Hospital Advisory Committee Meeting Wednesday, 05 August ... · Hospital Advisory Committee Meeting...

Hospital Advisory

Committee Meeting

Wednesday, 05 August 2015

9.30am

A+ Trust Room

Clinical Education Centre

Level 5

Auckland City Hospital

Grafton

He Oranga Tika Mo Te Iti Te Rahi

Healthy Communities, Quality Healthcare

Published 29 July 2015

Auckland District Health Board Hospital Advisory Committee Meeting 05 August 2015

Agenda Hospital Advisory Committee

05 August 2015

Venue: A+ Trust Room, Clinical Education Centre

Level 5, Auckland City Hospital, Grafton

Time: 9.30am

Committee Members

Judith Bassett (Chair)

Jo Agnew

Peter Aitken

Doug Armstrong

Dr Chris Chambers

Assoc Prof Anne Kolbe

Dr Lester Levy

Dr Lee Mathias

Robyn Northey

Morris Pita

Gwen Tepania-Palmer

Ian Ward

Auckland DHB Executive Leadership

Ailsa Claire Chief Executive Officer

Simon Bowen Director of Health Outcomes – ADHB/WDHB

Margaret Dotchin Chief Nursing Officer

Joanne Gibbs Director Provider Services

Naida Glavish Chief Advisor Tikanga and General Manager Māori

Health – ADHB/WDHB

Dr Debbie Holdsworth Director of Funding – ADHB/WDHB

Dr Andrew Old Chief of Strategy, Participation and Improvement

Rosalie Percival Chief Financial Officer

Linda Wakeling Chief of Intelligence and Informatics

Sue Waters Chief Health Professions Officer

Dr Margaret Wilsher Chief Medical Officer

Auckland DHB Senior Staff

Dr Vanessa Beavis Director Perioperative Services

Dr John Beca Director Surgical, Child Health

Dr Clive Bensemann Director Mental Health

Jo Brown Funding and Development Manager Hospitals

Judith Catherwood Director Long Term Conditions

Dr Mark Edwards Director Cardiac Services

Mark Fenwick Senior Communications Advisor

Dr Sue Fleming Director Women’s Health

Mr Wayne Jones Director Surgical Services

Auxilia Nyangoni Deputy Chief Financial Officer

Tony O’Connor Director Participation and Experience

Dr Michael Shepherd Director Medical, Children’s Health

Marlene Skelton Corporate Business Manager

Dr Barry Snow Director Adult Medical

Dr Richard Sullivan Director Cancer and Blood and Deputy Chief

Medical Officer

Clare Thompson General Manager Non Clinical Support Services

Frank Tracey General Manager and Acting Director Clinical

Support Services

Gilbert Wong Director Communications

(Other staff members who attend for a particular item are named at the start

of the respective minute)

Apologies Members: Robyn Northey.

Apologies Staff: Richard Sullivan.

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Agenda Please note that agenda times are estimates only

9.30am 1. Attendance and Apologies

9.35am 2. Register and Conflicts of Interest

Does any member have an interest they have not previously disclosed?

Does any member have an interest that may give rise to a conflict of interest with a matter on the agenda?

9.40am 3. Confirmation of Minutes 24 June 2015

9.45am 4. Action Points

9.50am 5. Provider Arm Performance Report

5.1 Scorecard

5.2 Overall Provider Performance including Health Target Updates

5.3 Financial and Operational Performance

10.00am 6. Directorate Updates

6.1 Mental Health Directorate

6.2 Women’s Health Directorate

6.3 Child Health Directorate

6.4 Surgical Services Directorate

6.5 Perioperative Services Directorate

6.6 Cardiovascular Directorate

6.7 Adult Medical Directorate

6.8 Cancer and Blood Directorate

6.9 Clinical Support Services

6.10 Non-Clinical Support Services

6.11 Community and Long Term Conditions Directorate

10.30am 7. Patient Experience Report

7.1 Inpatient and Outpatient Experience

10.35am 8. Resolution to exclude the public

Next Meeting: Wednesday, 16 September 2015 at 9.30am A+ Trust Room, Clinical Education Centre Level 5, Auckland City Hospital, Grafton

Hei Oranga Tika Mo Te Iti Me Te Rahi

Healthy Communities, Quality Healthcare

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Attendance at Hospital Advisory Committee Meetings

Members 0

2 A

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14

14

May

. 14

25

Ju

n. 1

4

06

Au

g. 1

4

17

Se

p. 1

4

29

Oct

. 14

10

De

c. 1

4

18

Fe

b. 1

5

01

Ap

r. 1

5

13

May

. 15

24

Ju

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15

5 A

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15

Judith Bassett (Chair) 1 1 x 1 1 1 1 1 1 1 1

Joanne Agnew 1 1 1 1 1 1 1 1 x 1 1

Peter Aitken 1 1 1 1 1 1 1 1 1 1 1

Doug Armstrong 1 1 1 1 1 1 1 1 1 1 1

Chris Chambers 1 1 1 1 1 1 1 1 1 1 1

Anne Kolbe 1 1 1 x 1 1 1 1 1 1 x

Lester Levy x 1 1 1 1 1 1 1 1 x 1

Lee Mathias 1 1 1 1 x 1 1 1 1 1 1

Robyn Northey 1 1 1 x 1 1 1 1 1 1 1

Morris Pita 1 1 1 1 x 1 1 x 1 1 1

Gwen Tepania-Palmer

1 1 1 1 1 1 1 1 1 x 1

Ian Ward 1 1 1 1 1 1 1 1 1 1

Key: x = absent, # = leave of absence

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Conflicts of Interest Quick Reference Guide Under the NZ Public Health and Disability Act Board members must disclose all interests, and the full

nature of the interest, as soon as practicable after the relevant facts come to his or her knowledge.

An “interest” can include, but is not limited to:

Being a party to, or deriving a financial benefit from, a transaction

Having a financial interest in another party to a transaction

Being a director, member, official, partner or trustee of another party to a transaction or a

person who will or may derive a financial benefit from it

Being the parent, child, spouse or partner of another person or party who will or may derive a

financial benefit from the transaction

Being otherwise directly or indirectly interested in the transaction

If the interest is so remote or insignificant that it cannot reasonably be regarded as likely to

influence the Board member in carrying out duties under the Act then he or she may not be

“interested in the transaction”. The Board should generally make this decision, not the individual

concerned.

Gifts and offers of hospitality or sponsorship could be perceived as influencing your activities as a

Board member and are unlikely to be appropriate in any circumstances.

When a disclosure is made the Board member concerned must not take part in any deliberation

or decision of the Board relating to the transaction, or be included in any quorum or decision, or

sign any documents related to the transaction.

The disclosure must be recorded in the minutes of the next meeting and entered into the

interests register.

The member can take part in deliberations (but not any decision) of the Board in relation to the

transaction if the majority of other members of the Board permit the member to do so.

If this occurs, the minutes of the meeting must record the permission given and the majority’s

reasons for doing so, along with what the member said during any deliberation of the Board

relating to the transaction concerned.

IMPORTANT

If in doubt – declare.

Ensure the full nature of the interest is disclosed, not just the existence of the interest.

This sheet provides summary information only - refer to clause 36, schedule 3 of the New Zealand

Public Health and Disability Act 2000 and the Crown Entities Act 2004 for further information

(available at www.legisaltion.govt.nz) and “Managing Conflicts of Interest – Guidance for Public

Entities” (www.oag.govt.nz ).

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Register of Interests – Hospital Advisory Committee

Member Interest Latest

Disclosure

Judith BASSETT (Chair)

Fisher and Paykel Healthcare

Westpac Banking Corporation

14.05.2014

Jo AGNEW Professional Teaching Fellow - School of Nursing, Auckland University

Appointed trustee Starship Foundation

Casual Staff Nurse - ADHB

01.03.2014

Peter AITKEN Pharmacy Locum - Pharmacist

Shareholder/ Director, Consultant - Pharmacy Care Systems Ltd

Shareholder/ Director - Pharmacy New Lynn Medical Centre

17.01.2014

Doug ARMSTRONG Fisher and Paykel Healthcare

Ryman Healthcare

Trustee – Woolf Fisher Trust

Daughter is a partner – Russell McVeagh Lawyers

Member - Trans-Tasman Occupations Tribunal

18.06.2015

Chris CHAMBERS Employee - ADHB

Wife is an employee - Starship Trauma Service

Clinical Senior Lecturer in Anaesthesia - Auckland Clinical School

Member – Association of Salaried Medical Specialists

Associate - Epsom Anaesthetic Group

Shareholder - Ormiston Surgical

26.01.2014

Anne KOLBE Joint owner - Kolbe Medical Services Ltd

Senior Consultant - Communio NZ

Senior Consultant - Siggins Miller, Australia

Member - Risk and Audit Committee, Whanganui District Health Board

Chair - National Health Committee

Member - Australian Institute of Directors

Husband:

Professor of Medicine, University of Auckland

Chair - Health Research Council of NZ, Clinical Trials Advisory Committee

Member - Australian Medical Council, Medical School Advisory Committee

Lead - Medical Specialties Advisory Committee Accreditation Team, Royal

Australian College of General Practitioners

Member - Executive Committee, International Society for Internal Medicine

Chair - RACP Re-validation Working Party

Member - RACP Governance Working Party

Son: Employee - Hawkins Construction

01.02.2014

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Lester LEVY Chairman - Waitemata District Health Board (includes Trustee Well Foundation

- ex-officio member as Waitemata DHB Chairman)

Chairman - Auckland Transport

Independent Chairman - Tonkin and Taylor Ltd (non-shareholder)

Director - Orion Health (includes Director – Orion Health Corporate Trustee Ltd)

Professor (Adjunct) of Leadership - University of Auckland Business School

Head of the New Zealand Leadership Institute – University of Auckland

Member – State Services Commission Performance Improvement Framework

Review Panel

Director and sole shareholder – Brilliant Solutions Ltd (private company)

Director and shareholder – Mentum Ltd (private company, inactive, non-

trading, holds no investments. Sole director, family trust as a shareholder)

Director and shareholder – LLC Ltd (private company, inactive, non-trading,

holds no investments. Sole director, family trust as shareholder)

Trustee – Levy Family Trust

Trustee – Brilliant Street Trust

19.02.2015

Lee MATHIAS Chair - Counties Manukau Health

Deputy Chair - Auckland District Health Board

Chair - Health Promotion Agency

Chair - Unitec.

Director - Health Innovation Hub

Director - Health Alliance Limited

Director - Health Alliance (FPSC) Limited

Chair - IAC IP Limited

Director/shareholder - Pictor Limited

Director - Lee Mathias Limited

Director - John Seabrook Holdings Limited

Advisory Chair - Company of Women Limited

Trustee - Lee Mathias Family Trust

Trustee - Awamoana Family Trust

Trustee - Mathias Martin Family Trust

Director – New Zealand Health Partnerships

29.06.2015

Robyn NORTHEY Self-employed Contractor - Project management, service review, planning etc. Board Member - Hope Foundation Trustee - A+ Charitable Trust

20.06.2012

Morris PITA Member – Waitemata District Health Board

Shareholder – Turuki Pharmacy, South Auckland

Owner and operator with wife - Shea Pita & Associates Ltd

Wife is member of Northland District Health Board

Wife provides advice to Maori health organisations

13.12.2013

Gwen TEPANIA-PALMER

Board Member - Waitemata District Health Board

Board Member - Manaia PHO

Chair - Ngati Hine Health Trust

Committee Member - Te Taitokerau Whanau Ora

Committee Member - Lottery Northland Community Committee

Member - Health Quality and Safety commission

02.04.2013

Ian WARD Board Member - NZ Blood Service

Director and Shareholder – C4 Consulting Ltd

CEO – Auckland Energy Consumer Trust

Shareholder – Vector Group

09.07.2014

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7

Auckland District Health Board Hospital Advisory Committee Meeting 24 June 2015 Page 1 of 13

Minutes

Hospital Advisory Committee Meeting

24 June 2015

Minutes of the Hospital Advisory Committee meeting held on Wednesday, 24 June 2015 in the A+ Trust Room, Clinical Education Centre, Level 5, Auckland City Hospital, Grafton commencing at 9.30am

Committee Members Present

Judith Bassett (Chair)

Jo Agnew

Peter Aitken

Doug Armstrong

Dr Chris Chambers

Dr Lester Levy [Arrived 10 am]

Dr Lee Mathias

Robyn Northey

Morris Pita

Gwen Tepania-Palmer [Arrived 10.27 am]

Ian Ward

Auckland DHB Executive Leadership Team Present

Ailsa Claire Chief Executive Officer

Dr Debbie Holdsworth Director of Funding – ADHB/WDHB

Dr Andrew Old Chief of Strategy, Participation and

Improvement

Rosalie Percival Chief Financial Officer

Linda Wakeling Chief of Intelligence and Informatics

Sue Waters Chief Health Professions Officer

Dr Margaret Wilsher Chief Medical Officer

Auckland DHB Senior Staff Present

Dr Vanessa Beavis Director Perioperative Services

Dr John Beca Director Surgical Child Health

Dr Clive Bensemann Director Mental Health

Judith Catherwood Director Community and Long Term

Conditions

Dr Mark Edwards Director Cardiac Services

Mark Fenwick Senior Communications Advisor

Dr Sue Fleming Director Women’s Health

Dr Wayne Jones Director Surgical Services

Dr Michael Shepherd Director Medical Child Health

Dr Barry Snow Director Adult Medical

Dr Richard Sullivan Director Cancer and Blood

Frank Tracey General Manager and Acting Director

Clinical Support Services

Marlene Skelton Corporate Business Manager

Michelle Webb Corporate Committee Administrator

Gilbert Wong Director Communications

(Other staff members who attend for a particular item are named at the

start of the minute for that item)

1. APOLOGIES

That the apologies of Associate Professor Anne Kolbe be accepted.

That the apologies of Executive Leadership Team Member Margaret Dotchin, Chief Nursing

Officer and senior staff members Clare Thompson, General Manager Non Clinical Support

Services and Jo Brown, Funding and Development Manager Hospitals be accepted.

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2. CONFLICTS OF INTEREST

Dr Lee Mathias (Deputy Chair) asked that it be recorded in the interests register that she

was now a Director with New Zealand Health Partnerships Ltd.

There were no declarations of conflicts of interest for any items on the open agenda.

3. CONFIRMATION OF MINUTES 13 May 2015 (Pages 8 to 20)

Resolution: Moved Jo Agnew / Seconded Chris Chambers

That the minutes of the Hospital Advisory Committee meeting held on 13 May 2015 be

confirmed as a true and accurate record.

Carried

4. ACTION POINTS 13 May 2015 (Page 21)

5. 4.1 Eating Disorders Service Model Redesign

Judith Bassett expressed her disappointment at the slow progress of the Ministry of Health decision in relation to the Eating Disorders Services. It was noted that the Auckland DHB Executive and Hospital Advisory Committee would continue active pursuit of this matter.

5 PROVIDER ARM PERFORMANCE REPORT

5.1 Scorecard (Pages 24 to 25)

Judith Bassett drew the Committee’s attention to the key indicator targets of interest and

their associated commentary; in particular Falls with Major Harm and the % Day Surgery

rate, noting that the Day Surgery rate was actively being worked on and that it showed a

slight downward trend.

Ailsa Claire advised that evaluation of the use of the Greenlane site was being undertaken

to assess its role in the separation of acute and elective day surgery.

It was pointed out that the activity related to elective volumes was not reflective of all

surgery undertaken. The lower volume activity for electives was reflective of the issues

being experienced around wait times which were less than a month in some cases. There is

full utilisation of staff at the Greenlane site and there are continuing efforts to enhance

efficiency.

It was noted that whilst Maori and Pacifica Did Not Attend (DNA) rates were nominally

down, there was still concern with the ongoing situation.

5.2 Overall Provider Performance including Health Target Updates (Pages 26 to 49)

[Secretarial Note: This item was considered in conjunction with item 5.1]

Judith Bassett commented that that the Health target updates indicated that most were

trending in the right direction, with the exception of the Increased Immunisation target for

8-month old children.

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5.3 Financial and Operational Performance Report (Pages 50 to66)

Rosalie Percival, Chief Financial Officer asked that the report be taken as read.

The following points were covered in discussion of the report:

The overall Provider Arm result for the month is $1.0M unfavourable but still

remains on track for year-end forecast. The key driver is unfavourable personnel

costs driven by Nursing FTE greater than budget and one off SMO related costs.

There is still a requirement to carefully manage the FTE budget. A significant

amount of work is being undertaken to ensure headcount remains within budget.

Regular meetings with Directorates are showing good engagement and a wide

group of people have committed to understanding and resolving the issue.

Directorates have moved to undertaking more work in-house, and paying close

attention to utilisation of time allocated and the related productivity. A significant

contributor to FTE variations is use of agency staff. There was a need to have

watches suitably staffed which also resulted in a noticeable FTE increase. Staff

attention has been drawn to TrendCare to demonstrate gaps and the required

actions to address these.

There are risks with the IDF wash up that have been provided for this financial

year. Should volumes be down in the following year there will be a need to

understand the reasons behind it. It will be important to evaluate the last four

months of data in relation to case weights to determine the effect on volume levels

up to June 2015 and to then consider whether the volumes predicted for next year

financial year are accurate.

Some Directorates have achieved good savings in relation to Business

Transformation while others are still facing challenges in achieving savings plans.

This can be attributed to over-optimism for some, in relation to model changes and

the lead time required to see benefits realisation. Others have seen high volumes,

for example Acute ED which has impeded them. However, a strong focus has been

placed on process improvement and efficiency so some Directorates have shown

results that are better than expected.

The Model of Care changes have the potential to deliver savings; some are long term with difficulties attached but will deliver a result. Monitoring of the savings plans within directorates occurs six-weekly and then there are weekly meetings with each Directorate to ensure regular updates on progress are obtained.

Actions:

1. That the Committee’s appreciation for the good work they are undertaking in

managing and improving expenditure related to personnel costs be conveyed to the

Directorates by the Chief Financial Officer.

2. That detail on the average cost per nurse, the financial impact of changing the ratio

of juniors to seniors and information on the Nurse Director Actions Management

currently in place be included in the Financial and Operational report to the August

HAC.

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That the Provider Arm Performance Report for June 2015 be received.

6 DIRECTORATE UPDATES

[Secretarial Note: Item 6.4 was taken first.]

6.1 Mental Health Directorate (Pages 68 to 73)

Dr Clive Bensemann, Director Mental Health asked that the report be taken as read.


There is a markedly high count for Incidents of Restraint for the month however 30% of the events are related to one patient.

A Surveillance Audit against the Health and Disability Services standards has been completed with satisfactory results and is complimentary about the service.

The resolution of the regional Eating Disorders Service Model continues to be slow, with MOH decisions still pending. Conversations are still being had at Chief Executive, Chief Medical Officer and Ministry of Health levels. The Service in the meantime is proceeding with matters to the extent of the current mandate that it has.

The implementation of Family Violence screening and training is in progress and has been rolled out across the Directorate.

While Auckland DHB is not formally part of the Waitemata DHB Youth Hub initiative, steps have been taken to implement the actions relating to Child and Youth Mental Health through the strengthening of mental health education within schools that the Auckland DHB itself is in partnership with.

Infrastructure requirements have been separated from IT clinical services programming development model. Care and service delivery all have work inplications and there will be a need to ensure regional DHB alignment. In terms of IT solutions it is acknowledged that Auckland DHB can make better use than it currently does of mobile technology.

Advice was given that on occasion staff start before actual Pre-employment Screening has been completed. A small number of new staff, due to time pressures, commence work prior to results being available. This is not the norm, but does create risk to the Auckland DHB however, this risk is regularly reported and a risk certification process is performed to identify staff working in high health risk areas.

Action:

1. That Sue Waters brief Morris Pita on the implementation of Family Violence

Screening.

2. That a paper on pre-employment screening for new Auckland DHB employees be

provided in the Health and safety report to the next meeting of the Board.

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6.2 Women's Health Directorate (Pages 74 to 80)

Sue Fleming, Director Women’s Health, asked that the report be taken as read. There were

no questions.

[Secretarial Note: Item 6.5 was considered next]

6.3 Child Health Directorate (Pages 81 to 89)

Dr John Beca, Director Surgical Child Health and Dr Michael Shepherd, Director Medical Child Health asked that the report be taken as read.


Good progress has been made on DNA rates, with a reduction to 9% this month resulting from a strong focus on this issue. One such example is the Children’s Health team’s efforts in working across DHBs and collaboratively with WINZ and CYFS to follow up on non-access of service by children.

Wait times for child disability assessments (including community based) are being well managed and volumes are being coped with effectively by a team of Developmental Paediatricians and Child Health staff working alongside each other.

Long term development planning for Starship is in underway but progress is dependent on the completion of a tertiary services review and the development of a clinical services specification which includes projected funding and financial information. Negotiation is also needed with national services and other DHBs. The future of the services needs to be known before investment required in facilities can be determined. While it is anticipated that the Clinical Services Review will be completed over the coming 3 to 4 months, the remainder of the work will take some time. This is why the Board has previously agreed that over the next four to five years it is a priority to make the Starship building sustainable to allow agreement of the tertiary services to take place.

Gwen Tepania-Palmer formally acknowledged the excellent work that had been

completed to date in relation to Rheumatic Fever Prevention Programme.


6.4 Surgical Services Directorate (Pages 90 to 97)

Dr Wayne Jones, Director Surgical Services Health asked that the report be taken as read. The following points were covered in discussion of the report:

A major improvement has been observed in DNA rates for Maori and Pacific; previously 24% they have continued to reduce to 16% which is a further gain on the previous month. The appointment of three System Navigators has contributed to this reduction.

The majority of DNA appointments are follow-up appointments. Work is being completed around follow-up protocols and streamlining to ensure culturally appropriate systems and processes, as well as consideration being given to whether or not the appointment meets the needs of the patient.

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The cost of a Surgical DNA is estimated at approximately $240 for FSA and $170 for DNA. Additional cost is incurred in terms of unanticipated empty appointments that might have been reallocated to other patients, and the future health issues the DNA patient may face as a result of not attending their appointment.

Work is being undertaken to determine just how relevant follow-ups are by creating them in different guises; for example, allowing GP’s to manage in relation to breast cancer to see what the rate then would be.

The number of scheduled appointments turning up on time and seen on time per patient is unknown at this time but is being considered as part of the work of the Patient Experience Officer.


6.5 Perioperative Services Directorate (Pages 98 to 103)

Dr Vanessa Beavis, Director Perioperative Services asked that the report be taken as read. The following points were covered in discussion of the report:

Financials for the month were unfavourable due to high theatre volumes being experienced.

The general increase seen in medication errors is due to a drive to encourage manual reporting of these errors. While reporting has increased the level of harm has not.

6.6 Cardiovascular Directorate (Pages 104 to 110)

Dr Mark Edwards, Director Cardiac Services asked that the report be taken as read. The

following points were covered in discussion of the report:

Reporting on medication errors has improved as a result of a Patient Safety Nurse being appointed.

The balance between acute and electives is being actively managed by reallocation of resources across the service. This includes theatres and (where appropriate to skill levels) staff.

ICU’s have demonstrated a willingness to embrace a more integrated care plan. For example, vascular patients can be managed in acute care while cardiothorasic patients cannot. There is not an intensive care plan currently in place that would allocate patients to other ICU’s. It is anticipated that the new DCCM leadership will progress this.

The noted reduction in the prevalence of coronary artery disease in the Auckland community versus other DHBs has been reducing over the last ten years. This appears to be due in part to regional ethnic proportions, in particular, Auckland’s higher Asian population.

6.7 Adult Medical Directorate (Pages 111 to 116)

Dr Barry Snow, Director Adult Medical asked that the report be taken as read. The


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Key achievements for the month include a range of improvements that have been implemented, the now active new directorate structure, and the appointment of a Nurse Advisor and Service Clinical Director DCCM.

Gastroenterology has resolved training issues in advance of the accreditation deadline.

Planning for a potential rebuild of the Endoscopy Suite at Greenlane is a strong area of focus going forward.

In a broader sense, there is a need to work towards the management of the unstable very sick patient. This type of patient requires a lot of time and work. So the focus is on the sick patient first to determine what changes might be made to streamline and reduce cost.

6.8 Cancer and Blood Directorate (Pages 117 to 125)

Dr Richard Sullivan, Director Cancer and Blood asked that the report be taken as read. The


DNA rates for all outpatient appointments have reduced to 9%.

The Ministry of Health has determined a new target of 85% for patients with high suspicion of cancer being treated within the 31/62 day target by July 2016, moving in July 2017 to a target of 90%.

The Medical Oncology service is now scoping the requirements of moving towards a strategy of patient focussed clinic care. Focus groups are occurring on the concept of an integrated clinic with the objective of reducing multiple visits and referrals for patients. Pilot joint clinics have already begun in two cancer stream areas. This is encouraging for patients however, the facilities need to be made to fit this new model of care. This fits with the new general theme of organising services around the patient.

[Secretarial Note: Item 6.11 was taken next]

6.9 Clinical Support Services (Pages 126 to 132)

Frank Tracey, General Manager and Acting Director Clinical Support Services asked that the

report be taken as read.


The Clinical Support Services scorecard was displaying multiple negative target variations due to reporting and data availability issues.

There are concerns with addressing the capacity and demand issues associated with meeting new MOH targets for MRI and ultrasound. CT is on track to meet targets.

Discussions with Waitemata DHB, and collaborative work with NRA are in progress to bring unified solutions to managing regional waitlists. Workforce challenges are contributing to waitlist issues, and details will be provided on this in the next report.

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Actions:

1. That a paper explaining current wait times, wait lists and the timeframes strategy be provided to the August meeting of HAC.

2. That details of the workforce challenges that are impacting on regional waitlists be incorporated in the next Clinical Support Services Directorate report to the August meeting of HAC.

[Secretarial Note: Lester Levy arrived for the start of item 9.10]

6.10 Non-Clinical Support Services (Pages 133 to 144)

In the absence of Clare Thompson, General Manager Non-Clinical Support Services, Frank

Tracey, Acting Director Clinical Support asked that the report be taken as read.


The increase in voluntary turnover annually was related to the transfer of the food service to Compass and is specifically related to this phase of the project. It is situation specific and not considered to be an emerging trend. The project team will continue to work very closely with Compass and are in discussions regarding the next phase.

The Cleaning Audit scores were extremely positive for the month.

The Literacy and Numeracy course for staff was producing notable benefits for staff, and good results were already being observed

Progress on redevelopment of the kitchen was making progress however some challenges had been experienced regarding phasing out existing kits. Focus was placed on maintaining current services while decommissioning some of the equipment. Health and Safety considerations were well integrated into the project and would continue to be of high importance.

Retail revenue from retail concessions and tenants was positive. The Muffin Break stall had been relocated, and clear guidelines regarding what can be sold to promote healthy eating had been successful.

Advice was given that the Hector Trust funding applications are restricted to funding for the Greenlane site; any opportunities have been pursued as appropriate. The Board Chair asked that the Director Communications write a piece about the Hector Trust in order to provide some credit for the work that they do.

Action:

That a communications piece on the history and work of the Hector Trust be developed. [Secretarial Note: Item 6.3 was taken next]

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6.11 Community and Long Term Conditions Directorate (Pages 145 to 151)

Judith Catherwood, Director Community and Long Term Conditions asked that the report

be taken as read.

Judith Bassett drew the Committee’s attention to the achievements made in employing

necessary changes, and in improved patient flow and reductions in leave liability. The


Improvements had been gained with the Nurse Director leading the processes and systems relating to patients presenting with pressure injury.

The relationship with the patient has improved as result of the new cluster model.

[Secretarial Note: Item 6.1 was taken next]

That the directorate updates for June 2015 be received.

7 PATIENT EXPERIENCE REPORT (Pages 152 to 156)

Inpatient and Outpatient Experience

Dr Andrew Old, Chief of Strategy, Participation and Improvement, asked that the report be

taken as read.


This was the first time that the Inpatient and Outpatient reports had been presented as one. The focus of the report had shifted to being values based. A decision had been made to have a low key push on values with the Level 5 reception space upgrade being the first evidence of the new values.

A Patient Survey on Anaesthetic was now live. A shorter survey would also be completed for ED, which was an area that was often unable to be surveyed due to the nature of service discharges. The surveys were also intended to be a mechanism to encourage increased use of the online portal. The newly appointed Director Participation and Experience will be leading community participation in surveys going forward.

The digital wall in the Level 5 Reception space was now live. Feedback received from those using public spaces had informed development plans for the reception space to improve access to information and utilities and increasing functionality of the space. A set of content had been developed for TV viewing and the spaces can also be used as Kiosk space on theme days.

That the Patient Experience report for June 2015 be received.

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8 INFORMATION PAPERS

8.1 Outpatients Did Not Attends: Research Opportunities (Pages 158 to 161)

Dr Margaret Wilsher asked that the report be taken as read.

Matters covered in discussion of the report and in response to questions included:

Morris Pita felt that if a deep dive were conducted by Auckland DHB staff

themselves that data collation and analysis regarding DNAs, FSAs and other

ambulatory appointments was required. It would be harder to determine and

measure what a DNA meant for a patient and the family. They may see no value

but the notion of value is different for different people and cultures. A more

consolidated report based on facts rather than opinion is required.

It was agreed that the challenge was to measure what the appointment means to

the patient and family and what the cost of missed opportunities is. Different

value is placed upon the appointment by patients of different ages, cultures and

genders. Additionally, the reasons for DNA’s may be different for different

services, so this would need to be considered at a Directorate level. Local and

regional data would be needed to inform the research.

There have been very positive gains made by the Directorates in DNA reduction

and these should be examined to determine what the success factors have been,

so that they can be included in future planning.

Sustainable transport options and accessibility issues are acknowledged as a

potential factor and are under consideration as part of the Sustainable Transport

Project, as cited in the Sustainable Transport Project Update report presented to

the May 2015 HAC meeting.

The Board Chair Lester Levy cautioned that the problem needed to be understood

first. That Auckland DHB could do its own piece of research which would inform

later instruction to the HRC in undertaking an investigation of the issue.

Action:

That the Sustainable Transport Project Update report presented to the 13 May 2015 HAC

meeting be recirculated to HAC members.

Resolution: Moved Judith Bassett / Seconded Jo Agnew

1) That the Outpatients Did Not Attends: Research Opportunities Report be received.

2) That the Committee support the suggestions in the Conclusions section of the Outpatients Did Not Attend: Research Opportunities report as the most practical way of progressing our work. That is;

17


a. Progress with existing work in the areas outlined in options 1 and 4). This

is the most expedient way to gain local data (and relevant data from

other DHBs) and those data can be consolidated into a report for the

provider to consider in respect of service delivery options.

b. That Dr Kathryn McPherson, CEO, HRC is invited to speak to the Board

on the options for HRC partnership funding, perhaps once the outcome

of the current HRC strategic refresh is known. This would allow time for

the Board to consider its strategic priorities in terms of research.

c. It is suggested that any instruction to the AAHA is left until more

information is available, especially as pilot studies are already in

progress.

