Hospital Advisory Committee Meeting. Wednesday, 07 June pm. A+ Trust Room Clinical Education Centre Level 5 Auckland City Hospital Grafton

Transcription

1 Hospital Advisory Committee Meeting Wednesday, 07 June pm A+ Trust Room Clinical Education Centre Level 5 Auckland City Hospital Grafton Healthy communities World-class healthcare Achieved together Kia kotahi te oranga mo te iti me te rahi o te hāpori Published 31 May

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3 Agenda Hospital Advisory Committee 07 June 2017 Venue: A+ Trust Room, Clinical Education Centre Level 5, Auckland City Hospital, Grafton Time: 1.30pm Committee Members Judith Bassett (Chair) James Le Fevre (Deputy Chair) Jo Agnew Michelle Atkinson Doug Armstrong Dr Lee Mathias Gwen Tepania-Palmer Auckland DHB Executive Leadership Ailsa Claire Chief Executive Officer Karen Bartholomew Acting Director of Health Outcomes ADHB/WDHB Margaret Dotchin Chief Nursing Officer Joanne Gibbs Director Provider Services Naida Glavish Chief Advisor Tikanga ADHB/WDHB Dr Debbie Holdsworth Director of Funding ADHB/WDHB Fiona Michel Chief Human Resources Officer Riki Nia Nia General Manager Māori Health Dr Andrew Old Chief of Strategy, Participation and Improvement Rosalie Percival Chief Financial Officer Shayne Tong Chief of Informatics Sue Waters Chief Health Professions Officer Dr Margaret Wilsher Chief Medical Officer Auckland DHB Senior Staff Dr Vanessa Beavis Director Perioperative Services Dr John Beca Director Surgical, Child Health Jo Brown Funding and Development Manager Hospitals Judith Catherwood Director Long Term Conditions Ian Costello Director of Clinical Support Services Dr Mark Edwards Director Cardiovascular Services Dr Sue Fleming Director Women s Health Mr Arend Merrie Director Surgical Services Rachel Lorimer Director Communications Auxilia Nyangoni Deputy Chief Financial Officer Anna Schofield Director Mental Health and Addictions Dr Michael Shepherd Director Medical, Children s Health Dr Barry Snow Director Adult Medical Dr Richard Sullivan Director Cancer and Blood Clare Thompson General Manager Non Clinical Support Services Michelle Webb Corporate Committee Administrator (Other staff members who attend for a particular item are named at the start of the respective minute) Apologies Members: Apologies Staff: Judith Bassett (Chair) - James Le Fevre to Chair the meeting Judith Catherwood, Sue Fleming, Fiona Michel, Barry Snow. 2

4 Agenda Please note that agenda times are estimates only 1.30pm 1. Attendance and Apologies 2. Register and Conflicts of Interest Does any member have an interest they have not previously disclosed? Does any member have an interest that may give rise to a conflict of interest with a matter on the agenda? 3. Confirmation of Minutes 26 April pm 4. Action Points 4.1 Auckland Integrated Cancer Centre Update (verbal update) 5. PERFORMANCE REPORTS 1.45pm 5.1 Provider Arm Operational Performance Executive Summary 5.2 Provider Arm Scorecard 5.3 Clinical Support Services 5.4 Women s Health Directorate 5.5 Child Health Directorate 5.6 Perioperative Services Directorate 5.7 Cancer and Blood Directorate 5.8 Mental Health Directorate 5.9 Adult Medical Directorate 5.10 Community and Long Term Conditions Directorate 5.11 Surgical Services Directorate 5.12 Cardiovascular Directorate 5.13 Non-Clinical Support Services 5.14 Provider Arm Financial Performance Report 6. INFORMATION REPORTS 2.15pm 6.1 Patient Experience Report 2.20pm 7. RESOLUTION TO EXCLUDE THE PUBLIC Next Meeting: Wednesday, 19 July 2017 at 1.30pm A+ Trust Room, Clinical Education Centre Level 5, Auckland City Hospital, Grafton Healthy communities World-class healthcare Achieved together Kia kotahi te oranga mo te iti me te rahi o te hāpori 3

5 01 Feb Mar Apr Jun Jul Aug Oct Nov Attendance at Hospital Advisory Committee Meetings Members Judith Bassett (Chair) c 1 1 Joanne Agnew c 1 1 Michelle Atkinson c 1 1 Doug Armstrong c X 1 James Le Fevre (Deputy Chair) c 1 1 Lee Mathias c 1 1 Gwen Tepania-Palmer c 1 1 Key: x = absent, # = leave of absence, c = meeting cancelled 4

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7 2 Conflicts of Interest Quick Reference Guide Under the NZ Public Health and Disability Act Board members must disclose all interests, and the full nature of the interest, as soon as practicable after the relevant facts come to his or her knowledge. An interest can include, but is not limited to: Being a party to, or deriving a financial benefit from, a transaction Having a financial interest in another party to a transaction Being a director, member, official, partner or trustee of another party to a transaction or a person who will or may derive a financial benefit from it Being the parent, child, spouse or partner of another person or party who will or may derive a financial benefit from the transaction Being otherwise directly or indirectly interested in the transaction If the interest is so remote or insignificant that it cannot reasonably be regarded as likely to influence the Board member in carrying out duties under the Act then he or she may not be interested in the transaction. The Board should generally make this decision, not the individual concerned. Gifts and offers of hospitality or sponsorship could be perceived as influencing your activities as a Board member and are unlikely to be appropriate in any circumstances. When a disclosure is made the Board member concerned must not take part in any deliberation or decision of the Board relating to the transaction, or be included in any quorum or decision, or sign any documents related to the transaction. The disclosure must be recorded in the minutes of the next meeting and entered into the interests register. The member can take part in deliberations (but not any decision) of the Board in relation to the transaction if the majority of other members of the Board permit the member to do so. If this occurs, the minutes of the meeting must record the permission given and the majority s reasons for doing so, along with what the member said during any deliberation of the Board relating to the transaction concerned. IMPORTANT If in doubt declare. Ensure the full nature of the interest is disclosed, not just the existence of the interest. This sheet provides summary information only - refer to clause 36, schedule 3 of the New Zealand Public Health and Disability Act 2000 and the Crown Entities Act 2004 for further information (available at and Managing Conflicts of Interest Guidance for Public Entities ( ). Confidential 5

8 Register of Interests Hospital Advisory Committee Member Interest Latest Disclosure Jo AGNEW Michelle ATKINSON Doug ARMSTRONG Judith BASSETT James LE FEVRE Lee MATHIAS Professional Teaching Fellow School of Nursing, Auckland University Casual Staff Nurse Director/Shareholder 99% of GJ Agnew & Assoc. LTD Trustee - Agnew Family Trust Shareholder Karma Management NZ Ltd (non-director, minority shareholder) Evaluation Officer Counties Manukau District Health Board Director Stripey Limited Trustee Starship Foundation Shareholder - Fisher and Paykel Healthcare Shareholder - Ryman Healthcare Shareholder Orion Healthcare (no personal beneficial interest as it is held through a Trust) Trustee Woolf Fisher Trust Trustee- Sir Woolf Fisher Charitable Trust Daughter Partner Russell McVeagh Lawyers Member Trans-Tasman Occupations Tribunal Trustee A+ Charitable Trust Shareholder - Fisher and Paykel Healthcare Shareholder - Westpac Banking Corporation Husband Fletcher Building Husband - shareholder of Westpac Banking Corporation Granddaughter - shareholder of Westpac Corporation Daughter Human Resources Manager at Auckland DHB Board member Waitemata DHB Emergency Medicine Specialist - Adult Emergency Department, Auckland DHB DHB Representative (Auckland and Waitemata DHBs) Air Ambulance Codesign Procurement Governance Board Fellow - Australasian College for Emergency Medicine - FACEM Shareholder - Pacific Edge Diagnostics Ltd Trustee - Three Harbours Health Foundation Wife - Medicolegal advisor, Medical Protection Society Wife Employee Waitemata DHB Department of Anaesthesia and Perioperative Medicine Chair - Health Promotion Agency Chair - Unitec Acting Chair - Health Innovation Hub Director - Health Alliance Limited (ex officio Counties Manukau DHB) Director/shareholder - Pictor Limited Director - Lee Mathias Limited Director - John Seabrook Holdings Limited Trustee - Lee Mathias Family Trust Trustee - Awamoana Family Trust Trustee - Mathias Martin Family Trust Member New Zealand National Party Confidential 6

9 2 Gwen TEPANIA- PALMER Board Member - Manaia PHO Board Member - Health Quality and Safety Commission Board Member Terenga Paraoa Ltd Northland Committee Member - Te Taitokerau Whanau Ora Committee Member - Lottery Northland Community Committee Chair - Ngati Hine Health Trust Life member National Council of Maori Nurses Alumnus Massey University Confidential 7

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11 Minutes Hospital Advisory Committee Meeting 26 April Minutes of the Hospital Advisory Committee meeting held on Wednesday, 26 April 2017 in the A+ Trust Room, Clinical Education Centre, Level 5, Auckland City Hospital, Grafton commencing at 1.30pm Committee Members Present Judith Bassett (Chair) James Le Fevre (Deputy Chair) Jo Agnew Michelle Atkinson Doug Armstrong Dr Lee Mathias Gwen Tepania-Palmer [arrived during Item 6.1] Auckland DHB Executive Leadership Team Present Ailsa Claire Chief Executive Officer Joanne Gibbs Director Provider Services Fiona Michel Chief Human Resources Officer Rosalie Percival Chief Financial Officer Shayne Tong Chief of Informatics Sue Waters Chief Health Professions Officer Dr Margaret Wilsher Chief Medical Officer Auckland DHB Senior Staff Present Dr Vanessa Beavis Director Perioperative Services Jo Brown Funding and Development Manager Hospitals Judith Catherwood Director Long Term Conditions Ian Costello Director of Clinical Support Services Dr Sue Fleming Director Women s Health Sarah Little Nurse Director, Child Health Mr Arend Merrie Director Surgical Services Anna Schofield Director Mental Health and Addictions Samantha Titchener General Manager Cardiovascular Services Dr Barry Snow Director Adult Medical Dr Richard Sullivan Director Cancer and Blood and Deputy Chief Medical Officer Michelle Webb Corporate Committee Administrator (Other staff members who attend for a particular item are named at the start of the minute for that item) 1. APOLOGIES The apologies of senior staff members Margaret Dotchin, Andrew Old, Mark Edwards, Michael Shepherd and John Beca were received. It was advised that Sarah Devine, Online Participation Manager was in attendance as delegate for Andrew Old and Margaret Dotchin. Michelle Atkinson observed that her surname had been misspelled in the attendance register. 2. REGISTER AND CONFLICTS OF INTEREST James Le Fevre informed that he was no longer a member of the Association of Salaried Medical Specialists and this could be removed from the register. Hospital Advisory Committee Meeting 26 April 2017 Page 1 of 12 8

12 3. CONFIRMATION OF MINUTES 15 March 2017 (Pages 8 to 23) Resolution: Moved Jo Agnew / Seconded Michelle Atkinson That the minutes of the Hospital Advisory Committee meeting held on 15 March 2017 be confirmed as a true and accurate record. Carried 4. ACTION POINTS (Pages 24 to 25) All items were either complete or in progress. 4.1 People Metrics for Directorate Reports (verbal update) Fiona Michel, Chief Human Resources Officer advised that the proposed alternative People Metrics for Directorate reports had been approved by the Board and would be incorporated into the directorate reports to the next Hospital Advisory Committee meeting. 4.2 Auckland DHB Training for Resilience (Pages 26 to 28) Fiona Michel, Chief Human Resources Officer spoke to the report, advising that there were a range of programmes provided to support staff resilience and stress management. The following matters were covered in response to questions: Wellbeing is one of the core promises we make to staff as part of the DHBs People Strategy. The Resilience and Stress training programmes were one of the tools being built to support achievement of the strategy. Individual services had implemented their own programmes to respond to local needs, such as the Critical Support tool that was developed by Women s Health. To ensure alignment with other DHBs elements of the support frameworks used by Waitemata DHB had been considered and incorporated where relevant. A series of bite-sized learning sessions were being developed to meet core needs across the organisation such as Challenging Conversations and Resilience and Stress Management. That the Hospital Advisory Committee receives the background information for key themes of the resilience training delivered within Auckland DHB. 5. PERFORMANCE REPORTS (Pages 29 to 158) 5.1 Provider Arm Operational Performance Executive Summary (Pages 29 to 34) [Secretarial Note: Items 5.1 and 5.2 were considered as one item] Jo Gibbs, Director Provider Services spoke to the report highlighting the following: Good progress was being made against implementation of the new 24/7 Hospital Functioning model of care Hospital Advisory Committee Meeting 26 April 2017 Page 2 of 12 9

13 Funding for the proposed Hyperacute Stroke Service had been approved by the Auckland DHB Finance Risk and Assurance Committee. A report seeking support would also be submitted to the Waitemata and Counties Manukau DHB Boards. The key issues and risks from a provider and operational perspective were: - Financial sustainability and capital investment pressure - The dependency of Mental Health Facilities on the private rental market - The ongoing workforce challenges and recruitment risks especially those being faced in Women s Health - New emerging service risks in Pathology and Cardiology - The high number of transplant services being provided above contract volumes and potential impacts of the draft Ministry of Health Organ Donation Strategy - The Orthopaedic surgery waitlist - Performance for Quarter 3 against the 6 hour target for the Adult Emergency Department which has not been met due to the sustained increase in presentation volumes. 3 Matters covered in discussion of the report and in response to questions included: Planning for specialist service models across metro-auckland would focus next on Head and Neck Cancer. Timing for transition to the new 24/7 Hospital Functioning model of care was as per the planned timeline. Recruitment to all roles was still in progress. 5.2 Provider Arm Scorecard (Pages 35 to 40) Jo Gibbs, Director Provider Services advised that the Provider Scorecard was currently being reviewed. Changes had been implemented for this reporting period with a more finalised scorecard to be presented at the June meeting. A new In Year target had been included to demonstrate progress made to date towards achievement of the overall target. Members agreed that the new scorecard format was much improved. [Secretarial Note: Item 5.4 was taken next] 5.3 Clinical Support Services (Pages 41 to 47) [Secretarial Note: this item was taken after Item 6.1] Ian Costello, Director Clinical Support Services asked that the report be taken as read highlighting the following: Positive improvements had been made against achievement of the MRI target A new Service Manager Clinical Engineering had been appointed A third pharmacist prescriber had qualified In response to earlier discussion during Item 5.10 regarding improvements being made to outpatient correspondence, advice was given that that the directorate had upgraded its texting capability and was now working on improvements to correspondence. [Secretarial Note: item 5.5 was taken next] Hospital Advisory Committee Meeting 26 April 2017 Page 3 of 12 10

14 5.4 Women's Health Directorate (Pages 48 to 56) [Secretarial Note: this item was considered after Item 5.2] Sue Fleming, Director Women s Health asked that the report be taken as read highlighting that the continuing critical issue was staffing within maternity services. The following matters were covered in response to questions: Whilst there was a Maori Workforce strategy under development there was not yet a specific programme for Pacific students identified. To support engagement, the Nurse Unit Manager was working actively in the Pacific community. There was still room for improvement in achieving a maternity workforce that was representative of the Auckland population. This was influenced by a number of factors including some ethnicities experiencing varying levels of engagement with tertiary education. [Secretarial Note: Item 5.11 was taken next] 5.5 Child Health Directorate (Pages 57 to 68) Sarah Little, Nurse Director Child Health spoke to the report highlighting the following: Good progress had been made towards implementation of the redesigned Community Services locality model. Good progress continued to made on the Clinical Excellence Programme Safe and high quality services had been maintained throughout the refurbishment of Starship Hospital and level 5. The increase in Paediatric Intensive Care admissions was noted. Advice was given that high intensity treatments were being performed. There was also an increase in the admission of long stay patients. This trend was also being observed internationally. The Chair expressed interest in receiving information on the progress of the quality research proposals approved as part of the Starship Foundation Research, Training and Education Programme. Action: That an update on the progress of the quality research proposals approved as part of the Starship Foundation Research, Training and Education Programme be provided within the Child Health directorate report when available. 5.6 Perioperative Services Directorate (Pages 69 to 76) Vanessa Beavis, Director Perioperative Services asked that the report be taken as read. Members queried the progress of the Single Instrument Tracking project. Advice was given that there had been no change in status and that further legal advice to inform how best to proceed was awaited. Hospital Advisory Committee Meeting 26 April 2017 Page 4 of 12 11

15 3 5.7 Cancer and Blood Directorate (Pages 77 to 83) Richard Sullivan, Director Cancer and Blood asked that the report be taken as read highlighting that the alignment project to realign services and space for implementation of a tumour stream approach had commenced. There were no questions. 5.8 Mental Health Directorate (Pages 84 to 98) Anna Schofield, Director Mental Health and Addictions asked that the report be taken as read highlighting the following: There had been increasing pressures in adult mental health due to growth in demand and acuity. The escalation plan to improve patient flow and access was now business as usual and assisting to manage flow however ongoing increases in demand were impacting on waitlists and creating work pressures for staff. Media and messaging relating to the release of the Peoples Review inquiry into the public mental health system had generated some discomfort for staff and potential negative perceptions of mental health services in the public. The Auckland housing market had resulted in a shortage of availability of rental facilities to accommodate respite care. The Child and Family Unit had commenced work on escalation planning for complex clients. Collaborative work with agencies on integrating the specialist stepped care model was in progress. Matters covered in response to questions included: A range of tools and actions had been implemented to ensure appropriate support for staff experiencing work pressures. Consideration was also being given to utilising resources differently to ease pressure on staff. The Strategic Facilities plan was on track and would be reported to the Committee in July. 5.9 Adult Medical Directorate (Pages 99 to 105) Barry Snow, Director Adult Medical asked that the report be taken as read highlighting the following: An unseasonal surge in demand had put pressure on acute flow and resulted in work pressures for staff. Staff health and wellbeing was imperative and had been identified as a key priority within the next Provider Services Business Plan. Despite these pressures there had been a sustained decrease in sick and annual leave taken by staff. Lee Mathias commented that the efficacy of the Ebola virus vaccine had been challenged in a Wall Street journal article and may warrant investigation. Hospital Advisory Committee Meeting 26 April 2017 Page 5 of 12 12

16 [Secretarial Note: item 5.12 was taken next] 5.10 Community and Long Term Conditions Directorate (Pages 106 to 114) Judith Catherwood, Director Community and Long Term Conditions asked that the report be taken as read. Clarification was sought regarding the process to reduce rescheduling rates. Advice was given that this was an activity of the Outpatients Improvement Programme. It was intended to reduce the number of appointments rescheduled by the service to demonstrate the value placed on patient time and choice. Judith Catherwood advised that recruitment for the Palliative Care service had been readvertised with good response received. The Chair requested that the Committee be kept informed on progress against the DNA action plan, with a particular focus on the Diabetes Service. Action That an update on the progress of the DNA Action Plan be provided to the Hospital Advisory Committee when available. [Secretarial Note: Item 5.13 was taken next] 5.11 Surgical Services Directorate (Pages 115 to 125) [Secretarial Note: this item was considered after Item 5.4] Arend Merrie, Director Surgical Services was welcomed by the Committee and asked that the report be taken as read. The unfavourable variance in revenue was noted. Advice was given that it was predominantly attributable to the increased number of transplants being performed above contract volumes and outsourcing in ophthalmology services to resource cataract surgeries. [Secretarial Note: Item 6.1 was taken next] 5.12 Cardiovascular Directorate (Pages 126 to 133) Samantha Titchener, General Manager Cardiovascular spoke to the report highlighting the following: The waitlist position for cardiothoracic surgery was positive The Room 1 Angiography Investigations Unit installation had been successfully completed It was asked whether or not the increases in the elective procedures waitlist could be attributed to population growth. Advice was given that clinicians had recently completed a validation process and needed to further analyse the data before reasons for increases could be formally confirmed. [Secretarial Note: item 5.10 was taken next] Hospital Advisory Committee Meeting 26 April 2017 Page 6 of 12 13

17 Non-Clinical Support Services (Pages 134 to 143) Rosalie Percival, Chief Financial Officer asked that the report be taken as read highlighting the following: An NZQA Level 3 graduation ceremony had been held on 13 March 2017 for Cleaners and Supervisors whom had successfully completed the qualification A further Workplace Literacy programme for staff had commenced in late February Cleaning services staff had continued to maintain high standards and receive positive feedback. The Inventory Management Category review was in progress. A brief discussion took place regarding the capacity and effectiveness of the Transition Lounge. It was noted that this area appeared to be very busy. A patient benefit of the way the transition lounge now operated was the wide range of qualified people available to ensure the patient was ready for discharge. The average wait time for patients in the lounge was dependent on the arrival time of their pick up. The Committee noted that the Transition Lounge appeared to be working very well and that renovations and further improvements were planned for approximately September It was observed that the figure appearing in the Support Services scorecard on page 135 of the agenda relating to the Voluntary turnover rate for less than one year appeared unusually high. Fiona Michel, Chief Human Resources Officer undertook to investigate and report back on this. Action That the Voluntary turnover rate figure appearing in the February 2017 Support Services scorecard be investigated Provider Arm Financial Performance Report (Pages 144 to 158) Rosalie Percival, Chief Financial Officer asked that the report be taken as read highlighting that the current position was behind target. Wash ups would address some issues however the Provider continued to struggle with personnel and outsourcing costs. This predominantly reflected FTE targets incorporated into the budget. That the Provider Arm Performance report for April 2017 be received. 6. INFORMATION REPORTS (Pages 159 to 163) 6.1 Patient Experience Update (Pages 159 to 163) [Secretarial Note: this item was considered after Item 5.11] Sarah Devine, Online Participation Manager spoke to the report. In 2015 the Board requested the development of a Net Promoter Score that would allow comparison with Waitemata DHB. To achieve this, Auckland DHB had included the Friends Hospital Advisory Committee Meeting 26 April 2017 Page 7 of 12 14

18 and Family Test question in the National Patient Experience Survey. From April 2016 Waitemata DHB had included the same question within its National Patient Experience Survey which has enabled comparison reporting. [Secretarial Note: Gwen Tepania-Palmer joined the meeting at 1.57pm]. Matters covered in response to questions included: The survey was carried out predominantly online by randomly selecting an extract of patients seen within a particular period. The National Patient Experience Survey required each DHB to survey 400 patients per quarter. The proportion of patients with was increasing with approximately 40% of patients across the DHB identifying as having an address. Surveys were also sent in hard copy by post for completion by writing if preferred. It was acknowledged that was more reliable than the postal service. The work relating to the Outpatient Model of Care within the Clinical Support directorate included improvements being made to patient correspondence including the and texting programmes. That the Hospital Advisory Committee receives the Patient Experience Update report. [Secretarial Note: Item 5.3 was taken next] 7. RESOLUTION TO EXCLUDE THE PUBLIC (Pages 164 to 167) Resolution: Moved James Le Fevre / Seconded Jo Agnew That in accordance with the provisions of Clauses 34 and 35, Schedule 4, of the New Zealand Public Health and Disability Act 2000 the public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below: General subject of item to be considered Reason for passing this resolution in relation to the item Grounds under Clause 32 for the passing of this resolution 1. Apologies That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] 2. Register and Conflicts of Interest As per that stated in the open agenda. That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] Hospital Advisory Committee Meeting 26 April 2017 Page 8 of 12 15

19 3 3. Confirmation of Confidential Minutes 15 March Confidential Action Points 5.1 Provider Services Business Plan 2017/ Seasonal Variation Plan Winter Elective Delivery Plan 2017/2018 Confirmation of Minutes As per the resolution(s) from the open section of the minutes of the above meeting, in terms of the New Zealand Public Health and Disability Act [NZPH&D Act 2000] Commercial Activities Information contained in this report is related to commercial activities and Auckland DHB would be prejudiced or disadvantaged if that information was made public [Official Information Act 1982 s9(2)(i)] Commercial Activities Information contained in this report is related to commercial activities and Auckland DHB would be prejudiced or disadvantaged if that information was made public [Official Information Act 1982 s9(2)(i)] Negotiations Information relating to commercial and/or industrial negotiations in progress is incorporated in this report and would prejudice or disadvantage if made public at this time [Official Information Act 1982 s9(2)(j)] Commercial Activities Information contained in this report is related to commercial activities and Auckland DHB would be prejudiced or disadvantaged if that information was made public [Official Information Act 1982 s9(2)(i)] Negotiations Information relating to commercial and/or industrial negotiations in progress is incorporated in this report and would prejudice or disadvantage if made public at this time [Official Information Act 1982 s9(2)(j)] Commercial Activities Information contained in this report is related to commercial That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in Hospital Advisory Committee Meeting 26 April 2017 Page 9 of 12 16

20 5.4 Women s Health Workforce Challenges and Strategy 6.1 Orthopaedic Services 6.2 Transplant Services activities and Auckland DHB would be prejudiced or disadvantaged if that information was made public [Official Information Act 1982 s9(2)(i)] Negotiations Information relating to commercial and/or industrial negotiations in progress is incorporated in this report and would prejudice or disadvantage if made public at this time [Official Information Act 1982 s9(2)(j)] Commercial Activities Information contained in this report is related to commercial activities and Auckland DHB would be prejudiced or disadvantaged if that information was made public [Official Information Act 1982 s9(2)(i)] Negotiations Information relating to commercial and/or industrial negotiations in progress is incorporated in this report and would prejudice or disadvantage if made public at this time [Official Information Act 1982 s9(2)(j)] Commercial Activities Information contained in this report related to commercial activities and Auckland DHB would be prejudiced or disadvantaged if that information was made public [Official Information Act 1982 s9(2)(i)] Negotiations Information relating to commercial and/or industrial negotiations in progress is incorporated in this report and would prejudice or disadvantage if made public at this time [Official Information Act 1982 s9(2)(j)] Commercial Activities Information contained in this report related to commercial activities and Auckland DHB would be prejudiced or disadvantaged if that information was made public [Official Information Act 1982 the disclosure of information which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 Hospital Advisory Committee Meeting 26 April 2017 Page 10 of 12 17

21 s9(2)(i)] Negotiations Information relating to commercial and/or industrial negotiations in progress is incorporated in this report and would prejudice or disadvantage if made public at this time [Official Information Act 1982 s9(2)(j)] 7.0 Quality Report Privacy of Persons Information relating to natural person(s) either living or deceased is enclosed in this report [Official Information Act s9(2)(a)] Prejudice to Health or Safety Information about measures protecting the health and safety of members of the public is enclosed in this report and those measures would be prejudiced by publication at this time [Official Information Act 1982 s9(2)(c)] 7.1 Complaints Privacy of Persons Information relating to natural person(s) either living or deceased is enclosed in this report [Official Information Act s9(2)(a)] Obligation of Confidence Information which is subject to an express obligation of confidence or which was supplied under compulsion is enclosed in this report [Official Information Act 1982 s9(2)(ba)] 7.2 Compliments Privacy of Persons Information relating to natural person(s) either living or deceased is enclosed in this report [Official Information Act s9(2)(a)] 7.3 Incident Management Obligation of Confidence Information which is subject to an express obligation of confidence or which was supplied under compulsion is enclosed in this report [Official Information Act 1982 s9(2)(ba)] Privacy of Persons Information relating to natural person(s) either living or deceased is enclosed in this report [Official Information Act s9(2)(a)] [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information which good reason for withholding would exist under any of sections 3 Hospital Advisory Committee Meeting 26 April 2017 Page 11 of 12 18

22 7.4 Policies and Procedures (Controlled Documents) Obligation of Confidence Information which is subject to an express obligation of confidence or which was supplied under compulsion is enclosed in this report [Official Information Act 1982 s9(2)(ba)] Prejudice to Health or Safety Information about measures protecting the health and safety of members of the public is enclosed in this report and those measures would be prejudiced by publication at this time [Official Information Act 1982 s9(2)(c)] Commercial Activities Information contained in this report related to commercial activities and Auckland DHB would be prejudiced or disadvantaged if that information was made public [Official Information Act 1982 s9(2)(i)] 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] That the public conduct of the whole or the relevant part of the meeting would be likely to result in the disclosure of information which good reason for withholding would exist under any of sections 6, 7, or 9 (except section 9(2)(g)(i)) of the Official Information Act 1982 [NZPH&D Act 2000] Carried The meeting closed at 3.56pm. Signed as a true and correct record of the Hospital Advisory Committee meeting held on Wednesday, 26 April 2017 Chair: Judith Bassett Date: Hospital Advisory Committee Meeting 26 April 2017 Page 12 of 12 19

23 Action Points from Previous Hospital Advisory Committee Meetings 4 As at Wednesday, 07 June 2017 Meeting and Item Detail of Action Designated to Action by 16 Sep 2015 Item Mar 2017 Item Mar 2017 Item Mar 2017 Item 5.12 Auckland Integrated Cancer Centre That the Strategic Assessment for the Auckland Integrated Cancer Centre business case be provided to the HAC December meeting. Update: discussions are occurring across the northern region relating to the development of a programme business case. Clinical Support Services Report (MRI Update) That the Hospital Advisory Committee be kept informed of the progress of the MRI accreditation initiative. Adult Medical Directorate Report (imoko tool) That a review of the imoko application tool be undertaken to determine its suitability for use within the Auckland region. Cardiovascular Directorate Report (Nursing Education Model) That regular updates on the progress of the review of the Nursing Education model within Cardiovascular Services be made within the Cardiovascular Directorate report. R Sullivan 7 June 2017 verbal update to be provided at the meeting I Costello 19 July 2017 complete (refer to Item 5.3 of this agenda) B Snow 19 July 2017 M Edwards 19 July Apr 2017 Item 5.5 Child Health Directorate Report: Quality Research Proposals J Beca, M Shepherd 30 August 2017 That an update on the progress of the quality research proposals approved as part of the Starship Foundation Research, Training and Education Programme be provided within the Child Health directorate report when available. 26 Apr 2017 Item 5.10 Community and Long Term Conditions Directorate That an update on the progress of the DNA Action Plan be provided to the Hospital Advisory Committee meeting when available. J Catherwood 30 August

24 26 Apr 2017 Item 5.13 Non-Clinical Support Services Report: Voluntary turnover rate on the February 2017 scorecard That the Voluntary turnover rate figure appearing in the February 2017 Support Services scorecard be investigated. F Michel Completed (clarification ed to Committee members on 4 May 17) 21

25 Provider Arm Performance Report Recommendation That the Hospital Advisory Committee receives the Provider Arm Performance report for June Prepared by: Joanne Gibbs (Director Provider Services) Endorsed by: Ailsa Claire (Chief Executive) Board Strategic Alignment Community, whanau and patient-centred model of care Emphasis/investment on both treatment and keeping people healthy Service integration and/or consolidation Intelligence and insight Evidence informed decision making and practice Outward focus and flexible service orientation Operational and financial sustainability Our Daily Hospital Functioning, Deteriorating Patients and Afterhours Inpatient Safety work programmes directly led to reviewing and enhancing patient safety practices and outcomes; we are currently transitioning to the 24/7 Hospital Functioning model of care. The FCT, ED and elective discharge targets focus on timely access to early interventions and effective treatments. Our Using the Hospital Wisely work programme aims to reduce pressure on our hospital services through improvement to processes, pathways and use of services. We have developed a database to capture data for the identified measures for the Deteriorating Patients work programme. The new 24/7 Hospital Functioning model of care will enhance clinical leadership 24/7 to support staff and make care for our patients safer, increase the number and capability of clinical leaders in the afterhours team, introduce a 'Patient at Risk' model and streamline bed management. Our Outpatients Model of Care work programme aims to review our current model of care to ensure we provide a high quality outpatient service and experience that is patient centric. To provide assurance of delivery of the three year financial savings plan we have introduced the Provider Financial Sustainability programme which has been endorsed by the Finance, Risk and Assurance Committee. 2. Executive Summary The Executive Team highlight the following performance themes for the June 2017 Hospital Advisory Committee meeting: The Emergency Department (ED) target was met by both AED and Child Emergency Department (CED) during this reporting period, in spite of increased attendance. Elective discharge performance against plan is 97.2% YTD (including orthopaedics). Faster Cancer Treatment quarterly performance for the current building six months Q4 is 81.4% as at 5 May The Provider Scorecard has been reviewed; a finalised scorecard is being presented to the Committee for on-going use. The Provider Services Business Plan has been refreshed for 2017/18 (refer to Confidential Item 5.2 of this agenda). The Directorate Business Plans have also been refreshed for 2017/18 and have been attached to the respective Directorate reports. 22

26 3. Progress/Achievements/Activity Emergency Department patients with an ED stay of less than 6 hours Both Emergency Departments achieved the target during this reporting period, in spite of increased attendance. AED recovered to report 95.87% while CED reported 96.05%. Elective discharge cumulative variance from target Elective discharge performance against plan is 97.2% YTD (including orthopaedics). We continue to project 100% performance against plan for year-end (not including orthopaedics); 98% including orthopaedics. Provider Scorecard As reported at the April Committee meeting, the Provider Scorecard is in the process of being reviewed. Changes include the introduction of a current year (17/18) target as well as the end state target. The finalised scorecard is being presented to the Committee for on-going use. Directorate Business Plans for 2017/18 The Directorate Business Plans have been refreshed for 2017/18 and have been attached to the respective Directorate reports. Provider Services 2016/17 Business Plan Using the Hospital Wisely Programme The Programme Board has prioritised the initial areas of focus to be discharge planning, clinical pathways, and palliative care. Subsequent work streams to increase Day of Surgery Admissions and to remodel and realign bed allocation have recently commenced. Discharge Planning Update Results of the ward self-assessment against discharge planning best practice continue to be shared with ward teams. Ward teams are being asked to select an area for local-led improvement, identify a lead, form a team, and develop a plan for improvement. Wards 34, 41 and 42 are focussing on increased use of the transition lounge on discharge. Workshops identifying opportunities were held in May. 23

27 Ward 66 General Medicine has commenced a holistic discharge planning project with additional support from the Community and Long Term Conditions Directorate to ensure increased best practice adoption and utilisation of community options for patients to reduce hospital stay. A work stream to improve predictability of length of stay for elective patients is progressing. System issues have been identified such as: - Length of stay has been predicted based on procedure codes on discharge; however these codes are different in the system used for booking patients so cannot be used. - The form used by clinicians in pre-admit to document estimated length of stay is tick-box and does not have the required granularity: one option is 3-7 days 5.1 Pathways Update The cellulitis pathway launch date is set for June 12. The introduction of the following improvements is expected to improve clinical care, patient experience and reduce hospital bed days by over 1,000 days per year: - Revised regional clinical pathway decision making tool - A paper based hospital clinical pathway tool - Introduction of a Cellulitis Coordinator role performed by the Rapid Response team - Introduction of To Take Away (TTA) oral antibiotics in ED and APU Chronic Care Pathways for COPD and Congestive Heart Failure (CHF) have been prioritised by the UHW programme board as next pathways to address. - A regional approach will be pursued. Regional synergy exists as both COPD and Heart Failure were identified as key to all 3 DHBs in a recent System Level Measures workshop. - The UHW programme board agreed to support ADHB clinicians to attend the Health Round Table Chronic Care workshops with a focus on COPD and CHF at the end of August. Palliative Care Update A work plan has been agreed with a focus on: - Earlier identification of palliative patients - Moving to a 7-day model - Increased use of community services - Further support of Goals of Care initiative to improve care in hospital Key measures for palliative care and support for patients in their final year of life is under development with support from the Business Intelligence team Day of Surgery Admissions Currently working to establish service specialty leads to drive increased DOSA rates. Bed Modelling and Realignment A team is currently forming with the aim to realign ward allocation and workforce to meet projected patient demand and gain efficiency by collocating services with synergies 24

28 The programme board is also continuing to review existing improvement work and identify new areas for improvement. An approach to disseminate and increase service level ownership for Health Round Table reports was agreed by the UHW programme board in May. The aim is to increase awareness of opportunity identification through the use of benchmarking at a service level. Faster Cancer Treatment Quarterly performance for the current building six months Q4 is 81.4% as at 5 May While the likelihood of a decrease was signalled in January, it has become more visible as we commence Q4 reporting due to the loss of the high performing months (October December 2016). A total of 21 HSC cases have breached the FCT 62 day target thus far during Q4. 8 are attributed to patient choice, 3 due to clinic consideration and 10 related to capacity issues over the Christmas / New Year period. The performance of the Gynae tumour stream (58.8%) has had the most significant impact on performance. A 90 day plan (May July 2017) has been implemented which focuses on areas that require improvement. The ability to forecast a Q4 performance position is limited due to the volume of interim HSC cases awaiting diagnostics. An audit of interim HSC cases indicates that there are an additional 18 cases with confirmed cancer awaiting first treatment that will breach in Q4. Key risks have been identified that are likely to impact further on Q4 performance and actions to mitigate these risks have been proposed. Actions include a focus on the following: - Oversight will be stepped up, and include a weekly breech meeting with the FCT team, and other services invited to speak to mitigation strategies. - Timeliness of triaging across various Services, with Women s Health and ORL (ENT) subject to constant monitoring. - Gynaecology 90 Day Plan (May July 2017) includes actions to address timeliness of SMO triage and attention to increasing post-menopausal bleeding rapid access clinics. SMO leave cover is to be improved to support this work. - HSC referrals less than anticipated, so specific attention to tracking these is underway. - Head and Neck ORL (ENT) triage process, with escalation to Clinical Director Surgical Services for resolution. - Radiology capacity to meet demand, with escalation to Director, Clinical Support. - Radiation Oncology capacity to meet demand, with SMO recruitment for current vacancies completed, SMO job sizing and work programme planning, including templating for FSAs, review of pathways and increased visibility of HSC cases. 25

29 24/7 Hospital Functioning Transition: Afterhours Inpatient Safety, Daily Hospital Functioning and Deteriorating Patients Programmes As outlined in the previous report, the Provider Group has made the decision to move to the new 24/7 Hospital Functioning Model of Care and Structure. Transition to the new model commenced in February 2017 and is being led by a Steering Group formed to ensure alignment of the contributing work programmes, manage risks and provide overall guidance. Our new operating model will further improve the care we provide 24/7, especially to those patients who are most at risk. Our new model has four areas of focus, which together will enable us to provide safer, more patient-centred care: - Deteriorating Patients - We're improving our hospital-wide system for identifying, monitoring and managing patients at risk (PAR) and introducing new multidisciplinary PAR care teams. - Clinical Nurse Managers - We're placing nursing leadership closer to our patients, especially afterhours, through our new Clinical Nurse Manager roles, which have a hospital wide focus on patient care. - More seamless handovers - We're putting in place a more systematic approach to handovers between clinical teams that are interdisciplinary and patient-focussed. - Patient flow initiatives - We're looking at new ways for patients to move through the Hospital, in both acute and elective flow, to ensure they receive the right care, in the right place at the right time. Appointees will start their new roles on 23 June, followed by a period of education and training which will focus on both clinical and non-clinical competencies. Contingency plans have been developed for roles where we have insufficient recruitment numbers to date, namely Clinical Nurse Manager and PAR Nurse Specialist (Child Health). We will continue to advertise these roles to ensure we recruit the full complement of staff. A communications plan has been developed to communicate an overview of the new model to all ADHB staff and is currently being rolled out throughout the organisation. A more focused communications plan from the project is also being developed to provide additional detail for key stakeholders. A RASCI (Responsible, Accountable, Support, Consulted, Informed) matrix has been developed which outlines the 24/7 Hospital Functioning operating model roles and accountabilities. A workshop was held to gather information to assist in the implementation of the new operating model, including the new CNM and PAR roles. A safety briefing framework has been drafted for Starship Child Health and is in the process of being adapted for the adult hospital. 5.1 While the safety net of afterhours Duty Managers and Bed Managers is still in place a 48 hour PDSA will be conducted to trial the new patient transfer process and the new roles and responsibilities to identify: - Current proportion of standard versus non-standard transfers - Current barriers to increasing the proportion of standard transfers 26

30 - Whether the proposed workload for Acute Flow Co-ordinators is feasible in the new operating model - What is will take to make this approach work effectively in future Two PDSA patient flow trials will take place during June. Recommendations will be developed based on analysis of the trials. Outpatients Model of Care Programme Programme vision statement agreed by key stakeholders and patient-centric format developed: Our Vision: Our outpatient services are easy to access, easy to understand, and available at a time, place and method that meets your needs and reduces unnecessary travel to our hospitals. Programme charter endorsed by Programme Board and awaiting sign-off by executive sponsor and programme lead Dual workstream programme approach (Current State and Transform) endorsed by Programme Board including phasing of Transformation stream First phase 1 project for Transform stream selected by Programme Board (Alternative Methods of Reporting of Results AMODOR) and project initiated Directorate level engagement and service specific outpatient footprint analysis commenced to identify further phase 1 priorities for scoping and prioritisation by programme board Telephone Interpreters project solutions endorsed and ongoing operational deployment handed back to business owners from late February 2017 (as part of Current State stream) 27

31 Regional outpatient programme forum established including discussion on areas for collaboration within Current and Transform streams. Access Booking and Choice policy generating interest and to be shared with metro DHBs once finalised Site visit to Waikato DHB to view Smart Health/ HealthTap platform and investigate future areas for cooperation In-depth analysis of patient experience data completed including consumer demand for alternative care delivery models. First Transformation stream consumer consultation (with Accessibility Reference Group) to occur in early June

