Agenda Bay of Plenty Hospital Advisory Committee · Hospital Advisory Committee meeting 25th May...

Agenda

Bay of Plenty Hospital Advisory Committee

Venue: Tawa Room, Education Centre, 889 Cameron Road, Tauranga Date and Time: Wednesday 5 August 2015 at 2:00pm

Health Targets Shorter Stays in Emergency Departments Improved Access to Elective Surgery Shorter Waits for Cancer

Treatment/Radiotherapy Increased Immunisation Better Help for Smokers to Quit More Heart and Diabetes Checks

Minister’s Expectations Better Public Services: Results for New

Zealanders National Health Targets Care Closer to Home Shorter Waiting Times Health of Older People Regional and Clinical Integration Living Within our Means

Board Priorities Health Targets Maori Health / Reducing Health Disparities Health of Older People Primary Health Wellness/Chronic Conditions Child and Youth

The Quality Safety Markers Falls Healthcare Associated Infections Central Line Associated Bacteremia Hand Hygiene Surgical Site Infection Perioperative Harm Medication Safety

Healthy, Thriving Communities

Bay of Plenty Hospital Advisory Committee Agenda – open

Item No. Item Page

1

Apologies

2 Interests Register

3

3 Minutes of Meeting

10

4 Matters Arising

4.1 Matters Arising – Nil

4.2 Committee Matters Arising – Nil

4.3 Regional HAC Committees

13

5

Reports requiring Decision

5.1 Chief Operating Officers Highlights Report

5.2 Chief Operating Officers Performance Report

5.3 GM Property Services Monthly Report

25

52

62

6

Reports for Noting 6.1 Work Plan

68

7

Presentations 7.1 Health Targets – COO

8

General Business

9

Resolution to Exclude the Public

10

Next Meeting – Wednesday 7 October 2015.

1

Bay of Plenty District Health Board Board Members Interests Register

(Last updated 19 June 2015)

INTEREST NATURE OF INTEREST CORE BUSINESS RISK OF CONFLICT DATE OF INTEREST

ARUNDEL, Mark Bethlehem Pharmacy 2001 Ltd

Director Pharmacy LOW: DHB does contract with Pharmacies but as Board member Mark is not in a position to influence the contract.

01/12/2001

Pharmaceutical Society of New Zealand

Member Professional Body NIL 1980

Pharmacy Guild of New Zealand INC

Member Agency for negotiation of DHB contract

LOW: DHB does contract with Pharmacies but as Board Member Mark is not in a position to influence the contract.

01/12/2001

Armey Holdings Director Property NIL 28/07/2005 Armey Family Trust Trustee Family Trust NIL 28/07/2005 Bay of Plenty Pharmacy Group

Member Pharmacy LOW: No contact at this stage 08/2010

Toi te Ora Wife is an employee Health Minor to Nil. No direct influence. 03/02/2014 Lakes BOPHAC DHB Community Rep Health LOW 04/2014 BOYES, Yvonne Boyes Family Trust Trustee Family Trust NIL 1999 Nautilus Trust Director Property NIL 1999 Riesling Holdings Ltd Director Property NIL 1999 Eastern Bay PHA Clinical Nurse Leader Health LOW: EBPHA has a contract

with the DHB but as a staff member Yvonne is not in a position to influence the contract’ to be consistent with the other disclosures

01/07/13

Rural Immersion Program Academic Advisor Health Moderate 04/2014 BOPDHB/University Auckland Academic Advisor for RHIIP

Programme xxxxx xxxxx May 2014

3

2


ESTERMAN, Geoff Western Bay of Plenty PHO Board Member Health LOW – WBOP PHO has contract

with the DHB but as a Board Member Geoff is not in a position to influence contracts.

28/11/2013

Western Bay of Plenty Primary Care Provider Incorporated Board

Board Member Primary Healthcare LOW 28/11/2013

Gate Pa Medical Centre Ltd Director, Manager & GP Health LOW – DHB does not contract directly with General Practices and as a Board Member Geoff is not in a position to influence contracts.

28/11/2013

Plunket Wife is a part time Nurse Health NIL 28/11/2013 GM and P Esterman Family Trust

Trustee Family Trust NIL 28/11/2013

Gate Pa Developments Ltd Director Property & Kiwifruit NIL 28/11/2013 Waterview Buildings Ltd Director Property NIL 28/11/2013 BOP Sexual Assault Services Wife is a part time Nurse Health NIL 17/3/2015 GUY, Marion Western Bay of Plenty PHO Board Member Health LOW: WBOPPHO has a contract

with the DHB but as a Board Member Marion is not in a position to influence the contract.

28/01/2005

BOPDHB Employee Health Care NIL 03/1996 South City Medical Centre Employee Health NIL 06/1996 National Health Board Board Member Health LOW: As a NHB Member Marion

is not in a position to influence BOP contracts.

12/2009

Health Practitioner Disciplinary Tribunal

Member Health LOW 12/2009

Providers Incorporated Executive Member Primary Healthcare NIL 02/2010 New Zealand Nurses Organisation

President Health NIL 17/3/2015

4

3


McCAUSLAND, Punohu Maori Health Runanga Chair DHB Health Partner LOW 25/02/2005 Nga Mataapuna Oranga PHO Director Health LOW – No influence and no

contract involvement 13/12/2007

Te Manu Toroa Board Member Health LOW – No influence and no contract involvement

13/12/2007

Waitaha Hauoranga Trust Trustee (Voluntary Support Worker)

Health Provider LOW – No influence and no contract involvement

13/12/2007

Te Kotahitanga o Te Arawa Fisheries Council

Director Fisheries NIL 13/12/2007

Te Whanau Poutiri-rangi-a-papa

Iwi Delegate BOP Iwi Governance Health Body

NIL 13/12/2007

McINTOSH, Gail Gail McIntosh Accountants Ltd Director Accountancy Services NIL 1994 GH McIntosh Family Trust Trustee Family Trust NIL 1994

NZICA Member Professional Body NIL 1994 Tauranga City Council Member Council LOW 2013 PARKINSON, Matua xxxxx xxxxx xxxxx xxxxx xxxxx SCOTT, Ron Tauranga Energy Consumers Trust and Director of associated entities

Trustee Manages $800 million of funds on behalf of beneficiaries of the Trust

LOW 2006

Stellaris Ltd and Stellaris PTE Ltd

Director Business Education and Training organisation

LOW 2005

SILC Charitable Trust Chair Disabled Care Low – As a Board Member Ron is not it the position to influence funding decisions.

July 2013

Lakes CPHAC/DSAC DHB Community Rep Health LOW June 2015 Waikato DSAC DHB Community Rep Health LOW June 2015

5

4


STEWART, David Tauranga District Licensing Committee.

Member 15/05/2015

Health Waikato Advisory Committee

Member 15/05/2015

Woodlands Partnership Partner 15/05/2015 David Stewart Family Trust Trustee 15/05/2015 WEBB, Sally Capital Investment Committee Member Health Capital

Allocation Minimal 24/1/2011

SallyW Ltd Director Consulting & Coaching

Nil 2001

Health Workforce NZ Member Health xxxxx June 2014 Taranaki DHB Deputy Chair Health LOW 03/2014 Central Regional Governance Group

Independent Chair Governance LOW

01/08/2014

6

1

Bay of Plenty District Health Board Committee Members Interests Register

(last updated 25 July 2014)


McCAUSLAND, Punohu: CPHAC/DSAC Runanga Rep Maori Health Runanga Chair DHB Health Partner LOW 25/02/2005 Nga Mataapuna Oranga PHO Director Health LOW – No influence and no

contract involvement 13/12/2007

Te Manu Toroa Board Member Health LOW – No influence and no contract involvement

13/12/2007

Waitaha Hauoranga Trust Trustee (Voluntary Support Worker)

Health Provider LOW – No influence and no contract involvement

13/12/2007

Te Kotahitanga o Te Arawa Fisheries Council

Director Fisheries NIL 13/12/2007

Te Whanau Poutiri-rangi-a-papa

Iwi Delegate BOP Iwi Governance Health Body

NIL 13/12/2007

NGATAI, Stewart: BOPHAC Runanga Rep Aotearoa Dive Limited Director NIL 2011 BOPDHB Planning & Funding Staff Member Health LOW – there are sufficient

safeguards to ensure Operational matters are not conflicting

2011

Child and Youth Mortality Review Committee member for the Māori Health Runanga

Runanga Iwi rep. Intersectoral NIL 2010

Ngati Makino Heritage Trust Member and Working Committee member

Governance Entity LOW 2008

Pasifika Community Centre Member Social LOW 2008 Toi Pasifika Cultural Advisor Health and Social LOW 2010 Pacific Islands Community Trust (Tauranga)

Member Health LOW 2008

Mount Under Water Club Committee member Recreational NIL 2012 Ngāti Mākino Iwi Authority Iwi rep. / Director Governance Entity LOW 2013

7

2


THURSTON, Lyall : CPHAC/DSAC Lakes DHB Rep QSO JP : Re-elected October 2010 & re-appointed Deputy Chair from 6.12.10-8.12.13 : Re-elected Oct 2013 & reappointed Deputy Chair from 09.12.13 – 04.12.16 Bay of Plenty Regional Councillor

Trustee of the Rotorua Energy Charitable Trust

Son, Oliver is Private Secretary to the Hon. Dr Jonathan Coleman MP, Minister of Defence, State Services and Associate Minister Finance 12.12.2011

Son Simon is a Policy Planner with the Rotorua District Council

Deputy Chair of Lakes District Health Board

Lakes DHB Disability Support Advisory Committee

Rotorua Museum Centennial Trust

Bay of Plenty Regional Council Public Transport Sub-Committee

Past National President & Life member CCS Disability – Action - Wellington

Life Member, CCS Disability Action Bay of Plenty

Chairman & Proprietors Representative John Paul College Board of Trustees

ay of Plenty Disability Support Advisory Committee &

Advisory Committee Member

8

3


Community & Public Health Advisory Committee BURDON, Mary

MARIU, Sharon

MCQUOID, Pauline

WADE, Clyde

WILLIAMS, Margaret

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Bay of Plenty Hospital Advisory Committee (open) Minutes

Minutes

Bay of Plenty Hospital Advisory Committee

Venue: Tawa Room, Education Centre, Tauranga Hospital Date and time: Wednesday 3 June 2015 at 2:00pm

Committee: Mark Arundel (Chair), Sally Webb, David Stewart, Geoff Esterman, Marion Guy,

Stewart Ngatai (Runanga Rep), Mary Burdon, Clyde Wade Attendees: Pete Chandler (Acting CEO), Bronwyn Anstis (Acting COO), Hugh Lees (Chief Medical

Advisor) Julie Robinson, Trevor Richardson, Annette Copeland (minutes)

Item No.

Item Action

1

Apologies

Phil Cammish (Chief Executive), Gail Bingham (GM Governance & Quality).

2

Interests Register

The Committee were asked if there were any conflicts in relation to items on the agenda.

3

Minutes

Resolved that the minutes of the meeting held 1st April 2015 be confirmed as a true and correct record.

Moved: S Webb Seconded: C Wade

4

Matters Arising

4.1 Matters Arising

The spelling of Karyn Borman’s name was corrected in the minutes.

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Item No.

Item Action

4.2

4.3

Committee Members Matters Arising There were no Committee Members Matters Arising Regional HAC Committees (Lakes / Waikato) There were no matters arising from Waikato / Lakes Regional HAC Committee minutes.

5

Reports requiring decision

5.1 Chief Operating Officers Highlights Report The Committee discussed the report as circulated with the agenda.

Resolved that the Committee receive the report.

Moved: G Esterman

Seconded: M Guy

5.2

5.3

Chief Operating Officers Performance Report The Committee discussed the report as circulated with the agenda.

Resolved that the Committee receive the report.

Moved: G Esterman

Seconded: M Burdon GM Property Services Monthly Report The Committee discussed the report as circulated with the agenda. Resolved that the Committee receive the report.

Moved: M Arundel Seconded: C Wade

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6

Reports for Noting

6.1 Work Plan The Committee noted the information.

7

Presentations

7.1 Productivity Improvements by Trevor Richardson (DSA) and Pete Chandler, Chief Operating Officer The Committee thanked Pete and Trevor for the informative presentation.

8

General Business There was no general business.

9

Next Meeting – Wednesday 5 August 2015

The meeting closed at 3.25 pm. The minutes will be confirmed as a true and correct record at the next meeting.

12

Hospital Advisory Committee meeting 25th May 2015 Page 1 of 6

MINUTES OF THE MEETING OF THE HOSPITAL ADVISORY COMMITTEE

HELD ON MONDAY 25th MAY 2015 AT 10.00 A.M. HOSPITAL BOARDROOM, PUKEROA STREET, ROTORUA Meeting No. [140] Present: M Burdon (Chair), D Shaw, I McLean, M Bentley, M Gallagher (from 10.25am), M Arundel, J

Calnan, D Honore, A Morgan and E Isaacs (alternate representative to N Wikaira) In Attendance: D Oliff, N Saville-Wood, G Lees, S Wilkie, E Berryman-Kamp, J Eilers, G Fannin (from 10.20am)

and B E Harris (Board Secretariat)

140.10 MEETING CONDUCT The Chair welcomed everyone to the meeting and asked E Berryman-Kamp to lead the karakia. 140.11 Apologies: D Loughlin, T Lloyd, N Wikaira and R Dunham Resolution: THAT the apologies be sustained. D Honore : J Calnan CARRIED 39.12 Schedule of Interests Register The Interest Register was circulated during the meeting with no additions/amendments added. 140.13 Conflict of interest relating to agenda items The Chair asked for any disclosures of interest regarding agenda items to which none were

submitted. 140.14 General Business: Nil

Presentation update on Mental Health and Addictions Services by G Goodfellow, Service Manager, Mental Health and Addictions Services

The presentation by G Goodfellow covered:- Medical cover Resources Back to basics Clinical activities Improving productivity Improving care Improving information Outcomes Other Audit activities In response to questions from the committee, the following points were noted:-

E Isaacs to make direct contact with Gail Goodfellow regarding issue she raised re mental health in Taupo.

Ageing mental health workforce creates challenges. Succession planning to retain good staff and engage young people in the services. Compassion fatigue with staff can be a

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problem. Lakes has a graduate programme and this year a new graduate occupational therapist

has been brought on board. A number of doctors visit people at their homes.

The Chair thanked G Goodfellow for an excellent and very informative presentation.

