Public HAC Meeting to open at 8 - wairarapa.dhb.org.nz · regards to QSMs for falls, safe surgery, hand hygiene and surgical site infection improvement (SSII) - orthopaedic surgery

Wairarapa District Health Board

AGENDAHeld on Monday 30 July 2018Lecture Room, CSSB Building, Wairarapa DHB, MastertonCommencing at 8.30am

HOSPITAL ADVISORY COMMITTEE PUBLIC SESSION

Public HAC Meeting to open at 8.30am1. PROCEDURAL BUSINESS 15 8.30am

1.1 Welcome R Karaitiana

1.2 Apologies ACCEPT

1.3 Continuous DisclosureInterest Register/Conflict of Interest

ACCEPT / CONFIRM

1.4 Minutes/Actions of previous meeting ADOPT

1.5 Matters Arising

2. REPORTS 60 8.45am

2.1 Quality Report NOTE C Stewart

2.1.1 Health & Safety Report NOTE C Stewart

2.1.2 Infection Prevention & Control Service Report NOTE C Stewart

2.2 Executive Leader Operations Report NOTE K McCann

2.3 Executive Leader Nursing NOTE M Halford

2.4 Executive Leader Medical NOTE T Gibson

3. DECISION PAPERS

4. DISCUSSION PAPERS

5. INFORMATION PAPERS

5.1 June Dashboard

5.2 Clinical Board Meeting Information paper

6. REPORTS 9.45am

Norman Gray presentation

7. LATE PAPERS

8. RESOLUTION TO EXCLUDE THE PUBLIC

Proceed to Public Excluded Session

Wairarapa HAC Meeting Public - Agenda

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Wairarapa District Health Board Page 1 of 6

HAC INFORMATION PAPER

Date: 9th July 2018

Author Chris Stewart, Executive Leader Quality, Risk and Innovation

Endorsed By Adri Isbister, Chief Executive, Wairarapa District Health Board

Subject Wairarapa DHB Quality Report for Hospital Advisory Committee (HAC)

RECOMMENDATION:

It is recommended that the Wairarapa DHB Hospital Advisory Committee:

a. NOTES the report for May and June 2018.

APPENDICES:

A. Infection, Prevention and Control Report B. Health, Safety and Preparedness Report

1. INTRODUCTIONAs a DHB we are working towards meeting our quality goals by working together at all levels of the DHB to achieve patient centred care, openness and transparency, learning from error or harm and ensuring that the contributions of staff for quality improvement and innovation are truly valued. All of our goals are in line with the triple aim outcomes, national and regional priorities as identified by the Health and Disability Services Standards, Health Quality and Safety Commission (HQSC), Regional Services Plan and the Wairarapa DHB Annual Plan.

2. CONSUMER VALUE (PATIENT EXPERIENCE)Focussing on consumer value encourages our DHB to involve our communities in improving current performance and planning for the future, and to achieve improved health outcomes and equity for our population. We receive consumer information through our complaints and compliments feedback and the National Patient Experience Survey.

WrDHB Annual Plan 2018/19 includes the Planning Priority “Improving Quality” which requires planned actions on how to improve patient experience as measured by HQSC’s national patient experience survey, for our lowest rated question which is related to medication advice on discharge, we will be working regionally on this.

a) Compliments and complaints

Compliments and complaints trends /numbers are reported on the WrDHB Dashboard. A more detailed breakdown for May and June is below:

Wairarapa HAC Meeting Public - Quality Reports

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Feedback May and June 2018

∑ We are seeing an increase in compliments for the Standard of Clinical Care year to date. Communication and Standard of Clinical Care are the highest complaints over this period.


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Response times for complaints in relation to the 20 working day requirement as per HDC guidelines.

Complaint Response Times

The Quality Patient Experience Coordinator has addressed ELT to discuss timeframes, policy, process, culture and learnings in a bid to improve time frames. It was suggested that the Patient Experience Coordinator reviews the OIA process to see if this would be a more effective way of monitoring timeframes. There was little difference in process other than the use of an ‘at a glance’ white board for the Communications Administrator, which has been implemented by the Patient Experience Coordinator. It was apparent that OIA’s are treated as a priority as the response timeframe is reported to the Ombudsman. Since the ELT meeting there has been an improvement in communication regarding complaints.


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b) National quarterly patient experience survey

WrDHB is required to and has consistently met the requirements by participating and submitting quarterly national adult patient experience survey (adult inpatient’s over 15 years of ages, excluding mental health patients) data as part of the MOH non-financial monitoring framework and performance measures report since August 2014.

Cemplicity (www.cemplicity.com) currently holds the contract with HQSC to administer the DHB National Adult In-Patient Experience survey. The benefits of using an external specialist provider is the advanced technology available to collect and report results, access to international ‘best-practice’ survey questions that are proven to be relevant and nationalbenchmarking.

Quarter 4(HQSC) April -June 2018 results will be available at the end of July 2018. A new reporting tool enable us to gain better visibility over equity and drill down into results.Date Range 1.7.17 – 30.6.18

The four domains show how Wairarapa DHB compares with the national average. The filter set represents Maori.

The tables below show our highest and lowest rated question.Filter set 1 =Asian, European, Other Ethnicity and PacificFilter set 2 = Maori

Our highest rated questions rate as follows:

Our lowest rated questions rate as follows:


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http://www.cemplicity.com/

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3. EFFECTIVENESSEffectiveness focuses on monitoring and evaluation of patient care and performance in relation to our peers to ensure focused quality improvement.

Medication Errors, Patient Falls, Hospital Acquired Pressure Areas data is also reported within the WrDHB Balanced Scorecard. In order for data driven decisions to be made, accurate data needs to be presented. SQUARE, our electronic reporting system which was implemented in April 2016 is where our data is pulled from and this is reliant on timely and accurate ratings being done.

The quality team is currently working on how to maximise the use of the data the system provides and also streamline administration requirements to encourage ease of use for end users. We are in the process of talking with staff as to what does and does not work and will then work on developing a new education package to get maximum gain from the reporting system and data it provides.

HQSC– Quality and Safety Markers HQSC is driving improvement in the safety and quality of New Zealand’s health care through the national patient safety campaign Open for better care. The quality and safety markers (QSMs) help evaluate the success of the campaign nationally and determine whether the desired changes in practices and reductions in harm and cost have occurred.

HQSC has introduced a 'dartboard' format to bring a range of measures together in one place, which are currently published on their website. This format allows them to put many different measures on the same scale and allows click-through to measures for the local system presented in time series and statistical process control format. This dashboard is publicly accessible from their website. The Central Region Quality alliance will be using a regional format of this to inform quality improvement focus and initiatives.

Dashboard of health system quality

WrDHB reporting for QSMs continues as required. Due to resourcing issues, the capturing of the monthly data required for the QSM is predominately done by the Quality Clinical Nurse Coordinator coinciding with the collection of the monthly falls QSM data. It is time consuming and very manual.

Specifically QSMs national compliance data report includes comparisons with DHB’s nationally in regards to QSMs for falls, safe surgery, hand hygiene and surgical site infection improvement (SSII) - orthopaedic surgery.

2018 brings about the introduction of 3 further un-resourced QSMs: the deteriorating patient, safe use of opioids and the reduction of harm from pressure injuries.

