board meeting - waitematadhb.govt.nz · resolution (moved james le fevre/seconded edward...

BOARD MEETING

Wednesday 2 October 2019

9.45am

AGENDA

Items to be considered in public meeting

VENUE Waitematā DHB Boardroom Level 1, 15 Shea Terrace Takapuna

TELECONFERENCE Phone: 0800 633 866 Pin: 8640 223 149#

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Karakia

E te Kaihanga e te Wahingaro

E mihi ana mo te ha o to koutou oranga

Kia kotahi ai o matou whakaaro i roto i te tu waatea.

Kia U ai matou ki te pono me te tika

I runga i to ingoa tapu

Kia haumie kia huie Taiki eee.

Creator and Spirit of Life

To the ancient realms of the Creator

Thank you for the life we each breathe to help us be of one mind

As we seek to be of service to those in need. Give us the courage to do what is right and help us to always be aware

Of the need to be fair and transparent in all we do.

We ask this in the name of Creation and the Living Earth.

Well Being to All.

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Waitematā District Health Board, Meeting of the Board 02/10/19

MEETING OF THE BOARD 2 October 2019

Venue: Waitematā DHB Boardroom, Level 1, 15 Shea Tce, Takapuna Time: 9.45am

Teleconference: Phone: 0800 633 866 Pin: 8640 223 149#

WDHB BOARD MEMBERS Judy McGregor - WDHB Board Chair Max Abbott - WDHB Board Member Edward Benson-Cooper - WDHB Board Member Kylie Clegg - WDHB Board Deputy Chair Sandra Coney - WDHB Board Member Warren Flaunty - WDHB Board Member James Le Fevre - WDHB Board Member Matire Harwood - WDHB Board Member Brian Neeson - WDHB Board Member Morris Pita - WDHB Board Member Allison Roe - WDHB Board Member

WDHB MANAGEMENT Dale Bramley - Chief Executive Officer Robert Paine - Chief Financial Officer and Head of Corporate Services Andrew Brant - Deputy Chief Executive Officer Jonathan Christiansen - Chief Medical Officer Debbie Holdsworth - Director Funding Jocelyn Peach - Director of Nursing and Midwifery Tamzin Brott - Director of Allied Health Fiona McCarthy - Director Human Resources Peta Molloy - Acting Board Secretary

APOLOGIES: Judy McGregor, James Le Fevre, Matire Harwood, Morris Pita, Debbie Holdsworth, Karen Bartholomew

REGISTER OF INTERESTS

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

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

PART 1 – Items to be considered in public meeting

AGENDA

9.45am 1. AGENDA ORDER AND TIMING

2. BOARD & COMMITTEE MINUTES

9.50am 2.1

2.2

Minutes of the Meeting of the Board (21/08/19)

Actions arising from previous meetings

Minutes of the Hospital Advisory Committee Meeting (11/09/19)

9.55am 3. CHAIR’S REPORT

4. EXECUTIVE REPORTS

10.00am 10.10am 10.15am

4.1 4.2 4.3

Chief Executive’s Report Health and Safety Performance Report Communications Report

5. PERFORMANCE REPORT

10.25am 5.1 Financial Performance Report – August 2019

6. INFORMATION PAPERS

10.30am

10.40am

6.1

6.2

System Level Measures Report – Quarter Four

Qlik Sense (Data Discovery Business Intelligence Tool) Update

11.00am 7. RESOLUTION TO EXCLUDE THE PUBLIC

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Waitematā District Health Board

Board Member Attendance Schedule 2019 Present Apologies given * Attended part of the meeting only # Absent on Board business ^ Leave of Absence

NAME Mar Apr May Jul Aug Oct Nov Dec

Judy McGregor (Board Chair)

Max Abbott

Edward Benson-Cooper

Kylie Clegg (Deputy Chair)

Sandra Coney

Warren Flaunty

James Le Fevre

Matire Harwood

Brian Neeson

Morris Pita

Allison Roe

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Board/Committee Member

Involvements with other organisations

Last Updated

Judy McGregor (Chair)

Associate Dean Post Graduate - Faculty of Culture and Society, AUT Member - AUT’s Academic board New Zealand Law Foundation Fund Recipient Consultant - Asia Pacific Forum of National Human Rights Institutions Media Commentator - NZ Herald Patron - Auckland Women’s Centre Life Member - Hauturu Little Barrier Island Supporters’ Trust Chair – Health Workforce Advisory Board

23/09/19

Max Abbott Pro Vice-Chancellor (North Shore) and Dean - Faculty of Health and Environmental Sciences, Auckland University of Technology Patron - Raeburn House Advisor - Health Workforce New Zealand Board Member - AUT Millennium Ownership Trust Chair - Social Services Online Trust Board member - Rotary National Science and Technology Forum Trust

19/03/14

Edward Benson-Cooper Chiropractor - Milford, Auckland (with private practice commitments) Edward has three (different) family members who hold the following positions: Family member; FRANZCR. Specialist at Mercy Radiology. Chairman for Intra Limited. Director of Mercy Radiology Group. Director of Mercy Breast Clinic. Family member; Radiology registrar in Auckland Radiology Regional Training Scheme. Family member; FANZCA FCICM. Intensive Care specialist at the Department of Critical Care Medicine and Anaesthetist at Mercy Hospital.

25/03/19

Kylie Clegg (Deputy Chair)

Trustee - Well Foundation Director - Auckland Transport Director - Sport New Zealand Trustee and Beneficiary - Mickyla Trust Trustee and Beneficiary, M&K Investments Trust (includes shareholdings in a number of listed companies, but less than 1% of shares of these companies, includes shareholdings in MC Capital Limited, HSCP1 Limited, MC Securities Limited, HSCP2 Limited, Next Minute Holdings Limited). Orion Health has commercial contracts with Waitematā District Health Board and healthAlliance. Director of High Performance Sport New Zealand Limited Board member, Counties Manukau District Health Board Shareholder – Genesis Energy Ltd

10/07/19

Sandra Coney Member - Waitakere Ranges Local Board, Auckland Council Patron - Women’s Health Action Trust Member - Portage Licensing Trust Member - West Auckland Trusts Services

15/12/16

Warren Flaunty Member - Henderson–Massey Local Board Auckland Council Trustee (Vice President) - Waitakere Licensing Trust Shareholder - EBOS Group Shareholder - Green Cross Health Director - Life Pharmacy Northwest Chair - Three Harbours Health Foundation Director - Trusts Community Foundation Ltd Trustee – Hospice West Auckland (past role) Shareholder - Genesis Energy

12/09/18

5



Board/Committee Member

Involvements with other organisations

Last Updated

Dr Matire Harwood Senior Lecturer - Auckland University Director - Ngarongoa Limited, which is contractor providing services to National Hauora Coalition GP at Papakura Marae Health Clinic Advisory Committee Member - State Foundation NZ (Māori Health) Member Te Ora, Māori Medical Practitioners Step-daughter is a surgical registrar at Waitematā DHB

10/05/18

James Le Fevre Emergency Physician - Auckland Adults Emergency Department Trustee - Three Harbours Foundation Member - Medical Protection Society Member - Northern Regional Clinical Practice Committee Shareholder - Pacific Edge Ltd DHB Representative (Auckland and Waitematā DHBs) - Air Ambulance Co-design Procurement Governance Board (past role) James’ wife is an employee of the Waitematā DHB, Department of Anaesthesia and Perioperative Medicine and a Medico-Legal Advisor for the Medical Protection Society Board Member - Auckland District Health Board (past role) Shareholder - Genesis Energy

21/11/18

Brian Neeson Member - Upper Harbour Local Board Member - Human Rights Review Tribunal Member - Auckland District Licensing Committee Managing Director - BK & VS Neeson Limited Managing Director - Apollo Property Investments Limited Property Development Consultant Chair – Wilson Home Committee of Management (past role)

19/12/18

Morris Pita Owner and Director - Shea Pita and Associates Limited. Shareholder - Turuki Pharmacy Limited Shareholder and Director of Healthcare Applications Limited. In December 2018 this company won an RFP with Waitematā DHB for provision of the Emergency Q software service to reduce overcrowding in the ED and the company is currently (as at 27 March 2019) in the final stages of negotiation for a potential contract for service at both North Shore and Waitakere EDs. Morris’ wife is a:

Board member - Northland District Health Board Board member - Auckland District Health Board Director - Healthcare Applications Limited Director - Shea Pita & Associates

10/07/19

Allison Roe Chairperson - Matakana Coast Trail Trust Member - Rodney Local Board, Auckland Council Member - Wilson Home Committee of Management (past role)

22/08/18

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Waitematā District Health Board, Special Meeting of the Board 02/10/19

Conflicts of Interest Quick Reference Guide

Under the NZ Public Health and Disability Act 2000, a member of a DHB Board who is interested in a transaction of the DHB must, as soon as practicable after the relevant facts have come to the member’s knowledge, disclose the nature of the interest to the Board. A Board member is interested in a transaction of a DHB if the member is:

a party to, or will derive a financial benefit from, the transaction; or

has a financial interest in another party to the transaction; or

is a director, member, official, partner, or trustee of another party to, or person who will or may derive a financial benefit from, the transaction, not being a party that is (i) the Crown; or (ii) a publicly-owned health and disability organisation; or (iii) a body that is wholly owned by 1 or more publicly-owned health and disability organisations; or

is the parent, child, spouse or partner of another party to, or person who will or may derive a financial benefit from, the transaction; or

is otherwise directly or indirectly interested in the transaction. If the interest is so remote or insignificant that it cannot reasonably be regarded as likely to influence the Board member in carrying out responsibilities, then he or she may not be “interested in the transaction”. The Board should generally make this decision, not the individual concerned. A board member who makes a disclosure as outlined above must not:

take part in any deliberation or decision of the Board relating to the transaction; or

be included in the quorum required for any such deliberation or decision; or

sign any document relating to the entry into a transaction or the initiation of the transaction. The disclosure must be recorded in the minutes of the next meeting and entered into the interest register. The member can take part in deliberations (but not any decision) of the Board in relation to the transaction if a majority of other members of the Board permit the member to do so. If this occurs, the minutes of the meeting must record the permission given and the majority’s reasons for doing so, along with what the member said during any deliberation of the Board relating to the transaction concerned. Board members are expected to avoid using their official positions for personal gain, or solicit or accept gifts, rewards or benefits which might be perceived as inducement and which could compromise the Board’s integrity. IMPORTANT Note that the best course, when there is any doubt, is to raise such matters of interest in the first instance with the Chair who will determine an appropriate course of action. Ensure the nature of the interest is disclosed, not just the existence of the interest. Note: This sheet provides summary information only. 2

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2.1 Confirmation of Minutes of the Board meeting held on 21 August 2019 Recommendation: That the Minutes of the Board meeting held on 21 August 2019 be approved.

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DRAFT Minutes of the meeting of the Waitemata District Health Board

Wednesday, 21 August 2019

held at the Boardroom, Level 1, 15 Shea Tce, Takapuna, commencing at 9.45am

PART I – Items considered in public meeting

BOARD MEMBERS PRESENT:

Judy McGregor (Board Chair) Max Abbott Edward Benson Cooper Kylie Clegg (Deputy Board Chair) Warren Flaunty Matire Harwood James Le Fevre Brian Neeson Morris Pita Allison Roe

ALSO PRESENT:

Dale Bramley (Chief Executive Officer) (until 12.30pm) Andrew Brant (Deputy Chief Executive Officer and Chief Medical Officer) Robert Paine (Chief Financial Officer and Head of Corporate Services) Jonathan Christensen (Chief Medical Officer) Jocelyn Peach (Director Nursing and Emergency Planning) Cath Cronin (Director of Hospital Services) Tamzin Brott (Director of Allied Health, Scientific and Technical Professions) Fiona McCarthy (Director Human Resources) Jonathan Christiansen (Chief Medical Officer) Rebecca Emery (Communications Advisor) Peta Molloy (Acting Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item)

PUBLIC AND MEDIA REPRESENTATIVES:

Jodi Yeats, The Rangitoto Observer WELCOME:

The Board Chair welcomed everyone to the meeting, acknowledging the members of public and staff in attendance.

APOLOGIES:

Apologies were received and accepted from Sandra Coney, Debbie Holdsworth and Karen Bartholomew and for early departure from Dale Bramley 12.30pm.

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DISCLOSURE OF INTERESTS

There were no interests declared that might involve a conflict of interest with an item on the open agenda. Morris Pita noted his registered interest related to public excluded item 4.7, he was not provided with the paper and will step out of the meeting for the discussion and decision making of this item. James Le Fevre noted his registered interest as an ED doctor in relation to public excluded item 4.7. Morris Pita confirmed that he had liaised with James Le Fevre early in the process for his thoughts only. The Board agreed that it would be helpful for James to remain in the room for the discussion of public excluded item 4.7. James Le Fevre also noted his registered interest as an ED doctor in relation to public excluded item 4.6; the Board noted this declaration and agreed that James could remain in the room for the discussion of this item. Later in the meeting Morris Pita noted that he was a ‘Owner and Director – Shea Pita Associates Limited’ (not Owner/Operator).

1 AGENDA ORDER AND TIMING

For the open meeting, items were taken in same order as listed in the agenda. The public excluded session was held first, from 9.45am to 12.06pm.

2 RESOLUTION TO EXCLUDE THE PUBLIC (agenda pages 6-10)

Resolution (Moved Warren Flaunty/Seconded James Le Fevre)

That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000:

The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

General subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

1. Minutes of Meeting of the Board - Public Excluded (10/07/19)

That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32 (a)]

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

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3. Minutes of the Audit and Finance Committee – Public Excluded (31/07/19)


Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.

[Official Information Act 1982 S.9 (2) (j)]

4. Minutes of the Hospital Advisory Committee – Public Excluded (31/07/19)


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

5. Board Chair’s Report That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32 (a)]

Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.

[Official Information Act 1982 S.9 (2) (j)] Improper gain or advantage The disclosure of information would not be in the public interest because of the greater need to prevent the disclosure or use of official information for improper gain or improper advantage. [Official Information Act 1982 S.9(2)(k)]

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6. Infrastructure Services Programme – Tranche 1 Business Case


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

[Official Information Act 1982 S.9 (2) (i)]



7. Elective Capacity Inpatient Beds – Infrastructure and related works






8. Special Care Baby Unit – Waitakere Hospital






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9. New Lease – 46 Taharoto Road, Takapuna




10. New Zealand Health Partnership


Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)]

11. Holidays Act – Memorandum of Understanding


Conduct of Public Affairs The disclosure of information would not be in the public interest because of the greater need to maintain the effective conduct of public affairs through the protection of members, officers and employees from improper pressure or harassment. [Official Information Act 1982 S.9 (2) (g)(ii)]

12. Safe Transfer of Patients to Urgent Care Clinics

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


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



13. Chief Executive Remuneration Review and KPIs


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

14. Adult Acute Inpatient Mental Health Quality Improvement Programme – Progress Summary


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

15. Legal Updates That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32 (a)]


Legal Professional Privilege The withholding of the information is necessary to maintain legal professional privilege. [Official Information Act 1982 S.9 (2) (h)]

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Obligation of Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which is subject to an obligation of confidence. [Official Information Act 1982 S.9 (2) (ba)]

16. E-notes presentation That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32 (a)]


9.45am to 12.06pm – public excluded session.

12.06pm – the meeting resumed in open session.

3 BOARD AND COMMITTEE MINUTES

3.1 Confirmation of Minutes of the Board Meeting held on 10 July 2019 (agenda pages 12-22) Resolution (Moved James Le Fevre/Seconded Edward Benson-Cooper)

That the Minutes of the Board meeting held on 10 July 2019 be approved.

Carried Actions arising from previous meetings (agenda page 23)

No issues were raised.

3.2 Draft Minutes of the Hospital Advisory Committee Meeting held on 31 July 2019 (agenda pages 24-31) Resolution (Moved Edward Benson-Cooper/Seconded Max Abbott)

That the draft minutes of the Hospital Advisory Committee meeting held on 31 July 2019 be received. Carried

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4 EXECUTIVE REPORTS

4.1 Chief Executive’s Report (agenda pages 32-49)

The Chief Executive introduced the report and thanked the staff for their work of the busy winter period. He acknowledged the appointment of Dr Jonathan Christensen to the role of Chief Medical Officer and Stuart Bloomfield’s appointment across both Waitematā DHB and Counties Manukau DHB in the role of Chief Information Officer. This appointment shows the increasing collaboration with Counties Manukau DHB. Dr Andrew was warmly thanked for the outstanding work he had done in the Chief Medical Officer role over the past ten years; Andrew is now leading the DHB’s vital facilities projects in his role as Deputy Chief Executive Officer. Recognition of the following was given:

The leapfrog programme has been selected as a finalist in the Talent Accelerator category of the IDC Digital Transformation (DX) Awards 2019.

Finalist in the Project Management Institute New Zealand (PMINZ), Project Management Office of the Year Award.

Healthy Homes Initiative as finalist under the Better Outcomes at the Spirit of Service Awards.

Other matters highlighted included:

Changes on the North Shore Hospital campus are underway, with a new carpark by Whenua Pupuke underway and works commencing around the Taharoto and Pupuke buildings in preparation for demolition.

Construction has commenced on the Mason Clinic site for the new mental health unit.

Warm acknowledgement of Mr Tim Astley who had retired after beginning his career in 1969. Dr Astley has made a significant contribution to healthcare throughout his career and is a father of Orthopaedics, alongside Mr John Cullen.

The DHB has signed a Memorandum of Agreement with the Cook Islands Ministry of Health. Opportunities for training were noted.

The performance metrics presented were acknowledged, noting the highest score obtained in the past five years for patient experience.

4.2 Health and Safety Performance Report (agenda pages 50-61)

Michael Field (Group Manager, Occupational Health and Safety Service) and Fiona McCarthy (Director, Human Resources) presented this item. The report was taken as read. Matters covered in discussion and response to questions included:

A more detailed report, once reviews are completed, regarding Lost Time Injury Frequency rate will be provided to the Board later this year.

Noting the anti-bullying toolkit launched in July.

Noting the number of aggression incidents are falling month on month.

MAPA (Managing Aggression and Potential Aggression) training is underway, an initial evaluation of the programme will be undertaken early 2020.

Noting that the installation of the security door is underway with the door ordered, works commissioned and contractors engaged.

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4.3 Communications Report (agenda pages 62-71)

Matthew Rogers (Director Communications) was in attendance for this item. He noted that at the last meeting the Board had viewed two of the DHB’s stories related to measles. TV3 online have since interviewed the father of Kaylee; this story was screen on 20th August 2019. The next story related to measles, filmed at a Marae, will be available on 23rd August on the DHB’s social media site. Matthew Rogers also noted that statistics related to OIA responses has been reported, the DHB is one of only two who have had all OIAs complied with. The DHB also has the second most number of OIAs published online. The Board acknowledged and thanked Matthew for the work in this area. In response to a comment, it was noted that the Communications Team actively promotes positive stories, with 47 proactive media releases produced in the year ended 30 June 2019.

Dale Bramley retired from the meeting. Meeting adjournment: 12.30pm – 1.04pm

5 DECISION ITEMS

5.1 Adoption of Waitematā DHB Governance Manual (including review of Code of

Conduct and Standing Orders) (agenda pages 72-196)

The Board Chair presented this report. She noted that the State Services Commission Code of Conduct will be incorporated into the manual once available. Clarification was sought from the DHB’s General Counsel on the matter of insurance protection (page 149 of the agenda) and residual liabilities; including travelling to and from Board and Committee meetings. Resolution (Moved Matire Harwood/Seconded James Le Fevre)

That the Board:

a) Approve the amended Code of Conduct as shown as Chapter 7 in the attached proposed Governance Manual. (Note: changes proposed are detailed in the agenda report.)

b) Approve the amended Standing Orders as shown as Appendix 2 to the attached proposed Governance Manual. (Note: changes proposed are detailed in the agenda report and, to be approved, require the support of three quarters of members present and voting.)

c) Approve the minor updates to the Waitematā DHB Member Remuneration,

Fees and Expenses Policy (as summarised in the agenda report).

d) (Subject to any changes approved by the Board) Adopt the Waitematā DHB Governance Manual.

e) Note that the State Services Commission, in its review of Crown entity and state sector legislation, is preparing a Code of Professional Conduct for Crown Entity

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Board members. When approved this will be incorporated into the Waitematā DHB Governance Manual.

Carried

5.2 Power of Attorney for the Board Chair (agenda pages 197-202)

Amanda Mark (General Counsel) presented this report. In response to a query about the Companies Act as it relates to deeds and whether there is a similar legislation for the Board Chair to sign a deed of lease, it was noted that there is not, but there is the ability to amend the DHB’s Delegated Authority manual and set up a power of attorney. Any matters signed under Power of Attorney will be reported to the Board’s Audit and Finance Committee on a regular basis. Resolution (Moved James Le Fevre/Seconded Allison Roe)

That the Board approve the Waitematā DHB Board Chair, Judith McGregor, being given power of attorney to execute deeds on behalf of Waitematā District Health Board provided the arrangement reflected in such a deed is within the delegated authority of the staff member seeking the deed’s execution or has been approved by the Board. The duration of power of attorney is for the appointed term of the current Board Chair, Judith McGregor.

Carried

6 PERFORMANCE REPORT

6.1 Financial Performance (agenda pages 203-216)

Robert Paine (Chief Financial Officer and Head of Corporate Services) summarised this report.

7 PERFORMANCE REPORT

7.1 The Wai 2575 – Health Services and Outcomes Waitangi Tribunal Inquiry Update (agenda pages 217-231)

Riki Nia Nia (General Manager, Māori Health) was present for this item. Riki Nia Nia introduced this item. Matters covered in discussion and response to questions included:

Noting that chapter 9.3.1 has a focus area on the Treaty of Waitangi principles, the recommendation refers to primary care, however, this could be carried across to the DHB. An example is including a reference at the front end of the Board’s governance manual; this was agreed and the manual will be updated.

Noting the DHB’s work in the area of establishing an Iwi-DHB Partnership Board.

That the conversation is happening with four key reports underway: the Ministry of Health Equity report, Wai 2575, the Health System Review and a report by the Health Quality and Safety Commission. These are substantial reports echoing and reaffirming each other.

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Stage 1 of the report has set the precedent for future stages and is adding positive pressure to other reviews. The report shows the system is failing Māori through areas such as not performing in a consistent manner.

The DHB can initiate changes now, including aligning with the Treaty of Waitangi. Looking at meaningful changes and changes in the population.

A key and consistent theme emerging from the various reports is the need to eliminate institutional racism/ unconscious bias.

The number of claims (over 200) for Wai 2575 was acknowledged.

It was noted that a study undertaken (in 2016) in the United States referred to clinician bias related to administering pain relief based on ethnicity. This has also been shown to happen in New Zealand, an example given was related to asthma and ethnic differences in children receiving gold standard. Reasons given were that it is believed some ethnicities will not take medication prescribed.

The General Manager, Māori Health suggested an audit of Waitematā DHB’s policies, practices and outcomes to ensure that a kaupapa Māori perspective was used to achieve wellness.

The Board Chair thanked Riki for the report.

