From: Date: September 2012 Subject: Report Purpose Cathy Taylor, Programme Manager, HealthShare Ltd Midland Region 2011-2012 Achievements To provide a summary report on achievements across the Midland Region in 2011-2012 Midland Region Key Achievements 2011-2012 Regional Approach to Quality and Safety for Maternity Belinda Chapman, Clinical Midwife Specialist from Taranaki was one of the first users of the training package. Under a new regional education programme, every clinician across the Midland region has access to an online education package around the use of CTGs (Cardiotocography or fetal surveillance); CTG machines give a reading or trace and enable monitoring of contractions and the baby s heartbeat during labour. CTG training assists clinicians in the interpretation and response to the CTG pattern by defining a standardised process of interpretation, documentation and management of CTG, in particular where variations from normal occur. CTG interpretation was identified as a key educational priority for the region. To fill this knowledge gap, the Midland DHBs secured agreement to go with a single education package. To access the training, each DHB was required to send a list of clinicians who would be users of the package, so that each clinician can then access and work through the package when it suits them. Page 1
Information and communication improves integration Communication and sharing of information has been made easier for the Midland Renal Action Group thanks to the development of a shared on line work space using NEXUS. The site allows members of the group to post information, have discussions, share resources and work collaboratively. Page 2
Better sooner more convenient care for patients with Acute Coronary Syndrome Dianne Penney, ACS Project Manager The Midland Cardiac Network was established in 2011. Midland DHBs had a number of challenges to ensure that national targets were met for those patients presenting with acute coronary syndrome (ACS). The Midland ACS Project, led by Project Manager Diane Penney from Waikato DHB, was put in place to identify and implement improvements across the Midland DHBs. This project runs until 2014, and has the goal of achieving equity of access for ACS patients. Already a number of systems and processes have been standardised across the 5 Midland DHBs, and an electronic quality improvement tool known as ANZACs QI went live in June 2012. This tool will enable the DHBs to monitor services and outcomes for ACS patients. The Midland DHBs have significantly improved access to angiography for patients with suspected ACS getting an angiogram within 3 days of presenting to hospital. The collaborative and concerted effort by the Midland DHBs is already helping to improve services for patients, meaning that more patients are getting care sooner. Although regional variability still exists, it has improved considerably and this will be the focus of the coming year s workstreams. Page 3
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Analytical Support Provides solid foundation for Regional Service Development Philippa Edwards, Analyst The appointment of Philippa Edwards in the role of HealthShare Analyst has enabled the Midland Region to take a strong focus on gathering data and information that has a regional focus to support regional planning and service development. All of the Midland DHBs have a strong focus on information and understanding their local environments. HealthShare needed to understand what the access and outcomes were across the whole of the Midland Region to identify where opportunities exist for improvement and to enable the region to identify priorities for action. As a result of the work to date we have been able to develop a model to identify services and outcomes for localities across the region, including the urban/rural differences where they exist. This has been particularly important given that 38% of the regions population live in rural areas. To date the focus has been on those services that the region has identified as vulnerable: maternity, cardiac, renal, and a range of elective services. In addition we will be looking at workforce and facility capacity across the region to identify future opportunities for regional collaboration that will best use available expertise and resource. Page 5
Midland Region Training Network Midland Region Training Network NATIONAL DIRECTION Minister of Health National Health Board HWNZ Board Ministry of Health HWNZ BU HQ&SC etc National Policies, Strategies & Plans Midland Region Training Network Director Regional Support Roles Regional Governance Midland Region Training Network Leadership Group Expert Work Streams Local District Training Coordination Systems & Personnel Local District Stakeholders Health Training Stakeholders (Local, National) In line with national direction, an objective of the Midland Region Clinical Services Plan 2011/12 was to establish a Midland Training Network. This has been achieved by region wide stakeholder consultation and engagement, comprehensive analysis and planning processes. The Midland Region Training Network is a cooperative system of interacting roles and functions. The components operate autonomously in a virtual and adaptive model. Mechanisms connect the components at a base level, while the Midland Region Training Network Leadership Group provides the overarching direction in agreement with Regional Governance. Externally a number of factors shape the network such as national direction, policies, strategies and plans. The network provides an interface for stakeholder relationships. The Midland Region Training Network will deliver a range of programmes and initiatives in 2012/13 and provide the Midland Region DHBs with a mechanism for working together. Regional resources will build on local infrastructure to establish a platform for regional cooperative activities. Page 6
