HOSPITAL ADVISORY COMMITTEE (HAC) MEETING. Wednesday 28 March 2018 A G E N D A

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1 HOSPITAL ADVISORY COMMITTEE (HAC) MEETING Wednesday 28 March pm A G E N D A VENUE Waitemata District Health Board Boardroom Level 1, 15 Shea Tce Takapuna 1

2 HOSPITAL ADVISORY COMMITTEE (HAC) MEETING 28 March 2018 Venue: Waitemata DHB Boardroom, Level 1, 15 Shea Terrace, Takapuna Time: 1.30pm Committee Members James Le Fevre Committee Chair Max Abbott WDHB Board Member Kylie Clegg WDHB Chair Sandra Coney Deputy Committee Chair Brian Neeson WDHB Board Member Morris Pita WDHB Board Member Allison Roe WDHB Board Member cc All Waitemata DHB Board Members WDHB Management Dale Bramley Chief Executive Officer Robert Paine Chief Financial Officer and Head of Corporate Services Andrew Brant Deputy Chief Executive Officer and Chief Medical Officer Jocelyn Peach Director of Nursing and Midwifery Cath Cronin Director of Hospital Services Joanne Brown Funding and Development Manager, Hospitals Tamzin Brott Director of Allied Health Fiona McCarthy Director Human Resources Peta Molloy Board Secretary APOLOGIES: Morris Pita and Cath Cronin AGENDA DISCLOSURE OF INTERESTS Does any member have an interest they have not previously disclosed? Does any member have an interest that might give rise to a conflict of interest with a matter on the agenda? PART I Items to be considered in public meeting All recommendations/resolutions are subject to approval of the Board. 1. AGENDA ORDER AND TIMING 1.30pm PRESENTATION: Whanau Centered Care Standards Programme 2. CONFIRMATION OF MINUTES 1.45pm 2.1 Confirmation of Minutes of Hospital Advisory Committee Meeting (14/02/18) Actions Arising from previous meetings 3. PROVIDER REPORT 1.50pm 3.1 Provider Arm Performance Report Executive Summary Human Resources Acute and Emergency Medicine Division Specialty Medicine and Health of Older People Services Child, Women and Family Services Specialist Mental Health and Addiction Services Surgical and Ambulatory Services/Elective Surgery Centre 3.00pm 3.15pm 3.25pm 4. CORPORATE REPORTS 4.1 Clinical Leaders Report 4.2 Human Resources Report 4.3 Quality Report 3.40pm 5. RESOLUTION TO EXCLUDE THE PUBLIC 2

3 Waitemata District Health Board Hospital Advisory Committee Member Attendance Schedule 2017 NAME Max Abbott Kylie Clegg Sandra Coney James Le Fevre (Committee Chair) Brian Neeson Morris Pita Allison Roe FEB MAR MAY JUN AUG SEP OCT DEC x x Attended the meeting x Absent * Attended part of the meeting only # Absent on Board business ^ Leave of absence 3

4 Board/Committee Member Max Abbott Kylie Clegg Sandra Coney James Le Fevre Brian Neeson Morris Pita Allison Roe Register of Interests Hospital Advisory Committee Involvements with other organisations Pro Vice-Chancellor (North Shore) and Dean Faculty of Health and Environmental Sciences, Auckland University of Technology Patron Raeburn House Advisor Health Workforce New Zealand Board Member, AUT Millennium Ownership Trust Chair Social Services Online Trust Board member Rotary National Science and Technology Forum Trust Trustee - Well Foundation Director Auckland Transport Director Sport New Zealand Chair - the Hockey Foundation Trustee and Beneficiary - Mickyla Trust Trustee and Beneficiary - M&K Investments Trust (includes a share of less than 1% in Orion Health Group) Member Waitakere Ranges Local Board, Auckland Council Patron Women s Health Action Trust Member Portage Licensing Trust Member West Auckland Trusts Services Board member Auckland District Health Board Emergency Physician Auckland Adults Emergency Department Pre-hospital Physician Auckland HEMS ARHT/Auckland DHB Trustee Three Harbours Foundation Member Medical Protection Society Member ACEM Hospital Overcrowding Subcommittee Shareholder Pacific Edge Ltd DHB Representative (Auckland and Waitemata DHBs) Air Ambulance Codesign Procurement Governance Board. James wife is an employee of the Waitemata DHB, Department of Anaesthesia and Perioperative Medicine and a Medico-Legal Advisor for the Medical Protection Society Member Upper Harbour Local Board Member Human Rights Review Tribunal Member Auckland District Licensing Committee Managing Director BK & VS Neeson Limited Managing Director Apollo Property Investments Limited Property Development Consultant Owner/operator Shea Pita and Associates Limited Shareholder Turuki Pharmacy Limited Member - Eden Park Trust Board Morris wife is member of the Northland District Health Board Shareholder and Director of Healthcare Applications Limited Chairperson Matakana Coast Trail Trust Member - Rodney Local Board, Auckland Council Last Updated 19/03/14 10/11/17 15/12/16 14/02/18 15/12/16 06/12/16 02/11/16 4

5 2.1 Minutes of the Hospital Advisory Committee Meeting held on 14 February 2018 Recommendation: That the draft minutes of the Hospital Advisory Committee meeting held on 14 February 2018 be approved. 5

6 Minutes of the meeting of the Waitemata District Health Board Hospital Advisory Committee Wednesday 14 February 2018 held at Waitemata District Health Board Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 1.30pm PART I Items considered in public meeting COMMITTEE MEMBERS PRESENT James Le Fevre (Committee Chair) Kylie Clegg Sandra Coney Brian Neeson Morris Pita ALSO PRESENT Warren Flaunty (Waitemata DHB, Board Member) Andrew Brant (Deputy Chief Executive Officer and Chief Medical Officer) Cath Cronin (Director of Hospital Services) Fiona McCarthy (Director of Human Resources) Jocelyn Peach (Director of Nursing and Midwifery) Tamzin Brott (Director of Allied Health) Peta Molloy (Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item.) PUBLIC AND MEDIA REPRESENTATIVES WELCOME APOLOGIES Sue Claridge, Auckland Womens Health Council The Committee Chair welcomed those present and acknowledged the work undertaken at the DHB. Apologies were received and accepted from Max Abbott, Allison Roe and Dale Bramley. DISCLOSURE OF INTERESTS James Le Fevre advised that he had stepped down as Deputy Chair of the Auckland DHB. He will remain a Board member until mid-april 2018 for the Auckland DHB. There were no declarations of interest relating to the open section of the agenda. 1. AGENDA ORDER AND TIMING Items were taken in the same order as listed in the agenda. 6

7 2. COMMITTEE MINUTES 2.1 Confirmation of the Minutes of the Hospital Advisory Committee Meeting held on 29 November 2017 (agenda pages 5 to 11) Resolution (Moved Brian Neeson/Seconded Kylie Clegg) That the Minutes of the Hospital Advisory Committee meeting held on 29 November 2017 be approved. Carried Actions Arising (agenda page 12 ) The actions arising were noted. 3. PROVIDER ARM PERFORMANCE REPORT 3.1 Provider Arm Performance Report November 2017 (agenda pages 13 to 74) Cath Cronin (Director Hospital Services) summarised the executive summary. She noted the updates provided on TransforMED; outsourcing of Radiology and the favourable financial summary. The Committee Chair noted the number of projects around value based programmes and that many are medium to long term. The Committee Chair also noted the reference to ORL procedures (page 29 of the agenda) and queried the thresholds; in response Cath Cronin advised that there has been an increase, but that they were still within benchmarking of other DHBs. Human Resources (agenda page 31 to 34) Fiona McCarthy (Director, Human Resources) summarised this section of the report. She provided an update to advise that annual leave balances of two years or more had now decreased by almost 14%. Acute and Emergency Medicine Division (agenda page 35 to 42) Alex Boersma, (General Manager, Acute and Emergency Medicine) and Gerard de Jong (Division head Acute and Emergency Medicine) summarised this section of the report. Alex Boersma summarised the report. Matters covered in discussion and response to questions included: Noting that the actual achievement for the Chest pain clinic wait time under 6 weeks was 90% for January 2018 (the target is 80%). Acknowledging the Lakeview Cardiology Centre s Platinum status in the Patient and Whanau Centred Care Standards Audits. Wards 2, 6 and 11 achieved gold status with another 11 Wards achieving silver. Noting that Ward 6 has moved to Home Warding. In response to a query about the new model of care in the ADU (Assessment and Diagnostic Unit) and ensuring all medical patients in the ADU are streamed 7

8 appropriately to avoid double movement of patients, Alex Boersma advised that when possible it is preferable for people to be seen in the emergency department if that is where they are rather than moving the patient to another area. Kylie Clegg acknowledged the Home Warding results and queried if there was maintenance of performance going forward; in response Gerard de Jong advised that better business intelligence is being developed, with students and staff supporting Home Warding. The Committee Chair acknowledged the divisions reported scorecard. Specialty Medicine and Health of Older Persons (agenda page 43 to 48) Dr John Scott (Head of Division) and Brian Millen (General Manager, Medicine and Health of Older People Services) presented this section of the report. John Scott summarised the reported highlight simultaneous achievement of the national key performance indicators for stroke services. Brian Millen summarised the update provided on surveillance of colonoscopies, he advised that the three key performance indicators are being achieved (page 44 of the agenda). Matters covered in discussion and response to questions included: That with regard to increasing demand, ways to improve utilisation as well as outsourcing is being investigated. It was noted that there has been an unprecedented increase in demand over the past three months. Data is not available to show if any patients waiting for up to 42 days for a diagnostic or surveillance colonoscopy opt to seek private care. That patients being seen for a surveillance colonoscopy are essentially people from the bowel screening programme. Patients in the surveillance cycle could be re-screened in 1, 2 or 5 years; the timeframe is dependent on findings of the initial colonoscopy as to whether short, medium or long term surveillance is required. With regard to funding for surveillance colonoscopies, Jo Brown advised that the original pilot did not include this type of screening as it is considered to be a DHB population cost. A recent update to funding has now provided some funding; the DHB s surveillance colonoscopies could number up to 800 annually with funding provided for approximately 400. The Committee Chair acknowledged the work being undertaken in the service. Child Women and Family (agenda page 49 to 56) An updated version of the Child Women and Family Services report was tabled at the meeting and replaces the published version. Dr Meia Schmidt-Uili (Head of Division Medical CWF) and Stephanie Doe (General Manager Child, Women and Family Services) were present for this item. Apologies were received from Emma Farmer (Head of Division Midwifery). Dr Meia Schmidt-Uili introduced the tabled report and formally apologised for the incorrect version published. He noted in particular the colposcopy service improvements as reported. 8

9 Stephanie Doe provided a summary on the tabled. Matters covered in discussion and response to questions included: That in May there will be 60 new graduates, 35 will go into practice and 25 applied for the DHBs new graduate programme. There has been a significant improvement in the area of recruiting to the physiotherapy vacancies within the community child health teams. Oral health enrolments for infants by 1 year of age are improving. Work is underway with the Counties Manukau Health executive team to continue improvements in the area of oral health; Saturday clinics continue to be successful. Noting that the Auckland Regional Dental Service had recently recruited 17 new graduates, of which 12 will be working in South Auckland. Morris Pita noted that cervical screening rates for Maori [in the primary care area] are lower than non-maori and this needs to be an area of focus. Meia Schmidt advised that the cervical screening provided by the Child Women and Family service is for patients who have received an abnormal screening and that initial screening is undertaken in primary care. Noting that with regard to colposcopy services that there has been a lot of work looking at audit and monitoring. Stephanie Doe also noted that there are rigorous guidelines in place for testing, it has been identified that a small number of tests were undertaken when not required, why this occurred is being investigated. The policy around colposcopy services is based on the national framework. Specialist Mental Health and Addiction (agenda page 57 to 61) Dr Susanna Galea (Head of Department, Mental Health Services) and Dr Pam Lightbown (General Manager) presented this section of the report. Pam Lightbrown summarised the report, noting in particular the five beds that were temporarily closed at He Puna Waiora on 11 October were re-opened on 18 December The service has successfully recruited five nurses who are new graduate entry to specialist practice nurses and also fully recruited all health care assistant roles. It was noted that the service now has a more overarching recruitment and retention strategy in place. Susanna Galea noted that the new Substance Addiction Compulsory Assessment and Treatment Act comes into effect on 21 February Matters covered in discussion related to the new Act included: To date there is no additional funding for the DHB, the DHB will need to respond to the Act from within its current resource; there is associated risk with this and concern about the impact on the DHB s population currently being treated. The Ministry of Health funded nine bed treatment facility is based in Christchurch and at this time Waitemata DHB has eight people needing care in this area. The DHB s service has developed an operational process to commence with the new Act, which includes appointed officers and specialists with systems in place to monitor risk areas. The former metro Auckland DHB Chair wrote to the Minister of Health in January 2018 detailing the concerns of the metro Auckland DHBs, the DHBs are awaiting a response. The DHB has taken appropriate steps to note its concern and the Committee will continue to receive regular updates on the implementation of the new Act. 9

10 Noting that the purpose and review of the Act is very good and was required. With regard to seclusion rates, it was noted that in the previous month there was a zero conclusion rate. When the DHB has one or two clients that are unwell and depending on the nature and complexity of the client, then the seclusion rate may raise for forensic services. The Government led mental health review was noted, the DHB is waiting to receive information on the review to determine how the service can participate. Surgical and Ambulatory Services/Elective Surgical Centre (agenda page 62 to 73) Dr Michael Rodgers (Chief of Surgery) and Lyn Wardlaw (Operations Manager, ESC Outpatients) presented this section of the report. Apologies from Debbie Eastwood were noted. Michael Rodgers summarised the report. Key points noted included: The update provided on OPIVA (outpatient intravenous antibiotic). The update on the Orthogeriatric Model of Care and the key performance indicators listed. The unprecedented demand for radiology. A new Radiology Clinical Director has been appointed. That a report on theatre culture is underway. Discussions are underway with a theatre leadership group to promote Waitemata DHB theatres as a great place to work. It is intended to formalise a leadership culture within theatres with surgeons. The report was noted. 3.2 Provider Arm Performance Report December 2017 (agenda pages 74 to 80) The report was noted. 4. CORPORATE REPORTS 4.1 Clinical Leaders Report (agenda pages 81 to 85) Dr Andrew Brant (Deputy Chief Executive Officer), Dr Jocelyn Peach (Director of Nursing and Midwifery; Emergency Systems Planner) and Tamzin Brott (Director of Allied Health) presented this item. Medical Staff Andrew Brant summarised this section of the report. Nursing and Midwifery Apologies from Jocelyn Peach were received and this section of the report was noted. Allied Health, Scientific and Technical Staff Tamzin Brott summarised this section of the report, noting in particular the commencement of the process for the 2018 scholarship programme. 10

11 The report was noted. 4.2 Human Resources (agenda pages 86 to 96) Fiona McCarthy (Director of Human Resources) was present for this item. The report was noted. 4.3 Quality Report (agenda pages 97 to 249) Jacky Bush (Quality and Risk Manager), (Penny Andrew (Clinical Lead Quality) and David Price (Director of Patient Experience) were present for this item. Jacky Bush summarised the report. Matters covered in discussion and response to questions included: Noting the flu planning underway for 2018; the Committee Chair noted the importance of increasing the rate of staff who received the flu vaccination. The problem of ipads freezing on the Wards has not yet been identified, but a team from both Microsoft and healthalliance working on resolving it. Noting the Patient Reported Outcomes Measures progress summary provided to the Committee and the importance of demonstrating uplift once the App is in place; this will be presented to the Board. Noting the report provided on communicable diseases. The Chair noted that the roles of the infection control team and the public health team need to be clearly communicated; Penny Andrew acknowledged this and advised that she would report that back to the IPC (Infection Prevention Control) Committee. David Price summarised the Patient and Whanau Centered Care update provided (page 153 of the agenda); he noted that due to an issue with retrieving data around patient experience feedback and it was unable to be provided at the time of reporting. The Committee Chair acknowledged the update provided, in particular the number of volunteers. David advised that there has been an increase in University and high school students volunteering on weekends. In response to a concern expressed by Sandra Coney about the gardens at the Waitakere Hospital site, David advised that work was underway with the Facilities Team to develop a gardening programme. Penny Andrew noted that Waitemata DHB was a finalist in the 2018 NZ HR Awards for an Award for Talent Development and Management in association with Lee Hecht Harrison. A copy of the video link will be sent to the Board. James Le Fevre noted the sad passing of Pat Booth, a respected former Board member of Waitemata DHB. The report was noted. 5. RESOLUTION TO EXCLUDE THE PUBLIC (agenda page 250) Resolution (Moved Morris Pita/Seconded Kylie Clegg) That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000: 11

12 The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below: General subject of Reason for passing this resolution in items to be considered relation to each item 1. Confirmation of That the public conduct of the whole or the Public Excluded relevant part of the proceedings of the Minutes Hospital meeting would be likely to result in the Advisory Committee disclosure of information for which good Meeting of reason for withholding would exist, under 18/10/17 section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 2. Confirmation of That the public conduct of the whole or the Public Excluded relevant part of the proceedings of the Minutes Hospital meeting would be likely to result in the Advisory Committee disclosure of information for which good Meeting of reason for withholding would exist, under 29/11/17 section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 3. Quality Report That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] 4. Human Resources Report That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution Confirmation of Minutes As per resolution(s) to exclude the public from the open section of the minutes of the above meeting, in terms of the NZPH&D Act. Confirmation of Minutes As per resolution(s) to exclude the public from the open section of the minutes of the above meeting, in terms of the NZPH&D Act. Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)] Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] Carried The open session of the meeting concluded at 3.50pm. SIGNED AS A CORRECT RECORD OF THE WAITEMATA DISTRICT HEALTH BOARD HOSPITAL ADVISORY COMMITTEE MEETING OF 14 FEBRUARY 2018 COMMITTEE CHAIR 12

13 Actions Arising and Carried Forward from Meetings of the Hospital Advisory Committee as at 21 March 2018 Meeting Agenda Ref Topic 06/09/ Provider arm Performance Report Presentation on the Whanau Centered Care Standards Programme, demonstrating a then and now situation. 06/09/ Quality Report Provide an update on a study by John Cullen about victim C treatment for carpal tunnel 18/10/ Provider Arm Performance Report A presentation from Helen Wood about the mental health workplace policy to be rolled out across all United Nation agencies. Person Responsible Jocelyn Peach Expected Report Back Comment 28/03/18 Presentation to be given at the Committee meeting 28/03/18. First quarter The vitamin C trial in carpal tunnel surgery trial has not progressed. It was stopped for multiple reasons, including loss of a designated list at Waitakere, and registrar turnover. 13

14 3.1 Provider Arm Performance Report January 2018 Recommendation: That the report be received. Prepared by: Robert Paine (Chief Financial Officer and Head of Corporate Services) and Cath Cronin (Director of Hospital Services) This report summarises the Provider Arm performance for January

15 Table of Contents Glossary How to interpret the scorecards Provider Arm Performance Report January 2018 Executive Summary / Overview Scorecard All services Health Targets Elective Performance Indicators Strategic Initiatives Financial Performance Human Resources Divisional Reports Acute and Emergency Medicine Division Specialty Medicine and Health of Older People Division Child, Women and Family Services Specialist Mental Health and Addiction Services Surgical and Ambulatory Services Elective Surgery Centre 15

16 Glossary ACC - Accident Compensation Commission ADU - Assessment and Diagnostic Unit ARDS - Auckland Regional Dental Service ALOS - Average Length of Stay CADS - Community Alcohol, Drug and Addictions Service CT - Computerised Tomography CWF - Child, Women and Family service ED - Emergency Department ECHO - Echocardiogram ESC - Elective Surgery Centre ESPI - Elective Services Performance Indicators FTE - Full Time Equivalent ICU - Intensive Care Unit IDF - Inter District Flow MRI - Magnetic Resonance Imaging ORL - Otorhinolaryngology (ear, nose, and throat) RMO - Registered Medical Officer S&A - Surgical and Ambulatory Services SMHA - Specialist Mental Health and Addiction Services SMO - Senior Medical Officer WIES - Weighted Inlier Equivalent Separations YTD - Year To Date 16

17 How to interpret the scorecards Traffic lights For each measure, the traffic light indicates whether the actual performance is on target or not for the reporting period (or previous reporting period if data are not available as indicated by the grey bold italic font). Measure description Traffic light Trend indicator Actual Target Trend Better help for smokers to quit - hospitalised 98% 95% The colour of the traffic lights aligns with the Annual Plan: Traffic light Criteria: Relative variance actual vs. target Interpretation On target or better Achieved % achieved 0.1 5% away from target Substantially Achieved %*achieved <94.9% achieved % away from target AND improvement from last month % away from target, AND no improvement, OR >10% away from target Not achieved, but progress made Not Achieved Trend indicators A trend line and a trend indicator are reported against each measure. Trend lines represent the actual data available for the latest 12-months period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. The small data range may result in small variations appearing to be large. Note that YTD measures (e.g., WIES volumes, revenue) are cumulative by definition. As a result their trend line will always show an upward trend that resets at the beginning of the new financial year. The line direction is not necessarily reflective of positive performance. To assess the performance trend, use the trend indicator as described below. The trend indicator criteria and interpretation rules: Trend indicator Rules Interpretation Current > Previous month (or reporting period) performance Improvement Current < Previous month (or reporting period) performance Decline Current = Previous month (or reporting period) performance Stable By default, the performance criteria are the actual:target ratio. However, in some exceptions (e.g., when target is 0 and when performance can be negative (e.g., net result) the performance reflects the actual. Look up for scorecard-specific guidelines are available at the bottom of each scorecard: Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-months period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. Small data range may result small variations perceived to be large. a. ESPI traffic lights follow the MoH criteria for funding penalties: ESPI 2: the traffic light will be green if no patient is waiting, blue if greater than 0 patients and less than or equal to 10 patients or less than 0.39%, and red if 0.4% or higher. ESPI 5: the traffic light will be green if no patient is waiting, blue if greater than 0 patients and less than or equal to 10 patients or less than 0.99% and red if 1% or higher. 17

18 Provider Arm Performance Report Executive Summary/Overview Summary January has been a challenging month to balance elective and acute demand within our available capacity. Our ED presentations at North Shore Hospital were markedly increased. However our teams all did what they do best and provided the best clinical care and experience that they could for our patients and whanau. I share with you some feedback we recently received. We constantly review our performance and can always seek opportunities to do things better but it is reassuring to receive an increasing numbers of compliments. Complimentary feedback regarding North Shore Hospital Have been visiting over the past 2 weeks. Compliments only hospital surrounds clean, ease of access, all good. Entry to Hospital spacious, warm and welcoming, love the armchairs, what a warm and friendly addition. Friendly and helpful desk staff well set up and clearly marked. Volunteer help desk with pleasant, willing to help volunteers. Separate Espresso Alley a great addition giving much ease for fast service. Good clear signage great art work around on walls. Impression coming here is that of a very pleasant hotel lobby sitting here writing this is a feeling of calm, carried through by the faces on those visitors leaving the hospital no feelings of stress or discomfort. Sitting here just watched a young man going straight to the blue signage, immediately was clear which way to go. Amazing well done in all respects. Highlight of the month Māori and Pacific Cancer Nurse Coordinators Waitemata has just employed Kim Wi (pictured right) as a full time Māori Cancer Nurse Coordinator to work alongside clinical staff and case manage high needs/complex Māori cancer patients and their whanau. Kim brings significant experience working with Māori in West and South Auckland having undertaken the majority of her nursing within a Māori healthcare setting. She has her first hui scheduled for 28 February and will work flexibly between the North Shore Hospital and Waitakere Hospital sites. Kim joins Sulu Samu (Pacific Island Cancer Nurse Coordinator pictured left) to work in partnership with clinical staff across the DHB, providing cultural case management of high needs/complex cancer patients. They also provide education to staff and act as a key link to primary health care providers. Waitemata was the first DHB to reach the 90% MoH target in 2017 however when separated out, Māori and Pacific patients treatment timeframes sit between 80-90%. Average Faster Cancer Treatment Compliance Pacific Maori Day 83.5% 91.6% 91.4% 93.5% 31 Day 93.6% 88.8% 90.9% 88.8% 18

19 Financial Performance Summary The Provider Arm result for the month ended January 2018 was favourable by $71k. The Provider Arm continues to implement the Financial Sustainability Portfolio which is a multi-year portfolio of initiatives to drive sustainable reductions in expenditure and generate revenue. Strategic initiatives such as TransforMED are continuing to deliver benefits through reduced average length of stay as the transition to business as usual. Scorecard All services Waitemata DHB Monthly Performance Scorecard ALL Services January /18 Health Targets Service Delivery Actual Target Trend Elective Volumes Actual Target Trend Shorter Waits in ED 96% 95% Provider Arm - Overall 99% 100% Faster cancer treatment (62 days) 95% 90% Waiting Times ESPI 2 - % patients waiting > 4 months for FSA Compliant Best Care ESPI 5 - % patients not treated w/n 4 months Non-Compliant ESPI 1 - OP Referrals processed w/n 10 days Compliant Patient Experience Actual Target Trend Complaint Average Response Time 15 days <14 days Patient Flow Net Promoter Score FFT Outpatient DNA rate (FSA + FUs) - Total 8% <10% Outpatient DNA rate (FSA + FUs) - Māori 17% <10% Improving Outcomes Outpatient DNA rate (FSA + FUs) - Pacific 18% <10% Better help for smokers to quit - hospitalised 99% 95% Average Length of Stay - Electives 1.64 days 1.59 days Average Length of Stay - Acutes 2.37 days 2.25 days Quality & Safety Trend Older patients assessed for falling risk 92% 90% Value for Money Rate of falls with major harm 0 <2 Good hand hygiene practice 89% 80% Financial Result (YTD) Actual Target Trend S. aureus infection rate 0 <0.2 Revenue 531,688 k 526,203 k Occasions insertion bundle used 100% 95% Expense 544,497 k 529,590 k Pressure injuries grade 3&4 0 0 Net Surplus/Deficit -12,808 k -3,387 k Capital Expenditure (% Annual budget) 81% HR/Staff Experience Trend Sick leave rate 3.3% <3.6% Contracts (YTD) Turnover rate - external 13% 8-12% Elective WIES Volumes 10,676 10,617 Vacancies - % 4.5% <6% Acute WIES Volumes 38,630 36,554 How to to read Performance indicators: Trend indicators: Achieved/ On track Substantially Achieved but off target Performance improved compared to previous month Not Achieved but progress made Not Achieved/ Off track Performance declined compared to previous month Performance was maintained Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range may result in small variations appearing to be large. A question? Contact: Victora Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB 19

20 Health Targets Faster Cancer Treatment Shorter Stays in Emergency Departments 20

21 Inpatient Events admitted through ED Emergency Department/ ADU Presentations 21

22 Improved Access to Elective Surgery Note: Changes were made to the electives health target for 2015/16 Percentage Change ED and Elective Volumes January 2018 Month Volumes % Change (last year) YTD Volumes % Change (last year) ED/ADU Volumes 11,198 10% 76,801 6% Elective Volumes 1,062 23% 8, % 22

23 Elective Performance Indicators Zero patients waiting over four months Summary (January 18) Speciality Non Compliance % ESPI2 0.67% ESPI5 0.36% ESPI ESPI Compliant Non Compliant ESPI 2 Anaesthesiology % Cardiology % Dermatology % Diabetes % Endocrinology % Gastro-Enterology % General Medicine % General Surgery 1, % Gynaecology % Haematology % Infectious Diseases % Neurovascular % Orthopaedic 1, % Otorhinolaryngology 1, % Paediatric MED % Renal Medicine % Respiratory Medicine % Rheumatology % Urology % Total 10, % ESPI 5 Cardiology % General Surgery 1, % Gynaecology % Orthopaedic % Otorhinolaryngology % Urology % Total 3, % 23

24 90% of outpatient referrals acknowledged and processed within 10 days ESPI 1 January 2018) Specialty Compliance % Anaesthesiology % Cardiology 96.23% Dermatology 97.32% Diabetes % Endocrinology 95.43% Gastro-Enterology % General Medicine 95.48% General Surgery 96.74% Gynaecology 99.68% Haematology 98.73% Infectious Diseases 97.96% Neurovascular % Orthopaedic 98.87% Otorhinolaryngology 99.49% Paediatric MED 99.26% Renal Medicine 98.94% Respiratory Medicine 98.57% Rheumatology % Urology 99.04% Total 98.38% Legend ESPI 1 ESPI 2 ESPI 5 Green if 100%, Yellow if between 90% and 99.9%, and Red if 90% or less. Green if 0 patients, Yellow if greater than 0 patients and less than or equal to 10 patients or less than 0.39%, and Red if 0.4% or higher. Green if 0 patients, Yellow if greater than 0 patients and less than or equal to 10 patients or less than 0.99%, and Red if 1% or higher Discharges by Specialty and Average Length of Stay Discharges by Specialty 24

25 Cumulative Bed Days saved through Hospital Initiatives 25

26 Predicted versus Actual Bed Days 26

27 Strategic Initiatives Variance Report Deliverable/Action On Track Faster Cancer Treatment 1. We will implement sustainable service improvement activities to improve access, timeliness and quality of cancer services: 2. Confirm a process to ensure all tumour streams appropriately apply the High Suspicion of Cancer flags December 2017 Work with Māori Health to (EOA): 3. Appoint a Māori Cancer Nurse Coordinator September Develop and implement a work plan to ensure equitable health outcomes for Māori patients September Document a clear pathway for all external and internal HSC P1 (high priority) gastroenterology patients, in conjunction with the Gastroenterology Service September Design a process to ensure all cancer follow-up patients are identified and receive follow-up at the correct time December Contribute to the development of plans for local delivery of medical oncology Developed by December All cancer-related MDMs will use electronic forms to document meeting outcomes In place by June Improve waiting times for diagnostic CT and MRI by reviewing options to increase capacity and implement changes to service model of care and delivery to improve planned patient access December 2017 National Bowel Screening 10. Meet the bowel screening quality standards for the Waitemata DHB programme - Ongoing 11. Continue to meet the waiting time standard for bowel screening colonoscopies - Ongoing 12. Waitemata DHB bowel screening programme structure and staffing in place to join the national programme January 2018 Areas off track for month and remedial plans All areas on track 27