7.2 Patient Report Outcomes Measures (PROMs) Programme Presentation (agenda pages 232-238)

Penny Andrew (Director, i3) presented this item. The Board noted the progress in developing a PROMs programme, the report was taken as read and a presentation given. Matters covered in discussion and response to questions included:

Monitoring the outcome of the measures is complex.

At this time the sharing of this information with general practitioners has not been investigated.

General business There were no items of general business.

Max Abbott retired from the meeting. The open meeting concluded at 2.09pm and the public excluded meeting reconvened. SIGNED AS A CORRECT RECORD OF THE MEETING OF THE WAITEMATA DISTRICT HEALTH BOARD - BOARD MEETING HELD ON 21 AUGUST 2019 CHAIR

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Actions Arising and Carried Forward from Previous Board Meetings as at 26 September 2019

Meeting Date

Agenda Ref

Topic Person

Responsible

Expected Report

back Comment

10/07/19 4.2 Health and Safety Update

A further update to be provided on the review being undertaken on organisational policies and procedures covering lone worker emergency response plans.

Michael Field

Report updated on this agenda. The review has commenced and a further update will be provided when available.

21/08/19 4.2 Health and Safety Update

A detailed report on Lost Time injury frequency rate will be provided to the Board later this year.

Michael Field

In progress

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2.2 Minutes of the Hospital Advisory Committee meeting

held on 11 September 2019 Recommendation:

That the Minutes of the Hospital Advisory Committee meeting held on 11 September 2019 be received.

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Draft Minutes of the meeting of the Waitematā District Health Board

Hospital Advisory Committee

Wednesday, 11 September 2019

held at Waitematā District Health Board Boardroom, Level 1, 15 Shea Terrace, Takapuna,

commencing at 1.32 p.m.

PART I – Items considered in public meeting COMMITTEE MEMBERS PRESENT

James Le Fevre (Committee Chair) Judy McGregor (Board Chair) Max Abbott Edward Benson-Cooper Kylie Clegg (Deputy Board Chair) Sandra Coney Warren Flaunty Matire Harwood Brian Neeson Morris Pita Allison Roe

ALSO PRESENT

Dale Bramley (Chief Executive Officer) Andrew Brant (Deputy Chief Executive Officer) Robert Paine (Chief Financial Officer and Head of Corporate Services) Jonathan Christiansen (Chief Medical Officer) Jocelyn Peach (Director of Nursing and Midwifery) Fiona McCarthy (Director Human Resources) Tamzin Brott (Director of Allied Health) Lorraine Bailey (IDF Performance Manager) Peta Molloy (Acting Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item.)

PUBLIC AND MEDIA REPRESENTATIVES PRESENT

Jodi Yeats, The Rangitoto Observer WELCOME

The Committee Chair welcomed those present. APOLOGIES

Apologies were received and accepted from Judy McGregor, Edward Benson-Cooper, Matire Harwood, Morris Pita, Cath Cronin and Jocelyn Peach.

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DISCLOSURE OF INTERESTS

There were no additions to the Interests Register. There were no interests declared that might give conflict with a matter on the open agenda.

1. AGENDA ORDER AND TIMING

Items were taken in the same order as listed in the agenda.

2. COMMITTEE MINUTES

2.1 Confirmation of the Minutes of the Hospital Advisory Committee Meeting held on 31

July 2019 (agenda pages 7-14) Resolution (Moved Kylie Clegg/Seconded Sandra Coney) That the Minutes of the Hospital Advisory Committee meeting held on 31 July 2019 be approved. Carried Actions Arising (agenda pages 15-16) The actions were noted. No issues were raised.

3. PROVIDER ARM PERFORMANCE REPORT 3.1 Provider Arm Performance Report – June 2019 (agenda pages 17-81)

Presentation: Telehealth

Gloria Paterson (Acting Team Lead Outpatient Physiotherapy, NSH) gave a presentation on the ‘Bowel Education Class Zoom Webinar Project’ to the Committee. Matters covered in discussion and response to questions following the presentation included:

The webinar project has been set up on a referral basis only, however, there is potential to open such classes up to the wider community.

The Zoom classes can be configured in a number of ways, with options for participants to communicate with the DHB only or one-another.

Classes need appropriate facilities/space and technology to proceed.

Whilst there were steps to overcome in developing the class there were no barriers. The class provides opportunity to talk to more people at one time instead of a one-to-one basis.

Noting the work and commitment taken to reach this project phase.

Options for patients and follow up appointments continue to develop and be implemented.

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Executive Summary/Overview

Andrew Brant (Deputy Chief Executive Officer) introduced this section of the report. The update on Faster Cancer Treatment (page 23 of the agenda) was noted and it was confirmed that he cases reported are per month. The data includes most types of cancers, but not some skin cancers. Later in the meeting, the Chief Executive tabled information related to the types of cancer included in Faster Cancer Treatment. In response to a question, it was noted that an update on the Measles epidemic later in the meeting. Human Resources

Fiona McCarthy (Director Human Resources) was present for this section of the report. The report was taken as read. Acute and Emergency Medicine Division

Gerard de Jong (Division Head, Acute and Emergency Medicine) and Melody-Rose Mitchell (Associate Director Nursing, Medicine), John Scott (Head of Division, Specialty Medicine and Health of Older People) and Brian Millen (General Manager) were present for this section of the report. Gerard de Jong introduced the report. Melody-Rose Mitchell noted the service achievement in receiving gold in the latest Patient and Whanau Centered Care Standards Audit (page 40 of eth agenda). The Committee Chair acknowledged and thanked the service for the work they do. Specialty Medicine and Health of Older People Division

John Scott (Head of Division, Specialty Medicine and Health of Older People), Brian Millen (General Manager) and Melody-Rose Mitchell (Associate Director Nursing, Medicine) were present for this section of the report. John Scott summarised the highlight of the month reported, better care for stroke patients using PREP2 and TMS to provide upper limb recovery predictions. Research will be provided on patients and evidence related to this project. Brian Millen noted the key issue reported, impact of tobacco on Māori and the persistent inequity gap (page 51 of the agenda). Matters covered in discussion and response to questions about this issue included:

The model has been developed with the Māori Health team.

It is believed a number of people have given up tobacco smoking and replaced it with vaping; a report on vaping is being prepared and will be presented at a later date.

Opportunities are taken to encourage patients to give up tobacco smoking.

The DHB is approximately 84% smokefree; the prevalence of smoking has greatly reduced. Later in the meeting the Chief Executive advised that the prevalence of smoking had dropped 15.7% and that Waitematā DHB is under

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the 12% smokefree target set by the Government and is on track to meet the 5% target by 2025. Māori and Pacific smoking rates are declining.

Brian Millen noted the endoscopy forecast reported and that additional resource was in place this year. Child, Women and Family Services

Stephanie Doe (General Manager) and Emma Farmer (Head of Division Midwifery) were present for this section of the paper. Stephanie Doe introduced the report. Emma Farmer summarised the key issue reported, provision of antenatal Anti-D (page 56 of the agenda). Work is underway to determine actual data for the preparation of a business case in this area. It was suggested that a review be undertaken of need for the region and reported to the Board. The Chief Executive provided an update on the Measles epidemic, the Auckland region currently has 959 cases (157 Waitematā DHB; 659 Counties Manukau DHB and 142 Auckland DHB), with up to 12 new cases per day. Of the reported cases, 75 people have been hospitalised in the Waitematā area. Measles is very contagious and people do not know they are contagious for up to five days before the rash begins. It is unfortunate that other parts of New Zealand are now experiencing more cases as well. Specialist Mental Health and Addiction Services

Pam Lightbown (General Manager), Alex Craig (Head of Division Nursing), Murray Patton (Consultant) and Derek Wright (Consultant) were present for this item. An apology was received from Susanna Galea-Singer. Murray Patton introduced the report. Alex Craig also summarised the Whitiki Maurea update (page 63 of the agenda). Matters covered in discussion and response to questions included:

Whitiki Maurea will expand to fit with available resource.

All DHB sites are smokefree. Support is provided in a variety of ways to assist clients in becoming smokefree; the service also supports clients who remain committed to smoking.

The service has a dedicated smoking practitioner. Data in this area will be available early 2020.

Most residential rehabilitation programmes are facilities run by NGO partners that are similar to the DHB with smokefree environments.

Noting the additional Government funding for mental health services over a four-year period; how the funding is allocated is to be determined.

Service improvement and support for staff continues to be a priority. Surgical and Ambulatory Services

John Cullen (Interim Chief of Surgery) and Karen Hellesoe (Operations Manager) were present for this item.

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John Cullen introduced the report. It was agreed that the surgical divisional dashboard in Qlik Sense would be presented to the Committee. The key issue reported, recruiting surgical pathology laboratory staff (page 70 of the agenda) was summarised by Karen Hellesoe. Matters covered in discussion and response to questions included:

Noting the update on the cholecystitis pathway reported and that further work is underway to review this area; including a review to determine accurate data is being captured.

That the reference to surgeon resignations related to the Elective WIES Volumes was noted and that this pertains to specific surgical specialities in the surgical division.

Diagnostic and Clinical Support Services

Jonathan Wallace (General Manager and Head of Division) was present for and summarised these sections of the report. The key issue report, MIT (Medical Imaging Technologist) strike was noted.

3.2 Provider Arm Performance Summary Report – July 2019 (agenda pages 82-92) The summary report was noted.

4. CORPORATE REPORTS

4.1 Clinical Leaders’ Report (agenda pages 93-105)

Tamzin Brott (Director of Allied Health) and Jonathan Christiansen (Chief Medical Officer), were present for this item. Jocelyn Peach’s apologies were noted. Medical Staff

This section of the report was noted. Allied Health, Scientific and Technical Professions

Tamzin Brott summarised this section of the report, noting the recent ARDS graduation of the second cohort. Nursing and Midwifery and Emergency Planning Systems

The report was received.

4.2 Quality Report (agenda pages 106-194)

Jacky Bush (Quality and Risk Manager), Penny Andrew (Clinical Lead, Quality) and David Price (Director of Patient Experience) were present for this item. Jacky Bush summarised her section of the report, noting the updates provided on pressure injuries, complaints, infection control, ESBL and influenza.

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In response to a question about hospital acquired infections, it was noted that these are largely not seasonal. With regard to the report regarding the use of luers, it was noted that there is a national training programme on IV lines. The use of luers is now digitally recorded to monitor when they need to be removed. Patient and Whanau Centered Care

David Price introduced and summarised his section of the report, noting the national inpatient survey, the net promoter score, the Koromai programme, the Consumer Council and Asian Health week. Matters covered in discussion and response to questions related to this section of the report included:

That Koromai programme users are asked how they came to know about the programme, the general response is via a poster on the wall. It was suggested and agreed that programme users could be asked for feedback about the care being provided and whether they would utilise the programme again.

That David Lui had been appointed as Chair of the Consumer Council.

In response to Board queries regarding the Consumer Council, it was noted that there would be a flow of information via the Consumer Council website (being developed). The website will also include profiles of each member. At this time, meetings are not open to the public while the Council establishes its programme of work and flow. Meetings will be held across the district. The Waitemata DHB Board will have the opportunity to engage with the Consumer Council, who are required to report to the Board. The Board will be updated on the decision made in forming the Consumer Council and intended relationship/interaction with the Board.

A letter of acknowledgement from the Board Chair will be sent to the newly appointed Consumer Council Chair.

i3 update

Penny Andrew summarised the section of the report related to i3,noting in particular the update on Qlik. The report was received.

5. INFORMATION ITEMS

There were no information items in the agenda.

6. RESOLUTION TO EXCLUDE THE PUBLIC (agenda page 195)

Resolution (Moved Kylie Clegg/Seconded Allison Roe) That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below:

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1. Confirmation of Public Excluded Minutes – Hospital Advisory Committee Meeting of 31/07/19



Confirmation of Minutes

As per resolution(s) to exclude the public from the open section of the minutes of the above meeting, in terms of the NZPH&D Act.

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


Privacy The disclosure of information would not be in the public interest because of the greater need to protect the privacy of natural persons, including that of deceased natural persons.

[Official Information Act 1982 S.9 (2) (a)]

3. Human Resources Report




Negotiations

The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.


Carried The open session of the meeting concluded at 3.52p.m. SIGNED AS A CORRECT RECORD OF THE WAITEMATĀ DISTRICT HEALTH BOARD HOSPITAL ADVISORY COMMITTEE MEETING OF 11 SEPTEMBER 2019

COMMITTEE CHAIR

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4.1 Chief Executive’s Report

Recommendation:

That the Chief Executive’s Report be received.

Prepared by: Dr Dale Bramley (Chief Executive Officer)

1. News and events summary A number of events of significance took place across the DHB over the past six weeks: Asian Health Week – Asian Health Services celebrated its 20th anniversary during the Asian Health Week (9-13 September) with a series of events at North Shore and Waitakere hospitals, including traditional tea ceremonies, panel discussions and workshops. Our Asian Health Services has 22 full-time employees, 30 bureau workers and over 200 interpreters – making it the biggest service of its kind in the DHB sector. Currently, 23% of our district population are of Asian ethnicity. Around 30% of the DHB’s total workforce is also of Asian descent. Our Asian Health team works hard to keep our communities connected and can put patients and their families in touch with interpreters to make sure that everyone get the most from the services we provide.

Guests of honour cut the ceremonial ribbon during Asian Health Week opening ceremony. L-R Manager of Asian, Migrant and Refugee Health Samantha Bennett, Kaunihera Kaumātua Matua Fraser Toi,

CEO Dr Dale Bramley, Director of Patient Experience David Price and Vivien Verheijen from the Consumer Council.

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Health Workforce Advisory Board - Congratulations to Professor Judy McGregor who has been appointed Chair of the Health Workforce Advisory Board, which will work in partnership with the Ministry of Health to provide oversight and leadership for New Zealand’s health workforce. Te Wiki o Te Reo Māori - Māori Language Week (9-13 September) was a chance to reinforce our commitment to embedding te reo Māori across the organisation. It’s been a little under seven months since we started offering free classes to our staff. Participants have another year until they have completed the course. Knowing even basic te reo Māori can make a big difference in improving patient experience and achieving better health outcomes for Māori so I am pleased to see, so many staff embracing the language. Mason Clinic blessing – A large contingent of staff attended a blessing at the Mason Clinic on 12 August at the site of the new-and-improved Tanekaha Building. The $22 million, 15-bed medium secure unit will replace the recently-demolished 10-bed Tanekaha building, which was no longer in-use. It will go a long way towards helping us meet the growing demand for specialist mental health services in the Northern Region and is scheduled for completion in late 2020.

Artist’s impression of the new Tanekaha Building at Mason Clinic

Healthier Homes - I was delighted to hear that the Healthy Homes Initiative won the Better Outcomes Award and the special Prime Minister’s Award at the Spirit of Community Awards function on 17 September. The initiative aims to help reduce hospitalisations by helping to create warm, dry, healthy homes for low-income families. It has helped to do this by delivering more than 46,000 housing interventions to 16,000 families. The award is an amazing recognition of the hard work and commitment of everyone involved, including many people who have supported the programme across our DHB. Transforming healthcare - The i3 team won the Organisational Transformation category at the Qlik Digital Transformation Awards in Sydney in August. Our Qlik Data Discovery Programme has developed and published almost 50 Qlik Sense apps that extract real-time data used for planning care with patients, managing flow in our hospitals and contributing to continuous quality improvement. In more good news, the Leapfrog programme was a finalist in the Talent Accelerator category of the IDC Digital Transformation Awards, which recognises the achievements of organisations that have successfully digitised one or multiple areas of their business through the application of digital and disruptive technologies. China delegation – On 17 September, we hosted a high-profile delegation from Shandong, China led by Vice Governor Hon. Mr Sun Jiye and Deputy Director-General of the Shandong Provincial Health Commission, Dr Qin Chengyong. This trip helped to keep our relationship strong with Asia and

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reinforced our efforts to improve healthcare technology. We have established a fellowship programme with Shandong, and Dr Maggie Ma from i3 will be the first fellow of the programme.

First row from L-R: Dr Qin Chengyong, Deputy Director-General, Shandong Provincial Health Commission; and Dr Andrew Brant, Deputy CEO. Second row L-R: Mr. Zhang Liansan, Deputy Director-General Shandong Provincial Government; Mr Xiao Yewen, Vice Consul-

General, Consulate General of the People’s of Republic of China; Hon. Sun Jiye, Vice-Governor of Shandong Province; Dr John Cullen, Director of ESC; Dame Naida Glavish, Chief Advisor Tikanga; and Dr Lifeng Zhou, Chief Advisor Asian International

Collaboration.

Research grant - Dr Corina Grey is co-leading a research team at the University of Auckland, with Associate Professor Dr Matire Harwood, that will tackle inequities in health outcomes from cardiovascular disease among Māori and Pacific people. This work has been made possible thanks to a $2 million research grant from the Heart Foundation. The three-year study will be the first major programme of its kind in New Zealand. On average, Māori and Pacific people live seven years less than other New Zealanders, and barriers to healthcare access are considered to be major contributors to this. The project will explore how the risk of heart disease is assessed and managed. The team will then develop a plan for health policy-makers and providers, which could alter the way healthcare is delivered across primary and secondary care. I look forward to seeing the outcomes of this research.

Dr Corina Grey and Dr Matire Harwood.

Finalists announced -The 2019 Health Excellence Awards finalists have been announced, recognising individuals and teams excelling at achieving better health outcomes and improving patient experience. The awards celebrate teamwork, innovation, quality and leadership across our

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hospitals, community and primary care sites. The judges selected the finalists from 69 entries across 10 award categories that displayed sustainability, strong collaboration and long-term success. The Awards will be held at ASB Waterfront Theatre on 29 October. Expanded services - Planning is well underway to move the Diagnostic Breast Service at North Shore Hospital into a new space that will provide a more welcoming environment for patients. The architects have started the design process, creating a plan to increase capacity and enable the delivery of a new model-of-care. Building will start later in the year. The expanded Breast Diagnostic Service will help us to meet the future needs of our growing community. Pop-up vaccination clinic - There was a strong turnout for Waitematā DHB’s free measles clinic at Waitakere Hospital on Saturday, 7 September. More than 440 people turned out to have a free vaccination at the pop-up clinic set-up in response to the current outbreak. We are very grateful to the team who organised this event and the staff who came in on a Saturday to make it happen. This was a team effort and we are very glad that so many people are now protected during the outbreak. The current focus is on vaccinating children aged 1-4 years old to maintain the National Immunisation Schedule and on unimmunised Pacific and Māori people under 30 years of age.

Director of Nursing and Midwifery Dr Jocelyn Peach (third from left) is pictured with staff at the pop-up vaccination clinic at Waitakere Hospital on 7 September.

Celebrating our physiotherapists - World Physical Therapy Day (Sunday, 8 September) was a chance to raise awareness about the crucial contribution our physiotherapists make to our DHB, by keeping people mobile and independent. All staff, patients and visitors were invited to visit special stalls at North Shore and Waitakere Hospitals on Friday, 6 September to find out more about the role of physiotherapists in managing chronic pain. We currently have 125 physiotherapists who work in our hospitals and in the community. Our physiotherapists are some of the main drivers in the annual Get Up, Get Dressed, Get Moving campaign, reminding staff to encourage active recovery among patients. Celebration time – On 26 August, our Wilson Centre team marked one year since the introduction of a new electronic system that streamlines the recording of medicines for our paediatric inpatients. The fully-digitised prescription process resulted in even stronger medication safety for our most-vulnerable young people. It also means less stress for parents of our child rehabilitation and respite patients, who no longer need to coordinate their child's medication between health providers.

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Staff at Wilson Centre celebrate one year since the introduction of digital systems.

Sharing the love – A new mum who stayed on our maternity ward at Waitakere Hospital recently had such a great experience with us that she sent us a big box of beautiful teddy bears to help spread the love. These cuddly bears will be passed on as gifts to new babies. We feel very blessed to receive the gifts that come in from our community.

Lenore, Nicky and Julie from our maternity team at Waitakere Hospital were more than happy to receive the fluffy donation.

Quality improvement - The ‘Patient and Whānau-Centred Care Standards quality improvement program’ was carried out in June across 43 clinical areas at Waitematā DHB. The latest results are the best we have ever seen, with the greatest improvement in the way we communicate with our patients. We’ve also improved our clinical monitoring, care environment, respect, dignity and privacy, personal care, self-care and nutrition and hydration methods. Thank you to everyone who has worked hard to make this happen. New published works – A number of our staff have had work featured in the August issue of the New Zealand Medical Council Journal. These staff were all part of the inaugural University of Auckland and Waitematā DHB Research symposium, held in April, to highlight the research work

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within our DHB community. Many of the research projects published were presented at our Health Excellence Awards last year. I am glad to see these outstanding research projects are getting the exposure they deserve and that other DHBs will be inspired by our work. Making a difference – We celebrated ‘Thank an Orderly Day' on 16 August. Our orderlies are the backbone of our hospitals, carrying out a wide range of tasks on top of carefully transporting our patients throughout the hospital. They are crucial to the smooth running of our services and the delivery of best care for everyone. Here’s an insight into the important role of hospital orderlies: https://www.facebook.com/WaitemataDistrictHealthBoard/videos/3001166393440840/ Hand hygiene – We have again achieved the highest hand hygiene compliance rate in the country. Latest figures released by Hand Hygiene NZ show that Waitematā DHB achieved a phenomenal 90% compliance rate between April and June 2019 across more than 14,000 hand hygiene ‘moments.’ This demonstrates our ongoing commitment to hand hygiene and patient safety. We have a team of over 180 auditors, including doctors, who monitor compliance across all divisions and help to keep hand hygiene front-of-mind at a department level. We also have hand-sanitising dispensers throughout our hospitals and posters that serve as an additional reminder to everyone about the importance of hand hygiene. This kind of focus makes hand hygiene an integral part of our day-to-day culture and keeps us well ahead of the national benchmark compliance rate of 80%. The Hand Hygiene New Zealand programme is run by the Health Quality & Safety Commission and is based on guidelines put in place by the World Health Organisation (WHO). Creating a culture of appreciation - A further 51 staff have been recognised in the CEO Awards, launched in mid-2014 to celebrate those staff, nominated by their colleagues and patients, who demonstrate our organisational values through their work. Each staff member, whose nomination is considered worthy of acknowledgement, receives a personalised letter of thanks, a certificate of appreciation and a small gift. Staff acknowledged with a CEO Award since the last Board meeting are included as Appendix One.

2. Upcoming events Looking toward the upcoming months, we can expect to see:

Ongoing – Site work in preparation for demolition of Pupuke and Taharoto buildings on the North Shore campus.

25 September – Performance by singer-songwriter Julia Grace in Whenua Pupuke

12 October – Local Body Elections

23-27 October – Mental Health Awareness Week

29 October – Health Excellence Awards at ASB Waterfront Theatre

31 October – Health Literacy Symposium at Whenua Pupuke

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https://www.facebook.com/WaitemataDistrictHealthBoard/videos/3001166393440840/


3. Future Focus

The Leapfrog programme was established as a means to support a focused, intensive burst to take a large leap in moving the DHB from where we are to where we want to be. The programme consists of a small number of strategic organisation-wide projects that are resourced to achieve significant change and impact on health outcomes and patient/family experience.

