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Counties Manukau District Health – Hospital Advisory Committee Agenda

Counties Manukau District Health Board Hospital Advisory Committee Meeting Agenda Wednesday, 9 April 2014 at 9.00am – 12.30pm, Innovation Lab, Ko Awatea, Middlemore Hospital, Hospital Road, Otahuhu, Auckland Time Item Page No

9.00am – 9.05am 1. Welcome

9.05am – 9.15am 2. Governance 2.1 Attendance & Apologies 2.2 Disclosure of Interests/Specific Interests 2.3 Acronyms 2.4 Confirmation of Minutes (5 March 2014) 2.5 Action Item Register

1-4 5 6-13 14

9.15am – 10.00am 3.1 Director of Hospital Services Report – Phillip Balmer 1) Executive Summary 2) Balanced Scorecard 3) Financial Summary 4) Surgery and Ambulatory Care 5) Assessment & Rehabilitation for the Health of Older People 6) Medicine 7) Women’s Health & Kidz First 8) Mental Health 9) Non-Clinical Support Services Director of Allied Health report Director of Nursing report Appendix A 3.2 National Maternity Care Information System Update – Phillip Balmer

15-16 17-19 20-22 23-26 27-33 34-40 41-55 56-63 64-72 72-73 74-75 76-78 79-82 83-86

10.00am – 10.15am Morning Tea

10.15am – 10.20am 4. Resolution to Exclude the Public 87-88

10.20am – 10.45am 10.45am – 11.15am

5. Confidential Items 5.1 Patient Safety Report – Dr David Hughes 5.2 Non-Resident Revenue Processes – Margaret

White, Deputy CFO Hospital Services

89-104 105-116

11.15am – 11.45am

6. Presentations 6.1 Medical Assessment Unit – Carl Eagleton, Clinical

Head Internal Medicine, Vanessa Thornton, Clinical Head ED and Brad Healey, GM Medicine

117-129

Next Meeting: 7th May 2014, Ko Awatea Innovation Lab

1

BOARD MEMBERS’ DISCLOSURE OF INTERESTS

9th April 2014

Member Disclosure of Interest

Dr Lee Mathias, Chair MD Lee Mathias Limited

Trustee, Lee Mathias Family Trust

Trustee, Awamoana Family Trust

Chair Health Promotion Agency

Deputy Chair Auckland District Health Board

Director, Pictor Limited

Director, iAC Limited

Advisory Chair, Company of Women Limited

Director, John Seabrook Holdings Limited

Wendy Lai, Deputy Chair Board member and partner at Deloitte

Board member Te Papa Tongarewa, the Museum of New Zealand

Arthur Anae

Councillor, Auckland Council

Board Member Phobic Trust

Member The John Walker ‘Find Your Field of Dreams’

Chairman, NZ Good Samaritan Heart Mission to Samoa Trust

Colleen Brown Chair Parent and Family Resource Centre Board (Auckland Metropolitan Area)

Member of Advisory Committee for Disability Programme Manukau Institute of Technology

Member NZ Down Syndrome Association

Husband, Determination Referee for Department of Building and Housing

Chair, Early Childhood Education Taskforce for COMET

Member, Manurewa Advisory Group

Member, Child Advocacy Group – Manukau

MSD Member, Auckland Social Policy Forum, Auckland Council

Deputy Chair, Auckland City Council Disability Strategic Advisory Group

Chair ECE Implementation Team Auckland South

2

Dr Lyn Murphy Member, International Society for Pharmacoeconomics and Outcomes Research (ISPOR).

Member of the New Zealand Association of Clinical Research (NZACRes)

Senior lecturer in management and leadership at Manukau Institute of Technology

Member, ACT NZ

Director, Bizness Synergy Training Ltd

Director, Synergex Holdings Ltd

Associate Editor NZ Journal of Applied Business Research

Member Franklin Local Board

Sandra Alofivae

Chair of the Auckland South Community Response Forum (MSD appointment)

Secretary for the Tausa’afia Trust (Aoga Amata PIC Mangere)

MSD Member, Auckland Social Policy Forum, Auckland Council

Member, Fonua Ola Board

David Collings

Chair, Howick Local Board of Auckland Council

Member Auckland Council Southern Initiative

Kathy Maxwell Director, Kathy the Chemist Ltd

Regional Pharmacy Advisory Group, Propharma (Pharmacy Retailing (NZ) Ltd)

Editorial Advisory Board, New Zealand Formulary

Member Pharmaceutical Society of NZ

Maxwell Family Trust Share in Orion House leased to Orion Health through Oyster Management Ltd

Member Manukau Locality Leadership Group, CMDHB

Dianne Glenn Member – NZ Institute of Directors

Member – District Licensing Committee of Auckland Council

Member – Auckland Conservation Board

Life Member – Business and Professional Women Franklin

President – National Council of Women Papakura/Franklin Branch

Member – UN Women Aotearoa/NZ

Vice President – Friends of Auckland Botanic Gardens and Member of the Friends Trust

Member – Friends of Regional Parks

Life Member – Ambury Park Centre for Riding Therapy Inc.

3

CMDHB Representative ‐ Franklin Health Forum/Franklin Locality Clinical Partnership

George Ngatai Arthritis NZ – Kaiwhakahaere

Chair Safer Aotearoa Family Violence Prevention Network

Director Transitioning Out Aotearoa

Director BDO Marketing

Reece Autagavaia Executive Member, Pacific Lawyers’ Association

Member, Labour Party

4

HOSPITAL ADVISORY COMMITTEE MEMBERS’ REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS

Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 9th April 2014

Director having interest Interest in Particulars of interest Disclosure date Board Action Wendy Lai

HBL – Food & Laundry & FPSC Programme

Ms Lai declared a specific interest in regard to Deloitte providing support to HBL in the food and laundry and FPSC Programme. Deloitte has mainly been providing Oracle implementation resources to FPSC. Ms Lai is not directly involved with this work

12 February 2014

That Ms Lai’s specific interest be noted and that the Board agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.

5

Glossary ACC Accident Compensation Commission

ADU Assessment and Diagnostic Unit

ARDS Auckland Regional Dental Service

BT Business Transformation

CADS Community Alcohol, Drug and Addictions Service

CAMHS Child, Adolescent Mental Health Service

CNM Charge Nurse Manager

CT Computerised Tomography

CW&F Child, Women and Family service

DNA Did not attend

ESPI Elective Services Performance Indicators

FSA First Specialist Assessment (outpatients)

FTE Full Time Equivalent

ICU Intensive Care Unit

iFOBT Immuno Faecal Occult Blood Test

MHSG Mental Health service group

MoH Ministry of Health

MTD Month To Date

MOSS Medical Officer Special Scale

OHBC Oral health business case

ORL Otorhinolaryngology (ear, nose, and throat)

PACU Post‐operative Acute Care Unit

PHO Primary Health Organisation

PoC Point of Care

SCBU Special care baby unit

SMO Senior Medical Officer

SSU Sterile Services Unit

TLA Territorial Locality Areas

WIES Weighted Inlier Equivalent Separations

YTD Year To Date

6

Minutes of the meeting of the Counties Manukau Health

Hospital Advisory Committee

Wednesday 5 March 2014

held at the Innovation Lab, Ko Awatea, Middlemore Hospital

commencing 9.00am

COMMITTEE MEMBERS PRESENT:

Dr Lee Mathias (Board Chair)

Dr Lyn Murphy (Committee Chair)

Ms Wendy Lai

Anae Arthur Anae

Ms Colleen Brown

Mr David Collings

Ms Kathy Maxwell

Mr George Ngatai

Ms Dianne Glenn

Apulu Reece Autagavaia

ALSO PRESENT:

Mr Geraint Martin (Chief Executive)

Mr Phillip Balmer (Director, Hospital Services)

Ms Margaret White (Deputy Chief Financial Officer, Hospital)

Mr Martin Chadwick (Director Allied Health)

Ms Denise Kivell (Director of Nursing)

APOLOGIES: Apologies were received and accepted from Ms Sandra Alofivae.

WELCOME Apulu Reece Autagavaia opened the meeting with a prayer.

2.2 DISCLOSURE OF INTERESTS

The Disclosures of interests were noted.

2.2 SPECIFIC INTERESTS

There were no additional specific interests to note with regard to the agenda for this

meeting.

2.3 ACRONYMS

The acronym list was noted.

7

2.4 CONFIRMATION OF PREVIOUS MINUTES

Confirmation of the Minutes of the Counties Manukau Health Hospital Advisory Committee

meeting held 26 February 2014.

Noted that the Board Sub-Committee secretary will forward a copy of the Executive

Summary from the Mid-Staffordshire report together with copies of the Don Berwick letters

to the members.

Resolution (Moved Ms Kathy Maxwell/Seconded Ms Dianne Glenn)

That the minutes of the Counties Manukau Health Hospital Advisory Committee meeting

held 26 February 2014 be approved.

Carried

(Mr George Ngati arrived 9.13am)

3. DIRECTOR OF HOSPITAL SERVICES REPORT

Mr Phillip Balmer took the committee through his report.

The main issues of note were:

• Financials

Overall the month result for the Provider Arm was a net deficit of $487k, a $60k

favourable variance.

Non resident bad debts - Every 3 years the Ministry do a recalculation of the amount

they pay CMH (proportionate share). In the last 3 years we have received $2.5m

contribution to non resident bad debts, our total non resident earnings are

approximately $7m so there is a gap. A level of those bad debts are paid over many

years. We are particularly keen to re-engage with the Ministry on this issue as we don’t

feel we’re getting the right level of recompense.

• FTEs

FTEs are under budget by 201. Due to the consistent fluctuation of FTE month on

month, hA have been requested to review the timing and methodology for the unpaid

day accruals and statutory day credits in lieu to provide certainty around the often -

large movements:

• Nursing is reporting an unfavourable variance of 2FTE for January. This balance

reflects the correction of the large fluctuations in previous months due to the accrual

methodology adopted for FTEs.

• The Support Staff unfavourable variance of 10FTE reflects additional cleaning and

orderly service requests related to CSB as well as casual Security staff to cover for high

incidence of sick and annual leave.

• Management and Administration Staff are under budget by 94. This represents annual

leave taken in January plus vacancies yet to be filled across the organisation.

8

• Activity summary

Wies volumes are 6.42% below contract for the month. This volume is driven by Acutes

being down on contract by 8.4% and Electives up by 1.2%. Discharges are 4.4% up on

last year with Elective volumes showing a 1% increase on last year and Acute, a 5%

increase. If we can discharge patients sooner into better community care we will see a

trend with the Wies reducing – impacted on length of stay. CMH is sitting 3rd lowest of

the national DHBs. Management of acute demand is about keeping people out of our

hospital.

• Emerging issues

Pressure on response times continues in Gastroenterology, Echocardiology and for

surgery and outpatients particularly in plastics and ophthalmology.

Significant volume growth in renal dialysis is creating pressure on available capacity and

other options are actively being sought. Discussion on diagnosing patients early

enough, prevention is about how readily patients go to their GP and get diagnosed –

regular visits. Testing children at school is too early to diagnose diabetes which is why

the screening programmes are set at certain age groups (35 for Maaori and 45 for

European).

The Maternity action plan is making progress but given the high profile associated with

this area ongoing focus on implementing the action plan is required.

Good progress has been made in the Whole of System Planning process in a range of

areas including Health of Older People, Mental Health, First 2000 days and the

Maternity Action plan.

(Mr David Collings arrived 9.22am)

• Clinical supplies trend is not good and we need to get some behaviour changes. We

have a number of initiatives in place:

• hA procurement for regional opportunities

• HBL – Linen & Laundry and Food

• Starting to inventory manage our clinical supplies

• Product Evaluation Committee for new products

• Visibility of prices – looking to roll out price ‘banding’ of products as

currently used at Waikato DHB

• Advanced Care Planning – We are trying to increase community and health professional

awareness to ensure we proactively encourage people to start thinking in advance,

particularly once they have developed chronic illnesses or illnesses that are likely to

continue to deteriorate, about what kind of treatment programme they might want to

follow. The CMH Renal Service is very actively perusing this planning. Evidence shows

that if you actively encourage people to think themselves about what sort of treatment

they would like to have and how they would like their treatment to be changed as their

disease progresses, people often opt for less obtrusive, less expensive and less life

prolonging but more life quality improving treatment than health professionals give to

them.

9

• Surgical Performance – FSA’s are ahead of target. The service team have set a goal to

significantly reduce FSA’s and follow ups through establishing guidelines and GP advice,

support for virtual clinics etc. We are also doing some work in General Surgery, ENT and

Cardiology looking at discharge prescriptions- one of the programmes under the 20,000

Days campaign is the Smooth Programme (smoother medications on transfer home)

where a pharmacist is doing a reconciliation of medicines that were dispensed during

the pts hospital stay and comparing that to what the GP list was and going through and

understanding what changes were made, then notifying the GP what changes occurred

and providing the patient with an information sheet which sets out that they are now

going from a ‘blue pill’ to a ‘red pill’ or a pill with ‘one stripe’ to ‘two stripes’. The initial

trial was very successful and is now going through a rollout process.

• Intervention Rates – we are looking comparatively across the region and also against

other large DHBs at intervention rates to decide what would be the right intervention

level for us and use that as the guideline. We are looking at piloting a ‘health navigator’

system in Mangere where someone will work alongside the patient in the community to

ensure they have the right drugs, ensure they get the right follow up etc with the

outcome that we get a prototype template to expand and develop right across the

region. The thresholds don’t always meet the patient’s needs, it needs to be the right

intervention, alternative to manage the condition which is better than surgery.

Noted the committee requested that Mr Martin have a discussion with Anne Kolbe

around national guidance on what the principals should be on setting intervention rates.

• Allied Health Waitlists – we have just started a process with the Papakura Home

Healthcare team looking at how to redesign how they work. This is a 6 week process

looking at the patient journey, how they interact with our system and how do we

redesign our system so it is more responsive to the need.

Noted that the committee requested that this be reported back in the Director of

Hospital Services report to the 7 May meeting.

• Elective Surgery - where is the tipping point for surgery under state funding. DHBs are

tasked with reducing the burden of illness, injury and disability so anything that has a

disability or potential ramification will be something that surgery will be accessed. Each

individual case will have its own merits, no hard and fast rules. By and large the decision

is made at the referral stage from the GPs, they make the decision whether it is an

appropriate referral to make.

Noted the committee requested:

• A presentation on renal services and issues including information on current clinical

studies.

• A presentation around the financials and bad debts for non-residents.

• The Director of Hospital Services report:

o include a balanced scorecard with key measures under the Emerging Issues

section indicating if targets were on track and if not, what plans are in place.

o include what it is we are doing around FSA’s and how that is working with

our trends.

o the financial result graphs for each service has commentary so the members

can see what the difference is in what was in the budget and the movement

since budget.

10

o the Community Allied Health Waitlist table should refer to localities rather

than suburbs and that if there are issues, the report should set out what the

issues are and what is underway to address the problem/s.

The report was received (Carried Ms Dianne Glenn/Seconded Dr Lee Mathias).

4. PRESENTATIONS

4.1 Women’s Health

Ms Nettie Knetsch, GM Women’s Health & Kidz First, Ms Thelma Thompson, Director of

Midwifery and Dr Sarah Wadsworth, O&G provided a powerpoint presentation. A copy of

the presentation is attached to the minutes.

Some of the matters highlighted were:

• Births 6-7% down nationwide due to number of reasons (ie) recession, changes in

access to support for young women, women choosing to have children later in life,

global financial crisis etc.

• Gestational/diabetes – look into providing inductions away from MMH into the primary

units. There is a gestational diabetes report due out shortly which might provide some

guidance.

• Starting to develop a plan with the National Hauora Coalition to set up some very

coordinated services between LMCs, our community midwives, Well Child providers

and services like Family Start and NHC resources, refocusing on whaanau support in

Manurewa. Within next 6 months we should have a well developed plan for Manurewa

together with Papakura, in conjunction with locality planning.

• Gynaecology electives slightly up on contract year on year largely driven by the need to

get from 5 to 4 months. Looking at how we can get back to the 100%. Done a lot of

work on decreasing follow ups, down by 1000 in last two years. Comfortable where we

are and the work we are doing to integrate back with primary care.

• Caesarean rate YTD 22.6 (21.9YTD June 2013).

• Exclusive breastfeeding rates at discharge from hospital 82% for MMH and 89% for

community units (BFHI target is 75%) (baby friendly hospital initiative accreditation).

• 6hr target for EC presentations gynaecology - 97%.

• Smoking cessation maternity – 93%.

• Number of unbooked women at birth – average 1 per day.

• Bookings before 14 weeks – 39% (October 2013) for women under DHB midwifery care.

• MSIC (Maternity clinical information system) – CMH is an early adopter to implement

the system, rollout in July. Will have a national spine in Christchurch and include a

woman’s portal so they can access their own records on line.

• Midwifery workforce – currently have 9 Maaori students in the 2nd and 3rd year pipeline

and this year specifically focussing on Pacific students.

• Goal is 75% of women under the care of LMCs as part of the Maternity Review.

Noted the committee requested an update on how the MCIS is progressing be included in

next month’s Director of Hospital Services’ report.

The Chair thanked the presenters for their report on the Women’s Health Division.

The presentation was received.

11

5. RESOLUTION TO EXCLUDE THE PUBLIC

Resolution (Moved Anae Arthur Anae/Seconded Ms Kathy Maxwell)

That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of

the NZ Public Health and Disability Act 2000:

The public now be excluded from the meeting for consideration of the following items, for

the reasons and grounds set out below:

General Subject of

items to be

considered

Reason for passing this

resolution in relation to each

item

Ground(s) under Clause 32 for

passing this resolution

1. Minutes of the

Meeting of HAC

with public

excluded 12

February 2014

That the public conduct of the

whole or the relevant part of the

proceedings of the meeting

would be likely to result in the

disclosure of information for

which good reason for

withholding would exist, under

section 6, 7 or 9 (except section

9(3)(g)(i))of the Official

Information Act 1982.

[NZPH&D Act 2000 Schedule 3,

S32(a)]

Confirmation of Minutes

For the reasons given in the previous

meeting.

2. Action Items

Register

That the public conduct of the

whole or the relevant part of the

proceedings of the meeting

would be likely to result in the

disclosure of information for

which good reason for

withholding would exist, under


9(3)(g)(i))of the Official

Information Act 1982.


S32(a)]

Confirmation of Action Items

Register

For the reasons given in the previous

meeting.

Carried

11.44am – 11.49am – Public excluded session.

12

6. CONFIDENTIAL ITEMS

6.1 CONFIRMATION OF PREVIOUS MINUTES

Confirmation of the Minutes of the Counties Manukau Health Hospital Advisory Committee

meeting held 26 February 2014 (agenda pages 77-85).

• Noted the following amendments to the minutes:

• Page 79 4th paragraph – percentage should be 5% not 15-16% as recorded.

• Page 82 Final paragraph – sepsus should be spelt ‘sepsis’.

• Page 83 Final paragraph – NZ Pulmonary should be spelt ‘NZ Pulmonery’

• Page 84 Hospital Advisory Committee recommendation should read ‘Requested that the

monthly report on complaints and incidents, including the serious & sentinel events

report be reported monthly to the Hospital Advisory Committee’.

• Page 85 4th paragraph should read ‘Mr Balmer advised that he hadn’t heard about the

Waikato DHB self diagnosis programme’.

Resolution (Moved Ms Dianne Glenn/Seconded Ms Colleen Brown)

That the minutes of the Counties Manukau Health Hospital Advisory Committee meeting

held 26 February 2014 be approved with the above amendments noted.

Carried

6.2 ACTION ITEMS REGISTER

Resolution (Moved Ms Dianne Glenn/Seconded Ms Colleen Brown)

That the Action Items Register of the Counties Manukau Health Community & Public

Health Advisory Committee be received.

Carried

Resolution (Moved Anae Arthur Anae/Seconded Ms Kathy Maxwell)

That the committee move out of Confidential.

Carried

11.49am – Open meeting resumed.

The Committee Chair thanked those present for their participation in the meeting and

closed the meeting with a prayer.

The meeting concluded at 11.55am.

13

Signed as a correct record of a meeting of Counties Manukau Health‘s Community & Public

Health Advisory Committee held 5 March 2014.

Chair

Dr Lyn Murphy

Items once ticked complete and included on the Register for the next meeting, can then be removed the following month.

14

Hospital Advisory Committee Meeting – Action Items Register – 9 April 2014

DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

5.3.2014

3.0

Director Hospital Services Report Presentation on renal services and issues including information on current clinical studies

TBC

Mr Phillip Balmer

5.3.2014

3.0

Director Hospital Services Report Non Residents Revenue Processes

April

Ms Margaret White

15

Counties Manukau District Health Board Director Hospital Services Report

Recommendation

It is recommended that the Hospital Advisory Committee receive the Director Hospital Services

Report covering activity in February 2014.

Prepared and submitted by: Phillip Balmer Director Hospital Services

16

Director Hospital Services .................................................................................................................... 17

1 Executive Summary .................................................................................................................. 17

2 BALANCED SCORECARD – in development .............................................................................. 20

3 FINANCIAL SUMMARY Best value for public health system resources .................................... 23

4 Surgery and Ambulatory Care .................................................................................................. 27

5 Assessment and Rehabilitation for the Health of Older People (ARHOP) ............................... 34

6 Medicine, Acute Care and Diagnostics .................................................................................... 41

7 Women’s Health and Kidz First ................................................................................................ 56

8 Mental Health .......................................................................................................................... 64

9 Non Clinical Support Services .................................................................................................. 72

Director of Allied Health ‐ report ......................................................................................................... 74

Director of Nursing ‐ report ................................................................................................................. 76

17

Director Hospital Services

1 Executive Summary

1.1 Financials

Overall the month result for the Provider Arm was a net surplus of $2,753k, a $19k favourable variance. YTD the Provider Arm had a $469k favourable variance. The breakdown of overall variances for the CMDHB group are summarised below:

Month YTD

Hospital Provider $120k $278 k

Integrated Care $(49)k $677 k

Ko Awatea $(21)k $(47)k

HBL $(31)k $(439)k

Total Provider $19k $469 k

CMDHB Funder $(121) k $361 k

CMDHB Governance $117 k $(510)k

Total CMDHB $15 k $320k

For the month, clinical services revenue was unfavourable against budget by $(292) k primarily due to the absence of Tahitian burns patients and a reduction in ACC cases for the month. Expenditure of $312k favourable is driven by the impact of the unpaid days and statutory day credits applied in January, partially offset against outsourced costs within the services. Clinical supply savings were achieved due to the consumption of inventory stock piled in previous months. Non clinical revenue and expenses were $(106) k due to bad debt and capital charges, largely offset by interest and favourable infrastructure costs.

