hac open agenda june 2016

HOSPITAL ADVISORY COMMITTEE (HAC) MEETING

Wednesday 29th June 2016 2.00pm

A G E N D A

VENUE

Waitemata District Health Board Boardroom Level 1, 15 Shea Tce Takapuna

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Waitemata DHB, Hospital Advisory Committee Meeting 29/06/16

HOSPITAL ADVISORY COMMITTEE (HAC) MEETING 29th June 2016

Venue: Waitemata DHB Boardroom, Level 1, 15 Shea Terrace, Takapuna Time: 2.00pm

Committee Members James Le Fevre – Committee Chair Lester Levy – WDHB Chair Max Abbott – WDHB Board Member Kylie Clegg – WDHB Board Member Sandra Coney – Deputy Committee Chair Warren Flaunty – WDHB Board Member Tony Norman – WDHB Deputy Chair Morris Pita – WDHB Board Member Christine Rankin – WDHB Board Member Allison Roe – WDHB Board Member Gwen Tepania-Palmer – WDHB Board Member Susanna Galea – Co-opted Member Willem Landman – Co-opted Member Donna Riddell – Co-opted Member David Ryan – Co-opted Member

WDHB Management Dale Bramley – Chief Executive Officer Robert Paine – Chief Financial Officer and Head of Corporate Services Andrew Brant – Chief Medical Officer Jocelyn Peach – Director of Nursing and Midwifery Cath Cronin – Director of Hospital Services Debbie Holdsworth – Director Funding Tamzin Brott – Director of Allied Health Fiona McCarthy – Director Human Resources Peta Molloy – Board Secretary

Apologies: James Le Fevre

AGENDA

DISCLOSURE OF INTERESTS Does any member have an interest they have not previously disclosed?

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

PART I – Items to be considered in public meeting All recommendations/resolutions are subject to approval of the Board.

TIME 2.00pm

1. AGENDA ORDER AND TIMING

2. CONFIRMATION OF MINUTES 2.00pm 2.1 Confirmation of Minutes of Hospital Advisory Committee Meeting (25/05/16) ........................... 6 Actions Arising from previous meetings .............................................................................. 16

3. ITEMS FOR CONSIDERATION AND RECOMMENDATION TO THE BOARD

4. PROVIDER REPORT 2.05pm 4.1 Provider Arm Performance Report – April 2016 ......................................................................... 17 Executive Summary ................................................................................................................. 21 Human Resources ................................................................................................................... 32 Medicine and Health of Older People Services ....................................................................... 34 Child, Women and Family Services ......................................................................................... 43 Mental Health and Addiction Services .................................................................................... 50 Surgical and Ambulatory Services/ Elective Surgical Centre ................................................... 58 Provider Arm Support Services ............................................................................................... 67 Hospital Operations ................................................................................................................ 68 Facilities and Development ..................................................................................................... 70 4.2 Provider Arm Performance Report – May 2016 ........................................................................... 72

5. CORPORATE REPORTS 3.00pm 5.1 Clinical Leaders’ Report ................................................................................................................ 81 3.10pm 5.2 Human Resources Report ............................................................................................................. 90

3.30pm 6. RESOLUTION TO EXCLUDE THE PUBLIC ............................................................................... 98

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Waitemata District Health Board

Hospital Advisory Committee Member Attendance Schedule 2016

Attended the meeting x Absent * Attended part of the meeting only # Absent on Board business ^ Leave of absence

NAME FEB APR MAY JULY AUG SEPT NOV DEC

Dr Lester Levy (Chair)

Max Abbott x x

Kylie Clegg

Sandra Coney

Warren Flaunty x

James Le Fevre (Committee Chair)

Tony Norman(Deputy Chair) x

Morris Pita

Christine Rankin x x

Allison Roe x

Gwen Tepania – Palmer

Co-opted members

Susanna Galea

Willem Landman

Donna Riddell x

David Ryan

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Register of Interests

Board/Committee Member

Involvements with other organisations

Last Updated

Lester Levy - Board Chairman

Chair – Auckland District Health Board Chairman – Auckland Transport Chairman – Health Research Council Independent Chairman – Tonkin & Taylor Chief Executive – New Zealand Leadership Institute Professor of Leadership – University of Auckland Business School Trustee - Well Foundation (ex-officio member) Lead Reviewer - State Services Commission, Performance Improvement Framework

03/02/16

Max Abbott Pro Vice-Chancellor (North Shore) and Dean – Faculty of Health and Environmental Sciences, Auckland University of Technology Patron – Raeburn House Advisor – Health Workforce New Zealand Board Member, AUT Millennium Ownership Trust Chair – Social Services Online Trust Board member – Rotary National Science and Technology Forum Trust

19/03/14

Kylie Clegg Board Member – Hockey New Zealand Trustee and Chairman – the Hockey Foundation Trustee and Beneficiary – Mickyla Trust Trustee and Beneficiary – M&K Investments Trust (includes a share of less than 1% in Orion Health Group) Trustee and Beneficiary of M&K Investments Trust (owns 99% share in MC Capital Ltd, MC Securities Ltd and MC Acquisitions Ltd)

25/11/15

Sandra Coney Chair – Waitakere Ranges Local Board, Auckland Council 12/12/13

Warren Flaunty Member – Henderson - Massey and Rodney Local Boards, Auckland Council Trustee (Vice President) - Waitakere Licensing Trust Shareholder - EBOS Group Shareholder – Green Cross Health Owner – Life Pharmacy North West Director – Westgate Pharmacy Ltd Chair – Three Harbours Health Foundation Director - Trusts Community Foundation Ltd

25/11/15

James Le Fevre Emergency Physician – Auckland Adults Emergency Department Pre-hospital Physician – Auckland HEMS – ARHT/Auckland DHB Co-opted Member – Whanganui District Health Board Hospital Advisory Committee Trustee – Three Harbours Foundation Member – Association of Salaried Medical Specialists Shareholder – Pacific Edge Ltd James’ wife is an employee of the Waitemata DHB, Department of Anaesthesia and Perioperative Medicine

12/08/15

Anthony Norman – Deputy Board

Chairman

Board Chair - Northland DHB Director - Health Alliance NZ Ltd Director - Health Alliance (FPSC) Ltd Trustee and Treasurer - Kerikeri International Piano Competition Trust Partner - Mill Bay Haven, Mangonui (accommodation provider)

05/11/14

Morris Pita Board Member – Auckland District Health Board Owner/operator – Shea Pita and Associates Limited Shareholder – Turuki Pharmacy Limited Wife is member of the Northland District Health Board

13/12/13

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Board/Committee Member

Involvements with other organisations

Last Updated

Christine Rankin Member - Upper Harbour Local Board, Auckland Council Director - The Transformational Leadership Company

15/07/15

Allison Roe Member – Devonport-Takapuna Local Board, Auckland Council Chairperson – Matakana Coast Trail Trust

02/07/14

Gwen Tepania-Palmer

Chairperson- Ngatihine Health Trust, Bay of Islands Life Member – National Council Maori Nurses Alumni – Massey University MBA Director – Manaia Health PHO, Whangarei Board Member – Auckland District Health Board Committee Member – Lottery Northland Community Committee

10/04/13

Co-Opted Members

Susanna Galea Member – New Zealand Medical Association Member – Association of Salaried Medical Specialists (ASMS) Member – Medical Protection Society Associate Director – Centre for Addictions Research

31/03/14

Willem Landman No current listings 10/12/14

Donna Riddell Member – New Zealand Nurses Organisation (NZNO) 08/12/14

David Ryan To be advised

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Waitemata District Health Board, Meeting of the Hospital Advisory Committee 25/05/16

2.1 Confirmation of Minutes of the Hospital Advisory Committee Meeting Held on 25th May 2016

Recommendation:

That the Minutes of the Hospital Advisory Committee meeting held on 25th May 2016 be approved.

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Minutes of the meeting of the Waitemata District Health Board

Hospital Advisory Committee

Wednesday 25 May 2016

held at Waitemata District Health Board Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 12.44p.m.

PART I – Items considered in public meeting COMMITTEE MEMBERS PRESENT

James Le Fevre (Committee Chair) Lester Levy (Board Chair) Kylie Clegg Sandra Coney (Deputy Committee Chair) Tony Norman (Deputy Board Chair) Morris Pita Gwen Tepania-Palmer Susanna Galea (co-opted member)

Willem Landman (co-opted member) Donna Riddell (co-opted member) David Ryan (co-opted member)

ALSO PRESENT Andrew Brant (Acting Chief Executive)

Robert Paine (Chief Financial Officer and Head of Corporate Services) Jocelyn Peach (Director of Nursing and Midwifery) Cath Cronin (Director of Hospital Services) Fiona McCarthy (Director of Human Resources) Debbie Eastwood (GM, Medicine and Health of Older People) Peter van de Weijer (HOD Medical, Child Women and Family Services) Emma Farmer (HOD Midwifery, Child, Women and Family Services) Stephanie Doe (Acting General Manager, Child, Women and Family) Ian MacKenzie (GM, Mental Health and Addiction Services) Jeremy Skipworth (Clinical Director, Forensic Services) Joanne Brown (Funding and Development Manager-Hospitals) (from 1.05pm) David Price (Director Patient Experience) Helen Wihongi (Acting Chief Advisor Tikanga) Peta Molloy (Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item.)

PUBLIC AND MEDIA REPRESENTATIVES Lynda Williams (Auckland Womens Health Council) APOLOGIES Apologies were received and accepted from Max Abbott, Warren

Flaunty, Christine Rankin, Allison Roe and Dale Bramley and for early departure from Morris Pita.

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WELCOME The Committee Chair welcomed those present. The Committee Chair welcomed and introduced the new Director of Patient Experience, David Price. DISCLOSURE OF INTERESTS There were no additions or amendments to the interests register. There were no declarations of interest relating to the open section of the agenda. 1. AGENDA ORDER AND TIMING

Items were taken in the same order as listed in the agenda.

2. COMMITTEE MINUTES

2.1 Confirmation of the Minutes of the Hospital Advisory Committee Meeting held on 06th April 2016 (agenda pages 7-32) Resolution (Moved Gwen Tepania-Palmer/Seconded Kylie Clegg) That the minutes of the meeting of the Hospital Advisory Committee held on 24th February 2016 be approved. Carried Actions Arising (agenda page 33) No issues were raised.

3. ITEMS FOR CONSIDERATION AND RECOMMENDATION TO THE BOARD There were no decision items.

4. PROVIDER ARM PERFORMANCE REPORT

4.1 Provider Arm Performance Report – March 2016 (agenda pages 34-95) Cath Cronin (Director of Hospital Services) introduced the report. Matters that she highlighted or updated included:

The letter of compliment (page 38 of the agenda) received was a pleasure to read and to share with the Committee.

That pathways and clinical improvements are progressing well with sustained change in practices being seen.

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The Shorter Stays in Emergency Departments target was achieved for the first quarter. The target was not reached in April, reaching the target in May and for the second quarter is a key focus.

That colonoscopy target performance is being closely managed with stabilising and improvement being seen, but not yet regular.

The Faster Cancer Treatment target is a priority to ensure the time to treat patients with cancer improves. The target rate has improved from 72% in the first quarter to 77.8% in the month of April with a goal of 85% by 30th June 2016.

With regard to the letter of compliment received, Morris Pita acknowledged the good work being undertaken in different parts of the organisation and the reflection on the organisations values. Human Resources Fiona McCarthy (Director Human Resources) briefly commented on this section of the report, noting in particular the impact of the work being undertaken within divisions around overtime and annual leave. She noted the overtime rate had seen a slight increase and as a result the strategies for using overtime are being investigated. Medicine and Health of Older Peoples Services Debbie Eastwood (General Manager, Medicine and Health of Older Peoples Services) presented this section of the report. Matters that she highlighted or updated included:

The value of the patient voice was noted in the design of the Waitemata DHB’s Stroke Service new model of care development, patients are being engaged with in the co-design. David Price will also be involved in supporting the co-design.

On 5th June 2016, the FAST [Face-Arms-Speech-Time] campaign rolls out nationally and encourages patients to present to ED helping to reduce the damage cause by stroke. The campaign will run for approximately ten weeks and include television, radio, digital and online adverts. There has been wide communication with staff about the campaign.

There are sustained allied health vacancies across services, recruitment strategies are being implemented including working with recruitment team leaders and setting in place advertising strategies. It was noted that the cost of living in Auckland was a consideration factor for overseas applicants.

Child, Women and Family Services Dr Peter van de Weijer (Head of Department Medical), Stephanie Doe (Acting General Manager Child, Women and Family Services) and Emma Farmer (Head of Department Midwifery, Child, Women and Family Services) presented this section of the report. Dr Peter van de Weijer introduced Stephanie Doe who is Acting General Manager (Child, Women and Family Services) while Linda Harun is undertaking larger project work until October 2016.

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Matters that were highlighted included:

That work around improving transfer of domiciled neonates from the Neonatal Intensive Care Unit (NICU) at Auckland DHB back to the Waitemata DHB Special Care Baby Unit (SCBU) is underway. It is recognised that there is a high level of anxiety for the parents around transferring between the two services. Charge nurses from WDHB are now visiting NICU on a regular basis and also have a list of who is domiciled to Waitemata DHB and are gaining a better sense of when a transfer may occur. In response to a question it was noted that there is no data on staff time to visit NICU, however, it is a much more timely and proactive way for WDHB to be proactive and go and meet with NICU and patient families rather than reactively responding.

There are currently 11 midwifery vacancies at North Shore Hospital and that nurses have been recruited to fill midwife vacancies. It was noted that there is the opportunity to recruit new graduates annually during the month of May; of the graduate pool approximately fifty per cent opt for self-employment and the remaining take opportunities across the three metro-Auckland DHBs. In response to a question it was noted that the midwife FTE at North Shore Hospital was 47 and that there is a pool of casual staff that can be called in. Emma Farmer advised that whilst there is concern at the number of vacancies, she is confident a safe service is being provided. It was requested that the Committee be further updated on this matter.

In response to a question about the implementation of the Waitemata DHB induction of labour guidelines, it was noted that the guidelines are reviewed every three years. Two years ago a regional group reviewed the induction of labour guidelines and reached regional consensus and this was added to the local Waitemata DHB guidelines. Of interest, a new method of induction is the use of balloon catheters, allowing patients to go home rather than staying in hospital. In terms of reviewing the guidelines, particular steps are taken including a clinical review, review of new evidence, consultation with clinicians, LMCS and consumer representatives.

The gestational diabetes guidelines are national with implementation taking place in 2015, ahead of the required June 2016 date. The new guidelines require routine screening and with lower rangers than previous, more women are being diagnosed. In response to a question on whether women should be labelled as being pre-diabetic, it was noted that the testing was a national decision. It was also noted that the outcome of undetected and uncontrolled gestational diabetes on a baby can lead to a lifelong track of complications. The testing allows greater control of a baby’s birth rate leading to a better result as well as positive outcomes including lifestyle advice, such as seeing a dietician. Sandra Coney requested a copy of the national gestational diabetes guidelines.

In response to a question it was noted that caesarean rates are decreasing. A report on caesarean rates is expected by the Committee every six months.

The Smokefree incentives programme for pregnant women has not been successful in a recent RFP and has now been stopped. The only referral process now available is Quitline, where historically there has been no success. It is an area of concern and the Funder has now included the matter on its risk register. It was noted that the smoking cessation programme may be an option as it is offered to outpatients and may therefore be available for pregnant women, this will be investigated.

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In response to a question from Kylie Clegg about the Gateway Assessment process and following the recent media story about a three year old boy, it was noted that the DHB is confident that all the necessary processes and systems are in place, along with working with CYF. Stephanie noted that a lot of work is being done with both CYF and the Police with regular meetings being held; the Gateway Co-ordinator will be attending the CYF operations meeting each month. Gwen Tepania-Palmer noted that 30 children waiting for over six weeks for a Gateway Assessment is a long time; in response it was noted that this wait time is of particular focus and it is anticipated the wait time will reduce. This matter will be reported back to the Committee.

1.20pm – the Board Chair briefly retired from the meeting.

Mental Health and Addiction Services Ian McKenzie (General Manager, Mental Health and Addictions Services), Dr Jeremy Skipworth (Clinical Director, Forensic Services) and Megan Jones (Quality and Improvement Lead, Mental Health Services Group) were present for this section of the report. Ian McKenzie noted that this was his last attendance at the Waitemata DHB Hospital Advisory Committee meeting as he has accepted a role as the General Manager of Mental Health at Northland DHB. He expressed his thanks to Waitemata DHB for is time at the DHB. The Committee Chair acknowledged and thanked Ian for his work at the DHB and with the Hospital Advisory Committee. 1.35pm – the Board Chair returned to the meeting.

Matters highlighted or updated on Mental Health included:

The acute service models for community mental health services have been running for two years now and are nearly completed. The main objective when the review commenced was to address what were clear problems and challenges of how the service was operating across the district, Rodney, North Shore and West. In listening to users and their families, steps have been put in place to ensure a better consistency for approach and referrals are handled efficiently. Service user feedback recently received expressed appreciation at the fast referral process. The Committee Chair noted the excellent work being undertaken.

Following an external review of security at the Mason Clinic, three different elements of security have been identified: physical, procedural and relational. Significant progress has been made with regard to the physical element, including better lighting and camera installation. The procedural element will see a better staff mix as historically clinical staff have been exclusively used and now there has been a shift of resource to include security staff onsite. The third important aspect was the relational element and ensuring the appropriate level of clinical and nursing staff with training support and supervision. Policy documents on all three security elements are being development, ensuring they are compliant with government security.

Susanna Galea noted that the submission on the proposed new Substance Addiction Bill had been submitted. The Committee Chair thanked Susanna for her work on the submission. Ian McKenzie noted that there would be a further

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report to the Committee at its next meeting on what it is thought the implications of the Bill will have on the DHB as a lead regional provider.

Surgical and Ambulatory Services Michael Rodgers (Chief of Surgery) was present for this item. He conveyed apologies from Michelle Sunderland (General Manager, Surgical and Ambulatory Services). Michael Rodgers highlighted the ‘clinically appropriate time to theatre’ improvement project and the effort to establish KIPs. A weekly report is now being produced on achieving the goals and will be reported to the Committee going forward. Another key issue highlighted is the faster cancer treatment times and that there is a drive to meet the targets set by the Ministry of Health and this is being closely monitored. Elective Surgery Centre Michael Rodgers noted that following the resignation of John Cullen he will continue as Chief of Surgery and that a clinical director will be appointed for the Elective Surgery Centre. Provider Arm Support Services Cath Cronin presented this section of the report, noting an area of concern was food service with more information to be provided to the Committee at its next meeting. Cath noted that the senior management team would be tasting food samples at its next meeting. Resolution (Moved Gwen Tepania-Palmer /Seconded Kylie Clegg) That the report be received. Carried

5. CORPORATE REPORTS

5.1 Clinical Leaders’ Report (agenda pages 96-101)

Dr Andrew Brant (Chief Medical Officer), Dr Jocelyn Peach (Director of Nursing and Midwifery) and Tamzin Brott (Director of Allied Health) presented this report. Andrew Brant noted that the next Waitemata DHB Primary Care Connections Forum is scheduled in July 2016. The forum has moved towards a more educational component, connecting services and providing an opportunity to learn. In response to a question form the Committee Chair about the DHB’s emergency planning system, Jocelyn Peach advised that there were a number of programmes nationally and that Civil Defence were preparing a new Psychosocial support plan. Particular exercises noted included the: Orewa Tsunami Exercise that will take place on 14th June 2016, Hobsonville’s fuel fire explosion exercise and passengers taken ill on a cruise liner. The Board Chair noted the importance of good communications to ensure people have access to and know how to find information in an emergency. Jocelyn will

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report back further on emergency planning systems and advise what the region has in place and the expectations of other DHBs. Jocelyn further noted both the nurses week and nurses day celebrations along with the recognition of Georgina MacPherson (Nurse Practitioner, Womens Health Colposcopy Service) who was nominated as Waitemata DHB’s Nursing Review Nursing Hero and Graham Zinsli who received the Red Cross Florence Nightingale Award for International Humanitarian Service. Tamzin Brott noted that the National Allied Health, Scientific and Technical Conference was hosted in Auckland and that Waitemata DHB received the overarching host prize. Tamzin also noted that the Interdisciplinary Fun Feeding Group has been re-established, which is having a positive impact on the children who need assistance and their families. With regard to the implementation of the community Allied Health mobile device project (page 101 of the agenda) it is anticipated that 80 iPads will be operational by the end of August 2016. Resolution (Moved Gwen Tepania-Palmer /Seconded Kylie Clegg) That the report be received. Carried

5.2 Human Resources (agenda pages 102-109)

Fiona McCarthy (Director Human Resources) presented this report and noted that average time to hire is steadily increasing; this is a combination of both the measure in time to recruit and the time it takes for a key professional to commence. Fiona also noted that a new candidate survey was undertaken in February 2016 to gain feedback on how the DHB can improve the candidate experience. Resolution (Moved Gwen Tepania-Palmer /Seconded Kylie Clegg) That the report be received. Carried

6.1 Winter Plan 2016 (agenda pages 110-111)

Cath Cronin (Director of Hospital Services) presented this report. In response to a question from the Committee Chair, Cath noted that she regularly meets with Auckland DHB and is will share the Waitemata DHB Winter Plan 2016 with Auckland DHB. Resolution (Moved Gwen Tepania-Palmer /Seconded Kylie Clegg) That the Committee notes the content and intent of the Winter Plan. Carried

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7. RESOLUTION TO EXCLUDE THE PUBLIC (agenda page 112)

Resolution (Moved Kylie Clegg /Seconded David Ryan)

That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000:

The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

1. Confirmation of Public Excluded Minutes – Hospital Advisory Committee Meeting of 06/04/16

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.

[NZPH&D Act 2000 Schedule 3, S.32 (a)]

Confirmation of Minutes

As per resolution(s) to exclude the public from the open section of the minutes of the above meeting, in terms of the NZPH&D Act.

2. Quality Report That the public conduct of the whole or the 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.


Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons.

[Official Information Act 1982 S.9 (2) (a)]

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




Negotiations

The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.

