CCDHB Public 21 February Item 3.2 Recommendations from CPHAC

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1 CCDHB Public 21 February Item 3.2 Recommendations from CPHAC 75

2 CCDHB Public 21 February Item 3.2 Recommendations from CPHAC Creating our CPHAC / HAC Health System Plan Advisory Committee CPHHAC 76

3 CCDHB Public 21 February Item 3.2 Recommendations from CPHAC Our legislative obligations a) improve, promote, and protect the health of people and communities: b) promote the integration of health services, especially primary and secondary health services: a) to seek the optimum arrangement for the most effective and efficient delivery of health services in order to meet local, regional, and national needs: c) promote effective care or support for those in need of personal health services or disability support services: d) promote the inclusion and participation in society and independence of people with disabilities: e) reduce health disparities by improving health outcomes for Maori and other population groups: f) reduce, with a view to eliminating, health outcome disparities between various population groups within New Zealand by developing and implementing, in consultation with the groups concerned, services and programmes designed to raise their health outcomes to those of other New Zealanders: g) exhibit a sense of social responsibility by having regard to the interests of the people to whom it provides, or for whom it arranges the provision of, services: h) foster community participation in health improvement, and in planning for the provision of services and for significant changes to the provision of services: i) uphold the ethical and quality standards commonly expected of providers of services and of public sector organisations: j) exhibit a sense of environmental responsibility by having regard to the environmental implications of its operations: k) be a good employer in accordance with section 118 of the Crown Entities Act

4 Hospital advisory committee CCDHB Public 21 February Item 3.2 Recommendations from CPHAC Our legislative obligations to advise on matters relating to hospitals, called the hospital advisory committee, and must provide for Maori representation on the committee. Community and public health advisory committee to advise on health improvement measures, called the community and public health advisory committee, and must provide for Maori representation on the committee. Disability support advisory committees to advise on disability issues, called the disability support advisory committee, and must provide for Maori representation on the committee. 78

5 CCDHB Public 21 February Item 3.2 Recommendations from CPHAC PROVIDING ADVICE TO THE BOARD 5 79

6 CCDHB Public 21 February Item 3.2 Recommendations from CPHAC Establishing a CPHHAC - Purpose How the system works: For our patients/clients, their families/whānau, and the communities we serve To meet our obligations to government Health System Development Investment planning to for outcomes for our populations Community and DHB provider arm Locality plans for outcomes for our communities Social and health sector integration Health needs assessment and populations analytics Health system performance Quality and effectiveness of services Equity amongst our populations System performance and impacts on health gain Outcomes amongst our community 80

7 Establishing a CPHHAC - Purpose How our services are performing: For our patients, family/whanau, communities, localities To meet our obligations to Government Performance oversight: CCDHB Public 21 February Item 3.2 Recommendations from CPHAC The performance, quality and delivery of the provider arm services (HHS/MHAIDS) The performance and quality of funded community services Even Better Health Care Performance Improvement/Provider Arm Integrated Care Collaborative Primary & Secondary Integration Service planning: Clinical services planning for the provider arm Community service planning Planning the clinical services network in the sub-region Regional clinical services planning 81

8 CCDHB Public 21 February Item 3.2 Recommendations from CPHAC How does it operate? Health system development Investment plans for outcomes for our populations Locality plans for outcomes for our communities Strategy development Health system performance System level performance and outcomes for our populations and communities Performance Oversight Regular reporting dashboards for monitoring performance * quality Exception and project reporting for service delivery Service Planning Service planning priorities Horizon planning for service development Receives advice from: Clinical Council Citizens Health Council Works with: Māori Partnership Board Sub-regional Pacific Advisory Group Sub-regional Disability Advisory Group Provides Advice to: FAC on business cases and investment plans Board on all activity 82

9 CCDHB Public 21 February Item 3.2 Recommendations from CPHAC What s important in our papers? Reporting reflects a whole of system approach Benefits realisation and system measurement is strongly represented: Structural measures Activity Competence and compliance System level performance Evidence Markers Quality Markers Impact Measures System impact People impact Focus on planning, implementation and results in health outcomes for our communities Checklist: Alignment to health system plan (next slide) Alignment to organisational and government priorities Who is served and impact for communities and populations Does it work? Is it working? What is the evidence? What is the experience? What is the impact on: Equity Quality Safety Clinical sustainability Financial sustainability 83

10 CCDHB Public 21 February Item 3.2 Recommendations from CPHAC Alignment to strategic purpose Alignment to our purpose which is to: Promote health and wellbeing Preventing the onset and development of avoidable illness Strengthening the health and wellbeing of people Supporting people to live better lives Support the end of life with dignity. We invest in in services and approaches that leverage the opportunities to: Simplify service delivery for those people who have good knowledge and resources Intensify service delivery for those who are vulnerable to achieve equity Work with communities to improve health and wellbeing Act early to improve outcomes and make better use of time and money Work together in interdisciplinary teams work together to provide better solutions in homes, communities and hospitals Innovate using technology to improve knowledge, choice and access to healthcare Efficient use of resources in homes, communities and hospitals. 84

11 CCDHB Public 21 February Item 3.2 Recommendations from CPHAC 85

12 CCDHB Public 21 February Item 3.2 Recommendations from CPHAC ELT draft proposal for allocation of work between the new committees and the Board CPHAC/HAC BOARD FAC Health System Plan & Strategy HHS MHAIDS SIPS Equity + outcome + access Even Better Health Care Works with: Disability Maori Partnership Board SRPSHG Citizens Council Clinical Council Workforce and OD Risk H & S Performance reporting Quality & Safety Children s Hospital Annual Planning ICT Strategy Service Investment Investment Strategy Receive Reports from: Disability Maori Partnership Board SRPSHG Citizens Council Clinical Council Financial Reporting Annual Budget CAPEX Contract approvals Internal audit External audit Business Cases Facilities, Asset Management LTIP Master Site Planning 86

13 CCDHB Public 21 February Item 4.1 Health and Safety Monthly Report Author: Endorsed By: Dave Lewis, Health & Safety Manager Thomas Davis, General Manager Corporate Services Ashley Bloomfield, Interim Chief Executive BOARD DISCUSSION Date: 7 February 2018 Subject: CCDHB HEALTH AND SAFETY REPORT (FOR THE MONTH OF JANUARY 2018) RECOMMENDATIONS It is recommended that the Board: a) Notes the number of reported Health & Safety incidents increased in January 2018 (147) compared with the previous month (117); b) Notes that there were no reported Notifiable Events this month, continuing a 15 month trend; c) Notes the number of incidents resulting in lost time injuries (LTI) has remained the same for General incidents and decreased for MHAIDS d) Notes the current Health and Safety Risks. EXECUTIVE SUMMARY 1. RISK REGISTER 2. INCIDENTS There are currently 16 active health and safety risks identified on the risk register The H&S risks listed on pages of the January Risk Report. Higher reporting indicates a stronger health and safety culture and provides a more realistic picture of the exposure to hazards experienced by our workers. It is the actual work injury claims that accurately reflect the level of harm that is occurring. Physical Assaults on staff was the highest category of reported incident category, followed by threatening behaviour. Hazardous Materials Fire/Smoke Other Person Assaulted Staff Assaulted Verbal Abuse Threatening Behaviour Slip, Trip, Fall Hit by or Ran Into Object Potential for Harm Pain or Discomfort Other Near Miss Patient Handling Object Handling Injured in Restraint Hazardous Substance Exposure Burn BBFE

14 CCDHB Public 21 February Item 4.1 Health and Safety Monthly Report 2.1 Performance Summary Performance Indicator Increased - Decreased - No Change Current Month Previous Month Status Trend (Past 12 months) H&S Incidents Total Number of Reported Incidents Number of Reported Incidents - Non MHAIDS Number of Reported Incidents - MHAIDS Number of Incidents involving visitors 0 0 Number of Incidents involving contractors 0 0 H&S Incident Lag Indicators Number of Notifiable Events 0 0 Blood or Body Fluid Exposure Slips, Trips, Falls 10 5 Physical Assault of Workers - Excluding MHAIDS 6 11 Physical Assault of Workers - MHAIDS Patient Handling 8 7 Object Handling 6 3 Performance Indicator - Meeting Target - Below Target Current Month Previous Month % of Pre-Employment Health Screening completed prior to start + 87% 91% 100% % of H&S Fundamentals Managers completed 83% 85% 90% Target Status Trend (Past 12 months) % of Managers Injury Management completed 68% 67% 90% % of H&S Incidents investigated within 14 days 56% 55% 100% (September 2017) + Pre-employment Health Declarations being received with less than the required 2 weeks notice is the cause of this Claims & Injury Statistics current period General excluding MHAIDS MHAIDS Trend General (Past 12 months) Trend - MHAIDS (Past 12 months) Number of ACC45 Injury Claims 8 2 Number of Medical Fees Only Claims 6 1 Number of Lost Time Injuries 2 1 Number of Lost Days 16 7 Lost Time Injury Frequency Rate month average Injury Claims - Any work related injury resulting in an ACC claim Medical Fee Only Claims - Any work related injury which results in an ACC claim for treatment but with no lost time Lost Time Injury - Any work related injury which results in an ACC claim and time off work Lost Time Injury Frequency Rate - The number of lost-time injuries (per million hours worked) within a given accounting period relative to the total number of hours worked in the same accounting period 88

15 CCDHB Public 21 February Item 4.1 Health and Safety Monthly Report 2.2 Lost Time Injuries (LTI) Current Month Category of Incident Slip, Trip, Fall Injured in Restraint Patient Handling Directorate Surgery, Women & Children s MHAIDS Past 12 months General Excluding MHAIDS Medicine, Cancer & Community Department Ward 6 North - Orthopaedics & Urology Haumitiketike (Adult Intellectual Disabilities Secure Unit) Community Health Nursing Services - Wellington Days Lost to Date General LTI's Total Days Lost MHAIDS MHAIDS LTI's Total Days Lost 2.3 Notifiable Events No Notifiable Event incidents were reported in January 2018 There have been no Notifiable Events in the past 15 months. 2.4 Serious Injury Reduction The Government has set a target of reducing serious injuries and fatalities in the workplace by at least 25% by As seen in 2.3 above, CCDHB has a very low incidence of Notifiable Events (serious injuries and fatalities). 89

16 CCDHB Public 21 February Item 4.1 Health and Safety Monthly Report 3. Employee Support 3.1 EAP Overall, the number of employees referring to EAP has slightly decreased this month compared with the previous month and the number of referrals for work related reasons decreased from 36 last month to 19 this month. Non-work related issues accounted for 74% of referrals Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Total number of Clients: New clients: Total number of Sessions: Monthly Cost $15, $10, $5, $0.00 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Note: January 2018 invoice not received at time of report production 3.2 Monthly Referrals to EAP: Reasons for Referrals (as stated by worker) by Directorate Workload Work Hours 2 2 Not Stated 10 Trauma Relationship with Relationship with Performance Surgery Women & Children's MHAIDS 3 6 Harassment Environment Conditions Career Bullying Medicine, Cancer & Community Clinical & Support Services

