Agenda Bay of Plenty Hospital Advisory Committee

Agenda

Bay of Plenty Hospital Advisory Committee

Venue: Education Centre, 889 Cameron Road, Tauranga Date and Time: Wednesday 5 November 2014 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 – Nil

2 Interests Register

3 Minutes of Meeting – 3 September 2014

3

4

Matters Arising

4.1 Matters Arising

4.2 Committee Matters Arising – Nil

4.3 Regional HAC Committees

7

8

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

5.4 Draft Work Plan 2015

17

35

43

50

6

Reports for Noting 6.1 Work Plan

52

7

Presentations – Nil

8 General Business

9

Resolution to Exclude the Public

10

Next Meeting – Wednesday 4 February 2014

DRAFT

Bay of Plenty Hospital Advisory Committee (open) Minutes

Minutes

Bay of Plenty Hospital Advisory Committee

Venue: CEO Building, Cnr Cameron Road & 20th Avenue, Tauranga Date and time: Wednesday 3 September 2014 at 2:00pm

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

McCausland (Runanga Rep) Attendees: Phil Cammish (Chief Executive), Gail Bingham (GM Governance & Quality), Pete

Chandler (Chief Operating Officer), Simon Everitt (GM Planning and Funding), Julie Robinson (Director of Nursing)

Item No.

Item Action

1

Apologies

Apologies were received from Clyde Wade, Marion Guy and Stewart Ngatai. Resolved that the apologies from C Wade, M Guy and S Ngatai be received.

Moved: M Arundel Seconded: D Stewart

2

Interests Register

The Committee were asked if there were any conflicts in relation to items on the agenda. No conflicts were identified.

3

Minutes

Resolved that the open and closed minutes of the meeting held 2 July 2014 be confirmed as a true and correct record.

Moved: G Esterman Seconded: M Arundel

3

DRAFT


Item No.

Item Action

4

Matters Arising

4.1 Matters Arising

As per report circulated with the agenda.

4.2 Committee Members Matters Arising

There were no committee member’s matters arising. Regional HAC Committees Lakes reported higher than usual ED attendances

5

Reports requiring decision 5.1 Regional Committee Minutes Resolved that the Committee include the minutes of

Lakes and Waikato Hospital Advisory Committees on the BOPHAC agenda.

Moved: S Webb

Seconded: M Arundel

5.1 Chief Operating Officers Highlights Report The Committee discussed the amended report as circulated at the meeting. The Committee discussed the higher Maori DNA rates.

Resolved that the Committee receive the report.

Moved: M Arundel

Seconded: D Stewart

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


Moved: S Webb

Seconded: G Esterman

4

DRAFT


Item No.

Item Action

5.3

GM Property Services Monthly Report The Committee discussed the report as circulated with the agenda.


Moved: M Arundel Seconded: S Webb

5.4 Health Excellence Complaint Letters The Committee discussed the report as circulated with the agenda. The Committee discussed the response examples. Letters need to address the CARE principles. There are things that could be done better but generally the letters are appropriate. Resolved that the Committee review the attached complaint and response which have been randomly selected from the complaints data base and provide feedback.

Moved: M Arundel Seconded: S Webb

GMGQ: Remove 20 days – will respond as soon as possible but before XXXX GMGQ: Repeat report in 1 year (Sept 2015)

6

Reports for Noting

6.1 Work Plan The Committee noted the information.

6.2 Ombudsman Office Visit Crimes of Torture Act 1989 The Committee noted the information.

7

Presentations There were no presentations.

8

General Business There was no general business

5

DRAFT


Item No.

Item Action

9

Next Meeting – Wednesday 5 November 2014.

The open section of the meeting closed at 3:00pm. The minutes will be confirmed as a true and correct record at the next meeting.

6

Bay of Plenty Hospitals Advisory Committee

Matters Arising – 5 November 2014

Meeting Date Item Action required Action Taken

3 Sept 14

5.4

Health Excellence Complaint Letters GMGQ to remove 20 days – will respond as soon as possible but before XXXX

completed

GMGQ to Repeat report in 1 year (Sept 2015).

7

Hospital Advisory Committee meeting 28th July 2014 Page 1 of 6

MINUTES OF THE MEETING OF THE HOSPITAL ADVISORY COMMITTEE

HELD ON MONDAY 28th JULY 2014 AT 10.00 A.M. HOSPITAL BOARDROOM, PUKEROA STREET, ROTORUA Meeting No. [132] Present: M Burdon (Chair), D Loughlin, D Shaw, I McLean, M Bentley, E Wilson, M Arundel, D Honore, A

Morgan and N Wikaira. In Attendance: D Oliff, N Saville-Wood, L Yule, P Tangitu, J Eilers, S Wilkie, G Fannin and Presenters G Lees –

Director of Nursing and Midwifery, S Andrews – ADON Primary & Community, C Ingram-Clark – ADON Professional Development and J Batt – ADON Maori and B E Harris (Board Secretariat)

132.10 MEETING CONDUCT The Chair welcomed everyone to the meeting and asked N Wikaira to open with the karakia. Disclosure of Interest & Interest Register The Chair asked for any disclosures of interest to which none were submitted. The Interest Register was

circulated during the meeting and no changes were made. 132.12 Apologies T Lloyd, J Calnan & R Dunham Resolution: THAT the apologies be sustained. E Wilson : M Bentley CARRIED 132.13 General Business : Nil

Presentation on Nursing Services by G Lees, C Ingram-Clark, S Andrews & J Batt

The presentation given by G Lees and his team covered:- Lakes DHB Nursing Structure National and Regional work of the DONM and ADONs Local activity Simulation Professional Development Unit Nurse Entry to Practice Programme (NETP) Post Graduate Study Professional Development and Recognition Programme (PDRP) PDU Moodle Course Development Flow Chart Associate Director of Nursing – Primary and Community ADON – Maori Role Achievements

The Chair thanked G Lees and his team for their informative presentation and congratulated the Nursing Directorate for its achievements as outlined in their address.

132.20 SIGNIFICANT ISSUES 132.21 Clinical Governance Minutes of Meeting 17th June 2014

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M Burdon sought clarification on the contention regarding visiting hours to which D Oliff advised that people come from out of town to visit patients and it was a matter of working in a flexible manner with these visitors. In some cases patients in ICU or CCU can have a lot of visitors at the one time. Lakes is working to improve on these situations.

Resolution: THAT the Clinical Governance Minutes of meeting dated 17th June 2014 be received. E Wilson : D Shaw CARRIED 132.30 GENERAL MANAGER – CLINICAL SERVICES 132.31 Clinical Services Monthly Report : June 2014 In taking the report as having been read, D Oliff highlighted the following items:-

Family Violence Intervention Programme (FVIP) – service is currently preparing for the 12 month MoH Audit due on 11 and 12 August 2014. She was hopeful that by June 2015, the national electronic child alert system being developed by the DHB under the auspices of FVIP would be fully implemented.

Physician Assistants – Six of the seven physician assistants in NZ visited Rotorua Hospital on 12 June 2014. They are employed in both primary health care and in emergency services in NZ with a varied background and practiced in a wide range of settings in the USA. Name change to physician associates under NZ legislation – practising at registrar level.

Taupo Planning Day – A formal planning day was held on 11 July 2014 in Taupo resulting in a very good turn out with both primary and secondary clinicians and staff focused on developing a “vision”, direction and exploration of the potential for Taupo services and resources in alignment with the new redevelopment of the Taupo Hospital. Scheduling another Taupo planning day in September to look at additional services for Taupo.

Critical Care Outreach Pilot – to proactively manage critically ill patients in the hospital. Vulnerable times are the evenings of Thursday, Friday and Saturday.

Maria Strachan employed to review every death, providing a formal report to Dr M Thomas, GM Clinical Services, Clinical Governance and Chief Executive. Systematic recording rests with Dr M Thomas and D Oliff.

Further expanding regional collaboration - moving into audiology and social work standardising process reporting and professional oversight.

Full ED quarterly report provided to MoH. This month Lakes has fallen from 93% to 91%. Small team of three (R Dunham, Dr M Thomas & D Oliff) visiting Capital Coast who have made significant progress in this area. Poor performance is service in medicine - need to map new way of doing things with new thinking at the front door, led by senior nurses.

Draft report of “Central Referral Project” – one point of entry for all referrals. Out for consultation currently.

Revised ENT Electronic Prioritisation Tool was intended to go live on 1st July but its implementation is on hold until the HOD returns from leave.

Visit from Medical Council of NZ to review Lakes accreditation for PGY1 House Officers – positive response with constructive advice for improvement in some areas.

New Volunteers Programme with Pauline Bennett assigned the Volunteer Coordinator. P Bennett previously managed Starship. Volunteers will man a new Help Desk positioned in the Atrium to assist patients and visitors with finding their way to appointments and around the hospital. Lakes is currently recruiting to these positions in the hope of having this facility up and running in the next two weeks.

Clinical Equipment Pool is a new initiative which has taken over the purchase, storage and allocation of Nursing and HCA uniforms previously managed by Facilities.

Mental Health Services – David Chaplow commenced early June 2014 and Ray Watson started 22nd July 2014 working on strategic planning and building on the strength and capability of staff. It is hoped to provide a presentation to a future HAC meeting. R Watson is located in the Te Ngako building.

9


Resolution: THAT the Clinical Services Monthly Report for June 2014 be received. D Loughlin : A Morgan CARRIED 132.32 ED Target Report D Oliff stated that over the next few months, Shorter Stays in Emergency Departments Health Target will

be fully focused on by Lakes. She expected that with Lakes being at 91%, a letter from the MoH will seek improvement.

132.33 Balanced Scorecard D Oliff reported that falls continue to be a challenge for Lakes DHB, along with the issue of annual leave.