1.2 Activity summary

WIES volumes are <1% above contract for the month. This volume is driven by Acutes being up on contract by 5% and Electives down by 10%.

Acute ServicesThis Yr Act

Funder agreement

% Var to funder

agreementThis Yr Act

Funder agreement

% Var to funder

agreement

- WIES 4,408 4,214 5% 39,823 39,072 2%

Elective Services - WIES 1,267 1,409 -10% 11,688 11,047 6%

TOTAL (includes other DHB's) - WIES 5,674 5,623 1% 51,510 50,119 3%

TOTAL - all patientsMonth February 14 YTD February 14

CMDHB-Provider Arm Volume Summary - February 14

18

Discharge volumes (i.e. patients) are 4% up on last year with both Elective and Acute volumes showing a 4% increase on last year.

Acute ServicesThis Yr Act Last Yr Act

% Var to Last Yr

This Yr Act Last Yr Act% Var to Last Yr

- WIES 4,408 4,164 6% 39,823 38,502 3% - Patients 5,322 5,034 6% 47,062 45,404 4%Elective Services - WIES 1,267 1,498 -15% 11,688 11,810 -1% - Patients 1,150 1,203 -4% 11,117 10,739 4%TOTAL (includes other DHB's) - WIES 5,674 5,662 0% 51,510 50,313 2% - Patients 6,472 6,237 4% 58,179 56,143 4%

CMDHB-Provider Arm Volume Summary - February 14

TOTAL - all patientsMonth February 14 YTD February 14

1.3 FTEs

FTEs are above budget by 55. To resolve fluctuation of FTE month on month, WDHB and CMDHB have agreed with healthAlliance to delay the payroll close for month end to capture data from pay runs closing in the week of each new month. This process commenced in February.

1. Nursing is reporting an unfavourable variance of 48 FTE for February. There are approximately 22 unbudgeted but funded positions that currently exist in the services for specific initiatives; for example Cancer Care Nurses. There was additional FTE for orientation for new graduates during February (19 FTE) and overtime for the renal service (7 FTE).

2. The Support staff unfavourable variance of 27 FTE reflects additional cleaning and orderly service requests as well as casual Security staff to cover for high incidence of sick and annual leave; this was offset by favourable infra‐structure costs in Medical Waste Removal and Patient Meals.

3. Management and Administration Staff are below budget by 15. This represents vacancies yet to be filled across the organisation.

1.4 Highlights

The Building Naming Ceremony for the Middlemore site was a very positive event, with celebration involving families highlighting the historical changes to the Middlemore campus and to it’s role in meeting the needs of the community. It was also an opportunity to acknowledge the significant contributions from a range of people over the decades.

The new facilities have been a tremendous boost to all staff with widespread engagement in the planning and commissioning process. Migration of services to the Harley Gray Building was successfully completed in mid February with the Middlemore Theatres relocated to the Harley Gray Building on 14/15 February and Neonatal beds, Sterile Supply and TADU also relocated. Early February included 2 weeks of formal facility orientation for over 300 theatre staff prior to migration on 15/16 February. The transfer to the new facilities by the theatre and neonatal teams went very smoothly because of the dedication of many and effective teamwork across the organisation including radiology, orderlies, non‐clinical support, emergency response, clinical engineering, CSSD, Women’s Health, ICU, wards, and EC. The robust planning meant there has been a high level of satisfaction with the new clinical working environment. The associated way finding signage has proven effective in enabling patients to easily find their way around the very large hospital campus.

19

Specific recognition for the incredible effort above and beyond expectations great team leadership was shown by Catherine Larsen (Service Manager, Theatre and CSSD), Terri England (Service Manager, Anaesthetics) and Patrick Long (Service Improvement Manager) and Gillian Cossey (General Manager). A special mention is due for the Anaesthesia staff, Robyn Hughes (theatre), Robert Hawke (PACU), Olivia Woodman (TADU), David Farmer (CSSD) and Jackie Reid who have all done a remarkable job. From Neonatal and Women’s Health special acknowledgements should go to Kirsten Kent, project manager, Nicky Brougham (CNM for Neonates), Lindsay Mildenhall, (Clinical Leader for Neonates), Gail McIver (Midwife Manager), Nettie Knetsch (General Manager).

Good progress has been made in the Whole of System Planning process in a range of areas including Health of Older People, Mental Health, First 2000 days, and with the Maternity Action plan. Whole of system planning for disease systems including Cardiovascular, Respiratory and Musculoskeletal are also making progress.

Ian Sturgess, Geriatrician and Physician from the Improvement Directorate in the NHS led a workshop on how to improve the acute patient journey. As a result of these discussions each service has spent time redefining what are the quality standards or principles they set for themselves as their part of the acute journey. The goal will be to work to ensure we can meet these standards 24/7, 365 days a year.

1.5 Emerging issues

There has been continued higher than forecast Emergency Care and acute surgical volumes and hospital occupancy; particularly in the mental health and medical wards, the response to which has been effective in meeting the clinical demand and in keeping a ward closed. The operational planning is well advanced for the opening of the new Medical Assessment Unit at the end of March. Winter Planning and contingency development work continues.

Demand management work continues on response times in Gastroenterology, Echo‐cardiology, and for surgery and outpatients particularly in plastics and ophthalmology. The significant volume growth in renal dialysis is creating pressure on available capacity and other options are actively being sought.

20

2 BALANCED SCORECARD – N.B. Some measures under development

(see definitions in Appendix A)

HOSPITAL ADVISORY COMMITTEE

SCORECARD

February 2014

BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCES

Def

Feb‐13 Feb‐14 Target Var Actual Target Var

Total Caseweight 5,662 5,641 5,623 0% 51,305 50,119 2% 1

Elective Caseweight 1,498 1,266 1,409 ‐10% 11,526 11,047 4% 2

Acute Caseweight 4,164 4,375 4,214 4% 39,779 39,072 2% 3

Outpatient FSA Volumes 7,373 7,247 ‐2% 62,619 63,733 ‐2% 4

Outpatient Follow Up Volumes 24,456 23,311 ‐5% 199,529 202,863 ‐2% 5

Budgeted FTEs 5,938 5,682 5,627 ‐1% 5,586 5,524 ‐1% 6

Operating Costs ($000) 20,331 21,546 21,318 ‐1% 181,587 175,763 ‐3% 7

Personnel Costs ($000) 39,896 40,334 40,874 1% 341,140 343,195 1% 8

Elective Surgical Discharges (excludes uncoded) 1,081 994 9,009 8,694 4% 9

Financial Result Total $m 3.2 2.8 2.7 1% 0.2 ‐0.3 167% 10

Virtual FSAs 250 160 180 ‐11% 1,937 1,122 73% 11

Reduce clinical outsourcing 1,272 1,710 1,602 ‐7% 14,118 13,020 ‐8%


% Staff with Annual Leave > 2 years 7.9% 5.0% ‐2.9% 12

ARHOP 8.8% 6.1% 5.0% ‐1.1%MACS 12.3% 11.5% 5.0% ‐6.5%SACS 13.4% 13.8% 5.0% ‐8.8%Mental Health 9.2% 8.8% 5.0% ‐3.8%KFWH 15.7% 19.3% 5.0% ‐14.3%

% Staff Turnover 0.6% 0.7% 2.0% 1.3% 8.5% 10.0% 1.5% 13

% Sick Leave 3.0% 3.4% 3.0% ‐0.4% 14

Workplace Injury Per 1,000,000 hours U/D U/D 10.50% 10.51% 0.0% 15

Mandatory Training Completed < 3 months U/D U/D 16

QUARTERLY REPORTING Q1 2014 Var

Workforce Diversity ‐ Leader data January 2014 workforce populationMaori 5.2% 16% 11%Pacific 9.5% 23% 14%Asian 26.3% 22% ‐4%Other 59.0% 38% ‐21%

IMPROVED QUALITY, SAFETY AND EXPERIENCE OF CARE


% electronic medication reconci liation completed for

high risk patients within 48 hours of admission 15.0% 57.2% 17

% Pressure Injuries Per 100 Patients 3.0% 3.0% 3.5% 0.5% 3.0% < 3.5% 18

Falls causing major harm per 1000 bed days 0.13 0.08 0.00 ‐8.0% 0.09 19

Rate of adverse drugs events per 1000 bed days 63.0 TBA 20

CLAB rate per 1000 l ine days 0.0 0.0 0.0 0.06 0.00 21

Rate of S. aureus bacteraemia per 1000 bed days 0.09 0.08 0.0 0.00 22

% Operations where all 3 parts of the Surgical Safety

Checkl ist used TBA 93.0% 95.0% 2.0% 95.0% 23

QUARTERLY REPORTING Q1 2013 Q1 2014 Target Var 2013 Target Var

% patients 75+ assessed for the risk of fall ing 98.0% 96.0% 90.0% 6.0% 98.0% 90.0% 8.0% 24

% patients assessed for falls who have falls intervention

plans 85.0% 84.0% n/a 9.0% n/a 24a

Quarter

Year to date

Year to date

Ensuring Financial Sustainability

Enabling High Perform

ing People

First, Do No Harm (Safety)

Month Year to date

Month

Month

Year

21


SCORECARD

February 2014


ED 6 hour target ‐ National Health Target 97% 95% 95% ‐0.1% 95% 95% 25

Seen By inpatient team < 3 hours 56% 52% 52% 26

% patients receive care within 4 weeks – Radiation

therapy 100% 100% 100% 0.0% 100% 100% 0 27

% patients receive care within 4 weeks – Chemotherapy 100% 100% 100% 0.0% 100% 100% 0 28

MAU seen by SMO within 4 hours 29

% MRI scans completed within 6 weeks from acceptance

of referral 61.0% 80.0% 80.0% 0.0% 76.2% 80.0% ‐4.8% 30

% CT scans completed within 6 weeks from acceptance of

referral 88.0% 68.0% 90.0% ‐24.4% 77.8% 90.0% ‐13.6% 31

Inpatient radiology times < 24hours U/D 32

EC radiology times < 2 hours U/D 33

% diagnostic colonoscopy patients receive the procedure

within 14 days 55.0% 64.6% 50.0% 14.6% 50.0% 35

% diagnostic colonscopy patients receive the procedure

within 42 days 12.2% 22.4% 50.0% ‐27.6% 50.0% 36

% surveil lance colonscopy patients receive their

procedure within 84 days of planned date 85.7% 99.9% 50.0% 49.9% 50.0% 37

Test turnaround time (TAT) ‐ Labs U/D 38

Time to PCI for STEMI within 90 mins 60.0% 89.0% 80.0% 9.0% 72.0% 80.0% ‐8.0% 40

% patients waiting longer than 5 months for their FSA ‐

Elective 0 2 0 ‐2 0 41

% patients waiting longer than 5 months for inpatient

treatment ‐ Elective Surgery 0 6 0 ‐6 0 42

Acute delay for surgery U/D 37

QUARTERLY REPORTING Q1 Q2 Target Var Actual Target Var

FCT % patients with a high suspicion of cancer who

receives their first cancer treatment within 62 days 51.4% 58.8% u/d 53.8% u/d 43

FCT % patients with a confirmed diagnosis of cancer who

receives their first cancer treatment within 31 days of

decision to treat 76.4% 80.1% u/d 78.0% u/d 44

% radiology results reported within 24 hours 54.0% 66.0% 75.0% ‐12.0% 59.9% 75.0% ‐20% 45


% children and youth (0‐19) seen by 3 weeks for non‐

urgent mental health services – DHB MH teams n/a 74.1% 75.0% ‐0.9% 74.8% 75.0% ‐0.2% 46

Access rate ‐ No. of CMDHB domiciled unique cl ients

seen by MH services in the preceding 12 months as a %

of population (0‐19 Years) n/a 3.10% 3.07% 0.0% 3.1% 3.1% 0.0% 47a



of population (20‐64 Years) n/a 3.80% 3.07% 0.7% 3.8% 3.1% 0.7% 47b



of population (65+ population) n/a 2.54% 2.80% ‐0.3% 2.5% 2.8% ‐0.3% 47c

ALOS ‐ Acute Inpatient 2.7 3 4.31 0.3 2.9 4.31 ‐33% 48

ALOS ‐ Acute Arranged and Elective Surgery 1.4 1.1 3.21 0.7 1.2 3.21 ‐63% 49

Acute Readmissions within 7 days ‐ Total 2.2% 3.0% 3% 50

Acute Readmissions within 28 days ‐ Total 6.0% 6.9% 8% 1.1% 7.2% 8.00% ‐10% 51

Acute Readmissions within 28 days ‐ 75+ 9.9% 10.3% 11.80% 1.5% 11.5% 11.80% ‐2% 52

% EC admissions ‐ 75+ 653 681 6714 n/a 53

% transcribed clinical summaries authorised within 7

days of the document being created 71.2% n/a U/D 54

% patients with EDD/CSD within 24 hours of admission U/D 55

% of patient outliers 0.9% 0.7% 2.0% 56

Timely

System Integration (Effective)

Quarter Year

Year to date

Month Year to date

Month

22


SCORECARD

February 2014

QUARTERLY REPORTING Q1 Q2 Target Var Actual Target Var

% eligible stroke patients thrombolysed 8.2% 6.5% 6.0% 0.5% 7.3% 6.0% 1.3% 57

ASH rates 0‐4 ‐ Total U/D 58

ASH rates 0‐4 ‐ Maaori U/DASH rates 0‐4 ‐ Pacific U/DASH rates 0‐74 ‐ Total U/D 59

ASH rates 0‐74 ‐ Maaori U/DASH rates 0‐74 ‐ Pacific U/D


FSA/ FUP ratio 30% 31% 31% 31% 31% 0% 60

Outpatient DNA rates ‐ Maaori 15% 14% < 10% ‐7% 15% < 10% 61

Outpatient DNA rates ‐ Pacific 12% 12% < 10% ‐2% 12% < 10% 61a

Theatre List Util isation 92% 97% 95% 6% 90% 88% 2% 62

Theatre Session Utilisation 96.5% 85% 14% 63

Day of Surgery Admissions (DOSA) 87% 92% 90% 6% 94% 64

Day Case Rate (Elective/ Arranged) 63% 65% 65% 3% 63% 65

% patients discharged to transit lounge or home by

1100hrs 13.0% 12.0% 30% 13.0% 66

% MAU patients with LOS < 28 hours 92% 90% 65% 38% 90% 65% 38% 67

% community NASC referrals managed via e‐referrals and

assessed within 48 hours U/D 68

% patients with District Nursing home help witihin 24

hours U/D 69

% of referrals received electronical ly U/D 70

Nursing Hours Per Patient Day U/D 71

Hospital beds occupied 20,203 20,850 3% 184,101 183,339 0% 72

LOS outliers 409 461 13% 3,751 3,739 0% 73


Patient Experience Survey (to be reported from August

2014) 74

Better Health Outcomes For All


% Infants Exclusively Breastfed At Discharge from

i l l79.0% 77.0% 75.0% 75


Hospital ‐ Maaori


Hospital ‐ Pacific

% of hospitalised smokers receiving smokefree advice &

support ‐ Total 96.0% 96.0% >95% 96.0% >95% 76

% of hospitalised smokers receiving smokefree advice &

support ‐ Maaori 97.0% 95.0% >95% 95.0% >95%% of hospitalised smokers receiving smokefree advice &

support ‐ Pacific 95.0% 96.0% >95% 96.0% >95%

Month Year

Equity

System In

tegration (Effective)

Patient W

haanau

Centred Care

Efficient

Month Year

Month Year

Quarter Year

23

3 FINANCIAL SUMMARY Best value for public health system resources

Month Ended: February‐14

Division: Provider Arm

Actual Budget Var Var % Actual Budget Var Var %

REVENUE

3,727 4,063 (336) (8)% Government Revenue 31,189 32,296 (1,107) (3)%

1,057 755 302 40% Patient/Consumer Sourced 7,232 5,889 1,343 23%

1,239 1,736 (497) (29)% Other Income 13,756 13,662 94 1%

58,610 58,372 238 0% Funder Payments 470,739 466,830 3,909 1%

64,634 64,926 (292) (0)% Total Revenue 522,916 518,677 4,239 1%

EXPENDITURE

40,334 40,874 540 1% Staff Costs 341,140 343,195 2,055 1%

5,229 4,572 (657) (14)% Outsourced Costs 43,008 36,780 (6,228) (17)%

8,384 8,254 (130) (2)% Clinical Costs 70,999 69,636 (1,363) (2)%

7,955 8,493 538 6% Infrastructure Costs 67,633 69,348 1,715 2%

(21) (0.3) 20 8,136% Internal Allocations (53) (2) 51 2,532%

61,880 62,192 312 1% Total Expenditure 522,728 518,958 (3,770) (1)%

2,753 2,734 19 (1)% Net Result 188 (281) 469 167%

5,682 5,627 (55) (1)% FTE 5,586 5,524 (61) (1)%

** April: Unpaid days accrual for Easter period, increased activity and outsourcing to meet 5 mnth waiting time target

**May13: Increased activity to meet 5mnth waiting time target

($000's)

CMDHB Provider

Month to Date Year to Date

($000's)

-5,000

-4,000

-3,000

-2,000

-1,000

-

1,000

2,000

3,000

4,000

Monthly result $000's

Monthly Net Result

Result Budget

17,000

18,000

19,000

20,000

21,000

22,000

23,000

24,000


Monthly Operating Costs

Result Budget

36,000

37,000

38,000

39,000

40,000

41,000

42,000

43,000

44,000

45,000

46,000


Monthly Staff Costs

Result Budget

24

Feb‐14 YTD

Total Variance: $19 $469

Revenue: $(292) $4,239

Salaries & Wages: $540 $2,055

Outsourced: $(657) $(6,228)

Clinical Supplies: $(130) $(1,363)

Infra‐Structure/Internal allocation: $558 $1,766

The YTD result $4,239k reflects MoH funding received for:

‐ 12/13 elective bonus $1m

‐ 20k bed days $1.7m

‐ $1.5m is offset by costs in the provider

Outsourced Costs are $657k unfavourable, represented by:

Non‐Clinical

‐ HBL phased increased cost for FPSC project $(31)k.

‐ hA increased costs have not been fully recognised in the budget $(165)k.

Clinical

‐ Medical outsourcing is offset in full with medical personnel $(308)k

‐ Private procedures have increased in Surgical Services, particularly in orthopaedics and plastics to maintain the 150 day waiting time MoH target $(458)k.

‐ Savings were achieved from repatriation of Biochem tests from ADHB, outsourced CT Scans and renal outsourcing of $100k

‐ The rheumatic fever initiative has underspent on budget by $120k for the month with an expectation that costs will flow through in later months.

Other Expenses are $558k favourable for February. Ko Awatea training costs have been reduced to capture savings to compensate for the reduction in revenue

for the month $144k. An increase in non‐resident billings has naturally increased the bad debt provision resulting in an unfavourable variance of $(318)k.

Additional savings achieved across the services for the month are:

‐ Bedding and linen $96k

‐ Transportation $60k

‐ Admin & Other $97k

Depreciation, Interest and Capital Charge costs are $439k favourable due to;

o Buildings & Plant Depreciation variance due to phasing $108k

o Vehicles write–back on disposal $34k

o Other equipment depreciation charge increase $(24)k

o The level of borrowings is lower than budgeted. This combined with the capitalisation of the CSB project has delivered a $450k favourable interest cost

variance for the month.

o Capital Charge unfavourable variance of $(125)k reflects the actual cost of capital charged by MoH.

Year end Forecast variance to Budget

Clinical Supplies are $130k unfavourable for the month, explained as follows:

‐ Clinical Support $(163)k – PCT drugs for Haematology Chemo volumes have increased 20% year on year and are offset by revenue.

‐ Medicine +$243k ‐ the stock piling of inventory in January has resulted in a favourable variance, particularly in renal supplies; as excess inventory is

consumed over the coming month.

‐ Surgical and Ambulatory $(143)k – unfavourable cost due to the provisioning of inventory for the new CSB theatres, offset by corporate adjustment in non‐

clinical.

‐ Patient Transport $(79)k – due to a delay in claims for patient transport for the month.

CMDHB Provider

Medical Personnel Costs are $364k favourable due to existing vacancies within the organisation and is offset by outsourced medical services.

Nursing Personnel Costs are $371k favourable for the month reflecting the reversal of unpaid days and statutory day credit accruals from January of $199k. A

delay in claims for courses and study fees has also impacted positively on nursing costs for the month of $171k.

Allied Health Personnel Costs are $41k favourable for the month, largely due to a national shortage of psychiatrists in the Mental Health sector.

Support costs are $70k unfavourable for the month. Casual staff hours continue for cleaners, orderlies and security to cover the high incidence of annual leave

and sick leave. In addition, the high penal rates applied over the statutory days impacted adversely on budget.

Admin costs are $166k unfavourable for the month due to the impact of unpaid and statutory day credit accruals from January.

Revenue is $292k unfavourable for the month of February.

Revenue targets in Ko Awatea have not been met in February $188k, but has been offset by reduced expenditure for the month.

An absence of Tahitian burns patients and a reduction of ACC cases for the month have adversely affected revenue to budget by $245k. This is compounded

by donation revenue being down on budget by $205k. This is currently under review.

Non‐resident billings has doubled against budget for the month of $435k.

Overall the month result for the Provider Arm was a net surplus of $2,753k, a $19k favourable variance.

