Quarter 4 progress report

Transcription

1 Quarter 4 progress report 20 July 2016

2 Contents Contents...2 Introduction...3 Areas assessed as not being on track (i.e. amber or red)...4 Cancer Services Midland Cancer Network...6 Cardiac Services - Midland Cardiac Clinical Network...10 Child Health - Midland Child Health Action roup (CHA)...14 Elective Services...16 Health of Older People...18 Maternity Services - Midland Maternity Action roup (MMA)...22 Mental Health and Addiction Services...25 Midland Radiology Action roup...28 Stroke Services (Midland Stroke Network)...30 Trauma Services - Midland Trauma System (MTS)...35 Midland Trauma Symposium: Understanding Trauma: Bridging the gaps May Regional strategic objectives...38 Objective 1: Improve Māori health outcomes...38 Objective 2: Integrate across continuums of care - hepatitis C services...45 Objective 3: Improve quality across all regional services...47 Objective 4: Build the workforce...48 Objective 5: Improve clinical information services...54 C On Track Caution A In Trouble R 2

3 Introduction This document provides a quarterly report of progress achieved as Midland DHBs work together to improve the health and wellbeing of the Midland populations and their experience with the NZ public health service. Agreed regional initiatives in the Midland Regional Services Plan (RSP) form the basis for this progress report, and are detailed at the end of this report. Further detail about the initiatives can be found in Appendix 4 of the Midland RSP. Contained in this report are a collection of feature articles. They assist with communicating how Midland DHBs are working together to achieve the region s strategic objectives ie to: 1) Improve Māori health outcomes 2) Integrate across continuums of care (to provide more timely effective care) 3) Improve quality across all regional services 4) Build the workforce 5) Improve clinical information systems, and 6) Efficiently allocate public health system resources. Feature articles to look out for include: a recent Midland child health respiratory seminar for clinicians; the benefits of linking with the Central region - enhancing consistency and sustainability for Midland ENT elective services; the use of InterRAI data and CHESS scores in relation to frailty in the Health of Older People programme; the Midland Maternity Transfer & Repatriation Standards - enabling smooth patient flow and ensuring the most appropriate, safest care is delivered as close to a woman s home as possible; FAST - a nationwide Stroke campaign (following a successful pilot in the Waikato region); and the inaugural Midland Trauma Symposium - where the benefits of data collaboration and tracking across emergency and health services were highlighted. Overall, we believe that the period from 1 April to 30 June 2016 has been valuable and the regional work is tracking to plan. An assessment of progress is provided using a colour coding of green (on-track), orange (caution), red (in trouble) or blue (completed). OVERALL ASSESSMENT (FOR S12 MINISTRY OF HEALTH) REIONAL OBJECTIVES Cancer Services Maternity Services Improve Māori health outcomes Cardiac Services Mental Health & Addictions Integrate across continuums of care Child Health Radiology Services Improve quality across all regional services A Elective Services Stroke Services Build the workforce Health of Older People Trauma Services (MTS) Improve clinical information systems A The colour assessments in this report are an indication of progress against agreed regional initiatives to strengthen and improve health services. Importantly, the assessments should not be regarded as an indication of the quality, safety and effectiveness of the health services that Midland DHBs provide. C On Track Caution A In Trouble R 3

4 Areas assessed as not being on track (i.e. amber or red) Area Regional cancer psychological and social support service - Implement Midland Psychosocial and Social Support Services Plan Implementing progressing not all positions yet filled Cardiac - Audit ANZACSQI resource for data entry and address with recommendations to the DHBs if not achieving target consistently. Child Health outpatient coding IT system Child Health triage system Child Health Map of Medicine pathways Electives - patients meet ESPI requirements and this tracking is deemed accurate and informs DHBs prior to breaches with regional tools that allow for utilization of regional capacity in times/areas of concern Electives - validation of information accuracy with the regions DHBs Maternity Services workforce forecasting Mental Health and Addiction Services - Supraregional Eating Disorders. Eating Disorders Inpatient Care. Continued regional provision of eating disorder inpatient services (Midland and Northern regions to implement the recommendations from the service review to ensure sustainable inpatient and community services). Stroke - Workforce issues are addressed for Allied Health; Nursing; Medical Stroke rehabilitation care audit and case review Trauma Services - implement an optimal workforce plan - commence inputting the data at DHB of origin - data inputting at each Midland DHB depends on status of adequate recruitment processes of each DHB Improve Quality Across All Regional Services - develop a collective quality strategy, framework and outcome measures A A R A A A A A A A A A A Reason / Resolution Lakes psychologist recruited and will start July Waikato psychologist recruitment in progress, likely to start July National KPIs for data entry to ANZACSQI within 30 days of patient discharge are not currently being met and a business case has been approved by Waikato Executive to increase cath lab FTE by 0.4 to achieve this. Due to CWS commitments this project was unable to be prioritised within the 15/16 year. However WDHB has made good progress in developing a local solution to code child health outpatient presentations. This is in the early stages of implementation but will be able to be utilised by other DHBs when any issues have been sorted. This project continues to be in the 2016/17 workplan. This objective is still a work in progress related to heavy workload of paediatricians at WDHB however WDHB have nominated a local paediatrician to get 10 guidelines done for the virtual FSAs. Work continues on identified maps however progress is slow and the group are looking to the newly recruited lead regional editor and project manager roles to assist in finalising identified maps. Meeting ESPI requirements continues to challenge Midland Region DHBs, particularly in Orthopaedics. DHBs have the tools to identify potential breaches and continue to explore opportunities to deliver elective services within the required timeframes. The validation of reporting between the MoH, DHBs, and HealthShare is being undertaken and will be completed within Q1 of the year. This requires checking that the business rules applied to the information are consistent. See Workforce Section below re obstetric workforce. DHB maternity workforce data has been provided, however, there is variability across DHBs, with some roles within Maternity Services assigned to other DHB workforce areas, eg Nursing, Education, making it difficult to match FTE and therefore forecast for the region. Midland continues to fully participate in the Supra-regional Transition Steering roup meetings. Direction sought from the Ministry of Health regards funding for access which has been provided. Awaiting the Ms Planning & Funding decision. Recent resignations of lead Stroke SMOs in two DHBs are being monitored. The most recent face to face stroke meeting had to be postponed and therefore rehab case reviews were not able to be undertaken the audit tool is a work in progress. The DHBs have employed dedicated staff for data entry. It is likely that the backlog will be cleared by the end of this year. We are unable to report on the 2015 data until this data is entered. The CEOs are reviewing the direction of quality for the region with new CEO appointed for BOP and new Quality lead at Lakes DHB. Likely a new patient safety / quality network will form that is wider than the current quality managers and will drive the key priority C On Track Caution A In Trouble R 4

5 Area Improve Quality Across All Regional Services - better integrate quality across the clinical networks, offering advice and support on particularly consumer engagement activity and quality improvement methodology through the Improvement Advisors. Improve Quality Across All Regional Services - develop a regional comparison report utilising the Quality and Safety Markers and the national patient experience survey and share learning from those DHBs in the upper quartile against these measures. Workforce - define project deliverables (competencies and training defined; applicability of learning materials for CareerForce modules; contract/service level agreement) Regional IS Midland Cancer Network : Regional Provation (BOP and Lakes) Regional IS - MH&A alignment to regional IS project for Orion Concerto Regional IS Midland Clinical Data Repository management of investigations Regional IS - Clinical Workstation: Access to Primary Data (Waikato) Regional IS Oral Health : Waikato Titanium implementation Regional IS - Patient Flow toolsets(ecwb) (Waikato) A A A A R A A A A Reason / Resolution work across the region, integrated with primary care and with consumer member Work beginning in the patient at risk (deteriorating patient) space and in the roll out of Advance Care Planning (ACP). Initial discussions have taken place links to the national dashboard development by HQSC. National Q&R managers working with HQSC and business support analysts to develop a joint workshop on measuring for improvement The CareerForce learning model is adopted in all DHBs for nursing support roles and is currently being piloted for Allied Health at BOP and Waikato. While good progress has been made on build, integration and testing kick off, the risks associated with BOP's progress are now presenting a number of specific issues that may impact their ability to meet the current go-live timeframes. Exact go-live date is still being confirmed due to working in with vendor availability. A 'technical go-live' to deploy the integration and networking changes into production will take place by the end of August. The Mental Health team is currently evaluating the options available for utilising developments from other regions with the potential to run an expression of interest process before a business case is created. The Project initiation continues with Bay of Plenty IT team working closely with the espace team to agree time lines and project scope. Rollout to practices progressing. SEHR access constraint with one PHO remains unresolved and are being worked through with the effected PHO. Progressing although slightly delayed due to Titanium issues identified during the design phase. Ministry approval for exemption from SNOWMED confirmed. Target o Live date to be revised, most likely with a 1 2 month delay. The RFP is complete and preferred supplier (HealthIQ) selected. Full business case to be finalised for submission for approval. Delivery timeline TBC. Requirements shared with HSL/eSPACE to enable regional alignment. HSL/eSPACE invited to take part in the process, however, not able to be achieved. C On Track Caution A In Trouble R 5

