CCDHB Public 7 November 2018 - Item 1.9 Chief Executive's Report
Capital & Coast DHB Board Financial Overview September 2018
Julie Patterson, Interim Chief Executive Officer Michael McCarthy, Chief Financial Officer
CCDHB Financial Overview Page 1 September 2018
68 CCDHB Public 7 November 2018 - Item 1.9 Chief Executive's Report
INANCIAL PERFORMANCE RESULT AND OVERVIEW Summary The DHB has a board approved deficit target of ($15.9m) for the 2018/19 financial year. The result for September was ($809k) unfavourable to budget, due to increased costs of treatment disposables, unachieved efficiency targets for the month ($320k) and bulk payment of prior year HVDHB disputed invoices.
Result for Period ended September 2018 September 2018 Year to Date 2018/19
Varian Varian Annual Account Type in $000s Actual Budget ce Actual Budget ce Budget Revenue 95,444 94,949 496 283,164 285,017 (1,853) 1,139,617 Labour Costs 40,271 39,908 (364) 124,529 125,980 1,451 509,791 Outsourced Services 1,992 2,105 113 6,301 6,190 (111) 24,709 Clinical Supplies 10,659 10,401 (257) 32,128 31,771 (357) 123,648 Infrastructure & Non-Clinical 10,576 9,831 (744) 31,333 29,722 (1,611) 117,523 Other Providers 31,703 31,651 (52) 95,621 94,953 (668) 379,811
Total 243 1,052 (809) (6,748) (3,599) (3,149) (15,864)
Year to Date Variances against Budget
Revenue is ($1.8m) unfavourable YTD, and was due to ($2.6m) of lower IDF revenue, offset by increased other income. The IDF volumes reflect the lower activity due to the nurse’s strike in July.
Labour costs, including Employee and Outsourced personnel, are favourable $1.5m YTD. Nursing costs account for the $380k, Medical $90k, Management & Admin $690k, and Allied $309k of the variance. The variance is due to annual leave movement, vacancies and lower nursing costs. During the month the NZNO MECA was implemented with lump sum costs of $3.5m and back pay to June 2018 of $2.1m. The budget for the additional costs were moved from reserves to the Directorates to offset the costs. An additional $695k of budget for Leave revaluation was also transferred.
CCDHB Financial Overview Page 2 September 2018
69 CCDHB Public 7 November 2018 - Item 1.9 Chief Executive's Report
Other expenditure is over budget by ($2.75m) YTD. This was made up of ($1m) of unachieved stretched efficiency target, ($1.4m) in other external Provider Costs related to stretched Community Pharmaceutical targets, higher costs of clinical supplies, ($300k) bulk payment of unbudgeted HVDHB prior year invoices, and increased costs of depreciation. External Providers Review
Month - September 2018 Capital & Coast DHB - Funder Year to Date Variance Ext Provider Payments - $000s Variance Actual Actual Last vs vs Last YTD September 2018 Actual vs Actual vs Actual Budget year Budget year Actual Budget Last year Budget Last year External Provider Payments: 5,852 5,385 6,222 (467) 370 - Pharmaceuticals 17,594 16,156 17,642 (1,438) 48 5,591 5,644 5,404 53 (187) - Capitation 16,857 16,931 16,125 74 (732) 1,802 1,802 1,694 0 (108) - ARC-Rest Home Level 5,381 5,406 5,116 26 (264) 3,629 3,765 3,760 136 131 - ARC-Hospital Level 10,610 11,296 11,226 686 616 1,734 1,695 1,646 (38) (87) - Other HoP 5,210 5,086 4,815 (125) (396) 2,041 2,229 1,901 188 (139) - Mental Health 6,481 6,687 5,661 206 (820) 3,168 3,247 2,818 79 (350) - Other services (incl demand driven) 9,724 9,740 8,750 16 (974) 7,886 7,883 7,995 (2) 109 - IDF Outflows 23,763 23,650 23,985 (113) 222 31,703 31,651 31,440 (52) (261) Total Expenditure 95,620 94,953 93,319 (668) (2,301)
External Provider expenditure: unfavourable variance year to date ($668k) The favourable variances are: ∑ Capitation favourable variation of $74k due to volume changes still to be captured. ∑ Aged Residential Care rest home and hospital with $712k due to better NASC management and pay equity costs not as high
The unfavourable variances offsetting these amounts are: ∑ Pharmaceuticals ($1,438k) due to stretch target applied. Some savings to come via additional rebates from Pharmac ∑ Demand driven costs unfavourable due to phasing in immunisations and dental services claims
CCDHB Financial Overview Page 3 September 2018
70 CCDHB Public 7 November 2018 - Item 1.9 Chief Executive's Report
Employee FTE Financial Reporting to Ministry of Health (MOH Accrued FTE)
For financial accounting purposes MOH require an accrued FTE measure (as shown in the table below). This measure includes all hours on an accrual basis including leave accruals, overtime and casual hours. As an FTE measure this is highly volatile for a 24/7 facility due to the divisor being set based on the number of working days in the month. The Year to Date total is an average for the year. The average $ per FTE is impacted by MECA increases year on year.
Month - September 2018 Capital & Coast DHB Year to Date Annual Variance MOH Accrued FTE Variance Annual Budget YTD September 2018 Actual vs Actual vs Actual vs Actual vs Average Actual Budget Last year Budget Last year Actual Budget Last year Budget Last year FTE Last year FTE 992 1,003 842 11 (150) Medical 963 971 865 8 (98) 952 865 2,483 2,533 2,223 49 (260) Nursing 2,361 2,399 2,236 39 (125) 2,400 2,236 752 782 686 30 (66) Allied Health 742 756 705 14 (37) 736 705 147 153 145 6 (2) Support 142 149 144 7 1 145 144 918 948 830 30 (88) Management & Administration 910 934 853 23 (57) 913 853 5,292 5,419 4,726 127 (566) Total FTE 5,119 5,209 4,802 91 (317) 5,145 4,802 Average $ per FTE 13,100 12,752 13,698 (349) 598 Medical 42,064 42,253 42,142 189 78 171,571 174,097 6,453 6,176 6,724 (277) 270 Nursing 20,514 20,349 20,381 (165) (134) 84,155 86,374 5,968 6,027 6,467 58 499 Allied Health 19,417 19,885 19,744 468 328 80,837 78,917 4,236 4,254 4,521 19 285 Support 13,799 13,848 13,503 49 (296) 55,657 54,955 5,685 5,868 6,033 184 349 Management & Administration 17,891 18,580 17,889 689 (2) 77,033 70,997 7,435 7,264 7,740 (172) 304 Cost per FTE all Staff 23,758 23,861 23,559 104 (199) 97,793 97,412
CCDHB Financial Overview Page 4 September 2018
71 CCDHB Public 7 November 2018 - Item 1.9 Chief Executive's Report
CCDHB STATEMENTS OF FINANCIAL POSITION
Aug -18 Month : September 18 Capital & Coast DHB Variance Balance Sheet September At June Actual vs Actual vs YTD September 2018 Actual Actual Budget 2017 2018 Budget September 2017 Notes 22 22 102 102 21 (81) (81) 1 Bank 2,795 3,477 19,825 23,411 17,581 (16,347) (19,933) 1 Bank NZHP 10,346 10,255 9,269 8,769 9,693 986 1,486 1 Trust funds 51,216 51,606 48,185 48,185 49,190 3,422 3,422 2 Accounts receivable 8,504 8,780 8,880 8,880 8,067 (99) (99) Inventory/Stock 5,183 5,655 6,789 6,789 3,075 (1,135) (1,135) Prepayments 78,065 79,795 93,050 96,136 87,628 (13,255) (16,341) Total current assets
551,744 553,128 552,613 459,424 555,233 515 93,703 Fixed assets 11,613 11,947 11,947 9,859 11,626 0 2,088 Work in Progress - CRISP 26,420 25,801 18,145 7,950 18,466 7,656 17,851 Work in progress 589,777 590,876 582,704 477,234 585,324 8,171 113,642 3 Total fixed assets
5,448 5,448 6,468 6,468 5,986 (1,020) (1,020) Investments in New Zealand Health Partnership 1,150 1,150 1,150 1,150 1,150 (1) (1) Investment in Allied Laundry 6,598 6,598 7,618 7,618 7,136 (1,020) (1,020) Total investments 674,439 677,268 683,372 580,988 680,088 (6,104) 96,281 Total Assets
0 0 0 0 0 0 0 Bank overdraft HBL 68,955 69,687 69,625 76,172 65,484 (63) 6,485 4 Accounts payable, Accruals and provisions 166 166 244 244 247 79 79 7 Loans - Current portion 4,115 6,173 6,170 0 (0) (3) (6,173) 6 Capital Charge payable 593 593 593 593 593 0 0 Insurance liability 30,170 26,496 25,792 24,212 24,750 (705) (2,285) 5 Current Employee Provisions 48,192 48,849 49,489 45,230 49,212 640 (3,619) 5 Accrued Employee Leave 7,242 10,051 7,423 7,423 17,818 (2,627) (2,627) 5 Accrued Employee salary & Wages 159,433 162,015 159,336 153,875 158,104 (2,679) (8,140) Total current liabilities
55 55 302 302 55 247 247 Crown loans 10,401 10,313 9,275 8,845 9,746 (1,038) (1,468) Restricted special funds 605 605 605 605 605 0 0 Insurance liability 5,642 5,642 5,868 5,868 5,642 226 226 Long-term employee provisions 16,703 16,615 16,050 15,620 16,048 (565) (995) Total non-current liabilities 176,136 178,631 175,387 169,495 174,151 (3,244) (9,135) Total Liabilities 498,304 498,638 507,986 411,492 505,936 (9,348) 87,145 Net Assets
764,628 764,402 764,631 769,398 768,845 (228) (4,996) Crown Equity 0 0 0 0 (3,484) 0 0 Capital repaid 136,496 136,813 136,776 23,671 136,404 37 113,142 Reserves (402,820) (402,577) (399,421) (381,576) (395,830) (3,154) (21,000) Retained earnings 498,304 498,639 507,986 411,493 505,936 (9,347) 87,145 Total Equity
CCDHB Financial Overview Page 5 September 2018
72 CCDHB Public 7 November 2018 - Item 1.9 Chief Executive's Report
Month : September 18 Capital & Coast DHB Year to Date Variance Statement of Cashflows Variance Actual vs Actual vs Actual vs Actual vs YTD September 2018 Actual Budget Last year Budget Last year Notes Actual Budget Last year Budget Last year Operating Activities 98,679 95,624 91,624 3,055 7,055 Receipts 293,170 285,181 275,681 7,989 17,489
Payments 39,537 41,913 37,413 2,376 (2,124) Payments to employees 128,554 127,440 113,410 (1,114) (15,144) 54,276 51,938 51,727 (2,338) (2,549) Payments to suppliers 164,727 156,534 155,551 (8,193) (9,177) 0 0 0 0 0 Capital Charge paid 0 0 0 0 0 733 246 246 (487) (487) GST (net) (505) (420) (420) 85 85 94,545 94,097 89,386 (448) (5,159) Payments - total 292,776 283,553 268,540 (9,223) (24,236) 4,134 1,528 2,239 2,607 1,896 6 Net cash flow from operating Activities 394 1,628 7,141 (1,234) (6,747)
Investing Activities 83 74 74 (9) (9) Receipts - Interest 448 248 248 (200) (200) 0 0 0 0 0 Receipts - Other 0 0 0 0 0 83 74 74 (9) (9) Receipts - total 448 248 248 (200) (200)
Payments 334 0 0 (334) (334) Investment in associates 334 0 0 (334) (334) 3,291 1,474 1,050 (1,817) (2,241) Purchase of fixed assets 13,969 5,976 3,919 (7,994) (10,050) 3,626 1,474 1,050 (2,151) (2,575) Payments - total 14,304 5,976 3,919 (8,328) (10,384) (3,543) (1,400) (976) (2,160) (2,584) 7 Net cash flow from investing Activities (13,855) (5,727) (3,671) (8,528) (10,584)
Financing Activities 0 6,000 0 (6,000) 0 Equity - Capital 0 6,000 0 (6,000) 0 0 0 0 0 0 Other Equity Movement 0 0 0 0 0 0 0 0 0 0 Other 0 0 0 0 0 0 6,000 0 (6,000) 0 Receipts - total 0 6,000 0 (6,000) 0
Payments 0 0 0 0 0 Interest payments 81 0 0 (81) (81) 0 0 0 0 0 Payments - total 81 0 0 (81) (81) 0 6,000 0 (6,000) 0 8 Net cash flow from financing Activities (81) 6,000 0 (6,081) (81) 592 6,127 1,262 (5,554) (689) Net inflow/(outflow) of CCDHB funds (13,542) 1,901 3,470 (15,843) (17,413)
13,162 23,069 31,020 9,907 17,858 Opening cash 27,296 27,295 28,812 (1) 1,516 98,762 101,698 91,698 (2,954) 7,046 Net inflow funds 293,619 291,430 275,930 1,789 17,289 98,171 95,571 90,436 (2,600) (7,734) Net (outflow) funds 307,161 289,529 272,460 (17,632) (34,702) 592 6,127 1,262 (5,554) (689) Net inflow/(outflow) of CCDHB funds (13,542) 1,901 3,470 (15,843) (17,413) 13,754 29,196 32,283 (15,442) (18,529) Closing cash 13,754 29,196 32,283 (15,442) (18,529)
CCDHB Financial Overview Page 6 September 2018
73 CCDHB Public 7 November 2018 - Item 1.9 Chief Executive's Report
Notes to the Balance Sheet and Cashflows
A) Notes to Balance Sheet: 1. The DHB’s cash balance at the end of September is lower than budget as the DHB has not drawn on budgeted equity injection. 2. Accounts receivable is $3.4m higher than budget due to timing differences. The 2 largest debtors are Hutt Valley DHB totalling $4.5M and Ministry of Health $4.6m. 3. Work in progress is higher than budgeted, with the Children’s Hospital and other project work running earlier than anticipated. 4. Accounts payable, accruals and provisions are in line with budget. 5. The employee salary accruals are higher than budgeted due to timing differences.
B) Notes to Cash flow statement: 6. The net cash receipts and payments from operating activities is in line with budget but lower than the prior year due to the payment of the NZNO settlement. 7. Cash flow on purchase of fixed assets is higher than budgeted due to the Children’s Hospital and other project work running earlier than anticipated. 8. There is a budgeted $6m equity injection this month but the DHB did not require this as yet, so this was not requested from the Ministry.
C) Ratios 9. Current Ratio – This ratio determines the DHB’s ability to pay back its short term liabilities. DHB’s current ratio is 0.49 (Aug 18: 0.49);
10. Debt to Equity Ratio - This ratio determines how the DHB has financed the asset base. DHB’s total liability to equity ratio is 26:74 (Aug 18 26:74).
CCDHB Financial Overview Page 7 September 2018
74 CCDHB Public 7 November 2018 - Item 1.9 Chief Executive's Report
Cash Forecast
This cash projection excludes the $15.9m deficit support. The cash forecast shows that we will need to draw down on deficit support to avoid going into overdraft. In January, there is a capital charge payment due of $15m. The working capital facility limit is $55.8m.
Cash Forecast
140 130 120 110 100 90 80 70 60 50 40 $m 30 20 10 0 -10 -20 -30 -40 -50 -60 -70 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 9 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 8 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / 6 6 6 6 5 5 5 5 4 4 4 4 3 3 3 3 3 2 2 2 2 1 1 1 1 2 2 2 2 2 1 1 1 1 0 0 0 0 9 9 9 9 9 8 8 8 8 7 7 7 7 7 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / / 3 6 9 2 6 9 2 5 8 1 4 7 1 4 7 0 3 4 7 0 3 7 0 3 6 0 3 6 9 2 5 8 1 4 8 1 4 7 0 3 6 9 2 6 9 2 5 9 2 5 8 1 2 1 0 0 2 1 1 0 2 2 1 0 3 2 1 1 0 2 1 1 0 2 2 1 0 3 2 1 0 0 2 1 1 0 2 2 1 0 3 2 1 0 0 2 1 1 0 2 2 1 0 0 Week
Borrowing Limit Danger Zone Weekly Actual Cash Balance Weekly Forecasted Cash Balance
CCDHB Financial Overview Page 8 September 2018
75 CCDHB Public 7 November 2018 - 3 FOR DECISION
PUBLIC
BOARD DECISION
Date: 7 November 2018
Author Rachel Haggerty, Director, Strategy, Innovation and Performance
Endorsed by Fran Wilde, Chair, Health System Committee
Subject HEALTH SYSTEM COMMITTEE RECOMMENDATIONS
RECOMMENDATIONS The Health System Committee recommends to the Board that it: (a) Agrees to the formation of eight Community Health Networks, noting that some flexibility will be required during the next phase of implementation planning; (b) Endorses the focus on initiatives to improve service delivery models in Kāpiti with the intention of improving health outcomes and reducing the burden of travel for avoidable hospital care for the people of Kāpiti; (c) Endorses the work of the Kāpiti Health Advisory Group and the need for collaboration between CCDHB and KHAG on developing Community Health networks and locality planning for Kāpiti; (d) Endorses CCDHB, KHAG and community stakeholders collaborating on service development and Locality planning for the Kāpiti locality having regard for the five priority areas identified by KHAG above; (e) Endorses the localities focus on South Porirua and the development of services to support the formation of the CHN within this locality. Noting, the importance of community responsiveness and the Committee’s request that staff bring back to the Board a graphic showing how CHNs and localities relate to each other; (f) Writes to Government Ministers responsible for Housing asking they consider legislative amendments to regulate for safer home heating for all citizens; (g) Writes to the Minister of Health in support of investment opportunities for healthy housing assessment and advice services to whānau with children experiencing asthma and acute upper respiratory tract infection; (h) Discusses the issue of access to information on hours and qualifications level of the aged residential care and support workforce to the National DHB Chairs and Chief Executives meeting for discussion.
APPENDICES 1. Draft HSC Minutes 24 October 2018; 2. Kapiti Health Advocacy Group (KHAG) presentation to Health System Committee.
1. PURPOSE This report summarises the key discussions at Health System Committee on 24 October 2018 held at the Kāpiti District Council Chambers in Paraparaumu. The minutes of the meeting are attached as appendix one. The full papers from this meeting are available on Boardbooks.