WIES volumes: MTD are <1% above contract for the month driven by acute being up on contract by 4.6% and electives down by 10% (Actual 5,675wies,

contract 5,623wies)

WIES volumes: YTD are 2.3% up on contract, with Acute up 3.4% and Electives down 1% (Actual 51,511wies, contract 50,119wies)

Financial Commentary ‐ Provider Arm

$372

25

Feb‐14

Key: Trend Arrows;

Shows improvement Shows deterioration Shows no change from previous month

Target Achieved (A), Target Not Achieved (NA)

Financial "Best Value" Service Result Target Variance Comment & Action Plan

Operating ExpensesProvider 21,558 21,330 (228)

Surgical & Ambulatory 5,128 4,764 (364)

Medical & Clinical Support 4,442 4,758 316

Womens/Kidz First 473 644 171

ARHOP 1,011 1,015 4

Mental Health 498 321 (177)

Facilities 2,061 2,099 38

Ko Awatea 442 561 119

Non‐Clinical 7,471 7,128 (343)

Personnel Costs

Provider 40,334 40,874 540

Surgical & Ambulatory 11,046 11,732 686

Medical & Clinical Support 12,000 11,355 (645)

Womens/Kidz First 4,877 4,727 (150)

ARHOP 3,640 3,848 208

Mental Health 4,806 5,059 253

Facilities 1,622 1,540 (82)

Ko Awatea 843 892 49

Non‐Clinical 1,170 1,429 259

Clinical outsourcing has had the greatest impact on operating expenses for February. Private surgical

procedures have increased in Surgical Services to maintain the 150 day waiting MoH target.

Favourable variance driven by the closure of ward 24 for refurbishment.

Outsourced Medical staffing overspent by $221k which is driven by SMO vacancies (see below).

Maintenance of FTE vacancies to offset lower revenue.

Total Employee Costs were $82k u for the month including employee costs in Support were $60k u ‐

included $19k f in Hotel Services Supervisors due to 3 FTEs vacancies in Non Clinical Support to be

replaced not yet fi l led; $54k u in Cleaners and $38k u in Orderlies due to casual staff covering very

high annual leave and sick leave taken, high penal costs due to statutory holidays, and increased

cleaning services to meet clinical demands and additional volumes; Security Officers $16k u due to

high overtime to cover high sick leave and annual leave taken; Maintenance Supervisors $21k f due

to 4 FTEs vacancies in Engineering to be fi l led.

Course fees in DON are fav $124k for the month due to a delay in claims being made in February.

Integrated care are carrying high vacancies particularly in HR fav +$169k. Gratuities and long

service leave has an increased provision based on previous years actual calculation by AON $(30)k.

Summary YTD: Gratuities and long service leave provisioning $(478)k, DON personnel +$60)k,

Integrated Care Vacancies $1m.

The closure of Ward 24 (for refurbishment) and high annual leave taken (without replacement) has

resulted in a favourable variance for personnel costs in Feb.

Underspend in Salaries; Medical $127k, Nursing $42k, All ied Health $62k and Admin $22k. Medical

Staffing salaries underspend is off‐set by locum medical costs ($221k) included in operating

expenses under outsourced services.

Main variance drivers in operating expenses are hA and HBL cost variation to contract $(211)k,

Stockpil ing for CSB theatres corporate adjustment offset in the services $(200)k, increase in bad

debts (directly attributable to the increase of Non‐Resident bil lings) $(318)k, Capital charge $(125)k

and interest expense due to capitalisation of interest for the CSB building $450k

The Personnel favourable variance of $540k is partially offset by Outsourced costs. Unpaid days and

stat day credits have had a favourable effect on the costs for this month as hA transition with a

process change to provide more accruate reporting. February result reflects the reversal of January

overaccrual.

Medical $379k fav ‐ primarily reflects SMO vacancies and Registrars leave transfers on rotation.

Nursing $273k fav ‐ impact of January unpaid days and stat day credits.

Externally funded positions for various projects 25.7FTE are offset by revenue $153k, 5 x RMO over

allocation within the service has reflected unfavourably on personnel costs by $50k, RMO increased

claims for WRE/CME $133k, additional sessions in radiology $74k, overspends for annual

leave/sick leave/stat day cover $101k.

Medical ‐($45K UnFav) ‐ additional costs for various projects (not budgeted) offset against

additional revenues, $17K for additional duties for NICU CSB move, Jr Doc AL transfers in/out.

Nursing/Midwives‐ ($53K unfav) additional costs for various projects (not budgeted) offset against

additional revenues, in addition, high sick leave, education leave, orientations and ACC leave in Feb

2014.

All ied Health ‐ ($5K unfav) ;Clerical ($46K unfav) ‐ additional costs for various projects (not

budgeted) are offset against additional revenue.

Outsourcing costs is the main contributor to the unfav variance (subcontracting CMDHB patients to

private providers) . Outsourcing is high in February due to loss of some surgical sessions during the

CSB transition. A level of outsourcing is required balance of year to meet ESPI targets.

Reflects savings in cl inical supplies and reduced volumes in renal, cathlab and gastro.

Favourable variance due to revenues and internal allocations for projects (not budgeted).

Favourable infra‐structure cost saving during the month for patient meals and medical waste

removal offset by security and util ity costs.

Reduction in course costs and consultants fees for the month.

NA

A

Balancing Excellence and Sustainability

26

Feb‐14

Key: Trend Arrows;

Shows improvement Shows deterioration Shows no change from previous month

Target Achieved (A), Target Not Achieved (NA)

Financial "Best Value" Service Result Target Variance Comment & Action Plan

FTE's

Provider 5,682 5,627 (55)

Surgical & Ambulatory 1,407 1,416 9

Medical & Clinical Support 1,547 1,502 (46)

Womens/Kidz First 717 653 (64)

ARHOP 590 607 17

Mental Health 643 674 30

Facilities 431 415 (16)

Ko Awatea 119 119 (0)

Non‐Clinical 190 195 5

‐25.7 Externally funded positions, including 20k bed days project

‐5 Overallocation of RMO's

‐7 Renal overtime, evening and additional shifts not budgeted

‐8.7 Nursing Orientation

Medical ‐ 8.7 FTE (unfav) from JR doc rotation

Nurse/Midwives ‐ 42 fTE (unFav) ‐ 12 offset against additional revenues, sick 8.39, Study 5.02,

orientation 5.2, ACC 2.35, OT 3.39, AUT Midwifery Development 2.4, Specials/Watch 3.25

All ied Health ‐ 6.72 (unfav) offset against additional revenues

Clerical ‐ 6.96 (unfav) ‐ 1.5 offset against additional revenues. 5.5 FTE for additional Midwifery

clinics and getting ready for MCIS implementation.

Nursing cost saving due to the closure of Ward 24 for rennovation.

High vacancy level in Mental Health.

Support 16.09 FTEs u – Cleaners 9.6 FTE u and Orderlies 15 FTEs u due to additional cleaning and

orderly service requests, high casual staff (48.44 FTEs ‐ 10.7% of cleaners and 27.1% of orderlies

rostered hours) covering annual leave and sick leave taken, annual leave accrued (14.81 FTEs for

Cleaners and 8.94 FTEs for Orderlies); Security Officers 1.37 FTEs u due to high overtime to cover for

high sick leave and annual leave taken; Hotel Services Supervisors 3 FTEs vacancies in Non Clinical

Support to be replaced not yet fi l led; Engineering 4 FTEs vacancies (1 replacement and 3 CSB

increase) to be fil led; and Facilities Projects 2 FTEs vacancies to be replaced not yet fil led.

Favourable variance in FTE reflects existing vacancies in the non‐cl incal services.

The unfavourable variance of 55 FTE reflect:

1) Nursing funded but unbudgeted positions, nursing orientation, overtime and sick leave (48u FTE)

2) Support staff ‐ additional cleaning and orderly service requests (27u FTE)

3) Management and Admin vacancies +15FTE

Existing vacancies across the service.

Maintenance of FTE vacancies during Feb14.

NA

Balancing Excellence and Sustainability

27

4 Surgery and Ambulatory Care

4.1 SERVICE PERFORMANCE

4.1.1 National Health targets

Elective Access Target Elective Discharges = 15,635 (N.B. Includes DHB of domicile) Elective Service Performance Indicators (ESPI Targets) ‐ 2 & 5 Target‐ 0 patients waiting>150 days for FSA or Treatment

Elective Discharge Volume February result – 104.5% YTD result – 115% ESPI February ESPI 2: FSA Not Achieved Two cases >150 days (Paediatric Med) ESPI 5: Treatment Not Achieved Six cases > 150 days (3 Plastics, 3 Orthopaedics)

4.1.2 Activity summary

Volumes FEB'14 Year to date Full yr Contract

Full yr Forecast

Last year

Actual Contract Variance % Actual Contract Variance % NZ WIES 13

NZ WIES 13

NZ WIES 12

ACUTES

‐ Adults 1736 1548 188 12.15% 14066 13433 633 4.71%

‐ Children 151 168 (17) (10.23%) 1378 1459 (80) (5.50%)

Total 1887 1716 171 9.95% 15445 14892 553 3.71% 22369 23156 20199

ELECTIVES

‐ Adults 1016 1164 (148) (12.74%) 9580 9128 452 4.95%

‐ Children 75 85 (11) (12.44%) 649 690 (41) (5.99%)

Total 1090 1249 (159) (12.72%) 10229 9818 410 4.18% 15261 15958 14234

TOTALS

Adults 2752 2712 40 1.47% 23646 22562 1,085 4.81%

Children 225 253 (28) (10.98%) 2027 2149 (122) (5.66%)

TOTAL 2977 2965 12 0.40% 25673 24710 963 3.90% 37629 39114 34433

Inpatient summary (WIES) The month and YTD activity is shown in the table below. In summary:

Acutes: 9.95 % above contract for month and 3.71 % above contract YTD

Electives: 12.72% lower than contract for the month, due largely to the move to the Harley Gray Building, but 4.18% higher than contract YTD. Substantial elective volume work is being done, both in‐sourced and outsourced to achieve the goal of 135 days for inpatient wait times by July 2014.

NOTE: Elective base contract for the month excludes Gynae but includes additional elective work. Adjustments made for uncoded hip and knee patients operated and discharged during the month but no adjustment has been made for Waiting list patients done on Acute Arranged lists.

Outpatient Summary (Visits First and follow up) for the month, 14.1% ahead of contract (YTD

20.2%) on FSA's and 3.6% up on contract for follow ups (YTD up 6.2%).

FEB'14 Year to date Full Yr

Contract

Full yr

Forecast

Actual Contract Variance % Actual Contract Variance %

FSA's 3036 2,660 376 14.14% 24481 20362 4,119 20.23% 29072 29072

Follow ups 6107 5,894 213 3.61% 50,811 47,837 2,974 6.22% 54,146 54,146

TOTAL 9143 8554 589 6.89% 75292 68199 7093 10.40% 83218 83,218

28

4.2 FINANCIAL: Best value for public health system resources


Division: Surgical & Ambulatory


REVENUE

406 611 (206) (34)% Government Revenue 4,177 4,529 (352) (8)%

103 200 (97) (48)% Patient/Consumer Sourced 1,009 1,450 (441) (30)%

128 328 (199) (61)% Other Income 1,910 2,166 (256) (12)%

938 923 15 2% Funder Payments 8,108 7,239 868 12%

1,575 2,062 (487) (24)% Total Revenue 15,204 15,385 (181) (1)%

EXPENDITURE

11,046 11,732 686 6% Staff Costs 91,398 94,213 2,815 3%

1,068 528 (541) (102)% Outsourced Costs 6,907 4,425 (2,481) (56)%

3,055 3,108 53 2% Clinical Costs 24,565 24,255 (310) (1)%

447 549 102 19% Infrastructure Costs 4,144 4,384 240 5%

558 580 22 (4)% Internal Allocations 4,929 4,633 (295) 6%

16,174 16,496 322 2% Total Expenditure 131,942 131,910 (31) (0)%

(14,598) (14,434) (164) (1)% Net Result (116,737) (116,525) (212) (0)%

1,407 1,416 9 1% FTE 1,342 1,306 (36) (3)%

**April:Unpaid days accrual for the Easter period,adjusted in May.

($000's) ($000's)

CMDHB Provider


-18,000

-16,000

-14,000

-12,000

-10,000

-8,000

-6,000

-4,000

-2,000

-

Mon

thly result $00

0's

Monthly Net Result

Result Budget

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Mon

thly result $000

's


Result Budget

9,500

10,000

10,500

11,000

11,500

12,000

12,500

13,000

Monthly result $00

0's

Monthly Staff Costs

Result Budget

29

Feb‐14 YTD

Total Variance: $(164) $(212)

Revenue: $(487) $(181)


Outsourced: $(541) $(2,481)

Clinical Supplies: $53 $(310)

Infra‐Structure/Internal Allocations: $124 $(55)

Year end Forecast variance to Budget $0

MTD favourable Variance of $124k is attributable to a number of factors. Bedding and linen underspend of $26k , Rental charges for Vac suction and pressure

mattresses $18k , Stationery supplies/printing $16k, Staff travel Domestic/Intl $7k . These favourable variances have now brought down the YTD variance to

$(55)k.The budget for 14/15 for Infrastructure costs and internal allocations has been maintained at current year levels.

Current Year end Forecast is for a breakeven. This is dependant on the capitalisation of costs for the CSB planning phase . A schedule of costs has been

prepared and awaiting confirmation by corporate.

Medical $379k MTH ($2.075m YTD) Primarily reflects SMO vacancies ($158k MTD, $828k YTD). The Registars are also favourable by $148k for the month

($661k YTD). The mix of Registrars for the run and the leave transfers on rotation have had a favourable affect on the Division.

Nursing $273k MTH ($164k YTD) Nursing has been affected by the impact of January unpaid days accrual reversal. This is expected to correct itself by

March.

Allied Health $38k MTH ($360k YTD) This reflects vacancies that have not been filled either as a result of the lack of skilled staff and the time lag for

recruitment. However this has to be viewed in conjunction with the outsourced costs of Allied Health personnel which amounts to $(73)k adverse.

Support Staff $(8)k MTH ($(94)k YTD) This is mainly due to Interpreter staff that have exceeded their buddget. The Division holds the budget for the entire

organisation providing interpreting services as and when required . The demand on the service has grown rapidly and servicing these demands has resulted in

more casual interpreters being recruited to meet expectation. This variance is set to continue for the year. 2014/15 budget expectation is that demand will

reduce to current years budget level.

Management Admin $3k MTH ($310k YTD) This has occurred due to non‐filling of vacancies on time and also better management of leave. A budget cut has

been made in 2014/15 to reflect currect activity.

The variance on Clinical Supplies for the month of $53k favourable is due to use of overstocked items in CSB in January. It is expected that there will be further

clawback on the YTD adverse variance of $(310)k in March, provided outputs remain at normalised levels. Clinical services have plans in place to manage

demand ie: acceptance of patients in line with capacity ‐ the benefit will be realised from July 2014.

Financial Commentary ‐ Surgical & Ambulatory

Outsourced costs on subcontracting $(458)k MTD ($(1.94)m YTD) ‐ Outsourcing elective patients has been essential to meet and maintain ESPI (Elective

Service Performance Indicator) targets. This has been compounded by the closure of elective theatres at MSC due to opening the CSB theatres. A level of

outsourcing is required balance of year to meet ESPI targets.

CMDHB Provider

Elective ACC Revenue was $205k unfavourable for the month ($(366k) YTD). The month's revenue has been adversely impacted by the closure of Theatres at

MSC due to staff transferred to MMH for the opening of CSB theatres. The variance will continue albeit at a lower level because priorty will be given to

operating on MoH patients to enable ESPI wait times to be met. Private patients $(125)k adverse for the month, $(469)k YTD. The main reason for this

variance is that we have had no acute Tahitian burns patients during this summer. This variance will continue to grow if we do not receive any Private Patients

this financial year. Other Income $(192)k unfav for the month and $(278)k unfav year to date. This is chiefly due to a timing issue relating to revenue

receiveable on the Delivery Redesign of Elective Services (DRES) project which will be Invoiced for by 30th June 2014.

The Division had an unfavourable variance of $164k for the month and $212k YTD. Detailed explanation for the months variance is given below.

Outputs for the month exceeded contract WIES by 0.4% or 12 WIES . There was an increase in Acutes of 9.95% or 171 WIES which was set off by a reduction in

Electives of 12.7% (159 WIES). The reduction in Elective WIES was due to closure of Elective Theatres at MSC on the two days prior to and the three days after

commissioning of CSB theatres . This was required to ensure that there were adequate numbers of trained Theatre staff at MMH to provide a seamless

transition for the CSB Theatres during the week of the opening.

30

4.3 QUALITY: Goal to improve the quality safety and experience of care

4.3.1 SAFETY First Do No Harm

Surgical Safety Checklist ‐ Patient Marker Audit for HQSC – 150 medical charts were audited in clinical records for the correct use of the Surgical Safety Checklist, with an improvement from 80% to 93% compliance.

CLAB Prevention –At end of February, CLAB free days are Ward 8 220 days, Ward 9 1,084 days, Ward 34N 3 (was 430 days to 25/02/14), Ward 34E 294 days, National Burns Unit 343. The celebration for Ward 34N (at 430 days) was a credit to the CNM and team.

Falls Prevention ‐ Twenty one in‐patient falls were reported in SAC services during February with one causing a major harm injury, and seven causing minor harm (lacerations or soft injury). There was one major harm injury from a fall in outpatients (head laceration requiring sutures and fractured thumb).

Surgical Services Falls 2011 - 2014

05

101520253035

Jan-

11

Apr-1

1

Jul-1

1

Oct-11

Jan-

12

Apr-1

2

Jul-1

2

Oct-12

Jan-

13

Apr-1

3

Jul-1

3

Oct-13

Jan-

14

Date range

Nu

mb

er o

f F

alls

Total falls

major harm

Pressure Injury Prevention: There were no grade 3 or 4 Pressure injuries identified, with nine grade 1‐2 pressure injuries identified and treated.

Surgical Site Surveillance: ‐ Orthopaedics: Audit of joints process is now in place with Infection Services team providing feedback to individual SMOs when an infection alert is triggered, enabling SMO audit of the case and feedback on the accuracy of data collection to Infection Services.

Other activity

A Combined Surgical/Medical Mortality and Morbidly Review meeting is scheduled for 13 March and cases have been organised.

Auditing has been completed on the Nursing Care plans and Admission Checklist with next audit to occur with medicine.

House Officer Patient Safety Hot shots training – on falls, open disclosure and serious incident investigation during February. Listening work is currently being done with the RMOs around perception of safety on the wards.

Telemetry ‐ a hospital‐wide audit of the new telemetry education sheets which are now attached to each telemetry machine has been completed with good engagement by the surgical wards.

31

4.3.2 TIMELINESS: “Every Hour Counts” if we are to achieve quality and safety outcomes”

Elective Service Performance Indicators (ESPI Targets) ‐ 2 & 5

ESPI 2: No patients wait more than 150 days for their First Specialist Assessment (FSA)

Two patients exceeded 150 days for FSA in Paediatric Medicine and a scheduled in March. The Hand Service addressed all cases waiting +150days from January and is continuing to implement solutions to maintain this improvement.

All other services achieved the 150 day target for FSA assessments.

ESPI 5: All Patients treated within 150 days

Six patients exceeded 150 days for surgery ‐ 3 Plastics and 3 Orthopaedics with both services due a code yellow ESPI 5 in April. This is 5 consecutive yellow results for Plastics. Despite the recent breaches, progress is occurring in managing access in the required timelines; early indications are that the March results will be compliant.

All other services achieved the 150 day target for treatment.

Regionally, there are 67 cases for FSA and 117 cases for Treatment exceeding 150 days target.

SACS Divisional Results for patients waiting more that 120 days for FSA or Treatment:

Good progress is being made towards achieving wait times less than 120 Days by December 2014, with General Surgery, Urology and Gynaecology along with smaller Medical services already achieving and/or maintaining the 120 day timeline for FSA.

Patients Waiting >120 days

31‐Jul

31‐Aug

30‐Sep

31‐Oct

30‐Nov

31‐Dec

31‐Jan

28‐Feb

31‐M

ar

30‐Apr

31‐M

ay

30‐Jun

FSA 152 112 111 251 190 183 348 254

For Treatment 201 207 271 322 232 317 369 316

At the end of February, there are 391 patients waiting 120+ for FSA and 316 patients waiting 120+ days for treatment – these will be due in March to sustain 150 day timelines. Orthopaedics had 58 and Plastics 34. Ophthalmology remains the largest contributor with 100.

Ophthalmology met the 150 day target for both FSA and treatment; however, the service remains on the Risk Register for Surgical Services given the high referral and patient volumes. Staff are working hard but need to continue to outsource significant numbers to help achieve thresholds. Ophthalmology is trialling a process for the preadmission process to be completed at the same time as the appointment where the decision to treat is made for Cataract procedures – this could save 750‐1, 00 preadmission appointments per year.

The Urology services FSA waiting list has been reduced and more patients are seen in clinically appropriate timeframes. However, the volumes waiting for Cystoscopy procedures are continuing to rise, numbers of expired follow‐up appointments and a larger numbers of patients are now requiring TURP surgery. Clinic templates have been reviewed to maximise throughput of these patients. Urology is using a virtual FSA tool to manage referrals and maximise FSA capacity. Of the 833 virtual FSA’s undertaken in Surgical Services, Urology completed 359 or 43%. TURP cases are outsourced, with monthly volume in excess of budget.

Use of Clinical Nurse Specialist Nurse‐led grading (with SMO oversight) of most referrals and Urodynamic clinics continue to make good progress, with the SMO’s supportive of the clinical processes and outcomes in reviewing results to determine future treatment paths. Through the Faster Cancer Treatment Initiative funding, a Urology 0.4FTE Cancer Nurse Coordinator has been appointed.

32

4.3.3 EFFICIENCY Avoiding waste, including waste of equipment, supplies, ideas and energy

Surgical Services monitor a number of efficiency measures including:

Theatre session utilisation ‐ Achieved (96.5% against target of 95%)

Theatre list utilisation (Elective) ‐ Achieved (89.66% against target of 85%)

Day of Surgery Admissions ‐ was 94% against a target of 95%. This is an improvement towards the target and reflects a more streamlined process for pre‐operative preparation, reducing the need for the patients to be admitted the day before for surgery.

Theatre Admission Discharge Unit – continues to focus on increasing utilisation and supporting the targets.

TADU Monthly Utilisation

0

100

200

300

400

500

600

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb

20122012201220122012201220122012201220122012201220132013201320132013201320132013201320132013201320142014

Pre-Op

Post-Op

Pre-op Target

Clinics

4.3.4 EFFECTIVENESS: Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit.

DRES Programme:

Primary Secondary Interface Redesign in ORL continues with review of the Canterbury Health Pathway template, input from ORL GP Liaison roles, and further GP engagement via ORL MOSS with intentions to engage with select GPs for input prior to finalisation of pathway for a “field trial”.