28 Financial Performance STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Jan-18 Provider ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency 76,216 72,617 3, , ,059 4, ,524 Other Income 2,393 2,793 (400) 18,248 17,145 1,104 32,357 Total Revenue 78,609 75,410 3, , ,203 5, ,881 EXPENDITURE Personnel Medical 16,293 15,848 (445) 105, ,338 (669) 181,197 Nursing 20,312 20, , ,188 (54) 239,546 Allied Health 9,153 8,900 (253) 65,225 68,204 2, ,926 Support 1,778 1, ,084 11, ,785 Management / Administration 5,374 5,366 (8) 39,916 38,920 (996) 67,229 Outsourced Personnel 1, (102) 9,168 7,416 (1,752) 12,735 53,962 53,495 (467) 369, ,607 (35) 637,417 Other Expenditure Outsourced Services 4,582 3,865 (717) 30,671 27,486 (3,185) 46,854 Clinical Supplies 9,629 8,843 (786) 72,081 67,259 (4,821) 115,908 Infrastructure & Non-Clinical Supplies 10,259 9,102 (1,157) 72,103 65,238 (6,865) 111,701 24,470 21,810 (2,660) 174, ,984 (14,872) 274,464 Total Expenditure 78,432 75,304 (3,128) 544, ,590 (14,907) 911,881 Cost Net of Other Revenue (12,808) (3,387) (9,421) (7,000) * Government and Crow n Agency : Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. Comment on major financial variances The Provider result was $9.421m unfavourable to budget for the YTD January The key variances are described below: Revenue Revenue was $5.485m favourable to budget YTD. This includes additional income received for clinical trials, rebates for product purchases and other MoH contracts. Expenditure Overall expenditure was unfavourable to budget by $14.907m YTD. The key variances are summarised below. Personnel ($35k unfavourable YTD) The unfavourable variance was driven by: Medical staff costs were unfavourable by $669k YTD. The unfavourable variance was driven by statutory leave payments during the holiday period. Nursing staff costs were unfavourable by $54k YTD. The unfavourable variance was driven by higher statutory leave uptake and lower training costs than planned over the holiday period. Allied Health staff costs favourable by $2.980m YTD. The favourable variance was driven by vacancies across all service areas. Support staff costs were favourable by $456k YTD. The favourable variance was driven by vacancies across all service areas, offset by over spends in outsourced cost. Management and administration staff costs were unfavourable by $996k YTD. 28

29 Outsourced Personnel unfavourable by $1.752m YTD. This unfavourable variance was driven by SMHA locum spend covering vacancies, however this spend has slowed down over the Christmas and New Year period and as vacancies have been filled. Outsourced Services ($3.185m unfavourable YTD) This variance was driven by unbudgeted outsourced radiology and gastroscopy and colonoscopy services. These procedures continue to be outsourced to meet MoH targets and population demand. Clinical Supplies ($4.821m unfavourable YTD) The unfavourable variance was driven by increased costs for clinical supplies, inpatient pharmaceuticals and unbudgeted repairs and maintenance. Infrastructure and Non-Clinical Supplies ($6.865m unfavourable YTD) The unfavourable variance was driven by Facilities and Development ($1.475m) YTD due to unbudgeted repairs and maintenance and unrealised expenditure reduction initiatives, including S&A ($3.009m) YTD due to unrealised expenditure reduction initiatives. Getting back on track Initiative The Provider Arm is progressing a comprehensive multi-year portfolio of initiatives to drive sustainable reductions in its cost base. The portfolio is executive lead, pan-directorate with regular status reporting. The portfolio includes strategic focus on both clinical transformation and value-based programmes of work along with a DHB wide improvement portfolio of over 200 service lead projects focused on enhanced productivity and quality, workforce deployment, procurement and supply chain and revenue optimisation. One such initiative is TransforMED which has reduced Average Length of Stay leading to a reduction in operating costs. 29

30 STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Jan-18 Provider ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget CONTRIBUTION Surgical and Ambulatory (12,879) (11,607) (1,273) (93,729) (87,779) (5,950) (153,055) Acute and Emergency (11,133) (11,392) 258 (80,677) (79,470) (1,207) (138,538) Specialty Medicine and HOPS (6,467) (5,750) (716) (48,655) (46,104) (2,551) (80,168) Child Women and Family (5,873) (5,844) (29) (47,930) (48,674) 744 (85,332) Specialist Mental Health and Addiction (9,145) (9,478) 333 (70,889) (72,499) 1,610 (126,745) Elective Surgery Centre (1,774) (1,992) 219 (15,585) (16,203) 617 (28,295) Provider Support 47,447 46,168 1, , ,342 (2,685) 605,134 Net Surplus/Deficit (12,808) (3,387) (9,421) (7,000) Comment on major variances by Provider Service The Provider result was $9.421m unfavourable to budget for the YTD January The key variances are described below: Surgical and Ambulatory Services The service was $5.950m unfavourable YTD. The variance was driven by increased unbudgeted RMO expenditure due to unbudgeted over allocations, ongoing unbudgeted outsourcing expenditure associated with Radiology. Radiology procedures continue to be outsourced to meet MoH targets and population demand. Clinical supplies costs continue to trend unfavourably due to volume and case mix pressures which will be mitigated through a focused programme of procurement initiatives. Unbudgeted repairs and maintenance, other one-off costs and unrealised expenditure reduction initiatives have also had an unfavourable impact. Acute and Emergency Medicine The service was $1.207m unfavourable YTD. The variance was driven by increased RMO costs due to over allocations, pricing variations and increased allowance costs. The strategies for reducing costs over the balance of the year will focus on maximising leave consumption and ongoing transition to the TransforMED Home Warding model. Sub Specialty Medicine and Health of Older People Services The service was $2.551m unfavourable YTD. The variance was driven by outsourced gastroscopy and colonoscopy procedures and increased demand for high level respite care for complex needs patients. Child Women and Family Services The service was $744k favourable YTD. The variance was driven by higher than planned Allied Health and Management/Administration vacancies across the service. Successful recruitment of new Dental Therapist staff in January 2018 will result in a reduction of this favourable trend in future months. Partially offsetting this position are unmet non staffing cost reduction initiatives that the service is working to achieve through supplier pricing negotiations or through looking at alternative ways of delivering services. Other cost pressures such as high maternity services staff costs associated with vacancy cover due to retention and recruitment challenges and clinical equipment repairs and maintenance costs are being managed with cost mitigation processes in place. Specialist Mental Health and Addiction (SMHA) Services The service was $1.610m favourable YTD. The variance was driven by favourable variances in personnel due to a large number of vacancies in nursing partially offset by casual staff and overtime cover. There were also vacancies in medical which was partly offset by locum cover. To minimise vacancies, a retention and recruitment committee is actively looking at options to attract and retain staff. Tight controls on covering these vacancies include regular 30

31 analysis and reporting on casual and overtime spend, with an emphasis to always use the internal bureau pool first to minimise premium paid on this cover. Elective Service Centre The service was $617k favourable YTD. This was driven by lower than planned personnel costs, package of care volumes and clinical supplies as a result of an additional week of Christmas shutdown. Various work streams focused on cost effectiveness and service optimisation are progressing. Provider Support Services The service was $2.685m unfavourable YTD. The Corporate and Support Services includes centrally budgeted efficiencies which are the major contributor to the unfavourable variance. Provider Support has a number of efficiency initiatives that are focused on areas of improvement including cost effectiveness, cost containment, productivity, process improvements and service reconfigurations. In addition, Corporate Services is undertaking a number of efficiency projects relating to procurement and supply chain and treasury management. Hospital Operations was $2.288m unfavourable YTD. The variance was driven by activity related non-pay expenditure including the cost of inpatient pharmaceuticals being $1.6m unfavourable YTD. Patient meals were also $349k unfavourable YTD due to increases in the contractual meal price. 31

32 Human Resources Method of calculation of graphs: 1. Overtime Rate: The sum of Overtime Hours worked over the period divided by Worked Hours over the period. 2. Sick Leave Rate (days): The sum of Sick Leave Hours over the period divided by Total Hours over the period. 3. Annual Leave balance 0-24 days: Count of Staff with less than 25 equivalent 8 hour days accumulated leave entitlement. 4. Annual Leave balance days: Count of Staff with between 25 and 50 equivalent 8 hour days accumulated leave entitlement. 5. Annual Leave balance days: Count of Staff with between 50 and 75 equivalent 8 hour days accumulated leave entitlement. 6. Annual Leave balance 75+ days: Count of Staff with over 75 equivalent 8 hour days accumulated leave entitlement. 7. Voluntary Turnover Rate: Count of ALL staff resignations in the last 12 months. This data excludes RMOs, casuals, and involuntary reasons for leaving such as redundancy, dismissal and medical grounds. 8. Internal Turnover: Involves employees leaving their current positions and taking new positions within the same organisation. 9. External Turnover: Involves employees leaving their current positions and taking new positions outside of the organisation. Sick Leave After a slight increase in November, December and January have reported a decreasing sick leave rate with the target met at month end January This is a positive result with the overall trend from August 2017 being a gradual decrease in sick leave usage. While there was a similar decrease for the same period last year, ongoing results are more stable for current reporting period. All divisions continue to report favourable results with the exception of CWF that have reported a slightly higher rate for this reporting period with average days per FTE just above the target of eight. As we move in to autumn and winter focus on sustaining reduced levels of sick leave will be needed. Planning is underway for the 2018 flu vaccination campaign and managers in all areas continue to work pro-actively to address specific concerns as they arise. 32

33 Overtime January has reported a decreased rate of overtime usage, tracking closer to target. Trends are similar to previous years and are impacted by summer weather and more staff taking annual leave for rest and recreation. While there has been a seasonal decrease overall rates for this year are slightly higher than previous and have not reduced to target over any of the reporting months to date. Hospital Operations and SMHA continue to be the highest drivers of overtime, both still reporting an average of around 4% sitting above both the organisational target and upper tolerance levels. The contributors in both services continue to reflect those reported over previous months there are approximately 26 FTE vacancies in Cleaner and Orderlies groups and recruitment has continued with a mixture of assessment centres and interview panels. There are still nine high acuity patients across inpatients units and continued nursing vacancies in Forensics which are being actively recruited to. Robust monitoring is in place with senior management reviewing progress in both of these areas and continued analysis to identify further opportunities to reduce overtime costs. Annual Leave There has been a noticeable reduction of leave balances from December This reflects a focus over the summer holiday period of maximising annual leave for staff, particularly those with higher balances and is the most positive movement for some time. The challenge will be to maintain and further reduce these numbers as we move out of the summer holiday period. All divisions are closely monitoring leave usage and planning and working pro-actively with staff who have accumulated high balances. 33

34 Annual Leave Management (headcount) Leave Balance 0-25 days Leave Balance days Leave Balance days Surgical and Ambulatory Elective Surgery Centre Child Women and Family Services Hospital Operations Facilities and Development Corporate Acute and Emergency Medical Division 1, Director Hospital Services Mental Health and Addiction Services 1, Specialty Medicine and Health of Older People Waitemata DHB Governance and Funding Total (January 2018) 5,632 1, Leave Balance 75 days + Comparison - December ,456 1, Comparison - January ,537 1,

35 Staff Turnover Volume turnover has increased slightly for this reporting period to remain above target but within the upper tolerance level and we are tracking at a rate that is deemed healthy for an organisation. CWF continue to reflect turnover slightly above the upper tolerance level, primarily movement of midwives and dental staff. Both areas have strategies in place to mitigate the impacts while they actively recruit. Acute and Emergency Division continue to be the other key contributor but results for this reporting period indicate highest turnover in the Administration/Support workforce with a decrease in turnover in Nursing. Analysis of the leaving data for the division does not highlight any issues with a wide range of reasons reported and no particular drivers standing out. This may be a one off and rates will be monitored for the next couple of months to see if any trends arise. 35

36 Divisional Reports Acute and Emergency Medicine Division Service Overview This division is responsible for the provision of General, Acute and Emergency Medical services. The division includes the departments of General Medicine, Assessment and Diagnostic Unit (ADU), Assessment, Diagnostic and Cardiology Unit (ADCU), Emergency Medicine, Cardiology, Medical wards and Hyperbaric Medicine. The service is managed by Dr Gerard de Jong (Division Head Acute and Emergency Medicine) and Alex Boersma (General Manager); Head of Division Nursing is Shirley Ross. The Clinical Directors are Dr Hamish Hart for General Medicine, Dr Willem Landman for Emergency Care, Dr Tony Scott for Cardiology, Dr Hasan Bhally and Dr Hugh de Lautour for ADU and ADCU and Dr Chris Sames for Hyperbaric Medicine. Highlight of the Month Home Based Wards The implementation of home based wards (patients managed by medical teams within a single geographical ward unit) as part of the TransforMED programme, continues across the General Medical Wards and the ADU at North Shore Hospital with over 6,900 bed days saved to date. Ward 6 became fully operational on 12 February 2018 following a month s closure for refurbishment. This is the final ward to go live with the home ward model for General Medicine. Ward 6 is a Gastroenterology themed General Medicine ward, supported by General Medicine SMOs with an interest in the subspecialty of Gastroenterology and there are clear admission criteria for the ward. Since the opening of Ward 6 the number of medical patients on outlier wards has reduced. As a result of the closure of Ward 6 the weekly ALOS became more variable from the middle of December 2017; we anticipate this will become less variable now that all of the wards are open. Dr Ratna Pandey and staff on Day 1 on Ward 6, 12 February

37 Home Warding Headlines 12% fewer (-22) beds occupied by acute general medicine patients (including outliers) since November compared to the same time last year. There is no change in the readmission rate for acute general medicine patients. Since August there have been 29% fewer (~20) stranded patients in North Shore Hospital under Medical services. Weekly ALOS variation has halved and we continue to see a 19 hour (20%) reduction for acute general medicine patients (although this is concentrated on three wards Ward 3, Ward 5 and Ward 11). There has been an increase in the number of daily discharges from some of the wards with Ward 2 (+30%), Ward 3 (+30%), Ward 5 (+17%). Increasing bed availability: Ward 2 now discharging 25% of patients before 12pm (versus 19% baseline). Much is being done to consolidate the gains we have made. Focusing on improving the structure and focus of the daily multidisciplinary board rounds, with a focus on estimated date of discharge and clinical criteria for discharge and the improved communication/co-ordination between doctors, nurses and Allied Health teams. We are also working to clarify and strengthen the role of the senior nurses participation in the ward round. 37

38 Key Issues Assessment Diagnostic Unit With the appointment of Dr Hasan Bhally to the clinical lead role of the ADU, supported by Dr Hugh de Lautour the ADU is the focus of phase four of TransforMED (Waitemata DHB Acute and Specialist Medicine Patient flow initiative) and as a result of this there will be a change in the model of care with dedicated ADU teams, and an increase in the after-hours cover in the ADU. The overarching aim is to increase the number of same day and next day discharges, thereby improving patient outcomes and reducing the number of patients admitted to the inpatient wards. To move from a post take to an intake model. Aim to increase the percentage of same day/next day discharges. With the implementation of Home Based Warding, there is an increased SMO presence in the ADU with four SMOs most mornings, three doing post-acute rounds and the fourth providing early senior review and decision making. The afternoons are now covered with two SMOs. One of the SMOs holds the ED/General Practitioner referral phone, assisting with streaming patients as appropriate. With support from the Pharmacist and ADU based Discharge Co-ordinators as well utilising the Medical Tutor Specialist, the evening shift (5:00pm-8:00pm) is now covered three days per week assisting with reviews, flow and facilitating discharges. Waitakere Hospital The implementation of Home Based Warding at WTH has been delayed until later in This is due to the intensity of resource required to support North Shore to embed and sustain the improvement achieved to date. Waitakere is adapting the TransforMED principles into their daily work patterns while waiting for the formal roll out of TransforMED at Waitakere, such as board rounds, red to green days and increased rounds in the ADU. 38

39 Scorecard Acute and Emergency Medicine Division Health Targets Waitemata DHB Monthly Performance Scorecard Acute and Emergency Medicine January /18 Service Delivery Actual Target Trend Waiting Times Actual Target Trend a. Shorter Waits in ED 97% 95% ADU - % seen from triage w/in 120 mins 71% 85% Elective coronary angiography w/in 90 days 83% 95% Angiography for ACS w/in 72 hours 71% 70% Best Care b. Chest pain clinic wait time under 6 weeks 81% 80% b. Patient Experience Actual Target Trend O/P Transthoracic Echo wait time under 12 weeks 51% 95% Complaint Average Response Time 23 days <14 days Net Promoter Score FFT Patient Flow Elective Discharge Volumes (Cardiology) 120% 100% Improving Outcomes Outpatient DNA rate 8% <10% PCI w/in 120 minutes (STEMI patients) 94% 80% Patients with EDS on discharge 90% 85% Better help for smokers to quit - hospitalised 100% 95% Average Length of Stay - Acutes 2.17 days <2.12 days Quality & Safety Value for Money Older patients assessed for falling risk 97% 90% Rate of falls with major harm 0 <2 Financial Result (YTD) Actual Target Trend Good hand hygiene practice 87% 80% Revenue 2,271 k 2,139 k Pressure injuries grade 3&4 0 0 Expense 82,948 k 81,609 k Net Surplus/Deficit -80,677 k -79,470 k HR/Staff Experience Capital Expenditure (% Annual budget) 190% Sick leave rate 3.0% <3.6% Turnover rate - external 16.9% 8-12% Contracts (YTD) Elective WIES Volumes Acute WIES Volumes 21,040 19,760 How to to read Performance indicators: Trend indicators: Achieved/ On track Substantially Achieved but off target Performance improved compared to previous month Not Achieved but progress made Not Achieved/ Off track Performance declined compared to previous month Performance was maintained Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range may result in small variations appearing to be large. a. Data for Medicine overall b. Dec Q result, Jan n/a yet A question? Contact: Victora Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB Scorecard Variance Report Best Care Complaint Average Response Time 23 days against a target of 14 days The Acute and Emergency Medicine Division resolved/closed nine complaints during January 2018 which included four complaints that were received prior to January Turnover Rate 16.9% against a target of 8-12% The rolling 12 month turnover average rate for the Acute and Emergency Medicine Division was 16.89% at January This is an increase since January 2017 when the rolling average rate was 13.4%. The voluntary turnover rate (Quarterly rolling average) of 14.8% remains stable from November However, the overall rate has increased compared to this time last year when the figure was 13.6% in January The services showing the highest turnover rate in November are Acute Medicine and the Medical Wards. Mitigations continue to be encouraged alongside regular use of annual leave, support for development and encouraging staff to take part in exit interviews to gain further insight into the factors affecting staff turnover. 39

40 Service Delivery ADU % seen from triage w/in 120 minutes 71% against a target of 85% General Medicine In January % of General Medicine patients were seen within 120 minutes of arrival time (as per the graph below). The RMO rosters in General Medicine are not currently aligned to peak patient presentation times with staffing higher over the morning shift and decreasing significantly after 4:00pm. This is the area of focus for ongoing work in the ADU and we are analysing data to look at peak referral times, referral patterns and seen by times to better understand and determine what time of the day is an issue. Numbers of clerking doctors in Medicine drops significantly after 4:00pm with fewer doctors available for clerking in the late afternoon/evening period. We are looking to address this in the new model of care. Surgery In January 63% of surgical patients were seen within two hours of triage and in December 60% of surgical patients were seen within two hours of triage. Orthopaedics In January 2018 the seen by time for orthopaedic patients dropped to 45% of patients seen within two hours of triage. Elective coronary angiography w/in 90 days 83% against a target of 95% The service has regularly met this target. All the Diagnostic Operators and some of the Percutaneous Coronary Intervention (PCI) Operators had varying periods of leave from middle of December to the end of January, limiting the throughput of diagnostic lists. There was also the impact of the public holidays. Current practice is that elective patients are not booked on the PCI lists two days before and after a long holiday (two days before Christmas and two days before New Year and after): in order to clear the inpatient acute patients pre and post the public holidays. This means there is limited outpatient PCI available between 21 December 2017 and 5 January In addition, patients are often reluctant to be booked in over this time. Extra patients have been scheduled since the Christmas break. O/P Transthoracic ECHO wait time under 12 weeks 51% against a target of 95% This is a significant improvement over previous months and we shall continue to work on the ECHO target. However, this target will continue to be challenging due to the volume of referrals received. Echo Cardiology shows the size, structure and movement of the various parts of the heart. Sonographers or Trainee Sonographers perform the procedure and provide a preliminary report. The Cardiology ECHO service routinely performs ECHOs on over 8,000 patients per annum, an average of 155 patients per week. Referrals are received from a number of services with the DHB including Cardiologist and a number are referred directly to ECHO from the patient s General Practitioner. A review of the ongoing demand is being undertaken over the next month. The productivity within Cardiology 2D ECHO has improved over time, partly due to the implementation of new echo machines in the middle of last year. However, with an increase in productivity there is the challenge to keep up with the reporting of these in a timely manner. With the recruitment of a locum SMO from the beginning of March 2018, until the substantive role is filled in 2019, there will be an increase in our ability to report more promptly. In addition, a robust validation process has been implemented and patient focused booking is also planned for routine (P3) ECHOs. 40

41 Strategic Initiatives Variance Report Deliverable/Action Shorter Stays in Emergency Departments 1. Analyse ED mental health attendances to understand the profile of presentations June Work with Mental Health to develop clinical and shared care pathways for regular and high users of ED with plans developed for known service users of Specialist Mental Health services March Implement shared care Mental Health pathways June Formalise the use of primary options for acute care in the ED develop and implement a range of pathways March Implement the OptimisED project in Waitakere ED to effectively utilising new ED areas to maximise patient flow June Continue to work with urgent care/primary care partners to improve access to primary care for primary care issues June 2018 On Track 7. Promote access afterhours to reduce low acuity presentations December Develop a pilot in Waitakere ED to more efficiently assess the low acuity patients June 2018 Delivery of Regional Service Plan Cardiac Services ACS 9. Audit compliance with the current pathway and the Timi assessment criteria/process December Audit the appropriate referral pathway for exercise tolerance test (ETT) December Audit the rate of negative vs. positive ETTs to inform this work December 2017 Cardiac Services Heart Failure 12. Audit all patients with a first diagnosis of heart failure to track their readmission rates December Engage in the regional process via the regional cardiac network to agree protocols, guidance, processes and systems to ensure optimal management of patients with heart failure June 2018 Areas off track for month and remedial plans All areas on track 41

42 Financial Results - Acute and Emergency Medicine STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Jan-18 Acute and Emergency Medical Divison ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency (26) 1,839 1, ,075 Other Income Total Revenue (10) 2,271 2, ,631 EXPENDITURE Personnel Medical 3,836 3, ,533 25,171 (1,362) 44,601 Nursing 5,269 5, ,883 38, ,582 Allied Health ,420 1, ,571 Support Management / Administration (38) 4,093 3,929 (163) 6,937 Outsourced Personnel ,136 9,978 10, ,530 70,226 (1,305) 123,842 Other Expenditure Outsourced Services Clinical Supplies 1,116 1, ,657 8, ,941 Infrastructure & Non-Clinical Supplies (178) 2,476 2,381 (95) 3,417 1,453 1,385 (68) 11,418 11,383 (35) 18,935 Total Expenditure 11,432 11, ,948 81,609 (1,339) 142,778 Cost Net of Other Revenue (11,133) (11,392) 258 (80,677) (79,470) (1,207) (139,147) * Government and Crow n Agency : Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. Comment on major financial variances The overall result for Acute and Emergency was $258k favourable for January but $1,207k unfavourable for the YTD. The YTD Acute Non-IDF WIES volumes were 5.5% above contracted volumes and Elective Non-IDF WIES were 7.0% above contract. Revenue ($10k unfavourable for January, $132k favourable YTD) The unfavourable variance for January was due to reduced ACC revenue for the Hyperbaric Unit. The YTD position was due to a combination of increased university training revenue and ACC revenue. Expenditure ($268k favourable for January, $1,339k unfavourable YTD) The favourable variance for January was due to bed closures in Wards 6, 11 and Anawhata. The unfavourable variance YTD was due to unbudgeted over allocations, pricing variations and increased allowance expenditure for Registrars, ($1,230k). House Officers were $157k unfavourable YTD due to annual leave creep and additional meal costs. Personnel ($1,305k unfavourable YTD) Medical ($1,362k unfavourable YTD) The unfavourable variance was due to $1,387k of cost increases in Registrars and House Officers, as a result of unbudgeted over allocations, pricing variations and additional allowance costs. SMOs were $455k favourable due to vacancies; churn and annual leave consumption, which has exceeded the Medical efficiencies target of $430k. The strategies for reducing expenditure over the balance of the year will continue to focus on maximising leave consumption and targeting a smooth transition to the TransforMED Home Warding initiative. 42

43 Nursing ($112k favourable YTD) The favourable position was due to bed closures in Wards 6, 11 and Anawhata during January $357k. Unfavourable variances in both the North Shore Hospital and Waitakere Hospital EDs from high staff turnover levels and resulting pressures on orientation expenditure mitigated the benefit of the bed closures. The balance of the year result is expected to benefit from the closure of 12 beds on Ward 11. Opportunistic benefits through flexing beds closed are being realised and continue to be expected through the remainder of the year. The financial benefits of the January bed closures and flexed beds will be transferred to the Director of Hospital Services division. Allied Health ($59k favourable YTD) The favourable variance was due to vacancies within Cardiology. The favourable position will continue through the balance of the year. Support and Management/Administration ($154k unfavourable YTD) The unfavourable variance was due to pricing variations in the ED and an unbudgeted role both within Patient Care and Access. Outsourced Personnel ($41k favourable YTD) The favourable variance was due to a reduced need for locum cover in January. Other Expenditure ($35k unfavourable YTD) Outsourced Services ($56k favourable YTD) The favourable variance was due to lower laboratory and pathology expenditure. Infrastructure and Non-Clinical Supplies ($95k unfavourable YTD) Printing, stationery and office expenses were $159k favourable and security services were $49k favourable, this was predominantly in the Wards and EDs. The favourable variances have been offset by a $333k expenditure reduction target that has not been realised. Getting back on track initiatives The TransforMED and ADU care initiatives continue to show positive results. The Home Warding pilot has been expanded to all medical wards at North Shore Hospital. These initiatives have combined to improve patient flow and shorten the average length of stay at North Shore Hospital and have facilitated progress in the bed flexing programme. Whilst this programme is having a significant impact on the operational performance at North Shore Hospital, the fiscal benefit is being realised through the Flexed Bed programme and our ability to close beds. Continued emphasis will be placed on ensuring appropriate annual leave consumption as well maintaining control over headcount levels. 43

44 Specialty Medicine and Health of Older People Division Service Overview This Division is responsible for the provision of medical sub-specialty and health of older people services. This includes respiratory, renal, endocrinology, stroke, dermatology, haematology, diabetes, rheumatology, infectious diseases, medical oncology, neurology, gastroenterology, smoke-free, fracture liaison services and Older Adults and Home Health, which in turn includes palliative care, geriatric medicine, district nursing, EDARS (early discharge and rehabilitation service), needs assessment and service coordination, the specialist gerontology nursing service Nga Kaitiaki Kaumatua, Mental Health Services for Older Adults, and the Assessment Treatment and Rehabilitation wards. The division also includes the Medicine patient service centre. Allied Health provides clinical support (inpatient, outpatient and community) across the Acute and Emergency Medicine Division, Specialty Medicine and Health of Older People Division and Surgical and Ambulatory Service and reports to the General Manager Specialty Medicine and Health of Older People. The service is managed by Dr John Scott (Head of Division) and Brian Millen (General Manager) with Shirley Ross Head of Department Nursing. The Clinical Directors are Dr Cheryl Johnson for Geriatric Medicine, Dr Sachin Jauhari for Psychiatry for the Older Adult, Dr Stephen Burmeister for Gastroenterology, Dr Simon Young for Diabetes/Endocrinology, Dr Janak De Zoysa for Renal, Dr Megan Cornere for Respiratory, Dr Ross Henderson for Haematology, Dr Blair Wood for Dermatology and Dr Michael Corkill for Rheumatology. The Clinical Director for Palliative Care is currently vacant. Highlight of the Month Waitemata DHB appointed its first orthogeriatrician in January Dr Min Yee Seow Hip fractures are a common and serious occurrence in elderly people. In Waitemata DHB, 406 patients fractured their hip in 2016 and 437 in Mortality in this condition is high, up to 20% at 6 months, and there are high rates also of functional decline and institutionalisation. Most patients have pre-existing functional deficits that not only contribute to sustaining a fall, but also limit recovery after surgery. Although surgery is the initial treatment for almost all hip fractures, ultimately outcomes are primarily determined by the management of comorbidities, the prevention of complications, and the provision of high quality post-operative rehabilitation. Persons who fracture their hips are almost always frail and elderly, usually with multiple morbidities and all the medical complexity that geriatricians are trained to manage. A team approach, incorporating the leadership of an ortho-geriatrician in managing medical issues, has been shown to improve outcomes such as mortality and discharge back to prior residence. Units that combine orthopaedic and geriatric care for acute hip fracture patients are increasingly common in the United Kingdom, Australia, and elsewhere, and there is a substantial evidence base demonstrating improved outcomes. The role of the orthogeriatrician includes: Regular medical assessment and management of common associated conditions (such as delirium, osteoporosis, venous thromboprophylaxis, pneumonia and other infections, and physical deconditioning). Rapid optimisation of fitness for surgery. Early identification of individual goals for rehabilitation to recover mobility and independence, and to facilitate return to pre-fracture residence and long-term wellbeing. Early identification of most appropriate service to deliver rehabilitation. Continued, coordinated, review and discharge planning liaison or integration with related services, including falls prevention, secondary fracture prevention, mental health, cultural services, primary care, community support services and carer support services. 44