140.20 SIGNIFICANT ISSUES 140.21 Clinical Governance Minutes of Meeting : 21st April 2015 The Chair took this opportunity to carry out introductions to assist new member Martin

Gallagher who responded that he was pleased as a second term Board member of the Waikato DHB to be the representative in place of Ewan Wilson. M Gallagher stated that he is a strong believer in collaboration and advised that the Waikato DHB valued Lakes DHB’s representatives on the Waikato advisory committees. Highlights from the Clinical Governance and Management Team meeting were:- Schedule of Actions list –a single file for the two sites (Rotorua & Taupo Hospitals) is

proposed. Presentation by G Fannin on Urology Acute Provision Contract – clinicians happy to

have opportunity for meetings to discuss the contract. Had to postpone L Yule’s presentation on SAC/RCA system and complaints process. ePharmacy switch over was smooth and is progressing well. Clinical people on committees appreciate that the focus of the reports are on quality

information. Missed new national target on hand hygiene results by 0.5%. Renal Unit scored 100% in

the audit and have not heard of anyone else achieving this score. M Burdon stated that it was good to see financial status reporting was planned for the next meeting.

Resolution: THAT the Clinical Governance Minutes dated 21st April 2015 be received. A Morgan : J Calnan CARRIED 140.30 GENERAL MANAGER – CLINICAL SERVICES 140.31 Clinical Services Monthly Report : May 2015 140.32 Elective Services 140.33 Balanced Scorecard D Oliff reported that:

A presentation was given on 6th May “Engaging the Medical Staff : Partnering with Doctors to Achieve Mutual Goals”.

23rd June : Community-based experience with RMOs to develop strategies to integrate community-based experience for RMOs as part of their development and experience in the DHB. D Oliff sits on the Steering Group to have RMO working in primary and community services.

Nursing and Midwifery Awards – 13 May 2015. This was an excellent turn out from hospital staff and was well worth the celebration in valuing the nursing staff.

Radiology – Of significance is that the MoH funded the Radiology Service Improvement project with the Radiology clinical assistant commencing orientation in the Radiology department on 28 April 2015.

Emergency presentation volumes slightly higher than last year. Shorter Stays in ED target performance for April = 93% overall with Taupo Hospital doing well at 96%.

Surgical Services – Enhanced Breast Service on schedule to commence the week of 4th May 2015. Difference in Enhanced Breast Service – surgery being held at Lakes with

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four surgeons carrying out the work and no longer have the need to go to Waikato. Alan Crombie commenced as HOD on 1st April 2015. MMU/Hospital Services – Lakes DHB hosted Gateway students from the region’s high

schools with presentations by MMU to those students interested in a career in medicine.

Fully recruited to RMO vacancies barring a few weeks in Psychiatry and Medicine due to two overseas staff resigning early.

Medicine Services – CWDs under budgeted volume delivery. Woman, Child & Family – Child outpatient services are only just maintaining ESPI

compliance within the four month target. Taupo Clinical Services Plan out for wide consultation – bring back to the Board. Presentation to HAC and Board June/July 2015. Snapshot of third quarter 2014/15 Improved Access to Elective Surgery Health Target

Delivery – Lakes DHB achieved YTD 108.3%. Dashboard – N Saville-Wood to give a presentation on workings with Health Round

Table. “Readmissions” occasionally called “frequent flyers”. During N Saville-Wood’s update at the Clinical Governance meeting, his view was that people who were readmitted was due to something else happening and not related to the first event. These patients were appropriately readmitted.

Resolution: THAT the Clinical Services Monthly Report for May 2015 be received along with the information

on Elective Services and the Balanced Scorecard. M Bentley : M Arundel CARRIED 140.40 REPORTS 140.41 Performance Monitoring (Finance & Audit) : 30th April 2015 N Saville-Wood spoke to the financials and from discussion, the following were noted:-

Lakes DHB uses a pool of nursing staff with FTEs established in the wards. Charge nurses meet daily at 9am to work out staffing requirements which are provided on request and worked off the Cap Plan. Lakes is reasonably concerned with nursing costs and is looking at programmes to assess issues are being done correctly.

Outstanding issue relating to Waikato DHB is now resolved. Medical locum costs continue to be of concern. Expectation is that Lakes will start picking up on the actual inpatient acute volumes

which are significantly below budgeted levels. Ophthalmology is run externally through the use of Lakes DHB’s facilities for 75% of

volumes. N Saville-Wood to provide the Paediatric Surgery figures to M Burdon as per page 31 of the YTD Variances to Contract.

Paediatric Surgery has been in operation since May last year. Length of stay remaining good. YTD overall is 1.91 as opposed to 2.03 in 2014. Average LOS month to date April 2015 (ATR – over 65s) is very high at 19.17. Lakes does not receive payment when acute demand is in excess of contract levels.

Resolution: THAT the Financial Report for 30th April 2015 be received. J Calnan : D Shaw CARRIED 140.42 Quality and Risk This report was taken as read with L Yule available to take questions.

Regional Incident and Risk Management System – present background to next HAC meeting. By next meeting will have testing site in place and updated configuration into the programme. There are a few issues to be solved at the back end.

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M Burdon reported to the meeting that the HDC report had been comprehensively looked at by the Board with recommendations from the HDC being effected.

Clarification on Rotorua Hospital Ebola patient report – Advised MoH has clear guidelines on what to look for and how to manage such situations. It is crucial the Medical Officer of Health is notified immediately.

In response to a question from M Bentley relating to the Hospital’s food and whether anything had changed in the kitchen since her recent hospitalisation, the meeting was informed that G Lees and D Oliff undertake key audits across the wards randomly meeting patients in both Taupo and Rotorua Hospitals. A report will be presented at a future date to HAC. M Bentley to liaise directly with L Yule on this issue.

Resolution: THAT the Quality and Risk report be received. E Isaacs : A Morgan CARRIED 140.43 Maori Health report Resolution: THAT the Maori Health report be received. D Shaw : I McLean CARRIED 140.50 SECRETARIAL 140.51 Minutes of previous HAC meeting held 28th April 2015 Resolution: THAT the minutes of the previous meeting held 28th April 2015 be confirmed as a true and

accurate record. A Morgan : D Honore CARRIED 140.52 Schedule of Tasks

Presentation to be given by Dr Nic Crook on unplanned readmissions D Oliff and G Lees to present on Hospital Key Audit

140.53 Copy of presentation slides on Paediatric Elective Surgery & Woman Child & Family Service : Noted

140.54 Matters Arising : Nil 140.60 INFORMATION AND CORRESPONDENCE 140.61 BoP DHB Hospital Advisory Committee Minutes 01.05.15 Resolution: THAT the BoP DHB Hospital Advisory Committee Minutes of 1 May 2015 be received. M Arundel : J Calnan CARRIED 140.62 Draft Waikato DHB Health Waikato Advisory Committee Minutes 08.05.15 Resolution: THAT the Draft Waikato DHB Health Waikato Advisory Committee Minutes of 8 May 2015 be

received. A Morgan : M Bentley CARRIED 140.63 Review of HAC Terms of Reference It was agreed that this issue be held over until the next meeting to allow time for M Gallagher,

new member and M Arundel to observe any improvements that could be helpful. Members

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noted that Midland representation was a trial pilot which needed to be reviewed at some stage and perhaps discussion should be held with colleagues around timing of this review.

140.64 Ewan Wilson letter of resignation 24.04.15 Resolution: THAT the letter be noted and that the Chair send a letter of appreciation to E Wilson for his

contribution towards the committee’s business. J Calnan : M Bentley CARRIED 140.65 Community Representative reports M Arundel

Issue in the Herald relating to midwifery providing information to mothers about vaccination. BoP has been aware of this over the last three years and the mothers’ sites on the web knocking anti-vaccines. Need to think of strategies at a Board level. A Morgan referred to a document on television which talked about the pros and cons of injections and immunisations.

BoP investigating clinical staff who do not wish to be vaccinated may have to wear masks.

Note to check the extent to which the MoH has definitive information around this issue and do we have links to authoritative sites? S Wilkie confirmed Lakes does have links to authoritative sites and also when Lakes produces releases, a number of websites particularly around immunisations are linked as part of that media release. D Shaw advised that MoH has a lot of information on its immunisation site with credible links.

The meeting noted that Lakes was the best of the 20 DHBs for the 8 month immunisations.

140.70 PUBLIC EXCLUDED Resolution: THAT the meeting move into Public Excluded at 11.50am. M Bentley : M Arundel CARRIED

…………………………………………………………………………………………….. 22nd June 2015 M C Burdon QSM – Chair

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SCHEDULE OF TASKS: Hospital Advisory Committee meeting 22nd May 2015

Agenda Item Action Responsibility of Timeframe

Presentations:

Pain Service THAT a presentation be given to HAC. D Oliff to follow up with presenter.

D Oliff 2015

ECT Audit THAT a presentation be given to HAC on the audit findings.

Darren Malone 27th July 2015

Regional Incident Software Project

THAT a presentation be given on this project.

L Yule 22nd June 2015

Unplanned Readmissions That a presentation be given to a future HAC meeting.

Dr Nic Crook As appropriate

Hospital Key Audits That a presentation be given on this issue.

D Oliff/G Lees As appropriate

Tasks

Taupo Clinical Services Plan

To be presented to HAC. D Oliff/J Eilers June/July 2015

Review of Hospital Advisory Committee Terms of Reference

That the review be held over until the 22nd June meeting to include input from the BoP and Waikato HAC representatives regarding observations for any improvements to the ToR.

B Harris

22nd June 2015

Midland representation on the Advisory Committees

That discussions be held with Midland colleagues around the timing of the review of this pilot.

Midland DHBs As appropriate

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Hospital Advisory Committee meeting 22nd June 2015 Page 1 of 6

MINUTES OF THE MEETING OF THE HOSPITAL ADVISORY COMMITTEE

HELD ON MONDAY 22nd JUNE 2015 AT 10.00 A.M. HOSPITAL BOARDROOM, PUKEROA STREET, ROTORUA Meeting No. [141] Present: M Burdon (Chair), D Shaw, I McLean, M Bentley (to 11.45am, M Gallagher, J Calnan, D Honore,

A Morgan, N Wikaira, D Loughlin, Tamarapa Lloyd In Attendance: D Oliff, N Saville-Wood, G Lees (to 11.30am), S Wilkie, E Berryman-Kamp, G Fannin, L Yule and

T Fraser (in lieu of Board Secretariat)

141.10 MEETING CONDUCT The Chair welcomed everyone to the meeting and requested E Berryman-Kamp to lead the

karakia. 141.11 Apologies: M Arundel Resolution: THAT the apologies be accepted. T Lloyd : D Loughlin CARRIED 39.12 Schedule of Interests Register (agenda 1.2) The Interest Register was circulated during the meeting with no additions/amendments added. 141.13 Conflict of interest relating to agenda items (agenda 1.3) The Chair asked for any disclosures of interest regarding agenda items to which none were

submitted. 141.14 General Business (agenda 1.4): Nil

Presentation on Regional Incident Software Project – L Yule

• This is a Midland DHBs project that has worked well in terms of collaboration • Request for Proposal process has been completed with Datix being the successful

provider • The marketing tool has been based on a philosophy of a move towards patient safety • There is an ability for PHOs to be involved at a later stage • Database will go live at the end of August with staff training happening from mid-July • Dashboard reports can be DHB personalised • Discussion held on the ability to be able to track against other Midland DHBs and

transfer of a patient’s data. Noted that any incident is investigated by the initial DHB with any clinical cross DHBs concern, relating to a patient, investigated by the DHB concerned with the patient’s care.

• Business rules for any changes have been established • Taranaki DHB will be the IT expert resource for the database • Customer service / satisfaction does not form part of the database • Northland DHB went live with the database November 2014 and have shared their

learnings with the Midland DHBs project group • In terms of “visibility” of an incident the Line Manager has the first accountability

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escalating through to the CE as appropriate • In terms of additional strategic information that we will gain from the database in the

future years, this was noted as being a reduction in patient harm and the risks of patient / staff harm being managed a lot better

• Benchmarking reports can be produced at a governance level • D Shaw noted that the database is a great regional initiative and congratulated all staff

involved

141.20 SIGNIFICANT ISSUES 141.21 Clinical Governance Minutes of Meeting (agenda 2.1) : 19th May 2015 G Lees provided an update on the minutes.

• Main discussion point at the meeting was the winter resourcing issues, plans and having the appropriate staffing levels (bearing in mind the DHB’s financial position). Need to plan for replacing staff rather than on a daily / ad hoc basis

• It was asked of G Lees, that in terms of the winter planning issue, what do staff wish from the Hospital Advisory Committee. G Lees advised that staff wish the Hospital Advisory Committee to be aware of the issue and using the minutes to be able to update on staffing initiatives

• The Chair noted that she found the minutes concerning and the comments made were from some seriously concerned staff

• The Chair inquired as to what progress is being made with the acuity tool. G Lees advised that work on the acuity tool is underway. Discussion on Cap Plan held.

• D Oliff advised that strategies have been put in place to manage winter demand and that this work occurs as part of normal operational processes

• The Chair asked the Hospital Advisory Committee members if a resolution should go to the Board requesting that a Hospital Advisory Committee Board member be a formal member of the Clinical Governance & Management Team. Discussion points on this included:

o The minutes reflect accurately the discussion points by staff at the meeting o The minutes are at the right level for the Hospital Advisory Committee’s

information o Need to ensure that having a Board representative on the Clinical Governance

and Management Team forum does not interfere with management and operational activities

o G Lees confirmed as the Hospital Advisory Committee representative for the Clinical Governance & Management Team meetings

o Noted that the Action List does not include all of the action points agreed to in the minutes

Resolution: THAT the Clinical Governance Minutes dated 19th May 2015 be received, concerns noted and

that G Lees to follow-up on the concerns. D Loughlin: J Calnan CARRIED 141.30 GENERAL MANAGER – CLINICAL SERVICES 141.31 Clinical Services Monthly Report (agenda 3.1.1) : May 2015

D Oliff provided an update that included: • Family Violence – Lakes DHB has received Ministry of Health accreditation for the Child

Alert System. R Dunham congratulated D Oliff and her team for all their work to achieve this outcome. D Oliff updated on the changes in practice that the clinical staff has had to undertake and also that ongoing meetings with Police, CYPS and other agencies have been put in place. There has been very good support from paediatricians and Dr P Freeman is also championing this in the Emergency Department.

