Quarter 2 Progress Report 20 January 2018

Transcription

1 Quarter 2 Progress Report 20 January 2018

2 Contents Introduction...3 Delivery of the New Zealand Health Strategy - Midland region highlights for the quarter...4 Areas self-assessed as not being on track (ie amber or red)...5 Cancer services Midland Cancer Network (MCN)...9 Cardiac services - Midland Cardiac Clinical Network (MCCN)...14 Child health services - Midland Child Health Action roup (CHA)...17 Elective services...20 Health of Older People (HOP)...22 Mental Health and Addiction Services (MH&A)...26 Midland Radiology Action roup (MRA)...31 Stroke services (Midland Stroke Network)...35 Trauma services - Midland Trauma System (MTS)...45 Regional strategic objectives...52 Objective 1: Health equity for Māori...52 Objective 2: Integrate across continuums of care - hepatitis C services...60 Objective 3: Improve quality across all regional services...66 Objective 4: Build the workforce...68 Objective 5: Improve clinical information services...71 Objective 6: Efficiently allocate public health system resources

3 Introduction This document provides a quarterly report of progress achieved as Midland District Health Boards (DHBs) work together to improve the health and wellbeing of the Midland populations and their experience with the New Zealand public health service. Agreed regional initiatives detailed in the Midland Regional Services Plan (RSP) form the basis for this progress report. Also contained in this report are a collection of feature articles; assisting with communicating how Midland DHBs are working together to achieve the region s strategic objectives: 1. Health equity for Māori 2. Integrate across continuums of care (to provide more timely effective care) 3. Improve quality across all regional services 4. Build the workforce 5. Improve clinical information systems, and 6. Efficiently allocate public health system resources. Feature articles include: - Cardiac services in Midland demonstrating an improvement towards equity for Māori in volumes per 10,000 cardiac procedures performed (page 14) - Healthy ageing working together regionally and nationally to support Advance Care Planning (page 22) - Midland trauma services - Hearty Hauora day with the mongrel mob (page 44), and Midland trauma incidence snapshots, including those identified as most at risk of trauma (page 49-51) - Hepatitis C regional service - Te Puia Springs Walk-In Fibroscan and chronic Hepatitis C Virus Assessment Clinic - taking the service to the people (page 60). The colour self-assessments in this report are an indication of progress against agreed regional initiatives to strengthen and improve health services, ie colour coding of green (on-track), orange (caution), red (in trouble) or blue (completed) is used. Importantly, the self-assessments should not be regarded as an indication of the quality, safety and effectiveness of the health services that Midland DHBs provide. Overall, we believe that the period from 1 October to 31 December 2017 has been valuable and the regional work is tracking to plan. OVERALL SELF ASSESSMENT (FOR SI2 MINISTRY OF HEALTH) MIDLAND S SIX REIONAL OBJECTIVES Cancer Services Mental Health & Addictions 1. Health equity for Māori Cardiac Services Radiology Services 2. Integrate across continuums of care regional Hepatitis C service Child Health Stroke Services 3. Improve quality across all regional services Elective Services 4. Build the workforce Trauma Services (MTS) Health of Older People A 5. Improve clinical information systems A 6. Efficiently allocate public health system resources: third party provider Audit & Assurance Service - regional internal audit service 3

4 Delivery of the New Zealand Health Strategy Midland region highlights for the quarter People-powered Closer to home Value and high performance One team Smart system Q1 Q2 Midland Trauma System Collaborating with WINTEC for patient and whānau experience study to understand people s needs, to help with design of services. Regional Internal Audit Service Identify where DHBs can improve the classification of patient events as ACC funded to help ensure all necessary health care for those patients is appropriately funded by ACC. Midland Trauma System Trauma Roadshow conducted in Rotorua detailing Lakes DHB trauma information. Members of the public and community groups were invited to come and participate in a day of trauma information sharing. Midland Radiology Action roup The operational Radiology Primary Access Criteria for each of the five Midland DHBs was mapped against the regionally agreed Minimum Clinical Access Criteria to provide a gap analysis across Midland DHBs. Discussions within the National Radiology Advisory roup (NRA) identified that where access is wider there are model of care reasons for this. It was found that although access varied across the Midland DHBs, it was usually with more rather than less access than the minimum clinical standard. Health of Older People Action roup Advance Care Planning (ACP) the ACP Facilitators from each of the Midland region now meet on a regular basis to share information and resources and work as a region on areas of common interest. Two Primary Health Organisations (PHOs) are now on board and attended the recent Midland Region ACP Facilitators meeting. Other PHOs will also be invited to attend. Regional Internal Audit Service Establish proactive monitoring and management of theatre waitlists within hospitals to ensure patient treatment is timely and fair to the highest scoring and longest waiting patients. People-powered Closer to home Value and high performance One team Smart system Midland Quality roup All Midland DHBs are actively involved in forming consumer councils and sharing best practice and processes. A discussion on a regional network to support these councils is underway. Midland Hepatitis C Service Working with community, ie needle exchange, eneral Practitioners, laboratory testing, etc. Taking the service to the people Te Puia Springs Hospital clinic was very well received (see Hep C report, page 60). Midland Cancer Network Midland Bowel Screening Regional Centre (Midland BSRC) The Midland BSRC Contract Agreement was signed on 1 September BSRC secondary clinical lead, primary care lead, and manager have been appointed. Quality project managers will commence in January and March 2018, and the equity project manager in January This will mean full recruitment of the team. Midland Child Health Action roup Toi Te Ora (Public Health) and partners (Heart Foundation and Bay of Plenty DHB Oral Health Promotion Service, and Healthy Families) have taken a collaborative approach to support schools in their region to remove sugar sweetened beverages. Work is also underway within some Midland DHBs to collaborate with their District Councils on wider implementation of policy initiatives. Midland Trauma System Midland DHBs collect Trauma data (majors and non-majors) and enter the data into the Trauma Registry. Analysis of the data for the 2016/17 fiscal year by MTS Hub staff has provided a Snapshot for each of the five Midland DHBs, covering trends since 2014 (see pages 49-51). The Snapshot includes information on volumes, process indicators, costs, and at risk (by incidence, gender, age and ethnicity). 4

5 Areas self-assessed as not being on track (ie amber or red) Area Midland Cancer Network (MCN) Faster Cancer Treatment (FCT) o Midland DHB melanoma self-assessments and data analysis completed by October 2017 o Establish a regional melanoma work group to review findings and develop regional report by December Midland Health of Older People Network (HOP) Strengthen the implementation of the New Zealand Dementia Framework: o Determine if Māori are being recognised as having problems with cognition at the same rate as non- Māori using InterRAI data, including the trigger rate of Dementia and Cognitive CAPs o Analyse and distribute the survey results. Identification and use of InterRAI data - determine if there is equity of assessment and access to Home and Community based support for Māori across the Midland region. New Zealand Healthy Ageing Strategy - identify regional initiatives from the Ministry of Health Implementation Plan. Frailty is a potential area of focus for the Midland region. Midland Trauma System (MTS) Improve the delivery of high quality care to trauma patients - define model of post injury rehabilitation care with locally based services and networks. Develop and maintain regional trauma infrastructure - complete mobile data collection trial (handheld). Midland Regional Quality Surgical site infection Action to be taken where results are below target. Medication safety Continue discussions on feasibility of achievement of medicines reconciliation by proposed HQSC date of 2016/17. Patient safety A A A A A A A A A Reason/Resolution Midland DHBs review against melanoma standards of service provision in NZ continues, but is behind timeline but isn t a critical issue/risk. The Melanoma draft report is to be tabled at the 15th March Midland Cancer Executive meeting. I. In November CentralTAS provided a preview of the new InterRAI visualisation tool. It was apparent that the tool would assist with determining if there is equity of assessment for Home Based and Community support services. The release of this tool in mid-december will allow the network to start work on these tasks. II. P Practice Dementia Pathway Survey - this task has yet to start. Work on completing the review of the Dementia Pathways is taking place earlier than planned and the time and resource for the survey are being used at this point on the pathways. It is anticipated that work on the survey will begin in Q3. (see note under I. above) Several initiatives have been discussed by the HOP Action roup during the process of preparing the HOP work plan, as part of the Midland Regional Services Planning. It is anticipated that the task of identifying initiatives for the 2018/19 year will be completed as part of this process. There has been minimal progress with discussions regarding regional trauma rehabilitation systems, as recommended by the Royal Australasian College of Surgeons (RACS) regional trauma verification review. This is to be reinvigorated in early This has not been completed due to staff change over and the addition of new priorities. Both Waikato (cardiac) and Lakes (orthopaedic) DHB are involved in the staph bundle collaborative. This will remain a standing item at the regional meetings. Dependant on espace programme and pharmacy resource. Severe concerns exist across the region with regard to the new QSM and the data collection that was due to start 1 January Existing manual collection and lack of resources makes this very difficult. C On Track Caution A In Trouble R 5

6 Area Regional Information Services: Digital Health 2020 Single Electronic Health Record (ehr) - primary care dataset o Lakes successful bilateral clinical access to primary/secondary CIS Digital Hospital: Lakes MedCheck BOPDHB to work with Lakes DHB to bring Lakes community pharmacy data into shared sub-regional Éclair CDR Lakes - capability across the Midland region has increased against assessment criteria elabs Orders continue local orders project based on regional results application. Initiative to utilise and align to regional. o Lakes ability to initiate and view orders electronically across Lakes and BOP Upgrade of Sub Regional PACS/RIS and implementation of view anywhere solution o Taranaki solution is current and enhanced functionality delivered Health and wellness dataset: Define and agree governance structure information governance is established across the Midland region HealthShare Align information standards across the Midland region for key datasets key datasets can be accessed across the Midland region enabling better information analysis HealthShare Preventative health IT capability: A A A A A Reason/Resolution Requirements gathering - potential scope overlap with espace Looking at incorporating into the espace programme Will now be completed within the espace programme Decision in regards to regional vs local solution pending and business case in development Not started yet HealthShare progressing through various projects Prepare for 2018 bowel screening rollout R o Waikato and Midland Bowel Screening Regional Centre (BSRC) o Lakes and Midland Bowel Screening Regional Centre (BSRC) A On hold as per MoH change to rollout approach. Preparing business case Regional IT foundations Midland Clinical Portal (espace Programme): Midland Clinical Portal Foundation Project (MCPFP) MCPFP live; clinician acceptance o BOP o Lakes o Taranaki A Following initial Midland Clinical Portal (MCP) go-live in August, access has been rolled out to all Waikato DHB clinicians as well as 1,500 clinical staff from Taranaki DHB and 435 clinicians from Bay of Plenty DHB. Planning for adding other users, including primary care and midwives, will continue to be rolled out in the New Year. C On Track Caution A In Trouble R 6

7 Area Midland Éclair Project (Regional Results) visibility of all regional Laboratory results within the regional repository from CWS within patient context; clinician acceptance o BOP transitioning BOP Éclair environment onto Midland Regional Platform o BOP, Lakes, Tairāwhiti, Taranaki, Waikato lab results (community and/or hospital) added to create regional repository o Lakes radiology reports for Lakes added to repository o BOP, Lakes, Taranaki, Waikato adoption of common results acknowledgement; electronic ordering Medications management emeds - including electronic prescribing and reconciliation o Taranaki eprescribing transition and upgrade MedChart onto Midland Regional Platform o BOP, Lakes, Tairāwhiti, Taranaki, Waikato to be scoped for eprescribe, edispense, ereconciliation and emanagement business case approved Regional IT foundations other: Telehealth o Waikato - actively progressing the rollout of Telehealth solution, inclusive of fixed Telehealth VC units and soft clients (Jabber); participation in the Stroke Thrombolysis Telehealth trial migration from Lync to Jabber aligned with regional direction. A A A Reason/Resolution Enhancements to MCP to improve system performance, stability and functionality are continuing. Lakes DHB have taken the lead in running an MCP end-to-end testing exercise which is still ongoing as at mid-december. As of December 2017, MCP contained 902,206 documents and information about: 518,787 patients, 371,630 emergency events, 422,996 inpatient events; and 1,659,610 outpatient events. Clinicians are reporting clinical and operational benefits arising from a regional view of patient information. A decision not to move the BOP hosted éclair on to the MRP has been made following a strong recommendation to implement a clean regional system that allows integration of Lab and Rad feeds of regional codesets. A new regional environment using Orion s Results software will be stood up in Q1, 2018 and initiation of integration into the development environment will commence. At this stage there is no intention to replace Sysmex/éclair. The intent is to build an Orion Results repository (led by clinicians), to test the concept of seamless visibility of clinical information across the Midland Clinical Portal, which will align with interoperability expectations of the Ministry of Health s Digital Health 2020 Strategy. This approach will use the existing licences of Orion s product suite purchased by the Region in On completion of this exercise, Orion and Sysmex will be evaluated against regional requirements (both clinical and technical) within the context of One Patient, One Record. Clinician expectation is that the solution will reduce the amount of duplication, improve the visibility of information and reduce the need to manually cut and paste data between standalone systems. Taranaki - Challenges with the New Zealand Universal List of Medicines (NZULM) transition but should be delivered early Planning for rollout of Medchart underway. The first phase of the Better Business Case Approach which delivered a strategic assessment was completed on time and under budget. A new Project Manager will join the espace team in late January and will implement Phase 2, as outlined in the Executive Brief, once one of two options has been decided: o o Option 1: completion of the BBC second stage. Option 2: Complete evaluation of regional requirements against Orion/MedChart licensed products and a produce a strategic roadmap, with an recommendation to establish a Proof of Concept environment for medicines functionality. Jabber delayed due to resource contention with higher priority initiatives. Targeted for full o Live in early 2018, with rollout to services commencing in late C On Track Caution A In Trouble R 7

8 Area Regional Information Services other ehealth business priorities: Maternity National Maternity Information System to commence once second adopter options released by national programme Reason/Resolution o BOP R Not progressing delayed while national issues sorted. o Lakes R Discovery almost complete. o Taranaki R Awaiting contact from Ministry of Health (MoH) around timeframes and way forward. o Waikato R Awaiting contact from MoH around timeframes and way forward. Nationally consistent electronic oral health record participation in MoH led programme o BOP o Taranaki National Immunisation Register (NIR) replacement support national initiatives and working groups where required o BOP, Lakes, Taranaki, Waikato Regional Internal Audit Service o Lakes DHB Internal Audit Plan R R A National RFP completed and no suitable option to move forward. Continuing with current Titanium product will be upgraded. Taranaki RFP completed and no suitable option to move forward. In process of planning a Titanium upgrade. No updates from MoH. Achievement of the 2017/18 programme is proceeding well. However, it is likely that one or two planned audits may not occur by year-end due to a lack of progress at the DHB or nationally with initiatives related to the audit topics. C On Track Caution A In Trouble R 8

