BOARD MEETING - Waitemata District Health Board€¦ · 1.15pm 4.1 Waitemata DHB owned and operated...

BOARD MEETING

Wednesday 21 September 2016

12.45pm

Note:

Open meeting from 12.45pm

Public Excluded Session from 2.00pm

AGENDA

Items to be considered in public meeting

VENUE Waitemata DHB Boardroom Level 1, 15 Shea Terrace Takapuna

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Karakia

E te Kaihanga e te Wahingaro

E mihi ana mo te ha o to koutou oranga

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

Kia U ai matou ki te pono me te tika

I runga i to ingoa tapu

Kia haumie kia huie Taiki eee.

Creator and Spirit of life.

To the ancient realms of the Creator

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

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

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

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

Well Being to All.

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Waitemata District Health Board, Meeting of the Board 21/09/16

MEETING OF THE BOARD

21 September 2016

Venue: Waitemata DHB Boardroom, Level 1, 15 Shea Tce, Takapuna Time: 12.45pm

WDHB BOARD MEMBERS Lester Levy - Chair Max Abbott - WDHB Board Member Kylie Clegg – WDHB Board Member Sandra Coney - WDHB Board Member Warren Flaunty - WDHB Board Member James Le Fevre - WDHB Board Member Tony Norman - WDHB Deputy Chair Morris Pita - WDHB Board Member Christine Rankin - WDHB Board Member Allison Roe - WDHB Board Member Gwen Tepania-Palmer - WDHB Board Member

WDHB MANAGEMENT Dale Bramley - Chief Executive Officer Robert Paine - Chief Financial Officer and Head of Corporate Services Andrew Brant - Chief Medical Officer Simon Bowen - Director Health Outcomes Debbie Holdsworth - Director Funding Jocelyn Peach - Director of Nursing and Midwifery Cath Cronin – Director of Hospital Services Tamzin Brott – Director of Allied Health Fiona McCarthy – Director Human Resources Peta Molloy - Board Secretary

APOLOGIES: Lester Levy (open meeting only) and Christine Rankin

REGISTER OF INTERESTS

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

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

PART 1 – Items to be considered in public meeting

AGENDA TIME 12.45pm (please note agenda item times are estimates only and that the public excluded session is from 2.00pm)

1. AGENDA ORDER AND TIMING

2. BOARD MINUTES

12.45pm 2.1 Confirmation of Minutes of the Meeting of the Board (10/08/16) Actions arising from previous meetings

3. EXECUTIVE REPORTS

12.50pm 1.00pm 1.10pm

3.1 Chief Executive Officer’s Report 3.2 Health and Safety Report 3.3 Communications Report

4. DECISION ITEMS

1.15pm 4.1 Waitemata DHB owned and operated jetty - Lake Pupuke

5. PERFORMANCE REPORT

1.25pm 5.1 Financial Performance

6. COMMITTEE REPORTS

1.35pm 6.1 Hospital Advisory Committee Meeting (10/08/16)

6.2 Auckland and Waitemata DHB’s Community and Public Health Advisory Committee Meeting (31/08/16)

7. INFORMATION PAPERS

1.40pm

1.45pm

1.50pm

2.00pm

7.1 Health and Safety Marker Report

7.2 Waitemata 2025 Update

7.3 Mason Clinic Remedial Works – Update

7.4 SkyBridge Project – Pedestrian Access Issues Report

8. RESOLUTION TO EXCLUDE THE PUBLIC

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Waitemata District Health Board

Board Member Attendance Schedule 2016

Apologies given *Attended part of the meeting only # Absent on Board business ^ Leave of Absence

NAME FEB APRIL MAY JULY AUG SEPT NOV DEC

Dr Lester Levy (Chair)

Max Abbott

Sandra Coney

Warren Flaunty

James Le Fevre

Anthony Norman (Deputy Chair)

Morris Pita

Christine Rankin *

Allison Roe *

Gwen Tepania-Palmer

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REGISTER OF INTERESTS

Board/Committee Member

Involvements with other organisations

Last Updated

Lester Levy - Board Chairman

Chair – Auckland District Health Board Chairman – Auckland Transport Chairman – Health Research Council Independent Chairman – Tonkin & Taylor Chief Executive – New Zealand Leadership Institute Professor of Leadership – University of Auckland Business School Trustee - Well Foundation (ex-officio member) Lead Reviewer - State Services Commission, Performance Improvement Framework

03/02/16

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

19/03/14

Kylie Clegg Board Member – Hockey New Zealand Trustee and Chairman – the Hockey Foundation Trustee and Beneficiary – Mickyla Trust Trustee and Beneficiary – M&K Investments Trust (includes a share of less than 1% in Orion Health Group) Trustee and Beneficiary of M&K Investments Trust (owns 99% share in MC Capital Ltd, MC Securities Ltd and MC Acquisitions Ltd)

25/11/15

Sandra Coney Chair – Waitakere Ranges Local Board, Auckland Council 12/12/13

Warren Flaunty Member – Henderson - Massey and Rodney Local Boards, Auckland Council Trustee (Vice President) - Waitakere Licensing Trust Shareholder - EBOS Group Shareholder – Green Cross Health Owner – Life Pharmacy North West Director – Westgate Pharmacy Ltd Chair – Three Harbours Health Foundation Director - Trusts Community Foundation Ltd

25/11/15

James Le Fevre Emergency Physician – Auckland Adults Emergency Department Pre-hospital Physician – Auckland HEMS – ARHT/Auckland DHB Co-opted Member – Whanganui District Health Board Hospital Advisory Committee Trustee – Three Harbours Foundation Member – Association of Salaried Medical Specialists Shareholder – Pacific Edge Ltd James’ wife is an employee of the Waitemata DHB, Department of Anaesthesia and Perioperative Medicine

12/08/15

Anthony Norman – Deputy Board

Chairman

Board Chair - Northland DHB Trustee and Treasurer - Kerikeri International Piano Competition Trust Partner - Mill Bay Haven, Mangonui (accommodation provider)

01/07/16

Morris Pita Board Member – Auckland District Health Board Owner/operator – Shea Pita and Associates Limited Shareholder – Turuki Pharmacy Limited Wife is member of the Northland District Health Board

13/12/13

Christine Rankin Member - Upper Harbour Local Board, Auckland Council Director - The Transformational Leadership Company

15/07/15

Allison Roe Member – Devonport-Takapuna Local Board, Auckland Council Chairperson – Matakana Coast Trail Trust

02/07/14

Gwen Tepania-Palmer

Chairperson- Ngatihine Health Trust, Bay of Islands Life Member – National Council Maori Nurses Alumni – Massey University MBA Director – Manaia Health PHO, Whangarei Board Member – Auckland District Health Board Committee Member – Lottery Northland Community Committee

10/04/13

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2.1 Confirmation of Minutes of the Board meeting held on 10th August 2016 Recommendation: That the Minutes of the Board meeting held on 10th August 2016 be approved.

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Minutes of the meeting of the Waitemata District Health Board

Wednesday 10 August 2016

held at Waitemata DHB, Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 11.00am

PART I – Items considered in public meeting BOARD MEMBERS PRESENT:

Lester Levy (Board Chair) Max Abbott Kylie Clegg Sandra Coney James Le Fevre Tony Norman (Deputy Board Chair) Morris Pita Christine Rankin Allison Roe Gwen Tepania-Palmer

ALSO PRESENT:

Dale Bramley (Chief Executive Officer) Andrew Brant (Chief Medical Officer) Debbie Holdsworth (Director Funding) Simon Bowen (Director Health Outcomes) Cath Cronin (Director of Hospital Services) (present until 1.31pm) Jocelyn Peach (Director of Nursing and Midwifery) Fiona McCarthy (Director of Human Resources) Tamzin Brott (Director of Allied Health, Scientific and Technical Professions) Murray Patton (Clinical Director, Mental Health Services) Peta Molloy (Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item)

APOLOGIES:

An apology was received and accepted from Warren Flaunty.

WELCOME

The Board Chair welcomed those present.

DISCLOSURE OF INTERESTS

There were no additions or other amendments to the Interests Register.

There were no declarations of interest relating to the open section of the agenda.

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1 AGENDA ORDER AND TIMING

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

The public excluded session was held first, from 11.01am to 11.43am

2 RESOLUTION TO EXCLUDE THE PUBLIC (agenda pages 6-11)

Resolution (Moved Gwen Tepania/Palmer/Seconded Christine Rankin)

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

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

General subject of items to be considered

Reason for passing this resolution in relation to each item

Ground(s) under Clause 32 for passing this resolution

1. Minutes of the Meeting of the Board with Public Excluded 29/06/16

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

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

Confirmation of Minutes

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

2. Minutes of the Hospital Advisory Committee with Public Excluded 29/06/16





3. Minutes of the Audit and Finance Committee with Public Excluded 20/07/16



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

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

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

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4. Minutes of the ADHB and WDHB Collaboration Committee – Public Excluded (06/04/16)



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

5. Minutes of the Three Harbours Health Foundation




6. Pharmacist Services





7. NZ Health Partnerships




Carried

11.43am – 12.51pm – adjournment. 12.51 pm – the meeting resumed in open session.

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3 BOARD MINUTES

3.1 Confirmation of Minutes of the Board Meeting held on 29 June 2016 (agenda pages 8-25) Resolution (Moved Gwen Tepania-Palmer/Seconded Kylie Clegg)

That the minutes of the Board meeting held on 29 June 2016 be approved.

Carried Actions arising from previous meetings (agenda page 26)

No issues were raised.

4 CHAIR’S REPORT

The Board Chair did not raise any matters at this point in the meeting.

5 EXECUTIVE REPORTS

5.1 Chief Executive’s Report (agenda pages 27-49)

The Chief Executive introduced the report. A video produced by Waitemata DHB on those living with/or caring for people with dementia was shown to the Board. Penny Andrew (Director of the Institute for Innovation and Improvement) and Jay O’Brien (Associate Director of Innovation, Person Centred Design) were present for the showing of the video and their involvement in producing the video was acknowledged.

Other matters that the Chief Executive highlighted or updated included:

That the official opening of the expanded Waitakere Hospital Emergency Department was held on 5 August 2016. The opening was well attended by Ministers, MPs and staff. The Emergency Department expansion is the DHB’s latest investment in health care facilities for West Auckland.

That the DHB hosted the Prime Minister for the launch of the new national childhood obesity target on 30 June 2016.

That the Waitemata and Auckland DHBs annual Pasifika week celebrations were held from 11-15 July. The DHB were honoured to host the Samoan Head of State, His Highness Tui Atua Tupua Tamasese Efi at the opening ceremony held at Waitakere Hospital.

That 151 of the DHB’s orderlies and cleaners graduated to the Level 3 NZQA standard. A graduation ceremony was held on 19 July. This achievement was acknowledged by the Board.

That both he and the Board Chair had visited the Anawhata Ward to view eVitals live. The Board Chair noted that he had asked the Chief Executive to arrange the visit to demonstrate what was being achieved with Leapfrog that clearly showed utility and speed. During the visit a junior doctor noted that eVitals now allows the sickest patients to be seen first during ward rounds, whereas previously ward rounds were completed by starting at one end of the ward and completing the round.

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Acknowledging the achievement of David Ryan on winning the Onelink Hospital Pharmacy Performer of the Year award at the 2016 Pharmacy Awards.

Noting that for the first time all endoscopy KPI indicators have been achieved, the DHB has met all the Ministry KPIs.

The Chief Financial Officer was acknowledged with the financial year end ahead of forecast with a slightly greater surplus. All three areas of the DHB are on track for the new financial year.

The following matters were raised in discussion and responses to questions included:

James Le Fevre acknowledged the clinicians in achieving the colonoscopy target. Kylie Clegg further acknowledged the work of staff after seeing the year end results and queried how the DHB recognises staff for their work. In response, the Chief Executive noted that more recognition could be given to staff, there are a lot of reward programmes in place including the CEO recognition awards, Team Hero, Health Hero awards and the marking of events (such as recognising years of service). Discussions are underway on how to keep staff rejuvenated and maintain momentum as the pressure of the health system is ongoing.

That in response to a comment about staff working when they are unwell, the Board Chair noted that health and safety had been bought up to standard to commensurate with new legislation. The focus has been on keeping safe from harm and had not yet truly crossed into wellness. The Chief Executive noted that there is a well at work programme being developed.

That it is important for staff to feel valued, particularly given much higher levels of expectations from people. In response, the Chief Executive noted that the DHB had produced postcards for each of the DHB’s values and that he personally sends up to 30 cards each week in acknowledgement.

That in response to a question on numbers of students in the Waitemata DHB Health Scholarship programme, it was noted that an update will be provided at the next meeting giving more specific details on the scholarship programme.

That in noting the update on the Abdominal Aortic Aneurysm Screening Pilot for Maori, the Chief Executive advised that the Public Health Physicians are working on a number of projects and that a discussion piece could be presented next year on the outcomes of epigenetics.

The report was received. 5.2 Health and Safety Performance Report – August 2016 (agenda pages 50-75)

Fiona McCarthy (Director, Human Resources) and Michael Field (Group Manager, Occupational Health and Safety) were present for this item.

Matters highlighted and responses to questions included:

That the recent governance audit had identified areas to improve in reporting and that a new report format will be presented later this year.

Security risk assessments have commenced. The tool being used to undertake the assessments enables specific risks to be identified in individual areas.

A coordinator for hazardous substances and new organism audits and compliance has now commenced, with outstanding work already underway.

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Board health and safety visits continue, the next visit is scheduled on Wednesday 17 August with a focus on moving and handling and contractor management.

With regard to healthy workplaces, a strategy has been completed for the next three years and has 13 aims. The strategy will be presented at the next meeting.

Additional work is being undertaken around culture and organisational development.

Michael Field noted that the meeting with WorkSafe New Zealand had now been held. The purpose of the meeting was to gain a more collaborative relationship and gain an understanding of their expectations as well as allow them to better understand the DHB’s working environments. The meeting was very positive with an agreed understanding on legislation.

Sandra Coney thanked Michael Field for the recent Board member health and safety visits attended. In response to a query about having two points of access to the North Shore Hospital security office staff area as highlighted in a recent site visit, Michael Field noted that access was shown to the Board members in attendance as an example of the type of things that are being identified and remedied. The matter was not reported as access to the area is already being addressed. The review of security includes addressing the requirements of the area for patients requiring a more retrained environment and appropriate training for staff around security and those responding to incidents where restraint may be required. It was noted that with regard to health and safety, workplace environments need to identify all health and safety options for consideration. The options considered and decisions made need to be clearly identified and recorded. An update on the location of Skybridge pillars will be provided at the next meeting. It was noted that barriers had been put in place and pedestrians can safely cross the road using the areas designated. The report was noted.

5.3 Communications (agenda pages 76-82)

Matt Rogers (Director of Communications) was present for this item. The Board Chair acknowledged and thanked Matt Rogers and the Communication Team for their work. Matt Rogers summarised the report noted that there had been an intense period of communications recently involved a number of complex media enquiries. He noted that an apology had been broadcast by TVNZ regarding the Marae Programme, this matter is now resolved In response to a query regarding the Crimes of Torture Act and the media clippings circulated to Board members, Matt Rogers noted that the media stories were based on a national review by the Ombudsman and that when the mental health facility review was undertaken the environment was considered acceptable and any issues identified are being addressed. Murray Patton further noted that an update on the Waiatarau facility has been included on the Hospital Advisory Committee agenda. He also noted that New Zealand signed up to an international protocol, the Crimes of

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Torture Act (COTA), and that it is enacted in New Zealand under the Chief Ombudsman. COTA allows an inspector from the Chief Ombudsman’s office to visit any facility where people may be detained in either an announced or unannounced visit. Two visits have taken place at Waitemata DHB facilities in 2016, an inspector identified words ‘no leave’ written on a whiteboard on a visit to Waiatarau and whilst an explanation was provided that the reference was in relation to a client with whom discussion had not been completed on care the reference was misinterpreted and the inspectors finding was maintained. With regard to it being reported that the Waiatarau facility clients did not have outside courtyard access, it was noted that people do have access to fresh air. Murray Patton noted that the DHB had raised this matter nationally expressing concern about the way it had been reported and with findings from visits by inspectors being made and not amended accurately. He further noted that clients do have access to go outside and that any voluntary client is entitled to leave the unit. A courtyard that has been temporarily locked while upgrades are undertaken affects a small number of clients under the Mental Health Act and is because of an event where a client was able to leave a high care courtyard. This is a temporary measure until the upgrades are completed. The report was received.

6 DECISION PAPERS

6.1 Appointment of Meng Cheong to healthAlliance NZ Limited Board (agenda page 83) Resolution (Moved Gwen Tepania-Palmer/Seconded James Le Fevre) That the Board:

a) Note that Anthony Norman has resigned as the Northland DHB Director of

both healthAlliance NZ Ltd and healthAlliance FPSC Ltd as of 1 July 2016. b) Note that Northland DHB has proposed that Meng Cheong, Northland DHB

Chief Financial Officer be appointed as a Director of healthAlliance NZ Ltd and healthAlliance FPSC Limited, to replace Anthony Norman.

c) Note that the Constitution of healthAlliance NZ Ltd and the Shareholder’s

Agreement provides that all shareholders appoint directors. Waitemata DHB is a shareholder in healthAlliance NZ Ltd.

d) Approve the appointment of Meng Cheong, Northland DHB Chief Financial

Officer, as a director of healthAlliance NZ Ltd.

Carried

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7 PERFORMANCE REPORTS

7.1 Financial Performance (agenda pages 84-100)

The Chief Executive summarised the report noting that the bottom line result was a requirement of a $2.8 million surplus and that a result of $2.956 million had been achieved. Max Abbott commended the Chief Executive and staff on the financial result. The report was noted.

8 COMMITTEE REPORTS (agenda pages 101-108)

8.1 Hospital Advisory Committee Meeting held on 29 June 2016

Resolution (Moved Gwen Tepania-Palmer/Seconded Allison Roe)

That the draft minutes of the Hospital Advisory Committee Meeting held on 229 June 2016 be received.

Carried 8.2 Auckland and Waitemata DHBs’ Community and Public Health Advisory

Committees Meeting held on 20 July2016

Resolution (Moved Gwen Tepania-Palmer/Seconded Allison Roe) That the draft minutes of the Community and Public Health Advisory Committee meeting held on 20 July 2016 be received.

Carried

8.3 Recommendation of the Auckland DHB and Waitemata DHB Disability Support

Advisory Committees Meeting held on 1 June 2016

Sandra Coney noted that the recommendation from the Auckland DHB and Waitemata DHB Disability Support Advisory Committees meeting required an amendment to recommendation 3. The resolution will be sent to Board via circular resolution.

9 INFORMATION PAPERS 9.1 Health and Safety Marker Report - Update August 2016 (agenda pages 118-134)

Fiona McCarthy (Director, Human Resources) was present for this item. In response to a query it was noted that regular meetings with onsite contracts were occurring. The report was noted.

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The Chair thanked those present. The meeting concluded at 2.20 pm SIGNED AS A CORRECT RECORD OF THE MEETING OF THE WAITEMATA DISTRICT HEALTH BOARD - BOARD MEETING HELD ON 10 AUGUST 2016 ________________________________CHAIR

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Actions Arising and Carried Forward from Previous Board Meetings as at 12 September 2016

Meeting Date

Agenda Ref

Topic Person Responsible

Expected Report back

Comment

10/08/16 5.2 Update report on the Skybridge pillars.