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• May and June have been very busy months for the hospitals • Taupo Hospital – nursing review underway • Woman, Child & Family – ESPI 4+4+ programme – everyone is being seen in four

months and treated in four months. • Mental Health Service is going from strength to strength • Surgical – current issue with Orthopaedic electives over production is being addressed • Emergency Department – has been very busy in conjunction with very sick people i.e.

levels three and four • Radiology – new initiative of plain film / xrays being actioned immediately upon referral

by GPs is working well and is a good outcome for the patient. GPs are advised of the results on the same day that the xray is conducted. Noted vulnerability in terms of shortage of sonographers. Two sonographers have been recruited to commence shortly and they will focus on ultra sounds wait lists. Urgent scans will always be managed. Noted that there is nationally a shortage of Sonographers

• D Oliff provided an update on the collaboration and work underway for South Waikato patients

• Discussion held on Gateway Students initiative, Lakes DHB involvement, encouraging more schools to be involved, and the work of Kia Ora Hauora for the Midland region

• I McLean noted that with regard to the increase in acute demand that it is critical that we know the patterns around presentations. Requirement for a different approach than we have now

141.32 Elective Services (agenda 3.1.2) D Oliff provided an update that included:

• ESPI requirements will be met by 30 June 2015 • Dermatology – update on initiatives underway • I McLean noted that the patient letters have been updated and requested that the

updated letters come to the July Hospital Advisory Committee meeting

141.33 Balanced Scorecard (agenda 3.1.3) D Oliff provided an update on the reports. D Oliff to check the Shorter Stays in ED figure as it

appears to be incorrect and maybe a data entry issue. Resolution: THAT the Clinical Services Monthly Report for June 2015 be received along with the information

on Elective Services and the Balanced Scorecard. A Morgan : D Shaw CARRIED 141.40 REPORTS 141.41 Performance Monitoring (Finance & Audit) (agenda 4.1) : 31st May 2015 N Saville-Wood spoke to the financials and from discussion, the following were noted:-

• Main contributors to May’s unfavourable results were related to: o high staffing costs for medical, nursing and allied health o locum costs for Obstetrics & Gynaecology, Taupo and Mental Health Service o clinical supplies o The financial reports were noted as demonstrating how busy the hospitals have

been however Inter District in-flows below target although number of Acute cases high

o Average length of stay very good Resolution: THAT the Financial Report for 31st May 2015 be received. M Burdon : J Calnan CARRIED

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141.42 Quality and Risk (agenda 4.2) This report was taken as read and L Yule provided an update that included:

• Good work has been completed on infection control education packages • Clinical handover work with new doctors in place with Dr S Bradley

Resolution: THAT the Quality and Risk report be received. D Loughlin: M Bentley CARRIED 141.43 Maori Health report (agenda item 4.3)

The report was accepted as read. Further discussion points included: • Health studies availability at schools is an issue. Could this be addressed regionally in

terms of health career opportunities? It was agreed that M Gallagher and E Berryman-Kamp discuss this further outside of this forum

• Maori Health team is still down by 1.0FTE • The Māori Health Plan Innovative Performance Improvement Monitoring Tool was

recently launched • T Lloyd queried whether we could analyse the acute demand increase by ethnicity. R

Dunham advised that work on this is currently happening Resolution: THAT the Maori Health report be received. A Morgan : D Honore CARRIED 141.50 SECRETARIAL 141.51 Minutes of previous HAC meeting held 25th May 2015 (agenda 5.1) Resolution: THAT the minutes of the previous meeting held 25th May 2015 be confirmed as a true and

accurate record. I McLean : D Honore CARRIED 141.52 Schedule of Tasks (agenda 5.2)

• Regional Incident database – completed • ECT Audit – to occur at July HAC meeting • Taupo Clinical Services Plan – to occur at July HAC meeting

141.53 Copy of presentation slides on Paediatric Elective Surgery & Woman Child & Family Service

(agenda 5.3) : Noted

141.54 Matters Arising (agenda 5.4) : Nil 141.60 INFORMATION AND CORRESPONDENCE 141.61 Letter of appreciation to E Wilson (agenda 6.1): Noted 141.62 Review of HAC Terms of Reference (agenda 6.2): It was agreed that this issue be held over until the next meeting to allow time for M Gallagher,

new member and M Arundel to observe any improvements that could be helpful. Comments to be brought to the July HAC meeting.

141.63 Lakes GP Liaison Newsletter May 2015 (agenda 6.3): Noted that the newsletter does not comment on how busy the hospitals are and that a

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patient’s primary contact is with their GP. D Oliff to discuss with Dr L Hughes. Resolution: Noted that the newsletter is of a high standard and contains very useful information. I McLean : M Burdon CARRIED

141.64 Letter 15 June 2015 from TRHOTA regarding representative on advisory committees (agenda 6.4): Received.

Resolution: THAT the letter from TRHOTA dated 25 June 2015 be received.

A Morgan : D Honore CARRIED 141.65 Community Representative reports (agenda 6.5) J Calnan:

With regard to infant immunisation in the primary sector it appears that text messages to mothers are being sent too early in terms of the baby’s vaccination timetable. Agreement for J Calnan and D Oliff to discuss and investigate as an operational issue. N Wikaira:

• IRB training attended • Updated on advisory committee representation

A Morgan: Attended the Māori Health Plan Innovative Performance Improvement Monitoring Tool launch Resolution: THAT the community representative reports be received. D Loughlin : T Lloyd

CARRIED

141.70 PUBLIC EXCLUDED Resolution: THAT the meeting move into Public Excluded at 11.55am. T Lloyd : D Shaw CARRIED

…………………………………………………………………………………………….. 27th July 2015

M C Burdon QSM – Chair

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SCHEDULE OF TASKS: Hospital Advisory Committee meeting 22nd June 2015

Agenda Item Action Responsibility of Timeframe Presentations:

Pain Service THAT a presentation be given to HAC. D Oliff to follow up with presenter.

D Oliff 23 November 2015

ECT Audit THAT a presentation be given to HAC on the audit findings.

Darren Malone 27th July 2015

Unplanned Readmissions That a presentation be given to a future HAC meeting.

Dr Nic Crook As appropriate

Hospital Key Audits That a presentation be given on this issue.

D Oliff/G Lees As appropriate

Tasks

Taupo Clinical Services Plan

To be presented to HAC. Dr P Malpass 24th August 2015

Review of Hospital Advisory Committee Terms of Reference

That the review be held over until the 27th July meeting to include input from the BoP and Waikato HAC representatives regarding observations for any improvements to the ToR.

B Harris

27th July 2015

Midland representation on the Advisory Committees

That discussions be held with Midland colleagues around the timing of the review of this pilot.

Midland DHBs As appropriate

Patient letters I McLean noted that the patient letters have been updated and requested that the updated letters come to the July HAC meeting.

D Oliff 27th July 2015

Balanced Scorecard (agenda 3.1.3)

D Oliff provided an update on the reports. D Oliff to check the Shorter Stays in ED figure as it appears to be incorrect and maybe a data entry issue.

D Olff 24th August 2015

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CHIEF OPERATING OFFICER’S HIGHLIGHT REPORT PROVIDER ARM June 2015

SUBMITTED TO: Bay of Plenty Hospital Advisory Committee

Submitted by: Pete Chandler, Chief Operating Officer

RECOMMENDED RESOLUTION: That Committee receive the report.

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HIGHLIGHTS SUMMARY CHIEF OPERATING OFFICER Verbal update MEDICAL DIRECTOR Good News SMO Credentialling Applications Reviewed and Approved

Number of Applications Reviewed

Tga Open Term

Tga Fixed Term/Locums

Whk Open Term Whk Fixed Term/Locums

May 1 8 Credentialling Committee Meeting held 26 May 2015 • SMO APLS / CPR Requirements

Discussion around the need for SMOs, either locum or permanent, to hold a current CPR/Resus Certification and whether a pragmatic approach rather than a prescriptive one needs to be taken around this issue. BOPDHB CPR Policy 6.3.7 states that all clinical staff are required to hold a minimum of Level 4 Resus while locum doctors must produce evidence of appropriate CPR competency at the time of employment. It was agreed that the Locum Credentialling Checklist form, and for permanent employees, the Individual Self-Assessment form, should ask the question whether an individual has an uptodate CPR/Resus Cert. It will then be up to the Head of Department to follow-up at their discretion.

• Credentials Committee Chairman John Fleming will be retiring as Chair of the Credentials Committee and from the Hospital in September 2015. Expressions of interest from Credential Committee members will be sought before looking outside the Committee.

• Credentialling Third Round

As the third round of 5 yearly Credentialling comes to an end it would be appropriate to review the Credentialling process and make any changes before moving into the fourth round. Discussion included the fact that to date little performance data has been required to be reviewed and the reluctance to make the SMO scope of practice letters prescriptive by drilling down to approved individual procedures. The question was also raised whether there is a place in Credentialling to become more involved in the performance appraisal process.

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2015 Ongoing Re-Credentialling Programme for Senior Medical Officers General Medicine The final draft General Medicine Credentialling report will be tabled at the next Credentials Committee meeting scheduled for Tuesday 23 June 2015. Anaesthetics 17 and 18 August 2015 knowing that with the large volume of SMOs, a third and possibly fourth day will also be required to cover off this Credentialling. Te Kaha GP Service Credentialling of the GPs in Te Kaha took place on the 25th May and the Credentialling report will be tabled at the next Credentials June meeting. DIRECTOR OF NURSING Good News Hand Hygiene Audit Period

30 June is the end of Q4 HH audit period. With 400 moments left BOP sits at 81.1% CCDM It is a highlight that the Director of Nursing is representing BOP and New Zealand at a Nursing Informatics conference in Korea, presenting in partnership with SSHWU on CCDM Risks and Mitigating Actions High Acute Demand Variance response measures are being fully actioned as both Tauranga and Whakatane nursing services experience HAD. Whilst VRM strategies in the wider CCDM context are mitigating actions, there is risk in a sustained period of HAD with school holidays in the mix. Daily Ops meeting, monthly CCUG with CCDM dashboard plus mid-term forecasting meetings across both sites are included in mitigating actions.

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SURGICAL, ANAESTHETICS & RADIOLOGY SERVICES Good News Perioperative Conference Following on from the TPOT (Productive Operating Theatre Project) the perioperative team organised a teambuilding workshop. This resulted in a successful perioperative conference held this month with great multidisciplinary attendance. The scenario training involved three theatres set up with the following situations

• Hypotensive and haemorrhaging patient • Fire in the theatre during surgery • Patient with malignant hypotension

Teams rotated through each scenario with opportunities for hands on realistic experiences followed by constructive feedback sessions.

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June ESPI Compliance Preliminary results show that the 4 month ESPI compliance has been achieved across all services which reflects a significant amount of work undertaken by clinical staff and Elective Services. Radiology e-referrals Work has been completed this month that will enable PHO’s to send the DHB electronic community radiology referrals from 1July. Risks and Mitigating Actions Sustainability of ESPI Compliance There has been a continued high inflow of acute activity, together with the winter illnesses affecting staff that places pressure on the hospitals capacity to manage the volume of both elective and acute workloads. MEDICINE Good News Emergency Department The community based health and wellness nurses have just completed a week in the Tga ED. They worked a number of shifts with the express purpose to

• Look at patient flow and if they could assist in reducing attendances • Increased awareness of their service in the community to patients and staff for referral

Work continues with the top 100 patients (readmission) and developing primary and secondary co-ordinated approaches to reducing attendance. The patients have been identified and distributed to the primary providers for awareness. The next step will be to meet and discuss each patient through an MDM process with primary and secondary to develop a plan. There continue to be high presentation across the weekend and on Monday (see data below) to assist where possible a mid shift is being put on for an SMO at weekends in ED (variance) and acute medicine continue to have a second SMO at weekends (variance) to facilitate discharges. Increased CNS and Nurse Practitioners have been rostered on Mondays to facilitate streaming continues but this is limited due to annual leave.

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Whakatane ED nursing continues to be under pressure due to both staff shortages (sickness and vacancy) and particularly in skill mix. Currently bureau use is limited and CNM and Educators are picking up extra and call back shifts. Tauranga ED is working with Whakatane ED to see if any rostering gaps could be filled from Tauranga. Health In Aging/Acute Stroke Unit ASU have seen an influx of admissions these last two months (May/June), and the 1000th stroke patient was entered into the data base on 9th June. Currently in HIA there are 17 stroke patients receiving rehabilitation and this does limit access to HIA rehab beds. Patient story - a lady who was admitted to ASU on 20th April, with a right MCA infarction. She was completely flaccid on her left side and could not sit, stand or move independently in her bed, requiring full assistance by staff. At day 65 she is in HIA with a discharge date of 30th Jun as she is able to feed herself, sit unaided, and can mobilise/walk with one person assistance using a quad stick. She has some fine motor skill difficulty with her left hand but it can now be used functionally eg holding a plate. Average length of stay for ASU patients is still less than 6 days Average length of stay for HIA is maintaining a reduction for this year down to 15 - 17 days. 2A Kaupapa The unit is celebrating Matariki (Maori New Year) from the 18th June for the month. Matariki meaning cluster of stars also known has Pleides. The Maori New Year is marked with the rise of Matariki and the sighting of the next new moon. The sighting of this years (2015) Matariki is around the 18th June. Matariki has two meanings – Mata Riki (tiny eyes) and Mata Ariki (eyes of God). This is a time for new beginnings, change, and the unit have an aspiration wall comprised of stars on the ward. Anyone can participate and write something for the near future they want to aspire to. At this time the unit also remember the ones who have passed on, so therefore, we have a remembrance korowai (cloak) that we can all add to. Whakatane Acute Care Unit The usual winter illnesses of both patient and staff have severely stretched services but everyone has risen to the challenge, and thanks in no small part to all the extra hours and shifts worked by the regular as well as bureau staff. The unit continue to maintain their CLAB zero target with no identified line infections. The ANZACs QI ACS data base is updated regularly and at the beginning of June we were audited by Charmaine Flynn, an outside auditor attached to the team working on the ANZACS QI Registry project. Gastroenterology A concerted effort by all staff to run additional lists during the week and at weekends has maintained ESPI compliance for colonoscopy and gastroscopy. Head of Department Abid Saadeddin is working in collaboration with Caroline Davey from Bay Navigator to design and establish a new and efficient referral pathway, for all open access endoscopy. This work will standardise referral data and criteria for prioritisation. Nurse consenting for endoscopy has now been initiated in the Medical Day Stay Unit. Clinical Parkinson’s Disease Last quarter the Nurse Practitioner a completed retrospective snapshot of people with Parkinson’s disease (PD) residing in aged residential care (ARC) settings. Extrapolation of results suggest that 144 residents with PD in ARC in the BOPDHB region. Next quarter the intention is to profile hospitalised patients with PD. It is known from recent international studies, that the rate of admission for PD patients internationally to hospital is high. Certainly, we average 8-10 patients with PD admitted to TPH per month. After four years post diagnosis, readmission rates can range from 38.5% - 50%. The significant factors for hospital admission relates to progressive neurological disease with related comorbidities, such aspirational pneumonia, falls risk with this population of 39% prevalence and of those 68% will sustain major fracture such as fracture of NOF. The service are therefore developing pathway guidelines for PD inpatient care – these are currently in draft.