2. DECISIONS
2.1 Community Health Networks – CCDHB Framework Strategy Innovation and Performance (SIP) staff outlined the proposed Community Health Network (CHN) Framework and approach for implementing eight CHNs across the CCDHB district. There was robust discussion about the difference between a locality and a CHN and staff described how a CHN is an organising system for health services within a locality. The Committee request that staff create a graphic to show more clearly the relationship between a locality approach and a CHN. Committee members considered implementing CHNs will be a positive step for our local health system while being mindful of the need to
Capital & Coast District Health Board Page 1 [Oct 2018]
76 CCDHB Public 7 November 2018 - 3 FOR DECISION
PUBLIC continue to emphasise equity factors and cultural responsiveness, which should be reflected more clearly in the proposed outcomes framework.
2.2 Kapiti – Delivering Care in the Community This paper outlined the priorities identified by CCDHB to support the localities approach in Kapiti. It was considered at the same time as the presentation from the Kapiti Health Advocacy Group (see item 5 below).
2.3 Porirua –Supporting Equity and Outcomes This paper outlined how CCDHB is approaching its localities work within Porirua. Effort is concentrated in support of South Porirua including reconfiguration of existing primary care funding and additional investment to support service integration as a first step. The Committee reiterated to staff the need to be clear about the differences between localities and CHNs. The Committee consider it is important to ensure there is authentic engagement and a strong community voice in this localities work and it is important to look beyond health sector partners to wider partners as the localities approach begins to be implemented. The Committee has advised staff that timelines are important and that we start to demonstrate progress with this work as it has been widely discussed with the community.
3. DISCUSSION ITEMS
3.1 Regional Public Health (RPH) Bi-Monthly performance update The Committee noted the wide range of activity being delivered by RPH in Porirua and the need to be more joined up with the activity underway within the DHB. This will become more critical as the CHN and localities work gathers pace.
3.2 Healthy Housing update RPH provided the committee with additional advice on the impact of its healthy housing initiatives in response to an action from the August HSC meeting. The report identifies substantial opportunity to improve health outcomes and suggests there are opportunities for enhanced investment in healthy housing assessments. Investing in healthy housing assessments for whānau with certain respiratory conditions, which do not currently meet criteria for funding (eg, asthma) would have a measurable impact on health outcomes including a reduction in hospital admissions for these conditions. The Committee considers the Board should write to Ministers endorsing an investment focus in this area.
3.3 MHAIDS Bi-monthly performance report The Committee noted the report and the ongoing demand pressures on the MHAIDS service. The current suicide cluster within Porirua was discussed and staff noted they are working closely with wider social services to ensure the community receives the appropriate supports.
3.4 Maternity Quality Report The Committee noted the report and discussed with staff the importance of good engagement with consumers, particularly Māori and Pacific new mums about their experiences. It was highlighted that there is a need to ensure that complaints processes are simple and fit for purpose. The Committee also briefly discussed the primary birthing facility feasibility study and asked for a progress update on this work.
3.5 Investment and Performance – PHOS, Older Persons Services and Community Pharmacies The Committee noted the report and its role in continuing to strengthen our understanding of how well our investments through national contracts meet the needs of our communities. Of particular interest being to understand the impact of these contracts on helping to address health equity. The Committee observed that having the data is valuable for highlighting the gap in outcomes particularly for Maori and Pacific but it is disheartening to see we are still to see an observable change in this area.
Capital & Coast District Health Board Page 2 [Oct 2018]
77 CCDHB Public 7 November 2018 - 3 FOR DECISION
PUBLIC The Committee discussed the need to understand the skill mix and working conditions in our Aged Residential facilities. It considers this is an issue that should be raised at the national DHB Chairs and CEs meeting with a view to a collective DHB approach to the Ministry for access to relevant information.
4. FOR INFORMATION
4.1 CCDHB/RPH Submissions on legislation Two submissions were prepared by RPH in support of legislative change to the Residential Tenancies Act (1986) and the establishment of Healthy Homes Standards. Both proposals would have a substantial health benefit for people living in rental accommodation through improved housing quality and more security of tenure. These submissions were prepared on our behalf in response to discussion at the August 2018 HSC meeting.
5. PRESENTATION BY KĀPITI HEALTH ADVOCACY GROUP (KHAG) The Kāpiti Health Advocacy Group (KHAG) gave a presentation to the Committee outlining their priority areas and objectives for the health and wellbeing of the Kāpiti community. The presentation is attached as Appendix 2. KHAG has given considerable thought to its priorities, which align well with the direction CCDHB has identified for Kāpiti. This reflects the ongoing emphasis on engagement with the KHAG and the community. The Committee considers these priorities provide a useful starting point for an ongoing collaborative approach between CCDHB, KHAG and other stakeholders in ongoing planning and implementing the localities approach for Kāpiti.
Capital & Coast District Health Board Page 3 [Oct 2018]
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CAPITAL AND COAST DISTRICT HEALTH BOARD DRAFT Minutes of the Health System Committee (HSC) Held on Wednesday 24 October 2018 at 9.30am Kapiti District Council Chambers, 175 Rimu Road, Paraparaumu
PUBLIC SECTION PRESENT: BOARD: Dame Fran Wilde (Chair) Ms ‘Ana Coffey Ms Sue Kedgley Dr Roger Blakeley Ms Eileen Brown Ms Sue Driver Dr Tristram Ingham
STAFF: Ms Julie Patterson, Interim Chief Executive arrives 9.39am Ms Catherine Epps, Executive Director, Allied Health, Technical and Scientific Ms Arawhetu Gray, Director, Māori Health Services Michael McCarthy, Chief Financial Officer Mr John Tait, Chief Medical Officer
CCDHB PRESENTERS: Ms Astuti Balram, Manager, Integrated Care, items 2.1 and 2.2 Te Pare Meihana, General Manager, Child, Youth and Localities item 2.3 Peter Gush, Service Manager, Regional Public Health, items 3.1 and 3.5 Nigel Fairley, General Manager, 3DHB MHAIDS Carolyn Coles, Associate Director of Midwifery, item 3.3 Wendy Devereux, MQSP Coordinator, item 3.3 Sandra Williams, General Manager, Primary and Complex Care, item 3.4 KHAG PRESENTERS: Kathy Spiers, Kāpiti Health Advocacy Group Adrian Gregory, Kapiti Health Advocacy Group Sandra Daly, Kapiti Health Advocacy Group Marilyn Stevens, Kapiti Health Advocacy Group Ngaire Cook, Kapiti Health Advocacy Group Conrad Petersen, Kapiti Health Advocacy Group Sandra Forsyth, Kapiti Health Advocacy Group
GENERAL PUBLIC: One member of the public was present ______1 PROCEDURAL BUSINESS
1.1 PROCEDURAL The Karakia was led by Tristram Ingham. Committee Chair, Dame Fran Wilde, welcomed the public, members and the DHB staff.
1.2 APOLOGIES Apologies received from Andrew Blair and Tino Fa’amatuainu Pereira
1.3 INTERESTS 1.3.1 Interest Register Committee members to advise any changes to the Committee Secretary.
1 CCDHB Minutes – 24 October 2018
79 CCDHB Public 7 November 2018 - 3 FOR DECISION
1.4 CONFIRMATION OF PREVIOUS MINUTES The minutes of the CCDHB Health System Committee held on 26 September, taken with public present, were confirmed as a true and correct record. Moved: Roger Blakely Seconded: Sue Kedgely Carried:
1.5 MATTERS ARISING
1.6 ACTION LIST The reporting timeframes on the other open action items were noted.
1.7 HSC Work Programme The Committee noted the plan. Actions: 1. Committee Secretary to start on 2019 Work Programme.
Note the agenda items are presented in the order that the Board considered them.
2 FOR DECISION
2.1 Community Health Networks – the CCDHB Framework The paper was taken as read. The Committee: a. Noted that as identified in the Health System Plan, Community Health Networks are CCDHBs mechanism to organise health services to meet the needs of the population in the network. b. Noted the attached framework provides a detailed description of the Community Health Networks as a supplement to the Health System Plan. It has been developed in partnership with the stakeholders from across the sector through the Integrated Care Collaborative (ICC). It provides the platform for establishing the Networks in the future. c. Noted the framework has been endorsed by the Integrated Care Collaborative which includes representatives of primary and secondary care. d. Endorsed the outcome measures for Networks as outlined in the paper and the development of Network specific measures as they are established e. Noted that Health Care Homes and primary care practices will form the core of the Networks, supported by connected specialist services. f. Endorsed the formation of eight Community Health Networks, noting that some flexibility will be required during the next phase of implementation planning. i. Endorsed the initial focus on Porirua South and Kāpiti in the establishment of Community Health Network prototypes. Discussion: ∑ Prior to discussing the paper, the Committee asked Arawhetu to provide an overview of how the Community Health Networks, Healthcare Homes, PHOs, NGOs RPH and the Localities approach fit in together. The Committee asked for a diagram to be developed and brought back to a future meeting to show the interconnections between these. It was noted this diagram would also be useful for engaging with communities.
2 CCDHB Minutes – 24 October 2018
80 CCDHB Public 7 November 2018 - 3 FOR DECISION
∑ The Community Health Networks (CHN) is a developmental process. As a concept it is well supported by the Integrated Care Collaborative (ICC) and the document incorporates feedback from PHOs. Primary healthcare is excited about the opportunities for strengthening relationships through this new way of working. ∑ There was discussion around being careful not to confuse demographic and geographic means of determining an area suitable for a network. Staff clarified that both demographics and geography was used to define the proposed network areas. ∑ It was noted that we need to think beyond primary health care and consider the role of public health within a network. ∑ Eileen asked whether there are sufficient resources to implement the proposed approach and Sue Driver noted we need to look at our skill levels in coordinating potentially competing groups. Staff noted that investment proposals would be put forward to support network infrastructure and governance. ∑ The Committee acknowledged that CHNs are a step forward in terms of health system maturity. They will provide a vehicle for change. ∑ The Chair asked that the Committee receive six monthly reports on progress with implementation as well as any issues in particular for Kāpiti and Porirua. ∑ Tristram suggested that equity measures and cultural responsiveness be more explicit in the outcomes framework ∑ Sue Driver suggested that the Cost quadrant of the proposed outcomes framework should be refined to reflect efficient use of resources and cost-effectiveness rather than simply cost.
HSC recommends the Board: a) Notes the Committee has considered the proposed framework for implementing Community Health Networks and endorses this mechanism for connecting health services within our communities. b) Note that Health Care Homes and primary care practices will form the core of the Networks supported by connect specialist services for effectiveness and efficiency. c) Note the CHN framework has been endorsed by the Integrated Care Collaborative which includes representatives of primary and secondary care. d) Agrees to the formation of eight Community Health Networks, noting that some flexibility will be required during the next phase of implementation planning. e) Note that SIP will report six monthly to the Committee on progress with implementing CHNs including any issues and how these are resolved. Actions: 1. Staff to develop a diagram for presenting at a future Committee meeting showing the interconnections between PHOs, NGOs, Health Care Homes, RPH within Community Health networks and the relationship with Localities. 2. SIP to provide the Committee with six monthly implementation progress updates including any issues, particularly for Kāpiti and Porirua. 3. Outcome measures to include equity and cultural responsiveness 4. Look at feasibility of developing outcomes measures that reflect efficiency and cost- effectiveness rather than simply reduced costs
Moved: Eileen Brown Seconded: Sue Driver Carried:
2.2 Kapiti – Delivering care in the community See end of minutes - paper was considered at the end of the meeting along with the presentation from the Kapiti Health Advocacy Group.
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2.3 Porirua – Supporting Equity and Outcomes The paper was taken as read. The Committee: a) Noted we are prioritising the development of our localities approach in Porirua through targeted investment during 2018/19 and the establishment of a localities plan grounded in partnership, reciprocity and strong communication and engagement. b) Noted the focus on South Porirua to reconfigure existing funding as well as additional marginal investment in key service development/integration priorities: ∑ Nurse-led services to work with family groups in our Pacific neighbourhoods with multiple and complex health services. ∑ Youth services for young people who need greater support including sexual health, mental health and addiction and gender/sexual identity. ∑ Services to support mothers and families with babies and young children who need greater support in this start of life. c) Endorsed the focus on South Porirua and the development of services to support the formation of the Community Health Network within this locality.
Discussion: ∑ ‘Ana noted there is still some confusion between Community Health Networks and Localities approaches. There needs to be responsive community engagement and discussion that enables a community led rather than a network discussion. She invites the SIP team to present to Porirua City Council and meet with community representatives, in particular, on the issues of children and youth. There are lots of conversations taking place on social media, noting concern with recent suicides. As a DHB, we need to figure out how we can engage with these conversations. ∑ Eileen Brown queried whether we are well equipped to be responsive to urgent and immediate issues such as recent suicides when they arise. ∑ The Porirua locality plan is still in development. The timeline is to be advised. Sue Driver noted we do need to become clearer on timelines. ∑ Porirua has a strong community. Both Roger and Tristram felt that it would be an opportunity lost if the approach did not begin with the voice of the Porirua community. ∑ Tristram Ingham noted we should include non-health sector partners in our engagement.
HSC recommends the Board: a) Endorses the localities focus on South Porirua and the development of services to support the formation of the Community Health Network within this locality, noting the importance of community responsiveness and the Committee’s request that staff bring back to the Board a graphic showing how community health networks and localities relate to each other.
Actions: 1. Report to the Board on the progress of Community Health Network in Porirua at a future meeting. 2. Staff to present the localities work to the Porirua City Council following invitation by ‘Ana Coffey.
Moved: Roger Blakely Seconded: ‘Ana Coffey Carried:
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3 FOR DISCUSSION
3.1 Regional Public Health Bi-Monthly Performance Report The paper was taken as read. The Committee: a) Noted the update on work in Porirua. b) Noted the update on alcohol related harm reduction (including Kapiti). c) Notes the update on public health nurse services in primary and intermediate schools in the CCDHB area. d) Noted the update on influenza surveillance and SHIVERS II research project e) Noted the update on the Australasian Tuberculosis conference 2018. f) Noted the RPH 2017-2018 visual ‘snapshot.’
Discussion: ∑ Committee was interested to see the range of activities being delivered by RPH within Porirua and noted this work needs to be joined up with the activity underway to develop Community Health Networks and establish localities approaches. ∑ Sue Driver noted she still struggles to see the strategic framework that RPH is working within and the need to make connections between the DHB’s strategic direction and that of RPH. ∑ Chair requested staff work towards future Committee papers incorporating an RPH perspective rather than separate papers so that issues can be considered from multiple perspectives in a coherent way. ∑ ‘Ana noted the liquor licensing activity and asked about the evidence of the impact of this activity on reducing alcohol harm including hospital admissions for this community. ∑ Chair suggests that the RPH work programme updates could be reduced to six monthly to allow a more thorough discussion.
HSC recommends the Board: a) Note the paper.
Actions: ∑ RPH to provide evidence on how liquor licencing impacts hospital admissions in the Porirua community ∑ CCDHB staff to look at how RPH perspectives could be incorporated into future issues based Committee papers. ∑ RPH performance report be reduced to a six month frequency.
3.5 Healthy Housing Update The paper was taken as read. The Committee: a) Noted the information provided as an update from the housing discussion of HSC August 2018 meeting. b) Considered the investment opportunity proposed for healthy housing assessment and advice services to be provided by Well Homes to those whānau with children experiencing Asthma and Acute upper respiratory tract infection.
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c) Noted the interim report on Well Homes services provided for Pacific whānau 1 March – 31 August 2018 as interim data prior to definitive qualitative analysis that will emerge from the Well Homes programme evaluation being done in 2019. Discussion: ∑ Roger recommended to Regional Public Health to get the discount rate linked into the Wellbeing Budget. ∑ Eileen Brown requested that the submissions on the Healthy Homes Standards and the Residential Tenancies Act (1986) to be made publicly available. ∑ Letter to the Chair of Greater Wellington Regional Council on the Housing Improvement Regulation has been prepared and to be sent and copied to the Committee. ∑ Chair recommends to write separate letter to the Government to regulate safe home heating for all citizens. ∑ Discussed the list of potentially avoidable hospitalisations due to the home environment diseases (PAHHE) and the exclusion of some key illnesses from Ministry of Health criteria for funding for healthy housing assessment – notably asthma and acute upper respiratory tract infections including croup. The Committee agreed this was an investment opportunity that would support achieving health equity. The Chair suggested the Board should write to the Minister in support of extending investment to this group.
HSC recommends the Board: a) Note the paper o To write to Government Ministers responsible for Housing asking they consider legislative amendments to regulate for safer home heating for all citizens o To write to the Minister of health in support of investment opportunities for healthy housing assessment and advice services to whānau with children experiencing asthma and acute upper respiratory tract infection. Actions: 1. Load the Healthy Housing paper onto the resource centre in Board books 2. Publish the submissions to the consultations on the Healthy Homes Standards and the Residential Tenancies Act (1986) on the website 3. RPH to draft a letter on behalf of the Board to Government Ministers asking them to consider legislative change that would support safer home heating methods. 4. RPH to draft a letter on behalf of the CCDHB to the Minister of Health asking that extending investment in healthy housing assessments to whanau with asthma or acute upper respiratory conditions be considered. .. Moved: Eileen Brown Seconded: Sue Kedgley Carried:
3.2 MHAIDS Bi-Monthly Performance Report The paper was taken as read. The Committee: a) Noted MHAID Service formally opened a new space for the MHAID Service Consumer Advisory Group, this is based at Kenepuru in the Te Manaaki building. b) Noted the Ministry of Health has released the Suicide Facts: Data Tables for 1996 – 2015 with some significant findings, as listed in this report.
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c) Noted The final Kahukura project for the Regional Rehabilitation and Extended Care Inpatient Service’s (RRS) current model of care (MoC) has been completed. A model of care clinical group is being established to lead the implementation of the operational recommendations. Discussion: ∑ The Ministry of Health has confirmed a cluster of suicides in Porirua and CASA has been activated. We are working closely with schools, NGOs and Porirua Council, to ensure we respond in the best way. ∑ There was a question from ‘Ana Coffey linked to the earlier discussion on the number of suicides in Porirua and community use of social media. ‘Ana asked if the DHB utilised social media to connect with parents, communities on suicide prevention and postvention information. Staff noted that we do not use social media for this particular issue as it has pluses and minuses but that we can look at this issue once again and report back our findings. ∑ Staff noted we are also changing our prevention/intervention/postvention approach and the Board has previously agreed to a zero tolerance for suicides project, which is progressing. ∑ ∑ Tristram Ingham asks if there is a strategy in place within the next 6 to 12 months to reduce demand for acute services. Since 1 October 2018, measures have been put in place to remediate the demand levels. Further upstream investment needs to be worked through and discussed. ∑ The Committee asked for an update on the current status of the MHAIDS Integration project.
