PATIENT STORIES. Healthcare Initiatives in Nelson Marlborough. Quality Report 2014

Transcription

1 PATIENT STORIES Healthcare Initiatives in Nelson Marlborough Quality Report 2014

2 Adrienne Frater CONSUMER ADVISOR Chris Fleming NMDHB CEO Garry Frater CONSUMER ADVISOR 2 CONSUMER ADVISORS MESSAGE When we were asked to be consumer representatives on the Quality Report Working Group we quickly said, Yes. We had both recently experienced a hospital stay and were delighted to be able to give something back. Our role has included attending a series of meetings where the 2014 Quality Report has taken shape. Each contribution describes a particular initiative or improvement and we comment on how user friendly the language is. It is very easy for professionals to write in what we call medi-speak. As lay people we repeatedly asked, What do you mean by this? Reading about the range of improvements has given us a greater understanding and has been a positive experience. The professionalism of the Quality Report committee meant they included us in all discussion and answered our many questions. As this report nears completion the remaining challenge is getting it out into the community and getting people to read it. Please do. CHIEF EXECUTIVE S MESSAGE This publication is an important snapshot of the work we do as a District Health Board. I would like to thank our community representatives Adrienne and Garry Frater for their input into this publication. Patients are at the heart of our services and the desire to create a better service for patients drives our quality improvements. I believe there is always a need for continuous quality improvement and our clinical staff, along with our Clinical Governance Group, strive to create a culture where innovation and excellence will flourish. Adverse events also drive our quality improvements and are important indicators of systems that need attention and lead us to make further improvements. Nelson Marlborough health professionals are committed to delivering the best service possible within the resourcing available. TELL US WHAT YOU THINK We need your suggestions about how we can improve the quality and safety of services. Tell us what matters to you by contacting us. Website Feedback_Form.aspx feedback@nmdhb.govt.nz or quality@nmdbh.govt.nz Mail The Chief Executive Private Bag 18 Nelson or Patient Relations Coordinator Private Bag 18 Nelson Telephone (03)

3 HEALTH TARGETS ACHIEVED NOT ACHIEVED ACHIEVED NOT ACHIEVED ACHIEVED NOT ACHIEVED NATIONAL HEALTH TARGETS The Ministry of Health sets New Zealand s Health Targets each year. The targets give us a focus for improvement in the specific areas of health care that will have the biggest impact on our community s well being. SO, HOW ARE WE DOING? Even though there are two areas where Nelson Marlborough DHB has not quite reached the target this year, we are getting very close. Offering Better Help for Smokers to Quit is working well for patients, staff and whanau in a hospital setting. However, if we are to meet the target, there s room for improvement outside the hospital, such as GP practices, workplaces or community clinics. We are continually improving towards More Heart and Diabetes Checks despite not quite meeting our target. The Increased Immunisation target has been met but we are still working hard to ensure the numbers of children being fully immunised continues to increase. ACHIEVED NOT ACHIEVED ACHIEVED NOT ACHIEVED ACHIEVED NOT ACHIEVED WHEN THINGS GO WRONG Despite our best efforts, things occasionally go wrong. When things go severely wrong, for instance where death or harm occurs during the process of healthcare, it s called a Serious Adverse Event. When these events happen, Nelson Marlborough DHB works openly with patients and whanau to ensure their needs are addressed. NMDHB Serious Adverse Events July 2013 June July 0 January 1 August 2 February 0 September 1 March 4 October 1 April 1 November 0 May 1 December 2 June We also review and learn from the event to continually improve patient safety. Some Nelson Marlborough DHB safety initiatives introduced as a result of Serious Adverse Events include:»» SAFER JOURNEYS HOME STRATEGY to ensure patients discharged from the hospital do not drive home while under the influence of medication.»» KEEP YOUR BABY SAFE DURING SLEEP making every sleep a safe one to prevent babies from dying suddenly in their sleep.»» DID NOT ATTEND POLICY to ensure patients that did not attend clinic appointments are followed up and managed safely. The policy also aims to make the best use of specialist resources and improve patient access to these services. 3

