Pg3 Canterbury DHB’s integrated care project recognised internationally

Pg4 ‘Walking in Another’s Shoes’ dementia training expanding

IN THIS ISSUE...

Welcome to...

Our PeopleWelcome to the latest edition of Our People, the newsletter that will inform you about all the great things happening in our hospitals and district health boards across the country.

You can read this on the DHBSS website media centre and we will also have copies for staff coffee tables.

www.dhbsharedservices.health.nz

Our People | Pg 1

Allied Health Assistants Workplace Training Going Strong

18 November 2013

Congratulations to Allied Health AssistantsFive Allied Health Assistants will qualify with a Level 3 National Certificate in Health, Disability and Aged Support (Rehabilitation Assistant) next year thanks to an on-the-job training scheme.

Allied Health Advisor and Occupational Therapist Amber Salanoa Haar says the qualifications will formally recognise the skills the assistants already have, as well as develop new skills and broaden their knowledge.

“The idea is that in the future rehabilitation assistants who currently assist with either occupational therapy or physiotherapy will work across Allied Health therapy services, not just one or the other. Allied Health Assistants work under a supervising health professional and once qualified will have a broader understanding of what different Allied Health professionals do,” says Amber.

“Instead of sending two people to follow up a patient – an occupational therapy and a physiotherapy assistant – we will be able to send just one person. It’s about giving them skills to work across Allied Health therapy services as we work towards

flexibility in our future workforce.”

The certificate programme is being run through Careerforce and has strands in Dietitian Assistance, Dental Assistance, Healthcare Assistance and Rehabilitation Assistance. The strands are being trialled as pilot projects in different South Island District Health Boards co-ordinated by Catherine Coups from South Island Alliance.

Julie McDonald (Buller), Ruth Galloway (Grey), Greer Crisp (Grey), Sarah Rayner-Davies (Hokitika) and Amanda James (Buller) are the Allied Health Assistants signed up for the programme.

Occupational Therapy Assistant Julie McDonald says she’s excited about the next 13 months and the opportunities for learning.

“The physiotherapy side of things is quite different to what I’m used to, so

I’m really interested in learning how the body works. And although we often have the same clients, we use different equipment.”

While the biggest challenge to completing the programme will be setting aside enough study time, Julie says the benefits of certification will be worth it. “We work closely with the therapists in the hospital environment but also alone much of the time, so it will be good to have our skills recognised.”

Physiotherapy Assistant Ruth Galloway says it’s still early days in the programme so the trainees are taking it “one day at a time”. “We’ve just completed the anatomy and physiology assessments and it’s only going to get easier as we get into the swing of study again.”

She says the group will be meeting regularly and supporting each other through the next 13 months.

From left – Amanda James, Ruth Galloway, Greer Crisp and Julie McDonald at a one of the group’s regular meetings.West Coast AHA’s in action. From left: Amanda James, Ruth Galloway, Greer Crisp and Julie McDonald at a one of the group’s regular meetings.

Five West Coast DHB Allied Health Assistants (AHAs) are looking forward to continuing the workplace learning which was introduced across the �ve South Island DHBs as part of a South Island wide training initiative, based on the Careerforce NZQA Level 3 National Certi�cate in Health, Disability and Aged Support (Health Assistants), last year.

Other DHBs in New Zealand have also initiated the Careerforce training, including another regional collaboration in the lower North Island involving Capital & Coast, Hutt Valley and Wairarapa DHBs.

From the South Island Julie McDonald (Buller), Ruth Galloway (Grey), Greer Crisp (Grey), Sarah Rayner-Davies (Hokitika) and Amanda James (Buller) are amongst the AHAs who signed up for the programme last October. Occupational Therapy Assistant Julie McDonald says she’s excited about the opportunities for learning the programme provides.

“The physiotherapy side of things is quite di�erent to what I am used to, so I am really interested in learning how the body works. And although we often have the same clients, we use di�erent equipment.”

Allied Health Assistants across the �ve South Island DHBs will bene�t from the AHA training and development project led by Catherine Coups, as part of the South Island Regional Training Hub.