Patient DeteriorationHQSC is running a five year national patient deterioration programme with the aim to reduce harm from failures to recognise or respond to acute physical deterioration for all adult inpatients (excluding maternity) by July 2021.

For WrDHB this saw the implementation of a new adult vital signs chart (EWS chart) from 14 February. The new EWS chart bought about a change in the scoring system and education sessions and follow up audit was maintained.


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https://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/quality-dashboards/dashboard-of-health-system-quality

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Pressure InjuriesHQSC states Pressure injuries are an indicator of the quality of care patients receive. They are often avoidable, have significant negative impacts on patients’ lives, increase hospital length of stay and are associated with extra resource consumption.In-hospital pressure injury QSM reporting is to be introduced from July. It is intended random monthly sampling across all inpatient areas excluding patients in emergency departments, day stay patients, patients on last days of life, patients in delivery suites, patients in acute mental health units, therefore includes neonates and maternity.

OpioidsHQSC states Opioid medicines are high risk medications, which are excellent at controlling pain but have a number of unintended side effects. Opioids are a leading contributor of healthcare associated harm ranging from patients experiencing mild distress to substantial patient harm and increased costs to hospital services in New Zealand. Following on from the national collaborative to reduce opioid-related harm, QSMs are being introduced.

Falls The QSM for falls are to continue and are not being retired as was indicated by HQSC.

∑ The WrDHB QSMs for falls QSM 1 (% of patients aged 75 and over (Maori and Pacific Islanders 55 and over) who received a falls risk assessment) is consistently highly achieved above the expected national threshold.

∑ For QSM 2 (% of patients being at risk have an individualised care plan which addresses their falls risk, WrDHB has not achieved levels as well as QSM 1. For the period Jan-March 2018 results of QSM 2 were 75%, this puts us in the middle group of the national threshold 75-89%.

These results were discussed at the falls committee meeting, at staff meetings in MSW and in Acutes, and clinical leads were emailed for input how we can improve this figure. Preliminary auditing for April showed a result of QSM 2 at 81% and May audit showed QSM 2 at 88%.

We continue to work closely with HQSC to ensure we gain maximum value from this QSM reporting and in August Gary Tonkin HQSC and a Quality Improvement Advisor from HQSC will be here to discuss/advise on QSM at a local level.

4. INFECTION CONTROL The May and June report is attached - please refer to Appendix A.

5. HEALTH AND SAFETY AND PREPAREDNESSThe Health and Safety and Preparedness report is attached - please refer to Appendix B.

6. RISKThe Wairarapa DHB SharePoint Risk Register is used for risk reporting.

Risk review is a standing item on the ELT agenda at the third meeting of every month where new risks are assessed and RAC rating agreed on, sign off on closed risks occurs and active risks are reviewed as per organisation policy.

A summary of the current risk register is provided in the Public Excluded Quality, Risk and Innovation Report.


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Date: 6th July 2018

Author Dianne Mazey, Health, Safety and Preparedness Coordinator

Endorsed By Chris Stewart, Executive Leader Quality, Risk & Innovation

Subject Health and Safety and Preparedness Report

RECOMMENDATION

It is recommended that HAC note the information in this paper.

PURPOSE

To update the Health Advisory Committee on significant:

∑ Health, safety and emergency preparedness risks within WrDHB

∑ Leading and lagging strategies to address health and safety hazards/risks

∑ Initiatives and improvements

∑ Significant trends in event reporting.

BACKGROUND

The role of Occupational Health & Safety is to support a progressive and continuous improvement philosophy within the WrDHB by providing health and safety advisory services and facilitating change aimed at improving the work environment to reduce risk.

1 INITIATIVES AND IMPROVEMENTS

∑ A chocolate fish award has gone to an OCS Orderly applauded for proactively waiting outside ready with a torch at night to escort nurses, who had finished their shift, to their vehicles, following a spate of security incidents in the carpark.

∑ Portable Water containers for potable water: Containers have now been distributed, along with instructions for filling and treatment, throughout the hospital campus.

∑ Radio Training Video: A radio training video, diagram and cheat sheet have been produced for quick, easy and readily accessible education on emergency radios.

∑ Three month gym membership: Membership donated by a local Gym has been awarded to a staff member in a random prize draw for completion and submission of their work station self-assessment.


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2 POSITIVE PERFORMANCE INDICATORS

∑ An independent hazardous substances site audit has been completed: initial audit feedback from the technical expert audit team provided at the summation meeting was very positive and that good systems and practices were evidenced. A final report with recommendations will follow.

∑ New Health and Safety Representative: a new Representative has been nominated for Procurement.

∑ Technical Advisory Service Audit of Emergency Management: an intensive audit undertaken 21st

through to 25th May. Audit summary meeting was exceedingly positive with it stated that excellent alignment with ISO Standard was evidenced. No areas for corrective action highlighted. A full report will be received in due course.

∑ ELT Emergency Management Workshop: the second workshop in series has been delivered to ELTwith a specific focus on: the recent Mass Casualty exercise in Acute Services, Incident Controller training update and a workshop session on emergency potable water project progression.

∑ Staff Well-being: A paper has been drafted proposing implementation of the Work Well programme following Work-Well advisor training undertaken by two staff recently.

∑ Training delivered on Health and Safety and Emergency Preparedness at usual specialised training day and additionally to potential Nursing Strike Volunteer staff.

∑ WrDHB Health and Safety Advisory Committee meeting convened June 2018 and included education topics:

- Trip hazards- Staff engagement survey results- PPE won’t protect you – unless you wear it

3 NOTIFIABLE EVENTS SINCE LAST REPORT

∑ Nil.

4 STATISTICS - REPORTABLE EVENT DATA YTD

Staff & Others Health and Safety Events by Specific Event Type - 1 January 2018 to 30 June 2018


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Safety/Security Events by Specific Event Type – 1 January 2018 to 30 June 2018

Commentary of Note: 1) Increased number of staff vehicles being either tampered with or stolen in broad day light in staff car park areas on the main hospital campus has emerged. This will be further discussed at the upcoming Police Liaison / Security meeting.2) A long and protracted security event in Acute Services has resulted in a hot debrief and follow-up multi-disciplinary incident investigation and further review via the Restraint Advisory Group.

5 HAZARDS OF SIGNIFICANCE (NEW, EMERGING OR REQUIRING ESCALATION)

Manual HandlingThe limited manual handling programme within the DHB remains a hazard.

- Review of manual handling injuries over a 1 year period has been completed and cross matched with training received by these individuals against recommended standard.

- training options, e.g. on-line modules to be completed- The trialled bariatric bed was a great success and CAPEX request has been submitted for

purchase

Night SecurityA decision paper has been drafted and submitted to Kate Sheridan, Security Lead on adequacy of current night security.

Verbal Abuse“Your Choice of Treatment” posters are now loaded on the new hospital electronic information screens. This campaign provides a clear statement that “We are here to help you at Wairarapa DHB so let us get on with our jobs free from abuse, violence and aggression and if you don’t, we’ll call the police. It’s your choice of Treatment.” An additional piece of work to be undertaken developing a charter of what acceptable behaviour looks like for display around the organisation, as positive reinforcement.


