Annual Quality Report 2012-2013

www.waikatodhb.health.nz/quality

ANNUAL QUALITY REPORT 2011-2012 1

What is a Quality Report? As part of ’s drive for quality improvement in health, there is a need for our patients, families, whanau and general public to have a balanced picture of the quality of services being delivered and what improvement plans each provider / district health board (DHB) has in place.

The annual quality report for Waikato DHB looks back on the previous year’s progress and looks forward, setting new areas of work, saying how we will achieve an improvement in the care for our patients and families in these areas and how we will measure that improvement.

Patients, members of the public and our own staff can use each year’s quality report to check the level of care we provide. We welcome your views and comments on the report.

We would also welcome suggestions for content for future reports.

Please contact:

Mo Neville Assistant Group Manager Quality and Patient Safety Waikato DHB

[email protected] Table of Contents

Part 1 Leadership team statement...... 3

Part 2 Performance Review...... 5 Ministry of Health National Health Targets...... 5 Serious and Sentinel events (SSE)...... 6 Waikato DHB Priorities 2012/13...... 7 Quality Safety Markers 2013 baseline measures...... 8

Part 2A Detail of priority areas 2011/12 ...... 9

Patient Safety...... 9 Priority 1: Reduce medication errors and improve prescribing practice...... 9 Priority 2: reduce the incidence of -acquired infection...... 10 Priority 3: reduce the incidence and impact of patient falls...... 11 Priority 4: Improve access to acute theatres...... 12 Priority 5: consistent access to appropriate health professionals available for patient care 24/7 (the hospital at night project)...... 13

Patient Outcomes ...... 14 Priority 6: reduce hospital mortality rates...... 14 Priority 7: reduce failure to rescue rates...... 15 Priority 8: reduce the hospital re-admission rates following discharge home .... 16 Priority 9: improve maternity care...... 17 Priority 10: reduce hospital-acquired ulcers...... 18

Patient Experience...... 19 Priority 11: improve timely access to all service users...... 19 Priority 12: improve discharge planning and reduce delay on date of discharge21 Priority 13: improve hospital cleanliness...... 22 Priority 14: improve customer service and responsiveness...... 23

Part 3: Our Future Focus...... 25

Our priorities for 2013/2014 ...... 25 Patient Safety ...... 25 Patient Outcomes...... 26 Patient Experience ...... 26

Capability Development ...... 27

Page 2 of 27 Part 1 Leadership team statement

This is our third Quality Report, which allows us to demonstrate the progress we have made in recent years. It also gives us an opportunity to set out our commitment to improving quality and to monitor the standards of care we provide to the communities we serve.

Against a backdrop of financial challenges and a broad range of major change programmes including Waikato DHB’s $500 million building development, our staff continue to work hard to provide excellent standards of care and develop new ways of improving the experience of our patients.

The quality report for 2013/14 will  Demonstrate how well we are doing against targets set by the Ministry of Health  Demonstrate how well we are doing against the targets set by ourselves in our ‘Quality and Safety at Waikato DHB: Our Strategy’ and in the 2011/12 quality report.  Highlight areas where we need to improve  Set out our priorities for the year ahead  Allow our public and staff to further scrutinise our performance

The Health Quality & Safety Commission as part of the new national patient safety campaign sets some of the priorities, for example reducing the number of patient falls that result in harm nationally. Others, like improving customer care and responsiveness, are because our patients and public have told us through complaints and other feedback that this is an area of concern for them.

We want people to have confidence that our , clinics and community teams provide the best care for all our patients / clients. It is what our patients expect and what our staff seek to deliver. This commitment is reflected in our policy statement -

Waikato DHB will strive to continuously improve the quality of its services for patients and clients by putting them at the heart of everything we do and by raising the focus and expected outcomes of both clinical and non clinical services. This means we will focus on our patients and their needs as a priority.

Our quality framework is based on three dimensions of quality and this report is structured to reflect our focus  Patient Safety  Patient Outcomes  Patient Experience

Page 3 of 27 We are pleased to present our report for 2012/13. We can confirm that to the best of our knowledge the information in this report is accurate. We hope that it gives you a useful insight into the quality of care we provide for our patients and our commitment to build on our achievements in the next 12 months

Jan Adams Sue Hayward Tom Watson Chief Operating Officer Director of Nursing and Chief Medical Advisor Midwifery

Page 4 of 27 Part 2 Performance Review

Ministry of Health National Health Targets Improving performance against the sector is fundamental to the Governments goal of Better, Sooner, More Convenient health services for all New Zealanders. One of the mechanisms used to monitor our performance is the nation wide health targets

National Target 2011/12 2012/13 Q4 Q1 Q2 Q3 Trend Shorter stay in (95%) 92% 86% 88% 89% = Improved access to elective surgery (100%) 107% 108% 111% 116% ⌂ Shorter wait for cancer treatment (100%) 100% 100% 100% 99.7% = Increased immunisation (85%) 92% 80% 82% 81% = Better help for smokers to quit (95%) 89% 93% 94% 93% ⌂ More heart and diabetes check (75%) 57% 60% 63% 67% ⌂

The performance has remained stable across the targets. Particularly pleasing is the increase in access to elective surgery and the heart and diabetes checks, which show a 10% improvement over the last year. Waikato DHB has challenges in achieving the 6-hour target of admitting, discharging or transferring patients from the Emergency Department (ED) within six hours but there are a number of things being done to improve this. In 2012/13 there has been a focus on providing alternatives to ED that GPs can use to care for their patients without the need to admit them to hospital. We have also created more single roomed ward facilities for children to speed up access to the hospital during the 2013 winter. We have invested significantly in working with GPs to develop clear clinical pathways for specific acute conditions. During 2013/14, this work will be rolled out through the Map of Medicine project to every GP and hospital specialist. A small number of people who frequent ED often have long-term health needs. We introduced better systems of case management so that their need to attend for urgent care should reduce. The hospital has also invested heavily in increasing the number of medical staff so that patients can be seen more quickly.

There was a slight deterioration in patients waiting for cancer treatment (radiotherapy and chemotherapy), in fact there was a single person waiting a few days longer than four weeks. This is resulting in changes to how we schedule some of the pre-therapy support for patients needing peripherally inserted central catheter (PICC) lines. There is a large amount of work underway around the faster cancer treatment targets including the appointment of additional nursing staff to co-ordinate the patient journey. A comprehensive database designed to monitor the timelines of