The DNA rating is improving as Gareth Fannin pointed out. Resolution: THAT the ED Target Report and Balanced Scorecard information be received. D Honore : D Loughlin CARRIED 132.40 REPORTS 132.41 Performance Monitoring (Finance & Audit) : 30th June 2014 In speaking to the financials, N Saville-Wood highlighted the following points:-

Provider had a favourable variance for the month of $1,580k and YTD unfavourable variance of ($178k).

Continue to under-perform in South Waikato volumes ($159k). Nursing costs ($164k). Outsourced Services – Medical locum costs ($363k). Outsourced Clinical – South Waikato volumes lower than planned $179k and South Waikato

endoscopy volumes also lower than planned $10k. Implants & prostheses ($142k) unfavourable implants due to increased volume of acute

orthopaedic work in June. Infrastructure and non-clinical costs – Carried out adjustments ($123k) related to unfavourable

Taupo building depreciation stage 1 and 2 of LHSIP. Inter District Flows (55) variance for the month. Did better than expected in Orthopaedics. Acute CWDs 1002.2 YTD. Also LOS improvement 2.02 v 2.08. Orthopaedics at 39 for period ending June 2014 as opposed to 61 the previous month – related

to unplanned IDF inflows. Area of concern at the moment is the under-delivery of ATR volumes but this should improve

with new locum on board. Resolution: THAT the Financial Report for 30th June 2014 be received. D Loughlin : D Shaw CARRIED

132.42 Maori Health 132.42.1 Maori Health Activity Update 132.42.2 Lakes DHB Maori Health Plan 2014/15 P Tangitu referred the meeting to page 62 of the Maori Health Plan relating to the Maori DNA rate (14%)

being higher than the non-Maori rate (4%). She confirmed this disparity required continued participation in the multi-disciplinary project to reduce the DNA rate at Rotorua and Taupo hospitals. M Arundle stated that every DHB in the country was having the same experience and that BoP DHB was awaiting advice from Dr George Gray. He believed Lakes DHB looked good at the moment considering this was a

10


national issue. It was also believed that health literacy played an important part in the high Maori DNA rate. E Wilson added that Waikato DHB also had the health literacy conversation a number of times. He suggested Lakes DHB, apart from monitoring and setting goals to significantly reduce disparity, liaise with the Whanau Ora Navigators for their assistance.

Resolution: THAT the Board indicate to management that although high DNA rates for Maori is an issue with the rest

of the country, because of the large Maori population in Lakes, a significant reduction of disparity of DNA rates between Maori and non-Maori is of importance to the organisation.

I McLean : A Morgan CARRIED N Wikaira paid tribute to Taupo Hospital staff member, Aroha Crowther who passed away on 27th July

2014 and Rawiri Rangitauira who also passed away on the same day and whose tangi was being held at Tunohopu, Ohinemutu. P Tangitu responded that she, E George and Lakes DHB staff would be attending Rawiri’s tangi the next morning at 7.45am and then travelling to Taupo to Aroha’s tangi.

132.50 SECRETARIAL 132.51 Minutes of previous HAC meeting held 30th June 2014 Resolution: THAT the minutes of the previous meeting held 30th June 2014 be confirmed as a true and accurate

record. A Morgan : D Shaw CARRIED 132.52 Heart Failure Clinic Pilot presentation slides : Noted 132.53 Matters Arising – Schedule of Tasks 132.53.1 N Saville-Wood tabled a paper “Single patient who was part of pilot” as a result of a task from

the previous meeting. He briefed the committee on its contents “savings for one patient”. 132.53.2 That DNA data over a two-year period be collected on how patients are reminded to attend

appointments and an update be provided to the HAC meeting in two months’ time (engagement and leadership around changing of systems).

132.60 INFORMATION AND CORRESPONDENCE 132.61 Legal sessions with Iris Reuvecamp 22nd July 2014 L Yule advised that this was a very successful session. 132.62 Community Representative Reports A Morgan

TRHOTA met last week and discussed Maori DNA in great depth. People in the community who had received letters did not understand them (in one sentence referral had been declined without explanation). The patient letters were different from that placed before HAC some time ago. S Wilkie advised of project involving communication managers across the country, led by Hawke’s Bay who considered all the templates and put together a new proposal. D Oliff to investigate and report on the situation.

D Shaw advised that he would be raising an issue at the next Midland Chairs/CEs meeting on 1st August

2014 requesting that Waikato/BoP/Lakes share the public section of the advisory committee minutes. This would be beneficial to the respective committees and give visibility of its activities.

132.70 PUBLIC EXCLUDED Resolution: THAT the meeting move into Public Excluded at 12noon.

11


M Burdon : I McLean CARRIED

…………………………………………………………………………………………….. 25th August 2014

M C Burdon QSM - Chair

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SCHEDULE OF TASKS: Hospital Advisory Committee meeting 28th July 2014

Agenda Item Action Responsibility of Timeframe

Presentations:

Pain Service THAT a presentation be given to HAC at some future date.

D Oliff 2014

Tasks

Patient letters THAT the situation be investigated and a report given to HAC. A project involving communication managers across the country, led by Hawke’s Bay, considered all the templates and had put together a new proposal.

D Oliff

D Oliff to investigate and report on the situation.

As appropriate

DNA data THAT DNA data over a two-year period be collected on how patients are reminded to attend appointments and an update provided to the HAC meeting in two months’ time (engagement and leadership around changing of systems).

D Oliff

29th September 2014

Maori DNA THAT the Board indicate to management that although high DNA rates for Maori is an issue with the rest of the country, because of the large Maori population in Lakes, a significant reduction of disparity of DNA rates between Maori and non-Maori is of importance to the organisation.

D Shaw

As appropriate

ASAP

13

WAIKATO DISTRICT HEALTH BOARD Minutes of the Health Waikato Advisory Committee Meeting

held on Wednesday 13 August 2014 commencing at 9.30 am

Present: Ms S Christie (Chair) Ms C Beavis Mr A Buckley Ms R Klos Dr P Malpass Ms S Mariu Mr K Price Ms G Shirley Dr C Wade Mr N Wikaira Mr E Wilson Ms M Burdon Mr D Stewart

In Attendance: Mrs J Adams (Chief Operating Officer) Ms M A Gill (Media & Communications) Dr N Murray (Chief Executive) Mrs C Atherfold (Clinical Nurse Director) Mr B Bark (Standards and Audit Facilitator) Mrs B Garbutt (Group Manager) Mrs M Ch’ng (Group Manager) Ms S Brodnax (Minutes Secretary)

IN THE ABSENCE OF DELEGATED AUTHORITY ALL ITEMS WERE FOR RECOMMENDATION TO THE BOARD

ITEM 1: APOLOGIES

Apologies were received from Mr B Simcock. ITEM 2: LATE ITEMS

There were no late items.

ITEM 3: INTERESTS

3.1 Changes to Register There were no changes to the Register

Health Waikato Advisory Committee minutes of 13 August 2014

14

3.2 Conflicts Related to Any Item on the Agenda No conflicts of interest relating to items on the agenda were foreshadowed.

ITEM 4: MINUTES OF PREVIOUS MEETING: 11 JUNE 2014

Resolved THAT The minutes of a meeting of the Health Waikato Advisory Committee held on 11 June 2014 be confirmed as a true and correct record.

ITEM 5: MATTERS ARISING FROM PREVIOUS MINUTES AND ACTION LIST

There were no matters arising.

ITEM 6: PRESENTATION ON CARE ESSENTIALS

A presentation was given on Care Essentials Audits, a process initiated by nursing and midwifery to gather information from inpatients on their experience, and issues they have noted, in order to improve the service we provide. The audit consists of a series of open-ended questions, asked of five patients, chosen randomly, in each inpatient area. There is plenty of room for free text in the audit. Future audits will increase to ten inpatients from each area audited, and will include Mental Health. The audit is undertaken by senior nurses and midwives from other wards/areas to that being audited. This is to prevent bias and promote peer review across services. Feedback is provided to the relevant charge nurse immediately; and plans are put in place to address any issues that have arisen. A summary of results is presented to the Board of Clinical Governance and disseminated across the organisation. A visit to Ward M2 (general surgery) was then undertaken and a sample audit done with several willing patients. Following this there was a feedback discussion which highlighted benefits and areas for clarification. The feedback included a number of comments that saw the process as a valuable commitment to improving the patient experience. Suggestions for improvements to this audit tool included:

• Auditing on weekends/evenings • Including medical and allied health staff in the audit • Ensure the auditor group includes a cross section of ethnicities

(in particular Maori) and age groups. • Ensure the audit is able to be reviewed longitudinally. • Considering capturing simple age/ethnicity data of those being

interviewed to enable capturing of themes.


15

• Encourage clinicians to wear name badges that are clear (this is underway).

• Include those who have complained in this, so we capture their concerns.

Also discussed briefly was the use of an acuity tool. A trial is in place at Waikato DHB using the CapPlan system, which also links to our rostering tool Onestaff. Three other DHBs also use the CapPlan/Onestaff product. A different tool (Trendcare) is being used by some DHBs.

ITEM 7: CHIEF OPERATING OFFICER’S REPORT The Chief Operating Officer noted the focus on meeting the elective services target of no patients waiting longer than five months – which was met for outpatients, and not met for eight inpatients. Staff have worked exceptionally hard to achieve this result, and the challenge is now to move to four months. There will be no financial penalty for Waikato DHB or the region. Meeting the four month target will be a stretch for some services, and we may need to outsource some procedures to achieve this. The report was received.

DATE OF NEXT MEETING Wednesday, 8 October 2014. Chairperson: __________________________________ Date: __________________________________ Meeting Closed: 11:55 am.


