HOSPITAL ADVISORY COMMITTEE (HAC) MEETING. Wednesday 03 May 2017 A G E N D A

Transcription

1 HOSPITAL ADVISORY COMMITTEE (HAC) MEETING Wednesday 03 May pm A G E N D A VENUE Waitemata District Health Board Boardroom Level 1, 15 Shea Tce Takapuna 1

2 1 HOSPITAL ADVISORY COMMITTEE (HAC) MEETING 03 May 2017 Venue: Waitemata DHB Boardroom, Level 1, 15 Shea Terrace, Takapuna Time: 1.30pm Committee Members James Le Fevre Committee Chair Max Abbott WDHB Board Member Kylie Clegg WDHB Deputy Chair Sandra Coney Deputy Committee Chair Brian Neeson WDHB Board Member Morris Pita WDHB Board Member Allison Roe WDHB Board Member cc All Waitemata DHB Board Members WDHB Management Dale Bramley Chief Executive Officer Robert Paine Chief Financial Officer and Head of Corporate Services Andrew Brant Chief Medical Officer Jocelyn Peach Director of Nursing and Midwifery Cath Cronin Director of Hospital Services Joanne Brown Funding and Development Manager, Hospitals Tamzin Brott Director of Allied Health Fiona McCarthy Director Human Resources Peta Molloy Board Secretary APOLOGIES: AGENDA DISCLOSURE OF INTERESTS Does any member have an interest they have not previously disclosed? Does any member have an interest that might give rise to a conflict of interest with a matter on the agenda? PART I Items to be considered in public meeting All recommendations/resolutions are subject to approval of the Board. 1. AGENDA ORDER AND TIMING 2. CONFIRMATION OF MINUTES 1.30pm 2.1 Confirmation of Minutes of Hospital Advisory Committee Meeting (22/03/17) Actions Arising from previous meetings 3. PROVIDER REPORT 1.35pm Provider Arm Performance Report February 2017 Executive Summary Human Resources Medicine and Health of Older People Services Child, Women and Family Services Mental Health and Addiction Services Surgical and Ambulatory Services Elective Surgical Centre Provider Arm Support Services Facilities and Development 3.2 Provider Arm Performance Report March 2017 Executive Summary 2.30pm 2.45pm 4. CORPORATE REPORTS 4.1 Clinical Leaders Report 4.2 Human Resources Report 5. RESOLUTION TO EXCLUDE THE PUBLIC 2

3 1 Waitemata District Health Board Hospital Advisory Committee Member Attendance Schedule 2017 NAME Max Abbott Kylie Clegg Sandra Coney James Le Fevre (Committee Chair) Brian Neeson Morris Pita Allison Roe MAR MAY JUN JULY SEP OCT NOV x Attended the meeting x Absent * Attended part of the meeting only # Absent on Board business ^ Leave of absence 3

4 1 Board/Committee Member Max Abbott Kylie Clegg Sandra Coney James Le Fevre Brian Neeson Morris Pita Allison Roe Register of Interests Hospital Advisory Committee Involvements with other organisations Pro Vice-Chancellor (North Shore) and Dean Faculty of Health and Environmental Sciences, Auckland University of Technology Patron Raeburn House Advisor Health Workforce New Zealand Board Member, AUT Millennium Ownership Trust Chair Social Services Online Trust Board member Rotary National Science and Technology Forum Trust Board Member - Hockey New Zealand Trustee and Chair - the Hockey Foundation Trustee and Beneficiary - Mickyla Trust Trustee and Beneficiary - M&K Investments Trust (includes a share of less than 1% in Orion Health Group and a shareholding in Nextminute Holdings Ltd) Trustee and Beneficiary - M&K Investments Trust (owns 99% share in MC Capital Ltd and MC Securities Ltd and a minority shareholding in HSCP1 Ltd) Member Waitakere Ranges Local Board, Auckland Council Patron Women s Health Action Trust Member Portage Licensing Trust Member West Auckland Trusts Services Deputy Chair Auckland District Health Board Emergency Physician Auckland Adults Emergency Department Pre-hospital Physician Auckland HEMS ARHT/Auckland DHB Trustee Three Harbours Foundation Member Medical Protection Society Shareholder Pacific Edge Ltd DHB Representative (Auckland and Waitemata DHBs) Air Ambulance Codesign Procurement Governance Board. James wife is an employee of the Waitemata DHB, Department of Anaesthesia and Perioperative Medicine and a Medico-Legal Advisor for the Medical Protection Society Member Upper Harbour Local Board Member Human Rights Review Tribunal Member Auckland District Licensing Committee Managing Director BK & VS Neeson Limited Managing Director Apollo Property Investments Limited Property Development Consultant Owner/operator Shea Pita and Associates Limited Shareholder Turuki Pharmacy Limited Member - Eden Park Trust Board Morris wife is member of the Northland District Health Board Shareholder and Director of Healthcare Applications Limited Chairperson Matakana Coast Trail Trust Member - Rodney Local Board, Auckland Council Last Updated 19/03/14 06/12/16 15/12/16 12/04/17 15/12/16 06/12/16 02/11/16 4

5 Minutes of the Hospital Advisory Committee Meeting held on 22 March 2017 Recommendation: That the minutes of the Hospital Advisory Committee meeting held on 22 March 2017 be approved. 5

6 2.1 Minutes of the meeting of the Waitemata District Health Board Hospital Advisory Committee Wednesday 22 March 2017 held at Waitemata District Health Board Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 1.35pm PART I Items considered in public meeting COMMITTEE MEMBERS PRESENT James Le Fevre (Committee Chair) Max Abbott Kylie Clegg Sandra Coney (Committee Deputy Chair) Brian Neeson Allison Roe ALSO PRESENT Dale Bramley (Chief Executive Officer) Andrew Brant (Chief Medical Officer) Cath Cronin (Director of Hospital Services) Fiona McCarthy (Director of Human Resources) Jocelyn Peach (Director of Nursing and Midwifery) Joanne Brown (Funding and Development Manager-Hospitals) David Price (Director of Patient Experience) Peta Molloy (Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item.) PUBLIC AND MEDIA REPRESENTATIVES Lynda Williams (Auckland Womens Health Council) Sue Claridge (Auckland Womens Health Council) Molly Neilson (Maternity Services Consumer Council) WELCOME The Committee Chair welcomed those present. He thanked the co-opted members whose terms had now concluded for their commitment and input to the Committee. The Committee will be looking to integrate internally and externally with stakeholders and the Chairs of the Board Committees will be reporting directly to the Board. The Committee Chair also thanked the report writers as the quality of the reporting is superb with a lot of information covered. He noted that since he has been a Board member, there has been a clear shift from more of a reactive organisation to a very much proactive organisation. APOLOGIES An apology was received and accepted from Morris Pita. 6

7 2.1 DISCLOSURE OF INTERESTS There were no additions or amendments to the interests register. There were no declarations of interest relating to the open section of the agenda. 1. AGENDA ORDER AND TIMING Items were taken in the same order as listed in the agenda. 2. COMMITTEE MINUTES 2.1 Confirmation of the Minutes of the Hospital Advisory Committee Meeting held on 14 December 2016 (agenda pages 5 to 11) Resolution (Moved Sandra Coney/Seconded Kylie Clegg) That the Minutes of the Hospital Advisory Committee meeting held on 14 December 2016 be approved. Carried Actions Arising (agenda page 12 ) There are currently no actions arising. 3. PROVIDER ARM PERFORMANCE REPORT Provider Arm Performance Report June 2016 (agenda pages 13 to 79) Cath Cronin (Director Hospital Services) and Robert Paine (Chief Financial Officer Head of Corporate Services) introduced the report. Matters highlighted and response to questions included: Noting that the Faster Cancer Treatment times have been met. It was also noted that the DHB does share what it is doing regionally. That there are some financial pressures for the Provider Arm, reporting on this matter will be provided to the Committee. That the ESPI 5 indicator was not achieved in January due to the RDA strike. That in response to a question about DNA reporting, a further breakdown of data by ethnicity, will be provided to the Committee at its next meeting. Noting that the ED 6 hour health target results are sustained; there has been a rapid decrease in the variability of performance against the target. Noting that with regard to unplanned/unbudgeted maintenance and repairs there had been a number of one-off situations such as the diesel spill at North Shore Hospital. Human Resources (agenda page 13) Fiona McCarthy (Director, Human Resources) summarised this section of the report. It was noted that overall indicators are within the DHB s expected parameters and that a 7

8 2.1 deep dive looking at turnover figures has been commissioned to identify indicators and relationship depth. Acute and Emergency Medicine Division (agenda page 33) Dr Gerard De Jong (Division Head Acute and Emergency Medicine) and Alex Boersma, (General Manager, Acute and Emergency Medicine) presented this section of the report. Matters covered in discussion and response to questions included: Noting that the Acute Speciality Assessment Pathway clinic in the Assessment and Diagnostic Unit is going well and that it is planned to roll-out the clinic at Waitakere Hospital. That the Division had achieved the ESPI targets during the RDA strike, which had a significant impact. Noting that the turnover for the medical wards is impacted by new graduates training and that the medical wards and ED could be reported separately. That in response to a question about reporting, it was noted that more clinical parameters were being developed with a focus on the quality aspect rather than management. Dale Bramley (Chief Executive) noted that each Division is developing a set of metrics, which will be reported to the Committee. Frequency of the metrics reporting to the Committee (being quarterly or to each meeting) is to be decided. Specialty Medicine and Health of Older Persons (agenda page 39) Debbie Eastwood (General Manager, Medicine and Health of Older People Services) and John Scott (Head of Division, Speciality Medicine and Health of Older People Services) presented this section of the report. Matters covered in discussion and response to questions included: Noting an in-depth review will be undertaken on sick leave within the service. Results of the review will be reported to the Committee. That with regard to safety and security incidents, education was need to ensure people are selecting the actual category for an incident instead of other. That service vacancies have reduced from 27 to 16. John Scott summarised the TORU project (page 39 of the agenda). He noted that Dianna MacGregor (Maori Geriatric Nurse Specialist) identified a gap in care and engagement for older Maori residents in rest homes and in linking with Kelston Girls College developed an NCEA programme. Maori students from the College now visit Maori residents and earn NCEA credits for spending time with them and supporting them culturally. The Committee acknowledged the work undertaken by Dianna MacGregor and requested a presentation to the Board on the TORU Project. Further matters covered in discussion included: That the DHB is funding a significant piece of work, the CARE project with is a programme based in primary care. 8

9 2.1 That with regards to the Needs Assessment Service, resource has been put in place to address any issues with service delays. The Committee will be provided information on time to assessment. That regarding Acute Stroke to Rehab, a substantial piece of work is underway within stroke services at Waitemata DHB and regionally. The work will identify treatment changes and evidence around rehabilitation and models of care. A business case will be submitted to the Board later in the year on this matter. Child Women and Family (agenda page 46) Meia Schmidt-Uili (Acting Head of Department Medical), Stephanie Doe (Acting General Manager Child, Women and Family Services) and Emma Farmer (Head of Department, Midwifery) presented this section of the report. Matters covered in discussion and response to questions included: Noting the Good Start in Life Project - the DHB was pleased to be chosen for the pilot, which is being led by the Minister of Education in collaboration with the Ministry of Health. Noting that the Gateway Assessment Service has maintained a low number of children waiting. That in response to a question about the dental incident at Pukekohe Intermediate School, it was noted approximately 2,000 children had been contacted with relatively good uptake for testing. Some parents had declined testing and there were 20 families still to be contacted. The work has been led by Counties Manukau DHB. To clarify dental services, it was noted that Auckland Region Dental Service is a school service for children and Waitemata DHB delivers the service for the region. The facilities are owned by the specific DHB and Waitemata DHB provides the service within those facilities. It was noted that a report will be provided to the Board on this matter. Mental Health and Addiction (agenda page 53) Susanna Galea (Acting General Manager, Mental Health) and Alex Craig (Associate Director of Nursing, Mental Health) presented this section of the report. Susanna Galea thanked the Committee following her term as a co-opted member, she noted that she had gained a lot and hoped that she had contributed. The Committee Chair thanked Susanna and noted that the Committee very much appreciated the insights of the four co-opted members during their terms. Matters covered in discussion and response to questions included: Noting the update on seclusion rates and that the DHB has the lowest seclusion rates in the country. That an initiative regarding bed planning to 2025 will be reported to the Committee at a future meeting. Noting that Substance Addiction compulsory assessment and treatment is now an Act. Work is underway with Funding and Planning around delivery of this Act. That courtyard work for Adult Inpatient Units is underway and the courtyards are opened. The fencing of the courtyards has been reviewed to ensure people feel contained and safe, whilst reducing the ability to climb over the fences to leave the hospital site. 9

10 2.1 Susanna Galea introduced the reported special interest highlight prescription and over-the-counter drug misuse: A focus on Codeine. Warren acknowledge the report and noted referred to an Australian press release dated 20 th December 2016 reporting that the Australian Government Therapeutic Goods Administration had confirmed all medicines containing codeine being classified as prescription. In response to a request, the Committee agreed to pass a resolution for a report to the Board on the implications of moving to codeine being a prescription medicine. Resolution (Moved Sandra Coney/Seconded Max Abbott) That the Board be presented with a paper on the options and implications of moving to codeine being a prescription medicine. Carried Surgical and Ambulatory Services/Elective Surgical Centre (agenda page 62) Michelle Sunderland (General Manager, Surgical and Ambulatory Services) and Michael Rodgers (Chief of Surgery) presented this section of the report. Michael Rodgers acknowledged and thanked Michelle Sunderland who had resigned from the DHB. Matters covered in discussion and response to questions included: Noting that the Clinical Excellence metrics reported will be further developed overtime, additional commentary will be provided for context. Noting that there has been an improvement in measuring the Utilisation of Theatre at Waitakere Hospital. Provider Arm Support Services (agenda page 74) Robert Paine summarised this section of the report. In response to a question about the food service quality improvement plan, it was noted that the DHB is focussed on improving the service being provided. Resolution (Moved Kylie Clegg/Seconded Max Abbott) That the report be received. Carried 4. CORPORATE REPORTS Clinical Leaders Report (agenda pages 80 to 87 ) Dr Andrew Brant (Chief Medical Officer) and Dr Jocelyn Peach (Director of Nursing and Midwifery; Emergency Systems Planner) presented this item. An apology was received from Tamzin Brott (Director of Allied Health). 10

11 2.1 Andrew Brant summarised the Medical staff section of the report, noting: The resignation of Dr Peter van de Weijer and steps being taken to fill the vacancies. That a RACMA (The Royal Australasian College of Medical Administrators) fellow will be assisting to seek the Registered Medical Officer s perspective and involvement with organisational clinical government activities. The Committee Chair noted strong support in involving doctors in governance activity during their training. Jocelyn Peach (Director of Nursing and Midwifery; Emergency Systems Planner) summarised the Nursing and Midwifery; Emergency Planning Systems section of the report. Matters highlighted and response to questions included: That in May there will be an intake of new nursing graduates with a particular focus on increasing Maori and Pacific graduates. That work continues on the Care standards with improvements being made. That planning is underway to cope with the impact of the 2017 World Master Games event commencing at the end of April It was noted that there will be over 25,000 participants, most of which will attend with one or more family members. Both Allison Roe and Kylie Clegg advised that they could connect Jocelyn Peach with the event management Board to ensure appropriate systems and planning is in place from a DHB perspective. Resolution (Moved Max Abbott/Seconded Sandra Coney) That the report be received. Carried 4.2 Human Resources (agenda pages 88 to 95) Fiona McCarthy (Director of Human Resources) introduced this report. In response to question about senior doctor recruitment, it was noted that there had been an unusually low period of time to recruit and that this can be cyclical. In response to a question about the scholarship programme and a student not completing the programme due to hardship, it was noted that the DHB offers all the assistance it can to support students who may have to defer participation in the programme due to personal circumstances/hardships. Placement on the programme remains open for the student to return if their circumstances change. Resolution (Moved Kylie Clegg/Seconded Max Abbott) That the report be received. Carried 11

12 RESOLUTION TO EXCLUDE THE PUBLIC (agenda page 96 ) Resolution (Moved Kylie Clegg/Seconded Brian Neeson) That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below: General subject of items to be considered 1. Confirmation of Public Excluded Minutes Hospita Advisory Committee Meeting of 14/12/16 Reason for passing this resolution in relation to each item That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] Ground(s) under Clause 32 for passing this resolution Confirmation of Minutes As per resolution(s) to exclude the public from the open section of the minutes of the above meeting, in terms of the NZPH&D Act. 2. Quality Report That the public conduct of the whole or the Privacy relevant part of the proceedings of the meeting The disclosure of information would not would be likely to result in the disclosure of information for which good reason for be in the public interest because of the greater need to protect the privacy of withholding would exist, under section 6, 7 or 9 natural persons, including that of (except section 9 (2) (g) (i)) of the Official Information Act [NZPH&D Act 2000 Schedule 3, S.32 (a)] deceased natural persons. [Official Information Act 1982 S.9 (2) (a)] 3. Human Resources Report That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act Carried [NZPH&D Act 2000 Schedule 3, S.32 (a)] The open session of the meeting concluded at 3.24pm. Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations. [Official Information Act 1982 S.9 (2) (j)] SIGNED AS A CORRECT RECORD OF THE WAITEMATA DISTRICT HEALTH BOARD HOSPITAL ADVISORY COMMITTEE MEETING OF 22 MARCH 2016 COMMITTEE CHAIR 12

13 2.1 Actions Arising and Carried Forward from Meetings of the Hospital Advisory Committee as at 15 March 2017 Meeting Agenda Ref Topic 22/03/17 Speciality Medicine and Health of Older People, Needs Assessment: include update on time to assessment 22/03/17 Speciality Medicine and Health of Older People, advise on timeline for report the Committee regarding indepth review undertaken on sick leave within the service 22/03/17 Mental Health and Addiction, advise on timeline for update to the Committee regarding bed planning to 2025 Person Responsible Expected Report Back Comment John Scott 03/05/17 See Provider Arm report. Debbie Eastwood 14/06/17 Alex Craig 14/06/17 Waitemata DHB Hospital Advisory Committee Meeting 14/12/16 13

14 Provider Arm Performance Report February 2017 Recommendation: That the report be received. Prepared by: Robert Paine (Chief Financial Officer and Head of Corporate Services) and Cath Cronin (Director of Hospital Services) This report summarises the Provider arm performance for February Glossary ACC - Accident Compensation Commission ADU - Assessment and Diagnostic Unit ARDS - Auckland Regional Dental Service ARRC - Aged Related Residential Care AT&R - Assessment Treatment and Rehab CADS - Community Alcohol, Drug and Addictions Service CAMHS - Child, Adolescent Mental Health Service CWF - Child, Women and Family service DHB - District Health Board DNA - Did not attend ESC - Elective Surgery Centre ESPI - Elective Services Performance Indicators HBSS - Home Based Support Services FSA - First Specialist Assessment (outpatients) FTE - Full Time Equivalent HCA - Health Care Assistant ICU - Intensive Care Unit LoS - Length of Stay MoH - Ministry of Health MHS - Mental Health Service NOF - Neck of Femur ORL - Otorhinolaryngology (ear, nose, and throat) RMO - Registered Medical Officer SAS - Surgical and Ambulatory Services SCBU - Special care baby unit SMO - Senior Medical Officer WIES - Weighted Inlier Equivalent Separations YTD - Year To Date 14