The Waitematā Clinical Digital Academy commenced on 16 September with a week-long course. The inaugural course has 16 multidisciplinary participants from across Waitematā DHB services and professions and is being taught by a collaboration of National Institute for Health Innovation (University of Auckland) and Waitematā DHB staff. Course participants spent time in parts of the hospital they would not normally work within to better-understand the role it could play. Those who complete the course could be selected as a Digital Academy Fellow in 2020 and work part-time on clinical IT projects in the DHB’s innovation institute i3.

The first cohort of the Waitematā Clinical Digital Academy

The Leapfrog Team were finalists in the IDC Digital Transformation Australasia Awards in the Talent Accelerator category announced in Sydney on the 5 September. eOrders Phase 2 has seen the roll-out of new soft wristbands at Waitakere Emergency Department and ADU. A survey is now underway to gauge the experience of staff and patients. Results will inform a planned North Shore Hospital roll-out in November. eCardiology request forms are being aligned regionally with a planned start date of February 2020. Recruitment for the new position of Telehealth Coordinator will begin in October. Once the position is filled, we can begin scaling-up the project and rolling it out to more services. More than 300 telehealth clinic appointments have been carried out over the past 12 months. eVitals development work has begun on the maternity early warning score (MEWS) with a view to go-live in November. Further development is underway on Inpatient Snapshot, with the ability to record a Venous Thrombo-Embolism (VTE) assessment against all inpatients now implemented.

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4. Board performance priorities The following provides a summary of the work underway to deliver on the DHB’s priorities: Relief of suffering Progress: Patient Experience Better Outcomes Progress: On track National Inpatient Survey

National Survey April- June 2019

In Quarter 2 (April-June), Waitematā DHB recorded the best results for this survey since it began in 2014. The biggest improvement was in the communication domain, which has been trending upwards for the last 12 months.

Two questions in this domain achieved their highest-ever score: “when you had important questions to ask a doctors, did you get answers that you could understand?” and “was your condition explained to you in a way that would could understand?”

Although the overall score remained the same as the last quarter, two questions around involvement in decisions about care and treatment, and inclusion of family in discussion about care received their highest ever score at 71% and 60% respectively, improving by over 10%.

Friends and Family Test In August, we achieved a Net Promoter Score (NPS) of 77 and feedback from 1,083 people, an improvement of 19% on the previous month. The NPS continues to consistently perform well and score above the DHB target of 65.

HQSC weighted results

Communication Partnership Co-ordination Needs

8.7 WDHB

8.5 WDHB

8.5 WDHB

8.6 WDHB

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Waitematā DHB Net Promoter Score over time

Achieving the priority targets – July 2019

Better help for smokers to quit (maternity) – 95% (target 90%)

Improved access to elective surgery – 111% (target 100%)

Shorter waits in ED – 95% (target 95%)

Faster cancer treatment – 84% (target 90%)

Increased immunisation – 93% (target 95%)

Raising healthy kids – 100% (target 95%) Health Quality and Safety markers Falls Falls risk assessment audits that inform the Health Quality and Safety Commission data continue and are conducted monthly. Overall, Acute & Emergency Medicine completed 98% of falls risk assessments, Specialist Medicine & Health of Older People completed 100% and Surgical & Ambulatory completed 96% on admission. Of those, Acute & Emergency Medicine completed 91%, Specialist Medicine & Health of Older People completed 60%* and Surgical and Ambulatory completed 69% within eight hours of admission (against a target of 90%). * Issue with information systems not recognising that AT & R ward patients are “Admitted” following transfer/discharge from an acute ward. This issue is being addressed.

Hand hygiene Waitemata DHB’s Hand Hygiene Compliance Audit result for August 2019 is 91%; this exceeds national target of 80% compliance. Healthcare-associated Infections The CLAB insertion bundle was used in ICU on 100% of occasions in August 2019. The insertion bundle compliance exceeds the national target of 90%.

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Māori Health Māori scorecard

Shorter waits in ED – 95% (target 95%)

Helping smokers to quit (hospitalised) – 98% (target 95%)

Older patients assessed for falling risk – 100% (target 90%)

Raising healthy kids – 100% (target 95%) Āke Āke app - The Āke Āke app has now been downloaded more than 2,500 times, providing our staff with direct access to Māori cultural protocols, phrases, words and songs relevant to the healthcare setting. Recently, the app was upgraded to include new interactive puzzles, audio translations, waiata and karakia. Te Reo Māori programme - We continue to implement our Level 3 Certificate in te reo Māori. Learning from the first year will inform future delivery of classes. There are currently 58 staff enrolled within Waitematā DHB. Pacific Health Pacific symposium - The inaugural Pasifika Allied Health Aotearoa NZ (PAHANZ) symposium took place on Saturday, 17 August. Around 60 health professionals attended the symposium, including DHB and community allied health staff. PAHANZ was formed as a connected voice between Le Va and DHBs to harness the expertise of Pasifika Allied Health academia and practitioners, provide value through a Pasifika lens and build the Pacific Allied Health workforce. Director of Allied Health Scientific and Technical Professions Tamzin Brott took part in Talanoa (conversations).

Attendees at the inaugural Pasifika Allied Health Aotearoa NZ.

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CEO Scorecard

Actual Target Trend Patient Experience Actual Target Trendm. Better help for smokers to quit - maternity 95% 90% p Complaint Average Response Time 10 days ≤14 days

m. Better help for smokers to quit - primary care 88% 90% p Net Promoter Score FFT 78 65 p

Improved Access to Elective Surgery - WDHB 111% 100% p

Shorter Waits in ED 95% 95% e. HQSC Quality and Safety Markers - Quarterly Trend

Faster cancer treatment (62 days) 84% 90% p Older patients assessed for falling risk 97% 90%

Increased immunisation (8-month old) 93% 95% Older patients assessed sig. fall risk with care plan 99% 90% p

Raising Healthy kids 100% 95% Good hand hygiene practice 90% 80% p

Occasions insertion bundle used - ICU 100% 90% p

Occasions maintenance bundle used - ICU 96% 90% p

Surgical site infection rate per 100 procedures 0.4 ≤0.93 p

Waiting Times Actual Target Trend b. Antibiotic in the right time 97% 100%

Planned care

ESPI 1 - 90% OP Referrals processed w/n 10 days Compliant Improving outcomesESPI 2 - % patients waiting > 4 months for FSA Non-Compliant Better help for smokers to quit - hospitalised 99% 95%

ESPI 5 - % patients not treated within 4 months Non-Compliant a. Ambulatory Sensitive Hospitalisation rate (ASH) 0-4 5724 ≤5263

Diagnostics f. Annual amenable mortality rate (per 100 000) 62.9 ≤63 p

% of CT scans done within 6 weeks 75% 95% Population coverage/Access Trend

% of MRI scans done within 6 weeks 94% 90% pm. Cervical Screening 70% 80% q

Urgent diagnostic colonoscopy (14 days) 100% 90% pm. Breast screening 66% 70% p

Diagnostic colonoscopy (42 days) 43% 70% qc. Bowel Screening

Surveillance colonoscopy (84 days) 53% 70% q % referred for colonoscopy (45 days) following +ve iFOBT 96% 95% p

TreatmentPatient Flow a. HSMR (Source: Health Round Tables) 0.82 ≤1.01 q

Elective Surgical Discharges (YTD) g. # NOF patients to theatre (48 hours) 98% 85% q

Elective Discharges - Total 1,430 1,452 qm. ST elevation MI receiving PCI (120 mins) 93% 80% p

Elective Discharges - Provider Arm 934 911 p AT&R referrals assessed (2 working days) 99% 90% p

Elective Discharges - IDF Outflow 496 540 p

EfficiencyOutpatient DNA rate (FSA + FUs) 8% ≤10% q

Staff Experience Actual Target Trend Major Capital Programmes Time Budget QualitySick leave rate 3.4% ≤3.4% q Elective Capacity and Inpatient beds

d. Turnover rate - external 12% ≤14% Mason Clinic Tanekaha replacement

Lost time injury frequency (12 mth rolling average) 19 ≤10 q

Financial Result Trend

Expense/Revenue (YTD Total) 162,032 k 160,117 k p

k. Priority Health Outcomes - Monthly Actual Target Trend m. Priority Health Outomes - Quarterly Actual Target TrendShorter Waits in ED 95% 95% q Better help for smokers to quit - maternity 94% 90% p

Increased immunisation (8-month old) 87% 95% p Better help for smokers to quit - primary care 88% 90% p

Better help for smokers to quit - hospitalised 98% 95% q

Faster cancer treatment (62 days) 90% 90% p Quality and Safety Markers - Quarterly

Raising Healthy kids 100% 95% h. Surgical site infection rate per 100 procedures 0 0.93

k. Quality and Safety Markers - Monthly m. Maori Workforce - QuarterlyOlder patients assessed for falling risk 100% 90% Māori percentage of overall workforce 6.8% 7.4% q

Older patients assessed sig. fall risk with care plan 98% 90% q Māori percentage of priority workforce group 5.8% 6.7% q

g. # NOF patients to theatre (48 hours) 67% 85% New employee ethnicity not specified 0% ≤5%

Existing employee ethnicity not specified 2% ≤5%

Performance indicators: Trend indicators:

Achieved/ On track Substantially Achieved but off target p Performance improved compared to previous month

Not Achieved but progress made Not Achieved/ Off track q Performance declined compared to previous month

Performance was maintained

Contact: Victoria Child - [email protected] - Reporting Analyst, Planning & Health Intelligence, Planning, Funding and Health Outcomes, Waitematā & Auckland DHBs Team

Waitematā DHB Monthly Performance Scorecard

CEO ScorecardJuly 2019

1. Most Actuals and targets are reported for the reported month/quarter (see scorecard header).

2. Actuals and targets in grey bold italics are for the most recent reporting period available where data is missing or delayed.

3. Trend lines represent the data available for the latest 12-months period. All trend lines use auto-adjusted scales: the vertical scale is adjusted to the data minimum-maximum range being represented. Small data range may result small variations perceived to be large.

a. Reported quarterly - latest available Mar Q3 18/19

b. Mar Q3 2018/19 (latest HQSC data available).

c. Bowel Screening - New Indicator - % referred for colonscopy (within 45 days) following positive iFOBT (Sep 16 - Mar 19).

d. Employees taking positions outside of the hospital/DHB

e. Prelim Data Jun Q4 18/19

f. Annual data - latest available 2015

g. Coding dep, rolling 3 mths - Jun 19

h. Reported quarterly - latest available, Dec Q2 18/19

k. Small volumes result in sensitivity to traffic light criteria

m. Reported quarterly - Jun Q4 18/19

Prioirity Health Outcomes

How to read

Managing our Business

Best Care

Provider Arm - Service Delivery

A question?

Key notes

Maori Scorecard

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Appendix 1 CEO Recognition

Yoomi Clarkson and John Ahn - Registrars, Cardiology. Nominated by Catherine Clow. “For their outstanding, down to earth and empathetic approach with patients and their families. Yoomi and John are very good examples of excellent practise and patient-centred care.” Iska Girard De Soucanton - Registered Midwife, North Shore KYM. Nominated by Rebecca Eade. “Iska has been working in various roles within our Community Midwifery Team to cover for leave. She is adaptable, diligent and an inspiring member of the team. She has worked in new challenging areas and ensured safe care is provided to our women using our service. We are grateful for her effort.” Norrieh Fadaie - Dental Therapist, Dental South 3. Nominated by Arshika Kumar. “Norrieh works very hard work and shows genuine empathy for the kids in her care.” Jaime Nito - Dental Assistant, Dental South 3. Nominated by Arshika Kumar. “Jaime is compassionate about the job he does and helping other team members.” Courtney Coe - Occupational Therapist, Child Development West. Nominated by Louise Guy. “Courtney is a very passionate Occupational Therapist who works tirelessly with families to get the best outcomes for the child. She is a fantastic advocate, approachable, caring, and compassionate. She goes the extra mile and really does care about the children on her case load and wants to ensure they are supported to achieve as well as possible and to make a difference.” Linda Flay - Operations Manager, Cardiology and Slark Hyperbaric. Nominated by Liane Dawson. “For her support and strong, compassionate leadership.” Pearl Morse - Clinic Coordinator, Women's Health Management. Nominated by Geraldine Kirkwood. “Pearl demonstrates that 'everyone matters'; she is patient focused and she influences the DNA rates positively by re-scheduling patients and assisting them with non-clinical questions. She strives for 'better, best, brilliant' outcomes for us all. Pearl is an asset to this organisation and deserves to be recognised for her very quiet and effective work.” The following people have been nominated by Alison Roper. Vicki Davis – Play Specialist, Child Rehab Therapy. Cara Davidson - Play Specialist, Residential Unit. “Vicki and Cara go above and beyond to keep the smiles on the children’s faces and in doing so also support families and colleagues. Many thanks for all your efforts in creating a wonderful mid-winter ball. It was amazing.” Isobelle Gorman and Kate Donovan - Physiotherapists, Inpatient North Therapies. Nominated by Taryn Kearney. “Izzy and Kate have done an excellent job providing rehabilitation for complex patient following a femur fracture. They have worked consistently with him to ensure he did not become bedbound. They have been creative in developing strategies to build his engagement and participation. Izzy and Kate have been strong advocates for getting this patient accepted for the rehabilitation which he requires.” Zoe Wells - House Officer, Orthopaedic Surgery. Nominated by Taryn Kearney. “Zoe did an exceptional job facilitating and leading a family meeting for a palliative patient. She was attentive to the family and patient’s needs and clear with her communication and recommendations. Zoe demonstrated all DHB values during this challenging family meeting.” Sue Huskinson - Charge Nurse Manager, Ward 9. Nominated by Taryn Kearney. “Sue was empathetic and supportive of a patient, providing practical advice for his care and discharge planning. Sue demonstrated all DHB values during this challenging family meeting.” Yvonne Bolweg - Registered Nurse, Dependant Haemodialysis. Nominated by Baskar Reddy. “Yvonne has gone out of her way to provide expert clinical support to help cover. She nurses with a very high standard of professionalism and dedication to patients in her care, demonstrating compassion and kindness to all. It has been a great pleasure working with Yvonne; she is a true asset to the team.”

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Ruth Dryfhout - Communications Advisor, Communication Team. Nominated by Georgina Tucker. “Ruth has been doing fantastic work to support awareness of immunisation in the context of the large measles outbreak affecting the Metro Auckland area. Ruth’s videos are engaging and are getting great feedback from our community; shared by other DHBs and being picked up by national media. Ruth has gone over and above to ensure the whānau being part of these videos have also been well-supported.” Margaret Titchener - Volunteer Chaplain's Assistant, Chaplaincy Department. Nominated by Uesifili Unasa. “As one of the first people we see when entering the hospital, Margaret is the friendly face of our DHB. She has a gentle and reassuring presence for patients and families. Margaret is a very committed member of the chaplaincy team. Although she continues to care for her own family commitments, Margaret always has time to fulfil her weekly commitment to the hospital and her fellow volunteers. I believe Margaret is a fine exemplar of our DHB values.” Ke Zhen Hu - Acting Charge Nurse Manager, Anawhata Ward. Nominated by the Hospital Palliative Care Team. “Ke Zhen has been Acting Charge Nurse Manager and has been excellent in this role. She shows real compassion for the palliative care patients in the ward. She always sees the bigger picture and is gracious and kind to work with.” Kayla Manwaring - Registered Nurse, Ward 4. Nominated by the Hospital Palliative Care Team. “Kayla is a very proficient nurse who is excellent with our palliative patients. She shows compassion and really demonstrates the values of the DHB.” Miki Kawagoe - Bureau Coodinator, Bureau Clinical. Nominated by Jan McClymont. “Miki is an outstanding Waitematā Central Staffing Team Nursing Co-ordinator. Her hard work, energy, attention to detail and ability to think outside the square in her role is amazing. She goes out of her way to ensure all ward requests are met and her contribution and professionalism is really valued.” Fraser Toi - Cultural Worker, Kaunihera Kaumatua, He Kamaka Waiora Māori Health. Nominated by Barbara Corning-Davis. “I’d like to express my heartfelt thanks and recognition for Fraser Toi, He Kamaka Wairoa Kaumatua, who delivered a very special karakia for 25 hospice and aged residential care providers as they engaged in quality improvement training. Fraser came on very short notice and rightfully set the tone for the mission of this very special group of caregivers. Kia ora!” Kim Hatton - Registered Nurse, Tanekaha Unit, Mason Clinic. Nominated by Sharon Price. “Kim has been gone above and beyond what is expected in her role involved in ongoing multi-agency liaison which involves building relationships in often challenging environment and her efforts should be commended.” Anabella Lacanilao - Dental Therapy Assistant, Dental Central 3. Nominated by Yumna Van Niekerk. “Thank you so much for your amazing hard-work and endless conscientious professionalism. You constantly help to improve the flow of day-to-day duties including the improvement of our services by always thinking outside the box. You always have the team and patient’s interest at heart and being that 'go to person' makes you invaluable.” Gale Robinson - Team Leader, Workforce Central. Nominated by Jeni Codner. “Thank you for never failing to bring support, knowledge, drive and enthusiasm to our day – everyday. Your commitment, understanding and passion for not just the organisation as a whole but for our team is unwavering. It really is fantastic to be part of your team.” Ailish Curran, Jake Helsby and Adam Leys - Physiotherapists, Inpatient North Therapies. Nominated by Dr Min Yee Seow. “Ailish, Jake and Adam are very hardworking and outstanding physiotherapists. They demonstrate how to be great team player and always give 110%. I would like to thank them for their dedications to patients.” Chloe Maeva - Registered Nurse, Moko Services. Nominated by Craig Heta.

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“This is for her leadership and tenacity during a very challenging time in our service. Chloe stepped up into a senior role when we were having capacity issues, handling the additional responsibilities in a very competent and professional way, all whilst maintaining her existing case-load and delivering best care to the tangata whai i te ora she works with. Well done, Chloe.” Joanna Nua - Business Support Administrator, CADS Regional Admin. Nominated by Keryn Wilson. “Jo is new to the role and has fitted into this role with professionalism. No task is too big or small. She has a real can do attitude, is helpful and supportive. We really appreciate her.” Kylie Kozenof - Registered Nurse, Womens Health Management. Nominated by Susan Shoby. “Kylie demonstrates the DHB values in her everyday practice. She shows her compassion for her patients and will go the extra mile to ensure patients receive the best care possible. Kylie's positive attitude, her depth of knowledge and willingness to support colleagues is felt on every shift she works.” Dr Mike Ngawati - Registrar, CADS Regional Admin. Nominated by Keryn Wilson. “Mike is new to our team and has fitted in so well. He is compassionate with the clients and has a caring nature. He seems to understand the patient journey and shows a real interest in making a difference.” Leanne McKenzie - Associate Clinical Charge Nurse, Radiology Services. Nominated by Lyndsay Kidd-Edis. “This is for consistently going above and beyond for patients and their families. Even when the patient has transferred to a ward, Leanne still visits them, often giving them a wash and checking the family have everything they need. Leanne is an exceptionally compassionate and caring, consummate professional. She also ensures her team is supported, she leads by example and creates a nurturing environment.” Sandra Classen - Registered Nurse and Clinical Coach, Nurse Educator Team. Nominated by Amanda Rose. “Sandra has gone above and beyond, to ensure that one of the patients on her ward received ‘best care’ possible. Sandra created a comprehensive detailed care plan for this patient Sandra was an amazing advocate and support person for this patient who was going through a very difficult journey to heal. Thank you so much Sandra for all that you have done for our patient.” Laura Broome - Project Manager, Institute of Innovation and Improvement. Nominated by Dr Jonathan Wallace. “Laura has done amazing work with Radiology on our improvement programme and lives our 'connected' value every day.” Carol Holmes - SMO Coordinator, General Medicine. Nominated by Debbie Hogan. “Carol has many balls in the air every day and embodies the value of 'everyone matters', ensuring the smooth running of general medicine rosters. Assisting the RMO unit with junior doctors and running the general medicine rosters and often having to cover gaps on the roster with a gentle phone call ensures that the service delivers the 'best care' for our patients.” Helen Martin - Enrolled Nurse, Home Health Support West. Nominated by Angela Smith. “Helen is an exemplary nurse, she is extremely hard working and goes above and beyond for her patients. Her care is excellent and of the highest standard. She is an asset to the district nurse team at Waitakere Hospital.” Nicola Moore - Registered Nurse, Prison Liaison Team. Nominated by Sharon Price. “Nicola has been with the team for less than a year and has adapted to her new role very easily. She should be commended for her high level of professionalism and her ability to be flexible and respond to the needs of the service.” The following people have been nominated by Lee Gaseltine. Nada Hadad - Medical Laboratory Scientist, Microbiology. Heena Kidiwala - Medical Laboratory Scientist, Microbiology. Elizabeth McChlery - Medical Laboratory Scientist, Labs Administration.

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Lynn Brott - Medical Laboratory Assistant, General Labs. Phillippa Reid - Medical Laboratory Technician, Microbiology. “These amazing staff members have helped organise another very successful Waitematā Scientific Seminar which has brought together various disciplines, colleagues, clinicians and patients through on-going education. They show initiative and professionalism to ensure the smooth running and delivery of the seminar to an excellent standard, not only to Waitematā DHB staff but also to staff from Northland to Taranaki - and they all do it with a ‘can do’ attitude which ensures a positive experience is had by all.” Melanie Taylor - Locality Assistant, Rodney Therapies. Nominated by Carli Hay. “Melanie assists a wide variety of allied health and nursing staff, and often has to juggle many tasks at once. She is always willing to assist and go the extra mile when an urgent issue arises, and can always be counted on to get the job done. Her lovely smile and kindness in the office also raises the overall morale. Thank you Melanie for all you do for the team!” Robyn Heaps - Dental Therapist, Dental North 4. Nominated by Beth Phillips. “Robyn is very knowledgeable and is currently passing on that knowledge to a new graduate that has just entered the dental service. Robyn always provides the best care to the children and families that visit the clinic where she works and she is a wonderful example to our new staff on how to best demonstrate WDHB values.” Helen Walsh - Sonographer Team Leader – Cardiology. Nominated by Georgina Dew. “Helen is a considered and compassionate team leader of the Echo Team. She is focused on and supports the team to provide the 'best care' for our patients. With the recent upgrade of our reporting system Helen managed the transition, ensuring that the roll out went as smoothly as possible. She is future focused for the improvement of our service for the benefit of our patients and community.” Pele Guttenbeil - Registered Nurse, Detox Centre – CADS. Nominated by Keryn Wilson. “In the words of her colleagues 'she’s just perfect'. Pele makes study and having a full time job look effortless. No task is too big or too small for Pele. She is a committed and energetic nurse who strives for excellence.” Kim Coulter - Physiotherapist, Child Rehabilitation Service. Nominated by Jane Hamer. “Kim has worked tirelessly and persevered to develop the NCRS e-referrals system. She has enthusiastically led the team through this change in process, collaborated widely across the DHB, and truly demonstrates the values of 'better, best, brilliant' and 'connected'.” Nicole Cope - Senior Psychologist, Youth Services – CADS. Nominated by Jason Cabral-Tarry. “Nicole is compassionate with her clients and colleagues, delivers excellent training and supervision to clinicians and her positive approach to often difficult situations makes us feel 'connected' and appreciated.” Viliamikapeni Anau - Security Coordinator, Security Services. Nominated by Louise Jamieson. “Our staff had some really good feedback in regards to Vili – he was very gentle when engaging with our client and provided support and reassurance. We are very thankful to Vili.” Jeremy Skipworth - Clinical Director, Forensics Management. Nominated by Shivika Singh. “Apart from the decision-making, communication and overall professionalism, the most important thing I have learnt from Jeremy is how to be a good clinician and to constantly think critically. The difference Jeremy makes is nothing short of legendary!” Mark Ashby - Operations Manager, Forensics - Mason Clinic. Nominated by Shivika Singh. “Mark sets the course for the rest of us. I appreciate him for being approachable and willing to listen. Thank you, Mark.” Clare McCarten - Associate Service Manager, Forensics Management. Nominated by Shivika Singh. “Clare motivates her team, and is a true inspiration. She does such a great job day in and day out! Thank you Clare.”