[Official Information Act 1982 S.9 (2) (j)]

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4. Education Programme 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.




Carried

The open session of the meeting concluded at 2.15pm. SIGNED AS A CORRECT RECORD OF THE WAITEMATA DISTRICT HEALTH BOARD HOSPITAL ADVISORY COMMITTEE MEETING OF 25 May2016 COMMITTEE CHAIR

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Actions Arising and Carried Forward from Meetings of the Hospital Advisory Committee

as at 23 June 2016

Meeting Agenda Ref

Topic Person Responsible

Expected Report Back

Comment

HAC 25/05/16

4.1 Child, Women and Family Services: - Update report on

midwifery vacancies to be provided.

- A copy of the national gestational diabetes guidelines to be sent to Sandra Coney.

Emma Farmer

See further update in the Provider Arm Report – April 2016. Actioned.

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4.1 Provider Arm Performance Report – April 2016

RECOMMENDATION That the report be received.

Prepared by: Robert Paine (Chief Financial Officer and Head of Corporate Services) and Cath Cronin (Director of Hospital Services)

This report summarises the Provider arm performance for April 2016.

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TABLE OF CONTENTS GLOSSARY

HOW TO INTERPRET THE SCORECARDS

PROVIDER ARM PERFORMANCE REPORT – APRIL 2016

EXECUTIVE SUMMARY/OVERVIEW

SCORECARD – ALL SERVICES

HEALTH TARGETS

ELECTIVE PERFORMANCE INDICATORS

FINANCIAL PERFORMANCE

HUMAN RESOURCES

DIVISIONAL REPORTS

MEDICINE AND HEALTH OF OLDER PEOPLE SERVICES

CHILD, WOMEN AND FAMILY SERVICES

MENTAL HEALTH AND ADDICTION SERVICES

SURGICAL AND AMBULATORY SERVICES/ELECTIVE SURGICAL CENTRE

PROVIDER ARM SUPPORT SERVICES

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GLOSSARY

ACC Accident Compensation Commission

ADU Assessment and Diagnostic Unit

ARDS Auckland Regional Dental Service

BT Business Transformation

CADS Community Alcohol, Drug and Addictions Service

CAMHS Child, Adolescent Mental Health Service

CNM Charge Nurse Manager

CLAB Central Line Associated Bacteraemia

CT Computerised Tomography

CW&F Child, Women and Family service

DNA Did not attend

ESC Elective Surgery Centre

ESPI Elective Services Performance Indicators

FSA First Specialist Assessment (outpatients)

FTE Full Time Equivalent

HNSO Hazardous Substances and New Organisms

ICU Intensive Care Unit

iFOBT Immuno Faecal Occult Blood Test

MHOPS Medicine and Health of Older People Services

MHSG Mental Health service group

MoH Ministry of Health

MTD Month To Date

MOSS Medical Officer Special Scale

NOF Neck of Femur

NSH North Shore Hospital

OHBC Oral health business case

ORL Otorhinolaryngology (ear, nose, and throat)

PACU Post-operative Acute Care Unit

PHO Primary Health Organisation

PoC Point of Care

S&AS Surgical and Ambulatory Services

SCBU Special care baby unit

SMO Senior Medical Officer

SSU Sterile Services Unit

TLA Territorial Locality Areas

WIES Weighted Inlier Equivalent Separations

WTH Waitakere Hospital

YTD Year To Date

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HOW TO INTERPRET THE SCORECARDS Traffic lights

For each measure, the traffic light indicates whether the actual performance is on target or not for the reporting period (or previous reporting period if data are not available as indicated by the grey bold italic font).

Actual Target Trend

Better help for smokers to quit - hospitalised 98% 95% The colour of the traffic lights aligns with the Annual Plan:

Traffic light Criteria: Relative variance actual vs. target Interpretation

On target or better Achieved

95–99.9% achieved 0.1–5% away from target Substantially Achieved

90–94.9% achieved 5.1–10% away from target AND improvement from last month

Not achieved, but progress made

<94.9% achieved 5.1–10% away from target, AND no improvement, OR >10% away from target

Not Achieved

Exception: Cardiac arrest calls is Green if number ≤1, Blue if = 2, Amber if = 3 and Red if ≥4 Trend indicators

A trend line and a trend indicator is reported against each measure. Trend lines represent the actual data available for the latest 12-months period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. The small data range may result in small variations appearing to be large.

Note that YTD measures (e.g., WIES volumes, revenue) are cumulative by definition. As a result their trend line will always show an upward trend that resets at the beginning of the new financial year. The line direction is not necessarily reflective of positive performance. To assess the performance trend, use the trend indicator as described below.

The trend indicator criteria and interpretation rules:

Trend indicator

Rules Interpretation

Current > Previous month (or reporting period) performance Improvement

Current < Previous month (or reporting period) performance Decline

Current = Previous month (or reporting period) performance Stable

By default, the performance criteria is the actual:target ratio. However, in some exceptions (e.g., when target is 0 and when performance can be negative (e.g., net result) the performance reflects the actual. Look up for scorecard-specific guidelines are available at the bottom of each scorecard:

1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header).

2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed.

3. Trend lines represent the data available for the latest 12-months period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. Small data range may

result small variations perceived to be large.

a. ESPI traffic lights follow the MoH criteria for funding penalties:

ESPI 2: the traffic light will be green if no patient is waiting, blue if greater than 0 patients and less than or equal to 10 patients or less than 0.39%, and red if 0.4% or higher.

ESPI 5: the traffic light will be green if no patient is waiting, blue if greater than 0 patients and less than or equal to 10 patients or less than 0.99% and red if 1% or higher.

Key notes

Trend indicator

Traffic light Measure description

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Provider Arm Performance Report – April 2016

Executive Summary/Overview

HIGHLIGHT AND KEY ISSUE OF THE MONTH The highlight for April and May is the improvement in the whole-of-hospital response to achieve timely quality in our hospitals.

Champion Clinician / General

Manager

Total patient

Breached

Dr Willem Landman / Debbie Eastwood 97 % 81

Dr Hamish Hart / Debbie Eastwood 99 % 2

Dr Meia Schmidt-Uili / Linda Harun 99 % 5

Dr Richard Harman/ Michelle Sutherland

Dr Matt Walker / Michelle Sutherland

Dr Murray Patton / Ian McKenzie 97 % 1

Dr Peter Van de Weijer / Linda HarunGynaecology 98 % 1 98 %

Orthopaedic 97 % 2 97 %

Acute Adult Mental Health 88 % 12 90 %

Paediatric MED 99 %

General Surgery 96 % 5 96 %

Emergency Medicine 96 % 119 96 %

General Medicine 94 % 40 96 %

Monthly achievement against the ED 95% 6 Hour Target by discharge specialty

Responsible Specialty North Shore WaitakereWDHB

Total patient

Breached

Month Ending 31 May 2016

WDHB QUARTER 4 (Apr - June) TO DATE IS: 95.5 %

MONTH'S PERFORMANCE: 96.40%

optimisED project delivering improvements in workflows and responsiveness to patient demand

Inpatient ward teams responding to timely discharge planning and optimising access to beds over seven days per week

Acute theatre teams managing access to theatre and reducing LOS in the pre-operative period

Outpatient Intravenous Antibiotics clinical service (OPIVA)

Interim care beds utilised in the community to free up acute hospital beds and associated increased discharges direct to home when the interim care team adds their expertise to the discharge planning

The sky bridge has opened and additional beds to come on line in June and up to 15 additional beds by July

Staffing overall in an improved position compared with this time last year

Waitemata Central well embedded and staffing nearly completed, which includes an increase in senior nurse cover to the inpatient wards out of hours – both operational and clinical expertise.

SCORECARD VARIANCE REPORT

HEALTH TARGETS Update noted above in highlight and key issues section.

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SERVICE DELIVERY Outpatient DNA for Māori and Pacific

A project is underway to review DNAs for our Māori and Pacific patients. We are waiting further reporting on the ‘GPs in the West’ focus which we believe to be an approach that will decrease DNAs overall but does need funding to progress. The DNA strategy paper was discussed at ELT on 20 June 2016 and endorsed to progress to Manawa Ora and HAC.

BEST CARE Pressure Injuries

There was one stage 4 pressure injury identified in the monthly audit and related to a heel injury. The injury was identified during the audit undertaken on each ward each month. The implementation of the pressure programme on the ward has been reviewed with the Charge Nurse Manager and the staff. Expectations have been reinforced. The DHB has a detailed programme of assessment on admission, care practices and monitoring. Prevention of pressure injury is part of the Patient and Whanau Care Standards relating to care when dependent, mobilisation and nutrition and hydration.

FINANCIAL PERFORMANCE The Provider services result for the ten months ended 30 April 2016 is $10,410K unfavourable to budget. This is attributed to by an unfavourable performance in Child Women and Family services $2,177K, Medicine and Health of Older People services $6,898K, Surgical and Ambulatory Services $1,900K, Elective Surgery Centre $295K offset by a favourable performance in Mental Health services $859K. The key drivers for services financial performance are summarised below.

Medicine and Health of Older People

The service is $6,898K unfavourable for the ten months ended 30 April 2016. Medical and Health of Older People YTD result is driven by a significant increase in demand for constant observation (watch) shifts $985K unfavourable, as well as increased nursing demand, particularly in the two EDs. The service was also impacted by leave revaluations following the MECA uplift, this is compounded by a general problem of enabling staff to take all of their annual leave entitlement. Acute demand continues to exceed contracted levels with General Medicine WIES and ED presentations both running at 108% and 106% of YTD contract respectively, resulting in higher than anticipated demand for personnel and supply costs.

Surgical and Ambulatory Services

The Service is $1,900K unfavourable year to date. The financial result this month is unfavourable due to the costs of running additional sessions in order to catch up on elective orthopaedic volumes while managing the sustained high level of acute volumes. The unfavourable result year to date is nominally due to higher than planned acute volumes, lower ACC revenues, unmet savings lines and unbudgeted nursing costs associated with running additional beds in the short stay ward.

Elective Service Centre

The service is $295K unfavourable year to date due to higher than planned elective volumes, 5.3% above plan year to date. Costs associated with the number of discharges have offset savings that might otherwise have been realised through under delivery of more complex cases. The year end forecast is for an unfavourable financial result as the service is planning to over-deliver on budgeted volumes to ensure the overall surgical programme meets the Waitemata DHB Surgical health Target.

Child Women and Family Services

The service is $2,177K unfavourable to budget for year to date April 2016. Revenue is $400k favourable year to date, driven by new service level agreements and several unplanned funding streams culminating to provide some relief against other unfavourable income and expenditure lines. Personnel costs are tracking $985K over budget and are attributed to a combination of high Medical allowances for covering registrar shortages, sick and sabbatical leave,

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cover for a regional shortfall in midwives, budget pricing issues within Allied Health staffing, unexpected back pay and several retirements. Personnel costs are being partially offset by under spending in other Allied Health and Management/Administration, due to vacancies.

Over spending in Outsourced costs $609K is being driven by a mixture of embedded savings $302K, nursing bureau $135K for sick and roster shortages, unbudgeted Anaesthetist costs and external postnatal services. Partially offsetting these costs are under spends in community radiology charging and lab send away tests.

Embedded savings initiatives $165K per month remain a significant challenge. The service is looking to further build on the savings that are currently being realised by exploring other areas such as community based logistics costs. Other group initiatives to support cost containment are highlighted in the financial commentary.

Mental Health Services

Mental Health’s favourable YTD variance after April $859K is primarily the result of revenue from the new CADs contract for drug referrals from the Ministry of Justice $625K and also the impact of high YTD vacancies in nursing $1,277K. This is partially offset with high overtime in nursing $471K due to the combination of a) roster/sick cover particularly in the Adult and Forensic services, b) high acuity care in the Forensic inpatient units where four patients require dedicated 2-on-1 or 3-on-1 observations, and c) additional security in the Adult MHS, where staffing has been increased in Waiatarau and He Puna Waiora units to improve supervision of the courtyard areas as a result of security concerns earlier in the year. Control of overtime remains a priority for the MHSG and introduction of better management tools has resulted in a 283-hour (23%) reduction per week in average Forensic overtime hours since July 2015. SMO covering gaps in the registrar roster $292K in Adult and Forensic services follows an increased number of Registrar vacancies this year and excessive targeting of this account for budget savings in previous years. The Audit and Finance Committee have approved the business case for CAMHS increased service capacity in Rodney, with this service commencing from April.

Provider Support Services

The overall result for Provider Support is $3.488M unfavourable for the year to date.

Expenditure budget is overspent by $12.836M, mainly due to unbudgeted repairs and maintenance $557K, outsourced colonoscopies $524K, unbudgeted gratuity and maternity leave payments $3.308M, overspends in additional cleaning and orderlies costs and clinical supplies in Hospital Operations due to increased volumes and centrally budgeted savings. Laboratory consumables and sendaway tests are unfavourable primarily due to an 8% increase in Microbiology testing. Blood product (Intragram) has increased 58% on last year. This is offset by additional revenue received of $9.347M, being $756K for outsourced colonoscopies (offset by unbudgeted outsourced costs), deficit support of $3.272M, additional funding for acute overdelivery of $4.6M, additional revenue for outpatient pharmacy $373K and orthopaedic outsourcing $346K.

HUMAN RESOURCES The DHB has recently released new HR reporting that provides organisation, responsibility centre and individual views of all people-based data, including leave, costs (overtime, penal payments), mandatory training and professional certifications.

Sick Leave

There has been a very slight upward movement in both the month end result for April and the annualised average for the year to date. Both results continue to sit above the organisational target. Child Women and Family and Mental Health and Addictions Services remain the two Divisions most significantly above target, with no noticeable downwards trend to date. With the commencement of the winter weather and increase in seasonal illnesses, there is a potential to manage any further increase in both month end and annualised figures if close monitoring and attendance management is sustained across all services.

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Overtime

The overtime rate for April has increased and is sitting at 1.6. The upward trend has not continued into May. While acuity, unplanned leave and vacancies are not the only key drivers of overtime, they are variable contributors that can impact on results from month to month. Mental Health and Addictions Services is recording the highest overtime rate for this reporting month, although it is noted that acuity accounts for approximately 53% of overtime in April and 41% of overtime in 2015/16 YTD.

Turnover Turnover results have remained constant this month, with no movement in the average and still within organisational tolerance levels. While the consistent and positive organisational results are pleasing, fluctuations within Divisions/services/teams are expected from time to time and will be analysed and responded to as needed.

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SCORECARD – ALL SERVICES

Actual Target Trend Elective Volumes Actual Target Trend

Better help for smokers to quit - hospitalised 98% 95% Provider Arm - Overall 103% 100%

Shorter Waits in ED 94% 95%

Faster cancer treatment (62 days) 74% 85% Waiting Times

ESPI 2 - % patients waiting > 4 months for FSA compliant

ESPI 5 - % patients not treated w/n 4 months compliant

ESPI 1 compliant

Patient Experience Actual Target Trend Patient Flow

Complaint Average Response Time 14 days <14 days a. Average Length of Stay - Electives 1.39 days 1.77 days

a. Average Length of Stay - Acutes 2.5 days 2.76 days

Quality & Safety Trend Outpatient DNA rate (FSA + FUs) - Total 9% <10%

Older patients assessed for falling risk 98% 90% Outpatient DNA rate (FSA + FUs) - Māori 20% <10%

Rate of falls with major harm 0.07 <2 Outpatient DNA rate (FSA + FUs) - Pacific 20% <10%

b. Good hand hygiene practice 81% 80%

S. aureus infection rate 0.00 <0.2

Occasions insertion bundle used 100% 95%

Pressure injuries grade 3&4 1.00 0.00 Financial Result (YTD) Actual Target Trend

Revenue 693,989 k 680,476 k

HR/Staff Experience Trend Expense 710,021 k 682,611 k

Sick leave rate 8.5 days <7.5 days Net Surplus/Deficit -16,032 k -2,135 k

Turnover rate 11% 8-12% Capital Expenditure 60,689 k 73,904 k

Contracts (YTD)

Elective WIES Volumes 13,856 14,396

Acute WIES Volumes 50,144 48,817

Performance indicators: Trend indicators:

Achieved/ On track Substantially Achieved but off target Performance improved compared to previous month

Not Achieved but progress made Not Achieved/ Off track Performance declined compared to previous month

Performance was maintained

a. December data not yet available.

Waitemata DHB Monthly Performance Scorecard

ALL ServicesApril 2016

2015/16

Contact:

Victora Child - Reporting Analyst, Planning & Health Intelligence Team: [email protected]

Planning, Funding and Health Outcomes, Waitemata DHB



3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range may

result in small variations appearing to be large.

a. 2015/16 new MoH Average length of stay definition.

b. Quarterly data - March

Health Targets

How to read

Value for Money

Best Care

Service Delivery

A question?

Key notes

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Health Targets

BETTER HELP FOR SMOKERS TO QUIT

SHORTER STAYS IN EMERGENCY DEPARTMENTS

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EMERGENCY DEPARTMENT/ADU PRESENTATIONS

IMPROVED ACCESS TO ELECTIVE SURGERY

Note: Changes were made to the electives health target for 2015/2016

PERCENTAGE CHANGE ED AND ELECTIVE VOLUMES

April 2015 Month Volumes % Change (last year)

YTD Volumes % Change (last year)

ED/ADU Volumes 9,821 4% 101,283 4%

Elective Volumes 1,225 −1% 10,464 −2.1%

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Elective Performance Indicators

ZERO PATIENTS WAITING OVER 4 MONTHS Compliant Non Compliant Non Compliant %

Speciality Non Compliance % ESPI 2 Anaesthes iology 57 - 0.00%

ESPI2 0.02% Cardiology 1,127 - 0.00%

ESPI5 0.52% Dermatology 158 - 0.00%

Diabetes 177 - 0.00%

Endocrinology 344 - 0.00%

Gastro-Enterology 753 - 0.00%

General Medicine 169 - 0.00%

General Surgery 1,261 - 0.00%

Gynaecology 865 - 0.00%

Haematology 100 - 0.00%

Infectious Diseases 20 - 0.00%

Neurology 57 0.00%

Orthopaedic 1,458 2 0.14%

Otorhinolaryngology 1,513 - 0.00%

Paediatric MED 770 - 0.00%

Renal Medicine 149 - 0.00%

Respiratory Medicine 402 0.00%

Rheumatology 207 - 0.00%

Urology 567 - 0.00%

Total 10,154 2 0.02%

ESPI 5 Cardiology 53 - 0.00%

General Surgery 1,185 0.00%


Orthopaedic 875 18 2.02%

Otorhinolaryngology 429 - 0.00%

Urology 357 - 0.00%

Total 3,424 18 0.52%

Summary (Apr 16) ESPI

90% OF OUTPATIENT REFERRALS ACKNOWLEDGED AND PROCESSED WITHIN 10 DAYS

Specialty Compliance %

Anaesthes iology 100.00%

Cardiology 98.63%

Dermatology 100.00%

Diabetes 98.91%

Endocrinology 96.38%

Gastro-Enterology 96.84%

Genera l Medicine 97.25%

Genera l Surgery 98.55%

Gynaecology 100.00%

Haematology 99.05%

Infectious Diseases 100.00%

Orthopaedic 98.20%

Otorhinolaryngology 99.17%

Paediatric MED 99.26%

Renal Medicine 100.00%

Respiratory Medicine 98.06%

Rheumatology 99.30%

Urology 96.19%

Total 98.32%

ESPI 1 (Apr 16)

Legend

ESPI 1: Green if 100%, Yellow if between 90% and 99.9%, and Red if 90% or less.

ESPI 2: Green if 0 patients, Yellow if greater than 0 patients and less than or equal to 10 patients or less than 0.39%, and Red if 0.4% or higher.

ESPI 5: Green if 0 patients, Yellow if greater than 0 patients and less than or equal to 10 patients or less than 0.99%, and Red if 1% or higher

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Discharges by Specialty and Average Length of Stay

DISCHARGES BY SPECIALTY

AVERAGE LENGTH OF STAY – ACUTE

AVERAGE LENGTH OF STAY – ELECTIVE

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CUMULATIVE BED DAYS SAVED THROUGH HOSPITAL INITIATIVES

PREDICTED VERSUS ACTUAL BED DAYS

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FINANCIAL PERFORMANCE CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Apr-16

Provider

($000’s)

Actual Budget Variance Actual Budget Variance Forecast Budget Variance

CONTRIBUTION

Surg & Ambulatory (12,915) (12,339) (576) (132,900) (131,000) (1,900) (156,881) (156,881) 0

Medical & HOPS (17,464) (15,963) (1,501) (180,428) (173,530) (6,898) (209,155) (209,155) 0

Child Women Family (5,818) (5,463) (355) (61,517) (59,340) (2,177) (71,722) (71,722) 0

Mental Health (8,771) (8,691) (80) (94,187) (95,046) 859 (114,596) (114,596) 0

Elective Surgery Centre (2,322) (1,750) (572) (18,717) (18,422) (295) (22,435) (22,435) 0

Provider Support 44,524 45,012 (487) 471,717 475,204 (3,488) 575,789 575,789 0

Net Surplus/Deficit (2,766) 806 (3,572) (16,032) (2,135) (13,897) 1,000 1,000 0

MONTH YEAR TO DATE FULL YEAR

CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Apr-16

Provider

($000’s)


REVENUE

Government and Crown

Agency 70,569 65,771 4,799 672,467 658,202 14,265 789,863 789,863 0

Other Income 2,331 2,290 40 21,523 22,274 (752) 28,149 28,149 0

Total Revenue 72,900 68,061 4,839 693,989 680,476 13,513 818,012 818,012 0

EXPENDITURE

Personnel

Medical 14,479 12,844 (1,635) 138,402 136,080 (2,322) 162,117 162,117 0

Nursing 19,513 18,238 (1,274) 182,730 177,854 (4,876) 213,257 213,257 (0)

Allied Health 9,756 8,705 (1,052) 88,641 87,964 (677) 105,747 105,747 0

Support 1,443 1,231 (212) 12,919 13,108 189 15,858 15,858 0

Management /

Administration5,286 4,538 (748) 50,952 50,364 (588) 59,583 59,583 0

50,478 45,557 (4,921) 473,644 465,370 (8,275) 556,562 556,562 0

Other Expenditure

Outsourced Services 6,288 4,971 (1,317) 54,187 49,813 (4,374) 59,998 59,998 0

Clinical Supplies 9,257 8,512 (745) 91,678 84,957 (6,721) 101,429 101,429 0

Infrastructure & Non-

Clinical Supplies9,644 8,216 (1,428) 90,512 82,471 (8,041) 99,023 99,023 0

25,189 21,699 (3,490) 236,377 217,241 (19,136) 260,449 260,449 0

Total Expenses 75,666 67,255 (8,411) 710,021 682,611 (27,411) 817,012 817,012 0

Net Surplus/Deficit (2,766) 806 (3,572) (16,032) (2,135) (13,897) 1,000 1,000 0

FULL YEARMONTH YEAR TO DATE

CONSOLIDATED STATEMENT OF PERSONNEL by PROFESSIONAL GROUP Reporting Date Apr-16

Provider


FTE

Medical 756 716 (40) 714 706 (8) 708 708 0

Nursing 2,894 2,785 (109) 2,753 2,766 12 2,771 2,771 0

Allied health 1,582 1,536 (46) 1,506 1,543 37 1,552 1,552 0

Support 355 340 (15) 319 339 21 339 339 0

Management 834 821 (12) 804 818 14 820 820 0

Total FTE 6,421 6,198 (223) 6,096 6,172 76 6,190 6,190 0


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Human Resources

GLOSSARY Method of calculation of graphs:

1. Overtime Rate: The sum of Overtime Hours worked over the period divided by Worked Hours over the period.

2. Sick Leave Rate (days): The sum of Sick Leave Hours over the period divided by Total Hours over the period.

3. AL bal 0-24 days: Count of Staff with less than 25 equivalent 8 hour days accumulated leave entitlement. 4. AL bal 25-49 days: Count of Staff with between 25 and 50 equivalent 8 hour days accumulated leave

entitlement. 5. AL bal 50-74 days: Count of Staff with between 50 and 75 equivalent 8 hour days accumulated leave

entitlement. 6. AL bal 75+ days: Count of Staff with over 75 equivalent 8 hour days accumulated leave entitlement. 7. Voluntary Turnover Rate: Count of ALL staff resignations in the last 12 months. This data excludes RMOs,

casuals, and involuntary reasons for leaving such as redundancy, dismissal and medical grounds.