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Acute Medicine June is ACE’s (acute care of the elderly) 1st birthday. ACE opened in June 2014 and has been developing ever since and continues to develop a function focused approach to care associated with beneficial outcomes for the older adult acute inpatient. Diabetes The service has been looking how to best utilise its nursing and SMO resource. All people with diabetes who are referred (and accepted) into the secondary care system will now be seen by the diabetes nurses first prior to being seen by the SMOs. The diabetes nurses will review the patient and then decide whether the person needs a consultation with the SMO. If yes the diabetes nurse will refer to SMO. If no, they will continue to consult with the patient or discharge back to GP. Exceptions to this are where the initial referral needs urgent SMO review and the SMO triaging will make that decision. The service has commenced “joint clinic” with SMO and Diabetes Nurses facilitating as the service has identified certain groups of patients with diabetes who would benefit from joint approach These include: Those on Insulin pump therapy (3 monthly clinic) (Maureen to coordinate) Adolescents high risk: i.e. repeated admissions, high HbA1c, etc. (3 monthly)( Rose to coordinate) Adults high risk as above and very complex co-morbidities (3 monthly) (Kaye to coordinate and Isabel) Haven’t d/w Kaye yet. (Pregnancy, already running and will continue as is.) Maureen and Miranda to coordinate) The idea is to improve quality and consistency of care, productivity and efficiency. An added bonus will be for ongoing training and education for the diabetes nurses particularly with regards to insulin pump therapy.

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Cardiology The posters below were recently presented to the whole Cardiology group following them being identified as areas for audit and presentation by the group.

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Risks and Mitigating Actions The main risk across ED and Acute Medicine at both sites is the increasing attendances as demonstrated by the graphs below,

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Clearly this demonstrates that all days are increasing but that weekends and Mondays are the most significant. The issue is further highlighted by the results on Weekends against the 6 hr target. MDSU A further consequence of the increased attendances has been that MDSU has had to used for overflow. The trendcare report identifying the impact

To date only 4 procedures have had to be cancelled but this continues to present on going risk

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Radiation Oncology The dashboard below highlights the over delivery against contract for Radiation Oncology and the issue to financial sustainability

WOMAN CHILD & FAMILY Good News Maternity The self-audit for the BFHI has been completed. June has been a busy month for both units with its usual peaks and troughs but the peaks lasted longer than the usual pattern. Both SCBUs have had the same peaks with Whakatane having periods of higher than usual occupancy. Consumer Engagement Maternity Quality & Safety Programme (MQSP) is working with consumers representatives on the Governance group to find ways in order to gather feedback from hard to reach population. Gathering and working on Feedback to MoH around the Extension of MQSP

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Small for gestational age (SGA) / Large for gestational age (LGA) Babies Audit Group is working on SGA and LGA babies audit. Anaesthetic Information on the maternity page Working towards recording urgency code for caesareans for Anaesthetists for future audit purposes. Paediatrics WCF service has presented to Countdown fresh future appeal with a wish list of $70,085.74. This is made up of a Continuous flow nitrous oxide machine, AirVo 2 humidifier, Seca scales a x-ray unit for the dental service and dental cart and light. This presentation was well received by Countdown. PEWS continues to be embedded within the organisation and is now part of daily practice. There have been no concerns noted of this process and/or patient outcomes. This is now moving to an evaluation phase. Paediatrics Tauranga The ED Paediatric Action Resource Group (PART) has been working closely with the paediatric unit to improve flow and ensure best practice. The request for the Countdown equipment (as discussed previously) is in part for ED so that earlier interventions may occur in ED prior transfer to the ward. Patient type Winter illness type of admissions has begun with an increase in respiratory disorders. Anorexic child has been admitted requiring a one to one staffing resource. This has been outsourced primarily to ‘med call’ as the internal bureau resource has been maximised throughout the organisation with the onset of increase demand due to seasonal illness (inclusive of staff illness). Staffing The unit is fully staffed and coping with the increasing winter illnesses. Occupancy sat at 89.5% and actual NHPPD (98.46) matches Required NHPPD (99.8) – as per graph below:

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Paediatrics Whakatane Winter illness type of admissions has begun with an increase in respiratory disorders. Occupancy has been 66.99 (Ave.) as seen in the graph 1.1. The unit has taken adults into the swing bed capability as medical (adult) demand has at times required more capacity. Staffing The staffing is more than adequate within the unit with Required NHPPD at 28.26 and actual being greater at 46.56.

Risks and Mitigating Actions Maternity The Lactation Service has been operating with a reduced workforce due to bereavement leave sick and sick leave since January, it will hopefully be fully staffed again end of July . Maternity Unit Tauranga has completed its recruitment, and offered short term contracts for the staff that are on extended leave or LWOP. Whakatane Maternity Unit managed their extended leave situations by having existing staff pick up the extra shifts.

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REGIONAL MAORI HEALTH Good News Matariki 2A is celebrating Matariki which commenced on June 18th 2015. The theme for 2015 is He rau tangata, he kōingo aroha | People gather and affirm love in a myriad of ways. The ward has display boards, Korowai for visitors and colleagues to add remembrance feathers and a Matariki stars wall for people’s aspirations to shared. Maori music is playing throughout the ward and each week there will be Waiata practice in the Whanau room over handover. The ward has collaborated with the kitchen services at Tauranga, Maori menu items and placemats are available for staffs to enjoy their breaks and have a conversation around Matariki and what it means for them. Regional Maori Health has also sent information emails to all the DHB to improve knowledge. DHB Cultural Program: A guiding document has been formulated to grow cultural programs at the DHB so Maori language, music, art, history and cultural practices are recognised, valued and celebrated by all members of the DHB. It is envisioned that Matariki and Maori Language week and potentially 2 other cultural programs are run over a 12 month period. Partnership Model of Practice: Driven out of the social work review process this model is currently being developed between Regional Maori Health and Allied Health Services. Staff consultation has commenced. Te Whe Program Program approval for Tauranga & Whakatane achieved. Teambuilding Sessions commenced every Friday at Tauranga site, soup days and teambuilding activities over lunch times. REGIONAL COMMUNITY SERVICES Good News Allied Health Projects Coordinator attended the Service Improvement Group meeting and saw this as an opportunity to gain knowledge of future projects which could benefit Allied Health and sharing of project strategies. Allied Health has rolled out an Electronic Referral system that has been trialled and will be implemented from 22nd June 2015. Docman is now active in Newborn Hearing Screening with all files copied over from G: Drive. Electronic clinics created for Physiotherapy with extra monitors/computers now installed for training due to commence for this project.

Dietitians annual push to raise the awareness of malnutrition in the hospital. Had a good response to emails about malnutrition especially one about hospital induced malnutrition. As a result are now planning to work with Hospital Volunteer Service around what they could do at meal times

Occupational Therapists on the acute wards have now developed a matrix/system to prioritise the workload across all wards as part of preparation for winter. It includes a brief 5 minute meeting to determine where the need is for OT input daily at 10am.This is now being documented in a spread sheet showing definite trends. (Monday, Tuesday being the busiest with the highest triaged patients).

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Position Description for new Occupational Therapists changed to reflect competencies. Strategic Planning meetings with Acute OTs in Tauranga and separately with the OTs in Whakatane have been held and it has great to see therapists engaged in the process. Physiotherapy have a successful acquisition of 2.0FTE staff for a weekend service and ED/APU cover through the week. These positions have now been advertised. Podiatry staff have been invited to an evening in Auckland to discuss new wound therapies for Diabetic foot ulceration. A meeting has been held with AUT placement supervisor to arrange placement later in the year and they have met with Health Workforce NZ & Podiatry Association to discuss future work and models of care for the profession. A casual podiatrist has worked two days this month to cover the service with this arrangement is working well. Speech Language Therapist attended NZ SLT Association AGM as area rep for BOP. The therapist participated in a questionnaire for a Masters study looking at communication on ICU. New Community OT Co-ordinator at Whakatane settling in well and is already making positive changes including more regular in-services and case load reviews. Physiotherapy Advisor for the DHB has had his first visit to Whakatane Physio. Experienced physiotherapist appointed to Child Development Service (CDS) at Whakatane following casual cover and vacancies over the last two years. Review completed of referral guidelines for SCBU to CDS. Whakatane staff visited Tauranga and are involved in a project to improve tracking equipment loaned to patients. Equipment is now being sent to Tauranga repair man via stores delivery van and we only pay for consumables used for repairs. Inpatient Social Workers daily allocation meetings are working well and having the desired effect of building positive relationships. SW has sourced excellent online training for SWs from Waitemata. Can be done together and rolled out to others if successful. Meetings instigated with Regional Maori Health Services in relation to integration of Maori Health Social Workers clinical competencies. Community Child & Youth Health Services PHN team are working well with high and complex need children/whanau. TB contract is going well and we have developed better systems for recording contacts and data. We were under recording TB nurse effort but we are functioning within the contract FTE limitations. Lift the Lip Training in the BOPDHB region now completed. All 4 workshops were well attended, either full to capacity or good numbers. Further training will be planned for 2015. Consultation complete across the BOPDHB region for the preschool enrolment dental project. We are tracking source of incoming referrals and can report non-Maori enrolment now at 104% and Maori at 63%. This is a 2% improvement on the previous month. We should see a steady increase of enrolment over the remainder of 2015. The new Oral Health Promoter in the EBOP is proving to be a very dynamic staff member. IT connectivity project for mobile dental units in the BOPDHB region is progressing and a business scoping proposal has been submitted to BOPDHB IT for consideration. Manager will be acting as the

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project manager for this and will involve 2 months’ work across the BOPDHB region which will be a significant project. The trip to Ruatahuna with the oral health promotion team, RMHS, Toi Te Ora and Safe Sleep Co-ordinator went incredibly well and was community development at its best. An article is to be published in Check-Up. . Replacement for CYF social work position within the DHB has been appointed to and Gail Hollands commenced her orientation on 15th June. We are reworking the model across the BOPDHB region as Whakatane was missing out on service. Further consultation with dental therapist regarding flexible working hours, career planning and retirement planning is commencing. We passed our national CPAS audit plus recertification with the MoH. We now have another 3year contract. District Nursing Advertising underway for district nurses and administration staff at Tauranga and casual district nurses for both sites. SLAT report has been collated and will be presented to the ALT board on 1st July. An opportunity to review short term services co-ordination is to be undertaken now that a staff member has left. No further damage to cars at the districting nursing car park in Tauranga has occurred since the increase in security. Security staff have been sitting in the car park for periods of time while we are waiting for cameras and signage to be put in Stores items being held in the district nursing storerooms have been dramatically cut back and this is having a positive impact on costs. If we could sort out nurses bags then that would be a huge change. Rheumatic Fever project continues to be going well. The project is waiting on a Paediatrician in Tauranga to complete the clinical information for patients going on the register (Lakes register). Support Net Meeting held with mental health NASC regarding joint funding of and LTS-CHC (Long Term Services-Chronic Health Conditions) client and agreement made for Support Net / Mental Health NASC / Lakes DHB to meet two monthly to discuss specific clients and generic issues. This is to be particularly concerned with jointly meeting the needs of this client group. Approval from Planning & Funding to continue work on development of model for re-design of HCSS in BOP using analysis of interRAI data to determine relative risk groupings and service patterns rather than case mix model Toi Te Ora Public Health Services Strategic Goal Programme update A key focus of the obesity prevention goal work is the development of advocacy, and the partnerships needed to support advocacy. In this respect, progress this month has included:

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− Presenting the strategy to the Lakes Te Whanake Governance Group which has the objective of advancing an effective Lakes-wide integrated maternal, child and youth health service delivery framework. Toi Te Ora’s obesity prevention strategy, and in particular the proposed healthy pregnancies work, has strong synergies with this Lakes DHB initiative and identifies practical ways of working together.

− Toi Te Ora is partnering with the local branch of the Heart Foundation to carry out formative research on ‘water and milk only’ schools. The findings will be used to advocate for ‘water and milk only’ policies within the education setting.

− The Medical Officer of Health report on childhood obesity prevention (http://www.ttophs.govt.nz/vdb/document/1370) submitted to Lakes CPHAC this month was well received with discussion focussing on how to support this work, including with a joined up and collaborative approach between Toi Te Ora, Lakes DHB and Bay of Plenty DHB.

− With a front-page feature article in the Bay of Plenty Times, significant media coverage was achieved on the role of sugar sweetened beverages in contributing to childhood obesity.

− The childhood obesity prevention strategy continues to be widely communicated and promoted to other agencies and groups with presentations scheduled in the next six weeks to several groups including: GPs in Taupo, the Roto Vegas Health Centre, the Physical Activity Nutrition Network, the Practice Managers in Eastern Bay PHA and Sport Bay of Plenty.

Toi Te Ora’s health needs assessment report on childhood respiratory infection admissions in the Bay of Plenty and Lakes is now complete. The report provides a comprehensive characterisation of the issues and recommendations that will contribute to and inform Toi Te Ora’s work and interventions in this area. Toi Te Ora’s Building Blocks 4 Under 5s toolkit has been completed and printed. This is a new, comprehensive resource developed to support early childhood education services with initiatives to improve children’s health and wellbeing. WorkWell WorkWell was recently launched with two new workplaces, Eastern Bay of Plenty Hospice and The Warehouse in Taupo. Both launches were very successful events, and excellent examples of organisations showing a commitment to improving the health and wellbeing of their workforce, and each is showing an interest in rolling the programme out nationally. The Healthy Families (NZ) portfolio manager has invited Toi Te Ora to support the next launch of the programme by Minister Coleman to be held in Invercargill in July. The proposal is for the launch to focus on health promotion in the workplace setting, and to feature Sanford who are currently discussing rolling out WorkWell across their five sites nationally, including Bluff. With the growing interest nationally in WorkWell, the Ministry has agreed to Toi Te Ora reinvesting a portion of its 2014/15 under expenditure in additional FTE to support activity that extends outside of this region. A proposal will be submitted to the BOPDHB for approval. Council Engagement The Local Government New Zealand (LGNZ) Committee has approved the Smokefree Remit below for consideration at the upcoming LGNZ AGM in July. Toi Te Ora has actively encouraged all councils in this region to support this remit.

