child.

Identification and resolution of data issues to ensure late cancellations are captured separately

from DNAs.

Telephone survey developed and piloted to explore barriers to attending appointments. 250

parents will be surveyed during September.

Formulation of three comprehensive DNA case studies and presentation of these to the

respiratory service. Recommendations have subsequently been developed with an emphasis

on ensuring highest need patients receive robust social work interventions during admission

and comprehensive discharge planning to support parents to attend clinics post discharge.


Immunisation of eight month olds

The 2014/15 immunisation target is 95% of 8 month old babies fully immunised and maintained to

July 2017. ADHB is achieving the target with 95% coverage as at 30 July 2015 (Maori 91%, Pacific

94%). There was an increase for Maori (5%) and no change for Pacific in the July period. Work is on‐

going to sustainably close the equity gap.

Immunisation of two year olds

The total coverage rate at age 2 is below target at 94% as at 30 July 2015. There was a decrease for

Maori (93%) and Pacific (98%) continues to exceed target.

The current national coverage rates are 93% at 8 months and 93% at 2 years.

These are good results however the equity gap for Maori in the eight month cohort has re‐

emerged. Sustaining high coverage is an on‐going challenge and area of focus.

Rheumatic Fever Prevention Programme

The Rheumatic Fever Prevention Programme is jointly funded by the Ministry of Health and

Auckland DHB. This is managed through a Service Alliance between Auckland DHB and the four

Auckland DHB PHOs. In addition to swabbing and treating sore throats, public health nurses and

community health workers are identifying and treating skin infections. A refreshed referral process

91


has increased information flow and reporting of outcomes for families with housing related issues

who have been referred to Auckland Wide Healthy Homes Initiative (AWHHI).

Clinics continued throughout July. In July 13% of students presenting with a sore throat tested

positive with Group A Streptococcal infection across the 16 schools. This is lower than the

preceding month (at 16%). There is a wide range across the individual schools (0‐28%), with some

schools consistently higher than others. Classroom education sessions, home visits and attendances

at school and community functions provide opportunities to speak with children, young people and

families, distribute promotional material and share positive health messages.

In June a Whole School Health Assessment was completed in a school that identified a high number

of skin issues. This included full skin assessment and also weight and height. Data has been collated

and is due to be presented.

In addition to the primary school clinics in June, community health workers CCHaDs commenced

throat swabbing and follow up care in four Secondary Schools. This supports the nurses in the

enhanced school based health service. Promotion of Rapid Response clinics for all family members

with a sore throat, liaison with other school based clinics for sibling follow‐up and good

communication links with social work referrals for families with housing related issues enhance

existing school health services in secondary schools.

Family Violence Screening

Family Violence Screening has decreased in the previous quarter (Februarh, March April) by an

average of 9.5% across Child Health with a resulting screening rate of 33%.

For this quarter the retrospective audit results (May, June) demonstrate a screening rate of 30.5%

which is a decrease of 2.5% on the previous quarter. Family Violence audit has been altered to

align with financial year end therefore this audit period has been 2 months.

The target screening rate has been increased by 5% to an expectation of 45% screening rate for

January – December 2015.

Family Violence screening in Mental Health services is currently being implemented. Of the

approximately 700 staff, 224 have been trained to date. It was anticipated that the (training)

rollout would be complete by December 2015. ADHB VIP systems and processes have been aligned

to meet Mental Health service needs.

Efforts to increase the screening rate include:

All staff are followed up on the ward and via email after attending the family violence study day

to encourage screening and to increase confidence.

Family violence team has made direct contact with all managers and offered update

sessions/short and sharp sessions on the wards with all staff.

Screening has been discussed with the steering group to highlight to members areas of low or

declining screening rates and taking responsibility for making a priority/focus.

Greater focus on family violence screening champions and supporting them and their

role. Supporting and meeting with the Family champions, offering our one on one availability

to them has occurred in 3 areas in this period.

Engaged Workforce

Staff turnover increased further to 11.5% in July. Spikes in turnover have been investigated by the

service leadership teams and with support from Human Resources, further work is underway to

understand and address issues of culture and employee engagement.

6.3

92


Employees with excess annual leave (>2 years) reduced to 9.1% of the workforce. Active

management of annual leave has continued and will remain a focus throughout 2015. Leave

management workshops are planned for all service leadership teams during August.


The initiatives listed below include a combination of financial strategy and quality and safety. These

will change and be added to as the child health strategy is finalised.


Clinical excellence programme

Establish clinical excellence programme structure In progress Identify outcome measures In progress

Cost containment:

FTE management On track

Leave management In progress Capacity planning On track

Clinical supplies management On track

Reduce medical staff costs In progress

Reduce non‐clinical operational costs

Revenue Growth in defined areas:

Increase outreach clinic volume In progress

Recover a greater portion of ACC funded volumes On track

Strategic partnership with Starship Foundation On track



Consultation on the proposed clinical excellence programme.

Completion of the Starship Operating Rooms Refurbishment Project.

Replacement of the biplane within the cardiac investigation unit.

Recruitment of the Operations Manager for the Community, General Paediatrics and Te

Puaruruhau portfolio (commences in August).

Commencement of the design phase for the refurbishment of Level 5 in Starship.

Commencement of the design phase for the refurbishment of the Outpatient Department in

Starship.


Launch of the Starship Child Health Clinical Excellence Programme.

Community Services review.

Recruitment to the nursing, medical and allied health roles for which additional national funding

was secured (Cardiac, Rheumatology, Metabolic).

93


Financial Results

Comments on major financial variances

The Child Health Directorate was $862k F for the month. Inpatient wise for the month was 92% to

contract (4% less than the same period last year). Discharges for the month were 95% of July last

year.

Factors impacting on the month’s performance are:

1. Revenue $469k U:

a. Donation income is $344k U to budget. Claims are subject to timing issues and

completion of projects and the month of August us expected to see a reverse

of this variance with funding due in relation to the Starship Theatres project.

2. Costs $849k F:

a. Personnel costs $1,020k F. The main driver for the variance is:

i. Unfilled vacancies 57.4F. The budget increase from 2014‐15 to

2015‐16 was 45.9 FTEs. Of these 41.2 were funded by new to

STATEMENT OF FINANCIAL PERFORMANCEChild Health Services Reporting Date Jul-15



REVENUE



Other Income 640 1,062 (421) U 640 1,062 (421) U

Total Revenue 19,926 20,395 (469) U 19,926 20,395 (469) U


Personnel Costs 9,280 10,286 1,007 F 9,280 10,286 1,007 F



Clinical Supplies 1,742 2,017 275 F 1,742 2,017 275 F


Total Expenditure 11,599 12,917 1,318 F 11,599 12,917 1,318 F

Contribution 8,327 7,478 849 F 8,327 7,478 849 F

Allocations 938 950 12 F 938 950 12 F

NET RESULT 7,390 6,528 862 F 7,390 6,528 862 F



Medical 215.4 224.9 9.4 F 215.4 224.9 9.4 F

Nursing 612.7 637.1 24.4 F 612.7 637.1 24.4 F

Allied Health 121.4 135.6 14.2 F 121.4 135.6 14.2 F

Support 0.0 0.0 0.0 F 0.0 0.0 0.0 F


Total excluding outsourced FTEs 1,028.7 1,085.3 56.6 F 1,028.7 1,085.3 56.6 F

Total :Outsourced Services 3.8 4.6 0.8 F 3.8 4.6 0.8 F

Total including outsourced FTEs 1,032.5 1,089.9 57.4 F 1,032.5 1,089.9 57.4 F

6.3

94


Auckland DHB income streams. The balance of 4.7 were included

for service restructures and model of service delivery changes and

were to be funded from internal savings. Extensive recruitment is

currently underway to ensure that recruitment to the new

positions has immediacy.

ii. Medical $392k F, 9.4 FTE F. Recruitment to new funded SMO

positions is underway

iii. Nursing $470k F, 24.4 FTE F. Actual Nursing costs for July were

the same as July LY. However, the position will change for August

with 19 new nursing hires made in July.

iv. Allied Health $114k F and 14 FTE F. Vacant FTE occupy a number

of the new funded positions

v. Overall active management of FTE for the whole Directorate

includes:

Weekly FTE reconciliation (actual‐budget) and review by the

Directors

Rationalisation of all FTE pending approval and being sourced

b. Clinical supply costs $275k F: Inpatient activity was 92% to contract this

month. Costs are lower than July LY and reflect the fact that activity this

month is only 96% of last July.

Summary

The Child Health Directorate now has an established and capable leadership team and is progressing

activity in priority areas including quality, safety, sustainability and productivity.

95


Surgical Services Directorate

Speaker: Wayne Jones, Director

Service Overview

The Surgical Services Directorate is responsible for the provision of surgical services for the adult

population. The Directorate leadership consists of Director Surgical Services Wayne Jones, Nurse

Director Anna MacGregor, Allied Health Director Kristine Nicol and General Manager Tara Argent.

Supported by Les Lohrentz (HR), Justin Kennedy‐Good (Service Improvement) and Jack Wolken

(Finance).

The services in the Directorate are structured into the following portfolios:

Orthopaedics, ORL, Neurosurgery

General Surgery, Trauma, Transplant, Urology

Ophthalmology, Surgical Out Patient Clinics, Oral Health

Scorecard

Surgical ServicesJul-15 Measure Target







Actual Prev Period









Elective day of surgery admission (DOSA) rate 75.8% 68% 75.9%

% Day Surgery Rate 59.3% 70% 62.4%



% Patients cared for in a mixed gender room at midday ‐ Adult 16.0% TBC 11.0%


Better Quality Care

6.4

96



Health Targets

Elective Discharges

In July, Adult Services delivered 97% of the Auckland DHB discharge target (‐21) of which the

biggest areas of deviation from plan were ‐55 Ophthalmology, +48 General Surgery, ‐17

Orthopaedics and ‐7 ORL.

The July IDF discharge position was 105% of the target (+24) the main areas of deviation were

Ophthalmology +34, Neurosurgery ‐7 and Urology ‐6.

At the end of July the ESPI 2 is compliant with 0 patients waiting longer than 4 months for their

FSA. The ESPI 5 position is moderately non‐compliant with 0.52%, which equates to 24 patients in

total for all services, not receiving a date for surgery within 4 months (the target is <1.0%).

This continues to demonstrate the ongoing work undertaken by all teams to sustain the 4 month

target.




Average Length of Stay for WIES funded discharges (days) ‐ Acute 3.43 TBC 3.19

Average Length of Stay for WIES funded discharges (days) ‐ Elective 1.42 TBC 1.23

31/62 day target ‐ % of non‐surgical patients seen within the 62 day target R/U 85% 45.5%

31/62 day target ‐ % of surgical patients seen within the 62 day target R/U 85% 88.9%

62 day target ‐ % of patients treated within the 62 day target R/U 85% 65.0%











Amber =

R/U =

31/62 day target ‐ % of non‐surgical patients seen within the 62 day target

31/62 day target ‐ % of surgical patients seen within the 62 day target

62 day target ‐ % of patients treated within the 62 day target

Engaged W

orkforce

Improved

Health

Status






Result unavailable.





97


During August and September 2015, it is anticipated that there will be pressures on the discharge

target. Extra capacity of ophthalmology and orthopaedics is scheduled to commence in

September and October 2015 respectively.


There were no medication errors with major harm reported for the month of July with 22

reported errors without harm consisting of:

7 x Incorrect dose/frequency

6 x Omission/delay

4 x Controlled Drug Documentation/Count errors

2 x Inappropriate medication/fluid

1 x Incorrect patient

1 x Incorrect route

1 x Extra dose/duplication

There were 32 falls incidents reported (none with major harm). Most of these were while

ambulating or toileting. Themes and actions for prevention continue to be discussed at the

Surgical Services Falls meeting and the Surgical Directorate weekly Quality meeting.

There were 29 pressure injuries reported for July categories as follows:

16 x Category 1 (Non‐blancable erythema)

11 x Category 2 (Partial thickness)

1 x Category 3 (Full thickness skin loss) this was noted on admission

Nil Category 4 (Full thickness tissue loss)

There were no adverse events causing harm (SAC 1&2) during July.

Better Quality Care

The DNA rate for appointments for all ethnicities in June has remained close to target at 9.51%.

Patients cared for in a mixed gender room at midday has increased in July to 16%; this is due to

the pressures on bed capacity as a result of the acute load, and the increase in General Medical

demand.

The number of outliers has from 120 in June to 134 in July. Where possible teams have been

working to align the capacity, co‐horting and repatriating patients to reduce the outliers across

the surgical bed base, to support the rest of the hospital and the patient flow.

Day surgery rates have improved from low at 59.3% against a target of 70%, although the elective

DOSA rate is good at 75.8% against a target of 68%.


Smoking Cessation

Performance is above target at 97.2% in July. Staff continue to offer the advice and support to

smokers to ensure that the target is sustained.

6.4

98


Engaged Workforce All Clinical Directors and line managers have been provided with excess leave reports and plans

are being asked to submit plans to ensure there is a reduction in excess leave across all staff

groups. Cases are being reviewed to ensure that the data is accurate as discrepancies have been

identified.

The management team are working with the CDs to introduce a 52 week planner detailing each

SMOs job size, annual/CPD/Conference leave which will allow for greater visibility of cover and

further improve productivity. This is being rolled out to ORL in the first instance, and across the

rest of adult surgical services.

Faster Cancer Treatment – Tumour Stream Coordinator position is out to advert for 1 year fixed

term initially.

The ORL investigation has now concluded and the recommendations from the external advisors

are being undertaken by the Senior Leadership Team.

Trendcare is being utilised by the nursing teams within the adult surgical wards lead by the Nurse

Advisors to allocate resources according to the demand. This has been well received by the staff

who are working across the wards, and it is strengthening team work. Senior nurses have been

continuing to work as part of the task teams supporting the wards and providing cover where

there are gaps in the rota that cannot be filled due to the high demand.


Deliverable/Action

Reduce average LOS Long stay patients ERAS in Ortho / Gen surgery

Outpatient Service Improvement ProgrammeReview / Standardise of Communications Standardised Processes 31/62 day cancer target



Relief of Pain Clinic in Oral Health

The way in which the relief of pain clinic is delivered has changed from patients queuing outside

Greenlane on a “first come first served” basis to a booked clinic, with a dedicated booking line and

a dentist allocated to undertake the triaging of patients. Slots are booked up to one week ahead

for patient triaged as routine, with slots allocated for urgent and a process in place to manage

walk‐in cases.

In the first two weeks of this new initiative there have been 156 slots available, 119 of which

have been booked (28 of whom have been paediatric patients), with only 3 DNAs.

Having the ability to forward plan has allowed the service to reallocate the dentists to booked

clinics and to cover short notice absence due to sickness. On one occasion an am clinic was

moved to pm, all patients contacted with no DNAs or complaints.

99


The queue for Relief of Pain Clinic at Greenlane at 06:30 prior to the new process being

implemented.

There is now no queue in the morning. Should any patient arrive the security guard provides them

with a leaflet detailing the process and telephone number and passes the name of the patient to

the service.

Ward 81 and 83 had their “roof shout” celebrations for the completion of the “releasing time to

care” module.


Delivery of the Ophthalmology PVS is behind plan, to address this weekend lists will commence

on 12 September 2015.

Transcription service, in light of the current backlog and recent Winscribe issues volunteers

have been identified from within Adult Surgical Services administration team who are to be

trained to provide support to their services to reduce the backlog.

Due to the acute demand across the hospital there has been occasion to cancel some elective

procedures which will impact on the ESPI and discharge position for the specialities affected.

All cancellations are being monitored and managed to ensure that those patients cancelled on

the day have their procedures within the required 28 days.


To roll out the Relief of Pain Clinic Model to the Oral Health service provided at Middlemore

and Buckland Road clinics.

Mitigate the impact of the recent elective cancelations.

Increase the Orthopaedic capacity to ensure delivery of the PVS.

Ophthalmology have an agreed work plan and governance group established to review and

implement changes in the way the service is delivered.

“Releasing Time to Care” is commencing on wards 75 and 77.

6.4

100


Financial Results


Surgical Services was unfavourable to budget in July with a net result of $261k U.

Overall volumes for the month, based on the latest coding, are 102% of contract. This equates to

$422k of revenue not recognised in the month result.

The key driver of the result is overspend in Clinical Supplies, predominantly in implants and

prostheses, which are $266k U. This reflects a combination of volumes over contract combined

with additional expenditure relating to the previous financial year – the underlying month spend

is close to budget.

Paid FTE

The 23.8 U FTE in Nursing is due mainly to budget savings not achieved. All efforts are being

made to utilise nursing staff efficiently without the need for outsourced staffing.

Business Improvement Savings

We are currently delivering on our Business Improvement Savings.

