Hutt PUBLIC Hospital Advisory Committee 21 October Agenda. 1.3 Minutes of previous meeting To Consider Virginia Hope 4

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1 Hutt Hospital Advisory Committee 21 October Agenda AGENDA Held on Friday 21 October 2016 Board Room, Pilmuir House, Hutt Hospital Commencing at 9am HOSPITAL ADVISORY COMMITTEE SECTION Item Action Presenter Min Time Page 1. Procedural Business 10 9am 9.10am 1.1 Apologies To Note Virginia Hope 1.2 Continuous Disclosure Interest Register Conflicts of Interest To Consider Virginia Hope Minutes of previous meeting To Consider Virginia Hope Matters Arising To Consider Virginia Hope 8 2. DISCUSSION PAPERS PRESENTATIONS 2.1 Walk through Infection Control Report To Note Matthew Kelly Clare Underwood am 9.40am 2.2 Operational Services Report To Note Dale Oliff am 9.50am Quality & Safety Report To Note Amber O Callaghan am 10.00am GENERAL 3.1 General am 10.10am 3.2 Resolution to Exclude the Public am 10.15am 50 CLOSE 10.15am ADDENDA Balanced Scorecard August HDC Complaints Report Hutt Valley DHB - Jan-Jun

2 Hutt Hospital Advisory Committee 21 October Procedural Business PROCEDURAL HUTT VALLEY DISTRICT HEALTH BOARD HOSPITAL ADVISORY COMMITTEE Interest Register Name Dr Virginia Hope Chair Ms Katy Austin Member Mr Ken Laban Member Mr John Terris Member David Ogden Member Hutt Valley District Health Board Interest Chair, Capital & Coast District Health Board Chair, Hutt Valley District Health Board Deputy Chair, 3 DHB CPHAC/DSAC committee Chair, Hutt Valley Hospital Advisory Committee Member, Finance Risk & Audit Committees, Hutt Valley and Capital & Coast District Health Board Health Programme Leader, Institute of Environmental Science & Research Director & Shareholder, Jacaranda Limited Fellow, Royal Australasian College of Medical Administrators Fellow and New Zealand Committee Member, Australasian Faculty of Public Health Medicine Fellow, New Zealand College of Public Health Medicine Member, Territorial Forces Employer Support Council Member, National Roundtable to Strengthen Pathology & Laboratory Services Member, Regional Governance Group, Central Region DHBs Brother and sister work in health sector in the Wairarapa (disability support and laboratory respectively) Member, Gillies McIndoe Research Institute Member, DHB Shared Services Executive Team (governance/oversight role) Member, Hutt Valley District Health Board Member, Hutt Valley Hospital Advisory Committee Fergusson Home (Upper Hutt) Voluntary input Member, Hutt Valley District Health Board Member, Hutt Valley Hospital Advisory Committee Member, Wairarapa, Hutt Valley and CCDHB Community Public Health Advisory Committee and Disability Support Advisory Committees Trustee, Hutt Mana Charitable Trust Member, Ulalei Wellington Member, Hutt City Sports Awards Committee Member, Greater Wellington Regional Council Commentator, Sky Television Broadcaster, Numerous Radio Stations Member, Christmas in the Hutt Committee Member, Hurricanes Rugby Board Member, Wellington Rugby Football Union Trustee, Tana Umaga Foundation Member, Hutt Valley District Health Board Member, Hutt Valley Hospital Advisory Committee Member, Hutt Valley Finance Risk & Audit Committee Member, Hutt Valley District Health Board Member, Hutt Valley District Health Board, Finance Risk & Audit Committee 2

3 Hutt Hospital Advisory Committee 21 October Procedural Business Yvette Grace Member Member, Hutt Valley District Health Board, Hospital Administration Committee Principal, Oak Chartered Accountants Limited Accountant, affiliated, with Simple Accounting Services Limited, which has various clients involved in the Health Sector Presiding Member Lotteries Commission Wellington and Wairarapa Communities Committee. This Funding Committee shares some applicants with regional health board providers Daughter was previously an Intern Psychologist with a Health Board outside this region. She is currently completing her doctorate Founding Trustee, E Tu Awakairangi Hutt Public Art Trust which is currently in discussions with management concerning the installation of a public art work in the HVDHB grounds Former Mayor and Councillor, Hutt City Council. Former regional councillor Member, Hutt Valley District Health Board Member, Hutt Valley Hospital Committee Chair, Te Oranga O Te Iwi Kainga Maori Relationship Board to Wairarapa DHB Trustee, Rangitane Tu Mai Ra Treaty Settlement Trust Manager, Compass Health Wairarapa Member, 3DHB Youth SLA (Service Level Alliance Member, Te Whiti Ki Te Uru Central Regions Maori Relationship Board Husband, Family Violence Intervention Coordinator and Child Protection Officer Wairarapa DHB Husband, Community member of Tihei Wairarapa Alliance Leadership Team Sister in law, Nurse at Hutt Hospital Sister in Law, Private Physiotherapist in Upper Hutt Niece, Nurse at Hutt Hospital 3

4 Hutt Hospital Advisory Committee 21 October Procedural Business DRAFT MINUTES Held on Friday, 19 August 2016 Boardroom, Hutt Valley District Health Board Commencing at 9.00am HOSPITAL ADVISORY COMMITTEE SECTION PRESENT Wayne Guppy (Chair) Ken Laban David Ogden Yvette Grace John Terris Katy Austin APOLOGIES Virginia Hope (Chair) IN ATTENDANCE Ashley Bloomfield (Chief Executive, Hutt Valley DHB) Dale Oliff (Chief Operating Officer, Hutt Valley DHB) Carrie Maniapoto (Committee Secretary) PRESENTERS Sarah Boyes, Director of Operations, Surgical, Women s & Children s Directorate Dr Stephen Purchas, General Surgeon Rebecca Kay, Associate Clinical Nurse Manager, Theatre 1.0 PROCEDURAL BUSINESS 1.1 APOLOGIES The Committee(s) ACCEPTED the apologies as listed above. 1.2 DECLARATION OF INTERESTS INTEREST REGISTER No amendment was declared by the Committee CONFLICTS OF INTEREST No conflicts of interest were declared for any items listed on the agenda. 1.3 CONFIRMATION OF MEETING MINUTES JUNE 2016 The Committee RESOLVED to approve the minutes of the meeting held on 17 June 2016 as a true and accurate record of the meeting. MOVED Ken Laban SECONDED David Ogden CARRIED Hutt Valley District Health Board Page 1 August

5 Hutt Hospital Advisory Committee 21 October Procedural Business 2.0 FOR DISCUSSION 21. PRESENTATION THEATRE EFFICIENCY PROJECT Sarah Boyes, Director of Operations, Surgical, Women s & Children s Directorate, Dr Stephen Purchas, General Surgeon and Rebecca Kay, Associate Clinical Nurse Manager, Theatre provided a presentation to the Committee providing an update on the Theatre Efficiency Project that is currently underway. The Presentation covered: - Why we need to look at theatre productivity - Critical success factors - Early progress - Benchmarking and analysis - Quick wins - Staff engagement - Focussed improvements. The Committee extended its thanks to the team for the great work that is underway. 2.2 OPERATIONAL SERVICES REPORT The Chief Operating Officer presented the Operational Services Report specifically noting the huge amount of work being done around the 6 hour target, the decrease in stroke presentations and the work currently being done to standardise prioritisation tools. It was noted that there has been almost no increase in overall ED attendances in the last two years. Data suggest that the integration work with Primary Care is having an impact and we need to be doing more given the admission rate remains low compared with other DHBs. The Hospital Advisory Committee: a. NOTED the balanced scorecard; b. NOTED the June Emergency Department (ED) target performance of 94.4% of patients being seen and discharged or admitted within six hours and 93.2 % for Quarter 4 (April to June); c. NOTED there has been almost no increase in ED attendances in the last two years and a decrease in Triages 4 and 5 presentations, many of whom can be managed in primary care, to ED; d. NOTED the improvement activities undertaken to improve performance and patient flow in the ED; e. NOTED the overall average length of stay for acute admissions was 2.2 days, compared with 2.63 days in June 2015; f. NOTED the increase in inpatient bed use (overnight stays), which is counter-balanced by the decrease in length of stay; g. NOTED a 19% drop in the average length of stay in the top three DRGs within medical services (respiratory infections, chronic obstructive airway diseases and stroke); these three DRGs make up 22% of all medical admissions and contributed significantly to the overall decrease of 2.5 beds in medical bed utilisation in 2015/16; h. NOTED the organisation is on track and continues to remain compliant with the 4 month wait for First Specialist Appointments and Waiting List; i. NOTED that in 2015/16 Hutt achieved 104% in elective procedures; Hutt Valley District Health Board Page 2 August