17 CCDHB Public 21 February Item 4.1 Health and Safety Monthly Report 4. Workplace Injury Management 4.1 Cost Past 12 months $70, $60, $50, $40, $30, $20, $10, $0.00 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 ACCPP Case & Claims Management Abatement (Employee still in work, but not working full hours) Medical Fees Weekly Compensation - Employee not in Work Statistics Claims by Directorate Past 12 Months Patient and object handling injuries continue to be the most common causes for claims, accounting for 26% of all claims over the past 12 months Lumbar sprain injuries remain the most frequent type of injury reported Surgery, Women and Children MHAIDS Medicine, Cancer & Community There have been 289 injury claims in the past 12 months Corporate Services 7 Clinical & Support Services EMPLOYEE PARTICIPATION AND ENGAGEMENT 5.1 Health & Safety Representatives (HSRs) HSR training continues to be delivered using an external training provider. Further sessions have been arranged and advertised for this year. 6. OTHER BUSINESS 6.1 Policies and Procedures The updated Management of Workplace and Aggression and Lone and Community Worker Procedures have been approved and are in the process of implementation. 6.2 Online Risk Assessment/Register System Work has commenced on designing a risk assessment/register system potentially utilising SharePoint. This will replace the current hazard registers. 91

18 CCDHB Public 21 February Item 4.1 Health and Safety Monthly Report 6.3 Steering Committees Health & Safety Steering Committee - This Committee meets every two months. Workplace Violence & Aggression Steering Committee this Committee is meeting on a monthly basis and is in the process of developing a work plan. Moving & Handling Steering Committee this Committee is meeting on a monthly basis and is in the process of developing a work plan. 6.5 Health & Safety Advisor Hazardous Substances The Health & Safety Advisor Hazardous Substances commenced position on the 22 nd January. The appointee will be working with Directorates and managers to ensure the meet the requirements of the Health and Safety at Work (Hazardous Substances) Regulations 2017 as well as performing general Health & Safety Advisors duties and task. 6.6 Managers elearning No. of Managers Who have Completed Directorate No of Health & Safety Injury Managers Fundamentals Management Chief Operating Office Clinical and Support Services Corporate Services Executive Office Medicine, Cancer & Community Mental Health (MHAID) SIP Surgery, Women & Children's Bullying The number of incidents reported to EAP that are classified as bullying was two for January All incidents reported by our EAP provider are shared with People & Capability. Where the employee agrees for their details to be known this is also shared. A dedicated intranet site has been set up by People & Capability Healthy Workplaces. This provides information on bullying and harassment and details what employees should do or who they can contact if they feel they are being bullied or harassed or if they witness bullying or harassment Bullying FEB-17 MAR-17 APR-17 MAY-17 JUN-17 JUL-17 AUG-17 SEP-17 OCT-17 NOV-17 DEC-17 JAN-18 General Manager People & Capability - The former Chief Executive commissioned an employee engagement survey to further understand what employees think about working at CCDHB and to enable organisational, directorate and team level actions to be targeted at the areas that would be benefit employee engagement. Growing our people is one of our three organisational priorities and the results of the survey are critical in informing the work programme for this priority. 92

19 CCDHB Public 21 February Item 4.1 Health and Safety Monthly Report The survey was developed internally based on seven identified drivers of engagement. It was open to all staff and took place 20 March to 10 April The Board has been previously briefed on the key findings. The DHB is using the survey results as a base line for future biannual surveys. In addition to the action plans that are being developed or in train for all directorates to support building engaged staff, the DHB has have an extensive programme in train to support building a positive workplace culture. Work includes: The introduction of a bullying and harassment prevention elearning module for all staff in late 2017 A management essentials bullying and harassment training package for managers also introduced in late 2017 The Cognitive Institute Speaking Up for Safety programme will be run across the DHB for all staff. The work for this starts in the second week of February The development of a People Strategy is in train. This will include goals and initiatives for staff wellbeing and a positive work environment The introduction of a Healthy Workplaces Group which will include unions and staff. The national group of DHB General Managers, Human Resources is also working on initiatives in this area that will be progressed at CCDHB. 93

20 CCDHB Public 21 February Item 4.2 Bi-monthly Hospital and Health Services Update PUBLIC BOARD DISCUSSION Date: February 2018 Author Endorsed by Chris Lowry, General Manager, Hospital and Healthcare Services Ashley Bloomfield, Interim Chief Executive Subject HOSPITAL & HEALTHCARE SERVICES FOR THE MONTH OF JANUARY 2018 RECOMMENDATIONS It is recommended that the Board: a) Note improvements continue to be made in acute flow with improved performance against the Shorter Stays in ED target b) Note the electives health target has been achieved YTD c) Note the ICU expansion is progressing and is on track to be completed by the end of July d) Note the performance against the radiology indicators and plans in place to assist with managing this. 1. OVERVIEW Areas of prority for the Hospital and Healthcare services include: Development of the work programme to support the Even Better Health Care plan as it relates to the Hospital and Healthcare services Acute patient flow and improving our systems and processes to support early senior assessment and timely discharge Progressing the service and building design for the new childrens facility Improving performance against the health targets Improvements in acute flow are continuing to be made with performance against the SSIED target at 92-93% 2. PRIORITIES 2.1 ICU Services The ICU expansion is progressing as per the timelines indicated within the Business case. The enabling works which include the fit out of level 3 of the Clinical Services block to support the relocation of the RMO lounge has been completed. Phase 2 of the project is progressing. 2.2 Capacity Planner The DHB has implemented a Capacity planning tool - a forecasting and capacity planning tool which gives us the ability to use historical data to manage our daily operational hospital resourcing and plan for future demand. This went live in September The tool allows us to accurately predict patient demand and forecast our required staffing on an annual, quarterly and daily basis. Capital & Coast District Health Board Page 1 February

21 CCDHB Public 21 February Item 4.2 Bi-monthly Hospital and Health Services Update PUBLIC The capacity planning tool was utilised to inform the planning for activity and staffing over the Christmas / New Year period. This ensured that resources were planned to match demand and then adjusted on a shift by shift basis. A comprehensive plan was in place to support as many staff as possible taking leave and supporting a more controlled holiday period.. Overall feedback for the period has been positive. An evaluation is currently being completed which will support the planning for next year. The planning tool is now being used to forecast and plan on a rolling three month basis. 2.3 Even Better Health Care Plan HHS Programme of work The Programme Manager and Project leader for the HHS programme of work were appointed in December. Work has been progressed to refine the programme of work for the HHS with priority projects confirmed. These are currently being scoped and builds on work completed to date. 2.4 Cancer Services From 14 February 2018, patients who live in the Wairarapa will receive chemotherapy from a new service that has been established at Wairarapa Hospital. The establishment of this service was a joint initiative between patients, the Wellington Blood and Cancer Centre (WBCC), CCDHB pharmacy, Wairarapa DHB, and the Cancer Society. This initiative will extend the outpatient services that WBCC currently offers at Wairarapa Hospital. The chemotherapy delivery service and clinics will initially be available to patients every Wednesday, with care provided by the WBCC clinical team. This service improvement is an outcome of the sub-regional cancer ambulatory model of care project, and will be the second outreach chemotherapy service provided by CCDHB. 3 HEALTH TARGETS 3.1 Acute Flow Shorter stays in emergency department (SSiED) Target: 95% of patients will be admitted, discharged, or transferred from the Emergency Department within six hours SSIED and Flow Results The SSiED performance for December 2017 was 93.7% with the result for Q2 being 92%. The performance for January 2018 was 92.7%. Improvements continue to be made in patient care including a reduction in the time in the department overall and a reduction in corridor patients. This result is in part due to the successful holiday period strategies including flexi beds at Kenepuru and Wellington which supported the reduction in occupancy, the introduction of the Interventional radiology ward and and ED Observation Unit (EDOU) models of care changes, and improvements achieved in the acute flow programme of work across the organisation overall Summary of Key features for the last two months The hospital-wide focus on the patient journey continues across all the major service groups focussing on reducing delays in the wards and ED, and on early senior review. The winter plan was in place until 1 November This year s plan had a more proactive approach which allowed for planned additional resourcing of increased bed capacity over winter months. This resulted in slightly lower occupancy levels and created some additional capacity to support patient Capital & Coast District Health Board Page 2 February

22 CCDHB Public 21 February Item 4.2 Bi-monthly Hospital and Health Services Update PUBLIC flow. There was an increase in SSIED compliance despite increased patient numbers compared to the same period last year. We continued to resource overnight beds in the interventional recovery ward for cardiology patients (opened early July ) to meet the ongoing deman. This has freed up the Short Saty Unit/EDOU for more ED observation beds providing additional capacity for ED over this period between Monday and Saturday morning. These changes also created additional capacity to manage regional cardiology demand and flow and supporting ANZACQI compliance Specific service improvement activities Frances Health (FH) has continued to support the key work streams in ED, General Medicine, General surgery, orthopaedics and mental health. Emergency Department New models of care have been consolidated through the last quarter embedding as business as usual: - Ambulatory area (C4) (converting a patient cubicle into a 4 chaired space) has freed up access to cubicles as patients wait for results/ review/ discharge. This has been successful in reducing LOS in the department - Rounding 4 times day by SMO, ACNM and PFC is business as usual and had improved communication and oversight within the team. - Change in Model of care for the Emergency Department observation unit (EDOU) continues to provide increased through put and reduced stay in ED. There was a decrease in EDOU admission over the Christmas holidays period (also lower ED Presentations). General Medicine The Four work streams have continued to be progressed through the quarter embedding them as business as usual. The works streams include Improving the interface between ED and MAPU improving transfer of patients to MAPU Facilitating Ambulatory Care in MAPU the model has been decided by the team and has resulted in an improvement in same day discharges. This is now transitioning to a work stream around a review of the model of care including changing the roster to a more distributive take system with the aim to: - Reduce unnecessary waiting and potential harm - Improve ability to undertake ambulatory care - Reduce the burden of post take peaks and troughs (fatigue) - Better align weekend resourcing - Create a sustainable roster - Ensure high quality training and supervision Surgical Services The focus continues on the following: Early time of discharge in Wards 7N and 6 S The Abdominal pain pathway to reduce multiple speciality referrals has progressed with good results. The team are now looking at other pathways. Increased response time to ED for orthopaedics Further work on fracture pathways. Mental Health Work continues with the mental health senior team to progress solutions to improve the current process and issues Capital & Coast District Health Board Page 3 February