That the Council resolves that: It put forward to the 2015 Local Government NZ AGM a remit that would instruct LGNZ to request central government to develop and implement legislation that would prohibit smoking outside cafes, restaurants and bars. The reasons for the notice include: Numerous measures will be necessary to achieve the goal of a Smokefree Aotearoa 2025.

This remit, if passed by LGNZ, would indicate to central government that society generally

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http://www.ttophs.govt.nz/vdb/document/1370

supports more such measures being taken. it is more efficient for legislative action aimed at addressing this major health issue to be

promulgated at the central government level rather than local government it would give further effect to PNCC's role in advocating for the well-being of our community. The Health Promotion Agency, in collaboration Toi Te Ora, Mid-Central Public Health Service, National Smokefree Coalition and the Lakes Smokefree Coalition will have a trade stand at the LGNZ conference in support of this remit. The aim of the stand is to promote the 2025 Smokefree Aotearoa goal and increase councils understanding of what actions they can take to support achieving this goal. Over the past two months Toi Te Ora has presented its feedback to councils on their long-term plans. The last of the hearings, held this month, was for the Rotorua Lakes Council’s long-term plan. At the hearing, Toi Te Ora provided specific feedback and advice on the issues of sub-standard housing, increasing smokefree outdoor spaces, and on proposed changes to waste collection and management. Contract Updates The Ministry of Primary Industries (MPI) and Ministry of Health have agreed to a generic Memorandum of understanding (MOU) to be put in place between MPI and each public health unit. The MOU guides work around food safety and takes effect on 1 July 2015 when the current contract with MPI ceases. Toi Te Ora will modify the MOU to include its own local arrangements with MPI and contact details before signing the document. . The new three year core contract with the Ministry of Health has been received and forwarded to the COO for signing. Risks and Mitigating Actions Allied Health Physiotherapy senior staff have come up with leave cover arrangements to mitigate the risk posed by the number of senior staff on leave this winter. Taranga social work department will potentially be three staff down by August due to staff resignations. Community Child & Youth Health Services The one vacancy in Whakatane for a PHN has been recruited to and job offer going out this week. We are committing a lot of extra nursing /admin resource at the B4SC contract to try and hit the 30th June 2015 target. We are confident that Plunket will achieve its volume of 900 but not confident we will achieve CCYHS target. We have never recovered from the poor start in 2014/2015 year with influenza impacting on staff and our patient group. The admin component in the WBOP needs a partial shift to someone in Whakatane who knows the community as it does not work doing booking for EBOP from WBOP. The FTE component is too lean for actual nurses doing checks in CCYHS and does not take into account uncontrollable elements such as sick leave, long service leave, epidemics etc. There is “no give” in the FTE formula for this contract. We have made a decision to increase the admin FTE component in the EBOP by 0.2FTE as of 01st July 2015 as our three month trial has proved this works and we are getting better results.

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The Vulnerable Unborn pilot is proving to be difficult to sustain and is taking up too much social work and PHN time. There is no new funding associated with this pilot and we are meeting further about this in July and August. The significant risks for dental as highlighted in January 2015 report are:

• The business case for more FTE dental assistants will not be fully successful which has many ramifications for the dental service. Staff burnout and loss of production is a real risk.

• Enrolment numbers into dental service continue to increase with no FTE increase. We are over delivering on projected 2016 Planning and Funding volumes by 3700 children approximately. New enrolments across the WBOP for primary and preschool and no natural attrition.

• The Mount Maunganui and Papamoa region has reached its capacity in relation to therapist FTE capacity and physical resources. Golden Sands Primary School students in Papamoa are being serviced by Te Puke Intermediate, which is not ideal as travel is quite some distance. The net effect of this is that Te Puke Intermediate dental clinic is at capacity too. Te Puke Primary School roll is now full as well. The preschool population is booming in the Mount and Papamoa region. Resources are now too stretched and school rolls in the WBOP continue to increase eg. some schools out in Papamoa had 50 new students at start of 2015 on top of the existing school roll we are servicing. These issues are affecting PHN capacity as well.

• Any management of change process with dental will be difficult as we move into 2015. Toi Te Ora Public Health Services An Environmental Court decision on Whakatane District Council’s plans for reticulation of waste water treatment for Matata, have put the proposals on hold while the council considers their options. Depending on the council’s decision Toi Te Ora will need to review its view on the adequacy of on-site waste disposal in Matata and any plans for improvements. The signing copy of the Health Promoting Schools contract is yet to be received. There are ongoing concerns among public health units around the prescriptive nature of the draft contract, which seems out of step with the direction of the core contract, and the move to greater integration across the sector. Some units, including Toi Te Ora, have been required to remove reference to Health Promoting Schools from its 2015/16 annual plan MENTAL HEALTH & ADDICTION SERVICES Good News Eastern Bay of Plenty meetings The service received a letter of concern from EBOP NGO and Iwi providers expressing concern at the lack of communication. The Clinical Director and Business leader have been meeting with individual providers to discuss their concerns, this has been well received by these providers and has identified a range of opportunities for closer working relationships and ways that services and systems could be improved for service users. Over the next month we will be feeding back the findings to teams and working on actions to address the issues raised. Adult Community Mental Health and Addiction Services Mental Health Needs Assessment Service Coordination: Andrew Neas, Team Leader for the NASC team, attended the quarterly NASCA general meeting in Auckland. The key presentation at the meeting was Dr John Hopkins (a Psychiatrist with Dual Disability expertise) who provided a framework for co-funding of clients with Dual-Disability needs. This is a helpful tool that can be used when NASC is

43

working with clients under Support Net / DSS to assist in providing a shared language and enabling more transparent discussion regarding funding obligations. From this, NASC and Support Net have agreed to establish 2-monthly meetings to review co-funded clients and discuss / problem solve new clients. This will also include Lakes DHB NASC to ensure greater communication regarding clients who move between the geographical areas. Case Management Spreadsheets: The case management tool has now also been introduced the spreadsheet into the North team. The spreadsheet is designed to create transparency and an opportunity for better oversight of the team functioning as well as prompts for the case managers in regards to reviews and acuity changes, NGO input has been added to the tool to ensure this is also considered as part of the process. Children of Parents Mental Illness Addiction Champion: The new MOH guidelines are expected to be issued shortly, in preparation for these one team the North team will trial implementing the new guidelines for the COPMIA programme. Wendy Perrin, social worker, has offered to be the champion for the north team. She has great enthusiasm for the cause and will assist in promoting and enlisting others into supporting clients and their families into programmes. The key focus is around having a conversations with Clients who are parents about their needs as parents and supporting them in this as part of their overall treatment, research suggests children with parents with MH&A needs have poorer outcomes and will later access MH&AS. This will require some changes in focus and the way services are delivered. Networking: Te Manu Toroa attended the team meeting last week to provide an Introduction of the services provided by their organisation. They can provide everyday assistance with transport to appointments and assisting with WINZ and other services that the clients may require support with, the service is now looking at how to work more closely with this provider to support the needs of service users in enabling them to attend arranged appointments etc. The team will get monthly updates on referrals to Te Manu Toroa and what work is occuring with clients. Eastern Bay of Plenty Consult Liaison: The new Eastern Bay of Plenty Consult Liaison service was established in December 2014. The service is resourced with a 0.5FTE registered nurse position and SMO input at 0.1FTE. A RMO on training rotation is also available for medical support to the service. The CL service provides an interface between medical and mental health services. Assessments and short term interventions for people with co-existing medical and mental health problems are a large part of the service offered, while education and training for general hospital staff also make up an important part of the CL registered nurse portfolio. Referrals have built gradually over the months. In May there were 14 referrals received which indicates this service is now being utilised. The largest percentages of referrals have come from the medical ward, while acute care and ED are also popular referral sources A number of educational presentations have been delivered to ED and the medical ward via the CL registered nurse role. Topics have included de-escalation, managing self-harm and suicide, and managing violence and verbal abuse in ED and other hospital departments. The SMO and registered nurse will present at grand round within the next two months. Quality improvement: The SMO and RN recently met with service auditor, to commence planning for a project to identify frequent general hospital service users who may have underlying mental health issues impacting on their physical health status. It is proposed that once these patients are identified they will be offered an initial assessment and short term interventions (up to four sessions utilising evidence based talking therapies). It is also proposed that a measurement tool such as PHQ-9 or Kessler 10, and a qualitative survey will be used to evaluate this component of the service. Further detail of this project proposal will follow by end of July.

44

Voyagers/CAMHS Dinosaur training: The Dinosaur training has commenced BOPDHB is the host for this training Jamila Reid from Seattle is delivering the Dinosaur training to 12 of our CAMHS/Voyagers staff, and 12 other participants from DHB’s, Ministry of Education and other agencies. This program is an evidence- based program for young children between the ages of 4-8 with severe oppositional behaviour, and is delivered in conjunction with their parents participating in the incredible years parenting program, once trained the service will be delivering this programme to children in the BOPDHB area, it is intended that this will be a collaborative process with Education. Friends for life training: CAMHS staff are also being trained by bring Anthony Sheerer from the Mental Health Foundation to deliver the Friends for Life training. This training will enable staff to become accredited facilitators in the friends for life 10 session group program which is based on a Cognitive- behavioural therapy approach but modified to the developmental needs of young children and adolescents. Grand Round: Transgender Identity Pathway: CAMHS has presented the joined transgender identity pathway with paediatrics at the grand round. The feedback has been extremely positive. Combined pathway for children with challenging behaviour: CAMHS/PAEDS/ Te Whanau Kotahi will be starting their joined pathway pilot for children with challenging behaviour in July. It is envisaged that the learnings from this joined work will enable us to provide more effective, efficient and quality care to young children presenting with ADHD, ASD or learning problems. Mental Health Services for Older People/Consultation Liaison Team Education Day: This year a team education programme was developed with the morning divided for the RN and HCA’s group to focus on relevant training for each group. The RN group covered a review of the series of audits that have been completed over the past year – Use of Antipsychotic Medication, with a case study, Communication, Fall’s and relationship to medication, development of the next series of quality activities, Trendcare and SPEC review, and finalizing the Covert Medication Policy. The HCA group morning session was facilitated by Patrick White and covered review of required policy and protocols, how to use your computer effectively and e-learning sessions. The afternoon series for all staff Non-Pharmacological Interventions for Agitation in Dementia and a review of training provided by Professor Andrews Stirling University – leading Dementia care expert. Overall the day was well received by staff involved. Nurse Clinic- Psychogeriatric Care – Althorp: In collaboration with our PG care provider a weekly nursing clinic has been established at Althorp, the number of residents with significant and ongoing challenging behaviours it was identified that the fortnightly Psychiatrist Clinic did not provide the timeframe required to develop the behavioural care plans and support for staff that is required. The new development has used existing resources and is only able to be offered when the specific RN is available, there will be a review of this clinic at the 3 month point.

Adult Inpatient Ward Te Whare Maiangiangi - The Productive Ward/Releasing Time to Care program continues to progress, the ideas from the launch have been collated into categories and the team is now working with staff to choose a project to work on. An article about this will feature in the Check-up magazine in July.

45

The monitoring of the entry and exit of clients and visitors through a sign in/out register is functioning well in both wards and identifies all non-BOPDHB staff on the wards.

The Team Leader on a return to work programme following an injury has been undertaking a range of light duties including Serious incident reviews. She is scheduled for an operation next week and it is unclear at this stage the timeframe will be for to her substantive role. Te Toki Maurere - A regular forum for NGO’s to meet with ward representatives has been established and is progressing satisfactorily, more work is needed in this area to address discharge planning for clients and providers. Consideration is being given to the redevelopment of the Te Toki Maurere to improve function and flow draft plans have been developed with Property services and further meetings are planned to refine the concept drawings SERVICE IMPROVEMENT UNIT PROJECTS UPDATE: Bay Navigator Improving access to information Rollout to community based clinicians of access to the hospital electronic medical records has begun. The new system allows practitioners who have signed a user agreement to access CHIP (the hospital electronic record) directly from their patient management system. Once set up the GP does not need to enter usernames or passwords as security is provided by BPAC, the company that supplies our regional eReferral system. By accessing through the general practice patient management system the clinician is taken directly to the patient they are looking after without needing to search. This makes the whole system far quicker and easier to use. It is believed that the access community providers now have to hospital records rivals that delivered anywhere else in New Zealand. That access is secure, maintains patient confidentiality and can be audited. By providing more information to practitioners it is felt that patient safety will be enhanced and duplication will be reduced. Pathways Fragility Fracture (Osteoporosis) pathway out for final consultation and due to be launched 1 July. Dates for a presentation evening are being discussed. ADHD pathway currently undergoing Pilot of 20 cases taking the patients through the proposed referral filter process ensuring they access the right team to provide care as quickly as possible. Cellulitis pathway is progressing with the development of the eReferral. The estimated cost of setting up an ‘Acute Demand Management’ (previously CPO) service in the EBOP is to be presented to BOPALT on 1st June to determine if funds can be found to support this in the EBOP. Kate Grimwade has been away for the last 4 weeks and we have been awaiting her return to answer some key questions before the pathway can be finalised and published. Menorrhagia pathway education evening documentation is complete. Endoscopy pathway is progressing if a little slowly due to the limited availability of team members. Website A new set of website analytics is being assessed as questions arose as to the validity of the metrics that were being obtained previously. We will be assessing these to determine if they can give us a better reflection of website usage.

46

Future Vision The future vision for Bay Navigator will once again be discussed at the BOPALT meeting in 1st July. A document outlining a suggested way forward has been submitted. Electronic referrals for radiology and improved access to diagnostics Electronic referrals to radiology will be launched on 1st July. This work has been progressed as collaboration between the Provider Arm, Planning and Funding, and the PHOs. As well as supporting a more efficient referral process, eReferrals also provide guidance to the referral regarding minimum access criteria. By building regionally agreed access criteria into the referral forms general practice will have direct access to CT scans for the first time. Additionally, the eReferrals are supporting the devolution of referral management to PHOs. As a first stage the referral management of breast imaging will be managed by the PHOs. ERAS Orthopaedics

• The sustainability plan for ERAS hip and knee joints has been finalised this month. • Recent visit to both hospital sites is informing ongoing discussions with Business Leader regards

‘where to from here with orthopaedics?’ • Fractured NOF patient information book being printed and final changes to the MDT protocol

expected by the end of June so that too can be published. • Medwise post discharge follow up of Tauranga joint patients is underway, commencing May and

to run for 6 months. To date 40 patients have been followed up and there are good examples of management by primary care where coordination of care and intervention has avoided what would probably have resulted in readmission.