HSC recommends the Board: b) Notes the report. . Actions: 1. Staff to re-look at the use of social media as a means of engaging with communities and report back to the Committee
3.3 Maternity Quality Report The paper was taken as read. The Committee: a) Noted the publication of the Women’s Health Service Annual Clinical Report 2017. b) Noted the publication of the Maternity Quality & Safety Programme Plan 2018-2019. c) Noted the Ministry of Health development of maternity services whole of system work programme. d) Noted strategic work the service is undertaking to improve equity in relation to women and babies. Discussion: ∑ Timeline on the development of the feasibility study on a primary birthing facility in central Wellington was requested. A survey has gone out to the consumers and health providers. The information is being collated currently and we are waiting for the finalised results. ∑ MQSP consists of 2 LMCs representative and 2 consumer group representatives who feedback to and from DHB, they are involved on the development of projects, feedback outcomes affected by the communities. The LMCs network is independent across all DHBs. CCDHB has regular meetings with the LMCs. Operation Managers and Clinical Leaders attend these meetings as well. These meetings provide a platform for the LMCs to voice their concerns. If women in the community have a complaint forms are available for consumers to feedback anonymously.
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∑ ‘Ana noted it was important that all consumers had a voice and there would be value in engaging with the Sub Regional Pacific Health Advisory Board and the Maori Partnership Board on ways to ensure the voices of young Māori and Pacific women could be heard.
HSC recommends the Board: a) Note the paper. Actions: 1. Staff to discuss the Maternity Quality Report with the Maori Partnership Board and the Sub Regional Pacific Health Advisory Board Moved: ‘Ana Coffey Seconded: Eileen Brown Carried:
3.4 Investment and Performance – PHOs, Older Persons Services and Community Pharmacies The paper was taken as read. The Committee: a) Noted that from 1 December this year the Budget 2018 initiatives to provide people with greater access to primary care which will include access to low-cost general practice visits to all community service card holders; and free general practice visits for children under the age of 14. b) Noted that in 2018/19 CCDHB will invest $67 million in local providers under the nationally negotiated Aged Residential Care Agreements for services that include rest home, continuing care, dementia and psychogeriatric services; c) Noted that in 2018/19 CCDHB will invest $86 million in local providers under the nationally negotiated Community Pharmacy Services Agreements for services that include dispensing and other services provided by community pharmacies and the costs of the pharmaceuticals dispensed; d) Noted the dashboards continue to show similar trends in performance and equity gaps. Health Care Homes and the 1 December implementation of the lower cost general practices fees for community services care holders and thirteen year olds is expected to reduce barriers to access and improve health outcomes for our population. e) Noted this reporting is part of our process of improving our understanding of how our investments in the national agreements for community pharmacy, primary health organisations and aged residential care, are working for our population including equity (or not) of access to health services, ensuring these services are high quality and safe, and understanding how they improve health outcomes in our community. Discussion: ∑ Members asked about qualifications for Aged Residential Care workers. The aged residential care and support workforce do require qualifications and the pay scale is related to qualification. However, we as DHB do not have the information on the hours and qualifications for the aged residential care and support workforce within specific facilities this information is collected by the Ministry but not shared with the DHBs. ∑ Sue Kedgley suggests that the DHBs collectively request that the national agreement be amended to require the release of information on qualifications and hours to DHBs. ∑ Tristram pointed out that equity has been a hot topic and he is disappointed to see that equity is still not translating in performance. Community Health Networks and Locality approaches will see an improvement. The Māori Health Strategy includes an action plan including specifics, timeframe and KPIs to address equity.
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∑ The Committee to look more closely at the dashboard at the next meeting. ∑ Eileen commented that from 1 December 2018 the Budget 2018 initiatives to provide people with greater access to primary care is good news.
HSC recommends the Board: a) Notes the paper. b) To take the issue of access to information on hours and qualifications level of the aged residential care and support workforce to the National DHB Chairs and Chief Executives meeting for discussion.
Actions: 1. To work with the DHBs to requests from the Ministry for the information on the qualifications level and hours of the aged residential care and support workforce.
4 FOR INFORMATION
4.1 CCDHB/Regional Public Health Submission on Legislation The paper was taken as read. The Committee: a) Noted the attached submissions prepared by Regional Public Health on behalf of the Committee for the Healthy Housing Standards and the Residential Tenancies Act (1986).
HSC recommends to the Board: a) To note the paper.
PRESENTATION BY KĀPITI HEALTH ADVOCACY GROUP Kathy Spiers (Chair) introduced the Group. The group has been established for 18 months and they meet on the monthly basis. Kathy also introduced Mayor Guru briefly talked about history Kāpiti health, the community health work, transport issues, accessibility. He would like to work with CCDHB on the Kāpiti Locality plan. Adrian Gregory gave a presentation on the purpose, objectives and priorities of Kāpiti Health Advocacy Group. The Committee noted the presentation.
Discussion: ∑ There are opportunities for CCDHB and KHAG to align their priorities in terms of health needs and locality. ∑ There needs more inclusion of the voices of the younger people. KHAG has been working with primary schools and counsellors. KHAG is also doing their best to get greater representation across all demographics to address the equity issue. ∑ Otaki boundary. KHAG said this issue needs to be recognise and find a short and medium term solutions. It has to do with how effectively communicate with the residents of Otaki through social media. The CEs of CCDHB and MidCentral are meeting on 1 November to discuss this issue and plan to put together a MOU. Julie will report back to the Board after the meeting.
HSC recommends to the Board: a) That CCDHB and Kāpiti Health Advocacy Group (KHAG) and its stakeholders collaborate proactively on the development of a Kāpiti Health and Wellbeing Locality Plan based on the five priority areas and that the planning group should:
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∑ Reflect on the implementation of the Otaki Health and Wellbeing Plan and the establishment of the Otaki Health and Wellbeing Advisory Group ∑ Establish and sustain open, two-way channels of communication ∑ Adopt an effective community engagement and communication plan ∑ Maintain an evidence-based annual review of progress towards and, post-implementation, the outcomes of the Locality Plan.
Sue Kedgley and Roger Blakely left at 12.20pm
2 FOR DECISION
2.2 Kāpiti – Delivering Care in the Community The paper was taken as read. The Committee: a) Noted CCDHB is prioritising the development of our localities approach in Kāpiti, as well as Porirua, through targeted service development and investment during 2018/19. b) Noted that with the Kāpiti community our locality focus is supporting service delivery models that support care closer to home to improve outcomes and ensure people do not travel unnecessarily for hospital and specialist care that is avoidable. c) Noted the progress of an acute and urgent care model development, telehealth trial, Health of Older People service development and medication management service development alongside Healthcare Home development are priorities within Kāpiti. d) Noted the change to the shuttle service from Kenepuru to Wellington Hospital increasing the number of patients from Kāpiti using the shuttle. e) Endorsed the ongoing development of the initiatives to improve service delivery models in Kāpiti with the intention of improving health outcomes and reducing the burden of travel for avoidable hospital care for the people of Kāpiti.
HSC recommends the Board: a. Endorse the focus on initiatives to improve service delivery models in Kāpiti with the intention of improving health outcomes and reducing the burden of travel for avoidable hospital care for the people of Kāpiti. b. Note and endorse the work of the Kāpiti Health Advisory Group and the need for collaboration between CCDHB and KHAG on developing Community Health networks and locality planning for Kāpiti.
Moved: Tristram Ingham Seconded: Eileen Brown Carried:
The Chair noted that Catherine Epps will be leaving CCDHB and this will be her last meeting. The Chair thanked Catherine for her support.
The meeting closed at 12.50.
5 DATE OF NEXT MEETING
28 November 2018, 9.30am, Board Room, Level 11, Grace Neill Block, Wellington Regional Hospital.
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Kāpiti Health Advocacy Group Kāpiti Health Advocacy Group
Kāpiti Coast District Council Presentation to CCDHB Health System Committee 24 October 2018
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The Kāpiti Health Advocacy Group
u The Group was initiated by Mayor Gurunathan u Its first meeting was on 22 March 2017 and was attended by 32 people from across community health, wellbeing and social groups
u A workshop was held on ‘What is Working Well, What is not Working Well, Where are the Gaps?’
u The work of the Health Advocacy Group, which is chaired by Kathy Spiers, covers the health needs of the Kāpiti Coast community from Paekakariki to Ōtaki u The Kāpiti Hospital Petition Group was also formed as a result of this first meeting
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Our Stakeholders
u The Kāpiti Coast community u Kāpiti Coast District Council u Capital & Coast District Health Board # u MidCentral District Health Board (Ōtaki Health & Wellbeing Plan) u Compass PHO & Central PHO u Wellington Free Ambulance & St John Ambulance Services u Home Support Services u NGO’s and like organisations across the health and wellbeing spectrum u Local iwi
# KHAG acknowledges the support of Jane Presto re the development of a CCDHB Locality Plan
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Purposes & Objectives
PURPOSES OBJECTIVES Our Purposes are to: Our Objectives are to: u Identify health needs of Kāpiti’s u Gather information that will assist in population of 52, 762 identifying the community’s health and associated needs u Prioritise identified needs u Empower our community to u Advocate for improved health articulate their health and social services needs u Enhance health services across u Identify where needs are not the community in partnership adequately being met with our stakeholders u Identify other factors that impact on u Evaluate long-term outcomes or are determinants of health status u Identify potential for resources to be regenerated, reallocated or remodelled
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Aligned with CCDHB’s strategic purpose and investment in services…
u Simplify service delivery for those people who have good knowledge and resources u Intensify service delivery for those who are vulnerable to achieve equity u Work with communities to improve health and wellbeing u Act early to improve outcomes and make better use of time and money u Work together in interdisciplinary teams to provide better solutions in homes, communities and hospitals u Innovate using technology to improve knowledge, choice and access to healthcare u Efficient use of resources in homes, communities and hospitals Ref: CCDHB Public 21 February 2018 – Item 3.2 Recommendations from CPHAC
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Priorities 2018
1. Access to Services (including Transport)
2. Urgent Care (otherwise referred to as Accident & Out of Hours)
3. Mental Health Services
4. Care of Older People
5. Care for people with Disabilities
NB: children and young people are incorporated under priorities 1, 2 3, and 5
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Priority 1 – Access to Services
ISSUES OPPORTUNITIES
u Services at Wellington & Kenepuru u Improved transport options – but… already a trial scheme underway at Kenepuru, and an improved u The barriers to accessing these Kāpiti Health Shuttle under from Kāpiti - cost/affordability, investigation timing (e.g. of appointment), ease (young, old, disabled) and u Extend and enhance health discomfort - impact across services in Kāpiti e.g. exploit multiple facets of our community potential at the Kāpiti Health Centre u Access to Urgent Care is also constrained by cost, after-hours u Planning for the implementation of times and policy changes (e.g. digital health services to be free to Under 14’s, Community delivered in or close to home Card holders)
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Priority 2 – Urgent Care
ISSUES OPPORTUNITIES u The Ōtaki boundary is an anomaly u Initially providers need to provide clarity (DHB, PHO, Ambulance etc), and transparency for their patients. The compounded by inconsistencies in Ōtaki community should be included in practice and lack of transparency any future consultation on for patients reconfiguration u Reducing ‘unnecessary’ visits to u Capitalise on proven positive impacts of A&E and A&M Health Care Home & ambulance/PHO initiatives u Availability of and demand on ‘after-hours’ services u No current or short-term or opportunities are apparent u Planning for urgent care provision in a major civil defence u Some planning is taking place – involve emergency in Kāpiti/Ōtaki – the KHAG/the community as a stakeholder in community/KHAG does not feel that process fully engaged
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Priority 3 – Mental Health
ISSUES OPPORTUNITIES u Unsurprisingly a major area of need - u There are a considerable number of local services across the spectrum appear to organisations actively engaging with be under- resourced with inadequate mental health issues across our provision for patients community. There seems to be overlap/duplication but the international u A Kāpiti-based crisis service is needed evidence suggests that there could be u Clinical pathways for mild to moderate significant gains by integrating these local presenting need to be developed and services with DHB/PHO funded services resourced in GP practices u While a national review of mental health u Additional resources and an services is underway, which may well integrated approach is needed for introduce some systemic changes, the mental health provision for young review is unlikely to look in any detail at people, including those at risk of local conditions such as those in Kāpiti, suicide so… u Planning needed to meet the needs of u Our recommendation is that the older people with depression, anxiety, stakeholders jointly undertake a local dementia and abuse review of mental health services in Kāpiti/Ōtaki , with an up-front u Specialist support services needed for commitment to acting on its findings perinatal mental health as Kāpiti’s population grows
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Priority 4 – Older People
ISSUES OPPORTUNITIES u 28.6% of Kāpiti’s population – 15,089 u A ‘One Stop Shop’ partnering across agencies, incorporating health and u Their priorities include: access to wellbeing services, built on 21st century services, transport, care co-ordination, knowledge of the aging process, and a restorative services, home care, health focal point for provider/workforce literacy, mental health… collaboration and development u The combination of longer life u Advocacy, counselling and expectancy with demand for longer- communication to empower users and term independent living has not been their whanau well recognised or responded to by providers u Enhancement of preventative measures, engaging people in their own long-term u Too few services are provided at or out health care of Kāpiti Health Centre u Involving user service groups (Parkinson, u Health and wellbeing services are not Stroke etc) to advantage those with well integrated and don’t address the long-term care needs recommendations made in the Health Aging Strategy 2016 or the NZ Health u Focus services closer to home – enhance Strategy services at Kāpiti Health Centre and increase availability of digital health services
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Priority 5 – People with Disabilities
ISSUES OPPORTUNITIES u Multiple and chronic disabilities u Include disabilities in CCDHB’s up- impact negatively on employment, coming Health Needs Analysis as the disease, obesity, activity, access basis for the development of a Kāpiti to/affordability of medical care… disabilities health & wellbeing strategy u Access to and distance from u Continue, and reinforce, the work accident, medical and outpatient already underway on disability and clinics not located in Kāpiti… access-sensitive transport solutions including access arrangements at stations (GWRC) u Review the current service provision for disabled users in Kāpiti and enhance u Too few clinics at Kāpiti Health services at Kāpiti Health Centre Centre u Adopt the proposed health & u Accessibility factors not well wellbeing strategy as a primary embedded in planning etc template in future planning and consenting processes u Relatively weak integration of local and national agencies with local u Adopt an integrated approach to user groups to provide well- disability health and wellbeing provision informed, user-focused services
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In conclusion…
We propose that the Advocacy Group (from January 2019, the Kāpiti Health Advisory Group) and its stakeholders collaborate proactively on the development of a Kāpiti Health & Wellbeing Locality Plan focused on these five priority areas. And that the planning group should… u Reflect on the implementation of the Ōtaki Health & Wellbeing Plan, and the establishment of the Ōtaki Health & Wellbeing Advisory Group u Establish and sustain open, two-way channels of communication u Adopt an effective community engagement and communication plan u Maintain an evidence-based annual review of progress towards and, post-implementation, the outcomes of the Locality Plan A graphic illustrating what this proposed approach would look like is shown on the following, final slide…
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Community Wellbeing: proposed Health model for Kāpiti
CCDHB/MDHB (Service providers to Kāpiti)
Joint Locality KCDC Planning Team Lobbies DHBs (DHBs, KHAG & ŌHWAG) Advocates – uses influence Maintains health database for the Informs and District advises Monitors health outcomes and re- Advisory Group assesses priorities Communicates with the public (current KHAG Executive)
Community Health Forum (Meets 2-3 times per annum) NGO/ WFA Media Private WREMO Sector
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BOARD DISCUSSION
Date: 26 October 2018 Author: Leigh McLachlan, Acting Health & Safety Manager Endorsed By: Thomas Davis, General Manager Corporate Services Subject: CCDHB HEALTH AND SAFETY REPORT (FOR THE MONTH OF SEPTEMBER 2018)
RECOMMENDATIONS (a) Notes the number of reported Health & Safety incidents has decreased slightly this month; (b) Notes that there were no reported Notifiable Events this month, continuing a 23 month trend; (c) Notes the number of incidents resulting in lost time injuries at the time of the report production was three; (d) Notes the current Health and Safety Risks in the Risk report. All information accurate at time of report production – 26/10/2018
EXECUTIVE SUMMARY
1. This report updates the DHB on Health and safety risks, outcomes and initiatives as at 26 October 2018.
2. RISK REGISTER There are currently 6 active health and safety risks identified in section at 4.7 of the June Risk Report.
3. INCIDENTS Higher reporting indicates a stronger health and safety culture and provides a more realistic picture of the exposure to hazards experienced by our workers. It is the actual work injury claims that accurately reflect the level of harm that is occurring. Unsafe staffing was the highest category of reported incident category followed by Physical Assaults on staff.