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33 Better Quality Care Patient Safety Auckland DHB Provider Scorecard for April 2017 Measure % AED patients seen within triage time - triage category 2 (10 minutes) % CED patients seen within triage time - triage category 2 (10 minutes) PR006 PR008 Target 17/18 Actual End State Target Prev Period >=80% 79.47% >=80% 84.27% >=80% 87.2% >=80% 96.92% Commentary CommentCurrent 5.2 Total number of reported incidents PR Number of reported adverse events causing harm (SAC 1&2) Central line associated bacteraemia rate per 1,000 central line days Healthcare-associated Staphylococcus aureus bacteraemia per 1,000 bed days Healthcare-associated bloodstream infections per 1,000 bed days - Adult Healthcare-associated bloodstream infections per 1,000 bed days - Child PR084 PR087 PR088 PR089 PR090 <= <= <=1 0 <=1 0 <= <= <= <= <= <= Falls with major harm per 1,000 bed days PR095 <= <= Nosocomial pressure injury point prevalence (% of in-patients) Rate of hospital-onset healthcare-associated Clostridium difficile inpatients >=16 years of age per 10,000 bed days (ACH) (Quarterly) * Nosocomial pressure injury point prevalence - 12 month average (% of in-patients) PR097 PR143 PR185 <=6% 2.14% <=6% 3.27% <= <= <=6% 3.48% <=6% 3.73% % Hand hygiene compliance PR195 >=80% 83.46% >=80% 82.73% Unviewed/unsigned Histology/Cytology results >= 90 days PR Significant progress over several months. Strategy agreed w ith Provider Group. to review the final tranche and ensure on-going management and governance. Quarterly review planned at Provider Group. (MOH-01) % AED patients with ED stay < 6 hours PR013 >=95% 95.87% >=95% 93.57% (MOH-01) % CED patients with ED stay < 6 hours PR016 >=95% 96.05% >=95% 94.57% % of inpatients on Reablement Services Wait List for 2 calendar days or less PR023 >=80% 92.45% >=80% 95.26% HT2 Elective discharges cumulative variance from target PR035 >= >= YTD total ADHB elective discharges to end of April are currently show ing 97.2% (a shortfall of 392 discharges). Orthopaedics (adult & Paed combined) are contributing 415 YTD to the shortfall. (ESPI-2) Patients waiting longer than 4 months for their FSA PR038 0% 0.33% 0% 0.21% (ESPI-5) Patients given a commitment to treatment but not treated within 4 months PR039 0% 3.8% 0% 4.11% ESPI 5 non-compliance is driven by Orthopaedics. 163/183 breeches are ortho patients. Cardiac bypass surgery waiting list PR042 <= <= % Accepted referrals for elective coronary angiography treated within 3 months PR043 >=90% 99.28% >=90% 97.79% % Urgent diagnostic colonoscopy compliance PR044 >=85% 76.09% >=85% 100% Compliance for April has not met due to a scheduling error. We are to be fully compliant in May 2017 after extensive w ork in rectifying the errors. % Non-urgent diagnostic colonoscopy compliance PR045 >=70% 93.84% >=70% 91.56% The majority of vacancies have been filled, but it has proven difficult to recruit experienced % Outpatients and community referred MRI completed < 6 weeks PR046 >=85% 55.86% >=85% 66% MRTs in to these roles. The majority of new recruits are recent graduates w ho require a further six months post-graduate training to be able to perform MRIs. In addition, overseas appointees must undergo this training as previous experience is not recognised by the New Zealand regulator. Outsourcing has also commenced. % Outpatients and community referred CT completed < 6 weeks PR047 >=95% 94.24% >=95% 96.68% Elective day of surgery admission (DOSA) rate PR048 >=68% 68.5% >=68% 68.84% % Day Surgery Rate PR052 TBC 53.92% >=70% 52.98% There has been a 0.94% improvement in day surgery rates for surgery. The sustained improvement in day of surgery admissions indicate this is genuinely linked to a more complex casemix delivered through ADHB. Inhouse Elective WIES through theatre - per day # PR053 >= >= % DNA rate for outpatient appointments - All Ethnicities PR056 <=9% 9.35% <=9% 9.28% % DNA rate for outpatient appointments - Maori PR057 <=9% 19.92% <=9% 19.68% % DNA rate for outpatient appointments - Pacific PR058 <=9% 17.19% <=9% 18.19% DNA for Maori have increased slightly since the last report. Having the appropriate resources to provide continual commitment has been an issue. Tautai Fakataha (The Pacific Navigators) continue to follow up call-backs to Oncology clinic appointments and Children w ith Club foot. Average LOS for WIES funded discharges (days) PR074 <= <= Day Readmission Rate - Total # PR078 <=8% 9.56% <=6% 11.04% Mental Health - 28 Day Readmission Rate (KPI Discharges) to Te Whetu Tawera Mental Health Average LOS (KPI Discharges) - Te Whetu Tawera % Very good and excellent ratings for overall inpatient experience # PR119 <=10% 5.26% <=10% 10.64% <= <= # PR154 >=90% 84.51% >=90% 82.41% Number of CBU Outliers - Adult PR % Patients cared for in a mixed gender room at midday - Adult 31/62 day target % of non-surgical patients seen within the 62 day target 31/62 day target % of surgical patients seen within the 62 day target 62 day target - % of patients treated within the 62 day target % Chemotherapy patients (Med Onc and Haem) attending FSA within 2 weeks of referral % Radiation oncology patients attending FSA within 2 weeks of referral PR120 PR175 <5% 12.94% 0% 14.73% # PR181 >=85% 87.5% >=85% 88.89% # PR182 >=85% 84.62% >=85% 86.36% # PR184 >=85% 86.08% >=85% 87.6% TBC TBC TBC TBC Readmissions slightly improved. Improvement w ork in progress. This high monthly Av. LoS was primarily driven by 3x discharges of >110 days. Driver analysis completed of dimensions w here improvement w ill have most impact on overall ratings. Directorate level analyses to be completed over next month. Incresed number of General Medical patients and acute volume in speciality services saw this as a challenge in April. Review KPI w ith Nurse Leads and refresh best practice. 29

34 Improved Health Status Breastfeeding rate on discharge excluding NICU admissions % Long-term clients with wellness plans in last 12 months Increase in demand for April, w ith 43% CS rate and w orkforce deficits contributed to a # PR099 >=75% 72.12% >=75% 73.67% reduction in overall exclusive BF rate. Recruitment to LC 1.2 FTE vacancy underw ay. 40% TBC % Hospitalised smokers offered advice and support to quit PR129 >=95% 94.57% >=95% 95.14% = Variance from target not significant enough to report as non-compliant. This includes percentages/rates w ithin 1% of target, or volumes w ithin 1 Amber value from target. # = Actual is the latest available result prior to April * = Quarterly measure PR143 (Quarterly) Actual result is for the period ending March Previous period result is for period ending December

35 Clinical Support Directorate Speaker: Ian Costello, Director 5.3 Service Overview The Clinical Support Directorate is comprised of the following service delivery groups; Hospital Daily Operations (including transit, resource, nursing bureau and reception), Patient Services Centre (Administration, Contact Centre and Interpreter services), Allied Health Services (including Physiotherapy, Occupational Therapy, Speech Language Therapy, Social Work and Dietetics), Radiology, Laboratory including community Anatomical Pathology, Gynaecological Cytology, Clinical Engineering and Pharmacy. The Clinical Support Services Directorate is led by: Director: Ian Costello General Manager: Kelly Teague Director of Nursing: Joyce Forsyth Director of Allied Health: Moses Benjamin Director of Primary Care: Dr Barnett Bond Directorate Priorities for 16/17 In 2016/17 our Directorate will contribute to the delivery of the six Provider Arm work programmes. In addition to this we will also focus on the following Directorate priorities: 1. Develop and implement a robust strategy for each service working in collaboration with other Directorates to deliver agreed priorities aligned to Auckland DHB s strategy. 2. Implement an appropriate leadership and organisational structure for each service to deliver on the agreed priorities. 3. Develop workforce, capacity and people plans for each of our services that support quality, efficiency and alignment with Auckland DHB values in delivering the organisational priorities. 4. Embed a discipline of quality driven activity, financial responsibility and sustainability in each service area and across the Directorate through further utilisation of MOS and other enablers. To enhance visibility of this through improved reporting and analysis against agreed priorities with key stakeholders. 5. To identify and implement collaborative opportunities with the University of Auckland, AUT and other potential partners to deliver improvement in quality, outcomes, research and joint ventures. 6. Achieve Directorate financial savings target for 2016/17. 31

36 Q4 Actions 90 and 180 day plan Priority Action Plan 1 Laboratory leadership structure consultation June 17 Pharmacy and Medicines strategy- Phase 2 implementation underway 2 Leadership appointments, orientation and induction programmes are underway in Allied Health MOS system established and functional at Directorate and departmental level in the following areas: Pharmacy, Daily Operations, Radiology, Laboratories and Clinical Engineering and recently in the AH cluster of services 3 Workforce planning completed in Pathology. Model to be applied across specialities and professions within the Laboratory Data and reports to support capacity planning in Radiology and Laboratories developed Four Clinical Support Staff members attending the next phase of the Improvement Practitioner (Green Belt) training Four Clinical Support Staff members attending the Coaching Programme Four Senior Clinicians/Managers attending Leadership Development Course. Next cohort identified 4 Introduce regular integrated Clinical Governance and quality meetings at service level Automation of Directorate Scorecard is underway Pharmacy and Clinical Engineering scorecards to be established Financial objectives set for each Department, monitoring and reporting process centralised at Directorate level Operational forecasting and planning - Production planning integrated with Daily Ops function supports weekly Capacity and Demand forum and seasonal plan development 5 Collaboration Steering Groups agreed with University of Auckland for Pharmacy, Radiology and Laboratories 6 Savings plan developed and risk assessed Interpreter services pilot completed. Transition to business as usual to Jun 17 Measures Measures Actual Target (End 16/17) Strategy and priorities agreed for each service Consultations Labs and documents Radiology published leadership structure approved by June 17 Daily Ops Dec 16 Leadership structures implemented Consultations documents published Labs and Radiology implemented by Jul17 Previous Period Pharmacy implemented Daily ops implemented Pharmacy and AH implemented 32

37 Measures Actual Target (End 16/17) Succession plans in place for key roles Key roles Key roles have identified leadership development plan within each department Workforce, capacity and quality outcome measures developed for all services Strategic plans agreed for collaborations with the University of Auckland and Unitec Breakeven to budget position and savings plan achieved Workforce and capacity data collection underway MoU s in development Savings plan developed. Suite of business management and quality reports in development. Workforce, capacity plans: Pharmacy completed Pathology completed Labs completed Radiology Jul 17 Steering groups established for Pharmacy, Radiology, Labs Breakeven Detailed business management and quality reporting implemented Previous Period n/a n/a n/a n/a 5.3 Key achievements in the month Radiology Service Manager appointed and to commence in July 2017 Clinical Engineering is compliant against our IPM programme at 96% for 17,200 medical devices Blood Sciences Upgrade project on track subject to additional funding for environmental and utility changes Delphic version 9 AP went live IANZ re-accreditation achieved in Radiology Agreement reached with Unitec around the MRT student placement and training strategy Key issues and initiatives identified in coming months Work through the Corrective Actions from International Accreditation New Zealand (IANZ) for Laboratories and Forensic Pathology Construction of substation outside the Forensic Pathology Department Continue progress on implementation of an Integrated Daily Operations Centre 33

38 Engaged Workforce Better Quality Care Patient Safety Continue to improve the process for patients receiving their appointment letters Continue with implementation of the Interpreter improvement project Orderly Service to commence review of patient dispatching and management of patient transfers Radiology waiting list recovery plan and strategic plan for MRT workforce planning Consult on Pathology and Laboratories leadership structure Work is underway to review and align our Radiology services with clinical pathways and organisational strategy and priorities. A visioning document is in development, including proposals for service structure, clinical configuration and clinical and quality metrics. This will cover the short and medium term. A longer term strategy will be developed through the Long Term Investment Plan (LTIP). Development of reports with BI to support efficient utilisation of our services Implement new MRT training strategy Scorecard Measure Auckland DHB - Clinical Support Services HAC Scorecard for April 2017 Actual Target Prev Period Medication Errors with major harm Number of reported adverse events causing harm (SAC 1&2) Number of complaints received % Outpatients and community referred MRI completed < 6 weeks % Outpatients and community referred CT completed < 6 weeks % Outpatients and community referred US completed < 6 weeks 5 No Target % >=85% 66% 94.24% >=95% 96.68% 85% >=95% 88.2% Excess annual leave dollars ($M) % Staff with excess annual leave > 2 years % Staff with excess annual leave and insufficient plan to clear excess by the end of financial year Number of Pre-employment Screenings (PES) cleared after the start date Sick leave hours taken as a percentage of total hours worked % Voluntary turnover (annually) % Voluntary turnover <1 year tenure $ $ % 0% 7.61% R/U 0% R/U % <=3.4% 3.4% 10.76% <=10% 10.95% 5.66% <=6% 6.96% Amber R/U Variance from target not significant enough to report as non-compliant. This includes percentages/rates w ithin 1% of target, or volumes w ithin 1 value from target. Not applicable for Engaged Workforce KRA. Result unavailable % Staff w ith excess annual leave and insufficient plan to clear excess by the end of financial year Result unavailable. Scorecard commentary Radiology Overall: Performance against the MoH indicators across modalities has decreased in April 2017 due to staff leave and unplanned absence impacting capacity. Recruitment strategies and staff training combined with process improvement activity and short term outsourcing will have a positive impact on the waitlist over the coming months. 34

39 MRI Performance against the MRI target of 85% of referrals completed within six weeks has deteriorated in April 2017 (55.86%) compared to performance in March 2017 (66%). The majority of vacancies have been filled, but it has proven difficult to recruit experienced MRTs in to these roles. The majority of new recruits are recent graduates who require a further six months post-graduate training to be able to perform MRIs. In addition, overseas appointees must undergo this training as previous experience is not recognised by the New Zealand regulator. 5.3 A number of challenges still remain with specialist investigations, especially congenital cardiac services, due to acute staffing issues. Directorates are working in collaboration to rectify this issue. The number of adult patients waiting longer than 42 days has increased to 325 patients in April 2017 compared to 140 patients at the end of March The number of paediatric patients waiting longer than 42 days has increased to 26 patients in April 2017 compared to 0 at the end of March A recovery plan is in place involving short, medium and long term strategies. Outsourcing to external providers was delayed due to contractual negotiations being more prolonged than expected but has commenced. This should flow through and impact performance against the MOH target over the next 6 weeks. Medium term we have recruited additional MRT graduates to provide succession planning and mitigate future occurrence of the recruitment gap. Longer term, workforce planning strategies are being developed with the training institutions. Agreement has been reached with Unitec around the MRT student placement strategy, including employment of tutors and numbers and placement of students Scoping the potential for a collaborative approach to training, support and utilisation of MRT staff across the three Auckland DHBs may also be of value. CT Performance against the MoH indicator of 95% of out-patients completed within six weeks has slightly deteriorated in April 2017 and is currently at 94.24% compared to 96.68% March A reliable service model is in place and there is a high degree of confidence that performance against this target will improve and be maintained over the coming months as recruitment to vacant posts continues. Ultrasound While this is an internal target (95%) we are mindful of the importance of patient access to service and safe waitlist management. Performance against this target has shown a slight deterioration to 85% of out-patients scanned within 6 weeks in April 2017 compared to 88.2% in March We continue to work on long term solutions to manage demand, for example, through direct communication with all GP referrers and providing clinical advice and guidance where required. Complaints There were 5 complaints received in April 2017 compared to 8 in March 2017, relating to communication issues and clinical decision making. We are reviewing options for customer service training for all booking, scheduling and Patient Contact Centre staff. The Directorate has recently introduced a complaints action plan database to ensure that actions are complete and that a lessons learnt approach is adopted which will be shared across all departments. 35

40 Incidents There were 3 medication incident in April 2017, two related to adverse reactions to contrast media and one related to extravasation of contrast media causing tissue damage requiring intervention. Unit / Ward Incident type tier two Datix ID Generic name Radiology Auckland Other 1106 Radiology Auckland Other 1112 iohexol Radiology Green Lane Allergy/ADR 1577 iohexol There was one fall incident reported for April 2017 A patient fell down while trying to get into bed for an Ultra sound test. She was an ambulatory patient who walked into the clinic on her own. The patient did not sustain any injuries. Quality and Patient Safety leads have been identified in each service to form the Directorate Quality, Safety and Governance Committee. Quality markers are being developed through this group for all our services together with an annual Clinical Audit Programme that aligns to corporate and Directorate strategies. Clinical Engineering has further increased compliance against the Safety Maintenance programme and has now reached 98% compliance for over 17,000 medical devices. The pilot of telephone interpreting consultations continues within a number of clinics within the Long Term Conditions and Surgical Directorates. The aim is to reduce waiting times and increase capacity in our interpreting services. Discussions on the potential for collaboration around Interpreting Services have begun with Counties Manukau DHB and Waitemata DHB. The Directorate is developing a strategic approach to education, training and research across a range of professions. A key element is the development of a strategic partnership with Auckland University through the Academic Health Alliance. Steering Committees have been formed with the University to review opportunities for collaboration in Pharmacy, Pathology and Radiology. The Directorate Health and Safety Committee continues to have oversight of Health and Safety issues in the Directorate. Each department has developed a risk register which in turn escalates to the Directorate Register. A gap analysis has been undertaken across the directorate to determine the training requirements for Health and Safety Representatives. A monthly HR report has been developed for the Directorates Senior Leadership to review and take action with regards to improving excess annual leave, sick leave and voluntary turnover. A mandatory training database has been developed for the Directorate to ensure all staff have the relevant training to support safety and competency requirements within each of our services. Auckland DHB values workshops have been undertaken in several departments with a view to a roll out. The Engagement Survey results have been analysed for each service. Initial analysis has identified areas for improvement in a number of services around engagement, awareness of strategy, workload and culture. Feedback to staff and support for our service leadership teams will be important to address the findings and improve staff engagement. The Speak up Campaign has been launched across all of our services through presentations and workshops. This year will see significant service transformation and strategy development in many of our services which will require staff engagement for this is to be successful. Support for senior managers across the directorate is being developed with the support of the Organisational Development department. 36

41 Financial Results STATEMENT OF FINANCIAL PERFORMANCE Clinical Support Services Reporting Date Apr-17 ($000s) REVENUE MONTH YEAR TO DATE (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance Government and Crown Agency 1,407 1,659 (251) U 14,976 16,534 (1,558) U Funder to Provider Revenue 2,982 2,982 0 F 30,266 30,266 (0) U Other Income 1,082 1,218 (136) U 12,102 11, F Total Revenue 5,471 5,858 (387) U 57,344 58,512 (1,168) U 5.3 EXPENDITURE Personnel Personnel Costs 10,184 10, F 102, ,026 5,952 F Outsourced Personnel (398) U 4, (3,670) U Outsourced Clinical Services F 5,814 5,049 (765) U Clinical Supplies 3,397 4, F 38,776 38,712 (64) U Infrastructure & Non-Clinical Supplies (344) U 5,277 4,515 (762) U Total Expenditure 15,240 15, F 156, , F Contribution (9,769) (10,079) 310 F (98,716) (98,240) (476) U Allocations (7,459) (7,686) (227) U (78,588) (78,805) (217) U NET RESULT (2,310) (2,393) 83 F (20,128) (19,435) (693) U Paid FTE MONTH (FTE) Comments on major financial variances - Clinical Support Services YTD result is $693 K U. The key drivers of this result are: YEAR TO DATE (FTE) (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance Medical F F Nursing F F Allied Health F F Support (1.3) U (2.1) U Management/Administration (2.4) U (0.5) U Total excluding outsourced FTEs 1, , F 1, , F Total :Outsourced Services (18.0) U (18.9) U Total including outsourced FTEs 1, ,403.7 (5.4) U 1, , F 1. Revenue is below budget in Radiology due to planned additional revenue for Clot Retrieval not yet received $1,541K, offset by on call roster not implemented and additional service billing so cost neutral for directorate. Other income is favourable due to a combination of increased Clinical Trial revenue in Pharmacy and Radiology, due to sale of assets. 2. Personnel costs including outsourced are $2,282K F to budget due to vacancies and cost per FTE being below budget reflecting initiatives to reduce overtime and other premium payments. 3. The main contributor to Outsourced Clinical Supplies is MRI scans in Radiology to meet Ministry of Health targets. 4. Internal allocations are lower than budget reflecting organisational volumes being below contract. 37

42 Transition Lounge utilisation and future plans to support patient flow The Transition Lounge has been steadily increasing patient services for both inpatient discharge and Day of Surgery (DOSA) admission since it became fully operational in Use of the Transition Lounge has increased steadily over the last 3 years Total Usage of Transition lounge Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec The DOSA patient pilot was successful and patients arriving for surgery for Level 8 Theatres and Level 4 Theatres are now routinely admitted through the Transition Lounge instead of waiting at main reception. Ward discharge via the Transition Lounge is a focus of a current Green Belt project led by Gareth Stanney, Patient Flow Manager. The Green Belt project will concentrate on increasing utilisation of the Transition Lounge by the Cardiac Directorate wards 31, 34, 41 and 42. The current rate of inpatient discharges from these wards via Transition Lounge is 11%. It is envisaged this project and ongoing work to facilitate more rapid discharge, led by the Discharge Planning Group, will increase overall use of the lounge for discharge patients. 38

43 The forecasted daily increase of patients is providing a baseline for the proposed expansion of the lounge with a business case for the next phase of facilities work nearing completion. Actual daily occupancy 5.3 Projected daily occupancy From August 2016 the Pharmacy Department has piloted a medicines discharge service in the transition lounge in collaboration with transition lounge staff. The clinical pharmacist conducts medicines reconciliation and review, provides medication education and facilitates medicines supply to discharge patients. A post discharge medicines helpline has also been established. The pharmacist conducts medication reviews for 23% of Transition Lounge patients and 1 in 6 patients have one or more discharge medication-related errors corrected. A user survey indicates that the service is extremely valued by patients (95% satisfaction rate). The pilot is due to end in July 2017 and a business case is in development. 39

44 Date: April 2017 A3 owner: Ian Costello Clinical Support Directorate Key priorities for Clinical Support Directorate In 2017/18 our Directorate will contribute to the delivery of the Provider Arm work programmes. In addition to this we will also focus on the following Directorate priorities: 1. Begin implementation of the agreed 5 year strategies for Daily Operations, Pathology & Laboratory Medicine Services, Radiology and Pharmacy & Medicines Management working in collaboration with other Directorates to deliver agreed priorities aligned to ADHB strategy. Develop service strategies for Clinical Engineering, Patient Administration, Contact Centre and Allied Health working in collaboration with other Directorates to deliver agreed priorities aligned to ADHB strategy. 2. Develop leadership structures, workforce, capacity and people plans for each of our services that support quality, efficiency, an engaged and empowered workforce and alignment with ADHB values in delivering the organisational priorities. 3. To implement a Quality and Safety Excellence Programme across the Directorate, building on work already in place and increasing visibility through improved reporting and analysis against agreed priorities with Directorates and other key stakeholders. 4. To develop and maximise research, quality improvement, development and business opportunities through the collaborations with the University of Auckland, in Pharmacy, Pathology & Laboratory Medicine Services and Radiology. To develop further collaborations with AUT and other potential partners to deliver improvement in quality, outcomes, training, research and joint ventures. 5. Identify and progress opportunities for regional collaboration and development of regional clinical networks within our services 6. Achieve Directorate financial savings target for 2017/18. Current condition 1. 5 year strategies for Pathology & Laboratory Medicine Services, Radiology and Pharmacy & Medicines Management have been agreed and implementation plans developed. Our other services currently have limited shared strategic focus and planning with agreed priorities which results in a reactive response and engagement with other Directorates/Services. 2. The Clinical Leadership model has recently been embedded across the Directorate. Improvement in performance, visibility, communication and engagement with other services and Directorates is still required. Some of our services do not currently have agreed capacity and workforce plans to facilitate delivery of required activity. This makes it difficult to identify the appropriate FTE and skill mix required and also limits our ability to respond to acute and long term changes in activity in a cost efficient manner whilst maintaining quality and safety. 3. An inconsistent approach to managing performance, safety and quality across our services. We have opportunities to build on areas of good practice in the Directorate and to achieve improvement through benchmarking services and agreeing appropriate standards of care with all Directorates. 4. Collaborations with UoA in Pharmacy, Pathology & Laboratory Medicine Services and Radiology established. Workplans in development. 5. Potential opportunities for regional collaboration have been identified with Pharmacy, Laboratories, Pathology and Radiology. Target condition 1. We proactively engage in strategic planning with other Directorates focusing on care pathways, clinical outcomes and agreed priorities. Our services are integrated to meet clinical and patient need, are flexible, patient focussed and tailored where appropriate, and are operationally and financially sustainable. 2. Clinical Leadership structure and leadership development is embedded across our Directorate. Our people are equipped and supported to lead and be successful. Each of our services have a workforce capacity plan and business model agreed at an organisational level that supports quality, safety, cost effective delivery, and operational and financial sustainability. 3. A patient safety and quality framework is in place within each service with clear, well defined quality and safety metrics defined with key stakeholders and agreed at an organisational level. An appropriate Directorate governance structure is in place to provide support and assurance. 4. Our services have embedded teaching, training, research and joint venture opportunities with our academic partners to improve quality, revenue, training, staff engagement and are delivering evidence based improvements in clinical outcomes via exploiting research opportunities. 5. Clinical networks established for Radiology, Pathology & Laboratory Medicine and Pharmacy & Medicines Management 6. Each of our services operates a balanced budget supporting quality, safety and service delivery Measures Current Target 18/19 (End 17/18) Strategy and priorities agreed for each service with all Directorates 3 of 8 services 6 of 8 services 8 of 8 People plans, Staff and Leadership Development Programme embedded across all services 2 of 8 services 6 of 8 8 of 8 Succession plans in place for key roles 2 of 8 services 6 of 8 services 8 of 8 Workforce, capacity and quality outcome measures developed for all services and agreed with Directorates 2 of 8 services 6 of 8 services 8 of 8 Directorate Governance structure in place. Quality and safety metrics reported routinely Underway Completed Embedded Measures of UoA collaboration success defined. Teaching, training and research outcomes delivered. 0 of 3 collaborations 3 of 3 collaborations Embedded Regional opportunities scoped, agreed and proposals defined 0 of 3 2 of 3 3 of 3 Breakeven to budget position and savings plan achieved in each service Balanced budget # Action Plan Owner Q1 Q2 Q3 Q4 1,2 Develop Strategy & Leadership structure Radiology, PSC & Contact Centre Dir/GM 1,2 Support the delivery of DHB Work Programmes. Service priorities agreed with Directorates. 2 Agree People plans, Staff and Leadership Development Programme for services Dir/GM/HR/ ND 2 Develop Workforce & Capacity Plans (Allied Health, Patient Service Centre, Contact Centre) building on work already done and benchmarking data All GM/AHD/ND 3 Finalise Quality and safety metrics for each service Dir/AHD/ND 4 Collaboration steering groups operating effectively define measures of success IC/SCDs 5 Discussions with regional partners to agree approach IC/GM/SCDs 6 Savings and revenue opportunities identified and agreed IC/KT 40

45 Women s Health Directorate Speaker: Dr Sue Fleming, Director Service Overview 5.4 The Women s Health portfolio includes all Obstetrics and Gynaecology services in addition to the Genetics services provided via the Northern Genetics Hub. The services within the Directorate are divided into six service groups: Primary Maternity Services Secondary Maternity Services Regional Maternity Services Secondary Gynaecological Services (including Fertility Services) Regional Maternity Services Genetics Services The Women s Health Directorate is led by: Director: Dr Sue Fleming General Manager and Nursing Professional Lead: Karin Drummond Director of Midwifery: Melissa Brown Director of Allied Health: Linda Haultain Director of Primary Care: Dr Diana Good Directorate Priorities for 16/17 Q4 1. Demonstrably safer care (Deteriorating Patients, Afterhours Inpatient Safety, Faster Cancer Treatment) 2. Strengthened leadership for both operational matters and clinical quality and safety (Leadership development, New Excellence programme) 3. An engaged, empowered and productive workforce (efficient rostering and scheduling, teaching and training, expanding scope of practice, living our values) 4. Delivery of services in a manner that is sustainable, closest to home and maximises value (Daily Hospital Functioning, Using the Hospital Wisely, Outpatient Redesign, Regional Collaboration) 5. Ensure business models for services maximise funding and revenue opportunities (address funding shortfalls, public/private revenue opportunities) Note: Italics shows alignment to Provider Arm work programmes and/or productivity and savings priorities. 41

46 Q4 Actions: 90 Day Plan Priority Actions Commentary Implementation of after-hours inpatient safety model Enhance outcomes for vulnerable populations Leadership training for all staff in leadership roles After-hours Acute Theatres Escalation Plan is confirmed After-hours Theatre Capacity Project is progressing well with strong multi-disciplinary engagement. Four options are now being costed and risks detailed pending final business case. We are recruiting for Clinical Charge Midwifery roles for our maternity wards which will strengthen Women s Health after-hours workforce and align it with the new 24/7 hospital functioning model of care. A workshop to enhance staff understanding of the needs of Pacific Women scheduled for Friday 19th May. ADHB Leadership programme continues for Women s Health staff. A successful event was held on May 15th to assist leaders to find an executive coach using a speed dating format 2 Strengthen and embed Women s Health Excellence Programme Women s Health Excellence meetings now established. Aspiring to Excellence programme is ongoing and well attended. This teaching environment is being increasingly utilised to disseminate learning from our various quality activities. The Consumer Voice project is progressing slowly. 2 Strengthen employee engagement We endeavour to ensure ADHB values underpin all of our activities. The Directorate as a whole has agreed on the following 3 priority areas: o o o Safety and Wellbeing: Address unacceptable levels of bullying and harassment observed or experienced across Women s Health. Recognition and Value: Strengthen employee sense of being valued by recognising efforts, and safety by demonstrating care for individuals. Contribution and Control: Strengths based leadership (manager focus on employee strengths more than weaknesses) so employees experience using their skills to contribute to success and improvement. We are working with our teams to more deeply understand the employee survey results and support our leaders/managers to develop action plans to address any concerns with their teams with a particular focus on the 3 key areas. To date we have not recieved any feedback from our RANZCOG Recertification Corrective Actions submission. 3 Efficient and safe rostering of medical staff We are progressing a full evaluation of preferred proprietary medical scheduling programme with a view to a one year trial. We have appointed a project/admin support to lead the redesign SMO and RMO rosters and transition to new scheduling program. Redesign of after-hours medical staff roster to ensure MECA compliance and safety for SMOs is still in the early stages. 42

47 Priority Actions Commentary 3 Maternity workforce plan developed & implemented A detailed work program to address maternity vacanices has been developed and is progressing well. Completed actions include: o Higher duties allowance for shift coordinators o Assistance from retired midwives o Introduce 12 hr shifts o A formal monthly forum, chaired by Chief Nurse has been established to work with MERAS, NZNO and College of Midwives to enable workforce planning and recruitment initiatives Other actions well under way include: o On call rosters for RMs and RNs o Increase in HCA support o Overnight ward clerk on WAU o Recruitment plan for RNs o Recognise and reward full time FTE o Basket of benefits to offer to staff o Foster a Culture of taking meal and tea breaks o Communication strategy o Enhanced recruitment o Development of broader career pathways for midwives New graduate midwives have started Pathways review for acute gynaecology patients Development of an escalation plan for acute gynaecology patients has been completed and is assisting workflow and improved communication. Redesign of acute gynaecology pathways is a formal project under Using the Hospital Wisely. It is in very early stage development. 4 Collaborative primary birthing project 4 Postnatal model of care We continue to work collaboratively with Birthcare to increase primary birthing. This project has encountered a significant setback due to difficulty recruiting midwives. New approaches are being explored. Several threads of work are underway (some now business as usual) to support an appropriate postnatal stay and timely discharge against agreed EDD. A to D planned for maternity admissions in final draft. A project to redesign postnatal pathways in collaboration with funders is in the early stages and sits as part of the workplan for Primary and Community Programme. There is ongoing refinement and improvement of the production planning process. 4 Enhancing surgical performance Better systems to manage medical workforce will help improve efficiency and productivity. Theatre capacity has been enhanced by now, fully utilising Friday lists. Analysis of anticipated demands on theatre capacity from the 43

48 Priority Actions Commentary maternity service (elective caesarean section demand) and the Gynae-Oncology service is underway. A number of clinician led initiatives are underway as part of our Excellence Programme to reduce unnecessary interventions including: 4 Reducing unnecessary obstetric interventions A new pathway has been developed for External Cephalic Version (ECV) for women with a breech presentation. This now includes ECV under regional anaesthesia which we belive will increase the success of ECV and hence the vaginal birth rate A review of the induction of labour pathway is being undertaken by the Maternity Clinical Excellence Group. Funding and ethics approval achieved for a multi-centre trial to assess the role of outpatient balloon induction. Planning at National level for new National Genetics Clinical Director and revised local accountabilities. 5 Sustainability plan for Genetics (5 yr plan) Early stage planning around four key priorities for delivering sustainable genetics services. o Genomics. To incorporate genomics as part of service planning where appropriate. o Education. To build genetics literacy amongst the wider healthcare community. o Mainstreaming. To partner with non-genetics health professionals to enable them to lead genetics testing. o Service delivery. To review practice to maximise overall service value. New pricing for private patients is now established. Improved workflow is enabled. 5 Sustainable Fertility service Strengthened leadership now with full leadership in place. Appointment of two SMO s. Capital funds for new IT system approved 5 Develop sustainability model for Gynae- Oncology service Recruiting for additional Gynae-Oncology workforce is underway. Offer pending for locum SMO on fixed term contract. Modelling of service needs for the next five years is in progress. 44

49 Measures Current Target (End 16/17) Median length of stay after elective CS 3.0 >/=3 FCT targets met (62 day target) 67% 85% 5.4 Elective surgical targets met 101% 100% % of category 2 caesarean section patients meeting 60 min. time target 6/12ly measure Number of unplanned transitions to care 0 0 Nursing and midwifery FTE variance from budget 8.7 F 0 FTE 95% Breakeven revenue and expenditure position YTD 1,289 UF Breakeven Vacancies in midwifery workforce Number of women having primary births at BirthCare/month Key achievements in the month Completed recruitment of new midwifery graduates. Seven new graduates commenced on 1 May Our Fertility Business Development project is on track. A Vision workshop has been completed and we have seen an increase in the volume of private patients. A multi-disciplinary, multi-directorate workshop to assist in the development of a business case for After-Hours Theatre Capacity was held to review all potential options. This included a detailed risk assessment for co-location of Women s Health afterhours theatres to level 8. A number of significant risks were identified some of which could not be fully mitigated. A number of other options have now been identified. Work progresses to assess risks and analyse costs. Our pregnancy and Parenting programme is tracking well and meeting the target of 30% coverage for the total ADHB resident birthing population. To date 1,333 (target 1,376 for the year) women have engaged by way of community and Kaupapa Maori courses, opportunistic education or a home visit. Performance against priority groups is also favourable with 30% targets being met or close to being met in all priority population groups, i.e. Maori, Pacific, Asian and those with limited comprehension of English. The Easter/ Anzac holiday period was used to ensure staff took annual leave. We managed to do this whilst also maintaining full service provisions We have a favourable financial position for the month Areas off track and remedial plans Midwifery staffing vacancies continue to be a significant risk to the service. A full project plan has been developed in collaboration with key stakeholders to systematically work through a multipronged approach to improve retention and recruitment We were unsuccessful in recruiting to the Gynae-oncology Nurse Specialist role due to no suitably qualified applicants. We plan to re-advertise this role more broadly. 45

50 Faster Cancer Treatment targets: During April, Women s Health performance against the 62 day target dropped to 66.7% (rolling 6 months from 01 January to 21 April 2017). Overall there were 15 HSC patients that entered our services. 10 out of the 15 patients achieved the FCT 62 day target, while 5 breached. In two cases this was due to patient choice and three cases breached due to capacity issues. We have implemented a 90 day plan to improve: Timeliness of clinical triaging of referrals Increase RAC capacity by increasing to two SMOs Additional capacity if required via AUB Clinic Our longer term Gynae Oncology business plan which includes increasing our Gynae Oncology staff and theatre capacity is key to enabling us to meet these targets in a sustainable manner. Key issues and initiatives identified in coming months We will recruit additional Clinical Charge Midwives (CCM) for our inpatient maternity areas all have to ensure 24/7 CCM cover in all maternity inpatient areas. On Monday 15 May for a period of two months trial in wards 96 and 98 we will commence a of a NICU trained nurse to look after the late pre-term babies. We are grateful for the support and generosity shown by the NICU team towards us during our time of midwifery shortages. Our Maternal Fetal Medicine and Obstetric Medicine services continue to be under pressure, this has been further exacerbated with unexpected sick leave by our Service Clinical Director. We are working closely with our team to provide support and resources. We have finalised our Annual Clinical Report speakers and work continues collating and critiquing the data for our annual report Gynae-oncology SMO interviews are taking place mid-may. We have a high calibre of applicants and expect to successfully recruit to this position. We have commenced recruiting to new SMO positions detailed as part of our 17/18 budget. This will enable us to strengthen our generalist teams in Obstetrics and Gynaecology, and to transition to a safer after hours staffing model. We are also advertising for an Operations Manager to work in partnership with our level 3 Service Clinical Directors to improve our operational and financial performance. A significant project will commence and run until the end of 2017 to redesign our SMO and RMO rosters. This will include working with the NRA to develop new rosters that meet the new RMO MECA requirement. To implement strategies to improve our workplace culture 46

51 Engaged Workforce Improved Health Status Better Quality Care Patient Safety Scorecard Measure Auckland DHB - Women's Health HAC Scorecard for April 2017 Actual Target Prev Period 5.4 Medication Errors with major harm Number of falls with major harm Nosocomial pressure injury point prevalence (% of in-patients) Nosocomial pressure injury point prevalence - 12 month average (% of in-patients) Number of reported adverse events causing harm (SAC 1&2) Unviewed/unsigned Histology/Cytology results >30 and < 90 days Unviewed/unsigned Histology/Cytology results >= 90 days % <=6% 0% 0% <=6% 0% HT2 Elective discharges cumulative variance from target (ESPI-1) % Services acknowledging 90% of FSA referrals in 15 calendar days or less (ESPI-2) Patients waiting longer than 4 months for their FSA (ESPI-5) Patients given a commitment to treatment but not treated within 4 months % DNA rate for outpatient appointments - All Ethnicities % DNA rate for outpatient appointments - Maori % DNA rate for outpatient appointments - Pacific Elective day of surgery admission (DOSA) rate % Day Surgery Rate Inhouse Elective WIES through theatre - per day Number of CBU Outliers - Adult % Very good and excellent ratings for overall inpatient experience % Very good and excellent ratings for overall outpatient experience Number of complaints received Number of patient discharges to Birthcare Average LOS for WIES funded discharges (days) - Acute Average LOS for WIES funded discharges (days) - Elective Post Gynaecological Surgery 28 Day Acute Readmission Rate 1.01 >=1 1 R/U 100% 100% 0% 0% 0% 0% 0% 0% 9.45% <=9% 8.76% 26.43% <=9% 26.46% 16.47% <=9% 18.15% 94.74% >=68% 96% 29.23% >=50% 35.91% 8.48 >= R/U >=90% 84.5% R/U >=90% 95.1% 5 No Target TBC <= <= R/U No Target 4.59% % Hospitalised smokers offered advice and support to quit Breastfeeding rate on discharge excluding NICU admissions 91.36% >=95% 96.67% R/U >=75% 72.12% Excess annual leave dollars ($M) % Staff with excess annual leave > 1 year % Staff with excess annual leave > 2 years % Staff with excess annual leave and insufficient plan to clear excess by the end of financial year Number of Employees who have taken greater than 80 hours sick leave in the past 12 months Number of Pre-employment Screenings (PES) cleared after the start date % Voluntary turnover (annually) % Voluntary turnover <1 year tenure $ $ % 0% 27.74% 14.4% 0% 15.31% R/U 0% R/U % <=10% 13.64% 6.25% <=6% 9.8% Amber R/U Variance from target not significant enough to report as non-compliant. This includes percentages/rates w ithin 1% of target, or volumes w ithin 1 value from target. Not applicable for Engaged Workforce KRA. Result unavailable (ESPI-1) % Services acknowledging 90% of FSA referrals in 15 calendar days or less Result unavailable until after the 16th of the next month. % Very good and excellent ratings for overall inpatient experience % Very good and excellent ratings for overall outpatient experience These measures are based on retrospective survey data, i.e. completed responses for patients discharged or treated the previous month. Post Gynaecological Surgery 28 Day Acute Readmission Rate This measure has been developed specifically for Women's Health and should not be compared to the 28 Day Readmission Rate reported by other Directorates. This measure is reported a month in arrears in order to accurately report the readmissions arising from the previous months admissions. Breastfeeding rate on discharge excluding NICU admissions Result unavailable until after the 20th of the next month. % Staff with excess annual leave and insufficient plan to clear excess by the end of financial year Result unavailable. 47

52 Scorecard Commentary We continue to perform well against our elective surgical targets Our DNA rates remain high, whilst there is some reduction in our pacific women DNA rates as a result of our green belt project. This approach is highly resource intensive and we have not yet been able to resource similar strategies for our Maori populations. We have performed less well than desired with respect to smoking advice given, primarily due to the staffing shortages in our Maternity areas Financial Results STATEMENT OF FINANCIAL PERFORMANCE Womens Health Services Reporting Date Apr-17 ($000s) REVENUE MONTH Actual Budget Variance Actual Budget Variance Government and Crown Agency F 2,030 1, F Funder to Provider Revenue 6,787 6,787 0 F 69,047 69,047 0 F Other Income (38) U 1,577 2,150 (573) U Total Revenue 7,211 7,216 (5) U 72,654 73,043 (389) U EXPENDITURE Personnel Personnel Costs 3,383 3, F 33,987 33,340 (647) U Outsourced Personnel F F Outsourced Clinical Services (8) U (26) U Clinical Supplies F 4,415 4,385 (31) U Infrastructure & Non-Clinical Supplies (32) U (82) U Total Expenditure 4,039 4, F 40,143 39,656 (486) U Contribution 3,172 3, F 32,512 33,386 (875) U Allocations F 7,687 7,273 (414) U NET RESULT 2,483 2, F 24,825 26,113 (1,289) U Paid FTE MONTH (FTE) YEAR TO DATE (10 months ending Apr-17) YEAR TO DATE (FTE) (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance Medical (6.2) U (5.7) U Midwives & Nursing F F Allied Health F F Support F F Management/Administration (5.4) U (4.3) U Other F F Total excluding outsourced FTEs F (1.2) U Total :Outsourced Services (0.1) U F Total including outsourced FTEs F (1.2) U 48

53 Comments on major financial variances (YTD) The Directorate s result YTD shows a budget variance of $1,289k U, mostly from lower private patient revenue, and higher personnel costs, higher Labs tests requested offset by a favourable reduction in doubtful debt provision. 5.4 Overall YTD CWD volumes remains on 106% of contract and Specialist Neonates were steady at 87% for YTD (FY15/16: 70%). The Gynaecology and Gynae-Oncology acute WIES continues to be high at 101%YTD of contract, and performance of their electives contract was 110% YTD (of WIES contract value, but not discharge target). Revenue Allocation analysis YTD The combined DRG and Non-DRG volumes equated to being $1,998k F (last month $1,938k F) of revenue above contract (not recognised in the Directorate result). Apr. 17: Year-to-date- financial analysis: 1 Revenue $389k U YTD. a. Non-Resident & Private patient billing dropped further and is now $465k U to budget. These revenues are unpredictable. b. Other income is $107k U and consists of donations of $38k F from Starship Foundation to fund the purchase of Pepipods (see below), which offsets a Genetics budgeted income variance of $151k U arising from a change in accounting policy for income received in advance. c. Government Revenue is $184k F due to ACC income, Colposcopy volume exceeding budget, and the new extension of the MFM contract which had been only budgeted to the known expiry date 2 Expenses Expenditure variance is now $900k U YTD; this variance is mostly the net result of: a. Personnel $647k U, mostly due to Medical payroll $745k U: i. Arising from 1.0 FTE Senior Medical Officer (SMO) to support elective surgical volume delivery and back fill MFM acute duties on generalist roster, and 1.0 FTE for unbudgeted Gynae-Oncology SMO. ii. House Officers FTEs 2.63 FTE U Continued efforts in the Midwifery & Nursing workforce across a range of HR and operational strategies and initiatives, has sustained a drop in Bureau cost, which were down 12% YTD compared to the same period YTD last year. b. Outsourced personnel $299k F; as a result of a continued University vacancy, and this offsets some of the Medical payroll budget variance c. Clinical supplies improved during the month to be $31k U YTD; consisting of Pepipod purchases $38k U (this is in regards to funding received in the Other Income, above) and a range of instrument and diagnostic cost over-runs that are tracking in line with the 49