STATEMENT OF FINANCIAL PERFORMANCESurgical Services Reporting Date Jul-15



REVENUE



Other Income 319 419 (100) U 319 419 (100) U

Total Revenue 22,164 22,375 (211) U 22,164 22,375 (211) U




Outsourced Clinical Services 341 327 (14) U 341 327 (14) U




Contribution 11,291 11,563 (272) U 11,291 11,563 (272) U

Allocations 2,460 2,470 11 F 2,460 2,470 11 F

NET RESULT 8,831 9,093 (261) U 8,831 9,093 (261) U



Medical 192.4 200.1 7.7 F 192.4 200.1 7.7 F

Nursing 495.5 471.7 (23.8) U 495.5 471.7 (23.8) U

Allied Health 37.7 37.4 (0.3) U 37.7 37.4 (0.3) U

Support 0.0 0.0 0.0 F 0.0 0.0 0.0 F


Total excluding outsourced FTEs 791.5 777.1 (14.4) U 791.5 777.1 (14.4) U


Total including outsourced FTEs 807.1 791.1 (16.0) U 807.1 791.1 (16.0) U

101


Perioperative Services Directorate

Speaker: Vanessa Beavis, Director

Service Overview

The Perioperative Service provides services for all patients who need anaesthesia care and

operating room facilities. All surgical specialties in Auckland DHB use our services. Patients needing

anaesthesia in non‐operating room environments are also cared for by our teams. There are five

suites of operating rooms on two campuses, and includes five (or more) all day preadmission clinics

every weekday. We provide the (24/7) acute pain services for the whole hospital. We also assist

other services with line placement and other interventions when high level technical skills are

needed.

Scorecard

Perioperative ServicesJul-15 Measure Target

% Acute index operation within acuity guidelines 73% ≥ 95% 86%

Wrong site surgery 0 0 0

% antibiotics within 60 mins of operation 80% ≥ 80 81%

Surgical safety checklist compliance R/U 100% R/U

Unplanned overnight admission 4.8% ≤ 3% 3.31%

Unplanned ICU / DCCM stay 0.2% ≤ 1% 0.1%

30 day mortality rate 1.3% ≤ 2% 0.3%

CSSD incidents 2.53% ≤ 2% 2.48%

Elective sessions planned vs actual 93% ≥ 97% 97%

Adjusted utilisation 85% ≥ 85% 85.8%

Late starts 7.5% ≤ 5% 6.5%


% Staff with excess annual leave >1 year <2 years 31% ≤ 30% 32.5%

% Staff with excess annual leave > 2 years 9.1% 0.0% 9.1%

Sick leave hours taken as a percentage of total hours worked 4% ≤ 3.9% 4%

% Voluntary turnover (annually) 7% ≤ 10% 6.9%

% Voluntary turnover <1 year tenure 7.3% ≤ 6% 3.7%

Actual Prev Period

Increased Patient

Safety

Better Quality

Care

Improved

Health Status

Engaged W

orkforce

Amber =

R/U = Result unavailable.

Surgical safety checklist compliance

The data is not being collected due to process change. Awaiting new auditing tool and therefore exempt from auditing to the Health, Quality

& Safety Commission.



6.5

102



Health Targets

Improved access to electives

Session usage for the month of July (i.e. the number of available sessions vs. those used) was 93%.

The top three reasons for non‐use of sessions were: ‘session released not filled, ‘unfilled by service’

and ‘surgeon unavailable’.

This is related to the July school holidays and associated annual leave.

Adjusted utilisation for all OR suites remains consistent at 85%. The international benchmark for

adjusted utilisation (i.e. a measure of how efficiently the available time in the session is used) is

85%.

‘All cause’ cancellation rate for patients was 11.8%. The predominant reasons for patient

cancellations/deferment in July were ‘acute substitution by acute’, ‘acute operation not needed’

and ‘acute cancellation’. In the context of 85% utilisation this is not an immediate problem and the

top three reasons suggest causes outside the control of the Operating Rooms.


Timely access to acute surgery is at 73%. This is related to the long days due to the number of

transplants in July.

There have been no incidents of wrong site surgery.

There were no SAC 1 or SAC 2 adverse events in July.

Across Perioperative Services in July there were five medication errors (with no sequelae).

There were no fall incidents reported in June. There were two minor pressure injuries reported in

July.

There was one minor patient complaint attributed to Perioperative Services in July.

Better Quality Care

30 day mortality rate remains below target at 1.3%.

CSSD incidents were only slightly above target at 2.53%. This is related to production pressure in

the face of workforce shortages. Six full time Technician roles and three casual Technician roles

have been appointed. We will be up to our budgeted FTE by the end of August.

No new risks have been added to the register. Current risks are:

1. Clinical: inability to proactively identify and link single instruments to individual surgical

procedures.

2. Operational: the inability to commence surgical procedures due to the contamination of

surgical operating kits coming from CSSD.

The single instrument tracking system implementation project is underway. The controls in place

are working well. Recruitment of a Project Manager has occurred. The hardware has been

ordered. The scope of work has been agreed and the steering committee set up. It is likely that

this project will not be fully implemented in the agreed time scale due to the size and scope of it

and delays with ensuring the instrument marking meets requirements.

103



Late starts are at 7.5%. Surgeon late caused 28 late session starts and pre‐op preparation caused

23 late session starts.

For the month of July there were 1,638 planned sessions, of those, 106 sessions were not used.

In addition, 65 sessions were recycled.

Engaged Workforce

Excess annual leave >2years remains unchanged from June at 9.1%.

Excess annul leave >1 year <2 years is at 31%. This is a challenge to manage given the production

requirements but we are working with staff on this.

Our staff turnover rate for July at 7% remains below target. Sick leave is only very slightly above

target at 4% and relates to general winter illnesses across all staff.



Starship Operating Rooms rebuild COMPLETED.

Hybrid Operating Room, Level 4

Hybrid Room is up and running.Increasing production as we can. Training of staff completed. Project is currently being wound up and we are working towards business as usual.

Single Instrument Tracking system

Statement of work has been completed with project timelines. Project will last approx. 14 months, completion date November 2016.

GSU – Optimisation of usage to maximise case mix and capacity

25 unused sessions for the month of July

- 23 Sessions released not filled - 2 Unfilled by service

Leave over the July school holiday period meant there were no surgical staff available to pick up the sessions so they remained vacant In the first two weeks of July we were down 18 sessions.



Single Instrument Tracking (S.I.T.) project is now underway.

Starship rebuild completed.

Hybrid room successfully up and running.

6.5

104



Projects are mostly on track at present except the S.I.T. project where the completion date has

been extended.

Session losses are still work in progress. Quarterly OR session allocation planning is underway.


Hand Hygiene Project ‐ we are seeing positive results where we have hand hygiene promotional

activities underway and plan to share these initiatives across the Perioperative Service. We are

planning regular auditing.

We are part of Cohort 1 for the team briefing / debriefing project for the Health Quality and Safety

Commission’s Reducing Perioperative Harm initiative. The initiative will introduce briefing and

debriefing to one surgical specialty as an initial trial.

We continue to do random audits of the Surgical Safety Checklist, which show good consistent

results.

We are contributing to the outpatient project with the reorganisation of the preadmission clinic.

This is a large project which will take time to complete. With the arrival of the new General

Manager for Greenlane we expect progress to be accelerated.

105


Financial Results


The net result for July is $143k U, primarily driven by unfavorable clinical supplies costs.

Volumes have increased (measured in minutes) from June 2015 by 4.6% and from July 2014 by 6.1%.

The number of cases has remained the same from June 2015 to July 2015 but has increased by 4%

from July 2014 to July 2015. This indicates that patient volumes overall continue to increase but also

cases are taking longer to perform which may imply an increase in the number of complex cases.

The clinical supplies unfavourable variance reflects the high theatre minutes for the month of July,

not reflected in the phasing of the budget.

Business Improvement Savings

Perioperative Business Improvement savings have been budgeted to begin in August 2015.

No savings were reported this month.

STATEMENT OF FINANCIAL PERFORMANCEPerioperative Services Reporting Date Jul-15



REVENUE


Funder to Provider Revenue 0 0 0 F 0 0 0 F

Other Income 15 18 (2) U 15 18 (2) U

Total Revenue 199 207 (8) U 199 207 (8) U








Contribution (11,175) (11,029) (146) U (11,175) (11,029) (146) U

Allocations 26 28 2 F 26 28 2 F

NET RESULT (11,201) (11,057) (143) U (11,201) (11,057) (143) U



Medical 155.2 164.8 9.7 F 155.2 164.8 9.7 F

Nursing 404.6 417.0 12.4 F 404.6 417.0 12.4 F

Allied Health 98.1 107.5 9.4 F 98.1 107.5 9.4 F

Support 107.0 113.8 6.8 F 107.0 113.8 6.8 F

Management/Administration 25.7 24.6 (1.0) U 25.7 24.6 (1.0) U




6.5

106


Cardiovascular Directorate

Speaker: Dr Mark Edwards, Director

Service Overview

The Cardiovascular Directorate comprises Cardiothoracic Surgery, Cardiology, Vascular Surgery,

CVICU, Organ Donation New Zealand and Hearty Towers. Mark Edwards is Director of the

Directorate, Anna MacGregor is Nurse Director, Kristine Nicol is Allied Health Director and Joy

Farley is General Manager. Jim Kriechbaum is the Primary Care Director. They are supported by

Melissa Marshall (HR), Justin Kennedy‐Good (Service Improvement), Sam Titchener (Service

Manager) and Martin McEvoy (Finance).

Scorecard

Cardiovascular ServicesJul-15 Measure Target








Actual Prev Period


(ESPI‐1) % Services acknowledging 90% of FSA referrals 100.0% 100% 100.0%


% DNA rate for outpatient appointments ‐ All Ethnicities 9.1% TBC 8.0%

% DNA rate for outpatient appointments ‐ Maori 15.4% TBC 13.0%

% DNA rate for outpatient appointments ‐ Pacific 22.7% TBC 17.0%

Elective day of surgery admission (DOSA) rate 34.4% TBC 36.8%

% Day Surgery Rate 35.3% TBC 35.4%




Better Quality Care

6.6

107



Health Targets

At the end of July the cardiac surgery waiting list totalled 60; lower than the 70 reported for last

month. The service continues with fortnightly teleconferences with the funder and the National

Health Board elective services team.

The service has delivered over plan for July; 76 patients were operated on against the plan of 72, of

these just two were weekend insourcing. The patient inflows on to the waitlist were in line with our

expectations.


Number of complaints received 1 0 2


Cardiac Bypass Surgery Waiting List 60 52-104 70

% Accepted referrals for elective angiography treated within 3 months 98.1% % 98.8%

% Adjusted theatre utilisation 82.5% 80% 81.7%

% Theatre cancellations 12.0% TBC 10.2%


Average Length of Stay for WIES funded discharges (days) ‐ Elective 3.57 TBC 2.85

Better Quality Care


Vascular surgical waitlist ‐ longest waiting patient (days) 92 114

Outpatient wait time for chest pain clinic patients (% compliant against 42 day target) 100.0% 70% 91.9%

CVD risk assessment 91.6% 91.5%










Engaged W

orkforce

Improved Health

Status

Amber =

R/U =





Result unavailable.





108


There were four Lung Transplants and three Extracorporeal Membrane Oxygenation (ECMO) cases

in the service which impacted on elective scheduled cases being cancelled. Overall there were 13

cancellations; lower than the 16 reported last month. These cancellations were predominately due

to substitution by acute work as above and staff shortages across the directorate due to sickness.

At month end there were seven inpatients waiting for surgery and 53 patients waiting up to 90

days. There were no patients waiting between 90‐120 days.


There were no SAC 1 incidents for July for the Directorate. There was one SAC 2 incident for July.

This was a fall causing harm and has been investigated.

The total number of pressure injuries reported for July was 13. This compares with 9 reported in

June. One was reported as a Grade 4 and was present on admission.

The total number of medication errors reported in July was 15. This compares with 18 for June and

remains within the longer term control limits for the directorate. One medication error in June is

the subject of a review as it may have resulted in harm. The final report for publication is nearing

completion.

There number of falls reported in July was 11, one of which resulted in harm. This compares with

10 reported in June.

Better Quality Care

The Cardiovascular Service is meeting the four month target in both elective service delivery

targets, ESPI2 and ESPI 5. The service continues to monitor and validate the cardiac waitlist weekly

along with the suspend waitlist.

A poster is being prepared for submission to the upcoming Asia Pacific Healthcare Conference

(APAC) in September on the patient experience project. The final phase of amending the waitlist

letter, development of a patient journal and follow up on the midpoint contact of patients is

underway with an aim for completion in August.

The major capital improvement protect planned for this year ‐ the replacement of the Cardiac

Investigation Unit Room 1 imaging equipment ‐ is now in the final process of configuration

requirements.

The hybrid operating room is now part of the weekly scheduling and the use of the room is being

transitioned from a project framework into business as usual; there is still work required on the

radiation licence and implications for users as part of on‐going utilisation of the room, however the

performance of the room and what it offers for future improvements in clinical care has been

applauded by all clinical staff. We are preparing for a project evaluation review and will set a date

for a formal opening.

Targets for interventional work continue to be met with 90.3% of ADHB‐domicile patients with

acute coronary syndrome undergoing coronary angiography within 3 days (target is >=70%). This is

an improvement from 88.3% in June.

Percentages of ‘do not attend rates’ for outpatient appointments for Maori and Pacific are

significantly higher than those across all ethnicities; strategies that target a reduction in these rates

have been incorporated into the Regional Cardiac Network plan against the objective of increasing

equity of access across the region for Maori and Pacific Islanders.

6.6

109


Access times for cardiac surgery for the quarter ended June 2014 are as follows:

DHB of Domicile Median wait time

(weeks) for outpatient

surgery

Median wait time (weeks)

for inpatient surgery

% of inpatients over

agreed priority wait

time (# of patients)

NDHB 10.6 0.4 5.3 (1)

WDHB 11.0 0.6 13.8 (8)

ADHB 10.7 0.3 0 (0)

CMDHB 11.1 0.7 18.0 (9)

Northern Region 10.9 0.6 11.5 (18)


The Cardiovascular Directorate continues to work on meeting the four targeted areas in July noting

that CVD risk assessment is a primary care process.

Engaged Workforce

There has been a small reduction across excess annual leave balances. Completion of the centralised

leave planner is underway, there are still several employees without adequate leave plans in place,

and this is being addressed.

Pre‐employment screening has returned to 100%, this process had been raised as an agenda item at

various management meeting, and with the Cardiovascular Recruitment support team. Turnover

rates are stable; sick leave is stable, and at a reasonable level given the winter quarter.

Currently the Directorate has 33 vacant positions with a number at offer stage. There has been good

progress over the last month with recruiting into the new structure with a number of key positions

being filled. However key vacancies remain in perfusion staff despite worldwide recruit efforts.

Development of in house training is seen as a key development for long term service management.




Bypass intervention rates 6.5 per 10,000 population 5.76

Angiogram discharges rates 34.73 per 10,000 (98.2% of target YTD)

30.07

PCI (angioplasty) + Cardiac Surgery rates 18.90 per 10,000 (99% of target year to date)

Not available

100% patients receive elective angiogram < 90 days Achieved Primary angioplasty “Door to balloon time” Achieved Acute coronary syndrome diagnostic angiogram > 70%

Achieved

110



Maintenance of our waitlist and waiting times at acceptable levels despite high levels of

Transplant and ECMO activity.

Commissioning of Hybrid OR.

Continued engagement regarding clinician leadership and operational management across

cardiovascular services.


We released our decision document for clinician leadership and operational management of

cardiovascular services after a period of consultation; implementation was on hold pending

outcomes of discussions with Surgeon group and CEO. This month:

A governance group governing Vascular Services including Interventional Radiology has been

formed based on multispecialty patient management and a shared responsibility for patient

outcomes. The role of this group is to assume shared responsibilities and accountability for

quality of service and patient outcomes, service delivery, strategic service development and

promoting research.

Cardiology continues with development of a governance structure for the service.

We are awaiting a proposal from cardiothoracic surgeons.


Working to maintain our waitlist at acceptable levels.

Managing the established trend towards higher numbers of Heart and particularly Lung

transplants.

Recruitment to key technical vacancies– perfusion and sonography.

Managing clinical leadership pending the revised process.

Continued focus on cardiothoracic surgery patient pathway redesign.

Meeting our savings and initiatives plan for 2015/16.

6.6

111


Financial Results


The month result is $326k F, revenue is $104k U under budget and net expenditure is favourable by

$430K.

Overall inpatient volumes are as follows: elective volumes +2.9%, acute volumes ‐10.1%; this is

unusual for this time of year and we don’t expect this to become established as a new trend.

Overall revenue variance YTD is $104k U due to:

Non‐Resident patient volumes being lower than budget; these fluctuate across the year.

To date overseas patient services are also lower than budgeted. This reflects lower referrals ‐

the current waitlist of only 4. We will continue to monitor this closely.