• Examples of patients directing their own discharge planning following hip and knee joint replacement through being fully informed are increasing with some patients (on both sites) achieving a 3 day length of stay.

IMPROVING OUTPATIENT ATTENDANCE

Orthopaedic appointments show adherence to seasonal variation although on review in relation to mean DNA (step change entered for when text reminding for orthopaedic clinics began in Feb 15), results look promising – results need to be monitored for longer periods to see any trends or signs of change outside of normal variation.

E F X X X X X X X

4.00%

5.00%

6.00%

7.00%

8.00%

9.00%

10.00%

11.00%

12.00%

Jul-1

2

Sep-

12

Nov-1

2

Jan-

13

Mar-1

3

May-1

3

Jul-1

3

Sep-

13

Nov-1

3

Jan-

14

Mar-1

4

May-1

4

Jul-1

4

Sep-

14

Nov-1

4

Jan-

15

Mar-1

5

May-1

5

Jul-1

5

Sep-

15

Nov-1

5

Special Cause Flag

Indi

vidu

al V

alue

Period

Total All DNA %

X X X X X X X

4.00%

5.00%

6.00%

7.00%

8.00%

9.00%

10.00%

11.00%

12.00%

Jul-1

2

Sep-

12

Nov-1

2

Jan-

13

Mar-1

3

May-1

3

Jul-1

3

Sep-

13

Nov-1

3

Jan-

14

Mar-1

4

May-1

4

Jul-1

4

Sep-

14

Nov-1

4

Jan-

15

Mar-1

5

May-1

5

Jul-1

5

Sep-

15

Nov-1

5

Special Cause Flag

Indi

vidu

al V

alue

Period

Total All DNA %

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Reasons for DNA in orthopaedic clinics gathered by phone show:

Patient feedback about the reasons will continue to be gathered with further questions to try and

identify where the system is not meeting patient need. “Thought it was a different day” is much more common than other reasons and most of these patients also had cellphone numbers – we need to test that our text reminders are being received. DNA patients are also being reviewed in relation to any diagnostic groups that are highly represented or any other identifiable trends. Age does not seem to be a significant factor.

Orthopaedic SOS data is continuing to be gathered and no patients offered the service have returned or attended ED to date. Numbers remain low. SOS is also being offered to other services e.g. Dental. Consumer parking was significantly improved by the opening of the new staff carpark in mid May. It will be interesting to see if this contributes to improved attendance having been a major factor identified in earlier patient surveying on barriers to attendance. Toi Ora - Opotiki GP Practices has continued calling patients who have appointments the next week. Feedback has been given in relation to the number of patients who have attended or rescheduled. There have been no DNAs during the period covered. Ngati Kahu Hauora GP Practice is also continuing to show some promising results.

0

2

4

6

8

10

12

0

2

4

6

8

10

12

Orthopaedic and Fracture Clinics DNAs Snapshot FY2015

Ortho Clinic

# Clinic

Had Cell Listed

48

General Surgery scheduler workshops have begun to redesign processes – currently working on service Mailbox and use for urgent referrals. Identification of other opportunities are being worked through.

ACUTE DEMAND MANAGEMENT MOJO 100 – list of top attenders to Tauranga ED has been provided PHOs and this will be worked through collaboratively. Wellness Centre Nursing – Observation period for Wellness Centre nurses in ED is currently underway. They are observing for 7 days (Mon – Sun) with the aim of identifying opportunities and indicative “demand” for:

1. Patients that could be “referred” to them once triaged for seeing and discharging – there are many barriers to this potentially, but will be useful to see indicative proportions to see if there is value in pursuing.

2. Patients that can be referred for follow up after being discharged by ED – this is a focus on education of the services available in the community that can provide valuable follow up.

3. Patients that can be referred for “reconnection with primary care” and therefore preventing further attendances at ED when they could be managed in primary care.

Early Supported Discharge (Supporting Vulnerable People on Discharge) – Proposal for pilot of a collaborative and responsive model of support for patients to transition back to community care efficiently and effectively has been submitted to GM Planning and Funding. ADMINISTRATION WORKFORCE CAPACITY, CAPABILITY AND DEMAND

• Focus group attendees finalised, dates set, and planning commenced on the content for each meeting.

• Further work completed on administration framework including translation of existing administration titles.

• Core administration domains refined. • Work commenced on production of administration job description template. • Discussion with external providers in relation to modular administration qualification continued. • Work commenced on internal training programme for administration staff from commencement

and on-going. HEALTH RECORD MANAGEMENT

• Planning for trial of use of bar code for clinical document (Anaesthesia record). • Commencement of clinical document inventory. • Further work on PID

COMMUNITY PHARMACY DISPENSING

• Five pharmacies are now live with data of the patients dispensing being able to be seen in Éclair.

• The Opt out process has a flow chart developed • A meeting with the IT Clinical Apps team is planned to schedule roll out to other pharmacies

following the passing of the Privacy Impact document at the June Bay IS meeting MICROSTER

• The project was presented to JCC on 11 June with no major new questions raised. • A formal summary report is being written to capture the programme of work that needs to

continue post the project completion WHAKATANE REDEVELOPMENT POST OCCUPANCY REVIEW

• The final report is due end June and will be tabled by Property Services for comment before release to the MOH as part of the planned Gateway 5 review of the project.

BUILDING QUALITY IMPROVEMENT CAPABILITY AND CAPACITY

49

IHI Open School • Over 220 staff started an IHI Open School course. Sixty-three staff have completed

Improvement Capability (QI101-QI106) course. As of 23/06/15, two staff have completed the course in June.

Quality Improvement (QI) Residency

• Improving the Management of Neonatal Hypoglycaemia will be the focus for Dr Anna Timmings, current QI Resident sponsored by WCF Medical Leader, Jeremy Armishaw.

• First quarter QI Resident Dr Holly Donnelly is preparing to extend the test of change for a combined Resuscitation Decision and Ceiling of Treatment form for one calendar month in July across the medical wards at Tauranga Hospital.

• Residency self-evaluation results (pre and post) from Dr Guy Fisher, second QI Resident has indicated significant improvement in understanding of QI methodology and confidence in leading projects at BoPDHB.

Supporting staff to advance QI initiatives • The electronic clinical audit register has been adapted to include the Model for Improvement

methodology and is due to go live as part of the Oneplace launch. DHB-wide promotion of this tool will remain on hold until the Clinical Auditor returns from annual leave. The register also enables services to add a list of required audits and frequency.

• Seven RMOs submitted to attend the APAC Forum in September. Confirmation that four RMOs are able to attend.

• Attended a meeting with ED SMO and RN Coordinator to provide guidance on approach with new streaming project.

• Attended a meeting lead by Clinical Physiology to consider the electronic collection and storage of ECGs.

APU REVIEW AND REDESIGN

• Time and motion study completed with the administration workforce working on APU and ED across three shifts (APU – 8.30am-6.00pm; ED – 3.00pm-11.30pm and 11.30am-8.00pm) and four roles (APU administrator, ED front desk x2 and ED mobile). Medical Service leaders requested the study across the two areas due to the shared responsibilities. The findings are to be presented to the service to consider recommendations.

• PLAN bookmark introduced by the ACNM for the doctors to flag any new or changes to the management plan of the patients in APU. This now includes Allied Health.

• Patient communication tool tested for one day with six patients in APU to provide a documented plan of care for the patient to keep at the bedside. The tool includes four questions that aim to improve the patients understanding of what is happening during the admission; what is the diagnosis? What is your treatment plan for today/tomorrow? What do you have to achieve to get home? When are you going home? Qualitative feedback requested from the patient, their family/friends, and the medical and nursing team. The test of change will inform further tests in late June.

• Management of Acute Patients (MAP) development with IT has been presented to General Surgery SMO for consideration as a tool to support acute patient management. MAP development behind by two weeks due to other urgent IT issues required developer time. Estimated timeframe mid-July.

CARE CAPACITY DEMAND MANAGEMENT

• Integrated Operations Centre (IOC) session took place for the first time across a weekend, on Saturday 20th and Sunday 21st June, including representatives from Tauranga Hospital and Whakatane Hospital chaired by the Senior Manager on Call. Following agreement at the Cluster Leaders meeting on 17th June a small test of change took place to extend the weekday IOC session across the weekend. Summary document outlining the small test of change to be finalised.

PATIENT EDUCATION RESOURCE CENTRE (PERC)

• Grand Round on the PERC and other IT-enhancements took place on 2nd June.

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• Patient Education button in the ED Discharge Summary module went live on 4th June. Following the go live date (from 4-23 June) 292 patient education sheets have been viewed and 200 printed.

iREFERRAL

• Three attendees of the project board visited Waikato DHB for a demonstration of how they are using Best Practice (BPAC – IT application GP/community use for referrals to secondary care) to complete electronic grading of referrals sent to the DHB.

• Project scope will now include electronic grading of GP/community referrals. • Project board kick-off meeting took place on 9th June. Feedback from the project board on the

Project Initiation Document (PID) closed on 23rd June. HOSPITAL SUPPORT SERVICES Good News 24/7 security began at Whakatane on Monday 22nd June Laundry closure finalised – no issues coming thru and well settled. Rationalisation of product list across both sites 80% achieved Volunteer Week very successful – 40 names have come through as potential volunteers. DX mail service has replaced NZ Post from June 15th. The cost to post with DX is 50% less however there are areas they do not service and NZ post is used at their rates– especially eastern BOP. DX will be extending the delivery sites however so financially will benefit from this contract. It incorporates Waikato Lakes and BOPDHB.

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COO Performance Report – April 2015 Page 1 of 10

CHIEF OPERATING OFFICER’S REPORT PROVIDER ARM May 2015

SUBMITTED TO: Bay of Plenty Hospital Advisory Committee

Submitted by: Bronwyn Anstis, Acting Chief Operating Officer

RECOMMENDED RESOLUTION: That the Committee receive the report.

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HIGHLIGHTS SUMMARY CHIEF OPERATING OFFICER CWDs • Elective CWD are 48 below the phased plan for May 2015 and 563 below YTD.

• Acute CWDs were 63 over plan in May (estimate due to un-coded cases) and 357 over plan YTD.

• Comparisons show total combined YTD CWD this year up by 931 or 2.7% over prior year.

Discharges • Elective surgical discharges are 13 below plan for the month and ahead by 511 YTD. • We have discharged 3.83% or 1,572 more inpatients YTD than for 2013-14, For May there were

228 or 6% more discharges than in the prior year. ED attendances • For the month of May 2015, Tauranga ED attendances resumed their high volume growth over

prior years. Attendances were up by 7.4% on same month prior year at Tauranga and up by 4.2% at Whakatane. There is a focus on weekend six hour target performance with some additional weekend resources targeted at these times.

53


The graphs below show year on year growth in ED attendances YTD for Tauranga, and inpatient discharge numbers across both sites. The graphs illustrate the relative magnitude of the growth over prior years.

Other activity • Outpatients are 18.9% or 386 First Specialist Assessments (FSA) ahead of contract for the month

and 2,865 or 14.1% ahead YTD.

• Follow-up visits are 2.4% or 120 below plan for the month and 2,747 or 5.6% ahead YTD.

Efficiency • As seen in the graphs below showing average length of stay per CWD, acute LOS is at historical

lows for May for acute CWD with electives recording a slightly higher rate.

2,500

2,700

2,900

3,100

3,300

3,500

3,700

3,900

4,100

4,300

Inpatient Discharges TGA & Whk (CWD funded)

2009

2010

2011

2012

2013

2014

2015

1.00

1.20

1.40

1.60

1.80

2.00

2.20

LOS / CWD Electives excludes daycase & maternity

2006 2007 2008 2009 2010

2011 2012 2013 2014 2015

3.00

3.20

3.40

3.60

3.80

4.00

4.20

4.40

4.60

LOS / CWD Acute & Arr excluding daycase & maternity

2006 2007 2008 2009 2010

2011 2012 2013 2014 2015

54


71.00

QUALITY, SAFETY & EXPERIENCE OF CARE

PATIENT & QUALITY May-14 May-15 Target Var Actual Target Var ORGANISATIONAL HEALTH & MONTIORING May-14 May-15 Target Var Actual Target Var

Outpatient DNA Rate 6.4% 6.1% 5.0% (1.1%) 6.6% 5.0% (1.6%) Staff Turnover % (FTE Basis) 0.6% 0.7% 1.5% 0.8% 0.6% 1.5% 0.9%

Outpatient DNA Rate MAORI 15.1% 14.2% 5.0% (9.2%) 15.4% 5.0% (10.4%) Sick Leave % 3.1% 3.3% 3.1% (0.2%) 3.0% 3.1% 0.1%

Waiting > four months for FSA (ESPI 2) 0.2% 0.0% 0.0% 0.0% % of staff with Annual Leave > 2yrs 6.2% 5.4% 0.0% (5.4%) 5.9% 0.0% (5.9%)

Waiting > four months for IP Treatment (ESPI 5) 0.0% 0.4% 0.0% (0.4%) Workplace Injury Per 1,000,000 hrs 10.0 0.0 5 5.00 5.3 5 0.25

Acute Readmission Rate 11.5% 10.9% 10.0% (0.9%) 11.4% 10.0% (1.4%) Mantatory Training Completed < 3 Months 87.7% 74.8% 100.0% (25.2%) 75.1% 100.0% (24.9%)

Acute Readmission Rate > 75 yrs U/D 0.0% 0.0%

FCT Indicator 1 [receipt of referral for urgent high suspicion of cancer FSA to first cancer treatment/other management < 62 days]

0.0% 58.3% 85.0% (26.7%) 63.4% 85.0% (21.6%)

FCT Indicator 3 [decision to treat confirmed cancer diagnosis to first cancer treatment/other management < 31 days]

0.0% 74.1% 0.0% 74.1% 75.9% 0.0% 75.9%

PROCESS & EFFICIENCY May-14 May-15 Target Var Actual Target Var FINANCIAL & CONTRACT PERFORMANCE May-14 May-15 Target Var Actual Target Var

ALOS - Elective Surgical CWD 3.63 3.43 3.17 (0.26) 3.24 3.17 (0.07) Total Caseweight (includes un-coded) 3,232 3,433 3,418 0.5% 35,337 35,543 (0.6%)

ALOS - Acute CWD (excl Mat & Neonatal) 4.04 3.90 3.91 0.010 3.89 3.91 0.018 Elective Caseweight (includes un-coded) 854 939 987 (4.8%) 9,278 9,840 (5.7%)

Discharge by 11.00am 16.9% 17.4% 30.0% (12.6%) 18.4% 30.0% (11.6%) Acute Caseweight (includes un-coded) 2,378 2,494 2,431 2.6% 26,060 25,703 1.4%