15 Table of Contents Glossary How to interpret the scorecards Provider Arm Performance Report February 2017 Executive Summary / Overview Scorecard All services Health Targets Elective Performance Indicators Financial Performance Human Resources Divisional Reports Acute and Emergency Medicine Division Specialty Medicine and Health of Older People Division Child, Women and Family Services Mental Health and Addiction Services Surgical and Ambulatory Services Elective Surgical Centre Provider Arm Support Services Facilities and Development 15

16 How to interpret the scorecards Traffic lights For each measure, the traffic light indicates whether the actual performance is on target or not for the reporting period (or previous reporting period if data are not available as indicated by the grey bold italic font). Trend Measure description Traffic light indicator Actual Target Trend Better help for smokers to quit - hospitalised 98% 95% The colour of the traffic lights aligns with the Annual Plan: Traffic light Criteria: Relative variance actual vs. target Interpretation On target or better Achieved % achieved 0.1 5% away from target Substantially Achieved % away from target AND Not achieved, but progress %*achieved improvement from last month made <94.9% achieved % away from target, AND no improvement, OR >10% away from target Not Achieved Trend indicators A trend line and a trend indicator are reported against each measure. Trend lines represent the actual data available for the latest 12 months period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. The small data range may result in small variations appearing to be large. Note that YTD measures (e.g. WIES volumes and revenue) are cumulative by definition. As a result their trend line will always show an upward trend that resets at the beginning of the new financial year. The line direction is not necessarily reflective of positive performance. To assess the performance trend, use the trend indicator as described below. The trend indicator criteria and interpretation rules: Trend indicator Rules Interpretation Current > Previous month (or reporting period) performance Improvement Current < Previous month (or reporting period) performance Decline Current = Previous month (or reporting period) performance Stable By default, the performance criteria is the actual:target ratio. However, in some exceptions (e.g., when target is 0 and when performance can be negative (e.g., net result) the performance reflects the actual. Look up for scorecard-specific guidelines are available at the bottom of each scorecard: Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-months period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. Small data range may result small variations perceived to be large. a. ESPI traffic lights follow the MoH criteria for funding penalties: ESPI 2: the traffic light will be green if no patient is waiting, blue if greater than 0 patients and less than or equal to 10 patients or less than 0.39%, and red if 0.4% or higher. ESPI 5: the traffic light will be green if no patient is waiting, blue if greater than 0 patients and less than or equal to 10 patients or less than 0.99% and red if 1% or higher. 16

17 Provider Arm Performance Report February 2017 Executive Summary/Overview Summary Both hospitals have been busy in February and March. The refubishments and rebuilds are progressing steadily with most being completed in April including additional beds and ED at Waitakere Hospital and Community Building 5 at North Shore. Highlight of the month Child Rehabilition Service, Wilson Centre have created a video designed for children and their families to watch before they arrive at the Centre so they can get a feel about what it s about. It has been done in a child friendly way with a child leading the tour. The division are also looking at doing similar videos for other areas such as maternity. Link to video: Key Issue of the Month All performance indicators are on track to be met by 30 June It is pleasing to see both ED and Faster Cancer performance being sustained. This is the result of whole of Provider team approach and I am grateful to all our teams for their work that exemplifies our values in action. We have some pressures to achieve our orthopaedic surgical volumes but our sense is that it is a good news story with our waiting volumes at low levels and very short waiting times. We are working with our General Practitioners to identify if we have unmet demand in our community particularly focused on upper and lower limb surgery. 17

18 Scorecard variance report Service delivery Performance to meet DNA targets is still variable. We have prioritised a programme of work to review and redesign our ambulatory and outpatients processes. This will include roll out of patient focused booking and review of nursing navigation roles in our high risk communities. Total DNA Rate New Patient Asian 10% Maori 19% Other 6% Pacific Island 18% New Patient Total 9% Follow Up Asian 6% Maori 19% Other 7% Pacific Island 17% Follow Up Total 9% Of note is our navigation of our pacific patients with cancer. With custom navigation we have seen an improvement in treatment times. We are redesigning the Maori nursing role to seek the same improvements. Ethnicity data for Faster Cancer Treatment Times MoH Target is 85% compliance by July 2016 increasing to 90% compliance by July Table below of rolling 12 months 62 Day 85% Target compliance (total patient numbers in brackets) Month Maori Pacific Island Asian European June % (17/28) 73.3% (11/15) 94.4% (17/18) 69.8% (155/222) July % (20/31) 78.6% (11/14) 94.1% (16/17) 74.6% (170/228) August % (21/33) 78.6% (11/14) 95.7% (22/23) 77.4% (199/257) September % (23/33) 86.7% (13/15) 92.0% (23/25) 79.2% (213/269) October % (20/28) 86.7% (13/15) 90.9% (10/11) 81.0% (230/284) November % (22/28) 87.5% (14/16) 84.8% (28/33) 83.0% (253/305) December % (21/27) 93.3% (14/15) 85.7% (30/35) 85.5% (282/330) January % (21/26) 92.9% (13/14) 86.1% (31/36) 87.4% (319/365) 18

19 Financial performance The Provider result is $8.804m unfavourable to budget for the YTD to February The key variances are described below. Revenue Revenue is $5.645m favourable to budget YTD. The favourable YTD variance includes $8.522m additional funder revenue received as compensation for the delivery of acute volumes. This is offset against interest revenue $1.947k less than budget, which is reflective of a combination of the cash balance and the continuing low-interest rates, drug trial and donation revenue of $614k. Expenditure Overall expenditure was unfavourable to budget by $14.448m YTD. The key variances are summarised below. Personnel ($5.484m favourable YTD) A significant contributor to the favourable variance is vacancies due to positions budgeted that have yet to be appointed. Medical staff costs are favourable by $2.191m YTD. The favourable variance is largely due to vacancies offset by costs related to strike action. Nursing staff costs are favourable by $997k YTD. The favourable variance is largely due to vacancies in Mental Health and Surgical and Ambulatory Services offset by unfavourable outsourced bureau costs to cover un-recruited vacancies, watch cover and sick leave. Allied Health staff costs were favourable to budget by $916k YTD, largely due to vacancies in the Sub Specialty Medicine and Child, Women and Family services. Support staff costs are favourable by $448k YTD. Management and Administration staff costs are favourable by $933k YTD. Outsourced Services Costs ($4.899m unfavourable YTD) The unfavourable variance relates to nursing bureau costs unfavourable by $1.480m YTD largely due to the requirement for unplanned watches. A Watch Pilot was initiated in November to actively mitigate this expenditure. The variance also includes planned savings targets. Clinical Supplies Costs ($12m unfavourable YTD) The unfavourable variance relates to increased costs for patient meals, clinical supplies, inpatient pharmaceuticals and unbudgeted repairs. Infrastructure and Non-Clinical Supplies ($11.921m unfavourable YTD) The YTD unfavourable variance is related to unbudgeted repairs and maintenance in Facilities and Development of $2.4m and planned saving targets recorded in infrastructure. 19

20 Scorecard All services Waitemata DHB Monthly Performance Scorecard ALL Services February /17 Health Targets Service Delivery Actual Target Trend Elective Volumes Actual Target Trend Shorter Waits in ED 96% 95% Provider Arm - Overall 103% 100% Faster cancer treatment (62 days) 92% 85% Waiting Times ESPI 2 - % patients waiting > 4 months for FSA Compliant Best Care ESPI 5 - % patients not treated w/n 4 months Compliant ESPI 1 - OP Referrals processed w/n 15 days Compliant Patient Experience Actual Target Trend Complaint Average Response Time 13 days <14 days Patient Flow Net Promoter Score FFT a Average Length of Stay - Electives 1.55 days 1.69 days a. Average Length of Stay - Acutes 2.57 days 2.51 days Improving Outcomes Outpatient DNA rate (FSA + FUs) - Total 9% <10% Better help for smokers to quit - hospitalised 98% 95% Outpatient DNA rate (FSA + FUs) - Māori 19% <10% Outpatient DNA rate (FSA + FUs) - Pacific 21% <10% Quality & Safety Trend Older patients assessed for falling risk 98% 90% Rate of falls with major harm 0.11 <2 Value for Money b. Good hand hygiene practice 85% 80% Financial Result (YTD) Actual Target Trend S. aureus infection rate 0.04 <0.2 Revenue 580,747 k 575,103 k Occasions insertion bundle used 95% 95% Expense 588,809 k 574,360 k Pressure injuries grade 3&4 0 0 Net Surplus/Deficit -8,061 k 743 k Capital Expenditure (% Annual budget) 54% HR/Staff Experience Trend Sick leave rate 3.2% <3.8% Contracts (YTD) Turnover rate 11% 8-12% Elective WIES Volumes 11,629 11,892 Acute WIES Volumes 40,827 39,765 How to to read Performance indicators: Trend indicators: Achieved/ On track Substantially Achieved but off target Performance improved compared to previous month Not Achieved but progress made Not Achieved/ Off track Performance declined compared to previous month Performance was maintained Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range may result in small variations appearing to be large. a. 2015/16 new MoH Average length of stay definition, new 2016/17 MOH based targets. b. Jan data - Feb n/a A question? Contact: Victora Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB 20

21 Health Targets Faster Cancer Treatment Shorter Stays in Emergency Departments 21

22 Inpatient Events admitted through ED Emergency Department/ADU Presentations 22

23 Improved Access to Elective Surgery Note: Changes were made to the electives health target for 2015/2016 Percentage Change ED and Elective Volumes February 2017 Month Volumes % Change (last year) YTD Volumes % Change (last year) ED/ADU Volumes 9,778-1% 82,064 1% Elective Volumes 1,054-1% 8, % 23

24 Elective Performance Indicators Zero patients waiting over four months Summary (Feb 17) ESPI Compliant Non Compliant Non Compliant % Speciality Non Compliance % ESPI 2 Anaesthesiology % 73 ESPI2 0.03% Cardiology % ESPI5 0.52% Dermatology % Diabetes % Endocrinology % Gastro-Enterology % General Medicine % General Surgery % Gynaecology % Haematology % Infectious Diseases % Neurovascular % Orthopaedic 1, % Otorhinolaryngology 1, % Paediatric MED % Renal Medicine % Respiratory Medicine % Rheumatology % Urology % Total 10, % ESPI 5 Cardiology % General Surgery 1, % Gynaecology % Orthopaedic % Otorhinolaryngology % Urology % Total 3, % 90% of outpatient referrals acknowledged and processed within 10 days ESPI 1 (Feb 17) Specialty Compliance % Anaesthesiology % Cardiology 99.49% Dermatology 99.35% Diabetes 97.20% Endocrinology 98.86% Gastro-Enterology 97.90% General Medicine 97.75% General Surgery 97.96% Gynaecology % Haematology 94.29% Infectious Diseases 98.36% Neurovascular % Orthopaedic 98.02% Otorhinolaryngology 99.40% Paediatric MED % Renal Medicine % Respiratory Medicine 97.92% Rheumatology % Urology 99.26% Total 98.69% Legend ESPI 1: Green if 100%, Yellow if between 90% and 99.9%, and Red if 90% or less. ESPI 2: Green if 0 patients, Yellow if greater than 0 patients and less than or equal to 10 patients or less than 0.39%, and Red if 0.4% or higher. ESPI 5: Green if 0 patients, Yellow if greater than 0 patients and less than or equal to 10 patients or less than 0.99%, and Red if 1% or higher 24

25 Discharges by Specialty and Average Length of Stay Discharges by Specialty Average Length of Stay Acute Average Length of Stay Elective 25

26 Bed days by Division * excludes events ended in ED Month comparison Year comparison Feb - Jan Division March 2015 March 2016 February February Chang Change - February - February e Acute and Emergency 7,603 8, , ,506 3,795 Medicine Specialist Services and HOP 2,552 3, ,583 38,645-1,938 Child, Woman and Family 3,478 3, ,284 48,564 3,280 Surgical and Ambulatory Services 5,354 5, ,121 69,811 4,690 18,987 20,829 1, , ,526 9,827 Total Growth 10% 4% Cumulative Bed Days saved through Hospital Initiatives 26

27 Predicted versus Actual Bed Days 27

28 Financial Performance CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Feb-17 Provider ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency 69,886 68,605 1, , ,130 9, ,886 Other Income 3,180 3,285 (104) 22,383 25,973 (3,590) 39,262 Total Revenue 73,066 71,889 1, , ,103 5, ,148 EXPENDITURE Personnel Medical 14,156 14, , ,857 2, ,380 Nursing 19,229 18,661 (568) 152, , ,824 Allied Health 8,557 8, ,988 71, ,939 Support 1,422 1, ,866 12, ,548 Management / Administration 5,165 5,128 (37) 41,356 42, ,389 48,529 48,183 (346) 390, ,115 5, ,080 Other Expenditure Outsourced Services 5,256 4,879 (377) 44,534 39,635 (4,899) 59,353 Clinical Supplies 9,342 8,702 (640) 76,296 73,184 (3,112) 110,938 Infrastructure & Non-Clinical Supplies 10,271 7,493 (2,778) 77,347 65,426 (11,921) 94,777 24,869 21,073 (3,796) 198, ,245 (19,932) 265,068 Total Expenditure 73,397 69,256 (4,141) 588, ,360 (14,448) 863,148 Cost Net of Other Revenue (331) 2,633 (2,965) (8,061) 743 (8,804) 0 CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Feb-17 Provider ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget CONTRIBUTION Surg & Ambulatory (12,253) (11,988) (265) (101,089) (97,370) (3,719) (150,360) Acute and Emergency (10,693) (10,110) (583) (85,595) (82,965) (2,629) (126,836) Sub Specialty Med and HOPS (7,045) (6,952) (93) (57,126) (57,444) 318 (88,077) Child Women Family (5,735) (5,890) 154 (49,183) (48,952) (231) (75,837) Mental Health (8,763) (9,120) 356 (72,920) (74,272) 1,352 (114,344) Elective Surgery Centre (2,292) (2,138) (153) (18,407) (17,867) (540) (27,217) Provider Support 46,451 48,831 (2,380) 376, ,614 (3,354) 582,504 Net Surplus/Deficit (331) 2,633 (2,965) (8,061) 743 (8,804) 0 Government and Crown Agency: Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. 28

29 Comment on major variances The Provider result is $8.804m unfavourable to budget for the YTD to February The key variances are described below.: Acute and Emergency Medicine The division is $2.629m unfavourable YTD. The volume of dedicated patient watches in the month was on budget however; on a YTD basis patient watches have generated an unfavourable variance in bureau costs. Nursing and medical costs are unfavourable to budget YTD with pricing and volume continuing to be a significant driver. Tight cost controls are also in place in all key areas of expenditure with regular reviews between the management team and Deputy Chief Financial Officer. Sub Specialty Medicine and HOPS The division is $318k favourable YTD. The favourable result is driven predominantly by vacancies within Allied Health, contributing $487k YTD along with additional revenue for Service Level Agreements and training. Child Women and Family Services The service is $231k unfavourable YTD. February was $154k favourable primarily due to unbudgeted revenue of $157k. Mental Health Services The service is $1.352m favourable YTD. This is primarily driven by favourable variances in personnel costs offset by casual staff and overtime cover. Other expenditure is favourable by $122k YTD driven by clinical supplies and infrastructure. Clinical supply variance is the flexifund account for patient s healthcare and wellbeing in community homes. Surgical and Ambulatory Services The service is $3.719m unfavourable YTD. The service has under-delivered on elective WIES at 95%, but continues to meet elective discharges at 109% due to skin lesions. The service has prepared and is executing a recovery plan. The service management team are closely monitoring surgical health targets on a weekly basis with the Director Hospital Services. Tight cost controls are also in place in all key areas of expenditure with regular reviews between the management team and Deputy Chief Financial Officer. Elective Service Centre The service is $540k unfavourable YTD. ESC has under delivered on elective WIES at 94% and elective discharges at 97%. Revenue is unfavourable YTD offset by unplanned ACC revenue and favourable personnel and outsourced services due to vacancies and lower volumes. Provider Support Services Provider Support is $3.354m unfavourable YTD. The Corporate and Support Services includes centrally budgeted savings which are the major contributor to the unfavourable variance. The overall result for Hospital Operations is $421k unfavourable YTD. This is primarily due to the cost of pharmaceuticals and patient meal costs. 29

30 Human Resources Sick Leave Commentary and planned actions Organisational sick leave rates continue to reflect a positive trend and are within target. There is normal seasonal reduction of sick leave at this time of the year but the result for this YTD has been much improved and showing a consistent reduction across all divisions. CWF and MHS have reflected considerable improvement. It will be necessary for managers to monitor sick leave absence over the next reporting period to identify any changes to these trends and review sick leave management processes and responses to maintain this positive shift as we move towards winter. The staff flu vaccination programme is underway as part of the wider employee wellbeing programme to support staff and maintain their health and resilience. Over 2,000 staff have been vaccinated to date. 30

31 Overtime Commentary and planned actions Overtime continues to sit above the organisation target and the annual average for this reporting period has increased to sit above the upper tolerance level of 1.5%. The key driver for this continues to be MHS. MHS continue to report well significantly above the upper tolerance level for overtime averaging between 3-4 % over reporting periods. Forensics is the greatest contributor and this continues to be driven by acuity levels. The service has had eight patients requiring 2:1 or 3:1 care over the last month. Adult Services also continue to report higher overtime and this is continuing to be closely monitored and tracked with key contributor being leave cover. Active recruiting continues in all areas to fill vacancies. Annual Leave Management (headcount) Divisions Leave Bal 0-25 days Leave Bal days Leave Bal days Leave Bal 75 days + Surgical and Ambulatory Elective Surgery Centre Child Women & Family Mental Health Services Hospital Operations Facilities and Development Corporate Acute and Emergency Medical Divison Director Hospital Services Sub Specialty Med and HOPS WDHB Governance and Funding Total 5,479 1,

32 Staff Turnover Commentary and planned actions The quarterly rolling average turnover remains just within the organisations upper tolerance level of 12% for this reporting period. In general, a turnover rate of between 15% (upper) and 5% (lower) is considered to be within a healthy range and our tolerance levels align within those parameters. However, in order to provide more targeted information to managers, work will be underway over the next couple of months to investigate ways in which more detailed turnover demographics can be reported. Acute and Emergency Medicine continues to reflect higher turnover and is sitting slightly above the upper tolerance level of 12%. There has been a focus on turnover and retention in the division over the past 12 to 18 months including focused exit and retention interviews in key areas. These have not highlighted any particular trends. However, enhanced turnover and retention reporting is being investigated over the next few months by the human resource team to look to provide more targeted information and any resulting pilots will be initiated in Acute and Emergency Medicine first. The staff Living our Values survey is currently underway and feedback will be analysed to identify and key trends and opportunities that the Waitemata DHB can follow up to continue developing an environment that retains our valued staff. 32