The Orthopaedic Pathway redesign work continues using the Canterbury Health Pathway baseline and a focus on feet pathways, and shoulders pathways for redesign. The GP Liaison for Orthopaedics is providing an initial GP perspective prior to wider GP engagement to finalise pathway for trial purposes.

General Surgery Pathway Redesign The Canterbury Health Pathway for Varicose Veins is being reviewed as a template for development. Four Ano‐rectal Clinics are utilising the follow‐up card for patients to seek further consultation, with ongoing work to monitor this new model. A paper has been written for the National Bariatric Pathway review on development of the Nurse‐ led follow‐up clinics for Bariatric patients.

Plastic Pathways Redesign Meetings of clinical heads from CM Health Plastic/Hands and General Surgery at Waitemata DHB have been ongoing to ensure clinical standards are adhered to and all steps are taken to provide a consistency of service across the region.

33

Regional Urology Pathway A second SMO has been appointed working across General Urology, the Spinal Unit, and ADHB, and a Clinical Nurse Specialist Urology increases urology capacity. The full repatriation of Urology patients will be primarily linked to local operating theatre resource.

Enhanced Recovery After Surgery (ERAS) Planning continues for ERAS visit by 20 Chinese doctors in March and the national ERAS Study Day in April. ERAS for Acute Cases are focused on standardising clinical processes for right iliac fossa pain management to reduce clinical variation.

20,000 Days Collaborative Programmes:

‘Well Managed Pain’ (WMP): Successful patient‐centred care is occurring with strengthened team communication and effectiveness, and averaging over 25 new referrals per month. The Acute, Chronic and Well Managed Pain services will present at the Grand Round in March and participate in the “Dragons Den” for application for continued funding.

Wound Care Service Nurse Consultant continues to run twice weekly clinic and education sessions and sixteen staff (RNs and DNs) completed the compression therapy course during February. Having Nurses on wards who can compression bandage may enable earlier discharges.

National Leadership:

Enhanced Recovery after Surgery (ERAS) for Primary Joints and # NOF – National Collaborative: The sign‐off of the Ministry of Health funding contract has enabled invoicing. The project team has ensured completion of detailed driver diagrams and the project charter to meet the Ministry of Health Collaborative methodology requirements. Additional Registered Nurse resource has been secured to co‐ordinate review of progress to date and there has been a focus on a review of EC Fast track NOF guidelines and Radiology changes as required, including a number of PDSA cycles. Anaesthetic involvement is being sought to assist with a standardised anaesthetic approach. Reporting of the first dataset is taking considerable resource and there will be ongoing process of data collection.

National Acute Spinal Cord Injury Review: The National Spinal Strategy Action Plan has been received. Counties Manukau Health is focusing on the impact of acute surgical intervention and will also be trialling the shared care plan. Work has commenced for all acute Spinal Surgery for the North Island to be delivered from Middlemore Hospital from 01 July 2014. The initial focus is on a review of the clinical criteria for referrals and development of referral process and criteria including confirming clinician communication processes (0800 contact number). A Charge Nurse leader has been seconded as the Clinical Nurse specialist role and will provide project leadership.

4.3.5 PATIENT AND WHANAU CENTRED CARE: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.

Staff training: All General Surgery Charge Nurses have attended Ko Awatea Lynne Maher’s “Sustaining Quality” workshops with the learning shared at the monthly Quality Forum. The Patient Experience Programme facilitated by Dr Lynne Maher is being attended by several surgical service groups.

Patient online booking Portal: investigating the options for a patient portal continue after viewing the Hutt Hospital DHB system. In February, a number of discussions occurred with vendors, and regional colleagues on the best options to link with Concerto and/ or iPMs systems.

Complaints/ compliments: are tracked monthly with strengths and gaps noted, analysed and acted on. There were 84 compliments and 25 complaints.

34

5 Assessment and Rehabilitation for the Health of Older People (ARHOP)



Middlemore Rehabilitation Services ‐ admitted 124 patients with 72 patients (58%) admitted acutely direct from Emergency Care. Of these patients, 57% were admitted to the Health of Older Persons Services (wards 4&5) and 22% admitted to Rehabilitation (ward 23). Ward 24 has been closed for refurbishment and modifications in February.

Discharges from AT&R Specialties

Discharges from AT&R specialty

0

50

100

150

200

2010 2011 2012 2013 2014

2010 119 85 95 88 96 94 76 64 90 84 86 96

2011 102 125 99 110 95 107 69 94 121 94 107 98

2012 99 147 134 99 120 122 108 111 129 115 130 134

2013 119 133 107 114 108 121 121 102 112 104 155 103

2014 139 135 137 143 131 112 97 81

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Average Length of Stay from AT&R

Average Length of Stay from AT&R

0.0

5.0

10.0

15.0

20.0

25.0

2010 2011 2012 2013 2014

2010 15.3 15.9 18.0 17.5 16.5 16.2 19.6 17.0 16.4 17.9 16.5 16.7

2011 16.1 15.7 13.6 14.6 14.1 14.6 17.3 16.1 15.0 15.7 17.3 17.2

2012 17.1 14.6 14.0 18.1 13.8 17.6 16.4 16.7 14.8 15.9 16.1 17.2

2013 16.2 16.2 16.2 19.0 17.4 15.0 16.4 16.4 13.3 16.3 16.1 15.6

2014 14.0 13.3 13.4 13.0 14.8 14.8 17.4 18.8

Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun

Auckland Spinal Rehabilitation Unit (ASRU) Activity ‐ Inpatient volumes at the Spinal Rehabilitation Unit remain high with occupancy at 91.5% and a waitlist forming. The service continues to manage discharge planning and transfer patients from acute facilities as space is available.

Home Health services Outpatient and Community Services –8,861 care contacts provided across all bases in February, with 605 new referrals and 795 discharges. Appointment Did Not Attend rates – Orakau 9%, Papakura 8%, Pukekohe 4% and Howick 1%. Papakura Home Health Care is currently working with the General Manager of Manukau Locality to review the models of service delivery and identify opportunities to improve efficiency and effectiveness.

35

HHC Contacts

1000

2000

3000

4000

5000A

pril

May

June

July

Aug

ust

Sep

tem

ber

Oct

ober

Nov

embe

r

Dec

embe

r

Janu

ary

Feb

ruar

y

Mar

ch

Apr

il

May

June

July

Aug

ust

Sep

tem

ber

Oct

ober

Nov

embe

r

Dec

embe

r

Janu

ary

Feb

ruar

y

Mar

ch

Apr

il

May

June

2012 2013 2014

Botany

Orakau

Papakura

Pukekohe

Needs Assessment and Service Coordination (NASC) – There have been 272 referrals, with the average contacts at 1,502 per month since February 2013. Average duration of NASC contacts is 59mins and 48% of contacts were Service Co‐ordinations. The Ministry of Health has provided $425k per annum to deliver more Home Based Support Services (HBSS) assessments (volumes) and services. This funding will be provided until 2016 to deliver additional services, and progress reporting on this additional activity to the Ministry of Health will occur in April 2014.

NASC Contacts

0

500

1000

1500

2000

2500

July

Aug

ust

Sep

tem

ber

Oct

ober

Nov

embe

r

Dec

embe

r

Janu

ary

Feb

ruar

y

Mar

ch

Apr

il

May

June

July

Aug

ust

Sep

tem

ber

Oct

ober

Nov

embe

r

Dec

embe

r

Janu

ary

Feb

ruar

y

Mar

ch

Apr

il

May

June

2013 2014

Co

nta

cts

NASC Contacts

Mean

LCL

UCL

Community Geriatrics Services – Contacts in Aged Residential Facilities and Community in February, the average duration was 60 minutes, with 43% First Contact, 46% at a Rest Home or Private Hospital location, 72% were by Nurse and 60% were for Assessment. There was a reduction in Consultant contacts for February was due to medical staff on conference and annual leave.

36

5.2 FINANCIAL: Best value for public health system resources


Division: ARHOP


REVENUE

309 338 (28) (8)% Government Revenue 2,782 2,700 81 3%

1 5 (4) (78)% Patient/Consumer Sourced 6 39 (33) (84)%

22 29 (7) (25)% Other Income 108 230 (121) (53)%

216 168 48 28% Funder Payments 1,814 1,345 469 35%

548 539 8 2% Total Revenue 4,710 4,314 396 9%

EXPENDITURE

3,641 3,848 207 5% Staff Costs 30,855 31,332 477 2%

339 341 2 1% Outsourced Costs 2,774 2,728 (46) (2)%

486 489 2 0% Clinical Costs 4,087 3,911 (176) (5)%

119 134 15 11% Infrastructure Costs 1,121 1,075 (46) (4)%

66 51 (14) 28% Internal Allocations 514 456 (58) 13%

4,651 4,863 212 4% Total Expenditure 39,352 39,502 150 0%

(4,104) (4,324) 220 5% Net Result (34,642) (35,188) 547 2%

590 607 17 3% FTE 622 627 6 1%

CMDHB Provider


($000's) ($000's)

-4,700

-4,600

-4,500

-4,400

-4,300

-4,200

-4,100

-4,000

-3,900

-3,800

-3,700

-3,600


Monthly Net Result

Result Budget

-

1,000

2,000

3,000

4,000

5,000

6,000



Result Budget

2,000

2,500

3,000

3,500

4,000

4,500


Monthly Staff Costs

Result Budget

37

Feb‐14 YTD


Revenue: $8 $396

Salaries & Wages: $207 $477

Outsourced: $2 $(46)


Infra‐Structure: $15 $(46)

Financial Commentary ‐ ARHOP

CMDHB Provider

The main reason for the favourable variance is the closure of Ward 24 for renovation ($176k for the month and $365k YTD). Medical Staffing is under budget

($25k for the month and $185k YTD) mainly due to RMOs seniorty level being less than budgeted.

YTD favourable variance is mainly due to the Funder cost reimbursement relating to the conversion of 10 long stay to AT&R beds in Pukekohe and Dementia

Project $430k off‐set by ACC and Non‐Resident revenue below budget $(47k).

Revenue for the 2014‐15 budget has been increased by $250k for the spinal inpatient/ACC revenue on current years budget.

The main reason for the underspend in the month is the savings in nursing costs due to the closure of Ward 24 ($151k for the month and $354k YTD).

Medical Staffing is under budget ($25k for the month and $185k YTD) mainly due to RMOs seniorty level being less than budgeted. YTD overspend in Home

Health care nursing ($299k YTD) and the Allied Health vacancies of and recruiting staff at a lower level wherever possible has resulted in a favourable

variance of $340k YTD.

The main variances YTD are, community woundcare ($87k), Community Continence ($71k) and Ostomy supplies ($56k). 2014/15 budget reflects reduced

useage of clinical supplies.


The year end forecast has been upgraded due to the closure of Ward 24 for refurbishment with no additional community services being put in place as a

result.


5.3.1 SAFETY First, Do No Harm

Pressure injuries: 2 pressure injuries identified in February; neither was acquired on the wards. This is a reduction from 3 in January.

Falls incidents: 35 recorded falls, an increase from 22 recorded falls last month. Of these, there were five falls with harm.

Medication errors incidents: No medication errors reported in February. This is a reduction from 3 in January

Occupational Health and Safety Bi‐Monthly Audit Tool Results / Safe Workplace: a sustainable audit and follow‐up system and process for Occupational Health and Safety is in place with 100% completion of these audits since November 2013.

5.3.2 TIMELINESS: “Every Hour Counts” if we are to achieve quality and safety outcomes

Needs Assessment and Services for Older People (NASC) new national timeliness measures are being discussed and will include 10 days “referral to services” for complex clients (those that have a homecare assessment) and 30 days for non‐complex (those that have a contact assessment interRAI). Reporting performance against these timeframes will be required and a regional discussion regarding achieving this via the Northern Regional Health Plan is underway.

interRAI rollout (aligned to Northern Regional Health Plan, Health of Older People work streams) is progressing with 64% (2432/3809) of clients receiving Home Based Support services (HBSS) having now received an InterRAI assessment.

38

Waitlist ‐ Allied Health Outpatients

Acute Allied Health Outpatient Waitlist

0

50

100

150

200

250

300

350

July

Aug

ust

Sep

tem

ber

Oct

ober

Nov

embe

r

Dec

embe

r

Janu

ary

Feb

ruar

y

Mar

ch

Apr

il

May

June

July

Aug

ust

Sep

tem

ber

Oct

ober

Nov

embe

r

Dec

embe

r

Janu

ary

Feb

ruar

y

Mar

ch

Apr

il

May

June

2013 2014

MSOP

Obstetrics/Gynae

MORRSA (rheumatology)

PT Hyperventilation

Cardiac Rehab

Pulmonary Rehab

OT Rheumatology

Waitlists – Community Allied Health

Previous month Total

Orakau (Mangere/ Otara)

Papakura

(Manukau)

Pukekohe

(Franklin)

Howick

(Eastern)

Waiting list Dietetics 17 24 9 4 6 5

Contacts Dietetics 105 83 24 24 19 16

Waiting list Occ Therapy 264 259 72 99 7 81

Contacts Occ Therapy 225 255 90 65 38 62

Waiting list Physiotherapy 101 105 4 48 13 40

Contacts Physio 233 254 102 71 59 22


Continence Service Re‐design ‐ the project is well established and is a ‘Whole of Systems’ Project to improve the patient experience across the care continuum. Critical linkages with primary health are being established and working groups are being formed. There is an appetite to fundamentally change the way the services are currently configured and to establish a single point of service entry for all adult patients with continence issues.

5.3.4 EFFECTIVENESS Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit.

20,000 Days Collaborative Programmes;

The Community Stroke Early Supportive Discharge – Supporting Life after Stroke has actively worked with 20 patients since the pilot commencement. Early Length of Stay (LOS) data is indicating that patients have achieved a reduction in LOS of 4 days. Outcomes are measured using the Functional Independence Measures (FIM) to categorise patients and comparison of patient outcomes for this pilot is the next step.

Dementia Pathway Implementation (Memory Team) – During February, 92% of patients referred with Dementia were seen by the Dementia Care (Memory Service) and 200 patients

39

have been referred to the pathway. The pathway has been reviewed to more clearly define the role of Alzheimer’s Auckland Trust. A trial of the Shared Care Plan has been agreed with a General Practice in Manurewa reflecting high referral numbers received from this Practice.

Acute Care for the Elderly (ACE): Development of a comprehensive Geriatric Assessment model for patients >85years acute cases continues with testing of the Needs Identification Tool in Emergency Care continues with issues identified with the tool and testing to continue into early 2014. The multidisciplinary team is reviewing patients to assess their need for inpatient care. Development of a care plan document continues with a new version being trialled. The new model is achieving reductions in the Length of stay for cases requiring AT&R admission.

The Acute Care for Elderly (ACE) model was presented to several other hospital services in New Zealand and Australia in February and March and continues to generate interest.

Community Geriatric Service team – The Community Geriatric Service (CGS) team provided support to 6 General Practices during February. There were 83 presentations from Aged Residential Care facilities to Emergency Care, with 15 being potentially avoidable. In February rate of Residential Care prescribing for Vitamin D was 92%.

ARRC Presentations to EC 2012‐14

0

20

40

60

80

100

120

140

Jul‐12

Aug‐12

Sep‐12

Oct‐12

Nov‐12

Dec‐12

Jan‐13

Feb‐13

Mar‐13

Apr‐13

May‐13

Jun‐13

Jul‐13

Aug‐13

Sep‐13

Oct‐13

Nov‐13

Dec‐13

Jan‐14

Feb‐14

Mar‐14

Apr‐14

May‐14

Jun‐14

ARRC presentations to EC

20,000 Days Target 2012/13

Regional Target 2012/13

Potientially Avoidable

Fracture Liaison (older people) Service ‐ The goal of establishing this service is to identify those at risk of fractures and proactively manage their hospital care to reduce risk. Service planning and implementation is underway, with data gathering to review the current state and clinical areas identified to start trialling a new model.

40

Delirium (CAM Tool) Roll Out (hospital care) – working with the Communications Team develop the website. A Delirium education package (‘How to’ Guide) has been completed for services to use and a presentation on Delirium management for House Officers orientation was well received.

Regional and National Service Developments:

InterRAI Long Term Care Facility Rollout (LTCF) – Regional target is 32% of facilities completed training by June 2014. For Counties Manukau, 38% of facilities have now completed training in the nationally mandated ‘InterRAI’ assessment and care planning system, and the roll out of InterRAI is ahead of target.

Elder Abuse and Neglect (EAN) development – Working Group meetings were held in February and VIP representative attended the Age Concern Advisory Group Meeting held during February. The EAN Procedure document is being finalised and sent out for wide feedback and Clinical Governance group approval. Once approved, training will commence in Adult Rehabilitation and Health of Older People services.

Auckland Spinal Rehabilitation Unit (ASRU) Spinal Pathways – The inpatient rehabilitation Spinal Unit pathway development continues to make good gains. Work has commenced on the Shared Care Plan which also forms part of the National Spinal Strategy action plan. It is expected that the shared care plan will complete the pilot of 10 clients by September 2014.

5.3.5 PATIENT AND WHANAU CENTRED CARE Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions

Facilities Environment Improvements: Ward 24 – Refurbishment and en‐suite development commenced in January 2014 and the ward reopening is mid‐March 2014. Spinal Unit – The refurbishment of the Motel Unit for family and outpatients use, and ward refurbishment is due for completion early March.

Rheumatic Fever ‐ The Rheumatic Fever Patient Experience programme (supported by Ko Awatea) have commenced. This work is being overseen by Locality General Managers, General Manager Kidz First/ Women’s Health and Ko Awatea, in conjunction with the Home Health Care Service District Nurses that deliver the community follow up service. The following targets have been set:

Target: There will be nil medication errors for this population. Target: All Rheumatic Fever patients managed by Home Health Care will receive their monthly injection within the 5 day tolerance time frame.

The Rheumatic Fever work group will focus on the following work streams. Trial improved management of “Did Not Attend” cases with potential use of the Community Support Worker role and use of Dialhog Text messaging to Rheumatic Fever patients seen in the community/ outside of the clinic will continue to be tested on a small group of patients across two localities.

Complaints/ compliments: Five Complaints were received in February, 1 for Home Health Care, 3 for NASC and 1 for ward 4. They relate to Attitude, Delay in Access, Communication and Privacy and are being investigated. A compliment was received by Ward 4 about staff ‐ Attitude, Courtesy, Care and Treatment.

41

6 Medicine, Acute Care and Diagnostics


6.1.1 National Health targets

Shorter stays in the Emergency Department 95% of patients wait < 6 hours to be admitted, discharged or transferred from an emergency department.

6 hour target February result – 95% YTD result – 95.5%

Shorter waits for cancer treatment All patients needing radiation treatment will commence treatment within four weeks

Cancer wait target February result – 100%


Volumes Month YTD Budget/ Contract

Last YTD

Act Bud / Contract

Var Act Bud / Contract

Var Forecast Act

INPATIENT (WIES)

Adult Acute Care 293 314 (21) 2,610 2,590 20 3,974 2,646

Adult Medical Care 1,740 1,688 52 15,643 16,305 (662) 23,992 15,883

TOTAL 2,033 2,002 31 18,253 18,895 (642) 27,967 18,529

INPATIENT (CASES) Contract = Last year actuals

Adult Acute Care 856 843 13 7,640 7,140 500 11,109 7,220

Adult Medical Care 1,976 1,819 157 17,346 17,371 (25) 25,825 17,676

Total 2,832 2,662 170 24,986 24,511 475 36,934 24,896

MEDICINE O/Patient

Procedural (contract) 585 618 (79) 585 618 (983) 8,587 5,154

FSA’s 1,341 1,081 260 10,053 8,086 1,967 13,453 8,428

Follow up’s 3,171 3,170 1 26,196 25,000 1,196 39,245 25,129

EMERGENCY CARE

Presentations (against last year)

7,901 7,538 363 69,911 67,617 2,294 101,284 67,617

Discharges (against contract)

7,952 7,392 560 69,955 67,342 2,613 100,602 67,600

BREAST SCREENING

No. of screens 2,047 2,094 (47) 16,732 16,752 (20) 25,128 15,802

Inpatients: The overall monthly WIES result reflects a 3% increase compared to contract and 7% increase compared to last year. General Medicine showed a 3% increase in WIES compared to contract and a 7% increase compared to last year. WIES was up for all services except Respiratory that had a 15% decrease on 2013. Inpatient Cases were 9% or 157 cases more than 2013, with a higher ALOS (at 3.4 days compared to 3.2). General Medicine (inpatients) saw 8% or 98 more cases compared to last year.

February admissions and discharges were slightly less than on January figures, with 1,197 compared to 1,312 in January. There were 1,229 discharges for February compared with 1,282 in January. However, physical occupancy increased slightly from 90% to 91% for February. The first half of the month saw the occupancy consistently high with a higher acuity, with the last two weeks less so and 36 beds were closed in the later half of the month.

42

Alongside patient acuity on many days throughout the month, especially the last 2 weeks, each of the medicine wards have been ‘over‐census’. This is usually implemented as a winter initiative however patient numbers required implementation of this to provide sufficient in‐patient beds.

Renal Volumes: Continued to increase above contract with 32 dialysis patients outsourced and 24 patients in the Western Campus Prefab, 34 patients on evening shifts in AMC and 9 in Rito MSC.

Outpatient volumes: Volumes for the month were 9.7% above contract and 3.5% higher than last year. FSA’s were 24.1 % above contract with increases in FSA’s done across a number of areas but most notably Respiratory. Follow‐ups were at contract and 2.4% lower than last year due with decreases against contract in General Medicine, Cardiology, Endocrine and Respiratory. These were offset by increases against contract in Diabetes, Gastroenterology Renal and Rheumatology.

Emergency Care: Continuing high volumes ‐ 4.8% volumes increase and 7.6% increase in discharges on 2013. There is significant variation in daily volumes from 230 to 304. Average daily patient volume in February was 282.

Breast screening: In February, the service did not achieve the total screening targets due to the short month and leave (maternity and ACC) of MRTs. However, the service exceeded the target Maori volumes and expects to continue to achieve targets for the full year.

Radiology: Overall Radiology volumes are 2% higher than the same time last year. In February, the reduced volume of ultrasound scans performed (due to maternity leave) was offset by the increases across the other modalities.