45 Waitemata DHB is delighted that we have been able to take the first steps in establishing a cohesive orthogeriatric service with the appointment from January 8 of our first Orthogeriatrician, Dr Min-Yee Seow. This is a pilot position for an initial six months which subject to good outcomes we hope to make permanent. Dr Min-Yee Seow is working full time with the orthopedic service, seeing hip fracture patients along with the regular junior doctors on the team, and has already made steps to standardise protocols in the service, provide consultation guidance and supervision to the junior orthopedic medical staff, and lead the multidisciplinary team to plan ward based interventions and future rehabilitation. As part of the pilot we are collecting data on outcomes including LOS, complications, return to usual residence, time of transfer to rehabilitation, and we expect to see real and tangible gains in these areas. Key Issue The Kingsley Mortimer Unit (KMU) (Older Adults Inpatient Mental Health) The KMU (also called Ward 12) is the DHBs 19 bedded acute secure inpatient ward for older adults who have mental health conditions of such severity that hospitalisation is required. People are only admitted to the ward if the Mental Health Services for Older Adults (MHSOA) community teams cannot care for them safely at home, in residential aged care facilities or in other inpatient wards at Waitakere Hospital or North Shore Hospital. In terms of the facility related challenges, the team are reviewing short, medium and longer term solutions that will reduce risk and provide for a more therapeutically healing environment. Options under review include converting an existing day room in the KMU into a four bedded room; cohorting and caring for depressed patients in an alternative ward within the hospital; co-locating suitable patients in the adult mental health unit and increasing the support we provide to community providers to enable them to care for more acutely unwell patients. Scorecard Specialty Medicine and Health of Older People Services a. a. b. Best Care Waitemata DHB Monthly Performance Scorecard Specialty Medicine and Health of Older People January /18 Service Delivery Patient Experience Actual Target Trend Waiting Times Actual Target Trend Complaint Average Response Time 21 days <14 days Urgent diagnostic colonoscopy w/in 14 days 96% 90% Net Promoter Score FFT Diagnostic colonoscopy w/in 42 days 59% 70% Surveillance colonoscopy w/in 84 days 69% 70% Improving Outcomes Patients admitted to stroke unit 93% 80% Patient Flow Acute Stroke to rehab w/in 7 days 71% 80% Outpatient DNA rate 10% <10% InterRAI assessments - LTHSS clients 98% 95% Patients with EDS on discharge 86% 85% Better help for smokers to quit - hospitalised 100% 95% Average Length of Stay - AT&R 20 days <19 days Quality & Safety Value for Money Older patients assessed for falling risk 72% 90% Rate of falls with major harm 0 <2 Financial Result (YTD) Actual Target Trend Good hand hygiene practice 90% 80% Revenue 4,886 k 5,190 k Pressure injuries grade 3&4 0 0 Expense 53,541 k 51,294 k Net Surplus/Deficit -48,655 k -46,104 k HR/Staff Experience Capital Expenditure (% Annual budget) 175% Sick leave rate 3.5% <3.6% Turnover rate - external 12% 8-12% Contracts (YTD) Elective WIES Volumes Acute WIES Volumes 1,233 1,186 How to to read Performance indicators: Trend indicators: Achieved/ On track Substantially Achieved but off target Performance improved compared to previous month Not Achieved but progress made Not Achieved/ Off track Performance declined compared to previous month Performance was maintained Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range may result in small variations appearing to be large. a. Dec 17 - coding dependent b. Quarterly Sep 17 A question? Contact: Victora Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB 45

46 Scorecard Variance Report Best Care Complaint average response time 21 days against a target of <14 days Complaint numbers continue to remain low with a downward trend and in January just two complaints were received. Although one was responded to within a few days, the complaint was kept open due to ongoing conversations with the patient s family. The other required a more in depth investigation. Acute stroke to rehab within seven days 71% against a target of 80% Seven stroke patients were waitlisted for rehabilitation in December 2017, five at North Shore Hospital and two at Waitakere Hospital. The North Shore Hospital patients all transferred within seven days, both Waitakere Hospital patients were delayed. Older patients assessed for falling risk 72% against a target of 90% Muriwai Ward did not meet the expected target for falls audit in January The ward falls champions were on leave and completed just two audits rather than the required ten. Shirley Ross (Head of Division Nursing) has followed up with the Charge Nurse who will ensure they meet compliance in February and beyond. Service Delivery Diagnostic colonoscopy within 42 days 59% against a target of 70% The endoscopy service did not achieve the MoH target for Diagnostic Colonoscopy (70% patients seen within 42 days) in January One of the main contributing factors was the unexpected increase in the number of patients added to the diagnostic colonoscopy waiting list in the prior months. The combination of an increase in demand coupled with the reduction in capacity in December and January has impacted on our ability to achieve the target. The Director Hospital Services is bringing together a clinical taskforce to work on a number of strategies including review of the recommendations identified in the Programme Business Case Bowel Investigation Services for the Northern Region 2015 to manage the immediate drop in performance and design a sustainable model of care for the future. 46

47 Strategic Initiatives Variance Report Deliverable/Action Better Help for Smokers to Quit Health Target 1. Produce reporting by ethnicity for Smoking Status, Brief Advice and Cessation Support for priority healthcare settings (Hospital population) January Improve data entry and IT tools to improve reporting of Brief Advice and Cessation Support in priority healthcare settings (e-vitals, hospital only) June 2018 Bowel Screening Access across all endoscopy services 3. Recruit two nurses with full 5-day week coverage to ensure timely access for high priority (P1) patients September Develop an annual production plan for all endoscopy procedures to enable weekly performance tracking In place by July Recruit to the two endoscopy fellow roles December CNS endoscopist role in place December Regional collaboration, through a contractual arrangement, to improve access and timeliness to colonoscopy procedures. Work with Auckland DHB through an outsourcing arrangement to do weekly lists for Waitemata DHB patients July 2017 On Track Delivery of Regional Service Plan Stroke 8. Ensure all Allied Health and Nursing staff in In-Patient Rehabilitation and Community Rehabilitation services complete a stroke competency training programme within the first year of employment - Ongoing 9. Support a range of health professionals working in stroke care to attend the Stroke Society of Australasia s annual conference - August 2017 Hepatitis C 10. Support the roll-out of the integrated Hepatitis C service across the region including GP practice support, raising awareness, extending services and monitoring progress Over 2017/18 Areas off track for month and remedial plans 6. Clinical Nurse Specialist Endoscopist role in place December 2017: This is still in progress. This will require a budget bid which has yet to be approved. The Nurse that planned to employ for this role is also currently on maternity leave and is expected to back around March She has however started her papers with The University of Auckland from January

48 Financial Results Specialty Medicine and Health of Older People STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Jan-18 Specialty Medicine and HOPS ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency ,314 4,389 (75) 7,455 Other Income (60) (229) 1,358 Total Revenue ,886 5,190 (304) 8,814 EXPENDITURE Personnel Medical 1,475 1, ,686 11,588 (98) 20,761 Nursing 2,195 2,020 (175) 15,587 15,279 (308) 27,250 Allied Health 1,478 1, ,401 11, ,311 Support Management / Administration ,175 3, ,603 Outsourced Personnel (37) (34) 623 5,643 5,567 (76) 42,251 42, ,548 Other Expenditure Outsourced Services (259) 2,429 1,599 (830) 2,673 Clinical Supplies 1, (166) 7,301 6,368 (934) 10,940 Infrastructure & Non-Clinical Supplies 159 (212) (371) 1, (658) 890 1, (796) 11,290 8,868 (2,423) 14,503 Total Expenditure 7,372 6,499 (873) 53,541 51,294 (2,247) 89,052 Cost Net of Other Revenue (6,467) (5,750) (716) (48,655) (46,104) (2,551) (80,238) * Government and Crow n Agency : Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. Comment on major financial variances The overall result for Specialty Medicine and Health of Older People Services was $716k unfavourable for January and $2,551k unfavourable for the YTD. Revenue ($156k favourable for January, $304k unfavourable YTD) The favourable variance for January was due to $185k of additional ACC revenue. The YTD unfavourable variance was due to outsourced gastroscopy services, offset by ACC revenue of $311k YTD. Expenditure ($873k unfavourable for January, $2,247k unfavourable YTD) The unfavourable variance for January was driven by $260k of unbudgeted outsourced gastroscopy services, $455k of unrealised expenditure reduction initiatives and $93k of additional client related expenditure on high level community care for complex needs patients. Nursing costs within the KMU were $68k unfavourable due to an increase in patient watches and nurses off work on paid leave. Favourable variances in the month included $85k of vacancies within Allied Health. Personnel ($175k favourable YTD) Medical ($98k unfavourable YTD) The unfavourable variance was due to sabbatical cover and infectious diseases SMO expenditure. 48

49 Nursing ($308k unfavourable YTD) The unfavourable variance was due to increased patient watch expenditure of $188k in the KMU and unrealised expenditure reduction initiatives. Allied Health ($579k favourable YTD) The favourable variance was due to vacancies within the Allied Health, Needs Assessment Service Centre and Renal services. Support and Management/Administration ($36k favourable YTD) The favourable variance was due to vacancies within Haematology Research. Outsourced Personnel ($34k unfavourable YTD) The unfavourable variance was due to increased patient watch costs in the KMU. Other Expenditure ($2,423k unfavourable YTD) Outsourced Services ($830k unfavourable YTD) The unfavourable variance was due to $1,122k of unbudgeted gastroscopy procedures outsourced to Auckland DHB and Waitemata Endoscopy offset by a $222k favourable position within Needs Assessment Service Centre respite. A transfer of two lists from the Bowel Screening Programme is currently under consideration with a view to reducing our exposure to the outsourced gastroscopy expenditure in the remainder of the year. Clinical Supplies ($934k unfavourable YTD) The unfavourable variance was due to $518k of increased expenditure on high level respite care for complex needs patients within the Mental Health of Older Adults service, $151k of unrealised expenditure reduction initiatives, $96k on mobility aids within the Allied Health service and $67k of treatment disposables within the Home Health service. Infrastructure and Non-Clinical Supplies ($658k unfavourable YTD) The unfavourable variance was due to unrealised expenditure reduction initiatives. Getting back on track initiatives The service is concentrating on maximising leave consumption, recruiting to cover vacancies instead of using overtime and external bureau, and flexing staffing levels with reduced bed demand where appropriate in conjunction with improved flow initiatives. The most significant financial pressure to the division is outsourced gastroscopies and colonoscopies, which has cost $1,672k YTD. This is being mitigated in part by using two lists of internal resource from the Bowel Screening Programme in the remainder of the year. 49

50 Child, Women and Family Services Service Overview This Division is responsible for the provision of maternity, obstetrics, gynaecology and paediatric medicine services for our community, for the regional Out of Home Children s Respite Service, the Auckland Regional Dental Service (ARDS), and the national Child Rehabilitation Service. Services are provided within our hospitals, including births, outpatient clinics and gynaecology surgery, and within our community, e.g. community midwifery, mobile/transportable dental clinics and the Wilson Centre. The service is managed by Dr Meia Schmidt-Uili (Division Head) and Stephanie Doe (General Manager). Head of Division Nursing is Marianne Cameron, Head of Division Midwifery is Emma Farmer and Head of Division Allied Health is Susan Peters. The Clinical Directors are Dr Sathananthan Kanagaratnam for ARDS, Dr Christopher Peterson for Child Health, Dr Diana Ackerman for Gynaecology and Dr Helen Allen (Acting) for Obstetrics. Highlight of the Month Better, Best, Brilliant - Implementation of the Healthy Housing Initiative The Healthy Housing Initiative (HHI) is a MoH funded programme, which was introduced at Waitemata DHB in March The programme aims to reduce preventable illness amongst low income families/whanau that are living in overcrowded, cold, damp and/or unhealthy homes. The programme provides: Support and advocacy for families through the completion of an entitlement assessment. Health promotion and education. Personalised and practical advice for a warmer, drier and healthier home. Support to access household supplies (such as blankets, mould cleaning kits, pyjamas and curtains). The service is delivered by 1.80 FTE Child Health social workers, in partnership with a community provider and the Waitemata/Auckland DHB funder. The service is targeted to: Families with a child aged <5 years old who has been hospitalised with a housing related indicator condition (e.g. bronchiolitis). Families with a child aged <5 years old where there at least two risk factors (for example: Oranga Tamariki finding of abuse and/or neglect; caregiver with a corrections history; mother with no formal educational qualifications; caregiver who is a long-term beneficiary). Vulnerable pregnant women and newborn babies. The programme has now been fully implemented - the team has developed processes to systematically identify eligible families/whanau, referral pathways and a biological-psychological-social needs assessment tool. The programme has also been actively promoted with clinicians working in Child Health, EDs and Maternity Services. To date, the team has supported 134 families to address housing related issues. For example, they have: Assisted families to move from social housing into private rental accommodation. Fast tracked social housing applications. Successfully supported families to resolve housing related issues by having repairs and refurbishment completed. Supported families to develop an understanding of the relationship between living in cold, damp, unhealthy homes and preventable illness. 50

51 Key Issues Update on previously raised issues Progress has been made towards addressing a number of issues that have been previously raised: 1. Midwifery vacancies Recruitment has been positive, and there is a goal to reach full staffing by May Our new graduate programme that was re-invigorated last year has proved to be highly successful and a magnet for graduates. A collaborative care model between nursing and midwifery has also been successfully implemented. 2. Child Health physiotherapy vacancies the service has successfully recruited into the majority of physiotherapy vacancies and at the time this report was being compiled only a 0.70 FTE vacancy remain. Credentialing and skill development is also underway to ensure that a consistent service can be provided across all areas of practice (respiratory and disability). 3. ARDS Improvement Plan good progress is being made on the implementation of the plan. Some of the key achievements to date include: a. A quarterly performance scorecard has been developed to report and track key aspects of the service s performance by DHB and provide an update on the progress against the improvement plan. b. Saturday clinics have been successfully expanded and are now being delivered from three additional sites (Wesley, Otara and Point England). c. Standing orders for the application of fluoride varnish have been completed and a training module for staff developed. Two Kohunga Reo and two Pacific Language Nests have agreed to participate in the initial roll out of the programme, which will commence in early March d. The identified bugs in clinical information system (Titanium) have been documented and prioritised and a minor upgrade to resolve these is currently being completed by the vendor. e. An audit of sterilisation processes has been completed and improvements identified. As a result, planning for the use of disposable instruments is underway - a kit has been itemised, a supplier sourced and trial clinics have been confirmed. An ARDS specific hand hygiene programme has also been developed in partnership with Infection Control. f. The Request for Proposal for the cleaning contract has been completed and a new provider identified. This will consolidate multiple contracts under one provider and will improve consistency and quality of cleaning across service. The new contract will commence from February g. The new preschool clinical prioritisation matrix has been completed and implemented in three teams. The tool guides clinical decision making and will ensure that recall dates set are consistent with clinical need. h. An external contractor register has been developed. All existing contracts have been sourced and centrally stored. i. Work has commenced on implementing a process to electronically reconcile enrolments against school rolls. At present, this is undertaken manually by clinic staff twice a year. j. An asset stock take has been completed across the service and asset registers have been transitioned into an electronic database. k. The clinical audit tool, which is consistent with the New Zealand Dental Council Practice Standards, has been reviewed and implemented. l. The process for confirming eligibility for service has been streamlined. The majority of families are no longer required to provide proof of eligibility, as this information is being received from alternative sources. m. An administrator has been appointed to co-ordinate all equipment and facility maintenance requests and a process for centrally managing maintenance requests has been developed. This will go live in late February

52 n. The ARDS registration form has been reviewed and improvements have been made. An electronic form has also been developed, which families and/or other health providers can complete and then to the service. The new form and process has been presented to Well Child/Tamariki Ora providers. o. The supportive treatment pathway has been rolled out in two further teams within Waitemata DHB and a process and implementation timeframe has been agreed to with Auckland DHB. p. A referral pathway has been developed in Auckland and Waitemata DHBs to ensure that children referred to the Gateway programme have access to oral health services. 4. Newborn Hearing Screening - in November 2016 a MoH audit identified areas for improvement within the Waitemata DHB Newborn Hearing Service. The audit revealed that the service was 20% non-compliant with the required standards, and recommended a number of corrective actions. Following a concerted quality improvement programme the service was re-audited in November 2017 and is now fully compliant with all the standards and all corrective actions have been signed off. For example, the programme requires 95% of all babies screened within one month of age. The service has seen persistant gains in this area over the past two years, with a slight dip in Q2 due to staff shortages (the team consists of 6.50 FTE, so any vacancy has an impact on service coverage). % of newborns completed screening within one month of birth The next audit will include patient experience measures. In anticipation the service has been conducting satisfaction surveys which are showing initial positive results. 52

53 Scorecard Child, Women and Family Services Waitemata DHB Monthly Performance Scorecard Child Women and Family Services and Elective Surgical Centre January /18 Actual Target Trend Elective Volumes Actual Target Trend Shorter Waits in ED 96% 95% Provider Arm - Overall 99% 100% CWF Services 93% 100% Best Care Waiting Times Gateway referrals waiting over 6 weeks 21 5 Patient Experience Actual Target Trend Complaint Average Response Time 6 days <14 days Patient Flow Net Promoter Score FFT Outpatient DNA rate 9% <10% Theatre utilisation Gynaecology 84% 85% Improving Outcomes Patients with EDS on discharge 85% 85% Exclusive breastfeeding on discharge 79% 75% Average Length of Stay - Maternity 2.4 days <2.5 days Women smokefree at delivery 94% 95% Average Length of Stay - Paediatrics 1.22 days <1.24 days Better help for smokers to quit - hospitalised 95% 95% Average Length of Stay - SCBU 9.57 days <10.4 days a. Oral health - % infants enrolled by 1 year 65% 95% a. Oral health - exam arrears 0-12 yr 21% <10% Value for Money Financial Result (YTD) Actual Target Trend Quality and Safety Revenue 3,182 k 3,151 k Good hand hygiene practice 90% 80% Expense 51,112 k 51,824 k Net Surplus/Deficit -47,930 k -48,674 k HR/Staff Experience Trend Capital Expenditure (% Annual budget) 49% Sick leave rate 3.8% <3.6% Turnover rate - external 13% 8-12% Contracts (YTD) Gynaecology Elective WIES (excl ESC) Gynaecology Acute WIES Maternity WIES 5,028 4,214 Paediatrics WIES 1,205 1,033 Neonatal WIES 1,360 1,275 How to to read Health Targets Service Delivery Performance indicators: Trend indicators: Achieved/ On track Substantially Achieved but off target Performance improved compared to previous month Not Achieved but progress made Not Achieved/ Off track Performance declined compared to previous month Performance was maintained Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range may result in small variations appearing to be large. a. Oral health data - Total WDHB, ADHB and CMDHB, DHB of service not domicile A question? Contact: Victora Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB Scorecard Variance Report Best Care Oral health - % infants enrolled by 1 year 65% against a target of 95% There has been no progress in the number of infants enrolled by one year over this month this continues to be driven by low enrolment rates of children domiciled in Counties-Manukau. Concerns regarding the lack of progress of implementing initiatives to improve enrolments for this age group have been escalated to the Counties Manukau Health Executive Leadership Team, where confirmation was received that there is support to progress enrolments from birth lists. The lack of progress in achieving the target in Auckland DHB has been investigated and it has been identified that the birth lists being received by the service are incomplete. The service is working with Auckland DHB to resolve this, with support from the Waitemata/Auckland DHB programme manager. 53

54 Oral health - exam arrears 0-12 years 21% against a target of <10% There has been an increase in arrears over December and January. This is the result of several factors, including a planned reduction in the number of open chairs (due to decreased availability of children and anticipated high non-attendance rates during the school holidays), dental therapy vacancies and reduced productivity in several teams. The table below provides an update on the key strategies in place to reduce arrears: Strategies Ensure productivity expectations are maintained Extend Saturday and twilight clinics Ensure children are being seen within the correct timeframes Update Individual discussions have been held with team leaders about their performance and a process for more transparently planning and monitoring chair utilisation has been implemented. This has seen an improvement in productivity over February New Saturday clinics have commenced in Wesley, Otara and Point England. To date, these have been successful and planning is underway to increase the number chairs operating in all three locations (commencing in Point England). Priority areas for further clinic development have been identified for the first six months of these include Kelston, Ranui, Beach Haven, Newton Gully and Mangere. Planning is currently underway to commence the Ranui Saturday clinic. The new preschool clinical prioritisation matrix has been completed and implemented in the three pilot teams. This tool guides clinical decision 54

55 Strategies Recruitment and retention of dental therapists Update making and ensure that recall dates set are consistent with clinical need. The pilot is currently being evaluated but initial results indicate that there has been a significant improvement in the alignment of recall dates and clinical need. The service has successfully recruited 17 new graduate therapists (12 of whom are working in South Auckland); as a result there has been a significant reduction in vacant positions. Sick leave rate 3.8% against a target of <3.6% The sick leave rate is above target in the Auckland Regional Dental Service and Women s Health. At present sick leave use and pattern by individual is being systematically reviewed across all service areas. Turnover rate external - 13% against a target of 8 12% Turnover has been particularly high in the North Shore Maternity Service. At present all staff are offered the opportunity to undertake an exit interview, but staff will be offered a face to face exit interview so a better understanding of the contributory issues can be obtained. Service Delivery Elective Volumes 93% against a target of 100% Gynaecology has not achieved the target, as over January a small number of elective gynaecology sessions were reallocated for provision of caesarean sections (as some scheduled elective caesarean lists fell on public holidays). Elective volumes have been achieved for the month of February to date. Gateway referrals waiting over 6 weeks 21 against a target of 5 There has been a significant increase in the number of children waiting for a Gateway Assessment as at the end of January. This is because there was a planned reduction in clinics held during December and January, as nonattendance is high due to family and social worker availability over this period. All children currently waiting have an assessment scheduled prior to 31 March

56 Strategic Initiatives Variance Report Deliverable/Action On Track Supporting Vulnerable Children 1. Increase screening rates for family violence Ongoing 2. Implement an enhanced assessment and referral pathway inclusive of mental health and neurodevelopmental assessments as part of the Gateway programme and improve processes to follow up referrals (pending MSD/MoH approvals) June Continue to work with Oranga Tamariki and education staff to monitor delivery and timeliness of services for children who have had a Gateway assessment, as outlined in the Interagency Services Agreement. In partnership with Oranga Tamariki, implement quality improvement actions in areas where access or timeliness is below expectations Ongoing Healthy Mums and Babies 4. Develop a programme to support new graduate midwives to enter the self-employed Lead Maternity Carer workforce June Continue to improve breastfeeding support for mothers and babies in the community Ongoing Keeping Kids Healthy 6. Increase oral health promotion and implement a system to deliver fluoride varnish for pre-schoolers June Roll out a supported process for high needs children who do not attend dental therapy appointments Jun2018 Areas off track for month and remedial plans 2. The MoH have advised that they are waiting further clarification as to whether the enhanced Gateway Assessment programme will proceed as initially anticipated. 56

57 Financial Results - Child, Women and Family Services STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Jan-18 Child Women & Family ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency (27) 2,732 2,812 (81) 4,821 Other Income Total Revenue (20) 3,182 3, ,416 EXPENDITURE Personnel Medical 1,363 1, ,603 10, ,664 Nursing 2,225 2,132 (93) 16,561 16,405 (156) 28,942 Allied Health 1,462 1, ,390 14,971 1,581 26,399 Support Management/Administration ,422 2, ,834 Outsourced Personnel (13) (141) 1,281 5,488 5, ,004 45,650 1,646 80,398 Other Expenditure Outsourced Services (12) (17) 461 Clinical Supplies (113) 3,649 2,943 (706) 4,988 Infrastructure & Non-Clinical Supplies (35) 3,146 2,934 (212) 4, (159) 7,108 6,174 (934) 10,269 Total Expenditure 6,305 6,297 (8) 51,112 51, ,668 Cost Net of Other Revenue (5,873) (5,844) (29) (47,930) (48,674) 744 (85,252) * Government and Crow n Agency : Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. Comment on major financial variances The overall result for CWF was $29k unfavourable for January and $744k favourable for the YTD. Revenue ($20k unfavourable for January, $32k favourable YTD) The unfavourable variance for January was driven by a combination of reduced Colposcopy activity and a coding change associated with specific Colposcopy events. Expenditure ($8k unfavourable for January, $713k favourable YTD) The YTD favourable variance continues to be driven by Allied Health, Management/Administration and to a lesser extent Medical vacancy mainly across community based services. This has provided an offset against as yet unmet embedded non staffing efficiency initiatives. The recent successful recruitment of many Allied Health and Nursing roles is expected to influence future favourable trends. Personnel ($1,646k favourable YTD) Medical ($30k favourable YTD) The favourable variance was driven predominately by Obstetrics and Gynaecology service vacancy. Nursing ($156k unfavourable YTD) The unfavourable nursing variance was due to staff retention and recruitment challenges across Maternity services. The service has actively managed this situation through a skill mix model change by utilising Registered Nurses in the maternity facilities. Future recruitment is looking more positive with a number of new graduate 57

58 midwives expressing an interest in this service. Acute demand for maternity services remains high with Acute Maternity WIES at 116% of contract YTD. Allied Health ($1,581k favourable YTD) Community based Allied Health vacancies remain the primary contributor to the services favourable result. Delays in recruitment are linked to workforce shortages and the timing of new graduates becoming available for employment. The recruitment of 17 Dental Therapist graduates in January will reduce the level of under spending over the remainder of the financial year. Support and Management/Administration ($333k favourable YTD) The favourable variance was due largely to service-wide Management/Administration vacancies. Outsourced Personnel ($141k unfavourable YTD) The unfavourable variance was due to cover for gaps in medical and nursing rosters. Other Expenditure ($934k unfavourable YTD) Outsourced Services ($17k unfavourable YTD) The unfavourable position comes as a result of a shortfall in achieving embedded expenditure reduction initiatives. The service has achieved 92% of embedded outsourced cost reduction targets to date. Clinical Supplies ($706k unfavourable YTD) The unfavourable clinical supplies variance was largely due to unrealised expenditure reduction initiatives. Other cost pressures compounding this are increased repairs and maintenance, demand for enteral feeding products, dental supplies and patient consumables. Infrastructure and Non-Clinical Supplies ($212k unfavourable YTD) The unfavourable infrastructure variance was driven primarily by unmet cost reduction initiatives. Volume driven expenditure pressures in laundry and cleaning supplies have made achieving these initiatives even more challenging. The service has managed to achieve 50% of its embedded cost reduction budget to date. Getting back on track initiatives The current ARDS improvement programme encompasses a review of the condition of ARDS clinic facilities and equipment and costs by supplier. Alternative ways of managing our equipment are being explored with an expected outcome of improving the operational efficiency of this service. The introduction of Kanban to control stock levels and potential risk of ordering errors or duplication and current procurement work on identifying more cost-effective products are additional work streams in progress. Planned changes in the model of care for the Colposcopy services are progressing to plan with recruitment now underway. These changes include moving from a medical model to a nurse-led model which is a more costefficient service. An internal work stream continues in reviewing the financial viability of all CWF service level agreements and purchases unit activity. The plan is to seek cost reductions, renegotiate funding or discontinue contracted activity where appropriate. The service is also progressing with a benchmarking exercise which targets areas where costs compare unfavourably to other similar DHB s and/or the national price for the particular service activity. Understanding the main drivers for the variance is the first step in being able to potentially influence the position. Annual leave continues to be actively managed. The service is looking to build on the successes it has had over the December/January period. 58

59 Specialist Mental Health and Addiction Services Service Overview This service is responsible for the provision of specialist community and inpatient mental health services to Waitemata residents. This includes child, youth and family mental health services, community alcohol, drug and other addiction services across the Auckland metro region, Maori and Pacifica mental health services and regional forensic services that deliver services to the five prisons across the northern region as well as eight in-patient villas and a regional medium secure Intellectual Disability unit including an intellectual disability offenders liaison service. The group is led by the Dr Susanna Galea-Singer (Director and Head of Division, Specialist Mental Health and Addiction Services), and Pam Lightbown (General Manager). Highlight of the Month Achievements towards Zero Seclusion Waitemata DHB Adult Services have significantly reduced the use of seclusion since 2004, following the National strategy for eliminating the use of seclusion using the 6-Core Strategies (NASMHPD, 2008). These strategies are continuously implemented across the service, driving change in culture and practice and enabling leadership engagement. Senior leaders, consumer advisors and other staff are involved in seclusion activities, at various levels, such as, the restraint and seclusion committee, local panel reviews, application of Calming and Restraint, sensory modulation; and seclusion prevention strategies (e.g. use of risk and safety plans and education on Trauma Informed Care). Waiatarau Adult inpatient unit is one of the leading units in the country with the lowest rates of seclusion. This is in line with the target set for reducing the use of seclusion by 50% for the 2016/17 year. Waiatarau was outstanding in their achievement of a reduction in the use of seclusion by 50% for the calendar year between 2016 and The data below identifies the Waitemata DHB adult seclusion rates (for He Puna Waiora and Waiatarau) against the National average: Seclusion rates overall and by ethnicity Percentage of people admitted to inpatient units that are secluded, Waitematā DHB and all DHBs, October 2014 September 2017 Percentage of people admitted to inpatient units that are secluded, by Māori and non-māori, Waitematā DHB and all DHBs, October 2014 September

60 Time spent in seclusion Below Graphs: Average number of hours people spent in seclusion during an admission, Waitematā DHB and all DHBs, October 2014 September 2017 Waitematā DHB All DHBs Key Issues Facilities The increase in temperature over the summer months has led to overheating issues in a number of buildings, both leased and owned. Facilities and SMHA are working together to review these risks and implement mitigations. Discussions related to the future proofing of temperatures in these buildings have been initiated. Workforce Specialist Mental Health and Addictions (SMHA) continue to have difficulty finding suitable applications for roles across this service. A Recruitment and Retention SMHA group has been established, with the aim of reviewing and improving workforce development strategies and processes within SMHA. Models of Care are also being looked at; skill mix; establishment of career pathways for nurses with senior roles to support new staff and to deliver expert care; preceptorship of new graduates; and, succession planning. The Director and General Manager are also members on the Trainee Psychiatrists Regional group - this includes looking at increasing the number of House Officer opportunities on rotation SMHA. Substance Addiction (Compulsory Assessment and Treatment) Act 2017 (SACAT) SACAT came into effect on the 21 February To date the Auckland region has received a number of enquires form whanau, police and other providers. Patients will require assessment to establish whether they meet the criteria for compulsory treatment and addiction treatment. Patients, once physically able to travel, will need to be transferred to the approved treatment centre in Christchurch. Given the number of enquiries received to date, the number of enquiries and applications made to the service are expected to be high. The capacity required to implement SACAT remains a concern. The ability to meet the needs of the population of clients seeking treatment voluntarily is impacted on significantly due to the legal requirements under SACAT. Resourcing requirements are being looked at currently. 60