Robert Paine/Nigel

Ellis

21/09/16 Actioned. See this agenda, item 8.2.

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3.1 Chief Executive’s Report Recommendation:

That the Chief Executive’s Report be received. Prepared by: Dr Dale Bramley (Chief Executive Officer)

1. News and events summary A number of events of significance took place across the DHB over the past six weeks:

It was with great sadness that we received the news of the death of Sir Graeme Douglas at the start of the month. Sir Graeme will be remembered as a pillar of the West Auckland community as well as a leader in business and an innovator in pharmacy. He was also a health philanthropist and his support for healthcare organisations, including Waitemata DHB via the Well Foundation, will have a lasting, positive impact.

http://www.waitematadhb.govt.nz/assets/Documents/news/media‐releases/2016/MediaReleaseSirGraemeDouglas6September2016.pdf

The DHB is about to take the next step in our strategy of working more closely with our partners in primary care to enhance capacity for patients to receive treatment earlier in their local communities. The imminent launch of the Community Health Plan will further cement our partnership with key primary health organisations and increase the range of local support available to people with a range of needs.

Our new mental health action plan focused on community and primary care. Our Health in Mind, will be launched in conjunction with Auckland University of Technology on World Mental Health Day on 10 October. As part of that process the DHB will also announce funding for the first mental health business case.

Dr Jonathan Christiansen has announced he is standing down as Head of the Department of Medicine after almost six years in the role. Jonathan has made an outstanding contribution at a time of unprecedented growth and change for our DHB as we strive to meet the needs of a rapidly growing and culturally diversifying population. At the time of writing, a suitable event was being planned to suitably recognise Jonathan’s efforts. He will be taking up a significant new role within the DHB in the near future.

Waitakere Hospital’s new Emergency Department was officially opened on 5 August, creating a world‐class emergency medicine facility for the people of West Auckland. The $9.8 million facility almost doubles the physical size and layout of the existing department, creating extra capacity to meet the needs of the West Auckland community. It includes a new front‐of‐house zone with separate adult and paediatric waiting area, an improved triage area allowing greater patient privacy, four ambulance bays and a whanau zone providing more space and comfort for patients’ families. The investment reflects the DHB’s commitment to meeting the needs of our growing population. The number of patients presenting at the Waitakere ED has increased from 28,000 in 2009 to 52,000 last financial year – the fastest increase of any ED in the country. Renovations within the ‘old’ Waitakere ED footprint, including a new paediatric zone, are expected to be complete in March 2017.

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http://www.waitematadhb.govt.nz/assets/Documents/news/media-releases/2016/MediaReleaseSirGraemeDouglas6September2016.pdf

http://www.waitematadhb.govt.nz/assets/Documents/news/media-releases/2016/MediaReleaseSirGraemeDouglas6September2016.pdf


CEO Dr Dale Bramley officially opens the new Waitakere Hospital ED with State Services

Minister Paula Bennett.

Members of the official party outside the Waitakere Hospital ED at the launch event.

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A large and diverse crowd reflecting the West Auckland community attended the opening.

http://www.waitematadhb.govt.nz/assets/Documents/news/media-releases/2016/MediaReleaseWaitakereEDopening5August2016.pdf

Workshops were held at both main hospital sites during August to recognise the valuable contributions of our volunteer workforce. The DHB has around 360 volunteers contributing to the experience of patients in our care and the workshops were an opportunity for them to join and discuss ideas for further coordination and improvement. Waitemata DHB is committed to becoming a national leader in volunteering and the feedback gathered at the workshops will assist in the development of a new strategy to lift engagement and satisfaction. A Volunteer Coordinator position began on 5 September to lead our volunteer programme, aimed at ensuring volunteers are supported effectively,

that their numbers grow and that these roles contribute to enhancing the patient experience. Groups involved in the workshops included the Green Coats, St Johns, City Impact Church, Women’s Auxiliary, Red Cross, Volunteer Stroke Scheme, Auckland Mandarin Christian Choir, Chaplains and the North Harbour Rose and Garden Society.

A Digital Programmes Expo was held on 23 August at North Shore Hospital, showcasing many of the different e-health projects being rolled-out by the DHB. This was an opportunity for staff to test out some of the latest technology supporting patient care. The expo included stalls promoting eVitals, ePrescribing, eLabs, eRads, Orion Ward 10 mobility solution, home screen optimisation for SMOs, Community Allied Health tablets, Insight report portal, iPads on Ward 7 and the National Electronic Health Record (NEHR). Based on the success of the North Shore event, a second expo is now planned for Waitakere Hospital.

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The Digital Programmes Expo at North Shore Hospital showcased the DHB’s e-health initiatives.

Chief Advisor Tikanga Naida Glavish has been recognised for her work in support of lifting Maori health outcomes. Naida recently received National Hauora Coalition’s award for ‘Courageous Leadership in Advocating for Maori’ as a tribute to her work as a champion of improving access to culturally appropriate health care for Maori people and to striving for equity in health outcomes.

CEO Dr Dale Bramley with award recipient Chief Advisor Tikanga Naida Glavish.

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Waitemata DHB has been awarded an investor confidence ‘B’ rating by Treasury as part of an audit of public sector organisations to assess their maturity in asset management, project, programme and portfolio management and change management. Organisations were ranked from A to E following an assessment of how well organisations develop and deliver their long-term strategy and associated projects. It was also an opportunity to assess how well they manage assets with a view to delivering maximum value from the investment of public money. The outcome of these audits was an investor confidence rating, which will impact how much support or autonomy Treasury provides an organisation over the delivery of its long-term plans. Waitemata’s rating is considered a significant achievement and credit is due to our Finance team for this result. The next round of audits will be held in two years.

Construction of the Waitemata Clinical Skills Centre on the North Shore lakefront is coming along rapidly. Building activity began on 15 June on this state-of-the-art, two-storey teaching facility. Completion is on-track for April 2017, creating a new home for many of the academic activities taking place across the DHB. It will include an auditorium and clinical teaching spaces, ensuring Waitemata’s reputation as a place of learning and excellence continues well into the future. The centre will also have a dedicated clinical skills laboratory occupying most of the first floor and an AUT exercise-testing laboratory.

An elevated shot showing construction status of the Clinical Skills Centre as at 7 September.

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Once complete, the centre will create a new home for academic activities across the DHB.

Waitemata DHB has had the distinction of nine of our staff being selected to present abstracts at the Health Informatics New Zealand (HiNZ) Awards in November. The HiNZ Awards are considered one of the country’s premier health informatics awards and it is a positive reflection on the calibre of the DHB to have so many of our talented people and their projects recognised. Congratulations to Robyn Whittaker, Lara Hopley, Kelly Bohot, Jenna Jacobsen, Eleri Clissold, David Ryan, Andrew Cave, Grant Christie and Peter Groom for receiving national recognition for the high quality of their work.

Our ongoing ‘Health Heroes’ awards programme recognising staff who exemplify our organisational values has seen further winners announced in both the individual and team categories. Ward 15 Charge Nurse Manager Adrienne Reed is the latest individual winner. Adrienne was recognised for her cooperative approach to colleagues on other wards in assisting with patients requiring acute admission during a particularly busy period. The winner of the team award was the staff of Titirangi Ward, Waitakere Hospital, for their compassion and support in caring for a challenging patient. Both Adrienne and the staff of Titirangi Ward have lived-up to our value of ‘Everyone Matters’ and are very worthy Health Hero award-winners.

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CEO Dr Dale Bramley with individual Health Hero award recipient Adrienne Reed.

Members of the Titirangi Ward team with Chief Medical Officer Dr Andrew Brant.

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Creating a culture of appreciation

A further 41 staff have been recognised in the CEO Awards, launched in mid-2014 to celebrate those staff, nominated by their colleagues and patients, who demonstrate our organisational values through their work. Each staff member whose nomination is considered worthy of acknowledgement receives a personalised letter of thanks, a certificate of appreciation and a small gift. Staff acknowledged with a CEO Award since the last Board meeting were:

Robert McCullough, CSSD Technician, Central Sterile Supply - Theatres, nominated by Nursing Team Endoscopy – WTH “Robert has high standards, a positive attitude, and a willingness to contribute to quality improvements.”

Carole Harkness, Lead Vision & Hearing Technician - Child Women and Family North, nominated by Paula van Well “Diligent in her work and is sincerely interested in making things better and more cohesive.”

Kristine Fabellar, Ward Clerk - Department of Nursing, nominated by Kylie Kozenof “For her patience and care with our patients who have severe dementia.”

Sue Osborne, Urology Nursing Practitioner - Urology, nominated by Xu Cui “I hear great feedback from patients about her wonderful nursing care all the time!”

Delia McKenna, Professional Clinical Leader - Social Work Allied Health, nominated by Jacqueline Joseph “Her practice epitomises Waitemata DHB values and behaviours.”

Gale Robinson, Workforce Central, HR Corporate, nominated by Nicola Doyle “Wonderful mentor and support person and goes out of her way to demonstrate the Waitemata DHB values and behaviours.”

Lesley Wildes, Group HR Manager, HR Corporate, nominated by Human Resources Team “Continuously demonstrates compassion and a professional connection to each of her team members.”

Kelly Bohot, Project Manager - New Initiatives, nominated by Shirley Campbell “Kelly is a completer and doing a fantastic job in driving the i-pad rollout with detail and perseverance.”

Adam Leys, iPad Implementation Lead, nominated by Shirley Campbell “Adam has a wealth of technical knowledge and is searches to solve all team members’ problems.”

Maree Martinovich, Clinical Psychologist - Community MH North 1, nominated by Andrew Paul “Maree has been the driving force behind the Clothing for Confidence (CFC) initiative.”

Inge Andersen, Registered Nurse - Home Health Support West, nominated by Karen Frederickson

Lyndsie Skelton, Clinical Nurse Specialist - Renal Ambulatory Non-Dialysis, nominated by Karen Frederickson “For going above and beyond for a patient – Inge and Lyndsie stayed late to address patient issues and do surgical dressings and to liaise and develop a plan to better-coordinate this patient’s care.”

Shinsuke Suzuki, Cleaner - Clinical Support Services, nominated by Elizabeth Hollier “A pleasure to work with and takes complete pride in his work.”

Lucy Byrnes, Personal Assistant - Quality & Training, nominated by Mandy Spenser “Without support staff like Lucy to manage meetings, managers, databases, files and often do the stuff no one else wants to do, there’d be chaos!”

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Ashley Simmons, Professional & Clinical Leader - Physio, nominated by Jane Hamer & all the CWF Physiotherapists “Truly embodies the Waitemata DHB value of ‘Connected’”

Emma Farmer, Head of Division Midwifery North Shore, nominated by Susan Rae “The tirelessly hard way she works for the staff, women and babies of the Waitemata DHB Maternity Service”

Michael Nares, Registered Nurse - Forensics Management, nominated by Catherine Erickson “Ensures the information shared is amended then presented so it is fully understood.”

Julie Gregory, Registered Nurse - Prison Liaison, nominated by Shivaka Singh “For having really good skills to work with some complex patients and staff within the team.”

Mark Snelson, Charge Nurse Manager - Prison Liaison, nominated by Shivaka Singh “For always being available and approachable to listen to staff.”

Carole Schneebeli, Clinical Nurse Advisor - New Graduate Nursing, nominated by Shivaka Singh “She is unbiased and acknowledges the needs and concerns of others, promotes a positive working environment.”

Hiromi Kominami, Social Worker - Rimu Unit, nominated by Chris McCloughen “Hard-working, thoughtful, good-humoured and approachable to both our staff and our patients.”

Zenzi Grabowski, Associate Clinical Charge Midwife - North Shore Facility nominated by Sam Davenport “For her enthusiasm and dedication towards the patient care standards programme.”

Lauren Townshend, Team Leader - Radiology MRI, nominated by Peter Keuning “A true representation of the DHB's goal to be the most-welcoming hospital in New Zealand.”

Ali McFarland, Registered Nurse - Home Health Support North, nominated by Marie Buchanan “Her commitment and compassion to the patients is a credit to her.”

Fane Halalupe, Cleaner - Clinical Support Services, nominated by Des Gilliam “Fane volunteers to assist patients on Sundays get to the chapel from the wards and back.”

Des Gilliam, Orderly - Clinical Support Services, nominated by Shaun Garea “He has been with the WDHB for 30 years – Des has continued an excellent work ethic, demeanour and contribution to the team.”

Nick Brooke, Senior Physiotherapist - North Therapies, nominated by Barbara Guthrie

Trina Robertson, Senior Physiotherapist - North Therapies, nominated by Barbara Guthrie “Exemplary professionals with a strong focus on supervising physiotherapy students on clinical placement.”

Ceinwen Rees, Administration Clerk, Radiology, nominated by Clerical Team - Radiology Waitakere “Goes beyond the call of duty and is always accommodating of challenges that are thrown at her.”

Irene Tunzelman, Clerical Worker, NSH Diabetes Service, nominated by Michele Garrett & the Diabetes Team “Irene does a brilliant job and goes out of her way to ensure that our patients are seen.”

Ashley Simmons, Clinical Leader - Physio, nominated by Clair Turner & the Acute Physio Team “Ashley always makes time for you, no matter how big or small this issue may be.”

Alisha Thompson, Registered Nurse, Outpatients North Shore, nominated by Xu Cui “Has great communication skills and able to build excellent working relationship within team.”

Luz Mancilla, Cleaner, Clinical Support Services, nominated by Kirsten Ter Braak “I have been impressed with her positive and efficient work ethic.”

Jenny Hansen, Administration Clerk, Waitakere Site Management, nominated by Helen McGregor

Ann Ryan, Administration Clerk, Waitakere Site Management, nominated by Helen McGregor

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Vanessa Houlgrave, Administration Clerk, Waitakere Site Management, nominated by Helen McGregor “They are incredible assets to Waitakere hospital and exhibit all of our WDHB values on a daily basis.”

Carol Lunjevich-Grigor, Registered Nurse - Occupational Health, nominated by Jalinda van der Westhuizen “Carol will always ask if she could help and, if needed, will escort the visitor to their destination.”

Lieske Regtien, Registered Nurse - Gastroenterology, nominated by Clerical Administrators for Gastro-Enterology Team “She goes the extra mile to support the Clerical Team. A big thank you, Lieske.”

Vanessa Aplin, Recruitment Manager - Recruitment, nominated by Ursula Viljoen & Ben Bradley “Thoughtful, approachable and inspires us to be creative in finding better ways to do things.”

John Powell, Orderly - Clinical Support Services, nominated by Vicky Toki “Knowledgeable and highly skilled who maintains high standard of health and safety.”

Claire Jones, Social Worker - Child & Family North, nominated by Anonymous “Claire ensures her staff are well supported and recognised for their valuable input.”

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

Further progress on the next phase of ‘Our Values, Your Values’ activity.

Progress on construction of the Clinical Skills Centre on the North Shore campus.

Continuation of the 2016 CEO Lecture Series.

Visit by the Director-General of Health on 16 September.

Launch of the Our Health in Mind five-year mental health action plan

Launch of the DHB’s Community Health Plan.

Board workshop in December on the next phase of the Leapfrog programme

3. Future Focus

The Leapfrog programme was established as a means to support a focused, intensive burst to take a large leap in moving the DHB from where we are to where we want to be.

The programme consists of a small number of strategic organisation-wide projects that are resourced to achieve significant change and impact on health outcomes and patient/family experience.

The intended benefits are to move these projects along at a faster pace with top-level support for the significant changes required, giving greater visibility and attention to those projects identified as being important in achieving the DHB’s priorities and purpose as well as instilling the culture of improvement and innovation.

As per the News and Events section, the Leapfrog team held a Digital Expo at North Shore Hospital in August providing demonstrations of new electronic systems being implemented at Waitemata DHB, including Voice-to-text, eVitals, eLabs and others. This was very well received by staff and we will continue to provide these sessions, with the next one to be held at Waitakere Hospital.

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A paper on the Leapfrog approach at Waitemata DHB has been accepted for an oral presentation at the Health Informatics NZ Conference in Auckland (31 October – 3 November). Team members will also be presenting on Voice-to-text, ePrescribing, eVitals, Mobility and the Community Allied Health iPads. The Mobility Strategy has moved to focus on the Mobile Enterprise Application Platform (MEAP), which will allow us to develop apps within our environment. healthAlliance are progressing with the implementation of the regional mobile device management system, which will require corporate mobile devices to be enrolled and managed. Meanwhile, 115 iPads are being used and monitored in the community with Allied Health staff. Our processes for approving, purchasing and - in the future - developing clinical mobile apps are being tested. This development is of great interest to the Ministry of Health and we intend to share our processes with other DHBs for their input and further refinement over the next few months. ePrescribing has rolled out to ESC, ICU, pre-op and PACU. Work continues on optimising performance of this critical system. Voice-to-text has faced some technical issues over the past month but is continuing with recruiting and training new departments and clinicians to the roll-out. These include Older Adults, orthopaedics, ICU and dermatology. eVitals has been rolling out successfully across Waitakere Hospital and is now commencing at North Shore Hospital. The Patient Experience Reporting System (PERSy) implementation is on-track with the first survey (Friends & Family Test) built and tested. The team has been working on potential options to support primary care – secondary care connectivity and technology options for remote consultations and online booking to support reducing outpatient follow-ups. These will continue to be worked-up in collaboration with healthAlliance and other partners. The eVitals rollout has commenced, with 118 beds live at Waitakere Hospital and approximately 75 beds live at North Shore. Feedback is positive and further rollout is planned for the North Shore tower block over the coming weeks. The rollout started slightly behind schedule due to technical issues. However, good progress is being made in catching-up.

4. Outcomes discussion

This month, I have asked Chief Information Officer Stuart Bloomfield and Director of Innovation Dr Robyn Whittaker to provide an update on Waitemata DHB’s progress toward a digital hospital.

Waitemata DHB is recognised as a leader in the movement toward a more mobile, electronic health record. National comparisons, using an international measure of electronic adoption in hospitals, rank Waitemata in the top three DHBs. This paper outlines how we have achieved this level of capability and the steps required to progress further. Electronic Medical Record Adoption Model (EMRAM)

Recently, the Ministry of Health commissioned an assessment of the digital maturity of the 20 DHBs’ acute hospital services as part of the Digital Health Work Programme 2020. Waitemata DHB scored extremely well on the Healthcare Information and Management Systems Society’s EMRAM scale. This international scale tracks healthcare organisations’ progress towards achieving a paperless patient record environment from Stage 0 through Stage 7, where few hospitals globally have achieved Stage 7.

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Waitemata DHB scored 5.275 against an overall national average of 2.78.

Figure 1: EMR Adoption Model Scores for District Health Boards The reasons for Waitemata’s leading position nationally include our implementation of the following functionality:

Electronic prescribing. All three DHBs that achieved Stage 5 of EMRAM have implemented a central medication management system.

Nursing documentation at the bedside through eVitals (successfully rolled-out to Waitakere wards) and in all mental health services.

Radiology images available for review through the clinical portal. Medication inventory tracking through automated distribution cabinets (Pyxis) in the wards. Electronic ordering of radiology (complete) and laboratory (planned for 2017) Physician documentation in systems such as the electronic discharge summary, our

cardiovascular disease and mental health information systems.