9 Cancer Services Midland Cancer Network (MCN) Key feature article Kia Ora E Te Iwi community based health literacy programmes Two programmes were delivered in Tairāwhiti - one delivered on 23 November 2017 in Te Karaka, and one in Uawa on 12 October. Faster Cancer Treatment (FCT) The region achieved the FCT Health Target. Work has commenced on upgrade enhancement to the three DHBs Cancer Care System (CCS). The aim is to align the CCS with the Midland FCT breach analysis and reporting guideline. This should be completed in early Ministry of Health FCT Team Advisor and Clinical Champion as well as the psychosocial support service national and Midland regional leads visited Lakes DHB 14th November. In addition the National Clinical Lead CNCI Natalie James facilitated a FCT nursing workshop for cancer nurses. New alert system developed and testing has been done, awaiting support from the Lakes FCT work group. Ministry of Health FCT Team Advisor and Clinical Champion visited BOP DHB on 15 November. Waikato FCT Business Manager is working very closely with cancer care coordinators and clinical nurse specialists monitoring patient pathways from initial date of referral. the region was well represented at the National Cancer and Electives Forum held 2 and 3 November. Midland Cancer Multidisciplinary Meetings (MDM) ap Analysis ap analysis against future state business processes and data definitions completed. Options analysis and procurement plan underway. Midland MDM Service Improvement Plan sent to DHBs and MDM clinical chairs. Midland Bowel Screening Regional Centre (Midland BSRC) Midland BSRC Contract Agreement signed 1 September BSRC secondary clinical lead, primary care lead and manager appointed. Quality project managers to commence January and March and equity project manager in January This will mean full recruitment of the team. Chair: Humphrey Pullon Manager: Jan Smith Q1 Q2 Q3 Q4 1. Faster Cancer Treatment (FCT) 1.1 In partnership with DHBs coordinate a regional review of national melanoma standards (tbc) of service provision and identify key activities to address issues identified as a result of the regional review Undertake a stocktake of melanoma services and gap analysis against the national melanoma standards of service provision in New Zealand Midland DHB self-assessments and data analysis completed by October 2017 A A Establish a regional melanoma work group to review findings and develop regional report by A December In partnership with DHBs coordinate a regional review of national upper I standards (tbc) of service provision and identify key activities to address issues identified as a result of the regional review. Undertake a stocktake of upper I standards and gap analysis against the national colorectal standards of service provision in New Zealand Midland DHB self-assessments and data analysis completed by April 2018 Establish a regional upper I work group to review findings and develop regional report by June Continue to support DHBs to implement service improvements from previous regional reviews, i.e. gynae-oncology, colorectal, lung, breast lymphoma, sarcoma, myeloma 1.4 Continue the MCN-Waikato Faster Access to Cancer Services through a Staged Tumour Approach to Treatment Project Continue the MCN-Lakes FCT Service Improvement Project Continue the Midland Routes to Cancer Diagnosis and Treatment Project Continue the Midland Patient Information Resource Project 2016/ /18 C On Track Caution A In Trouble R 9

10 Chair: Humphrey Pullon Manager: Jan Smith 1.8 Continue to implement the Midland Psychological and Social Support Services Plan Q1 Q2 Q3 Q4 1.9 Support the delivery of one Kia Ora E Te Iwi community health literacy programme per DHB 1.10 Continue Lakes-Waikato medical oncology, radiation oncology and haematology model of service improvement project Support implementation of Lakes resident medical oncology service at Waikato 1.11 Support national cancer work programme i.e. phase 2 tumour work programme, national radiation oncology plan, CNCI (within available resources) 1.12 Regional work to support national Cancer Health Information Strategy Plan initiatives Continue the Midland multidisciplinary meetings (MDM) systems gap analysis project against business processes, systems requirements and data requirements (tbc) Midland radiation oncology plan and data extracts and reasons for possible variations National tumour standards core data and measurability work (tbc) 1.13 Scope and review implications of implementing the national Adolescent and Young Adult Cancer Patient in New Zealand including Standards of Care (note resource dependent) 1.14 Identify components of the national Early Detection of Lung Cancer uidance that can begin to be implemented (note resource dependent) 2. Improve Midland palliative care services 2.1 Update the Midland Specialist Palliative Care Service Development Plan following the National Adult Palliative Care Service review recommendations Support Midland Health of Older People work programme related to workforce development on palliative care and last days of life Support national palliative care work programme i.e. outcomes framework 2.2 Continue to support Midland to implement the Midland Medical Advanced Palliative Care Trainee Model of Service Continue to support implementation of Waikato Palliative Care Strategy Plan Support Lakes and BOP to develop local Palliative Care Strategy Plans 3. Midland bowel screening regional centre 3.1 Implement Midland bowel screening regional centre set up phase activities as directed by Ministry C of Health Agreement service specifications (to be signed by 30 June 2018) 3.2 Support Midland DHBs to plan and get ready for bowel screening roll out 4. Improved access to colonoscopy/endoscopy services 4.1 Evaluation of the regional direct access to colonoscopy ereferral is completed tbc 4.2 Implement any enhancements to the colonoscopy ereferral as required. 5. National lead for the lung cancer work programme Midland Cancer Network is working in partnership with the Ministry of Health Cancer team to finalise the national lung cancer work programme for 2017/ /19 on initiatives such as: implement and evaluate the national Early Detection of Lung Cancer uidance develop national standardised lung cancer key performance indicators develop nationally consistent information to be collated at lung cancer multidisciplinary meetings (MDM) aligning with National CHIS review and update the 2015 Standards of Service Provision for Lung Cancer Patients in New Zealand to the revised national tumour standards template develop nationally consistent Lung Cancer Standards Review methodology and template undertake a high level national benchmarking exercise to identify areas of variation to inform further enhancements to service delivery. Note: 2017/ /19 New Zealand lung cancer work programme to be determined and confirmed by Ministry of Health. Draft work plan sent to Ministry 12/12/16. C On Track Caution A In Trouble R 10

11 What we did in addition to what we said we would do Following the recommendations from the Cancer Nurse Coordinator Initiative (CNCI) Evaluation Report (Litmus) two CNCI/CNS work streams have been developed to enhance patient perceived communication and inter DHB transfer of care communication. Waikato DHB is to be the second New Zealand DHB to undertake online self-review against national Adolescent and Young Adults (AYA) standards of care and development of an improvement plan. This was facilitated by AYA Cancer Network in partnership with Midland Cancer Network. Adolescent and Young Adults (AYA), Acute Lymphoblastic Leukaemia service change proposal of a shared care model between Waikato DHB, Lakes, Tairāwhiti and Auckland, and Bay of Plenty and Auckland was discussed at a inter-regional workshop on 17 November The aim is to improve AYA outcomes and reduce inequalities. A proposal for change proposal will be developed early PET-CT the four regional cancer networks in partnership with PET-CT Variance Committee Chairs supported the Northern Cancer Network to facilitate a review of PET-CT including national clinical indicators. Currently there is no national body to undertake the 2014 recommendation. Midland Cancer Network has made recommendations to Midlands PET-CT Variance Committee and MDM clinical chairs, feedback on recommendations should occur early The aim is to have national consistency of clinical indicators and reporting. Midland Cancer Network and Midland Radiology Network have recommended adoption of the Northern Cancer Network cancer radiology pathways and protocols. Early 2018 the network will work with key stakeholders. The Midland Bowel Screening Regional Centre (Midland BSRC) facilitated a Midland regional bowel screening hui on 6 November The hui provided an opportunity to establish strong Māori and Pacific governance, explore strategies to increase participation for Māori and Pacific, and ways to establish strong regional and district level Māori and Pacific governance for bowel screening. Following the Ministry postponement of the Waikato DHB National Bowel Screening Programme (NBSP) roll out, linking to Waikato DHB challenges around meeting the Ministry of Health colonoscopy wait time indicators, the Midland BSRC Manager has been assisting Waikato DHB to focus on key areas to ensure readiness, in particular the resourcing required to open up a 4th endoscopy room. The Ministry have brought forward Lakes DHB NBSP roll out to September Prior to the appointment of the Lakes DHB bowel screening project manager, the Midland BSRC Manager has been assisting Lakes DHB in setting up their bowel screening governance including developing TOR, Lakes DHB NBSP project plan and related documents and setting up required bowel screening work streams. The Ministry announced (22 December 2017) a delay in the NBSP rollout, Hauora Tairāwhiti will be in 2019/20 and BOP, Taranaki and Waikato will be 2020/21. An implications paper has been requested by Midland CEs for early C On Track Caution A In Trouble R 11

12 Quantitative data Faster Cancer Treatment (FCT) Health Target Source: Midland FCT 2017/18 Q1 Ministry return file Note: 2017/18 Quarter 2 FCT data was not available at time of preparing this report C On Track Caution A In Trouble R 12

13 Colonoscopy Indicators Source: MoH DHB level colonoscopy reports, as at 23/11/17 Source: MoH DHB level colonoscopy reports, as at 23/11/17 Source: MoH DHB level colonoscopy reports, as at 23/11/17 C On Track Caution A In Trouble R 13

14 Cardiac Services - Midland Cardiac Clinical Network (MCCN) Key feature article There has been an improvement towards equity for Māori in volumes per 10,000 cardiac procedures performed. This is demonstrated in recently published annual standardised intervention rates (SIR) for cardiac procedures. These rates were updated with 2016 data published in June 2017 by the Ministry of Health. The exception in achieving SIR is with angioplasty, where both Māori and non-māori are below national rates. Region Ethnicity Midland Māori Trend over Time Selected Procedures Specialty Year End Māori Standardised Discharge Rate per 10,000 Māori change in Standard Intervention Rate (SIR) Māori Variance from National Target Discharge Rate per 10,000 or from National Average if no Target set Angiography 31 Dec Significantly above Angiography 31 Dec Not Significantly Different Angiography 31 Dec Not Significantly Different Angiography 31 Dec Not Significantly Different Angiography 31 Dec Not Significantly Different Angioplasty 31 Dec Significantly Below Angioplasty 31 Dec Significantly Below Angioplasty 31 Dec Significantly Below Angioplasty 31 Dec Significantly Below Angioplasty 31 Dec Significantly Below Coronary Artery Bypass rafting (CAB) 31 Dec Not Significantly Different Coronary Artery Bypass rafting (CAB) 31 Dec Not Significantly Different Coronary Artery Bypass rafting (CAB) 31 Dec Not Significantly Different Coronary Artery Bypass rafting (CAB) 31 Dec Not Significantly Different Coronary Artery Bypass rafting (CAB) 31 Dec Significantly above Revascularisation 31 Dec Significantly Below Revascularisation 31 Dec Significantly Below Revascularisation 31 Dec Significantly Below Revascularisation 31 Dec Significantly Below Revascularisation 31 Dec Not Significantly Different Cardiac Surgery + PCI 31 Dec Significantly Below Cardiac Surgery + PCI 31 Dec Significantly Below Cardiac Surgery + PCI 31 Dec Not Significantly Different Cardiac Surgery + PCI 31 Dec Not Significantly Different Cardiac Surgery + PCI 31 Dec Not Significantly Different Interventional Cardiology 31 Dec Not Significantly Different Interventional Cardiology 31 Dec Not Significantly Different Interventional Cardiology 31 Dec Not Significantly Different Interventional Cardiology 31 Dec Not Significantly Different Interventional Cardiology 31 Dec Significantly above Source: MOH SIR reporting C On Track Caution A In Trouble R 14

15 Key achievements National Expected Standards - gap analysis is underway for fields that are currently collected. Acute Coronary Syndrome (ACS) - an audit of three day angio fails in Key Performance Indicators (KPI) 1 for Tairāwhiti and Taranaki, has initiated Waikato to give consideration to extra resource on Thursdays and Fridays to clear the pre-weekend backlog of acute angiograms. The Cath Lab forecasting model is being trialled by Bay of Plenty (BOP). Waikato demand capacity modelling, based on the forecasting, confirmed the current 30 elective angiograms in Midland, being outsourced, are predictably short of capacity. STEMI (ST-Elevation Myocardial Infarction) - EC transmission issues have been resolved and a decision made for all out of hours STEMI to go to Waikato as BOP does not currently have the resources out of hours. A STEMI coordinator role is being defined. Primary prevention the Network recommends Midland District Health Boards consider implementing the BOP-Waikato Paediatric Outpatient (OP) module as a mechanism to count and track clinical presentation reasons, outcomes and demographics for cardiac OP clinic attendances and extend this to all sub-specialties. Waikato Population Health is undertaking an analysis of Atrial Fibrillation (AF) admissions and readmissions across the five Midland DHBs, as the largest cause of cardiac admissions and readmissions to hospital. Chair: Jonathan Tisch, Bay of Plenty DHB Manager: Philippa Edwards 1. Ischaemic Heart Disease Recommendations against National Expected Standards per Midland DHB Continuously improved ACS forecasting Standard Operating Procedures (SOP) and Variance Response Management Plans (VRMs) for Cardiac Services Documented understanding of how secondary prevention and rehabilitation will be delivered across the five Midland DHBs Achieve no inequality across ethnicity or residential location in Key Performance Indicators (KPIs) 2. Heart failure 16/17 stocktake of services and analysis of data will inform recommendations to meet the National Expected Standards per Midland DHB Document how heart failure services will ideally be delivered across the five Midland DHBs to improve outcomes for the worst affected groups now identified as Māori, low deprivation, male, ages Atrial fibrillation Undertake a stocktake of services Request analysis of data by population health to inform recommendations to meet the National Expected Standards per Midland DHB Document how atrial fibrillation services will ideally be delivered across the five Midland DHBs to improve outcomes for the worst affected groups once identified. 4. IS and IT projects Explore development of an outpatient coding system across the five DHBs aligning to coding standards and similar to the Bay of Plenty DHB paediatric system that is in place. This is required to understand what conditions patients are being referred to FSA for. In the context of Cardiology Chest Pain, Heart Failure, Arrhythmias espace Service Transformation: Cardiology; o ereferrals and shared service data sets o Electronic transfer of data between, ANZACSQI and DHB Clinical Work Station (CWS) fields Design a Regional ACS Whiteboard Live Management Tool Engage with National Patient Flow Out Patient (NPF OP) aspects to ensure coding of OP appointments will differentiate Ischemic Heart Disease (IHD), Heart Failure (HF) and Arrhythmias. This information with inform future service needs analyses Q1 Q2 Q3 Q4 C On Track Caution A In Trouble R 15

16 Jan Mar May July Aug Oct Dec Feb Apr June Aug Oct Jan Mar May July Aug Oct Dec Feb Apr June Aug Oct Jan Mar May July Aug Oct Dec Feb Apr June Aug Oct Jan Mar May July Aug Oct Dec Feb Apr June Aug Oct Jan Mar May July Aug Oct Dec Feb Apr June Aug Oct Percentage of patients What we did in addition to what we said we would do Cardiac Surgery Waikato Hospital Over the past six months work continues to effectively manage the cardiac surgery waitlist. All patients now on the waitlist meet the standard elective definition as fit, willing and able. There has been a reduction in the waitlist from 99 to 65 patients. This meets the MoH expectations for the Midland region. The current model has been changed where inpatients are given precedence over elective, than longer waiting patients. This has also resulted in a reduction in patients on the waiting list for a long period. A cancellation procedure is now in place and as such over the past three months, 205 cases have been completed with six cancellations which demonstrate a 2.9% cancellation rate. New data set in ANZACSQI for Cardiac Implantable Devices proposed by MoH and National Cardiac A business case is being developed by HealthShare on behalf of the Cardiac Network for Information System consideration in the 2018/19 budget, along with the other Regional Shared Services Agencies. Discussions between National Cardiac and the MoH considered this as a preferred way to seek regional funding rather than a business case to each DHB. Quantitative data MoH KPI - Registry Completion, October 2017 Monthly Report 110% 100% 100% 100% Midland DHB - Registry completion monthly report December 2017 against 95% target 100% 100% 96% 90% 80% 70% 92% 60% 50% 40% 56% 44% 61% 60% 30% 20% Bay of Plenty Lakes Tairāwhiti Taranaki Waikato Data source: ANZACS-QI, Ministry of Health dataset C On Track Caution A In Trouble R 16