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CHIEF OPERATING OFFICER’S HIGHLIGHT REPORT

PROVIDER ARM September 2014 SUBMITTED TO: Chief Executive xx xxxx xx

Submitted by: Pete Chandler, Chief Operating Officer

RECOMMENDED RESOLUTION: That CEO receive the report.

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HIGHLIGHTS SUMMARY CHIEF OPERATING OFFICER Good News Risks & Mitigating Actions MEDICAL DIRECTOR Medical Staffing Unit Recruitment is completed for the year commencing Nov/Dec and orientation programmes are being planned SMOs: New SMOs started/starting are:

• Kirsten Ramsey Physician/Respiratory (22/9) • Laurie Wing AT Registrar 6/12 then moving to Physician/Endocrinologist (29/9) • Ian Gove Physician/Acute Geriatrician (6/10) • Jagteswar Sandhu – Paediatrician 13 or 20/10 (Visa dependent)

Whakatane:

• Brad Holcombe MO Emergency (1/9) • Dale Foster Physician (15/9)

CREDENTIALLING COMMITTEE SMO Credentialling Applications received and reviewed

Number of Applications Reviewed

Tga Open Term

Tga Fixed Term/Locums

Whk Open Term

Whk Fixed Term/Locums

August 14 5 1 2 Credentialling Committee Meeting held 26 August 2014 • Credentialling of individual ED Medical Officers for overnight admission to the acute care area in

the new Whakatane Hospital were approved. 2014 Ongoing Re-credentialling Programme for Senior Medical Officers

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ICU Credentialling Credentialling of ICU took place on Thursday 14th August 2014. Credentialling Report to be finalised. ENT Credentialling Planned for Friday 7 November 2014. DIRECTOR OF NURSING Good News NHS Site Visit for Care Capacity Demand Management (CCDM). The Executive Director of Nursing Salford Royal NHS foundation Trust and Chief Nurse East Lancashire NHS Hospitals Trust were in New Zealand (NZ) mid-September as part of a Florence Nightingale travel award to review nurse staffing and patient acuity work in Australia and NZ. They were hosted by the national Safe Staffing unit and spent a day at BOPDHB to look at CCDM in action and our use of TrendCare to inform decisions about nurse staffing. The feedback at the end of the day was positive. The Directors of Nursing both expressed the view that there was much in common with the issues we are trying to address and thought NZ and the UK should be working together more. They also noted NZ was addressing the Safe Staffing agenda from a patient care perspective which they did not find in Victoria (Australia) with their mandated ratios. While the NHS site visit was in progress Board members were also invited to attend the ops centre meeting to observe the use of the electronic information, such as Hospital Status at a Glance and Variance response tools, to help inform daily management of patient flow. Nurse Specialist Cancer Coordinator Role Evaluation Qualitative feedback received for the above BOPDHB roles is positive albeit the survey numbers are small for this first national survey coordinated by LITMUS. The following comments are quoted from the survey. “I felt like I had someone to talk to when problems arose and [Nurse] rang you back the same day to advise you, which you need in your stressful times.” “She sat in on the initial appointment with surgeon opposite so was able to 'interpret' what he had told me.” SURGICAL, ANAESTHETICS & RADIOLOGY SERVICES Good News General Surgery Improvement Project This project has commenced with Dorothy McKeown as the Project Manager. Risks and Mitigating Actions

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Whakatane Theatre staffing Whakatane Perioperative Department staff remains resistant to changing their rosters to the outcome of the Management of change process. The outcome being the introduction of a variety of shifts (8, 9 & 10 hours) that form the roster to ensure service requirements are met. Challenge has come via APEX and NZNO and as a result a further consultation process is in progress. High Acute Surgical Volumes The volume of surgical acutes continues to be greater than forecast during the first part of this month, impacting on electives and staffing resources. Winter Flu High numbers of admissions for winter flu continues to impacted on the throughput in ICU. High staff sick leave early this month Fire in Stanton Building Whakatane September 24 fire from second floor of Stanton building impacted on the laboratory’s ability to function for several days which resulted in one elective surgical case being deferred due to potential blood transfusion requirements. MEDICINE Good News Level 2 wards – Focus 2c this month The Hand Hygiene initiative using the FLO concept (Frontline Ownership) began in September this year across the level 2 floor. This initiative was supported by Lou Fowler nurse educator following attendance at a hand hygiene conference. 2c hand hygiene champions Anne Ward (RN) and Rachelle Smith (HCA) created original posters and prompts to wash hands and use Sterigel as per hand hygiene recommendations and sought feedback from the entire 2c team. The posters and prompts are original and address key areas. For example, to use Sterigel or wash hands before putting on gloves. Many of the posters and prompts have been put up by the hand hygiene champions themselves. The Acute Care of the Elderly (ACE) unit opened on 2C in June of this year. Too often, highly functioning older adults are admitted to hospital and are so weakened by their experience they become too frail to return to their independent lives. The ACE team understands the risk factors for hospitalised elders and pays special attention to ensure patients are moving as soon as possible to prevent functional (physical and cognitive) decline. A patient-centred team with expertise in gerontology includes consultant Geriatrician Dr Henstridge, Clinical Nurse Manager Viv Jimmieson, Clinical Nurse Specialist Rosie Winters, registered nurses, health care assistance, social worker, occupational therapist, physiotherapist and liaison with mental health services for the older person (MHSOP). The team meet and discuss all ACE patients daily. Discharge planning begins the day of admission. The ACE unit aims to provide safe quality care of hospitalised elders with a hybrid practice that integrates acute care specialty knowledge with gerontological knowledge and skill through a multidisciplinary patient centred team. This model of care has been introduced with zero cost increase. Medication reconciliation pilot scheme for 2c commences on September 22nd prioritising patients who are likely to obtain maximum benefit patients >65 years. Two volunteers started in 2c in August this year assisting with general administrative tasks, engaging with patients and keeping them up to date with current affairs, assisting with transferring patients to the transit lounge, walking with patients, assisting patients with making telephone calls and providing a listening ear. 2C CNM carrying the patient flow phone and pulling all patients for the home ward 2C from APU.

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The homeward provides an opportunity to improve standards and management of specialised care. Using the FLO concept and with the support of Dr Poole and respiratory CNS Zoe Briggs. Two RN’s, Rebecca Connolly and Gina Mamutuk, created a resource (prompt sheet) for the management of underwater seal drains (UWSD) (still a work in progress). Coloured robust denture and hearing aid containers introduced by Sandra Fielding to the level 2 floor in August to reduce the numbers of these items lost. Clinical Physiology Ewan Morris, Section Head of Respiratory, successfully completed the Midland Leadership in Practice course - certificate presentations were by the CEO last week. Small tests of change - electronic referral forms in progress - due to go “live” next week. Will be Emailed to desk top file in Clinical Physiology by referrer for immediate retrieval and actioned by staff for patient tests. CME sessions have always been a challenge for our Whakatane team to attend here in Tauranga. Cisco Jabber software has now been installed in Clinical Physiology giving a video link into the presentation room during CME sessions. Staff remain in the department and therefore still available for an acute service as required. (also used for team meetings) The service has a student studying for Respiratory Science degree. One of the pacing physiologists has been awarded a travelling scholarship to Nice and will be attending Electrophysiology and pacing conference with Dr Dean Boddington. Medical Day Stay Unit Medical day stay Unit : Report on current quality initiatives underway in Medical day stay unit - August/ September 2014

Data Quality exercise for the ministry of health

Improvement of quality of data held in colonoscopy wait times indicator data set

The endoscopy unit is currently recording and reporting on diagnostic colonoscopy throughput

This purpose is to ensure the wait time indicators are accurate

Audits On Bowel Prep Regime The introduction of a new bowel prep regime

• The audit is to identify if the tool is user friendly

• To interpret the results of the bowel prep under the new regime.

• Audit commenced in August and the number under audit review 150

Audit on post procedure peg placement The PEG resource nurses in medical Day stay unit have introduced a new

Nursing protocol : A care pathway for patients with peg placements with a regime on how the patients should be nursed post procedure

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An audit is currently be conducted by medical day stay resource nurses

• The Placement of tube

• The integrity of the skin around tube

• The patency of the tube

The completion of GRS census • Quality of patient experience

• Clinical quality

• Workforce

• training

The time in motion study Currently underway the capturing of data

To assess efficiency of service and utilisation of

• Appropriateness of staffing and skill mix

• Efficiency of time management

• The ancillary tasks not captured through electronic patient system on

• E.G. Doctor reporting

• Consenting

• Review of patient medical surgical history

• Number of acute procedures

• Unexpected incidents and events

• Difficult procedures and conversion of point/slot of procedure

• Delays in lists

• Point allocation to lists

• Type of procedures allocated to lists

• The number of hours allocated for grading

Re-launch of EUG meetings Appointment of members and new terms of reference

Introduction to nurse led consent process Setting of a training and development framework for nurses

