together SIX issue OUR Working About our Midland region In this 4 Introducing... 8 Breastfeeding REGIONAL OBJECTIVES 21%

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1 M I D L A N D SUMMER 2017/18 E-NEWSLETTER Workng together In ths ssue 2 A word from the HealthShare CEO 3 Mdland Clncal Portal 4 Introducng... Davd Kooker 5 6 Health equty hu workng together to make a dfference Mdland Regonal Pathways of Care (Map of Medcne) 7 Stroke recovery usng onlne appontments 8 Breastfeedng smartphone app provng popular beyond Mdland 10 Mdland Regonal SUDI Plannng 11 Mdland Bowel Screenng Regonal Centre Mdland Cardac Clncal Network Trauma Servces n Mdland Dramatc changes are underway n hepatts C servces South Wakato cardac nurses fnd new ways to reach more patents About our Mdland regon 21% 5 DHBs DHB Bay of Plenty Lakes The Mdland regon covers an area of 56,728 km 2, or 21% of New Zealand s land mass. Stretches from Cape Egmont n the West to East Cape and s located n the mddle of the North Island. Fve Dstrct Health Boards: Bay of Plenty, Lakes, Hauora Tarāwht, Taranak, and Wakato. Includes major populaton centres of Tauranga, Rotorua, Gsborne, New Plymouth and Hamlton. 920,825 people (2017/18 populaton projectons), ncludng 236,830 Māor (26%) and 43 local w groups. Hauora Tarāwht Taranak Wakato PHO Name Eastern Bay Prmary Health Allance Nga Mataapuna Oranga Ltd Western Bay of Plenty Prmary Health Organsaton Ltd Pnnacle - Lakes Rotorua Area Prmary Health Servces Ltd Pnnacle - Tarāwht Ngat Porou Hauora Chartable Trust Pnnacle - Taranak Haurak PHO Pnnacle - Wakato *Natonal Hauora Coalton *MOH categorses Countes Manukau DHB as the lead DHB for the Natonal Hauora Coalton (NHC), whch excludes NHC from the Mdland DHB lst, however NHC fgures have been added nto the above table for both Hauora Tarawht and Wakato DHB - where NHC provdes a locally based servce. OUR SIX REGIONAL OBJECTIVES Health equty for Māor Integrate across contnuums of care Improve qualty across all regonal servces Buld the workforce Improve clncal nformaton systems Effcently allocate publc health system resources 1

2 A word from the HealthShare CEO contnung our journey together towards one team HealthShare - He Rourou Taktah ( a small flax food basket ) was establshed n 2001 to support the Mdland DHBs through approved regonal work programmes and agreed regonal servce delvery. The success of Mdland s regonal work s dependent on the collaboratve relatonshps between HealthShare s staff and teams, and those from across Mdland DHBs and Prmary Health Organsatons. The regon s networks weave together such dverse areas of health as: cancer, cardac, chld health, electves, health of older people, hepatts C servce, mental health and addctons, radology, stroke, and trauma. The regonal enablers supportng ths one team approach of workng together are: regonal IS, espace, workforce development, audt and assurance servces, and nternal audt servces. Gudng these regonally agreed work programme actvtes are Mdland s two overarchng strategc objectves: 1. mprove the health of the Mdland populatons 2. elmnate health nequaltes. In determnng what success n the regon looks lke, t s valuable to reflect on and evaluate What s good, better, and best?. Consderng what has mproved or worsened? How the regon s health outcomes can be mproved and how nequaltes can be elmnated? Our values underpn the crtera we use to evaluate our success (or falure); producng an overall judgment of our performance. Health equty for Māor s the number one regonal objectve, and as such, s a central value underpnnng what we do and how we work ntentonally n our regon. Stores of change s a way to focus on the change that has taken place as a result of an ntatve; hghlghtng narratves of ntended postve (and occasonally unntended negatve) outcomes. I encourage you to check out some of the stores of change contaned n ths newsletter, such as, Ra Kot s postve experence of stroke consultatons usng smart onlne technology; the dfference made for Cate Shepherd as a cardac specalty clncal nurse, workng across a wde geographc area n Mdland to provde recovery cardac support; and the experence of Bree Claudatos, as breastfeedng nformaton s made avalable 24/7 va a smartphone app, buldng her confdence to manage ssues as her baby develops. These stores of change show what s valued by consumers and our staff; descrbng the changes that have taken place as a result of ntatves n health. As we reflect on the past year of changes, we endeavour to work more ntentonally and collaboratvely together and look forward to what 2018 wll brng. Personally, I wsh everyone a very happy Chrstmas and a tme of refreshment wth famly, whānau and frends over the festve season. Andrew Campbell-Stokes CEO, HealthShare Mdland Dstrct Health Boards shared servces agency December 2017 Fnd out more about HealthShare Andrew Campbell-Stokes CEO, Healthshare andrew.campbell-stokes@healthshare.co.nz 2