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Infection Prevention and Control Service HAC Report July 2018Covering: May/June 2018Nurse: Lizzie DaniellMedical Staff: Matthew Kelly

Standard 1 Managed environment:∑ IPC initiative for vaccinating AT&R inpatients with seasonal influenza vaccine.∑ Standard AS 4381: 2015 Single-Use Face Masks was brought to our attention, have reviewed and

confident our current masks meet NZ requirements.∑ World Hand Hygiene Day 5/5/18 was promoted.∑ Advice given to Maintenance re: preferred options for repair of damaged vinyl wall in Theatre Three.∑ OCS continue to exceed cleaning ‘standards’ requirements .Quarterly report for April – June 2018:

OCS Cleaning Audits Apr - Jun 2018.pdf

∑ Alterations made to reporting on mRSA after discrepancy noted to the algorithm.

Standard 2 Adequate IPC resources:

n/a

Standard 3 Policies and Procedures:∑ Implementing Quality Guideline on management of Patient Fridges.∑ Waste Management Policy review and update, first draft pending.∑ Draft IPC Programme 2018 – 2021 going to next IPC Committee meeting for their approval.

Standard 4 Education:∑ N95 mask use - paeds∑ IPC general update - Allied Health, CNSs, and 2 ARC facilities∑ CNS attended HQSC IPC Workshop and webinar on antibiotic use/resistance/prescribing in NZ∑ WrDHB IPC Study Day to be held on Thursday 25/10/18∑ The HQSC SSII programme quarterly webinars available for relevant DHB staff


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Standard 5 Surveillance:

2018 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec YTD 2017 2016 2015 2014

mMRSA 0 0 0 0 1 1 6 9 6 1

ESBL E.Coli 1 0 2 1 0 4 10 21 8 6

ESBL Klebsiella 0 0 0 0 0 0 1 1 0

C difficile 1 0 0 0 0 1 6 4 9 13

CLAB 0 0 0 0 0 0 0 0

HASABSIs 0 1 0 0 0 1 1 1 4 1

Hip/knee SSI 0 0 0 0 0 0 0 0 0 1

Hand Hygiene 90% % %

∑ Hand Hygiene audits are done 3 x per year, deadlines met ∑ SSII national programme quarterly report from the HQSC for the months of October to December

2017 has been released and shows no SSIs for WrDHB this quarter. WrDHB is among the 12 DHBs who achieved both QSMs (antibiotic prophylaxis timing and dose). It is of note that we have achieved the QSM for antibiotic dose consistently for the last 12 quarters; and for prophylaxis timing we have achieved the QSM for the last 5 quarters:

SSIIP National Orthopaedic Report_Oct-Dec17.pdf

SSIIP Individual DHB report_oct-dec17_WAIRDHB.pdf

Standard 6 Antimicrobial Stewardship:

n/a


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Date: 9 July 2018

Author Kieran McCann – Executive Leader Operations


Subject Provider Arm Report for Hospital Advisory Committee (HAC)

RECOMMENDATION It is recommended that the Hospital Advisory Committee:

NOTES the content of this report

This report outlines the consolidated position for the overall DHB provider services for the reporting period of June 2018.

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The Provider Arm for the year to 30 June 2018 is a net deficit of ($5.2m), which is unfavourable to budget by ($1.3m).

The key factors contributing to this result are as follows:

RevenueTotal Revenue for the Provider is $68.4m, favourable to budget by $1.3m.

∑ Revenues from other DHB’s are favourable by $183k, mostly arising from Radiology services $178k.

∑ ACC revenue is favourable for the month by $12k, reducing the YTD shortfall to ($185k). Employee related ACC claim reimbursements are $172k favourable YTD, which is offset by labour costs. Patient related recoveries are under budget by ($357k) due to substantially less AT&R revenue ($415k) and small losses across the departments with the exception of additional revenue in Imaging of $98k YTD.

∑ In Other Income, donations and bequests of $483k YTD, of this $299k is offset by the cost of a specific pharmaceutical product and a donation from ACC of a “sim man” manikin valued at $120k.

∑ An unplanned gain on sale of $80k made on sale of the Tinui Property in September.

∑ Focus funding of ($346k) has been transferred to support home and community services within the Funder Arm, along with the associated expenditure. The Pharmac rebates is up on budget by $372k, offsetting some of the additional pharmaceutical costs. Additional revenue received for Bowel Screening of $196k, of which $110k offsets nursing costs.

Expenditure Total Expenditure for the Provider is $73.6m YTD, which represents an overspend to budget of ($2.6m).

Staffing costs∑ Total personnel expenses (employed and outsourced) were ($96k) unfavourable in June, with YTD

($2,163k) unfavourable;

Medical personnel expenses, employed and outsourced, were ($309k) unfavourable to budget this month, with YTD at ($814k) unfavourable.

The Medical employed workforce costs were ($242k) unfavourable for the month and ($127k) YTD. Year-end adjustments of ($115k) impacted the monthly result, as has recruitment and relocation costs for two new SMO’s. The impact of the Orthopaedic job sizing is offset by an additional 1.0 FTE RMO that was phased in from November that didn’t commence, more than expected PGY1’s (first year RMO’s) and CME is also favourable $70k YTD. A 0.5 FTE vacancy in Ophthalmology has not been recruited to but this has an offsetting outsourced costs whereby we have used visiting specialists.


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Medical outsourced is unfavourable ($67k) for the month and ($687k) unfavourable YTD. Additional locum cover above budget has been required for RMO’s, an Anaesthetic vacancy earlier in the year, General Surgery leave cover and a vacancy, Mental Health demand and long term sick leave. A replacement General Surgeon has started following a recent retirement in March.

Nursing Personnel expenses, employed and outsourced, were ($312k) unfavourable this month, YTD stands at ($1.432k) unfavourable.

Additional unbudgeted Health Care Assistants (HCA’s) have been required for patient watches in both MSW and AT&R. At times the use of the AAU (Acute Assessment Unit) that is not resourced has impacted. Excess sick leave cover and ACC cover which has a revenue offset of approximately $195k. $110k Bowel screening revenue received from the MoH for additional nursing staffing can also be offset, as can outsourced HCA’s which are favourable $78k YTD. A year end accrual of ($178k) has been taken up to cover the potential nurses MECA settlement that is over and above the 2% that has already been accrued since the MECA’s expiry.

Outsourced nursing staff in place for a community Paediatric patient ($56k) which is offset by favourable outsourced Health Care Assistants costs of $78k where DHB casuals have been used in place of agency casuals

Allied Health personnel expenses, employed and outsourced, were unfavourable by ($8k) to budget this month, YTD $12k favourable. Earlier vacancies are being actively recruited to and the services are overall are within budget.

Management & Admin workforce, employed and outsourced, ($63k) favourable for June, YTD is $105k favourable, due to vacancies and time to recruit to the positions and some roles being covered by other areas. Additional administration cover has been required post WEBPAS to clear backlogs


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Other Outsourced Expenses were unfavourable by ($26k) in June, bringing the YTD position to $144k favourable;

Underspends in Focus outsourced service of $393k YTD, due to lower service demand than planned, is offset by the deduction in funding of internal revenue. Radiology is $235k under budget due to lower than budgeted demand for PRL services and slow MRI turnaround at HVDHB and the accrual release of $157.5k for the increase in Radiographer Service which have not met the agreed service level. Outsourced Ophthalmology is overspent by ($201k) in mitigation of non-compliance of elective wait time. Other Outsourced Surgical Services ($143k) of which $117k is offset in medical employed expenses.