54 volume increases of inpatients referred to above in the comments in Revenue Allocation analysis. d. Infrastructure & Non-Clinical total of $82k U due to budgeted savings not met e. Internal Allocations total $414k U Mostly due to higher than budgeted Labs test requests $337k U for Gynaecology, Maternity and Send-away tests for Genetics. Also includes Nutrition $60k U. 50

55 Date: 27 March 2017 A3 owner: Sue Fleming Women s Health Directorate Our vision: Excellent Women s Health outcomes through Empowerment and Partnership Our mission: To deliver gold standard maternity, gynaecological and genetics care Key priorities for Women s Health Directorate In 2017/18 we will continue to contribute to the Provider Arm work programmes. In addition to this we will also focus on the following Directorate level priorities: 1. Demonstrably safer afterhours care 2. Enhanced outcomes for our vulnerable populations 3. Strengthened leadership for both operational matters and clinical quality and safety 4. An engaged, empowered and productive workforce 5. Develop pathways of care that are patient focused, and maximise value 6. Develop sustainable delivery models for all services Current condition 1. Access to acute theatres afterhours is suboptimal. SMO workpatterns do not fully reflect agreed best practice. Afterhours nursing and midwifery leadership afterhours inconsistent. 2. Outcomes for our most vulnerable women and babies needs strengthening. Our gains in delivering care in a culturally appropriate manner can be further strengthened. 3. Women s Health Excellence Programme is now defined. Leadership accountabilities in place. 4. Our maternity and sub-specialty workforce are stretched because of vacancies. This is impacting on our ability to deliver consistently excellent care. 5. We have opportunities to improve efficiencies in our care delivery models and resource utilisation for both inpatients and outpatients. Our acute services are under pressure. 6. We have good plan in place for service delivery for the next 12 months. Target condition Excellent Women s Health outcomes 1. Strengthened staffing and resources afterhours. A strong safety culture is embedded. 2. Care delivery aligned to needs of priority populations. Pathway for and markers of vulnerable women and babies is agreed. Care is delivered in a culturally appropriate manner. 3. Decision making in respect of strategy, major operational matters, resource allocation and clinical quality and safety are in a more joined up manner that delivers measurable value. 4. Vacancies are fully recruited to and a sustainable workforce model is in place for all key areas. 5. Key patient pathways strengthened, including acute gynaecology, postnatal care and faster cancer. 6. A 5 year sustainablity plan developed for Genetics, Fertility Plus and Gynae Oncology. 1 1 Action plan Owner Q1 Q2 Q3 Q4 Afterhours Inpatient Safety model implemented (After Hours Inpatient Safety Programme) Agreed plan for enhanced access to theatre afterhours (After Hours Inpatient Safety Programme) 2 Vulnerable women pathways agreed LH 2 Markers of vulnerability determined LH 3 Women s Health Excellence Programme fully rolled out SF 3 Consumer forum established SF 3 Competent and confident WH Leaders SF/LB 4 Strengthen employee engagement LB 4 Efficient rostering of medical staff SF 4 Maternity workforce plan developed and implemented MB 5 Pathways review for acute gynaecology patients (Using the Hospital Wisely Programme) 5 Collaborative primary birthing project MB 5 Induction of labour pathway review MB 5 Postnatal pathway redesign (Primary & Community Programme) MB 6 Develop sustainability plan for Genetics KD 6 Develop sustainablity plan for Fertility Plus KD 6 Develop sustainability model for gynae-oncology KD Measures Current Target 1 Patients achieving access to theatres within defined acuity timeframes Not met Fully met 1 SMO workpatterns fully compliant with agreed standards Not met Fully met 1 Afterhours senior clinical leadership model agreed and implemented Not imp Fully Imp 2 Care delivery aligns with agreed pathway for vulnerable women Partly met Fully met 3 Consumers appointed for all Excellence groups Not met Fully met 3 Regular structured reporting and KPIs for all services Not met Fully met 4 Maternity staffing compliant with agreed models of care Not met Fully met 4 Midwifery vacancies 20 <10 5 New pathway for acute gynae patients agreed and implemented Implemented 5 New pathway for postnatal care agreed Current system New pathway 5 Faster cancer targets met 85% 95% 6 5 year plans developed for all key services Partially achieved Fully achieved MB SF SF

56

57 Child Health Directorate Speakers: Dr John Beca, Surgical Child Health Director and Dr Michael Shepherd, Medical Child Health Director. 5.5 Service Overview The Child Health Directorate is a dedicated paediatric healthcare service provider and major teaching centre. This Directorate provides family centred care to children and young people throughout New Zealand and the South Pacific. Care is provided for children up to their 15th birthday, with certain specialised services beyond this age range. A comprehensive range of services is provided within the two Directorate portfolios: Surgical Child Health Paediatric and Congenital Cardiac Services, Paediatric Surgery, Paediatric ORL, Paediatric Orthopaedics, Paediatric Intensive Care, Neonatal Intensive Care, Neurosurgery. Medical Child Health General Paediatrics, Te Puaruruhau, Paediatric Haematology/Oncology, Paediatric Medical Specialties (Dermatology, Developmental, Endocrinology, Gastroenterology, Immunology, Infectious Diseases, Metabolic, Neurology, Chronic Pain, Palliative Care, Renal, Respiratory, Rheumatology), Children's ED, Consult Liaison, Safekids and Community Paediatric Services (including Child Health and Disability, Family Information Service, Family Options, Audiology, Paediatric Homecare and Rheumatic Fever Prevention). The Child Health Directorate is led by Director Surgical: Dr John Beca Director Medical: Dr Mike Shepherd General Manager: Emma Maddren Director of Nursing: Sarah Little Director of Allied Health: Linda Haultain PhD Director of Primary Care: Dr Barnett Bond Directorate Priorities for 16/17 In 2016/17 our Directorate will contribute to the delivery of the six Provider Arm work programmes. In addition to this we will also focus on the following Directorate priorities: 1. Further embedding Clinical Excellence programme 2. Financial sustainability and achieve Directorate financial savings target for 2016/17 3. Community services redesign 4. Aligning services to patient pathways 5. Hospital operations/inpatient safety 6. Meaningful involvement from our workforce in achieving our aim 7. Tertiary service / National role sustainability 52

58 Q4 Actions 90 day plan Priority Action plan area 1. Robust system of safety event reporting and review 1. Excellence programme development within all services 2. Ongoing effective financial management 3. Community service redesign 4. Establish hospital Allied Health leadership and integration 4. Rehabilitation service and TBI pathway development 5. Implementation of deteriorating patients model; implementation of afterhours inpatient safety model Commentary Safety Management System (Datix) dashboard developed for Weekly Clinical Safety Meeting. Safety Management System (Datix) dashboard to be developed for Safe Care Meeting. Safety measures developed as part of directorate and servicelevel dashboard. Amendments to directorate structure/managers/access levels and notification information in the Safety. Management System (Datix) being undertaken. Managers training for Safety Management System (Datix) in collaboration with Quality department. Directorate wide measures/dashboard. Development of service-level scorecards in progress. Resources to support service-level clinical excellence programmes developed and in use. Patient safety culture survey actions being implemented. Exploring options to capture families perceptions of safety culture. Patient experience survey findings reviewed for potential inclusion on Directorate scorecard. Several services exploring the potential use of HQSC feedback survey Dual emphasis on revenue (ACC, donations, tertiary services) and cost containment. Further financial mitigations were developed and presented to the oversight committee An extensive leave management programme is in place across Child Health with a $100k reduction year to date. Emphasis on financial strategy across multiple years to ensure enduring change. Governance group established Locality and outcomes leadership positions commenced. Transition and implementation plans developed. Implementation planned for May SCD Allied Health role has made immediate progress in a range of workforce, revenue, reporting and improvement areas. Collaboration with Waitemata DHB around the delivery of the full continuum of rehabilitation services continues. ADHB has subcontracted WDHB to provide residential rehab and outpatient services. Outreach plan, operational guideline and pathway developed in collaboration with Waitemata DHB. Pain services ACC contract being worked up in alignment with rehabilitation contract. PaR governance structure and escalation process finalised Phase 1 of organisational Deteriorating Patients database completed which will enable reporting of identified measures once system change implemented. 24/7 Hospital Functioning Decision document released. 53

59 Priority Action plan Commentary area 5. Surgical performance The core requirements for a surgical dashboard have been agreed. The immediate priority is to provide sub-specialty production planning data for paediatric spinal surgery. Dataset agreed in March and validated by the surgeons at a spinal planning meeting in April. 5. Acute flow Direct admission from CED for General Paediatric patients is now occurring 24/7 and further refinements are being made to the process. Discharge planning improvement project continues with focus on Improving use of the EDD (estimated date of discharge) Criteria led discharge Improving discharge documentation / process. 6. Leadership development All Child Health service-level leadership staff have now participated programme in or are scheduled to participate in the leadership programme. Excellent feedback has been received to date and participants have identified development goals. 6. Improved programme of funding for research and training for all Starship Child Health staff 7. Tertiary services stakeholder engagement The Starship Foundation research, training and education programme was launched in July with $500k available for the initial round of proposals. Seven high quality research proposals have been approved for funding in 2017 A strategy for future funding has been developed with Starship Foundation. A proposal to the Ministry of Health is expected to be delivered in Measures Measures Current Target (End 2016/17) 2017/18 All services are developing 1. Quality and Safety metrics Reporting and metrics and reporting has Well defined metrics established across services improving begun 1. Quality and safety culture (AHRQ) Measured, priority areas identified, implementation commenced Improved Improved 2. Meet budget Revenue now on track, continued savings focus Budget met Budget met 2. Achieve planned savings target Nearly achieved Achieved Achieved 3. Community redesign programme 4. Operational structure that follows patient pathways 4. Rehabilitation service model Implantation commenced Consultation completed, implementation commenced Sustainable funding model aligned to service design Includes Allied Health Includes all Includes all Service commenced Dec 2016, pathway developed, outreach clinics planned from June 2017 Implemented 5. Acute Flow metric 96% 95% 95% Pathway operational 54

60 Measures Current Target (End 2016/17) 2017/18 5. Surgical performance and pathways 5. Defined safety metrics Code Pink, urgent PICU transfer from ward 6. Leaders completed leadership training 6. Staff satisfaction 7. Tertiary services Metrics in development, spinal surgery emphasis 3 outcome measures set up on provider metric dashboard. Further 6 in development. Data collection beginning with PaR service commencement. Balanced safety, performance, efficiency Defined and improving 25/25 20/25 All Engagement survey complete, action plans in development Report complete, summaries being finalized for publication Measured Consultation complete and outcome agreed Improving performance Improved Improved Implementation of agreed national approach Key achievements in the month Community services leadership roles (Locality Leads and Outcomes Lead) orientation and planning for initial 90 days commenced. Transition plan initiated. Safe, productive and high quality services maintained during significant facilities projects within Starship including the patient lift replacement programme, level 5 refurbishment, outpatient refurbishment and cath lab HVAC installation. New Service Clinical Director appointed for the Paediatric ORL Service, Mr Michel Neef. Areas off track and remedial plans Appointment to the Lead Clinician Clinical Excellence role a suitable candidate has been identified who is likely to commence late Financial performance unfavourable result YTD, continued focus on optimising revenue and cost containment. Significant risk related to the unreliable function of the link lift 2. This is a sole lift required for safe transfer of patients from 23b (paediatric cardiac ward) to PICU, theatre and radiology. Contingency plans in place for patient transfer. Lift will need to be replaced, business case is in development. Significant risks emerging from the refurbishment of level 5 in Starship which have potential to impact Child Health and Adult Health bed capacity into winter. Twice weekly risk mitigation meetings are occurring to ensure effective project delivery and to maintain clinical safety and minimise disruption to services. Key issues and initiatives identified in coming months Starship level 5, outpatients and cath lab projects will continue until May June Starship lift replacement programme will continue until September Community Redesign Project implementation will occur from May

61 Continued development of the service-level clinical excellence groups and finalisation of the service-level outcome measures. Tertiary services proposal to the Ministry of Health timeline and strategy to be agreed. Starship Clinical Excellence Programme 5.5 The following scorecard is the latest iteration of the directorate wide Clinical Excellence programme measures. Child Health is developing these measures and the corresponding targets and internationally relevant benchmarks. Over the next few months we will refine these measures and their use to either monitor clinical quality or assist with improvement. It represents a balanced view of quality for the directorate. We plan to highlight different services clinical outcomes each month, in this month s example the key clinical effectiveness indicators for the Paediatric and Congenital Cardiac Service (PCCS) are profiled. Safety Metric Frequency Actual Target Benchmark Previous Central line associated bacteraemia rate per 1,000 central line days Nosocomial pressure injury point prevalence - 12 month average (% of in-patients) Monthly 0 <=1 0 Monthly 4.9% <=6% 4.6% Medication and Fluid Errors requiring intervention Monthly R/U Lower R/U Medication and Fluid Error rate reported per 1,000 bed days Monthly 4.6 Higher Good Catches Monthly 3 Higher 3 Unexpected PICU admissions Monthly 8 Lower 10 Ward Code Blue Calls Monthly 4 Lower 7 % PEWS Compliance Monthly 94% >=95% 91% % Hand hygiene compliance Monthly 89.1% >=100% >=80% 86.7% Starship Best Starship Average PCCS Safety Culture PCCS Timeliness Metric Frequency Actual Target Benchmark Previous (MOH-01) % CED patients with ED stay < 6 hours Monthly 96% >=95% 95% Median acute time to theatre (decimal hours) - Starship Monthly 2.8 Lower 5.3 (ESPI-2) Patients waiting longer than 4 months for their FSA Monthly 0.36% 0% 0.19% (ESPI-5) Patients given a commitment to treatment but not treated within 4 months (ESPI-5) Number of patients given a commitment to treatment but not treated within 4 months - Maori (ESPI-5) Number of patients given a commitment to treatment but not treated within 4 months - Pacific (ESPI-5) Number of patients given a commitment to treatment but not treated within 4 months - Asian (ESPI-5) Number of patients given a commitment to treatment but not treated within 4 months - Deprivation Scale Q5 (ESPI-5) Number of patients given a commitment to treatment but not treated within 4 months - Total (ESPI-2) Number of patients waiting longer than 4 months for their FSA - Total (ESPI-2) Number of patients waiting longer than 4 months for their FSA - Maori (ESPI-2) Number of patients waiting longer than 4 months for their FSA - Asian (ESPI-2) Number of patients waiting longer than 4 months for their FSA - Deprivation Scale Q5 (ESPI-2) Number of patients waiting longer than 4 months for their FSA - Pacific Monthly 5.1% 0% 4.75% Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly Monthly

62 Efficiency Metric Frequency Actual Target Benchmark Previous % Day Surgery Rate Monthly 70% >=55% 47% 66% % Adjusted Session Theatre Utilisation Monthly 78.2% >=80% 77% 80.3% Occupancy Monthly 89% >= 95% 94% Inpatient Median Length of Stay (days) Monthly Inpatient Length of Stay over 30 days Monthly FSA to FU Ratio Monthly 1:3 1:3 Pathway Use Monthly R/U Higher R/U Laboratory cost per bed day Monthly $76.31 Lower $77.29 Antibiotic cost per bed day Monthly $17.29 Lower $27.44 Radiology cost per bed day Monthly $ Lower $ % of patients discharged on a date other than their estimated discharge date Monthly 33.3% % PICU Exit Blocks Monthly 3 Lower 3 Effectiveness Metric Frequency Actual Target Benchmark Previous 28 Day Readmission Rate - Total Monthly R/U <=6% 7.0% 28 Day Readmission Rate - Maori Monthly R/U <=6% 7.9% 28 Day Readmission Rate - Pacific Monthly R/U <=6% 10.0% 28 Day Readmission Rate - Asian Monthly R/U <=6% 2.9% 28 Day Readmission Rate - Deprivation Scale Q5 Monthly R/U <=6% 7.8% Service Outcome and Benchmarking Measures PCCS Frequency 2016 Target Benchmark Australasia Operative mortality Annually 3.5% TBC 1.7% No major surgical complications Annually 86% TBC 88% Extubated within 6 hours Annually 44% TBC 28% Patient Centred Metric Frequency Actual Target Benchmark Previous % Was Not Brought (WNB) rate for outpatient appointments - All Ethnicities % Was Not Brought (WNB) rate for outpatient appointments - Maori % Was Not Brought (WNB) rate for outpatient appointments - Asian % Was Not Brought (WNB) rate for outpatient appointments - Pacific % Was Not Brought (WNB) rate for outpatient appointments - Deprivation Scale Q Monthly 12% <=9% 10.5% 11% Monthly 24% <=9% 10.5% 21% Monthly 8% <=9% 10.5% 7% Monthly 22% <=9% 10.5% 21% Monthly 20% <=9% 10.5% 19% Number of complaints received Monthly 7 Lower 8 Number of compliments received Monthly 3 Higher 17 % Very good and excellent ratings for overall inpatient experience % Very good and excellent ratings for overall outpatient experience Monthly R/U >=90% 77.3% Monthly R/U >=90% 85% Child Health Nursing Family Feedback Monthly 95% >=90% 95% 57

63 Engaged Workforce Better Quality Care Patient Safety Scorecard Measure Central line associated bacteraemia rate per 1,000 central line days Medication Errors with major harm Number of falls with major harm Auckland DHB - Child Health HAC Scorecard for April 2017 Nosocomial pressure injury point prevalence (% of in-patients) Nosocomial pressure injury point prevalence - 12 month average (% of in-patients) Number of reported adverse events causing harm (SAC 1&2) Unviewed/unsigned Histology/Cytology results >30 and < 90 days Unviewed/unsigned Histology/Cytology results >= 90 days Actual Target Prev Period 0 <= % <=6% 0% 4.9% <=6% 4.59% HT2 Elective discharges cumulative variance from target (MOH-01) % CED patients with ED stay < 6 hours (ESPI-1) % Services acknowledging 90% of FSA referrals in 15 calendar days or less (ESPI-2) Patients waiting longer than 4 months for their FSA (ESPI-5) Patients given a commitment to treatment but not treated within 4 months % DNA rate for outpatient appointments - All Ethnicities 0.9 >= % >=95% 94.57% R/U 100% 100% 0.36% 0% 0.19% 5.1% 0% 4.76% 11.66% <=9% 10.68% % DNA rate for outpatient appointments - Maori % DNA rate for outpatient appointments - Pacific Elective day of surgery admission (DOSA) rate % Day Surgery Rate Inhouse Elective WIES through theatre - per day % Very good and excellent ratings for overall inpatient experience % Very good and excellent ratings for overall outpatient experience Number of complaints received 28 Day Readmission Rate - Total % Adjusted Session Theatre Utilisation Average LOS for WIES funded discharges (days) - Acute Average LOS for WIES funded discharges (days) - Elective 23.54% <=9% 21.11% 21.79% <=9% 21.21% 65.81% TBC 60.71% 70.33% >=52% 65.79% TBC R/U >=90% 77.3% R/U >=90% 85% 7 No Target 8 R/U <=10% 6.98% 78.2% >=85% 80.3% 4.52 <= <= Excess annual leave dollars ($M) % Staff with excess annual leave > 1 year % Staff with excess annual leave > 2 years % Staff with excess annual leave and insufficient plan to clear excess by the end of financial year Number of Pre-employment Screenings (PES) cleared after the start date Sick leave hours taken as a percentage of total hours worked % Voluntary turnover (annually) % Voluntary turnover <1 year tenure $ $ % 0% 29.53% 9.46% 0% 10.27% R/U 0% R/U % <=3.4% 4.3% 12.1% <=10% 12.08% 6.72% <=6% 5.97% Amber R/U Variance from target not significant enough to report as non-compliant. This includes percentages/rates w ithin 1% of target, or volumes w ithin 1 value from target. Not applicable for Engaged Workforce KRA. Result unavailable (ESPI-1) % Services acknowledging 90% of FSA referrals in 15 calendar days or less Result unavailable until after the 16th of the next month. % Very good and excellent ratings for overall inpatient experience % Very good and excellent ratings for overall outpatient experience These measures are based on retrospective survey data, i.e. completed responses for patients discharged or treated the previous month. 28 Day Readmission Rate - Total A 35 day period is required to accurately report all acute re-admissions for the previous month's discharges. (35 days = 28 days post discharge as per MoH measures plus 5 w orking days to allow for coding). % Staff with excess annual leave and insufficient plan to clear excess by the end of financial year Result unavailable. 58

64 Scorecard Commentary Elective discharges The Child Health Directorate is at 90% of the target for ADHB discharges at the end of April 17. Recovery plans are in place with emphasis on ORL, orthopaedic and paediatric surgery. Whilst demand is limiting performance in the short term to some extent, recovery plans include extra clinics to maintain clinic volumes and stimulate surgical demand, insourced and out sourced lists. Elective performance Elective surgery performance continues to be actively managed to maintain 120 day compliance and elective discharges. ESPI -1 (acknowledgement of referral) 99% ( 1 Paed NeuroSurg ) ESPI-2 (Time to FSA) 0.35% Non-compliant, 4 Paed Ortho, 3 Paed ORL and 1 Paed Neurosurgery, in total 8 cases breached, all other services were 100% ESPI-2 compliant at the end of April. ESPI-5 (Time to Surgery) 5% non-compliant, 41 cases breached (27 Paed Ortho, 4 Paed Surgery,2 ACHD and 5 Paed Cardiac ) contributing factors include spinal surgery capacity constraints, acute demand. Mitigations include re-allocated theatre sessions, Insourced and outsourced sessions including Saturday operating. DNA rates The Child Health Directorate has prioritised work on DNAs (also referred to as was not brought, WNB) for the past 12 months. DNA/WND data continues to fluctuate with rates for Maori and Pacific patients of particular concern. A new report has been commissioned from the business intelligence team that reports the DHB of domicile of children who WNB, this report is prospective in nature, alerting us to children who are due to attend, who have a previous history of not attending A recent review of the children who WNB (from 3 to 10 times each) has revealed that the majority of them are engaged in follow up care. It was encouraging to note that Doctors, Allied Health staff, Schedulers and our colleagues in the primary health sector were all going the extra mile, providing additional appointments, transport and health literacy coaching to ensure children were not left to fall through the cracks. While time consuming, telephoning families and ironing out systemic challenges is a worthwhile activity enabling a deeper appreciation of the day-to-day challenges families experience getting their child to clinic. This work will continue are resource allows. Negotiations continue to secure the services of a Pacific Social Worker to assist us to respond to a specific group of children (from the club foot clinic) who WNB The child health community redesign process continues to maintain a strong focus on reducing health inequalities, and addressing issues associated with barriers to access. This forms part of the integrated approach to access to child health services. 59

65 Excess annual leave usage Excess annual leave management is continuing and the financial benefits of this work are now being realised with reductions in early In summary the key activity is: Enhanced and more granular reporting at directorate, service, team and individual level, both annual leave and time in lieu. Dual emphasis on reducing excess leave and annual consumption of the leave entitlement of each employee. Monthly review of each service s leave performance with the Director, General Manager and Finance Manager. Targeted leave reduction plans with all employees whose leave exceeds two years. 5.5 Staff turnover (annual) Staff turnover consistently performs just above the organisational target, and fluctuates minimally month on month. Service-level analysis of the turnover data has revealed a small number of services where turnover is of concern. This is being addressed within services and will be strengthened through information gained in the recently completed staff engagement survey and in the leadership development of all Child Health service-level leadership staff. Engagement plans are currently being developed for all Child Health Services. 60

66 Financial Results STATEMENT OF FINANCIAL PERFORMANCE Child Health Services Reporting Date Apr-17 ($000s) REVENUE MONTH Actual Budget Variance Actual Budget Variance Government and Crown Agency F 9,347 8,051 1,296 F Funder to Provider Revenue 17,862 17,942 (80) U 176, ,297 (2,533) U Other Income 1,454 1, F 11,163 11,649 (486) U Total Revenue 20,306 19, F 197, ,997 (1,724) U EXPENDITURE Personnel Personnel Costs 10,659 10, F 105, ,096 (489) U Outsourced Personnel (7) U 1,346 1,224 (122) U Outsourced Clinical Services F 2,370 2, F Clinical Supplies 1,933 1, F 19,816 18,935 (881) U Infrastructure & Non-Clinical Supplies (106) U 3,536 2,782 (754) U Total Expenditure 13,342 13, F 132, ,422 (2,232) U Contribution 6,965 6, F 64,619 68,575 (3,956) U Allocations F 8,875 9, F NET RESULT 6,087 5, F 55,744 59,137 (3,393) U Paid FTE MONTH (FTE) YEAR TO DATE (10 months ending Apr-17) YEAR TO DATE (FTE) (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance Medical (0.7) U (4.2) U Nursing F F Allied Health F F Support F F Management/Administration (23.3) U (19.1) U Total excluding outsourced FTEs 1, ,114.6 (12.9) U 1, ,111.6 (13.8) U Total :Outsourced Services (2.0) U (3.3) U Total including outsourced FTEs 1, ,118.5 (15.0) U 1, ,115.5 (17.1) U Comments on major financial variances The Child Health Directorate was $483k F for the month of April and is now $3.393M U year to Date, including $1.8M of wash-up risk on core volumes. Year to date revenue is $1.724M unfavourable and driven primarily by wash-up risk on core WIES and non-wies revenue ($1.8M U), and donation revenue ($0.5M U). Year to date total expenditure (including allocations) is at $1.670M U (101.2% of budget levels) - compared to inpatient activity at 98% of budget volumes. Total inpatient WIES for the month was 7% lower than 15/16 and 8 % lower than contracted volume. Year to date WIES is now 1 % above last year although 2% below budget. Factors impacting on the April year to date performance are as follows: 1. Revenue $1.724M U: a. PVS base contract revenue $1.8M U. Primarily relates to surgical inpatient underdelivery across Orthopaedics and Paediatric Surgery. Total elective WIES is now at 95% compared to 93% last month and a peak of 97% in January. Additional elective surgical activity is currently scheduled for the balance of the year to improve this position. 61

67 b. Donation revenue is $0.498M U. Donation receipts are $1.25M F over the past three months. This trend will continue to year end - delivering to budget levels. c. ACC $1.120M F. The Rehab service commenced in December generating new ACC revenue of $515k YTD (although there is approx. $346k of related expenditure). In March $400k of revenue was accrued for Safekids Home Safety Campaign. Excluding the Rehab contract and Safekids, ACC revenue is now tracking at 107% of budget. 2. Expenditure $1.670M U: a. Overall year to date expenditure is 101.2% of budget, compared to inpatient volumes at 97.8% of contract. Clinical supply costs were 105% of budget at March YTD ($881k U), although $335k relates to asset write-offs that will be transferred to Corporate in May. Main cost drivers for the month were relatively high treatment disposables; and much higher implant costs in Orthopaedics ($100k U) on the back of higher orthopaedic volumes (100% for April month). YTD overall cost per cwd is approximately 107% of budget (which drops to 105% when backing out asset writeoffs). Total Child Health clinical supply costs are $881k U primary drivers due to very high haematology/oncology volumes ($258k U); and in Surgery, NICU ($219k U) and PICU ($287k U), due to record occupancy levels; and orthopaedic implant costs ($476k U), due to budget short-fall. These are partly offset by low cardiac costs ($327k F). b. Employee costs are $489k U from the budget for year to date. The primary driver to this increased expenditure is additional RMO positions to budget (8.5 fte U, $192k U year to date). However registrar costs have dropped significantly in the past two months both fte and average cost - and this has the main driver of favourable employee costs over March/April. Other year to date employee costs are reasonable overall but would need to drop further to achieve budget fte and cost levels, given assumed saving initiative levels ($1.7M U year to date). 3. FTE 17.1 FTE U: The year to date result is 17.1 FTE U. This budget includes a savings target of 21.7 FTE. RMO staff are 8.5 FTE U which is the major reason the directorate is not closer to the target FTE level. All other staff categories are running well within budgeted levels. However they would need to be at yet lower levels in order to achieve overall FTE targets inclusive of the savings target. 4. Key strategies currently employed to mitigate the budget deficit include the following: 1. On-going focus on revenue streams management of elective volumes, ACC, donations and non-residents. The ACC Rehab Service contract has now been executed, which has commenced 1 December and the Safekids Home Safety Campaign is about to be executed. On-going risk is now primarily wash-up. Donation receipts are strong. 2. Monitoring of clinical activity to ensure bed closures that are consistent with both clinical requirements and budgeted expenditure across the full financial year. However there were significant bed pressures over the past three months through general wards, PICU and NICU. 3. Implementation of Directorate savings initiatives in addition to participation in Provider level projects. 4. Tight management of vacancy and recruitment processes; and a focus on leave management. However leave balances are now greater than target reductions

68 Date: 17 May 2017 A3 owners: Dr John Beca and Dr Mike Shepherd Starship Child Health Directorate Key priorities for Starship Child Health Directorate Our aim is to deliver patient and whanau centred, world class paediatric healthcare to all of the populations we serve. In 2017/18 our Directorate will contribute to the delivery of the Provider Arm work programmes. In addition to this we will also focus on the following Directorate priorities: 1. Clinical Excellence programme 2. Financial sustainability 3. Re-designed Community services model implementation 4. Aligning services to patient pathways 5. Hospital operations/inpatient safety 6. Meaningful involvement from our workforce in achieving our aim 7. Tertiary service / National role sustainability Current condition 1. A well functioning clinical excellence framework for the directorate, with services developing more coordinated clinical excellence reporting and improvement. Lack of consistent clinical outcomes reporting or improvement. 2. Ongoing financial challenges particularly related to Tertiary Services and donation timing. Expenditure at budget. 3. Recently reconfigured community services, with further work required to deliver whanau centered care, an outcomes focus (reducing inequity ) and culturally appropriate services. 4. Many activities are delivered along somewhat ad hoc, service led pathways rather than patient pathways, resulting in some duplication, reduced efficiency and lack of standardisation. 5. Hospital operations continue to develop and there is alignment with key organisational workstreams which will enhance hospital functioning and safety. These will impact on hospital performance required particularly surgical production, acute flow and safety. 6. Capable and motivated workforce, but some small services and highly specialised roles which creates vulnerability. Access to an HR Manager will enable improved planning and targeted areas of engagement and improvement. 7. Diverse range of Tertiary and National Services with uncertainty around sustainability, model of delivery and funding. Target condition World class patient and whanau centred paediatric healthcare delivery 1. Coordinated quality and safety programme fully functioning across the Directorate. Measurement, reporting and improvement of clinical outcomes, including equity. 2. Financial sustainability 3. Community services are integrated, easy to navigate, empower whanau, community centric and sustainable 4. Services aligned to patient pathways delivering greater quality including improved patient outcomes and greater standardisation 5. Highly reliable and efficient inpatient service 6. Sustainable workforce with high levels of engagement in priority initiatives 7. Well described and agreed plan and effective funding model for Tertiary and National services Action Plan Owner Q1 Q2 Q3 Q4 1 Excellence Programme development within all services JB/MS 1 Measurement, reporting and benchmarking of clinical outcomes MS/JB 2 Ongoing effective financial management including contract rationalisation and revenue development 3 Community service redesign implementation MS 4 Pathway development across services particularly pain and cardiac JB/EM 4/5 Surgical/Operating Room pathways, performance and leadership JB 4/5 Facilities programme for safety and patient experience EM 5 Embedding the Patient At Risk model SL 5 Embedding of afterhours inpatient safety model - including multidisciplinary handover practice 5 Acute flow (Discharge planning focus) MS 6 Directorate and service level engagement action plans EM / HR 6 Establish HR priorities and programme of work EM / HR 6 Improved programme of research and training for all Starship staff JB/MS 7 Updated and publically available service descriptions EM Measures 1. Quality and Safety metrics established across services Current (End 2016/17) Services with metrics EM SL Target (2017/18) Further development of clinical outcome metrics 1. Quality and safety culture (AHRQ) Measured Improved and Re-measure Improved 2. Meet revenue and expenditure targets 2. Complete contract rationalisation and explore new revenue opportunities 3. Community redesign programme 4. Operational structure that follows patient pathways Expenditure met, Revenue not met Need and methodology identified Implementation commenced Budget met Contract rationalisation complete, revenue opportunities identified Implemented 2018/2019 Reporting and improving Budget met Includes Allied Health Includes Surgical Includes all Revenue aligned to service delivery costs Delivering according to outcome framework 4. Pain service model Model Developed Implemented Pathway operational 4. Functioning clinical pathways Few Every service has at least 1 Every service has many 5. Acute Flow metric 95% 95% 95% 5. Surgical performance and pathways Scattered metrics 5. Safety metrics Code Pink, urgent PICU transfer from ward 6. New and emerging leaders completed leadership training 6. Staff engagement Balanced safety, performance, efficiency Unknown Defined and improving Improved Improving performance 20/25 25/25 All current and emerging Measured, highs and lows identified 7. Tertiary services Report complete Action plans complete Consultation complete and outcome agreed Measurable improvement in engagement Implementation of agreed national approach 63

69 Perioperative Directorate Speaker: Dr Vanessa Beavis, Director Service Overview 5.6 The Perioperative Directorate provides services for all patients who need anaesthesia care and operating room facilities. All surgical specialties in Auckland DHB use our services. Patients needing anaesthesia in non-operating room environments are also cared for by our teams. There are five suites of operating rooms on two campuses, and includes five (or more) all day preadmission clinics every weekday. We provide the (24/7) acute pain services for the whole hospital. We also assist other services with line placement and other interventions when high level technical skills are needed. The Perioperative Directorate is led by Director: Dr Vanessa Beavis General Manager: Duncan Bliss Nurse Director: Anna MacGregor Director of Allied Health: Kristine Nicol Directorate Priorities for 16/17 In 2016/17 our Directorate will contribute to the delivery of the six Provider Arm work programmes. In addition to this we will also focus on the following Directorate priorities: 1. Single Instrument tracking implementation. 2. Financial position tracking to budget. 3. Oracle Consignment module utilised and ready to upgrade to enable tunnel project. 4. All day operating lists fully resourced and utilised. 5. Support the delivery of the PVS and ESPI compliance. 6. A workforce that is fully engaged, recruited to establishment in line with demand and fully trained. 64

70 Q4 Actions 90 day plan 1. Single Instrument tracking implementation Activity Implementation of single instrument tracking Progress Completion date for the single instrument tracking project has been extended timeline yet to be confirmed due to IT and significant operational impacts. Further work is in progress regarding the suitability of the system. It is likely that an upgrade to the existing system will be preferred. There is high level contingency work underway by ha at present to provide some critical stabilisation of the current system. This ongoing issue was raised through the Directorate Quarterly review with escalation to agree an approach moving forward. 2. Financial position tracking to budget Activity Review of material management stock levels Ordering and usage of loan equipment Progress This will be the next phase of the oracle consignment stock implementation. Small working groups are working on multiple projects in the interim. This will be supported by the RFID process when implemented. All OR suites have worked with the procurement team through April with the exception of Starship where the number of days stock held has been reduced with projected savings of over 100k FYE. This will form part of the end to end stock management project commencing in early 2017 The Product Management Committee commenced in November which is establishing a process for new stock items to be assessed before being available to order. The RFID tunnel has been procured following approval through CAMPC which is intended to be implemented through July 17 enabling tracking of all loan sets in OR. Late notice cancellations work with specialities to understand the financial impact The top 20 consumable spends for both cost and volume have been reviewed by the project team to ensure products have been reviewed within the last year. Weekly scrum meetings have allowed recycling of sessions to avoid preventable losses. Session utilisation has continued further to over 96% in April. 65

71 3. Oracle Consignment module utilised and ready to upgrade to enable tunnel project. Activity NOS National Oracle Project Progress Project plan being pulled together, data cleansing in progress. At present there is no further progress as we wait for national input ADHB roll out currently scheduled for tranche All day operating lists fully resourced and utilised. Activity Convert half day operating lists to full day Progress Phase 1 complete. There is now focus on the sessions at GSU OR sessions to increase full day operating. Further reviews have continued through April in planning OR sessions for 17/18 with the proposed increase in volumes for acute and elective cases in the current PVS schedule. 5. Support the delivery of the PVS and ESPI compliance. Pre- admission capacity and pathway review SCRUM process Patients booked for elective surgery require an anaesthetic assessment (as well as other possible interventions) prior to surgery being confirmed. The current model has variable work flows that limit the ability to offer economies of scale, and causes frustration for services and staff day to day through the layout and management of this stage of the elective pathway. In addition, the current model will not cope with elective volume demand for the 17/18 financial year and beyond. The project group has been formed and work has commenced with the assistance of the performance improvement team. Continue to reallocate sessions through the SCRUM process to reduce the number of sessions unfilled by service/late notice. Session utilisation is currently running at 96.4% YTD against the internal target of 95% 6. A workforce that is fully engaged, recruited to establishment in line with demand and fully trained. Review of current Models of Care across ORs Nurse Director working with all OR managers to identify the current state and ensure that the skill mix is correct to deliver a safe service. 17/18 OR requirements will inform the Models of Care across the DHB with predicted significant increases in acute operating. 66

72 Measures Measures Actual - April Current Target (End of 16/17) Single instrument tracking in place TDoc Nexus or TDoc upgrade Increase in access/capacity to ORs reduce the number of half day lists and flex sessions. Reduction in waiting times for Anaesthesia assessment clinic, including Paediatrics Recruiting to the identified reallocation of sessions to accommodate full day lists Project manager recruited - Feedback from a number of Anaesthetists and Preassessment Clinic Staff on what the guiding principles should be All level 4/8/9 to be full day lists Establish new guiding principles for on-going improvement in preadmission clinics Reduction in the number of preventable session losses 45.1% 45.1% 65% Key achievements in the month Perioperative Nurses's Choice Award OR - Winner: Elizabeth Kanivatoa, Finalists: Carol Andrew and Jude Fetalino Perioperative Nurses's Choice Award PACU - Winner: Gemma Parker, Finalists: Anna Bostock and Melissa Pilapil Two more nurses have completed the new to OR programme at the Greenlane Surgical Unit. New Finance Manager for Perioperative Services Alison West Successful world CSSD day event organised by the CSSD staff took place on Monday, 10 April. Areas off track and remedial plans The single instrument tracking project is under review and delayed. Some additional legal requirements have been identified as being necessary. Health alliance and our legal team are working on this at Stabilisation of the TDoc platform is required urgently to mitigate the critical clinical risk of an unstable system. A briefing paper has been submitted to the Director of Provider Services outlining the current risk which is to be presented back through the executive group. 67

73 Engaged Workforce Improved Health Status Better Quality Care Patient Safety Key issues and initiatives identified in coming months Issues with the new system safety management system DATIX is still work in progress. Reports are not being distributed evenly and the information provided is not accurate. The new system does not provide a brief report or enough visibility or content to the staff receiving the report. This matter is potentially going on the risk register. ORDA for the Level 8 Operating Rooms has issues with lack of space for patients in area, difficult to maintain confidentiality / privacy. Ophthalmic nursing team at the Greenlane Surgical Unit is stretched to cover Saturday lists, contract clinic lists, flex sessions, and on-calls. 5.6 Scorecard Auckland DHB - Perioperative Services HAC Scorecard for April 2017 Measure % Acute index operation within acuity guidelines Wrong site surgery % Elective prophylactic antibiotic administered <= 60 mins from procedure start Actual Target Prev Period 77.11% >=90% 71.79% % >=90% 80.9% % Unplanned overnight admission % Cases with unintended ICU / DCCM stay % 30 day mortality rate for surgical events % CSSD incidents 3.41% <=3% 4.36% 0.24% <=3% 0.17% 0.1% <=2% 0.15% 3.04% <=2% 3.27% % Elective sessions planned vs actual % Adjusted theatre utilisation - All suites (except CIU) % Late starting sessions 96.4% >=97% 97% 85.54% >=85% 86.6% 5.8% <=5% 5.3% Excess annual leave dollars ($M) % of Staff with excess annual leave > 1 year < 2 years % Staff with excess annual leave > 2 years Sick leave hours taken as a percentage of total hours worked % Voluntary turnover (annually) % Voluntary turnover <1 year tenure $ $ % <=30% 27.24% 11.56% 0% 10.82% 4.6% <=3.9% 4.6% 9.74% <=10% 10.16% 6.58% <=6% 6.33% Scorecard Commentary There were two complaints received for Perioperative services for April No SAC 1 and one SAC 2 incident was reported in the three months from 1 February 2017 to 30 April Recommendations from previous RCAs have been implemented. Formal auditing of the surgical safety check list has recommended this quarter, with good rates of engagement (and compliance). There were two medication incidents reported for April 2017, without harm. Each department holds a monthly quality meeting where all incidents are reviewed and investigated. This is monitored by a Directorate quality meeting where any recurring trends are reviewed and action plans agreed as necessary. 68

74 Unplanned overnight admissions in April were 3.41% against a target of 3%, which is attributed to the acute load and case mix. The April planned vs actual elective session usage was 96.4%, this is attributed to the improved attendance of the SCRUM meeting and the release and reallocation of sessions across departments. Late start information is being provided to the relevant department managers to investigate and identify any trends that can be addressed. It is part of the MOS board directorate focus areas. There is ongoing attention to this issue, the causes of which are multifactorial. Flu vaccinations are being carried out on each level with in team vaccinators. Waste Management recycle training session was organised for and attended by the non-clinical staff on 4 April. The anaesthesia website is being updated, lots of new features including advertising meetings, fellowships, job vacancies, patient information publishing our guidelines etc. Financial Results Summary Net Result STATEMENT OF FINANCIAL PERFORMANCE Perioperative Services Reporting Date Apr-17 ($000s) REVENUE MONTH Actual Budget Variance Actual Budget Variance Government and Crown Agency (2) U 1,890 1,905 (15) U Funder to Provider Revenue F F Other Income F F Total Revenue F 2,121 2, F EXPENDITURE Personnel Personnel Costs 7,699 7, F 77,374 75,747 (1,627) U Outsourced Personnel (1) U (174) U Outsourced Clinical Services F F Clinical Supplies 4,185 3,667 (518) U 37,870 35,460 (2,410) U Infrastructure & Non-Clinical Supplies (98) U 1,792 1,559 (234) U Total Expenditure 12,178 11,570 (608) U 117, ,194 (4,444) U Contribution (11,951) (11,361) (590) U (115,517) (111,101) (4,416) U Allocations F F NET RESULT (11,969) (11,386) (583) U (115,777) (111,370) (4,408) U Paid FTE MONTH (FTE) YEAR TO DATE (10 months ending Apr-17) YEAR TO DATE (FTE) (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance Medical F F Nursing F F Allied Health F F Support F F Management/Administration (9.0) U (9.0) U Total excluding outsourced FTEs F F Total :Outsourced Services (3.0) U (3.0) U Total including outsourced FTEs F F 69