33 Divisional Reports Acute and Emergency Medicine Division Service Overview This Division is responsible for the provision of General, Acute and Emergency Medical services. The division includes the departments of General Medicine, Assessment and Diagnostic Unit (ADU), Assessment, Diagnostic and Cardiology Unit (ADCU), Emergency Medicine, Cardiology, Medical inpatient wards and Hyperbaric Medicine. The service is managed by Dr Gerard De Jong, Division Head Acute and Emergency Medicine and Alex Boersma, General Manager. Head of Division Nursing is Shirley Ross. The Clinical Directors are Dr Hamish Hart for General Medicine, Dr Willem Landman for Emergency Care, Dr Tony Scott for Cardiology, Dr Laura Chapman for ADU and ADCU and Dr Chris Sames for Hyperbaric Medicine. Highlight of the Month Success of the Patient attendant (watches) and Care with Dignity project Shirley Ross, Nursing Head of Department completed a review of the work done to date in relation to patient attendants (watches) across the medical and AT&R wards. The use of external bureau has reduced considerably since November 2016 and the overall use of HCA patient attendants has stabilised to a more sustainable and consistent number. This is due to the implementation of the Care with Dignity project across the medical and AT&R wards. Four key processes that have been implemented: 1. a review, comprehensive nursing assessment and approval of all requests for patients requiring a higher level or 1:1 observation. 2. HCAs employed by Waitemata DHB who undergo training to manage patients with behaviours of concern and are taught to develop more therapeutic relationships with these patients. 3. an electronic bureau request form that enables accurate reporting and data collection. 4. an approval process that ensures Head of Department approval for any external bureau nurses and HCAs. The graph below shows the reduction in use of external bureau and the stabilisation of the usage of HCA/patient attendants. 33

34 There are a number of further recommendations to emerge from this review of the literature and the work done at Waitemata DHB to date. These are grouped as current work in progress and new recommendations for consideration: Current work in progress 1. Continue to support and monitor the current Care with Dignity programme, providing education and development of the HCA workforce to develop therapeutic relationships with patients and be confident in managing patients with behaviours of concern. 2. The approval process for requesting a 1:1 Patient Attendant is supported in the literature. Continue to employ senior Registered Nurses to review patients and approve a higher level of observation. 3. Continue to ensure patients are cohorted in four bedded rooms on the medical wards where possible to ensure effective use of the HCA resource. 4. Consider the investment required for falls prevention when a 1:1 patient attendant is required, more commonly in the AT&R wards for rehabilitating patients. All patients must have an individualised care plan for falls prevention that incorporates appropriate strategies for that specific patient. 5. Continue to use the electronic bureau request form to ensure accurate data information and reporting. 6. Manage HCA sick leave. New recommendations 7. Explore new models of care for anorexic patients at Waitemata DHB where they are cared for in the right environment and not on a busy acute medical ward. Allocate the correct budget to cover the required nursing resource. 8. Delirium is a medical issue and usually worst at night when the consultant responsible for the patient's medical care is usually not on duty. Further work should be done to ensure vulnerable older adults receive an appropriate assessment in ADU and have a comprehensive patient centred care plan when transferred to the ward. This will facilitate focus on preventing the patient from developing a delirium. 9. A ward where all the patients have delirium is not supported in the literature. Alternative strategies to manage wandering and absconding patients could be considered. Explore alternative options and consider the cost benefit of implementing a GPS patient tracking system on the inpatient wards to assist with managing patients who wander. 10. Roll out the project Waitemata DHB wide and include ED, ADU and the surgical wards. 11. Consider further work to develop an HCA psychiatric trained role to manage patients that currently require a security guard. The focus of this work would start in ED and ADU. Key Issues Acute Length of Stay The Acute length of stay in the organisation in the last quarter was 2.97 days (3.03 in quarter one and 3.02 in quarter two). The Division of Acute and Emergency Medicine is committed to reducing the average length of stay for patients admitted to the Medical wards and we have implemented a number of strategies to help to reduce the average length of stay for our patients. This includes regular white board rounds on the inpatient wards with a focus on individualised goal orientated care plans for patients. Starting discharge planning on the day of admission with the participation of the patient, their whanau and the multidisciplinary team, increasing the use of primary options for acute care and removing barriers to discharge. Issues are regularly escalated and there is a regular review of patients with a length of stay of over 10 days and the Head of Department reviews patients with a length of stay of over 21 days. 34

35 This work is ongoing and will ultimately link into the Acute and Speciality Medicine Patient Flow Improvement project which is due to start in April The focus of this project is the ADUs and the medical inpatient wards. Scorecard Variance Report Best Care Variance Report Patient Experience Average complaint response time currently 22 days against a target of < 14 days There has been an increase from last month (18 days) a total of 23 complaints were received during February with the ADU receiving 1, Cardiology 2, the Emergency Department 13. General Medicine 2 and the Medical Wards 5. This is an increase on the number received in February for the past two years and a number of the complaints are complex. The complaints closed in February included nine complaints received during January 2017 and the resolution time for these complaints ranged between 17 and 39 days. Improving Outcomes PCI within 120 minutes (STEMI patients) 54% against a target of 80% This target relates to Acute Myocardial Infarction patients getting to a Cath Lab within 120 minutes. When a Waitemata DHB patient is transferred to Auckland City Hospital (ACH) after hours, results are impacted by any delays in the process at that hospital. The reperfusion team at Waitemata DHB, which comprises of representatives from Lakeview cardiology nursing, Waitemata DHB cardiologists, ED nursing and ED medical have a regular teleconference with their regional counterparts to review each patient and identify areas where improvement is required. Of the February group of patients entered into Australia New Zealand Acute Coronary Syndrome QI under this category, two were impacted in their time to the Cath Lab by delays at ACH due to communication issues at that site. These issues have since been addressed by the ACH team. Turnover rate 14% against a target of 8-12% The rolling 12 month turnover rate for the Acute and Emergency Medicine service was 13.9% in February. This is against a target of 8-12% and is slightly higher than in January 2017 see graph one below. A more in-depth analysis of the data shows that Acute Medicine is at 7.4%, Cardiology and Hyperbaric at 15.3% and the Medical Wards at 13.3%. The significant outlier this month is the Emergency Department with 24.2% turnover in nursing and 30% turnover in clerical. The clerical turnover is high in the Emergency Department this month following two retirements and changes to the clerical roster (through a consultative process) to improve the flexibility and equity of the roster and this has resulted in a number of staff choosing to leave. With regards to the nursing staff in the Emergency Department ED has always been a training ground the workforce is young and they become experienced and then choose to travel and they move to other roles within the organisation (ICU and duty nurse manager roles). A number relocate to other areas of New Zealand or reduce their FTE on return from maternity leave. Maintaining and improving the clerical and nursing workforce in the ED will continue to be an area of focus for the service. 35

36 Service Delivery Variance Report ADU - % seen from triage within 120 mins 70% against a target of 80% This was last month s highlight so it is disappointing that there has been a decline in the performance of General Medicine in North Shore Hospital. The percentage of general medicine patients seen within two hours of referral fell from 84% in January 2017 to 73% in February The daily volumes through the ADU increased from 82 per day in January to 90 per day in February. The numbers reflect the extra pressure on the system. We are working with the clinicians in the ADU to understand why there has been a fall in performance despite there being an ASAP (Acute Specialty Assessment Pathway) functioning throughout the month. 36

37 Scorecard Acute and Emergency Medicine Division Waitemata DHB Monthly Performance Scorecard Acute and Emergency Medicine February /17 Health Targets Service Delivery Actual Target Trend Waiting Times Actual Target Trend a. Shorter Waits in ED 96% 95% ADU - % seen from triage w/in 120 mins 70% 85% Elective coronary angiography w/in 90 days 100% 95% Angiography for ACS w/in 72 hours 68% 70% Best Care Patient Experience Actual Target Trend Patient Flow Complaint Average Response Time 22 days <14 days Elective Discharge Volumes (Cardiology) 93% 100% Net Promoter Score FFT Outpatient DNA rate 9% <10% b. Average Length of Stay - Acutes 2.42 days <2.39 days Improving Outcomes Patients with EDS on discharge 85% 85% PCI w/in 120 minutes (STEMI patients) 54% 80% Better help for smokers to quit - hospitalised 99% 95% Quality & Safety Value for Money Older patients assessed for falling risk 97% 90% Rate of falls with major harm 0 <2 Financial Result (YTD) Actual Target Trend c. Good hand hygiene practice 83% 80% Revenue 2,656 k 2,058 k Pressure injuries grade 3&4 0 0 Expense 88,250 k 85,023 k Net Surplus/Deficit -85,595 k -82,965 k HR/Staff Experience Capital Expenditure (% Annual budget) 136% Sick leave rate % <3.8% Turnover rate 14% 8-12% Contracts (YTD) Elective WIES Volumes Acute WIES Volumes 21,852 21,336 How to to read Performance indicators: Trend indicators: Achieved/ On track Substantially Achieved but off target Performance improved compared to previous month Not Achieved but progress made Not Achieved/ Off track Performance declined compared to previous month Performance was maintained Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range may result in small variations appearing to be large. a. Data for Medicine overall b. 2015/16 new MoH Average length of stay definition, new 2016/17 MOH based targets. c. Dec data, Feb n/a A question? Contact: Victora Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB 37

38 Strategic Initiatives Variance Report Deliverable/Action On Target Cardiac Services 1. FSA chest pain clinics fully established to meet the MoH requirements from July Establish Cardiac Rehab programme based on regionally agreed best practice principles by October 2016 (a regionally agreed standardised data collection using Enigma will be used to measure referral, participation and completion rates) 3. Complete the model of care change to cardiac follow-up appointments by increasing nurse-led clinics for all cardiologists by October Identify cohort of Māori patients with DNA history who have co-morbidities and implement plan to reduce DNA rate in this cohort by June 2017 Shorter Stays in Emergency Departments 5. Analyse ED attendance data to build activity profile with options to reduce avoidable attendances report to inform quality improvement service redesign developments to be compiled by December Develop and implement specific pathways (such as Renal Colic, Sepsis, Back pain) in Implement the Accelerated Chest Pain Pathway by December 2016, review and audit by June Improve timely access to diagnostics and validation (particularly CT scan) working collaboratively with Radiology improvement initiatives by December Implement the Quality Framework, including Morbidity and Mortality, Clinical Audits, Audit schedule, data collection, metrics, and monthly quality report by December Implementation of the ED Quality Framework by June 2017, including systems in place to enable monitoring of all the mandatory and non-mandatory measures Areas off track for month and remedial plans 1. FSA chest pain clinics fully established to meet the MoH requirements from July Target not yet achieved but positive gains through shift in scheduling to provide appointments for Chest Pain patients within 42 days as part of Patient Focused Booking process change. SMO allocated to weekly Chest pain clinic. 3. Complete the model of care change to cardiac follow-up appointments by increasing nurse-led clinics for all cardiologists by October This area is progressing with three Nurse led clinic sessions per week specifically for post discharge follow up. These are resourced by the Nurse Practitioner Intern and supervised by nominated cardiologists. The plan is to increase the number of these clinics using other Clinical Nurse Specialist resource. The FTE available from the current CNS group is limited due to their commitment to cardiac rehab and heart failure demands. 8. Improve timely access to diagnostics and validation (particularly CT scan) working collaboratively with Radiology improvement initiatives by December Emergency Department is linked into radiology improvement initiatives and dashboard for access times currently under development with IT. 38

39 Financial Results - Acute and Emergency Medicine CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Feb-17 Acute and Emergency Medical Divison ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency ,265 1, ,706 Other Income Total Revenue ,656 2, ,087 EXPENDITURE Personnel Medical 3,500 3,424 (76) 28,681 27,349 (1,332) 42,124 Nursing 5,311 4,963 (348) 41,005 40,267 (738) 61,252 Allied Health (21) 1,567 1, ,475 Support Management / Administration (42) 3,661 3,429 (232) 5,269 9,469 8,990 (480) 74,914 72,725 (2,189) 111,220 Other Expenditure Outsourced Services (51) 1, (1,035) 850 Clinical Supplies 1, (87) 8,802 8, ,656 Infrastructure & Non- Clinical Supplies ,927 2,803 (124) 4,197 1,499 1,378 (121) 13,336 12,298 (1,039) 18,703 Total Expenditure 10,968 10,368 (600) 88,250 85,023 (3,227) 129,923 Cost Net of Other Revenue (10,693) (10,110) (583) (85,595) (82,965) (2,629) (126,836) * Government and Crown Agency: Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. Comment on major financial variances The overall result for Acute and Emergency Medicine is $583k unfavourable for February and $2,629k unfavourable for the YTD. Revenue ($598k favourable YTD) The favourable position is due to the reimbursement for medical costs to cover the RMO strikes and additional training revenue. 39

40 Expenditure ($3,227k unfavourable YTD) Personnel ($2,189k unfavourable YTD) Medical ($1,332k unfavourable YTD) The unfavourable position is as a result of costs to cover the RMO strikes, additional allocations and category variations within the RMOs. Nursing ($738k unfavourable YTD) Increases in acute volumes, higher occupancy rates and orientation costs are the key factors contributing to the unfavourable nursing variance. Allied Health ($50k favourable YTD) Vacancies with Cardiology Technicians and MRT staff are generating the favourable variance. Support and Management/Administration ($168k unfavourable YTD) The unfavourable variance is due to adverse positions with penal costs, sick leave, overtime and annual leave creep. Other Expenditure ($1,039k unfavourable YTD) Outsourced Services ($1,035k unfavourable YTD) The unfavourable variance is predominantly as a result of patient watch costs performed by HCAs. This is augmented by unfavourable external bureau costs used to support unplanned leave within nursing. Clinical Supplies ($120k favourable YTD) The favourable position is a result of lower volumes of ICDs used in the Cardiology service. Infrastructure and Non-Clinical Supplies ($124k unfavourable YTD) The unfavourable variance is due to increased usage of bariatric beds and higher laundry volumes. Getting back on track initiatives The financial position for Acute and Emergency Medicine as at February 2017 is $2.6m unfavourable to budget and the full year forecast is for the deficit to increase to between $2.9-$3.3m. The service has an on-going recovery plan. The management team are closely monitoring health targets and controls are in place in all key areas of expenditure with monthly reviews by members of the senior management team. Regular, timely budget information will greatly assist with the management of the variance. Most of the unfavourable variance YTD and forecasted will not be reversed by year end. This is primarily driven by RMO run category increases and over allocations, increased acute volumes, and unmet savings obligations. A limited amount of the forecasted unfavourable variance in the remaining months to year end could be influenced. These include clinical supplies, overtime, price assumptions (CME, ACC levy) and Allied technical cover (MITs) and patient watch costs. In November 2016 the service implemented a pilot to manage the watch demand and this resulted in favourable in watch costs over the last three months and the balance of year forecast is for this to continue with an improvement in the YTD. The service is $656k overspent YTD but costs of $520k have been avoided as a result of implementing this strategy. 40

41 Specialty Medicine and Health of Older People Division Service Overview This Division is responsible for the provision of medical sub-specialty and health of older people services. This includes respiratory, renal, endocrinology, stroke, dermatology, haematology, diabetes, rheumatology, infectious diseases, medical oncology, neurology, gastroenterology, smoke-free, fracture liaison services and Older Adults and Home Health, which in turn includes palliative care, geriatric medicine, district nursing, community Allied Health, needs assessment and service coordination, Mental Health Services for Older Adults, and AT&R wards. The division also includes the Medicine patient service centre. Allied Health (AH) provides clinical support (inpatient, outpatient and community) across the Acute and Emergency Medicine Division, Specialty Medicine and Health of Older People Division and Surgical and Ambulatory Service (SAS) and reports to the General Manager Specialty Medicine and Health of Older People. The service is managed by Dr John Scott, Head of Specialty Medicine and Health of Older People and Debbie Eastwood, General Manager, with Shirley Ross Head of Department Nursing. The Clinical Directors are Dr John Scott for Older Adults and Home Health, Dr Rob Butler for Psychiatry for the Older Adult, Dr Stephen Burmeister for Gastroenterology, Dr Simon Young for Diabetes /Endocrinology, Dr Janak De Zoysa for Renal, Dr Megan Cornere for Respiratory, Dr Ross Henderson for Haematology, Dr Blair Wood for Dermatology and Dr Michael Corkill for Rheumatology. Highlight of the Month Needs Assessment/Service Co-ordination (NASC) Service We would like to highlight the service provided by our NASC staff and give an insight into the difference the service makes to people s lives by supporting them to remain in the community, often in their own homes. We have provided a profile of two of our most complex patients who are being supported to remain at home with their family. Whilst the NASC service faces challenges in terms of recruitment and retention along with ensuring a timely response to patients we are proud of the service we provide to our population and the difference this makes to them and their quality of life. Background The NASC service enables adults and their caregivers to access support services in the community. They enable older adults to stay at home as safely and independently as possible as their needs change or following an admission to hospital. Support services are available to: People over 65 years of age who have disability or health related needs People under 65 years of age who need support resulting from an acute or severe illness, including palliative care People over 16 years of age who require support due to long term chronic health related issues Caregivers who require support and respite (Taikura Trust, and Child Woman and Family based services, organise support provision for other groups). Support services available are: Personal cares such as showering, dressing, medication, assistance with eating Meals Household management Day programmes Residential facilities Support for carers to take time out (respite). The responsibility for allocating funded Home Based Support Services (HBSS), sits with the NASC Service. The NASC staffs also have formal delegated authority in each DHB to approve entry into the four categories of aged related residential care (ARRC). NASC service is mandated by Waitemata DHB to carry out needs assessments for entry into long term residential care under s69f(1) of the Social Security Act Effectively they are the assessors and approvers of around $28m of HBSS and $153m of ARRC spend. 41

42 Service Specification and Performance Priority one patients are generally described as those patients with some aspect of the following: patients who have high level of dependency for personal cares, patients whose condition has rapidly deteriorated and or they or their carer is at risk. One hundred percent of patients triaged as priority one are contacted within one working day and from this contact the NASC staff member confirms the assessment timeframe. If the patient remains a priority one after this assessment they are seen within five working days. Priority two patients are those patients with some aspect of the following: patients with a moderate level of dependency and/or patients who may require some level of personal cares or patients for whom their current supports are inadequate and/or their carer needs support. We aim to see these patients within 10 working days; however, currently we are taking longer to achieve this assessment. The lower priority patients can be patients in ARRC who wish to return home and/or transfer or patients who are independent with personal care but may require assistance with household tasks and some patients may require a residential care subsidy application to be carried out. These patients wait an average of nine weeks to be seen. Below is a graph which outlines the distribution of the current patients accessing services managed via NASC and if they reside in ARRC or are receiving HBSS in the community (their own home). Current patient numbers accessing services from NASC split into Low, Medium, High and Very High needs levels Below are the profiles of two patients with complex needs that we are supporting with HBSS packages so they can remain in their own homes: year old patient with Motor Neurone Disease. He has very complex needs including: requiring two person hoist transfers, PEG feeding, high levels of anxiety, deteriorating breathing, lack of trunk control (unable to sit up or hold balance), complex medical needs including subcutaneous lines and specialist bowel programme. He is unable to communicate verbally and uses a text-to-voice device for communication. Care is required 24 hours a day. His wife and daughters are managing him at home with the assistance of NASC organised supports; he would otherwise, without these supports, require Private Hospital level care. Current DHB funded supports include 31 hours personal cares this includes daily showering and 3 x 8 hour overnight cares. This is at the upper limit of support available. His wife really appreciates NASC input and appreciates how we have been amenable to change things to try and help them. She was also grateful for us putting the overnight supports, which has helped her sleep; she stated if she could not sleep at night she would not be able to cope in the day. 42