Improving our Electronic Medical Record Adoption

In order to continue pushing towards paperless records and achieve Stage 6, there are two main areas of focus. First, we need to complete full ‘Closed Loop’ medication management - an important final step in reducing patient adverse events through medications issued to the wrong patient. This involves full patient and medication barcoding, which requires further development within our existing prescribing and administration systems and equipment. Options to determine the best solution are being developed now and the Leapfrog team will present a business case to the Board as soon as possible. The second area is around structured clinician documentation and notes. We are already progressing many developments in this area and the systems that will really make a difference in achieving this are the roll-out of voice-to-text for dictation of letters and notes, eVitals for nursing assessments,

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electronic order sets and internal referrals and the upgrade of Concerto (Portal 8) to enable a new clinical workflow suite. To achieve a full electronic medical record, we need to enable fast implementation of systems that are resilient, flexible and secure and support mobility. The current model of local implementation and systems management impedes our progress. For example, the Concerto upgrade to Portal 8 will take over two years from planning to implementation, frequent outages disrupt clinical care and our platform to develop mobile apps will not be available to use effectively until June 2017. Cloud-based solutions for both infrastructure and software reduce the time and cost of implementation and provide more reliable systems. We should be looking at moving to cloud-based options for all future developments. A workshop will be held in December to discuss potential new ideas for the next phase of the Leapfrog programme and some of the issues mentioned above will be discussed.

5. Board performance priorities The following provides a summary of the work underway to deliver on the DHB’s priorities: Relief of suffering Progress: Patient and Whānau Centred Care Patient feedback National Inpatient Survey The last national survey was recently sent out via mail to 400 patients who were discharged between

1-4 August. Results from this survey will be available in mid-October.

Friends and Family Test During July 2016, we received feedback from 979 people through the Friends and Family Test (FFT).

From our peak in March 2016 during Patient Experience Week, responses to the Friends and Family

Test have declined. The Net Promoter Score (NPS) for July was 71, well above the DHB target of 65

and the highest for the 2016 calendar year-to-date.

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Family and Friend Test Comments

“The service provided was of the highest order and I won't hesitate to recommend to all that wish

to hear me. Thank you all so much”. Allied Health Outpatients – Physiotherapy

“Very prompt assessment, from all doctors, nurses and technicians. Nurses very pleasant and

helpful”. - Ward 2, NSH

“Hine Ora ward is fantastic the nurses and the other staff are the best. I felt welcomed the moment I

arrived and well cared for the time I left. Great job team!” – Hine Ora Ward, NSH

“Nice and friendly people that work on this ward and explain everything well to me - even the

pharmacist spent time with me and made things clearer to me.” – ADCU, WTH

“All staff attentive and take time to explain and update us on the condition of my father. Medical

and nursing care very good. Unit environment clean and comfortable.” - Anawhata Ward, WTH

Patient Stories We currently have 33 patient videos, including stories about dementia, dental services, mental health services, Asian health support services, thrombosis services, disability support, surgical services, SCBU, emergency admissions, upper GI cancer, ORL, discharge planning and end-of-life-care. Three further stories are currently in production, including a video about depression. Those that are able to be viewed publicly are available on the DHB website at http://www.waitematadhb.govt.nz/Patients-visitors/Patient-stories. Patient Information Patient Information booklet The North Shore Hospital patient information booklet has been finalised and will be printed and

rolled-out to the wards in conjunction with Patient Safety Week (October 30-November 4). The

Waitakere Hospital information booklet has commenced development.

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http://www.waitematadhb.govt.nz/Patients-visitors/Patient-stories


Continuous Quality Improvement Director of Patient Experience - experiences night shift David Price, Director of Patient Experience, spent two evenings at North Shore Hospital to understand both the patient and staff experiences after-hours. David shadowed the Duty Managers and the Clinical Nurse Managers for two shifts from 9pm – 1am. It was a great opportunity to meet night staff and gain insight into the patient experiences during these times. Two key insights were the many noises at night that can impact on patient’s sleep and challenges to access specific support that is only available during standard working hours. Many staff commented on how they appreciated the visit and were very open in providing feedback about their experiences at night. Volunteer Review Two focus groups with representation from 10 different groups of volunteers that support Waitemata DHB were conducted in August. More than 80 volunteers attended the workshops held at North Shore Hospital and Waitakere Hospital. The workshops aimed to prioritise various improvements recommended by the recent volunteer review and to co-design key solutions with volunteers to ensure Waitemata DHB provides a supportive and rewarding experience. Volunteers spoke highly of the workshops and are excited by the momentum of potential change for the organisation and the recent announcement of the Volunteer Coordinator appointment.

In Your Shoes Sessions In November, the Patient Experience Team with the support of Organisational Development will be facilitating ‘In Your Shoes’ sessions for Gynaecology services and service-users with a disability. These listening events aim to understand the patient experience of services. These narratives provide valuable insights for continuous service-improvement directly from patient feedback.

Other Patient Experience Work The patient experience team are also involved with the following programmes of work:

- Maternity Services Review - Safe & Secure - Staff Scripting in de-escalation of challenging behaviours - Breast Cancer Services Co-Design Workshops - Clinical Support Services Education Program - Wilson Centre Community Engagement - Waitemata 2025 – Community Engagement and Design Principles - Outpatient Check-In Kiosks - Persons of Size Pathway - System Level Measures – Patient Experience of Care Workstream (Primary Care) - EDARS – Patient Interviews - MIDAS Patient Experience Project - Community Lactation Consultation Clinic Patient Experience Project - Sleep Strategy

Recruitment Associate Director of Patient Experience & Volunteer Coordinator Ravina Patel was recently appointed to the Associate Director of Patient Experience and will commence on October 10 to support the patient experience work currently progressing throughout the organisation. Ravina is currently the Customer Insights Advisor for Auckland Transport and has experience in co-design and customer experience methodology and data analytics.

Genevieve Kabuya was recently appointed to the Volunteer Coordinator position and commenced on 5 September to lead the new Waitemata DHB volunteer program. The strategy aims are to ensure

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volunteers are supported effectively, increase volunteer numbers and ensure their roles contribute to enhancing the patient experience at Waitemata DHB. Genevieve is from St John Community Health Services where she coordinated the National HEARTsafe program. Facilities development NSH Sky Bridge Main project is complete and will close out. Gas main repair to be planned and completed over the next three months. NSH Community Building 5 Is now expected to be concluded in March 2017 due to the complexities and the renovations. NSH Surgical Pathology Offices Relocation Construction is currently underway and due to be completed in October. NSH Pupuke Building Services Relocation (CYF Mental Health and Child Health services) MHS and CHS will be relocated out of Pupuke by the end of October and plans are underway to begin demolition by Christmas. WTH ED New Build New ED opened as planned and is fully operational, with refurbishment works of the ‘old’ ED now underway. WTH Additional Beds – Wainamu and Muruwai Wards Construction design and tenders are complete. However, the project has had a scope change involving relocation of cardiology beds. This scope change and decanting options are being investigated and a revised business case will be presented to the Board in September. SCBU WTH & NSH This project is for extension of the SCBU at WTH and refurbishment of the SCBU at NSH. The WTH extension is required to enable NSH works. Seed funding of $430,000 was endorsed at the CAMP meeting on 30 June. Design is progressing presently at concept design Better Outcomes Progress: On track Achieving the health targets – as at 4 September 2016

Shorter waits in Emergency Departments – 97% quarter-to-date (target 95%)

Improved Access to Elective Surgery – 98% (target 100%)

Increased immunisation – 93% (target 95%)

Better help for smokers to quit - maternity – 97% quarter four 2015-16 (target 90%)

Raising healthy kids – 64% (target 80%)

Faster Cancer Treatment (FCT) – 90% three-month coverage (target 90%)

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Health Quality and Safety Markers Falls Falls risk assessment audits that inform the Health Quality and Safety Commission data continue and are conducted monthly. Overall, MHOPS completed 98 percent of falls risk assessments and Surgical and Ambulatory achieved 100 percent on admission. Of those, MHoPS achieved 88 percent while Surgical and Ambulatory achieved 79 percent within eight hours of admission (against a target of 90%). Hand Hygiene Waitemata DHB’s Hand Hygiene Audit results for July 2016 are a compliance rate of 81 percent meeting the national target of 80%. Waitemata DHB’s national April – June 2016 quarterly rate was 83.3 percent compared with the aggregated national average compliance rate of 82.5 percent Healthcare-Associated Infections The CLAB insertion bundle was used in ICU on 100 percent of occasions in July 2016. The insertion bundle compliance exceeded the national target of 90%. Elective Surgery Centre (ESC) ESC discharges for July sat at 94 percent of planned elective targets. Operationally, ESC continues with its efficient and productive service for its patients and clinicians, with a total of 420 patients operated on for the month. Patient satisfaction remains very high, with a total of 111 satisfaction surveys completed for the month, 96 of which included positive comments. Māori Health Abdominal Aortic Aneurism Pilot The Abdominal Aortic Aneurism (AAA) Screening Pilot for Māori proceeds to plan, with a total of 436 patients screened. Waitakere Union General Practice completed screening on 26 August and achieved a coverage rate of 84 percent. Screening started in the last participating practice (Te Puna Hauora) on 29 August and should be completed by the end of September. A business case is being developed to extend AAA screening to the rest of the Waitemata Maori population. The cost-effectiveness and feasibility of pairing atrial fibrillation screening with the AAA screening is being investigated through an application to the Health and Research Council of New Zealand. Smoking cessation The Māori Health Gain Team is working with our MOU partner, Te Rūnanga o Ngāti Whātua, to implement a pilot programme for the delivery of communication and marketing initiatives that are developed by youth/rangatahi to promote stopping the initiation of smoking and for smoking cessation. Waitemata DHB has partnered with Rodney College and Mahurangi College, which will develop social media-based initiatives to promote becoming and staying smokefree. Cervical Screening HPV Self-Sampling Auckland and Waitemata DHBs have two projects approved to provide access to cervical screening Human Papilloma Virus (HPV) self-sampling to priority group women over the next three years. The intention of both projects is to clarify the participation rate for priority women using self-sampling in order to inform national policy as the National Cervical Screening Programme (NCSP) moves to changing the screening test from a pap smear to an HPV test in 2018. HPV self-sampling is not

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currently included in the NCSP programme change. However, the NCSP is very supportive of research evidence to inform further policy development. 1. A HPV self-sampling feasibility and acceptability project for 200 Māori women in West

Auckland (DHB-led project; a partnership between Māori health, women’s health, Te Whānau O Waipariera, primary care, colposcopy service, laboratory, and HPV experts).

2. A HPV self-sampling study comparing mail-out and clinic-based invitation strategies with usual care across both Auckland and Wellington for Māori, Pacific and Asian Women (Massey University-led project with DHB partnership, recently announced funding by the Health Research Council).

Both projects are progressing.

Pacific Health

Pacific Cultural Competency Training uptake: Pacific Best Practice Over the last 12 months, a total of 330 Waitemata DHB staff have been trained in the Pacific Best Practice Training modules, including the engaging Pasefika online module. As we roll-out this training, we will look to focus training workplace teams so as to foster the “in our shoes” staff experience.

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CEO Scorecard

Actual Target Trend Patient Experience Actual Target Trend

Better help for smokers to quit - maternity 89% 90% q Complaint Average Response Time 13 days <14 days

Better help for smokers to quit - primary care 91% 90% p Net Promoter Score FFT 72 65 p

Improved Access to Elective Surgery - WDHB 94% 100% q

Shorter Waits in ED 97% 95% p Quality & Safety Trend

Faster cancer treatment (62 days) 85% 85% p Older patients assessed for falling risk 100% 90% p

Increased immunisation (8-month old) 93% 95% p Occasions insertion bundle used 100% 95%

Raising Healthy kids 52% 50% a. Good hand hygiene practice 81% 80%

Pressure injuries grade 3&4 0.00 0.00

ICU - CLAB rate per 1000 line days 0.87 <1 p

b. Antibiotic in the right time 96% 100% q

Waiting Times Actual Target Trend Improving outcomes

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

ESPI 2 - % patients waiting > 4 months for FSA compliant Population coverage/Access Trend

ESPI 5 - % patients not treated within 4 months compliant g. Cervical Screening 76% 80%

Diagnostics g. Breast screening 67% 70% p

% of CT scans done within 6 weeks 95% 95% qc. Bowel Screening Participation

% of MRI scans done within 6 weeks 91% 85% q - Round 2 54% 60% p

Urgent diagnostic colonoscopy (14 days) 90% 85% q - Round 3 54% 60%

Diagnostic colonoscopy (42 days) 79% 70% p

Surveillance colonoscopy (84 days) 70% 70% q Treatmentd. HSMR (Source: Health Round Tables) 95% <99% q

Patient Flow e. Surgical intervention rates (per 10,000 pop)

Elective Surgical Discharges (YTD) - Angioplasty 14.6 12.5 p

Elective Discharges - Total 1,555 1,683 q - Angiography 40.8 34.7 p

Elective Discharges - Provider Arm 1,051 1,133 q - Major joints 21.4 21 p

Elective Discharges - IDF Outflow 504 550 q - Cataract 33.2 27 p

Efficiency a. # NOF patients to theatre (48 hours) 83% 85% q

Outpatient DNA rate (FSA + FUs) 9% <10% p ST elevation MI receiving PCI (120 mins) 79% 80% q

Average Length of Stay - Electives 1.57 days <1.69 days q AT&R referrals assessed (2 working days) 90% 90% q

Average Length of Stay - Acutes 2.62 days <2.51 days q

Staff Experience Actual Target Trend Major Capital Programmes Time Budget Quality

Sick leave rate 8.3 days <7.5 days p Te Atarau car park (mid 2016) - completed

Turnover rate 11% 8-12% WTH Emergency Department redevelopment (Apr 2016) f. Lost time injury rate (per 100 00 hours worked) 3.34 <5 q Mason clinic - 15 Bed medium secure unit (May 2017)

Lakefront (Apr 2017)

Financial Result Trend NSH Building 5 Refurbishment (Mar 2017)

Net Surplus/Deficit (YTD) -1,153 k -1,159 k Clinical and Learning Skills Centre (Apr 2017)

Elective Capacity and Inpatient beds (TBC)

Bridge ESC to Medical Tower (Sep 16)

Performance indicators: Trend indicators:

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

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

Performance was maintained

Waitemata DHB Monthly Performance Scorecard

Contact:

Victora Child - Reporting Analyst, Planning & Health Intelligence Team: [email protected]

Planning, Funding and Health Outcomes, Waitemata DHB

CEO ScorecardJuly 2016

2016/17

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

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

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

small variations perceived to be large.

a. One month in arrears - as at June

b. Antibiotic at the right time - As at Dec Q2 2015/16 (latest data available).

c. Bowel Screening a quarter in arrears - Round 3 commenced (participation rate for invites Jan - March 2016).

d. HSMR reported quarterly - as at June Q4 2015/16.

e. SI Rates reported one quarter in arrears -as at March Q3 2015/16.

f. New method of calculation and target June 2016 - Rate per 100 000 hours worked

g. As at June Q4 2015/16

Health Targets

How to read

Managing our Business

Best Care

Provider Arm - Service Delivery

A question?

Key notes

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3.2 Health and Safety Performance Report – September 2016

Recommendation:

That the report be received and that the Board note the Healthy Workplaces Strategy 2016-2019 in Appendix 1.

Prepared by: Michael Field (Group Manager, Occupational Health and Safety)Endorsed by: Fiona McCarthy (Director of Human Resources)Healthy Workplaces Strategy endorsed by the Senior Management team in July 2016

1. Purpose of report

The purpose of the Health and Safety (H&S) report is to provide quarterly reporting of health, safety and wellbeing performance including compliance, indicators, issues and risks to the Waitemata District Health Board.

New reporting format for November Board meeting

From November 2016, the Health and Safety Performance report will be presented in a new reporting format. The aim of the new format is to provide a summary of key H&S information with narrative or graphical detail alongside for additional information. Reporting information and lessons learned will be gained from Auckland Transport and other leading private and public firms.

2. Strategic Alignment

Community, whanau and patient centred model of care

This report comments on issues and risks that impact on patient care and organisational culture.

Emphasis and investment on both treatment and keeping people healthy

This report comments on organisational health information via incidents, health monitoring, and leave information.

Intelligence and insight The report provides information and insight into workplace incidents and what the DHB is doing to respond to these and other workplace risks.

Evidence informed decision making and practice

The leading and lagging indicator dashboard is based on current best practise indicators and targets.The Healthy Workplaces Strategy is based on national and international evidence based practise and learnings.

Outward focus and flexible, service orientation

Health, safety and wellbeing risks and programmes are inherentlyfocused on staff, patients, visitors, students and contractors. All strategic and operational work programmers and policy decisions are discussed with relevant services e.g. site visits, approaches to reduce risks (Section 6).

Operational and financial sustainability

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

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3. Highlights of the month

3.1 Healthy Workplaces Strategy 2016-19

Working for the betterment of patients and striving to provide a great staff experience are of key importance to the DHB, and having a healthy workplace supports us to achieve these aims. Not that long ago, having a healthy workplace was defined as having a clean and functional building to work in. Thanks to work by eminent international bodies, we now better understand that workplace culture, psychosocial factors, employee wellbeing, leadership, worker engagement and involvement significantly contribute to a healthy workplace as much as fit for purpose facilities.

Waitemata DHB has been an early adopter of healthy workplace principles with a strategy in place since 2013, acknowledging the importance a healthy workplace has on supporting overall staff health, safety and wellbeing and the multiple inextricable links.

Using the 2010 World Health Organizations (WHO) Healthy Workplace definition and action model as a guide, enables a holistic, strategic, quality improvement approach.

The strategic framework of our 2016-19 Healthy Workplaces strategy is outlined below and demonstrates the DHBs focus on aligning systems, drivers, evidence and outcomes to meet the DHB priorities.

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Our outcomes model aligns actions and desired outcomes the DHBs will monitor over the next 3 years.

The DHB is supported by a committed and enthusiastic group (see Appendix 1) to undertake the development and implementation of the programme. Progress will be reported to the Board every 6 months.

3.2 Board Health and Safety Site visit

The fourth health and safety Board site visit was held in August. The site visit was broken into two segments; Moving and Handling and Contractor Management.

During the Moving and Handling visit, Board members gained an appreciation of the risks associated with moving patients, both to the patient and to staff, as well as some of the latest innovations and technologies being implemented. This included an exercise where Board members were able to play the role of patients and experience how some of the technology was implemented in practice. It was noted that, at present, we had few of the newer technologies available on our sites, including those designed with the dual purpose of moving and evacuation. The Board members expressed their agreement that the numbers of these equipment types should be increased with some urgency, to assist in reducing the risk associated with moving patients, both to staff, from back related injuries, as well as patients.

During the Contractor management segment, Board members were taken to the construction site of Aphina, situated adjacent to our Helipad at North Shore Hospital. During this visit, Board members met the construction company’s Health and Safety site manager, who explained the various

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processes in place to ensure that health and safety was actively managed on their site, including the process implemented for dealing with inbound helicopters.

The Board were then provided with an overview of the processes in place for managing new contracts, as well as some of the challenges, the two main being the difficulty in recruiting appropriate staff and the need for up-to-date information technology platforms, such as Share Point, to allow for further progress (NB: work on system solutions is underway for both Facilities and Occupational Health and Safety Systems).

It was also highlighted that work on the management of Trades related contractors carrying out maintenance related tasks, was a focus to bring them in-line with large construction contractor processes.

4. Actions from the last Board report

4.1 Numbers of contractors vs staff.We will give a verbal update at the meeting.

4.2 Secondary employment.The DHB does not hold a separate database of secondary employment declarations. However we provide annual communications to staff reminding them to declare secondary employment and conflicts of interest and any declarations are reviewed by the manager, addressed as necessary and kept on the staff member’s personal file for future reference.