75 Comments on major financial variances Month The net result for April is an unfavourable variance of $583k. Total minutes were 336,003 (3,819 cases) compared to budgeted 363,966 minutes (4,156 cases), equating to 7.6% below budget for the month. Clinical supplies for the month are unfavourable due to a delayed depreciation expense recognised in April. 5.6 Year to Date The year to date result is an unfavourable variance of $4,408k. This result reflects a combination of activity levels greater than budget; savings targets not fully achieved and unbudgeted delayed depreciation expense. The volumes worked year to date of 3,625,428 minutes (40,680 cases) compare to budgeted minutes of 3,548,652 minutes (40,204 cases), equating to 2.2% above budget. This reflects the growing number of transplant cases (179 YTD compared to 157 in 2016) and increasing weekend elective cases (76 in Apr 17 compared to 17 in Jul 16). The increased volumes have made it difficult to achieve savings targets in Personnel costs, and this is the main driver of the $1,627k unfavourable variance for Personnel costs. Focus continues on minimising wastage in session times. Clinical supplies are unfavourable due to a delayed project capitalization / clean up, recognising $1.3m in depreciation and an asset write off valued at $950k. The average cost per minute for Perioperative services to date is $32.09 compared to a budgeted average of $ This compares to the average cost per minute of $31.38 in 2015/16. Business Improvement Savings Total savings achieved are $466k YTD. 70

76 Date: March 2017 A3 owner: Dr Vanessa Beavis Perioperative Directorate Key priorities for Perioperative Directorate In 2017/18 our Directorate will contribute to the delivery of the ADHB Provider Arm work programmes. In addition to this we will also focus on the following Directorate priorities: 1. Respond to the key findings to Directorate results of the 2016 staff engagement survey 2. Address the outstanding financial, production and clinical risk relating to instrument tracking 3. Redesign and integrate pre-admission processes/protocols for elective surgery 4. Quality improvements relating to handover and briefings 5. Assign OR capacity to increasing demand surgery volumes 6. Revision and refresh of the service leadership structure that enables collaboration with other Directorates Current condition 1. The key findings from the Perioperative staff engagement survey demonstrates a theme of a pressured and overcommitted workforce that feel under valued. 2. Delays to the CSSD system update mean we continue to have no way of tracking OR instruments to individual patients and associated risk. 3. There are continued cancellations on the day of surgery and poor patient experience that can be addressed through improved pre-admission processes. 4. There are themes impacting on quality throughout the directorate linked to handover and briefings. 5. The continued increase in overall acute demand and increased elective volume requirements have resulted in a shortfall of OR capacity to meet the needs of our patients. 6. Continued opportunity for collaboration between Directorates and current silo working. Target condition 1. Engaged workforce with best patient outcomes in a good place to work. 2. Ability to track and trace theatre instruments for surgery across ADHB. 3. Reduction in cancellations and improved patient experience through improved pre-admission processes. 4. Reduction in incidents relating to handover, briefings and improved outcomes in care and co-ordination events 5. Established capacity to meet the agreed PVS volume through ORs 6. Embedded leadership structure inline with ADHB clinical leadership model and strengthened policies and procedures promoting collaboration. Measures Current Target (End 2016/17) 1. Improved results in employee pulse survey Positive attitude 46% 50% 65% 2. Implementation of TDOC upgrade V8 V13 3. Reduction in cancellations on the day linked to pre-admission processes 4. % reduction in incidents related to care and co-ordination incidents 15% 12% 10% 5. $ per minute to be within 2% variance of 2016/17 actual costs $31.78 </= $ Implementation of revised leadership structure Consultation document released 1 1 TBA TBA 2017/18 Full implementation Action Plan Owner Q1 Q2 Q3 Q4 By use of a pulse survey to perioperative staff by area focusing on the themes of the 2016 engagement survey to establish solutions to improve staff engagement OR dashboard to include engaged workforce as part of knowing how we are doing across all suites with potential reward structure for continually high performing areas Clinical Directors and OR Managers Clinical Directors and OR Managers 2 Implementation of TDOC upgrade from Version 8 to Version 13 CSSD Manager 3 The review criteria admission criteria for surgery at GSU GSU CD 3 Review and refresh patient documentation issued at pre-admission Explore opportunities for one stop services for pre-admission for high clinics with high conversion rates Implement a formalised handover from OR to PACU as part of the 4 th stage of the SSCL Substantive recruitment to remaining flex sessions across all OR suites for elective capacity Increased Acute operating recourse during weekends and public holidays Service Clinical Director General Manager Clinical Directors OR Managers OR Managers 5 Substantive recruitment for increased GSU OR capacity on Saturdays OR Managers 6 Implement approved leadership structure including consultation and communication to appropriate stakeholders Service Director 71

77 Cancer and Blood Directorate Speaker: Dr Richard Sullivan, Director Service Overview 5.7 Cancer is a major health issue for New Zealanders. One in three New Zealanders will have some experience of cancer, either personally or through a relative or friend. Cancer is the country s leading cause of death (29.8%) and a major cause of hospitalisation. The Auckland DHB Cancer and Blood Service provide active and supportive cancer care to the 1.5 million population of the greater Auckland region. This is currently achieved by seeing approximately 5,000 new patients a year and 46,000 patients in follow-up or on treatment assessment appointments. The Cancer and Blood Directorate is led by: Director: Richard Sullivan General Manager: Deirdre Maxwell Director of Nursing: Brenda Clune Finance Manager: Dheven Covenden HR Manager: Andrew Arnold Director of Allied Health: Carolyn Simmons Carlsson Directorate Priorities for 16/17 In 2016/17 our Directorate will contribute to the delivery of the six Provider Arm work programmes. In addition to this we will also focus on the following Directorate priorities: 1. Tumour stream service delivery 2. Faster Cancer Treatment (FCT) 3. Haematology Service Model of Care 4. Supportive Care Service initiative 5. Northern Region Integrated Cancer Service (NRICS) development 6. Employee engagement in support of achieving these priorities 7. Achieve Directorate financial savings target for 2016/17 72

78 Q4 Actions 90 day plan 1. Developing and implementing a tumour stream approach within Cancer and Blood Directorate. Our alignment project is well underway. We have membership across all the service areas to ensure engagement with staff on the floor. Prioritised work sits with daystay and infusions, and clinics and utilisation as the first focus; with acutes and the haematology model of care as later areas of focus due to staffing and service pressures. However, given the interlinked nature of this work, we are including further definition of acutes within the daystay piece. Significant pressure points have been identified around clinic visibility and capacity. In the daystay group we have identified a range of nursing/clinical activities that do not appear to be counted, and are working on patient flows across the whole service. 2. Meeting the 62 day Faster Cancer Treatment (FCT) Target within Cancer and Blood. The FCT Lead Tumour Stream Coordinator continues to work closely with our Service Clinical Directors, their teams and the scheduling lead to improve Cancer and Blood response times consistent with FCT and demand pressures. Achievement against the target has dipped across the previous three months, with focus on specific areas e.g. Gynae Oncology, access to MRI, triage processes. Within our directorate, our current focus continues to be on radiation oncology, where we are resizing SMO jobs as part of the mapping of demand to capacity. We have recruited to SMO vacancies mapped to tumour stream FTE availability using this methodology, and await these new staff members. 3. Development and implementation of Haematology Model of Care We continue to monitor to manage our patient BMT waitlist on a weekly basis, to ensure we do not breach Ministry guidelines re waiting time. The progression of the Models of Care work is subject to the recruitment of a new Service Clinical Director, with process in train currently. 4. Supportive Care Services Our Regional Lead Psychologist has left our Service to take up the National Lead role with the Ministry of Health. We are completing a recruitment process to fill this important Regional Lead role, along with some clinical psychology tenths vacated.the Ministry of Health has confirmed the key focus areas for the initiative include: patients at the front of the treatment pathway (from high suspicion/recent diagnosis through treatment), patients and whanau with complex psychological and social issues associated with cancer, and groups within communities who may find it more difficult to access and utilise services, e.g. Maori, Pacific, socio-economic disadvantaged, remote and rural populations and tumour groups with few existing supports. 5. Northern Region Integrated Cancer Service development, including local delivery of chemotherapy Pilot Adjuvant Herceptin delivery at Counties Manukau DHB: Our Auckland DHB service has completed its hands on support of this pilot, with the service now operating one day per week within Counties Manukau DHB. Breast and Bowel Cancer - Chemotherapy Local Delivery: We are exploring extending pilot herceptin delivery to Waitemata DHB. Regional work has commenced under the banner of the Long Term Investment Plan (Deep Dive for Cancer), with a range of proposals to be presented to the Regional Executive Group to ensure that activity remains aligned and moving forward across the region. 6. Employee Engagement Initiatives Our Cancer and Blood Directorate is now working on the issues raised through the DHB-wide Employee Survey. Each Service is working up their top three priorities and associated plans, with 73

79 consideration of these to lead to a selection of the aggregate top three priorities for our Directorate. A survey is currently underway to determine progress. 7. Breakeven revenue and expenditure position We are working with our Service Clinical Directors and wider teams to ensure savings plans are produced and delivered, to meet with $1.3M savings target required. Please refer Financial Results section. 5.7 Measures Measures Current Target (End 2016/17) 2017/18 3 additional tumour streams implemented within Cancer and Blood (Gastro-intestinal, Breast, G-U) 62 day FCT target (1)Jan March 2017 rolling (Ministry) (2)Oct March 2017 rolling (Ministry) Development /implementation of Haematology Model of Care Supportive Care Services - % urgent referrals contacted within 48hrs from across all DHB cancer services 1 3 N/A 81.3% (1) 87.0% (2) 20% (baseline work) June % July % July 50% implementation June % 100% July 100% July 100% 100% implementation year end 2017/18 Northern Region Integrated Cancer Service - Local delivery of chemotherapy (Counties Manukau DHB) Auckland DHB meets regional project timeframes 100% July 2017/18 commencement 100% Employee engagement initiatives underway 3 3 tba Breakeven revenue and expenditure position Breakeven Key achievements in the month Linear Accelerator Implementation underway We have established a Steering Group to oversee this complex implementation, reporting to Dr Richard Sullivan as Sponsor. We have established a project structure to manage the work. Memorandum of understanding with the Cancer Society A paper has been approved by Board to sign an MOU that describes the points of agreement. We very much appreciate the services the Cancer Society provide with and for our patients/whanau and look forward to a formal signing process in due course. Areas off track and remedial plans Achieving Financial Savings We have developed financial savings plans, and although these are in place they are proving challenging to deliver against. Health and Safety - The roof leaks in Building 8, and current lift upgrades remain high on the health and safety risk register. We continue to take all possible steps to mitigate these issues to ensure the ongoing safety of our patients, families/whanau and staff. 74

80 Key issues and initiatives identified in coming months Early Phase Trials Unit Establishment Work continues on the establishment of this Unit, including appropriate governance oversight spanning Auckland DHB and the University of Auckland under the Academic Health Alliance, physical space readiness in the old BMT Ward area, and an appropriate clinical and management infrastructure. Radiation Therapy and Medical Physics career structures Work is progressing on a review of the Radiation Therapy and Medical Physics career structures and pathway to align with other workforce groups across Allied Health, Scientific and Technical groups. 75

81 Engaged Workforce Improved Health Status Better Quality Care Patient Safety Scorecard Measure Auckland DHB - Cancer & Blood Services HAC Scorecard for April 2017 Actual Target Prev Period 5.7 Medication Errors with major harm Number of falls with major harm Nosocomial pressure injury point prevalence (% of in-patients) Nosocomial pressure injury point prevalence - 12 month average (% of in-patients) Number of reported adverse events causing harm (SAC 1&2) Unviewed/unsigned Histology/Cytology results >30 and < 90 days Unviewed/unsigned Histology/Cytology results >= 90 days % <=6% 0% 5.2% <=6% 4.7% (ESPI-1) % Services acknowledging 90% of FSA referrals in 15 calendar days or less % DNA rate for outpatient appointments - All Ethnicities % DNA rate for outpatient appointments - Maori % DNA rate for outpatient appointments - Pacific Number of CBU Outliers - Adult % Very good and excellent ratings for overall inpatient experience % Very good and excellent ratings for overall outpatient experience Number of complaints received 28 Day Readmission Rate - Total Average LOS for WIES funded discharges (days) - Acute % Cancer patients receiving radiation/chemo therapy treatment within 4 weeks of DTT % Chemotherapy patients (Med Onc and Haem) attending FSA within 4 weeks of referral % Radiation oncology patients attending FSA within 4 weeks of referral % Patients from Referral to FSA within 7 days 31/62 day target % of non-surgical patients seen within the 62 day target 31/62 day target % of surgical patients seen within the 62 day target 62 day target - % of patients treated within the 62 day target R/U 100% 100% 4.62% <=9% 5.36% 8.46% <=9% 9.7% 10.5% <=9% 11.79% R/U >=90% 77.8% R/U >=90% 94.1% 0 No Target 4 R/U TBC 27.78% 3.91 TBC % 100% 100% 100% 100% 97.73% 86.9% 100% 89.5% 23.63% TBC 33.38% R/U >=85% 87.5% R/U >=85% 85% R/U >=85% 86.25% % Hospitalised smokers offered advice and support to quit 96.43% >=95% 86.21% BMT Autologous Waitlist - Patients currently waiting > 6 weeks Excess annual leave dollars ($M) % Staff with excess annual leave > 1 year % Staff with excess annual leave > 2 years % Staff with excess annual leave and insufficient plan to clear excess by the end of financial year % Staff with leave planned for the current 12 months % Leave taken to date for the current 12 months Number of Pre-employment Screenings (PES) cleared after the start date Sick leave hours taken as a percentage of total hours worked % Voluntary turnover (annually) % Voluntary turnover <1 year tenure $ $ % 0% 30.95% 7.61% 0% 8.62% R/U 0% R/U R/U 100% R/U R/U 100% R/U % <=3.4% 3.4% 13.2% <=10% 13.41% 4.76% <=6% 2.33% Amber R/U Variance from target not significant enough to report as non-compliant. This includes percentages/rates w ithin 1% of target, or volumes w ithin 1 value from target. Not applicable for Engaged Workforce KRA. Result unavailable (ESPI-1) % Services acknowledging 90% of FSA referrals in 15 calendar days or less Result unavailable until after the 16th of the next month. % Very good and excellent ratings for overall inpatient experience % Very good and excellent ratings for overall outpatient experience These measures are based on retrospective survey data, i.e. completed responses for patients discharged or treated the previous month. 28 Day Readmission Rate - Total A 35 day period is required to accurately report all acute re-admissions for the previous month's discharges. (35 days = 28 days post discharge as per MoH measures plus 5 w orking days to allow for coding). 31/62 day target % of non-surgical patients seen within the 62 day target 31/62 day target % of surgical patients seen within the 62 day target 62 day target - % of patients treated within the 62 day target Results unavailable from NRA until after the 20th day of the next month. % Staff with excess annual leave and insufficient plan to clear excess by the end of financial year % Staff w ith leave planned for the current 12 months % Leave taken to date for the current 12 months Results unavailable. 76

82 Scorecard Commentary Patient Safety/Quality The Directorate Quality Forum includes a deep dive into focussed areas each meeting with the most recent being patient experience. The Risk Register is updated and monitored at the Quality Forum and H & S meetings. No Falls with Harm or Grade 3 and 4 hospital acquired Pressure Injuries in April. Mixed gender Motutapu is consistently compliant and Ward 64 is variable. Trendcare in Ward 64 and Motutapu is progressing. Hand hygiene 91.7 %. We continue to roll out production planning methodologies to provide quicker access to all aspects of our services, with radiation oncology work underway. The service is currently experiencing SMO Engaged Workforce We are now seeing a small reduction in excess annual leave. Financial Results STATEMENT OF FINANCIAL PERFORMANCE Cancer & Blood Services Reporting Date Apr-17 ($000s) REVENUE MONTH Actual Budget Variance Actual Budget Variance Government and Crown Agency 791 1,200 (410) U 9,495 12,004 (2,509) U Funder to Provider Revenue 7,804 7,804 0 F 80,072 79,072 1,000 F Other Income (3) U F Total Revenue 8,619 9,032 (413) U 90,161 91,357 (1,197) U EXPENDITURE Personnel Personnel Costs 3,051 3,018 (33) U 30,415 29,622 (793) U Outsourced Personnel F F Outsourced Clinical Services F 2,155 2, F Clinical Supplies 3,379 3, F 36,344 36,022 (322) U Infrastructure & Non-Clinical Supplies (35) U 1, (382) U Total Expenditure 6,662 7, F 70,389 69,504 (885) U Contribution 1,957 1, F 19,772 21,853 (2,082) U Allocations F 5,998 6, F NET RESULT 1,408 1, F 13,774 15,832 (2,059) U Paid FTE MONTH (FTE) YEAR TO DATE (10 months ending Apr-17) YEAR TO DATE (FTE) (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance Medical (4.1) U (2.0) U Nursing F F Allied Health F F Support (1.7) U (1.0) U Management/Administration (4.5) U (4.6) U Total excluding outsourced FTEs (4.9) U F Total Outsourced Services F (0.7) U Total including outsourced FTEs (4.4) U F 77

83 Financial Commentary The result for the year to date April is an unfavourable variance of $ 2,059k. This excludes the PCT wash-up revenue of $ 3.2m for IDFs, which if included, would result in a favourable variance to budget (the actual PCT costs are already accounted for in the YTD result but the corresponding revenue is only washed up at year-end). 5.7 Volumes: Overall volumes are 99.6% of contract. Total Revenue $ 1,197k unfavourable - mainly due to Haemophilia blood product reimbursement $ 2,339k U (demand driven and offset by lower blood product costs) Provision for wash-up on Auckland DHB PCT costs $ 1,000k F Non Residents Income $ 117k F Total Expenditure- $ 862k unfavourable mainly due to Personnel including Outsourced Personnel $ 384k U partially due to unfavourable SMO costs in Radiation Oncology (mainly locum cover for extended paid sick leave) offset by vacancies in Allied Health and Outsourced personnel. The key driver of the unfavourable variance was savings target not fully achieved. Clinical Supplies $ 458k U made up of Haemophilia $ 2,102k F decrease in Haemophilia Blood product costs (demand driven and offset by decreased revenue). Oncology $ 1,647k U- primarily pharmaceuticals driven by the volume of high cost PCTs, mainly Herceptin and Melanoma drugs (demand driven) combined with unbudgeted new high cost drug Pertuzumab. This was partially offset by the provision for PCT wash-up revenue of $ 1,000k F. Haematology $ 798k U mainly due to blood products costs $ 618k U and pharmaceuticals $ 106k U (volume driven combined with high cost BMT patients). Currently the YTD Haematology volume performance is 3.1 % over the PVS contract equating to $ 654k over delivery against contract. Infrastructure and Non Clinical Supplies - $ 382k U This is primarily due to the unachieved opex savings target. FTE 0.3 FTE favourable 78

84 Date: 24 March 2017 A3 owner: Dr Richard Sullivan Cancer and Blood Directorate Key priorities for Cancer and Blood Directorate Our Regional Cancer and Blood Services aim to provide the best cancer care services today, and the even better care tomorrow. The following are the key areas within which we will drive change. In 2017/18 our Directorate will contribute to the delivery of the six Provider Arm work programmes, including savings opportunities. In addition to this we will also focus on the following Directorate priorities: 1. Tumour stream service delivery (subspecialisation) 2. Improving Our People s experience 3. Faster Cancer Treatment 4. Research enabled 5. Financial sustainability 6. Regional collaboration Current condition 1. We continue to reorganise our entire service in a tumour stream model, as this will provide better patient experience and outcomes. We are co-locating medical & radiation oncology clinics, reconfiguring daystays, and demand/capacity modelling in haematology preparatory to reorganise this service. 2. Following from the burnout project and engagement survey work we will develop a clear action plan for each service. 3. We will work toward achieving the 31 day target for all our patients while continue to oversee DHB-wide achievement of the 62 day target 90% of people with high suspicion receive treatment within 62 days. 4. We will work with university partners to better embed research in the ways we work, consistent with regional agreement. The establishment of our Phase 1 Trials unit in 17/18 is consistent with this intent. 5. We fully support the financial sustainability projects, and will specifically work on the implementation of a Purchase Unit Codes for radiation therapy (SABR, hypofractionation and usual treatment) given that our service is the most efficient in the country, and refresh plans for high cost technology and simulation. 6. We will continue to fully engage with our regional DHB partners to identify, develop and implement regionally agreed models of care. In 17/18 this is likely to include further local delivery of chemotherapy (breast and bowel), and overarching governance mechanisms. Measures Current Target (End 2017/18) Clinics co-located and new model of care in daystays as per plan Demand/capacity modelling in haematology and identification of model of care Employee survey projects following confirmation of issues at service level, as per plans 0% 100% na 10% 100% na 0% 100% na Phase 1 trial s unit operational No Yes na Refresh replacement plans for high cost technology 0% 100% na ADHB meets Faster Cancer Treatment target, including 31 day target within Cancer and Blood SABR Purchase Unit Code identified, costed and implemented Breakeven revenue and expenditure position % 90% 90% 0% 100% na Breakeven 2018/19 Action Plan Owner Q1 Q2 Q3 Q4 Reorganisation & Colocation of clinics, & daystay, consistent with alignment project goals Haematology Model of Care agreed following demand/ capacity modelling Employee survey projects implemented within services Consistently implement 31 days (ref-fsa) within Cancer and Blood Service CDs Project leads Haematology Service CD Service CDs Service CDs Target condition Realign our Cancer and Blood Services consistent with Alignment project goals Maintain sustainable, high levels of staff engagement in priority initiatives Provide DHB assistance in meeting the Faster Cancer Treatment target, and meet 31 day target within Cancer and Blood Establish a Phase 1 (First in Human) trials unit Achieve and maintain financial sustainability Prepare and reshape Cancer and Blood Services consistent with regionally agreed programmes 5 Develop/refresh high cost technology plan 6 Phase 1 trials unit established 7 New PUC established within radiation oncology 8 Regional collaboration as per regional agreement Local Delivery of Oncology Radiation oncology Service CD Director, Research Service CD Radiation oncology SCD, GM Director, GM, Medical Oncology Service CD 79

85 Mental Health and Addictions Directorate Speaker: Anna Schofield, Director Service Overview 5.8 This Directorate provides specialist community and inpatient mental health services to Auckland residents. The Directorate also provides sub-regional (adult inpatient rehabilitation and community psychotherapy), regional (youth forensics and mother and baby inpatient services) and supraregional (child and youth acute inpatient and eating disorders) services. The Mental Health and Addictions Directorate is led by Director: Anna Schofield Director of Nursing: Tracy Silva Garay Director of Allied Health: Mike Butcher Director of Primary Care: Kristin Good Medical Director: Allen Fraser General Manager: Alison Hudgell Directorate Priorities for 16/17 In 2016/17 our Directorate will contribute to the delivery of the six Provider Arm work programmes. In addition to this we will also focus on the following Directorate priorities: 1. AN INTEGRATED APPROACH TO CARE: An implementation plan to align services with the five locality boundaries. Tamaki integrated care recommendations implemented. The physical move of the Community Mental Health team from St Lukes in September 2017 will be part of this plan. 2. RIGHT FACILITIES IN THE RIGHT PLACE: A Facilities Plan will be developed to ensure facilities (leased or DHB owned) are fit for purpose, align with integrated models of care and locality approach and are informed by the Clinical Services Plan (CSP). New facilities will be identified to replace the existing facilities with leases due to expire in the next 18 months. 3. SAFE ACUTE ENVIRONMENT (Te Whetu co-design): Systematic approach to implementing an assault reduction / increased safety programme. Te Whetu Tawera (TWT)/Community Mental Health Service (CMHS) integration in care planning, MDT and staff development to manage acute flow / transitions. 4. RIGHT INTERVENTIONS AT THE RIGHT TIME: Stepped Care key work training provided to staff involved in the first step of the care pyramid. Credentialing framework confirmed for Steps 2 and SUPPORTING PARENTS HEALTHY CHILDREN (SPHC): Implementation Plan in place that encompasses the Essential Elements of the SPHC framework. Regional dataset for SPHC data collection confirmed. 6. EQUALLY WELL: Strengthened governance and relationships across mental health, NGO and PHO services for integrated care planning to improve the physical health of people with Severe Mental Illness (SMI). Develop template GP discharge summaries for service users highlighting physical health risks. 7. Achieve Directorate financial savings target for 2016/17. 80

86 Q4 Actions - 90 Day Plan # Action Plan Owner 1 Develop Integrated Approach to Care implementation plan to align services with five locality boundaries 2 Facilities Plan developed, aligned with the CSP and priority services moved as leases expire AS/AH AH 3a Complete and evaluate the TWT/CMHS escalation plan and collaborative MDT implementation. AS 3b Adoption and implementation of best evidence assault reduction activities MB 4a Specialist Stepped Care keyworker training and credentialing implemented with web resources MB 4b Shared care plan implementation AS 5 SPHC implementation plan and regional data set developed MB 6a 6b Cross primary, secondary, NGO governance group established, TOR and implementation plan developed Template for GP discharge summaries for service users highlighting physical risks KG KG 7 Balance clinical need, risk and safety with fiscal responsibility AS/AH 1 Implementation Plan to Align Services with Locality Approach The Mental Health Directorate is an integral part of the Primary and Community Programme Board and continues to engage in working on options for aligning mental health service provision and support to provide services closer to home. 2 Facilities Plan A Mental Health Directorate wide Strategic Facilities Plan will be provided to the Board for July To date a stocktake has been undertaken of all facilities and a health and safety assessment has been, or is planned, for all our facilities including those that are leased and DHB owned. There is a constant focus on alignment with the clinical services plan (including future need and potential co-location of services) and on prioritising services requiring alternative facilities in the next months. Of note is: Agreement has been reached to move ACOS to the Rehab Plus building at Point Chevalier meaning high and complex needs service will be co-located on one site. This will reduce some of the health and safety risks associated with ACOS service users at the St Lukes site. The options for the residential eating disorder service will be progressed once it is understood what the supra-regional requirements are for this service which will, in turn, 81

87 determine the type and size of facility needed. The clinically preferred model is for the adult residential service to be co-located with the day programme and outpatient service. The lease for the existing facility is until February Proposed options, sized for a supraregional service, have been scoped and shared with CAMP and the executive leadership team. 5.8 The Early Intervention Service focused on first incidence psychosis for year olds will, following a comprehensive review, be centralised. A suitable facility has been identified and we are in the process of confirming capital to ensure the facility is fit for purpose. 3 (a) Te Whetu Tawera (TWT)/Community Mental Health Service (CMHS) Escalation Plan The purpose of the escalation plan is to improve flow and access across the acute mental health service delivery continuum. Ideally, acute inpatient units should run at an average occupancy of 85% in order to manage acute demand in a timely manner. Te Whetu Tawera frequently operates at % occupancy. This in turn does impact on the Community Acute Service s ability to have people who require acute inpatient care admitted to TWT. It also impacts on wait times in the ACH Emergency Department. The Escalation Plan has been implemented. However due to the ongoing increase in acute demand we are constantly operating at near full or full capacity. Other respite and planned acute care services are at capacity managing high acuity in the community. 3 (b) Adoption and Implementation of Best Evidence Assault Reduction Activities In early 2016 a project to reduce a high level of assaults occurring in Te Whetu Tawera was commenced. This initial programme of work has now been incorporated into Project Haumaru, a wider change programme at TWT focusing on improving safety, patient flow and staff wellbeing. The project aims to proactively engage and involve all staff. Te Tumanako (ICU), where there is the greatest risk of assault, was the initial focus for assault reduction and the South London and Maudsley Trust (SLaM) model of assault reduction was implemented and subsequently rolled out to the open wards.. The major components of the SLaM model implemented include the Dynamic Appraisal of Situational Aggression (DASA), Intentional Rounding, and the nursing handover tool ISoBAR. Other initiatives being undertaken as part of Project Haumaru, and likely to have a positive long term impact include: Development of a Compact ( Understanding Each Other ) with service users. This is a component of the SLaM model noted above that establishes a baseline for how both service users and staff wish to be treated at Te Whetu Tawera. Each service user will be given a copy on admission and can personalise it to express their goals whilst in Te Whetu Tawera. It is being developed in consultation with both staff and service users. Establishment of a Whare Tautoko which is a small room dedicated in particular, but not exclusively, as a space for use by Maori service users and their whanau within Te Tumanako. The employment of a Recreation Assistant to work alongside other staff such as occupational therapists, to provide service users in Te Tumanako with a broad daily programme of activities. 82

88 Results of all these interventions appear to be flowing through with reduced levels of assault across Te Whetu Tawera. The significant reduction in the overall number of assaults since August 2016 suggests a sustained change although it can be expected that the rates will vary at times according to acuity, service user complexity and individual service user profile. In March 2017 there were 12 reported assaults in Te Whetu Tawera. Year to date performance against an annual target of no more than 15 assaults per month on average, is 8.5 (9 months). Episodes of Restraint: There were 38 episodes of restraint during March involving 13 service users. This represented a slight increase over the previous month. Episodes of Seclusion: Three individuals were secluded over five episodes during March for a total of 22.3 hours. Although Auckland DHB has a very low seclusion rate when compared nationally, a range of initiatives are being undertaken expected to contribute toward achievement of goals set to reduce the rates by May 2018 These include the DASA, Intentional Rounding, the Compact, the Whare Tautoko, increased use of Sensory Modulation, improved communication, Reflective Practice Panels and increasing activity options. 4 (a) Specialist Stepped Care Stepped Care is a system of delivering and monitoring treatments so that the least intrusive treatment is delivered to meet service user s presenting need within adult community mental health services. It involves matching people's needs to the level of intensity of the intervention and only 'stepping up' to intensive or specialist services as clinically required. This approach aims to support self-care as an important aspect of managing demand across primary, community and specialist care settings. Stepped care work uses robust tools to routinely collect outcomes data to support people's journey into, through and out of services. Progress for specialist stepped care to date includes the development of additional resources available on the Intranet; refinement of the credentialing process for specialised interventions and the appointment of a Nurse Educator to support workforce development and enable implementation of a range of clinical programmes related to Stepped Care. Training sessions for the initial six modules are currently being provided in each of the six community services, with a completion date of end June Initial feedback from staff is positive. 4 (b) Shared Care Plan A shared care plan is an electronically stored plan which details goals agreed by the service user and health professionals, along with actions and activities to support the achievement of these goals. One of the key benefits of the shared care plan is the ability for services outside of mental health (such as Emergency Department) to view portions of the plan to support patient led care and smooth the continuum of care through shared communication. It also facilitates appropriate information sharing with primary care. The implementation of collaborative shared care plans across adult Community Mental Health services commenced in All adult CMHCs, Fraser McDonald Unit and the Mental Health Services for Older People (MHSOP) Community Team have now received training and begun to use the tool. The adult acute inpatient unit TWT will commence using the tool later in 2017 as a component of discharge planning. Services are receiving monthly reports of uptake. Further training and support is 83

89 being provided in adult community teams to improve utilisation. This includes input from a Consumer Leader. 5 Supporting Parents Healthy Children (SPHC) The Government led SPHC programme aims to support parents to do the best for their children by providing guidelines and assistance to all mental health and addiction services to work in a familyfocused way. The aim to ensure the wellbeing of children is everyone s responsibility and not just infant child and adolescent services. SPHC also supports the children of parents to improve outcomes for children and youth as set out in Rising to the Challenge (Ministry of Health, 2012). 5.8 The SPHC guidelines includes voices of parents and young people talking about their experiences of services and provides evidence based practice to support both parents and their children. The first phase of the SPHC guidelines, the Essential Elements, are almost all now achieved and being implemented. All services have SPHC champions in place at both leadership and frontline levels to support practice change to incorporate a family focus and support for children of service users. An ongoing focus is to continue to increase the number of service users who are screened for their parenting status. An SPHC page on the Intranet has been developed which provides training material and resources for staff. A brief SPHC in-service training has been developed and is currently being delivered to all adult mental health service teams. This training will support culture and practice change through an increase in the awareness of the importance of SPHC, supporting processes and procedures, and the availability of resources. 6(a) Cross Primary, Secondary, NGO Governance Group Equally Well Governance Group: In New Zealand and overseas, people with mental health and addiction problems tend to have worse physical health and a shorter life expectancy than their counterparts in the general population. Diabetes, cardiovascular disease, metabolic syndrome, cancer and oral health issues are more prevalent for this population group. Equally Well is about working together for change with the common goal of reducing physical health disparities for those who experience mental health and addiction problems. This group has representation from the DHB, PHOs and NGOs. There is consensus that this initiative will provide an opportunity to work differently and collaboratively to improve patient outcomes; and support for exploring the use of the Health Improvement Profile in an integrated fashion across primary and secondary care. The Governance Group has been provided with information on initiatives currently underway in other parts of the country and has subsequently agreed to focus on establishing baseline data, determining elements to be included in the physical check, GP education, funding extended GP consultations and creation of contributory measures for inclusion in the Amenable Mortality System Level Measure. 84

90 Community Mental Health Service Primary/Secondary Integration Strategic Group: Primary/secondary integration has been identified in Rising to the Challenge (Ministry of Health, 2012) as a means to provide seamless, effective services across the continuum for people experiencing mental health and addiction issues. Specialist mental health services have committed to addressing infrastructural barriers to enhancing coordination and integration between primary and specialist services. The Community Mental Health Service Primary/Secondary Integration Strategic Group has been recently reconfigured. It is working collaboratively on a work plan to address the gap in access to appropriate care within the community for patients whose needs are currently unmet in either primary or secondary care. With the confirmation of funding for PREDICT as a key enabler for this initiative, this group given its effective and widespread use in primary care will work towards incorporation within primary and secondary services. The CMHS primary/secondary integration initiative is provided in addition to the Tamaki Mental Health and Wellbeing Project being led by the Service Improvement Team. 6(b) Template for GP Discharge Summaries for Service Users Adult community mental health services (CMHCs) use a discharge letter template within the electronic clinical record (HCC) to enable information to be shared electronically between specialist services and General Practitioners in a consistent format. Since July 2016 electronic discharge letters have been provided to GPs for 45% of discharges, and the Directorate aims to increase this to 90% by In addition, letters have been sent to GP s to update progress on current clients in 60% of cases and the service aims to improve this to 80% by CMHCs are using the local KPI forum to track progress and share learnings to support the achievement of this goal. The recent forum identified a number of action points for follow-up including technical and clinical. A key next step is to identify and implement an appropriate digital dictation system that will interface with the electronic clinical record. This work will also be discussed at the supra regional supra-regional KPI forum being held at the end of May, (a component of the national mental health adult KPI stream.) Our acute adult inpatient unit Te Whetu Tawera is in the early stages of exploring the possibility of generating discharge summaries for GPs through the electronic clinical record software, HCC. Currently these are generated and sent via Concerto. 7 Balance Clinical Need, Risk and Safety with Fiscal Responsibility With significant Mental Health funding being FTE based, we continue to address skill mix, including clinical and non-clinical staff. We are working with our clinical and management teams to ensure staff are working to their strengths, and working collaboratively within and across services, to manage and lead clinical and operational components of mental health services. We have almost fully recruited Mental Health Assistants to the permanent staff teams in Te Whetu Tawera thus implementing this skill mix change and decreasing our reliance on casual staff. With users across our services presenting with increased acuity, our clinical teams are stretched to deliver safe, quality, clinical care and with a recovery focus in the community. 85

91 In terms of recruitment, anecdotally we are aware of applicants who express interest in, or are offered, roles but subsequently fail to progress with the recruitment process due to the current cost and availability of housing. This applies to international recruiting as well as from other regions in New Zealamf. We continue to think of creative ways to access overseas staff, including offering fixed term contracts that enable more senior staff from overseas to take sabbaticals from existing roles for 18 months with the view to them supporting the growth of our own less experienced staff, along with increasing our internships from nursing and allied health. 5.8 Measures Measures Current Target (End 2016/17) 2017/18 Integrated Approach to Care Plan, aligned with localities approach signed off Development stage. With Primary /Community Programme Board Plan signed off Staged implementation Facilities Plan, aligned with CSP signed off EDS residential has been scoped. Alternative ACOS facility confirmed St Lukes relocated by Q4 Residential EDS options confirmed and implementation plan Work through facilities by priority Escalation Plan implemented in 2 services and evaluated Implementation complete Evaluation completed, plan refined and roll out underway Roll out to other services Shared Care Plan in place for adult CMHS clients Development stage 80% of CMHS users have a Shared Care plan 90% target Assault reduction best practice plan developed and rolled out Implementation ongoing Reduction in assaults for staff and patients Maintenance of assault reduction Stepped Care keyworkers trained in all modules Credentialing completed for relevant staff doing Step 2 and 3 Training resources on-line Implementation in progress 80% keyworkers in CMHS trained in all modules 80% of staff credentialed for Steps 2 and 3 100% of training resources available online 95% of keyworkers trained in all modules SPHC implementation plan developed and regional data set agreed Data set agreed. Training underway Plan signed off >80% of new service users screened for parental/care giving status 90% of all service users screened Equally Well governance group established and plan developed Governance group established, plan in development Implementation Plan signed off 80% of GPs have discharge summaries that include physical risks for service users Staged implementation Breakeven revenue and expenditure position Ongoing with regular monitoring and review Breakeven 86

92 Key achievements in the month Te Whetu Tawera (TWT) The TWT leadership team have implemented Project Haumaru which aims to improve patient safety, staff well-being and safety and patient flow. This builds on and incorporates the co-design work undertaken in Te Whetu Tawera. The environmental upgrade and improvements identified through the co-design work are now complete. Project Haumaru is led by the SCD supported by a project manager, with input from the Performance Improvement team as appropriate. With all service development and improvement work in Te Whetu Tawera now sitting under the umbrella of Project Haumaru, staff across all disciplines, as well as consumer representatives are actively engaged in order to increase ownership and buy-in by staff and embed changes They are represented on the Steering Group and a range of sub committees including assault reduction, codesign, co-morbidities, staff wellbeing, outcomes and the development of a Compact ( Understanding Each Other ). There is also a renewed focus in 2017 on seclusion and restraint reduction complemented through work underway in the national KPI forum. As already noted in this report, Project Haumaru appears to be having a positive impact with regard in particular to a significant and sustained reduction in assaults on service users and staff since August Work is now being undertaken to better understand the barriers to discharge and to link these to measures of acuity and complexity. New Zealand is a signatory to the Optional Protocol to the Convention Against Torture (OPCAT) and meets its obligations to the Convention through the Crimes of Torture Act (COTA) In March an announced follow-up visit to Te Whetu Tawera was undertaken by the Office of the Ombudsman in order to follow-up on recommendations from a visit in October The draft report on the March visit notes that nine of eleven recommendations had been achieved, one was partially achieved and another was not checked at the time of the visit. Nurse Practitioner Tracey Forward completed the final process of her Nurse Practitioner journey in April 2017 to become our first Mental Health Nurse Practitioner. In her new role Tracey will provide advanced mental health nursing assessments, diagnosis and brief interventions (including prescribing as regulated by the NZNC) to adults (18-65 years) presenting with mental health difficulties in the primary health care sector. This will also include specialist consultation and liaison across the primary / secondary mental health and addictions sector, the primary health care sector and nongovernment organisations (NGO s) to achieve positive mental health outcomes for our population. Areas off track and remedial plans Supra- Regional Eating Disorder Service Auckland DHB has acknowledged the Midland DHBs notice of intention to withdraw from all but the adult residential component of the supra-regional eating disorder programme. Work has been initiated to identify a suitable location for the EDS residential service and a feasibility project has scoped options. 87

93 Alternative options and financial and clinical impacts were developed by the provider, funder and NRA, and the recommended model endorsed by the Board. Midland DHBs have recently provided a response to the adult residential proposed funding model and the facility required for this service in the future will depend on the outcome of ongoing negotiations. Ligature Risk at Te Whetu Tawera 5.8 Several of the identified ligature risks within TWT have been mitigated in the currently allocated funding. This includes an agreed new prototype for taps in ensuites and shower roses. These are being tested in the next few months in two ensuites and it is anticipated this will not require the walls to be opened. Whilst this is a longer wait than anticipated, it does reduce the disruption to wards. However due to the structure of the building, more detailed work revealed that costs associated with mitigating ligature risks posed by some windows would be significantly greater than budgeted for. This is because the structure of the current facility means replacement of windows would be cost prohibitive ($1 million plus). The other option is to seal windows and install an HVAC system and this too would require a significant investment. These options have been discussed by the DHB Leadership Team and considered for the 2017/18 capex plan. St Lukes CMHC and Acute Community Outreach Service (CMHC) Facility As noted earlier, there are current challenges with sourcing an alternative facility for the St Lukes CMHC including our inability to secure a preferred facility to date. We continue to look for alternative options, including the use of the Point Chevalier campus. However there are numerous interdependencies associated with the use of this site and it will require the Executive Leadership Team to make a decision regarding priority service/s to be accommodated on this campus. Child and Family Unit The increase in occupancy in the CFU has been maintained with an overall occupancy of 86% for the year to date. Of note is the extremely high occupancy of the High dependency unit (HDU) sitting at 94% occupancy. Over the last year there have been 71 days where the occupancy of the HDU has exceeded 100% (compared to 8 days in the year prior). An escalation plan has been developed to communicate acuity to key staff and is currently being implemented. Analysis of AWOL s early in 2017 identified several possible mitigating activities which have now been implemented. Formal repeat analysis will occur on a quarterly basis however anecdotally there has been a significant reduction of AWOLs. There is an on-going concerted effort being made to work collaboratively with our Oranga Tamariki (Ministry of Vulnerable Children) colleagues at the regional and national level and the Ministry of Health to facilitate the best outcomes for children and young people with care and protection and mental health issues that access the Child Youth and Family Unit. This has culminated in a secondment of a previous senior CYF manager to support interagency processes. Currently the CFU leadership structure is being reinforced with Anna Schofield as Acting Service Clinical Director and a more rigorous approach to roles and responsibilities, the health excellence framework and responsiveness to referrer needs across the supra-region. 88