Total Expenditure YTD is $430k F, this is mainly due to:

STATEMENT OF FINANCIAL PERFORMANCECardiac Services Reporting Date Jul-15



REVENUE

Government and Crown Agency 114 113 1 F 114 113 1 F


Other Income 456 561 (105) U 456 561 (105) U

Total Revenue 12,011 12,115 (104) U 12,011 12,115 (104) U





Clinical Supplies 2,563 2,636 73 F 2,563 2,636 73 F



Contribution 4,091 3,700 391 F 4,091 3,700 391 F

Allocations 1,069 1,004 (65) U 1,069 1,004 (65) U

NET RESULT 3,021 2,695 326 F 3,021 2,695 326 F



Medical 88.3 92.1 3.8 F 88.3 92.1 3.8 F

Nursing 313.2 316.0 2.8 F 313.2 316.0 2.8 F

Allied Health 65.5 66.5 1.0 F 65.5 66.5 1.0 F

Support 3.0 3.0 0.0 F 3.0 3.0 0.0 F



Total Outsourced Services -0.2 1.7 1.9 F -0.2 1.7 1.9 F


112


Personnel and Outsourced personnel costs are net $440k F; FTEs are 11.6 FTE below budget

arising from timing of vacancies, in particular the impact of Registrars coming in and out of their

rotation across the directorate. The favourable variance also includes higher budget costs for

the new financial year, which will reduce as the cost increases occur.

Outsourcing Clinical is $64k U arising from there being higher than usual outsourced lead

extractions for the month; a process to bring these back in house is underway now the Hybrid

OR has been commissioned.

Internal Allocations are $65k U due to higher cost reflecting high volume of interventional

radiology procedure for the month for vascular patients. These costs can vary month to month.

FTE Employed/Contracted – YTD 11.6 FTE Fav

This result is due in part to current vacancies and the timing of Registrar rotation going out of the

Directorate. We are mindful that the base budget includes assumptions regarding vacancies based

on historic trends; balancing this against meeting service delivery expectations and staying within

budget will be challenging.

Summary

The high number of transplants this month highlights the need to examine the capacity required

within the national Heart and Lung Transplant service and the Adult Extracorporeal Membrane

Oxygenation (ECMO) service to meet increased demand for these services. We are partnering with

Planning ‐ Funding and Outcomes to initiate discussions with the National Health Board; briefings to

the Northern Region CEO/CMO group have been provided.

We continue our efforts in implementing change across the Cardiothoracic Surgery Patient

Pathway. This has been made more challenging by the ongoing process with respect to clinical

leadership and operational management of our directorate however we do have a sense of steady

progress.

6.6

113


Adult Medical Directorate

Speaker: Dr Barry Snow, Director

Service Overview

The Adult Medical Service is responsible for the provision of emergency care, medical services and

sub specialties for the adult population. The leadership within this directorate consists of Barry

Snow, Director, Brenda Clune, Nurse Director, Carolyn Simmons Carlsson, Allied Health Director and

Kelly Teague, General Manager. Kelley Teague, General Manager, is now on maternity leave. Dee

Hackett is covering as Interim GM and Robyn Dunningham is covering as Interim Deputy GM.

The services in the Adult Medical Directorate are structured into 2 portfolios:

Group 1

General Medicine, Infectious Diseases, Neurology, Renal, Respiratory and Gastroenterology.

Group 2

Adult Emergency, APU, Critical Care, Air Ambulance.

Scorecard

Adult Medical ServicesJul-15 Measure Target








(MOH‐01) % AED patients with ED stay < 6 hours 92.2% 95% 94.1%







% Patients cared for in a mixed gender room at midday ‐ Adult 18.0% TBC 17.0%




% Urgent Diagnostic colonoscopy procedures treated < 14 days 96.0% 75% 80.0%

% Non urgent colonoscopy procedures treated < 42 days 98.0% 0% 98.0%

% Surveillance Colonoscopies Treated 98.0% 0% 99.0%


Actual Prev Period


Better Quality Care

6.7

114



Health Targets

Acute Flow

Adult acute flow performance for July 2015 was at 92.2%. This is a complex issue compounded by

very high presentations with unusually high numbers of very sick patients, staff shortages due to

illness, and the hospital bed occupancy running at record levels meaning that patients cannot flow

out of the second floor. A comprehensive paper will be presented discussing management of acute

flow across the provider arm.

Smoking Cessation

Performance for July 2015 was 94%. Improvements in General Medicine need to be made in order

to achieve compliance and plans are in place to address this.


There were 27 medication errors in July 2015. The ward based pharmacy technician pilot

commenced in Ward 63 and 65 on the 29 June 2015 and there has been a reduction in the number

of errors related to omissions/delays in the pilot wards to date.

There has been 2 Adverse Events causing Harm and a full investigation is taking place for both of

these.

% Hospitalised smokers offered advice and support to quit 94% 95% 95.0%






% Staff with leave planned for the current 12 months 3.9% 100% 19.0%

% Leave taken to date for the current 12 months 40.2% 100% 67.9%





Amber =

R/U =



Improved

Health

Status

Engaged W

orkforce



Result unavailable.




115


Better Quality Care

ESPI‐2 compliance

Is compliant with 0% of patients waiting greater than 4 months.

Did Not Attend (DNA) rates

There has been a slight deterioration in DNA rates for all ethnicities within the directorate, 9.4% for

July 2015 compared to 9% in June 2015. There has also been deterioration in Maori and Pacific

populations.

The Patient Administration System (PAS) team have established a pilot which commences on 1

August 2015. As part of the pilot patients will no longer be asked to contact the call centre to

confirm their appointment on receipt of their appointment letter. The new process sees the PAS

schedulers contacting patients one week before their appointment date to confirm attendance.

This will see an improvement in DNA rates.


For the past year the Gastroenterology Department have over performed on the MOH targets.

From 1 July 2015 our performance will reduce in order to accommodate the training lists but will

still be within the MOH % targets.

A working group has been established to review the short and long term options for delivering

nurse endoscopy from July 2016 and a potential new build for the Endoscopy Suite at Green Lane.

Architects are currently undertaking a feasibility study.

Faster Cancer Treatment

Demonstrated in the graph below are the specialities involved with tracking (highlighting high

suspicion on the referral form) High Suspension of Cancer within our Directorate and their

performance to date. Prospective management systems are required organisationally to determine

whether each of these patients are meeting the 31/62 day target. Gastroenterology reporting has

been inaccurate due to recording issues, which are now being dealt with. We are in the process of

recruiting a Tumour Stream Coordinator for the Adult Medical Directorate.

Cancer Flagged

0

5

10

15

20

May‐15 Jun‐15 Jul‐15

No of Patients

May‐15 Jun‐15 Jul‐15

Respiratory 18 11 18

Gastro 0 0 2

High Suspicion of Cancer Flagged

May – July 2015

6.7

116


Engaged Workforce

Excess annual leave plans have not improved and this is a result of the wards, Admission & Planning

Unit and the Emergency Department not having the flexibility to enable staff to take their planned

leave. Plans are in place to continue to address excess leave balances across the directorate.



Develop a 5 year strategy for the directorate In progress

Scoping exercise for the re‐design for the Emergency Department

Almost complete

Write a business case for the development/expansion of the renal dialysis services at Green Lane

Early stages

Scoping exercise for a potential new build for the endoscopy suite

Early stages



Appointment of the Nurse Unit Manager for Renal and Gastroenterology.

Appointment of the Service Clinical Director for Gastroenterology.

Short term options identified to accommodate a nurse endoscopy programme from July 2015.

Review of Counties Manukau DHB model of care for managing the 6 hour AED target.


Areas of concern Action required Responsibility Deadline

1. Annual leave management Monthly meetings with all specialities to review progress and to increase the focus.

Kelly Teague On‐going


Areas of concern Action required Responsibility Deadline

1. Acute flow Acute flow working group and a clear governance and accountability structure identified.

Barry Snow 31/08/15

2. FCT management Appoint a Tumour Stream Co‐ordinator and map the current and proposed patient journey in order to meet the 31/62 day target

Barry Snow 30/10/15

117


Financial Results

Financial Commentary

Month financial analysis: The result for July 2015 is a favorable variance of $ 726k.

Volumes: Overall volumes are 106.4 % of contract. This equates to $828k above contract

(revenue not recognised in the Adult Medical Provider result).

Total Revenue ‐ $ 112k unfavorable – primarily due to timing of non‐ resident income $66k U. Total Expenditure ‐ $892k favorable due to:

Personnel Costs including outsourced personnel‐ $ 819k F – mainly due to favorable variances in medical costs $349kF and nursing costs $446kF.

Medical ‐ $ 349k ‐ favorable across all services mainly due to vacancies resulting from the delay in recruiting the new positions approved for 2015/16.

Nursing ‐ $ 446k favorable is mainly due to vacancies resulting from the delay in recruiting the new positions approved for 2015/16.

Clinical Supplies ‐ $ 177k favorable primarily due to timing of renal fluids and blood products.

6.7

118


Cancer and Blood Directorate

Speaker: Richard Sullivan, Director

Service Overview

Cancer is a major health issue for New Zealanders. One in three New Zealanders will have some

experience of cancer, either personally or through a relative or friend. Cancer is the country’s

leading cause of death (29.8%) and a major cause of hospitalisation.

The Auckland DHB Cancer and Blood Service provide active and supportive cancer care to the 1.5

million population of the greater Auckland region. This is currently achieved by seeing

approximately 5000 new patients a year and 46000 patients in follow‐up/or on treatment

assessment appointments.

The leadership within this directorate consists of Richard Sullivan, Director, Brenda Clune, Nurse

Director, Carolyn Simmons Carlsson, Allied Health Director and Deirdre Maxwell, General Manager.

Scorecard

Cancer and Blood ServicesJul-15 Measure Target







(ESPI‐1) % Services acknowledging 90% of FSA referrals 100.0% 100% 100.0%




% Cancer patients receiving radiation/chemotherapy treatment within 4 weeks of DTT 100.0% 100% 100.0%

% Chemotherapy patients (Med Onc and Haem) attending FSA within 4 weeks of referral 100.0% 100% 99.5%

% Radiation oncology patients attending FSA within 4 weeks of referral 100.0% 100% 98.8%







% Patients from referral to FSA within 7 days 28.5% TBC 30.0%

31/62 day target ‐ % of non‐surgical patients seen within the 62 day target R/U 85% 45.5%

31/62 day target ‐ % of surgical patients seen within the 62 day target R/U 85% 88.9%

62 day target ‐ % of patients treated within the 62 day target R/U 85% 65.0%

Actual Prev Period


Better Quality Care

6.8

119



Chemotherapy Policy Priority

The service continues to meet the 28 day policy priority. An improvement project to review the

capacity of the medical oncology day stay has been implemented.

Radiation Therapy Policy Priority

The service continues to meet this policy priority and we are looking at new ways of delivering

radiation therapy to continue to improve capacity and the quality. These include:

Increased/flexible working hours for Radiation Therapists.

Introduction of more efficient delivery techniques e.g. VMAT & SABR.

Protocol standardization.

Hypo‐fractionation (e.g. Breast, Palliative, SABR).

Optimised scheduling of the shared Linac/Brachytherapy bunker – planning is underway for a separate brachytherapy bunker through CAPEX processes. This will allow increased optimization of machine usage.

SMO tumor streaming for cross cover.

Increased planning efficiency (e.g. RayStation, Pinnacle Smart Enterprise).

Rapid Access clinics.


BMT Autologous Waitlist ‐ Patients currently waiting > 6 weeks 7 0 7





financial year N/A 0% N/A

% Staff with leave planned for the current 12 months N/A 100% 8.2%

% Leave taken to date for the current 12 months N/A 100% 91.2%





Amber =

R/U =

31/62 day target ‐ % of non‐surgical patients seen within the 62 day target

31/62 day target ‐ % of surgical patients seen within the 62 day target

62 day target ‐ % of patients treated within the 62 day target

N/A Not available

% Staff with excess annual leave and insufficient plan to clear excess by the end of financial year

% Staff with leave planned for the current 12 months

% Leave taken to date for the current 12 months

Engaged W

orkforce

KPIs related to annual leave for this directorate are being reviewed, hence not reported.

Improved

Health

Status






Result unavailable.





120


% Radiation oncology patients attending FSA within 4 weeks of referral

All patients accepted by the service received their FSA within 4 weeks. In light of the 31/62 day

target, work is being undertaken to reduce FSA waiting times by 50% within the next year with a

view to all FSA’s being seen within 7 working days from receipt of referral by July 2016. The

introduction of Rapid Access Clinics is an example of this.

% Chemotherapy patients (Med Oncology & Haematology) attending FSA within 4 weeks of

referral

100% of patients across both services achieved this month compared to 99.5% & 98.8% in the

previous period. Weekly prioritisation and monitoring of referrals and wait times continue. The

Medical Oncology service working towards matching patient specific demand by tumour stream

against clinical capacity to move towards increasing the number of joint medical oncology/

radiation oncology patient centred clinics by tumour stream. In addition, clinical pathways from

referral to the service to FSA have been identified and mapped. A production planning tool that

enables clinicians and scheduling staff to prioritise workload and plan clinic needs has been

designed and implemented. The resultant report is emailed to the medical oncology tumour leads

twice per week and discussed at their weekly meeting. We expect these activities to significantly

reduce the wait between referral and FSA. This work is starting to show positive gains.

Health Targets

Chemotherapy Policy Priority

The service continues to meet the 28 day policy priority. An improvement project has commenced to

review the capacity of the medical oncology day stay. The main focus of this project is to review patient

flow and scheduling of treatments in order to increase throughput. The unit has implemented a new

scheduling process that provides increased visibility of nursing requirements plus increased capacity. A

dose banding pilot has started and a new ‘assess’ clinic form approved. We will be auditing the outcome

of this project.

Radiation Therapy Policy Priority

The service continues to meet this policy priority and we are looking at new ways of delivering

radiation therapy to continue to improve capacity. We are planning to maintain timely service

provision during the upcoming upgrade of a linear accelerator.


There were nine medication errors in June which have all been reviewed and analysed.

There has been 1 SAC 2 adverse event with harm, where a patient sustained a fractured hip

following a fall in the oncology outpatient area. Work is underway in oncology outpatients to ensure

that patients are appropriately assessed on admission, and the right assistance is provided.

Better Quality Care

Faster Cancer Treatment Target (31/62 day target)

The Ministry of Health has determined that that the new target will be that 85% of patients with a

high suspicion of cancer will be treated within the 31/62 day target by 1 July 2016, moving to a

target of 90% by 1 July 2017. The 31 day target is measured from decision to treat to first definitive

treatment and 62 days is measured from an urgent General Practitioner referral for suspected

cancer to first definitive treatment.

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Progress against compliance for the 62 day target for Auckland DHB for the last quarter ending 30

June 2015 was 64.4.6% (measured from volumes 38/59 cases). Progress against compliance for the

31 day target was 84.3% (measured from volumes 220/261 cases). The volumes of patients

identified within the appropriate cohorts are increasing as services prioritise this work.

A regional steering group conducts a range of activities aimed to increase the identification and

streamlining of patient pathways across the region. New high suspicion definitions have been

received from the Ministry (5th August), with these being widely circulated across clinical areas

region‐wide. Work will focus on the identification of patients crossing DHB boundaries to ensure

that services are aware of people already on 62 day trajectories. ADHB operates a FCT pathways

group to coordinate our approach to FCT work. Four tumour stream coordinator roles are currently

being recruited to, with the FCT group now including a wider range of clinical and

booking/scheduling staff to inform priorities. Tumour stream pathways mapping continues as

planned.

% Chemotherapy patients (medical oncology and haematology) attending FSA within 4 weeks of

referral

In light of the 31/62 day target, work is being undertaken to reduce FSA waiting times by 50%

within the next year with a view to all FSA’s being seen within 7 working days from receipt of

referral by July 2016. Measurement shows performance hovering around 30.0%. Discussions are

underway with the medical and senior nurse workforce to enable Nurse Specialists within tumour

streams to run dedicated clinics, removing this workload from medical staff and again increasing

capacity for FSA.


Smoking Cessation Advice

Services have been concentrating on providing advice as required, with a further focus of activity

required as July performance is 82.5%. Discussion is underway within day‐stay as we need to be

sensitive to the repeat nature of patient attendances.

BMT Autologous waitlist patients waiting > 6 weeks from stem cell harvest to transplant

The Haematology Service Review resulted in a business case to create 3 additional beds and day

stay capacity for a fixed term (7 months), as a means to deliver 28 transplants and in so doing clear

the autologous transplant waiting list. In tandem there are a range of projects to ensure that

models of care are appropriate, for example looking at shifting appropriate BMT cases to

outpatient delivery. Current measurement indicates that there are 18 patients waiting for

transplant, of which 4 are waiting longer than the national guidelines.

