SOUTH ISLAND HEALTH SERVICES PLAN QUARTER ONE REPORT 2014-2015 Introduction The South Island Alliance continues to build on the outcomes from the previous year in the first quarter of 2014 2015. We are pleased to have supported the establishment of two new Workstreams. The South Island Major Trauma Workstream will be chaired by Dr Mike Hunter, Southern District Health Board. The initial focus of the Workstream has been determining an approach to address data collection, establish registries and identify designated major trauma leads in each of the South Island DHBs. The Workstream has formed close working relationships with the Midland Regional Trauma services as it looks to incorporate their learnings and provide direction into the development of a major trauma action plan and avoid unnecessary duplication. Our Palliative Care services provided to the people of the South Island are expected to be enhanced as a result of the recently established South Island Palliative Care Workstream. The group forms a Workstream under the Health of Older People Service Level Alliance. The Workstream is chaired by Dr Kate Grundy, Canterbury District Health Board. The members of the Workstream bring a wide knowledge and understanding of the needs of patients requiring palliative care and the current systems and resources in place in the South Island to provide that. Their initial focus has been to agree on the direction of the 2015-16 workplan. Five key areas have been identified, these are; Information Technology, Service Provision by Hospitals and Hospices, Workforce, Primary Care Models of Care, Networking and Engagement. One of the other key tasks of the group to date has been establishing engagement with the sector key stakeholders and the wider community. The high level outcomes for inclusion in the Best for People, Best for System outcomes framework have been agreed. These are: Improved environment to support health and wellbeing People die with dignity Decreased rates of people in care facilities People received prompt care People have delayed/avoided burden of long term conditions No wasted resource People are protected from harm or needless death Increased planned care The next step is to complete the framework and agree the measure to be used. 1 P age
Key Outcomes Achieved in this Reporting Period Improved Access and Treatment for Cancer Patients MDM Patient Management Support System The implementation of the Faster Cancer Treatment programme has resulted in an increase in the number of multidisciplinary meetings (MDM) being held for patients with cancer. Through a proof of concept approach the Southern and Central Cancer Networks have worked together with Orion Health to develop and evaluate an MDM Patient Management tool. The tool has been designed to support the administrative processes an MDM requires, along with enhancing the quality of the discussion for care planning by bringing together all the key clinical information in one place for the clinical team to access. There was overwhelming support for such a system from clinicians and managers who saw the prototype. Support is now being sought from the Ministry of Health to be able to develop this approach further enabling the system to be rolled-out across the South Island, which will also build on earlier work in Southern DHB. The system will provide the people of the South Island with access to a consistent MDM management tool and processes regardless of their geographical location. Better Mental Health and Addictions Support for Consumers and their Families To ensure that the people of the South Island continue to have access to specialist Mother and Babies service provision regardless of geographical location the district/consult liaison mechanism for Mothers and Babies services has been reviewed. Recommendations have been provided to the Mental Health Service Level Alliance to support more effective collaboration between each South Island DHB and regional services provided as part of the district/consult liaison hub and spoke model. The regional Service Provision Framework relating to perinatal and maternal mental health has been adjusted accordingly to include the redesign of the consult/district liaison mechanism to ensure best integration and coordination of services for the people of the South Island. The Mental Health Service Level Alliance have agreed criteria for High and Complex Need with South Island DHB Mental Health General Managers and Clinical Directors. Data on this target group is being collated across South Island DHBs to inform the next steps in developing a collaborative mechanism. Quality, Timely and Accessible Treatment for Children Supported by the Information Services, Service Level Alliance e-prosafe has now been rolled out in four of the five DHBs in South Island. The database supports improved protection for the children of the South Island by providing risk assessments and interventions to prevent child abuse and family violence cases. It also allows for the sharing of relevant clinical information across the South Island DHBs in a timely and safe manner. There is a common drive by multiple agencies to reduce the number of youth presentations to emergency departments and admissions to hospital caused by alcohol. This drive has resulted in the agreement to form a joint partnership between the Health Promotion