3 Mdland Clncal Portal One patent, one record espace Programme Gateway Revew The espace Programme underwent a Gateway Revew n early October. Gateway s an ndependent project/ programme peer revew methodology that provdes advce and support to the Senor Responsble Owner (SRO) of a programme or project. It operates out of Treasury and apples to all projects and programmes that are defned as hgh rsk wthn the state sector. The Gateway Revew team assessed the espace Programme as AMBER, where successful delvery appears feasble but sgnfcant ssues already exst, requrng management attenton. These appear resolvable at ths stage and f addressed promptly, should not mpact delvery or benefts realsaton. The prevous assessment of the espace Programme n 2015 was AMBER/RED, so the latest assessment demonstrates a sgnfcant mprovement n confdence n the programme to delver. The revew provded some key recommendatons for how we could do thngs better, both as a team and a regon, to ensure the success of the Programme. At the request of espace SRO Maureen Chrystall, the espace team wll put together a summary of the report s fndngs and crculate to nterested stakeholders before the end of the year. The team wll also develop an acton plan before the end of the year, based on the themes and recommendatons dentfed by the revew. For more nformaton about Gateway, vst: nvestmentmanagement/revew/gateway MCPFP Update Followng ntal Mdland Clncal Portal (MCP) go-lve n August, access has been rolled out to all Wakato DHB clncans as well as 1,500 clncal staff from Taranak DHB and 453 clncans from Bay of Plenty DHB. Plannng for addng other users, ncludng prmary care and mdwves, wll contnue to be rolled out n the New Year. Enhancements to MCP to mprove system performance, stablty and functonalty are contnung. Lakes DHB have taken the lead n runnng an MCP end-to-end testng exercse whch s stll ongong as at md-december. The Programme has also recently ntroduced a lve dashboard of key MCP statstcs (see Dd you know? left and Number of Patents Records accessed by DHB graph below). Dd you know? As at 1.30pm on Frday, 15 December, MCP contans: 515,220 Regstered Patents (Snce 24 October 2016) 2,544,188 Patent Events Recorded (Snce 24 October 2016) 878,983 Documents Uploaded (Snce 1 September 2017) Heard the news? Sgn up to receve our monthly e-newsletter, Fllng the espace. Sent on the frst Frday of every month, t features the latest news, vews and updates from the espace Programme. Emal mcp@healthshare.co.nz to subscrbe. For more nformaton, vst: mdlandclncalportal.health.nz or emal: mcp@healthshare.co.nz 3

4 Introducng... Davd Kooker Programme Analyst espace, HealthShare What does your job nvolve? Searchng Subject Matter Experts wthn the Mdland DHBs Buldng rapport wth personnel wthn the Mdland DHBs Lstenng to the voce of the customer and documentng those wants n functonal and nonfunctonal requrements Draftng SOPs (Standard Operatng Procedures) and How-To gudes Transton the Mdland Clncal Portal to the establshed Servce Provder. Why dd you choose to work n ths feld? I began my IT journey n very techncal roles and decded n the past 10 years to evolve to a more people person role. I fnd t easy to blend wth medcal personnel compared to other felds. What do you lke about t? I can lsten to anyone and have the ablty to translate busness speak to techncal speak and vce versa In the course of my role, I get to travel around our beautful regon capturng some great photos along the way. What are the challenges of your job? In some cases, HealthShare may be vewed as an outsde entty by the Mdland DHBs. Therefore, t can be tough to buld rapport wth folks when you re vewed as an outsder. In actualty, I enjoy fgurng out how we can work together to make ther jobs easer. What do you do when you are not at work? Photography; Wngspan Brd of Prey Trust, Otanewanuku Kw Trust, and/or around New Zealand. I post my mages on The Yankee Down Under Photography on Facebook and other varous New Zealand based photography groups. Known n the wldlfe photography communty as That Brd of Prey Guy Trampng I am a Foode wth heaps of Asan cusne (ncludng Indan) experence and expandng nto Italan and Slavc recpes Beer connosseur. 4

