2004 CDHB Quality & Innovation Awards Ceremony

2012 Canterbury DHB Quality Improvement & Innovation Awards Chief Executive David Meates and the Canterbury DHB Clinical Board were pleased to welcome back the Quality Improvement & Innovation Awards in 2012. The Awards were not held in 2011 for the first time since their introduction in 2003 while our health system and community began the process of recovering from the Canterbury earthquakes. The return of the Awards came with a few changes to the programme. New categories were announced for 2013, aligning with the New Zealand Triple Aim for quality improvement in health established by the Health Quality & Safety Commission:  Improved Quality, Safety & Experience of Care  Improved Health & Equity for Populations  Best Value for Public Health System Resources These new categories succeeded in reflecting Canterbury’s ‘Whole of System’ approach to health services, allowing for a good mix of projects within each category rather than the separation of community and hospital-based projects. Another important change to the Awards programme in 2012 was the addition of Site Visits to the assessment process. After reading the written submissions, Assessors ventured out across the health system and met with project teams to learn more about the projects first hand. The new Site Visits received enthusiastic approval from Assessors and Entrants alike. The 2012 Quality Improvement & Innovation Awards winners and runners-up were announced at the Awards Ceremony on Wednesday, 21st November 2012, with Entrants, Mentors, and Assessors involved in the programme celebrating nearly a year of hard work. The following profiles of winning projects have been adapted from the original submission documents and assessor feedback reports by Emma Kenagy.

Improved Health & Equity for Populations Category Winner: Senior Chef: Cooking Classes for Older Adults Older Person’s Health Specialist Service, Canterbury DHB In Canterbury, local research has shown that a significant number of older adults living in the community are at high risk of poor nutrition, with eating alone and difficulty cooking being common factors. Senior Chef is a community-based cooking programme that addresses these findings for Canterbury’s ageing population. The eight week programme provides older adults with the opportunity to improve their cooking skills and knowledge and to socialise and share meals as a group. Senior Chef was launched Canterbury-wide after two successful pilots were conducted in 2009. Since the programme launched in 2010, 59 courses have been delivered throughout Canterbury with 591 older people graduating from the programme. Ongoing evaluation has demonstrated positive results with participants rating their food and nutrition knowledge, confidence to cook, cooking skills and consumption of fruit, vegetables and milk higher post course. These improved dietary changes have been maintained a year after course completion, contributing to the aim of keeping older people healthy and living in their own homes as long as possible. Graduates are also supported to maintain their interest in cooking, eating well and socialising with others by regular socials, a newsletter and a Senior Chef website. Due to the success of the programme in Canterbury, Senior Chef has since been adopted in other regions of New Zealand.

Improved Health & Equity for Populations Category Runner-up: Not Just Bricks and Mortar: Responding to Community Mental Health Needs After the Earthquakes Specialist Mental Health Service, Canterbury DHB

The Not Just Bricks and Mortar project encompasses the response to community mental health needs immediately following the Canterbury earthquakes of September 2010 and February 2011. Prior to September 2010, the Canterbury DHB Specialist Mental Health Services (SMHS) had no plan for responding to the psychological needs of the community post disaster. By drawing on existing expertise in the SMHS and recent literature outlining best practice in response to civil emergencies, resources were developed to assist welfare centre staff and residents, spreading the work across people with the appropriate skills, and gradually building up an ethical and practical system for providing psychological support. The project goal was to provide guidance for specialist mental health input relating to the psychological wellbeing of welfare centre staff and residents. Following the fatal quakes on 22 February 2011, SMHS staff were able to rely on new procedures and relationships to participate more quickly and more fully in the psychological recovery of the people of Canterbury. As a result of the project, constructive relationships have been established between SMHS staff and staff from other services, including those from outside CDHB, with SMHS staff being called on to assist the Police liaison team working with bereaved families, attend community meetings, and support CERA led teams door-knocking in communities zoned red. The project has received national and international recognition, and community mental health is now recognised as a significant part of emergency response planning.