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4.2 Health and Safety Performance Report

Recommendation:

That the Board receives the report. Prepared by: Michael Field (Group Manager, Occupational Health and Safety Service) Endorsed by: Fiona McCarthy (Director, Human Resources)

1. Purpose of report

The purpose of the Health and Safety Performance Report is to provide quarterly reporting of health, safety and wellbeing performance including compliance, indicators, issues and risks to the Waitematā DHB.

2. Strategic Alignment

Community, whanau and patient centred model of care

This report comments on issues and risks that impact on staff health and safety and therefore patient care and organisational culture.

Emphasis and investment on both treatment and keeping people healthy

This report comments on organisational health and safety information via incident reports, health monitoring and identified hazards.

Intelligence and insight This report provides information and insight into staff workplace incidents and what Waitematā DHB is doing to respond to these and other workplace risks.

Evidence informed decision making and practice

The leading and lagging indicator dashboard is based on current best practice indicators and targets. Risk controls are regularly audited to align to an evidence base.

Outward focus and flexible, service orientation

Health, safety and wellbeing risks and programmes are focused on staff, visitors, students and contractors. All strategic and operational work programmes and policy decisions are discussed with relevant Services, such as site visits and approaches to reduce risks.

Operational and financial sustainability

As appropriate, programmes of work will outline how Services will ensure operational sustainability, how measures of success are set and value and return on investment is monitored.

3. Executive Summary For the July reporting period Waitematā DHB has met the majority of leading and lagging indicators.

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Two particular highlights are: 1. Our influenza vaccination rate which is 66% against a target of 60%.

2. Our target for pre-employment health screening prior to employment has increased to 72%

against a target of 70%. Achievement of the target has been possible with some additional pre-employment screening nurse hours. Managers are always contacted as part of our standard process, to follow up staff that have not been screened and to clarify the expectation that all staff complete their pre-employment health screening prior to commencement.

The Lost Time Injury Frequency Rate (LTIFR) remains challenging, with a higher number of incidents requiring lost time, per million hours worked, than our target (18 against a target of 10). Programmes to address incident rates are ongoing, with regular communications and advice being provided to staff, through regular DHB communications, posters and during face-to-face Divisional meetings. Although the LTIFR remains challenging, the Lost Time Incidents (LTIs) requiring less than seven days off work remains strong at 58%, compared with a target of 65%. This shows that many of the actions we have undertaken, to reduce the consequence of incidents, are delivering positive results. Overall, reported incidents have reduced and follows downwards trend since July 2018. In relation to top accident types: 1. Slips, trips and falls decreased this month to a total of nine. Three slipped for no apparent

reason, two fell off chairs, two tripped over items on the floor, one tripped in the car park and

one tripped over their own feet.

2. Moving and Handling of patient incidents decreased significantly this month from 18 in June to seven in July with the Moving and Handling team reviewing and following up on all incidents, including auditing moving and handling equipment in the areas injuries were sustained. In addition, new online training is being developed, to ensure the widest access for staff, especially those that do not handle patients, but are involved in lifting/moving, such as orderlies and cleaners.

3. Physical Aggression incidents have increased this month to 66, up from 43 in June, although rates are decreasing year on year. As previously reported, a number of actions are in place to manage the likelihood of physical aggression incidents occurring and/or to reduce the severity of consequence when incidents occur. In July, 91 per cent of all physical aggression incidents were caused by people who had no intention to cause harm.

45


4. Performance Dashboard

0

50

100

150

200

250

300

350

400

Au

gust

Sep

tem

ber

Oct

ob

er

No

vem

ber

Dec

emb

er

Jan

uar

y

Feb

ruar

y

Mar

ch

Ap

ril

May

Jun

e

July

Reported Incidents

2019

2018

77

0

34

1 1

55

0

83

41 28

Number of Incidents by Division July 2019

Physical Assault (Body Only)

29%

Unsafe Shift Pattern & Hours of Working

26%

Verbal Assault (General)

18%

Caught / Struck In or By

14%

Inappropriate Behaviour

13%

Top Five Incidents by "Nature of Incident" July 2019

Cuts, Abrasions or Bruises

3%

Musculoskeletal Injury (Soft

Tissue) 4%

Neurological Effect

1%

Psychological Effect 92%

Injury Outcomes of Aggression Incidents July 2019

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

2019 15 14 22 14 20 32 16

2018 11 13 16 21 20 23 14 20 23 15 15 9

0

5

10

15

20

25

30

35

Moving and Handling Incidents

Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec

2019 96 78 89 65 61 43 66

2018 34 26 51 45 44 108 89 75 86 63 63 87

0

20

40

60

80

100

120

Physical Aggression Incidents

22

0 2

0 0 0 0

22

16

4

Physical Aggression Incidents by Division July 2019


2019 15 14 19 12 10 12 9

2018 21 16 15 21 19 13 26 12 17 19 15 10

0

5

10

15

20

25

30

Slips Trips Falls Incidents

2

0 0

1

0

3

0

2

0

1

Slips Trips & Fall Incidents by Division July 2019

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5. Occupational Health Activity

As previously requested, outlined below is a summary of occupational health activity undertaken in the DHB.

0

50

100

150

200

250

300


Vaccines Given

2019

2018

0100200300400500600700800900

100011001200130014001500160017001800190020002100

Jan

Feb

Mar

Ap

r

May

Jun

e

July

Au

g

Sep

t

Oct

No

v

Dec

Pre Employment Forms Processed

2019

2018

0

50

100

150

200

250

300


Contact Traces Staff Involved

2019

2018

0

1

2

3

4

5

6

7

8

9

10

Jan Feb Mar Apr MayJune July Aug Sept Oct Nov Dec

Work Station Assessments

2019

2018

0

5

10

15

20

25

30

Blood and body fluid explosures

2019

2018

0

200

400

600

800

1000

1200

1400

Jan Feb Mar Apr MayJune July Aug Sept Oct Nov Dec

Nurse Consultations

2019

2018

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6. Work related injury Claim Data for July 2019 Outlined below is our injury claims data for July. Work injury claims data is for all work injuries currently managed by the DHB, including injuries that occurred in previous years, up to and including injuries for July 2019.

INJURY CLAIM DATA

Total: Injury Claim Report for July 2019

Lost days Treatment cost Weekly compensation

costs (80% of salary) Staff cover cost Total

Number of lost

days for month

$ total for

month $ total for month

$ total cover cost

for month

Total $ cost for

month

300 $47,680.64 $57,391.39 $71,739.24 $176,811.27

High accident events account for approximately 63% of the claims, as below:

High Accident

Injury type

Lost days this

month

% of cost this

month

Cost this month Year to date trend for injury

claims

Moving and handling 51 20% $35,437.11

Slips Trips Falls 110 35% $61,470.54 ↑

Aggression 28 15% $27,222.12 ↑* Due to lower

costs from April this trend is now starting to flatten

*Actions taken to mitigate high accident types are noted in the Executive Summary.

The following table has been included to provide information on the total cost of aggression related injury claims only (13 month rolling table).

Although there are the expected peaks and troughs, the overall trend is unfavourable due to higher costs in prior months, although as noted the trend is now starting to flatten out. Please note, these costs are those expensed by Waitematā DHB during the reported periods, and do not reflect incidents that occurred within that same reported period. This is because there is a lag between an

$12,834.24

$31,632.87

$22,789.79 $23,866.19

$36,256.00

$52,417.28 $51,973.25

$30,303.24

$47,379.29

$21,031.12 $17,765.09

$38,153.51

$27,222.12

Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19 Jun-19 Jul-19

Aggression Related Claims Costs

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incident occurring and costs being expensed, and that injuries can span multiple report periods, sometimes over multiple years, depending on the severity and time required to return to work (RTW).

7. Stakeholder feedback

7.1 Facilities and Development – Health and Safety Management Systems Key Highlights - July 2019 The table below provides an oversight of the department’s adherence to work monitoring, contractor management and health and safety performance.

Health and Safety Statistics - July 2019

Facilities Development

Facilities Management

Total

Incidents and accidents

Lost Time Injuries 0 0 0

Serious Harm Accidents 0 0 0

Accidents Requiring Medical Attention 0 0 0

Accidents Requiring First Aid 0 0 0

Near Miss Incidents

This Month 0 0 0

Monthly Average 0

Year to Date 28

Safety Inspections completed this Month

Projects NA*

Facilities Operations

100%

H&S / Toolbox Meetings this Month

Projects NA*

Facilities Operations 100%

Contractor Site Inductions

This Month 6

Year to Date 457

NA* - No active facilities and development projects during the month of July.

Injuries and Accidents

Incidents and accidents are monitored across all DHB sites and include data for staff and contractors.

Near Miss / Incidents Near Miss and Incidents are monitored across all DHB sites and include data for staff and contractors.

Safety inspections Safety Inspections are expected to be completed weekly during the construction period for all projects.

Health and Safety Toolbox meetings

All contractors and staff are expected to attend one health and safety / toolbox meeting per construction week for projects.

Facilities Management staff are expected to attend fortnightly health and safety / toolbox meetings.

Contractor site inductions

This is an indication of the number of new contractor staff on site and will vary significantly with

construction project work load.

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8. Health and Safety Risks

As discussed during the Board Health and Safety workshop, we have introduced new reporting of our key hazard areas and the resulting actions. The table below outlines our key health and safety risk categories, commentary on the current projects related to that risk, and whether those projects impact the likelihood or consequence/outcomes of that risk. Traffic lights indicate progress of each project.

Key

Progress Indicator

Red Major delays

Amber Minor delays

Green On track

Risk Measure Addressed

L Likelihood

C Consequence

Risk Update Start Date Est. Date to

Complete Progress Indicator

Risk Measure

Addressed

Biological Risks

Blood and Body Fluid Exposures (BBFE)

Needle stick injuries

Needleless Systems: Both North Shore and Waitakere Hospital audits have been completed and recommendations either closed or being followed up. Audits Complete: 100% Audit findings and recommendations to be discussed at the October Executive Health, Safety and Wellbeing meeting. A ‘sharps safety week’ has been scheduled for December 2019, in-line with the international sharps awareness month. Complete: 0%

Sep 2018

Dec 2018

Oct 2019

Dec 2019

L L

Splashes Incorporated within all BBFE related projects, including Personal Protective Equipment (PPE).

Ongoing Ongoing L/C

Substances hazardous to health

Asbestos Register

Refurbishment surveys are carried out prior to invasive works. Current projects underway are: Taharoto building demolition Various other refurbishment surveys have also been completed for smaller projects managed by Facilities, in line with Safe Systems Of Work (SSOW) process. No concerns to date.

Ongoing

Ongoing L

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Mould OH&SS continue to review all air testing reports relating to mould and provide advice to the relevant Service managers and Facilities. No concerns to date.

Ongoing Ongoing L/C

Chemicals Hazardous Substances and New Organisms (HSNO) Audits: Review of new Act has been completed and audits of 33 high risk areas (67 physical locations) have recommenced. Audits completed: 58% Hazardous Goods Store for Waitakere Hospital: Case approved to install hazardous goods bunkers by mid-2020 Complete: 20%. Trial on transferring HSNO waste within the main hospitals: new trial set to commence Aug 2019 for a further 6 weeks. New Trial: Complete: 50%

Sept 2016

Dec 2016

Jun 2018

Dec 2020

April 2020

Sept 2019

L L

L/C

Ergonomics

Moving and Handling

On-going actions: Meetings with managers will continue to be held to discuss moving and handling requirements including training, to provide support to services. There are no concerns to date.

Ongoing Ongoing L/C

Posture There is online self-assessment guidance available for all staff to access. Workstation assessments are ongoing, as staff requests them.

Ongoing Ongoing L

Physical

Machinery A schedule has been set up for Facilities Maintenance staff to check/review and service all machinery. There are no concerns to date.

Ongoing Ongoing L

Equipment Clinical Engineering hold a master file of all clinical equipment across WDHB and this equipment is serviced on a recurring schedule. There are no concerns to date.

Ongoing Ongoing L

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Electrical safety

A project to identify all electrical equipment has been completed, with all external contract maintenance providers having been contacted and the standards that equipment is serviced to have been reviewed for compliance. Clinical Engineering holds all records, including service maintenance schedules. Clinical Engineering following up with all non-compliant suppliers.

Ongoing Ongoing L/C

Uneven surfaces

On-going actions: Communications continue to be developed and released regarding Slips, Trips and Falls hazards, focussed heavily on staff rushing to complete tasks. Each incident of this type is followed up by OH&SS, with any corrective actions tracked to completion. There are no concerns to date. BIEMS Upgrade: Delivery Complete: Stage 1 build: 100% and Stage 2 rollout: 100%. Installed and deployed including Dashboard for real time analysis.

Ongoing

Dec 2017

Ongoing

Sept 2019

L/C L

Roading Pedestrian Crossings: Stage 1 of the North Shore Hospital pedestrian crossings programme (repainting of existing crossings) has been completed. Stage 2 – All crossing works has now been completed Helipad: The pedestrian crossing to service the helipad, including appropriate lighting, has been scheduled for completion in 2019. Construction works on the raised crossing will start on 9 September and will take around 22 days. Operational plan & disruption notice is in progress. Planning complete: 85% Physical works complete: 70%

Oct 2017

Oct 2017

Feb 2017

March 2019

April 2019

September 2019

L L L

Buildings Loading Docks: CAPEX has been approved to finalise the concept design.

Feb 2017 Oct 2019 L

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A Business Case is due to the Executive Leadership Team once confirmation has been received from Fire Engineer regarding the proposed location for the waste/recycling bins. Estimate time for construction to be confirmed. Planning complete: 85%

Emergency Management

Fire Fire evacuation drills are conducted regularly by the Fire Safety Officer and fire safety equipment, such as sprinklers and smoke alarms, are regularly audited for compliance, overseen by Facilities. Responsibility for hospital based emergency management sits with the Director Hospital Services and for Community Services sits with the Director of Nursing.

Ongoing Ongoing L/C

Civil emergency

WDHB conducts desk-top emergency drills on an ongoing basis. Emergency response team personnel have been identified and trained. This includes contact points with Civil Defence. An audit on emergency preparedness is planned for 2020.

Ongoing Ongoing C

Bomb threats WDHB conducts desk-top emergency drills on an ongoing basis. Emergency response team personnel have been identified and trained. This includes evacuation and contact points with Emergency Services (Police and Fire). Drills are completed annually.

Ongoing Ongoing C

Firearms WDHB conducts desk-top emergency drills on an ongoing basis. Emergency response team personnel have been identified and trained. This includes evacuation and contact points with the NZ Police. Drills are completed annually.

Ongoing Ongoing C

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Psychological

Aggression The new Managing Aggression and Potential Aggression (MAPA) training has started being implemented across Waitemata DHB. The following actions have been completed: • Four educators were accredited to

deliver the MAPA Foundation programme

• Three educators have been accredited for the Advanced programme

• Five MAPA Foundation (2 day) programmes were delivered to 60 ED, Security and Duty Manager staff during June 2019

We reviewing currently available education resource due and took account of a busy winter period. MAPA delivery is scheduled as the following per month: 1 x MAPA Foundation 1 day 1 x MAPA Foundation 2 day 1 x MAPA Advanced 2 day

• First MAPA Advanced workshops scheduled for September, October and November targeting emergency response roles to attend first.

Complete: 90% (due Dec 2019) Additional Security Door Access, North Shore Hospital: New access way and design approved by internal stakeholders (OH&SS, ED and Security). Design stage: 100% Installation complete: 0% (completion due Sept 2019)

Feb 2018

Oct 2016

Dec 2019

Install from Sept 2019

L/C

L/C

Bullying and harassment

Toolkit on Speaking up about bullying and harassment on Staffnet. HR Learn session held July 2019

Ongoing Ongoing L/C

Lone workers Following on from the previous work completed, a new project has commenced to review all organisational policies and procedures covering lone worker emergency response plans. This is to ensure that response plans are available within all areas with lone

Jun 2018 Dec 2019 C

54


workers, and that they are complete and communicated to staff. Complete: 30%

Stress/Distress/Fatigue

EAP services in place. No issues. Ongoing

Ongoing

L/C

Safe staffing RMO rosters: House Officers rosters developed, consulted and implemented: 100% Registrar rosters: rosters developed, consulted and implemented: 25% Consultation complete but not yet implemented. Rosters will be implemented once recruitment for specific rosters is complete- this is occurring with all urgency. Complete: 75% Nursing Care Capacity Demand Management (CCDM) and NZNO MECA Accord recruitment: CCDM: Services completing CCDM FTE reviews: 0%

Dec 2018

Feb 2019

Dec 2019

Jun 2021

L

55


4.3 Communications Report

Recommendation:

That the report be received.

Prepared by: Matthew Rogers (Director, Communications)

Communications support The communications team provided advice and support to the following projects/campaigns/issues/ events over the last six weeks:

Ongoing activity re start of works on new hospital building on North Shore campus

Staff parking changes – further updates

Telehealth clinics proactive media pitch

Podiatry partnership with AUT proactive pitch

2019 Yearbook planning and early production

Medical Imaging Technicians (MIT) industrial action

Heath Excellence Awards finalists announcement

Support metro Auckland IMT measles comms approach

Money Week

Mental Health Awareness Week

Asian Health Week

Māori Language Week

Bowel screening comms

Violence Intervention Programme event planning

Psychologists’ industrial action

Asian health delegation official visit

Consumer Council comms presentation

HDC decision reactive comms

Career profiles for Recruitment Team

Compassion campaign

Annual Plan content

Ongoing implementation of Board decision re incorporation of macron

Major facilities development communications

Identification, scheduling and production of social media content and issues management

Ongoing publication of messages via the Medinz primary care communications platform

Health Heroes awards coordination

Coordination of responses to ‘Dear Dale’ emails to the CEO from DHB staff

Review of content for submission to health sector publications

Ongoing weekly internal communication via StaffNet home page and Waitematā Weekly

Ongoing management of Official Information Act responses

Liaison with Well Foundation Marketing and Communications

Ongoing liaison with Metro Auckland DHB communications leads

Ongoing after-hours and weekend media line cover and senior management communications support

Proof-read leaflets, booklets and brochures for various departments

Ongoing compilation and distribution of proactive media material

56


Event photography and video

Drafting of correspondence from the corporate office

CEO Board Report

Review of copy for DHB website

Management of organisation-wide screensaver content

Approval of all-user staff emails

Weekly Board briefing

Fortnightly A Note From the CEO email to all staff

Weekly National Health Targets and clinically-led metrics updated and communicated

Waitematā DHB website – Google Analytics Statistics

Waitematā DHB website

Number of visits August 2018 August 2019

Total visits to this site 60,230 71,249 (+18.29%) New Zealand 27,852 32,550 Australia USA

734 445

1,059 663

United Kingdom 275 313 Top areas August 2018 August 2019

37,736 13,219

4,258 3,160 2,799

Waitemata DHB staff page 31,557 Home page 13,823 North Shore Hospital Waitakere Hospital Contact us

4,118 3,431 2,763

Traffic sources

August 2018

August 2019

73% 23%

4%

Search traffic 74% Direct traffic 21% Referral traffic

5%

57


16,00018,00020,00022,00024,00026,00028,00030,00032,00034,00036,00038,00040,00042,00044,00046,00048,00050,00052,00054,00056,00058,00060,00062,00064,00066,00068,00070,00072,00074,00076,000

www.waitematadhb.govt.nz

Number ofvisits

2018/19

Social media Facebook Waitematā DHB Facebook page likes have increased by 95% since August 2018, with 8,691* current likes (4,456 likes - August 2018). Total audience reach between 1 August 2019 and 31 August 2019 was 172,241 views. Top three posts between 1 August 2019 and 31 August 2019 are:

*As at 9 Sept 2019.

58


1. Waitakere measles clinic (Audience reach: 55,483 including 9,305 engagements )

59


2. Measles message, Lance Norman (Audience reach: 35,219 including 2,105 engagements)

60


3. Measles Message - Dr Meia Schmidt-Uili (Audience reach: 37,467 including 5,600

engagements)

61


Twitter Waitematā DHB Twitter followers have grown by 11.33% since August 2018, with 2,524 current followers* (2,267 followers as at August 2018). Total audience reach between 1 August 2019 and 31 August 2019 was 19,500. Top tweet between 1 August 2019 and 31 August 2019: Flashback Friday – The Last Pour (1,569 reach)

*As at 9 Sept 2019.