43 2. A 90 year old patient who had major stroke in January She also has complex needs including: two person Hoist transfers and incontinence. She rarely gets out of bed now. She is not mobile and if up, is in a wheelchair. Current package of care: 31.5 hours personal cares - two carers for one hour in the morning Monday - Friday and one carer for up to two hours Saturday and Sunday, a carer for one hour x seven days at lunchtime. A carer for 1.5 hours x 7 days each evening to help prepare for bed Respite at Home four hours per week. Her husband is in his late 90s and still does most of the cooking, purchases housework privately as they do not hold a Community Services Card. The Social Worker and Geriatrician have regular input. The patient is also someone who would, without supports, require Private Hospital level care but her wish is to remain at home and so NASC has continued to work with her and her husband to provide a support package to meet her very high needs. Key Issues Patient Focused Booking (PFB) Background One of the areas identified as an improvement opportunity for our service was outpatient bookings for First Specialist Appointment (FSA) and will be the exemplar to be rolled out to other services. Apart from high priority patients all other patients were sent an assigned appointment which they could reschedule if that did not suit them, however, the appointment was not negotiated up front with the patient or their carer. The key opportunities for improvement identified with our First Specialist Appointments (FSA) booking processes were: 1. Further improve patient experience by offering patients up front a reasonable choice in appointment day and time. 2. Achieve a minimal level of rescheduling of patient appointments which impacts on the clerical staff workload. 3. Improve our DNA rates as DNA management impacts on both clinical and clerical staff. 4. Reduce the complexity to FSA wait list management when shared among multiple clerks thereby improving staff satisfaction. 5. To continue to meet the MoH compliance, as well as consistently seeing patients within the designated priority period for each specialty. Change Management The medicine team was supported by an Improvement Specialist from the Waitemata DHB Institute of Innovation and Improvement and the Health Information Group who have worked for over twelve months on redesigning our systems and processes to enable us to move to patient focused booking for FSAs. Go Live After many months of planning, reviewing and more planning we went live with patient focused booking on 27 February 2017 for all FSA appointments across the medical subspecialties. We elected to go live for FSA and to do this across the all the medical subspecialties rather than break it down and roll out by each specialty. This reduced the risk in running two system and processes concurrently. Following go live we have already received some positive feedback from patients who are now able to phone in and make an appointment such as this is a wonderful system, whoever thought of this should be recognised and thank you for allowing me to arrange an appointment for when it suits me, I wish they all did this. Pleasingly our work on PFB has also been shared with the MoH and two Waitemata DHB staff has been involved in a working party to develop a document Patient Focused Booking Principles in Practice which is available to all DHBs. These two staff will also be presenting on patient focused booking at a workshop in Wellington later in the month. 43

44 Scorecard Variance Report Best Care Variance Report Complaint Average Response Time 17 days against a target of <14 days Our complaint response time for February was impacted by one complaint that was particularly complex and took significantly longer than 14 days to investigate and complete a response. We ensured the complainant was updated regarding the delay. As a service we receive approximately eight complaints per month, however, in February we only received four complaints in total across our service. The complaint that impacted on our reported result in February was received in a prior month, but closed in February. Acute Stroke to Rehabilitation w/in 7 days 61% against a target of 80% This is a challenging target for the stroke service in its current configuration in terms of the existing model of care and ward structure. We have spent a considerable amount of time supported by the Institute to develop a new model of care/service that meets the needs of both under and over 65 year old stroke patients. The proposed model of care and its associated patient outcomes are strongly evidenced based and would therefore enable us to reach this target. Along with the model of care work we are also looking at our options to develop one of our existing wards into an integrated stroke unit. All this work will be part of our stroke business case that will focus on local stroke service delivery; however, it will also align with the regional work on both the hyper acute stroke pathway and clot retrieval. Service Delivery Variance Report Average Length of Stay AT&R 21.4 days against a target of <19 days The average Length of Stay (LoS) for the month is based on the patients who were discharged in that month Graph 1. In February we had three patients whose LoS was at the farther end of the LoS distribution at 93 days, 95 days and 104 days respectively. These longer LoS patients were all complex slow stream stroke patients, with one of the patients rehabilitation being further complicated by a fracture. As noted in graph 2 the median LoS for February is 17.5 days, however, as you can see there is a long tail from approximately 50 days to 104 days. Graph 1 44

45 Graph days is the median wait time for AT&R patients in February, the left axis shows the number of discharges with the individual patients the length of stay along the bottom of the graph. The LoS ranges from one day through to 104 days. Scorecard Specialty Medicine and Health of Older People Services Best Care Waitemata DHB Monthly Performance Scorecard Specialty Medicine and Health of Older People February /17 Service Delivery Patient Experience Actual Target Trend Waiting Times Actual Target Trend Complaint Average Response Time 17 days <14 days Urgent diagnostic colonoscopy w/in 14 days 100% 85% Net Promoter Score FFT Diagnostic colonoscopy w/in 42 days 75% 70% Surveillance colonoscopy w/in 84 days 73% 70% Improving Outcomes a. Patients admitted to stroke unit 84% 80% Patient Flow a. Acute Stroke to rehab w/in 7 days 61% 80% Outpatient DNA rate 9% <10% InterRAI assessments 92% 95% Average Length of Stay - AT&R 21.4 days <19 days Better help for smokers to quit - hospitalised 93% 95% Patients with EDS on discharge 84% 85% Quality & Safety Older patients assessed for falling risk 99% 90% Rate of falls with major harm 0.08 <2 b. Good hand hygiene practice 87% 80% Pressure injuries grade 3&4 0 0 Financial Result (YTD) Value for Money Actual Target Trend Revenue 6,619 k 5,865 k HR/Staff Experience Expense 63,746 k 63,309 k Sick leave rate 3.3% 3.8% Net Surplus/Deficit -57,126 k -57,444 k Turnover rate 11% 8-12% Capital Expenditure (% Annual budget) 131% Contracts (YTD) Elective WIES Volumes Acute WIES Volumes 1,382 1,311 How to to read Performance indicators: Trend indicators: Achieved/ On track Substantially Achieved but off target Performance improved compared to previous month Not Achieved but progress made Not Achieved/ Off track Performance declined compared to previous month Performance was maintained Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range may result in small variations appearing to be large. a. Jan dependent on coding b. Dec 2016 data - Feb n/a A question? Contact: Victora Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB 45

46 Strategic Initiatives Variance Report Deliverable/Action On Target Better help for smokers to quit 1. Maintain the Ask, Brief Advice and Support to Quit approach by providing training, resources and support to the Smokefree Lead in each inpatient hospital service ongoing 2. Set a hospital target for the percentage of smokers that make a supported quit attempt (prescribed NRT and/or accept a referral to a Stop Smoking Service) by October 2016 Stroke Services 3. Complete work initiated in 2015/16 to establish Waitemata DHB Stroke services plan and implement service improvement in two key areas of the stroke pathway by June Work regionally to implement regional hyper acute stroke pathway as agreed in 2015/16 and implement local improvements to enable the successful implementation of the regional clot retrieval service by June 2017 Cancer Services 5. Audit two tumour specialties for appropriate application of the high suspicion cancer flags (to increase identification of these patients) by December Identify the percentage of high suspicion patients who fit the criteria of high suspicion cancer who access their treatment in the private sector by June Identify the ethnicity-specific high suspicion cancer conversion rate by June Continue to contribute to the prevention and early detection of cancer through programmes including healthy lifestyles (in particular obesity, alcohol and tobacco) and screening ongoing 9. Participate in the transition to the national bowel screening programme during 2016/17 Improved Access to Diagnostics 10. Introduce a nursing role to support the selection and allocation of clinically appropriate elective patients to endoscopists 11. Continue to recruit to the endoscopy fellow roles 12. Develop the nurse endoscopist role 13. Using the Global Rating Scale as part of the National Endoscopy Quality Improvement Programme (NEQIP) ongoing 14. Ensure appropriate use of the National Referral Criteria for Direct Access Outpatient Colonoscopy ongoing Areas off track for month and remedial plans 12. Nurse Endoscopist we have completed a business case which will now go forward through the usual approval channels, however the national papers required to be completed as part of the training programme Are unlikely to be run this year due to a shortfall in applications. 46

47 Financial Results Specialty Medicine and Health of Older People CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Feb-17 Sub Specialty Med and HOPS ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency (99) 5,906 5, ,890 Other Income (30) ,029 Total Revenue (129) 6,619 5, ,918 EXPENDITURE Personnel Medical 1,530 1, ,321 12,602 (719) 19,593 Nursing 2,203 2,175 (27) 17,604 17, ,857 Allied Health 1,527 1, ,968 13, ,840 Support 0 (1) (1) 0 (10) (10) (15) Management / Administration (20) 3,638 3,527 (111) 5,445 5,699 5, ,530 47,207 (323) 72,721 Other Expenditure Outsourced Services ,451 2,229 (222) 3,379 Clinical Supplies 1,443 1,339 (104) 11,543 11, ,434 Infrastructure & Non- Clinical Supplies ,222 2, ,460 1,931 1,923 (9) 16,215 16,102 (113) 24,274 Total Expenditure 7,631 7, ,745 63,309 (437) 96,995 Cost Net of Other Revenue (7,045) (6,952) (93) (57,126) (57,444) 318 (88,077) * Government and Crown Agency: Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. Comment on major financial variances The overall result for Specialty Medicine and Health of Older People is $93k unfavourable for February and $318k favourable YTD. Revenue ($755k favourable YTD) The favourable position is due to the reimbursement for medical costs to cover the RMO strikes, additional training revenue, income from Service Level Agreements and funding for management trainees/fellows. Expenditure ($437k unfavourable YTD) Personnel ($323k unfavourable YTD) Medical ($719k unfavourable YTD) The unfavourable position is as a result of costs to cover the RMO strikes and continuing medical education expenditure. 47

48 Nursing ($29k favourable YTD) The favourable position is due to vacancies within senior nursing roles. Allied Health Support ($487k favourable YTD) The favourable position is due to vacancies across the Allied Health disciplines. Support and Management/Administration ($121k unfavourable YTD) The unfavourable position is as a result of the additional resource to support the gastroenterology service and the management trainee/fellow program. Other Expenditure ($113k unfavourable YTD) Outsourced Services ($222k unfavourable YTD) The unfavourable position is due to respite services provided by NASC (Needs Assessment and Service Coordination) and external nursing bureau costs to backfill unplanned leave. Clinical Supplies ($26k favourable YTD) The unfavourable position in the month is as a result of higher volumes of PCT s (Pharmaceutical Cancer Treatments) used in the Haematology service. On a YTD basis Haematology PCT volumes are below budget giving rise to the favourable variance. Infrastructure and Non-Clinical Supplies ($82k favourable YTD) The favourable position is due to savings in building rentals, uniform and laundry costs. Getting back on track initiatives Following recent changes by PHARMAC, high cost biologic drugs are being prescribed for a wider range of conditions. This is particularly evident in the Rheumatology Service where there is a 31% increase in costs over the prior year. Based on current trends, the cost of biologic medications will be unfavourable to budget by year end. ACC revenue within the AT&R service is now unfavourable to budget on an YTD basis. Further investigation is underway to confirm that invoicing is done in a complete and timely manner and to understand if any changes in patient volumes and/or length of stay under ACC. 48

49 Child, Women and Family Services Service Overview This Division is responsible for the provision of maternity, obstetrics, gynaecology and paediatric medicine services for our community, for the regional Out of Home Children s Respite Service, the Auckland Regional Dental Service, and the national Child Rehabilitation Service. Services are provided within our hospitals such as births, outpatient clinics and gynaecology surgery, and within our community including community midwifery, mobile/transportable dental clinics and the Wilson Centre. The service is managed by Dr Meia Schmidt-Uili (Division Head Acting) Child, Women and Family and Stephanie Doe (General Manager). Head of Division Nursing is Marianne Cameron, Head of Division Midwifery is Emma Farmer and Head of Division Allied Health is Susan Peters. The Clinical Directors are Dr Sathananthan Kanagaratnam for ARDS, Dr Christopher Peterson (Acting) for Child Health, Dr Thomas Wimbrow (Acting) for Gynaecology and Dr Helen Allen (Acting) for Obstetrics. Highlight of the Month Recruitment of New Graduate Midwives On 20 February the Waitemata DHB Maternity Service held an open day for third year midwifery students. The day was well supported by the Auckland University of Technology, our clinical coach and midwife educators. During the day students were orientated to the service and both sites, met with key staff including current new graduates and were introduced to the reconfigured programme for 2017 (devised by the new graduate working group as part of the Maternity review). The programme will provide new graduate midwives with a wide range of maternity experiences across the two hospital sites. The feedback received from the day was extremely positive. For example, the following was received via from one attendee: I just wanted to say what a wonderful day it was! It was very helpful getting the tours I enjoyed the informal aspect of it, and it was very helpful having staff members come in and out and chat to us. Due to the open day, I have actually decided to rethink my plans for employment and will be applying for Waitemata DHB, when I had been planning to go LMC this year Applicants for the programme have now been interviewed and have recruited six highly enthusiastic and passionate new midwives, including our successful Maori scholarship student, who will be starting with the service in the beginning of May This is a significant improvement from last year, where the service was unable to attract a cohort of new graduates. Key Issues Changes in the delivery of the Human Papillomavirus (HPV) school based immunisation programme The school based immunisation programme has been a core component of CWF for many years. Up until recently the programme included the provision of a three dose HPV vaccine to all girls in school Year 8 and a single dose Boostrix (tetanus, diphtheria and pertussis) vaccine to all students in school Year 7. Last year the MoH confirmed that from 2017 the HPV three dose immunisation programme will change to a two dose programme and will be extended to boys in an effort to reduce the prevalence of head and neck cancers. It is estimated that the changes in programme will result in a 40% increase in the total number of vaccinations delivered by the CWF. Predictions undertaken by the MoH indicated that approximately 30% of eligible boys would consent to participate in the programme. They also indicated that the introduction of the new programme would be cost neutral. 49

50 Initial indications from the return of consent forms within Waitemata DHB suggest that at least 50% of boys have consented to being immunised. This is significantly higher than the MoH predictions, but is consistent with overseas experience, for example in Australia a coverage rate of 61.4% was achieved within just one year. Waitemata DHB has recognised that there will be a need for increased staffing to cover the increase in consenting students. Consequently, the service has been allocated additional funding that has enabled the recruitment of 2.0 FTE public health nurses, 2.0 FTE community health workers and 1.0 FTE data administrator. Despite the additional resource, the service has found it challenging to cover the roster to respond to the increased demand for the programme and as a result has had to make changes to the existing programme, such as no longer providing catch up programmes in schools. The service will continue to work closely with primary care providers to support students to complete both doses of the programme. The uptake of the programme will also be closely monitored in partnership with the Planning, Funding and Outcomes team to understand the ongoing impact on service delivery and coverage rates. Update - Midwifery The service is continuing to make progress in recruiting to midwifery vacancies at North Shore Hospital (currently there are 2.0 FTE vacancies). Waitakere Hospital is currently fully staffed. Seven work streams have been developed in response to the findings of the Maternity Inpatient Service Review. These are: 1. Model of care (better, best, brilliant) 2. Care standards (better, best, brilliant) 3. Woman and family/whanau experience (with compassion) 4. New graduates and students (everyone matters) 5. Culture and wellbeing (everyone matters) 6. Lead Maternity Carer interface (everyone matters; better, best, brilliant) 7. Leadership and governance (better, best, brilliant). The model of care work stream that is underway is reviewing the current acuity in our maternity units to understand the pressure areas and how best we can configure the staff to meet the needs of women, babies and their families. The deliverables of the work stream have been developed in conjunction with senior staff within the service and representatives from the both inpatient facilities. The work stream is investigating the changes to workload complexity and acuity and reviewing the staffing structure. It is anticipated this will result in report and recommendations by July Scorecard Variance Report Best Care Variance Report Complaint average response time 18 days versus a target of <14 days The complaint average response time is above target this month. This is primarily due to a complex complaint received, which involved multiple services and required responses from a number of clinicians. There continues to be a focus on resolving complaints within the 14 day target. Oral health - % infants enrolled by one year 63% versus a target of 95% There continues to be steady improvement in the percentage of infants enrolled in the Auckland Regional Dental Service by one year of age. The difference in performance across DHBs reflects the progress of implementation of the multi-enrolment process. The project was initially rolled out in Waitemata DHB, followed by Auckland DHB. Counties Manukau DHB have agreed to adopt the process, but as this occurred at a later date, the enablers (e.g. implementing a new consent process) are still being worked through. This work is progressing in partnership with the Counties Manukau programme manager and maternity services. 50

51 Given the significant progress seen in Waitemata enrolments over the last six months, it is anticipated that Auckland DHB will be achieving the target by the end of June It is anticipated that Counties Manukau will also achieve the target by December The feasibility of upgrading the electronic record (Titanium) to automate enrolment at birth is currently being explored. If possible, this will further streamline the enrolment of infants in the service. Oral health - exam arrears 0-12 yrs 19% versus a target of <6% Arrears have reduced to 19% over February and further improvements have been seen in March (arrears are 18.4% at the time this report is being collated). There are two primary initiatives underway in the service at present to reduce arrears: 1. Improved productivity productivity continues to be closely monitored by teams each week. A weekly reporting system has been put in place so there is transparency in each team s performance and the operations manager is actively working with teams who are not consistently achieving expectations. 2. Improved accuracy of examination intervals an initial analysis undertaken suggests that some low risk children are having examinations scheduled more frequently than what is clinically indicated. The service is reviewing the current practices to make changes and improvements to ensure that an evidence based approach is being taken to meet the needs of the population and that children are being seen within the most appropriate timeframe. 51

52 Service Delivery Variance Report Gateway referrals waiting over 6 weeks 11 versus a target of 0 There continues to be good progress in reducing the number of children waiting for a Gateway assessment. The service is on track to minimise the waitlist by 31 March Outpatient DNA rate 11% versus a target of <10% The outpatient DNA rate is above target this month. This is an unusual result for the division. DNA rates by speciality will be closely monitored over the coming months to ensure that any trends are quickly identified and responded to. Average Length of Stay SCBU days versus a target of <7.02 days During February there has continued to be a number of early premature babies (i.e weeks gestation) being cared for in SCBU. Specifically, there were two Waitemata domiciled babies with complex health issues who were transferred back North Shore SCBU from the Neonatal Intensive Care Unit at Auckland DHB. There were also two Waitemata domiciled babies in Waitakere SCBU with complex health and social issues who required an extended length of stay. 52