Improved Quality, Safety & Experience of Care Category Winner: Community Point of Care INR Monitoring Canterbury Health Laboratories in collaboration with Halswell Health, Kaikoura Medical Centre, Pegasus 24 Hour Surgery, Burwood Hospital and Canterbury Health Laboratories Ashburton Hospital

The inspiration for the Community Point of Care INR Monitoring project came from Chief Executive David Meates, who commented that “the biggest waste in our system is the patient’s time.” The project team focused on minimising the time patients on warfarin spend waiting for test results. Warfarin is given to patients to minimise the risk of experiencing a blood clotting event. Regular monitoring is required to ensure the correct levels are maintained and traditionally monitoring of warfarin patients is carried out in a GP or laboratory setting where the patient is bled and the sample sent off to a laboratory for processing. Through moving the monitoring process to point-of-care-testing at four pilot sites across Canterbury, the Community Point of Care INR Monitoring project achieved outstanding results for patients. This included a dramatic reduction in the average time a patient has to wait for their INR (International Normalised Ratio) test result from 6 hours to 15 minutes, and a much simpler and less painful blood sampling process – a finger prick rather than venepuncture. As one patient explained, “the experience is so quick and painless. I have difficult veins and I can’t believe how simple this was. I just wish you had started it years ago.”

Improved Quality, Safety & Experience of Care Category Runner-up: MindSight Programme for the Treatment of Borderline Personality Disorder Adult Community Service, Specialist Mental Health Service, Canterbury DHB

MindSight is a treatment programme within Christchurch Community Mental Health Teams for clients with Borderline Personality Disorder (BPD). BPD is a serious psychiatric disorder and, due to emotional dysregulation, clients with BPD are historically very high users of mental health and emergency services. Previous standard psychiatric treatments have proven to be ineffective and this has led to therapeutic pessimism amongst mental health practitioners in regard to the benefits of treating clients with BPD. However, there have been recent advances in the range of effective psychotherapies for BPD.

The MindSight training course for case managers was developed and over two years more than a 100 frontline staff undertook a two-day training workshop. The training was designed to align knowledge and understanding of BPD diagnosis, treatment, and response to clinical issues across staff so that a consistent model of care could be established that promotes good clinical outcomes and reduces risks to clients and staff. All clients with BPD are now receiving standardised and enhanced care through Enhanced Therapeutic Case Management, providing consistent care and treatment for clients.

Best Value for Public Health System Resources Joint Winner: Building the Capacity for Delivery and Sustainability of Lean Based Projects within the CDHB Hospital and Specialist Services Laboratory & Support Services and the Business Development Unit, Canterbury DHB

Over the last five years, approximately 3,500 Canterbury DHB staff members have been exposed to Lean Thinking theory through various initiatives of the Canterbury DHB Business Development Unit (BDU). During this time, BDU staff have observed that there has been limited success in the sustainable development of Lean skills and knowledge, methodologies and results, with project scope and timeframes tending to drift after the initial introduction of Lean principles. In response to these concerns, Building the Capacity for Delivery and Sustainability of Lean Based Projects aimed to build organisational capability to undertake and sustain Lean initiatives by improving the methodology by which Lean is taught and utilised. The initiative included pilot projects executed in the Operating Theatres, Laboratories and Sterile Services Unit, and Pharmacy Services. Over the course of this programme, more than 100 staff members from various parts of the organisation have been exposed to Lean principles, tools and methodologies. A range of Lean training was delivered at different levels according to staff roles and their involvement with the improvement projects, with project team members developing specific skills to continue improvement initiatives within their own areas of work. The projects included in the pilot have delivered measurable and meaningful results to the organisation. Improvements in productivity, turn around times, process flows and customer service have been achieved through the application of Lean methods such as layout changes, standard work, visual management and workload levelling. These outcomes have become embedded as part of day-to-day operations and results have been maintained, demonstrating the success of the initiative to build organisational capacity for achieving sustainable results through Lean.