23 CCDHB Public 21 February Item 4.2 Bi-monthly Hospital and Health Services Update PUBLIC The Crisis Resolution Service (CRS) senior medical officer is now available in ED 8-4:30 Monday to Friday. The CRSregisterd nurse is in ED 8 a.m. to 11 pm 7 days per week to assist with assessments, plans and disposition. This has seen a significant improvement in timeliness of assessment of patients presenting acutely. 3.2 Elective Services Elective Discharges Health Target Performance against the total elective health target is unfavourable (40) for the month and favourable 58 year to date. The under delivery in elective surgical PUC (359) YTD is being offset by over delivery in Elective Arranged Nonsurgical PUCs which is 417 YTD. Performance against the total elective health target is unfavourable (76) for the month of December but remains favourable at 46 year to date. The under delivery in elective surgical PUC (284) YTD is being offset by over delivery in Elective Arranged and Non surgical PUC which is 330 YTD. TOTAL Actual Plan var Actual Plan var Jan-18 Jan-18 Jan-18 YTD YTD YTD TOTAL (40) 6,354 6, CCDHB (93) 3,776 4,190 (414) Outsourced (7) (45) IDF Outflow (12) Elective Surgical PUC (112) 5,193 5,552 (359) Elective Non-Surgical PUC Arranged Surgical PUC Arranged Non-Surgical PUC Elective - Arranged & Non- Surgical PUC , CCDHB in-house results show (93) belwo target for the month and (414) below target year to date. We continue to back fill and pick up extra theatre sessions for our locum General Surgeons and Neurosurgery are also back filling Wellington theatre sessions. There is currently an issue with pre assessment capacity within all services. General Surgery and Orthopaedics are struggling to have patients pre assessed in readiness for theatre session, back filling cancellations and sending to private to out-source. A dedicated piece of work in being undertaken to identify options to manage and work through these issues. We were adverse (7) for the month and (45) year to date against our outsourcing plan. The private providers have a three week closure through the Christmas period and although we had planned the volume to achieve the outsource plan for January, an Ophthalmology list was cancelled due to bereavement leave. The outsource planned volume has been rephrased and will be caught up by the end of March. IDF Outflow is (12) behind for the month and 100 ahead of target Year to date. This positive variance will continue with the delivery of skin lesions and plastic surgery at Hutt. Elective Arranged and Non-Surgical PUC continue to be ahead of target and we expect this to continue. Capital & Coast District Health Board Page 4 February

24 CCDHB Public 21 February Item 4.2 Bi-monthly Hospital and Health Services Update Elective Services Performance Indicator (ESPI) compliance PUBLIC December ESPI 2 and 5 results are not yet confirmed by MOH. Our internal reporting indicates that we remain compliant in both measures. We are forecasting 8 non-compliant for January month end in ESPI 2 and 14 non-compliant patients in ESPI 5. This will be within the tolerance levels for compliance at organisational level Cardiothoracic waiting list The cardiac waitlist is currently sitting at 55 agaist a maximum volume of 71. ICU capacity has not impacted to the same extent over the past two months as a result of lower occupancy as expected for this time of the year. 3.3 Faster Cancer Treatment Day Cancer Target: Target 85% The target is that patients receive their first cancer treatment within 62 days of being referred with a high suspicion of cancer and the triaging clinician believes the patient needs to be seen within two weeks. The 62-day wait is measured from receipt of the referral to the date of the patient s first cancer treatment (or other management). From June 2017, 90% of patients meeting the criteria should commence treatment within 62 days. Approximately 25 per cent of newly-diagnosed cancer patients will be covered by the 62-day target. A large proportion of newly-diagnosed cancer patients will continue to access treatment through pathways not covered by the target. Significant improvement has been made and sustained against the FCT target with 94% achieved for January and 91% for quarter 2. This is demonstrated in the tables below. Monthly results Capital & Coast District Health Board Page 5 February

25 CCDHB Public 21 February Item 4.2 Bi-monthly Hospital and Health Services Update PUBLIC Day Indicator: patients with a confirmed diagnosis of cancer to receive their first cancer treatment within 31 days Qualified for 31day indicator Within 31days Delays Percentage achievement 85% In January 56 patients were included at time of reporting. 48 patients (86%) were within the indicator timeframe Strategies to improve performance Work continues to be progressed led by the HHS governance group focused on Faster Cancer Treatment Improving outcomes for patients. Key elements of this work includes: Identification of high suspicion of cancer Progress: FCT Button functionality improvements have been made Notification has been added to the front page of the clinical portal as a prompt Discussions with Clinical Leader meetings Improved data quality capture FCT documentation update includes FCT Button use - will enable reporting Development of a Prospective tracking tool Progress: Project initiated with ICT Options are being explored FSA availability Progress: Updated prioritised, unbooked report is now provided Triage category added to prioritised unbooked report Review of FSA appointment slots acrossthe DHB is underway FSA trend report completed. 3.4 Radiology CT and MRI Ministry of Health (MoH) Targets Capital & Coast District Health Board Page 6 February

26 CCDHB Public 21 February Item 4.2 Bi-monthly Hospital and Health Services Update CT performance has remains between 63 66% against a target of 95%. PUBLIC Additional volumes were outsourced in December to assist with reducing the backlog of patients waiting. Waiting time for routine patients is now at 12 weeks with a reduction in patients on the waiting list of 109 patients. MRI performance against the indicater is sitting between 21-35% against a target of 85%. Output has increased over the past months however given the increasing demand, performance against MOH indicator has decreased. A large increase in demand and staffing challenges have impacted on waiting times which have grown to 16+ weeks for routine out patient referrals. Throughput in January was also lower as a result of annual leave. Inpatient emergency and 2 week OP scans conti ue to be treated within the appropriate time frames. The waiting list was reduced by 47 patients during the month of December due to additional outsourcing. All MRI MRT vacancies are now filled. Outsourcing continues. Output through January is expected to be lower than usual due to Annual leave/study leave. We are looking at a number of strategies to reduce the time patients are waiting including: the introduction of scanning at the DHB of domicile for patients referred to the DHB s tertiary services. This reduces the need to travel for patients where this is appropriate and also utilises capacity across the region. We are also developing options for increasing the hours the machines are resourced including evenings and weekends. A radiology demand-management group consisting of members from Radiology, SWC and MCC has been established and had a first meeting in January. The group will meet fortnightly to identify and plan for active demand management moving forward. In the interim we will continue to outsource to private to assist with reducing the back log of patients waiting. Capital & Coast District Health Board Page 7 February

27 CCDHB Public 21 February Item 4.3 Bi-monthly SIP Report PUBLIC BOARD DISCUSSION Date: 21 February 2018 Author Endorsed By Subject Jenny Langton, Principal Advisor, Strategy Innovation and Performance Rachel Haggerty, Director, Strategy Innovation and Performance Ashley Bloomfield, Interim Chief Executive STRATEGY INNOVATION AND PERFORMANCE (SIP) DIRECTORATE BI-MONTHLY UPDATE RECOMMENDATIONS It is recommended that the Board: a) Notes that progress has been made in contract management for 2018/19 to ensure CCDHB is well prepared to implement the Health System Plan; b) Notes that Annual Planning preparation is progressing as expected and that funding advice from the Ministry of Health is expected to be part of the 2018 Budget process and available in May 2018; c) Notes strong performance against health targets with a range of actions in place to improve immunisation rates and achievement of the Healthy Kids target in our community, with a strong focus on equity; d) Notes that 26,699 PHO enrolled patients who smoke were offered advice to quit, which is 90.9% of the target population; CCDHB is now ranked in first place for this target (nationally the achievement of this target is 88.3%) e) Notes that there is close monitoring of the Home and Community Support Service contract and Age Residential Care, with a focus on peoples experience, and that CPHAC received a full update on the monitoring of quality and outcomes in these services at its meeting on 12 February; f) Notes that services to support the implementation of Substance Abuse Compulsory Assessment and Treatment Act are in place, and the new Act comes into force on 21 February; g) Notes the continued work on the Investment Strategy covering Prioritisation, Investment Review, Investment Opportunities and Funding Mechanisms. APPENDIX 1. Distribution of health care homes practices. 1 PURPOSE This paper updates the Board on the Strategy Innovation and Performance (SIP) Directorate s priority activity and issues during December 2017 and January This update includes contract management 2018/19, annual planning, performance monitoring, strategic planning and service development 2 INTRODUCTION SIP has a comprehensive work programme that includes implementing an investment across CCDHB through system design, commissioning, procurement and contracting, and performance management across both CCDHB and the health system funded by CCDHB. Capital & Coast District Health Board February

28 CCDHB Public 21 February Item 4.3 Bi-monthly SIP Report 3 CONTRACT MANAGEMENT 2018/19 Capital & Coast District Health Board February 2018 PUBLIC The annual provider contract roll over and community investment process for 2018/19 has begun and the Board will be provided with the Commitments Schedule for approval at its 28 March meeting. The contract process is where we implement investment change to invest in new and/or under resourced groups of people and services all contracts have been allocated to one of four categories: Service Coverage (national and local) contracts (e.g. ARRC, PHO, Pharmacy, Dental, immunisation, diabetes, bowel screening) Community Investment contracts (local contract. Service change planned possibly including bespoke % increase including contracts arising as a result of the prioritisation process) Exit contracts (contracts the DHB intends to exit from on 30 June or during the coming financial year) Rollover contracts (local contract. No substantive change planned other than potential % change) The intention is that as much new and existing funding as possible will go into Community Investment Contracts. Investment opportunities are being identified as part of investment plans for populations, as well as the initial prioritisation process underway as part of the DHB s overall approach to Annual Planning. Service Coverage and Rollover contracts, which focus on core business as usual services will receive funding at a level sufficient to ensure sustainability of these services. SIP is focusing on strengthening investment in Primary Mental Health, Child and Youth and Health of Older people where there is strong evidence this will have a positive impact on future inpatient hospital and mental health demand. 4 ANNUAL PLANNING The Ministry of Health sent the CCDHB final draft Annual Plan 2017/18 to the Minister of Health for signing in December The DHB is awaiting the signatures of the Minsters of Health and Finance before publishing the Annual Plan. The Board has a full report on CCDHB Annual Planning for 2018/19 in a separate paper. The report covers the four key activities of Investment & Prioritisation, Operational Planning, Budget and the MoH Annual Plan, which together provide the Board with a strong, integrated approach to planning and performance monitoring for the coming financial year. 5 PERFORMANCE MONITORING The integrated approach to performance monitoring is continuing to improve the DHB s performance against Non-Financial Monitoring Framework and Performance Measures. Interim results indicate five of the seven national Health Targets were met in the second quarter, up from two in the fourth quarter. Action plans are now being implemented to ensure all seven targets are achieved by quarter three as signed off by ELT. As performance against health targets improves, we are implementing an integrated approach that encompasses all the indicators we monitor on behalf of the DHB. 5.1 Primary and community care Better Help for Smokers to Quit Primary Care The DHB has achieved the Better Help for Smokers to Quit Primary Care health target for the second quarter in a row. 26,699 PHO enrolled patients who smoke were offered help to quit smoking by a health care practitioner in the last 15 months (90.9%), an increase of 0.8% on the previous quarter. The DHB league table shows CCDHB ranked in number one place for giving brief advice (nationally the achievement of this target is 88.3%). Our partner PHOs continue to show leadership in tobacco control, increasing both performance on the health target and the number of referrals to the Regional Stop Smoking Service who offer face-to-face 102