61 Youth Applications Adult Applications The table below reflects enquiries and assessments from 21 February to 16 March 2018: Waitemata DHB (Metro Auckland area) To date All enquiries to Authorised Officers 17 Applications made to the service 3 Assessments made by Authorised Officers 1 Referrals made to Approved Specialists 2 Numbers of Compulsory Treatment Certificates Issued 2 Numbers of Compulsory Treatment Certificates deferred because treatment centre bed not available 0 Numbers of Compulsory Treatment Certificates deferred because of other reasons (please provide in narrative) 0 Admitted to Treatment Centre 0 Number of people voluntarily engaging once SACAT process commenced 0 TOTAL 25 All enquiries to Authorised Officers Applications made to the service Assessments made by Authorised Officers Referrals made to Approved Specialists Numbers of Compulsory Treatment Certificates Issued Numbers of Compulsory Treatment Certificates deferred because treatment centre bed not available Numbers of Compulsory Treatment Certificates deferred because of other reasons (please provide in narrative) Admitted to Treatment Centre Number of people voluntarily engaging once SACAT process commenced TOTAL 0 61

62 Scorecard Specialist Mental Health and Addiction Services Waitemata DHB Monthly Performance Scorecard Specialist Mental Health and Addiction Services January /18 Actual Target Trend Waiting Times (latest available) Actual Target Trend Shorter Waits in ED 79% 80% a. Youth (0-19) <3 weeks 70% 80% a. Adult (20-64) <3 weeks 85% 80% a. CADS (0-19) <3 weeks 91% 80% Best Care a. CADS (20-64) <3 weeks 95% 80% Patient Experience Actual Target Trend a. Forensic (20-64) <3 weeks 93% 90% Complaint Average Response Time 16 days <14 days Prison inpatient waiting list 0% 0% Improving Outcomes b. Patient Flow Better help for smokers to quit 99% 95% Bed Occupancy - Adult Acute 93% 80-90% Seclusion use Forensics - Episodes 46 <14 Bed Occupancy - CADS Detox 102% 80-90% Seclusion use Adult - Episodes 6 <5 Bed Occupancy - Forensics Acute&Rehab 87% 80-90% Adult Inpatient Units AWOL (clients) 1 1 Bed Occupancy - ID 76% 80-90% Forensic Units AWOL (clients) 0 1 Average Length of Stay - Adult Acute Average Length of Stay - CADS Detox a. MH Access Rates 0-19 years (Total) 3.78% 3.10% Community Care a. MH Access Rates 0-19 years (Maori) 4.89% 4.40% Treatment days per service user - adult 3.1 days 3-5 days a. MH Access Rates years (Total) 3.58% 3.40% Treatment days per service user - child 1.9 days 2-4 days a. MH Access Rates years (Maori) 8.23% 7.60% Treatment days per service user - youth 2.2 days 2-4 days Treatment days per service user - CADS 2.1 days 2-4 days HR/Staff Experience Treatment days per service user - forensics 1.7 days 2-4 days Sick leave rate 3.6% <3.6% Turnover rate - external 10% 8-12% Preadmission community care - adult 79% 75% Post discharge community care - adult 70% 90% Value for Money Community service user related time - adult 46% 35% Contact time with client participation - adult 83% 80-90% Financial Result (YTD) Actual Target Trend Whanau contacts per service user - adults 67% 70% Revenue 3,609 k 3,350 k Whanau contacts per service user - child 100% 80% Expense 74,498 k 75,849 k Whanau contacts per service user - youth 100% 80% Net Surplus/Deficit -70,889 k -72,499 k Capital Expenditure (% Annual budget) 41% How to to read Health Targets Service Delivery Performance indicators: Trend indicators: Achieved/ On track Substantially Achieved but off target Performance improved compared to previous month Not Achieved but progress made Not Achieved/ Off track Performance declined compared to previous month Performance was maintained Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range may result in small variations appearing to be large. a. Reported 2 months in arrears (Nov data). b. New rolling 3 month indicator and target A question? Contact: Victora Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB Scorecard Variance Report Best Care Complaint Average Response Time 16 days against a target of <14 days In December we reduced our average response time to a 13-days, however in January 2018, response timeframe was 16 days, which exceeds the timeframe by two days. This was due to difficulty in confirming a date to meet with a service user over the Christmas/New Year period. Seclusion use Forensic - episodes 46 against a target of <14 The Forensic Service has been experiencing high acuity which is reflected in the seclusion statistics. This is particularly due to three individuals contributing to episodes of seclusion, who could not be managed in a high care environment without seclusion. There is also one service user who has planned seclusion overnight equating to 7.5 hours daily which contributes to the variance. Seclusion Adult 6 against a target of <5 There were six seclusions occurring in January 2018 within Adult Services, all occurred at He Puna Waiora. Each event was reviewed by a seclusion panel and reported back through the Seclusion and Restraint Committee. The numbers of people secluded reflect a level of acuity within the unit throughout January. 62

63 Service Delivery Waiting Times Youth (0 19) <3 week 70% against a target of 80% Referral numbers to Child and Adolescent Mental Health Services remain high. The service is actively working to meet demand for first appointments without compromising their capacity to provide follow-up treatment. Access Rates for 0-19 including Māori remain higher than National benchmark. Face to Face contacts continue to meet benchmark. Family Whanau contact remains at 100% across Child and Youth services. Bed Occupancy CADS detox 102% against a target of 80-90% The unfunded transition bed was used which increased occupancy. As of February 2018 this has stopped and actual occupancy rate is expected to reduce to around 90% going forward. Treatment days per service user forensics 1.7 days against a target of 2-4days January has historically been associated with low contacts, which correlates with a high staff leave period. The Service anticipates improvement in this next month. Post Discharge Community care Adult 70% against a target of 90% Post discharge community follow up remains below target at 70%. The target measures includes people who do not receive follow up from a mental health service, for example, people who are discharged to their General Practitioner or, people referred to a mental health service outside of Waitemata DHB. Unfortunately the measure will also not count people who have been seen by their community team on the day of discharge. It is usual for the discharge planning meeting (attended by the community key worker) to occur on the day of discharge. Concerns around the way that this KPI is measured continue to be raised at national KPI meetings. A new report is being prepared to enable managers to identify early those who have not yet been seen following discharge within five days to ensure early identification of those who had not received follow up within that time frame. This will be disseminated to all team managers and coordinators for monitoring within the next month. Strategic Initiatives Variance Report Deliverable/Action Mental Health Reduce Māori under community treatment orders (CTO) rate 1. Undertake analysis of underlying data to understand pathways, gaps and opportunities for improvement December Develop recommendations for evidenced-based interventions to address the disease and health burden June 2018 Physical health outcomes 3. Establish metabolic screening and primary care services protocols for people with serious myocardial infarction >12 months, including reporting June Establish baseline volumes of physical health screening Suicide prevention and postvention 5. Fully implement Suicide Prevention in ED guidelines June Pilot and evaluate Kaupapa Māori Suicide prevention trainings (EOA) June 2018 On track Areas off track for month and remedial plans All areas on track 63

64 Financial Results Specialist Mental Health and Addictions Services STATEMENT OF FINANCIAL PERFORMANCE Specialist Mental Health & Addiction Services ($000 s) Reporting Date Jan-18 MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency ,189 1, ,538 Other Income (0) 1,420 1,740 (320) 3,120 Total Revenue ,609 3, ,658 EXPENDITURE Personnel Medical 1,893 1, ,761 15,811 1,050 28,012 Nursing 4,487 4, ,138 32, ,396 Allied Health 1,982 1,898 (84) 16,774 17, ,655 Support (17) (12) 789 Management / Administration ,329 3, ,041 Outsourced Personnel (32) 1, (875) 1,036 8,948 9, ,935 70,348 1, ,930 Other Expenditure Outsourced Services (115) 312 Clinical Supplies ,572 Infrastructure & Non-Clinical Supplies ,441 4,436 (6) 7, ,563 5,501 (62) 9,456 Total Expenditure 9,717 9, ,498 75,849 1, ,386 Cost Net of Other Revenue (9,145) (9,478) 333 (70,889) (72,499) 1,610 (126,728) * Government and Crow n Agency : Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. Comment on major financial variances The overall result for SMHA was $333k favourable for December and $1,610k favourable for the YTD. Revenue ($164k favourable for January, $259k favourable YTD) Revenue was favourable for January due to both pregnancy and parental support contract revenue, as well as higher than expected court billing revenue. Expenditure ($169k favourable for January, $1,351k favourable YTD) The favourable January variance was due to timing of statutory days in lieu processing for the Christmas and New Year period. The YTD result of $1,351k favourable for expenditure is mainly due to vacancies. Personnel ($1,413 favourable YTD) Medical ($1,050k favourable YTD) The favourable variance was due to vacancies valued at $587k (average of 8 FTE), as well as pricing. This is offset by locum cover in outsourced personnel below. Allowances were also over budget at ($215k) due to expenditure for job sizing in line with expectations. Nursing ($591k favourable YTD) The favourable variance was due to vacancies valued at $2,374k (average of 103 FTE), offset by casuals ($390k) and overtime ($1,120k). Allowances were over budget by ($203k) due to 35% loading for inpatient units in lieu of penals. 64

65 Allied Health ($456k favourable YTD) The favourable variance was due to lower skill mix in staffing complement as well as higher leave taken than anticipated in September and November. Support and Management/Administration ($191k favourable YTD) The favourable variance was due to vacancies offset by overtime casual spend ($137k). Outsourced Personnel ($875k unfavourable YTD) The unfavourable variance was due to locum spend covering approximately four of the eight consultant psychiatrist vacancies at a 30% premium. This spend has slowed down over the Christmas and New Year period and as vacancies have been filled. Other Expenditure ($62k unfavourable YTD) Outsourced Services ($115k unfavourable YTD) The unfavourable variance was due to expenditure for services provided for clinical services and research for forensics. Getting back on track initiatives The Mental Health recruitment and retention committee continue to meet and explore new ideas of attracting and retaining staff. Mental health has also increased their new graduate intake, and in particular their mid-year intake to six nurses, using the nursing vacancies to fund these positions. 65

66 Surgical and Ambulatory Services/Elective Surgical Centre Service Overview The Surgical and Ambulatory Services provides elective and acute surgery to our community encompassing surgical specialties such as general surgery, orthopaedics, otorhinolaryngology and urology, and includes outpatient, audiology, clinics, operating theatres and pre and post-operative wards. ICU and radiology services are with this service. The service is managed by Dr Michael Rodgers (Chief of Surgery) and Debbie Eastwood (General Manager). The Head of Division Nursing is Kate Gilmour. The Elective Surgery Centre provides elective surgical services to our community, managed by Dr Bill Farrington (Clinical Director) and Lyn Wardlaw (Operations Manager). Highlight of the Month Over the past three years there have been significant gains in the Patient Service Centre (PSC) for the Surgical Specialties inclusive of Orthopaedic, Urology, Gynaecology, Otorhinolaryngology and General Surgery. We have standardised work practices, improved communication with patients, families and colleagues and worked within MoH compliance timeframes, reporting frameworks and this work has been supported by stringent data quality management. We have recognised the value of having nurses clinically guiding, supervising and supporting the administrative teams through the required key steps in the patient journey. The addition of Faster Cancer Treatment processes and targets has also increased the need for strong clinical oversight and management of specific timeframes for each step in the patient journey. Our current model did not align the clerical and nursing teams through a common reporting line, nor did it give one point of clinical accountability for patient care. In order to build on the good work that has already been achieved and further develop our clerical and nursing teams we have changed our model. For Orthopaedics, Urology/ORL and Gynaecology we have developed a Perioperative Nurse Co-ordinator (PNC) Lead role. The PNC Lead will clinically guide, supervise and support the perioperative nurses, the clerical administrators (booking clerks) and Senior Clerical Administrator through the required key steps in the patient journey. This will ensure clinical guidance, supervision and management of referrals, waiting lists, patient care and service delivery requirements for each clinician and across the surgical speciality. This new PNC Lead role will work closely with both their respective operations manager and clinical director to ensure demand and capacity are matched and we are utilising our clinics and theatre lists effectively across all sites. Key Issues Anaesthetic Technicians Recruitment/Retention/Training As discussed in previous Hospital Advisory Committee reports, the recruitment and retention of technical staff has been challenging and we have therefore run with a level of staff vacancy that has put stress on the rest of the team. Currently we have a low number of vacancies due to successful graduate recruitment. However, our rolling 12-month average turnover at 11.5% is higher than we would ideally like. In order to manage the shortfall, we have had to reduce annual leave and/or request staff work overtime. We have been approached by a private health provider to enter into a collaborative relationship to train two staff for them from February 2018 to March We will benefit from this proposal as the private provider will provide an educator to work alongside their trainees for seven months which will effectively give us an additional FTE Monday to Friday. The additional support from the trainee technicians and the educator will be positive for 66

67 our staff both in terms of supporting the clinical workload, but also sharing of knowledge. The operations manager has gained the required sign offs for this arrangement and will evaluate it in March next year. Scorecard - Surgical and Ambulatory and Elective Surgical Centre Health Targets Waitemata DHB Monthly Performance Scorecard Surgical and Ambulatory Service / Elective Surgical Centre January /18 Service Delivery Actual Target Trend Elective Volumes Actual Target Trend Shorter Waits in ED 91% 95% Provider Arm - Overall 99% 100% Surgical and Ambulatory Services 108% 100% Elective Surgical Centre - ESC (YTD) 97% 100% Elective Surgical Centre - ESC (month) 65% 100% Best Care Waiting Times Patient Experience Actual Target Trend % of CT scans done within 6 weeks 74% 95% Complaint Average Response Time 19 days <14 days % of MRI scans done within 6 weeks 66% 90% b. Complaint Average Response Time - ESC 7 days <14 days % of US scans done within 6 weeks 57% 75% Net Promoter Score FFT - SAS Patient Flow Improving Outcomes Outpatient DNA rate (SAS & ESC) 8% <10% a. #NOF patients to theatre w/in 48 hours 83% 85% Theatre utilisation - NSH 86% 85% Better help for smokers to quit - hospitalised 98% 95% Theatre utilisation - WTH 70% 85% Theatre utilisation - ESC 79% 85% Quality & Safety Patients with EDS on discharge 86% 85% Older patients assessed for falling risk 88% 90% Average Length of Stay - Acutes 3.1 days <3.57 days Occasions insertion bundle used 100% 95% Average Length of Stay - Electives 1.9 days <2.17 days Good hand hygiene practice 88% 80% Average Length of Stay - Electives - ESC 0.9 days <1.05 days ICU - rate of CLAB per 1000 line days 0.8 <1 Value for Money HR/Staff Experience Sick leave rate 3.0% <3.6% Financial Result (YTD) Actual Target Trend Sick leave rate - ESC 3.2% <3.6% Revenue 5,097 k 4,792 k Turnover rate - external 13% 8-12% Expense 114,411 k 108,773 k Turnover rate ESC - external 12% 8-12% Net Surplus/Deficit -109,314 k -103,982 k Capital Expenditure (% Annual budget) 98% Contracts (YTD) Elective WIES Volumes - SAS 4,755 4,663 Elective WIES Volumes - ESC 3,568 3,685 Acute WIES Volumes - SAS 8,783 8,795 How to to read Performance indicators: Trend indicators: Achieved/ On track Substantially Achieved but off target Performance improved compared to previous month Not Achieved but progress made Not Achieved/ Off track Performance declined compared to previous month Performance was maintained Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range may result in small variations appearing to be large. a. Dec 17, coding dependent b. Sep 17 data - no complaints since A question? Contact: Victora Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB Scorecard Variance Report Best Care Patient Experience Complaint Average Response Time 19 days against a target <14 days We had a small number of complaints that required extended time to investigate and/or annual leave impacted on our ability to complete the investigation. The complainants were kept updated on our progress and when they would receive a response. We plan to be back on track next month. HR/Staff Experience Turnover rate external 13% against a target of 8 12% The rolling 12 months average turnover for S&A is 13% with nursing turnover at 16.5%, this is primarily the surgical wards at 16.5% and the theatres at 14%. All other staff groups were within the target with clerical and allied staff averaging 11% and medical staff at 5%. 67

68 Service Delivery Elective Volumes - Elective Surgical Centre ESC (month) 65% against a target of 100% The elective volumes for ESC were reduced by the planned three week shut down for ESC theatres. This represents approximately 80 elective operations that were not scheduled during January. It is expected to meet the surgical health target 30 June. Waiting Times - % of CT scans done within six weeks 74% against a target of 95% Access to outsourcing was reduced over December/January and has impacted on achievement the CT target. We expect to be back on track by April. Mitigation - Outsourcing commenced in February along with multiple additional sessions scheduled February until mid-march when the old scanner at Waitakere Hospital will be decommissioned. We have also successfully recruited staff to replace CT trained staff who recently resigned and staff training is underway. A second CT scanner will come on line at Waitakere Hospital at year end, whilst a business case for a third CT scanner is being submitted to the next Audit and Finance Committee meeting. Waiting Times - % of MRI scans done within six weeks 66% against a target 90% The combination of resignations, the holiday day period with fewer working days, as well as the reduction in outsourcing, resulted in a marked drop in compliance against MoH targets. Mitigation - Outsourcing commenced in February and additional voluntary weekends also resumed from February. We have been successful in recruiting two technical staff of which one will start in February and the other in March. A commitment was also made for on-going training with a trainee appointed for each semester in Waiting Times - % of Ultrasound scans done within six weeks 57% against target 75% Ultrasound was significantly impacted by the reduction in outsourcing and this was further impacted by the ongoing staff shortages and fewer working days over the holiday period. Mitigation - Outsourcing commenced in February and voluntary additional sessions also resumed from February. We have been successful in recruiting two technical staff. However, both are from overseas and will only start towards the end of the year. Recruitment is on-going and negotiations are underway with two more applicants. Work is well underway in Radiology on the phase two of the sustainable implementation programme to optimise internal production and prioritisation. This programme supported by the Francis Group will enable the service to better respond to significant increases in demand across all radiology modalities and to assist the service, supported by the wider DHB to move from reactive to more proactive planning and service delivery. Patient Flow Theatre Utilisation Waitakere Hospital 70% against a target 85% Whilst not meeting the 85% utilisation target we are seeing an improvement month on month in the booking of lists. We need to do some further work on the ORL lists which ran at 60% utilisation for January, which is lower than previous months for this specialty. And as noted in our last report we are on track to have additional Auckland DHB lists run at Waitakere Hospital by mid-2018, if not earlier. Patient Flow Theatre Utilisation ESC 79% against a target 85% September 2017 October 2017 November 2017 December 2017 January % 86.82% % 79.48% In January we have not fully booked all lists due to bed constraints (Ward 6 refurbishment). Whilst this has primarily impacted on the North Shore Theatre utilisation, we have also not fully booked ESC lists where there was a requirement for an inpatient bed to enable some flex to support North Shore Hospital. ESC has also been 68

69 impacted by the challenge to identify patients who are available for surgery over the holiday period. However, we plan to be back on track achieving the 85% utilisation target going forward. Session Utilisation Definition the difference between first patient ready and last patient out of theatre for a session as a proportion of the scheduled session time (excluding early starts and late finishes) Strategic Initiatives Variance Report Deliverable/Action Improved Access to Elective Surgery 1. Recruit additional specialist workforce in ORL and Orthopaedics to maintain elective surgical volumes Appointed by June 2018 Reduce unnecessary follow-up appointments through different ongoing strategies, including: 2. Develop standardised patient care pathways for outpatient clinic follow-up appointments June Implement self-referral of symptoms initiative for follow-up appointments in ORL December 2017 On Track Engage with primary care to develop community assessment and undertake minor ORL procedures: 4. Develop service model of care with GPs for ORL assessment of patients and minor ORL procedures to be delivered from primary/community care settings June Train GPs to assess patients and perform minor ORL procedures June Complete roll out of E-triage process in all surgical specialties June Continue to implement and appropriately use national Clinical Prioritisation Access Criteria tools to improve referral quality and appropriateness, and ensure fair and equitable access - Ongoing Areas off track for month and remedial plans All areas on track 69

70 Financial Results - Surgical and Ambulatory and Elective Surgical Centre Combined STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Jan-18 S&A and ESC ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency ,492 4, ,984 Other Income (163) (114) 1,991 Total Revenue ,097 4, ,975 EXPENDITURE Personnel Medical 5,139 5,061 (77) 36,810 36,613 (197) 65,564 Nursing 3,321 3, ,174 25, ,600 Allied Health 1,157 1, ,297 8, ,752 Support ,342 1, ,590 Management / Administration (47) 4,152 4, ,249 Outsourced Personnel ,492 4,398 (94) 7,464 10,853 10, ,267 80, ,219 Other Expenditure Outsourced Services (553) 4,170 1,819 (2,351) 2,926 Clinical Supplies 3,504 3,470 (34) 26,888 26,383 (505) 45,553 Infrastructure & Non-Clinical Supplies 383 (140) (523) 3, (2,968) (382) 4,661 3,551 (1,110) 34,144 28,319 (5,824) 48,097 Total Expenditure 15,514 14,435 (1,078) 114, ,773 (5,638) 190,316 Cost Net of Other Revenue (14,653) (13,599) (1,054) (109,314) (103,982) (5,333) (181,341) * Government and Crow n Agency : Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. Comment on major financial variances The overall result for S&A and ESC was $1,054k unfavourable for January and $5,333k unfavourable for the YTD, with S&A $5,950k unfavourable YTD and ESC $617k favourable YTD. The unfavourable S&A variance was due to ongoing unbudgeted expenditure in outsourced services, clinical supplies, repairs and maintenance, and unrealised benefits from expenditure reduction initiatives. Personnel costs were favourable, with unbudgeted FTE expenditure offset by ongoing unfilled vacancies in other services which is impacting capacity to deliver. Initiatives are underway to review vacant positions, and management of patient flow/demand to identify workforce optimisation opportunities, particularly in Radiology. The favourable ESC variance was due to expenditure reduction related to an additional week of Christmas closure, lower than planned volumes and case mix variances resulting in lower than planned package of care and clinical supplies expenditure. This was slightly offset by a one-off depreciation adjustment for the Mako robot. Plans are being developed to address under-delivery of joints volumes and review associated expenditure of catch-up. Work streams are under development for the optimisation of service delivery and operational efficiencies. 70

71 Refer to below commentary for a detailed overview for S&A and ESC performance against budget. Surgical and Ambulatory S&A STATEMENT OF FINANCIAL PERFORMANCE S&A ($000 s) Reporting Date Jan-18 MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency ,492 4, ,984 Other Income (163) (114) 1,991 Total Revenue ,097 4, ,975 EXPENDITURE Personnel Medical 5,139 5,060 (79) 36,810 36,599 (211) 65,538 Nursing 3,003 2,985 (17) 21,820 21,745 (75) 38,352 Allied Health 1,157 1, ,297 8, ,748 Support ,298 1, ,506 Management / Administration (58) 3,995 4, ,895 Outsourced Personnel (164) (188) (24) (1,311) (1,479) (169) (2,738) 9,852 9,704 (147) 70,909 70,821 (89) 125,300 Other Expenditure Outsourced Services (549) 4,039 1,684 (2,355) 2,694 Clinical Supplies 2,826 2,768 (58) 21,377 20,574 (802) 35,477 Infrastructure & Non-Clinical Supplies 306 (231) (537) 2,500 (509) (3,009) (1,450) 3,883 2,739 (1,144) 27,916 21,750 (6,166) 36,722 Total Expenditure 13,735 12,443 (1,292) 98,825 92,571 (6,255) 162,022 Cost Net of Other Revenue (12,879) (11,607) (1,273) (93,729) (87,779) (5,950) (153,047) * Government and Crow n Agency : Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. Comment on major financial variances The overall result for S&A was $1,273k unfavourable for January and $5,950k unfavourable for the YTD. Revenue ($19k favourable for January, $305k favourable YTD) The favourable variance YTD was due to higher than budgeted ACC revenue for Orthopaedics and Radiology, as well as higher than budgeted revenue from Auckland DHB for Radiology services. Expenditure ($1,292k unfavourable for January, $6,255k unfavourable YTD) The unfavourable variance for January was due to $79k of RMO and House Officer over allocations, $106k of Radiology outsourcing costs, $344k ORL outsourcing costs accrual adjustment to reflect outstanding invoices, and $534k unmet expenditure reduction Initiatives. The YTD unfavourable variance was due to the following key drivers: Unbudgeted Radiology outsourcing expenditure of $ 1,525k YTD due to increased population demand and pressure to meet MoH targets. A business case and project plans are currently being finalised for the implementation of new CT scanners at North Shore Hospital and Waitakere Hospital to mitigate ongoing outsourcing and drive service optimisation. 71

72 Unbudgeted ORL procedures to Southern Cross of $844k YTD, due to higher than expected volumes and workforce planning issues. These issues have now been addressed via increases to thresholds for accepting patients with no further outsourcing forecast beyond January. Higher than budgeted volumes and more complex case mix driving clinical supplies costs of $802k YTD, comprised of unbudgeted repairs and maintenance of $230k, implants and prosthesis of $398k, $140k of instruments and equipment (mainly related to Gastroenterology). Reviews of procurement and supply chain are underway, along with focus on clinical pathways, new product requests and one-off procedures to identify areas of expenditure increase. Unmet expenditure reduction initiatives of $3,218k, with work streams under review to identify optimisation and expenditure opportunities. Focus is on delivering a portfolio of robust initiatives which will deliver benefits in the longer term. Personnel ($89k unfavourable YTD) Medical ($211k unfavourable YTD) The unfavourable variance was due to unbudgeted RMO and House Officer over allocations, FTE in Orthopaedics and General Surgery, offset by vacancies across other services. Management of annual leave continues to be a focus. Nursing ($75k unfavourable YTD) The unfavourable variance was due to overtime and higher use of casual staff for Surgical Theatres, overtime in ICU to as a result of vacancies, and unbudgeted cost commitments in Radiology nursing which is offset by favourable variances due to ongoing vacancies. Allied Health ($184k favourable YTD) The favourable variance was due to vacancies, primarily driven by ongoing recruitment challenges in Radiology which is a regional issue. Support and Management/Administration ($182k favourable YTD) The favourable variance was due to vacancies in the Central Sterile Services Department, along with vacancies in other clerical and administrative roles. Outsourced Personnel ($169k unfavourable YTD) The unfavourable variance was due to locum costs in Anaesthesia, Radiology, ORL/Audiology and General Surgery, along with external nursing personnel in Surgical Theatres and Surgical Wards. Other Expenditure ($2,355k unfavourable YTD) Outsourced Services ($2,355k unfavourable YTD) The unfavourable variance was due to ongoing Radiology Outsourcing costs for CT, MRI and Ultrasound, along with outsourcing of ORL procedures. A business case is underway for the implementation of new CT scanners to address capacity constraints, with improved processes in ORL to reduce acceptance thresholds and manage demand. A review of demand and capacity management models is underway across Radiology and Orthopaedics. Clinical Supplies ($802k unfavourable YTD) The unfavourable variance was due to increasing expenses incurred in Gastroenterology and Surgical Theatres in line with increasing volumes and case complexity. Initiatives are underway to review the management of new product and one-off requests, along with fleet management of certain equipment to reduce risk and improve forecasting. Infrastructure and Non-Clinical Supplies ($3,009k unfavourable YTD) The unfavourable variance was due to unrealised expenditure reduction initiatives, with low probability of initiatives delivering realised benefits in the current fiscal year. The key focus is developing a portfolio of robust initiatives which will deliver benefits in the longer term. These include procurement and supply chain reductions, 72

73 along with other workforce and organisational optimisation opportunities to drive productivity and expenditure reduction. Operational Highlights/Initiatives: Demand modelling project for Orthopaedics Service in discovery/initiation phase to address management of patient flow, demand and workforce planning issues. Improved tracking and management of patient flow will reduce administrative overhead for operation managers, improved demand management and productivity, and reduced risk of under/over production. CT scanner project business case being submitted for approval. Approval of which is critical for improved service delivery, meeting compliance targets, patient experience, employee engagement and health and safety. Patient wait lists and reduction in compliance continue to be driven by demand pressures and changing clinical pathways. Improved processes have been implemented within ORL to mitigate future outsourcing issues, with further work required to ensure acceptance thresholds/criteria are appropriate across ORL and Audiology to manage demand and manage expenditure. General Surgical Pathway s project is being progressed with cost benefit analysis submitted for dedicated Abscess Theatres potential benefits of improved patient outcomes and reduced LOS. Implementation of CWLRota for Anaesthesia is improving productivity through reduced time spent on rostering activities. Initial discussions held to discuss development of dashboards to track benefits and expenditure reductions. Elective Surgical Centre - ESC STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Jan-18 ESC ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency 5 (0) 5 0 (0) 0 (0) Other Income Total Revenue 5 (0) 5 0 (0) 0 (0) EXPENDITURE Personnel Medical Nursing ,354 3, ,248 Allied Health Support Management / Administration Outsourced Personnel ,803 5, ,203 1,001 1, ,358 9, ,918 Other Expenditure Outsourced Services (4) Clinical Supplies ,512 5, ,076 Infrastructure & Non-Clinical Supplies , ,227 6, ,376 Total Expenditure 1,779 1, ,585 16, ,294 Cost Net of Other Revenue (1,774) (1,992) 219 (15,585) (16,203) 617 (28,294) * Government and Crow n Agency : Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. 73