4 WHO WE ARE THE PEOPLE OF NELSON MARLBOROUGH DISTRICT Nelson Marlborough District Health Board is responsible for the publicly-funded health services available to the 137,000 residents of the region s census tells us that there are 7,000 more people than at the 2006 census the highest rate of increase among all South Island DHBs. After the Christchurch earthquake in 2011 our district s population grew significantly. Most of the migration was to Nelson and Tasman, with Nelson city s population increasing by 8.3% since Overall, the district s population is split almost into thirds, with 34% living in Nelson City, 34% in the Tasman district and 32% in Marlborough GP visits 1179 people living in aged care facilities 4 babi a da the d 249 radiology exams 4

5 es born y in hb 3321 laboratory tests 1630 presecriptions filled DEMOGRAPHICS With 18.6% of our residents aged 65 or over (20.5% in Marlborough), NMDHB has had the highest growth in older population of all DHBs. At the 2006 census that figure was 14.7%. We are becoming more ethnically diverse 9.4% of us identify as Maori (up from 8.7% in 2006), and more people identify themselves as Asian 3.1% or Pacific 1.7%. Ethnicity also marks differences in our younger population; 45.9% of people identifying as Maori are under the age of 20, compared to 22.8% of the non Maori population. Ethnicity also marks differences in economic circumstances. Our Maori population tend to live in areas of higher deprivation than non Maori. These and other significant facts from the 2013 census shape the way the district s publicly-funded health services are planned and delivered. 37 surgeries performed 5

6 PATIENT SAFETY 100% 90% 80% 70% National Target 60% 50% 40% 30% 20% 10% 0% April June 2014 Nov Mar 2014 July Oct 2013 April June 2013 Nov Mar 2013 July Oct 2012 HAND HYGIENE Good hand hygiene prevents healthcare related infections. This measure has five hand-cleansing moments which are: before patient contact; before a procedure; after a procedure; after patient contact; and after contact with patient surroundings. Observed moments compliant with the 5 moments of hand hygiene 100% 90% National Target 80% 70% 60% 50% 40% 30% 20% 10% 0% Quarter Quarter Quarter Quarter FALLS PREVENTION This includes identifying patients at risk and preparing plans to keep them safe. This national patient safety campaign to reduce harm and improve quality and safety in health and disability care settings was introduced by The Health Quality & Safety Commission. Priority areas where evidence showed change could reduce patient harm are: Medication Safety, Preventing Harm from Falls, Perioperative Harm and Healthcare Associated Infections. Each priority area has Quality Safety Markers shown in the graphs below. Falls risk assessment compared with threshold 100% 90% National Target 80% 70% 60% 50% 40% 30% 20% 10% 0% Quarter 1 Quarter 2 Quarter 3 Quarter 4 SURGICAL SAFETY CHECKLIST This measures the percentage of theatre teams that used the World Health Organisation checklist that has shown to reduce surgical harm. Percentage of operations where all three parts of the checklist were used 6

7 QUITTING SMOKING Tobacco use is the single most preventable cause of death in New Zealand. To help more people become smokefree, staff at Nelson Marlborough DHB use the ABC approach to smoking cessation. When Tania took steps to become smokefree, she asked her whanau to join her on a smokefree journey to better health. Through simple steps, good support and medication a person s chances of successfully quitting smoking are significantly increased. Health professionals in Nelson and Wairau play an important role in helping people quit smoking by following the ABC approach. The ABC approach is made to all inpatients, parents of children admitted to hospital, DHB staff, pregnant women and their whanau. TANIA S STORY Although relatively young (mid 40s), quite fit and not particularly overweight, Tania ended up in the Emergency Department because she was having a heart attack. After she d had an angiogram, the cardiology team inserted stents (small mesh tubes) into two of her arteries. Tania s whanau nearly lost her that day and the medical staff told Tania the chances of her being around in ten years time were not good. They said kei a koe (it s up to you). From that moment Tania decided to become smokefree and eighteen months on is still smokefree. I didn t realize that over a few days I was having a heart attack. At first I was very breathless when I was swimming lengths, then when I was out walking. When it woke me at night I thought I d better go to ED. They told me years of smoking had narrowed my arteries. I didn t find it too hard to quit. It just came down to preparing myself. I went cold turkey in hospital and used that time to sort out how I d deal with my favourite smoke times. So instead of having my after-breakfast smoke, I popped a peppermint. I didn t put myself under pressure; I just took one day at a time. I m from a big family - we all loved sport and all smoked. I drew courage from the fact that the rest of my family had the willpower and grit to quit when they were training, so I could too. It amazes me that although I never really wanted to give up smoking, I still managed to kick it. Ask patients if they smoke Provide brief advice Offer cessation options I didn t find it too hard to quit. It just came down to preparing myself. 7