6 Hutt Hospital Advisory Committee 21 October Procedural Business j. NOTED that since the end of February, 115 patients received their eye surgery at Hutt Hospital, of which around 70% were for cataracts (older patients), and that post implementation review of the Ophthalmology Service will be undertaken 9 months after commencement of the service at Hutt witha report to the Board in December; k. NOTED the progress made in terms of appointment of the Bowel Screening progamme manager and that the team is working closely with the Ministry of Health and Waitemata DHB to prepare for implementation of the programme at Hutt Valley and Wairarapa DHBs from 1 July 2017; l. NOTED The Influenza season is late, and there have been no influenza outbreaks notified this season across the sub region; m. NOTED the Provider arm financial result for year to date (YTD) 30 June 2016 was a net deficit of ($18,132k), which was favourable to budget by $670k. 2.3 QUALITY AND SAFETY REPORT It was noted that staff appear to be happier in the workplace. Staff health is integral to how we perform as an organisation. The Quality Walk Rounds are proving to be beneficial and we are looking to undertake a staff engagement survey mid The Hospital Advisory Committee: a. NOTED that in the National Patient Experience Survey Hutt Valley DHBs highest scoring questions were the same as the nationally highest scoring questions. Overall, did you feel staff treated you with respect and dignity while you were in the hospital? with 88% of patients answering Yes, always. HVDHB scored 86%, which is a decrease from 91% last quarter. This was HVDHB s highest-equal score along with; Overall, did you feel staff treated you with respect and dignity while you were in the hospital? with 86% of patients answering Yes, always. HVDHB scored 86%; which is in line with the national average and similar to the 88% recorded last quarter; b. NOTED the lowest scoring question in the National Patient Experience Survey nationally and for HVDHB was Did a member of staff tell you about medication side effects to watch for when you went home? Nationally the score was 50% and HVDHB scored 57%, which is an increase from 45% last quarter; c. NOTED that for the Hand Hygiene audit period 1 April 2016 to 31 June 2016, HVDHB achieved an 80.4% compliance rate; this is an increase of 2.4% from our quarter 3 publication, and is the first time we have reported meeting the 80% target in the National QSM data set; d. NOTED that for the falls marker audit period January March 2016, HVDHB showed an increase from 66% to 72% of patients aged 75 and over (Maori and Pacific Peoples 55 and over) that were given a falls risk assessment; e. NOTED that Hutt Valley DHB underwent a full Certification Audit from May The Certification Audit Report was submitted to HealthCert by the DAA Group on 11 July 2016 and the DHB is working on an action plan for corrective actions that will be monitored by the Quality Team and ELT; f. NOTED that the Hutt Valley Health System Clinical Council is now settling into its work, having had its fourth meeting on 5 July 2016; g. NOTED that the second Quality and Safety Walk-Round took place in the Children s Ward in July and the third one on the medical ward in August. Parents and patients spoken with praised the environment, good food, fantastic staff and great support, saying both the care and communications were excellent; Hutt Valley District Health Board Page 3 August

7 Hutt Hospital Advisory Committee 21 October Procedural Business h. NOTED that the Clinical Council and the Hutt Valley DHB ELT have endorsed the concept of establishing the Consumer Council as proposed and a proposal is on the agenda for this month s Board meeting; i. NOTED that Patient Safety Week 2016 will run from Sunday 30 October to Saturday 5 November 2016; he theme is Let s Talk and planning is in progress; j. NOTED that Hutt Valley DHB will be participating in a co-design programme sponsored by the HQSC. This programme will assist the DHB in increasing it capability skills in understanding the patient and staff experience and co-design work to help us design and deliver better healthcare services. 3.0 OTHER BUSINESS 3.1 GENERAL There was no general business to discuss. 3.2 RESOLUTION TO EXCLUDE THE Committee members RESOLVED to AGREED that as provided by Clause 32(a), of Schedule 3 of the New Zealand Public Health and Disability Act 2000, the public are excluded from the meeting for the following reasons: SUBJECT REASON REFERENCE Serious & Sentinel Event Update To protect the privacy of natural persons, including that of deceased natural persons 9 2 (a) Meeting Closed at 10.18am Next meeting to be held Friday 21 October, Boardroom, Pilmuir House, Hutt Valley DHB, commencing 9am Hutt Valley District Health Board Page 4 August

8 Hutt Hospital Advisory Committee 21 October Procedural Business SCHEDULE OF MATTERS ARISING - HAC COMMITTEE Item # Topic: Action: Responsible: How Dealt With: Delivery Date: Ex HAC Meeting June Infection Prevention and Control Annual Report 2015 The Chief Operating Officer to invite Dr Matthew Kelly to attend a future HAC meeting to further discuss the Infection Prevention and Control Annual Report 2015 Dale Oliff Dr Kelly and Clare Underwood invited to next HAC meeting On agenda October 2016 meeting 8

9 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS HAC DISCUSSION PAPER Date: 21 October 2016 Authors Dale Oliff, Chief Operating Officer Andy Harris, Interim Executive Director Allied Health, Scientific & Technical Sisira Jayathissa, Chief Medical Officer Helen Pocknall, Executive Director Nursing & Midwifery Endorsed By Ashley Bloomfield, Chief Executive Officer Subject DHB Provider Operational Service Report October 2016 RECCOMMENDATIONS It is recommended that the Hospital Advisory Committee: a. NOTES the balanced scorecard (appended); b. NOTES the August Emergency Department (ED) target performance of 94.4% of patients being seen and discharged or admitted within six hours and 94.2 % for Quarter 1 (July to September 2016); c. NOTES there have been a 6% less ED attendances in the last two months than during the same period last year; d. NOTES 19% (134) more patients were seen in less than three hours in the first two months of the year compared with the same period last year; e. NOTES the improvement activities undertaken to improve performance and patient flow in the Emergency Department; f. NOTES there were 328 more discharges from the hospital during July and August compared with the same period last year, most of which were day cases; g. NOTES that while we were non-compliant for August with ESPIs two and five, we remain compliant overall with the four month wait for First Specialist Appointments (FSAs) and surgery; h. NOTES that the DHB is has delivered 105% of the target number of elective procedures YTD; i. NOTES the Provider arm result for year to date (YTD) August 2016 is a net deficit of ($89k), which is favourable to budget by $60k. ADDENDUM HVDHB Balanced Scorecard August BALANCED SCORECARD VARIANCE AND SERVICE DELIVERY 1.1 Effective Emergency Department Meeting the Shorter Stay Target In August 94.4% of patients were seen and discharged or admitted within six hours. For the first quarter of the year (July to September) Hutt achieved 94.2% of the ED Target. Of these patients, 88 % were admitted and 97 % were treated and discharged within six hours. This is a significant improvement on the result (86%) during the same period last year. Hutt Valley District Health Board HAC October

10 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS On average patients were in ED for 47 minutes less than for the same period last year and is a credit to all the team Triage nurse, SMOs, medical registrars and MAPU working together to pull patients who clearly required further workup through ED. The proportion of attendees who Did Not Wait is at 5.7% (9.7% same period last year), another good result. There were 213 less children (0-14) presenting to ED during August 2016 compared with August 2015, suggesting that people are accessing free primary care for under 13 year olds. Below is the analysis of the target, comparing this to the previous four years. For this time of the year, we are doing comparatively well. The improvement in the target is a result of initiatives that address of a number of stages during the patient s journey through the department including arrival to triage, triage to seen and seen to discharge, as well as a focus on specialities seeing patients in a timely manner. Hutt Valley District Health Board HAC October

11 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Hutt Valley District Health Board HAC October

12 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Hutt Valley District Health Board HAC October

13 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS 1.2 Faster Cancer Treatment Services Definition: 62 Day Cancer Target: patients referred urgently with a high-suspicion of cancer to receive their first cancer treatment within 62 days of being referred with a high suspicion of cancer and the triaging clinician believes the patient needs to be seen within two weeks. The 62-day wait is measured from receipt of the referral to the date of the patient s first cancer treatment (or other management). The target is that by July 2016, 85 per cent of patients meeting the criteria should commence treatment within 62 days, increasing to 90 per cent by June Hutt achieved 80% in August, which was a better result than the same period in the previous two years, and the result for the quarter date is 68.75%. FinYear 31 Day Ind FinYear Number of 62 Day Ind - 62 Day Ind - Month - Target 31 Day Ind - 62 Day Ind - Quarter Patients Patients Target Met Met Target (%) Target (%) 2016/2017 Quarter 1 Jul % % Aug % % 2016/2017 Total % % 2015/2016 Quarter 1 Jul % % Aug % % Sep % % 2015/2016 Total % % 2014/2015 Quarter 1 Jul % % Aug % % Sep % % 2014/2015 Total % % The cancer groups that did not meet the 62 day target were lung (2 patients) and skin (3 patients) tumour streams. There were a number of reasons for the delays: - patient choice (one patient) - Another patient just exceeded the target by one day, and one of these days was a public holiday. The wait time to bronchoscopy was 9 days instead of 2 days as the patient had to stop his anticoagulant for a week prior to the procedure - The remaining two patients were waiting for a procedure under the plastics service Following are highlights from the Central Region Faster Cancer Network Report (Quarter 4 March to June 2016): - Performance for the Central Region against the 62 day indicator was 75% for the current period, slightly down on 78% for the previous period. The regional result of 75% was just above the national result (74%). Hutt Valley District Health Board HAC October

14 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS - Regional performance against the 62 day indicator was 79% for patients treated at their own DHB compared with 62% for patients treated at another DHB. The network will be commencing a project to look at inter-dhb communication and referral to further investigate this and identify improvement opportunities. - First treatment types with the lowest results for the 62 day indicator continue to be concurrent radiation and chemotherapy (51%) and radiation (60%). The Regional Cancer Networks and Radiation Oncology Work Group will be meeting shortly to discuss ways of improving the performance nationally. - In the Central Region overall, 22% of total FCT patients have their first treatment at a DHB other than their own DHB; for Hutt Valley this is at 43%. - Lung and melanoma account for most of total patients treated at other DHBs within the region. 1.3 Hospital Average Length of Stay (ALOS) In August 2016 the overall average length of stay for acutes was 2.5 days, and year to date the figure is 2.3days against a target of 2.5 days. Electives were 1.2 days for the month and 1.3 days year-to-date against a target of 1.5 days. Of note: There was an increase of 328 discharges; almost all the increases were day cases Almost 50% of the day cases were elective procedures There were 10 less acute inpatient admissions There were 6 more elective inpatient admissions. In the last 2 months there was 1.8 fewer beds used per day, which is pleasing given the time of the year. So saying, September has been very busy in the hospital, which is likely to have an impact on this result. Discharge Financial Year Data Jul Aug Grand Total 2016/2017 Discharges Avg LOS Beds Required/Mth /2016 Discharges Avg LOS Beds Required/Mth Variation Per Day Hutt Valley District Health Board HAC October