74 Comment on major financial variances The overall result for ESC was $219k favourable for January and $617k favourable for the YTD, with a current forecast surplus of $216k for the full year 2017/18. Expenditure ($214k favourable for January, $617k unfavourable YTD) The favourable variance for January was due to expenditure reduction initiatives realised from the extended Christmas shutdown period across personnel $133k, package of care $30k and implant and prosthesis expenditure $96k. This was partially offset by a one-off accounting adjustment of $90k for unbudgeted Mako Robot depreciation, with ongoing monthly expenditure of $15k included in full year 2018/19 budget bids. A benefits realisation review should now be undertaken. The YTD favourable variance due to $182k personnel expenditure, $83k package of care, treatment disposables, implants and prosthesis expenditure of $96k driven by lower than planned volumes and case mix variances (joint volumes being behind plan, but catch-up included in forecast). Plans are being developed to address underdelivery of joints volumes and review associated expenditure of catch-up. Vacancies in Management/Administration positions have also had a favourable impact, with budget review and re-allocation required. Operational Highlights/Initiatives: Expenditure reductions were realised as forecast from an additional week of Christmas shut down, however, under-delivery of joints volumes against plan will need to be reviewed to ensure costs of catchup are minimised. Work streams are under development for the optimisation of service delivery and models of care, including Ticket Home in the Cullen Ward, improving discharge processes and patient experience. Revision of the linen contract is expected to realise costs savings in quarter one of the next financial year, and is included as part of Financial Sustainability. 74

75 4.1 Clinical Leaders Report Recommendation: That the report be received. Prepared by: Dr Andrew Brant (Deputy Chief Executive Officer and Chief Medical Officer), Dr Jocelyn Peach (Director of Nursing and Midwifery; Emergency Systems Planner) and Tamzin Brott (Director of Allied Health, Scientific and Technical Professions) Medical staff Royal Australasian College of Physician (RACP) training accreditation The RACP NZ adult medicine committee undertook a site visit to both the North Shore and Waitakere Hospitals for accreditation of basic training of physicians on 8 November Waitemata DHB is the biggest provider of basic physician training the New Zealand. The committee recommended conditional accreditation of one year for North Shore Hospital as a training site, and the committee plans to return in March 2019 for a further accreditation visit. The committee require a report on trainee surveys and a month attendance log for teaching sessions by mid- 2018, and by March 2019 to address workload issues, ensure protected educational sessions, ensure consistent on-site outpatient supervision and improved communication between RMO and SMOs. At this stage North Shore Hospital retains accreditation for three years of training time but there is risk this could be reduced to 24 months. The basis of the conditional accreditation was a reflection that general medicine is undergoing significant change through the TransforMED process, and we expect the process once completed, will address the issues raised in the report. Dr Cheryl Johnson (Director of Physician Education) will be leading the Waitemata DHB response to the actions required by the RACP committee. We note that trainees at North Shore Hospital continue to have excellent success in the FRACP (Fellow of the Royal Australasian College of Physician) examinations. The committee also undertook an accreditation assessment for the Waitakere Hospital site. The committee recommended full accreditation of five years with the next site visit in The only point raised was to ensure that RMO had appropriate supervision in the ambulatory setting. The maximum training time at Waitakere is one year for a trainee. Both reports highlight that by 2020 that there will be increased requirement of FRACP educational leaders and educational supervisors to be accredited. This will require the need for individuals to undergo specific training and workshops. Radiology Clinical Director Dr Hament Pandya has taken over as Clinical Director of Radiology. Hament has worked for Waitemata DHB for more than five years and has worked across the public and private sectors. Hament is passionate about developing innovative sustainable healthcare services. He has previously been involved in developing CT PET, nuclear medicine and one stop shop services. We welcome Hament to his new leadership role at Waitemata. 75

76 New SMO starts This year we have new SMO starts with Dr Nathan Atkinson gastroenterology, Dr Ann-Marie Stevenson anaesthesia, Dr Sebastian Alvarez Grandi mental health, and Dr Claudia-Letitia Dobranici mental health for older people. Nursing and Midwifery Nurses, Midwives and Health Care Assistants account for 43% of the total DHB workforce. Nurses across all services are working hard to support the orientation of the February 2018 new graduate nurse and midwife intake. The transition from student to registered nurse and registered midwife can be challenging but the support process of preceptor, educator and coaches has proved successful as the new person assumes a clinical workload with responsibilities. Work continues with the Safe Staffing Healthy Workplace Unit and the Care Capacity Demand Management programme that is required of all DHBs as part of the MECA agreement. Waitemata DHB has been involved with this work for some years and is progressing with the additional requirements using the Trendcare workload monitoring system. Workforce Development Nurse Educators are working hard to implement in-house clinical safety and effectiveness education opportunities completed before the winter demand period when all ceases. Practice Quality and Clinical Effectiveness and Patient Outcomes New infusion pumps will be implemented as a roll-out in April May across the medical and surgical wards. This will require a change management process. The Patient and Whanau Centred Care Standards programme work continues, with refreshed audit and improvement approaches being implemented. The two wards applying for Accreditation will be assessed in May The next six monthly review will occur in June A presentation to the committee on the achievements of the Patient and Whanau Centred Care Standards Programme will occur in the meeting. Emergency Systems Planning Contingency planning progresses for influenza surge response regionally and in the DHB. The personal protective equipment supplies have been assured for the DHB. 76

77 Allied Health, Scientific and Technical Professions Everyone Matters, With Compassion, Connected and Better, Best, Brilliant Friends and Family Test Allied Health February 2018 Some of the comments received in December 2017 include: Everyone cares and listens and supports. Brilliant service, understanding, offered some options. Very friendly, caring and attitudes relates well. Great advice. Understanding, very patient. Always treated with respect. Fabulous treatment and helped my problem. Thank you for your effort to solve the problem. Made me feel at ease, very polite and kind. Understood me and listened and took his time. Excellent manner. Very helpful friendly physios etc. NZ public hospital at its best. Thank you. Connected and Better, Best, Brilliant Allied Health, Scientific and Technical (AHST) Inter-professional New Graduate/Trainee Programme (Pilot) The inaugural new graduate/trainee programme for new graduates and trainees across the AHST group was launched on 13 February 2018 with 26 attendees from nine disciplines, across the five Provider Arm divisions. The programme involves attendance at ten one-hour modules across the year, created following a feedback programme from previous new graduates and trainees. The aim of the new graduate/trainee programme is to provide an additional tool to assist new graduates/trainees in their first year of practice, to become confident and valued members of the AHST service, to build capabilities for effective interprofessional collaboration and increase connections by learning with/from AHST colleagues to enable a successful transition from student to clinician or into a successful trainee. 77

78 Programme Objectives include: 1. Providing a semi structured, supportive first year of practice for new graduates/trainees entering the workforce. 2. Facilitate the transition from student to professional. 3. Building capabilities for effective interprofessional collaboration by learning with, from AHST colleagues. 4. Ensure new graduates/trainees become confident members of the AHST service. 5. To utilise a framework of critical thinking and reflective practice in a group environment. 6. To consolidate Waitemata DHB values and behaviours. The first two modules have taken place with a focus on introducing our values, an opportunity to hear from and ask questions of previous new graduates and trainees, and tips and techniques in workflow management including time management, prioritisation, caseload management and delegation opportunities. Modules yet to come include: Effective conversations and strategies Patient and family centred care Wellbeing at work Interprofessional practice Being an effective team member Culturally safe practice in Aotearoa Leadership 78

79 Each module is followed up with a survey, to ensure we have met the learning needs of the participants, with a view to rolling the programme out to a wider group in Feedback from the first two sessions has been incredibly positive (see graph below from session one) with free text feedback adding richness to the data: Thank you for making me feel valued rather than a new grad burden. Thank you. It was awesome. Thank you. The workflow module was engaging and forced me to engage in discussion which at times I shy away from. Information was relevant, and tips were handy. Thanks I found the 'Waitemata DHB values in practice' presenter engaging I found the recent graduate discussion section valuable The content of the session was appropriate to my learning The session was clearly structured The resources used were appropriate and useful (Feedback from New Graduate/Trainee Programme Values Session) National Allied Health Data Standard I am pleased to announce the publication of the Allied Health Data Standard by HiSO (Health Information Standards Organisation) on Friday 2 March A working party of seven lead authors have been working on the standard since 2016, and it is very pleasing to see it come to fruition. Traditionally allied health data has been captured in multiple ways with no defined standard. This has made benchmarking and planning across the health sector difficult, if not impossible. The standard defines the minimum data required to be captured by allied health staff, in District Health Boards across New Zealand, to record patient-related clinical activity. The data set is designed to ensure allied health services received by patients are identified, classified and recorded in a common way across New Zealand. Collecting data in a common form will enable the generation of knowledge applicable to service development, national benchmarking and comparative service analytics. The standard supports more consistent and detailed inter-district data sharing that can be used for allied health service delivery and workforce planning. 79

80 We have taken the opportunity during the development of the data set to align it to SNOMED CT (Systematised Nomenclature of Medicine - Clinical Terms). SNOMED is described as the global language of health care, a comprehensive system of clinical terminology used to capture precise, structured and actionable information about a person's health status and the care they receive. SNOMED makes capturing and reusing quality personal health information at point of contact a straightforward and valuable part of clinical workflow and case management, and with its 300,000 plus concepts, the standardised data we will receive will enable services to be meaningfully benchmarked to each other regionally, nationally and internationally. SNOMED is owned, and developed, by the intergovernmental body the International Health Terminology Standards Development Organisation (IHTSDO). New Zealand is one of 28 member countries to the IHTSDO. The Ministry of Health is represented on the IHTSDO general assembly and member forum. The Ministry of Health distributes SNOMED in New Zealand and registered health providers and software vendors can use SNOMED without licence cost in New Zealand and in other member countries. SNOMED has been endorsed in New Zealand as a HISO standard since The professional disciplines identified for inclusion at this stage are: occupational therapy, physiotherapy, social work, dietetics and speech and language therapy. The standard can be accessed via the following link: 80

81 4.2 Human Resources Report Recommendation: That the report be received. Prepared by: Fiona McCarthy (Director Human Resources) Purpose of report This report outlines key people and organisational development activities across Waitemata DHB and reports on progress with workforce plan actions. 1. Strategic Alignment Community, whanau and patient centred model of care Service integration and/or consolidation Intelligence and insight Evidence informed decision making and practice Outward focus and flexible, service orientation Operational and financial sustainability The report outlines recruitment, workforce or organisational development programmes and actions that can impact internal and external models for care. The report outlines work undertaken collaboratively across the organisation. The recruitment and ethnicity dashboards give information and insight into the impact of our recruiting processes. Where possible, all improvement or new programmes of work will use evidence based frameworks to develop and/or evidence to enhance existing work. All programmes are evaluated to understand the value and return on investment. Improvements sought in relation to policy, process or programmes will be co-designed with service users. Robust recruitment, workforce and organisational development frameworks, strategies and actions support sustainable business practises. 2. Recruitment 2.1 Recruitment Dashboard January and February 2018 January 2018 February 2018 Total number of hires (Headcount) 128 Hires, 128 offers accepted (headcount) 135 Hires,136 offers accepted (headcount) Average time to hire (days) (days) Current number of vacancies by speciality we are recruiting to (FTE) Medical Nursing Allied Health Support Mgmt./Admin (vacancy rate of 4.5% of total FTE) (as at 29 January) Medical Nursing Allied Health Support Mgmt./Admin (vacancy rate of 4.3 % total FTE) (as at 27 February) 81

82 The following achievements for February include: All nine Midwifery New graduates offered roles have accepted and are due to start on 3 April A Health Care Assistant Assessment Centre was run on 6 March with 31 invited, 14 attending and 10 progressing to reference checking (two applicants were Maori and one Pacific). The number of candidates attending the centre are lower than we had previously so we will be reviewing the time of the day we run the Centre to see if this helps with increased attendees. Current hard to fill roles include: Midwives, Anaesthetic Technicians, Sonographers, Alcohol and Drug Clinicians and Mental Health Registered Nurses. We also have several roles where we have a number of vacancies we are recruiting to, including: Orderlies and Cleaners 22.5 FTE, clinical psychologists 8 FTE, and Security Guards 5.5 FTE. For all these roles we have active recruitment methods and attractions strategies underway including additional graduate or training roles, expressions of interest advertisements, assessment centres, videos on staff experience, attending job fest careers expos, international recruitment campaigns, billboard advertising, external sourcing agencies and using social media. We have also engaged with Work and Income to attract people wishing to start their career in health. An example of our bus advertising for Security guards follows: 2.2 Time to Hire The average time to hire (YTD) for February has increased since December (Table 1) and as a result of increasing time to hire since August, our trend line is now starting to even out. We are finding health professionals other than Senior Medical Officers (SMOs) are taking longer to recruit. The average time to hire this time last year was 70 days. With the exception of casual roles, 32 roles took longer than 90 days to recruit and 10 of these were over 200 days (1 Midwife, 1 Sonographer, 1 Alcohol and Other Drug clinician and 4 Mental Health Nurses). 82

83 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 Table 3 shows the average time to hire for SMOs. Unusually, the SMO time to recruit was lower than that for other staff at 34.5 days in February. If we exclude SMOs, the average time to hire is days (Table 2). NB Time to Hire - Calculated from the time a Recruitment Requisition is approved to the time an offer is verbally accepted by a candidate. 150 Average Time to Hire (OverAll) Total Linear (Total) Table 1: Overall Average time to hire February 2016 to Average Time to Hire (OverAll) Total Linear (Total) Table 2: Average time to hire for all other roles (excluding SMOs) February Average Time to Hire (SMO) SMO Linear (SMO) Table 3: Average time to hire for SMOs February

84 2.3 Top sources of Applications Rank / Source 1. Waitemata DHB careers and career section February 2017 February % 35% 2. A Friend 23% 21% 3. Waitemata DHB Intranet 12% 12% Comments Consistently strongest source of candidates and an increase from last year Continued use of friend referrals is positive % 8% % 4% Table 4: Top 5 Sources of Hire for February 2018* *The above source dashboard is taken from Taleo E Recruitment system. Applicants enter where they heard about the position when they apply for a job. 84

85 2.4 Ethnicity of new employees Below are two tables detailing the ethnicities of current employees by profession (Table 5) and the ethnicities of staff recruited in the last three months, also by profession (Table 6). Analysis for the last three months shows strong recruitment in Asian, Maori and European ethnicities Asian Pacific Maori MELAA European Other Total FTE Total % Row Labels FTE % FTE % FTE % FTE % FTE % FTE % MEDICAL PERSONNEL % % % % % % % NURSING PERSONNEL % % % % 1, % % 2, % ALLIED HEALTH PERSONNEL % % % % % % 1, % SUPPORT PERSONNEL % % % % % % % MGT/ADMIN PERSONNEL % % % % % % % Grand Total 1, % % % % 3, % % 6, % Table 5: Ethnicity of all staff for three months as at 1 March 2018 Asian Pacific Maori MELAA European Other Total FTE Total % Row Labels FTE % FTE % FTE % FTE % FTE % FTE % MEDICAL PERSONNEL % % % % % % % NURSING PERSONNEL % % % % % % % ALLIED HEALTH PERSONNEL % % % % % % % SUPPORT PERSONNEL % % % - 0.0% % % % MGT/ADMIN PERSONNEL % % % - 0.0% % % % Grand Total % % % % % % % Table 6: Ethnicity of staff recruited within the last three months MELAA is a group amalgamation of Middle Eastern, Latin American and African ethnicities. NB. The ethnicity criteria used is level 1 which means that NZ ethnicity is classed as Other. 85

86 3. Organisation Development 3.1 Pacific Health Science Academies Contract Renewal Counties Manukau DHB, as funders of the Regional Pacific Health Science Academies, have secured funding for a further two years. A key part of the new contract is a programme name change to Programme W&AT (Working and Achieving Together). The programme continues to provide a suite of services to support the pathway/pipeline from high school through tertiary education to employment, including the Health Science Academies and mentoring programmes The new academic year With the start of the new academic year, the Pacific Health Science Academies team has been in the schools engaging with health science academy cohorts in six schools. Our presentations coincided with the push to deliver critical information about the Census 2018, where we engaged with Academy students as part of the student s Civic Duty learning module. We are currently working closely with schools in delivering the following upcoming events: a) Year 11 and Year 12 Leadership Camp, designed to prepare students for identity and leadership. b) Regional Year 13 Camp (Fit for Purpose), designed to prepare Year 13 students for their exams and their on-going tertiary pathways. 3.2 Auckland and Waitemata DHB Maori Workforce Plan Scholarship programme Applications for the Waitemata DHB Health Scholarships 2018 have now closed and interviews are almost complete. There have been some impressive candidates with applicants from the following disciplines gaining interviews: Dietetics, Medicine, Midwifery, Nursing and Occupational Therapy. Due to the new government s fee free for one year initiative a number of candidates will not become eligible for the scholarship until their second year of study. We have engaged with them however and they will be invited to apply for Current scholarship students are required to reapply for their place on the programme, providing an opportunity to capture the experiences of the students. Common themes noted as highlights include: great placement experiences within the DHB successful academic achievement reduced financial burden accomplishment and pride at having been awarded the scholarship. Students report enjoying the formation of new relationships on campus and professionally within the Waitemata DHB. The appetite for increased opportunities to develop their networks and access mentoring is significant. 86

87 3.2.2 Rangatahi Student Cadetships The 2017/18 Rangatahi cadetship programme concluded on Wednesday 7 February. Pictured to the left are four of the five cadets with Abel Smith, Clinical Nurse Director, Pacific Health, in the chapel at North Shore Hospital. Abel helped welcome the cadets to the Waitemata DHB and provides clinical supervision for the Rangatahi. The cadets had placements in Muriwai and Anawhata wards at Waitakere Hospital and Wards, 2, 7, and 9 at North Shore Hospital. As part of the programme, joint wananga were held with Auckland DHB. The first hosted by Waitemata DHB at the beginning of the cadetship at Waitakere Hospital marae and the second by Auckland DHB at Manawanui in late January. The wananga served as development days for the cadets offering them professional development from staff across the three Auckland Metro DHBs as well as the chance to network with peers and reflect on their experience of placement. Waitemata and Auckland Rangatahi Cadet Wananga 2017, Manawanui Marae, Pt Chevelier. 3.3 Resident Medical Officer Peer Mentor Programme Dr Chris Mysko, one of our two Medical Education Fellows has recently established a medical student peer mentor programme with the following key aims: To facilitate a social and supportive culture through which senior medical students act as guides and mentors for more junior medical students. 87

88 To create a culture where medical students actively engage in the promotion of wellbeing for themselves and others. To play a positive role in protecting student welfare by linking medical students to appropriate support services as needed. The programme takes place during the academic year. Each fourth year student has a year 5 peer mentor, and each fifth year student has a year 6 peer mentor. The role of the mentor is to guide and support mentees in some of the following areas: study-life balance optimising wellbeing curriculum career inter-personal and inter-professional communication strategies goal setting time management. A small group of sixth year students will be trained as Peer Mentor Leaders who are supported by the fellow and university staff. Guidelines, oversight and escalation processes are in place to protect the wellbeing of all involved. 3.4 International Exchange programme for two Chinese Registered Nurses Planning in conjunction with Lifeng Zhou (Waitemata DHB Chief Advisor for Asian International Collaboration) is underway to develop and implement an international collaboration strategy with Asian countries. Part of the strategy is to develop staff exchange and fellowship programmes. Renji Hospital of Shanghai Jiao-tong University China has approached us to establish a nurse exchange programme. The first exchange programme will be undertaken in March when two experienced nurses from Renji Hospital will be welcomed to Waitemata DHB for a four week clinical observership. 3.5 Safety and Security Training On Thursday 15 February the Waitemata DHB launched the new CALM Communication module. The module is available to all staff and provides education at a foundational level in communication and deescalation skills. Also in development is an online Introduction to Staff Safety and Security at WDHB for all staff to complete as part of orientation. The training will deliver the foundational requirements to the Staff Safety policy training in the following areas: S.T.E.P. Matrix for risk assessment Know how to call for assistance and respond to calls for help Security alerts and incident reports Security and safety tools. Additional education for community workers includes information on risk management, preparedness and safety planning. 88

89 4. Knowledge and Research 4.1 Library usage The Waitemata DHB has two facilities and an online portal (EZProxy) where staff can access books, journals and articles for clinical, professional and research purposes. EZProxy enables staff to access the e-resources from outside of the Waitemata DHB. The Health Research Premium collection is now live on the Waitemata DHB corporate website and available to all GPs and primary care organisations within Waitemata DHB. This was in response to an enquiry from the Royal NZ College of GPs requesting access to electronic library resources for their registrars. While the DHB has been able to provide some access, due to the licensing agreements with vendors and the cost of extending licensed access to those outside of the hospital confines, full access is unable to be accommodated. The Library Manager (Sally Simpson) has attended the medical student orientations to advise what supports are now available for them at the Library. New changes for the medical students include offering after-hours access to the Library and the ability to borrow books. This was not available previously due to students having short run periods at the hospital. This was trialled last year by the sixth year medical students and has now been rolled out to include fourth and fifth year students. Library usage from November to January 2018 is as follows: Items lent to our own people 855 Items lent to other libraries 63 Items borrowed from other Libraries 62 Computer searches by Library staff 889 Number of searches/downloads from our on line journal collections 26, Research projects The research and knowledge management team continue to support a large number of audit and clinical research projects. In the quarter November to January 2018, 66 new projects were registered By Project Type 31 Audit/Evaluation (includes Programme Implement, Resource Develop, Quality Improvement and Innovation). 21 Observational Research. 14 Interventional Research - includes eight industry sponsored. 4.3 Research Publications: All years: 2017: 2018: 2,183 publications 196 publications 2 publications Note: while all publications have a Waitemata DHB connection, not all publications will relate to a project registered in the database and some projects in the database will have many related publications. 89

90 4.4 Health Excellence Awards 2018 The 2018 Health Excellence Awards will be held on 10 May 2018 at Whenua Pupuke. The preliminary judging round for oral presentations will be held on 9 and 11 April where 19 oral presentations will be evaluated as well as 24 poster presentations. The awards are always a fun and informative evening where special recognition is given to excellence inpatient care and workforce experience. 90

91 4.3 Quality Report (January/February 2018) Recommendation: That the report be received. Prepared by: Dr Penny Andrew (Clinical Lead, Quality) and Stacey Hurrell (Corporate Compliance Manager) Contents 1. Health Quality and Safety Markers 2. HQSC QSM Dashboard 3. DHB Quality Indicator Trends Nov/Dec Key Quality Indicators 5. Improvement Active Projects Report 6. Safe Care 7. Patient and Whānau Centered Care 91

92 Acronyms Acronym Definition Acronym Definition ADU Assessment and Diagnostic Unit LOS Length of Stay AH Allied Health MACE Major Adverse Cardiac Events AMS Antimicrobial Stewardship MRO Micro Resistant Organism BSI Blood Stream Infections MRSA Methicillin Resistant Staphlococcus aureus CAUTI Catheter Associated Urinary Tract N/A Not Applicable Infection CDI Clostridium difficile (C.difficile) NPS Net Promoter Score (C.diff) infection CLD Criteria Led Discharge ORCA Orthopaedic Review Clinic and Assessment CLAB Central Line Associated Bacteraemia PACE Pathway for Acute Care of the Elderly ESC Elective Surgery Centre PDP Patient Deterioration Programme epa Electronic Prescribing and PERSy Patient Experience Reporting System Administration emr E-Medicine Reconciliation PHO Primary Health Organisation ED Emergency Department PICC Peripherally Inserted Central Catheter EDARS Early Discharge and Rehabilitation PM Project Manager Services ELT Executive Leadership Team PROM Patient Reported Outcome Measure ETT Exercise Tolerance Test QI Quality Improvement FFT Friends and Family Test QSM Quality and Safety Markers FHC Front of House Coordinator SAB S.aureus bacteraemia FY Financial Year SAC Severity Assessment Code HABSI Hospital Acquired Blood Stream S&A Surgical and Ambulatory Infection HDU High Dependency Unit SAQ Safety Attitude Questionnaire HH Hand Hygiene SCBU Special Care Baby Unit HOD Head of Division SMO Senior Medical Officer HQSC Health Quality and Safety Commission SMT Senior Management Team HRT Health Round Table SSI Surgical Site Infection ICU Intensive Care Unit TBA To Be Advised IORT Intraoperative Radiotherapy TRAMS Tracheostomy Review and Management Service IP&C Infection, Prevention and Control UAT User Acceptance Testing ISBAR Identify, Situation, Background, UTI Urinary Tract Infection Assessment, Recommendation IT Information Technology WTK Waitakere Hospital IVL Intravenous luer WIP Work in Progress KPI Key Performance Indicator Waitemata DHB Hospital Advisory Committee Meeting 28/03/

93 1. Health Quality and Safety Markers The Health Quality and Safety Commission (HQSC) commenced quarterly publication of the national Quality and Safety Markers (process markers) in December 2013 (reporting Quarter 3, June-September 2013 data). The Quality and Safety Markers (QSMs) are used by the Health Quality and Safety Commission to evaluate the success of its national patient safety campaign, Open for better care, and determine whether the desired changes in practice and reductions in harm and cost have occurred. The markers focus on the four areas of harm covered by the campaign: 1. falls 2. healthcare associated infections (hand hygiene, central line associated bacteraemia and surgical site infection) 3. perioperative harm 4. medication safety. For each area of harm there are a set of process and outcome markers. The process markers show whether the desired changes in practice have occurred at a local level (e.g. giving older patients a falls risk assessment and developing a care plan for them). The outcome markers focus on harm and cost that can be avoided. Process markers at the DHB level show the actual level of performance, compared with a threshold for expected performance: 90% of older patients are given a falls risk assessment 90% of older patients at risk of falling have an appropriate individualised care plan 90% compliance with procedures for inserting central line catheters in ICU (insertion and maintenance bundle compliance) 80% compliance with good hand hygiene practice 100% primary hip and knee replacements antibiotic given 0-60 minutes before knife to skin [first incision] 95% primary hip and knee replacements right antibiotic in the right dose - Cefazolin 2g or more The future timetable for Health Quality and Safety Marker reporting in 2018 is: Period covered Falls, Safe surgery, Medication safety Surgical Site Infection Hand Hygiene Publication date (indicative) March report October - December 2017 July September 2017 None End March 2018 June report January March 2018 October December 2017 November 2017 March 2018 End June 2018 September report April June 2018 January March 2018 April June 2018 End September 2018 December report July September 2018 April June 2018 July October December

94 2. Health Quality and Safety Commission QSM Dashboard Health Care Associated Infections Falls Quality Safety Markers (QSM) Hand Hygiene (HH) CLAB Surgical Site Infections Meets or exceeds the target % older patients assessed for falls risk. % older patients assessed as significant risk of falling with an individualised care plan. Target Q Q Q Q Q Q Q Q Q Last Quarter Change 90% 99% 97% 98% 99% 99% 98% 95% 99% 97% 90% 95% 97% 98% 95% 96% 96% 96% 100% 95% % of compliant HH moments. 80% 81% 81% 83% 85% 86% 86% 86% 87% 88% % occasions insertion bundle used in ICU. % occasions maintenance bundle used in ICU (not currently an HQSC Target). Surgical Site Infections rate per 100 procedures [target has not been set by HQSC. National Q rate 0.8 infections per 100 ops). 100% primary hip and knee replacements antibiotic given 0-60 minutes before knife to skin [first incision]. 95% primary hip and knee replacements right antibiotic in the right dose - Cefazolin 2g or more. 100% of post-operative antibiotic prophylaxis stopped within 24 hours. Within 5% of the target 90% 100% 99% 99% 100% 100% 99% 100% 99% 100% 90% 93% 98% 92% 97% 97% 95% 98% 91% 96% HQSC has not defined a target More than 5% away from target % 96% 92% 92% 98% 95% 94% 90% * 0.3* Cumulative rate 1.1 (From Mar 13) *Preliminary Results 95% 95% 94% 94% 95% 97% 96% 97% Waiting for HQSC data (QSM results delayed by one two quarters) 91% 93% 94% 94% 94% 93% 94% Positive increase No change Positive Decrease Negative Increase Negative Decrease 94

95 Peri- Operative Care Quality Safety Markers Surgical Safety Uptake, % of audits where all components were reviewed. Engagement, % of audits with engagement scores of five or higher. Observations, number of observational audits carried out for each part of the surgical checklist (Minimum of 50 observations per quarter). Target Q Q Q Q Q Q Q Q Q Last Quarter Change Sign In 94% 100% 90% 100% 100% 100% Time Out 93% 98% 93% 100% 100% Sign Out 84# 98% 98% 100% 95% Sign 86% 87% 85% 75% 94% Waiting for In HQSC data Time 87% 79% 92% 89% 84% (QSM results Out delayed by Sign 88% 93% 83% one quarter) Out Sign In Time Out Sign Out Data not published by the HQSC if audits were <50 Less than 75% More than 75% Target Achieved 95