Carried

9 RESOLUTION TO EXCLUDE THE PUBLIC (Pages 162 to 163)

Resolution: Moved Judith Bassett / Seconded Morris Pita

That in accordance with the provisions of Clauses 34 and 35, Schedule 4, of the New Zealand 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

item to be considered

Reason for passing this resolution

in relation to the item

Grounds under Clause 32 for the

passing of this resolution

3. Confirmation of Confidential Minutes 13 May 2015

Confirmation of Minutes As per resolution(s) from the open section of the minutes of the meeting, in terms of the NZPH&D Act 2000.

That the public conduct of the

whole or the relevant part of the

meeting would be likely to result

in the disclosure of information

which good reason for

withholding would exist under

any of sections 6, 7, or 9 (except

section 9(2)(g)(i)) of the Official

Information Act 1982 [NZPH&D

Act 2000]

4. Confidential Action Points

Confirmation of Action Points As per resolution(s) from the open section of the minutes of the meeting, in terms of the NZPH&D Act 2000.










Act 2000]

3

18


5. Health and Safety

Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 s9(2)(i)]

Obligation of Confidence

The disclosure of information

would not be in the public interest

because of the greater need to

protect information which is

subject to an obligation of

confidence [Official Information

Act 1982 s9(2)(ba)]










Act 2000]

6. Risk Report Commercial Activities To enable the Board to carry out, without prejudice or disadvantage, commercial activities [Official Information Act 1982 s9(2)(i)]

Negotiations To enable the Board to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations) [Official Information Act 1982 s9(2)(j)]








Act 1982 s9(2)(ba)]










Act 2000]

7. Quality Report (includes complaints, compliments, incidents, and policies and procedures)









Act 1982 s9(2)(ba)]










Act 2000]

19


9. Information Papers (includes National Orthopaedic Report, Improved Access to Elective Surgery, and Wāhine/Women’s Health Collaboration Maternity Proposals)



The disclosure of information would not be in the public interest because of the greater need to protect information which is subject to an obligation of confidence [Official Information Act 1982 s9(2)(ba)]











Act 2000]

Carried

The meeting closed at 1:10pm.

Signed as a true and correct record of the Hospital Advisory Committee meeting held on Wednesday, 24 June 2015

Chair: Date:

Judith Bassett

3

20

Auckland District Health Board Hospital Advisory Committee Meeting 24 June 2015

Action Points from Previous Hospital Advisory Committee Meetings

As at Wednesday, 24 June 2015

Meeting and Item

Detail of Action Designated to Action by

6 Aug 2013

Item 6

Ethnicity Data

Ethnicity Data/benchmarking data to be provided when the new national Cardio surgical Database is implemented

Director Provider Services

Date to be advised when determined

by MoH

17 Sep 2014

Item 6.1

Eating Disorders Service Model Redesign

That a brief presentation on the outcome of the model redesign be provided in the new year.

C Bensemann Pending MOH decision

18 Feb 2015

Item 6.10

Security

GM Non-Clinical Support Services to work with the Health and Safety Committee on the organisation’s capacity to lock down in crisis situations and report back to a future meeting.

C Thompson Report on outcomes of the external review to be provided for

Sept 2015 HAC meeting

24 Jun 2015

Item 5.3

Financial and Operational Performance Report

1. That the Committee’s appreciation for the

good work they are undertaking in managing

and improving expenditure related to

personnel costs be conveyed to the

Directorates by the Chief Financial Officer.

R Percival 5 Aug 2015

2. That detail on the average cost per nurse, the

financial impact of changing the ratio of juniors

to seniors and information on the Nurse

Director Actions Management currently in

place be included in the Financial and

Operational report to the August HAC.

R Percival and M Dotchin

5 Aug 2015

Complete – see Item 5.3

on this agenda

24 Jun 2015

Item 6.1 Mental Health Directorate Update

1. That information on pre-employment

screening for new Auckland DHB employees be

provided in the Health and safety report to the

next meeting of the Board.

S Waters Complete – referred to

ADHB Board 5 Aug 2015

4

21

Auckland District Health Board Hospital Advisory Committee Meeting 24 June 2015

24 Jun 2015

Item 6.9 Clinical Support Services

1. That a paper explaining current wait times,

wait lists and the timeframes strategy be

provided to the August meeting of HAC.

Frank Tracey 5 Aug 2015

Complete – see Item 9.1

on the Confidential

agenda

2. That details of the workforce challenges that

are impacting on regional waitlists be

incorporated in the next Clinical Support

Services Directorate report to the August

meeting of HAC.

5 Aug 2015

Complete – incorporated within Item 9.1 on the

Confidential agenda

24 Jun 15

Item 6.10 Hector Trust

That a communications piece on the history and

work of the Hector Trust be developed.

G Wong 16 Sep 2015 Complete -

article scheduled for publishing in

the next edition of

ADHB Nova magazine and

intranet

24 Jun 15

Item 8.1 Outpatients Did Not Attends: Research

Opportunities

That the Sustainable Transport Project Update

report presented to the 13 May 2015 HAC meeting

be recirculated to HAC members.

A Old 5 Aug 2015 Completed 17

Jul 2015

22


5 Provider Arm Performance Report

Recommendation

That the Provider Arm Performance Report, which is comprised of the following sections, be

received:

5.1 Scorecard

5.2 Overall Provider Performance Including Health Target Updates

5.3 Financial and Operational Performance

Prepared by: Michelle Webb, (Corporate Committee Administrator)

Endorsed by: Marlene Skelton, (Corporate Business Manager)

5

23


Auckland DHB Provider Scorecard

For June 2015

Actual TargetPrev

PeriodCommentary

% AED patients seen within triage time - triage

category 2 (10 minutes)PR006 82.1% >= 80% 84.9%

Green Green % CED patients seen within triage time - triage

category 2 (10 minutes)PR008 87.4% >= 80% 86.7%

Green Green Number of reported adverse events causing

harm (SAC 1&2)PR084 10 <= 12 19

Green Red Central line associated bacteraemia rate per

1,000 central line days PR087 0 <= 1 0

Green Green Healthcare-associated Staphylococcus aureus

bacteraemia per 1,000 bed daysPR088 0.12 <= 0.25 0.28

Green Red Healthcare-associated bloodstream infections

per 1,000 bed days - AdultPR089 0.96 <= 1.6 1.6

Green Green Healthcare-associated bloodstream infections

per 1,000 bed days - ChildPR090 2.29 <= 2.4 2.36

Green Green Falls with major harm per 1,000 bed days PR095 0.09 <= 0.09 0.24

Green Red Healthcare-associated Clostridium difficile

infection rate per 10,000 bed days (Quarterly)* PR143 2.39 <= 4 4.6

Green Red

% Hand Hygiene Compliance (4-Monthly) * PR144 78.4% >= 80% 79.1%

ADHB now reports all hand hygiene

compliance data not just that from the

national reporting wards. For this reason it

is not surprising that the target was not

achieved. Excellent result overall though.

Nosocomial pressure injury point prevalence (%

of in-patients) PR097 2.6% <= 6% 2%

Nosocomial pressure injury point prevalence - 12

month average (% of in-patients)PR185 3.8% <= 6% 3.9%

Green Green

Pat

ien

t Sa

fety

Measure

(MOH-01) % AED patients with ED stay < 6 hours PR013 94.1% >= 95% 96%Amber Green

(MOH-01) % CED patients with ED stay < 6 hours PR016 94.8% >= 95% 95.9%Amber Green

% Inpatients on Older Peoples Health waiting list

for 2 calendar days or lessPR023 58.7% >= 80% 86.5%

Red Green HT2 Elective discharges cumulative variance from

targetPR035 0.99 >= 1 0.97

Amber Red (ESPI-2) Patients waiting longer that 4 months for

their FSAPR038 0% 0% 0%

Green Green (ESPI-5) Patients given a commitment to

treatment but not treated within 4 monthsPR039 0.8% 0% 0.8%

Amber Amber Cardiac Bypass Surgery Waiting List PR042 70 <= 104 78

Green Green % Accepted referrals for elective coronary

angiography treated within 3 monthsPR043 98.8% >= 90% 98.9%

Green Green % Urgent Diagnostic colonoscopy procedures

treated < 14 daysPR044 81.8% >= 75% 93.3%

Green Green % Non urgent colonoscopy procedures treated <

42 daysPR045 98.3% >= 60% 100%

Green Green

Be

tte

r Q

ual

ity

Car

e

Norovirus in June resulted in bed closures

which impacted on flow. This has now

resolved which will improve this position.

The Directorate has also stretched this

target from 4 days to 2 days and intend to

make changes to processes which should

see further improvement.

5.1

24


% Outpatients & community referred MRI

completed < 6 weeksPR046 43.9% >= 80% 46.5%

Grey Red

% Outpatients & community referred CT

completed < 6 weeksPR047 82.3% >= 90% 76.1%

Grey Red Elective day of surgery admission (DOSA) rate PR048 68.6% >= 68% 67%

Green Amber

% Day Surgery Rate PR052 60.9% >= 70% 58.2%

Red Red Inhouse Elective WIES through theatre - per day PR053 124.43 >= 99 117.63

Green Green % DNA rate for outpatient appointments - All

EthnicitiesPR056 8.7% <= 9% 8%

Green Green

% DNA rate for outpatient appointments - Maori PR057 15.5% <= 9% 15.1%

Red Red

% DNA rate for outpatient appointments - Pacific PR058 17.4% <= 9% 15.8%

Red Red

% Chemotherapy patients (Med Onc and Haem)

attending FSA within 4 weeks of referralPR059 98.8% 100% 99.5%

Amber Amber % Radiation oncology patients attending FSA

within 4 weeks of referralPR064 99.5% 100% 99.5%

Amber Amber % Cancer patients receiving radiation/chemo

therapy treatment within 4 weeks of DTTPR070 100% 100% 100%

Green Green Average LOS for WIES funded discharges (days) PR074 2.83 <= 3 3.16

Green Amber 28 Day Readmission Rate - Total PR078 R/U <= 6% 8.1%

Grey Red Breastfeeding rate on discharge excluding NICU

admissionsPR099 76.4% >= 75% 76.2%

Grey Green Mental Health - 28 Day Readmission Rate (KPI

Discharges) to Te Whetu TaweraPR119 R/U <= 10% 13.3%

Grey Red

Mental Health Average LOS (KPI Discharges) - Te

Whetu TaweraPR120 26.8 <= 21 39.2

Red Red % Very good and excellent ratings for overall

inpatient experiencePR154 R/U >= 90% 85.9%

Grey Red

Bet

ter

Qu

alit

y C

are

Although this is above national target, LOS

is considerably lower than in past years;

admission numbers are increased over

previous years (access and flow has

improved) and the median length of stay is

similar to neighbouring DHBS and close to

national target.

Close monitoring of FSA and triage times

continues, with a focus on breast and GI

tumour streams to reduce referral to FSA

wait times by prioritisation of referrals and

better matching demand to capacity.

The team continues to ring for cancer and

blood and endocrinology appointments. The

low numbers can still cause a significantly

variable shift as seen here in the DNA

increase.

While there has been a minimal increase in

the DNA rate over the period, we continue

to support Cancer & Blood/Cardiac Service,

including the recruitment of the 2 social

work positions over the next quarter, post

the Cancer navigation Pilot.

Day Surgery rates have increased in month

and we are working with the specialities to

identify more cases to move to day case.

CT capacity continuing to increase with all

patients waiting longer than 6 weeks

identified and targeted for appointments

within the next month.

Outsourcing negotiations with private

providers nearing completion and aim to

have approximately 40-50 additional

patients scanned per week. GCC MRI

evening sessions commence August 2015 -

additional 20 patients per week.

25


Number of CBU Outliers - Adult PR173 371 0 340

Red Red % Patients cared for in a mixed gender room at

midday - AdultPR175 11.9% 0% 10.1%

Red Red 31/62 day target – % of non-surgical patients

seen within the 62 day targetPR181 R/U >= 85% 71.4%

Grey Red 31/62 day target – % of surgical patients seen

within the 62 day targetPR182 R/U >= 85% 44.4%

Grey Red 62 day target - % of patients treated within the 62

day targetPR184 R/U >= 85% 56.3%

Grey Red

Mental Health % long-term clients with relapse

prevention plans in last 12 months (6-Monthly)* PR125 91.4% >= 95% 95%

Red Green % Hospitalised smokers offered advice and

support to quitPR129 95.1% >= 95% 96.2%

Green Green

Amber

R/U

*

Actual result is for the period ending March 2015. Previous period result is for period ending December 2014.

PR078, PR119

A 35 day period is required to accurately report all acute re-admissions for the previous month's discharges. (35 days = 28 days post discharge

as per MoH measures plus 5 working days to allow for coding).

PR154

This measure is based on retrospective survey data, i .e. completed responses for patients discharged the previous month.

Results unavailable from NRA until after the 20th day of the next month.

= Variance from target not significant enough to report as non-compliant. This includes percentages/rates within 1% of target, or

volumes within 1 value from target.

= Result unavailable

PR144 (4-Monthly)

Actual result is for the period ending June 2015. Previous period result is for period ending March 2015.

= Quarterly, 4-Monthly or 6-Monthly Measure

PR125 (6-Monthly)

Actual result is for the period ending June 2015. Previous period result is for period ending December 2014.

PR143 (Quarterly)

This has fallen below target 95%. Of the

total 8.6% of eligible patients without an 'up

to date' relapse prevention plan >80%

already have a plan but this requires review.

Services are emphasising the importance of

reviewing existing plans.

Imp

rove

d H

eal

th S

tatu

sDaily focus on outliers. Seasonal variation

affects the number of outliers as we see a

rise in General Medical patients July -

September.

Daily focus with Nurse Unit Managers and

Charge Nurses.

PR181, PR182, PR183

5.1

26


Trend Information

The following control charts plot process data in a time-ordered sequence to identify common cause

and special cause variation.

Expected Variation Region

The area between the lower and upper control limits (LCL and UCL), where the process is

expected to perform. This is also known as common cause variation and refers to occurrences

that contribute to the natural variation in any process.

Unexpected Variation Region

The area beyond the control limits, also known as special cause variation. Special causes are

unusual occurrences that are not normally (or intentionally) part of the process and create

instability.

Upper Control Limit (UCL)

Lower Control Limit (LCL)

Target

Average

Measure Data Points

Trend Line

27


% Hand Hygiene Compliance (PR144)

The percentage of hand hygiene compliance amongst staff of National Reporting wards as per the

Hand Hygiene New Zealand Campaign requirements.

Current Target Performance

Auckland DHB has shifted from reporting only the compliance data from the national reporting

wards to reporting all compliance data from across the organisation. Some clinical areas are still

working on local improvement strategies. Overall this is a very good result for Auckland DHB.

Current/Planned Improvements

The Auckland DHB Hand Hygiene Coordinator left in April of this year. The role has been filled

and the new coordinator will be starting later this month.

The focus will be on poor performing areas as identified in the monthly reports to the IPC

Committee.

5.1

28


% Inpatients on Older Peoples Health waiting list for 2 calendar

days or less (PR023)

Percentage of Inpatients to Older Peoples Health on the waiting list for 2 calendar days or less


Norovirus in June resulted in bed closures in OPH which significantly impacted on flow and

waiting times. We have also stretched this target from 4 to 2 days as a deliberate measure to

drive up performance to support whole of hospital flow.


A rapid response service is being implemented in July to support admission avoidance and early

discharge from all adult wards and departments in the hospital. The focus will be on older

adults. This will augment the existing deployed resource of a gerontology nurse in the ED.

Locality community team detailed planning will commence in August, with a plan to have

community multi-disciplinary teams operating including rapid response as integral components

by July 2016.

An intermediate residential bed scheme is to be piloted this winter which will also reduce bed

pressures and improve flow in older people’s health. This is in the final stages of planning.

29


% Outpatients & community referred MRI completed < 6 weeks

(PR046)

The percentage of accepted Outpatient & Community referred MRI's completed within six weeks.


44% against target of 80%.


Productivity initiatives currently being undertaken within Radiology which will contribute

significantly to achieving the MOH indicators by January 2016/February 2016 include:

o Outsourcing to private providers – negotiations completed by mid-July will result in

additional 40-50 patients per week.

o Evening sessions at GCC MRI will commence by end of August will result in additional 20

patients per week.

o Ongoing recruitment and training of MRI MRT’s.

o Introduction of 40 week for MRT’s will result in additional 15 patients/week across the 3

Auckland DHB MRI scanners.

5.1

30


% Outpatients & community referred CT completed < 6 weeks

(PR047)

The percentage of accepted Outpatient & Community referred CT's completed within six weeks.


Further increase to 82% against target of 90%.


Further audit of wait list.

Increased focus on booking all patients waiting in excess of 6 weeks.

On-going training of MRT’s in CT.

Introduction of 40 hour week for MRT’s will result in increased capacity of 60/week across the 4

CT scanners which have out-patient bookings; this will also relieve pressure on the Level 2

scanner which support the Emergency Departments.

We are confident that performance against this target will continue to improve in the coming

months with the aim of meeting MoH indicators by November 2015.

31


% Day Surgery Rate (PR052)

The percentage of WIES funded elective surgical procedures that are daycases.


60.9% against a target of 70%.

Performance has improved in month.


We continue to evaluate the requirements to increase the utilisation at Greenlane.

Patient criteria for day case surgery will be reviewed to ensure that demand is in line with any

planned capacity.

5.1

32


% DNA rate for outpatient appointments – Maori (PR057)

The percentage of appointments booked for Maori where the patients Did Not Attend (DNA).


There is a minimal increase in Maori DNAs over the period ie; 0.4% overall, however Cancer &

Blood as well as Cardiac Service’s DNA rates over the 2 periods has improved.


While the Cancer Navigator pilot has ended, provision has been made for 2 Social Work positions

to be recruited to build on the learnings identified in the pilot phase. The May and June 2015

period showed significant improvements in the rate ie; April 17% - May 8%, June 13%.

He Kamaka Waiora will continue ring to remind patients in the Cardiac Services area.

33


% DNA rate for outpatient appointments – Pacific (PR058)

The percentage of appointments booked for Pacific People where the patients Did Not Attend

(DNA).


The team continues to ring for cancer and blood and endocrinology appointments. The low

numbers can still cause a significantly variable shift as seen here in the DNA increase.


We have finished with the long term conditions directorate endocrinology appointments call-

backs which proved to be successful. This will be become part of the scheduling team role

moving forward. There were only 2 DNAs out of 34 PI appointments since we started making the

calls (6%). This has also contributed to bringing the overall DNA rate for Endocrinology down to

below 3% for the past three weeks consecutively. We will look at other DNA “hotspots” in the

long term conditions directorate and also work with Dr. Margaret Wilsher’s DNA project and

Karen Bartholomew’s work with Maori Health DNA.

5.1

34


% Chemotherapy patients (Med Onc and Haem) attending FSA

within 4 weeks of referral (PR059)

Percentage of patients attending Medical Oncology First Specialist Assessment (FSA) within four

weeks of referral


Current performance 98.8% (previous period 99.5%).


Performance against this policy priority continues to be monitored closely. Production planning

processes are in place. Weekly meetings continue to ensure that the individual patients are

booked/scheduled as appropriate according to timeframes and patient need. Tumour stream

leads also meet weekly to ensure that these processes result in the best matching of demand

and capacity possible. The tumours streams under most scrutiny in this regard are breast and

GI.

35


Mental Health Average LOS (KPI Discharges) - Te Whetu Tawera

(PR120)

The monthly average length of stay (LOS) for Mental Health Adult Acute Unit - Te Whetu Tawera

(limited to discharges meeting National KPI definition for inclusion).


Although this is above national target, LOS is considerably lower than in past years; admission

numbers are increased over previous years (access and flow has improved) and the median

length of stay is similar to neighbouring DHBs and close to national target.


Review of ‘alternatives to admission’ and discharge/accommodation/rehabilitation options as

part of clinical services planning.

5.1

36


Number of CBU Outliers – Adult (PR173)

The number of patients with an assigned CBU (Clinical Business Unit) that is not the CBU of the ward

the patient was admitted or transferred to.


Expected seasonal variation due to high demand of General Medical beds.


Daily focus on transfer of patients to home wards.

37


% Patients cared for in a mixed gender room at midday – Adult

(PR175)

The percentage of patients cared for in a mixed gender room based on census at midday – Adult.


Improving.


Remains KPIU for Nurse Unit Managers and Charge Nurses.

5.1

38


Mental Health % long-term clients with relapse prevention plans in

last 12 months (PR125)

The proportion of Long Term Service users with an up-to-date Relapse Prevention Plan


This has fallen below target 95%. Of the total 8.6% of eligible patients without an 'up to date'

relapse prevention plan >80% already have a plan but this requires review i.e. of more than 1200

eligible patients, 19 have no plan.


Services are emphasising the importance of reviewing existing plans. The nationally set target is

95% to assure a high quality ‘relapse planning’ process, but work is ongoing to endeavour that all

eligible patients have such plans.

39


Mental Health Provider Arm Services: SAC1&2 Suicides (PR194)

A monthly count of suicides/suspected suicides advised to MH services and meeting the definition

for SAC1 or SAC2


Data displays a stable number of events. No target is set.


Continue regular monitoring via control chart. All SAC 1 &2 suicides are reviewed using

nationally defined (HQSC) procedures. There have been no suicides during inpatient episodes of

care during the last year.

5.1

40

Shorter Stays in Emergency Departments

Adult Acute Patient Flow Target: 95 per cent of patients will be admitted, discharged, or transferred from the adult emergency department within six hours.

Target Champions – Brenda Clune, Dr Barry Snow


Adult Emergency Department achieved the MOH Shorter Stays in ED target for the quarter 1 April 2015 to 30 June 2015.

Current/ Planned Improvements

An Auckland DHB Acute Flow Governance Group has continued to meet fortnightly.

Focus of governance has been on:

Reporting and analysis of breaches of AED six hour target for review by Directors to inform work programme and improvement activity.

Establishment of scorecards to monitor performance across the system.

Review of work programme including resource requirements to prioritise and accelerate improvement activity.

Review of alternative models of care for patients requiring assessment by inpatient specialties including the function of the Admission and Planning Unit.

Analysis of the numbers of acute patients who require a short inpatient stay following assessment by an inpatient service.

5.2

41

Shorter Stays in Emergency Departments – continued

Children’s Acute Patient Flow Target: 95 per cent of patients will be admitted, discharged, or transferred from the children’s emergency department within six hours.

Target Champion – Mike Shepherd


Children’s ED achieved the target for June 2015 and for the quarter 1 April 2015 to 30 June 2015.


Ongoing improvement is focussed on maintaining this performance through winter. o Admission streamlining. o Acute flow coordinator. o Increased CED nursing capacity.

42

Improved Access to Elective Surgery Target: The volume of elective surgery will be increased by at least 4000 discharges per year nationally. DHBs have negotiated local targets taking into consideration the health needs of their communities. Collectively these targets contribute to a national increase in elective surgery discharges. ADHB’s objective is to deliver the MoH target for elective surgical discharges (13,872).

Target Champions – Wayne Jones, Paul Browne, Tara Argent


Internal reporting has confirmed that Auckland DHB has delivered 100% of the elective discharge target.

The final position is not confirmed by the Ministry of Health until 5 August; during this time Auckland DHB will be ensuring that all coding is complete and confirmed with the funder.


All directorates are now focusing on the delivery of the 15/16 elective discharge target, working with the production planning team to make the weekly reporting more robust to be able to respond to seasonal/demand variation in a more timely manner.

5.2

43

Shorter Waits for Cancer Treatment Target: All patients, ready for treatment, wait less than four weeks for radiotherapy or chemotherapy. The policy priority is for patients who are ready to treat. It excludes patients who require other treatment prior to radiotherapy or chemotherapy, who are not fit to start treatment because of their medical condition or who choose to defer their treatment.

Target Champions – Giuseppe Sasso, David Porter, Richard Doocey, Deirdre Maxwell

Note: One patient not treated in December 2014 causing drop in percentage to 99.66%


Chemotherapy

Achieved 100% ‐ The service continues to meet policy priority requirements.

Radiation Therapy

Achieved 100% ‐ The service continues to meet policy priority requirements.


The Cancer and Blood Service continue weekly prioritisation meetings to ensure that our response matches demand. This has required some staffing flex in radiation oncology to accommodate increased demand.

44

Increased Immunisation

Target: 95 per cent of eight‐month‐olds will have their primary course of immunisation (six weeks, three months and five month immunisation events) on time by December 2014 and maintained to 2017.

The quarterly progress result includes children who turned eight months old during the three month period of the quarter and who were fully immunised at that stage.

Target Champion – Mike Shepherd


Auckland DHB's coverage to 30 June 2015 remains 94%. Overall, this is just below the target rate of 95%. Maori is 87%; Pacific 94%; Asian 97%; Others 93% and NZE 94%.

Note: This data is provisional until confirmed by the MOH and is reported quarterly.


Six month milestone plan continues, to promote early enrolment of nominated infants, improve on‐time immunisations at 3 and 5 months, and initiate prompt referral to outreach immunisation services when appropriate. Agreement reached to aim for 85% of 6 month infants fully immunised. 4 month prompt initiated by PHOs to rapidly follow‐up children who turn 4 months old and are overdue 3 month immunisations.

Focus on increasing and improving new‐born enrolment processes to ensure all babies are enrolled with a GP by 3 months of age, to enable access to precall and recalls. New resource completed and provided to all Auckland DHB/Waitemata DHB General Practices to standardise process. Pilot underway with 4 general practices.

Monthly monitoring of practice acceptance and declines of NBE nominations by NIR, with PHOs following up with Practices as required.

Maternity / PHO enrolment data‐match audit completed and report finalised and released. Outcomes will inform strategies to increase new born enrolments with primary healthcare.

75%

80%

85%

90%

95%

100%

Jun‐1

4

Sep‐1

4

De

c‐1

4

Mar‐1

5

Jun‐1

5

Act

ualand T

arge

t%

95% of 8 months olds are fully immunised ‐ Total Actual vs Target ‐ March 2014 to March 2015

Actual Percentage MOH Target %

5.2

45

The antenatal (AN) video developed as a collaboration by the four Northern DHBs for use in AN clinics and child birth education classes promoting AN immunisations, on‐time childhood immunisation and the value of early enrolment with GP and LMC, is completed. Released during Immunisation Week 2015 and distribution ongoing.

46

Better Help for Smokers to Quit Target:

1. 95 per cent of hospitalised patients who smoke and are seen by a health practitioner in public hospitals and 90 per cent of enrolled patients who smoke and are seen by a health practitioner in general practice are offered brief advice and support to quit smoking.

2. Within the target a specialised identified group will include progress towards 90 per cent of pregnant women (who identify as smokers at the time of confirmation of pregnancy in general practice or booking with Lead Maternity Carer) are offered advice and support to quit.

Target Champions – Stephen Child, Margaret Dotchin, Karen Stevens


1. We continue to achieve the 95% target albeit a drop in June to 95.5% (fully coded) ‐ the graph is somewhat misleading. This may be connected with winter overload. Once reports are complete we aim to reboot training.

2. This target will change in 2015‐2016 with the emphasis on DHB Community midwives rather than independent midwives. For quarter 4 2014 ‐2015 there were 1730 booked to birth at NWH of which 101 were current smokers (5.8%). Unfortunately only 35 were documented as being referred for smoking cessation. This in spite of an advertising campaign earlier this year.


1. A number of initiatives are planned to happen within the hospital. The roll out of our form for referral of carers and parents of children in Starship who are smoking. An NRT campaign aimed at house officers. A brochure for patients who are currently smoking for help to quit and self‐refer.

2. With the maternal health target changing its orientation in the next quarter to DHB midwives we have invested in carbon monoxide monitors to be available to them in their clinics as triggers to move pregnant women who smoke to accept help to quit.

5.2

47

More Heart and Diabetes Checks Target: 90 per cent of the eligible population will have had their cardiovascular risk assessed in the last five years.

Target Champion – Jagpal Benipal

Current Performance

The ‘More Heart and Diabetes Checks’ result is reported by the MoH as a National Health Target and is part of the Integrated Performance Incentive Framework (IPIF). The quarter three denominator for Auckland DHB is 153,904. The denominator increase between quarter two 2014‐15 and quarter three 2014‐15 for Auckland DHB was 874. The quarter three results released by the MoH are as follows:

Auckland DHB 92% (141,522 people CVD risk‐assessed) o Total coverage↑ 0.1% from quarter one. This is currently ranked first in the

country. o Coverage for Māori ↑by 0.1% (from 88.4% to 88.5%) and for Pacific ↓ by 0.2%

(from 90.1% to 89.9%). o Auckland DHB is first in the country for Māori coverage and is third in New

Zealand for Pacific coverage.


The increase in CVD risk assessments has been achieved through: • Weekly reporting and monitoring of PHO level performance. • Improved access to services. • Increased support to practices from PHO support teams. • Access to advanced IT tools to identify and assess patients who have not had a

risk assessment. • Access to CVD incentive payment on achieving the target.

The Primary Care team continues to meet with the PHOs on a monthly basis (or more frequently as necessary) to discuss coverage and activities undertaken to maintain the 90% target. Recent meetings continue to focus on increasing coverage for Maori and Pacific people.

48

Cardiac Bypass Surgery Target: To enable timely access to cardiac bypass surgery, the wait list should be no greater than 104. To support the national cardiac bypass intervention target, 1038 bypasses should be completed in 2014/2015.

Target Champion – Dr Mark Edwards


During June the service delivered 79 eligible procedures against a plan of 85. The service has had 2 lung transplants and 1 ECMO patient. 91 new patients were added to the waiting list in June.

Despite seeing an increase in the inflow numbers onto the waitlist the service saw the waitlist decrease from 78 at the end of May to 70 at the end of June.

The service has had a total of 14 cancellations. The cancellations were primarily due to ICU bed unavailability and staff shortages in perfusion.

At Month end, there were 4 patients waiting in hospital, 66 waiting up to 90 days and 1 patient waiting between 90 and 120 days.

Fortnightly teleconferencing with the MOH to update them on the service performance and production continues.

The challenge for the service over the next few months is likely to be managing the increase in the number of patients that are typically added to the waitlist during the winter period within their target wait times. The service has remained ESPI 2 and 5 compliant.

The service will also be challenged with perfusion staff shortages which are contributing to unscheduled sessions. Recruitment worldwide continues for perfusion staff.


Live cases are now being scheduled for the hybrid. The challenge for the service will be resourcing the hybrid room in light of perfusion shortages.

Weekend contracts to continue due to the anticipated winter inflows increasing.

Patient improvement project moving into implementation phase for agreed changes.

A number of work streams are progressing with a focus on ward rounds and patient pathways.