15 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Acute ALOS: The ALOS project continues to progress with fortnightly steering group meetings. Admissions through the Medical ward have increased to 611 for July and August (547 the previous two months). This has seen a slight increase in ALOS for patients of 2.43 days in July and 3.15 days in August due to a higher acuity of patients during the winter months. Key workstreams continue in particular: - Communication strategy focusing on bedside handovers and good communication within the team - Stroke model of care changes that are now embedded in business as usual. People with acute strokes, when medically stable, are transferred to rehabilitation as a priority with the same clinicians caring for the patient in both wards. This has seen a decrease in the overall length of stay for stroke patients. - Nursing model of care changes continue with end of shift checklists and nursing pause points being taken up consistently by staff. There is ongoing work to embed bedside handovers with staff providing feedback in an evolutionary fashion to make this process more sustainable and successful. - Board rounds, documentation of estimated date of discharge (EDD) and discharge before midday remain focus areas. - A review of Health Roundtable (HRT) data has identified other areas of opportunity including Heart Failure and Diabetes. Meetings have occurred with both Diabetes and Cardiology to investigate these areas further to improve outcomes for this cohort of patients. These will be a subset of the ALOS workstream to leverage off the current governance structure around this project. 1.4 Surgical Production Hutt Valley District Health Board HAC October

16 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS We delivered 105% of the required volumes in August with 107.5% year-to-date. Most of the additional delivery was in ophthalmology and general surgery (Hutt put through 151 procedures more that the same period last year). IDF outflow was over by three discharges. There were 99 less IDF outflow procedures delivered than for the same period last year and these were mostly in ophthalmology, urology and general surgery. 1.5 Elective Services Performance Monitoring Indicators (4 month compliance) Feb Mar April May June July Aug Sept Prelim Oct Forecast ESPI 2 - FSAs ESPI 5 - surgery preli m ESPI 2 (FSAs) The preliminary result for ESPI 2 for September is non-compliant. There were three services contributing to this: 21 patients in Ophthalmology, 21 patients in Plastics and 5 patients in ENT. Ophthalmology relates to SMO leave with no backfill available from CCDHB (surgeons are outsourced from CCDHB). Process mapping and production plan will be completed to have a better understanding of demand and capacity issues. In ENT this relates to annual leave and vacancies. October is looking favourable with enough capacity in all specialties to see patients waiting although ophthalmology will continue to be challenging. ESPI 5 (Surgery) The preliminary result for ESPI 5 for September is non-compliant. These are mostly in Orthopaedics and Ophthalmology. 1.6 Reducing Rates of Outpatient Clinic DNA s (Did Not Attend) The overall DNA for the month of August was 6.1%. A breakdown is as follows: Target August 16 Year to Date Maori 17% 12.4% 12% Pacific 19% 11% 12% Other 9% 4% 5% Overall 9% 6% 6% The initiative by the Pacific team to reduce DNAs was originally only targeting under 15 year olds. The team is now addressing all patients attending key vulnerable services such as Ears Nose and Throat (ENT), gynaecology, colposcopy, rheumatology, cardiology and audiology. The Maori Health team has been targeting audiology, paediatric, ENT, plastics and dental services patients. The trend is one of ongoing improvement, as the graphs below indicate. Hutt Valley District Health Board HAC October

17 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Hutt Valley District Health Board HAC October

18 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Hutt Valley District Health Board HAC October

19 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Hutt Valley District Health Board HAC October

20 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Hutt Valley District Health Board HAC October

21 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS 1.7 Use of Minders The usage of minders was high in June but has since dropped in August. Policies and training are already in place to ensure the decision process is robust. The use of minders is discussed at the daily bed meetings in the Operations Centre. Graph: Hours of minder use by month since July 2014 Hutt Valley District Health Board HAC October

22 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS 1.8 Influenza Below is a breakdown of the presentations to ED with Flu-like symptoms. Presentations to the Emergency Department were low until the start of September. ED Presentations with Flu-Like Symptoms There was an Influenza outbreak in OPRS on 19 August, affecting the West ward with nine patients with symptoms. A total of four patients tested positive for Influenza A. Seven staff had varying symptoms of coughs and colds and influenza-like illness during this time. The outbreak was very successfully contained by effective infection control and communication to all teams. Three patients were exposed to Influenza in ICU. Contacts were treated prophylactically with Tamiflu and one staff member required prophylactic Tamiflu. 2 KEY ISSUES AND INITIATIVES FOR THE COMING MONTHS 2.1 Emergency Department Improvement Project The shorter stays in ED target has been steadily improving over the last year and in July and August the result has been just under the 95% target 94.4 and 94.2% respectively. The ED workstreams continue to progress with key areas of focus being models of care for nursing and medical staff. There has been a change in administration rosters resulting in better coverage of the reception. Ongoing discussions are occurring with the preferred provider for volunteers based in the ED. The aim is for this to commence in February 2017 following an extensive recruitment drive before and after the festive season. The role of the volunteers will include directing and assisting patients in the waiting room and helping staff in the back of house non-nursing activities. Hutt Valley District Health Board HAC October

23 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Dr Stephen Dee is now the Interim Clinical Lead for the Emergency Department while the service continues to recruit to the permanent role. It is anticipated this will be completed in early In the interim, Dr Dee has been meeting with the medical staff on a regular basis and providing weekly updates to them. His input and support has been very much appreciated by the medical staff and there is a noticeable improvement in clinical engagement. The GP Liaison has been meeting with ED staff to have a better understanding of the behaviours of patients presenting to ED. Some of the discussions include direct access to plain films during working hours and improving communication between secondary and primary. Lightfoot (an external service improvement agency) will be running a workshop in October that will allow clinicians in the service to see their data in a patient flow system and to identify opportunities for change/projects for the future. The restorative workshops have now been completed with a report with recommendations from the Occupational Health specialist who ran the workshops. This will provide a good basis for ED to develop their own Charter and ensure staff members are aware of expectations regarding behaviour and continue to feel empowered to challenge inappropriate and unacceptable behaviours. The leadership team continues to have monthly teleconferences with the Ministry s ED 6 hour champion who is pleased with progress not only in the target but the processes and culture. 2.2 Bowel Screening In late July a small group of clinicians from Hutt and Wairarapa DHBs attended an introductory meeting with the Waitemata Bowel Screening Programme (BSP) team. Attendees included the HVDHB CEO, the 2DHB Bowel Screening Programme Manager, representatives from the 3DHB ICT team and the Ministry of Health. This informative day included discussions and sharing on the background of the programme, international trends, data and development of the national programme. The Waitemata team outlined their specific pathway and provided a demonstration on the BSP Register. The Register is the central repository for participants and initiation of the Pre-Invite, Invite and Kit, and Active Follow Up components of the pathway. The Clinical Head of Department at Waitemata spoke about stakeholder engagement, management of lists from a quality perspective, results and multidisciplinary team meetings. The Clinical Nurse Specialist from Waitemata presented an outline of her pivotal role in nurse triage of referrals, nurse pre-assessment, bowel preparation, results management and participant outcomes. Monitoring indicators produced by the Ministry are extracted from the Register, and Waitemata is also monitored against the Quality Standards. Hutt and Wairarapa will have to meet the same Quality Standards and undertake a readiness to go live assessment that is partially based on these indicators. The group also visited Lab Plus to view the screening test process, from receipt of the kit at the lab, through to explanation of the quality processes around sample handling and processing. The second part of the laboratory pathway is histopathology (which involves processing and examination of any specimens taken during colonoscopy), and the group was taken through a demonstration of the pathway of a sample and proforma reporting that meets BSP quality standards. Hutt Valley District Health Board HAC October

24 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Previous work on the Ministry s Business Case for Treasury was completed at DHB level and Cabinet approval for the funding for 2016/17 was given in early September. The Hutt-based Programme Manager 2DHB commenced early August, and the Wairarapa based Project Lead more recently on 12 September. They have already established a collaborative approach for the project aspects of implementation. Governance of the programme is in place and the Steering Group, co-chaired by the Hutt Valley and Wairarapa CEOs, includes representatives from ELT, DLT, Primary Care, SIDU, Clinical Leads, ICT, Pacific and Maori Health. 2.3 Update from Clinical Support Recycled outdoor Furniture The DHB has beautiful grounds and has the opportunity to provide a great surrounding for staff and families to relax e.g. during meal breaks. However, there are very few locations with tables and seating currently and local businesses were contacted to support the DHB to purchase these seating. We have just placed an order for recycled timber outdoor tables and seating to be erected around the campus, starting at the front of the Clock Tower and Heretaunga Block. Plaques will be placed on the furniture to acknowledge the support from the local businesses. Waste Minimisation As part of the savings initiatives, a small group made up of pharmacy, food and theatre have been meeting regularly to reduce the waste and footprint on recycling in the kitchen and theatres. The DHB s waste minimisation project has been recognised by the Waste Management Institute of NZ who have asked for representatives from the DHB to give a presentation on achievements in recycling. Debbie Jennings, Manager Domestic Services and Chris Jay, Manager Pharmacy will be presenting at the conference on 19 October Kohanga Reo initiative Pharmacy staff members are supporting the Tu Kotahi Maori Asthma Trust with establishing Asthma First Aid Kits in Kohanga Reo. Schools have processes for sourcing inhalers for their emergency kits through the Medicines Legislation, but unfortunately Kohanga do not fall under the definition of a school in the Education Act. As a result, they are prevented from providing inhalers for the young, sometimes vulnerable children when the need arises. Although there are several challenges, the Pharmacy team is committed to working with the Trust to achieve the desired outcome of having inhalers available at all Kohanga Reo. NZQA Training A number of Orderlies and Cleaning staff have passed their NZQA qualifications for NZ Certificate in Health and Wellbeing (Orderlies Services Level 3) and the National Certificate in Cleaning and Caretaking Level 3. The staff members were presented with certificates and it was very humbling to see the pride they all showed in achieving this. Hutt Valley District Health Board HAC October