SICK LEAVE

OVERTIME

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ANNUAL LEAVE MANAGEMENT (HEADCOUNT)

STAFF TURNOVER The staff turnover rate is 11.4% for April and 12% for May.

COMMENT ON MAJOR VARIANCES Sick Leave

While still reflecting the highest sick leave result, Child Women and Family Services have shown a reduced level for this reporting month, sitting at 9.7, which translates to a 0.1% reduction in spend compared with last month. This is positive when taking into account that the service has been maintaining an average of 10 days sick leave per staff member or above for some time.

Within the Division, Child Health Services – SCBU, Home Care for Kids, Paediatrics and the Wilson Centre Inpatient units are the key services contributing to the CWFS group average. Long-term sick leave in the last 12 months has included sick leave due to cancer (several staff members) and serious illness of family members. There have also been several serious work and non-work related injuries (including a significant head injury), which required lengthy absence and rehabilitation periods. Managers are having conversations with staff about their sick leave.

Mental Health and Addictions continues to reflect the second highest rate and has increased from 9.1 to 9.6 for this reporting month. The services with highest levels for April were Adult and Māori Mental Health services. Managers and the service HR team are continuing to work together in the framework of the structured attendance management plan introduced in late 2015, and will continue to address areas of high absence.

Overtime

Mental Health and Addictions continue to reflect the highest overtime rate, sitting at 6.25% for April.

Active monitoring and management of Forensic inpatient unit overtime costs is ongoing during 2015/16. This has resulted in a 283-hour reduction in average overtime hours between July 2015 and April 2016. The largest reduction occurred in Tanekaha, which had a 29% reduction over the period. The effect of this intervention has not been fully seen in the 12-month rolling average figures. Active recruitment to vacancies as per approved business cases is continuing, with some success in appointing to positions.

The Director HR met with service representatives to discuss the increased rate for April and to review interventions and analyse detailed reporting provided to determine priorities. As previously mentioned, the outcomes are clarification that 53% of overtime in April is related to patient acuity (i.e. staff watches). Other actions that will positively impact overtime are successful recruitment to key roles and reviews of roster practise.

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Divisional Reports

Medicine and Health of Older People Services

SERVICE OVERVIEW This Division is responsible for the provision of emergency care, medical services and sub-specialties (including cardiology, dermatology, diabetes, endocrinology, gastroenterology, haematology, infectious diseases, renal, respiratory and rheumatology), and services for older people, including assessment, treatment and rehabilitation (AT&R), mental health services, and home-based support services.

The service is managed by Debbie Eastwood with the Heads of Departments: Dr Jonathan Christiansen, Medical; Shirley Ross, Nursing; and Jo Grounsell, Acting Allied Health. The Clinical Directors are Dr Hamish Hart for Medicine, Dr John Scott for Health of Older Adults, Dr Rob Butler for Psychiatry for the Older Adult, Dr Willem Landman for Emergency Care, Dr Stephen Burmeister for Gastroenterology, Dr Simon Young for Diabetes/Endocrinology, Dr Tony Scott for Cardiology, Dr Hasan Bhally for Infection Diseases, Dr Janak De Zoysa for Renal, Dr Megan Cornere for Respiratory, Dr Ross Henderson for Haematology, Dr Cathy Miller for Palliative, Dr Blair Wood for Dermatology and Dr Michael Corkill for Rheumatology.

HIGHLIGHT OF THE MONTH E Prescribing Roll Out in MHOPS

E prescribing continues to be successfully implemented across MHOPS. The last wards to be rolled out are wards 3 and 6. We are on track to complete the roll out by the end of May, with some resource staying on the team to support the surgical wards. The 16 FTE of nursing resource continues to support this process, with minimal impact on ward nursing FTE and cover for the rosters.

The project roll out has been successful on all levels and is a good example of collaboration and connectedness between pharmacy and nursing. The MHOPS division committed to 16 FTE of nursing resource for the duration of the roll out of e prescribing across the Emergency Departments, ADU and remaining medical wards at NSH. Nurses were seconded from the wards and their FTE backfilled with resource nurses.

Jo Rogers, Clinical pharmacist, has led a team of dedicated pharmacists and nurses who provided training and support 24/7 in all areas.

The nurses have seen this as an opportunity to expand their skills and be involved in a Waitemata DHB-wide quality improvement process that directly impacts on patient safety. They have all enjoyed the opportunity to broaden their expertise and scope across the DHB to teach and support their colleagues to ensure they meet competencies in e prescribing and maintain patient safety.

KEY ISSUES Sick leave

Sick leave has remained unchanged at 8.2 days per year against the target of less than 8 days for our division. We are still working to improve our performance. Managers are attributing the current rate to seasonal illnesses, some longer term illnesses and injuries. We have formal processes in place to address the high rates with a number of individuals, particularly on the medical wards, who do not appear to have any significant health issues but take regular short amounts of leave.

Allied Health Student Placements

Meeting contracted student volumes is becoming increasingly challenging. Contributing factors are the Allied Health high turnover rate, high vacancy rate and difficulty in recruiting an appropriate workforce. Maintaining contracted numbers of students is very difficult for the teams and clinical centre leaders to manage in the current environment.

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Physiotherapy student numbers for 2016

AUT have requested we take 30 Year 4 students in 2016, as the university’s intake has increased. This has created pressure on the placements available in the acute services in the DHB and there are indications AUT will want to negotiate that we accept more students in 2017. As noted in previous reports, we are looking at our recruitment strategy to fill our vacancies as we understand the importance of supporting graduates, who are our future workforce.


BEST CARE VARIANCE REPORT Patient Experience

Complaints – 18 days versus a target of 14 days

We received 29 complaints in April, with a turnaround time of 18 days; 32 complaints were closed in the month. This target remains a priority for our service, and the operations managers and their clinical teams endeavour to prioritise a timely response. We also work closely with the Quality Assurance Team who provide support; resignations in this team have impacted on the workload and the complaint turnaround times. Recruitment is now underway to fill the vacancies within the quality team. We may need to review the option of providing additional service-based resources as we move forward.

SERVICE DELIVERY VARIANCE REPORT Waiting Times

ADU % seen from triage within 120 minutes – 63% versus a target of 85% (target is a combination of ADU at North Shore Hospital and ADCU at Waitakere Hospital)

The result for Waitakere Hospital ADCUs, noted in the graph below, has slipped from 86% in March to 81% in April. This has been due to 2 key elements:

1) When ED has large volumes of patients (surges) arriving into the department, the General Medicine junior medical staff are asked to prioritise the ED patients target, subject to clinical safety of ADU presentations that have yet to see a doctor. General Medicine has two entry points for admissions: ED and the ADU direct; when demand in ED takes priority, the ADU target may be compromised

2) Leave demand was greater than our ability to cover registrars. One of our UK employees required bereavement leave at short notice in addition to paternity leave and sick leave requirements. This left the team short and cross covering on a number of shifts, translating into some delays for patients to be seen.

At North Shore ADU, our performance has remained fairly static over the last 9 months. As noted in previous HAC reports, we expect to see an improvement in our performance when the third ADU junior medical team start in Q3 (May/June). We will also have the community house officers allocated to ADU in Q3. We do have a challenge in Q4 (August/September) when the house officers return to their community placement and our fourth ADU junior medical team do not start until Quarter 1 (November/December).

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Diagnostic Colonoscopy (P2) within 42 days – 55% against a target of 65%

Our result reflects the actions related to the recovery plan to ensure both our internal and outsourced production is maximised from February to the end of the financial year.

Our third endoscopy fellow is due to start work in late May and he will be available to support our internal production by covering lists and doing some highly productive all day lists. We have also introduced a new nursing role to assist with patient selection for endoscopy lists; early indications show that this role provides valuable support to the booking staff and is available to talk to patients regarding their procedure. Alongside the recovery plan is the production plan, which clearly identifies the productivity required to achieve the diagnostic and surveillance indicators by 30 June 2016.

Surveillance Colonoscopy within 84 days – 59% against a target of 65%

We are continuing to improve our performance against this target and remain on track with our recovery plan. We had a productive meeting with input from NRA regarding the development of the CNS role in managing the surveillance lists, waiting lists and patients who might be suitable for CTC rather than colonoscopy. As at 17th June, all targets were met for the first time. Patient Flow

Patients with EDS on discharge – 83% against a target of 85%

We are continuing our improved performance against this target, with Waitakere General Medicine achieving >80% from November. We are reviewing our winter strategies, which include having additional support for the medical teams at North Shore; one of their key tasks is to prepare the discharge summaries.

Average Length of Stay AT&R – 20.7 days against a target of 19 days

AT&R LOS tends to increase when a cohort of longer stayers are all discharged in the same month, which is what we experienced in April. We had five patients across the three AT&R wards, whose LOS ranged from 56 to 84 days. Two of these patients had experienced a stroke, one was awaiting a PPP&R process, and two other patients had complex clinical needs.

VALUE FOR MONEY Elective WIES – 1,311 against a target of 1,413

The elective WIES for MHOPS is primarily for Cardiology, with a number of other specialties carrying out a small amount of elective work (Respiratory, Renal, General Medicine and Gastroenterology). The smaller specialties are either on or above contract, although this is offset by a reduction in Cardiology elective volumes. Cardiology elective angiography and pacemaker volumes are impacted by the acute demand for hospital beds and are cancelled when bed availability becomes a priority issue. The effect is transparent in the higher acute volumes during a period when the elective volumes are lower. The impact on the elective waitlist is low, with minimal wait times being achieved for angiography. The wait list volume for pacing and ICD generator changes carries a higher risk, but the total cohort of these patients is small and they are regularly monitored and admitted if the clinical risk increases. ICD procedures generate a higher WIES than angiography/PCI or pacemaker procedures. ICD volumes were low for April with the single EP specialist on leave for the last 2 weeks of April. Acute ICDs were transferred to ACH during this period.

There is potential for the higher WIES generated by ICDs to be noted in the May AVR reporting as catch up happens, but this is somewhat dependent on the tension with the acute demand for pacemaker implants. Capital Expenditure

The current year to date target of $680K is taken from the Annual Plan for 2015/16 Capital expenditure only. Current year actual spend of $804K includes $428K spent on Capital projects rolled over from the 2014/15 financial year. When adjusted, our 2015/16 Capital expenditure is under budget.

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SCORECARD – MEDICINE AND HEALTH OF OLDER PEOPLE SERVICES

Actual Target Trend Waiting Times Actual Target Trend

Better help for smokers to quit - hospitalised 98% 95% ADU - % seen from triage w/in 120 mins 63% 85%

Shorter Waits in ED 94% 95% Elective coronary angiography w/in 90 days 100% 90%

Angiography for ACS w/in 72 hours 86% 70%

Urgent diagnostic colonoscopy w/in 14 days 91% 75%

Diagnostic colonoscopy w/in 42 days 55% 65%

Patient Experience Actual Target Trend Surveillance colonoscopy w/in 84 days 59% 65%

Complaint Average Response Time 18 days <14 days

Patient Flow

Improving Outcomes Elective Discharge Volumes (Cardiology) 112% 100%

Patients admitted to stroke unit 89% 80% Outpatient DNA rate 10% <10%

PCI w/in 120 minutes (STEMI patients) 76% 80% b. Average Length of Stay - Acutes 2.4 days <2.67 days

a. InterRAI assessments 83% 75% Average Length of Stay - AT&R 20.7 days <19 days

Patients with EDS on discharge 83% 85%

Quality & Safety

Older patients assessed for falling risk 97% 90%

Rate of falls with major harm 0.07 <2

c. Good hand hygiene practice 81% 80%

Pressure injuries grade 3&4 0 0

Financial Result (YTD) Actual Target Trend

HR/Staff Experience Revenue 10,836 k 9,707 k

Sick leave rate 8.2 days <8 days Expense 191,264 k 183,238 k

Turnover rate 12% 8-12% Net Surplus/Deficit -180,428 k -173,530 k

Capital Expenditure 804 k 680 k

Contracts (YTD)







Contact:




Medicine and Health of Older PeopleApril 2016

2015/16



3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data

range may result in small variations appearing to be large.

b. 2015/16 new MoH Average length of stay definition.

c. Quarterly data as of Feb

a. Quarterly InterRAI data - March

Health Targets

How to read

Value for Money

Best Care

Service Delivery

A question?

Key notes

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37


STRATEGIC INITIATIVES VARIANCE REPORT Deliverable/Action On Target

Better help for smokers to quit

1. Develop a process to follow-up on patients prescribed NRT in hospital by June 2016 2. Refresh the training provided to health professionals (to improve the quality of support to quit and

increase the number of support quit attempts, particularly to Māori and Pacific patients) - by December 2015

3. Ensure training is available to all health professionals, including community health, mental health and addictions, child health, Māori and Pacific teams in the Ask, Brief advice and Support to Quit approach - by 30 June 2016

Cardiac Services

4. Best practices Cardiac rehab programmes will be established by July 2016 which will be regionally consistent and with a whole-of-system approach that includes primary care

5. Measure retention rates by ethnicity on current cardiac rehabilitation programme to enable comparison once new programme established – by September 2015

6. FSA Chest pain clinic pilot to be established by 1 July 2015, with evaluation on the impact to reduce wait times to within target post implementation by Oct 2015

7. Audit of selected patients who have been prioritised for surgery using the CPAC tool to assess correct use of tool – completed by November 2015

8. Work with regional colleagues to manage the acute patient flow to minimise patient wait time and refine transfer process using CPAC tool, to be regionally agreed to and applied by June 2016

9. Work with the regional, and where appropriate, national, cardiac networks to improve outcomes for patients with heart failure (MoH new priority)

10. Continue to work on improving systems for data input and recording for cardiac registry data – ongoing Stroke Services

11. Identify Older Adult Service processes that could be integrated into the Stroke Service, which support early engagement with stroke patients’ families and their journey from admission to rehabilitation and then back into the community, pending ESD business case approval before end of 2015

12. Establish a pathway for MDT family meetings and nurse-led ward rounds within the stroke ward, to commence by June 2016

13. Assess the swallow documentation and review the process for assessment to ensure it reflects best practice – ensure updated documentation available on the stroke and allied health intranet by December 2015

14. Improve existing stroke thrombolysis quality monitoring e.g. door to needle, protocol adherence, and haemorrhagic complications by working with the public health specialist to ensure the accuracy of collected data (the stroke pathway will be explored in a similar way to the cardiac pathway recently developed in ED) by October 2015

15. Review stroke thrombolysis pathway and identify aspects for improvement that would assist identification of suitable patients at the front door – review completed by December 2015. Identified improvements implemented by June 2016

16. Develop best practice clinical guidelines identifying ‘appropriate’ patients to be admitted to stroke ward by June 2016

Shorter Stays in Emergency Departments

17. Implement five more clinical pathways/best care bundles: cellulitis, respiratory infections; renal colic gastroenteritis; and dental conditions by 30 June 2016

18. Commence the Waitakere ED extension by July 2015 19. Fully embed the accelerated chest pain pathway by December 2015: identifying the low to moderate risk

patients (with a TIMI score of 0), monitor these patients in ED for two hours rather than admitting

20. We will work with clinical directors to improve the timeliness of review, acceptance and transfer of patients by June 2016 - develop and embed an escalation pathway to improve timeliness of medical and surgical review of ED patients

Areas off track for month and remedial plans

5. Public Health Groups - This is a regional initiative which did not meet the September 2015 date for confirmation that all regional DHBs would collect ethnicity information for cardiac rehabilitation. ADHB are

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doing an indepth review of the CTSU service processes and have provided some analytical information identifying factors which contribute to or influence wait times for surgery, particular for Waitemata DHB and Counties Manukau DHB.

6. Recently introduced initiatives to improve the Waitemata DHB regional KPI results for chest pain referral wait times to 80% of patients seen within 6 weeks, have been implemented. The results of the initiatives are to be evaluated and will be submitted in the next report.

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FINANCIAL RESULTS – MEDICINE AND HEALTH OF OLDER PEOPLE CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Apr-16

Medical & HOPS

($000’s)


REVENUE

* Government and

Crown Agency 926 842 84 9,544 8,424 1,120 10,109 10,109 0

Other Income 103 128 (25) 1,292 1,283 9 1,540 1,540 0

Total Revenue 1,030 971 59 10,836 9,707 1,128 11,649 11,649 0

EXPENDITURE

Personnel

Medical 4,965 4,516 (449) 50,974 49,057 (1,916) 58,013 58,013 0

Nursing 6,962 6,420 (542) 73,599 70,719 (2,880) 86,848 86,848 0

Allied Health 1,713 1,680 (34) 17,556 18,507 950 21,835 21,835 0

Support 0 (16) (16) 0 (181) (181) (214) (214) 0

Management /

Administration873 792 (81) 9,203 8,605 (599) 10,192 10,192 0

14,513 13,392 (1,121) 151,332 146,706 (4,626) 176,675 176,675 0

Other Expenditure

Outsourced

Services618 457 (161) 6,036 4,600 (1,436) 5,633 5,633 0

Clinical Supplies 2,682 2,589 (93) 27,530 27,044 (486) 32,601 32,601 0

Infrastructure &

Non-Clinical

Supplies

681 497 (184) 6,365 4,887 (1,478) 5,895 5,895 0

3,981 3,543 (439) 39,931 36,531 (3,400) 44,129 44,129 0

Total Expenditure 18,494 16,934 (1,560) 191,264 183,238 (8,026) 220,804 220,804 0

Cost Net of Other

Revenue(17,464) (15,963) (1,501) (180,428) (173,530) (6,898) (209,155) (209,155) 0

YEAR TO DATE FULL YEARMONTH

COMMENT ON MAJOR FINANCIAL VARIANCES Medicine and Health of Older People (MHOPS)

Revenue

ACC revenue has been overachieved to plan ($549K favourable, 110% of budget) in the 10 months to April, in particular in AT&R, where bed days are 105% YTD of contract. AT&R has been focusing on improving identification of ACC patients and working with ACC to maximise billing of eligible patients. This will be a continuing focus for the remainder of the year. Revenue for unbudgeted SLAs totals $437K April YTD and includes Whānau Ora, the Gerontology Nurse Specialist for CARE, and the Palliative Care Advanced Trainee Registrars.

Key Volumes

Presentations to ED in April were 103% of contract and are 108% of contract YTD. General Medical WIES were 106% of contract in April and 108% of contract YTD. Cardiology WIES for both acute and elective were 93% of contract in April and 100% of contract YTD.

Personnel

Medical ($1,916K unfavourable YTD)

The impact of statutory holidays and in lieu days on Medical was $226K unfavourable for the month and $853K unfavourable for the year. Course fees and CME costs have accumulated to an unfavourable position of $322K as at April. For the first six months of the 2015/16 financial year (July – December 2015) there was an unbudgeted Haematology SMO, whose cost reached $102K. The position is currently vacant and will remain so until July 2016.

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From December 2015, an unbudgeted 8.0 FTE of House Officers have been utilised to facilitate night cover above budget as a result of the PGY1 New Graduates being unable to undertake this work. To date this has cost $268K, and costs will continue to be incurred for these staff until May 2016. Further to the SLAs, the cost of the Palliative Care Advanced Trainees is $164K year to date.

Nursing ($2,880K unfavourable YTD)

Nursing continues to accumulate annual leave costs in excess of budget, with a variance of $788K YTD. Sick leave has reached a position of $339K YTD unfavourable. In the cover models, nursing sick leave is factored at 7 days per annum, the rolling 12 month average for nursing personnel is 9.1 days. This has a direct impact on the requirement for additional bureau and overtime requirements. Internal nursing bureau is $1,172K unfavourable YTD and nursing overtime is $647K unfavourable YTD.

Nursing actual worked FTE YTD is 1,143, +3.4% of budget. Actual nursing expenses are 4.1% over budget, reflecting the premium for the additional hours.