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Financial Performance

Consolidated Statement of Financial Performance - June 2015

Provider Month (Jun-15) YTD (Jun-15)

$000s Actual Budget Variance Actual Budget Variance

Income

Government and Crown Agency sourced

8,894 6,963 1,930 F 87,553 80,024 7,529 F

Non-Government & Crown Agency Sourced

7,326 8,309 (983) U 91,442 96,391 (4,950) U

Inter-DHB & Internal Revenue

2,002 1,294 708 F 15,296 15,044 252 F

Internal Allocation DHB Provider

98,877 96,811 2,066 F 1,145,864 1,128,483 17,382 F

117,098 113,377 3,721 F 1,340,155 1,319,942 20,213 F

Expenditure

Personnel 67,875 69,479 1,604 F 827,667 827,831 165 F

Outsourced Personnel 2,468 1,297 (1,171) U 24,656 15,548 (9,108) U

Outsourced Clinical Services 2,928 1,814 (1,114) U 24,986 22,666 (2,320) U

Outsourced Other 4,117 3,373 (744) U 43,750 42,692 (1,058) U

Clinical Supplies 20,617 19,986 (631) U 238,310 232,930 (5,380) U

Infrastructure & Non-Clinical Supplies

16,691 14,122 (2,569) U 175,781 168,884 (6,897) U

Internal Allocations 788 783 (4) U 9,421 9,364 (57) U

Total Expenditure 115,483 110,855 (4,628) U 1,344,570 1,319,915 (24,656) U

Net Surplus / (Deficit) 1,615 2,522 (907) U (4,416) 27 (4,443) U

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Consolidated Statement of Financial Performance – June 2015

Performance Summary by Directorate

By Directorate $000s Month (Jun-15) YTD (Jun-15)

Actual Budget Variance Actual Budget Variance

Adult Medical Services 1,610 2,021 (411) U 15,630 21,188 (5,558) U

Adult Community and LTC 2,458 2,156 302 F 22,841 21,692 1,149 F

Surgical Services 9,488 10,996 (1,507) U 116,872 124,760 (7,888) U

Women's Health & Genetics 3,692 3,350 342 F 38,479 40,131 (1,652) U

Child Health 5,829 5,804 25 F 66,934 65,215 1,719 F

Cardiac Services 2,651 3,102 (451) U 28,574 29,285 (710) U

Clinical Support Services (2,267) (2,239) (28) U (28,344) (32,156) 3,812 F

Non-Clinical Support Services

(2,511) (1,457) (1,054) U (20,893) (17,634) (3,259) U

Perioperative Services (11,091) (10,524) (567) U (127,639) (125,484) (2,156) U

Cancer & Blood Services 2,190 2,643 (453) U 29,399 28,472 927 F

Operational - Others 1,380 846 534 F 15,597 17,839 (2,242) U

Mental Health & Addictions (215) 42 (257) U 3,666 487 3,179 F

Ancillary Services (11,600) (14,218) 2,619 F (165,531) (173,768) 8,237 F

Net Surplus / (Deficit) 1,615 2,522 (907) U (4,416) 27 (4,443) U

Consolidated Statement of Personnel by Professional Group – June 2015

Employee Group $000s Actual Month

Budget Month

Variance Month

Actual YTD

Budget YTD

Variance YTD

Medical Personnel 23,121 25,871 2,750 F 305,935 306,359 425 F

Nursing Personnel 23,143 22,289 (854) U 275,969 267,442 (8,527) U

Allied Health Personnel 11,868 12,051 183 F 137,381 143,574 6,193 F

Support Personnel 2,009 2,070 62 F 23,749 24,724 975 F

Management/ Admin Personnel 7,735 7,198 (537) U 84,633 85,732 1,099 F

Total (before Outsourced Personnel)

67,875 69,479 1,604 F 827,667 827,831 165 F

Outsourced Medical 881 783 (98) U 9,827 9,378 (449) U

Outsourced Nursing 401 218 (183) U 3,399 2,620 (778) U

Outsourced Allied Health 252 149 (103) U 2,656 1,790 (866) U

Outsourced Support 208 7 (201) U 2,031 79 (1,951) U

Outsourced Management/Admin 726 140 (586) U 6,744 1,680 (5,064) U

Total Outsourced Personnel 2,468 1,297 (1,171) U 24,656 15,548 (9,108) U

Total Personnel 70,343 70,776 433 F 852,323 843,379 (8,944) U

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Consolidated Statement of FTE by Professional Group – June 2015

FTE by Employee Group Actual FTE Month

Budget FTE

Month

Variance FTE

Month Actual FTE

YTD

Budget FTE YTD

Variance FTE YTD

Medical Personnel 1,274 1,321 47 F 1,286 1,315 29 F

Nursing Personnel 3,470 3,416 (55) U 3,415 3,405 (10) U

Allied Health Personnel 1,821 1,889 69 F 1,788 1,879 90 F

Support Personnel 385 535 150 F 483 535 52 F

Management/ Admin Personnel

1,194 1,219 26 F 1,179 1,218 38 F

Total (before Outsourced Personnel)

8,144 8,381 237 F 8,151 8,351 200 F

Outsourced Medical 41 34 (7) U 31 34 3 F

Outsourced Nursing 7 0 (6) U 8 0 (7) U

Outsourced Allied Health 12 3 (9) U 9 3 (6) U

Outsourced Support 57 0 (57) U 48 0 (48) U

Outsourced Management/Admin

87 10 (77) U 80 10 (71) U

Total Outsourced Personnel 204 46 (158) U 176 46 (129) U

Total Personnel 8,348 8,428 80 F 8,327 8,397 70 F

Consolidated Statement of FTE by Directorate – June 2015

Employee FTE by Directorate Group

Actual Month

Budget Month

Variance Month

Actual YTD

Budget YTD

Variance YTD

(including Outsourced FTE)

Adult Medical Services 800 804 3 F 805 799 (6) U

Adult Community and LTC 532 540 8 F 526 540 14 F

Surgical Services 805 789 (16) U 797 789 (8) U

Women's Health & Genetics 377 360 (17) U 378 360 (18) U

Child Health 1,049 1,045 (4) U 1,022 1,045 24 F

Cardiac Services 511 495 (15) U 505 495 (10) U

Clinical Support Services 1,425 1,427 2 F 1,387 1,411 24 F

Non-Clinical Support Services 276 339 63 F 347 340 (7) U

Perioperative Services 796 835 39 F 787 827 41 F

Cancer & Blood Services 312 297 (15) U 298 296 (3) U

Operational - Others 0 0 0 F 0 0 0 F

Mental Health & Addictions 718 740 22 F 711 740 29 F

Ancillary Services 746 755 9 F 765 756 (9) U

Total Personnel 8,348 8,428 80 F 8,327 8,397 70 F

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Month Result The Provider arm result for the month is $0.9M unfavourable. This result is driven by unfavourable expenditure – some of the additional expenditure is funded, but the key drivers are unfavourable outsourcing costs and Nursing costs. Overall volumes are 96.4% of month contract – this equates to $3.2M below base contract (not recognised in the month result). Full year volumes are very close to base contract at 99.2%. Provider arm revenue for the month is $3.7M (3.3%) favourable, with the key variances as follows:

Additional unbudgeted MOH contract and project revenue $1.0M, including Genetics waiting list, Maternal Fetal Medicine, and additional Colonoscopy volumes.

ACC Income $0.5M favourable, reflecting high volumes for rehabilitation.

Capital Charge Income $0.3M favourable, additional base revenue to cover the capital charge arising from the upward revaluation of assets - offset by additional Capital Charge costs.

LabPlus - additional Cytology contract $0.3M favourable (not budgeted, and offset by additional unbudgeted expenditure) and particularly high volumes of LabPlus external revenue for referred tests $0.3M favourable.

Research Income $0.4M favourable, offset by equivalent expenditure.

Haemophilia funding $0.2M favourable for abnormally high blood product usage, offset by additional costs.

Total expenditure is $4.6M (4.2%) unfavourable, with the key variances as follows:

Nursing $0.9M unfavourable due to FTE 55 above budget ($0.4M unfavourable) – the additional FTE reflects the need to flex up for high acute volumes, particularly high levels of patient attenders and sick leave as well as a number of unbudgeted but funded positions. See FTE commentary for details of actions underway by Nurse Directors to closely manage FTE. The balance of the unfavourable variance primarily reflects average cost per FTE targets not met.

Medical $2.8M favourable – the month’s variance is due to a one off $3.1M review in the valuation of the provision for Continuing Medical Education expenditure

Clinical Supplies $0.6M unfavourable – the key variances are $0.2M for abnormally high blood product costs in Cancer & Blood Services, offset by additional Haemophilia funding, and $0.1M one off repair costs for renal dialysis reverse osmosis unit. The balance of the variance, $300k (1.5%) is spread widely across a number of services.

Infrastructure and Non Clinical Supplies $2.6M unfavourable – this variance primarily reflects a number of one off costs and catch-up costs not specific to the current month – Capital Charge is $0.3M unfavourable (although this is offset by additional Capital Charge income), facilities costs are $0.8M unfavourable reflecting a catch-up in capitalisation of buildings and fit-outs (and subsequent depreciation costs) and maintenance charges, university nursing training fees for the first semester are $0.4M unfavourable but offset by additional MOH revenue, insurance excess and the contribution to the HBL risk pool for ADHB is $145k unfavourable, one off project fees $0.3M, higher cost of goods sold for retail pharmacy $0.1M unfavourable (offset by additional revenue). The balance is spread across a number of different accounts.

Outsourced Personnel $1.2M unfavourable – Outsourced Support for contract cleaning staff $0.2M unfavourable (but substantially offset by favourable Personnel Costs and FTE) and Administration / Nursing / Medical $1.0M - covering vacancies and project work.

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Outsourced Clinical Services $1.1M unfavourable – key variances are additional elective surgery outsourcing in Adult Surgery to meet discharge targets $0.4M unfavourable, catch-up in Radiology charging from WDHB and CMDHB for outpatient clinic diagnostics $0.2M unfavourable, and project costs in Women’s Health $0.2M (offset by additional funding).

Full Year Result The full year Provider arm result is $4.5M unfavourable to budget. This result is primarily driven by unfavourable expenditure – a significant amount of additional expenditure is funded, but the primary driver of the result is unfavourable total Personnel and Outsourced Personnel Costs as a result of cost per FTE targets not being fully achieved. Overall volumes are very close to base contract at 99.2% YTD – this equates to $7.8M below contract (not recognised in the Provider arm result). Full year revenue is $20.3M (1.5%) favourable, primarily due to non-patient care revenue streams with offsetting expenditure. The key variances are as follows:

Research Income $4.4M favourable, offset by equivalent expenditure and bottom line neutral.

Capital Charge Income $4.0M favourable, additional base revenue to cover the capital charge arising from the upward revaluation of assets - offset by additional Capital Charge costs.

Haemophilia funding $2.5M favourable for abnormally high blood product usage, offset by additional costs.

LabPlus additional Cytology contract $1.7M favourable – not budgeted, and offset by additional unbudgeted costs.

Financial Income $1.2M favourable interest income.

Additional unbudgeted MOH contract and project revenue $3M, including Mental Health Mother & Baby Unit, Genetics waiting list, Maternal Fetal Medicine, Colonoscopy, surgical prioritisation tool implementation.

One off rebate income $0.9M.

Total expenditure is $24.8M (1.9%) unfavourable, with the key variances as follows:

Nursing $8.7M (3.3%) unfavourable – full year FTE are slightly over budget (10 unfavourable) but planned average cost per FTE targets have not been met. See FTE commentary for details of actions underway by Nurse Directors to closely manage FTE.

Allied Health / Technical $6.2M (4.3%) favourable – reflecting average 90 FTE under budget for the full year (down to 68 for the month of June), spread widely across all directorates, although most significantly in Clinical Support and Mental Health.

Outsourced Personnel $9.1M (58.3%) unfavourable: o $2.0M of this relates to contract cleaning staff - $1.2M of this is offset by favourable

Cleaning Personnel Costs and FTE, with the remaining $0.8M due to a number of staff transferred to ADHB with very high leave balances and there has been a concerted effort to try and get as many staff off on leave as possible to reduce this leave liability, thus driving higher outsourced costs.

o Outsourced Administration Personnel is $5.1M unfavourable - covering vacancies (full year Administration FTE are 38 below budget) as well as project work.

o Outsourced Allied Health Personnel is $0.9M unfavourable – primarily in Public Health and offsetting vacancies.

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o Outsourced Nursing is $0.8M unfavourable - $0.4M of this is in Mental Health and offsets underspend in Nursing personnel costs. The balance is spread widely and is part of the Nursing overspend being addressed by Nurse Directors.

Outsourced Other $1.0M unfavourable – one off costs associated with the food services and linen projects.

Clinical Supplies $5.4M (2.3%) unfavourable - $2.4M of this variance is for abnormally high blood product costs in Haemophilia which is offset by additional funding, $0.5M is in Intra-abdominal Transplants reflecting high volumes, above YTD contract and last year’s actuals. The balance of $2.5M, equating to 1.0%, is spread widely across a number of services.

Infrastructure and Non Clinical Supplies $6.9M (4.1%) unfavourable due to additional funded or one off costs – Capital Charge is $3.8M unfavourable due to the upward revaluation of assets, although this is offset by additional Capital Charge income; financing costs are $0.3M unfavourable, but similarly offset by favourable Financial Income; one off costs for food services and other projects are $1.2M unfavourable; facility rental costs for new community laboratory contracts are $0.9M unfavourable (but funded through contract revenue).

FTE Total FTE (including outsourced) for June is 8,348 which is 80 FTE below budget. This includes an unfavourable variance of 20 FTE for the new LabPlus Cytology contract not budgeted, and a favourable variance of 106 FTE for Food Services (now outsourced) – excluding these, the net position is 6 above budget – this is a reduction from the net position last month which was 82 above budget. Nursing FTE New Graduate Nurse recruitment model to strategically shift nursing skill mix and the financial impact ADHB is implementing a graduate nursing recruitment model developed by the Ministry of Health Chief Nursing Office which assists District Health Boards to adjust their skill mix with the replacement of existing nursing turnover with new graduate nurses. The model is dynamic to allow DHBs to model differing scenarios. The model relates to Registered Nurses currently employed on the NZNO MECA. The model also allows you to view your Registered Nurse Skill Mix compared to population ethnicity and headcount by age group compared to national data. Turnover rate is applied across Registered Nurse Steps 1 to 5 of the NZNO MECA. ADHB has made the following assumptions in using this model for 2015. 1. 215FTE (RN Step 1-5) will leave ADHB Adult and Paediatric services in 2015 (11% turnover). 2. This turnover should be replaced with 179 New Graduate Nurses through the Nursing Entry to

Practice Programme over three intakes (February, March / April and September). With this change the RN composition (Step 1 – 5) still allows ADHB to have an experienced (in post graduate years) nursing workforce i.e. 76% of nurses employed will have greater than 5 years’ experience. Modelling costs based on these assumptions and the NZNO MECA salaries (March 2012-28 February 2015) will reduce the cost of salaries of RN (Step 1-5) by approximately $1M in Year One and $1.9M in Year Two if the same number of graduates are employed in 2016. The model only considers base salaries. It does not include the impact on penal / overtime and levels of practice payments. Consideration of the ‘non-productive time’ of supporting new graduates needs also to be considered.

55


ADHB employed 99 new graduate nurses in the February and April 2015 intakes and will need to appoint 80 into the September NETP (excluding Aged Residential Care and Primary Care) programme. ADHB employed 128 new graduate nurses in 2014 (calendar year) into the NETP programme (excluding Aged Residential Care and Primary Care). The focus on new graduate employment also has the added benefit that we are preparing for the increase turnover of nurses expected due to the aging nursing workforce. Nursing FTE management Nursing FTE are 18 below last month but still 61 above budget for the month (including Personnel as well as Outsourced) - the additional FTE reflects the need to flex up for high acute volumes, particularly high levels of patient attenders and sick leave as well as a number of unbudgeted but funded positions. The following action plan is in place within the Adult Medical, Adult Surgery, Cardiac and Community Long Term Conditions Directorates to manage nursing staffing FTE and costs across their Directorates.

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Item Area Owner Actions Implemented Output Data reviewed Measure Commenced Expected end date

1 Daily review of staffing levels and skill mix

Nurse Directors

Daily Wrap up meeting - attended by: Nurse Directors, Nurse Advisors/Nurse Unit Managers (NUM), Flow Coordinator, Bed and Duty Managers and Clinical Nurse Advisor. This includes Daily review of previous 24 hour variance to staffing plan and bureau usage. Daily capacity planning including nursing roster review and mitigation strategies

Senior nurses rostered to cover gaps in the first instance. Daily staffing guidelines updated and supplementary staffing approvals elevated to NUM level for signoff. Review of staffing requirements for the night and following morning shifts and allocation of senior nurses into gaps.

This includes review of Trendcare data, the occupancy forecast report, Clinical Staffing Sheets and bureau usage report

Reduction in supplementary staffing and associated costs.

Jun-15 on going

2 Project to review the increase of patient attender use

Nurse Directors

Process map of current patients who have been allocated patient attenders. Cohort patients who require watches where possible

Analyse if usage required and appropriate allocation of resources (spend), to ensure patients safety and reduction in the current overspend in this area. Review of the role of support worker in the AOU

Behaviour of concern pathway and directorate supplementary staffing

Update of Behaviour of concern pathway and policy - linked to Acute Observation Unit (AOU) project

July Sep-15

3 Project to review the increase in additional AOUs

Jane Lees

Patients assessed for commencement on Better Brain Pathway.

Delirium screening of patients to be used as the criteria for establishing additional AOUs

Audit of existing patient pathways

Develop criteria for the establishment of AOUs and admission into them.

May Sep-15

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4 Discharge Coordination

Nurse Directors

Daily review of length of stay report and transition lounge usage to expedite discharging. Elevation at 1015 meeting of any delays to discharge

Timely discharge and better utilisation of bed usage

Length of stay report. Transition lounge usage report

Reduction in delays to discharge

Feb

5 Trendcare utilisation to inform staffing decisions

Nurse Directors

Use of Trendcare data to inform staffing decisions in those areas that have Trend care. Re-engineering and smoothing of staff rosters. Roster overview and sign off by NUM’s in all areas

Staff reallocated based on Trendcare data.

Trendcare data Better use of staffing resource. Reduction in supplementary staffing use ($)

April on going

6 Employee leave management

Nurse Directors

*Action plans for excess leave management developed and monitored on Directorate MOS boards. *Sickness absence proactively managed at a local level, concerns elevated to NUM

Individual excess leave plans, support and for individuals. Management according to ADHB sickness and absence policy

Push report data

Reduction in supplementary staffing use / roster gaps ($)

April on going

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7 Nursing Skill Mix review

Nurse Directors

Development of a monthly report showing target skill mix per area, actual skill mix in FTE per level, Budget ($) and actual in ($). On-boarding of New Graduates prior to NeTP programme to reduce the backfill of vacancy.

Appropriate balance of skill mix across areas. Reduction in cost per FTE for those areas with a variance to plan

Monthly nursing skill mix report

Reduction in cost per FTE

Feb on going

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The following action plan is in place within the Women’s Health Directorate to manage midwifery staffing FTE and costs within the Directorate.

Item Area Owner Actions Implemented

Output Data reviewed Measure Commenced Expected end date

1

Project to review

midwifery model of

care

Midwife Director/General

Manager

Project has commenced to

implement a new model of

midwifery care that is based on accepted staff: patient ratios, occupancy and

regional benchmarking.

The project includes

implementation of good management

processes – benefits are to

include a reduction in

bureau, overtime usage and in staff

sickness.

A centralised leave management tool has been developed to ensure leave provisions are in line with model of care

Bureau usage and overtime usage report. Sick leave and excess annual leave reports.

Occupancy reports.

Reduced bureau usage

Apr-15 Dec-15

Newly appointed midwife managers have had training in the implementation of the staff sickness policy and long standing issues sickness are being tackled.

Reduced overtime usage

A consistent orientation programme, in particular for new graduate midwives and new starters is being implemented

Reduced sick leave

All rosters are now developed centrally in line with ward models of care, This allows staff to better manage skill mix, with lines designated for senior core midwives and more junior rotating midwives

Less hours required for orientation

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Item Area Owner Actions Implemented

Output Data reviewed Measure Commenced Expected end date

Working with Business Intelligence, and Workforce Central to develop a variance report showing variances to published rosters, this will also show all non-clinical paid hours.

Reduced fixed rosters

Strengthen daily staffing meetings to ensure adherence to models of care and align demand with acuity and activity.

Improved reporting and escalation processes

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14/15 Savings Programme

For 2014/15 one of our key priorities is to continue with a business transformation framework to deliver long-term financial and service sustainability in line with our strategic plan to live within our means.

Key Strategies

For the 2014/15 annual plan, the required savings to be found to close the budget gap was $49.5M. The Provider Arm savings represents $39.3M, categorised as either Business as Usual ($9.8M) or Business Transformation ($29.5M).

The savings target of $39.3M is linked to each directorate’s objective and fall into one of three key strategies being cost containment, model of service delivery changes and revenue growth in defined areas.

For HAC the Business Transformation target of $29.5M and monthly progress will be reported in this paper.

Table 1: Provider Arm Services Savings Target ($000’s)

Cause of Change Revenue growth Model of service delivery

Cost Containment

14/15 Savings Target

Business as Usual $848 $1,580 $7,405 $9,832

Business Transformation $5,471 $7,439 $16,565 $29,476

Grand Total $6,319 $9,019 $23,970 $39,308

FTE Impact on 14/15 budget

25.40 0.50 25.90

Business Transformation – June Update

The 2014/15 savings target of $29.5M has been achieved. Additional Funder savings ($586k) and Children’s clinical supplies ($800k) has contributed to the year-end result. Revenue Growth ($1.3M U) and Model of Service ($2.9M U) strategies have been offset by a favourable Cost Containment strategy ($4.2M F).

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Table 2: Business Transformation – June 15 YTD ($000’s)

Strategy Main Category 14/15 Savings Budget

YTD Actual YTD Budget

Variance

Revenue growth Government& Crown Agency

$3,387 $660 $3,387 -$2,728

Non-Government & Crown Agency

$2,084 $3,467 $2,084 $1,383

Revenue growth in defined areas Total $5,471 $4,127 $5,471 -$1,344

Model of service Personnel $4,001 $3,036 $4,001 -$965

Outsourced Services $2,058 $200 $2,058 -$1,858

Clinical Supplies -$105 $113 -$105 $218

Infrastructure &Non-Clinical

$575 $0 $575 -$575

Funder payments $586 $586

Internal Alloc’n DHB Provider

$910 $607 $910 -$303

Model of service delivery changes Total $7,439 $4,542 $7,439 -$2,897

Cost Containment Personnel $5,296 $7,409 $5,297 $2,112

Clinical Supplies $10,579 $11,768 $10,579 $1,189

Infrastructure &Non-Clinical

$690 $889 $690 $199

Internal Alloc’n DHB Provider

$0 $742 $0 $742

Cost Containment Total $16,565 $20,807 $16,566 $4,241

Grand Total $29,476 $29,476 $29,476 $0

Category of Savings

The two main categories of savings are clinical supplies (40%) and personnel (35%) with a combined

total of $22M. The balance represents revenue $4.1M (14%), Internal $1.3M (5%), Infrastructure $0.9M

(3%), Funder offset $0.9M (2%) and outsourced services $0.2M (1%).

Key Points by Service:

Adult Medical – exceeded budget by $209k F. This is mainly attributed to emergency medicine

laboratory cost reductions exceeding budget by $323k F. This has helped to mitigate unfavourable

variances in Critical Care ($82k U) and IVIG ($32k U).

Adult Community & LTC – exceeded budget by $135k F. The savings are mainly driven by the OPH

skill mix review and reduction in 8 OPH beds.

Adult Surgical – unfavourable variance of $2.3M U. No savings reported for key initiatives such as

co-payments and Ophthalmology revenue ($1.5M U) and the pathway redesign/theatre productivity

initiatives ($1M U) but savings achieved against renal transplant revenue and cost containment. The

Pathway redesign and Theatre productivity initiatives are in consultation phase and the Scheduling

& Booking initiative is awaiting approval.

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Women’s – unfavourable variance $186k U. The key initiative is the Redesign of Community

Midwifery model of care which will not proceed until after the collaboration with WDHB has been

completed. This is has delayed the programme and the expected savings will not be realised until

15/16.

Children’s – exceeded budget by $531k F. Unbudgeted clinical supplies savings ($800k) has reversed

the earlier unfavourable position experienced with increased personnel costs incurred in May. ACC

($1M F) and Non-resident revenue ($587k F) have continued to track ahead of budget to offset the

unfavourable variances in co-payment funding ($983k U), Strategic Partnership with Starship

Foundation ($400k U) and personnel initiatives ($511k U).

Cardiac Services – unfavourable variance $879k U. The year end savings of $306k are mainly due to

clinical supplies ($247k). The unfavourable initiatives include heart valve cost initiative ($192k U),

reduce blood use in CTSU ($285k U), cardiac surgical efficiencies ($191k U) and outsourcing ($200k

U). The service has negotiated reduced prices for heart valves and while some savings are being

reported this year, the timing delays will result in benefits flowing into 15/16.

Clinical Support – exceeded budget by $1.2M F. The favourable result is attributed to unbudgeted

personnel savings $2M F and clinical supplies $193k F. This has offset initiatives including

outsourcing reductions ($608k U), Scheduling & Booking process ($225k U) and other personnel

initiatives ($352k U).

Non Clinical Support – unfavourable variance of $323k U. Unbudgeted savings (offsets) from

photocopier and printers ($328k F) have offset Food ($375k U), Waste volume ($200k U) and

security initiatives ($158k U).

Perioperative Services – exceeded budget by $403k F. The savings are attributed to cost

containment of clinical supplies and waste management initiatives.

Cancer & Blood – exceeded budget by $103k F. The savings relate to Haematology FTE vacancies.

Mental Health – unfavourable variance of $103k U. The savings achieved to date relate to

managing excess leave and flexi-fund reduction initiatives which has offset the ACC/non eligible

revenue initiative ($200k U).

Functional – exceeded budget by $581k F. Savings reported in interest revenue ($594k F) and

unbudgeted IM revenue ($319k F) to offset unfavourable capital charge ($332k U).

Human Resources – achieved budget savings of $3.7M F. This is attributed to SMO savings ($3.5M)

and sick leave savings ($226k).

HealthAlliance – achieved procurement target

Funding & Planning – favourable variance of $586k F. The $586k has been applied to offset the

provider services shortfall against total target savings of $29.5M.

5.3

64


Table 3: Savings by Service – June 15 YTD ($000’s)

Service Strategy Savings Budget

YTD Actual

YTD Budget Variance

Adult Medical Model of service delivery $70 $38 $70 -$32

Cost Containment $177 $418 $177 $241

Adult Medical Total $247 $456 $247 $209

Adult Community & LTC Model of service delivery $810 $945 $810 $135

Adult Community & LTC Total $810 $945 $810 $135

Surgical Revenue growth $2,821 $993 $2,821 -$1,829

Model of service delivery $1,262 $48 $1,262 -$1,214


Surgical Total $4,083 $1,783 $4,083 -$2,301

Womens Model of service delivery $180 -$6 $180 -$186

Womens Total $180 -$6 $180 -$186

Children’s Revenue growth $1,950 $2,192 $1,950 $242

Model of service delivery $2,395 $1,884 $2,395 -$511

Cost Containment $800 $1,600 $800 $800

Children’s Total $5,145 $5,676 $5,145 $531

Cardiac Model of service delivery $450 $59 $450 -$391

Cost Containment $735 $247 $735 -$488

Cardiac Total $1,185 $306 $1,185 -$879

Clinical Support Revenue growth $300 $149 $300 -$151

Model of service delivery $1,697 $987 $1,697 -$710

Cost Containment $1,879 $3,983 $1,879 $2,104

Clinical Support Total $3,876 $5,119 $3,876 $1,243

Non Clinical Support Model of service delivery $575 $0 $575 -$575


Non Clinical Support Total $765 $442 $765 -$323

Perioperative Cost Containment $400 $803 $400 $403

Perioperative Total $400 $803 $400 $403

Cancer & Blood Cost Containment $135 $238 $135 $103

Cancer & Blood Total $135 $238 $135 $103

Mental Health Revenue growth $200 $0 $200 -$200


Mental Health Total $449 $343 $445 -$103

Functional Revenue growth $200 $794 $200 $594

Cost Containment $500 $491 $504 -$13

Functional Total $700 $1,285 $704 $581

Human Resources Cost Containment $3,700 $3,700 $3,700 $0

Human Resources Total $3,700 $3,700 $3,700 $0

healthAlliance Cost Containment $7,800 $7,800 $7,800 $0

healthAlliance Total $7,800 $7,800 $7,800 $0

Funding & Planning Offset $586 $586

Funding & Planning Total $586 $586

Grand Total $29,476 $29,476 $29,476 $0

65


Volume Performance

1) Combined DRG and Non-DRG Activity (All DHBs)

June 2015 Year to Date

$000s $000s

Directorate Service Cont Act Var Prog % Cont Act Var Prog %

A+ Links, HOP, Rehab 4,230 3,860 (371) 91.2% 47,918 43,839 (4,079) 91.5%

Ambulatory Services 2,097 1,847 (250) 88.1% 23,682 22,500 (1,182) 95.0%

6,327 5,707 (620) 90.2% 71,600 66,338 (5,262) 92.7%

AED, APU, DCCM, Air

Ambulance1,855 1,876 22 101.2% 21,272 22,748 1,477 106.9%

Gen Med, Gastro, Resp,

Neuro, ID, Renal9,905 9,988 83 100.8% 116,513 122,617 6,104 105.2%

11,760 11,865 105 100.9% 137,785 145,365 7,581 105.5%

Elective, Interp 19 19 0 100.0% 231 231 0 100.0%

Gen Surg, Trauma,

Ophth, GCC, PAS8,022 8,333 311 103.9% 93,282 93,891 608 100.7%

N Surg, Oral, ORL,

Transpl, Uro8,622 7,967 (655) 92.4% 99,859 98,903 (956) 99.0%

Orthopaedics Adult 4,243 3,998 (245) 94.2% 50,727 48,641 (2,085) 95.9%

20,907 20,318 (589) 97.2% 244,099 241,665 (2,433) 99.0%

8,198 8,114 (84) 99.0% 94,760 91,156 (3,604) 96.2%

10,922 9,269 (1,653) 84.9% 123,605 123,721 117 100.1%

Child Health & Disability 910 912 1 100.2% 10,686 10,623 (63) 99.4%

Medical & Community 6,242 6,496 254 104.1% 72,086 72,388 302 100.4%

Paediatric Cardiac & ICU 3,562 3,580 18 100.5% 42,706 41,250 (1,456) 96.6%

Surgical & Community 4,655 4,544 (112) 97.6% 53,906 51,200 (2,706) 95.0%

15,369 15,531 162 101.1% 179,385 175,461 (3,924) 97.8%

1,979 2,023 44 102.2% 21,747 23,352 1,605 107.4%

5,825 5,825 0 100.0% 69,283 69,283 0 100.0%

39 39 0 100.0% 469 469 0 100.0%

129 129 0 100.0% 1,537 1,537 0 100.0%

102 102 0 100.0% 1,216 1,216 0 100.0%

Genetics 230 293 63 127.4% 2,525 2,981 456 118.1%

Women's Health 6,754 6,103 (651) 90.4% 81,237 78,919 (2,317) 97.1%

6,984 6,396 (588) 91.6% 83,762 81,901 (1,861) 97.8%

88,541 85,318 (3,224) 96.4% 1,029,247 1,021,466 (7,781) 99.2%

Women's Health

Women's Health Total

Grand Total


DHB Funds

Mental Health & Addictions Total

Public Health Services

Support Services

Surgical Services Total

Cancer & Blood Services

Cardiac Services

Children's Health

Children's Health Total

Adult Community & LTC Total

Adult Medical

Services

Adult Medical Services Total

Surgical Services

Adult Community

& LTC

5.3

66


2) Total Discharges for the YTD June 2015

Directorate Service 2014 2015 Last YTD This YTD % Change Last YTD This YTD Last YTD This YTD