53 Scorecard Child, Women and Family Services Waitemata DHB Monthly Performance Scorecard Child Women and Family Services and Elective Surgical Centre February /17 Health Targets Service Delivery Actual Target Trend Elective Volumes Actual Target Trend Shorter Waits in ED 96% 95% Provider Arm - Overall 103% 100% CWF Services 108% 100% Best Care Waiting Times Gateway referrals waiting over 6 weeks 11 0 Patient Experience Actual Target Trend Complaint Average Response Time 18 days <14 days Patient Flow Net Promoter Score FFT Outpatient DNA rate 11% <10% a. Average Length of Stay - Maternity 2.3 days <2.5 days Improving Outcomes b. Average Length of Stay - Paediatrics 1.16 days <1.56 days Exclusive breastfeeding on discharge a. 77% 75% Average Length of Stay - SCBU 9.87 days <7.02 days Women smokefree at delivery 95% 95% Theatre utilisation Gynaecology 87% 85% Better help for smokers to quit - hospitalised 92% 95% Patients with EDS on discharge 87% 85% d. Oral health - % infants enrolled by 1 year 63% 95% d. Oral health - exam arrears 0-12 yr 19% <6% Quality and Safety c. Good hand hygiene practice 89% 80% Financial Result (YTD) Value for Money Actual Target Trend Revenue 9,163 k 8,742 k HR/Staff Experience Trend Expense 58,347 k 57,694 k Sick leave rate 3.7% <3.8% Net Surplus/Deficit -49,183 k -48,952 k Turnover rate 11% 8-12% Capital Expenditure (% Annual budget) 21% Contracts (YTD) Gynaecology Elective WIES (excl ESC) 1, Gynaecology Acute WIES Maternity WIES 5,281 4,632 Paediatrics WIES 1,120 1,107 Neonatal WIES 1,263 1,316 How to to read Performance indicators: Trend indicators: Achieved/ On track Substantially Achieved but off target Performance improved compared to previous month Not Achieved but progress made Not Achieved/ Off track Performance declined compared to previous month Performance was maintained Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range may result in small variations appearing to be large. a. 2014/2015 original internal definition for 'Average length of stay'. b. 2015/16 new MoH Average length of stay definition, 2016/17 MOH based target. c. Dec data, Feb n/a d. Oral health data - Total WDHB, ADHB and CMDHB, DHB of service not domicile A question? Contact: Victora Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB Strategic Initiatives Variance Report Deliverable/Action On Target Reducing the number of assaults on children 1. Implement the neglect of care medical guidelines by June Develop the training on guidelines ready for implementation by June Develop and implement an acute paediatric (inclusive of Emergency) care and protection pathway by June Implement a monthly internal audit process to monitor implementation of screening for family violence across Mental Health, Addiction, Child, Maternity and Emergency services from October 2016, and report audit results to Family Violence Steering Group at least quarterly 5. Maintain Waitemata DHB s Child Protection Policy and CYF liaison social worker role ongoing Cancer Services 6. Identify the percentage of high suspicion patients who fit the criteria of high suspicion cancer who access their treatment in the private sector by June Identify the ethnicity-specific high suspicion cancer conversion rate by June 2017 Areas off track for month and remedial plans All on track 53

54 Financial Results - Child, Women and Family Services CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Feb-17 Child Women & Family ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency 1,187 1, ,701 8, ,720 Other Income Total Revenue 1,249 1, ,163 8, ,119 EXPENDITURE Personnel Medical 1,298 1, ,272 10,968 (304) 16,988 Nursing 2,377 2,166 (211) 18,673 18,372 (301) 28,312 Allied Health 1,874 2, ,703 16, ,602 Support Management / Administration ,604 2, ,213 5,856 5, ,399 48, ,353 Other Expenditure Outsourced Services (2) 1,713 1,450 (263) 2,144 Clinical Supplies (58) 3,957 3,548 (409) 5,358 Infrastructure & Non- Clinical Supplies ,278 4,058 (220) 6,101 1,128 1,121 (7) 9,947 9,056 (892) 13,604 Total Expenditure 6,984 6,981 (3) 58,347 57,694 (652) 88,956 Cost Net of Other Revenue (5,735) (5,890) 154 (49,183) (48,952) (231) (75,837) * Government and Crown Agency: Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. Comment on major financial variances The overall result for CWF is $154k favourable for February and $231k unfavourable for the YTD. Revenue ($421k favourable YTD) CWF funding continues to track favourably driven primarily by a variety of unbudgeted new service level agreements or one off funding streams via the Ministry of Social Development, University of Auckland, MoH, Auckland DHB and Northern Regional Alliance. A reduction in Colposcopy activity to budget is adversely impacting the overall funding position to date. The service has also been reimbursed $66k for costs associated with the recent RMO strikes. 54

55 Expenditure ($652k unfavourable YTD) Personnel ($239k favourable YTD) Medical ($304k unfavourable YTD) Medical overspending is associated primarily with high allowance costs, course and conference fees, cover for RMO strikes and Registrar run category changes. Nursing ($301k unfavourable YTD) Nursing costs have been impacted by gaps in maternity ward rosters along with challenges in filling vacant positions. Increased allowances and overtime have been notable features in the YTD result. Vacancies across public health nursing over recent months have provided some cost mitigation. A recruitment drive of public health nurses for the upcoming Human Papillomavirus immunisation programme has recently been undertaken. Allied Health Support ($830 favourable YTD) Allied Health under spends are associated primarily with vacancies across ARDS. The service has recently completed its annual recruitment of new graduate dental therapists. Other Expenditure ($892k unfavourable YTD) Outsourced Services ($263k unfavourable YTD) Use of external bureau nursing services to resource gaps in nursing rosters as well as outsourcing postnatal care to Birthcare Auckland and Urodynamic studies activity are the main drivers of the adverse Outsourced Services cost spend. A reduction in community radiology charging $80k is providing some cost mitigation to date. Clinical Supplies ($409k unfavourable YTD) Unmet embedded cost efficiencies are the dominant factor in this Clinical Supplies under spend. The YTD efficiency target of $400k along with cost pressures in treatment disposables and diagnostic supplies are being partially offset by a range of other supplies to date. Infrastructure and Non-Clinical Supplies ($220k unfavourable YTD) Unmet embedded cost efficiencies also feature as a significant variance in the Infrastructure and Non Clinical supplies to date. The YTD efficiency target of $467k is being partially offset by under spends such as transportation expenses $103k as well as utilities and maintenance costs $77k. Getting back on track initiatives In addition to the $766k of reported savings in the consolidated saving initiative schedule the following are streams of work that are being targeted as areas of further financial gain. The service continues its focus on reducing high annual leave balances without compromising clinical activity. Medical staff annual leave is currently $126k favourable to budget to date despite pressures arising from recent RMO strikes. The service has plans in place to target the April 2017 school holidays to maximise staff leave where possible. The full rollout of the Kanban stock management system along with new scanning facilities continues across CWF. The service has been engaging with healthalliance in undertaking a review of ARDS cleaning, logistics and maintenance contracts along with telecommunications. The request for proposal of the cleaning contract has been extended to March It is anticipated that opportunities for cleaning cost efficiencies are likely to be realised from July 2017 onwards. A review of maintenance vendors along with distribution services in terms of rationalising resources is also a consideration for the service. Financial benefits continue to be realised through a change in the supplier of specific dental products with costs reduced by $100k. The service remains focused on building on this over time. 55

56 Mental Health and Addiction Services Service Overview This division provides specialist community and inpatient mental health services to Waitemata residents. It also provides community alcohol, drug and other addiction services, and forensic services to the northern region. The group is currently led by the Director, Speciality Mental Health and Addiction Services (Susanna Galea), Clinical Director Forensic Services (Dr Jeremy Skipworth) and Acting General Manager (Alex Craig). Highlight of the Month New Entry into Speciality Practice, Mental Health and Addiction Nursing Graduate Programme 2017 marks 20 years since the first mental health and addiction new graduate nursing programme was run at Waitemata DHB. Waitemata is the only DHB in the country to have consistently maintained a programme provider contract for the programme. The DHB receives $20,000 per new graduate nurse to cover the costs of the University study, clinical release time and clinical workshops. By managing the contract, the DHB has been able to be innovative and develop a unique programme which consistently graduates high calibre mental health nurses. Since 1997 the programme has prepared over 300 mental health and addiction nurses and a recent search of staffing shows over 50% of the alumni are still, or have returned to, Waitemata DHB employment, with several now holding senior leadership roles. The Te Pou funding supports each new graduate nurse to complete a post graduate certificate in mental health nursing awarded by the University of Auckland, receive professional supervision, workplace preceptorship, clinical workshops and pastoral support from the programme co-ordinator. The programme supports nurses in their first year of mental health and addiction nursing practice across a range of clinical settings, including the NGO sector, and this year for the first time, in primary healthcare. The programme has received national recognition and endorsed by Te Rau Matatini, the National Maori Workforce Development Agency for the bi-cultural group supervision component, known as Whai Arataki. Whai Arataki focuses on the development of clinical/cultural competencies in a practical and understandable service delivery model to ensure culturally safe practice, within a framework of cultural/clinical skill competencies which include: Te Reo with coaching on pronunciation, Pepeha development, Karakia, Waiata, Whanau vs Family understanding, an in depth understanding of Te Whare Tapa Wha and other models of care and how to apply the principles of the Treaty of Waitangi into clinical practice. This year Whai Arataki will also be offered to Occupational Therapy and Social Work new graduates employed into the mental health and addictions service as well as Waitemata DHB graduate management trainee. The DHB receives funding for 19 participants (population based percentage of the National funding pool), and this year a further four nurses are being supported by the services to complete the programme. Key Issues Infant focused services Infant Mental Health (Matua Tuhonoga) The development new Matua Tuhonoga Infant Mental Health (0-4 years) service for Waitemata DHB continues with 5.2 FTE which includes a part-time specialist psychiatrist. Since opening in June 2016 the Matua Tuhononga service has seen a steady increase in referrals with clinicians already struggling to keep up with the demand. In the six month period October 2015 March 2016 there were seven referrals for infants aged 0-4 years, compared with 53 referrals in the six months October 2016-March Since June 2016, the service has spent a significant period of time liaising with stakeholders about the benefits of the service and have strengthened the referral pathways between the neonatal unit and paediatric services. The Matua Tuhononga service will also work in partnership with Dayspring Trust to deliver the Secure Beginnings 56

57 service. Secure Beginnings is an intensive attachment therapy service which provides vulnerable families with the opportunity to make sense of their parenting struggles and strengthen their relationship with their infant/children. CADS Pregnancy and Parental Services (CADS PPS) CADS PPS provides an outreach initiative for pregnant women and mothers with infants up to three years who are alcohol or drug addicted. The MoH has invested $1m per year over the next four years to Northland, Tarawhiti and Hawkes Bay DHBs to replicate the CADS Pregnancy and Parental Service model within these other DHBs. Waitemata CADS PPS are contracted to provide support to each of these DHBs in developing their programmes. The services will target infants with Child Youth and Family engagement, or substantiated findings of abuse or neglect, and where the infant was supported by benefits for more than 3-4 years of their lifetime. In addition, criteria also include parental involvement with the criminal justice system and where the mother has no formal qualifications. The evidence around the country is that 1% of five year olds will have this history. Analysing a representative group of 10 of these five year olds, this is how their lives may play out: after high school, seven would not have NCEA2, by 21, four would have been on a long term benefit, and by age 35, a quarter will have been in prison. These are the social costs of a poor start to life, but there are also financial costs to the community and society as a whole. On average, each child in this group will cost taxpayers $320,000 by the age of 35 and some over a million dollars. Forensic Services 15 Bed Medium Secure Unit New Build - this build started May 2016 and is still on track with a completion date of 28 June 2016 and official opening tentative date of 21 July in-patient Intellectual Disability medium secure care and rehabilitation beds - are running over capacity with 11 beds occupied. The regional intellectual disability secure service providers intend to engage the MoH in the issue, as similar pressures are being faced in other units. Mental Health Services in the ED/ADU Over recent years there has been an increase in the use of ED/AUD as a place of assessment for people presenting with mental health issues. Scoping work is currently being undertaken to review the pathway for mental health service users who access the ED/ADU. Areas of concern include: Length of time service users are spending in the ED and ADU. Availability of inpatient mental health beds and timeliness in transfer of people to these. Number of Mental Health teams working within the ED. Use of security as watches for mental health service users in the ED/ADU. A preliminary action plan to address these concerns is currently being consulted on with MHS and ED/ADU. The plan includes a proposal for providing a one team model covering 24/7 in the ED/ADU. Increasing the use of mental health trained staff in the ED and options for the flexible use of inpatient beds to meet demand. 57

58 Scorecard Variance Report Service Delivery Variance Report Wait Time Youth (0-19) < 3 weeks, 64% vs 80% Compliance continues with a slow upward trend (59% in Q1, 61% in Q2 and 64% in Q3). Over the past 12 month significant work has been done to reduce wait times. Post Discharge Community Care adult, 75% vs 90% There is concern regarding the dropping percentages of people being seen within seven days of discharge. The low PRIMHD volumes since July 2016 have been highlighted and an audit was run by the mental health service information analyst. This identified three files that were submitted to ministry and run through their compliance database but not loaded into production. This error has caused the poor post discharge performance as 55.6% is not reflective of what we report locally. Resubmission of these files will correct this going forward. Scorecard Mental Health Services Health Targets Waitemata DHB Monthly Performance Scorecard Mental Health Services February /17 Service Delivery Actual Target Trend Waiting Times (latest available) Actual Target Trend Shorter Waits in ED 90% 80% a. Youth (0-19) < 3 weeks 64% 80% a. Adult (20-64) < 3 weeks 86% 80% a. CADS (0-19) < 3 weeks 89% 80% Best Care a. CADS (20-64) < 3 weeks 89% 80% Patient Experience Actual Target Trend a. Forensic (20-64) < 3 weeks 92% 80% Complaint Average Response Time 10 days <14 days Prison inpatient waiting list 0% 0% Improving Outcomes Patient Flow Better help for smokers to quit 100% 95% Average Length of Stay - Adult Acute 15 days days Seclusion use Forensics - Episodes 12 <14 Average Length of Stay - CADS Detox 7 days 6-8 days Seclusion use Adult - Episodes 1 <5 Bed Occupancy - Adult Acute 91% 85% Adult Inpatient Units AWOL (clients) 0 1 Bed Occupancy - CADS Detox 90% 90% Forensic Units AWOL (clients) 0 1 Bed Occupancy - Forensics Acute&Rehab 96% 95% Bed Occupancy - ID 92% 70% a. MH Access Rates 0-19 years (Total) 3.36% 0% a. MH Access Rates 0-19 years (Maori) 4.51% 4.40% Community Care a. MH Access Rates years (Total) 3.31% 3.40% Treatment days per service user - adult 3.2 days 3-5 days a. MH Access Rates years (Maori) 7.52% 7.60% Treatment days per service user - child 2.1 days 2-4 days Treatment days per service user - youth 2.3 days 2-4 days HR/Staff Experience Treatment days per service user - CADS 2.1 days 2-4 days Sick leave rate 3.6% <3.8% Treatment days per service user - forensics 2.0 days 2-4 days Turnover rate 8% 8-12% Preadmission community care - adult 78% 75% Value for Money Post discharge community care - adult 75% 90% Community service user related time - adult 60% 35-45% Financial Result (YTD) Actual Target Trend Contact time with client participation - adult 84% 80-90% Revenue 9,497 k 9,222 k Whanau contacts per service user - adults 68% 70% Expense 82,418 k 83,494 k Whanau contacts per service user - child 100% 80% Net Surplus/Deficit -72,920 k -74,272 k Whanau contacts per service user - youth 100% 80% Capital Expenditure (% Annual budget) 29% How to to read Performance indicators: Trend indicators: Achieved/ On track Substantially Achieved but off target Performance improved compared to previous month Not Achieved but progress made Not Achieved/ Off track Performance declined compared to previous month Performance was maintained Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range may result in small variations appearing to be large. a. Reported 3 months in arrears (Dec data). A question? Contact: Victora Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB 58

59 Strategic Initiatives Variance Report Deliverable/Action Child and Adolescent Mental Health and Youth Alcohol and Drug Services 1. Ensure early communication and initial transitional engagement and planning for youth aged years discharged from CAMHS and Altered High into primary care using MOH/Werry Centre guidelines ongoing Transition plans for CAMHS continue with an upward trend (compliance last reported at 79.5%) All new staff to CAMHS are required to complete orientation/ training on transition planning and administration tasks required to confirm that transition plans are in place prior to discharge. On Target Reducing Unintended Teenage Pregnancy 2. Develop regional clinical standards, protocols and clinical pathways for primary and secondary care and implement from November 2016 Rising to the Challenge/Mental Health and Addition Services 3. Providers will be reliably and consistently collecting social outcome indicators by June Run focus groups with non-māori clinical staff to better understand perceived differences in assessment and treatment of Māori under CTOs (Section 29), identify gaps in current service delivery to Māori and recommend steps for improvement by June Ensure routine metabolic screening for secondary service users, with priority focus on Māori and Pacific (who have the highest physical health comorbidities) by June Implement the priority actions identified from Everyone s Business: a mental health and employment strategy for the Auckland and Waitemata DHB regions by June Support Parents Healthy Children (COPMIA) all services to develop action plans, and establish routine data collection and service champions by June 2017 Areas off track for month and remedial plans All on track 59

60 Financial Results - Mental Health Services CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Feb-17 Mental Health Services ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency 1, ,933 7, ,993 Other Income ,564 1,893 (329) 3,060 Total Revenue 1,319 1, ,497 9, ,053 EXPENDITURE Personnel Medical 1,988 2, ,818 17, ,563 Nursing 4,495 4, ,824 36, ,204 Allied Health 2,253 2,243 (10) 19,057 18,628 (429) 28,935 Support (5) (21) 761 Management / Administration ,585 3, ,951 9,200 9, ,802 76, ,413 Other Expenditure Outsourced Services (162) 1,330 1,060 (271) 1,475 Clinical Supplies ,611 Infrastructure & Non- Clinical Supplies (27) 4,575 4, , (145) 6,616 6, ,984 Total Expenditure 10,082 10, ,418 83,494 1, ,397 Cost Net of Other Revenue (8,763) (9,120) 356 (72,920) (74,272) 1,352 (114,344) * Government and Crown Agency: Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. Comment on major financial variances The overall result for MHS is $356k favourable for February and $1,352k favourable for the YTD. Revenue ($275k favourable YTD) There is an unfavourable variance due to Service Level Agreements requiring MHS overspend before funding for new and extended Child and Youth services in Rodney will be received ($803k). This was partially offset by other items such as Te Pou funding, ID new contract price, court reporting $275k, PPS Contract, strike cost at $295k offset in medical expenditure below and reimbursement from funder for Auckland University of Technology fees which is offset in outsourced services expenditure below. 60

61 Expenditure ($1,077k favourable YTD) Personnel ($954 favourable YTD Medical ($476k favourable YTD) This is mainly due to vacancies $512k (average seven FTE YTD). Annual leave is also favourable with more taken than accrued at $411k, but partially offset by covering RMO strike at $271k and court report SMO not budgeted. Nursing ($672k favourable YTD) There is a large vacancies impact of $3.325m which is being offset by covering with casuals $1.338m and overtime for nursing ($952k). Nursing allowances is $232k unfavourable. Allied Health ($429k unfavourable YTD) There is cost incurred for casual cover at $375k YTD, partially substituting prior vacancies in Allied and Allied staff are also covering nurse vacancies and management/administration vacancies. We allow recruitment above cap in Allied to ensure all Allied clinical positions remain in place. Support and Management/Administration ($235k favourable YTD) The favourable result is mainly due to vacancies of $297k and is partly offset above by employment into Allied worth $247k for the quality team. Other Expenditure ($122k favourable YTD) Outsourced Services ($271k unfavourable YTD) The unfavourable outsourced result is mainly to cover vacant medical posts. Clinical Supplies ($225k favourable YTD) The favourable result mainly due to the flexifund and individual contracts for patients healthcare and wellbeing in community homes, with spend picking up in recent months. Pharmaceuticals are overspent by $66k YTD. Infrastructure and Non-Clinical Supplies ($169k favourable YTD) The favourable result mainly due to lower rent and transport costs. These favourable variances are helping meet budget and the total is partially offset by, savings targets YTD of $374k. Getting back on track initiatives Mental health is favourable YTD and its focus remains on recruitment to bring vacancies and level of underspend down. A retention and recruitment committee has been established to analyse and explore ways of attracting staff and retaining them. Within the services, Forensics continues to focus on tracking overtime usage and sick leave on each inpatient unit and utilise their bureau first. Adult have implemented a mid-day shift to help with overtime and acuity on the community teams. 61