By department, nursing costs for ED are $1,120K unfavourable YTD, 109% of budget which is trending consistently with the increase in presentations over contract of 108% YTD. Nursing costs for the medical wards are $640K unfavourable YTD, 103% of budget compared with a 108% increase in WIES.

Allied Health ($950K favourable YTD)

Allied Health has carried a high level of vacancies, running at an average worked FTE of 97% to budget YTD, resulting in a large underspend. Turnover of these staff remains high at 13.2% in the 12 months to April 2016, and recruitment into these roles can be challenging. MHOPS carries a general savings line of 10 FTE to be unfilled at any one point in time, under a ‘support’ line, and historically Allied Health vacancies have achieved this.

Non-Personnel

Outsourced costs are primarily external nursing bureau, for the provision of both Patient Attendant (Watch) shifts and the backfill of unplanned leave, such as sick leave and bereavement leave. MHOPS has seen a 67% increase in demand for Patient Attendant Shifts this financial year, resulting in an unfavourable variance of $1,105K YTD, $121K in April. The Watch Pilot, which commenced in February, will run until June, with an initial evaluation in May on the first three months’ results; if successful, we will look to embed it across MHOPS wards on an ongoing basis.

Clinical supply costs continued their unfavourable result to budget in April. Older Adults are coming under increased demand for respite care, with MHSOA respite costs reaching $318K unfavourable. The expenditure on mobility aids remains unfavourable to budget by $284K. Consideration is being given to having a co-ordinator to be responsible for all hospital mobility aids, centralising control with a view to reducing costs. In the medical wards the use of air beds has increased steadily, resulting in an unfavourable variance of $189K YTD. Demand for home haemodialysis has not reached target levels, currently at 82% for April and 87% of YTD contract. A factor contributing to this is that half of the transplant patients this year have come from the home haemodialysis group, resulting in a favourable position of $207K YTD in renal fluids. District Nursing continues to accumulate efficiencies and savings with their wound dressing initiative, with $123K favourable YTD.

MHOPS holds a savings line of $1,333K YTD under ‘Infrastructure’, and all service areas have been engaged to identify where they can support the achievement of this target. The focus on ACC revenue in the AT&R wards is one initiative put forward, as were procurement focused areas. These small procurement initiatives remain under development to ensure they are operationally practicable and to identify the level of savings that may be achieved.

MHOPS - Getting back on track initiatives

The most significant initiative underway to reduce costs is the Watch Pilot. Whilst the focus of the Pilot was predominantly on Ward 5, its influence has extended across the other medical wards at NSH. When comparing the first three months of the Pilot with the three months ending January 2016, total watch costs have reduced by $213K (excluding Ward 3, given the refurbishment). A paper will be presented at the conclusion of the Pilot with a view to assessing performance, summarising the benefits and recommending a continuance of the processes driving the gains currently achieved. From a health and safety perspective, the number of falls during the period of the pilot reflects a 46% decrease on the quarterly average over the past 12 months.

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Continued focus and attention is being directed to overtime levels and the need to take annual leave. The trend for annual leave creep is taking a positive turn with the total creep for the division almost on par with the same period in the previous year.

Francis Group International are continuing their ED review with particular focus on the POD structure, which targets improvements in flow efficiency. This process is currently under trial.

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Child, Women and Family Services

SERVICE OVERVIEW This Division is responsible for the provision of maternity, obstetrics, gynaecology and paediatric medicine services for our community, of the regional Out of Home Children’s Respite Service, the Auckland Regional Dental Service (ARDS), and the national Child Rehabilitation Service Services are provided within our hospitals, e.g. births, outpatient clinics and gynaecology surgery, and within our community, e.g. community midwifery, mobile/transportable dental clinics and the Wilson Centre. The division is managed by Stephanie Doe, Acting General Manager with Dr Peter van de Weijer HOD Medical CWF and Clinical Director Gynaecology and Emma Farmer HOD Midwifery; Marianne Cameron HOD Nursing, Susan Peters Acting Allied Health Lead, Dr Sathananthan Kanagaratnam Clinical Director ARDS, Dr Sue Belgrave Clinical Director Obstetrics, and Dr Meia Schmidt-Uili Clinical Director Child Health.

HIGHLIGHT OF THE MONTH Child, Women and Family Achievements

There have been a number of significant achievements across the Division this month. These include:

Erine Lynn (physiotherapist, Child Health Service) won the Allied Health poster presentation at the recent national Allied Health conference for her poster Paediatric Physiotherapy Bronchiectasis Service – Improved Care for Children

Staff working in the Division won three poster categories in the Health Excellence Awards:

o Overall winner and people’s choice poster – Before School Checks, Securing our Future: Waitemata Plunket and Waitemata DHB working together

o Excellence in clinical care poster – Assessment and Treatment of Tongue-Tie in Newborns

o Excellence in integrated care poster – Every Opportunity in Partnership… Working in Partnership to increase Human Papilloma Virus (HPV) Coverage Rates.

The Special Care Baby Unit (SCBU) at Waitakere Hospital received the hand hygiene sustained improvement award. The unit’s compliance rate went from 83% in January 2016 to 98% in March 2016.

KEY ISSUES Obstetric Physician Service

The obstetric medicine service provides care planning and oversight for women who have complex medical problems in pregnancy. The physiological changes in pregnancy can result in significant changes to an otherwise well-managed medical condition, and medical problems can present for the first time during pregnancy (e.g. gestational diabetes).

Current staffing shortages in medicine have resulted in a reduction in service provision from 4 April 2016. Specifically, clinics were reduced from four to two per week. At present, Dr Pat Henley is providing care plans and liaising with primary care providers. He is also providing advice and support to General Medicine physicians and cover for clinics. Of key concern is cover for Dr Henley when he is on leave.

The service is continuing to work in partnership with Medicine to recruit an appropriately qualified physician. Auckland DHB has been approached, but they are unable to provide assistance at this time. Support has also been sought from other DHBs, both regionally and nationally. Northland DHB has indicated that they are able to support the service at North Shore by providing obstetric physician cover for two clinics per month. These ongoing issues will be tabled at the regional Service Review Programme Advisory Group.

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Midwifery vacancies

A shortfall of midwives continues at North Shore Hospital; a recruitment strategy is ongoing. Turnover rates were reviewed and are at 15.8%. The Culture Safety Survey was completed across both sites. A review of the results has not detected noticeable differences between the two sites, so employee exit data are also being reviewed. The service is currently reviewing strategies to provide both short- and long-term solutions. Meetings have been scheduled with staff to obtain their views on the issues impacting recruitment and retention, and what initiatives may assist. A plan is being developed that will overview the key areas that require attention and actions to be taken.


BEST CARE VARIANCE REPORT Complaint average response time

The complaint response time was 17 days this month. Over April there were two complaints that required an extension. Continuing to achieve the target is a key focus and response times are being closely monitored.

Women smokefree at delivery

The target for women smokefree at delivery has not been achieved this month. Following a Ministry of Health-led review of smokefree service provision, the only current source of support for pregnant women is Quitline. A new provider has been identified but is yet to be announced; there is concern that the new service (operational from 1 July 2016) is unlikely to focus on pregnant women for some time. This is likely to affect the ability to deliver on this target.

Oral Health - percentage infants enrolled by 1 year

Oral health enrolment numbers at 1 year remain below target. Implementation of a process for automatically enrolling babies born within a Waitemata or Auckland DHB facility is well underway, and a tentative ‘go live’ date has been set for 1 July 2016. Alongside this, enrolment numbers by geographical area are being actively reviewed and opportunities to participate in local community events are being identified.

Sick Leave Rate

The sick leave rate remains above the target in all three service areas within the Division. Sick leave usage is continuing to be closely monitored and specific issues or concerns addressed when they arise. In some areas, it has been identified that overtime hours are being undertaken by nurses who were sick within the same pay period. Consequently, it has been agreed that overtime will not be offered to staff who have been sick within a two-week period.

SERVICE DELIVERY VARIANCE REPORT Gateway Referrals

The number of children waiting for a Gateway Assessment with completed referrals beyond contracted timeframes remains at 30 this month. Year to date assessment completions and wait times were significantly affected by non-attendances at assessments (52 year to date).

The Gateway co-ordinator is proactively collaborating with Child, Youth and Family (CYF) social workers to identify families who may not attend assessments, and implementing a plan that will support attendance.

Additional clinic sessions have been scheduled in June to reduce the number of children waiting. To date, 19 children and young people who have been waiting beyond the 6-week timeframe have a scheduled assessment. The service is aiming at reducing the waiting list by two children per week. Waitlist numbers are being monitored and reported weekly to the Director of Hospital Services. At the time of compiling this report, the number of children waiting had been reduced to 21.

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Theatre utilisation – gynaecology

Theatre utilisation in gynaecology has not met target this month (actual 79%, target 85%). There are ongoing issues with scheduling and management of women who DNA, which continue to be addressed.

VALUE FOR MONEY VARIANCE REPORT Paediatric WIES

Year to date paediatric medical activity (Rangatira ward) is 8% below contracted volumes. This is primarily due to lower volumes over winter 2015.

Neonatal WIES

There has been an improvement in neonatal activity this month, but it remains 9% below contracted volumes. It is anticipated that volumes will improve during May 2016, as there has been significant pressure on cots regionally. Consequently, both Waitemata DHB SCBUs have had periods where they have been over capacity.

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SCORECARD – CHILD, WOMEN AND FAMILY SERVICES



Shorter Waits in ED 97% 95% CWF Services 99% 100%

Waiting Times

Gateway referrals waiting over 6 weeks 30 0

Patient Flow

Patient Experience Actual Target Trend Outpatient DNA rate 9% <10%

Complaint Average Response Time 17 days <14 days b. Average Length of Stay - Maternity 2.5 days <2.5 days

c. Average Length of Stay - Paediatrics 1.33 days <1.56 days

Improving Outcomes b. Average Length of Stay - SCBU 7.25 days <7.02 days

Exclusive breastfeeding on discharge 78% 75% Theatre utilisation Gynaecology 79% 85%

Women smokefree at delivery 93% 95% Patients with EDS on discharge 92% 85%

a.Oral health - % infants enrolled by 1 year 51% 98%

Quality and Safetyd.

Good hand hygiene practice 78% 80%

Financial Result (YTD) Actual Target Trend

HR/Staff Experience Trend Revenue 11,561 k 11,161 k

Sick leave rate 10 days <8 days Expense 73,078 k 70,502 k

Turnover rate 9% 8-12% Net Surplus/Deficit -61,517 k -59,340 k

Capital Expenditure 525 k 1,006 k

Contracts (YTD)

Gynaecology Elective WIES (excl ESC) 1,322 1,353

Gynaecology Acute WIES 1,069 1,000

Maternity WIES 5,761 6,037

Paediatrics WIES 1,364 1,479

Neonatal WIES 1,630 1,799





Contact:




Child Women and Family Services and Elective Surgical CentreApril 2016

2015/16





b. 2014/2015 original internal definition for 'Average length of stay'.

c. 2015/16 new MoH Average length of stay definition.

a. Technical problem with the report. (December data). d. April data n/a yet (Feb)

Health Targets

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Value for Money

Best Care

Service Delivery

A question?

Key notes

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STRATEGIC INITIATIVES VARIANCE REPORT Deliverable/Action On Target 1. ARDS will begin a training programme for WCTO and other child health providers in key messages

related to oral health literacy by December 2015

Pregnancy and Parenting Maternity Quality and Safety Programme

2. Implement the new national Post-Partum Haemorrhage guideline and review incidence rates by June 2016

3. Review the Waitemata DHB induction of labour guidelines by September 2015 4. Review episiotomy practices and outcomes by ethnicity by August 2016

Gestational Diabetes

5. Implement new guidelines, as appropriate, by June 2016 6. Work with regional counterparts to agree a regional approach for women with HbA1C of 41% to 49%

in the first trimester by June 2016.

7. Work with Waitemata DHB inpatient services to increase reporting and referral of children identified at admission who require immunisation - extend to paediatric emergency department services by March 2016. Review the feasibility of extending to out-patients services by June 2016

Reducing the number of assaults on children

8. Maintain the National Child Protection Alerts System to tackle child abuse and child vulnerability by placing Child Protection Alerts in clinical records, national health index medical warning system and DHB internal systems on all appropriately identified mothers, infants, children and youth, to be completed by March 2016

9. Develop care plans following placement of alerts by June 2016 10. Ensure all Māori wahine/women and/or their children/tamariki who are admitted to North Shore and

Waitakere Hospitals are offered Whānau/Pai Ora assessments, to be implemented from March 2016


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FINANCIAL RESULTS CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Apr-16

Child Women Family

($000’s)


REVENUE

* Government and

Crown Agency 1,081 1,055 26 10,844 10,828 15 12,906 12,906 0

Other Income 94 33 61 717 333 384 400 400 0

Total Revenue 1,175 1,088 87 11,561 11,161 400 13,305 13,305 0

EXPENDITURE

Personnel

Medical 1,346 1,282 (64) 14,427 13,926 (501) 16,538 16,538 0

Nursing 2,163 2,118 (45) 22,848 22,590 (257) 27,800 27,800 0

Allied Health 1,884 1,741 (142) 19,924 19,500 (425) 23,385 23,385 0

Support 19 16 (3) 179 174 (5) 205 205 0

Management /

Administration308 307 (1) 3,117 3,320 203 3,950 3,950 0

5,719 5,464 (255) 60,496 59,511 (985) 71,879 71,879 0

Other Expenditure

Outsourced

Services227 162 (65) 2,262 1,653 (609) 1,979 1,979 0

Clinical Supplies 476 438 (38) 4,877 4,446 (431) 5,323 5,323 0

Infrastructure &

Non-Clinical

Supplies

570 487 (83) 5,444 4,892 (552) 5,847 5,847 0

1,274 1,088 (186) 12,582 10,991 (1,591) 13,148 13,148 0

Total Expenditure 6,993 6,551 (441) 73,078 70,502 (2,576) 85,027 85,027 0

Cost Net of Other

Revenue(5,818) (5,463) (355) (61,517) (59,340) (2,177) (71,722) (71,722) 0


COMMENT ON MAJOR FINANCIAL VARIANCES Contribution position for Year to Date April 2016 ($2,177K unfavourable)

Revenue ($400K favourable Year to Date)

Child, Women and Family Services remains on track to meet budgeted funding expectations through ongoing new and unbudgeted funding streams. Child Health Services Rheumatic fever programme $163K, Regional Dental services preschool oral health funding $84K, University of Auckland $181K and Newborn Hearing Screening new contract variation $158K are the most significant additions. There are many other favourable minor funding streams that contribute to offsetting the budget shortfall associated with the Regional Dental Service.

Demand for Child Rehabilitation services for ACC patients has increased in recent months, allowing the service to recover from its previous volume-related funding shortfall to currently track ahead of budgeted levels.

Expenditure ($2,576K unfavourable Year to Date)

Personnel costs are currently $985K over spent Year to Date driven by Medical $501K, Nursing $257K and Allied Health $425K staffing groups. Current Registrar and Midwifery resourcing issues are placing increasing pressure on budgets, along with higher than normal levels of sick and sabbatical leave. Unexpected backpays and retirements as well as understated penals, allowances, kiwisaver costs are also major contributing factors to date. Vacancies across Management/Administration and Allied Health staffing continue to provide some cost mitigation year to date.

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Higher than planned spending in outsourced costs $609K is primarily attributed to embedded savings of $302K, external nursing bureau as cover for sick and vacant positions $135K, unbudgeted Anaesthetists costs $88K and to a lesser extent outsourcing to Birthcare for over flow from the Waitakere Maternity Facility $36K. Ongoing under spends in community radiology and lab send away tests $124K are providing much needed partial cost offsets. Clinical Supplies $431K and Infrastructure and Non Clinical costs $552K continue to be driven by embedded budget savings initiatives of $1,223K. Other notable ongoing cost pressure areas include continence products for community-based services $79K, lease/rental costs $90K, Cleaning Outsourced $102K and uniforms $47K. These costs are being partially mitigated by under spending in transportation $195K, treatment disposable products $203K and utilities costs $116K. In addition to these under spends, much of the following ‘getting back on track’ initiatives will contribute to the savings targets.

Getting back on track initiatives

The controls that the service has put in place for managing high annual leave balances continue to show positive signs. Staff with high leave balances have leave plans in place and are taking leave. Leave will continue but will need to be carefully managed as the service has registrar resourcing issues through to June, which will impact the delivery of medical services in O&G if gaps in the roster cannot be filled when staff are on leave. The high winter demand within Paediatrics should also be considered. Although reported on a monthly basis, leave balances are now being monitored more frequently via the new HR reporting portal. Any savings from this initiative will be realised where there is no requirement for cover.

Financial benefits continue to be realised through a change in the supplier of specific dental products. These benefits were initiated in 2014/15 and have continued through to 2015/16, and are being tracked on a monthly basis. Significant gains were made in getting non catalogue ordered products onto the catalogue. This will enable Health Alliance to engage with suppliers of these products to seek better pricing. Further work is underway to determine whether additional efficiencies exist in this part of the business.

The Home Care for Kids service transitioning its Huggies nappies product range onto the USL catalogue is nearing completion. The anticipated savings resulting from this change are expected to be realised over the coming months. It is anticipated that this development will yield annual savings in the vicinity of $25K.

The introduction of the Kanban stock management system into SCBU is progressing well. The system has been introduced in WTH SCBU and NSH SCBU, and is on track for completion in mid-June 2016. The successful integration of a Clinical Supplies Coordinator across North Shore Hospital CWF inpatient services focuses on reducing the risk of potential purchasing errors or duplication and the number of orders being placed compared with individual units managing their own ordering. The recruitment of a second Clinical Supplies Coordinator position for Waitakere Hospital CWF inpatient services has been delayed due to a service structure review.

Gynaecology clinical practice/model of care initiative is planned for implementation in early 2016/17. The service is currently working on the business case to support this low cost surgical initiative, which is expected to provide financial benefits for Surgical and Ambulatory Services through the reduced need for anaesthetic support and overnight stays.

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Mental Health and Addiction Services

SERVICE OVERVIEW This division provides specialist community and inpatient mental health services to Waitemata residents. It also provides community alcohol, drug and other addiction services, and forensic services to the northern region. The group is managed by Acting General Manager Alex Craig, with Clinical Director Dr Murray Patton for Mental Health and Clinical Director Forensic Services, Dr Jeremy Skipworth.

HIGHLIGHT OF THE MONTH Whītiki Maurea – Model of Care

MOKO Services is our Māori Mental Health Service, and was established in the 1990s to provide cultural support to the District Mental Health Services. Whītiki Maurea grew out of that Service to include clinical care and Māori Addictions (Alcohol and Drug) services, to address issues of health disparity and improve access for Māori. The service is supported by Naida Glavish, Chief Tikanga Advisor and the Kaunihera Kaumātua. The service has recently reviewed their structure and strengthened their model of care. The service had previously operated as two separate teams, Moko Services (for Mental Health) and Te Ātea Marino (the Addictions Service); cultural staff were previously embedded in Moko Services. The changes in the model of care has included a structural change with the development of a new cultural team, Te Pae Ahurea. Te Pae Ahurea is offering cultural interventions for the whole of Whītiki Maurea and Māori who access District Mental Health services.

The 3 teams within Whītiki Maurea are: 1. Moko Mokai, the Māori Mental Health Clinical Service 2. Te Ātea Marino, the Māori Alcohol and Other Drug Service 3. Te Pae Ahurea, the new Māori Cultural Team.

The service is now finalising their service delivery pathways, including the new processes associated with Te Pai Ahurea. The review has provided service clarity around pathways for clinical staff, tangata whaiora (service users) and their whānau. Measures on service provision are supporting the implementation of the new way of working. The review has meant a significant culture change for the team and there has been steady progress regarding changes to practice. There is acknowledgment from the team that the changes provide a better balance of working between cultural and clinical support for tangata whaiora/whānau and a stronger oversight of the team.

Moko Mokai is the newly named Māori Mental Health Team. Service leaders have recently held two half-day planning sessions with clinicians and cultural staff in attendance. This provided the opportunity for clinicians and cultural staff to endorse their new model of care and discuss the team’s key objectives for 2015/16. There was excellent discussion and a positive shift for the team in understanding where the clinical team of Moko sits within the three teams.

To accompany the new model of care, the service has also developed a quality forum to support the implementation of their quality improvement plan and provide staff with assurance, guidance and support on all aspects related to quality activities, including Health and Safety, quality management, quality assurance and service improvement.

Te Ātea Marino is the Alcohol and Addictions Team, which provides a regional service to Māori clients across Auckland in terms of interventions for alcohol and other drugs, often working alongside CADS in providing group interventions. As part their service improvement, Te Ātea Marino is committed to raising their annual whole team contact statistics by 20%. The graph below shows the progress against last year:

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Te Pae Ahurea is the newly formed Māori Cultural Team, which provides cultural support to tangata whaiora in Waitemata. The team provides cultural support services and interventions, including cultural assessment and supporting culturally therapeutic programmes for tangata whaiora and whānau. The team works with whakapapa and supports tangata whaiora to establish connections to whānau, hapu and iwi, whilst supporting knowledge in Māori concepts and practices. Te Pae Ahurea works alongside Moko Mokai and Te Atea Marino clinicians to provide an

integrated service, led by the Kaumātua, who ensures that cultural protocols are observed and

practised. Te Pae Ahurea provides cultural support to mainstream District Mental Health Teams, with a highly successful trial of cultural support in the Rodney District for 3 days a week.

Whītiki Maurea and Takanga a Fohe (the Pacific Mental Health team) are two of our cultural specialist services. Collaborative and leadership meetings are held to support quality developments and benchmarking. The following domains were identified for use in undertaking self-assessment within the service:

A. Being the best at what we do B. Whānau ora in practice C. Healthy and motivated workforce

Below is the model that Whītiki Maurea is working with in relation to the broader sector, including government agencies, NGO agencies and the community through the Whānau Ora Pathway. Whītiki Maurea have identified that they will be working particularly with NGOs in the coming year to ensure progression of the Whānau Ora Pathway across service relationships for Māori tangata whaiora and whānau. A collaborative Māori network has been established, known as Te Pae Herenga Ora. This group is an affiliated stream associated to the Waitematā Stakeholder’s Network.