29 CCDHB Public 21 February Item 4.3 Bi-monthly SIP Report Capital & Coast District Health Board February 2018 PUBLIC support for individuals and families to quit smoking. Cosine (CCDHB) achieved 93.9%, Compass Health (CCDHB) achieved 91% and Ora Toa achieved 89.6%. More Heart and Diabetes Checks In 2017 the DHB realigned funding for early detection of cardiovascular disease and diabetes - More Heart and Diabetes Checks - to improve health equity for Māori men aged years. Six-months into the change in funding, the DHB performance in delivery of More Heart and Diabetes Checks to Māori men aged years has increased to 68.4% which is a 1.2% increase on the previous quarter. As at 31 December ,208 Māori men aged years have had a check. The PHOs have taken up the challenge and are working with practices to improve engagement to reach the Māori men in their populations. We look forward to continued improvement over the next six months. 5.2 Immunisation Targets Improved immunisation coverage leads directly to lower rates of vaccine-preventable disease, and consequently better health and independence for children, particularly for the most vulnerable groups. This equates to longer and healthier lives. Increasing immunisation is a pro-equity strategy, producing greater improvement for those with initially the worst coverage, including Māori infants. Despite not achieving the 95 percent target for Quarter 2, CCDHB continues to perform strongly for the infant immunisation health target with coverage of 94.4 percent, and 94 percent has also been achieved for Māori infants. The Ministry will incorporate our outcomes for Māori children into our current review of Māori immunisation coverage, which will be used to create an action plan to support resilience in maintaining high immunisation coverage levels for Māori infants. Both Compass Health and Cosine Primary Care Network Trust exceeded the 95 percent target for infant immunisation coverage. Ora Toa PHO had coverage of only 90 percent, but this partly reflects the very small patient numbers and decline rates and child illness. Primary care quality initiatives - Immunisation: To achieve the target there has been a focus on primary care quality initiatives, The Outreach Immunisation Service (OIS) continues to provide vaccinations within the home and other community settings that suit whānau arrangements. The weekly clinic runs every Wednesday and extra clinics alongside the Tamariki Ora Services and B4Schools clinic to vaccinate 4 year olds. Ora Toa run a monthly Saturday clinic that rotates around their four medical centres. Home visits are also a good opportunity to observe and assess the family s needs and the service often make referrals to other services to support the whanau. This includes; dental registrations, quit smoking advice, Wellchild and GP referrals. The service follow up whanau and this often results in successful vaccination. Extensive links through the Ora Toa staff and community networks greatly supports this process. The OIS team regularly presents to community groups about immunisation and promotes the service and immunisations at community events. Compass Health generate a list of providers with 8-month Māori babies needing immunisation to meet 95% and this is quickly extended to also include 8-month total population and Pacifica babies, which is drilled down to NHI level to provide more useful information. The lists cover both Capital & Coast and Wairarapa Compass Health practice areas and numbers have reduced over time. The focus has shifted to 6-month coverage: progress towards meeting 95% target to improve timeliness. A separate weekly list is generated to identify 6-month total population; Māori and Pacifica babies and their NHI s. These lists are larger than for 8-months, but it is anticipated that these should reduce over time. A number of babies have been identified as having no GP provider and are referred directly to OIS at just over 6 weeks. Some babies will stay with OIS to complete the primary series (dependent on the families circumstances), while also trying to find a provider for them alongside this. Our OIS community health worker also has a weekly time slot allocated on the radio station Atiawa Toa FM and promotes our services, and immunisations. 103

30 CCDHB Public 21 February Item 4.3 Bi-monthly SIP Report 5.3 Raising Healthy Kids PUBLIC CCDHB received an outstanding rating for the Raising Healthy Kids (RHK) Target for Quarter /2018, which was that by December 2017, 95 percent of obese children identified in the Before School Check (B4SC) programme will be offered a referral to a health professional for clinical assessment and family based nutrition, activity and lifestyle interventions. CCDHB achieved 98% of children referred. The target monitors the number of declines by families who do not wish their child to be referred to the health professional. For Quarter 2 the rates of declined referrals have decreased (30% vs. 36%). This can be seen for all ethnicities. Achieving both the referrals and reduction in decline rate is due to investment in systems and tools as well as audit and feedback via monthly meetings by CCDHB Child Health team, Plunket and PHOs. We consider these initiatives have had a substantial impact. A new system was implemented to centralise the referrals, with all referrals being acknowledged within 24 hours and Plunket have invested in the Be Smarter tool, which is an added resource for the team to use during the checks. A monthly health target meeting has been implemented (incorporating the RHK target), connecting all PHOs and relevant providers as well as providing a regular touch point for the DHB with all providers and the most recent data. Quarterly B4SC meetings continue; WCTO providers, the pre-school active families coordinator, Public Health and all CCDHB PHOs were also attendance. Plunket has attended several in-service days with the PHOs providing expert assistance. They provided helpful tools to assist nurses when having the conversation with parents and also recommended an App which has proved invaluable. 5.4 Home and community support services The Home and Community Support Service (HCSS) sector for people over 65 years of age has undergone a significant change with the establishment of a single provider, bulk funded restorative service (via Access) in both HVDHB and CCDHB in HVDHB holds the contract on behalf of both DHBs. This service has quality targets to meet and incentives to enable people to do as much of their daily living activities as they can (see February CPHAC paper for more information on quality targets and incentives). The graphs below show that while the total delivered hours of care has fallen, the number of people who received home-help services is not declining. This is to be expected through rationalising services within a bulk-funded contract environment. We are closely monitoring the quality of services and the experience of patients and their families. Capital & Coast District Health Board February

31 CCDHB Public 21 February Item 4.3 Bi-monthly SIP Report PUBLIC We have been monitoring admissions to ARC carefully and the trend continues to show lower number of admissions to ARC facilities over the last 12 months. We are confident that there is no negative impact on ARC entries arising from the rationalisation of delivered home-help hours to one provider as we would have seen it by now in the admissions trend. 6 STRATEGIC PLANNING AND SERVICE DEVELOPMENT SIP has oversight of CCDHB s implementation of the Health System Plan (HSP), which informs our strategic service development. Investment planning for child and youth, mental health and wellbeing, whole of life NASC, localities, integration and system design (through Even Better Health Care) and regional care arrangements are current priorities. 6.1 Mental Health and Addictions This update focuses on three of the ten critical projects within MHA SIP and the key actions achieved to date: Substance Abuse Compulsory Assessment and Treatment (SACAT) Act This compulsory treatment Act is required to be implemented by all DHBs on 21 February Implementing the Act does not come with additional Ministry funding. In preparedness for this CCDHB have completed some of the following key elements for roll out of the Act: Appointment of a 3DHB Director to the Responsible Clinician role as required under the Act. Capital & Coast District Health Board February

32 CCDHB Public 21 February Item 4.3 Bi-monthly SIP Report PUBLIC Establishment of a process to appoint authorising officers to manage the process of the ACT currently two appointments for HVDHB/CCDHB & WRDHB localities. Engagement with clinicians and services across the 3DHBs, including consumers, to describe and document the service pathway into and out of the Act. Establishment of a training schedule on awareness of the Act and its implementation for MHAIDs services and staff. While the Ministry anticipates the Act will be used for a limited number of people - up to 200 nationally - clinicians are concerned this may escalate. The immediate concern is additional demand for managed withdrawal services and care requirements for those subject to applications under the Act. CCDHB continue to be engaged with the Ministry on any changes to either funding to implement the Act or regional responses. Te Whare Oki Oki Establishment of Te Whare Oki Oki (wet house), is a key priority for the Wellington City Council. CCDHB are working alongside WCC to determine what they believe their clinical and support needs will be for clients of the house. Within CCDHB there has been some confusion as to the purpose of the Whare, and CCDHB s ability to access that service for our own clients, SIP has taken the role as liaison point for Wellington City Council and CCDHB clinicians as part of developing our localities and community relationships. Mental Health Oversight Group At the beginning of 2017, SIP, in consultation with MHAIDS, developed the first ever joint work programme. The purpose of this was to provide a focus for, and commitment to, key 3DHB MHAIDS/SIP projects that are critical to improving the access and care of those requiring MHAIDS services. The Mental Health Oversight Group includes representation from all 3DHBs and all projects are reporting to this group monthly to maintain the focus on progress. The Programme includes: MHAIDS integration plan - progressing well and to timetable (note separate report) Crisis Resolution Service recruitment to vacancies and finalization of model of service continues. Roll out of a Client Record progressing well with Stage 2 being supported by EBHC. Youth Respite Service Request for Proposals completed, initial provider identified for new service. Mental Health Strategy on task to complete the strategy and an action plan for the Oversight Group to consider mid-year. 6.2 Health Care Homes Launched 1 July 2017 Launched 1 Oct 2017 Launched 1 Jan 2018 Island Bay Medical Centre Newtown Medical Centre Porirua Union Health Service Whitby Medical Centre Paraparaumu Medical Centre Waikanae Medical Centre Titahi Medical Centre Mana Medical Centre Capital & Coast District Health Board February

33 CCDHB Public 21 February Item 4.3 Bi-monthly SIP Report There are an additional 50,000 people enrolled in the six primary care practices that went live with the CCDHB Health Care Home (HCH) model in the last six months of A further 16,000 people are enrolled in the practices that went live on 1 Jan 2018 and in Due to launch 1 March 2018 Cammack & Evans Courtney Medical Centre Northland Kelburn Medical Ngaio Medical Centre PUBLIC March there will be 19,000 people in the practices that join the CCDHB HCH model. This will be the completion of Tranche 2, which in combination with the previous tranche of practices that launched during 2016/17, the HCH model will reach about 145,879 people, about 49% of the CCDHB population. The map attached as an Appendix shows the distribution of practices across the first two tranches of HCHs that were launched in 2016/17 and are being launched in 2017/18. Of the care teams that are part of the Tranche 1 HCHs, feedback through a recent Otago University report includes feedback on the model. Selected quotes from the report: The early positive trends for the HCH cohort for hospital presentations shared in the Board update in December continue to be monitored. 6.3 Virtual Care - Enablers CCDHB is introducing Zoom, a secure cloud based video conferencing service, to enable virtual care within Health Care Homes for people with complex care needs and to support the care of children through the Child System Design project. The 3DHB ICT Directorate has trialled Zoom itself. It is considered a cost effective solution for person to person and multiple party video calling as well as simple to use and reliable. Zoom can work with our current more traditional video conferencing platforms and it is increasingly used by health organisations The application of this virtual care enabler, was recently demonstrated in a trial at one of the Health Care Home (HCH) primary care practices, with their associated District Nurses and Allied Health members from the hospital services. These members have previously come together as multidisciplinary teams for proactive care planning for people at higher risk of admission to hospital and for timely discussions to support people they are actively working with. These multidisciplinary meetings have previously required up to six or more people coming together at the practice. While this has been essential for building working relationships, the travel time has put additional resource pressures on the services and a virtual care tool was being investigated. After a trial with different technology that did not meet the needs of the teams, Zoom was successful. Further testing, process refinement and experience with the use of this tool is now needed to progress this for wider use. Considering just the first nine HCHs practices there could be a saving of about 288 hours in care team time, which would increase as its use expanded across the other HCHs. Capital & Coast District Health Board February

