Counties Manukau District Health Board Hospital Advisory ......Next Meeting: 1 October 2014, Ko Awatea Innovation Lab . 2 BOARD MEMBER ATTENDANCE SCHEDULE – HAC 2014 Name ... Kathy

Counties Manukau District Health Board – Hospital Advisory Committee Agenda

Counties Manukau District Health Board Hospital Advisory Committee Meeting Agenda Wednesday, 10 September 2014 at 9.00am – 12.30pm, Innovation Lab, Ko Awatea, Middlemore Hospital, Hospital Road, Otahuhu, Auckland Time Item Page No

9.00am – 9.05am 1. Welcome

9.05am – 9.15am 2. Governance 2.1 Attendance & Apologies 2.2 Disclosure of Interests/Specific Interests 2.3 Acronyms 2.4 Confirmation of Public Minutes (13 August 2014) 2.5 Action Item Register Public

2 3-6 7 8-14 15-17

9.15am – 9.25am

9.25am – 9.35am 9.35am – 9.45am

9.45am – 9.55am

9.55am – 10.05am

10.05am – 10.15am 10.15am – 10.20am 10.20am – 10.25am 10.25am – 10.30am

3.0 Director of Hospital Services Report – Mr Phillip Balmer 1) Executive Summary 2) Balanced Scorecard 3) Financial Summary 4) Non-Clinical Support Services 5) Actions Arising Responses 6) Appendix A – Scorecard Glossary 3.1 Surgery and Ambulatory Care – Ms Gillian Cossey 3.2 Adult Rehabilitation/ Health of Older People –Ms Dana Ralph-Smith 3.3 Medicine, Acute Care & Clinical Support - Mr Brad Healey 3.4 Women’s Health & Kidz First – Ms Nettie Knetsch 3.5 Mental Health – Ms Tess Ahern 3.6 Director of Allied Health report – Mr Martin Chadwick 3.7 Director of Midwifery report – Ms Thelma Thompson 3.8 Director of Nursing report – Ms Denise Kivell

18-19 20-24 25-30 31-37 38-41 42-46 47-50 51-63 64-71 72-87 88-100 101-110 111-112 113-114 115-116

10.30am – 10.45am Morning Tea

10.45am – 11.15am 11.15am – 11.45am

4. Presentation 4.1 Healthpoint – Kate Rhind 4.2 Health Literacy – Dr Siniva Sinclair, Population Health

- -

11.45am – 11.55am

5. For Information 5.1 Health Excellence Framework – Mr Martin Chadwick

117-118

6. Resolution to Exclude the Public 119-120

11.55am – 12.05pm 12.05pm – 12.15pm 12.15pm – 12.25pm 12.25pm – 12.28pm

12.28pm – 12.30pm

7. Confidential Items 7.1 Patient Safety Report– Dr David Hughes 7.2 Risk Register – Dr David Hughes 7.3 Non Resident Profile Update – Ms Margaret White 7.4 Confirmation of Confidential Minutes (13 August

2014) 7.5 Action Item Register Confidential

121-146 147-159 160-173 174-182 183

Next Meeting: 1 October 2014, Ko Awatea Innovation Lab

2

BOARD MEMBER ATTENDANCE SCHEDULE – HAC 2014 Name

Jan 12 Feb 5 Mar 9 Apr 7 May 11 Jun 2 Jul 13 Aug 10 Sept 1 Oct 5 Nov 3 Dec

Lee Mathias (Chair)

No

Mee

ting

Wendy Lai

X

Arthur Anae

X

Colleen Brown

* X X

Sandra Alofivae

X X

Lyn Murphy

X

David Collings

X X

Kathy Maxwell

George Ngatai

X

Dianne Glenn

Reece Autagavaia

* Attended part meeting only

3

BOARD MEMBERS’

DISCLOSURE OF INTERESTS

10 September 2014

Member Disclosure of Interest

Dr Lee Mathias, Chair • MD Lee Mathias Limited

• Trustee, Lee Mathias Family Trust

• Trustee, Awamoana Family Trust

• Chair Health Promotion Agency

• Deputy Chair Auckland District Health Board

• Director, Pictor Limited

• Director, iAC Limited

• Advisory Chair, Company of Women Limited

• Director, John Seabrook Holdings Limited

• Chairman, Unitec

Wendy Lai, Deputy Chair • Board member and partner at Deloitte

• Board member Te Papa Tongarewa, the Museum of

New Zealand

Arthur Anae

• Councillor, Auckland Council

• Board Member Phobic Trust

• Member The John Walker ‘Find Your Field of

Dreams’

• Chairman, NZ Good Samaritan Heart Mission to

Samoa Trust

Colleen Brown • Chair Parent and Family Resource Centre Board

(Auckland Metropolitan Area)

• Member of Advisory Committee for Disability

Programme Manukau Institute of Technology

• Member NZ Down Syndrome Association

• Husband, Determination Referee for Department of

Building and Housing

• Chair, Early Childhood Education Taskforce for

COMET

• Member, Manurewa Advisory Group

• Member, Child Advocacy Group – Manukau

• MSD Member, Auckland Social Policy Forum,

Auckland Council

• Deputy Chair, Auckland City Council Disability

Strategic Advisory Group

• Chair ECE Implementation Team Auckland South

• Chair IIMuch Trust

4

Dr Lyn Murphy • Member, International Society for

Pharmacoeconomics and Outcomes Research

(ISPOR).

• Member of the New Zealand Association of Clinical

Research (NZACRes)

• Senior lecturer in management and leadership at

Manukau Institute of Technology

• Member, ACT NZ

• Director, Bizness Synergy Training Ltd

• Director, Synergex Holdings Ltd

• Associate Editor NZ Journal of Applied Business

Research

• Member Franklin Local Board

Sandra Alofivae

• Chair of the Auckland South Community Response

Forum (MSD appointment)

• MSD Member, Auckland Social Policy Forum,

Auckland Council

• Member, Fonua Ola Board

• Appointed to the Ministerial Forum on Alcohol

Advertising & Sponsorship

• Board Member, Pacifica Futures

David Collings

• Chair, Howick Local Board of Auckland Council

• Member Auckland Council Southern Initiative

Kathy Maxwell • Director, Kathy the Chemist Ltd

• Regional Pharmacy Advisory Group, Propharma

(Pharmacy Retailing (NZ) Ltd)

• Editorial Advisory Board, New Zealand Formulary

• Member Pharmaceutical Society of NZ

• Trustee, Maxwell Family Trust

• Member Manukau Locality Leadership Group,

CMDHB

Dianne Glenn • Member – NZ Institute of Directors

• Member – District Licensing Committee of Auckland

Council

• Life Member – Business and Professional Women

Franklin

• President – National Council of Women

Papakura/Franklin Branch

• Member – UN Women Aotearoa/NZ

• Vice President – Friends of Auckland Botanic

Gardens and Member of the Friends Trust

• Life Member – Ambury Park Centre for Riding

Therapy Inc.

• CMDHB Representative - Franklin Health

Forum/Franklin Locality Clinical Partnership

5

George Ngatai • Arthritis NZ – Kaiwhakahaere

• Chair Safer Aotearoa Family Violence Prevention

Network

• Director Transitioning Out Aotearoa

• Director BDO Marketing

• Board Member, Manurewa Marae

Reece Autagavaia • Member, Pacific Lawyers’ Association

• Member, Labour Party

• Member, Auckland Council Pacific People’s Advisory

Panel

• Board Member, United Otara Market

6

HOSPITAL ADVISORY COMMITTEE MEMBERS’ REGISTER OF DISCLOSURE OF SPECIFIC INTERESTS Specific disclosures (to be regarded as having a specific interest in the following transactions) as at 10th September 2014 Director having interest Interest in Particulars of interest Disclosure date Board Action Wendy Lai

HBL – Food & Laundry & FPSC Programme

Ms Lai declared a specific interest in regard to Deloitte providing support to HBL in the food and laundry and FPSC Programme. Deloitte has mainly been providing Oracle implementation resources to FPSC. Ms Lai is not directly involved with this work.

12 February 2014

That Ms Lai’s specific interest be noted and that the Committee agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.

Wendy Lai

Te Pou Matakana Deloitte is currently working with Te Pou Matakana (TPM) which is a subsidiary of Waipereira Trust. TPM has been awarded the contract as the Commissioner for Whaanau Ora services for North Island Maori.

7th May 2014 That Ms Lai’s specific interest be noted and that the Committee agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.

Sandra Alofivae

Board Member, Pacific Futures Board

7th May 2014 That Ms Alofivae’s specific interest be noted and that the Committee agree that she may remain in the room and participate in any deliberations, but be excluded from any voting.

7

Glossary ACC Accident Compensation Commission

ADU Assessment and Diagnostic Unit

ARDS Auckland Regional Dental Service

BT Business Transformation

CADS Community Alcohol, Drug and Addictions Service

CAMHS Child, Adolescent Mental Health Service

CNM Charge Nurse Manager

CT Computerised Tomography

CW&F Child, Women and Family service

DNA Did not attend

ESPI Elective Services Performance Indicators

FSA First Specialist Assessment (outpatients)

FTE Full Time Equivalent

GPSI GP with Special Interest

HSMR Hospital Standardised Mortality Rate

ICU Intensive Care Unit

iFOBT Immuno Faecal Occult Blood Test

MHSG Mental Health service group

MoH Ministry of Health

MTD Month To Date

MOSS Medical Officer Special Scale

OHBC Oral health business case

ORL Otorhinolaryngology (ear, nose, and throat)

PACU Post-operative Acute Care Unit

PHO Primary Health Organisation

PoC Point of Care

SCBU Special care baby unit

SMO Senior Medical Officer

SSU Sterile Services Unit

TLA Territorial Locality Areas

WIES Weighted Inlier Equivalent Separations

YTD Year To Date

8

Minutes of the meeting of the Counties Manukau District Health Board

Hospital Advisory Committee Wednesday 13 August 2014

held at the Innovation Lab, Ko Awatea, Middlemore Hospital

commencing 9.00am

COMMITTEE MEMBERS PRESENT: Dr Lee Mathias (Board Chair) Dr Lyn Murphy (Committee Chair) Ms Wendy Lai Ms Colleen Brown Ms Sandra Alofivae Ms Kathy Maxwell Mr George Ngatai Ms Dianne Glenn Mr David Collings Apulu Reece Autagavaia Anae Arthur Anae

ALSO PRESENT: Mr Geraint Martin (Chief Executive) Mr Phillip Balmer (Director, Hospital Services) Mr Martin Chadwick (Director Allied Health) Dr Gloria Johnson (Chief Medical Officer) Ms Margaret White (Deputy Chief Financial Officer, Hospital Services)

APOLOGIES: Apologies were received and accepted from Ms Denise Kivell (Director of Nursing).

WELCOME The Chair opened the meeting with a short prayer. 2.2 DISCLOSURE OF INTERESTS The Committee noted that Ms Dianne Glenn is no longer a Member of the Friends of Regional Parks. 2.2 SPECIFIC INTERESTS There were no additional specific interests to note with regard to the agenda for this meeting. 2.3 ACRONYMS The acronym list was noted.

9

2.4 CONFIRMATION OF PUBLIC MINUTES Confirmation of the Public Minutes of the Counties Manukau Health Hospital Advisory Committee meeting held 2 July 2014. Resolution (Moved Ms Colleen Brown/Seconded Dr Lee Mathias) That the public minutes of the Counties Manukau Health Hospital Advisory Committee meeting held 2 July 2014 be approved. Carried 2.5 PUBLIC ACTION ITEMS REGISTER Matters Arising from the Action Items: • Midwifery Immunisation Rate – Midwifes currently at 33%, lowest staff category we

have at CMH. Ms Thelma Thompson (Director of Midwifery) has been in touch with ADHB and will be following some of their initiatives next year. We will also be setting immunisation as a hard and fast KPI next year and noting that we want to see a significant increase in the number of midwifes immunised. We will agree a target with them.

Resolution (Moved Dr Lyn Murphy/Seconded Dr Lee Mathias) That the Public Action Items Register of the Counties Manukau Health Hospital Advisory Committee be received. Carried 3.0. RESOLUTION TO EXCLUDE THE PUBLIC Resolution (Moved Ms Dianne Glen/Seconded Ms Sandra Alofivae) That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General Subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

6.1 Expansion of Haemodialysis Facilities-Based Capacity

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S9(2)(i)]

Carried

10

9.09am Public excluded session. 9.58am Open meeting resumed. 3.1 DIRECTOR’S REPORT Mr Balmer took the Committee through his report. Medicine (pages 63 – 76) Mr Brad Healey, GM Medicine took the Committee through this section of the Director’s report. New records in EC for June – 8996 presentations. 4.1% higher than May and 4.4% higher than last year. Medical Assessment Unit working well. Admission rate reduced from 15% in April to 10% in June. Discharge Lounge has been a step in the right direction – working well but still more work to be done. Medicine has coped well over winter, been fully staffed. Looking at capacity planning across the 3 DHBs. Surgical & Ambulatory Care (pages 43-53) Ms Gillian Cossey, GM Surgical & Ambulatory Care took the Committee through this section of the Director’s report. Successful year – maintained elective results, hit targets, moved into the Harley Gray building and achieved a favourable financial result. When looking at outsourcing, the principal is to use internal resources to the maximum then outsource things that are more cost effective to be done externally, it’s a careful balance. General Surgery hit the 120day waiting time target for electives 6 months ahead of schedule and are managing to maintain that. Theatre Cap Plan – the first report on acute wait times to theatre showed some delays in the ‘urgent Priority 1 and 2’ cases - Ms Cossey to come back to the Committee with further information when the data has been analysed, need to measure where the delay is occurring. Child volumes and WIES – Mr Balmer to report back to the Committee what the key DRGs are which are causing concern. Health & Safety – we have health & safety auditors within the divisions who audit the workplace each month. There is a compliance rate. Health & safety is to be on the Board agenda every month. Mr Balmer to provide the document/register that shows the H&S audit of the various CMH campuses to be put onto Diligent for the Committee to look at. Adult Rehabilitation & Health of Older People (pages 54-62) Ms Dana Ralph-Smith, GM ARHoP took the Committee through this section of the Director’s report. Collaborative with Medicine on the Acute Care for the Elderly model going well in Ward 5. National Spinal Action Plan has been approved by the Minister and will see work now progress rapidly on creating a more coordinated patient pathway. NASC team transition – proposal to relocate Home Health Care bases to align with the localities consultation process continues.

11

Women’s Health & Kidz First (pages 77-89) Ms Nettie Knetsch, GM WH & Kidz First and Ms Thelma Thompson, Director of Midwifery took the Committee through this section of the Director’s report. Women’s Health Community Midwifery Services have now fully implemented their new model of care to ensure continuity of lead maternity carer during the anti and post-natal period. Seeing significant difference in our DNA rates. LMC midwifery numbers have gone up to 60%, aim is to get to 75% by the end of 2017. Looking for a venue in Manurewa for a daily midwifery clinic. KidzFirst volumes remain similar to last year however, discharges YTD are up by 140. Challenges are with the neonatal unit, not seeing a drop in numbers - doing a regional piece of work to get an understanding on this. Teenage pregnancies right around the country continue to decrease. Ms Knetsch to provide in the next Director’s report numbers on what the pregnancy rates are at the Manurewa school/s that are running the Teen Mother classes. Rotovirus immunisation - with Rotovirus going onto the immunisation schedule are there any plans to do a catchup. Particularly important to do Rotovirus at 6 weeks, 3 months and 5 months. Ms Knetsch to report back in the next Director’s report on when and how we might do a catchup for the community. (Ms Sandra Alofivae left the meeting at 11.00am) Midwifery (pages 112-113) Ms Thelma Thompson, Director of Midwifery took the Committee through this section of the Director’s report. Safe Staffing Health Workplace continues – the main aim is to establish and recommend an acuity based mechanism for staffing DHB maternity units that reflects the NZ Maternity Standards and the NZ Maternity Model of Care. The Midwifery workforce Grow Our Own pipeline is working well with 17 Maaori and 16 Pacific students currently in the pipeline. Resolution (Moved Dr Lyn Murphy/Dr Lee Mathias) That the Director of Hospital Services report be received. Carried 4.0 PRESENTATION 4.1 Mental Health Service Ms Tess Ahern, GM Mental Health and Mr Peter Watson, Clinical Director Mental Health took the Committee through their presentation. A copy of the presentation is available on the CMH website. 1 in 10 adults aged 18 and over living in Counties Manukau received care for a mental health disorder. Mental health disorders and long term physical health conditions commonly occur together (ie) Mental health and diabetes 4000 people; Mental health and CVD 2000 people.

12

Risks and mitigation - recruitment & retention of specialist medical workforce; acute volumes and limited inpatient capacity; Tiaho Mai facility constraints. Overview of development of a new acute mental health inpatient unit – 75 bed facility located on Middlemore campus – 60 beds staffed from Y1; wards with flexible spaces which can be low or high dependency; improved spaces outdoors and indoors; supported by a new model of care. Approximate cost $45.5m. The Chair thanked the presenters for their informative presentation. 5. RESOLUTION TO EXCLUDE THE PUBLIC Resolution (Moved Ms Dianne Glen/Seconded Ms Sandra Alofivae) That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:




6.2. Patient Safety Report

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.

[NZPH&D Act 2000 Schedule 3, S.32 (a)]

Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons. [Official Information Act 1982 S.9 (2) (a)]

6.3Risk Register That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.



6.4 Briefing Paper

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information

Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities.

13

Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

[Official Information Act 1982 S9(2)(i)]

6.5 Minutes of HAC meeting 2 July 2014


Confirmation of Minutes For the reasons given in the previous meeting.

6.6 Action Items Register


Action Items Register For the reasons given in the previous meeting.

Carried 12.10pm Public excluded session. 12.25pm Open meeting resumed. 7. FOR INFORMATION 7.1 Population Health Status and Data Shifts Resolution (Moved Dr Lee Mathias/Seconded Ms Wendy Lai) The Hospital Advisory Committee noted the information regarding the composition of our ‘’other’ population. Carried

14

The Chair thanked everyone for an excellent discussion. Meeting concluded at 12.29pm. The minutes of the Counties Manukau Hospital Advisory Committee meeting held on Wednesday 13 August be approved. (Moved /Seconded ) Chair Dr Lyn Murphy Date

Items once ticked complete and included on the Register for the next meeting, can then be removed the following month.

15

Hospital Advisory Committee Meeting – Action Items Register – 10th September 2014 DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

11.6.2013 3.1 Health Literacy - all committee members to keep

health literacy front of mind about what the Board can do in this area over its next 3 years. Health Literacy presentation from SPMO Office & Workbase.

September

All committee members Mr Balmer

18.6.2014

Finance & Audit

Presentation on broad population projections. Drivers of growth areas for our population - utilisation patterns to be incorporated into a health services planning update.

November September/November

Dr Winnard Ms Scott

This action will inform a broader strategy refresh and a session at ELT is required before presenting to the Board sub-committees so item deferred to November.

18.6.2014

Finance & Audit

Presentation by the Haemophilia Service on how the service is funded and what this means in terms of costs (related to the latest additional funding)

TBC Mr Balmer

2.7.14 2.4 Confirmation of Previous Minutes Presentation from Kate Rhind, Healthpoint.

September Mr Balmer

2.7.14 3.1 Director’s Report –presentation (Kim Wiseman) on our workforce diversity long term strategy and the impact it is having on our workforce. Definition of medical devices - report back on the hA work with Pharmac. Taikura Trust –Ms Kivell to report back on how many issues have been escalated to the GM ARHoP and why.

October September TBC

Mr Balmer Ms White Ms Kivell

Included in Director’s Report this month Included in Director’s Report this month


16

DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

Community Geriatric Service – copy of the CN ARHoP investigation report on the increase in aged related residential care admissions to EC to come to HAC when available.

Sep/October

Mr Balmer

Included in Director’s Report this month

2.7.14 6.1 Patient Safety Report – VHIU - Mr Martin to discuss with Dr Harry Rea and report back on how many of the 2000 patients in top section of the triangle would no longer be there now due to them moving down into the ARI category.

TBC

Mr Martin

13.8.2014 6.1 Expansion of Haemodialysis Facilities-Based Capacity Mr Healey to review the procedure for acceptance into the renal replacement therapy programme and report back to the Committee.

Oct/Sept

Mr Healey/Mr Balmer

Included in Director’s Report this month

13.8.2014 3.1 Director’s Report Theatre Cap Plan – the first report on acute wait times to theatre showed some delays in ‘urgent Priority 1 and 2’ cases – Ms Cossey to report back with further information when the data has been analysed, need to measure where the delay is occurring. Child volumes & WEIS – Mr Balmer to report back what the key DRGs are that are causing concern. Health & Safety – Mr Balmer to provide the document/register that shows the H&S audit of the various CMH campuses to Dinah to put on Diligent for the Committee to access. Ms Knetsch to provide numbers on what the pregnancy rates are at the Manurewa school/s

Oct/Sept September September September

Ms Cossey/Mr Balmer Mr Balmer Mr Balmer Ms Knetsch/Mr Balmer

Included in Director’s Report this month Included in Director’s Report this month Awaiting advice from the Board Chair in relation to this item Included in Director’s Report this month


17

DATE ITEM ACTION DUE DATE RESPONSIBILITY COMMENTS/UPDATES COMPLETE

that are running the Teen Mother classes. Ms Knetsch to report back on when and how we might do a Rotovirus immunisation catch up for the community.

September

Ms Knetsch/Mr Balmer

13.8.2014 6.2 Patient Safety Report Incidents Entered as a % of Unique Inpatient NHI –Dr Hughes to report back on if a patient has more than 1 admission and an incident on both of those admissions, will it only be counted as 1 incident.

September

Dr Hughes/Dr Johnson

13.8.2014 6.3 Risk Register Risk #616 to have a comprehensive update prior to submission to next month’s meeting. Risk #635 to be updated prior to submission to next month’s meeting.

September September

Dr Hughes/ Dr Johnson Dr Hughes/ Dr Johnson

Included in this agenda Included in this agenda

1

Counties Manukau District Health Board Hospital Services Report

Recommendation It is recommended that the Hospital Advisory Committee receive the Hospital Services Report covering activity in July 2014 as follows:

Prepared and submitted by: Phillip Balmer, Director Hospital Services

Hospital Services Report .............................................................................................................. 1

1. Executive Summary .............................................................................................................. 3

2. BALANCED SCORECARD (See definitions in Appendix A) ...................................................... 8

3. FINANCIAL SUMMARY Best value for public health system resources.................................. 14

4. NON-CLINICAL SUPPORT SERVICES 21

5. ACTION ITEM RESPONSES 25

6. APPENDIX A - SCORECARD GLOSSARY ................................................................................ 30

Additional Acronym and abbreviations used in this report

ALOS Average Length of Stay ARHOP Adult Rehabilitation / Health of Older People Division ARRC Aged Related Residential Care ASRU Auckland Spinal Rehabilitation Unit AT&R Assessment Treatment and Rehabilitation AUT Auckland University of Technology BSC Balanced Score Card CEO Chief Executive Officer CGS Community Geriatric Service CLAB Central Line Associated Bacteraemia CTCA Computerised Tomography Coronary Angiography DHB District Health Board DOSA Day of Surgery Admission DRES Delivery Redesign Elective Services DSS Decision Support Service (within Health Intelligence & Informatics Ko Awatea) EC Emergency Care e-MR Electronic Medication Reconciliation ETT Exercise Tolerance Test GAIHN Greater Auckland Integrated Health Network

018

2

GP General Practitioner hA healthAlliance HBL Health Benefits Ltd HCC Health Care Community (mental Health electronic documentation) HDC Health and Disability Commission HSQC Health Quality and Safety Commission ICT Intensive Community Team (mental health) IUCD Intrauterine contraceptive device iPM i-Patient Management (hospital patient data tool) KPI Key Performance Indicator LMC Lead Maternity Carer LTS-CHC Long Term Support – Chronic Health Conditions (funding stream) MCIS Maternity Care Information System MECA Multi -Employer Collective Agreement MHSOP Mental Health Services Older people MIT Manukau Institute of Technology MORRSA Multidisciplinary clinic with Occupational Therapist, Physiotherapist &

Rheumatology Nurse Specialist. MSC Manukau Super Clinic MRI Magnetic Resonance Image MRO Multi-Resistant Organisms MRT Medical Radiation Technician MSOP Musculoskeletal Outpatient Physiotherapy NASC Needs Assessment / Service Coordination NNU Neonatal Unit NTA National Travel & Accommodation (MoH agreement) NZHPA New Zealand Hospital Pharmacy Association NZQA New Zealand Qualifications Authority PACU Post Anaesthetic Care Unit PCT Pharmaceutical Cancer Treatments PDRP Professional Development and Recognition Programme PER Partnership in Evaluation towards Recovery (mental health service) PSA Public Service Association PWCC Patient/ Whaanau Centred Care RAC Referral and Appointment Centre REAMHS Research, Evaluation and Audit - Mental Health Services RIS PAC Radiology Information System / Picture Archive & Communication RMO Registered Medical Officer SACS Surgical & Ambulatory Care Services STEMI- PCI ST segment elevation myocardial infarction (STEMI) - Percutaneous coronary

interventions (PCI). SUDI Sudden Unexpected Death in Infancy VAP Ventilator Acquired Pneumonia WH Women’s Health

019

3

1. Executive Summary 1.1 Month in review: July

July saw all services busy with unprecedented winter service levels, and the on-going Winter Plan to manage additional demand for Middlemore Hospital. Overall admission/ discharge volumes were similar (and near maximum capacity) in July 2014 compared to 2013, but there was much greater demand for Medical wards.

In addition to the unprecedented winter demand, services and teams continued to focus on sustaining results for all National Health Targets for the month and quarter 1 of 2014/15. A number of other targets including the elective treatment, outpatient and diagnostic access wait times are requiring significant resources and attention by teams.

Northern Supra-Regional Spinal Cord Impairment Service - Following the National Spinal Cord Impairment Initiative by ACC and Ministry of Health/ National Health Board, two national centres for patients with acute Spinal Cord Injury arising from traumatic injuries are to be established. This group of patients will now come directly to Middlemore for expert and specialised care by a dedicated and passionate team. To ensure streamlined access and expert care, collaboration between EC, ICU, spinal surgeons, Ward 11, Allied Health, Radiology and Auckland Regional Spinal Unit (ARSU) has resulted in guidelines, policies, procedures and models of care being developed. Diversity Ball - Staff from across CM Health enjoyed the Diversity Ball on 9th August, as a great opportunity to celebrate together in the midst of the winter. Over 600 people attended and were entertained by a variety of Pacific performers and groups. APAC – Melbourne 2014 - Fifty staff are being supported to attend and contribute to APAC in Melbourne in early September, with many of them taking with them presentations and poster displays of service improvement and quality initiatives underway at Counties.

1.2 Activity summary

a) Emergency Care (EC) presentations actual versus 2013/14 presentations

Volumes July '14 Year to date

EMERGENCY CARE Actual Budget/

Contract Variance %

variance Actual Budget /

Contract Variance %

variance

Presentations (against 2013) 9,561 9,474 87 0.92% 9,561 9,474 87 0.92%

Discharges (against 14/15 contract) 9,525 9,654 -129 -1.34% 9,525 9,654 -129 -1.34%

N.B. Presentations refer to all people entering Emergency Care, while Discharges only include those that are admitted and treated and includes a growth assumption on last year volumes (excludes a small number of cases that leave unseen, or are transferred).

b) WIES volumes actual versus projected for 2014/15 - as agreed with the Funder

The month (and YTD) WIES volumes are 2% below funded agreement (2% for Acute and 2% for Electives). However, within this acute adult medical was 5% up, while acute surgical 12% down but electives for Kidz First surgical were particularly busy (up 11% on last year).

020

4

CMDHB-Provider Arm Volume Summary - July 14 as compared to 2014/15 agreement TOTAL - all patients Month July 14 YTD July 14

Acute Services

This Yr Act

Funder agreement

% Var to funder

agreement

This Yr Act

Funder agreement

% Var to funder

agreement

- WIES 5,287 5,404 -2% 5,287 5,404 -2% Elective Services - WIES 1,580 1,610 -2% 1,580 1,610 -2% TOTAL (includes other DHB's) - WIES 6,867 7,014 -2% 6,867 7,014 -2%

Note these volumes are ‘Run 3’ data – extracted on 20.08.14 and may change with further coding.

c) Patient discharge volumes actual versus 2013/14 patient discharge volumes.

The July (and YTD) patient discharges are down 3% on last year (Elective down 7% and Acute 2%), however Elective WIES was only down 3% reflecting higher case complexity.