4.3 Fund for Health and Safety improvements

As mentioned in May, the DHB has developed a fund for significant health and safety improvements. When requests to the fund need to be activated, the CFO or Director of HR will get in touch with the Board Chair to organise a meeting of the Board subcommittee.

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5. Performance Scorecard

Legend 20% variation – Green21-50% variation – AmberOver 50% variation - Red

The leading and lagging indicators in the above scorecard are indicative of Health and Safety performance across the organisation.

Using trends and traffic light indicators will emphasise the areas where we are on or progressing towards our targets and when we need to improve. Some of our targets are staged to show improvement over time.

Glossary for Monthly Performance Scorecard and Report

Lost time incidents Any injury claim resulting in lost time.Lost time injury Frequency Rate Number of lost time Injuries per million hours worked.Injury Severity Rate Mathematical calculation that describes the number of lost days

experienced as compared to the number of incidents experienced.

Lost Time Injury Rate Mathematical calculation that describes the number of lost time injuries per 100 fulltime employees at any given time frame.

Notifiable Injury/illness (a) Amputation of body part, serious head injury, serious eye injury, serious burn, separation of skin from underlying tissue, a spinal injury, loss of bodily function, serious lacerations.(b) any admission to hospital for immediate treatment(c) any injury /illness that requires medical treatment within 48 hours of exposure to a substance(d) any serious infection (including occupational zoonoses) to which carrying out of work is a significant factor, including any infection attributable to carrying out work with micro-organisms,

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that involves providing treatment or care to a person, that involves contact with human blood or bodily substances, involves contact with animals, that involves handling or contact with fish or marine mammals.(e) any other injury/illness declared by regulations to be notifiable.

Notifiable Incident An unplanned or uncontrolled incident in relation to a workplacethat exposes a worker or any other person to a serious risk to that person’s health or safety arising from an immediate or imminent exposure to an escape, spillage or leakage of a substance; an implosion explosion or fire; an escape of gas or steam; an escape of a pressurised substance; an electric shock; a fall or release from height of any plant or substance; collapse or partial collapse of a structure; interruption of the main system of ventilation in an underground excavation or tunnel; collision between two vessels or capsize; or any other incident declared by regulations to be a notifiable incident.

Notifiable Event Death of a person, notifiable injury or illness or a notifiable incident.

Pre- Employment Health screening for new employeesSignificant Hazard (Instead of a definition all hazards are risk rated to determine how serious they are in the new legislation)

A hazard with the potential to cause serious harm.

Psychosocial Risk Might be those aspects of the design and management of work and its social and organisational contexts that have the potential for causing psychological or physical harm.

Patients who are away without leave (AWOLs)

Patients under the Mental Health (compulsory Assessment and Treatment) Act 1992, who leave DHB premises without prescribed or approved leave

PCBU Person conducting business or undertaking

Officer Person occupying the position of a director of a company or includes any other person occupying a position in relation to the business or undertaking that allows the person to exercise significant influence over the management of the business or undertaking.

Worker An individual who carries out work in any capacity for the PCBU e.g. employee, contractor or sub-contractor, employee of the sub-contractor, employee of labour hire company, outworker, apprentice or trainee, person gaining work experience, volunteer.

Reasonably Practicable Means that which is or was at a particular time reasonably able to be done in relation to ensuring health and safety, taking into account and weighing up all relevant matters.eg the likelihood of the hazard/risk occurring and the degree of harm resulting, what the person knows about hazard/risk and how to eliminate/ minimise the risk and the cost associated with elimination of the hazard/risk.

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6. Key Health and Safety Risks

The table below outlines our key health and safety risks together with commentary on the current status/issues related to that risk and any actions to address issues.

We have added residual risk (the portion of risk that is left after a risk assessment has been conducted) to this table. The actions reported each month are controls in progress and the residual risks from each of these identified risk areas will vary. The DHB has attempted to note the residual risk in the context of the original risk using a traffic light after each risk below.

Risk Previous Report Action Previous % Complete

Current Action Residual Risk % Complete

Aggression-physical and verbal

The Community Alarms project is progressing well, with final review of tender documents having been undertaken. Tender and tender evaluation should be completed within the next two months.

A meeting has been held with NZ Police, Inpatient Mental Health and H&S, to gain a better understanding of our options relating to client assaults on staff. This meeting was very collaborative in nature and suggestions from NZ Police were very gratefully accepted. This is being followed up with a scheduled meeting to begin work on developing some recommendations for an official approach to how these incidents are escalated and how we interact with NZ Police, to ensure the best possible outcomes (see Section 7).

The scheduled meeting with WorkSafe NZ is due on 3 August.

20%

10%

Awaiting tender responses.

Our Legal Services manager is developingpolicy guidelines for referral of staff assaults to police.Once completed, this will be circulated for feedback before being finalised and published. A communications strategy will also be developed to ensure that all relevant managers are made aware of the new policy and what it means for them and their staff.

The meeting with WorkSafe NZ was held in July. It allowed WorkSafe NZ to gain a much better understanding of the

As these projects are still underway, the residual risk has not changed. It is envisioned that the residual risk levels will reduce upon project delivery.

20%

15%

100%

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Following two incidents, afull hazard and risk review has been undertaken by OH&S and the services, relating to reception areas of shared mental health/community health facilities. Recommendations have been provided to reduce the risk and potential harm of future incidents.

environments in which our staff work, as well as the inherent risks associated with these environments, especially relating to assaults on staff. We were also able to clearly understand what WorkSafe NZ’s expectations were regarding appropriate measures to reduce the risk of harm.

OH&S are currently following up on the options suggested to Mental Health.

He Puna Waiora has also experienced a number of incidents over the last month. Initial meetings have been held and a risk assessment is currently underway.

50%

10%

Original Risk Residual Risk

Risk Previous Report Action

Previous % Complete


Blood and Body Fluid Incidents (BBFA)

The review is still pending the needleless system pilot.

30% The review is still pending the needleless system pilot.

Nil change 30%



Previous % Complete


Hazardous Substances(HSNO)

The first audit has now been completed, with the audit report being finalised. The North

100% NSH Laboratory -70.6% to 72% compliance rating (on-going).

As this audit project progresses and each area becomes

10%

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Shore Hospital Laboratories was chosen for this audit, as it represents the most complicated and challenging area, with the largest number of hazardous substances andtherefore the highest level of risk.

The costs were received for the Dangerous Goods Store for Waitakere Hospital, but were far in excess of what was initially considered and a complete review of quotes was requested of Facilities.

WTH Gastro – 81% compliance rating (in progress)

The audit tool has now been finalised.

Revision of store design underway to assist with review of quotes.

compliant, this residual level of risk will reduce.

100%

20%



Previous % Complete

Current Action Residual Risk

% Complete

Contractor and Procurement Management

The previous Health, Safety and Environmental Advisor has resigned. Advertising is underway to find a replacement. In order to reduce the risk associated with Facilities, the Group Manager, OH&S and the OH&S ClinicalTeam Leader are covering this area until a replacement can be found.

The newly appointed H&S Investigator and Auditor, who startedon 8th August, will allow us to more proactively audit the systems and processes that Facilities have in place for contractor management, to ensure compliance.

50%

50%

A replacement Health & Safety Advisor has been found and a contract sent. This person is currently situated in South Africa, now has a work visa and we are awaiting a start date.

The new H&S Investigator and Auditor has commenced work.

Nil change. 80%

100%

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Asbestos auditing is continuing, with leased properties now being audited.

70% A communications issue has been identified as part of the auditing process and a resolution is now in place to ensure new areas being audited are advised in advance. The process is complemented by follow up to building users following receipt of the survey report.

We are also working on processes to follow up with staff and contractors who may be identified as having a higher potential risk of asbestos exposure. We are working with ADHB on this process.

70%

10%



Previous % Complete


Manual and Patient Handling

Moving and Handling are now attending each OH&S team meeting, to ensure a closer working relationship. OH&S are engaging with Moving and Handling as soon as issues arise, allowing us to respond far more swiftly to incidents, but also to identify potential risk areas for intervention.

OH&S representation is now included with all new builds and refurbishments, with a much stronger focus on reviewing layout plans and recommendingchanges where required.

50%

100%

A close working relationship has been established and is working well.

The H&S Construction guideline has been presented to all Facilities and Development Project Managers, with clear instructions on its use provided. Facilities and Development have undertaken to utilise this guideline on all new build and refurbishment

Nil change. 80%

100%

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projects, with OH&S agreeing readily to provide any support necessary.



Previous % Complete


Health and Wellbeing (stress, fatigue, depression)

The Senior Management team have endorsed the Strategy and it will be presented to the September Board meeting for information

95% The healthy workplaces strategy is attached.

Communications for the launch is underway.

Nil change. 100%



Previous % Complete


Physical environment (ventilation, lighting, equipment)

OH&S have agreed an approach with Facilities for all maintenance requests thatmention H&S as a risk factor. These are being forwarded to the OH&S mailbox and the Duty Nurse is ranking them from 1 to 10 (where 1 is Critical H&S Risk Requiring Immediate Action and 10 is Not Considered a genuine H&S Risk).

A full hazard review and recommendations report has been undertaken for the Helipad and immediate concerns addressed (loose items in close proximity to helipad). Further recommendations will be reviewed by the Helipad Advisory Committee for action.

50%

70%

Although this process has been agreed, no requirement to rank maintenance requests has been received from Facilities and Development. Any H&S related maintenance requirements that OH&S are directly identifying are being addressed immediately.

The Helipad Advisory Committee has reviewed and agreed to all recommendations.Work to undertake these is currently being scheduled by Facilities and Development.

The residual risk remains the same at present until we review the efficacy of the H&S maintenance priority system.

50%

80%


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Previous % Complete


Slips trips and Falls

Audit checks for ‘slippery when wet’ signage during wet periods are progressing well, with only three noted entryways missing a sign, out of 16 checks carried out during the period. Where signage is not present, Clinical Support Services are notified, but OH&S staff also place signage immediately.

Signage for umbrella bag systems is currently being finalised by Facilities.

Work has also begun on communicating the leading causes of slips, trips and falls to staff, to raise general awareness of where caution is necessary. This will include signage (posters).

100%

80%

20%

Spot checks have continued with no noted issues.

Facilities and Development have reviewed the draft design, but requested a number of changes to be made.

Planning is currently underway, with key messages being identified, in collaboration with ACC.

The residual risk has dropped for entryways, however this makes up a small proportion of overall slip, trip and fall events, requiring the residual risk to remain the same. As staff communications are developed and delivered, it is expected that this residual risk will fall.

100%

80%

30%


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7. Stakeholder feedback

Funding, Planning and Outcomes

The DHB have engaged Simpson Grierson to provide further specialist advice on our plan and strategic capability assessment tool which we anticipate will be completed by October. They have advised a 'one size fits all' approach will not benefit Waitemata DHB or its providers and will facilitate a stratified risk assessment of our contract categories to classify the risk profile of the services delivered.

As previously advised, a number of our national contracts are low risk and we can rely on the existing contract and regulatory framework. There is however a requirement to develop and document a process for managing these to ensure compliance which they will undertake.

For contracts considered to be of higher risk, they will work with us to determine what level of information is required to refine the strategic capability assessment tool and develop a process for engaging with these providers to support compliance and also provide assurance to the Waitemata DHB executive and Board.

Regulatory Bodies

WorkSafe NZ (WSNZ).

The meeting with WorkSafe NZ was held in July and found to be very beneficial. It allowed WorkSafe NZ to gain a much better understanding of the environments in which our staff work, as well as the inherent risks associated with these environments, especially relating to assaults on staff. We were also able to clearly understand what WorkSafe NZ’s expectations were regarding appropriate measures to reduce the risk of harm, which mirrored our own approach perfectly. Both parties have agreed to continue with a close working relationship and WorkSafe NZ have expressed their readiness to discuss any issues with us as required.

8. Staff Reported Incidents

Glossary CO – CorporateCWF – Child, Women and Family ServicesESC – Elective Surgical CentreHO – Hospital OperationsMEDHOP – Medical and Health of the Older Persons ServiceMH - Mental Health and Addictions ServicesOH&S - Occupational Health and Safety SA – Surgical and ambulatory services

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8.1 Staff incidents

The number of reported incidents by staff during the month of July 2016 was 144 compared to 165in June.

The rate of staff incidents per discharged patients is 1.45% (based on inpatients only). (144 ÷ 9958 x 100)

The rate of staff incidents per FTE for the month of July 2016 is 1.93% (144 ÷ 7468 x 100).

Table 1: Number of reported staff incidents for July 2016 and prior 23 months

Table 2: Staff incidents by type for July 2016

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Table 3: Staff Incidents by Service July 2016 excluding contractors

9. Notifiable Events

The DHB noted:

1 notifiable event in July 2016

Staff member walked under traffic barrier arm (which was in the upwards position) which then hit her on the head causing her to lose consciousness.∑ Action – Reviewed site and noted that no pedestrian access was provided, so staff and visitors

were forced to walk under barrier arms. Barrier arms have been locked in the open position, until such time as pedestrian access is provided – preliminary plans received and reviewed.

10. Top Incidents types that cause harm

The main types of incidents that cause harm to our staff and their management are outlined in the following tables.

10.1 Aggression

Work is underway to review staff training requirements, which includes dealing with aggressive behaviour, with a view to creating robust and complete training schedules for all staff.

Hazard and risk assessments for He Puna Waiora, and Mental Health community facilities are underway and include developing a standardised set up for Mental Health reception areas. This work will ensure that adequate precautions are in place and taken to protect our staff from physical assault. This work is being supported through a closer working relationship with both WorkSafe NZ and the NZ Police.

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Table 4: Aggression Incidents by Service – July 2016

Table 5: Physical assaults root cause July 2016

19

6

3

10

2

MH CWF HO MEHOP Facilities

Aggression Incidents by service July 2016

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Table 6: Physical Assault outcomes July 2016

Table 7: Mental Health & MEHOP - Physical Assault (root cause Aggression) July 2016

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10.2 Slips, Trips and Falls

The 15 Slips, trips and falls in July were categorized as being caused by restraint (1) environment (2) ergonomic (2) faulty equipment (1) inattention (1) obstruction (2) uneven surface (2) unsafe/improper practice (2) wet Floors (2).

Table 8: Slips Trips & Falls by service July 2016

10.3 Moving & Handling

Moving & Handling injuries to staff since January have been recorded in table 9.

Of the ten incidents recorded in July, two of these incidents resulted in sprain/strains to necks and backs. Seven incidents were categorized as resulting in pain & discomfort at some level. One incident incurred no injuries at all.

Of the ten July incidents all of them occurred in MEHOP.

A close relationship has been established with our Moving and Handling Coordinator and Moving and Handling training is being provided for two OH&S staff, who will act as ‘knowledge centres’ for the rest of the team.

A project has also been initiated with between OH&S and Clinical Support Services to look at ways to eliminate linen bags from our process and therefore remove the issue of overfilling of these bags (over weight). Hard receptacles on wheels are being considered initially.

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Table 9: Moving and Handling injuries to staff in 2016

11 Health, Safety and Wellbeing Activity

11.1 Occupational Health

Influenza VaccinationsCurrent flu vaccinations levels stand at 56% (3,923 employees), with vaccines still available.

We are also arranging to train more in team vaccinators and will commence 2017 flu planning in November.

Sick LeaveThe July figures show a continued trend above our sick leave target with a result of 9.6 days average per fte against the target of 8 days or 3.6% (against a target of 3%). Promisingly, the annualised average reflects an overall slight downwards trend for the period to end of July 2016 and a better result than reported for this period in the previous two years.

11.2 Hospital patient evacuation

Patient evacuation plans are highly complex and significantly informed by the site the patient is located.

Our patient fire evacuation is horizontal in the first instance which means we move patients sideways to the next safe fire zone. We have appropriate fire rated doors and zones and all our processes are approved and directed by the Fire Service.

The DHB fire evacuation plan is to remain in place on a floor and move to the next protected zone. If we need to physically move patients out of the North Shore tower, we’d evacuate the out of the fire exits down the side of the building. Floors 1-6 can be evacuated using the fire service tender.

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For floors 7 and upwards we move people down in a stretcher on the outside of the building or if more suitable down the stairwell. The Fire Service manage this process.

We are investigating the use of hovermats for evacuation instead of stretchers and a capital proposal is being developed.

Staff receive evacuation training every six months as part of the DHB compliance with evacuation schemes but we do not evacuate sick patients. We do however practise moving people down the outside of the North Shore Tower and have also practiced moving ICU patients to the next fire zone. It takes 20 minutes per patient to get ready for more distanced moves.All patients can be moved – it just takes time and the right staff to help with the move.

The DHB fire plan is informed by NZ hospital practice and aligns with Fire Service regulations.

11.3 Staff Vacancies

Two positions remain to be filled, however we are very close to recruiting both positions. One is for an OH&S Nurse and the other for an H&S Advisor. We have an offer to an H&S Advisor based in South Africa and are currently assisting with their immigration process. It is estimated this could be up to four months. We are also in the process of finalising documentation for a new OH&S Nurse, who will likely begin within the next month. This will see all historic roles filled.

12. Health and Safety Prosecutions

Taiwanese tourist’s family to receive $70,000 after scuba dive death 9 August 2016

The family of a Taiwanese tourist who drowned on a recreational SCUBA dive at Hahei in November 2014 will receive $70,000 in reparations.

Waikato diving operator, Cathedral Cove Dive Limited (CCDL) and its director Russell Cochrane had earlier pleaded guilty to three charges under the Health and Safety in Employment Act 1992 (HSE) for failing to keep the victim safe. A reserved sentencing decision was released by the Hamilton District Court today. No fine was imposed.

On 4 November 2014, the victim was left to swim unsupervised while wearing scuba equipment selected by Cochrane- she swam out of the enclosed bay where the dive was taking place, exhausted her air supply and was later found hours later floating face down in the water.

Aside from inadequate supervision, she was fitted with a buoyancy compensator device (BCD) which was too large which made it far more difficult for her to lift her head out of the water to breathe.WorkSafe Chief Inspector, Keith Stewart, says the victim’s death was entirely preventable if CCDL had given her appropriately sized gear and supervised her as they were required to do.

Learning for Waitemata DHB: the prosecution does not have specific relevance to Waitemata DHB activities but does highlight the importance of the supervision.

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Healthy Workplaces Strategy

Foundation Document 2016 - 2019

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ACKNOWLEDGEMENTS

The DHB acknowledges the expert and generous contributions from the Healthy Workplaces Steering Group and the Well@Work group in the preparation of this strategy.

This document has been prepared by Janice Riegen, Clinical Nurse Specialist - Occupational Health and Safety with contributions from:

Dr Pat Alley (Director of Clinical Training, at time of development of this document)

Dr Patricia Bolton (Pubic Health Physician, Planning, Funding and Outcome)

Adam Craigie (NZNO Organiser)

Michael Field (Sustainability Development Manager, at time of development of this document, now Occupational Health and Safety (OH&SS) Group Manager )

Margaret Kamphuis (Occupational Health and Safety (OH&SS) Group Manager, at the time of development of this document)

Brendan Lane (PSA Organiser)

Fiona McCarthy (HR Director)

Saraha McLeod (Workforce Development Manager, at time of development of this document)

Blair Nugent (MHSG HR Manager)

Kathryn Scott (Team Leader, People Capability, Awhina Learning & Development)

Lesley Wildes (HR Group Manager)

Lifeng Zhou (Senior Epidemiologist and Asian Health Advisor, Planning and Funding)

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Executive Summary: Healthy Workplaces (HWP) Strategy 2016-2019

Health, work and wellbeing are inextricably linked (Black, C. 2012). Waitemata District Health Board (WDHB) is committed to the health, safety and wellbeing of their workforce, their

population and improving the quality of care and services delivered. With an on-going commitment to the organisational purpose, promise of ‘Best care for Everyone’ and the values of

‘Everyone matters, With compassion, Connected and Best better, brilliant’, the Healthy Workplaces Strategy and associated plan is supported, endorsed and funded by senior leadership

under ‘Everyone matters – staff’.