96 Rate per 1,000 Occupied Bed Days Rate per 100 Patients Rate per 1,000 Occupied Bed Days Rate per 100 Patients 3. DHB Quality Indicator Trends November/December Jan-14 Mar-14 Jun-14 Sep-14 Dec-14 Mar-15 Jun-15 Sep-15 Dec-15 Mar-16 Jun-16 Sep-16 Dec-16 Mar-17 Jun-17 Sep-17 Nov-17 Feb-18 Fall Definition A fall is defined as inadvertently coming to rest on the ground, floor or other lower level, excluding intentional change of position to rest in furniture, wall or other objects. (World Health Organisation, 2007: WHO global report on falls prevention in older age) Outcome data is based on the rate of falls with major harm (SAC 1 and 2) or with harm (SAC 1-3) per 1,000 bed days Falls per 1,000 Occupied Bed Days Jan Feb 2018 Falls with Major Harm per 1,000 Occupied Bed Days Jan Feb 2018 UCL=5.804 _ X=4.410 LCL=3.015 UCL= Hospital Diagnosis Standardised Mortality Ratio (HDxSMR) (12 months (Oct 2016 Sept 2017) Waitemata s (NSH + WTH) HDxSMR = 89 Episodes = 103,871 Deaths = 813 Expected deaths = NZ HDxSMR = 1056 NZ HDxSMR for Oct Sep 2017= 106 Using the legacy HRT HSMR Methodology Waitemata s HSMR would have been 85 compared to a combined HRT HSMR of 76 Hospital Diagnosis Standardised Mortality Ratio (HDxSMR) The HDxSMR is expressed as a ratio and seeks to compare actual deaths occurring in hospital (or in hospital and following hospital admission), with a predicted number of deaths based on the types of patients admitted to the hospital. The HDxSMR is a new HRT mortality methodology introduced in November 2016 (see Key Quality Indicator Mortality below for further description of the new HRT mortality methodology). Funnel plot of HRT HDxSMRs compared to the combined NZ HDxSMR Oct 2016 Sept 2017: HRT Waitemata = 89 (all HRT = 87; NZ HRT = 106) Y Axis = HDxSMR (0 200) + X Axis = Expected Deaths (0-1200) Jan Mar-14 Jun-14 Patients with Pressure Injuries per 100 Patients Jan Feb 2018 Sep-14 Dec-14 Mar-15 Jun-15 Sep-15 Dec-15 Mar-16 Jun-16 Sep-16 Dec-16 Mar-17 Jun-17 Sep-17 Nov-17 Feb-18 UCL=5.412 _ X=1.536 LCL=0.00 Pressure Injury Definition A pressure injury is a localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. (National Pressure Ulcer Advisory Panel, 2007). Outcome data is based on the rate of pressure injuries Grade 3 and 4 + ungradeables or total, per 100 patients. 2.5 Stage 3, 4 & Unstageable Pressure Injuries per 100 Patients Jan Feb UCL= _ X= _ X=0.326 Jan-14 Mar-14 Jun-14 Sep-14 Dec-14 Mar Jun-15 Sep-15 Dec-15 Mar-16 Jun-16 Sep-16 Dec-16 Mar-17 Jun-17 Sep-17 Nov-17 Feb-18 LCL=0.00 Funnel based on two standard deviations from NZ rate, adjusted for over - dispersion 0.0 Jun-14 Sep-14 Dec-14 Mar-15 Jan-14 Mar-14 Jun-15 Sep-15 Dec-15 Mar-16 Jun-16 Sep-16 Dec-16 Mar-17 Jun-17 Sep-17 Nov-17 Feb-18 LCL=

97 Rate per 1,000 Occupied Bed Days Rate per 1,000 Line Days Days Between Infections Jan-14 Hospital Acquired Blood Stream Infections (HABSI) Jan Feb 2018 (IP & C Occupied Bed Days) Mar-14 Jun-14 Sep-14 Dec-14 Mar-15 Hospital Acquired Blood Stream Infections (HABSI) HABSI is defined as a bloodstream infection attributable to hospital where acute or rehabilitation care is provided, if the infection was not incubating on admission. Typically bacteraemia diagnosed after 48 hours of admission, on readmission, related to a device, or within 30 days of a procedure (if no alternate source identified) is categorised as a HABSI. There is no recognised national benchmarking 'acceptable' rate or target for HABSI. Comment HABSI rate /1,000 bed days (n=67); HABSI rate: Jan / Feb Source Jan (n=4) Feb (n=5) CAUTI 1 - CLAB (PICC) - 1 IV Luer - 1 Other 3 1 Procedure - 1 Unknown - 1 Jun-15 Sep-15 Dec-15 Mar-16 Jun-16 Sep-16 Dec-16 Mar-17 Jun-17 Sep-17 Dec-17 Feb-18 UCL= _ X= LCL= Jan-14 Mar-14 Jun-14 1 Central Line Associated Infections (CLAB) Jan Feb Sep-14 Dec-14 Mar-15 Jun-15 Sep-15 Dec Mar-16 Jun-16 Sep-16 Dec-16 Mar-17 Jun-17 Sep-17 Dec-17 Feb-18 Central Line Associated Bacteraemia (CLAB) Patients with a central venous line are at risk of a blood stream infection (CLAB). Patients with a CLAB experience more complications, increased length of stay, and increased mortality; and each case costs approximate $20,000 - $54,000. CLAB infections are largely preventable using a standardised procedure for insertion and maintaining lines (insertion and maintenance bundles of care). NSH s ICUs compliance with standard procedure and rates of CLAB are Health Quality and Safety Markers. Comment Rate of CLAB/1,000 line days: Jan 2018 rate is 0.80/1,000 line days and Feb 2018 rate was 0.79/1,000 line days The target for this is <1 per 1,000 line days. ICU/HDU 59 CLAB Free days as at 28 February 2018 (* restarted as of 01/01/2018). The National target is >90% compliance for insertion and maintenance bundles use. Month Insertion Bundle Maintenance Bundle January % 96% February % 93% Ward maintenance compliance rates and CLAB free days for other areas are reported in the Quality Report UCL= _ X= LCL= /01/ /05/ /11/ /03/2015 Staph Aureus Blood Stream Infections The rate of S.aureus bacteraemia (SAB) infections attributed to healthcare is the national outcome measure for hand hygiene compliance. The SAB rate is based on HHNZ s definition to maintain consistency in DHB reporting. This is a days between control chart and, therefore, the clustering of data points below the mean (Ẋ) represents events occurring close in time or an increased relative frequency of events. Comment The length of time between infections is increasing which may reflect improved compliance with hand hygiene practices. There were no S.aureus infections in January 2018 and one in February 2018 related to an IV Luer. Waitemata DHB s SAB rate (quarterly rate of per 1,000 bed days) is consistently well below the national average ( per 1,000 bed days) with an approximate average of one SAB per month SAB Rate = /08/ /11/ /05/2016 SAB Rate: Jan 2018 = 0.0/Feb 2018 = 0.05 Staph. Aureus Blood Stream Infections (SABSI) Jan Feb /07/ /10/ /01/ /03/ /06/ /10/ /02/2018 UCL=83.35 _ X=30.16 LCL=

98 4. Key Quality Indicators 4.1 Hospital Acquired Blood Stream Infections (HABSI) Target Measure 0 Total # of infections Prev. Report Period 5 (Dec) Current Report Period 4 (Jan) 5 (Feb) Commentary HABSI is defined as a bloodstream infection attributable to hospital where acute or rehabilitation care is provided, if the infection was not incubating on admission. Typically bacteraemia diagnosed after 48 hours of admission, on readmission, related to a device, or within 30 days of procedure (if no alternate source identified) is categorised as a HABSI. There is no recognised national benchmark acceptable rate or target for HABSI # of infections per 1,000 occupied bed days 0.24 (Dec) 0.18 (Jan) 0.24 (Feb) Mean rates of HABSI/1,000 occupied bed days over the last three years are: Rate N= HABSI SOURCE Vascular device related 10 (6 CLAB, 4 IVL) 14 (6 CLAB, 8 IVL) 14 (3 CLAB, 11 IV) 9 (5 CLAB, 4 IVL) CAUTI Post procedure/ surgical Other (mostly UTI) Unknown TOTAL

99 Target Measure Prev. Report Period Current Report Period Commentary HABSI Analysis January 2018 Source Total Ward Organism Comments CAUTI 1 Other 3 Coronary Care Unit (CCU) Wainamu 8 (x 2) Proteus mirabilis ESBL KP + E coli Indwelling urinary catheter was placed in a patient with urinary retention following a cardiac procedure; catheter was removed 2.5 hours. Patient was agitated and pulling at the catheter causing trauma. All of these patients developed HABSI from urosepsis; identified as unavoidable and Indwelling urinary catheters not implicated. HABSI Analysis February 2018 Source Total Ward Organism Comments CLAB 1 2 Enterobacter cloacae + Stenotrophomonas maltophilia Other 1 15 ESBL KP + E coli IVL 1 Huia Staph Aureus Procedure 1 ESC E coli Portacath in place for chemotherapy; investigation identified poor documentation of management of the portacath. Ward nurses not familiar with management of Portacath. Staff to undertake CLAB e-learning module in relation to the management and documentation when caring for central intravenous line. Patient developed HABSI from urosepsis; identified as unavoidable and Indwelling urinary catheter not implicated. Patient required readmission with thrombophlebitis (inflammation of the vein wall) five days after the removal of an IV luer which had been placed in the crook of their elbow. Investigation identified inconsistent documentation but no sign of infection when the leur was removed and the patient discharged home. Patient developed urosepsis following a prostate biopsy procedure despite prophylactic antibiotics; aseptic non-touch technique maintained throughout procedure. Unknown 1 3 Pseudomonas aeruginosa Patient was admitted with an upper respiratory tract infection. 99

100 4.2 Hand Hygiene (HH) Compliance Target Measure >80% % rate of compliance with five Hand Hygiene Moments Prev. Report Period 89% (Dec) Current Report Period 89% (Jan) 89% (Feb ) Commentary Waitemata DHB achieved an overall 88% HH compliance rate for Quarter (September - December); the DHB has consistently exceeded the National Target of >80% since August The Hand Hygiene Reports for January and February 2018 are attached - Appendix 1 (a) + (b) February highlights: Clinical areas achieving 100% compliance: o Maternity North Shore Hospital o Totara Unit Mason Clinic o Tane Whakapiripiri Unit Mason Clinic o Rata Unit Mason Clinic o Kahikatea Unit Mason Clinic o Kauri Unit Mason Clinic o CADS Clinical areas achieving above 95%: o Cullen Ward 98% o Hine Ora Ward 98% o Ward 6 98% o CVU North Shore Hospital 97% o Muriwai Ward 96% o Te Aka Mason Clinic 96% o Titirangi Ward 96% The professional groups with the highest compliance in February 2017 were Nurses /Midwives and Phlebotomist/Invasive Technicians (92%) Clinical units performing below the 80% benchmark were: o Ward 2 79% o ADU Waitakere Hospital 79% o Theatre North Shore Hospital 75% o Haemodialysis North Shore Hospital 73% o CCU North Shore Hospital 70% o ED North Shore Hospital 66% o PACU Waitakere Hospital 66% o Maternity Waitakere Hospital 64% 100

101 Target Measure Prev. Report Period Current Report Period Commentary Healthcare worker groups performing below the 80% HH compliance were: o Meal Staff 70% o Orderlies and Cleaners 68% o Student Doctors 68% 101

102 Target Measure Prev. Report Period Current Report Period Commentary 102

103 Target Measure 0 Total # of Hospital Acquired SAB infections Prev. Report Period 1 (Dec) Current Report Period 0 (Jan) 1 (Feb) Commentary Waitemata DHB s Staphylococcus Aureus Bacteraemia (SAB) rate (quarterly rate of per 1,000 bed days) is consistently well below the national average ( per 1,000 bed days) with approximately one SAB per month. Compared to the National Average, Waitemata DHB SAB HCA-BSI is low as shown in the graph below: Healthcare Associated S.aureus Bacteraemia ( ) Waitemata DHB rate per 1,000 bed days vs. National Rate # of Hospital Acquired SAB infections per 1,000 bed days 0.05 (Dec) 0.0 (Jan) 0.05 (Feb) Q Q Q Q Q Q Q Q Q National Rate Waitemata DHB Rate 4.3 Surgical Site Infections Target Measure Previous Report Period TBA - 2.2% (SSI rate Q1 Jan Mar 2017) Current Report Period 1.2% (SSI rate Q2 Apr Jun 2017) Commentary Surgical Site Infections (SSIs) in scope procedures for SSI are primary and revision hip and knee arthroplasty at either North Shore Hospital or the Elective Surgery Centre (ESC) in accordance with the National Surgical Infection Improvement Programme. The preliminary Quarters 3 and SSI rate for Waitemata DHB shows a reduction - both 0.3/100 operations with one deep hip and one deep knee SSI respectively identified. 103

104 Target Measure Previous Report Period Current Report Period Commentary SSIs per 100 operations (January 2014 December 2017) Quarter Q1 Q1 Q1 Q1 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q Q2 Q3 Q4 Procedures #SSIs Waitemata s Rate National Rate TBC TBC Number of SSI per quarter by classification (January 2014 December 2017) Quarter Q1 Q1 Q1 Q1 Q2 Q3 Q4 Q2 Q3 Q4 Q2 Q3 Q Q2 Q3 Q4 Superficial hip Deep hip Superficial knee Deep knee Total SSIs Central Line Associated Bacteraemias (CLAB) Target Measure Previous Report Period Current Report Period Commentary <1 # of CLAB infections per 1,000 line days (ICU) 0.82 (Dec) 0.80 (Jan) 0.79 (Feb) The ICU is currently 59 days CLAB Free as at 28 February Central lines are inserted in the operating theatre and maintenance of the lines on the wards is followed up by theatre, ICU and the Infection Prevention and Control team staff supporting ward staff. The total number of central lines (centrally and peripherally) inserted in January = 35/February = 34. CLAB rates at Waitemata DHB remain low and most wards have very long CLAB free periods due to both good 104

105 Target Measure Previous Report Period Current Report Period Commentary >98% % bundle compliance at insertion (ICU) 100% (Dec) 100% (Jan) 100% (Feb) compliance and infrequency of patients with central lines. 59 (restarted on 01/01/2018) CLAB free days across the DHB as of 28 February 2018 are: >98% % bundle 96% 96% 93% 59 CLAB Free Days (as of 28/02/2018) compliance (Dec) (Jan) (Feb) Service/Department CLAB Free Days maintenance Surgical and Ambulatory (ICU) Hine Ora Ward 59 ICU/HDU 59 Ward 4 59 Ward 7 59 Ward 8 59 Ward 9 59 Acute and Emergency Medicine Ward 2 0 Ward 3 59 Ward 5 59 Ward 6 59 Ward Ward Anawhata Ward 59 Huia Ward 59 Titirangi Ward 59 Wainamu Ward 59 Child Women and Family SCBU Waitakere Hospital 59 Renal Tunnel Line CLAB Rate June 2016 June 2017 (HCA and HABSI) 16/17 Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Line days 1,814 1,828 1,731 1,948 2,001 2,071 2,155 1,879 2,121 2,152 2,195 2,086 2,229 2,241 2,242 2,308 2,337 2,

106 Target Averag e/day Measure Previous Report Period Current Report Period Commentary CLAB Falls with Harm Target <5.0 Measure Total number (#) of falls Number of falls per 1,000 Occupied Bed Days (OBD) Total number of multi-fallers >90% % patients 75 years and over (55 years and over Maori and Pacific) assessed for the risk of falling >90% % patients 75 years and over (55 years and over Maori and Pacific) assessed for the risk of falling within eight hours of admission >90% % patients 75 years and over (55 years and over Maori and Pacific) assessed as being at sufficient risk of falling have an individualised care plan in place Total number of falls with major harm (SAC 1 and 2) Prev. Report Period 142 (Dec) 5.3 (Dec) 17 (Dec) 97% (Dec) 85% (Dec) 94% (Dec) 4 (Dec) Current Report Period 132 (Jan) 4.6 (Jan) 14 (Jan) 92% (Jan) 75% (Jan) 89% (Jan) 1 (Jan) 104 (Feb) 3.8 (Feb 10 (Feb) 92% (Feb) 73% (Feb) 94% (Feb) 1 (Feb) Commentary Renal CLAB Rate for 2017 = 0.46/1,000 line days Director of Nursing Dr Jocelyn Peach has noted the poor compliance for staff to complete the Falls Risk Assessment in particular the target within eight hours of admission. Dr Peach is looking at the e-vitals data and audit data to understand where the poor compliance is occurring and what the potential barriers are to completing this assessment in a timely manner and ensuring patients have the correct individualised care plan. 106

107 Target Measure Number of falls with major harm per 1,000 Occupied bed day <1 Total number of fractured neck of femurs (NOF) as a result of a fall while in hospital (included in the major falls with harm rate) Prev. Report Period 0.15 (Dec) 1 (Dec) Current Report Period 0.04 (Jan) 0 (Jan) 0.04 (Feb) 0 (Feb) Commentary 4.6 Peri-Operative Harm surgical safety checklist Target Measure Previous Report Period Current Report Period 100% Uptake: % of audits where all three components of the Surgical Safety 100% 100% Checklist were reviewed. 95% Engagement: % of audits with engagement scores 82% 87% of five or higher. 50 Observations: number of observational audits carried out for each part of the surgical checklist (Minimum of 50 observations per quarter). Sign in 52 Time Out 53 Sign Out 49 (Apr Jun 2017) Sign in 51 Time Out 56 Sign Out 52 (Jul-Sep 2017) Commentary No new update available at this time. 107

108 4.7 Pressure Injuries Target Measure Prev. Report Period Current Report Period Commentary 100% % patients risk assessed within specified time frame (eight hours) 100% % patients audited who received a score 100% % patients with the correct care plans implemented Number patients with pressure injuries per 100 patients (Audit) Number patients with reported confirmed pressure injuries (Incident Reporting System Risk MonitorPRO) Number of Stage 3, 4 or 0 unstageable pressure injuries (Audit) Number of confirmed Stage 3, 4 or unstageable 0 pressure injuries(incident Reporting System Risk MonitorPRO) 60% (Dec) 90% (Dec) 97% (Dec) 1 (Dec) 49 (Dec) 0 (Dec) 2 (Dec) 52% (Jan) 89% (Jan) 100% (Jan) 1 (Jan) 41 (Jan) 0 (Jan) 1 (Jan) 65% (Feb) 94 (Feb) 100% (Feb) 2 (Feb) 42 Feb) 0 (Feb) 2 (Feb) Currently the pressure injury data is taken from the monthly pressure injury audit undertaken on the wards/units; this is an audit of five random patients per ward/unit per month. We are now presenting confirmed reported (via incident reporting system Risk MonitorPRO) volumes of pressure injuries (total and Stage 3, 4 and Unstageable). We will gradually transition to the reported pressure injury data initially presenting in numbers and adding a rate once a denominator has been agreed on. 4.8 Specimen Errors Target Measure <1% Total # of specimen errors/month Prev. Report Period 657 (Dec) Current Report Period 663 (Jan) - (Feb) Commentary The FY2015/16 specimen error defect rate was 1.7% which is consistent with the previous two financial years; the data collected at that time was combined non-phlebotomy staff and phlebotomy staff (specially trained to draw blood) which gave a lower error defect rate. 108

109 Target Measure Prev. Report Period Current Report Period Commentary The average error defect rate for FY2016/17 was 2.7% which is attributed to the non-phlebotomy staff data only. The rate for 2017 rate was 2.6%. In January % (n=174) of specimen errors were related to labelling; The average rate for 2017 was 20%. FY2016/17 Error rate July % August 2.6% September 2.3% October 2.8% November 2.5% December 3.0% January % February 2.6% March 2.4% April 2.9% May 2.5% June 2.8% July 2.0% August 2.7% September 2.6% October 2.5% November 2.3% December 2.6% January % 4.9 E-Medicine Reconciliation (emr), eprescribing and Administration (epa) Target Measure 100% % patients with emr completed within 24 hours on admission and discharge Previous Report Period Current Report Period Commentary - - Electronic Medicines Reconciliation (emr) emedrec (electronic Medicines Reconciliation) remains live in 894 acute beds across North Shore Hospital and Waitakere Hospital. Coverage for inpatients is consistently high with 75-85% of ward patients having an emedrec form completed by a pharmacist during each admission (in areas where emedrec is available). 109

110 Target Measure Previous Report Period Current Report Period Commentary The final planned roll-out to Paediatrics is expected to be completed before June 2018, with planning now underway for deployment of emedrec to Rangitira Ward (paediatrics), to be utilised for appropriately complex cases. Following this, there are no plans for further rollout at present. Waitemata DHB is working together with HQSC and other emedrec stakeholder DHBs to agree on nationally appropriate quality and safety markers (QSMs) around the Med Rec process. New QSMs have been proposed, and stakeholders are now awaiting feedback from the vendor (Orion) and HQSC regarding test script development and feasibility. Over the next 12 months, goals are to: o Increase utilisation of emedrec and eprescribing functionalities to benefit acute patients by facilitating timely and accurate charting of regular medications on admission. o Look to further increase the use of the software, with a dual focus on: - Earlier initiation of the emedrec process at admission - Increasing numbers of MedRec generated patient medication (yellow) cards, given to those transferring home. o Seek opportunities for ongoing improvement of the software through: - Participation in ongoing development and enhancements with Orion Health - Local, service specific SMTs enhancements and streamlining - Integration with other relevant electronic processes Electronic Prescribing and Administration (epa) epa is in place in 965 beds across three sites. The remaining patient beds that do not have epa are: Maternity, Paediatrics, SCBU, ESC (partial) and the Inpatient Detox Unit. We are currently testing a new MedChart version but it has significant performance issues. Further releases are delayed MedChart Performance: Multiple causes of slowness on client PCs have been identified; a problem management team is working to identify the causes and remediate. A case is being logged with Microsoft to try and determine why applications slow significantly when PCs have not been rebooted. An automatic nightly reboot is being tested on computers on wheels (COWs) on ward 3 starting on 6 December We are continuing to focus on getting MedChart moved to the cloud, as a test environment hosted in Amazon web services has shown performance improvement of > 35% compared with our current on-premise production environment. ipad Freezing: Problem Management is underway (caching enabled and slow switching disabled on SWA2 - SWA wireless network, which significantly reduced the freezing. However, freezing is still occurring; healthalliance is working to setup logging as recommended by Apple and the aim is to start error capture on Friday 8 December

111 4.10 Complaint Responsiveness Target <15 days Measure Average time to respond to complaints in the reporting month Previous Report Period 10 (Dec) Current Report Period 15 (Jan) 9 (Feb) Commentary The average days to respond for 2017 was 15 calendar days in comparison to 2016 (19 calendar days) and 2015 (18 calendar days) Hospital Mortality Key Quality Indicators Mortality (death rate) Target Measure <100 Hospital Standardised Mortality Ratio (HDxSMR) Previous Report Period 98 [NSH + WTH FY ] Current Report Period 92 [NSH + WTH FY ] Commentary See also latest data under Section 3 DHB Quality Indicators Dashboard. There has been a 6.3% reduction in Waitemata DHB s standardised mortality rate from FY 2015/16 (98) to FY 2016/17 (92) 111

112 5. Improvement Team Active Projects Report Innovation and Improvement Project Team: Active Projects Report February Overall Status Project Name Project Summary Sponsor(s) PM Resource Budget Forecast Variance Organisation wide / Multiple Divisions Patient Deterioration Programme (PDP) An organisation and national programme to improve the management of the clinically deteriorating patient. The Programme has three main streams: (i)recognition and response systems; (ii) Kōrero mai: Patient, family and whānau escalation; (iii) Shared goals of care. PDP: Standardised communication tool (ISBAR). Andrew Brant Jos Peach Penny Andrew Jos Peach Mike Rodgers This Period Last Period Phase Jeanette Bell N/A N/A Planning Jeanette Bell N/A N/A Closing PDP: Kōrero mai: Patient, family and whānau escalation. David Price Olivia Anstis N/A N/A Executing PDP: Recognition and Response Systems. Penny Andrew Sue French N/A N/A Planning Survive Sepsis Improvement Collaborative Leapfrog (refer to Leapfrog project update) PROMs Programme Patient Safety Survey To reduce inpatient sepsis mortality to <15% by September Data Discovery Project (Qlik): Implement and ensure use of QlikSense Business Intelligence tool across Waitemata DHB. Dr Penny Andrew Dr David Grayson Dr Matt Rogers Shirley Ross Kate Gilmour Kelly Bohot Arti Chandra Kelly Fraher Renee Kong N/A N/A Closing Penny Andrew Renee Kong $1.2 0% Executing District Nurse Mobility. Dale Bramley Kelly Bohot N/A N/A Scoping Outpatients. Robyn Whittaker Kelly Bohot N/A N/A Planning Establish a system for developing, collecting and utilising patient reported outcome measures (PROMS) to inform patient experience and outcome improvements in clinical practice and health care delivery planning. Develop process for patient safety surveys as part of the Patient and Whānau Centred Care Standards and Ward Accreditation Programme, and for organisational use. Jay O Brien Olivia Anstis N/A N/A Planning Penny Andrew Jerome Ng N/A N/A Closing 112

113 February Overall Status Project Name Project Summary Sponsor(s) PM Resource Budget Forecast Variance Connecting Journeys Surgical IC-Net Optimisation Tracheostomy Outreach Service ED Urine Testing Process Improvement Medical Chest pain pathway and Exercise Tolerance Testing (ETT) ED SWIFTCare Lakeview Radiology- ED To implement an improved orderly task management system (Smartpage) to improve workflow, efficiency, patient flow, reduce wasted resources and improve communication and visibility across services. To operationalise the ICNet solution in the Waitemata DHB environment for the IP&C team. To introduce a multidisciplinary tracheostomy outreach service to improve the experience and outcome for patients with a tracheostomy being cared for on general wards. To establish a lean end to end process for mid-stream urine (MSU) testing that is aligned to best practice to achieve accurate and timely diagnosis and treatment of patients presenting with urinary tract infections (UTIs) in ED. Complete a review of the chest pain pathway including: - Review of local and international literature - Audit of ETTs and patient outcomes Enhance ED capacity and patient flow while providing the most appropriate care. This project has two streams (North Shore Hospital, Waitakere Hospital) under one project charter but different Gantt charts due to the different dynamics at North Shore Hospital and Waitakere Hospital. Establish new radiology suite with one X-ray digital machine physically located in ED, implement lean and efficient operational model of care for Radiology services within ED. Refine the e-ordering process by adopting Choosing Wisely approach to create a list of indications Indication list for patients requiring abdominal and chest x-rays, with the aim of reducing the unnecessary X-ray orders. This programme has 4 main streams: This Period Last Period Phase Leith Hart Kelly Fraher N/A N/A Closing Matthew Rogers, Stuart Bloomfield Jonathan Casement, Jocelyn Peach Arti Chandra/ Barbara Corning-Davis Arti Chandra/ Barbara Corning-Davis N/A N/A Executing N/A N/A Planning Matt Rodgers Dina Emmanuel N/A N/A Execution Jonathan Christiansen Laura Chapman, Kate Allan Kelly Bohot N/A N/A Execution Willem Landman Dina Emmanuel N/A N/A Execution Willem Landman Dina Emmanuel N/A N/A 113

114 February Overall Status Project Name Project Summary Sponsor(s) PM Resource Budget Forecast Variance Child Woman and Family Family Centred Tube Feeding 1. Model of care for radiology services in ED. Scoping 2. Choosing Wisely-establish indication list for abdominal X- ray requests. 3. Choosing Wisely-establish indication list for chest X-ray requests. 4. Relocate and set up Gynae rooms in ED (original rooms used for new ED radiology suite). Co-design project to improve management of paediatric feeding tubes at home. This Period Last Period Phase Scoping Scoping Scoping Susan Peters Olivia Anstis N/A N/A Closing Other Work In Progress Overview Involvement Sponsor(s) PM Resource Comment Pleural Service Model of Care Research and design a pleural clinic service for the rapid, combined diagnosis and management of pleural disease. Research and content development of case for change and support development of a business case. Debbie Eastwood Donny Wong Nick Eichler (Public Health Registrar) Closed. Now with General Manager and Senior Medical Officer to progress. TransforMED Acute Patient Flow Programme: Four workstreams Medical Model, Inpatient Wards, ADUCare and PACE. Partnership with The Francis Group. Alex Boersma Kelly Bohot Renee Kong Ongoing Intraoperative Radiotherapy (IORT) Review evidence for IORT and potential research project. Develop paper describing evidence for IORT and make recommendation about future research at Waitemata DHB. Dale Bramley Vanessa Selak (Public Health Physician) Paper completed. Paper to be presented to ELT. Bed Booking Development of new model for managing inpatient bed booking to support TransforMed programme. Data and systems design support. Alex Boersma Lucy Adams Delwyn Armstrong Ongoing General Surgery Clinical Pathways (appendicitis, laparoscopic cholecystectomy, abscesses) Improve general surgery patient experience: reduce LOS, variation and cost of care. Angie Hakiwai will commit 0.5 FTE and be supported by Renee Kong on a consultation/mentoring role. Richard Harman Renee Kong Ongoing Management Foundations Teach QI skills to 22 participants and mentor each to deliver a QI project. Content development and delivery Ongoing mentorship. Sue Christie Dina Emmanuel Starting 2018 Clinical Portal Upgrade Clinical Portal Upgrade Working Group Participate in working group and facilitate Stuart Bloomfield Kelly Bohot Ongoing 114

115 Other Work In Progress Overview Involvement Sponsor(s) PM Resource Comment Working Group Innovation Partnership Safety in Practice Imprivata Pilot Develop, test and refine mobile app review process. Safety in Practice (SiP) is designed to enhance quality improvement capability of general practice teams within the Auckland region, by focusing on patient safety. Imprivata is a security solution that enables quick authentication and single sign on for access to patient information (via swipe card or finger print). Develop a business case for the pilot of Imprivata in ED. feedback from Allied Health Therapy Group. Research and develop a process including a review questionnaire to screen apps based on business/clinical relevance, quality, functionality and security. Work with Primary Healthcare Organisation (PHO) and staff within practices to provide quality improvement support and facilitation. Delivery of a business case seeking approval for Pilot using the P3M3 format and process. Robyn Whittaker Stuart Bloomfield Robyn Whittaker Stuart Jenkins (ADHB/WDHB) Neil Houston Kelly Bohot Kelly Fraher Robyn Whittaker TBA TBA Ongoing Ongoing Support Requests Current Support Requests Project Name Sponsor / Requestor Organisation-wide/Multiple Divisions Orthogeriatrician Model of Care Acute Kidney Injury Quality Improvement Programme Debbie Eastwood John Scott John Hornell Stuart Jenkins Neil Houston Madhu Koya Description Support to develop model of care for 6/12 orthogeriatrician pilot (orthogeriatrician starting 08/01/17). Scope a QI programme that would include Safety in Practice (primary/community care) and acute inpatient care (medicine, surgery and maternity). Request received Scoping Completed Approved date Assigned to 13 November Penny Andrew Delwyn Armstrong 6 November In progress Arti Chandra Barbara Corning-Davis Comment In progress In progress 115

116 Support Requests Current Support Requests Project Name Child Women and Family Service Obstetric Service Models of Care Surgical Sponsor / Requestor Cath Cronin Description Support to scope new models of care for Obstetric Services including workforce planning for midwifery and obstetrician model of care. Operating Theatre Mike Rodgers Support for further development of Blue Form (challenging behaviours) process. Medical N/A Closed since last report Request received Scoping Completed Approved date Assigned to Comment 15 November For further discussion 15 November On hold. Supporting Chief of Surgery to develop quality and innovation plan for 2018 Project/Work/Request Sponsor/Requestor Overview Outcome Close out / summary report location N/A 116