Supplies and Treatment Costs ∑ Clinical supply costs were ($353k) unfavourable for June, YTD ($1,794k) unfavourable to budget;

o Treatment disposables were overspent on Bloods ($288k) YTD, with Intragam contributing ($239k) of this variance.

o Implants and prostheses were overspent by ($212k) this month and ($615k) YTD, due to increased acute Orthopaedic activity since November in addition to a higher mix of shoulder surgery with the associated higher average implants cost.

o Pharmaceuticals are ($77k) unfavourable this month and ($648k) YTD, due to monoclonal antibody drugs, including Infliximab which is ($257k) and Aglucosidase Alfa and TPN costs ($337k). This can be in part offset by a donation of $299k for the dispensing of Aglucosidase Alfa and $372k estimated additional PHARMAC rebate recorded in the revenue account codes.

o Air ambulance is ($15k) unfavourable for June returning an overall ($98k) unfavourable YTD position, due to more expensive individual transports than planned, particularly out of the 3DHB region.


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Non Clinical Supplies ∑ Non clinical supply costs were $27k favourable to budget for June, YTD is $1,049k favourable;

o Hotel and Laundry costs are $149k favourable YTD, due to reductions in food and groceries costs and meal volumes $154, offset by higher than budgeted demand driven laundry costs ($17k) over budget.

o Deferred CSSB painting costs $197k.

o Transport and Travel YTD $85k favourable. Business related travel is underspent by $62k and vehicle maintenance is underspent YTD by $19k.

o ITC expenses are $319k favourable YTD, due to favourable outcomes for IT rentals $69k, software license fees $45k, from deferred database developments in Focus, repairs & maintenance costs $34k and telecoms $27k, due to timing/deferral of projects in the business and efficiencies in telecoms. In June, $129k Outsourced ITC accruals were released on the basis of Central TAS actual billing to June 2018, this included the re classification of opex to Capex.

o Consultancy Fees ($117k) unfavourable YTD. This includes cost related to the seismic engineering reviewof the Hospital.

o Other Operating Expenses ($42k) unfavourable YTD, due to stock adjustments ($81k), additional printing and print room costs ($43k), offset by $111k yearend adjustments to clear the Balance Sheet.

o Depreciation phasing due to the timing of capitalisation has resulted in a $24k favourable result for the month and $419k YTD of which $311k relates to intangibles.

∑ Financing Expenses are $150k favourable to budget due to the Capital Charge calculation coming in under budget.

Graphs of Key Expenditure ItemsThe following graphs show the Provider Arm total expenditure, total personnel costs (employee & outsourced) and total clinical supplies expense by month for the current financial year against budget and 2017 financial year. Note dollars are in thousands.


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Activity and performance measurementsEmergency Department – There have been 796 more ED presentations this year than last year and 1,473 (8.8%) more than 15/16. Triage 5 presentations continue to decrease however triage 3 and 4 have increased. Overall the ED volumes continue the gradual upward trend towards volumes last experienced in 2011/12.

The ED health target was achieved for the first quarter and not achieved for the last three quarters.


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17/18 Within 6 HoursTotal Non-ED Admitted PerformanceWithin 6 HoursTotal Admitted PerformanceAll presentationsWithin 6 Hour presentations PerformanceJul-17 1,274 1,311 97.2% 159 193 82.4% 1,504 1,433 95.3%Aug-17 1,304 1,326 98.3% 185 206 89.8% 1,532 1,489 97.2%Sep-17 1,218 1,248 97.6% 161 200 80.5% 1,448 1,379 95.2%Oct-17 1,300 1,329 97.8% 138 194 71.1% 1,523 1,438 94.4%Nov-17 1,202 1,230 97.7% 203 251 80.9% 1,481 1,405 94.9%Dec-17 1,340 1,379 97.2% 228 293 77.8% 1,672 1,568 93.8%Jan-18 1,341 1,390 96.5% 185 235 78.7% 1,625 1,526 93.9%Feb-18 1,307 1,375 95.1% 39 47 83.0% 1,422 1,346 94.7%Mar-18 1,210 1,270 95.3% 169 224 75.4% 1,494 1,379 92.3%Apr-18 1,193 1,246 95.7% 152 181 84.0% 1,427 1,345 94.3%May-18 1,229 1,289 95.3% 102 140 72.9% 1,429 1,331 93.1%Jun-18 1,181 1,248 94.6% 124 197 62.9% 1,445 1,305 90.3%

QRT1 17/18 3,796 3,885 97.7% 505 599 84.3% 4,484 4,301 95.9%QRT2 17/18 3,842 3,938 97.6% 569 738 77.1% 4,676 4,411 94.3%QRT3 17/18 3,858 4,035 95.6% 393 506 77.7% 4,541 4,251 93.6%QRT4 17/18 3,603 3,783 95.2% 378 518 73.0% 4,301 3,981 92.6%

Non ED Admits (excludes EMER)

Admits (ward EMER) Grand Total

Theatre events have increased by approximately 200 cases based on last years actvity. This growth is associated with the additonal activity in endoscopy as a result of the bowel screening activity. The longer term trend is provided for comparrison.

15/16 16/17 17/18

Theatre Events 3,839 3,846 4,058

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3,950

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WrDHB Theatre Events

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2016 2017 2018

WrDHB Colonoscopy and Gastroscopy

Gastroscopy Colonscopy


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Overall Caseweighted discharges both acute and electively were slightly up from last year

1,150

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1,550

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WrDHB Caseweights (locally delivered) Actual vs Contract -Elective

Actual CWD's - Elective Contract CWD's - Elective

0

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7,000

15/16 16/17 17/18

WrDHB Caseweights (locally delivered) Actual vs Contract -Acute

Actual - CWD's - Acute + Arranged Contract - CWD's - Acute + Arranged

Activity and contract performance Non-compliance for both ESPI2 (patients waiting longer than 4 months for a first specialist appointment) and ESPI5 (patients waiting longer than 4 months for surgery) has seen the need to pay some outsourced clinical services more than budget. The penalty for 4 months non-compliance for ESPI’s is a 2 month deduction of 5% of total electives funding. Total Electives funding for this year is $2,840,167, therefore the potential penalty is $284k, being a financial risk for the DHB. Results post January 18 are not available due to reporting issues, it is anticipated that the DHB has been non-compliant for both ESPI2 & ESPI5 through to June18. A letter for consideration has been sent to the MoH.

Elective Services Performance IndicatorsJul Aug Sep Oct Nov Dec Jan Feb Mar Apr May June

ESPI 2 - FSAsESPI 5 - Surgery Prelim Prelim Prelim Prelim Prelim Prelim

Given the challenges of ESPI compliance and the additional lost work due to the nurses strike dates we have a total of 8 elective orthopaedic procedures which were performed on 26 June and 13 July. These included 4 hips 2 knees and 1 shoulder replacement and an ankle arthrodoesis. Procedures were done using Selina Sutherland and Private surgical capacity.

We have undertaken 8 additional colonoscopies on Saturday 14 July for the purpose of wait time compliance challenges

With the return of reporting data following the implementation of WebPAS more comprehensive activity and production monitoring reports will be provided going forward for the 2018/19 year.