Catherine says the framework will also guide the development of regional and local orientation processes, clinical competencies, access to support and supervision and on-going professional development.

May 2014

OUR PEOPLE

The NZ Nurses Organisation (NZNO) is working closely with DHBs throughout the country to implement the joint Safe Staffing Healthy Workplaces (SSHW) initiative - Care Capacity Demand Management (CCDM).

The focus of the programme is to enhance patient care, provide a positive work environment for sta� and support the best use of health resources.

Hilary Graham-Smith, associate professional services manager of the NZNO, says the CCDM is an ‘absolute priority’ for her organisation.

“The program uses a validated tool to determine what sta�ng design is needed based on patient acuity, unit by unit and service by service. At this point the clinical context relates to wards themselves and the tool helps us understand how much each patient needs and how to get the skill mix right. “

March 2016

Pg6 SSHW initiatives predicted to develop across all clinical areas

You can read this in the communications & media section of the TAS website, under Strategic Workforce Services – Employment Relations and we will also have copies for sta� co�ee tables.

www. centraltas.co.nz/strategic-workforce-services/employment-relations

Welcome to...

Our People

Pg8Mobile surgical bus helps Whanganui dental surgery patients

NZNO sets out its plans to improve sta�ng and quality of workplace

IN THIS ISSUE...

Our People | Pg 1

Hilary Graham-Smith

Continued on page 2

Image courtesy of NZNO

NZNO sets out its plans to improve staffing and quality of workplace Continued from page 1...

Our People | Pg 2

Hilary points out that nowhere else in the world is the programme being implemented to the level of that in New Zealand.

“On the world stage we are leading the charge. This was very evident when we presented at the International Congress of Nurses in Korea last year where we focused on the partnership between NZNO and the DHBs in underpinning the project.

“Lisa Skeet, National Director for the SSHW Unit in TAS, talked there about the experience of implementing the programme while Julie Robinson, the director of nursing from the Bay of Plenty DHB, spoke about implementing the programme in a DHB. We received a lot of interest from our Canadian colleagues as well as other interested groups, in particular from the UK and Ireland who wanted to know more about the programme.

“They’re especially interested in how the programme has improved patient safety and how it is so pivotal to staff safety, especially in preventing stressed and busy nurses from making mistakes”.

She says the Safe Staffing, Healthy Workplaces initiative is really about supporting nurses do the job they want to do.

“When we get it right and see examples of it working really well, it’s an enormous pleasure for us as an organisation.”

Hilary says that led by nurses, she would like to see CCDM fully implemented in every DHB throughout New Zealand. To help

achieve this, the NZNO has developed a number of education modules to help nursing staff better understand the programme.

“This is essential to help staff understand the benefit to them and not just as another computer program involving more work.”

Another area of importance for the NZNO to help nurses ‘get their heads around’ the increasing use of technology and social media, especially Facebook.

“We want them to realise what this means in terms of keeping patient confidentiality and, of course, protecting themselves.”

“I think social media has a valid role to play full stop. It’s a great way of informing and discussing and debating, but it is a whole other issue when it comes down to a personal level.

“So it’s about making nurses aware of not going off on Facebook after they have had a bad day and forgetting that what they post will not be seen by just their friends but potentially the rest of the world.”

“They’re especially interested in how the programme has improved patient safety and how it is so pivotal to staff safety, especially in preventing stressed and busy

nurses from making mistakes”.

The Safe Staffing Healthy Workplace initiative, CCDM is well embedded at Tauranga Hospital.

Ward 4B, the Orthopaedic Unit, is a particularly good example of how these initiatives are achieving successful outcomes for both patients and nursing staff.

Ross Turner, the clinical nurse manager on the ward for the past six years, is in charge of implementing CCDM within the unit. He does this by working in partnership with his nurse leader and the other surgical nurse managers to ensure that all nursing staff have a full understanding of the initiatives.

”There are no hidden agendas,” he says, “Everything is out in the open; people are very clear about what’s happening, especially overnight, weekends and on public holidays. They know that there is a process to go through to achieve and maintain a SSHW unit at all times.”