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WHĀNAU

COMMUNITY

GOVERNMENT

MINISTRIES Health EducationSocial

Development

Māori

DevelopmentJustice Police

Te Pae

Herenga OraW H Ā N A U O R A P A T H W A Y

Primary

Health Care

Māori

Health & Social

Providers

Whānau ownership of

their health & wellbeing

Building capacity &

capability

Integrated service

delivery

Te Hā Oranga o

Ngāti Whātua

Te Puna

Hauora ki te

Raki Pae

Whenua

Te Whānau

o Waipareira

Trust

Te Kōtuku ki te

Rangi TrustNgāti Manuhiri

Waitemata

DHB

Whītiki Maurea

WHĀNAU ORA INTEGRATED SYSTEM APPROACH

Māori Mental Health & Addictions

Te Pou

Matakana

WHĀNAU

ORALiving a healthy life

Outcomes

Achieve KPI targets

Address systemic factors

Improve health, social, educational, justice

outcomes for Maori

Outcomes

Intergeneration change

Improved Māori social mobility

Break the cycle of disengagement

KEY ISSUES Enhanced Relationship between Forensic Services and the Department of Corrections

Tangible evidence of a better working relationship with the Department of Corrections was realised this month with our invitation to participate in the planning for the replacement of the prison at Paremoremo, scheduled to open in 2017/18. The prison currently has just over 681 inmates, 260 of whom are in the Maximum Security facility - the only maximum security prison in New Zealand. More than 10% of the prisoners experience a serious mental illness, such as schizophrenia, and often have complex comorbidities including substance abuse, personality disorder, head injury and intellectual disability. Therefore, it is critical that the model of care being operated gives appropriate support for these conditions and maximises rehabilitative opportunities with both Forensic and Correctional health staff, while also managing the high risks evident with this population.

The new facility is being developed under a Public Private Partnership (PPP) with the private sector partner, Next Step Partners LP, responsible for designing, building, financing and maintaining the new facility, while the operation of the prison and custody of prisoners will continue to be the responsibility of the Department of Corrections.


BEST CARE VARIANCE REPORT Complaints

A small number of complaints have taken longer to resolve than the 14 days allocated. The majority of complaints were closed within 14 days.

Seclusion in Forensic Services

Three patients (on Rata, Totara and Pohutukawa) with high acuity required periods of seclusion. Although these seclusion episodes are high, they remained relatively brief. This variance is considered to be a natural occurrence and the result of acuity related to the individuals’ mental health.

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Sick Leave

Sick leave rates have continued to reduce to target, but remain outside of the target. Managers are continuing to utilise the systems now in place to monitor the use of sick leave.

SERVICE DELIVERY VARIANCE REPORT Wait Times for Youth

Youth wait times remain below target due to increasing service demand which is surpassing capacity for the service to respond. The service is currently reviewing these wait times and actively looking at the issues. There are some problems with reporting of the data which have now been identified and will be repaired within the next month. All 6 positions have been filled but there is a delay for 2 two staff in commencing employment.

Inpatient Average Length of Stay (Adult)

The average length of stay for Inpatient units is higher this month, as a long-term service user was discharged from He Puna Waiora to the High and Complex Needs Service. Average length of stay is calculated at the time of discharge. The average length of stay has been consistently on target at both units prior to this discharge.

Post Discharge Community Care (Adult)

Post discharge community care is part of a range of national KPIs. This KPI is calculated on the day after discharge and for the next 7 days. The April rate of 78% is below the national target of 90%. However, when patients who were discharged out of the DHB’s area or straight back to their GPs were excluded, the rate increased to above the target. This national KPI and its business rules are being reviewed as none of the large DHBs in New Zealand have managed to meet the target since it was originally set.

Whānau Contacts Per Service User (Adult)

Whānau/family contacts per service user have dropped by 2% since the last HAC report, after showing a gradual increase this calendar year. Staff are reminded regularly of the importance of whānau input into a person’s recovery.

Capital Expenditure

Unfavourable variance relates to projects approved against the Health and Safety and Legislation and Compliance budgets (account coding reclass pending) relating to the Mason Centre CCTV upgrade $237K and CCTV cameras at 44 Taharoto Rd and Paramount Drive sites $42K, respectively.

Prison Inpatient Waiting List

The prison wait list target of 0% is % non-compliance with the prison model of care, i.e. acutely unwell prisoners admitted within 6 weeks and non-acute within 3 months. This non-compliance refers to red flags in the prison waiting list, which indicate that the patient has been waiting longer than these times. The 17% variance refers to three patients.

A number of variables have contributed to the above figure, including substantially more referrals to the forensic prison team, which has been increasing over recent years, which may affect the increased awareness of the psychiatric needs in prisons. There is also an increased number of prisoners, including opening of the new prison in South Auckland. Treatment priority decisions take into account not only time on the waiting list, but also treatability, management problems whilst in prison, degree of suffering, legal circumstances and safety issues. The availability of suitable beds is also a factor; some of our patients at times require a longer inpatient stay than ordinary psychiatric inpatient units.

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SCORECARD – MENTAL HEALTH SERVICES

Actual Target Trend Waiting Times (latest available) Actual Target Trend

Better help for smokers to quit 98% 95% a. Youth (0-19) < 3 weeks 60% 80%

Shorter Waits in ED 88% 80% a. Adult (20-64) < 3 weeks 90% 80%

a. CADS (0-19) < 3 weeks 93% 80%

a. CADS (20-64) < 3 weeks 95% 80%

a. Forensic (20-64) < 3 weeks 91% 80%

Patient Experience Actual Target Trend Prison inpatient waiting list 17% 0%

Complaint Average Response Time 20 days <14 days

Patient Flow

Improving Outcomes Average Length of Stay - Adult Acute 28 days 15-21 days

Seclusion use Forensics - Episodes 34 <14 Average Length of Stay - CADS Detox 7 days 6-8 days

Seclusion use Adult - Episodes 3 <5 Bed Occupancy - Adult Acute 93% 85%

b. Adult Inpatient Units AWOL 0 <1 Bed Occupancy - CADS Detox 99% 90%

b. Forensic Units AWOL 0 <1 Bed Occupancy - Forensics Acute&Rehab 95% 95%

Bed Occupancy - ID 99% 70%

c. MH Access Rates 0-19 years (Total) 3.15% 3.00%

c. MH Access Rates 0-19 years (Maori) 4.47% 3.60% Community Carec. MH Access Rates 20-64 years (Total) 3.51% 3.50% Treatment days per service user - adult 3.4 days 3-5 days

c. MH Access Rates 20-64 years (Maori) 7.68% 8.00% Treatment days per service user - child 1.7 days 2-4 days

Treatment days per service user - youth 1.9 days 2-4 days

HR/Staff Experience Treatment days per service user - CADS 2.1 days 2-4 days

Sick leave rate 9.3 days <7.5 days Treatment days per service user - forensics 2.1 days 2-4 days

Turnover rate 9% 8-12%

Preadmission community care - adult 79% 75%

Post discharge community care - adult 78% 90%

Community service user related time - adult 42% 35-45%

Financial Result (YTD) Actual Target Trend Contact time with client participation - adult 78% 80-90%

Revenue 11,047 k 9,877 k Whanau contacts per service user - adults 63% 70%

Expense 105,234 k 104,923 k Whanau contacts per service user - child 100% 80%

Net Surplus/Deficit -94,187 k -95,046 k Whanau contacts per service user - youth 100% 80%

Capital Expenditure 470 k 221 k





Contact:




Mental Health ServicesApril 2016

2015/16





a. Reported 3 months in arrears (January data) c. Reported 3 months in arrears (February data)

b. New indicators Mar 2016.

How to read

Value for Money

Best Care

Service Delivery

A question?

Key notes

How to read

Health Targets

54


STRATEGIC INITIATIVES VARIANCE REPORT Deliverable/Action – Prime Minister’s Youth Mental Health Project On Target

Child and Adolescent Mental Health and Youth Alcohol and Drug Services 1. Complete primary care roll-out of e-referrals by December 2015

2. Opportunities for delivering CAMHS and Altered High services locally are fully explored and changes implemented to maximise access (particularly in rural and under-served areas) by June 2016

3. CAMHS will review service provision: - Develop a configuration plan to allocate resources to meet population demand, projected growth, need in

rural areas and underserved populations by December 2015 - Ensure dedicated Infant Mental Health FTE are employed by October 2015

Rising to the Challenge/Mental Health and Addition Services

4. Implement a new model of care in He Puna Waiora (the new adult inpatient unit) to be operational from May 2015, and the new model of care to be fully implemented by December 2015

5. Implementation of sustainable community residential services for people with high and complex needs completed by June 2016

6. Full roll-out of enhanced acute service based at Waitakere Hospital ED by December 2015 7. Implementation of a new model of community acute response (Pilot from February 2015 and complete

roll out July 2016).Will achieve district wide service consistency, earlier responses, better support to GPs, and increased capacity to deliver services in the home environment

8. Māori and Pacific service users have the highest physical health comorbidities. Ensure routine metabolic screening for secondary service users, with priority focus on Māori and Pacific clients by June 2016

9. Facilitate whānau hui with Tagata Whai I te Ora and their whānau who receive mental health treatment from the Waitemata DHB Māori Mental Health Services to gain insights into the negative and positive effects of compulsory community treatment orders by March 2016

10. Ensure reliable collection of data for use of seclusion and restraint for Māori, and analyse the data to understand differential rates of use for Māori, by December 2015

11. Provider Arm will review systems to reliably collect social outcome data (housing, employment and PHO enrolment) using agreed KPI definitions and align with NGO collection approaches and PRIMHD collection protocols. This process is to commence by July 2015

12. Ministry COPMIA guidelines (expected in April 2015) will be implemented. All staff will have increased knowledge of available COPMIA resources and increased competencies to promote COPMIA child and family focused practice


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Mental Health Services

($000’s)


REVENUE

* Government and

Crown Agency 933 844 90 9,301 8,436 865 10,123 10,123 0

Other Income 187 151 36 1,746 1,441 305 1,742 1,742 0

Total Revenue 1,120 994 126 11,047 9,877 1,170 11,865 11,865 0

EXPENDITURE

Personnel

Medical 1,978 2,051 73 21,819 22,111 292 26,240 26,240 0

Nursing 4,274 4,288 14 45,497 46,185 688 56,751 56,751 0

Allied Health 2,221 2,088 (133) 23,269 23,417 148 27,720 27,720 0

Support 64 61 (2) 590 628 38 739 739 0

Management /

Administration443 443 (0) 5,012 4,867 (146) 5,788 5,788 0

8,980 8,932 (49) 96,187 97,208 1,021 117,239 117,239 0

Other Expenditure

Outsourced

Services258 87 (172) 1,616 868 (748) 1,042 1,042 0

Clinical Supplies 64 132 68 1,158 1,318 160 1,582 1,582 0

Infrastructure &

Non-Clinical

Supplies

588 535 (54) 6,273 5,529 (744) 6,598 6,598 0

911 754 (157) 9,047 7,716 (1,331) 9,223 9,223 0

Total Expenditure 9,891 9,685 (206) 105,234 104,923 (311) 126,461 126,461 0

Cost Net of Other

Revenue(8,771) (8,691) (80) (94,187) (95,046) 859 (114,596) (114,596) 0

YEAR TO DATE FULL YEARMONTH

COMMENT ON MAJOR FINANCIAL VARIANCES Revenue ($1,170K favourable for the year to date)

Favourable variance to April 2017 YTD resulted primarily from the new and unbudgeted contract in CADs for drug referrals from the Ministry of Justice ($625K favourable), an increase in the Ministry of Health Forensics ID contract price ($85K favourable) as well as a new contract to expand the service for Mothers with Substance Abuse ($53K favourable). The impact of increased revenue for contracts, such as Court Reporting in Forensics ($97K favourable), Relapse in Prevention in Psychosis ($65K favourable) and the Infant Perinatal Fund ($17K favourable), is neutral with equivalent costs reflected in outsourced services and Clinical and Non-Clinical supplies.

Personnel ($1,021K favourable for the year to date)

The primary driver of YTD variance is vacant posts ($1,792K favourable), most notably in the medical ($147K favourable), nursing ($1,277K favourable) and allied ($368K favourable) staff categories. In recent months, the favourable variance has progressively reduced as posts have been filled. For example, Nursing and Allied vacancies reduced by 19 FTEs in Q2 and then by a further 18 FTEs in Q3 (currently 27 FTE vacant posts).

The favourable variance is partially offset in Nursing by high overtime ($471K unfavavourable) due to: a) roster/sick cover, particularly in the Adult and Forensic services; b) high acuity care in the Forensic inpatient units, where there are 5 patients requiring 2-on-1 and 3-on-1 care; and c) additional security in the Adult MHS, where staffing has been increased in Waiatarau and He Puna Waiora units to improve supervision of the courtyard areas

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as a result of security concerns. Control of overtime remains a priority for the MHSG and the introduction of better management tools (explained below) have resulted in a 283-hour (23%) reduction in average weekly Forensic nurse overtime hours since July 2015.

The premium paid for SMOs covering the registrar on-call roster ($292K unfavourable) in Adult and Forensic services follows excessive targeting of this account for budget savings in previous years.

Management/Administration Personnel costs include the Our Health in Mind project ($89K unfavourable).

Other Direct Costs ($1,331K unfavourable year to date)

Unfavourable variance largely reflects targeted divisional savings ($1,220K unfavourable), which are to be achieved across the division.

Additional outsourced medical staff have been required in the Adult service ($392K unfavourable) to cover vacancies at He Puna Waiora, sick leave cover at North Community and a registrar vacancy (H1 rotation) at Rodney.

Additional outsourced security in the Forensic service ($153K unfavourable), including 3 guards (to December) as well as repairs and maintenance of duress fobs and floodlight replacements as per the external security review (the Greet report).

This is partially offset with favourable variance in the Forensic community service for step-down beds ($235K favourable) and also across the entire division for the flexi-fund account ($224K favourable) designated to patients transitioning into homes in the community.

Control of Overtime

Active monitoring and management of Forensic inpatient unit overtime costs is ongoing during 2015/16. As noted above, this has resulted in a 283-hour reduction in average weekly nurse overtime hours between July 2015 and April 2016. The largest reduction occurred in Tanekaha, which had a 58% reduction over the period. For the service as a whole, this is equivalent to a $13K average saving per week which, if sustained, would yield a $696K saving per annum.

Active management of overtime is achieved through review of ‘live’ overtime tracking spreadsheets at the unit manager level, with weekly overview by the Service Manager and monthly review of newly introduced overtime usage graphs. This strict control of overtime supports unit managers to better understand the connection between clinical choices and costs incurred, as well as improve utilisation of lower cost bureau staff.

To ensure bureau staff availability, additional casual staff were recruited to the bureau roster. Recruitment is also underway for a nursing floater roster within Forensics to allow more flexible and cost effective in-house coverage, primarily of sick leave requirements.

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Surgical and Ambulatory Services/Elective Surgical Centre

SERVICE OVERVIEW This Division provides elective and acute surgery to our community, encompassing surgical specialties such as general surgery, orthopaedics, otorhinolaryngology and urology, and includes outpatient, audiology, clinics, operating theatres and pre- and post-operative wards. ICU, radiology and breast screening services are with this service. The service is managed by Michael Rodgers, Chief of Surgery and Michelle Sutherland, General Manager. The Head of Division Nursing is Kate Gilmour and the Acting Head of Division Allied Health is Jo Grounsell.

HIGHLIGHT OF THE MONTH General Surgery

As part of our drive to reduce treatment variation and smooth patient flow, Dr Richard Harman, Clinical Director and the General Surgery team have introduced acute care pathways for a number of conditions. Seven acute clinical protocols were developed, which are currently being implemented to ensure patients are assessed appropriately and receive the right treatment in a timely manner. Patient discharge information sheets have been aligned with the protocols and will soon be available to select on electronic discharge summaries. The Practice Improvement Clinical Nurse Specialist has collaborated with ICU, anaesthetics, the pain team and palliative care in case reviews, which have resulted in:

Pain management protocol developed for patients with catastrophic inoperable acute abdominal pain, with other useful documents embedded, in particular ‘how to have difficult conversations’ for junior medical staff

Operation Note handover form to give detailed information on the surgical procedure with clear instructions for post-operative care and the discharge plan.

We expect this will assist to standardise care for patients, reduce time to the decision to treat, improve timeliness to transfer the patient to the right inpatient bed or discharge home, and improve patient experience.

KEY ISSUES Faster Cancer Treatment (FCT)

Focused work and a recovery plan is being undertaken to improve and achieve the FCT target of 85%. The Director of Hospital Services together with the General Managers, Heads of Divisions and Cancer Leads are reviewing all patients to ensure they receive their diagnostic interventions and treatment in a timely manner in order to meet the MoH 62 day FCT target. Overall improvements to the patient pathway are underway with both a Waitemata DHB and Auckland DHB focus.


HEALTH TARGETS VARIANCE REPORT Shorter Waits in ED

91% achieved; the main reason for not meeting the 95% target is late referral to the specialty service from ED.

BEST CARE VARIANCE REPORT Improving Outcomes

#NOF patients to theatre within 48 hours

88% achieved against the target of 95%. A review of patients’ clinical records who breached is underway to determine if there are remedial reasons for the breaches, e.g. pathological fracture, types of investigations required and medical presentation, or if there are delays in access to acute theatre. The Surgical Public Health Physician is undertaking a review of the #NOF pathway to understand what is working well and where further improvements can be achieved.

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SERVICE DELIVERY VARIANCE REPORT Waiting Times - Percentage of ultrascound scans done within 6 weeks

An improvement is noted from last month’s result (54%), with 58% of patients referred to ultrasound receiving their scan and had it reported on within 6 weeks. Waitemata DHB has agreed to increase the outsourcing of ultrasound scans for a period of up to 12 weeks. Following this initial outsourcing of 400 scans per week, it is planned for a further 12 weeks of outsourcing of 200 scans per week, which will result in reducing the waitlist and thus achieving a better result. The outsourcing to community providers is to commence on 20 June.

Patient Flow – Theatre utilisation at Waitakere Hospital

65% against a target of 85%. A new schedule will be in place from 1 July 2016 and we expect to see improved utilisation of all sessions.

Patients with EDS on Discharge

81% achieved (target is 85%). General Surgery is undertaking a more detailed review of the reasons for an EDS not being completed on discharge with the Health Improvement Group. They are trialing having the patients who require an EDS automatically entered onto the Team House Officers’ homepage in Concerto in a similar way to the radiology report process; if not completed/overdue, they will be escalated to the Registrar and then the SMO.

ELECTIVE SURGERY CENTRE

SERVICE OVERVIEW This division provides elective surgical services to our community, working alongside the Surgical and Ambulatory and Women and Child Health Services. It provides general surgery, orthopaedic surgery, gynaecology and urology. It has its own outpatient clinic, operating theatres, CSSD and a post-operative ward. The Director of the service is Mr Mike Rodgers and it is managed by Mark Watson.

HIGHLIGHT OF THE MONTH Planning is well underway for hosting the 2nd Australasian Breast Congress on 7–10 July 2016. The congress is hosted by the Australasian Society for Breast Disease and the Breast Surgeons of Australia and NZ, and is focusing on ‘Advances and Controversies in Breast Cancer’. The key component of the Congress will be the live screening of two separate operating lists at ESC to the Congress. This will entail high definition visual and audio links from two of the ESC theatres, through to the hospitals conference room, with internationally renowned guest surgeons joining our Waitemata DHB breast surgeons to operate on selected patients. Prior to surgery, all the patients will be fully informed to ascertain that if they are comfortable with their surgery being filmed and to obtain consent.

KEY ISSUES The ESC is working with S&AS to implement an elective surgical plan for 2016/17 where all three theatre locations will be fully utilised. We envisage an increase in the surgical diversity of patients treated at ESC and a subsequent increase in patients that require inpatient post-operative care, along with increased day surgery at Waitakere.


BEST CARE VARIANCE REPORT HR/Staff Experience - Sick leave rate ESC

The sick leave rate for the team is noted and we have been extremely busy over the past few months. Whilst it is not ideal to breach the 7.5 day target, there are no major concerns at this stage and all staff will be monitored by the senior team.

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SERVICE DELIVERY VARIANCE REPORT Patient Flow – Theatre Utilisation ESC

ESC shows a utilisation rate of 78% versus a target of 85%. This result has led us to improve the process in orthopaedic theatres for recording time into the anaesthetic room. We are also looking to improve the utilisation of plastic surgical theatres and gynaecology theatres to ensure improved performance over the coming months.

VALUE FOR MONEY Contracts – Elective WIES Volumes ESC

Whilst the surgical discharge volumes are sitting at 104% of the budget YTD, the WIES remains 10% lower than budget for a number of reasons. Key drivers for this current situation include the increased day case and case mix for both Urology and General Surgery. The volume of orthopaedic discharges at ESC has increased over the last two months to meet the surgical health target.

SCORECARD - SURGICAL AND AMBULATORY AND ELECTIVE SURGICAL CENTRE



Shorter Waits in ED 91% 95% Surgical and Ambulatory Services 103% 100%

Elective Surgical Centre - ESC (YTD) 104% 100%

Elective Surgical Centre - ESC (month) 114% 100%

Waiting Times

% of CT scans done within 6 weeks 98% 90%

Patient Experience Actual Target Trend % of MRI scans done within 6 weeks 91% 80%

Complaint Average Response Time 11 days <14 days % of US scans done within 6 weeks 58% 75%

Complaint Average Response Time - ESC 8 days <14 days

Patient Flow

Improving Outcomes Outpatient DNA rate (SAS & ESC) 9% <10%

a #NOF patients to theatre w/in 48 hours 88% 95% b. Average Length of Stay - Acutes 3.1 days <3.74 days

Transfers from ESC to NSH 1.7% 5% b. Average Length of Stay - Electives 1.4 days <2.26 days

b. Average Length of Stay - Electives - ESC 1.0 days <1.16 days

Quality & Safety Theatre utilisation - NSH 88% 85%

Older patients assessed for falling risk 98% 90% Theatre utilisation - WTH 65% 85%

Occasions insertion bundle used 100% 95% Theatre utilisation - ESC 78% 85%

Good hand hygiene practice 82% 80% Patients with EDS on discharge 81% 85%

ICU - rate of CLAB per 1000 line days 0.9 <1

HR/Staff Experience

Sick leave rate 7.8 days <7.5 days Financial Result (YTD) Actual Target Trend

Sick leave rate - ESC 7.9 days <7.5 days c. Revenue 15,560 k 14,093 k

Turnover rate 12% 8-12% c. Expense 167,177 k 163,515 k

Turnover rate - ESC 12% 8-12% c. Net Surplus/Deficit -151,617 k -149,422 k

Capital Expenditure 2,813 k 3,507 k

Contracts (YTD)


Elective WIES Volumes - ESC 4,862 5,320






b. 2015/16 new MoH Average length of stay definition.

c. Combined SAS & ESC data. Financial Results (new for Q2 Dec 2015) therefore short trend line.