Unsafe Staffing 28 Hazardous Materials 0 Fire/Smoke 3 Other Assaulted 4 Staff Assaulted 23 Verbal Abuse 17 Threatening Behaviour 18 Slip, Trip, Fall 13 Potential for Harm 3 Pain or Discomfort 1 Other 8 Near Miss 2 Motor Vehicle Accident 0 Patient Handling 8 Object Handling 3 Injured in Restraint 6 Hazardous Substance Exposure 0 Collision with Object or Person 5 Burn 1 BBFE 19
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3. Performance Summary
s
t
Performance Indicator u s h h n o
t t Trend i u e t r n n v r a e o o (Past 12 months) u r Increased - Decreased - No Change t C M P M S H&S Incidents
∑ Total Number of Reported Incidents 162 166
- Number of Reported Incidents - Non MHAIDS 105 100
- Number of Reported Incidents - MHAIDS 57 66
∑ Number of Incidents involving visitors 0 0
∑ Number of Incidents involving contractors 0 1
∑ Number of Notifiable Events 0 0
Key Performance Indicators Excluding MHAIDS MHAIDS Indicator Current Previous Target Current Previous Target (*=estimated) % Change % Change Month Month (By June Month Month (By June 2019) 2019) ACC Injury Claims 6 11 -45% N/A 3 6 -50% N/A MFO Claims 4 9 -55% N/A 2 4 -50% N/A LTIFR - 12 mth 7 8 -12% 7 13 15 -13% 12 Severity Rate - 12 mth 11 11 - 9 11 12 -8% 8 TRIFR - 12 mth 6 6 - 5 8 8 - 7 TRIFR - 12 mth Including 11 11 - 9 10 10 - 8 BBFE Notifiable Events 0 0 - 0 0 0 - 0
s t t h
u Trend n h e t
Performance Indicator s t o e i g n r n u v r o r t
o (Past 12 months) e a u r a M T t P - Meeting Target - Below Target C M S ∑ % of Pre-Employment Health Screening NA 88% 100% completed prior to start+ ∑ % of H&S Fundamentals Managers completed 78% 81% 90%
∑ % of Managers Injury Management completed 61% 75% 90%
∑ % of Incidents closed within 14 days (April 2018) 61% 73% 100% ∑ No. of H&S Rep vacancies 21% 16% 20% Data not available as yet ∑ No. of H&S Reps who have attended training 73% 66% 80% Data not available as yet +Submission of Pre-employment Health Declarations with less than 2 weeks start date is usual cause Definitions ∑ Injury Claims - Any work related injury resulting in an ACC claim ∑ MFO Claims - Medical Fee Only Claims. Any work related injury which results in an ACC claim for treatment but with no lost time
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∑ LTIFR - Lost Time Injury Frequency Rate. The number of lost-time injuries (per million hours worked) within a given accounting period relative to the total number of hours worked in the same accounting period ∑ Severity Rate - The average number of lost days experienced as compared to the number of incidents experienced i.e. Number of lost days divide by the number of lost time injuries ∑ TRIFR -- Number of incidents where injuries/illness occurred requiring medical treatment by a medical professional (Number of injury claims X 200,000 / Number of hours worked)
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3.1 Lag Indicators (last 13 months)
Blood or Body Fluid Exposure (BBFE) Slip, Trip, Fall 25 15 20 15 10 10 5 5 0 0
Physical Assaults - MHAIDS Physical Assaults - Non MHAIDS 30 50 40 20 30 20 10 10 0 0
Patient Handling Object Handling 12 10 10 8 8 6 6 4 4 2 2 0 0
……………………….. Trend
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3.2 Lost Time Injuries (LTI) Current Month Days Lost Category of Incident Directorate Department to Date Patient Handling Medicine, Cancer & Ward 6 South 7 Community Patient Handling Medicine, Cancer & ORA Inpatients - Ward 4 4 Community Physical Assault MHAIDs Haumietiketike (ID Inpatient) 4
Past 13 months General (Excluding MHAIDS) 12 200 180 t
10 s
160 o s L '
I 140 s T 8 y L a
f 120 D
o
f .
6 100 o o
. N 80 o N
4 60 l a t
40 o
2 T 20 0 0 Septem Novem Septem October Decemb January, Februar March, April, May, June, July, August, ber, ber, ber, , 2017 er, 2017 2018 y, 2018 2018 2018 2018 2018 2018 2018 2017 2017 2018 General LTI's 8 5 4 6 5 2 10 4 3 3 4 2 2 Total Days Lost 70 64 24 37 36 9 78 181 10 36 47 19 11
MHAIDS
5 100
4 90 t s
80 o 4 L
s s
' 70 y I 3 a T
L 60 D
f 3 f o
50 o
. 2 . o 40 o N 2 N
30 l a 1 20 t o 1 10 T 0 0 Septem Novem Decem Februa Septem Octobe Januar March, April, May, June, July, August, ber, ber, ber, ry, ber, r, 2017 y, 2018 2018 2018 2018 2018 2018 2018 2017 2017 2017 2018 2018 MHAIDS LTI's 4 3 3 3 3 0 1 1 0 3 1 2 1 Total Days Lost 74 9 26 8 88 0 40 9 0 30 3 43 4
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4. Workplace Injury Management 4.1 Cost – Past 13 months $45,000 $40,000 $35,000 $30,000 $25,000 $20,000 $15,000 $10,000 $5,000 $0 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 ACCPP Case & Claims Management Medical Fees Top-up (payment employeee would have received if in work over and above base salary i.e. shift allowance) Weekly Compensation - 1st Week - Employee not in Work or not working full hours Weekly Compensation - Employee not in Work (week 2+) or not working full hours 4.2 Statistics 4.3 Claims by Directorate – Past 13 Months ∑ Patient and object handling injuries continue to be the most common causes for claims, accounting for 39% of all claims over the Surgery, Women and Children 58 past 12 months MHAIDS 73
∑ Lumbar sprain injuries remain the most frequent type of injury Strategy Innovation & Performance 1 reported Medicine, Cancer & Community 87
Corporate Services 6
Clinical & Support Services 41
Chief Executive's Office 0
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5. Workplace Violence and Aggression Statistics
General (Excluding MHAIDS) - Last 24 Months 18 16 14 12 10 8 6 4 2 0 Oct - Nov Dec Jan -Feb - Mar Apr - May Jun - Jul - Aug Sep -Oct - Nov Dec Jan -Feb - Mar Apr - May Jun - Jul - Aug Sep - 16 - 16 - 16 17 17 - 17 17 - 17 17 17 - 17 17 17 - 17 - 17 18 18 - 18 18 - 18 18 18 - 18 18
MHAIDS - Last 24 Months 40 35 30 25 20 15 10 5 0 Oct - Nov Dec Jan -Feb - Mar Apr - May Jun - Jul - Aug Sep -Oct - Nov Dec Jan -Feb - Mar Apr - May Jun - Jul - Aug Sep - 16 - 16 - 16 17 17 - 17 17 - 17 17 17 - 17 17 17 - 17 - 17 18 18 - 18 18 - 18 18 18 - 18 18
6. OTHER BUSINESS 6.1 Steering Committees ∑ Health & Safety Steering Committee - This Committee meets every two months. ∑ Preventing Workplace Violence Steering Committee - This Committee is meeting on a monthly basis and is in the process of developing a work plan. ∑ Moving & Handling Steering Committee - This Committee is meeting on a monthly basis and is in the process of developing a work plan.
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7. Employee Support 7.1 EAP
Last 12 Months 120
100
80
60
40
20
0 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Total number of Clients: New clients: Total number of Sessions:
100 Work Related v Non-Work Related Referrals 80
60
40
20
0 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Non Work Related Work Related
Monthly Cost $18,000.00 $16,000.00 $14,000.00 $12,000.00 $10,000.00 $8,000.00 $6,000.00 $4,000.00 $2,000.00 $0.00 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18
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7.2 Monthly Referrals to EAP: - Work related reasons for referrals (as stated by worker)
Critical Incident Debriefing 1 Workplace safety Drug & Alcohol Management Employment Conditions 1 Mentoring/Supervision Harassment Relationships 3 Pressure/Stress 9 Workplace change Training Professional development 2 Job Performance 5
0 1 2 3 4 5 6 7 8 9 10
- By Directorate
EAP for September
Chief Operating Office Surgery, Women's & Children's Medicine, Cancer & Community Mental Health Mental Health (MHAID) H&S Clinical and Support Services Personal Corporate Services Work Executive Office SIP Not stated
0 5 10 15 20 25 30
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BOARD INFORMATION
Date: 18 October 2018
Authors Anne Stewart, Acting Executive Director (Operational) Quality Improvement & Patient Safety Sarah Jackson, Acting Executive Director (Clinical) Quality Improvement & Patient Safety
Endorsed by Julie Patterson, Interim Chief Executive John Tait, Chief Medical Officer Andrea McCance, Executive Director Nursing and Midwifery Catherine Epps, Executive Director Allied Health Technical & Scientific
Subject QUALITY AND SAFETY REPORT
RECOMMENDATIONS It is recommended that the Board: (a) Notes the progress with the implementation of the Clinical Governance Review; (b) Notes the quarterly results of the National Patient Experience Survey; (c) Notes the success of the Poster winner at the HQSC Scientific Symposium; (d) Notes the quarterly results of the HQSC quality and safety markers; (e) Notes the CCDHB quarterly results in the updated HQSC quality measures dashboard.
APPENDICES 1. CCDHB Quality and Safety Marker Results; 2. Summary of CCDHB measures from HQSC dashboard; 3. Photo of winner of HQSC Scientific Symposium poster competition.
1. INTRODUCTION
The purpose of this report is to inform the board of the quality, improvement and patient safety activity within the Capital & Coast District Health Board (CCDHB) Hospital & Health Services for the period July 2018 to September 2018.
One of the core functions of CCDHB is to maintain and improve the safety and quality of our health and disability services. We focus on patient safety and patient experience as the key indicators of our progress. Growing evidence indicates that better patient experience, developing partnerships with consumers, and patient and family-centred care are linked to improved health, clinical, financial, service, and patient satisfaction outcomes.
At CCDHB, quality of care is underpinned by the “Triple Aim”, an international healthcare improvement policy (adopted in New Zealand by the Health Quality and Safety Commission) that outlines a plan for better healthcare systems. Through our clinical governance structures we are able to provide direction and leadership of priorities for quality, continuous improvement and patient safety, and influence behaviours, and system and process design to enable the DHB to achieve these priorities.
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2. CLINICAL GOVERNANCE UPDATE
Good progress is being made on implementing the recommendations from the Clinical Governance review. This includes development of a clinical governance framework and progress with the improvements to the sub- committees.
∑ A Clinical Governance Framework has been developed and is included in this agenda as a separate item. ∑ The Credentialing Committee is due to meet for the first time on 20th November with a view to undertaking the first service credentialing in April. ∑ The Family Violence Committee has its first meeting on 29 October and the Point of Care Testing Committee has also recently met. ∑ The Patient Quality Safety Indicators meeting has been dis-established and is re-forming as the Patient Safety Committee. ∑ A new Chair for the Death Review Committee (to change name to Morbidity and Mortality Committee) has been identified as the current Chair plans to retire next year. The current and proposed chair are leading discussions with the Departmental Leads for M&M about improving the processes around M&M meetings (becoming multi-disciplinary, standardised format and reporting) and it is planned to have a meeting early next year to formalise these changes. ∑ The terms of reference for the clinical governance sub-committees are being reviewed and standardised to give greater clarity and purpose to their function and responsibility. ∑ Discussions have been had with the chairs of a number of other committees and there is a plan underway to get all the chairs together in early December for a combined session about clinical governance, their roles as chairs of clinical governance committees as well as what support they need.
An area of concern is ensuring we have the appropriate resource to support these committees.
3. CONSUMER ENGAGEMENT AND PARTICIPATION
3.1 Compliments & Complaints The number of complaints received remains within normal variation. The three main complaint issues relate to standard of care, communication and administration/process.
100% of complaints received in August were first acknowledged by letter or email within the five day timeframe. 65% of our August complaints were closed within the 20 working day time frame. There are a number of factors impacting on completion timeframes with the main one being availability of clinical staff to review and respond. The timeframe does not take into account extensions that have been granted as the system calculates the number from the date the complaint is first entered.
Numbers of complaints and compliments per month Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Complaints 71 60 96 54 68 84 103 78 74 70 85 83 90 Compliments 85 74 86 43 74 67 85 97 62 81 99 110 48
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3.2 Health & Disability Commission Complaints The number of HDC complaints for CCDHB remains within normal variation. During September we received five new complaints from HDC. Two of these require a response to HDC (both SWC), one complaint has been referred
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3.3 CCDHB National Quarterly Patient Experience Survey DHBs are required to participate in a national patient experience survey as part of the Health Quality and Safety Commission (HQSC) work programme. Results for quarter 4 are in the table below:
HQSC National Adult Patient Experience Survey: Q4 (Aug Results)
Quarters by HQSC 3 4 1 2 3 4 1 2 3
Quarters by MOH 1 2 3 4 1 2 3 4 1
Aug Nov Feb May Aug Nov Feb May Aug Date 2016 2016 2017 2017 2017 2017 2018 2018 2018 Communication (CCDHB AP Target 8.4) CCDHB 8.5 8.3 8.2 8.3 8.3 8.0 8.4 8.5 8.4
NZ 8.3 8.4 8.3 8.5 8.3 8.4 8.3 8.5 8.6
Co-ordination (CCDHB AP Target 8.4) CCDHB 8.3 8.3 8.1 8.4 8.4 7.9 8.4 8.4 8.3
NZ 8.3 8.4 8.3 8.5 8.4 8.6 8.3 8.6 8.5
Partnership (CCDHB AP Target 8.6) CCDHB 8.8 8.5 8.3 8.8 8.5 7.9 8.4 8.7 8.5
NZ 8.5 8.6 8.5 8.7 8.5 8.5 8.4 8.7 8.5
Physical and emotional needs (CCDHB AP Target 8.5)
CCDHB 8.6 8.3 8.4 8.5 8.4 8.1 8.7 8.7 8.5
NZ 8.7 8.7 8.6 8.8 8.6 8.8 8.6 8.8 8.7
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Response Rate CCDHB 32% 30% 31% 34% 29% 13% 28% 29% 27%
NZ 27% 27% 28% 24% 26% 23% 28% 17% 24%
There is currently a small group from Learning & Development & QIPS looking at communication training needs at CCDHB. The first area being looked at is the Open communication training with a view to enhancing the current programme.
3.4 Co-design improvement programme In September the HQSC led co-design programme commenced with the first workshop. We have five project teams (consisting of up to five staff and 1-2 consumers) taking part in the programme. ∑ Kōrero Mai – patient, family and whānau escalation of a deteriorating patient ∑ Patient centred scheduling (post stroke) - a project based at Kenepuru. ∑ Meeting the needs of patients, whanau and communities when they/their whanau are staying in the Wellington Heart & Lung unit. We also want to ensure patients have the right information and support when they are discharged to reduce the likelihood of further readmissions. ∑ Facilitating a more consumer friendly pathway for Spinal (as a starting point) injury presentations to access the most appropriate treatment and service in the timeliest manner (right care, right place, right time). ∑ Review of disability alerts.
These projects will support the CCDHB Improvement Plan System level improvement measures for patient experience within HHS as well as supporting improvements in other parts of the system.
4. CLINICAL EFFECTIVENESS
4.1 Certification Surveillance Audit CCDHB inpatient services We are making good progress on actions for the 16 corrective actions from the April Certification surveillance audit of hospital and mental health services at CCDHB. There were three moderate actions submitted during September and remaining 13 are due by 17th December.
4.2 HQSC - Quality Safety Markers The Health Quality & Safety Commission is driving improvement in the safety and quality of New Zealand’s health care through the national patient safety campaign Open for better care. The quality and safety markers (QSMs) help evaluate the success of the campaign nationally and determine whether the desired changes in practice and reductions in harm and cost have occurred.
There have been excellent results this quarter for Hand hygiene, Surgical Site Infection Orthopaedic and Cardiac Surgery, and Patient deterioration. Some improvement needed in the Safe Surgery checklist around engagement and in Falls assessments.
The CCDHB Quality and Safety Marker results for the period April to June 2018 are in Appendix 1.
4.3 HQSC Dashboard of health system quality The Health Quality Safety Commission dashboard provides a summary of a range of measures together in one place. The latest update of results for CCDHB is available in Appendix 2.
4.4 Hospital Acquired complications There has been a continued focus on the hospital acquired complications as highlighted in the April 2018 the Health Roundtable (HRT) Executive Briefing. Following the analysis of post-operative sepsis further work has occurred to improve clinical documentation and coding to improve data capture. An improvement programme is underway
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4.5 Clinical Ethics Advisory Group (CEAG) The CEAG has received an average of one referral per month during 2018. Themes have been: CEAG support around treatment decision making where there is lack of clarity and possible conflict of values; post- event discussion about the ethical issues of treatment already given and identification of correct follow up action; the CEAG’s views on ways in which student health practitioners work with patients; privacy issues; human rights; capacity to consent and justification and morality of forced administration of medication.
The CEAG Chair and Clinical Ethics Advisor have both pursued additional education in clinical ethics – the Chair completing a course at Harvard School of Medicine Bioethics Centre in June – and have presented at clinical ethics events. The clinician education role of the CEAG has included two Grand Rounds, an in-house study session for CEAG members, presentations at international conferences and teaching sessions with medical, nursing and midwifery staff.
5. QUALITY IMPROVEMENT & PATIENT SAFETY
5.1 Improvement Movement - Improvement Training The improvement training continues with the two models of 1hr taster sessions and 12 week programmes running concurrently. The one day Frontline Leadership Programme (FLP) sessions also continue. In addition the improvement team have developed an enhancing data literacy training session to support the implementation of the data visualisation programme (Qlik). The sixth 12 week programme commenced in September with 12 participants and they will graduate in December.
2018 Improvement movement campaign details as of September:
Numbers Training Type 2018 Target % of target trained to date Stream 1: Join the Movement! 1 hour 143 415 34.5% taster sessions Stream 2: 12 week improvement training 24 45 53.3% Stream 3: FLP 1 day training 39 40 97.5% Stream 4: Enhancing data literacy training 12 40 30% Total number of staff trained in 238 500 47.6% improvement methodology
5.2 RMO Quality Improvement and Clinical Leadership Residency Following a successful trial of RMO improvement training in conjunction with the RDA and Synergia earlier in the year we decided to run our own in-house programme. Two RMOs per quarter will participate in the 12 week improvement training programme, complete their own project and learn about clinical leadership through the quality and patient safety lens. This revised programme began in September and further participants will be selected through an expression of interest process.
5.3 Poster winner at HQSC Scientific Symposium There was another success for a participant of one of our 12 week programmes. Ward 5 North’s Associate Charge Nurse Manager Connie Rodrigues and Physiotherapist Shana Hall presented a poster at the recent HQSC Quality Improvement Scientific Symposium held in Wellington. (See Appendix 3)
They were awarded the prize for best poster for their work analysing inpatient de-conditioning and enabling patients to be more active on 5 North – the acute oncology, haematology and renal ward.
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3.3.4 Controlled Documents (Policies/Procedures/Protocols/Guidelines) Current overall CCDHB compliance is 73.7%. Keeping the controlled documents up to date is an ongoing challenge and was identified in the certification surveillance audit as such. There are many different types of documents and responsibility for review and approval is at several layers within the organisation. With full hospital certification scheduled for September 2019 updating the controlled documents is an important issue. We need to have the documents a minimum of 85% in date for certification. The aim is to meet this target by the end of July 2019.
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Appendix 1 QUALITY & SAFETY MARKERS - CCDHB results 2017/2018
The Health Quality & Safety Commission is driving improvement in the safety and quality of New Zealand’s health care through its quality improvement programmes. The quality and safety markers help evaluate the success of the programmes and determine whether the desired changes in practice and reductions in harm and cost have occurred. The quality and safety markers concentrate on specific areas of harm: falls, healthcare associated infections and safe surgery. Below are our performance results as at 30 June 2018.