CMDHB-Provider Arm Volume Summary - July 14 as compared to 2013/14 volumes TOTAL - all patients Month July 14 YTD July 14

Acute Services

This Yr Act Last Yr Act % Var to Last Yr This Yr Act Last Yr Act

% Var to Last Yr

- WIES 5,287 5,381 -2% 5,287 5,381 -2% - Patients 6,290 6,395 -2% 6,290 6,395 -2% Elective Services - WIES 1,580 1,624 -3% 1,580 1,624 -3% - Patients 1,340 1,434 -7% 1,340 1,434 -7% TOTAL (includes other DHB's) - WIES 6,867 7,005 -2% 6,867 7,005 -2% - Patients 7,630 7,829 -3% 7,630 7,829 -3%

021

5

1.3 Financials

The Provider Arm produced a $320k deficit for the month, reporting a breakeven result against budget for July 2014. This contributes to the consolidated DHB result of $18k favourable to budget. Unfavourable revenue timing differences, an inability to realise clinical supply savings initiatives budgeted for July, plus a higher capital charge were offset by favourable employee costs and other expenses. 1.4 Emerging Issues

As detailed in the Balanced Scorecard, in July the Directorate has:

- had discharge and WIES volumes at slightly less than July 2013 and forecast for 2014/15; this is despite record presentation numbers at Emergency Care, and also higher than forecast full occupancy for the month;

- experienced a winter peak of emergency volumes in mid-July, which has remained through August;

- seen higher demand for services and inpatient occupancy especially in Mental Health and Renal Services;

- continued to focus on supporting staff with excess annual leave owed to be able to take holidays, however there has been a further small deterioration on excess leave rates due in part to winter workloads and also increased sick leave being required;

- seen a positive reduction in Outpatient follow up appointment volume growth, and achieved the ESPI FSA target of no cases waiting more than 150 days for all sub-specialities.

- achieved better than our internal target results for length of stay greater than 10 days, 7 day readmission rates, 28 day readmission and Day of Surgery Admission utilisation.

- seen a number of measures of timeliness challenged, including Radiology and Histology Turn-round times.

1.5 Service Highlights

Operationally, the Emergency Care team saw in excess of 9,500 presentations. This was 1% higher than this time last year. There remains significant day-to-day variation with numbers ranging from 244-357, with an average of 308.4 presentations per day – up from average of 300 in June, with Mondays averaging 340 presentations, up from 316 in June. Twenty days were over 300 presentations, (compared with 13 in June) with most in the last 2 weeks and 3 of the 4 Saturdays and Sundays all seeing over 300 presentations. The quietest days were Wednesdays and Fridays.

Reflecting the high use of Emergency Care, sustaining safe hospital occupancy was also a challenge and there were two Dot Days near the end of the month (27th and 30th July). On a series of days in late July and early August, the medical wards were full to capacity and medical patients were admitted to surgical wards in greater numbers as ‘outliers’.

The Discharge Lounge continues to be well utilised, with a total of 667 patients through the lounge for July – with both surgical and medicine wards using the lounge. There continues to be improvement in the numbers of patients discharged before 1100hrs and 1400hrs. The discharge lounge option is working well with positive patient feedback; however work is still required to

022

6

get the patients to the lounge earlier in the day which would then free up ward beds earlier. A review of medical ward-round processes is currently being undertaken. Implementation of the new CM Health Inpatient Survey:

Following the latest report from the survey portal, a total of 142 surveys have been completed to the end of July. Below is a report showing the monthly results for overall care rating for the last four months. Training sessions on the survey portal have been conducted by the vendor Buzz Channel, with key staff in Middlemore Central. A slight increase on the email collection number is noted for the surveys sent out in the first week of August. A number of aspects of the survey have been progressed in the last month including: - Communication and discussion with Emergency Care clerks regarding the collection of

patient email details and developing wider communication (from Director Hospital Services) about the need for collection of patient email details.

- The project board confirmed a decision to send a link to the Survey to patients via a text SMS message and this is scheduled to start in the second week of August.

- Buzz Channel is in the process of migrating all the patient experience data to New Zealand-based data warehouses a completing this with Datacom.

- A patient email collection form is drafted to assist staff to collect patient email details

Patients are asked a series of questions related to the following and to rate their experiences. - Getting Good Information - Communication (discussed care and treatment) - Being treated with compassion, dignity and respect - Getting consistent and coordinated care while in hospital - Being involved in decisions about my health and care - Managing pain - Managing nausea (sickness) - Feeling confident about the quality of my care and treatment - Cleanliness and Hygiene - Food and dietary needs

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7

- Enabling whaanau, family and friends to support me - Coordination of care between hospital, home and other services (including before admission

and after discharge) - Respecting my values, beliefs and cultural needs - Other comments. National Survey: The first set of data extract will be done on 26 Aug for patients admitted for the period 4 Aug – 17th Aug and sent to patients on 26 Aug. Patient and Whaanau Experience Programme

In Mid-July, the teams participating in the Patient and Whaanau Experience programme for 2014 celebrated their learning; new relationships and achievements. During the programme, 13 project teams have been using methods and tools to engage patients and whaanau, capture experiences of the service they are receiving, organise the data to create themes of what is providing a good experience and where improvements can be made and finally working together (sometimes known as co-design)to understand and design improvements. Focus areas of the projects areas included:

- Working with consumers to improve recovery planning and self -management in Mental Health Services,

- Understanding the challenges of people at risk of rheumatic fever and helping to ensure they receive their prophylactic penicillin,

- Exploring the needs of patients / relatives in Middlemore following Critical Care Experiences, - Working in partnership with transgender youth to develop improved service delivery, - Review and redesign of the Out-patient Intravenous Antibiotic programme, and - Maanakitanga Whanau Ora- understanding how people are better able to manage their own

care.

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2. BALANCED SCORECARD (See definitions in Appendix A)

HOSPITAL SERVICES BALANCED SCORECARD

JULY 2014

NOTES

* performance is against 2012/13 actual~ YTD figures not applicable, or reliant on further work to establish a data set# YTD records Baseline (2013 audit) results∆ ESPI interim results subject to change - YTD figure is total number of breaches YTD in 2013/14 year^ Ambulatory Sensitive Hospitalisation rates and targets data from MoH - rates are standardised (100% national average). Data reported March/ Sept+ FCT measure targets to be finalised by MoH for 2014/15 reporting

NATIONAL HEALTH TARGETS - hospital

Def

Jul-14 Target Var Actual Target VarEmergency Care - 6 hour LOS target 95.0% 95% 0.0% 95.0% 95% 0.0% 28

% Cancer Treatment (ADHB Radiotherapy) in 4 weeks 100% 100% 0.0% 100% 100% 0.0% 30

Elective Access - discharges 112.3% 100% 12.3% 112% 100% 12%% smokers receive smokefree advice -Total 95% >95% 1% 95% >95% 1% 77

BEST VALUE FOR PUBLIC HEALTH SYSTEM RESOURCES

Def

Jul-14 Target Var Actual Target VarTotal Caseweight 6,867 7,014 -2% 6,867 7,104 -3% 1

Acute Caseweight 5,287 5,404 -2% 5,287 5,404 -2% 2

Elective Caseweight 1,580 1,610 -2% 1,580 1,610 -2% 3

Total Discharges * 7,630 7,829 -3% 7,630 7,829 -3% 4

Budgeted FTEs 5,555 5,786 4.0% 5,555 5,786 4.0% 6

Operating Costs ($000) 23,858 23,422 -1.9% 23,858 23,422 -1.9% 7

Personnel Costs ($000) 44,254 45,189 2.1% 44,254 45,189 2.1% 8

Financial Result Total ($000) -320 -320 0 -320 -320 0 9

Outpatient FSA Volumes* 10,867 11,767 -8% 10,867 11,767 -8% 10

Outpatient Follow Up Volumes* 23,489 27,234 -14% 23,489 27,234 -14% 11

Virtual FSAs (GP consult and nonpatient appointments) 173 294 -41% 173 294 -41% 12

Reduce clinical outsourcing ($000) 1,296 1,313 18 1,296 1,313 18 13

Jul-14 Target Var Actual Target VarStaff Annual Leave - Dollars ($000) (excess > 10 weeks) 2,469 0 2,469 2,469 ~ 2,469

Adult Rehab / Health of Older People 13 0 13 13 ~ 13Medicine/ Acute Care and Clinical Support 846 0 846 846 ~ 846

Surgical/ Ambulatory Care 840 0 840 840 ~ 840Mental Health 325 0 325 325 ~ 325

Kidz First/ Women's Health 444 0 444 444 ~ 444

% Staff Annual Leave >2 years (YTD rol l ing average % of las t 12 months) 11.8% 5.0% -6.8% 11.9% 5.0% -6.9% 14

Adult Rehab / Health of Older People 7.4% 5.0% -2.4% 6.6% 5.0% -1.6%Medicine/ Acute Care and Clinical Support 9.8% 5.0% -4.8% 10.9% 5.0% -5.9%

Surgical/ Ambulatory Care 14.4% 5.0% -9.4% 14.2% 5.0% -9.2%Mental Health 9.1% 5.0% -4.1% 8.7% 5.0% -3.7%

Kidz First/ Women's Health 17.1% 5.0% -12.1% 17.1% 5.0% -12.1%% Staff Turnover (YTD no. voluntary turnovers by average headcount) 0.7% 2.0% 1.3% 9.1% 10.0% 0.9% 15

% Sick Leave 3.2% 2.8% -0.4% 3.1% 2.8% -0.3% 16

Workplace Injury Per 1,000,000 hours 1.39 10.50 9.11 13.21 10.50 -2.71 17

ANNUAL REPORTING Var VarWorkforce Diversity - Leader data January 2014 workforce population workforce population 19

Maaori 4.7% 16.3% -11.6% 4.8% 16.3% -11.5%Pacific 8.5% 23.1% -14.6% 8.0% 23.1% -15.1%Asian 28.9% 23.0% 5.9% 26.8% 23.0% 3.8%

NZ European / non-specified/ other 57.9% 37.6% 20.3% 60.4% 37.6% 22.8%

Ensu

ring F

inan

cial S

usta

inab

ility

Enab

ling H

igh

Perfo

rmin

g Peo

ple

Year to date

Year

Year to date

Year to date

Jul-14 Jul-13

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JULY 2014

IMPROVED QUALITY, SAFETY AND EXPERIENCE OF CARE

NB data reported from June 14 to align with patient safety report Jul-14 Target Var CL rate Target Var% e-medication reconciliation -high risk patients within 48hrs 63.0% 80% -17.0% 55.0% 80% -25% 20

% Serious Pressure Injuries rate / 100 Patients 0.0% 3.5% 3.5% 0.3% 3.5% 3.2% 21

Falls causing major harm rate / 1,000 bed days 0.038 0.00 -0.04 0.09 0.0 -0.09 22

Rate of adverse drugs events rate / 1,000 bed days (Dec 2013) 48.82 tbc 48.11 23

CLAB rate / 1,000 line days 2.55 0.0 -2.6 2.89 0.0 -2.9 24

Rate of S. aureus bacteraemia rate / 1,000 bed days 0.265 0.0 -0.27 0.065 0.0 -0.07 25

Q3 13/14 Target Var Q3 13/14 Target Var% Operations - all 3 parts of the Surgical Safety Checklist used # 90.0% 90.0% 0.0% 90.0% 90.0% 0.0% 26

% 75+ years assessed for the risk of falling # 98.0% 90.0% 8.0% 98.0% 90.0% 8.0% 27

% 75+ years assessed for falls risk with falls intervention plans # 94.0% 90.0% 4.0% 94.0% 90.0% 4.0% 27a

Jul-14 Target Var Actual Target Var% Radiotherapy commences in 4 weeks - National Health Target 100% 100% 0.0% 100% 100% 0.0% 30

% Chemotherapy commences in 4 weeks – National Health Target 100% 100% 0.0% 100% 100% 0.0% 31

% MRI scans completed within 6 weeks from referral - MOH IDP 65% 75% -9.7% 74% 75% -1% 33

% CT scans completed within 6 weeks from referral - MOH IDP 79% 85% -5.8% 76% 85% -10% 34

% urgent diagnostic colonoscopy within 14 days - MOH IDP 78.3% 75% 3.3% 64% 75% -11% 37

% diagnostic colonoscopy patients within 42 days - MOH IDP 35.0% 60% -25.0% 31% 60% -29% 38

% surveillance colonoscopy patients within 84 days - MOH IDP 99.0% 60% 39.0% 77% 60% 17% 39

% cardiac STEMI-PCI (angiography) <120mins - Northern Region 55.0% 80.0% -25.0% 55% 80.0% -26% 41

% Coronary Angiography within 90days - MOH IDP (1mth arrears) 100% 85.0% 15.0% 99% 85.0% 14%

ESPI 2: No. patients waiting >5 mths for FSA - Elective ∆ 0 0 0 0 0 0 42

ESPI 5: No. patients waiting >5 mths treatment - Elective ∆ 2 0 -2 2 0 -2 43

Radiology - Inpatient radiology completion times <24hrs 92% 100.0% -8.0% 90% 100.0% -10.0% 35

Radiology- Emergency Care radiology completion times <2 hrs 96% 100.0% -4.0% 96% 100.0% -4.0% 36

Acute Surgery Priority Score - delay for surgery 84% 80% 4% 84% 80% 4% 44

Q4 Target Var Actual Target VarFaster Cancer Treatment - % high suspicion first cancer treatment within 62 days - MOH FCT + target by 2016 70.3% 85.0% -14.7% 62.7% 85.0% -22.3% 45

Faster Cancer Treatment - % confirmed diagnosis first cancer treatment within 31 days - MOH FCT + 87.0% na 82.1% na 46

% Radiology results reported within 24 hours 54.0% 75.0% -21.0% 59.0% 75.0% -16.0% 47

Jul-14 Target Var Actual Target VarAverage Length of Stay - Acute Inpatient - MOH IDP 2.92 2.98 0.06 2.92 2.98 0.06 50

Average Length of Stay - Acute Arranged/ Elective - MOH IDP 1.37 1.37 0.00 1.37 1.37 0.00 51

MMH % patients to discharge lounge or home by 1100hrs 18.1% 30% -12% 18.1% 30% -12%Acute Readmissions within 7 days - Total 3.0% 2.89% -0.1% 3.0% 2.89% -0.1% 52

Acute Readmissions within 28 days - Total - MOH IDP 6.4% 8% 1.2% 6.4% 8% 1.2% 53

Acute Readmissions within 28 days - 75+ years - MOH IDP 9.9% 11.85% 1.9% 9.9% 11.85% 1.9% 54

EC Presentations - 75+ year olds (5% reduction on 2013) 1017 807 -26% 1,017 807 -26% 55

% clinical summaries (meddocs) authorised <7 days of creation 76.0% 95% -19% 76.0% 90% -14% 56

% of patient outliers - not on home ward <5% 6.5% 5.0% -1.5% 6.5% 5.0% -1.5% 58

QUARTERLY REPORTING

Syst

em In

tegr

atio

n (E

ffec

tive)

Tim

ely

Firs

t, Do

No

Harm

(Saf

ety)

Year to date

Year

Year to date

Year

Health Quality and Safety QSM - QUARTERLY AUDIT REPORTING

Year to date

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JULY 2014

Q4 Target Var Actual Target Var% Eligible stroke patients thrombolysed - Northern Region 5.7% 6.0% -0.3% 7.0% 6.0% 1.0% 59

Mental Health access rate - clients seen in last 12 months as % of population (0-19 Years) 2.98% 3.15% -0.2% 2.98% 3.15% -0.2% 49a

Mental Health access rate - clients seen in last 12 months as % of population (20-64 Years) 3.79% 3.15% 0.6% 3.79% 3.15% 0.6% 49b

Mental Health access rate - clients seen in last 12 months as % of population (64+ Years) 2.56% 2.70% -0.1% 2.56% 2.70% -0.1% 49c

Ambulatory Sensitive Hospitalisation rates - MOH IDP ^ See note - standardised national 2013.140-4 years - Total 104% 101% -3% 99% 60

0-4 years - Maaori 128% 118% -10% 119%0-4 years - Pacific 136% 118% -18% 136%0-74 years - Total 120% 114% -6% 122% 60a

0-74 years- Maaori 206% 119% -87% 220%0-74 years- Pacific 184% 119% -65% 187%

Jul-14 Target Var Actual Target VarOutpatient - First Specialist : Follow-up Clinic ratio 46% 43% 7% 46% 43% 7% 61

Outpatient - DNA rates - Maaori 11% 10% -1% 11% 10% 1% 62

Outpatient - DNA rates - Pacific 9% 10% 1% 9% 10% 1% 62a

Theatre List Utilisation 83.9% 88.7% -5% 83.9% 88.7% -5% 63

Day of Surgery Admissions (DOSA) 91% 90% 1% 91% 90% 1% 65

Day Case Rate (Elective/ Arranged) 63.1% 65% -2% 63.1% 65% -2% 66

% Medical Assessment patients with LOS < 28 hours 99% 65% 34% 99% 65% 34% 68

No. Hospital bed days occupied (against forecast open beds) 21,164 20,329 -4% 21,164 20,329 -4% 73

No. Length of Stay outliers (LOS >10 days)* 266 274 3% 266 274 3% 74

Jul-14 Target Var Actual Target VarPatient Experience Survey (to be reported from August 2014) 75

Better Health Outcomes For All

Jul-14 Target Var Actual Target Var% Infants Exclusively Breastfed at discharge - Total 81% 75% 6% 81% 75% 6% 76

% Infants Exclusively Breastfed at discharge - Maaori 82% 75% 7% 82% 75% 7%% Infants Exclusively Breastfed at discharge - Pacific 74% 75% -1% 74% 75% -1%

% smokers receive smokefree advice - Maaori 97% >95% 2% 97% >95% 2% 77

% smokers receive smokefree advice - Pacific 95% >95% 0% 95% >95% 0%

% Women (45-60yrs)with Breastscreen in 24months - Total 69% 70.0% -1% 69% 70% -1% 78

% Women (45-60yrs)with Breastscreen in 24months - Maaori 69% 70.0% -1% 69% 70% -1%% Women (45-60yrs)with Breastscreen in 24months - Pacific 73% 70.0% 3% 73% 70% 3%

Year

Effic

ient

Syst

em In

tegr

atio

n (E

ffec

tive)

QUARTERLY REPORTINGYear

Equi

ty

Year

Year

Patie

nt

Wha

anau

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2.1 National Health Targets July 2014:

All graphs demonstrate consistent performance in meeting national health targets. All targets were achieved for Quarter 4 and for the 2013-14 year.

SmokeFree Support for hospitalised Smokers – Target 95% are identified and offered support.

Emergency Care Department – Length of Stay – Target 95% are seen and admitted or discharged within 6 hours.

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12

Elective Discharges – Target 100% of additional discharges are delivered

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13

2.2 Elective Wait Time target trends:

N.B. Current target is <150 days (31/12/2014 target <120 days)

Report Run Date: 25/07/2014 - data subject to change

Patients given a commitment to treatment but not treated within FOUR months.

2013 07 2013 08 2013 09 2013 10 2013 11 2013 12 2014 01 2014 02 2014 03 2014 04 2014 05 2014 06 2014 07225 202 218 222 157 294 350 356 252 280 163 193 284107 162 191 209 157 195 263 240 305 267 141 227 192155 186 124 103 114 109 119 153 194 171 112 111 144163 175 217 193 162 209 296 241 302 211 123 159 398

2,256 2,222 2,399 2,344 2,034 2,662 3,625 3,202 2,957 2,947 1,851 1,952 2,710

Patients given a commitment to treatment but not treated within FIVE months.

2013 07 2013 08 2013 09 2013 10 2013 11 2013 12 2014 01 2014 02 2014 03 2014 04 2014 05 2014 06 2014 0714 28 29 35 30 37 54 57 31 33 25 7 230 1 2 1 4 2 5 5 4 19 2 2 2

14 28 4 9 6 8 7 10 46 61 12 23 4323 24 24 22 20 27 24 23 23 35 16 11 92

351 379 248 319 282 351 681 628 393 689 409 150 313

Patients waiting longer than FOUR months for their first specialist assessment (FSA).

2013 07 2013 08 2013 09 2013 10 2013 11 2013 12 2014 01 2014 02 2014 03 2014 04 2014 05 2014 06 2014 07559 470 449 431 521 575 737 558 483 532 374 531 639211 173 177 348 276 240 391 283 339 214 214 200 185171 242 262 267 269 327 491 373 386 234 150 158 162763 902 1,009 1,222 958 1,204 1,242 1,111 831 687 655 604

5,045 5,093 5,143 5,705 5,068 6,032 7,494 6,261 5,329 4,280 3,560 3,547 2,129

Patients waiting longer than FIVE months for their first specialist assessment (FSA).

2013 07 2013 08 2013 09 2013 10 2013 11 2013 12 2014 01 2014 02 2014 03 2014 04 2014 05 2014 06 2014 0724 15 21 12 15 85 53 30 36 35 24 20 180 0 0 2 0 0 19 2 2 2 2 4 0

12 9 12 6 12 8 32 9 9 12 11 4 1214 29 15 0 0 24 87 11 18 23 0 13

518 475 460 326 242 570 792 375 175 346 230 190 113

NorthlandWaitemata

Counties Manukau

AucklandCounties ManukauNorthlandWaitemata

National Total:

Number of patients waiting more than four, five months for Treatment or an FSA

National Total:

Auckland

NorthlandWaitemata

Counties Manukau

Waitemata

Counties Manukau

National Total:

Auckland

Northland

National Total:

Auckland

0

500

1,000

1,500

Regional ESPI - Treatment over 120 Days

Auckland

CountiesManukau

Northland

Waitemata

0

50

100

150

200

Regional ESPI - Treatment over 150 Days

Auckland

CountiesManukau

Northland

Waitemata

0

500

1,000

1,500

Regional ESPI - FSA over 120 Days

Auckland

CountiesManukau

Northland

Waitemata

0

50

100

150

200

Regional ESPI - FSA over 150 Days

Auckland

CountiesManukau

Northland

Waitemata

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3. FINANCIAL SUMMARY Best value for public health system resources 3.1 Consolidated Statement of Financial Performance – Provider

Fig. 1

Variance Result: XX F = favourable variance to budget, (XX) U = unfavourable to budget

Actual Budget Variance Actual Budget Variance$(000) $(000) $(000) $(000) $(000) $(000)

RevenueGovernment Revenue 3,791 4,552 (761) U 3,791 4,552 (761) UPatient/Consumer Sourced 757 700 57 F 757 700 57 FOther Income 2,365 2,224 141 F 2,365 2,224 141 FFunder Payments 60,881 60,816 65 F 60,881 60,816 65 FTotal Revenue 67,793 68,292 (499) U 67,793 68,292 (499) U

ExpensesPersonnel 44,254 45,189 935 F 44,254 45,189 935 FOutsourced Personnel 1,099 877 (222) U 1,099 877 (222) UOutsourced Clinical 1,391 1,458 67 F 1,391 1,458 67 FOutsourced Other 2,371 2,381 10 F 2,371 2,381 10 FClinical Supplies (excluding Depreciation) 9,204 8,060 (1,144) U 9,204 8,060 (1,144) UOther Expenses 4,712 5,425 713 F 4,712 5,425 713 FTotal Expenses 63,031 63,390 359 F 63,031 63,390 359 F

Earnings before Depreciation, Interest and Capital Charge 4,762 4,901 (140) U 4,762 4,901 (140) U

Depreciation 2,780 2,846 66 F 2,780 2,846 66 FInterest 1,083 1,280 198 F 1,083 1,280 198 FCapital Charge 1,218 1,095 (124) U 1,218 1,095 (124) U

Total Depreciation, Interest and Capital Charge 5,081 5,221 140 F 5,081 5,221 140 F

Net Surplus/(Deficit) Provider (320) (320) 0 F (320) (320) 0 F

Month Year to Date

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3.2 Financial Performance Trends

**May14: Adjustment to provision for Haemophilia, offset by funding for additional electives $3.2m

**Jun14: Revaluation of year end provisions. Offset by Funder and Governance.

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3.3 Financial Performance

Fig 2

Fig 3

Actual FTE

Variance FTE

Variance $000's Actual FTE

Variance FTE

Variance $000's

Medical Personnel 748 48 F $697 F 748 48 F $697 FNursing Personnel 2,502 57 F $(250) U 2,502 57 F $(250) UAllied Health Personnel 1,075 49 F $210 F 1,075 49 F $210 FSupport Personnel 458 24 F $128 F 458 24 F $128 FManagement/Administration Personnel 772 54 F $149 F 772 54 F $149 F

Total (before Oursourced Personnel) 5,555 231 F $935 F 5,555 231 F $935 FOutsourced Medical 20 (4) U $(106) U 20 (4) U $(106) UOutsourced Nursing 9 (5) U $(60) U 9 (5) U $(60) UOutsourced Allied Health 6 (1) U $(10) U 6 (1) U $(10) UOutsourced Support 9 (1) U $(7) U 9 (1) U $(7) U

Total Outsourced Personnel 43 (11) U $(184) U 43 (11) U $(184) UTotal Personnel 5,598 220 F $751 F 5,598 220 F $751 F

Consolidated Statement of Personnel By Professional Group - July 2014

Month Year to date

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3.4 Month Result Variances

Major variances for the Provider Arm Statement of Financial Performance (Fig. 1) follow:

Revenue is $(499)k unfavourable for the month of July. The main drivers for the current month’s variance are:

- Government Revenue $(761)k; Base disability support, timing of revenue to budget $(626)k. This revenue is booked to Corporate Services.

- Patient/Consumer Sourced $57k; Non-residents income is $91k favourable against budget reflecting the continuing upward trend from last year (partially offset by doubtful debts $(73)k).

- Other Income $141k; Interest Received is $130k above budget for the month and donations exceeded expectation by $54k.

- Funder Payments $65k; Additional revenue from Funder for contracts outside base funding.

Expenditure –is $359k favourable for July.

Major variances are explained below:

- Personnel costs $935k favourable for July - reflects high vacancies across the organisation in all personnel categories, partially covered by bureau, overtime and casual staff.

- Nursing Personnel Costs $(250)k unfavourable for July. This reflects a $262k target saving initiative for nursing costs that are yet to be phased into the organisation.

- Outsourced Costs $(145)k unfavourable for July. This is offset by personnel costs. Mental Health is the main contributor, due to a national shortage of psychiatrists.

- Clinical Supplies $(1.1)m unfavourable for July. This includes a target savings budget of $(652)k which has not yet been realised. $417k of the target savings has been provisionally booked to the Health Alliance cost centre (fig 2). Our finance team are working closely with hA to definitively measure and report savings from procurement initiatives using a price volume methodology.

- Clinical Support $(329)k unfavourable explained by a drug overspend of $90k driven by demand across the organisation (partly offset by PCT revenue). Laboratory blood products are over by $104k, driven by three high-cost patients in ICU, Emergency Care and Renal Dialysis. Increased use of Microbiology testing kits this month reflects an 11% increase on last year and a $66k overspend.

- Non-Clinical is $69k unfavourable. Patient transport and lodging agreement with NTA (National Transport and Accommodation) is over budget due to increased demand of these services in July.

- Other expenses are $713k favourable for July reflecting savings in patient meals $88k, and utilities $72k, and timing differences for audit fees $62k, legal fees $23k, corporate training $114k and expenses relating to base disability revenue not invoiced in July $290k.

- Depreciation, Interest and Capital Charge costs $140k favourable due to; Depreciation Vehicles and Other equipment $67k favourable, CMDHB level of borrowings is lower than budgeted delivering a $197k favourable interest cost variance for the month. The Capital Charge

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18

unfavourable variance of $(124)k reflects the actual cost of capital charged by Ministry of Health.

3.5 Full Time Equivalents FTE

FTE are favourable by 220 FTE (including outsourced) (Fig 3 above) are summarised below:

- Medical personnel are favourable by 48FTE, $697k. Mental Health has 11 vacancies due to a national shortage of psychiatrists. There are 11 vacancies in Surgical Services, reflecting SMO’s partially covered by outsourcing. 13FTE additional vacancies exist across other services and 16FTE is a result of net annual leave.

- Nursing personnel are favourable by 7FTE, primarily attributable to vacancies 106 FTE, offset by overtime (17)FTE, internal bureau (21)FTE and funded projects (12)FTE. The financial $(250)k unfavourable variance for the month reflects a $262k target saving initiative for nursing costs that is yet to be phased into the organisation.

- Allied Health personnel are favourable by 49FTE, $210k. A high level of vacancies exist within Allied Health of 58FTE, with partial cover of (11)FTE provided in the form of overtime, casuals and outsourcing.