34 CCDHB Public 21 February Item 4.3 Bi-monthly SIP Report PUBLIC Planning is also underway in the Child System Design project that through rapid cycle improvement processes to test the potential for Paediatric specialists to carry out virtual consultations with Primary care clinicians and patients. This has the potential to save patient time, resolve attendance issues at outpatient clinics, improve linkage of specialist teams and primary care. A cross sector planning meeting was held and three preliminary focus areas were identified: People with transport difficulties could be supported with alternative appointment at the local primary care practice for videoconference with a paediatrician Virtual outpatient follow-up clinic could be carried out especially for complex clients where there are benefits for three-way conversation (GP, specialist, whanau) Avoiding an unnecessary hospital referral where a videoconference can give GP and whanau assurance they can manage patient in community These will be developed in further discussion with the cross sector group and moved to a testing phase in next few months. Over and above video conferencing capabilities, Zoom includes functionality for Group collaboration such as instant messaging, screen sharing documents, photos and video clips. Simultaneous screen sharing, annotation and co-annotation, remote keyboard and mouse control and white-boarding are all part of Zoom s features. Security is managed authentication via work , single sign-on (SSO) or Google login, with both input and communication encrypted. Features are further enhanced with integrations to other products and services such as Skype, Outlook, Slack, One Driver, Dropbox. With these functionalities, CCDHB will continue to explore how Zoom can support both people and clinicians in providing smart care through the Integrated Care Even Better Health Care Projects and the Integrated Care Collaborative (ICC) Programme and ICT Directorate. 6.4 Integrated analytics to make better decisions As discussed in the November SIP report the shift from a diagnostic to prescriptive analytical model for the DHB is underway and is the subject of a detailed presentation to CPHAC this month. The first two projects giving effect to this change are beginning to deliver useful insights for changing the way the DHB views its investment in Mental Health & Addictions (MH&A) and Child & Youth (C&Y). The SIP analytics team have worked with Synergia to develop one-off integrated data models for the purpose of the MHAIDS Integration and Child & Youth Health Systems Design projects. These data models use an encrypted NHI number to link separate data sources and relate it back to demographics from the PHO register. The projects are learning platforms for the introduction of more sophisticated and sustainable analytical models. The following diagram is a good example of the insights being created. It compares service access to mental health and addictions services by young people in two Local Territorial Authorities within CCDHB. For example, it generates questions about the different proportions of Porirua and Kāpiti youth accessing secondary versus primary care services to inform appropriate service development responses to community need. Capital & Coast District Health Board February

35 CCDHB Public 21 February Item 4.3 Bi-monthly SIP Report PUBLIC Initial analytics based on this rich data have revealed a number of insights into the way mental health and addictions and child and youth services are accessed, and identify further lines of investigation to focus on to support the next stage of the MHAIDS integration project, which is due to report back in June. The next step in integrated data is joining the MHAIDS Integration and Child & Youth System Design data models. Joining these data models will enable data interrogation that offers insight into service use across multiple parts of the health system. Two priority areas that will benefit from this approach are Maternal Mental Health and SUDI (Sudden Unexpected Death of an Infant) risk factors (e.g. Household members physical and mental health, infant birth weight, neonatal admission). Insight into these areas will identify opportunities for targeted intensive intervention and light touch programmes adopting universality principles. 6.5 Investment Strategy Work on the investment approach has progressed with the development of a programme plan that outlines key projects that will shift the DHB from funding activity to outputs, outcomes and ultimately impacts over a three to five year period. Key deliverables are: Prioritisation - as indicated in the paper on annual planning and signalled in the contracts section of this report an explicit prioritisation process for all Operational Expenditure and Capital Expenditure has been implemented for the 2018/19 FY. This supports the DHBs movement towards a system wide investment approach to the allocation of its resources. Investment Review - this analysis is developing a shared transparent view of CCDHB s funding allocation, cost and revenue trends to support a whole of system approach to prioritisation and investment. This will be described by directorate (MHAIDS, SIP & HHS), patient (populations) (ethnicity, age, sex and location), care setting (home or hospital etc.) and model of care (prevention, early intervention, long term conditions etc.). Investment Opportunities - key strategic documents (eg, Health System Plan 2030), population health analysis and the investment review will inform the development of investment opportunities to optimise the performance of the health system, supports care delivery when and where it will make best use of resources, meets people s needs at the earliest and lowest cost opportunity, and reduces demand driven by avoidable health loss. Capital & Coast District Health Board February

36 CCDHB Public 21 February Item 4.3 Bi-monthly SIP Report PUBLIC Funding mechanisms these are being redeveloped to more explicitly fund for outcomes and impact based on the investment opportunities identified. Currently the three directorates have different funding mechanisms. The HHS directorate is funded via the Price Volume Schedules (PVS) primarily on activity, MHAIDS is funded by the PVS primarily by FTET and SIP directorate funds services through contracts with PHOs, NGOs and community services. There are discrete projects streams within the programme; MHAIDS, SIP and HHS. The HHS project stream has been prioritised for development activities outlined below; Volume Schedule - the current Price Volume Schedule (PVS) approach is not a funding mechanism that helps with understanding or managing the cost drivers of CCDHB. The PVS is being reviewed and agreed between HHS and SIP before draft submission to the Ministry. Moving forward the PVS will be an activity indicator that supports a broader funding mechanism for HHS, include Inter District Flows and more accurately measure all activity not just the lines associated with revenue. Funding Incentives - developing funding incentives to target improvements for 2018/19 and prepare for future commissioning models. We expect these funding mechanisms will enable innovation and explicitly target outcomes and impact. Funding Mechanisms - reviewing the technical mechanisms used to fund provider arm services e.g. tertiary adjustor allocation and the 2010 Service level agreements. Capital & Coast District Health Board February

37 CCDHB Public 21 February Item 4.3 Bi-monthly SIP Report Appendix 1 Distribution of Health Care Homes PUBLIC Capital & Coast District Health Board February

38 CCDHB Public 21 February Item 5.1 Even Better Health Care Report Update PUBLIC BOARD INFORMATION Date: 21 February 2018 Author Endorsed by Jenny Langton, Principal Advisor, Strategy Innovation and Performance Rachel Haggerty, Director, Strategy, Innovation & Performance Ashley Bloomfield, Interim Chief Executive Subject EVEN BETTER HEALTH CARE (SUSTAINABILITY) PLAN UPDATE RECOMMENDATIONS It is recommended that the Board: a) Notes the programme/project resources are in place and project plans are completed for the initial projects; b) Notes the Hospital and Healthcare Services (HHS) has two priority initial projects; the Optimal Ward and Hospital Overnight; c) Notes Mental Health, Addictions and Intellectual Disability Service (MHAIDS) 3DHBhas identified four priority project areas include the Intensive Rehabilitation Model of Care, a 24hr Operations Centre Project, Digital Client Pathways Project and Team Resource Management; d) Notes the Integrated Care programme has two priority projects; Specialist Ambulatory Care and Community Health Network Enablers; e) Notes the actions from Service Planning have been incorporated into the EBHC programme of care; f) Note project capability development is progressing with the recruitment of people with key skills, the standardisation of project methodology and the use of PSODA (cloud-based programme and project management software) to manage project milestones and monitor benefits realisation; g) Note the process of scoping the projects has informed the prioritisation of ICT projects and is ensuring consistency and reducing duplication across the business; h) Note that our primary care partners and clinical leaders are engaged in the programmes of work. 1 PURPOSE This paper updates the Board on developments within the Even Better Health Care (EBHC) Work Programme during January and advises on progress. 2 BACKGROUND As previously advised, the EBHC plan is focussing on four key areas to enhance the way CCDHB works for our communities and staff, and programmes are being established to deliver gains within HHS, Integrated Care, MHAIDs and Infrastructure. These programmes are supported by strengthening our data and analytics (including data visualisation), people and capability development (through the Cognitive Institute) and technology (ICT). EBHC links strongly with the longer term strategic direction signalled in the CCDHB Health System Plan (HSP) - Vision Capital & Coast District Health Board 112

39 CCDHB Public 21 February Item 5.1 Even Better Health Care Report Update 3 PROGRESS TO DATE PUBLIC 3.1 HHS Programme The HHS programme has been designed to deliver increased efficiency, improved patient flow and optimised care across the organisation. A detailed review of the proposed approach along with detailed scoping and engagement with subject matter experts within HHS has been completed. The service design approach has been agreed and the programme is being delivered in two parts: The core programme, which will deliver quick wins and lessons learnt over six months including; Capital & Coast District Health Board OPTIMAL WARD incorporating people, processes, tools and flow within the context of the inpatient ward. The integration of the clinical model of care; the use of ICT including the use of existing technology and technology by the bedside. HOSPITAL AT NIGHT the processes for managing workflow and resources across WRH overnight when the risk of a gap between resources and patients is most likely. The second and supporting programme of work is a combination of discovery and delivery progressed through the year, including; Integrated operations centre building on the work of the Hospital at Night and the Optimal Ward Hospital patient flow Service planning reviews The core programme will deliver: The service design through the process, including patients and family at the centre of the process and seeking support from Māori and Pacific teams Accelerate the delivery time and build on quick wins Shrinks the change and contains the environment, reducing risk and improving the likelihood of success Shortens the communication and engagement channels Engagement with all professionals in defining problems and opportunities An operating model that can be implemented across all wards quickly following validation of the model (noting some variation and adjustment will be required) The metrics for optimal performance More broadly the programme will align with health, safety and quality initiatives underway within the organisation as we progress through the design process, including reducing violence and supporting the staff engagement work. Central to the service design process and developing target operating model(s) are patients, whānau and families. The programme will consider patient flow and experience in the context of the processes, technology, people and the environment to provide optimal care. Further, the programme expects to capture a number of learnings as the service design approach and model of care will encourage multi-disciplinary teams and patients and families, to work together through the design process. 3.2 Service planning As advised previously, the Service Planning Programme has been established with the support of FRAC. Service planning reports have been completed for: Cardiology Neurosurgery 113

40 CCDHB Public 21 February Item 5.1 Even Better Health Care Report Update NICU Capital & Coast District Health Board PUBLIC The reporting and monitoring of progress against the plans is being managed through the HHS programme within EBHC. Processes have been initiated with: Haematology Medical oncology Radiation oncology Ear Nose & Throat. The work programme is integrated within the HHS Programme of EBHC. The reviews have identified areas of work that range from operational improvements, to service changes and consideration of wider regional and technical issues such as national pricing. These opportunities are, where appropriate, being converted into projects within EBHC. We have implemented a clearing house within the EBHC Sponsors group to assess proposals arising from service planning reviews. The clearing house will consider these proposals relative to other potential projects to determine the priority of specific initiatives and allocate resources as appropriate. 3.3 Integrated Care Programme Additional project management resource started on 8 January providing the Integrated Care Programme the ability to gear up on its two priority areas of focus. There are exciting pockets of excellence across the CCDHB system which the Integrated Care Programme will build on to achieve goals set within the Health System Plan. This programme is designed to accelerate our work in Healthcare Homes and Community Service Integration. The first priority is Specialist Ambulatory Care (SAC) and the development of the service framework that identifies how specialist ambulatory care and advice can be provided in the community. The framework will then guide the expansion of CCDHB s Community Health Networks increasing the range of services provided in our communities. The project anticipates delivery of the framework within three months. This framework will be applied to the provision of specialist services across the organisation and, like the optimal ward, will enable the systematic change in the way care is delivered. The second area of focus is Community Health Network Enablers. This work is developing the ICT, model of care and process enablers that support the development of the range of services provided in Community Health Networks. The enablers include e-referrals and virtual consultation. These developments are likely to require changes to models of care, processes and technology. This work is critical for ensuring people receive high quality, timely access to health services in community health networks wherever safe and possible to improve patient experience and health outcomes. There is strong interest in this work both internally to CCDHB and our community providers including the PHOs. The project is working closely with our primary care partners in the design of the framework. 3.4 MHAIDS Programme The detailed scoping of key projects that will improve resource management in MHAIDS is well progressed. The project manager for the MHAIDS programme commenced on 8 January and has undertaken a discovery phase through internal stakeholder and business owner engagement to scope the above four projects. A prioritisation workshop using the project prioritisation tool was held with the MHAIDS leadership team to determine, whether a long list of around 45 proposed projects. Of the 35 projects considered in scope, four projects were identified as having the highest priority for initiating first as they have system benefits. 114