25 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS 2.4 Heart Failure Project Following a recent presentation from Health Round Table (HRT), each team was asked to consider initiatives to improve the outcome for the patient, and/or increase the efficiencies within the hospital. In terms of savings in bed days, Hutt has the opportunity to improve on patients admitted with heart failure and make savings of up to 650 bed days each year when compared to the exemplar hospitals in New Zealand and Australia. A small team was set up to review the HRT data and a further audit was undertaken of a cohort of patients admitted between January and December Over 12% of patients were readmitted within 30 days this is much higher than the average readmission rate for the organisation (8%). The team then undertook further analysis of this cohort of patients and identified the following: The average length of stay for patients readmitted was 12 days, which is almost double that of the average heart failure patient. 43% were discharged from CCU and 57% from other wards. The readmission rate was higher for those admitted to other wards than those admitted to CCU. Maori and Pacific patients were over-represented among people readmitted at 21% and 19% respectively 73% were prescribed 10 or more medications 17% did not have a discharge weight identified in their discharge summary; this was higher for those admitted to a non-ccu ward 62% of those readmitted died within 6 months of their readmission but only 12% received palliative care. Wider discussions have occurred with PHOs, hospice and medical team as the team recognises the need to link with the patient s GP and whanau in order to improve quality of life and end-of-life care for this group of patients. Further actions include: Support and education to other wards by CCU nurse specialists Improve appropriateness and accessibility of services for Maori patients Improve documentation in discharge summaries Early involvement of pharmacists with medicine rationalisation Develop a palliative care/heart failure clinic. The team of a palliative care specialist, cardiologist and clinical nurse specialist has now put forward a proposal to start the Heart Failure Supportive Care Clinic. The monthly clinic will start in October initially targeting those with end-stage cardiac conditions with complex symptom management, frequent readmissions and who the organisation has identified as being able to benefit from better engagement or accept support to accept and manage their condition. The clinics will initially be limited to referrals from secondary services but is likely to extend to primary care. Hutt Valley District Health Board HAC October

26 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS 2.5 Exercise Tangaroa Exercise Tangaroa is a national exercise designed to test the response to a national tsunami event. The scenario was based on a regional source tsunami following an earthquake in the Tonga Kermadec Trench, with the tsunami hitting Wellington region just under 2.5 hrs after the earthquake. The exercise provided an opportunity to examine: 1. The current warning and assessment system 2. HVDHB coordination capabilities 3. Health Sector and Wellington Regional Emergency Management Office coordination. Attendees included Duty Nurse Managers, Director of Operations 24 hours, Occupational Health and Safety, Communications, Clinical Support Services, Allied Health, Patient Flow Coordinator, Community Mental Health and Community Dental. There was the opportunity to engage with representatives from Aged Residential Care facilities, Home and Community Support Service providers, other healthcare providers and NASCs in a separate exercise. The exercise highlighted opportunities to learn and improve the resilience to tsunami events. Key lessons from the exercise include: Improving initial alerting cascade Improve internal staff notification Tsunami reduction, readiness, response and recovery documentation to be reviewed and updated Tsunami specific staff, team, directorate documentation to be developed Update GIS maps of healthcare providers located within inundation zones Liaise with healthcare providers and review their preparedness and response documentation Health sector to engage with WREMO to develop robust notification process Hutt Valley District Health Board HAC October

27 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS 3 Financial Update DHB Provider Statement of Financial Performance For the period ending 31 August 2016 $000s Month Year to Date Annual Actual Budget $ Var Actual Budget $ Var Budget Revenue (26) MOH - Public Health 1,346 1,364 (17) 8, MOH - Personal Health 1,293 1, , MOH - Disability Support Services , Clinical Training Agency ,364 1,502 1, Non-Devolved MOH Revenue 3,712 3, , (45) ACC Revenue (91) 5,769 2,976 3,317 (341) IDF Inflows 6,290 6,631 (341) 39, (35) Other DHB Revenue (36) 3, Other Revenue 1,103 1,135 (33) 6,785 14,332 14, Funder Revenue 28,182 28, ,444 20,244 20,423 (179) Total Revenue 40,777 41,077 (300) 240,891 Expenditure Personnel Costs 4,225 4, Medical Personnel Cost 8,131 8, ,978 5,270 5, Nursing Personnel Cost 10,092 10, ,829 2,377 2, Allied Health Personnel Cost 4,648 4,643 (4) 27, Support Personnel Cost 1,114 1, ,928 1,804 1, Management/Admin. Personnel Cost 3,422 3, ,241 14,259 14, Total Personnel Costs 27,408 28, ,894 Outsourced Services (69) Outsourced Medical (8) 2, (16) Outsourced Nursing (63) (3) Outsourced Allied Health (4) Outsourced Support (9) (28) Outsourced Management/Admin (100) (112) Total Outsourced Personnel Costs (184) 3, (191) Outsourced Clinical Services (225) 2, Outsourced Corporate Services , (177) Total Outsourced - other 1,389 1,186 (203) 7,020 1, (289) Total Outsourced Services 2,243 1,855 (388) 11,003 Clinical Supplies (14) Treatment Disposables 1,594 1, , Diagnostic & Other Clinical Supplies (4) Instruments & Equipment , (14) Patient Appliances (6) (57) Implants & Prostheses (76) 4, (131) Pharmaceuticals (155) 4, (3) Other Clinical & Client Costs ,182 2,355 2,170 (185) Treatment Related Costs 4,417 4,286 (131) 25,730 Infrastructure & Non-Clinical Supplies Hotel Services, Laundry & Cleaning , (9) Facilities , Transport , (48) IT Systems & Telecommunications (24) 3, Professional Fees & Expenses , (190) Other Operating Costs (130) 2, (3) Democracy Costs 8 2 (6) 9 1,101 1,099 (2) Asset Expenses 2,209 2,195 (13) 13,549 2,723 2,539 (184) Non Treatment related Costs 5,064 5, , (1) Total Interest & Financing Costs 1,835 1, ,968 (16) (17) (1) Internal Allocations (31) (33) (2) (198) 21,470 21,332 (139) Total Expenditure 40,935 41, ,202 (1,226) (908) (318) Net Surplus/Deficit Before Overhead Alloc. (159) (219) 60 (6,311) (35) (35) Overhead Allocations (69) (69) (423) (1,191) (873) (318) Net Surplus/Deficit (89) (150) 60 (18,802) Month Employee Details for August 2016 Year to Date Annual Actual Budget Variance FTE Actual Budget Variance Budget Medical Nursing (0.53) Allied Health Non Health Support Management/Administration , , Total 1, , , Hutt Valley District Health Board HAC October

28 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS The Provider arm result for year to date (YTD) August 2016 is a net deficit of ($89k), which is favourable to budget by $60k. The key factors contributing to this YTD result were as follows: 3.1 Revenue Non-Devolved MOH Revenue favourable by $166k; $73k due to higher volumes of screening than budgeted offset by outsourced screening costs ($48k). ACC revenue is unfavourable by ($91k) YTD and ($45k) for the month. The adverse variances are mainly in OPRS ($60k) YTD, Physical Therapies ($27k) for the month and ($34k) YTD; however $76k of the budgeted additional revenue has been achieved. The recruitment of a clinical advisor is underway and should see an improvement in identifying accident related injury cases. Other DHB revenue is unfavourable by ($36k) YTD and ($35k) for the month arising from: o o o o Capital & Coast DHB overall favourable due increase in Imaging & X-Ray $65k, Outpatients Clinics ($2k) and the reversal of 3DHM HR manager cost recoveries YTD ($61k). Wairarapa $126k YTD primarily due to the recovery of 2DHB services $117k (unbudgeted), Imaging and X-Ray $19k, Screening $5k, unfavourable ENT recoveries ($9k) and Child development ($5k) Canterbury DHB adverse by ($27k) as no Plastics procedures provided. Mid Central DHB favourable by $31k mainly due to favourable Imaging and X-ray recoveries $14k and Anaesthetics $14k. Other Revenue is unfavourable by ($33k) YTD primarily in Surgical ($53k) relating to the savings initiative for additional electives, primarily in Plastics, for CCDHB, Interest income ($26k), Car parking ($46k), Cafeteria ($27k) and Audiology ($20k). Recoveries on account of IBD Research and Cardiology Research favourable $164k offset by expenditure. IDF inflows unfavourable by ($341k) resulting from: o o o o o o o Capital & Coast ($251k) unfavourable, Plastics ($154k), [acute ($164k) and $10k elective), Orthopaedics ($61k), general Surgery ($35k) offset by Rheumatology $21k and Maternity $21k. Mid Central ($116k) unfavourable, Plastics ($113k) [acute ($31k) and elective ($81k)]. Nelson Marlborough ($54k) adverse mainly due to Plastics ($51k) [acute ($12k) and elective ($39k)]. (See IDF section) Whanganui ($102k) unfavourable primarily in Plastics ($90k) [acute ($57k) and electives ($33k)] Hawkes Bay $132k favourable mainly in Plastics $128k [acute $116k, electives $12k] Canterbury $62k favourable primarily in Plastics $59k acute. Taranaki $62k favourable in Plastics $62k acute ($6k) and Electives $68k, Hutt Valley District Health Board HAC October

29 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Funder Revenue is favourable by $35k mainly due to additional funding received from the Ministry for Rheumatic Fever Prevention programme for July and August. 3.2 Expenditure Personnel costs are $681k favourable employees $865k and outsourced ($184k). YTD Variance ($000) Employee Outsourced Total Medical 443 (8) 435 Nursing 50 (63) (14) Allied Health (4) (4) (8) Support 48 (9) 39 Management & Admin 329 (100) 228 Total 865 (184) 681 Total annual leave balances are lower than this time last year, $16,132k versus $16,518k last year. The number of staff with more than two years annual leave is now 192 against 213 in August last year. Percentage sickness leave when compared to August 2015 has dropped by 0.9%. 17,000 Accrued Annual Leave $ % 4.5% % Sick Leave 16, % 16, % 15,500 15,000 14, % 2.5% 2.0% 1.5% 14, % 13, % Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun 0.0% Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun / / /16 Medical staffing: Senior Medical Officers are FTE YTD below budget and favourable by $339k, Orthopaedics (1.5 FTE), General Surgery (1.15 FTE), Mental health (3.88 FTE), Paediatrics (1.5 FTE) and Imaging (1.27 FTE). This has been offset in part by additional outsourced costs. The 3D mental health service is now employing some clinicians as 3DHB at CCDHB, which then appear as outsourced staff for Hutt Valley but is overall within budget. RMOs are (5.33) FTEs over budget mainly in Plastics, General surgery and General medical with Fellows covering vacant SMO positions. Nursing staffing is 2.36 FTE s over budget and $50k under budget YTD, including overtime, however the number of employed nursing FTE has fallen steadily by 42 FTEs since August last year. Internal Bureau Nurses are overspent by ($212k), 14.0 FTEs over, this is mostly in emergency department, mental health, children s, maternity and plastics. Health care assistants are overspent by ($111k), 10.8 FTE s YTD, which is mostly for minders primarily in Plastics, orthopaedics, general medical ward, OPRS, children s and mental health. Allied Health is unfavourable by ($4k) YTD and favourable $51k for the month. FTEs are 9.67 FTEs favourable YTD. FTE s are below budget in Medical (mainly Physical Therapies) FTE s, Community Dental (Child Oral Health) FTE s, and Regional Public Health over by (9.19 FTE s). Hutt Valley District Health Board HAC October