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Services Updates

Allied Health Scientific & Technical The appointment of a Director of Allied Health, Scientific and Technical was approved in March. This brings WrDHB to the same status as 19 other DHBs in having a designated DAHST role to advance, advocate for and represent the AHST workforce.

Engagement of AHST staff in the Speak Up staff satisfaction survey in early 2018 was excellent, with AHST being one of the highest engaging groups across the organisation. Work is underway within the AHST teams to reflect on, analyse and identify actions they can take in light of the survey outcomes.

Allied Health achieved the highest rate of flu vaccination update across the organisation, with 77% of allied health staff having the flu vaccination.

In the last quarter of the year a business case to introduce 2.63FTE of new resource approved for allied health leave cover in March 18. Prior to this there was no budgeted leave cover for allied health staff which presented significant challenges maintaining service. Almost all disciplines have now recruited to this, with occupational therapy and assistant recruitment anticipated over the next month. This FTE is being used flexibly within each team to support core service delivery and leave cover with a focus on ensuring acute inpatient cover is as consistent as possible.

Introduction of the Calderdale Framework within allied health is supporting effective workforce utilisation, particularly in regards to skill sharing between clinicians and delegation to assistants. There is a lot of potential in this work and momentum is growing – albeit with the challenge of engaging clinicians who already have significant demands on their time. We now have one fully endorsed Calderdale Facilitator (Nicky Rivers) and one trainee Facilitator (Max Goodall).

Violence Intervention Programme (VIP) Numbers of clinicians attending VIP core training (as mandated by the MoH) has increased significantly over the last 6 months due to a focus on training from the VIP team. The next phase is to strengthen the VIP clinical champions’ network to help embed this work into everyday clinical practice with a focus on paediatrics and child services, the emergency department and maternity services.

Pharmacy The Pharmacy team are progressing well with the implementation of E-pharm to align with the new WebPAS administration system. This is on track and on budget for completion by late 2018. A 0.6FTE Pharmacist was appointed in early 2018, strengthening the pharmacy resource and ensuring on call cover is shared across a wider number of Pharmacists. This mitigated the Pharmacist rostering risk that was on the risk register – this risk has now been closed.

Social Work Over the last quarter of the year the Social Work team have developed an outline for a three month pilot Social Work weekend service, consisting of an on-site service on Saturdays and Sunday on call cover. This has now been finalised and is due to commence in late July 18.

Radiology Radiologist staffing challenges at Hutt have impacted on imaging services locally, with significantly decreased Radiologist cover over the Feb – June 18 period. This has resulted in delays in reporting turnaround time.Non acute interventional and fluoroscopy procedures have been significantly restricted over this period due to limited on site radiologist availability, resulting in extended wait times for clients. Acute and critical work in this area has been outsourced to Hutt.


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52% 61%

MRI scanning waitlist target are starting to improve with gains continuing to be made since the low point at the start of 2018. MRI wait times remains a significant challenge for the wider region with the 3 DHBs facing significant challenges against the targets. Ongoing difficulty with MRT recruitment remains the most significant barrier in service provision for MRU waiting. CT waiting times continue to track to target and have remained above the target of 95% for the entire year.

In 2016/17 there were an average of 128 referrals being received into imaging for Ultrasound per week in 2017/18 this has risen to an average 143 referrals per week which represents a demands increase of around 12%. Current production allows for scanned on average 100 patients per week over 2017/18 so a significant gap continues. Staffing remains the rate limiting factor in this service and as reported in previous reports we eagerly await the new sonographer due to start in the second quarter of the 2018/19 year. In the interim we continue to work with providers to look at the prioritisation of referrals to manage the current constraint on service. Two new ultrasound machines were purchased in Dec 17 to replace old machines. The new machines have improved image quality, thereby increasing clinical accuracy. In addition one of our sonographers completed her Diploma in Medical Ultrasound.

Trial rostering changes within the Imaging team have now been implemented permanently, with regular weekend imaging cover supporting timely investigations and flow for ED clients. MRTs have also reported improved work-life balance as a result of this. This trial also resulted in a sustained reduction in costs for the service as a result of reduced call back payments.

Child Development Services The WrDHB Child Development Service is now fully local, with all clinicians in the team now WrDHB employees. Having a Wairarapa based team (2.3FTE across 5 disciplines) allows the team to be fully integrated alongside other child disability services and to respond to local needs. The next step is to migrate referral management and admin support as these continue to be delivered via the Hutt at present.


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Referral volumes and caseloads remains consistent over the year in this service with the wait times drop off in the second half of the year. Note that at the start of 2017 there were almost 80 children waiting for this service.

Implementation of the 3DHB ACC Falls Prevention and Management model commenced in Dec 17.Significant momentum is anticipated from July onwards as both the local Programme Coordinator (0.3FTE) and Physiotherapist in home strength and balance (0.7FTE) roles have now been recruited to – these roles will work alongside primary care and hospital based services to deliver this model across the Wairarapa. The 3DHB Programme Manager role has also been filled which will provide a regional framework and ensure the components of the model are integrated across the region.

Challenges for 2018/19The challenges of a minimally resourced allied health team are ongoing. This is strongly evident in the rehabilitation area, as current FTE is insufficient to provide comprehensive rehabilitation, particularly in the community. The majority of allied health client complaints over the past year have been related to perceived insufficient intensity of services post discharge, and / or prolonged wait time for outpatient and community allied health input.

The delivery of paediatric SLT services is an increasing challenge due to increasing demand and complexity within this client group. Addressing this will be a focus for the next six months.

The introduction of WebPAS to replace the Galen referral management system in early 2018 has been a challenge, and continues to be so. Lack of baseline reporting has severely impacted visibility of service activity and has affected core reporting requirements. The impact of the introduction of WebPAS on clinical and administration staff has been significant in terms of ensuring consistent and accurate referral management.


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Date: 13 July 2018

Author Michele Halford, Executive Leader Nursing, Wairarapa District Health Board


Subject Nursing Hospital Advisory Committee Report

RECOMMENDATION

It is recommended that the Board:

a. NOTES: Summary of the following nursing report

1. MAY FINANCIAL REPORT – NURSING Nursing employee expenses are ($72k) unfavourable month to date (MTD) and ($816k) year to date (YTD). FTE is over by 13.6 FTE on budgeted levels for the month and 11.2 FTE YTD.

FiscalYear 2018FTEFiscalPeriod 11

Row Labels Actual Budget Variance Actual Budget Variance FY

BudgetNursing Staff 187.0 173.5 -13.6 184.7 173.5 -11.2 173.5

Enrolled Nurses 8.6 10.0 1.4 9.2 10.0 0.8 10.0Health Service Assistants 21.3 15.4 -5.9 22.5 15.4 -7.1 15.4Nurse Practioners 1.5 1.4 -0.1 1.5 1.4 -0.1 1.4Registered Nurses 127.3 116.6 -10.6 122.6 116.6 -6.0 116.6Senior Nurses 28.3 30.0 1.7 28.8 30.0 1.2 30.0

Grand Total 187.0 173.5 -13.6 184.7 173.5 -11.2 173.5

Month Year

Wairarapa HAC Meeting Public - Executive Leader Nursing Report

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Registered Nurses (RN’s) are unfavourable by ($80k) for the month and ($659k) YTD. RN FTE is 6.0 FTE over budget YTD. This can be offset against favourable enrolled nurse costs of $29k YTD due to resignations being replaced by RN’s. Some of the negative variances are due to additional staffing in the Acute Assessment Unit (AAU) at peak times which is not budgeted. Sick leave cover, in particular ACC cover has impacted unfavourably however there is some revenue offsets noted below.