- Support personnel are favourable by 24FTE, $128k which reflects 89FTE vacancies within Facilities, covered by overtime and casuals (62)FTE and offset by favourable infra-structure costs (e.g.: Medical Waste Removal, Patient Meals)

- Management and Administration personnel are favourable by 54FTE, $149k reflecting existing vacancies across the business.

3.6 2014/15 Practising Sustainability Healthcare Programme

The approved 2014/15 Annual Plan includes a commitment to Provider Arm target savings of $23m for FY 2014/15. This sits within a $37.7m whole of DHB savings plan.

Savings have been categorised as follows: Bud 14/15PSHC Summary $m'sExpenditure initiativeshA/HBL procurement savings targets (primarily clinical supplies) 8.1 Reduce surgical outsourcing (services) 4.4 Reduce Bed Day demand (clinical supplies & personnel) 2.0 Inventory & supply chain roll-out (all supplies) 0.5 Environmental sustainability initiatives 0.5 HBL Linen & Laundry savings plan 1.0 Clinical staffing skill mix realignment 1.5 Management & Admin. Review 0.9 ACC Levy 1.3 Other initiatives 1.1 Sub-total 21.4 Revenue initiativesAdditional Surgical revenue (Acute spines) 1.4 Sub-total 1.4 TOTAL PROVIDER PHSC Budget Savings plan 22.8

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Savings will be monitored and reported using a comparative of actuals to target baselines for procurement initiatives, and actual cost versus budget for all other initiatives. These will be reported in more detail in the Practising Sustainable Healthcare monthly report. The HBL Linen and Laundry savings target of $1m has been re-forecast to $0.5m due to delays in rollout and additional savings initiatives will be identified to cover this gap.

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3.7 Human Resources

Human Resource metrics are provided to outline performance for Annual Leave Balances, Sick Leave and Turnover rates. Below are the 13 month trend graphs to July 2014.

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4. Non-Clinical Support Services

4.1 SERVICE PERFORMANCE

4.1.1 Non- Clinical Support - Orderlies and Cleaning Services

Hospital Admissions have been well over 300 per day as anticipated with the Winter Plan. This has been a challenge for Non-Clinical Support services to keep up with demand given that staff have also had high levels of sick leave with colds and flu, and the school holidays at the beginning of July.

The number of Isolation Cleaners has been increased for the winter months and will continue until at least the end of October.

The extension of the Discharge Lounge project to the end of the year is also impacting the Orderlies and Cleaners, who have been kept busy by admission/discharges occurring in a quicker timeframe.

It is a credit to the Orderlies completing NZQA qualification that even during this extremely busy time, they are managing to get unit standards achieved and signed off by the internal assessors. The vacant Operations Manager Cleaning and Contracts and Supply Manager positions have been filled by two internal candidates.

Victorian Standard Audit Results – July 2014

4.1.2 Food Services

Planning is underway to begin provision of meals for the Tamaki Oranga patients from the Middlemore kitchen along with the current Spinal Unit patient meal trolley and delivery to site. Work with the Regional Healthy Food Environment group continues, with the policy and guideline documents agreed and signed off by the group. Each DHB will promote the documents via their internal communications during August. A meeting to review the CM Health vending machine products resulted in the decision to review vending product in all three metro DHB’s in line with the new policy documents.

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Patient Survey Results Month Wards Quality of Meals - % response rate Overall Impression Breakfast

Lunch Dinner

VG & Good Satisfactory




May AT&R 58 37 56 42 58 37 60% 36%

June Gen Surgery (Food Service

Associate)

68 28 68 31 67 27 79% 16%

June Mental Health 54 46 46 33 54 31 41% 25%

July Surgical 66 40 56 32 56 32 72% 10%

4.1.3 Clinical Engineering and Equipment

Recruiting to the Clinical Engineering technical personnel remains problematic. MIT are to initiate a training programme for technician’s and will take a national approach. CM Health currently has 19,259 items in the Clinical Engineering database. At the end of July, 11.27% of the medical devices are out of date for a valid annual (WoF) check. This continues to be due to a significant vacancy rate (15%) and lack of senior technician, the impact on resources from the Windows 7 Project and C the required equipment reviews, together with staff on sick and planned annual leave. The team continues to reprioritise workload and allocated FTE accordingly, work overtime to address backlogs created, recruit staff and work with MIT to develop the new Clinical Engineering training course. This situation will continue to be monitored until an acceptable risk level is achieved of <8% non-compliance. The Equipment Pool and Task Manager Dispatcher have now moved into a more suitable area, and the equipment “Warrant of Fitness” team and Bed Workshop are located in the basement of Harley Gray Building. Clinical Engineering, Theatres, and Anaesthetic Department have met to discuss a proposed policy and procedures to clarify the roles and responsibilities pertaining to the management of faulty medical equipment.

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4.2 FINANCIAL RESULTS: Best value for public health system resources

Actual Budget Var Var % Actual Budget Var Var %REVENUE

0 0 0 0% Government Revenue 0 0 0 0%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%

48 33 16 48% Other Income 48 33 16 48%0 0 0 0% Funder Payments 0 0 0 0%

48 33 16 48% Total Revenue 48 33 16 48%

EXPENDITURE1,792 1,956 163 8% Staff Costs 1,792 1,956 163 8%

0 0 0 0% Outsourced Costs 0 0 0 0%3 55 52 94% Clinical Costs 3 55 52 94%

2,018 2,185 166 8% Infrastructure Costs 2,018 2,185 166 8%0 0 0 0% Internal Allocations 0 0 0 0%

3,814 4,195 381 9% Total Expenditure 3,814 4,195 381 9%(3,766) (4,163) 397 10% Net Result (3,766) (4,163) 397 10%

FTE17 19 2 13% Allied Health 17 19 2 13%

384 414 30 7% Support 384 414 30 7%26 26 (1) (3)% Management/Admin 26 26 (1) (3)%

427 459 32 7% FTE Total 427 459 32 7%

**Jun14: Recovery of motor vehicle lease costs

**Jun14: Recovery of motor vehicle lease costs

STATEMENT OF FINANCIAL PERFORMANCE - FACILITIES

Month to Date Year to Date

($000's)

July 2014

($000's)

-4,300-4,200-4,100-4,000-3,900-3,800-3,700-3,600-3,500-3,400-3,300-3,200

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

500

1,000

1,500

2,000

2,500

Mon

thly

resu

lt $0

00's

Monthly Operating Costs

Result Budget

-

500

1,000

1,500

2,000

2,500

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

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Month YTD

Total Variance: $397 $397

Revenue: $16 $16

Salaries & Wages: $163 $163

Outsourced: $0 $0

Clinical Supplies: $52 $52

Infra-Structure: $166 $166

Internal Allocations: $0 $0

Year end Forecast variance to Budget

As per budget.

Infra-Structure Costs $166k favourable including Patient Meals Outsourced $86k; R&M (account 5151 - 5159) $14k; Utilities $73k; MV Leases $15k; MV Fuel $13k; Software Maintenance Fees $(34)k reallocation of security cameras software license costs.

$0

Clinical Supplies were $52k favourable mainly due to Clinical Equipment R&M $42k - varies month to month.

STATEMENT OF FINANCIAL PERFORMANCE - FACILITIES

Total Employee Costs were $163k favourable for the month:Non Clinical Support $16k - 2 FTEs vacancies to be filled.Cleaners $59k - high vacancies in cleaning, 16FTE.Orderlies $(33)k - additional cleaning and orderly service requests in ALBU and Discharge Lounge, (6)FTE; High use of in-house casual pool staff to cover vacancies, annual leave and sick leave taken. Security Officers $9k - high use of overtime and in-house casual pool staff, offset by vacancies yet to be filled, 3FTE. Maintenance Supervisors & Engineers $97k due to 7.25 FTEs vacancies in Engineering. 'In-house' casual staff are being managed within the service.

Food services meals on wheels overhead recovery.

Overall the Division was $397k favourable for July 2014.Lower employee costs due to high vacancies and reduced cost for in-patient meals and utilities have been the main drivers for the overall favourable variance for the month.

July 2014

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5. Actions Arising Responses

2 July 14 item 3.1 Director Report Medical Devices and hA/ Pharmac update Two weeks ago, Pauline Hanna hosted a meeting with one of the Pharmac Directors responsible for Clinician engagement and one of her colleagues. The topic was “What is a medical device?” The discussion focussed on how to identify and agree where there is duplication between Pharmac, HealthAlliance and HBL processes and developments. A number of CM Health Clinical Heads attended to session, along with the Chief Financial Officer and Director Hospital Services. There was an excellent discussion and from that there are a number of actions to be taken. These will focus on helping all parties to understand where the duplication is with DHB and healthAlliance involvement. Pharmac is very clear that they have a legislative mandate and the definition of device under the legislation is very broad. However, the impression is that they were open to discussion and working in partnership with CM Health and healthAlliance. Taikura Trust escalated incidents – further information Designated NASC services Leaders from CM Health and from Auckland DHB and Waitemata DHB meet with Taikura Trust once a month to discuss any clients/ patients that there is uncertainty about regarding funding stream for community support services.

Usually the clients that require a resolution are either being referred to Taikura Trust from DHB services and/or are for DHB funded LTS-CHC. In most cases they have multiple and complex medical and disability needs that make allocation to a single funding stream complex.

Wherever possible, the intention is to resolve such cases at face-to-face meetings with Taikura and DHB attendance and as soon as possible. If an outcome is not able to be agreed from these meetings, then the case is escalated to the National Review Panel, with representatives from DHBs, the Disability Support Services team at Ministry of Health and other key advisors.

Reflecting the amount of work undertaken in the last 5 years to improve processes and agree standard interpretations, there have been much fewer issues regarding the funding interface with Taikura Trust (and the Disability Support Services funding) that have needed to be escalated to the General Manager ARHOP in recent months.

In the last year, there have been 2 spinal patients accepted by Taikura as eligible for Disability Support Service funding for Home Based Support. However, the package of care needed to include providing bowel cares. Taikura deemed this to be outside the scope of their Home Based Support provider’s contract and considered it to be Advanced Personal Cares that should be provided via DHB funded services. There is currently no national definition of advanced personal cares and consequently this wider issue has been escalated to the National Panel for further discussion in a face to face national meeting in Wellington to be scheduled in the next couple of months.

Occasionally the NASC service also deal with cases requiring dual-funding for patient’s through LTS-CHC and those have generally been able to be resolved by meeting with Taikura and agreeing allocation of the funding proportions and who will provide the required assessments. These cases require a good understanding of the funding eligibility and policy to be interpreted consistently.

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ARRC presentations to Emergency Care – Clinical Nurse Director Review: Report summary Target <80 Emergency Care presentations from residential facilities per month

- July 2014 saw 118 Aged Related Residential Care (ARRC) clients present to Emergency Care. Of these, 11 presentations were falls related and 13 potentially avoidable.

A review has been completed on the increase in Emergency Care presentations from the Aged Residential Care sector over the previous three months. This has identified the recent reduction in support from the Community Geriatric Service Nursing team to be the most probably cause of increased presentations. These Nurses work solely in the sector providing clinical advice, support and mentoring with clinical managers and Registered Nurses of Counties Manukau Aged Residential Care facilities. The staff reduction was due to the resignation of one of the two designated Community Clinical Speciality nurses. The vacancy is currently being advertised.

An action plan has been put in place to support facilities that have high Emergency Care presentations in an attempt to reduce preventable admissions. Strategies include increasing CGS Nursing input into Emergency Care high user facilities and reminding all Residential Care facilities of the importance of accessing the Geriatric Hotline for clinical support.

The monthly ARRC Education Sessions will focus on falls prevention and assessment of the acutely unwell resident.

The increase in avoidable emergency care presentations has also been added as an agenda item for the Aged Residential Care Forum to be held in August, which always has a high attendance rate from the sector.

Although EC Presentation numbers were higher in recent months, hospital admission numbers from Residential Care facilities to Middlemore continue to reduce, with the initiatives to enable on-going care to be sustained within Residential Care.

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13 August 14 - item 3.1 Directors Report Theatre CapPlan data and Acute Theatre priority data: Further information to understand the report that shows some Priority 1 and 2 patients did not get to theatre on time.

The reporting of this measure is in development and being reviewed to better understand processing and implications. Over the last month, the service has identified the files of July patients that did not meet the timeframe. This information has been provided to the Clinical Director to enable further investigation as to the reasons for the 10 Priority 1 or 2 cases being delayed in getting to theatre in July.

The initial impression is that several cases may have had the wrong priority score allocated, but this will be confirmed by review of the case by Clinical Director and further update provided when there is more evidence. This may also identify if anything stands out as a problem to be fixed, or a pattern of events that require further investigating including is there is incorrect allocation to a priority category.

The July results were an improvement on June:

- The June result was 43%. In July, 75% of Priority 1 patients had operation in time (Surgical Services only excluding Obstetrics). There were 2 of 8 Priority 1 patients in July that did not meet the timeframe.

- The June result was 50%. In July, 65% of Priority 2 patients had operation in time (Surgical Services only excluding Obstetrics). There were 8 of 23 Priority 2 patients in July that did not meet the timeframe.

Of the July cases, the common theme is that 4 of the patients were under the Gynae team with the 2 priority 1 cases having theatre dates reversed. Five of the ten cases were triaged, and 6 of the 10 cases had surgery commence either before 0800hrs or after 1700hours.

Priority 1 Case 1: Triaged 1908hrs, sent for 2045hrs, arrived 2101hrs. Theatre commenced 2115hrs. Query why priority

1/ need surgery within 20min timespan. Case 2: Transferred from MSC-2 1800hrs, sent for 2009hrs, arrived 2026hrs. Theatre commenced 2029hrs. No

indication in notes as to why the delay.

Priority 2 Case 1: Triaged 1735hrs, Nursing assessment 1809hrs, sent for 2054hrs. Arrived 2110hrs Theatre commenced

2140hrs. Case 2: a secondary procedure; sent for 1415hrs, arrived 1423rs. Theatre commenced 1423hrs. Nothing in

noted to indicate surgery is urgent. Case 3: Triaged 1153hrs, sent for 2002hrs, arrived 2021hrs. Theatre commenced 2037hrs Case 4: Triaged 2310hrs, admitted to Ward 0300hrs, needed CT prior to theatre, sent for 1020hrs, arrived

1054hrs. Theatre commenced 1125hrs. Case 5: Triaged 0615hrs, Ultrasound 1510hrs, sent for 1602hrs, arrived 1631hrs. Theatre commenced 1652hrs. Case 6: Triaged 1345hrs, sent for 2038hrs, arrived 2050hrs. Theatre commenced 2118hrs Case 7: Triaged 2035hrs, Anaesthetic review, sent for 2258hrs, arrived 2332hrs. Theatre commenced 2352hrs. Case 8: Triaged 1100hrs. Sent for 1404hrs, arrived 1420hrs, Theatre commenced 1500hrs.

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Child Surgical Volumes Paediatric WIES were down in the year ended 30 June 2014 compared to the previous year.

Three areas showed decreases: ENT, Orthopaedics and Plastics. All teams have advised that they have accepted all referral received and that the only major change that has occurred at CM Health is the recent reduction in the number of new births.

In ENT, the main decline in WEIS was in Myringotomy (grommets) volumes. Clinical preference is moving to less use of grommets than previously, but this needs to be substantiated with evidence.

In Plastics, the decrease was predominantly in cleft cases. There have been a number of new cases in the last two months as opposed to the last few months of the 13/14 year. The Plastic team believe it is a question of timing, as the number of cleft cases has increased in the last two years, but the staging (timing) of operations is influenced by a number of different factors. The following factors would have impacted on all Plastics Paediatric WIES.

1. There has been a greater complexity of the patients that has meant cases were completed at Starship instead of here at Middlemore when Neurological or Cardiac input required.

2. There has been some deferring of Cleft Cases to accommodate other long wait cases (normally do 4 cleft per 8 hour Operating Theatre list). This is only done if there is not impact on the clinical outcome and deferred 2 – 3 months at most. Cleft babies have a status of “elective Staged” and do not affect the ESPI wait time targets.

3. Specifically for Cleft surgery, there is a time lag derived from cases born that would have impacted volumes of surgery. July–Dec 2012: 15 new-born cleft babies, Jan – Jun 2013: 16 new born cleft babies (total 31) compared to July–Dec 2013: 26 new-born cleft babies , Jan – Jun: 24 new-born cleft babies (total 50)

4. However, this will pick up again and there will be more cases treated in the next 9 months. The timing of the babies born, with more in the last couple of months and more surgery is now planned for the next 6 months than last year.

5. If the overall WIES includes procedures like fistula repairs, redo IVV, alveolar bone grafts etc. rather than grouped to Cleft cases, the service are doing fewer re-do and fistula repairs cases with on-going improvements to quality of surgery and our outcomes

Teen Pregnancy rates at Manurewa teen mother units What is the pregnancy rate at the Manurewa schools running the Teen Mother classes? The requested information is not reported by providers to the DHB and has now been requested from Teen Pregnancy Unit providers. Rotovirus Immunisation catch-up plan Rotovirus (Rota Teq) is now on the immunisation schedule. What plans does Counties have to do a catch-up, as it is particularly important to do Rotovirus at 6 weeks, 3 months and 5 months? There are two aspects to be considered for a catch-up plan:

1. Rota Teq was available on the immunisation schedule as of the1 July 2014 2. Babies are eligible for Rota Teq between the ages of 6 weeks and 14 weeks 6 days.

The implementation plan is underway and to date has included during June 2014:

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29

o CM Health hosted education days for PHOs, General Practices, and Kidz First Hospital (secondary care) emphasising this small window of opportunity for babies to be immunised.

o Updates were sent out on the schedule changes and these communications are to be included in:

- PHO intranets, - CM Health e-Update for Primary Care

o The PHOs received a spread sheet (for dissemination to Practices) that included details of babies (with dates of births detail) who needed to be prioritised and vaccinated on 1 July. Babies born on the 19 March 2014 had only 1 day to catch up before they turned 15 weeks and became ineligible.

For on-going improvement in coverage there is continual monitoring by the Primary Care team (as reported to the Community and Primary Health Advisory Committee meeting) of the immunisation coverage rates at the General Practice and DHB level. Formal performance reporting of rates (at Practice, PHO and DHB level) occurs via the PHO Performance Programme quarterly measures, and included the childhood immunisation rates. In collaboration with the PHOs, processes are being developed to address the timeliness of child immunisation. This is monitored on-going at monthly immunisation operational meetings.

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Appendix A – Scorecard Glossary - in development

HEALTH ADVISORY COMMITTEE SCORECARD NOTES AND DESCRIPTIONS 1 Total Case weight – C Nouwens – DSS – This is the total MOH funded WIES for the month and year to date, from the

front page of the most recent Redbook WIES reporting. 2 Acute Case weight – C Nouwens – DSS - This is the total ACUTE MOH funded WIES for the month and year to date,

from the front page of the most recent Redbook WIES reporting. 3

Elective Case weight – C Nouwens – DSS - This is the total ELECTIVE MOH funded WIES for the month and year to date, from the front page of the most recent Redbook WIES reporting.

4

Total Discharges – C Nouwens – DSS - Total number of patients discharged for the month and year to date, from the front page of the most recent Redbook reporting. There is no target/ funder agreement given for this measure, so last year’s actual is used as the target.

5 6 Budgeted FTE – Finance – Finance - FFARs FTE actual and budget by month and YTD, as reported in the Provider Arm.

7 Operating Costs ($000) – Finance – FFARs actual and budget by month and YTD, as reported in the Provider Arm.

All expenditure less staff/personnel costs plus 8000-xxxxx internal allocations. 8 Personnel Costs ($000) – Finance – FFARs actual and budget by month and YTD, as reported in the Provider Arm.

9 Financial Result – total $m (negative is contribution) – Finance – FFARs actual and budget by month and YTD, as

reported in the Provider Arm $m. 10 Outpatient FSA Volumes – C Nouwens – DSS – The total number of outpatient type of ‘New Patient’ for the month

and year to date. There is no target/ funder agreement for this measure, so last year’s actual is used as the target. 11

Outpatient Follow Up Volumes – C Nouwens – DSS – The total number of outpatient type of ‘Follow-up’ for the month and year to date. There is no target/ funder agreement for this measure, last year’s actual is the target.

12 Virtual FSAs – C Nouwens – DSS – volumes of outpatient events for PUC codes M00010 Virtual Medical Firsts and S00011 Virtual Surgical Firsts against contract. To show ‘Increase from baseline by 10%’, a baseline to be provided. Currently using the contract for the year.

13

Reduce clinical outsourcing – Finance. Spend on clinical service outsource against budget

14 Accrued Annual Leave (Rate based measures of staff with excessive annual leave balances within the DHB) – B Watson - HR - Excessive leave is considered to be those employees with an annual leave balance in excess of 2 years’ worth of their current annual entitlement. Factors in FTEs. Numerator: A count of the number of employees with an excessive annual leave balance as defined above. Denominator: A count of the number of employees with an annual leave balance.

15 Staff Turnover (A rate based measure of staff turnover within the DHB) – B Watson - HR – Numerator: The number of employees who cease employment due to voluntary resignation during the period. Denominator: The total headcount of employees at the beginning of the period.

16 Sick Leave (A rate based measure of paid and unpaid sick leave hours taken by employees within the DHB) – B Watson - HR - Measure the proportion of DHB employees’ paid and unpaid hours that are lost to sick leave. Provides an indication of relative effectiveness in maintaining healthy staff and managing absenteeism in the DHB. Does not measure all forms of absenteeism. Numerator: The total number of paid and unpaid sick leave hours taken by DHB employees during the reporting period. Denominator: The total number of DHB paid hours during the reporting period.

17 Incidences of days lost due to staff injuries per 1,000,000 hours worked – B Watson – HR Measures the proportion of DHB employees who have days lost due to workplace injuries or illness. Injuries or illness associated with the workplace contribute towards lost work hours.

18 Mandatory Training Completed < 3 months:– B Watson - HR This measure is under development

19 Workforce Diversity – B Watson – HR 20 Patient Safety e-MR within 48hrs per 100 patients – E Currie – MMC

Aligns with monthly patient safety report 21 Patient Safety Rate of patients with hospital acquired pressure injuries per 100 patients – E Currie – MMC

Aligns with monthly patient safety report

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22 Patient Safety Rate of all falls in hospital causing major harm per 1,000 bed days. All inpatients including satellite facilities such as Franklin Memorial – E Currie – MMC Aligns with monthly patient safety report

23 Patient Safety Adverse Drug events per 1000 bed days – E Currie – MMC Aligns with monthly patient safety report

24 Patient Safety Rate of CLAB in patient that had a central line that is not related to an infection at another site expressed as per 1000 central line days – E Currie – MMC Aligns with monthly patient safety report

25 Patient Safety Rate of Staph. Aureus Bacteria infection per 1,000 bed days – E Currie – MMC Aligns with monthly patient safety report

26 Quality Safety Marker, HQSC. % Operations with all 3 Surgical Safety Checklist complete A baseline audit completed in Q1, 2013 had CM Health at 86% – E Currie - MMC

27 Patient Safety % patients 75+ years old (55+ years old for Maaori and Pacific) assessed for risk of falling – Ko Awatea/ Regional Plan - M Cope

27a Patient Safety % patients assessed for falls who have falls intervention plan – Ko Awatea/ Regional Plan - M Cope

28 National Health Target. Numerator: number of patient presentations to the Emergency Department with an Emergency Department length of stay of less than six hours from the time of presentation to the time of admission, transfer and discharge. Denominator: total number of patient presentations to the Emergency Department.

29 Seen by inpatient team <3 hours – C Thomas – DSS - 3 hours rule calculation is based on “If a patient is discharged from EC with a discharge description as "Admit to Ward" and the difference between EC DTTM of Arrival and IP Admit DTTM or if EC DTTM of Arrival to EC Discharge DTTM is >180 M then they fail the 3 hour rule or else they pass . 1 being fail and 0 being pass, No Triage mins logic has been included into this”

30 National Health Target: Percentage of radiotherapy patients receiving treatment within 4 weeks from date of decision to treat. Waiting time for treatment is from date of First Specialist Assessment to the beginning of treatment. The goal is that no one should wait longer than 4 weeks due to reasons of capacity constraint. Patients who wait due to clinical considerations or by their own choice are omitted from the results.

31 National Health Target: Percentage of chemotherapy patients receiving treatment within 4 weeks from date of decision to treat. Waiting time for treatment is from date of First Specialist Assessment to the beginning of treatment. The goal is that no one should wait longer than 4 weeks due to reasons of capacity constraint. Patients who wait due to clinical considerations or by their own choice are omitted from the results.

32 Medical Assessment Unit - seen by SMO within 4 hours: This measure is being developed

33 MOH Developmental measure, MOH Indicator of DHB Performance. 75% of accepted referrals for MRI scans will receive their scan within than 6 weeks (42 days). Overall patient event numbers (Community and Outpatient Referrals) – including planned patient events; Waiting times (Community and Outpatient Referrals) – excluding planned patient events; Monthly activity and demand (Community and Outpatient Referrals) – excluding planned patient events.

34

MOH Developmental measure, MOH Indicator of DHB Performance. 85% of accepted referrals for CT scans will receive their scan within than 6 weeks (42 days). Overall patient event numbers (Community and Outpatient Referrals) – including planned patient events; Waiting times (Community and Outpatient Referrals) – excluding planned patient events; Monthly activity and demand (Community and Outpatient Referrals) – excluding planned patient events.

35

Radiology - Inpatient Radiology times within 24 hours: This measure is being developed

36 Radiology - EC radiology times <2 hours :– P Hewitt – Radiology This measure is being developed

37 MOH Developmental measure, MOH Indicator of DHB Performance. 50% of people accepted for an urgent diagnostic colonoscopy will receive their procedure within two weeks (14 days)

38

MOH Developmental measure, MOH Indicator of DHB Performance. 50% of people accepted for a diagnostic colonoscopy will receive their procedure within six weeks (42 days)

39

MOH Developmental measure, MOH Indicator of DHB Performance. 50% of people waiting for a surveillance or follow-up colonoscopy will wait no longer than twelve weeks (84 days) beyond the planned date

40

Laboratory - Test turnaround time (TAT) – Labs This measure is being developed

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41 Northern Region Target. Proportion of percutaneous coronary interventions (PCIs) carried out within the recommended 90 minute guideline in emergency cardiac care, specifically in the treatment of ST segment elevation myocardial infarction (STEMI). Measure is Door to Balloon, that is, from the arrival of the patient to when they receive a balloon angioplasty (inflation of balloon in a blocked coronary artery)

42

Ministry of Health Elective Service Performance Indicator (ESPI). Number of patients currently waiting longer than five months (150 days) from date of referral for their First Specialist Assessment. ESPI 2.

43

Ministry of Health Elective Service Performance Indicator (ESPI). Number of patients currently waiting longer than 5 months (150 days) for Treatment – elective. ESPI 5.

44

Surgical Acute Priority Score -delay for surgery. Theatre Central MMC [definition to be added]

45 Faster Cancer Treatment – MOH target The maximum target length of time taken for a patient referred with a high-suspicion of cancer (that is, person presents with clinical features typical of cancer, or has less typical signs and symptoms but the triaging clinician suspects there is a high probability of cancer), to receive their first treatment (or other management) for cancer.

46 Faster Cancer Treatment – MOH target The maximum target length of time a patient should have to wait from date of decision-to-treat to receive their first treatment (or other management) for cancer. The 31 day indicator includes all patients who receive their first cancer treatment, irrespective of how they were initially referred.

47 Radiology % radiology results reported within 24 hours – C Thomas [definition to be added]

48 Mental Health national target, Indicator of DHB Performance. % child/ youth seen by 3 weeks for non-urgent mental health services – The wait time will be counted from the time the referral is received for a person who has not been seen for at least a year (or not at all) to the time of the first face to face contact with a mental health or addiction professional.

49 a.b.c

Mental Health national Access rates - CMDHB domiciled unique clients seen by MH in preceding 12 months as % of population (0-19years, 20-64years and over 65 years)

50

MOH, Annual Plan Indicator of DHB Performance. ALOS – Acute Inpatient – C Nouwens – DSS ALOS for Admit type Acute Inpatients across all services.

51 MOH, Annual Plan Indicator of DHB Performance. ALOS – Elective Surgery – C Nouwens – DSS ALOS for Admit type Elective, Arranged and Waiting List Inpatients across all services.