17 Child Health - Midland Child Health Action roup (CHA) Key achievements A stocktake of current activity was undertaken for the broader implementation of the Sugar Sweetened Beverage (SSB) policy across the Midland DHBs. It identified a variance of initiatives across the region which included: The focus is on water, with some policies now being referred to, as either water and milk only or water-only policies rather than SSB Population Health are providing policy support on request by Early Childhood Education (ECE) centers Audits of ECEs and schools are either planned or have been completed to gauge water only policies with these organisations Toi Te Ora and partners (Heart Foundation and Bay of Plenty DHB Oral Health Promotion Service and Healthy Families) have taken a collaborative approach to support schools in their region to remove SSBs Work is underway within some DHBs to collaborate with District Councils on wider implementation of policy initiatives. CHA has begun discussions with eneral Managers Planning & Funding, and Population Health, to identify opportunities to align oral health initiatives across Midland including the System Level Measures that would improve oral health across the region. Planning for this will begin in Quarter 3. A report on the child/parent attachment project has been developed that demonstrates what is already in place, and what needs more work. The model of care document for the children s centre has a reference to continuing with this work. With the centre not opening until the end of November 2018 the evaluation of that work will take some time. Chair: David raham, Paediatrician, Waikato DHB Manager: Jane Hawkins-Jones 1. Childhood obesity and oral health NCHIP linked to oral health databases (where implemented) All DHBs will have access to an evidence based lifestyle programme for at risk children/families identified in the obesity pathway Childhood obesity care pathway (Map of Medicine) will be in use across the region Q1 Q2 Q3 Q4 Broader implementation of the SSB policy/position statement/plan of action. 2. Implementation of the Harti Hauora tool Formal evaluation of the secondary unit Harti Hauora tool is underway (subject to funding likely to be a three year process) Implementation of the Harti Hauora tool into other Midland DHBs Work will be underway to integrate the current Harti Hauora tool with community based child health services and determine enhancements required of the tool 3. Regional pathways of care (RPoC) reviews of asthma and bronchiolitis care pathways (Map of Medicine) 4. Sharing of information and resources Paediatric outpatient coding Investigate and support work on a national platform for outpatient coding through the Ministry of Health Consider broader implementation of web based paediatric outpatient coding and electronic growth chart in the remaining three Midland DHBs. Child/parent attachment project (Lakes DHB) Review the Lakes DHB evaluation and learnings as they implement the child/parent attachment project see commentary above for more detail on the opening of the children s centre. Consider and develop plan of action for implementation across remaining four DHBs. What we did in addition to what we said we would do A Rheumatic Fever (RF) report has been developed to provide a summary of initiatives and activities undertaken by each of the Midland DHBs for CHA. Although RF is no longer a Better Public Service target it will continue to be a focus area for the high incidence DHBs. This will be ensured through: RF continuing to be a performance measure in annual plans C On Track Caution A In Trouble R 17

18 Continued implementation of RF prevention plans Contract management of RF prevention services Healthy Homes initiatives. During this quarter CHA has supported the development of a proposal to Midland United Regional Integrated Alliance Leadership (MURIAL) team with a key outcome of a regional integrated approach to assist high risk patients and whānau with children 0-5 years to engage with Primary Care. This is to improve health outcomes and reduce demand on secondary care. MURIAL have endorsed HealthShare to recruit a Project Manager for a period of six months to develop a business case in collaboration with DHBs, Primary Health Organisations (PHOs), Lead Maternity Carers, and Well Child Tamariki Ora providers. It is envisaged that CHA will continue to support this process. Rodney Jones, Data Scientist, and Ruth Ross, Regional Director of Workforce Development attended a recent CHA meeting. They presented DHB area medium population projections and DHB workforce data using Qlik Sense noting that all DHBs already have access to the DHB workforce data. Discussions about how both sets could be combined to support child health workforce resourcing, and targeting the workforce according to geographical areas of high need. These discussions will continue, including the Primary Care Organisations, to identify workforce development opportunities and future planning for 2018/19. Quantitative data Immunisation at eight months - Immunisations complete for children at eight months National Immunisations Register Annual Results by Ethnicity Data source: Māori have achieved lower immunisation results than Non-Māori in each year for each Midland DHB. The results in this graph are also provided in an equity gap format in the following two graphs. The equity gap graphs provide the difference between Māori and Non-Māori results through two different lenses: Absolute difference (Non-Māori results less Māori results) This difference is calculated as the Non-Māori result less the Māori result. Results higher than 0% indicate that Non-Māori are achieving a higher rate of immunisations than Māori: C On Track Caution A In Trouble R 18

19 eg 91.6% Māori 88.2% Non-Māori = 3.4% Results lower than 0% indicates that Māori are achieving a higher rate of immunisations than Non-Māori. In the graph below we can see that the equity gap between Māori and Non-Māori results was trending downwards between June but more recently the gap has begun to widen for all Midland DHBs, except Taranaki. Ideally each DHB should be trending downwards ie reducing the gap between Non-Māori and Māori results to 0% or less, by achieving a higher immunisation result for Māori. Relative difference (Non-Māori results Māori results) This difference is calculated as the Māori result divided by the Non-Māori result. The relative difference is reported as a rate and shows the relationship between the two results rather than the difference between them: Results between indicate that Māori are achieving a poorer rate of immunisation than Non-Māori: eg 87.5% Māori 81.6% Non-Māori = 0.96 Results at 1.00 indicate that Māori are achieving immunisations at the same rate as Non-Māori Results greater than 1.00 indicate that Māori are achieving a better rate of immunisation than Non-Māori. Ideally each DHB should be trending upwards ie increasing the rate between Māori and Non Māori results to 1.00 (equal rate) or higher (better rate). Data source: HealthShare, using data from C On Track Caution A In Trouble R 19

20 Elective Services Key achievements The first regional vascular meeting was held on 14 December with service managers and clinicians from Taranaki, Bay of Plenty and Waikato DHBs joining a virtual conference to discuss using the Ministry of Health (MoH) Action Plan as the framework for the Midland Region Vascular Project. There was group consensus that the region would benefit from progressing the initiative and a face to face meeting will be held prior to 30 March 2018 with representation from all five Midland DHBs, including primary care, nursing, and allied health. Clinical Leads: Mr Thodur Vasudevan and Mr Mark Morgan Q1 Q2 Q3 Q4 Manager: Jocelyn Carr 1. Service improvement initiative Vascular Services Clinical leads are agreed Specialty and electives initiative agreed and draft work programme developed Issues and/or opportunities to enhance the Midland Vascular Services Model of Care (hospital services) are identified and plans developed where appropriate Clinical pathways are developed and localised where these are appropriate Vascular services initiative is implemented within agreed timeframes 2. Ongoing development of regional information tools Accurate and timely Information enabling a regional view of elective services delivery by specialty and procedure supports decision making and reporting across the region. Information includes: o Volumes o Waiting times o Intervention rates o Demographics (age, gender and ethnicity) o eographical location Work plan for tool is developed and agreed Tool is delivering agreed enhancements as per work plan What we did in addition to what we said we would do Further analysis of neurology data and ongoing discussions are supporting a regional discussion regarding the value of addressing neurology service issues regionally. This will be progressed with the Chief Operating Officers (COO) roup in the New Year. Quantitative data Elective Services Performance Indicators (ESPIs) - Waiting Times Indictors Midland DHBs are responsible for meeting waiting times requirements for first specialist assessment (FSA) and surgical procedures, however, the MoH also monitor ESPIs at a regional level. As at 31 October there were 120 people waiting greater than four months for an FSA. The main contributor was Orthopaedics (86) There were 93 people waiting greater than four months for a surgical procedure. The main contributors were Orthopaedics (40) and eneral Surgery (12). The region is RED for ESPI-2 and AMBER for ESPI-5. C On Track Caution A In Trouble R 20

21 C On Track Caution A In Trouble R 21

22 Health of Older People (HOP) Key feature article Advance Care Planning The Midland Region Advance Care Planning (ACP) Facilitators group has continued to meet, sharing resources and working regionally where possible. Recent work includes an agreement to approach Central TAS regarding InterRAI Long Term Care Facilities assessments and how to better identify when an ACP is in place; agreement to work as a region with the National ACP Cooperative to determine the most effective approach for learning, what is happening in other DHBs, and reviewing regional pathways of care to determine which pathways should include a link to the Midland ACP pathway. Key achievements ereferral for Dementia - HealthShare s Regional Pathways of Care team have received endorsement from all seven of the Midland Region Alzheimer s and Dementia organisations for a standardised ereferral form for eneral Practitioner s to use when making referrals to these organisations. The ereferral form is currently under development by the vendor. HOP Regional Project Managers meeting - HealthShare Clinical and Systems Data Analyst, and HOP Project Manager attended the HOP Regional Project Managers forum in Wellington. CentralTAS provided a preview of the new InterRAI visualisation tool and its potential benefits. It was apparent that the tool would assist with the Dementia and InterRAI initiatives identifying whether Māori are diagnosed with cognition problems, at the same rate as non-māori, and determining if there is equity of assessment for Home Based and Community support services. These two tasks are currently marked as A in the table below. The new tool will allow the network to start work on these tasks. Also presented was Health Round Table data relating to the health of older people and the group discussed the 2018/19 Regional Services Plan in conjunction with Phil Wood in his role as Chief Advisor, Health of Older People, Ministry of Health. HOP Workforce The DHB shared services agency has determined that it will take the lead to establish the mechanism to collect whole of sector workforce data. Some information for home based and community based care and support workers is available via the Ministry of Health pay equity data base. The Aged Residential Care (ARC) providers have not contributed to this as their funding model, to cover the additional remuneration for these workers, is different. The DHB shared services agency is also looking at the allied health, kaiawhina and carer and support services workforce, working with older people (including those requiring palliative care). In addition HealthShare has accessed 2013 census information for ARC and will be able to provide a snapshot from that data set. The next census is due in March With regards to training and support for this workforce Midlands DHBs are providing support for Careerforce to ensure that the Level 4 qualification is fit for use. Follow-up is happening with Health Workforce NZ regarding a query about funding for another advanced trainee for palliative care. Chair: Phil Wood, Waikato DHB Manager: Kirstin Pereira Q1 Q2 Q3 Q4 1. Strengthen the implementation of the New Zealand Dementia Framework and the actions specified in Improving the Lives of People with Dementia (Ministry of Health 2014). Action 11a Healthy Ageing Strategy Through the continued coordination and support of the Dementia Pathway Working roup strengthen areas of the dementia pathways being used in primary care. Develop e-referrals to Alzheimer s and Dementia organisations in conjunction with the Regional Pathways of Care (RPoC) team Coordinate review of the evidence base and best practice underpinning the dementia assessment and management pathways Determine if Māori are being recognised as having problems with cognition at the same rate as non- Māori using InterRAI data, including the trigger rate of Dementia and Cognitive CAPs A Develop and deliver a survey of P Practices to determine use of the dementia assessment and management pathways and their impact on P and Practice Nurse confidence levels A Analyse and distribute the survey results A Determine any changes to the pathways to be made as an outcome of the survey Implement changes identified in the review of the dementia pathways Based on the outcomes of reviewing InterRAI data on cognition, identify ways to support primary care to recognise cognitive decline in older Māori in the same was as in non- Māori and support NASCs to provide for those needs equitably. Ensure education and support programmes for family and whānau carers of people with dementia are standardised and accessible. Support the development of a framework for the delivery of education and support programmes for family and whānau carers Review and endorse quality and equity indicators identified by DHBs for delivery across the C On Track Caution A In Trouble R 22

23 Chair: Phil Wood, Waikato DHB Manager: Kirstin Pereira Q1 Q2 Q3 Q4 region Support the sector to identify ways to ensure access for family and whānau carers to the education and support programmes. 2. Identification and use of InterRAI data to support quality initiatives and service improvement in the sector. Action 8b New Zealand Healthy Ageing Strategy Continue to provide and monitor InterRAI reporting created in 2016/17 Determine if there is equity of assessment and access to Home and Community based support for Māori across the Midland region A Identify the means of addressing any identified equity gaps and begin implementation Identify the data required by the sector for service improvement through workshops Provide the identified requirements in a user friendly format Support the sector to identify quality indicators to be reported against on an agreed frequency. 3 Health of older people workforce Work in collaboration with the Ministry of Health, DHB Shared Services and the sector working with older people to establish the mechanism to collect whole of sector workforce data Identify the allied health, kaiawhina and carer and support services workforces working with older people (including those requiring palliative care) and their family / whānau / informal carers Palliative Care has been included here as this will involve exactly the same workforce as described in the Health of Older People Workforce Develop a workforce plan to ensure that those working with older people, including older people requiring palliative care, have the training and support they require to deliver highquality, person-centred care - Palliative Care has been included here as this will involve exactly the same workforce as described in the Health of Older People Workforce. 4. New Zealand Healthy Ageing Strategy - placeholder Review the Healthy Ageing Strategy implementation plan Identify regional initiatives from the Ministry of Health Implementation Plan. Frailty is a potential area of focus for the Midland region A Agree initiative to be started in the 2017/18 year Utilise the Healthy Ageing Strategy to inform the 2018/19 plan. 5. Advance Care Planning (ACP) In conjunction with the National ACP Regional Implementation Manager, work with DHBs to expand the current Midland Regional ACP network Support DHBs, through the Midland Regional ACP network, to ensure processes are in place to maximise completion of Level 1 training and attendance at Level 1A and 2 training (if training is available) Promote DHB participation in national Conversations that Count Day Quantitative data The following is an extract from a report created by HealthShare s Clinical and Systems Data Analyst and provided to Midland Chief Executive s and Midland DHB s Health of Older People representatives. The aim of the report was to provide an indication of the potential future population with dementia in the Midland Region and estimated associated costs. The dementia component of the report was based on assumptions and results provided in the Dementia Economic Impact Report 2016 (DEIR), published by Deloitte in March 2017 for Alzheimer s New Zealand ( ). The 2016 report is the third DEIR published by Deloitte (2008, 2012). Deloitte s report provides an excellent primary information source on the size and scale of dementia in New Zealand. They note that they depend on assumptions drawn from international and Australian data and it is disappointing that, after ten years, there is still no New Zealand-specific data available. Using the assumptions provided in the DEIR and projected population data from the Ministry of Health, some very broad estimations were made about the future potential number of people with dementia in the Midland region and the future associated cost. C On Track Caution A In Trouble R 23