Q1 2017 Q2 2017 Q3 2018 Q4 2018 NZ Average Marker Definition NZ Goal July - Sept Oct - Dec Jan - March April - June July – Sept 18 Falls: % if patients aged >75 (Māori and Pacific 90% 91% 93% 89% 85% 92% Islanders >55) that are given a falls risk assessment Falls: % of patients assessed as being at risk who have 90% 92% 95% 95% 94% 95% an individualized care plan which addresses their falls risk Falls: 88.8% 85.8% 91% % of patients receiving falls risk assessment Sign In 100% - 98% 98% Safe Surgery: % of audits where all components Time Out 100% 100% - 99% 100% of checklist were reviewed Sign Out 100% - 100% 100% Sign In 94% - 80% 80% Safe Surgery: % of audits with engagement Time Out 95% 99% - 90% 89% scores of 5 or higher Sign Out 98% - 95% 88% 8
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Hand Hygiene: % of opportunities for hand hygiene for health 80% 84% ** 82% 80% 84% professionals Surgical Site Infections - Dosing: % of primary procedures where antibiotics were 89.5% 100% 100% 98% administered in the right time Surgical Site Infections - Timing: % of hip and knee arthroplasty primary 100% 100% 99% 100% 100% 98% procedures that were given an antibiotic at the right time Surgical Site Infections - Dosing: % of hip and knee arthroplasty primary 95% 98% 99% 99% 100% 97% procedures that were given an antibiotic in the right dose Cardiac Surgery - Timing: % of audited patients where an antibiotic is given 100% 100 100% + + 97% 0-60 minutes before knife to skin Cardiac Surgery - Dosing: % of audited patients given correct antibiotic 95% 99% 100% + + 97% dose Cardiac Surgery – Skin prep: 100% of audited patients given appropriate skin 100% 99% 100% + + 100% antisepsis in surgery Patient Deterioration % of audited patients that triggered an escalation * * 98% 84% 65% of care and received the appropriate response to that escalation Patient Deterioration * * 96% 91% 93%
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Number of patients where Early Warning Score was calculated correctly for the most recent set of vitals Patient Deterioration Number of eligible wards using early warning * * 79% 100% score
- Fewer than 50 observations * Deteriorating patients is a new safety marker which did not start until January 2018, there are currently no goals or NZ average on the HQSC site. ** reported 3 times a year, therefore no data point is shown for Q4 + reported 6 months after the other QSMs
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Appendix 2 - Summary of CCDHB measures from HQSC Dashboard – updated 31 August 2018
Full interactive summary can be found at: https://public.tableau.com/profile/hqi2803#!/vizhome/Dashboard2_0Aug2018/Home
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Appendix 3: Poster winner — HQSC Scientific Symposium
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BOARD DISCUSSION
Date: 30 October 2018
Author James Crawford, Project Director
Endorsed by Thomas Davis, General Manager Corporate Services
Subject NEW CHILDREN’S HOSPITAL PROGRAMME OF WORKS STATUS REPORT
RECOMMENDATIONS It is recommended that the Board: Health & Safety Report (a) Notes that there has been no incidents since the last report. New Children’s Hospital Programme of Works (a) Notes that Ministers of Health and Finance have approved the business case for the design and build of the new Children’s Hospital. (b) Notes that the Concept design works for reconfiguration of the Oncology Dept is continuing whilst the Oncology Department undertake a review of the Oncology Services. (c) Notes that the CCDHB teams completed reviews of the 50% Detailed Design documents that were issued to the CCDHB on the 17 September 2018 and discussed our comments with the architect but did not submit formal comments due to the incomplete status of the 50% design drop. (d) Note that discussions with the Māori Partnership Board identified a location for laying of the Mauri stones, with this ceremony is expected to take place 07 November 2018. (e) Notes an event is planned on 07 Novemeber 2018 to mark the commencement of the new Children’s Hospital works on the site, which will involve a wide range of stakeholders such as; CCDHB staff, the Crown, CCDHB Board, the Benefactor and his team, Consumer Groups, CCDHB Partnerships, and other as will be identified.
1. INTRODUCTION
1.1 Purpose The purpose of the paper is to inform the CCDHB Board regarding progress with the new Children’s Hospital Programme of Works. The CCDHB new Children’s Hospital Programme of Works (projects) includes:
∑ New Children’s Hospital, including a new drive up drop off and pick up ramp and associated roadways ∑ Civil Diversion works ∑ Demolition works ∑ Car parking (temporary) works ∑ New Link Bridge works ∑ Internal reconfiguration works within the Regional Hospital ∑ Building (Engineering) Services works ∑ Landscaping (Hard & Soft) works ∑ New Car parking deck works
Capital & Coast District Health Board Page 1 Oct 2018
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2. UPDATE
2.1 Health & Safety There has been no incidents in the last calendar month.
SiteSafe has been engaged to audit the new Children’s Hospital and Riddiford sites each month until each project achieves Practical Completion. SiteSafe will undertake monthly onsite audits for the active projects with the reports being provided to the Executive PCG and the Portfolio Board.
2.2 Business Case Approval from Ministers of Health and Finance has been received for the design and build of the new Children’s Hospital. The approval is subject to a number of conditions which management will ensure are met.
2.3 Resourcing the new Children’s Hospital Programme Currently the Programme is resourced via a combination of internal and external resources. Given the progress of the Programme to date and taking into consideration the resourcing required for the work ahead, management are considering the need for suitable resources to plan and manage the works ahead.
An FF&E manager will be recruited on a fixed term basis to manage the specification, procurement, logistics, storage, installation and commissioning of FF&E. This will include working with the Foundation to identify FF&E that can be sourced from in kind donations, supporters and existing suppliers of CCDHB.
2.4 Design
2.4.1 New Children’s Hospital project. The CCDHB teams have completed their reviews of the 50% Detailed Design. ∑ Further to that review, the Benefactors Architect will be ready with their 100% Detail Design for CCDHB review from the 9th Nov. ∑ Early indications from the Architect in regard to the CCDHB’s earlier Develop Design reviews, is that 99% of the feedback had been incorporated in the full 100% detail Design package due for release on 9th Nov. ∑ The remaining 1% was not related to clinical/Technical outcomes. The 1% is deemed as relating to items/areas that the Architect did include and changed claiming their design had improved outcomes over CCDHB suggestions.
2.4.2 Internal reconfiguration works within the Regional Hospital project. Concept design works for reconfiguration of the Oncology Dept L3 (Regional Hospital) continues with the End Users and the designers meeting to work through the design considerations. Key Milestone dates include: Nov 2018 Identify & Approve the additional office space Dec 2018 Concept Design completed Dec 2108 Budget Approved Feb 2019 Develop Design interior corridor, Oncology & replacement offes Mar 2019 Building Concept approved June 2019 Successful open tender appointed Aug 2019 Phase 0 works complete (new office area, complete) Dec 2019 Phase 1 works complete (New Chair & assoc spaces) Mar 2020 Phase 2 works complete (new consult & office space) May 2020 Phase 3 works complete (corridor, records, office & services ) May 2020 Phase 3b works complete (Link – corridor & ready for NCH services)
Capital & Coast District Health Board Page 2 Oct 2018
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2.5 Stakeholders
Māori Partnership Board and the new Children’s Hospital project team continue to meet regularly and provide updates on progress. Recent discussions identified a location for laying of the Mauri stones, with this ceremony expected to take place 07 November 2018.
CCDHB plans to provide an update in regard to the new Children’s Hospital design process to the Consumers Group in early November.
2.6 Communication
Communication with the staff and neighbours continues and is being well received.
The CCDHB are planning an event on 07 Novemeber 2018 to mark the commencement of the new Children’s Hospital works on the site, which will involve a wide range of stakeholders such as; CCDHB staff, the Crown, CCDHB Board, the Benefactor and his team, Consumer Groups, CCDHB Partnerships, and other as will be identified.
2.7 Timeline programme The Civil Diversion Works Project is now completed.
High level New Chlidren’s Hospoital Programme of Works timelines noted below:
Target % Complete on Task Completion site (as at Sept Comment Date 2018) Civil Diversion Works 20/8/18 100% All inspections complete and expect CCC Project to be issued soon. Demolition Works Project 26/04/19 65% Updated Programme identifies completion as late March 2019. Internal Reconfiguration 1/12/19 0% See milestone timesline included in works within Regional report (Item 2.7.2) Hospital Building Services Works 20/5/19 0% Engineering scope of work yet to be Project (WRH) determined in conjunction with the findings of Aurecon & WCC flood Planning McKee Fehl Main 4/12/20 0% MKF submitted detailed Construction Children’s Hospital Programme. Practical Completion - Construction 29.10.2020. Hand over -20.11.2020 New Children’s Hospital Apr 2021 0% Time allocation allowance for the CCDHB Project to complete the final fitout / installation of FF&E
Capital & Coast District Health Board Page 3 Oct 2018
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The New Children’s Hospital Project – Milestones Programme as at 12 Oct 2018 below:
CCDHB Wellington Children Hospital Project - Milestones Programme as at 12 Oct 2018
Construction & Associated Activities Start Complete Current Status Design - Stages 25/05/2018 29/05/2019 Commenced Approval of Budget and Development Deed Signed 20/08/2018 20/08/2018 Completed Resource Consent 28/05/2018 25/07/2018 Completed Building Consents (5 stages) 27/08/2018 22/05/2019 Commenced Building Consent #1 - Foundations 3/10/2018 8/11/2018 Nearing Completion Nearing Building Consent #2 - Superstructure (Building) 29/10/2018 7/01/2019 Commencement Building Consent #3 - Balance of works (Envelope, Services, Fitout) 7/11/2018 16/01/2019 Design Stage Building Consent #4 - Link Structure & Associated Works 22/01/2019 23/03/2019 Design Stage Building Consent #5 - Eastern carpark 23/01/2019 22/03/2019 Design Stage Nearing Construction 15/10/2018 2/09/2020 Commencement Foundation 15/10/2018 26/03/2019 Commenced Superstructure 5/03/2019 2/09/2019 Design Stage Envelope 1/07/2019 11/11/2019 Design Stage Roof 14/10/2019 26/11/2019 Design Stage Main Building Services 4/07/2019 13/01/2020 Not due Internal works & FFE 17/07/2019 2/09/2020 Design Stage Link - Oncology to WCH 28/06/2019 10/03/2020 Design Stage External & Associated works 29/04/2019 10/03/2020 Design Stage Project Completion (processes) 20/08/2020 5/11/2020 Not due CCC/CPU 22/10/2020 29/10/2020 Not due Project Practical Completion 29/10/2020 29/10/2020 Not due Handover 30/10/2020 5/11/2020 Not due Client Defect notification - Architectural 6/11/2020 12/02/2021 Not due Client Defect notification - Engineering Services 6/11/2020 5/11/2021 Not due
Capital & Coast District Health Board Page 4 Oct 2018
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BOARD INFORMATION
Date: 29 October 2018
Author Valentino Luna Hernandez, Sustainability Manager
Endorsed by Gina Lomax Executive Director, Clinical and Support Services
Subject UPDATE ON SUSTAINABILITY ACTIVITIES AT CCDHB
RECOMMENDATION It is recommended that the Board: (a) Notes the results from sustainability activities and the progress with projects underway.
APPENDIX 1. Environmental Sustainability News and Articles.
1. INTRODUCTION
1.1 Purpose This is the first quarterly report for sustainability-related activities. Reports will be produced quarterly in November, February, May and August.
1.2 Previous Board Discussions/Decisions
“Update on Sustainability Activities at CCDHB” was provided for the June 2018 Board meeting and it was requested that activity is reported quarterly.
The work in sustainability includes monthly metric/KPIs as well as qualitative (initiatives, projects, awards) elements. This update is then split into two parts, a table with metrics and a narrative update of new projects/initiatives.
Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun 2018 2018 2018 2019 2019 PVC IV bags recycling actual (cumulative Kgs diverted from landfill) 3,600 4700 Community sharps (actual Kgs collected) 1987 1938 Furniture recycling (estimated $ savings) 90,000 110,000 Electricity carbon emissions (CO2e)(tonnes) 865 971 Gas carbon emissions (CO2e)(tonnes) 1,249 2,134 Fleet carbon emissions (CO2e)(tonnes) 150 153
2. ACTIVITY REPORT
All reporting is done following the high level targets of the Environmental Sustainability Policy: ∑ Material and waste flows ∑ Sustainable energy management ∑ Sustainable Journeys
Capital & Coast District Health Board Page 1 November 2018
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∑ Design for sustainability ∑ Sustainable water management ∑ Carbon management and reduction
Impact area Project description Outcomes (Environment, Budget, Risks) Material and waste Food waste diversion – Trial of ORCA food waste 7,000 KG of food waste diverted flows digester in Wellington Hospital main kitchen. from landfill in the first 6 weeks Microorganisms process for waste to liquid form of operation. which goes through trade waste First of its kind in Wellington region. Visited by regional trade waste officers. Material and waste Pallet waste is a problem waste due to the size and About 120 pallets/week are flows difficult manoeuvrability. CCDHB works with diverted from landfill charities, Marae and NGOs to reuse and recycle 90% The saving is skip bin hire is over of the pallet waste $1,000/week Material and waste Kenepuru A&E and Wellington ED departments are 30 kg of steel has been diverted flows recycling single use stainless steel instruments. If the from landfill, sterilised and put trials are successful they will be replicated in other back into products clinical areas. Material and waste A second container load of (electricity powered) beds This work prevented disposal of flows was donated through the ‘Take my Hands’ charity. equipment that is still usable Volunteers from CCDHB helped load the beds into The receiving organisations containers. have access to equipment that otherwise they would not be able to afford The Charity that CCDHB is working with has been nominated for a Sustainable Business Network award for their work with CCDHB Sustainable Journeys Bike parking facilities were installed at the front of the Incentive for staff to bike to Wellington Regional Hospital. The 12-rack-rainbow- work coloured facility is used by staff, patients and visitors Positive feedback from stakeholders Sustainable Journeys Supporting cycling awareness by offering ‘have a go’ Tens of staff tried electric bikes trials of electric bikes to staff during SUFS and for the first time Wellness Week A small increase in usage of the fleet electric bike after trials Sustainable Journeys Advocacy to extend #18E route to cater for staff Awaiting reply from Chief working shifts. The region-wide issues with the new Executive GWRC. bus network can be a deterrent to staff and patients adopting public transport as their mode to access to CCDHB hospitals
Sustainable Energy Theatre LED lighting project finished. This project saw Estimated $2,000 savings year Management the installation of LED lights and specialist (cyanosis) to date (from 1 July) LED tubes in all theatres in the Wellington Regional Positive coverage in the NZ Hospital. The new lights are more energy efficient. Herald and Stuff Website Reported in Health Matters
Capital & Coast District Health Board Page 2 November 2018
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3. THEMES FOR THE NEXT QUARTER
3.1 Sustainability in tenders for café outlets and general services In order to achieve greater environmental outcomes, it has been agreed to have more explicit sustainability requirements in the recent Request for Tenders for coffee outlets and the large General Services contract. The sustainability-related information received will inform scoring. Examples include: - Reduction in plastic food containers and cutlery - Increase in recycling infrastructure - Information about the source of goods brought into patient meals
3.2 Energy planning As outlined in last month’s update regarding electric vehicles, a group of functional managers including Sustainability and Facilities Management will start to develop the framework for the future of energy consumption within CCDHB.
This plan must support future service and campus development as well as the site master planning process.
3.3 Reporting to Ministry of Health Another stocktake of sustainability initiatives will be reported to the Ministry of Health in January 2019. This is a requirement from the Ministry and will be completed in conjunction with Strategy Innovation and Performance. A copy of the report will be provided in the February update.
Capital & Coast District Health Board Page 3 November 2018
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APPENDIX 1 – Environmental Sustainability news and articles
Energy efficient lighting offers more than just a reduced power bill. New Zealand companies that have made the switch from traditional fluorescent and HID lighting technology to LEDs are reaping the benefits in improved working conditions, health and safety and, in some circumstances, saving lives.
An LED lighting conversion had never been done at a New Zealand port before and the project faced a harsh salt, wind and corrosion environment, huge safety requirements and the challenges of generating working light at ground level from lights on poles 30m high.
Ports of Auckland accessed Energy Efficiency and Conservation Authority Technology Demonstration Funding to switch floodlights on their city-side wharves to energy efficient LEDs.
Matt Ball, head of communications for the port, says port engineers had been studying alternatives for a few years, so jumped at the chance to work with EECA to test new technology on one half of the wharves.
"EECA funding support gave us the opportunity to report, measure and monitor for other ports around the country," says Ball. "It was really helpful to have support for a more rigorous approach to monitoring, to prove LEDs' effectiveness. We've measured a 50 per cent drop in lighting costs, the equivalent of 147 households' use."
The Ports of Auckland conversion aimed to demonstrate that LEDs are now a viable alternative in many HID lighting applications. The port changed floodlights on 46 light towers to a new type of LED, Philips Clear Flood. Twenty percent fewer light fittings were required, the challenges of the maritime environment were all met and the port plans to roll out the technology to a further 23 towers.
EECA Technology and Innovation Manager, Dinesh Chand, says "The funding contributes to the cost of demonstrating proven technology or an innovative process improvement opportunity that has yet to be widely adopted in New Zealand. It could apply to almost anything that would see new-to-New Zealand technology saving energy and/or reducing carbon emissions in business."
For New Zealand's district health boards, money saved on energy is money that can be spent on patient health. When Capital & Coast District Health Board (CCDHB) started their energy management journey in 2013, they understood that energy savings of potentially up to 10 per cent each year were possible.
Capital & Coast District Health Board Page 4 November 2018
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LOUISE GOOSENS New NATA certified cyanosis LED tubes have been installed in 15 operating theatres in Wellington Hospital thanks in part to EECA’s Technology Demonstration Funding,
As part of CCDHB's efforts to reduce energy, some of the identified changes were surprisingly simple such as installing LED lighting, saving approximately $37,000 per year. Since work began on upgrading heating, ventilation and air conditioning as well as lighting, CCDHB has reduced its carbon footprint by over 980 tonnes per year.
Their most recent energy efficiency project involves the installation of new NATA certified cyanosis LED tubes in 15 operating theatres in Wellington Hospital. For this they were able to access EECA's Technology Demonstration Funding, as the lights had not been put to work in New Zealand before.
Cyanosis refers to a medical condition whereby skin can turn a bluish colour, indicating that the tissue is low on oxygen and therefore potentially a result of cardiac or respiratory problems. It is a symptom that medical professionals are trained to look for and that is easier to spot under special lighting.