Health Care Assistants (HCA’s) are unfavourable ($26k) for the month and ($348k) for the year. This is due to patient watches in MSW and AT&R which are unbudgeted and sick leave and ACC cover.

Other nursing expenses are $7k favourable MTD and $57k YTD. This is due to training being favourable $17k and timing of payments for Health Workforce.

$329k of the unfavourable YTD nursing personnel variance can be offset by ACC staff related revenue which is 9k this month and $157k favourable YTD. Bowel screening revenue of $101k YTD has also been received to offset new nursing roles and outsourced nursing is favourable 6k favourable MTD and $71k YTD due to DHB casual HCA’s being used in place of agency HCA’s.

Notes/Risks: Nursing MECA is being accrued at 2% there is a risk this will settle for a higher %. Long term sick leave including ACC HCA’s not budgeted (forecasted) AT&R ACC revenue (393k) YTD Pay equity revenue released by funder to cover support workers in community Bowel screening staff recovery released to Periop & OPD AAU when used and additional staff are required is not budgeted

2. DUTY NURSE TEAMThis team of nurses who have the flexibility to work where required is now fully recruited to the approved FTE

3. CARE CAPACITY DEMAND MANAGEMENT (CCDM) The first steps towards complying with the MECA mandated Care Capacity Demand Management (CCDM) Programme have been take. We are committed to working in partnership with the Nurses Organisation in having the programme fully implemented by mid-2021. Recruitment of a programme coordinator is currently underway and we have a visit from the Safe Staffing Unit scheduled early August which will enable work to begin on developing a detailed implementation plan

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Date: 13 July 2018

Author Tom Gibson, Chief Medical Officer Wairarapa District Health Board

Endorsed By Adri Isbister, Chief Execute Wairarapa District Health Board

Subject Medical Hospital Advisory Report

RECOMMENDATION

It is recommended that the Hospital Advisory Committee :NOTES the contents of this report

1. SUMMARY OF QUALITY AND SAFETY CONFERENCEDuring the last few weeks. I have been on leave in Europe which has provided a very welcome break. Whilst there I attended the International Conference on Quality and Safety in Healthcare in Amsterdam. This conference was attended by over 3000 delegates from around the world. It was great to meet and hear from so many healthcare practitioners whose focus and passion is on quality. Whilst the technical advances in medicine continue, there is little doubt that there is a large and increasing wave of awareness that good healthcare outcomes depend hugely on the way in which we care for people, perhaps more than the increase in technical expertise.

On one of the days in the conference I was invited to join an Executive Forum which focused on the difficulties faced by organisations seeking to implement programs of change and quality improvement within their organisations. Speakers from Europe and America talked about the resistance that was often met in this area and explored some of the reasons for that resistance. One area that was explored was that of mind-set. ‘closed’ and ’open’ mind-set is were explored. ‘Closed’ mind-sets caused barriers in terms of change management. This was characterised by a resistance to change, and desire to maintain the status quo, and the difficulty in engaging in the conversations of “how could we do this differently”. ‘Open’ mind-set people were open to new thoughts, new ideas, lateral ways of approaching problems. There was an excellent presentation from a psychologist about the nature of these two mind-sets, how they could be identified, and some strategies for helping alter the thinking of the closed mind-set person.

This led to a deeper discussion about change management. Many executives in attendance talked about the difficulty of translating good new ideas into changed practice within their organisations and it is clear that good change management requires skill, significant resource, and time.

Whilst engaging in this session I reflected on our WebPas experience in which we put great effort into the technical process of change, but perhaps could have placed more resource into the management of the change process amongst our staff, I have taken this is a lesson learned.

The poster session in the Main Hall contained more than 100 posters about different quality initiatives from many health services which had improved the quality and safety of patient healthcare.

Almost all of these ideas could provide benefit to the Wairarapa.

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A challenge for this DHB as for many is to have the resource and capacity to help facilitate changed ways of working and relating to each other to improve health care outcomes. In this context the work that follows the staff engagement survey will be of great value, I believe to this DHB.

I appreciated the opportunity to attend this event.

2. MEDICAL STAFFING UPDATEThe DHB is pleased to welcome two new staff members into the service.

Mr Ken Hosie is a distinguished colorectal surgeon from the UK. He has been responsible for leading and developing a major colorectal surgery unit in Southwest England and has also great interest in the training and education of medical staff through College programs. Ken and his wife Magda have taken the step of coming to live in the New Zealand. Magda has been appointed as a full-time gastroenterologist in the Hutt hospital and will be providing clinical services in the Wairarapa. Ken isplanning to work on a part-time basis and already staff have been enjoying his quiet and friendlyapproach.

Dr Jill Arliss is a consultant obstetrician and gynaecologist, who has come here from West Virginia. Jill, her husband, and her 3 children have made the decision to come to New Zealand and Jill has left behind a very busy and demanding practice in the US. Jill is an accomplished obstetrician and gynaecologist and her skills include the use of the da Vinci robotic surgical system (which I have assured her will not be available here in the foreseeable future!).Jill will, I am sure, prove to be a very valuable member of staff, will help to improve the quality of obstetric care within our unit and reduce our reliance on locum doctors for much of cover.

A replacement physician has been interviewed, has now accepted our employment offer and is scheduled to start here in February 2019. The medical staff are certain he will provide excellent service for the medical team.

Dr Prieur du Plessis has indicated that he is moving to Gisborne. Prieur came to us as a non training Medical Officer Specialist Scale (MOSS) in orthopaedics and has provided a very valuable service particularly in the area of acute fracture management. His move to Gisborne will allow him more time with his family and we wish him well for his future. We appreciated the good work he has provided for our DHB.

A replacement orthopaedic surgeon, one who is New Zealand trained and has recently achieved specialist status, has been engaged to work on a long-term locum from August to December of this year. The understanding is that this is a locum with a view and provided that both parties are satisfied, he has indicated he may well wish to stay in a more permanent position.

3. HDC, ADVERSE EVENTS AND COMPLAINTSOver the last three months the mapping of the process of the management of these important parts of our service has been undertaken and is currently the result of consultation before being finalised. As part of this process, I have looked at the volumes in each of these categories that have presented in the last two years.

94 complaints about health service delivery have been managed.

There have been 33 HDC complaints managed and responded to, from which only one has currently been found to have breached patient rights. I estimate that there will be another three cases that may result in a breach finding when they are completed.

There have been 21 adverse events of various types investigated.


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This month with the DHB received advice from the HDC that as a result of one investigation, both the clinician and the service were found to have breached patient rights.

This case involved the failure to review the definitive radiology report of a patient who was admitted acutely and had an incidental x-ray finding not recorded on the urgent report but contained within the subsequent report which was missed.