Nurse Hours per patient day 5.39 5.46 5.60 2.5% 5.46 5.45 (0.2%) Outpatient FSA Volumes 2,158 2,423 2,037 18.9% 23,181 20,316 14.1%

Ward Bed Utilisation 91.8% 92.5% 90.0% (2.5%) 90.6% 90.0% (0.6%) Outpatient FU Volumes 4,826 4,837 4,957 (2.4%) 52,181 49,434 5.6%

LOS Outlier (long) 3.09% 4.15% 1.5% (2.7%) 3.60% 1.5% (2.1%) FTEs 2,328 2,212 (116)

Oral Health - Utilisation of DHB-Funded services by adolescents (9-17yrs)

U/D 0.0% 0.0% Operating Costs ($000) 10,993 10,663 10,441 (222) 116,993 109,382 (7,611)

Mental Health Patients referred for non-urgent AOD seen <3 weeks (0-19yrs) U/D 0.0% 0.0% Personnel Costs ($000) 18,064 17,715 16,839 (876) 189,551 184,980 (4,572)

Smokers >15yrs receive B&C during inpatient episode

91.5% 92.6% 95% (2.4%) 89.8% 95% (5.2%) BOP Elective Surgical Discharges (excludes un-coded)

685 665 678 (1.9%) 7274 6763 7.5%

Theatre Session Utilisation [Main Theatres] 94.1% 91.2% 93.0% (1.8%) 91.0% 93.0% (2.0%) Financial Result Total $m (negative is contribution)

0.51$ 1.86-$ 2.66-$ 12.68-$ 23.43-$

ED KPI 2 (2hr target TGA Only) 46.9% 48.2% 95.0% (46.8%) 51.0% 95.0% (44.0%)

ED 6 hr Target 92.8% 92.5% 95.0% (2.5%) 93.4% 95.0% (1.6%)

Colonoscopy Diagnostic - urgents seen < 14 days 0.0% 20.5% 75.0% (54.5%)

Colonoscopy Surveillance/Follow Up < 84 days beyond planned date 0.0% 0.1% 60.0% (59.9%)

Electronic Inpatient Discharge Summaries sent < 24 hours 53.4% U/D 95.0% U/D 95.0%

KEY

Month Year to date Month Year to dateBEST VALUE FOR HEALTH SYSTEM RESOURCES

55

May-15

Key: Trend Arrows shows improvement, shows deterioration, shows no change, from previous month

Target Achieved (A), Target Not Achieved (NA)

Experience of Care: Service Result Target Variance Comment & Action Plan

Outpatient DNA Rate Provider 6.1% 5.0% (1.1%)Surgical 6.4% 5.0% (1.4%)Medical 4.3% 5.0% 0.7%WCF 7.6% 5.0% (2.6%)

Outpatient DNA Maori Provider 14.2% 5.0% (9.2%)Surgical 13.1% 5.0% (8.1%)Medical 11.9% 5.0% (6.9%)WCF 17.9% 5.0% (12.9%)

Waiting > 5mnths for FSA (ESPI2) Provider 0.0% 0.0% 0.0%Surgical 0.0% 0.0% 0.0%Medical 0.0% 0.0% 0.0%

WCF 0.0% 0.0% 0.0%

Waiting > 5m for Treatment (ESPI5) Provider 0.4% 0.0% (0.4%)Surgical 0.7% 0.0% (0.7%)

Medical0.0% 0.0% 0.0%

WCF 0.0% 0.0% 0.0%

FCT Indicator 1 (<62days) (PP30) Provider 58.3% 85.0% (26.7%)

Surgical 60.0% 85.0% (25.0%)

Medical 50.0% 85.0% (35.0%)WCF 100.0% 85.0% 15.0%

Acute Readmission Rate (OS8) Provider 10.9% 10.0% (0.9%)Surgical 9.0% 7.1% (1.9%)

Medical 14.0% 13.8% (0.2%)

WCF 8.9% 12.3% 3.4%

Provider 20.5% 75.0% (54.5%)Surgical 66.7% 75.0% (8.3%)

Medical 17.0% 75.0% (58.0%)

Provider 0.1% 60.0% (59.9%)Surgical 0.4% 60.0% (59.6%)

Medical 0.0% 60.0% (60.0%)

Radiology CT < 42 days (PP29) Provider 92.7% 90.0% 2.7%

Service Result Target Variance Comment & Action Plan

ALOS - Elective Surgical (OS3) Provider 3.43 3.17 -0.26 Surgical 3.57 3.25 -0.32

WCF 2.43 2.56 0.13

ALOS - Acute (OS3) Provider 3.90 3.91 0.01Surgical 4.64 4.56 -0.08

Medical 3.96 3.98 0.02

WCF 2.00 2.14 0.14

Discharge by 11am Provider 17% 30% (12.6%)Surgical 20.0% 30.0% (10.0%)

Medical 14.0% 30.0% (16.0%)

WCF 27.5% 30.0% (2.5%)

NAFocus on orthopaedic readmits with post Dx phone callsWork being done within ED Acute flow to look at the top 100 presenters. ED is working with primary health to identify pathways and MDM approach to these patientsAchieved

NA

NA

Colonoscopy Diagnostic - urgents seen within 14 days (PP29)

Colonoscopy Surveillance/FU < 84 days beyond planned date (PP29)

Balanced Score Card

NA

NA

A

NA

A

NA

A

NA

Focus on Orthopaedic followup clinics where there is high DNA

AchievedNot achieved. DNA project continues to be a focus

AchievedAchieved - concern around Dermatology due to resource availabil ity

Achieved

Achieved

Achieved

We continue to look at early discharge and use of the transit lounge. Key issue includes medical rounding identifies highest risk patients first.

Close to targetAchieved

As above

Not achieved. DNA project continues to be a focus

Not achieved due to a few Ortho and ENT patients- on target to achieve for JuneAchieved - concern around Gastroenterology however production planning meetings in place identifying key actions - Saturday l ists, extras etc.

Achieved

Achieved

Close to target

Achieved

NAImprovement on last month. Overall, there is a 9% improvement on previous quarter's published result.

Achieved

56


NHPPD Provider 5.46 5.60 2.5%Surgical 5.07 5.21 2.7%Medical 5.44 5.80 6.2%WCF 6.07 5.33 (13.9%)

Mental Health 11.21 12.22 8.3%

Ward Bed Utilisation Provider 92% 90% 2.5%Surgical 96.7% 90.0% 6.7%

Medical 100.8% 90.0% 10.8%

WCF - Paeds 69.9% 75.0% (5.1%)WCF - Mat 51.3% 85.0% (33.7%)

Oral Health - % 5yrs Caries Free (PP11) Provider 50.0% 64.0% (14.0%)

Theatre Session Utilisation Provider 91.2% 93.0% (1.8%)Surgical Tga 93.5% 93.0% 0.5%

Surgical Whk 85.5% 93.0% (7.5%)

WCF 96.4% 93.0% 3.4%

ED KPI 2 (2 hr Target TGA only) Provider 48.2% 95.0% (46.8%)Surgical 48.0% 95.0% (47.0%)

Medical 50.6% 95.0% (44.4%)

WCF 45.1% 95.0% (49.9%)

6 Hour Target Provider 92.5% 95.0% (2.5%)

NA

LOS Outlier Provider 4.2% 1.5% (2.7%)Surgical 4.3% 1.5% (2.8%)

Medical 5.4% 1.5% (3.9%)

WCF 2.3% 1.5% (0.8%)

Provider 92.6% 95.0% (2.4%)

NA

System: Service Result Target Variance Comment & Action Plan

Sick Leave Provider 3.3% 3.1% (0.2%)Surgical 3.4% 3.1% (0.3%)

Medical 2.8% 3.1% 0.3%WCF 2.1% 3.1% 1.0%Support Service 3.5% 3.1% (0.4%)Maori Health 6.0% 3.1% (2.9%)RCS 3.0% 3.1% 0.1%Mental Health 4.2% 3.1% (1.1%)

Mandatory Training completed Provider 74.8% 100.0% (25.2%)< 3m of start date Surgical 60.0% 100.0% (40.0%)

Medical 82.9% 100.0% (17.1%)

WCF 91.7% 100.0% (8.3%)

Support Service 0.0% 100.0% (100.0%)

Maori Health 0.0% 100.0% (100.0%)

RCS 80.0% 100.0% (20.0%)

Mental Health 71.6% 100.0% (28.4%)

Annual Leave balance >2yrs Provider 5.4% 0.0% (5.4%)Surgical 6.1% 0.0% (6.1%)

Medical 5.7% 0.0% (5.7%)

WCF 10.3% 0.0% (10.3%)Support Service 4.9% 0.0% (4.9%)Maori Health 12.7% 0.0% (12.7%)RCS 4.4% 0.0% (4.4%)

Mental Health 2.3% 0.0% (2.3%)

A

A

NA

NA

NA

NA

NA

NA

NA

Impact of Whakatane

High acute demandBed util isation driven by increased acute demand

High demandAll services were under NHPPD for the month - this wil l be investigated furtherImpact of Whakatane

consistency of information entry requires improvement, further investigation to be undertaken.

Achieved

Focus continues result impacted by nurtian and acess to oral hygine and flouridation

The data used to measure this target is inaccurate as it requires manual entry by ED staff of disposition decision and time. No time recorded impacts. In general the 6-hour target is achieved.

Weekends continue to be the key issue as resources l imited over weekends and public holidays. ED attendance continue to grow particularly with winter impacts. Bed block either in APU or wards does create issues. Work continues with the primary care on the Acute Flow projects being led by Planning and Funding

Individually reviewed to ensure clinically appropriate

Capacity allowance for unplanned acutes that impacts on result. Service looking to adjust elective session minutes Achieved

Overall ED target improved (especially given the winter surges). There are issues with recording - question if this target is needed on the scorecard

6 hour target where patients are directly discharged from ED is 96.8%

High Sick leave this month however following seasonal pattern with no special cause variance.AchievedAchieved

Sick Leave Plans in place

All LOS outliers are reviewed and as appropriate MDM involvement to facil itate discharge. Issues continue with patient "trapped" in the hospital due to no funding externally for care.Children with eating disoders affect the result

Done

Team leaders to monitor

Continued focus on Mandatory training

AchievedSeasonal impact of winter i l lnesses

Teams Leaders requested to monitorContinued focus on Mandatory training

Team leaders to monitor

Smokers Receive B&C during inpatient episode (>15yrs)

Team leaders advised of high outliers in each area and developing leave plans

Balances are reducing, leave balances actively being managed

Affected by staffing resources available to cover (particulary in Theatre Nusring and Anaesthestists). Noted to be an improvement compared to May 2014

Impacted by winter and access to bureau due to lack of resource

Impacted by SMO and Midwife accrued leave - service monitoring

Leave Plans in place

57

Service YTD Result YTD Target Variance Comment & Action Plan

Elective CWD Provider 9,278 9,840 -563 Surgical 7,842 8,342 -500 Medical 753 767 -14

WCF 683 731 -48

Elective Discharges Provider 7,274 6,763 511Surgical 6,460 5,941 519WCF 814 822 -8

Acute / Arranged CWD Provider 26,060 25,703 357Surgical 8,355 7,947 408Medical 12,664 12,736 -73 WCF 5,042 5,019 22

OP FSA Provider 23,181 20,316 2,865Surgical 12,428 10,762 1,666Medical 7,068 6,444 624WCF 3,685 3,110 575

OP FU Provider 52,181 49,434 2,747Surgical 24,630 25,545 -915Medical 18,246 16,122 2,124WCF 9,305 7,766 1,539


Operating Expenses Provider 10,663 10,441 -222

Surgical 3,074 3,559 485

Medical 3,061 2,505 -556

WCF 327 350 23

Support Service 95 77 -18 Maori Health 14 13 -2 RCS 1,161 1,006 -155

Mental Health 495 326 -169

Personnel Costs Provider 17,715 16,839 -876 Surgical 5,402 4,872 -530

Medical 4,596 4,280 -317

WCF 1,759 1,532 -227 Support Service 697 566 -131 Maori Health 334 295 -39 RCS 2,410 2,285 -125

Mental Health 2,254 2,243 -11

FTE's Provider 2,328 2,212 -116

Surgical 613 573 -41

Medical 562 525 -37 WCF 172 160 -12 Support Service 155 139 -16

Maori Health 54 51 -4

RCS 398 391 -7

Mental Health 311 304 -7

NA

NA

NA

NA

A

A

A

A

Close to target, service monitoring contract delivery

achieved

Variances in MHSOP inpatient and adult inpatient wards

District Nursing and All ied Health over budget - responding to demandHigher nursing HCA and all ied costs contributing to overspend and increase in overtime costs this month.

Significant variance to budget for nursing in theatres (Budget set at 7.5 theatres where 8 in constant use , plus growing acute demand required to meet contracted volumes and targets)

Acute offset

Over delivery to meet 4 month ESPI targets

Mental Health and Peadiatric nursing over Fte

Locums costs, antipsychotic costs, minor opex furnishings and screens for video conferencing main drivers.