41 CCDHB Public 21 February Item 5.1 Even Better Health Care Report Update PUBLIC Project plans have been developed for approval by the SROs and EBHC Sponsors group. A key challenge will be staging these projects within available resource to ensure we can maximise the potential benefits these projects represent. These are: KAHUKURA Project (Implementing the rehabilitation Model of Care) o o MHAIDS have had a detailed review of the model of care for people in intensive rehabilitation. These people are small in number and intensive resources. Their wellbeing is important. This project is analyzing the findings from this review and planning how the changes will be progressed. MHAIDS 24hr Operations Centre Project o Scope, Design and Implement a MHAIDs Operation Centre that allows the service to optimise resources and manage access to care effectively. There is currently a small hub managing staffing and beds during daytime hours only. This project will scope a 24 hour operations centre and ensure standardization of technology and processes with HHS. Digital Client Pathways Project o This project has completed stage one. We are now scoping stage two which is essential to get the operating benefits of the electronic case management. Stage two will consider how care plans are shared with primary care and NGOs to ensure integrated care for our clients. EBHC will support the focus on benefits realisation. Management by Establishment by Team Project o Scope, and assess the impact of implementing a workforce management tool. This will be considered as an organisation wide initiative. 3.5 Information, Communications & Technology (ICT) The scoping of the projects under EBHC has created the focus required to prioritise our ICT investments. All of our planned and current investments have been categorised in our five key focus areas: Stable Secure Responsive Systems Digitising Consumer Experience Digitising End to End Processes Communication & Collaboration Information & Governance The process of project plan development has identified linkages between the current ICT projects and ensuring a joined up approach across CCDHB and with our key primary care partners. The process has started to identify priorities and reduce duplication. 3.6 Cognitive Institute An update on progress with implementing the Cognitive Institute partnership has been provided in the People and Capability report. 3.7 Data visualisation CCDHB has purchased Qlik Sense, data visualisation software that will enhance decision making by making data much more accessible to support planning and decision making across the organisation and wider system. The software will be installed and developers will be trained in February. Capital & Coast District Health Board 115

42 CCDHB Public 21 February Item 5.1 Even Better Health Care Report Update PUBLIC The core of Qlik Sense is an application or app. The first apps are going to cover HR KPIs, theatre metrics, community mental health metrics, enhanced reporting for the integrated care collaborative, length of stay analysis to support the NICU service plan implementation, reportable events and financial analysis. All of these should enable the service planning review process to run more smoothly and make it easier for services to integrate data into ongoing service planning. The work is governed by a Business Intelligence Stewardship Group. An architecture framework has been completed. A framework for security and access is under development and a privacy impact assessment will be finalised when that framework is completed. Individual projects for app development will begin in March. Apps should be available from May/June CAPABILITY DEVELOPMENT 5 RISKS Recruitment of skilled individuals, following the FRAC approval in December, with analytical capability to support EBHC and other strategic priority areas, is underway. The focus is on principal-level analysts across a range of skill sets. Good interest has been shown with a number of applicants to the roles. Good progress has been made with our capability to develop and deliver key projects and realise benefits. Progress includes the development of the Sharepoint site to share information; the use of PSODA to manage project milestones and achievements, the standardisation of the project management methodology and updating our associated policies. All of the programmes have a strong need for analytics to inform action and determine appropriate programme level benefits. Any delays in recruiting additional analytical capability may impact on timeframes for key deliverables. This will be mitigated by the use of short term contract resources if required. There is also a risk that we are unable to maintain staff buy-in to project and programme objectives due to competing priorities with business as usual. This will be mitigated through good engagement and communication with stakeholders. Capital & Coast District Health Board 116

43 CCDHB Public 21 February Item 6.2 Resolution to Exclude the Public PUBLIC BOARD DECISION Date: 21 February 2018 Author Subject Andrew Blair, Capital & Coast District Health Board Chair RESOLUTION TO EXCLUDE THE PUBLIC RECOMMENDATION It is recommended that the Board: a) Agree that as provided by Clause 32(a), of Schedule 3 of the New Zealand Public Health and Disability Act 2000, the public are excluded from the meeting for the following reasons: SUBJECT REASON REFERENCE Public Excluded Minutes Public Excluded Matters Arising from previous Public Excluded meeting Chair s report CEO s report NZ Health Partnerships FRAC Recommendations Children s Hospital Update 2018/19 Annual Planning Process * Official Information Act For the reasons set out in the respective public excluded papers For the reasons set out in respective public excluded papers Papers contain information and advice that is likely to prejudice or disadvantage commercial activities and/or disadvantage negotiations 9(2)(b)(i)(j) Capital & Coast District Health Board 117

44 CCDHB Public 21 February APPENDIX Capital & Coast DHB staff news Staff Christmas feasts: See photos inside Christmas fire safety: Tips for summer Healthy Workplaces: Reducing bullying, harassment, victimisation and discrimination Health Matters is on the staff intranet - you can read all issues online THANKS from our ce: Debbie Chin s farewell in her final CE column pg 3 A DAY IN THE LIFE: CCDHB medical photographer pg 9 patient INfoRMATIon: Health informaton use and access rights pg

45 CCDHB Public 21 February APPENDIX Compliments Outpatients Kenepuru Community Hospital I would like to compliment all the reception staff at outpatients in their manner and respect of a wide variety of patients ages and ethnicities. They are a credit to the hospital and the national health system. From the CE Ward 7 North Wellington Regional Hospital I wish to sincerely thank all personnel who were involved in my care, from the surgeons to the cleaners. All were very kind, thoughtful and caring. This is my last chief executive column. I finish up at the end of the year. Emergency Department Wellington Regional I d like to take this opportunity to thank you all for your support and commitment during my near decade at the DHB. Please pass on my thanks to the staff who work in the ED. I was struck by the warmth and friendliness of the staff, receptionist, the triage nurse, and the doctor and nurse who assessed me. I wanted to make sure I wrote to express my thanks, especially when it is such a busy department and staff were attending much sicker people then me. I felt so well cared for. You, the staff, have been my inspiration for doing this job. I feel privileged to have worked with so many caring, hardworking and passionate people. Hospital Quality care and patients are at the heart of what you do. Thank you to all the staff who have honest conversations with me about what changes mean for staff and patients, this has helped me immensely when making decisions. Community Nurse Kapiti I was visited at home for several weeks to dress a wound. All the nurses were exceptionally good, totally professional, friendly, and helpful with clear advice and instructions. I cannot imagine better service. Looking back, it is amazing where we have come from. I am incredibly proud that we are now one of the most efficient hospitals in New Zealand and across Australasia. The trust and respect we have built with our primary care colleagues is also the envy of many around the country. Radiology Wellington Regional Hospital There was no waiting for my appointment, and the woman that did the CT was very friendly and polite. The gentleman at the desk also very helpful. Overall the service was excellent. This DHB is a leader nationally, it has strong partnerships in our community and is an organisation full of people that care. It also has very strong leadership in this organisation both clinical and management. ICU and Ward 5 South Wellington Regional Hospital Even though a new chief executive has yet to be appointed, I am confident that this strong leadership will mean you continue to move forward. The care was exemplary. I felt very safe and confident with the staff. All nurses were very positive and upbeat, and when I could, we had a few laughs. Just a fantastic department with very skilled staff. The high dependency unit in ward 5 south was also a safe haven. Staff were very attentive and caring. Almost all nurses were very caring, helpful, cheery, and compassionate. The two dinner people Riley and Jamon were very cheerful, respectful and polite. Lovely to see them each day. I wish you all a safe and happy Christmas, and all the best and every success for next year. COVER PHOTO: Dale Luke from Team Disorderly competing in the IronMāori event. 2 l Debbie Chin Chief Executive CCDHB Health Matters December

46 CCDHB Public 21 February APPENDIX christmas fire safety Times when people get together to celebrate at parties or festivals are the times when there are more deaths and injuries from fires. Just think about it: there are more people than usual in your home, perhaps people are drinking and smoking. You ve put up extra lights and maybe candles. Here are some top tips to help you be safe: in a proper candle holder, so they don t fall over out of reach of children and pets out of draughts and away from curtains, other fabrics or furniture, which could catch fire with at least one metre between the candle and any surface above it, i.e. the ceiling. Putting candles out - never leave a candle unattended. Make sure you: put out candles before you leave a room and before you go to bed never leave a burning candle or oil burner in a child s bedroom double-check that they are completely out and not still smouldering Decorations are made of light tissue paper or cardboard and burn really easily, so keep them away from lights, heaters, barbecues and candles. Decorative Lights some fairy lights and Christmas tree lights don t get used very often, so you should make sure they are in good working order before using them: If you get new ones, read the instruction before you use them Check that the lights aren t damaged or broken and look out for loose or worn wires If bulbs blow replace them Don t leave these lights on when you go to bed or if you leave the house Keep the bulbs away from anything that can easily burn, like paper or Christmas decorations Don t overload electrical sockets or extension leads. Candles are naked flames, and you need to take care where you put them. Candles are not allowed in hospitals, but if you use them at home, they are best placed: on a heat-resistant surface be especially careful with night lights and tea lights, which get hot enough to melt plastic CCDHB Health Matters December l 3

47 CCDHB Public 21 February APPENDIX 2017 Staff Chr 4 l CCDHB Health Matters December

48 CCDHB Public 21 February APPENDIX istmas feasts Answer three questions correctly and go into the draw to win two Embassy theatre tickets donated by the Wellington Hospitals Foundation. This months questions are: 1. When does our CE leave the DHB? 2. What goes in the Green ( co-mingled ) recycle bin? 3. What are the two values that underpin the way we work together, discovered in the People Strategy workshops? your answers to us at: healthmatters@ccdhb.org.nz with the subject line Health Matters Competition before 18 January. We ll announce the winner each month in Health Matters. WIN movie tickets Congratulations to this months winner - Gill Petherick, registered social worker, Primary Health Care Liaison. 5 l CCDHB Health Matters December