Contact:




Surgical and Ambulatory Service / Elective Surgical CentreApril 2016

2015/16





a. Reported 1 month in arrears - March data

Health Targets

How to read

Value for Money

Best Care

Service Delivery

A question?

Key notes

How to read

60


STRATEGIC INITIATIVES VARIANCE REPORT

Deliverable/Action On Target 1. Work with the bariatric service to identify and remedy barriers within the triage service to improve

Māori and Pacific acceptance rates onto the bariatric surgery waiting list – by December 2015

Cancer Services

2. Identify existing models/processes of investigations and treatment which negatively impact on faster cancer treatment times and implement changes recommended by local and regional cancer round one improvement projects to improve performance by June 2016

3. Clinically led implementation of key findings at Waitemata in each tumour stream of the round one MoH service improvement project by UniServices by December 2015

4. Participate in the IT-led National Patient Flow system and track patients undergoing assessment and treatment for cancer in real time and intervene if their journey is delayed at any point, to be implemented by June 2016

5. Ensure all tumour streams have high suspicion flags which are used actively by the clinicians by December 2015

6. Implement guidance on active surveillance treatment for prostate cancer care (available mid 2015), ensuring clinicians receive information and care pathways and MDM proformas are updated

7. Review local MDM terms of reference by December 2015 8. Audit local tumour stream MDM volumes and completeness to identify which tumour streams would

benefit from more MDM coordination support by December 2015

9. Undertake annual cancer patient experience survey, commencing in February 2016 and completing in April 2016

10. Implement the Ministry-funded Cancer Supportive Care suite of psychological and social services to improve cancer patient support by June 2016

11. Support Northern Cancer Network (NCN) conducting at least two additional tumour type reviews against National Tumour Standards by June 2016

12. Implement the action points of the endoscopy review undertaken in 2014 by June 2016 Improved Access to Elective Surgery/Major Trauma

13. Establish hand surgery and breast reconstruction services locally on eligible and agreed patients who previously would have attended Counties Manukau DHB for these services from July 2015

14. Offer non-surgical pain management to appropriate patients with muscular skeletal pain through our chronic pain service from 1 July 2015 and incorporate as business as usual

15. Review regional options for two surgical sub specialty procedures during 2015/16 16. Continue to embed the learnings over 2015/16 from the elective productivity and Shorter Journey

projects into our business as usual e.g. patient-focused bookings

17. Ensure triage consistency and equity of access by using national CPAC tools in all specialties - ongoing Improved Access to Diagnostics

18. Participate in the National Radiology Service Improvement Initiative, with the implementation of the WISDOM project (Waitemata Imaging Services Demand OptiMisation) – over 2015/16.

19. Two MRT trainee technicians to become proficient at operating the MRI scanners by June 2017 Quality and Safety

20. Introduce team briefing and debriefing for each operating theatre list to improve patient safety, teamwork and communication within the teams by June 2016

21. Implement a quality improvement project co-designed with consumers to improve pain management and the safe prescribing and administration of opiate medication by May 2016

Elective Surgical Centre - Deliverable/Action 22. Continue to embed the learnings over 2015/16 from the elective productivity and Shorter Journey

projects into our business as usual e.g. patient-focused bookings.

23. Ensure triage consistency and equity of access by using national CPAC tools in all specialties - ongoing


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FINANCIAL RESULTS

SURGICAL AND AMBULATORY


Surg & Ambulatory

($000’s)


REVENUE

* Government

and Crown

Agency

1,535 1,183 352 13,570 12,072 1,498 14,583 14,583 0

Other Income 141 156 (15) 1,352 1,567 (215) 1,884 1,884 0

Total Revenue 1,676 1,339 337 14,921 13,639 1,282 16,467 16,467 0

EXPENDITURE

Personnel

Medical 4,892 4,556 (336) 50,170 49,763 (407) 58,879 58,879 0

Nursing 3,583 3,305 (278) 35,979 35,294 (685) 43,194 43,194 0

Allied Health 1,273 1,218 (54) 12,885 13,265 380 15,668 15,668 0

Support 173 162 (11) 1,800 1,785 (15) 2,109 2,109 0

Management /

Administration886 860 (25) 9,310 9,391 81 11,099 11,099 0

10,806 10,101 (705) 110,144 109,498 (646) 130,949 130,949 0

Other Expenditure

Outsourced

Services411 325 (86) 4,200 3,295 (905) 3,962 3,962 0

Clinical Supplies 2,727 2,827 100 28,010 27,648 (362) 33,386 33,386 0

Infrastructure &

Non-Clinical

Supplies

646 424 (222) 5,467 4,198 (1,269) 5,050 5,050 0

3,784 3,577 (208) 37,677 35,141 (2,536) 42,398 42,398 0


Cost Net of Other

Revenue(12,915) (12,339) (576) (132,900) (131,000) (1,900) (156,881) (156,881) 0


COMMENT ON MAJOR FINANCIAL VARIANCES Production Activity

This month, surgical acute WIES are at 106% of contract (102% YTD) and electives discharges are at 105% of the Elective Surgical Health Target (102% YTD). While elective volumes are on track to deliver 104% by year end, orthopaedic volumes are trailing; there will be an ongoing effort across surgical services to catch up on these volumes over the remaining months.

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Overall financial result

The financial result for Surgical and Ambulatory Services is $1.9M unfavourable year to date. Contributing to the unfavourable position are costs associated with higher than planned acute volumes, unmet savings lines and the costs of running additional beds in the short stay ward. These costs have offset savings that might otherwise have been expected due to year to date under delivery of elective orthopaedic volumes. The financial performance this month and over the remaining months of this year are anticipated to be unfavourable as the surgical teams catch up on elective volumes while meeting ongoing high levels of acute cases.

Revenue ($1,282K favourable for the year to date)

This month additional revenues were received for the one-off reimbursement of costs in nursing $138K associated with Waitemata Central, and a catch up of revenue for a new registrar position that started in December $60K. Revenue is favourable year to date due to new SLAs $611K, reimbursements of $346K to cover outsourced costs during PSA industrial action, and additional revenue received from Auckland DHB for additional Radiology referrals $245K and Ophthalmology rentals $179K. Orthopaedic ACC revenue is ($294K) unfavourable, but it is noted there is an offset of additional ACC revenue in ESC of $137K.

Personnel ($646K unfavourable for the year to date)

Medical costs are $407K unfavourable year to date due to over-delivery of acute and elective volumes delivered across S&AS and ESC services. This month’s costs are unfavourable due to these high volumes and the catch up of an under accrual of $150K in costs incurred in March. The accrual process has been revised since March to ensure more timely information in support of accruals from April onwards.

Nursing costs are high this month due to redundancy costs of $138K. Nursing costs are $685K unfavourable year to date, primarily due to the additional beds remaining open in the Short Stay ward since August ($563K). These additional beds will be budgeted for 2016/17, and a cover model review of nursing across all Surgical Services has been initiated to determine the appropriate levels of staffing needed to meet the required ‘hours on the floor’, allowing for the appropriate levels of leave and reducing any avoidable costs associated with undue reliance on overtime and external agencies.

Allied Health costs are $380K favourable year to date due to vacancies; however, costs have increased in recent months with the appointment of radiology assistants to cover sonographer vacancies, and additional technician costs due to increased volumes.

Outsourced Services ($905K unfavourable for the year to date)

Outsourced services are unfavourable year to date due to external agency nursing costs ($501K), outsourced orthopaedic volumes during industrial action ($323K), outsourced radiology volumes due to machine outages and a catch up to ensure we meet the Faster Cancer Treatment targets ($173K), skin lesions ($154K), and unmet savings lines ($247K). Offsetting this, medical costs recharged to ESC are $188K above budget year to date due to high elective volumes at ESC, and other outsourced clinical service costs are below budget at $185K.

Clinical Supply Costs ($362K unfavourable for the year to date)

This month was favourable due to a recharge of interim care costs to corporate services, and lower implant costs. Year to date, disposable instruments and supplies are favourable $326K due to lower year to date volumes in orthopaedics and general surgery, but these savings are offset by additional costs being realised due to the increased price and volumes of surgical pathology testing kits ($159K), additional costs for antibiotic pumps ($166K) due to the OPIVA early discharges project, prior year costs ($156K) and under-budgeted depreciation in Breast Screening ($153K) and ambulance costs ($139K).

Non-Clinical Supply Costs ($1,269K unfavourable for the year to date)

Non-clinical supply costs are unfavourable year to date, primarily due to embedded savings lines ($1.3M).

Getting Back on Track Initiatives

Overtime is being managed to minimise spend

Use of external bureau – prior to booking an external bureau shift the options are considered in this order: o Staff are transferred internally between surgical wards to fill vacant shifts wherever possible

63


o If a ward still has a vacant shift, where practical and possible, five beds are closed for that shift (with consideration to number of patients in ED/ADU potentially being admitted)

o If neither of the above is possible, then all external bureau requests must be approved by the HoD Nursing (during business hours) and Duty Nurse Managers (after hours) before a booking is placed

o An enhanced bureau booking process being deployed this month will afford managers better visibility and auditability of internal and external bureau utilisation

OPIVA unbudgeted costs for antibiotic pumps are offset by savings from reduced patient length of stay

Sutures – Johnson & Johnson agreement will be in place from February 2016 for sutures, this will generate approximately $98K per annum.

ELECTIVE SURGICAL CENTRE – ESC


Elective Surgery Centre

($000’s)


REVENUE

* Government and

Crown Agency 92 45 47 638 454 184 552 552 0

Other Income 0 0 0 0 0 0 0 0 0

Total Revenue 92 45 47 638 454 184 552 552 0

EXPENDITURE

Personnel

Medical 0 9 9 59 97 38 116 116 0

Nursing 379 317 (62) 4,087 4,092 5 5,042 5,042 0

Allied Health 0 2 1 9 17 8 20 20 0

Support 15 3 (12) 51 36 (15) 43 43 0

Management /

Administration12 35 23 256 359 103 428 428 0

406 366 (40) 4,462 4,601 139 5,649 5,649 0

Other Expenditure

Outsourced

Services1,200 701 (499) 7,588 7,011 (577) 8,519 8,519 0

Clinical Supplies 722 686 (35) 6,783 6,846 63 8,312 8,312 0

Infrastructure &

Non-Clinical

Supplies

87 42 (45) 522 418 (104) 506 506 0

2,008 1,429 (579) 14,893 14,275 (618) 17,337 17,337 0

Total Expenditure 2,415 1,795 (619) 19,356 18,877 (479) 22,986 22,986 0

Cost Net of Other

Revenue(2,322) (1,750) (572) (18,717) (18,422) (295) (22,435) (22,435) 0


COMMENT ON MAJOR FINANCIAL VARIANCES Production Activity

This month has seen steady production with elective discharges at 113% against the Elective Surgical Health Target (104% YTD), with 394 elective patients seen and a further 31 ACC/IDF/Acute cases also operated on. Year to date activity (shown below) highlights that most specialties volumes and WIES are aligned, except for the General Surgical volumes, which are significantly above budget but generating lower WIES, and Urology where volumes and WIES are below budget year to date. Key drivers for the under delivery in WIES for both Urology and General Surgery is case mix and the high number of day cases.

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Overall result

The division is $572K unfavourable for the month and $295K unfavourable YTD. Contributing to the year to date unfavourable position are costs associated with the over delivery of discharges tracking at 5% above plan, unmet savings lines and additional costs of running additional weekend sessions. This month’s step increase in outsourced costs is attributed to an under-accrual of POC costs in March. The financial result over the remaining months this year are anticipated to be unfavourable as ESC plan to over deliver on their budgeted volumes to contribute to the overall surgical programme and the Waitemata DHB Surgical Health Target.

Revenue ($184K favourable for the year to date)

Total revenue is favourable year to date due to additional ACC revenue, partially offsetting S&AS under delivery. There is one contract across Waitemata DHB Surgical programme.

Personnel ($139K favourable for the year to date)

Nursing costs are $62K unfavourable this month due to additional weekend lists. Administrative costs are currently favourable $103K, but it has been agreed that the Operations manager’s costs currently being charged to S&AS will be recoded to ESC from May 2016.

Other Expenditure ($618K unfavourable for the year to date)

Outsourced services are unfavourable year to date due to POC ($426K), inline with discharges at 5.3% above plan, and unmet savings lines ($200K), offset by a one-off reimbursement for accommodations of Hine Ora patients $129K between July and November.

Clinical supplies are unfavourable this month due to over delivery on discharges and higher volumes of joints. The favourable year to date result is due to the year to date under-delivery of implant and prosthesis $280K offsetting costs associated with discharges: disposable instrument costs ($99K), hook wire costs and other supplies ($81K).

Savings in some non-clinical supplies $85K are fully offset by embedded savings lines of ($167K) and increased CSSD compliance costs ($22K).

Getting back on track initiatives

Ongoing monitoring of patients to ensure timely and appropriate discharge. Active management of staffing will continue, and inpatient beds will be closed as appropriate to contain costs.

However, as greater volumes are being undertaken at ESC to ensure the overall surgical programme delivers to budget across all three sites, this will result in over-delivery against the ESC targets to meet the Waitemata DHB Elective Surgical Health Target and lead to increased consumable costs, surgical fees and implant costs.

Increasing the diversity of surgery will assist with increasing the WIES and utilisation of inpatient beds.

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S&AS AND ESC COMBINED


Surg & Ambulatory - ESC

($000’s)


REVENUE

* Government and

Crown Agency 1,627 1,228 399 14,208 12,526 1,682 15,135 15,135 0

Other Income 141 156 (15) 1,352 1,567 (215) 1,884 1,884 0

Total Revenue 1,768 1,384 384 15,560 14,093 1,467 17,018 17,018 0

EXPENDITURE

Personnel

Medical 4,892 4,565 (327) 50,229 49,860 (369) 58,994 58,994 0

Nursing 3,962 3,622 (341) 40,066 39,386 (680) 48,236 48,236 0

Allied Health 1,273 1,220 (53) 12,894 13,282 388 15,688 15,688 0

Support 188 166 (22) 1,851 1,821 (30) 2,152 2,152 0

Management /

Administration898 895 (3) 9,566 9,750 184 11,527 11,527 0

11,213 10,467 (746) 114,607 114,100 (507) 136,598 136,598 0

Other Expenditure

Outsourced Services 1,611 1,026 (585) 11,788 10,306 (1,482) 12,480 12,480 0

Clinical Supplies 3,449 3,514 65 34,793 34,494 (299) 41,699 41,699 0

Infrastructure &

Non-Clinical

Supplies

733 466 (267) 5,989 4,616 (1,373) 5,557 5,557 0

5,793 5,006 (787) 52,570 49,416 (3,154) 59,736 59,736 0


Cost Net of Other

Revenue(15,237) (14,089) (1,149) (151,617) (149,422) (2,195) (179,315) (179,315) 0


COMMENT ON MAJOR FINANCIAL VARIANCES Overall

The overall result is $2,195K unfavourable year to date. The financial results for ESC and S&AS are anticipated to be unfavourable over the remaining months this year, as both services catch up on agreed elective volumes and incur additional costs attributed to outsourced orthopaedic volumes and ultrasound scans. Activity

Part of providing the overall health target volumes rely on active planning and partnership between ESC and S&AS. Greater volumes in General Surgery are being undertaken at ESC to ensure the overall surgical programme delivers to budget across all three sites.

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Provider Arm Support Services

SERVICE OVERVIEW Corporate Services include offices of the Chief Executive Officer/Chief Financial Officer/Chief Medical Officer/Director of Nursing/Director of Allied Health, Corporate Finance, Operational Finance, Information Systems and Management, Facilities and Development, Quality, HR and Awhina and Māori Services. It also includes outsourced healthAlliance services, NZ Health Partnerships, Other affiliation costs and financing costs. Robert Paine has overall financial responsibility for the Corporate Group.

SCORECARD – PROVIDER SUPPORT SERVICES

HR/Staff Experience Actual Target Trend Productivity Actual Target Trend

Sick leave rate 6.3 days <7.5 days Clinical Typing

Turnover rate 9% 8-12% Clinical letters turnaround time - P1 (urgent) 1.5 days <1 days

Clinical letters turnaround time - P2 2.7 days <5 days

Clinical Codinga. % coding complete by 21st next month 99% 95%

Financial Result (YTD) Actual Target Trend b. % coding complete YTD 99% 95%

Revenue 636,584 k 629,504 k

Expense 113,928 k 104,837 k Major Capital Programmes Time Budget Quality

Net Surplus/Deficit 522,656 k 524,667 k Te Atarau car park (Sep 2015)

Capital Expenditure 56,078 k 68,491 k Department of Medicine (Mar 2016)

WTH Emergency Department redevelopment (Apr 2016)

% catalogue item purchases 90% 75% Mason clinic - 15 Bed medium secure unit (Jun 2016)

Bridge ESC To Medical Tower (Jun 2016)

Lakefront (Dec 2016)





Contact:




Provider Support ServicesApril 2016

2015/16



3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range

may result in small variations appearing to be large.

a, b. March data at 23052016

How to read

Value for Money

Best Care Service Delivery

A question?

Key notes

How to read

67


STRATEGIC INITIATIVES VARIANCE REPORT

Specific deliverables/actions to deliver improved performance will consider: On Target 1. Support the implementation of Phase 2 of the National Patient Flow (NPF) Collection Programme led

by the IT team from July 2015, collecting Phase 3 information from July 2016 to enable the Ministry to collect more patient journey data

2. Inventory management for clinical and non-clinical supplies

3. Infrastructure costs/contracts and energy efficiency reviews and savings (Energy NZ review has identified opportunities for Energy Savings).

Hospital Operations - Specific deliverables/actions to deliver improved performance will consider:

4. Rollout Electronic Prescribing as part of Medication Safety Strategy, phase 3 by June 2016


4 This is in process, and will be completed by mid-August instead of by 30 June. This is as a result of adding additional areas to the rollout (ESC NSH beds, and ICU/HDU).

HOSPITAL OPERATIONS

SERVICE OVERVIEW

The Group Manager of Hospital Operations is Leith Hart. Hospital Operations includes Pharmacy, Laboratories, Nutrition and Food Services, Traffic and Fleet, Security, Clinical Engineering, Clinical Support Services, Contact Centre Collaboration, Decanting and Migration of services and Furniture Fixtures and Equipment (FF&E).

HIGHLIGHT OF THE MONTH The ePrescribing implementations into ED, ADU, Cardiology, all of the medical wards, Hine Ora and SSW, North Shore Hospital are completed. Implementation into the surgical wards will start on 16 May 2016.

KEY ISSUES Clinical Engineering is struggling to maintain high compliance with Inspection and Preventive Maintenance Programme (IPM). Increase of 500 assets since July 2015 (2,200 increase since August 2013).

The Waitemata DHB clinical equipment base is expanding to cope with the increased clinical demands across all areas and there has been a gradual resource gap between the increased volume of equipment and the technical support to maintain it. Currently, this shortfall is being managed by targeting high risk assets and staff working overtime, which is not sustainable or desirable.

The increased IPM workload is estimated at approximately 1 FTE and a business case is being formulated for submission and consideration.

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HOSPITAL OPERATIONS CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Apr-16

Hospital Operations

($000’s)


REVENUE

* Government and

Crown Agency 174 0 174 2,052 0 2,052 0 0 0

Other Income 648 621 26 6,350 6,133 216 7,411 7,411 0

Total Revenue 822 621 201 8,402 6,133 2,269 7,411 7,411 0

EXPENDITURE

Personnel

Medical 59 52 (7) 505 564 59 669 669 0

Nursing (4) 4 9 59 48 (11) 59 59 0

Allied Health 1,171 1,147 (23) 12,477 12,430 (48) 14,724 14,724 0

Support 925 860 (64) 8,960 9,481 521 11,202 11,202 0

Management /

Administration131 106 (25) 1,390 1,135 (256) 1,347 1,347 0

2,281 2,171 (111) 23,391 23,657 266 28,001 28,001 0

Other Expenditure

Outsourced Services 270 221 (50) 3,653 2,205 (1,448) 2,646 2,646 0



Clinical Supplies1,045 949 (96) 10,046 9,280 (766) 11,250 11,250 0

3,543 3,260 (283) 35,950 31,938 (4,012) 37,439 37,439 0


Cost Net of Other

Revenue(5,002) (4,809) (193) (50,939) (49,462) (1,477) (58,030) (58,030) 0


COMMENT ON MAJOR FINANCIAL VARIANCES The overall result for Hospital Operations is $1.5M unfavourable for the year to date April 2016.

Revenue ($2,269K favourable for the Year to Date)

Total revenue is favourable year to date, primarily due to additional funding of $1.6M received to offset additional costs incurred for unbudgeted services approved in 2016/17. This includes Outpatient Pharmacy at Waitakere Hospital, VRE screening and additional security at Waitakere Emergency Department. Additional revenue of $416K was received from Pharmac for rebates relating to 2014/15 that were higher than the amount advised in July 2015. Laboratory income for tests done for other DHBs is $133K favourable year to date and recharges to other inpatient services for security services is $71K favourable for the year to date.