43

6.2 FINANCIAL RESULTS: Best value for public health system resources


Division: Acute Care


REVENUE

8 0 8 0% Government Revenue 8 0 8 0%

0 0 0 0% Patient/Consumer Sourced 0 0 0 0%

0 4 (4) (94)% Other Income 2 32 (30) (94)%

0 0 0 0% Funder Payments 0 0 0 0%

8 4 4 109% Total Revenue 10 32 (22) (69)%

EXPENDITURE

2,193 2,129 (64) (3)% Staff Costs 19,419 18,874 (545) (3)%

30 23 (7) (32)% Outsourced Costs 267 180 (87) (48)%

221 226 5 2% Clinical Costs 1,951 1,809 (141) (8)%

104 119 14 12% Infrastructure Costs 946 949 2 0%

83 82 (0) 0% Internal Allocations 671 640 (31) 5%

2,631 2,579 (52) (2)% Total Expenditure 23,255 22,452 (803) (4)%

(2,623) (2,575) (48) (2)% Net Result (23,245) (22,421) (824) (4)%

290 276 (14) (5)% FTE 298 284 (14) (5)%

**April:Unpaid days accrual for the Easter period,adjusted in May.

($000's)

CMDHB Provider


($000's)

-3,500

-3,000

-2,500

-2,000

-1,500

-1,000

-500

-


Monthly Net Result

Result Budget

-

100

200

300

400

500

600



Result Budget

-

500

1,000

1,500

2,000

2,500

3,000


Monthly Staff Costs

Result Budget

44

Feb‐14 YTD

Total Variance: $(48) $(824)

Revenue: $4 $(22)

Salaries & Wages: $(64) $(545)


Infra‐Structure/Internal Allocations $14 $(29)

$(64)k MTD

$54k u ‐ Medical staff ‐ additional 0.9fte SMO in EC, 1xfte SMO for ACC cover, RMO CME/WRE claims $30k u.

$(545)k YTD

$421k u ‐ Medical ‐ includes approx $179k unbudgeted winter initiative costs transferred back to the service from the DHS budget and $242k u due to

additional SMO/Moss in EC to address increased volumes.

$129k u ‐ Nursing due mainly to AOU/MSS open additional unbudgeted weekends / nights to address increased volumes in EC.

YTD overspend is across all expense categories but mostly treatment disposables. This is driven by a YTD volume increase of 3% above contract and 3%

above this time last year.

The year end forecast for the division is $224k unfavourable against budget at year end. The division is currently $824k u ytd but we are currently

investigating strategies to bring this back in line with budget.

CMDHB Provider

The current month variance is mostly due to the overspend for additional medical staffing and ACC cover in EC.

YTD EC is $824k u (3.6%). This includes approx $179k u for the winter initiative costs transferred back to the service from DHS budget. The balance is due to

additional overspends in medical staffing, nursing and clinical supplies driven by increased volumes in EC (3% above contract YTD). Strategies are currently

being explored to manage volumes and bring the year end forecast back in line with budget.

Financial Commentary ‐ Acute Care

Year end Forecast variance to Budget $(224)

45


Division: Medicine


REVENUE

256 222 34 15% Government Revenue 1,868 1,779 89 5%


67 62 5 9% Other Income 1,258 521 737 142%

122 74 48 64% Funder Payments 1,310 595 715 120%

446 359 87 24% Total Revenue 4,437 2,895 1,541 53%

EXPENDITURE

5,552 5,169 (383) (7)% Staff Costs 46,166 44,308 (1,857) (4)%

250 294 44 15% Outsourced Costs 2,404 2,354 (50) (2)%

1,050 1,293 243 19% Clinical Costs 10,173 10,245 71 1%


649 566 (82) 15% Internal Allocations 5,088 5,242 154 (3)%

7,716 7,576 (140) (2)% Total Expenditure 65,796 64,175 (1,621) (3)%

(7,270) (7,217) (53) (1)% Net Result (61,359) (61,279) (80) (0)%

684 640 (44) (7)% FTE 680 635 (45) (7)%

($000's)

CMDHB Provider


($000's)

-8,400

-8,200

-8,000

-7,800

-7,600

-7,400

-7,200

-7,000

-6,800

-6,600

-6,400

-6,200


Monthly Net Result

Result Budget

-

800

1,600

2,400

3,200



Result Budget

-

1,000

2,000

3,000

4,000

5,000

6,000

7,000


Monthly Staff Costs

Result Budget

46

Feb‐14 YTD

Total Variance: (53) (80)

Revenue: 87 1,541

$425k f ‐ refund for Icodextrin (renal fluids) overcharge. Partly relates to 13/14.

$76k f ‐ additional PCT revenue (Funder payment)

Salaries & Wages: (383) (1,857)

$(383)k MTD

Outsourced: 44 (50)

Clinical Supplies: 243 71

$243k MTD

$27k f ‐ protective clothing. Possible under accrual will correct in March.

Infra‐Structure/Internal Allocations: (43) 215

Despite the unbudgeted costs for Winter intiatives, over allocation of RMO's and the unbudgeted Renal growth (total cost $1180k), the division will meet

budget at year end due partly to savings from vacancies incurred in the early half of the year and icodextrin refund partly relating to prior year.

$38k f ‐ Misc savings across the division including stationery, laundry & other office expenses

$13k f ‐ Cost recovery for unbudgeted Cancer Care Coordinator postions

$214k YTD

$61k f ‐ Infrastructure savings is mainly in Laundry and Cleaning supplies

$41k u ‐ Drugs ‐ Clinical Haematology ‐ due to Velcade vols 68% higher than ytd ave. Part offset by additional PCT revenue.

$55k u ‐ Drugs ‐ Other‐ high usage in Rheum for Rituximab for patients as a last resort treatment. Under investigation with Senior Manager.

$16k u ‐ mainly due to higher MRI charges


The year end forecast is for the division to meet budget.

$(44)k MTD

$71k YTD

Mainly in Pacemakers due to higher stock levels carried forward from 12/13

$30k f ‐ Misc variances across the division

$237k f ‐ due to vacancies at the beginning of the year. Now mostly filled.

$121k u ‐ unbudgeted funded positions (offset by revenue)

$262k u ‐ unbudgeted winter initiative transferred from DoHS budget (Budgeted locally for 2014/15)

$50k u ‐ unbudgeted RMO overallocation ‐ 5FTE

$19k u ‐ additional nursing costs to staff additional Renal night shifts to treat unbudgeted renal growth

$(1,857)k YTD

$1024k u ‐ unbudgeted funded positions (offset by revenue & internal allocations)

$85k u ‐ higher WRE charges by NORTH ‐ possibly due to timing and higher allocation of RMO's but awaiting explanation from NORTH

CMDHB ProviderFinancial Commentary ‐ Medicine

$63k u ‐ Increased kiwisaver charge

0

$101k f ‐ Reimbursement for unbudgeted Cancer Care Coordinator positions.

$68k f ‐ Savings in drug costs mainly due to Haematology and Renal

The division was slightly over budget for the month ($53ku variance). Overspends in staffing costs were mostly offset by separate funding for unbudgeted

positions, as well as savings in clinical supplies.

YTD the division is $80k unfav.

$45k f ‐ renal fluids are favourable due to slightly lower volumes in CAPD and home dialysis treatment.

$43k f ‐ Cathlab vols unusually low for the month. 23% down on YTD.

$48k f ‐ Gastro ‐ using up excess stock from Jan. As advised last month, over stocked due to staff annual leave.

Medicine showed a 3% increase in WIES for the month compared to contract and a 7% increase compared to last year. General Medicine (inpatients) saw 8% or

98 more cases compared to last year.

Current month favourable variance is due mostly to funding for unbudgeted project positions ‐ 21.8 ftes.

YTD variance is due to:‐

$1040k f ‐ revenue for unbudgeted project positions, predominantly 20k days project.

$45k u ‐ Other overspends are mainly SMO additonal duties for leave cover and sick leave

$127k u ‐ higher WRE charges by NORTH ‐ possibly due to timing and higher allocation of RMO's but awaiting explanation from NORTH

$187k u ‐ Increased kiwisaver charge

$280k u ‐ unbudgeted RMO overallocation ‐ 5FTE

$214k u ‐ additional nursing costs to staff additional Renal night shifts to treat unbudgeted renal growth

$47k f ‐ Respiratory equipment ‐ release of ytd provision not requred following account reconciliation

47


Division: Clinical Support


REVENUE

432 449 (18) (4)% Government Revenue 3,642 3,746 (104) (3)%


310 131 179 137% Other Income 1,537 1,049 488 46%

32 0 32 0% Funder Payments 254 0 254 0%

774 581 194 33% Total Revenue 5,433 4,796 637 13%

EXPENDITURE

4,255 4,057 (198) (5)% Staff Costs 35,331 35,045 (286) (1)%

452 537 85 16% Outsourced Costs 4,185 4,294 109 3%

2,646 2,483 (163) (7)% Clinical Costs 21,338 20,470 (868) (4)%


(1,464) (1,390) 74 5% Internal Allocations (12,180) (11,753) 427 4%


(5,321) (5,377) 56 1% Net Result (45,340) (45,434) 94 0%

573 584 11 2% FTE 561 576 15 3%

($000's)

CMDHB Provider


($000's)

-7,000

-6,000

-5,000

-4,000

-3,000

-2,000

-1,000

-


Monthly Net Result

Result Budget

-

1,000

2,000

3,000



Result Budget

-

2,000

4,000

6,000


Monthly Staff Costs

Result Budget

48

Feb‐14 YTD


Revenue: $194 $637


Outsourced: $85 $109

Clinical Supplies: $(163) $(868)

Infra‐Structure/Internal Allocations: $139 $501

YTD overspend was mostly due to:

$253k u ‐ Pharmacy 6.7 unbudgeted FTE on 20k bed days project, offset by funding

$67k f ‐ Pharmacists 1.4 vacancies

$45k u ‐ Radiology 1.4 fte Winter Initiative

$100k u ‐ Radiology SMO additional sessions and film reads to cover vacancies

$102k f ‐ Patient Information 3 fte vacancies

$57k u ‐ misc


YTD saving was mostly due to Pharmacy and Patient Information vacancies, offset by the overspend by Lab clinical supplies driven by volume growth.

YTD overspend was due to:

$397k u ‐ PCT drug due to Haematology Chemo volume up 20% from last yr

$272k u ‐ Anaesthetic drugs driven by Surgery volumes

$317k f ‐ Nutrition ‐ Pegfilgrastim now issued by community Pharmacy

$152k f ‐ Lab blood products volume down 1%

$83k u ‐ Lab winter initiative reversed from DoHS

$125k u ‐ Repatriation of Biochem tests from ADHB

$214k u ‐ Microbiology testing kits ‐ vols up 14% from last year

$121k u ‐ Laboratory equipment maintenance

$34k u ‐ Radiology shunts and stents driven by vascular surgery

$72k u ‐ Radiology clinical supplies ‐ CT volumes up 13% from last year

$19k u ‐ miscellaneous

YTD saving was mostly due to the repatriation of Biochem tests from ADHB ($125k f).

Current month saving was due to the repatriation of Biochem tests from ADHB ($58k f) and saving on outsourced CT ($20k f).

Current month saving was mostly due to drug cost recovery ($121k f).

Year end forecast is expected to be $94k favourable, mostly due to Pharmacy and Patient Information vacancies which are now filled.

Current month overspend was mostly driven by drug costs and Lab blood products:

$114k u ‐ PCT drugs due to Haematology Chemo volume up 20% from last year

$45k u ‐ Infection drugs driven by Surgery volumes

$30k f ‐ Nutrition ‐ Pegfilgrastim now issued by community Pharmacy

$31k u ‐ Laboratory and blood products due to three high cost patients in Ward 1 (Renal)


CMDHB Provider

Current month overspend was mostly due to:

$32k u ‐ Pharmacy 6.7 unbudgeted FTE on 20k bed days project, offset by funding

$18k u ‐ MRT back pay

$18k u ‐ NRA RMO training charge

$53k u ‐ Radiology SMO additional sessions and film reads

$21k u ‐ Radiology over time to cover vacancies and maternity leave

$56k u ‐ Laboratory penal, allowance and stat in lieu for AKL Anniversary & Waitangi Day

Current month $194k favourable ‐

$151k f ‐ due to the timing of hospital rebate from Pharmac

$32k f ‐ cost reimbursement for 6.7fte unbudgeted Pharmacists ‐ 20k bed days project

$19k f ‐ Increased Radiology ACC revenue due to better reporting

$8k u ‐ misc

Current month saving was mostly due 6 monthly Pharmac rebate and Patient Information vacancies, offset by Radiology SMO additional sessions, film reads

allowance and MRT backpay.

Financial Commentary ‐ Clinical Support

$94

YTD saving was due to drug cost recovery ($350k f), MRI cost recovery ($44k f) and misc saving ($107k f).

YTD $637k favourable ‐

$303k f ‐ Breast Screening film read revenue from Southland DHB

$253k f ‐ cost reimbursement for 6.7 unbudgted fte Pharmacists on 20k bed days project

$140k f ‐ Radiology ACC revenue up due to improved reporting


49



Zero Patient Harm activities and audits continue, with the use of the display boards in in‐patient areas. Feedback to frontline staff on audit results and staff involvement is ensuring continued improvements to improving patient care and safety.

Hand Hygiene ‐ The recent Hand Hygiene NZ National audit included 2 medicine wards. Ward 32N achieved 75.1% and Ward 33 North achieved 87.0%. This was a multidisciplinary audit, with all healthcare staff included in the audit.

Falls Prevention – There were 32 falls across the medicine wards up 9 falls from January. 12 falls had harm including lacerations with two serious harm (fracture) cases. An audit of risk assessments completions will be completed and intentional rounding continues on the wards.

Medication Reconciliation – 82% of all high risk patients had medication reconciliation initiated and completed during their hospital stay. Overall 60% of all admissions and transfers from adult medical, surgical and ATR wards had a validated medication history carried out by a pharmacist. In the last week of February 41% of high risk patients in adult medical and surgical wards received a discharge medication management service (SMOOTH) prior to discharge.

Incidents ‐ There were four SAC 2 events for Medicine in February: two falls, one pressure injury and one telemetry case. These are being investigated and practice improvements identified will be applied in practice as relevant.

Other Activity

The Radiology IANZ Audit ‐ The 4 yearly full audit is scheduled for mid‐May. This audit will involve the Obstetric department ultrasound suite and also the Radiology Services at 79 Middlemore Crescent. An internal pre‐audit has indicated areas requiring focus and these will be addressed through March and April.

BreastScreen The updated BreastScreen Aotearoa National Policy and Quality Standards were published in December 2013, and the service will review all policies and procedures to ensure they meet these standards.


The Ministry of Health will work with DHBs to reduce waiting times; in particular:

Reducing waiting times for radiation and chemotherapy treatment and ensuring Faster Cancer diagnosis;

Achieved 100%: All radiation and chemotherapy commenced within 28 days for patients ready for treatment.

Faster Cancer Treatment Indicator performance A project plan is in place to achieve this new Health Target from 1 July 2014. Refinement of the target detail, data collection and reporting processes continues. Service‐level communication is underway across all services providing cancer assessment and care.

Currently for the 12month average (Target is 70%)

59.9% of eligible patients commencing treatment within 62 days

76.8% of eligible patients receiving treatment within 31 days of decision to treat.

50

Mar‐2013 (Met/Total cases)

Jun‐2013 (Met/Total cases)

Sep‐2013 (Met/Total cases)

Dec‐2013 (Met/Total cases)

Rolling 12‐month average (Met/Total cases)

62‐day indicator 66.7% (130/195) 61.5% (131/213)

51.1% (91/178)

58.8% (50/85)

59.9% (402/671)

31‐day indicator 77.2% (156/202)

74.4% (169/227)

76.4% (165/216)

80.1% (125/156)

76.8% (615/801)

The process and responsibilities for Faster Cancer Treatment have been established including data collection and reporting responsibilities. Work continues in establishing baseline compliance levels for each indicator and by tumour stream, in expectation of the implementation by 1 July 2014.

Reducing waiting times for important diagnostic tests (such as CT scans, MRI scans, angiograms and colonoscopies).

Targets for Diagnostic Indicators (test or procedures) N.B. As these are new indicators compliance will be phased in over a number of years to allow for DHBs to set up reporting and monitoring frameworks and work toward any required service improvements. Because they are new areas of reporting the thresholds for colonoscopy, CT and MRI will be reviewed after at least 6 months of data collection.

Colonoscopy by June 2015 ‐ 95% of people should receive:

Urgent colonoscopies within 14 days Non urgent colonoscopies within 42 days Surveillance colonoscopies no later than 84 days beyond a planned date

Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) by June 2015 ‐ 95% of patients should receive their CT or MRI scan and have it reported on within 42 days unless it is a planned procedure. Coronary Angiography by June 2015 ‐ 95% of patients accepted for elective coronary angiography should receive their procedure within three months (90 days).

Colonoscopy ‐ by June 2014, 50% of people should receive: Urgent diagnostic colonoscopies: Achieved: results 64.6% (from 86% in Jan). Non‐urgent colonoscopies:

Not achieved: results are 22.4%. Surveillance/Follow‐up colonoscopy: Achieved: results 99.9%

The priority two wait lists continue to grow and strategies for management continue. These include developing a business case for increased resources (FTE and facilities) to manage the volumes of gastroenterology patients, use of outsourcing for approximately 250 colonoscopies up to June 2014. The MoH has also provided additional funding for approximately 256 colonoscopies to be completed.

Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) – by June 2014,

CT Scan ‐ 90% within 42 days ‐ Not Achieved 68% MRI Scan ‐ 80% within 42 days – Achieved 80%

51

Coronary angiography Greater than 75% of ACS patients have their angiogram within 72 hours.

>78% of ACS patients had their angiogram within 72 hours for the Q2 2013/2014. Greater than 80% of High risk ACS patients have their PCI procedure within 120 minutes.

Achieved: >92% of STEMI patients have their PCI procedure within 120 minutes for the Q2 2013/2014 (see graph below).

Greater than 90% of accepted referrals for elective coronary angiography will receive their procedure within 3 months (90 days).

Achieved: 97% of elective angiography within 3 months.

Data taken from ANZAC – QI database

Other access and wait time targets

Cardiology Echo Wait Times

The outpatient wait list increased by 97, with 880 patients waiting for a standard transthoracic Echo.

The situation is due to increased referral volumes, in‐patient/acute demand and staff planned leave. The service continues to work on efficiency gains and is running Saturday lists as a short term

52

measure. The additional trainee sonographer has started employment and will have impact volumes after initial training completion anticipated in 6 months.

Breast screen coverage target 70% women 45‐69 years screened in the last 24 months. Achieved: 70% (including Maori 68.0% + Pacific 73.1%)

BSCM Screening Coverage

0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

Jul-0

8

Nov

-08

Mar

-09

Jul-0

9

Nov

-09

Mar

-10

Jul-1

0

Nov

-10

Mar

-11

Jul-1

1

Nov

-11

Mar

-12

Jul-1

2

Nov

-12

Mar

-13

Jul-1

3

Nov

-13

Months

Cove

rage Maori Coverage

Pacific Coverage

All Coverage

Laboratory – Targets for Tests are based on the following requests required urgently (within 60min) ‐ 90 percentile of four indicative tests Potassium (K), Haemoglobin, PT/INR and Troponin I (TNI) for Emergency Care within 60 minutes.

The laboratory is meeting these targets and most cases exceeding the target,

Emergency Care – more than 95% of EC presentations are admitted or discharged in less than six hours.

Achieved: 95%

Monthly EC 6hr LOS Percentage Pass

80%

85%

90%

95%

100%

Jun 10

Sep 10

Dec 10

Mar 11

Jun 11

Sep 11

Dec 11

Mar 12

Jun 12

Sep 12

Dec 12

Mar 13

Jun 13

Sep 13

Dec 13

Month

Pass %

6000

7000

8000

9000

10000

% pass Mean LCL UCL Target UCL

53

February EC volumes ‐ presentations were again higher than forecast. The Emergency Care presentation daily average was 282 and there were significant fluctuations with days in excess of 300. The high level of self‐referrals continued, particularly over the public holidays when access to primary care is significantly reduced. Significant numbers of inpatients were in the EC overnight, awaiting admission with the Adult Observation Unit open 24/7 and Medical Short Stay area opened during the weekend on two occasions. This is a reflection of the reduced bed capacity within the hospital with ward refurbishments and containment of the Norovirus outbreak.

Increasing access to specialist appointments; all patients accepted for services are provided this service within 150 days and from January 2015 within 120 days

Achieved:

All medical outpatient services met the target with services continuing to monitor and manage wait‐times very closely. The total number of patients on the medical outpatient waiting list for an FSA has increased by 106 patients from last month but overall, there has also been a further slight decrease in medical speciality patients waiting >3 and 4 months across most areas.

The improvement work in the General Medicine outpatients and the modelling to achieve shorter wait‐times can be seen on the following graph since the work started in early 2013. There is still further work to be done on decreasing the “time to be seen” length for priority 1 patients. The overdue or expired follow‐up appointments are down to 15 patients, compared with approximately 300 overdue appointments 12months ago.


Gastroenterology – The department is continuing to work on efficiencies utilising the National Endoscopy Quality Improvement Programme (NEQIP) methodology and tools, along with the Gastroenterology Service Improvement Project. The target of this work is to implement and maintain efficiencies for the patient journey through the department. The main focus is on developing a robust referrals management process, to reduce delays to diagnosis and treatment leading to significantly poor patient outcomes. Ideally a new referrals clerk will provide a central point for referrals to be received and managed.

The Renal Haemodialysis Facility Procurement Project is continuing with options evaluated and a paper with the analysis of findings, comparisons and recommendations will be completed and presented to ELT and then the Board.

54

Radiology – MRI & CT In sourcing ‐ The move to 79 Middlemore Crescent remains on track for go live on 1st April 2014. Temporary arrangements for support equipment (such as resuscitation trolleys and patient monitoring) are in place while new equipment ordered.

Radiology is waiting for the conclusion of the ADHB and WDHB 3T MRI scanner RFP, so that privity can be used to obtain the desired 3T MRI scanner. Delivery takes 12‐16 weeks, therefore 3T MRI scanning service will occur approx. end of September. In the meantime, the 1.5T MRI scanner obtained through the leasing will be used to reduce the need to outsource. Note that a small number of outsourced Breast MRI scans remain until the 3T scanner is functional as this is not available on the 1.5T MRI scanners.