30 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Support Staff is favourable by $48k made up of 7 FTE under budget YTD, primarily in Tradesmen, Cleaners, Hotel Services supervisors, Laundry staff and Security Patrolmen. Management/Admin favourable $329k YTD due to due to allowance for new management structure phased throughout the year. Outsourced Clinical cost is unfavourable ($225k), with outsourced radiology ($107k) for reading films and afterhours cover, Breast Screening ($48k) due to new provider offset by additional revenue. Charges from CCDHB for clinical services in ENT ($15k) and Ophthalmology ($49k). Outsourced Corporate Costs are favourable by $21k, mostly in Corporate Services and relates to the favourable variance $63k in IS services, Human Resources - unfavourable ($35k) and relates to the restructure of the DHB. Clinical Supplies (Treatment Related Costs) are adverse by ($131k). Primarily the overspend is in: o o o o Pharmaceuticals are adverse ($154k) primarily in medical day stay ($96k) for Mabs, children s ward ($20k) for rheumatology drugs and Plastics ($40k) for a Haematology patient. Implants and Prosthesis ($76k) mainly due to Knee, Spinal and Orthopaedic implants. Instruments and Equipment under by $61k mainly in for repairs not yet required. Treatment disposables favourable $25k. Blood costs are favourable for the month by $15k and YTD $7k. Non Treatment Related costs are favourable by $10k largely due to favourable variances in Compliance costs $91k, Hotel and Laundry $54k, Transport and Travel Costs $29k. Trust related costs are adverse ($130k) but are offset by additional trust revenue. Asset Expenses unfavourable by ($13k), primarily due to unfavourable variances in Clinical equipment depreciation across a number of areas. 3.3 Hospital Throughput Actual Month Hutt Valley DHB Year to Date Annual Variance Variance Hospital Throughput Variance Variance Variance Actual vs Budget Actual vs Last year YTD Aug-16 Actual vs Budget Actual vs Last year Annual Budget Budget vs Last year Budget Last year Actual Budget Last year Last year Discharges 1, (118) 978 (128) Surgical 2,199 2,045 (154) 2,024 (175) 12,778 12, ,666 1,495 (171) 1,611 (55) Medical 3,288 2,936 (352) 3,165 (123) 16,964 18,286 (1,322) (114) 448 (44) Other (103) 1, ,985 5,916 (931) 3,264 2,860 (404) 3,037 (227) Total 6,445 5,836 (609) 6,204 (241) 34,727 36,850 (2,123) CWD 1,119 1,045 (73) 1,019 (99) Surgical 2,277 2,187 (91) 2,132 (146) 13,092 12, , (78) 1, Medical 2,033 1,964 (69) 2, ,683 11,769 (1,086) (102) 357 (53) Other (3) ,264 4,950 (686) 2,576 2,323 (253) 2,445 (131) Total 5,078 4,916 (162) 5, ,039 29,483 (1,444) Other 4,062 4,007 (55) 4, ED Attendances 8,093 7,805 (288) 8, ,859 47,666 (3,807) 1,048 1,027 (21) 1,039 (9) ED Admissions 2,158 2,022 (136) 2,035 (123) 11,642 11, (30) 841 (39) Theatre Visits 1,755 1, , ,152 11, ,654 7,015 (638) 7,449 (205) Bed Days 14,965 15, ,010 1,045 81,063 86,031 (4,968) (0.17) 4.49 (0.08) ALOS Inpatient (0.08) ALOS Total Note: Other inpatient includes mental health and maternity Hutt Valley District Health Board HAC October

31 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS IDF inflows Purchase Unit Actual Budget Variance Caseweights Caseweights Caseweights D01001 Dental Treatment M00001 General Medicine M05001 Emergency Medical Services M10001 Cardiology M25001 Gastroenterology M55001 Paediatric M70001 Rheumatology S00001 General Surgery S25001 Ear, Nose and Throat S30001 Gynaecology S40001 Ophthalmology Last year YTD S45001 Orthopaedics S60001 Plas tics/max/burns W06003 Specialist Neonates W10001 Maternity Inpatient Grand Total Acute & Elective Note: Ophthalmology and Plastics business cases only had impact from February 2016 At the end of August, elective CWDs are under budget by 51 and acutes by 20, creating an adverse result of ($341k). This is also lower than the same period last year but is likely to be impacted by late coding with 33% of IDFs not yet coded. Elective Plastic surgery is behind by 17 and elective Rheumatology is down 15 CWDs but up 19 acute. Acute CWDs are 20 behind budget, notably Plastic surgery 15 and orthopaedics 10, this is offset by the over provision in acute rheumatology 19 CWD. Note the 2016/17 CWD price is $4,825. Hutt Valley District Health Board HAC October

32 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS 4 CLINICAL LEADER REPORTS 4.1 Chief Medical Officer Update (Dr Sisira Jayathissa) The Hutt Valley DHB Training Committee has been established to oversee and support the medical training activities across the hospital. Our goal is to be the best medium-sized training hospital in the country, building on our already good reputation for medical training. Membership of the Committee includes representatives from RMOs and SMOs, Pre-vocational Educator Supervisors and the Manager, Clinical Training Unit. The CMO is sponsoring the work. Emergency Department Dr Stephen Dee has taken over the role of Interim Clinical Head of Department (CHOD), ED until a replacement Clinical Leader can be appointed. We are working hard to identify and appoint a Clinical Leader with FACEM qualifications to ensure maintenance of accreditation for registrar training. Other initiatives for improving ED service are progressing well, which is reflected in the improved performance on the ED target and much greater engagement from ED staff, including SMOs. Clinical Leadership Development: Strong clinical leadership is essential in providing very good quality of care and improving hospital efficiency. The first course for 20 Clinical Leaders is nearing completion and the second one commences October The benefits of visible changes in behaviour and activity among clinical leaders have been noticeable. Research and Innovation There is progress on the development of a Clinical Research Unit at Hutt with help from the Clinical Trials Unit at Capital & Coast DHB. Such a unit will enable researchers to easily conduct research at Hutt Valley DHB and develop projects related to service improvements and innovations. Credentialing Credentialing of SMOs is an important part of clinical governance of Hutt Valley DHB. There has been an improvement in annual credentialing from around 35 percent last year to 85 percent this year. We are re-establishing service credentialing as a paper exercise in the first instance. A pilot will be run with a smaller service ahead of wider rollout. Senior RMO Leadership group Two meetings have been held and the participants have found the forum to be useful in terms of discussing process issues and any emerging concerns. Matthew O Connor, a senior medical registrar, is the Chair. Junior doctors are in regular contact with our patients and their opinions and concerns are vital in improving our systems and ensuring patient safety. We hope this forum will help in engaging junior staff, improve their leadership skills and ultimately, the quality of patient care. HVHS Clinical Council The Clinical Council was established to provide an advisory role to the Board and ELT and this is an important step forward. A Planning half day will be held before the end of the year to map out a process for reviewing clinical initiatives (like the recent ICU Proposal) prior to them coming to ELT and later the Board. Hutt Valley District Health Board HAC October

33 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Another area of focus is the communication with the wider hospital and primary care community on the role of the HVHS Clinical Council and how the information flow between the Council and the wider health community can be enhanced. Medical Council of NZ Accreditation Visit Report The report of the NZMC Accreditation visit has been compiled but not yet released. Overall the report was very positive. HVDHB Mortality and Morbidity Committee This committee has been established to review deaths that take place in the hospital. The committee includes medical, nursing, allied health and non-clinical staff and it also looks at trends in mortality and morbidity. Notes of the patients who have died during three months prior to the meeting date are screened prior to the committee meeting. Overall the documentation of the events was very good. Service M&M reports are provided to the CMO who reviews them confidentially and key themes are identified, and presented to the committee. Cases involving multiple services will be reviewed on a formal basis and the first such review will take place in October. Based on the Health Round Table data, Hutt Valley DHB standard mortality ratio is below the national average and from a patient safety perspective we are viewed as one of the safer hospitals. 4.2 Director Allied Health, Scientific and Technical Update (Andrew Harris) The 3DHB Allied Health, Scientific & Technical (AHST) Awards for 2016 were held on Thursday, 8 September 2016, celebrating the achievements of the AHST professions from across the 3DHBs. It was a fun evening and fantastic to see all the great work being done by the Allied Health Scientific and Technical professions across the DHB. It was also an opportunity to take time out to reflect, and acknowledge the wonderful contribution AHST staff make to the care of the people within the communities we serve Congratulations are due to the large number of nominees, finalists and winners from across the range of professions and the three DHBs, who have demonstrated fantastic examples of working towards improving the health and wellbeing for individuals, whānau and the wider community. 4.3 Executive Director Nursing and Midwifery Update (Helen Pocknall) Nursing Entry to Practice (NETP) and Nursing Entry to Specialty Practice (NESP) Programmes The 2016 midyear intake commenced in August 2016 with a final total of fifteen new graduates across the health system: twelve in the Provider Arm and three with external providers. Meanwhile the process has begun for the first intake of 2017 of graduates with applications processed through the Advanced Choice of Employer (ACE) portal. Initial indications of numbers for the Provider Arm are four to five at the start of the year, with one confirmed for general practice and a possible five to six others externally as well. Heath Workforce New Zealand Post Graduate Education Hutt Valley District Health Board HAC October