5 Health equty hu workng together to make a dfference On 25 September a jont hu was held n Rotorua at Lakes Dstrct Health Board, between Nga Toka Hauora (General Managers Māor Health) and health equty related DHB staff, and Regonal Clncal Network Project Managers from HealthShare. As the regonal shared servce agency, HealthShare s very supportve of ensurng that health equty for Māor s front and centre n all of the regonal work undertaken. The Mdland DHBs have agreed sx regonal objectves, wth health equty for Māor beng the frst objectve. Mdland Mental Health & Addcton Regonal Network The ntenton of the hu was to consder a common tool to be appled to Health Equty Assessment, relatve to the ntatves and actvtes contaned n the Mdland Regonal Servces Plan (RSP). The Mdland RSP detals Nga Toka Hauora s four health equty tasks, as outlned n ther Health Equty Template: buldng the evdence base by establshng and embeddng ethncty data reportng buldng a culture of equty by undertakng health equty assessment mprovng health lteracy buldng Māor health workforce. Snce the late 1980s the Mdland Mental Health & Addcton Regonal Network has nvested sgnfcantly n the development of Kaupapa Māor servces n the Non Governmental Organsaton (NGO) sector. The Mdland regon has the largest number of Kaupapa Māor NGOs natonally. From a mental heath and addctons perspectve further work s needed to ensure the health equty for Māor s fully mplemented. Ths wll ensure that for Māor who journey through our servces ther experence s mana enhancng and leaves the whanau ntact. Nga Toka Hauora consdered the presentatons and subsequently affrmed prortsng ts support to focus on Māor health prortes, as well as the need to reconvene Nga Toka Hauora to reach a common agreement on the health equty assessment approach and preferred tool to be used. Nga Toka Hauora also reterated ther representaton and advocacy on Mdland Regonal Clncal Networks. The day was an excellent opportunty to get to know one another, to ask and answer questons centred on supportng health equty assessments of regonal ntatves and actvtes planned n the regon. It s antcpated that a further hu wll take place n December, and HealthShare looks forward to beng able to contrbute towards ths ongong work wth Nga Toka Hauora over the comng months. 5

6 Mdland Regonal Pathways of Care (Map of Medcne) Chrs Scott and Jo Hollobon Utlsaton data for pathways vewed on Map of Medcne over the last 12 months: Top 20 pathways vewed over last 12 months there has been an ncrease n the use of the pathways over the last 12 months the hghest users are GPs followed by nurses n general practce we contnue to brng new users onto Map of Medcne each month. Pathways publshed nto the Map of Medcne: we have publshed 24 new pathways n the past 12 months three of these are fully regonal pathways: - Weght management and obesty n chldren - Advance Care Plannng (ACP) development led from Taranak DHB - Hepatts C In the last few months we have also publshed: - Supaventrcular Tachycarda (SVT): communty management - Early pregnancy & bookng appontment - B12 & folate defcency - Pelvc organ prolapse - the Prmary Optons manual has been added to the Acute Care pathway/s Other pathway / ereferral actvty: Regonal lung cancer pathway the ereferral s now mplementated n Tarawht makng t a regonal ereferral Colonoscopy e Referral went lve n Lakes, Tarāwht and Taranak completng full regonal mplementaton the medcal termnaton of pregnancy ereferral went lve for Lakes and BOP n September and the Wakato termnaton of pregnancy ereferral had an update so t can now be used by Lakes, BOP and Wakato DHB GPs Wakato ED developed an nformaton box and access to Acute Care pathways to support patent flow n the acute demand area went lve n September 2017 Teledermatology BOP and Taranak DHBs are both lookng at mplementng ths model wth local varaton. Further GP engagement evenngs have been held at Wakato DHB wth the followng presentatons: Teledermatology and a Demonstraton of BPAC dermatology suspected skn cancer ereferral advce servce presented by Dr Mark Taylor, GP Lason and Assocate Prof. Amanda Oakley ED acute referrals - case studes on postve and negatve flows and dscusson on process mprovement presented by Daman Tomc, Clncal Drector Prmary Care, Jo-Anne Deane, Drector Integrated Care, Sherll-Ann Wlson, GP Lason, wth presentatons from ED clncans and SMOs. For more nformaton about the Mdland Regonal Pathways of Care (Map of Medcne) contact: Chrs Scott Project Manager HealthShare e chrstne.scott@healthshare.co.nz Jo Hollobon Regonal Lead Edtor HealthShare e jo.hollobon@healthshare.co.nz Regster for logn access to the Map of Medcne e mom@wakatodhb.health.nz 6