Development of protocol in facilitation of nurse led consent process

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Oncology The Medical Oncology unit recently implemented a new nurse led/initiated follow up service for patients receiving oral chemotherapy in the community. These patients don’t have the same regular contact with their health professionals compared to the patients attending regularly for IV treatments. The service now runs two virtual clinics of every oncology patient taking oral chemotherapy in the community. The patients now receive a weekly nurse led telephone assessment, using a specifically designed assessment tool derived from the international gold standard (National Cancer Institute) Depending on grade of toxicity, the virtual clinic model has the flexibility to easily be escalated to a physical consultation- either with CNS or medical depending on situation- on the same day when mandated. Initially the service trialed this model on one individual drug. The feedback from patients and SMO’s has been fantastic, and the service are now seeing levels of toxicity reduce to minimal levels. Toxicities are caught earlier and this helps to keep them to below dose limiting levels. This means patients can stay on treatment, and minimise the effect on quality of life etc. As a result of how well its working, the service have now rolled the new model out across every oral drug used. Respiratory Chest Drain teaching was given to nurses on Ward 2C by Zoe Briggs (Team Leader & CNS Resp) & Dr Suzanne Poole. A laminated chest drain management prompt sheet to go in the patient notes and a resource folder is being designed by 2 of the ward nurses assisted by Zoe. A Respiratory Education in service programme will be commenced shortly for the nurses on Ward 2C by the Respiratory Nursing Team. An update was give to the SMO’s at WHK regarding prescribing oxygen & follow up required to ensure appropriate pts are prescribed oxygen. The Community Oxygen protocol has been updated and a new script has been designed, it is in the final stages of consultation. New Resp Lab software- Different report style but same data, Preliminary reports (data only) will be published on Éclair for speedy access; these will then be followed by a full report. WHK spirometry will also be on Éclair. HIA Fracture Liaison: Background - Bay of Plenty District Health Board provides acute care to approximately 163 people a year over the age of 65 years who experience a hip fracture. • Approximately 50% of fractured hips are preceded by a prior fracture, indicative of the person

experiencing the fracture as being at high risk. • Osteoporosis management has the potential to reduce the progression to hip fracture

significantly, provided it is introduced at first presentation with a fragility fracture. • Preventative treatment has the potential to reduce costs and markedly improve the quality of

life and maintenance of independence in this population. Proposal - Bay of Plenty District Health Board establish a Fracture Liaison Service to reduce the risk and incidence of hip and other fragility fractures in patients who present with first incidence of fragility fracture. Approval to advance the proposed have been granted. Cardiac Rehabilitation Programme Patients and relatives feedback on the service has been very positive : “the programme gets you motivated”, “now I can understand ‘it all’ “, “excellent programme, needs more promotion” are recent comments on the patient evaluations. Those attending the programme showed more understanding of their risk factors, emergency actions and were exercising regularly, whilst those that did not attend were more likely to be experiencing increased stress and continuing to smoke. Renal

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Training - Post grad study: This semester, the CNM is doing post grad (last paper for PGDIP and a further staff member will be doing a stand-alone renal paper with Auckland. Regional training to standardise practice in the Midland satellite units: Staff have attended a vascular access workshop held in Waikato, also renal advanced study day coming up in September, staff rotating to attend. Also four members of staff have been sent to Waikato regional centre for updating of skills as per regional meeting. Patient numbers - Remain stable for PD. Both Tauranga and Whakatane HD units full. There is a waiting list for Tauranga- 2 pts waiting in Waikato and four expected transfers from other areas. Three patients currently waiting to access the Whakatane unit. We also have at least two patients having temporary HD at Rotorua. Video conference- Jabber accounts set up both in TGA unit and Whakatane Unit. Daily teleconference with Whakatane and the CNM, providing clinical leadership, follow ups and guidance to RNs on duty is in place. Teleconference used for review the Whakatane bloods on a monthly basis is working very well. Shorter Waits in Emergency Departments The August 2014 result of 91% is improved from the previous month’s performance. This result is within the context of a record 5,386 attendances for August, and was 13% higher than August 2013. Attendances exceeded 5,000 for the second consecutive month. Whakatane ED continues to deliver above target (98%), with Tauranga performance at 88% the most impacted by the growth in volumes. There has been an expansion of both junior and senior medical ED staff with increased permanent House Officers from 2 to 3 at night and two new SMO have started firming up greater flexibility in the week The hospital at night project initiatives are now well established in particular the night hand over meeting which is being grounding into daily tasks of the junior medical staff. General Medicine is looking at a number of shortest of change initiatives around the process of patients flowing through APU. Surges in patient numbers and high acuity have been contributing factors with weekend demand also influencing the result. In response, a third Medical Registrar is now rostered on to the weekends to assist in managing demand. The monitoring and measurement of demand continues to improve, with ‘breach’ reporting in place to identify individual ‘breaches’ with the cause and effect for daily analysis. The model of medicine introduced in mid-July continues to be developed to increase the focus on the front door.

September’s early results are looking promising for continued improvement as per the graphs below

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WOMAN CHILD & FAMILY Good News Paediatrics Both sites have been focussed on acute demand with high ward occupancy and managing some very sick children. Mix in Match The Mix in Match resources were developed to provide DHB’s with a robust evidenced based method to assess what work is required in a service, the optimum skill mix associated with this work, the number of staff required and the optimal schedule to match variance in patient demand. Tauranga paediatricians have collected data for a summer and winter period and the draft report is complete. Once final editing the findings will be discussed with Woman, Child & Family cluster and Director of Nursing. Bethlehem Birthing Centre (BBC) WCF and Planning & Funding have worked together to develop the service specifications for the unit. The transfer protocols have been drafted. The centre expects to be operational mid November 2014. Children Teams Key staff attended the follow-up workshop for the stakeholders in the Eastern Bay for the Children’s Team. Maternity The Maternity Quality & Safety Programme 2013/14 Annual Report has been accepted by the Ministry of Health. REGIONAL MAORI HEALTH Good News

• Clinical Nurse Manager attended APAC Forum in Melbourne – Asia Pacific Premier Healthcare Forum - The most common theme ‘Patient Centred Care’, Stories of the Patient and families, safety, the use of the consumers in the design of health services. ‘put more joy in your day’. All Indigenous peoples face the same or similar challenges. There was a sense of how well we are moving in terms of quality improvement in this the Bay of Plenty District Healthy Board

• Tobacco Health Target - Audit 100% Questions? (A) do you smoke? (B) Advice to quit, (C) Cessation support.

• Regional Māori Health Kaupapa ward hosted a well know Kaumatua of the Ratana faith. The Kaumatua is acutely unwell and being a long time member of the faith it was arranged that the local Ratana brass band and members hold a service for the Kaumatua. There was also a visit by Ratana Brass Band members from Wanganui who were returning home from the Turangawaewae marae Kingitanga celebrations. A short church service or whakamoemiti and hymns from his Faith

• Maori in The 21st Century Seminar facilitated by Mason Durie in Rotorua. The seminar involved korero on the Foundations/Origins of Māori from the beginning of time. Discussion on Māori in 2013 which include and in depth look at his Health Model of Whare Tapa. There was also explanations of Māori realities of Mauri Ora, Ahi Kaa, Wairua also the impact of the

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economy and employment on Health and wellbeing of Māori particularly Maori therapies and medical models walking along side each other.

• Maori Health Welcomed two Māori Chaplins to Whakatāne. The first being on September 3, Ponty Hauwhao of Tuhoe decent and most recently on Monday 22 September, Maureen Martin of Ngati Kahungungu. This is a milestone for Whakatāne and indeed the Bay of Plenty District Health Board.

Risks and Mitigating Actions

• We are short on the ground of a number of Social Workers. Working as social work as a whole. There is a triage system in place to better manage referrals and workloads. This has involved staff Team Leaders and Health and Safety

• Recruitment for 2 FTE in Allied health and RMHS underway to quickly fill vacancies.

REGIONAL COMMUNITY SERVICES Good News Allied Health (AH) Allied Health go live on VRM from Tuesday 23 September 2014. This includes Dietitians, Occupational Therapy Physiotherapy, Social Work Speech & Language and the Allied Health Community team. The next step is to see AH on the Dashboard. Speech Language Therapy (SLT) is involved in the promotion of International Communication Project through stand, table barkers, flash mob and interviews with children and Laryngectomees and aphasic groups. This completes SLT commitment to this International Project and our own National Awareness Week. SLT team have found this fun, energising, informative and has raised the profile of SLT. We have done this collaboratively with Audiology in the Main Street so again representing engagement with Allied Health. SLT have had 14 high calibre applicants for the vacancy that became effective on 21 September. New Born Hearing Screening MOH has advised that all recommendations for the UNHSEIP Audit have been addressed and the process is now closed. District Nursing Request to Recruits approved for:

• Whakatane 10.30am to 6.30pm shift and is currently being advertised • Tauranga - 2.0 FTE 0.8 will be a new Graduate position and

1.2 FTE RN DN Staff have worked really hard to cover sickness and maintain response to workload during the last month. Videoconferencing is up and running at 399 Cameron Rd can be booked under the Jacaranda Meeting room. Community Child & Youth Health Services (CCYHS) Martin Steinman commenced his role as Manager CCYHS replacing Pam Day who lead the team for the last 14 years. The last three weeks has been focused on orientating to the service and DHB.

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Support Net A new organisation has been contracted to provide Local Area Coordination services to the Support Net area. Imagine Better is the organisation and they are experienced and well known in the disability sector. They have a strong community development background and credibility in working with disabled people and their families. Western BOP Home and Community Support Service providers meeting held. This was a very positive meeting. Networking meeting with Alzheimers Society Tauranga & Support Net team held. Meeting with Alzheimers Society EBOP & Mental Health Service for older People to discuss Uncomplicated Dementia Pathway and current implementation. Team Leader attended launch of Western BOP PHO Nursing service with follow up meeting to discuss collaboration with Support Net for mutual clients and the potential use of interRAI assessment tool. Support Net Lead Clinician for InterRAI, provided training and support for Cavill Group (5 facilities) of ARC providers Toi Te Ora Public Health Services Te Aitanga a Hauiti Hauora Trust (Hauiti Hauora) has been successful in its application to lead the Healthy Families NZ programme for the East Coast. The East Coast covers Tairawhiti DHB and the Opotiki District. Toi Te Ora is part of the collective which will support the development of the programme, which will be known as Horouta Whanaunga East Cape.

Public health communications development this month has included:

- The development of an on-line discussion forum for staff via our intranet. The forum will improve the dissemination of information and enable more issue-specific discussions between teams and across offices

A focus of communications work this month has been Cervical Screening Awareness Month with media activity including a media release and a number of media interviews. National workforce development teleconferences have been re-established between a number of public health units including Toi Te Ora, Auckland Regional Public Health Service, Whanganui, Canterbury, Northland and Hawkes Bay. The purpose of the teleconferences is to link workforce development coordinators in public health units around New Zealand to provide support, share resources and approaches to improving workforce development.