6 Cancer Services Midland Cancer Network Key Achievements Midland DHB Lymphoma Standards Review - draft report tabled at MCN Executive meeting 16 June 2016 and distributed to DHBs for feedback. MCN Executive roup approved extension to 31 August 2016 due to lead clinician away. FCT Service improvement Review of Lakes FCT completed. Lakes DHB 62 day breach report developed to assist cancer nurses tracking of HSCAN patients from referral to first treatment. Lakes generic patient pathway template developed for approval. Lakes FCT service improvement plan developed and implementation monitored at monthly Lakes FCT Work roup meetings. Lakes/Waikato oncology/haematology project in progress with short term and long term options agreed. Implementation planning commenced. Midland Radiation Oncology Exceptional Circumstances uidance was reviewed, updated and implemented. Initial feedback is that it is working well. Regional radiation oncology work plan agreed across the two providers. Requested Midland DHBs to provide a summary update on progress of implementing national guidance on the use of active surveillance treatment for men with low grade prostate cancer. Map of Medicine updated the lung cancer pathway. HSCAN definitions have been loaded into the BPAC ereferrals for Midland, Bay of Plenty using Bay Navigator. Updated Map of Medicine guidelines for PMB. Monthly Midland FCT Work roup teleconferences continue. Assistance provided to Lakes and Bay of Plenty DHBs to identify and resolve data quality issues. Waikato FCT Round 2 project: Continued focus on improving lung cancer pathway and resolving bottlenecks in general surgery for breast cancer. Development of processes for inter-dhb referrals for patients on 62 day pathway so that HSCAN breach date is identified on referral letter or MDM proforma. Waikato PMB and Endometrial Cancer FCT project audit of all gynae-oncology referrals completed. Development of business case in progress for community based PMB clinic that includes pelvic exam, ultrasound, and uterine biopsy (pipelle). Improving quality of FCT data and data collection Upgrade enhancements to the Waikato and Lakes Cancer Care System completed and user guide updated. Business case approved to implement Hauroa Tairāwhiti Cancer Care System over June-July. Waikato DHB: While database enhancements reduce some manual data entry the phased implementation of the Waikato Elective Surgical and Procedural Pathway currently means all general surgery decision to treat dates generated using waitlist booking date must be manually reviewed as that date no longer meets the DTT definition (patients now waitlisted only once they have had anaesthetic check and cleared for surgery). Urology records now reviewed as active surveillance and targeted therapy as first treatments not captured electronically. Hauroa Tairāwhiti implementing PalCare, resulting in all Midland hospices will have same system to extract data for FCT. Midland Kia Ora E Te Iwi - Kia ora e te iwi programme held in Kihikihi June in collaboration with Maori Women s Welfare League, Waikato BOP Cancer Society, DHB provider arm with facilitation by a trained MCN Consumer/Carer representative. Midland Hei Pa Harakeke: Midland Hei Pa Harakeke meeting was held on 19 th April in Waikato Waikato Palliative Care Strategy Plan : The Waikato palliative care strategy plan was released for public consultation on the 30 of May, followed by a joint Board sub-committee workshop. The Waikato palliative care strategy plan was endorsed by the Waikato DHB on 22 June. The final version of the plan is currently being published for release. National lung cancer programme Midland Cancer Network submitted the final National Lung Cancer Standards to the Ministry of Health in August These were finally published May The National High Suspicion of Lung Cancer definition published April The Early Detection of Lung Cancer Sub Working roup established and MCN facilitated the initial meeting 24 June Clinical chair, membership and terms of reference confirmed. National Early Detection of Lung Cancer uidance document drafted for sub-group consultation only. Agreed with Ministry time extension beyond the initial planned September completion date. Colonoscopy/endoscopy ProVation Lakes and BOP training completed and implementation on track to be completed by September Hauora Tairāwhiti agreed to implement using Waikato server. Requested Midland COOs to plan for updates to be regional. Midland colonoscopy direct access e-referral draft made available to stakeholders. Further work undertaken post feedback from stakeholders. Still 2-3 months away from implementation. NZ Bowel Screening rollout working with Ministry to hold a regional workshop 1 August. Midland Colorectal Work roup meeting presentation on Waikato s implementation of Dendrite clinical information system. This was well received and supported by Midland clinical leads. Presentation to MCN Executive and Ministry of Health CHIS MDM Project. Waikato Endoscopy Unit Operational Manual drafted and out for consultation. C On Track Caution A In Trouble R 6

7 Chair: Dr Humphrey Pullon Manager: Jan Smith Faster Cancer Treatment Health Target Deliver against the Midland FCT Implementation Plan (2015/16) and support DHBs to achieve the health target. Improving the quality of data and data collection Support DHBs to implement national tumour standard phase two initiatives HSCAN definitions and national tumour data sets (tbc). Support DHBs with implementation of the New Zealand Cancer Health Information Strategy (2015) recommendations within available resources. Regional cancer psychological and social support service Implement Midland Psychosocial and Social Support Services Plan Implementing progressing not all positions yet filled Regional tumour standard reviews Facilitate in partnership with Midland DHBs a stocktake of sarcoma services and gap analysis against national sarcoma tumour standards. Facilitate in partnership with Midland DHBs a stocktake of lymphoma services and gap analysis against national lymphoma tumour services. Service Improvement Support DHBs to identify actions to improve the timeliness and quality of the cancer patient pathway from the time patients are referred into the DHB through treatment to follow-up/palliative care. Q1 Q2 Q3 Q4 C A A A C Implement the Midland FCT Service Improvement round 2 projects Implement national guidance on the use of active surveillance treatment for men with low grade prostate cancer. Improve multidisciplinary meetings (MDMs) Support DHBs to deliver against the Midland MDM Action Plan (2015). Support Cancer Nurse Coordinators Continue to support DHBs with the implementation of the CNCI Initiative. Midland Hei Pa Harakeke Work roup seeks to reduce the impact and inequalities Midland DHBs work in partnership with Midland Cancer Network, DHB Māori health services and stakeholders. Shorter waits for non-surgical cancer treatment Support DHBs to sustain performance against the radiotherapy and chemotherapy wait time targets by more efficient use of existing resources; and investing in workforce, capital and capacity as required. Primary secondary pathway tools Support DHBs in the Midland Map of Medicine (MoM)/Bay Navigator initiatives. Improve palliative care services Facilitate DHBs/Hospices to implement the Midland Adult Specialist Palliative Care Service Development Plan recommendations. Implement the national lung cancer work programme C Facilitate the National Lung Cancer Working roup. Support DHBs to implement national tumour standard phase two initiatives HSCAN definitions. C Develop national early detection of lung cancer guidance. Improve Endoscopy/Colonoscopy Services Continue to support DHBs implementation of the lobal Rating Scale. Continue to support DHBs to improve waiting times for Colonoscopy. Continue to develop Midland demand & capacity modelling tool. C C On Track Caution A In Trouble R 7