Engaged Workforce

Excess annual leave management

The service continues to work with staff with excess leave balances. Plans are underway to ensure

that staff take this year’s leave allocation within the 12 month period. We are progressing the

restructure within the Cancer & Blood Directorate, with detailed leave information about areas of

concern compiled to assist Service Clinical Directors.

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Deliverable / Action Status/Deadline Implementation of tumour streams across the directorate

Continued work within directorate, overseen by new Service CDs.

√ √ √ √ √

Implement new directorate structure

Implementation underway, with orientation and directorate strategy days planned. Recruitment to NUM, RUM roles underway.

√ √ √

Implementation BMT business case to deliver 28 autologous transplants

Work underway, recruitment to nursing positions underway. Service delivery commencement planned Sept.

√ √ √ √ √

Develop a business case for an Integrated Cancer Centre

Under development: Sub‐projects underway as planned. Decant for Building 7 planned.

√ √ √ √ √

Implement Ministry of Health Supportive Care initiative (Psychosocial and Social Support)

Underway: Recruitment to lead psychology role in progress, with DHB professional leads engaged.

√ √ √ √



Faster Cancer Treatment target

Work is underway to improve the volume, quality and transfer of data to identify resourcing issues

and develop cancer tracking reports across all steps of the cancer pathway to increase compliance

to the target. New tumour stream coordinator positions have been advertised (lead within Cancer

and Blood, 3 others across surgical, medical and women’s health directorates). Baseline numbers

across all contributing clinics is compiled, and shows increased numbers of patients with high

suspicion are being recorded.


Faster Cancer Treatment: Robust process in place to manage the Faster Cancer Treatment target:

Development continues on developing cancer reports across all steps of the cancer pathway.

This includes the operation of the ADHB FCT pathways group, linking with the Regional FCT

group, mapping the MDM pathway by creating a virtual pathway in PHS and further work on

mapping patient pathways by tumour stream.

Increased support for prospective FCT patient tracking and pathways improvement is underway,

with the recruitment to 4 tumour stream coordinator roles underway. The lead position is sited

within Cancer and Blood, with substantive engagement with surgery, medicine, and women’s

health directorates.

Haematology activity: High inpatient volumes are impacting capacity in the Haematology unit and

waitlist volumes and wait times are increasing:

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Engagement with the Regional Haematology network has been reactivated to understand

regional capacity, demand and step changes to access criteria for treatment.

A business case to facilitate an additional 28 autologous BMT procedures has been approved.

Three beds and day stay capacity will be increased for a 7 month period, commencing

September.

Directorate restructure: completion of consultation and implementation of new structure.

The Service Clinical Director roles have been appointed to, with an orientation planned for early

September and a strategy review planned for early October to ensure that our activities

continue to be fit for purpose.

Supportive care: The Ministry of Health has confirmed that funding is available to support

additional psychology and social work roles within each DHB, to provide improved patient/whanau

support.

Recruitment to a regional lead psychology role is underway, with further recruitment to

psychology and social work positions to follow.

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Financial Results

Financial Commentary

Month financial analysis:

The result for July is an unfavourable variance of $90k.

Volumes: Overall volumes are 94 % of contract. This equates to $ 538k below contract

(not recognised in the Cancer and Blood Provider result).

Total Revenue ‐ $182k favourable mainly due to

i) Haemophilia blood reimbursement $117k F – demand driven offset by higher blood product

costs.

ii) NZ Familial Gastrointestinal Cancer Service $62k F – additional MoH revenue to fund database

offset by increased infrastructure costs.

Total Expenditure‐ $ 273k unfavourable mainly due to

Personnel and Outsourced Personnel combined $139k F. This is driven by Nursing costs $85k F

and Allied Health $51k F – vacancy driven.

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Clinical Supplies $256k U ‐ primarily due to

Treatment disposables and blood product $151k U – made up of Haemophilia Blood product

costs (offset by increased revenue) and Haematology blood costs.

Pharmaceutical $165k U – mainly increased spend on Herceptin (currently under

investigation)

Summary

Detailed work continues on improving the volume, quality and transfer data to meet the 31/62

day target. Auckland DHB has a particular focus on pathways identification across all

contributing services. Recruitment to 4 tumour stream coordinator positions is underway to

support increased identification and prospective tracking of this patient cohort across

directorates.

The Directorate has completed a directorate structure redesign, with recruitment completed to

the Service Clinical Director roles. Recruitment to NUM, RUM roles underway.

Due to high inpatient volumes the Haematology inpatient ward is over capacity and bone

marrow transplant waitlists have increased with wait times more than 6 weeks. Weekly BMT

reporting & a Haematology review is underway. Short term strategy is to increase BMT capacity

on Motutapu ward to reduce wait times and develop a sustainable long term plan, with a

business case being approved to deliver 28 transplants over a fixed term.

Psychological support services are being augmented in line with a new Ministry of Health

initiative, and consistent with a Northern Region Plan. Recruitment into a regional lead

psychology role is underway, with further psychology/social work positions to follow.

126



Speaker: Frank Tracey, General Manager and Acting Director

Service Overview This service delivery group is comprised of Daily Operations (including, transit, resource, bureau,

and reception), Greenlane Clinical Centre (including Outpatient facilities, Patient Administration,

Contact Centre & Interpreter services), Allied Health Services (including Physiotherapy,

Occupational Therapy, Speech Language Therapy, Social Work and Hospital Play Specialist services),

Radiology, Laboratory – including community Anatomical Pathology and Gynaecological Cytology,

Clinical Engineering, Nutrition, and Pharmacy.

Scorecard

Clinical Support ServicesJul-15 Measure Target





% Outpatients & community referred MRI completed < 6 weeks 39.0% % 44.0%

% Outpatients & community referred CT completed < 6 weeks 88.0% % 82.0%

% Outpatient & community referred US completed < 6 weeks 44.0% % 44.0%




financial year R/U 0% R/U





Amber =

R/U =

Result unavailable until WFC goes l ive.

Result unavailable.

% Staff with excess annual leave and insufficient plan to clear excess by the end of financial year



Actual Prev Period

Increased

Patient Safety

Better Quality Care

Engaged W

orkforce

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Health Targets

Radiology

Overall performance in the past month against the MOH target has been variable across modalities.

It has increased for CT scans and decreased for MRI. Variability in performance relates to a number

of factors including an increase in referral rates which place additional pressure on existing

resource focused on clearing waitlists and the need for flexibility as we respond to higher than

anticipated admissions that require imaging diagnostics.

MRI

Performance against the MRI target showed a slight decrease from June 44% to July 39% (80%

target). We continue with our efforts to accelerate progress toward achieving target through a

number of planned initiatives. A detailed plan has been presented to the Committee and we are

measuring performance against planned activity on a weekly basis. Outsourcing arrangements are in

place for adult referrals to assist manage demand and in excess of 280 additional procedures have

been completed in a 3 week period in the month of August (this will feature in reporting data to the

MoH for August).

Capacity on our new build MRI scanner is increasing and will further increase in September with the

introduction of a 40hr week roster for MRTs. A focus on direct patient contact has been initiated as

part of waitlist management and in an effort to decrease DNAs. Recruitment and staff training

combined with outsourcing and process improvement activity within the department will have a

positive impact on the waitlist over the coming months.

CT

Performance against MoH 90% target of out‐patients completed within six weeks is showing a

steady improvement over recent months and continues this trend from June 82% in to July 88%.

We are confident that performance against this target will continue to improve in the coming

months.

Ultrasound

While this is an internal target (75%) we are mindful of the importance of patient access to service

and safe waitlist management. Our performance shows an increase in activity for from June 42% to

July 44%. We are working on long term solutions to manage demand, for example, through our

Director Primary Health we are in direct communication with all GP referrers to help them prioritise

and proactively manage referrals. A Ministry of Health funded pilot to deliver out of hours

ultrasound for acute patients in ED has ended. The pilot showed some encouraging outcomes

including contributing to improved ED wait times assisting hospital flow and impacting the quality of

patient care. We are exploring how this service can be provided on a sustainable basis.


The seven medication errors, without any major harm to patients, were mostly omissions/delays.

The SAC 2 event related to the release of the wrong Tupapaku to the funeral director. A written

apology has been given to the family and an internal review is being undertaken to review the

process around this.

128


Better Quality Care

There were a total of three complaints, two involving radiology which was around potential missed

diagnosis and delayed reporting. These have been investigated and closed by the Quality

Department. We had one involving the PAS which was around cancellations/rebooking. This was

investigated and closed as well.

Engaged Workforce

The Directorate has established a senior leadership team that meets monthly and utilises the MOS

operating system to assist effectively manage operations. A health and safety committee has been

established and meets regularly, the focus is on ensuring compliance with legislative requirements,

improving reporting and management of risk in the workplace.

Strategic Initiatives Deliverable/Action Status

PC3 Lab build Site works advancing Due for completion Aug/Sep 2016. Planning underway in collaboration with UoA re workforce development/training and research opportunities.

Level 4 Lab shell Site works advancing, project on track Due for completion Aug/Sep 2016.

Pharmacy: PAPU (Pharmacy Aseptic Production Unit) Application for License to manufacture medicines

Project underway Application to Medsafe in development. Decision – currently under review progress contingent on facility capability

Call Centre Collaboration (WDHB/ADHB)

Joint CC Manager appointed. Initiatives to improve response to call volumes underway. New telephony solution finalised planning underway to implement by Sep/Oct 2015.

Integrated daily Operations Centre and Hospital at Night

Work on improving acute flow including development of an Integrated Daily Operations centre and management of our ‘Hospital at Night’ is underway. Implementation of an agreed model is projected for May 2016. Progress will be reported to the Committee.


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Directorate

Work is underway to develop ‘clinical governance’ groups in the departments of Allied Health,

Pharmacy, Radiology and Laboratory. The aim is to support development of clinician

leadership across the Directorate.

The Directorate leadership team is finalising a ‘Directorate wide score card’ which will reflect

individual department performance against key deliverables.

Daily Operations

Our Hospital Seasonal Plan has been implemented. The plan includes facilitation of daily and

weekly ‘hospital status’ meetings that bringing together representation from all departments

to identify and problem solve issues that are likely to impact patient safety, presentations,

admissions, discharge and hospital flow. This has greatly assisted us manage our increase in

presentations and occupancy and in keeping our patients safe.

An improvement process focusing on realignment of booking and scheduling resources,

systems and processes with Directorates and clinical services is underway. The aim is to

engage staff, improve patient experience, assist accelerate admissions and reduce wait times

for outpatient clinics. The work undertaken continues to contribute significantly to meeting

MoH elective targets.

Work is underway to review the current model of support provided by Orderlies across Level 2

(ED and APU) – due for completion in September 2015

Radiology

Detailed plans have been implemented to address excess waiting times for MRI.

Planning has commenced with the Department to introduce ADHBs Clinician Leadership

model.

Pharmacy

The department has initiated a pilot initiative aimed at improving medicines reconciliation and

medication safety; the project undertaken in the Emergency Department and Adult Medicine

is assisting patient flow. Feedback from patients and clinical staff has been positive. We are

exploring how to convert this initiative to as business as usual.

The department has released a proposal for change document to support implementation of

ADHBs Clinician Leadership model. Consultation closes 11th September.

Laboratory

Lab Plus has developed a ‘Department Scorecard’ with a focus on performance against key

deliverables including turnaround times (TATs) for adult ED and Surgery (pathology).

Review of Forensic Pathology

The final report has been reviewed by senior management. Recommendations have been

accepted and a Governance structure established to guide implementation.

A number of service and process improvements have been undertaken to improve operational

performance and efficiency.

130


Recommendations from an internal clinical audit of the FP theatre are being implemented.

The Ministry of Justice have agreed to an extension to the existing contract term (expired June

2015). This is to allow for continuity of service while the Ministry determine how it will progress

provision of the service over the longer term.


Radiology

A detailed production plan (with weekly targets) has been developed to address the capacity

and demand issues associated with meeting Ministry of Health Targets (MRI). These include,

additional MRIs for adults, bringing on additional capacity at GCC and outsourcing. Reporting to

senior management weekly.

Daily Operations

Planning is underway in collaboration with the Adult Medical Services Directorate to develop

and establish a service model to improve patient flow through Adult ED.


Area Timeframe

Directorate

Implement ADHBs ‘clinician leadership’ model across the Clinical Support Services Directorate

Pharmacy – August /September 2015

Allied Health – Aug 2015

Laboratory – Sep/Oct 2015

Radiology – Sep/Oct 2015

Daily Ops – Nov 2015

Radiology

Reduction of Ultrasound and MR waitlists

Develop business case for reconfiguration of L2 Radiology ACH

Paper re planned actions implemented July 2015

Underway – due for completion September 2015

LabPLUS

Discussion with CMDHB and WDHB regarding regional planning for Laboratory Services in the region

July/Aug 2015

Pharmacy

Improvement projects in drug management (imprest, waste, safety) and dispensing to continue.

Retail pharmacy redesign (L5 ACH and GCC) aim is to improve patient/customer experience and improve revenue realisation.

Project underway to obtain a manufacturing licence. This could allow for increased ability to manufacture/compound specific products on behalf of ACH, other DHBs and the private sector.

Oct 2015

Completed and outcome successful

First phase completion Jun 2015

Remedial work required to plant will impact on phase 2 dates for completion TBD

Daily Operations

Develop an integrated Daily Operations Centre and revised Model for management of Hospital at Night

Completed by May2016

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131


Financial Results

STATEMENT OF FINANCIAL PERFORMANCEClinical Support Services Reporting Date Jul-15



REVENUE

Government and Crown Agency 456 1,114 (657) U 456 1,114 (657) U

Funder to Provider Revenue 3,306 3,306 (0) U 3,306 3,306 (0) U

Other Income 2,345 1,775 570 F 2,345 1,775 570 F

Total Revenue 6,108 6,195 (87) U 6,108 6,195 (87) U








Contribution (10,093) (10,504) 411 F (10,093) (10,504) 411 F

Allocations (7,751) (7,799) (48) U (7,751) (7,799) (48) U

NET RESULT (2,342) (2,705) 364 F (2,342) (2,705) 364 F



Medical 131.0 140.9 9.9 F 131.0 140.9 9.9 F

Nursing 78.5 73.4 (5.1) U 78.5 73.4 (5.1) U

Allied Health 840.3 854.4 14.1 F 840.3 854.4 14.1 F

Support 73.2 68.4 (4.8) U 73.2 68.4 (4.8) U


Total excluding outsourced FTEs 1,429.6 1,452.1 22.5 F 1,429.6 1,452.1 22.5 F


Total including outsourced FTEs 1,448.2 1,453.2 4.9 F 1,448.2 1,453.2 4.9 F

Forensic Pathology

A review of the Department of Forensic Pathology and the National Coronial service (provided under contract to the MoJ) has been completed. The aim is to assist the department develop a contemporary service delivery model and robust and sustainable infrastructure to support a national service. A range of improvement initiatives are underway within the department including:

workforce training

clinical audit

policy development

Formal interface meetings with key stakeholders – office of Chief Coroner, Police and MoJ.

October 2015

132


Comments on major financial variances The July Result is $364K F. The key drivers of this result are:

Personnel Costs $634K F due to FTE being 22 below budget. This is partly offset by outsourced

personnel.

Government and Crown Agency revenue is below budget which is offset by other income. This is

due to an accounting adjustment which will be corrected next month.

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Non‐Clinical Support Services

Speaker: Clare Thompson, General Manager

Service Overview

This service delivery group is comprised of Corporate Support Services including Commercial

Contract management, Clinical Education Centre, Sustainability, Security, Retail, Health Alliance

Procurement & Supply Chain relationship, Health Benefits–Food & Linen programmes, Fleet

Management, Car‐parking, Mailroom, and Crèche. It also covers Non‐Clinical Support Services

within the Provider Arm including, Bed Management, Cleaning, Contact Centre, Food Services,

Volunteers and Waste Collection.

Leadership team includes: Clare Thompson, General Manager, Manjula Sickler, Business Manager,

Leanne Gatman, Finance Manager, Shankara Amurthalingam, Operations Manager Non‐Clinical

Support Services, Jane Woolford, Operations Manager Procurement & Supply Chain, Stuart Almao,

HR Manager and Reg Prasad, Property & Project Manager.

Scorecard



Parking

The recent hospital capacity has impacted on car park availability. There was an initial reduction

in delays when Car Park A opened but recent visitor flows are still causing some congestion at

peak times. Traffic volumes are expected to decrease as the summer approaches.

The Sustainable Transport project is considering ways to increase capacity to meet public

demand for car‐parking.

The Fortlock installation of CCTV camera on Level 7 in Carpark A is expected to be completed by

mid‐Sept 2015. This will provide improved security coverage and monitoring.