Midland DHBs Developing Clinical Action Groups and Networks Summary of achievements 2011-12 Programme Manager: Cathy Taylor In the 2011/12 year the Midland Region established 6 Clinical Action Groups and Networks: Maternity Renal Rural Health Elective Services Cardiac Radiology The establishment of each of these the new clinical networks or action group included: Establishment of the clinical networks or action groups with each group having representatives from across the 5 DHBs. Members are nominated by the DHBs, and include a mixture of clinical and management roles, including representatives from clinical areas, Planning and Funding, DoNM, Chief Medical Advisors, Maori Health and Chief Operating Officers. Identifying a clinical chair for each group Developing formal terms of reference Developing and delivering an agreed programme of work The work of the clinical action groups and networks is overseen by the Midland Regional Planning Steering Group. Each of the groups worked through the agreed programmes of work, with examples of outcomes outlined below. Midland Maternity Action Group Chair: Corli Roodt, Waikato DHB The Maternity Standards were reviewed and a number of activities were pursued on a regional basis including the development of templates for MDT meetings, the Maternity Strategic Plan, the Maternity Annual Report, development of standardised maternity procedures, and the development of a regional maternity and neonatal emergency response plan. All DHBs have submitted a draft Maternity Strategic Plan. Considerable work was done in identifying opportunities for shared education to more effectively and efficiently use resources and enhance learning opportunities for maternity staff across the region. The purchase of the on-line CTG training package for the region was an example of this, as was the review of the First Year of Practice Programme, the Quality and Leadership Programme, and technical skills workshops. The Maternity Quality and Safety Programme was reviewed and opportunities for regional activity/collaboration associated with this programme were considered by the 5 DHBs it was agreed that 50% of the funding and associated deliverables will be managed on a regional basis a large component of the 2012/13 regional plan for maternity relates to the implementation of this programme. The implementation of the programme will support close alignment and improved standardisation across the region with the regional project manager working closely Page 7
with their local counterparts. A stock take of rural maternity services and the rural maternity workforce has been commenced - this work is being done in conjunction with the Rural Health Action Group. Midland Renal Action Group Chair: Jo-Anne Deane, Waikato DHB A large focus of the Renal Action Group has been on enhancing relationships across the DHBs so as to maximise the use of regional expertise and standardise systems and processes for renal patients where possible. Shared clinical management protocols have been developed to improve the primary and secondary interface for renal services An evaluation of renal dietetic services across the region is in progress with consideration being given as to how this role can be developed to provide increased support to patients with chronic renal failure. An evaluation of the roles deployed in renal services is in progress. An innovative workforce planning method has been designed to support clinicians to identify opportunities for greater workforce flexibility and skills utilisation. The method in use promotes focussed discussion around patient flow pathways, roles, task analysis and allocation. This will support workforce innovation to enable sustainable service delivery. In addition other activities included: Interhospital Transport project links for renal patients defining transport and retrieval protocols Profiling of regional renal services Development of an electronic alert system linked to NHI for renal patients Improving communication processes to GPs Agreed CKD referral criteria Review and approval of Kidney Health CKD guidelines Maori workforce development options Midland Rural Health Action Group Chair: Dr Ross Lawrenson, Waikato Clinical School The Rural Health Action Group spent some time confirming the definition of what constitutes a rural community and then progressed to the mapping of rural localities including location of general practices. This preliminary work set the foundation from which further detailed analysis can be undertaken on access to services and health outcomes for the regions rural communities. The Region held 2 Primary Care Leadership Forums, both well attended by a large majority of the Midland PHOs. The PHOs are committed to working collaboratively and have identified clinical pathways and some IS developments as providing good opportunities for collaboration in the short term. A stock take of rural maternity services and the rural maternity workforce was commenced this work will be concluded in 2012-13. A Regional Rural Health Executive was established to oversee the activities of the action group, ensure alignment to other regional groups, and validate data, information and definitions that inform regional activity. Page 8