A+ Links, HOP, Rehab 0 0 2,308 2,194 (4.9%) 17 17 0.7% 0.8%

Ambulatory Services 1,696 1,690 2,019 2,008 (0.5%) 1,841 1,829 91.2% 91.1%

Adult Community & LTC

Total 1,696 1,690 4,327 4,202 (2.9%) 1,858 1,846 42.9% 43.9%

AED, APU, DCCM, Air

Ambulance 10,754 11,094 10,755 11,108 3.3% 7,844 8,071 72.9% 72.7%


Neuro, ID, Renal 18,947 18,660 19,198 18,924 (1.4%) 3,374 3,069 17.6% 16.2%

Adult Medical Services

Total 29,701 29,754 29,953 30,032 0.3% 11,218 11,140 37.5% 37.1%

Cancer & Blood Total 4,860 4,817 5,358 5,323 (0.7%) 2,405 2,481 44.9% 46.6%

Cardiac Services Total 7,892 7,844 8,186 8,084 (1.2%) 2,035 1,917 24.9% 23.7%

Medical & Community 14,424 14,903 15,942 16,415 3.0% 9,468 9,454 59.4% 57.6%

Paediatric Cardiac & 2,075 2,280 2,263 2,518 11.3% 480 496 21.2% 19.7%

Surgical & Community 9,270 9,665 9,897 10,245 3.5% 4,648 4,880 47.0% 47.6%

Children's Health Total 25,769 26,849 28,102 29,178 3.8% 14,596 14,830 51.9% 50.8%

Gen Surg, Trauma,

Ophth, GCC, PAS 16,375 16,537 18,490 18,464 (0.1%) 10,111 9,864 54.7% 53.4%

N Surg, Oral, ORL,

Transpl, Uro 10,635 10,747 11,305 11,497 1.7% 4,476 4,627 39.6% 40.2%

Orthopaedics Adult 4,871 5,009 5,199 5,335 2.6% 1,019 917 19.6% 17.2%

Surgical Services Total 31,881 32,293 34,994 35,296 0.9% 15,606 15,408 44.6% 43.7%

Women's Health Total 22,187 21,544 23,001 22,270 (3.2%) 9,135 8,626 39.7% 38.7%

Grand Total 123,986 124,791 133,921 134,385 0.3% 56,853 56,248 42.5% 41.9%

Same Day as % of all

discharges

Children's Health

Surgical Services

Adult Medical Services


Cases Subject to WIES

Payment

Inpatient

All Discharges Same Day discharges

67


3) Caseweight Activity for the YTD June 2015 (All DHBs)

Directorate Service Con Act Var Con Act Var Prog % Con Act Var Con Act Var Prog % Con Act Var Con Act Var Prog %

813 784 (29) 3,807 3,673 (135) 96.5% 115 123 8 537 576 39 107.3% 928 907 (20) 4,344 4,248 (96) 97.8%

AED, APU, DCCM,

Air Ambulance3,018 3,233 215 14,130 15,136 1,007 107.1% 0 0 0 0 0 0 0.0% 3,018 3,233 215 14,130 15,136 1,007 107.1%

Gen Med, Gastro,

Resp, Neuro, ID,

Renal

16,370 17,375 1,005 76,642 81,348 4,706 106.1% 4 0 (4) 20 0 (20) 0.0% 16,374 17,375 1,001 76,662 81,348 4,685 106.1%

19,388 20,608 1,220 90,772 96,484 5,712 106.3% 4 0 (4) 20 0 (20) 0.0% 19,392 20,608 1,216 90,792 96,484 5,692 106.3%

Gen Surg, Trauma,

Ophth, GCC, PAS8,677 8,592 (85) 40,626 40,229 (397) 99.0% 7,196 7,045 (151) 33,691 32,982 (709) 97.9% 15,873 15,637 (236) 74,317 73,211 (1,106) 98.5%

N Surg, Oral, ORL,

Transpl, Uro8,110 7,795 (315) 37,969 36,494 (1,475) 96.1% 6,922 7,115 193 32,408 33,311 903 102.8% 15,032 14,909 (122) 70,378 69,805 (572) 99.2%

Orthopaedics

Adult5,704 5,790 87 26,705 27,110 406 101.5% 4,060 3,548 (512) 19,011 16,612 (2,399) 87.4% 9,764 9,338 (426) 45,716 43,722 (1,993) 95.6%

22,490 22,177 (313) 105,300 103,833 (1,467) 98.6% 18,178 17,707 (471) 85,110 82,905 (2,205) 97.4% 40,669 39,885 (784) 190,410 186,738 (3,671) 98.1%

6,019 5,722 (297) 28,180 26,790 (1,390) 95.1% 0 0 0 0 0 0 0.0% 6,019 5,722 (297) 28,180 26,790 (1,390) 95.1%

14,824 13,720 (1,104) 69,406 64,238 (5,168) 92.6% 9,161 10,206 1,044 42,894 47,782 4,888 111.4% 23,986 23,926 (60) 112,300 112,020 (280) 99.8%

Medical &

Community10,300 10,394 93 48,226 48,663 437 100.9% 0 0 0 0 0 0 0.0% 10,300 10,394 93 48,226 48,663 437 100.9%

Paediatric Cardiac

& ICU5,883 5,530 (352) 27,543 25,893 (1,650) 94.0% 2,383 2,538 155 11,156 11,882 726 106.5% 8,265 8,068 (197) 38,699 37,775 (924) 97.6%

Surgical &

Community5,803 5,130 (673) 27,168 24,017 (3,151) 88.4% 4,390 4,394 4 20,553 20,573 20 100.1% 10,193 9,524 (669) 47,721 44,591 (3,130) 93.4%

21,986 21,054 (932) 102,937 98,573 (4,364) 95.8% 6,773 6,932 159 31,709 32,455 747 102.4% 28,758 27,986 (773) 134,645 131,028 (3,617) 97.3%

10,210 10,100 (110) 47,802 47,288 (514) 98.9% 2,117 1,831 (286) 9,913 8,572 (1,340) 86.5% 12,327 11,931 (396) 57,715 55,861 (1,855) 96.8%

95,730 94,165 (1,564) 448,204 440,879 (7,325) 98.4% 36,349 36,799 450 170,183 172,291 2,108 101.2% 132,078 130,964 (1,114) 618,387 613,170 (5,216) 99.2%

Excludes caseweight Provision

$000s

Adult

Medical

Services



Surgical

Services

$000s Case Weighted Volume

Women's Health Service

Grand Total

Case Weighted Volume $000s Case Weighted Volume


Cancer & Blood Service

Cardiac Service

Children's

Health


Acute Elective Total

As noted in last month’s report, the recoding of cardiac activity has led to a significant change in the acute and elective profile against contract. Acute activity dropped from 99.7% of contract to 98.4%, while electives was sitting at 96.3% and is now 101.2% of contract. Note that this recoding has no impact on ADHB’s performance to elective target as it related solely to IDF discharges under Cardiothoracic. Year end performance has increased by 195 CWDs based on the most up to date coding. This is predominantly non ADHB activity, which partly mitigates the year end wash up risk, although overall delivery for other DHBs has dropped between 2013/14 and 2014/15.

5.3

68


Acute As noted above the recoding has changed the acute and elective profile. After adjusting for the Cardiothoracic changes the other DHB inflows are 1% lower than the previous year’s activity. ADHB discharges were only 0.8% higher than last year, but the WIES profile for the ADHB population is up by 3% reflecting a number of high WIES discharges in the year. This is highly variable and changes from year to year and over populations. For example, for ADHB population there were 5 cases over 50 WIES contributing to 923 WIES in 2014/15 compared with last year where there were only 2 cases contributing 361 WIES, while all other populations only had 167 WIES across 3 patients.

The acute medical discharge increase is slightly above population growth (0.8% across all populations). Average WIES is up on last year at driven primarily by the very high WIES discharges (over 800 WIES for 3 patients in medical specialities).

Acute surgical discharges have dropped even after adjusting for the Cardiothoracic recoding. This is predominantly in the IDF population. Overall, excluding Cardiothoracic there has been very little change to average WIES or length of stay over the past 4 months.

Obstetric and Newborn activity has continued to drop, discharges have continued dropping since March. However, there has been a slight increase in average WIES reflecting some long stay cases discharged at year end.

Elective

Elective throughput (excluding Cardiothoracic) was 1.27% higher than last year. Average WIES has ended up about the same as last year. ADHB population WIES was up on last year, although discharges were not, while other DHB activity had a lower average WIES than previous year (excluding Cardiothoracic).

69


4) Non-DRG Activity (ALL DHBs)

June 2015 Year to Date

$000s $000s

Directorate Service Cont Act Var Prog % Cont Act Var Prog %

A+ Links, HOP, Rehab 4,230 3,860 (371) 91.2% 47,918 43,839 (4,079) 91.5%

Ambulatory Services 1,748 1,572 (176) 89.9% 19,338 18,251 (1,086) 94.4%

5,979 5,432 (547) 90.9% 67,256 62,090 (5,166) 92.3%

AED, APU, DCCM, Air

Ambulance654 558 (95) 85.4% 7,142 7,612 470 106.6%


Neuro, ID, Renal3,626 3,439 (187) 94.9% 39,850 41,269 1,419 103.6%

4,279 3,997 (282) 93.4% 46,992 48,881 1,889 104.0%

Elective, Interp 19 19 0 100.0% 231 231 0 100.0%

Gen Surg, Trauma,

Ophth, GCC, PAS1,738 1,797 59 103.4% 18,966 20,680 1,714 109.0%

N Surg, Oral, ORL,

Transpl, Uro2,585 2,413 (172) 93.4% 29,481 29,097 (384) 98.7%

Orthopaedics Adult 457 485 28 106.1% 5,011 4,919 (92) 98.2%

4,799 4,715 (84) 98.2% 53,689 54,927 1,238 102.3%

5,984 5,530 (454) 92.4% 66,580 64,365 (2,214) 96.7%

1,001 991 (9) 99.1% 11,305 11,701 396 103.5%

Child Health & Disability 910 912 1 100.2% 10,686 10,623 (63) 99.4%

Medical & Community 2,151 1,877 (274) 87.3% 23,861 23,726 (135) 99.4%

Paediatric Cardiac & ICU 363 287 (76) 79.1% 4,008 3,475 (533) 86.7%

Surgical & Community 564 586 22 103.9% 6,185 6,609 424 106.9%

3,988 3,662 (326) 91.8% 44,740 44,433 (307) 99.3%

1,979 2,023 44 102.2% 21,747 23,352 1,605 107.4%

5,825 5,825 0 100.0% 69,283 69,283 0 100.0%

39 39 0 100.0% 469 469 0 100.0%

129 129 0 100.0% 1,537 1,537 0 100.0%

102 102 0 100.0% 1,216 1,216 0 100.0%

Genetics 230 293 63 127.4% 2,525 2,981 456 118.1%

Women's Health 2,153 1,645 (508) 76.4% 23,521 23,059 (463) 98.0%

2,383 1,938 (445) 81.3% 26,047 26,040 (7) 100.0%

36,488 34,384 (2,104) 94.2% 410,860 408,296 (2,565) 99.4%


DHB Funds


Adult Community

& LTC

Adult Community & LTC Total

Adult Medical

Services


Surgical Services


Children's Health

Cardiac Services

Cancer & Blood Service

Grand Total

Women's Health Total

Mental Health & Addictions

Public Health Service

Support Services

Women's Health

The year end non DRG wash up is now $1.3m (a further increase on last month of $500k).

Other areas of note at year end are:

Ophthalmology - $1.86m of over delivery (of which $1.7m is not funded by the Waitemata funder).

Adult Medical - has over delivered due to:

o ED activity up 4% on last year and 7% on contract, reflecting the reduction in contract in

1415.

o Colonoscopy increases to meet waiting times according to an elective initiative and

o Renal dialysis modalities.

5.3

70


Cancer under delivery which is a mix of lower patient flow ($400k radiotherapy and $1.4m

chemotherapy) and the successful implementation of reduced follow up ($921k). Unfortunately, as

this is one of the few services to be subject to wash up, we cannot offset underdelivery in this area

against over delivery in other areas.

71


6 Directorate Updates

Recommendation

That the Directorate Updates report, which is comprised of the following sections, be received:

6.1 Mental Health Directorate

6.2 Women’s Health Directorate

6.3 Child Health Directorate

6.4 Surgical Services Directorate

6.5 Perioperative Services Directorate

6.6 Cardiovascular Directorate

6.7 Adult Medical Directorate

6.8 Cancer and Blood Directorate

6.9 Clinical Support Services

6.10 Non-Clinical Support Services

6.11 Community and Long Term Conditions Directorate



6

72


Mental Health Directorate

Speaker: Clive Bensemann, Director

Service Overview

This Directorate provides specialist community and inpatient mental health services to Auckland

residents. Our team provide a range of services at various levels: sub-regional (adult inpatient

rehabilitation & community psychotherapy), regional (youth forensics) and supra-regional (child and

youth acute inpatient & eating disorders). The Mental Health Directorate is led by Director: Dr Clive

Bensemann, with General Manager: Maria West, Director of Nursing: Anna Schofield and Director of

Allied Health: Mike Butcher.

Scorecard

Mental Health

Jun-15 Measure Actual Target Prev Period

In

cre

ase

d P

ati

en

t Sa

fety

Medication Errors 17

0 15

Falls with major harm 0 0 0

Nosocomial pressure injury point prevalence (% of in-patients) 0.0% % 0.0%

Nosocomial pressure injury point prevalence - 12 month average (% of in-patients) 0.0% % 0.0%

Number of reported adverse events causing harm (SAC 1&2) 0 0 2

Seclusion. All inpatient services - episodes of seclusion 0 <=7 3

Restraint. All services - incidents of restraint 72 <=86 108

Mental Health Provider Arm Services: SAC1&2 Suicides 0 2

B

ett

er

Qu

alit

y C

are

7 day Follow Up post discharge

97.4%

95%

97.6%

Mental Health - 28 Day Readmission Rate (KPI Discharges) to Te Whetu Tawera R/U 10% 13.3%

Mental Health Average LOS (KPI Discharges) - Te Whetu Tawera 26.8 <=21 39.2

Mental Health Average LOS (All Discharges) - Child & Family Unit 10.1 <=15 8.8

Mental Health Average LOS (All Discharges) - Fraser McDonald Unit 41.1 <=35 20.5

Waiting Times. Provider arm only: 0-19Y - 3W Target 83.3% 80% 83.0%




Waiting Times. Provider arm only: 65Y+ - 3W Target 74.3% 80% 76.9%

Waiting Times. Provider arm only: 65Y+ - 8W Target 88.7% 95% 90.2%

Im

pro

ved

He

alth

Sta

tus

% Hospitalised smokers offered advice and support to quit

100.0% 95%

92.0%

% Long-term clients with relapse prevention plans in last 12 months (6 monthly)

* 91.4% 95% 95.0%

Mental Health access rate - Maori 0-19Y 5.12% % 4.94%

Mental Health access rate - Maori 20-64Y 10.52% % 10.56%

Mental Health access rate - Maori 65Y+ 3.77% % 3.77%

Mental Health access rate - Total 0-19Y 2.91% 3% 2.84%

Mental Health access rate - Total 20-64Y 3.96% % 3.98%

Mental Health access rate - Total 65Y+ 3.34% % 3.33%

6.1

73


En

gage

d W

ork

forc

e Excess annual leave dollars ($M) $0.18 0 $0.16

% Staff with excess annual leave > 1 year 27.2% 0% 25.4%

% Staff with excess annual leave > 2 years 6.1% 0% 6.3%

% Staff with excess annual leave and insufficient plan to clear excess by the end of financial year

97.9%

0%

97.9%

% Pre-employment Screenings (PES) cleared before the start date 91.7% 100% 100.0%

Sick leave hours taken as a percentage of total hours worked 4.1% 3.4% 4.1%

% Voluntary turnover (annually) 9.9% 10% 9.9%

% Voluntary turnover <1 year tenure 2.7% 6% 1.4%

Scorecard Commentary

Health Targets

95% of hospitalised smokers offered advice and support to quit

100% achieved in the reporting period.

Increased Patient Safety

Medication Errors

Eight errors reported for BRC. Four of which were related to Blister packs. The change from Blister

packaging to administration commenced from July. A rapid reduction in these errors is expected.

Better Quality Care

Length of Stay: Although this is above national target, LOS is considerably lower than in past years;

admission numbers have increased over previous years (access and flow has improved) and the

median length of stay is similar to neighbouring DHBS and close to national target.

Improved Health Status

Relapse Prevention Plans: This has fallen below target 95%. Of the total 8.6% of eligible patients

without an 'up to date' relapse prevention plan >80% already have a plan but this requires review

i.e. of more than 1200 eligible patients, 19 have no plan.


Services are emphasising the importance of reviewing existing plans. The nationally set target is 95%

to assure a high quality ‘relapse planning’ process, but work is on-going to endeavour that all eligible

patients have such plans.

Amber =

R/U =

Variance from target not significant enough to report as non-compliant. This includes percentages/rates within 1% of target, or volumes

within 1 value from target.

Results Unavailable.

Mental Health - 28 Day Readmission Rate (KPI Discharges) to Te Whetu Tawera

A 35 day period is required to accurately report all acute re-admissions for the previous month's discharges. (35 days = 28 days post

discharge as per MoH measures plus 5 working days to allow for coding).

Note: * reported 6 monthly, actual value for period ending June 2015.

74


Family Violence Screening

Family Violence screening in Mental Health services is currently being implemented. Of the approx.

700 staff, 180 have been trained to date. ADHB VIP systems and processes have been aligned to

meet Mental Health service needs.

Efforts to increase the screening rate include:

All staff are followed up in the clinical setting and via email after attending the family

violence study day to encourage screening and to increase confidence.

Family violence team has made direct contact with all managers and offered update

sessions/short and sharp sessions on the wards with all staff.

Screening has been discussed with the steering group to highlight to members areas of low

or declining screening rates and taking responsibility for making a priority/focus.

Greater focus on family violence screening champions and supporting them and their role.

Engaged Workforce

The services continue to actively work with the group of staff with excess leave to plan annual leave

across the year and to identify and process applications where ‘buy out’ is appropriate.

Strategic Initiatives

Deliverable/Action Status

Ensure that people are engaged at the right level of service at the right time (using resources effectively/links to stepped care)

Monitor consult liaison activity from secondary care to primary care, schools and other public agencies

Continue to implement the long term restraint/seclusion minimisation strategy

Implement actions from the Child and Youth MH&A Direction with interagency partners

Implement enhancements to Maternal Mental Health continuum

Improve social inclusion through increased access to employment

Regional MoC Eating Disorders Off Track

Contribute to development of Regional Youth Forensic pathway and MoC

Increased Patient Safety Better Quality Care Economic Sustainability Improved Health Status Engaged Workforce

Key achievements in the month

MH Directorate Restructure

Of the newly created positions; 5 of the 6 Service Clinical Directors are now in post. The Nurse Unit

Manager for TWT has commenced in post and the Nurse Unit Manager for FMU/CFU has also been

recruited and is due to commence in August. The new TWT Nurse Consultant position recruitment is

close to completion.

6.1

75


Areas off track and remedial plans

Regional Eating Disorders MoC

Following delays in the regional process, the Directorate, together with the Children’s Health

Services, is working with the Funder and the Director of Provider Services to formulate a project

team during August 2015. A brief for the Board is being prepared for next month’s meeting.

BRC Medication Errors

Approval processes for changes to medication management systems at BRC delayed the go live date

to early July. Implementation has now commenced and blister packaging errors are predicted to

reduce. Implementation has included improved pharmacy processes, staff upskilling, and regular

reviews alongside improvement to the medication clinic environment to improve efficiency and

reduce risk.

Health & Safety

The Asbestos identified in the Community Mental Health Service building has been removed in

compliance with regulations. The workforce has been kept fully informed during the process.

Key issues and initiatives identified in coming months

Pathway for Police Referral and Assessment

Collaboration continues between MH&A Directorate and the Emergency Department developing a

pathway for assessment. Minor structural work is probably required in the current interview space

and facilities estimates for this are being developed.

Shared Care Pilot – MHSOP

The MHSOP Community Service is piloting the use of electronic Shared Care Plans with staff using

tablets to work with consumers in the community setting. This is part of the ADHB/ProCare project

for implementation of Shared Care Plans across a range of services.

76


Financial Results

Comments on Major Financial Variances

The result for the month is a loss of $215k, leaving an unfavourable variance of $257k against

budget. The YTD result is a surplus of $3,666k against a budgeted surplus of $487k, a favorable

variance of $3,179k.

The June results include one-off $312k revenue claw-back from Funder for the Regional Youth

Forensic Service mostly relating to prior months and a number of year end wash-ups of final costs

including facilities charges, motor vehicle repairs and special projects.

($000s) MONTH YEAR TO DATE


REVENUE

Government and Crown Agency 66 79 (14) U 826 921 (95) U

Funder to Provider Revenue 8,009 8,309 (300) U 98,994 99,705 (711) U

Other Income 103 42 61 F 1,142 471 671 F

Total Revenue 8,178 8,431 (253) U 100,962 101,097 (135) U

EXPENDITURE

Personnel Costs

Medical 1,734 1,737 3 F 19,749 20,696 947 F

Nursing 2,107 2,244 137 F 25,780 27,055 1,274 F

Allied Health 1,781 1,892 111 F 20,604 22,700 2,096 F

Support 27 23 (3) U 297 279 (17) U

Management/Adminstration 335 320 (15) U 3,824 3,819 (5) U

Total Personnel Costs 5,984 6,217 233 F 70,254 74,549 4,295 F

Outsourced Personnel 92 35 (58) U 1,303 415 (888) U

Outsourced Clinical Services 76 71 (5) U 899 850 (49) U

Clinical Supplies 23 64 41 F 797 770 (26) U

Infrastructure & Non-Clinical Supplies 521 290 (231) U 3,780 3,481 (299) U

Total Expenditure 6,697 6,677 (20) U 77,034 80,066 3,032 F

Contribution 1,481 1,754 (273) U 23,928 21,032 2,897 F

Allocations 1,696 1,712 16 F 20,263 20,545 282 F

NET RESULT (215) 42 (257) U 3,666 487 3,179 F

Paid FTE

MONTH (FTE) YEAR TO DATE ( FTE)


Medical 87.1 92.5 5.4 F 87.9 92.4 4.6 F

Nursing 294.6 301.5 6.9 F 285.1 301.5 16.4 F

Allied Health 262.6 282.5 19.9 F 263.2 282.5 19.3 F

Support 5.6 5.3 (0.3) U 5.9 5.3 (0.6) U

Management/Administration 57.4 57.5 0.1 F 57.4 57.5 0.1 F

Total excluding outsourced FTEs 707.2 739.3 32.1 F 699.5 739.2 39.7 F

Total :Outsourced Services 10.9 0.5 (10.4) U 11.5 0.5 (11.0) U

Total including outsourced FTEs 718.1 739.8 21.7 F 711.0 739.7 28.7 F

Statement of Financial Performance for June 2015

Auckland DHB - Mental Health

6.1

77


The main driver of the YTD result is the favorable personnel costs of $3,407k (including outsourced

Personnel) due to high FTE. The service is actively recruiting and there has been an improvement in

clinical FTE over the last 6 months, however vacancies are expected to be ongoing for short term

with the mixed factors of recruitment difficulties and resignations. We are looking at further projects

in Te Whetu Tawera, Kari Centre and other services with higher turnover and recruitment difficulties

to increase retention in these areas.

Summary

Mental Health is unfavourable to budget for the month but favorable to the whole financial year.

We are working to achieve a full workforce which will enable a reduction in excess annual leave and

cost per FTE.

78


Women's Health Directorate

Speaker: Dr Sue Fleming, Director

Service Overview

The Women’s Health portfolio includes all Obstetrics and Gynaecology services plus Fertility and

Termination services. The team is contracted to provide primary, secondary and tertiary services.

The Maternal Fetal Medicine group provide quaternary services and are contracted to lead the

National Maternal Fetal Medicine network.

The Northern Hub of the National Genetic service is also under the umbrella of the Women’s

Healthcare Service Group.

Scorecard

Jun-15 Measure Target

Number of healthcare-associated bloodstream infections 1 TBC 0

Number of healthcare-associated Staphylococcus aureus bacteraemia 0 TBC 0

Medication Errors 9 0 7





HT2 Elective discharges cumulative variance from target 0.93 >=1 0.92

(ESPI-1) % Services acknowledging 90% of FSA referrals R/U 100% 100.0%

(ESPI-2) Patients waiting longer than 4 months for their FSA 0.00% 0% 0.00%

(ESPI-5) Patients given a commitment to treatment but not treated within 4 months 0.00% 0% 0.00%

% DNA rate for outpatient appointments - All Ethnicities 8.0% 9% 5.0%

% DNA rate for outpatient appointments - Maori 14.0% 9% 12.0%

% DNA rate for outpatient appointments - Pacific 17.0% 9% 12.0%

Elective day of surgery admission (DOSA) rate 84.9% % 84.9%

% Day Surgery Rate 52.3% 0% 47.7%

Inhouse Elective WIES through theatre - per day 7.48 >=4.5 6.32

Number of patients discharged to Birthcare 235 TBC 276

Number of CBU outliers 1 0 5

% Very good and excellent ratings for overall inpatient experience R/U 90% 81.7%

% Very good and excellent ratings for overall outpatient experience R/U 90% 86.0%

Number of complaints received 7 TBC 2

28 Day Readmission Rate - Total R/U TBC 4.5%

Average Length of Stay for WIES funded discharges (days) - Acute 2.04 >=2 2.11

Average Length of Stay for WIES funded discharges (days) - Elective 1.27 >=1.25 1.36

Actual Prev Period

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Health Targets

Our year end position for our elective discharges was as predicted; below contract. The reasons for

this are detailed in a formal electives paper to be presented separately for information.


There were 9 minor medication errors; none of which resulted in patient harm. There were two SAC

2 events which are being fully investigated. One of these events related to an unwitnessed fall in our

outpatient area. It is not clear that harm resulted. The patient is under the care of their GP who is

investigating symptoms that may be related to the fall.

Better Quality Care

We continue to remain compliant with our ESPI targets meeting all 3 ESPI targets for the month.

Our DNA rates for Maori and Pacific continue to be around 8 % higher than DNA rates of other

ethnicities. These DNA’s occur across both our gynaecology and maternity service. We recognise

that the reasons for this are complex but include the fact that the ways in which we deliver care do

not always align with the cultural needs of the Maori and Pacific women. As part of our Women’s

Health strategy we are exploring ways to provide care more culturally appropriate care to women in

these communities. We have recently formalised a Maori community midwifery team to better

serve Maori women and where possible provide care in the community.

% Hospitalised smokers offered advice and support to quit 89.4% 95% 92.5%

Breastfeeding rate on discharge excluding NICU admissions 76.4% % 76.2%

Cervical Screening Rate (Quarterly) * 78.7% 0% 78.9%

NCSP DNA rates R/U 9% 4.0%Imp

rove

d H

eal

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Stat

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Amber =

R/U =

Results unavailable due to staff absenteeism

Results unavailable until after the 17th day of the month.

Note: * reported quarterly, actual value for period ending March 2015.




% Very good and excellent ratings for overall inpatient experience

% Very good and excellent ratings for overall outpatient experience

(ESPI-1) % Services acknowledging 90% of FSA referrals

Results unavailable until after the 10th working day of the month; 15th July, 2015.

NCSP DNA rates

Number of Employees who have taken greater than 80 hours sick leave in the past 12 months

These measures are based on retrospective survey data, i.e. completed responses for patients discharged or treated the previous month.

28 Day Readmission Rate - Total



80



For the month of June we had 6 women from 3 clinical areas where smoking cessation advice was

not offered. We have made this a focus of our ward level MOS meetings to ensure this is a daily

focus for staff.

Auckland cervical screening rates do not meet target. We are performing slightly better than the

National rates and have seen an 8.5 % increase. However, although we report on this target we do

not have the ability to directly influence this activity.

Engaged Workforce

The service continues to manage midwifery and nursing leave within our defined models of care and

purpose built leave tracker; however our current FTE model is not sufficient to allow all leave

entitlements to be taken and sustain a safe staffing model. We do not have the capacity to reduce

accumulated leave. In view of this the service has undertaken a comprehensive project to look at

leave management and to determine how we might best ways to address this challenge.


Women’s Health strategic initiatives as outlined below continue on track.

The Women’s Health Collaboration work is in the process of reviewing our strategic document

following feedback from HAC.

We continue to see excellent results with the WAU acute flow project and have had no 6 hour

breeches in AED as a result of these changes.


Maternity Strategy establishes clear regional pathways for pregnant women

Regional SGA guideline completed

Regional induction of labour pathway completed

Diabetes pathway-under development

On track

Women have appropriate access to primary birthing options (tied to Maternity Collaboration)

Normal birthing pathway-under development

Increasing primary birthing options- under development

Delayed

Secondary maternity services are delivered in an optimal and sustainable manner (tied to Maternity Collaboration).

Delayed

Maternity services are better aligned meet the needs of pregnant women, including vulnerable women (tied to Maternity Collaboration).

Delayed

6.2

81


Recovery after Obstetric Surgery ( EROS) On track

Referral pathways for women with common gynaecology problems are agreed.

Abnormal uterine bleeding- completed

Urogynaecology pathway- completed

On Track

Women’s Health Assessment Unit acute flow project

Redesign-completed

Evaluation and refinement-underway

On track.

Development of Women’s Health Management Operating System and Clinical Governance framework aligned with new leadership structure.

On track

Completed for L2

On track for L3

Support staff and monitor staffing

Defining models of care- completed

Consultation with unions- completed

Reviewing leave process –underway

On track

Faster cancer pathways development plan

Stage 1- mapping

Stage 2- implementation

Stage 1 completed

Stage 2

commencing

Epsom Day Unit redevelopment

Redesigning model of care- underway

Rebranding of EDU- conceptual stage

Facilities redevelopment- early stage planning

Early stage



Met Clinical Genetics recovery plan with all patients waiting greater than 4 months with

booked appointments. Secured on-going funding to continue to work on recovery plan.

Completed transition training programme for all of our new Midwifery and Nursing Leaders.

Now rolling out weekly training/support group sessions to enable them to embed new skills.

Completion of phase 1 of our faster cancer project.

Ended the month of June favourable to budget.