Enhancing Cancer Multidisciplinary Meetings ‐ Project plan for implementation is being finalised. Working with healthAlliance procurement on regional installation of videoconferencing equipment anticipated for April 2014. Work is underway to establish baseline MDM performance in terms of clinical participation and volume of patients presented. Activity is aligned with the Ministry of Health MDM guidance document to establish a consistent process and MDM structure. Outpatient clinic space availability is beginning to impact on service capacity, particularly in Respiratory. Alternative locations to MSC and Botany are being explored ensuring clinical capacity to see patients is maximised.

CVD Risk Assessment Risk assessments continue with 89 patients assessed in January and another 90 patients screened but excluded. This specific hospital based initiative will stop on 30 June 2014 when funding ceases but other screening work will continue.

20,000 Days Collaborative Programmes

Healthy Hearts The team logo has been redesigned to include the words ‘healthy hearts’ in different languages. The group continue to work with AUT to run the Heart Failure Exercise pilot at AUT. Two classes run each week with continued good success and positive patient feedback, and there are two women’s only sessions. Assessments are being done at Fitness plus gym, and this approach is working well. Eight Heart Failure programme participants will complete the Round the Bays in March, supported by CM Health staff and whaanau. Patient stories and experiences continue to be captured through videos.

Better Breathing & VHIU a sustainable funding business case has been developed between the respiratory service and Locality General Manager and been submitted via the localities as an integrated approach.

SMOOTH project is working on further spread and improving the use of the checklist for high risk discharges in medical, surgical and rehab. PDSA cycles testing is occurring utilising the SMOOTH and SMART FTE to bolster the core clinical team and improve process efficiencies. Data shows 41% of all high risk patient discharges receive a SMOOTH discharge service prior to discharge in late February.

SMART project model of care has been rolled out to all 15 general medical teams covering all week days admitting teams till 10pm. A PDSA cycle with the Medical Assessment Unit and Emergency Care pharmacists saw a significant increase in patient coverage

Inpatient Care for People with Diabetes work continues on a number of changes to reduce length of stay and readmissions for patients with diabetes. This includes clinical guideline work,

55

RMO teaching and resources, a focus on high users, and changes to care plans, documentation, handover and alerts processes.

Feet for Life (Renal) work to reduce the burden of foot disease in renal patients, reduce length of stay and amputations includes online referral development, Podiatrist seeing high risk patients and preparing for presentation to progress this project to phase 2.

6.3.5 PATIENT and WHANAU CENTRED CARE Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions

Advance Care Planning Over 450+ Advance Care Planning patient conversations are occurring per month on average (conservative estimate). More than 70+ DHB and locality staff have been trained at level 2 with further training opportunities in April and June 2014. Co‐op ACP documentation has been introduced at CM Health following development of a short term electronic solution to capture and share plans. Planning for a qualitative research project is underway to capture the patient and family/whaanau experience of the ACP pathway and this will inform development of the ACP process into the future.

Renal “Home and Kidney First” is now underway, whereby patients are offered home based treatments before in‐centre haemodialysis as a first option. The current percentage is 42%, a drop from last month due to a number of patients having to have interim in‐centre haemodialysis or have received (happily) renal transplants.

Complaints/ Compliments

56

7 Women’s Health and Kidz First

7.1 SERVICE PERFORMANCE 7.1.1 Activity summary Inpatient Cases /Discharges:

Discharges Act Contract Variance % varianceAct Contract Variance % varianceKF EC 213 225 -12 -5% 2139 2155 -16 -1%Pead Medicine 339 337 2 1% 3882 3773 109 3%Pead ICU 1 2 -1 -50% 25 30 -5 -17%NICU - Unit 47 59 -12 -20% 511 466 45 10%NICU-W H 100 98 2 2% 925 802 123 15%KF Surgical Acute 184 171 13 8% 1391 1356 35 3%KF Surgical Elective 117 133 -16 -12% 968 1097 -129 -12%

Total KF (Discharges) 1001 1025 -24 -2% 9841 9679 162 2%WH Gynae Acute 261 234 27 12% 1964 1923 41 2%WH Gynae Elective 135 136 -1 -1% 1121 1079 42 4%Total WH (Discharged) 396 370 26 11% 3085 3002 83 3%

Month YTD

Inpatient WIES /Births/Outpatients

Contract Last YTDWIES Act Contract Variance % varianceAct Contract Variance % variance Forecast ActKF EC 63 63 0 0% 596 587 9 2% 867 847Pead Medicine 179 174 5 3% 2076 2101 -25 -1% 3000 2936Pead ICU 1 2 -1 -50% 22 14 8 57% 25 37NICU - Unit 225 132 93 70% 1801 1530 271 18% 2668NICU-WH 59 30 29 97% 374 311 63 20% 484KF Surgical Acute 148 168 -20 -12% 1378 1459 -81 -6% 2018 2018KF Surgical Elective 76 85 -9 -11% 634 690 -56 -8% 1086 1086Total KF (WIES) 751 654 97 15% 6881 6692 189 3% 9896 10076WH Gynae Acute 130 129 1 1% 1055 1047 8 1% 1550 1444WH Gynae Elective 119 127 -8 -6% 1038 968 70 7% 1500 1638WH Primary Unit (WIES equivalent) 168 174 -6 -3% 1522 1590 -68 -4% NA 2316WH Secondary 437 455 -18 -4% 3951 4210 -259 -6% 1500 1638Total WH (WIES) 854 885 -31 -13% 7566 7815 -249 -3% 4550 7036Births (Deliveries) 526 629 -103 -16% 4832 5382 -550 -10% 7894 7894

Contract Last YTDOUTPATIENT Act Contract Variance % varianceAct Contract Variance % variance Forecast Act

KF FSA 182 167 15 9% 1352 1197 155 13% 1700 1849KF FU 283 260 23 9% 2120 1984 136 7% 3060 2851Gynae FSA 200 186 14 8% 1897 1615 282 17% 2500 2655Gynae FU 251 261 -10 -4% 1943 1995 -52 -3% 3000 2778Colp 187 208 -21 -10% 1655 1667 -12 -1% 2500 2656Colp HC 14 22 -8 -36% 132 177 -45 -25% 265 268Colp HC in OT 6 7 -1 -14% 55 57 -2 -4% 85 109Gynae HC 63 54 9 17% 520 433 87 20% 650 638

2900

Month YTD

Month YTD

Inpatients Kidz First Medicine / EC/ ICU Inpatient WIES remain very similar to last year. Discharges are up slightly. Kidz First Surgical Inpatient acute WIES is down YTD by 6 %, however acute discharges are up by 3% suggesting a different casemix to last year. Kidz First Surgical acute volumes can vary significantly depending on the number of children with severe burns (low volume but high WIES) and this year has seen fewer children with severe burns. Kidz First Surgical elective WIES and Discharges are both down. Kidz First Neonatal WIES (for babies discharged from the Neonatal Unit and babies on the postnatal floor attracting a Neonatal WIES) remains significantly higher for the year (up 18%). The actual discharges from the Unit are up by 10% only, reflecting the very high acuity seen over the first three months of 13/14 and again in January and February 2014. Maternity The number of births (deliveries) in February was down again and YTD remains 10% down on volumes in 12/13. Maternity WIES across the primary and secondary inpatient areas is only down just under 6% reflecting the higher acuity and in line with the high Neonatal WIES and discharges. Outpatient volumes across Kidz First and Women’s Health (Gynaecology) are up for FSAs. The Kidz First outpatient volumes reflect the ongoing requirements for children with developmental/ behavioural/ disability conditions to have longer term management in secondary care.

57



Division: Women's Health


REVENUE



36 3 33 1,330% Other Income 184 20 164 819%


42 9 34 387% Total Revenue 242 70 173 249%

EXPENDITURE

2,426 2,442 16 1% Staff Costs 21,137 21,343 206 1%


153 140 (13) (9)% Clinical Costs 1,073 1,118 45 4%

98 135 37 27% Infrastructure Costs 974 1,080 106 10%

29 46 17 (37)% Internal Allocations 251 365 114 (31)%


(2,733) (2,821) 87 3% Net Result (24,097) (24,372) 275 1%

341 335 (7) (2)% FTE 346 335 (11) (3)%

CMDHB Provider


($000's) ($000's)

-4,000

-3,500

-3,000

-2,500

-2,000

-1,500

-1,000

-500

-


Monthly Net Result

Result Budget

-

100

200

300

400

500

600

700

800

900

1,000



Result Budget

-

500

1,000

1,500

2,000

2,500

3,000

3,500


Monthly Staff Costs

Result Budget

58

Feb‐14 YTD


Revenue: $34 $173

Salaries & Wages: $16 $206

Outsourced: $(3) $(369)

Clinical Supplies: $(13) $45

Infra‐Structure: $37 $106

Internal Allocation: $17 $114

Increased costs are anticipated due to 5 graduate midwives commencing in February with another 10‐15 due to commence in May 2014. The expectation is to

meet budget for 2013/14.


$17k MTD

Additional revenue for various projects (not budgeted) are offset against costs, i.e. BFA ($11K), Safe Sleep ($7K)

$114k YTD

Additional revenue for various projects (not budgeted) are offset against costs, i.e.BFA ($85K), Safe Sleep ($57K)

$(13)K MTD: Replacement of 6 transducers in ALBU

$45k YTD: Lower use of clinical supplies due to reduced volumes of deliveries.

$0

On Track for the month of Feb 2014.

$106k YTD

Savings have been made in bedding and linen due to reduced volumes of deliveries.

2014‐2015 Bedding and Linen budget had been reduced by $47K against 2013‐2014 budget to reflect lower contract prices.

CMDHB Provider

Additional costs for various projects (not budgeted) are offset against additional revenue.

$34k MTD: MoH complex Care course ($20K), safe sleep ($4K)clinic room rental ($5K) and mics Rev ($5K) for the month of Feb 2014

$173k YTD: MoH complex Care course ($20K), clinic room rental ($36K), safe sleep ($43K), and mics Rev ($5K tech skills, research)

Financial Commentary ‐ Women's Health

Additional costs for various projects (not budgeted) are offset against additional revenues, i.e. Ccrep Research,MoH complex Care course .

NICU was moved from Galbraith to Harley Gray Bldg in Mid Feb 2014. Many employees both Kf and WH divisions were involved in the move. High sick leave,

education leave, orientations and ACC leave in Feb 2014 have had a negative impact.

$16k MTD

Medical‐ $19k fav (Junior doctor rotation transactions in Feb 2014)

Nuring/Midwives‐ $72K unfav (mostly due to high sick, study, orientation, costs offset by additional revenue)

Allied Health‐ $5K unfav costs offset by additional revenues

Clerical ‐ $32K unfav mostly due to increased # of MW clinics and preparing for MCIS implementation for WH and KF costs offset by additional revenues.

$206k YTD

Medical‐ $342k fav (less experienced junior doctors and discontinuation of weekend day and night payments for SMOs)

Nursing/Midwives‐ $151K fav (mostly due to MW vacancies offset against high sick, study, orientation, additional duties for NICU move)

Allied Health ‐ $63K unfav (offset by additional BFA revenues)

Clerical ‐ $224K unfav mostly due to increased # of MW clinics and preparing for MCIS implementation

KPI's for the service are on track against contract, although deliveries are 10% down YTD against last year's actual. Annual leave management over

Anniversary and Waitangi day has impacted favourably on the result.

On track for the month of Feb 2014

$(369)k YTD

$14K for colp sessions

$280 for External Bureaus to offset MW / Nursing vacancies and skill mix issues

$14K for Admin Casual

$107K for AUT MDES (Midwifery Development) ‐ not budgeted ‐ proposal to be funded by Maternity Review Board.

59


Division: Kidz First


REVENUE



135 115 20 17% Other Income 1,161 921 240 26%

73 33 41 124% Funder Payments 586 262 325 124%

209 148 61 41% Total Revenue 1,763 1,183 580 49%

EXPENDITURE

2,451 2,285 (166) (7)% Staff Costs 20,679 20,067 (612) (3)%


163 163 (0) (0)% Clinical Costs 1,328 1,363 35 3%

71 83 12 15% Infrastructure Costs 685 728 44 6%

(136) (13) 123 936% Internal Allocations (767) (105) 662 628%


(2,366) (2,394) 28 1% Net Result (20,531) (21,065) 535 3%

375 318 (57) (18)% FTE 346 322 (24) (7)%

CMDHB Provider


($000's)($000's)

-3,500

-3,000

-2,500

-2,000

-1,500

-1,000

-500

-


Monthly Net Result

Result Budget

-

50

100

150

200

250

300

350

400



Result Budget

-

500

1,000

1,500

2,000

2,500

3,000

3,500


Monthly Staff Costs

Result Budget

60

Feb‐14 YTD


Revenue: $61 $580


Outsourced: $(2) $(173)

Clinical Supplies: $(0) $35


Internal Allocation: $123 $662


$123k MTD

Additional revenue for various projects (not budgeted) are offset against costs, i.e.Gateway ($37K), ManaKidz ($99K)

$662k YTD

Additional revenue for various projects (not budgeted) are offset against costs,, i.e.Gateway ($296K), ManaKidz ($395K)

On Track for the month of Feb 2014

$35k YTD

Less activity in KF surgical and KF medical has impacted favourably on clinical supplies due to lower consumption.

CMDHB Provider

Additional costs for various projects (not budgeted) are offset against additional revenues, i.e. Gateway, Alternative Education, Ccrep Research, ASD, and

Mana kidz. NICU was moved from Galbraith to Harley Gray Bldg in Mid Feb 2014. Many employees both Kf and WH divisions were involved in the move.

High sick leave, education leave, orientations and ACC leave in Feb 2014 have had a negative impact.

$(166)k MTD

Medical ‐ $27 unfav (Junior doctor rotation transactions in Feb 2014)

Nursing‐ $125K unfav (mostly due to NICU move to HGB and additional costs for various projects (not budgeted) offset against additional revenues)

Allied Health‐ $1K fav

Clerical ‐ $15K unfav costs offset by additional revenues

$(612)k YTD

Medical‐ $212k fav (partial off set against locum costs)

Nursing‐ $712K unfav (costs offset by additional revenues. High sick, study, orientation and additional duties for NICU move.)

Allied Health ‐ $51K unfav costs offset by additional revenues

Clerical ‐ $62K unfav costs offset by additional revenues

Additional costs for various projects (not budgeted) are offset against additional revenues.

$61k MTD Alternative Education ($31K), Ccrep Research ($16K), ASD ($15K) for the month of Feb 2014

$580k YTD Alternative Education ($252K), Ccrep Research ($100K), ASD ($87K), Health Promoting Schools ($72K) and misc revenue


$(173)k YTD

$14K for colp sessions

$60k for External Bureaus to address nursing vacancies and skill mix issues in KF inpatients (mostly in NICU)

$16K for Admin Casual

$51K for research costs ‐ offset against additional revenue

Volumes for the service are on track YTD; Wies YTD actual 6881, contract 6692. Close monitoring of NICU volumes has been enforced in the service to

mitigate potential volume over runs. Annual leave management over Anniversary and Waitangi day has assisted to mitigate unplanned costs.

Due to Level 3 NICU in Harley Gray and Level 2 NICU in KFMed C‐pod, we have additional FTEs until end of May 2014

We are anticipating increased costs in NICU but the service will meet the 2013‐14 budget.

Revenues for projects are recovered on a monthly basis. Lower volumes in KF Medical and KF Surgical has assisted in maintaining this level of revenue.

Financial Commentary ‐ Kidz First

$0


$44k YTD

Savings have been made in bedding and linen due to reduced volumes in KF surgical and KF medical for the year.

2014‐2015 Bedding and Linen budget has been reduced by $39K against 2013‐2014 budget to reflect lower contract prices.

61



The safety measures for the Kidz First and Women’s Health service are shown in the table below which include the following:

Safety measures ward based audits associated with emergency trolley, hand hygiene, fall prevention/intervention, MRO screening, pressure injury assessment/intervention continue.

Safe Sleep and Violence intervention educational programme are being rolled out.

CLAB Prevention insertion and maintenance bundle compliance is monitored. There was one CLAB identified in the Neonatal Unit in February.

Surgical Site Infection programme the Caesar wound infection surveillance process is slow to gain traction.

Safety Service

‐ = no data available

KF Med

ical

KF Surgical

NNU

GCU

ALBU

Mat. N

orth

Mat. South

Papakura

Botany

Pukekohe

Emergency Trolley checks – target 100% 100 100 80 100 81 ‐ ‐ ‐ ‐ ‐

Hand Hygiene – target 100% 96 100 ‐ 90 ‐ ‐ ‐ ‐ ‐

Falls prevention assessment ‐ target 100% 100 ‐ ‐

Falls intervention – target 100% NR ‐ ‐

Safety Service

‐ = no data available

KF Med

ical

KF Surgical

NNU

GCU

ALBU

Mat. N

orth

Mat. South

MRO screening – target 100% 95% 77% ‐ 80% 65% ‐

Pressure Injury Assessment ‐ target 100% 100 80 80 100 ‐ 100 100

Pressure Injury Intervention ‐ target 100% 100 100 100 ‐ 100 100

BPEWS/PUP/MEWS tool – target 100%

100

CLAB Prevention ‐ insertion bundle ‐ target 100%

100

CLAB prevention‐ maintenance bundle‐ target 100%

90

Safe Sleep – educational roll out Education programme rollout underway in all CM Health areas

Violence Intervention training rollout Education programme roll out underway at Middlemore Maternity (with other areas already completed)


Timely Measures Result

Six Hour EC LOS Target – 95% of EC presentations are seen/ admitted/ discharged within 6hrs

Achieved Paediatric Medicine: 98.6% month, 98% YTD Gynaecology : 93 %month, 95% YTD

FSA <150 Days ‐ Kidz First outpatients Achieved

FSA <150 Days ‐ Women’s Health Gynaecology

Achieved

62


Efficiency Measures Result

ALOS Kidz First Surgical Actual YTD 2.50 vs. 2.43 for 2012/13

ALOS Kidz First Medical Actual YTD 1.8 vs. 1.8 for 2012/13

ALOS Neonatal Care Actual YTD 11.90 vs. 12.4 for 2012/13

ALOS Gynaecology (all) Actual YTD 1.4 vs. 1.3 for 2012/13

ALOS Obstetric (Maternity) Actual YTD 2.32 vs. 2.14 for 2012/13


Effectiveness Actions (Right care right place right time)

Result/ Progress

Clinical Pathways Development Menorrhagia/ PID/ Hyperemesis

Pilot underway

Locality Development Obstetric clinics in Mangere / Otara locality

SMO Obstetric clinics to start in March

7.3.5 EQUITY

Equity Actions (Better outcomes for all campaign)

Result/ Progress

New Born Hearing screening 90% target.

YTD Feb = 91% (in hospital and outpatient clinic screening)

B4 school checks 56% overall YTD (and 52% for high deprivation pop) ‐ below level expected. 1,536 checks in progress requiring the Vision/ Hearing (CMH) or the Nurse (Plunket) visit completed. Strategies are in place to improve coverage for the Q3 with weekly monitoring at ECE facilities resumed.

Increase LMC access and market share (target 51%)

57% YTD ‐ up 6% on last year

Rheumatic Fever Programme Mana Kidz operational in 61 primary/ intermediate schools in Papakura, Manurewa, Mangere and Otara (includes Sore Throat Swabbing Programme) 17 secondary schools operational with Sore Throat Swabbing Programme. Working with GP practises to commence the Rapid Response clinics

Prevention and screening measures commentary:

Rheumatic Fever Meetings are underway with the Ministry of Health regarding effective medication adherence in Mana Kidz programme. Children with a Group A Streptococcal positive throat swab need to take 10 days of antibiotics and there is concern about the completion of the treatment. In March a workshop will be held to explore whether Intramuscular injections (one dose) could be introduced into the programme.

HPV vaccinations The programme is on track to meet Ministry of Health national targets for this programme.

63

Exclusive breastfeeding rates at discharge from hospital (BFHI target is > 75%) were well maintained throughout 2012/13 year with Middlemore Maternity reaching 82% (Maori 79% and Pacific 82%) and the Community Units reaching 89%. Figures for early 2014 will be available in April.


Patient and whaanau/fono centred care

Increase postnatal Length of Stay for 40% of women with high needs (target 2.6 ALOS)

YTD = February 2.7 days for first time mothers

Complaints / Compliments Kidz First – one complaint received and has been resolved, two compliments and one concern/suggestion. Women’s Health – two complaints received, both awaiting resolution, with no compliments received.

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8 Mental Health


8.1.1 National Health target ‐ Mental Health 3 Key Performance measures:

PP6 is Total access rates for all ethnicities to Mental Health service by age group; PP7 is Proportion of clients with an up to date RPP plan; PP8 is Shorter waits for non urgent Mental Health and Addiction Services;

PP6 Total access rates for all ethnicities to Mental Health service by age group Measure Actual Feb Target Variance Action

PP61 Number of Unique Clients –Maori 0‐19

4.29% 4.45% (0.16)% Continued focus on developing cultural capability at point of access; triage consult assessment and liaison including community settings. Monthly training and education sessions on cultural response and capability. Cultural advisors involved PDRPs when indicated. Development of school based services that are culturally capable.

PP61 Number of Unique Clients – Total 0‐19

3.10% 3.07% 0.03%

PP61 Number of Unique Clients –Maori 20‐64

8.21% 7.75% 0.46%

PP61 Number of Unique Clients – Total 20‐64

3.80% 3.07% 0.73%

PP61 Number of Unique Clients – Maori 65+

3.01% 2.80% 0.21%

PP61 Number of Unique Clients – Total 65+

2.54% 2.80% (0.26)% There is an ongoing focus to ensure easy access services for those >65. Referral rates have been slowly increasing over the past few months.

PP7 is Proportion of clients with an up to date RPP plan Measure Actual

Jan Actual Feb

Target Variance Action

PP7 Proportion of clients with an up to date RPP plan

93.9% 90.7% 95% (4.3)% 6/8 adult community teams did not achieve the target. All managers are addressing the reasons for this result and ensure that effective strategies are in place to achieve the target in March.

PP8 Shorter waits for non‐urgent mental health and addiction services: Mental Health Provider Arm ‐ <= 3 weeks Total Actual

2013/2014 Quarter 1

Actual 2013/2014 Quarter 2

Target Feb 14 Variance Action

0 ‐ 19 76.05% 75.3% 75.00% 74.51% (0.49)% Plans underway to enhance Triage Assessment Liaison Team to include immediate response to urgent referrals to allow the teams

65

to deliver an earlier response to routine referrals.