34 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS A roadshow with all the tertiary education providers was held for Hutt Valley DHB in August Numbers attending this year were smaller than Applications for funding close mid-october As Registered Nurse Prescribing was fully enacted in September, discussions have commenced with directorate teams as to where it may be most appropriate to have RN Prescribers within a service and how then to best support them. This conversation is also necessary with regards to supporting the development of Nurse Practitioners within specific services/disciplines. If a service indicates a willingness to introduce and fully support these roles within their models of care then those nurses will be prioritised for funding. Mental Health, Addictions and Intellectual Disability Services There has been an increase in admissions to Te Whare Ahuru (TWA) over the last two months that has led to having to admit over the bed numbers in the unit. This is most notable in the Te Rangimarie (deescalation area) having for short periods up to eight patients in it when there are only four bedrooms and two seclusion rooms. Options are being considered to help with this situation. Midwifery The Maternity unit has been very busy over August and September. There continue to be challenges recruiting qualified midwives and we are working hard to ensure gaps are filled. Advertising for two new graduates is looking positive, which will assist in alleviating the staffing challenges. Birth numbers for September were (one stillbirth and one set of twins); 128 were under the care of a Lead Maternity Carer (LMC) independent midwife and thirteen were private Obstetricians clients. The breastfeeding rate (on discharge) for the last month was 78 percent. The Baby Friendly Hospital Initiative audit will be undertaken in November. The NZ College of Midwives biannual conference was held in Auckland early September where the CEO was one of the invited keynote speakers, with the assigned topic being Is the New Zealand Health System a Safe Place to Work?. There has been very good feedback on the presentation and we took the opportunity to promote the Hutt Valley DHB as a great place to work. TrendCare The timing studies in Mental Health have now been completed and staff did really well to gather all the necessary data when the Unit was very busy. The TrendCare Coordinator has introduced the rostering module into PACU, Day Stay and SAU with CSSD to shortly follow. Preliminary work has commenced with Out Patient s Department whilst ED is on hold for now. There is a need to revisit an alternative training booking system to OneStaff with the ultimate aim of stopping its use all together. The Practice Development Unit, TrendCare Coordinator and the Clinical Training Unit will explore options together. Falls The Falls Committee has agreed to adopt the Health Quality and Safety Commission s (HQSC s) Releasing Time to Care (RTC) module as its plan of work. The latest Quality Safety Markers show improvement but the DHB still sits below the national average for Falls assessment and management and we committed to further improvement. All relevant areas are expected to be using the Falls Assessment tool in TrendCare by 1 November 2016, including identifying champions to work with the Hutt Valley District Health Board HAC October

35 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS TrendCare coordinator to roll out the tool. The tool is currently in use in the Older Person and Rehabilitation Service and Orthopaedics departments and about to be rolled out in the Coronary Care and the Medical Assessment and Planning Units. Direction and Delegation To help address identified concerns around roles and responsibilities regarding Direction and Delegation, the August Nursing Ground Round was dedicated to this topic. The Professional Nurse Advisor from NZNO presented on this, with excellent engagement from attendees highlighting responsibilities and accountabilities for the RN, other staff and the employer. The E-learning Coordinator for Professional Development is adapting the e-learning packages to better reflect what s needed. The 3DHB draft policy for direction and delegation has been resurrected and gone out for further comment. It will cover allied health, scientific & technical workforces as well as nursing and midwifery across the three DHBs. Health Care Assistants Draft Terms of Reference have been developed for a specific project around this workforce and the first meeting held. Workstreams include training and education of HCAs, minding/close observation and policies and documentation. Care Planning The first meeting of the project group undertaking this work in response to the Certification Audit has been held. An environmental scan has been undertaken of the documentation currently in use and a literature search of the best available international research around care planning has been completed. A snapshot of the patient journey has been completed for adult acute and elective patients, and for paediatric patients to highlight what documentation is need at each stage of the journey. These will be analysed at the next meeting and workstreams will then be established. There is considerable enthusiasm for this project, which will improve the patient journey and the quality of our care and discharge planning especially for patients who are cared for in more than one service during their stay. CCDM Programme The new CCDM Site Coordinator Karen Holden commenced at the beginning of October Having the role in place allows the DHB to move forward with the partnership programme with the NZNO and Safe Staffing Unit. Regular updates will be provided to ELT, HAC and the Safe Staffing Unit (which is hosted by NZNO). General Dr Erin Fraher (a medical physician and academic) has been on a sabbatical with Health Workforce New Zealand. She was very interested in exploring the role of the Registered Nurse (RN) within the primary health care setting whilst she was in NZ so the EDoNM offered to host her at Hutt Valley. The various roles and responsibilities of the RN role in the primary health care setting in NZ are at a more advanced level compared to the USA. Upon her return to the States Erin was to complete a report, among other things for the purpose of building a case for increasing the recognition and value of RNs in primary health care in the USA. Hutt Valley District Health Board HAC October

36 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS In the USA RNs are not commonly employed in primary health care, rather the GPs are supported to provide their care with equivalent Enrolled Nurses (Licenced Practice Nurse LPN) and Health Care Assistants. In the USA GPs and NPs provide most of the primary care for patients, unlike here in NZ where RNs provide immunisation, smears, nurse led clinics including for long term conditions such as for management of diabetes (and insulin initiation). Erin was taken to Upper Hutt Health Centre where she interviewed the Nurse Manager about the RN roles in that facility. She also interviewed a diabetes nurse prescriber (DHB employed) who works closely with nurses in primary health care to upskill them in the area of diabetes management. Hutt Valley District Health Board HAC October

37 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Author Endorsed By HAC INFORMATION PAPER Date: 21 October 2016 Amber O Callaghan Executive Director Quality & Risk Wairarapa and Hutt Valley DHBs Ashley Bloomfield, Chief Executive Officer Subject HVDHB Quality Report for Hospital Advisory Committee (HAC) August September 2016 RECOMMENDATION It is recommended that the HVDHB Hospital Advisory Committee: a. NOTES that the HDC Complaint report (1 January to 30 June 2016) identifies the most common primary complaint issue category was care/treatment (52.4%), while the most common specific primary issue was unexpected treatment outcome (19.0%); Hutt Valley DHB is ranked 18th compared with 10th in the previous six-month period; b. NOTES that Hutt Valley DHB will be participating in a co-design programme sponsored by the Health Quality and Safety Commission (HQSC). This programme will assist the DHB in increasing it capability skills in understanding the patient and staff experience and codesign work to help us design and deliver better healthcare services; c. NOTES that for the Hand Hygiene audit period 1 April- 31 June 2016 HVDHB achieved an 80.4% compliance rate, an increase of 2.4% from our quarter 3 result; this is the first time we have reported meeting the 80% target in the National QSM data set; d. NOTES that the Falls marker audit period April June 2016 showed an increase from last quarter at 72% to 86% of older patients receiving a falls risk assessment, and from 73% to 82% for patients receiving an individualised care plan; e. NOTES that improvement work continues on the action plan for corrective actions relating to our May 2016 Certification Audit, which is being monitored by the Quality Team and ELT; f. NOTES that the September Quality and Safety Walk-Round took place in Te Whare Ahuru g. NOTES that the Hutt Valley Health System Clinical Council continues to develop and has robust discussions about issues that impact on delivering a safe, equitable, and best value services; arrangements are in place to hold an Annual Planning day for the Council; h. NOTES that Patient Safety Week 2016 will run from Sunday 30 October to Saturday 5 November 2016 and the theme is Let s Talk ; planning is in progress; i. NOTES that planning is in progress for Infection Prevention Control Week October; he theme is Breaking the Chain of Infection ; j. NOTES that the 2016 Hutt Valley DHB Quality Awards Striving for Excellence, will be held on Friday 18 November, 6-8pm at Boulcott s Farm and all Board Members are invited. ADDENDUM 1. HDC Complaints Report, Hutt Valley DHB, 1 January 30 June 2016 Hutt Valley District Health Board 1 37

38 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS 1 PATIENT EXPERIENCE Focusing on consumer value supports the involvement of our communities in improving current performance and planning for the future, and to achieve improved health outcomes and equity for our populations. As individual DHBs, we receive consumer feedback through our complaints and compliments processes, DHB-specific patient satisfaction surveys and consumer group forums. This information is analysed and reflected in specific and continuous improvements, focused on access, quality, safety, sustainability and efficiency of health service delivery. 1.1 Health and Disability Commission Complaint Report (1 January to 30 June 2016) During the six month period 1 January to 30 June 2016, the HDC nationally received a total of 383 complaints about care provided by all District Health Boards. This total number of complaints (383) shows a very small increase over the average number of complaints received in the previous four periods, but a 10% decrease over the number of complaints received in the previous six month period. However, the trend in regards to the services and issues complained about are broadly consistent with what was seen in the first half of 2015/2016. Surgical services continued to be the most commonly complained about service type at DHBs. A missed, delayed or incorrect diagnosis remained the most common primary issue complained about. Anthony Hill, the Health and Disability Commissioner, noted the prominence of communication issues; 42% of consumers complaining about DHB services were concerned with how staff at the DHB had communicated with them. The Commissioner notes this as a timely reminder of the importance of consumer engagement and informed consumers. An engaged consumer is an empowered consumer. Clear, open and honest communication with consumers is vital to the principles of patient autonomy and informed consent. In the period Jan Jun 2016, the HDC received a total of 21 complaints about care provided by Hutt Valley District Health Board. The table below shows the rate of complaints to the HDC per total discharges from Hutt Valley DHB (15,832) compared with the rate of complaints per total discharges nationally (470,202). Number of complaints Hutt Valley DHB Number of discharges Rate per 100,000 discharges National (All DHBs) Rate per 100,000 discharges 21 15, When DHBs were ranked according to their rate of complaints, Hutt Valley DHB was DHB 18 compared with DHB 10 in the previous six month period. It should be noted that a DHB s number and rate of complaints can vary considerably from one six month period to the next. For smaller DHBs, a very small absolute increase or decrease in number of complaints received can dramatically affect the rate of complaints. Accordingly, much of the value in this data lies in how it changes over time, as such analysis allows trends to emerge which may point to areas which require further attention. Hutt Valley District Health Board 2 38