Valentino Luna Hernandez, Sustainability Manager for CCDHB, says "Wellington Hospital is expected to save 40,000 kilowatt hours each year across all theatres, with additional cost savings on maintenance as the lights are longer lasting than the old fluorescent tubes – which also means reduced disruption to life-saving theatres to replace bulbs."
One of the requirements of EECA's Technology Demonstration Funding is replicability. The CCDHB theatre lighting project easily met this ask, as there are an estimated 150 operating theatres across other New Zealand DHBs, as well as in private hospitals.
For public sector organisation, Crown Loans are another funding stream that can help with efficient lighting and other projects that will save money for public funded organisation and reduce their energy use or emissions.
Shelley Park School in Auckland contracted Direct Energy Solutions to convert all their exterior and interior lights to modern LEDs through EECA's Crown Loan funding. Crown Loans are a low cost, interest free way to fund energy efficiency and renewable energy projects for publicly funded organisations such as schools, local councils, universities and polytechnics, government departments and hospitals.
Capital & Coast District Health Board Page 5 November 2018
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EECA PORTS OF AUCKLAND Ports of Auckland save 66 per cent on annual lighting costs by switching to LED floodlights
The monthly energy savings from reduced power bills at Shelley Park go towards paying back the loan and, as the savings continue, the money can be invested in education facilities at the school. In the meantime, teachers and students are benefiting from an improved quality of light in classrooms.
"I strongly recommend other schools participate and take up this [Crown Loan] offer," says Brian Rolfe, Principal of Shelley Park School. "It is absolutely worthwhile to take the opportunity to save money for the school – I don't imagine there are too many schools who are happy to pay more than they have to for electricity," he said.
For more information about EECA funding, visit EECABusiness.govt.nz
Capital & Coast District Health Board Page 6 November 2018
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Capital & Coast District Health Board Page 7 November 2018
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BOARD INFORMATION
Date: 31 October 2018
Author Roger Palairet, Chief Legal Counsel
Endorsed by Julie Patterson, Interim Chief Executive
Subject BOARD GOVERNANCE MANUAL - REVIEW
RECOMMENDATIONS It is recommended that the Board: (a) Notes that the 2017 version of the Board Governance Manual is largely up to date; (b) Notes that the references to the previous Hospital Advisory Committee (HAC) and Community and Public Health Advisory Committee (CPHAC) and the Terms of Reference of those committees are out of date given the establishment of the Health System Committee; (c) Notes that the Terms of Reference of the Finance Audit and Risk Committee (FRAC) and the Memorandum of Understanding with the Maori Partnership Board are being reviewed and may change; (d) Agrees that the Board Governance Manual should be amended (and resubmitted to the Board for approval) to take into account the Health System Committee arrangements.
1. PURPOSE
This report comments on the status of the Board Governance Manual and identifies areas that should be updated.
2. BOARD GOVERNANCE MANUAL
The Board considered the current version of the Board Governance Manual in September 2017, and it was finalised in October 2017. This version largely remains up to date. There have been no law changes since 2017 that require the manual to be updated.
2.1 Statutory Committees There is a mismatch between what the Board Governance Manual says about the Board statutory committees and the current practice of CCDHB. The Health System Committee (HSC) has been formed as a combination of the previous Hospital Advisory Committee (HAC) and Community and Public Health Advisory Committee (CPHAC). This Board Governance Manual does not reflect this change because the manual still refers to HAC and CPHAC and includes their Terms of Reference in the schedules.
HSC has its own Terms of Reference, which are based on the Terms of Reference of HAC and CPHAC. The Board Governance Manual should be amended to replace the Terms of Reference in the schedules. The new Terms of Reference are careful to say HSC comprises HAC and CPHAC, and it is important that the manual also makes this distinction because HAC and CPHAC are statutory committees of the Board, that are required to be established under sections 34 and 26 of the New Zealand Public Health and Disability Act 2000 (NZPHDA).
The Disability Support Advisory Committee (DSAC) is the third statutory committee that is required to be established under section 35 of the NZPHDA, and there has been no change in its status as a joint CCDHB and HVDHB committee.
Finance Risk and Audit Committee
Capital & Coast District Health Board Page 1 November 2018
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PUBLIC The Finance Risk and Audit Committee (FRAC) is an important Board subcommittee, but it is a committee established under Schedule 3 of the NZPHDA rather than being a named statutory committee like HAC, CPHAC and DSAC. The Board Governance Manual includes the Terms of Reference of FRAC, but FRAC has resolved to review these Terms of Reference.
If the FRAC Terms of Reference are amended, the revised version will need to be added to the Board Governance Manual.
2.2 Maori Partnership Board The Board Governance Manual includes a copy of the Memorandum of Understanding with the Maori Partnership Board. I am aware that the Maori Partnership Board has proposed a new MOU, but the issues that arose have not been resolved. When a new MOU is agreed, it will need to be incorporated in the Board Governance Manual to ensure it remains up to date.
Capital & Coast District Health Board Page 2 November 2018
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BOARD INFORMATION
Date: 30 October 2018
Authors Anne Stewart, Acting Executive Director Operations, Quality Improvement & Patient Safety Sarah Jackson, Acting Executive Director Clinical, Quality Improvement & Patient Safety
Endorsed by Julie Patterson, Interim Chief Executive
Subject CLINICAL GOVERNANCE REVIEW UPDATE
RECOMMENDATIONS It is recommended that the Board: (a) Notes the progress on the implementation of the Clinical Governance recommendations; (b) Notes the development of a Clinical Governance Framework for the CCDHB Provider Directorates.
APPENDIX 1. Clinical governance framework.
1. INTRODUCTION
The purpose of this paper is to update the Board on the progress of implementing the recommendations from the Clinical Governance review. The paper follows up on an earlier paper at the Board meeting on 12 September which outlined our response to the Clinical Governance Review undertaken by Dr Mary Seddon in April 2018 and a proposal for implementation of the recommendations.
Good progress is being made on implementing the recommendations. This includes development of a clinical governance framework and progress with the improvements to the sub-committees.
2. UPDATE
2.1 Clinical Governance Sub-Committees ∑ The Credentialing Committee is due to meet for the first time on 20th November with a view to undertaking the first service credentialing in April. ∑ The Family Violence Committee has its first meeting on 29 October and the Point of Care Testing Committee has also recently met. ∑ The Patient Quality Safety Indicators meeting has been dis-established and is re-forming as the Patient Safety Committee. ∑ A new Chair for the Death Review Committee (to change name to Morbidity and Mortality Committee) has been identified as the current Chair plans to retire next year. The current and proposed chair are leading discussions with the Departmental Leads for M&M about improving the processes around M&M meetings (becoming multi-disciplinary, standardised format and reporting) and it is planned to have a meeting early next year to formalise these changes.
Capital & Coast District Health Board Page 1 October 2018
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∑ The terms of reference for the clinical governance sub-committees are being reviewed and standardised to give greater clarity and purpose to their function and responsibility. ∑ Discussions have been had with the chairs of a number of other committees and there is a plan underway to get all the chairs together in early December for a combined session about clinical governance, their roles as chairs of clinical governance committees as well as what support they need.
An area of concern is ensuring we have the appropriate resource to support these committees.
2.2 Clinical Governance Framework A Clinical Governance Framework has been developed in consultation with the Professional Leads and, Clinical Executive Directors and chairs of the existing clinical governance sub-committees. It describes the systems, responsibilities and accountabilities for Clinical Governance for CCDHB Provider Directorates.
The attached Clinical Governance Framework Document includes the Overall framework description, Committee structure, Terms of Reference for the Clinical Governance Board, Clinical Governance systems, processes and committees.
Capital & Coast District Health Board Page 2 October 2018
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CCDHB Clinical Governance Framework
Introduction
Clinical governance is the system by which the governing body, managers, clinicians and staff share responsibility and accountability for the quality of care, continuously improving, minimising risks, and fostering an environment of excellence in care for consumers/patients/residents.1 It requires a shared commitment from all clinical and non‐clinical staff to provide high quality and safe care, and organisational support from board to the ward. It is more than a structure, although this is required to support clinical governance (and should be reviewed every three years). It should permeate every aspect of care in a DHB and all staff (clinical and non‐clinical) should feel able to contribute to patient safety and quality improvement. This document provides a framework of how clinical governance is organised at CCDHB.
Vision
CCDHB strives to provide a culture of patient safety with quality, patient centred care by making patient safety and quality improvement of patient care everybody’s business.
This is achieved by having all staff (clinical and non‐clinical) working together, putting patient/whānau at the centre of our focus and always striving to improve the quality of care provided. CCDHB also strives to provide a just, restorative environment for staff to work in.
Approach
An effective clinical governance framework has four components2. These are: consumer engagement and participation clinical effectiveness quality improvement and patient safety engaged effective workforce
They provide a structure to implement strategies to improve and enhance the quality of care. The clinical governance framework for CCDHB is attached in Appendix 1 and is divided into these four domains. This structure aims to bring individual elements together to strengthen and sustain ongoing improvement around the six dimensions of quality; safe, timely, equitable, effective, efficient and people centred (STEEEP).
Structure
CCDHB considers that everyone involved with the organisation, whether it is as board member, manager, clinician or support staff, has a responsibility to positively contribute to clinical governance. Below are the key structural components with their responsibilities and accountabilities.
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Board of governors The board of governors has responsibility for creating the expectation of safe and quality patient services and has responsibility for holding the chief executive accountable for meeting this expectation.
Chief executive, executive management team and other management staff The chief executive, executive management team (ELT) and other managers are accountable for ensuring that a culture of patient safety permeates the organisation and that, within their respective divisions or areas of responsibility, there are appropriate standards in place and resources available to enable staff to deliver to the expected standard, and that systems are in place and operational to ensure monitoring, measurement and risk management.
Provider Directorate Clinical Governance Board Overseeing clinical governance is the Provider Directorate Clinical Governance Board (CGB) which reports to the chief executive. It has authority and influence on all matters related to patient safety and quality of care. Its key responsibility is to maintain standards, lead improvements in patient care and promote a culture of safety, quality and accountability. The terms of reference are attached in appendix two.
Committees and professional reference groups All committees of the clinical board and directorate clinical governance groups report to the CGB. This structure enables all staff to raise concerns and make suggestions for improving safety and quality, clinical governance being everybody’s business. Clinical committees have a clinical chair and report to the CGB using a standardised format. The terms of reference for the subcommittees include a set of responsibilities, accountabilities and key performance indicators and are signed by the chair of the CGB.
With the support of the clinical governance board and defined terms of reference, the committees have the authority to establish working groups with a direct reporting line to that committee or professional or service group.
Other service/directorate committees (clinical or non‐clinical) can raise identified clinical risks for patients, staff and organisation to the CGB and will have the opportunity to address the board in the reporting plan.
Quality improvement and patient safety The Quality Improvement and Patient Safety Directorate (QIPS) acts as the operational arm of the clinical governance board. It has responsibility for coordinating quality and risk activities and providing the CGB, clinical leaders and management with the formal linkages required to ensure the organisation takes a coordinated approach to quality improvement and patient safety.
Policies, procedures and guidelines The clinical governance board ensures there are clinical processes in place and that policies and procedures are current and evidence‐based. Policies arising from the committees are signed off by the CGB chair.
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Commitment The chief executive and professional heads support the vision and aims outlined in this document. However, the vision and aims can only become a reality if every member of staff makes patient safety and quality of care improvement their business.
References
1. National Model Clinical Governance Framework. Australian Commission on Safety and Quality in Healthcare. Nov 2017
2. Clinical Governance Guidance for Health and Disability Providers. Health Quality and Safety Commission. Feb 2017
Appendices
1. Clinical board structure 2. Terms of reference
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Key CCDHB Board Proposed Exisiting CEO Clinical Council Change in function
3DHB Clinical Governance Board Provider Directorates Clinical Governance Board Integrated Care Collaborative
MHAIDS Quality Patient Safety Primary & Secondary Surgery Women’s & Children’s and Morbidity & Mortality Infection Prevention & Group Clinical Governance Medicine Cancer & Community Committee * Control Committee* Directorate Clinical Governance Committees Serious Event Review Primary Care Vascular Access & Adverse Event Committee* Treatment Committee Organisations Clinical Committee* Governance Committees Surgery Women’s & Children’s and Medicine Cancer & Community Policy & Procedure Directorate Service Improvement Group Restraint Advisory Family Violence Group meetings Group* Committee*
Patient Safety Mortality & Morbidity Transfusion Committee Committee* Committee*
Clinical Recognition & Clinical Practice Medicines Advisory Response Committee Committee Group*
Quality Improvement Medicines Review Research & Audit Committee Committee* Committee* Key: * Links with committee Research & Audit Credentialing in MHAIDs Committee* Committee*
Clinical Ethics Advisory Point of Care Testing Group Committee*
The Voice Consumer Choosing wisely Group
Clinical Governance Committees are supported by Quality Improvement & Patient Safety, Information Communication & Technology, Strategy Innovation & Performance, Communications, People & Capability and Executive Leadership Team.
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CCDHB terms of reference
Provider Directorate Clinical Governance Board
Month l Year
Purpose: The Provider Directorate Clinical Governance Board’s (CGB) key purpose and responsibility is to oversee clinical governance activities throughout the DHB. These include activities in all four domains of clinical governance; quality improvement and patient safety, consumer engagement, clinical effectiveness and engaged, effective workforce.
Objectives: The Clinical Governance Board should lead clinical governance at CCDHB by; Promoting consumer engagement and co‐design Prioritising quality improvement and patient safety Measuring clinical processes and outcomes Effectively managing clinical risks Promoting a transparent, open learning culture Ensuring effective multi‐disciplinary teamwork Ensuring health services are provided in an equitable manner
The agenda will be structured to reflect these objectives
Function: Lead the expectation to continually improve and raise the standard of patient care and patient experience Provide clinical input and advice to support all clinical governance sub‐committees and service improvement committees Monitor progress against HQSC quality markers and Atlas of Variation Review external and internal reports on DHB performance Review clinical risks and ensure these risks are minimised Agree an annual patient safety, quality and risk programme Agree an annual consumer engagement programme Oversee the processes for assessing the organisation’s internal compliance, including certification and accreditation Monitor clinical systems and standards to ensure that the care delivered is safe and evidenced‐based Have oversight of processes of managing the recommendations from clinical incident analysis, Health and Disability Commissioner (HDC) and coronial investigations Set the culture for clinical research, audit and innovation
Accountability: The CGB will receive reports from all clinical governance sub‐committees and QIPS every quarter. The CGB will receive reports from the Primary Secondary Clinical Governance and Quality Patient Safety Group every quarter The CGB will provide verbal monthly reports and written quarterly reports to the Chief Executive
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Chairperson and Membership: The chair shall be the General Manager of Clinical Governance and will be supported by the Executive Directors (Clinical and Operational) from QIPS.
Standing members; Consumers Maori representative Pacific representative Executive Directors (Clinical), one representative from MCC, SWC and MHAIDs Executive Director (operational) one representative from SWC/MCC/MHAIDs Professional Heads (Chief Medical Officer, Director of Nursing and Midwifery and Director of Allied Health)
Appointed members (term of two years, deputy to attend when member absent) Medical representative or deputy (nominated by Medical Reference Group) Nursing representative or deputy (nominated by DONM) Allied Health representative or deputy (nominated by Director of Allied Health)
The designated members of the committee are expected to attend all meetings. Attendance will be monitored annually.
Decision making process: A quorum shall consist of half the formal membership Decision making is by consensus, any matter not decided by this will result in the matter being decided by the Chief Executive
Agenda: Agendas will be circulated no less than 3 working days prior to the meeting. All items will be submitted to the Chair and no items can be submitted without their approval.
Minutes: Minutes of meetings will be circulated no later than 10 working days after the meeting
Procedure: The CGB may call staff to report, present, explain and/or review any matter coming within the scope of their activities and will do so with the authority of the Chief Executive The requirements of the CGB will be conveyed to the relevant Executive Director, Director or Professional Head through its minutes in the first instance The CGB may request that the relevant Executive Director, Director or Professional Head act directly to address issues of concern to the Clinical Governance Board, where it has been unable to bring about the attainment of basic levels of quality performance or risk mitigation The CGB may highlight for the relevant sub‐committee any issues of significant concern which have not been addressed to its satisfaction within a timeframe commensurate with the risk involved. Any reporting of this nature will be discussed with the Chief Executive well prior to being included in any Committee agenda The Board will review its performance against the requirements of the Terms of Reference annually
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Clinical Governance Systems, Processes and Committees
Consumer Engagement & Participation Clinical Effectiveness Committees: Working Groups: Committees: Directorate/Service: Consumer Council Co‐design projects Clinical Recognition and Response Service Morbidity and Mortality The Voice Committee meetings Consumer representatives on Clinical Ethics Advisory Group Service Audit groups Committees Point of Care Testing Committee Service Research Groups Morbidity and Mortality committees Service audits Research and Audit Committees Service Credentialing
Other: Other: Feedback/complaints processes Consumer engagement policies, Health Roundtable data Policies, Protocols, Guidelines Patient experience surveys protocols and guidelines Quality Safety Markers Perinatal and Maternal Mortality Advance Care Planning Consumers employed Clinical Indicators Reviews Open Communication (disclosure) Maternal Quality Safety Programme Child Youth Mortality Reviews
Engaged effective workforce Quality Improvement/ Patient Safety Committees: Directorate/Service: Org wide: Directorate/Service: Credentialing committee Orientation Infection Prevention and Control Service Improvement Groups Peer review Committee MHAID Quality Patient Safety Group Reflective Practice Vascular Access and Treatment Primary Secondary Clinical Governance Performance appraisal Committee SWC Governance Meeting Staff development Medicines Review Committee MCC Governance Meeting Sabbatical Quality Improvement Committee Patient Safety Committee Family Violence Steering Group Adverse Event Review Committee Transfusion Restraint Advisory Group Other: Other: Training and professional development Improvement Movement Training Certification SQUARE – adverse event reporting Speaking up for safety programme RMO Improvement Residency Learning from Excellence Serious event review processes Restorative Practice HQSC Patient Safety Programmes Cold Chain monitoring Risk Management Processes Legislative compliance
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BOARD DECISION
Date: 17 October 2018
Author Andrew Blair, Capital & Coast District Health Board Chair
Subject RESOLUTION TO EXCLUDE THE PUBLIC
RECOMMENDATION It is recommended that the Board: (a) Agrees that as provided by Clause 32(a), of Schedule 3 of the New Zealand Public Health and Disability Act 2000, the public are excluded from the meeting for the following reasons:
SUBJECT REASON REFERENCE For the reasons set out in the respective public excluded Public Excluded Minutes papers. Public Excluded Matters Arising from For the reasons set out in respective public excluded previous Public Excluded meeting papers. Chair’s report Papers contain information and advice that is likely to 9(2)(b)(i)(j) prejudice or disadvantage commercial activities and/or CEO’s report disadvantage negotiations FRAC Recommendations Risk Report New Children’s Hospital Programme of Works Status Report Allied Laundry Workforce and Employment Relations Update Investment Plan Update * Official Information Act 1982.