7 Stroke recovery usng onlne appontments Followng a stroke n February 2017 Ra Kot experences aphasa, whch makes t dffcult for hm to express or artculate hmself n speech. Speech and language therapy twce a week s helpng hs recovery, but the travel and organsaton requred to get to ongong appontments at Wakato Hosptal takes ts toll. Snce the stroke, Ra tres easly, says Ra s wfe Jak. Gettng up early, gettng ready, fndng a park and gettng n to the hosptal for appontments s really stressful. Then Ra was asked whether he wanted to try havng consultatons from home on hs laptop usng SmartHealth, Wakato DHB s onlne health servce. We alternate face-to-face appontments wth onlne vdeo consults and t s so nce and easy to use, says Jak. Ra has had seven consults from our home computer so far and t s great. Ra agrees. He says usng the laptop from home s a good experence. It has helped my recovery. The speech and language therapy team also use SmartHealth to gve Ra onlne checklsts to work through. Homework from the grls, Jak calls t. The lsts help keep Ra motvated between appontments and gve hm somethng to acheve ndependently. Ra and Jak are so happy wth how SmartHealth s helpng them, they want to tell others about t. There are so many people ths could help, says Jak. For more nformaton contact: Dr Ruth Large FACEM FDRHM Clncal Drector Thames Hosptal, Emergency Physcan Wakato Hosptal e ruth.large@wakatodhb.health.nz 7

8 Breastfeedng smartphone app provng popular beyond Mdland The popularty of a free smartphone app desgned to provde new mothers, especally those n remote areas, wth practcal advce and support on breastfeedng has exceeded expectatons snce ts launch n August 2015 wth more than 12,000 downloads across New Zealand. BreastFedNZ s a free app avalable on Tunes and Google Play Stores. It provdes smple, consumer focused nformaton alongsde llustratons, photos, vdeo clps, web lnks and personal stores. Bree and daughter, Qunn, from Naper The app was developed by the Mdland Maternty Acton Group, a clncal network of the fve Mdland Dstrct Health Boards, n response to feedback from a 2013 study* whch dentfed a need to harness smartphone technology to provde new mothers wth nstant user-frendly advce and support about breastfeedng. Content developer, Karen Palmer, sad the number of downloads and the uptake across New Zealand had exceeded ntal predctons. We knew the demand was out there but are delghted to see the volume of downloads from mothers, ther famles, and health professonals and to receve endorsement that the content and style s httng the mark. It s also encouragng that the app s beng pcked up mothers and health care provders beyond the Mdland regon. New mother Bree Claudatos from Hawke s Bay sad she was ntroduced to the BreastFedNZ app when her daughter was only a few weeks old. It has been the best tool to have to get nformaton and deas nstantly. It has gven me confdence to keep breastfeedng and provded me wth new deas when feedng got tough durng that frst month or so, she sad. I was able to learn some useful tps and trcks to get around problems I was facng and fnd out nvaluable nformaton that was relevant to the dfferent stages and ssues we were experencng. Whlst my daughter s now three months old, I stll refer to t, and beng an app on my phone means I m able to easly access nformaton at any tme and contnue to educate myself. I ve spoken about ths app often to other new Mums n my coffee group and would recommend BreastFedNZ as a must to download to all new Mums. The app has also been well receved by health professonals. Fona Hermann, Assocate Clncal Mdwfery Drector, Wakato Dstrct Health Board sad the 8

9 BreastFedNZ app provdes a quck, easy, convenent place for women and whanau to access accurate breastfeedng nformaton and help. It s rght where you are breastfeedng n the car or on the couch at home; t s really handy f you are a bt remote or don t have servces near you as t s lke havng a knd expert n your phone. Just the rght amount of nformaton wthout overloadng women, but wth lnks to fnd more help or nfo as and when you need t. BreastFedNZ contans sx chapters coverng pregnancy and brth, the frst few days, early weeks, breastfeedng the older baby, twns and early babes, and ths and that. Answers are also provded to common questons and concerns. The app also ncludes deas for those n the supportve role for mothers, such as dads, partners, frends, and extended famly members. Karen Palmer pad trbute to the collaboraton wth mothers, mdwves, lactaton consultants, publc health and obstetrcans n the app s development. Throughout ts development n 2015 we worked wth and sought feedback from these groups and feel confdent that women wll fnd BreastFedNZ a useful tool to help establsh and mantan breastfeedng, ultmately lftng breastfeedng rates n New Zealand. Karen Palmer The content developer of BreastFedNZ, Karen Palmer, s an experenced nurse, mdwfe, and lactaton consultant, who works for Western Bay of Plenty Plunket as the Communty Lactaton Servces Coordnator. Background nformaton The ntal objectve of the app was to fnd a more consumer frendly way to support the work of the Baby Frendly Hosptal Intatve (BFHI) and the Ten Steps to Successful Breastfeedng (The Ten Steps). Durng 2013, the NZ Insttute of Rural Health was commssoned to carry out the Mdland Regon Rural Maternty Servces Consumer Engagement Study. The study recommended the need for a moble phone app for pregnancy and brth whch should be provded free to newly pregnant women. Combned, these two needs and recommendatons provded the catalyst for the Mdland Maternty Acton Group to forge ahead wth the development of the breastfeedng app. For more nformaton contact: Suzanne Andrew Manager, Regonal Servce Plan & Executve Projects e Suzanne.Andrew@healthshare.co.nz BreastFedNZ 9