52

Acute Readmissions within 7 days – Total – M Ng – DSS

53 MOH, Annual Plan Indicator of DHB Performance. Acute Readmissions within 28 days – Total – M Ng – DSS

54 MOH, Annual Plan Indicator of DHB Performance. Acute Readmissions within 28 days – 75+ years– M Ng – DSS

55 Annual Plan % EC admissions – 75+ years – DSS

56 Discharge Information % transcribed clinical summaries authorised within 7 days for document created, that is, authorised to be published in Concerto and sent out to GPs and patients. Data collection only started from November 2013.

57 % patients with Goal Discharge Date (EDD/ CSD) within 24hours of admission: This measure is being developed

58 Patient outliers (patients admitted to a ward different from that which they are meant to be in. For example, a medical patient placed in a surgical ward due to the lack of beds) Numerator: patient outliers in ARHOP, Medical and Surgical adult inpatients, excluding EC/ Short Stay. Denominator: occupancy in Medical, Surgical and ARHOP services only.

59 Northern Region Health Plan Target. Eligible stroke patients, that is, only patients with ischaemic stroke.

60 MOH, Indicator of DHB Performance. Hospitalisations of children aged 0 - 4 years old resulting from diseases sensitive to prophylactic or therapeutic interventions that are deliverable in a primary health care setting. The baseline national rate is expressed as 100% and DHB performance is reported against the national rate.

60a MOH, Indicator of DHB Performance. Hospitalisations of people aged 0 - 74 years old resulting from diseases sensitive to prophylactic or therapeutic interventions that are deliverable in a primary health care setting. The baseline national rate is expressed as 100% and DHB performance is reported against the national rate.

61 FSA/Follow up ratio – C Nouwens – DSS – Using the OP measures from measure 4, the number of new patients

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divided by the number of follow-up appointments for the time period. There is no target; the previous year is the variance.

62 Outpatient DNA rates – Maaori – C Nouwens – DSS – All DNA’s for all hospitals for Maaori ethnicity divided by all outpatient appointments at all hospitals for Maaori ethnicity patients.

62a Outpatient DNA rates – Pacific – C Nouwens – DSS – All DNA’s for all hospitals for Pacific ethnicity divided by all outpatient appointments at all hospitals for Pacific ethnicity patients.

63 MOH, Annual Plan Indicator of DHB Performance Theatre List Utilisation – C Nouwens – DSS – from Report Manager Actual operating minutes vs. resourced operating minutes for all CMDHB theatres. : https://nth-reports.healthcare.huarahi.health.govt.nz/Reports/Pages/SearchResults.aspx?SearchText=theatre%20utilisation&ViewMode=List

64 Theatre Session Utilisation – C Nouwens – DSS – also from reporting manager, Report currently broken, waiting for fix.

65 MOH, Annual Plan Indicator of DHB Performance Day of Surgery Admissions (DOSA) – N Raj – DSS – Percentage of all elective discharges (excluding day surgery) where the surgical procedures take place on the day of admission.

66 MOH, Annual Plan Indicator of DHB Performance Day Case Rate (Elective/Arranged) – N Raj – DSS – Percentage of all elective discharges that have the same admission and discharge date.

67 Inpatient Services % patients discharged to discharge lounge or home by 1100hrs. Including Manukau Super Clinic.

68 % MAU patients with LOS <28 hours – DSS – the time a patient spent in MSSU/SSMED during stay in EC

69 % Community NASC referrals via e-referrals and assessed within 48hours. This is a part of e-referral project. This measure is being developed, Baseline data being collected will start reporting in the 2014/15 financial year.

70 % patients discharged and with District Nursing / Home Help within 24hours This measure is being developed, Baseline data being collected will start reporting in the 2014/15 financial year.

71 % FSA Referrals received electronically - This is a part of Regional e-referral project. Baseline data is currently being collected and will start reporting to this in the 2014/15 financial year.

72

Nursing Hours per patient days: MMC This measure is being developed as part of the McKesson development

73 Hospital beds occupied – C Nouwens – DSS – number of inpatient bed days for the month and year to date. Target for month does not include Neonates and Critical Care as no forecast capacity

74 LOS outliers – C Nouwens – DSS – count of encounters with a LOS >10 days, excluding burns, spinal, long stay psych and long stay geriatrics.

75

National HQSC MCC - patient experience survey which all DHBs are expected to implement in 2014/15. Project nearing completion - To be nationally reported from August 2014.

76 MOH, Annual Plan Indicator of DHB Performance GM Kidz First/ Womens Health - Infants who are exclusively breastfed upon discharge from Middlemore Baby Friendly Hospital Initiative Maternity facilities only. Excludes the three primary maternity units.

77 National health target. SmokeFree team - Percentage of identified smokers who have been identified through diagnostic coding as having received advice to quit.

050

https://nth-reports.healthcare.huarahi.health.govt.nz/Reports/Pages/SearchResults.aspx?SearchText=theatre%20utilisation&ViewMode=List

1. Surgery and Ambulatory Care

Service Overview Surgical and Ambulatory Care is managed by Gillian Cossey, General Manager with Mr Wilbur Farmilo Clinical Director - Surgery, Catherine Simpson Clinical Director - Critical Care, Jacqui Wynne-Jones Clinical Nurse Director Surgery, and Annie Fogerty Clinical Nurse Director Acute and Critical Care. CM Health services include: Surgical services (primarily acute at Middlemore Hospital and elective at Manukau Surgical Centre) and outpatient services including sub-specialities - Anaesthetics & Pain, Ear Nose & Throat, Plastics/ Hands (regional), Orthopaedics, Ophthalmology, Urology, Vascular and General Surgery. Specialist Care facilities including National Burns Centre, Critical Care complex - Intensive Care, High Dependency Unit, and Post-operative Care Unit (MSC). The Middlemore Theatre admission/ discharge Unit and the Manukau Day Surgery service. Ambulatory Care at Manukau Super Clinic provides outpatient clinics and services operational oversight – including Referral & Appointments Centre (RAC), Translator Services and facilities for all outpatient specialist clinics (Surgical, Medical, Women’s Health and Paediatrics), and the regional multidisciplinary Hand Therapy Service.

Highlights General Surgery has maintained achievement of “no patients waiting more than 120 days for FSA or Treatment”, and at 31 July all other services achieved zero patients waiting greater than 150 days for FSA.

The “Patient at Risk” hospital team recently presented a service profile to ELT and received very positive feedback. This team continues to be busy, with 200-300 referrals per month.

The Plastic Services completed a first Laser list under General Anaesthetic support at Manukau Super Clinic (theatre 25) on 22 July 2014, showing great team work in getting this model of care in place. There are many people who have worked hard to make it happen, with special mention to Plastic Surgeon Jonathan Heather. This model of care will open opportunities to do more good work for this group of patients.

The new regional Spinal Referral process has commenced with the first spinal tracheostomy patient admitted to Ward 11.

Surgical division Customer Service and staff Long Service celebrations were held in July. Challenges /Emerging Issues

July saw high numbers of medical outliers on the surgical wards, coupled with winter sick leave. Despite this, the wards have coped very well, showing good leadership and teamwork. Ophthalmology and Orthopaedics face ongoing challenges to maintain the ‘less than 150 days’ elective waiting time target and reduce to less than 120 days by December. Orthopaedics has to follow very strict acceptance criteria for referrals. Issues for Orthopaedic include a combination of increasing referral rates; rising volumes of patients declined by ACC and returning to the public sector, a decrease rate of private insurance for patients aged over 65 years and also ongoing SMO

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FTE vacancies. Ophthalmology have filled the two SMO vacancies, and had SMOs on sabbatical/ annual leave return to work. A fixed-term replacement for a SMO on maternity leave will be appointed.


1.1.1 Activity summary – at 18.08.14

Surgical Volumes (WIES - Acute and Elective) Volumes JULY '14 Year to date

Act Bud / Contract Variance % variance Act

Bud / Contract Variance % variance

ACUTES - Adults 1,528 1,858 -330 -17.77% 1,528 1,858 -330 -17.77% - Children 129 188 -59 -31.27% 129 18 -59 -31.27% Total 1,657 2,045 -389 -19.01% 1,657 2,046 -389 -19.01% ELECTIVES

- Adults 1266 1260 7 0.52% 1266 1260 7 0.52%

- Children 109 78 31 40.52% 109 78 31 40.52%

Total 1375 1337 38 2.84% 1375 1337 38 2.84%

COMBINED TOTAL

- Adults 2797 3118 324 10.38% 2794 3118 324 10.38%

- Children 238 265 27 10.26% 238 265 27 10.26%

TOTAL 3032 3383 351 10.37% 3032 3383 351 10.37%

Inpatient summary (WIES) The month and YTD activity is shown in the table above. In summary:

• Acutes - 19.01% lower than contract for July.

• Electives - 2.84% higher than contract for July.

NOTE: Elective base contract for the month excludes Gynaecology but includes additional elective work. Adjustments made for un-coded hip and knee patients operated and discharged during the month but no adjustment has been made for Waiting list patients completed on Acute Arranged lists.

Substantial Elective work continues both internally and externally to reach the goal of 135 days for inpatient wait-times by financial year end.

Outpatient Summary (Visits First and follow up) for the month, FSA outpatients – 8.37% lower than contract for July and Follow ups – 15.3% lower than contract for July .

JULY '14 Year to Date Actual Contract Variance % Actual Contract Variance % FSA's 2615 2854 239 8.37% 2615 2854 239 8.37% Follow ups 5931 7005 1074 15.33% 5931 7005 1074 15.33%

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Commentary on Balance Scorecard:

• Theatre session utilisation rate is now included on scorecard – July result 93% against target of 95%.

• The Middlemore Hospital per cent of patients discharged to Discharge Lounge or home by 11.00am – surgical wards July result was 21.6% and is continually improving.

• There is pleasing improvement in DOSA and Day Case Rates.

• The slightly higher Outpatient DNA rate in July is attributed to July school holidays.

• A continued focus will be on the elective cancellations on the day of surgery. The Plastic and Hand service has identified an incorrect bookings process and patients not fully worked up for surgery. The team is working hard to improve this process.

• External out-source contracting costs were very close to budget (variance of only $2,000). Services are trying very hard to bring work in-house, but it is not always possible. Outsourcing use and costs continued to be monitored with regard to Elective targets. General Surgery did no outsourcing in July, Plastic/Hand utilised 50% of their allocation. However, Ophthalmology exceeded allocation and Orthopaedics may well need to use their total annual budget from July through December.

Please refer to details below for further details on the key results.

053

Surgical and Ambulatory Care SCORECARD

JULY 2014


Def

Jul-14 Target Var Actual Target VarTotal Caseweight (Provider view) 3,032 3,383 -10.4% 3,032 3,383 -10% 1

Elective Caseweight 1,375 1,337 2.8% 1,375 1,337 3% 3

Acute Caseweight 1,657 2,046 -19.0% 1,657 2,046 -19% 2

Elective Surgical Discharges 1,463 1,362 7.4% 1,463 1,362 7.4% 4

Outpatient FSA Volumes 2,341 2,854 -18.0% 2,341 2,854 -18% 10

Outpatient Follow Up Volumes 4,751 7,005 -32.2% 4,751 7,005 -32% 11

Virtual FSAs -(GP consult and nonpatient appointments) 62 144 -82 62 144 -82 12

Reduce clinical outsourcing ($000) 283 281 -2 283 281 -2 13

Jul-14 Target Var Actual Target Var% Staff with Annual Leave > 2 years 14.4% 5.0% -9.4% 14.22% 5.0% -9.2% 14

% Staff Turnover 0.3% 2.0% 1.7% 7.3% 10.0% 2.7% 15

% Sick Leave 2.9% 2.8% -0.1% 2.8% 2.8% 0.0% 16

Work Place Injury per 1,000,000 hours 0.0 10.5 10.5 11.76 10.5 -1.26 17


Jul-14 Target Var Actual Target VarHand Hygiene compliance rate (based on June Gold Audit) 83% 80% 3% 83% 80% 3%Pressure Injuries / 1000 bed days 0% 0% 0% 0% 0% 0%Falls causing major harm / 1000 bed days 0% 0% 0% 0% 0% 0% 22

Severe Pressure Injury (ungradeable) per 1000 bed days 0% 0% 0% 0% 0% 0%Surgical Site Surveillance for Major joints 0%

Anitbiotics given 0-60mins before "knife to skin" 75% 95% -20% 75% 95% -20%2 grams or more Cefazolin given 98% 100% -2% 98% 100% -2%

Appropriate skin preparation 84% 100% -16% 84% 100% -16%% Operations - all 3 parts of Surgical Safety Checklist used 91% 90% 1% 91% 90% 1%CLAB rate/ 1000 line days 0% 0% 0% 0% 0% 0% 24

Rate of S. aureus bacteraemia per 1000 bed days 0% 0% 0% 0% 0% 0% 25

VTE - number of SACS re-admissions due to VTE 11 0 -11 11 0 -11

Jul-14 Target Var Actual Target VarAcute Time to theatre compliance (Categories 1-4 ex Obstetrics) 82% 80% 2% 82% 80% 2%Pre-operative Length of Stay Days (from admit to surgery) 1 1.0 0% 1 1.0 0%ESPI 2 No. patients waiting >5 mths for FSA - Elective (Surgical Services incl Gynae) 0 0 0 0 0 0 42

ESPI 5 No. patients waiting >5 mths Treatment - Elective (Surgical Services incl Gynae) 2 0 -2 2 0 -2 43

Jul-14 Target Var Actual Target VarAverage Length of Stay - Acute Inpatient incl Burns 4.0 3.8 -0.20 4.00 3.8 -0.20 50

Average Length of Stay - Acute Inpatient excl: Burns 3.98 3.8 -0.18 4.0 3.8 -0.18 Average Length of Stay - Electives 1.3 1.5 0.20 1.3 1.5 0.20 51

Acute Readmissions within 7 days - Total 3.05 3.43 0.38 3.05 3.43 0.38 52

Number of patients referred to POAC 7 10 -3 7 10 -3

Jul-14 Target Var Actual Target VarTheatre list utilisation - % used MMH/MSC (MOH OS5) 83.9% 85.0% -1.1% 83.9% 85.0% -1.1%Theatre session utilisation - % used MMH/MSC 93.0% 95.0% -2.0% 93.0% 95.0% -2.0%Elective Theatre turnaround times- Mins (MMH/MSC) 16.7 15 -1.7 16.7 15 -1.70 Elective cancellations - Day of surgery as % of all Elective (all reasons) 8.1% 5.0% -3.1% 8.1% 5.0% -3.1%Day of Surgery Admissions (DOSA) 93.0% 90.0% 3.0% 93.0% 90.0% 3.0% 65

Day Case Rate (Elective/ Arranged) 63.0% 65.0% -2.0% 63.0% 65.0% -2.0% 66

MMH % patients discharged to discharge lounge or home by 1100hrs 21.6% 30% -8.4% 21.6% 30% -8.4%

Ratio FSA/FU clinic ratio 37.8% 31% 6.8% 37.8% 31% 6.8% 61

Outpatient DNA rates - overall 8.6% 10% 1.4% 8.6% 10% 1.4% 62

Outpatient DNA rates - Maori (FSA) - Surgical Services 16.4% 10% -6.4% 16.4% 10% -6.4% 62

Outpatient DNA rates - Pacific (FSA)- Surgical Services 14.5% 10% -4.5% 14.5% 10% -4.5% 62

Jun-14 Target Var Actual Target VarPatient Experience Survey (to be reported from August 2014) 74

BETTER HEALTH OUTCOMES FOR ALL

Jul-14 Target Var Actual Target Var% of hospitalised smokers receiving smokefree advice & support -Total (Surgical) 95.0% 95% 0.0% 95.0% 95% 0.0% 77

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1.2 FINANCIAL: Best value for public health system resources


577 623 (46) (7)% Government Revenue 577 623 (46) (7)%129 150 (21) (14)% Patient/Consumer Sourced 129 150 (21) (14)%715 675 40 6% Other Income 715 675 40 6%

1,035 1,035 0 0% Funder Payments 1,035 1,035 0 0%2,456 2,483 (27) (1)% Total Revenue 2,456 2,483 (27) (1)%


574 541 (33) (6)% Outsourced Costs 574 541 (33) (6)%3,242 3,244 2 0% Clinical Costs 3,242 3,244 2 0%

526 552 27 5% Infrastructure Costs 526 552 27 5%603 639 36 (6)% Internal Allocations 603 639 36 (6)%

16,739 17,010 272 2% Total Expenditure 16,739 17,010 272 2%14,283 14,527 244 2% Net Result 14,283 14,527 244 2%

FTE263 287 24 8% Medical 263 287 24 8%748 776 28 4% Nursing 748 776 28 4%107 116 10 8% Allied Health 107 116 10 8%

73 67 (6) (9)% Support 73 67 (6) (9)%126 127 1 1% Management/Admin 126 127 1 1%

1,316 1,373 56 4% FTE Total 1,316 1,373 56 4%

**April:Unpaid days accrual for the Easter period,adjusted in May.

($000's) ($000's)

STATEMENT OF FINANCIAL PERFORMANCE - SURGICAL & AMBULATORY

Month to Date Year to DateJuly 2014

12,500

13,000

13,500

14,000

14,500

15,000

15,500

16,000

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

1,000

2,000

3,000

4,000

5,000

6,000

Mon

thly

resu

lt $0

00's


Result Budget

10,000

10,500

11,000

11,500

12,000

12,500

13,000

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

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1.3 QUALITY: Goal to improve the quality safety and experience of care

1.3.1 SAFETY First Do No Harm

Month YTD


Revenue: $(27) $(27)


Outsourced: $(33) $(33)


Infra-Structure/Internal Allocati $63 $63

July 2014

Outsourced costs on subcontracting $(33)k Unfavourable. Adverse variance due to external bureau nursing cost for staffing unresouced beds $19k, Medical staff payments for locum work $ 11k and $5k for locum Anaesthetic technicians.

STATEMENT OF FINANCIAL PERFORMANCE - SURGICAL & AMBULATORY

Government Revenue: Elective ACC Revenue was ($45k) unfavourable for the month. The month's revenue is below target as the division will be giving priority to MoH patients to enable Acute wait times and ESPI wait times to be met. This would inevitably result in Elective ACC patients being adversely impacted as there is limited Capacity for treatment . Patient/Consumer Sourced: Private patients $(22)k adverse for the month due to a reduction in acute Tahitian burns patients during the month.Other Income $40k favourable for the month reflecting unbudgeted burns revenue. Funder Payments: Funder revenue for elective work on budget for the month.

The Division had a favourable variance of $244k for the month . Detailed explanation for the months variance is given below. MoH outputs for the month were less than contract by 351 WIES or 10.37% . This was based on 84% coding of patient charts. There was a reduction in acutes of 19.01% or 389 WIES and an increase in electives of 2.84% (38 WIES).

Medical $121k favourable for the MTH - Primarily reflects SMO vacancies 11FTE and a higher rate of annual leave taken 12FTE. House Officers account for $43k. The mix of RMO's for the run and the leave transfers on rotation have had a favourable affect on the Division. Nursing $42k favourable for the MTH - Favourable variance represents vacancies in the process of being filled 31FTE, partially offset by external bureau $(19)k (outsourcing).Allied Health $105k fav for MTH - Favourable variance due to vacancies 13FTE. Vacancies have not been filled as a result of the lack of skilled staff and the time lag for recruitment. Support Staff $11k Adverse for the MTH, represent vacancies 8FTE, offset by casual Interpreters (13)FTE. Note: that the Division holds the budget for the entire organisation providing interpreting services as and when required. The demand on the service has grown rapidly and servicing these demands has resulted in more casual interpreters being recruited to meet expectation.Management Admin $18k unfavourable for the MTH - Favourable 1.2 FTE, reflecting 8FTE of vacancies, offset by cost overspend due to net annual leave $(6)k, (1.7)FTE and overtime $(7)k, (5)FTE.

The variance on Clinical Supplies for the month is $2k unfavourable.

Current Year end Forecast is for a breakeven by financial year end

Year end Forecast variance to Budget $0

Underspend for the month mainly due to lower MRI charges, lower bedding and linen costs and monies recouped for Cancer control coordinators.

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- Falls Prevention 29 falls within SACS this month, with 2 causing harm.

- Pressure Injury Prevention: No severity 3 or 4 Pressure Injuries recorded this month.

- CLAB Prevention: No CLABs occurred for surgical services again for the month.

- Medication Safety Training Anaesthetic Technicians currently undergoing Medication Safety Training, enabling the same access rights to Pyxis as Registered Nurses. This makes the theatre team more efficient and flexible in supporting drug management. Vanessa Wheeler commenced as a surgical Quality Speciality Nurse – she will be working on the on-going implementation of the Surgical Safety Checklist, and has a poster accepted for APAC.

- Critical Care - Ventilator Associated Pneumonia (VAP):

1.3.2 TIMELINESS: “Every Hour Counts” if we are to achieve quality and safety outcomes”

Elective Services Elective Service Performance Indicators (ESPI Targets) - 2 & 5 Note that ESPI Compliance: Green if 0 patients, Yellow if greater than 0 patients and less than 0.39%, Red if 0.4% or higher. Penalties are incurred when three red combined ESPIs in a row.

ESPI 2: No patients will wait more than 150 days for their First Specialist Assessment (FSA)

At the end of July, all services achieved the “less than 150 days” timeline for FSA. The Ministry Elective Services ESPI report shows small breaches for ESPI 2 in recent months have occurred for CM Health - so it is good to get back to green again for the start of 2014/15. There continues to be a number of services also achieving “less than 120 days” including some of the smaller Medical services, General Surgery and Gynaecology.

Looking forward - Ophthalmology has 93 patients needing FSA in August to remain 150 day compliant and Orthopaedics has 26. Orthopaedics and Ophthalmology services each have in the range of 170-270 patients waiting over 90 days. This is the volume which needs to be seen in August, if these services are to achieve a “less than 120 days” timeframe by the end of the month.

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ESPI 5: Patients given a commitment to treatment will be treated within 150 days

The total number waiting on the list for treatment was 4,282 at the end of July, a drop of 334 from the June and 642 from the May total.

At the end of July, CM Health had 3 patients breach the 150 day timeline for surgery access - one Plastic and one Orthopaedic case and this breach will incur a code yellow ESPI 5 result for July. CM Health has not achieved a green ESPI 5 since July 2013, as a result of a small number of on-going breaches (cases waiting over 150 day to access to treatment). Orthopaedics in particular is struggling to provide timely access to patients but is reviewing acceptance thresholds to help manage inflows.

At the end of July, there were 289 ESPI 5 eligible patients waiting over 120 days for treatment in August to sustain the “less than 150 days” timeline. This is the same position as the end of June, but with a different mix of service volumes. Ophthalmology remains the largest contributor to that volume with 150, the service is working hard but needing to continue to outsource significant numbers to help achieve compliance thresholds, ORL has 50 cases and Orthopaedics has 49 cases.

Regionally, there were 35 cases for FSA and 81 cases for Treatment identified as exceeding the 150 days target.

SACS Results of no patients waiting >120 days for FSA / Treatment by Dec 2014:

Patients Waiting >120 days

31-Ju

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31-A

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30-S

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31-O

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30-N

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31-D

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31-Ja

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28-F

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31-M

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30-A

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31-M

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30-Ju

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31 Ju

ly

FSA 152 112 111 251 190 183 348 254 313 202 214 169 185

For Treatment 201 207 271 322 232 317 369 316 389 332 234 261 289

Jan-14

Feb-14

Mar-14

Apr-14

May-14

June-14

July-14

General Surgery 55 27 56 29 12 0 0 ORL 25 46 58 68 43 65 50

Ophthalmology 123 118 145 116 111 111 150 Orthopaedics 67 61 72 94 50 58 49

Plastic Surgery 49 36 47 22 17 26 10 Urology 11 5 3 3 1 1 1

SACS total 330 293 381 332 234 261 260 Gynaecology 34 41 28 13 15 28 29

Cardiology 0 0 0 0 0 0 0 CM Health total 364 334 409 345 249 289 289

Acute Services

Theatre Cap Plan is beginning to produce new useful reports of timeliness for the teams. The first report showed delays in category 1 and 2 cases. It is pleasing to see improvements in the acute priority score for surgical services (July Cat 1 75% - up from 43% in June; July Cat 2 65% -up from 50% in June).

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Total Acute Priority Score - Jul 2014

Priority Operation

in time Operation overtime

Total % In Time

1 20 Mins 52 5 57 91% 2 1 hour 61 20 81 75% 3 6 hours 95 18 113 84% 4 24 hours 574 117 691 83% 5 48 hours 47 7 54 87% 6 7 days 54 4 58 93%

Total 883 171 1054 84%

Surgical Services Acute Priority Score - Jul 2014

Priority Operation


Total % In Time

1 20 Mins 6 2 8 75% 2 1 hour 15 8 23 65% 3 6 hours 71 18 89 80% 4 24 hours 560 113 673 83% 5 48 hours 47 7 54 87% 6 7 days 53 4 57 93%

Total 752 152 904 83%

Obstetrics Acute Priority Score - Jul 2014

Priority Operation


Total % In Time

1 30 Mins 46 3 49 94% 2 1 hour 45 12 57 79% 3 2 hours 23 23 100% 4 24 hours 9 3 12 75% 5 48 hours 0 6 7 days 1 1

Total 124 18 142 87%

059

060

Total acute numbers include all acute operations in CM Health theatres. Wait time is based on booked date/time to operation start date/time. Although Obstetrics are measured against their own priority times, they are included in the equivalent priority category for the total numbers. Data source is Theatre Capacity Planner. 1.3.3 EFFICIENCY Avoiding waste, including waste of equipment, supplies, ideas and energy

Theatre Admission Unit July utilisation shows a slight reduction in patients presenting pre-operatively. This may be due to the number of lengthy and complex elective cases resulting in an all-day theatre list only has one patient (a procedure taking 8 or more hours to complete). The overall number of patients required to re-present for treatment in July was slightly lower again this month when compared to the previous two months. This is likely due to the acute theatre minutes being at a very manageable level in July. This was similar to June, with the number of patients having to re-present on one or two days having decreased slightly, and no patients required re-present more than 2 days while awaiting surgery.

E-Grading continues to be rolled out across services; following ORL and Rheumatology testing the system and this has been going well. The time taken to grade referrals is significantly less and the

061

feedback from clinicians is that it is more efficient, saves time and better quality grading. Nearly 2,000 referrals have now been graded this way at CM Health, with half of these for ORL services. Services that are already live include ORL, General Medicine, Dermatology, Infectious Diseases, Rheumatology, Respiratory, Diabetes, Endocrinology, Stroke, and Audiology. Services in progress/ discussion include General Surgery, Renal Paediatrics and Gastroenterology. Services that are awaiting Pre-Triaging enhancement are Ophthalmology, Orthopaedics and Cardiology.

Take Home Medications - Trial for Three Months - A survey of 350 patients who received take home medications for post-operative pain management and nausea from MSC PACU discovered that very few patients used these. For a 3 month trial, no medications will be dispensed and instead pre-operative instructions will inform the patient to purchase mild analgesia before surgery. If successful, this will save CM Health the cost of the medications, but also reduce the volume of unused medications at the patients’ home. Analysis also concluded that purchasing mild analgesics over the counter were cheaper than the cost prescription charges for the patient.

1.3.4 EFFECTIVENESS: Providing services based on scientific knowledge to all who could benefit,

and refraining from providing services to those not likely to benefit.

Delivery Redesign of Elective Services (DRES) Programme:

The Governance Group review and sign-off the Stage 4 progress report raised questions regarding the specificity and sensitivity of the contracted measures being reported. Time-frame clarification was given for the volumes and percentages for some measures for this report, and further work will occur for the Stage 5 report.

Gathering further responses for the Provider Satisfaction Survey continues using a range of forums including the CM Health GP Continuing Medical Education evening and PHO CME sessions. Engagement with the clinical leads for Primary Health Organisations (Total Healthcare Ltd, ProCare and East Health) has also been occurring; with ProCare emailing and encouraging clinicians to complete the survey, and asking to be sent a copy of the results of the survey.

There is ongoing contact with the Regional Pathways planning and implementation process. Administration has transitioned from Greater Auckland Integrated Health Network (GAIHN) to CM Health and a new management structure is being finalised, however the process map remains the same for ongoing regional pathways development.

Primary/ secondary Interface redesign updates

– The ORL referral pathway redesign (for Hoarseness, Epistaxis, Chronic Sinusitis, Neck Lumps and Otitis Media) has engaged with regional DHB partners to finalise the regional health pathways through Healthpoint. Hoarseness will be tested as a seamless e-referral process incorporating the pathway before others follow suit.

– GP Liaison for Orthopaedics has led a focus on feet and ankle pathways to be on the CM Health Healthpoint site; the potential for regional utilisation of health pathways is to be considered.