62 Surgical and Ambulatory Services/Elective Surgical Centre Service Overview This Division provides elective and acute surgery to our community encompassing surgical specialties such as general surgery, orthopaedics, otorhinolaryngology and urology, and includes outpatient, audiology, clinics, operating theatres and pre- and post-operative wards. ICU and radiology services are with this service. The service is managed by Mr Michael Rodgers ( Chief of Surgery) and Gill Cossey (General Manager). The Head of Division Nursing is Kate Gilmour. Highlight of the Month General Surgery Skin Service Work is underway with the Institute to develop a skin service that would bring together patients currently seen in General Surgery, ORL and Dermatology. It will enable consistency in the referral, grading and triage processes. General Surgery is currently taking the lead in improving administrative processes in that there is a dedicated clerical booker for skin lesions resulting in decreased time for a patient to have their FSA with a consultant. A Peri-Operative Nurse Coordinator has input into the management of the direct to theatre waitlist and oversight of priority one or urgent patients. Increased utilisation of the General Practitioner skin lesion scheme has resulted in decreased time to surgery and reduced the patient volumes awaiting a FSA. Key Issues Fractured Neck of Femur Time to Theatre Update NOFs Avg Hrs to Theatre Within 48 hrs > 48 hrs % Patients % Patients Avg Hrs to Theatre Jul % 27 4% 1 48 Aug % 25 17% 5 73 Sep % 24 11% 3 68 Oct % 25 22% Nov % 21 9% 2 54 Dec % 24 11% 3 60 Jan % 18 10% 2 52 The performance achievement for 85% of patients with fractured neck of femur to be operated on within 48 hours is being maintained. The time to surgery indicator is one of the most crucial factors affecting the patient experience, outcomes and mortality following a hip fracture with wait times longer than 48 hours associated with increased mortality, increased lengths of stay and morbidity. Best practice is for surgery to be performed within 48 hours as a key marker of quality. Scorecard Variance Report Best Care Variance Report Patient Experience - Net Promoter Score FFT The result of 51 to target of 65 is an outlier for this month to previous results. The result was caused by two areas and on review of the data this was due in part to the number of responses of likely. These are not considered in the net promoter score calculation. The other cause for the lower score this month was due to the very low number of responses in one area which will be a focus of work in coming months. Service Delivery Variance Report Patient Flow - Theatre Utilisation Waitakere Hospital There is limited improvement envisaged until we implement the 2017/18 theatre schedule and increase theatre sessions. The most significant strategy for improving utilisation will be increased orthopaedic surgery at Waitakere Hospital with commencement of junior medical team cover and overnight stay for elective patients. 62

63 Elective Surgical Centre Service Overview This division provides elective surgical services to our community, working alongside the Surgical and Ambulatory and CWF. It provides general surgery, orthopaedic surgery, gynaecology and urology. It has its own outpatient clinic, operating theatres, CSSD and a post-operative ward. The Clinical Director of the service is Mr Bill Farrington and the Group Manager (acting) Michelle Sutherland. Highlight of the Month We are delighted to announce the appointment of Alynne Ledesma to the position of Charge Nurse Manager of the Cullen ward, outpatients and the perioperative assessment team in the ESC. Alynne has held various nursing roles in the ESC since 2013 and more recently has been in the Acting Charge Nurse Manager position. Scorecard Variance Report Service Delivery Variance Report Patient Flow - Theatre Utilisation ESC 80% achieved to target of 85%. The Clinical Director for ESC, Bill Farrington is continuing the reviews of individual surgeons and their theatre utilisation performance in an effort to increase the utilisation. At present most surgeons determine a volume of cases to be completed in an all-day session. When the list finishes early the surgeon leaves for the day but the remainder of the theatre team are scheduled for a ten hour day and this is how the session time and subsequent utilisation are calculated, hence the deficit. We are exploring options to configure the lists differently to improve the use of these personnel resources. 63

64 Scorecard - Surgical and Ambulatory and Elective Surgical Centre Waitemata DHB Monthly Performance Scorecard Surgical and Ambulatory Service / Elective Surgical Centre February /17 Health Targets Actual Target Trend Elective Volumes Actual Target Trend Shorter Waits in ED 94% 95% Provider Arm - Overall 103% 100% Surgical and Ambulatory Services 109% 100% Elective Surgical Centre - ESC (YTD) 97% 100% Elective Surgical Centre - ESC (month) 97% 100% Best Care Waiting Times Patient Experience Actual Target Trend % of CT scans done within 6 weeks 96% 95% Complaint Average Response Time 8 days <14 days % of MRI scans done within 6 weeks 83% 85% d. Complaint Average Response Time - ESC 7 days <14 days % of US scans done within 6 weeks 96% 75% Net Promoter Score FFT - SAS Patient Flow Improving Outcomes Outpatient DNA rate (SAS & ESC) 9% <10% a. b. #NOF patients to theatre w/in 48 hours 90% 85% Better help for smokers to quit - hospitalised 98% 95% Service Delivery Average Length of Stay - Acutes 3.2 days <3.58 days b. Average Length of Stay - Electives 1.7 days <2.2 days b. Average Length of Stay - Electives - ESC 1.05 days <1.07 days Quality & Safety Theatre utilisation - NSH 87% 85% Older patients assessed for falling risk 98% 90% Theatre utilisation - WTH 63% 85% Occasions insertion bundle used 95% 95% Theatre utilisation - ESC 80% 85% c. Good hand hygiene practice 85% 80% Patients with EDS on discharge 81% 85% ICU - rate of CLAB per 1000 line days 0.95 <1 Value for Money HR/Staff Experience Sick leave rate 3.0% <3.8% Financial Result (YTD) Actual Target Trend Sick leave rate - ESC 3.5% <3.8% Revenue 4,334 k 5,508 k Turnover rate 11% 8-12% Expense 123,831 k 120,746 k Turnover rate - ESC 9% 8-12% Net Surplus/Deficit -119,497 k -115,238 k Capital Expenditure (% Annual budget) 67% Contracts (YTD) Elective WIES Volumes - SAS 5,140 5,236 Elective WIES Volumes - ESC 4,159 4,346 Acute WIES Volumes - SAS 9,636 9,788 How to to read Performance indicators: Trend indicators: Achieved/ On track Substantially Achieved but off target Performance improved compared to previous month Not Achieved but progress made Not Achieved/ Off track Performance declined compared to previous month Performance was maintained Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range may result in small variations appearing to be large. a. Reported 1 month in arrears - Jan 2017 data b. 2015/16 new MoH Average length of stay definition, 2016/17 MOH based targets. c. Feb not available - Dec data d. Oct data - no complaints to respond to since A question? Contact: Victora Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB 64

65 Strategic Initiatives Variance Report Deliverable/Action On Target 1. Develop an adult overweight health pathway, including information resources and a bariatric pathway by June Continue involvement in joint Waitemata and Auckland DHB bariatric surgery project to further develop equitable access to bariatric surgery and improve success rates for all Waitemata DHB population with increased Māori and Pacific volumes - ongoing Cancer Services 3. Audit two tumour specialties for appropriate application of the high suspicion cancer flags (to increase identification of these patients) by December Identify the percentage of high suspicion patients who fit the criteria of high suspicion cancer who access their treatment in the private sector by June Identify the ethnicity-specific high suspicion cancer conversion rate by June Localise and implement the prostate pathway in primary care by June 2017 (consistent with the Ministry of Health s Prostate Cancer Management and Referral Guidelines) 7. Continue to contribute to the prevention and early detection of cancer through programmes including healthy lifestyles (in particular obesity, alcohol and tobacco) and screening ongoing 8. Participate in the transition to the national bowel screening programme during 2016/17 Improved Access to Elective Surgery/Major Trauma 9. Recruiting additional specialist workforce, specifically an additional spinal surgeon by October Continue surgical clinical excellence programme, including ERAS, falls, surgical checklist in theatres, reduced length of stay (LOS) ongoing 11. Continue to submit data to the National Trauma Registry ongoing Improved Access to Diagnostics 12. Implement business scheduling rules for management of procedural rooms to optimise room utilisation Quality and Safety 13. Implement the HQSC s quality account guidance, promote key messages and the theme of Patient Safety Week 2016 in the 2016/17 quality account and publish online by December Implement briefing and debriefing for each theatre list in all operating theatres by June Implement local improvement methodology and front-line ownership for all surgical site infection programmes (hip and knee operations) by June Continue to: implement the falls prevention programme including falls champions on each ward, falls risk reporting at each handover, falls education and training days, and standardisation of falls reporting and investigations ongoing 17. Consistently use evidence-based structured risk assessment of pressure injury to support clinical judgement and implement effective prevention ongoing 65

66 Elective Surgical Centre 18. Continue to embed the learnings over 2015/16 from the elective productivity and Shorter Journey projects into our business as usual e.g. patient-focused bookings. 19. Ensure triage consistency and equity of access by using national CPAC tools in all specialties - ongoing Areas off track for month and remedial plans All on track 66

67 Financial Results - Surgical and Ambulatory and Elective Surgical Centre STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Feb-17 Surgical and Ambulatory ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency (66) 4,906 4,969 (64) 7,454 Other Income (148) 809 Total Revenue ,297 5,508 (211) 8,262 EXPENDITURE Personnel Medical 4,882 4, ,558 39,134 (424) 60,393 Nursing 3,228 3,110 (118) 24,948 25, ,445 Allied Health 1,152 1,073 (79) 9,148 8,849 (300) 13,592 Support ,499 1, ,360 Management / Administration (33) 4,601 4,374 (227) 6,717 9,999 9,847 (152) 79,754 79,076 (678) 121,508 Other Expenditure Outsourced Services (5) (100) (95) 963 (759) (1,722) (1,193) Clinical Supplies 2,825 2,579 (245) 22,729 21,528 (1,200) 32,827 Infrastructure & Non- Clinical Supplies ,940 3, ,561 3,147 2,830 (317) 26,632 23,803 (2,829) 36,196 Total Expenditure 13,146 12,677 (469) 106, ,879 (3,508) 157,704 Cost Net of Other Revenue (12,253) (11,988) (265) (101,089) (97,370) (3,719) (149,441) * Government and Crown Agency: Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. Comment on major financial variances The overall result for SAS is $265k unfavourable for February and $3,719k unfavourable for the YTD. The unfavourable result is primarily driven by; RMO over allocations and run category increases, increased repairs and maintenance costs and CT service contracts (Waitakere Hospital) and unmet savings obligations. Savings due to the under delivery on elective health targets YTD have been offset by a journal adjustment of negative revenue. As a result, the bottom line is not impacted by under delivery. 67

68 Production Activity Table: Surgical Health Target Activity (year to date February 2017) S&AS have under-delivered on elective WIES at 95% and over-delivered on elective discharges at 109% due to skin lesions. Revenue ($211k unfavourable YTD) The unfavourable result is due to the adjustment for under delivery and ACC revenue $368k tracking unfavourably as the services focus remains on the catch up of elective targets. The service has engaged with the ACC team to consider options including the option to back fill sessions where possible with ACC cases. In quarter 4 there may be some opportunity to increase ACC cases. Expenditure ($3,508k unfavourable YTD) Personnel ($678 unfavourable YTD) Medical ($424k unfavourable YTD) RMO costs continue to track unfavourably due to run category increases including one off leave revaluations and over allocations throughout the year in General Surgery and Orthopaedics ($916k). This is offset by savings in SMO costs in line with the YTD under delivery of volumes in SAS and ESC. Nursing ($218k favourable YTD) The favourable position net of embedded savings is offset by outsourced services agency costs of ($335k) YTD. Tight cost controls are in place with all overtime requests being reviewed by the General Manager. Allied Health ($300k unfavourable YTD) Overtime costs and high sick leave rates are being incurred due to cover issues, additional sessions and ongoing vacancies. Cover models and shifts have being re-examined to minimise the reliance on overtime pending appointments. Support and Management/Administration ($172k unfavourable YTD) The unfavourable position is due to front of house reception costs in Outpatients, which will be mitigated in March with the budget uplift for Building 5. Other Expenditure ($2,829k unfavourable YTD) Outsourced services ($1,722k unfavourable YTD) The unfavourable position is due to external agency nursing, and medical outsourced costs due to outsourced orthopaedic volumes ($373k), medical fee for service costs ($296k), lower than planned Point of Charges recharges to ESC and unmet savings. The service is currently outsourcing some elective procedures to meet year end volumes and there is a premium to outsource procedures that will be actively monitored. 68

69 Clinical supplies ($1,200k unfavourable YTD) The unfavourable position is due to; over delivery on higher joint volumes in SAS, one off repairs and maintenance costs and the Waitakere CT service contract, inflation on some supplies, pending budget allocations and unmet savings. Elective Surgical Centre - ESC STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Feb-17 Elective Surgery Centre ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency (383) (0) (383) (0) Other Income (154) 0 (154) (580) 0 (580) 0 Total Revenue (137) 0 (137) (963) (0) (963) (0) EXPENDITURE Personnel Medical Nursing (10) 3,976 4, ,217 Allied Health 1 0 (1) 3 0 (3) 0 Support 3 3 (0) (2) 40 Management / Administration ,225 4, ,708 Other Expenditure Outsourced Services (24) 6,468 6, ,151 Clinical Supplies (4) 6,103 6, ,299 Infrastructure & Non- Clinical Supplies ,060 1,621 1,598 (24) 13,220 13, ,509 Total Expenditure 2,154 2,138 (16) 17,445 17, ,217 Cost Net of Other Revenue (2,292) (2,138) (153) (18,407) (17,867) (540) (27,217) * Government and Crown Agency: Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. Comment on major financial variances The overall result for ESC is $153k unfavourable for February and $540k unfavourable for the YTD. This was due to the under delivery on elective health targets YTD, the service has realised cost savings. These estimated savings have been offset by a journal adjustment of negative revenue $1.051m. As a result, the bottom line is not impacted by under delivery. 69

70 Production Activity ESC has under-delivered on elective WIES at 94% and elective discharges at 97%. Revenue ($963k unfavourable YTD) This result was due to the revenue adjustment for under delivery $1.051m partially offset by additional ACC revenue $72k. Expenditure ($423k favourable YTD) Personnel ($150k favourable YTD) Personnel costs are tracking favourably due to under delivery and ongoing vacancies in management. Other Expenditure ($272 favourable YTD) This expenditure is tracking favourably due to under delivery including lower implant costs $268k due to under delivery on joints offset by one off repair costs and higher patient consumables attributed to complex breast surgery and spinal volumes. 70

71 SAS and ESC Combined STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Feb-17 Surg & Ambulatory - ESC ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency (50) 4,522 4,969 (447) 7,454 Other Income (188) 539 (728) 809 Total Revenue ,334 5,508 (1,174) 8,262 EXPENDITURE Personnel Medical 4,882 4, ,559 39,147 (413) 60,416 Nursing 3,739 3,612 (127) 28,925 29, ,662 Allied Health 1,153 1,073 (80) 9,151 8,849 (303) 13,592 Support ,527 1, ,400 Management / Administration (16) 4,817 4,650 (167) 7,146 10,532 10,388 (144) 83,979 83,451 (528) 128,216 Other Expenditure Outsourced Services (119) 7,431 5,920 (1,511) 8,958 Clinical Supplies 3,554 3,305 (249) 28,832 27,637 (1,195) 42,126 Infrastructure & Non- Clinical Supplies ,589 3, ,621 4,768 4,427 (341) 39,852 37,294 (2,557) 56,705 Total Expenditure 15,300 14,815 (485) 123, ,746 (3,085) 184,921 Cost Net of Other Revenue (14,545) (14,126) (419) (119,497) (115,238) (4,259) (176,659) * Government and Crown Agency: Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. 71

72 Comment on major financial variances The overall result for SAS and ESC are $419k unfavourable for February and $4.259m unfavourable YTD. Production Activity The service has under-delivered on elective WIES at 95% but continues to meet elective discharges at 104% due to skin lesions. This rate will balance as planned to % by 30 June Forecast Result The combined Surgical Services forecast is $5.6-$6.5m unfavourable by 30 June Key assumptions in the forecast include: The forecast is based on the extrapolation of the YTD financial result, adjusted for any timing issues and one off costs such as stock, prior year adjustments, repairs and leave revaluations. Catch up costs are based on delivering at % of the Surgical Elective Health Target. The additional orthopaedic elective volumes will be met by additional funding of $1.5m. There is no contingency for outsourced ORL volumes to meet treatment times as these volumes were planned to be completed internally. There is no adjustment for any potential transfer of revenue for over delivery of gynaecology volumes. Getting back on track initiatives The service has prepared and is currently executing a recovery plan. The service management team are closely monitoring surgical health targets on a weekly basis with the Director of Hospital Services. Tight cost controls are in place in all key areas of expenditure: Delegations have been escalated to General Manager Level. External bureau and all overtime requests are now approved by the General Manager. Service to design a Radiology service production plan for all modalities to ensure optimum efficiency and productivity. Monthly meetings with Director of Hospital Services, Manager Funding and Development Hospitals, Deputy Chief Financial Officer, Chief Financial Officer, General Managers, Chief of Surgery, Nursing Head of Division and Chief Medical Officer will commence in March. The Provider teams including surgical services also have fortnightly finance review meetings (since November) with the General Manager and Deputy Chief Financial Officer. The focus is on the identification of financial risks and early implementation of appropriate cost mitigations for any areas of overspend. The Human Resource reporting series highlights any over reliance on external agency and overtime hours, sick leave patterns and the success or otherwise of active leave management plans for all staff. Each division reports through to the Director Hospital Services monthly. 72

73 Cover models have been reviewed for all wards and theatres and coupled with the new Bureau Booking system are enabling far better control of planned versus actual rostered hours on the floor and acuity cover. Annual leave plans are being maximised during school holidays. Shift patterns are being re-examined to ensure minimal reliance on overtime, and a number of options have been identified. Every avenue of cost mitigation is being considered, however, the extent of the savings obligations will clearly require more substantive solutions. ESC is working with SAS to implement the elective surgical plan for FY18 where all three theatre locations will be fully utilised. The unbudgeted over delivery of clinics is being considered. Monitoring of patients ensures timely discharge and inpatient beds are being closed as appropriate to contain costs. Provider Support Services Service Overview Corporate Services include offices of the Chief Executive Officer/Chief Financial Officer/Chief Medical Officer/Director of Nursing/Director of Allied Health, Corporate Finance, Operational Finance, Information Systems and Management, Facilities and Development, Quality, HR and Awhina and Māori Services. It also includes outsourced healthalliance services, NZ Health Partnerships, Other affiliation costs and financing costs. Robert Paine has overall financial responsibility for the Corporate Group. Hospital Operations The Group Manager of Hospital Operations is Leith Hart. Hospital Operations includes Pharmacy, Laboratories, Nutrition and Food Services, Traffic and Fleet, Security, Clinical Engineering, Clinical Support Services, Contact Centre Collaboration. Scorecard Provider Support Services Waitemata DHB Monthly Performance Scorecard Provider Support Services February /17 Best Care Service Delivery HR/Staff Experience Actual Target Trend Productivity Actual Target Trend Sick leave rate 2.9% 3.8% Clinical Typing Turnover rate 12% 8-12% Clinical letters turnaround time - P1 (urgent) 1.5 days <1 days Clinical letters turnaround time - P2 3.2 days <5 days Value for Money Clinical Coding % coding complete by 21st next month 99% 95% Financial Result (YTD) Actual Target Trend a. % coding complete YTD 98% 95% Revenue 538,319 k 535,337 k Expense 104,847 k 100,329 k Major Capital Programmes Time Budget Quality Net Surplus/Deficit 433,472 k 435,008 k WTH Emergency Department redevelopment (Apr 2016) Capital Expenditure (% Annual budget) 53% Mason clinic - 15 Bed medium secure unit (May 2017) NSH Building 5 Refurbishment (Mar 2017) % catalogue item purchases 90% 75% Clinical and Learning Skills Centre (Apr 2017) Elective Capacity and Inpatient beds (TBC) How to to read Performance indicators: Trend indicators: Achieved/ On track Substantially Achieved but off target Performance improved compared to previous month Not Achieved but progress made Not Achieved/ Off track Performance declined compared to previous month Performance was maintained Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range may result in small variations appearing to be large. a. data at 13/03/2017 A question? Contact: Victora Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB 73