10 Mdland Regonal SUDI (Sudden Unexpected Death n Infancy) Plannng Snce y 2007 the Mnstry of Health has been workng to establsh a Natonal SUDI Preventon Programme (NSPP) and regonal DHB coordnaton of SUDI preventon actvtes. Both the programme and regonal coordnaton actvtes am to reduce the rate of SUDI to 0.1 n every 1000 brths by The current rate n New Zealand s approxmately 0.7 n every 1000 babes born. Two key SUDI preventon rsk factors wll be prortsed, e reducng exposure to tobacco smoke durng pregnancy and preventng bed sharng wth a baby. Hap te Hauora Trust (Hapa) have recently been contracted by the Mnstry of Health to provde natonal coordnaton of the NSPP. Hapa wll provde leadershp, oversght and montorng of the programme. Addtonally, four Regonal SUDI Coordnators have been apponted. The four areas covered by the coordnators are algned wth regonal DHB catchments - Auckland/Northland, Mdland, Central and Southern. In the Mdland area, Kate Stewart had been apponted as the Regonal SUDI Coordnator. The regonal SUDI plannng process requres DHBs to work n a collaboratve and coordnated manner to develop and mplement SUDI preventon servces and actvtes wthn the regon. Each DHB s also requred to develop and mplement a local SUDI preventon plan. Local plans wll reflect prortes and actons dentfed n the regonal plan, talored to meet the specfc needs of each DHB. The Mdland Regonal SUDI Coordnator has been workng wth SUDI representatves from each of the fve Mdland DHBs, and other key stakeholders, to progress development of the Mdland regonal SUDI preventon plan. The plan wll nclude a populaton analyss, stocktake of current SUDI servces/ actvtes n the regon, servce/ actvty strengths, gaps and areas for mprovement and SUDI preventon actons that wll be promoted and supported between November 2017 and 30 June New regonal plans are requred annually. For more nformaton contact: Kate Stewart Regonal SUDI Coordnator Mdland e KateSt@slngshot.co.nz 10