8 What we did in addition to what we said we would do New Pharmac drugs for melanoma infusion (Opdivo) - Facilitated regional representation at the national Pharmac workshop 5 July Circulated a Waikato modelling tool for use at other Midland DHBs. Also circulated Pharmac new drugs information for national consultation. National Bowel screening roll-out worked with Ministry of Health to assist with arrangement of a regional workshop 1 August. NZ Adult Palliative Care Services Review facilitated a regional workshop 28/6/16 to review and update the national draft report that summarised current DHB services against the national Resource & Capability Framework and key issues/gaps. HQSC Atlas of Variation draft bowel cancer KPIs circulated to relevant stakeholders for review and feedback. National Radiation Oncology Plan - participated in national project team teleconference with regional cancer networks and provided feedback as required. National regional cancer network service specification contract agreement participated in the review and update of the RCN service specification for Midland Cancer Network contract agreement will transfer to HealthShare Ltd 1 July National ynaecology SNOMED reference set draft circulated to regional stakeholders requesting feedback. National Nursing Standards for Antineoplastic Drug Administration in NZ circulated to Midland stakeholders for implementation. National Prostate Cancer Roadshow communicated to stakeholders regarding pathology roadshow planned for September. National CHIS overnance regional representation - facilitated regional process to find regional representation still work in progress. Facilitated NZCHIS national MDM project visits to Bay of Plenty Breast MDM on 25 May and Waikato chest conference (lung cancer) on 8 June for current state mapping including interviews with key stakeholders. National cervical screening changes found out national service changes planned, summarised and sent to Midland CEOs as requested. Midland breast screening - participated in BOP meeting with BSM and NSU about how to improve achievement against targets. National Service Provision for AYA cancer patients including standards of care circulated and provided feedback as part of formal consultation process. Facilitated regional papers on radiation oncology demand and capacity, FCT and improving cancer outcomes. National radiation oncology plan participated in national project team teleconference to clarify role of regional cancer networks functions related to the national plan. Commenced a Hauora Tairāwhiti cancer nurse care coordinator framework project to review current service and plan for the future. Assisted DHBs with annual plan cancer section. Sought Midland EOI for sector representatives to assist the Ministry to develop guidance to implement Te Ara Whakapiri (Last Days of Life). Two Midland Maori representatives were submitted 15 June with the proviso that if they are accepted that they will participate in the Midland Palliative Care Work roup. National Cancer Consumer lead provider submitted request to Midland Cancer Network to identify Midland consumers to attend national consumer representative training work in progress. New Zealand Health Research Strategy draft circulated to stakeholders to participate in public discussions. Quantitative data key data that shows achievement of health target or indicators or links closely with work the regional group is doing. An equity perspective is also expected to be demonstrated, as a given. C On Track Caution A In Trouble R 8

9 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Midland DHB 62 day Health Target achievement Bay of Plenty Lakes Tairawhiti Waikato Midland NZ Q1 2015/16 Q2 2015/16 Q3 2015/16 Q4 2015/16 Target C On Track Caution A In Trouble R 9

10 Cardiac Services - Midland Cardiac Clinical Network Key Achievements A high level of regional agreement and engagement by clinicians and management The 3-days ACS target is consistently achieved as a region, and has improved for all 5 Midland DHBs Current state mapping per DHB of ACS patient flow identifying strengths and problems Increased lab capacity at start and end of week at Waikato Hospital, and on public holidays Share capacity across the region - flow of ACS patients from Lakes DHB to Tauranga Hospital cath lab for initial angiogram diagnostics. BOPDHB are expanding their PCI intervention service and are looking to perform PCIs for Lakes and other DHB patients when demands on Waikato are high and when clinically appropriate for a patient to be cared for at a secondary level facility rather than a tertiary facility. Centralised planning to facilitate the utilisation of capacity at both Waikato and BOP - development of a forecasting and planning model for the Cath labs at Waikato, BOP and Taranaki to inform daily, monthly and annual planning, with a view ot optimising the use of resources and the timeliness of service delivery to acute and elective cardiology patients. The Accelerated Chest Pain pathways underwent evaluation by Dr John Pickering as part of a national audit and were commended Upgraded the e-referral form on NEXUS website for referrals between secondary and tertiary hospitals Worked with regional IS to identify functionality that would support a regional integrated service ie. CWS, regional whiteboard of Acute Coronary Syndrome patient progress along IP pathways MCCN clinical lead became the CD of the Heart Foundation, and attended 2 Midland Strategic Forums and two National Cardiac Network meetings Strengthened the relationship with MOH to receive SIR data reported by ethnicity. Chair: Dr erry Devlin Manager: Philippa Edwards Form a virtual regionally-integrated Midland Cardiac Service Map the current state of services in the region Identify opportunities for service improvement Map the ideal future state by the cardiac clinical network Develop capacity modelling based on population demand forecasts, to determine what services will be required in the future to deliver equitable access across the region Develop seasonal and day of week forecasting and production planning processes for the region based on demand at each of the DHBs Develop aligned resource and facility planning processes across the region Agreement by regional CDS and CEOs on the future model of service delivery Q1 Q2 Q3 Q4 Ischemic Heart Disease (IHD) Improve the assessment and management of patients with IHD - to receive evidence based timely and equitable care Continue the introduction of Accelerated Chest Pain Pathways (ACCPs) in Midland Emergency Departments, which began in 2014/15. Provide regional network support to effective audit and the sharing of solutions to ACCP problems. Report quarterly. Develop regional MoM pathways to ensure clarity of management of primary risk factors, and access from primary care to secondary care Audit ANZACSQI resource for data entry and address with recommendations to the DHBs if not achieving target consistently Work with patient pathway mapping to identify targeted service improvement initiatives at each DHB to eliminate delays across acute and elective services Use data and regional production planning to optimise the flow of ACS patients and to meet the MOH targets for service timeliness equitable across the regions domiciles and ethnicities Review the national report from the Cardiac Society on cardiac rehabilitation services and develop a local plan to address any access, equity or quality issues identified A A A Heart Failure Management effective prevention, delay in onset and management of heart failure to improve quality of life for patients and to reduce acute presentations Review the national report from the Cardiac Society on cardiac rehabilitation services and develop a local plan to address any access, equity or quality issues identified Develop an ideal future state for heart failure patients of the Midland region C On Track Caution A In Trouble R 10

11 Q4 Update Initiative 1: Form a virtual regionally-integrated Midland Cardiac Service The 15/16 year closes with a lot of work having been completed in the integrated cardiology space. A key output is the development of a forecasting and planning tool to be used across the Midland region on Cath lab capacity for angiograms and PCIs, for both acute and elective patients. The tool forecasts acute demand by month and day of week and subtracts this from the capacity to identify how many electives can be scheduled. It is currently in excel and being prototyped over a three month period. It will then be developed into an annual planning tool with the hope that it can be deployed eventually as a web based tool for business as usual access at DHBs along with automated variance reporting to inform iterative improvement. The diagram below demonstrates the principle being used whereby the effective use of planned and fixed capacity is smoothed by forecasting acute patient demand and planning elective volumes around this. A gap analysis to inform elective volumes to be scheduled per DHB was completed between what each DHB must deliver to meet standardised intervention rates, the PV schedules and the actual capacity planned to deliver this. Initiative 2: Ischemic Heart Disease (IHD) Improve the assessment and management of patients with IHD Q4 saw the formation of two sub groups to work on Heart Failure and on Prevention and Rehabilitation across the Midland region. There groups will TC monthly and to date have developed their TOR, identified what works well in their DHBs and their areas of concern. These sub groups are also linking to initiatives identified by the national cardiac network and the cardiac society, are each clinically led by a regional Cardiologist and will take an action orientated focus. Work in Q4 for Ischemic Heart Disease: stocktake of the entire ECHO service, capacity and demand stocktake of the Cardiac service FTE and sessions across the Midland region to understand the current service and to inform workforce and capacity future requirements Progressed data gathering for a CT Coronary Angiogram brief to executives to assess if volumes could be reduced in the Cath lab by utilising CT. And to understand the requirements for the region to form a regional reporting roster for CTCA studies carried out at the DHB of domicile. Benefits being patients receiving a diagnosis quickly, in their own DHB and reducing the number for other tests required i.e. ETT, Nuc scan, Stress tests, and transfers for cath lab angiograms Initiative 3: Heart Failure Management effective prevention, delay in onset and management of heart failure to improve quality of life for patients and to reduce acute presentations. The Heart Failure Subgroup formed and has developed a course of action that will start by consulting with the Public Health Units, collecting data across the region to assess acute presentations and unmet need, and doing a gap analysis between the National Cardiac Standards for each of the five Midland DHBs. This initiative has been carried forward to the 16/17 RSP. C On Track Caution A In Trouble R 11

12 Quantitative data: Three day Angiogram Door to Cath target performance for the Midland region C On Track Caution A In Trouble R 12

13 Thirty day Data Registry completion target performance for the Midland region Angiogram Standard Intervention Rates for Maori and Other, Midland region C On Track Caution A In Trouble R 13