Best Value for Public Health System Resources Joint Winner: Simplifying the Process: Redesigning the Stores System in the Burwood Spinal Unit Burwood Spinal Unit, Burwood Hospital, Canterbury DHB

In 2009, Health Care Assistants and other staff working in the Burwood Spinal Unit (BSU) stores area identified a lack of defined processes relating to stores ordering and organisation, and reliance on one person to order supplies each week. The consequence of this situation was unreliable stock levels, which had a potential impact on patient care and safety as adequate levels of certain products were not always maintained. The flow-on effect was high demand on nursing time to obtain urgent supplies. The overall aim of the project was to organise and document a clearly defined stores system that was simple and easy to use by all BSU staff. Staff input was gathered throughout each part of the process as the project team conducted a comprehensive stock take, reorganised storage spaces, and introduced a new ordering system and a lean approach to stock levels by monitoring trends in usage over time. These changes have resulted in a structured ordering and delivery system that has delivered significant financial and time savings. Positive outcomes include a 50% reduction in space, $7588 saved by reducing waste in the airway/breathing cupboards, $40,000 per annum savings in urgent deliveries, 684 hours per year released back into patient care, and $12,324 saved in staff time. Over the two year project period, the total amount saved by the BSU was $121,350. Most importantly, the project has released time, space and financial resources for other opportunities to improve patient care and outcomes.

Improved Health & Equity for Populations Category Winner: Senior Chef: Cooking Classes for Older Adults Older Person’s Health Specialist Service, Canterbury DHB In Canterbury, local research has shown that a significant number of older adults living in the community are at high risk of poor nutrition, with eating alone and difficulty cooking being common factors. Senior Chef is a community-based cooking programme that addresses these findings for Canterbury’s ageing population. The eight week programme provides older adults with the opportunity to improve their cooking skills and knowledge and to socialise and share meals as a group. Senior Chef was launched Canterbury-wide after two successful pilots were conducted in 2009. Since the programme launched in 2010, 59 courses have been delivered throughout Canterbury with 591 older people graduating from the programme. Ongoing evaluation has demonstrated positive results with participants rating their food and nutrition knowledge, confidence to cook, cooking skills and consumption of fruit, vegetables and milk higher post course. These improved dietary changes have been maintained a year after course completion, contributing to the aim of keeping older people healthy and living in their own homes as long as possible. Graduates are also supported to maintain their interest in cooking, eating well and socialising with others by regular socials, a newsletter and a Senior Chef website. Due to the success of the programme in Canterbury, Senior Chef has since been adopted in other regions of New Zealand.

Improved Health & Equity for Populations Category Runner-up: Not Just Bricks and Mortar: Responding to Community Mental Health Needs After the Earthquakes Specialist Mental Health Service, Canterbury DHB

Improved Quality, Safety & Experience of Care Category Winner: Community Point of Care INR Monitoring Canterbury Health Laboratories in collaboration with Halswell Health, Kaikoura Medical Centre, Pegasus 24 Hour Surgery, Burwood Hospital and Canterbury Health Laboratories Ashburton Hospital

Improved Quality, Safety & Experience of Care Category Winner: MindSight Programme for the Treatment of Borderline Personality Disorder Adult Community Service, Specialist Mental Health Service, Canterbury DHB

Best Value for Public Health System Resources Joint Winner: Building the Capacity for Delivery and Sustainability of Lean Based Projects within the CDHB Hospital and Specialist Services Laboratory & Support Services and the Business Development Unit, Canterbury DHB

Best Value for Public Health System Resources Joint Winner: Simplifying the Process: Redesigning the Stores System in the Burwood Spinal Unit Burwood Spinal Unit, Burwood Hospital, Canterbury DHB