117 Patient Deterioration Programme (PDP) Progress Summary Opportunity / Problem Statement: Our processes and systems to support safe, consistent, effective 24 hour care for the clinically deteriorating patient are not always adequate, presenting an on-going risk to patient safety. Local and national scoping has identified a number of improvement opportunities and initiatives to further develop and strengthen our management of the deteriorating patient. Waitemata DHB has identified a local programme of work to consider as well as participation in the Health Safety and Quality Commission (HQSC) national and regional patient deterioration programme (July 2016 to June 2021). Objective / Aim: To introduce a patient deterioration programme to promote a structured and systematic approach towards improving the management of deteriorating patients at Waitemata DHB. Status Update: Overall New governance structure in place and monthly Executive Sponsor meetings commenced with regular updates to Clinical Governance Board scheduled. Bimonthly Northern Regional Alliance meetings and monthly HQSC meetings. Recognition and Response Systems (see separate progress summary reports) Planning: Local Implementation of National vital signs chart and early warning system. Planning: Response teams escalation pathway in consultation phase, recommendation paper to Clinical Governance Board deferred to March Closing: ISBAR Standardised Communication tool project. Project complete, closing report completed, final report back still required. Korero mai: Patient, family and Whānau Escalation (see separate progress summary report) Planning: Regular advisory and working group meetings. Workshop with HQSC held in February. Engagement with consumers and staff to be completed in March. Solution workshops planned for March, solution testing by July. Workshop with HQSC held February. Shared Goals of Care Not started. Scoping to commence April Measurement National HQSC quality and safety markers confirmed, regional working group established to develop regional dataset 1 st meeting March 2018, local working group meetings commenced January 1 to develop dashboard and programme measures. Sponsor: Project Manager: Phase: Andrew Brant, Jos Peach, Penny Andrew Jeanette Bell Planning Project Risks: Large scale of programme and change. Clinician availability, staff engagement. Potential for local and national priorities and timelines to differ. Project Issues: Resource requirements to introduce new systems (work stream 1 and 2) likely to impact on agreed timelines. Local concern about parameters of National vital signs chart and potential for delaying local implementation and timelines. Additional resource commitment for regional measurement group. Reallocation of project management support like to slow programme progress in transition period. Next Steps: Recognition and response system options paper to Clinical Governance Board March Report back to Clinical Governance Board on ISBAR project. Confirm and commence data collection and reporting of initial dataset. Commence Shared Goals of Care work stream scoping. Timeline Recognition and Response Systems - Implementation of National Vital Signs Chart and Early Warning Score Recognition and response systems: Structured Communication ISBAR Korero mai: Patient, family and Whānau Escalation Co-design Milestone Status Completion Planning In progress June 2018 Closing Closing February 2018 Planning In progress June 2018 Shared Goals of Care Not started Not started Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Capex $ N/A N/A $0 On track On track N/A Opex $ N/A N/A $0 September

118 PDP Work Stream 1: Recognition and Response Systems Opportunity / Problem Statement: Ensuring deteriorating patients receive appropriate and timely care is essential to meeting the aim of safe, effective, quality patient care. Early recognition and response to clinical deterioration can minimise and reverse the severity of deterioration and the level of intervention required to stabilise a patient s condition and can reduce patient harm, morbidity and mortality, hospital length of stay and associated health costs. Evidence demonstrates that patients exhibit many signs and symptoms of deterioration for a reasonable period of time before cardiac arrest or unplanned admission to intensive care occurs. Evaluation of our current systems indicates that there is inconsistent processes and pathways and an absence of processes and mechanisms to support safe, consistent, effective 24 hour care for the deteriorating patient. Objective / Aim: Deliver and deploy a robust strategy for the implementation of a Waitemata Recognition and Response program that will reduce the harm associated with unrecognised deterioration and its subsequent delayed treatment for all adult in-patient care areas. Status Update: Executive steering group information update 01 March Comparative analysis of response (escalation) models and operational management issues data collated; comparing Counties, Auckland, Wellington and Christchurch Hospital models. Proposed mandatory response (escalation) pathway stakeholder consultation with Clinical Directors and Senior Clinical Nurses will be complete 8 March Assessment of work force capacity for escalation will be completed 16 March Project management planning in Mental Health and Addiction services on hold during options development process for adult general health area. evitals software upgrade completed 28 February 2018, work can commence from 01 March 2018 to input graphics for New Zealand Early Warning Score (NZ-EWS). Clinical Leads: Project Manager: Phase: Project Risks: Jonathan Casement, Shirley Ross Sue French Planning Engagement from existing clinical teams Human resource resistance to organisation wide change process Resource requirements (clinical staff ) for potential changes to escalation and response systems Potential that DHB will be unable to meet the expected July 2018 deadline Project Issues: Clinicians working with national guidelines for oxygen delivery and chronic respiratory conditions have raised clinical safety concern for the oxygen rate and delivery, respiratory rate and tissue oxygenation parameters. Concern has been escalated to national clinical lead for programme Next Steps: Short paper to Executive Steering Group, week commencing 12 March 2018 explaining options for introduction and resource requirement. Preferred option and implementation plan presentation to Clinical Governance Board March Timeline Milestone Status Estimated Completion Date Initiating Complete September 2017 Planning In progress April 2018 Executing Pending June 2018 Closure Pending TBC Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Capex $ N/A N/A $0 On track On track N/A Opex $ N/A N/A $0 118

119 PDP Work Stream 2: Kōrero mai: Patient, Family and Whānau Escalation Progress Summary Opportunity / Problem Statement: Staff inaction in the face of patient or family/whānau reports of patient deterioration is considered an adverse event. Sadly, case studies in New Zealand identify that lack of follow up by staff following such reports have led to poor patient outcomes and/or death. The Health and Disability Commissioner has identified that communication between patients, families and medical teams is a key point of concern in approximately 42% of complaints. It is thought that an escalation process for patients, family and whānau will help reduce adverse events occurring in response to reports of patient deterioration. There is no such system currently in place at Waitemata DHB. The Health Quality and Safety Commission (HQSC) are sponsoring Waitemata DHB as one of four national sites to co-design a patient, family and whānau escalation system (Kōrero Mai). Objective / Aim: To co-design a patient, family and whānau escalation system for deteriorating patients with consumers, family, whānau and staff at Waitemata DHB. Status Update: Second workshop held with Lynne Maher and the HQSC to report back on progress to date, and results of the hui held in November HQSC fed back they were impressed with the high standard of work, and that Waitemata DHB were far ahead of other DHB s in their progress with the project. Staff interviews continuing to take place. Senior staff, doctors, security and chaplaincy will be interviewed in March Asian Health facilitated nine consumer interviews. Pacific Health team working with Carol Hayward to establish a hui for Pacifica in March. Solutions workshops to be held end of March. Scoping and planning for solutions in April may require funding, resource will need to be allocated. Alerted Advisory Group. Synergia conducting on-site visits in February/March to interview members of co-design group, to construct an evaluation report for the HQSC. Sponsor: Project Manager: Phase: David Price Olivia Anstis Executing Project Risks: Talking with consumers about their experiences may prompt further complaints to the Health Disability Commission (some have taken our interest in their stories as an indication that something went wrong). Project Issues: Delays and lack of access to transcription services have seen a shift in the way we manage qualitative data. We will no longer seek transcription for interviews, but will listen to them in groups of 2-3 and report back on the themes arising. This will limit the amount of quotes we are able to use in reporting, and may reduce the thoroughness of analysis of the data. Next Steps: Consumer and staff engagement to continue early Next workshop with Lynne Maher to be held 20 February Scoping of solutions to start early March Timeline Milestone Status Estimated Completion Date Initiating Complete 29 August 2017 Planning Complete 31 October 2017 Executing In progress 1 June 2018 Closure Pending 30 June 2018 Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Capex $ N/A N/A $0 On track End June 2018 N/A Opex $ N/A N/A $0 119

120 PDP: Standardised Communication Tool (ISBAR) Progress Summary Sponsor: Project Manager: Phase: Jos Peach, Mike Rodgers Jeanette Bell Closing Opportunity / Problem Statement: Poor communication is a significant causative factor in incidents of patient harm. A structured handover process can promote staff confidence and effectiveness in clinical conversations about patients and patient care. The use of a standardised communication tool such as ISBAR (Identify, Situation, Background, Assessment, Recommendation) is a strategy for improving patient safety and is recommended by the World Health Organisation, the Health Quality & Safety Commission as part of the safer surgery and patient deterioration programme and the New Zealand Resuscitation Council. Presently at WDHB, ISBAR is not used consistently for referral of patients. Objective / Aim: To reintroduce ISBAR as a standardised approach to communication for patient referral across Waitemata DHB inpatient settings. Status Update: Organisational tools in place - lanyard prompts, stickers, phone pads, posters, training package, policy, website, Smart Page. Post implementation audit completed in February 2018 (delayed due to introduction of ISBAR onto Smart Page). Closure report completed. New ISBAR Advisory Group established to oversee ISBAR post project closure. Project nominated and accepted into Waitemata DHB Health Excellence Awards 2018 oral presentations by project leads Sonya English and Keryn Bradley. Project Risks: Sustaining use of ISBAR at completion of project. Project Issues: Nil Next Steps: Schedule first ISBAR advisory group meeting. Schedule presentation/report to Clinical Governance Board, and other forums. Timeline Waitemata DHB Health Excellence Awards. Milestone Status Estimated Completion Date Initiating Complete December 2016 Planning Complete March 2017 Executing Complete November 2017 Closure In progress December 2017 Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Capex $ N/A N/A $0 On track December 2017 N/A Opex $ N/A N/A $0 120

121 Survive Sepsis Improvement Collaborative - Progress Summary Sponsor: Project Manager: Dr Penny Andrew, Dr David Grayson, Shirley Ross, Kate Gilmore and Dr Matt Rogers Kelly Bohot Problem Statement: Sepsis poses significant morbidity and mortality risks to our patients, and with every hour delay to treatment there is an 8% increase in mortality. Waitemata DHB does not reliably recognise and treat patients with sepsis in a timely manner. Aim: To reduce the rate of inpatient sepsis mortality to less than 15% by August 31, Status Update: Work stream 1: Best Practice Guidelines - Antimicrobial stewardship committee have agreed to be owners of the adult inpatient suspected sepsis guidelines. - Maternity guidelines complete and now awaiting sign off. - Barbara Corning Davis working with Paediatrics to scope improvement requirements. Work stream 2: Improvement Activities Work stream 3: Clinical education program Work stream 4: Measurement and Evaluation Qlik dashboard under development. Phase: Project Issues: Closing Paediatric Sepsis guidelines require additional project management resource to complete. Next Steps: Work stream 1: Best Practice Guidelines Adult guidelines Reinitiate controlled document process with antimicrobial stewardship committee as owners. Maternity guidelines Marilyn Boo and Dr Shiu Kumar to present maternity guidelines at the antimicrobial stewardship committee meeting on 20 th March Paediatric guidelines - Await outcome of scoping from Barbara Corning Davis. Work stream 3: Education program Transition to business as usual activities. Work stream 4: Measurement and Evaluation Project Implementation Review document in progress. Qlik dashboard under development. Due April Project Timeline Activities Status Timeline Publish adult guidelines In progress January 2018 Complete maternity guidelines In progress January 2018 Identify resource for paediatric workstream In progress January 2018 Develop test and analyse Qlik data In progress April 2018 Complete Project Implementation Review In progress April 2018 Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Capex $ N/A N/A $0 On track Extend end April closing N/A Opex $ N/A N/A $0 121

122 Patient Reported Outcome Measures (PROMs) Progress Summary Sponsor: Project Manager: Phase: Jay O Brien N/A Initiating Opportunity / Problem Statement: Data collection for patient reported and clinician assessed outcome measures and patient experience of service is currently fragmented and lacks transparency for clinical providers and service funder and planners. Collecting and learning from this clinical data requires extensive resource commitment from all service users and the Health Intelligence Group (HIG); reducing efficiencies and capacity to make improvements in real time for patients and whānau. Health Outcomes Prediction Engineering (HOPE) tool will provide clinical staff with unique predication capacity to help guide patients, this will be used in addition to data obtained from universal Quality of Life (QoL) measures and condition-specific PROMs. Objective / Aim: Triangulate patient reported outcomes, patient experience and clinical outcomes data to provide a meaningful and reliable dataset for clinicians about an individual patient s potential to achieve improved quality of life throughout their condition and treatment. To create a synthesis between PROMs, PERSy and the HOPE project for greater efficiency and improvement opportunities for service providers and end user application. Status Update: Euro-Qol license agreement approved by Amanda Mark, and signed by both parties. Confirmation from Intelecta and Mulesoft processes completion date not yet achieved. PROMs symposium postponed until further notice. Project Risks: High volume of requests for PROMs commencement at service level creates burden for PERSy programme writing team. Cost/acquisition of electronic devices for individual services to carry out surveying with patients. Project Issues: None Next Steps: Develop Project Plan (with timeline and communications plan) for implementation of universal EQ-5D and service-specific PROMs. Commence work with Sharon Puddle and PERSy developers in readiness for EQ-5D software to be integrated in February Timeline Milestone Status Estimated Completion Date Initiating Complete July 2017 Planning Complete August 2017 Executing Pending March 2018 Closure On track September 2018 Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Capex $ N/A N/A $0 On track On track N/A Opex $ N/A N/A $0 122

123 Patient Safety Survey - Progress Summary Sponsor: Jay O Brien Opportunity / Problem Statement: Waitemata DHB has been using the internationally recognised Safety Attitude Questionnaire (SAQ) as a tool to measure the safety climate of wards and services on an ad hoc basis for several years. Several groups and services including the Ward Accreditation Programme would like to use the SAQ and a system is required to enable ready access to the validated surveys (questionnaires) and timely reporting of results. In addition there are currently no guidelines outlining the purpose, use, timing, reporting, and follow up required when using the SAQ. Objective / Aim: To introduce a standardised tool and process to support the use of the Safety Attitude Questionnaire at Waitemata DHB. Project Manager: Phase: Project Risks: Carolyn Czepanski Initiating Competition with other staff surveys may impact engagement. Project Issues: Existing demand to use survey now from one service and one programme. Next Steps: Finalise and publish support guide. ED has completed third survey using new e-survey tools. Reporting developed in Qlik. Formatting of reporting being reviewed by ED leadership team. Status Update: Development of step by step guide for staff utilising the e survey tool ongoing. How To Guide completed for staff/departments utilising the e-survey. To be discussed with PWCCS executive sponsor group meeting. Emergency Department updated with how to guide and access process to be loaded onto Qlik. ICU and Lakeview accreditation did not utilise the e-survey format this round. Currently planning for next accreditation round with North Shore Hospital SCBU. Timeline Milestone Status Estimated Completion Date Initiating In progress 31 September 2017 Planning In progress 31 September 2017 Executing In progress 30 November 2017 Closure To be confirmed To be confirmed (Project Manager support on hold) Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Capex $ N/A N/A $0 On track Extend end of November N/A Opex $ N/A N/A $0 123

124 Connecting Journeys - Progress Summary Sponsor: Leith Hart Opportunity / Problem Statement: The orderly IT system at Waitemata DHB, Task Manager, has been the primary method of task allocation and management for the orderlies, some cleaners and transit care team. In 2016, 393,889 jobs were created in Task Manager. It is a very busy system trying to cope on old, unsupported software and any delays in use of the system can result in orderly delays. Objective / Aim: To implement an improved orderly task management system (SmartPage) to improve workflow, efficiency, patient flow, reduce wasted resources and improve communication and visibility across services. Status Update: Successful implementation of SmartPage on 29 November 2017 at Waitakere Hospital. Successful implementation of SmartPage on 11 December 2017at North Shore Hospital. Task Manager access via Concerto removed 14 December Some post implementation fixes and improvements in testing and being added to next update. Validation and improvements of data in warehouse is in progress. Data reporting work initiated. Data analysis and evaluation in progress. Project Manager: Phase: Project Risks: Nil Project Issues: Nil Next Steps: Kelly Fraher Closure Complete final system changes/additions. Complete reporting functionality for services. Complete data analysis and evaluation. Timeline Milestone Status Estimated Completion Date Initiating Complete October 2017 Planning Complete October 2017 Execution Complete December 2017 Closure In progress March 2018 Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Capex $ N/A N/A $0 On track Extended - March N/A Opex $ N/A N/A $0 124

125 ICNet Optimisation Progress Summary Opportunity / Problem Statement: ICNet (electronic infection control surveillance system) went live at Waitemata DHB on 28th March This is a shared system with Auckland DHB. The system was implemented out of the box and needs to be configured in order to deliver the benefits highlighted in the business case. The technical implementation of ICNet is managed by heathalliance. Objective / Aim: (Time boxed for 3 months - 1 st May to July 31 st 2017) To operationalise the ICNet solution for the Infection Prevention and Control (IP&C) team to realise the benefits of : 1) improving patient safety by facilitating earlier identification of patients with health-care associated infection (HCAI). 2) improving data quality, providing real time quality information and timely access to clinical knowledge. 3) reducing administrative overhead so the IP&C team can focus on infection prevention best practice. Status Update: Project Management handed over to Infection, Prevention and Control (IPC)Quality Improvement Lead, Graham Upton with support From Barbara Corning-Davis. Laboratory rules testing in User Acceptance Testing (UAT) is in progress by Graham Upton. Anticipated to be complete and approved for use in live in Feb This will enable usability if ICNet by IP&C team. Trendcare ICNet interface roadblocks cleared. Work now progressing between healthalliance, vendor and DHB. MedChart interface: Project Sponsor is in process of establishing and getting agreement from Antimicrobial Stewardship on requirements from interface. Sponsors: Matthew Rodgers, Stuart Bloomfield Project Manager: Handed over by Arti Chandra to Graham Upton Infection Prevention and Control, supported by Barbara Corning-Davis (i3) Phase: Executing Project Risks: Nil Project Issues: Vendors made changes directly in live environment. Escalated to healthalliance. Surveillance on-going. Incomplete testing and validation in UAT before going live. Lack of confidence in data integrity. End to end UAT testing delivered by healthalliance in Dec 2017 and testing currently in progress. healthalliance project budget overrun; managed by healthalliance project manager. Next Steps: Complete end to end testing of laboratory rules and restore usability. Finalise standard operating procedure for BSI and transition service to utilising ICNet. Timeline Milestone Status Estimated Completion Date Initiating Complete June 2017 Planning Complete June 2017 Executing (Project handed over to Service January 2018) Extended February 2018 Closure Extended March 2018 Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Nil N/A N/A $0 On track Extended until March 18 N/A 125

126 Tracheostomy Service Project - Progress Summary Sponsor: Project Manager: Supported by Barbara Corning-Davis (i3) Phase: Opportunity / Problem Statement: Intensive Care Unit (ICU) Senior Medical Officers and Critical Care Outreach staff have identified a gap in the management of patients with tracheostomies on general wards at Waitemata DHB. There is an increasing number and complexity of patients being admitted to wards at Waitemata DHB with a tracheostomy in-situ, and care of these patients is not well coordinated. There is no formal tracheostomy service in place and there is no formal referral or tracheostomy management process in place. As a result, referral to ICU and other services is inconsistent, ad-hoc, and uncoordinated. Currently medical teams are responsible for the management of patients with tracheostomies. However, most teams have limited experience in leading, coordinating and making key clinical decisions. The overall number of inpatients with tracheostomies is small, making it difficult for nursing and medical staff to maintain confidence and skill in caring for a tracheostomy patient. This presents a significant clinical risk for this patient group. There is no centralised system for collecting data on inpatients with tracheostomies, so the activity associated with this cohort of patients is not readily available. Objective / Aim: To introduce a multidisciplinary tracheostomy outreach service to improve the experience and outcome for patients with a tracheostomy being cared for on general wards at Waitemata DHB. Status Update: Working group meetings progressing at fortnightly intervals on track for small scale pilot planned for May, where Tracheostomy Review and management Service (TRAMS) team will follow one patient s journey from admission to discharge with two ward rounds per week to test the proposed process. Discussions progressing to set up IPM alert system for flagging in-scope patients to TRAMS group for review. Project charter complete and sent to sponsors for sign off. Project handed over to Lead, Sara Olley (ICU)with Quality Improvement support from Barbara Corning-Davis (i3). Project Risks: Nil Project Issues: Nil Next Steps: Timeline Dr Jonathan Casement, Jos Peach Handed over by Arti Chandra to Sara Olley ICU, Planning Working group to complete preparations and tasks Pilot. Project sponsors to sign off on project charter. Align with Home Warding project. Milestone Initiating Planning and testing Status Complete Extended Estimated Completion Date June 2017 May2018 Executing/Roll Out On track June 2018 Closure On track July 2018 Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Nil N/A N/A $0 On track On track N/A 126

127 ED Urine testing process improvement - Progress Summary Opportunity / Problem Statement: The end to end process of Mid-Stream Urine (MSU) testing in ED (from presentation of patient with Urinary tract infections (UTIs) to prescribing appropriate antibiotic treatment) is not clearly understood. There is no clear decision support pathway for the best time and method of collection to achieve a good quality urine sample in ED. There is no clear accountability process of reviewing samples and test results in the laboratory. There are gaps in the process of flow of information on complete microbiology test results to the respective medical team for decision review. Objective / Aim: To establish a lean end to end process for MSU testing that is aligned to best practice and Choosing Wisely. Achieve accurate and timely diagnosis and treatment of patients presenting with UTIs in ED. Status Update: UTI bundle is updated and in use. The new pathway reduces the overall amount of urine testing required for point of care (POC) testing and samples sent to the Laboratory. Completed How to take mid-stream urine sample poster layout and translated into different languages so it is easier for non-english speaking patients to understand the procedure. The languages are Korean, Mandarin, Maori and Samoan- All in one poster. All patient toilets in Emergency Department for both hospitals (North Shore Hospital and Waitakere Hospital) have the new communication poster How to take mid-stream urine sample. Estimated annual financial benefits based on the full implementation of the new process is over $200,000. This is based on reducing laboratory samples by 60% (3,042 samples annually) and point of care urine tests by 43% (3,146 samples annually). Sponsor: Project Manager: Phase: Matthew Rogers Dina Emmanuel Execution Project Risks: Not all staff are willing to follow the new pathway in the updated UTI bundle Project Issues: Resistance from some staff to follow the new testing pathway Next Steps: Continue communicating the new pathway to ensure all staff are aware of the change and following the new process. This will be mainly by communication in person during nurse and doctor handover meetings and group . Increase staff engagement, in particular staff resisting the new process, by providing evidence supporting the new process-detailed is prepared and communication meeting is scheduled to finalise layout. Conduct patient experience survey to measure the effectiveness of the new posters. Timeline Milestone Status Estimated Completion Date Initiating Complete 18 August 2017 Planning Complete 30 September 2017 Executing In progress March 2018 Closure To be confirmed March 2018 Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Capex $ N/A N/A $0 On track Extended N/A Opex $ N/A N/A $0 127

128 Chest pain pathway - Progress Summary Sponsor: Christiansen and Alex Boersma Clinical Leads: Laura Chapman and Kate Allan Project Manager: Kelly Bohot Problem Statement: The purpose of the project is to understand whether our care of patients presenting with chest pain can be improved. The pathway was implemented 3-4 years ago. Since this time there have been new publications about improving care processes for patients with chest pain/acute coronary syndrome. The review of the pathway includes: - Review of national and international literature. - Review of local data. - We are investigating: 1. Which of our current three risk scores identifies patients a. who are safe to discharge? b. who will have a coronary event <30 or < 180 days from presentation? 2. Is an exercise tolerance test (ETT) useful for low risk patients? 3. Does an ETT have negative or positive predictive value or neither? 4. Is high risk ethnicity a predictor of clinical course? 5. Do demographics alone identify safe for discharge/high risk patients? Status Update: - Locality ethics approval complete. - Biostatistician from University of Auckland has started to analyse the data set. Preliminary baseline data complete. Biostatistician has five more days with us to work through the project protocol. - Reviewed data set on 28 February Agreed to expand data set to include patients who present with chest pain query cardiac and go on to develop cardiac difficulties but who are not treated on the chest pain pathway. Also agreed to expand reporting of major adverse cardiac events (MACE) to include three points in time: initial presentation, and representation at 28 days and 180 days. Phase: Project Risks: Nil Execution Project Issues: Nil Next Steps: Continue to develop protocol with input from biostatistician. Re run data set to include new fields. Milestone Status Estimated Completion Date Complete Literature review Complete December 2017 Agree local data set Complete December 2017 Develop and test tool for manual audit of In progress January 2018 ETTs Complete audit and data analysis In progress March 2018 Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Capex $ N/A N/A $0 On track Under investigation N/A Opex $ N/A N/A $0 128

129 ED SWIFTCARE - Progress Summary Sponsor: Project Manager: Phase: Willem Landman Dina Emmanuel Executing Opportunity / Problem Statement: Currently all ED patients go through one clinical assessment process; however, not all patients need to go through the same process. Patients presenting with primary care conditions can be assessed differently to patients presenting with acute conditions. Additionally more conditions can be seen in front of house in consult rooms rather than occupying beds unnecessarily. Objective / Aim: Enhance ED capacity and patient flow while providing the most appropriate care. The project will analyse, process map and implement changes to improve patient flow in front of house i.e waiting room, triage and consult area. Performance measurement will be comparing before and after dwell time (the time spent by clinician with the patient), length of stay (LOS) and number of patients who would normally have been sent to the Flight Deck that are seen at the front of house. Status Update: - Moved from pilot runs to business as usual for both North Shore Hospital and Waitakere Hospital. - Completed patient experience survey for Waitakere Hospital and North Shore Hospital. North Shore Hospital updates - Reallocated nursing resources to take the role of Front of house coordinator-fhc which assisted in the implementation and embedding of the new process and communication of the new process during shift handover meetings. This is working very well. - Having dedicated FHC speeds up the management of patients returning to ED (as they already know the patient from earlier encounter and can advise the most appropriate course of action. - It has been noted things work better when there is a senior doctor on the consult room. This minimises unnecessary investigations/tasks and speeds up disposition. This cannot be guaranteed as junior doctors need exposure to waiting room patients as part of their training. - Feedback on team engagement is positive. - WIP to install shelving in consult rooms. Waitakere Hospital updates - Continue encouraging patients to be diverted and seen at White Cross. These patients are issued with vouchers allowing them access the service for free with a shorter waiting time; this provides the opportunity for more acute patients to be seen at front of house. - Project team reviewed and agreed on full assessment on paediatric patients age five and under. - Very encouraging results: reduction in mean dwell time by 28% and reduction in LOS by 23% for nonemergent stream patients. Increased numbers of issued White Cross vouchers. Project Risks: Lack of engagement and not accepting the new process as it s a change to the operation Project Issues: Doctors completing the mandatory screening section (family violence and child protection) need to complete eight hours training course. Next Steps: Finalise the mandatory screening if it needs to be done by doctors, or confirm alternative option. Reinforce the new process at staff handover meetings. Continue encouraging patients to be seen at White Cross. Measure vouchers issued on monthly basis. Complete outstanding tasks to fulfil project objectives and close project. Timeline Milestone Status Estimated Completion Date Initiating Complete July 2017 Planning Complete July 2017 Executing In progress 28 Feb 2018 Closure In progress TBC Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Capex $ N/A N/A $0 On track Extended N/A Opex $ N/A N/A $0 129

130 Lakeview Radiology-ED - Progress Summary Sponsor: Project Manager: Phase: Willem Landman Dina Emmanuel Scoping Opportunity / Problem Statement: Time delays to perform the required radiology procedure for ED patients. Patients need to be transferred long distance (233 meters) from ED to radiology department and this is largely dependent on the availability of orderly and/or transit nurse and patient readiness. The growing demand in ED is outstripping the growth in radiology resources. Over requesting chest x-ray and abdominal x-ray is another reason causing delays in processing needed x-ray requests and impacting negatively on demand management strategies. Objective / Aim: Implement improved and more efficient model of care for radiology services in ED and reduce the time from requesting to performing x-ray for ED patients. In addition, reduce the over requested chest and abdominal x-rays for ED patients. Status Update: The project streams are in scoping stage. The plan is to establish new radiology suite with one x- ray digital machine physically located in ED, implement lean and efficient operational model of care for Radiology services within ED. Refine the e-ordering process by adopting Choosing Wisely approach and clinical examination to create a list of indications Indication list for patients requiring abdominal and chest x-rays with the aim of reducing the unnecessary x-ray orders. This programme has four main streams: 1 Model of care for radiology services in ED. 2 Choosing Wisely-establish indication list for abdominal X-ray requests. 3 Choosing Wisely-establish indication list for chest X-ray requests. 4 Relocate and set up Gynae rooms in ED (original rooms used for new ED radiology suite). Project Risks: Lack of engagement and not accepting the new process as it s a change to the operation. Poor engagement from clinical teams due to time constraint. Project Issues: Nil Next Steps: Complete project scoping document. Confirm team members for each stream. Establish detailed plan for each stream. Timeline Milestone Status Estimated Completion Date Scoping Work in progress 26 March 2018 Initiating Not started TBC Planning Not started TBC Executing Not started TBC Closure Not started December 2018 Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Capex $ N/A N/A $0 On track N/A Opex $ N/A N/A $0 130

131 Family/Whānau Centered Feeding Tube Management Project - Progress Summary Opportunity / Problem Statement: A project completed in 2016 investigated a perceived lack of coordination of the insertion of feeding tubes, several recommendations were made for both adult and paediatric services. In the paediatric service, there was strong support for a more family and whānau-focused patient pathway, and greater wrap-round psychosocial/multidisciplinary care. There is yet to be any implementation of the recommendations and redesign of services in response to this. Objective / Aim: The current project aims to co-design a paediatric service family and whānau-centred tube feeding and weaning management pathway with staff and service users, to be completed by December Status Update: Final report with key themes and recommendations for service redesign in final stages of development. Care pathway being updated with family/whānau experience/needs. Project being presented at Health Excellence Awards presentation in development. Scoping potential e-pathway for patient and whānau-centred care undertaken with Todd Warner, Susan Peters and Elizabeth Maritz. In process. Change management has become an issue with affected services. Sponsor: Project Manager: Phase: Susan Peters Olivia Anstis Closing Project Risks: Change management for staff for redesigning service provision. Project Issues: Funding for any potential support solutions to be determined. Next Steps: Finalise report Present at Health Excellence Awards in April Update care pathway. Project Management support may be required in 2018 for dissemination of results and support of solution and epathway development. Timeline Milestone Status Estimated Completion Date Initiating Complete 30 August 17 Planning Complete 15 October 2017 Executing Complete 15 December 2017 Closure In progress 9 March 2018 Milestone Status Setting aims Complete April 2017 Understand the system Complete June 2017 Generate ideas and test On hold July 2017 Make ideas happen On hold TBC Estimated Completion Date Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Capex $ N/A N/A $0 On track N/A N/A Opex $ N/A N/A $0 131