Expenditure ($3,745K unfavourable Year to Date)

The unfavourable variance year to date is due to unbudgeted additional services and activity-related consumable costs. Services not included in the budget that have offset additional revenue are $1.6M unfavourable year to date. Additional Clinical Support Services (cleaning and orderlies) not budgeted are $940K unfavourable for the year to date. Laboratory consumables and sendaway tests are $387K unfavourable for the year to date, primarily due to a 8% increase in Microbiology testing. Blood products are also $374K unfavourable year to date due to volume, particularly Intragram, which has increased 58% on last year.

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HEALTH INFORMATION GROUP

HIGHLIGHT OF THE MONTH The National Health Board has initiated a project that used the Healthcare Information and Management Systems Society (HIMSS) Analytics Electronic Medical Record Adoption Model (EMRAM) to score the 20 District Health Boards across New Zealand. The scoring has 7 stages, and each stage needs to be completed before progressing to the next stage. The initial results released in early June shows Waitemata DHB as one of just three DHBs who scored over 5; the remaining DHBs scored under 3.

This is a great result and the Leapfrog programme has been a key contributor. The investment in eOrders (Radiology and Laboratory), eVitals and in particular ePrescribing have made a big difference.

KEY ISSUES National Collection Compliance

The amount of resource needed to manage and maintain compliance of our National Collections is increasing. This requires a significant amount of correction work to our Patient Management System. It has been logged as a risk and to mitigate, a bid has gone in for an additional FTE in 2016/17.

SCORECARD VARIANCE REPORT Clinical Typing P1

Whilst the April incoming dictation volumes decreased by 12% on the previous month’s volume, the average turnaround time moved from 1.4 days in March to 1.5 days in April. This was due to higher than average sick leave, staff being away on annual leave, as well as four transcriptionists working on the LeapFrog Voice Recognition project. The external contractor’s output decreased by 4% relative to the March output. Overtime, temporary and outsourced transcription services increased and a result the average turnaround time has dropped to 1.3 days in May.

FACILITIES AND DEVELOPMENT

HIGHLIGHT OF THE MONTH The Waitemata DHB Asbestos Management Group has been established to provide guidance and to set

Waitemata DHB policy in regard to the Asbestos regulations and Health and Safety at Work Act.

KEY ISSUES Key F&D positions are vacant at present, recruitment is under way to source replacements; however, the

market for these types of roles is presently very tight o HSE manager – recruitment has commenced o Two F&D engineers – one engineer employed o Sustainability manager – recruitment has commenced

Waitemata 2025 programme impacts on resourcing, programme uncertainty and availability of experienced senior managers. Recruitment has commenced.

Availability of on-site storage for reserve beds and equipment. Onsite equipment storage is causing elevated fire and evacuation risks. Project has been initiated.

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Provider Support

($000’s)


REVENUE

* Government and

Crown Agency 66,002 61,801 4,201 628,570 617,987 10,583 741,590 741,590 0

Other Income 1,806 1,822 (17) 16,415 17,650 (1,235) 22,584 22,584 0

Total Revenue 67,808 63,624 4,184 644,986 635,637 9,348 764,174 764,174 0

EXPENDITURE

Personnel

Medical 1,298 430 (867) 954 1,126 171 2,330 2,330 0

Nursing 2,152 1,791 (361) 720 (1,026) (1,746) (6,377) (6,377) 0

Allied Health 2,666 1,976 (690) 14,996 13,258 (1,738) 17,119 17,119 0

Support 1,173 1,004 (168) 10,299 10,666 367 12,975 12,975 0

Management /

Administration2,765 2,101 (664) 24,053 23,822 (230) 28,125 28,125 0

10,053 7,303 (2,750) 51,022 47,846 (3,177) 54,172 54,172 0

Other Expenditure

Outsourced

Services3,573 3,239 (334) 32,486 32,386 (99) 38,863 38,863 0


Infrastructure &

Non-Clinical

Supplies

7,071 6,231 (840) 66,442 62,547 (3,895) 75,126 75,126 0

13,230 11,309 (1,921) 122,247 112,587 (9,659) 134,213 134,213 0


Cost Net of Other

Revenue44,524 45,012 (487) 471,717 475,204 (3,488) 575,789 575,789 0



Provider Support

($000’s)


CONTRIBUTION

Corporate Services (8,194) (7,923) (270) (78,122) (82,209) 4,088 (97,923) (97,923) 0

Facilities and Developm (2,149) (2,260) 111 (25,433) (23,307) (2,126) (27,842) (27,842) 0

Hospital Operations (5,002) (4,809) (193) (50,939) (49,462) (1,477) (58,030) (58,030) 0

Provider Mgmt 59,869 60,004 (135) 626,210 630,184 (3,973) 759,583 759,583 0

Net Surplus/Deficit 44,524 45,012 (487) 471,717 475,204 (3,488) 575,789 575,789 0


COMMENT ON MAJOR FINANCIAL VARIANCES The overall result for Hospital Operations is $1.5M unfavourable for the year to date April 2016.

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Waitemata DHB Hospital Advisory Committee Meeting 29/06/2016

4.2 Provider Arm Performance Report – May 2016

Recommendation That the report be received. ___________________________________________________________________________ Prepared by: Robert Paine (Chief Financial Officer and Head of Corporate Services) and Cath Cronin (Director of Hospital Services)

This report summarises the Provider arm performance for May 2016.

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Table of Contents

GLOSSARY HOW TO INTERPRET THE SCORECARDS

SCORECARD – ALL SERVICES HEALTH TARGETS ELECTIVE PERFORMANCE INDICATORS FINANCIAL PERFORMANCE

73


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

CLAB Central Line Associated Bacteraemia

CT Computerised Tomography

CW&F Child, Women and Family service

DNA Did not attend

ESC Elective Surgery Centre

ESPI Elective Services Performance Indicators

FSA First Specialist Assessment (outpatients)

FTE Full Time Equivalent

HNSO Hazardous Substances and New Organisms

ICU Intensive Care Unit

iFOBT Immuno Faecal Occult Blood Test

MHOPS Medicine and Health of Older People Services

MHSG Mental Health service group

MoH Ministry of Health

MTD Month To Date

MOSS Medical Officer Special Scale

NOF Neck of Femur

NSH North Shore Hospital

OHBC Oral health business case

ORL Otorhinolaryngology (ear, nose, and throat)

PACU Post-operative Acute Care Unit

PHO Primary Health Organisation

PoC Point of Care

S&AS Surgical and Ambulatory Services

SCBU Special care baby unit

SMO Senior Medical Officer

SSU Sterile Services Unit

TLA Territorial Locality Areas

WIES Weighted Inlier Equivalent Separations

WTH Waitakere Hospital

YTD Year To Date

74


How to interpret the scorecards

Traffic lights For each measure, the traffic light indicates whether the actual performance is on target or not for the reporting period (or previous reporting period if data are not available as indicated by the grey bold italic font).

The colour of the traffic lights aligns with the Annual Plan:

Traffic light Criteria: Relative variance actual vs. target Interpretation

On target or better Achieved

95-99.9% achieved 0.1% - 5% away from target Substantially Achieved

90-94.9%*achieved 5.1% - 10% away from target AND improvement from last month

Not achieved, but progress made

<94.9% achieved 5.1% - 10% away from target, AND no improvement, OR >10% away from target

Not Achieved

Exception: Cardiac arrest calls is Green if number ≤ 1, Blue if =2, Amber if = 3 and Red if ≥4 Trend indicators A trend line and a trend indicator is reported against each measure. Trend lines represent the actual data available for the latest 12-months period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. The small data range may result in small variations appearing to be large. Note that YTD measures (e.g., WIES volumes, revenue) are cumulative by definition. As a result their trend line will always show an upward trend that resets at the beginning of the new financial year. The line direction is not necessarily reflective of positive performance. To assess the performance trend, use the trend indicator as described below. The trend indicator criteria and interpretation rules:

Trend indicator

Rules Interpretation

Current > Previous month (or reporting period) performance Improvement

Current < Previous month (or reporting period) performance Decline

Current = Previous month (or reporting period) performance Stable

By default, the performance criteria is the actual:target ratio. However, in some exceptions (e.g., when target is 0 and when performance can be negative (e.g., net result) the performance reflects the actual. Look up for scorecard-specific guidelines are available at the bottom of each scorecard:

Actual Target Trend

Better help for smokers to quit - hospitalised 98% 95%



3. Trend lines represent the data available for the latest 12-months period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. Small data range may

result small variations perceived to be large.

a. ESPI traffic lights follow the MoH criteria for funding penalties:

ESPI 2: the traffic light will be green if no patient is waiting, blue if greater than 0 patients and less than or equal to 10 patients or less than 0.39%, and red if 0.4% or higher.

ESPI 5: the traffic light will be green if no patient is waiting, blue if greater than 0 patients and less than or equal to 10 patients or less than 0.99% and red if 1% or higher.

Key notes

Trend indicator

Traffic light Measure description

75


Scorecard – All services



Shorter Waits in ED 96% 95%

Faster cancer treatment (62 days) 73% 85% Waiting Times

ESPI 2 - % patients waiting > 4 months for FSA compliant

ESPI 5 - % patients not treated w/n 4 months compliant

ESPI 1 compliant

Patient Experience Actual Target Trend Patient Flow

Complaint Average Response Time 12 days <14 days a. Average Length of Stay - Electives 1.30 days 1.77 days

a. Average Length of Stay - Acutes 2.5 days 2.76 days

Quality & Safety Trend Outpatient DNA rate (FSA + FUs) - Total 9% <10%

Older patients assessed for falling risk 99% 90% Outpatient DNA rate (FSA + FUs) - Māori 20% <10%

Rate of falls with major harm 0.03 <2 Outpatient DNA rate (FSA + FUs) - Pacific 19% <10%

b. Good hand hygiene practice 82% 80%

S. aureus infection rate 1.00 <0.2

Occasions insertion bundle used 96% 95%

Pressure injuries grade 3&4 1.00 0.00 Financial Result (YTD) Actual Target Trend

Revenue 772,060 k 748,645 k

HR/Staff Experience Trend Expense 788,531 k 748,572 k

Sick leave rate 8.5 days <7.5 days Net Surplus/Deficit -16,471 k 72 k

Turnover rate 11% 8-12% Capital Expenditure 66,728 k 82,839 k

Contracts (YTD)







a. December data not yet available.


ALL ServicesMay 2016

2015/16

Contact:





3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range may

result in small variations appearing to be large.

a. 2015/16 new MoH Average length of stay definition.

b. Quarterly data - March

Health Targets

How to read

Value for Money

Best Care

Service Delivery

A question?

Key notes

How to read

76


Health Targets

Better Help for Smokers to Quit

Shorter Stays in Emergency Departments

77


Emergency Department/ ADU Presentations

Improved Access to Elective Surgery

Note: Changes were made to the electives health target for 2015/2016

Percentage Change ED & Elective Volumes

May 2016 Month Volumes % Change (last

year) YTD Volumes

% Change (last year)

ED / ADU Volumes 10,103 1% 111,385 4%

Elective Volumes 1236 -1% 12017 -2%

78


Elective Performance Indicators

Zero patients waiting over 4 months

90% of outpatient referrals acknowledged and processed within 10 days

Legend

ESPI 1: Green if 100%, Yellow if between 90% and 99.9%, and Red if 90% or less.

ESPI 2: Green if 0 patients, Yellow if greater than 0 patients and less than or equal to 10 patients or less than 0.39%, and Red if 0.4% or higher.

ESPI 5: Green if 0 patients, Yellow if greater than 0 patients and less than or equal to 10 patients or less than 0.99%, and Red if 1% or higher.

Compliant Non Compliant Non Compliant %

Speciality Non Compliance % ESPI 2 Anaesthes iology 66 - 0.00%

ESPI2 0.01% Cardiology 1,217 - 0.00%

ESPI5 0.23% Dermatology 158 - 0.00%

Diabetes 166 - 0.00%

Endocrinology 335 - 0.00%

Gastro-Enterology 808 - 0.00%

General Medicine 131 - 0.00%

General Surgery 1,306 - 0.00%


Haematology 93 - 0.00%

Infectious Diseases 30 - 0.00%

Neurology 58 0.00%

Orthopaedic 1,494 1 0.07%

Otorhinolaryngology 1,621 - 0.00%

Paediatric MED 812 - 0.00%

Renal Medicine 165 - 0.00%

Respiratory Medicine 384 0.00%

Rheumatology 199 - 0.00%

Urology 540 - 0.00%

Total 10,450 1 0.01%

ESPI 5 Cardiology 37 - 0.00%

General Surgery 1,174 0.00%


Orthopaedic 872 8 0.91%

Otorhinolaryngology 450 - 0.00%

Urology 366 - 0.00%

Total 3,473 8 0.23%

Summary (May 16) ESPI

Specialty Compliance %

Anaesthes iology 100.00%

Cardiology 96.28%

Dermatology 99.07%

Diabetes 99.02%

Endocrinology 100.00%

Gastro-Enterology 98.64%

Genera l Medicine 100.00%

Genera l Surgery 98.19%

Gynaecology 99.81%

Haematology 99.50%

Infectious Diseases 100.00%

Orthopaedic 99.30%

Otorhinolaryngology 98.82%

Paediatric MED 99.39%

Renal Medicine 100.00%

Respiratory Medicine 99.21%

Rheumatology 100.00%

Urology 93.60%

Total 98.63%

ESPI 1 (May 16)

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Financial Performance

CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date May-16

Provider

($000’s)


REVENUE

Government and Crown

Agency 76,276 65,848 10,428 748,743 724,050 24,693 789,863 789,863 0

Other Income 1,794 2,320 (526) 23,317 24,595 (1,278) 28,149 28,149 0

Total Revenue 78,071 68,169 9,902 772,060 748,645 23,415 818,012 818,012 0

EXPENDITURE

Personnel

Medical 14,608 12,151 (2,457) 153,010 148,231 (4,780) 162,117 162,117 0

Nursing 19,035 17,865 (1,169) 201,765 195,719 (6,046) 213,257 213,257 (0)

Allied Health 9,477 8,392 (1,085) 98,118 96,356 (1,762) 105,747 105,747 0

Support 1,404 1,520 116 14,323 14,628 305 15,858 15,858 0

Management /

Administration5,419 3,916 (1,503) 56,371 54,280 (2,090) 59,583 59,583 0

49,942 43,844 (6,098) 523,586 509,214 (14,373) 556,562 556,562 0

Other Expenditure

Outsourced Services 5,415 5,055 (360) 59,602 54,868 (4,734) 59,998 59,998 0

Clinical Supplies 9,938 8,779 (1,159) 101,616 93,736 (7,880) 101,429 101,429 0


Clinical Supplies13,214 8,284 (4,930) 103,726 90,755 (12,972) 99,023 99,023 0

28,567 22,117 (6,450) 264,944 239,359 (25,586) 260,449 260,449 0

Total Expenses 78,509 65,962 (12,548) 788,531 748,572 (39,958) 817,012 817,012 0

Net Surplus/Deficit (439) 2,207 (2,646) (16,471) 72 (16,543) 1,000 1,000 0


CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date May-16

Provider

($000’s)


CONTRIBUTION

Surg & Ambulatory (13,298) (12,108) (1,190) (146,198) (143,108) (3,089) (156,881) (156,881) 0

Medical & HOPS (17,518) (16,069) (1,449) (197,946) (189,599) (8,347) (209,155) (209,155) 0

Child Women Family (6,005) (5,649) (356) (67,522) (64,990) (2,532) (71,722) (71,722) 0

Mental Health (8,963) (8,646) (317) (103,150) (103,692) 542 (114,596) (114,596) 0

Elective Surgery Centre (2,326) (1,917) (409) (21,043) (20,339) (704) (22,435) (22,435) 0

Provider Support 47,671 46,596 1,075 519,387 521,801 (2,413) 575,789 575,789 0

Net Surplus/Deficit (439) 2,207 (2,646) (16,471) 72 (16,543) 1,000 1,000 0


CONSOLIDATED STATEMENT OF PERSONNEL by PROFESSIONAL GROUP Reporting Date May-16

Provider


FTE

Medical 700 725 24 713 707 (5) 708 708 0

Nursing 2,880 2,819 (62) 2,765 2,770 6 2,771 2,771 0

Allied health 1,575 1,580 6 1,512 1,547 35 1,552 1,552 0

Support 347 337 (10) 321 339 18 339 339 0

Management 828 828 0 806 819 13 820 820 0

Total FTE 6,331 6,289 (42) 6,117 6,183 65 6,190 6,190 0


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5.1 Clinical Leaders Report

Recommendation That the report be received.

Prepared by: Dr Andrew Brant (Chief Medical Officer), Dr Jocelyn Peach (Director of Nursing and Midwifery; Emergency Systems Planner) and Tamzin Brott (Director of Allied Health)

Medical Staff 1. College Accreditation for training

a. The College of Intensive Care medicine of Australia and New Zealand visited the ICU at North Shore Hospital in February 2016 as part of their routine re-accreditation of ICU training. The service was accredited for 5 years. The Team highlighted the enthusiastic, proactive and collegial culture within the service and very supportive specialist and nursing group, the service was well structured and active outreach service. No matters need to be addressed for accreditation purposes, but for the future needed to look at administrative support to ICU and establish a process to increase the proportion of postgraduate critical care certified nursing staff.

b. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists undertook a reaccreditation visit to North Shore Hospital in March 2016 for training. North Shore Hospital was granted full accreditation for a period of 4 years. The report noted that “North Shore Hospital has transformed itself into an outstanding training site, with a positive supportive culture for training. There is strong leadership with a proactive approach to future development of service staff and training” The report did identify a shortage of registrar numbers, as a result of unfilled posts and maternity leave, recommended looking at the consultant team structure and on-call consultant gynaecology cover, expansion of education programme, and protected training/teaching time. We will be providing a progress report in 12 months on these issues.

2. RMOs a. We have had confirmation from the medical council for two new education supervisors, Andrew

Herd in General Surgery and Valerie Ozorio in General Medicine/ADU. This now provides with the appropriate level on education supervisors for our PGY1 and PGY2 junior doctors

b. We have successfully implemented a new educational training programme for PGY2 (second year junior doctors), which full day workshop twice a quarter. This is an innovative programme for the second year junior doctors, Dr Eleri Clissold; education fellow has developed this programme.

Nursing and Midwifery; Emergency Planning Systems Emergency Planning Systems

In May a request was made for a description of the DHB Emergency Planning processes. A brief overview is presented in anticipation of further discussion. Health emergency planning is integrated into the national emergency planning structure from government through local Civil Defence and Emergency Management groups [CDEM].

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The national Civil Defence Emergency Management plan 2015 [CDEM] requires that DHBs are able to function to the fullest possible extent during and after an emergency by:

Providing continuity of care for existing patients, the management of increased demand for service and assistance with the recovery of services

Planning in an integrated way locally and regionally through plans that are aligned with emergency services and regional group planning

Planning and response is integrated with public health planning and responses All health agencies have emergency plans that are consistent in regards to guiding principles and link from central national agencies to frontline processes. The guiding principles underpinning all emergency plans include:

all-hazards (‘hazardscape’) approach considering the needs of the Waitemata district and population in the context of the Auckland region

planning that includes risk reduction and processes for readiness, response and recovery

self-sufficiency using an Incident Management Team [IMT] applying the Coordinated Incident Management System [CIMS]

connectedness with other agencies

[i] across the district [i.e. primary care, residential aged care, cultural groups, disability and NGO agencies] [ii] regional health providers [i.e. other district health boards, St John, Auckland Regional Public Health Service]

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[iii] emergency service providers [i.e. Auckland Council Civil Defence Emergency Management, Fire, Police, Lifelines Groups] [iv] national [i.e. Ministry of Health, other DHBs]

• link with welfare and support agencies. Ensure special provisions for hard-to-reach, vulnerable communities, different cultures and communities, resources, both human and other, to help people from culturally and linguistically diverse communities, and overseas visitors who may be unfamiliar with New Zealand practices. Also planning for welfare of our staff who are affected by the emergency, including those operating during it.

All DHBs have a range of plans that support the organisation and lead individuals to prepare for and respond to a wide range of possible emergency situations. Plans exist as follows:

Why STRATEGIC (Vision and Culture)

Health Emergency Plan [HEP]

What TACTICAL (Supporting Systems)

Major Incident Plan

How OPERATIONAL (Underpinning

Processes/Business Continuity Plans)

Emergency Preparedness and Response Processes

Local plans

Contingency and resilience

All emergency plans use the 4R’s framework of reduction, readiness, response and recovery.

Reduction Identifying and analysing risks and taking steps to eliminate these risks and reducing the likelihood and magnitude of their impact.

Readiness Developing operational systems and capabilities before an emergency happens. These include self-help and response programs

Response Actions taken immediately before, during and directly after an emergency, to save lives and property, prevent spread of disease and support community health needs

Recovery Activities beginning after the impact has been stabilized in the response phase. Extends until community capacity for self-help has been restored.

All emergency services in New Zealand use the Coordinated Incident Management System [CIMS] to manage the command and control processes in an emergency situation. The DHB Incident Management Team [IMT] process is led by an Incident Controller, supported by key roles of Planning and Intelligence, Operations and Logistics and operationally manages the event. They liaise closely with the senior management team.

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Waitemata DHB Structure

The Waitemata DHB emergency planning processes is led by the Emergency Systems Planner [0.2] who holds the strategic oversight and external relationships role. The Emergency Response Advisor [1.0] and Fire Specialist Trainer [0.8] focus on planning, training and exercises for the DHB staff and facilities [owned and leased].

The DHB Executive Leadership Group oversees the Emergency Planning agenda, supported by the Emergency Systems Governance Oversight group.

The DHB provider services have representatives on the DHB Emergency Systems Governance Oversight group which is coordinated by the Emergency Systems Planner.

The Waitemata DHB Emergency Systems Planner represents the DHB on the northern region Health Coordinating Executive Group [HCEG], which reports to the Chief Executives of the region. Dale Bramley is the lead Chief Executive for Emergency Planning on behalf of the regional group.