8 WATER BIRTHS 8 An audit into all water births and water immersions at Wairau Maternity facility since 2011 has produced some interesting findings and provided a good comparison with low risk land births Angela, mother of two, has experienced both a land and water birth and is definitely a fan of the pool. ANGELA S STORY My first child was a posterior baby and I found the water fantastic to labour in. As soon as I got in the pool the pain in my back was less and I relaxed. When I went in to labour with my second child, I was coping all right at home but I just wanted to sit in the pool. My biggest fear was that I would get anxious and the adrenaline would kick in and slow my labour down, but as soon as I got in the water I relaxed. I had done a bit of reading about water births and I liked the whole hands off approach - me doing it my way and not having everyone touching me and telling me what to do. I am pregnant again and I am definitely aiming at another water birth. As soon as I got in the pool the pain in my back was less and I relaxed. WATER BIRTH AUDIT Wairau Hospital s new maternity unit opened with a purpose built pool for water births and water immersions during labour. Since 2011, 109 women have used the pool and their experiences have been audited and compared with low risk land births. WATER VS LAND BIRTHS First time mums 42% Land Births 58% Water Births Mums who had previous pregnancies 58% Land Births 42% Water Births Mums who did not require pain relief 19% Land Births 37.6% Water Births Babies who had skin to skin for an hour after birth 77% Land Births 82% Water Births Babies who initiated breast feeding within the first 24 hrs of birth 85% Land Births 89% Water Births Low risk births are full term, single baby pregnancies, with a head first presentation and no obstetric complications. The audit involved conversations and feedback from women about their birthing experience at the unit and details from birthing notes. Although there s only a small number involved, the audit revealed some interesting findings. More first time mums used water during labour and Maori women were more likely to use the pool during labour. The women feel being in water helps reduce the need for pain relief, promotes relaxation and gives an overall positive birthing experience. The audit findings show many similarities between water and land based births around epidural rates, lengths of labour, caesarean section rates and blood loss. There s a slightly higher rate of normal birth using water. This information is available to inform women and midwives on local outcomes when considering the use of water during labour and birth.

9 FREE PRATIQUE To help protect our country from infectious diseases, all vessels entering our ports direct from overseas, must be granted pratique or permission to use the port. This process used to involve fax machines, telephone operators, admin staff and Health Protection Officers, but now there s a new electronic pratique process in place. The new electronic pratique system provides a more efficient, cost effective and streamlined system for vessels arriving at our ports. To help keep diseases, such as ebola, from entering New Zealand via our ports, all vessels arriving direct from overseas must complete quarantine requirements. Whether it s a cargo ship, a foreign fishing vessel or a cruise ship with several hundred passengers, the ship s agent has to request pratique or permission to enter the port for the first time, by following the Port Health Authority Pratique Procedure. Part of the process involves the agents submitting a No Change of Health Status Report, signed by the ship s master, to the Public Health Service between 12 and 24 hours before arrival. If the health status of the ship is OK, pratique will be granted. If the report is received late or not at all, or if pratique is denied due to illness on board, the vessel will have quarantine restrictions. Before 2012, this procedure involved a lot of time and people. The new streamlined process for issuing pratique involves an electronic shipping board developed by the Nelson Marlborough District Health Board. All pratique notices are now ed via the shipping board and the Health Protection Officer (HPO) deals directly with the agent. Agents usually get an instant response to their requests for pratique. The electronic system also allows for continuity of work when there is a changeover of on-call HPO, as the relevant information is always up to date. Nelson and Marlbrough are often the first ports of call for vessels entering New Zealand. The new electronic pratique system provides a more efficient, cost effective and streamlined system for vessels arriving at our ports. 9