132 General Surgery Clinical Pathways - Progress Summary Opportunity / Problem Statement: The Department of General Surgery has identified an opportunity to quantify ways to improve patient outcomes and experience, and reduce health care costs within General Surgery. The focus of this work is the development and implementation of evidence-based protocols for three presentations abscess, appendicitis and cholecystitis, which account for around two thirds of general surgery acute cases booked for theatre. Objective / Aim: To identify and implement solutions to meet target length of stay and improve patient experience and outcomes for patients who undergo simple abscess drainage, appendectomy, and cholecystectomy procedures by August Status Update: Criteria Led Discharge (CLD) Pilot - Pilot began 30 th January for patients discharging from Short Stay Ward. Pilot extended to include patients in scope discharging from Day Stay Unit. Training underway to extend to Elective Surgical Centre (acute beds). - Positive feedback received on new Electronic Discharge Summary/Operation Note as it cuts down on administrative time and ensures patients are discharged with an e-discharge summary (EDS). Working through issues, such as the need for stronger pain relief after cholecystectomy, printing profiles, and adding an electronic work certificate. Trial of Acute Arranged Cholecystectomies complete with results document being reviewed by Surgical Fellow and Registrar. Planning and development of Acute Arranged Abscesses pilot underway. Initial data analysis, criteria, and process drafted. Early buy in from General Surgery Consultants to reduce number computed tomography (CT) scans for suspected Appendicitis. Appendicitis review planned for 9 March to provide further information. Three General Surgery Pathway Qlik applications published for data exploration. Application being used for project and audits. Further data development for HAC reporting. Sponsor: Project Manager: Discrete Work: Richard Harman Angie Hakiwai Mentorship Renee Kong Project Risks: Nil Project Issues: Unable to extend CLD pilot further or include an electronic Work Certificates until Concerto Upgrade in April. Next Steps: Extend CLD pilot to Elective Surgical Centre (acute beds). Plan Acute Arranged Abscesses pilot. Publish results of Acute Arranged Cholecystectomies trial. Identify further improvement ideas. Timeline Milestone Status Estimated Completion Date Initiate Complete September 2017 Plan Complete December 2017 Execute In progress May 2018 Close On track August 2018 Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Capex $ N/A N/A $0 Opex $ N/A N/A $0 On track On track N/A 132

133 Safety in Practice - Progress Summary Opportunity / Problem Statement: Safety in Practice (SiP) is designed to enhance quality improvement capability of general practice teams within the Auckland region, by focusing on patient safety. In order to achieve this goal, a range of tools and resources (adapted from the Scottish Patient Safety Programme in Primary Care), alongside support from improvement and clinical experts are provided to general practice teams to foster a patient safety culture. For this year (year 4), we are also working with community pharmacy and acute care clinics to develop pharmacy/acute care clinic bundles to help improve patient safety. Objective / Aim: To develop more reliable practice systems and to promote a safety and improvement culture within general practices and community pharmacies. Sponsor: Project Manager: Phase: Project Risks: Nil Project Issues: Stuart Jenkins Kelly Fraher (Improvement Advisor role) Ongoing Insufficient resource/mismatch of skills and expertise required to support programme (administration; data systems and analysis; project management; quality improvement; programme development). Administration tasks and other deliverables missed such as reporting for Primary Healthcare Organisations (PHOs). Next Steps: Complete preparation work for learning sessions Continue GP practice, pharmacy and urgent care clinic visits/support Status Update: Teams involved: 59 general practices + 20 community pharmacies + four urgent care clinics. Learning Sessions: Planning in progress for next round of sessions (Pharmacy Learning Session Tuesday 20 March, GP Learning Sessions - Tuesday 10 and Thursday 12 April. Multiple GP Practice, pharmacy and urgent care clinic visits completed. All very positive with excellent work happening across each. Practices and pharmacies currently working on Safety Climate Survey and Trigger Tool and discussing how to improve based on their findings. Urgent care clinics working on deteriorating patients and high risk medicines. As a result of the programme clinics have significantly reduced high-risk prescribing of NSAIDs (nonsteroidal anti-inflammatory drugs). Timeline Milestone Status Estimated Completion Date Setting practice specific aims On track October 2017 Understand the system On track January 2017 Generate ideas and test On track April 2018 Make ideas happen On track July 2018 Year 4 closure On track August 2018 Budget Spend to Date Forecast to Complete Variance Scope Timeline Budget Capex $ N/A N/A $0 On track On track N/A Opex $ N/A N/A $0 133

134 6. Safe Care 6.1 Infection Prevention and Control (IP&C) IP&C Surveillance Overview and Audit Results for 2017/18 Month Total ESBL (Def) Total ESBL (Prob) Total HABSI Total C.diff (HO-HCA) Average MRO Screening Rate Total National Hand Moments % National HH Moments Passed (Ave %I&PC Facilities Standards Met Overall (Ave) % Commodes Clean January % 4,156 84% 97% 98% February % 4,208 87% 98% 96% March % 5,223 86% 97% 90% April % 5,099 86% 98% 96% May % 5,261 87% 98% 97% June % 5,513 85% 98% 97% July % 5,023 88% 97% 94% August % 5,497 88% 98% 97% September % 5,245 87% 98% 97% October % 5,025 88% 99% 95% November % 5,033 88% 99% 97% December % 4,283 89% 98% 98% January ,935 89% 100% 98% February ,441 89% 99% 100% RAG Rating Legend % National HH Moments Passed % I&PC Facilities Standards Met % of Clean Commodes 80% 99% 99% 70% 90% 90% < 70% < 90% < 90% 134

135 6.2 Surveillance Extended Spectrum Beta Lactamase (ESBL) ESBL Definitions 1) Hospital Acquired ESBL (HA-ESBL) A. Definite Isolation of ESBL from clinical or screening specimen after 48 hours of admission in either a high risk patient (as per MRO report) and not previously colonised and with a negative ESBL admission screen or a low risk patient not meeting the criteria for admission screening. B. Probable Isolation of ESBL from clinical or screening specimen after 48 hours of admission in high risk patient not previously ESBL colonised and ESBL admission screen not done. C. Possible: Isolation of ESBL from clinical or screening specimen on admission in community patient not previously known to have ESBL, admitted to a Waitemata DHB acute care facility within the last 30 days (NB: if previous admission one month ago then community acquired. If referral from a Rest Home or Private Hospital other health care facility (HCF) acquired) D. Infection in known ESBL colonised Isolation of ESBL from clinical specimen after 48 hours hospitalisation in previously known ESBL colonised or infected patient. ESBL 2017 Overview 2) Community Acquired ESBL (CA-ESBL) - Isolation of ESBL from clinical or screening specimen within 48 hours of admission in a low risk patient with no exposure to an acute or long term care facility in the last 30 days (NB: such patients will not be routinely screened on admission) 3) Other Healthcare Facility onset ESBL (Other HCF-ESBL) - Isolation of ESBL on admission screen or clinical isolate within 48 hours admission in patients not previously colonised, admitted to Waitemata DHB acute care from a rest home, private hospital or other acute care facilities January 2018 NSH WTH Counts Rates Counts Rates HA*-ESBL (A, B, D) HA Definite (A) HA infection (D) HA Probable (B) CA*-ESBL (incl.) February 2018 NSH WTH Counts Rates Counts Rates HA*-ESBL (A, B, D) HA Definite (A) HA infection (D) HA Probable (B) CA*-ESBL (incl.)

136 Hospital Acquired (HA) ESBL (Overall)- Rate per 10,000 Bed Days Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 HA ESBL NSH HA ESBL WTH Hospital Acquired (HA) Probable ESBL - Rate per 10,000 Bed Days Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 HA -Prob NSH HA -Prob WTH Hospital Acquired (HA) Probable ESBL - Rate per 10,000 Bed Days Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 HA -Prob NSH HA -Prob WTH 136

137 40 Hospital Acquired ESBL Infection - Rate per 10,000 Bed Days HA Infection NSH HA Infection WTH 0 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16Dec-16 Jan-17 Feb-17Mar-17Apr-17May-17Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17Dec-17 Jan-18 Feb Community Acquired (CA) ESBL - Rate per 10,000 Bed Days Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 CA ESBL NSH CA ESBL WTH Methicillin Resistant Staphlococcus aureus (MRSA) Current Waitemata DHB MRSA surveillance Definitions 1) Community onset MRSA: - New MRSA identified from either clinical isolate or screening within 48 hours of admission in a patient with no contact with acute healthcare or contact>30 days prior to identification 2) Health onset MRSA: A) New healthcare onset (hospital acquired HA) MRSA identified after 48 hours of hospital stay B) Previous Waitemata DHB admission (Ex Waitemata DHB) MRSA identified <48 hours after admission in a patient with prior contact in the last 30 days with North Shore Hospital/Waitakere Hospital C) Other healthcare facility (other) - MRSA identified <48 hours of admission and attributable to other healthcare facilities 137

138 No MRSA Update for January/February NSH/WTH 2016 NSH/WTH 2017 NSH/WTH Total MRSA isolates 160/111 (total 271) 181/223 (total 304) 180/151 (total 331) Community MRSA (new isolate on admission) 105/80 (185) 119/93 (212) 117/123 (240) Community MRSA (known on admission) 24/12 (36) 31/17 (48) 29/13 (42) New New healthcare onset 22/6 (28) + 21/11 (32) 22/9 (31) Health care onset (known on admission 13/9 (22) 8/4 (12) 12/6 (18) Vancomycin Resistant Enterococcus (VRE) Waitemata DHB surveillance definitions for VRE VRE burden total number of new and previously known VRE colonised/infected patients seen at North Shore Hospital/Waitakere Hospital during the month. VRE incidence newly identified VRE colonised or infected patients during a particular month. Definite hospital acquired: if admission screen was negative and subsequent screening cultures >48 hours after admission confirm VRE. Probable hospital acquired: if admission screen not performed and subsequent screening cultures >48 hours after admission confirm VRE. VRE 2017 Overview Other: if VRE isolated on admission screen or within 48 hours of admission to North Shore Hospital/Waitakere Hospital. VRE Infection: any infection diagnosed either on admission to, or during, hospital stay. Active VRE surveillance (similar to ESBL) has been undertaken since the May 2015 and ward outbreaks were identified 138

139 No VRE Update for January/February Graph: VRE rate per 10,000 bed days at Waitemata DHB (excluding all mental health and well-baby units, haemodialysis) Infection Incidence Burden 2 0 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec C. difficile Infections (CDI) Waitemata DHB Surveillance Definitions for CDI Healthcare facility Onset (HO-HCA) - CDI symptom onset more than 48hrs after admission (third calendar day) Community Onset healthcare facility associated (CO-HCA) -Discharged from a healthcare facility within previous four weeks Community Onset Community Associated (CO) -No admission in the last 12 months Indeterminte -Discharged from a healthcare facility within the previous 4-12 weeks Recurrent -Episode of CDI that occurs eight weeks or less after the onset of a previous episode provided the symptoms from the prior episode Clostridium difficile (C.difficile) infection (CDI) Summary Clostridium difficile infection (CDI) typically results from the use of antibiotics that affect the normal gut flora, promoting the growth of gut flora. Prevention, therefore, is dependent on appropriate antibiotic use. C.difficile has the potential to spread in healthcare facilities due to its persistence in the environment and contamination of healthcare workers hands. There is no national data on the rate of CDI in NZ hospitals, but it is thought to be lower than European countries and the USA, with hyper virulent strains being very rare in NZ. The MoH is considering a hospital-based CDI surveillance strategy with an initial focus on standardisation of testing and definitions. Waitemata DHB commenced quarterly surveillance of CDI in mid-2013 using standard definitions from the US (Society of Healthcare Epidemiology and Centre for Disease Control). The surveillance strategy has been updated to include real-time notification, feedback, and prevention strategies to reduce hospital-acquired CDI. Waitemata DHB has an active feedback process for all cases of HO HCFA (definitions below) where root cause analysis is undertaken by the ID physician/microbiologist and AMS pharmacist at the time of diagnosis of CDI. A letter outlining the causes and corrective actions are sent to the responsible clinician if the case is considered avoidable. The CDI working group in conjunction with AMS/I&PC will continue to focus on early recognition, improving diagnostic testing requests, isolation practice and antimicrobial stewardship as the key areas. 139

140 Rate per 10,000 Bed Days CDI January/February 2018 Overview A total of 15 CDI cases in January and February Total of 10 CDIs in January. Total of five CDIs in February. The proportion of HO-HCA infections for year to date is 47% (40% in January and 60% in February). There were no avoidable HO-HCA CDIs in January or February. The overall CDI rate for 2018 is 3.6 per 10,000 bed days. The rates for January and February were 4.7 and 2.4 respectively Waitemata DHB Total CDI Rate per 10,000 Bed Days YTD Influenza Surveillance Data includes only confirmed patient cases where influenza like illness (ILI) symptoms developed 48 hours after admission. Source of acquisition variable (healthcare worker, patient, visitors) No Influenza Update for January/February

141 6.2.6 Communicable Diseases Jan/Feb 2018 Disease Total Cases Ward/Unit Pertussis (Whooping Cough) 4 Ward10/ED/ADU (1) ED WTH (2) ED/ADU NSH (1) # of patient contacts 6 3 # of staff contacts 0 7 Comments Nil Clusters and Outbreaks Jan/Feb 2018 Disease/MRO # of Outbreaks/ Clusters Ward Ward Closure Lost Patient Bed Days # Patients Affected #Staff Affected Comments Index case was a transfer from North Shore Hospital to Auckland Hospital and VRE isolated on admission to Auckland Hospital. Initially contacts in Ward 7 room B were screened for VRE with one contact returned positive. VRE Cluster Jan Entire ward was screened for VRE. Ward closed for 24 hours with no admissions and transfers. 33 patients screened negative for VRE. Infection control strategies implemented with heighted auditing and admission and discharge screening Two staff and two patients developed pertussis. Pertussis Cluster Ongoing Jan/Feb Waiatarau First case was staff member; followed by another staff member; and then the two patients. Several staff have been away from work with reported respiratory like illness; however Pertussis PCR retuned negative. Staff and patent contacts were offered prophylaxis by the Occupational Health and Safety Team 141

142 7. Patient and Whānau Centered Care 7.1 Patient Experience Feedback National Inpatient Survey The next Adult In-Patient survey round is on Tuesday, 27 February 2018 for patients discharged between the 5 and 18 February Preliminary results are due 9 April 2018 with final weighted reports due to be provided on 30 April The patient experience team has met with the Health Information Group this month to ensure the process for loading data on the National Inpatient Survey server is streamlined and that there is a backup in place in case of absences. This is due to the challenges with the last quarters data upload. Previous quarter reports are summarised in the table below. Patient Experience System Level Measure targets for each domain are 8.5 in 2017/18. The results have remained fairly consistent throughout the year. Year and Total Surveys Communication Partnership Coordination Needs Quarter Overall *Oct - Dec n/a n/a n/a n/a Jul Sep Apr Jun Jan - Mar Overall Oct - Dec Jul - Sep Apr - Jun Jan - Mar Table 1: National Survey Results *Anomaly with survey methodology Friends and Family Test In January 2018 we received feedback from 893 people through the Friends and Family Test (FFT). This is down significantly from 1,162 responses the previous month. For the last three months, the Net Promoter Score (NPS) has remained consistent at 73, tracking well above the DHB target of

143 Friends and Family Test Overall Results Figure 1: Waitemata DHB overall NPS Graph 1: Waitemata DHB overall FFT results Table 2: Waitemata DHB FFT results (each question) Once again, the Net promoter scores (NPS) in January for all Friends and Family Test questions have met target. Welcoming and friendly and show care and respect both scored in the high 80s. 143

144 Net Promoter Score over time WDHB Target Net Promoter Score Graph 2: Waitemata DHB Net Promoter Score over time Waitemata DHB continues to score well above target with the overall NPS. Average NPS for 2017 was 72.6 with scores ranging from 67 to 78. (Average NPS for 2016 was 69, therefore a notable improvement in 2017). Total Responses and NPS to Friends and Family Test by ethnicity Jan-18 Māori Overall Asian Overall Pacific Other Responses NPS Table 3: NPS by ethnicity All ethnicities identified have met the Waitemata DHB NPS target. The scores are up for Maori from 69 in December to 76 this month. Scores are down for all other ethnicities this month, with a noticable drop in Pacific from 78 in December to 66 this month. 144

145 Friends and Family Test Comments All the staff have been very friendly and helpful and explained the things I didn't understand. Ward 9, North Shore Hospital Amazing care. All staff so friendly and helpful, thank you. Surgical Unit, Waitakere Hospital Every nurse that I had the pleasure of seeing was very warm and helpful. SSW, North Shore Hospital Thank you to the doctor and mental health nurse for their wonderful care of my daughter. ED, Waitakere Hospital Receptionist very friendly and welcoming. Make a day with bright smile. Paediatric Outpatient Clinic, North Shore Hospital Pleasant and helpful staff at all levels making the stay as pleasant as possible. Technical communication was also good. Wainamu, Waitakere Hospital True wrap around care from entire team and nurses looked after mum very well. Huia, Waitakere Hospital Friends and Family Test by ward Division Service Responses NPS AH AH Community Adults North 4 25 AH AH Community Adults Rodney 6 83 AH AH Community Child Health North 3 33 AH AH Community Child Health West AH AH Dietitian OP North AH AH EDARS 9 89 AH AH Outpatients Physiotherapy North Shore Hospital 8 88 AH AH Outpatients Physiotherapy Waitakere Hospital AH AH Renal Dietitian Dialysis 2 50 AH AH Renal Dietitian Outpatients ESC ESC Ward A&EM NSH ADU SMHOP NSH Gastroenterology SMHOP NSH Haematology Day Stay S&A NSH Hine Ora Ward 5 80 S&A NSH ICU/HDU A&EM NSH Lakeview Cardiology Centre CWF NSH Maternity Unit S&A NSH Outpatients Mains S&A NSH Outpatients ORL SMHOP NSH Renal Unit

146 Division Service Responses NPS SMHOP NSH SCBU S&A NSH Short Stay Ward A&EM NSH Ward A&EM NSH Ward S&A NSH Ward A&EM NSH Ward S&A NSH Ward S&A NSH Ward S&A NSH Ward A&EM NSH Ward A&EM NSH Ward SMHOP NSH Ward SMHOP NSH Ward CWF Wilson Centre 6 67 A&EM Waitakere Hospital ADCU A&EM Waitakere Hospital Anawhata Ward A&EM Waitakere Hospital ED A&EM Waitakere Hospital ED Waiting Room A&EM Waitakere Hospital Huia Ward CWF Waitakere Hospital Maternity Unit SMHOP Waitakere Hospital Muriwai Ward S&A Waitakere Hospital Outpatients Mains 2 0 CWF Waitakere Hospital Rangatira Ward 9 67 SMHOP Waitakere Hospital Renal Service CWF Waitakere Hospital SCBU S&A Waitakere Hospital Surgical Unit A&EM Waitakere Hospital Titirangi Ward A&EM Waitakere Hospital Wainamu Ward Table 4: FFT results by ward 146

147 This month, only 37% of all services and wards met their response targets. 78% of these wards/services scored above the Waitemata DHB target for NPS. Three wards achieved an NPS score 90+, these were NSH SCBU, NSH Ward 15 and Waitakere Hospital SCBU, with patients reporting caring, hardworking and kind staff, great service and exceptional baby care as the main reasons for the positive experience. NSH Outpatients mains achieved the lowest NPS rating of 36, followed by Waitakere Hospital Titirangi Ward (score 59) and NSH SSW (score 61), with patients reporting long wait times/appointments running late, and other issues such as poor signage, parking cost, slow discharge and poor treatment as reasons for giving a low score. Five ARDS services are now collecting data and in January they completed a total of 37 surveys with all achieving an NPS score well above our target of 65. ARDS Westgate completed 22 surveys and achieved an NPS score of 77. The feedback continues to be positive with good explanations/communication, friendly and kind staff, and offering great service being key reasons for the positive feedback. Volunteers will start to survey patients during the week and at weekends, at both North Shore and Waitakere Hospital to increase FFT response rates. A trial at the weekends which ran between October and December was successful and we are now confident that a regular programme run by volunteers will increase response rates. Based on the results for January, the Patient Experience team will visit the following services over the next month to understand reasons behind the scores: Ward/Service Reason Target Responses Achieved NPS Score Ward 15, NSH Exceptional NPS score Outpatients Mains, NSH Low NPS ED Waiting Room, Waitakere Hospital Low response rate The team will feed back next month with key insights gained Happy or Not Results This month Happy Or Not is being used to gather patient satisfaction around wait times. The new reporting system allows us to easily target days and specific times where people are reporting they are less happy with wait times. This data is useful to support work being undertaken in Radiology, who have requested to extend the timeframe of Happy or Not machine use by another month. We currently have five terminals in the Outpatients Department at NSH gathering baseline patient experience data around how satisfied patients were with the communication about wait times and delays. This is part of a bigger service improvement project where through an experience based questionnaire patients identified dissatisfaction with communication about delays. This is intended to be used as a baseline measure of patient satisfaction to help validate whether particular interventions around improving communication to do with wait times are successful. 147

148 Figure 2: Happy or Not results for Outpatients NSH 7.2 Patient Experience Activity Highlights Volunteer Recruitment Update Prior to the establishment of the Volunteer Programme, the total number of volunteers available was 29. From February 2017, volunteer numbers have increased by 141 (or %). Green Coats Volunteers (FOH) (A) Other allocated Volunteers (B) Volunteers on boarded awaiting allocation (C) Total volunteers available (D) (A) + (B) + (C) =(D) Table 5: Volunteers Recruitment 148

149 Other activities volunteers allocated to Waitakere shop Ward (Short Stay Ward (SSW), Ward 14 and Titirangi) Health and Safety safety audits and wheelchair inspection Weekend Service Patient Experience Surveys Assistance with projects Tea Trolley in outpatients Outpatient department support Working bee and gardening Assisted Wilson Centre with the recruitment of 13 volunteers. Two of these volunteers have become employees at the centre. Volunteers awaiting interviews (E) Volunteers awaiting police checks (F) Volunteer Withdrawal or Resignation (G) Total Volunteer Applications (D) + (E) + (F) + (G) Table 6: Volunteers withdrawal/onboarding Reason for resignation Retirement = 8.33% (1) Move out of area = 25% (3) Health status = 33.33% (4) Change of circumstance (found job, increase in work with previous commitments.) = 33.33% (4) Reason for withdrawal Long wait for onboarding = 7.09% (10) No further contact post application = 38.29% (54) Lost details =2.84% (4) Change of circumstances (Health status, find job, issue with visa) = 50.35% (71) Police record = 1.42% (2) Volunteer Activity Highlights Volunteer Recruitment Update A recruitment drive is planned for mid-2018, volunteers recruited last year are being progressively assigned to various roles and safely inducted in specific areas. New volunteers attend general training day sessions organised for all volunteers working on DHB sites and then they go through local induction specific to their area of voluntary work. At present, with feedback received from volunteers working in ward 14, Titirangi and outpatient, we are working with respective staff to set up a safe and flexible ways to manage and integrate new volunteers. The process will be useful to implement volunteer service in other wards such as ward 15. St John is undergoing a recruitment drive to find volunteers to support Ward

150 Volunteer Initiatives Working bee with volunteers for the Rotary reflection garden was successfully held on Friday 9 February 2018 and an annual plan is being drafted with Facilities for other gardens. Gardening work will also be conducted with the support of corporate and church organisations. Weekend volunteer s roster will continue from March, to continue the collection of FFT responses and food services evaluation. A weekend roster at Waitakere is also planned for March. 17 volunteers are now working on a roster in Ward 14. Some of these volunteers are also working as Front of House (FOH) volunteers. Orientation/training day for volunteers will be held on Monday 12 and Thursday 15 March at North Shore and Waitakere hospital. Other roles such as sleep packs creation, newsletter publication are currently being scoped with input of volunteers and other Waitemata DHB staff. Actively recruiting a volunteer to support the sustainability team with a recycling programme. Patient Experience Team Highlights Air New Zealand and Sleep Pack Partnership Air New Zealand delivered 32,000 eye masks to NSH in late January and volunteers have commenced putting Sleep Packs together for distribution to the wards. Once the sleep packs are ready for distribution, staff education will be provided to ensure conversations about sleep are had with our patients. Sleep challenges are consistently fed back via the FFT as an area of concern; poor sleep also has negative impact on patient outcomes. Health Quality and Safety Commission (HQSC) Let s Talk Conference Key Note Speaker The Director of Patient Experience on the invitation from HQSC made two presentations at their Let s Talk Conference held in Wellington on 8 th and 9 th March. The event is hosted by the Minister of Health Hon. Dr David Clark and highlights the ways we work with communities to improve quality of healthcare. Asian Health Services Team Highlights Asian Patient Support Service Consumer Survey Results Asian Patient Support Service collects consumer feedback on a daily basis and conducts a quality survey for staff and users every two years according to the Quality Action Plan. Overall feedback from the surveys is very positive. 150

151 Highlights of consumer survey outcomes Survey period: June to October 2017 (data analysis and final report in Dec 2017) Response rate: 62% (60 Chinese and 40 Korean survey forms distributed; 62 clients submitted their feedback forms) Client Ethnicity English Level 2% 14% Fluent 51% 47% Chinese Korean Taiwanese 44% 42% Basic English skill Non-English speaking How long were you supported by a cultural support coordinator? 151

152 How would you rate the level of service provided? 1) Cultural support, emotional support and coordination support 2) Communication support, cultural advice at family meetings or discharge plan meeting 152

153 3) NZ Health system information Was the service helpful? 153

154 How would you rate the overall level of support and service provided by your Asian cultural support coordinator? Please Note: staff survey results will be included in February report 154

155 Korero Mai Asian Project Asian Health team is working with the Korero Mai project coordinator for an Asian survey project in January and February Due to cultural and language barriers many Asian inpatients are reluctant to express their concerns when feeling pain or deteriorating health. The survey will be conducted for North Shore and Waitakere Hospital Asian inpatients especially non-english speaking migrants and their families to collect their views on how they would like to receive support and from whom. The survey will be completed by end of February. Asian Media Promotion for WDHB s Asian Health and Wellbeing Event on 27 February When 27 Feb am to 12noon Where Netball North Harbour Stadium 44 Northcote Rd What Health talks, free health checks and 25+ health information stalls The Asian Health and Wellbeing event is designed to provide NZ health system information, GP information and an opportunity for free health checks to Asian communities in our DHB catchment area. Waitemata DHB services, PHOs and Health NGOs will provide useful information and advice on health and wellbeing. Active promotion has occurred via Asian media outlets (Chinese Herald, Sky Kiwi and Korea post) and Asian community networks. Asian Health Services (AHS) staff - FTE No. of current staff 16.7 FTE No. of management 1 No. of icare Call Centre and Asian Patient Support Service 4.7 No. of Asian Mental Health Service 5.25 No. of WATIS interpreting service 4.75 No. of Primary health interpreting 1 No. of maternity leave 1 No. of interpreters (cover 90+ languages and dialects) 154 Asian Patient Support Service and icare call Centre (January 2018) No. of total enquiries 957 No. of icare call centre enquiry - NZ Health info, GP, breast screen 585 etc. No. of new inpatient referrals - complex issue and cultural support 86 No. of support episodes by cultural support coordinators 372 No. of clinical meetings and face to face liaison 245 No. of phone support 63 No. of clinical coordination 64 No. of community health seminar 0 No. of document cultural review 12 (6 Chinese and 6 Korean) 155

156 Asian Mental Health Service (January 2018) No. of new mental health client 9 No. of active mental health clients 85 (target KPI: 75) No of client support hours 226 No. of support meeting hours 136 No. of Liaison psychiatry referral 0 No. of acute and emergency management referral 2 No. of Asian Clinical Psychological Service referral 12 No. of exit 9 No. of Asian Wellbeing Group Sessions /meetings 3 WATIS Interpreting Service (January 2018) No of interpreters (cover 90+ languages) 154 No of interpreting episodes 3,126 No. of face to face interpreting 1,787 No. of appointment confirmation 1,006 No. of telephone assignment 209 No. of telephone interpreting 124 No. of document translated or proof reading 17 (8 Chinese, 8 Korean and 1 Vietnamese) % DNA of Waitemata DHB bookings WATIS users 0.87% Booking unfulfilled 3.05% Pastoral Care Pastoral Care Activity for Chaplains North Shore Hospital (January 2018) No. of visits to patients 438 No. of visits to family 57 No. of visits to staff 74 Worship services (regular and special) 5 No. of call out to serious condition 5 No. of after-hours call out 7 No. of room blessings 0 No. of deaths attended 2 No. of funerals taken 0 156

157 Pastoral Care Activity for Chaplains Waitakere Hospital (January 2018) No. of visits to patients 8 No. of visits to family 155 No. of visits to staff 26 Worship services (regular and special) 4 No. of call out to serious condition 0 No. of after-hours call out 0 No. of room blessings 1 No. of deaths attended 1 No. of funerals taken 5 Pastoral Care Activity for the Chaplains Mason Clinic (January 2018) No. of visits to patients 377 No. of visits to family 0 No. of visits to staff 169 Worship services (regular and special) 36 No of training sessions provided 14 In January, chaplaincy services at North Shore and Waitakere Hospital show a decrease in activity with two chaplains on holidays. Mason Clinic activity was high. Again, due to the nature of work in Mason Clinic, there are no visitations to family members No. of visits to staff No. of visits to family No. of visits to patients North Shore Waitakere Mason Clinic Jan Graph 10: Waitemata DHB Chaplain Activity 157