There are multiple drivers that have been considered as part of this strategy. We have an ageing workforce and population and a resulting increase in long-term health conditions that will

affect our staff as a subset of the community; changing healthcare demands; technological advances; a need for sustainable use of resources (both people, financial and fixed assets); and

acknowledgement that poor mental health is identified as becoming a leading cause of workplace absence. There is a wealth of evidenced-based literature that showcases the critical links

between staff engagement and wellbeing. With NZ adopting the new Health and Safety at Work Act (2015) in April 2016, there are increased responsibilities of providing a safe

environment, physically and psychologically, with psychosocial risks identified internationally as the one of the biggest, mostly unknown and unquantified, risks facing organisations. In

healthcare creating healthy workplaces is imperative for effective, safe and sustainable delivery of healthcare and of their workforce.

A collective leadership approach is essential to ensure a strategic, collaborative approach that safeguards engagement at every level. Using the World Health Organisations (WHO) Healthy

Workplace definition and action model ensures a holistic, strategic quality improvement approach. This strategy has been developed with union partners, principally the Public Service

Association (PSA) and the New Zealand Nursing Organisation (NZNO) who collaborated in this work as part of the Steering Group and adds to the Enhancing Engagement commitment and

sound people capability practices. The strategy aligns with WDHB’s strategic direction at multiple levels and the challenges it will face with the Waitemata 2025 Vision. This work ensures

alignments and commitments to Te Tiriti o Waitangi, Te Whare Tapa Wha; Waitemata DHB Board Priorities; Annual Plan’s commitments, the Regional Planning and the Ministry of Health’s

(MoH) key outcomes for the health sector.

The HWP Steering Group has reviewed international best practice using a PESTLE environmental scan analysis (Political, Economic, Sociological, Technical, Legal and Environmental). This analysis takes into consideration existing work within Waitemata DHB. This strategy focuses on activities where the DHB has a partial or no match to best practise. The work is divided into two phases. Phase One consists of a focus on: engagement, feedback and communications; age friendly work environment; health and wellbeing and improved physical environments; a stock-take of HWP initiatives/activities across the DHB; development of HWP measures; workload management and website development for an interactive platform and a communications plan Phase Two focuses on: shift work and fatigue management; teamwork; diversity; health promoting hospitals; developing support for areas to develop their own HWP activities and research and network opportunities. The total cost of the programme over three years is $181,000 and will be funded through budget currently unallocated but set aside for such purpose.

The literature supports potential benefits and outcomes at numerous levels. Individually we could expect to see improved individual health and wellbeing; job satisfaction; morale;

resilience; trust and meaning and purpose with less incidents. Organisationally we could see increased: engagement; collaboration; productivity; trust; creativity and innovation and

attraction of quality staff and decreased: sickness/absence; presenteeism; turnover costs and incidents. For patients/clients, family/whanau: we could expect to see improved: safety,

quality of care, outcomes and experience, with less incidents. There will be a contribution to the wider population health societal outcomes, as well as the economy.

Internationally there is a call for action and Waitemata DHB is well placed to lead the way in supporting this work. Through an active commitment to creating healthy workplaces, Waitemata DHB will contribute to being a ‘a place that cares for their staff’; that is a healthy, happy organisation, fostering good work practices that influences safer, quality of care, outcomes and experiences; influence societal outcomes and impacts on organisational outcomes. As the Canadian Quality Work life Quality Healthcare Collaborative (QWQHC): state that:

“A fundamental way to better healthcare is through healthier healthcare workplaces. It is unacceptable to work in, receive care in, govern, manage and fund unhealthy healthcare workplaces” (2007).

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1. Introduction

Health, work and wellbeing are inextricably linked (Black, C. 2012). Waitemata District Health Board (WDHB) is committed to the health, safety and wellbeing of their workforce, their

population and improving the quality of care and services delivered. With an on-going commitment to the organisational purpose, promise of ‘Best care for Everyone’ and the values of

‘Everyone matters, With compassion, Connected and Best better, brilliant’, the Healthy Workplaces Strategy and associated plan is supported, endorsed and funded by senior leadership

under ‘Everyone matters – staff’.

The development of this strategy is to build on the existing 2013 strategy. The Healthy Workplace (HWP) Steering Group, with the active support and engagement of the PSA and NZNO has undertaken a review of the Healthy Workplaces Plan (HWP), using a PESTLE environmental scan analysis (Political, Economic, Sociological, Technological, Legal and Environment). This has identified areas for improvement, and provides an updated strategic framework and platform specifically for Waitemata DHB, using a basis of continuous quality improvement, which is underpinned by the growing body of literature and best practise evidence. Specific actions and accountability will enable measurable outcomes whilst reviewing and recognising the good work that has already been embarked on as well as linking initiatives and activities in a coordinated approach to ensure alignment with Waitemata DHB’s strategic directions. Waitemata DHB has recently aligned the staff values programme with the Patient Experience programme in recognizing the critical interface between engagement and staff health and wellbeing and patient/client safety and quality of care, outcomes and experience, plus the well-documented, direct correlations to organisational outcomes. The HWP steering group has endorsed the use of the World Health Organization’s (WHO) HWP model, as it is holistic, strategic and a quality improvement model. This approach supports a specific New Zealand focus in alignment with the Te Tiriti o Waitangi and Te Whare Tapa Wha (Durie, 82).

World Health Organization (WHO) defines ‘Healthy Workplaces’ as:

“A healthy workplace is one in which workers and managers collaborate to use a continual improvement process to protect and promote the health, safety and well-being of all workers and the sustainability of the workplace…” (2010, p.6). The four areas of focus are the physical work environment; the psycho-social work environment; personal health resources available and community involvement. These are underpinned by ethics, values, leadership and engagement and worker involvement. WHO has identified, it is: The Smart thing to do; The Legal thing to do and The Right thing to do do (WHO, 2010, p.4-5)

(WHO healthy Workplace Action Model: avenues of influence, process and core principles (2010, p.6)

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1.1 Call for action There is a call for urgent action, to develop healthy workplaces for the future success of a safe, sustainable, effective healthcare service. An evidence informed and influenced overview

and action strategy, which gives direction of the broad focus, needs to have a collaborative, collective leadership approach and commitment, which is supportive of the ‘Enhancing

Engagement’ agreement with the Unions. There is recognition that healthcare workers are struggling to provide quality care, due to unhealthy workplaces. There are also profound

impacts on the quality, effectiveness and efficiencies on patient/client safety, quality care, outcomes and experience through the health and wellbeing of the workforce. The Lucian

Leape Institute identify that we need to “…create urgency for action, and point the way forward for the future.” (2014, p.25).

The cost of inaction is high and as Simon Stevens the NHS England Chief Executive announced on the 2/9/15 a major investment of £5m in the health and wellbeing of the workforce:

“……. creating healthy and supportive workplaces is no longer a nice to have, it’s a must-do…”

2. What are the drivers? With Waitemata DHB recognised as the largest DHB from a population perspective, and as the fastest growing in NZ, it is in “… a phase of significant growth and transformation…” (Annual Plan (AP) 2015, p.9). This growth will present an economic and social landscape that will impact on the services we provide, as well as on our own workforce. Creating Healthy Workplaces at Waitemata DHB will significantly contribute to Waitemata DHB’s commitment to our organisational purpose, promise and values that guide’s direction. To enable the DHB to move forward will require a collective leadership approach where everyone takes responsibility for organisational success. In ‘Developing collective leadership for healthcare’, The Kings Fund identifies that “the most important determinant of the development and maintenance of an organisation’s culture is the current and future leadership” (2014, p.4). Leaders directly influence the workforce engagement, commitment and trust that will contribute to a need for flexibility, innovation and creativity necessary for the future sustainability of healthcare. “Our workforce is central to the delivery of key organisational priorities …” (AP 2015, p.94). With 70% plus of organisational costs attributed to workforce, there are clear business drivers that significantly influence sickness/absence; presenteeism and productivity; therefore increasing engagement is critical to ensure we can successfully ‘live within our means’. “We must be a financially sustainable and productive organisation …” (AP 2015, p.69). In healthcare there are inherent and increasing factors that impact on workforce health and wellbeing. With a predicted international shortfall of health professionals and global competition, there will be a need to retain and attract quality staff. It is well documented that there are significant effects impacting on the workforce, including: increasing workloads, constant change, stress, fatigue, burnout, low morale and job satisfaction levels. Internationally it is well recognised

‘Te Whare Tapa Wha’ (Health): Te taha wairua – spiritual health; Te taha hinengaro- psychological health; Te taha tinana – physical health and Te taha whanau – family health” (Mason Durie, 1982). The four cornerstones (or sides) of Māori health. This focuses on equal sides and strong foundations. (NZ Ministry of Health – Māori Health Models)

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that poor mental health, mainly anxiety and depression are set to become the leading cause of workplace absence and there needs to be a focused approach on improving the health and wellbeing of workers. For the DHB “With growth has come an increased organisation-wide focus on quality to continue to enhance patient safety and optimal health outcomes” (AP, 2015, p.9). There is a wealth of evidence-based literature that notes the critical interdependencies between an engaged workforce and staff health and wellbeing that will significantly impact on our ability to achieve this. Learning's from the Francis Report (2013) highlighted the need for an engaged, supported workforce with effective leadership to provide ‘good care’ for patients. Waitemata DHB’s two priorities for the next three years are identified as ‘Better Outcomes (for patients, whanau, clinicians, our staff and our population) and Enhance Patient Experience’, (AP, p.16). The HWP strategy is well placed to contribute towards meeting these priorities as noted in our Annual Plan, “With the support of our dedicated and focused workforce, we continue to approach each challenge…” (AP, 2015 p.10). With recent focus on long-term conditions, there is an opportunity for the DHB to lead by example in contributing to a public health awareness campaign through health promotion in the workplace. This could be multifactorial: through the healthy foods in the DHB’s; increasing opportunities for encouraging physical activities; focusing on national campaigns and other avenues as identified by the workplace. It is acknowledged that the workplace is second to education in importance of transferring knowledge to populations. With the new Health and Safety legislation to the Health and Safety at Work Act (2015) in place since April 2016, there are greater responsibilities placed at all levels of the organisation to provide a safe and healthy environment. There is recognition that this is not only looking at the physical environment, but also at the psychosocial work organisation as it is identified by Stedlatschek the “Psychosocial risks represent one of the key priorities in health and safety in the modern workplace…” (van Stolk et al. 2012, p.7). Healthy Workplaces will contribute to Waitemata DHB’s commitment to monitor our risk management practices (AP 2015, p.89) and building capacity through supporting national campaigns and working with other agencies.

3. What are the benefits? Waitemata DHB will become renowned as a workplace that cares for their staff with improved patient/client safety, quality of care, outcomes and experience. Fostering HWP practices through a values led, collective leadership will become the norm at all levels of the business, engaging with the workforce and collaborative work with Unions. The literature notes the following benefits of creating a healthy workplace are far reaching and at multiple levels:

Patients/clients, family and whanau: improved quality and safety of service, care, outcomes and experience; less incidents and meaningful interactions with an engaged workforce

Individuals: improved personal health and wellbeing and resilience; increased engagement with being valued, respected and higher job satisfaction and productivity, morale, trust, meaning and purpose

Teams: increased cohesion and effectiveness of teams leading to better outcomes; creating supportive learning and valued environments that increase productivity whilst fostering collaboration, creativity and innovation

Organisation: Increases: quality and safety of care, outcomes and experience for patients/clients; productivity; engagement; collaborative work; trust; staff health and wellbeing; industrial relations; creativity and innovation; attraction of a quality workforce and contribution to MoH high level outcomes and reputation of the DHB Decreases: sickness/absence; presenteeism; recruitment and retention costs; incidents patients/clients + staff

Community & society: contribution to improving the health and wellbeing of society towards the MoH high level outcomes and social determinants of health and increases trust in the healthcare system

Economy: contributes to affordable, sustainable, safer healthcare provision and overall a productive society

***Specific benefits in the action plan are noted for each activity***

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4. What are the enablers and alignments? Using the WHO HWP framework and model, ensures a holistic, strategic, quality improvement approach that is becoming more widely used and recognised internationally. The framework aligns well with Te Tiriti o Waitangi and the Maori model of health ‘Te Whare Tapa Wha’ (Durie, 82), and will ensure alignment and integration into every part of the business. Providing a platform for recognition and acknowledgement of the great work that we have started and begin to connect the dots throughout the organisation will enhance the WHO approach and working collaboration with the Unions ensures commitment to the ‘Enhancing Engagement’ agreement. Through a commitment by leadership to support and endorse the HWP strategy, the DHB will ensure demonstration of the organisational commitment, upholding Waitemata DHB’s purpose, promise and values. The National Institute for Health and Care Excellence (NICE) endorses this leadership commitment where they identify that organisations need to “Make health and wellbeing a core priority for the top management of the organisation. Value the strategic importance and benefits of a healthy workplace.” (2015, p.6) They go on to identify that this is essential to “ensure all managers in the organisation, including directors and board members, are committed to the health and wellbeing of their workforce and act as good role models” (2015, p.6). Collective leadership will give recognition to the critical role everyone plays, especially that of the line managers, and how the role is recognised and supported. With a focus on a commitment to improving the health and wellbeing of our populations which are inclusive of the workforce, the strategy will align with the NZ Ministry of Health’s (MoH) Statement of Intent (2015-2019): “New Zealanders live longer, healthier and more independent lives; the health system is cost effective and supports a productive economy”. To support these there are a number of high-level outcomes in addition to including a multi-faceted strategy that are inclusive of “maintain wellness for longer by improving prevention; improve the quality and safety of health services and strengthen the health and disability workforce” (MoH, 2015). In addition reference is also made to the Northern Regional Health Plan and other associated work (AP 2015-16, p.18-19). Waitemata DHB strives “… to be a good employer at all ages and stages of our employee’s careers” and provided varying supporting programmes that are inclusive of “…management,

leadership, professional development and healthy workplaces….” (AP, 2015-16, p.69). In addition the strategy is aligned with: the Values programme; the Waitemata DHB Experience

programme; Waitemata DHB’s Risk Management practices; the current Security Review and Community Engagement frameworks. Leadership and leadership development to support

patient experience and outcomes is a key priority for the DHB and is supported through our care redesign/transformational care, care standards career development training and self-

management skills (e.g. specific clinical skills, leading our values, aspiring managers, diversity training, Bullying and Harassment prevention, cultural diversity, managing diverse teams)

and the ward accreditation programmes.

The strategy also supports the DHBS other developmental programmes including the GROWTH Coaching, Pacific Health Science Academies at Waitakere College and Onehunga High School the Rangatahi programme, Health Scholarships and the supported recruitment programmes for Maori and Pacific Health Care assistants, and Nurses who have been out of practise for more than 5 years.

5. What is the supporting evidence base? WHO identify that creating healthy workplaces is the smart, legal and right thing to do. “The wealth of the business depends on the health of workers” (Neira, 2010 p.ii). There is now an abundance of supporting evidence from all disciplines noting the critical interdependencies of the importance of creating healthy workplaces in healthcare. It is essential to look holistically, strategically and use an evidence-based approach. The evidence shows clear links of a positive engaged workforce to positive outcomes for the workforce, the patients or clients, organisational outcomes, society and the economy. There is a clear call for action to be taken at all levels in creating healthy workplaces in healthcare. Governments, policy makers, researchers, educators, managers, clinicians, all staff and the public have parts to play. The sustainability of healthcare is dependent on resources, staff and outcomes. Nicklin and Barton (2007) identify that “the need for a strong focus on a healthy work environment is increasingly acknowledged and respected as fundamental to the provision of safe, effective healthcare” (QWQHC, 2010, p.59). This is reinforced by a large multi-method study looking at culture and behaviour in the UK NHS and reported in the BMJ Quality and Safety Journal,

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where they identify that “Organisations need to put the patient at the centre of all they do, get smart intelligence, focus on improving organisational systems, and nurture caring cultures by ensuring that the staff feel valued, respected, engaged and supported” (Dixon-Woods, M. et al, 2014, p. 1). The Kings Fund identifies that best practice shows it is through Collective Leadership, which means “… everyone taking responsible for the success of the organisation as a whole, will lead a way forward”. In healthcare this ensures there is “…. collective responsibility for delivering safe, high quality and compassionate care …” with all staff adopting leadership capabilities in their roles (West et al; 2014, p.4). NICE highlight in the ‘Workplace policy and management practices to improve the health and wellbeing of employees’ (2015) to improve the health and wellbeing of employees, the organisation needs to evidence healthy workplace practice and for this to be seen as a core organisational priority with a focus on leadership, organisational culture and the critical role of line managers. Improving engagement is crucial for improving organisational performance.

A number of prominent healthcare focused organisations are showcasing the way: The Lucian Leape Institute (2013) identify that we have been missing workplace safety as an indicator or organisational culture impacting on patient safety. “If we expect the health care workforce to care for patients, we need to care for the workforce” “Workplace safety is also inextricably linked to patient safety” (p.1) The Point of Care Foundation (2014) identify that: “Staff engagement is a function of good management and teamwork, staff satisfaction and staff health and wellbeing. These are, in turn, related to a number of aspects of clinical quality, patient experience and productivity and costs. Staff wellbeing, for example is an important antecedent of patient care performance” (p.12) The Royal College of Physicians (2015): ‘Work and wellbeing in the NHS: why staff health matters to patient care’ highlight a number of 10 key points that trusts, health boards, commissioners, governments and physicians need to focus on as a priority.:

“High quality patient care relies on motivated and skilled staff who are not only physically and mentally well enough to do their jobs, but also feel valued, well supported and engaged” (p.3) “Far from being a discretionary luxury at a time of unprecedented financial and clinical pressures, investment in staff health is more crucial than ever to enable value-for-money, sustainable services and high-quality patient care” (p.7) “There is an inextricable link between levels of engagement and wellbeing amongst NHS staff, and the quality of care that those staff are able to deliver” (p.10) The Francis Report (2013) highlighted the need for an engaged, supported workforce with effective leadership to provide ‘good care ‘for patients’. The Royal College of Nursing recent release of the ‘Healthy Workplace toolkit – Healthy workplace, healthy you’ (Sept, 2015) identify that for nurses to deliver the highest standard of nursing care, it is essential to create the best working conditions. These look at five domains: work-life balance; dignity at work; health and safety; job design and learning and development (p.4). NHS Employers ‘Creating healthy NHS workplaces’ toolkit (Sept, 2015) identifies that “Maintaining and improving the health and wellbeing of NHS staff is fundamental to achieving high quality, safe and compassionate care” (p.3). They discuss how Dr Steve Boorman in 2009 in a review of the NHS staff, “…recognised that the health, safety and wellbeing of staff directly contributes to organisational success and effective patient care” and how it is essential at a board level, ward level and is the responsibility of every staff member (p.4). There is growing recognition of the importance of addressing the psychosocial risk factors in the workplace as they are a determinant of outcomes at multiple levels. There is a growing body of measures of a healthy workplace but as noted by Lowe (2006), there are no best practise measures. Instead Lowe encourages businesses to use existing data mixed with some evaluation measures.