Actual FTE within our inpatient Maternity wards remains higher than budgeted FTE. Work is

underway to develop a scorecard to track daily variances between planned rostering of staff and

actual staffing levels and aligning this with occupancy levels.

82



The SMO have requested a review of their current after hour remuneration. Their rate of

remuneration is not indexed nor has it been reviewed since 2007.

A Maternity Quality and Safety workshop is being held by the MOH to enhance primary

birthing, diabetes management and broader quality initiatives from a national perspective.

The Women’s Health Annual Clinical Report (2014) is due to be completed in July and the

clinical outcomes will be critiqued at the Annual Clinical Review day on 21 August.

Financial Results

STATEMENT OF FINANCIAL PERFORMANCE

Womens Health Services Reporting Date Jun-15



REVENUE

Government and Crown Agency 1,040 191 848 F 3,233 2,296 938 F

Funder to Provider Revenue 7,324 7,324 0 F 87,502 87,502 0 F

Other Income 327 164 163 F 2,025 1,963 62 F

Total Revenue 8,691 7,679 1,012 F 92,760 91,761 999 F

EXPENDITURE

Personnel

Personnel Costs 3,468 3,015 (453) U 38,576 36,097 (2,479) U

Outsourced Personnel 66 69 3 F 891 824 (67) U


Clinical Supplies 486 433 (53) U 5,182 5,197 16 F


Total Expenditure 4,324 3,618 (705) U 46,459 43,335 (3,124) U

Contribution 4,367 4,061 306 F 46,301 48,426 (2,125) U

Allocations 675 711 36 F 7,822 8,295 473 F

NET RESULT 3,692 3,350 342 F 38,479 40,131 (1,652) U

Paid FTE



Medical 62.5 65.5 3.1 F 64.8 65.5 0.7 F

Nursing 253.7 237.4 (16.3) U 254.9 237.4 (17.6) U

Allied Health 18.6 18.3 (0.3) U 18.7 18.3 (0.4) U

Support 0.0 0.0 0.0 F 0.0 0.0 (0.0) U

Management/Administration 37.9 36.6 (1.3) U 35.9 36.6 0.7 F

Other 0.0 0.0 0.0 F 0.0 0.0 (0.0) U

Total excluding outsourced FTEs 372.6 357.7 (14.9) U 374.3 357.7 (16.6) U


Total including outsourced FTEs 376.9 360.3 (16.6) U 378.4 360.3 (18.1) U

6.2

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The result for the month was $342k F and so the YTD result improved to $1,652 U.

CWD volumes for the month were 97% of contract and YTD steady at 97% of contract. Specialist

Neonates are steady at 95% YTD. Gynae acutes are on 113% of contract for the month and YTD

remain at 99.4% to contract.

Total discharges from the Directorate YTD are 3.2% lower than the same period last year.

Year to date financial analysis:

The YTD result is $1,652k U with the key variances being unfavorable Nursing variance of $2,154k U

offset by a favorable variance form a variety of Non-Devolved MoH contract funding of $499k F.

1 Revenue $999k F YTD arising from: a. Genetics Additional Revenue re Waitlist Resourcing $400k F this is extra MoH

funding to enable reduction in genetics waiting list. These revenues are offset by YTD costs of $128k of costs and a liability recognised of $272k for providing employee costs and clinical services to contract.

b. MoH Non-Devolved Contracts $499k F. These included funding for MFM Network co-ordination, establishment, Ante-natal HIV screening programme, Maternity Quality and Safety, Gynae Onc Faster Cancer Project, Gynae MoH surgical prioritisation tool. The funding for non-devolved initiatives is not always budgetable - the timing of funding remitted is mostly unpredictable.

c. Private patient income is $183k F to budget, due to Fertility Plus YTD activity being 18% above budget. The revenue for patients in the Fertility Plus service relates to treatments completed – that revenue fluctuates from month to month depending on patients completing their treatment cycles.

d. Non-Resident Income $152k U to budget. Although down on budget it is in line with prior year.

2 Expenditure a. Personnel $2,479k U. Midwifery costs are the main driver. The implementation of

changes, including the new models of care and a new leadership structure, have taken longer than anticipated because of the size and complexity of that work.

b. Outsourced Clinical Services $271k U. Major item $106K for the Genetics Waitlist Project offsets the income, above.

c. Infrastructure and nonclinical supplies $323k U – mainly Bad Debts of $216k U for non-resident billing. Also costs incurred are for Pepipods for $35k for Community Clinics which have an offsetting equivalent donation income. YTD also has one-off costs for; Audit Report on Epsom Day Unit, and cost sharing for the collaboration of maternity services with WDHB.

d. Allocations $473k F. Mainly from to Labs and Radiology favourable variances.

84


Child Health Directorate

Speaker: Dr John Beca, Surgical Child Health Director and Dr Michael Shepherd, Medical Child

Health Director

Service Overview

The Child Health Directorate is a dedicated paediatric healthcare service provider and major

teaching centre. This Directorate provides family centred care to children and young people

throughout New Zealand and the South Pacific. Care is provided for children up to their 15th

birthday, with certain specialised services beyond this age range.

A comprehensive range of services are provided within the two directorate portfolios;

Surgical Child Health (Director, Dr John Beca)

Paediatric and Congenital Cardiac Services, Paediatric Surgery, Paediatric ORL, Paediatric

Orthopaedics, Paediatric Intensive Care, Neonatal Intensive Care, Neurosurgery, Consult

Liaison.

Medical Child Health (Director, Dr Michael Shepherd)

General Paediatrics, Te Puaruruhau, Paediatric Haematology/Oncology, Paediatric Medical

Specialties (Dermatology, Developmental, Endocrinology, Gastroenterology, Immunology,

Infectious Diseases, Metabolic, Neurology, Chronic Pain, Palliative Care, Renal, Respiratory,

Rheumatology), Children's ED, Safekids and Community Paediatric Services (including Child

Health and Disability, Family Information Service, Family Options, Audiology, Paediatric

Homecare and Rheumatic Fever Prevention)

The leadership team members are: Dr Michael Shepherd, Director, Dr John Beca, Director, Emma

Maddren, General Manager, Sarah Little, Nurse Director, Linda Haultain, Allied Health Director.

Scorecard


Central line associated bacteraemia rate per 1,000 central line days 0 <=1 0






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(MOH-01) % CED patients with ED stay < 6 hours 94.8% 95% 96.0%








Elective day of surgery admission (DOSA) rate 55.3% TBC 51.5%

% Day Surgery Rate 61.9% >52% 68.4%

Inhouse Elective WIES through theatre - per day 26.43 TBC 23.72




28 Day Readmission Rate - Total R/U 10% 7.7%

% Adjusted theatre utilisation 80.5% 80% 82.7%

Average Length of Stay for WIES funded discharges (days) - Acute 4.1 4.2 4.5

Average Length of Stay for WIES funded discharges (days) - Elective 1.1 <1.5 0.9

Immunisation at 8 months 94.0% 5% 94.0%

Excess annual leave dollars ($M) $0.50 0 $0.45



% Staff with excess annual leave and insufficient plan to clear excess by the end of

financial year 100.0% 0% 100.0%





Enga

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86



Health Targets

Shorter stays in ED

Performance against the target was 94.8% for June. The number of presentations and acuity

remained high during June with 5% higher presentations than the same period in 2014.

The acute flow steering group is addressing systemic issues to optimise flow throughout Starship and

refocusing efforts on the patient experience. During June there was particular focus on a more active

presence from the surgical teams in CED and direct medical admissions. The flow coordinator roles

continued through June to further support flow across Starship.

Immunisation of 8 month olds

Auckland DHB performed slightly below the target for June with 94% coverage (Maori 86%, Pacific

94%). There was no change for Maori (1%) and a slight decrease for Pacific (3%) in the June period.

Access to elective surgery

Elective surgery performance continues to be actively managed to maintain 120 day compliance and

elective discharges. ESPI 8 (use of a nationally approved prioritisation tool) is introduced in July 2015

and work has begun in Paediatric ORL to achieve compliance on this target. The prioritisation tool is

being trialled by the surgical team and banding, overrides and thresholds will be agreed once all

surgeons are using the tool.

ESPI -1 (acknowledgement of referral) 100% compliant.

ESPI-2 (Time to FSA) 100% complaint.

ESPI-5 – (Time to Surgery) 2.01% non-compliant, 15 cases breached (8 Paed Ortho, 4 Paed CTSU and

3 Paed Surg) contributing factors include spinal surgery capacity, access to PICU beds post-surgically

and acute demand. Mitigations include additional funded PICU nursing FTE under recruitment and

pursuit of regional solutions to spinal surgery capacity constraints.

Elective discharges continue to track ahead of target with 107% performance YTD to 30 June.


There were no Central Line Associated Bacteraemia (CLAB) events in June. It has been 307 days since

the last CLAB event.

Medication errors for June reduced to 26, all were minor in nature and no patient harm resulted.

There were no adverse events (SAC 1) in the Child Health Directorate during June.

Better Quality Care

Patient and family complaints

There were 5 new complaints received in June. The key themes identified within the complaints

remain communication, attitude and courtesy along with care and treatment. Where possible direct

(face to face or telephone) contact is being made with family who have expressed concerns about

the care provided for their child to discuss concerns and agree the best means of addressing these.

6.3

87


DNA rates

Patient access and DNA rates are an important area of focus for the Child Health Directorate. The

overall DNA rate remained at 9% in June. DNA rates for Maori reduced from 16% to 15% however

Pacific rates increased from 15% to 17%.

A project was initiated in August 2014 to address DNA rates in services with the highest rates. This

work links to the Maori and Pacific DNA initiative and is being led by Allied Health Director, Linda

Haultain. The current focus is on paediatric respiratory, paediatric general surgery and general

paediatrics with an emphasis on high risk children and families within these services.

The whanau ora assessment tool will be used for all children admitted with bronchiectasis and a

comprehensive discharge plan developed. If children being treated as outpatients are identified as

being at risk of not attending appointments they will participate in a whanau ora assessment.

Work is currently underway to gather data and ensure appropriate linkages between aligned activity

across ADHB. Linda Haultain is working in consultation with Macloid Rodrigues (PAS Child Health),

Sarah Danko (Operations Leader Patient Service Centre), and Laurel Webb (Child Protection

Coordinator).

Phase one of the project is to develop a clear pathway for the appropriate recording and

management of children who were not brought to clinic. DNA will be re-conceptualized as Was Not

Brought (WNB) so the issues associated with child welfare, and children’s needs in respect to

attending medical appointments are at the center of practice.


Immunisation of eight month olds

The 2014/15 immunisation target is 95% of 8 month old babies fully immunised and maintained to

July 2017. ADHB is slightly below the target with 94% coverage as at 30 June 2015 (Maori 86%,

Pacific 94%). There was no change for Maori and a slight decrease for Pacific (1%) in the June period.

Work is on-going to develop sustainability in closing the equity gap.

Immunisation of two year olds

The total coverage rate at age 2 is below target at 94% as at 30 June 2015. There was a decrease for

Maori (94%), and Pacific (97%) continues to exceed target.

The current national coverage rates are 93% at 8 months and 93% at 2 years.

These are good results however Auckland DHB remains consistently below the eight month target

and the equity gap for Maori in the eight month and two year old cohort has re-emerged. Sustaining

high coverage is an on-going challenge and area of focus.

Rheumatic Fever Prevention Programme

The Rheumatic Fever Prevention Programme is jointly funded by the Ministry of Health and

Auckland DHB. This is managed through a Service Alliance between Auckland DHB and the four

Auckland DHB PHOs. In addition to swabbing and treating sore throats, public health nurses and

community health workers are identifying and treating skin infections. A refreshed referral process

has increased information flow and reporting of outcomes for families with housing related issues

who have been referred to Auckland Wide Healthy Homes Initiative (AWHHI).

88


Clinics continued throughout May and June. In May 16% of students presenting with a sore throat

tested positive with Group A Streptococcal infection across the 16 schools. This is higher than the

preceding months and also June when 11% of students tested positive. There is a wide range across

the individual schools; 7 – 25% in May and 0 – 25% in June, with some schools consistently higher

than others for the two month period. Classroom education sessions, home visits and attendances at

school and community functions provide opportunities to speak with children, young people and

families, distribute promotional material and share positive health messages.

In June a Whole School Health Assessment was completed in a school that identified a high number

of skin issues. This included full skin assessment and also weight and height. Students in Years 1 and

2 also had “lift the lip” which provided information about the extent of tooth decay. Data is

presently being collated. Dental hygiene was discussed with Years 1 & 2 students. Other health

promotion activities emphasised hand washing, keeping skin clean and covering sores.

In addition to the primary school clinics in June, community health workers CCHaDs commenced

throat swabbing and follow up care in four Secondary Schools. This supports the nurses in the

enhanced school based health service. One school in particular has noted the community health

workers’ engagement with students and whanau has highlighted the importance of having sore

throats checked and treated and is increasing awareness of Rheumatic Fever and its prevention.

Promotion of Rapid Response clinics for all family members with a sore throat, liaison with other

school based clinics for sibling follow-up and good communication links with social work referrals for

families with housing related issues enhance existing school health services in secondary schools.

Family Violence Screening

Family Violence Screening increased in the previous quarter (Nov, Dec, Jan) by an average of 15%

across Child Health with a resulting screening rate of 42.5%.

For this quarter the retrospective audit results (February, March, April) demonstrate a screening rate

of 33% which is a decrease of 9.5% on the previous quarter. The target screening rate has been

increased by 5% to an expectation of 45% screening rate for January to December 2015.

Family Violence screening in Mental Health services is currently being implemented. Of the approx.

700 staff, 180 have been trained to date – within the previous months. Auckland DHB VIP systems

and processes have been aligned to meet Mental Health service needs.

Efforts to increase the screening rate include:

All staff are followed up on the ward and via email after attending the family violence study

day to encourage screening and to increase confidence.

Family violence team has made direct contact with all managers and offered update

sessions/short and sharp sessions on the wards with all staff.

Screening has been discussed with the steering group to highlight to members areas of low

or declining screening rates and taking responsibility for making a priority/focus.

Greater focus on family violence screening champions and supporting them and their role.

Engaged Workforce

Staff turnover increased slightly to 10.5% in June, just above the organisational target.

6.3

89


Employees with excess annual leave (>2 years) also increased slightly to 9.3% of the workforce.

Active management of annual leave has continued and will remain a focus throughout 2015.

There is an expectation that all staff will have a leave plan, with particular emphasis on use of

all leave accrued for the year and any excess leave balances.


The initiatives listed below have been developed as part of the Child Health Directorate Financial

Strategy and are therefore heavily weighted to financial sustainability. The broader strategic

programme for the Child Health Directorate is under review and initiatives targeting quality and

safety will be a significant focus during the balance of 2015.


Cost containment:

FTE management

Leave management

Capacity planning

Reduce surgical outsourcing costs

Clinical supplies management

Reduce medical staff costs

Pharmaceutical costs met by DHB of domicile

Reduce non-clinical operational costs

Revenue Growth in defined areas:

Increase outreach clinic volume

Increase non-resident patient volume and pricing

Recover a greater portion of ACC funded volumes

Secure new or additional funding for national services

Strategic partnership with Starship Foundation

TPN co-payments



Initial draft and consultation on the Starship Child Health Clinical Excellence Programme.

Introduction of the Starship clinic scrum process to increase utilisation of all medical and surgical

clinics.

Confirmed increased National funding for paediatric metabolic, rheumatology and cardiac

services.

Completion of phase 10 of the Starship operating rooms refurbishment project.

Commencement of the replacement of the biplane within the cardiac investigation unit

Development of the 2015/16 financial strategy.

90



Launch of the Starship Child Health Clinical Excellence Programme.

Recruitment of the Operations Manager for the Community, General Paediatrics and Te

Puaruruhau portfolio.

Formal opening of the refurbished Starship operating rooms.

Commencement of the design phase for the refurbishment of level 5 in Starship.

Commencement of the design phase for the refurbishment of the outpatient department in

Starship.

Financial Results

Comments on major financial variances

The Child Health Directorate was $25k F for the month but $1,719k F for the year. Inpatient wise for

the month was 104.3% to contract (13% increase over prior year) and 97% for the year (1% increase

over last year). Full year discharges are 4% higher than last year. Patients with a LOS > 60 days are

21% higher than last year. See comment under nursing for impact on employee costs


Child Health Services Reporting Date Jun-15



REVENUE

Government and Crown Agency 1,071 773 298 F 10,309 9,272 1,037 F


Other Income 727 1,089 (362) U 11,243 13,070 (1,827) U

Total Revenue 18,873 18,937 (64) U 221,218 222,008 (790) U

EXPENDITURE

Personnel

Personnel Costs 9,602 9,483 (120) U 114,097 113,381 (716) U

Outsourced Personnel 146 147 1 F 1,549 1,762 213 F

Outsourced Clinical Services 250 213 (37) U 2,869 2,554 (315) U

Clinical Supplies 1,748 2,122 373 F 21,827 25,459 3,632 F


Total Expenditure 12,111 12,219 108 F 143,766 146,214 2,448 F

Contribution 6,762 6,718 44 F 77,452 75,794 1,658 F

Allocations 933 914 (19) U 10,519 10,579 61 F

NET RESULT 5,829 5,804 25 F 66,934 65,215 1,719 F

Paid FTE



Medical 215.1 220.7 5.7 F 216.5 220.6 4.1 F

Nursing 618.9 606.8 (12.0) U 599.7 606.8 7.2 F

Allied Health 123.9 129.1 5.2 F 119.3 129.1 9.8 F

Support 0.0 0.0 0.0 F 0.0 0.0 0.0 F


Total excluding outsourced FTEs 1,037.7 1,039.9 2.2 F 1,015.7 1,039.9 24.2 F


Total including outsourced FTEs 1,049.2 1,045.4 (3.8) U 1,021.6 1,045.4 23.8 F

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Factors impacting on the full year performance are:

1. Revenue $790k U:

a. ACC income is $1,038k F to budget. Paed ORL and Paed Orthopaedics have been

focussed on ensuring that ACC patient revenue is correctly captured. This has resulted in

a significant growth this year in ACC patient related income.

b. Donation income is $1.31m U to budget. Claims are subject to timing issues and

completion of projects.

c. Non-resident income $586k F to budget. This has been mainly generated by Paed

Cardiac services and is significantly higher than for the same period last year.

d. Other Income is $1.2m U to budget. This relates to projects for the 2014-15 year

representing a range of different initiatives. These projects aimed, for example, to

increase funding for TPN by way of co-payments and increase funding for national

services to recognise the additional unfunded work being achieved. The additional

funding for national projects has been achieved but will not occur until the 2015-16 year.

The co-payment income as not been achieved. 2. Costs $2,448k F:

a. Personnel costs $503k U. The main driver for the variance is:

i. Medical $342k U YTD, 4.1 FTE F. The driver is the FTE overrun for Registrars and House Officers

ii. Nursing $955k U YTD, 7.2 FTE F. Nursing costs were F until the end of March. However the patient mix and volume in the last 3 months has been such that, the number of watches required, the associated nursing intensity, the volume of long stay patients and the increase in patient discharges over contract has driven cost and FTE overruns on the wards. Key mitigations include:

Short term – FTE management, new graduate recruitment, watches reviewed eight hourly and cohort patients where possible, weekly report on bureau utilisation, active management of sick leave, weekly capacity planning with stringent nursing roster review and sign off of rosters by NUMs.

Medium term – further advanced training in workforce central, develop roster guidelines for consistent roster development, identify models of care for children with medical complexity who require longer lengths of stay, review and benchmark nursing models of care against internationally comparable children’s hospitals.

Long term – monitor nursing activity utilising Trendcare data and develop business case for NICU nursing requirements.

iii. Allied Health $307k F and 9.8 FTE F. The vacant FTE are mainly in the child community services and recruitment is ongoing for these positions

iv. Admin $166k, 2.6 FTE. This has been achieved by holding vacancies

v. Overall active management of FTE for the whole Directorate includes:

Weekly FTE reconciliation (actual-budget) and review by the

Directors

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Rationalisation of all FTE pending approval and being sourced

b. Clinical supply costs $3.6m F: The patient mix for the last year is the key driver as

reflected in the following data:

i. Decreases in the average wise per discharge e.g. Paed Surgical down 9% and Paed Cardiac down 9%.

ii. Inpatient discharges have increased and are 104% of the same period last year

iii. Number of Ward days has increased by 4.8% over the same period last year

iv. Costs associated with high cost procedures e.g. catheters, blood products and implants are all significantly less than the same period last year. A review of the consumption of implants for the Paed Orthopaedic service was undertaken but the consumption appears to be in line with the DRGs.

Summary

The Child Health Directorate now has an established and capable leadership team and is progressing

activity in priority areas including quality, safety, sustainability and productivity.

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Surgical Services Directorate

Speaker: Wayne Jones, Director

Service Overview The Surgical Services Directorate is responsible for the provision of surgical services for the adult

population. The Directorate leadership consists of Director Surgical Services Wayne Jones, Nurse

Director Anna MacGregor, Allied Health Director Kristine Nicol and General Manager Tara Argent.

Supported by Les Lohrentz (HR), Justin Kennedy-Good (Service Improvement) and Jack Wolken

(Finance).

The services in the Directorate are structured into the following portfolios:

Orthopaedics, ORL, Neurosurgery, Oral Health

General Surgery, Trauma, Transplant, Urology

Ophthalmology Clinic Facilities, Clinic Nursing, Pre Admit

Scorecard
















Elective day of surgery admission (DOSA) rate 77.6% 68% 79.4%

% Day Surgery Rate 64.9% 70% 59.4%

Inhouse Elective WIES through theatre - per day 66.36 TBC 58.54


% Patients cared for in a mixed gender room at midday - Adult 11.0% TBC 9.0%





Average Length of Stay for WIES funded discharges (days) - Acute 3.31 TBC 4.23

Average Length of Stay for WIES funded discharges (days) - Elective 1.22 TBC 1.48

31/62 day target - % of non-surgical patients seen within the 62 day target R/U 85% 71.0%

31/62 day target - % of surgical patients seen within the 62 day target R/U 85% 44.0%

62 day target - % of patients treated within the 62 day target R/U 85% 56.3%

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Health Targets

Elective Discharges

The forecast position for the full year of the Auckland DHB discharge target is 100% delivery of the

12,970 discharges. This will not be confirmed until 3 August 2015 as the position is not closed until

the 5th Monday after month end. There is a reliance on the coding team to ensure that all eligible

procedures are coded and submitted.

Adult services have delivered 97% of the Auckland DHB target (-223) of which the biggest areas of

shortfall are -100 General Surgery, -53 Orthopaedics, and -66 Urology.

The June IDF discharge position was 104% of the target (+181) the main areas of over delivery are;

+84 General Surgery, and +140 in Urology

At the end of June the ESPI 2 is moderately non-compliant, with 2 patients waiting longer than 4

months for their FSA, these patients have been given dates in July (target is <0.4%).

The ESPI 5 position is moderately non-compliant with 0.59%, which equates to 26 patients in total

for all services, not receiving a date for surgery over 4 months (the target is <1.0%). This continues

to demonstrate the ongoing work undertaken by all teams to sustain the 4 month target.











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31/62 day target - % of non-surgical patients seen within the 62 day target

31/62 day target - % of surgical patients seen within the 62 day target

62 day target - % of patients treated within the 62 day target













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A total of 17 falls (with no harm) incidents reported for June, which is an improvement of 6 on the

May position. We continue to undertake a review of all incidents at the Surgical Services Falls

meeting.

There was 1 fall with major harm in June, which is being reviewed as a SAC 2 event, immediate

actions were taken to ensure that the patient fall care plan was updated and communicated clearly

to the patient.

Pressure Injuries – 16 incidents reported for June, which is a decrease on the May position. There

were:

8 Category 1 (Non-blanchable erythema)

8 Category 2 (Partial thickness)

0 Category 3 (Full thickness skin Loss)

0 Category 4 (Full thickness tissue loss)

A total of 17 medication errors in June. These were of low risk; including omission, documentation

and duplication. As a directorate.

Adverse Events - There was 1 SAC 2 (Fall as described above) and no SAC 1 events reported in June.

Better Quality Care

The DNA rate for appointments for all ethnicities in June has remained on target at 9.0%.

Patients cared for in a mixed gender room at midday has increased in June to 11%, this is due to the

pressures on bed capacity as a result of the acute load, and the increase in General Medical demand.

The number of outliers has decreased again from 160 in May to 120 in June. Where possible teams

have been working to align the capacity, cohorting and repatriating patients to reduce the outliers

across the surgical bed base, to support the rest of the hospital and the patient flow.

Day surgery rates have improved from 59.4% in May to 64.9% in June against a target of 70%.


Smoking Cessation

Performance to target in June of 96.3%. Staff continue to offer the advice and support service to

smokers to ensure that the target is sustained.

Engaged Workforce

As a result of the ongoing investigation in the Head and Neck service, the management team will

need to consider how to address some of the cultural issues that have become apparent as a result

of interviews undertaken. There will be a team building exercise undertaken to assist them in

refocussing and to rebuild engagement.

A long running back-pay issue with one of the neurosurgeons was settled at mediation, this dates

back to 2008 when a job sizing exercise was launched and commitments were made to back date

pay.

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One of the priorities for the Surgical Directorate is cost management. A number of ideas on how

expenditure could be better managed are being considered and actioned, the first of these being a

reduction in the amount of untaken annual leave. Staff members with more than 320 hours (2

years) of leave accrued have been identified and details provided to the Service Clinical Directors

and management teams.

If all leave above 320 hours is taken there is a potential saving of approximately $1 million. At the

newly introduced monthly Speciality/Clinical Service Director meetings the operational management

teams have been asked to prepare leave plans for staff with excess leave and bring these to the next

meeting in August.


Deliverable/Action

Reduce average LOS

Long stay patients

ERAS in Ortho / Gen surgery

Outpatient Service Improvement Programme

Review / Standardise of Communications

Standardised Processes

31/62 day cancer target


Key achievements in the month Delivery of the Discharge target for the Auckland DHB population has been the main focus

for Surgical Services in June. This has resulted in 100% achievement as a result of the

contingency plans all being delivered and with a considerable team effort from all staff

involved in the delivery of patient care including the booking and scheduling team.

The Directorate has implemented monthly “Dashboard” meetings for each speciality, these

are designed to provide business support and information to the Service Clinical Directors

attendees include the HR Manager, Finance Manager, Nurse Advisor, Charge Nurse, Service

Manager, Director of Surgical Services, Nurse Director and General Manager. This forum

allows interrogation of financial and HR data with an aim to agree actions going forward that

will be monitored monthly.

Appointment of the Service Clinical Director for the Adult National Intestinal Failure Service

(NIFS).

Roll out of the Validation team for the adult surgical services and the Patient Tracker List

(PTL) validation meetings, providing an overview and scrutiny of the waiting lists.

3 Wards are celebrating the completion of all modules of Releasing Time to Care (RTC)

The majority of clinical areas have achieved hand hygiene scores above the target of 80%.

Areas off track and remedial plans ESPI8 – National Prioritisation tool – we continue to work with the teams to ensure that all

appropriate ORL patients are prioritised using the National Tool.

Nursing Spend (FTE) – The nursing contribution to the personal financial position has been driven by

2 main areas:

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1) Occupancy and acute demand – flexing up the bed base

2) Increased demand for patient attenders

Mitigation Strategies:

Area Owner Actions Implemented

Daily review of staffing levels and skill mix

Nurse Directors

Daily Wrap up meeting - attended by: Nurse Directors, Nurse Advisors/NUM, Flow Coordinator,

Bed and Duty Managers and Clinical Nurse Advisor. This includes Daily review of previous 24 hour variance to staffing plan and bureau usage. Daily capacity planning including nursing roster

review and mitigation strategies

Project to review the increase of patient attender

use

Nurse Directors

Process map of current patients who have been allocated patient attenders. Cohort patients who

require watches where possible

Project to review the increase in additional AOUs

Jane Lees Patients assessed for commencement on Better

Brain Pathway.

Discharge Coordination Nurse

Directors

Daily review of length of stay report and transition lounge usage to expedite discharging. Elevation at

1015 meeting of any delays to discharge

Trendcare utilisation to inform staffing decisions

Nurse Directors

Use of Trendcare data to inform staffing decisions in those areas that have Trend care. Re-

engineering and smoothing of staff rosters. Roster overview and sign off by NUM’s in all areas

Employee leave management

Nurse Directors

*Action plans for excess leave management developed and monitored on Directorate MOS boards. *Sickness absence proactively managed at a local level, concerns elevated to NUM

Nursing Skill Mix review Nurse

Directors

Development of a monthly report showing target skill mix per area, actual skill mix in FTE per level, Budget ($) and actual in ($). On boarding of New Graduates prior to NeTP programme to reduce the backfill of vacancy.

Hand Hygiene scores, Ward 77 and 61 will be key areas of focus to ensure that they achieve the 80%

target.

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Key issues and initiatives identified in coming months The high acute/medical demand on the hospital is putting the ESPI position at high risk. This is being

closely managed on a daily basis in conjunction with the SMOs to ensure patient safety is not

compromised whilst ensuring ADHB remains within the threshold of moderately non-compliant.

The management team are working with the funder arm to develop a plan for a complete review of

the Ophthalmology service to match capacity to demand.

Financial Results

Current Month result

The June month result is $1,221k U.

1. Total actual revenue of $23.8M is better than Budget by $359k due to significant Orthopaedic ACC revenue of $307k (budgeted of $201k), the balance being Inter DHB charges for the Waitakere satellite clinic ($224k F).

2. Personnel costs are the result of historical individual contract settlements and Nursing FTE 21 or 5% over budget of 470, and significant 1 on 1 patient attenders in Neurosurgery. Nursing is being managed to standard models of care including the controlling of nursing bureau allocations.


Surgical Services Reporting Date Jun-15



REVENUE

Government and Crown Agency 1,010 844 166 F 9,704 10,124 (420) U


Other Income 722 529 193 F 5,156 6,347 (1,190) U

Total Revenue 23,842 23,483 359 F 272,130 273,740 (1,610) U

EXPENDITURE

Personnel


Outsourced Personnel 350 235 (115) U 3,218 2,821 (398) U




Total Expenditure 11,946 10,109 (1,837) U 127,100 121,162 (5,938) U

Contribution 11,896 13,373 (1,478) U 145,030 152,579 (7,549) U

Allocations 2,407 2,378 (30) U 28,158 27,819 (339) U

NET RESULT 9,488 10,996 (1,507) U 116,872 124,760 (7,888) U

Paid FTE



Medical 187.5 200.5 13.1 F 193.2 200.7 7.6 F

Nursing 491.6 470.3 (21.4) U 484.6 469.8 (14.8) U

Allied Health 36.5 38.5 2.0 F 37.8 38.5 0.7 F

Support 0.0 0.0 0.0 F 0.0 0.0 0.0 F

Management/Administration 65.6 66.0 0.4 F 66.3 65.7 (0.6) U




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3. Outsourcing was significant and impacted by the months high acute load (e.g. General Surgery acutes 20% above contract, Neurosurgery 13% above, Ophthalmology 90% above, etc.), compromising elective capacity to meet annual patient treatment targets.