24 Estimated number of people with dementia in the Midland region DHB / Estimated at 2.9% Estimated % of population with dementia 1.3% 2.3% Figures are calculated using estimated 2.7 rate of increase of # of people in NZ with dementia from 2016 to 2050 Bay of Plenty 2,947 6,406 7,956 Lakes 1,386 2,643 3,743 Tairāwhiti 622 1,166 1,680 Taranaki 1,519 3,034 4,100 Waikato 5,195 11,222 14,027 Midland Region 11,669 24,472 31,506 Estimated health cost in the Midland region DHB / Health cost estimated at $17,745 per person No adjustment made for inflation in future years $million $million $million Bay of Plenty $52 $114 $141 Lakes $25 $47 $66 Tairāwhiti $11 $21 $30 Taranaki $27 $54 $73 Waikato $92 $199 $249 Midland Region $207 $434 $559 C On Track Caution A In Trouble R 24

25 Breakdown of estimated 2050 Midland Region Health Cost Health Service % of total cost Bay of Plenty Lakes Tairāwhiti Taranaki Waikato $0.00 million Midland Region Aged Care 76.8% Hospital Admissions 14.5% Community Care 6.1% Non admitted hospital 1.3% Allied health 0.5% Research 0.4% Ps 0.3% Pharmaceutical 0.1% Pathology & imaging 0.0% Total 100.0% C On Track Caution A In Trouble R 25

26 Mental Health and Addiction Services (MH&A) Key feature article At a National Substance Addiction Compulsory Assessment Treatment (SACAT) Steering roup meeting held on 5 December 2017 in Auckland, the Ministry of Health (MoH) reached agreement for four regional submissions to form a consolidated SACAT budget bid to the Minister of Health on 26 January A proposed meeting is scheduled for 19 January 2018 where the MoH will consider the regional submissions and associated costings as tabled by each region. Each submission is to describe the top three priorities for resourcing the implementation of SACAT, however it remains unclear what level of initial and future resourcing support is available for the SACAT implementation. A considerable amount of work has already been completed across the Midland region to support a submission. The Midland Addiction Model of Care and Local Implementation Readiness Reports have formed the background information for this process. The final draft Midland Proposal has been submitted to the Midland Ms Planning & Funding for approval. Chair: Professor raham Mellsop Regional Director: Eseta Nonu-Reid Q1 Q2 Q3 Q4 Narrative Update 1. Midland eating disorders model of care continued regional provision of eating disorder inpatient services Final Eating Disorder Service (EDS) Model of Care submitted to the Ministry of Health for approval. Awaiting outcome. EDS Liaison quarterly meeting occurred in November. EDS Map of Medicine pathway discussed at the November meeting. To be discussed further at Mach meeting. EDS Workforce Development discussed at November meeting. Further work to occur at March meeting. Implement the Midland Eating Disorders Model of Care as outlined in the Ministry of Health (MoH) Change Management proposal Implement the workforce recommendations 2. Substance abuse legislation improved addiction service capacity and capability for implementation of substance abuse legislation Submit a Midland proposal to the MoH C C Implement the objectives as identified in the proposal Implement the workforce development requirements 3. Physical health care for low prevalence mental health disorders develop a plan to improve physical health outcomes of people with low prevalence disorders Develop a regional agreement across the Midland region that identifies an agreed strategy to ensure physical health needs for low prevalence C disorders are identified and addressed consistently Develop an integration paper in collaboration with Primary Mental Health to determine an agreed A C model of care focusing on whole-ofhealth needs. Midland Addiction Model of Care completed and signed off by the regional CEs for submission to the MoH Substance Addiction Compulsory Assessment Treatment (SACAT) Implementation Readiness workshops have completed across the region facilitated by the Workforce Planning Lead. These were followed by Mana Enhancing workshops facilitated by Te Rau Matatini in November. Midland Funding proposal drafted for Ms Planning & Funding sign off. Following discussion and presentations at the combined Clinical overnance and Portfolio Managers meeting it was agreed that the physical healthcare for low prevalence mental health disorders was a better fit at a local level and reported through the District Annual Plan (DAP) process. There is strong evidence at a local level that a number of initiatives are occurring in each of the DHBs which are inclusive of the Primary sector. C On Track Caution A In Trouble R 26

27 Chair: Professor raham Mellsop Regional Director: Eseta Nonu-Reid Q1 Q2 Q3 Q4 Narrative Update 4. MH&A clinical workflow the successful implementation of MH&A workflows within a regional clinical portal across the Midland region Ensure all approvals for PID and Business Case are obtained and there is regional agreement going C C forward Undertake a Training Needs Analysis across the region and design a n/a workforce plan Work with local Champions roup to ensure local processes are implemented. 5. Midland Infant Perinatal Clinical Network - the Midland Infant Perinatal Clinical Network will: Complete the review of the primary care pathway (Map of Medicine) and consult with primary, maternity and mental health and addictions services Develop regionally agreed policies, procedures and clinical best practice guidelines to ensure regional consistency Participate in the evaluation of the e-learning Tool in partnership with the Central region. A espace continue to develop high level mapping and are working on a way to speed up delivery and implementation which will build on the work already done by the region and will closely involve clinical champions. There has been an expectation by the region s leaders that multiple documents are developed and signed off before entering a build-phase; this will result in significant delay. Therefore to expedite implementation, espace have developed a strategy of rapid development that will allow the development to move forward at a rapid pace. This strategy is contingent on acceptance by the region s leadership. Map of Medicine pathway completed. To progress with Maternity and Primary Health for final comments before publishing. Four regional best practice guidelines placed on the agenda for discussion at next quarter s regional meeting. No progress made with Central region re the e- Learning Tool. What we did in addition to what we said we would do Regional Stakeholder Network meetings held in the quarter: o Te Huinga o Nga Pou Hauora (Māori) o He Tipuana Nga Kakano (Consumer) o Te Ao Whānau (Family) o Addiction Leadership o Infant Perinatal Clinical Network o Eating Disorders Clinical Network o Joint Clinical overnance and Portfolio Managers Networks Participation in the National SACAT regional meetings hosted by the MoH and Matua Raki Migration of the Regional MH&A Network from Lakes DHB to the Waikato DHB platform National Shared Services meeting held at Northern Regional Alliance (NRA) SACAT funding teleconferences HealthShare Senior Leadership planning day MH&A Regional Team planning day. C On Track Caution A In Trouble R 27

28 Quantitative data 1. Infant Perinatal Contacts The data shows total contacts (excluding Did Not Attend) for the Midland DHBs as access to NO data is reestablished. Each DHB shows a different trend, but appear to have increased again in Q1 2017/ Section 29 Ethnicity for Māori Health Plan No reports received from the MoH C On Track Caution A In Trouble R 28

29 3. Seclusion Minimisation The proportion of Māori to Non-Māori seclusion still continue to be high, however discussions are being held at regional level to look at seclusion reduction strategies. 4. DHB and NO wait Times Overall progress has been made by Midland DHBs and NOs compared to the previous reports in meeting their wait times targets. Discussions held regionally and locally to address inconsistencies on utilising PRIMHD codes and data input. C On Track Caution A In Trouble R 29

30 C On Track Caution A In Trouble R 30

31 Midland Radiology Action roup (MRA) Key feature article Midland Scanning Modality Workload and Capacity Capture Regional radiology volumes and case mix by modality have been collected to inform regional impact assessments and capacity planning when new demands are placed on the modalities from clinical service changes in models of care. The case mix categories are defined on the basis of resources used. The stocktake and ongoing annual tracking will inform resource planning and detect trends within each case mix. This work was initiated with Computerised Tomography (CT) and has now begun in Ultrasound (US). It has been difficult for some DHBs to provide the information, however, once the first annual set of data has been extracted; the annual updates will be easier and will allow for trend analysis. Total numbers 2016/17 Financial Year Count by referral/visit if possible rather than per exam (Lakes cannot count multis) DHBs Waikato In room time (Mins) Reporting time (Mins) Scanner location CT Modality - Room Time Analysis of Current Workload in the Midland Region No. of Scanners CT Brain/Head (CAT H) incl Sinuses, Soft Tissue Neck, IAMs, Facial, Mandible, Temporal, Orbits CT CAP (CAT CAP) incl Chest Abdo Pelvis, CT Chest, CTPA, HRCT (CAT CH) incl All Abdos, Pelvis, Urograms (CAT A) incl multiphasic livers, kidneys, pancreas, adrenal CT Musculo Skeletal (CAT M) incl all spine, all extremities CTA (CAT CTA) All other angiograms not captured separately - Circle of Willis,abd aorta,thoracic Aorta CTC (CAT CTC) Colon CTCA (CAT CTCA) Coronary angiogram CT Intervention al (CAT I) incl Biopsies, Drainages, Arthrograms, Sympathec, Injections, Venogram CT CAP plus Head or Neck (CAT HNCAP) Inc CAP plus head or neck CT Trauma (CAT T) ie Referral for neck, chest, abdo, pelvis TOTAL CT Count per Site per annum TOTAL CT TOTAL Count per Hours per Scanner scanner per per Week week Hamilton 2 9,003 3,312 1,832 2,269 1, , Thames 1 1, , BOP Tauranga 1 4,636 1,075 1, , Whakatane 1 2, , Taranaki New Plymouth Lakes Rotorua Tairawhiti isborne 1 1, , Sum of CT vol % per Category of CT totals 8 18,604 5,771 4,372 4,243 3,185 1, ,239 46% 14% 11% 11% 8% 4% 2% 1% 1% 1% 1% 100% Data source: Data Supplied by DHB Radiology Departmental Managers from their Radiology Information Systems (RIS) Key achievements Membership Dr Roy Buchanan, Bay of Plenty (BOP), has accepted the Clinical Lead role of MRA replacing Dr Alina Leigh after two years service. Alina is passionate about public radiology services and has made a significant contribution to the Midland and National work. She led the development of Minimum Primary Radiology Clinical Access Criteria which has been adopted New Zealand wide. Over the past two years MRA has benefited from increased cohesion of the group on topics of national significance. Dr Kim McAnulty will replace Sabaratnam Muthukumaraswamy as the Waikato clinical representative. Bowel Screening - the Ministry of Health (MoH) recently confirmed with Lakes DHB a go live date of September 2018 for the National Bowel Screening Programme (NBSP). Lakes DHB have a working group and an action plan in place. Radiology s involvement is to perform CTC (CT Colonography) for failed scope patients, or those in which scope would be inappropriate, but where CT imaging is still indicated. Lakes are working on a 10% maximum failed colonoscopy rate as provided by the MoH at the initial Midland regional bowel screening planning meeting. Faster Cancer Treatment Northern Protocols MRA support these in principle if they are endorsed by the Midland Oncologists. C On Track Caution A In Trouble R 31

32 espace Clinical Work Station (CWS) a demonstration of the CWS timeline was provided and valuable enhancements identified. MRA have requested that current Orion solutions for referrals in Christchurch, Taranaki and Auckland are sourced for consideration. Other requirements will include comparisons of electronic grading ability, auto-generated consent forms and patient information brochures. Regional Pathways of Care (RPoC) the Pathways team have the primary access criteria and are aware they are minimum access criteria and also the best practice criteria at the time of publishing. Therefore this is a good baseline for the imaging step in pathways. MRA and National Radiology Advisory roup (NRA) will update these bi-annually as imaging criteria changes with technology change very quickly. RPoC share the current pathways being worked on with MRA. Regional RIS/ PACS Lakes DHB have undergone due diligence towards aligning with the Midland Regional RIS/ PACS solution. Currently awaiting sign-off from the MoH prior to formalising the arrangement. National Radiology Advisory roup (NRA) update - Andrew Simpson, Medical Director, MoH discussed how to link Radiology into formative stages of clinical service change proposals. Most service developments ultimately impact on radiology capacity and require radiology input to determine the best modality and imaging timeframes for detection and review. PET CT - the Northern Cancer Network is leading some activity on National Indications, volumes, etc. The Network would like to include national data sets on what investigations are being offered to patients around the country. Chair: Roy Buchanan, Bay of Plenty DHB Manager: Philippa Edwards Q1 Q2 Q3 Q4 1. Demand capacity modelling Ultrasound (US) - the volumes, case mix and machine time for US will be modelled across the Midland DHBs to inform resource preparation required to respond to national and local demands and priorities Collect US data counting per scan US modelling to provide regional clarity on demand trends per referrer type and per US examination along with the resources used to achieve current delivery. This data will be useful to inform DHB and regional decisions on how to most effectively support achievement of volumes required in meeting national priorities and/or changes in service delivery models. Ratios of US caseload outputs at Midland DHBs DNA rates analysis for US by multiple factors including ethnicity, deprivation, location to services, availability by phone for appointment text, transport option, wait time. 2. Ultrasonography workforce sustainability Conduct the second bi-annual survey of sonographers across the Midland regions public and private providers as a part of ongoing work to predict and track the Sonographer workforce trends and requirements for training within the Midland region. In collaboration with the Ministry of Health and DHB shared services MRA will: Include Echo technicians in this survey round Analyse the gap between forecast workforce status and actual workforce status across Midland region Evaluate the number of trainee positions required across the region to home grow the future Sonographer workforce Evaluate the turnover of Midland Sonographers against the national trends to see if the home-grown approach via the 50:50 public private training model is effective. 3. Involvement in cancer streams/pathways at a regional level to reduce delays in patient flows Improve the value proposition and performance delivered by working closely with the Midland Cancer Network and other services criteria, timeliness required. Access cancer pathway data where possible to inform where radiology needs to improve its timeliness of service delivery Be actively involved in the local implementation of the cancer stream work and related national radiology cancer pathways and guidance and Regional Pathways of Care (RPoC). 4. National and local initiatives Improve the value proposition and performance delivered by working with: C On Track Caution A In Trouble R 32

33 Percentage of community & out patients referrals Percentage of community & out patients referrals Percentage of community & out patients referrals Percentage of community & out patients referrals Percentage of community & out patients referrals Chair: Roy Buchanan, Bay of Plenty DHB Manager: Philippa Edwards National Radiology Advisory roup (NRA) and key national groups such as Pharmac, Cancer Stream Pathways, Health Workforce New Zealand (HWFNZ) to offer formal advice on the impacts of new treatments and ensure the implication of national guidelines on imaging services and clinical efficacy are well understood. Midland Regional IS and espace teams to ensure effective functionality of the regional CWS, ereferrals and regional PACS systems with regional integration for information access and patient flow are patients centric Regional Pathways of Care (MoM) on local pathways within and across DHBs, with cognisance of the Choosing Wisely methodology where appropriate Work with Midland Workforce to understand the ratio of Māori to non Māori Radiology workforce across the five Midland DHBs. Q1 Q2 Q3 Q4 Quantitative data: MOH KPI 95% of CT referrals from Primary and Out Patients to be performed within 42 days Data source: Quickr, Ministry of Health dataset 100% Percentage of community and out patient referrals receiving CT scans in 42 days (6 weeks) or less 90% 80% 70% 60% 50% Target Waikato 40% Calendar year Percentage of community and out patient referrals receiving CT scans in 42 days (6 weeks) or less 100% 90% 80% 70% 60% 50% Target 40% Calendar year BOP Percentage of community and out patient referrals receiving CT scans in 42 days (6 weeks) or less 100% 90% 80% 70% 60% 50% Target 40% Calendar year Taranaki Percentage of community and out patient referrals receiving CT scans in 42 days (6 weeks) or less 100% 90% 80% 70% 60% 50% Target 40% Calendar year Lakes Percentage of community and out patient referrals receiving CT scans in 42 days (6 weeks) or less 100% 90% 80% 70% 60% 50% Target 40% Calendar year Tairawhiti C On Track Caution A In Trouble R 33