10 ALLIED HEALTH IN THE EMERGENCY DEPARTMENT Basing a physiotherapist and a social worker in the Emergency Department fits well with the DHB s aim of delivering better, sooner, more convenient services for patients. Having a physiotherapist and a social worker in the Emergency Department (ED) is saving time and helping patients connect to the right services. Nursing and medical staff also feel more supported since allied health staff were introduced to ED. The ED triage nurse refers some patients directly to the physiotherapist and others see a doctor first. With physios seeing the minor fractures, strains and sprains, medical staff can spend time with more complicated injuries. This improves the flow in ED when it s busy, and interventions can be started straight away, whether it s in the wards or as a follow up in the community. The ED social worker also takes referrals from the medical and nursing staff or the ED at a Glance computer system that shows which patients are coming through and what s happening to them. The social work service ensures patients are connected with the right services in the community. This includes support for children and families, and follow up on home care or liaison with ACC. Feedback to having allied health staff working in ED has been very positive. Admissions to hospital have been avoided and connections to community services enhanced. MARY S STORY Mary is 91 and lives alone. She came in to ED with pain in her arm after getting down to the floor to clean. An x-ray showed a previous fracture in Mary s arm was healing well and she was discharged with physiotherapy follow up and increased home care. It s much easier having physiotherapy seeing me at home to help get my arm moving again. I ve been very happy with the extra care that has come in. I feel smothered with care. It s helped me to be able to stay at home. ANNE S STORY Anne had been unable to work for two weeks due to being unwell. She was also looking after her unwell husband and caring for her elderly mother. The ED social worker contacted Anne to see what supports could be put in place: The offer of assistance and followup from the Social Worker to help over a particularly tough time was quite unexpected and very much appreciated. I feel smothered with care. It s helped me to be able to stay at home. 10

11 PREADMISSIONS HUB Attending the pre-admission hub reduces the risk of surgery cancellations, removes potential bottlenecks in the system, and enhances patient safety and satisfaction. The hub benefits every patient accepted for surgery that requires a general or regional anaesthetic. At their first specialist appointment patients having surgery under a general or regional anaesthetic now visit a pre-admission hub before they leave the building. At the hub they fill out a health questionnaire, receive information on their elective surgery procedure, and have their base line measurements taken, including height, weight, blood pressure and body mass index. Within three days this information is reviewed and patients are prioritised according to whether they are fit and healthy and ready for surgery, or if there are any health issues that may need to be dealt with before surgery, such as reducing their blood pressure. The pre-admission process avoids dealing with concerns at the last minute, which may cause a cancellation. At the hub appointment patients who are available for short notice surgery are also identified, so if there is a cancellation or deferred surgery, the place can be quickly filled. Two days before their surgery, patients are called to check if they have a cold or any other health issues that might defer their surgery. This allows time to book someone else if necessary. By completing the preadmission process as soon as they have seen the specialist and been accepted for surgery, most patients won t have to make extra trips to hospital or take unnecessary time off work. It also frees up nursing time for people who may have higher risks. The staff were wonderful, they made us feel cared for during a most difficult time. The pre-admission hub covers all specialty areas and sees over a hundred people a week as they are prepared for their surgery. The experience has benefits for both patients and medical staff, as patients are better prepared for surgery, they have less appointments, shorter waiting times and earlier interventions when needed. TONY AND LISA S STORY We were both patients within weeks of each other. We found the pre-admission experience to be very thorough, and it made us feel well informed and prepared before surgery. The staff were wonderful, they made us feel cared for during a most difficult time. 11