4. Clinical Supplies were $440k U reflecting the high Orthopaedic and Neurosurgery Implant costs arising from Outsourcing.

5. Infrastructure and Non-clinical Supplies costs were essentially charges related to the Waitakere satellite clinic that have been recognised in Inter DHB revenue and a high bad debt write off for non-resident patients (Neurosurgery $68k U).

YTD/Full Year result

The June full year result is $7,888k U with the main themes being:

Government and Crown Agency revenue streams continue to be below expectation at $420k U (e.g. $646k U for ACC revenue), while Other Income of $1,190k U is due to low non-resident volumes and delays in achieving revenue initiatives.

Personnel $2,393k U primarily due to nursing which are 15 FTE over budget YTD resulting from a combination of planned vacancies not being met and delays in FTE reductions, while high numbers of neurosurgery patients requiring 1 on 1 nurse/patient attenders 24/7 has also impacted. As noted above, nursing is being closely managed to standard models of care including the controlling of nursing bureau allocations.

Outsourcing required in meeting elective discharge targets totals $1,176k U. e.g. Oral Health $199k U with elective discharges 22% above contract YTD and Urology $235k U with elective discharges 6% above contract YTD.

Clinical Supplies $2,210k U – mainly related to the Transplant Services $510k U reflecting higher activity YTD (blood products, pharmaceuticals and transport) for renal (22% above contract YTD) and liver transplants (31% more patients received transplants this year). The balance relates to high patient volumes impacting Ophthalmology ($453k U, with an over delivery of patient volumes by 6%) and delays in achieving savings targets.

Internal allocations totalled $339k U primarily for Radiology charges in General Surgery which is $447k U.

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Perioperative Services Directorate

Speaker: Vanessa Beavis, Director

Service Overview

The Perioperative Service provides services for all patients who need anaesthesia care and operating

room facilities. All surgical specialties in Auckland DHB use our services. Patients needing

anaesthesia in non-operating room environments are also cared for by our teams. There are five

suites of operating rooms on two campuses, and includes five (or more) all day preadmission clinics

every weekday. We provide the (24/7) acute pain services for the whole hospital. We also assist

other services with line placement and other interventions when high level technical skills are

needed.

Scorecard


Health Targets

Improved access to electives

Session usage for the month of June (i.e. the number of available sessions vs. those used) remains

steady and at target at 97%. The top three reasons for non-use of sessions were: ‘unfilled by

service’, ‘no beds available’ and ‘patient unfit for surgery’.


% Acute index operation within acuity guidelines 86% ≥ 95% 83%

Wrong site surgery 0 0 0

% antibiotics within 60 mins of operation 81% ≥ 80% 77%

Surgical safety checklist compliance R/U 100% R/U

Unplanned overnight admission 3.31% 3% 4.81%

Unplanned ICU / DCCM stay 0.1% 1% 0.2%0.9

30 day mortality rate 0.3% ≤ 2% 0.9%

CSSD incidents 2.48% ≤ 2% 2.04%

Elective sessions planned vs actual 97% 97% 96%

Adjusted utilisation 85.8% 85% 86%

Late starts 6.5% ≤ 5% 5.7%


% Staff with excess annual leave >1 year <2 years 32.5% 30% 31.8%

% Staff with excess annual leave > 2 years 9.1% 0.0% 9.0%

Sick leave hours taken as a percentage of total hours worked 4.0% ≤ 3.9% 3.9%

% Voluntary turnover (annually) 6.9% ≤ 10% 7.3%

% Voluntary turnover <1 year tenure 3.7% ≤ 6% 5.3%

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The data is not being collected due to process change. Awaiting new auditing tool and therefore exempt from auditing to the Health,

Quality & Safety Commission.

Surgical safety checklist compliance

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Adjusted utilisation for all OR suites remains consistent at 85.8%. The international benchmark for

adjusted utilisation (i.e. a measure of how efficiently the available time in the session is used) is 85%.

‘All cause’ cancellation rate for patients was 13.2%. The predominant reasons for patient

cancellations/deferment in June were ‘acute substitution by acute’, ‘acute operation not needed’

and ‘substitution by acute’. In the context of 85.8% utilisation this is not an immediate problem and

the top three reasons suggest causes outside the control of the Operating Rooms.


Timely access to acute surgery is at 86%. This reflects the acute workload in the hospital. Lack of

meaningful data is still problematic but progress is being made.

There have been no incidents of wrong site surgery.

There were no SAC 1 or SAC 2 adverse events in June.

Across Perioperative Services in June there were five medication errors (with no sequelae).

There were no fall incidents reported in June. There were no pressure injuries reported in June.

There were no patient complaints attributed to Perioperative Services in June.

Better Quality Care

30 day mortality rate remains below target at 0.3%.

CSSD incidents were only slightly above target at 2.48%. This is related to production pressure in the

face of workforce shortages. Interviews were held on 14.07.14 and six full time Technician roles and

three casual Technician roles have been appointed. We will be up to our budgeted FTE by the end of

August.

No new risks have been added to the register. Current risks are:

1. Clinical: inability to proactively identify and link single instruments to individual surgical

procedures.

2. Operational: the inability to commence surgical procedures due to the contamination of

surgical operating kits coming from CSSD.

The single instrument tracking system implementation project is underway. The controls in place are

working well. Recruitment of a Project Manager has occurred. The hardware has been ordered.

The scope of work has been agreed and the steering committee set up.


Late starts are at 6.5%. Previous session overruns caused 23 late session starts and pre-op

preparation caused 26 late session starts.

For the month of June there were 1,530 planned sessions, of those, 45 sessions were not used.

In addition, 44 sessions were recycled.

Engaged Workforce

Excess annual leave >2years remains relatively unchanged from May at 9.1%.

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Excess annul leave >1 year <2 years is at 32.5%. This is a challenge to manage given the production

requirements but we are working with staff on this.

Our staff turnover rate for June at 6.9% remains below target. Sick leave is only very slightly above

target at 4% and relates to general winter illnesses.



Starship Operating Rooms rebuild All major work has been completed. Small remedial work is taking place. Official opening on 24 July 2015.

Hybrid Operating Room, Level 4

Hybrid Room is up and running.

Increasing production as we can.

Training of staff completed.

Single Instrument Tracking system

The vendor for supplying the SIT system will be on site at ACH on 20.07.15.

Statement of work has been completed with project timelines.

GSU – Optimisation of usage to maximise case mix and capacity

Only 5 unused sessions for the month of June – this was due to the fact that Surgical Services prioritised cases to GSU to meet annual discharge volumes.

- 2 Sessions unfilled by service. - 3 Sessions Surgeon unavailable

Ophthalmology did a number of additional sessions in GSU to meet DHB discharge volumes.



The new process for the surgical safety check list has been successfully rolled out across all of

Perioperative Services. The Quality Commission has been informed and we hope to formally publish

the results soon. An inter-hospital audit to check on progress will start the end of July.

Hybrid room successfully up and running

Starship rebuild completed

Dee Hackett, General Manager for Greenlane, has taken up her role.


Projects are mostly on track at present. Session losses are still work in progress.

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Hand Hygiene Project - We are seeing positive results where we have hand hygiene promotional

activities underway and plan to share these initiatives across the Perioperative Service. We are

planning regular auditing.

A Surgical Safety Checklist observational audit tool is being developed along with the Health Quality

and Safety Commission.

We are part of Cohort 1 for the team briefing / debriefing project for the Health Quality and Safety

Commission’s perioperative stream of “first do no harm”. This requires we start project planning in

July 2015.

Progress has been made on the greenbelt project for breakages and damage to the rigid scopes. This

(repair/replace issue) is an area of significant cost for the service. Savings will be made once

completed. Recommendations are in the process of being implemented across the service

We are contributing to the outpatient project with the reorganisation of the preadmission clinic.

This is a large project which will take time to complete. With the arrival of the new General Manager

for Greenlane we expect progress to be accelerated.

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Financial Results


Summary Net Result There are two main reasons for the $567k unfavourable result.

High theatre activity (8% above June last year) which impacted clinical supplies and outsourced personnel, although there were also large savings made within clinical supplies on pharmaceuticals as part of the Perioperative Target Savings, reducing the final unfavourable variances to just $24k and $56 respectively.

A $320k transfer of Personnel costs from Starship to Perioperative was made this month for services provided earlier in the year.

High volumes continued into June (320,978 minutes this month compared with 306,632 minutes in June last year and 321,419 minutes last month) causing the overspend in clinical supplies predominantly in sutures, patient consumables and sterile solutions. This also drove high spend (approximately $67k) on the use of outsourced nursing personnel. June YTD


Perioperative Services Reporting Date Jun-15



REVENUE

Government and Crown Agency 196 214 (17) U 2,329 2,564 (235) U

Funder to Provider Revenue 0 0 0 F 0 0 0 F

Other Income 13 19 (5) U 184 225 (41) U

Total Revenue 210 232 (23) U 2,513 2,789 (276) U

EXPENDITURE

Personnel

Personnel Costs 7,727 7,299 (428) U 86,708 86,792 84 F

Outsourced Personnel 67 43 (24) U 786 515 (272) U

Outsourced Clinical Services 0 0 0 F 0 0 0 F




Contribution (11,066) (10,497) (569) U (127,314) (125,167) (2,147) U

Allocations 25 27 2 F 325 317 (9) U

NET RESULT (11,091) (10,524) (567) U (127,639) (125,484) (2,156) U

Paid FTE



Medical 157.8 166.0 8.3 F 157.5 164.8 7.3 F

Nursing 406.8 423.0 16.2 F 396.4 417.0 20.6 F

Allied Health 99.0 108.2 9.2 F 96.5 107.5 11.0 F

Support 105.6 111.8 6.3 F 110.7 111.8 1.2 F





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Increased theatre activity has also been the main cause of the unfavorable YTD result. It continues to run higher than last year at 5.6% higher YTD (3,554,980 operating minutes this year vs 3,364,466 last year) which has impacted variable clinical supply and outsourced costs to a similar extent (clinical supplies 4.6% higher spend than LY). Business Improvement Savings Perioperative Business Improvement savings have been achieved and reported on MOH Target Saving Reports at $800k, as proposed at the start of the year.

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Cardiovascular Directorate

Speaker: Dr Mark Edwards, Director

Service Overview

The Cardiovascular Directorate comprises Cardiothoracic Surgery, Cardiology, Vascular Surgery,

CVICU, Organ Donation New Zealand and Hearty Towers. Mark Edwards is Director of the

Directorate, Anna MacGregor is Nurse Director, Kristine Nicol is Allied Health Director and Joy Farley

is General Manager. Jim Kriechbaum is the Primary Care Director. They are supported by Melissa

Marshall (HR), Justin Kennedy-Good (Service Improvement), Sam Titchener (Service Manager) and

Martin McEvoy (Finance).

Scorecard

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Health Targets

At the end of June the cardiac surgery waiting list totalled 70; lower than the 78 reported for last

month. The service continues with fortnightly teleconferences with the funder and the National

Health Board electives team.

We have not required any support from Waikato DHB and have managed our inflows and waitlist

numbers with weekend insourcing. Our inflows have seen an increase throughout June however the

Thoracic surgery referrals remain low.

During the month there were 79 patients operated on against a plan of 85 of these 7 were weekend

contract cases.

There were 16 cancellations during the month of June predominately due to staff shortages,

particularly in perfusion, in addition to cardiovascular intensive care bed unavailability. The

perfusion team are currently holding vacancies despite worldwide recruitment strategies – we are

continuing to try and recruit whilst looking longer term at developing our training programme.

There has been scheduled mandatory training in the new hybrid operating theatre which also

contributed to some sessions not being utilised. The acute transplant work remained consistent

throughout June with two transplants over the month.


Vascular surgical waitlist - longest waiting patient (days) 114 <=150 114

Outpatient wait time for chest pain clinic patients (% compliant against 42 day target) 91.9% 70% 100.0%

CVD risk assessment 91.5% 5% 90.8%










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At month end there were 4 inpatients waiting for surgery and 66 patients waiting up to 90 days.

There were no patients waiting between 90-120 days.


There were no SAC 1 incidents for June for the Directorate. There was one SAC 2 incident for June.

This is currently under review.

The total number of pressure injuries reported for June was 9. None have been reported as Grade 3

or 4.This compares with 12 reported in May.

The total number of medication errors reported in June was 18. This compares with 20 for May but

is within the longer term control limits for the directorate. One medication error is the subject of a

Case Review as it may have resulted in harm.

There were falls reported in June was 10, none of which resulted in harm. This compares with 9

reported in May.

Better Quality Care

The Cardiovascular Service is meeting the 4 month target in both elective service delivery targets,

ESPI2 and ESPI 5. The service continues to monitor and validate the cardiac waitlist weekly and

reviews all patients waiting longer than 90 days. The service is also validating the suspend waitlist

weekly.

The cardiac patient experience project is now in its implementation phase: three key outcomes have

been identified and work continues to finalise these outcomes to present to the project sponsors.

Planned replacement of the Cardiac Investigation Unit room 1 imaging equipment is now in the early

phase of the project. Design plans are being worked through with clinical staff to adequately

configure the room.

The hybrid operating room is now commissioned and training has been completed. The first live case

was completed at the end of June. The hybrid committee continues to work to refine scheduling and

booking rules and increase case numbers and complexity through the room as the teams gain

increased experience in the room.

Targets for interventional work continue to be met with 88.5% of ADHB-domicile patients with acute

coronary syndrome undergoing coronary angiography within 3 days (target is >=70%). This is a slight

improvement from 85% in May.


The Cardiovascular Directorate met three of the four targeted areas in March.

Engaged Workforce

Turnover has dropped by half for those with less than 1 year’s tenure to only 2.1%. However annual

turnover has increased slightly to 8.8% which is still below target.

Annual leave plans over school holidays have seen a slight drop in those with more than two years to

13.3%. However there has been an increase also in those employees with more than 1 year’s

6.6

109


entitlement to 33.9%. The Cardiovascular Directorate has most of its annual leave liability within a

small group of long serving clinical employees with the 20 most significant balances totalling

$448,106 as of now. The focus is currently on reducing all annual leave balances across the

Directorate as the financial liability over the two year entitlement in particular is substantial.

Sick leave is being maintained at a reasonable level given the winter quarter.


Last month we reported the following outcomes; we will update these for Quarter 4 once the data

becomes available.


Bypass intervention rates 6.5 per 10,000 population 5.32 (Q3)

Angiogram discharges rates 34.73 per 10,000 (98.2% of target YTD)

30.62 (Q3)

PCI (angioplasty) + Cardiac Surgery rates 18.90 per 10,000 (99% of target year to date)

Not available

100% patients receive elective angiogram < 90 days Achieved (Q3)

Primary angioplasty “Door to balloon time” Achieved (Q3)

Acute coronary syndrome diagnostic angiogram > 70% Achieved (Q3)


Key achievements in the month Maintenance of our waitlist and waiting times at acceptable levels

Commissioning of Hybrid OR.

Continued engagement regarding clinician leadership and operational management of

cardiovascular services.


We released our decision document for clinician leadership and operational management of

cardiovascular services after a period of consultation; implementation was on hold pending

outcomes of discussions with Surgeon group and CEO. This month:

A proposal for the vascular service has been accepted.

Draft proposal from Cardiology is under consideration.

We are awaiting a proposal from cardiothoracic surgeons.

Recruitment to Nursing leadership roles is underway.


Working to maintain our waitlist at acceptable levels.

Recruitment to key technical vacancies– perfusion and sonography.

Managing clinical leadership pending the revised process.

Balancing winter planning in particular for CVICU services against managing our budget

110


Continued focus on cardiothoracic surgery patient pathway redesign

Meeting our savings and initiatives plan for 2015/16.

Financial Results


The year end result is $710k U, revenue is slightly above budget overall however net expenditure is

unfavourable $526K. Overall inpatient volumes are 0.2% below contract (elective volumes + 11.4%

acute volumes -7.4%).

Overall revenue variance YTD is $184k U across;

Favourable variances within ACC (mainly Cardiology), CTA funding for Physiology technician

training and additional income from a recharge to National Health Board and Fund

Donations from A+ Trust.

Unfavourable variance with revenue for overseas patient services (Tahiti) due to in-house

capacity constraint.


Cardiac Services Reporting Date Jun-15



REVENUE

Government and Crown Agency 120 87 33 F 1,390 1,042 348 F


Other Income 408 558 (150) U 6,163 6,695 (532) U

Total Revenue 11,804 11,922 (118) U 135,064 135,248 (184) U

EXPENDITURE

Personnel


Outsourced Personnel 65 52 (13) U 501 623 121 F

Outsourced Clinical Services 104 74 (30) U 1,094 1,491 397 F

Clinical Supplies 2,424 2,477 53 F 29,732 29,749 17 F

Infrastructure & Non-Clinical Supplies 203 133 (70) U 1,570 1,596 26 F

Total Expenditure 8,057 7,827 (229) U 95,186 94,382 (804) U

Contribution 3,748 4,095 (347) U 39,878 40,866 (988) U

Allocations 1,097 993 (104) U 11,304 11,582 278 F

NET RESULT 2,651 3,102 (451) U 28,574 29,285 (710) U

Paid FTE



Medical 92.7 88.8 (3.9) U 90.9 88.6 (2.3) U

Nursing 311.7 305.2 (6.5) U 311.6 305.2 (6.4) U

Allied Health 65.8 66.5 0.7 F 65.1 66.5 1.4 F

Support 3.0 3.0 0.0 F 3.0 3.0 0.0 F

Management/Administration 31.2 30.1 (1.2) U 31.9 30.1 (1.8) U


Total Outsourced Services 6.1 1.7 (4.4) U 2.2 1.7 (0.5) U


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Total Expenditure YTD is $526k U, this is mainly due to

Personnel and Outsourced personnel costs are net $1,245k U; this is in part due to lower

than planned vacancies and drivers in service delivery. The base budget includes reductions

in FTE on the assumption that vacancies will occur as they have in the past. To date, as a

consequence of meeting service delivery expectations, and severely curtailing outsourcing,

those vacancy assumptions have not been met. This has been exacerbated with a planned

increase of resourcing of CVICU to support the cardiac surgery waitlist management as part

of our winter plan for CVICU staffing.

Outsourcing Clinical is YTD $397k F; YTD we have had to undertake some judicious use of

outsourcing alongside regular weekly insourcing to support reduction of our waitlist. Overall

this remains at much lower levels than previous years; we have outsourced only 16 cases to

private providers.

Internal Allocations are $278k F due to lower Radiology charges.

FTE Employed/Contracted – YTD 9.6 FTE U

The base budget includes reductions in FTE on the assumption that vacancies will occur as they have

in the past. To date, as a consequence of meeting service delivery expectations, and severely

curtailing outsourcing, those vacancy assumptions have not been met.

Summary

Managing the peak in the cardiac surgery waiting list early in the year has consumed significant

resources –this is reflected in the financial result. Our focus is on carrying forward and building on

efficiencies in the upcoming months, however this is going to be challenging.

We continue our efforts in implementing change across the Cardiothoracic Surgery Patient Pathway.

However change in culture is slow; this is made more challenging by the ongoing process with

respect to clinical leadership and operational management of our directorate. Notwithstanding the

above comments, two work streams have been combined under the joint leadership of the Nurse

Director and a Cardiothoracic surgeon. Three meetings of the new joint work stream have taken

place and more detailed plans and timeframes are in place for actions to improve patient journey

recommendations.

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Adult Medical Directorate

Speaker: Dr Barry Snow, Director

Service Overview

The Adult Medical Service is responsible for the provision of emergency care, medical services and

sub specialties for the adult population. The leadership within this directorate consists of Barry

Snow, Director, Brenda Clune, Nurse Director, Carolyn Simmons Carlsson, Allied Health Director and

Kelly Teague, General Manager.

The services in the Adult Medical Directorate are structured into 2 portfolios:

Group 1

General Medicine, Infectious Diseases, Neurology, Renal, Respiratory and Gastroenterology

Group 2

Adult Emergency, APU, Critical Care, Air Ambulance

Scorecard

Adult Medical ServicesJun-15 Measure Target



Central line associated bacteraemia rate per 1,000 central line days 0 <=1 0






(MOH-01) % AED patients with ED stay < 6 hours 94.1% 95% 96.0%







% Patients cared for in a mixed gender room at midday - Adult 17.0% TBC 15.0%


Number of complaints received 16 0 8


% Urgent Diagnostic colonoscopy procedures treated < 14 days 82.0% 75% 93.0%

% Non urgent colonoscopy procedures treated < 42 days 98.0% 0% 100.0%

% Surveillance Colonoscopies Treated 99.0% 0% 99.0%


Actual Prev Period

Incr

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Health Targets

Acute Flow

Adult acute flow performance for June 2015 was at 94.1%. High volumes, surges of patients and

high complexity continue to be features of acute flow. Extra medical resource during predicted peak

periods has improved sign on times in AED. However, there are a number of SMO’s on long term sick

and cover plans are being established but this will leave gaps in the rosters until 1 August 2015. The

Directorate are currently working on a plan to resolve this situation.

Smoking Cessation

Performance for June 2015 was 95%.


There were 31 medication errors in June 2015. The ward based pharmacy technician pilot

commenced in Ward 63 and 65 on 29 June 2015 as part of the integrated multidisciplinary approach

to inpatient medication management.

There has been 1 adverse event causing harm which is a grade 3 pressure injury in ward 66 noted on

admission and undergoing review.







% Staff with leave planned for the current 12 months 19.0% 100% 19.1%

% Leave taken to date for the current 12 months 67.9% 100% 61.7%





Amber =

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Better Quality Care

ESPI-2 compliance

Is compliant with 0% of patients waiting greater than 4 months.

Did Not Attend (DNA) rates

There has been a slight deterioration in DNA rates for all ethnicities within the directorate, 9% for

June 2015 compared to 7% in May 2015. There has also been deterioration in Maori and Pacific

populations.

The Patient Administration System (PAS) team have established a pilot which commences on 1

August 2015. As part of the pilot patients will no longer be asked to contact the call centre to

confirm their appointment on receipt of their appointment letter. The new process sees the PAS

schedulers contacting patients one week before their appointment date to confirm attendance. This

will see an improvement in DNA rates.


Capacity and demand modelling has been undertaken to ensure the correct number of training lists

for our Gastroenterology and Colorectal Surgical trainees are delivered within the college guidelines.

These additional lists will be available from 1 July 2015.

For the past year the Gastroenterology Department have over performed on the MOH targets. From

1 July 2015 our performance will reduce in order to accommodate the training lists but will still be

within the MOH % targets.

A working group has been established to review the options for a potential new build for the

Endoscopy Suite at Green Lane. Architects are currently undertaking a feasibility study.

Faster Cancer Treatment

Demonstrated in the graph below are the specialities involved with tracking (highlighting high

suspicion on the referral form) High Suspension of Cancer within our Directorate and their

performance to date. Prospective management systems are required organisationally to determine

whether each of these patients are meeting the 31/62 day target.

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Cancer Flagged

Engaged Workforce

Excess annual leave plans have slightly improved but this issue is a result of the wards, Admission &

Planning Unit and the Emergency Department not having the flexibility to enable staff to take their

planned leave. Plans are in place to continue to address excess leave balances across the

directorate.



Develop a 5 year strategy for the directorate In progress

Scoping exercise for the re-design for the Emergency Department

Almost complete

Write a business case for the development/expansion of the renal dialysis services at Green Lane

Early stages

Scoping exercise for a potential new build for the endoscopy suite

Early stages



Appointment of the Operations Manager for the Directorate.

Appointment of all Service Clinical Directors except Gastroenterology.

All asset registers have been reviewed and updated.

0

2

4

6

8

10

12

14

16

18

May-15 Jun-15

18

11

0

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No

of

Pat

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Respiratory

Gastro

High Suspicion of Cancer Flagged

May – June 2015

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Areas of concern Action required Responsibility Deadline

1. Annual leave management Monthly meetings with all specialities to review progress and to increase the focus.

Kelly Teague On-going


Areas of concern Action required Responsibility Deadline

1. Acute flow Acute flow working group and a clear governance and accountability structure identified.

Barry Snow 30/06/15

2. Asset Management Reconciliation of assets and life expectancy against the organisational register. An organisational piece of work is also being undertaken.

Kelly Teague 31/07/15

3. Lack of budget for Ward 62 Write a paper for our monthly review to demonstrate the usage of the ward for all specialities and the urgent requirement for appropriate funding.

Kelly Teague

Brenda Clune

30/06/15

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Financial Results

1. Financial Commentary


The YTD result for June is an unfavorable variance of $ 5,558k.

Volumes: For the YTD June Inpatient and Outpatient volumes we have achieved 105.5 % of contract (mainly ED and Acute Inpatients). This equates to $ 7.6 m revenue not recognised.

Total Revenue - $ 386k favorable – primarily due to:

118


i) Funding boost for Colonoscopy $598k F,

ii) Non- resident income $182k F,

iii) Other DHB Revenue $360k U - includes unfavorable Neurology outreach income and Renal

Revenue unfavorable due to WDHB no longer using GLCC for their patients.

Total Expenditure - $ 5,944 k unfavorable due to:

Personnel Costs including outsourced personnel- $ 4,279k U - mainly due to unfavorable

variances in Medical costs $ 1,682k U and Nursing costs $ 3,040k U offset by Allied Health $270k

F and Admin $ 190k F.

o Medical - $ 1,682k U is primarily driven by

AED $ 1,445k U (mainly due to a lump sum payment of $ 118k back pay for roster shifts

(backdated to 2010) combined with additional costs incurred to cover SMOs and MOSS on

ACC and sick leave, roster gap cover and additional surge shifts to deal with patient

workload , General Medicine $ 757k U due to high reliever costs (FY 14/15 budget

understated). This was offset by DCCM $ 476k F (partially due to CD vacancy).

o Nursing - $ 3,040k U is spread mainly across

o DCCM - due to an increase in patient volumes and call back with occupancy increasing

by 40% this year. This is mainly as a result of changes introduced per the

recommendations of the DCCM external review and cover for a HCA on long term ACC

leave covered by internal bureau.

o APU - high attendances and patient workload, high use of watches to cover roster gaps,

flexing up into ward 62 during the year to create additional capacity on level 2 combined

with long term ACC leave cover.

o Gastro - mainly due to additional colonoscopy lists.

Clinical Supplies - $ 770k U - primarily due to DCCM blood products and pharmaceuticals costs

(demand driven) and Gastro (mainly immunosuppression drugs). These were offset by favorable

variances in all other services.

Allocations - $ 811k U - primarily due to unfavorable radiology costs $ 808k U (volume driven

mainly DCCM $265k U, Neurology $219k U, Respiratory $133k U and Gastroenterology $174k U).

6.7

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Cancer and Blood Directorate

Speaker: Richard Sullivan, Director

Service Overview

Cancer is a major health issue for New Zealanders. One in three New Zealanders will have some

experience of cancer, either personally or through a relative or friend. Cancer is the country’s leading

cause of death (29.8%) and a major cause of hospitalisation.

The Auckland DHB Cancer and Blood Service provide active and supportive cancer care to the 1.5

million population of the greater Auckland region. This is currently achieved by seeing approximately

5000 new patients a year and 46000 patients in follow-up/or on treatment assessment appointments.

The leadership within this directorate consists of Richard Sullivan, Director, Brenda Clune, Nurse

Director, Carolyn Simmons Carlsson, Allied Health Director and Deirdre Maxwell, General Manager.

Scorecard













% Cancer patients receiving radiation/chemotherapy treatment within 4 weeks of DTT 100.0% 100% 100.0%

% Chemotherapy patients (Med Onc and Haem) attending FSA within 4 weeks of referral 99.5% 100% 99.5%

% Radiation oncology patients attending FSA within 4 weeks of referral 98.8% 100% 99.5%





28 Day Readmission Rate - Total R/U TBC 24.2%


% Patients from referral to FSA within 7 days 30.0% TBC 26.8%

31/62 day target - % of non-surgical patients seen within the 62 day target R/U 85% 71.0%

31/62 day target - % of surgical patients seen within the 62 day target R/U 85% 44.0%

62 day target - % of patients treated within the 62 day target R/U 85% 56.3%


BMT Autologous Waitlist - Patients currently waiting > 6 weeks 7 0 8

Actual Prev Period

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Chemotherapy Policy Priority

The service continues to meet the 28 day policy priority. An improvement project to review the

capacity of the medical oncology day stay has been implemented.

Radiation Therapy Policy Priority

The service continues to meet this policy priority and we are looking at new ways of delivering

radiation therapy to continue to improve capacity and the quality. These include:

Increased/flexible working hours for Radiation Therapists

Introduction of more efficient delivery techniques e.g. VMAT & SABR

Protocol standardization

Hypo-fractionation (e.g. Breast, Palliative, SABR)

Optimized scheduling of the shared Linac/Brachytherapy bunker

SMO tumor streaming for cross cover

Increased planning efficiency (e.g. RayStation, Pinnacle Smart Enterprise)

Rapid Access clinics

% Radiation oncology patients attending FSA within 4 weeks of referral

All patients accepted by the service received their FSA within 4 weeks. In light of the 31/62 day

target, work is being undertaken to reduce FSA waiting times by 50% within the next year with a






% Staff with leave planned for the current 12 months 8.2% 100% 8.5%

% Leave taken to date for the current 12 months 91.2% 100% 69.6%





Enga

ged

Wo

rkfo

rce

Amber =

R/U =

31/62 day target - % of non-surgical patients seen within the 62 day target

31/62 day target - % of surgical patients seen within the 62 day target

62 day target - % of patients treated within the 62 day target













121


view to all FSA’s being seen within 7 working days from receipt of referral by July 2016.The

introduction of Rapid Access Clinics is an example of this.

% Chemotherapy patients (Med Oncology & Haematology) attending FSA within 4 weeks of

referral

99.5% & 98.5% achieved this month compared to 99.5% in the previous period. Weekly

prioritisation and monitoring of referrals and wait times continue. The Medical Oncology service is

beginning a review to match patient specific demand by tumour stream against clinical capacity to

move towards increasing the number of joint medical oncology / radiation oncology patient centred

clinics by tumour stream. In addition, clinical pathways from referral to the service to FSA have been

identified and mapped. A production planning tool that enables clinicians and scheduling staff to

prioritise workload and plan clinic needs has been designed and implemented. The resultant report

is emailed to the medical oncology tumour leads twice per week and discussed at their weekly

meeting. We expect these activities to significantly reduce the wait between referral and FSA.

Health Targets

Chemotherapy Policy Priority

The service continues to meet the 28 day policy priority. An improvement project has commenced to

review the capacity of the medical oncology day stay. The main focus of this project is to review patient

flow and scheduling of treatments in order to increase throughput. The unit has implemented a new

scheduling process that provides increased visibility of nursing requirements plus increased capacity. A

dose banding pilot has started and a new ‘assess’ clinic form approved. We will be auditing the outcome

of this project.

Radiation Therapy Policy Priority

The service continues to meet this policy priority and we are looking at new ways of delivering

radiation therapy to continue to improve capacity. We are planning to maintain timely service

provision during the upcoming upgrade of a linear accelerator.