Two Toi Te Ora staff completed the Midlands Leadership Course this month. The Ministry of Health has introduced new report functionality into the National Immunisation Register system across the country for identifying children who are “not fully immunised”; this new report is based on an earlier Toi Te Ora project. It is good to see Toi Te Ora’s work being adopted and used nationally.

Dr Jim Miller, Medical Officer of Health, has begun his two-month secondment to the Ministry of Health as Acting Deputy-Director of Public Health. A quality improvement project has been implemented to provide more robust systems for the ordering, reporting and timely follow up of laboratory tests for cases and contacts. This has included the development of a protocol for requesting laboratory tests, a process for ensuring timely follow up of test results and access to the laboratory reporting system for all Toi Te Ora staff involved in case and contact management.

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Toi Te Ora was invited by the Health Promotion Agency to present the WorkWell programme at their recent Occupational Health and Safety Industry Group conference in order to bring a greater focus on wellbeing to the conference. This was the first of these conferences attended by our staff who found it very beneficial with the wellbeing content around 50% of the programme. As always feedback on the programme was very positive with Toi Te Ora continuing to be seen as leaders in this space.

The Building Blocks for Under 5s evaluation report has been finalised. The project lead met with the Health Promotion Agency’s Education Setting Advisor and gave her an overview of the pilot. She was very impressed with its comprehensive approach and has since invited the project lead to present and the upcoming national Health Promoting Schools forum. As part of Toi Te Ora’s orientation programme a Mihi Whakatau with Regional Maori Health Services was held. Six new staff attended and feedback is always really positive. This is an important process as it signals the importance of Toi Te Ora’s engagement with Regional Maori Health Services and highlights for new staff the value of appropriate engagement with our Maori communities and the cultural considerations of our work. Risks and Mitigating Actions District Nursing District nursing service is seeing a number of patients who can’t afford to go to the GP’s. Support Net A number of MOH contracted residential providers are having difficulty maintaining support for a small number of complex, difficult and high risk clients. Support Net attempts to reduce the risk by involving behaviour support, MOH contract relationship managers, and other services as appropriate. However, there are a significant number of these ‘high risk’ clients currently posing placement and support challenges. There has been a high level of sick leave taken in the last month with people suffering from colds and flu. Staff are not encouraged to be at work if they are unwell, and one staff member, despite her protests, was recently sent home. Continued monitoring of work associated with palliative clients Toi Te Ora Public Health Services Toi Te Ora has identified that local border stakeholders may not have the same level of awareness of Ebola and other disease risks. A health protection officer is working with Customs and the Ministry of Primary Industries to ensure they are aware of disease risks to New Zealand. MENTAL HEALTH & ADDICTION SERVICES Good News General The VRM system had been adjusted to accommodate the specifics of Mental Health and that is now fully operational. Inter-rater reliability training is underway in October.

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Mental Health awareness week 6-12 October 2014, a range of initiatives are planned across the district including diplays at Bay fair, Tauranga Hospital and joint initiatives with Iwi providers. Nursing New Graduate postion have been increased for next yer from 5 to 7 FTE successful candiates will commence in January 2015. Inpatient Services The Inpatient Clinical Coordinator attended the Midland Region Inpatient Group this is a new group that has been developed to build regional capacity and shared initiatives around service delivery. A Practice Development Day is being planned for the 7th of November with a focus on Health Care-Self Care. Community Mental Health Portable technology is being trialled by the NASC team (touch screen notebooks). Testing the scribing of Needs Assessment / Shared Support Plan documents using the touch screen directly to determine if this is effective and usable and to reduce administration time, and allow for collaborative note writing. Hepatitis C – Three sessions have been organised for the Hep C foundation to train Alcohol and Addictions staff in rapid finger prick screening for Hepatitis C this will assist in early identification and treatment for those at risk. The service would like to welcome Dr Rupert Bird, locum Consultant Psychiatrist to the team. Rupert arrived this month and will be with us until the end of December. Dr Bird is an experienced Psychiatrist and did much of his training at Tauranga Hospital some years ago and is pleased to have the opportunity to return to the Bay of Plenty. Denise Signal has been appointed as the new Team Leader for the Community Mental Health team in Whakatane, Denise has been with the Whakatane CMH team for 9 years. Risks and Mitigating Actions 4 coroners notifications were received during September One for a client being seen in the Whakatane Community mental health team suspected of suicide. The three other notifications were for individuals or clients with either no contact with service or no contact in the past 2 years. A serious incident occurred involving a client causing damage to property, police were called to assist and resolve the incident, significant damage was sustained in the IPC area of Te Whare Maiangiangi, this incident will be reviewed via the standard review process. 2 serious incidents have occurred involving patients self harming during September. The first a young women who ingested glass and needed medical treatment, a family meeting was held to discuss the clients current presentation. The second a patient who whilst on leave set himself on fire suffering burns to 48% of his body he is in a serious condition requiring burns treatment in Auckland. There was significant media coverage of this event. Terms of Reference are being developed for a review of this case. An investigation is currently underway due to family matters in the personal life of a RN Case manager and CYFS. The RN had been suspended while investigation is in progress. A final written warning and a performance management plan for a period of 3 weeks was the result of an investigation into an event where a RN used force to give an injection to an elderly person. A Nursing Competency assessment in which the RN failed 8 of the competencies has been completed

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and a plan to address these deficits has been developed and a reassessment will occur in 2 weeks. The Health and Safety service are involved as the person is currently on sick leave and receiving support. SERVICE IMPROVEMENT UNIT Good News CIRCA & OTHER PROJECTS UPDATE: CIRCA

Master summary outlining the reviewed programme standards and evaluation criteria has been migrated to DocMan for speciality progress to be updated. Where possible, the Service Improvement Unit are updating the progress from existing reports/sources.

Risks and mitigating actions To report against the evaluation standards in the master summary requires the manual extraction of data or information from multiple sources including existing reports and relies on the ability to access this information. This may result in further delays in order to demonstrate, where possible, true representation of status. The Service Improvement Unit will highlight any issues in reporting as they occur with the CIRCA Steering Group.

CIRCA 1

Criteria 1B: Confirmation of Diagnostic Results and Electronic Recording of Activities

Community Pharmacy Dispensing to Éclair CDR. Significant work by IT has occurred in developing the interface between the Community Pharmacy data systems TONIQ and LOTS, and Éclair. The first PDSA cycle occurred on the 18th September with a small run of patient data into the test environment to check the integrity of the message exchange. The next step is to repeat this with the same pharmacy and then to test with a second pharmacy. Clinician rollout will not occur until IT and the Project Group are confident the message is timely and reliable.

E-ordering for laboratories (Éclair CDR). This project is having background work undertaken but is not as advanced as the Pharmacy project.

CIRCA 5

IHI Open School

The Service Improvement Unit are continuing to promote the IHI Open School course and are reviewing progress to provide follow-up and support to staff where required. Over 200 staff have applied to access the course, and of those 140 have accessed the course. The current license allows up to 250 staff to access the course through to the end of June 2015.

Developing a pilot residency Quality Improvement programme for 2nd year House Officers

A project team has been formed to develop a pilot residency programme for second year House Officers at Tauranga Hospital and (tbc) Whakatane Hospital, to enhance their understanding, gain practical experience and participate in quality improvement across the next two runs commencing in November 2014 and February 2015. Applications for expressions of interest will close in mid-October with confirmation of appointment placement by late October. The first pilot will commence on 1st December for a 3 month period.

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MICROSTER FOR DOCTORS

Progress is steady on this project.

Co-ordination of rollout with the Digital team’s new Intranet project is occuring as one of the features is the Microster Self Service tab, which allows for staff to electronically see own roster and request leave. This is being piloted in September in Whakatane ED with feedback and evaluation to occur at the end of the trial.

A request for changing the time frame for Tauranga ED doctors was made to Service leadership with agreement made to begin roster development with this team ahead of the scheduled rollout

The ability to incorporate complex operational on call rosters into Microster continues to be investigated. The Microster team will attend the User group meeting in Wellington in November Jane Simeon from the RMO office will also attend, to meet with the CDHB staff who are using Microster for RMO’s. This will enhance understanding of the operationalising of a complex roster onto the system.

PROJECT WAKA- Whakatane Hospital site redevelopment

A number of the work streams from the rebuild project have moved into the three month review phase with meetings scheduled for Clerical Unit Administrators and Models of Care Hot floor users to review practice in the new environment.

Visits continue from other DHB’s looking at our layout and colocation of services and rationale for Models of Care.

After Hours Hospital Project at Tauranga Hospital The video shoot has taken place as part of the production of a promotional video for the after hours handover meeting and application of SBARR. The project team has a presentation slot at Grand Round, Tauranga Hospital on 28th October to premiere the video and present a summary of the project objectives and outcomes achieved. The project team are finalising an evaluation report for the Clinical Support Nurse role introduced as part of a trial over winter 2014. The project team will be recommending a permanent appointment of a Clinical Support Nurse role to continue to provide additional senior nursing resource after hours. Risks and mitigating actions The completion of the Clinical Support Nurse trial is due at the end of September and the project team are concerned that there may be an expectation from staff working after hours that this role is permanent and therefore a reduction in workforce. There will need to be a clear communication from the Nursing leadership team and the project team to the wider team working after hours, to confirm the conditions of the trial and the next steps. BAY NAVIGATOR Pathways Opioid Substitution Treatment Driven by a legislative change individual GPs are being contacted on a case by case basis and being introduced to OST prescribing by a BOPAS employed GP Liaison nurse practitioner. The majority of GPs to date have been willing to take on the prescribing of OST under the new ‘shared care’ arrangements. This is very encouraging.