Non-Clinical Support ServicesJul-15 Measure Target










Actual Prev Period

Engaged W

orkforce

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Procurement

Supply Chain Distribution – healthAlliance is providing daily reports to the DHB on staffing

levels, potential backlogs and mitigation plans as a way of improving the communication

between the supply chain and clinical services. HealthAlliance also attend the weekly demand

and capacity meetings to ensure resourcing is in place to meet the increased demand/peak.

Auckland DHB and Health Alliance are also reviewing the service levels provided to wards to

ensure that it is aligned with clinical requirements.

Cleaning Services

Combined average audit score of 91% for the month of July 2015. See updated graph below.

Security

Access Control/CCTV Project has now entered the Discovery Phase with Fortlock making good

progress with GLCC now fully complete and ACH 25 % complete.

Code Orange calls: 93 Code Orange responses were attended in July, an increase of 24 from

June (increase 35 %).

Patient Security Watches: There were 170 requests during July, compared to 183 in June

(reduction 7%). This trend reflects the increase in hospital presentations and admissions.

Updated graph below:

135


Procurement

Project Update

Procurement ‐ the 15/16 Procurement plan was signed off by ADHB.

F14/15 carry over $2,533,980

New initiatives to be banked in F15/16 $2,297,522

Total $4,831,502

To be carried over into F16/17 $1,645,418

The Supply Chain and Procurement team worked with both Health Partnerships NZ and health

Alliance procurement to get a better way of reporting and verifying the data. Challenges

remain for the Auckland DHB finance team to verify the savings at RC level, but work is

continuing to resolve this.

Inventory

Health Alliance supply chain has provided a number of very good reports which is allowing

more detail on the Auckland DHB spend patterns which improve understanding of which areas

to target to reduce inventory and to ensure that the users are accessing the most

advantageous contract.

On contract, on catalogue transactions represent 71% of total spend. The majority of value of

spend is using IProc. The team will be focussing on this category to ensure that Auckland DHB

personnel are utilising the tool correctly and to identify any spend which would better

inventory managed.

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POTENTIAL EXCESS/OBSOLETE INVENTORY

Month PANDEMIC STORE THEATRE VMI WARD Grand Total SOH EOM % SOH Not

Required

Jun‐14 720,609 0 818,776 1,014,386 687,866 3,241,638 9,935,199 33%

Jul‐14 720,571 0 813,688 994,374 621,454 3,150,088 9,864,034 32%

Aug‐14 720,527 0 726,170 994,374 626,521 3,067,592 9,820,818 31%

Sep‐14 720,307 213 720,952 994,374 578,882 3,014,728 9,673,370 31%

Oct‐14 720,279 788 653,020 1,009,750 635,309 3,019,146 9,921,658 30%

Nov‐14 720,275 2,498 700,347 1,009,750 640,616 3,073,486 9,926,093 31%

Dec‐15 720,228 41,246 732,223 1,009,750 730,545 3,233,993 10,272,443 31%

Jan‐15 720,190 13,417 746,311 1,012,201 795,084 3,287,203 10,248,617 32%

Feb‐15 720,178 1,359 758,572 1,012,021 733,109 3,225,239 10,103,320 32%

Mar‐15 720,169 1,082 752,683 1,026,328 720,616 3,220,879 10,252,688 31%

Apr‐15 720,142 701 705,787 884,751 632,302 2,943,683 9,860,057 30%

May‐15 720,153 1,217 656,327 906,838 632,204 2,916,738 9,860,057 30%

Jun‐15 720,153 2,171 643,842 606,038 903,868 2,876,072 9,911,104 29%

137


Better Quality Care

Cleaning Services

A cleaning action plan has been implemented to focus on lifting the standard of Starship public

areas. Periodic floor cleaning is carried out in evenings in public areas

Linen

There was a $54k saving on non‐sterile linen for the month of July 2015, representing

continued savings in respect of the linen rationalisation project undertaken in 2013.

As a result of the rationalisation project, linen utilisation (74%) and supply rates (98%) are

tracking close to or exceeding KPIs despite the recent high demand and occupancy levels.

A regional review of sterile linen is being proposed to reduce waste and costs on expired linen

items

Security

Parking continues to be an on‐going issue and particularly with illegal parking in evenings and

weekends with special attention is focussed on the ambulance car parks, disabled car parks,

loading docks. Additional signage is in place but security continues to tow illegally parked

vehicles.

300,000

350,000

400,000

450,000

500,000

550,000

600,000

650,000

July Aug Sept Oct Nov Dec Jan Feb Mar Apr May JuneMonth

Non Sterile Linen Values

2015/16

2014/15

2013/14

2012/13

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Food & Nutrition Project Update – Key Milestone Update

Updated milestones for the food project per the following timeline.

Food Project update:

Compass Group re‐submitted main kitchen design plans and these have been approved by the

Steering Committee.

Compass Group to submit additional information on the ward‐based kitchen plans for review

and subsequent approval by the Steering Group on 8 September 2015.

There has been continued work on ensuring operational requirements are factored into the

development of the Customer Services Statement. This will be concluded when the asset

valuations are in hand and after asset transfer negotiations.

Awaiting the analysis of cafeteria customer satisfaction survey. The data will help inform the

future service model and specification for cafeteria and retail services. This work links with the

Public Spaces project and therefore are working closely with the Quality Improvement Team

and Compass Group to ensure best outcomes.

Engaged Workforce

Cleaning Services

ACH Frontline Leadership Course – attendance is averaging 90%.

There is also growing interest in the ACH new workplace literacy course with 5 candidates

registered.

GCC Workplace Literacy Course – GCC has had a significantly higher uptake and response to the

programme overall with a graduation ceremony planned for August.

NZQA Level 3 Certification ‐ Registration of staff (students) underway. Additional assessor

training sessions scheduled later in year and will result in all other supervisors and Service

Delivery Coordinators complete this requirement.

Performance Development Review planning underway for January/February 2016.

139


Procurement & Supply Chain

The procurement co‐ordinator commenced this month with an initial focus to verify the data

from healthAlliance procurement implementation packs to the F15/F16 procurement plan to

the Auckland DHB operating budget.

Retail Concessions & Tenants

Planning is underway to discuss with retailers the adoption of the healthy eating guidelines.

Security

The changes in First Security personnel are continuing. New personnel have been inducted on

the site and rotations in positions are in progress with a strong focus on:

o Uniforms and security staff presentation

o Staff attitude and professional manner while performing duties

o Timely change‐over of shifts

o Familiarity with current duties and responsibilities

o Appointment of Security Co‐ordinator

o All staff will be issued with the new Security Uniforms.

Sustainability

The CEMARS (certified emissions measurement and reduction scheme) methodology for sizing

the current carbon footprint and data has been finalised.

The calculation of the emission inventory and developing an Emissions Management &

Reduction Plan has now been completed.

The monthly Sustainability Forums are well attended with increased awareness in reducing the

carbon footprint. Discussions with Auckland City Council and University of Auckland are

continuing.

A workshop is scheduled for 19 October 2015 to define the various aspects of the DHB’s

environmental strategy and to help develop a programme of work that will minimise risk to the

environment and reduce carbon emissions.

Discussions are continuing with theatres and other services to introduce PVC recycling and

achieve uniformity in processes for PVC recycling together with training for wards that generate

high levels of PVC waste.



Motor Vehicle – Service Review In Progress √ √ √

Motor Vehicle Fleet Strategy Not Commenced √ √ √ √ √

healthAlliance/Procurement Framework In Progress √ √ √

Supply Chain Framework In Progress √ √ √

Security Access Control & CCTV System In Progress √ √ √

Security‐for‐Safety work programme In Progress √ √ √

Security Strategy Not Commenced √ √ √

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Sustainability ‐ CEMARS Certification In Progress √ √ √

Sustainability Strategy Not Commenced √ √ √

Sustainable Transport In Progress √ √ √

Transforming Food Service Delivery Model In Progress √ √ √

Waste Transformation Project In Progress √ √ √



Food Service Project

Main kitchen design plans approved by the Steering Committee

Security

Security Access Control & CCTV Discovery phase completed at GLCC and underway at Grafton.

Independent Security Risk Assessment completed and proposal now under consideration.

CEMARS inventory of emissions data and reduction plan completed and awaiting review by

external auditors in October.


Food Service Project

If project timelines are breached, Compass Group has an alternative option to provide

Steamplicity from alternative sources if required to meet deadlines.


Area Timeframe

Cleaning Services

Staff development and training programme

On‐going

Dock Safety

Further dock review to identify potential risks

Sept 2015

Food & Nutrition Service

Finalise Design plans for ward based kitchens

Awaiting independent valuation of kitchen and cafeteria assets.

Finalise pricing for Steamplicity in Motutapu Ward

Finalise Customer Services Statement

Sept 2015

Sept 2015

Sept 2015

Sept 2015

Security Services

Finalise Access Control & CCTV discovery phase process

Sept 2015

141


Supply Chain

Improvements to receipting inwards stock process to avoid shortage of

supplies in Wards and Theatres

Inventory stock level review to reduce obsolescence/write off

October 2015

October 2015

Sustainability

CEMARS emission inventory & Reduction Plan

CEMARS on‐site audit of emissions source

Sept 2015

October 2015

Financial Results

STATEMENT OF FINANCIAL PERFORMANCENon-Clinical Support Services Reporting Date Jul-15



REVENUE

Government and Crown Agency 0 0 0 F 0 0 0 F

Funder to Provider Revenue 0 0 0 F 0 0 0 F

Other Income 756 772 (16) U 756 772 (16) U

Total Revenue 756 772 (16) U 756 772 (16) U


Personnel Costs 737 989 252 F 737 989 252 F




Infrastructure & Non-Clinical Supplies 2,246 2,208 (38) U 2,246 2,208 (38) U


Contribution (2,455) (2,445) (10) U (2,455) (2,445) (10) U

Allocations (852) (811) 41 F (852) (811) 41 F

NET RESULT (1,603) (1,634) 31 F (1,603) (1,634) 31 F



Medical 0.0 0.0 0.0 F 0.0 0.0 0.0 F

Nursing 0.2 0.2 0.0 F 0.2 0.2 0.0 F

Allied Health 0.5 0.5 0.0 F 0.5 0.5 0.0 F

Support 158.0 222.2 64.2 F 158.0 222.2 64.2 F





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Comments on Major Financial Variances Non Clinical Support Services

Result for July is $31K F. The key drivers of this are:

Personnel costs are $252K F due to vacancies. The majority of these are in the cleaning service

and are offset by outsourced personnel costs.

Infrastructure and Non Clinical Supplies are F due to linen savings.

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Community and Long Term Conditions Directorate

Speaker: Judith Catherwood, Director

Service Overview

The Community and Long Term Conditions Directorate is responsible for the provision of care of

Older People’s Health Services, Rehabilitation Services, Palliative Care Services, Community Based

Nursing and Allied Health Services and Ambulatory Services for the adult population.

The Directorate Leadership Team consists of Directorate Director, Judith Catherwood, Interim

Medical Director, Barry Snow, General Manager, Alex Pimm, Primary Care Director, Jim

Kriechbaum, Nurse Director Jane Lees and Allied Health Director, Anna McRae.

The services in the Directorate have been restructured under the clinician leadership model into six

service groups:

Reablement (in patient assessment, treatment and rehabilitation services)

Sexual Health Services

Community Services (Chronic Pain, Home Health and Mobility Solutions)

Diabetes Services

Ambulatory Services (Endocrinology, Dermatology, Immunology and Rheumatology)

Palliative Care Services

Scorecard

Women's HealthJul-15 Measure Target







Actual Prev Period









Elective day of surgery admission (DOSA) rate 82.2% % 85.0%

% Day Surgery Rate 50.3% % 51.1%

Better Quality Care

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There were three SAC 2 events in the month of July. One event is being recoded and will no longer

be classified as a SAC 2 event. There were two were falls with harm and the other related to an

event in the community. All are being fully investigated.

There were twenty four pressure injuries and thirty five falls reported in July. Fifteen (63%) of the

pressure injuries were acquired prior to admission. Of the nine acquired in the service, eight were

grade two and one was grade one.

Inhouse Elective WIES through theatre ‐ per day 6.67 >=4.5 9.00

Number of patients discharged to Birthcare 281 TBC 235






Average Length of Stay for WIES funded discharges (days) ‐ Acute 2.20 >=2 2.03

Average Length of Stay for WIES funded discharges (days) ‐ Elective 1.47 >=1.25 1.23


Breastfeeding rate on discharge excluding NICU admissions R/U % 76.4%

Cervical Screening Rate (Quarterly) * 78.7% % 78.9%

NCSP DNA rates 13.0% 9% 5.0%







Number of Employees who have taken greater than 80 hours sick leave in the past 12

months R/U

118



Engaged W

orkforce

Improved Health

Status

Better Quality Care

Amber =

R/U =

Results unavailable until after the 17th day of the month.

Number of Employees who have taken greater than 80 hours sick leave in the past 12 months

Breastfeeding rate on discharge excluding NICU admissions

Results unavailable until after the 20th day of the next month.



Note: * reported quarterly, actual value for period ending March 2015.



Result unavailable.





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The point prevalence 12 month rolling average has improved and is now within target. There is a

daily focus on pressure injury management which supports reporting and a focus on early

identification and management to aid learning and improvement.

There were seven medication errors predominately relating to documentation errors and

omissions. No harm was caused by these incidents. There has been a small increase however we

are actively encouraging areas that would not normally report, to report any medication incident,

which explains the rise in reporting.

Better Quality Care

The Directorate was 100% compliant for ESPI 1 and 2 targets. No patient waited longer than four

months for their FSA. Our Directorate is working towards reduced waiting times and is currently

achieving a maximum three month waiting time for services.

The Did Not Attend (DNA) rate for appointments is above target and remains a concern. Our

Directorate action plan to address this continues to progress and is reviewed monthly. Our initial

focus is on our Diabetes Service which has the highest DNA rates. Most of our other services have

DNA rates within target. We have set targets to reduce DNAs across our services and focus specific

attention on activities to reduce Māori and Pacifica DNA rates. Our directorate will be

implementing direct booking in all services during 2015. We also plan to review the model of care

in diabetes in 2015/16 to improve our engagement with our community to help address this issue.

The Directorate remains committed to minimising the number of patients in mixed gender rooms

and the rate in July was 1% and within target.

OPH and Rehab Plus waiting time performance and patient flow have improved since June despite

large patient volumes. Our decompression plans are in place and are being implemented as

required. Our average length of stay is improving and we are on track to meet our new stretch

targets.

Patient experience surveys have not been fully implemented across our Directorate by the patient

experience team. Our outpatient services are to begin the patient experience surveys in September

2015. Current feedback is reviewed by all staff. We are working with the patient experience team

to increase the number of patients providing feedback through this service.

Complaints are being actively managed within our Directorate meetings and action plans to address

any learning points have been created and are being monitored. There were four complaints

received in the month of July and all were responded to within the agreed target.


Performance on the smoking advice metric is 86% this month. One patient was missed but we have

identified this as a coding error, as advice was given and recorded. The Nurse Director has taken

action to address this issue in the reablement wards and we expect this to revert to 100%.

Engaged Workforce

The Directorate continues to make progress on reducing excess leave. We have reduced excess

leave by 70% in the last year. Plans to address the remaining staff with excess leave are being

made. Sick leave is marginally above target. It is being actively managed across the directorate

applying the Auckland DHB Wellness guide.

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Patient Flow and Intermediate Care Work Stream including:

Gerontology and community service presence within ED

Rapid response and early discharge team model

Intermediate care” step home” bed model

Reduce avoidable admissions from ARRC

Streamline NASC and Service Coordination process

Implementation in progress

√ √ √ √ √

Locality Service Delivery Model Planning phase √ √ √ √

Dementia Care Pathway Implementation in progress

√ √

Infusion Services Work Stream Implementation in progress

√ √ √ √

Stroke pathway and development of integrated all age services (in partnership with Acute Medical Directorate)

Implementation about to commence

√ √ √

Regional Sexual Health Service change programme Implementation in progress

√ √ √

Ambulatory Out Patient Service Improvement work stream


√ √ √ √

Directorate operational performance and savings programme including:

ACC revenue

Skill mix and cost per FTE

Leave Management

Service and job sizing

On going √

Directorate structure review to implement clinical leadership model


√ √ √

MOS Implementation Programme Implementation in progress

√ √ √



The Directorate is currently working through the final stages of the recruitment process to the

new service leadership roles as a result of the restructuring and development of the clinician

leadership model. Orientation of our new service leaders took place in early August 2015.

We welcome Alex Pimm, as our new General Manager.

A new project to support an integrated diabetes service model with Auckland PHO has

commenced. This project begins a process of diabetes service integration between primary and

secondary care.

The “step home” bed pilot, supporting older adults through rehabilitation pathways prior to

final decisions about long term care has commenced. This scheme is a pilot within existing

resources and will be fully evaluated.