This is an ongoing major clinical risk for this DHB due to the lack of an electronic sign off of laboratory and radiology results. Without a comprehensive and reliable system of sign off, the risk of missing significant results remains high and will be an ongoing risk for this DHB. As has been often repeated, the need to have electronic sign off developed within the new WebPas is of major importance and urgency. For the patient concerned there has been a full process of open disclosure and support provided and he is now under the care of the Mid Central DHB service. Full support has also been given to the clinicians involved and work is currently underway to address the requirements stated by the HDC for the DHB to respond to.

4. WAIT LIST TIMESWait list time remain a concern. On the latest data available (this has been difficult because of the WebPas upgrade and changes that have required to have been made), the latest ESPI2 (time to first appointment) has moved out of red and to amber.

This is a credit to the ongoing work of Mair Moorcock in outpatients.

However the ESPI5 (time from first appointment to operation) remains firmly in the red. The electivesgroup has explored this backlog. The main area of concern within these patients are a group of 20 major orthopaedic procedures (joint replacements) that are now beyond the four-month wait. Currently a program is underway to try to have the bulk of these operations performed under contract with Selina Sutherland which will incur significant additional expense. The difficulties that the DHB faces in this regard is that the total number of joints replacements performed in the last year have exceeded our funding target.

This means that we are performing more joint replacements than the number for which funding is allocated but in spite of this are unable to keep up with demand in a timely manner. This is a reflection of our ageing population and is a situation that is likely to continue and indeed possibly deteriorate.

Whilst the financial penalty for ESPI5 breech has now been removed, nevertheless the target is an important one in terms of quality of patient care. As part of clinical service planning, there will need to be a special focus on the role of joint replacement within the services provided by this DHB.

These are expensive, resource intensive, procedures that do produce significant benefit in terms of quality of life but also place considerable demands upon the resources of the DHB.

5. FASTER CANCER TREATMENT (FCT)Faster cancer treatment targets remain well on track with no major problems currently occurring.

These times will continue to be reported to the Ministry of Health.

6. ED TARGETSED targets of again failed to reach the 95% target, with the last quarter of being scored at 92.8%. This is in spite of ED numbers being somewhat lower this year than last year.


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7. CLINICAL SERVICES PLANBefore my departure on leave a number of meetings were held with providers of health care for the elderly and a start made on exploring the needs of this population group.

From these meetings, it became clear that clinical services planning will involve a considerable body of work.

It is planned to work with the facilitators of the Hutt Valley and Capital and Coast clinical service plans to progress this process, with a view to also identifying the potential for shared services across the 3DHBs.


37

Wairarapa DHB: Dashboard Report - June 2018

HEALTH TARGETS

90.2%

86.0%

88.0%

90.0%

92.0%

94.0%

96.0%

98.0%

Jul

Aug

Sep

Oct

Nov Dec Jan

Feb

Mar

Apr

May Jun

Actual % Target 95%

-

500

1,000

1,500

2,000

2,500

3,000

Jul

Aug

Sep

Oct

Nov Dec Jan

Feb

Mar

Apr

May Jun

YTD Actual No. YTD Target No.

104%

0%

20%

40%

60%

80%

100%

Jul

Aug

Sep

Oct

Nov Dec Jan

Feb

Mar

Apr

May Jun

Actual % Target 90%

100%

80%

85%

90%

95%

100%

Dec Jan

Feb

Mar

Apr

May Jun Jul

Aug

Sep

Oct

Nov Dec Jan

Feb

Mar

Apr

May Jun

Actual % Target 95%

91%

50%

60%

70%

80%

90%

100%

Dec

Jan

Feb

Mar

Ap

r

Ma

y

Jun

Jul

Aug

Sep Oct

Nov

Dec

Jan

Feb

Mar

Ap

r

Ma

y

Jun

Hospitals Actual % Primary Care Actual % Maternity Actual %

Hospitals Target Primary & Maternity Target

Hospital 93% ˚Primary 90% ¸¸Maternity 100% ¸¸

0%

20%

40%

60%

80%

100%

120%

Dec Jan

Feb

Mar

Apr

May Jun Jul

Aug

Sep

Oct

Nov Dec Jan

Feb

Mar

Apr

May Jun

Actual % Target 95%

KEY INDICATORS

250

750

1,250

1,750

Jan

Feb

Mar

Apr

May Jun Jul

Aug

Sep

Oct

Nov Dec Jan

Feb

Mar

Apr

May Jun

2017-18

ED PresentationsTotal Triage (4 & 5)

-

2.00

4.00

6.00

Jan

Feb

Mar

Apr

May Jun Jul

Aug

Sep

Oct

Nov Dec Jan

Feb

Mar

Apr

May Jun

2017-18

Average Length of Stay (ALOS)

Elective & Arranged Acute

-

2,000

4,000

6,000

Jul

Aug

Sep

Oct

Nov Dec Jan

Feb

Mar

Apr

May Jun

2017-18

CaseweightAcute Actual Elective ActualAcute Target Elective Target

0%

20%

40%

60%

80%

100%

Jan

Feb

Mar

Apr

May Jun Jul

Aug

Sep

Oct

Nov Dec Jan

Feb

Mar

Apr

May Jun

2017-18

Theatre Utilisation

Theatre Utilisation Target

NUMBER LONG WAIT PATIENTS ( >4 Months)

DIAGNOSTIC WAIT TIMES

PROCESS & EFFICIENCY FINANCIAL RESULT

-

50

100

Jan-

17

Mar

-17

May

-17

Jul-1

7

Sep-

17

Nov

-17

Jan-

18

Mar

-18

May

-18

First Specialist Assessment - ESPI 2

Booked Unbooked

-

10

20

30

Jan-

17Fe

b-17

Mar

-17

Apr-

17M

ay-1

7Ju

n-17

Jul-1

7Au

g-17

Sep-

17O

ct-1

7N

ov-1

7D

ec-1

7Ja

n-18

Feb-

18M

ar-1

8Ap

r-18

May

-18

Treatment- ESPI 5

Booked Unbooked

Diagnostics Target ActualMRI Wait List seen in 42 days 90.0% 52.0% ˚

Ultrasound Waitlist seen in 42 days 85.0% 54.0% ˚CT Waitlist seen in 42 days 95.0% 99.0% ¸¸

Urgent Colonoscopy - Wait or Procedure within 14 Days 90.0% 83.3% ˚Non-Urgent Colonoscopy - Wait or Procedure within 42 Days 70.0% 44.9% ˚

Surveillance Colonoscopy - Wait or Procedure within 84 Days 70.0% 62.3% ˚

Target Mnth YTD

Elective/Arranged Day Surgery rate 62% 77.0% 67.3% ¸¸Ward Bed Utilisation - MSW 85% 95.2% 97.7% ¸¸Caesarean Rate (Elective & Acute) 25% 34.5% 25.8% ˚Acute Readmission Rate 8% 4.4% 4.5% ¸¸Theatre Sessions Starting on Time 90% 97.7% 96.2% ¸¸Theatre Session Utilisation (Time in Theatre) 85% 70.7% 73.4% ˚Cancellation on Day of Surgery 5% 5.2% 4.5% ¸¸Did Not Attend (DNA) Rate 6.2% 6.5% 7.5% ˚Did Not Attend (DNA) Rate - Maori 6.2% 14.4% 15.9% ˚Did Not Attend (DNA) Appointments 1649 131 2008 ˚¸ = Meets Target ¸¸ = Exceeds Target ˚ = Does Not Meet Target