Midland Elective Services Action Group Chair: Dr Martin Thomas, Lakes DHB The Electives Services Acton Group spent some time gathering regional data to ascertain the specialty areas that should be progressed as a priority across the region. The priorities identified were orthopaedics, chronic pain services, and regional capacity and production planning. A regional elective services proposal was subsequently submitted under the ES RFP process and gained support from the National ES Steering Group. This work will be further progressed in the 2012-13 year. Midland Cardiac Network Chair: Dr Gerry Devlin, Waikato DHB The main focus of the Cardiac Network in 2011-12 was to improve access to angiography for patients with acute coronary syndrome. A number of systems and processes have been put in place to standardise and streamline referral processes and to improve access to cardiology services across the region where secondary patients in the region require tertiary care, this includes standardised approaches to risk stratification, standardised approaches to Interhospital transfer and repatriation to maintain effective bed utilisation, and regular reporting so that delays can be identified and acted upon. BOP DHB have implemented an interventional cardiology service, the next steps for the region are to determine the secondary and tertiary providers capacity, further potential efficiency gains and develop approaches to maximise use of existing resources across the region. The cardiac network has also been monitoring regional cardiac surgery intervention rates to ensure they remain at the recommended level. Midland Radiology Network Chair: Jill Wright The Midland Radiology Network was established during the 2011-12 year. At that time it was focused primarily on secondary radiology service engagement and in the identification of key areas of work to enhance standardisation across the region where possible and to identify opportunities for collaborative development. Radiology was identified as a regional priority area for 2012-13 and since that time the group was expanded to include a wider focus across primary, secondary and tertiary radiology services. In addition to the establishment of the network, an initiative to develop primary referred radiology guidelines was led by the Midland Health Network Service Level Alliance Team, a regional expert advisory group has now been established to consider their implementation across the Midland Region. Page 9
Midland DHBs Established Networks Summary of achievements 2011-12 Midland Mental Health & Addictions Network Programme Director: Eseta Nonu-Reid, Chair: Professor Graham Mellsop, Waikato School of Medicine. Mental Health and Addiction Workforce Development Regional Projects: Takarangi Competency Framework 2 day workshop completed. 155 participants at $111 per person Co-existing Problems Workshops 1 day workshop completed. 144 participants @ $95 per person Real Skills plus Sei Tapu 1 day workshop completed. 83 participants (Taranaki, BOP & Tairawhiti) at $498 per person Consumer Leaders Supervision 2 day workshop Scholarships completed. 10 recipients @ $200 per person Motivation to Changes Consumer 2 day workshop Scholarships completed. 10 recipients at $380 per person Clinical Services Plan 2011 2012 Projects: Midland Regional Collaboration project - transition of the Midland MH&A Network into the Shared Services environment completed Addictions Clinical Qualifications project - Guidelines completed and implemented across the region Clinical Governance project completed Expression of Interest process undertaken and Clinical Governance Network established Alignment to the Regional Service Plan Steering Group Prof Mellsop the MH&A representative sitting on this group Three workshops undertaken in Governance, Strategy and Planning and Business as Usual Terms of Reference finalised Input into the mental health addictions component of the Regional Work plan CAMHS Inpatient project interface with Starship and clinical pathways Service Level Agreements completed. Sign off process underway. Mental Health Services for Older Peoples and Dementia Pathway project - final draft report completed Midland PRIMHD Integration : 100% compliance with providers electing to use PRIMDH Online 7 providers electing to use a vendor still to go live Monthly data quality checks completed and discussed with providers Annual graphs of provider data collated and sent out to providers for trend analysis Page 10
Midland Cancer Network Programme Director: Jan Smith The following is a summary of key achievements for the Midland Cancer Network during 2011-12: Midland Radiation Oncology Demand and Capacity Modelling 2012-2020 - report completed: purchase of additional Aria Activity Capture licences to assist with the national radiation oncology indicator reporting. Waikato and Tairawhiti Adult Cancer Services project to review the feasibility of Waikato DHB being the provider of adult cancer services to Tairawhiti was completed and endorsed. a joint work group has commenced work to manage the transition of service provision from MidCentral DHB to Waikato DHB effective 1 July 2013 Tairawhiti DHB moved from Central Cancer Network to Midland Cancer Network effective 1 July 2012. Faster Cancer Treatment - the four regional cancer networks were requested by the Ministry of Health to commence a new work programme developing national tumour standards and Faster Cancer Treatment (FCT) patient pathways. The networks developed and agreed a high level project plan and obtained lead cancer services DHB support, and endorsement on behalf of each region. Established the National Breast Cancer