147


Workshops have commenced to support the development of the locality service model for

home health and community services. All stakeholders are being engaged in this planning

process including primary care, funding and planning, aged care and home based support

agencies.

Administration services within community services have been reviewed and a revised structure

has been proposed. A consultation process has commenced.


There has been an increase in number of complex patients requiring home based support. The

pathway for patients has changed to incorporate a short term phase of home support prior to

finalising long term care packages. We are evaluating this scheme at present but early

indications are the process does reduce the need for highly complex home care packages in the

longer term.

DNA action plan for the Directorate has been developed and is being implemented across all

services.

Leave management is being monitored on a weekly basis, specific targets have been set in high

risk areas and action plans to address high leave balances within teams are being put in place

across the service.

A number of our services use HCC to record activity. There are no clear business rules in place

to ensure the services record activity and volumes accurately which has an impact on revenue,

funding, projection planning and understanding patient flow. A plan has been developed with

Business Intelligence to address this issue.


Complete recruitment to the Directorate Leadership team.

Implementation, orientation and development of the revised Directorate structure which

introduces the new clinician leadership model. A key priority for our directorate is the

development of clinician leadership skills and capability.

Embed management operating system across the directorate at service and ward/team level.

Continue work on the Directorate Work Programme with partners across the sector and develop

the Directorate Strategic and Clinical Services Plan.

Further development of community services through the development of the locality model.

Detailed planning has commenced. This will reduce duplication of effort and enhance

community responsiveness.

Continue the development of work streams to improve the quality and outcome of the patient’s

journey including intermediate care, avoidable admissions, dementia care and the stroke

pathway.

Development of a capital planning programme for the Directorate and the facilities our services

utilise. A number of our buildings are in need of refurbishment. Plans for refurbishment have

been drafted for OPH, Rehab Plus and ambulatory and community services based at Greenlane.

Our future requirements need to be informed by our clinical services plans and support a whole

of Auckland DHB approach.

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Develop improved performance within our ambulatory services through a combination of

enhanced production, demand and capacity planning, benchmarking and quality improvement

to create sustainable, accessible services within available resources.

Financial Results


The YTD result is $657k F.

Revenue YTD is $247k F mainly due to high ACC income. Patient occupancy and volumes have been

high in the Reablement service.

Overall Price Volume Schedule (PVS) volumes are below base contract at 97% YTD. This equates to

$221k below contract of which a significant proportion is linked to a planned service change in

Sexual Health. This is not recognised in the Directorate result.

Total Expenditure YTD is $395k F. Significant drivers of this are:

STATEMENT OF FINANCIAL PERFORMANCEAdult Community and LTC Reporting Date Jul-15



REVENUE

Government and Crown Agency 1,310 1,063 247 F 1,310 1,063 247 F


Other Income 40 21 20 F 40 21 20 F

Total Revenue 7,774 7,507 267 F 7,774 7,507 267 F





Clinical Supplies 654 725 71 F 654 725 71 F



Contribution 2,942 2,279 662 F 2,942 2,279 662 F

Allocations 371 366 (5) U 371 366 (5) U

NET RESULT 2,571 1,913 657 F 2,571 1,913 657 F



Medical 67.6 70.2 2.6 F 67.6 70.2 2.6 F

Nursing 276.9 273.1 (3.8) U 276.9 273.1 (3.8) U

Allied Health 124.7 132.7 8.0 F 124.7 132.7 8.0 F

Support 0.0 0.0 0.0 F 0.0 0.0 0.0 F





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Personnel and Outsourced Personnel combined of $330k F due to 9.2 F in FTE. The budget

phasing is also favourable in July. Recruitment to new budgeted roles will result in FTE coming

back to budget in August 2015.

Clinical Supplies are $71k F mainly due to under budget expenditure in Immunology Blood $28k F

and Rheumatology Pharmaceuticals $27k F. These fluctuate significantly with patient acuity and

volumes.

Summary

The Directorate has developed a significant transformation and change agenda ahead. A key feature

of our plan is the development of the clinician leadership model and enhancement of leadership

skills at service level.

Other improvements are linked to integration of services across the directorate, the provider arm

more broadly and with primary care, enhancing equality of access, increasing intermediate care

provision and rapid response services, and improving our response through integrated locality team

working. Our Directorate continues to strive for service improvement including, a further reduction

in waiting times, improvements in patient flow, improved community service capacity and response,

reductions in leave liability, and improved chronic disease and long term health outcomes. Our

strategy and plan continues to be developed and will inform future reports to HAC.

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ADHB Inpatient & Outpatient Values Report August 2015: 1

Aim high - Angamua We aspire to excellence and the safest care One of our four values is to Aim High - Angamua: We aspire to excellence and the safest of care.

In the latest quarter we have continued to demonstrate improvement with now over half of both inpatient and outpatient respondents rating their overall care and treatment as excellent (see time trend graphic, below left).

Aim High is about aspiring to provide exceptional care without exception. This means uncompromising excellence. There are many, many examples in the patient experience surveys where patients have described exceptional care.

“The ward blew me away - across the board from the surgeon, doctors and nurses everyone (particularly the nurses and my surgeon/consultant) were phenomenal. It was not only the nurse’s highly professional, consistently safe, highly skilled care that was amazing, but also their compassion-made my hospital stay - best it could have been under the circumstances. Phenomenal care on this ward!”

However, there are also examples from our patients where we fall well short, such as reports of staff complaining to patients, or to colleagues within ear-shot of patients, about their workload, duties, or other staff members.

Patients considered their experience to be exceptional when:

• They feel fully empowered to make informed decisions about their care and treatment;

• We welcome the people they turn to for support, including them in discussions and allowing them to stay alongside them;

• We show empathy and compassion, particularly at times they are feeling worried, upset or vulnerable;

• We tailor our communication to the patient – e.g. providing simple, clear information to children;

• We work together as a team.

“All the staff, doctors, nurses, even the cleaners I found exceptionally pleasant, kind and caring. I consider myself very lucky to be born in a country that has such a great health system.”

Patients understandably want to see staff aspiring to excellence and the safest care. Delivering to that high standard is something to be celebrated and proud of.

Tony O’Connor, PhD Director of Participation and Experience

WHAT MATTERS MOST A very efficient and effective way to make a positive difference to a patient’s experience of care is by focusing on what matters most to the patient. Evidence shows that improving experience positively correlates with improvements to quality and safety of care. See A systematic review of evidence on the links between patient experience and clinical safety and effectiveness Doyle, Lennox, Bell. BMJ Open 2013;3

45% of respondents to the outpatients’ survey say having confidence in their care and treatment is 3rd most important to them (Information is most important, Organisation of care is 2nd). Most of these respondents (85%) rate their confidence in the quality of care as very good or excellent (8-10 on a scale 0 -10).

How confident are patients in the quality of care?

4 11 85 Poor Moderate Very good

42% of inpatient survey respondents say that the coordination of care is the 3rd most important factor to them (Communication is 1st, followed by Confidence in quality and safety). Most of these respondents rate coordination as very good or excellent (8-10 on a 10-point scale)

How is the coordination of their care?

7 21 72 Poor Moderate Very good

Patients’ experiences: Aim High Auckland District Health Board – Inpatient and Outpatient surveys

Excellence: How are we doing? Inpatients rated care as excellent (%)

*Difference is significant (p <.05)

Outpatients rated care as excellent (%)

*Difference is not significant (p >.05)

45 48 49

52

Sep-14 Dec-14 Mar-15 Jun-15

53 55 55 55

Sep-14 Dec-14 Mar-15 Jun-15

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ADHB Inpatient & Outpatient Values Report August 2015: 2 – Aim High | Angamua

Empower patients - fully

Aim high - Angamua The last of Auckland DHB’s core values to be covered in these reports is Aim high – Angamua. This value is about aspiring to excellence and the safest care.

Back in March 2013, we looked at the qualities that differentiate good/very good and excellent care (inpatients).

Those who rated our care and treatment as excellent said that staff:

• responded to them individually and understood their needs; • interacted with them in a warm and friendly manner; • were caring and kind towards them and showed compassion; • appeared to be genuinely concerned and interested in their welfare and wellbeing; • were motivated by this compassion to provide great care and treatment, make them comfortable,

and reassure them; • were helpful, responsive and anticipated their needs; and • worked well together.

This report focuses on the qualities that our patients are telling us differentiate excellent and exceptional care, and on our patients’ views on the safest care.

WE ASPIRE TO EXCELLENCE AND THE SAFEST CARE

Patients want to feel empowered to make the best decisions about their care and treatment. They consider care to be excellent when staff listen to them and provide them with quality information relevant to their situation and circumstances. They ask that staff allow them time to consider the options before making a decision, and if necessary discuss it with loved ones. This allows them to make their decisions with confidence. Ensuring patients have access to available options, information, along with time to consider it and discuss it with staff, family and friends, and make a decision which is respected, is more likely to be seen as empowering, and exceptional care.

“No words can describe how skilled, patient, and empathetic my anaesthetist taking care of me in theatre was. She helped me make the right decision about my care at a time that I was too ill to. She explained all the risks of the different options available, and told me the stats of each risk which really helped me feel confident in the choice of treatment I made. She also really listened and acted on my concerns about the type of pain relief I got post-surgery.”

“The doctors and nurse specialist were excellent. They took their time to listen and explain things. I felt they considered me as an individual and my specific situation. They gave me time to think matters through. They didn't pressurize me in any way when making my decision. They appeared well informed in their field.”

Patients do not appreciate it when staff do not give them the information they need to make a decision, nor the time they need to consider the information and make an informed decision.

They rate their care and treatment poorly when they believe that staff are making decisions on their behalf, or not fully explaining the options available to them.

“A decision on treatment had already been made - it was clear that the doctor had a preference, and there was pressure to accept her choices rather than mine.”

“I felt rushed to make a decision, perhaps while waiting I could have been given written information on the condition and options for treatment and consequences of non-treatment.”

“I think people should be offered options when it comes to treatment/small procedures. If they are uncomfortable with a procedure, there should be discussion about what else/what sort of other procedure or action could be taken. Even if the Dr thinks one course of action would be the 'best', if a patient is uncomfortable with that course of action an alternative should be suggested or found - even if that means it the result will take longer or include more steps.”

“I feel very powerless when I am just thrown the next treatment round and people forget I have a choice to proceed even if there are no other options.”

WHAT OUR PATIENTS APPRECIATE WHAT OUR PATIENTS DON’T WANT TO SEE

ADHB Inpatient & Outpatient Values Report August 2015: 2 – Aim High | Angamua 152

Enable patients to access support


Patients want support from their friends and whānau/family. These are the people patients turn to when making decisions about their health and treatment. They are also the people patients turn to when they need support.

Staff actively involving patients’ loved ones in conversations, and allowing their loved ones to stay with them and provide support makes for an ‘excellent’ experience.

Making sure their loved ones were made to feel welcome, comfortable or offered support is more likely to make it an ‘exceptional’ experience.

“The unit I was in couldn't do enough for me I will be forever grateful to them. Being away from home and under harrowing circumstances the tender care helped immensely. My partner needed to find accommodation close to the hospital and the Nurses assisted with this giving suggestion as to hotels nearby.”

“As a mum with a daughter with severe disabilities I felt we were both taken care. The watcher over night was invaluable as I could function to do all my daughters day cares. I also learnt a lot from the nurses and staff and this will help my daughter in the care I provide with her health needs. 5 star rating on ward.”

Patients do not want to see their family members treated rudely or ignored.

“The doctors/registrars didn't give me a very good say in my care, never listened to the important things I had to say. They were even rude to my parents.”

“I found my consultant quite rude to me and my family at times… She didn't like being questioned by my daughter.”

“Every time we had to re-schedule, the scheduling lady, made us feel pressured as if she was doing us a favour and we were a burden to her. She acted consistently short and even rude on a couple of occasions – there was even a moment where I had to ask her not to be rude. I did not feel welcome or respected - neither did my wife - on these occasions.”

Family members are concerned when they are not included in the care of children, aged relatives or those with conditions such as dementia.

“When you are treating someone who also suffers dementia communicating with family would be intelligent one would have thought.”

“As primary care giver for my 90 year old aunt, I would have liked more information about her state of health & what was happening. I made sure I was there when the doctor did his round, otherwise I wouldn't have known anything.”


Show empathy – at vulnerable moments

Patients appreciated being shown empathy, particularly at vulnerable moments. Empathy was often shown through an acknowledgement of distress, or through small acts of kindness or reassurance, such as a hand squeeze, or reassuring comment. Patients felt that staff went the extra mile. Patients felt that these acts, at times of vulnerability, lifted care from great to exceptional.

“I apologised for crying. He just asked me ‘what has you most worried?’ which I thought was a great question to ask as it helped to put me at ease and acknowledged that I was upset without dwelling too much on it.”

“The nurse [named] related really well to my son and was fantastic distracting him as well as making him laugh even when he was sore. His surgery went longer than anticipated and she stayed 20 minutes after her shift to try to see him and calm my nerves - most definitely committed. All of your nurses were exceptional but she is who my son still talks about...”

Patients do not want to feel forgotten, that they do not matter, or that their requests are annoying to staff. They want to be a priority at times of vulnerability. For example they do not want to have to wait unnecessarily long periods for critical test results and/or diagnoses.

“During busy periods I felt forgotten of my requests and needs.”

“I wasn't showered for 3 days because the nurses were too busy, I was upset by this. Some of the night staff through the night were not very kind and made me feel like my requests to the toilet was annoying. I was told to hang on when I asked to go to the toilet one night so unfortunately urinated a little in my pants.”

“Do you have any idea how insane a person goes from discharge, knowing they have cancer, and not knowing the diagnosis for weeks and weeks until the first oncology specialist appointment? It’s just cruel not knowing what you’re dealing with.”


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WHAT OUR PATIENTS DON’T WANT TO SEE

Tailor care and communication – clear and engaged

Patients and their families appreciate it when the communication and care is tailored to the needs of the patient. For example they appreciated it when staff talk to the children directly using clear, child friendly language. Similarly, those with a medical background or long term conditions want full and detailed medical explanations.

“Great communication and the doctor spoke to my son at his level and explained everything very well.”

“All the doctors and nurses are amazing with children. While dealing with my son in Ward 27 they met his needs. He's a very shy and withdrawn child who finds it hard to trust strangers and nurses (they have the needles) but they did their best to try keeping him comfortable. Amazing.”

“Doctor [named] always involves my child in the discussion and decision making.”

Patients do not like it when they perceive staff to be condescending or rude, nor when they are not given information that will help them make decisions.

“The doctor that initially sent us home was vague and condescending.”

“The nurse gave me a very short, jargon, acronym filled explanation basically summed up with 'not a big deal, it's all OK now'. So I'm still not certain what DID happen.”

“Doctors need to talk to elderly patients instead of amongst themselves in front of them. They may have bodies that don't work so well but have a mind and need to be informed.”

“It’s about people sick people; they see you, hear you, not always understand you. Do you see them, hear them, and do you always understand them.”


A team effort from everyone at the hospital or clinic

Patients consider their care to be exceptional when everyone, from the receptionist to those delivering meals, is warm, friendly and treat them respectfully.

Every person working at the hospital or clinic has an impact on the experience and helps to make it exceptional.

“My care was simply outstanding and I will never cease to be grateful for this. This care started with kindness of those who delivered meals and drinks, the cleaners, the incredible nurses, the specialists and their team and finally the hospital admin. staff.”

“Everything was 'particularly good' from the lovely tea lady, the Energiser bunny of a cleaner, to the nurses who have a genuine empathy and a well-developed sense of humour (well, most of them) and the doctors who have adapted (once again) a more holistic healthcare manner and a genuine desire to assist people like me.”

“My handsome doctor, the anaesthetics team, nurses, cleaners (I just don't know the right word to describe them). They were AWESOME and I fell in love with all of them for their kindness. I wouldn’t use the word good to describe the hospital care, caring, superb and the list goes on.”

Patients do not appreciate any staff with a grumpy or unfriendly disposition, or those who lack compassion.

They do not want to feel that they are an interruption to staff’s day rather than the reason for staff being there.

“Some of the staff who deliver meals are really grumpy - seemed to be a "throw and go" situation.”

“The cleaning staff were really rude and would walk straight into my room and open the curtain without calling out or asking if it was ok. Twice I had two different male cleaners walk straight in while I was undressing or having the nurse examine me and I was half naked both times and then didn't apologise or say anything just continued around the room while I tried to cover up until they left.”

“Reception staff should not be grumpy with us, we have enough to put up with don't need rudeness or be giving the impression we are an interruption to their day.”

“The nurse on the ward was less than helpful when we were worried about the length of time it took my daughter to come out of recovery. She behaved in a way that showed we were interrupting her and that she was bored having to deal with us. It was disconcerting and increased my level of anxiety unnecessarily.”