Capital & Coast District Health Board October 2018
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Capital & Coast DHB staff news
I SSUE 42 • OCTOBER 2018 HealthMatters
3DHB Allied Health, Scientific and Technical Award winners
Keeping people safe - orderlies take charge
IMPROVEMENT MENTAL HEALTH CCDM UPDATE MOVEMENT AWARENESS WEEK focus Ward 5 south getting Mental wellbeing for Additional nurses and patients up and dressed health professionals midwives to be employed
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F rom the interim CE
The principles of restorative Compliments practices are incorporated into schools, many workplaces and community life. Nine Just wanted to say I am thoroughly impressed years living and working in with the care, kindness and treatment I am Whanganui opened my eyes receiving in your ED today. Wonderful, friendly to the the benefits of such a staff and very prompt. Thank you! people-focused approach. Whanganui’s goal to Dental – Kenepuru Community Hospital become New Zealand’s first My son had a dental operation and received general “restorative city” was built anaesthetic. I just wanted to offer a big thank you to on the belief that individuals all staff involved. The nurses, anaesthetist and dental and communities thrive in an environment of positive surgeon were of professional but personable manners relationships. – it made myself and my son at ease. No judgements While I was in Whanganui I saw firsthand that when a were given, just calm staff who guided us through the relationship is harmed, a restorative approach can help process and they made my son laugh. The anaesthetist those involved to understand what went wrong and how especially had created a story of heading into space for to move on in a safe and respectful way. When I arrived at him and he was in giggles by the time the gas mask was CCDHB, I was excited to learn that there was real interest on. The experience made it so much better for me. Full in adopting restorative practices within our organisation. credit to you all. You all do a wonderful job. With a goal of maintaining and improving relationships there’s a lot healthcare organisations can gain from this – Wellington Regional Hospital U rology approach, not only in terms of workplace culture and I wish to congratulate and thank all those involved in safety but also with patients, family and whānau. I hope my treatment today. Helpful, clear, friendly and caring you’ll join Victoria University’s Professor Chris Marshall, staff. The care could not have been more pleasant. I an internationally recognised restorative practices expert, believe you strive to deliver an excellent level of service at our November 8 Grand Round (page 14) where he will and from my perspective you achieved that fully. share his insights and analysis. A patient story shared with our Board recently, (page 11) Capital Support powerfully illustrates the importance of thinking about Thank you for understanding our situation and directing the effect behaviour can have on those around us. The us to the respite care programme which has been a patient, who has a lung condition, was understandably long waiting concern to be resolved for our family. upset because while she was grateful to have an outside Thank you for all the information given to us and the view, she was disheartened to see people (including staff) kind support you and the capital support team offer. smoking in a blatant breach of our policy. Please think about this and what you can do to help as we play our part kni d staff member – Wellington Regional Hospital in helping New Zealand become smokefree by 2025. A gentleman phoned in with the following compliment. Walking in the shoes of others is at the heart of patient- He had an appointment at the Eye Clinic at 7.30am centred care. And it’s fabulous to see more great on Friday 28 September. When he got to the parking examples in this month’s edition - from the work of the ticket machine his eftpos card wouldn’t work. A DHB Improvement Movement (page 7) to the recipients of employee noticed, and paid for the parking with his this month’s Allied Health Scientific and Technical awards own credit card. When the gentleman asked for his (page 4). A hearty congratulations to all our finalists and name so he could repay him, he wouldn’t give it, and winners – thank you for all the work you do caring for our said make a donation to a church instead – which he community. has now done. Thank you whoever you are, it was very Enjoy this month's edition of Health Matters. much appreciated.
Cover photo: Chantalle Corbett, service manager, Wellington Community ORA; Catherine Epps, execetive director, allied Ngā mihi, health, scientific and technical; and Kate Marshall, team leader, Kenepuru Community ORA at the 3DHB Allied Health, Scientific and Technical Awards night earlier this month. Julie Patterson Interim chief executive
2 l CCDHB Health Matters October 2018
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The security orderly team have been working on a new approach to keep people safe in our hospitals.
Orderly staff keeping an eye on hospital activities
Keeping people safe The security orderly team has been The team is also taking a more proactive approach when a potentially troublesome patient comes into the working on a new approach to keep hospital. This could be a patient with a history of violence, situations where babies are being uplifted or a patient people safe in our hospitals. with threatening visitors. Last month the team dealt with around 50 security “We work with the services looking after the patient and emergencies, including assisting with aggressive patients come up with a patient safety management plan. We see and visitors. ourselves as part of the patient journey,” says training “Hospitals can be stressful and frustrating places so we assessor Jason Tamaki. take an empathetic approach. Most people follow the This new approach has seen a drop in the number of rules when they’re here but there’s a few that don’t. Our people needing physical intervention. goal is to manage that one percent better,” says orderlies service manager Karemoana Matamua. “I’m really proud of the team and how much they have achieved. It’s been a massive turnaround but we want to There’s no textbook or best practice on hospital security. do more,” says Karemona. In the past, orderlies turned up and responded how they thought best. Responses varied depending on who turned up. Security call outs For the past two years the team has been focused on 777 Code Black security emergencies are top priority upskilling orderlies, supporting ward staff and formalising and responded to immediately. processes so responses are consistent and coordinated. Where orderlies are located at the time of the call will All 75 orderlies across Wellington Regional and Kenepuru dictate how quickly they can respond – rest assured Community Hospitals have completed an NZQA they are on their way. qualification in customer service and managing challenging A senior orderly is on duty at all times. They assess the incidents. Two trainer positions have been created to jobs coming in and prioritise them. support orderlies and provide education to ward staff. If there are multiple security emergencies happening, “When we step into a conflict situation, our presence the one of greatest risk will be first priority. can feel threatening. One of the first things we do now is You can see the progress of your job on the Smartpage introduce ourselves and explain why we are there. Our system. behaviour influences how someone responds and being The more information you provide about the security respectful is one way to help de-escalate a situation,” says emergency, the more likely the right person and training assessor Dale Luke. equipment will be sent.
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158 CCDHB Public 7 November 2018 - APPENDIX Allied Health, Scientific & Technical Awards
Congratulations to all the finalists and session and developing a consistent process to follow for nutrition information sheets – of which there are over winners of the fourth biannual sub- 250! regional Allied Health Scientific and Excellence in Clinical Practice Technical Awards. This award recognises an individual who has improved Seventy five nominations were received from across clinical care, patient safety, patient experience and/or the three DHBs. Around a quarter of the Allied Health health outcomes. Scientific and Technical staff were included in a Winner: Liz Hunt - charge nomination. There were eight award categories. The sonographer, HVDHB finalists and winners are listed below. Liz Hunt is the charge Allied Health Scientific and Technical covers over 40 sonographer in professional groups. Staff work in the community, the Hutt Hospital outpatient settings, and hospitals. They work with all ages, Radiology Department. and across all the different areas of health and disability She is continually services. improving practice, To add to the festivities of the night, a talented crew aware of recent research of home grown Allied Health, Scientific and Technical and challenging colleagues musicians provided entertainment. to ensure the best standards of Thank you to all the nominees and allied health staff who care. Liz is generous with her expertise and leads teaching came out to support the awards evening. sessions for clinical staff. She has also been involved in the national sonographer recruitment campaign. AWARD WINNERS Delivering the DHB Vision Champion for Collaboration & This award recognises individuals or teams who have Integration “Delivered the DHB Vision” by achieving goals and/or priorities of their organisation. The recipient(s) will have This award recognises individuals, teams and services that achieved exactly what was needed to improve the way have worked collaboratively with peers from different their organisation could deliver its services. services, DHBs or organisations leading to tangible benefits Chris Little - for the patient. Winner: pharmacist, CCDHB Winner: 3DHB Nutrition and Dietetic Services, Chris has been the Wairarapa, Hutt Valley infectious diseases pharmacist at CCDHB and Capital & Coast since July 2016 and in DHBs that, time has worked The Nutrition and hard to develop the Dietetic Services work role to a high standard of collaboratively across clinical and organisational the three DHBs to ensure care. He has embraced the DHB’s there is a consistent approach aims, and on a daily basis provides care that demonstrates to professional development, shorter, safer patient journeys, growing our people and supervision and the development of resources. This best value for money. includes setting up a shared monthly dietetic education
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the phone are impressive. The Outstanding Contribution by a New quality and consistency of Graduate telephone triaging for the service has greatly This award recognises an individual who is within their first improved since she two years of practice and who demonstrates exemplary became the team contribution to patient care and/or team workings. leader and there is Winner: Natasha now a high level of Lewthwaite - confidence in the service. physiotherapist, CCDHB Natasha joined Supporting the the physiotherapy Growth of Others team at CCDHB as a rotational This award recognises individuals who act as preceptors, new graduate in supervisors, mentors or educators to make a real difference 2017. During this in the growth and development of others. This will be short time, not only evidenced through providing support, mentoring, coaching, has she consolidated her training and guidance. They will motivate and foster physiotherapy skills but she enhanced learning in those they support. has also further extended her clinical, communication Winner: Max Goodall - dietitian and leadership skills beyond the expectations of a new and AH health informatics graduate. She is already demonstrating strong leadership lead, Wairarapa DHB qualities. Max has been essential Outstanding Assistant in supporting the Wairarapa allied health This award recognises individuals who provide exceptional team with the transition support and assistance for their Allied Health, Technical or to the regional Web PAS Scientific colleagues in the provision of clinical care and/ referral management or support in diagnostic or system. His willingness to technical processes. work alongside the allied health Winner: Jane Duncan - staff and ICT has been the glue that allied health assistant, has bought this project together. His efforts resulted in CCDHB staff being aware, engaged and willing with this work. Jane works in the ORA Wellington Team of the Year Community Team This award recognises a team who exhibits and delivering rehabilitation demonstrates excellence in patient/client outcomes, inter- in the community. She personal working and a high level of competency, to deliver has excellent skills in working an outstanding service. with patients to maximise their independence and works Winner: MRI team, HVDHB closely with occupational therapists to come up with solutions for patients. Jane also takes a lead in managing This team has pulled the equipment flow and a number of safety audits. together when under pressure and shown resilience, patient focus Inspirational Leadership award and a fantastic team This award recognises individuals who have empowered culture. They have others to fulfil their potential. They are individuals that are proactively supported not exclusively titled ‘managers’, but have the dedication the plan to improve and charismatic inspiration to lead others and inspire MRI wait times, and had others to act. excellent communication with Winner: Alicia Graham - team leader, Te Haika, MHAIDS referrers and their patients. There has been a marked improvement in service delivery and Alicia is the Team Leader for the Te Haika telephone quality outcomes for patients. contact centre for MHAIDS. Her skills in helping people problem solve complex issues while under pressure over
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CCDMat upd e Additional nurses and midwives allocated to clinical areas ore nurses and midwives are being employed “The inclusive approach has been appreciated and Mto provide immediate relief to clinical areas the additional funding for the maternity areas will with staffing pressures as part of a one-off $38 million be welcomed by midwives,” said MERAS co-leader nationwide Government package. (midwifery) Caroline Conroy. An extra 34 nursing and midwifery FTE will be “PSA appreciates the thoughtful approach the Council employed, with recruitment already underway. has taken. This makes sure workers and patients get the The Care Capacity Demand Management (CCDM) greatest possible benefit from this funding, including Council, which includes DHB and union representatives, in mental health nursing and midwifery,” says PSA analysed data from payroll, SQUARE and, where organiser Alex Ward. available, the DHB’s acuity tool TrendCare, to determine The extra staff are part of a one-off Government the areas in greatest need. They also used criteria from package included in the 2018 DHB NZNO multi- the Safe Staffing Healthy Workplace unit. employer collective agreement (MECA). Capital & CCDM Council Chair and executive director of nursing Coast DHB’s proportion of this package was nearly $2.6 and midwifery Andrea McCance says a lot of thought million. and work has gone into deciding where the additional The Government package also included resources staff go. to support the implementation of CCDM. The CCDM “It was a robust process done in partnership with Council has agreed to use for a permanent Trendcare the unions. “This allocation is the start of alleviating coordinator role across mental health (MHAIDs), and workload pressures experienced by our members. three CCDM project support coordinators for a three NZNO representatives on the CCDM council ensured the year period. funding allocation was used in a way that best benefits The CCDM programme is run partnership between the nurses and midwives and to do this as soon as possible. DHB and three health unions (NZNO, PSA and MERAS). There is more work to be done towards ensuring safe Once fully operational, CCDM will help us better match staffing and healthy workplaces is achieved at CCDHB.” the capacity to care with patient demand and workload says NZNO professional nursing advisor Suzanne Rolls. using data from across our patient areas and wards.
Additional FTE allocated through Government funding package Ward FTE Workforce capacity Ward FTE Workforce capacity Outpatients - 1 additional 0.8 FTE RN 1 additional RN on AM shifts 1.2 Ophthalmology 1 additional 0.4 FTE RN 6 South 2.2 1 additional RN on PM shifts Outpatients - Thu-Fri 0.8 1 additional 0.8 FTE RN Orthopaedics 7 North 1.7 1 additional RN on nights 1 additional RN on nights Emergency Ward 1 - Paediatrics 3.4 1.7 1 additional RN on swing shift 1 additional RN on PM Department 1 additional RN on MAPU 1.7 1 additional RN Ward 2 - Paediatrics 0.8 AM Mon-Fri Paediatric Diabetes 1 1 additional RN on AM Mon-Fri 1 additional RM or RN Community Nursing 4 North - Maternity 1.7 1 1 additional RN on AM Mon-Fri on AM Service - Wellington 1 additional RM or RN Community Nursing Delivery Suite 1.7 1 1 additional RN on AM Mon-Fri on PM Service - Keneperu NICU 0.5 1 additional RN on Sat-Sun Ra Uta MHOP 1 additional RN on AM Psychogeriatric 3.4 1 additional RN on AM shift 5 North 3.4 1 additional RN on night Inpatient Unit 1 additional RN on AM shifts Hikitea ID Youth 1 additional RN on AM shift 5 South 1.7 3.4 (shared with 6 East) Inpatient Unit 1 additional RN on PM shift 6 North 1.7 1 additional RN on nights
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Connie and Shana helping patients
get up and about on the ward Improvement Movement
Ward 5 North are trying different as well as making sure they had the right equipment to support people getting active. The pair have run three well ways to get their patients up, attended staff education sessions and put up prompt signs including one asking patients if they have been for a walk dressed and moving to prevent today. deconditioning. They also designed a walking map with short and long T he ward was averaging eight referrals a month for walk options after feedback from patients that the deconditioned patients. Deconditioning is when a patient hospital corridors look the same and they get lost. becomes weaker and their mobility or independence Getting active could be as simple as moving from the bed reduces while they are in hospital. Patients who to a chair to eat a meal, but patients weren’t using the experience deconditioning end up staying in hospital chairs because the chairs didn’t have arms. longer. “Patients told us they need chairs with arms so they can “People were playing the role of patient, just lying in bed,” get in and out easier and feel more supported. We’ve got says associate charge nurse manager Connie Rodrigues. more high backed armchairs and are trialling them in one As part of the Improvement Movement, Connie and pod for the spot audit to see if it makes a difference ” says physiotherapist Shana Hall got together to look at ways to Shana. get patients active on the ward. While it’s still early days, they are already seeing positive The first step was understanding why. They took a results. Last week, only a third of patients where in a bed team approach to map out how their patients became at midday, and last month there were only two referrals deconditioned and what signs staff would see. This for deconditioned patients. included surveying patients and staff as well as doing spot The ‘Active Ward’ project won them the Improvement audits to see how many patients were in bed, dressed or Movement people’s choice award and a Health Quality sitting in a chair. and Safety Commission award. They decided to focus on patient and staff education Congratulations Last month’s winner of the Embassy theatre tickets is – Nik Mounter, staff nurse, NICU
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162 CCDHB Public 7 November 2018 - APPENDIX Thanks Special thanks and recognition to the following staff
5 Years Walter Theurl, mental health Staff Profile Nathan Fayen, community support worker mental health nurse Peter Dunn, registered nurse Gladis Jose, registered nurse (casual) Helen Costello, Natasha Lewthwaite Christine Quimbo,registered associate director of nursing P hysiotherapist nurse Martin Adams, Jacqualene McGivern, clinical security orderly nurse manager He Jiang, registered nurse What’s your role here? Sarah Barton, oncologist Helen Harrison, associate I'm a rotational physiotherapist Shinae Bailey, hand therapist charge nurse Robert Lenihan, currently based at Wellington Regional Puka Apineru, mental health 3DHB Hospital. My role involves assessing support worker manager - infrastructure ICT Liezyl Tacderas, and rehabilitating patients after surgery Belinda Christie,registered delivery suite or illnesses and assisting them to nurse assistant Akemi Teahan, reach their potential. To do this, I use Haide Hille, theatre store registered techniques to help improve patients’ person nurse respiratory, neurological, and overall Mary Crewdson, registered function. nurse (casual) 15 Years Katherine Baguley, ENT Sohila Tayabi, registered nurse Who’s in your team? surgeon Nicole Minskip, district nurse There are roughly 20 physiotherapists Aelred Refendor, registered Tukitama Tutaki, health care based in the Wellington inpatient team nurse associate (casual) alone, with more based at Keneperu, in Shini Paul, registered nurse Susan Allan, administrator the community and in outpatients. Some Shiny John, registered nurse Richard Steele, respiratory are rotational staff like myself while Nicola Walker, registered physician others are in senior or specialised roles. nurse Mary-Clare McCarthy, Rakesh Patel, pharmacy registered nurse (casual) What’s the best part assistant of your job? Kesiya Mithun Abraham, 20 Years pharmacy technician I love the nature of a rotational position, Timothy Blackmore, infectious Tessa Petelo, registered nurse and moving between wards regularly. diseases physician I get to meet and work with new Carol Reid, dietitian patients, nurses, doctors and allied 25 Years health staff across the DHB, and I’m 10 Years Deborah Forsyth, specialist, constantly learning and expanding my Jacqueline Highgate, health anaesthesia knowledge base. care assistant Graham Titchener, clinical Maree Brown, health service leader Tell us something most assistant staff wouldn’t know Susan Bastion,community 30 Years nurse about you Matelagi Mita, sterile services Steven Robinson, service technician I’ve played the flute since I was 12, and operations manager - Sanh To Tri, security orderly am currently in an amateur concert Kenepuru & transport band. I enjoy playing as a de-stressor and Grethel Navales, registered way to meet new people. nurse
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163 CCDHB Public 7 November 2018 - APPENDIX Cardiac sonographers Echocardiograms; an ultrasound that looks at the size, shape and performance of the heart, are in hot demand, with the number of scans quadrupling in the past decade. We have a team of seven cardiac sonographers who are the experts at doing these scans. Alex Sasse, cardiologist, says while doctors are trained to “Patients are booked weeks and sometimes months in and can do an echo, it makes much more sense to have a advance for surgery or other elective procedures but we specialist workforce to do them. often get told the patient needs an echo just before the “They are able to do them at a much higher quality and planned procedure. We then have to do a frantic rejig to more efficiently.” get it done. A bit more notice when possible would mean we could schedule it in.” One scan can take anywhere from 20 minutes to over an hour with around 90 images and video clips captured. Some medical staff in places such as ICU, ED, NICU and Electrodes are put on a patient’s chest and an ultrasound anaesthetics have been trained to carry out ‘point of care probe is placed on different places on the chest to ultrasounds’. This is very useful to quickly guide diagnosis look at the heart. Once all the images, video clips and and treatment, and if they require further information a measurements are taken, the sonographer records their formal echo is requested of the cardiology team. findings and writes a report. A cardiologist will then re- Training to be an cardiac sonographer isn’t assess the images and write a further report. straightforward. You start off as a cardiac physiologist The job is physical which can take its toll in sore muscles which in itself requires five years education and training, and aches and strains. To help with this, an average day is and then spend six months or so in a laboratory as a split into two. A morning may be spent doing a clinic load rookie to make sure you’re up to the task. If you are, you of outpatients and the afternoon doing scans on the wards may enroll for training at one of two places in Australia or in more specialised scanning such as stress echoes, while employed as a trainee sonographer in New Zealand transoesophogeal echoes, or in theatre to help guide a for the two year post-graduate diploma. procedure. Because there is no local training, many of the cardiac Catherine Googin, section head echocardiography, says sonographers working in New Zealand are recruited the team go above and beyond to get urgent work done internationally. Over half of the team here on time. They work to capacity and urgent short notice are from overseas. requests can be tricky, so a bit of extra notice for non- acute work would really help them.