39 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS It is also important to note that numbers of complaints received by HDC is not always a good proxy for quality of care provided and may instead, for example, be an indicator of the effectiveness of a DHB s complaint system or features of the consumer population in a particular area. Additionally, complaints received within a single six month period will, sometimes, relate to care provided within quite a different time period. From time to time, some DHBs may also be the subject of a number of complaints from a single complainant within one reporting period. Number and rate of complaints received in last five financial years HVDHB Jul- Dec 11 Jan Jun 12 Jul Dec 12 Jan Jun 13 Jul Dec 13 Jan Jun 14 Jul Dec 14 Jan Jun 15 Jul Dec 15 Complaints received Average of last 4 6-month periods Jan Jun 16 Rate per 100,000 discharges The rate for the Jan Jun 2016 (132.64) was similar to the average rate of complaints received for the previous four periods. Note that the overall increase in complaints over the past few years is mirrored nationally. Service Types Complained About Service Type Number of complaints Primary issues identifed in each complaint Dental 2 Lack of access to services Failure to communicate effectively with family Emergency Department 1 Missed/incorrect/delayed diagnosis General Medicine palliative care General Medicine Respiratory 1 Failure to communicate effectively with family 1 Inadequate/inappropriate monitoring General Medicine Other 2 Lack of access to services Inaccurate report/certificate Maternity 2 Inadequate/inappropriate treatment Unexpected treatment outcome Mental Health 3 Waiting list/prioritisation issue Inadequate/inappropriate follow up Disrespectful behaviour Surgery General 2 Disrespectful manner/attitude x2 Surgery Gynaecology 2 Unexpected treatment outcome x2 Hutt Valley District Health Board 3 39

40 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Surgery Plastics and reconstructive 4 Lack of access to services Inadequate/inappropriate examination/assessment Missed/incorrect/delayed diagnosis Unexpected treatment outcome Other Health Service 1 Inadequate coordination of care/treatment Similar to what was seen nationally and last period at Hutt Valley DHB, the most complained about service type at Hutt Valley DHB was surgical services (38.1%). Similar to what was seen last period, Hutt Valley DHB received a higher proportion of complaints regarding plastic and reconstructive surgical services (19.0%) than was seen nationally, which is unsurprising as we host this regional service. Similar to national trends and what was seen in the last period at Hutt Valley DHB, the most common primary complaint issue category for Hutt Valley DHB was care/treatment (52.4%). The most common specific primary issue was unexpected treatment outcome (19.0%). This is in contrast to last period at Hutt Valley DHB when missed/incorrect/delayed diagnosis was the most common primary issue. On analysis of all issues identified in complaints about Hutt Valley DHB, the most common issues were failure to communicate effectively with consumer (52.4%), inadequate response to consumer s complaint by DHB (47.6%) and inadequate/inappropriate clinical treatment (38.1%). Hutt Valley DHB received a higher proportion of complaints regarding inadequate response to consumer s complaint by DHB in Jan-Jun 2016 than was seen nationally. The HDC closed 29 complaints about Hutt Valley DHB in Jan Jun 2016, and 482 complaints nationally. The HDC closed two complaints about Hutt Valley DHB following investigation in this period. Outcomes for Hutt Valley DHB of complaints closed table below: Outcome for Hutt Valley DHB Number of Complaints Investigation 2 Breach Finding 1 No Breach Finding 1 Non-investigation 27 No further action with follow-up or educational comment 3 Referred to Advocacy 2 Referred to DHB 8 No further action 14 TOTAL Consumer Engagement Co-design (with consumers) is a relatively new improvement methodology and Hutt Valley DHB is pleased to be building capability in this area. Many service improvement projects have patient involvement; co-design is different in that it focuses on understanding and improving patients Hutt Valley District Health Board 4 40

41 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS experiences of services as well as the services themselves, helping to ensure that improvements are successful. Training will be provided on-site by Dr Lynne Maher, Ko Awatea s Director for Innovation, and supported by the HQSC s Partners in Care programme. The co-design programme involves clinicians working alongside consumers on a specific improvement project over a six month period, with onsite workshops and teleconferences. It is based on the Experience-Based Design approach developed by the National Health Service in England and uses patient and staff experience for quality improvement and enhanced service design. The Quality, Service Improvement and Innovation team is co-ordinating five project teams, and has been encouraged by the enthusiasm of staff to participate in co-design and develop their skills in this methodology. We have participants from clinical services, Quality Advisors, Business Development, Strategy Planning and Outcomes, and Te Awakairangi Health Network. Observers from the Ministry of Health and the HQSC will also be attending. The programme for Hutt Valley DHB will commence mid-october 2016 and go through to mid- February EFFECTIVENESS Effectiveness focuses on monitoring and evaluation of patient care and performance in relation to our peers to ensure focused quality improvement. 2.1 The Health Quality Safety Commission Quality Safety Markers The Health Quality & Safety Commission (HQSC) is driving improvement in the safety and quality of New Zealand s health care through the national patient safety campaigns. The quality and safety markers (QSMs) help to evaluate the success of the campaigns nationally and determine whether the desired changes in practice and reductions in harm and cost have occurred. Hutt Valley District Health Board 5 41

42 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Performance across Hutt Valley DHB since July 2015 is detailed in the following table: Marker Definition FALLS: Percentage of patients aged 75 and over (Maori and Pacific Islanders 55 and over) that are given a falls risk assessment. FALLS: Percentage of patients assessed as being at risk have an individualised care plan which addresses their falls risk. HAND HYGIENE: Percentage of opportunities for hand hygiene. SURGICAL SITE INFECTIONS:* Antibiotic given -60 minutes before knife to skin SURGICAL SITE INFECTIONS: Right antibiotic in the right dose - 2 grams or more cefazolin given SURGICAL SITE INFECTIONS: Appropriate skin antisepsis in surgery using alcohol/ chlorhex or alcohol/ providone iodine NZ Goal NZ Avg DHB Jul Sept 2015 Oct Dec 2015 Jan Mar 2016 Apr Jun 2016 Comment 90% 91% HVDHB 72% 66% 72% 86% Improving: further work continues to deliver improvements on this indicator. 90% 94% HVDHB 62% 60% 73% 82% Improving: further work continues to deliver improvements on this indicator. 80% 82% HVDHB 78% - 80% 80% Target Met: continuous improvement in results. (National compliance data is reported 3 times per annum, therefore no data point is shown specifically for Q4 in any year.) 100% 97% HVDHB 98% 94% 96% Target not met*, the data appears to be a time recording issue rather than one of not following the process, this is being addressed. 95% 95% HVDHB 99% 97% 97% Target met*. 100% 99% HVDHB 100% 100% 100% Target met*. *As the Commission uses 90-day outcome measures for surgical site infection, these data run one quarter behind other measures. Safe Surgery Safe Surgery (previously Perioperative Harm): A new quality and safety marker aimed at measuring levels of teamwork and communication was rolled out during the financial year. The first public reporting will be in December 2016 on data for quarter 3, Improvement plans continue to be in place for the Falls and Hand Hygiene Quality Safety Markers; these are markers where HVDHB has previously fallen short of the national goals. Hutt Valley District Health Board 6 42

43 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Falls Nationally, 91% of older patients were given a falls risk assessment in quarter 2, Nationally there has been a shift upwards, back to expected achievement levels, since the drop in the previous quarter. Nationally about 94% of patients at risk of falling received an individualised care plan. Results from Hutt Valley DHB improved significantly compared with the previous quarter, from 72% to 86% of older patients receiving a falls risk assessment and from 73% to 82% receiving an individualised care plan. Improvement work continues to reduce harm from falls in our hospital. Hand Hygiene The Hand Hygiene compliance audit period 1 April 2016 to 30 June 2016 has been completed. Hand Hygiene compliance is audited against the five moments of Hand Hygiene outlined by the World Health Organization (WHO). These are the key moments in patient care where hand hygiene is required to stop the transfer of microorganisms and decrease Hospital Acquired Infections. Hand Hygiene moments were collected in 12 clinical areas to portray a cross section of compliance across the hospital. In this audit seven clinical areas achieved compliance above the national target of 80%. There have been slight decreases in compliance in the areas of GSG, Orthopedics, Medical and PACU although the compliance in the hospital overall has increased. It is not clear why there has been a decrease in compliance in these areas but it highlights the need for ongoing hand hygiene campaigns. There have been significant improvements in the Hand Hygiene compliance of Student Nurses, Healthcare Assistants, Medical Practitioners and Phlebotomists. The trends at Hutt Valley DHB are similar to both the national and international trends where the After a Procedure and After touching a patient moments have a higher rate of compliance than the before moments. A total of 1,797 Hand Hygiene moments were collected which is in line with our required moments. Our compliance rate for this audit period audit was 80.4%. This is an increase of 2.4% from our quarter 3 publication, and is the first time we have reported meeting the 80% target in the National QSM data set. The national average compliance by DHB for this audit period is 81%. Surgical Site Infections For the marker Antibiotic given-60 minutes before knife to skin, HVDHB scored just below the national average of 97% at 96%. Rather than the process not being performed within the timeframe, the issue is that some anaesthetists are not recording the correct time as they are signing off completion when they sign all the drugs off, which is when the patient is asleep not at the time given. An improvement process has been initiated by members of the surgical team to improve our indicator figure and data reporting. The skin preparation QSM was introduced in February 2014 as part of a bundle of interventions to reduce surgical site infections. The HQSC has agreed to stop reporting the current QSM for surgical skin antisepsis as appropriate skin antisepsis is now established as usual clinical practice across DHBs performing hip and knee joint replacement surgery. This change was agreed 22 July and QSM data collected from 1 July 2016 will not be reported on by the Commission. DHBs have been encouraged to continue to collect the skin preparation data for hip and knee surgery for local quality improvement and quality assurance activities. Hutt Valley District Health Board 7 43