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New Zealand has limited but growing levels of evidence in the recognition of the importance of creating healthy workplaces. Working well is known in the health sector

from the Safe Staffing and Healthy Workplaces Unit, and workload planning via a patient acuity tool links the importance of work to wellbeing. Position statements from the Australasian Faculty of Occupational and Environmental Medicine are focussed on key aspects of ‘good work’ for healthy workplaces. Discussion is growing however as is support for employers to develop a healthy workplace, for example: the first conference re this was run by the Health Promotion Agency (HPA) and they have a ‘Wellplace’ website that encourages discussion about wellbeing at work as well as sponsoring forums. There are now other conferences in NZ around ‘Healthy Work’; Wellness in the workplace – Policy and practice (Oct 16) and the inaugural ‘Good Work Steering Group’ that is cross government and organisations (set for 18th August 2016) being promoted. In addition there was the Southern Cross survey ‘Wellness in the Workplace’ on health and wellbeing which was run in 2015. We still have a long way to go in terms of longitudinal research based on New Zealand based studies, measures, benefits and interventions for healthy workplaces.

6. What are the opportunities? Waitemata DHB has the opportunity to lead the way in creating a HWP, where ‘walk-the-talk’ is clearly evident. Becoming a ‘values led’ and driven organisation, provides ideal opportunity for this innovative creative, holistic vision of creating a healthy workplace as envisioned in the WHO framework. This opportunity showcases good practice that is underpinned by a sound evidence base where the health and wellbeing of the workforce and the critical links to patient/client safety and quality as well as to business outcomes, become embedded into everyday practice and made a priority.

6.1 How are we going to build on creating HWP at Waitemata DHB? Through the Waitemata DHB HWP Steering Group and the PESTLE analysis, there has been the opportunity to look at best practice internationally and where Waitemata DHB sits with creating a HWP. A working party from the wider group, inclusive of the Unions identified no, partial or full matches and their criticality. Focusing on no or partial matches, an action plan has been developed for the next three years. This will need to be reviewed annually to ensure alignment with the organisational priorities and best practice. There will need to be some flexibility if there are identified priorities that differ from the plan. With an organisational commitment will begin the journey of creating a HWP, recognizing the great work already being undertaken and link these to the wider objectives.

6.2 What are the strategic objectives? To create a healthy workplace at Waitemata DHB that is strategic and holistic using the WHO Healthy Workplace model, quality improvement model To improve the health and wellbeing of the workforce and the organisation in alignment with WDHB’s purpose, promise , values and strategic directions To underpin healthy workplaces using the evidence base To have specific measurable actions that are targeted and aligned to the needs of Waitemata DHB To contribute to the improvement of the patient/client safety, quality of care, outcomes and experience To contribute to the sustainability of the healthcare workforce and healthcare itself

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6.3 What are the actions? Through the PESTLE analysis a few target areas were identified and prioritized as the basis for the Action Plan. These are ambitious goals and only through a collective leadership approach, with adequate resourcing will ensure successful outcomes. Although the actions are prioritized, there may be a flexible approach needed as some actions will integrate with others and priorities may change. These actions are divided into two phases:

Phase 1: Phase 2:

To increase workforce engagement through effective employee feedback and communication systems

To develop and promote positive age friendly working environments that supports best practice and our ageing workforce

To align with public health initiatives using evidenced-based practices that promote health and wellbeing

To provide a safe and healthy physical environment for all that use our facilities

To ‘connect the dots’ recognising and acknowledging the work across that DHB that contribute towards creating HWP using the holistic WHO HWP model

To develop a reporting structure that captures and demonstrates a commitment to creating HWP

To acknowledge and support existing work and to build shared understanding of workload management

To provide an interactive platform that acknowledges the great work we are doing in creating HWP and provides links to the evidence base

To provide a comprehensive communications plan that contributes to increasing awareness and understanding of HWP and the supporting activities to a wide audience

To promote good shift-work and fatigue management practises To foster effective teamwork practices that are known to improve outcomes at all

levels To be inclusive of and embrace diversity ( race, ethnicity, gender, sexual orientation,

socio-economic status, age, physical abilities, religious or political beliefs or other ideology) at all levels of the business

To evaluate if the DHB would benefit from achieving standard 4 – Promoting a healthy workplace – of the health promoting hospitals standards

To create an environment that fosters local healthy workplace practices and supports with opportunities, knowledge and practices

To develop a platform for linkages and networking opportunities for relevant and associated research

**See Appendix 1 for full details**

There is recognition that the Action Plan activities fit into different parts of the WHO HWP model sometimes in multiple areas as well as ‘business as usual’:

WHO Healthy Workplaces model DHB activities Leadership, ethics, values, worker engagement Engagement, feedback & communications; development of HWP measures; age friendly work environment;

stocktake of HWP initiates and activities; teamwork; communications plan; research & networking Personal Health Resources Health and wellbeing long term health conditions focus; website development Psycho-social work environment Teamwork; age friendly work environment; engagement, feedback and communications; shift work and

fatigue; engagement, workload management Physical work environment: Health and wellbeing – physical environment Community Engagement Diversity; Health Promoting Hospitals framework; research and networking

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7. Conclusion Waitemata DHB is leading the way through its commitment to supporting and recognising the need to create a healthy workplace. Through the development of this strategy as a quality improvement with regular review, will ensure that the work is kept alive and up to date with evidenced based practices. This will guarantee it is aligned to and able to inform strategic direction for the DHB using a collaborative and a collective leadership approach, inclusive of the Unions. We will use the WHO Healthy Workplaces definition and our action plan as a basis to ensure a holistic, strategic approach. This approach fits with the working definition of a ‘Healthy Healthcare Workplaces’ developed by the Quality Work Life Quality Healthcare Collaborative QWQHC: “A work setting that takes a strategic and comprehensive approach to providing the physical, cultural, psychosocial and work/job design that maximize health and wellbeing of health providers, quality of patient/client outcomes and organization performance “(2007,p.6)

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Appendix 1: Healthy Workplaces Action Plan

Phase 1: Starting 2016 Activities Key Leads Expected Benefit, Outcomes & dates Resources Engagement, feedback & communication

Aim 1: To increase workforce engagement through effective employee feedback and communication systems

As part of the PERSy programme of work:

Source and implement a technological platform to measure and report staff experience – aligned with patient experience reporting and Waitemata DHB Values and Behaviours

Establish a communication framework for reporting at all levels of the organisation

Develop a toolkit of guidelines and resources for managers to support action planning in response to opportunities for improvement.

Standards and behaviours campaign ‘Give and receive feedback’ + ‘Speak up for others’

Alignment with Patient Experience Programme e.g. just culture

Lesley Wildes David Price Workforce lead

Outcomes

Patient and Staff Experience System implemented by end 2016

First staff survey completed – October/November 2016

Integrated communication framework in place - 2017

Manager’s toolkit developed and available to support improvement opportunities for improved staff experience and engagement. End 2016

Benefits – regular staff feedback at an organisational and local workplace level through questions designed to let the DHB know of issues with staff engagement and culture so they can be addressed in a timely manner.

1.

16-17 Funded by PERSy Business Case

Ageing Workforce

Aim 2: To develop and promote positive age friendly working environments that supports best practice and our ageing workforce

To investigate and explore the impact of the ageing workforce. Pilot in Mental Health

Explore use of the Workability Index which is a way of identifying early stage health risks that might contribute to early retirement

To explore opportunities that will provide financial education with a focus on retirement planning suitable to our needs

To investigate other opportunities for retirement planning in general

Blair Nugent Janice Riegen Blair Nugent Union Rep Janice Riegen Blair Nugent

Outcomes

To have a greater understanding of the issues and the applicability to the wider organisation

To develop a set of ideas for consideration for the Mental Health Service and use their learning's

Have a greater understanding of what this is and how it might be used to support our ageing workforce

To provide relevant retirement planning information to our workforce Benefits 1. Tailored suggestions for creating an age friendly workplace and test which approaches makes a difference 2. Provision of information on financial security in retirement which contributes to a government goal that all NZer’s plan for their retirement

$4000 per annum for 16/17 No cost No cost initially

1 A meta-analysis by Gallup Organisation done in 2013 estimates that highly engaged organisation can reduce turnover, absenteeism and boost productivity by 20-40%

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Phase 1 continues Activities Key Leads Expected Benefits, Outcomes & dates Resources Health & wellbeing: Chronic conditions awareness: focusing on +ve mental health, Lifestyle risks assessments + 2. Improved physical environments

Aim 3: To align with public health initiatives using evidenced-based practices that promote health and wellbeing

To provide opportunities to improve positive mental health for staff through recommendations from evaluations of the pilots re Mindfulness and Wellbeing

To evaluate existing data collected from CVD + Diabetes risk assessments with Funding & Planning

To explore healthy lifestyle assessment opportunities with Funding & Planning (x100)

To create a toolbox of online resources

To create & support health promotion opportunities with the Well@Work group as identified and funding available

To evaluate ‘ How are you feeling’ NHS Employers toolkit for its potential usefulness in our environment

Put in place phase one of the SMO Wellbeing plan

Kathryn Scott Janice Riegen Dr Gavin Pilkington Janice Riegen & Funding & Planning lead Gillian Purkis Janice Riegen Communications Janice Riegen Gillian Purkis Janice Riegen Leanne Catchpole Maggie O’Brien Gillian Purkis Roslyn Norrie Rebecca McLean

TBA – Clinical lead

Fiona McCarthy Dr Courtenay Kenny Dr Michael Rogers Naomi Heap

Outcomes

Continue with mindfulness and wellbeing sessions which have been supported by the evaluations of the pilots

Funding & Planning to work with OH&SS for evaluations by end of 2016

Feasibility action plan by end of 2016 for 100 lifestyle assessments

To make available health and wellbeing information links to evidence based information for all of our workforce to access

Encourage & support local & current initiatives , inclusive of gym

Team Walking Challenge (1000)- Sept 2017

To sponsor a DHB fitness event (entry, T shirts and BBQ x1000) already arranged via Sport Waitakere and Sport Auckland – summer 2019

Wellbeing Expos March 2017 and March 2019

Walking, running, biking groups- summer for 4 weeks

Discuss learn to kayak, windsurf, paddle board with Lake Pupuke Club

Waka Ama sponsorship (Dragon Boating) opportunity

Corporate sponsorship of squash club

Investigate promotion opportunities with local sports groups & stars

Support regional and national healthy food and drink initiatives

Contribute to our local information available for staff

Consider feasibility of using this & make recommendations

Phase one of the SMO Wellbeing plan – GPs, CVD checks, age related screening reminders, grief counselling

Benefits

To raise awareness and promote healthy lifestyles for our workforce

To promote engagement and health promotion opportunities in house

To develop relationships through community groups.

SMOs, who tend to be in the older age bracket have a personal health assessment and undertake associated health related actions to ensure they are aware of health status and maintain health and fitness for work.

16/19: Mindfulness x 2; Wellbeing x 6 + Evaluations = $15000p.y No cost 17-19 $5000 16/17 - $3000 student internship No cost + gym budget 16/17: $30000 & 18/19 $30000 17-19 $10000 pa No cost 16/17$2000 16-19 $2000 16-19 $2000 No cost No Cost 16-19 $5000

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Phase 1 continues Activities Key Leads Expected Outcomes & dates Resources Health & wellbeing cont: Improved physical environments

Aim 4: To provide a safe and healthy physical environment for all that use our facilities

Creation of the Health, Safety & Wellbeing (HS&W) committee

To ensure all areas of WDHB are aware of the Design, Construction and Renovation policy, inclusive of the 2025 leads

To highlight & increase visibility of slips, trips & falls; violence + manual handling

To consider using the 6s workplace assessment tool

Margaret Kamphuis & Fiona McCarthy Michael Field Michael Field Anne McMahon Brendon Lane Joanna Barnes – Links with the Institute for Innovation & Improvement

Outcomes

To bring together health, safety and wellbeing risk management through engagement and participation. Group will be set up and active by May 2016

To educate and promote H&S responsibilities in design, construction & renovation at all levels

To develop specific H&S sign off responsibilities

To raise awareness of these risks through active promotional activities

Pilot the 6s tool in an identified workplace Benefits

to increase engagement and participation with health, safety and wellbeing accountability and actions in the organisation

to increase visibility and use of healthy and safe design principles to reduce accidents caused by manual handling or inattention errors

No cost No cost No cost No cost No cost

Stocktake of HWP initiatives/activities across the DHB

Aim 5: To ‘connect the dots’ recognising and acknowledging the work across the DHB that contributes towards creating HWP using the holistic WHO HWP model

Complete stocktake using existing knowledge of activities, initiatives throughout DHB, integrate into WHO HWP Model

Send to all business areas to capture the breadth

To share and acknowledge through the identified interactive platform

Communication of stocktake findings

Janice Riegen Fiona McCarthy Michael Field Maggie O’Brien

Outcomes

To provide an overview of Waitemata DHB’s activities that are contributing towards a HWP by March 2017

Identify work that should be shared further and/or incorporated into the healthy workplaces strategy

Benefits

To acknowledge, value and share the good work and encourage others areas to link to existing knowledge

To showcase our healthy workplaces work via relevant forums

To contribute to NZ knowledge base on healthy workplaces

No cost

Development and reporting of HWP Measures

Aim 6: To develop a reporting structure that captures and demonstrates a commitment to creating HWP

Develop a framework of HWP measures

Fiona McCarthy Lifeng Zohu David Price Quality lead

Outcomes

Develop and report on workplace indicators for success by March 2017 (*dependent on engagement survey timeframes)

Benefits

Establish our own benchmarks on measures of success of a healthy workplace

Measure the value of our action plan over time

Contribute to the global conversation on measures on suitable healthy

workplace measures and interventions

No cost

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Phase 1 continues Activities Key Leads Expected Outcomes & dates Resources Workload management/organisation

Aim 7: To acknowledge and support existing work and to build shared understanding of workload management

To support a shared language and good practice guiding principles on workload management

Support existing workload management networks

Jos Peach Tamzin Brott NZNO Organiser Brendon Lane

Outcomes

DHB has a shared understanding of workload management and can apply a set of principles to workload issues

Benefits

Networks feel supported by issues/actions being discussed and progressed

No cost

Website development

Aim 8: To provide an interactive platform that acknowledges the great work we are doing in creating HWP and provides links to the evidence base

To investigate development of website

To undertake scoping of potential content

To explore opportunity for student intern

Communications Janice Riegen Student

Outcomes

Provide an interactive evidenced base platform by July 2017 Benefits

Knowledge transfer is a cornerstone of the healthy workplaces strategy

16-17:$3000

Communications Plan

Aim 9: To provide a comprehensive communications plan that contributes to increasing awareness and understanding of HWP and the supporting activities to a wide audience

To develop a specific plan, that supports the activities than have been endorsed by SMT and the Board

To develop a graphic representation

Communications Janice Riegen Michael Field

Outcomes

There will be a greater understanding of the healthy workplaces strategic objectives and associated activities

Will provide a simple key framework to work from Benefits

A wider understanding of the key messages for Healthy Workplaces and what Waitemata DHB are doing towards this

No cost

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Phase 2: starting 2017 Activities Key Leads Outcomes & Dates Resources Shift-work and fatigue

Aim 10: To promote good shift-work and fatigue management practises

To investigate available best practice

To review the OHSA + RCN nursing guidelines for shift work

Assessment of and promotion of the Massey University on line fatigue management training for RMO’s

Jos Peach Naomi Heap NZNO Organiser Gillian Purkis Kathryn Scott

Outcomes

Develop & provide access to good shift work/fatigue management guidelines

Assess the suitability of the Massey University’s on line fatigue management training for the wider DHB. If training is suitable, to fund x100 sessions for relevant staff

Benefits

To empower self-management/care

To promote the use of available evidence to support good shift work practises

Using sustainable on line technologies to provide knowledge to staff

17/18 - $6000

Teamwork

Aim 11: To foster effective teamwork practices that are known to improve outcomes at all levels

To promote the use of the existing DHB teamwork education

Develop effective teamwork through upcoming values campaigns related to the ‘Teamwork Standard’

Kathryn Scott Sue Christie Maggie O’Brien

Outcomes

Increase usage of existing teamwork learning opportunities

Work with a range of stakeholders to increase team effectiveness

Benefits

Teamwork is supported as a contributor to the board priorities

Increase engagement, performance, support and communication within teams

No cost

Diversity

Aim 12: To be inclusive of and embrace diversity ( race, ethnicity, gender, sexual orientation, socio-economic status, age, physical abilities, , religious or political beliefs or other ideology) at all levels of the business

To investigate the feasibility of a Diversity Stocktake

To identify and utilise key areas of expertise, such as Diversity Works NZ (EEO Trust) & the UK Equality Act 2010 guidance

Review all recruitment and employment policies and make recommendations to improve inclusion and employment opportunities

Link with Institute of Innovation and Improvement for development of e-CALD resources for workforce

Support “Grow our own” Maori and Pacific workforce development, leadership and retention initiatives

Flexi work policies

Fiona McCarthy Jenny Parr Samantha Dalwood Vanessa Aplin Jay O’Brien Sue Lim Workforce Development

Outcomes

To identify key areas of focus for the organisation

To utilise best practice guidelines

Staff are provided with guidance on undertaking carer responsibilities

Continue to raise awareness of cultural and linguistic diversity

WDHB will have continue to have a focus on growing our own Maori & Pacific workforce

To be aligned to the NZ Disability Strategy and the Waitemata DHB/ADHB Strategies

Fully inclusive HR policies that support the employment of disabled people

The DHB has data on the disability status of its staff

Recommendations for moving forward for central HR funding supports for staff with impairments (rather than funded by services)

No Cost 17/18 - $10000

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Phase 2 (cont.): starting 2017

Activities Key Leads Outcomes & Dates Resources

Diversity - Cont.

Aim 12: Cont. To support and link with the Disability Strategy to ensure a coordinated approach:

Collect data on staff with disabilities Work with hiring managers to increase disability awareness

Working with HR to identify those with disabilities

Investigation into the development of central HR funding for any adaptations needed for staff with disabilities

Benefits

WDHB will become a workplace that celebrates diverse environments that values, supports and contributes to people being valued and safe whilst supporting them to contribute to their full potential

The DHB has an understanding on the number of staff with disabilities, what those disabilities are and how we can better support a healthy workplaces for these staff

The DHB has a positive employment diversity and inclusive environment

Health Promoting Hospitals (HPH) Standards

Aim 13: To evaluate if the DHB would benefit from achieving standard 4 – Promoting a healthy workplace – of the health promoting hospitals standards

Review evidence and determine if standard would be beneficial for Waitemata DHB

Undertake self-assessment and other actions based on review findings, and formulate an implementation plan

Public Health Lead – Funding & Planning Clinical Lead David Price Monique Veza

Outcomes

To make recommendations on the value of achieving standard 4 of the Health Promoting Hospitals standards in the context of Waitemata DHB

Benefits

Achieving a global standard in health promotion – the standard is part of a number that make up the health promoting hospitals standards

Integrating health promotion into the daily life of the DHB

No cost

Support for local areas developing Healthy Workplace activities/initiatives

Aim 14: To create an environment that fosters local healthy workplace practices and supports with opportunities, knowledge and practices

To identify ways that local teams can establish their own healthy workplace initiatives

To develop mechanisms to enable this to happen

To link in with existing Waitemata DHB activities

Promote the DHB as having a point of difference

Michael Field Monique Veza

Outcomes

A programme to assist local teams to develop their own healthy workplace initiatives

Benefits

Sharing of good practice

Raise awareness of HWP practices

Local leadership and ownership for making own work environments a healthy workplace

Recruitment and retention

18/19 - $10,000

Development of research and networking opportunities

Aim 15: To develop a platform for linkages and networking opportunities for relevant and associated research

Link with Institute of Innovation and Improvement to identify research and networking opportunities between healthy workplaces and patient experience.