Because of this Ross is confident that his nursing staff are able to make informed decisions about staffing levels or staffing mixes and that neither of these are any longer viewed as simply ‘a numbers game’. Instead they are more accurately determined by the acuity of the patients in the ward.

Ross says nursing staff employ a ‘mixed response’ measurement that allows them to determine when the ward is in a ‘green colour’

state, which he describes as a ‘good space’ to be in.

They are then able to see if they can loan one of their staff to another ward. Likewise they can determine whether a nurse or a healthcare assistant is needed in their own ward, even if it’s just for a few hours.

“This is so much better than a few years ago, before CCDM, when we always insisted that we had a minimum of seven nurses on duty whether or not they were needed.

“Now when there is an adverse event, the duty manager will look throughout the organisation and redeploy someone from another area to help us through the issue. As I said it may only be for two or three hours until we get back into a stable environment and the adverse event has been settled.”

Ross says the orthopaedic clinicians are very supportive of the CCDM initiative because they see that maintaining a stable working relationship within the nursing teams enables them to have happy patients who are progressing to plan.

Making smart decisions for staff and patients – all the time

Ross Turner and his wife Ann

Our People | Pg 3

Image courtesy of NZNO

Dogged and Inclusive Leadership Drives CCDM Implementation

In the nicest possible comparison, it’s easy to see why the Care Capacity Demand Management (CCDM) programme is on track and on song.

Leading the implementation is Lisa Skeet, a national director of the SSHW unit who is based in Cambridge and counts as one of her trusted allies, her pet bulldog, Annie.

While Winston Churchill’s bulldog leadership persona was always mirrored in the style of that canine breed, Lisa’s leadership style also has that inclusive and staunch thread, that intangible quality of being able to take people on the journey willingly with commitment, the same as the relationship Lisa enjoys with Annie.

“The programme is in good shape and we have a number of pockets of success. The main challenge is increasing the pace of implementation,” says Lisa.

“There are a number of reasons why the programme implementation pace is where it is. Each DHB is different and we have to take that into account.

“We know that the programme needs to be adaptable and flexible enough to fit each DHB. CCDM is not new to the DHBs, it is something they do every single day.”

She says the programme strengthens what they do: “We need to ensure we are not reinventing the wheel and that CCDM supports other projects and priorities while maintaining the integrity and principles of the programme. This takes time.”

CCDM is an evidence based practical programme developed from the clinical environment. The SSHW unit is responsible for the implementation support. The benefits and expected outcomes are largely dependant on the partners (the DHBS and the Health unions), making & sustaining the change, she says.

Lisa believes the programme has the necessary credibility which was highlighted recently with the independent evaluation of the programme last year. All 20 DHBs have endorsed the resulting action plan.

This showed the increased commitment from DHBs for CCDM, which has the unit working with 14 DHBs, with two others able and wanting to implement the programme in the near future.

The recent Nursing and Midwifery MECCA has also seen a strengthened clause around the commitment to CCDM. Another important part of the work for the SSHW Unit is supporting the Allied Health workforce on their journey, to be able to fully implement the CCDM programme.

Allieds’ journey can be informed by the nursing and midwifery work: “However it will be quite a different roadmap for this clinical workforce”, Lisa says.

“We have also set a high priority for introducing a web based software package for the staffing methodology within the programme, which will help speed up implementation. Our vision is to have all 20 DHBs implementing the programme, which includes having a validated patient acuity system. Acuity data drives the staffing methodology.”

Lisa who started her career in health as an 18 year-old trainee nurse in Hawkes Bay, has also worked in the UK, and in intensive care and clinical roles in New Zealand for almost twenty five years.

Lisa has been director of the programme since 2013.

Our People | Pg 4

Lisa SkeetDirector, Safe Staffing Healthy Workplaces Unit

“We know that the programme needs to be adaptable and flexible enough to fit each DHB. CCDM is not new

to the DHBs; it is something they do every day.”