94 Key issues and initiatives identified in coming months Facilities We will continue to proactively work on our Facilities Plan and to source fit for purpose facilities in the community or DHB facilities where existing leases are ending. There are significant interdependencies that impact on our ability to source appropriate facilities and we ensure these are clarified and considered in decision making processes. Mental Health ED Increasing pressures for the Emergency Department and Mental Health services has highlighted a need to improve the flow and experience for Mental Health patients through ED services. This has led to collaboration between senior clinicians and management from both departments to develop an action plan to move towards enhanced models of care. The agreed principles underpinning this plan are the Right Care in the Right Time by the Right People in the Right Environment. The implementation of the action plan is a focus for the year ahead with input and oversight from the leadership teams. Roll Out of Safe Practice and Effective Communication Programme (SPEC) SPEC is a new nationally consistent safety programme for staff in inpatient units which is an update and improvement on the previous local programme. Key outcomes of this new programme include: the transportability of training nationally and therefore lower on-boarding costs for (some) new staff; lower risk to service users and pain free holds for restraint; increased staff competency in communication and de-escalation skills; within a framework that highlights Recovery, and Person- Centred and Trauma Informed Care. SPEC is an important part of our work programme to reduce and eliminate restraint and seclusion. All staff in our three acute inpatient units (Child and Family Unit, Te Whetu Tawera, and Fraser MacDonald Unit) are being trained in the new programme within a short timeframe. This is necessary so that staff teams can quickly transition from the old to the new processes. Approximately two hundred staff are being trained, including rostered nursing and mental health assistants, allied health, and regular bureau staff. In order to release staff for this four day training, we have needed to backfill our staffing rosters through increased use of overtime and outsourced staffing, greatly increasing our inpatient running costs over the duration of the SPEC training. The first four of 14 planned courses were held in April. These have been very well received, with high levels of engagement reported by the trainers, and good feedback from participants (the majority of April participants rated the content, methods and facilitators a 5 on a Likert scale where 5 was the most positive response). 89

95 Engaged Workforce Improved Health Status Better Quality Care Patient Safety Scorecard Measure Auckland DHB - Mental Health HAC Scorecard for April 2017 Actual Target Prev Period 5.8 Medication Errors with major harm Number of falls with major harm Nosocomial pressure injury point prevalence (% of in-patients) Nosocomial pressure injury point prevalence - 12 month average (% of in-patients) Number of reported adverse events causing harm (SAC 1&2) - excludes suicides Seclusion. All inpatient services - episodes of seclusion Restraint. All services - incidents of restraint Mental Health Provider Arm Services: SAC1&2 (Inpatient & Non-Inpatient Suicides) % <=6% 0% 0% <=6% 0% <= <= No Target 1 7 day Follow Up post discharge Mental Health - 28 Day Readmission Rate (KPI Discharges) to Te Whetu Tawera Mental Health Average LOS (KPI Discharges) - Te Whetu Tawera Mental Health Average LOS (All Discharges) - Child & Family Unit Mental Health Average LOS (All Discharges) - Fraser McDonald Unit Waiting Times. Provider arm only: 0-19Y - 3W Target Waiting Times. Provider arm only: 0-19Y - 8W Target Waiting Times. Provider arm only: 20-64Y - 3W Target Waiting Times. Provider arm only: 20-64Y - 8W Target Waiting Times. Provider arm only: 65Y+ - 3W Target Waiting Times. Provider arm only: 65Y+ - 8W Target 91% >=95% 96% R/U <=10% 5.26% 29.9 <= <= <= % >=80% 73.7% 89.1% >=95% 90.1% 89.7% >=80% 90% 95% >=95% 95.4% 68.3% >=80% 68.8% 88.9% >=95% 89.7% % Hospitalised smokers offered advice and support to quit Mental Health access rate - Maori 0-19Y Mental Health access rate - Maori 20-64Y Mental Health access rate - Maori 65Y+ Mental Health access rate - Total 0-19Y Mental Health access rate - Total 20-64Y Mental Health access rate - Total 65Y % >=95% 97.92% 5.95% >=5.5% 5.93% 9.64% >=12% 9.57% 4.04% >=4.25% 3.8% 3.24% >=3% 3.24% 3.53% >=4% 3.53% 3.14% >=4% 3.12% Excess annual leave dollars ($M) % Staff with excess annual leave > 1 year % Staff with excess annual leave > 2 years % Staff with excess annual leave and insufficient plan to clear excess by the end of financial year Number of Pre-employment Screenings (PES) cleared after the start date Sick leave hours taken as a percentage of total hours worked % Voluntary turnover (annually) % Voluntary turnover <1 year tenure $ $ % 0% 23.33% 4.83% 0% 5.26% R/U 0% R/U % <=3.4% 4.5% 12.08% <=10% 11.52% 10.99% <=6% 8.14% Amber R/U Variance from target not significant enough to report as non-compliant. This includes percentages/rates w ithin 1% of target, or volumes w ithin 1 value from target. Not applicable for Engaged Workforce KRA. Result unavailable Mental Health - 28 Day Readmission Rate (KPI Discharges) to Te Whetu Tawera A 35 day period is required to accurately report all acute re-admissions for the previous month's discharges. (35 days = 28 days post discharge as per MoH measures plus 5 w orking days to allow for coding). % Staff w ith excess annual leave and insufficient plan to clear excess by the end of financial year Result unavailable. 90

96 Scorecard commentary Average LOS: Te Whetu Tawera Average Length of Stay is at 29.9d for April which is above target. The median this month is 18d. The higher average has been heavily influenced by 3 long-stay discharges which were >110d. LoS is regularly monitored and the services is measuring and reporting on barriers to discharge with a view to formulating strategies to address key issues. Restraint Although this month has a high count of incidents of restraint, the numbers of individuals involved are not exceptionally high. This reflects that a quarter of all incidents are attributable to a single service user and nearly half (48%) are associated with just three service users. 7 day Follow Up Post-Discharge This month s figure is a little below target. However, the actual count of discharges not seen within 7 days is not exceptionally high this month. Rather, because the total count of discharges is quite low compared to other months, the number not seen has a large impact on the percentage. Waiting Times The introduction of the Starship Consult Liaison service into MoH reporting and the management of memory clinic clients within MHSOP continue to impact on rolling 12m results. Waiting times remain a challenge for the older adult Community Team (MHSOP) and for our Child and Adolescent services. Both services have experienced growth in demand and associated activity in the first half of 16/17FY compared to the same period in 15/16FY. This increase in demand and waiting times is occurring for CAMHS services nationally. MHSOP has made changes to memory clinic referrals. These, together with measures put in place to improve waiting times for MHSOP are proving effective. However, given that the data is for the previous 12 months, this will take several more months to demonstrate significant improvement. % Hospitalised Smokers Offered Advice and Support to Quit This month s figure is below target, which mental health services generally achieve. Services are reviewing this. Access (DHB-wide) Access is a count of mental health service contact with, or about, Auckland DHB residents in any DHB or NGO services during a 12 month period. This count is calculated as a percentage of the projected population. Access rates for Auckland DHB includes activity within Auckland DHB Provider Arm MH services and the NGO sector, as well as provider arm services contracted by Auckland DHB for delivery via Waitemata DHB (e.g. Community Alcohol and Drug services and Forensic services). While access rates for the Maori 20-64y group remains a challenge, Auckland DHB does have the highest access target for this group in the country. It should be noted that, across the adult continuum, Auckland DHB provider arm delivers approximately 36% of the access for this group with NGOs, community alcohol and drug services (CADS) and other DHB services delivering the balance. It 91

97 is challenging to understand the relative performance of different parts of this continuum from this broad access data provided by the MoH. Leave Management The cost of excess Annual leave increased from $ 0.10 (M) in March 2017 to $ 0.13 (M) in April The Directorate continues to require that leave plans be agreed for employee with excessing annual leave balances Turnover and Recruitment 5.8 Voluntary turnover increased from 11.5% in March 2017 to 12.1 % in April The Directorate is identifying possible initiatives to improve employee morale and increase retention as part of the FY17-18 business planning and current engagement planning processes. Attracting mental health nurses continues to be challenging. Selection of new nursing graduates has been a significant current focus and work is underway on re-establishing the Allied Health Internship programme within the Directorate. The Directorate is also looking to work closely with the recruitment team to identify opportunities for improving our current approach and administrative processes to reduce the time it takes from identifying a need for recruitment through to making an offer to a successful candidate. We know that our current practices have led to some candidates accepting competing offers. Staff Engagement Survey and Action Plans Employee survey results have now been shared with all Mental Health and Addictions staff at a Directorate level. Some teams are making good progress and already have engagement action plans in place. The Directorate Leadership team has been working on an all of Directorate plan with a view to supporting team plans. Proposed initiatives are targeted at improving the connection and support between teams within the Directorate and the wider Auckland DHB. Increasing the visibility of the Directorate Leadership Team and recognising and valuing staff are also focus areas for the Directorate plan. Initiatives are partially implemented. 92

98 Financial Results STATEMENT OF FINANCIAL PERFORMANCE Mental Health & Addictions Reporting Date Apr-17 ($000s) REVENUE MONTH Actual Budget Variance Actual Budget Variance Government and Crown Agency F F Funder to Provider Revenue 8,882 8,882 0 F 88,823 88,823 0 F Other Income F F Total Revenue 9,004 8,997 7 F 90,081 89, F EXPENDITURE Personnel Personnel Costs 6,553 6, F 63,320 64,331 1,012 F Outsourced Personnel (110) U 1, (1,008) U Outsourced Clinical Services F 704 1, F Clinical Supplies F (78) U Infrastructure & Non-Clinical Supplies (44) U 3,686 3,580 (106) U Total Expenditure 7,257 7,242 (15) U 70,138 70, F Contribution 1,747 1,755 (8) U 19,943 19, F Allocations 1,765 1, F 17,754 18, F NET RESULT (18) (43) 25 F 2,189 1, F Paid FTE MONTH (FTE) YEAR TO DATE (10 months ending Apr-17) YEAR TO DATE (FTE) (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance Medical F F Nursing (6.6) U F Allied Health (0.9) U F Support F F Management/Administration (0.9) U (6.1) U Total excluding outsourced FTEs (5.0) U F Total :Outsourced Services (9.8) U (11.2) U Total including outsourced FTEs (14.8) U F The result for the month is a loss of $18k against a budgeted loss of $43k, leaving a favourable variance of $25k. There was $66k unfavourable variance in Personnel costs including outsourcing in the month. This is attributed to high sick leave, high acuity in inpatient units and backfill for inpatient SPEC training occurring over a 14 week period. This is further compounded by difficulties and delays in recruitment for our mental health services and high outsourcing to cover this. The $71k variance in Outsourced Clinical Services is the key driver for the overall favourable results in April. The majority of the under-spending is from Flexi-funding, however a significant amount is committed. The Infrastructure and Non-Clinical Supplies expenditures are $44k unfavourable. This is mainly caused by building repairs and maintenance, funded training and one-off legal costs. 93

99 The change in the Auckland DHB nutrition supplier is the main contributor to the $33k favourable variance under allocations. The key drivers of the favourable YTD results are:- - Low Flexi-funding which is committed but not spent; - A change in supplier for Auckland DHB Nutrition services which has reduced our internal allocations costs. 5.8 Actions: - There is on-going review of relevant HR expenditure including Authority to Recruits (ATR) and Model of Care. - The on-going strategy to recruit new graduate nurses and interns will contribute in the long term to a lower skill mix and reduction in the premium paid on backfill. - The service is actively monitoring and reviewing non-clinical spending. Various controls and mitigations are being explored. Savings: Overall we are meeting our savings target for the year to date to April. This is achieved mainly through vacancy and annual leave management. There are on-going challenges and major risks around this with increasing demand and increasing clinical complexity. Forecast: The directorate is currently forecasting to be $457k favourable to budget result at year end. This is because there are higher costs in the balance of the year, including: additional costs of backfill to enable the implementation of the required National Safe Practice and Effective Communication (SPEC) Training Programme in the 3 acute units flexifund commitments high recruitment to address acuity impact of MECAS especially for junior doctors additional facility costs due to high maintenance expected in the coming quarter. 94

100 Date: May 2017 A3 owner: Anna Schofield Mental Health and Addictions Directorate Key priorities for MH&A Directorate Integral to our business plan is a patient and family/whānau focus along with integration and collaboration. We will work with mental health and physical health services and other agencies and sectors locally, regionally and further afield to improve outcomes for our service users. In 2017/18 our Directorate will contribute to the delivery of the Provider Arm strategic programmes. In addition to this we will also focus on the following Directorate priorities: 1. An integrated approach to care 2. Right facilities in the right place 3. Safe care across the continuum 4. Right interventions at the right time 5. Right people to provide the right care Current condition 1. Our Community Mental Health Services are organised across four localities & resource allocations reflect current demand. There are inconsistent boundaries for children, young people, adult & older people s mental health services. Integration of these services with health and other social sector providers varies. 2. Many of the MH facilities (some owned, others leased) are in disrepair or not fit for purpose. Alternatives to St Lukes is a priority as is the residential EDS and other leases are terminating in There are multiple interdependencies impacting on the ability of the mental health directorate to source suitable facilities. Other much needed repairs & refurbishments are in, or have been submitted to, the CAPEX plan. 3. There is an ongoing focus on patient and staff safety across the continuum of care and this work is encapsulated in a number of service improvement programmes across the Directorate. 4. There are a number of workforce development initiatives either in the developmental or implementation stage to support the right interventions. This includes the secondary focused Stepped Care training and credentialing framework. Pathways are being identified and developed to support consistent and/or integrated care. 5. The ADHB model of senior clinical leadership is embedded in the MH Directorate with recent changes to the Directorate wide leadership team. We are focusing on skill mix for clinical and non clinical staff. Recruitment drives have been undertaken for some Mental Health roles and we need to extend this to support a sustainable Mental Health staffing model. Target condition 1. Develop an implementation plan to align mental health services with a localities approach and the provision of services closer to home and better integrated with other health and social service provision 2. Strategic facilities plan developed, signed off and implemented, with St Lukes and the residential eating disorder service as priority areas. This inextricably links with the localities approach 3. We have a safe environment for patients and staff, including on going assault reduction work and a focus on factors that influence this. The service improvement work will be embedded to ensure it is sustained. 4. Service users have access to the right intensity of psychosocial interventions through implementation of secondary stepped care. Pathways across services, directorates and with external stakeholders, including the Ministry for Vulnerable Children, are developed and implemented. 5. Mental Health workforce practicing at the top of their scope. Up skilling leadership, enabling secondary and support staff to increase scope of work & enable non-clinical support to support this. Innovative recruitment drive to enable a sustainable cross Mental Health workforce and succession planning # Action Plan Owner Q1 Q2 Q3 Q4 a) Active participation in the Primary and Community programme board b) Primary Secondary Integration pilots in CMHCs with primary care (GPS and NGOs) a) Mental Health Strategic Facilities Plan developed b) Alternative facility for St Lukes CMHC sourced and investment confirmed to ensure it is fit for purpose c) Supra-regional investment in residential Eating Disorder service confirmed and facility sourced to reflect this d) ACOS service moved to the Auckland DHB Pt Chevalier site e) Early Intervention service is centralised in a facility and investment confirmed to ensure it is fit for purpose f) Explore options for Manaaki CHMC alternative facility, including service improvement team led initiative with Tamaki Alison Hudgell Sati Sembhi Alison Hudgell # Measures Current 1. b) Pilots are initiated and evaluated To commence 2. Facilities plan developed and signed off Underway a) Key elements of Project Haumaru are sustainably embedded in TWT Staged plans for b) to e) are developed and implemented a) Credentialing is completed and a full suite of training tools is developed which has been rolled out across the community services b) c) & d) Evidence based pathways are developed and implemented for CFU, ED and shared clients e) There is an agreed work plan with shared outcomes and actions a) Active participation in the management certificate pilot and subsequent training programme b) & c) Identification and development of standardised objectives across professional groups in every service across the directorate d) Administration support is fit for purpose to meet needs of clinical staff e) Development and pilot completed of an innovative recruitment strategy On track Underway On track Underway Underway To commence To commence Underway Underway Target (End 17/18) Pilots complete and planning for full roll out underway Facilities plan is implemented Project Haumaru is BAU All improvement projects are implemented Stepped care is embedded into practice Pathways are implemented Work plan is agreed 50% level 3 and 4 managers have completed 2 modules Objectives identified across each professional group Admin review is complete Strategy complete a) Project Haumaru b) CFU Service Improvement and collaborative work c) ED Mental Health Model d) Workforce Development e) Develop Pathways a) Stepped care credentialing and training continues to be implemented b) CFU admission and discharge pathways developed in consultation with stakeholders c) ED pathways to be reviewed and streamlined in collaboration d) Better understand (i) the different pathways across Directorates where we have shared clients and (ii) opportunities to refine these e) The Innovate mapping is completed re: the current situation and a work plan is developed and agreed to address gaps and overlaps a) Management development b) Allied Health new graduate approach c) Nursing graduates across the Directorate d) Non clinical support staff e) Innovative recruitment strategy Peter McColl Anna Schofield Allen Fraser AF/TSG/MB AS/AH Sati Sembi Anna Schofield Allen Fraser Anna Schofield Alison Hudgell Professional Leads Mike Butcher Tracy Silva Garay Alison Hudgell HR Consultant 95

101 Adult Medical Directorate Speaker: Dr Barry Snow, Director Service Overview 5.9 The Adult Medical Directorate is responsible for the provision of emergency care, medical services and sub specialties for the adult population. Services comprise: Adult Emergency Department (AED), Assessment and Planning Unit (APU), Department of Critical Care Medicine (DCCM), General Medicine, Infectious Diseases, Gastroenterology, Respiratory, Neurology and Renal. The Adult Medical Directorate is led by: Director: Dr Barry Snow General Manager: Dee Hackett Director of Nursing: Brenda McKay Director of Allied Health: Carolyn Simmons Carlsson Director of Primary Care: Dr Jim Kriechbaum Directorate Priorities for 16/17 In 2016/17 our Directorate will contribute to the delivery of the six Provider Arm work programmes. In addition to this we will also focus on the following Directorate priorities: 1. Developing the service/speciality leadership team to support the delivery of service transformation, performance management, living the values and financial management. 2. Meeting the organisational targets across all specialities. 3. Investing and developing our facilities and infrastructure to ensure they are fit for purpose and meet health and safety requirements. 4. Planning and implementation of service developments. Focus on at least one service development per speciality that improves the patient experience. 5. Overall reduction in the number of falls with serious harm, Grade 3 and 4 Pressure Injuries (PIs) and full compliance of 80% for hand hygiene across the Directorate. 6. Identify areas of waste that can be eliminated to save costs and improve quality and efficiency of care. Achieve Directorate financial savings target for 2016/17. 96

102 Q4 Actions 90 day plan Weekly team and monthly Directorate meetings are working well. Each service developing and delivering MOS. Held 17/18 Directorate planning day in March Each service developed a comprehensive action plan for 17/18 delivery. Monthly meetings with each service reviewing priority plans, finance information, HR information and newly developed service scorecards with each service. Continuing with monthly steering group to progress renal business case. Strategic discussions for future spoke delivery have started with Tāmaki Regeneration Company. Business case to be submitted following further discussions with Tāmaki Regeneration Company. Construction of CDU will begin in June Construction meetings held and reporting to Level 2 Design Board. A working group has been established to plan clinical infrastructure of CDU and a separate group to explore the use of APU. Quality forum delivered. New scorecards for all services developed that include quality items. Scorecards reviewed with services on a monthly basis. Recovery plan for gastroenterology/ colonoscopy as we did not meet April target. Investigation identified that this was due directly to booking. Plans for Q4 full delivery and projecting May 2017 fully met. Measures Measures Current Target (End 2016/17) ED target, ESPI, FCT and FSA and FUs Fully met 2017/18 Business case submissions Level 2 Renal BCs L2 CDU build completed Reduction in number of falls with serious harm 50% reduction from current 75% reduction from current Completion Reduction in the number of PIs grade 3 and 4 hospital acquired 50% reduction from current 100% reduction from current Hand hygiene 80% 95% Breakeven revenue and expenditure position Breakeven 97

103 Key achievements in the month Directorate planning day for 17/18 delivered with excellent attendance and engagement form across the whole Directorate. Continuing to meet Q3 AED target despite increased attendance. Continued delivery of the contract with Waitemata for Colonoscopy. Monitoring weekly with staff from Waitemata and currently working well. CDU design progressing and construction to start in June 2017 and a working group established to manage the build and developments within APU. Decant plans for cardiology developing with good engagement. Renal spoke concept design complete and design group established in preparation for concept design. Full engagement with Tāmaki Regeneration Company. Continued sustained improvement in hand hygiene across Directorate. Extensive planning underway for Hyper Acute Stroke and go live date set for the 24 th July Areas off track and remedial plans Not met monthly gastroenterology colonoscopy target. Plan to meet the Q4 targets as issues with booking and scheduling identified. Meeting weekly to actively performance manage and projected target met for May DNA rates still an issue but remaining consistent. Will be looking at models of care for 17/18 to review DNAs. Higher percentage within FUs. Key issues and initiatives identified in coming months Progressing development of community dialysis provision and working collaboratively with Tāmaki Regeneration Company for future provision of capacity. Plan to achieve and maintain AED target. Need to access in-patient short stay beds to enable effective flow through AED. Monthly priority plan and service performance meetings continuing with good engagement. Continuing with Neurology, Gastroenterology and Respiratory capacity and demand planning. Implementation of recommendations from the rapid improvement event in care of cellulitis. Development and delivery of implementation plans for regional Hyperacute Stroke service for stroke and clot retrieval. Continuing to deliver extra colonoscopy capacity for Waitemata. 98

104 Engaged Workforce Improved Health Status Better Quality Care Patient Safety Scorecard Auckland DHB - Adult Medical Services HAC Scorecard for April 2017 Measure Central line associated bacteraemia rate per 1,000 central line days Medication Errors with major harm Nosocomial pressure injury point prevalence (% of in-patients) Nosocomial pressure injury point prevalence - 12 month average (% of in-patients) Number of falls with major harm Number of reported adverse events causing harm (SAC 1&2) Unviewed/unsigned Histology/Cytology results >30 and < 90 days Unviewed/unsigned Histology/Cytology results >= 90 days Actual Target Prev Period 0 <= % <=6% 3.8% 4.9% <=6% 5.2% (MOH-01) % AED patients with ED stay < 6 hours (ESPI-1) % Services acknowledging 90% of FSA referrals in 15 calendar days or less (ESPI-2) Patients waiting longer than 4 months for their FSA % DNA rate for outpatient appointments - All Ethnicities % DNA rate for outpatient appointments - Maori % DNA rate for outpatient appointments - Pacific Number of CBU Outliers - Adult % Patients cared for in a mixed gender room at midday - Adult % Patients cared for in a mixed gender room at midday - Adult (excluding APU) % Very good and excellent ratings for overall inpatient experience Number of complaints received 28 Day Readmission Rate - Total % Urgent diagnostic colonoscopy compliance % Non-urgent diagnostic colonoscopy compliance % Surveillance diagnostic colonoscopy compliance Average LOS for WIES funded discharges (days) - Acute 95.87% >=95% 93.57% R/U 100% 100% 0% 0% 0.13% 11.08% <=9% 10.93% 20.69% <=9% 26.73% 17.71% <=9% 19.74% % 0% 30.28% 6.31% TBC 12.5% R/U >=90% 80% 12 No Target 14 R/U <=10% 11.39% 76.09% >=85% 100% 93.84% >=70% 91.56% 68.27% >=70% 74.61% 2.93 TBC 3.33 % Hospitalised smokers offered advice and support to quit 93.86% >=95% 93.56% Excess annual leave dollars ($M) % Staff with excess annual leave > 1 year % Staff with excess annual leave > 2 years % Staff with excess annual leave and insufficient plan to clear excess by the end of financial year % Staff with leave planned for the current 12 months % Leave taken to date for the current 12 months Number of Pre-employment Screenings (PES) cleared after the start date Sick leave hours taken as a percentage of total hours worked % Voluntary turnover (annually) % Voluntary turnover <1 year tenure $ $ % 0% 33.53% 12.38% 0% 11.92% R/U 0% R/U R/U 100% R/U R/U 100% R/U % <=3.4% 4.1% 11.02% <=10% 11.52% 4.44% <=6% 4.26% Amber R/U Variance from target not significant enough to report as non-compliant. This includes percentages/rates w ithin 1% of target, or volumes w ithin 1 value from target. Not applicable for Engaged Workforce KRA. Result unavailable (ESPI-1) % Services acknowledging 90% of FSA referrals in 15 calendar days or less Result unavailable until after the 16th of the next month. % Very good and excellent ratings for overall inpatient experience This measure is based on retrospective survey data, i.e. completed responses for patients discharged or treated the previous month. 28 Day Readmission Rate - Total A 35 day period is required to accurately report all acute re-admissions for the previous month's discharges. (35 days = 28 days post discharge as per MoH measures plus 5 w orking days to allow for coding). % Staff with excess annual leave and insufficient plan to clear excess by the end of financial year % Staff with leave planned for the current 12 months % Leave taken to date for the current 12 months Results unavailable. 99

105 Scorecard Commentary There were three Grade 3 and 4 pressure injuries for the month all of which were present on admission. There was one fall with harm which is also an adverse event causing harm. The fall occurred in AED with a patient falling when getting off a stretcher and walking to a bed. The patient sustained a fracture of the right ankle. Full investigation is underway. There were 5 adverse events in April. Two of these events were for the same incident which was an incorrect patient label on 2 units of red blood cells from the lab which required additional blood to be drawn from the patient. There was a Grade 4 pressure Injury which was noted on admission from a private hospital and exposure to environmental hazards in AED when medications and CT was administered to a pregnant woman. AED target met in April DNA rate still an issue but remains consistent. Not met monthly gastroenterology colonoscopy target. Plan to meet the Q4 targets as issues with booking and scheduling identified. Meeting weekly to actively performance manage and projected target met for May Mixed gender rooms remain an on-going focus with the need to balance the number of times a patient is moved, the cost effective utilisation of patient attenders in our Acute Observation Units (AOU) and management of hospital capacity. AED, Ward 63 and 65 are particularly affected and have strategies in place to reduce mixed gender rooms. 81.5% hand hygiene which meets the target. Slight increase on the last period in the excess annual leave (greater than two years) but continuing to work on this with services. Overall there has been a decrease of nearly 19% in the hours of leave accumulated. An increase in general medicine can be directly aligned to nursing staffing issues. Sick leave has also increased with a marked increase within general medicine nursing staff

106 Financial Results STATEMENT OF FINANCIAL PERFORMANCE Adult Medical Services Reporting Date Apr-17 ($000s) REVENUE MONTH Actual Budget Variance Actual Budget Variance Government and Crown Agency F 3,013 2, F Funder to Provider Revenue 11,842 11,842 0 F 127, ,616 0 F Other Income F 4,573 4, F Total Revenue 12,632 12, F 135, , F EXPENDITURE Personnel Personnel Costs 8,428 8, F 83,007 82,535 (473) U Outsourced Personnel F F Outsourced Clinical Services (16) U F Clinical Supplies 1,685 1, F 18,150 17,305 (845) U Infrastructure & Non-Clinical Supplies (164) U 1,911 1,004 (907) U Total Expenditure 10,510 10,464 (46) U 104, ,302 (2,151) U Contribution 2,122 2, F 30,748 32,100 (1,352) U Allocations 2,079 1,966 (113) U 21,131 20,135 (996) U NET RESULT (45) U 9,617 11,966 (2,348) U Paid FTE MONTH (FTE) YEAR TO DATE (10 months ending Apr-17) YEAR TO DATE (FTE) (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance Medical (12.1) U (9.6) U Nursing F (11.9) U Allied Health F F Support F (0.0) U Management/Administration (10.4) U (11.9) U Total excluding outsourced FTEs (15.3) U (27.6) U Total :Outsourced Services F F Total including outsourced FTEs (14.1) U (27.5) U Financial Commentary The result for the year to date April 2017 is an unfavourable variance of $2,348k. Volumes: Overall volumes are % of contract. This equates to $354k over contract (variance not recognised in the Adult Medical Provider result). Key drivers of the Unfavourable Variance Total Revenue - $799k favourable - primarily due to additional colonoscopy revenue for achieving the 15/16 target $233k F, nurse endoscopy training revenue $95k F and WDHB Colonoscopy $305k F. 101

107 Personnel Costs - $ 414k unfavourable (including Outsourced Personnel costs) This is mainly unachieved savings target made up of personnel cost target saving of $901k offset by favourable variances in Allied Health $535k F. The savings initiatives comprises the management of overtime spend, patient attenders, allowances, sick leave, staff mix and annual leave. Clinical Supplies - $ 845k unfavourable mainly due to Treatment disposables $ 437k made up of - Blood product costs $218k U - mainly ED due to high cost patients and increased volume, - Renal fluids $124k U (increase in the usage of APD and Co APD (high performance fluids) which are more expensive than CAPD), - Respiratory Patient Consumables $94k U (mainly due to increased replacement of NIV machines in the Community). 5.9 Instruments and Equipment $276k unfavourable mainly due to - Clinical Equip RandM $116k U - unplanned repairs and maintenance to scopes and bariatric equipment, - Clinical Equip Rental - $77k U mainly increased usage of pressure relieving mattresses and respiratory ventilators at home. Pharmaceuticals $129k unfavourable mainly due to Gastroenterology $145k U (increases in IBD patient using high cost Biological infusions (infliximab). Infrastructure and Non-Clinical supplies - $ 907k unfavourable This is primarily due to the partially unachieved opex savings target. Internal Allocations (Service Billing) - $ 996k unfavourable Mainly due to Radiology $ 740k U primarily ED and DCCM (volume driven) and Neurology (Clot Retrieval). FTE The YTD unfavourable Medical FTE variance is overstated due to RMO leave transfers combined with increased medical FTE in AED and Gen Med (volumes and complexity). The unfavourable Nursing FTE variance is mainly in AED also due to volumes and complexity, combined with unachieved FTE savings target. 102

108 Date: 3 April 2017 A3 owner: Dr Barry Snow Adult Medical Directorate Key priorities for Adult Medical Directorate In 2017/18 our Directorate will contribute to the delivery of the Provider Arm programmes. In addition to this we will also focus on the following Directorate priorities: 1. Meeting the organisational targets across all specialities 2. Identifying areas of waste within each service and developing a plan to remediate the costly areas of the system 3. Development and implementation of a plan to support the findings from the organisational employee engagement survey and a plan to support the role of the Speak Up campaign 4. Safe staffing planning and implementing the new MECA deal and further development and use of Trendcare to predict unsafe staffing levels 5. Plans to deliver all organisational, regional and local service improvement / development projects within each service Current condition 1. Organisational targets: Issues maintaining the AED target with high levels of attendance and higher acuity. ESPI compliant but capacity issues within neurology and respiratory which we are managing. Undertaken capacity and demand work and should be able to predict volumes that we need to undertake weekly to support clinical team in managing their capacity. 2. Each service working up a waste project that can identify savings which will be part of the Directorate savings plan 3. Each service reviewing employee engagement survey data and compiling bespoke actions plans for each area 4. Identifying specific clinical services affected by the new MECA deal and examining impact on current roster. Working with nursing to use Trendcare to predict staffing needs and staff to those levels 5. Service developments: several projects underway. CDU redevelopment, hyper acute stroke service, expansion to OPIVA, cellulitis pathway, readmissions work, renal spoke development and progressing the readmission and management of COPD. Measures Current Target (End 2017/18) AED target, ESPI, FSA and FUs Fully met 2018/19 Business case submissions Renal BCs Renal spoke delivered L2 CDU build completed Action plan for employee engagement survey delivered Full uptake of Speak Up campaign Using Trendcare to predict safer staffing levels and deploying staff appropriately Compliant MECA roster. Development of career pathways for physiology Savings plans delivered in full Completion Completion Completion Ongoing Completion Full delivery Action Plan Owner Q1 Q2 Q3 Q4 Continue with weekly and monthly meeting structure to review service improvements Review progress monthly of priority plans to ensure delivery Delivery of capacity and demand projects across directorate Regular review of KPIs to ensure performance delivery and development of balanced scorecard to monitor delivery Ensure each initiative within Directorate is reviewing cost effectiveness and value for money. Each service to have developed at least one savings specific project BS BS and OD department BS, and TD BS and TD BS and TD Target condition 1. Meeting all targets across the whole system in Adult Medicine and having remedial plans for issues that arrive. 2. Plan for waste delivery projects that deliver significant savings across the Directorate 3. Whole Directorate employee engagement survey development plan that is delivered across the Directorate 4. Full understanding of MECA compliance across Directorate and use of Trendcare with full functionality 5. Delivery of all identified projects to time and within budget across Directorate Develop service plans for employee engagement survey feedback. Collate for a Directorate plan Understanding MECA compliance issues across Directorate and identifying specific services that will not be compliant Fully understanding use of trendcare and achieving full data compliance across the adult medical ward base 5 Delivery of projects across Directorate. Monitor each one through a project approach. Monitor progress of design and build for level 2 CD BS and DH BS and PH CSC BS and BMcK BS 103

109 Community and Long Term Conditions Directorate Speaker: Alex Pimm, General Manager Service Overview 5.10 The Community and Long Term Conditions Directorate is responsible for the provision of care of Older People s Health Services, Adult Rehabilitation Services, Palliative Care Services, Community Based Nursing, Community Rehabilitation, Community Allied Health Services, Sexual Health and Sexual Assault Services and Long Term Condition and Ambulatory Services for the adult population. The services in the Directorate are structured into six service groups: Reablement (in patient adult assessment, treatment and rehabilitation services) Sexual Health Services (including adult sexual assault assessment and treatment service) Community Services (Chronic Pain, Locality Community Teams and Mobility Solutions) Diabetes Services Ambulatory Services (Endocrinology, Dermatology, Immunology and Rheumatology) Palliative Care Services The Community and Long Term Conditions Directorate is led by Director: Judith Catherwood General Manager: Alex Pimm Nursing Director: Jane Lees Allied Health Director: Anna McRae Primary Care Director: Jim Kriechbaum Medical Director: Lalit Kalra Directorate Priorities for 16/17 In 2016/17 the Directorate will contribute to the delivery of the six Provider Arm work programmes. In addition to this the directorate will also focus on the following priorities: 1. Embedding clinical governance culture across the Directorate to support all decision making. 2. Leadership and workforce development programme. 3. Outpatient improvement programme. 4. Improvement in health outcomes through new models of care. 5. Achieve Directorate financial savings target for 2016/

110 Q4 Actions 90 day plan 1. Extend and develop clinician leaders and managers through leadership and management programmes A programme of facilitated team development based on Board mandatories, values and strategic direction has continued to progress. Service Leadership Team events to support this are in progress across the Directorate. Two members of our new clinician leadership team have completed their leadership development programme. Nine members of staff are currently on the programme in various cohorts in A programme of people leaders regular networking meetings have been established with a focus on the engagement survey and other people leadership hot topics. Leadership and management support and training for our new leaders and level four team members has been identified as a priority for this year and is being supported. 2. Implement plan for advancement in roles for nurses, allied health and support staff Workforce planning for nursing and allied health role development continues to progress. New community health assistant (CHA) roles are being developed to support our community locality teams. The staff are currently working through a competency programme so they can support the full range of community staff. The new service developments in progress, including rapid response, intermediate care, early supported discharge and stroke services provide opportunities to enhance nursing and allied health roles. An advanced clinician role and nurse specialist role in Reablement Services have been recruited to. Nursing roles in Sexual Health, Diabetes, Dermatology and Rheumatology services are also currently being developed to support service requirements and support nurses to safely work at the top of their scope of practice. 3. Complete the implementation of the Directorate outpatient improvement programme DNA action plan continues to be implemented with our initial focus on Diabetes Services. Our DNA rates have declined by 5% this month in this service. A report will be provided to HAC at the August meeting to further describe this work in more detail. The process to reduce service initiated rescheduling rates by applying a six week booking rule is in place in a number of outpatient clinics. Our rescheduling rates continue to slowly reduce and the trajectory is on target to meet our goal. At present we do not have data to indicate how many appointments are rescheduled due to patient choice versus service requirements. This is work in progress. Baseline assessment to ensure accurate measurement of virtual contacts is progressing in all services. Our services are increasing the use of virtual contacts in all services. Implementation of business rules into Reablement outpatient services and Community Services has been completed to ensure accurate activity and waiting times reporting. Reporting processes have been completed with Business Intelligence. 105

111 4. Implement the stroke plan and work towards a comprehensive adult stroke unit The integrated all age stroke rehabilitation unit opened in July Early Supported Discharge Services (ESD) also commenced simultaneously. The hyper acute stroke pathway is in the process of implementation. The quarterly data on admissions to a rehabilitation service within 7 days of an acute stroke presentation showed an improvement with 54.1% achievement in the last quarter. We expect our quarterly data to reflect continuous improvement each quarter as a result of the implementation of a new referral pathway for stroke patients. In our most recent data for March % of ADHB patients were transferred within the seven day target, an improvement on the previous month. Plans to create the comprehensive adult stroke unit are progressing and will continue through 2017 as it will require a full business case to be developed Extend the locality model of care to other services The locality model continues to develop with Community Services and Diabetes Services. A plan to achieve this in full by end of 2016/17 is in place and progressing well. Geriatric Medicine are in the process of finalising a plan and work is now in progress to ensure gerontology support is in place in all localities. A programme of work to support integration of the locality model across the four main directorates engaged in community service delivery is in progress across the provider arm. The adult palliative care strategy continues to be implemented. The decision document on the new adult palliative care clinical leadership structure has been released. We are recruiting to these new roles and interviews are planned for June The final improvement events to plan improved care for those at end of life have been held in March An action plan has now been finalised and will be progressed through the Using the Hospital Wisely Programme. A new workforce model for Sexual Health and Sexual Assault Services has been released and is in the process of being implemented. A transition period to implement the new workforce model will take place over the course of 2017 with the aim to be fully implemented by December Implement the frailty pathway The first stage of the frailty pathway was implemented successfully in August Further work is progressing to develop care pathways across the hospital and extend this to older adults living in their own homes and in aged care facilities over time. The aim of the pathway is to standardise the care bundle provided to all frail patients presenting to the ED and ensure rapid access to the most appropriate services and a comprehensive geriatric assessment early in the care pathway, with the aim of improving outcomes for frail adults, reducing the length of stay in hospital or supporting care in patient s own homes to reduce any unnecessary admissions. 7. Implement step up/step down intermediate care models Rapid Response Services continue to be delivered and are now accessible from ED, hospital services, general practice, aged care facilities, St John and Homecare Medical referral sources. Rapid Response is being rebranded to the Rapid Community Access Team (R-CAT) to reduce confusion with the 24/7 Hospital Deteriorating Patient s support services. Our new Early Supported Discharge Service has proved very successful and is now delivering to capacity. We continue to promote 106

112 services and are working on a new community central referral model to enhance navigation and access to services. An approach to utilise the interim care contract for a wider group of patients has been agreed. We have also completed work with Orthopaedics to enhance allied health and gerontology nursing input to these patients during their care period in aged care. 8. Develop long term conditions strategy across the organisation This strategy and plan is being reconsidered. The Using the Hospital Wisely Programme and other programmes outside of the provider arm has taken some of the outcomes envisaged forward in a different manner. We anticipate delivering similar outcomes using these programme board planning process. Measures Measures Current Target (end 16/17) Previous Period Did not attend (DNA) rate 11.06% <9% 12.11% Rescheduling rate 51.4% <40% 53.3% Proportion of activity undertaken as virtual or non-face-to-face activity Patient waiting times outpatients, community and inpatients Admissions to age-related residential care Proportion of HCAs and TAs as percentage of total workforce Percentage of stroke patients transferred to rehabilitation services within seven days of admission (MOH definition, quarterly reporting) Percentage of patients transferred to hospice within 24 hours of being clinically ready to transfer 4% 5% 1% Outpatients 90% with 91 days all within 4 mths Inpatients 92% within 2 days Community 88% within 6 weeks 132 people Outpatients max 3 months; a Inpatients max 2 days; a Community max. 6 weeks 5% reduction per quarter Q4 Target: 78 Outpatients max.4 mths Inpatients 92% within 2 days Community 84% within 6 weeks 124 people 12.0% 15% 11.4% 54% 80% 43.1% 55.5% 85% 37.5% Breakeven revenue and expenditure position Favourable Breakeven Favourable Key achievements in the month The Directorate is delivering to all three FCT targets for those referred with a high suspicion of skin cancer. We expect to maintain this going forward. A new programme of work has commenced in Reablement Services to enhance the rehabilitation culture in all our wards. A single waiting list and entry to Reablement Services has been put in place. A review of the Chronic Pain Service has been undertaken by the clinical team and opportunities to improve identified. An action plan is being developed to support these improvements. 107

113 The final decision document on the new Adult Palliative Care Clinical Leadership model has been released and recruitment has commenced. Staff team engagement planning events have commenced, to support how our teams, services and Directorate team can make the working environment and experience more positive. Our aim will be to increase engagement scores across our teams. A syphilis action plan has been developed and resourced to support the Sexual Health Service to proactively address the increasing incidence of this STI in the Auckland Region. We are grateful for the support of the Communications Team in the public communications element of this plan. The DNA rate has reduced this month. There has been a 5% reduction in the DNA rate in Diabetes Services where there has been specific focus. A full report on our approach to reducing DNAs will be prepared for the August 2017 meeting Areas off track and remedial plans DNA action plan for the Directorate has been developed and is being implemented across all services. Recruitment to clinical positions has proved challenging, particularly in Community Services. We have completed a recruitment initiative with HR support. Our recruitment position and high level of vacancies remain on the directorate s risk register. The position is slowly improving and we have a number of staff resourcing plans in place. Key issues and initiatives identified in coming months Complete recruitment to the Directorate Leadership team. Recruitment to the last two key leadership posts in the Directorate is in progress currently. Implementation and development of the revised Directorate structure, which embeds the clinician leadership model. This will be extended to leadership development events to promote shared team working between our senior people leaders. Embed improved clinical and service governance processes and decision making systems across the Directorate at service level. Further development of the locality model within community services, integrating Diabetes Services, Palliative Care and Geriatric Medical Services into the model during 2016/17. Implement the new clinician leadership model in the Adult Palliative Care Services across the district and integrate specialist palliative care. Recruitment to the Strategic Clinical Director and the Service Lead Clinician is taking place. Implement the outpatient improvement programme in all relevant areas of our directorate. Implement the specialist diabetes plan across ADHB and continue to support the DSLA in their work to redesign the care pathway for people with diabetes in WDHB/ADHB. Develop the full business case for the integrated stroke unit. 108

114 Deliver the recommendations of the Reablement Services clinical review, which will contemporise the rehabilitation model of care and support patients in achieving the most effective outcomes/level of independence. Continue work to improve our skill mix and use of support staff in all aspects of our service provision, in particular nursing and allied health workforce in Community and Reablement Services. Complete service sizing in palliative care, geriatric medicine and endocrinology to ensure services remain strategically focussed, responsive and effective. Continue to implement the revised staffing model for Sexual Health Services to ensure we have a responsive service to meet the specialist sexual health and sexual assault care needs of the Auckland regional population. 109