49 CCDHB Public 21 February APPENDIX Dr Ashley Bloomfield will be seconded as the acting chief executive (CE) for Capital & Coast DHB. He will take on the role from 1 January 2018 while the final stages of recruitment for the permanent CE are completed. Recruitment is well advanced, but it was important to the Board that we had an interim measure in place while we complete this process. Our current CE, Debbie Chin, finishes on the 31 December. There are a number of significant work streams underway, including the build of a new Children s Hospital, and we want to maintain momentum on these. Ashley is already very familiar with our work programme, the leadership team and staff at the organisation. His secondment will provide consistency but is also an opportunity to strengthen the collaboration and relationships across the Wellington region. Ashley did not apply for the permanent CE role and will return to his role at Hutt Valley DHB at the end of the secondment. Ashley will be fully focussed on Capital & Coast DHB while acting in this role. Hutt Valley DHB s current Chief Operating Officer Dale Oliff will step into the role of Chief Executive at Hutt Valley DHB while Ashley is at Capital & Coast DHB. Andrew Blair Board Chair VIEW FROM THE BOARD ROOM UNDERPINNED BY THE TRIPLE AIM Helping staff address unacceptable behaviour Bullying, harassment, victimisation and discrimination are a recognised health and safety risk within our organisation. This was highlighted in the recent staff engagement survey. As part of our ongoing work to address this, we have developed an elearning module to help staff identify what constitutes unacceptable behaviour and the avenues for addressing it, says capability development manager Sue Seymour. For example, the elearning module will help staff identify factors that influence their behaviour at work, and the risks and effects of unacceptable behaviour on colleagues and the organisation. All new staff are expected to complete this online training through Connect Me. Existing staff are strongly encouraged to complete the elearning, particularly if they think they are experiencing or witnessing unacceptable behaviours A workshop for managers and leaders has also been developed to support them with the skills and confidence to address issues of unacceptable behaviours in their teams. Managers can sign up through Connect Me. GROWING OUR PEOPLE These tools support HERE FOR the range of initiatives currently underway to help YOU! create a healthy workplace for our staff. This includes a Speaking Up for Safety campaign, which will see the appointment of 18 Speaking Up for Safety trainers. Everyone here has a role in preventing bullying, harassment and other unacceptable workplace behaviour, and we are committed to supporting our staff to do this, Sue says. For more information, visit our Healthy Workplaces intranet page. 123

50 CCDHB Public 21 February APPENDIX UNDERPINNED BY THE TRIPLE AIM GROWING OUR PEOPLE Heading here Nurse symposium Nurses at Wellington Regional Hospital hosted a nationwide neuroscience symposium in late November. It is the first time in many years a conference supported by the Australasian Neuroscience Nurses Association was held in New Zealand. Clinical nurse educator Caroline Woon organised the conference along with Angela Davenport from ABI rehabilitation - an ACC-contracted service that provides intensive rehab for patients with traumatic brain injuries in the North Island, nurse educator Adelaide Jason-Smith, and Vanessa Pullan from Healthcare New Zealand. The symposium, Nursing Through the Journey, was a three-day conference with a focus on the patients journey of patients suffering from neuroscience conditions. The first day focused on acute neurosciences, the second on rehabilitation, and the third day was a forum for senior nurses, so they could network and share perspectives on leadership and education. Caroline and the other organisers wanted the first two days of workshops and presentations to keep the focus on patients. We had a lady who came in to speak about her experiences having had a stroke and an interview with a patient who has a brain tumour. These stories really helped us as nurses to understand how we contribute to the patient journey, she says. Lots of positive feedback was received about their symposium, and many want to see it become a yearly event. Attendees came from across the country. It was important that as many people could attend, and the cost to attend was kept as low as possible a ticket for all three days cost $30. We had sponsors for the catering to keep costs low. To compare, the Australian conference Caroline attended earlier in the year cost hundreds of dollars, and that s excluding travel and accommodation costs. The genesis of the conference was planted when Caroline attended a conference in Australia. I thought we could have something similar, so that we [neuroscience nurses] could get together and see what we re all doing around the country, says Caroline. It was originally only meant to be one day, but it just grew and grew. As a result a national group has been created called the New Zealand Australasian Neuroscience Nurses Association (NANNAs!) so nurses can continue to network and work together to make a difference to our services. CCDHB Health Matters December 2017 l 7 124

51 CCDHB Public 21 February APPENDIX Thanks Special thanks and recognition to the following staff 5 Years Vivien Tamayao, registered nurse Maria Gayondato, registered nurse Jerry Almine, nurse coordinator Lynda Downing, registered nurse Penelope Forsyth, clinical nurse specialist Catherine Curran, registered nurse Donna Tofts, specialty clinical nurse Catherine McNamara, specialty clinical nurse Belinda Aquino, registered nurse Jason Elliott, specialty clinical nurse Bianca van der Merwe, speech language therapist Nani McCluskey, community mental health nurse Joy Munt, registered nurse Marianne Strachan, registered nurse (casual) Matthew Janssen, occupational therapist Teresa Conroy, community nurse Bridget Moulder, community nurse Ernest Caballero, registered nurse John Miranda, registered nurse Amabelle Aliviado, registered nurse Debora Santos, enrolled nurse Megan Gatlin, administration coordinator Angela Palmer, clinical typist Shelley Pearson, staff radiation therapist co-ordinator Rebecca Lloyd, staff radiation therapist Annie Talbot, clinical psychologist Peter Mahon, theatre support assistant Donna Davies, midwife Janne Scoullar, security coordinator/administrator Gilbert Tangitutu, mental health support worker 10 Years Alan Board, clinical coordinator Kylie Kerrison, registered nurse Karen Straker, dental assistant - dental Kate Wild, charge nurse manager Huria Biddle, mental health support worker Wendy Gledstone, administration coordinator Mary-Anne Reid, mental health support worker Francenne Smith, social worker Helen McLean, corporate records coordinator Gloria Graham, health service assistant Christine Carlisle, clinical coder Malia Gray, health care assistant Kim Chin, registered nurse Stephen Anderson, consumer council Patricia Tanu, consumer council Melita MacDonald, senior L & D advisor Debra Morriss, clinical trials coordinator Jillian Geraghty, medical records clerk Petronella Pienaar, clinical typist 15 Years Steven MacKey, ophthalmologist Lotomaulo Brown, heath service assistant - nursing Nalini Latta, staff radiation therapist Judy Espiritu Viernes, registered nurse Faanuualii Aniterea, health care assistant Jeremy Krebs, physician diabetes 20 Years Warren Symons, clinical engineering technician Amba Chhiba, health care assistant - staff support 25 Years Sheila Howard, therapy assistant Matewai De-Thierry, telephonist - telephone exchange 30+ Years Silaina Sione, enrolled nurse Russell Quested, security orderly Fiona Jones, clinical midwife specialist Wendy Rudd, charge nurse manager Gerard Pratley, registered nurse Mandy Maiava, administration clerk Brigid Tuohy, registered nurse Maxine Paterson, liaison nurse Hinerangi Simpson, clerk - facilities Staff Profile Dr Alex Psirides ICU Specialist what s your role here? Specialist in Intensive Care. Who s in your team? Everyone who works in ICU nurses, 24 doctors, 3 physios, 3 departmental secretaries, 1 pharmacist, 1 dietitian, 1 ward clerk, and a partridge in a pear tree. What s the best part of your role? Working with and in a diverse supportive team with the patient at the centre of it. And helicopters. Tell us something we might not know about you... In 2005, I was part of a team that ventilated a chimpanzee in Wellington Zoo for three days. 8 l CCDHB Health Matters December

52 CCDHB Public 21 February APPENDIX A day in the life medical photographer Louise Goossens has been working as a medical photographer round these parts since In her 32-year career based at Wellington Regional Hospital, no two days have been the same. There s no such thing as a typical day for me. Unless I have a booking on, I have no idea what to expect every morning until my phone rings, Louise says. Louise is called all over the hospital campus to photograph (or record on video) surgeries, patient wounds, trauma, skin rashes you name the medical malady, and she s photographed it. For the most part, her photographs supplement patient medical records. Louise s footage is uploaded directly to MAP, so that clinicians also have a visual record to refer to. It s also to aid telemedicine. I regularly take photos of injuries/wounds to send to a doctor based in the Plastics Unit, Hutt, for example. Louise says her favourite part of her position is the huge variety within her role. She is sent everywhere within the hospital, so is familiar with almost every clinical team. She also loves the photography. I think a lot of people think my job is all blood and gore, and all they see is horribleness while I see art, she says. The most challenging part of her job is being called to work with patients that have suffered non-accidental injuries. When Louise first started at the hospital, she developed the film and printed in a darkroom, and clinicians had to wait up to five days to see a photograph. Now, all the medical photography is done digitally, and staff can expect an almost instant turnaround. As the DHB s only medical photographer, Louise s work is not only unique, but invaluable. CCDHB Health Matters December 2017 l 9 126

53 CCDHB Public 21 February APPENDIX Team disorderly take on the - IronmA ori At the beginning of the year, our Safety and Security Advisor, Vanessa Broughton, challenged Security Orderly trainers Dale and Jason Tamaki to join her in a team to complete the Ironmāori a half-ironman held in Napier. Despite never having done a triathlon before, both Dale and Jason took up the challenge. The event its a 2km sea swim, 90km bike ride, and 21.1km run. At the beginning, Dale couldn t swim more than one length, and Jason had never run more than 100 metres. However, with the support of Vanessa, and their managers Gina Lomax and Karemoana Matamua, the group spent the last 10 months training for the event. On 1 December, they crossed the finish line together. While it was a tough day in the Hawkes Bay heat, the team loved their experience and are now looking forward to their next challenge. They have already decided to do an individual triathlon. Dale and Jason have noticed huge benefits to committing to such a big fitness challenge. Both are leading much healthier lifestyles, and Jason has lost over 25kgs. Thy encourage anyone else to take up this challenge, so if you see them around the hospital stop and ask them all about it. Ironmāori was created to encourage Māori into healthier lifestyles through triathlon. Ka mau te wehi Team Disorderly! 10 l CCDHB Health Matters December

54 CCDHB Public 21 February APPENDIX P Changes to staff parking from 1 February During the development of the site for the new children s hospital, there will be some changes to where patients, visitors and staff park. The changes, effective from 1 February, will be as follows: the B parking zone on Mein St will be designated as A zone and public to help ensure we can maintain similar public parking capacity for patients B zone will be removed and staff with B Zone permits will be offered C zone permits additional C zone parking will be provided (the location of which will be confirmed in early January). In order to minimise the impact these changes will have on staff and visitors: 50 additional car parks will be created for staff by adjusting the existing layout a stacked parking plan will be implemented for DHB pool cars extra bike racks in a secure area and additional showers will be provided for active commuters. See the staff intranet for more details. sustainability three easy ways to be more sustainable Being a sustainability superhero doesn t take superpowers. Here s some tips to be more environmentally friendly at work. 1. ReCYCling, of course Reducing the carbon foot print of the healthcare service we provide is literally in our hands. You may have noticed our coloured bins here s what goes in each. green ( co-mingled ) Paper hard plastics (nothing scrunchable) tin. Blue (glass) any colour remove lids no medical lab glass containers. Pink PVC medical equipment empty IVF bags O2 masks and tubing. Yellow heavily contaminated with body fluids no sharps! They go in the sharps bin. white slightly contaminated with body fluids general waste biochar turned into land fertiliser paper cups. 2. Why not swap your plastic shopping bags for a reusable tote? disposable lunch containers and clingfilm for a lunchbox? disposable coffee cups for a reusable cup? 3. Reduce and reuse, too Recycling is important, but it s good to remember to reduce and reuse. Consider buying a product that will last years, instead of something disposable, or something you know won t last. Buying quality will not only be easier on your pocket, but it s easier on the planet. UNDERPINNED BY THE TRIPLE AIM BEST VALUE FOR MONEY CCDHB Health Matters December 2017 l