WHAT OUR PATIENTS APPRECIATE

ADHB Inpatient & Outpatient Values Report August 2015: 4 – Aim High | Angamua 154


The safest care

Patients are saying they feel safe when they have their questions answered, are given full information about their options, care and treatment, and the information is consistent between staff members.

“You have to have trust and confidence in your care and treatment or you will become very uneasy and feeling a bit scared. You have to be relaxed and assured and feel safe.”

They are more likely to consider their care to be exceptional when in addition to this; they feel all staff are working together as a professional team, from the receptionists through to the cleaners, to provide a safe environment.

“The receptionist nurse & anaesthetist were professional friendly caring and centred on ensuring all areas of care required were sorted so I could have my surgery the following week. I found the staff especially the anaesthetist very reassuring and kind, answering all my questions and providing me with the information I needed to feel confident and reassured. I walked away from the clinic feeling I was in safe competent hands.”

“What gave me confidence was the professionalism from the receptionist, the nurses. The anaesthetist, the doctors, the surgeons, everyone. It was good to feel that I felt safe and that I had confidence in the people that were caring for me.”

Patients are also concerned about hygiene and the cleanliness of the facilities, including toilets, bathrooms and waiting areas. They notice when staff pay attention to hygienic practices such as hand washing.

“They used the safety gloves before injecting IV or taking blood samples etc.”

“High standard of hygiene from all staff as well as the facilities. Cleanness is priority in my eyes as a lot of people are ill at hospitals and it's important to keep the environment clean for everyone's safety and well-being.”

Patients are asking staff to be responsive when they express concerns about their safety.

“Everything was fine and very efficient. Everyone gave the impression of being on the top of their game and were about providing the best care and service they could and minimising any potential for errors and mistakes. Post operation care by the nurses was particularly good. I was also surprised and delighted at the positive response I received when I pointed out something which caused me concern and asked if (the specialist) would take a look at which he was only too pleased to do.”

Patients feel unsafe when they are not listened to, their decisions are ignored, or they are given conflicting information.

“Each Dr came in with different treatment plans and changed what the last had done. Also the nurse had an argument with the Junior Doctor in front of me - I found this very unprofessional.”

“Seeing specialists from many departments gets confusing as often they give you conflicting information. It would be good to have an overall care plan. I have a good medical knowledge so I can usually work it out for myself but if I didn't conflicting treatments could be dangerous.”

Patients are also concerned about hand hygiene and the hygiene and cleanliness of clinics and wards.

“I am sure staff washed hands but it should be done in front of patient/ carer more. Patients today are so worried about picking up hospital acquired infections if gives reassurance when you see it being done. I did see lots of nurses walk in rubbing hands so you knew that had used sanitation outside the room.”

They do not appreciate it when staff are not responsive to any safety or hygiene concerns that they have, or if they fail to apologise for mistakes.

“The nurse came to do a dressing in the room with gloves on - she had touched her hair, the curtain, picked something up off the floor and then proceeded to remove my wound packing and undertake (an examination). When I asked her to stop and put on clean gloves she argued with me and said that she didn't need to. I withdrew my consent until she had done so, which caused me distress and embarrassment.’

“On the day of arrival in ward, toilets had no toilet paper, no soap, no paper bin and no hand sanitizer although you displayed signs warning of dangerous bugs and the need to use sanitizer. I informed staff but nothing was done all that day and only the next morning they provided just only the toilet paper, the other items mentioned were never attended to. When a floor cleaning person came into the ward she only swept along the middle of the ward leaving blood stained plasters and bits of dressings around the beds.”

“Doctors should never ever say things like that is just how the system works when appointments for referrals were lost and not made, that is not good enough and I am a living person, don’t care about systems, my care should be paramount and if an oversight was made it should be corrected not excused.”


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Patients’ experiences: Togetherness

ADHB Inpatient & Outpatient Values Report July 2015: 1

Together – Tuhono We are a high performing team This month’s report focuses on how well care teams work together. It is clear reading the comments presented in this report that care teams need to be seen and heard to be working well together for patients to feel as though they are receiving safe, high quality care. Further, they want to feel they play their due-part in those conversations and decisions. There are many quotes from our patients that demonstrate care teams and patients were working well together, but there are also some concerning quotes to the contrary. See inside.

As the quotes from our patients in this report show,a high performing team is one that:

• Shares information • Communicates, collaborative and consults • Achieves as a team - colleagues, patient and

family • Celebrates success and recognises others

What nobody want to see is a team:

• That is micromanaged • Blames others • Competes at the expense of the patient or

other staff • Works in silos

I remember a comment made by our Chairman of the Board several years ago; to paraphrase Dr Levy, he said what we need is an organisation of high-performing teams, not an organisation of high performing individuals. And that is what our patients say they need; they need everyone from their scheduler, their GP, their consultant, their nurses and everyone else involved in their care to work as a team. Even if those individuals are absolute stars at their jobs, if they do not work together as a high-performing team, patient care will be compromised. Read on to see what our patients say about how well we work together.

Tony O’Connor, PhD Director of Participation and Experience

WHAT MATTERS MOST If we focus on what matters most to patients we can make a positive difference to their experience of care. Whilst communication is most important to our inpatients and information is most important to our outpatients, other dimensions that also make a difference to patients care and treatment are:

More than half of outpatients (55%) say organisation, appointments and correspondence makes a big difference to the quality of their care and treatment. See our earlier report on organisation.

How are we doing on organisation?

6 19 74

Poor Moderate Very good

45% of inpatients say that feeling confident about the quality of their care and treatment makes a difference. See our earlier report focusing on confidence.

How confident are our patients?

7 20 73

Poor Moderate Very good

Togetherness: How are we doing? ‘Togetherness’ may be best decribed in the dimensions which look at consistent and coordinated care, all of which have remained steady, showing minor fluctuations over the last 12 months. Consistent and coordinated care whilst in hospital (inpatients)

Coordination of care between home, hospital and other services (inpatients)

Coordination of care (outpatients)

7.8 7.8 8.2 8.2

Jul- Sep 2014 Oct - Dec 2014 Jan - Mar 2015 Apr - Jun 2015

6.9 7.1 6.6 7.4


7.3 7.7 7.6 7.5


Auckland District Health Board – Inpatient and Outpatient surveys

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ADHB Inpatient & Outpatient Values Report July 2015: 2 – Together | Tuhono

Togetherness - Tuhono Over the past 12 months 42 per cent of inpatients say that the coordination of care in hospital and after discharge (12%) are two of the things that make the most difference to their care and treatment.

Similarly, 20 per cent of outpatients say the coordination of care between the clinic, GP and other services are components of care that make the most difference to their care and treatment.

Their comments show that they want us to be working as a high performing team. Their comments also provide us with important insights about what working as a team looks like from their point of view, and how we can improve.

It is noted that of the 1821 patients who commented on our teamwork (coordination of care) between 1 July 2014 and 30 June 2015, almost two-thirds of the comments (62%) were positive. Of the remainder one quarter (24%) were mixed, and the rest (14%) were negative.

So what does working together look like from our patient’s point of view?

SHARE LEARNING, COMMUNICATE, COLLABORATE AND CONSULT

Of the 1821 patients who commented on our teamwork between 1 July 2014 and 30 June 2015, almost two-thirds (61%) commented on aspects of our values of “share learning”, and “communicate, collaborate and consult”. Whilst most had a positive experience of care, there are areas for improvement.

Note that the percentages in the headings refer to the percentage of patients who have commented over the last twelve months (unprompted) about this particular area of their care and treatment.

Teams work on the ‘same page’

The clinical team (working with the same condition) are on the same page about the patient’s history, condition and care plan and knows what their jobs are.

• Good handover between nurses is critical • Doctors/nurses have read clinical

records, know the patient’s history and what has previously been decided

“At all times, with movement between all services involved, it was clear that each different department was fully aware and up to the minute, on the state of my treatment progress.”

“I had a number of different doctors treating me and they all were in communication with each other.”

“Getting the same message from the doctors and the nurses about my treatment was really good.”

The interaction between the specialist nurses and the drs was fantastic. I felt like they were on the same page and gave consistent information and advice. It was a stressful shocking time but they totally understood what we [were] going through. I don't think I would have coped if it wasn't for their care.”

Staff have different ideas about a treatment plan. This occurs when:

• Conflicting information is given to the patient,

• There are conflicting ideas among colleagues about the best treatment course

• Patients having to remind doctors of other treatments decided upon.

“I received conflicting answers from various professionals however no one could answer this consistently and organising time off work was a nightmare. I wish they would all be on the same page in how things work and if they did not know...that would be fine also.”

Staff don’t know the patient history; Clinical records are unread, patients have to repeat information, and patients have to remind doctors of things other teams have done.

“There seemed to be a different doctor each time, so there was a need to explain yourself each time. So you got the feeling that either these explanations were not recorded, or if they were, that they were not read. This lead to a feeling of inconsistency and lack of coordination.”

WHAT OUR PATIENTS APPRECIATE (18%) WHAT OUR PATIENTS DON’T WANT TO SEE (13%)

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Share learning, communicate, collaborate and consult (cont…)

Staff are informed and keep others informed of patients’ treatments, results and further needs for care.

“Prior to being despatched the doctor phoned my GP, appointments were made with outpatients urology, renal, district health nurse and dietician.”

“Although the staff members are on shift work I didn't feel like I was repeating myself to different members of staff, they seemed well informed and up to date on my condition…”

Share information

GPs are not updated about their patients, and they do not (or are slow to) receive test results, discharge summary or medication changes etc.

“Just recently I had some issues with my local GP about medication we had got at hospital which was not relayed to our GP. It was an issue as we required more. It took over a week to finally get the script.”

“I informed my GP of my clinical visit. Following this (10 days later) I tried to explain what was to happen next. Surely a letter from the specialist to the GP would help the GP to help me.”


Seamless coordination between staff and teams

There is seamless coordination between different teams, for example working on different conditions or across different departments. Examples include when staff:

• Consult for advice or extra information • Understand each other’s current treatment

plans and check they don’t interfere • Have a clear division of responsibilities

“As a patient with a complex medical history, it is extremely important that different specialists consult each other on any decisions.”

Staff work in silos, don’t take notice of other teams who have worked with the patient, don’t work with other teams currently treating the patient, and there is confusion over which department is responsible.

“My son has complex medical needs and each speciality team only focus on their bit so it means there is no integration… (each team) expect us to follow their plan even though we are juggling multiple hospital plans. It also means that we end up having multiple visits.”


Correct and complete clinical records and test results

The complete and correct test results and clinical records are accessible to staff across the different departments and services when they need them.

“All the staff involved were well informed and the record keeping made that possible.”

“Test results are shared with those that need to know.”

Clinical records are left incomplete, are incorrect, test results are inaccessible or received late, patients have to repeat basic information and answer the same questions without explanation.

“I told them about my insulin times and doses but this information didn't seem to make it upstairs to the ward.”


Connection between services

Staff ensure patients are connected with other departments or expertise who can assist with their care.

“Doctors from different disciplines visited me as my health condition was determined.”

Patients have to follow up departments or other services alone OR do not get other services at all.

“I asked my nurse about getting additional pain relief when my pain pump had been removed and she said the pain team would be visiting me later that day and would sort it out. But they never did visit (I was there another 3 days).”


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ACHIEVE TOGETHER AS A TEAM – COLLEAGUES, PATIENTS AND FAMILIES

Follow up is followed through

Referrals, appointments, procedures and follow ups easily scheduled, communicated/reminded and followed though.

“The different aspects of my recovery clicked together like clockwork, each aspect & service following each other.”

It is difficult to get an appointment, test or procedure done, there are constant changes to appointment schedules, cancellations, having to 'chase' administration staff, not being informed of appointments, long wait times between procedures or testing due to miscommunication, conflicting appointments, and appointments are not booked.

“Previous appointments have only occurred because I followed up. Twice I've had referrals go missing…”


Next steps are clearly communicated

Patient conditions, results, care plans, procedure steps and post-care steps are clearly communicated to them (and their families) and they feel reassured and confident. Examples of this are when handover is done in front of the patient, and correspondence between GP/specialist is seen by the patient.

“At each step there was paperwork (notice of appointment etc.) which gave me an idea of what was coming and what to expect when I got there. Then everyone was clear about the next step as I went through the process. Nurses and doctors communicated with each other such that I didn't have to repeat myself too many times and when there was a need to repeat anything they had already told me this would be the case so it didn't [faze] us.”

Patients don't know what the next step is or understand what is wrong with them, the patient lacks confidence in the treatment plan, the treatment is changed and not communicated to the patient, they are unsure who is looking after their care, and unsure if GP is getting all the information and is involved in their care.

“I would like to have a doctor discuss my treatment options before a nurse just walks in with my medication that I haven't been told about or had a chance to discuss previously.”

“I have no idea of what will happen next. When is my next appointment?”

“It would help to make it very clear what is required of me and what the next step is and when I could expect to be operated on.”


Patients are listened to

Patient experiences, perspectives, questions and care wishes are listened to, addressed and respected.

“The team ethos among the staff was evident and consequently I was made to feel part of the team.”

“The Dr … looked me in the eyes as I spoke about my fears and deeper reasons for coming into the hospital. She didn't judge me. She had clear compassion just because of the listening skills….”

Patient requests are ignored or not followed through, patient questions are left unanswered, or staff inappropriately query patient decision.

“Doctors seem inconsistent despite receiving same tests i.e. mri scans, yet coming to alternate solutions. As a patient I felt bullied into undergoing a surgery despite not feeling 100% comfortable with the doctors in charge as they were constantly changing and didn't know what was going on. It decreased my trust in those that would potentially be opening my body as I didn't feel they would do/be able to do what was necessary to ensure minimal damage.”



More than half (55%) of the 1821 patients who commented on our teamwork between 1 July 2014 and 30 June 2015, commented on the way we “achieve together as a team – colleagues, patients and families”.

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ACHIEVE TOGETHER AS A TEAM – COLLEAGUES, PATIENTS AND FAMILIES (cont…)

Appointments and plans are coordinated

Patients and family personal situation (financial, geographical, time commitments, family support) taken into account when deciding treatment plans/details.

Examples of this include: • rescheduling appointments so timing works

better/patients don't have to travel as far • informing patients of the costs or cheaper

options if financially struggling • waiting for parents to arrive at hospital

before doing child’s morning rounds

“When we were told my daughter needed to see another specialist the senior consultant went out of her way to make sure that this daughter would see the same specialist my other daughter sees and on the same day to make it easier on me.”

There are multiple conflicting appointments, patients are stressed financially or for time, the patient’s living situation or support network upon discharge is not taken into account, and family visitation denied e.g. after they travelled a long way.

“I attend a few clinics and would like them to be more co-ordinated so that either attend more than one on each visit or spread them more apart. I have been to the clinics 4 times in the last 4 weeks.”

“Prefer appointments scheduled on the same day , already run out of sick and holiday pay after surgery......”



Patients are treated like people, not numbers

Patients like it when they are treated like a person not a number. When this happens, patients feel respected, supported and cared about.

“Pleasant staff treated me, an elderly lady, as an intelligent person, able to comprehend anything spoken about.”

“My family were made to feel very welcome and were encouraged to support me. It really helped to have them there. The doctors and nurses even learnt their names! That meant a lot to me and to my family.”

Patients say they are left without knowing who they are being seen by or when they are being seen, patients’ names and details are wrong, they feel rushed, receive rude treatment, feel like they are on an assembly line, or their private medical issues are discussed in public spaces.

“On one particular night my pain was extreme - she (the nurse) did not care, argued with me, said she would get a doctor and then did not bother further for over 3 hours, while I lay in my bed crying in agony.”


Care is consistent

Patients appreciate it when they have a consistent team and feel like they know who are caring for them. They like it when they are introduced to staff at shift change or when new staff join the team, and when the same physicians and nurses are caring for them, day after day.

“It was great that I had the same Dr from my original problem right through to the latest procedure. It really built my confidence level in the plan of care he came up with, because he knew my circumstances. In fact, I think this was the key to this being such a positive experience for me.”

Patients comment negatively when they feel passed from one person to another, there are 'too many' different people caring for them, an unknown doctor performs treatment, or they don’t know who is responsible for care.

“We had little continuity of care. There were far too many different doctors and nurses in a short period of time. Most of them had differing points of view and different ways of doing things. It was EXTREMELY distressing… We were promised things that never happened. During Dr rounds he said to get certain things but they never eventuated. We chased but they still didn't happen. The hospital system has failed us on many levels and we are angry.”


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Participation and Experience Update

Recommendation

That the Hospital Advisory Committee:

1. Receives the Participation and Experience Update report for September 2015.

2. Recommend to the Board that:

a. It endorses the creation of a composite Net Promoter Score based on existing

Patient Experience Survey measures.

b. Auckland DHB makes its Patient Experience Survey results publically available.