62


OIAs received A total of 27 new Official Information Act requests were received between 6 August and 19 September 2019:

Name withheld to protect privacy - Information regarding CAMHS whanau disclosure policy when involved with a young person

S. Brown (National Party MP Pakuranga) - Information related to finances paid to NZ Drug Foundation since Oct 17

M. More (Barrister) - Information regarding youth health care in secondary schools

C. Hutton (Radio NZ) - Information regarding Funded Family Care (FFC) including number of claims, cost and policy

P. Mitchell - Information regarding Service Level Agreement with Police

M. Davidson-Beker (Rodney Surgical Centre) - Details of consideration given to providing care close-to-home when outsourcing services

D. Henry (NZ Herald) - Minutes from meetings for the Care Capacity and Demand Management (CCDM) council since start of year

C. Montague - Information regarding gender dysphoria including numbers diagnosed, comorbidity rate and prescribed medications

C. Williams (Stuff) - Details of complaints made regarding mental health services for adults and children

C. Dixon (PSA) - Mental health staff vacancies, skill levels and client numbers accessing services

Dr M. Arnold (NZ Society of Gastroenterology) - Data regarding colonoscopy rates for Māori

E. Russell (NZ Herald) - Allegations of bullying, harassment or inappropriate behaviour by staff over last five years

C. Cook (Radio NZ) - Number of deaths by suicide over last three years

N. Jones (NZ Herald) - Complaints about residential care and any investigations since January 2019

C. Dixon (PSA) - Disciplinary investigations in mental health service over the last 12 months

N. Jones (NZ Herald) - Copy of current risk register including any briefings, memos and correspondence

L. Kirkness (NZME) - Questions regarding security staff wearing camera vests

J. Appleby - Child adolescent mental health data including referrals, scores and involvement with Oranga Tamariki

L. Nichols (NZME) - Number of patients treated for gunshot wounds and stabbing injuries from 2016-19

A. Bland - Measles and vaccination data including identified strains, recorded cases and admissions

A. Wilson - Number of patients admitted with measles

M. Davidson (Rodney Surgical Centre) - Number of endoscopies outsourced in the last three years for patients in the Rodney area

B. Macdonald (Renews - TVNZ) - Number of schools offering HPV vaccine over the past 10 years

K. Dickinson - Copies of internal memos to staff regarding the management and recording of measles cases

C. Grey - Measles titre testing process followed by doctors

63


J. Yeats (Devonport Flagstaff and Rangitoto Observer) - Measles vaccination rates for five-year-olds broken down into suburbs

R. Cunliffe – Details of notifications of any measles cases by an individual primary school

Media Clippings – 6 August – 16 September 2019

Positive +

Neutral 0

Negative -

Page no. Dominion Post

64 GP lived her own measles hell 0

Page no. Franklin County News

49 Suicide help approach ‘must change’ -

Page no. Gulf News

16 Dental clinic to close for rebuild 0

Page no. Listener New Zealand

88 Blood pressure 0

Page no. Nor West News

43 Telehealth a ‘game changer’ for patients +

83 Helping hand for new mums +

Page no. North Harbour News

3 Nurse parking up 200pc -


71 Millions spent on weights ops +


Page no. North Shore Times

1 Nurse parking up 200pc -

5 Foot clinic for diabetes patients +

17 Bowel screening saving lives 0


Page no. NZ Doctor

13 October revolution: Hauraki practices’ revolt sparks kaupapa Māori PHO gain

0

82 Taking te reo into practices – sparking connections +

64


Page no. NZ Herald / Weekend Herald

7 Baby died with high blood alcohol 0

8 Mum: He was searching for pop star -

10 Measles scare: Students told to stay away from school 0

11 Nursing ‘crisis’ 0

22 Grieving mum reveals nobility of spirit 0

27 Medication botch-ups come with huge cost -

30 Step right up: Council ready for big show 0

40 Failure to scrub up risks lives +

42 Govt steps in over measles 0

51 Measles frontline 0

56 The dangers of staying at home +

61 Welcome to the dark ages 0

70 Max, 12, faces 50% prospect of dying from measles +

77 Vaccination clinic +

78 Cars hits house 0

87 Air Force vet takes to the skies again 0

97 In tune with life 0

Page no. Otago Daily Times

29 Auckland measles cases soar to 616 0

39 Hand hygiene falls short in quarter of all DHBs +

Page no. Pharmacy Today

55 Pharmacist of the year wins $2000 for monitors 0

Page no. Rodney Times

37 Telehealth a ‘game changer’ +

59 Millions spent on weight ops +

76 What’s on – Waitematā DHB election candidates 0


Page no. Sunday Star Times

23 How David Downs beat cancer 0

Page no. The Press, Christchurch

15 Measles outbreak still in full swing 0

36 ‘A plague on our young’ -

67 GP lived her own measles hell 0

Page no. The Rangitoto Observer

19 Five patients die of flu caught in a Waitematā DHB hospital -

20 Hospital patients at risk of infection with super bugs -

65


21 Students treat high-risk foot wounds to avert amputations +

Page no. Western Leader


72 Suicide help approach ‘must change’ -


66


5.1 Financial Performance Report - August 2019

Recommendation:

That the Committee receives this report. Prepared by: Simon Watts (Deputy Chief Financial Officer), David Dodds (Financial Planning Manager), Cliff La Grange (Deputy Chief Financial Officer - Funder) Endorsed by: Robert Paine (Chief Financial Officer and Head of Corporate Services)

Glossary

ACC - Accident Compensation Commission AIR - Advanced Interventional Radiology DHB - District Health Board ED - Emergency Department FPIM - Financial and Procurement Information Management System FTE - Full Time Equivalents IDF - Inter District Flow MECA - Multi-Employer Collective Contract MHSOA - Mental Health Services Older Adults MoH - Ministry of Health MRI - Magnetic Resonance Imaging NGO - Non-Government Organisation NZNO - New Zealand Nurses Organisation ORL - Otorhinolaryngoloy PHO - Primary Health Organisation RMO - Resident Medical Officer SLA - Service Level Agreement WDHB - Waitematā District Health Board -

Background

The report summarises the financial performance of the DHB for the month and the two months ended August 2019. The report covers all operating units of the DHB, being the Funder Arm, Provider Arm and Governance.

1. Executive Summary

The DHB result for August 2019 was a deficit of $2.06m, favourable by $0.02m against budget. The Year to date result is a deficit of $3.97m against a budgeted deficit of $4.02m, and therefore favourable to budget by $44k. The DHB has submitted a break even budget for 2019/20. While challenging to deliver, Management is committed to do so without reducing services or patient care, nor increasing clinical risk.

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WDHB has a comprehensive multiyear financial sustainability programme to enable the DHB to live within its means. 1.1 Highlights

Year to date operating deficit of $3.97m, favourable by $0.05m against a budgeted deficit of $4.02m.

Funder $1.3m favourable year to date - key financial performance factors:

Community Pharmacy Services: adverse impact of PHARMAC’s recently advised expenditure forecasts relating to the reduced Drug Rebate receivable component of the Combined Pharmacy Budget, as well as a reduction in Hospital Medicines funding receivable from PHARMAC.

PHO Capitated Services: favourable impact of utilisation/demand based expenditure

Home Based Support Services: adverse impact of utilisation/demand based expenditure

Generic: favourable impact of phasing-based underspend from budgeted initiatives not yet contracted

Governance $352k favourable year to date - key financial performance factors:

HR Employee: underspend within Planning and Funding from positions not yet recruited to

HR Outsourced Contractors: related phasing underspend within Planning and Funding Provider $1.6m unfavourable year to date - key financial performance factors:

Delays in the realisation of savings under the financial sustainability programme

Additional nursing hours in Maternity and Acute Medicine as a result of high patient demands

Reliance to overtime in Specialist Mental Health due to acute caseloads and high sick leave The financial impacts noted above were partially offset by savings due to:

Delayed commitments to new initiatives

Release of residual provisions for MECA settlements The savings programme is a priority for all management team, with monthly reporting to the Audit and Finance Committee, and weekly updates to the Executive Leadership Team (ELT). Savings obligations have been phased evenly in the budget. The financial savings target for the whole year currently totals $30m. This target will be revised down in September to reflect anticipated phased implementation of new initiatives, and price assumptions on MECA settlements. It is anticipated that the monthly shortfall to budget will close as initiatives are implemented.

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1.2 Financial Indicators

Table 1: Financial Indicators for August 2019

FINANCIAL PERFORMANCE

$ millions

Actual Budget Variance Actual Budget Variance Forecast Budget Variance

Funder Arm -0.3 0.0 -0.3 1.3 0.0 1.3 0.0 0.0 -0.0

Provider Arm -1.9 -2.1 0.2 -5.7 -4.0 -1.6 0.0 0.0 0.0

Governance Arm 0.1 0.0 0.1 0.4 0.0 0.4 0.0 0.0 0.0

DHB Result : Surplus / (Deficit) -2.1 -2.1 0.0 -4.0 -4.0 0.0 0.0 0.0 -0.0

FINANCIAL POSITION

$ millions


Crown Equity (net worth) 611.4 611.4 0.0 611.4 611.4 0.0 639.8 639.8 0.0

Capital Expenditure 1.9 1.9 0.0 4.7 4.7 0.0 81.4 81.4 0.0

Cash Flow Balance 52.1 52.1 0.0 52.1 52.1 0.0 30.5 30.5 0.0

CLINICAL ACTIVITY


ED Attendances 9,993 10,093 100 20,194 19,764 -430 113,299 113,299 0

Acute Volumes (WIES) 6,114 5,702 -412 12,026 11,404 -622 67,317 67,317 0

Elective Volumes (WIES) 1,519 1,708 -189 3,089 3,361 -272 18,348 18,348 0

A negative variance in ED Attendances reflects higher than planned presentations

A negative variance in Acute Volumes (WIES) reflects a higher than planned acute demand

A negative variance in Elective Volumes (WIES) reflects under delivery

Month YTD Full Year

Month YTD Full Year

Month YTD Full Year

69


2. Waitematā DHB Consolidated Financial Performance

2.1 Financial Result

Table 2: Waitematā DHB Consolidated Financial Result for the month ended August 2019

2.2 Financial Performance August 2019 Revenue: ($0.39m) unfavourable to budget The unfavourable variance in revenue includes:

Governance and Funder Arm revenues (refer section 3.0 for commentary) Offset by Provider Arm additional non-resident and ACC revenues $0.9m.

Expenditure: $0.39m favourable to budget The favourable variance in expenditure includes:

Personnel costs, offset by outsourced personnel costs are favourable in the month due to reduced reliance on overtime costs in Mental Health Services and a one-off residual benefit from MECA settlements.

Supplies costs are favourable to budget in part due to volume variances.

Infrastructure costs include financial savings obligations of $30.0m phased evenly throughout the year. Against this budget it is anticipated savings will steadily increase throughout the year. Details on the financial savings programme are provided to Audit & Finance in a monthly report.

Funder Provider Payments upside of $0.7m resulting mostly from the favourable impact of demand/utilisation based budget underspend across third party services in the community.

CONSOLIDATED FINANCIAL PERFORMANCE

$ 000's Full Year

Actual Budget Variance Actual Budget Variance Budget

REVENUE

Crown 157,154 157,798 -645 314,959 315,535 -576 1,893,033

Other 2,363 2,109 254 4,675 4,255 419 40,239

Total Revenue 159,517 159,907 -391 319,634 319,791 -156 1,933,272

EXPENDITURE

Personnel 58,791 60,216 1,424 118,363 119,493 1,130 719,381

Outsourced Personnel 1,933 1,539 -393 3,835 3,051 -784 17,500

Outsourced Services 5,325 5,758 433 10,767 11,372 605 68,580

Clinical Supplies 10,698 11,220 523 22,138 23,222 1,084 133,552

Infrastructure & Non-Clinical Supplies 9,847 7,558 -2,289 19,713 15,319 -4,395 86,152

Funder Provider Payments 74,982 75,675 694 148,792 151,351 2,559 908,105

Total Expense 161,575 161,967 392 323,607 323,807 200 1,933,272

DHB Result : Surplus / (Deficit) -2,058 -2,060 1 -3,973 -4,017 44 0

Month YTD

70


Refer to section 3.0 for commentary on Funder Arm financial performance. Refer to section 4.0 for commentary on Provider Arm financial performance.

3. Funder Arm Commentary On Financial Performance Funder Arm Financial Performance: August 2019 The Funder consolidated core result variance is $315k adverse for the month and $1.33m favourable for the year to date. This is the net position across all four of the Funder divisions. The four Funder divisions are: Funder NGO, Funder Own Provider, Funder IDF and Funder Governance. The Funder NGO division is the main focus of Funder performance and refers to contracted health services delivered by third party providers. These consist mostly of community services providers with approximately 80% of the services being demand based. They are mostly delivered by means of national agreements, with little or no opportunity for DHBs to directly influence either the number of service providers, or the number of patient/client presentations. The Funder’s $1.33m favourable position for the year to date consists of a favourable Funder NGO variance of $1.19m, a favourable Funder Own Provider variance of $252k, an adverse Funder IDF variance of $117k and a nil variance within Funder Governance The table below summarises the key components of the Funder core result in terms of revenue and expenditure and across the four Funder divisions. Funder Arm Financial Performance

FUNDER ARM FINANCIAL PERFORMANCE

$'000 Month Aug-19 Full Year


REVENUE

Funder NGO 47,207 48,194 (987) 95,020 96,388 (1,368) 578,328

Funder Own Provider 73,863 75,930 (2,067) 149,963 151,860 (1,897) 911,159

Funder IDF 27,423 27,481 (58) 54,847 54,963 (116) 329,777

Funder Governance 1,330 1,342 (11) 2,678 2,684 (6) 16,103

Total Funder Revenue 149,823 152,947 (3,124) 302,507 305,895 (3,387) 1,835,367

EXPENDITURE

Funder NGO 47,672 48,194 522 93,828 96,388 2,560 578,328

Funder Own Provider 73,826 75,930 2,104 149,711 151,860 2,149 911,159

Funder IDF Outflows 27,310 27,481 172 54,964 54,963 0 329,777

Funder Governance 1,330 1,342 11 2,678 2,684 6 16,103

Total Funder Expenditure 150,139 152,947 2,809 301,181 305,895 4,715 1,835,367

CORE RESULT

Funder NGO (465) 0 (465) 1,191 0 1,191 0

Funder Own Provider 37 0 37 252 0 252 0

Funder IDF 114 0 114 (117) 0 (117) 0

Funder Governance 0 0 0 0 0 0 0

FUNDER RESULT Surplus/(Deficit) (315) 0 (315) 1,326 0 1,326 0

YTD Aug-19

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FUNDER TOTAL REVENUE The Funder consolidated revenue variance is $3.12m adverse for the month and $3.39m adverse for the year to date. Most of this variance is the net consequence of new and/or changes in Ministry initiatives introduced after budgets had been set and have equivalent expenditure variances that offset. The Funder NGO Revenue Funder NGO revenue variance was $987k adverse for the month and $1.37m adverse for the year to date. Most of this variance is as a result of PHARMAC reducing their forecast national revenue allocation to DHBs for Hospital Medicines. The national Hospital Medicines funding was originally advised as $160m and subsequently reduced to $120m in PHARMAC’s most recent forecast. DHBs each receive their Population Based Funding Formula (PBFF) share of this national revenue allocation. There were other minor variances in Funded initiatives which have equivalent expenditure and nil effect on the core result. Funder Own Provider Revenue The Funder Own Provider revenue variance was $2.07m adverse for the month and $1.90m adverse for the year to date. A one off adjustment of $2.07m was made for Wilson Centre as this component of revenue was invoiced directly by the Provider Arm. This created an adverse variance in the month and year to date which was offset by an equivalent favourable expenditure variance and had a nil impact on the core result. Other variances were in Funded initiatives which have equivalent expenditure and nil effect on the core result Funder IDF Revenue The Funder IDF revenue variance was $58k adverse for the month and $116k adverse for the year to date. This is the result of a service change for Auckland Regional Dental Services which was effected after the budget was set. Funder Governance Revenue No variances of note for the month. FUNDER TOTAL EXPENDITURE

The Funder consolidated expenditure variance was $2.81m favourable for the month and $4.71m favourable for the year to date. The year to date expenditure variance consists of a $2.56m favourable variance in Funder NGO expenditure, a $2.15m favourable variance in Funder Own Provider expenditure, a nil variance in Funder IDF outflow expenditure and a $6k favourable variance in Funder Governance expenditure. It is typical for variance drivers within Funder to have equivalent offsets between Funder divisions and/or between Funder revenue and Funder expenditure. Within Funder expenditure, it is also typical for monthly expenditure to vary between months and for associated variances to mostly offset between months and/or between services. This is usually related to monthly variations in utilisation and claiming patterns across Funder demand services.

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Funder NGO Expenditure The Funder NGO expenditure variance was $522k favourable for the month and $2.56m favourable for the year to date with this being the net position across all Funder NGO community services. The year to date variances are mostly a consequence of the normally expected variations across Funder services as previously explained. These variances apply particularly within Funder NGO services and mostly arise out of variations in demand/utilisation within Community Pharmacy, GP Demand, Age Related Residential Care (ARRC), Home Support Services and Primary Health Organisations (PHO). Is also of note that these services constitute the most substantial component of Funder NGO expenditure. Pharmaceutical rebates are received retrospectively and have been accounted for based on PHARMACs June 2019 forecast. This has resulted in an adverse year to date variance of $320k. Additional to this are the usual variances related to budgeted initiatives not yet contracted and to new Ministry Funded Initiatives implemented and/or changed after budgets had been set. Funded Initiatives variances have a nil net impact on the core result, and include the Ministries Pay Equity initiative. Funder Own Provider Expenditure The Funder Own Provider Expenditure variance is $2.10m favourable for the month and $2.15m favourable for the year to date. This is mostly the result of the Wilson Centre adjustment as mentioned under Funder Own Provider Revenue and has a nil impact on the core result. Funder IDF Expenditure No variances of note for the month and year to date.

Funder Governance Expenditure No variances of note for the month and year to date.

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4. Provider Arm Commentary on Financial Performance 4.1 Financial Statement Table 4: Summary of Provider Arm Financial Performance for August YTD 2019

The deficit in August 2019 was $1.9m, favourable by $0.2m against a budget deficit of $2.1m. 4.2 Service Commentary on YTD result Table 5: Provider Arm Financial Performance by Service for August YTD 2019

PROVIDER ARM FINANCIAL PERFORMANCE

$ 000's Full Year


REVENUE

Crown 81,176 80,781 395 162,220 161,501 720 968,825

Other 2,345 2,106 239 4,497 4,250 247 40,209

Total Revenue 83,522 82,887 634 166,717 165,751 966 1,009,033

EXPENDITURE

Personnel 57,814 59,011 1,196 116,438 117,082 645 704,919

Outsourced Personnel 1,714 1,296 -418 3,382 2,565 -816 14,586

Outsourced Services 4,815 5,254 439 9,753 10,364 610 62,530

Clinical Supplies 10,697 11,220 523 22,136 23,221 1,086 133,548

Infrastructure & Non-Clinical Supplies 10,364 8,166 -2,198 20,661 16,535 -4,126 93,450

Total Expense 85,405 84,947 -458 172,369 169,768 -2,602 1,009,033

Provider Result : Surplus / (Deficit) -1,883 -2,060 176 -5,652 -4,017 -1,635 0

Month YTD

$000's Total

Actual Budget Variance Actual Budget Variance Variance

PROVIDER ARM FINANCIAL PERFORMANCE YTD

Acute & Emergency Medicine 770 586 183 24,161 24,115 -46 138

Sub Specialty Med HOPS 1,749 1,460 290 15,588 15,425 -164 126

Surgical Services 1,562 1,505 57 23,005 23,231 226 283

ESC 0 0 0 4,936 4,977 42 42

Child, Women & Family 1,379 1,451 -72 15,032 14,773 -259 -331

Mental Health & Addiction Services 2,658 2,519 139 22,133 21,866 -267 -128

Corporate & Provider Support 158,600 158,229 371 67,516 65,381 -2,134 -1,764

Total Provider 166,717 165,751 966 172,369 169,768 -2,602 -1,635

Direct Revenue YTD Direct Expenditure YTD

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Acute and Emergency Medicine – YTD $0.1m favourable to budget The favourable variance was driven by:

Personnel cost savings due to lower watch numbers and a skill mix benefit in Medicine.

Implementation of Transformed Waitakere now planned for in the second half of the year. The service has a number of savings initiatives including flexing beds, a review of patient watches, and nursing models of care. Specialty Medicine and Health of Older Persons Services – YTD $0.1m favourable to budget The service is tracking close to budget. The service has a number of savings initiatives, including a review of ACC events, and enhanced services for mobility aid managements. Surgical and Ambulatory Services – YTD $0.3m favourable to budget The service is tracking close to budget. Savings resulting from volume variances have been offset by additional costs realised in the following areas:

Leave creep in the current run of Registrars and House Officers.

High levels of long service leave within Anaesthesia.

Over-delivery of skin lesions due to GP referrals. Elective Surgery Centre (ESC) – YTD $0.0m favourable to budget The service is tracking close to budget. Child, Women and Family Services – YTD ($0.3m) unfavourable to budget The unfavourable variance was driven by:

Continued high admission rates across both Neonatal units and Paediatrics. Demand for Paediatric inpatient services is expected to reduce over the summer months.

Inpatient and community based services demand driven increase in clinical supplies. The service is progressing tactical savings initiatives that include alternative Obstetric and Anaesthetic on-call accommodation options, changes in Child Rehabilitation and Respite contract costs to better align with a new funding model, and changes in the provision of clinical supplies to families within the Community Child Nursing team. Specialist Mental Health and Addiction Services – YTD ($0.1m) unfavourable to budget The unfavourable variance was driven by:

Overtime in Adult Services due to acute caseloads and high sick leave.

Medical on-call roster cover due to a high number of registrar vacancies.

Facilities repairs & maintenance. Corporate and Provider Arm Support Services – YTD ($1.8m) unfavourable to budget The unfavourable variance was driven by:

Delayed realisation of financial savings obligations (phased straight line). Year to date budgeted savings amount to $4.907m.

75


Offsets to the shortfall in savings obligations include:

Release of residual provisions for settled MECA.

Interim savings pending commitments for new initiatives.

Increased breast screening and non-resident income (partially offset by associated costs).

Lower Pyxis pharmaceutical lease costs, pending an upgrade to implement closed loop medication management.

5. Waitematā DHB Financial Position 5.1 Summary of Financial Position Table 6: Summary financial position as at August 2019

The Financial position reflects the current view of the DHB’s balance sheet as at 30 June 2019. Currently, no substantive provision has been booked for the underpayment of Holiday Pay. Work is continuing in this area and the final financial position as at 30 June 2019 may be amended. 5.2 Financial Position Commentary The negative ‘Net Working Capital’ balance of $117.1m at 31st August 2019 is expected, due to the nature of current liabilities including annual leave provisions and the current portion of other staff entitlements, such as Continuing Medical Education (CME) entitlements. While these liabilities are considered current, any significant draw down is considered unlikely, as accrued entitlements tend to offset leave claims over time. The ‘Cash and Bank Balance’ of $52.1m at 31st August 2019 includes a term deposit of $10m with ANZ Bank invested via NZHPL.

$000's Jul-19 Variance to Jun-19

Actual Budget Variance Actual Last Month Actual

Crown Equity 611,447 611,405 42 597,155 14,292 599,069

Represented by:

Cash & Bank Balances 52,114 52,114 -0 36,176 15,938 36,685

Other Current Assets 95,867 95,192 675 90,316 5,551 86,472

Current Liabilities -265,066 -265,554 488 -265,910 844 -251,768

Net Working Capital -117,086 -118,248 1,162 -139,418 22,332 -128,611

Fixed Assets 728,127 728,126 1 728,331 -204 726,180

Long Term Investments in Associates 42,958 42,959 -1 42,958 0 42,940

Term Liabilities -42,552 -41,432 -1,120 -34,716 -7,836 -41,440

Total Employment of Capital 611,447 611,405 42 597,155 14,291 599,069

31-Aug-19

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5.3 Detailed Statement of Cash Flow Table 7: Detailed Statement of Cash Flow as at August 2019

Note: The cash balance includes $10m in term deposit with ANZ bank via NZHPL. The equity injection of $16.35m in August relates to the Mason Clinic land purchase. Settlement for the land purchase will occur in September. The cash forecast at 30 June 2020 is $30.4m.