ActualYTDvs

Target

(2,000)

(1,500)

(1,000)

(500)

-

500

Jul

Aug

Sep

Oct

Nov Dec Jan

Feb

Mar

Apr

May Jun

Variance Surplus/(Deficit) - MTD ($000)

(5,000)

(4,000)

(3,000)

(2,000)

(1,000)

-

1,000

Jul

Aug

Sep

Oct

Nov Dec Jan

Feb

Mar

Apr

May Jun

Variance Surplus/(Deficit) - YTD ($000)

Actual Budget Variance

(2,488) (927) (1,561) ˚

MTD ($000) Actual vs Budget Actual Budget Variance

(7,453) (3,159) (4,294) ˚

YTD ($000) Actual vs Budget

0%

50%

100%

Urgent ColonoscopyResult Target 85%

0%

50%

100%

Non-Urgent ColonoscopyResult Target 70%

0

100

200

300

Did Not Attend (DNA) AppointmentsResult Target

40%

90%

Ward Bed Utilisation Result Target

(600)

(400)

(200)

-

200

400

Jul

Aug

Sep

Oct

Nov Dec Jan

Feb

Mar

Apr

May Jun

PROVIDER - Variance Surplus/(Deficit) - MTD ($000)

(1,500)

(1,000)

(500)

-

500

Jul

Aug

Sep

Oct

Nov Dec Jan

Feb

Mar

Apr

May Jun

PROVIDER - Variance Surplus/(Deficit) - YTD ($000)

Actual Budget Variance

(1,256) (998) (258) ˚

PROVIDER MTD ($000) Actual vs Budget Actual Budget Variance

(5,145) (3,927) (1,218) ˚

PROVIDER YTD ($000) Actual vs Budget

0.0%

5.0%

10.0%

Acute ReadmissionsResult Target

0%

10%

20%

30%

40%

C-Section RateResult Target

2500

4500

6500

8500

10500

12500

Year to31/12/13

Year to31/12/14

Year to31/12/15

Year to31/12/16

Year to31/12/17

Wairarapa Other Wairarapa MaoriWairarapa Total National Total

96%

Wairarapa HAC Meeting Public - Information Papers

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QUALITY MEASURES

STAFF

0%

5%

10%

15%

20%

Jan-

17

Feb-

17

Mar

-17

Apr-

17

May

-17

Jun-

17

Jul-1

7

Aug-

17

Sep-

17

Oct

-17

Nov

-17

Dec

-17

Jan-

18

Feb-

18

Mar

-18

Apr-

18

May

-18

Jun-

18

Staff Turnover Actual % Target 10%

YTD FTE Actual Budget VarMedical 45 48 3

Nursing 242 231 (11)

Allied 71 72 1

Support 16 16 (0)

Mgmt/Admin 106 102 (4)

Total 480 468 (12)

Appraisals Last 12m 24%

0%

1%

2%

3%

4%

5%

Jan-

17

Feb-

17

Mar

-17

Apr-

17

May

-17

Jun-

17

Jul-1

7

Aug-

17

Sep-

17

Oct

-17

Nov

-17

Dec

-17

Jan-

18

Feb-

18

Mar

-18

Apr-

18

May

-18

Jun-

18

% Sick LeaveActual Target 2.5%

48 49 52

49 50 53

50 54 54

59 58 59

51 51 53 56 55 56

Jan

-17

Feb

-17

Ma

r-17

Ap

r-17

May

-17

Jun

-17

Jul-1

7

Au

g-17

Se

p-17

Oct

-17

Nov

-17

Dec

-17

Jan

-18

Feb

-18

Ma

r-18

Ap

r-18

May

-18

Jun

-18

No. of Staff with >24 Months Annual Leave

INTER DISTRICT FLOWS

0

1,000

2,000

3,000

4,000

IDF Outflow - CWDActual Budget

0

100

200

300

400

Jul

Aug

Sep

Oct

Nov Dec Jan

Feb

Mar

Apr

May Jun

IDF Inflow - CWDActual Budget

-4

0

4

8

Jul-1

7

Aug-

17

Sep-

17

Oct

-17

Nov

-17

Dec-

17

Jan-

18

Feb-

18

Mar

-18

Apr-

18

May

-18

Jun-

18

Patient Falls SAC 1 - 3

-4

0

4

8

Jul-1

7

Aug-

17

Sep-

17

Oct

-17

Nov

-17

Dec

-17

Jan-

18

Feb-

18

Mar

-18

Apr-

18

May

-18

Jun-

18

Medication Errors SAC 1 - 3

0

5

10

15

20

Jul-1

7

Aug-

17

Sep-

17

Oct

-17

Nov

-17

Dec-

17

Jan-

18

Feb-

18

Mar

-18

Apr-

18

May

-18

Jun-

18

Complaints

-2

0

2

4

6

Jul-1

7

Aug-

17

Sep-

17

Oct

-17

Nov

-17

Dec-

17

Jan-

18

Feb-

18

Mar

-18

Apr-

18

May

-18

Jun-

18

Hospital Acquired Pressure Areas

0

5

10

15

20

25

Jul-1

7

Aug-

17

Sep-

17

Oct

-17

Nov

-17

Dec-

17

Jan-

18

Feb-

18

Mar

-18

Apr-

18

May

-18

Jun-

18

Compliments

NOTES - JUNE 2018

The only measures not currently avaiable due to WebPas is the ESPI5 result and theatre utilisation is incomplete. Note also that IDF data appears with a lag, so updates to prior months can occur particularly at year end. Some quarterly results are as yet not available, Smokefree Primary and Maternity, ASH rates. Theatre utilisation is now available post WebPas however February and March are incomplete. The financial result is the draft result subject to final audit.


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Date: 13 July 2018

Author Chris Stewart, Acting Chair of Wairarapa Clinical Board

Endorsed By Adri Isbister, Chief Executive Wairarapa District Health Board

Subject Wairarapa Clinical Board Summary Document

RECOMMENDATION

a. NOTES: Summary of Wairarapa District Health Board June Clinical Board Meeting

Draft Quality Plan

Draft Quality Plan was reviewed and approved to be circulated for consultation and discussion. Need to define how each clinical area is giving to monitor clinical effectives per Alan Shirley’s paper.

Clinical Board Terms of Reference

Terms of Reference to be reviewed at the next meeting once Chair has returned. Noted the lack of Senior Medical Officer in attendance at Clinical Board meetings.

Locum Doctors

Concerns raised about Locum doctors compliance with local policies. It appears to be an ongoing issue.

Orientation needs to be addressed and reviewed

Commendations

Commendation to Michelle Thomas Maternity, achieving qualification as an Improvement Advisor in June. Commendation sent to our Pharmacy department for having zero PHARMAC breaches for the period of 2016/2017. This is a fantastic achievement for our DHB. Please note these results are a year behind the 2017/2018 results have not been published yet. Commendation sent to our Maternity Team for the commitment to lowering and achievement of the caesarean section rate for the Wairarapa District Health Board. This is also a fantastic achievement for our DHB.

General

Recognition of frontline staff workload and working at full capacity.


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Documents

Public HAC Meeting to open at 8 - wairarapa.dhb.org.nz · regards to QSMs for falls, safe surgery, hand hygiene and surgical site infection improvement (SSII) - orthopaedic surgery