– The Acute Low Back pain pathway has received regional sign-off for integration into the regional Healthpoint pathway and has been submitted to Healthpoint, for their review.

General Surgery Pathway Redesign PR Bleed Clinics analysis parameters are being set, with a key focus on statistical analysis for the level of effect. Final analysis will use data to November clinic.

The Plastic Pathways clinics and theatre sessions are progressing as expected at Waitemata DHB.

The Regional Urology referral pathways are in the regional development progress for referrals to the service. The Business Case for establishing local Urology services at CM Health is being completed.

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Pain Services

There are currently several complex patients who have been in hospital for lengthy periods and have complex needs. The Acute Pain Service Team is working to integrate care with the Well Managed Pain team and methodology to ensure improved care and communication for this cohort.

Well Managed Pain Service data collected so far shows that the majority of the referred patients have severe acute pain rather than the chronic pain patients having multiple presentations. Prior to the collaborative, these patients would have been seen by the Acute Pain Service only, with less continuity of care and potentially a longer length of stay. A ‘snap-shot’ of the Well Managed Pain collaboration so far shows:

- 85 patients have been assessed, with 25 having had multiple hospital presentations for pain and,

- 60 patients experienced severe acute pain requiring intensive, multidisciplinary input by the well managed pain team including pharmacy.

- 100% of patients had rationalisation of their medications improving safety and efficacy for the patient.

- 84% of patients were discharged from hospital with a pain management plan that was communicated with their General Practitioner, a new intervention for these patients. General Practitioners have noted that this co-ordinated transition to Primary Care for patients with complex pain issues (previously known and managed by the GP), has improved pain management for patients.

- Patient satisfaction has significantly improved with patients also satisfied with receiving better education to manage their pain (source Patient Satisfaction Tool).

- In summary, involvement of a multidisciplinary pain team has led to safer, rationalised pain management for patients along with improved satisfaction and co-ordinated discharge to community.

1.3.5 PATIENT AND WHAANAU CENTRED CARE: Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.

Complaints/ compliments: are tracked monthly with strengths and gaps noted, analysed and acted on. Compliments numbers (80) continue to outweigh the number of complaints (41).

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2. Adult Rehabilitation / Health of Older People (ARHOP)

Service Overview

Adult Rehabilitation and Health of Older People (ARHOP) is managed by Dana Ralph-Smith, General Manager, with Dr Peter Gow, Clinical Director and Lyn Cooper, Clinical Nurse Director (ARHOP). In addition, to support the Health of Older People contracted services, Kathy Peri is Clinical Nurse Director. CM Health services include:

Rehabilitation Services - inpatient and outpatient care, Auckland Spinal Rehabilitation Unit and Assessment Treatment and Rehabilitation;

The Assessment, Treatment and Rehabilitation (AT&R) inpatient service consists of 4 wards at Middlemore Hospital (wards 4, 5, 23, and 24). All wards provide geriatric care but have a particular focus. Ward 4 - orthogeriatric and restorative. Ward 5 - frail elderly assessment/ treatment and restorative. Ward 23 - adult rehabilitation for under and over 65 years and Ward 24 provides frail elderly restorative care and adult rehabilitation.

The CM Health Spinal Injury Service is a regional service which provides comprehensive care for people with a Spinal Cord Impairment from the Central North Island to the far North. The service is currently based at the Auckland Spinal Rehabilitation Unit (ASRU) in Baird’s Road Otara. Allied Health services – provide inpatients and outpatients services including Dieticians, Occupational Therapy, Physiotherapy, Speech Language Therapy and Social Work.

Community Services including Home Health Care (District Nursing and Allied Health teams) have devolved to Locality geographical hubs. Non-government organisations also provide a range of contracted community support services, residential care services and home-based support services.

Highlights

The Assessment, Treatment and Rehabilitation service has been operating at 90% - 100% capacity. There have been delays to community admissions in particular because of the full capacity in Middlemore.

The National Spinal Action Plan acute pathway development planning work continues and will begin implementation from 18 August 2014.

The Community Needs Assessment and Service Coordination (NASC) team begins transitioning to the Locality structures and locations from 18 August 2014.

Planning for the upcoming ward 23 refurbishment and a linked trial of supportive discharge model of care for older people from October/ November 2014 is underway.

064


1.1.1 Activity summary

*Service commenced May 13

Commentary of Balanced Scorecard

• The Division is continuing to monitor and manage high annual leave balances. There will be a significant opportunity during refurbishment of ward 23 for staff to take leave over Christmas. Sick Leave rates also continue to be monitored and managed.

• The Division is working with teams to identify any barriers to e-referrals use and has had more Hotline calls to Community Geriatric Services this month.

• There will be a more detailed balance scorecard/performance measure developed for Needs Assessment and Service Coordination (NASC) to monitor performance during the Locality integration process over the next 12 months. Continuing to make good gains in Needs Assessment and Service Coordination (NASC) interRAI assessments and have commenced analysing data for service planning.

• Implementing a Whole of System for Health of Older People 75 years and older to reduce length of stay and readmissions which has achieved good overall performance this month.

please refer to details below for further details on the key results.

Volumes

ActBud /

Contract Var % var ActBud /

Contract Var % var

INPATIENT AT&R 2,102 1,839 263 14% 2,102 1,839 263 14%

Spinal 410 428 -18 -4% 410 428 -18 -4%

Stroke Rehabilitation 382 345 37 11% 382 345 37 11%

Acute Care for the Elderly 336 381 -45 -12% 336 389 -53 -14%COMMUNITY

DN & AH Contacts 9,957 11,037 -1,080 -10% 9,957 11,037 -1,080 -10%NASC

Contacts 2,050 1,983 67 3% 2,050 1,983 67 3%

ARHOP Volumes (Bed days and Contacts)JULY '14 Year to date

065

SCORECARD

Adult Rehabilitation and Health of Older People SCORECARD

July 2014


Def

Jul-14 Target Var Actual Target VarSpinal Inpatient ACC Revenue(in '000s) 455 438 18 455 438 18 Non-acute Rehabilitation ACC Revenue(in '000s) 451 350 101 451 350 101


% Staff Turnover 1.1% 2.0% 0.9% 12.4% 10.0% -2.4% 15

% Sick Leave 3.2% 2.8% -0.4% 3.0% 2.8% -0.2% 16



Jul-14 Target Var Actual Target VarFalls - % of falls assessments done in first 6 hours 91% 100% -9% 91% 100% -9%Falls - % of Interventions completed 91% 100% -9% 91% 100% -9%Pressure Injuries - % of assessments done in first 6 hours 100% 100% 0% 100% 100% 0%Pressure Injuries - % of interventions completed 100% 100% 0% 100% 100% 0%Reduce over ride rate of Pyxis on ATR wards decrease medication errors to 15% 17% 15% -2% 17% 15% -2%

Jul-14 Target Var Actual Target VarStroke discharges - CVD risk profile, medications and 3 month follow-up 100% 90% 10% 100% 90% 10.0%Proportion of referrals managed via e-referrals across all Services (ARHOP) 13.5% 50% -37% 13.5% 50% -37%Access to Outpatient specialist services - Maintain or increase volumes of Geriatric A&R Hotline Calls 43 29 14 43 29 14

QUARTERLY REPORTING Q1 Target Var Actual Target Var% NASC referral to services -high complex within 10 days (or less), urgent < 24 hrs & low complex clients <30 days (new measure 2014/15)

Jul-14 Jul-13 Var Actual Target VarReduce number of patient 75’s or older LOS > 10 days in AT&R wards by 2% 68 57 11 68 50.8 -17 51Reducing direct admissions from GPs to ATR wards by 5% 17 39 -22 17 20 3% of Estimated Discharge date set following assessment 97% 75% 22% 97.0% 75% 22%Avoidable presentations to EC from Aged Residential Care Facilities (ARRC) 13 18 -5 13 20 7.0MMH % patients discharged to discharge lounge or home by 1100hrs 38% 30% 8% 37.6% 30% 8%Rehabilitation 7 day Readmissions rate 0.0% 0.0% 0% ~ ~Acute Readmission within 28 days - Total for Rehabilitation beds 5.6% 12.7% 7% 5.6% 10% 4.4% 53

QUARTERLY REPORTING Q3 Target Var Actual Target Var% +65years with long term HBSS - comprehensive clinical assessment &care plan 70% 75% -5% 70% 75% -5%

Jul-14 Target Var Actual Target VarPatient Experience Survey (awaiting Patient Whaanau Centred Care Data)


Jul-14 Target Var Actual Target VarNumber of Spinal Rehabilitation Outreach Clinic days - (new measure 2014/15) 4 4 0 4 47 -43 47

Year to date

Tim

ely

Patie

nt

Wha

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Ce

ntre

d Ca

re Year to date`

Year to date

Equi

ty Year to date

Syst

em In

tegr

atio

n (E

ffect

ive) Year to date

Effic

ient

Year to date

Ensu

ring

Fina

ncia

l Su

stai

nabi

lity Year to date

Enab

ling

High

Pe

rfor

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Firs

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(S

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066

Inpatient and Specialist services Middlemore Rehabilitation Services - Adult Rehabilitation and Health of Older People admitted 200 patients with 127 patients (63.5%) admitted acutely direct from Emergency Care. There were 138 discharges in the month. There was an increase in the number of discharges for people aged 75 years and older with a length of stay more than 10 days in Assessment Treatment and Rehabilitation (AT&R). For July 2014 there were 68 cases, an increase from 57 for July 2013. Auckland Spinal Rehabilitation Unit Activity - Inpatient volumes at the Spinal Unit reduced with occupancy being 73.5% for July (327 bed days utilised). There are 6 patients waiting for transfer with estimated goal transfer dates set and acute rehabilitation services are planned to ensure early intervention. Auckland Spinal Rehabilitation Unit bed days by funder

Spinal Unit Outpatient Service referrals have decreased, however 21 outreach patients were seen along with 34 patients in clinics at the unit (excluding Urology). Work has commenced with the Urologists around a clinical pathway. Outpatient and Community Services Home Health Care - Community District Nurses and Allied Health Teams - The Home Health service is available to people in their home or at a clinic. The Home Health teams are aligned to the Localities and operationally report to the Locality General Managers. Home Health Care volumes are stable and the teams received 1,086 referrals, discharged 1,134 clients and completed 9,957 contacts across all bases in July. Did Not Attend Rates – Orakau 7%, Papakura 7%, Pukekohe 2% and Howick 2% Community Geriatric Service - Contacts in Aged Residential Facilities and Community - CGS Contacts are increasing and service disposition is stable, with more activity than in 2013. For July, there were 186 contacts; the average contact duration was 61 minutes. 45% of contacts were a First Contact, 43% of contacts were at a Rest Home or Private Hospital location, 71% of contacts were by a nurse and 59% were for an Assessment. Needs Assessment and Service Coordination (NASC) -NASC received 412 referrals during the month of July. Contacts average since April 2013 is 1541. Average duration of contacts is 75 minutes, 47% of contacts for the month of July were service co-ordinations.

067

1.2 FINANCIAL: Best value for public health system resources


365 358 7 0 Government Revenue 365 358 7 2%0 0 (0) (100)% Patient/Consumer Sourced 0 0 (0) (100)%

19 49 (30) (61)% Other Income 19 49 (30) (61)%185 168 17 10% Funder Payments 185 168 17 10%569 576 (7) (1)% Total Revenue 569 576 (7) (1)%


369 355 (14) (4)% Outsourced Costs 369 355 (14) (4)%579 488 (91) (19)% Clinical Costs 579 488 (91) (19)%138 132 (6) (4)% Infrastructure Costs 138 132 (6) (4)%

87 69 (18) 27% Internal Allocations 87 69 (18) 27%5,084 5,102 18 0% Total Expenditure 5,084 5,102 18 0%

(4,515) (4,526) 11 0% Net Result (4,515) (4,526) 11 0%

FTE 31 30 (1) (2)% Medical 31 30 (1) (2)%

255 262 7 3% Nursing 255 262 7 3%280 296 16 5% Allied Health 280 296 16 5%

48 55 7 13% Management/Admin 48 55 7 13%615 644 29 4% FTE Total 615 644 29 4%

STATEMENT OF FINANCIAL PERFORMANCE - ARHOP


($000's) ($000's)

July 2014

-4,600

-4,500

-4,400

-4,300

-4,200

-4,100

-4,000

-3,900

-3,800

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

200

400

600

800

1,000

1,200

1,400

Mon

thly

resu

lt $0

00's


Result Budget

2,000

2,500

3,000

3,500

4,000

4,500

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

068



Against a goal of Zero Patient Harm:

• Pressure injuries: There were 5 pressure injuries in July; all 5 were hospital acquired (during present admission or found on transfer from another inpatient area).

• Falls incidents: There were 31 recorded falls in July, a decrease from 33 recorded falls last month. Of these there were 6 falls with harm, a reduction from 7 in June.

• Medication errors incidents: There were 9 medication errors reported in July. This is a reduction from 11 recorded medication errors reported in June.

1.3.2 TIMELINESS: “Every Hour Counts” if we are to achieve quality and safety outcomes

Waitlists - Acute Allied Health Outpatients Waitlist Activity Includes: Cardiac Rehabilitation, Physiotherapy Hyperventilation Service, Multidisciplinary Clinic, Occupational Therapist, Physiotherapist & Rheumatology Nurse Specialist (MORRSA), Musculoskeletal Outpatients (MSOP), Occupational Therapy Rheumatology, Pulmonary Rehab (Howick, Otara, Middlemore Hospital, Pukekohe), Women’s Health Gynaecology, Women’s Health Obstetric Waitlists in the women’s health service have been steadily reducing since more resource has been diverted into the service. The target is to get the waitlist down to 100 which will take another 16 weeks. Despite high referral numbers, activity is stable and waitlists in all other services are remaining steady and are in the targeted priority range. The only exception is musculoskeletal outpatients which has had a recent increase in its waitlist due to vacancies.

Month YTD


Revenue: $(7) $(7)



Clinical Supplies: $(91) $(91)

Infra-Structure: $(6) $(6)

Internal Allocations: $(18) $(18)

The main variances for the month are Clinical Equipment (Minor) in Lymphoedema and Community $(28)k, Dressings costs in Inpatients and Community $(17)k, Patient Consumables (Burns Garments) $(16)k, Clinical Equipment repairs in Wards 4 & 5 $(11)k Community Ostomy $(10)k and Continence supplies $(4)k. 2014/15 budget reflects reduced useage of clinical supplies.


The July month result reflects personnel costs below budget for Medical and Nursing, offset by clinical supplies overspends as detailed below.

Medical Staffing is under budget $45k mainly due to RMOs seniority level being less than budgeted. Nursing vacancies, 6.6FTE has resulted in a favourable variance of $65k. The Allied Health vacancies, 15FTE and recruiting staff at a lower level wherever possible has resulted in a favourable variance of $36k.

STATEMENT OF FINANCIAL PERFORMANCE - ARHOPJuly 2014

069

1.3.3 EFFICIENCY Avoiding waste, including waste of equipment, supplies, ideas and energy

Wound Care – The wound care project group interactive launch and education session was attended by 50 District Nurses. This session included new documentation format, the self-care booklet, wound mapping progress, tools for assessment and the management of infected wounds and correct use of antimicrobials. A new product range will be confirmed in the next month and be introduced to the team via a road-show. Documentation audits will be followed up in six weeks and three months to monitor changes in practice. Staff feedback has been requested on the new tools and processes. Needs Assessment and Services for Older People (NASC) – The NASC implementation plan is in place for NASC staff to commence moving to the four Localities hubs during August. 1.3.4 EFFECTIVENESS Providing services based on scientific knowledge to all who could benefit,

and refraining from providing services to those not likely to benefit.

Acute Care for the Elderly (ACE): Comprehensive Geriatric Assessment model for >85 years. The ACE project is progressing well, with all major targets being met with the exception of acute length of stay. This has reduced significantly over the past 6 months with implementation of new initiatives. Over 50 ACE patients were seen during July. Work is turning towards the business case for on-going funding and extension of the ACE model. The ACE Model will be presented via a poster at the APAC conference in Melbourne by Ward 5 Charge Nurse Manager. The Daily Huddle has been adopted by the service and will become business as usual.

Dementia Pathway Implementation (Memory Team) – Alzheimer’s Auckland Charitable Trust has completed deed of access and training to use the e-shared care plan and is investigating the purchase of the hardware required to enable access to the e-shared care platform. As at end July 2014, the Memory Service had received 321 referrals, of which 60.5% were referred by Primary Care. For July, the service received 27 referrals.

The Community Stroke Early Supported Discharge – Supporting Life after Stroke has actively worked with 38 patients since pilot commencement. The team will be presenting a poster at APAC in September. A new Section Head will commence in September.

Community Geriatric Service (CGS) team – An important component of the Systems Integration/Locality development is to provide additional Geriatrician support to primary care practices and aged residential care facilities. A new Clinical Specialty Nurse has commenced with the team and is completing orientation programme and integrating into the team. The CGS team provided support to five General Practices during July. Prescribing rate for Vitamin ‘D’ for the quarter is 85%.

The National Spinal Strategy – The final National Spinal Strategy Action Plan has been signed off by Ministers of Accident Compensation Corporation (ACC) and the Ministry of Health (MoH). There is a

Month Mar-14 Apr-14 May-14 Jun-14 Jul-14Added 490 365 389 418 513Seen 336 232 356 273 368Removed Other 114 79 44 104 67

Total on Waiting List 914 877 720 818 819Waiting > 150 days 38 33 11 10 10Waiting > 120 days 53 38 24 18 31Waiting > 90 days 71 94 84 79 65

070

large piece of work being undertaken on the acute care pathway of spinal patients at CM Health. There is also work progressing on piloting e-shared care planning and database redesigns at the two Spinal Rehabilitation Unit sites (Christchurch–Burwood Spinal Unit and CM Health–Auckland Spinal Rehabilitation Unit).

Auckland Spinal Rehabilitation Unit (ASRU) Spinal Pathways – The inpatient rehabilitation Spinal Unit pathway development continues to make good gains. The first three patients have been enrolled on the Shared Care Plan. Following the Spinal Unit motel unit and ward refurbishment in March, discussions with Burwood have started on a plan for using one of these for a transitional living facility for patients.

1.3.5 PATIENT AND WHAANAU CENTRED CARE Providing care that is respectful of and responsive

to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions

Complaints/ compliments: There were two complaints received during July, one regarding the NASC service and one regarding Allied Health. Compliments – there were four compliments received - all for Ward 4.

071

3. Medicine, Acute Care and Clinical Support

Service overview The Division of Medicine, Acute Care and Clinical Support services is managed by Brad Healey, General Manager, with Clinical Directors Dr Jeff Garrett (Medicine), Dr Catherine Simpson (Emergency Care), Dr Ross Boswell (Laboratory), Dr Sally Urry (Radiology), and Clinical Nurse Director To’a Fereti.

CM Health Services include:

Department of Medicine – acute and elective inpatient and outpatient services including sub-speciality Cardiology, Dermatology, Diabetes/ Endocrinology, Gastroenterology, Haematology, Palliative Care, Renal, Respiratory, Stroke and General Medicine.

There are specialist Emergency Care, Renal Dialysis and Coronary Care facilities.

Clinical and diagnostic services comprising Radiology, Laboratory, Pharmacy, Breast Screen and the Clinical Photography and Patient Information Services.

Highlights Emergency Care – July volumes were 9,525 presentations, 6.2% higher than June and 0.9% higher than July 2013. This is the highest number of presentations in July on record; with average daily volumes were 308 with presentations fluctuating between 238 and 347.

Patient Information - The Archives NZ Public Records Act Audit final report has been received from the visit in June 2014. The audit found that -

“Counties Manukau Health was making good progress with developing its record keeping capability. Overall, the awareness of requirements and responsibilities under the Public Records Act and mandatory standards is good. There is evidence of work being done in the records management area showing positive steps for improvement and Counties Manukau District Health Board has a sound basis for good on-going records management”.

072

The Chief Archivist had no specific recommendations to make, however, it was suggested that contact be made with Archives NZ to discuss identifying and assessing physical records created prior to 1983 for archival value, and reviewing the Corporate Records Manager role prior to recruiting to incorporate new responsibilities in line with the new Document Management System.

Pharmacy - The Pharmacy Service hosted the NZHPA “Compounding Nutrition and Oncology” 2014 special interest group meeting at Ko Awatea. There was higher than anticipated turnout and a sufficiently broad range of speakers covering the three dedicated themes. The day was successful as a result of much discretionary effort by staff on the organising committee.

Laboratory - Electronic Orders have slowed the rate of increases in both Haematology (0.5% increase) and Biochemistry (a 3% increase compared to 2013, despite the repatriation of a significant number of tests) since its introduction approximately 2 years ago. Investigation is required to determine the best way to successfully implement e-orders into Microbiology.

Breast screening: Monthly total screening volumes for July exceeded the monthly target by 12%.

Emerging Issues

Gastroenterology Capacity - capacity issues continue to result in increasing waiting lists and whilst productivity continues to be the highest in the region, there is an increasing demand which is outstripping the ability to meet demand and achieve the Diagnostic Access targets within current capacity.

A number of procedures have been outsourced to private providers, funded partially by CM Health and also from a MoH initiative to reduce the waiting lists, but this has not enabled the waiting lists to be managed adequately. Production planning and modelling shows that continued outsourcing will also be necessary in the new financial year, at a rate of approximately 60 procedures per month. Additional resources for the department are under review, with the proposal for Procedure Facilities to be developed in the Galbraith Buildings vacated operating rooms. Staffing resources to manage these facilities include a new SMO who will start in December and a new fellow position.

Cardiology - Growth of referrals for Cardiac Investigation Unit procedural work continues to challenge administrative and technical resource capacity including an on-going shortage of sonographers. A report outlining the Cardiology capacity and workforce issues is being prepared. The problem of data storage for Exercise Tolerance Test results remains unresolved and is with health Alliance. Approval for additional network storage, but this has yet to be implemented and the risk of loss of data remains.

The Regional Cardiac Catheter Laboratory service After-hours/ On-call service roster demands have again been raised - both locally and at the regional group. Currently, at CM Health SMOs are rostered on non-clinical duties the morning after being on-call, however, where it is not possible, one of the other two SMO’s try to be available to cover acute cases to enable appropriate breaks for on-call colleagues. The Auckland Region Cardiac Network is preparing a paper on the regional management of after-hour’s on-call breaks for the CEO forum.

CT Coronary Angiography (CTCA) - There is a strong desire to offer this for in-patients on weekdays, once capacity is available in November 2014. The challenge in providing this service are related to both funding SMO and nursing time, and the lack of capacity the current Cardiologists have to take on new work without the recruitment of an additional position. The Service Manager is working with the Clinicians to develop a paper outlining the benefits and options for delivery of this service to be complete by late 2014.

073

CT Colonography - The regional and local implications of “Faster Cancer Treatment” target times are still being discussed, however, it is likely there will be a near doubling of the demand for CT Colonography over the next 12-18 months and increased demand for CT guided biopsies.

Patient Information Systems–

iPM upgrade - This will be a regional project with Waitemata DHB and this has been prioritised in the IT Capital Plan as both DHBs have old, unsupported versions of iPM. A workshop with CM Health, Waitemata DHB and CSC representatives to review the release notes for the latest version of iPM. At this workshop, the two DHBs assessed the new functionality that has been developed since the previous upgrade in 2009, and agreed to what will be included in the Statement of Work.

Regional Patient Administration System (PAS) The procurement process has commenced with the regional panel for vendor selection including Dr Gloria Johnson, Dr Stuart Barnard, Sarah Thirlwall, Kathie Smith and Janet Gibson as the CM Health representatives, and is expected to be completed by the end of December 2014.

Concerto Upgrade - Initial meeting with Orion Health to discuss an upgrade of Concerto in 2014-15 - as a joint project with Waitemata DHB. The next version has a very different look and feel, and will require significant change management. This upgrade is required to resolve a number of the performance issues being experienced with the current Concerto suite.

Pharmacy – e-MR upgrade Project - This project has been put on hold, as the vendor has been unable to commit to the delivery of the enhancements requested to improve cross encounter workflow issues with the eMR tool. The issue has been raised at the national level, and a meeting is being organised with the vendor and delegates from the Northern Region e-Medicines Group to progress the matter. The current version of e-MR is only supported until April 2015, beyond which there will be no development of this product.

Ascribe Support - The current Pharmacy Ascribe support agreement is providing support only on weekdays from 8am to 5pm. However, the Pharmacy service is open 7 days a week (8 am to 1pm on weekends). Being able to have access support if required is critical, however the current service agreement has been an extension of the old which did not have support for outside usual business hours. The issue has been raised with Health Alliance, and requested they broker a support agreement with the vendor to include the additional hours of operation.

074


1.1.1 Activity summary – at 15.08.14

Medicine Volumes (WIES and CASES) Volumes JULY '14 Year to date

Actual Bud / Contract Variance % variance Actual

Bud / Contract Variance % variance

EMERGENCY CARE Presentations (against 12/13) 9,561 9,474 87 0.92% 9,561 9,474 87 0.92%

Discharges (against contract) 9,525 9,654 -129 -1.34% 9,525 9,654 -129 -1.34%

INPATIENT (WIES) Adult Acute Care 387 354 33 9.32% 387 354 33 9.32% Adult Medical Care 2,262 2,228 34 1.53% 2,262 2,228 34 1.53% TOTAL 2,649 2,582 67 2.59% 2,649 2,582 67 2.59% INPATIENT (CASES) Adult Acute Care 872 1,023 -151 -14.76% 872 1,023 -151 -14.76% Adult Medical Care 2,467 2,312 155 6.70% 2,467 2,312 155 6.70% Total 3,339 3,335 4 0.12% 3,339 3,335 4 0.12%

OUTPATIENTS - Medicine

Procedural (contract) 364 644 -280 -43.48% 364 644 -280 -43.48% FSA’s 1,235 1,227 8 0.65% 1,235 1,227 8 0.65% Follow up’s 3,124 3,708 -584 -15.75% 3,124 3,708 -584 -15.75% BREAST SCREENING No. of Screens 2,418 2,160 258 11.94% 2,418 2,160 258 11.94%

Inpatients: The overall monthly WIES result reflects a 1.5% increase compared to contract and 5% increase compared to 2013. For General Medicine, there was a 4% decrease in WIES compared to contract and a 1% increase compared to last year. There was a 7% (155) increase in cases on July 2013, with a 3% decrease in the ALOS compared to last year. General Medicine (inpatients) saw 7% or 118 cases more compared to last year and a 3% decrease in the ALOS.

For July, the average bed occupancy was 225 beds for the medicine wards and it was an extremely busy month with on average 16 more beds needed each day than capacity. Total admissions were 1,715 up from 1,415 in June, while discharges were 1,724, an increase from 1,452 last month.

Outpatient volumes: Overall, volumes for the month were 10.1% above contract and 5.1% higher than last year. FSA’s were 9% below contract and 0.7% lower than last year. Most specialties had lower than contracted FSA volumes except Respiratory was 100% higher than contract. Follow-ups were 1.7% below contract but 12.7% lower than last year.

Renal Volumes: Continued increase above contract with 32 in-centre dialysis patients outsourced. There are 24 patients using the Western Campus Prefab, with 45 patients on evening shifts in AMC and 9 in Rito MSC, totalling 110 patients over current in-centre capacity for the year to date.

Radiology: All modalities showed increased throughput over the previous month, but noticeably General x-rays (due to winter chest x-rays) and interventional procedures. There is a long-term trend of increasing arterio-venous fistulograms associated with the increasing renal dialysis load and a backlog is being addressed.

075

Laboratory: Overall, July test volumes showed a 5.7% increase compared to last year, with all departments except Histology experiencing record volumes of test numbers. Histology and Microbiology increased by 11%.

Commentary on BSC

• Diagnostic Access Targets

Radiology Results – MRI Scans have seen large peaks in demand from in-patient referrals and this, (in addition to vacancies) has led to delays for community patient MRI scans. The additional CT capacity created by Building 58 CT scanner has seen an improvement in this result.

Colonoscopy Results – Gastroenterology continues to have capacity issues resulting in increasing waiting lists. Productivity continues to be the highest in the region, but there is an increasing demand which is outstripping the department’s ability to meet the demand and Ministry targets within current capacity.

Priority 1 and Surveillance continue to meet targets; however Priority 2 cases are continuing to grow and forming bulk of the current waiting list. Strategies for management of the waiting list continue, including a business case for the required resources (FTE and facilities) to manage the volumes for all gastroenterology patients. Ministry of Health funding may become available however, production planning suggests a further 60 procedures per month will need to be outsourced to manage the waiting lists.

• Cardiac STEMI-PCI Target -This month’s result is for July only, with 6/11 patients meeting target.