44 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS 2.2 Certification Certification is the auditing of inpatient services provided by Hutt Valley DHB to ensure we comply with the Health and Disability Sector Standards. Hutt Valley DHB has a service agreement with the DAA Group to provide certification services as our audit agency. Certification provides the DHB with an opportunity to highlight the things that we do well. It also provides the opportunity for an external lens to be applied to our organisational management and patient care systems and procedures to identify areas for improvement. Hutt Valley DHB underwent a full Certification Audit from May The DHB has received a copy of a report outlining the Corrective Action Requests, and a reporting schedule from the Ministry of Health that includes dates for updates on the corrective actions to be reported on. The Quality team will continue to monitor the progress on the Corrective Action Request improvements. Continued reporting to the ELT with regard to progress on corrective actions will occur in line with the reporting schedule. 2.3 Quality and Safety Walk Rounds Quality and Safety Walk Rounds (walk-round) involve members of the ELT visiting an area in the DHB to meet with patients and staff. The aims include demonstrating leadership s commitment to quality and safety for patients, staff and the public; increasing staff engagement; and strengthening commitment and accountability for quality and safety. Through structured and informal discussions issues can be raised, good practices identified and actions agreed to improve quality and safety. Walk-rounds are planned to occur monthly. During September s walk-round the ELT spoke to clients and staff in our Mental Health Inpatient unit, Te Whare Ahuru (TWA), about their experiences in the unit and the challenges they face. Both staff and patients were positive about TWA and its role as a caring environment for people with mental health issues. Key findings from the visit were that clients felt well cared for and staff felt they were like a family, were doing well and look after each other. Pictured: RN Remco de Ket; Chief Operating Officer Dale Oliff Jo Lambert, Quality Facilitator, MHAIDS 3DHB and RN Riz Evans Hutt Valley District Health Board 8 44

45 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS The 15 Steps Challenge (a UK-based programme that focuses on first impressions) found that overall, the whole ward, both on the open side and in the ICU, was warm, clean and tidy, although it could do with a facelift! Clients of the ward felt that they were listened to and communication between staff and clients was very good. One young woman said it was her first time at TWA. She had come in with two goals firstly to get well and then to be discharged. She strongly endorsed the care she had received and as a result she was now working towards achieving her second goal of being discharged. Following the walk-rounds staff members are debriefed on the findings, highlighting the positives, and including the things that could be improved upon. Written feedback goes to the ward area within four day; accompanying this is an action plan where recommendations are noted for follow up, this includes the senior leadership team providing support on actions for improvement. 3 CLINICAL GOVERNANCE Clinical governance refers to the systems and processes in place across the organisation to ensure accountability for quality and safety. A number of activities are underway to strengthen clinical governance at HVDHB. One significant development is the establishment of a Clinical Council. 3.1 Hutt Valley Health System Clinical Council The Clinical Council has continued to meet monthly and progress its work in clinical governance, advising on a range of issues that span improved quality, safety and experience of care, improved health and equity for all populations, and best value for public health system resources. It is a group of experienced multidisciplinary clinicians from across primary and secondary care in the Hutt Valley. The group has welcomed Helen Bryant, Professional Leader for Physiotherapy, as the previous allied health professional (Paul Skirrow) was no longer able to attend meetings due to family commitments. Andy Harris was thanked for his contribution to the Council as Acting Director Allied Health Scientific and Technical, and will be replaced by Claire Tahu when she commences in the permanent role later this month. Notable topics from recent meetings have included: Patient stories: Videos of people recalling their experiences of care in the Hutt Valley Health System have been provided by the Quality team for each meeting. These stories provide a focus on patient-centered care and highlight the opportunities for system improvement, to improve the patient experience. Recent stories have prompted broad discussion and learning points. Maternity Quality and Safety: Jo McMullan and Nicola Giblett updated the group on the Maternity Quality and Safety Programme, their Clinical Governance Group, activities and achievements. The Council acknowledged the excellent work and felt others could learn from their experience. The Clinical Council endorsed a proposal from Jaco van der Walt, Radiologist regarding the withdrawal of the present sonographer on call service at Hutt Hospital for a period of three months, as the current roster is not sustainable with the existing workforce. Options and risk mitigation were discussed. Hutt Valley District Health Board 9 45

46 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Andy Harris presented on the 3DHB Allied Health Scientific and Technical (AHST) workforce career framework. This piece of work has a number of aspects which contribute to ensuring that the AHST workforce continue to develop, plan for the future and contribute to leadership and quality improvement. Claire Jennings, Nursing Director Practice Development Unit presented the work of the falls committee, noting a recent increase in HQSC quality safety marker related to falls risk assessment and care plans. Clinical Council s own development continues with agreement on definition of clinical governance, framework, work plan, communications plan, and arrangements for an annual planning day. 4 GENERAL QUALITY MATTERS Health Quality & Safety Commission (HQSC) The HQSC approached Hutt Valley DHB to see if we would be interested in assisting them with a photo-shoot in order to build up the Commissions library of positive images to promote good health care. Naturally we said yes! You will see some of our staff and facilities appearing in HQSC promotions in the future. The HQSC DHB Dashboard The Health Quality Safety Commission has made available its first iteration of a DHB dashboard. Across the HQSC s various publications on their website, they have over 250 indicators of quality and safety published for each DHB, but these are split across numerous publications making a difficult to gain a more aggregated view of a local situation. By bringing these together in one interactive dashboard the HQSC hopes to help address this. The first iteration available at this brings together QSM and hospital patient experience survey data to one place. The HQSC intend to expand this tool over the next year. In line with the HQSC s improvement ethos, they present data primarily showing change over time, enabling us to see how indicators of safety and patient experience have progressed. The HQSC intend to keep this underpinning principle in place as they extend the dashboard s content. All the information currently in the dashboard is publicly available on the HQSC website. The HQSC intend to publish this iteration of the dashboard in October with quarterly updates from We are working through a process to enable Hutt Valley DHB to present the dashboard data, with appropriate narration on what the data means, in the coming weeks. Patient Safety Week Patient Safety Week 2016 will run from Sunday 30 October to Saturday 5 November The Commission has worked with a sector group, including quality and risk managers, consumers and representatives from primary care to develop the approach for the week. Hutt Valley District Health Board 10 46

47 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Last year s theme Let s talk was very well received, and will be the theme again in HVDHB is currently planning our promotion of Patient Safety. The overall theme, Let s talk, emphasises that communication with patients and between staff members, is key to keeping patients safe. We are planning for daily themes across the week for example: Medication Safety, Preventing Falls, 24/7 Hospital/services, Hospital Acquired Infections, Consumer engagement. We will be working with our teams to highlight improvement work, share resources, and undertake a modified whole of hospital walk-round. Safe Surgery NZ The Safe Surgery NZ programme is supporting all DHBs to implement start-of-list briefing and endof-list debriefing. The safe surgery quality and safety marker went live on 1 July All DHBs will now be undertaking observational audit of surgical team engagement with paperless surgical safety checklists. HVDHB is in cohort two of the programme roll-out and is in the middle of the implementation phase of the programme. It is anticipated that, by the end of the implementation period, cohort members will have embedded the paperless checklist into usual practice and started implementing briefing and debriefing. The new QSM looks at how engaged teams are, and uses an observational audit methodology. Infection Prevention Week October 2016 The theme of Infection Control week is Breaking the chain of infection. The IPC team are planning for this week, and will show themselves as superheroes. The theme will be demonstrated in a mounted display in the hospital foyer, including the DHB s various efforts to break the chain of infection, including: hand hygiene, cleaning, cough and cold etiquette, antibiotic use, and more. This will help identify the work the team and the hospital have accomplished this year, adding in a central message of infection prevention and control safety to staff and visitors and identify how they can be a superhero too. The IPC team will be running a competition for wards and departments for the best IPC display or innovation. The prize is a $100 voucher kindly donated from Brew d. The team will also be handing out spot prizes during the week for good hand hygiene and this will include raffle tickets for a hamper of goodies Hutt Valley DHB Quality Awards Striving for Excellence The 2016 Hutt Valley DHB Quality Awards Striving for Excellence ceremony will be held on Friday 18 November, 6-8pm, at Boulcott s Farm. The event will have nibbles provided, and tickets are being sold for a nominal $5 to cover the cost of a drink. Hutt Valley District Health Board 11 47

48 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS The awards have been designed to encourage and celebrate innovative quality improvements within the DHB and primary healthcare across Hutt Valley Health System. We are delighted that Dr David Galler has agreed to be a guest speaker at our awards ceremony. Dr Galler is an Intensive Care Specialist at Middlemore Hospital, Clinical Director at Ko Awatea, and is well known for his Quality Improvement work. Dr Galler has recently published a memoir, Things that Matter: Stories of Life and Death. We have asked Dr Galler to talk a little about his book and his drive for quality improvement. We are confident that what Dr Galler has to say will resonate with people striving for excellence whist working in our health system. Ken Laban, has kindly agreed to act as the MC for the Awards Ceremony, and we are looking forward to his genuine and light-hearted way of engaging with others to help make our ceremony a success. We would like to thank Ken in advance for representing the values of our organisation as an MC for this event. Nominations are now open for the event and include the following categories: Excellence in Community Health/Wellbeing This award is for teams or individuals who have demonstrated innovative thinking and creative solutions that have improved the health outcomes and wellbeing of the Hutt Valley community. This could include targeting hard to reach populations, overcoming social and cultural barriers and adopting unique solutions to healthcare issues. Excellence in Clinical Care This category recognises teams and individuals working in a clinical discipline who have improved clinical care, patient safety or health outcomes for the Hutt Valley population. These improvements can be large scale or localised improvements. Excellence in Process and Systems Improvement This award is aimed at clinical and non-clinical teams and individuals who have identified sustainable quality improvements that demonstrate measurable outcomes and efficient ways of working in healthcare. These improvements can be large scale or localised. Excellence in Research Awarded to individuals or teams who have published original research in high quality peer review journals since 1 September Applications should include a copy of the research paper. Excellence in the Workplace For teams or individuals who have implemented sustainable practices to improve the skills and wellbeing of employees, improve the workplace, and improve overall job satisfaction. For example, this could be the development of workplace training, recruitment, encouraging workplace diversity or staff wellbeing. Excellence in Integration This award is for teams or individuals who are developing, or have implemented, an approach to care that demonstrates integration between the primary, secondary or community sectors. A wide range of people from the health sector have been invited to be on judging panels that relate to their areas of expertise. Hutt Valley District Health Board 12 48

49 Hutt Hospital Advisory Committee 21 October DISCUSSION PAPERS Hutt Valley District Health Board 13 49