115 Engaged Workforce Improved Health Status Better Quality Care Patient Safety Scorecard Measure Auckland DHB - Adult Community & Long Term Conditions HAC Scorecard for April 2017 Medication Errors with major harm Number of falls with major harm Nosocomial pressure injury point prevalence (% of in-patients) Nosocomial pressure injury point prevalence - 12 month average (% of in-patients) Number of reported adverse events causing harm (SAC 1&2) Unviewed/unsigned Histology/Cytology results >30 and < 90 days Unviewed/unsigned Histology/Cytology results >= 90 days Actual Target Prev Period % <=6% 0% 3.20% <=6% 3.6% (ESPI-1) % Services acknowledging 90% of FSA referrals in 15 calendar days or less (ESPI-2) Patients waiting longer than 4 months for their FSA % DNA rate for outpatient appointments - All Ethnicities % DNA rate for outpatient appointments - Maori % DNA rate for outpatient appointments - Pacific % Patients cared for in a mixed gender room at midday - Adult % Very good and excellent ratings for overall inpatient experience % Very good and excellent ratings for overall outpatient experience Number of complaints received % of inpatients on Reablement Services Wait List for 2 calendar days or less % Discharges with Length of Stay less than 21 days (midnights) for OPH and Rehab Plus combined R/U 100% 100% 0% 0% 0% 11.06% <=9% 12.11% 25.24% <=9% 27.91% 21.36% <=9% 25.56% 6.06% <=2% 10.32% R/U >=90% 60% R/U >=90% 92.4% 1 No Target % >=80% 95.26% 76.36% >=80% 69.74% % Hospitalised smokers offered advice and support to quit 90.91% >=95% 100% Excess annual leave dollars ($M) % Staff with excess annual leave > 1 year % Staff with excess annual leave > 2 years % Staff with excess annual leave and insufficient plan to clear excess by the end of financial year Number of Pre-employment Screenings (PES) cleared after the start date Sick leave hours taken as a percentage of total hours worked % Voluntary turnover (annually) % Voluntary turnover <1 year tenure $ $ % 0% 31.95% 3.57% 0% 3.25% R/U 0% R/U % <=3.4% 3.5% 13.69% <=10% 14.21% 4.17% <=6% 5.41% R/U Result unavailable (ESPI-1) % Services acknowledging 90% of FSA referrals in 15 calendar days or less Result unavailable until after the 16th of the next month. % Very good and excellent ratings for overall inpatient experience % Very good and excellent ratings for overall outpatient experience These measures are based on retrospective survey data, i.e. completed responses for patients discharged or treated the previous month. % Staff with excess annual leave and insufficient plan to clear excess by the end of financial year Result unavailable. 110

116 Scorecard Commentary There have been no significant adverse events in the Directorate for the last three months. Overall there has been a clear downward trend in actual falls in Reablement Services over the last two years and the ward staff are being congratulated for their achievements in creating a safer rehabilitation environment for our patients. Point prevalence data on pressure injuries indicates a stable picture and the 12 month rolling average continues within target. There was a rise in prevalence in the last month. There is a daily focus on pressure injury management in all our wards. We are compliant with ESPI 1 and ESPI 2 standards. Our performance with faster cancer treatment targets has improved significantly and we have achieved and are maintaining delivery to target for all three measures for those with a high suspicion of skin cancer. We continue to work with services to support improvement in waiting times and are working towards a three month maximum waiting time within the Directorate. Our DNA action plan continues in all services with a significant reduction in the last quarter. We remain committed to reducing these rates. The Directorate remains committed to minimising the number of patients in mixed gender rooms but was above target in April We are working on a plan to minimise the use of mixed gender rooms in Marino Ward, where demand for patients on the fractured neck of femur pathway has resulted in an above normal use. No patient was in a mixed gender room for more than 24 hours and all patients consented to be placed there rather than wait for admission to our service. We have seen a significant improvement in this metric in the last three months and expect our normal standard of less than 2% to be achievable. Plans are in progress to change the current way we support patients with behaviours of concern so that acute observation units become single gendered. Patient flow targets were met in April Improved flow remains one of our goals and overall our trajectory is one of improved flow and responsiveness. We continue to work to reduce length of stay and minimise the number of patients who have an extended LoS that could be avoided through improved discharge planning with stakeholders and other providers. Complaints are being actively managed within our Directorate and action plans to address any learning points have been created and are being monitored. There was one complaint received in the month of April. The Directorate has achieved a significant reduction in excess leave in the last year and we continue to see a reduction in leave balances. Sick leave is monitored monthly and currently just above target and is being actively managed applying the Auckland DHB Wellness Guide. We have established the Directorate Wellness Group to support staff health. Turnover was increasing but is now reducing, and is being actively monitored including regrettable turnover levels by service. As a Directorate with a significant change agenda, some turnover is expected. We have also completed a plan with Recruitment Services to work more strategically on hard to fill posts and recruitment at all levels as we have some significant recruitment challenges in leadership roles and in some specific clinical posts at this time. It is positive to note most of our senior leadership positions are now filled and the leadership team is now almost complete. 111

117 Financial Results STATEMENT OF FINANCIAL PERFORMANCE Adult Community and LTC Reporting Date Apr ($000s) REVENUE MONTH Actual Budget Variance Actual Budget Variance Government and Crown Agency 1,141 1, F 11,148 10, F Funder to Provider Revenue 5,906 5,906 0 F 59,899 59,899 0 F Other Income (16) U F Total Revenue 7,059 7, F 71,354 70, F EXPENDITURE Personnel Personnel Costs 3,961 4, F 39,563 40,804 1,241 F Outsourced Personnel (82) U 1, (559) U Outsourced Clinical Services F 1,340 1, F Clinical Supplies F 7,005 6,581 (424) U Infrastructure & Non-Clinical Supplies (60) U 1,512 1,155 (357) U Total Expenditure 5,069 5, F 50,676 50,663 (13) U Contribution 1,990 1, F 20,679 20, F Allocations F 4,101 4, F NET RESULT 1,586 1, F 16,578 15, F Paid FTE MONTH (FTE) YEAR TO DATE (10 months ending Apr-17) YEAR TO DATE (FTE) (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance Medical F F Nursing F F Allied Health F F Support F F Management/Administration (7.4) U (7.2) U Total excluding outsourced FTEs F F Total :Outsourced Services (15.7) U (9.4) U Total including outsourced FTEs F F The current month result for April is $170k U, and the year to date result is $651k F. Current month The significant drivers in the directorate s result are: Income: Crown agency revenue $69k F reflects new (unbudgeted) service level agreements: In-home Strength & Balance Falls Prevention Program; the Fracture Liaison Service; and Transgender Clinical Leadership. ACC revenue is on budget. The continued low volumes in Reablement Services are offset by higher volumes in sexual assault. 112

118 Expenditure: Personnel costs, including outsourced, were $200k F in April as a result of higher annual leave being taken around public holidays, plus the continuing effect of vacancies within nursing and allied health staff (27.1 FTE F combined). Outsourced personnel costs were $82k U in April, mainly a result of providing backfill for vacancies. Year to date result Total net result YTD is $651k F. Significant drivers of this are: Personal health contract revenue is $362k F, reflecting the new service level agreements. Personnel costs, including outsourced, is $682k F largely due to high levels of vacancy within Reablement and Community Services. Recruitment levels are positively trending upwards due to a significant recruitment plan being in place. Clinical supplies are $424k U predominantly due to scheduled high-cost immunosuppressant drug treatments ($245k U), plus increased volumes of patients requiring continence products ($161k U). Supply cost pressures have been partially offset by a small pharmacy rebate of $56k however further rebates are unlikely to reduce the variance significantly. Non-clinical supplies show $357k U due to containing a high proportion of the directorate s targeted cost savings. These have largely been mitigated by managing vacancies. Allocations are $249k F, mostly in three areas where slightly lower volumes and greater efficiencies have occurred: laboratory testing, radiology (including MRIs), and patient food services. Clinical activity Reported price volume schedule (PVS) activity is $5,457k (9.1%) below base contract for the year to date. The key drivers of the under-delivery are in the ADHB population, while inter-district flows (IDF) are over-delivered by $479k. The under-deliveries are mainly in Community Services due to the measuring of activity on actuals (in previous years recorded at budget), and partly lower inpatient bed days in Reablement Services. The directorate has improved the accuracy of mapping of activity in Community Services and is working with the clinical teams to improve productivity and support clinicians to spend more face-to-face time with patients. The net under delivery of volumes is not recognised in the overall directorate result. Savings The directorate s savings are slightly ahead of budget and remain on track to deliver all savings by year end through various mitigating strategies. Forecast The directorate is forecasting to achieve a 1.6% - 1.8% surplus on budget by June 2017, partly due to the new service level agreements and vacancies, which have a positive impact on the bottom line. 113

119 Date: April 2017 Owner: Judith Catherwood Community and Long Term Conditions Directorate Purpose To provide quality, patient-centred, self-directed care closer to home. Goals Develop new models of care and services, focussed on integration with primary care and other community health providers. Develop and provide responsive services to prevent hospital admission and support safe and early discharge from hospital. Building community resilience and capacity to enable excellent, high quality care with all our partners. Provide holistic and equitable rehabilitation across the continuum of care, maximising independence for our population. Enhance workforce engagement, succession planning and supporting staff to enable whole system navigation of care for the community. Principles Working in partnership, enabling self-management, promoting independence. Key priorities for CLTC Directorate In 2017/18 our Directorate will contribute to the delivery of the Provider Arm programmes. In addition to this we will also focus on the following Directorate priorities: Fully implement the locality model of care and care closer to home services and measure their impact across the system. Implement an integrated needs-based Reablement Services to provide patient-centred and equitable care for all patients regardless of age. Design sustainable models for outpatient services underpinned by workforce development. Enhance clinical, operational and financial governance, including the implementation of a service review programme. Build engagement within our workforce and with patients and public. Current condition Locality model of care is being embedded but has not yet achieved full maturity and effectiveness. Intermediate care services are in place but their impact has yet to be fully realised by the hospital, primary and community care. Palliative care integration with hospice/community services agreed but yet to be implemented. Reablement Services operate different models of care in different sites and have yet to embed an allage needs based approach. Stroke services are continuously improving but a more streamlined comprehensive unit is required. Outpatient model of care needs to be reviewed, to include as range of access options. Nurses and allied health staff are not consistently working to top of their scope in practice in outpatients services. Clinical and service governance is in development but not yet mature. Staff and patient/public engagement is variable across services. Models of care have yet to fully build in patient driven goals and outcomes. Target condition Locality models and care closer to home services are fully developed and their impact on the hospital and primary care is understood and being continuously monitored. The wider hospital team is supported to manage patients in the most appropriate environment as close to home as possible and understand the range of alternatives to hospital services available. Palliative care integration and community service developments are progressed. The needs-related, all-age model for Reablement Services is fully implemented and recommendations of the clinical review are embedded. Stroke change plan complete with robust plans for implementation of an comprehensive adult stroke unit. Outpatient models of care are developed, patient goals are embedded into care plans and our workforce is supported to work at the top of their scope across all disciplines. Clinical and service governance is fully understood, mature and embedded. Staff and patient engagement is developed and improved across all services, in particular visibility at Greenlane and off-site locations. Internal and regional engagement and collaboration is occurring for relevant services and changes. Measures Current Target Proportion of activity undertaken as non-face-to-face contacts in outpatient services Proportion of outpatient activity delivered by non-medical staff Number of nurse prescribers Admissions to age-related residential care Percentage of stroke patients transferred to rehabilitation services within seven days of admission Percentage of patients transferred to hospice within 24 hours of being clinically ready to transfer Utilisation of Rapid Response Service Utilisation of Early Supported Discharge Services Number of overdue actions from SAC1 and SAC2 events Voluntary turnover (rolling 12 months) # Action Plan Lead Q1 Q2 Q3 Q Clinical and service governance system is developed and mechanisms of quarterly reviews and visits are embedded. Visibility of leadership is improved. Palliative Care integration is embedded and service planning to support community services is put in place A plan to fully engage staff and patients/public in service development is created and implemented. We make CLTC a great place to work and receive support or care. Implement stroke plan and work towards a comprehensive adult stroke unit. Locality model of care and care closer to home services are fully developed and impact is being measured. 6 Reablement Services change is completed and embedded Outpatient models of care are fully reviewed and new ways of 7 working are developed Nursing and allied health workforce is developed to work at the top of 8 their scope of practice in outpatient models of care Director SCD Palliative Care Director GM/AHD SCD Community Services SCD Reablement Services GM/SCDs AHD/ND/GM

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121 Surgical Directorate Speaker: Arend Merrie, Director Service Overview 5.11 The Surgical Services Directorate is responsible for the provision of secondary and tertiary Surgical Services for the adult population, but also provides national and regional services in several specialities. The services in the Directorate are now structured into the following four portfolios: Orthopaedics, Urology General Surgery, Trauma, Transplant, Ophthalmology ORL, Neurosurgery, Oral Health The Surgical Directorate is led by: Director: General Manager Nurse Director Director of Allied Health Director of Primary Care Arend Merrie Duncan Bliss Anna MacGregor Kristine Nicol Kathy McDonald Supported by Les Lohrentz (HR), and Alison West (Finance). Directorate Priorities for 16/17 In 2016/17 our Directorate will contribute to the delivery of the key Provider Arm work programmes. In addition to this we will also focus on the following Directorate priorities: 1. Throughput of cases at the Greenlane Surgical Unit 2. Achieve all health targets including discharges and ESPI targets within financial constraints and efficiency expectations 3. Surgical OR list/clinic templates need to be designed to accommodate the FCT demand 4. The standardisation of surgical pathways within Auckland DHB, across the region and nationally 5. Establish multidisciplinary pathways in all departments to optimise and streamline the patient journey 115

122 Q4 Actions 1. Throughput of cases at the Greenlane Surgical Unit Activity Urology phase 1 Increased Theatre Capacity at GSU and planning for 17/18. Progress Additional capacity allocated and cases moved to GSU from level 8 Urology stack system with 3D capability was approved by CAMP in December arrived in March for increased casemix from April Theatre model presented at Surgical Board in April 2017 with proposed recruitment to the existing 14 flex sessions over the 4 week roster. Ophthalmology Ocular Plastics & increased Cataract capacity Previously unallocated all day OR sessions are being utilised for additional Ocular Plastic sessions. This will continue through to the new financial year. Increased Saturday activity has also been agreed from March to July 17 and weekly reports provided to the Funder with planned vs performance. 2. Achieve all health targets including discharges and ESPI targets within financial constraints and efficiency expectations Activity Review of all activity being undertaken in non-clinic/or settings to ensure all activity is captured and funded Weekly Service ESPI Reviews Progress Review of Nursing MOC and activity underway including: Additional nursing activity not being captured, with potential revenue generation Use of patient attenders for patients on the behaviour of concern pathway (BOC) requiring support capturing data and ensuring we have up to date info of where these patients are. There continues to be weekly ESPI and PVS reviews at service level to track compliance to explore ways of increasing discharge volumes. Services are on track with their recovery plans with the exception of Orthopaedics which has dispensation from the Ministry until 1 July Looking at further ways for Urology and General Surgery to increase activity for Q4. 3. Surgical OR list/clinic templates need to be designed to accommodate the FCT demand Activity Managing capacity and demand Progress There is on-going work through the Surgical Board assessing the existing OR capacity, the demand for 17/18 and ways in which the GAP will be addressed. 116

123 Waitlist management and SCRUM This continues to be effective in the OR setting and is now being rolled out in surgical outpatients to ensure that clinic capacity matches the demand for FCT FSA slots. The Surgical Board also now monitors a watch list of the least used OR sessions with a view to reallocate to services that will use them OR Session usage was 96.4% for April. 4. The standardisation of surgical pathways within ADHB, across the region and nationally Activity National Bowel Screening Progress Representatives from Surgery are working as part of a regional group to deliver the service specification for the National Bowel Screening programme Metro Auckland Exploratory Work National Intestinal Failure Service Oral Health Regional working group established in April to agree regional approach and establish spoke services at CMDHB for Paediatric Oral Health. Urology Continued work around the existing regional acute service for Urology and how this could be extended to elective Services. Ophthalmology Agreement through the Ophthalmology Steering Group for the continued increase in services at Waitakere Hospital. Meeting with the MoH Governance Board to review progress of NIFS to date. Successful Education Day held. Advances with the database and the national network. NIFS contract will be extended for a further 3 years from July

124 Engaged Workforce Improved Health Status Better Quality Care Patient Safety Scorecard Measure Auckland DHB - Surgical Services HAC Scorecard for April 2017 Actual Target Prev Period Medication Errors with major harm Number of falls with major harm Nosocomial pressure injury point prevalence (% of in-patients) Nosocomial pressure injury point prevalence - 12 month average (% of in-patients) Number of reported adverse events causing harm (SAC 1&2) Unviewed/unsigned Histology/Cytology results >30 and < 90 days Unviewed/unsigned Histology/Cytology results >= 90 days % <=6% 2% 3.2% <=6% 2.8% HT2 Elective discharges cumulative variance from target (ESPI-1) % Services acknowledging 90% of FSA referrals in 15 calendar days or less (ESPI-2) Patients waiting longer than 4 months for their FSA (ESPI-5) Patients given a commitment to treatment but not treated within 4 months (ESPI-8) Proportion of patients prioritised using nationally recognised processes or tools % DNA rate for outpatient appointments - All Ethnicities % DNA rate for outpatient appointments - Maori % DNA rate for outpatient appointments - Pacific Elective day of surgery admission (DOSA) rate % Day Surgery Rate Inhouse Elective WIES through theatre - per day Number of CBU Outliers - Adult % Patients cared for in a mixed gender room at midday - Adult % Very good and excellent ratings for overall inpatient experience % Very good and excellent ratings for overall outpatient experience Number of complaints received 28 Day Readmission Rate - Total Average LOS for WIES funded discharges (days) - Acute Average LOS for WIES funded discharges (days) - Elective 31/62 day target % of non-surgical patients seen within the 62 day target 31/62 day target % of surgical patients seen within the 62 day target 62 day target - % of patients treated within the 62 day target 0.94 >= R/U 100% 85.7% 0.62% 0% 0.38% 4.15% 0% 4.61% 99.6% 100% 100% 9.25% <=9% 8.8% 19.37% <=9% 17.37% 15.58% <=9% 15.96% 77.43% >=68% 78.02% 56.84% >=70% 56.54% TBC % TBC 11.91% R/U >=90% 87% R/U >=90% 84.7% 19 No Target 25 R/U <=10% 9.66% 3.18 TBC TBC 1.1 R/U >=85% 87.5% R/U >=85% 85% R/U >=85% 86.25% % Hospitalised smokers offered advice and support to quit 96.81% >=95% 96.77% Excess annual leave dollars ($M) % Staff with excess annual leave > 1 year % Staff with excess annual leave > 2 years % Staff with excess annual leave and insufficient plan to clear excess by the end of financial year Number of Pre-employment Screenings (PES) cleared after the start date Sick leave hours taken as a percentage of total hours worked % Voluntary turnover (annually) % Voluntary turnover <1 year tenure $ $ % 0% 30.83% 17.2% 0% 17.77% R/U 0% R/U % <=3.4% 3.4% 12.21% <=10% 12.53% 5.43% <=6% 5.32% Amber R/U Variance from target not significant enough to report as non-compliant. This includes percentages/rates w ithin 1% of target, or volumes w ithin 1 value from target. Not applicable for Engaged Workforce KRA. Result unavailable (ESPI-1) % Services acknowledging 90% of FSA referrals in 15 calendar days or less Result unavailable until after the 16th of the next month. % Very good and excellent ratings for overall inpatient experience % Very good and excellent ratings for overall outpatient experience These measures are based on retrospective survey data, i.e. completed responses for patients discharged or treated the previous month. 28 Day Readmission Rate - Total A 35 day period is required to accurately report all acute re-admissions for the previous month's discharges. (35 days = 28 days post discharge as per MoH measures plus 5 w orking days to allow for coding). 31/62 day target % of non-surgical patients seen within the 62 day target 31/62 day target % of surgical patients seen within the 62 day target 62 day target - % of patients treated within the 62 day target Results unavailable from NRA until after the 20th day of the next month. % Staff with excess annual leave and insufficient plan to clear excess by the end of financial year Result unavailable. 118

125 Measures Measure Current Target Previous Period ESPI compliance ESPI % 0.41% 0.38% ESPI % 0% 5.29% ESPI % 100% 100% DNA rates for all ethnicities (%) 9.8% 9% 8.8% Elective day of surgery admission rate (DOSA) % 77.42% 68% 80.2% 5.11 Day surgery rate (%) 56.42% 70% 56.54% FCT delivery 85% Key achievements in the month Improved DOSA rate due to successful implementation across services bringing patients in on day of surgery. Sustained improvement of rates of day surgery. Continued delivery of bed savings through daily flexing of the surgical bed base. Administration validation complete for Ophthalmology follow up pending list resulting in over 300 patients being removed from the waiting list and ensuring we have the most accurate data to clinically risk assess patients waiting beyond their intended wait time. This work has extended to working through the highest risk patients and ensuring they have dates to be seen. Removal of all patients in Ophthalmology with a risk score of over 6 from the follow-up pending list. Improved in ESPI 5 which continues into March moving back into moderately non-compliant. Deterioration in ESPI 2- which continues to improve into March moving back into moderately non-compliant. Established recruitment to WDHB site to improve capacity to deliver 20,000 FUPs from July Continued focus in Orthopaedics in establishing solutions to reduce backlog of patients and meet volumes if in 2017/

126 Key issues and initiatives identified in coming months Elective Surgical performance Current Target Performance YTD total Auckland DHB elective discharges to end of April is currently showing 97.2% (a shortfall of 392 discharges). Total Auckland DHB elective discharges for month of April only is currently showing 105.9% including ortho (a surplus of 69 discharges). Current/Planned Improvements YTD total Auckland DHB elective discharges to end of April is currently showing 97.2% (a shortfall of 392 discharges). This position includes the Orthopaedic elective position where there is ESPI 5 dispensation until 30 June 2017 and under-delivery against the discharge target is approximately 400 YTD which is unlikely to improve. As of 5 May 2017, the Board now have agreement with 2 providers across Auckland to deliver increased orthopaedic elective volumes through Q4 and beyond. Auckland DHB are currently working through the exact volumes to allow us to forecast recovery which should be finalised in the next 2 weeks. On removing the Orthopaedic volume (both plan and actual) from the numerator and denominator, Auckland DHB elective performance is 99.6% using the MOH numbers as the start point. This is for the total Auckland DHB discharge target (includes everything: all services, above the line, below the line, outflows, non-surgical PUCs and 70 hysteroscopy discharges). Auckland DHB remain committed to deliver 100% of the elective surgery volume plan for 2016/17 by 30 June with the exception of Orthopaedics. 120

127 08/03/ /03/ /03/ /03/ /03/ /04/ /04/ /04/ /04/ /04/ /04/2017 Ophthalmology Follow-Up Outpatients As at the end of April 2017, all patients with a risk score above 6 have appointments scheduled. The data above is a rolling set of figures. Each month patients may move up a risk band however, the overall number of overdue patients is declining. The rate of decline will be proportional to the clinics opening at Waitakere from July The below table shows the current status of the service overdue follow up. Risk Score > < DQ Deceased Total Overdue (over 1.5x) Risk Score: 6 and over Responding to the Staff Engagement Results Through April the senior leadership team have worked through the Directorate priorities for 2017/18 where we acknowledge improved workforce engagement as a key priority. Planning for 17/18 Elective and Acute Volumes With no reduction in patient length of stay the Provider will require an additional 13 beds on 16/17 across adult services and a further 19 beds to reduce bed block risk by achieving a 90% average occupancy. There is additional physical bed capacity to cover this shortage. The cost of resourcing this additional capacity is $3.1M 121

128 With no improvement in utilisation the Adult Surgical Directorate will require an additional 1,600 OR hours of patient in OR time to achieve the 17/18 PVS. The Directorate has identified operating capacity to resolve this gap. The cost of this additional capacity is $2.9M Action At the April Surgical Board meeting it was agreed that a morning workshop would be established in May 2017 to agree recommendations for how capacity can be increased in 2017/18 to meet the increased acute and elective demand. Service Quality and Governance 122

129 Quality and Safety Highlights for April 2017 Over 250 days without a fall with harm Reviewing and closing of risk pros continues (from 900 to 399) Great initial uptake of Datix system for reporting incidents Ward 76 as early implementer for National Early Warning score and vital sign chart going well great engagement and feedback from medical and nursing teams General Surgery developing audit meeting to incorporate wider quality issues such as RCA reports, complains, incidents and audit feedback from services outside of General Surgery Two surgical areas included in the bedside documentation trial (Neuro wards and Orthopaedics) Submissions from most surgical wards to contribute to the April Falls month display Development of team charter as a request and response from Speak Up managers training with Pre-admit nursing team Values sessions for ward staff delivered (Orthopaedics and General Surgery) 5.11 Surgical Services: Summary Net Result STATEMENT OF FINANCIAL PERFORMANCE Surgical Services Reporting Date Apr-17 ($000s) YEAR TO DATE MONTH (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance REVENUE Government and Crown Agency (21) U 7,765 7, F Funder to Provider Revenue 22,489 22,489 0 F 211, ,679 (4,400) U Other Income F 4,609 3, F Total Revenue 23,972 23, F 223, ,168 (3,515) U EXPENDITURE Personnel Personnel Costs 7,683 7, F 77,375 76,595 (781) U Outsourced Personnel (244) U 3,505 2,650 (855) U Outsourced Clinical Services (34) U 2,238 5,205 2,967 F Clinical Supplies 2,084 2, F 23,621 22,468 (1,153) U Infrastructure & Non-Clinical Supplies (370) U 2,623 1,203 (1,420) U Total Expenditure 11,300 10,993 (307) U 109, ,121 (1,241) U Contribution 12,672 12, F 114, ,047 (4,756) U Allocations 2,217 2, F 23,350 24, F NET RESULT 10,455 10, F 90,941 94,865 (3,924) U Paid FTE MONTH (FTE) YEAR TO DATE (FTE) (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance Medical (14.2) U (6.9) U Nursing (34.2) U (18.4) U Allied Health (0.4) U (0.4) U Management/Administration F F Other (24.9) U (24.9) U Total excluding outsourced FTEs (72.7) U (49.4) U Total :Outsourced Services (10.4) U (7.5) U Total including outsourced FTEs (83.0) U (56.9) U Month The net result for April is a favourable variance of $183k. 123

130 Inpatient WIES volumes at month end were at 100% of contract with this expected to continue in May. We note that Level 8 theatre achieved good utilization with theatres minutes running 1% higher for March & April combined than the same months last year (timing of Easter break). Year to date The YTD result for April is an unfavourable variance of $3.9M. The two key drivers to the result are:- Revenue $4.4M U due to the Funder Provider revenue wash-up. This is slightly lower than the reported Price Volume Schedule (PVS) volumes of $4.5M (2%) below base contract. Expenditure including Internal Allocations $0.4M F due to the impact of lower volumes, offset by business improvement savings not yet achieved. Minutes in Surgical Directorate related Theatres have increased 2% compared to the same period last year. This reflects the growing number of renal and liver transplant cases (136 YTD compared to 105 LYTD) and increasing weekend elective cases. WIES volumes have increased by $0.7M compared to the same period last year. Business Improvement Savings We have achieved $2.2M of $6.5M budgeted savings YTD ($4.3M U YTD). Please refer to the more detailed analysis on the separate reports:- Surgical excluding Orthopaedics Orthopaedics 124

131 Orthopaedic Services: Summary Net Result STATEMENT OF FINANCIAL PERFORMANCE Orthopaedics Reporting Date Apr ($000s) REVENUE MONTH Actual Budget Variance Actual Budget Variance Government and Crown Agency (26) U 1,819 2,105 (286) U Funder to Provider Revenue 5,204 5,204 0 F 43,314 47,414 (4,100) U Other Income 1 14 (13) U (69) U Total Revenue 5,390 5,429 (39) U 45,207 49,663 (4,456) U EXPENDITURE Personnel YEAR TO DATE (10 months ending Apr-17) Personnel Costs 1,386 1, F 13,977 15,048 1,070 F Outsourced Personnel 2 0 (2) U 32 0 (32) U Outsourced Clinical Services F (6) 3,959 3,965 F Clinical Supplies F 9,372 8,454 (917) U Infrastructure & Non-Clinical Supplies 33 1 (32) U (229) U Total Expenditure 2,305 2, F 23,615 27,472 3,857 F Contribution 3,086 2, F 21,592 22,191 (598) U Allocations F 3,872 3, F NET RESULT 2,730 2, F 17,721 18,230 (510) U MONTH (FTE) YEAR TO DATE (FTE) (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance Medical (5.5) U (2.3) U Nursing (3.1) U F Allied Health F F Support 0.0 F 0.0 F Management/Administration F F Savings (11.6) U (11.6) U Total excluding outsourced FTEs (19.0) U (11.1) U Total :Outsourced Services (0.4) U (0.6) U Total including outsourced FTEs (19.3) U (11.8) U Comments on major financial variances Month The Orthopaedics service is $0.5M F for the month. Underlying volumes were $1.8M U which was not recognised in the month and was offset by low outsourcing. YTD YTD volumes are $7.6M under contract and $4.1M of this is recognized in our result via the Funder to Provider revenue wash-up. The key drivers of the $0.5M unfavourable result are (1) savings targets not fully achieved, particularly in staffing and implants and (2) vacancies in Surgeons combined with lower than budgeted allowances. Outsourcing has not yet commenced, reflected in lower volumes. The full year increase in contracted volumes compared to last year (15/16) is 18.5% and $9.2M. 125

132 Summary Net Result (Surgical Services excluding Orthopaedics) STATEMENT OF FINANCIAL PERFORMANCE Surgical Services - excl Orthopaedics Reporting Date Apr-17 ($000s) REVENUE Comments on major financial variances MONTH Month The net result for April is an unfavourable variance of $291k U. Actual Budget Variance Actual Budget Variance Government and Crown Agency F 5,946 5, F Funder to Provider Revenue 17,284 17,284 0 F 167, ,265 (300) U Other Income F 4,535 3, F Total Revenue 18,582 18, F 178, , F EXPENDITURE Personnel Personnel Costs 6,298 6,236 (61) U 63,398 61,547 (1,851) U Outsourced Personnel (242) U 3,473 2,650 (823) U Outsourced Clinical Services (383) U 2,244 1,246 (998) U Clinical Supplies 1,225 1, F 14,249 14,014 (236) U Infrastructure & Non-Clinical Supplies (338) U 2,383 1,192 (1,191) U Total Expenditure 8,995 8,210 (785) U 85,748 80,649 (5,098) U Contribution 9,587 9,998 (411) U 92,698 96,856 (4,158) U Allocations 1,862 1, F 19,478 20, F NET RESULT 7,725 8,017 (291) U 73,220 76,635 (3,415) U Paid FTE MONTH (FTE) YEAR TO DATE (10 months ending Apr-17) YEAR TO DATE (FTE) (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance Medical (8.7) U (4.7) U Nursing (31.2) U (20.5) U Allied Health (1.0) U (1.0) U Management/Administration F F Savings (13.3) U (13.3) U Total excluding outsourced FTEs (53.7) U (38.2) U Total :Outsourced Services (10.0) U (6.9) U Total including outsourced FTEs (63.7) U (45.1) U Revenue - No funder wash-up occurred for the Surgical Directorate this month. At monthend, patient activity volumes in the month of April were 2.8% over contract, with inpatient activity 5.3% over delivered against contract. This includes the anticipated upsides highlighted last month due to high volumes of transplant patients and uncoded Ophthalmology outsourcing. Expenditure including internal allocations - $665k U mainly driven by high outsourcing in Ophthalmology, high volumes and savings targets not fully achieved. 126

133 YTD The net result for the year to date is an unfavourable variance of $3.4M U, primarily driven by the $3.0M revenue not recognized, and business improvement savings not yet fully achieved. Revenue Total patient volumes are 98% of contract year to date despite the two JRMO strikes reducing capacity, with Neurosurgery inpatients at 112% of contract to date and of those, inpatient acutes are 19% over delivered YTD Performance against contract End of Year forecast Service General Surgery 100% 100% Neurosurgery 112% 109% Ophthalmology 100% 100% Oral Health 95% 95% ORL 100% 100% Transplants - Liver 106% 111% Transplants - Renal 102% 102% Urology 103% 103% Total 98% 101% Although our reported Price Volume Schedule (PVS) volumes are $3.0M F, our Funder Provider revenue wash-up is $0.3M U. The $3.3M upside is offset by the Orthopaedics under-delivery. Business improvement savings not yet achieved Surgical excluding Orthopaedics annual expenditure savings budget is $4.9M pa, $4.1M for the YTD. Overall expenditure including internal allocations is $4.4M U YTD due to costs associated with additional volumes, especially Transplant immunosuppressants and Ophthalmology demand and outsourcing, and for Ophthalmology Lucentis usage in line with Pharmac guidelines for improved health outcomes. Projected income, though revenue upside will reduce the deficit YTD close to breakeven. 127

134 Date: April 2017 A3 owner: Arend Merrie Surgical Services Directorate Key priorities for Surgical Services Directorate In 2017/18 our Directorate will contribute to the delivery of the ADHB Provider Arm work programmes. In addition to this we will also focus on the following Directorate priorities: 1. Develop a culture of quality and safety that responds to the key themes of the 2016/17 employee engagement survey in line with the ADHB People Strategy 2. Align surgical capacity with demand for acute and elective services 3. Establish strategies for sustainable delivery of high quality surgical services focusing on opportunities for closer working across metro Auckland 4. Establish integrated autonomous clinical business units at service level Current condition 1. The results of the employee engagement survey have identified key themes for our Directorate in terms of our strengths as well as areas where we could improve. We have started developing action plans for each service. High level of unsigned clinical results and lack of visibility of quality measures and complaints High level of excess leave 2. Variable performance against target for delivery of acute and elective surgery The continued increase in overall acute and elective demand has resulted in a shortfall in capacity to meet the needs of our patients in a timely fashion. 3. Poor long term regional planning across metro Auckland for surgical services has resulted in: Service duplication Non sustainable service delivery Variable delivery of timely services Lack of patient focused delivery of care 4. There is a current culture of finances, activity volumes, savings and strategy sitting at a Directorate level Target condition 1. Embed a culture of quality and safety through: Service level charters Clinical Leadership in quality at service and Directorate level Service and Directorate level quality dashboards Increased visibility and engagement of the Directorate leadership team High level of engagement in the Speak Up & Wellness programmes 2. Deliver agreed surgical elective and acute volumes within ESPI & FCT guidelines and budget 3. Explore at service and directorate level opportunities for: Centres of excellence and hub & spoke service delivery Shared service delivery across metro Auckland Delivery of patient focused care closer to home where appropriate 4. Clinical and financial accountability held at service level enabled and governed by the Directorate Measures Current Target (End 2016/17) 1. Improved results in employee pulse survey 1. % sign off of éclair and ROERS results Overdue leave balance 2. % delivery of PVS volumes for acute activity % delivery of PVS volumes for elective activity % ESPI compliance by service (1,2,5) % FCT compliance by service % delivery of IDF activity delivered as a spoke service 4. % of surgical services with future strategy % surgical services delivering PVS within allocated budget /18 Action Plan Owner Q1 Q2 Q3 Q4 1 Employee pulse survey DB 1 Devise and implement service level charter across surgical services 1 Appoint Service leads for clinical quality and safety SCDs 1 Develop directorate and service level quality dashboards KQ/AM Joint working with Perioperative services to determine current capacity Joint working with Perioperative Services and Surgical Board to determine acute surgical model of care Joint working with Perioperative Services to use remaining flex sessions across all OR suites for elective capacity. Joint working with Perioperative Services to increase GSU OR capacity on Saturdays. Partnership approach with metro Auckland DHBs to increase Ophthalmology volumes at Waitakere Hospital. Partnership approach with metro Auckland DHBs to increase paediatric oral surgery at WDHB & CMDHB 3 Partnership approach with metro Auckland DHBs to deliver Urology services 3 Ophthalmology, Orthopaedics and Transplant Surgery to have future strategies approved. AM AM AM DB DB DB DB AM/DB SCDs 3 Partnership approach with metro Auckland DHBs to deliver AM cancer services 4 Develop service level priorities through planning day process SCDs 128

135 Cardiovascular Directorate Speaker: Mark Edwards, Director 5.12 Service Overview The Cardiovascular Directorate comprises Cardiothoracic Surgery, Cardiology, Vascular Surgery and the Cardiothoracic and Vascular Intensive Care Unit delivering services to both our local population and the greater Northern Region. Our team also delivers the National Heart and Lung Transplant Service on behalf of the New Zealand population. Our other national service is Organ Donation New Zealand. The Cardiovascular Team is led by Director: Dr Mark Edwards Nurse Director: Anna MacGregor Allied Health Director: Kristine Nicol Primary Care Director: Dr Jim Kriechbaum General Manager: Sam Titchener Directorate Priorities for 16/17 In 2016/17 our Directorate will contribute to the delivery of the six Provider Arm work programmes. In addition to this we will also focus on the following Directorate priorities: 1. Continue to develop Clinical Governance and quality frameworks supported by our Clinician Leadership model 2. Reconfigure service delivery for patient pathway(s) 3. Plan for future service delivery 4. Continued focus on communication and development of partnerships across our Directorate staff 5. Financial sustainability 129

136 Q4 Actions 90 day plan 1. Develop Clinical Governance and quality frameworks supported by our Clinician Leadership model Regular clinical leadership meetings are in place with a quality focus embedded; Monthly service meetings have commenced with Service Clinical Directors leading these meetings, which will continue to develop over time. The directorate is revisiting and updating the RASCI both at senior leadership and directorate leadership levels. The process toward selection of an appropriate Cardiac surgical database to align with the national direction and address the risk posed by the inability of the current version of the database to collect risk-adjusted outcome measures continues. We are in the process of establishing a steering group to develop the business case for the selected database. People leaders continue to work with their sub groups on actions in response to the engagement survey results. As part of this work there is an opportunity across the Directorate, as in other directorates, to engage with the Speak Up program as that is rolled out across the organisation. 2. Reconfigure service delivery for patient pathway(s) The consultation process around the nursing model of care in the cardiothoracic inpatient ward and the Nurse Specialist model across the cardiac surgery patient pathway has commenced. Work has commenced reviewing the current nursing education model across the Cardiovascular Directorate. As previously described, the decision document has now been published, recruitment to roles and implementation of the changes is ongoing. 3. Planning for future service delivery As previously noted we have signalled a piece of work with Northland DHB to develop a shared plan for delivery of pacemaker clinics by local staff. Northland DHB is developing their cardiology service strategy and will include the local delivery of pacemaker clinics within that strategy. The final report of the Clinical perfusion review has now been endorsed by the steering group. The report is to be distributed to the working group, who will be engaged to progress the implementation of the recommendations. The Directorate is actively involved in the Solid Organ Transplant Board, with several members. Recruitment has commenced across directorates for positions commencing 17/18. Mapping of clinical pathways for heart and lung transplant patients has been completed. Work has started on developing our approach to transplantation capacity needs over the next 5 years. This will include workforce, capital and operating costs and refining the clinical pathways as necessary. A Guideline from the National Cardiology and Cardiac Surgery Clinical Networks for the provision of TAVI in New Zealand for Symptomatic Severe Aortic Stenosis was circulated for comment and discussed at the recent Cardiac Clinical Network meeting. Auckland DHB has consulted with relevant stakeholders and provided feedback on the document. 130

137 Review of pricing and products with regard to catheters in cardiology continues. Work also continues with reviewing revenue and costs with regards to lead extraction procedures; the service is working on a co-payment paper for lead extractions. Planning for out of hours use of the Hybrid OR has been completed for Cardiology/CTSU. The hybrid standing committee will be presenting the final recommendation for endorsement to the Governance group. Work has commenced on the out of hours capability for vascular and interventional radiology An operational review of the adult Electrophysiology Service at Auckland DHB will commence in May The review will facilitate an understanding of the current end to end operational processes (predominantly waitlist and scheduling processes) in the service and what needs to be developed to maintain and improve service delivery to ensure high quality care is achieved for their patients. A discussion paper is being developed looking at potential recruitment and retention strategies for cardiac physiologists and cardiac sonographers. Both groups have been identified as vulnerable workforces. 4. Financial sustainability Please refer to the financial results section Measures Measures Current Target (end 16/17) 2. Adverse events: number of outstanding recommendations by due date 2. Adverse events: number of days from Reportable Events Brief- A submission to report ready for Adverse Events Review Committee (working days) tba <10 >100 days <70 days 2. % of patients with address submitted at admission 30% 85% 2. Inpatient experience very good or excellent 91% >90% 3. Number of Service redesign projects timeframes off track % P1 patients waiting outside priority wait times 0 5% 4 Staff feedback from development and implementation of comms plan 6. Directorate remains within budget (within 5% variance) and Savings plan projects favorable to budget NYC Off plan Favourable On budget 131

138 Key achievements in the month Introduction of second type of valve to TAVI programme achieved. ESPI2 Outpatient Clinic Reports instituted to improve visibility of breach risks to clinicians. Charge Nurse Ward 42 received the Chief Nurse award. Relationships with Tahiti CPS continue to strengthen. Further development of relationship planned by a liaison visit of paediatric and adult clinical and management staff to Tahiti in June Continued steady cardiothoracic surgery volumes have seen the waitlist reduce significantly over the last few months. There has been an associated improvement in P2 and P3 wait times. Steering group set up to manage implementation of the new haemodynamic monitoring system for the Adult and Paediatric catheter labs. Electrophysiology (EP) scheduling project commenced with waitlist validation being undertaken by clinicians across the region. Planning underway for waitlist meeting to be developed. New automated waitlists and booking procedure codes for EP have been completed to help improve visibility, identify breaches earlier, and standardise data for audit. Supply chain review has been completed with good engagement in the cardiovascular directorate. Improvements have been identified and embedded in business as usual. Employee survey action plans are underway. Areas off track and remedial plans Development of a Metric Dashboard encompassing clinical outcome measures for each service is delayed while decision making takes place on the cardiac surgical database. The EP waitlist continues to grow with an increase in referrals; mitigation measures are outlined in the key achievement section above. Continued close monitoring of the Haemodynamic monitoring project is required, time frames remain critical to the project due to an unsupported system after 31 December Elective Auckland DHB discharge targets for Cardiothoracic and Vascular are below target. The services have made some progress on the recovery of the discharge targets, particularly in Cardiothoracic, and we will continue to monitor and manage this closely. Physiology vacancies are proving difficult to recruit to and resultant staff shortages are impaction on their ability to carry out a range of clinical work; a project team is looking at ways to improve recruitment as well as retention of new staff. Key issues and initiatives identified in coming months Monitoring progress against the savings plan and making budget in the context of our waitlist challenges. Monitoring our elective discharge volumes against the recovery plan Managing the costs of clinical supplies against service delivery and ongoing vacancy management. Implementation strategy for the new nursing education model, recruitment to positions. New Haemodynamic System tender awarded and plans for installation by Q4 underway good progress with ha and supplier being made Implementation of new Cardiothoracic pathway nursing structure once consultation complete 132

139 The perfusion project evaluating recent RFP proposals for all Perfusion Equipment Consumables and Services has been transferred across to NZ Health Partnerships Limited; they are now managing all national projects. We have requested an update on progress. Clinical Decision Unit build will impact on the Coronary Care Unit. Decant process of 8 beds is required. A group from CCU and the CDU project team are managing risk and planning. EP external operational review to commence. EP Room 4 Upgrade planning has begun for a build commencing Dec 2018 New automated waitlists and booking procedure codes for ECHO and Intervention procedures will be developed