12 COMMUNITY RHEUMATOLOGY The waiting time to see a rheumatologist has been greatly reduced with the introduction of a community-based rheumatology service. The community clinics offer specialist clinical assessments, management plans, information, education and support to people with inflammatory arthritis. The community-based rheumatology service offers patients more timely appointments, greater efficiency and safety, and a high level of patient satisfaction. The rheumatology service team, made up of a rheumatology nurse, GPs with a special interest in rheumatology and a rheumatologist, has moved from Nelson Hospital to Nelson Bays Primary Health at the new health hub in Richmond. Marlborough currently has a rheumatology clinic on the Wairau Hospital site but this will move into a new community-based site when the Marlborough PHO moves into their new location. The rheumatology service is based on the idea that people with arthritis are not sick and don t necessarily need to be seen at a hospital. Patients with inflammatory arthritis are referred to the clinic either by their GP through the Care Coordination Centre, or through the hospital. Complex cases may stay within the hospital system, but others will be given an appointment for the rheumatology service. The community clinic sees around 24 patients in each session and has a minimal waiting list. The clinic has three GPs in Nelson and two in Wairau, with the rheumatologist providing clinical oversight. There s also a hospital physician involved to ensure there s a good link with the hospital clinical teams. The rheumatology nurse provides patient education, which is particularly important for those with a recent arthritis diagnosis, and liaises with the patient s own GPs. Other specialised nursing staff give information on medications and can make referrals for orthotics or other assistance. Every 12 months or so the GPs will rotate with other practitioners who have indicated an interest in joining the clinic, so that a good pool of knowledge will be developed across our general practices. Before the clinic service was established rheumatology patients were referred to the specialist at the hospital or would have to make a private appointment. This system often meant there were long delays before patients were seen. The community-based rheumatology service offers patients more timely appointments, greater efficiency and safety, and a high level of patient satisfaction. PATIENT FEEDBACK If it hadn t been for the arthritis nurse, I would still be in unbearable pain now. There is a real need for the clinic in my mind. 12

13 ENHANCED RECOVERY AFTER SURGERY Helping patients to get fitter sooner after their surgery is the key focus of the Enhanced Recovery After Surgery (ERAS) programme. When Jackie had her colorectal surgery, she felt well prepared for the journey ahead, and was up and walking from day one. JACKIE S JOURNEY Before the surgery I needed to deal with my fears. I contacted a hospital social worker and had a big cry and voiced all my scary thoughts. I was then clear to ask the surgeon the relevant questions. She showed me a great diagram of the bowel and explained how the operation would be done. The ERAS nurse described the post-op care. On the day of my surgery I felt very calm. The first night was pretty surreal with tubes and morphine but next morning I was asked if I wanted a shower and to sit in a chair.although I felt really fragile there was an expectation that I could cope. I think being encouraged to do normal things, psychologically, makes you feel stronger. I was keen to get home but anxious about managing without nursing support. I had questions for the occupational therapist and the dietitian, and I knew Carolyn was there if I was worried. Their encouragement affected how I felt about myself, and my expectations. It was great. When I look back on my experience I m amazed that I could be in theatre on Wednesday and then on Monday be home getting on with life. WHAT IS ERAS? The Enhanced Recovery After Surgery programme of care aims to provide patients having colorectal surgery with a better understanding of what to expect, less time in hospital and a faster return to normal activities. This programme starts at the patient s first specialist appointment and follows their surgical journey until 30 days after their operation. Every health professional involved in the patient s care during that journey is part of the programme: the surgeon, anaesthetist, nursing staff, dietitian and physiotherapist. Throughout the programme there are clear clinical pathways or steps followed. These include good nausea and pain control to enable patients to eat, drink and mobilise sooner after surgery. Colorectal surgery covers a variety of procedures used to repair damage to the colon, rectum, anus, and pelvic floor. I think being encouraged to do normal things, psychologically, makes you feel stronger. 13