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Risks and mitigating factors It is important that GPs feel supported in this role that will be new to many. The secondary services are offering this support and will be only a telephone call away to assist with any queries. Attention Deficit Hyperactivity Disorder – renamed Child Behaviour, Inattention and Development pathway The Child Development Service has agreed to be part of discussions to determine how paediatrics, CAMHS and Child Development can work together. Barry Davies (from the Child Development Service) will be attending the next pathway group meeting. This is hopefully the first step toward a more integrated service. Risks and mitigating factors There is a Board that oversee the running of the Child Development Service and any integration will require their approval. As their funding stream is directly from the Ministry any integration will need to take this into account. Fragility Fractures Modifications to the pathway are being made and it is progressing. Risks and mitigating factors The Fracture Liaison Service position is currently being advertised, so it seems likely that this will not hold up the publication of the pathway. Cellulitis The pathway is almost complete. The next step is to ensure that the CPO guidelines reflect the Bay Navigator pathway. Risks and mitigating factors There are some quite significant changes to the recommended drugs/dosing/administration method from the current CPO guidelines. We will need to work closely with the PHO to embed and educate on these new recommendations. Woundcare This pathway in the consultation phase and will be presented to the Governance Group at the October meeting. Risks and mitigating factors Wound care is essentially the domain of the practice nurse so we need to ensure the presentations reflect this. Rheumatic Fever This is progressing well. Information is at hand to try to address some of the ‘social’ issues and P+F have some other initiatives in the pipeline which will be added as they become available. Risks and mitigating factors Jim Millar our clinical lead has been seconded to a Ministry project so will only be intermittently available. Lindsay Lowe the Public Health nurse is taking the lead in his absence. Lindsay has been a driving force so I do not foresee that this will affect progress. Menorrhagia An updated pathway has been presented to the group with a supporting eReferral document. Feedback from group participants is now awaited. Risks and mitigating factors All parties need to agree to the proposed pathway. $ needs to be found to create an eReferral (it does seem that this should be easily found however) and the creation of the eReferral needs to occur within an acceptable timeframe.

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Website The digital team have advised that they have the ability to build the website by early November, allowing it to go live before Christmas and allowing education visits to be made from February 2015. The issues that we were having with the new pathway tool have been addressed. We are waiting for the updated version to be transferred to the most up to date pathways, so that we can complete a functional check on them all, before asking the clinical leads to update any clinical information that they contain. Risks and mitigating factors The digital team are key to progress on this project and many other aspects of Bay Navigator work. In order to engender a feeling of being part of the team, they now attend our weekly Bay Navigator meetings to report on progress. Map of Medicine The MoM/Bay Navigator interface was discussed at the September Governance Group. The Bay of Plenty utilisation figures for the MoM are currently very low. To date primary and secondary care physicians have been advised of its availability via emailed documentation and user-guides, along with individual passwords for access. The pathway work emphasis has remained with Bay Navigator and, while we continue to attend the monthly Regional Map of Medicine meetings, these meeting are not directing the work we do in the BOP. Once we have the new pathway tool implemented and the pathways reviewed the plan is to start transferring our pathways onto the Map of Medicine Midland view, so that they can be shared with other regions. This process will identify 1) whether the format of the Bay Navigator pathways is easily transferable to the MoM framework, 2) whether the pathways are easier to view in the MoM framework 3) the ease of use (or otherwise) of the MoM pathway building tool. The answers to these questions will in turn provide information which will help to direct the future vision of the Bay Navigator/ Map of Medicine interface. Risks and mitigating factors It is important to have all the information to hand to direct this future vision. General Practice Liaison Good News stories

• Successful presentation on Future Care Planning to Age Concern • BOPDHB developed service specific referral forms being used by other Midland DHBs • Integrated Healthcare Strategy grand round presentation at Whakatane Hospital

Projects

• Whakatane GP after-hours service continues. Three month evaluation due in October • Future care planning – BOP form is now with Design and Print working up a first draft due 20th

October. Agreement on where we will upload completed documents in the patient electronic record.

• EReferral forms – amendments requested to District Nursing, sleep apnoea and major joint replacement forms. Development of a community requested radiology referral form is being initiated.

• Acute Demand – Frequent attender project is being initiated building on work commenced in ED to develop management plans for patients. The intent is to develop integrated management plans that consider the entire patient journey and are developed in collaboration with patients.

• An integrated model of care for palliative care services in EBOP. There have been initial stakeholder meetings with Hospice, Whakatane Hospital clinicians, and palliative care specialists. Aiming for a single work shop in October.

Risks

• Continuing problems with discharge summary delivery to general practice. Issues are multifactorial and we are still uncertain as to the extent of the problem.

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• CHiP for GPs integration into Medtech (the most commonly used GP patient management system) has been achieved technically but there are delays in roll out. It is not entirely clear what these are but the delays do relate at least in part to other work being prioritised.

• Development of a sustainable after-hours service for Opotiki has stalled. EBPHA is leading. • Increasing feedback from general practice regarding the appropriateness of transfer of care

from specialists back to general practitioners, and in particular the expectation that GPs will follow up investigations ordered by specialists. This is a national debate without an clear solution but it is undermining relationships.

HOSPITAL SUPPORT SERVICES Good News Still on track for 100% coding and 24hr turnaround in the referral centre. The use of contract coders have ceased. Medical typing 2 day turn around and decreasing contract typist use. The improved performance has occurred after actually getting applicants apply for vacant positions – for 3 years we have not had applicants with the medical typing skills and coding qualifications required. For some reason this round we had applicants. It has made a significant difference to output. Volunteers 2 new positions - a meet and greet at the main reception tauranga hospital – this person will help manage drop off parking, assist with wheelchairs, use the cart to transport elderly to their cars and give people directions to places in the hospital. - a way finder for clinical physiology assisting these patients at their appointments and helping them find treatment rooms

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COO Report – mmm yyyyy Page 1 of 8

CHIEF OPERATING OFFICER’S REPORT PROVIDER ARM September 2014

SUBMITTED TO: Bay of Plenty Hospital Advisory Committee xx xxxx xx

Submitted by: Pete Chandler, Chief Operating Officer

RECOMMENDED RESOLUTION: That the Committee receive the report.

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HIGHLIGHTS SUMMARY CHIEF OPERATING OFFICER CWDs • Elective CWD are 82 below the phased plan for September 2014 and 100 below YTD.

• Acute CWDs were 39 over plan in September. (estimate due to un-coded cases) and 37 over plan YTD.

• Comparisons with YTD September 2013 show the total combined CWD is up by only 33 CWD.

Discharges • Surgical discharges are 85 above plan for the month and ahead by 267 YTD. • For the month there were 10 more inpatient discharges when compared with September 2013

and YTD compared to 2013-14 there have been 424 or 3.65% more discharges. ED attendances • September saw a reduced growth in ED attendances from what we have recently experienced.

The 2.5% growth experienced at Tauranga was much more manageable than the 8%+ growth often recorded over the past 12 – 15 months. This reduced growth rate combined with additional staffing resulted in a performance improvement of 4% in the 6 hour target for Tauranga ED compared to September 2013.

• The daily performance graph on the left below shows variation has reduced which is another good sign of improvement. This improvement is quite remarkable with the intended consequences being improved patient safety and better patient outcomes.

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The graph below shows year on year weekly ED attendances for 6 Hour target qualifying attendances. The graph illustrates just how consistent and sustained the growth in numbers has been over the last 15 months.

The Whakatane ED attendance numbers in the table below have had the weekend GP numbers seen in ED removed. The impact has been fewer patients seen by ED staff, particularly on Sundays.

TGA Whk TotalSeptember 2013-14 3,946 1,531 5,477 September 2012-13 3,851 1,622 5,473

Growth 2.5% -5.6% 0.1%

12 Months to September 48,077 19,876 67,953 12 Months Prior Year to September 44,610 19,550 64,160

Growth 7.8% 1.7% 5.9%

YTD Current Fin Year September 12,753 5,032 17,785 YTD Prior Fin Year September 11,862 5,114 16,976

Growth 7.5% -1.6% 4.8%

Year On Year Compariitive Change Month 95 91- 4

12 Months 3,467 326 3,793 YTD 891 82- 809

ED Attendances (Including DNWait)

5001,0001,5002,0002,5003,0003,5004,0004,5005,000

July

Dece

mbe

rM

ayOc

tobe

rM

arch

Augu

stJa

nuar

yJu

neNo

vem

ber

April

Sept

embe

rFe

brua

ryJu

lyDe

cem

ber

May

Octo

ber

Mar

chAu

gust

Janu

ary

June

Nove

mbe

rAp

rilSe

ptem

ber

Febr

uary

July

Dece

mbe

rM

ay

Q1_20 04Q2_20 04Q3_20 04Q4_20 04Q1_20 05Q2_20 05Q3_20 05Q4_20 05Q1_20 06Q2_20 06Q3_20 06Q4_20 06Q1_20 07Q2_20 07Q3_20 07Q4_20 07Q1_20 08Q2_20 08Q3_20 08Q4_20 08Q1_20 09Q2_20 09Q3_20 09Q4_20 09Q1_20 10Q2_20 10Q3_20 10Q4_20 10Q1_20 11Q2_20 11Q3_20 11Q4_20 11Q1_20 12Q2_20 12Q3_20 12Q4_20 12Q1_20 13Q2_20 13Q3_20 13Q4_20 13Q1_20 14Q2_20 14Q3_20 14Q4_20 14Q1_20 15

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

ED Attendances (excl Whk GP & Including DNW)

TGA

WHK

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Other activity • During September hospital occupancy was 98.26% at Tauranga and 75.78% at Whakatane

• Outpatients are 4.6% or 88 First Specialist Assessments (FSA) ahead of contract for the month and 377 or 6.8% ahead YTD.