Link with Universities and other international leads in Healthy Workplaces to develop relationships and share findings

Jay O’Brien David Price Janice Riegen

Outcomes

Demonstrate the critical interface of patient and staff experience and the links to improved patient outcomes

Development of networks to share knowledge, experience and the potential for ongoing research opportunities

Benefits

WDHB will be leading by example and bring a NZ perspective to the evidence base

No cost

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Of Note:

This plan needs to be flexible and adaptable to suit the needs of Waitemata DHB as identified

It is recognised that Phase 1 & 2 activities may well change or need to span different time periods

In some areas, ‘no cost’ is identified, but this may change as further investigation and recommendations are realized

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Appendix 2: Healthy Workplaces Logic Model 3.2

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Appendix 3: References

Black, C, (2012). Personal communication

Black, C. (2015) Health and Wellbeing at Work Conference Programme, 2016: Keynote introduction : http://healthwellbeingatwork.co.uk

Boorman, S. (2009a). NHS Health and Well-being Review. Interim Report. Leeds: Department of Health: http://www.nhshealthandwellbeing.org/InterimReport.html

_____. (2009b). NHS Health & Wellbeing Final Report. Leeds: Department of Health: http://www.nhshealthandwellbeing.org/FinalReport.html.

Dixon-Woods, M., Baker, R., Charles, K., Dawson, J., Jerzembek, G., Martin, G., … West, M. (2014). Culture and behaviour in the English National Health Service: overview of lessons from a large multi-method study. BMJ Quality & Safety, 23(2), 106–15. doi:10.1136/bmjqs-2013-001947 http://qualitysafety.bmj.com/content/early/2013/08/28/bmjqs-2013-001947.short

Durie, M. (1998 ). Whaiora. Maori health development (2nd ed.). Oxford: Oxford University Press.

Francis, R. (2013). Report of the Mid Staffordshire NHS Foundation Public Enquiry. United Kingdom: The Stationery Office on behalf of the Controller of Her Majesty's Stationery Office.

Lowe, G.S. (2006). Making a Measurable Difference: Evaluating Quality of Work Life Interventions. Submission prepared for the Canadian Nurses Association. http://www.cna-aiic.ca/~/media/cna/page-

content/pdf-fr/quality_workplace_indicators_e.pdf

Ministry of Health (MoH) 2015: Statement of Intent: http://www.health.govt.nz/publication/statement-intent-2015-2019).

Ministry of Health (MoH): Maori Health Models: http://www.health.govt.nz/our-work/populations/maori-health/maori-health-models/maori-health-models-te-whare-tapa-wha

National Institute of Health and Clinical Excellence. (2015). Workplace policy and management practices to improve the health and wellbeing of employees. https://www.nice.org.uk/guidance/ng13/resources/workplace-health-management-practices-1837269751237

NHS Employers. (2015). Creating Healthy Workplaces. http://www.nhsemployers.org/news/2015/09/creating-healthy-workplaces-a-toolkit-for-the-nhs

Nicklin, W., & Barton, M. (2007). CCHSA Accreditation: A change catalyst toward healthier work environments. Healthcare Papers: New Models for the New Healthcare, 7 (Special Issue), 58-63. Retrieved from

http://www.ncbi.nlm.nih.gov/pubmed/17478996

Ontario Health Quality Council. (2010). A Framework for Public Reporting on Healthy Work Environments in Ontario Healthcare Settings. Retrieved from www.ohqc.ca/

Point of Care Foundation. (2014). Staff care. Staff care: how to engage staff in the NHS and why it matters. Retrieved from www.pointofcarefoundation.org.uk/Downloads/Staff-Report-2014.pdf

Quality Worklife Quality Healthcare Collaborative (QWQHC). (n.d). The power to act. Ottawa: Quality Worklife Quality Healthcare Collaborative (QWQHC). Retrieved from

http://www.qwqhc.ca/documents/QWQHCPowertoAct2011_Eng.pdf

Quality Worklife Quality Healthcare Collaborative (QWQHC). (2007). Within our grasp. A healthy workplace action strategy for success and sustainability in Canada's healthcare system: Quality Worklife Quality

Healthcare Collaborative (QWQHC),. Retrieved from http://www.accreditation.ca/uploadedFiles/2007%20QWQHC%20Within%20Our%20Grasp.pdf

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http://healthwellbeingatwork.co.uk/

http://www.nhshealthandwellbeing.org/InterimReport.html

http://www.nhshealthandwellbeing.org/FinalReport.html

http://qualitysafety.bmj.com/content/early/2013/08/28/bmjqs-2013-001947.short

http://www.cna-aiic.ca/~/media/cna/page-content/pdf-fr/quality_workplace_indicators_e.pdf

http://www.cna-aiic.ca/~/media/cna/page-content/pdf-fr/quality_workplace_indicators_e.pdf

http://www.health.govt.nz/publication/statement-intent-2015-2019

http://www.health.govt.nz/our-work/populations/maori-health/maori-health-models/maori-health-models-te-whare-tapa-wha

https://www.nice.org.uk/guidance/ng13/resources/workplace-health-management-practices-1837269751237

http://www.nhsemployers.org/news/2015/09/creating-healthy-workplaces-a-toolkit-for-the-nhs

http://www.ncbi.nlm.nih.gov/pubmed/17478996

http://www.ohqc.ca/

http://www.pointofcarefoundation.org.uk/Downloads/Staff-Report-2014.pdf

http://www.qwqhc.ca/documents/QWQHCPowertoAct2011_Eng.pdf

http://www.accreditation.ca/uploadedFiles/2007%20QWQHC%20Within%20Our%20Grasp.pdf


Appendix 3: References continued

Royal College of Nursing - RCN. (2015). Healthy Workplace Toolkit. Retrieved from http://www.rcn.org.uk/__data/assets/pdf_file/0004/640588/Healthy-Workplace-Toolkit.pdfRoy

Royal College of Physicians. (2015). Work and wellbeing in the NHS : why staff health matters to patient care. https://www.rcplondon.ac.uk/sites/default/files/work-and-wellbeing-in-the-nhs.pdf

Stevens, S. (2015) NHS England » Simon Stevens announces major drive to improve health in NHS workplace. ttp://www.england.nhs.uk/2015/09/02/nhs-workplace/

Southern Cross Health Society, & Business NZ. (2015). Wellness in the Workplace. Retrieved from https://www.businessnz.org.nz/__data/assets/pdf_file/0013/108400/Wellness-in-the-Workplace-Survey-Report-2015.pdf

The Lucian Leape Institute. (2013). Through the eyes of the workforce: Creating joy, meaning, and safer health care. National Patient Safety Foundation, 1–43. Retrieved from http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Through+the+eyes+of+the+workforce:+Creating+joy,+meaning,+and+safer+health+care.#0

van Stolk, C. et al. (2012). The Management of Psychosocial Risks Across the European Union: Findings from ESENER. Contemporary Occupational Health Psychology: Global Perspectives on Research and Practice (Vol. 2). doi:10.2802/92077 https://osha.europa.eu/en/tools-and-publications/publications/reports/drivers-barriers-psychosocial-risk-management-esener

Waitemata District Health Board. (2015). 2015/16 Annual Plan. http://www.waitematadhb.govt.nz/DHB-Planning/Organisation-Wide-Planning/Annual-Plan

Waitemata District Health Board – Community Engagement Strategy 2015

Waitemata District Health Board – Disability Strategy 2013-16

Waitemata District Health Board – Enhancing Engagement 2011

Waitemata District Health Board - Healthy Workplaces Strategy 2013-2014.

Waitemata District Health Board – Risk Management Strategy 2015

West, M., Eckert, R., Stewart, K., & Passmore, B. (2014). Developing collective leadership for health care. The King’s Fund, (May), 1–36. Retrieved from http://www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/developing-collective-leadership-kingsfund-may14.pdf

World Health Organisation, (WHO). (2010). Healthy Workplaces: a model for action. For employers, workers, policy-makers and practitioners. Geneva: WHO. Retrieved from

http://www.who.int/occupational_health/healthy_workplaces/en/

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http://www.rcn.org.uk/__data/assets/pdf_file/0004/640588/Healthy-Workplace-Toolkit.pdfRoy

https://www.rcplondon.ac.uk/sites/default/files/work-and-wellbeing-in-the-nhs.pdf

https://www.businessnz.org.nz/__data/assets/pdf_file/0013/108400/Wellness-in-the-Workplace-Survey-Report-2015.pdf

https://www.businessnz.org.nz/__data/assets/pdf_file/0013/108400/Wellness-in-the-Workplace-Survey-Report-2015.pdf

http://scholar.google.com/scholar?hl=en&btnG=Search&q=intitle:Through+the+eyes+of+the+workforce:+Creating+joy,+meaning,+and+safer+health+care.#0

https://osha.europa.eu/en/tools-and-publications/publications/reports/drivers-barriers-psychosocial-risk-management-esener

http://www.waitematadhb.govt.nz/DHB-Planning/Organisation-Wide-Planning/Annual-Plan

http://www.who.int/occupational_health/healthy_workplaces/en/


3.3 Communications Report Recommendation: That the report be received. Prepared by: Matthew Rogers (Director of Communications)

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

Communications support for audit of facilities for presence of asbestos as required by health and safety legislation

Communications advice to Wilson Home Trust Committee of Management

Participate in regional emergency planning tsunami exercise

Opening of new Waitakere Hospital Emergency Department

Planning for launch of Community Health Plan

DHB end-of-year financial result – correct Radio NZ reporting

Hospital occupancy communications to primary care

CARE project communications in support of the Well Foundation

Filming of North Shore Hospital physiotherapy patient with Attitude Pictures

Review of Auditor-General’s report Health Sector: results of the 2014/15 audits

Reviewing proposal to promote Clinical Care app to staff

Communications support for Delirium Project

Communications support for DHB elections

Media relations around RDA roster negotiations

Preparations for a proactive media pitch on EDARS (Early Discharge and Rehabilitation Service)

Acknowledgement of the passing of Sir Graeme Douglas

Communications support for Digital Programmes Expo

Supported DHB’s involvement with NZ Blood Service’s “Missing Type” national campaign

Communications for Waitakere staff gym announcement

Communications support for Ministry of Social Development STEP initiatives

Development of ‘where should I go for healthcare?’ multi-channel campaign

Management of requests for assistance on university and school student assignments

Assistance with advertising placements for services

Oversight of the communications roll-out of the Our Health in Mind action plan

Coordination of 2016 CEO Lecture Series

Liaison with Well Foundation Marketing and Communications

Liaison with Waitakere Health Link

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

Proof read leaflets, booklets and brochures for various departments

Ongoing management of Official Information Act requests and responses

Management of requests to film on DHB sites

Ongoing social media strategy, activity and issues management

Responses to ‘Dear Dale’ email questions and comments from staff

Event photography

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Fortnightly CEO recognition award communications

Drafting of correspondence from the corporate office

Review of copy for DHB website

Planning September-October edition of Healthlines magazine

Planning for 2016 Yearbook

Management of requests from external organisations to place collateral in hospital foyers

Management of DHB general all-user screen saver content

Approval for all-user staff emails

Weekly Board briefing

Publications

The communications team published the following during the last six weeks:

July-August edition of Healthlines magazine (Issue 216)

Waitemata Weekly e-news bulletin to all staff

Boards - Mason team and duty

Booklet - Preparing for change CADS

Booklet - Ileo Pouch Anal Surgery

Booklets - Facilitator Guidelines CADS

Diagram - Integrated Maori Health Contracts

Diagram - Waitemata DHB Strategic Themes

Document - International Benchmarking of Asian Health Outcomes Report

Document - 2015-2016 Annual Report

Flipchart - Pregnancy and Parenting Programme Resource

Illustration - Net Promoter Score

Lapel badge - Health & Safety

Leaflet - Advanced heart failure

Leaflet - Advanced Lung Disease

Leaflet - Birth after Caesarean

Leaflet - Breast Changes After the Loss of Your Baby

Leaflet - Turning Your Breech Baby

Leaflet - Talking Immunisation for Midwives

Maps - update North Shore Hospital and Waitakere Hospital

Maps - MRI location

Poster – Immunisation - Tell Us What You Think

Screensavers (2) - World Alzheimer’s Month (September)

Waitemata Weekly, emailed to all staff users

Fortnightly A Note From the CEO email to all staff

Weekly national health targets updated and communicated

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Waitemata DHB, Careers and Awhina websites – Google Analytics Statistics Waitemata DHB website

Number of visits July 2016 August 2016 Total visits to this site 42,026 43,321 New Zealand 39,516 40,700 Australia 769 778 United Kingdom 320 321 United States 315 339

Top areas July 2016 August 2016 Home page 16,893 18,199 Waitemata DHB staff page 20,539 18,619 North Shore Hospital 7,613 7,993 Waitakere Hospital 3,253 2,928 Contact us 1,340 2,013 Traffic sources July 2016 August 2016 Search traffic 71% 72% Direct traffic 21% 20% Referral traffic 8% 8%

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Careers website

Number of visits July 2016 August 2016 Total visits to this site 15,980 16,978 New Zealand 13,354 14,421 United Kingdom 777 744

Australia 514 585

United States 228 162

Canada 139 80

Awhina Health Campus website

Number of visits July 2016 August 2016 Total visits to this site 1,045 1,129 New Zealand 916 1,029 United Kingdom 77 29 Australia 10 8 United States 10 6

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Social media

Waitemata DHB Facebook page likes – 1971* Waitemata DHB Facebook star rating - 4.3/5 (172 reviews)* Twitter – 1599 followers* *As at 8 September 2016

OIAs received A total of 20 new OIA requests were received between 28 July and 6 September 2016:

A.King (Labour) - Number of qualified sonographers

B. Fraser (Green Party) - Domestic violence programme intervention evaluations

T. Dillane (North Shore Times) - Information in relation to fire truck stationed outside North Shore Hospital on the banks of Lake Pupuke

S. Wallace (NZ Aged Care Assoc) - Number of LTCF interRAI assessments completed by aged residential care providers

A. Beheshta - Kelston community pharmacy seeking demographic information on its local population

O. Hamed (APEX) - Needlestick injuries over the last five years

A. Marett (Labour) - Elective services funding and budget figures for 2015/16

D. Snelgar (HealthWEST) - Copy of the terms of reference and related correspondence in re an audit of HealthWEST Ltd in 2015

A. Marett (Labour) - Fundraising or charitable trusts used to fund projects

A. Marett (Labour) - Final actual amount of efficiencies achieved against budget for the year ending 30 June 2016

U. Cranmer (Wilson Home Trust Family Action Group) - Various information in relation to dis-establishment of co-ordinator roles at the Wilson Centre

C. Wallbridge - Request for oral health data for primary school children at three Glen Innes schools for July 2015-July 2016

S. Cotterall - Cost of abortions over the last year

A. Marett (Labour) - Information and any correspondence in relation to the elective recording/measuring of skin lesions and Avastin injections prior to 2011/12

J. Weekes (Fairfax Media) - The number of people admitted to hospitals and care facilities due to foreign objects since 2014

O. Hamed (APEX) - Staff flu vaccination rates by professional grouping

D. Biddle (Fairfax Media) - Data on mental health patients since 1996

A. Marett (Labour) - Mental health occupancy rate, bed numbers, growth numbers and staff resources

M. Rhodes (NZ Taxpayers Union) - Information in relation to board members including name, gender, remuneration and attendance

A. Marett (Labour) - Withheld Board papers and minutes of Three Harbours Health Foundation and NZ Health Partnerships

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Media Clippings 28 July - 5 September 2016

Positive +

Neutral 0

Negative -

Channel Auckland

Well said +

Devonport Flagstaff

Young joyriders crash cars near Esplanade 0

Dominion Post

Health ministry changes tack on tech +

Men in care deserve sex life: lawyer -

Men in care among most dangerous 0

Men unable to tell of alleged mistreatment 0

Listener NZ

Let’s get personalised 0

Mahurangi Matters

Calls for PPP agreement for public surgery in Warkworth 0

North Harbour News

Growing pains prompt rebuild +

Hospital expansion +

GPs best for health boards says doctor 0

Colourful knits for patients +

North Shore Times

Dr says vote for GPs 0

Community show addresses suicide 0

Doctors in mediation -

Distractions for patients +

Nor West News Brief

Family first for health trust 0

Waitakere Hospital’s ED doubles in size +

Roe making a marathon effort +

Election candidates revealed 0

Waitemata health board meets ministry targets +

NZ Doctor

GP’s action on methadone funding yields concessions from DHB chief +

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NZ Herald/Herald on Sunday/NZherald.co.nz/Weekend Herald

To keep or sell the rental 0

Donors, take a bow 0

I thought I was dying, says mum 0

Patients win bid to appeal smoking ban 0

NZ Nursing

Career Paths 0

Super city collaboration for better mental health 0

NZ Optics

Meet the … nurse practitioner 0

ADONZ and IOA at Visionz 2016 0

Otago Daily Times

Bowel-screening scheme for South in 2018 0

Don’t celebrate screening yet 0

Shortfalls show stress on system 0

Pharmacy Today

And the finalists are … +

Housing crisis affecting pharmacy 0

Hospital pharmacy performer +

Sunday Star Times / Sunday News

New Mum’s cancer battle 0

Media’s gastro break 0

Waikato Times

Trio suing over their treatment in state custody -

Western Leader

A journey of the heart 0

Roe makes big marathon effort +

Waitakere hospital expansion +

Special blanket helps baby Leon +

Hospital expansion +

Worst bar for ‘last drink’ 0

Conversations - Elections 0

Election candidates errors 0

Hammer attack 0

Meet DHB candidates 0

Waitemata DHB meets government targets +

TOTAL:

Positive + 17

Neutral 0 30

Negative - 3

Total items 50

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4.1 Waitemata DHB Owned and Operated Jetty - Lake Pupuke

Recommendation:

That the Board notes the report and:

a) Notes that a recent Health and Safety review has identified the Waitemata DHB owned and operated Jetty onto Lake Pupuke has been identified as a health and safety risk.

b) Endorses the proposed measures to reduce the risk to staff and public including: i. The use of signage at the entrance to and on the jetty.

ii. The provision of a security gate at the entrance to the jetty fitted with security card access.

iii. That a comprehensive communication plan will be implemented to explain these measured before they are implemented.

Prepared by: Nigel Ellis (General Manager, Facilities and Development) Endorsed by: Robert Paine (Chief Financial Officer and Head of Corporate Services), Fiona McCarthy (Director of Human Resources), Michael Field (Group Manager, Occupation Health and Safety Services) and Matt Rogers (Director of Communications)

1. Executive Summary This paper is to advise the Board of the outcome of a recent health and safety review, which has identified hazards present at the Waitemata DHB owned jetty which extends into Lake Pupuke and to seek endorsement of the proposed actions to mitigate the risks to the public and staff from these hazards.