14 DIABETIC EYE CLINIC Loss of sight is a very real possibility for a person with diabetes, but it can be prevented with early detection and intervention. The Diabetic Retinopathy clinic at Nelson Hospital screens patients who are at risk of developing diabetic retinopathy or retina disease. Diabetic retinopathy is a retinal complication that affects about a third of people with diabetes. It damages small blood vessels at the back of the eye and can lead to deteriorating vision. It causes no symptoms in the early, treatable stages. I was very pleased with the service I received recently during my diabetic retinal screening. Everything was fully explained to me and any questions I had were answered. The good news is that diabetic retinopathy can be detected through screening, and early intervention can prevent or help reduce the loss of vision. It s recommended everyone with diabetes has two yearly photo-screening. The screening appointment at the Diabetic Retinopathy clinic involves a visual acuity check and taking photographs of the back of the eyes. Some people may need dilating eye drops but the new non-mydriatic camera may produce acceptable photos without the need for drops. The images are then checked by the optometrist and reported to the person's GP. The specialised digital retinal photography shows up any changes that could affect sight, for instance, leakage from the blood vessels in the eye. The whole process takes around an hour and identifies those patients doing well and those that need more monitoring or follow up treatment by an eye specialist. Recently the service has been streamlined with a specialist optometrist carrying out the screening process using an updated retinal camera. Previously, it involved three stages - a nurse to put the drops in, the photographer and then either a GP or optometrist to grade the pictures. The current process is shorter and the optometrist is able to have a discussion with patients about their eyes before they leave the clinic. The patients can also view any photographic evidence of the effects of uncontrolled diabetes. The screening appointment is not a full comprehensive eye examination. It is only checking for diabetic eye disease of the retina and doesn t necessarily pick up other things. Patients need to go to their optometrist for a full examination. ROBBERT S STORY I was very pleased with the service I received recently during my diabetic retinal screening. Everything was fully explained to me and any questions I had were answered. 14

15 ADVANCED DIRECTIVE An Advanced Directive is a way for a person to be heard during a mental health crisis when they may be less able to participate in their treatment decisions. When Marjorie s Advanced Directive video was needed, it gave staff guidelines for her treatment and was also a useful message to herself. During a mental health crisis a person is often unlikely, or unable, to have meaningful discussions about their treatment and care. For anyone with an ongoing illness the Mental Health Commission recommends they consider making an Advanced Directive to ensure their wishes about their treatment and care during any future episodes are known. Advanced Directives follow certain criteria and are put together when a person is well and able to make choices about their mental health care. A directive can identify what medications and treatments have worked in the past and what haven t. Arrangements can be specified for the care of children and pets, and clients can nominate the support people they want to see, or not, when they are unwell. An Advance Directive can result in a shorter and more satisfactory stay in hospital, more appropriate treatment and a better outcome for all. MARJORIE'S STORY I had an Advanced Directive on paper, but we decided to put it on a DVD because when I was unwell I would try and dispute what I had written. On the video it s obvious it s me and I hoped I would listen to myself. The video also gives staff an insight as to who I am when I m well. The person they see at my acute admission is not the person I am. Putting it together involved a lot of planning and discussion. It's not all about me, it s about the support I have and the partnerships I ve built. I was quite emotional when we were filming it because at the time I was well, but I got a bit teary thinking I could become unwell and need it. I've since used my Advanced Directive and it was useful not only for me but for the people caring for me. I watched it several times and the treatment plan went a lot quicker and I was able to return to my life sooner. It's not all about me, it s about the support I have and the partnerships I ve built. 15

16 CARES COORDINATED ACCESS REFERRAL ELECTRONIC SERVICE CARES or the Coordinated Access Referral Electronic Service is a single referral system for patients needing physical and mental health services in the community. Referrals are sent in electronically to a coordination centre, where they are prioritised and forwarded on to the appropriate service. If a patient needs help from a community based service, their GP fills out an electronic referral form, and with the press of a key it s sent through a secure link to a coordination service. The Coordinated Access Referral Electronic Service, or CARES, manages around 12,000 referrals and requests for help a year. It coordinates community based services such as Support Works, AT&R, Meals on Wheels, Physiotherapy, Occupational Therapy, District and Oncology Nursing as well as dietitians and falls prevention programmes. Many of the referrals are from GPs but they can also be from other sources including ACC, St Johns, Work and Income and hospital outpatients. A CARES CASE A 78 year old reclusive man, living in a tiny hut in an extremely remote area, was found wandering and confused in his neighbour s property. Physically he appeared very frail, although his neighbours reported that just a couple of years earlier he was a fit, strong man. This man had complex social issues, but as a result of the referral through CARES he is now on the books of District Nursing and Support Works, and he is being encouraged to register with a GP for medical reviews as his health needs change. If they need to add more detail. They also note what other services the person may already be known to, so each service knows who else is connected with a patient. The CARES staff check that each referral is going to the right service, if there s enough information provided or if someone has multiple issues and is referred to multiple community services, the system flags their case and it s discussed at a multi-disciplinary team panel. This helps coordinate all the services involved. Some of the benefits of CARES are; better quality referrals to services, faster help to patients, better coordination of services and quicker discharges, because support can be in place before a patient goes home. CARES is about making sure referrals get to the right place, at the right time, with the right information. 16