20 ‐ 64 87.48% 87.9% 80.00% 87.84% 7.84%

65 + 88.33% 89.1% 80.00% 88.49% 8.49%

Total 83.95% 83.4% 78.10% 82.93% 4.83%


Volumes January 2014 YTD Full Year

Forecast Last Year

Act Bud Var Act Bud Var Bud Forecast Act

Community FTE(Jan 2014) 422.0 443.3 21.3 420 443 22.3 443

422

66



Division: Mental Health


REVENUE



2 10 (8) (77)% Other Income 40 80 (40) (50)%


6 13 (8) (58)% Total Revenue 67 107 (40) (37)%

EXPENDITURE

4,806 5,059 253 5% Staff Costs 40,121 41,773 1,652 4%

252 31 (221) (725)% Outsourced Costs 1,554 244 (1,309) (536)%

13 17 4 24% Clinical Costs 124 139 15 11%


27 33 6 (17)% Internal Allocations 252 264 12 (5)%


(5,299) (5,367) 68 1% Net Result (43,765) (44,245) 480 1%

643 674 31 5% FTE 636 674 38 6%

CMDHB Provider


($000's) ($000's)

-5,900

-5,800

-5,700

-5,600

-5,500

-5,400

-5,300

-5,200

-5,100

-5,000

-4,900


Monthly Net Result

Result Budget

4,900

5,000

5,100

5,200

5,300

5,400

5,500

5,600

5,700

5,800

5,900



Result Budget

4,200

4,400

4,600

4,800

5,000

5,200

5,400

5,600


Monthly Staff Costs

Result Budget

67

Feb‐14 YTD


Revenue: $(8) $(40)


Outsourced: $(221) $(1,309)

Clinical Supplies: $4 $15


Financial Commentary ‐ Mental Health

CMDHB Provider

The financials are tracking well against budget. Though the acute demand management costs remain high, this has been more than off‐set by the vacancies

in community. The vacancies in the community have resulted in underspends in Nursing , Allied Health and Admin ($125k for the month and $878k YTD) and

also vehicle related expenses ($27k for the month and $107k YTD) off set by overspend in Medical Staff ($83k for the month and $587k YTD). The service has

made good progress in reducing overtime costs‐ $89k for Feb 14 as against $178k in the corresponding month of Feb 13.

Medical staff is underspent by $127k for the month and $778k YTD. There is a national shortage of psychiatrists and therefore locums, mainly from

overseas are contracted to provide services (ref outsourced services below). The vacancies in the community have resulted in underspends in Nursing , Allied

Health and Admin ($125k for the month and $878k YTD).

The main reason for the variance is the spend in Locum Medical staff (211k for the month and $1360k YTD). This is partially off‐set by the favourable

variance in Medical Staff salaries ($127k for the month and $778k YTD).


The favourable variance is mainly driven by vacancies in the Community.

The main items of underspends are vehicle related expenses ($27k for the month and $107 YTD) and deferred maintenance ($34k YTD). As the community

vacancies are filled and the service gears to provide services to the clients in their locality, the monthly underspend in vehicle related expenses will reduce.


Framework for Change update The FFC Consultation document was finalised and prepared for circulation to staff with a covering letter highlighting the scheduled activities for the next weeks. The steering group continues to meet monthly regarding governance and strategic matters. Three work streams continue to focus on developments and testing of the acute pathway and its service components. Workforce training needs are being determined and planned.

An acute forum is being established – stakeholders of the acute pathway will make up this forum and provide a monitoring and oversight function. Many staff will be engaged in preparing to implement the new reconfigured adult acute pathway with GO LIVE provisionally set for 5th May 2014. The PSA had raised (on behalf of their members) concerns about roster patterns, staff numbers and team location. Meetings were scheduled with delegates to investigate and address the concerns.


Mental Health Acute 28 Day Readmission rate – the Tiaho Mai Readmission rates continue to track down, and is now less than 5%. This is due to the additional support provided by the Supported Discharge Teams. There were 6 readmissions in February. Two of these were related to immediate

68

substance misuse that cause relapse of symptoms. 1 was due to the client leaving the respite facility and stopping medication and the remaining 3 were related to poor compliance with medication.

8.3.2 TIMELINESS: Every Hour Counts” if we are to achieve quality and safety outcomes

Reducing waiting times for youth alcohol and drug treatment: The CAMHS & AOD collaboration is underway with a steering group of clinicians from CAMHS, Altered High, Odyssey and Tupu established in February to determine working group priority areas. The first priority is for clinicians from each service to jointly agree concrete plans on working collaboratively with clients that they have in common. For example shared CEP groups for clients, work place exchanges, and AOD clinicians from respective services to be matched to Youth teams and attend Multidisciplinary Team meetings.


Adult Inpatient Services – Tiaho Mai: February was a particularly busy month in alignment with the usual annual pattern of admissions. There have been five days when Tiaho Mai was over‐capacity and supporting between 52 and 55 service users. In addition to this, one bed has been out of use for 7 days because of water damage. 7 service users were bought into Tiaho Mai over numbers and all were outside of regular working hours. They waited between 2 ½ hours and 20 hours to be admitted.

Length of Stay The average length of stay for February was 15 days. This is a significant reduction and may be due to several factors, including the Supported Discharge Team (4 FTE) and engaging

69

with service users earlier to facilitate discharge. In addition, the pressure on beds requires discharges in order to admit more unwell users

There were 23 service users who had a length of stay of 7 days or less, with one person was admitted for 14 hours. This is very significant and represents approximately 25% of the total capacity of the unit. It is not clear whether this is a new anomaly and more work is being done to understand the drivers for these admission but it seems likely that the admission was to complete an assessment. It is this group of service users that the adult short stay unit will assist by ensuring that a full assessment can be completed prior to an intervention being determined.

A small number of service users have a length of stay over 35 days in Tiaho Mai. Access to supported accommodation in the community has been one factor that drives longer length of stay. Three service users have been waiting for a residential rehabilitation bed, and the length of time taken to develop the plans has been an issue that is being addressed. The main challenge is co‐ordination of multiple funding agencies to get agreement on the funding package and then finding the appropriate community service.

Mental Health Services for Older People (MHSOP) Occupancy was high for Ward 35E which is a consistent pattern for the past 4 months. Taking an average over the past 2 years the average

70

occupancy for 2012/13 for the same period was 87.8% and for the same period in 2013/14 it was 86%. The increase in admissions was accompanied by an overall increase in referrals to the Community Team. The clinical staff report that there is an increase in complexity and acuity for the same time period.

Adult community Service: Clinician contacts ‐ There was a 5% reduction on clinician contacts for the month of February. (January 17219, February 16351) and this is attributed to the number of clinical staff who took annual leave in the month, and particularly on 7 February to support the HCC IT platform upgrade as well as fewer working days in the month. The contact numbers are expected to increase during March.

Child and Youth Service: Clinician contacts ‐ Weekly monitoring and individual job planning is being implemented to increase clinician face to face time and to improve client focused response. Job plans are designed to be shared and to transparently set out allocation slots for Core and Specialist interventions and structured time for completion of standard clinical documentation.

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Multi family Groups in schools are designed to give children at risk of exclusion access to psychological help whilst also working with their families and the school. This intervention is aimed at children under 14 years with behavioural, emotional and social difficulties who are at risk of exclusion; and their families. It brings together children, parents, teachers and CAMH’s, ensuring a shared understanding of a child’s mental health needs. The focus is on families helping families facilitated by group facilitators. The group is activity based with clear behaviour targets agreed from the outset by school and parents in collaboration. Activities are designed to promote social skills, communication, positive interaction and the development of life skills.

Progress of current initiative: Services have met with two schools to present this initiative and discuss a pilot group. The two schools are in very different decile areas and with very different pupil demographics in order to compare and contrast what works and does not work in each school. Both schools are very enthusiastic and have agreed to have pilots in their schools starting in term two.

OUTCOMESOUTCOMESFamily

Improvement in Mental HealthAccessibility to Mental Health Professionals in a non‐stigmatising environment

Direct, regular access to teaching staffChild improves academically and behaviourally at the same time

Improved relationships between parent and childImproved relationships between parents and teachers

Improved relationships with peers

SchoolImproved attendance and attainment of children in group

Increase in staff knowledge and ability to identify and work with children with Mental

Health problemsReduction in staff stress levels

Reduction in exclusion rates and behaviour incidents

Improved relationships with challenging parents

Improved access to Mental Health supportOverall improved school environment

HealthAppropriate referrals to CAMH’s

Engagement of hard to reach sections of the community

Improved partnerships with Education professionals

Better adherence to treatment because both parent and child are involved

Better treatment outcomes with improvement in long term prognosis post

treatmentEarly intervention reduces the possibility of

more serious issues developing later

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Counties Manukau Health Patient and Whaanau Experience programme The Professional Leader Peer Support is sponsoring a Peer Support Specialist and service user from The Cottage to participate in the CMH Patient and Whaanau Experience Programme facilitated by Lynne Maher of Ko Awatea. The focus of The Cottage project will be capturing the experience of participating in a WRAP (Wellness Recovery Action Planning) programme and its impact on the service user’s experience and wellbeing. The Cottage PSS and service user participant are actively participating in the programme and have attended all of the sustainability workshops at Ko Awatea. The service user involved describes being excited about the work and it is already helping her to overcome previous anxiety regarding participation in community activities, with the added benefit to our service in having her share her experience and feedback with us in a meaningful ‘real‐time’ context.

Complaints / Compliments

9 Non Clinical Support Services


9.1.1 Orderlies Services

The Orderly Services worked closely with Neonatal and Theatre Services to ensure a smooth transition of equipment, patients and services to the new facilities in Harley Gray building, including dummy runs, and using new bed moving equipment and baby moving equipment (Giraffes). Theatre Orderlies are now located in the new unit. These arrangements will be monitored to ensure coverage is adequate. Additional Orderlies have also been allocated to ALBU given Theatres have moved, for a 4 week period to trial new processes. The Orderlies’ new NZQA qualification commenced in February and CM Health has the first signed up student, who was the first in the country, a major achievement for Non Clinical Support so we celebrated it!

9.1.2 Cleaning Services:

The Cleaners are settling into their new additional duties in the Harley Gray building, and coverage will be monitored as services get established.

Victorian Standard Audit Results – Middlemore Hospital January 2014

MIDDLEMORE HOSPITAL ‐ Victorian Cleaning Standards

% Across Risk Factors

97 96 96

8991 92

95 95 95

0

20

40

60

80

100

Nov‐13 Dec‐13 Jan‐14

Very High

High

Moderate

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Victorian Standard Audit Results – Satellites January 2014

SATELLITES ‐ Victorian Cleaning Standards

% Across Risk Factors

80

85

90

95

100

105

Nov‐13 Dec‐13 Jan‐14

Very High

High

Moderate

9.1.3 FOOD SERVICE

Patient Survey Results

Quality of Meals

Overall Impression of Food Service?

% response rates

Month Wards Surveyed

Breakfast Lunch Dinner

VG&G Satis VG&G Satis VG&G Satis VG&G Satis

Dec Tiaho Mai 70 30 72 18 61 23 65% 21%

Jan Surgical MMH 53 44 59 31 55 39 51% 41%

Feb Surgical MSC 66 31 60 17 66 29 77% 14%

Feb Maty & GCU 58 21 58 32 62 32 71% 23%

Feb 8&9, 34N&E 61 23 66 20 66 22 71% 17%

Continue awaiting communication from HBL on next steps with the FMSS Food Service project. The Regional Healthy Food Environment work continues, moving towards a Healthy Food Policy and standards for retail food service to be applied to vending, retail shops and staff cafeterias in the Northern Regional DHBs. The new meals on Wheels menu implemented this month.

9.1.4 CLINICAL ENGINEERING AND EQUIPMENT

CM Health has 18,735 items in the Clinical Engineering MIS database, with 10.6% devices out of validity (WoF) date. The service target (of less than 5% out of date) was not met due to additional resources required to assist with testing and preparation of CSB areas and delays to getting resolution with the snag list items, some initial problems with the introduction of the new anaesthetic equipment and monitors and an ongoing senior technician vacancy . Work is being reprioritised, and recruitment efforts continue in 2014.

9.1.5 LINEN AND LAUNDRY

Spotless Linen and Laundry Services have notified that they won the tender process for the 15 year laundry and linen services to all DHBs throughout New Zealand.

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Counties Manukau District Health Board Director of Allied Health

Recommendation

It is recommended that: the Hospital Advisory Committee note the report from the Director of Allied

Health.

Prepared and submitted by: Martin Chadwick – Director Allied Health

Strategic issues

He Pou Oranga (Allied Health Enabling Localities Project) continues, with a focus on how to better align the Allied Health workforce to population health needs within the community, and an appropriate skill mix for effectiveness and efficiency of care delivery. The next step planned is to look at tasks that could be more effectively shared across disciplines and the competencies that will need to be developed to allow this to occur safely.

The methodology used within He Pou Oranga has been developed further for use with the broader Home Healthcare team at Papakura. Using lessons learnt to date, the process has been condensed to roll‐out over a 6 week period. The first two sessions have been held with staff and are forming the basis as to how staff can redesign their service delivery to be more efficient and utilise skill sets more effectively.

Director Allied Health chairing of the Manukau Locality Interim Leadership Group continues. During leave over the past month, the two meetings have been chaired by a local GP, which is a positive step in seeing more local engagement and ownership of this concept.

Allied Health Workforce development

The Anaesthetic Technicians training stability continues to be addressed. Modelling around understanding as to what the “need” is as far as a graduating workforce has been progressed and is showing a progressive gap in the out years. AUT has been approached to look at how to have a stream of new graduates that is matched to demand which has also prompted a revisiting of how training is currently provided in‐house. This has bought to the fore the need for clear leadership of this workforce with the proposal for the establishment of a Professional Leader role being progressed to the point of an Approval to Recruit request and an associated Job Description being generated.

The Sonography Workforce project continues to be progressed through the NRA. Work continues on the 12 week intensive clinical block and the best way to do this as well as associated costing. Funding has allowed for the Sonographer Tutor role to be advertised in collaboration with the metro DHB’s and the University. There has been good interest in this work nationally, with other DHB’s outside of the region looking to send candidates.

The defined allied health career pathway within Counties Manukau Health continues to progress with a process being agreed to work through with staff to determine how they would align within the titles “Advanced Clinician” and “Advanced Practitioner” as provided for in the PSA MECA, as well as Clinical Specialty roles. The balanced scorecard concept for Allied Health from a Clinical Leadership perspective continues to be developed.

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Health Excellence Framework

Roll‐out of the programme and drafting of an initial application document continues building on the operational profile. Each themed area now has an ELT sponsor and work is being done on authoring a response to each of these areas. The first draft document is due to be submitted to ELT in April.

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Counties Manukau District Health Board Director of Nursing

Recommendation

It is recommended that: the Hospital Advisory Committee note the report from the Director of

Nursing.

Prepared and submitted by: Denise Kivell Director of Nursing

Nursing Strategic issues

Counties Manukau has hosted the Global Nurse Executives workshops at Ko Awatea to which seven DHBs belong. The theme was innovation and transformation. Some of the tools/ learning gained were used at our first Clinical Nurse Directors, PHO and Locality Nurse Leader’s integration workshop.

The Director of Nursing (DON), as chair of Nurse Exec NZ attended the NZ Nurse Leaders forum. The value of this role is that it provides insight to national key issues. The DON tabled the issue of Anaesthetic Technician shortage and the proposed peri‐operative Nursing Course. Health Workforce NZ is supportive of joint work with nursing: key work plans are maximising new graduate employment and advanced nursing roles that align with the MOH strategic intent.

The DON attended the Health Quality and Safety Commission Quality Account workshop. Year two will see the Quality Accounts line up with the Annual Planning processes and have a stronger theme of patient/consumer engagement in the final document.

Workforce

Investing in our future nursing workforce is a strategic imperative. Challenging the status quo to take on new graduates often needs to be balanced with recruiting an experienced nurse to replace the previous experienced nurse. This concept also has financial implications. A small working group are exploring a change in the model. This group incorporates representatives from Ministry of Health, Human Resources, Ko Awatea workforce unit, business managers and nursing.

The Ko Awatea Transition process looking at education roles in the organisation have held several workshops and focus groups. The Professional Nursing Development Unit (PNDU) which incorporates the Nurse Coordinators for under graduate placements, new graduates, post graduate plus the nurse educators are all part of this review. Several workgroups are reviewing Professional Development portfolios, mandatory training and education methods fit for 2014. The Waikato DHB returned for a further visit to look at our Dedicated Education Units which they are now progressing. Currently we have 12 units with one at Howick Baptist Residential care Unit. These units are helping to maximise a positive student and staff experience in undergraduate training.

The National Public Health Nurse Education Framework Advisory group are progressing work to influence and develop a stronger public/population heath role in nursing. The CMH Director of Nursing is the national DON representative. There is a variety of public health nursing roles country wide.

77

Mental Health senior nurses, our Chief Nurse Advisor Primary and Integrated care and GP Liaison are working with the College of Primary Care Nurses to credential Registered General Nurses to work with people experiencing mental health issues. Currently, some of our nurses who trained under the hospital system are out of scope.

Nursing Practice issues

Middlemore Transfer of the entire Neonatal Unit over one weekend in February went well, an amazing and successful team effort. Currently addressing the neonate loss of body temperature and associated risks on transfer following an incident, so that processes are enhanced.

IHI Innovation Project (Introduction of tablets/mobile technology in healthcare) timeline has been modified due to Windows 7 rollout. The concept of working completely with mobile (mHealth) technology has already indicated efficiencies and changed work practices for the Kidz First Homecare Nursing Team.

The Mana Kids Rheumatic Fever programme Public Health Nurse workload continues to be demanding, due to high volumes of positive swabs (11‐17%) and associated follow‐up. Many of the service model systems have undergone reconfiguration and a close review of this project is highlighting areas to improve or question.

Safe Staffing Healthy Workplaces (SSHW)

A safe handling and lifting group led by Occupational Health and Safety is reviewing care processes for the increasing numbers of bariatric patients, and a lack of utilisation of the bariatric equipment pool in light of associated nursing injuries.

The value of safe rostering is a strategic imperative. This document was utilised around NZ with support from nursing, midwifery and our union partners. The ‘Standards of Rostering’ document is being reviewed with a planned re‐launch on completion.

Patent and Whaanau centred care work

The Programme Board are utilising the Health Excellence Framework ‐ Customer Focus section to strengthen the organisational approach taken to this work. Capturing work, experience, and information is enabling a stronger platform to work from and has been surprising to see the amount of work that is underway in relation to patient and whaanau centred care.

Early results from the “co‐design workshops” now called Capturing Patient Experience indicate that the staff involved are open and supportive of the concept. Nineteen programmes are underway with leadership from Lynne Maher, Director of Innovation, Ko Awatea. Hearing staff describe how capturing their patient’s experience is shaping their current and future work is humbling.

Patient Experience Indicators (HSQC) the national patient experience indicators (Inpatient only) will be operational by October 2014. Currently, the survey questions are confirmed with work on funding and contracts being signed off by the DHB CEOs. A literature review has been completed as part of the development of a programme to capture patient, whaanau and staff experience at the front line. Ko Awatea in particular Lynne Maher Director of Innovation and Jonathan Grey Director of Ko Awatea, are keen to utilise the opportunity to develop and possibly brand the programme. Work on measuring and defining the indicators is taking time as it aligns current and future level measures.

Patient Safety work

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Medication Safety for Nurses is key focus locally and regionally, and the ‘5 Rights’ campaign continues with 83 education sessions planned to capture the majority of nurses over the year, and raise the profile of this approach to supporting medication administration.

30 incidents reported in February (in‐patient only)

The Green Bag – Patient own medication storage system ‐ Thirty three ward areas are now using this system. The Green bag project is one of four concepts that may have a regional approach depending on the HQSC intentions regarding medication safety. The other concepts are around allergies, opioids and medicine reconciliation. The Counties system is also now one of the projects within the Ko Awatea co‐design Capturing Patient Experience projects.

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Appendix A

HEALTH ADVISORY COMMITTEE

NOTES AND DESCRIPTIONS

1 Total Caseweight – C Nouwens – DSS – This is the total MOH funded WIES for the month and year to date, from the

front page of the most recent Redbook WIES reporting.

2 Elective Caseweight – C Nouwens – DSS ‐ This is the total ELECTIVE MOH funded WIES for the month and year to date,

from the front page of the most recent Redbook WIES reporting.

3

Acute Caseweight – C Nouwens – DSS ‐ This is the total ACUTE MOH funded WIES for the month and year to date, from

the front page of the most recent Redbook WIES reporting.

4

Outpatient FSA Volumes – C Nouwens – DSS – The total number of outpatient type of ‘New Patient’ for the month and

year to date. Contracts are not calculated in this way, so target is blank. Previous year volumes are used to calculate

the Var. In the Year section, the previous year volumes are used as the target also.

5 Outpatient Follow Up Volumes – C Nouwens – DSS – The total number of outpatient type of ‘Followup’ for the month

and year to date. Contracts are not calculated in this way, so target is blank. Previous year volumes are used to

calculate the Var. In the Year section, the previous year volumes are used as the target also.

6 Budgeted FTE – Finance – FFARs FTE actual and budget by month and YTD, as reported in the Provider Arm.

7 Operating Costs ($000) – Finance – FFARs actual and budget by month and YTD, as reported in the Provider Arm. All

expenditure less staff/personnel costs plus 8000‐xxxxx internal allocations.

8 Personnel Costs ($000) – Finance – FFARs actual and budget by month and YTD, as reported in the Provider Arm.

9 Elective Surgical Discharges (excludes uncoded) – C Nouwens – DSS – the total number of elective patients discharged

from Adults Surgical Care and KidzFirst Surgical. There is no target given for this measure, so last years actual is used as

the target. Cases that haven’t yet been coded are excluded from this measure, as per the name.

10 Financial Result – total $m (negative is contribution) – Finance – FFARs actual and budget by month and YTD, as

reported in the Provider Arm $m. (Negative reflects surplus position).

11

Virtual FSAs – C Nouwens – DSS – volumes of outpatient events for PUC codes M00010 Virtual Medical Firsts and

S00011 Virtual Surgical Firsts against contract. If the intention of this is to show ‘Increase from baseline by 10%’ then a

baseline will have to be provided. Currently using the contract for the year.