$000's

Actual Budget Variance Actual Budget Variance

Cash flows from operating activities:

Inflows

Crown 154,882 150,919 3,963 308,338 304,604 3,734

Interest Received 126 164 -38 350 320 30

Other Revenue 1,616 4,412 -2,796 5,691 8,870 -3,179

Outflows

Staff 53,592 55,454 1,862 114,016 117,581 3,565

Suppliers 25,848 21,469 -4,379 46,649 38,048 -8,601

Other Providers 74,982 76,210 1,228 148,792 153,528 4,736

Capital Charge 0 0 0 0 0 0

GST (net) 698 858 160 1,135 850 -285

Net cash from Operations 1,504 1,504 0 3,787 3,787 0

Cash flows from investing activities:

Outflows

Capital Expenditure 1,916 1,916 0 4,708 4,708 0

Investments 0 0 0 0 0 0

Net cash from Investing -1,916 -1,916 0 -4,708 -4,708 0

Cash flows from financing activities:

Inflows

Equity Injections 16,350 16,350 0 16,350 16,350 0

New Debt 0 0 0 0 0 0

Deposits Recovered 0 0 0 0 0 0

Outflows

Interest Paid 0 0 0 0 0 0

Funds to Deposit 0 0 0 0 0 0

Net cash from Financing 16,350 16,350 0 16,350 16,350 0

Opening cash 36,176 36,176 0 36,685 36,685 0

Net increase / (decrease) 15,938 15,938 0 15,429 15,429 0

Closing cash 52,114 52,114 0 52,114 52,114 0

Closing Cash Balance in HBL Sweep account 52,114 52,114 0 52,114 52,114 0

Month YTD

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6. Statement of Capital Expenditure The Portfolio Investment Committee (“PIC”) continues to robustly prioritise all investment requests to ensure best value is achieved from the available capital budget. Signals from the Centre are that Crown funding may be lower than requested. PIC has considered a number of investment scenarios to ensure priority projects will proceed in the event that the level of funding differs from that requested. Capital expenditure on Land relates to the Mason clinic and will occur in September. Table 8: Summary of Capital Expenditure as at August 2019

7. Clinical Activity

YTD ED attendances are slightly higher than plan. YTD acute volume WIES are higher than plan. The FY19/20 budget assumes demographic growth of 2.9% on FY18/19 forecast acute volumes. YTD elective volumes are lower than plan. Lower than planned volumes, notably in General Surgery and Orthopaedics, have been attributed to a lack of backfill for SMO leave, shortages in skilled nursing due to high sick leave, and minor encroachment of acute sessions. Surgical staffing gaps are being filled, current pressures will be resolved in the next few months.

7.1 Clinical Activity Scorecard

Table 9: Clinical Scorecard for July

$000's Full Year


Capital Expenditure

Land 0 0 0 0 0 0 17,000

Buildings & Plant 963 963 0 2,167 2,167 0 47,333

Clinical Equipment 666 666 0 2,000 2,000 0 14,488

Other Equipment 98 98 0 141 141 0 283

Information Technology 172 172 0 383 383 0 2,048

Motor Vehicles 17 17 0 17 17 0 292

Total Capital Expenditure 1,916 1,916 0 4,708 4,708 0 81,444

Month YTD

CLINICAL ACTIVITY


ED Attendances 9,993 10,093 100 20,194 19,764 -430 113,299 113,299 0

Acute Volumes (WIES) 6,114 5,702 -412 12,026 11,404 -622 67,317 67,317 0

Elective Volumes (WIES) 1,519 1,708 -189 3,089 3,361 -272 18,348 18,348 0

A negative variance in ED Attendances reflects higher than planned presentations

A negative variance in Acute Volumes (WIES) reflects a higher than planned acute demand

A negative variance in Elective Volumes (WIES) reflects under delivery

Month YTD Full Year

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6.1 System Level Measures – Quarter Four Report

Recommendation:

That the Board notes the Quarter Four results for the Third System Level Measures (SLM) Improvement Plan.

Prepared by: Wendy Bennett (Planning & Health Intelligence Manager) Endorsed by: Karen Bartholomew (Director Health Outcomes), Debbie Holdsworth (Director Funding) and Tim Wood (Funding and Development Manager, Primary Care)

Glossary

ACP ALT ARPHS ASH

- - - -

Advance Care Plan Alliance Leadership Team Auckland Regional Public Health Service Ambulatory sensitive hospitalisations

CEO - Chief Executive Officer CVD - Cardiovascular disease DHB - District Health Board ED - Emergency Department HT - Health Target HQSC - Health Quality and Safety Commission NHI - National Health Index PES - Patient Experience survey PHC - Primary health care PHO - Primary Health Organisation POAC - Primary Options for Acute Care QI - Quality Improvement SLM - System level measure WCTO - Well Child/Tamariki Ora


Community, whānau and patient centred model of care

Our commitment to improvement against the System Level Measures (SLMs) demonstrates our dedication to our communities, patients and families to work to continually improve the quality of care we deliver and enhance the experience of our patients in their interactions with health care providers.


System Level Measures focus us to make improvements across the whole system. Activities focused on both treatment and keeping people healthy are identified within the 2018/19 System Level Measures Improvement Plan.

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Intelligence and insight

The SLM programme of work is focused on using evidence-based solutions to effect change across the system and monitoring for that change to help us understand how our activities contribute to our overarching goals.



Taking a ‘whole of system’ approach also focuses us on how we work together to achieve not only better outcomes for our patients and communities, but also how we achieve that sustainably, effectively and efficiently.

2. Introduction The System Level Measures (SLMs) Framework was developed by the Ministry of Health with the aim of improving health outcomes for people by supporting DHBs to work in collaboration with health system partners (primary, community and hospital) using specific quality improvement measures. This provides a framework for continuous quality improvement and system integration. System Level Measures are set nationally and designed to be outcomes focused, requiring all of the health system to work together to achieve. They are focused primarily on children, youth and those parts of the population, who experience poorer health outcomes than others. DHBs are able to choose from a suite of ‘contributory’ measures or devise their own – which they have identified as having the biggest impact on achievement of each system level measure. These in turn are connected to local clinically led quality improvement activities. System Level Measures recognises that good health outcomes require health system partners to work together. Therefore the district alliances are responsible for implementing SLMs in their districts. District alliances are responsible for:

Harnessing perspectives from all relevant parts of the health system to identify a shared vision and key objectives

Applying alliancing principles (way of working)

Using SLMs to drive system integration in their districts

Allocating resources required for the development, implementation, monitoring and reporting of the SLMs

Leading the development of the SLM improvement plan. The Counties Manukau Health, Auckland and Waitematā Alliances are firmly committed to achieving the SLM milestones over the medium to longer term. The 2018/19 System Level Improvement Plan reflects a strong commitment to the acceleration of Māori health gain and the elimination of inequity for Māori. The steering group continues to meet in order to further develop key actions (particularly at a local level), monitor data, and guide the ongoing development of the SLMs. Steering group membership includes senior clinicians and leaders from the seven PHOs and the three DHBs. The steering group is accountable to the two Alliance Leadership Teams (ALTs) and provides oversight of the overall process. A PHO Implementation Group also meets to support and enable implementation of SLM improvement activities.

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This paper provides final results on the current (third) improvement plan: 2018/19. The six System Level Measures are: 1. Ambulatory Sensitive Hospitalisation (ASH) rates per 100,000 for 0 – 4 year olds 2. Acute hospital bed days per capita 3. Patient experience of care 4. Amenable mortality rates 5. Babies living in smokefree households at six weeks 6. Youth are healthy, safe and supported. For each SLM, there is an improvement milestone to be achieved in 2018/19. The milestone must be a number that improves performance from the district baseline, reduces variation to achieve equity, or for the developmental SLMs, improves data quality. In 2018/19, the Auckland Metro Region has focused on cross–system activities which have application to multiple milestones. Activities with a prevention focus may show collective impact across the life course over time. It seems pragmatic for each milestone to benefit equally from activities which add value in multiple areas. This year we also recognise those activities which enable achievement of the SLM activities and milestones. This essential work is the foundation for quality improvement activities, and illustrates enabling activities such as building relationships, providing support and education, and creating and maintaining essential data management processes. This report includes the most up-to-date data available at quarter four for each DHB for both the SLMs and contributory measures. It also outlines progress against the improvement activities identified each SLM in the SLM Improvement Plan.

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Scorecard – Part 1

Actual

Data

Period Trend

Measure: Auckland 6,588 (max.) 6,940 12-monthly

Counties Manukau 6,630 7,056 to

Target 2018/19: Waitemata 5,263 5,729 Mar-19

Metro Auckland 6,124 6,536









Measure: Auckland 389 (max.) 402 12-monthly

Counties Manukau 450 458 to

Target 2018/19: Waitemata 398 406 Mar-19

Metro Auckland na




Metro Auckland na




Metro Auckland na

Measure: Auckland 15% As

Counties Manukau 13% at

Target 2018/19: Baseline response rates - Maori Waitemata 15% May-19

Measure: Auckland 18% As

Counties Manukau 10% at

Target 2018/19: Baseline response rates - Pacific Waitemata 13% May-19

Alliance Health Plus 8.2% (min.) 11.5% As

Auckland PHO 13.2% 7.7% at

Comprehensive Care 12.0% 10.1%

EastHealth 7.6% 8.4%

National Hauora Coalition 6.7% 12.8%

Procare 9.7% 6.9%

Total Healthcare n/a 12.9%

Metro Auckland

3% reduction by June 2019


DHB Adult Inpatient Experience

Survey:

Measure: Primary Care Patient Experience

Survey Response Rates

May-19

Target 2017/18:Increase response rate for completed

surveys by 2%: Maori and Pacific

3. Patient Experience of C are

DHB Adult Inpatient Experience

Survey:

DHB / RegionTarget

Performance

1. Ambulatory Sensitive Hospita lisations: 0-4 Year-Olds

Age-standardised rate per 1,000

domiciled population - Total

Population

Rate per 100,000 domiciled 0-4 year-

olds - Total Population

3% reduction in rate by June 2019

2. Acute Hospita l Bed Days


olds - Pacific



olds - Maori



domiciled population - Maori


domiciled population - Pacific


4,000

9,000

400

450

500

540

640

740

5,000

10,000

15,000

20,000

Dec-16 Dec-17 Dec-18

5,000

10,000

Dec-16 Dec-17 Dec-18

500

700

900

0%

5%

10%

15%

20%

25%

Nov-17 May-18 Nov-18 May-19

Maori Total

Pacific Total

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Scorecard – Part 2

Actual

Data

Period TrendDHB / RegionTarget

Performance

Measure: Auckland 70.0 (max.) 74.0 12 monthly

Counties Manukau 100.2 101.2 to

Target 2020/21: 6% reduction by 2020Waitemata 63.0 62.9 Dec-15

Metro Auckland 78.9



Target 2018/19: 2% reduction for Maori population by

June 2019 Waitemata 148.6 113.1 Dec-15

Metro Auckland 170.6



Target 2018/19: Waitemata 112.3 139.6 Dec-15

Metro Auckland 177.0

Measure: Auckland 15% (max.) 9.9% 12 monthly

Counties Manukau 15% 11.2% to

Target 2018/19: Waitemata 15% 11.0%Dec-18

Metro Auckland 15% 10.7%

Measure: Alcohol-related ED presentations Auckland 10% (max.) 3% 12 monthly

Counties Manukau 10% 4% to

Target 2018/19: Waitemata 10% 92% Mar-19

Metro Auckland 10% 29%

Measure: Auckland 67% 12 monthly

Counties Manukau 53% to

Target 2018/19: Waitemata 62% Dec-18

Metro Auckland 60%

2% reduction for Pacific population by

June 2019

2% increase on baseline

5. Youth Health

Note: the methodology for

this indicator has changed

so the target in the SLM plan

is no longer applicable

Proportion of babies living in

smokefree homes at 6 weeks

postnatal

4. Amenable Morta lity

Chlamydia testing coverage for 15-24

year-olds.

15% coverage rate by June 2019

6. Babies Liv ing in Smokefree Households

Reduce ‘unknown’ alcohol related ED

presentation status to less than 10%

by 30 June 2019.


domiciled 0-74 year-olds.





0%

5%

10%

15%

Dec-16 Jun-17 Dec-17 Jun-18

0

70

140

2008 2010 2012 2014 2016

0

100

200

300

2008 2010 2012 2014 2016

0

100

200

300

2008 2010 2012 2014 2016

Target met / on track

Improvement needed

Significant improvement needed Improvement needed

Legend

Metro Auckland Region

Auckland DHB

Counties Manukau DHB

Waitematā DHB

83


Overall Progress Report Overarching activities for Q4:

Implementation of the 2018/19 SLM Improvement Plan is on-going and has become business as usual for many of the stakeholders involved.

Q4 reporting approved by the Ministry

Reporting is released quarterly or more frequently where available to PHOs via Citrix Sharefile or from Healthsafe, which allows safe and secure sharing of confidential information.

The 2019/20 SLM Improvement Plan has been developed and approved by the Ministry of Health.

3. System Level Measures Report

3.1 Keeping children out of hospital

ASH rates per 100,000 for 0–4 year olds Improvement Milestone: 3% reduction (on Dec-17 baseline) (by ethnicity) by 30 June 2019

Milestone Target Actual – 12 months to March 2019 (latest available)

Auckland

Counties Manukau

Waitematā Auckland Counties Manukau

Waitematā

Total pop. 6,588 6,630 5,263 6,940 7,056 5,729

Māori 6,645 6,386 5,646 6,489 6,398 6,415

Pacific 12,791 10,853 10,433 15,476 11,774 12,697

Ambulatory sensitive hospitalisations (ASH) are mostly acute admissions that are considered potentially reducible through prevention or therapeutic interventions deliverable in a primary care setting. In New Zealand children, ASH accounts for approximately 30 percent of all acute and arranged medical and surgical discharges in that age group each year. However, determining the reasons for high or low ASH rates is complex, as it is in part a whole-of-system measure. It has been suggested that, admission rates can serve as proxy markers for primary care access and quality, with high admission rates indicating difficulty in accessing care in a timely fashion, poor care coordination or care continuity, or structural constraints, such as, limited supply of primary care workers. ASH rates are also determined by other factors, such as hospital emergency departments and admission policies, health literacy and overall social determinants of health. This measure can also highlight variation between different population groups, which will assist with DHB planning to reduce disparities. In 2018/19, the overall improvement milestone, and the milestone for both Māori and Pacific ASH rates was to achieve a reduction of 3% for 0-4 year olds by June 2019. Ethnic specific targets are important to ensure that interventions reduce, not worsen inequity. Metro Auckland’s rate is 6,538 per 100,000 for the 12 months to March 2019 for the total population. This is a 3.5% increase (worsening) on the results to December 2017 (baseline) of 6,314 per 100,000 of the population. At an ethnic specific level, results have also deteriorated – for Māori by 2.9% and Pacific by 10.7%.

84


The higher rates for Auckland DHB Pacific children persist – non-standardised rates, particularly for asthma, respiratory infections, pneumonia and cellulitis, results far outweigh those for other ethnicities.

0

2,000

4,000

6,000

8,000

10,000

Mar-15 Mar-16 Mar-17 Mar-18 Mar-19

ASH

rat

e p

er

10

0,0

00

12 months ending

Non-standardised (age specific) ASH rate by DHB: 0-4 year olds, all conditions

Auckland Counties Manukau Waitemata Metro-Auckland National

0

5,000

10,000

15,000

20,000

ASH

rat

e p

er

10

0,0

00

12 months ending

Non-standardised ASH rate by DHB: 0-4 year olds, all conditions, by Ethnicity

Auckland Counties Manukau Waitemata Metro-Auckland National

Pacific

OtherMaori

85


3.2 Using health resources effectively

Total acute hospital bed days

Improvement Milestone: 3% reduction (on Dec-17 baseline) for Māori and Pacific population by 30 June 2019

Milestone Target Actual – 12 months to Mar 19 (latest available)

Auckland

Counties Manukau

Waitematā Auckland Counties Manukau

Waitematā

Total pop. 389.0 450.2 397.6 401.8 457.5 406.3

Māori 565.5 657.7 515.1 591.0 727.7 582.5

Pacific 764.4 718.8 702.3 819.2 742.3 805.6

Acute hospital bed days per capita is a measure of the use of acute services in secondary care that could be improved by efficiencies at a facility level, effective management in primary care, better transition between the community and hospital settings, optimal discharge planning, development of community support services and good communication between healthcare providers. Good access to primary and community care and diagnostics services is also a component of this. The measure is the rate calculated by dividing acute hospital bed days by the number of people in the New Zealand resident population. The acute hospital bed day’s per capita rates will be illustrated using the number of bed days for acute hospital stays per 1,000 population domiciled within a DHB with age standardisation. Certain conditions are more likely to result in unplanned hospitalisation, alongside other contributory factors, such as the referral process to ED (self, provider variation, ambulance etc.). Social determinants of health are key drivers of acute demand. The Auckland Metro age standardised acute bed day rate per thousand population was calculated to be 424.5 as at December 2017 with a target set to reduce the rate by:

3% for the Māori population – 588.0 standardised acute bed days/1000 by June 2019

3% for the Pacific population – 726.1 standardised acute bed days/1000 by June 2019 It must be noted that the opening of new beds within the region will have an impact on this indicator. While the overall standardised rates for Auckland and Waitematā DHBs have been generally declining each year, Counties Manukau DHB’s rates remain persistently higher. The metro-Auckland ethnic specific rates to March 2019 are underperforming against the December 2017 target at 644.7 standardised acute bed days/1000 for Māori and 772.1 for Pacific. At a DHB level, only Waitematā has a rate better than target for Māori, with Counties Manukau some way from achievement. For Pacific, no DHBs met the target, with a deterioration in Waitematā DHB rates and both Auckland and Waitematā DHBs now well away from target. A small improvement can be seen for Counties Manukau DHB.

86


0

100

200

300

400

500

600

700

800

900M

ar-1

4Ju

n-1

4Se

p-1

4D

ec-

14

Mar

-15

Jun

-15

Sep

-15

De

c-1

5M

ar-1

6Ju

n-1

6Se

p-1

6D

ec-

16

Mar

-17

Jun

-17

Sep

-17

De

c-1

7M

ar-1

8Ju

n-1

8Se

p-1

8D

ec-

18

Mar

-19

Standardised Acute Bed Days per 1,000 Maori Population: 12 months ending

Auckland DHB


Waitemata DHB


Target

0

100

200

300

400

500

600

700

800

900

Mar

-14

Jun

-14

Sep

-14

De

c-1

4M

ar-1

5Ju

n-1

5Se

p-1

5D

ec-

15

Mar

-16

Jun

-16

Sep

-16

De

c-1

6M

ar-1

7Ju

n-1

7Se

p-1

7D

ec-

17

Mar

-18

Jun

-18

Sep

-18

De

c-1

8M

ar-1

9

Standardised Acute Bed Days per 1,000 Pacific Population: 12 months ending

Auckland DHB


Waitemata DHB


Target

87


3.3 Patient Experience

‘Person centred care’ or how people experience health care is a key element of system performance that can be influenced by all parts of the system and the people who provide the care. Integration has not happened until people experience it. The intended outcome for this SLM is improved clinical outcomes for patients in primary and secondary care through improved patient safety and experience of care.

Hospital inpatient survey response rates by ethnicity

The nationally applied DHB Adult Inpatient Survey has been conducted quarterly since 2014 and the SLM Improvement Plan continues to include a focus on the Adult Inpatient Experience Survey. This survey captures four measured domains - communications, partnership, coordination, physical and emotional needs. The 2018/19 target is to establish a baseline response rate by ethnicity, which has been achieved. Interventions are aimed at promoting the survey to improve participation and using the results to improve quality. Individual DHBs need to improve survey participation. This may include working with Māori, Pacific and Asian provider teams within the hospital to facilitate feedback from recently discharged patients, and/or language specific initiatives. Related interventions to improve response rates include increasing email uptake during administration processes, and promoting the patient experience survey to patients via pamphlets and other resources. The national response rate for May 2019 is 24%, compared to 34% for Waitematā, 19% for Auckland (a deterioration from the previous 29% response rate), and 17% for Counties Manukau. Response rates for Māori and Pacific patients were lower than those observed overall.

Improvement milestone: Baseline response rate by ethnicity by 30 June 2019.

Hospital Inpatient survey – response rates by ethnicity, 12 months to May 2019

number invited response rate

ADHB CMDHB WDHB ADHB CMDHB WDHB Metro-Auckland

Māori 150 232 117 15.3% 13.4% 14.5% 14.2%

Pacific 192 387 103 17.7% 9.8% 12.6% 12.5%

Note: 12 month result given due to small quarterly numbers

The focus for 2018/19 has been on increasing response rates for Māori and Pacific patients. This is supported through continuing to work on improving communication within the hospital, with a stronger focus on culturally appropriate communication and health literacy.

Primary health care patient experience survey (PHC PES) response rates by ethnicity

The PHC PES was implemented in practices over the 2017/18 year. Currently, completed surveys for Māori and Pacific invitees are lower than for other ethnicities. As such, the focus this year has been on increasing the response rate for Māori and Pacific patients, to work towards equitable response rates. This has involved working with practices to ensure good utilisation of the PHC PES data, through Plan, Do, Study, Act (PDSA) improvement cycles.

88


Response rates for the Primary Care Patient Experience Survey are between 7% and 13% for Māori and Pacific across all PHOs, as at May 2019. Rates have remained between 9% and 10% for Māori and Pacific across Metro Auckland over the last year.

3.4 Preventing and detecting disease early

Amenable mortality

Improvement milestone 6% reduction for each DHB (on 2013 baseline) by 30 June 2020. 2% reduction for Māori and Pacific by 30 June 2019.

Milestone Target Actual – 2015 deaths

Auckland Counties Waitematā Auckland

Counties Manukau

Waitematā

Total Pop 70.0 100.2 63.0 74.0 101.2 62.9

Māori 164.2 231.0 148.6 158.0 219.6 113.1

Pacific 146.6 194.0 112.3 162.5 199.2 139.6

Amenable mortality is defined as premature deaths that could potentially be avoided given effective and timely care. That is, deaths from diseases for which effective health interventions exist that might prevent death before 75 years of age. This indicator considers all deaths for those aged 0-74, in the relevant year with an underlying cause of death included in the defined list of amenable causes. It takes several years for some coronial cases to return verdicts, therefore results for this indicator are approximately 2-3 years delayed. 2016 mortality coded mortality data has been delayed, so we are unable to provide updated results currently.

Based on five year trends, all three Metro Auckland DHBs show consistently declining rates as illustrated in the graph above, despite an increase between 2013 and 2014 for Auckland and Waitematā DHBs. Comparing current (2015) rates with baseline (2013) rates, there is a 2% decline in rates for metro-Auckland, or 6% when comparing the 5 year rates. Given that there will always be some annual fluctuation and that the target extends to 2020, we should be on track to meet the 6% reduction by 2020.

0

20

40

60

80

100

120

140

160

180

Rat

e p

er 1

00

,00

0 p

op

ula

tio

n 5

yea

r ro

llin

g

Amenable mortality rates per 100,000 by DHB

New Zealand Waitemata Auckland Counties Manukau

89


While rates for Māori are also declining, the sharp, consistent decline seen for overall rates is not evident. This is even more so for Pacific rates, however smaller numbers will mean greater year on year variation.