Work Group and programme to commence development of national breast cancer standards in 2012-13. A clinical chair and project resource were appointed, and a National workshop was held. New Zealand Lung Cancer Work programme: national lung cancer standards published national DHB stock take and gap analysis against the new national standards completed development of national lung cancer core data set commenced and discussed with HSIO. Establishment of an endobronchial ultrasound service (EBUS) commenced at Waikato for regional DHBs. Bay of Plenty Palliative Care Service Plan developed: established local BOP Palliative Care Work Group and annual work programme. Lakes Palliative Care Service Plan developed: established local Lakes Palliative Care Work Group and annual work programme Waikato specialist medical outreach service commenced in Rotorua. Waikato Palliative Care Service Plan development commenced and will be completed in 2012-13: developed draft regional medical advanced training model of service Waikato participated in the Tairawhiti palliative care service review. Tairawhiti DHB commissioned a palliative care review. Development of cancer multidisciplinary meetings (MDMs): financed and facilitated the upgrade of Waikato, Rotorua and Tauranga Hospitals radiology rooms with audio-visual equipment in preparation for introducing high definition video conferencing regional stock take of cancer multidisciplinary meetings in preparation for the NHB releasing new sustainable funding for further development of cancer MDMs in 2012-13 Assisted the Ministry of Health in the development of "Achieving best practice cancer care: Guidance for implementing quality multidisciplinary meeting". Midland Chemotherapy Nursing Certification Framework developed and implemented. Upgrade/implementation of Aesculapius chemotherapy system for Midland DHBs to enable new medical oncology indicator reporting. Hei Pā Harakeke - Midland Māori Cancer Work Group established and developed a two year Page 11
action plan. Midlands Prostate Cancer Study progressing: The three year Health Research Council and Ministry of Health funded study has completed a review of GP use of PSA testing. Northern Cancer Network HRC Lung Cancer Project to identify the barriers and management of people with lung cancer in primary care and description of best practice solutions project has been completed. Lakes DHB and Midland Cancer Network participated in this collaborative initiative. The project has been completed with the publication of the final report Recommendations to Expedite the Diagnosis of Lung Cancer. Midland Enhanced Recovery After Surgery (ERAS) programme introduced: Midland Cancer Network is a strategic partner in this regional elective services initiative as colorectal cancer is a priority area. The network assisted Bay of Plenty (lead DHB) in obtaining funding and development of the regional work programme. The network has assisted Waikato / Thames pilot initiative and in the early stage of start up with Lakes DHB by completing the pre audit. Lakes DHB Global Rating Scale trial demonstration site continues. Midland comprehensive colorectal patient diary implemented regionally (originally developed by Waikato). Rauawaawa Trust palliative care and health literacy interviews completed, findings of this research are expected to be published November 2012. Participated in the development of BreastScreen Midland Plan to improve the coverage of Maori and Pacific women. Second Midland Adolescent Young Adult Cancer Service review completed and action plan developed. Midland Smokefree Programme Programme Director: Gary Thompson In December 2011 the Midland Smokefree Vision statement was updated: Our vision is for a Smokefree Tobacco Free Midland by 2025. Our children and rangatahi deserve a future where smoking is history. In February 2012 the vision was expanded to include all 5 Midland DHBs In March 2012 the Midland Smokefree Tobacco Free vision statement was re-affirmed and signed by the DHB Chairs of Taranaki, Bay of Plenty, Lakes, Tairawhiti, Waikato and the Chair of the Midland Iwi Relationship Board. In May 2012 the Midland Smokefree Programme Director was appointed. Page 12
Midland DHBs Support Networks Summary of achievements 2011-12 Midland Regionalisation Programmes Programme Manager: Erica Holtsbaum In order to effectively manage the scope and complexity of new national directions Midland Region made the decision in early 2011 to formalise existing regional collaborative workstreams by placing them into an existing regional shared services agency, HealthShare. The first group of regional functions and staff transferred to HealthShare in August 2011 to join the existing Quality and Audit function: Programme management of regional programmes of change Midland regional planning function Programme management of the developing regional clinical service networks Midland Cancer network Midland Mental Health and Addictions network Workforce development Midland Smokefree Director role. During 2011/12 the region also approved a number of additional functions to transition into HealthShare including: Regional internal audit function Bringing together the existing DHB teams into a regional team and increasing the internal support to two smaller DHBs (completed operational from 1 July 2012) Recruitment and Selection Phase 1 the implementation of a single regional talent management system (completed - implemented across the 5 Midland DHBs) Phase 2 the development of a regional recruitment and selection service (to progress in early 2013) Support for learning and development activities E-learning the development of a single regional platform and leadership development support. (this work is ongoing) Media and communications Production efficiencies and a regional support team. (this work is ongoing) Information systems HealthShare to manage the implementation of the MRISP The development of a regional IS team. (this work is ongoing). The region appointed a new HealthShare CE to drive regionalisation and to replace Lakes DHB CE, Cathy Cooney. During the 2011/12 year Cathy nurtured the development of HealthShare into a shared agency that was capable of taking on broader regional functions. HealthShare teams work virtually across the region, with many being co-located with DHB staff. Page 13