17 SERVICE USER BOARD The Service User Board gives people with an intellectual or physical impairment the opportunity to make choices that can change their lives. Rosemary has been on the Board for three years and enjoys going to the meetings, learning new things and speaking up. NMDHB Disability Support Services (DSS) provide community based residential support, day services and respite care for people with an intellectual or physical impairment. They help nearly 217 service users to achieve, grow and enjoy optimum quality of life in 56 suburban homes across Nelson Marlborough. DSS established a Service User Board to enable the people who use the service to have their say about how the service is run. The first meeting was held in February The Board has eight representatives from homes and day services, and meets once a month. With the help of a facilitator, the representatives talk about anything that affects their daily life. For instance changes in policies, or their involvement in interviews for new group managers following a management restructure. Board members bring questions and ideas from the homes they represent to the meetings and provide feedback. There s an application process, usually done in conjunction with a facilitator, to become a representative on the Board, and aspiring members can attend a meeting to see how they d fit in and find out what s involved. The Board has given people who use the service a voice and an opportunity to make choices and be heard. At the meetings we get to ask some good questions and have a say in all sorts of things. ROSEMARY S STORY I ve been on the Board for five years - and I want to keep doing it. I go round the houses or ring up and have a yarn to the people there and I also ask the team leaders if they have anything for the meeting. At the meetings we get to ask some good questions and have a say in all sorts of things. It has been good for me cos I am learning new things but I ve still got lots more to go. I have been to a Speaking Up workshop and been part of interviews. A new thing for me is being a Peer Support person. I ve never done anything like this in my life. I used to be shy and hide behind people, and get nervous, but I don t anymore. 17

18 FUTU FOC Harold Wereta General Manager, Maori Health & Whanau Ora Oral Health improving access rates to community services. Helen Steenbergen Service Manager, Women, Child & Youth More timely access to a specialist Recruitment of paediatric psychologist. Peter Burton Service Manager, Public Health, Rural & District Nursing Healthier Warmer Homes the Public Health Service role in identifying patients who would benefit from a warmer home through the newly launched home insulation project. Lynley Gardner Service Manager, Surgical Introducing Enhanced Recovery After Surgery (ERAS) Orthopaedics. Pat Davidsen Service Manager, Specialist Services Develop Radiology Dashboards for CT, MRI, Ultrasound and Plain Images. This will contribute to the overall National Radiology Service Improvement Project. Robyn Byers General Manager, Mental Health and Addictions Support the Inpatient workforce to reduce seclusion based on national and international best-practice examples. 18

19 RE US Hilary Exton Director/Service Manager, Allied Health Service Accreditation Project - Different Allied Health staff will be accredited to issue equipment via MOH funding. John Winter Service Manager, Clinical Support Service Improvement in Clinical Support meeting the changing needs of the patient and the health system through shorter waiting times and enhanced patient flow. Rosey Wilson Service Manager, Medicine Faster Cancer Treatment. Andrew Lesperance General Manager, Strategy, Planning & Alliance Support Increasing access to Community Pharmacy Anti-coagulation Management Service (CPAMS) for people on warfarin. Keith Rusholme General Manager, Disability Support Services Staff culture survey to identify and work through issues to improve standard of support offered. Tell us what you think... We need your suggestions about how we can improve the quality and safety of services. Tell us what matters to you by contacting us. Website Form.aspx feedback@nmdhb.govt.nz quality@nmdbh.govt.nz Mail The Chief Executive Private Bag 18 Nelson or Patient Relations Coordinator Private Bag 18 Nelson Telephone (03)

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