14 Child Health - Midland Child Health Action roup (CHA) Midland Region Child Health Respiratory Seminar In May this year we ran a respiratory seminar for a range of clinicians from primary, secondary and community services. We were lucky enough to have excellent speakers from Auckland and Hawkes Bay; Wendy McNaughton: Respiratory Services Manager, Comprehensive Care Ltd Laura Campbell: Respiratory nurse specialist, Waitemata DHB Sue Ward: Respiratory Clinical Nurse Specialist, Hawkes Bay DHB Julie Shaw: Nurse Manager, Breathe Hawkes Bay Wendy and Laura spoke on the ASP tool. ASP is a personalised asthma management tool delivered via the internet which dramatically reduces costs, hospital admissions and emergency room visits. It enhances patient health outcomes by an assisted self-management approach to providing a tailored selfmanagement plan to the patient. They shared how the tool is used and the outcomes for patients, which showed a vast improvement in management and symptom control for patients. This innovative tool was developed by Wendy and is being used by a large number of organisations now it has a highly effective education programme to ensure it is well implemented and utilised. Sue and Julie presented on Redesigning Respiratory Management in Hawkes Bay: From fragmented to integrated care. This excellent presentation outlined the issues that asthma patients were experiencing including regular visits to emergency departments and poor control of their symptoms. This comprehensive project that included a pilot of nurse run respiratory clinics in nine practices; there was a structured rollout, the introduction of Respiratory CNS role / Asthma HB Respiratory Nurse Specialists assigned to general practice, IT development of an advanced form, with regular support from a community respiratory CNS and good access to spirometry. The participants enjoyed the day immensely and there was a lot of interest in running the ASP training in the Midland region so that nurse led respiratory models of care might be considered more broadly within the region. Chair: David raham, Paediatrician, Waikato DHB Manager: Kerry-Ann Adlam Q1 Q2 Q3 Q4 Implement an outpatient coding IT system across the remaining four DHBs - similar to the BOP DHB system that is in place Implementation of IT outpatient coding system Training for clinicians to code outpatient presentations Reports generate across five DHBs for comparison and information sharing Implementation of a standardised paediatric early warning system across Midland DHBs Standardised form agreed across the five Midland DHBs Process for implementation agreed Develop a regional child health roadmap that outlines priorities for child health over the next decade to assist in setting direction for services to improve child health outcomes Literature review of future trends and services national and international Dataset development Finalised document available for all child health services Two clinical projects will be undertaken to focus on decreasing the acute and chronic burden of disease for tamariki Māori, children living in poverty and other populations suffering a disproportionate burden of disease Asthma Meaningful data outlining disease/disorder incidence and prevalence at a census area unit be shared with DHBs and other relevant providers Development of models of care, care pathways, standing orders, teaching and learning resources etc for use by DHBs and other relevant providers R R R C On Track Caution A In Trouble R 14

15 Chair: David raham, Paediatrician, Waikato DHB Manager: Kerry-Ann Adlam Establish a consistent triage process for outpatient referrals across the five Midland DHBs Identify entry points in organisations. Work up measure of triaging demand that is consistent and agreed Standardise what a referral should include (with primary care referrers) Standardise triaging timeframes across the DHBs Develop guidelines of triaging criteria to ensure consistence and equity irrespective of clinician triaging Implement process Q1 Q2 Q3 Q4 The Child Health Action roup will continue to lead and support work to identify, establish and implement agreed pathways through Map of Medicine Key pathways are identified for development across primary/community and secondary sectors Pathways developed and published Developed pathways will be reviewed in a timely way with primary/community partners The following pathways will be developed for 2015/ Asthma A National Child Health Information Programme (NCHIP) CHA will support the roll out of NCHIP across the region A C On Track Caution A In Trouble R 15

16 Elective Services ENT Services: enhancing consistency and sustainability in the Midland region A meeting of Midland ENT clinicians was held on the 10 June in Rotorua to discuss the delivery of ENT services across the region. The group was joined by Paul Mason, Hawkes Bay DHB ENT specialist to establish a linkage between Midland and Central region clinicians. This linkage will minimise duplication of effort and enable sharing of information. A range of information was presented to the clinicians including: Intervention rates for both first specialist attendance (FSA) and surgical procedures Delivered volumes by age Delivered volumes for the top 15 procedures P referral pathways for vertigo and rhinosinusitis. Initially developed by Auckland DHB these have been localised for Hawkes Bay DHB Prioritisation tools for FSA. This included a tool particularly for tonsillitis which drives approximately half the demand for FSA referrals. The discussion focused on the variation in service delivery across the region and the usefulness of the tools to support Midland DHBs achieve compliance of key performance indicators (KPIs), improve equity of access and ensure quality of service delivery. Progression of the ENT project will be discussed at the July Midland Action roup meeting. Chair: Dale Oliff Manager: Joce Carr Consistent and equitable services using learning to develop widely applicable tools for use by the regions DHBs Q1 Q2 Q3 Q4 Roll out of national CPAC tools Patients receiving treatment/have received treatment are identifiable in a way that shows if patient treatment is becoming more equitable and consistent Tools developed which can accurately monitor regional prioritisation for specialties which have applied national CPAC scores Identification of areas at risk of not maintaining ESPI compliance or meeting health target and aid in identifying best practice regional facilities/dhbs Patients meet ESPI requirements and this tracking is deemed accurate and informs DHBs prior to breaches with regional tools that allow for utilization of regional capacity in times/areas of concern Variations around treated conditions are identified within Paediatric Surgery regionally. These have been discussed and clinical validated and ways to reduce variations have been approved by the regional Electives Action roup or Electives overnance roup where appropriate. Patients follow a higher number of standard pathways (e.g. Map of Medicine). A new pathway developed by the end of each calendar year for each clinical work stream). Creation of a regionally agreed referral criteria by a regional clinical network with approval from the Electives Action roup and overnance roup Regional Production planning and modelling Collection of regular datasets from a wide range of providers to inform production planning models A Establishing regional oversight to ensure any actions required to contribute to or implement the National Patient Flow collection are regionalised Clear on-going communications on what is available regionally Patient and the treatments provided regionally are understood allowing for DHB boundary discussions -where these populations are treated and for what Identify patient cohorts each year (identified by action and governance group) with tracking of that patient cohort and with reductions demonstrated over the year Validation of information accuracy with the regions DHBs A Formation of draft production planning models for theatre Formation of regional capacity modelling relating to Paediatric Surgery e.g. visibility of bottle necks, beds, theatres, etc. A C On Track Caution A In Trouble R 16

17 Summary The regional electives work programme has delivered most outcomes within the required timeframes. The outstanding items relate to validating information between MoH, HealthShare and DHBs by ensuring the business rules applied to the data are consistent. The validation task will be completed by the end of quarter one There is no expected impact on the electives work programme. The ENT project scheduled for has commenced earlier than expected. An initial clinical forum has been held and links to the Bay of Plenty DHB ENT project have been identified. What we did in addition to what we said we would do Providing analytical tools as requested by the regional DHBs Tools have been provided to all regional DHBs as requested Drafting of regional documentation to ease regional transfers between regional DHBs To enable ease of regional transfers Qlik Sense applications have been developed and analytical reports provided as requested by DHBs. C On Track Caution A In Trouble R 17