Agency and the Child Health Service Level Alliance to run a collaborative scoping project in South Island Emergency Departments that will focus on reducing the number of youth presentations to the emergency departments and admissions to hospital caused by alcohol. The children and their families/whanau of the South Island can expect to benefit from the development of a draft Regional Action Plan focused on addressing the Childhood Obesity. This draft plan includes background information and outlines potential management options. The Child Health Service Level Alliance have adopted a multi-agency collaboration approach in the development of the draft Regional Action Plan. South Island People enjoy Quality of Life and are Prevented from Dying Prematurely from Heart Disease ANZACS-QI register All South Island DHB hospitals have completed the implementation and training for the ANZACS-QI register. Regional data reports are now being generated and show the South Island is exceeding the targets of >95% of patients presenting with ACS who undergo coronary angiography have 2 P age
completion of ANZACS QI ACS & Cath/PCI registry data collection and >70% of high-risk ACS patients accepted for coronary angiography having it within 3 days of admission. ( Day of Admission being Day 0 ). See Appendix One for further information. Elective Services People of the South Island are now benefiting from a South Island Regional Bariatric Service that has been achieved with the support of the Ministry of Health. The five DHBs agreed pooling to the Bariatric Initiative base, additional volumes and associated funding across the South Island to support a South Island regional service. The South Island Bariatric Surgery HealthPathway has now been implemented. The first South Island wide patient selection meeting of the South Island Bariatric Surgery Multi-Disciplinary Selection committee took place in August.. More Efficient Support Services through Collaboration District Health Boards have made a transition, initiated by Health Benefits Ltd (HBL), whereby health Alliance (ha) is now responsible for procurement matters. DHBs will still be responsible for significant Out of Scope procurement and are currently forming processes now that health Alliance s role has been confirmed. The reporting of savings, which has been a major component of Support Services work, will continue, but is still being clarified in consultation with ha and HBL. Collaborative Information Systems enabling the health sector Electronic Prescribing and Administration Project Success The regional rollout of the Electronic Prescribing and Administration (MedChart) continues its success with further implementations in both Invercargill (Southern DHB) and Hillmorton (Canterbury DHB) hospitals. This project aims to improve patient safety by streamlining and standardising the medication process. The solution enables clinicians and nursing staff to administer and record medications electronically, resulting in less errors and duplication, and supporting greater prescribing accuracy. The region has collaborated well on this project with the Canterbury DHB team participating in Southern DHBs Invercargill implementation. This not only supported the Invercargill implementation but also allowed Canterbury s project team to learn from the Southern DHB implementation process and incorporate this learning into planning the Canterbury DHB implementation process. This demonstrates the benefits South Island DHBs utilising the alliance framework. With Canterbury s project well prepared for go-live they have been able to efficiently and effectively implement Electronic Prescribing and Administration into the first of their DHBs site, Hillmorton Hospital. The project has received positive feedback from the clinicians to the point where the project timelines were re-base lined to support a faster implementation process. Child Protection Database Now Live in Four South Island DHBs In conjunction with the Child Health Service Level Alliance eprosafe, the child protect database that supports improved child protection is now implemented in four of the five South Island DHBs. This database provides risk assessments and interventions for the reduction of child abuse and family violence cases. It also allows for the sharing of relevant clinical information across DHB's in a timely and safe manner. Health Connect South Programme - Sharing Learnings The Information Services, Service Level Alliance is seen a leader for successfully implementing the Health Connect South clinical workstation. The South Island now has three of the five DHBs live. The Information Services, Service Level Alliance has hosted a workshop with HealthShare to share lessons learnt from the Health Connect South programme. New Clinic Data Repository 3 P age