55 people & capability update PEOple STRATEGY UPDATE The People s Strategy for the DHB will be finalised and confirmed in the new year we re going for launch in Thank you to everyone who has contributed to the development of the people strategy through the staff engagement survey (2999 people) earlier in the year and recently in workshops across five sites (200+ people). The survey gave us the eight themes you can see here. We also used the workshops to explore what matters to our people within each theme. Staff in the workshops felt that these eight themes made sense to them. The idea that respect and kindness underpin the way we work together was seen as particularly important by participants. Our team has been busy collating all the post-it notes and you can see the results on the intranet. We have also taken your observations, ideas, and aspirations to panels of managers who make decisions every day about how CCDHB operates, as well as our expert and technical staff in the areas you have spoken about. In the panels, we explored what matters to you, ict update Unlimited calls and texts from work phones Staff no longer have to worry about running out of minutes or text messages while at work. ICT have managed to secure a new contract with mobile provider Skinny for all DHB-issued cellphones. Staff on the standard DHB plan now have unlimited texting and calling to any phone in New Zealand and Australia. Business analyst Rupert Applin says this will take the pressure off busy staff who may have been second-guessing whether they have the minutes (or texts) left to ring a fellow staff member for advice, or text a patient in the community to check in. Now they don t have to think about it they can just pick up the CCDHB Public 21 February APPENDIX our people, alongside what research and best practice tells us. We also have to keep in mind the priorities of the Health System Plan (2030). This week we are taking all of this to the Executive Leadership Team, the Hospital and Health Services leadership team and the Mental Health Addictions and Intellectual Disability Services leadership team. Next steps: We are looking forward to finalising and confirming the CCDHB People Strategy in the New Year so we are go for launch Happy Holidays everyone we hope you have a safe and relaxing summer break! phone, and dial, Rupert says. We want there to be no barrier to quality care. It s also saving the DHB about $10,000 a month. The contract was enabled by the Ministry of Internal Affairs. The only phones excluded from the new plan are devices under an emergency-only plan. There are only a few phones on this plan which are primarily used by casual, part-time and non-clinical staff. However, if the devices on this plan find they do need to call more often than their current plan allows, it s an easy switch to the new contract. Staff can also benefit from a new buddy plan available on their personal phones, also via Skinny. If you have a work phone signed up to the DHB contract, you can buddy your personal phone to enjoy a 50% discount on minutes and data. For information on how to access these discounts and set up your device, visit skinny.co.nz/buddybonus. 12 l CCDHB Health Matters December

56 CCDHB Public 21 February APPENDIX research the flower study Do you want to take part in an exciting new research project to help prevent diabetes? We have found that an extract from a common edible plant can lower glucose levels in mice. Now we want to see if it does the same in people. This extract may eventually be used for the treatment of pre-diabetes or type two diabetes. The aim of this study is to better understand the effects of the extract in people with pre-diabetes. Specifically the effect on the way the body processes glucose. We are looking for twenty men aged between with pre-diabetes to take part in this study. You may not know if you have pre-diabetes, but if you are overweight and have a history of diabetes in your family then you may do. If you would like to take part in the study you cannot ever have been diagnosed with diabetes or taken any glucose lowering medication, you cannot have liver, kidney or heart disease, and you cannot have had bariatric surgery. This study will involve coming in to the research clinic for four visits at least one week apart plus having blood samples taken at a local laboratory before and after each visit. If you would be interested in finding out more about the study please contact us on or diabetesresearch@ccdhb.org.nz privacy & security What do we do with patient information? A new internet statement and posters addressing health information use and access rights will be available early in the new year. Although it s a message designed predominantly for the patients, each staff member should also familiarise themselves with the advice so that we re able to advise patients if or when they ask. Generally speaking, we use a patient s health information only for the explicit purpose of facilitating their treatment. However, there are some exceptions, such as where records are shared with approved organisations outside the DHB but they re always for the purpose of providing the best possible care for the patient. One of the obligations of the DHB under the Health Information Privacy Code is that we must inform patients of their rights with respect to health information held about them, and for what purpose it may be used by us. At CCDHB we aim to meet this obligation in our Patient Information Form (PIF), but a recent decision by the Office of the Privacy Commissioner (regarding another DHB) has meant that we ve had to think about how effective, far reaching and appropriate that PIF form message actually is. The Commissioner s decision related to a complaint made by an orthopaedic patient that her treating DHB had not told her that her information would be provided to the New Zealand Joint Registry. The Office of the Privacy Commissioner found that the DHB breached Rule 3 of the Health Information Privacy Code which says that health agencies must tell patients what they are going to do with their information. This decision has sharpened our focus of ensuring that we clearly express information use and access rights to our patients. 130 CCDHB Health Matters December 2017 l 13

57 Compass health WellingtON SEXUAL HealtH SERVICE CliniCS Over 17,500 sexual health consultations were delivered around the Greater Wellington Region last year with the help of Compass Health. The Wellington Sexual Health Service (WSHS) is openaccess, and based out of a main clinical site at 275 Cuba Street. There is also outreach clinics located in Porirua, Hutt Valley, and collaboration clinics with the NZ Prostitutes Collective and NZ AIDS Foundation. Patients are able to access a huge range of services at the clinics. There s specialist doctors and nurses on hand for the diagnosis and treatment of sexually transmitted infections, including HIV and syphilis, and even chronic and complex sexual health problems. In collaboration with the New Zealand AIDS Foundation, the clinics also offer self-collected sexually transmitted infection testing programme for fast tests for syphilis and HIV. This increases access to high risk gay wellington hospital foundations update First Hospi Clinic Huge success! CCDHB Public 21 February APPENDIX UNDERPINNED BY THE TRIPLE AIM SHORTER, SAFER HEALTH JOURNEYS and bisexual males who may not be engaged with or prefer not to see a primary care provider. WSHS also provides educational, specialist registrar training and support for primary care providers. This service supports the work of general practices by extending their scope, joining up services and enabling more access options for patients, closer to home in a community setting, says the chief executive of Compass Health Martin Hefford. This demonstrates our Health Care Home neighbourhood ethos and vision in action, where general practices work collaboratively with other support organisations in the community. This also reduces the burden on our hospital services. It s also the only specialist sexual health service working outside a hospital setting in New Zealand, he says. As part of the Very Welly Christmas festival in November, Wellington Hospitals Foundation held a Hospi Clinic where children could bring their own Hospi soft toy and get it checked up by Wellington Children s Hospital s clinical staff. The Hospi s had their blood pressure, heart rate, and temperature checked out, and also received an MRI scan, oxygen, and bandages! Over the weekend we had about 400 children bring their Hospis through the clinic. A huge thanks to all the nurses, doctors, and other volunteers who helped us make this event a huge success! Hospi Parades around the Wellington Region This Christmas season Hospi (on behalf of Wellington Regional Children s Hospital) took part in the Petone, Johnsonville, Tawa, Kilbirnie and Upper Hutt Christmas Parades. The parades are a great way for Hospi and Wellington Regional Children s Hospital to engage with the community and it was fantastic to see so many children waving out to Hospi. Thanks to Capital City Motors for lending us their ute for the weekend. Thank you Countdown Kids Hospital Appeal - $109,000+ raised! A massive thanks to Countdown Kids Hospital Appeal which has raised over $109,000 for Wellington Regional Children s Hospital this year! The ongoing support from Countdown and its customers has been incredible. A huge thank you to everyone involved. 14 l CCDHB Health Matters September

58 CCDHB Public 21 February APPENDIX MAPU s Ambulatory Care Project increasing discharge Chris Andersen rates improving The Medical Assessment and Planning Unit Ambulatory Care Project was started last December to help improve acute flow with shorter stays in ED, while increasing the discharge rates for same-day patients. One year on, the project has contributed to MAPU s adherence to the national health target of shorter stays in ED and more efficient care. It was also named as a finalist in the excellence in clinical care category in this year s Celebrating our Success Awards. The project was born out of some of the timely care work being done in the general medical department. It saw the creation of a dedicated assessment space for patients that are sent in by their GPs for assessment, but not necessarily for admission. The initial goals of establishing the project were to properly identify which patients that GPs called about would be appropriate for ambulatory care and to approach those patients slightly differently than other referrals that come through to general medicine and MAPU, says general medicine SMO Chris Andersen. This includes setting safe discharge criteria, and establishing better follow-up protocols for those patients who are safe to send home but need to be re-reviewed. We ve seen an improvement of about 5 percent in the percentage of patients being sent home on the same day. acute But just as important, we re starting to see more of a cultural shift amongst the SMOs and RMOs about how we approach those patients being referred. Instead of parking patients in a bed for the night and waiting for a more thorough SMO assessment, we re looking at whether or not the patient would actually benefit from a hospital stay. Chris is part of the general medicine team that helped get the project off the ground. He worked with allied health s physiotherapist Debbie Chapman and social worker Wendy Thompson, as well as MAPU nurse educator Eun- Sil Choi who led the project with former charge nurse manager Felix Corpuz. The project is ongoing, and the project team are currently renovating one of the MAPU consult rooms to be the permanent ambulatory care bay. We ll be continuing to promote ambulatory care amongst RMOs, SMOs and the MAPU nursing staff. We re also setting our sights on developing a dedicated ambulatory nursing model. CCDHB Health Matters December 2017 l

59 CCDHB Public 21 February APPENDIX NEWSinBRIEF New Ask Ruru app for mental health workers A new app to support our mental health workers is on its way. Ask Ruru, the brainchild of our own nurse Dion Howard, logs text messages and calls between a client and a community mental health worker. It won runner-up at this year s Clinician s Challenge a joint Ministry of Health and HiNZ initiative that seeks out innovative healthcare technology. Ease up on the drinks this Christmas It s the silly season, and the Emergency Department is expecting the annual spike in presentations from those who have overindulged at Christmas parties. Last Christmas, one in four presentations at ED were related to alcohol intoxication. They re planning to wear ease up on the drinks t-shirts, supplied by the Health Promotion Agency, as a reminder to patients and their families coming to ED. Frontline Leadership Programme This month, over twenty staff graduated from this year s Frontline Leadership Programme (FLP). Over seven months, these staff were provided with new frameworks of knowledge, as well as networking and support opportunities. Their individual projects, which were on display at the graduation, explored how they could improve patient care, service, or business unit performance. Congratulations! Pacific Health Scholarships The Pacific Health Scholarships are now open for The governmentfunded programme pays for the tuition of Pacific students studying in medical fields. Over $1 million has been allocated for this year s scheme. The scholarships are an important pillar of the health system as we look to grow the Pacific health workforce, says Associate Health Minister Jenny Salesa. You can find out more at: populations/pacific-health/pacifichealth-scholarships-2018 Sings your lungs out Wellington Regional Hospital was treated to a performance by Sing Your Lungs Out choir in the atrium this month. They sang Christmas carols, as well as a Beatles melody. Sing Your Lungs Out is made up of people living with chronic respiratory illnesses. The choir is a way for them to come together, and exercise their lungs. New vinyl floor at Kenepuru s A&M clinic The Accident and Medical Clinic at Keneperu Community Hospital has had a bit of a facelift. Brand new flooring has been installed in the patient waiting area. New vinyl gives the place a fresher and cleaner feel. The reception area has also had new carpet installed 16 l CCDHB Health Matters December