Our People | Pg 5

The Safe Staffing Healthy Workplaces (SSHW) Unit was established by the District Health Boards (DHBs) and the New Zealand Nurses Organisation in 2006 to address ongoing concerns about staffing levels and the quality of the work environment.

The original task of the Unit, which is now based in TAS, was to �nd an alternative for nurse to patient ratios. It has grown to become a whole system of approach involving a range of professional groups with the PSA now also involved.

A structured programme based on a partnership approach between DHBs and Health unions has resulted in the Care Capacity Demand Management (CCDM) Programme.

The CCDM Programme constitutes a unique approach to healthcare delivery, enabling healthcare organisations to align their resources to better manage variability in the demand for patient care and to deliver it in a successful, e�cient and productive manner.

It allows DHBs to maximise the quality of the patient experience, eliminates many of the system factors that underlie patient harm events, and optimises operational e�ciency. A further important outcome of the programme is to enhance the quality of the clinical work environment for sta�.

CCDM achieves these outcomes by giving rigorous attention to a hospital’s production system, ensuring it is well set up to deliver

the right care to every patient, 24 hours a day, 7 days a week. CCDM refers to this as ensuring the ‘capacity/demand match’.

The CCDM Programme has three main components:

1. An evidence based method for setting the sta�ng model (numbers, mix and schedule) based on validated patient acuity data.

2. A sophisticated system for alerting any variance between demand and capacity and rigorous processes for mounting an appropriate response.

3. Developing technical and social processes around a core set of data that are meaningful from the �oor to the board.

Some remarkable results have been reported and DHBs who have adopted CCDM as ‘business as usual’ are beginning to report observable gains in productivity and service improvement.

CCDM has been presented both nationally and internationally over the past year, with the three perspectives of the programme (Nurses Organisation, SSHW Unit and DHB) given at the International Council of Nurses conference in South Korea.

Nationally it was presented at the Nurse Educators Tertiary Sector, NZNO Nurse Leaders & Colleges section, the lower North Island PSA meeting, and a poster at the APAC conference.

International interest around the programme continues to be high, with contact made by the UK, Ireland and Canada to discuss and also see the programme in action.

Our People | Pg 5

Safe Sta�ng Health Workplaces Unit and the Care Capacity Demand Management Programme

DISTRICT HEALTH BOARDS

NZNO & OTHER HEALTH UNIONS

SAFE STAFFING HEALTHY

WORKPLACES UNIT

SSHW initiatives predicted to develop across all clinical areasFor a DHB CE with a nursing background, it’s not difficult understanding and contributing to a governance role for the Safe Staffing, Healthy Workplaces initiative, which is expected to grow across all clinical areas in the future, says Julie Patterson, Whanganui DHB executive.

Julie is a member of a 12-strong governance group that meets around six times each year – yet another meeting commitment in a busy personal schedule that to anyone else would seem overwhelming.

“Commitments outside my core role do take some scheduling but I have a good team that helps me keep my priorities in focus,” Julie says.

“I also chair the Workforce and Employment Relations strategy groups on behalf of the 20 DHB CEOs so I have a very privileged insight into workforce activities across the sector.”

Julie says her background in nursing makes it easier for her to understand the aims and objectives of the CCDM programme and the value it adds to patient care, the workload of nurses and hospital efficiency.

Julie Patterson Chief Executive Whanganui DHB

SSHW Governance Group

Julie Robinson (Co-Chair) Director of Nursing Bay of Plenty DHB

Hilary Graham–Smith (Co-Chair) Associate Professional Services Manager NZNO

Julie Patterson Chief Executive Officer Whanganui DHB

John Pine General Manager HR Southland DHB

Martin Chadwick Director of Allied Health CMDHB

Hugh Lees Medical Director

Grant Bookers NZNO President

Warwick Jones PSA Associate National Secretary

Memo Musa NZNO CE

Jane O’Malley MOH Chief Nurse

Mick Prior General Manager, Strategic Employment Relations TAS

Lisa Skeet Director of SSHW Unit

“While the programme came later to Whanganui, it has become an integral part of our nursing service. It has in fact made a significant

measurable difference to the way our hospital operates.”