18 Health of Older People Clarifying the medical picture using HOP data InterRAI InterRAI continues to be a great source for future information. The structure and use of the InterRAI data has been clarified with a meeting between the lead analyst and Andrew Downes. The utilisation of CHESS scores and their relation to frailty will be particularly useful for up-coming work in the frailty space. This further builds on the InterRAI work presented in the Q3 report. Knowledge in this space helps to identify at risk clients whom can be helped to reduce their risk of requiring certain interventions (e.g. wrapping increased care around at risk clients in their home environments, to reducing the likelihood of admissions to a resthome/residential care facility until appropriate). An example of some of the CAPs are shown below. This style of information allows for analysis of the link between these clients which trigger particular CAPs and the possible impact on other CAPs. ED population example: The below graphs (ED attendances older persons (over 65) and ED attendances young (under 65) highlight some of the differences between the age bands regionally. This high level view simply looks at ED attendances and admissions in one calendar year with only the change in one variable; over 65yrs vs under 65 years. The blue bars on the two left hand graphs (ethnicity and gender) show ED attendances and the pink bars are the Statistics New Zealand population for the Midland region. The top graph to the right (service hour for) shows attendances by time of day (24hr time) and by medical triage level. The bottom graph (ED attendances by 5ry age bands) shows this data in lower age bands. Please be weary when reading these graphs of the axis on the graphs as the older age group is smaller than the under 65s. However, these graphs do highlight a significant ethnicity difference between these two age groups. Further, time of day for admission and the triage level (lower levels/numbers associated to triage being more serious admissions) are different across these groups. Ultimately these sorts of graphs and tools which are interactive provide information for both clinicians and managers to better discuss the health of older people area and compare it against varying situations and across DHBs. The ultimate goal is to highlight regional best practice and share stories of what has been done exceptionally well in some DHBs so that others can apply this to their own populations. Chair: Dr Phil Wood, Waikato DHB Manager: Sam MacKenzie Q1 Q2 Q3 Q4 Improving the services for people with dementia Complete developing dementia awareness and education resources. Targets will include primary care, community care workers and LTC facilities which do not have their own internal educational processes. Undertake a series of education presentations to primary care through roadshows and other communications with Primary Care regarding dementia pathways A A A Recruit dementia pathway educators across the region (within the context of national directives and funding) A Undertake targeted education and presentations around key strategic areas of dementia support Complete regional implementation of the Midland Dementia Pathways Delirium service development Develop a Midland DHBs pathway/continuum for the treatment and care of people with delirium Completing regional implementation of Midland Delirium pathways operationalise the sharing of resources across the region where practicable Work with DHBs and the MOH to improve data collection in information relating to delirium Develop suitable simple measures of knowledge and skill relevant to the Carer/clinical level Wrap around services for Older Persons, including home based support services, primary and secondary care services Ongoing analysis of benchmarking data including interrai data, and share this on a regular basis Engage with Planning and Funding to seek information from specialist services for older people and aged residential care facilities to find gaps and opportunities Provide opportunities to share learning, resources and initiatives for service integration Update data on available workforce in DHBs and benchmark Frail Elderly Academic leaders and practitioners inform the analysis to be modelled including outcome measures, methodology etc Access available data (in sustainable ways) Use analysts and software tools on current projects/initiatives A Present examples to DHB regional and local groups clinicians, managers and across the continuum of service settings Inform national guidance about new service delivery initiatives, and to refine current initiatives e.g. Fracture Liaison services C On Track Caution A In Trouble R 18

19 Quantitative data: Example Outcome Measures for InterRAI CAPs: C On Track Caution A In Trouble R 19

20 ED attendances older persons (over 65): *for ethnicity and gender graphs above the pink bar represents the total population where the blue bar represents ED admissions. C On Track Caution A In Trouble R 20

21 ED attendances young (under 65): *for ethnicity and gender graphs above the pink bar represents the total population where the blue bar represents ED admissions. C On Track Caution A In Trouble R 21

22 Maternity Services - Midland Maternity Action roup (MMA) Midland Maternity Transfer & Repatriation Standards Background The Midland Maternity Transfer & Repatriation Standards have been developed over the past three years into a comprehensive regional document, which was formally approved on 25 May 2016 by the Midland Maternity Action roup and approved by the Midland Chief Operating Officers roup on 23 June The Standards: - focus on enabling smooth patient flow and ensuring best, most appropriate and safest maternity care is delivered as close to the woman s home as possible - describe the transfer and repatriation processes between the Midland region s secondary to tertiary hospital, and repatriation from tertiary back to secondary hospitals - provides guidance on discharge of women back to their home domicile, where they no longer require admission to a secondary hospital. Waikato Hospital Maternity Services staff, including ACMMs, providing 24/7 support to the Midland region for incoming in-utero transfers and repatriations The regional transfer process The Standards have been developed over the past three years, involving extensive circulation, rounds of iterative consultation and feedback, and trialing of the process over the past few months in the region. During this period Waikato DHB has established the Associate Charge Midwife Manager (ACMM) roles, providing 24/7 coordination and facilitation of incoming maternity inter hospital transfer and repatriation processes. Consumer s experience of transferring from New Plymouth to Waikato We arrived at Taranaki Base at 27 weeks with light bleeding. I knew this would mean my hospital stay was likely to be brought forward, which I was happy with. Dr X met with my husband and I, and voiced his concerns about having vasa previa, and the set-up of Taranaki Base Hospital - the distance to theatre and theatre staff being on call at night. He felt the risk to me and our baby was too high, and we were so thankful for his honesty and call on that. We were happy to be transferred. Number of maternity transfers from Midland hospitals to Waikato Hospital (2014/15) The transfer happened quickly; within a few hours. And my admission to Waikato was processed fairly quickly. We were discharged from Waikato Hospital to River Ridge East Birth Centre two days after the caesarean, and returned home ourselves after that. I honestly can't say enough how well we (including my husband, and our baby after he was born) were cared for. Our midwife provided so much support even while I was in Waikato, and came up for our caesarean. We are so grateful for that, I appreciated having someone voice and carry out our wishes for us before and during the surgery. The midwives were all lovely, caring and kind. We felt listened to, and the few concerns I had were always addressed. They even set up a postnatal room for us on the antenatal ward as I had been there so long and was comfortable with all the staff there. This made the two days post birth feel relaxing and calm I felt like I was 'home'. All the staff I met on the ward; including the orderlies, cleaning and food staff were always happy, chatty and kind. It wasn't an ideal situation to be in, but everyone involved made it into an honestly pleasant stay. [Misty, New Plymouth] Misty and Shaun s baby C On Track Caution A In Trouble R 22

23 Chair: Corli Roodt, Associate Director of Midwifery, Waikato DHB Manager: Suzanne Andrew Workforce development and forecasting Q1 Q2 Q3 Q4 Intelligence - design a strategy for a sustainable maternity workforce across the region A Intelligence - ensure stronger engagement with workforce monitoring in conjunction with Ms HR to enable DHBs to understand maternity workforce issues Utilisation - identify future maternity workforce requirements and develop plans Utilisation - explore options to develop Midland maternity education packages that can be delivered across the region Education - consider emergent health issues to inform the development of a prioritised regional health education plan and support regional education Education - maximise collaboration Education - investigate the increasing use of Moodle as an electronic platform for e-learning Education - load Midland DHB education into a regional education calendar Maternal Mental Health Services Map of Medicine Perinatal Mental Health (primary) Pathway developed with local content linked into this and accessible by LMCs in the Midland region Pre and post pregnancy directories developed at each Midland DHB and linked to the Map of Medicine Perinatal Mental Health (primary) pathway Support better knowledge in the maternity sector of the perinatal mental health services available to women Support the linking of maternal mental health services into local MQSP governance boards Consider how best to inform women about access and treatment for maternal mental health services Protective parenting : smoke free, safe sleep, breastfeeding, immunisation, family violence, and never shake a baby Smoke free - enable training around best practice to support attainment of quit smoking support indicator for pregnant Māori women within Midland Smoke free - pilot an initiative that incentivises smoking quit support uptake amongst pregnant women in Waikato. Smoke free - partner and support the Midland Safe Sleep Programme facilitated by Te Puna Oranga on behalf of Nga Toka Hauora Smoke free - networking and sharing of resources throughout the Midland region Safe sleep - continue the implementation and auditing of the Midland Safe Infant Sleeping (Birth to 1 Year) Policy and Midland Safe Sleep Programme to reduce Māori SUDI rates, in alignment with national indicator Safe sleep - partner /support the Midland Safe Sleep Programme facilitated by Te Puna Oranga on behalf of Nga Toka Hauora and with Change For Our Children Safe sleep - networking and sharing of resources throughout the Midland region Breastfeeding - complete Mama Aroha breastfeeding training with key health practitioners C C Breastfeeding - explore the development of IT tools, to improve access to information for all parents, particularly Māori and vulnerable mothers Breastfeeding - networking and sharing of resources throughout the Midland region Immunisation, family violence, never shake a baby - networking and sharing of resources throughout the Midland region, share education resources across the Midland region Pregnancy and parenting programmes Engage with Midland DHB planning and funding divisions to support improved access and uptake of pregnancy and parenting education/classes Collect and analyse data, including ethnicity breakdown, from Midland DHB planning and funding divisions on the utilisation of Midland s pregnancy and parenting/antenatal education/classes Support and partner with Te Puna Oranga (TPO) Waikato DHB, Maori Health Service on behalf of Nga Toka Hauora (Midland Maori eneral Managers Forum) with TPO s proposal to develop and produce a Hapu Wananga Curriculum & Toolkit for the Midland region C C C Support the development of the Hapu Wananga curriculum and toolkit content design C On Track Caution A In Trouble R 23