12

Rate based measures of staff with excessive annual leave balances within the DHB. Excessive leave is considered to be

those employees with an annual leave balance in excess of 2 years worth of their current annual entitlement.

Factors in FTEs.

Numerator: A count of the number of employees with an excessive annual leave balance as defined above.

Denominator: A count of the number of employees with an annual leave balance.

13 A rate based measure of staff turnover within the District Health Board (DHB). Numerator: The number of employees

who cease employment due to voluntary resignation during the period. Denominator: The total headcount of

employees at the beginning of the period.

14 A rate based measure of paid and unpaid sick leave hours taken by employees within the District Health Board (DHB).

Measure the proportion of DHB employees’ paid and unpaid hours that are lost to sick leave. Provides an indication of

relative effectiveness in maintaining healthy staff and managing absenteeism in the DHB. Does not measure all forms

of absenteeism.

Numerator: The total number of paid and unpaid sick leave hours taken by DHB employees during the reporting

period. Denominator: The total number of DHB paid hours during the reporting period.

15 Incidences of days lost due to staff injuries per 1,000,000 hours worked. Measures the proportion of DHB employees

who have days lost due to workplace injuries or illness. Injuries or illness associated with the workplace contribute

towards lost work hours.

16 Mandatory Training Completed < 3 months: This measure is under development

17 eMR within 48hrs per 100 patients

18 Rate of patients with hospital acquired pressure injuries per 100 patients.

19 Rate of all falls in hospital causing major harm per 1,000 bed days. All inpatients including satellite facillities such as

80

Franklin Memorial.

20 Adverse Drug events per 1000 bed days

21 Rate of CLAB in patient that had a central line that is not related to an infection at another site expressed as per 1000

central line days.

22 Rate of S Aureus Bact per 1000 bed days

23 Quality Safety Marker, HQSC. % Operations with all 3 Surgical Safety Checklist complete. A baseline audit completed in

Q1, 2013 had CM Health at 86%.

24 QUARTERLY ‐ % patients 75+ years old (55+ years old for Maaori and Pacific) assessed for risk of falling and % patients

assessed for falls who have falls intervention plan.

25 National Health Target. Numerator: number of patient presentations to the Emergency Department with an Emergency

Department length of stay of less than six hours from the time of presentation to the time of admission, transfer and

discharge. Denominator: total number of patient presentations to the Emergency Department.

26 Seen by inpatient team <3 hours – C Thomas – DSS ‐ 3 hours rule calculation is based on

“If a patient is discharged from EC with a discharge description as "Admit to Ward" and the difference between EC

DTTM of Arrival and IP Admit DTTM or if EC DTTM of Arrival to EC Discharge DTTM is >180 M then they fail the 3 hour

rule or else they pass . 1 being fail and 0 being pass, No Triage mins logic has been included into this”

27 National Health Target: Percentage of radiotherapy patients receiving treatment within 4 weeks from date of decision

to treat. Waiting time for treatment is from date of First Specialist Assessment to the beginning of treatment. The goal

is that no one should wait longer than 4 weeks due to reasons of capacity constraint. Patients who wait due to clinical

considerations or by their own choice are omitted from the results.

28 National Health Target: Percentage of chemotherapy patients receiving treatment within 4 weeks from date of

decision to treat. Waiting time for treatment is from date of First Specialist Assessment to the beginning of treatment.

The goal is that no one should wait longer than 4 weeks due to reasons of capacity constraint. Patients who wait due to

clinical considerations or by their own choice are omitted from the results.

29 MAU seen by SMO within 4 hours: This measure is being developed

30

Developmental measure, MOH Indicator of DHB Performance. 75% of accepted referrals for MRI scans will receive

their scan within than 6 weeks (42 days). Overall patient event numbers (Community and Outpatient Referrals) –

including planned patient events; Waiting times (Community and Outpatient Referrals) – excluding planned patient

events; Monthly activity and demand (Community and Outpatient Referrals) – excluding planned patient events.

31

Developmental measure, MOH Indicator of DHB Performance. 85% of accepted referrals for CT scans will receive their

scan within than 6 weeks (42 days). Overall patient event numbers (Community and Outpatient Referrals) – including

planned patient events; Waiting times (Community and Outpatient Referrals) – excluding planned patient events;

Monthly activity and demand (Community and Outpatient Referrals) – excluding planned patient events.

32 In patient Radiology times within 2hours: This measure is being developed

33 EC radiology times <2 hours :– P Hewitt – Radiology – under development

34 Results sign off within 14 days – awaiting report development

35

Developmental measure, MOH Indicator of DHB Performance. 50% of people accepted for an urgent diagnostic

colonoscopy will receive their procedure within two weeks (14 days)

36 Developmental measure, MOH Indicator of DHB Performance. 50% of people accepted for a diagnostic colonoscopy

will receive their procedure within six weeks (42 days)

37

Developmental measure, MOH Indicator of DHB Performance. 50% of people waiting for a surveillance or follow‐up

colonoscopy will wait no longer than twelve weeks (84 days) beyond the planned date

38 Test turnaround time (TAT) ‐ Labs

39 Results sign off with 5 days ‐ Labs

40

Northern Region Target. Proportion of percutaneous coronary interventions (PCIs) carried out within the

recommended 90 minute guideline in emergency cardiac care (ECC), specifically in the treatment of ST segment

elevation myocardial infarction (STEMI). Measure is Door to Balloon, that is, from the arrival of the patient to when

they receive a balloon angioplasty (inflation of balloon in a blocked coronary artery)

81

41

Ministry of Health Elective Service Performance Indicator (ESPI). Percentage of patients currently waiting longer than

five months from date of referral for their First Specialist Assessment.

42 Patients waiting longer than 5 months (150 days) for Treatment – elective (ESPI 5

43 The maximum target length of time taken for a patient referred with a high‐suspicion of cancer (that is, person

presents with clinical features typical of cancer, or has less typical signs and synptoms but the triaging clinician suspects

there is a high probability of cancer), to receive their first treatment (or other management) for cancer.

44 The maximum target length of time a patient should have to wait from date of decision‐to‐treat to receive their first

treatment (or other management) for cancer. The 31 day indicator includes all patients who receive their first cancer

treatment, irrespective of how they were initially referred.

45 % radiology results reported within 24 hours – C Thomas – DSS

46

MOH, Indicator of DHB Performance. % child/ youth seen by 3 weeks for non urgent mental health services – The wait

time will be counted from the time the referral is received for a person who has not been seen for at least a year (or

not at all) to the time of the first face to face contact with a mental health or addiction professional.

47 Access rates ‐ CMDHB domciled unique clients seen by MH in preceding 12 months as % of population

(0‐19years, 20‐64years and over 65 years)

48 ALOS – Acute Inpatient – C Nouwens – DSS – ALOS for Admit type Acute Inpatients across all services.

49

ALOS – Elective Surgery – C Nouwens – DSS – ALOS for Admit type Elective, Arranged and Waiting List Inpatients across

all services.

50 Acute Readmissions within 7 days – Total – M Ng – DSS

51 Acute Readmissions within 28 days – Total – M Ng – DSS

52 Acute Readmissions within 28 days – 75+ – M Ng – DSS

53 % EC admissions – 75+ ‐ C Thomas – DSS

54 % transcribed clinical summaries authorised within 7 days for document created, that is, authorised to be published in

Concerto and sent out to GPs and patients. Data collection only started from November 2013.

55 % patients with EDD/ CSD within 24hours of admission: This measure is being developed

56 Patient outliers are patients admitted to a ward different from that which they are meant to be in. For example, a

medical patient placed in a surgical ward due to the lack of beds. Numerator: patient outliers in ARHOP, Medical and

Surgical adult inpatients, excluding EC/ Short Stay. Denominator: occupancy in Medical, Surgical and ARHOP services

only.

57 Northern Region Target. Eligible stroke patients, that is, only patients with ischaemic stroke.

58 Hospitalisations of children aged 0 ‐ 4 years old resulting from diseases sensitive to prophylactic or therapeutic

interventions that are deliverable in a primary health care setting.

59 Hospitalisations of people aged 0 ‐ 74 years old resulting from diseases sensitive to prophylactic or therapeutic

interventions that are deliverable in a primary health care setting.

60 FSA/FUP ratio – C Nouwens – DSS – Using the OP measures from measure 4, the number of new patients divided by

the number of follow‐up appointments for the time period. There is no target as such, so I’ve used the figure for the

previous year to determine the variance.

61 Outpatient DNA rates – Maaori – C Nouwens – DSS – All DNA’s for all hospitals for Maaori ethnicity divided by all

outpatient appointments at all hospitals for Maaori ethnicity patients.

61

a

Outpatient DNA rates – Pacific – C Nouwens – DSS – All DNA’s for all hospitals for Pacific ethnicity divided by all

outpatient appointments at all hospitals for Pacific ethnicity patients.

62 Theatre List Utilisation – C Nouwens – DSS – from Report Manager Actual operating minutes vs resourced operating

minutes for all CMDHB theatres. : https://nth‐reports.healthcare.huarahi.health.govt.nz/Reports/Pages/SearchResults.aspx?SearchText=theatre%20utilisation&ViewMode=List

63 Theatre Session Utilisation – C Nouwens – DSS – also from reporting manager, report currently broken, waiting for fix.

64 Day of Surgery Admissions (DOSA) – N Raj – DSS – Percentage of all elective discharges (excluding day surgery) where

the surgical procedures take place on the day of admission.

65 Day Case Rate (Elective/Arranged) – N Raj – DSS – Percentage of all elective discharges that have the same admission

82

and discharge date.

66 % patients discharged to discharge lounge or home by 1100hrs. Including Manukau Super Clinic.

67

% MAU patients with LOS <28 hours – C Thomas – DSS – the time a patient spent in MSSU/SSMED during their stay in

EC

68 % Community NASC referrals via e‐refferasl and assessed within 48hours

This is a part of e‐referral project. Baseline data being collected will start reporting to this in the 2014/15 financial

year.

69 % patients with District Nursing / Home Help within 24hours

70

This is a part of our e‐referral project. Baseline data is currently being collected and will start reporting to this in the

2014/15 financial year.

71 Nursing Hours per patient days: This measure is being developed

72 Hospital beds occupied – C Nouwens – DSS – number of inpatient bed days for the month and year to date.

73

LOS outliers – C Nouwens – DSS – count of encounters with a LOS >10 days, excluding burns, spinal, long stay psych and

long stay geriatrics.

74 National patient experience survey which all DHBs are expected to implement in 2014/15. To be reported from August

2014.

75 Infants who are exclusively breastfed upon discharge from Middlemore Baby Friendly Hospital Initiative Maternity

facilities only. Excludes the three primary maternity units.

76

National health target: percentage of identified smokers who have been identified through diagnostic coding as having

received advice to quit.

83

Counties Manukau District Health Board Update on National Maternity Care Information System

Recommendation It is recommended that the Hospital Advisory Committee note the following Information update on the national rollout of the Maternity Care Information System (MCIS) as requested by the committee at the March meeting.

Prepared and submitted by: Nettie Knetsch, General Manager Kidz First and Women’s Health

Summary

CMH is one of five early adopter DHBs for the national Maternity Clinical Information System (MCIS).

The purpose of the MCIS is to be able to share clinical information between the health professionals involved in the woman's circle of care. This includes hospital staff, Lead Maternity Carers and GPs.

The programme of work also includes a neonatal module to be used by Neonatal Unit staff, and a woman's Maternity View where the woman can view her own maternity information via an electronic device.

The national project teams have been working for the last 18 months on working through the information governance and privacy requirements, and modifying the content of the system for the NZ maternity model. The UK based vendor has established a base for data repository, employed NZ staff and are working on interfaces required to other national systems.

CMH are currently testing the system with clinical scenarios and recommending essential changes before the system can be further tested and go live. healthAlliance are working through the local interfaces that are required with Concerto, Eclair and iPMs. It is planned that go live for the first DHB will be in July 2014.

More details about these programmes of work are available at: http://ithealthboard.health.nz/ programmes/shared‐health‐information/maternity.

Maternity clinical information system project (from IT Health Board site)

The maternity clinical information system project will link relevant information that is already collected about a woman and her baby during pregnancy and until her baby is 4–6 weeks old. Access to information about a woman’s clinical/medical and maternity history will mean different health professionals providing care, such as midwives, GPs, hospital doctors, nurses and hospital specialists, can work together more effectively.

Information that should be shared would include:

that recorded at the time of registration with the lead maternity carer (LMC) any significant medical history allergies and alerts past obstetric history prescribed medicines results of blood tests and scans

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information for maternity facility booking birth plan labour and birth summary discharge summary

LMCs, GPs, relevant hospital/ facility staff and the woman would have access to this information.

How the system will work

The system will exchange information with existing community‐based maternity systems and, in the future, will interface with general practice management systems. It will link this community‐based maternity information with hospital‐based maternity information. The system will enable relevant information to be pulled together. This information can then be viewed by women and the health professionals caring for them.

Health professionals caring for a woman and her baby can record details relating to that care, including midwifery notes, screening and test results, and medication. In time, the new system will provide a seamless flow of information between health professionals when care is being provided by both community and hospital health services, during pregnancy, birth and up to six weeks after the birth. The new system will be underpinned by a standardised maternity data set which will make it easier to collect consistent, quality information about maternity.

Portal for health professionals and women

Health professionals caring for a woman and her baby will be able to access information directly via a DHB’s computer system or remotely via a health care professional’s portal. There will be a view of booking and pregnancy reports, alerts, identified risk factors, and care received. The portal will allow health professionals to enter comments or questions which are viewable by other clinical users.

In time woman will have access to a summary view of their information within the maternity system via an online website or portal.

A portal is a web‐based access point that brings information together from various sources so it can be viewed as a summary record. An example is online banking websites, where you can view information from your different accounts. Information is brought together from a number of sources, and displayed in an easily viewable format.

There is still to be discussion about women’s/parental access to summary neonatal information via the online portal should their newborn be admitted to a neonatal intensive care unit. In the meantime, women/parents will continue to have access to their newborns’ neonatal information through the usual hospital channels.

Implementation and dates

The new system is being developed in stages and will be introduced through district health boards (DHBs) at different times. DHBs are encouraged to use the new maternity information system but it is not compulsory. All DHB CEOs have agreed in principle to a national maternity system. DHBs will move onto the national platform when they are ready to do so over the next few years.

MidCentral, Whanganui, Counties Manukau, Capital & Coast and Tairawhiti DHBs will be the first to introduce the new systems, in 2014. Women in these DHBs are expected to be able to see their information online by 2014/15.

85

Women in other locations will be able to see their summary information online as their DHBs introduce the new system. They will need to continue keeping a copy (paper or electronic) of their own maternity notes in the meantime.

Information system provider

The company providing the maternity and neonatal systems is Clevermed. Clevermed will provide a fully managed service, including software and ongoing maintenance, enhancements and support. The service will be hosted in New Zealand and data kept in New Zealand. Having a managed service means that, rather than a one‐off software delivery, Clevermed will commit to working with the project team to upgrade the service in response to changes in technology, innovation, customer suggestion and regulations on a regular basis to ensure it continues to meet local and national needs and requirements. Clevermed’s customers include many hospitals in the UK as well as sites in Ireland and Australia, and soon in New Zealand.

How the system works

The application used by health professionals will operate on Windows XP or later operating systems. It will be installed on each desktop workstation required to access a person’s data. It can be centrally installed by the local IT department within each hospital/DHB either through a central software management system or installed manually at each workstation. The application has a reporting function that includes letters and documents covering registration and birth process as well as reporting relating to national clinical quality indicators. Clevermed will provide a ‘service desk’ that allows users to log requests for assistance or suggest changes to the platform, and provide help pages, telephone, and email support to assist with problem resolution during New Zealand office hours.

Accessing the new system

The application used by health professionals will operate on Windows XP or later operating systems. It will be installed on each desktop workstation required to access a person’s data. It can be centrally installed by the local IT department within each hospital/DHB either through a central software management system or installed manually at each workstation. Health professionals will also be able to access the system remotely through a health professionals’ portal. Clevermed will provide a ‘service desk’ that allows users to log requests for assistance or suggest changes to the platform, and provide help pages, telephone, and email support to assist with problem resolution during New Zealand office hours.

Lead maternity carers

Lead maternity carers (LMCs) will access the new system in a variety of ways, depending on which system they are currently using. They can view maternity data via the health professional’s portal. If they are providing information, this will be done via the community systems they are currently using, or directly into the database, if they are working in a hospital setting. LMCs who currently use one of the two electronic community maternity systems will have the key data that they enter into these systems transferred to the national maternity system electronically. This will decrease the requirement to do manual transfers.

Health professionals other than lead maternity carers

Health professionals will be able to access information directly via the DHB’s computer system or remotely via the health care professional’s portal. There will be a view of booking and pregnancy reports, alerts, identified risk factors, and care received. The portal will allow health professionals to enter comments or questions which are viewable by other clinical users. Governance measures will ensure only appropriate and defined records are viewed.

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Counties Manukau District Health Board

Hospital Advisory Committee Meeting – 9th

April 2014

4.0 Resolution to Exclude the Public

Resolution:

That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ

Public Health and Disability Act 2000 the public now be excluded from the meeting for

consideration of the following items, for the reasons and grounds set out below:

General Subject of

items to be considered

Reason for passing this resolution in

relation to each item

Ground(s) under Clause 32 for

passing this resolution

5.1. Patient Safety

Report

That the public conduct of the whole

or the relevant part of the proceedings

of the meeting would be likely to result

in the disclosure of information for

which good reason for withholding

would exist, under section 6, 7 or 9

(except section 9 (2) (g) (i)) of the

Official Information Act 1982.

[NZPH&D Act 2000

Schedule 3, S.32 (a)]

Privacy

The disclosure of information would

not be in the public interest because of

the greater need to protect the privacy

of natural persons, including that of

deceased natural persons.

[Official Information Act 1982

S.9 (2) (a)]

5.2. Non-Resident

Revenue Processes

That the public conduct of the whole

or the relevant part of the

proceedings of the meeting would

be likely to result in the disclosure of

information for which good reason

for withholding would exist, under


9(3)(g)(i))of the Official Information

Act 1982.


S32(a)]

Commercial Activities

The disclosure of information would

not be in the public interest because

of the greater need to enable the

Board to carry out, without prejudice

or disadvantage, commercial

activities.

[Official Information Act 1982

S9(2)(i)]

117

Acute Care

Vanessa Thornton, Carl Eagleton

Acronyms

• TC – Triage Category

• AOU – Adult Observation Unit

• Pareto % = the Pareto rule (also known as the 80-20 rule, the law of the vital few and the principle of factor sparsity) states that for many events roughly 80% of the effects come from the 20% of the causes

• PCI – Primary Coronary Intervention

• IP - Inpatient

118

119

What ‘good’ looks like EC

1st Hour– TC1 patients seen immediately– TC2 patients seen in 10 minutes– Nursing assessment in 15 minutes– All patients seen by a doctor within one hour of arrival

2nd Hour– EC patients referred to inpatient speciality teams – Specialty teams advised patient requires review– All speciality patients seen in one hour by decision making doctor

4th Hour– Bed allocated and bed available (in one hour of allocation)– Ward nurse to request hand over within one hour of bed allocation– Standardised (exception) handover

5th Hour– Patient transferred to short stay– Patient discharged with discharge papers– Patient admitted to inpatient ward– No inpatients boarding in acute EC or in short stay wards

121

Why ‘good’ is hard to achieve

Increasing % of self referrals – 61% in 2000 – 74% in 2012 and 76% 2013

Managing more patients through EC.

EC presentation by referral type

0

20000

40000

60000

80000

100000

120000

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

GP referrals Self

122

Self presenters by locality 2013

Self Referrals to EC8%

27%

5%

14%

28%

5%

13%

Eastern

Others

Franklin

Mangere

Manukau

Otahuhu

Otara

123

GP presentations by locality 2013

GP Referrals to EC

14%

24%

8%11%

27%

2%

14%Eastern

Others

Franklin

Mangere

Manukau

Otahuhu

Otara

124

Why did you come to EC?• Over last 14 years there has been an unprecedented and sustained

increase in patient presentations to MMH ED

• Existing research between 15-40% of patients in ED have had contact with their GP prior to coming to ED

• Establish demographic profile of self-presenting patients TC 3-5

• 25% self-presenting patients had contacted their GP prior to their ED presentation

• Most common reason for self-presentation is the belief that they are acutely ill

• 30% attended out of hours because GP service was closed

• Cost did not feature as a reason for attendance

125

Primary and secondary causes of delays >6hrsdata for 2013 (Excl AOU). Overall breaches = 3.4% (Clinical = 0.5%)

0

200

400

600

800

1000

1200

1400

1600

TB

S E

C

Bed

ava

ilabi

lity

Clin

ical

lyap

prop

riate

TB

S M

edic

al

Bed

Req

uest

TB

S S

urgi

cal 0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

primary reason secondary reason % pareto

126

Initiatives to improve quality of clinical care in EC

% patients getting PCI within 90 minutes

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Jan-

11

Apr

-11

Jul-1

1

Oct

-11

Jan-

12

Apr

-12

Jul-1

2

Oct

-12

Jan-

13

Apr

-13

Jul-1

3

Oct

-13

Jan-

14

Month

% p

atie

nts

get

ting P

CI w

ithin

90

min

ute

s

127

Time to antibiotics in Sepsis

Average time to antibiotics for all patients presenting to EC with sepsis / severe sepsis

UCL

0:00

1:00

2:00

3:00

4:00

5:00

6:00

7:00

8:00

May

2013

Jun

2013

Jul 2

013

Aug

2013

Sep

2013

Oct

201

3

Nov

201

3

Dec

2013

Jan

2014

Feb

201

4

tim

e (h

ou

rs)

Chris Lash, Vanessa Thornton, Debbie Hailstone

128

Reduce ED conversions to admits in over 65 year olds

by 10% (medicine only) by June 2015

EC to IP Admission

0200400600800

10001200140016001800

1

2013

2 3 4 5 6 7 8 9 10 11 12 1

2014

2

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

Total % to IP

Early SMO review and seen-by within one hour;

Early decision making;

Allied Health support and linking with localities

Afternoon ward/board rounding in Medical Assessment

129

Questions ?

What good looks like?

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