There were 9 medication errors in June which have all been reviewed and analysed.

There has been 1 SAC 2 adverse event with harm, which was a Grade 4 pressure injury in Ward 64.

While it was likely that this pressure injury was acquired prior to admission this was not

documented, and so it has been treated as acquired on site. An audit of recent pressure injuries is

being undertaken to review assessments and trends.

Better Quality Care

Faster Cancer Treatment Target (31/62 day target)

The Ministry of Health has determined that that the new target will be that 85% of patients with a

high suspicion of cancer will be treated within the 31/62 day target by 1 July 2016, moving to a

target of 90% by 1 July 2017. The 31 day target is measured from decision to treat to first definitive

treatment and 62 days is measured from an urgent General Practitioner referral for suspected

cancer to first definitive treatment.

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Progress against compliance for the 62 day target for Auckland District Health Board for the last

quarter ending 31 December 2014 was 57.6% (measured from volumes 19/33 cases). Progress

against compliance for the 31 day target was 89.7% (measured from volumes 209/233 cases).

A regional steering group is underway and conducts a range of activities aimed to increase the

identification and streamlining of patient pathways across the region. An example is the resolution

of portacath insertion and removal issues to ensure that patients can commence treatment in a

timely manner, and that the portacath is removed when treatment is completed. High suspicion

data collection is being reviewed, with draft national definitions of high suspicion of cancer having

been released in early March. ADHB has also established a FCT pathways group to develop tumour

work streams to measure outcomes against this target. An FCT template has been developed to

measure these.

% Chemotherapy patients (medical oncology and haematology) attending FSA within 4 weeks of

referral

In light of the 31/62 day target, work is being undertaken to reduce FSA waiting times by 50% within

the next year with a view to all FSA’s being seen within 7 working days from receipt of referral by

July 2016. Measurement shows improvement in this between reporting periods from 26.8% to

30.0%. Discussions are also underway with the medical and senior nurse workforce to enable Nurse

Specialists within tumour streams to run dedicated clinics, removing this workload from medical

staff and again increasing capacity for FSA.


Smoking Cessation Advice

Services have been concentrating on providing advice as required, with a further focus of activity in

the month of June. This shows improvement from 72.7% previous report to 88.9% this report.

BMT Autologous waitlist patients waiting > 6 weeks from stem cell harvest to transplant

The new Motutapu Haematology Ward including the Northern Region Bone Marrow Transplant

opened in mid-August 2014 at 24/30 bed capacity. As previously indicated, the ward has

experienced high BMT and non BMT inpatient volumes with a spike of new acute leukaemia patients

in January and February. The secondary Auckland DHB and regional tertiary non BMT inpatient

demand is also higher. In addition there appears to be a significant increase in the number of BMT

patients that are worked up and ready for their transplant, particularly since December 2014.

Measurement indicates that in June, 17 patients were waiting longer than the national guideline of 6

weeks to transplant. This has been the subject of focused activity, with a business case being

developed to support the opening of 3 additional transplant beds for a period of 7 months. This will

allow 28 autologous BMT transplants such that the wait time for these patients can be reduced to

national guideline levels in a sustainable way. The Regional Haematology network is involved to

understand regional capacity and demand and step changes to access criteria for treatment. In the

meantime the service will be reporting the BMT waitlist status weekly to Funders and the Executive

Team.

123


Engaged Workforce

Excess annual leave management

The service continues to work with staff with excess leave balances. Plans are underway to ensure

that staff take this year’s leave allocation within the 12 month period. We are progressing the

agreed restructure within the Cancer & Blood Directorate, and will incorporate these activities

within the wider restructure requirements.


Deliverable / Action Status/Deadline

Implementation of tumour streams across the

directorate

30th June 2015 √ √ √ √ √

Re-design the directorate structure

Final decision

communicated.

√ √ √

Agree a regional cancer strategy alongside

colleagues at neighbouring District Health

Boards. Strategy paper completed and

approved by RGG, CEO/CMO forum & Cancer

Governance Board.

June 2015 √ √ √

Develop a business case for an Integrated

Cancer Centre

Under

development

19th

May 2015 –

Completed - Auckland

Integrated Cancer

Centre pre concept

design workshop.

June 2015 - Project

structure completed

with clinical lead &

team for service plan

workstream in place

√ √ √ √


Areas off track and remedial plans Faster Cancer Treatment target

Work is underway to improve the volume, quality and transfer of data to identify resourcing issues

and develop cancer tracking reports across all steps of the cancer pathway to increase compliance to

the target.

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124


DNA rates for outpatient appointments

Māori and Pacific – this is currently running at 10 to 13%. The navigation staff have completed their

fixed term appointments. An evaluation is being completed, the learnings from which will be shared

regionally as part of the Ministry FCT project commitments.


Daystay Capacity unit currently operating at full capacity with a risk of failing to deliver to the

chemotherapy treatment time target:

Daystay Capacity project has introduced a new scheduling system to improve patient flow

and match resources to workload and capacity.

Robust process in place to manage the Faster Cancer Treatment target:

Development continues on developing cancer reports across all steps of the cancer pathway.

This includes the operation of the ADHB FCT pathways group, linking with the Regional FCT

group, mapping the MDM pathway by creating a virtual pathway in PHS and further work on

mapping patient pathways by tumour stream.

Develop robust production planning processes for the management of clinics to meet the

chemotherapy policy priority:

A production planning project is well underway to map clinic mix and capacity by tumour

stream in Medical Oncology, as above.

High inpatient volumes are impacting capacity in the Haematology unit and waitlist volumes and

wait times are increasing:

Engagement with the Regional Haematology network has been reactivated to understand

regional capacity, demand and step changes to access criteria for treatment.

A business case to facilitate an additional 28 autologous BMT procedures has been

produced. If accepted, this will result in the fixed term operation of 3 beds on Motutapu.

Restructure – completion of consultation and implementation of new structure. The Service Clinical

Director roles have been appointed to, with an orientation planned for early September and a

strategy review planned for early October to ensure that our activities continue to be fit for purpose.

The Ministry of Health has indicated that funding is available to support additional psychology and

social work roles within each DHB. Regional Cancer Centres will also be implementing a lead

psychology role to oversee regional pathways and referral processes. Work is underway with the

Ministry and other Northern region DHBs in the production and implementation against a Regional

Support Services Plan.

125


Financial Results


The YTD result for June is a favourable variance of $956k.

Total Revenue - $2,657k favourable mainly due to

i) Haemophilia blood reimbursement $2,390k F - driven by Haemophilia reimbursement for

FEIBA usage for 2 patients (offset by higher blood product costs).

ii) Donation income for the BMT/Haematology ward $158k F.

Total Expenditure- $ 1,701k unfavourable mainly due to

Personnel and Outsourced Personnel combined $946k F. This is driven by

o Medical costs $482k F - driven by vacancies and the impact of expired CPE written off,


Cancer & Blood Services Reporting Date Jun-15



REVENUE



Other Income (19) 93 (112) U 996 1,115 (119) U

Total Revenue 9,480 9,292 188 F 110,289 107,632 2,657 F

EXPENDITURE

Personnel

Personnel Costs 2,549 2,802 253 F 32,167 33,191 1,024 F

Outsourced Personnel 117 67 (49) U 882 804 (78) U





Contribution 2,810 3,267 (456) U 36,442 35,759 683 F

Allocations 592 623 32 F 7,013 7,287 273 F

NET RESULT 2,219 2,643 (425) U 29,428 28,472 956 F

Paid FTE



Medical 62.1 63.1 1.0 F 61.0 62.1 1.1 F

Nursing 142.4 138.0 (4.4) U 139.0 138.0 (1.0) U

Allied Health 88.9 81.6 (7.4) U 83.9 80.6 (3.3) U

Support 1.4 1.0 (0.4) U 1.4 1.0 (0.4) U



Total Outsourced Services 9.2 1.3 (7.9) U 3.0 1.3 (1.7) U


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o Nursing costs $273k F - primarily due to vacancies in Senior Nurses $212k F and RNs $543k

offset by the increased use of bureau nurses to cover vacancies and patient attenders

$574kU

o Allied Health $151k F – vacancy driven

o Management / Admin $48k F

Outsourced Clinical Services $224k U - mainly Radiology charges for WDHB and CMDHB

(demand driven).

Clinical Supplies $2,531k U - primarily due to treatment disposables and blood product $3,673k

U – made up of Haemophilia Blood product costs $2,272k U (mainly due to FEIBA demand for 2

patients offset by increased revenue), Haematology blood products $1,155k U, Oncology Blood

product $169k U. This was offset by Instruments and Equip $583k F (mainly timing impact of

depreciation) and Pharmaceuticals $566k F.

Internal Allocations - $273k F - due to favourable variances in Research overhead recovery

$113k F and Radiology charges $255k F.

Summary

Detailed work continues on improving the volume, quality and transfer data to meet the

31/62 day target. Auckland DHB has a particular focus on pathways identification across all

contributing services.

The Maori/Pacific Island Navigator project funded by the Ministry of health has been

completed with an evaluation due August 2015.

The Cancer & Blood Directorate has completed a directorate structure redesign, with

recruitment completed to the Service Clinical Director roles.

Due to high inpatient volumes the Haematology inpatient ward is over capacity and bone

marrow transplant waitlists are increasing with wait times more than 6 weeks. Weekly BMT

reporting & a Haematology review is underway. Short term strategy is to increase BMT

capacity on Motutapu ward to reduce wait times and develop a sustainable long term plan,

with a business case under consideration.

Production planning for medical oncology continues with tools developed to ensure

reporting compliance with the chemotherapy 28 day FSA target.

127



Speaker: Frank Tracey, General Manager, Acting Director

Service Overview This service delivery group is comprised of Daily Operations (including, transit, resource, bureau, and

reception), Greenlane Clinical Centre (including Outpatient facilities, Patient Administration, Contact

Centre & Interpreter services), Allied Health Services (including Physiotherapy, Occupational

Therapy, Speech Language Therapy, Social Work and Hospital Play Specialist services), Radiology,

Laboratory – including community Anatomical Pathology and Gynaecological Cytology, Clinical

Engineering, Nutrition, and Pharmacy.

Scorecard


Health Targets

Radiology

Overall; performance in the past month against the MOH target has been variable across modalities.

It has increased for CT scans and decreased for MRI. This relates to an increase in referral rates

which is placing additional pressure on existing resource and waitlists and the need to respond to

increased admissions requiring imaging diagnostics. A more detailed paper on planned activity to

reduce wait times and manage demand is provided under separate cover.

MRI

Performance against the MRI target showed a slight decrease from May 46% to 44% in June (80%

target). We continue with our efforts to accelerate progress toward achieving target through a

number of initiatives. Outsourcing arrangements are being investigated for adult referrals to assist





% Outpatients & community referred MRI completed < 6 weeks 44.0% % 46.0%

% Outpatients & community referred CT completed < 6 weeks 82.0% % 76.0%

% Outpatient & community referred US completed < 6 weeks 44.0% % 43.0%




financial year R/U 0% R/U





R/U =

% Staff with excess annual leave and insufficient plan to clear excess by the end of financial year

Results unavailable until WFC goes live.


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manage demand. An analysis on the capacity/demand for MRI is being undertaken with a view to

understanding the ongoing need for outsourcing. The additional sessions held at CAMRI for both GA

and non GA paediatric scans have been completed. This has helped to clear urgent referrals however

demand remains high making it challenging to keep pace with urgent referrals and clear the waitlist.

Capacity on our new build MRI scanner (February 2015) is increasing. Recruitment and staff training

combined with outsourcing and process improvement activity within the department will have a

positive impact on the waitlist with the aim of reaching MoH indicators by January/February 2016.

CT

Performance against MoH 90% target of out-patients completed within six weeks is showing a

steady improvement over recent months and continues this trend from 76% May to 82% in June. We

are confident that performance against this target will continue to improve in the coming months

with the aim of meeting MoH indicators by November 2015.

Ultrasound

While this is an internal target (75%) we are mindful of the importance of patient access to service

and safe waitlist management. Our performance shows a small increase in activity for June (42%)

against our May performance of 43%. We are working on long term solutions to manage demand for

example, through our Director Primary Health we are in direct communication with all GP referrers

to help them prioritise and proactively manage referrals. A Ministry of Health funded pilot to deliver

out of hours ultrasound for acute patients is nearing conclusion (June 2015). The pilot is showing

some encouraging outcomes including contributing to improved ED wait times and hospital flow and

the quality of patient care. We are impacted by FTE vacancy (sonographers) however a proactive

recruitment campaign has led to the successful recruitment of 2 FTE in the past month.


We had 1 SAC 2 that was related to the unsuccessful resuscitation of a patient in the car park outside

Building 32. A team is being established to carry out a root cause analysis (RCA).

Better Quality Care

We have had 4 complaints in the month of June all of which have been resolved – x 1 involving

radiology, x 1 scheduling services, x1 laboratory services and 1 involving health Alliance. Complaints

related to a procedure being done in a painful manner, cancelled appointment, delayed reporting of

results and a patient writing to her for her health bill to be waived-which was dealt with by the CFO

and CEO’s office.

Engaged Workforce

The Directorate has established a senior leadership team that meets monthly and utilises the MOS

operating system to assist effectively manage operations. A health and safety committee has been

established and is functional; the focus is on ensuring compliance with legislative requirements,

improving reporting and management of risk in the workplace. Work is underway to develop ‘clinical

governance’ groups in the departments of Pharmacy, Radiology and in the Laboratory. The aim is to

support development of clinician leadership across the system of care.

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PC3 Lab build Site works advancing

Due for completion Aug/Sep 2016.

Planning underway in collaboration with UoA re workforce development/training and research opportunities.

Level 4 Lab shell Site works advancing, project on track

Due for completion Aug/Sep 2016.

Ministry of Justice - ROI initiated for delivery of a National Forensic Pathology Service

Process on hold as per advice from MOJ – ADHB await formal communication.

x x

Pharmacy: PAPU (Pharmacy Aseptic Production Unit) Application for License to manufacture medicines

Project underway

Application to Medsafe in development.

Decision – currently under review progress contingent on facility capability

Call Centre Collaboration (WDHB/ADHB)

Joint CC Manager appointed.

Initiatives to improve response to call volumes underway.

New telephony solution finalised planning underway to implement by Sep/Oct 2015.



Daily Operations

Our Hospital Seasonal Plan has been finalised, communicated and implemented. The plan

includes facilitation of daily and weekly fora that bringing together representation from all

departments to identify and problem solve issues that are likely to impact patient safety,

presentations, admissions, discharge and hospital flow.

A number of initiatives to support staff in delivering care are underway these include annual

leave planning, allocation of additional staff and adjustment of skill mix to ensure a safe

environment during busy periods.

Work on improving acute flow including development of an Integrated Daily Operations

centre is underway. Progress will be reported to the Committee over the coming months.

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An improvement process focusing on realignment of booking and scheduling resources,

systems and processes with Directorates and clinical services is underway. The aim is to

engage staff, improve patient experience, assist accelerate admissions and reduce wait

times for outpatient clinics. The work undertaken continues to contribute significantly to

meeting MoH elective targets.

Radiology

Performance improvement initiatives (Service Excellence II) is underway including an after-

hours ultrasound pilot. Early data and feedback from patients and clinicians is positive.

Pharmacy

A redesign of the retail pharmacy floor space at ACH to assist prioritising patient and family

service and privacy has been implemented. Feedback has been very positive. Further

improvements are in the design stage.

Our retail pharmacy has introduced a ‘healthy lifestyle’ product range in keeping with ADHB

healthy choices initiative.

The department has initiated a pilot initiative aimed at improving medicines reconciliation

and medication safety; the project undertaken in the Emergency Department and Adult

Medicine is assisting patient flow. Feedback from patients and clinical staff has been positive

to date.

The department has developed a proposal for change document to support implementation

of ADHBs Clinician Leadership model. This is due to go to staff for consultation in July 2015.

Laboratory

After a period of transition (late March 2015) the Anatomical Pathology and Gynae Cytology

Service (Mt Wellington) is beginning to stabilise and as a consequence shown improvement

in productivity and achievement of expected turn around times -TATs. Feedback from

referrers has been largely positive. An experienced Laboratory manager has been recruited

and is due to commence in September 2015.

Review of Forensic Pathology

A number of service and process improvements have been undertaken to improve

operational performance and efficiency

An internal clinical audit of the FP theatre has taken place and a report prepared.

Recommendations are being considered

Contract discussions are underway with the Ministry of Justice regarding an extension to the

existing contract (which came to an end in June 2015). This is to allow for continuity of

services while the Ministry determine next steps on the 2013/14 national tender process.

We have established an agreement to continue with the current arrangements.


Radiology

A series of initiatives have been introduced to better understand and ultimately address the

capacity and demand issues associated with meeting new Ministry of Health Targets (CT

under 6 weeks 90% and MRI under 6 weeks 80%). These include, additional MRIs for adults,

a pilot project providing after hours ultrasound (evening and weekend) and bringing on

additional capacity at GCC. A detailed paper will be provided to the committee.

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Daily Operations

Planning is underway in collaboration with the Adult Medical Services Directorate to develop

and establish a service model to improve patient flow through Adult ED.

Planning is advancing to develop an Integrated Daily Operations Centre – site visits to

CMDHB and CCDHB have been undertaken. Resource implications for ACH are currently

being assessed.

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Area Timeframe

Directorate

Implement ADHBs ‘clinician leadership’ model across the

Clinical Support Services Directorate

Pharmacy – Jul 2015

Allied Health – Aug 2015

Laboratory – Sep/Oct 2015

Radiology – Sep/Oct 2015

Daily Ops – Nov 2015

Radiology

Reduction of Ultrasound and MR waitlists

Initiate after hours ultrasound pilot

Develop business case for reconfiguration of L2 Radiology ACH

Paper re planned actions to be

presented June 2015 HAC

Underway - complete Jun 2015

Underway – due for completion

Sep 2015

LabPLUS

Discussion with CMDHB and WDHB regarding pricing for non

scheduled testing and future planning for Laboratory services in

the region

Jul/Aug 2015

Pharmacy

Improvement projects in drug management (imprest, waste,

safety) and dispensing to continue.

Project underway to obtain a manufacturing licence. This could

allow for increased ability to manufacture/compound specific

products on behalf of ACH, other DHBs and the private sector.

Oct 2015

First phase completion Jun 2015

Daily Operations

Develop an integrated Daily Operations Centre

Dec 2015

Forensic Pathology

A review of the Department of Forensic Pathology and the

National Coronial service (provided under contract to the MoJ)

has been completed. The aim is to assist the department

develop a contemporary service delivery model and robust and

sustainable infrastructure to support a national service. A range

of improvement initiatives are underway within the department

including:

workforce training

clinical audit

policy development

Formal interface meetings with key stakeholders –

office of Chief Coroner, Police and MoJ.

Oct 2015

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Financial results

Comments on major financial variances - Clinical Support Services

YTD Result is $3,670K F. The key drivers of this result are:

1. Personnel Costs $3,217K F due to FTE being 26 below budget May YTD. This is part of a planned process which sees vacancies being carefully managed to support service delivery in key areas. $1,221K of this is offset by use of outsourced personnel.

2. Outsourced Clinical Services were $1,014K U. $362K was due to CT and MRI project being delayed for the first six months of the financial year. These costs were being offset by savings in depreciation and employee costs. The remainder was in Laboratories due to cost of sendaway tests being higher than budget and targeted savings not achieved. This is being actively managed.

3. Clinical Supplies were favourable in Radiology and Laboratories. Savings in Laboratories due to

savings for demand management being achieved and volumes being lower than budget. $606K savings in Radiology due to depreciation savings. Price and volume savings across directorate contributed to favourable variance.


Clinical Support Services Reporting Date Jun-15



REVENUE


Funder to Provider Revenue 3,014 1,948 1,066 F 30,972 21,374 9,598 F

Other Income 2,104 2,948 (844) U 22,020 31,483 (9,463) U

Total Revenue 6,282 5,660 621 F 65,492 62,096 3,396 F

EXPENDITURE

Personnel

Personnel Costs 10,397 10,399 3 F 119,050 122,426 3,376 F

Outsourced Personnel 570 263 (307) U 4,741 3,138 (1,603) U

Outsourced Clinical Services 593 540 (53) U 7,751 6,684 (1,067) U

Clinical Supplies 3,874 3,792 (82) U 43,823 44,454 630 F


Total Expenditure 16,163 15,420 (743) U 181,472 181,951 479 F

Contribution (9,881) (9,760) (121) U (115,979) (119,855) 3,875 F

Allocations (7,623) (7,521) 102 F (87,644) (87,699) (55) U

NET RESULT (2,258) (2,239) (20) U (28,336) (32,156) 3,820 F

Paid FTE



Medical 131.0 139.6 8.6 F 128.1 135.2 7.1 F

Nursing 69.6 69.6 0.0 F 69.1 69.6 0.5 F

Allied Health 827.6 841.1 13.5 F 806.3 832.2 26.0 F

Support 71.1 68.4 (2.8) U 71.8 68.4 (3.4) U


Total excluding outsourced FTEs 1,403.6 1,424.1 20.5 F 1,369.2 1,407.6 38.5 F


Total including outsourced FTEs 1,425.4 1,427.3 1.9 F 1,386.9 1,410.8 23.9 F

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4. Infrastructure and Non Clinical Supplies are unfavourable due to costs incurred in transitioning the Community Cytology and Anatomical Pathology contracts to ADHB. These are offset by additional revenue.

5. Funder to provider revenue is above budget which is offset by other income. This is due to the budget for Anatomical Pathology contract revenue being included in other income.

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Non-Clinical Support Services

Speaker: Clare Thompson, General Manager

Service Overview This service delivery group is comprised of Corporate Support Services including Commercial

Contract management, Clinical Education Centre, Sustainability, Security, Retail, Health Alliance

Procurement & Supply Chain relationship, Health Benefits–Food & Linen programmes, Fleet

Management, Car-parking, Mailroom, and Crèche. It also covers Non-Clinical Support Services

within the Provider Arm including, Bed Management, Cleaning, Contact Centre, Food Services,

Volunteers and Waste Collection.

Leadership team includes: Clare Thompson, General Manager, Manjula Sickler, Business Manager,

Leanne Gatman, Finance Manager, Shankara Amurthalingam, Operations Manager Non-Clinical

Support Services, Jane Woolford, Operations Manager Procurement & Supply Chain, Stuart Almao,

HR Manager and Reg Prasad, Property & Project Manager.

Scorecard

Note 1 - Excess annual leave and insufficient plan The Cleaning service was brought in-house April 2014 with high excess leave and this is being addressed. Note 2 - % Voluntary turnover (Annually) The increased %age in voluntary resignations (annually) relates to Nutrition Management resignations during May/June following the transfer of the food service to Compass Group. Note 3 - % Voluntary turnover (< year tenure) Although the cleaning work-force has stabilised, a minor negative movement in voluntary turnover (< year tenure) being reported is based on previous 12 months turnover which has impacted on the overall KPI.


Increased Patient Safety Parking

The construction of an additional floor on car-park Building A was completed and operational on

28 June 2015. This will provide an additional 69 public car-park spaces.

There has been a noticeable reduction in traffic queues during the first 10 days of operations but

a further impact analysis is underway.

Awaiting quote from Fortlock to install CCTV camera at Level 7 in Carpark A. This will improve

security coverage and monitoring.

Wilsons will also be installing parking barrier arms at Level 7 in August 2015 to restrict public

access.







% Pre-employment Screenings (PES) cleared before the start date 100.0% 100% Null




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Cleaning Services

Combined average audit score of 91% for the month of June 2015.

In line with Health & Safety policies, all cleaning trollies now have lockable compartments.

Security

Access Control/CCTV Project has now entered the Discovery Phase with Fortlock making good progress at GLCC which is 80% complete.

An independent safety risk assessment of lock-down procedures and site safety has been completed.

A Training Matrix has been designed to monitor progress of the security staff to achieve a multi-skilled workforce.

Code Orange calls: 69 Code Orange responses were attended in June, an increase of 11 from May (increase 19%).

Patient Security Watches: There were 183 requests during June, compared to 104 in May (increase 76%). This trend reflects the increase in hospital presentations and admissions.

137


Procurement

Project Update

Gloves savings for June were $26K.

Work continues with healthAlliance and St John Ambulance to review regional patient transfers to improve the quality of service between sites and St Johns.

New supplier approval process by ADHB has been implemented to provide early notification of new product and suppliers.

The year to date budgetary savings as reported by healthAlliance was $5.1M.

Dock Safety

The majority of the work to improve safety around the dock sites has been completed. The

pedestrian crossing outside carpark A and the dock markings is underway.

There has been a notable reduction in pedestrians using the road as a footpath behind the level

five dock, and staff accessing the support building via the dock. The area is now secured out of

hours by locking the roller door at 5.00 pm. Further dock reviews are on-going to identify

potential risks.

-

200

400

600

800

1,000

1,200

1,400

1,600

2014-07 2014-08 2014-09 2014-10 2014-11 2014-12 2015-01 2015-02 2015-03 2015-04 2015-05 2015-06

$ Th

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Budgetary Benefit (Current FY) HBL Target - Monthly

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Dock management and suppliers’ delivery schedules are in train and will also include greater

utilisation of CSSD to improve the delivery of product to shelves. The use of CSSD dock has been

identified as a solution to resolve the problems with the support building lifts.

Building 21

Building 21 second floor is now operating as a controlled swing/storage space for obsolete and excess stock. A schedule of obsolete and unwanted furniture items are posted on the intranet. This is being updated regularly to coincide with surplus items that have been identified from recent moves. The recycling of excess furniture will result in minor capital saving and also reduce waste to landfill. This is to promote greater sustainability within the organisation.

Inventory

Clinical users reviewed and confirmed and estimated $282K stock identified as obsolete. This has

been provided for in the F14/15 financial year. It is primarily in the orthopaedic theatre area.

The stock is being written off the system and removed from the shelf. Where possible, the

supplier will be requested to credit or it will be offered to other DHBs who are still able to utilize

it. The remainder will be either donated to charity or disposed of.

POTENTIAL EXCESS/OBSOLETE INVENTORY

Month PANDEMIC STORE THEATRE VMI WARD Grand Total SOH EOM % SOH Not Required

Jun-14 720,609 0 818,776 1,014,386 687,866 3,241,638 9,935,199 33%

Jul-14 720,571 0 813,688 994,374 621,454 3,150,088 9,864,034 32%

Aug-14 720,527 0 726,170 994,374 626,521 3,067,592 9,820,818 31%

Sep-14 720,307 213 720,952 994,374 578,882 3,014,728 9,673,370 31%

Oct-14 720,279 788 653,020 1,009,750 635,309 3,019,146 9,921,658 30%

Nov-14 720,275 2,498 700,347 1,009,750 640,616 3,073,486 9,926,093 31%

Dec-15 720,228 41,246 732,223 1,009,750 730,545 3,233,993 10,272,443 31%

Jan-15 720,190 13,417 746,311 1,012,201 795,084 3,287,203 10,248,617 32%

Feb-15 720,178 1,359 758,572 1,012,021 733,109 3,225,239 10,103,320 32%

Mar-15 720,169 1,082 752,683 1,026,328 720,616 3,220,879 10,252,688 31%

Apr-15 720,142 701 705,787 884,751 632,302 2,943,683 9,860,057 30%

May-15 720,153 1,217 656,327 906,838 632,204 2,916,738 9,860,057 30%

Jun-15 720,153 2,171 643,842 606,038 903,868 2,876,072 9,911,104 29%

Better Quality Care

Cleaning Services

A cleaning action plan has been implemented to focus on lifting the standard of Starship public areas. Periodic floor cleaning is carried out in evenings in public areas

The Topcat (Auditing) System & User forum was held on 11th June. Topics covered basic device

overview, operations and reporting. There is an opportunity for these forums to standardise

auditing processes nationally and/or regionally.

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Linen

Total linen savings for the 2014/15 financial year are $1.1M. The key drivers being change in

service delivery model which has led to reduction in imprest and utilisation levels and improved

efficiency in distribution and reduced FTE levels.

Security

Parking continues to be an on-going issue and particularly with illegal parking in evenings and weekends. Special attention is focussed on the ambulance car parks, disabled car parks, loading docks. There is a need for additional signage and work is now underway to address this.

Trust Funding

The Hector Trust which receives revenue from stalls held at Greenlane has approved $4,266 funding for Play Room Squabs for the Greenlane Surgical Unit. The new squabs will provide additional seating and children can use them for playing. The squabs are covered in vinyl and can be easily cleaned.


Food & Nutrition Project Update – Key Milestone Update

The changes to the key milestones for the food project have been updated per the following

timeline.

300,000

350,000

400,000

450,000

500,000

550,000

600,000

650,000

July Aug Sept Oct Nov Dec Jan Feb Mar Apr May JuneMonth

Non-Sterile Linen Cost 12/13 vs 23/14 vs 14/15

2014/15

2013/14

2012/13

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Food Project update:

The DHB Health & Safety and Infection Control representatives are part of the Design and

Construction Working Group. This group meets weekly to progress approval of main kitchen and

ward based change process. The design, plans and time-lines have now been re-submitted by

Compass Group and are being reviewed by the ADHB Design and Construction Working Group

prior to finalised documents being submitted to Steering Group for approval.

Design plans for ward based kitchens are currently under review by the Project Design &

Construction lead.

Three alternative options for Steamplicity in Motutapu ward are being priced.

Analysis of Compass Group pricing for perishable ward supplies has resulted in this area being

excluded from the service offering due to negative cost benefit to ADHB.

The roll-out of TrendCare to provide the data feed for CMS and Saffron is proceeding to plan.

Good progress has been made in developing the Customer Services Statement. This will be

concluded when the asset valuations are in hand and after asset transfer negotiations.

The end of service celebration for kitchen staff was held on 26 June 2015. This was well

attended by staff and positive feedback was received.

Engaged Workforce

Cleaning Services

A number of staff development initiatives were held in June including the NZQA Level 3

Certification, Communication Course for Greenlane staff and Assessor Training. Hospital Orderly

Services also being offered training material used as a resource.

Performance Development Review planning underway for January/February 2016.

Kronos In-Touch will provide two trial biometric terminals for the Cleaning Service. The

objective being to move cleaners using paper-based timesheets to biometric signing in/out. The

terminals will be located on Level 3. A start date has yet to be confirmed.

Procurement & Supply Chain

A procurement co-ordinator has been appointed and will commence in August.

Retail Concessions & Tenants

The newly refurbished Muffin Break (Level 5, Grafton site) re-opened for trading on Monday 8 June 2015.

To promote the opening, Muffin Break gave staff free 400 ‘keep cups’ to promote sustainability and reduce waste. This is equivalent to a waste reduction of 146,000 paper cups annually.

Security

The changes in First Security personnel are continuing. New personnel have been inducted on the site and rotations in positions are in progress.

Sustainability

The CEMARS (certified emissions measurement and reduction scheme) methodology for sizing

the current carbon footprint and data is being finalised. The next stage is in calculating the

emission inventory and developing an Emissions Management & Reduction Plan.