24 What we did in addition to what we said we would do BreastFedNZ app launch and implementation in Midland 5,400+ downloads as at 20 July Facebook followers 250+ accredited breastfeeding spaces uploaded to PS activated map on app, with more to be added website and Facebook page launched ( and Breastfed NZ FB Page) supporting and linking midwifery practices, parenting and education providers, and consumers with breastfeeding messaging, eg one BreastFedNZ Facebook post was shared 14 times pregnancy focused messaging incorporated, eg Taranaki s resource 5 things to do within the first 10 weeks of pregnancy Other work completed by MMA in Midland Safe Sleep Programme (established in Midland 2012) continued implementation of the Midland Safe Infant Sleeping (Birth to 1 Year) Policy across Midland DHB facilities, including participation in wahakura wananga and the Change For Our Children Pepi-Pod Programme. For babies aged 1-52 weeks (all causes and not just SUDI), during 2015 there was a small increase in mortality rates overall, but a reduction for Maori. The most important fact from these stats is that the drop in deaths is holding, especially for Maori. Stephanie Cowan, Director, Change For Our Children, 2 June 2016 Maori Non- Maori Total Management of the Bariatric Pregnant Woman protocol has been developed and approved by MMA; with approval requested from the Midland Chief Operating Officers roup shortly. Midland-wide Midwifery Quality Leadership Programme developed for the region. CO monitors were purchased by MMA and delivered to the Midland DHBs, based on the number of pregnant women who smoke in each district, to support smoke free pregnancies. MMA facilitated three Mama Aroha Breastfeeding Talk Cards workshops in the BOP district, with over 100 Well Child Tamariki Ora providers, Plunket staff, Midwives, Lead Maternity Carers, Child Birth Educators, and Public Health staff attending. These workshops were held to support the implementation of the MoH s national funding of Mama Aroha resources to health care providers. A Midland healthy pregnancies healthy families DVD resource has been collated and circulated to Midland DHBs. The content includes national and regional short film resources, eg never shake a baby, and links to Midland developed resources eg the BreastFedNZ app and the Child Health Action roup s skin conditions work. Additional Mama Aroha breastfeeding resources purchased for Lakes DHB and also for inclusion in the Hapu Wananga Curriculum & Toolkit being developed by Te Puna Oranga Waikato DHB Maori Health Service on behalf of Nga Toka Hauora (Midland Maori eneral Managers Forum). C On Track Caution A In Trouble R 24

25 Mental Health and Addiction Services Chair: Professor raham Mellsop, Midland MH&A Clinical overnance Regional Director: Eseta Nonu-Reid 1. Supra-regional Eating Disorders. Eating Disorders Inpatient Care. Continued regional provision of eating disorder inpatient services (Midland and Northern regions to implement the recommendations from the service review to ensure sustainable inpatient and community services) 2. High and Complex Needs. Improved mental health and addiction service capacity for people with high and complex needs 3. Youth Forensics. Development and implementation of actions for a Community Youth Forensic Service Plan 4. Perinatal Infant / Maternal Mental Health & Addictions services. Establish a coordinated network for FTE working in Perinatal MH&A to support supervision and workforce development 5. Forensic Inpatient Care. Robust regional contribution to the national network of forensic inpatient services Q1 Q2 Q3 Q4 A A C C C C C C C C C C C C What we did in addition to what we said we would do Supra-regional Eating Disorders Midland continues to fully participate in the Supra-regional Transition Steering roup meetings, Only one meeting occurred in the quarter Final decision making escalated to M and CE level, awaiting outcome Perinatal Infant Mental Health & Addictions All local Infant Perinatal Networks have been set up The regional Infant Perinatal Clinical Network met during the quarter Joint E-Learning for CSW project completed and website launched in the quarter MH&A Clinical Workstation Project MH&A component to the CWS has been put on hold while the scope of the work is reviewed with by Orion Champions groups will continue to progress documents and review Service Provision frameworks Te Huinga o Nga Pou in the process of developing a regional Cultural Assessment form AOD Residential Continuum Review Project Final report completed and approved by Clinical overnance and the Regional Portfolio Managers group for release Recommendations are to be progressed in financial year Co-existing Problems Enhanced Practitioner Project Evaluation report to be completed and tabled for sign off with Clinical overnance and the Regional Portfolio Managers group Midland Regional Networks All regional networks met during the quarter. Work has commenced on planning each groups strategic objective: o Addiction Leadership AOD Continuum of Care project o Maori Leadership Development of a regional Cultural Assessment Tool o Whanau Leadership Enhancing Family Whanau Leadership o Consumer Leadership Implementing Te Pou Service User Competency Framework o Workforce Leadership District Wide Workforce Plans Clinical Networks met during the quarter o Inpatient Care Clinical Network o OST Clinical Network o Infant Perinatal Clinical Network District Wide Workforce Plans Project Workshops completed in all five Midland DHB areas. ood attendance from the sector. Draft plans to be written up and circulated to attendees for feedback. Supporting Parents Healthy Children and Social Indicators Workshops scheduled throughout April in each of the DHB areas to provide training to staff in the use of the new T Codes for SPHC and the reporting requirements for the Social Indicators. Further workshops will be scheduled if there is a demand C On Track Caution A In Trouble R 25

26 Midland Maternal Mental Health (DHB & NO) Face to Face and Non-Face to Face The MoH Quarter 2 report requested detailed information on the Perinatal face to face and non-face to face contacts. PRIMH provides the source data but does not include infant data as this has been difficult to extract from the ICAMHS data sets. The two tables below use the Central region s reporting format. DHBs Midland Infant Perinatal (DHB & NO) Total Contacts Data source: PRIMHD 2014/ /16 Q3 Q4 Q1 Q2 Q3 Trend Bay of Plenty DHB Lakes DHB Hauora Tairawhiti Taranaki DHB Waikato DHB This table shows the same information but separates out the Face to Face and Non-Face to Face contacts by DHB by quarter. Section 29 Data (identified as a measure within the Maori Health Plan) The chart below illustrates the number of unique clients per 10,000 ethnic population by Midland DHBs over a period of six quaters. Unique client refers to an individual who is under the Mental Health Act. On an average the ratio for people put under the Act sits at one Non-Maori to three Maori with an exception of Taranaki and the BOP DHBs which is doing well in tackling CTO with a particular reference to Maori. Slight reductions noted in Hauora Tairāwhiti and Waikato DHB. C On Track Caution A In Trouble R 26

27 C On Track Caution A In Trouble R 27

28 Midland Radiology Action roup Key Achievements 1. Regional stock take and analysis of US workforce via a collaborative effort with public and private providers 2. Provided advice and consideration to a wide range of topics at national and regional level 3. MRA leadership change and a high level of engagement across the regions attendees on complex issues raised at regional and national level 4. Designed and agreed the data required to build a regional CT pipeline model. Chair: Dr Alina Leigh, Taranaki DHB Manager: Philippa Edwards Midland Radiology Action roup (MRA) will consider a proposal from Waikato DHB to develop regional Out of Hours Cover arrangement for Radiology Imaging 1. Proposal received by Q1 2. Proposal considered, evaluated and range of options developed with recommendations 3. If change is agreed MRA would inform an implementation plan developed by the proposers Workforce - Regional Solutions to Sonographer Workforce shortage in conjunction with the Midland Regional Training Network (MRTN) 1. Collect sonographer workforce data and map the current state with HR modelling in conjunction with MRTN 2. Submit proposed regional solutions to the DHB investment prioritisation process Demand - Capacity Modelling to Respond to National Priorities and changes on Models of Care -CT Colonography, CT Coronary Angiograms, MRI Multiple Sclerosis 1. Analytics gathered on current and future volume requirements, throughput and capacity 2. Modelling to deliver required volumes 3. Investigate how the region could be structured to improve equity of access to diagnostics Q1 Q2 Q3 Q4 A A A What we did in addition to what we said we would do The additional focus of the quarterly meetings in 15/16 has been advisory and responding to consideration of national and regional radiology topics such as Clinical Workstation functionality and benefits identification, MDM protocols, cancer imaging protocols, MOH funded radiology service improvement initiatives, CTCA proposal from Cardiac Network, National Patient Flow implementation, POCUS (Point of Care US) by non-radiology staff, primary access criteria and Choosing Wisely, Hep C Fibro scanning and DVT ultrasound follow up criteria via CPO/POAC (Primary Options funding). MRA project manager will project manage the National Radiology Action roup (NRA) for 2 years. The benefits of this include closer alignment of national radiology topics to local topics. Alina Leigh and Mark Spittal attend the national quarterly meetings on behalf of the Midland region. Q4 Update Initiative 1: Radiology Regional Night Cover Waikato canvassed the regional DHBs who did not see the need for a proposal as they had existing arrangements in place which they did not wish to disrupt. Consequently Waikato did not produce a proposal for service for which there were no buyers. Initiative 2: Sonographer Workforce Considerable work has been done in this area and the findings and recommendations of this work are being collated in a report for DHB executives for Q1 16/17. This has been delayed due to resignations within the Midland Regional Training Network stalling the predictive analysis. Of note, Tairāwhiti is the most productive training DHB having 1.6fte training with 2.45 Sonographers fully qualified staff to do the training. And during the project BOPDHB has increased its trainees and adopted the successful Waikato DHB model of sharing training with a private provider in a 50:50 model. The workforce work entailed a sonographer workforce stocktake in Dec 2015 across the public and private ultrasound providers in the Midland region. Fields were: District, Practice Name/DHB, Role Sonographer, Trainee or Vacancy, FTE, Employment type - Permanent, Trainee or Locum, Maori/Non Maori, Age band, ender. C On Track Caution A In Trouble R 28