0

50

100

150

200

250

300

2009 2010 2011 2012 2013 2014 2015

Rat

e p

er 1

00

,00

0 p

op

ula

tio

n 5

yar

ro

llin

g

Amenable mortality age standarised rates 0-74 year olds: Maori 2009-2015

Auckland

CountiesManukauWaitemata

Total NZ

0

50

100

150

200

250

300

2009 2010 2011 2012 2013 2014 2015

Rat

e p

er 1

00

,00

0 p

op

ula

tio

n 5

yar

ro

llin

g

Amenable mortality age standarised rates 0-74 year olds: Pacific 2009-2015

Auckland

CountiesManukauWaitemata

Total NZ

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3.5 Youth access to and utilisation of youth-appropriate health services

Chlamydia testing coverage in 15-24 year olds

Improvement milestone: increase coverage of chlamydia testing to 15% (reported by gender and ethnicity) for 15- 24 year olds Results for the 6 month period to December 2018.

Demographic variable Population Chlamydia test rate

DHB domiciled

Auckland 85,145 9.9%

Counties Manukau 82,785 11.2%

Waitematā 83,290 11.0%

Gender Female 121,195 18.0%

Male 130,025 3.9%

Age group (years) 15-19 110,360 7.7%

20-24 140,860 13.1%

Ethnicity (Level 1, prioritised)

Māori 37,665 12.4%

Pacific 41,915 10.3%

Asian 66,720 4.7%

Other 104,920 14.1%

Total Metro Auckland 251,220 10.7%

Youth have their own specific health needs as they transition from childhood to adulthood. Most youth in New Zealand successfully transition to adulthood but some do not, mainly due to a complex interplay of individual, family and community stressors and circumstances, or risk factors. Research shows that youth whose healthcare needs are unmet can lead to increased risk of poor adult health and overall poor life outcomes.

The focus for 2018/19 has been on sexual and reproductive health – specifically on Chlamydia Screening for 15-24 year olds. Chlamydia is the most commonly reported sexually transmitted infection in Auckland, usually diagnosed in females aged 15-19 years and in males aged 20–24 years. However, in the context of SLMs, chlamydia screening is being used as a proxy for access to sexual health services.

6%

8%

10%

12%

14%

16%

Dec-16 Jun-17 Dec-17 Jun-18 Dec-18

Chlamydia test rate for youth aged 15-24 years (population level)

Auckland Counties Manukau Waitemata

Metro-Auckland Target

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At a population level, screening coverage rates appear to have dropped when compared to the same time last year and after a period of gradual increase over time. This will need further monitoring to understand if there is a data quality issue, or a real decline. Overall, the target of 15% coverage is not being reached, although for females alone, this is being achieved at 18% (though has declined from 20.1% at June 2018).

By ethnicity, only other ethnicities have surpassed the 15% target and rates for all are reasonably static.

3.6 Healthy start

Proportion of babies who live in a smoke-free household at six weeks post-natal Improvement milestone: Increase the proportion of babies living in smokefree homes by 2% (December 2017 baseline)

Note: Targets cannot be set on December 2017 baseline as planned, due to a change in methodology for calculating this measure

Reporting period DHB of domicile

New Zealand Auckland Counties Manukau Waitematā

Jan 18 - Jun 18 53.8% 66.8% 52.8% 61.9%

Jul 18 – Dec 18 56.1% 68.3% 54.7% 62.2%

Due to the changes in methodology for calculating measures on previous Ministry of Health releases, it is therefore only possible to compare the results for the last two time periods (supplied in the last release).

This measure aims to reduce the rate of infant exposure to cigarette smoke by focusing attention beyond maternal smoking to the home and family/whānau environment. It will also encourage an integrated approach between maternity, community and primary care. It emphasises the need to focus on the collective environment that an infant will be exposed to – from pregnancy, to birth, to the home environment within which they will initially be raised.

Data is sourced from Well Child Tamariki Ora providers and shows that around 55-70% of babies live in a smokefree household at 6 weeks post-partum and that this has improved slightly between reporting periods.

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Dec-16 Jun-17 Dec-17 Jun-18 Dec-18

Chlamydia test rate for youth aged 15-24 years by ethnicity (population level) - metro-Auckland DHBs

Maori Pacific Asian Other Target

92


Fewer Māori babies live in smokefree homes - 25% in Counties Manukau, 39% in Waitematā and 42% in Auckland compared to other ethnicities. Rates for Pacific are also lower than other ethnicities. This correlates with rates of smoking in pregnancy, and general smoking, in Māori and Pacific populations. Further data points will be necessary to understand trends.

4. Improvement Activities and Contributory Measures

Improvement activities create change and contribute towards improved outcomes in the various SLM milestones. These activities are measured locally by contributory measures which support a continued focus in each area. Activities support the improvement of the system as a whole. For 2018/19, Auckland Metro region are focused on choosing activities which relate to multiple milestones where possible for best collective impact.

4.1 Respiratory Admissions in 0-4 year olds

SLM Milestones impacted: Ambulatory Sensitive Hospitalisation (ASH) Rates per 100,000 for 0 – 4 Year Olds Amenable mortality Babies in Smokefree Homes Acute hospital bed days

Respiratory conditions are the largest contributor to ASH rates in Metro Auckland. Pertussis (whooping cough) and influenza are potentially very serious conditions in infants and young children, and can lead to further respiratory complications. Both of these are vaccine preventable. Social factors like housing and smoking also contribute to poor respiratory health. We are working to increase referrals to healthy housing programmes and to help more pregnant women quit smoking. In early 2019, e-referrals for smoking and healthy housing went live to support a reduction in ASH admissions.

0%

10%

20%

30%

40%

50%

60%

70%

80%

Maori Pacific Peoples Others

Proportion of babies aged <56 days living in a smokefree household at six weeks post-natal: Metro-Auckland

Jan 18 - Jun 18 Jul 18 - Dec 18

93


0%

10%

20%

30%

40%

50%

60%

Jun-17 Jun-18 Jun-19 Jun-17 Jun-18 Jun-19

Maori Pacific

Influenza and pertussis vaccination coverage rates for pregnant Maori and Pacific women who birthed in the previous 12 months

enrolled in metro-Auckland PHOs

Auckland Counties Manukau Waitemata Target

0%

5%

10%

15%

20%

25%

30%

Jul-

17

Jul-

18

Jun

-19

Jul-

17

Jul-

18

Jun

-19

Jul-

17

Jul-

18

Jun

-19

Jul-

17

Jul-

18

Jun

-19

Asian Euro/Other Maori Pacific

Flu vaccination rates at July 2017, July 2018 and June 2019 for children hospitalised with a respiratory condition

Auckland Counties Manukau Waitemata 2018/19 Target

Indicator Target Results Influenza vaccination coverage for children hospitalised for respiratory illness

15%

Commentary

Overall coverage has increased from 8.1% in May to 12.6%.

Auckland Metro June coverage has surpassed coverage for July 2018 (12.6% vs 11.9%).

Auckland DHB domiciled individuals have the highest coverage at 16.6%.

Five of the seven PHOs have surpassed their July 2018 coverage, although PHO rates should be interpreted with caution because of small numbers. Individuals of Asian ethnicities have the best coverage rates, with Pacific and Māori coverage significantly lower

Implementation of the special immunisation programme had wide support by PHOs, although a national shortage of influenza vaccine may have adversely affected these results. The data matching process conducted by DHBs produced valuable lists for action supported by PHOs. Further integration of processes in practice PMS and workflow will likely see greater gains. Integration into wider systems such as outpatient clinics and outreach contracts are under consideration and would likely see improved vaccination rates.

Increase influenza and pertussis vaccine coverage rates for pregnant women (Māori and Pacific)

50%

94


0

50

100

150

200

250

300

350

1 Jan - 31 Mar 1 Apr - 30 Jun 1 Jul - 30 Sep 1 Oct - 31 Dec 1 Jan - 31 Mar 1 Apr - 30 Jun

2018 2019

Number of referrals to the Maternity Incentive Stop-Smoking Programme

ADHB CMDHB WDHB Metro-Auckland 2018/19 Target

Indicator Target Results Commentary Antenatal vaccination coverage rates have improved markedly over time. Antenatal pertussis vaccination rates for Māori and Pacific were below 10% for all the metro-Auckland DHBs in 2016. The recent two quarters have seen a significant uplift across multiple ethnicities. Compared with Q4 2018, coverage has increased to 52.7% in Q2 2019 (a 24.7% improvement) among Auckland DHB domiciled Pacific women, to 39.3% among Waitematā DHB Pacific women (a 10.1% improvement) and to 37.8% among Counties Manukau DHB Pacific women (a 9.1% improvement). A large uplift among Waitematā DHB and Counties Manukau DHB was also observed with coverage rising to 40.3% from Q4 2018 among Waitematā Māori (a 13% improvement) and to 27.1% among Counties Manukau Māori (an 8.7% improvement).

Combined antenatal influenza and pertussis vaccination rate results have more than doubled since June 2017, however coverage for both Māori and Pacific pregnant women is still well below the target of 50%.

Maternal vaccination rates may improve with a more systematic approach in primary care. There is strong support from PHOs for development and implementation of an Early Pregnancy Assessment Tool which will support this approach for vaccination, referral to smoking cessation, and referral to healthy housing.

Increase referrals to maternal incentives smoking cessation programmes, for pregnant women

ADHB = 46 WDHB = 83 CMH = 180

= 309 per quarter

Commentary While only Counties Manukau DHB met their quarterly target in the last quarter, there has been a significant improvement in referral numbers since the same period last year - overall a 27% increase.

A system, whereby pregnant women are required to opt out of referral to smoking cessation was successfully trialled in one DHB and has been adopted by the other two and is being considered by PHOs. Implementation has been incomplete and will be further supported over the next year. Better integration with Maternity Services is also needed.

95


0%

20%

40%

60%

80%

100%

Mao

ri

Pac

ific

Oth

er

Tota

l

Mao

ri

Pac

ific

Oth

er

Tota

l

Mao

ri

Pac

ific

Oth

er

Tota

l

2016 2017 2018

0-4 year olds enrolled in DHB funded oral health services

Auckland DHB Counties Manukau DHB

Waitemata DHB Metro Auckland region

Target

4.2 Oral Health

SLM Milestones impacted: Ambulatory Sensitive Hospitalisation Rates per 100,000 for 0 – 4 Year Olds Acute hospital bed days

Poor oral health is a significant and increasing health issue for Pacific and Māori children. Poor oral health leads to dental decay, with many children requiring fillings or teeth extraction under general anaesthetic, resulting in ASH admissions. Dental decay is linked to a range of other health conditions. There are opportunities in primary care to provide health promotion messages and address barriers to care, and links with messaging in the child healthy weight space.

Indicator Target Results Enrolment of 0-4 year olds in DHB funded oral health services

95%

Commentary There is little change overall across the DHBs for the three years. There are some small improvements in Pacific rates for Waitematā DHB particularly and a small decline in rates for Māori across all DHBs.

The Ministry of Health are planning to undertake a data matching process to identify children that are not enrolled with oral health services and this information will be provided to the Auckland Regional Dental Service.

4.3 Alcohol Harm Reduction

SLM Milestones impacted: Youth access to and utilisation of youth-appropriate health services Acute bed days Amenable mortality

Identifying and monitoring alcohol-related ED presentations will enable better understanding of alcohol harm, populations and communities that are most affected. From July 2017, a mandatory data item was added to the National Non-admitted Patient Collection. In some DHBs, full implementation and reporting to the Ministry is not complete or is more recent than 1 July 2017. The mandatory question is “Is alcohol associated with this event?” Possible answers are: yes, no, unknown and secondary (e.g. passenger in car driven by drunk driver, or victim of violence where alcohol is involved). It should be noted that the response recorded may be a subjective assessment by healthcare staff and not confirmed by alcohol testing. Data quality has been a significant issue, particularly for Waitematā DHB, with significant missing data in some areas. However, quality improvement work undertaken during 2018/19 plan has resulted in this now becoming a mandatory question for all DHB Emergency Departments, therefore data should improve for the 2019/20 year. There has also been a focus on quality improvement for alcohol data collection across primary care, and youth services.

96


0%

5%

10%

15%

20%

25%

30%

35%

40%

Q3 Q4 Q3 Q4 Q3 Q4 Q3 Q4

Asian Maori Other Pacific

Enrolled smokers who received cessation support by DHB of practice location - 2018/19

Auckland Counties Manukau Waitemata Target

Indicator Target Results Commentary Percentage of ED presentations where alcohol involved

Baseline 2018/19 data quality at Waitematā DHB is insufficient to be able to baseline metro-Auckland results currently.

Data capture is now mandatory at Waitematā DHB resulting in improved quality for 2019/20 reporting.

Reduce ‘unknown’ alcohol related ED presentation status

<10% Results to March 2019 (DHB of service):

Auckland DHB = 2.5% Counties Manukau DHB = 4.1% Waitematā = 91.5%

See above.

4.4 Smoking Cessation

SLM Milestones impacted: Ambulatory Sensitive Hospitalisation Rates per 100,000 for 0 – 4 Year Olds Acute bed days Amenable mortality Babies in smokefree homes

Tobacco smoking is a major public health problem in New Zealand. In addition to causing around 5,000 deaths each year, it is the leading cause of disparity, contributing to significant socioeconomic and ethnic inequalities in health. In 2011, the Government set a goal of reducing smoking prevalence and tobacco availability to minimal levels, essentially making New Zealand a smoke-free nation by 2025. In 2013, 15% of New Zealanders smoked tobacco every day. That rate was even higher among Māori (33%) and Pacific people (23%). Differences continue to be evident in the prevalence of smoking between the three ethnicity groupings of European/Other, Māori and Pacific.

Indicator Target Results Increase cessation support received by enrolled patients who are current smokers

28.4% (10% increase) (Baseline = 25.8% at December 2017)

Commentary Ministry data by ethnicity is only available for quarters 3 and 4 of 2018/19 for this indicator. Overall, the target is being met for total enrolled population at 29.4% for Quarter 4 2018/19. Counties Manukau rates are lowest and, by ethnicity, rates for Pacific are lowest.

Considerable effort has gone into understanding practice data for smoking cessation support. A baseline for referral and for prescribing medications has been established. Simpler electronic systems for referral have been implemented and the focus in the future will be on improving referral rates and recording in the practice management system.

97


78%

80%

82%

84%

86%

88%

90%

92%

Percentage of eligible Maori population CVD risk assessed

ADHB CMDHB WDHB Metro-Auckland Target

4.5 Cardiovascular Disease Risk Assessment and Management (CVDRA)

SLM Milestones impacted: Acute bed days Amenable mortality

Cardiovascular Disease (CVD) is a major cause of premature death in New Zealand and contributes substantially to the escalating costs of healthcare. Modification of risk factors, through lifestyle and pharmaceutical interventions, has been shown to significantly reduce mortality and morbidity in people with diagnosed and undiagnosed CVD. Patients with established CVD (and those assessed to be at high CVD risk) are at very high risk of coronary, cerebral and peripheral vascular events and death, and should be the top priority for prevention efforts in clinical practice.

The burden of CVD falls disproportionately on Māori and Pacific populations, and there are well-documented inequities in CVD mortality, case fatality and incidence. Reducing these inequities is a high priority and can be achieved through increased use of evidence-based medical management of high-risk patients.

Indicator Target Results 90% coverage CVD Risk Assessment for Māori

90%

Commentary Results show performance is declining over time, particularly for Waitematā DHB. Various strategies have been tried by PHOs to engage with young Māori men to measure cardiovascular risk. Considerable resource has been required with minimal results. Many of these men do not engage with primary care. PHO led initiatives at work places and at social events have encountered barriers including:

Difficulty in obtaining blood results

No clear criteria for referral and follow-up for patients at different levels of clinical acuity

Lack of processes resulting in poor flow of data between systems including practice management systems, Testsafe and risk assessment tools

Patients being enrolled in different PHOs

Cost of running initiatives Extensive discussions on approaches and results have been conducted at both Implementation and Steering Group level, with the resulting view that a nationally driven health promotion approach is more likely to result in success. The introduction of the new CVDRA algorithms following the 2018 consensus statement has likely contributed to lower CVDRA rates.

98


40%

45%

50%

55%

60%

65%

70%

Percentage of those Maori and Pacific patients with a prior CVD event prescribed triple therapy

ADHB CMH WDHB Metro-Auckland 2018/19 target

Increase prescribed triple therapy for those Māori and Pacific with a prior CVD event.

54.6% (5% increase) (Baseline = 59% at December 2017)

Commentary There was a stepped improvement for Counties Manukau approximately a year ago, with a small recent improvement for Counties Manukau and a more marked improvement for Auckland DHB. Auckland DHB are now surpassing the 2018/19 target for this measure.

However, results vary significantly between Māori and Pacific individually. Rates for Pacific are exceeding the target for all three DHBs – 65.8% for the metro-Auckland region at June 2019. Whereas, results for Māori are below target for all three DHBs – 58.2% for the metro-Auckland region at June 2019.

See commentary above.

4.6 Complex Conditions


Improving chronic condition hospital admission rates for adults requires improved integration of services and a ‘whole of system’ approach that engages patients and their families, as well as community and hospital based services. A number of activities have been shown to be effective in reducing avoidable hospitalisations for chronic conditions, including system or institution-wide programmes to improve access to health services, comprehensive disease management programmes which are patient-focused and involve multidisciplinary teams, education and self-management programmes in association with disease management programmes and disease-specific management programmes for long-term conditions.

99


0

50

100

150

200

250

300

350

2015 2016 2017 2018 2019

Ambulatory Sensitive Hospitalisations 45-64 years: COPD

ADHB CMH WDHB Metro-Auckland 2018/19 Target

0

50

100

150

200

250

2015 2016 2017 2018 2019

Ambulatory Sensitive Hospitalisations 45-64 years: CHF

ADHB CMH WDHB Metro-Auckland 2018/19 Target

0

2,000

4,000

6,000

8,000

10,000

2015 2016 2017 2018 2019

Ambulatory Sensitive Hospitalisations 45-64 years: Maori

ADHB CMH

WDHB Metro-Auckland

2018/19 Metro-Auckland target

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

2015 2016 2017 2018 2019

Ambulatory Sensitive Hospitalisations 45-64 years: Pacific

ADHB CMH

WDHB Metro-Auckland

2018/19 Metro-Auckland target

Indicator Target Results Commentary Reduction in ASH rates for COPD for adults aged 45-64 years old.

172 per 100,000 (2% reduction) (Baseline = 175 per 100,000 at December 2017)

The target of increasing utilisation of POAC for Māori and Pacific patients aged 45 – 64 years with ASH conditions has not been measured as it requires improved coding for ASH in primary care. We are monitoring utilisation of POAC for ASH related conditions for this cohort. Data sharing between primary and secondary care to improve coding for ASH conditions contributing to acute hospital bed days has been agreed under the Metro Auckland Data Sharing Framework. We are waiting on supply of the data from the Ministry of Health. Improved coding of long term conditions in primary care will support targeting appropriate cohorts with Quality Improvement (QI) activity.

Reduction in ASH rates for CHF for adults aged 45-64 years old.

122 per 100,000 (2% reduction) (Baseline = 124 per 100,000 at December 2017)

Reduction in the overall ASH rate for Māori adults aged 45-64 years old.

6,877 per 100,000 (2% reduction) (Baseline = 7,017 per 100,000 at December 2017)

Reduction in the overall ASH rate for Pacific adults aged 45-64 years old.

8,839 per 100,000 (2% reduction) (Baseline = 9,019 per 100,000 at December 2017)

100


0%

1%

1%

2%

2%

3%

3%

4%

4%

POAC initiation rate for ASH conditions per 100 Maori and Pacific 45-64 year old enrolled patients by PHO

2017 2018 Target

4.7 Primary Options for Acute Care


Primary Options for Acute Care (POAC) provides healthcare professionals with access to investigations, care or treatment for their patient, when the patient can be safely managed in the community. Access to existing community infrastructure and resources is utilised to provide services that prevent acute hospital attendance or shorten hospital stay for patients who do attend or are admitted. The aim of POAC is to deliver timely, flexible and coordinated care, meeting the healthcare needs of individual patients in a community setting. We aim to have more individuals being treated (where appropriate) through the POAC pathway, thus preventing unnecessary and costly acute hospital admission.

Indicator Target Results Commentary Increased POAC initiation rate for 45-64 year old Māori and Pacific people with ASH conditions

3 per 100 (3%) per PHO

Variation by PHO (split by DHB location) across the metro-Auckland region (PHOs not identified)

Initiation rates vary by geographic location, even where the PHO is the same. Overall rates have declined slightly between reporting periods. Regular POAC data has not been available until recently as such, quality improvement activities have not been supported. PHO education evenings in 2017 resulted in significantly greater use of POAC. This increase has dropped off somewhat as it has not been followed up with practice level data that can support QI. National Health IndexI level data is now available to PHOs.

See commentary above.

101


0%

10%

20%

30%

40%

Dec 17 Mar 18 Jun 18 Sep 18 Dec 18 Mar 19

Percentage of enrolled patients with an e-portal login

Metro Auckland Target

4.8 E-portals

SLM Milestones impacted: Patient experience of care

E-portals are a single gateway for patients to gain access to their general practice information which can include: booking appointments, ordering repeat prescriptions, checking lab results, and viewing clinical notes/records. More general practices are offering patient portals and there is scope within primary health care for them to positively impact on patient experience. This can be enabled through alternative access point/navigation for the patient, enabling coordinated self-managed care provision; maintaining and providing online communication; and partnering with the patient to work collaboratively online (lab results, appointment bookings, care monitoring-physical needs).

Indicator Target Results Commentary Baseline and increase in practices offering prescriptions, laboratory results and view of consultation notes [via e-portals]

Baseline and increase

Unavailable Currently this cannot be systematically collected from current systems. Discussions with vendors need to occur to establish collection of this data.

Percentage of each PHO’s enrolled population with login access to a portal

20%

Variation by PHO across the metro-Auckland region and change over time (PHOs not identified)

This was achieved in five of the seven PHOs and achieved for the Metro Auckland enrolled population. One PHO that did not achieve the target is actively piloting a new portal system.

4.9 Patient Experience Surveys in Primary and Secondary Care

SLM Milestones impacted: Patient experience of care

‘Person centred care’ or how people experience health care is a key element of system performance that can be influenced by all parts of the system and the people who provide the care. Integration has not happened until people experience it. The intended outcome for this SLM is improved clinical outcomes for patients in primary and secondary care through improved patient safety and experience of care.

102


0%

5%

10%

15%

20%

Nov-17 Feb-18 May-18 Aug-18 Nov-18 Feb-19 May-19

Primary Health Care Paitient Experience Survey - response rates: Maori

ADHB CMDHB WDHB Metro-Auckland

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

Nov-17 Feb-18 May-18 Aug-18 Nov-18 Feb-19 May-19

Primary Health Care Paitient Experience Survey - response rates: Pacific

ADHB CMDHB WDHB Metro-Auckland

Indicator Target Results Commentary Percentage of each PHO’s practices participating in PHC PES to PDSA ‘You said, we did’ quality improvement initiative at least once in the financial year

50% No data currently available. All PHOs reported actively supporting this programme in practices. However, data was not collected to quantify.

Increase response rate for completed surveys for Māori patients

2% increase: ADHB – 12.7% CMH – 11.3% WDHB – 14.6%) (Baseline = ADHB – 10.7% CMH – 9.3% WDHB – 12.6%) Note: by DHB of practice

Only Auckland DHB is meeting target. Overall, metro-Auckland response rates have improved slightly compared to February 2019 results.