141


The monthly Sustainability Forums are well attended with increased awareness in reducing the carbon footprint. Discussions with Auckland City Council and University of Auckland are continuing.

A workshop is being planned to define the various aspects of the DHB’s environmental strategy and to help develop a programme of work that will minimise risk to the environment and reduce carbon emissions.

Discussions are continuing theatres and other services to introduce PVC recycling and achieve uniformity in processes for PVC recycling.



Bed Management Business Case Not Commenced √ √ √ √ √

Motor Vehicle – E Fleet RFP Completed √ √ √ √ √

Motor Vehicle – E Fleet Business case In Progress √ √ √

Motor Vehicle Fleet Strategy Not Commenced √ √ √ √ √

healthAlliance/Procurement Framework In Progress √ √ √

Supply Chain Framework In Progress √ √ √

Security Access Control & CCTV System In Progress √ √ √

Security Independent Security Assessment In Progress √ √ √

Security Strategy (MSD report) Not Commenced √ √ √

Staff Car-park Grafton Implementation phase √ √ √

Sustainability - CEMARS Certification In Progress √ √ √

Sustainability Strategy Not Commenced √ √ √

Sustainable Strategy Hand-dryers Implementation phase √ √ √

Sustainable Transport In Progress √ √ √

Transforming Food Service Delivery Model In Progress √ √ √

Waste Converter Trial at Grafton Completed √ √ √

Waste Converter Trial Evaluation Completed √ √ √

Waste Transformation Project In Progress √ √ √



Retail Concessions

Muffin Break re-opened for trading on Monday 8 June with positive feedback regarding the new look and its change to a healthier food offering (i.e. the salad bar).

Car-parks

The successful completion of construction on the additional floor on car-park Building A.

Food Service Project

Design plans for ward based kitchens received and being reviewed by the project Design and Construction lead.

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Perishable ward supplies pricing review has revealed a negative cost benefit to the DHB, therefore this service will be excluded from the Food Service Contract with Compass Group.

The end of service celebration for kitchen staff held on 26 June was well attended.

Security

Security Access Control & CCTV Discovery phase underway.

Independent Security Risk Assessment completed.


Food Service Project

There has been a delay in approval of main kitchen design and programme related to Compass Group rejecting the preliminary plans and pricing submitted by their third party contractor Southern Hospitality.

If project timelines are breached, Compass Group has an alternative option to provide Steamplicity from alternative sources if required to meet deadlines.


Area Timeframe

Cleaning Services

Staff development and training programme.

On-going

Dock Safety

Complete pedestrian crossing and dock markings.

Further dock review to identify potential risks.

July 2015

August 2015

Food & Nutrition Service

Finalise the preliminary plans and pricing of main kitchen design with Compass Group.

Finalise Design plans for ward based kitchens.

Awaiting independent valuation of kitchen and cafeteria assets.

Finalise pricing for Steamplicity in Motutapu Ward

Finalise Customer Services Statement

July 2015

July 2015

Mid-July 2015

August 2015

August 2015

Linen

$1.1M of non-sterile linen savings has been reported for 14/15.

Security Services

Finalise Access Control & CCTV discovery phase process.

Review Independent security assessment report.

July 2015

August 2015

Supply Chain

Improvements to receipting inwards stock process to avoid shortage of supplies in Wards and Theatres

Inventory stock level review to reduce obsolescence/write off

October 2015

October 2015

Sustainability

CEMARS emission inventory and Emissions Management & Reduction Plan.

CEMARS onsite audit of emissions source

August 2015

October 2015

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Financial Results – Non Clinical Support Services

Comments on Major Financial Variances Non Clinical Support Services

YTD Result is $3,260K U. The key drivers of this result are:

1. One off costs of $2,142K associated with the Food Services Implementation which were included in the business case but not in the 14/15 budget.

2. Costs associated with the three Auckland Metro DHB’s contribution to a Linen and Laundry Work programme of $245K in conjunction with HBL are included above.

3. Costs associated with cleaning are $572KU due to cleaners transferring with high leave balances. A concerted effort to reduce this liability is driving increased outsourced personnel costs.

4. Revenue is favourable due to car parking and lease revenue being above budget.


Non-Clinical Support Services Reporting Date Jun-15



REVENUE

Government and Crown Agency 0 0 0 F 0 0 0 F

Funder to Provider Revenue 0 0 0 F 0 0 0 F

Other Income 780 716 64 F 8,976 8,593 383 F

Total Revenue 780 716 64 F 8,976 8,593 383 F

EXPENDITURE

Personnel

Personnel Costs 1,330 1,298 (32) U 15,050 15,529 479 F

Outsourced Personnel 276 14 (262) U 2,443 167 (2,276) U


Clinical Supplies 29 56 27 F 586 668 82 F

Infrastructure & Non-Clinical Supplies 1,917 1,612 (305) U 20,446 19,545 (901) U

Total Expenditure 4,095 2,980 (1,115) U 39,514 35,909 (3,605) U

Contribution (3,314) (2,264) (1,051) U (30,538) (27,315) (3,222) U

Allocations (803) (807) (4) U (9,645) (9,682) (37) U

NET RESULT (2,511) (1,457) (1,054) U (20,893) (17,634) (3,259) U

Paid FTE



Medical 0.0 0.0 0.0 F 0.0 0.0 0.0 F

Nursing 0.2 0.0 (0.2) U 0.2 0.0 (0.2) U

Allied Health 1.4 4.8 3.5 F 3.2 4.8 1.6 F

Support 185.8 316.9 131.0 F 262.0 316.9 54.9 F

Management/Administration 24.4 17.3 (7.1) U 28.7 18.2 (10.5) U



Total including outsourced FTEs 275.8 339.0 63.1 F 346.7 339.9 (6.8) U

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Community and Long Term Conditions Directorate

Speaker: Judith Catherwood, Director

Service Overview The Community and Long Term Conditions Directorate is responsible for the provision of care of

Older People’s Health Services, Rehabilitation Services, Palliative Care Services, Community Based

Nursing and Allied Health Services and Ambulatory Services for the adult population.

The Directorate Leadership Team consists of Directorate Director, Judith Catherwood, Interim

Medical Director, Barry Snow, Primary Care Director, Jim Kriechbaum, Nurse Director Jane Lees and

Allied Health Director, Anna McRae.

The services in the Directorate have been restructured under the clinician leadership model into six

service groups:

Reablement (in patient assessment, treatment and rehabilitation services)

Sexual Health Services

Community Services (Chronic Pain, Home Health and Mobility Solutions)

Diabetes Services

Ambulatory Services (Endocrinology, Dermatology, Immunology and Rheumatology)

Palliative Care Services

Scorecard









% Inpatients on Older Peoples Health waiting list for 2 calendar days or less 58.7% 80% 86.5%

% Inpatients on Rehab Plus patients waiting list for 2 business days or less 68.4% 80% 31.3%




% Patients cared for in a mixed gender room at midday - Adult 1.0% 2% 2.0%



% Discharges with Length of Stay less than 21 days for OPH and Rehab Plus combined 60.8% 0% 64.4%

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There were two SAC 2 events in the month of June. One related to a pressure injury and the other a

fall with harm. Both are being fully investigated.

There were nineteen pressure injuries and thirty eight falls reported in June. Eleven of the pressure

injuries were acquired prior to admission. Of the eight acquired in the service, four were grade two

and three were grade one. One was unclassified. One pressure injury advanced to a grade three

and was recorded as a SAC 2 event (as above).

The point prevalence 12 month rolling average is close to target although there was a slight increase

month to month from the May results. There is a daily focus on pressure injury management which

supports reporting and a focus on early identification and management to aid learning and

improvement.

There were two medication errors related to an omission/delay and a documentation issue. No

harm was caused by these incidents

The Director and Nurse Director have been active in reviewing practice in the wards due to the

recent rise in falls with harm and pressure injury reports, and changes to practice have been

addressed as a result of this intervention.

Better Quality Care

The Directorate was 100% compliant for ESPI 1 and 2 targets. No patient waited longer than four

months for their FSA. Our Directorate is working towards a maximum three month waiting time for

all services.










Amber =

R/U =








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The Did Not Attend (DNA) rate for appointments is above target and remains a concern. Our

Directorate action plan to address this is progressing and is being monitored closely. Our initial

focus is on our Diabetes Service which has the highest DNA rates. Most of our other services have

DNA rates within target. We have set targets to reduce DNAs across our services and focus specific

attention on activities to reduce Māori and Pacifica DNA rates. Our directorate are working in

partnership with the Patient Administration Team to introduce phone to negotiate/direct booking

strategies in all our services. We also plan to review the model of care in diabetes in 2015/16 to

improve our engagement with our community to help address this issue.

The Directorate remains committed to minimising the number of patients in mixed gender rooms

and the rate in June was 1% and within target.

OPH waiting time performance and patient flow has deteriorated in June. Rehab Plus saw an

improvement in performance but is still outside our new revised stretch target. An outbreak of

norovirus in OPH resulted in significant bed closures to protect patients from infection and this

impacted on flow in the month of June. We have recently stretched the waiting time target to 2

days or less from the previous 4 days in line with evidence base practice that patients ready for

rehabilitation should receive this as soon as possible to achieve the best outcome. This will also

have impacted on the June result in our scorecard. The escalation plans in place and are being

implemented as required. Our directorate is committed to achieving change in the referral pathway

to reablement services and maintaining flow at the new stretch target, and the new rapid response

service commencing in late July should support this effort.

We have revised our overall length of stay metric and target to better reflect the Directorate aims

and the organisational needs. Benchmarking data suggests we should aim for a length of stay in

AT&R areas of 21 days through improving community based rehabilitation options for patients. Our

services overall average length of stay is within these parameters but we have some patients whose

stay is far longer. This is in part complicated by the legal processes when patients with incapacity

have no power of attorney in place. We aim to improve our performance against this measure over

the coming months and have plans in place for both improvement in community rehabilitation

services and changes to PPPR processes to maintain LOS within our new stretch target.

Patient experience surveys have not been fully implemented across our Directorate by the patient

experience team. At present only inpatient areas in our directorate are targeted. Current feedback

is reviewed by all staff. We are working with the patient experience team to increase the number of

patients providing feedback through this service.

Complaints are being actively managed within our Directorate meetings and action plans to address

any learning points have been created and are being monitored. There were two complaints

received in the month of June and all were responded to within the agreed target.


Performance on the smoking advice metric is 86% this month. The Nurse Director has taken action

to address this issue in the reablement wards and we expect this to revert to 100% in the following

month.

6.11

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Engaged Workforce

The Directorate continues to make progress on reducing excess leave. It is now at its lowest overall

level and has reduced by 70% in the last year. Plans to address the remaining staff with excess leave

are being made. Our aim is to eliminate excess leave and ensure all staff roster regular leave in all

services. Sick leave had been decreasing overall but the rate slightly increased in the month of June

and is marginally above target. It is being actively managed across the directorate applying the

Auckland DHB Wellness guide.



Patient Flow and Intermediate Care Work Stream including:

Gerontology and community service presence within ED

Rapid response and early discharge team model

Intermediate care step down bed model

Reduce avoidable admissions from ARRC

Streamline NASC and Service Coordination process

Implementation in progress

√ √ √ √ √

Locality Service Delivery Model Planning phase √ √ √ √

Dementia Care Pathway Implementation in progress

√ √

Infusion Services Work Stream Implementation about to

commence

√ √ √ √

Stroke pathway and development of integrated all age services (in partnership with Acute Medical Directorate)

Implementation about to

commence

√ √ √

Regional Sexual Health Service change programme Implementation in progress

√ √ √

Ambulatory Service Improvement work stream Diagnostic phase

√ √ √ √

Directorate operational performance and savings programme including:

ACC revenue

Skill mix and cost per FTE

Leave Management

Service and job sizing

On going √

Directorate structure review to implement clinical leadership model

On track √ √ √

Directorate team development On track √ √ √

MOS Implementation Programme On track √ √ √


148


Key achievements in the month The Directorate is currently working through the final stages of the recruitment process to

the new service leadership roles as a result of the restructuring and development of the

clinician leadership model.

The new service model for the Regional Sexual Health Service began operation on 1 July

2015. The transition year will monitor access by the public and through other referral

sources. A regional clinical governance group has been established and a final workforce

plan for the service will be completed at the end of June 2016.

A benchmarking project involving all ambulatory services has been completed. The project

reviews quality, service and models of care with peers across NZ, Australasia and the UK.

The report outcomes will support changes in models of care to ensure contemporary

practice is maintained.

The new rapid response model, using a redesign of existing resources and budget, will

commence in July 2015. This initiative was part of our DAP for 2014/15 and was a

requirement set by the MOH for DHBs. This service will improve patient flow, with initial

focus on supporting ED, APU and the acute adult in patient services. The service is nurse led

and will focus on early discharge and admission avoidance support packages. This

A further intermediate care service offering is in development for winter 2015. The

Directorate is in the final stages of planning a pilot of an intermediate residential bed

scheme. This scheme will also support improved patient flow and better service outcomes

for the frail older adult. It is also being achieved through a redesign of existing resources

and will be fully evaluated.

A project to ensure consistent business processes are in place for all services using HCC has

commenced. This will ensure accurate data and volume reporting.

The Directorate has commenced a formal production planning process with a monthly POP

meeting to ensure our capacity and demand to deliver to volume and waiting time targets is

achieved.

Areas off track and remedial plans There has been an increase in number of complex patients requiring home based support.

The pathway for patients has changed to incorporate a short term phase of home support

prior to finalising long term care packages. We are evaluating this scheme at present but

early indications are the process does reduce the need for highly complex home care

packages in the longer term.

DNA action plan for the Directorate has been developed and is being implemented across all

services.

Leave management is being monitored on a weekly basis, specific targets have been set in

high risk areas and action plans to address high leave balances within teams are being put in

place across the service.

A number of our services use HCC to record activity. There are no clear business rules in

place to ensure the services record activity and volumes accurately which has an impact on

revenue, funding, projection planning and understanding patient flow. A plan has been

developed with Business Intelligence to address this issue.

6.11

149


Key issues and initiatives identified in coming months Complete recruitment to the Directorate Leadership team.

Embed management operating system across the directorate at service and ward/team

level.

Continue work on the Directorate Work Programme with partners across the sector and

develop the Directorate Strategic and Clinical Services Plan.

Implementation and development of the revised Directorate structure which introduces the

new clinical leadership model.

Orientation for new clinical leaders and new operational managers has commenced and will

continue with a leadership development plan over the coming months.

Further development of community services through the development of the locality model.

Detailed planning for this commences in August. This will reduce duplication of effort and

enhance community responsiveness.

Continue the development of work streams to improve the quality and outcome of the

patient’s journey including intermediate care, avoidable admissions, dementia care and the

stroke pathway.

Development of a capital planning programme for the Directorate and the facilities our

services utilise. A number of our buildings are in need of refurbishment. Plans for

refurbishment have been drafted for OPH, Rehab Plus and ambulatory and community

services based at Greenlane. Our future requirements need to be informed by our clinical

services plans and support a whole of Auckland DHB approach.

Develop improved performance within our ambulatory services through a combination of

enhanced production planning, benchmarking and quality improvement to create

sustainable, accessible services within available resources.

150


Financial Results

Comments on Major Financial Variances The YTD result is $1,245k F.

Revenue YTD is $640k U mainly due to low ACC income. We were projecting a 10% ACC increase

over the same period last year. Increased efficiencies within the service (e.g. lower lengths of stay)

have reduced income projections overall.

Total Expenditure YTD is $1,609k F. Significant drivers of this are:

Personnel and Outsourced Personnel combined of $327k F due to 13.8 F in FTE. There are

high vacancies in Allied Health personnel ($566k F, 8.6 FTE F). Recruitment is in progress.



REVENUE

Government and Crown Agency 1,533 1,268 266 F 14,519 15,211 (692) U


Other Income 59 19 40 F 277 225 53 F

Total Revenue 7,956 7,650 306 F 86,791 87,431 (640) U

EXPENDITURE

Personnel Costs

Medical 1,202 1,157 (45) U 14,094 13,785 (310) U

Nursing 1,762 1,728 (34) U 20,957 20,790 (167) U

Allied Health 802 835 33 F 9,342 10,031 689 F

Support 0 0 0 F 0 0 0 F

Management/Adminstration 284 307 23 F 3,302 3,661 359 F

Total Personnel Costs 4,051 4,027 (24) U 47,694 48,267 572 F

Outsourced Personnel 34 55 20 F 901 656 (245) U

Outsourced Clinical Services 160 133 (27) U 1,569 1,596 27 F

Clinical Supplies 553 734 181 F 7,636 8,806 1,170 F

Infrastructure & Non-Clinical Supplies 274 187 (87) U 2,159 2,244 85 F

Total Expenditure 5,073 5,136 63 F 59,959 61,568 1,609 F

Contribution 2,883 2,514 369 F 26,832 25,863 969 F

Allocations 328 358 29 F 3,895 4,171 276 F

NET RESULT 2,554 2,156 398 F 22,937 21,692 1,245 F

Paid FTE



Medical 67.4 70.1 2.7 F 69.0 70.1 1.1 F

Nursing 272.5 274.1 1.7 F 270.0 274.1 4.1 F

Allied Health 129.6 137.7 8.1 F 129.3 137.7 8.5 F

Support 0.0 0.0 0.0 F 0.0 0.0 0.0 F





Statement of Financial Performance for June 2015

Auckland DHB - Adult Community and LTC

6.11

151


Clinical Supplies are $1,170k F mainly due to under budget expenditure in Immunology

Blood $472k F and Rheumatology Pharmaceuticals $416k F. These fluctuate significantly

with patient acuity and volumes.

Allocations are $276k F, mainly due to reduced Lab service billing in Ambulatory $185k F. There are a

number of drivers including lower patient acuity, change in practice and lower than budget volumes.

Summary The Directorate has developed a significant transformation and change agenda ahead. A key feature

of our plan is the development of the clinician leadership model and enhancement of leadership

skills at service level.

Other improvements are linked to integration of services across the directorate, the provider arm

more broadly and with primary care, enhancing equality of access, increasing intermediate care

provision and rapid response services, and improving our response through integrated locality team

working. Our Directorate has achieved reductions in waiting times, improvements in patient flow

and reductions in leave liability, whilst delivering a number of change programmes and service

redesign. Our strategy and plan continues to be developed and will inform future reports to HAC.

152


6 Patient Experience Report

Recommendation

That the Hospital Advisory Committee receives the Patient Experience report.



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153

ADHB Inpatient & Outpatient Values Report June 2015: 1

Respect – Manaaki We respect, nurture and care for each other

Since we began surveying patients about their experience of care in 2011, we have asked the same questions about respect (and dignity) each time. The feedback we get is consistent. Because each run of the survey is to a new group of patients, and because we tend to hear the same things each time, we can have confidence that our survey feedback is a reliable indication as to how things are for our patients, even though the sample is a small percentage of our total patient population (about 4%).

This report focuses on what patients tolds us about respect and dignity over the last 12 months of our patient experience surveys.

Patients told us that they felt treated with respect and dignity when staff:

• Listened to their points of view; • Showed compassion; • Took care when discussing sensitive information ; and • Asked for permission, particularly if there are extra staff or

students present, and before touching them.

They tell us that they did not feel treated with respect when staff:

• Shouted; • Talked down to people, were judgemental or

condescending; • Made racist, sexist or homophobic remarks ; • Took others time for granted, such as keeping patients

waiting, without explanation or apology; and • Ignored patients and focussed on other things.

Overall, 85 per cent of outpatients and 83 per cent of inpatients say they were treated with respect, which is very close to the percentage of patients who rated their overall experience of care as “very good” and “excellent”. This suggests that being treated with respect clearly matters in terms of patients’ overall experience of care.

As the time-trend graphic to the left shows, the proportion of patients rating the care they received as “excellent” is steadily growing, while the proportion of patients who rate their care as “poor” is not changing. This means that fewer patients are rating their care experience as simply “good”. As time goes by, more staff are delighting our patients which is fantastic to see and something to be proud of.

Tony O’Connor, PhD Director of Participation and Experience

WHAT MATTERS MOST If we focus on the areas that matter most to patients, we can make the most difference to the way they experience our services, and the way they rate their overall experience.

Getting good information is the aspect of our care most outpatients (67%) say makes a big difference to the quality of their care and treatment. See our earlier report on information.

How are we doing on outpatient information?

6 19 74

Poor Moderate Very good

49% of inpatients say communication makes a big difference to the quality of their care and treatment. See our earlier report focusing on communication.

How are we communicating with inpatients?

7 20 73

Poor Moderate Very good

‘Excellent’ on the rise Since the survey began, there has been a steady but significant rise in those who rate their care as excellent, from 43 per cent per quarter in March 2012, to 49 per cent in the most recent quarter ending March 2015 (p < .05). The percentage of patients rating their overall experience as poor or fair, however, has remained largely unchanged over this period, fluctuating between 5 per cent and 7 per cent.

0102030405060

Excellent Poor/Fair 154

Respect - Manaaki What we all want to see Being treated with respect matters. One-third of inpatients (34 %) and one-fifth (21 %) of outpatients say that being treated with respect is one of the things that makes the most difference to their care and treatment.

Listen to different points of view

Patients want us to listen to and respect their point of view.

What does “listen to different points of view” look like to our patients? Our patients ask that we actively listen to what they have to say.

• Overall 14 per cent of our patients (5% inpatients, 9% outpatients) commented, unprompted, about this.

Patients appreciate it when their views and opinions are respected and taken into account.


Patients want their condition and treatment options discussed with them, not told to them.


Our patients are asking for their religious and cultural values to be respected.


Show compassion

Patients across the services told us kindness and compassion was important to them. Those who were inpatients found this to be particularly the case.

What does “show compassion” look like to our patients?

Our patients want to be reassured. Some commented how vulnerable they felt, and how unfamiliar the hospital environment was to them.


Patients appreciate it when staff appeared to genuinely care about their wellbeing.


Our patients want us to take time with them, and not rush them through.


Lastly, our patients ask us to notice when they need help. • Overall 2 per cent of our patients (1% inpatients, 1% outpatients) commented,

unprompted, about this.

PATIENT VOICES

LISTEN TO DIFFERENT POINTS OF VIEW

“They listened to all my concerns and made sure that my concerns were passed to everyone that was working with me...”

“All the staff - nurses doctors cleaners kitchen hand were fabulous great listeners answered all questions.”

“I felt like all of my options were clearly discussed with me so I could make true informed choices. There was no pressure to choose a particular option either.”

“They were very respectful towards my culture and understanding when I requested anything out of the ordinary a little bit.”

“The staff always talked to me and asked if I understood, they treated me as an equal and my opinion was listened to.”

“Spoke in audible tones that only i could hear, made good eye contact and was receptive and respectful of my views and feelings.”

SHOW COMPASSION

“All staff were very compassionate and caring. Always helpful and did not make you feel a burden.”

“Each staff member spoke to me confidently about what was happening and when I was concerned about things they stayed to reassure and monitor me.”

“The team were welcoming and caring. They could tell I was very nervous and they made me better, just by holding my hand and talking to me whilst the anaesthetic team prepared me for surgery. I remember seeing the surgical team again in recovery and later on the ward that evening. This reassured me and made me feel well cared for and safe.”

“I felt cared for and looked after by staff, everyone was warm, gentle, confident, friendly; I felt talked to as a person.”

“I am always treated with respect and kindness and feel my best interests are always at heart.”

“The doctor I saw was friendly and very informative with myself and my family, he answered all of our questions and took the time to make sure we understood.”

ADHB Inpatient & Outpatient Values Report June 2015: 2 – Respect | Manaaki

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Protect dignity and privacy

Patients value being treated with dignity.

What does “protect dignity and privacy” look like to our patients? Privacy is important to our patients.

Patients comment that they appreciate it when staff appear to generally respect their need for privacy.


Our patients appreciate it when staff respect their dignity and privacy during examinations, in particular ensuring that curtains are closed, they are kept covered up, and their modesty is protected.


Patients want to be kept informed, but ask that staff respect their privacy by discussing personal and sensitive health matters so that others cannot overhear the conversation. This includes in rooms, wards, and receptions or other public areas.


Our outpatients are asking us to ensure there is privacy at reception and personal information is not divulged.

• Overall, 1 per cent of our outpatients commented, unprompted, about this.

Ask permission

What does “ask permission” look like to our patients? Patients value staff introducing themselves and asking permission for other staff or students to be present.


Our patients appreciate being asked permission before being treated or touched.


PATIENT VOICES

PROTECT DIGNITY AND PRIVACY

“I was always kept covered up even when examined put in a separate room to discuss issues.”

“I was given time and privacy to change into hospital clothes”

“I surprised myself when confronted with the male doctor. I hadn't expected to be uncomfortable with this situation but he was very understanding and immediately arranged for me to see a female colleague. Thank you. This was really important as I don't think I would have engaged in any dialogue if I hadn't seen this lovely doctor.”

“There were three vulnerable women in our room that were often naked getting treatment and we felt very uncomfortable with a male patient that was in our room. He was discreet but we felt surely there must have been another bed in the ward he could have gone to.”

“It was behind closed doors and curtains - privacy was adhered to, and I was spoken to, in a very nice quiet and respectful way I preferred that other patients, did not hear what I was spoken about thankyou.”

“Reception was discreet and all contact with medical staff was done in private and with dignity and respect.”

ASK PERMISSION

“When I had to be naked or anything they would ask for permission especially the male doctors or nurses when they had to touch me anywhere they would always ask first and the nurses would always make me feel comfortable before any procedure was performed.”

“Even though the surgeon had trainee doctors with him, he always asked my permission before they took part. They were polite and not intrusive in anyway.”

“The doctor was respectful and also asked my 4 year old son permission to examine him.”

“Asking my permission in doing things and am I comfortable please let them know if I am not or anything else that may help make me feel at ease.”

“A nurse introduced herself explaining she was a student and asked if it was ok for her to do my observations. I felt respect when she asked me permission and she had a friendly attitude.”


Highlights

Mostly we treat people with respect.

• 85% of outpatients say their views were always taken into account and respected

• 83% of inpatients say they were treated with respect • 61% of inpatients say their cultural needs were met

Overall, we are doing well. In the last 12 months:

• 84% of in patients rated their overall care as very good or excellent • 87% of outpatients rated their care as very good or excellent

156

PATIENT VOICES Respect - Manaaki What nobody wants to see Over the past year around six per cent of inpatients and four per cent of outpatients have rated their overall experiences of our services as fair or poor. Around one-third of patients who rate their care poorly describe how staff were rude, or unkind towards them, lacked empathy or compassion, or treated them disrespectfully. Some found this deeply upsetting.

Shout and talk down to people

What does “shout and talk down to people” look like to our patients?

Patients do not like being talked down to, shouted at, or subjected to rude, racist or homophobic comments. Some patients were very upset by terse, unkind or rude interactions.


Take others’ time for granted

What does “take others’ time for granted” look like to our patients?

One of the greatest sources of frustrations for outpatients in particular is having to wait for appointments. Patients are asking us to communicate with them, provide explanations and apologise if clinics are running late.


Disregard cultural differences

What does “disregard cultural differences” look like to our patients?

Patients are telling us that they want to have their customs, practices, values, worldview and religious view respected.

Six percent of inpatients have cultural needs associated with their care and treatment. Most felt they were treated respectfully; however one-third did not feel as if their needs were fully met. They are asking to be treated respectfully, whether or not we share their cultural views.

Bully or belittle people

Some patients commented that they felt judged, pressured, bullied or belittled.

• Overall 3 per cent of our patients (2% inpatients, 1% outpatients) commented, unprompted, about this. Note that the overall ratings were very poor when patients experienced this behaviour.

SHOUT AND TALK DOWN TO PEOPLE

“A few of the nurses were extremely rude, and what felt like, discriminated toward my age”

“I became tearful and the nurse on that occasion, rather than ask what was wrong, snapped at me that "There is no reason to be crying". I find this both startling and disturbing, as if by becoming upset you become a nuisance to the nursing staff and quite frankly, I just cannot understand it...”

TAKE OTHERS’ TIME FOR GRANTED

“Stop making patients feel like cattle, the long waiting times.”

“As i said you were very busy but it would have been nice if reception could have let people know that there would be a long wait, this would have made all the difference.”

“After waiting quietly for an hour I asked when I might be seen (wondering if I'd been forgotten) - she pulled a horrible face like she smelled something rotten, looked down her nose at me, and said "The files have gone through, I don't know" and that was all she would say...”

DISREGARD CULTURAL DIFFERENCES

“My culture wasn't taken into consideration,

“The nurse made some inappropriate comments re culture generalising my family to what she knows about the culture.”

“Staff being able to pronounce my baby’s name properly and respecting when they were corrected on how to pronounce her name properly.”

BULLY OR BELITTLE PEOPLE

“The nurse insinuated that I was a big baby when it came to pain and the negative impact on that was that I didn't want to ask for pain relief when she was on duty as I felt like I was being judged.” “As a patient I felt bullied into undergoing a surgery despite not feeling 100% comfortable with the doctors in charge as they were constantly changing and didn't know what was going on.”


Areas for improvement

• One quarter of outpatients (25%) rate the waiting time at the appointment as poor or fair.

• One-third of those who have cultural needs do not feel as if these are met.

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157


Resolution to exclude the public from the meeting

Recommendation That in accordance with the provisions of Clauses 34 and 35, Schedule 4, of the New Zealand 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 item

to be considered

Reason for passing this resolution in

relation to the item

Grounds under Clause 32 for the

passing of this resolution

3. Confirmation of Confidential Minutes 24 June 2015

Confirmation of Minutes As per resolution(s) from the open section of the minutes of the meeting, in terms of the NZPH&D Act 2000.

That the public conduct of the whole or

the relevant part of the meeting would

be likely to result in the disclosure of

information which good reason for

withholding would exist under any of

sections 6, 7, or 9 (except section

9(2)(g)(i)) of the Official Information Act

1982 [NZPH&D Act 2000]

4. Confidential Action Points

Confirmation of Action Points

As per resolution(s) from the open

section of the minutes of the meeting,

in terms of the NZPH&D Act 2000.








1982 [NZPH&D Act 2000]

6. Risk Register Report Obligation of Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which is subject to an obligation of confidence [Official Information Act 1982 s9(2)(ba)]









1982 [NZPH&D Act 2000]

7. Quality Report (includes complaints, compliments, incident management and policies and procedures)

Obligation of Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which is subject to an obligation of confidence [Official Information Act 1982 s9(2)(ba)]

Privacy of Persons To protect the privacy of natural persons, including that of deceased natural persons [Official Information Act s9(2)(a)]








1982 [NZPH&D Act 2000]

8

158


8. Quality and Standards Reviews’ Report










1982 [NZPH&D Act 2000]

9. Discussion Papers (includes Managing MRI, CT and Ultrasound Demand at Auckland District Health Board)


Negotiations

To enable the Board to carry on, without prejudice or disadvantage, negotiations (including commercial and industrial negotiations) [Official Information Act 1982 s9(2)(j)]









1982 [NZPH&D Act 2000]

159

Hospital Advisory Committee Meeting Wednesday, 05 August ... · Hospital Advisory Committee Meeting...

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