29 Jan-14 Mar-14 May-14 Jul-14 Sep-14 Nov-14 Jan-15 Mar-15 May-15 Jul-15 Sep-15 Nov-15 Jan-16 Mar-16 May-16 Jan-14 Mar-14 May-14 Jul-14 Sep-14 Nov-14 Jan-15 Mar-15 May-15 Jul-15 Sep-15 Nov-15 Jan-16 Mar-16 May-16 FTE The MOH provided DHB ultrasound examination volumes for 2012 by patient age band. Cooperation across the region s DHBs and the multiple private providers was excellent with providers expressing a will to be a part of the solution where possible. The networks have identified that focusing on increasing the number of locally trained sonographers will provide sustainability of the workforce due to ultrasound being a post graduate qualification. There is a national initiative looking at opportunities and pathways for overseas sonographers to join the NZ workforce. Limitations to the workforce projection are considered to lead to an underestimate of required future workforce numbers: 1. Private US volumes were not widely available so projections were made based on Mercy Ascot 2012 private US data 2. Projections were made based on the current model of care and demand drivers. raphs: 2012 MOH data: Demand Curves for US by Age band per DHB and predicted additional FTE Sonographers Midland DHBs Ultrasound Percent Of the Total Volume by Age,ender and Ethnicity band (2012) Additional sonographers(ftes) needed in Public and Private Midland Region (as at 2012) 5% 5% 6.0 Additional sonographers(ftes) needed every year in Public and Private 4% 4% 3% 3% 2% 2% F Other F Maori F Pacific M Other M Maori M Pacific % 1% 1.0 0% raph: 2015 Stocktake data: Sonographer Workforce Midland Region Sonographer Workforce Midland Region - Public/Private FTE by District Private Public Private Public Private Public Sonographer Trainee Vacancy Waikato BOP Taranaki Lakes Tairawhiti Initiative 3: Capacity Modelling The CT Pipeline data has been agreed and design of the collection sheets completed. athering the data will get underway in July and this project will be carried forward to the 16/17 RSP. This project has been delayed due to a shortage of analytic support within HSL and has become the primary focus for MRA once the US workforce report is completed. Quantitative data: MOH Wait time KPIs for CT and MRI raphs: CT and MRI MOH KPI tracking BOP and Tairāwhiti achieve both targets, Improvement at Waikato and Taranaki, deterioration in timeliness of delivery at Lakes % 90.00% 80.00% 70.00% 60.00% 50.00% MOH CT KPI - MIDLAND DHBs Waikato CT KPI Bay of Plenty CT KPI Taranaki CT KPI Lakes CT KPI Tairawhiti CT KPI Target % 90.00% 80.00% 70.00% 60.00% 50.00% MOH MRI KPI - MIDLAND DHBs Waikato MRI KPI Bay of Plenty MRI KPI Taranaki MRI KPI Lakes MRI KPI Tairawhiti MRI KPI Target 40.00% 40.00% 30.00% 30.00% 20.00% 10.00% 0.00% 20.00% 10.00% 0.00% C On Track Caution A In Trouble R 29

30 Stroke Services (Midland Stroke Network) Think FAST! Stroke campaign goes live A nationwide stroke campaign has begun following a hugely successful trial which doubled the number of people able to recognise the main symptoms of a stroke. The Ministry of Health is funding a nationwide FAST campaign, based on the Stroke Foundation s pilot campaign that was run in the Waikato region 18 months ago. FAST is a life-saver, Stroke Foundation CEO Mark Vivian said. An easily-understood television package and innovative radio strategy are at the heart of the two-month campaign, supported by promotion on websites and social media. FAST is an internationally established acronym to help people remember three of the main signs of stroke. It stands for FACE ARMS SPEECH TIME. FACE - Is their face drooping on one side? Can they smile? ARM - Is one arm weak? Can they raise both arms? SPEECH - Is their speech jumbled or slurred? Can they speak at all? TIME - Time is critical. Call 111. The two-month nationwide campaign follows an extremely successful pilot in the Waikato, and encouraging results overseas. Waikato DHB s Dr Sarah Fowler said: Following the campaign here I have seen a real increase in patients and their whanau recognising the FAST acronym and repeating it to me on their arrival to our hospital. Many of them proudly tell me, I knew I had to come quickly as I knew the signs and didn t want to miss out on my opportunity to get the best treatment in the fastest time. Before the Stroke Foundation s pilot campaign, just under two out of 10 people in the Waikato could identify three main signs of stroke. After six weeks of TV and other advertising of the FAST message that number had reached almost four out of 10. The campaign ran in October and November ABOUT THE 2014 WAIKATO CAMPAIN The FAST message has been proven to identify 90% of strokes The 30-second TVC shown in the Waikato in October-November 2014 can be viewed at Stroke-FAST, along with the posters, leaflets, fridge magnets and wallet cards distributed throughout the region. The online aspect of the campaign surpassed industry standards with click through rates from Facebook adverts nearly 5,500% higher than an average campaign. Traffic to increased well beyond normal during the campaign and oogle analytics showed most of this traffic came from the Waikato area. C On Track Caution A In Trouble R 30

31 STROKE FACTS AND FIURES Stroke is the third largest killer in New Zealand after heart disease and cancer Each year around 9,000 people have a stroke over 2,500 die from stroke About 15% of all stroke survivors are institutionalised; disabilities from stroke make it one of the highest consumers of hospital beds, services and community support in New Zealand There are an estimated 60,000 stroke survivors in New Zealand Up to half of all stroke cases could be treated with clot-busting drugs (thrombolysis or tpa) if they arrive within three hours of the stroke s onset at a hospital. Lifetime costs per stroke patient in New Zealand were estimated in 2009 at $73,600 per person, with a total cost to the country of over $450 million annually. Chair: Peter Wright, Waikato DHB Manager: Andrew Campbell-Stokes Work programmes Each region to maintain and have lead stroke nurse and lead stroke physician Q1 Q2 Q3 Q4 Workforce issues are addressed for Allied Health; Nursing; Medical A A A Discussion with DHB executive teams to obtain support for adequately resourcing stroke services Explore feasibility of Clinical Nurse Specialist in stroke services Education Programmes Standard of education provision to be set and standardised across the region Providing education resources to primary and secondary care Support of Stroke study days: national, regional and local days Support NZ Stroke Foundation awareness raising campaigns Māori and Pacific - links to Tikanga best practice Māori access to services, outcomes not equivalent Identify the inequity of thrombolysis rates between Māori/Pacific and others Regional Projects Service provision - ensure thrombolysis services across the region align to the NZ Organised Acute Stroke Service Specifications (prepared by the National Stroke Network) Undertake a gap analysis of the Midland DHBs against the NZ Organised Acute Stroke Service Specifications Work collaboratively with regional ambulance service to ensure timely access to thrombolysis National Stroke Network advice is fed into the regional networks Correct data for the region is to be reported monthly Quarterly measures are monitored To advocate for 24 hour thrombolysis service where there is a CT scanner. The region to provide support to thrombolysis clinicians to facilitate service. Clinical governance at regional level is established Active clinical membership and participation into regional network activity Rehabilitation services for stroke patients across the region aligns to the NZ Organised Stroke Rehabilitation Service Specifications (in-patient and community) (prepared by the National Stroke Network) Undertake a gap analysis of the Midland DHBs against the NZ Organised Stroke Rehabilitation Service Specifications (in-patient and community) a. Stocktake current community based rehabilitation for each DHB b. Stocktake of what psychological support there is across the region - psychological input and support at inpatient and post discharge care Recommendations from the Midland rehabilitation stocktake are addressed where feasible - proposals for Supported Discharge programmes and implementation in the Midland region Identify consistent rehabilitation audit measures in conjunction with the National Rehabilitation roup Six monthly case review audits of rehabilitation services for under 65s against agreed criteria are completed A C On Track Caution A In Trouble R 31