11 Mdland Bowel Screenng Regonal Centre The Mdland Bowel Screenng Regonal Centre (Mdland BSRC) has recently sgned a three year fxed term contract (1 September 2017 to 30 June 2020) and wll provde four key roles to the Natonal Bowel Screenng Programme (NBSP) wthn the Mdland regon: supportng the Mdland DHBs n the Natonal Bowel Screenng Programme (NBSP) plannng and mplementaton, and ncludes colonoscopy and symptomatc colorectal pathway exploraton clncal leadershp and support develop regonal equty plan and support mplementaton overvew of performance of Mdland DHBs aganst qualty standards and support opportuntes for mprovement. The Mdland BSRC Governance Group commenced February 2017 and oversees the work programme. The Mdland BSRC membershp wll consst of the followng: Programme Manager Brent McMlln Project Manager Qualty Coordnaton recrutment n progress Project Manager Equty Manager recrutment n progress Clncal Lead prmary care Dr Jo Scott Jones, Medcal Drector, Pnnacle Clncal Lead secondary care Mr Ralph Van Dalen, Co-Char Mdland BSRC Governance Group and Colorectal Surgeon Wakato DHB. The Mdland BSRC recently facltated the ntal Mdland bowel screenng workshop on 5 October The workshop provded the Mdland regonal bowel screenng stakeholders an update of the NBSP, nformed the current regonal colonoscopy capacty and gave an opportunty to explore and co-desgn strateges and/or ntatves to address challenges around equty, communty awareness and prmary care ntatves for non-responders and/or prorty populatons. A Mdland regonal bowel screenng hu was held n Rotorua 6 November The hu provded an opportunty to establsh strong Māor and Pacfc governance, explore strateges to ncrease partcpaton for Māor and Pacfc and ways to establsh strong regonal and dstrct level Māor and Pacfc governance for bowel screenng. The Mnstry of Health has recently announced that Lakes DHB wll be the frst Mdland DHB to roll out the NBSP n September 2018, wth the remanng Mdland DHBs havng ndcatve roll out dates of 2019/20. The Mdland BSRC s assstng and supportng Lakes DHB n settng up ther bowel screenng and assstng the DHB to map out ther current end-to-end symptomatc colonoscopy and colorectal pathways. Ths mappng wll be utlsed as a baselne to dentfy any barrers to optmal patent flow and dentfy any servce mprovement opportuntes along the colorectal pathway. The Mdland BSRC has also begun assstng the Mdland DHBs wth hgh level symptomatc colonoscopy producton plannng, ncludng the Mnstry of Health s projected NBSP colonoscopes and what downstream effect t may have on the Mdland DHBs endoscopy servces and the wder Mdland DHBs servces. In addton, the Mnstry of Health has agreed that Mdland BSRC wll hold the contract for the Natonal Māor Bowel Screenng Network. The Central BSRC wll facltate the Natonal Pacfca Bowel Screenng Network. We hope that the servce specfcaton and contract agreement wll be n place n the next month. For more nformaton contact: Brent McMlln Project Manager, Mdland Cancer Network HealthShare e brent.mcmlln@healthshare.co.nz 11

12 Mdland Cardac Clncal Network Cardovascular dseases (CVD) are a leadng cause of death n New Zealand. The Mdland Cardac Clncal Network s vson s a populaton wth ncreasngly well managed rsk factors. To acheve ths, the network members across the fve Mdland DHBs are workng to enable equtable and tmely access to the natonal Mnmum Expected Clncal Standards of preventon, detecton and nterventon n cardac dsease across ethncty and resdental locaton. Health Outcome Measures The data beng tracked to show mprovement are rates of Cardovascular Dsease Rsk Assessment (CVDRA), rates of hosptal admsson, readmsson, nterventon wth procedures, medcaton regmes and adherence, and mortalty due to heart dseases. Addtonally, a natonal servce gap analyss s underway aganst the Mnmum Expected Standards to dentfy where targeted mprovements are requred n the three bg dsease categores of Arrhythmas, Heart Falure and Coronary Arteroscleross. The graphs below show the level of admssons per Mdland DHB for each of these condtons. Graph: Admsson numbers at each Mdland DHB by Arrhythma, Heart Falure and Coronary Atheroscleross showng Atral Fbrllaton (AF) as the hghest number of admssons 120 Cardac AdmssonTrends and Numbers by DRG at Mdland DHBs 100 Number of Admssons Sep Nov Jan Mar May Sep Nov Jan Mar May Sep Nov Jan Mar May Sep Nov Jan Mar May Sep Nov Jan Mar May Wakato Bay of Plenty Taranak Lakes Tarawht Arrhythma, Cardac Arrest & Conducton Dsorders Heart Falure & Shock Coronary Atheroscleross (Source: MoH NMDS) 12

13 Health Equty The Mdland regon has acheved hgh rates of cardac procedures for Māor, except for Angoplasty where both Māor and Non-Māor are below natonal target rates. Regonal ntegrated plannng s beng used to dentfy where unmet need exsts across the Mdland regon, and to fnd ways to ncrease the number of angoplastes delvered to meet ths need. The charts below show the performance for each of the Mdland DHBs, for Māor and Non-Māor, aganst the natonal targets for cardac nterventons. Red ndcates a below target number of procedures per 10,000 populaton. Charts: Standardsed Interventon Rates (SIRs) per 10,000 for Cardac Procedures (Source: MoH SIR Quckr) Standarsed Interventon Rates (SIRs) for Cardac Procedures - Acute + Electve Maor - Year End Dec 2016 Wakato Bay of Plenty Taranak Lakes Tarawht MIDLAND Angography Angoplasty Cardac Surgery CABG Revascularsaton Cardac Surgery + PCI Valve replacement/repar All Electrophysology Interventonal Cardology Permanent Pacemaker Defbrllator Combned Dag and Therapeutc EP Dagnostc EP Therapeutc EP (Source: MOH SIR data provded on Quckr) KEY: Sgnfcantly below MOH Target Not Sgnfcantly Dfferent Sgnfcantly Above Standarsed Interventon Rates (SIRs) for Cardac Procedures - Acute + Electve Non Maor - Year End 2016 Wakato Bay of Plenty Taranak Lakes Tarawht MIDLAND Angography Angoplasty Cardac Surgery CABG Revascularsaton Cardac Surgery + PCI Valve replacement/repar All Electrophysology Interventonal Cardology Permanent Pacemaker Defbrllator Combned Dag and Therapeutc EP Dagnostc EP Therapeutc EP (Source: MOH SIR data provded on Quckr) KEY: Sgnfcantly below MOH Target Not Sgnfcantly Dfferent Sgnfcantly Above For more nformaton contact: Phlppa Edwards Project Manager, HealthShare e Phlppa.Edwards@healthshare.co.nz 13