Waitemata DHB

Executive Leadership

Team

Emergency

Response

Advisor

[1.0 fte]

Fire Specialist

Trainer [0.8]

Emergency

Systems

Planner

[0.2fte]

Northern Health

Coordinating

Executive Group

Northern CEOs

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Plans and processes are documented for a range of potential situations and area available for reference by key staff for training and response. These documents outline the response procedures for the operational component guidance preparation and response. There are checklist and Unit Specific Emergency Plans. And also description of roles and responsibilities of individuals or groups during specific events.

Education of teams includes orientation awareness, warden training, IMT training

There is an Incident Management Team [IMT] and key staff are trained for lead roles to undertake a Coordinated Incident Management System [CIMS] response.

Testing and Exercising of the plans and processes are coordinated to ensure that staff know how to respond to a range of simple or more complex situations and to work with the IMT if needed. This develops capability and capacity.

There is an Incident Operations Centre [IOC] identified and resourced where the IMT can work in the event there is a situation requiring a major response. There are two IOC options: Elective Surgical Centre administration and lower ground floor at North Shore Hospital site. Local Incident Control Points [ICP] can be set up on any site.

There are resources available that can be used for various situations e.g. emergency phones, additional lighting, emergency cabinets, reference documents and maps.

The hospital buildings are planned for strength and resilience e.g. sprinklers and EWIS fire alert systems, emergency power, water storage, fuel/diesel storage, supply contracts.

Planning as part of the northern regional Health services and Civil Defence and Emergency Services. Waitemata DHB works with the health agencies for the northern region includes the following agencies:

Auckland Region Public Health Services

Counties Manukau DHB

Waitemata DHB

Northland DHB

St John

Waitemata DHB works with the Civil Defence Emergency Management [CDEM] and other emergency services Auckland City CDEM and Welfare agencies MCDEM regional representatives Police Fire Coast Guard

The health agencies plan and test the plans for a range of scenarios and events at a regional and local level. These include:

Ill passenger [Flu Cruise scenario and quarantine]

Mass rescue of cruise ship with 2100 people evacuated

Blue sky [International Airport]

Mass arrival

Remote ashfall impact

Power outage impact on a hospital being unable to function for a period and other hospitals in the region needing to help to manage demand

Tangaroa Tsunami Exercise - 31 August, 14 September, and 28 September 2016

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There is considerable planning underway as a region for the 2017 World Games and health is developing plans to cope with the potential for increased demand. In the event of a major incident, health works together as a region, in liaison with the CDEM and other agencies. Health works out of the Northern Health Incident Management Centre on Level 5 at Auckland City Hospital.

This brief overview is supported by considerable detail should further information be required.

Allied Health, Scientific and Technical Staff “With Compassion”, Better, Best Brilliant”, “Everyone Matters” and Connected”

2016 Health Volunteer Awards – Margaret Wickens – Runner-up Long Service Volunteer Award, Volunteer Stroke Scheme

The Health Volunteer Awards celebrate and recognise those volunteers who give many hours of their time to help our communities. We are delighted to announce that Margaret Wickens was awarded a runner-up long service volunteer award on Monday 13 June for her tireless work with our Volunteer Stroke Scheme over the 26 years she has volunteered with the service.

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Margaret Wickens trained as a volunteer conversation partner with the Volunteer Stroke Scheme in 1990, and since then has given thousands of hours to helping people with post-stroke communication impairments. Over this time, she has worked as a conversation partner with seven different patients at various times. This involves using strategies recommended by the speech-language therapist so that the patient has focused conversation time to practice these strategies and gain confidence. Margaret has also helped to facilitate three different conversation groups over approximately nine years, meeting each week with two or three other volunteers, and up to eight clients, to converse together. Margaret’s role as a facilitator is to help provide a safe environment, where the clients are encouraged to talk, and are enabled to do so as a result of the skills and strategies she uses. The 2016 Minister of Health Volunteer Awards were presented on 13 June 2016 in Wellington, with regional presentations made during National Volunteer Week (19–25 June 2016). Margaret was presented with her award by the Hon Simon O'Connor during the regional presentation at Ko Awatea, on Thursday 23 June 2016.

About the Service – The Volunteer Stroke Scheme (VSS) is an Auckland regional service run by Waitemata DHB that supports people in using, maintaining and enhancing their communication after a stroke. The service provides volunteers (currently approximately 125 volunteers) who are trained as “conversation partners” and who use Total Communication Strategies to give people opportunities to participate in effective communication and social interaction. This interaction takes place in a one-to-one or conversation group setting. People referred remain under the oversight of a speech language therapist for the duration of their time with the Volunteer Stroke Scheme.

Allied Health Quality Improvement Lead With Kelly Bohot’s secondment in the Allied Health Quality Improvement Fellow role coming to an end at the end of June, I am pleased to announce the appointment of Amanda Bishop to the role of Allied Health Quality Improvement Lead. Amanda has held the role of Allied Health Team Leader for the West and Rodney teams of community allied health, outpatient physiotherapy and EDARS (Early Discharge and Rehabilitation Service) since 2011. Amanda has an occupational therapy clinical background and has extensive clinical and leadership experience within Waitemata DHB across the Orthopaedics, Acute Medical, AT&R and Community Health services. Amanda holds a Master of Health Science (MHSc) and is in the final days of completing a Master of Business Administration (MBA). Over the past five years Amanda has lead a number of quality initiatives across the services involving multiple disciplines. In addition Amanda is a skilled professional supervisor. Amanda starts in the role on July 25 2016. “Better, Best Brilliant”, “Connected” Launch of the Stroke Service CeDSS site Clinicians working with stroke patients now have a new clinical guidance resource that can be accessed via the CeDSS (clinical e-decision support site) on Staffnet.

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Along with medical and nursing guidelines the Stroke Service CeDSS site holds a comprehensive rehabilitation and recovery section. The rehabilitation and recover section has been compiled by senior rehabilitation physiotherapist Luke Skinner and professional leader for occupational therapy Louise Lennon. Their work builds on a CeDSS/AUT summer studentship collaboration with allied health students Vanessa Bruining and Mei Morton to make the complex New Zealand Stroke Guidelines more accessible. Medical information is provided by neurologist Dr Nicholas Child and nursing resources by Binita Prakash. Contact and referral information are also available

New Podiatry Clinics in conjunction with AUT We are developing a conjoint clinic with AUT podiatry school at the new AUT clinic in Northcote. Our patients will be seen by Waitemata DHB staff at the AUT clinic in conjunction with students and AUT clinical educators. This will provide enhanced access to services for patients and exposure for students to working with active foot complications and managing the high risk foot. It will provide us with additional clinic space, access to equipment such as in-shoe pressure measurement and in-depth gait analysis, facilitate research opportunities and improve collaboration with the Podiatry School at AUT. Project planning is currently underway with a projected start date for patients in mid 2017. Ward 5 Allied Health Electronic Whiteboard Referral Trial We have been working with Lightfoot on a number of medical ward quality initiatives. The primary objective of the trial is to reduce the number of inappropriate allied health referrals which in turn necessitates an allied health clinical review. By reducing inappropriate referrals we are able to better utilise clinical time screening notes and assessing patients who will benefit from allied health clinical input. An associated objective is to improve the quality of referrals. All allied health referrals on Ward 5 are now received via the electronic whiteboard (eWW) only.

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Preparation and tools included developing a one page allied health referral criteria handout, which has been laminated and positioned at each computer, plus and education programme for Medical and Nursing staff on the ward. The trail has been underway for approximately five weeks and results so far have shown a decrease in the percentage of inappropriate referrals for Physiotherapy. Whilst we have manually measured this on Ward 5 for Physiotherapy only, it is assumed that this effect is also occurring for other disciplines such as occupational therapy and social work. The charge nurse manager on Ward 5 is monitoring referrals. Plan: The plan is to move the trial out to Ward 6 early June and monitor results. If the same results occur electronic whiteboard referrals for allied health will be rolled out across all general medical wards. “Everyone Matters” Sonography staffing We are pleased to welcome Paula Edwards, Sonography Team Leader, to Waitemata DHB as we continue to build and grow the Sonography team. We are working regionally and nationally reviewing training options and new ways of supporting sonographers in the future. Our current vacancy stands at 3.75fte of our budgeted 10.20fte, a reduction of 3.25fte from the vacancy gap of 7.00fte* as at 31 January 2016 (*Draft Strategic Workforce Services DHB Sonographer Workforce Workforce Assessment Report, 29 April 2016). We have one overseas candidate who has completed her REA assessment and we await her results, along with a second overseas candidate who is working through the MRTB and immigration process to join the team later this year. Our trainee sonographer Emma sits her final exam this week and has been offered a full time position with Waitemata DHB. We have two other trainees due to qualify at the end of this year and plan to be fully staffed by December.

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5.2 Human Resources

Recommendation: That the report be received. Prepared by: Fiona McCarthy (Director Human Resources) Glossary

CME - Continuing Medical Education FTE - Full Time equivalent SMO - Senior Medical Officer Time to Hire - Calculated from the time a Recruitment Requisition is approved to the time an offer is

accepted by a candidate.

Purpose of report

This report outlines key people and organisational development activities across Waitemata District Health Board and reports on progress with workforce plan actions. 1. Highlight of the month The scholarships awarded for 2016 were presented to successful candidates on 15 April. Current recipients and first time recipients were invited together with their whānau to come and celebrate all their achievements in the year gone by, and to share encouragement and inspiration for the year ahead. The event was well supported by 15 scholarship recipients, their whānau, our Director of Human Resources, the Pacific Health team, and the Maori health team. Commendation goes to the Workforce Development team who arrange and support the scholarship students. 2. Strategic Alignment

Community, whanau and patient centred model of care

The report outlines recruitment, workforce or organisational development programmes and actions that can impact internal and external models for care.

Service integration and/or consolidation

The report outlines work undertaken collaboratively across the organisation.

Intelligence and insight

The recruitment and ethnicity dashboards give information and insight into the impact of our recruiting processes.

Evidence informed decision making and practice

Where possible, all improvement or new programmes of work will use evidence based frameworks to develop and/or evidence to enhance existing work. All programmes are evaluated to understand the value and return on investment.

Outward focus and flexible, service orientation

Improvements sought in relation to policy, process or programmes will be co-designed with service users.

Operational and financial sustainability

Robust recruitment, workforce and organisational development frameworks, strategies and actions support sustainable business practises.

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3. Recruitment 3.1 Recruitment Dashboard for March and April 2016

March 2016 April 2016 Total number of hires 207 203 Average time to hire 93.5 days 95.45 days Average number of positions recruiting to (FTE)

306.26 (FTE)

307.40 (FTE)

Current number of vacancies from the vacancy report (FTE)

Service FTE Service FTE Medical 31 Medical 31.7 Nursing 180.9 Nursing 203.1 Allied Health 76.5 Allied Health 68 Support 38.4 Support 37.5 Mgt/Admin 38.8 Mgt/Admin 38 Total 365.6 Total 378.3 (vacancy rate of 5.4% of total FTE)

(as at 30 March 2016) (vacancy rate of 5.4% of total FTE)

(as at 29 April 2016) The average number of FTE vacant has remained stable over 300 FTE as has the vacancy rate of 5.4%. There has been an increase in the FTE vacant in Nursing and a slight decrease in Allied Health. The hires and average time to hire also remained high but stable over 200 and over 90 days. 3.2 Time to Hire The average time to hire below has been slowly increasing to over 90 days (Table 1). In April the overall time to hire was 95.44 days. The increase can be attributed to the increase in recruitment time for a number of roles as below: • Team Leader sonography took 333 days • Clinical Director - Quality Improvement (Fixed Term) – took 127 days • HSNO coordinator role – 112 days – had to be re-advertised • Procurement and Supply Chain Analyst – 125 Days • Faster Cancer Tracking Facilitator (1FTE, 3 year fixed term (181 Days), Cancer Services - had to be

re-advertised • Specialty Nurse/ Clinical Nurse Specialist (0.5FTE) - 115 days • Medical Radiation Technologist – 120 days – hard to fill role • Staff Physiotherapist – 339 days – Hard to fill role

Most Senior Medical Officer roles tend to take longer to recruit to and it is possible that the time it takes to recruit to one role can lift the overall average so Table 3 shows the average time to hire for SMOs which was 77.3 days in April which is lower than the previous months. If we exclude SMOs from our overall average time to hire, the average is 80.15 days (Table 2).

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Table 1: Overall Average time to hire May 2014 to April 2016

Table 2: Average time to hire for all other roles (excluding SMOs) May 2014 to April 2016

Table 3: Average time to hire for SMOs May 2014 to April 2016

0102030405060708090

100 Average Time to Hire (OverAll)

Total

Linear (Total)

0102030405060708090

100 Average Time to Hire (other)

Other

Linear (Other)

0

50

100

150

200

250

300

May

-14

Jun-

14Ju

l-14

Aug-

14Se

p-14

Oct

-14

Nov

-14

Dec-

14Ja

n-15

Feb-

15M

ar-1

5Ap

r-15

May

-15

Jun-

15Ju

l-15

Aug-

15Se

p-15

Oct

-15

Nov

-15

Dec-

15Ja

n-16

Feb-

16M

ar-1

6Ap

r-16

May

-16

Jun-

16

Average Time to Hire (SMO)

SMO

Linear (SMO)

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3.3 Top sources for recruitment The two highest sources for Waitemata continue to be the friend referral and the Waitemata DHB careers site. The use of Seek has increased to accommodate a large number of non-clinical roles being advertised in the project space.

Rank / Source April 2015 April 2016

1. www.wdhbcareers.co.nz 22% 31%

2. A Friend 14% 15%

3. WDHB Intranet 8% 10%

4. Seek 6% 9%

5. www.kiwihealthjobs.co.nz 5% 6%

Table 4: Top 5 Sources of Hire for Apr 2015 vs Apr 2016 3.4 Ethnicity of new employees Below are two tables detailing the ethnicities of current employees by profession (Table 5) and the ethnicities of staff recruited in the last three months, also by profession (Table 6). Analysis of the data shows us that in the last three months there have been more hires of Asian and MELAA ethnicities than the existing ethnicity profiles.

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http://www.wdhbcareers.co.nz/


NZ / European

Asian

Pacific

Maori

MELAA

Total FTE Total %

FTE % FTE % FTE % FTE % FTE %

MEDICAL PERSONNEL 494.88 66% 205.97 27% 13.00 2% 14.58 2% 22.15 3% 750.58 100%

NURSING PERSONNEL 1,519.87 59% 847.99 33% 102.90 4% 79.50 3% 31.68 1% 2,581.94 100%

ALLIED HEALTH PERSONNEL 1,039.54 67% 302.37 20% 80.19 5% 101.30 7% 20.80 1% 1,544.20 100%

SUPPORT PERSONNEL 133.97 45% 103.31 35% 41.42 14% 18.84 6% 1.00 0% 298.54 100%

MGT/ADMIN PERSONNEL 682.04 79% 97.99 11% 35.79 4% 41.10 5% 9.74 1% 866.66 100%

Grand Total 3,870.30 64% 1,557.63 26% 273.30 5% 255.32 4% 85.37 1% 6,041.92 100% Table 5 – Ethnicity of all staff for three months to 30 April 2016 - MELAA is a group amalgamation of Middle Eastern, Latin American and African ethnicities

NZ / European

Asian

Pacific

Maori

MELAA

Total FTE Total %

FTE % FTE % FTE % FTE % FTE %

MEDICAL PERSONNEL 42.32 61% 22.60 32% 3.00 4%

0% 2.00 3% 69.92 100%

NURSING PERSONNEL 87.39 58% 48.10 32% 8.00 5% 3.80 3% 4.60 3% 151.89 100%

ALLIED HEALTH PERSONNEL 37.33 57% 17.30 27% 2.00 3% 8.60 13%

0% 65.23 100%

SUPPORT PERSONNEL 1.81 16% 7.95 69% 0.75 7% 1.00 9%

0% 11.51 100%

MGT/ADMIN PERSONNEL 32.14 77% 6.27 15% 0.50 1% 1.00 2% 2.00 5% 41.91 100%

Grand Total 200.99 59% 102.22 30% 14.25 4% 14.40 4% 8.60 3% 340.46 100% Table 6 – Ethnicity of staff recruited within the last 3 months MELAA is a group amalgamation of Middle Eastern, Latin American and African ethnicities

Table 2 – Ethnicities of New Staff

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4. Workforce Development

4.1 Health Care Assistant Development programme The Health Care Assistant Development is a programme of supported training for new and inexperienced health care assistants to enter our workforce. The group of two Māori, three Pacific, two NZ European and one other trainee commenced on 18 April. The course is scheduled to conclude on 13 May. 4.2 Rangatahi Programme 2016/17 Planning is underway for the 2016/17 Rangatahi Programme paid cadetships at Waitemata DHB. The Rangatahi Programme is designed to showcase healthcare as a career option and to grow our Maori and Pacific workforce, and comprises three parts

1. Introduction to healthcare careers – run by Auckland DHB 2. Work experience week – run by Auckland DHB 3. Cadetships – five at Auckland DHB and five at Waitemata DHB

The Clinical Nurse Director – Pacific Health is working on placements to be confirmed in June/July, and the managers in the areas who host the cadets will receive supports including a briefing hui and a manual as a reference guide. The programme of recruitment, selection, screening, mandatory training, and orientation will be developed and confirmed by June/July. 4.3 Regional Pacific Health Science Academy & Mentoring Programme Term 2 has seen the introduction of weekly tutorials for Academy students at both Waitakere College and Onehunga High. The approach reflects an initiative to promote students helping students (mentoring) and was adopted from a model in place at De La Salle Academy. The Auckland University of Technology Science Sizzler was held at AUT City Campus during the Term 1 school holidays. Approximately 70 Year 11 academy students attended from across the region, and found it a good learning experience. Academy students have also registered with the Rangatahi programme at ADHB. Students apply to the programme with support from their careers advisor. Onehunga High students are already accessing the programme in large numbers. For academy students at Waitakere College this will be their first year on the programme. The first Principals forum was hosted by Counties Manukau DHB at the end of April. The meeting was led by Director Strategic Development, Margie Apa, and attended by the CEO, Geraint Martin. Principals found the forum positive and useful. There are two more scheduled at Waitemata DHB with the first on 5 August 2016. 4.4 Auckland region management training scheme project Last year the region agreed to put in place a management training scheme to fast track the growth of Operations Managers in the health sector. The intent of the programme is to have eight trainees across the region by 2017/18. Waitemata DHB have fully committed to this programme with one trainee in 2016 and two in 2017. In addition we have appointed two health management fellows as part of the DHB Fellows programme.

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Frances Cullinane and Robyn Steinbeck started in twelve month, fixed term health management fellow roles in April. Frances has started in Medicine and Health of Older People service and Robyn has started in Surgical and Ambulatory Services. Frances and Robyn will rotate across services to gain broad health management experience, including two, four month rotations with operational manager responsibilities for 20 hours a week. Kelsey Wheaton, Waitemata DHBs graduate management trainee has been in her role for two months and is assigned to Medicine and Health of Older People. The region has contracted Talent Wire to provide specialist support for DHB placement managers working with the graduate health management trainees. Waitemata DHB elected to use the time to engage in a discussion about what the DHB needs to be thinking about and planning for the post two-year phase once the graduate health management trainees have completed the programme.

5. Education, Knowledge and Research

5.1 Leading Quality Care programme (frontline leader development programme) The Leading Quality Care programme is designed to build leader capability to influence and strengthen performance centred on quality care and patient outcomes. Cohort 4 has completed blocks 1 and 2 of this three block programme, which culminates in participants presenting a quality project on 21 September. Discussions are underway with HODs Nursing and Allied Health about future development of this successful programme. 5.2 Virtual learning for junior doctors The RMO teaching portal has been reviewed and revised making it more learner focused and user friendly and a project is underway to increase offerings for RMOs on Ko Awatea Learn The DHB is now sending a RMO Weekly Update emails to all prevocational doctors. The email contains information about upcoming learning opportunities, links to online learning resources and DHB resources. The landing page of the online portal is shown here.

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The initiative has been well received and is growing in popularity (see Table 7).

Table 7 RMO Weekly Update uptake figures 5.3 Primary Healthcare nurse leader development programme The Primary Healthcare Nurse Leader development programme is designed to build leader capability to influence and strengthen performance centred on quality care and patient outcomes within the primary healthcare sector. It is based on the Leading Quality Care programme for secondary care CNMs. The first day is planned for 30 June 2016. 5.4 Return to Practice Programme The Return to Practice Programme (RTP) supports the Waitemata DHB nursing workforce recruitment plan. The programme commenced on 11 April with 9 RTP nurses due completion by 20 June. Recruitment discussions are underway with most placement areas for possible employment on completion of the course. A Nursing Council of New Zealand audit of the programme took place on 19th May as part of the three yearly audit cycle. The scope of the monitoring visit was to determine that Waitemata District Health Board:

(a) Has the necessary facilities and quality management systems to run a Competence Assessment Programme; and (b) Curriculum development and delivery complies with the Nursing Council Standards for Competence Assessment programmes.

Verbal feedback from the auditor was very good and the programme meets all criteria with no corrective actions. 5.5 Research Research and related activity in the DHB continues to increase with 54 new registrations in the quarter to April 2016. The total number of research projects in the DHB is 344. In addition 27 projects are being supported by the Clinical Research/Audit Database a platform designed to assist staff in the collection and collation of their research and audit data In 2016, DHB staff have published 61 times in journals and at conferences.

0

50

100

150

09-Mar 16-Mar 23-Mar 30-Mar 06-Apr 13-Apr 20-Apr 27-Apr 04-May

No.

of R

MO

s

Enagagement with RMO Weekly Update

Recipients who opened the weekly update

Recipients who followed links to educational resources within the Weekly Update

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6 Resolution to Exclude the Public

Recommendation:

That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000:

The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:




1. Confirmation of Public Excluded Minutes – Hospital Advisory Committee Meeting of 25/05/16

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.


Confirmation of Minutes

As per resolution(s) to exclude the public from the open section of the minutes of the above meeting, in terms of the NZPH&D Act.

2. Quality Report That the public conduct of the whole or the 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.




3. HR Update 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.


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)]

Negotiations

The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.

[Official Information Act 1982 S.9 (2) (j)]

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hac open agenda june 2016

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