Only Waitematā DHB met target. Overall, metro-Auckland response rates have improved slightly compared to February 2019 results.

Increase response rate for completed surveys for Pacific patients

2% increase: ADHB – 9.8% CMH – 9.8% WDHB – 7.2%) (Baseline = ADHB – 7.8% CMH – 7.8% WDHB – 5.2%) Note: by DHB of practice

Commentary This is a challenging milestone to achieve. Feedback from primary care, focus groups conducted by DHBs and an expert report by Sapere Consulting have highlighted that the electronic survey format is unlikely to engage Māori and Pacific participants. The principal reason is a preference for face to face discussion. Overall response rate did not appreciably increase over time. This may be in part due to the regular three monthly cycle of the survey coinciding with a three monthly prescription cycle for primary care patients. This may have resulted in the same cohort being asked again to respond in a six month period. This concern has been raised with the Ministry. Engagement with practice teams has also been challenging with some suggesting they participate for reasons of compliance rather than for the value of the survey results. PHO facilitators continue to work with practice managers

103


0%10%20%30%40%50%60%70%80%90%

100%

Percentage of practices within each PHO who are participating in the Primary Health Care Patient Experience Survey (PHC PES)

Nov-17 Feb-18 May-18 Feb-19 2018/19 Target

0%

5%

10%

15%

20%

25%

Maori and Pacific inpatient survey response rates - metro-Auckland

Maori Pacific

Indicator Target Results Commentary as part of a change management approach, reinforcing the value of the patient voice. They also integrate this QI activity with Foundation Standards and Cornerstone to ensure efficiency for the practice. The focus of improving results for a specific question as well as collection of valid email addresses may lead to better traction with practice teams in 2019/20.

Maintain or increase practice participation in the PHC PES as at June 2018

June 2018 baseline = 90%

The majority of PHOs are meeting the target to maintain baseline participation rates.

Response rate by ethnicity in the secondary care in-patient survey

Establish baseline Note: numbers are small, contributing to variability

A baseline response rate for the inpatient survey was established and available to DHB Patient Experience teams.

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Waitematā District Health Board, Meeting of the Board 02/10//19

6.2 Qlik Sense (Data Discovery Business Intelligence Tool) Update

Recommendation:

That the Board notes the progress in implementing Qlik Sense.

Prepared by: Penny Andrew (i3 Director) Endorsed by: Dale Bramley (Chief Executive Officer)

1. Executive Summary

A presentation will be made to the Board to demonstrate progress made in implementing and using Qlik Sense (Qlik), a data analytics platform, at Waitematā DHB (WDHB). In September 2016, the Board approved a business case to purchase and install Qlik to help WDHB resource data-driven, clinically-led outcomes based care. The business case identified the following benefits to be delivered by implementing Qlik:

A tool that frontline clinical staff and operational teams use to access and manipulate data in

order to drive clinical decisions, design new models of care and, track patient experience

and outcomes, and drive service improvements

Provide access to data across multiple datasets and systems

Provide access to real-time data with the ability to drill down data to the individual patient

level to answer questions as they arise

Identify and track measures of the impact of service redesign and new models of care with

clinical, financial, operational, and population level data

A Data Discovery Business Intelligence (BI) Tool project commenced in January 2017, as a Leapfrog Programme project, with the purpose of setting up, developing and rolling out Qlik across the DHB. The project was completed in January 2019 achieving the project objectives and coming within 1% of the budget (a small overspend of $1,163 was within the contingency buffer). The project team received training in March 2017 and within six weeks published the first application (app), an Outpatient explorer. By the end of the project, a total of 33 applications (data dashboards) had been published with at least one application built for every provider arm division, an application for primary health and another for regional use. All the applications have been built in-house and are supported by WDHB staff. The applications range from visualisations of single datasets for easy dissemination of data, to visualisations of multiple datasets to answer complex questions. Two applications show current inpatients and update every 10 minutes. One of these near real-time applications also includes predictive data modelling for elective surgical bed management. All other applications have data no greater than a day old, giving users easy access to current data. The developed applications have been promoted through presentations at clinical, operational, and governance groups locally, nationally, and internationally. The project team hosted a launch event, played a key part in a Digital Innovations Expo at WDHB, has hosted other district health boards for further demonstrations, and has presented at conferences within and outside New Zealand.

105


Over 1,000 licenses have been accessed by users from each level of the organisation. The highest engagement is from the Auckland Regional Dental Service whose clinicians, management and clerks are all using the same application. The application has replaced 200 reports and allowed users to identify children carrying high risk of caries, reduce missed appointments, and find errors in the data previously hidden. In addition to training end users, the project team has created and run designer and developer training, using clinical examples, for over 40 other staff members. Those trained form an internal Qlik Development Community. Quarterly events with this group have been held since the start of the community. Feedback from clinicians, managers and other staff is that Qlik has broken down blocks to data access, saved administration time, enabled service planning and continuous quality improvement, and caused users to answer questions they didn’t know to ask previously. At least five successful proposals to the Senior Management Team have used and were visualised through a Qlik application. The key lessons learnt from the project are the importance of having a clinical lead in app development, the benefit of having dedicated data warehouse resource, the value of building a good team culture, and the advantage of an Agile approach for large-scale pieces of work. Qlik continues to grow and as of September 2019, over 50 applications have been published and over 1,300 licenses accessed. The i3 project team is continuing to lead the development of Qlik. The focus of the next phase is to refine and embed the applications already published.


Community, whānau and patient centred model of care

Qlik apps have been developed over a wide range of datasets including inpatients, outpatients, community, mental health and clinical services. The apps are modelled using multiple datasets that can include patient experience feedback and patient experience outcome measures (PROMs). The apps enable evidence-based co-design of models of care, providing insight into what matters most to patients, and what is needed to improve patients’ experience.


By linking multiple datasets, a complete patient journey can be visualised providing insight at multiple levels aggregated at a population and community level through to data at an individual patient level.

Intelligence and insight

Qlik Sense has enabled visualisation and analysis of data across the patient journey and within a specialty. This has resulted to a shift from spending the majority of time collecting and collating data, to now spending time on analysis and quality improvement. This has enabled the organisation to learn from iterative tests of change, which drives continuous improvement. Papers in Appendix 1 demonstrate how Qlik has been used to drive continuous improvement.


Clinical Pathways apps display metrics identified in evidence-based in-hospital clinical pathways, including costing, Emergency Department, medicine and surgery stay, rehabilitation stay,

106


radiology, laboratory, SaferSleep (anaesthesia), surgical pathology and Allied Health data that can be used in real-time to inform clinical decision making and practice


Qlik apps include costing data built with clinicians so the data is meaningful and easily understood. Apps are used for continuous improvement, service planning and delivery, efficiency, and effective resource allocation

3. Introduction/Background

The Data Discovery BI Tool project commenced in January 2017 with the aim of democratising access to data – putting data in the hands of the clinicians who can use it to improve care. A project goal was set: to provide better access to health-related data through Qlik Sense’s interactive, data discovery visualisations for more than 1,000 users across WDHB by the end of 2018. Qlik Sense is an end-to-end data analytics platform that combines multiple data sources into a single view. Applications (apps) are the primary object developed on the platform which includes a data model and visualisations. Qlik’s ‘associative engine’ creates relationships between all values in the data at the lowest grain (for example, at an individual patient level). Users can explore the data in any direction, discovering what data is and is not related. Visualisations update immediately as the user makes selections – a significant advantage over traditional data reporting tools. The succeeding diagram (Figure 1) shows the relationship between source data systems and Qlik apps, and demonstrates that the apps that have been built draw on many data sources and join data from otherwise siloed source systems.

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SOURCE DATA SYSTEMS

General Surgery PathwaysAppendicitis

Acute CholecystitisAbscesses

Internal eReferrals

Provation Endoscopy

ECG Manager

iPM

Medchart ePrescribing

PatienTrak eVitals

RMS eReferrals (from GPs)

Trendcare Nursing Acuity

HCC Mental Health EHR

ED Whiteboard

SaferSleep Anaesthesia

Plato Cl inical Coding

Healthware Maternity

Nexus ESC Operating Theatres

Titanium School Dental

XIMS Cathlab

PyxisPharmacy dispensing machines

Winscribe

Research & Audit

SMT with Electronic Discharge Summ

Paceart pacemakers

Optomize retinal screening

PERSy

Costing

Eclair (eOrders of rad & lab)

ED presentations

inpatient events

outpatient events

theatre events

waitlists

referrals

Payroll

InterRAI

HR

General Ledger - Finance

ED Explorer

Inpatient and Theatre Explorer

Outpatient Explorer

Care Standards

Nursing Documentation

Health and Safety Audits

Food & Nutrition Audits

Infection Prevention and Control

Patient Safety Audits

Ward Audits &Care Stds

Friends & Family Test

EWS Audits

EDARS Explorer

Diabetes Dashboard

Medcial Specialties &Health of Older Adults Clinical Metrics

Paediatric Dashboard

TransforMED Dashboard

Renal Explorer

Surgical Divisional Dashboard

Transcription Explorer

eReferrals Explorer

Colonoscopy KPIs

NOF # Pathway

Stroke Pathway

Inpatient Allied Health Explorer

Cancer Explorer

Radiology Explorer

Gastro Dashboard

Acoustic Neuroma Pathway

Deteriorating Patient Dashboard

Anaesthesia Explorer

Smartpage Orderly & dr messaging

Newborn Hearing Screening

Orderly Task Explorer

Bed Allocation System

Population Projections

Elective LOS Dashboard

Population Projections

QLIK APP

SOURCE SYSTEM

Maternity Explorer

Newborn hearing Screening

Soprano Workflow Engine

RIS Radiology Info System

LIS Laboratory Info System

Mental Health Explorer

QLIK APPS

QLIK APPS

Figure 1

4. Approach

A set of standards, guidelines, and processes were defined to ensure consistency of app development, app reusability, reduce the risk of overwriting another developer’s work, and to manage size and performance of apps. The project team developed an operating framework that documents the application development lifecycle, coding conventions, design guidelines, peer review process, and Qlik deployment framework. A set of prioritisation categories were established to assess requests and stage development apps:

108


Concept Well developed and prototyped with metrics defined

Developed, possibly prototyped, with some measurements defined

Work has not begun on concept development

Data availability

All data is available in the Red data warehouse (Red) or the Operational Data Store (ODS) (and there is no plan to build in Red)

Data available in ODS Data build into Red required or new data feed

Presentation/ Design Layout well defined and socialised

Layout defined Work has not begun on design or presentation

Engagement Clinical lead is very engaged and committed to working closely with working group

Clinical lead has been identified and needs to be engaged for work to progress

Clinical lead has not been identified

Value/ alignment to purpose

Acknowledged by the sponsor and/or key clinicians as aligning well to the project purpose, expected to add high value, or strategically important

Will add value to the division.

Value not yet defined, nice to have

Table 1: Prioritisation Categories

The diagrams below (figures 2 and 3) show the development timeline of each app and the split between clinical and operational apps. The mandate from the CEO was that, the tool must benefit clinicians wanting to improve patient outcomes and experience. Therefore, the project team started with development of clinical apps. As the Development Community grew, so did the number of apps with an operational focus. The apps can be grouped into six types: Clinical Pathways, Divisional/Speciality Dashboards, Models of Care Dashboards, Patient Safety dashboards, Strategic / Improvement Programmes, and Explorers.

Figure 2: App Development Timeline

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Figure 3: App Development by Division and Primary Audience

Real time reporting and predictive analytics have been integrated into the apps. In January 2018, a summer student completed a 10 week project to integrate R, a programming language for statistical analysis including predictive analytics, into Qlik as a proof of concept. In May 2018, developers in the project team received R training and working with a data scientist developed an Elective Surgical Bed Management app with an algorithm to predict length of stay. The app refreshes every 10 minutes and is 90% accurate to within one day of actual length of stay. The app was developed in response to issues in elective surgery bed management with a bed shortage an increasingly common reason for theatre cancellations and surgical bed needs having peaks and troughs and seasonal variation (bed shortage is greatest over winter when acute medical admissions are the highest). Historically bed needs have been predicted based on staff judgment.

Figure 4: elective surgical bed management - predicting LOS

Another real time app has been developed to show data on Current Inpatients. The app is used at daily operations meetings with Charge Nurse Managers and Operations Managers to resolve issues with beds, staffing, and patient flow. A User Training Programme has been developed, which includes one-day designer training and two day developer training courses run by members of the project team. By the end of the first year, 22 staff were trained and joined the WDHB Developer Community. In November 2018, the training material for both courses was re-written to fit into a two day training course to be run by a member

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of the Qlik project team. To date, 39 staff have been trained. In addition, shorter hour-long training sessions are being offered to staff and i3 and project team members attend clinical group meetings to support and encourage the use of the apps. To manage the risk of data being inappropriately accessed, the project put in place the following safeguards: • Limited the patient identifiable data available in the Qlik apps to NHI so that further

identification requires clinical portal log in • Required users to complete an on-line privacy course • Audit of Qlik app usage • Limited access to apps which show clinician names and sensitive information (such as

complication rates) • Required users to sign up to our Qlik Honour Code – similar to the Health Roundtable honour

code, as shown below.

Figure 5

5. Impact

In mid-2018, Qlik organised for the Waitematā Qlik Sense story to be recorded. The video Transforming Waitematā with Qlik Sense was published on Qlik’s YouTube channel: https://www.youtube.com/watch?v=ZcTjICHsloI Throughout the project, feedback has been received from clinicians, managers and other staff. The consistent themes from this feedback is that Qlik has broken down blocks to data access, saved administration time, enabled service planning and caused users to answer questions they didn’t know to ask previously. In early 2019, Sharon Puddle, a project team member and Head of Digital Transformation at i3, was selected as one of 80-90 people internationally to be a Qlik Luminary. She is one of only two selected in the Pacific region. A luminary is selected if they can demonstrate that they are:

Passionate about Qlik and widely recognized as a BI innovator and expert in his or her field Active and consistently helpful on Qlik Community.

Active on online forums, industry social networks, and/or organizational or personal blog.

Willing to share best practices and knowledge at industry events, forums, in the press, and with industry analysts.

Prolific content creator who creates or contributes to blogs, white papers, reviews, articles, videos, etc.

The Qlik project team was invited to participate in a panel for the 2018 Qlik Data Revolution Tour in Sydney. Delwyn Armstrong and Sharon Puddle attended and presented the DHB’s Qlik work.

Qlik Honour Code

Qlik Sense information is available for service improvement.

All users must agree to abide by the Qlik Honour Code which requires that:

No user shall criticise the performance of another clinician or service, or use any of the information to the detriment of a clinician or service.

No external distribution of data or conclusions based on Qlik data is made without the consent of your Head of Department or the Director of Hospital Services, unless required by law

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https://www.youtube.com/watch?v=ZcTjICHsloI


In May 2019, the project leads along with Stefan Van der Walt, an Emergency Medicine Consultant and first clinician developing in Qlik at WDHB, were invited to present at the international Qlik conference, ‘Qonnections 2019’ in Texas. In June 2019, the Leapfrog Programme won the CIO Award for Business Transformation through Digital and IT. The Data Discovery project was part of the submission. In July 2019, Waitematā DHB was the winner of the Organisational Transformation Award at the 2019 ANZ Health and Public Sector Analytics Summit. Post Implementation, a project evaluation led by the National Institute for Health Innovation (NIHI) will be conducted over the next two months. Learning from this evaluation will be in the form of an Action Plan to December 2020. A core outcome of the plan to December 2020 is increasing usage of apps and the number of improvement initiatives identified using Qlik. This work will include further exploration and implementation of new features and extensions in Qlik Sense.

Handover of Qlik apps to the Health Intelligence Team for ongoing support and maintenance has begun. This will continue over the next 18 months.

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Appendix 1 – Conference Posters These posters were submitted to conferences to demonstrate how Qlik has been used to deliver value in the organisation.

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© 2019 QlikTech International AB. All rights reserved. Qlik®, Qlik Sense®, QlikView®, QlikTech®, Qlik Cloud®, Qlik DataMarket®, Qlik Analytics Platform®, Qlik NPrinting®, Qlik Connectors®, Qlik GeoAnalytics®, Qlik Core®, Associative Difference®, Lead with Data™, Qlik Data

Catalyst™, Qlik Associative Big Data Index™, Qlik Insight Bot™ and the QlikTech logos are trademarks of QlikTech International AB that, where indicated by an “®”, have been registered in one or more countries. Other marks and logos mentioned herein are trademarks or

registered trademarks of their respective owners.

Vote for Poster #

Waitematā District Health Board (DHB) is one of three DHBs in the Auckland metro region in New Zealand. As

part of the second stage of our eReferrals project, we implemented DHB Elective eReferrals (DeeR) to enable

hospital clinicians to refer patients for elective care electronically within our DHB, and between DHBs in the

Auckland region. The DeeR implementation involved a regional project team (CareConnect) across the three

DHBs and primary care, along with our shared IT service agency healthAlliance. In March 2018 we had a

successful soft launch within our DHB, with the other two DHBs launching in June/July 2018. The first eReferral

was submitted within 10 minutes of go-live, and one year on we have had almost 65,000 eReferrals.

DHB Elective eReferrals (DeeR) ExplorerThe only issue was the lack of automated reporting, so our Information Analyst involved with CareConnect had to

extract and analyse data during the early stages of the implementation while waiting on a reporting solution from

healthAlliance. Once she was trained on Qlik Sense she developed a DeeR Explorer to report on Waitematā’s

uptake. When requested, she was able easily export and share results with the other two DHBs. On request from

our CIO we were able to negotiate a contract extension to allow read-only for the other DHBs to access to the

DeeR app. Below is the DeeR Summary for CareConnect:

Intra + Inter DHB eReferralsWaitematā District Health Board

DISCOVERIES

This was a successful cross-DHB project

which has laid the foundation for an almost

complete referral network within the

Auckland metro region. However without Qlik

we would not have been able to monitor the

uptake of DeeR referrals, or to track the intra

and inter-DHB referrals flow.

AUDIENCE

We have set up regional access to this

app for CareConnect project members

• CIOs, clinical leads, data managers,

information analysts

DATA AND ADVANCED ANALYTICS

• WDHB_EREFERRALS database

• OHCP_REF_OHCLINICAL database

ACHIEVEMENTS

• We were able to support a regional

project with our DeeR app to allow the

project team to easily monitor:

o uptake by DHB and specialty

o draft referrals

o declined referrals not yet

acknowledged by the referrer

• An audit of handwritten paper referrals for

Waitematā between Sep 2018 (n=428)

and Mar 2019 (n=168) showed a

significant decrease of 60%

##

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© 2019 QlikTech International AB. All rights reserved. Qlik®, Qlik Sense®, QlikView®, QlikTech®, Qlik Cloud®, Qlik DataMarket®, Qlik Analytics Platform®, Qlik NPrinting®, Qlik Connectors®, Qlik GeoAnalytics®, Qlik Core®, Associative Difference®, Lead with Data™, Qlik Data

Catalyst™, Qlik Associative Big Data Index™, Qlik Insight Bot™ and the QlikTech logos are trademarks of QlikTech International AB that, where indicated by an “®”, have been registered in one or more countries. Other marks and logos mentioned herein are trademarks or

registered trademarks of their respective owners.

Vote for Poster #

Machine Learning for Bed

ManagementWaitematā District Health Board

AUDIENCE

The predictions will be used by the Elective

Surgical booking team to manage their

inpatient beds.

Next steps are to build in predicted acute

demand to the visualisation, and building a

model to predict current inpatient length of stay

based on a richer clinical data set

DATA AND ADVANCED ANALYTICS

• iPM: Theatre, Inpatients, Waiting List

ACHIEVEMENTS

• 72% accuracy of current model to actual

elective length of stay

• Surgical booking team can now see predicted

bed occupancy information alongside theatre

bookings in one application to improve theatre

utilisation

##

Integrating a Predictive Algorithm for Elective Surgery Cases into Care PlanningAs we have limited inpatient bed supply, this can be a bottleneck for patient flow. Previously forecasting of bed

numbers has relied on staff judgments. We had the potential to get better estimates using available data and new

data modelling techniques.

We collaborated with data scientists from iVise to create a machine learning model to predict elective surgery

bed demand based on information about patients who are on the current surgical waitlist and their theatre

booking details (ie age, surgical specialty, sub-specialty, waitlist category, laparoscopic indicator, surgical

procedures [1-9], CPAC score and previous ASA grade). Working with a data set of 40,000 discharges (36k to

build a model, 4k to test), a Random-Forest model was developed.

Machine Learning Model1. Data is extracted nightly for our machine learning model

2. LOS predictions are calculated with Random-Forest

model in R

3. LOS predictions are saved nightly into data warehouse

4. Qlik Sense dashboard is updated every 10 mins with

LOS predictions along with surgical admissions and

theatre sessions

5. New discharges are fed into the system each weekend

and a new model is built. A recency factor is included in

the model so that more recent discharges are weighted

more heavily to reflect service changes

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7. Resolution to Exclude the Public

Resolution: That, in accordance with the provisions of Schedule 3, Sections 32 and 33, of the NZ Public Health and Disability Act 2000: The public now be excluded from the meeting for consideration of the following items, for the reasons and grounds set out below: General subject of

items to be considered Reason for passing this resolution in relation to each item


1. Minutes of Meeting of the Board - Public Excluded (21/08/19)



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




[Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.





[Official Information Act 1982 S.9 (2) (i)] Negotiations

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The disclosure of information would not be in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.


4. Minutes of the Hospital Advisory Committee – Public Excluded (11/09/19)




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

5. Community Pharmacy Audit Policy Update







6. Draft Annual Report 2018/2019




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7. 10-Year Information Systems Financial Plan – Affordability Review







8. New Zealand Health Partnership - Updated Resolution




9. National Child Health Information Platform (NCHIP) - Memoranda of Understandings




10. Mason Clinic: Tranche 1 Business Case



Commercial Activities The disclosure of information would not be in the public interest because of the greater need to enable the Board to carry out, without prejudice or disadvantage, commercial activities. [Official Information Act 1982 S.9 (2) (i)] Negotiations The disclosure of information would not be

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in the public interest because of the greater need to enable the board to carry on, without prejudice or disadvantage, negotiations.


11. Mason Clinic Land Purchase Planning





12. Structural Standard Options for the ECIB Facility Build





13. Holidays Act Update That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for

Conduct of Public Affairs The disclosure of information would not be in the public interest because of the greater need to maintain the effective conduct of public affairs through the

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which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982.


protection of members, officers and employees from improper pressure or harassment.

[Official Information Act 1982 S.9 (2) (g)(ii)]

14. Legal Update That the public conduct of the whole or the relevant part of the proceedings of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist, under section 6, 7 or 9 (except section 9 (2) (g) (i)) of the Official Information Act 1982. [NZPH&D Act 2000 Schedule 3, S.32 (a)]


Legal Professional Privilege The withholding of the information is necessary to maintain legal professional privilege. [Official Information Act 1982 S.9 (2) (h)]

Obligation of Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which is subject to an obligation of confidence.

[Official Information Act 1982 S.9 (2) (ba)]

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board meeting - waitematadhb.govt.nz · resolution (moved james le fevre/seconded edward...

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