• Laboratory Turn-round times – Histology TAT has reduced further to 54% from 62% due to shortages of Technical Staff with a recruitment process now underway.

• Radiology Turn-around times – inpatient volumes continued to vary considerably through July. Production Plans are expected to assist with better prediction and managing of resource. In Emergency Care, 872 patients were seen, this is 60 more patients than in June and resulted in a drop in the turnaround target result.

• Medical “To be seen” times have deteriorated as a result of exceptionally high volumes.

• Patient Information Service – The “same week turn-around time” has been achieved for all services and the backlogs have reduced by a further 49 hours in July. A large number of Doctors were on leave during the school holidays.

• Stroke Management and care – the target was achieved for the first time in Q4. This is due to the model of care development on ward 6, and also lower total numbers of stroke patients. The thrombolysis target will increase to 8% from July 2015. An increase to Stroke Team presence in EC is helping with Registrar training.

076

SCORECARD

July 2014


Def

Jul-14 Target Var Actual Target VarTotal Caseweight 2,461 2,559 -4% 2,461 2,559 -4% 1

Elective Caseweight 44 48 -8% 44 48 -8% 2

Acute Caseweight (includes ICU) 2,417 2,510 -4% 2,417 2,510 -4% 3

Outpatient FSA Volumes 6,360 5,546 15% 6,360 5,546 15% 4

Outpatient Follow Up Volumes 12,017 12,105 -1% 12,017 12,105 -1% 5

Virtual FSAs 89 144 -38% 89 144 -38% 10


% Staff Turnover 0.6% 2.0% 1.4% 7.8% 10.0% 2.2% 13

% Sick Leave 3.0% 2.8% -0.2% 2.9% 2.8% -0.1% 14



Jul-14 Target Var Actual Target Var% electronic medication reconciliation completed for high risk patients within 48hrs 63.0% 80.0% -17.0% 63.0% 80.0% -17.0% 21

% Pressure Injuries Per 100 Patients 3.5% ~ 3.5% 22

Falls causing major harm per 1000 bed days 0.00 ~ 0.00 23

Jul-14 Target Var Actual Target Var% MRI scans completed within 6 weeks from acceptance of referral 60% 75% -15.0% 75.5% 75% 1% 34

% CT scans completed within 6 weeks from acceptance of referral 81% 85% -4.0% 73.6% 85% -11% 35

Radiology - Inpatient radiology times < 24hours 92% 100% -10.0% 90.0% 100% -10% 36

Radiology EC radiology times < 2 hours 96% 100% -5.0% 95.0% 100% -5% 37

% diagnostic colonoscopy patients receive the procedure within 14 days 78.3% 75% 3.3% 63.6% 75.0% -11.4% 38

% diagnostic colonscopy patients receive the procedure within 42 days 35.0% 60% -25.0% 31.2% 60.0% -28.8% 39

% surveillance colonscopy patients receive their procedure within 84 days of planned 99% 60% 39.0% 76.8% 60.0% 16.8% 40

% cardiac STEMI - PCI (angiography) within 120 mins - Northern Region Target 55% 80% -25.0% 54.5% 80.0% -25.5% 41

ESPI 2: No. patients waiting >5 mths for FSA - Elective ~ 0 0 0 0 0 0.0 42

Medical Assessment – Triage3-5 patients seen by SMO within 60 min 70 60 mins -10 70 60 mins -10.0 46

Laboratory -Test turnaround time (TAT) within 60mins new reporting from 2014/15 49

Potassium 96% 90% 6% 96% 90% 6% 50

Haemoglobin 97% 98% -1% 97% 98% -1% 51

PT/INR 99% 98% 1% 99% 98% 1% 52

Troponin 1 for EC 93% 90% 3% 93% 90% 3% 53

Histology - All - 5 working days 54% 90% -36% ~ 90% 54

-Breast - 3 working days 100% 100% 0% ~ 100% 55

-Non gynae FNAs - 5 working days 100% 100% 0% ~ 100% 56

Blood Bank - antibody screen within 4 hours 93% 90% 3% ~ 90% 57

MicrobiologyCSF cell count <30mins 92% 90% 2% ~ 90% 58

ESBL screens <2days 94% 95% -1% ~ 95% 59

CDT (C. diff Toxin) <25hrs 87% 90% -3% ~ 90% 60

UCHM (Urine Chemistry) <60mins 90% 95% -5% ~ 95% 61

Year to date

Tim

ely

Medicine, Acute and Clinical Support Scorecard

Year to date

Year to date

Year to date

Ensu

ring

Fina

ncia

l Su

stai

nabi

lity

Enab

ling

High

Pe

rfor

min

g Pe

ople

Firs

t, Do

No

Harm

(S

afet

y)

077

July 2014

Medicine, Acute and Clinical Support Scorecard

Door to Cathlab suspected Acute Coronary Syndrome < 3 days (median time) 84% 70% 14% 78% 70% 8% 63

General Medince - Seen By Time ~1st Time to be seen Triage 1 & 2 patients (median time) 40 <30mins -10 ~ <30mins 64

1st Time to be seen Triage 3 - 5 patients (median time) 70 <60mins -10 ~ <60mins 65

2nd Time to be seen Triage 1 & 2 patients (median time) 50 <30mins -20 ~ <30mins 66

2nd Time to be seen Triage 3-5 patients (median time) 87 <60mins -27 ~ <60mins 67

QUARTERLY REPORTING Q4 Target Var Actual Target VarFaster Cancer Treatment - % high suspicion first cancer treatment within 62 days - MOH FCT + 70.3% 85% 13% 62.7% 85% -22% 68

Faster Cancer Treatment - %confirmed diagnosis first cancer treatment within 31 days - MOH FCT + 87.0% TBC 82.1% TBC 69

% radiology results reported within 24 hours 54.0% 75.0% -21% 59.0% 75.0% -16% 70

Jul-14 Target Var Actual Target VarAverage Length of Stay - Acute 2.49 2.59 0.1 2.49 2.59 0.1 71

Average Length of Stay - Acute Arranged / Elective 2.1 1.84 -0.26 2.1 1.84 -0.3 72

Acute Readmissions within 7 days - Total 3.6% 3.4% -0.2% 3.5% 3.4% -0.1% 73

Acute Readmissions within 28 days - 75+ - MOH IDP 9.3% 11.8% 2.5% 10.1% 12% 1.7% 75

% transcribed clinical summaries (meddocs)authorised <7 days of creation 76.0% 90.0% -14.0% 76.0% 90% -14.0% 76

QUARTERLY REPORTING Q4 Target Var Actual Target Var% eligible stroke patients thrombolysed - Northern Region Target 5.7% 6.0% -0.3% 7.0% 6.0% 1.0% 84

Stroke patients on stroke pathway 68.7% 80% -14.5% 65.5% 80% -14.5% 85

Jul-14 Target Var Actual Target Var% Discharges from transit lounge or home by 1100hrs 14.6% 30% -15% 15% 30% -15% 89

% MA short stay patients discharged home from Medical Assessment 38% 80% -42% ~ 80% 90

Implement provation upgrade - Gastro data management and integrity 90% 100% -10% 90% 100% -10%Implement Home First Renal policy - increase CAPD & HD rate) 45% 50% -5% 45% 50% -5%

Jul-14 Target Var Actual Target VarImplementation of Advance Care Planning - number of conversations 330 218 112 330 218 112 95


Jul-14 Target Var Actual Target Var% Women with Breastscreen in last 24 months - total 69.2% >70% -0.8% 69% >70% -1% 98

% Women with Breastscreen in last 24 months - Maaori 68.6% >70% -1.4% 69% >70% -1% 99

% Women with Breastscreen in last 24 months - Pacific 72.6% >70% 2.6% 73% >70% 3% 100

Year

Syst

em In

tegr

atio

n (E

ffect

ive)

Effic

ient

Year

Equi

ty

Year to date

Patie

nt W

haan

au

Cent

red

Care

Year

Year

Year

Tim

ely

078


July 2014


0 0 0 0% Government Revenue 0 0 0 0%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%0 0 0 0% Other Income 0 0 0 0%0 0 0 0% Funder Payments 0 0 0 0%0 0 0 0% Total Revenue 0 0 0 0%


15 23 8 34% Outsourced Costs 15 23 8 34%253 233 (19) (8)% Clinical Costs 253 233 (19) (8)%119 122 3 3% Infrastructure Costs 119 122 3 3%

94 93 (1) 1% Internal Allocations 94 93 (1) 1%3,072 3,211 138 4% Total Expenditure 3,072 3,211 138 4%

(3,072) (3,211) 139 4% Net Result (3,072) (3,211) 139 4%

FTE 53 54 1 1% Medical 53 54 1 1%

199 217 18 8% Nursing 199 217 18 8%0 1 1 100% Allied Health 0 1 1 100%0 1 1 100% Support 0 1 1 100%


STATEMENT OF FINANCIAL PERFORMANCE - ACUTE CARE


($000's) ($000's)

-3,500

-3,000

-2,500

-2,000

-1,500

-1,000

-500

-

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

100

200

300

400

500

600

Mon

thly

resu

lt $0

00's


Result Budget

-

500

1,000

1,500

2,000

2,500

3,000

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

079

July 2014Month YTD


Revenue: $0 $0


Outsourced Costs: $8 $8



STATEMENT OF FINANCIAL PERFORMANCE - ACUTE CARE

The year end forecast is a for the division to meet budget.

Overall the division was $139k favourable for the month. Savings in EC Medical, Nursing and Admin staff costs in MAU were the main drivers, due to vacancies and recrutiment delays. The high volumes in EC (9561 presentations) resulted in "wait to be seen times" exceeding 6hrs and increased delays in assessing patients.

Current month:-


Medical staff $74k, 1FTE fav - SMO/MOSS vacancies, salary variations and high annual leave taken over the July school holidays.Nursing staff $51k, 18FTE fav - savings due to delays in the recruitment of MAU nursing staff. Miscellaneous $23k

080


488 502 (14) (3)% Government Revenue 488 502 (14) (3)%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%

136 170 (34) (20)% Other Income 136 170 (34) (20)%16 0 16 0% Funder Payments 16 0 16 0%

640 672 (32) (5)% Total Revenue 640 672 (32) (5)%


405 369 (37) (10)% Outsourced Costs 405 369 (37) (10)%3,077 2,748 (329) (12)% Clinical Costs 3,077 2,748 (329) (12)%

239 290 51 18% Infrastructure Costs 239 290 51 18%(1,654) (1,596) 58 4% Internal Allocations (1,654) (1,596) 58 4%

6,783 6,653 (130) (2)% Total Expenditure 6,783 6,653 (130) (2)%(6,142) (5,981) (162) (3)% Net Result (6,142) (5,981) (162) (3)%

FTE72 76 4 5% Medical 72 76 4 5%39 40 1 3% Nursing 39 40 1 3%

302 306 4 1% Allied Health 302 306 4 1%162 168 6 4% Management/Admin 162 168 6 4%576 591 15 2% FTE Total 576 591 15 2%

STATEMENT OF FINANCIAL PERFORMANCE - CLINICAL SUPPORT


($000's) ($000's)

July 2014

-6,400

-6,200

-6,000

-5,800

-5,600

-5,400

-5,200

-5,000

-4,800

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

1,000

2,000

3,000

Mon

thly

resu

lt $0

00's


Result Budget

2,000

4,000

6,000

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

081

Month YTD

Total Variance: $(162) $(162)

Revenue: $(32) $(32)





Internal Allocations: $58 $58

STATEMENT OF FINANCIAL PERFORMANCE - CLINICAL SUPPORTJuly 2014

The division was $(162)k unfavourable for the current month due to an overspend for blood products and testing kits in Microbiology. The overspend in blood products were driven by 3 high cost patients at EC, ICU & Dialysis. Microbiology volumes were up 11% from this time last year.

Current month:-Funder Payments: $16k - cost reimbursement for 2.7 FTE unbudgeted Pharmacists - 20k bed days projectGovernment Payments: $20k - MOH funding for Radiology improvement project, $(70)k - Breast Screen ring fenced fundingMiscellaneous: $2k

Current month:- $(16)k - Pharmacy , (3)FTE unbudgeted - 20k bed days, offset by funding$150k - Vacancies across the service (Medical 2.5FTE, nursing 2FTE, Allied Health 12.5FTE, Management/Admin 2FTE) $39k - Radiology - 1.57 FTE SMO vacancies $(47)k - Radiology - SMO additional sessions and film reads to address the volume growth & vacancies.

Current month:-$(20)k - cost accrual for Radiology improvement project - offset by MOH funding$(17)k - miscellaneous

Current month:- $(90)k - Drugs overspend driven by demand across the organisation & recovered through internal charging: - $(68)k - PCT drugs due to Haematology Chemotherapy volumes up 25% from last year. Partly offset by PCT revenue. $(22)k - miscellaneous $(104)k - Lab blood products driven by 3 high cost patients in ICU, EC & Dialysis.$(66)k - Microbiology testing kits - volumes up 11% from this time last year driven by Medicine$(22)k - Radiology shunts & stents - driven by vascular surgery$(47)k - Miscellaneous

Forecast for the division is to meet budget.


Current month:-$80k - Drug cost recoveries - offsets drug overspend above$(22)k - Miscellaneous

082




494 366 128 35% Total Revenue 494 366 128 35%


406 406 (0) (0)% Outsourced Costs 406 406 (0) (0)%1,422 1,371 (51) (4)% Clinical Costs 1,422 1,371 (51) (4)%

259 251 (8) (3)% Infrastructure Costs 259 251 (8) (3)%718 666 (52) 8% Internal Allocations 718 666 (52) 8%

8,702 8,657 (45) (1)% Total Expenditure 8,702 8,657 (45) (1)%(8,207) (8,290) 83 1% Net Result (8,207) (8,290) 83 1%

FTE155 160 5 3% Medical 155 160 5 3%418 410 (8) (2)% Nursing 418 410 (8) (2)%

48 47 (2) (3)% Allied Health 48 47 (2) (3)%1 0 (1) Support 1 0 (1)

40 40 0 0% Management/Admin 40 40 0 0%663 656 (6) (1)% FTE Total 663 656 (6) (1)%

July 2014STATEMENT OF FINANCIAL PERFORMANCE - MEDICINE


($000's) ($000's)

-8,400

-8,200

-8,000

-7,800

-7,600

-7,400

-7,200

-7,000

-6,800

-6,600

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

800

1,600

2,400

3,200

Mon

thly

resu

lt $0

00's


Result Budget

4,600

4,800

5,000

5,200

5,400

5,600

5,800

6,000

6,200

6,400

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

083



Falls Prevention – There was a significant increase in falls over the month of July with 41 falls reported across the medicine wards compared with 24 for June. Although 17 more falls were reported, 10 falls were reported with harm. With the medicine wards at over 100% occupancy on a number days of July, this increase is likely a symptom of increased workloads and more complex patients, including an increased rate of confused elderly mostly related to infection, primarily chest infection. Afternoon and Nights remain the predominant time for falls to occur.

Preventive measures for identified individual patients at high falls risk include low beds, visibility, ‘intentional rounding’ (which continues in most of the wards), with ‘watches’ utilised as necessary. Work continues on an initiative to improve the accuracy of reporting in Riskpro. A collaborative initiative is underway with HSQC to trial “Falls signs” as a way to improve the identification of patients at risk of falling.

Pressure Injury Prevention -The pressure injury group is considering development of a documentation audit - comparing the bundle of care interventions with clinical documentation, and this will demonstrate the extent to which staff are implementing the appropriate bundle of care to prevent pressure injury for the patient. Further learning will focus on promoting timely and appropriate interventions.

Month YTD

Total Variance: 83 83

Revenue: 128 128

Salaries & Wages: 65 65

Current Mth:-

Outsourced: (0) (0)

Clinical Supplies: (51) (51)

Infra-Structure: (8) (8)

Internal Allocations: (52) (52)

STATEMENT OF FINANCIAL PERFORMANCE - MEDICINE

The year end forecast is a for the division to meet budget.

Current Mth:-$(20)k - Pacemakers due to 38% more patients than monthly average

0Year end Forecast variance to Budget

Current month:-$(40)k - PCT Drugs overspent- Chemotherapy volumes 4% up on 1314 average. Offset by revenue above. $(12)k - Misc drug overspends mainly Rheumatology

$(83)k - unbudgeted positions funded externally (offset by revenue), (9.6)FTE

Other income: $26k - Renal Transplant recoveries 3 FTEFunder Payments: $60k - cost recoveries for unbudgeted project positions - 5.7 FTE plus outsourced staff

Government Revenue: $43k - higher PCT revenue (Funder payment) due to higher PCT Drug spend

$(26)k - staffing costs to staff additional Renal night shifts to address renal growth (3.3)FTE$118k - Medicine vacancies, 13FTE$56k - Net Annual Leave/penals/allowances favourable, 1.4FTE

The division was $83k favourable against budget for the month. Detailed explanation for the months variance are given below.

Current Month:-

July 2014

084

e-Medications Reconciliation (e-MR) – there were 3,038 admissions covered by e-MR, with 1,792 medication histories commenced. 88% of high risk patients received e-MR during admission (65% within 48hours). The high volumes admitted in July saw a slight drop in coverage rates.


Refer to BSC for results to reduce waiting times; in particular:

A. Reducing waiting times for radiation and chemotherapy treatment;

B. Faster Cancer Treatment Indicator performance against 12month average (Target 85%)

C. Developmental targets for reducing waiting times for important diagnostic tests (such as CT scans, MRI scans, angiograms and colonoscopies).

D. Laboratory – Targets for Tests are based on the following requests required urgently (within 60min) - 90 percentile

Other access and wait time targets

Most Medical Specialities have seen a decrease in FSA’s on the wait list - except Cardiology where the waitlist has nearly doubled in the last month. There is no additional resource available to clear this backlog. All services continue achieve the current out-patient (ESPI 2) targets and are tracking well to achieve the 31 December 120 day target. There has been a decrease in patients waiting > 90 days by 115 patients across all specialities. The number of patients waiting > 120 days has also decreased by 10 patients over the last month. Only 12 patients waited > 135 days without an appointment.

Cardiology waitlists

Echo Wait Times - Cardiology Echo median wait times and the wait list continue to grow and standard wait list now comprised 1,256 (a decrease of 72 from last month) patients waiting for an Echo. The sonographer recruitment efforts continue. The Priority 3 wait-times continue to lengthen, with the longest waits for these patients at 38.95 weeks in July - an increase from June by 2.67 weeks. The service continues to work on efficiency gains, Saturday lists and training the trainee sonographers but referral volume continue to be significant.

Exercise Tolerance Testing (ETT) In an effort to reduce the outpatient waiting times an additional 6 week nurse-led clinic has been completed at MSC. This will result in an additional 20 Outpatient procedures being performed above normal capacity. The outpatient list remains high, with 37 patients without appointments.

Radiology – there is a continued focus on sustaining the community referred MRI and CT scan volumes, however the on-going staff vacancies and high winter acute demand has been a challenge. Nationally, CM Health performed the greatest number of community referred MRI scans and the second most CT Scans for all DHBs. CM Health has the greatest volumes of CT scan referrals, and third highest number of MRI referrals, a growth trend that has continued over the last 12months.

Gastroenterology - Outsourcing of colonoscopies with the Ministry of Health additional funding has now been completed with targets being met. The initiative has only had a minor impact on the waiting lists, and the colonoscopy volume targets and capacity issues still require addressing in order to meet demand. Production planning and modelling has demonstrated that there is a requirement to continue outsourcing to private providers.

085

As part of the Gastroenterology Service Improvement Project, a review of staff roles, workload, reporting lines and requirements has occurred. The recommendations have now been implemented and the new/changed roles have been recruited to. The new Service Delivery Manager- Sharon Ranson has commenced. A new SMO has also been recruited, and will start in December, and an additional fellow has also been recruited but delays in registration may delay a start to early next year. Laboratory urgent test turnaround times continue to be achieved, however there are ongoing issues for the Histology services with process improvements, IT system and facility upgrades impacting on response times.


Radiology – Vacant MRI Technician positions have not been filled and are likely to remain difficult to fill in the short term. Cancelled session rates have reduced following a change to enabling MRI trained technician’s to scan singularly, supported by a general senior MRT. The team is supportive of this approach in the short term to spread the scanning load.

Procurement processes for both a CT scanner in Emergency Care and a new 3T MRI scanner continue. The CM Health upgrade of the RIS/PACS Impax bridge to Xero /ICIS, is underway with specification development and hA input.

Laboratory –The Histology review is continuing, and in conjunction with the Histology Clinical Head, Histologists, Senior Technicians and the Laboratory Quality Manager, a number of process improvements have been implemented.

The upgrade of the Sysmex APv9 has been completed on schedule and is running relatively smoothly. A significant effort was made by the IT project manager and Histology staff to enable the upgrade. The focus now shifts to the regional histology Specimen Tracking system specifications and regional RFP in conjunction with hA procurement.

Construction of the modifications for Central Specimen Reception, Blood Bank and Histology facilities is nearing completion, and on-going Business Case development discussions regarding us of additional space in the Harley Gray Building for future Laboratory.

1.3.4 EFFECTIVENESS Providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit.

Cancer Services - The work to embed the Cancer Multidisciplinary Meeting processes continues with ongoing attention to the videoconference capacity at regional sites. National reporting of the Cancer Coordinator work commenced on 1 July, with the first data expected in late August.

Respiratory Services - The FSA waitlist continues to track well, with no patients exceeding the incoming 120-day target, and the overall waitlist volume at its lowest level in the past 15 months.

Breast screen – The service has met the coverage targets for women aged 45-69 years, and is working to achieve the target for 50-69years age range and for Maaori women.

Renal Services – demand remains high, with Dialysis volumes exceeding capacity at growth rate of 5-6% pa. These volumes (a total of 109 patients over capacity) continue to be managed by 24 patients dialysing at the Western Campus Prefab facility, outsourcing of 32 patients to Nephrocare (private facility), running evening shifts in the AMC and Rito Unit - currently at 54 patients. Home Therapies cases increased 3% in July, and work continues to implement the Acute Peritoneal Services as the western campus.

086

1.3.5 PATIENT and WHAANAU CENTRED CARE Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.

The division continues a range of patient-focused processes, including follow-up of Bereavement Care referrals and Family meetings to address concerns.

The Medical services Nurse forum used a number of falls incidents case studies to reflect and de-brief with staff. There was positive discussion of potential options that support patients and family to assist staff with care. One outcome was recognition that this will need further education and assistance to family members involved in ward routines.

087

4. Women’s Health and Kidz First

Service Overview

Kidz First and Women’s Health is managed by Nettie Knetsch, General Manager with Dr Wendy Walker Clinical Director (Kidz First), Dr Sarah Tout Clinical Director (Women’s Health), Thelma Thompson (Director Midwifery) and Michelle Nicholson- Burr, Clinical Nurse Director. CM Health Services include:

Women’s Health provides Antenatal, Birthing and Assessment (Primary, Secondary/Tertiary) and Postnatal inpatient care at Middlemore, and Birthing and Assessment and Postnatal inpatient care at the 3 Primary Birthing facilities (Botany, Papakura and Pukekohe). Gynaecology inpatient care is provided both at Middlemore and Manukau Surgery Centre. Early Pregnancy Assessment and Specialist Obstetric Ultrasound Services are provided at Middlemore.

Outpatient Gynaecology/ Colposcopy and Obstetric clinics are provided at Manukau Super Clinic with Botany Super Clinic and the 3 Primary Birthing Units also providing Obstetric antenatal clinics. There are midwifery antenatal clinics across the district with a cluster of clinics and drop-in centres provided at Dawson Road (Otara) and the Mangere Community Health Centre.

Kidz First provides Paediatric Emergency Care, Medical and Surgical inpatient care, Neonatal Care, Child Protection, Play and Recreation at Kidz First Hospital and the Harley Gray Building.

Outpatient clinics are provided at the Manukau Super Clinic, Botany Super Clinic and Pukekohe Hospital. Community services include Child Development, Home Care Nursing, Specialist Youth Health, Public Health Nursing, Hearing and Vision Screening Teams. Children in Care/ Child Protection services are provided from the Multi-Agency Centre at Manukau.

Highlights

Birthing volumes appear to have plateaued after the significant decrease in the 2013/14 year. July 2014 saw a small increase in Births. While the Community Units continue to have a decrease in numbers, postnatal activity (occupancy) at all three Community Units remains excellent. This is allowing for women to have post-natal stays closer to home and babies requiring additional care when discharged from the neo-natal unit able to go to the Community Units with their mothers.

After many months of high acuity and volumes in the Neonatal Unit, the second half of July and first couple of weeks in August have seen volumes in line with the birthing volumes. There is regional work underway to understand the drivers for neonatal admissions as the regional decrease in births in 2013/14 did not see a decrease in neonatal admissions at all.

The Kidz First Public Health Nurses working in the Mana Kidz programme are participating in a number of evaluations and studies of the Rheumatic Fever Prevention part of the programme.

The Vision and Hearing B4SC services have commenced joint planning with Plunket to streamline the developmental, hearing and vision parts of the check for ‘hard to reach children’. Planning is underway for a Mangere locality approach for a cohort of 1,300 children.

088


1.2 Activity summary – at 14.08.14

Kidz First:

Kidz First Volumes (WIES and CASES) Volumes JULY '14 Year to date

Actual Bud /

Contract Var % var Actual Bud /

Contract Var % var

INPATIENT (WIES) Kidz First EC 90 84 6 7.1% 90 84 6 7.1% Paediatric Medicine 368 354 14 4.0% 368 354 14 4.0% Paediatric ICU 5 0 5 - 5 0 5 - NNU - Unit 206 218 -12 -5.5% 206 218 -12 -5.5% NNU Women’s Health 34 54 -20 -37.0% 34 54 -20 -37.0% Kidz First Surgical - Acute 129 188 -59 -31.4% 129 188 -59 -31.4% Kidz First Surgical - Elective 109 82 27 32.9% 109 82 27 32.9% Total KF WIES 941 980 -39 -4.0% 941 980 -39 -4.0%

INPATIENT (CASES) Contract = Last year actuals

Kidz First EC 311 352 -41 -11.6% 311 352 -41 -11.6%

Paediatric Medicine 612 632 -20 -3.2% 612 632 -20 -3.2%

Paediatric ICU 4 3 1 33.3% 4 3 1 33.3%

NNU - Unit 60 72 -12 -16.7 60 72 -12 -16.7

NNU Women’s health 94 135 -41 -30.4% 94 135 -41 -30.4%

Kidz First Surgical - acute 129 159 -30 -18.9% 129 159 -30 -18.9%

Kidz First Surgical - elective 151 131 20 15.3% 151 131 20 15.3%

Total KF CASES 1361 1484 -123 -8.3% 1361 1484 -123 -8.3%

OUTPATIENTS Act Bud /

Contract Var % var Act Bud /

Contract Var % var

FSA's 151 187 -36 -19.3% 151 187 -36 -19.3%

Follow-ups 263 290 -27 -9.3% 263 290 -27 -9.3%

Virtual 37 42 -5 -11.9% 37 42 -5 -11.9%

Total KF Outpatients 451 519 -68 -13.1% 451 519 -68 -13.1% *there are some discrepancies in system with contracted WIES and discharge figures for July 2014. Contracted WIES will be corrected for Aug 2014.

The Kidz First Medicine/ EC/ ICU in-patient WIES remains very similar to last year (WIES 25), but discharges are down. High winter volumes started in the last week of June, followed by a ‘lull’ during the first 2 weeks of July (school holidays), but were busy again from the second half of July. Actual presentations to Kidz First EC were up by 70 on last year with more children being assessed and discharged within 3 hours and not requiring a short stay or inpatient admission. A similar pattern is occurring in early August with EC presentations averaging 105 children per day.

Kidz First Surgical inpatient acute WIES was down 59. Acute discharges are down 30 for the month. Kidz First Surgical acute volumes vary significantly depending on the number of children with severe burns (low volume but high WIES). July saw fewer children with severe burns, as well as lower other acute admissions.

089

Kidz First Neonatal Care WIES for babies discharged in July was down, as was the number of discharges across both the Neonatal Unit and babies on the post-natal floor attracting a neonatal WIES. This has come as a welcome break from the high volumes over the past 3 months and gives the Neonatal staff the ability to further consolidate the transition into the new Unit (particularly the level II area which moved in May).

Outpatient volumes for Kidz First Medicine are up for both FSAs and Follow ups. Follow-Ups (FU) in Kidz First reflect the on-going pressure of children with developmental/ behavioural/ disability conditions requiring longer term management by secondary care. Virtual FSA numbers are down for the month, due to the 2 SMOs doing most of the Virtual FSA process being on leave during the July school holidays.