74 Strategic Initiatives Variance Report Specific deliverables/actions to deliver improved performance will consider: On Target 1. Participate in activity relating to all phases of National Patient Flow (NPF), including identification of, and engagement with, local, regional and sectorwide quality improvement opportunities ongoing 2. Inventory management for clinical and non-clinical supplies 3. Infrastructure costs/contracts and energy efficiency reviews and savings ongoing Hospital Operations - Specific deliverables/actions to deliver improved performance will consider: 4. Continue to implement electronic prescribing and administration and emr, complete implementation by June 2017 Areas off track for month and remedial plans All on track Hospital Operations Highlight of the Month There has been positive feedback from Rangatira ward at Waitakere Hospital, following provision of a ward beverage trolley by Compass Group. This supports ward staff to give parents freshly made hot drinks and allows those who cannot leave their children s bedside to keep hydrated. Key Issues Clinical Support recruitment challenges Clinical support service has a high number of vacancies in both cleaning and orderly staffing, the service is working with recruitment on what initiatives can be undertaken to attract applicants. With staff turnover in the service currently at 20% many of those leaving staff are taking up other roles within the organisation, have accepted job offers outside of the DHB or are moving outside of Auckland. The service will be working with Human Resources to see if they can identify any other trends from exit interviews with the staff retention issues. Health Information Group Highlight of the Month Éclair forms Creatinine Clearance calculator Recently we had a session with our industry partner Sysmex showing them a Creatinine Clearance calculator form we have developed in Éclair (a clinical information system that stores and presents diagnostic results and orders). We wanted to make sure they knew what kind of development we were doing to reduce the risk of issues when upgrading the system and to make sure they knew the value of this capability to us. Sysmex were impressed with the functionality and technical capability of the form. We have shared these with other DHBs. Bay of Plenty DHB, who have now imported the form and has it running in production. A good example of cross-dhb sharing. 74

75 Key Issues ENTERPRISE COnTENT Management system (ECMS) This project is progressing with a go-live planned for June. It delivers: Intranet front page Pharmacy intranet site Our place intranet site Pharmacy Team Workspace 2 Mobile Page Layouts for Intranet Landing page and Our place landing pages Controlled documents PRA Compliance for the above the docs published. Key risks: Recruiting a permanent SharePoint Functional Application Support FTE to start in the new Fiscal Year. Portal 8: This program replaces our current Concerto with a new clinical portal 8. Built on new infrastructure, the new portal will be shared with Counties Manukau DHB and will access with more than 20 core clinical systems. Both Auckland DHB and Northland DHB have recently signalled their intention to join this new regional platform. The project is progressing with requirements definition and development well underway this iterative approach will allow us to review and test as its being built. It has the following dependant projects that require an upgrade to ensure compatibility with the modern technology platform. These projects are being managed as a program of work to help balance the resources, configurations and risk. Key issues: Whiteboard Rhapsody (integration engine) Soprano Medical Template (SMT) SWE, SWO and Offline forms MedDocs to be replaced by Winscribe ipm - patient management system Original Concerto(s) have been improved at each DHB over the past five years and the ongoing process of change discovery and consolidation into a new application is starting to impact timelines. A shared Portal requires regionalisation of some of its reference data. This requires a regional review and agreement of codesets. It is likely a small number of our code descriptions may change. ha resource availability is a constant issue to this large program. The timing and approach to Auckland DHB and Northland DHB joining the new Portal will probably impact timelines. Scorecard Variance Report Service Delivery Variance Report Clinical Typing Clinical Records turnaround time P1 (urgent) Performance against the Transcription Key Performance Indicators for priority one dictation. Since the introduction of the Priority one in March 2014, Transcription Service has failed to fully achieve the required turnaround times. Currently the P1 workload average turnaround time is 1.4 days,

76 days outside the target. This is partially due to the legacy system s inability to accurately timestamp the starting time. It has been agreed to increase this target to 1.5 days which has been met this month. Facilities and Development Highlight of the Month NEW AREAS COMMISSIONED IN WAITAKERE HOSPITAL ED AND CB 5 ADDITIONAL BEDS. (DOES THIS READ RIGHT) Key Issues To meet bed availability and service requirements, priority projects have been identified that need fast track delivery. Acceleration of these projects will require reprioritisation to meet expected delivery times. A negotiation concerning a property in Northcote is underway, although has been complicated by Seismic issues. This has the potential to delay a number of dependent projects and alternate planning regarding these other projects is underway. 76

77 Financial Results - Provider Support CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Feb-17 Provider Support ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency 66,360 65,154 1, , ,370 7, ,125 Other Income 2,523 2,802 (279) 19,441 22,338 (2,897) 33,584 Total Revenue 68,883 67, , ,708 4, ,708 EXPENDITURE Personnel Medical (218) 4,014 8,497 4,483 9,696 Nursing 1,105 1, ,726 11,759 1,033 13,537 Allied Health 1,541 1, ,543 12, ,495 Support 1,160 1, ,673 10, ,065 Management / Administration 3,010 2,960 (50) 23,051 24,230 1,179 36,365 7,772 7,637 (136) 60,006 67,337 7,330 92,157 Other Expenditure Outsourced Services 3,641 3,541 (100) 30,001 28,403 (1,597) 42,547 Clinical Supplies 2,704 2,518 (186) 22,453 20,573 (1,879) 30,752 Infrastructure & Non- Clinical Supplies 8,316 5,430 (2,886) 59,758 47,780 (11,977) 68,499 14,661 11,489 (3,172) 112,211 96,757 (15,454) 141,798 Total Expenditure 22,433 19,125 (3,308) 172, ,094 (8,124) 233,956 Cost Net of Other Revenue 46,451 48,831 (2,380) 376, ,614 (3,354) 581,753 * Government and Crown Agency: Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. Comment on major financial variances The overall result for Provider Support is $2,380k unfavourable for February and $3,354k unfavourable for the YTD. Getting back on track initiatives Provider Support has a number of savings initiatives that are focused on areas of improvement including cost effectiveness, cost containment, productivity, process improvements and service reconfigurations. In addition Corporate Services is undertaking a number of savings projects relating to procurement and supply chain and treasury management. The single largest item in the variance this month is in relation to an accrual of $1.5m for the demolition of Pupuke building. 77

78 Hospital Operations CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Feb-17 Hospital Operations ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency , ,227 0 Other Income (8) 2,734 2,795 (60) 4,192 Total Revenue ,961 2,795 1,166 4,192 EXPENDITURE Personnel Medical (8) (34) 703 Nursing Allied Health 1,261 1,249 (12) 10,054 10, ,612 Support 1,069 1, ,603 9, ,836 Management / Administration , ,665 2,522 2, ,479 21, ,343 Other Expenditure Outsourced Services (49) 1,620 1,034 (586) 1,551 Clinical Supplies 2,386 2,269 (118) 19,303 18,220 (1,084) 27,502 Infrastructure & Non- Clinical Supplies 1, (54) 8,736 8,216 (521) 12,378 3,590 3,370 (220) 29,659 27,469 (2,190) 41,430 Total Expenditure 6,112 5,979 (133) 50,139 48,552 (1,587) 73,773 Cost Net of Other Revenue (5,650) (5,630) (20) (46,178) (45,757) (421) (69,581) * Government and Crown Agency: Includes MoH direct revenue, ACC and CTA revenue. Excludes PBFF revenue. Comment on major financial variances The overall result for Hospital Operations is $20k unfavourable for February and $421k unfavourable for the YTD. Revenue ($1,166k favourable YTD) Additional revenue of $872k has been received from Funder to offset unbudgeted costs incurred in the service relating to Outpatient Pharmacy and community based blood products and tests. Hospital Medicines rebate received from Pharmac relating to 2015/16 is $252k favourable as the amount received was greater than advised in July 2016 for Waitemata DHB to accrue. Laboratory income for tests done for other DHBs and trials is also favourable for the YTD. 78

79 Expenditure ($1,587k unfavourable YTD) Unbudgeted costs that are offset by the additional revenue from Funder are $872k unfavourable for the YTD. Activity related non-pay costs are $838k unfavourable for the YTD. This includes inpatient pharmaceutical costs which are 9% higher than This is due to the compound growth in Infliximab used to treat autoimmune diseases and Ferinject used for iron infusions. The additional pharmaceutical costs incurred will be partially offset by additional rebates receivable as revenue in future periods. The activity related variance also includes patient meal costs which are unfavourable for the YTD due to a 1% increase in price for indexation per the terms of the contract, plus a further 5.5% uplift in price due to lower than anticipated number of DHBs participating in the national Food Services Agreement. Getting back on track initiatives Hospital Operations are getting back on track by implementing quality assurance measures that ensures high cost blood products, lab tests and pharmaceuticals are efficiently and appropriately used. This is being achieved by engaging with referring services and benchmarking to other DHBs. We have also been involved in regional purchasing processes to negotiate savings in new supply contracts for laboratory and cleaning consumables, as well as looking to maximise revenue opportunities from the outpatient pharmacies and lab tests done for third parties. 79

80 3.2 Provider Arm Performance Summary Report March Recommendation: That the report be received. Prepared by: Robert Paine (Chief Financial Officer and Head of Corporate Services) and Cath Cronin (Director of Hospital Services) This report summarises the Provider arm performance for March Glossary ESPI - Elective Services Performance Indicators WIES - Weighted Inlier Equivalent Separations YTD - Year To Date 80

81 Table of Contents 3.2 Glossary How to interpret the scorecards Provider Arm Performance Summary Report March 2017 Scorecard All services Health Targets Elective Performance Indicators Financial Performance 81

82 How to interpret the scorecards 3.2 Traffic lights For each measure, the traffic light indicates whether the actual performance is on target or not for the reporting period (or previous reporting period if data are not available as indicated by the grey bold italic font). Measure description Traffic light Trend indicator Actual Target Trend Better help for smokers to quit - hospitalised 98% 95% The colour of the traffic lights aligns with the Annual Plan: Traffic light Criteria: Relative variance actual vs. target Interpretation On target or better Achieved % achieved 0.1 5% away from target Substantially Achieved % away from target AND %*achieved improvement from last month Not achieved, but progress made % away from target, AND no <94.9% achieved improvement, OR >10% away from target Not Achieved Exception: Cardiac arrest calls is Green if number 1, Blue if =2, Amber if =3 and Red if 4 Trend indicators A trend line and a trend indicator is reported against each measure. Trend lines represent the actual data available for the latest 12 months period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. The small data range may result in small variations appearing to be large. Note that YTD measures (e.g., WIES volumes, revenue) are cumulative by definition. As a result their trend line will always show an upward trend that resets at the beginning of the new financial year. The line direction is not necessarily reflective of positive performance. To assess the performance trend, use the trend indicator as described below. The trend indicator criteria and interpretation rules: Trend Rules indicator Current > Previous month (or reporting period) performance Current < Previous month (or reporting period) performance Current = Previous month (or reporting period) performance Interpretation Improvement Decline Stable By default, the performance criteria is the actual:target ratio. However, in some exceptions (e.g., when target is zero and when performance can be negative (e.g., net result) the performance reflects the actual. Look up for scorecard-specific guidelines are available at the bottom of each scorecard: Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-months period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. Small data range may result small variations perceived to be large. a. ESPI traffic lights follow the MoH criteria for funding penalties: ESPI 2: the traffic light will be green if no patient is waiting, blue if greater than 0 patients and less than or equal to 10 patients or less than 0.39%, and red if 0.4% or higher. ESPI 5: the traffic light will be green if no patient is waiting, blue if greater than 0 patients and less than or equal to 10 patients or less than 0.99% and red if 1% or higher. 82

83 Scorecard All services 3.2 Health Targets Waitemata DHB Monthly Performance Scorecard ALL Services March /17 Service Delivery Actual Target Trend Elective Volumes Actual Target Trend Shorter Waits in ED 96% 95% Provider Arm - Overall 105% 100% p Faster cancer treatment (62 days) 94% 85% p Waiting Times ESPI 2 - % patients waiting > 4 months for FSA Compliant Best Care ESPI 5 - % patients not treated w/n 4 months Compliant ESPI 1 - OP Referrals processed w/n 15 days Compliant Patient Experience Actual Target Trend Complaint Average Response Time 10 days <14 days p Patient Flow Net Promoter Score FFT a Average Length of Stay - Electives 1.33 days 1.69 days p a. Average Length of Stay - Acutes 2.22 days 2.51 days p Improving Outcomes Outpatient DNA rate (FSA + FUs) - Total 8% <10% p Better help for smokers to quit - hospitalised 99% 95% p Outpatient DNA rate (FSA + FUs) - Māori 18% <10% p Outpatient DNA rate (FSA + FUs) - Pacific 18% <10% p Quality & Safety Trend Older patients assessed for falling risk 100% 90% p Rate of falls with major harm 0.03 <2 p Good hand hygiene practice 86% 80% q Financial Result (YTD) Value for Money Actual Target Trend S. aureus infection rate 0.11 <0.2 q Revenue 659,890 k 647,181 k p Occasions insertion bundle used 100% 95% p Expense 667,395 k 645,419 k q Pressure injuries grade 3&4 0 0 Net Surplus/Deficit -7,505 k 1,762 k p Capital Expenditure (% Annual budget) 64% HR/Staff Experience Trend Sick leave rate 3.3% <3.8% q Contracts (YTD) Turnover rate 12% 8-12% Elective WIES Volumes 13,353 13,601 p Acute WIES Volumes 46,873 44,937 p How to to read Performance indicators: Trend indicators: Achieved/ On track Substantially Achieved but off target p Performance improved compared to previous month Not Achieved but progress made Not Achieved/ Off track q Performance declined compared to previous month Performance was maintained Key notes 1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header). 2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed. 3. Trend lines represent the data available for the latest 12-month period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. A small data range may result in small variations appearing to be large. a. 2015/16 new MoH Average length of stay definition, new 2016/17 MOH based targets. A question? Contact: Victora Child - Reporting Analyst, Planning & Health Intelligence Team: victoria.child@waitematadhb.govt.nz Planning, Funding and Health Outcomes, Waitemata DHB 83

84 Health Targets 3.2 Faster Cancer Treatment Shorter Stays in Emergency Departments 84

85 3.2 Emergency Department (ED)/ Assessment and Diagnostic Unit (ADU) Presentations Improved Access to Elective Surgery Note: Changes were made to the electives health target for 2015/16 Percentage Change ED and Elective Volumes March 2017 Month Volumes % Change (last year) YTD Volumes % Change (last year) ED/ADU Volumes 10,841 5% 92,904 2% Elective Volumes 1,403 10% 10, % 85

86 3.2 Elective Performance Indicators Zero patients waiting over 4 months Summary (Mar 17) ESPI Compliant Non Compliant Non Compliant % Speciality Non Compliance % ESPI 2 Anaesthesiology % ESPI2 0.00% Cardiology 1, % ESPI5 0.60% Dermatology % Diabetes % Endocrinology % Gastro-Enterology % General Medicine % General Surgery 1, % Gynaecology % Haematology % Infectious Diseases % Neurovascular % Orthopaedic 1, % Otorhinolaryngology 1, % Paediatric MED % Renal Medicine % Respiratory Medicine % Rheumatology % Urology % Total 11, % ESPI 5 Cardiology % General Surgery 1, % Gynaecology % Orthopaedic % Otorhinolaryngology % Urology % Total 3, % 90% of outpatient referrals acknowledged and processed within 10 days ESPI 1 (Mar 17) Specialty Compliance % Anaesthesiology % Cardiology 95.65% Dermatology % Diabetes 96.94% Endocrinology % Gastro-Enterology 98.90% General Medicine 99.07% General Surgery 98.59% Gynaecology % Haematology 98.17% Infectious Diseases % Neurovascular % Orthopaedic 99.19% Otorhinolaryngology 98.14% Paediatric MED 99.82% Renal Medicine % Respiratory Medicine 97.87% Rheumatology 98.85% Urology 99.07% Total 98.73% Legend ESPI 1: Green if 100%, Yellow if 90% or less. ESPI 2: Green if zero patients, Yellow if greater than zero patients and less than or equal to 10 patients or less than 0.39%, and Red if 0.4% or higher. ESPI 5: Green if zero patients, Yellow if greater than zero patients and less than or equal to 10 patients or less than 0.99%, and Red if 1% or higher 86

87 Financial Performance 3.2 CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Mar-17 Provider ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget REVENUE * Government and Crown Agency 73,908 68,772 5, , ,902 14, ,886 Other Income 5,235 3,307 1,928 27,618 29,279 (1,661) 39,262 Total Revenue 79,143 72,078 7, , ,181 12, ,148 EXPENDITURE Personnel Medical 15,487 14,070 (1,417) 129, , ,380 Nursing 19,645 19,009 (637) 172, , ,824 Allied Health 9,803 9,174 (630) 80,791 81, ,939 Support 1,458 1, ,323 13, ,548 Management / Administration 5,511 5,210 (301) 46,867 47, ,389 51,904 48,928 (2,976) 442, ,043 2, ,080 Other Expenditure Outsourced Services 6,021 4,985 (1,036) 50,554 44,620 (5,935) 59,353 Clinical Supplies 10,550 9,671 (880) 86,847 82,855 (3,992) 110,938 Infrastructure & Non-Clinical Supplies 10,111 7,475 (2,636) 87,458 72,901 (14,557) 94,777 26,682 22,131 (4,551) 224, ,376 (24,483) 265,068 Total Expenditure 78,587 71,059 (7,527) 667, ,419 (21,976) 863,148 Cost Net of Other Revenue 556 1,019 (463) (7,504) 1,762 (9,266) 0 CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE Reporting Date Mar-17 Provider ($000 s) MONTH YEAR TO DATE FULL YEAR Actual Budget Variance Actual Budget Variance Budget CONTRIBUTION Surg & Ambulatory (15,102) (15,001) (101) (116,192) (112,372) (3,820) (150,380) Acute and Emergency (11,872) (11,399) (473) (97,467) (94,365) (3,102) (126,836) Sub Specialty Med and HOPS (8,933) (8,279) (655) (66,060) (65,723) (337) (88,077) Child Women Family (7,741) (7,449) (292) (56,924) (56,401) (523) (75,837) Mental Health (11,081) (11,345) 265 (84,001) (85,617) 1,616 (114,344) Elective Surgery Centre (1,331) (2,432) 1,101 (19,739) (20,299) 560 (27,217) Provider Support 56,617 56,924 (307) 432, ,538 (3,661) 582,691 Net Surplus/Deficit 556 1,019 (463) (7,504) 1,762 (9,266) 0 87