The new Clinical Data Repository has been implemented within Health Connect South (the South Island s clinical workstation). This will allow for laboratory and radiology results to be uploaded directly into Health Connect South, and will also enable wider functionality as Health Connect South is deployed across the remaining South Island District Health Boards. ereferrals Programme The Electronic Referral Management System (ERMS) programme continues to progress throughout the South Island. Southern DHB have had their local implementation business case fully approved and will be joining the other four South Island DHBs on this regional programme. ereferrals continues to receive positive feedback, especially with respect to the noticeable reduction in administration time once practices start using ERMS as illustrated by the feedback received below: Traditionally at least six of our twelve GP's have dictated letters and had our administrator type them. Since moving to ERMS, a large percentage of this work is now being done by the GP's themselves. Even though we had templates set up for letters before, there is a real shift to using ERMS and doing their own typing. I believe that they can see the benefit of seeing the referral submitted and having an acknowledgement of receipt straight away. This is the case for even our most technophobe doctors!!! So all in all we are very happy with ERMS as it has cut down on a lot of duplication of work with the GP's often cutting and pasting directly from their consult notes instead of dictating. Judy Gilmour, Practice Manager, Stoke Medical Centre Nelson Marlborough DHB joins the Regional PAC/RIS The Nelson Marlborough DHB PAC/RIS project went live during Quarter 1. This is the fourth South Island DHB to join the regional instance. South Island Patient Information Care System The South Island Patient Information Care System (SI PICS) Programme is progressing. The Blue Prints have been developed which map out the workflow process. This will provide the basis for the foundation solution. The regional and local DHB programme teams are being formed and the teams are strongly engaged with Orion Health. Supporting our Health Workforce The South Island Sonography training work group has held first meeting. The workgroup includes representatives from DHBs, private providers and tertiary education providers. The possibility of a South Island training programme has been raised with the group by University of Otago. A stocktake of current sonographers and trainee sonographers has been undertaken and significant issues have been identified which will challenge future workforce development. The first draft of a Gerontology Acceleration Programme tool kit has been produced. The Regional Training Hub will be actively supporting the roll out of this tool kit across the South Island. A Nursing Education Community of Practice has been endorsed by the South Island Directors of Nursing. The membership is broad and includes representation from DHBs, PHOs and Community Health Services. The vision is to develop a nursing workforce within a collaborative environment to meet population health needs of the South Island, with a focus on shared learning resources and supporting new graduate recruitment and retention. The Mental Health Service Level Alliance leadership team has endorsed the development of a regional core skills group who will establish an agreed set of regional mental health and addictions core training which are intended to be portable across disciplines and meet the identified needs of the South Island. 4 P age
Quality & Safety South Island DHB and Patient Safety project members continue to work closely to coordinate and support the South Island s implementation of the Open for Better Care campaign, sharing learning and ideas, monitoring performance and feeding back on improvement processes. The Quality and Safety Service Level Alliance is supporting the focus on reducing falls and there have been some notable improvements and innovative approaches in the region. In South Canterbury DHB from July 2013 to April 2014, the number of falls with harm reduced by 65.6%, well ahead of the 20% target, with a total of only 10 harm falls and no reported serious harm from falls during this period. A number of falls prevention workshops have been held across the South Island DHBs with good attendance from DHB and aged residential providers. The South Island DHBs have implemented a number of successful initiatives to raise the profile of peri-operative harm and surgical site infection within surgical operating teams, such as embedding surgical safety checklists into operative procedures and initiatives to support effective communication and fostering teamwork between members of the operative teams. Implementation of the regional electronic risk management system commenced in August and is progressing well against the project timeline. This system (RL6 Risk) will make it easy for staff to report valuable information about patient safety and risk, enabling DHBs to monitor what is and is not working well and support managers to continuously improve the care that is provided. Furthermore the new system will make it easy for staff to access and share clinical learnings from outcome reviews, enable the creation of consistent reporting and support the collection and monitoring of patient safety data. There has been considerable input from each DHB into the taxonomy working group with us meeting the time line for submission of these to RL Solutions for the configuration of the system. Of particular note we have had exceptional response to the naming competition receiving 268 entries from throughout the South Island. Each DHB has been asked to shortlist to their top five preferred names, then the South Island Project team will look to identify the top three for the project board to make a recommendation to the South Island DHBs CEOs. 5 P age