• Follow-up visits are 0.8% or 39 above contract for the month and 613 or 4.5% ahead YTD.

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

historical lows and the electives are just above their reported lowest levels.

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

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63.00

QUALITY, SAFETY & EXPERIENCE OF CARE

PATIENT & QUALITY Sep-13 Sep-14 Target Var Actual Target Var ORGANISATIONAL HEALTH & MONTIORING Sep-13 Sep-14 Target Var Actual Target Var

Outpatient DNA Rate 6.6% 6.6% 5.0% (1.6%) 6.3% 5.0% (1.3%) Staff Turnover % (FTE Basis) 0.5% 0.4% 1.5% 1.1% 0.6% 1.5% 0.9%

Outpatient DNA Rate MAORI 15.8% 14.6% 5.0% (9.6%) 14.3% 5.0% (9.3%) Sick Leave % 3.8% 3.7% 3.1% (0.6%) 3.9% 3.1% (0.8%)

Waiting > five months for FSA (ESPI 2) 0.0% 0.0% 0.0% (0.0%) % of staff with Annual Leave > 2yrs 6.5% 6.4% 0.0% (6.4%) 6.3% 0.0% (6.3%)

Waiting > five months for IP Treatment (ESPI 5) 0.0% 0.3% 0.0% (0.3%) Workplace Injury Per 1,000,000 hrs 2.7 7.8 5 -2.76 5.0 5 0.04

Acute Readmission Rate 11.7% 12.6% 10.0% (2.6%) 11.8% 10.0% (1.8%) Mantatory Training Completed < 3 Months 68.4% 67.7% 100.0% (32.3%) 77.8% 100.0% (22.2%)

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% #DIV/0! 85.0% #DIV/0! 45.2% 85.0% (39.8%)

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

0.0% #DIV/0! 0.0% #DIV/0! 71.7% 0.0% 71.7%

PROCESS & EFFICIENCY Sep-13 Sep-14 Target Var Actual Target Var FINANCIAL & CONTRACT PERFORMANCE Sep-13 Sep-14 Target Var Actual Target Var

ALOS - Elective Surgical CWD 3.41 3.29 3.17 (0.12) 3.29 3.17 (0.12) Total Caseweight (includes un-coded) 3,292 3,260 3,303 (1.3%) 9,980 10,043 (0.6%)

ALOS - Acute CWD (excl Mat & Neonatal) 4.30 4.00 3.91 (0.09) 3.90 3.91 0.011 Elective Caseweight (includes un-coded) 816 846 928 (8.9%) 2,592 2,692 (3.7%)

Discharge by 11.00am 17.8% 20.2% 30.0% (9.8%) 19.6% 30.0% (10.4%) Acute Caseweight (includes un-coded) 2,477 2,414 2,375 1.7% 7,388 7,352 0.5%

Nurse Hours per patient day 5.30 5.28 5.45 3.1% 5.22 5.40 3.3% Outpatient FSA Volumes 1,735 2,005 1,917 4.6% 5,934 5,557 6.8%

Ward Bed Utilisation 91.8% 93.5% 90.0% (3.5%) 95.5% 90.0% (5.5%) Outpatient FU Volumes 4,277 4,703 4,664 0.8% 14,135 13,522 4.5%

LOS Outlier (long) 4.27% 3.96% 1.5% (2.5%) 3.87% 1.5% (2.4%) FTEs 2,272 2,214 (58)

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

U/D 0.0% 0.0% Operating Costs ($000) 9,532 10,493 9,958 (535) 31,713 29,994 (1,719)

Mental Health Patients referred for non-urgent AOD seen <3 weeks (0-19yrs) U/D 0.0% 0.0% Personnel Costs ($000) 15,615 16,757 16,181 (576) 50,487 49,488 (999)

Smokers >15yrs receive B&C during inpatient episode

94.2% 84.3% 95% (10.7%) 87.4% 95% (7.6%) BOP Elective Surgical Discharges (excludes un-coded)

592 723 638 13.3% 2117 1850 14.4%

Theatre Session Utilisation [Main Theatres] 96.1% 91.3% 93.0% (1.7%) 92.8% 93.0% (0.2%) Financial Result Total $m (negative is contribution)

2.06-$ 2.31-$ 3.15-$ 6.13-$ 8.84-$

ED KPI 2 (2hr target TGA Only) 45.4% 50.7% 95.0% (44.3%) 52.0% 95.0% (43.0%)

ED 6 hr Target 91.2% 93.7% 95.0% (1.3%) 91.5% 95.0% (3.5%)

Colonoscopy Diagnostic - urgents seen < 14 days U/D

Colonoscopy Surveillance - urgents seen < 14 days U/D

Electronic Inpatient Discharge Summaries sent < 24 hours 52.0% 52.4% 95.0% (42.6%) 46.9% 95.0% (48.1%)

KEYN/A = Not availableU/D = Under DevelopmentNote: ESPI figures include ungraded. This will be reviewed and they maybe excluded in future

* Due to changed criteria, no comparison to last year is available

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

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FINANCIAL

Month Ended: FY Period 3 -SeptemberDivision: PROVIDER

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

6,795 6,095 700 11% Government Revenue 24,380 24,380 - 0%1,046 950 96 10% Other Revenue 3,800 3,800 - 0%

80,492 81,278 786- -1% Funder Revenue 319,120 319,120 - 0%88,333 88,323 10 0% Total Revenue 347,300 347,300 - 0%

EXPENDITURE50,487 49,488 999- -2% Staff Costs 201,760 201,760 - 0%

6,433 5,661 772- -14% Outsourced Costs 21,984 21,984 - 0%14,939 14,073 866- -6% Clinical Costs 56,690 56,690 - 0%

4,137 4,101 36- -1% Infrastructure Costs 16,410 16,410 - 0%6,204 6,159 44- -1% Recharges 24,638 24,638 - 0%

82,199 79,482 2,717- -3% Total Expenditure 321,482 321,482 - 0%6,133 8,841 2,707- -31% Net Result 25,818 25,818 - 0%

2272.13 2214.21 -57.92 -3% FTE 2,211.81 2,211.81 - 0%

BOPDHB Provider2014/2015

Year to Date Year End Estimate

-5,000

-4,000

-3,000

-2,000

-1,000

-

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

Mon

thly

resu

lt $0

00's

Monthly Operating Costs

Result Budget

13,500

14,000

14,500

15,000

15,500

16,000

16,500

17,000

17,500

18,000

18,500

Mon

thly

resu

lt $0

00's

Monthly Staff Costs

Result Budget

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FTE RESOURCE MANAGEMENT

FY Period 3 -September YTDTotal Variance: 841,819-$ 2,707,966-$

Revenue: 269,639$ 9,840$

Salaries & Wages: 576,040-$ 998,740-$

$55,037-$659,764

Outsourced: 313,059-$ 771,631-$

-$154,426-$162,783-$705,858

-$22,810-$130,032

Clinical Supplies: 68,379-$ 865,928-$

-$187,776-$1,459

-$302,382-$14,931

-$392,574-$310,647$306,280

Infra-Structure: 134,100-$ 36,455-$

-$45,663-$31,810

Recharges: 19,122-$ 44,283-$

-$29,395-$2,112

Year End ForecastActual: 25,817,989$ -$

* Laundry* Patient meals

* Renal fluids and supplies* Road & Air Ambulance

* Instruments & equipment

* Blood products ($201k Intragam)* Pharmaceutical drugs excluding Oncology

* Implants

* Vehicle use

Variance to Budget:

* Publishing

A very large growth in acute presentations YTD

BOPDHB Provider

After a very busy August, September acute demand has dropped to the same level as prior year overall though still up 2.5% at Tauranga.

Financial Commentary - PROVIDER

ACC revenue is up $327k on budget. KKC Centre revenue was budgeted for full year and will now start 1st October with a resulting $806k reduction YTD. Colonoscopy under delivery of 128 resulted in $130k shortfall YTD.

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.

* Doctors are over budget* Nursing is over budget YTD

* Oncology drugs

* Outsourced doctors* Orthopaedic outsourced

* Outsourced nursing

* Ophthalmology outsourced

* Outsourced Radiology

FY Period 3 -SeptemberData

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 296.20 311.28 15.08 4.84% 295.81 311.28 15.47 4.97%NURSING PERSONNEL 2202 1,118.77 1,056.87 -61.90 -5.86% 1,112.84 1,056.87 -55.97 -5.30%ALLIED HEALTH PERSONNEL 2402 459.91 462.10 2.19 0.47% 452.14 462.10 9.96 2.16%SUPPORT PERSONNEL 2602 84.91 81.90 -3.01 -3.68% 87.50 81.90 -5.60 -6.83%MANAGEMENT ADMIN PERSONN 2802 328.40 302.06 -26.34 -8.72% 323.85 302.06 -21.79 -7.21%Grand Total 2,288.19 2,214.21 -73.98 -3.34% 2,272.13 2,214.21 -57.92 -2.62%

Month YTD

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CONTRACTS The graphs below illustrate the under delivery of elective CWD in September. Orthopaedic CWD are the single largest contributor to this negative variance at 175 CWD below plan YTD.

The main concern with Procedure funded contracts is Colonoscopies as they are 128 below YTD plan. As at the end of September 2014 there were 3 Colonoscopy patients waiting outside the target timeframe. BOPDHB is working closely with the MOH and local clinicians to resolve any service delivery issues.

Printed: 10 October 2014

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

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GM Monthly Report – September 2014

DocMan/Management

Property Services General Manager Monthly Report

September 2014

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

5 November 2014 SUBMITTED BY: Jeff Hodson, GM Property Services ENDORSED BY: Phil Cammish, CEO RECOMMENDED RESOLUTION(S): RESOLVE that: BOPHAC receive the Property Services Monthly General Manager’s Report for September 2014.