Nursing costs contributing largely to this overspend see FTE variance belowNursing is over by 271K and admin by 32k (this being attributable in part to endoscopy NEQUIP project extension)

Result reflects nursing budgeted vs actual requirements

Under budgetLocums, KKC and pharmaceuticals all the main drivers

underbudget for the month

Impact of demand driven activity (Clinical supplies and descretionary spend)

Over delivery on FSAs

Over delivery due to inflows

Affected by overdelivery in FSA to meet ESPI targetsOver delivery on Fus

Over delivery being monitored by service

Driven by the nursing and admin as per aboveNursing and admin personnel over budget FTE YTD due to actual requirements

Continue to manage nursing budgets. Te Pou kokiri are under recruited although administration is sti l l highDistrict Nursing and All ied Health over budget

close to target

High acutesSmall variance due to a couple of patients primarily in Cardiology

Demand driven

Minor variance representing only a couple of patients

58

FINANCIAL

Month Ended: FY Period 11 -MayDivision: PROVIDER

Actual Budget Var Var % Actual Budget Var Var %($000's) REVENUE ($000's)

23,813 22,348 1,465 7% Government Revenue 26,300 24,380 1,920 8%4,824 3,483 1,341 39% Other Revenue 4,700 3,800 900 24%

290,590 291,960 1,370- 0% Funder Revenue 318,060 319,120 1,060- 0%319,227 317,791 1,436 0% Total Revenue 349,060 347,300 1,760 1%

EXPENDITURE189,551 184,980 4,572- -2% Staff Costs 205,862 201,760 4,102- -2%

26,930 20,083 6,847- -34% Outsourced Costs 30,063 21,984 8,079- -37%51,143 51,667 524 1% Clinical Costs 56,870 56,690 180- 0%16,246 15,047 1,199- -8% Infrastructure Costs 16,960 16,410 550- -3%22,674 22,585 89- 0% Recharges 24,638 24,638 - 0%

306,544 294,361 12,182- -4% Total Expenditure 334,393 321,482 12,911- -4%12,684 23,430 10,746- -46% Net Result 14,667 25,818 11,151- -43%

2328.08 2211.92 -116.16 -5% FTE 2,211.81 2,211.81 - 0%

BOPDHB Provider2014/2015

Year to Date Year End Estimate

-3,500

-3,000

-2,500

-2,000

-1,500

-1,000

-500

-

500

1,000

Mon

thly

resu

lt $0

00's

Monthly Net Result

Result Budget

6,000

7,000

8,000

9,000

10,000

11,000

12,000

13,000

Mon

thly

resu

lt $0

00's

Monthly Operating Costs

Result Budget

15,000

15,500

16,000

16,500

17,000

17,500

18,000

18,500

19,000

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

59

FTE RESOURCE MANAGEMENT

FY Period 11 -May YTDTotal Variance: 792,571-$ 10,746,363-$

Revenue: 306,107$ 1,436,064$

Salaries & Wages: 876,354-$ 4,571,620-$

-$317,043-$3,025,267-$1,506,441

Outsourced: 75,338-$ 6,846,976-$

-$350,982-$242,236

-$2,413,176-$71,397

-$481,308-$250,550

-$2,198,225

Clinical Supplies: 223,862$ 523,841$

$103,982$127,176

-$587,902$670,463

$51,651-$715,852$409,552

Infra-Structure: 116,715-$ 1,198,762-$

-$149,139-$176,743

-$55,771

Recharges: 254,396-$ 88,909-$

-$56,300$10,838

Year End ForecastActual: 14,666,819$ 11,151,170-$

* Oncology drugs

* Outsourced doctors* Orthopaedic outsourced

* Outsourced nursing

* Ophthalmology outsourced

* Outsourced Radiology

* Outsourced Radiotherapy (KKC)* Outsourced Gastro

Outsourced Orthopaedics is higher than plan as 16 Waikato DHB patients had their procedures performed in Grace organised through BOPDHB to assist with Waikato elective target delivery. Radiotherapy through KKC is over budget YTD and heading towards $2.5m overspend by year end at current rate of variance.

Variance to Budget:

* Publishing* Vehicle use

* Cleaning* Laundry* Patient meals

BOPDHB Provider

High inpatient acute workload with lower doctor vacancy rate. Clinical admin is 16 FTE and $791k over plan YTD.

Financial Commentary - PROVIDER

ACC revenue is up $1.163m on budget. Acute CWD are over plan by 357 worth $1.671m. ED attendances are above YTD plan worth $1.587m. Radiotherapy is over budget $2.198m YTD.

* Management Admin is over budget YTD

* Road & Air Ambulance

* Instruments & equipment

* Blood products ($264k Intragam saving)* Pharmaceutical drugs excluding Oncology

* Implants

* Renal fluids and supplies

* Doctors * Nursing is over budget YTD

FY Period 11 -MayData

Account Report Group1FTE

ActualFTE

Budget

FTE Variance Actual to Budget

FTE Variance% Actual to Budget

FTE Actual YTD

FTE Budget

YTD

FTE Variance Actual to

Budget YTD

FTE Variance% Actual to

Budget YTD

MEDICAL PERSONNEL 2002 323.86 310.68 -13.18 -4.24% 307.94 310.90 2.95 0.95%NURSING PERSONNEL 2202 1,180.46 1,056.87 -123.59 -11.69% 1,139.26 1,056.87 -82.39 -7.80%ALLIED HEALTH PERSONNEL 2402 491.23 462.10 -29.13 -6.30% 462.34 462.10 -.24 -0.05%SUPPORT PERSONNEL 2602 84.57 81.90 -2.67 -3.26% 88.19 81.90 -6.29 -7.69%MANAGEMENT ADMIN PERSONN 2802 343.04 299.06 -43.98 -14.71% 330.34 300.15 -30.19 -10.06%Grand Total 2,423.16 2,210.61 -212.55 -9.61% 2,328.08 2,211.92 -116.16 -5.25%

Month YTD

60

CONTRACTS Acute CWD are again slightly above plan for the month and the Orthopaedic Service is the single largest contributor to negative variances for elective CWD YTD.

Preliminary results show that as at 31st May 2015 there were no patients waiting longer than 4 months for either a medical or surgical FSA. There are currently 12 waiting longer than 4 months for a surgical procedure within the following specialties: ENT 4, General Surgery 2 and Orthopaedics 6. We are expecting to be fully compliant with ESPI wait times by the end of June 2015. Colonoscopy wait times and service delivery is an area of focus going forward. Currently wait targets are not being met and a plan is being put in place to address this.

Printed: 15 June 2015

Note: Graphs monitor all Funder contracted CWD with BOPDHB Provider ArmElectives = All elective CWDAcute & Arranged = all acute and arranged CWD

0

500

1000

1500

2000

2500

3000

3500

4000

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

Total CWD Delivery - 2014/15

Elective Acute Contract

0

500

1000

1500

2000

2500

3000


Acute & Arranged CWD Delivery - 2014/15Acute Uncoded Est Acute Actual

Acute Contract

0

150

300

450

600

750

900

1050

1200

1350


Elective CWD Delivery - 2014/15

Elective Unocoded Est Elective Actual Elective Total Contract

Elective Base Target Adj Elect Target

61

Property Services General Manager Monthly Report

May 2015

SUBMITTED TO: Bay of Plenty District Hospital Advisory Committee (BOPHAC) 05 August 2015

SUBMITTED BY: Jeff Hodson, GM Property Services ENDORSED BY: Phil Cammish, CEO

1. Highlights Tauranga Campus Car Parking The new 17th Ave leased car park was opened to DHB staff during May. This released 200 existing staff car parks in the Clarke St car park for patients and visitors. There has been a noticeable reduction in visitors driving around trying to find car parks, and patient no-show to clinic appointments. B50 L2 Construction Contract Expression of Interest was received from 6 contractors. Three capable contractors have been selected to be invited to tender for the construction contract. In selecting the contractors, the nominated staff were considered, as one of the key attribute, with a particular focus on the services supervisor.

2. Red Flags & Updates

Whakatane Project Waka Domestic Water - Update A trial installation of tempering values has been completed. The trial demonstrated that it will be reasonably easy to retro-fit tempering values to the existing hot water system. A full roll-out of installing tempering values is now being planned, and will be capitalised into the project.

Tauranga Fire and Smoke Dampers Compliance Remediation Works Extensive discussions have been undertaken with the supplier of the dampers to establish the extent of the approved installation variation. TCC sign-off will now be sought before proceeding with the remediation work.

3. General

Tauranga Extra Car Parking See highlights above.

62

GM Monthly Report – April 2015 DocMan/Management

4. Project Waka

General Fletchers have continued to make good progress on close-out of the defects. However, there is still a significant number of minor defect works to be closed. Major defects to be resolved:

1. Fire and smoke damper compliance 2. Energy management system

The current plan is to have these closed out by 30 June 2015. The 3 day building services proof of performance workshop was undertaken in May. The workshop validated the performance of the building services systems. The performance of the system either exceeded or met our consultant expectations.

5. Tauranga Master Plan Forward Planning A site master plan briefing session was undertaken, with the executive and senior clinical staff. A further session with be held in July to review more detailed options that better reflect the BOPDHB capital and operational funding affordability model.

6. RSA Flats Discussions are ongoing with Tauranga Community Housing Trust (TCHT). We are awaiting a

valuation report which will provide a better understanding of the assets value and rental capability. Once both parties have evaluated all the options it is intended that we will have a further meeting in late June to discuss the basis of how TCHT could manage the accommodation long-term.

7. Pharmacy Lease Discussions are on-going with the lessee to make them understand their lessee rights are

limited. 8. Tauranga Genset

The procurement strategy has been agreed. Final design packages will now be completed in line with the procurement strategy.

9. Other Major Projects

Tauranga B50 L2 - Fit-out Preliminary Design Preliminary design is complete. The revised budget, based on preliminary design, is less that the concept budget. A value management session has been undertaken to ensure the specification / scope of work is realistic.

63


Detailed design is now underway. Construction Contract See highlights above. Planned Completion Date April 2016 - Design Percentage complete last month 23% - Design Percentage complete this month 30%

Whakatane – Redevelopment Stage 2 - Santon Demolition All soft fit-out materials have been removed from the building and removal of asbestos has commenced. Planned Completion Date 30 June 2015 Revised Completion Date 11 December 2015 - Percentage complete last month 13% - Percentage complete this month 20%

Whakatane – Redevelopment Stage 2/5 - Dawson Refurbishment The completion of the new link from the main corridor past Dawson building entry and down to the maternity corridor has created a hospital look and feel. Planned Completion Date January 2015 Revised Completion Date 28 February 2015 - Percentage complete last month 95% - Percentage complete this month 97%

Whakatane – New Water Tanks

The preliminary copy of the Geotech final design report has been received. It recommends the use of steel piles instead of wooden piles. This will add approximately $50,000 cost to the project budget. We have instructed the consultant to finalise and issue their report. We are awaiting delivery of the final design report at the end of April. Planned Completion Date Late 2015 - Percentage complete last month 18% - Percentage complete this month 18% Whakatane – OPD Flooring Upgrade The project was to replace the floor and wall carpet in the OPD main corridor. The project has received positive feedback from the staff. Planned Completion Date June 2015 - Percentage complete last month 0% - Percentage complete this month 90%

Whakatane – Ward 8 Stage 3 Works

64


The increased scope of work has been agreed with the business unit. The extra work will delay the completion by 6 weeks. Planned Completion Date June 2015 Revised Completion Date August 2015 - Percentage complete last month 10% - Percentage complete this month 75%

Tauranga B24 L1 Work is progressing well with minimal disruptions to the services on the floor. Completion Date June 2015 - Percentage complete last month 10% - Percentage complete this month 75%

Tauranga Lift Wall Upgrade Work is planned to commence in May. A contract has been awarded. Work has been delayed due the ceramic tiles that were selected being on indent. Work is now expected to commence in June. Planned Completion Date June 2015 - Percentage complete last month 14% - Percentage complete this month 15% Tauranga Theatre UPS Upgrade A further highly invasive stage was successfully completed during this month. There are now only 2 stages to complete the project. Planned Completion Date December 2014 Revised Completion Date August 2015 - Percentage complete last month 40% - Percentage complete this month 60%

Tauranga Campus – EECA Energy Management Programme Stage 1 is nearing completion. The last 25% is awaiting EECA funding sign-off. Stage 1 Completion Date June 2015 - Percentage complete last month 75% - Percentage complete this month 75%

Tauranga Campus – Security Access System Upgrade The programming of the cards and the system is now complete, and the buildings hardware will be progressively cut-over to the new system during the next 3 months. Revised Completion Date 30 June 2015 Percentage complete last month 2% Percentage complete this month 40%

65


Tauranga Lamson System Transportation of Blood Products Planning of the system route has examined several options and a final route has been selected The final budget is yet to be finalised. Tauranga Lamson System Extension to the New Pathlab Building Planning of the system route in the hospital ceiling has identified a number of pinch points. The alternative basement route is being evaluated. Planned Completion Date December 2015 - Percentage complete last month 5% - Percentage complete this month 8%

Pathlab have been promoting our system to be upgrade to carry blood products. The upgrade will require system alterations. We are awaiting advice to the location of the stations from the Provider Arm before we can obtain a budget for the proposed work. Planned Completion Date TBC - Percentage complete last month 1% - Percentage complete this month 5%

Whakatane New Lamson System Planning of the system route in the hospital ceiling has identified a number of pinch points. The alternative basement route is being evaluated. Planned Completion Date December 2015 - Percentage complete last month 0% - Percentage complete this month 5%

10. Third Party Projects

Northern Campus Development (NCD) Stage 1 (Pathlab) Work is proceeding on construction of the new building.

Pathlab project manager has requested access to the DHB fire sprinkler system, as the TCC Cameron Road water mains have insufficient capacity. The request is being evaluated.

11. Risk, Compliance & OHS

Tauranga Smoke and Fire Damper Fletchers and their sub-contractors have commenced the remediation works. It is expected to take 6 months or longer to progressively complete the works. Due to a lack of agreement between, the fire damper supplier, Fletchers and the Council, the upgrade works have been delayed until final agreement is achieved. The project has also identified further defects in the inter tenancy walls which require fire rating.

66


Planned Completion Date August 2015 Percentage complete last month 9% Percentage complete this month 9%

12. Facilities Management Update

This Month Fire Alarms Activation (false) TGA - Site General 0 - Acute Mental Health 0 WHK - Site General 0 - Ward 8 0 Fire Alarms Activation (real) TGA - Site General 0 - Acute Mental Health 0 WHK - Site General 0 - Ward 8 0 Reportable Events TGA 0 WHK 1 Power interruption TGA 0 Power interruption WHK 0 Lost time injury TGA 0 Lost time injury WHK 0 After Hours Calls TGA this month 29 WHK this month 11

13. Property Management

Nothing to report.

67

Updated 20/3/2014

Bay of Plenty Hospitals Advisory Committee Work Plan 2015

Month Activity Documentation Source

January • No meeting February • Monthly COO Report

• General Manager Property Services Report

• COO • GMPS

March • No Meeting April • Focus Topic: Quality & Safety

• COO Highlights Report • COO Performance Report • General Manager Property

Services Report

• COO • COO • COO • GMPS

May • No Meeting June • Focus Topic: Productivity

Improvements • COO Highlights Report • COO Performance Report

Productivity • General Manager Property

Services Report

• COO

• COO • COO • COO • GMPS

July • No Meeting August • Focus Topic: Health Targets

• COO Highlights Report • COO Performance Report • Health Target • General Manager Property

Services Report

• COO • COO • COO • COO • GMPS

September • No meeting October • Focus Topic: Integrated Health

Strategy (IHS) • COO Highlights Report • COO Performance Report • Integrated Health Strategy (HIS) • General Manager Property

Services Report

• COO • COO • COO • COO • COO • GMPS

November • No Meeting December • Focus Topic: Patient Centred

Care • COO Highlights Report • COO Performance Report • General Manager Property

Services Report

• COO • COO • COO • COO • GMPS

January • No Meeting February • No Meeting

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