DAY IN THE LIFE
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164 CCDHB Public 7 November 2018 - APPENDIX view from the board e’ve marked two major milestones this month – Wthe decision to appoint a single a chief executive across Hutt Valley and Capital & Coast DHBs, and signing the development deed for the new Children’s Hospital. Both of these are exciting developments which will help us better serve our communities. The decision to appoint a single chief executive was a collective one by both Boards after a thorough process which included several combined workshops. The Boards’ view is that having a united vision and approach across the entire greater Wellington region will be essential to ensuring we are best placed to meet demand, improve the wellbeing of our communities, and to continue our strong relationship with neighbouring DHBs. I want to thank interim CE Julie Patterson, who along with Dale Oliff at Hutt Valley DHB, is focused on preparing for the new model including strong childrens leadership at both DHBs and collaborative processes. We can’t put an exact timeframe on the recruitment hospital process. The main goal is ensuring we get the right person for the job. A search and recruitment is about update to get underway and I will keep you updated. Deed paves way for Children’s Hospital construction to begin Construction company McKee Fehl are now on site following the demolition of the The signing of the new children’s hospital development old renal office and the sports complex, deed with benefactor and developer Mark Dunajtschik and the completion of the diversion and this month was an important milestone and comes as stormwater works. construction gets set to begin on the site. Mr Dunajtschik is contributing most of the cost McKee Fehl’s site offices have been set up, of the building and is taking responsibility for the and the crane has been delivered to site construction of the new building. The development and will be erected by mid-November. deed sets out the details of how the project will proceed. A Mauri stone laying ceremony will be held on Wednesday 7 November to mark the beginning of construction work on the site.
Foundation work is expected to get underway in late November.
The Riddiford building demolition is progressing to timeframe and external plaster removal is still being undertaken at the north end of the Riddiford Building. Demolition of the building is expected to Children’s Hospital benefactor Mark Dunajtschik (left) and be completed by late March 2019. Board Chair Andrew Blair (middle) sign the development deed in front of the Health Minister Hon. Dr David Clark.
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165 CCDHB Public 7 November 2018 - APPENDIX Patient’s experience highlights impact of staff and visitors smoking The importance of the DHB’s non- staff and visitors adhere to our smokefree policy, which is here to keep us all healthy and well,” Julie says. smoking policy has been highlighted in CCDHB’s smokefree policy is focused on encouraging and a powerful story told by a patient who providing support for patients, visitors and staff to make witnessed staff and visitors smoking healthy decisions. All staff are encouraged to constructively and politely on our premises. bring the policy requirements to the attention of anyone The Board heard last month how a patient with a lung who is smoking on our premises. condition, who regularly spends time in Wellington “I appreciate how difficult this is – as a health organisation Regional Hospital, had seen people smoking on hospital let’s lead the way” Julie says. grounds, including our carparks. What does CCDHB’s smokefree policy say? "On a recent stay, I had a view outside to the [area nearby Smoking is prohibited on CCDHB premises and grounds the] emergency department. It is always nice to be part Pre-employment screening of staff and assistance to of the outside world, with something to look at, but I was quit is to be offered to those who smoke very perturbed to see smokers outside my window. Expectation that staff will not smoke during work hours Interim chief executive Julie Patterson says the patient is Assistance is offered to patients who normally smoke very courageous in bringing the issue to the attention of through the ABC Pathway and referrals to stop smoking the board. She was also concerned about the challenges services it raised in terms of reaching New Zealand’s goal of being smokefree by 2025. CCDHB provides staff training in smokefree ABC and NRT training, as well as a specific smokefree mental “Many of our patients will have had similar experiences health and addiction services learning programme and likely find the presence of smoking Associated risk to those patients who are under equally distressing. We all have observation, surrounding patients, or staff that has a part to play in been identified to outweigh the risk associated with helping smoking, the patient may be accompanied outside the hospital grounds to smoke under supervision.
Wnta help to quit smoking? ABC smoking cessation guide and e-learning: www.smokefreenurses. org.nz/ABCQUIT+CARDS.html. CCDHB offers nicotine replacement therapy (NRT) training and eLearning so that our health practitioners can administer NRT and offer quit support to patients. For more information on quit cards and NRT training, contact Hori Waaka, smoking facilitator at Ora Toa ([email protected]).
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Speaking Up for Safety Speaking up for Safety starting to effect change
I t doesn’t just apply to our staff ne of our staff spoke up about the behaviour of a police officer and they’ve Ochanged their training to avoid it happening again. A nurse spoke up about the behaviour of a police officer following the death of a young Pacifika man in hospital. They didn’t feel the police officer's behaviour helped the family or staff deal with the trauma of the unexpected death. The incident was formally followed up and the response from Police was positive. There was a meeting with the police officer involved to discuss the impact of his response on the family. The scenario is now part of the police values training package for all new staff. Speaking up for Safety gave the nurse a framework to address the unprofessional behaviour with confidence and support.
O ne email stopped a medication error linical typists have spoken up about the quality of dictation and as a result of Cspeaking up, stopped a patient taking a double dose of their medication. When a dictation is unclear it can be misinterpreted and end up causing harm to a patient. It can be unclear for a number of reasons including loud background noise, the speaker multi-tasking during dictation or lack of clarity for complex medical terminology. One typist mentioned that when she had a hunch a doctor, for whom she had typed many letters over the years, had prescribed double the usual dose, she emailed him to check. Her hunch turned out to be correct; the wrong dose of medication had been prescribed, and she was profusely thanked by the doctor. She said it felt good to avert patient harm and have enough confidence to raise a concern, even if she was wrong. She felt empowered, respected and valued by the doctor. As a result of this situation, clinical leaders and service leaders have been asked to tell medical staff about the effect of noise during dictation. Planning is underway with capability development to incorporate this feedback into orientation of new medical staff.
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Mental Health Awareness Week Last month we celebrated Mental massage, resilience testing, TED talks, tree planting ceremonies, mindful money workshops, running and Health Awareness Week across the walking groups, art displays and a client concert at the three DHBs, in a joint approach to Ratonga Rua o Porirua campus. It’s an important time for us as health professionals to raise awareness of the importance take stock of our own wellbeing, and take a moment of our mental wellbeing as health for ourselves. The themes of the week highlight the importance of creating a culture of support - we want professionals. all our people to feel safe to ask for help and lead from This year’s theme was ‘let nature in - Mā te taiao, kia the front. whakapakari tōu oranga - which focused on boosting This fits in well with the next part of our supporting our wellbeing by inviting the elements of the outdoors safety culture programme, where we will be holding into our lives. forums for Capital & Coast and MHAIDS staff to Mental Health, Addictions and Intellectual Disability share and discuss results of the Safe and Supportive Service (MHAIDS) and the three DHBs held activities Workplace Survey. and provided tools across the week centred on the Mental Health Foundation’s ‘five ways to wellbeing’. Please keep an eye out for further information and Activities included mindful movement sessions, staff forum dates on the intranet.
Celebrating our success awards 2018 The awards ceremony is being held on Wednesday 21 November at Foxglove Bar from 5.30pm. See the intranet for info and to buy tickets. 13 l CCDHB Health Matters October 2018
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GRAN D ROUND W hat is restorative justice and how might it help us build a strong safety culture? ome and find out at Grand Round, where we’ll hear The approach is based on Cform Professor Chris Marshall, the inaugural Chair the concept that individuals in Restorative Justice at the School of Government at and communities thrive Victoria University. in an environment of positive Chris is an international expert on restorative relationships. When a relationship is harmed, a justice. He has a strong interest in conflict resolution restorative approach is used to help those involved to and peacemaking and will talk about the need for understand what went wrong and how to move on in a restorative principles in healthcare. safe and respectful way. Restorative principles are used in workplaces to Join us, as we explore the role of restorative practice underpin communication and help create a just and in ‘Supporting Safety Culture at our place’. restorative culture. The approach can help workplaces build and maintain positive relationships among staff Grand Round: How might restorative justice help us and transform conflict when it occurs. build a strong safety culture? New Zealand has well-established restorative justice When: 12-1pm on Thursday 8 November processes in courts, particularly the Family Group Where: Nordmeyer Lecture Theatre, School of Conference system. However its philosophy has Medicine and Health Sciences also been introduced more widely with Whanganui Grand Rounds are video linked to the Kenepuru becoming the country's first "restorative city”. Community Hospital education centre.
URITY PRI Y & VSAC EC Protecting ourselves and our patients online s a health care organisation we are at high risk of The campaign focused on Acyber-attacks. In fact, every day we experience the simple actions staff cyber-attacks on our IT systems, which could result in can take to help protect the release of private information or lock down of our the patient information we systems. share with other providers. The Cyber Smart Week campaign took place this “One of the ways we can do this is using encryption. month. This year’s theme – protecting your online Encryption allows us to encode a message or self – provided a great opportunity for staff to become information in such a way that only authorised parties more aware of the simple measures they can take to can access it,” John says. protect themselves and our patients online. He says the new ‘encrypt’ button in our Outlook tools “Health information is valuable to hackers. As we allow users to automatically encrypt emails by simply increasingly move towards electronic forms of clicking on the button. communication, protecting online information John also recommends password protecting files becomes even more important,” says John Lambert containing sensitive information. from the 3DHB ICT team. The DHB communicates with a range of different internal and external health providers such as GPs, For more information about encryption and password rest homes, palliative care facilities, private hospitals protecting documents, visit our Cyber Smart intranet and NGOs. page, under 'Staff Stuff'.
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169 CCDHB Public 7 November 2018 - APPENDIX LTH CA SO MP S HEA wellington hospitals foundation update
New equipment for ED We’ve purchased a videolaryngoscope for Wellington Hospital’s ED. Raumati Road Surgery team members receive The videolaryngoscope Health Care Home certification enables practitioners to see down a patient’s Health Care Home helping people throat. across greater Wellington “It’s a fantastic piece of equipment. Not ndependent research has found that people enrolled in a only does it make IHealth Care Home (HCH) practice are less likely to need intubation so much emergency department or hospital care. easier, safer and The research – from the University of Auckland for the faster in emergency Productivity Commission – coincided with the release of the situations, it’s also HCH ‘achievements & reflections’ report. The report provides wonderful for teaching,” says a broad overview of the HCH’s second year in the Wellington Dr Andre Cromhout, Director of Emergency region. Medicine. “HCH has represented a significant change in the delivery of primary care, and was achieved through successful Walk through the Heart of the City to collaboration between the DHB and local PHOs – Ora Toa, support our Heart & Lung Unit Cosine and Tū Ora Compass Health,” said CCDHB interim chief Join us on Saturday 17 executive Julie Patterson. November from 2pm “It puts patients and families’ needs at the heart of local to help raise funds healthcare delivery. It’s an investment in helping to ensure to upgrade the people can access services closer to home and stay well in the Wellington Hospital’s community.” Heart & Lung Unit’s The research findings align with our own tracking of 42,000 patient lounge. patients over two years – which also found that HCH patients Participants walk use technology more to manage their primary health care from Waitangi Park needs, and benefit from triage or telephone assessment and to Wellington Hospital, treatment. finishing with a healthy BBQ. Some practices even report that 35 percent of patients are Tickets are $20 per person or $30 for the being successfully managed over the phone, freeing up time whole family (includes BBQ). Tickets can be to see people with more purchased at the Wellington Hospital Gift Shop urgent needs. Keyct fa s or from the foundation website. 42 practices across greater I'm pleased that more Wellington have adopted the and more practices are HCH model. Patient uses his birthday to give back! Tuhiwai has been a patient at Wellington joining the HCH quality 240,000+ people are enrolled Children’s Hospital three times in his life so programme,” said Tū Ora in a HCH practice across far. Following his most recent stay Compass Health chief greater Wellington. a few weeks ago, Tuhiwai executive Martin Hefford. 35 percent of HCH patients on asked for donations to “Their early achievements average are being successfully the hospital instead of in providing more managed by phone, avoiding presents for his 5th patient-centred care are the need for a face-to-face birthday. He and his encouraging, and we are appointment. mum wrote a poem delighted to be rolling 4.8 percent decrease in HCH and sent it to family out the model out to the patients needing medical or and friends. He Wairarapa, based on the surgical admissions to hospital. raised over $600. success of our practices in 3.4 percent decrease in HCH CCDHB.” patients needing emergency department care. CCDHB CCDHB Health Health Matters Matters October October 2018 2018 l l 15 15
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Webinar A naesthesia A llied health, and video Day 2018 scientific and conferencing This month we marked World technical staff Anaesthesia Day, commemorating Staff can now participate in webinars the first successful demonstration of videos and video conferences hosted by ether anaesthesia in October 1846. external parties. We recently published short videos The theme was ‘Anaesthesia isn’t of some of our allied health, scientific Webex, GotoMeeting and Skype sleep. It’s so much deeper’, and and technical staff talking about what Meetings are available on DHB the Anaesthesia Department had it’s like to work at CCDHB and what computers with Windows 10. They a display in Wellington Regional they love about living here. don’t work in Citrix, or on kiosk or Hospital’s atrium. Among those The videos will be used to help clinical terminals. Use Zoom to host to visit was CCDHB interim chief recruitment and will be featured on your own video conference. executive Julie Patterson, who took the CCDHB Facebook page over the the opportunity to try her hand at If you have any questions, call the coming weeks. You can watch them intubating a patient. 3DHB ICT Service Desk on #6146. at www.ccdhb.org.nz under Careers.
Pregnancy Ministry staff Staff Christmas warning labels structure feast dates on alcohol E very year a Christmas meal is put change on for CCDHB staff at the four main Pregnancy warning labels will now Director-General of Health, Dr campuses as a thank you for your be required on alcohol, reminding Ashley Bloomfield has reviewed the hard work druing the year. There are people how dangerous drinking way the Ministry business units are five events held over two weeks in during pregnancy is. organised and, following a three week early December. The decision was made by the consultation period with staff, he has Friday 7 December: 7-8.30am Australian and New Zealand Forum on made some changes to the structure. (breakfast) & 12-2pm (lunch) - Food Regulation. They agreed that, The new structure and operating Wellington Regional Hospital based on the evidence, a mandatory model will help to ensure that the Monday 10 December: 12-2pm labelling standard for pregnancy Ministry’s work programme is well (lunch) - Ratonga Rua o Porirua warning labels on packaged alcoholic led and governed. Tuesday 11 December: 12-2pm beverages should be developed and For more information, visit the (lunch) - Kenepuru Community include a pictogram and relevant Ministry of Health website. Hospital and 2.30-4pm (afternoon warning statement. tea) - Kapiti Healh Centre.
16 l CCDHB Health Matters October 2018
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19 October 2018
SSHW Council c/- Andrea McCance Executive Director of Nursing Capital and Coast DHB (Sent by Email)
Dear Andrea,
APPROVAL FOR ADDITIONAL MOH FUNDING TO ADDRESS WORKFORCE CAPACITY ISSUE AND SUPPORT CCDM IMPLIMENTATON
As you are aware the Director General delegated responsibility for reviewing DHBs plans to the Safe Staffing Healthy Workplaces (SSHW) Governance Group (Ministry of Health Guidance and information for DHBs on the additional funding to address workforce capacity issues and support CCDM implementation dated 29 August 2018)
On Friday 19 October the Governance group considered and approved your DHBs plans for addressing workforce capacity issues and supporting CCDM implementation.
The Governance group has informed the Chief Nursing Officer at the Ministry of Health who will facilitate the release of funding.
The Governance Group looks forward to maintaining an overview of your implementation progress through your submission of two monthly reporting. Your first report is due on 31 December 2018
Yours Sincerely
Julie Robinson Hilary Graham-Smith Co-Chairs of the SSWH Governance Group
69 Tory Street, Wellington 6011, PO Box 23 075, Wellington 6140, New Zealand | Phone: +64 4 801 2430, Fax: +64 4 801 6230 Email: [email protected] Website: www.tas.health.nz
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