1. Red Flags

Tauranga Fire and Smoke Dampers The air conditioning contractor testing the Fire and Smoke dampers for BWOF compliance has advised that there is a significant failure rate, such that they won’t sign-off the BWOF. Fletchers have been advised of this residual defect. The expectations being that rectification work should be FCC’s responsibility. Further investigations have confirmed that there is some FCC liability. Whakatane Light Fitting Fire The fire caused by failure of a light fitting in the Santon building highlighted a number of across the system shortfall. The incident is being treated as a serious event, and two investigations are under way.

The physical fire and how the fire protection systems responded to the event. The response of the 777 system.

The findings of the above reports will be shared with the stakeholder and interested staff. It should be acknowledged that the Whakatane team undertook a clean-up of the smoke and water damaged areas, air tests (testing for the presence of asbestos dust) to confirm it was safe to re- occupy the affected areas, and had all of the operations back up and running within 2 weeks. A great effort by Property Services, the cleaners, and support from the effected staff.

2. Highlights September was a month where two compliance projects were concluded. Emergency Lighting The whole of the Project Leo automated emergency lighting is now fully operational, and BWOF compliant for the first time in it’s 7 year life. It has required substantial investment to achieve compliance.

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GM Monthly Report – September 2014 DocMan/Management

Body and Cardiac Protect Areas Every outlet in a body and cardiac protect area needs to be tested annually. Previously, the DHB has used in-house electrical resources which were distracted by reactionary work. The whole testing programme is now outsourced and all of the body and cardiac protected areas have been asset tagged, tested and are recorded as compliant. The current body and cardiac protected area procedure has been updated to current standards. A progressive preventative maintenance programme will be put in place for the ongoing annual testing.

3. General

Tauranga Site Designation – Car Parking Management Plan The TCC designation requires the DHB to complete a Parking Management Plan (PMP) and a Traffic Management Plan (TMP). The PMP has been completed by our consultant. The TMP will now be prepared and submitted to TCC.

4. Project Waka

General Progress is being made on as-built documentation. The use of the online system has created an improved outcome for the DHB.

5. Other Major Projects

Tauranga MSB 5 (MSB3 Replacement) Electrical Work See highlights above. The Black Building Test scheduled for 3 September 2014 was successful. This was the last stage of the project. The project remains on budget. Planned Commencement Date April 2014 Planned Completion Date August 2014 - Percentage complete last month 99% - Percentage complete this month 100%

Tauranga B50 L2 - Fit-out Preliminary Design Preliminary concept has been reviewed by the project exec team and feedback provided to the project team. Further layout (flow and function) work needs to be undertaken to better align the L2 proposed layout with existing floor penetrations. The business cases will be prepared for 4 separate projects, and submitted to AMC for approval.

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A paper will be prepared for AFRM, once the layout has project Executive team sign-off. Planned Commencement Date December 2015 - Percentage complete last month 7% - Percentage complete this month 7%

Whakatane – Paediatric Clinic Refurbishment The work is out to tender Planned Completion Date December 2014 - Percentage complete last month 10% - Percentage complete this month 12% Whakatane – Pharmacy New Build A contract has been awarded to Watts & Hughes. Work will commence in 2 weeks. The Whakatane site management group have been asked to review the layout of the courtyard for the DHB Xmas lunch. Planned Completion Date January 2015 - Percentage complete last month 15% - Percentage complete this month 17%

Tauranga Master Plan The Master Plan is yet to be endorsed by the Executive team. Final details and matching to the Capex plan have been agreed. Further work of the timing/affordability of Pohutakawa House and B24 needs to be undertaken during the next 6 months. Whakatane – Redevelopment Stage 2 - Santon Demolition Tenders for the demolition close on 13 October. The extensive planning of the basement services relocation will have de risked the project. Planned Completion Date 30 June 2015 - Percentage complete last month 5% - Percentage complete this month 8%

Whakatane – Redevelopment Stage 2/5 - Dawson Refurbishment Tender documents have been issued to the contractors. We are still confident that the tenders will come in on the original concept budget. Planned Completion Date January 2015 - Percentage complete last month 7% - Percentage complete this month 10%

Whakatane – New Water Tanks

The detailed geotech report has been completed.

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Preparation of the contract documentation is ongoing. Planned Completion Date February 2015 - Percentage complete last month 13% - Percentage complete this month 15%

Whakatane – Ward 8 Toilet Upgrade and General Refurbishment Tenders are awaited. Planned Completion Date February 2015 - Percentage complete last month 10% - Percentage complete this month 12%

Whakatane – Redevelopment Stage 2/1 Relocation of Pathlab to a Stand-alone Facility Good progress has been made by the contractor. Following the adverse publicity on Shadow Clad cladding, we have elected to change the cladding to Linea which is the same material that was used on Project Waka. There is a cost penalty, however, long-term performance is the key decision maker. Revised Planned Completion Date December 2014 - Percentage complete last month 25% - Percentage complete this month 40%

Tauranga CAMHS Additional Accommodation The COO has signed off the final plans. We are seeking tenders. Completion Date February 2015 - Percentage complete last month 5% - Percentage complete this month 5%

Tauranga B24 L1 and Theatre Assessment Rooms Detailed plans are being developed with the users. The works will be progressively completed through to February 2015. Completion Date February 2015 - Percentage complete last month 8% - Percentage complete this month 10%

Tauranga Lift Wall Upgrade A durable tile surface has been selected. The options for a more user friendly directory board are being reviewed before committing to the project works. Planned Completion Date December 2014 - Percentage complete last month 10% - Percentage complete this month 12%

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Tauranga Theatre UPS Upgrade Planning for this project is underway. Planned Completion Date January 2014 Revised Completion Date November 2014 - Percentage complete last month 25% - Percentage complete this month 25%

Tauranga Boiler House Seismic Upgrade Good progress has been achieved.

Planned Completion Date October 2014 - Percentage complete last month 10% - Percentage complete this month 65% Tauranga Cancer Centre Funding from the Trust account has been approved. Detailed documentation is being prepared. The delay in access to the KKC L2 tenancy will result in a delay in the start of this project. Until the staff move to the KKC tenancy, we do not have the spare space in the Cancer Centre building. Planned Completion Date January 2015 - Percentage complete last month 10% - Percentage complete this month 12% Tauranga Campus – Energy Management Programme A very detailed report was delivered. I will report in next month’s report on the high level findings.

Tauranga Campus – Security Access System Upgrade No progress due to other commitments of the project team. Planned Completion Date 30 June 2014 Revised Completion Date 30 May 2015 - Percentage complete last month 5% - Percentage complete this month 5% Tauranga – Emergency Lighting Upgrade This project is not complete. See the Highlight above for specific comments. Planned Completion Date August 2014 - Percentage complete last month 95% - Percentage complete this month 100%

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6. Third Party Projects Radiotherapy Development (KKC)

As previously advised, occupation of the DHB tenancy has been delayed until November.

Northern Campus Development (NCD) Pathlab has lodged for an excavation consent, and is awaiting TCC approval. The DHB has handed over the site to Pathlab. The current issues that need to be resolved are: Discharge of storm water, the NCD could trigger a deficiency in the current storm water

discharge and result in a major upgrade being required by the Regional Council. 7. Risk, Compliance & OHS

Tauranga Emergency Lighting See the emergency lighting project report above. Now closed. Tauranga Cardiac and Body Protecting Testing Stage 1 - records and testing and now complete. Stage 2 - full compliance with the standard will take 6 months to complete and cost $200,000. Currently there is no budget provision to cover this cost. Whakatane Cardiac and Body Protecting Testing We have undertaken an independent audit of Project Waka. A number of con-compliance items have been identified. Some are project related, others are DHB. Tauranga Smoke and Fire Damper See Red Flag above.

8. Facilities Management Update This Month Fire Alarms Activation (false) TGA - Site General 0 - Acute Mental Health 0

WHK - Site General 1 - Ward 8 0 Fire Alarms Activation (real) TGA - Site General 0 - Acute Mental Health 0

WHK - Site General 1 - Ward 8 0

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Reportable Events TGA 0 WHK 0 Power interruption TGA 0 Power interruption WHK 0 Lost time injury TGA 0 Lost time injury WHK 0 After Hours Call-outs TGA this month 7 WHK this month 1

9. Property Management We are completing a detailed review of the RSA outgoing costs and recovery from the Lessee. It can be confirmed that all costs have been recovered in accordance with the lease document

10. National & Regional Facilities Management Initiative Regional Nothing to report. National Jeff Hodson is co-ordinating the National Conference in Auckland in November.

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2015 Work Plan SUBMITTED TO: Bay of Plenty Hospital Advisory Committee 5 November Submitted by: Gail Bingham, GM Governance & Quality RECOMMENDED RESOLUTION: That the Committee endorses the 2015 BOPHAC Work Plan. ATTACHMENTS: 2015 BOPHAC Work Plan.

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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


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


January • No Meeting February • No Meeting

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Updated 26/08/2014

Bay of Plenty Hospitals Advisory Committee Work Plan 2014

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


May • No Meeting June • No Meeting

July

• Focus Topic: Productivity Improvements

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

Services Report

• COO


August • No meeting

September

• Focus Topic: Health Targets • COO Highlights Report • COO Performance Report • Health Target • General Manager Property

Services Report


October • No Meeting

November

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

Services Report

• COO • COO • GMPS

December • No Meeting January • No Meeting

February

• Focus Topic: Patient Centred Care

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

Services Report

• COO

• GMPF • COO • COO • GMPS

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Agenda Bay of Plenty Hospital Advisory Committee

Documents

Transcript of Agenda Bay of Plenty Hospital Advisory Committee