34 Percentage of community & out patients referrals Percentage of community & out patients referrals Percentage of community & out patients referrals Percentage of community & out patients referrals Percentage of community & out patients referrals MOH KPI 85% of (Magnetic Resonance Imaging) MRI referrals from Primary and Out Patients to be performed within 42 days Data source: Quickr, Ministry of Health dataset 100% 80% 60% 40% 20% Percentage of community and out patient referrals receiving MRI scans in 42 days (6 weeks) or less Target 0% Calendar year Waikato 100% 80% 60% 40% 20% Percentage of community and out patient referrals receiving MRI scans in 42 days (6 weeks) or less Target BOP 0% Calendar year 100% 80% 60% 40% 20% Percentage of community and out patient referrals receiving MRI scans in 42 days (6 weeks) or less Target Taranaki 0% Calendar year 100% 80% 60% 40% 20% Percentage of community and out patient referrals receiving MRI scans in 42 days (6 weeks) or less Target 0% Calendar year Lakes 100% 80% 60% 40% 20% Percentage of community and out patient referrals receiving MRI scans in 42 days (6 weeks) or less Target 0% Calendar year Tairawhiti C On Track Caution A In Trouble R 34

35 Stroke Services (Midland Stroke Network) Key feature article Midland Region Telestroke Business Case the development of this document was the main focus for Quarter 2. The business case proposes an out of hours Telestroke service for Lakes, Bay of Plenty and Taranaki DHBs and is driven by the positive outcomes from the pilot undertaken in Lakes, Thames, and Waikato Hospitals. The Telestroke service will allow Waikato DHB to provide the expertise required to deliver stroke thrombolysis treatment out of hours. The Midland region business case is based on the business case created by Waikato DHB who were seeking approval to recruit the required additional full time equivalent (FTE) for the Neurology Service to provide the out of hours cover for the Midland region Telestroke service. Each of the Midland DHBs was involved in reviewing the final document prior to it being submitted to the Midland Chief Operating Officers (COOs). It was supported in principle by Waikato, Lakes, Bay of Plenty and Taranaki DHBs. A response to some queries are required from Waikato, however, the COOs have agreed to continue with the intent of Telestroke in terms of the planning for the 2018/19 year. Key achievements Thrombectomy work is underway to determine the required components of the key stages in the patient s journey to receive Thrombectomy at Auckland Hospital. The main focus for Quarter 2 has been the intra-hospital transfers from Midland Hospitals to Auckland Hospital. Peter Wright and Karim Mahawish, representing the Midland Stroke Network, met with Annette Forrest to discuss intra-hospital transfers and a subsequent meeting was planned in Rotorua to specifically discuss transfers from Rotorua Hospital to Auckland Hospital. Regional Stroke Project Managers meeting - HealthShare Clinical and Systems Data Analyst, and the HOP Project Manager attended the Regional Stroke Project Managers meeting in Wellington. The forum allowed the project managers to share progress in each of the four regions, discuss data collection issues, receive an update on the new REDCap Thrombolysis register and the RegionCARES research. Chair: Peter Wright, Waikato DHB Manager: Kirstin Pereira 1. Organisation of stroke services including thrombolysis and rehabilitation Thrombolysis Support and facilitate the implementation of a pathway of care for accessing thrombectomy services through Auckland DHB (ADHB) Q1 Q2 Q3 Q4 Support and facilitate the development of a pathway of care for accessing thrombectomy services through Waikato DHB (WDHB) (five-year timeframe) Support the implementation and evaluation of the Telestroke pilot in Hamilton/Thames/Rotorua hospitals. If demonstrated positive patient outcomes consider providing this service regionally as part of long term planning. 2. Education, training and audit Undertake a prospective audit to identify disparities between Māori and non-māori accessing acute and rehabilitation stroke services. This will include: o the number of Māori vs non-māori accessing inpatient rehabilitation o the number of Māori vs non-māori accessing thrombolysis treatment o the number of Māori vs non-māori accessing the acute stroke unit o the number of Māori vs non-māori accessing community rehabilitation services then develop plan of action to improve these disparities. BOPDHB will also undertake a three-month audit to ascertain reasons why Māori stroke patients delay accessing stroke services The Midland Stroke Network will support the delivery of all local, regional and national acute stroke and rehabilitation study sessions/days; have representation at all study days and provide feedback to the wider group Ensure all stroke and rehabilitation study days are available to the primary/community sector Set up and support regular /online sharing of relevant research and information amongst the group C On Track Caution A In Trouble R 35

36 Chair: Peter Wright, Waikato DHB Manager: Kirstin Pereira Consider setting up a Facebook group for Midland Stroke Network to better enable sharing of key stroke information. 3. Workforce Provide collegial support for new incumbent lead stroke clinicians through the meeting structure and peer support groups e.g. regional CNS group. 4. Information Technology Establish virtual regional analyst group to streamline and troubleshoot data collection and identified issues for quarterly and ad hoc reporting. Q1 Q2 Q3 Q4 Quantitative data Stroke Audit Results for Q1 2017/18 The data below is provided to HealthShare quarterly by the five Midland DHBs. Audit 1 80% of all eligible stroke patients are to be cared for in a stroke unit The following tables and graphs show the percentage of eligible stroke admissions that spent some time in a stroke unit: Midland Region* 15/16 16/17 17/18 Ethnicity Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Non Maori 72% 74% 73% 77% 74% 76% 77% 79% 80% Maori 67% 64% 68% 70% 59% 66% 71% 74% 77% Total 71% 72% 72% 76% 72% 74% 76% 78% 79% *These results have been updated from the previous quarterly report C On Track Caution A In Trouble R 36

37 C On Track Caution A In Trouble R 37

38 C On Track Caution A In Trouble R 38

39 Results by numerator/denominator DHB BOP DHB Lakes DHB Tairāwhiti DHB Taranaki DHB Waikato DHB Midland Region* Ethnicity Non Maori Maori Total Non Maori Maori Total Non Maori Maori Total Non Maori Maori Total Non Maori Maori Total Non Maori Maori Total Numerator Denominator 15/16 16/17 17/18 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 # admissions # eligible # admissions # eligible # admissions # eligible # admissions # eligible # admissions # eligible # admissions # eligible # admissions 12 # eligible 12 # admissions 9 # eligible 9 # admissions 21 # eligible 21 # admissions # eligible # admissions # eligible # admissions # eligible # admissions # eligible # admissions # eligible # admissions # eligible # admissions # eligible # admissions # eligible # admissions # eligible *These results have been updated from the previous quarterly report Data notes Inclusions Eligibility uses codes I61, I63 and I64 who stayed more than 24hrs in the hospital. Terminal patients Exclusions I60 - subarachnoid haemorrhage; 45 - TIA; and I61, I63, I64 patients from ED with less than 24 hour stay in the hospital. Numerator # Admissions: those who are eligible and who spent any time in the Stroke Unit, or if not the Stroke unit but were in Intensive Care Unit (ICU), High Dependency Unit (HDU), Coronary Care Unit (CCU), or in a neurosurgical ward under a neurosurgeon - as these locations constitute being in an acute stroke unit. Denominator Whakatane. # eligible: all eligible I61, I63 and I64 patients including patients at hospitals with no stroke unit i.e. T-Hospitals, Taupo and C On Track Caution A In Trouble R 39

40 Audit 2 8% of stroke patients are thrombolysed In 2017/18 the thrombolysis target for stroke changed from 6% to 8%. The following table and graphs show the percentage of patients who received thrombolysis: Midland Region* 16/17 17/18 Ethnicity Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Non Maori 8% 6% 6% 7% 8% Maori 10% 7% 8% 15% 10% Total 8% 6% 7% 8% 8% *These results have been updated from the previous quarterly report C On Track Caution A In Trouble R 40

41 C On Track Caution A In Trouble R 41

42 DHB BOP DHB Lakes DHB Tairāwhiti DHB* Taranaki DHB Waikato DHB Midland Region* Ethnicity Non Maori Maori Total Non Maori Maori Total Non Maori Maori Total Non Maori Maori Total Non Maori Maori Total Non Maori Maori Total Numerator Denominator 16/17 17/18 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients # patients thrombolysed # total ischaemic & non spec stroke patients *These results have been updated from the previous quarterly report Data notes Numerator Denominator Codes = I63, I64 (infarct/ischemic stroke + those not specified). # Patients Thrombolysed: patients who have received thrombolysis. # total ischaemic & non spec stroke patients: I63 +I64 (infarct/ischemic stroke + those not specified). C On Track Caution A In Trouble R 42

43 Audit 3 80% of stroke patients are transferred to inpatient rehab services within seven days of acute stroke admission The following table and graphs show the percentage of patients who were transferred to inpatient rehab services within seven days of acute stroke admission: Midland Region 16/17 17/18 Ethnicity Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Non Maori 83% 65% 80% 84% 87% Maori 100% 77% 83% 92% 83% Total 85% 67% 80% 85% 87% C On Track Caution A In Trouble R 43

44 DHB BOP DHB Lakes DHB Tairāwhiti DHB Taranaki DHB Waikato DHB Midland Ethnicity Non Maori Maori Total Non Maori Maori Total Non Maori Maori Total Non Maori Maori Total Non Maori Maori Total Non Maori Maori Total Numerator Denominator 16/17 17/18 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 # transferred within seven days # transferred # transferred within seven days # transferred # transferred within seven days # transferred # transferred within seven days # transferred # transferred within seven days # transferred # transferred within seven days # transferred # transferred within seven days # transferred # transferred within seven days # transferred # transferred within seven days # transferred # transferred within seven days # transferred # transferred within seven days 1 # transferred 1 1 # transferred within seven days # transferred # transferred within seven days # transferred # transferred within seven days # transferred # transferred within seven days # transferred # transferred within seven days # transferred # transferred within seven days # transferred # transferred within seven days # transferred Data notes Codes =I61, I63, I64 (total stroke admissions). Numerator # Transferred within seven days: Codes I61, I63, I64, discharge date <=7 days, discharge type DW, HSC of the following admission is Rehab (D00-D84) with a PD of one of: Z50.9 Rehabilitation - most often used Z50.7 Occupational (therapy) Z50.4 Psychotherapy Z50.8 Specified NEC Denominator # Transferred: Ischaemic and Non Specified Stroke Admissions (I63+I64) C On Track Caution A In Trouble R 44

45 Trauma Services - Midland Trauma System (MTS) Key feature article The Midland Trauma System along with a number of other health services, NOs and PHOs, participated in the first ever Hearty Hauora day which sought to demystify services and reduce barriers to accessing health for whānau members of the mongrel mob. Although predominantly attended by mongrel mob members from the Waikato district, whānau also attended from Bay of Plenty, East Cape and areas further south. Other gangs and homeless were also invited to attend the health day. rant Christey, Clinical Director of Midland Trauma System, gave a presentation that looked at the ripple effect of trauma on families and communities and how that starts with the choices that are made by individuals. When asked who in the crowd had either been in hospital because of a trauma or who had had someone in their family in hospital with a trauma very few hands, if any, remained down. He held the attention of the audience by talking about, and reflecting on, real stories and photos of real trauma events. This message was further enhanced by a personal story of a whānau mother and son s journey of trauma which started with poor decision making and resulted in hospitalisation and time in the justice system. This decision lost the young man an NFL contract and a promising rugby career. As reported in Stuff, Waikato Health Board executive Darrin Hackett said, "This is definitely a first-time event. What we want to do is learn from this, because this is a really good way of people engaging in health in a way that they're comfortable with. And it's very much around some of the values that the DHB is working with about giving and earning respect." "They reached out to us, saying this is where we want to go, we want to create different futures and we want to create hope for our people and we want to normalise how we get healthy," Hackett said. "We are walking with them instead of just providing something to them." The demographics of the membership of the mongrel mob reflects the statistical at risk groups we see in a lot of the Midland trauma statistic profiles. Participation in this event delivered on several of the MTS strategic plan objectives including: Identify and address inequalities in access to trauma care in our communities. Identify groups at high risk of injury in the Midland community and work in partnership with key community groups to enable targeted interventions. Develop an integrated injury prevention programme in codesign with responsible agencies and community groups Nurture a progressive environment that fosters innovation in our training, education and service delivery. C On Track Caution A In Trouble R 45

46 (Click here to open a PDF version) Key achievements Collaboration with Wintec on Patient Experience Study and Quad bike studies. Acceptance of two papers into peer-reviewed journals (Work-Related Injury; Trauma in Older Persons) Commenced reporting from TQual data platform Commencing phase 2 of TQUAL relational database build. Chair: rant Christey, Clinical Director, Waikato DHB Manager: Alaina Campbell, Waikato DHB Q1 Q2 Q3 Q4 1. Improve the delivery of high quality care to trauma patients Complete review of CNS, TOC and data management roles: define appropriate FTE for Hub and clinical services ain endorsement and support from regional service management and professional bodies, and work through governance levels to ensure implementation of resourcing Ensure membership and engagement to appropriate professional bodies by MTS personnel Identify and implement action plan based on the findings and recommendations from regional trauma verification Develop push reporting system on key information to assist clinicians to highlight priorities in clinical care Develop breach reporting process within clinical feedback loop Define model of post injury rehabilitation care with locally based services and networks A Implement and monitor trial of prehospital and inter-hospital destination policy matrices Develop tools within TQual to guide clinical strategies Update guidelines and review current challenges to use. Develop implementation plan that encourages compliance Complete qualitative research study in collaboration with WINTEC and Monash university to assess patient experience with trauma services Implement sustainable long term patient/family feedback process Coordinate and report preliminary PATCH trial findings C On Track Caution A In Trouble R 46