140 Engaged Workforce Improved Health Status Better Quality Care Patient Safety Scorecard Auckland DHB - Cardiovascular Services HAC Scorecard for April 2017 Measure Central line associated bacteraemia rate per 1,000 central line days Medication Errors with major harm Number of falls with major harm Nosocomial pressure injury point prevalence (% of in-patients) Nosocomial pressure injury point prevalence - 12 month average (% of in-patients) Number of reported adverse events causing harm (SAC 1&2) Unviewed/unsigned Histology/Cytology results >30 and < 90 days Unviewed/unsigned Histology/Cytology results >= 90 days Actual Target Prev Period 0 <= % <=6% 4.2% 4.9% <=6% 4.6% HT2 Elective discharges cumulative variance from target (ESPI-1) % Services acknowledging 90% of FSA referrals in 15 calendar days or less (ESPI-2) Patients waiting longer than 4 months for their FSA (ESPI-5) Patients given a commitment to treatment but not treated within 4 months % DNA rate for outpatient appointments - All Ethnicities % DNA rate for outpatient appointments - Maori % DNA rate for outpatient appointments - Pacific Elective day of surgery admission (DOSA) rate % Day Surgery Rate Inhouse Elective WIES through theatre - per day Number of CBU Outliers - Adult % Very good and excellent ratings for overall inpatient experience % Very good and excellent ratings for overall outpatient experience Number of complaints received 28 Day Readmission Rate - Total % Adjusted Session Theatre Utilisation % Theatre Cancellations Average LOS for WIES funded discharges (days) - Acute Average LOS for WIES funded discharges (days) - Elective Cardiac bypass surgery waiting list % Accepted referrals for elective coronary angiography treated within 3 months 0.92 >= R/U 100% 100% 0% 0% 0% 0% 0% 0% 10.08% TBC 11.46% 27.59% TBC 28.24% 20% TBC 21.26% 21.65% TBC 20.19% 0% TBC 1.72% TBC R/U >=90% 96.8% R/U >=90% 82% 1 No Target 3 R/U TBC 14.7% 79.6% >=85% 83.3% 17.58% TBC 12% 4.34 No Target No Target <= % >=90% 97.79% % Hospitalised smokers offered advice and support to quit Vascular surgical waitlist - longest waiting patient (days) Outpatient wait time for chest pain clinic patients (% compliant against 42 day target) 95.45% >=95% 97.22% 87 <= % >=70% 95.52% Excess annual leave dollars ($M) % Staff with excess annual leave > 1 year % Staff with excess annual leave > 2 years % Staff with excess annual leave and insufficient plan to clear excess by the end of financial year Number of Pre-employment Screenings (PES) cleared after the start date Sick leave hours taken as a percentage of total hours worked % Voluntary turnover (annually) % Voluntary turnover <1 year tenure $0.6 0 $ % 0% 31.82% 13.78% 0% 13.69% R/U 0% R/U % <=3.4% 4.2% 12.35% <=10% 11.6% 4.48% <=6% 7.94% Amber R/U Variance from target not significant enough to report as non-compliant. This includes percentages/rates w ithin 1% of target, or volumes w ithin 1 value from target. Not applicable for Engaged Workforce KRA. Result unavailable (ESPI-1) % Services acknowledging 90% of FSA referrals in 15 calendar days or less Result unavailable until after the 16th of the next month. % Very good and excellent ratings for overall inpatient experience % Very good and excellent ratings for overall outpatient experience These measures are based on retrospective survey data, i.e. completed responses for patients discharged or treated the previous month. 28 Day Readmission Rate - Total A 35 day period is required to accurately report all acute re-admissions for the previous month's discharges. (35 days = 28 days post discharge as per MoH measures plus 5 w orking days to allow for coding). % Staff with excess annual leave and insufficient plan to clear excess by the end of financial year Result unavailable. 134

141 Scorecard Commentary There were no SAC 1 or 2 events scored for April for the Cardiovascular Directorate There was one complaint received in April relating to a long wait time in outpatient clinic and poor communication about the delays. This has been resolved. There were no Grade three or four pressure injuries reported and no medication errors resulting in serious harm There was one fall occurring in March that resulted in harm. The patient suffered a small cerebral bleed and has since recovered. Pressure injuries, medication errors and falls remain within previous trends. There has been no significant change in reporting rates since the introduction of the new Safety Management System (Datix) at the beginning of April. The Cardiovascular Service continues to meet the 4 month target in elective service delivery targets, ESPI /2 and ESPI 5. At the end of April the cardiac surgery eligible bypass waitlist was at 62; we continued to see inflows onto the waitlist in line with the plan however production remained close to plan therefore reducing waitlist numbers. The service performed 5 transplants in April and cared for 5 extracorporeal membrane oxygenation (ECMO) patients and still sustained production. Vascular surgery continues to meet ESPI 2 and 5 but continues to be challenged in achieving the Auckland DHB elective discharge targets. The service plans to work towards mitigating this are in place. The Vascular service continues to work through service improvement processes and is seeing positive changes in their scheduling practises as a result. This is one of the countermeasures to address the challenge of managing increasing acute volumes and the need to maintain elective throughput. ESPI2 in Cardiology is meeting 4 month targets due to a focus within the service to improve clinic cancellations and change clinic FSA to follow-up ratios. The Cardiology Electrophysiology waitlist is still trending up due to higher demand but we are validating the waitlist and a project has commenced on understanding the scheduling process to identify opportunities to reduce the wait list and improve waitlist and scheduling management. The Cardiology Interventional Waitlist is stable and our opportunity to improve lies with repatriating regional STEMI patients to their DHB of domicile to improve bed flow and reduce LOS. The sick leave levels remain the same as last period; leaders are monitoring this to ensure staff are taking adequate breaks and fatigue is being managed actively. The leave liability related to people with more than two years-worth remains static efforts to reduce SMO excess leave in the Cardiology area continue; Allied Health employees have significant leave liability this aligns to technical staff shortage and difficulty in recruiting. A working group is scheduled to consider the problems

142 STATEMENT OF FINANCIAL PERFORMANCE Cardiovascular Services Reporting Date Apr-17 ($000s) REVENUE MONTH Actual Budget Variance Actual Budget Variance Government and Crown Agency (18) U 1,187 1, F Funder to Provider Revenue 10,636 10,636 0 F 106, ,955 0 F Other Income F 5,742 5,860 (118) U Total Revenue 11,618 11, F 113, ,979 (95) U EXPENDITURE Personnel Personnel Costs 5,657 5,472 (185) U 55,369 53,686 (1,683) U Outsourced Personnel (10) U F Outsourced Clinical Services F F Clinical Supplies 2,560 2, F 27,769 26,997 (772) U Infrastructure & Non-Clinical Supplies (102) U 1,672 1,239 (433) U Total Expenditure 8,507 8, F 85,626 82,972 (2,654) U Contribution 3,111 2, F 28,258 31,007 (2,749) U Allocations F 10,262 9,994 (267) U NET RESULT 2,180 1, F 17,996 21,013 (3,016) U Paid FTE MONTH (FTE) YEAR TO DATE (10 months ending Apr-17) YEAR TO DATE (FTE) (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance Medical (0.4) U (0.2) U Nursing (4.7) U F Allied Health (0.3) U F Support F (0.0) U Management/Administration (8.6) U (8.2) U Total excluding outsourced FTEs (14.0) U (2.6) U Total Outsourced Services (1.7) U (0.8) U Total including outsourced FTEs (15.7) U (3.4) U Financial Results The year to date result is $3,016 U driven by lower Other Income, higher than budgeted SMO costs and higher clinical supply costs. Total year to date inpatient WIES are 6% higher than and 103% of budget. Overall year to date WIES activity now has cardiology at 104% of budget, cardio-thoracic at 102% and vascular surgery 103%. The overall total WIES position is 103% of year to date budget. YTD FTE Employed/Contracted is 2.6 FTE unfavourable. 1. Revenue Overall revenue variance year to date is $95k U due to: $80k unfavourable on Non-resident revenue. We are ahead of budget for Cardiology and Vascular, but behind by about $508k on Cardiothoracic. We expect to be close to total budget by the end of the year, although Tahiti volumes may still be a little low. We are encouraged by the relationship with CPS, the Tahiti insurer, in recent months. ACC revenue is in a favourable position, being 108% of budget. 136

143 2. Expenditure Total Expenditure (including Allocations) Year to date is $2,921k U, this is mainly due to: Personnel and Outsourced personnel costs being net $1,607k U; primarily due to higher SMO costs ($1,660k U) due to higher levels of insourcing than budgeted, and savings targets. Outsourced Clinical is $159k F year to date and will remain below budget for the year. Clinical Supplies is $772k U. There are three key drivers: - Cardiology clinical supply costs at $481k U are impacted by both volume (104%) and cost drivers. In Cardiac Electrophysiology (EP), catheters are 110% of budget ($186k U). A review of usage and price was undertaken in early September. While we have subsequently seen a significant reduction in average catheter cost/case, patient volume growth continues to trend upwards, particularly in the percentage of complex cases over the last three months. Total Cardiology clinical supply costs fell significantly in January and February ($306k F) due to the impact of one cath lab closure for refurbishment for the majority of that period. In March we saw an increase to December levels however only 96% of budget for the month and April a further increase to pre-christmas levels and 107% of budget. - At the same time that catheter costs have pulled back we have seen very large increases in EP Implant costs ($766k U year to date) with September, October and November being particularly high months. We are investigating this further but the spend was much lower in December and January, increasing slightly in February, March and a further rise in April (132% of budget) - Cardiothoracic costs $552k unfavourable. Blood costs ($267k U) due to 5 high cost patients. Catheter costs ($155k U) are 56% higher than last year s cost. We are investigating this further but again the spend did reduce significantly in December, January and February however we have seen an increase in March and April - Equipment depreciation is $15k U however much of this cost relates to 15/16. In spite of the above drivers, average year to date cost per wies equivalent (excluding depreciation) is slightly lower than last year actuals (97%), and is now below budget levels (99% of budget), as volume growth has increased faster than expenditure. Cardiothoracic activity continues to be higher than budget but not out of step with prior year costs (101%), whilst high activity levels have held cardiology costs below budget (98%). Infrastructure and Non-Clinical Supplies is $433k U. Internal Allocations are $267k U mainly due to Vascular Radiology charges and Nutrition charges. We are actively working on implementation of Directorate savings initiatives, and participating in provider level projects. Other key actions to date include: - Completing CPS non-resident pricing increase from Jan 2017 now actioned - Looking to introduce a different surgical skill mix into cardiac surgery for the next calendar year - Review of catheters and TAVIs pricing and products in cardiology (TAVI now implemented) - Compiling a case for co-payment for lead extractions under-way - Review of other consumable costs through supplier negotiation - Ongoing vacancy management

144 Date: May 2017 A3 owner: Mark Edwards Cardiovascular Directorate Key priorities for the Cardiovascular Directorate In 2017/18 our Directorate will contribute to the delivery of the Provider Arm work programmes. In addition to this we will also focus on the following Directorate priorities: 1. Continue to embed the Clinical Governance model and quality frameworks supported by our Clinical Leadership model 2. Reconfigure service delivery for patient pathway(s) with a particular focus on cardiac and thoracic surgery and cardiology pathways. 3. Ensure equitable and clinically appropriate access for acute/elective flow for patients accessing services within cardiovascular, working in collaboration and integration with the region. 4. Plan for future service delivery Identify resource and structure to support areas of growth within the Cardiovascular Directorate, in particular heart/lung Transplant, TAVI, lead extraction and cardiovascular critical care strategy. 5. Focus on building meaningful action plans identified from the employee survey, to develop strong team culture and engagement. 6. Ensure financial resources are appropriately allocated for delivery of safe high quality care. Current condition 1. Service leadership positions are now filled; these appointments are developing accountability across all areas, defining roles and responsibilities and building and integrating relationships. 2. Activities that support the various work streams to reconfigure the model of care for Cardiac, thoracic Surgery patients are well underway. Cardiology model of care /pathways review will commence, both work streams will align to the organisational work programmes, deteriorating patients and using the hospital wisely. 3. Acute /elective flow and waitlist management varies across services. Equity of access and clinically appropriate scheduling to be reviewed across all services with a focus on scheduling and waitlist management process. 4. There are several areas of growth within the directorate influenced by changing population, new technologies and changes in clinical management of patient groups. The services needs to identify requirements to ensure systems and process are in place to deliver safe quality patient focused care. 5. Results of employee survey have been disseminated, identification of action plans for strengths and areas of improvement to be developed. 6. Ongoing challenges to meet budget continues, influenced by increased volume delivery driving higher than planned clinical costs. Target condition 1. Clinical Leadership structure developed. Accountability for quality achievements and integration of quality plans is in place. A safety culture is firmly embedded with primary focus on patient centered care. 2. Service redesign projects on track. 3. All patients, have appointments scheduled within clinically appropriate and accepted timeframes. Regular waitlist meetings are established for all services. 4. Areas of future growth within the directorate pathways identified and resources in place to support them to reduce any variation in delivering clinical outcomes. Identify vulnerabilities in medical, nursing, allied health and support staff and have targeted workforce development plans. 5. Action plans identified and improvement of staff engagement and satisfaction reported. 6. Achieve delivery of quality care within budget. Measures Current Target 2. Nursing Education model Started Delivered according to framework 2, 4 Number of recommendations off track- EP operational review/ CTSU pathway review- pre-op, discharge planning, MOC and routine/complex pathways and Perfusion review 3. Number of waitlists across the directorate that have been validated and working within access, booking and choice policy framework. To commence On track All areas on track to agreed timelines All waitlists validated 4. National cardiothoracic database selected and implemented To commence Fit for purpose database Implemented 4. Implementation of ECMO service model. To commence Delivered according to service model 5 Number of employee engagement survey action plans off track On track Action plans complete, improved engagement in identified areas. 6. Meet revenue and expenditure Budget met Budget met Action Plan Owner Q1 17/18 1 Continue to develop leadership meetings, commence and develop service monthly meetings with a quality focus and Service Clinical Director accountability Leadership team 2,4 Nursing education model-implementation across the Directorate ND,NUMs 2,4 CTSU service redesign- Shared Cardiology/Cardiothoracic area for preoperative patients, improve discharge planning- across complex and routine pathways, reconfigure MOC ward 42 2,3 4 Cardiology EP operational review 2,4 Develop Critical Care strategy, align with the Deteriorating Patients programme. 2,4 6 Continue to develop transplant strategy in alignment with the Transplant board. 2,4 Support the delivery of the 24/7 work programme. Directorate to transition to the 24/7 MOC. 3 Review Vascular/Cardiology scheduling, acute/elective management of patients and improve waitlist practise 4 Develop and implement sustainable solution for national cardiothoracic database. SCD,ND, GM, Director, Ops,NUM GM, NUM, Ops, SCD GM,Dir,NUM,S CD,ND Dir, SCD s GM Dir, ND, NUM, SCD s Ops, SCD, NUM SCD s, GM 4 Implementation of perfusion review recommendations. Ops,SCD 4 Implementation National ECMO service model SCD,NUM, Ops 5 Roll out action plans across Directorate for employee engagement survey 6,4 Work with Health alliance to improve competitive procurement strategies across the Directorate. all Ops,NUM Q2 17/18 Q3 17/18 Q4 17/18 138

145 Commercial and Non Clinical Support Directorate Speaker: Rosalie Percival, Chief Financial Officer 5.13 Service Overview The Commercial and Non Clinical Support Directorate is responsible for service delivery and management of Cleaning and Waste arrangement, Security, Food and Nutrition, Linen and Laundry, Car-parking, Motor Vehicle Fleet, Property leases, Retail, Dock management, Commercial Contracts, Clinical Education Centre, Sustainability, Volunteers, Mailroom, Health Alliance Procurement and Supply Chain relationship (including NZ Health Partnerships Ltd, Pharmac and Ministry of Business Innovation and Employment). The Directorate has undergone a review of its services which has resulted in four core service groups and with a single point of accountability for each function; 1. Commercial Services Business Improvement 2. Commercial Contracts Management 3. Operations Non Clinical Support 4. Procurement and Supply Chain The leadership team of Commercial and Non Clinical Support Directorate is led by; General Manager Operations Manager Business Improvement Operations Manager Non Clinical Support Operations Manager Procurement and Supply Chain Manager Finance Manager Commercial Contracts Manager Directorate Priorities for 16/17 The Commercial and Non Clinical Support Directorate developed a work programme that would align with the delivery of both the Provider Arm and Corporate Services key priorities including regional and national initiatives. This programme of work included; 1. Enhancing the Directorate s readiness to serve framework to align with the Provider Arm and Corporate Services planning protocols. 2. Developing an enhanced leadership model for single point of accountability for key service teams to improve quality of stakeholder engagement and decision making. 3. Provision of values training to align with enhanced patient safety and better quality care. 4. Improving culture and team engagement to develop the workforce to improve performance and deliver on agreed plans. 5. Engagement in integrated service planning and monitoring of service delivery against key performance targets. 6. Development of systems at local, regional or national level as enablers for improved accountability and transparency within all services. 7. Identification of commercial revenue generation and other value for money opportunities. 8. Development of a sustainability framework. Hospital Advisory Committee Meeting 7 June

146 Key Actions 16/17 The following actions are currently being progressed to ensure delivery of Strategic Initiatives for Commercial and Non Clinical Support. Service Group Deliverable/Action Q3 Q4 17/18 Contracts Contracts Database Contracts Contracts Management framework Contracts Transforming Food Service Delivery Business Improvement Motor Vehicle Service Review Business Improvement Motor Vehicle Fleet Strategy Business Improvement Sustainability Strategy Business Improvement Sustainable Transport Operations NCS Security-for-Safety work programme Operations NCS Security Strategy Operations NCS Waste Transformation Project Procurement and Supply Chain healthalliance/procurement Framework Procurement and Supply Chain Supply Chain Framework Procurement and Supply Chain Auckland Regional Supply Chain Review Procurement and Supply Chain Gap analysis for National Oracle system Scorecard Key achievements in the month Cleaning Services The combined average audit score for April 2017 was 93%. By sites - Auckland Hospital (92%) and Greenlane Clinical Centre (94%). The score is consistent with the previous month s trends and reflects the continuous engagement with staff and on-going training to maintain high cleaning standards. Working with hospital operations and capacity demand management teams has resulted in improved resource management including the prioritisation of discharge cleans to improve patient flow. Isolation cleaning requests in conjunction with the RAG (Red, Amber, and Green) system continues to be effective and this has resulted the collection of key data to help monitor volume and respond to critical locations across Auckland City Hospital. Hospital Advisory Committee Meeting 7 June

147 Red Cleans (Deprox) for the month of April has increased to 38 compared to 37 in previous month. Cleaning-related slips and trips continue to be low. There were no cleaning-related slips and trips reported in April. Training for cleaning services team managers and Health and Safety reps on the newly implemented Datix Safety Management System. While transition to the new system has been relatively seamless, follow up training will be provided to ensure notifications for respective managers are correctly established,. Cleaning Services staff attended pilot training for the upcoming implementation of the Tri-Bins and Desk Cube initiative. This was well received and generated relevant questions on the issues around climate change, pollution and segregation of waste for recycling. This is a positive step in supporting the overall sustainability programme across the DHB in reducing its carbon footprint. Three groups will celebrate completion the Workplace Literacy Course with a graduation ceremony in May. Planning is underway for three additional groups to be launched in mid-july. The overall training programme has been well received and supported by staff taking a greater interest in continuing the literacy programme and participating in other training provisions. NZQA Level 3 Certification is continuing with a second group of staff. Registration of assessors is currently being planned for August The Leadership Training course continues with two course modules now completed. Feedback continues to be positive and practices taught are being applied within the workplace. Coaching sessions planned from May further support this programme and reinforce learning. Content made available via web continues to promote further enquiry into developing digital literacy. Service managers have been encouraged to participate and share this journey of leadership, experiences and encourage learners. Recruitment process is underway for Service Delivery Coordinator, Resource Specialist, Permanent Cleaners and Casual Cleaners. The first phase of new cleaners are expected to commence in mid-may. Casual staff interviews will be on-going to supplement the existing casual pool. There is a strong focus to support recruitment of Limited Service Volunteers in an effort to widen the recruitment pool and encourage application of Pacific Island and Maori in healthcare roles. Vulnerable Children s Act vetting process currently underway with Cleaning and Waste Services. Customer Experience Portal - Cleaning standards continue to be rated highly, although a small decline to 7.9 on the cleanliness/hygiene rating in April. There were improvements to hospital rooms and bathroom noted in comparison to previous month. A summary off the feedback for April is set out in table below Rating Comment Location of Discharge 10 Staff were attentive to good hygiene Ward It's always clean Ward 38 - Cardiology Day Unit 10 Cleanliness self-evident Ward 38 - Cardiology Day Unit 10 No concerns whatsoever Ward 24A 10 I was Impressed with the nursing staff how they sanitised after dealing with different patients and after each procedure that they performed Totara Day Stay Unit - Ophthalmology 10 No issues thanks Haematology Day Stay 10 No complaints, very clean facility Greenlane Surgical Unit 10 Everything was very clean! Greenlane Surgical Unit 10 Staff always uses gloves and hand sanitizers Ward 67 Hospital Advisory Committee Meeting 7 June

148 Rating Comment Location of Discharge 10 Very clean tidy bed. Nurses always used glasses bed and or sanitised hands. Toilets clean and tidy. Always toilet paper and hand towels etc. well stocked. Ward 97 Staff Residences Residence occupancy for month of March was 76% (Level 3 83%%, Level 5 86%, Level 6 62% and Level 7 75%). There has been a general uplift in the number of booking enquiries during the month and this is being reflected in the increase in occupancy levels. OHandS have signed and approved the House Rules (Terms and Conditions). Residents will be provided a copy of the updated agreement together with the planned rental increase. Six-monthly audits for staff residences will be conducted alongside Cleaning and Waste Services audit. This will be initiated once a permanent Staff Residences Administrator has been appointed. Recruitment for this is moving towards shortlisting of candidates in preparation for interviews. A review of fire evacuation processes and posters at the Staff Residence has been completed with planned evacuation drills scheduled in August. An updated evacuation procedure document is being drafted following recommendations from the Fire Advisor. On-going maintenance work is being carried out during business hours with minor disruption to tenants. Further service improvements will focus on the facilities safety, access, eligibility and also the possibility of a software-based booking system. Overall, the improvement programme to date for the building is now taking effect. Security for Safety Programme All work-streams are progressing well with key progress including; Completion of Access Control in mortuary and Level 6, Building 01 Completed installation of external cameras around Grafton site Commencement of access control upgrade for perimeter doors (Grafton site) Consultation on Code Black policy and; Access plan development for Women s, public spaces and Long Term Conditions Supply Chain and Procurement Supply Chain Review The 8 streams of work under the 90-day plan are set out below. The second 90-day plan is well underway and to maintain similar protocols and closer alignment across the region this includes the Northland DHB. All four northern DHB s have signed an extension to the Onelink contract to provide 3 rd party logistics support covering inventory management, warehousing and distribution. Prices were updated at each of the DHB s to reflect a negotiated reduction in margin for non-contracted items procured by Onelink on behalf of the DHBs. Hospital Advisory Committee Meeting 7 June

149 Stream A Strategic, risk, maturity matrix, frameworks and policies including an inventory management policy for the region. The key actions as part of the Northern Region and healthalliance work programme include the development of a number of regionally consistent frameworks to cover; o A cost to service model which measures service provided, incorporating Onelink, health Alliance and each DHB o A consistent Returns policy to ensure that each DHB is recovering costs from supplier errors and incorrect deliveries, and managing non performing suppliers o Implementing an effective backorder process which is visible and effective for frontline staff o Determining consistent set of KPIs across the organisations across the supply changes to ensure that all participants have common goals. o Agree a common inventory strategy across the region which will support operational efficiencies within health Alliance and support the ability to move stock around the region as part of strategy to reduce obsolete and excess stocks People establish Responsibilities, Accountabilities, Supportive, Consulted and Stream B Informed (RASCI) across all 4 entities, appropriate staffing levels and training framework. Reduced intervention and effort with simplified Procure-to-pay process. Stream C The recommendations from the initial round of workshops were signed off on 24 th November by the Supply Chain Operation Group (SCOG). The second round of workshops to determine priorities for next 90 days commenced in January Information and data integrity held on Oracle data quality relating to product Stream D and services held on Oracle is poor. DHBs and healthalliance to work towards the data requirements for the National Oracle System (NOS) project. Clinical personnel have been included in the teams. Document the physical flows at each hospital in the Auckland Metro to better Stream E meet the needs of customers and improve efficiency of the region s distribution network. This also supports the renegotiation of the Onelink contract. Better represent Customer needs. The teams have been developing a regional Stream F customer matrix-model to agree on service priorities and resourcing in consultation with each DHB s service management. The expectation is this work-stream will align with healthalliance resources and budget for its supply chain service. The recommendation on the model-matrix was presented to the SCOG 24 th November. The work re-commenced after Christmas to allow the DHBs to test the matrix-model and that it performed as expected Inventory Management Category Reviews The inventory category review team have created a structured process to reduce days of inventory without impacting service. This is an opportunity to identify further savings. The service is working with the clinical teams to identify changes to practice while maintaining the confidence that the stock levels will continue to meet clinical needs and there are no risks to patient care. Laboratories have been completed with a $70,000 inventory saving identified. They also identified of supply chain savings through reduced frequency of counts, and have Hospital Advisory Committee Meeting 7 June

150 listed opportunities for service improvements and cost reductions which will be feed into the supply chain review. The team have also been working with Auckland DHB and HA staff to move reporting from prototype into production. The key benefits will allow RC and finance managers to have greater visibility and control over their inventory spend. This function will be made available to Northern Region DHBs. Pandemic stock The Northern DHBs, St John and Onelink have formed a group which regularly meets to create a regional stock holding and response team for initially pandemic stock holding but eventually any other major event which requires a coordinated regional response. Procurement As requested by MBIE, Auckland DHB identified 13 significant service contracts including the Funder Arm contracts. Further work is now underway to prepare mitigation plans for each of these contracts and incorporated into the business continuity planning process as appropriate. Health Alliance are managing the contracts which Auckland DHB shares with the rest of the region. Security Operations Bike thefts have declined sharply since the establishment of secured Bike Park. The Level 5 secure bike park is now fully operational. Car Park B secure bike park is nearing completion. Police liaison is on-going to help prevent/address bicycle thefts. Security control room operators have been advised of the new CCTV placements and access controlled doors. This is an on-going process. System configurations have eliminated concerns around freezing cameras. This will still be monitored by to ensure the systems are operations at all times. All security room operators now hold individual logins for access. Security Parking A zero tolerance approach to parking in the drop-off area has eased parking issues on Level 4. However, non-compliant parking during nights and weekends continues create challenges for the security staff specifically the ambulance bays, cars on yellow lines, disabled car-parks and LabPlus restricted parking areas at both sites. Monitoring and removal of infringing vehicles that are causing Health and Safety concerns around access, walking and wheelchair access. Since January 2017, a total of 48 cars have been towed from Auckland Hospital site. Waste Services and Sustainability The General Waste audit is scheduled for May 2017 with participation by CSSD and Theatres and will be conducted by the waste management contractor. Previously, audits reported a continued reduction in waste contamination and reflects close adherence to waste management practice. Tug Machine used to pull waste bins is under trial and review by OHandS. The value added benefits include an increase in productivity, improve safety in corridors and reduce the risk of back injuries. The trial machine has been well received by the staff and pending review by OHandS it is likely that a full implementation will follow. The DHB celebrated Earth Day in participation from various partner services involving a display of pop-up stands. The key theme for Earth Day was to promote sustainability and raise Hospital Advisory Committee Meeting 7 June

151 awareness on recycling and reducing waste. The response of the stands was positive with large number of visitors and staff visiting the stands. This is planned to become an annual event in promoting sustainability and reducing the DHB s environmental footprint on the planet Grafton Café has implemented bio-degradable containers and cutlery which was showcased at the Earth Day stalls and Sustainability forums. This has replaced plastic cutlery as well as provision of plastic bags with paper bags. This marks a significant improvement in Auckland DHB and Compass delivering sustainable initiatives. On-going organisation-wide staff training is being provided by Baxter s for PVC recycling and waste services contractor on segregation and recycling general waste in staff kitchens and public areas. The recycling training programme is to support the eco-recycling bins and desk cubes initiative scheduled to commence in June. This is part of the sustainable office programme to improve waste segregation at source and diverting waste to landfill. Property Leases St Luke s Community Mental Health lease expires in October 2017 with a right of renewal for 3 years. Suitable alternative building has not been located and the service has requested the lease is extended with an early termination clause (12 months notice). This proposal will enable the service to continue looking for alternative premises and relocate within 12 months. The landlord has requested the 12 months notice apply to both parties. Discussions are underway. Water leak in the kitchen roof uncovered asbestos material. The landlords and their insurance company are working on a plan to remove the asbestos and repair damages. Awaiting for contractor to fix water damage. A suitable property has been located for the Mental Health Early Intervention Team. An agreement has been prepared to lease level 1, 95 Great South Road to accommodate the Early Intervention Team. The Agreement is subject to a due diligence clause for Auckland DHB or Landlord to obtain satisfactory Zoning, Asbestos, Seismic and a Building Conditions report. St Luke s Community Mental Health is planning to re-locate the ACOS team to the Carrington Site. Manaaki House; 15 Pleasant View Road, Panmure site lease expires in March Discussions are still underway with the landlord to renew with refurbishment options. The following rent reviews/lease extensions are underway or completed in March 2017: Hospital Advisory Committee Meeting 7 June

152 o o o o The lease for the Lab Services located in Carbine Road, Mt Wellington has been extended to September 2018 (as per the agreement). Awaiting for formal response from landlord. Lab Services Lease renewal for 46 Taharoto Ave Takapuna is underway. 126 Khyber Pass Road Community Mental Health lease renewal underway. CMDHB Dental Clinic new 2-year lease is underway. CMDHB have proposed a rent increase by $16k pa. In discussions with the parties. The service has requested that the additional rent be offset against the FTE costs Auckland DHB have been subsidising. Property Other The broken lift at the Sexual Health Clinic in Henderson cannot be repaired. The landlord obtained quotes ($112k) and has placed an order for a new lift replacement which has a lead time of approximately 30 weeks. The landlord has requested Auckland DHB contribute towards the replacement of the lift. Auckland DHB has rejected this request and reduced the rent by $1,000 per month. The service is now considering re-location options. Community Mental Health Services are reviewing other MHS leased properties. JLL has completed a property inspection and health and safety report for off-site leased premises. The report has been reviewed and further clarification on the findings has been received. HealthAlliance has requested nil rent charge for the areas they currently occupy at Auckland DHB. The matter has been referred to Corporate Services for review. Auckland DHB has formally sent a letter outlining the proposed lease terms for the New Zealand Blood Bank building extension. Awaiting a response. Leased Retail Outlet Paper Plus will be opening a Pop-Up bookshop for 6 months on 15 May 2017, a slight delay due to personal circumstances. Negotiations with the Florists to provide a florist cart /station in the area currently occupied by Planet Espresso is on-going. Make good of the premises is due in June 2017 and plans to have a florist in place by July Park Road - Auckland Barbers have exercised their right of renewal for a further term of 4 years commencing 1 May Documentation underway. Compass Makita Shop Lease renewal extended for 3 years. Documentation underway There are on-going discussions with 2 Degrees to install suitable communication equipment on Auckland City Hospital land to enable better connectivity. Parking and Shuttle Services AMP has proposed an increase public parking rates. Discussions underway to delay start date by 6 months. A usage survey of Carpark A is planned for May 2017 in an effort to identify and discourage non Auckland DHB related use of the carparks. Davis Crescent off-site parking lease has been extended for a further 2 years. Documentation underway. Auckland Trotting Club lease has been extended for 6 months whilst the Trotting Club determines the building construction requirements. Documentation underway. Hospital Advisory Committee Meeting 7 June

153 Clinical Education Centre April has historically has low occupancy at the CEC with Easter, Anzac Day and School Holidays. The pilot event for the Auckland DHB Staff Orientation Navigate Auckland DHB was held in the CEC on April 3 with 200 new DHB employees attending. This event was a huge success and three such events have been booked for the rest of Contract Management Linen A major breakdown of machinery at a critical processing time created shortages in the general supply of flannel blankets, baby receivers and patient gowns. Utilisation for month of March is 79% (Target 85%); figures for April are not currently available. Improved efficiency has been achieved in the standardisation bed making project. At present the policy is being developed for circulation and review. The implementation of this project does have potential for savings to be made for Auckland DHB. At the regional level a sample of the Adult universal patient gown is due to be made available for trial. The Paediatric universal patient gown has entered the 1st phase of trialling in CMDHB and this is reported to have been successful. 2nd phase of trialling is expected to commence end of May in different wards within CMDHB. Food and Nutrition Services The trial for Steamplicity in Older Peoples Health has been extended. Standing orders for ward supplies have been reviewed and finalised. Compass group and Auckland DHB have established a new process to ensure increased visibility over orders and invoicing. Implementation of the Auckland DHB Healthy Food and Drink Policy plan has been established. The first phase has been applied to all food outlets on the Auckland DHB premises including vending machines and stock contained. By May there will be an increase in meal options and removal of all confectionary. It is intended that compliant cookies, fruit, nut, cereal bars will also be included. By July, non-compliant snack options will be removed and replaced by popcorn and/or bagel chips. Hygiene and Pest Control Services Initial Hygiene is considering using weight scales to record waste data volumes removed from ACH as part of the sustainability programme to report on sanitary waste being removed from site. The new Hygiene and Nappy bin service model has not been rolled out as yet with the other DHB on the North Island, CMDHB are under discussions at the moment. Rentokil have endeavoured to work closely with Auckland DHB in addressing flea issues experienced in various departments. Review on the areas to take place and course of action shortly detailed thereafter. Review of historical reports also taken into account as part of this review. Print Services Rationalisation of printers reviewed, determined further work necessary to reduce the number of un-networked printing devices. At present this makes up for 29% of the current fleet. Hospital Advisory Committee Meeting 7 June

154 Targeted devices include those nearing end of life and subsequently a project plan to improve rationalisation is being developed. Simultaneously, efforts to look into alternative technologies and functions available with printers also being investigated to enhance the end user experience. To enhance the decision making process in requesting printers and determining options available, a policy document is being prepared in consultation with healthalliance. Uniforms Fashion Uniforms Uniform returns process has been drafted, signed off and loaded on Hippo intranet site, making it available closer to the determined implementation date. Relevant updates to the policy documents are also underway and progressing. Target date for uniforms is still on track for mid- August Vending Direct Discussions are taking place regarding product changes that will enable the products to comply with the National Policy (Healthy Eating), meetings occur every forth night to work towards compliance The following time lines have been agreed: Key issues and initiatives identified in coming months Area Cleaning Services Staff development and training programme Implement staff PDRs Cleaning staff recruitment Timeframe On-going Commence Mar 17 On-going Sustainability Waste Reduction Programme Jun 17 Security for Safety Programme On-going Security CCTV and Access Control upgrade On-going Motor Vehicle Fleet Strategy Dec 17 HealthAlliance Regional Supply Chain Review Jun 17 Oracle V12 Upgrade On-going Oracle V12 Upgrade - data Integrity audits and recovery of moneys due On-going DHB/HealthAlliance review of OneLink contract Jun 17 Taylor s Linen Contract sterile linen expiry extension March 17 Mail Services Investigation of Mail House Service On-going Sustainable Transport Programme Jul 17 Hospital Advisory Committee Meeting 7 June

155 Financial results Non-Clinical Support Services STATEMENT OF FINANCIAL PERFORMANCE Non-Clinical Support Services Reporting Date Apr ($000s) REVENUE Comments on major financial variances MONTH YTD result is close to budget at $72K F. The key drivers of this result are; Actual Budget Variance Actual Budget Variance Government and Crown Agency F F Funder to Provider Revenue F F Other Income F 8,673 8, F Total Revenue F 8,904 8, F EXPENDITURE Personnel Personnel Costs F 8,484 9,915 1,432 F Outsourced Personnel (152) U 1,430 0 (1,430) U Outsourced Clinical Services F F Clinical Supplies F F Infrastructure & Non-Clinical Supplies 2,371 2, F 24,717 24,095 (622) U Total Expenditure 3,367 3, F 34,732 34,219 (514) U Contribution (2,467) (2,523) 56 F (25,828) (25,523) (306) U Allocations (1,018) (995) 23 F (10,453) (10,074) 378 F NET RESULT (1,449) (1,528) 79 F (15,376) (15,448) 72 F Paid FTE MONTH (FTE) YEAR TO DATE (10 months ending Apr-17) YEAR TO DATE (FTE) (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance Medical F F Nursing F F Allied Health F (0.1) U Support F F Management/Administration F F Total excluding outsourced FTEs F F Total :Outsourced Services (42.8) U (40.4) U Total including outsourced FTEs F F 1. Revenue is above budget due to the sale of kitchen assets $134K. Cafeteria revenue of $104K has been received $50K relates to prior year. 2. Infrastructure and Non Clinical Supplies are $622K U. This is mainly driven by food costs being higher than budget. Some of these are one off costs. Hospital Advisory Committee Meeting 7 June

156

157 Provider Arm Financial Performance Consolidated Statement of Financial Performance - April Provider Month (Apr-17) YTD (10 months ending Apr-17) $000s Actual Budget Variance Actual Budget Variance Income Government and Crown Agency sourced Non-Government & Crown Agency Sourced Inter-DHB & Internal Revenue Internal Allocation DHB Provider Expenditure 7,606 7,932 (326) U 77,400 80,669 (3,269) U 7,479 7, F 71,113 70, F 1,074 1,345 (271) U 11,189 13,060 (1,871) U 102, , F 1,021,651 1,020, F 118, , F 1,181,353 1,184,766 (3,414) U Personnel 73,239 74,455 1,216 F 733, ,572 1,184 F Outsourced Personnel 2,229 1,068 (1,161) U 20,074 10,753 (9,321) U Outsourced Clinical Services 1,827 2, F 18,810 20,839 2,029 F Outsourced Other 4,383 4,271 (112) U 43,768 42,712 (1,056) U Clinical Supplies 20,306 21,612 1,307 F 214, ,207 (6,075) U Infrastructure & Non- Clinical Supplies 20,732 15,400 (5,332) U 161, ,884 (6,633) U Internal Allocations () U 5,314 5,315 1 F Total Expenditure 123, ,421 (3,827) U 1,197,153 1,177,281 (19,872) U Net Surplus / (Deficit) (4,604) (975) (3,629) U (15,800) 7,486 (23,286) U Hospital Advisory Committee Meeting 7 June

158 Consolidated Statement of Financial Performance April 2017 Performance Summary by Directorate By Directorate $000s Month (Apr-17) YTD (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance Adult Medical Services (45) U 9,617 11,966 (2,348) U Adult Community and LTC 1,586 1, F 16,578 15, F Surgical Services 10,455 10, F 90,941 94,865 (3,924) U Women's Health & Genetics 2,483 2, F 24,825 26,113 (1,289) U Child Health 6,087 5, F 55,744 59,137 (3,393) U Cardiac Services 2,180 1, F 17,996 21,013 (3,016) U Clinical Support Services (2,310) (2,393) 83 F (20,128) (19,435) (693) U Non-Clinical Support Services (1,449) (1,528) 79 F (15,376) (15,448) 72 F Perioperative Services (11,969) (11,386) (583) U (115,777) (111,370) (4,408) U Cancer & Blood Services 1,408 1, F 13,774 15,832 (2,059) U Operational - Other 4,758 5,260 (502) U 48,844 52,353 (3,509) U Mental Health & Addictions (18) (43) 25 F 2,189 1, F Ancillary Services (17,858) (13,894) (3,965) U (145,026) (144,847) (178) U Net Surplus / (Deficit) (4,604) (975) (3,629) U (15,800) 7,486 (23,286) U Consolidated Statement of Personnel by Professional Group April 2017 Employee Group $000s Month (Apr-17) YTD (10 months ending Apr-17) Actual Budget Variance Actual Budget Variance Medical Personnel 26,981 27, F 278, ,593 (4,009) U Nursing Personnel 25,887 25,159 (728) U 246, ,301 (1,722) U Allied Health Personnel 11,742 12, F 117, ,300 2,507 F Support Personnel 1,600 1, F 15,617 16, F Management/ Admin Personnel 7,029 7, F 75,351 78,853 3,503 F Total (before Outsourced Personnel) 73,239 74,455 1,216 F 733, ,572 1,184 F Outsourced Medical 1, (287) U 8,640 7,483 (1,157) U Outsourced Nursing (279) U 2, (2,515) U Outsourced Allied Health (11) U (59) U Outsourced Support (140) U 1, (1,328) U Outsourced Management/Admin (445) U 6,219 1,957 (4,262) U Total Outsourced Personnel 2,229 1,068 (1,161) U 20,074 10,753 (9,321) U Total Personnel 75,469 75, F 753, ,325 (8,137) U Hospital Advisory Committee Meeting 7 June

159 Consolidated Statement of FTE by Professional Group April 2017 FTE by Employee Group Actual FTE Month (Apr-17) Budget FTE Variance YTD (10 months ending Apr-17) Actual FTE Budget FTE Variance Medical Personnel 1,393 1,331 (62) U 1,379 1,332 (47) U Nursing Personnel 3,601 3,384 (217) U 3,562 3,409 (152) U Allied Health Personnel 1,845 1,846 1 F 1,839 1, F Support Personnel F F Management/ Admin Personnel 1,216 1, F 1,228 1, F Total (before Outsourced Personnel) 8,429 8,270 (159) U 8,391 8,297 (95) U Outsourced Medical (3) U (1) U Outsourced Nursing 11 6 (5) U 12 6 (6) U Outsourced Allied Health 10 4 (6) U 9 4 (6) U Outsourced Support 40 0 (40) U 37 0 (37) U Outsourced Management/Admin (82) U (77) U Total Outsourced Personnel (136) U (127) U Total Personnel 8,628 8,333 (295) U 8,581 8,359 (222) U 5.14 Consolidated Statement of FTE by Directorate April 2017 Employee FTE by Directorate Group (including Outsourced FTE) Actual FTE Month (Apr-17) Budget FTE Variance YTD (10 months ending Apr-17) Actual FTE Budget FTE Variance Adult Medical Services (14) U (27) U Adult Community and LTC F F Surgical Services (83) U (57) U Women's Health & Genetics F (1) U Child Health 1,133 1,118 (15) U 1,133 1,116 (17) U Cardiac Services (16) U (3) U Clinical Support Services 1,409 1,404 (5) U 1,406 1,407 1 F Non-Clinical Support Services F F Perioperative Services F F Cancer & Blood Services (4) U F Operational - Others 0 (216) (216) U 0 (189) (189) U Mental Health & Addictions (15) U F Ancillary Services F F Total Personnel 8,628 8,333 (295) U 8,581 8,359 (222) U Hospital Advisory Committee Meeting 7 June