14 Trauma Servces n Mdland Rotorua Trauma Roadshow, 6 October 2017 Local staff members and Mdland Trauma System (MTS) hub members contrbuted to the Trauma Roadshow at Rotorua Hosptal to publcse the Mdland regon s trauma servce, the reason for a trauma system, and to show patterns of trauma and trauma care emergng from the data collected by MTS. The Road Show was well publcsed by the local MTS crew and occuped an open area close to the hosptal entrance. There were a few tables and notceboards avalable, and places to drnk coffee. The general response from hosptal staff and vstng members of the publc was that the show was very nterestng, nformatve and professonally presented. Lakes DHB trauma personnel, Cherry Campbell and Carolyn Duncum had taken two of the free-standng notce boards and pnned up the posters representng general trauma and assault on ether sde of the area. Steve Holmes from the MTS hub ran a realtme verson of the Trauma Rsk Calculator developed for the Feldays that was populated wth Lakes regonal data. Vstors were able to assess ther own rsk of dfferent types of njury based on ther age, gender, ethncty, and domcle. The team provded gveaway frst ad kts and Frsbees that were very popular to passng staff and members of the publc. Followng ths Grant Chrstey delvered the Grand Round enttled: Trauma n Lakes; Patterns and Progress. Ths was well attended and gave an overvew of the specfc features of trauma n the dstrct that may be amenable to nterventon. Key topcs ncluded: Falls n chldren: age group, ethncty, mechansms, domcle, and local schools Mountan-bke njures: partcularly year old males from outsde of the dstrct on weekends at the mountan bke parks Interpersonal volence: demographcs, tme of day, day of the week, and locaton. Process Indcators: how s Lakes DHB dong wth key ndcators n the delvery of trauma care? Costs of trauma: opportuntes for cost savng n treatment of hgh-volume nonmajor admtted trauma patents requrng surgery. Overall the Trauma Roadshow succeeded n brngng strong messages and awareness to trauma problems focused on the specfc needs of the Lakes dstrct. Smlar programmes wll be rolled out across all the Mdland DHBs over the next sx months. For more nformaton on the Mdland Trauma System contact: Alana Campbell Programme Manager - MTS, Wakato DHB e Alana.Campbell@wakatodhb.health.nz 14

15 Dramatc changes are underway n hepatts C servces Photo: Mdland Regon Communty Hepatts C Servce team members Nancy Carey, Jo de Lsle and Wakato DHB endoscopy specalst Frank Welert wth one of the fbroscanners Dramatc changes n the way hepatts C s dagnosed and treated are underway n Wakato and the wder Mdland health regon, thanks to research, advances n technology, new treatment drugs, fundng decsons and a sprt of collaboraton. As a result, people dagnosed wth hepatts C can be treated (and often cured) wth new ant-vral drugs n ther own communty. Jo de Lsle, who s coordnatng changes across the Mdland regon, says the key to these mprovements s a focus on curng, communty and collaboraton. The result s a Mdland Regon Communty Hepatts C Servce and an approach that nvolves both prmary care practtoners and hosptal specalsts usng one agreed patent pathway. The key change s that responsblty for treatng patents wth hepatts C has moved to prmary care. Ths avods a lot of vsts to hosptal clncs durng the treatment stage. A workng group, ncludng a patent representatve, developed the regonal patent pathway last year 15