47 Chair: rant Christey, Clinical Director, Waikato DHB Manager: Alaina Campbell, Waikato DHB Q1 Q2 Q3 Q4 2. Develop and maintain regional trauma infrastructure ain approval and secure funding for business case Implement all elements of business case including epidemiologist to maximize information Implement recommendations from trauma verification to improve MTS infrastructure and function Identify and secure external sources of funding to support MTS activities with indicative target of $500k over three years Complete build of TQual relational database Define and implement information for automation from internal DHB hospital systems into TQual Review and analyse all parts of data collection process e.g. St John EPRF, data collect, audit process to ensure alignment throughout Midland/nationally Maintain training and education programmes to ensure a consistent flow of complete, accurate and representative trauma data into the registry Submission of data to the New Zealand Major Trauma Registry no more than 30 days after patient discharge Complete mobile data collection trial (handheld) A Establish and optimise sever based Qlik Sense for data visualisation in district hospitals Develop strategic plan for Midland Trauma Research Centre (MTRC) including marketing strategy that supports research to address the needs of the Midland community Develop web based common node on Midland trauma website linked to TQual Deliver annual trauma symposium and research training workshop 3. Support injury prevention and awareness Complete regional injury incidence study programme for baseline data on injury patterns and equity Develop functional information pathways with key partners to translate trauma data into reduction of injury rates Utilise trauma calendar dates of interest to promote MTS registry information to extend the uses and impact of trauma data e.g. Falls month Extend community education and awareness programmes to schools, councils, community groups Complete prevention pilots with WINTEC and University of Waikato assess collaboration outputs for ongoing and relationships. Assess feasibility of extension of programme regionally. Develop and implement a programme of infographics and communication tools that can be used in DHBs and communities to support trauma prevention in target groups and creation of action plans Capture individual patient and family/whānau stories to reveal the reality of the impact of trauma. To be used in various communication and education programme Optimise website to address the needs of clinicians and members of the public 4. Establish a Trauma Quality Improvement Programme (TQIP) to enable evidence-based change Develop detailed TQIP structural plan with definable actions and outcomes Identify external data sources that may extend the influence of TQIP to pre-hospital and post-hospital realms e.g. Met Service, LTSA, St. John s Complete construction of the TQual relational data platform to provide high quality information for TQIP and local reporting capability Review and define service and process indicators and implement regular regional reporting regime Develop detailed TQIP structural plan with definable actions and outcomes Identify external data sources that may extend the influence of TQIP to pre-hospital and post-hospital realms e.g. Met Service, LTSA, St. John s Complete construction of the TQual relational data platform to provide high quality information for TQIP and local reporting capability Review and define service and process indicators and implement regular regional reporting regime Review information pathways for trauma services in each DHB with emphasis on reporting, escalation, feedback and loop closure processes C On Track Caution A In Trouble R 47

48 Chair: rant Christey, Clinical Director, Waikato DHB Manager: Alaina Campbell, Waikato DHB Q1 Q2 Q3 Q4 Develop regional clinical case discussion programme with defined templates and reporting mechanisms Develop professional development pathways that expose MTS staff to new opportunities and to enable MTS personal to lead new trauma programmes regionally and nationally e.g. verification, AIS instructing, Trauma Team Training (TTT), research Provide funding avenues to support staff to in trauma training and professional development Promote MTS staff involvement in research centre production Continue to develop programme for National Major Trauma Registry hosting and introduction of Qlik Sense tool for data visualisation in New Zealand DHBs. What we did in addition to what we said we would do Participation in the Hearty Hauora Kaupapa 11 November 2017 Regional Snapshot reports for each Midland DHB Requested the provision of patient cost data from each DHB - current status of provision is: Quantitative data See pages C On Track Caution A In Trouble R 48

49 C On Track Caution A In Trouble R 49

50 C On Track Caution A In Trouble R 50

51 Midland DHB Bay of Plenty DHB Lakes DHB Hauora Tairāwhiti Taranaki DHB Waikato DHB Midland Trauma System (MTS) - Trauma 2016/17 Snapshot ( At risk excerpt) Source: Midland Trauma System 2016/17* (*all data based on fiscal year 2016/17) At risk in each Midland DHB (includes commentary specifically looking at trauma incidence for Māori) There are significant volumes of trauma in the elderly. Although most of this is non-major trauma. It carries significant costs for BOP DHB. Young (15-24 years) male Māori are at extreme risk of trauma, with high rates of sports related injury, road traffic crash, and assault related injuries. Approximately 30% of Lakes DHB trauma admissions involve patients not residing within the Lakes DHB catchment area. Many of these admissions involve road traffic crashes or cycling injuries (especially mountain biking), most go to Rotorua Hospital. Male, non-lakes DHB residents, aged years at risk of mountain bike injuries. Paediatric injuries, especially burns. Male Māori years at high risk of assault related injury. Approximately 40% of injuries occurred within a private home. Māori have a higher incidence of trauma admissions than non-māori (874 and 538 per 100,000 per year respectively). High rates of injury in pre-schoolers and year olds. Young (15-29 years) male Māori are of extreme risk of injury. There is 1.5 times the risk of injury occurring rurally from age 10 to 70 years compared to urban or semi-urban. Almost all causes are higher rurally, such as falls, road traffic crash, and machinery. Pre-schoolers and year olds are at high risk. Road traffic crash (RTC) trauma continues to rise, partly explains very high rates of Majors (trauma) in year olds. Māori are at high risk of road traffic crash and sports injury across all age groups. Pre-schoolers, with falls at home, are at notable risk, especially Māori. Rural male farmers, years, on quad bikes at risk. NZ European males are at high risk of motorcycle crashes across all ages. C On Track Caution A In Trouble R 51

52 Regional strategic objectives The regional networks and action groups work in partnership with other regional work programmes to deliver on the region s six strategic objectives. The assessment of progress of these work programmes now completes the remainder of this report. Objective 1: Health equity for Māori Lead: Nga Toka Hauora (Midland DHBs Ms Māori Health) eneral commentary Lead Chief Executive: Jim reen reater focus on health equity for Midland s clinical networks/action groups HealthShare, with the support and leadership of Nga Toka Hauora Māori (Midland eneral Managers Māori), met in Rotorua (Lakes DHB) on 25 th September This was an initial meeting for some HealthShare staff to meet the Ms and talk through their role and responsibility. A specific focus was to consider a Health Equity tool/framework that can be used across the Midland network programmes. Nga Toka Hauora Māori affirmed prioritising its support to focus on Māori health priorities, as well as the need to reconvene in January 2018 to develop a planned approach to support Midland regional clinical networks as they consider Health Equity in the following areas: A common agreement on the health equity assessment approach? And the following are to be considered and/or confirmed and bare in mind there are other responses that we need to make as a system/ health services to build that cultural equity. Nga Toka Hauora also reiterated their representation and advocacy on the regional clinical networks/action groups. Collate the tools and strategies; Levels of tools, planning and prioritising; Using the NZ Framework to stocktake on identifying what we have and what we need canvasing the landscape; Use what tool is appropriate, ie: o Health Equity Assessment Tool o Whānau Ora Impact Assessment may also be appropriate to assess the impact of policy, and that this is especially relevant in assessing policies of sectors that have a role to play in the wider determinants of health. Health equity in planning Further, the regional clinical networks/action groups are looking at 1-2 initiatives per current work programme with the focus on health equity for Māori in mind. Drafting of the work plans has commenced and health equity is a core component of planning, ie, Is there evidence of inequalities for Māori based on data? If there is evidence of inequalities, provide detail. Health equity in action The Midland Trauma System has also recently participated in Waikato DHB s event: Hearty Hauora Kaupapa working with Mongrel Mob Waikato (see pages 45-46). Approximately 250 members of Mongrel Mob (predominantly Waikato but not exclusively) attended the Kaupapa and received presentations from a range of service providers; including trauma, Youth Intact, oral health, sexual health, Whare Ora and Hep C. All parties share the common goal of reducing barriers to accessing appropriate health services for this whānau. One of the planned objectives was to understand the most appropriate way for Nga Mangaru o Waikato whānau to receive information at the Kaupapa so engagement is positive, meaningful and sustainable - Nga Mangaru members and advisors were consulted early and ideas and approaches were checked by them before becoming approved deliverables for the day. Health equity reporting An example of a Midland regional clinical network that is looking at data and findings by ethnicity is the Midland Trauma System (MTS) see snapshots for Midland DHBs and a table of those identified as At risk in the Midland region (pages 49-51). C On Track Caution A In Trouble R 52

53 Building a culture of equity Building the evidence base Health Equity Template Quarter 2 reporting Priority area Outcome reported Establish and embed ethnicity data reporting by: Carrying out detailed analysis of relevant data and information relevant to each clinical regional priority to establish whether, and where, inequalities exist and to: establish baseline performance data monitor and report on progress towards targets and inequality inform health equity assessment of current or future services as appropriate. Health equity assessment either scheduled or undertaken: or health equity assessment using HEAT, or an appropriate tool, will be carried out on existing services to assess the effectiveness of current delivery models for meeting the needs of Māori health equity assessment using HEAT, or an appropriate tool, will be carried out on proposed services to assess the likely impact of proposed delivery models on meeting the needs of Māori. Time- frame Q2 Responsibility Milestones reported against Progress update Regional groups supported by Nga Toka Hauora (Chair M) Q Nga Toka Hauora (Chair M) HealthShare 100% of regional priorities have baselines established that measure inequality between Māori and non- Māori 1 100% of regional priorities are reported quarterly by ethnicity 2 all regional groups will have carried out a health equity assessment of their work plan initiatives and activities, or will have scheduled a health equity assessment. Data report included in Q2 report utilising the Trendly tool s reporting of 13 indicators, and a Midland region indicator dashboard summary (Māori and non-māori). Data reported by ethnicity (where available) for regional groups, eg Midland Trauma System s reporting of at risk of trauma in each Midland DHB for year 2016/17. Detail on types of trauma incidence, gender, and age groupings most at risk for Māori are identified (see eneral Commentary). Health Equity Matrix developed based on Midland DHBs chosen contributory measures towards System Level Measures; alignment with Trendly tool, national Māori Health indicators; Whānau Ora Outcomes Framework and initiatives and activities of regional groups related to the DHBs chosen contributory measures. The Matrix was submitted to the Midland DHBs Chief Executives and Midland Region overnance roup (Midland DHB Board Chairs). A subsequent paper has been requested to provide examples of health equity work by regional clinical networks/action groups. Nga Toka Hauora to develop template(s) and tools to be used by regional clinical networks and action groups to assist with keeping Equity to the fore. Where possible, representatives will be sought through the Midland DHBs Nga Toka Hauora who will be nominated as members on regional clinical networks/action groups; or available as a point of contact to provide a Māori world view, and to bring a Māori whānau and communities perspective. Midland Trauma System will benefit greatly from having Marama Tauranga, Health Equity Manager at Bay of Plenty DHB on its Strategic overnance roup. Marama has a clinical background in Emergency Medicine / Trauma and has previously worked with MTS. 1 & 1 In year one we will determine whether this can be achieved. C On Track Caution A In Trouble R 53

54 Workforce Health literacy Improve health literacy by: assessing the need to review existing information resources within the department or service using Rauemi Atawhai: A guide to developing health education resources in New Zealand 3 with a view to improving information available to patients and whānau. undertaking a health literacy review with a view to improving information available to patients and whānau so that they can obtain, process and understand. Build Māori health workforce: each Midland DHB provides a workforce profile report that identifies the number and percentage of Māori employed by professional group within each of the DHBs. This workforce profile is utilised to track building Māori health workforce capacity development. establish a strategy to increase the Māori health and disability workforce, by DHB. Q Q1 Q2-Q3 Q1-Q Regional groups supported by Nga Toka Hauora (Chair M) RDOWD Ms HR supported by Nga Toka Hauora (Chair M) all regional services have carried out a health literacy review scope the opportunities for development of a health literacy app, working together collaboratively. a regional workforce profile will be established for all Midland DHBs that identifies the Māori and non-māori workforces strategy in place across Midland DHBs for Māori workforce increase in priority areas (refer workforce section of RSP) quarterly reporting of regional workforce by DHB are routinely produced and distributed. The Six Health Literacy Dimensions are: o Leadership and management o Consumer involvement o Workforce o Meeting the needs of the population o Access and navigation o Communication Nga Toka Hauora has also offered its assistance with guiding health literacy reviews of information for patients and their whānau. Regional DHBs each have access to the workforce data for their workforces via the HWIP system. A report comparing numbers by ethnicity has been developed and provided to CEs, Ms Māori Health, and Ms HR. A report has been developed providing information about ethnic hiring practices. Quantitative data See pages for data reporting on national Māori Health Indicators utilising the Trendly Tool. Source: Trendly Promoting High Performance in Health. 3 Ministry of Health Rauemi Atawhai: A guide to developing health education resources in New Zealand. Wellington: Ministry of Health C On Track Caution A In Trouble R 54

55 Indicator Rank (Māori) Source: Trendly Promoting High Performance in Health - data available as at 3 January 2018 Number who are enrolled in PHOs in the DHB for the quarter, divided by the Statistics NZ projected Māori population for the DHB. Data reported quarterly by the Ministry of Health. Numerator: Number of usually resident Māori within the DHB who were enrolled in any PHO in New Zealand during the quarter. Denominator: The projected number of Māori resident within the DHB for the respective quarter, based on Census 2013 data provided to the Ministry of Health from Statistics New Zealand. Ambulatory sensitive hospitalisation (ASH) rates per 100,000 per year in the 0-4 years age group. Numerator: ASH numbers in the specified age group. Denominator: numbers within the specific ethnic group and age group within the DHB based on Census 2013 projections. Rates are not age-standardised. Ambulatory sensitive hospitalisation (ASH) rates per 100,000 per year in the years age group. Numerator: ASH numbers in the specified age group. Denominator: numbers within the specific ethnic group and age group within the DHB based on Census 2013 projections. Rates are age-standardised to the Indigenous Standard Population. C On Track Caution A In Trouble R 55

56 Infants are exclusively or fully breastfed at six weeks. Data provided by the Ministry of Health. Numerator: exclusive or fully breastfed (source: WCTO NHI dataset). Denominator: breastfeeding at six weeks = not null (source: WCTO NHI dataset). Note that this source differs from that stated in the WCTO Quality Improvement Framework and the annual Māori Health Plan uidance. Infants are exclusively or fully breastfed at three months. Data provided by the Ministry of Health. Numerator: exclusive or fully breastfed (source: WCTO NHI dataset). Denominator: breastfeeding at three months = not null (source: WCTO NHI dataset). Infants are receiving breast milk at six months (exclusively, fully or partially). Data provided by the Ministry of Health. Numerator: exclusive, full or partial (source: WCTO NHI dataset). Denominator: breastfeeding at six months = not null (source: WCTO NHI dataset). C On Track Caution A In Trouble R 56

57 Percentage of eligible women aged years who have had a BreastScreen Aotearoa mammogram within the past two years. Numerator: number of women screened. Denominator: number of eligible women in the DHB based on Census 2013 projections. Percentage of women aged years who have had a cervical screening event in the past 36 months. Numerator: number of women screened. Denominator: number of eligible women in the DHB based on Census 2013 projections and adjusted for the prevalence of hysterectomies The number of children who turned the milestone age of 8 months during the quarter and who have completed their age appropriate immunisations by the time they turned the milestone age. Data reported quarterly by the Ministry of Health. Numerator: Those who completed their age-appropriate immunisations and who turned eight months of age within the quarter. Denominator: The denominator comprises the number of infants eligible for full immunisation. C On Track Caution A In Trouble R 57

58 Immunisation (influenza) Proportion of those immunised with the seasonal influenza vaccination in the eligible age group (65 years and over). Percentage of preschool children enrolled with community oral health services. Data reported for each calendar year (Jan-Dec). Source: Ministry of Health. Smokefree mothers at 2 weeks postnatal Percentage of mothers who are smoke free at 2 weeks postnatal, reported time period, based on Census 2013 data provided to the Ministry of Health from Statistics New Zealand. Numerator: In the year to which the reporting relates, the total number of children under five years of age, i.e. aged 0 to 4 years of age inclusive, who are enrolled with DHBfunded oral health services (DHB s Community Oral Health Service and other DHB-contracted oral health providers such as Māori oral health providers). Denominator: In the year to which the reporting relates, the projected number of children aged C 0 to 4 years within On Track the DHB, based on projections from the 2013 Census, provided to the Ministry Caution A In Trouble R of Health by Statistics New Zealand. 58 Five year annualised average rate of sudden unexpected death in infancy (SUDI) per 1,000 live births by DHB of domicile. Numerator: The number of cases of SUDI over a five year period. Denominator: The number of live births over a five year period. Ethnic group categories are presented as they appear on the source dataset provided by the Ministry of Health.