160 Month Result The Provider Arm result for the month is $3.6M unfavourable. This result is expenditure driven, reflecting abnormal facilities and financing costs during the month. Underlying operating expenditure was favourable to budget for the month. Overall base volumes are reported at 97.1% of the seasonally phased contract - this equates to $2.6M below contract for the month. The latest coding update indicates 98.5% performance, equating to $1.2M below contract. Total revenue for the month is very close to budget at $0.2M favourable. The key variance is Non Resident income at $0.8M favourable this revenue varies from month to month, with the current month reflecting a number of high value cases. This favourable variance is partly offset by a number of smaller unfavourable variances for miscellaneous revenue streams. Total expenditure is $3.8M (3.2%) unfavourable, with the key variances as follows: Interest and Finance Charges $2.2M (47.1%) unfavourable, due to release of cashflow hedge reserve under Ministry debt equity swap policy change. This will be offset by equivalent favourable revenue. Facilities $1.9M unfavourable due to health and safety related expenditure and asbestos removal. Bad/Doubtful debts $0.5M unfavourable, in line with higher than budgeted non resident income Clinical Supplies $1.3M favourable, reflecting volumes below contract for the month combined with a on off prior period adjustment $0.6M favourable Combined Personnel/Outsourced Personnel costs are very close to budget at $0.1M (0.1%) favourable. Total FTE at 8,628 are 295 (3.5%) above budget due to FTE savings targets incorporated into the budget not fully achieved. However the total cost variance is in line with budget due to lower cost per FTE (reflecting initiatives to reduce overtime and other premium payments). Year to Date Result The Provider Arm result for the year to date is $23.3M unfavourable. This result reflects a combination of unfavourable expenditure due to savings targets not fully achieved and abnormal one off expenditure items as well as revenue below budget due to base volumes slightly under contract. Overall volumes are reported at 99.3% of the seasonally phased contract - this equates to $6.6M below contract for the year to date. The latest coding update indicates 99.4% performance, equating to $5.3M below contract, and this has been provided for in the result as washup liability. Total revenue for the year to date is $3.4M (0.3%) unfavourable, with the key variances as follows. Key favourable variances: o Funder to Provider additional revenue outside of price volume schedule contract $4.6M favourable. o Research Income $2.7M favourable, offset by equivalent expenditure and bottom line neutral. o ACC revenue $1.9M favourable primarily due to one off revenue for new contracts and high value revenue for a small number of very high cost patients. Key unfavourable variances: o Funder to Provider base contract revenue $5.2M unfavourable for estimated washup liability for volumes below contract. Hospital Advisory Committee Meeting 7 June

161 o o o o o Donations $0.9M unfavourable revenue fluctuates from month to month, depending on timing of key projects, with the full year budget still expected to be achieved. MOH Public Health Funding $1.2M unfavourable, in line with services delivered this revenue is expected to be closer to budget by year end. Haemophilia funding $2.3M unfavourable for low blood product usage, offset by reduced expenditure of $2.1M (balance of $0.2M relates to revenue phasing which will balance out by year end). Financial Income $1.6M unfavourable driven by term deposit rates lower than budgeted rates. Inter DHB revenue $1.9M unfavourable primarily reflecting budgeted targets for additional IDF funding not fully achieved Total expenditure is $19.9M (1.7%) unfavourable, with the key variances as follows: Personnel/Outsourced Personnel costs $8.1M (1.1%) unfavourable reflecting total FTE 197 (2.4%) above budget due to FTE savings targets incorporated into the budget, partially offset by lower cost per FTE (reflecting reductions in overtime and other premium payments). Clinical Supplies $6.1M (2.9%) unfavourable, comprising the following key variances: o Haemophilia blood products $2.1M favourable due to low product usage year to date (highly variable), offset by reduced income. o PCT (cancer) drugs $2.0M unfavourable due to increased volumes of Herceptin and melanoma drugs combined with unbudgeted new high cost drug Pertuzumab (note partially offset by additional revenue of $1.1M year to date, will be subject to full washup at year end and be bottom line neutral in Provider Arm). o Cardiovascular $0.8M unfavourable reflecting volume growth over the same period last year for both Cardiology and Cardiothoracic (total WIES up 5.2% on last year), combined with a small number of patients with very high blood costs. o One off costs for loss on disposal of assets $1.6M. o Savings targets for procurement and logistics not fully achieved $2.7M unfavourable. Outsourced Clinical Services $2.0M (9.7%) favourable, reflecting no Orthopaedic elective surgery outsourcing for year to date ($3.9M favourable but this is offset by an unfavourable Orthopaedics elective revenue position), and this is offset by costs of additional outsourcing in Ophthalmology to address waitlist $1.0M unfavourable, and for MRIs to meet MOH targets $0.6M unfavourable. Infrastructure & Non Clinical Supplies $6.6M (4.3%) unfavourable, with the main variance being unfavourable facilities costs due to additional health and safety related expenditure ($4.6M). Other key variances are Bad/Doubtful debts $0.5M unfavourable (in line with higher than budgeted non resident income), and project costs for Advance Care Planning $0.8M unfavourable (offset by additional revenue). FTE Total FTE (including outsourced) for April month were 8,628 which is 295 FTE above budget. The unfavourable variance predominantly reflects FTE targets incorporated into the budget this is partially offset by lower cost per FTE (reflecting reductions in overtime and other premium payments). April month FTE is a decrease of 48 from March, with the decrease spread across Allied Health, Support and Administration. Hospital Advisory Committee Meeting 7 June

162 2016/17 Savings Programme Significant steps have been taken to reduce costs at Auckland DHB over the past four years, underpinned by a comprehensive savings programme. Living within our means is core to sustaining our services and for 2016/17 our savings programme continues with a Provider target of $37.35M and the key priority being to deliver services in a cost efficient and productive manner. Key Strategies For 2016/17, the $37.35M savings have been targeted within one of three key strategies Managing cost growth, Purchasing/Productivity Improvement and Service Reconfiguration. Table 1: Provider 16/17 Savings Target ($000 s) Strategy Revenue Personnel Clinical Supp. Infrastructure Total Managing Cost Growth 2,000 19,098 4, ,263 Purchasing/Productivity 1,425 3,091 1,271 1,300 7,287 Service Reconfiguration 580 3,220 3,800 Grand Total $4,005 $25,409 $5,844 $1,300 $37,350 Year to Date Result 10 months to April 2017 For the ten months to April, the Provider arm reported $14.7M savings against the budget of $31.1M, resulting in an unfavourable variance of $16.4M. These savings relate mainly to personnel, bed management, productivity gains and supply chain. The total savings also includes unbudgeted savings (offsets) of $4.2M. Unlike previous years, the offsets have not been at levels to reduce the overall unfavourable position. The year to date savings position continues to reflect the challenges in progressing work-streams to implementation which together with service demand pressures has resulted in some initiatives not delivering bottom line savings. Table 2: Savings Update 10 months to April 2017 ($000 s) Strategic Initiative Category Y/e F'cast Target Act. Bud. Var. Managing Cost Growth Revenue 413 2, ,667-1,379 Personnel 9,083 19,098 8,642 15,915-7,272 Outsourced Services Clinical Supplies 1,416 4,573 1,268 3,811-2,543 Infrastructure Managing Cost Growth Total $11,928 $26,263 $11,125 $21,885 -$10,760 Purchasing/Productivity Improvement Revenue 561 1, , Personnel 1,095 3, ,576-1,755 Outsourced Services 500 1, , Clinical Supplies 807 1, , Infrastructure Purchasing/Productivity Improvement Total $3,162 $7,287 $2,502 $6,073 -$3,570 Service reconfiguration Revenue Personnel 1,143 3, ,683-1,781 Service reconfiguration Total $1,419 $3,800 $1,040 $3,167 -$2,127 Grand Total $16,509 $37,350 $14,668 $31,125 -$16,457 Hospital Advisory Committee Meeting 7 June

163 Category of Savings Personnel-related initiatives of $10.4M (70%) continue to be the main source of savings of the total $14.7M reported savings. The balance is made up of Clinical Supplies $2.2M (15%), Outsourced services $0.8M (6%), Revenue $0.7M (5%), and infrastructure $0.6M (4%) Table 3 Category of savings Offsets The Provider arm unbudgeted savings of $4,159k are offset to mitigate unfavourable variances. These are mainly in Personnel ($2,108k, 51%), Outsourced Services ($1,128, 27%), Clinical Supplies ($371k, 9%) and Revenue ($553k, 13%). Key Points by Programme The Provider Arm 16/17 savings programme covers fifteen key work-streams and although some have no reported savings, the overall programme is being progressed. Some directorates have reported unbudgeted savings ($4,159k) to help offset other unfavourable initiatives but this has not been sufficient to reduce the year to date unfavourable position. Hospital Advisory Committee Meeting 7 June

164 Table 3: Summary of Savings by Programme / Directorate 10 months to April 2017 ($000 s) Hospital Advisory Committee Meeting 7 June

165 Volume Performance 1) Combined DRG and Non-DRG Activity (All DHBs) 5.14 April 2017 YTD (10 months ending Apr-17) $000s $000s Directorate Service Cont Act Var Prog % Cont Act Var Prog % Ambulatory Services (168) 82.0% 9,847 9,210 (637) 93.5% Adult Community Community Services 2,038 1,298 (740) 63.7% 20,817 16,288 (4,529) 78.2% & LTC Diabetes (29) 93.6% 4,590 4, % Palliative Care % % Reablement Services 2,035 2,003 (32) 98.4% 20,107 19,359 (748) 96.3% Sexual Health (33) 91.9% 4,149 4, % Adult Community & LTC Total 5,906 4,904 (1,002) 83.0% 59,899 54,442 (5,457) 90.9% AED, APU, DCCM, Air Adult Medical Ambulance Services Gen Med, Gastro, Resp, Neuro, ID, Renal Adult Medical Services Total 1,940 2, % 20,376 21,571 1, % 9,903 9,588 (314) 96.8% 107, ,399 (840) 99.2% 11,842 11, % 127, , % Surgical Services Gen Surg, Trauma, Ophth, GCC, PAS 7,687 7,555 (132) 98.3% 82,391 82, % N Surg, Oral, ORL, Transpl, Uro 7,962 8, % 87,515 90,346 2, % Orthopaedics Adult 4,909 4,135 (773) 84.2% 46,539 38,993 (7,546) 83.8% Surgical Services Total 20,557 20,025 (533) 97.4% 216, ,898 (4,547) 97.9% Cancer & Blood Services Cardiovascular Services 7,804 7,118 (686) 91.2% 79,072 78,733 (339) 99.6% 9,088 10,194 1, % 106, ,075 3, % Child Health & Disability (56) 94.0% 9,373 9,196 (177) 98.1% Children's Health Medical & Community 5,858 4,611 (1,247) 78.7% 63,581 62,780 (802) 98.7% Paediatric Cardiac & ICU 4,803 4,439 (364) 92.4% 46,042 45,093 (949) 97.9% Surgical & Community 4,161 4, % 45,027 42,447 (2,580) 94.3% Children's Health Total 15,756 14,347 (1,410) 91.1% 164, ,516 (4,508) 97.3% Clinical Support Services Non-Clinical Support DHB Funds Perioperative Services Public Health Services Support Services 3,084 2,994 (90) 97.1% 31,304 32, % % % 6,178 6,178 (0) 100.0% 61,783 61,782 (1) 100.0% % % % 1,295 1, % % 1,013 1, % Genetics (35) 86.2% 2,583 2, % Women's Health Women's Health 6,292 6, % 66,644 70,333 3, % Women's Health Total 6,544 6, % 69,227 72,955 3, % Grand Total 87,016 84,459 (2,557) 97.1% 918, ,196 (6,581) 99.3% Hospital Advisory Committee Meeting 7 June

166 2) Total Discharges for the YTD (10 Months to April 2017) Cases Subject to WIES Payment Inpatient All Discharges Same Day discharges Same Day as % of all discharges Directorate Service Last YTD This YTD % Change Last YTD This YTD Last YTD This YTD A+ Links, HOP, Rehab 0 0 1,771 0 (100.0%) % 0.0% Adult Community & LTC Ambulatory Services 1,382 1,578 1,695 1, % 1,587 1, % 95.3% Reablement Services , % % 2.5% Adult Community & LTC Total 1,382 1,578 3,467 3, % 1,595 1, % 49.4% AED, APU, DCCM, Air Ambulance 10,436 11,575 10,440 11, % 7,523 8, % 71.7% Adult Medical Services Gen Med, Gastro, Resp, Neuro, ID, Renal 16,365 16,145 16,530 16,349 (1.1%) 2,965 2, % 17.2% Adult Medical Services Total 26,801 27,720 26,970 27, % 10,488 11, % 0.0% Cancer & Blood Total 4,136 4,168 4,481 4, % 2,243 2, % 53.0% Cardiovascular Services Total 6,937 7,077 7,190 7, % 1,786 1, % 24.1% Medical & Community 12,369 11,350 13,428 12,443 (7.3%) 7,704 7, % 58.5% Children's Health Paediatric Cardiac & 1,826 1,851 1,980 1, % % 20.8% Surgical & Community 7,588 7,463 8,066 7,954 (1.4%) 3,785 3, % 46.5% Children's Health Total 21,783 20,665 23,474 22,391 (4.6%) 11,905 11, % 50.9% Gen Surg, Trauma, Ophth, GCC, PAS 14,910 15,205 17,352 17,200 (0.9%) 9,860 9, % 55.9% Surgical Services N Surg, Oral, ORL, Transpl, Uro 9,328 9,613 9,922 10, % 3,869 4, % 39.2% Orthopaedics Adult 4,115 4,096 4,370 4,265 (2.4%) % 0.0% Surgical Services Total 28,353 28,915 31,644 31, % 13,729 13, % 43.0% Women's Health Total 17,559 18, % % 0.0% Grand Total 106, ,385 97,226 97, % 41,746 42, % 43.2% Hospital Advisory Committee Meeting 7 June

167 3) Caseweight Activity for the YTD (10 Months to April 2017 (All DHBs)) Directorate Service Con Act Var Con Act Var Prog % Con Act Var Con Act Var Prog % Con Act Var Con Act Var Prog % Adult Community & LTC Adult Medical Services AED, APU, DCCM, Air Ambulance Gen Med, Gastro, Resp, Neuro, ID, Renal Adult Medical Services Total Acute Elective Total Case Weighted Volume $000s Case Weighted Volume $000s Case Weighted Volume (13) 3,309 3,248 (61) 98.2% (6) (30) 93.2% (19) 3,758 3,667 (91) 97.6% 2,905 3, ,014 15,239 1, % % 2,905 3, ,014 15,239 1, % 14,790 14,754 (36) 71,359 71,185 (174) 99.8% 5 0 (5) 26 0 (26) 0.0% 14,796 14,754 (42) 71,385 71,185 (201) 99.7% 17,695 17, ,372 86,424 1, % 5 0 (5) 26 0 (26) 0.0% 17,700 17, ,399 86,424 1, % $000s 5.14 Gen Surg, Trauma, Ophth, GCC, PAS Surgical Services N Surg, Oral, ORL, Transpl, Uro Orthopaedics Adult Surgical Services Total Cancer & Blood Services Cardiovascular Services Medical & Community Children's Paediatric Cardiac Health & ICU Surgical & Community Children's Health Total Women's Health Services Grand Total Excludes caseweight Provision 7,527 7, ,317 36, % 6,343 6,154 (189) 30,601 29,691 (910) 97.0% 13,870 13,751 (119) 66,918 66,342 (575) 99.1% 7,072 7, ,119 36,905 2, % 5,786 5, ,917 28, % 12,858 13, ,036 65,102 3, % 4,809 4, ,203 24, % 4,138 2,456 (1,682) 19,967 11,850 (8,117) 59.3% 8,948 7,436 (1,512) 43,170 35,876 (7,294) 83.1% 19,408 20, ,639 97,584 3, % 16,267 14,454 (1,813) 78,485 69,737 (8,748) 88.9% 35,676 34,680 (996) 172, ,320 (4,803) 97.2% 5,026 4,953 (74) 24,251 23,896 (355) 98.5% % 5,026 4,953 (74) 24,251 23,896 (355) 98.5% 11,683 12, ,365 59,329 2, % 8,346 8, ,268 40, % 20,029 20, ,633 99,646 3, % 8,866 9, ,774 44,007 1, % % 8,866 9, ,774 44,012 1, % 4,965 4,877 (89) 23,956 23,529 (427) 98.2% 2,077 1,899 (178) 10,021 9,160 (861) 91.4% 7,042 6,775 (267) 33,977 32,689 (1,288) 96.2% 4,588 4,204 (384) 22,136 20,284 (1,852) 91.6% 3,635 3,503 (132) 17,539 16,903 (636) 96.4% 8,223 7,708 (516) 39,675 37,186 (2,488) 93.7% 18,419 18,202 (217) 88,866 87,819 (1,047) 98.8% 5,712 5,403 (309) 27,560 26,069 (1,491) 94.6% 24,131 23,605 (526) 116, ,888 (2,538) 97.8% 8,349 8, ,281 42,390 2, % 1,635 1, ,889 8, % 9,984 10, ,169 51,104 2, % 81,266 83,050 1, , ,690 8, % 32,060 30,107 (1,953) 154, ,255 (9,422) 93.9% 113, ,157 (169) 546, ,944 (815) 99.9% Hospital Advisory Committee Meeting 7 June

168 Acute Services Performance to contract has continued to rise. This appears to be due to a greater number of high WIES cases than the previous year and the impact of the WIES version changes between years. Discharges over 20 WIES have increased by 11%, representing 952 more WIES than last year for this cohort. Key points by service type: There has been a gradual easing of medical demand compared to last year, with February and April being lower than the previous year. However, the number of high WIES cases is up significantly, with a 19% increase in discharges equating to a 45% increase in total WIES. Acute surgical demand has not increased over the past two months, leading to a slight reduction in total WIES (as the average WIES has dropped). Year to date demand is sitting at about 2% higher than last year. Obstetric discharges have declined slightly but still 104% higher than last year. Birth numbers have been on the same period as last year every month except for February and April which have shown big drops reflecting the high level of variability in this area. Neonatal discharges have increased, as expected due to the higher number of births. Neonates tend to be discharged after obstetric discharges and as such are even more unpredictable. There has also been an increase in the average WIES over the period. Elective Services There has been an increase in elective activity compared to contract over the last two months, with performance to contract up by 0.5%. Year on year, the discharge numbers are up by 2%, but the average WIES is down 1.5%. The impact of this is mostly in Child Health and Adult Surgical services, with both of these directorates having a lower WIES profile of over 2%. Of note has been the increase in outsourcing, particularly in Adult Surgical. April reporting is understated as coding is not complete and there are likely more outsourced cases that will need to be updated into the system. Hospital Advisory Committee Meeting 7 June

169 4) Non-DRG Activity (ALL DHBs) April 2017 YTD (10 months ending Apr-17) $000s $000s Directorate Service Cont Act Var Prog % Cont Act Var Prog % Adult Community & LTC Adult Community & LTC Total Ambulatory Services (152) 74.3% 6,088 5,543 (545) 91.0% Community Services 2,038 1,298 (740) 63.7% 20,817 16,288 (4,529) 78.2% Diabetes (29) 93.6% 4,590 4, % Palliative Care % % Reablement Services 2,035 2,003 (32) 98.4% 20,107 19,359 (748) 96.3% Sexual Health (33) 91.9% 4,149 4, % AED, APU, DCCM, Air Adult Medical Ambulance Services Gen Med, Gastro, Resp, Neuro, ID, Renal Adult Medical Services Total 5,565 4,578 (986) 82.3% 56,141 50,775 (5,366) 90.4% (6) 99.1% 6,363 6,331 (31) 99.5% 3,436 3,155 (281) 91.8% 35,855 35,215 (640) 98.2% 4,085 3,798 (287) 93.0% 42,217 41,546 (671) 98.4% Surgical Services Gen Surg, Trauma, Ophth, GCC, PAS 1,506 1,297 (209) 86.1% 15,474 16, % N Surg, Oral, ORL, Transpl, Uro 2,507 2,317 (190) 92.4% 25,479 25,244 (235) 99.1% Orthopaedics Adult (29) 91.3% 3,369 3,117 (252) 92.5% Surgical Services Total 4,342 3,914 (427) 90.2% 44,322 44, % Cancer & Blood Services Cardiovascular Services 5,364 4,799 (565) 89.5% 54,821 54, % 1, (27) 97.3% 10,208 10, % Child Health & Disability (56) 94.0% 9,373 9,196 (177) 98.1% Children's Health Medical & Community 2,057 1,677 (380) 81.5% 20,807 18,767 (2,039) 90.2% Paediatric Cardiac & ICU 1,198 1, % 12,066 12, % Surgical & Community (46) 91.1% 5,352 5,261 (91) 98.3% Children's Health Total 4,711 4,237 (473) 89.9% 47,598 45,628 (1,970) 95.9% Clinical Support Services Non-Clinical Support DHB Funds Perioperative Services Public Health Services Support Services 3,084 2,994 (90) 97.1% 31,304 32, % % % 6,178 6,178 (0) 100.0% 61,783 61,782 (1) 100.0% % % % 1,295 1, % % 1,013 1, % Genetics (35) 86.2% 2,583 2, % Women's Health Women's Health 1,806 1,629 (177) 90.2% 18,474 19, % Women's Health Total 2,059 1,846 (212) 89.7% 21,057 21, % Grand Total 36,650 33,581 (3,069) 91.6% 372, ,251 (5,766) 98.5% 5.14 The non DRG performance to contract has dropped in April which was 92% of contract. This is probably due to the number of holidays in the month which had a greater impact than anticipated on the phasing. Hospital Advisory Committee Meeting 7 June

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171 INPATIENT EXPERIENCE SURVEY 01: March 2017 IN FOCUS Our patient experience surveys allow us insight into what patients say make the most difference to their care and treatment. We can also use their responses to understand the dimensions where making improvements would have the most positive impact on patient experience. For this report, we have conducted a driver analysis to help us understand the areas most highly correlated to an excellent experience and where patients tell us there is some room for improvement. These dimensions are: consistent and coordinated care; coordination between home, hospital and other services and, information. OVERALL RESULTS HOW DO WE RATE? (APR MAR 2017) Excellent Very good Good Fair (n=4358) 3% 2% 9% 50% Rate us Excellent 36% 50% Poor DIMENSIONS Communication (clear answers I could understand) Confidence about the quality of care & treatment Getting consistent and coordinated care while in hospital Getting good information Being treated with dignity and respect Being involved in decisions about health and care Cleanliness and hygiene Managing pain Co-ordination between hospital, home & services Allowing whānau, family and friends to support Food and dietary needs OUR MAORI PATIENTS SAY... We aim to have 90% of patients rating their overall care as either very good or excellent. OVERALL CARE RATINGS APR MAR 2017 The dimensions of care are ordered according to what matters most to our inpatients. Poor (0-4) Moderate (5-7) Very good (8-10) The three dimensions that matter most to Māori inpatients are Communication Confidence in care matters to 54% of Māori respondents matters to 40% of Māori respondents rate our performance rate our performance 76% as very good 87% as very good This month s report looks at the three dimensions where improvement would make the most difference for patient experience Very good/excellent 55 % matters 51% 46% 38% 38% 36% 23% 16% 15% 13% 8% 7% Dignity and respect matters to 39% of Māori respondents 84% % Average Poor/Fair 82 (n=4358) 85 86% Average rate our performance as very good (n=387) OUR NEW LOOK REPORT We have redesigned our patient experience reports with the assistance of ADHB clinical, managerial and communications staff to make them easier to read and action. Overall reports will be interspersed with directorate-level reporting with data by directorate, and actions that are specific to them. REPORT KEYS Each graph in the report is colour coded. Green indicates where we are doing well, and gold and orange indicate where there is room for improvement. YEAR ON YEAR DIFFERENCES All information in this report has been compared with data from the same period last year (01 April March 2016). Any statistically significant differences (<p.05) are noted. FEEDBACK If you have any feedback on this new look reporting, or you have something you wish to see included, please contact: Sarah Devine SarahD@adhb.govt.nz or Jing Yin jingy@adhb.govt.nz What matters to you? Ask what matters Listen to what matters Do what matters Page 1 of

172 01: CONSISTENT AND COORDINATED CARE 01 April March 2017 AT A GLANCE HOW DO WE RATE? 7% 76% 18% Consistent and coordinated care is about providing patients with seamless care and great teamwork whilst they are in hospital. CONSISTENT AND COORDINATED CARE MATTERS 38% of patients tell us that consistent and coordinated care is one of the three things that matter most to their care and treatment. (n=1627) Very good (8-10) Moderate (5-7) Poor (0-4) Consistent care is strongly correlated to overall ratings (.601). If we can give more patients a very good experience in terms of consistent care then we should see an associated rise in overall ratings. AVERAGE RATING OVER LAST FOUR QUARTERS 8.3 Apr - Jun Jul - Sep Oct - Dec Jan - March 2016 (n=1627) 8.2 KEY AREAS CONFLICTING INFORMATION 72% 22% 5% Never Sometimes Often (n=4354) Staff always gave consistent information. Sometimes or often a staff member would say one thing and another would say something quite different. All the staff seemed prepared and knew exactly what would happen next. There was no conflicting information given. Everyone had a role in the process and they all seemed to work together. Different view points in care and treatment being expressed by different! medical teams resulting in the need to seek repeated clarification. p *Other staff: staff such as physiotherapists, radiographers, occupational therapists or dietitians. HOW WELL STAFF WORK TOGETHER We asked patients to rate how well staff worked together. 43% 41% 39% 40% 12% 13% Doctors and Nurses/ Midwives Other staff with healthcare team p Excellent Very good Good Fair (Doctors, Nurses and Midwives n=4294; Other staff n=2513) 3 points The ratings for other staff* have increased by three percentage points since the same period last year.! Each change of nursing staff, doctors visits, surgeons all seemed to understand exactly what my situation was and how to approach each stage of my recovery. I never felt I was left out of those decisions and everything was explained when I asked. Often I d request something eg help, info, pain relief and then I would be told to wait a second as staff were changing shift then be completely forgotten about or unaddressed by next staff on shift or have to completely repeat the request. Poor ACTIONS More than 1133 patients commented on consistent and coordinated care between April 2016 and March OUR PATIENTS APPRECIATE IT WHEN... There is good communication between staff, teams and departments, particularly regarding medication. prescribed, and any other care and treatment decisions Healthcare practitioners involved in the patient s care appear informed about their case and that information is consistent with other members of the healthcare team. The information given to patients about what is happening, why it is happening and, most importantly, when, is consistent and timely. Handovers are coordinated and staff appear organised. Any requests or questions that they have not been responded to are noted and followed up.? HOW MIGHT WE... Communicate with each other to ensure patients get consistent information about their care and treatment? Ensure clinical records are clear and that every staff member is working with the same information? Support great communication between our staff, and patients and their families particularly at handover or other critical transitional periods? Take action to avoid patients experiencing long and unexplained waits? Page 2 of 4 164

173 02: COORDINATION BETWEEN HOME, HOSPITAL AND OTHER SERVICES 01 April March % 6points AT A GLANCE HOW DO WE RATE? Very good (8-10) Moderate (5-7) Poor (0-4) 23% 55% (n=542) The number of patients who rate coordination as poor has increased by six percentage points since March 2015! Service integration, and the experience of seamless integrated services before and after discharge, is a key strategic theme for Auckland DHB. COORDINATION MATTERS TO ONE IN TEN INPATIENTS AVERAGE RATING OVER LAST FOUR QUARTERS 6.9 Apr - Jun Jul - Sep 2016 Despite only one in 10 patients indicating that coordinated care matters, its strong correlation (.519) to overall ratings means that improving our performance around coordinated care has the potential to make the biggest impact to our patients overall experience. 7.1 Oct - Dec Jan - March (n=542) 6.1 KEY AREAS PREPARATION FOR LEAVING HOSPITAL One in ten inpatients say they leave hospital without information on what they should or should not do, and/or they have not been told the danger signals to watch out for and/ or have no one to contact if they are worried. p 10% 33% 57% (n=4269) I received a note from my GP within days of discharge. That note contained references to shared care arrangements. I was impressed with the timeframe in which the discharge summary was received by my GP. I was also briefed and given a copy of the discharge summary before I left the hospital. I knew what it contained, the next steps in my care and who to contact if I needed to Our patients tell us we do a better job of coordinating their care prior to their arrival in hospital than we do after they leave! RATING COORDINATION OF CARE BEFORE COMING TO HOSPITAL 36% 35% 17% RATING COORDINATION OF CARE AFTER DISCHARGE 29% 31% 21% Excellent Very good Good Fair 7% 5% (n=4299) 10% 8% (n=2997) Poor I was released to go home but over a period of 2 weeks recovering I still felt quite ill to find out Im back in hospital for the same thing... so to me I feel like I was discharged when I wasn t fully well and there were no info given to me with plans of how to manage it etc just one week of antibiotics, get [a clinic] appointment in 6 weeks etc. ACTIONS More than 417 patients commented on coordination between home, hospital and other services between April 2016 and March Nearly half of these were negative. OUR PATIENTS APPRECIATE IT WHEN... They are expected at hospital and everything is ready for them There is follow up after discharge between hospital, GP, and other services like district nurses and occupational therapists They get good information about what to do at home, what to expect, who to contact Information is shared between services and is wellcoordinated Appointment scheduling processes are efficient and coordinated with other services Their discharge process is good and they are well prepared for leaving hospital The preadmission and discharge processes are clearly described in any communication HOW MIGHT WE... Involve patients in discharge plans to ensure that these work for them and are suitable for their needs? Ensure information given about other services is accurate and that discharge plans can be met? Work with other DHBs, GPs, LMCs and ACC to ensure good communication between services especially after discharge? Avoid miscommunications about appointments? Find out? from the patient what their needs are that might impact or influence appointment scheduling? Proactively ensure patients have enough information to confidently manage their condition at home? Page 3 of 4 165

174 03: INFORMATION 01 April March 2017 AT A GLANCE HOW DO WE RATE? Very good (8-10) Moderate (5-7) Poor (0-4) 73% 7% 20% (n=1639) There is a strong correlation between information and overall ratings (.530). Even a small improvement in information can make a difference to patients overall experience. Provision of information is an important part of enabling patients and their families to understand their condition and make informed decisions about their care. INFORMATION MATTERS TO FOUR IN TEN INPATIENTS 38% AVERAGE RATING OVER LAST FOUR QUARTERS Apr - Jun 2016 Jul - Sep 2016 of patients tell us that getting good information is one of the three things that matter most to their care and treatment. 7.9 Oct - Dec Jan - March (n=1639) KEY AREAS p Doctor was clear why they were doing different tests. And advised me to write down any questions I might have as I thought of them during the week so I could ask them when I saw the doctor next THE RIGHT AMOUNT OF INFORMATION (n=4307) 87% 13% We asked patients about the amount of information given to them about their care and treatment It would have been useful to have been given some written information Most got the right amount.! about the injury and surgery required, especially whats involved in the About one in every eight say they didn t get enough information Very few (28 respondents or 0.7%) told us they received too much information p! Ward rounds and individual nurse contacts gave clear and helpful information throught my hospital stay. Printed information brochures in the patient pack excellent - immediately informative, great graphics, and easy to refer back to as treatment proceeds surgery, how long it will take, how simple or complicated it is, how long it would take to recover. Alternatively, a link to a website that addresses the above. I don t know how to cope or what my next step was. I didn t feel I was told anything and wasn t given information about my condition what I could expect in the future what was actually happening how to deal with it emotional physically and mentally. Why was my blood pressure high? Was I going to die? ACTIONS More than 1287 patients commented on information between 01 April March 2017 OUR PATIENTS APPRECIATE IT WHEN... They are well prepared to leave hospital They are kept informed and know what to expect, what is happening next and have a time frame for when that will happen Good pre- and post-operative information is provided both verbally and in a written form Explanations are clear and jargon free There is time to ask questions and have them answered Clear information about their diagnosis, treatment and recovery options is given to them. HOW MIGHT WE... Keep patients up to date with what is happening for them? Ensure patients have all the information they need to feel confident about their care and treatment options? Check that we have answered all of our patient s questions and that they understand our answers? Make sure patients leave with good discharge information which includes what they should or should not do, danger signals to watch out for and a person to contact if they have any concerns? Ensure all patients understand their diagnosis and treatment options? Make sure that all staff give consistent information? Check if patients have received enough information to meet their needs? Page 4 of 4 166

175 OUTPATIENT EXPERIENCE SURVEY 01: March 2017 IN FOCUS Our patient experience surveys allow us insight into what patients say make the most difference to their care and treatment. We can also use their responses to understand the dimensions where making improvements would have the most positive impact on patient experience. For this report, we have conducted a driver analysis of the outpatients survey to help us understand the areas most highly correlated to an excellent experience and where patients tell us there is some room for improvement. These dimensions are: involvement in decisions; information and other services and confidence in care and treatment. OVERALL RESULTS We aim to have 90% of patients rating their overall care as either very good or excellent. MAIN REASON MET? OVERALL CARE RATINGS APR MAR 2017 We ask our outpatients if the main 89 reason they went to the clinic was dealt with to their satisfaction (n=7031) 83% 14% Eight out of 10 say it was Around one in six say it was to some extent 235 outpatients, or 3 percent, say that it was not dealt with DIMENSIONS Getting good information about care and treatment Organisation, appointments and correspondence Confidence about the quality of care & treatment Communication Being involved in decisions about health and care Being treated with respect (privacy, values, cultural needs) Co-ordination between the clinic and other services Cleanliness and hygiene Allowing whānau, family and friends to support The dimensions of care are ordered according to what matters most to our outpatients Poor (0-4) Very good/excellent 23 Moderate (5-7) Very good (8-10) % Average Poor/Fair 88% Average (n=7007) % matters 67% 54% 51% 30% 29% 23% 22% 10% 5% OUR NEW LOOK REPORT We have redesigned our patient experience reports with the assistance of ADHB clinical, managerial and communications staff to make them easier to read and action. Overall reports will be interspersed with directorate-level reporting with data by directorate, and actions that are specific to them. REPORT KEYS Each graph in the report is colour coded. Green indicates where we are doing well, and gold and orange indicate where there is room for improvement. YEAR ON YEAR DIFFERENCES All information in this report has been compared with data from the same period last year (01 April March 2016). Any statistically significant differences (<p.05) are noted. FEEDBACK If you have any feedback on this new look reporting, or you have something you wish to see included, please contact: Sarah Devine SarahD@adhb.govt.nz or Jing Yin jingy@adhb.govt.nz 6.1 OUR MAORI OUTPATIENTS SAY Information matters to 64% of Māori respondents rate our performance 70% as very good The three dimensions that matter most to Māori outpatients are... Organisation matters to 51% of Māori respondents 54% rate our performance as very good 81% Confidence matters to 43% of Māori respondents rate our performance as very good (n=387) What matters to you? Ask what matters Listen to what matters Do what matters Page 1 of 4 167

176 01: INVOLVEMENT IN DECISIONS 01 April March 2017 AT A GLANCE Involvement in decisions is a key part of becoming a more patient-centric health system one of our strategic themes at Auckland DHB. HOW DO WE RATE? 5% 80% 15% (n=1969) Very good (8-10) Moderate (5-7) Poor (0-4) There is a strong correlation between involvement in decisions and overall ratings (.625). Even a small improvement here can make a difference to patients overall experience. INVOLVEMENT IN DECISIONS MATTERS 29% AVERAGE RATING OVER LAST FOUR QUARTERS 8.3 Apr - Jun 2016 Jul - Sep 2016 of patients tell us that being involved in decision-making is one of the three things that matter most to their care and treatment Oct - Dec 2016 Jan - March 2016 (n=1627) 8.5 (n=6864) KEY AREAS BEING INVOLVED IN DECISIONS ABOUT CARE AND TREATMENT We asked our patients if they were as involved as they wanted to be in decisions about their care and treatment 77% 19% 4% p p Most say they were definitely involved! Around one in five say they were involved to some extent 268 outpatients, or 4 percent, say they were not involved at all! All the medical staff described what was happening to me and gave me options for my treatment/s. They discussed candidly and professionally what I was to expect and involved me in the decision making process Being treated as an intelligent person managing my condition [and] allowing me the dignity to understand my body and how it responds to infections and other down turns is very empowering. There was NO opportunity to have any discussion about my choices, this was made clear as NOT an option - that as a LAY person, I couldn t possible be involved. There was no discussion about what is available in the market or possible best choices, it was implied a one type fits all - and that I had no say in the matter! While the specialist was very nice and listened to me, he said that I had to make a decision right then at the consultation on whether or not to have the [operation] he was proposing to proceed with. He said that I couldn t think about it and get back to him. ACTIONS More than 1300 patients commented on involvement in decision-making between April 2016 and March OUR PATIENTS APPRECIATE IT WHEN... They are fully involved in decision making, are well informed and get good information, including information about what to do between appointments They feel empowered to make decisions, are in control and have their care plan modified with their feedback They are given choices and can discuss options with plenty of time and information to make a decision They are listened to They have opportunities to ask questions Their opinions and decisions are respected HOW MIGHT WE... Establish if patients feel they have been given enough options and choices? Ensure patients have enough time to make decisions? Communicate? in ways that show patients we respect their views? Ensure patients never feel excluded from decision making? Establish if patients have the information they need to make decisions, including getting test results in time for appointments and good information at discharge? Clarify that we have answered all the questions patients have? Page 2 of 4 168

177 02: INFORMATION 01 April March 2017 AT A GLANCE HOW DO WE RATE? Very good (8-10) Moderate (5-7) Poor (0-4) 6% Sharing good, complete and timely information with patients allows them to make informed decisions about their care and treatment INFORMATION MATTERS TO SEVEN IN TEN OUTPATIENTS 67% of outpatients tell us that getting good information is one of the three things that matter most to their care and treatment % 17% (n=4606) AVERAGE RATING OVER LAST FOUR QUARTERS Information is strongly correlated to overall ratings (.615). Improving information has the potential to impact overall ratings. Apr - Jun 2016 Jul - Sep 2016 Oct - Dec 2016 Jan - March 2016 (n=542) KEY AREAS AMOUNT OF INFORMATION We asked outpatients if they got enough information about their condition or treatment (n=6900) 88% of outpatients say they got the right amount 11% say they didn t get enough Only 34 out of 6900 respondents told us they received too much. INFORMATION FOR INFORMED CHOICES Do outpatients have the information they need to make informed choices? 74% 74% say they do (n=6841) 20% say they do, to some extent 5% say they don t. CLEAR ANSWERS 87% 89% 86% 11% 9% 12% Doctor or dentist Nurse or midwife Other healthcare staff* While most outpatients say that staff always answer their questions in a way they can understand, about one in eight say this happens sometimes or never (2%). *Other healthcare staff: staff such as physiotherapist, occupational therapist, optometrist, psychologist (Doctors/dentists n=5295; nurses/midwives n=1370=; other staff n=1375) TIMELY RESULTS Three out of 10 outpatients told us they received x-rays and test results in a timely manner always (70%) sometimes (24%) or never (6%) (n=6895) p! Anything I wanted to know was forthcoming... I feel that any professional I dealt with was well-informed and well-trained and educated in their field, explaining things in language I could understand. None of the people I saw had read all the information I sent in, including the pain questionnaire and all the specialist letters [so] I spent the whole appointment time telling them what was in the questionnaire and letters. Ran out of time for them to make any conclusions. ACTIONS Nearly 3500 patients commented on information between April 2016 and March Nearly two-thirds of these were positive. OUR PATIENTS APPRECIATE IT WHEN... We give them thorough and detailed information that is clear, concise and easy to understand, and check their understanding. Doctors give good explanations. Staff fully answer their questions and allow time for new questions that arise. Information is provided using different methods and media (information sheets, brochures, websites). They feel they are fully informed about what is happening during and after appointments. HOW MIGHT WE... Ensure patients are knowledgable and up to date about their care and treament? Check patients have sufficient information about their procedure and post-op care? Give consistent? information? Check patients feel listened to? Ensure we always give patients their test results? Keep patients better informed about administrative details including waiting times, appointments and time frames? Page 3 of 4 169

178 03: CONFIDENCE IN CARE AND TREATMENT 01 April March 2017 AT A GLANCE Confidence and trust is at the heart of the clinician-patient relationship. 2points HOW DO WE RATE? Very good (8-10) Moderate (5-7) Poor (0-4) 87% 4% 9% (n=3503) Very good ratings have increased by two percentage points since the same period last year. HAVING CONFIDENCE IN CARE MATTERS TO HALF OF OUTPATIENTS AVERAGE RATING OVER LAST FOUR QUARTERS p Apr - Jun 2016 Jul - Sep 2016 Although our patients ratings for confidence in care are relatively high, the strong correlation between confidence and overall ratings (.652) means even a slight improvement has the potential to positively impact overall ratings. Oct - Dec 2016 Jan - March (n=3503) KEY AREAS CONFIDENCE IN COMMUNICATION We asked patients if staff talked about tests, x-rays or procedures in ways they could understand 80% said yes, completely 17% said yes, to some extent 3% said they did not. We asked patients if staff explained options, side effects and benefits in ways they could understand. 80% said yes, they did 17% said yes, to some extent 3% said they did not. (n=5185) (n=5991) *Other healthcare staff: staff such as physiotherapist, occupational therapist, optometrist, psychologist AWARENESS OF MEDICAL HISTORY Nine out of 10 patients say that staff fully understood or knew enough about their medical history. Doctor or dentist Nurse or midwife Other healthcare staff* 56% 49% 51% 36% 42% 41% Fully understood Knew enough Knew little Knew nothing (Doctors/dentists n=5354; nurses/midwives n=1443=; other staff n=1459) OVERALL CONFIDENCE We asked patients if they had confidence in the staff treating them. Doctor or dentist Nurse or midwife Other healthcare staff* 87% 88% 85% 11% 10% 12% Always Sometimes No (Doctors/dentists n=5339; nurses/midwives n=1442=; other staff n=1448) p p! When [clinical staff] spoke to me it was evident that they were knowledgable about my past and present state of health and what was required by them and me to maintain it I was seen by a consultant who I have met before. She is familiar with my history and has specialised knowledge in my condition. She invoked great confidence. Treated as a number than a patient. Information given was rushed and not explained in a way I can understand. Too much jargon. Wasnt given options. Side effects etc were not explained. I was doing all the asking questions as nothing was expalined clearly ACTIONS More than 2300 patients commented on confidence and trust between 01 April March 2017 OUR PATIENTS APPRECIATE IT WHEN... We are confident, competent and thorough We give them good explanations and options Staff are friendly, caring and helpful, it makes them feel reassured They are listened to, have their questions answered and discussions are open, this makes them feel respected We double check their details, history and symptoms They see us working together well, and we are polite and professional They are kept informed HOW MIGHT WE... Clarify with patients that they have all the information they need, with clear and precise explanations? Make sure we are familiar with each patient s care, treatment or condition? Check that patients are happy with consultations processes and outcomes? Avoid interruptions during consultations. Build confidence by communicating better with other departments, services, GPs and DHBs? Ensure patients feel the consultation time has been spent constructively? Page 4 of 4 170