32 Quantitative data: Audit 1 80% of all eligible Non Maori stroke patients are to be cared for in a stroke unit. For eligibility use codes I61, I63 and I64 who stayed more than 24hrs in the hospital. Split into Maori and Non Maori, and only include the Non-Maori patients. Also ensure that terminal patients are included. Excludes I60 - subarachnoid haemorrhage; 45 - TIA; and I61, I63, I64 patients from ED with less than 24 hour stay in the hospital. 120% 100% 80% 60% 40% 20% 0% 14/15 Q2 14/15 Q3 14/15 Q4 15/16 Q1 15/16 Q2 15/16 Q3 Bay of Plenty DHB Lakes DHB Tairawhiti DHB Taranaki DHB Waikato DHB Midland Total All Midland Targets All Midland Targets Bay of Plenty DHB Lakes DHB Tairāwhiti Hauora Taranaki DHB Waikato DHB Midland Total 14/15 Q2 14/15 Q3 14/15 Q4 15/16 Q1 15/16 Q2 15/16 Q3 % 80% 80% 80% 80% 80% 80% Denominator Numerator % 70% 61% 73% 60% 54% 75% Denominator Numerator % 73% 59% 84% 77% 72% 76% Denominator Numerator % 100% 100% 100% 100% 100% 100% Denominator Numerator % 57% 82% 86% 61% 62% 73% Denominator Numerator % 77% 74% 72% 74% 82% 84% Denominator Numerator % 72% 71% 76% 69% 70% 79% Denominator Numerator Data notes Numerator = those who are eligible and who spent any time in the Stroke Unit, or if not the Stroke unit but were in Intensive Care Unit (ICU), High Dependency Unit (HDU), Coronary Care Unit (CCU), or in a neurosurgical ward under a neurosurgeon - as these locations constitute being in an acute stroke unit. Denominator = all eligible I61, I63 and I64 patients including patients at hospitals with no stroke unit i.e. T-Hospitals, Taupo and Whakatane. Data Source Data is obtained from the Stroke Audit document which DHB s update as part of the manual collection of data. C On Track Caution A In Trouble R 32

33 Audit 2 80% of all eligible Maori stroke patients are to be cared for in a stroke unit. For eligibility use codes I61, I63 and I64 who stayed more than 24hrs in the hospital. Split into Maori and Non Maori, and only include the Maori patients. Also ensure that terminal patients are included. Excludes I60 - subarachnoid haemorrhage; 45 - TIA; and I61, I63, I64 patients from ED with less than 24 hour stay in the hospital. 120% 100% 80% 60% 40% 20% 0% 14/15 Q314/15 Q415/16 Q115/16 Q215/16 Q3 Bay of Plenty DHB Lakes DHB Tairawhiti DHB Taranaki DHB Waikato DHB Midland Total All Midland Targets All Midland Targets Bay of Plenty DHB Lakes DHB Tairāwhiti Hauora Taranaki DHB Waikato DHB Midland Total 14/15 Q3 14/15 Q4 15/16 Q1 15/16 Q2 15/16 Q3 % 80% 80% 80% 80% 80% Denominator Numerator % 17% 17% 64% 15% 100% Denominator Numerator % 58% 53% 79% 80% 60% Denominator Numerator % 100% 100% 100% 100% 100% Denominator Numerator % 50% 100% 100% 50% 50% Denominator Numerator % 69% 74% 68% 94% 65% Denominator Numerator % 64% 62% 75% 68% 68% Denominator Numerator Data notes Numerator = those who are eligible and who spent any time in the Stroke Unit, or if not the Stroke unit but were in ICU, HDU, CCU, or in a neurosurgical ward under a neurosurgeon - as these locations constitute being in an acute stroke unit. Denominator = all eligible I61, I63 and I64 patients including patients at hospitals with no stroke unit i.e. T-Hospitals, Taupo and Whakatane. Data Source Data is obtained from the Stroke Audit document which DHB s update as part of the manual collection of data. C On Track Caution A In Trouble R 33

34 Audit 3 6% of acute ischemic stroke patients are thrombolysed. Pull codes = I63, I64 (infarct/ischemic stroke + those not specified). 40% 30% 20% Bay of Plenty DHB Lakes DHB 10% 0% 14/15 Q3 14/15 Q4 15/16 Q1 15/16 Q2 15/16 Q3 All Midland Targets Bay of Plenty DHB Lakes DHB Tairāwhiti Hauora Taranaki DHB Waikato DHB 14/15 Q3 14/15 Q4 15/16 Q1 15/16 Q2 15/16 Q3 % 6% 6% 6% 6% 6% Denominator Numerator % 6% 8% 6% 11% 7% Denominator Numerator % 0% 0% 0% 0% 0% Denominator Numerator % 0% 15% 12% 7% 33% Denominator Numerator % 10% 0% 0% 3% 0% Denominator Numerator % 5% 10% 7% 12% 9% Denominator Numerator Data notes Numerator = those who have had thrombolysis. Denominator = I63 +I64 (infarct/ischemic stroke + those not specified). The target will move to 8% by Dec 2015 and 10% by Dec Data Source Data is obtained from the Stroke Audit document which DHB s update as part of the manual collection of data. C On Track Caution A In Trouble R 34

35 Trauma Services - Midland Trauma System (MTS) Midland Trauma Symposium: Understanding Trauma: Bridging the gaps May workshop participants How to get started in clinically relevant research 90+ Symposium delegates Understanding trauma Bridging the gaps a reflection of our drive toward collaborative use of related datasets and a commitment to get relevant information to regional action groups that need it to make positive change Dr rant Christey, Clinical Director - MTS A new system to track details of trauma, which can be shared by all emergency and health services, could be up and running for the Midland health region by the end of the year. The idea was presented at the Midland Trauma Symposium at Claudelands Events Centre in Hamilton on Friday, 20 May. Clinical director rant Christey said the new trauma system will allow data from all agencies to be shared, and will form one online database. Agencies dedicated to improving the health of New Zealanders, like St John, ACC, New Zealand Transport Agency, and Metservice, are all keen to take a look at the new platform. "There is no such thing as an accident, it's always preventable, and this new system will allow us to find ways to cut the trauma rates down." Christey said by using the new platform Midland Trauma will be able to identify high risk trauma areas and then notify community groups of how these can be improved. "If there are a lot of dog attacks occurring in a specific area, we can measure this and find a sensible and meaningful way to address the problem." He said there are a lot of areas of trauma that need focusing on, but the platform is a good start towards dealing with the issues. "We will be able to prioritise those bigger areas that need attention, and support change." Excerpt from Waikato Times, 20 May 2016, Caitlin Moorby. Full article available at: Did you see us at the Fieldays? The staff from Midland Trauma and Waikato Mental Health and Addictions got out their gumboots and headed off to Mystery Creek for the 2016 Agriculture Fieldays. With over 130,000 people visiting the Fieldays, we were not alone. Our first appearance at the Fieldays was well received. Our stand s backdrop reflected rural New Zealand, with written material, covering physical and mental wellbeing and our verbal interaction focusing on our key message - Keep you and your family safe. The sheep and cow stress balls were a popular gift. We have calculated that approximately 3,500 people received information from our stand during the four days. So many brochures were distributed and important conversations were had. We have received very positive feedback and look forward to next year. C On Track Caution A In Trouble R 35