16 followng a plot by the Hepatts Foundaton of New Zealand n the Bay of Plenty dstrct. Ths pathway s now beng mplemented across the fve Mdland Dstrct Health Boards (DHBs) Wakato, Bay Of Plenty, Hauora Tarawht, Lakes and Taranak as the Mdland Regon Communty Hepatts C Servce, coordnated by Wakato Hosptal n partnershp wth the Hepatts Foundaton of New Zealand. All the major groupngs of Dstrct Health Boards are dong somethng smlar across New Zealand. What makes t easer for us s the electronc referral system we already have n Mdland for prmary care referrals to a regonal-based servce, says de Lsle. The new ant-vral drugs (Vekra Pak and Vekra Pak-RBV) were approved by the Mnstry of Health and are now fully funded by PHARMAC. These new medcatons are dramatcally ncreasng the cure rate for people wth hepatts C to over 90 percent, compared to 50 percent before the new medcaton was avalable. They are one of the drect actng ant-vral (DAA) group of medcatons that are a focus of nternatonal development n the treatment of hepatts. Wakato Hosptal s Gastroenterology Clncal Trals Unt has partcpated n nternatonal clncal trals of DAA medcatons snce Intal patent assessment and blood testng s done through general practces then referred to the Mdland Communty Hepatts C Servce for a fbroscan*. Ths smple dagnostc procedure tells the clncal team the stage of the hepatts, whch wll determne what sort of treatment s avalable. It s also an opportunty for educaton and dscusson. Some fbroscans are done at Wakato Hosptal but communty fbroscan nurse Jllan Whte provdes the same dagnostc and educaton servce by clncs held where and when they are needed n communtes across the regon. Once the dagnoss s done and t s clear what stage the hepatts C s at, then any treatment medcaton can be prescrbed and managed locally by general practtoners and prescrbng nurses. De Lsle says that the combnaton of communty GP and nurse prescrbng, moble servces, electronc referrals, more portable and cheaper fbroscanners, means the servce can provde hepatts C support and servces much closer to home for patents. * A fbroscan (also known as a transent elastography) s smlar to an ultrasound, usng a tool held aganst a person s sde close to where the lver s located. It checks the amount of scarrng or fbross by measurng the degree of stffness n the lver. In the past, ths dagnoss was done by bopsy, where a pece of lver was taken from a person for analyss. Wth the fbroscan, the dagnoss s non-nvasve, not panful, and quck. Wakato Hosptal got ts frst fbroscan machne n 2010 for $200,000, and t was a cumbersome machne compared to the current very portable models that cost around $80,000. For more nformaton on the Mdland Regon Communty Hepatts C Servce contact: Jo de Lsle Project Manager, Joanne.deLsle@healthshare.co.nz. 16

17 South Wakato cardac nurses fnd new ways to reach more patents An nclusve approach to patent care by a team of cardac secondary preventon nurses means patents n South Wakato are beneftng from better access to support servces. Cate Shepherd s a specalty clncal nurse n Wakato Dstrct Health Board s cardac secondary preventon servce, a team of sx nurses who provde recovery support to people who have been n hosptal wth heart problems. Cate sngle-handedly covers the area from Putaruru to Mangakno, and shares responsblty for the area from Te Kut to Natonal Park, and Hamlton. It s an enormous area to cover wth a large rural populaton, says Cate. We have to be smart about how we use our tme and resources, but also ensure all cardac patents have equal opportuntes to access cardac rehab support. Wth smaller numbers n rural areas, rsk factor management classes that offer patents expert nformaton about medcaton management, exercse and det, are dffcult to offer locally. But the long drve, up to sx hours return from places lke Taumarunu, means many patents are unable to attend weekly sessons n Hamlton. To overcome these ssues, the cardac secondary preventon team took a dfferent approach and condensed the classes down to a sngle three-hour sesson offered at Tokoroa hosptal. They then added a lve Telehealth vdeo lnk to patents n Taumarunu. The response from the communty has been postve. We ve held cardac classes usng Telehealth a couple of tmes now and t s workng well, says Cate. When we make the effort, people tell us they really apprecate beng ncluded and havng somethng avalable closer to where they lve. It s defntely somethng we wll expand on for patents n South Wakato, as we fne-tune how t works. For more nformaton contact: Dr Ruth Large FACEM FDRHM Clncal Drector Thames Hosptal, Emergency Physcan Wakato Hosptal e ruth.large@wakatodhb.health.nz Ths e-newsletter s produced by HealthShare Ltd (Mdland DHBs shared servces agency). 16 Clarence Street, Hamlton 3240 PO Box 19064, Hamlton 3244 phone: emal: healthshareadmn@healthshare.co.nz HealthShare Annual Report for Year Ended 30 June