59 Trendly Tool - Dashboard Summary (Māori) - data available as at 3 January 2018 for Q2 Progress Report Indicator Date Period Target BOP Lakes Tairāwhiti Taranaki Waikato Reached Target PHO Enrolment Oct-Dec % 95.0% 101.0% 100.0% 85.0% 93.0% 2 ASH (0-4 yrs) ASH (45-64 yrs) Breastfeeding (6 wks) Breastfeeding (3 mths) Breastfeeding (6 mths) Breast Screening (50-69 yrs) Cervical Screening (25-69 yrs) Immunisation (8 mths) Immunisation (Influenza) Yr to Mar 2017 Yr to Mar Jan-Jun % 64.0% 51.7% 59.7% 49.6% 56.3% 0 Jan-Jun % 44.5% 41.4% 38.2% 41.3% 41.4% 0 Jan-Jun % 53.6% 57.7% 55.4% 46.8% 49.1% Q4 70% 57.7% 63.5% 67.6% 61.7% 57.7% Q4 80% 69.1% 70.7% 69.8% 73.2% 66.7% Q4 95% 79.2% 88.9% 82.6% 85.3% 85.7% 0 Mar-Aug % 53.8% 32.0% 53.8% 42.1% 47.4% 0 Oral Health Jan-Dec % 67.3% 88.1% 95.7% 81.4% 72.0% 1 Smokefree 2 wk postnatal Jul-Dec % 61.0% 70.0% 57.0% 66.0% 64.0% 0 SUDI Trendly Tool Dashboard Summary (Non-Māori) - data available as at 3 January 2018 Indicator Date Period Target BOP Lakes Tairāwhiti Taranaki Waikato Reached Target PHO Enrolment Oct-Dec % 100.0% 97.0% 98.0% 96.0% 95.0% 1 ASH (0-4 yrs) ASH (45-64 yrs) Breastfeeding (6 wks) Breastfeeding (3 mths) Breastfeeding (6 mths) Breast Screening (50-69 yrs) Cervical Screening (25-69 yrs) Immunisation (8 mths) Immunisation (Influenza) Yr to Mar 2017 Yr to Mar Jan-Jun % 77.1% 66.2% 77.8% 66.7% 69.3% 2 Jan-Jun % 67.4% 57.9% 57.4% 59.2% 61.5% 2 Jan-Jun % 72.4% 62.5% 69.5% 68.0% 67.3% Q4 70% 71.2% 71.8% 72.9% 76.4% 70.4% Q4 80% 82.6% 78.0% 80.0% 82.3% 78.5% Q4 95% 85.7% 94.4% 88.9% 92.3% 89.3% 0 Mar-Aug % 58.2% 37.5% 53.4% 52.7% 52.7% 0 Oral Health Jan-Dec % 114.6% 127.3% 113.2% 101.0% 72.1% 4 Smokefree 2 wk postnatal Jul-Dec % 82.0% 81.0% 69.0% 84.0% 83.0% 0 SUDI Target attained Within 10% of target 10-20% away from target More than 20-% away from target Target field is blank where there is either no target for the indicator assigned by the Ministry of Health, or where there are specific targets tailored to each DHB. C On Track Caution A In Trouble R 59

60 Objective 2: Integrate across continuums of care - hepatitis C services Key feature article - by Jillian White (RN) Walk-In Fibroscan and chronic Hepatitis C Virus (HCV) Assessment Clinic 30 November 2017 at Te Puia Hospital, Te Puia Springs, East Coast, isborne Purpose: For chronic HCV and at risk HCV patients to help remove patient access barriers and reduce inequity. A Nurse led Community Fibroscan Clinic held by Fibroscan and Hepatitis Nurse Jillian White and Te Puia Hospital Practice Nurse Lisa Porter. Prior to the clinic, both nurses worked to date to identify and book chronic HCV patients from the East Coast area, some who had been previously lost to follow-up. The clinic was a mix of booked known HCV patients and allowed time for Walk-In at risk HCV patients. All five Hauora from the East Coast participated by referring patients and promoting the HCV clinic to patients via word of mouth, HCV posters, promoting the Fibroscan clinic date, contacting patients directly to be booked or notifying patients to attend the clinic if possible. The East Coast Hauora and medical staff involved in the clinics success included: Te Puia Hospital Tokomaru Bay Health Centre Tologa Bay Health Centre Te Araroa Matakaoa Health Centre Ruatoria Medical Centre RN Jillian White and RN Lisa Porter Due to an East Coast and isborne wide Radio Campaign aired on Radio Ngati Porou and Ngati Porou s Facebook page, plus clinic promotional posters being placed in all Hauora, patients were able to self-refer, by walking into Te Puia Hospital and asking for the Fibroscan Clinic on the day. The local radio adverts enabled far reaching awareness of the Fibroscan Clinic and people felt welcomed and comfortable to attend. We were able to provide lunch and offer tea and coffee to the patients, which was also culturally appropriate for the area. In total, 12 patients were assessed and Fibroscanned during the Clinic with a further person being scanned the day before at isborne Hospital Hep C Clinic to accommodate the patient. Being flexible and having good relationships with the Specialist team made this achievable. Having clinics like these we were able to remove access barriers for these patients and have them assessed, blood tested where necessary, Fibroscanned and ultimately referred for treatment if eligible. C On Track Caution A In Trouble R 60

61 Patient Story Some patients had known of their chronic Hepatitis C for some time. They had heard there may be a possible medical cure for the condition but had not gained access to treatment for various reasons. Some patients were at risk of HCV and just wanted to check if they had the virus or not. The instant Fibroscan test result was able to show the patient if they had any liver damage. Following the scan they were referred to either eneral Practice (P) or Specialist Care, depending on their level of liver damage. The patients were able to leave the clinic armed with the latest HCV education with regards to treatment, renewed confidence in managing their chronic condition and with a plan of care going forward. One patient had been aware of his HCV for some years but had previously refused treatment and had preferred to use a healthy lifestyle approach in the hope he was able to self-cure. The instant Fibroscan result showed some liver damage. This assessment and result was enough for the patient to want to be treated for his HCV and also continue with the healthy lifestyle approach, therefore avoiding possible further liver scaring. The Te Puia Hospital Walk-In clinic was a huge success due to the management and co-ordination of the HealthShare Project Manager, pre-work by the nurses to book patients where possible, and in partnership with the local medical staff. The friendly yet informative radio campaign welcomed people at risk of HCV to have their liver assessed through a Fibroscan. The support of isborne Hospital medical staff to enable patients to be scanned that were unable to attend the Te Puia Hospital Clinic provided options for patients. Community care and education for HCV was provided in a safe, relaxed atmosphere which included providing refreshments and small but much appreciated petrol vouchers. This made all the difference to the local medical staff and most importantly the patients, who voiced being especially vulnerable to HCV stigmatisation in small communities such as these. Local East Coast area Nurses and Ps were able to become more informed and educated in a practical sense around HCV and the current referral and treatment processes. Due to the success, another clinic will be planned, to provide an opportunity for all at risk people in the East Coast area can receive treatment. Key achievements Face to face education sessions, including all stakeholders isborne, New Plymouth and Hawera Further education sessions planned for Tokoroa, Thames, Tauranga and Hamilton in Quarter 3 Second presentation to Midland Opioid Substitute Treatment (OST) Clinical leads Hep C Positive effect on intervention and treatment. Further invites from this meeting to present to other groups. Series of posters distributed around the region Re-issue of historic lab results completed. Pharmac data matching to see if this process results in treatment completed with 9% for lab results being treated. This is not the only measure of success, eg may confirm diagnosis and therefore determines eligibility for treatment, refer for Fibroscan and re-engage with P eresponse template to P submitted for development Taking the service to the people Te Puia Springs Hospital clinic was very well received (see report above) The Hearty Hauroa (Mongrel Mob day) engaging the unengaged identified 21 people to follow up with blood tests. Mob navigators will follow up Needle Exchange hep C clinic now fortnightly at Mount Maunganui. Clinic held on 29 December achieved seven people being Fibroscanned from 9 am until 1 pm Collaboration across region continues to grow. C On Track Caution A In Trouble R 61

62 Clinical Chair: Frank Weilert, Waikato DHB Project Manager: Andrea Coxhead (Waikato DHB) Key Actions Q1 Q2 Q3 Q4 1. Continue to raise community and P awareness, and education of the hepatitis C virus (HCV) and the risk factors for infection 2. Providing targeted testing of individuals at risk for HCV exposure 3. Continue to raise patient and P awareness of long term consequences of HCV and the benefits of treatment, including lifestyle management and antiviral therapy 4. Providing community based access to HCV testing and care that will include Liver Elastography Scans 4 services to the Midland region as a means for assessment of disease severity and as a triage tool for referral to secondary care and prioritisation for antiviral therapy 5. Establishing systems to report on the delivery of Liver Elastography Scans in primary and secondary care settings 6. Providing community based ongoing education and support (including referral to needle exchange services, community alcohol and drug services, P primary care services or social service agencies) 7. Providing long term monitoring (life-long in people with cirrhosis and until cured in people without cirrhosis) 8. Providing good information sharing with relevant health professionals 9. Working collaboratively with primary and secondary care to improve access to treatment. What we did in addition to what we said we would do Presentation to Midland region s DHB Chief Executives (CEs), Primary Health Organisation CEs and District Health Board (DHB) eneral Managers Planning and Funding Midland Region Hepatitis C Service our regional success story Community hep C nurses plus some DHB clinical staff have received access to Waikato DHB Clinical workstation (CWS) to access Fibroscan and lab results therefore allowing more timeliness and transparency of clinical information. 4 Liver Elastography Scans include mobile and fixed Fibroscan machines and Shear Wave machines being used in radiology departments. C On Track Caution A In Trouble R 62

63 Quantitative Data Measure 1: Number of people diagnosed with hepatitis C per annum by age and genotype Measures 1. Number of people diagnosed with hepatitis C per annum by genotype. Data collection process DHB regions to obtain data (by age bands) from 5 reference labs on the total number of people with a positive HCV 5 PCR 6 test and report to the Ministry of Health via six monthly Regional Service Plan reports 1.1 By Age Number of people diagnosed with hepatitis C per annum, by age Jul-Dec 2016 Jan-Jun 2017 Jul-Dec 2017 Age bands Total % Total % Total % % - 0% % - 0% 1 1.0% % 7 6% 7 5.0% % 14 12% % % 34 28% % % 47 39% % % 18 15% % % - 0% % - 0% % 1 0% - - Total % % % Note: Two indeterminate results not included Complete data as at 1 February HCV Hepatitis C virus 6 PCR - Polymerase chain reaction C On Track Caution A In Trouble R 63

64 1.2 By enotype Number of people diagnosed with hepatitis C per annum by genotype Jul-Dec 2016 Jan-Jun 2017 Jul-Jun 2017 enotype Total % Total % Total % Note: 1a % 61 52% % 1b 25 12% 9 8% % 2 9 4% 5 4% 8 4.0% % 40 34% % 4 2 1% 2 2% 3 2.0% 5-0% - 0% % 1 1% - - Total % * % ** % *Recently identified may have a data gap for Midland region as no previous data received from LabPlus for Jun 2017 **One patient not counted as genotype 1 but couldn't be typed further **One was a genotype 1a and 3 mix therefore counted twice **Two indeterminate result not included **Complete data as at 1 February 2018 Measure 2: Number of HCV Patients who have had a Liver Elastography Scan 7 in the last year Measures 2. Number of HCV patients who have had a Liver Elastography Scan in the last year (a) new patients (b) follow up. Data collection process DHB regions to establish a data collection process to obtain regular data (by age and ethnicity) from the delivery of Liver Elastography Scans in primary and secondary care and report to the Ministry of Health via six monthly Regional Service Plan reports. Note all Liver Elastography Scans are to be counted irrespective of the device used 7 Liver Elastography Scans include mobile and fixed Fibroscan machines and Shear Wave machines being used in radiology departments. C On Track Caution A In Trouble R 64

65 2.1 By Age Number of HCV patients who have had a Liver Elastography Scan, by age Jul-Dec 2016 Jan-Jun 2017 Jul-Dec 2017 Age bands (a) New patients (b) Follow up patients Total % (a) New patients (b) Follow up patients Total % (a) New patients (b) Follow up patients % % % % % % 1-1 1% % % % % % % % % % % % % % % 2-2 2% % % % % % Total % % *174 * % *Note: Complete data as at 1 February By Ethnicity Number of HCV Patients who have had a Liver Elastography Scan by ethnicity Total % Ethnicity New patients Follow up patients Jul-Dec 2016 Jan-Jun 2017 Jul-Dec 2017 Total % New patients Follow up patients Total % New patients Follow up patients Total % Māori % % % Pacific 4-4 2% 2-2 2% % Other % % % Total % % *174 * % *Note: Complete data as at 1 February 2018 C On Track Caution A In Trouble R 65

66 Objective 3: Improve quality across all regional services Key achievement Both Taranaki and Waikato DHBs are seeing success with their co-design projects. Representative: Mo Neville (Waikato DHB) - on behalf of Midland DHB Quality Managers Key Priorities: overnance A proposed structure for a wider membership for the regional quality network to be agreed by the Midland CEOs including refreshed terms of reference and reporting to support the draft strategy Regional groups exist for deteriorating patients, infection control and falls that report to the current Q&R group. To reduce the number of falls Complete an update on falls reduction activity across the Midland DHBs. Q1 Q2 Q3 Q4 Status commentary Stocktake of activity across national, regional and local priorities has been completed and key themes identified to work on over the next months, along with alternative approaches to a regional alliance with QPS staff linked to appropriate clinical networks to drive the strategy. An away day is scheduled for early in 2018 to take this work forward. Recruitment for the possible three regional spaces for quality improvement advisor places has begun. Existing quality improvement advisors at Waikato DHB have formed a learning set and lead the DHB safety projects end of life, deteriorating patient / sepsis six, etc. The infection control facilitator is involved in the HQSC staph bundle programme. There is ongoing discussion about how to support the mental health QI staff and the quality improvement programme regionally. Regional groups are in place. C Complete To improve hand hygiene Increase publicity and awareness campaign across all DHBs. Ongoing campaigns and focus across all DHBs. QSM range for Midland is 71 (Tairāwhiti), 72 (Taranaki), 81 (BOP and Lakes), and 85 (Waikato). A shared approach on ways taken to improve and sustain is via the IPC regional group. Safe surgery Ensure that data is being collected prior to the go live of the new QSM in July C All DHBs collecting data but struggle with sufficient numbers in sign out. C On Track Caution A In Trouble R 66