88 4.1 Clinical Leaders Report 4.1 Recommendation: That the report be received. Prepared by: Dr Andrew Brant (Chief Medical Officer), Dr Jocelyn Peach (Director of Nursing and Midwifery; Emergency Systems Planner) and Tamzin Brott (Director of Allied Health) Medical Staff Medical Council The Medical Council of New Zealand is currently considering changes to the recertification for vocationally registered doctors and earlier this year released a consultation document. The Council has the responsibility for ensuring that recertification programmes for doctors are robust and help assure the public that the doctor is competent and fit to practise. The council currently achieves this by setting standards and accrediting providers of recertification programmes, which are the medical colleges. The colleges are charged with ensuring each doctor completes their recertification programme and they determine details of audit of medical practice and peer review. The Medical Council is proposing to set new standards for recertification programmes that will replace the current recertification requirements. The essence of the proposal is that there is the development of an individualised Professional development Plan (PDP) and CPD activities to support their PDP. The colleges would also need to provide opportunities for regular practice reviews and assist doctors to use performance and outcome data to develop their PDP. Waitemata DHB is generally supportive of this approach, but we have noted to the Council the challenges around the outcome data and resources required to develop them, although this approach is very much aligned with the direction of clinical outcome data that we are developing within the services. We have also highlighted to Council the need to avoid the duplication of recertification, credentialing and annual practice review processes within the organisation. The Council is currently considering the feedback on their proposal. Medical Credentialing We have undertaken a review of our medical credentialing process. Credentialing essentially confirms qualifications and experience of the SMO and defines the scope of clinical practice within the organisational context. This is separate from the recertification process that is undertaken by the Medical Council of New Zealand along with the medical colleges. The current SMO credentialing policy is based on a MoH framework from 2001 and reflects updates from We aim to undertake credentialing of our services every five years and SMO re-credentialing at that time. In Australia there have been a number of updates in recent years and we have tried to reflect some of these developments in our processes. The changes we have made include being more defined over core and extended scopes of practice, incorporating changes in scope in the intervening five year period, locums and disaster medicine credentialing. We have also developed a template to standardise credentialing reporting along with a credentialing guide. 88

89 4.1 Quality We are implementing the ISBAR clinical communication tool for all verbal patient referral within our DHB, as we know that effective communication is essential in improving patient safety/ and better quality of care. ISBAR prompts staff to Identify themselves, the respondent and the patient, describe the Situation, state the relevant clinical Background, make an Assessment and make a Recommendation. ISBAR referral process is aimed at improving clinical conversations by ensuring all relevant information is shared helping to facilitate effective escalation of care. It also improves critical thinking and builds confidence within the multidisciplinary teams and is applicable to nurses, doctors, physiotherapists, pharmacists and anaesthetic technicians. Nursing and Midwifery and Emergency Planning Systems Over the past two years there has been an increase in the number of nurses and midwives retiring with twenty plus years of service to this DHB. The DHB has been fortunate to have professionals who have organisational memory, commitment to our community and values, desire to develop the workforce particularly mentoring new nurses and being willing to take on senior roles within the teams. For example: Donna Riddell retires after a career lifetime at Waitemata DHB, initially starting in her teens as an enrolled nurse at Waitakere Hospital and currently Charge Nurse Manager on Anawhata Ward; Judy Vette in Emergency Department North shore Hospital is retiring after 39 years in the department. There are multiple examples of experience, expertise and contribution which will be missed. We are pleased to advise that Dianna McGregor has been appointed to the role of Clinical Nurse Director for Maori Health [1 FTE] for Waitemata DHB and Auckland DHB. The role reports to the General Manager for Maori Health Riki Nia Nia and works in association with the Directors of Nursing for the two DHBs. The role also works in close association with Abel Smith who works as Clinical Nurse Director for Pacific Health [0.8] across the two DHBs. Workforce Development New Graduate Nurse Employment On 1 May 2017, 13 new graduate nurses and six midwifery new graduates will commence the Entry to Practice Programme orientation programme. The nurse and midwife coaches will provide support to help these staff transition to advanced beginner practice by August. Return to Practice 18 nurses have commenced the return to practice programme and will be available for employment by July Health Care Assistant National Certification Programme A new cohort of health care assistants commenced the annual certificate course in April Waitemata and Waikato DHBs have developed the acute care certificate curriculum and the content is now made nationally available by Careerforce. The programme makes a substantial difference to these frontline staff who have not had the education opportunity, but who are very motivated to make a difference for the patients and health teams they work with. 89

90 4.1 Emergency Systems Planning The Executive team participated in Coordinated Incident Management Systems [CIMS] training in late March and work continues to achieve confidence in a provider incident management team response. Work is underway with Aged Residential Care facilities across the metro Auckland area to ensure that plans align and there is increased readiness for response in an event. Emergency Systems Planning work with primary health care continues: The regional Primary Health Care Technical Advisory Group is reviewing the pandemic plan and how primary health organisations would work together with Accident & Medical Centres, St John and Labtests to meet community needs in a regional pandemic situation. Waitemata DHB has progressed work on a communication portal and the pilot has been successful. This will be tested in other DHBs in the metro Auckland area in the next month. All residential aged care facilities regionally and home care provider agencies are completing a survey of their readiness for an emergency situation. Results will be reported in a month and a rapid cycle plan is underway. Allied Health, Scientific and Technical Professions With Compassion, Better, Best Brilliant, Everyone Matters and Connected Allied Health, Scientific and Technical Action Plan 2020 During the review of the Director of Allied Health Scientific and Technical role in 2015 staff were asked what was important for them as clinicians and members of this DHB. At the time four key priorities were identified (patient outcomes, professional standards, workforce and productivity/workflow). Alongside these priorities, there was a strong message regarding the need for a clear vision and strategic oversight for the group, with a focus on promoting quality improvement and innovation to improve patient experience and outcomes. To progress this work a survey was undertaken in March 2017 across the Allied Health Scientific and Technical group. The purpose of the survey was to validate the previously identified priorities, unearth new areas of focus and to ensure that as a group we were aligning our key quality improvement work plans with our promise, purpose, priorities and values. The survey resulted in 309 data points for exploration which were collated using thematic analysis into four main themes with underlying action points. 90

91 4.1 At the time of this report workshops are being held across the DHB with an open invitation to all Allied Health Scientific and Technical staff to explore the emerging themes and ensuring that we have heard the voice across the group correctly. To date the workshops have confirmed the emerging themes and have resulted in a wealth of feedback and ideas on how to meet the identified action points. Next steps are to complete the workshops, collate the feedback and present back to the Allied Health Scientific and Technical group for final confirmation prior to presenting to the Executive Leadership Team and the Hospital Advisory Committee at the end of May/June Friends and Family Test Allied Health How likely Mar 17 Feb 17 Jan 17 Dec 16 Nov 16 Oct 16 Sept 16 Aug 16 July 16 are you to recommend our ward to friends and family? Did we see you promptly? Did we listen and explain? Did we show care and respect? Did we meet your expectations? Allied Health Allied Health Allied Health Allied Health Allied Health Allied Health Allied Health Allied Health Allied Health Were we welcoming and friendly? 91

92 4.1 Better, Best Brilliant, Everyone Matters and Connected Waitemata DHB Health Scholarship Awards Ceremony The Health Scholarship Programme supports Maori and Pacific residents of the Waitemata region (North Shore City, Waitakere City and Rodney District) to undertake health-specific tertiary study with an accredited New Zealand education provider. A ceremony was held on 13 April 2017 to welcome our new scholarship students to the DHB. Alongside their nursing, midwifery and medical colleagues, four physiotherapists and one social worker have been awarded new scholarships this year, joining their existing peers on the scholarship programme. The addition of these new scholarship recipients takes our projected number of Allied Health, Scientific and Technical undergraduate students completing their studies at the end of this year to four. The four physiotherapists completing their studies in December 2017 will be transitioned in our new graduate physiotherapy rotation programme. Better, Best Brilliant Collaboration with Unitec Institute of Technology Professor Dale Sheehan has commenced a research project for Unitec Institute of Technology focusing on From theory to Practice. The application of workplace learning theory to the development of a clinical placement for Medical Imaging Technology students. Waitemata DHB and Auckland DHB are working in partnership with Professor Sheehan with our Senior Medical Imaging Technologist Tracy de Bueger assisting with this research. The project covers a 12 month period and is due to be completed in December This education research project wraps around and supports Unitec s curriculum development process. In semester two, 2017, the Medical Imaging Technology pathway may be moving from an integrated model for placements to block placement. The Medical Imaging Technology pathway staff are charged with the responsibility of defining content, implementing the new practicum, managing provider relationships 92

93 4.1 and evaluating the programme with stakeholders. Te Waka and Te Puna Ako will work with staff to develop the clinical placement. This project supports these tasks while taking the opportunity to take an evidence based approach, test this within the specific context of the Medical Imaging Technology programme and Unitec and disseminate these findings. This project seeks to inform the development of more robust theory that identifies the links between design, intervention and outcome by exploring how, what and why work experience works in real contexts from the perspective of all stakeholders The ENRICH (Evaluating, Nutrition Risk and Intervening to encourage Healthy eating) Study We continue to collaborate with Massey University and the ENRICH study. The ENRICH study started in 2013 and this year it will target patients admitted within the first seven days into residential aged care facilities. Previously studies have been completed in two rehabilitation wards within Waitemata DHB across two consecutive years, with a community study undertaken in a West Auckland Medical centre last year. The 2017 study was launched at the recent Aged Related Residential Care Services (ARRC) provider forum on 29 March Jacqui Allen, ORL consultant, is supporting this study and the impact of dysphagia on this cohort. This study is particularly useful in providing evidenced based dietetic practice for residential aged care in this DHB. Teresa Stanbrook, Waitemata DHB professional and clinical leader dietetics, has been involved in the training of the three Masters students who are collecting the data for the ARRC component of the study, and a PhD student who is collating the evidence across the three year trial. Waitemata DHB Dietitian Rebecca Watkin presented outcomes to date of this study in residential aged care at the Waitemata Health Excellence Awards preliminary round in April. The 2013 study has been accepted for publication in the Australian Journal on Ageing later this year (2017). 93

94 4.2 Human Resources Recommendation: 4.2 That the report be received. Prepared by: Fiona McCarthy (Director Human Resources) Purpose of report This report outlines key people and organisational development activities across Waitemata DHB and reports on progress with workforce plan actions. 1. Strategic Alignment Community, whanau and patient centred model of care Service integration and/or consolidation Intelligence and insight Evidence informed decision making and practice Outward focus and flexible, service orientation Operational and financial sustainability The report outlines recruitment, workforce or organisational development programmes and actions that can impact internal and external models for care. The report outlines work undertaken collaboratively across the organisation. The recruitment and ethnicity dashboards give information and insight into the impact of our recruiting processes. Where possible, all improvement or new programmes of work will use evidence based frameworks to develop and/or evidence to enhance existing work. All programmes are evaluated to understand the value and return on investment. Improvements sought in relation to policy, process or programmes will be co-designed with service users. Robust recruitment, workforce and organisational development frameworks, strategies and actions support sustainable business practises. 2. Recruitment 2.1 Recruitment Dashboard February and March 2017 March 2017 February 2017 Total number of hires 209 (headcount) 154 (headcount) Average time to hire (days) days Current number of vacancies by speciality we are recruiting to (FTE) Medical Nursing Allied Health Support Management/Administration (vacancy rate of 4.8% of total FTE) (as at 31 March 2017) Medical Nursing Allied Health Support Management/Administration (vacancy rate of 4.4% of total FTE) (as at 28 February 2017) 94

95 March sees a slight increase in recruitment activity especially in Allied Health, Nursing and Support, as we prepare for winter staffing Time to Hire The average time to hire has decreased to 58.6 days in March (Table 1). Most Senior Medical Officer (SMO) roles tend to take longer to recruit to Table 3 shows the average time to hire for SMOs which was days in March. Driving the SMO time to recruit was a Haematologist that was offered in December 2015 and started in March 2017 (522 days) and two psychiatrists who took 118 days each. If we exclude SMOs from our overall average time to hire, the average is 55.6 days (Table 2). NB Time to Hire - Calculated from the time a Recruitment Requisition is approved to the time an offer is verbally accepted by a candidate. 150 Average Time to Hire (OverAll) Total Linear (Total) Table 1: Overall Average time to hire April 2015 to March Average Time to Hire (other) Other Linear (Other) -30 Table 2: Average time to hire for all other roles (excluding SMOs) April 2017 to March

96 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May Average Time to Hire (SMO) SMO Linear (SMO) 4.2 Table 3: Average time to hire for SMOs April 2017 to March Top sources of Applications Rank / Source 1. Waitemata DHB careers and career section March 2017 Comments 33% Increase and strongest source of candidates 2. A Friend 18% Slight drop from last month % Increase in Corporate roles being advertised % Slight increase in applicants using KHJ 5. Waitemata DHB Intranet 6% Drop since last month Table 4: Top 5 Sources of Hire for March 2017 The above source dashboard is taken from Taleo. Applicants enter where they heard about the position when they apply for a job. The two highest sources for Waitemata continue to be the friend referral and the Waitemata DHB careers site. The figures are based on 154 responses in February Ethnicity of new employees The following are two tables detailing the ethnicities of current employees by profession (Table 5) and the ethnicities of staff recruited in the last three months, also by profession (Table 6). Analysis of the data shows us that in the last three months the percentages of Maori, MELAA and European recruited were slightly higher than the percentage of the existing ethnicity profiles. 96

97 Asian Pacific Maori MELAA European Other Total FTE Total % Row Labels FTE % FTE % FTE % FTE % FTE % FTE % MEDICAL PERSONNEL % % % % % % % 4.2 NURSING PERSONNEL % % % % 1, % % 2, % ALLIED HEALTH PERSONNEL % % % % % % 1, % SUPPORT PERSONNEL % % % % % % % MGT/ADMIN PERSONNEL % % % % % % % Grand Total 1, % % % % 3, % % 6, % Table 5 Ethnicity of all staff for three months to 1 April 2017 MELAA is a group amalgamation of Middle Eastern, Latin American and African ethnicities NB The ethnicity criteria used is level one which means that NZ ethnicity is classed as Other. Other Asian Pacific Maori MELAA European Total FTE Row Labels FTE % FTE % FTE % FTE % FTE % FTE % MEDICAL PERSONNEL % 2.0 3% 3.0 5% 2.0 3% % % % NURSING PERSONNEL % 4.5 4% % 1.0 1% % 4.6 4% % ALLIED HEALTH PERSONNEL % 0.8 1% 1.1 1% 2.9 4% % 1.0 1% % SUPPORT PERSONNEL % 0.6 9% % % % - 0% 6.9 3% MGT/ADMIN PERSONNEL % 2.0 3% 3.6 6% 2.8 5% % 0.8 1% % Grand Total % 9.9 3% % 9.5 3% % % % Table 6 Ethnicity of staff recruited within the last three months NB The ethnicity criteria used is level one which means that NZ ethnicity is classed as Other. MELAA is a group amalgamation of Middle Eastern, Latin American and African ethnicities 97

98 3 Organisation Development 4.2 Auckland and Waitemata DHB Maori Workforce Plan.1 Data collection, storage and reporting A Māori workforce scorecard for the Auckland DHB and Waitemata DHB Boards has been developed to measure and monitor Maori recruitment performance against the targets per DHB and for priority professional group. Waitemata DHB staff who identify with multiple ethnicities one being Maori, are recorded in our payroll systems as non-maori in approximately 78% of cases. The issue has been addressed going forward and the appropriate payroll staff will be trained to input the correct ethnicity data in line with the Government ethnicity collection guidelines. A full audit of relevant Waitemata DHB staff records (approximately 160 records) has been arranged. Auckland DHB staff ethnicity data collection and storage process is being reviewed for compliance with guidelines. The function to enter ethnicity data into Payroll is performed in-house. Waitemata DHB has also completed a survey to obtain missing ethnicity data from 7% (n=488) of its workforce. Response rate was 25% (n=125), lifting the completeness of ethnicity data from 93% to 95%. Direct contact will continue to obtain the remaining missing information. Auckland DHB completed a survey to obtain missing ethnicity data from 10% of its workforce (n=1500). Response rate was 50% (n=750), lifting the completeness of ethnicity data from 90% to 96%. Communications to managers of relevant staff will continue to obtain the remaining missing responses. A dashboard is being developed to understand the Maori applicant journey including applicant behaviour (frequency of application and types of roles) and success rates at each stage of recruitment for all metro-auckland DHBs..2 Recruitment activities Kia Ora Hauora and the Rangatahi Programme activities continue to engage and support Maori and/or Pasifika secondary school students in priority schools to engage in and succeed in sciences, whilst exploring health career pathways. The Youth Employment Pledge is a partnership with metro-auckland DHBs and Auckland Council to address the issue of Maori and Pasifika youth unemployment in Auckland. The pledge signing event is scheduled to occur in June. Waitemata DHB and Auckland DHB are working together to align best practice and share findings from Maori recruitment and retention projects under the Maori Workforce Alliance Leadership Team (MALT) Action Plan. There is an upward trend in Maori New Entry to Practise (NETP) nurse recruitment as a result of intentional and targeted approaches. Waitemata DHB employed 15 NETP and four New Entry to Specialist Practise (NESP) nurses in February Retention activities A targeted approach has increased the uptake of Maori trainees on the Health Workforce NZ Hauora Maori Training Fund scholarships from eight to

99 Opportunities for targeted Maori leadership development pathways are being scoped across Waitemata DHB and Auckland DHB as part of the Maori Workforce Alliance Leadership Team MALT Action Plan Scholarship programme 2017 Waitemata DHB Health Scholarship programme supports up to 50 Maori and/or Pacific people from the Waitemata district to graduate from health related degrees and transition into the health workforce. Recipients (except medical students) are bonded to enter into employment with Waitemata DHB as new graduates and a recruitment guideline is in place to support this operationally. All of the 2016 programme graduates except one were employed by Waitemata DHB. Waitemata DHB Health Scholarship students Completed in 2016 Maori Pasifika Medicine 1 Employed at Northland DHB Nursing 3 3 Occupational Therapy 1 Physiotherapy 3 Totals 5 6 The 2017 scholarship programme year has commenced with the DHB recruiting 13 new Maori students and six Pasifika students, resulting in a full complement of 49 students on the Waitemata DHB scholarship. On 13 April the DHB welcomed seven of the 13 new scholarship students through an awards hui. Both DHB staff and students shared their commitment and support of the programme and their personal journeys that have inspired them along the healthcare career path. The event, also attended by the students whanau was inspiring. The projected completion numbers for 2017 are as below. Waitemata DHB Health Scholarship students Expecting to complete in 2017 Maori Pasifika Medicine 1 1 Midwifery 1 2 Nursing 6 1 Physiotherapy 2 2 Totals

100 4.2 Scholarship awards hui 13 April. 3.3 elearning The DHB continues to embrace new ways of learning that appeal to a wide variety of skills, education preferences and generations. In doing so, patient focussed learning is enabled that ensures we can meet our organisational priorities to enhance the patient experience and ensure better patient outcomes. Some of our online courses due to launch and in development are as follows: Next Course Launch Started/Under Development Delirium, Dementia, Depression (3Ds) Patient Management/Scheduled Care Electronic Discharge Summary Alcohol Withdrawal Management Patient Experience Moving and Handling We are also increasingly using videography to capture regular learning for sharing outside the organised session and patient videos either for educational or patient perspectives. Recent examples of video work include: training for doctors to access via their education portal Delirium patient education Advanced care planning education Intravenous line education for nurses The DHB also makes extensive use of multi-disciplinary meeting technology ensuring that teams at multiple sites can meet to discuss patients and share learning. 3.4 E Primary Care Nursing Development Waitemata DHB has a primary care nursing development team undertaking key activities to train, develop and support primary care nursing. An update on recent work is as follows: 100