Prepared by: Dr Tony O’Connor (Director of Participation and Experience) Approved by: Dr Andrew Old (Chief of Strategy, Participation & Improvement) Endorsed by Executive Leadership Team: Tuesday, 08 September 2015

Glossary NPS: Net Promoter Score FFT: Friends and Family Test PES: Patient Experience Survey

1. Executive Summary

Work is underway to bring a sharper and stronger focus to improving patient experience and provide

more meaningful opportunities for patient and family participation.

We recommend using the overall experience rating scale in our patient experience surveys (i.e.: both

the inpatient and outpatient surveys) to create a Net Promoter Score (NPS). The score would be

derived using NPS methodology.

We have excellent, valuable data on patients’ experiences at Auckland DHB. The monthly patient

experience survey reports show that we have a lot to be proud of and that there are things we can

improve on. In the interests of transparency we recommend that we make our monthly reports

more widely available, including to the public.

2. Participation and experience work programme

A workshop was held on 7 August 2015 with consumers, staff from Counties Manukau DHB and

Waitemata DHB, and members of the executive team, clinicians, service managers, volunteers and

others from Auckland DHB. Feedback on the workshop has been positive, including from this

consumer representative who said

“… thank you for including me as a participant in your workshop on Friday. It

was a wonderful opportunity to interact with a group of people committed to

reshaping the existing paradigm to deliver healthcare.”

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The Participation and Experience team is now writing up the workshop feedback under 6 themes shown to be critically important to making gains in patient experience and participation in care:

1. Leadership, vision and culture 2. Involvement of patients and families 3. Measurement and feedback 4. Supportive built environment (spaces and places that work for people) 5. Supportive human interactions, communication and technology 6. Working with communities

We will define a multi-year work-plan that addresses the 6 themes listed above. Note that we have a

strong track-record in some areas e.g.: patient experience surveys, co-design, working with

particular communities especially Tamaki/GI, but some of current activity needs additional support

and/or refinement and some new activity needs to be introduced. The work-plan will ensure:

1. We know what Aucklanders want

o We ask people what matters to them and involve them in re-orientating and improving services and facilities where needed

2. What matters most to each patient comes first o Patients know better than anyone what is going on in their lives to make them

unwell and what needs to happen for them to be well. We listen and deliver to that 3. We know how well we are doing

o We know how much good we did/ value-based outcome measures that include patient self-assessment

The work-plan will have a special focus on addressing inequalities, by ensuring we work with

patients and communities with the highest risk and disease burden.

3. Use overall experience rating as the ‘net-promoter score’

The net promoter score (NPS) is designed to measure the extent to which users of a product or

service would recommend it to others.

It does this by asking:

"How likely is it that you would recommend our company to friends or colleagues?"

Typically respondents are asked to score the organisation concerned on an 11 point (0 to 10) scale.

The NPS score is calculated by simply subtracting the percentage of detractors (i.e.: people who rate

the service poorly) from the percentage of promoters (i.e.: from those who rate the service highly).

The ‘passives’ (i.e.: those that fall somewhere in between) are ignored. The equation delivers a

simple numeric output anywhere in the range -100 (all detractors) to +100 (all promoters). The basic

premise is that Promoters are highly loyal, advocates of the organisation, whereas detractors are at

risk of being lost to competitors - hence a higher score indicates a more satisfied customer base.

Recently the NPS has been applied in healthcare, most notably in the UK, as the ‘Friends & Family

Test’ (FFT). The Care Quality Commission in the UK commissioned Picker Institute Europe to identify

the best single ‘overarching’ question to ask patients and service users about their experiences of

healthcare. They specifically tested NPS style questions and despite revisions and re-testing the

focus on recommendation failed time and again.

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They concluded that:

“We do not recommend the Net Promoter Score for NHS use. Interviewees reacted badly to

the concept of ‘recommendation’, particularly in the mental health setting, and a number of

interviewees misunderstood what the question was asking.”1

For instance, in terms of misunderstanding, some respondents interpreted the question to mean

whether they would recommend a friend or family member that they go to hospital if they were sick

or injured.

Instead, what Picker found did test well was asking people to score their overall experience of care.

We have such a question in both our inpatient and outpatient experience surveys. The question we

use is

“Now thinking about your whole stay in hospital overall, how would you rate the care you

received?”

That question is based on the wording recommended by Picker. We use a 5 point scale – Poor, Fair,

Good, Very Good, Excellent – for respondents to rate their experience of care. For the purposes of

the NPS we propose to categorise those who rate our services as:

‘Poor’ and ‘Fair’ (1 and 2) as "detractors"

‘Good’ and ‘Very good’ (3 and 4) as "passives"; and

‘Excellent’ (5) as "promoters"

‘Poor’ and ‘Fair’ are clustered as “detractors” because respondents who give those ratings tend to

make a strongly felt criticism of some aspect of their care experience.

‘Good’ and ‘Very Good’ are clustered as “passives” because these respondents tend to have, on

balance, a mixed experience, although the ‘very good’ may have only one criticism to make or short-

coming to provide us with feedback on.

We recommend that only respondents who rate their experience of care as ‘Excellent’ be considered

as ‘promoters’ because it is only these people who have nothing but praise for their care providers.

The following charts show our NPS.

Net promoter score by quarter - inpatients, Jan 2014 to June 2015

n=5995

1 Graham C & MacCormick S. Overarching questions for patient surveys: development report for the Care

Quality Commission (CQC). Picker Institute Europe (2012). Available from: http://www.nhssurveys.org/Filestore/reports/Overarching_questions_for_patient_surveys_v3.pdf

43 41 39 41 43 47

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10

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30

40

50

60

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http://www.nhssurveys.org/Filestore/reports/Overarching_questions_for_patient_surveys_v3.pdf


Net promoter score by quarter - outpatients, January 2014 to June 2015

n=7192

Net promoter score by quarter - inpatients and outpatients, January 2014 to June 2015

n=13,187

4. Publically reporting PES results

Background

Surveying patients about their experience2 of health care services has become almost commonplace

across New Zealand and internationally. There are numerous approaches to surveying patients

about their experience and reasons for doing so.

At Auckland DHB, we survey patients to find out what makes the most difference to their care,

where they think we are doing well, and where they think improvements are most needed. Building

on the ground-breaking work of organisations like the Studer Group and the Picker Institute,

Auckland DHB started surveying inpatients in 2011. We have started rolling out surveys across our

Outpatient services, and are finalising an approach to surveying patients in our Emergency

Department. The results are analysed and written up by an external agency (Point Research). The

reports the agency produces are circulated internally.

In 2014, New Zealand’s Health Quality and Safety Commission started a national patient experience

survey and compared the results at the DHB level. The results are publically reported. Counties

2 Patient ‘experience’ is different to ‘satisfaction’. Satisfaction asks about ‘how good’ patients thought

something was or how ‘happy’ patients were. ‘Experience’ also asks patients about how something made them feel or the difference something made. That additional level of information provides much more meaningful and hence useful data for service quality assessment and improvement purposes.

46 49 48 51 49 51

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Manukau DHB started surveying their patients about their experience of care in 2014. They use a

survey tool very much like ours and use the same online survey technology provider (Cemplicity) and

agency for analysis and report preparation.

Counties Manukau Health have made their patient experience survey reports publically available

since later last year and have fielded literally “one, maybe two” public enquiries about them.

Waitemata DHB is not publically reporting its patient survey results.

Proposed changes to how we report our results

We propose to make the results of patient experience survey public to show that we make a

concerted effort to learn about patients’ experiences of our services and where patients think we

need to make improvements.

There is a page set up on the new website ready to start hosting the regular patient experience

survey reports. We do not as yet have a confirmed ‘go live’ date for the website but it will be within

the next month (if not by the time the Committee meets).

Additional Costs

The proposals to make the patient experience surveys publically available will not come with

additional costs.

Risks/Issues

The risk of the proposal is that media choose to highlight poor results/feedback and thereby

diminish the good work both highlighted by patients and done by staff. To mitigate against that risk

we will ensure that we publish comprehensive information about the positive aspects of our

feedback.

5. Conclusion

Staff, community and consumer representatives are being involved in defining a vision and work-

plan for participation and experience at Auckland DHB. We have a strong track-record in some areas

but some new activity needs re-orientating and some new activity needs to be introduced. The

Committee will be kept informed of these developments.

We want to take a special focus on inequalities and be more open with our patients and

communities, including by letting the public know where patients say we are doing well, where

patients think we need to improve and what and how we will involve patients and communities in

making improvements to the way we provide health care.

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Auckland Integrated Cancer Centre (ICC)

Recommendation

That the Hospital Advisory Committee:

1. Receive the Auckland Integrated Cancer Centre (ICC) report.

2. Note the updated provided.

3. Note that the Strategic Assessment, being the first part of the business case, will be

submitted to December 2015 Board meeting.

Prepared by: Richard Sullivan (Director Cancer and Blood) Endorsed by: Ailsa Claire (Chief Executive)

Glossary

BBC Better Business Case

ICC Integrated Cancer Centre

1. Executive Summary

This report provides a progress update on the development of an Auckland Integrated Cancer Centre

on the Auckland DHB Grafton site. This report provides information on the overarching intent, and

progress of the business case development to support this work.

There are significant issues with current cancer services and facilities, with a number of existing

buildings no longer fit for purpose. The requirement to address facilities problems has provided a

significant opportunity to engage with patients/whanau and the wider health and education sectors

to relook at how services can be better provided. This approach is consistent with the substantive

working partnership between Auckland DHB and the University of Auckland – termed the strategic

health alliance partnership. We have long recognised that the development of an integrated cancer

hub would result in better health outcomes. Our stated vision is:

“A multidisciplinary, inter-institutional centre focused on improving health outcomes for people with

cancer through advances in clinical care, research, education and training, and community

engagement”.

We will work across the sector to develop new service models to enable this to happen, so our work

is focused firstly on this. We will use a patient co-design process, and work with our regional DHB

partners to agree which services are best provided from a regional centre. These services will be

consistent with future-proofed clinical advice; and education, training and research best practice

models. Facilities planning, funding and other workstreams will follow as a means to enact these

new service models, once approval to proceed is granted.

In order to achieve this vision, we are producing a business case that is consistent with Treasury and

Ministry of Health requirements. The business case will be split into three elements: the Strategic

Assessment (the case for change); the Indicative Business Case (potential options and a

recommended way forward); and the Detailed Business Case (detailed approach and costings for the

preferred option). The first element, the Strategic Assessment, is due to be presented to the Board

and Council in December 2015.

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2. Introduction/Background

Under the umbrella of the Auckland Academic Health Alliance, Auckland DHB and the University of

Auckland are developing a business case for a new model of care for Cancer and Blood Services.

In 2014, the Board approved seed funding for the development of the business case. The business

case will be developed to meet the requirements of NZ Treasury for Better Business Case (BBC)

major capital investments. Approval for the business case will be sought from Auckland DHB, the

University of Auckland, and Ministers of Health and Finance.

There are significant issues with current cancer services. The existing facility issues have provided

the opportunity to address a number of existing problems. These relate to service-fragmentation

issues, inconsistent cancer patient pathways and the lack of a consistent research focus that is

apparent in other world-leading cancer centres. Whilst there is a degree of collaboration between

the University of Auckland and Auckland DHB; opportunities for collaborative research, teaching and

education are not being maximised. There are also inefficiencies in the way services are currently

delivered. These issues are contributing to a service which is not meeting the health and support

needs of people/whanau experiencing cancer within Auckland and wider Northern region. Cancer

care outcomes are not as good as those in Australia, and the overall patient journey is a poor

experience for many patients and their whanau.

The intention is to create an integrated cancer centre (ICC) with strong leadership and direction to

bring together cancer clinicians, researchers, teachers and students into a unique organisation that

will provide the best research informed services across the entire cancer journey for a patient. The

vision of the ICC is to create “A multidisciplinary, inter-institutional Centre focused on improving

health outcomes for people with cancer through advances in clinical care, research, education and

training, and community engagement”.

Through the process of developing the business case, options for resolving the issues will be

identified and a preferred approach will be determined and costed.

3. Risks/Issues

The key risk at this stage of the business case development is the potential for lack of

agreement/alignment between the Northern Region DHBs on the future service delivery models for

cancer services. This is being addressed through Regional fora. The most significant service elements

will be clarified prior to the completion of the Detailed Business Case.

4. Progress/Achievements/Activity

In discussion with representatives of the Ministry of Health (National Health Board) and NZ Treasury,

the format of the business case has been confirmed as Strategic Assessment, Indicative Business

Case and Detailed Business Case. The anticipated timeline is outlined below:

Milestone Indicative Timescale (completion)

Scoping finalised and business case structure agreed Jun - Jul 2015

Strategic Assessment Oct - Dec 2015

Indicative Business Case Feb – Apr 2016

Detailed Business Case Apr – Jun 2016

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A project has been established to develop the business case. The project is being overseen by a

Steering Committee jointly chaired by Auckland DHB and the University of Auckland. A number of

interlinked workstreams have responsibility for developing the business case, including a new

service model and, if required, the design for a new facility. The project structure for the ICC

Business Case development is shown below.

An introductory workshop was attended by representatives of all the key organisations and groups involved in the project planning and development, as well as the architects commissioned to develop a Cancer Centre facilities concept, was held on 19 May 2015.

Workshops have been held/are scheduled with key stakeholders to: define the problems; identify the expected benefits and opportunities; confirm the investment objectives; and identify potential and preferred solutions.

The key stakeholders for the proposed investment are:

Auckland DHB

University of Auckland

Regional Blood and Cancer Services

Patients and their families

The community

Philanthropists/philanthropic organisations

Other Northern Region DHBs

Cancer Society Auckland Northland

5. Conclusion

The project is currently developing the Strategic Assessment as the first element of the business

case. This is due to be presented to the Board in December 2015 and will describe the local, regional

and national context and the drivers for the proposed investment.

It is expected that the Strategic Assessment will also indicate potential solutions, although the

detailed analysis of options and recommendations will be presented in the Indicative Business Case.

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Resolution to exclude the public from the meeting

Recommendation That in accordance with the provisions of Clauses 34 and 35, Schedule 4, of the New Zealand 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 item

to be considered

Reason for passing this resolution in

relation to the item

Grounds under Clause 32 for the

passing of this resolution

3.

Confirmation of Confidential Minutes 05 August 2015

Confirmation of Minutes As per resolution(s) from the open section of the minutes of the meeting, in terms of the NZPH&D Act 2000.

That the public conduct of the whole or

the relevant part of the meeting would

be likely to result in the disclosure of

information which good reason for

withholding would exist under any of

sections 6, 7, or 9 (except section

9(2)(g)(i)) of the Official Information Act

1982 [NZPH&D Act 2000]

4. Confidential Action Points

Confirmation of Action Points As per resolution(s) from the open section of the minutes of the meeting, in terms of the NZPH&D Act 2000.








1982 [NZPH&D Act 2000]

5.

Risk Register Report










1982 [NZPH&D Act 2000]

6. 1

Complaints










1982 [NZPH&D Act 2000]

9

169


6.2

Compliments


Privacy of Persons

To protect the privacy of natural persons, including that of deceased natural persons [Official Information Act s9(2)(a)]








1982 [NZPH&D Act 2000]

6.3

Incident Management










1982 [NZPH&D Act 2000]

6.4

Policies and Procedures


Negotiations To enable the Board to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations) [Official Information Act 1982 s9(2)(j)]








1982 [NZPH&D Act 2000]

6.5

Adverse Events Reviews April to June 2015










1982 [NZPH&D Act 2000]

6.6

External Audits and Accreditations








170


Negotiations

To enable the Board to carry on,

without prejudice or disadvantage,

negotiations (including commercial and

industrial negotiations) [Official

Information Act 1982 s9(2)(j)]


1982 [NZPH&D Act 2000]

7.0

Quality and Standards Reviews Report

7.1 - Acute Flow Performance

7.2 -Faster Cancer Treatment

7.3 - Lift Failure A32 Link Lift E3578

7.4 - Cardiothoracic Surgery

7.5 - Department of Critical Care Medicine

Obligation of Confidence

The disclosure of information would not

be in the public interest because of the

greater need to protect information

which is subject to an obligation of

confidence [Official Information Act

1982 s9(2)(ba)]









1982 [NZPH&D Act 2000]

8.1

Complaints to the Health and Disability Commission Involving Auckland DHB










1982 [NZPH&D Act 2000]

9.1

Acute Patient Flow - Provider Response

Obligation of Confidence

The disclosure of information would not

be in the public interest because of the

greater need to protect information

which is subject to an obligation of

confidence [Official Information Act

1982 s9(2)(ba)]

Commercial Activities

To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 s9(2)(i)]








1982 [NZPH&D Act 2000]

9

171

Documents

Hospital Advisory Committee Meeting Wednesday, 16 ... · 9.40am 3. Confirmation of Minutes 05 August 2015 9.45am 4. Action Points 9.50am 5. Provider Arm Performance Report 5.1 Scorecard