Women’s Health:

Women's Health Volumes (WIES and CASES) Volumes JULY '14 Year to date

Actual Bud / Contract Var % var Actual

Bud / Contract Var % var

INPATIENT (WIES) WH Gynae - acute 120 125 -5 -4% 120 125 -5 -4%

WH Gynae - elective 125 161 -36 -22% 125 161 -36 -22% WH Primary Unit (wies equi) 186 183 3 2% 186 183 3 2%

WH secondary 532 503 29 6% 532 503 29 6%

Total WH WIES 963 972 -9 -1% 963 972 -9 -1%

Births/ Deliveries Total 628 622 6 1% 628 622 6 1%

INPATIENT (CASES) WH Gynae - acute 210 248 -38 -15% 210 248 -38 -15%

WH Gynae - elective 132 176 -44 -25% 132 176 -44 -25%

Total WH CASES 342 424 -82 -19% 342 424 -82 -19%

OUTPATIENTS Act Bud /

Contract Var % var Act Bud /

Contract Var % var

Gynae FSA's 179 295 -116 -39% 179 295 -116 -39%

Gynae Follow-ups 183 268 -85 -32% 183 268 -85 -32%

Gynae Virtual 23 6 17 283% 23 6 17 283%

Colposcopy 190 213 -23 -11% 190 213 -23 -11%

Colposcopy HC 23 22 1 5% 23 22 1 5%

Colposcopy HC in OT 3 7 -4 -57% 3 7 -4 -57%

Gynae HC 55 65 -10 -15% 55 65 -10 -15%

Total WH Outpatients 656 876 -22 -25% 656 876 -22 -25% *there are some discrepancies in system with contracted WIES and discharge figures for July 2014. Contracted WIES will be corrected for Aug 2014.

090

Following the decreasing trend in the first 9 months of 2013/14, this is the third month with a small increase (6) on last year’s birth numbers. For the month, there were 25 more births at Middlemore, but 19 less at the 3 Community Units. The WIES or WIES equivalent from Middlemore and the 3 Community Units are both up. While numbers at the Community Units are down, the increase is in WIES reflecting the acuity and complexity of women transferring from Middlemore to the Community Units following birth.

Gynaecology discharges and WIES are down for both acutes and electives for the month. This year phasing of the contracted volumes for Gynae electives reflects the high number of procedures and WIES performed in July 2013, when anticipated leave and scheduling was anticipated in August/ September but that is not the case this year.

Gynaecology FSAs are down this year, reflecting the different scheduling but Virtual FSA's are up. The scheduling for both outpatients and elective procedures is on track for both overall volumes, as well as meeting ESPI targets. Gynaecology Nurse-Led Clinics show increased activity, particularly the Nurse Led IUCD/ Jadelle/ Mirena clinics at Manukau Super Clinic that are well attended. This clinic is also used as a training clinic for junior medical staff and GPs.

Obstetric FSAs continue to decrease in line with better streamlining and co-ordination between midwifery and consultant clinics. In addition, there are many Virtual FSAs that take place in the Obstetric Clinics (in particular the clinics at the 3 Community Units), with processes for effectively counting this activity are being finalised.

Commentary on BSC • Annual Leave and Sick Leave - Annual Leave accrual > 2 years remains high. Both Divisions have

now met with most of the staff with high accrual and annual leave plans are being put in place. For the Kidz First Neonatal SMOs we are working on a annual leave cash out option as with a 1:5 roster (after hours on call) the opportunities for a longer period of leave are limited. Both Kidz First and Women’s Health had a decrease in the sick leave hours taken this July compared to July 2013.

• Average Length of Stay for Kidz First Medical was in line with WIES and a higher number of children with Rheumatic Fever and cardiac complications requiring a longer admission.

091

• B4 School Checks Despite the July school holidays, good progress was made in maintaining the number of B4S hearing and vision checks with the service achieving the MoH target for monthly checks. Other community services volumes and activities were as expected.

• Expired Appointments (all Follow-Ups) Kidz First Outpatients The service is working with SMOs to review the Expired Follow-Up outpatient appointment lists and to reconfigure clinics where necessary with more Follow-up versus FSAs. The reduction in Expired Appointments is pleasing.

• Readmission Rate (Level 1, 2, 3 Neonates within 28 days) - Although the percentage is showing 13.6% this only reflects 2 babies.

• Unplanned Admission Rates Babies -The actual measure here is the number of babies born at CM Health facilities who are admitted within their first year of life and is an overall system measure to see how well babies are doing in their first year of life. The national average for admissions in the first year of life is 14%. It is pleasing to see that the overall rate for July is 17% with, in particular, Maaori babies showing a decrease from 29% to 24%.

• The Caesarean Section rate - The Caesarean Section rate for July 2014 is 23.9% (2013/14 was 23%). The mix of acute and elective Caesarean Section remains the same as the previous year (66% acute and 34% electives).

• Community Midwives visits Data entry for this service occurs till 6 weeks after birth and is therefore not in line with the monthly reporting parameters. The year-to-date data is used as a comparison on activity. The activity is down, mostly due to the overall decrease in births and the increasing number of women now accessing self-employed LMC care. However, this decrease has meant that women are now receiving an average of 6 visits from booking during the antenatal period and 7 postnatal visits under CM Health Community Midwifery Care.

• Work is underway with the Kidz First Medical and Disability Clinics to meet the new >135 days wait time target by the end of August. Gynaecology is already achieving the target.

092

July 2014


Def

Jul-14 Target Var. Actual Target Var.Deliveries TOTAL 628 622 6 628 622 6

Deliveries at MMH 552 527 25 552 527 25Deliveries at Primary birthing units 76 95 -19 76 95 -19

Gynae Acute WIES 120 125 -5 120 125 -5 3

Gynae Elective WIES (Private) 4 0 4 4 0 4 2

Gynae Elective WIES 121 161 -40 121 161 -40 2

Gynae Acute - Discharges 210 248 -38 210 248 -38Gynae Elective - Discharges 132 176 -44 132 176 -44Maternity WIES 718 686 32 718 686 32 1

Outpatient Gynae First 179 295 -116 179 295 -116Outpatient Gynae Follow-up 183 268 -85 183 268 -85Gynae nurse-led clinic 115 87 28 115 87 28Gynae SMO VFSA 23 6 17 23 6 17Obstetric Outpatient FSAs S/B Doctors 217 285 -68 217 285 -68Obstetric Outpatient F/U S/B Doctors 321 329 -8 321 329 -8

DHB Community Midwives Antenatal visits 1,297 1,604 -307 17,983 25,000 -7,017DHB Community Midwives Postnatal visits (3 months in arrear) not including ward follow up (April 2014 data)

903 1,536 -633 15,142 16,000 -858

Jul-14 Target Var. Actual Target Var.% Staff with Annual Leave > 2 years 21.0% 5.0% -16.0% 20.6% 5.0% -15.6% 12

% Staff Turnover 1.1% 2.0% 0.9% 10.2% 10.0% -0.2% 13

Sick leave hrs. taken FTEs Nursing/Midwifery inc unpaid 8.13 8.96 0.83 ~Study leave hours taken FTEs in Nursing/Midwifery 5.52 5.86 0.34 ~Orientation hours taken FTEs in Nursing / Midwifery 2.85 3.75 0.90 ~Performance reviews completed per annum 79% 90% -11%


Jul-14 Target Var. Actual Target Var.Total Caesarean Percentage 23.9% 21.7% -2.18% 23.9% 21.7% -2.18%

Caesarean - elective number 58 44 14 58 44 14 Caesarean - acute number 92 91 1 92 91 1

Inductions of labour % 24% 26% 2% 23% 21% -2%Inductions of labour - total number compared to last year 153 154 1 1705 1636 -69Surgical Site Infection - C-section (3 month in arrear) Qtrly - July for April , Oct for June, Jan for Oct, April for Jan

4 6 2 72 75 3

Jul-14 Target Var. Actual Target Var.ESPI 2 - No. waiting >4 months for FSA Dec 14 - Elective 0 0 0 0 0 0 41

Jul-14 Target Var. Actual Target Var.Average Length of Stay Gynaecology - MSC Inpatients 0.74 0.76 0.02 0.85 0.85Average Length of Stay Obstetric (DHB Mat) (1 mo in arrear) 2.27 2.14 -0.13 2.31 2.12 -0.19 Average Length of StayObstetric (Ind. Mat) (1 mo in arrear) 2.15 2.10 -0.05 2.33 2.16 -0.17 Average Length of Stay Vaginal Deliveries overall 1.98 2.03 0.05 1.97 1.97

Maaori - 1st time mothers 2.32 2.12 2.52 2.56 2.56Pacific - 1st time mothers 2.83 2.52 -0.31 2.46 2.46

CM Health Midwifery/ LMC Split at BookingClosed unit / Shared Care 48% 51% -3% ~

Access Holders 52% 49% 3% ~CM Health Midwifery/LMC Split at delivery

Closed unit / Shared Care (#) 261 256 5Access Holders (#) 367 366 1

Closed unit / Shared Care (%) 42% 41% 0%Access Holders (%) 58% 59% 0%

Year to date

Year to date

Year to date

Year to date

Year to date

WOMEN'S HEALTH SCORECARD

Ensu

ring

Fina

ncia

l Sus

tain

abili

tyEn

ablin

g Hi

gh P

erfo

rmin

g Pe

ople

Firs

t, Do

No

Harm

(Saf

ety)

Tim

ely

Syst

em In

tegr

atio

n (E

ffec

tive)

SCORECARD

093

Note: the service have some measures with no YTD result reported - as they are reported one month in arrears

Jul-14 Target Var. Actual Target Var.FSA / FUP ratio - Gynae 1:1.02 1:1 0.02 1:1.02 1:1 0.02DNA - Midwifery Antenatal clinics - First 18% 21% -3% ~ 23%DNA - Midwifery Antenatal clinic - Follow up 17% 18% -1% ~ 16%DNA - Doctor Antenatal clinics- FSA 11% 13% -2% ~ 14%DNA - Doctor Antenatal clinics - Follow up 14% 12% 2% ~ 12%

% Resourced Occupancy (avg of 9am & 9pm)Gynaecology Ward 78.1% 96.5% 18% 91.8%

Maternity Ward - Maternity (45 beds) (lodgers included) 80.8% 80.6% 0% 78.4%Maternity Ward - Nursery (30 beds) (lodgers included ) 87.1% 106.2% 19% 86.4%

Botany Maternity Unit (lodgers included) 95.3% 96.2% 1% 93.6%Papakura Maternity Unit (lodgers included) 89.7% 78.4% -11% 82.0%

Pukekohe Maternity Unit (lodgers included) 81.8% 72.0% -10% 79.4%

Def

Jul-14 Target Var. Actual Target Var.Nursing Hours per Patient Day (not including HCA)at MMH

NHPPD - Maternity Ward North (including nursery PD) 6.30 6.07 -0.23 5.50NHPPD - Maternity Ward South (including nursery PD ) 5.99 5.29 -0.70 5.50

Nursing Hours per Patient Day - Gynae 5.73 4.85 -0.88 5.63


Jul-14 Target Var. Actual Target Var.% Infants Exclusively Breastfed Discharge MMH - Total 81.0% 75% 6.0% 81.0% 75% 6.0% 75

% Infants Exclusively Breastfed Discharge MMH - Maaori 82.0% 75% 7.0% 83.0% 75% 8.0%% Infants Exclusively Breastfed Discharge MMH - Pacific 74.0% 75% -1.0% 74.0% 75% -1.0%

Year

Year

Year to date

Effic

ient

Equi

ty

094

Note: the service have some measures with no YTD result reported - as they are reported one month in arrears

July 2014


Def

Jul-14 Target Var. Actual Target Var.Gen Paeds Outpatients FSAs 151 175 -14% 151 175 -14% 4

Gen Paeds Outpatients Follow Ups 263 296 -11% 263 296 -11% 5

Gen Paeds Virtual FSAs 37 42 -12% 37 39 -5% 11

KF Surgical Ward discharges 141 159 -11% 141 159 -11%KF Surgical Ward WIES 138 199 -31% 138 199 -31%KF Medical Ward + Short Stay Discharges 612 632 -3% 612 632 -3%KF Medical Ward + Short Stay WIES 368 354 4% 368 354 4%

Neonatal Care Discharges - Neonatal Unit 60 72 -17% 60 72 -17%Neonatal Care Discharges - WH Neonatal 94 135 -30% 94 135 -30%Neonatal Care WIES - Neonatal Unit 206 218 -6% 206 218 -6%Neonatal Care WIES - WH Neonatal 34 54 -37% 34 54 -37%EC Attendances <15 years 2,575 2,505 3% 2,575 2,505 3%

Jul-14 Target Var. Actual Target Var.% Staff with Annual Leave > 2 years 13.1% 5% -8.1% 13.7% 5% -8.7% 12

% Staff Turnover 1.2% 2% 0.8% 11.2% 10.0% -1.2% 13

% Sick leave 3.9% 3% -0.9% 3.7% 3.0% -0.7%Workplace injury per 1,000,000 hours 9.83 10.50 0.67 8.75 10.50 1.75

Nursing Sick leave hours taken in FTEs (inc unpaid sick) 7.98 12.27 4.29 ~Performance reviews completed 64% 90% -26.0%Study (both internal & external) leave taken FTE RN 3.16 2.95 -0.21 ~


Jul-14 Target Var. Actual Target Var.Expired Planned Appointments KF outpatients 544 544

Jul-14 Target Var. Actual Target Var.% transcribed Discharge Summary authorised >7 days of created 80.1% 75.0% 5.1% 80.1% 75.0% 5.1% 54

Readmission Rate (KF med) within 7 days (one month in arrear) 6.9% 5.7% -1.2% 6.1% 6.0% -0.1%Readmission Rate (KF med) within 7 days (Maaori) 8.1% 6.8% -1.3% 6.3% 6.3% -0.0%

Readmission Rate (KF med) within 7 days Pacific 5.7% 5.4% -0.3% 5.9% 6.0% 0.1%Readmission Rate (Level 1,2, 3) within 28 days (one month in arrear ) 13.6% 0.0% -13.6% 8.1% 4.2% -3.9%Readmission Rate (all Neonates) within 28 days (one month in arrear ) 7.0% 2.2% -4.8% 5.1% 3.9% -1.2%Unplanned Admission Rate Babies (Total) 17% 21% 4.0% 20% 20.0%

Unplanned Admission Rate Babies (Maaori) 24% 29% 5.0% 26% 26.0%Unplanned Admission Rate Babies (Pacific) 26% 24% -2.0% 28% 28.0%

ALOS (raw) - Kidz First - Surgical - Surgical Floor 2.6 2.7 0.1 2.6ALOS (raw)- Kidz First Medicine - KF Wards 3.1 2.6 -0.5 2.6ALOS (raw)- Kidz First Medicine - EC Short Stay (hrs) 5.8 4.4 -1.4 5.2ALOS (raw) - Kidz First - Neonatal Unit discharge only 9.2 11.8 2.6 13.9ALOS (raw)- Kidz First - Neonates including WH 5.4 5.9 0.5 6.7

Jul-14 Target Var. Actual Target Var.Outpatient DNA - FSA 8.0% 7.3% -0.7% 8.26%Outpatient DNA - Follow up 15.0% 14.0% -1.0% 12.85%

Nurse Hours per Patient Day - KF Med 4.96 5.59 0.63 6.00Nurse Hours per Patient Day - KF Surg 4.84 5.32 0.48 4.80Nurse Hours per Patient Day- Neonatal 10.28 9.88 -0.40 9.67

% Resourced Occupancy - Kidz First Medical (against 13/14) 84.6% 85.0% 0.4% 77.8%% Resourced Occupancy - Kidz First Surgical (against 13/14) 71.7% 80.5% 8.8% 73.3%% Resourced Occupancy- Neonatal (against 13/14) 93.7% 98.3% 4.6% 89.8%

Jul-14 Target Var. Actual Target Var.Patient Experience Survey (to be reported from August 2014) 74


Jul-14 Target Var. Actual Target Var.Percentage of 'eligible' inpatients are referred to AWHI na 100.0% 0.0% ~

Enab

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W

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Effic

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Firs

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No

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(S

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y)

KIDZ FIRST SCORECARD

Year to date

Year to date

Ensu

ring F

inan

cial S

usta

inab

ility

Year to date

Year

Year to date

Year

Year

095





319 248 71 29% Total Revenue 319 248 71 29%

EXPENDITURE2,814 2,755 (60) (2)% Staff Costs 2,814 2,755 (60) (2)%

44 18 (26) (140)% Outsourced Costs 44 18 (26) (140)%216 173 (43) (25)% Clinical Costs 216 173 (43) (25)%

79 91 12 13% Infrastructure Costs 79 91 12 13%(77) (23) 54 231% Internal Allocations (77) (23) 54 231%


FTE45 43 (1) (3)% Medical 45 43 (1) (3)%

207 197 (10) (5)% Nursing 207 197 (10) (5)%69 68 (1) (2)% Allied Health 69 68 (1) (2)%29 29 (1) (2)% Management/Admin 29 29 (1) (2)%

350 338 (13) (4)% FTE Total 350 338 (13) (4)%

($000's)


($000's)

STATEMENT OF FINANCIAL PERFORMANCE - KIDZ FIRSTJuly 2014

-2,900

-2,800

-2,700

-2,600

-2,500

-2,400

-2,300

-2,200

-2,100

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

100

200

300

400

500

600

700

800

900

1,000

Mon

thly

resu

lt $0

00's


Result Budget

-

500

1,000

1,500

2,000

2,500

3,000

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

096

Month YTD


Revenue: $71 $71

Salaries & Wages: $(60) $(60)




Internal Allocation: $54 $54

Revenue for projects are recovered on a monthly basis. Additional costs for various projects (not budgeted) are offset against additional revenues.

July 2014

$0Year end Forecast variance to Budget

Additional revenue for various projects (not budgeted) are offset against costs, ManaKidz $58K

$(30)K for Home care nursing and $13K for Neonatal care unit due to high volume and acuity.Additional clinical supplies were required in the Home care nursing team with expected useage over the July/August period.

STATEMENT OF FINANCIAL PERFORMANCE - KIDZ FIRST

Additional costs for various projects (not budgeted) are offset against additional revenues/internal allocations from the funder, i.e. Ccrep Research, ASD, and Mana Kidz. NICU continues to experience a higher level of acuity level 3 babies in July 2014. High sick leave, education leave, orientation and ACC leave have had a negative impact in July.Medical - $43k - Good AL leave manament over School holidays in July 2014Nursing- $(96)k - Additional costs for various projects (not budgeted 5.2 FTE at $43K) are offset against additional revenue. Also High level of sick leave and ACC leave. - Unpredictable high NICU volumes (acuity and occupancy) in July (ongoing since Sept 2013) and vacancies/ skill mix issue. NICU used $42K of internal bureaus, (10.4)FTE and $24K Overtime, (2.4)FTE to maintain a safe staffing level. Allied Health- $6k - Good AL management over school holidays and 2FTE vacancies.Clerical - $(7)k - Budget / Actuals not aligned in July 2014. An admin FTE resigned and will be replaced with a clinical FTE.

Funder Payment: NilGovernment Revenue: ACC $5KOther Income: ASD $11k, Reumatic Fever Research $22K, CCREP $14K , Univ $3.5k, F&P $5K, NRA $4K, ADHB $5K

$(10)k for external bureau, $(7)K for University of Auckland $(8)k for secondment from ADHB clinicians for Centre for Youth from March 2014

Kidz First Medicine/EC/ICU Inpatient WIES remains similar to last year. Volumes for the service are on track ; WIES July 2014 including Neonates actual 886, contract 980. Close monitoring of NICU volumes has been enforced in the service to mitigate potential cost over runs. Contracted/targeted volumes for 2014-2015 are agreed but still being reviewed for accuracy by casemix team.

097




117 83 34 41% Total Revenue 117 83 34 41%

EXPENDITURE2,789 2,753 (36) (1)% Staff Costs 2,789 2,753 (36) (1)%

56 65 10 15% Outsourced Costs 56 65 10 15%126 133 6 5% Clinical Costs 126 133 6 5%127 132 5 3% Infrastructure Costs 127 132 5 3%

27 49 21 (44)% Internal Allocations 27 49 21 (44)%3,125 3,132 7 0% Total Expenditure 3,125 3,132 7 0%

(3,008) (3,049) 40 1% Net Result (3,008) (3,049) 40 1%

45 44 (0) (1)% Medical 45 44 (0) (1)%248 247 (1) (0)% Nursing 248 247 (1) (0)%

5 5 (1) (14)% Allied Health 5 5 (1) (14)%48 45 (3) (8)% Management/Admin 48 45 (3) (8)%

347 341 (6) (2)% FTE Total 347 341 (6) (2)%

July 2014STATEMENT OF FINANCIAL PERFORMANCE - WOMENS HEALTH


($000's) ($000's)

-3,500

-3,000

-2,500

-2,000

-1,500

-1,000

-500

-

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

100

200

300

400

500

600

700

800

900

1,000

Mon

thly

resu

lt $0

00's


Result Budget

-

500

1,000

1,500

2,000

2,500

3,000

3,500

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

098



The safety measures for the Kidz First and Women’s Health service are shown in the table below which include the following:

• Monthly ward audits of the safety measures continue to be implemented: focus on emergency trolley, hand hygiene, fall prevention/intervention, MORO screening, pressure injury assessment/intervention.

• Safe Sleep and Violence intervention educational programmes continue being rolled out.

• CLAB – Neonatal Unit CLAB insertion and maintenance bundle compliance is monitored.

For 2014/15 all areas have a version of an Early Warning Scoring System that will measure compliance with Physiological Unstable Patients (PUP) for Gynae, Maternity Early Warning System

Month YTD


Revenue: $34 $34

Salaries & Wages: $(36) $(36)

Outsourced: $10 $10



Internal Allocation: $21 $21

STATEMENT OF FINANCIAL PERFORMANCE - WOMENS HEALTH

Additional costs for various projects (not budgeted) are offset against additional revenue.Other Income: AUT student days $12K, safe sleep $7K, clinic room rental $5K and miscellaneous $12K

July 2014

Additional costs for various projects (not budgeted) are offset against additional revenues, i.e. Ccrep Research High sick leave, education leave, ACC have had a negative impact and is offset against a favourable net Annual Leave FTE.Medical- $4k - good AL ManagementNursing/Midwives- $(20)K unfavourable for July 2014; as detailed below. - unexpected high volume and high acuity in NNC resulting in more NNC graduates on Maternity Ward.- $66k spent on Internal bureaus,(11)FTE and $36K for OT, (4)FTE due to Midwifery vacancies of 20FTE, skill mix, high sick, study leave and orientation. - Womens Health continues to absorb additional Midwifery Study days and orientation days, (8)FTE.Allied Health- $(7)K unfav costs, (2)FTE - offset by additional revenues for Breastfeeding Advocates.Clerical - $(13)K unfav additional costs, (1)FTE offset by additional revenues, maternity review board. 3FTE vacnaancies in the maternity ward have been offset by sick leave (4.6)FTE.

KPI's for the service are on track against contract, deliveries are 1% up against last year's actual. Delivery numbers at MMH were up by 25 and community units down by 19 for the month (total 6). Contracted/targeted volumes for 2014-2015 are agreed but still being reviewed for accuracy by the casemix team.

$(27)k for External Bureaus to offset MW / Nursing vacancies and skill mix issues$(8)k for AUT MDES (Midwifery Development) - not budgeted - proposal to be funded by Maternity Review Board.$37K favourable for Univ of Auckland due to ACC leave$7K favourable due to accrual reversal for Colp and Radiology charges

Year end Forecast variance to Budget

Additional revenue for various projects (not budgeted) are offset against costs, i.e. BFA $11K, Safe Sleep $7K, Cancer Care $4K

$0

099

(MEWS) for Maternity Ward and Birthing and Assessment and the Paediatric Early Warning System (PEWS) for Kidz First Medical and Surgical wards.


Refer to BSC


Refer to BSC


Clinical Pathways Development: Menorrhagia/ Hyperemesis pathways pilot is underway with good participation from General Practices. A SMO Obstetric Clinic for Otara commences August.

LMC access and market share increases: at registration YTD July 2014 = 52%, and at birth (target 51%) YTD July 2014 = 58%

Screening Programmes: New Born Hearing screening and B4 school checks (quarterly data) – on track for the quarterly volumes

1.4.5 PATIENT and WHAANAU CENTRED CARE Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions.

Patient and whaanau/ fono centred care

Increase postnatal Length of Stay for 40% of women with high needs

Increasing LOS across all groups - Overall LOS 2.27 vs 2.14 - First Time Maaori 2.32 vs 2.12 - First Time Pacific 2.83 vs 2.52

Complaints / Compliments: Kidz First and Women’s Health – received 12 complaints and 27 compliments received.

100

5. Mental Health

Service Overview

Mental Health is managed by Tess Ahern, General Manager, with Peter Watson Clinical Director and Jane Earl Clinical Nurse Director. CM Health services include:

Inpatient Services – Tiaho Mai (adult) and Koropiko (MHSOP), Psychiatric Liaison service.

Community Services for Infant, Child and Youth – are based at Whirinaki (East Tamaki) which also includes Maori and Pacific clinical teams, Early Psychosis Intervention Team and Maternal Mental health team. Adult Community Services - Community Mental Health Teams (four bases), Intensive Community Treatment teams, Maori and Pacific clinical teams and Services for Older People – two community teams (Middlemore). In addition, the team has Consumer and Family Advisors, the Research, Evaluation and Audit in Mental Health (REAMHS) and Partnership in Evaluation towards Recovery (PER) teams.

Non-government organisations also provide a range of contracted community-based support services, residential services and some Alcohol and Drug treatment services.

Regional Services provided by CM Health are inpatient rehabilitation (Tamaki Oranga at Otara), Dual Disability team, and a Dementia Behavioural Support and Advisory Role. Regional Services available to CM Health are the Alcohol and Drug Services, Forensic Services (Waitemata DHB), and Child and Youth Inpatient Services (Auckland DHB).

Highlights

Framework for Change Update - The key work-streams (Mental Health Short Stay, Supported Discharge and Acute Pathway) are complete. Phase 1 developments are mostly concluded and are to be handed over to the Adult Acute Pathway Operational Team for implementation. The Acute Forum meetings are held fortnightly and the membership has increased with key personnel recruited. Infrastructure to support clinical staff with HCC Whiteboard and access to appropriate electronic forms has progressed.

System Integration - A collaborative workshop with NGO and DHB providers identified how best to provide a NGO Recovery Support to service users during an acute episode when receiving Home-based Treatment services. A pilot project is proposed which will be guided by a governance group.

Emerging Issues

Tiaho Mai beds: In July, 2 beds have been closed at Tiaho Mai for repairs due to building integrity issues. It is extremely challenging for Tiaho Mai to reduce bed numbers, given the high demand and frequent over-capacity. Until repairs are completed in the next month, other space has been transformed into a bedroom and a bathroom nominated. Tiaho Mai will access a Ward 35E (Koropiko) bed, when appropriate, to assist with the demand.

Facilities advice is that more occurrences of this nature will arise in the near future. Further information is being sought from Facilities on any preventative activities that can be carried out - given the challenge for staff and patients in Tiaho Mai when bed capacity is reduced.

101

Acute Mental Health Inpatient Unit Project Update: July 2014

The final location option decision conference was held on the 24 July 2014, to look at the two final options for a site for the new inpatient unit. This process confirmed the selection of the Middlemore Campus and the current Tiaho Mai site. The confirmation of a final location for the re-development of the new mental health acute inpatient unit has been impacted by various master-planning considerations that will impact on the timeframes. These are:

1. The impact of the new facility on the hospital Ring Road and how it would be managed;

2. The staging of the new build and related impacts, specifically:

a. the ability to have a corridor link from the new unit to the main Hospital spine

b. the proposed new tiered Lecture Theatre facility at Ko Awatea

c. future Harley Gray Building expansion

Professional advice has been sought as to how these can be managed and more work will be done over the next few months during the investigative stages of the concept design phase.

A longer exploratory study will be needed before arriving at a final location for the new unit. This is extending the timeframe from the original project delivery date for a location agreement by 6 weeks and this has impacted on the timing of subsequent stages of the business case development. In addition, advice now received is that the Concept Design process will take a total of 22 working weeks from RFP to a costed design, which is 12 weeks longer than the timeline in the Business Case Project Brief.

An RFP for concept design is underway, with the investigative and design stages due to commence the week starting 22 September 2014. This will affect the earliest the Detailed Business Case can go to Capital Investment Committee in 2015. This delay poses clinical and operational risks to the service/ organisation.