67 Representative: Mo Neville (Waikato DHB) - on behalf of Midland DHB Quality Managers Key Priorities: Surgical site infection Q1 Q2 Q3 Q4 Status commentary Present quarterly SSI report to Midland quality meetings Action to be taken where results are below target. A A Both Waikato (cardiac) and Lakes (orthopaedic) DHB are involved in the staph bundle collaborative. Medication safety Continue discussions on feasibility of achievement of medicines reconciliation by proposed HQSC date of 2016/17. A Waikato DHB working with HQSC on a co-design project regarding medicines on discharge and linked to the System Level Measures. To promote consumer engagement Develop / refine the consumer engagement framework for the region. All DHBs actively involved in forming consumer councils and sharing best practice and processes. A discussion on a regional network to support these councils is underway. Patient safety Support and implement the deteriorating patient work stream in line with the objectives and timescales of the national program Regional working group to be in place by end of June 2017 An agreed regional plan to be in place by end of December 2-17 Shared learning from pilot in Tairāwhiti for EWS to be discussed and regional adoption planned. A Regional working group in place with a successful face to face meeting 19 October in Hamilton, facilitated by HQSC. Out of hours and sepsis areas of focus for a number of the DHBs. EWS observation chart and trigger process in place in Tairāwhiti and goes live at Waikato in February. Regional business case for patient track being discussed. Severe concerns exist across the region with regard to the new QSM and the data collection that was due to start 1 January Existing manual collection and lack of resources makes this very difficult. C On Track Caution A In Trouble R 67

68 Enhancing capacity Objective 4: Build the workforce Representative: Regional Director of Workforce Development function Q1 Q2 Q3 Q4 Status commentary Review current workforce data available and access review completed. Each quarter workforce data is mined and added to the QlikSense library. The 2013 census information has been uploaded, divided into industries, and occupational groups. Average age, gender, and ethnicity are available by DHB, unless the numbers are too small. This is to prepare for data from the 2018 census when it becomes available. Identify gaps (clinical networks, DHBs, DHB Shared Services, Ministry of Health) gap analysis completed. Develop sustainable plan to access data required plus enhance modelling capability plan developed. Utilise work of national occupational taskforces to inform regional workforce development planning. Build a regional analyst network to share knowledge and skills and increase utilisation and access to workforce information network established. Produce regular workforce intelligence reports for DHBs and sector groups with analysis of workforce trends including workforces with lower numbers. Have been producing regular Word versions of DHB Human Resource KPI reports for local DHB Boards, to support their decision making Identify potential for a sector interest group to increase understanding of workforce needs across the sector, current workforce development, and to share information, ideas, and so that a broader perspective of the needs of those utilising health care workers can be taken during planning identify potential stakeholders; identify how to market concept. Develop communication approach including regular information sources, mechanism complete communications plan; identify resource requirements for implementation. Review the medical pipeline in the Midland region, identify issues and propose process to correct if required review the Ministry of Health (MoH) pipeline, establish regional implications. Support DHB led initiative to share low fidelity simulation scenarios and establish competency assessment simulation packages identify support requirements and implement. C On Track Caution A In Trouble R 68

69 Enhancing succession planning Enhancing diversity Representative: Regional Director of Workforce Development function Q1 Q2 Q3 Q4 Status commentary Support older or retired employees to continue to use their workplace skills (if necessary) support medical taskforce ageing workforce initiative; identify outcomes that could be applied within DHBs. Reliant on medical taskforce completing their work. Explore areas of need to improve utilisation, capability, or capacity of the nursing and midwifery workforces. Identify opportunities to work regionally. Identify if the pipeline needs to be improved - identify stakeholder group and engage; identify measures and access workforce data; determine planning methodology and engage with stakeholders; scope drafted for approval. Received MoH model in December Will interrogate and identify regional issues. May inform service planning. Mental Health & Addictions (Midland Mental Health & Addictions Network) workforce capacity and capability - work regionally to implement the actions sett in the Mental Health and Addictions Workforce Action Plan : o Review alignment with Midland Region Workforce Strategic Plan and update Midland plan. o Priorities agreed. Priorities have been agreed which align with national plan. Priorities for use of data gathered to revise and adapt workforce infrastructure; work collaboratively towards integration; improving general health of people with mental health issues; develop Māori health workforce. o Scoping documents for top priorities drafted and approved. Identify opportunities for DHBs to enhance numbers of Māori health workforce via policy, systems or processes (see Māori Health equity template) - analysis of legislation and policy; identify potential to amend systems and processes. Identify opportunities to support Kia Ora Hauora graduates to transition to work - develop a strategy across Midland DHBs for Māori workforce increase in priority areas. Identify opportunities to enhance access to cultural competence training complete stocktake and provide DHBs with results. Support DHBs to implement the State Service Commission leadership and talent management framework, and the NO and Volunteer sector (if required) - identify where shared service can add value. C On Track Caution A In Trouble R 69

70 Building workforce flexibility Representative: Regional Director of Workforce Development function Q1 Q2 Q3 Q4 Status commentary Collaborate with the Industry Training Organisation, and community health care providers to increase the numbers of workforce with L3 qualifications scoping document completed. Identify opportunities to increase numbers of the assistant workforce with the L3 qualification scoping document completed. C On Track Caution A In Trouble R 70

71 Objective 5: Improve clinical information services Regional priorities Digital Health 2020 Initiative/project overview Single Electronic Health Record (ehr) Single national ehr - involvement in Sector Advisory Committee; business case approved o Taranaki Primary care dataset complete delivery of integrated primary / secondary data to authorised DHB and primary/community users to increase clinical visibility of patient data o BOP successful bi lateral clinical access to primary/secondary CIS Status overall Continue to work with MoH as required Status commentary We have achieved bilateral data sharing between primary and secondary care primary already had access to secondary information. We are now working on extending that so that all primary care data is available to all our primary and community users. That will mean that every authorised user (community, primary, secondary) has access to filtered primary care data, community pharmacy data and DHB secondary care data. o Lakes successful bi lateral clinical access to primary/secondary CIS A Requirements gathering - potential scope overlap with espace. o Tairāwhiti successful bi lateral clinical access to primary/secondary CIS o Taranaki successful bi lateral clinical access to primary/secondary CIS o Waikato integration with Primary and Community Partners (PHO, LMC, Pharmacy, St John, etc) No update at this point Project Connect underway to provide Bi-directional summary data between Primary and secondary care. Proof of Concept complete and successful. One-click or Web portal integration in place for primary care, palliative, and community care (1053 users). High usages (600 users using it at least once per month, and 700 patient data accesses per day). Currently rolling out for Community Pharmacy, St John, and LMCs. DHB access to Pinnacle PHO held data delayed due to vendor issues, rescheduled to Jan-18. Digital Hospital Lakes MedCheck BOPDHB to work with Lakes DHB to bring Lakes community pharmacy data into shared sub-regional Éclair CDR o Lakes - capability across the Midland region has increased against assessment Looking at incorporating into the espace programme. A criteria elabs Orders continue local orders project based on regional results application. Initiative to utilise and align to regional. o BOP implementation of electronic orders in secondary care pilot to be Initial proof of concept with Whakatane Paediatrics complete. Extension of pilot to followed by phased roll out Paediatrics across Tauranga underway. Linkages with Regional espace being maintained. o Lakes ability to initiate and view orders electronically across Lakes and BOP A Will now be completed within the espace programme. o Waikato eorders (Laboratory and Radiology) Business case for tactical solution approved by BRR & espace Programme Board. In C On Track Caution A In Trouble R 71

72 Digital Health 2020 Initiative/project overview Status overall Status commentary delivery. Targeting May-18 o Live. Will transition to regional solution once available. Local integration of Independent Midwives information system o Tairāwhiti successful clinical access to primary maternity information and No update at this point. results management o Waikato successful clinical access to primary maternity information and LMC access to CWS in delivery phase. Awaiting MoH to progress national maternity solution. results management Upgrade of Sub Regional PACS/RIS and implementation of view anywhere solution o BOP solution is current and enhanced functionality delivered System upgrades and extensions completed. Planning for future upgrades underway. o Tairāwhiti solution is current and enhanced functionality delivered System upgrades and extensions completed. Planning for future upgrades underway. o Taranaki solution is current and enhanced functionality delivered A Decision in regards to regional vs local solution pending and business case in development o Waikato - solution is current and enhanced functionality delivered 2017 upgrades completed. In planning for 2018 upgrades (voice recognition, View Anywhere portal, SMS Appointment Reminders, Win10 compatible version). Lifecycle refresh of PACs and RIS and review of regional solutions as an option 3 rd party care provider access to radiology images enabled for patients in shared Not scheduled to start yet care; solution implemented/upgraded Health and wellness dataset Define and agree governance structure information governance is established across the Midland region o HealthShare A Not started yet Align information standards across the Midland region for key datasets key datasets can be accessed across the Midland region enabling better information analysis o HealthShare A Progressing through various projects Preventative health IT capability Prepare for 2018 bowel screening rollout o Waikato and Midland Bowel Screening Regional Centre (BSRC) R On hold as per MoH change to rollout approach. o Lakes and Midland Bowel Screening Regional Centre (BSRC) A Preparing business case Regional IT foundations - Midland Clinical Portal (espace Programme) Midland Clinical Portal Foundation Project (MCPFP) MCPFP live; clinician acceptance o BOP o Lakes o Tairāwhiti o Taranaki o Waikato A C On Track Caution A In Trouble R 72 Following initial Midland Clinical Portal (MCP) go-live in August, access has been rolled out to all Waikato DHB clinicians as well as 1,500 clinical staff from Taranaki DHB and 435 clinicians from Bay of Plenty DHB. Planning for adding other users, including primary care and midwives, will continue to be rolled out in the New Year. Enhancements to MCP to improve system performance, stability and functionality are continuing. Lakes DHB have taken the lead in running an MCP end-to-end testing exercise

73 Digital Health 2020 Initiative/project overview Midland Éclair Project (Regional Results) visibility of all regional Laboratory results within the regional repository from CWS within patient context; clinician acceptance o BOP transitioning BOP Éclair environment onto Midland Regional Platform o BOP, Lakes, Tairāwhiti, Taranaki, Waikato lab results (community and/or hospital) added to create regional repository o Lakes radiology reports for Lakes added to repository o BOP, Lakes, Taranaki, Waikato adoption of common results acknowledgement; electronic ordering Medications management emeds including electronic prescribing and reconciliation o Taranaki eprescribing transition and upgrade MedChart onto Midland Regional Platform o BOP, Lakes, Tairāwhiti, Taranaki, Waikato to be scoped for eprescribe, edispense, ereconciliation and emanagement business case approved Status overall A A A Status commentary which is still ongoing as at mid-december. As of December 2017, MCP contained 902,206 documents and information about: 518,787 patients, 371,630 emergency events, 422,996 inpatient events; and 1,659,610 outpatient events. Clinicians are reporting clinical and operational benefits arising from a regional view of patient information. A decision not to move the BOP hosted éclair on to the MRP has been made following a strong recommendation to implement a clean regional system that allows integration of Lab and Rad feeds of regional codesets. A new regional environment using Orion s Results software will be stood up in Q1, 2018 and initiation of integration into the development environment will commence. At this stage there is no intention to replace Sysmex/éclair. The intent is to build an Orion Results repository (led by clinicians), to test the concept of seamless visibility of clinical information across the Midland Clinical Portal, which will align with interoperability expectations of the Ministry of Health s Digital Health 2020 Strategy. This approach will use the existing licences of Orion s product suite purchased by the Region in On completion of this exercise, Orion and Sysmex will be evaluated against regional requirements (both clinical and technical) within the context of One Patient, One Record. Clinician expectation is that the solution will reduce the amount of duplication, improve the visibility of information and reduce the need to manually cut and paste data between standalone systems. Challenges with the New Zealand Universal List of Medicines (NZULM) transition but should be delivered early Planning for rollout of Medchart underway The first phase of the Better Business Case Approach which delivered a strategic assessment was completed on time and under budget. A new Project Manager will join the espace team in late January and will implement Phase 2, as outlined in the Executive Brief, once one of two options has been decided: o o Option 1: completion of the BBC second stage. Option 2: Complete evaluation of regional requirements against Orion/MedChart licensed products and a produce a strategic roadmap, with an recommendation to establish a Proof of Concept environment for medicines functionality. C On Track Caution A In Trouble R 73

74 Digital Health 2020 Initiative/project overview Status overall Status commentary Regional IT foundations - other Telehealth o Lakes telehealth foundation project telehealth services can be utilised in Telehealth services are being used for clinical practice. C clinical practice o Waikato actively progressing the rollout of Telehealth solution, inclusive of Jabber delayed due to resource contention with higher priority initiatives. Targeted for full fixed Telehealth VC units and soft clients (Jabber); participation in the Stroke o Live in early 2018, with rollout to services commencing in late A Thrombolysis Telehealth trial migration from Lync to Jabber aligned with regional direction IaaS transition to Ao IaaS solution o Waikato IAAS live Progressing in accordance with plan. 1st 3 migration phases completed with no issues. o BOP IAAS transition First 4 waves of migration completed. Over 70% of production servers and data including all clinical systems migrated to IAAS. o Lakes IAAS transition First Wave Complete. Service Establishment expected before end of year. Other ehealth business priorities Initiative/project overview Status overall Status commentary Maternity National Maternity Information System to commence once second adopter options released by national programme Implementation to commence following review and approval of business case; plan for implementation (subject to other priority projects) o BOP R Not progressing delayed while national issues sorted. o Lakes R Discovery almost complete o Taranaki R Awaiting contact from Ministry of Health (MoH) around timeframes and way forward. o Waikato R Awaiting contact from MoH around timeframes and way forward. Nationally consistent electronic oral health record Participation in MoH led programme o BOP o Lakes n/a Continuing with current Titanium product. R National RFP completed and no suitable option to move forward. Continuing with current Titanium product will be upgraded. o Taranaki RFP completed and no suitable option to move forward. In process of planning a Titanium R upgrade. o Waikato Titanium implemented. Awaiting outcome of national RFP re addressing vendor issues. Implement Titanium across hospital Dental Service (implemented for community oral health) C On Track Caution A In Trouble R 74

75 Other ehealth business priorities o Waikato - Titanium utilised by hospital dental service o Waikato - CIO representation on EOHR Programme Cancer Information Strategy support national initiatives Participation in MoH led programme o Waikato work with Midland Cancer Network to develop required business case(s) business case developed. National Immunisation Register (NIR) replacement support national initiatives; involvement in national initiatives and working groups where required business case developed o BOP R No update from MoH o Lakes R No update from MoH o Taranaki R No update from MoH o Waikato R No update from MoH n/a Additional key initiatives Initiative/project overview Status overall Status commentary Chronic conditions (diabetes and gastro) solution (Waikato) Solution (Hicom) implementation progressing. Will be utilised across Rheumatology, Diabetes (Child & Adult) & astro. Targeting May-18 o Live Patient Flow toolsets (ecwb) (Waikato) In early stages of detailed configuration, working closing with Change Team & vendor. Disaster Recovery Solution (Waikato) Plan to submit BC to MoH for approval in May-18 Windows 10 (Waikato) BC approved by BRR. To be submitted to RCC & Board. Draft BC issued to MoH. Nutrition and food management system (Waikato) BC approved by BRR, RCC, & Board. Submitted to MoH for approval. C On Track Caution A In Trouble R 75

76 Midland espace roadmap (the espace roadmap is subject to change and espace governance approval) C On Track Caution A In Trouble R 76