“It is ever-evolving and it has certainly become the most reliable indicator to ensure patient needs and nursing resources are fully matched.

“While the programme came later to Whanganui, it has become an integral part of our nursing service. It has in fact made a significant measurable difference to the way our hospital operates.”

Julie says its introduction has made a significant difference to the way their organisation budgets for the nursing service. Her Board understands and supports the programme because of its contribution to safe patient care.

“It has taken a while for nurses to understand and trust the methodology but as their understanding has grown they have become more supportive.”

Julie predicts CCDM will grow and develop across all clinical areas in the future, including community nursing and mental health, “and I am really looking forward to a similar methodology being used to support the allied services.”

Our People | Pg 6

Our People | Pg 7

The Waitemata DHB team: Sarah McLeod, , Sue Christie, Jenny Parr, Fiona McCarthy and Jay O’Brien.

Waitemata DHB wins national award for patient experience programme

“By involving staff and patients in developing our standards, we know that by living up to them we are

meeting staff and community expectations of their health service,” says Dr Bramley.

Waitemata District Health Board has again been nationally recognised for its work linking the experiences of patients to the growth of staff and services.

The DHB won the award for Talent Development and Management at the recent New Zealand HR Awards for an extensive programme connecting its organisational values of ‘everyone matters’; with ‘compassion; connected and better, best, brilliant’ with the experiences of staff and patients.

Waitemata DHB Chief Executive Dr Dale Bramley says the award is underpinned by an organisation-wide commitment to growth and positive change from the perspective of their patients.

“We are immensely proud of the accolade as the awards are judged across private and public sectors, making it a significant achievement for our nearly 7000 staff who have worked extremely hard to put the experiences of our patients at the forefront of their daily work,” says Dr Bramley.

Since the programme first began in 2011, the DHB has worked consistently to make understanding how patients experience their services a priority within the organisation.

The DHB collects data from an ongoing ‘In Your Shoes’ programme gathering real-time feedback from patients and whānau in each service, capturing over 1000 responses from across the organisation each month.

The feedback is then collated in an innovative report which maps the patient feedback received to standards and behaviours. The reporting is made available to each ward and allows teams to focus their attention on specific improvements to the service they provide.

“By involving staff and patients in developing our standards, we know that by living up to them we are meeting staff and community expectations of their health service,” says Dr Bramley.

The programme allows the DHB to tailor improvements to the areas that are most important to patients and families. One example showed that staff being welcoming and friendly was significant in patients having a positive experience. As a direct result, a campaign commenced to become ‘the most welcoming DHB in New Zealand.’

“This award recognises that our focus on patient experience has both improved our service design and delivery and inspired staff to provide the best possible care to each and every person who walks through our doors,” says Dr Bramley.

Our People | Pg 8

Whanganui Hospital campus hosted the mobile surgical bus for only the second time in 14 years for two days in February. Having the bus onsite at the hospital was to help the Whanganui District Health Board (WDHB) provide more timely care for local residents requiring dental surgery, which is normally held in one of the hospital’s four theatres.

The bus, which has a particular focus on providing surgery for children living in rural areas, was used by Whanganui Hospital

dental staff to help reduce the waiting time for patients requiring dental surgery under general anaesthetic, explains WDHB oral health care manager, Barb Dewson.

Barb said that up to 18 people were treated on the two days the bus was onsite at the hospital. Treatment received included fillings and extractions for young children, and wisdom teeth and full extractions for adults.

“We were extremely lucky with our timing in requesting the bus because, due to a cancellation, it was able to come to Whanganui almost immediately,” she said. Whanganui Hospital was the first in the country to have a bus onsite 14 years ago.

Mobile surgical bus helps Whanganui dental surgery patients

From left: Wendy Lorentz (Mobile Health clinical nurse manager), Colleen Clotworthy (WDHB dental assistant), Bev Larsen (Mobile Health anaesthetic technician) and Peter Liston (Maxillo facial specialist).