Mental Health Volumes (Bed days and Service Access) Volumes July '14 Year to date

Actual Budget Variance %

variance Actual Budget Variance %

variance INPATIENT Bed days Tiaho Mai 1,569 1,370 -199 -15% 1,569 1,370 -199 -15%

Tamaki Oranga 591 558 -33 -6% 591 558 -33 -6%

Koropiko - MHSOP

403 395 -8 -2% 403 395 -8 -2%

Service Access

No. of unique CMDHB domiciled clients seen

over 12 months 17,613 16,041 1,572 9.8% N/A N/A N/A

Note - Actual Bed days exceeding the target - shown as negative variance (- %) as over-capacity.

102

Comments on BSC results

• Number of Unique Clients – 0-19 years Focus remains on increasing access via school based services

• Number of unique Maaori 0-19 years – Focus on Kohia/He Kaakano is for early engagement and school-based Mental Health services.

• Shorter waits for non-urgent services: Mental Health Provider Arm - <= 3 weeks 0-19 years - The service has dropped below this target with high acuity at point of entry delaying routine appointments. Universal systems and productivity KPIs being developed to support responsive manage demand and case management flow. An electronic booking system is planned to go live on 31 August. The service has reorganized teams, including the implementation of an acute response team and the alignment of youth teams to localities. We expect to see improvement in time contact in the coming months.

• Number of Unique Clients – 64+ years - Although the target was not met, the number of referrals to MHSOP has been slowly increasing over this year. MHSOP have a number of clients younger than 65 years (some as young as mid 40’s) with dementia-related challenging behaviour, which other services have difficulty managing.

103

SCORECARD

Mental Health SCORECARD

July 2014


Def

Jul-14 Target Var Actual Target VarMedical staff locum Costs (in $000s) $143 $144 $1 $143 $144 $1Overtime costs(in $000s) $94 $86 -8 $94 $86 -$8


% Staff Turnover 0.8% 2.0% 1.17% 11.0% 10% -1.00% 15

% Sick Leave 4.0% 2.8% -1.24% 3.6% 2.8% -0.83% 16



Jul-14 Target Var Actual Target VarNo. of Seclusion events - (Rolling 12 months in development) 144

Jul-14 Target Var Actual Target VarMental Health Access rate - unique clients seen by all MH services ((PRIMHD reporting services include AoD and NGO services) 12 months as a % of population

0-19 years 2.98% 3.15% -0.17%20-64 years 3.79% 3.15% 0.64% ~

65+ years 2.56% 2.70% -0.14% ~Readmissions within 28 days - Total 10.34% 12.00% 1.66% 10.34% 12.00% 1.66%

Jul-14 Target Var Actual Target VarOccupancy - Tiaho Mai acute mental health unit 99.1% 85% 14.1% 99.1% 85% 14.1%No of Patient LOS (Tiaho Mai inpatient) < 5 days 18 tbc tbc

Jul-14 Target Var Actual Target VarPP7-Relapse Prevention Plan - Maaori 96.6% 95.0% 1.6% 96.6% 95% 1.6%PP7-Relapse Prevention Plan - Pacific 94.5% 95.0% -0.5% 94.5% 95% -0.5%


Jul-14 Target Var Actual Target VarAccess rate - No. CM domiciled unique clients seen by MH services (PRIMHD) 12 months as a % of population - Maori 5.99% 6.0% -0.01% ~Access rate - No. CM domiciled unique clients seen by all MH services (PRIMHD) 12 months as a % of population - Total 3.41% 3.1% 0.31% ~

Equi

ty

Year

Effic

ient

Year

Year

Patie

nt

Wha

anau

Ce

ntre

d Ca

re

Firs

t, Do

N

o Ha

rm

(Saf

ety) Year to date

Syst

em In

tegr

atio

n (E

ffect

ive)

Year to date

Ensu

ring

Fina

ncia

l Su

stai

nabi

lity Year to date

Enab

ling

High

Pe

rfor

min

g Pe

ople

Year to date

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3 3 (0) (1)% Government Revenue 3 3 (0) (1)%0 0 0 0% Patient/Consumer Sourced 0 0 0 0%2 6 (4) (66)% Other Income 2 6 (4) (66)%

22 0 22 0% Funder Payments 22 0 22 0%27 10 18 182% Total Revenue 27 10 18 182%


186 17 (169) (1,012)% Outsourced Costs 186 17 (169) (1,012)%18 17 (0) (2)% Clinical Costs 18 17 (0) (2)%

227 236 9 4% Infrastructure Costs 227 236 9 4%35 31 (3) 11% Internal Allocations 35 31 (3) 11%


FTE67 80 13 16% Medical 67 80 13 16%

305 322 16 5% Nursing 305 322 16 5%206 223 17 8% Allied Health 206 223 17 8%


STATEMENT OF FINANCIAL PERFORMANCE - MENTAL HEALTH


($000's) ($000's)

July 2014

-6,000

-5,800

-5,600

-5,400

-5,200

-5,000

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

-

100

200

300

400

500

600

700

800

900

Mon

thly

resu

lt $0

00's


Result Budget

4,400

4,600

4,800

5,000

5,200

5,400

5,600

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

* Jun14 - outsourcing $270k unfav -locum medical staff; YTD allocation of vehicle transfer costs $170k unfav

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Mental Health Acute Inpatient services – Tiaho Mai: Overall occupancy was slightly lower at 98.9% in July. However, there were 19 occasions where the unit was over-capacity and this is not reflected in this data. On one occasion, the unit was 4 users “over-numbers”.

Month YTD


Revenue: $18 $18






Acute demand management costs remain high in July, this has been more than off-set by the vacancies in the community. The vacancies have resulted in underspends in Allied Health $34k.

Medical staff is underspent by $138k, 51.5FTE for the month. There is a national shortage of psychiatrists and therefore locums, mainly from overseas are contracted to provide services (ref outsourced services below).Current medical vacancies for the month are 10.6FTE. Vacancies in the community have resulted in underspends in Allied Health of $34k, 17FTE. Nursing costs are $12k over budget, reflecting 14FTE vacancies offset by overtime and bureau (9.11)FTE.


Locum Medical staff $(143)k partially off-set by the favourable variance in Medical Staff salaries $138k.

STATEMENT OF FINANCIAL PERFORMANCE - MENTAL HEALTHJuly 2014

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Other measures:

Mental Health Acute 28 Day Readmission rate and Seclusion rate measures continue to be developed. Refer to BSC.

1.3.2 TIMELINESS: Every Hour Counts” if we are to achieve quality and safety outcomes

Single point of contact – Mental Health staff have worked with Health Alliance to confirm telecommunication requirements for the new 0800 number that will be implemented once other functions are ready.


Average Length of Stay – Tiaho Mai: In July, the average length of stay was impacted on by the number of users with high length of stay discharged in the month.

Length of Stay > 35 days Tiaho Mai: Fourteen service users were discharged with a length of stay over 35 days and 3 discharged with a length of stay over 100 days. The primary reason for the first groups extended stays were treatment resistance and complexity of health issues, while for the second group the issue was accessing appropriate community support that remains a challenge.

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Mental Health Services for Older People (MHSOP): Occupancy has reduced in July but is comparable to 2013. The seasonal occupancy of the hospital was high with accompanying high acuity, but occupancy for mental health services for older adults is not comparable.

Adult Community Service: Clinician Contacts: There was a 6% increase in clinician contacts with 19,459 contacts in July compared to 18,318 in June, with Awhinatia, ICT, The Cottage Faleola and Manaaki Ora all recording increases during the month.

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Child and Youth Service: Clinician Contacts: This month has continued with an upward trend for contacts following suicide postvention activities in schools requiring more clinician contact and responsiveness particularly within the cultural teams. The addition of new staff across the service has also contributed to increased clinician contacts.


Adult Community Service: 7 Day Post Discharge Contact: In July, 83.75% of clients were seen in the 7days following discharge from the inpatient unit. This figure does not capture those clients discharged in July that will be seen in early August. The last month recalculated figure was 92%. Managers are aware of the need to ensure that clients are actively followed up upon discharge from inpatient.

Child and Youth Service: not seen last 90 days: Cultural teams have had an increased focus on acute assessment and risk management within vulnerable communities; this has adversely affected non-acute work. The rest of the service has made progress with regular services to routine clients.

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Regional Symposium – Occupational Therapy Professional Leaders with Mental Health and Addictions from across the Auckland Metro DHBs have each been facilitating a symposium to support and encourage practitioners to focus on ‘Occupation’ as a specialty area within mental health. The CM Health Symposium was held at Ko Awatea on 8 July was attended by over 70 Occupational Therapists across Auckland, Northland and Waikato DHBs.

Suicide prevention and post-vention DHB Toolkit development workshop: The Ministry of Health are developing a DHB suicide toolkit for suicide prevention/postvention and a 2-day workshop was arranged to support this process, which also created an opportunity for the intersectoral group to convene and discuss the local response.

1.3.5 PATIENT and WHAANAU CENTRED CARE Providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions

CM Health Mental Health Services and HDC: Real Time Feedback Pilot: Lynne Lane, the Mental Health Commissioner hosted a workshop with representatives from six of the seven Real-time Feedback pilot sites at the Mental Health Foundation in July. A review of what was working well, some of the current challenges and a detailed review of the third survey iteration was covered. The new survey questions will be analysed for accuracy and available by the end of July.

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Counties Manukau District Health Board Director of Allied Health - report

Recommendation

It is recommended that: the Hospital Advisory Committee note the report from the Director of Allied Health.

Prepared and submitted by Martin Chadwick – Director Allied Health

Strategic Development

He Pou Oranga (Allied Health Enabling Localities Project) continues with a focus on how to better align the Allied Health workforce to population health needs within the community.

• The packages of work for Papakura that were detailed last month continue to progress and this has provided a mechanism for the group to become better linked to some of the broader organisational work, especially around e-referrals.

• The work done with the Maaori Health unit also continues to progress and has provided a platform for continued integration of the team.

• Planning has now been initiated to take the lessons learnt from Papakura and the Maaori Health Unit to look to rollout to the other Localities with enthusiasm from the Locality General Managers supporting this approach.

• Work has been initiated with Waikato DHB to use this methodology to assist with their re-design process. When the concept was presented, a trial of the concept with the Child Health Unit was greeted with enthusiasm from the consultant staff.

• Lessons learnt through these cycles continue to be collated and will be applied to any planning around a roll-out to the Allied Health inpatient services settings.

Allied Health Workforce

The Sonography Project continues to be progressed through the NRA. CM Health has been integral in supporting the establishment of this programme; and it has taken considerable resource from within the department to assist University of Auckland in getting the programme up and running which is to be commended.

Anaesthetic Technicians - The stability of training Anaesthetic Technicians continues to be an issue, and is being addressed with AUT. A meeting with AUT highlighted the disconnect between the provider (AUT) and the consumer (ourselves) in understanding how to best meet the need of the sector. This has provided a forum to look at the Theatre Assistant training programme being suggested for Nurses and ensuring better linkages from this point on. The certainty of supply of Anaesthetic Technicians continues to be worked through.

Renal Physiologists - Establishment of a training programme for Renal Physiologists through MIT progresses with the programme commencing. There have been teething issues which are being worked through to ensure there is the support required for a new programme. This highlights the

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need to balance meeting our future need while being cognisant of a very stretched service in the current state.

Clinical Engineers - Work is underway with MIT to establish a training programme for Clinical Engineers given that there is currently no programme in NZ.

The balanced scorecard concept for Allied Health from a Clinical Leadership perspective continues to be developed and should be ready in September.

The defined allied health career pathway within CM Health continues to progress with a process being agreed to work through staff to determine how they would fall within the titles “Advanced Clinician” and “Advanced Practitioner” as provided for in the PSA MECA, as well as Clinical Specialty roles. Ensuring that this framework meets the needs of the service is the main point being worked through which result in a slightly longer and formal consultative may process being undertaken.

Health Excellence Framework

The Health Excellence Framework process continues with an on-site visit by the evaluators planned for the middle of September and a staff awareness-raising plan being undertaken across the organisation.

Supporting Locality Development

Chairing of the Manukau Locality Interim Leadership Group continues and there has been solid progress made in implementing the At Risk Individual (ARI) model. An ambitious roll-out plan in now being enacted with a firm report-back sequence now been established to be able to better monitor the progress occurring within the locality.

Project Swift

Considerable time has been devoted over the last month to attend multiple Project SWIFT workshops and contribute from both an ELT and Allied Health perspective.

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Counties Manukau District Health Board Director of Midwifery – report

Recommendation

It is recommended that: the Hospital Advisory Committee note the report from the Director of Midwifery.

Prepared and Submitted by: Thelma Thompson, Director of Midwifery, July 2014

National

Maternity Care and Child Wellbeing and Protection Multi Agency

In 2011, a National Multidisciplinary Group was established with the goal to provide best practice care for mothers, babies and their families, when child wellbeing and protection concerns are identified. Fundamental to achieving this is providing a supportive environment for the health provider charged with delivering that care. This agency has developed a toolkit including Terms of Reference and processes that is being piloted for 2 months in Hawke’s Bay, Bay of Plenty and Southern District Health Boards (DHBs). This will then be available as a resource for other DHBs, and we look forward to reviewing and assessing the possibilities for use in the Counties area.

Maternity Clinical Information System (MCIS)

The National IT Health Board, through the Maternity Information Systems Programme, is leading work to enable sharing of relevant maternity records electronically between the different health professionals a woman sees when she is pregnant and during and after birth. The new system will improve communication and enable easy and timely access to information.

Debra Fenton, Primary Maternity Services Manager is leading the MCIS project within CM Health. CM Health is one of a small group of early adopter DHBs who are progressing towards ‘going live’ on the new maternity system this year. Mid-Central and Whanganui DHBs will go live first with South Canterbury and Counties Manukau DHBs planned for October 2014. The CM Health MCIS Project Group has been working on refining the software and hardware system requirements for CM Health to go live, and developing rollout, training and support plans. Once CM Health ‘goes live’, the new system will be piloted with a small number of bookings, and a gradual transition to entering clinical information directly into the system. Timing of the ‘go live’ and rollout of the new system at CM Health is dependent on national contracts that are yet to be finalised.

Midwifery Workforce

Pre-registration Midwifery Education Standards

The Midwifery Council of New Zealand is currently consulting on standards for approval of pre-registration midwifery education programmes and accreditation of tertiary education. The consultation closes on the 5th September.

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Pu Ora Matatini Maaori Midwifery

Since 2010 CM Health has supported a wrap-around student support scholarship programme in partnership with Te Kupenga (and then Te Hononga O Tamaki Me Hoturoa when they amalgamated); and the Auckland University of Technology (AUT). The aim was to support and grow Counties’ Maaori midwifery workforce. This has been made possible due to the support from the Tindall Foundation. Seven Maaori midwives have completed their training and of these, four are employed by CM Health and 3 work as Lead Maternity Carers (LMCs) in Counties. The success rate of Maaori students at AUT School of Midwifery is now equivalent to other students.

CM Health has reviewed this programme in consultation with all partners and has decided not to renew the current contract; instead this programme will be managed within the Building Capacity Team of Ko Awatea. There are currently 12 within the programme.

CM Health initiatives

Sudden Unexpected Death in Infancy (SUDI) Prevention and Safe Sleep

Whakawhetu and TAHA are running workshops regularly through 2014 for Women’s Health staff. These have been included as part of the Patient Safety Training day which is compulsory for nursing and midwifery staff to attend. These workshops are supported and monitored by the Ministry of Health.

The Counties Manukau Pepi-pod Pilot Programme commenced on 2 July 2014. The pilot is available initially for 100 women in Counties and is focused on women with risk factors. This programme has been made possible through a contribution from The Middlemore Foundation for the benefit of our vulnerable new mothers and babies, to reduce the SUDI rate in Counties Manukau. Following an evaluation process of this pilot, we intend to source more funding to move forward with a more comprehensive intervention programme.

Counties Manukau Health employed a Safe Sleep Coordinator in August 2013 to lead this work locally and work with our regional partners.

Vaccination rates

The midwifery profession at Counties Manukau Health has the lowest uptake of influenza vaccinations of all professional groups. Over the past three years the rates have improved from 2012 (24%); 2013 (33%) to 2014 at 42%. The strategies used this year have been reviewed including consultation with other DHB’s who have higher rates of midwifery staff vaccination uptake. These will be put in place for the 2015 staff influenza vaccination programme.

The Maternity Quality and Safety Plan for 2014/15 include action to increase the number of pregnant women who receive the influenza vaccine and Pertussis vaccination. These actions include education for LMCs, and hospital staff on the importance of encouraging Pertussis and Influenza vaccination during pregnancy, and exploring options for vaccination availability to decrease any barriers to pregnant women obtaining a vaccination.

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Counties Manukau District Health Board Director of Nursing - report

Recommendation

It is recommended that: the Hospital Advisory Committee note the report from the Director of Nursing.

Prepared and submitted by Denise Kivell Director of Nursing

Highlights

Utilisation of the Global Nurse Executive Advisory Com membership is a priority this year. Learning from the international health sector, as well as a national perspective provides insight and ideas to assist our issues. Enhancing patient safety is the key focus, with two of eight opportunities discussed as a recent webinar are now to be further investigated (Emergency care and care of Older Person). A workshop on instilling accountability and the value of nursing engagement is planned for November.

The Clinical Nurse Director Kidz First/Women’s Health, (Michele Nicholson-Burr) will continue to challenge and lead the development of Nursing mobile health concept. The Kidz Home Care mHealth project received funding from Gen-i Health and the Innovation Hub to test the integration with Forms On-line.

Clinical Practice

The safe introduction and orientation for the staff caring for patients on the new Spinal and Head and Neck contracts has been a priority for the surgical services. Education has played a major role, with Nurse Educators from orthopaedics and plastic surgery working collaboratively with the multidisciplinary team across the services. The new tracheostomy referral pathway and guidelines are in final consultation.

The Leadership walk-rounds focussed on assessing ‘How safe are we?” have entered the next test phase. Aligning the quantitative and qualitative data will provide an answer and drilling down on the data gained will expose if there disconnect is emerging for the CM Health, aimed at avoiding risks as per the Mid-Staffordshire review.

Workforce

Safe Staffing - Higher than expected winter volumes this year, plus staff shortages due to unplanned leave have been challenging and have possibly lead to increase in sick leave due to the relentless demands of winter. Registered Nurse bureau cover or redeployment has not always been available. This has resulted in areas escalating concerns and adapting their model of care for safety reasons. The Director of Nursing and Director of Midwifery both receive a daily Incidents Report on “unsafe staffing or resource staffing issues” and address these as appropriate.

Undergraduate Programmes - Feedback from undergraduate Nursing students is captured regularly as part of their programme, however a survey was undertaken to assess new ways of working and preparing for their first year of practice as a RN. Research indicates uncertainty and anxiety leads to feeling unprepared for the RN role. Manukau Institute of Technology, the CM Health Nursing

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Professional Development Unit, and the Medication Nurse Coordinator have taken up the challenge and focussed on developing the use of Concerto and Pyxis medication dispensing. In the survey, on the question “Pyxis access supports students to develop accountability in safe medication practice” 85% strongly agree/agreed. The key recommendation informing the next part of the project is development of a consistent approach to orientating or socialising students to the clinical setting, which includes how to access relevant policies, procedures and guidelines.

In excess of 80 students were hosted for a day at Nga Whetumarima, the days aim was showcasing Mental Health as a career choice and helping with de-stigmatisation. The students participated in a range of activity with Nurses, Occupational Therapists, Kaumatua and Kuia. The overall response was positive.

Professional Development Recognition programme (PDRP)

The NZ Nursing Council requires a quarterly audit on our PDRP. This portfolio demonstrates Nursing competency. Currently CM Health has the highest compliance in the country. CM Health has contracted with several Residential Care facilities and Primary Health Organisations to share the programme. The portfolios have a 3-year tenure with yearly updates. MIT are currently assisting in a PDRP review.

Jul-14

Level Senior RN

RN Competent

RN Proficient

RN Expert

EN Competent

EN Proficient

EN Expert TOTAL

Number 309 932 610 149 38 22 17 2,077 Non compliance 92 127 58 17 10 4 1 309 Compliance Rate 70.2% 86.3% 90.4% 88.5% 73.60% 81.8% 94% 85.1%

Patient and Whaanau Centred Care (PWCC)

The inaugural six month programme of Patient and Staff co-design experience has concluded. A total of 266 ‘consumers of our health care” were part of the programme. The challenge is now to establish and maintain a network. Twelve of the sixteen projects were completed with some varying follow-up work to be undertaken. Additionally, the design work and research resulting from this capturing the patient’s experience process will be prepared publication.

The Science Fest 2014 included for the first time a category - ‘Supporting Excellence in Patient and Whaanau Experience’. The prize monies for the category were provided by the Hector Trust.

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Becoming a health literate organisation Counties Manukau Health: the journey

Siniva Sinclair, public health physician Population Health Team

September 2014

Overview

• Health literacy concepts • Health literate organisations • How health literate is CM Health? • Health literacy strategy for CM Health • Health literacy reviews • Moving forward • Discussion

Health literacy

• “The capacity to obtain, process and understand basic health information and services in order to make informed and appropriate health decisions”

• In most health settings, there is a significant mismatch between a consumer’s health literacy skills and health sector demands - so need to: – (1) Develop the health literacy skills of consumers and – (2) Reduce the health literacy demands of the health

sector • Important to do both:

– “be careful not to assume that health literacy must focus solely on developing consumers’ skills”

Health literate organisations

• “make it easier for people to navigate, understand, and use information and services to take care of their health”

• Six dimensions identified for NZ: – Leadership and management – Consumer involvement – Workforce – Meeting the needs of the population – Access and navigation – Communication

How health literate is CM Health?

• Health literacy recognised as an overarching system driver in Population Health Approach adopted Dec 2012

• Health literacy symposium hosted Feb 2014 • First health literacy review carried out by oral

health service with Workbase, 2013-14 • Draft strategy agreed in principle by ELT,

August 2014

Health literacy strategy for CM Health

• Approach focuses on organisation, health system and workforce

• Health literacy (self-) reviews by services key to deepening understanding, addressing burden

• Health literacy skills of consumers addressed by promoting “universal precautions” approach

• Every interaction should build health literacy e.g. “Ask, Build, Check” model

• Policies re health literacy across organisation • Evaluation – always crucial!

Health literacy reviews

• First review undertaken by oral health service with Workbase, 2013-14

• Used draft “Guide to undertaking an organisational health literacy review”

• Document reviews, interviews and observations re health literacy practices

• Key issues identified and health literacy interventions planned

• Early implementation / evaluation by end 2014 • Further reviews key priority in HL strategy

Issue identified Action plan goal Key health literacy intervention(s)

Range of understandings of health literacy among leaders in CM Health (including oral health)

To develop a shared understanding of, and commitment to, health literacy among CMH and oral health leadership

Development of health literacy strategy for CM Health

Commitment to implementation of the health literacy action plan for oral health

Lack of integration of oral health with primary care

To support the discussion of oral health within primary health care

Develop clear oral health messages, health literacy approaches to building patient knowledge/ behaviour for primary care, community health workforce

Adult population only seeking event-based care

To improve adult understanding of the value of oral health and regular oral health checks

Professional development for oral health workforce re conversations which build health literacy

Direct messaging strategy (e.g. early intervention) for adult population +/- community champions

Clarify pathways for accessing funding, interpreters

Low rates of pre-school participation in oral health services

To achieve greater participation of pre-schoolers in oral health services

Health literacy education package focused on babies’/ pre-schoolers’ health for Well Child/ Tamariki Ora providers

Clarify eligibility, processes for accessing services / multi-lingual assistance

Adolescents becoming disconnected from oral health services and poor participation (and poor transition to adult services)

To increase active participation by adolescents in oral health and successful transition to adult oral health services

Develop adolescent-appropriate oral health literacy messages

Professional development for oral health workforce re approaches which build health literacy

Clarify process for adolescent enrolment, follow-up of those not enrolling

Moving forward

• Strategy outlines key actions: – Capacity building approach for health literacy reviews

and interventions – Reviews carried out by services – Action plan development and implementation – Staff awareness and training – Policies re health literacy across organisation – Evaluation

• Further consultation in process to refine/ progress, align with other initiatives

Discussion

• “If you want to go fast, go alone; if you want to go far, take others with you”

Counties Manukau District Health Board

Health Excellence Framework

Recommendation It is recommended that the Hospital Advisory Committee note: • The HEF evaluation team site visit is scheduled for 15-17th September 2014 • The rationale as to why this process is being undertaken by the organisation Prepared and submitted by: Mark Young on Behalf of Martin Chadwick Purpose The purpose of this paper is to update HAC on the Health Excellence Framework and inform them of the scheduled evaluation site visit in September from the 15th to 17th as part of the Business Excellence Programme 2014. Background With the shaping up of the “Achieving a Balance” strategy, the opportunity arose to revisit the appropriate accountability framework to adopt as an organisation. With the stated goal of “Being the Best Healthcare System by 2015” there is the challenge of how we measure and quantify if this goal has been achieved.

Since 2008, when the decision was made to not seek accreditation, several options have been examined to identify what will work best for CMDHB to be able to have in place a robust accountability framework. The Health Excellence Framework (HEF) has been reviewed and compared to other options and was accepted as the best fit for the organisation. The HEF is not a certification process, nor is it an accreditation process. Rather it provides an accountability framework to allow the organisation to articulate how it performs the functions of a high performing organisation.

HEF ties directly in to our Triple Aim and the six executable strategies of our Achieving a Balance programme, and is an integral part of monitoring and measuring our goal to be the ‘best healthcare system in Australasia by 2015’. In December 2013 it was agreed by ELT that CM Health would enter an application in the Business Excellence Award in 2014 as an organisational quality improvement initiative.

The award process is aligned to the Baldrige criteria for Performance Excellence. The major focus of the awards is on performance in the six key areas: Leadership, Strategic Planning, Customer Focus, Measurement, Analysis and Knowledge Management, Workforce Focus, Operations Focus and Results. In January 2014 a working group was set up representing key people from across CM Health. Each member of the working group was responsible for an area from the 7 criteria led by an executive lead from ELT.

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The following table represents the working group and executive leads: Criteria Working Group Lead Executive Lead

1. Organisational Profile Mark Young Martin Chadwick 2. Leadership Dr Karina McHardy

Dr David Galler Professor Jonathan Gray

3. Strategic Planning Marianne Scott Margie Apia 4. Customer Focus Dr Lynne Maher Denise Kivell 5. Measurement, Analysis & Knowledge Mgt

Alex Poor Dr Mataroria Lyndon

Professor Jonathan Gray

6. Workforce Focus Kim Wiseman Professor Jonathan Gray 7. Operations Focus Jenny Pooley Phillip Balmer 8. Results Margaret White Ron Pearson In May 2014 an application was completed and submitted with the intention of being an organisational quality improvement initiative. In June 2014 seven national evaluators were selected to review our application and prepare to carry out the site visit. The evaluation team are:

• Trish Macpherson, (Team Leader), Kamo Home and Village • Tracey Hancock, Thexton, St John NZ • Phil Carter, International Accreditation NZ • Nardi Dyke, Auckland Council • Warren McLuckie , Royal NZ Navy • Justin Walsh, Spectrum Care Trust • Fiona Gavriel – CEO NZBEF (Observer)

With the application submitted and the evaluation team confirmed, our attention turns to the site visit, which has been set for September 15 -17th. During the 3 day visit the evaluators will conduct pre scheduled interviews as well as general walk a rounds and informal interviews with team members. Feedback from the evaluation team will be received in November of this year. This will form the basis of any action points raised through the process as to how we need to improve as an organisation to reach our stated goal of being “The Best Healthcare System in Australasia by 2015”.

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Counties Manukau District Health Board Hospital Advisory Committee Meeting – 10 September 2014

6.0 Resolution to Exclude the Public Resolution: That in accordance with the provisions of Schedule 3, Clause 32 and Sections 6, 7 and 9 of the NZ Public Health and Disability Act 2000 the public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:




7.1 Patient Safety Report




7.2 Risk Register That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.



7.3 Non Resident Profile Update




7.4 Minutes of HAC meeting 13 August 2014

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of

Confirmation of Minutes For the reasons given in the previous meeting.

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information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9(3)(g)(i))of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S32(a)]

7.5 Action Items Register


Action Items Register For the reasons given in the previous meeting.

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Documents

Counties Manukau District Health Board Hospital Advisory ......Next Meeting: 1 October 2014, Ko Awatea Innovation Lab . 2 BOARD MEMBER ATTENDANCE SCHEDULE – HAC 2014 Name ... Kathy