HealthShare s role is to help the Midland region look for new ways of working to help answer some of the issues that Midland region faces: What steps can we take relative to today s approach that can dramatically improve health outcomes and eliminate inequalities? Where can we reduce duplication of administration across the five Midland DHBs? What are acceptable ways for us to make the Health Dollar go further? Are we doing everything we can to help colleagues within the region and share innovation? How do we increase the participation of clinicians in decisions about how we plan and fund hospital, primary and community services? How can we shore up services to make them more clinically sustainable across the region? How can we deliver services to people as close as possible to where they live, in a clinically safe model of care? How do we get better alignment of health services both within the region and between primary, secondary and tertiary care settings? Regional Workforce Planning and Development - Programme Manager: Angela Norman In common with other developed health systems, New Zealand faces a major challenge in acquiring a clinically skilled health workforce. Population demographics, service and workforce affordability and global shortages further compound an already demanding situation. Improving the supply of the health workforce is only part of the answer. To find enduring solutions service providers will need to strengthen innovation, new ways of working and the development of sustainable workforces into the future. 2011/12 was a formative year for the regional workforce planning and development programme. Key achievements include: Programme establishment within HealthShare Ltd, including the development of a strategic framework; programme planning; project delivery and building dedicated capacity and focus. Regional planning completed to design and establish the Midland Region Training Network. Development of innovative workforce planning methods and tools to enable workforce innovation. Initial development of an online regional training programme. Regional Information Systems Programme Manager: Darrin Hackett MRISP specific Regional Clinical systems PACS/RIS Tairawhiti went live on the regional PACS/RIS solution (joining BOP/Waikato) Regional Clinical systems Hospital Pharmacy approvals and planning Regional Clinical Systems - Regional Clinical Workstation and Data Repository programme scoping commenced. MCH - Connected Health certified circuits implemented across DHBs. Shared Clinical service being delivered PACS/RIS Video proof of concept implemented beginning implementation of regional solution Page 14
In progress Secure Email Gateway for DHBs and related health entities In progress aggregated internet and managed service storage facilities Platform In progress. Business case approved moving to implementation. HBL interest in leveraging Midland platform for national programmes. ereferrals -BPAC ereferrals live in three of five DHBs and in progress at remaining two Specialist form development occurring in individual DHBs as precursor to regional form library Regional IS Governance established including: regional IS Executive established to oversee MRISP and regional IS delivery, supported by clinical IS and IT services delivery programmes regional prioritisation of all IS investment aligned to DHB financial planning cycles regional portfolio, architecture and PMO functions established to support MRISP and regional IS Non-MRISP there are a number of activities that are outside of the MRISP but which relate to MRISP activities: BayNavigator BOP initiative being assessed for regional opportunities. Discussions with Midland Health Network regarding potential for link with MHN s Map of Medicine pilot. BayNavigator also includes: Clinical Pathways development and tool Primary secondary information exchange portal services, contacts, education opportunities, GP communications, blog Éclair4GPz link from practice management system CDR -Eclair4GPz primary care access to Éclair CDR for hospital & community laboratory results, hospital radiology results, hospital diagnostic cardiology results, hospital and community spirometry results. CHIP Clinical Health Information Portal tactical replacement for Healthviews. Went live for secondary services in July. Within three months will reach stage where Healthviews will be turned off and CHIP will be delivered to primary sector alongside Éclair4GPz. Hospital emeds - Taranaki implemented medicines reconciliation and eprescribing as a lead DHB for the national emedicines programme Endoscopy - Taranaki project established to implement solution aligned to national clinical network Erecruitment - Taleo solution implemented across Midland DHBs led by GMs HR Acute Coronary Syndrome clinical tool - online Enigma tool implemented across the Midland Region Page 15