2. Introduction/Background Waitemata DHB undertakes systematic health and safety assessments of all of its facilities in order to ensure the DHB provides a safe and healthy environment and to ensure compliance with legislation. A recent review of the lake from area has identified the jetty as a hazard and risk and the DHB is required to assess what can reasonably be done to minimize this risk. The DHB fire system requires supply of water from the lake to meet the required fire system water supply and flow for the North Shore campus. The pump house suction line extends out into the lake supported by the jetty. At the end of the jetty the pipe diverts downward into the lake to a level below the lowest expected lake levels.

The jetty is designed to support, protect and provide access to the suction pipe only and was not designed for general public or staff access to the lake. It includes a walkway platform approximately 1m wide and an access ladder for access to the water level. A wooden covered section at the extremity protects the pipe as it diverts downwards into the lake. There is no safety or handrails fitted to the jetty and it is narrow creating a sense of vertigo when walking along it.

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3. Risks/Issues The hazards identified by the review are as follows:

The jetty was only designed to access the suction pipe, is narrow and has no safety or handrails.

The wooden section at the end of the jetty is slippery and creates a fall hazard.

The water below the jetty is shallow, with rocks and debris for two-thirds of its length.

The water at the end of the jetty is deep. However, the suction pipe located at end of jetty creates a hazard to swimmers.

Hazards to swimmers or diving from jetty. Anyone using the jetty for lake access or swimming is therefore exposed to these hazards. Our knowledge of people accessing the jetty or the immediate lake front area of the jetty is based on observational reports and to the best of our knowledge includes the following groups:

Waitemata DHB staff casual access – the lake front area is frequently visited with occasional use of the jetty observed.

Waitemata DHB staff planned access – the jetty is accessed periodically for maintenance checks.

School children from the neighbouring Carmel College – children walk past the area daily and occasionally use the jetty.

Members of the public using the jetty for fishing - occasional use of jetty observed.

Swimmers – none have been observed recently.

4. Discussion

Given that the Health and Safety Work Act 2015 requires the controlling PCBU (Person Conducting a Business or Undertaking) to take reasonable measures to protect staff and public from hazards on its property, it is considered necessary that the DHB implements measures to protect people from the hazards associated with the jetty.

Various measures have been considered by the Health and Safety Committee and are set out below with a corresponding recommendation for the Board’s consideration:

Recommended actions

1. Add signage to inform of jetty hazards and danger to people. 2. Add suction protection to the end of pipe in the form of a sieve screen large enough to reduce

risk of entrapment by suction and signage for swimmers. 3. Add security gate to control access to jetty. Gate to be fitted with a magnetic lock controlled by

DHB swipe card on the land side and a push-button release on the lake side. 4. Implementation of appropriate risk management procedures whenever DHB staff and

contractors are required to access the jetty (already implemented)

Other options considered but not recommended

1. Upgrade the jetty to include safety handrail. This would involve the addition of suitable handrails along the length of the jetty. (Not recommended on the basis of efficacy and cost)

It was considered that whilst this would decrease risk of falling off the jetty, it would increase risk by promoting the potential for use of the jetty for activities such as swimming.

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5. Communications There is a high level of local interest in the lake given the significant natural habitat that we share with our neighbours. The DHB, as a good neighbour, would like to ensure we communicate with nearby residents ahead of any changes to jetty access arrangements coming into effect. The jetty has existed for a considerable number of years and is considered by many local users to be community infrastructure. It will be important to help the community understand why the Board has made any changes to access. Our communications should aim to inform lake-users about the reasons for restricting access and to avoid any surprises when the gate is installed. This would be achieved by proactively engaging with the community via the following means:

1. Direct email communications to local residents with whom the DHB was engaged following the leakage of diesel earlier in the year.

2. Proactive use of the DHB’s corporate social media channels, including close monitoring to ensure rapid responses to any concerns or queries raised.

3. Placement of information on the DHB’s website. 4. Communication to DHB staff via the Waitemata Weekly e-newsletter, distributed each Monday

to all employees. 5. Announcement to the local community via North Shore Times. 6. Preparation of key messages for the Head of Corporate Services and/or General Manager,

Facilities and Development in the event it is necessary to engage in media interviews. It is recommended that the effectiveness of the above communications be assessed before the gate is installed.

6. Conclusion The board is asked to endorse the implementation of the following proposed safety measures:

1. Signage at the entrance to the jetty and the end of the jetty to inform people of the dangers

and risks of using the jetty. 2. Add protection to the end of pipe to reduce the risk of entrapment. 3. Add a security gate to the entrance to the jetty fitted with a magnetic lock controlled by a

Waitemata DHB swipe card on the land side and a push button release on the lake side.

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5.1 Financial Performance Report

Recommendation: That the following performance reports for the month and attachments be received:

1 Financial Overview of the 2016/17 result 2 Financial Performance - DHB Arms 3 Financial Performance - Other Indicators / Trends 4 Capital Expenditure 5 Financial Position 6 Cash flow Position 7 Treasury

Prepared by: Rosemary Chung (Deputy Chief Financial Officer) Endorsed by: Robert Paine (Chief Financial Officer and Head of Corporate Services)

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1 Financial Overview of the 2016/17 result

For the month of July, the DHB result is a deficit of $1.153m against a budgeted deficit of $1.159m and is therefore $6k favourable to budget. The Provider arm is $4k favourable to budget, the Funder Arm is $1k favourable to budget and the Governance and Funding Arm is $1k favourable to budget. The result included achieving the savings targets of $1.8m in the month which represented a solid start to the financial year. The financial result for the month of July 2016 compared to the budget is summarised in the table below.

Comment on Major Variances Revenue Revenue is $1.366m unfavourable to budget. The variance relates to budget phasing which will be offset in August. Interest revenue is less $175k than budget reflective of a combination of the cash balance and the continuing low interest rates. Expenditure Overall expenditure was favourable to budget by $1.372m for the month. The key variances are summarised below: Personnel Costs ($3.219m favourable month) A significant contributor to the favourable variance is vacancies due to positions budgeted in the new financial year that have yet to be appointed.

WAITEMATA DISTRICT HEALTH BOARD

CONSOLIDATED STATEMENT OF FINANCIAL PERFORMANCE

($000's)

MONTH YEAR TO DATE

Actual Budget Variance Actual Budget Variance Forecast Budget Variance

REVENUE

Crown 133,114 133,221 (106) 133,114 133,221 (106) 1,598,785 1,598,785 0

Other 1,932 3,191 (1,260) 1,932 3,191 (1,260) 39,611 39,611 0

135,046 136,412 (1,366) 135,046 136,412 (1,366) 1,638,396 1,638,396 0

EXPENDITURE

Personnel

- Medical 13,076 14,416 1,340 13,076 14,416 1,340 177,050 177,050 0

- Nursing 18,938 19,850 912 18,938 19,850 912 228,632 228,632 0

- All ied Health 8,735 9,087 352 8,735 9,087 352 108,717 108,717 0

- Support 1,455 1,536 80 1,455 1,536 80 18,976 18,976 0

- Management / Administration 5,509 6,044 535 5,509 6,044 535 71,958 71,958 0

Total Personnel 47,713 50,933 3,219 47,713 50,933 3,219 605,333 605,333 0

Other

Outsourced Services 6,399 5,457 (942) 6,399 5,457 (942) 64,919 64,919 0

Clinical Supplies 9,506 9,437 (69) 9,506 9,437 (69) 110,600 110,600 0

Infrastructure & Non-Clinical Supplies 9,602 8,596 (1,005) 9,602 8,596 (1,005) 95,265 95,265 0

Funder Provider Payments 62,979 63,148 169 62,979 63,148 169 757,779 757,779 0

88,486 86,638 (1,847) 88,486 86,638 (1,847) 1,028,563 1,028,563 0

Total Expenditure 136,199 137,571 1,372 136,199 137,571 1,372 1,633,896 1,633,896 0

NET RESULT (1,153) (1,159) 6 (1,153) (1,159) 6 4,500 4,500 0

31 July 2016Reporting Date

FULL YEAR

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Variances in Personnel Cost categories were as follows:

Medical staff costs are favourable by $1.34m for the month of July. This favourable variance is due to vacancies and annual leave taken in line with school holidays. The favourable variance includes savings achieved of $400k.

Nursing staff costs are favourable by $912k for the month of July. The Provider services have continued to have a strong drive on monitoring overtime hours which has been a positive contributor to the variance. Annual leave taken over the school holidays has contributed, together with vacancies. The favourable variance is offset by unfavourable outsourced bureau costs to cover un-recruited vacancies and sick leave.

Allied Health staff costs were favourable to budget by $354k. For July, this is due to newly budgeted

approved positions yet to be recruited and vacancies.

Support staff costs are favourable by $80k for the month. This variance mainly relates to cleaners where the cost is offset by over spends in outsourced services.

Management and Administration staff costs are favourable by $535k. The finance team is currently completing a restructure and as a result, the favourable variance is offset in part by outsourced costs. The variance also includes un-recruited positions and savings.

Outsourced Services Costs ($942k unfavourable for the month)

The variance relates to positions to be recruited and vacancies which are covered by outsourced resources. This includes nursing bureau costs unfavourable by $267k and corporate contractor costs unfavourable by $172k. The variance also includes savings targets which have been met in other cost lines.

Clinical Supplies Costs ($69k unfavourable for the month)

The unfavourable variance comprises savings targets offsets against underspends in implants and prosthesis resulting from lower orthopaedic volumes. A number of procurement and supply chain initiatives are underway to achieve savings and contribute to mitigating price increases.

Infrastructure costs ($1.005m unfavourable for the month)

The key contributors to the variance include

General maintenance expenses in excess of the July budget of $168k were incurred.

Utilities costs for electricity and water in total resulted in an unfavourable variance of $67k.

Target Savings of $452k whilst unfavourable in infrastructure, were offset by savings in other expense lines.

Funder Provider Payments ($200k favourable for the month) Funder Provider payments as reported in the Consolidated Statement of Financial Performance table are inclusive of Funder payments to third party NGO providers as well as Funder payments to other District Health Boards through Inter District Flow expenditure. It does not however include payments made to the Waitemata DHB’s own Provider Arm. The $200k favourable variance is gross of corresponding additional Provider Arm payments of $100k that offset.

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2 Financial Performance - DHB Arms The financial performance for each of the DHB Arms for the month and the year is summarised in the table below, and the detailed Statement of Financial Performance by DHB Arm is attached to this report (Attachment 1).

2.1. Provider Clinical Services

The Provider Clinical services result for the month ended 31 July 2016 is $1.798m favourable to budget. The result represented a solid start to the financial year. This result included achievement of a savings target of $1.8m in the month. The key drivers of the services financial performance are summarised below. Medicine and Health of Older People The service is $791k favourable for the month ended 31 July 2016. The Medical and Health of Older People result is driven predominantly in three areas, firstly with increased annual leave taken by Medical personnel with an added consequence of lower clinical supply costs, particularly in Cardiology. Secondly, Nursing costs being driven by pipeline vacancies from the budget uplift. Lastly, Allied Health continues to remain favourable as a result of vacancies currently under recruitment. Medical bed occupancy was 106% of what it was in July 2015 and 101% of the current year bed plan. Surgical & Ambulatory Services

The service is $154k favourable for the month of July 2016. Contributing to the favourable position are savings associated with leave management around school holidays and uncovered vacancies. The service has under-delivered in July and as production increases and budgets for efficiency gains are realized, the financial result is anticipated to become very tight. Weekly financial review meetings have been initiated, the focus being around identification of financial risks and the early implementation of appropriate cost mitigations for any areas of overspend. Cost containment initiatives are embedded with on-going monitoring of patients to ensure timely discharge, inpatient beds will be closed as appropriate to contain costs. The new HR reporting series is now live and is affording better visibility of external agency and overtime hours, sick leave taken and the progress of active leave management plans for all staff. Cover


FINANCIAL PERFORMANCE BY DHB ARM

($000's) MONTH YEAR TO DATEActual Budget Variance Actual Budget Variance Forecast Budget Variance

REVENUEProvider Arm - Clinical Services 3,875 3,933 (58) 3,875 3,933 (58) 47,196 47,196 0 Provider Arm - Corporate & Support Services 66,762 67,875 (1,113) 66,762 67,875 (1,113) 815,952 815,952 0 Governance & Funding Admin Arm 1,054 1,081 (27) 1,054 1,081 (27) 12,969 12,969 0 Funder 128,593 128,688 (95) 128,593 128,688 (95) 762,280 762,280 0 Elimination (65,238) (65,165) (73) (65,238) (65,165) (73) 0 0 0 Consolidated 135,046 136,412 (1,366) 135,046 136,412 (1,366) 1,638,397 1,638,397 0

EXPENDITUREProvider Arm - Clinical Services 48,024 49,879 1,856 48,024 49,879 1,856 633,382 633,382 0 Provider Arm - Corporate & Support Services 24,144 23,463 (681) 24,144 23,463 (681) 229,766 229,766 0 Governance & Funding Administration 1,053 1,081 28 1,053 1,081 28 12,969 12,969 0 Funder 128,217 128,313 96 128,217 128,313 96 757,780 757,780 0 Elimination (65,238) (65,165) 73 (65,238) (65,165) 73 0 0 0 Consolidated 136,199 137,571 1,372 136,199 137,571 1,372 1,633,897 1,633,897 0

NET RESULTProvider Arm - Clinical Services (44,149) (45,946) 1,798 (44,149) (45,946) 1,798 (586,186) (586,186) 0 Provider Arm - Corporate & Support Services 42,618 44,412 (1,794) 42,618 44,412 (1,794) 586,186 586,186 0 Governance & Funding Admin Arm 1 0 1 1 0 1 0 0 0 Funder Arm - Own Provider/Governance 0 0 (0) 0 0 (0) 0 0 0 Funder 376 375 1 376 375 1 4,500 4,500 0 Elimination 0 (0) 0 0 (0) 0 0 0 0 Consolidated (1,153) (1,159) 6 (1,153) (1,159) 6 4,500 4,500 0

FULL YEAR

Reporting Date 31 July 2016

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models have been updated for all wards and theatres and coupled with the Bureau Booking system will afford better reporting and compliance of acuity cover and the standard hours rostered on the floor. Elective Service Centre The service is $4k unfavourable for the month of July 2016. The service has under-delivered in July, elective discharges are at 93% however it is noted that orthopedic joint volumes are tracking close to plan. Child Women & Family Services The service commenced the 2016/17 financial year with a $248k favourable July result. Revenue was $30k unfavourable as a result of fewer Child Rehab Inpatient bed days. This is expected to be a one off funding shortfall as referrals for the following months are looking substantially better. Personnel costs were $325k favourable driven by an increased uptake of annual leave in medical staffing along with a one off RMO annual leave adjustment. Allied Health was $123k favourable with vacancies across regional dental services expected to be filled over the coming months. Higher than anticipated spending in outsourced costs $56k associated with a need to source external nursing bureau staffing to cover unplanned leave along with outsourcing Urodynamic studies activity. Clinical were under spent largely due to the timing of processing orders for community based nursing services. A bulk order was placed in June resulting in reduced actual purchases for July against budget. Child, Women and Family Services continues to focus on identifying opportunities for further cost reductions within community based logistics, telecommunications plans, cleaning and repairs & maintenance contracts. The service has already realised cost benefits through annual leave reduction, pricing benefits on community nursing continence supplies, specific dental and maternity products. The introduction of the Kanban stock management system and scanning facilities across all inpatient wards and the creation of clinical supplies coordinator roles across North Shore and Waitakere Hospitals to reduce the risk of potential over ordering and purchasing errors along with a new more cost effective, efficient and less invasive model of care for Gynaecology patients are other strategies that are being embedded into the service. Mental Health Services The service finished favourable to budget after July by $478k. Key drivers include the impact of vacant medical and nursing posts $435k favourable; this variance is contributed to by leave taken in line with school holidays. There has also been limited recruitment to posts relating to approved budget bids. A favourable variance from the rent expense has accrued relating to pending reviews later in the year and new premises yet to be identified for the new and extended Child & Youth service in Rodney. With recruitment closer to the budget cap and revised monthly budget phasing, it is anticipated that month on

month variance will reduce in the coming months. 2.2 Corporate & Support Services

The overall result for Provider Support is $1.794m unfavourable for the month.

Revenue is unfavourable to budget by $1.113m for the month due to phasing of revenue, these will be offset in August. Expenses are unfavourable to budget by $681k mainly due to centrally budgeted savings initiatives and unbudgeted repairs and maintenance $262k The overall result for Hospital Operations is $7k favourable for the month of July. Unfavourable activity related supply costs in Outpatient Pharmacy and Laboratories are being offset by favourable payroll

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related costs which are due to staff taking leave during the school holidays and new FTE approved for 2016/17 budget still being recruited. 2.3 Financial Performance – Funder

The Funder position as reported in the Financial Performance by DHB Arm table represents the totality of the Funder and is inclusive of Funder Own Provider Arm Services, Funder NGO Services and Funder IDF Services. The Funder net result is on budget for the month and year to date.

2.4 Financial Performance - Governance and Funding Administration Arm

The Governance and Funding Administration (GFA) represents the Waitemata DHB share of the Joint Planning Funding and Outcomes Arm and includes the Waitemata DHB share of the Northern Regional Alliance. The GFA net result is on budget for the month and year to date.

3 Financial Performance – Other Indicators/Trends

3.1 Net Result

The actual net result performance against the budget for the DHB tracked over time is illustrated in the graph below. The overall DHB result for the month to 31 July 2016 is a deficit of $1,153k which is $6k favourable to budget.

3.2 Savings Targets and Initiatives The Provider Arm has an aggressive savings plan embedded in the full year budget of $4.5m. The Savings Initiatives which have currently been identified are summarised as:

Savings Category $000s

Annual Leave Review and Management 700

Overtime reviews 1,000

Other Personnel Initiatives 2,075

Elective Surgery 400

Elective theatre efficiency 320

Deloitte projects 480

Waitemata Central 1,100

Revenue Generation 500

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Fleet Strategy 500

Procurement 2,000

Supply Chain 1,000

Other Non Personnel Initiatives 7,307

To be allocated 4,334

TOTAL 21,716

The Initiatives have been allocated to the Services in the following manner:

Service $000s

Medicine & Health of Older People 1,728

Surgical 1,550

Elective Surgical Centre 588

Child, Women & Families 568

Hospital Operations 1,062

Provider- Other 4,893

Mental Health 2,100

Corporate 9,226

TOTAL 21,716

It is anticipated that of the savings, $2m will come from hA (FPSC) procurement activity and a further $1m

from Supply Chain initiatives.

WDHB is working with hA(FPSC) to identify activities which will yield the expected savings from

procurement and supply chain activity. The Northern Region has undertaken a supply chain review and a

number of work programmes are currently being actioned in order to achieve savings over a two year

period.

Corporate has a number of savings initiatives in action. This includes revenue generation plans, lease and

facility rationalisation and fleet and transport improvements and a $1m reduction in corporate

overheads.

4 Capital Expenditure Capital expenditure planned for the 2016/17 year is $46.859m. The table below summarises performance against the capital expenditure budget for the month and for the year. The detailed capital expenditure statement is attached to this report (Attachment 2).

Note: The Full Year Budget is based last filed DAP.

Actual Budget Variance Actual Budget Variance

Land 0 0 0 0 0 0 0

Buildings & Plant 31,449 3,763 2,621 (1,142) 3,763 2,621 (1,142)

Clinical Equipment 7,872 510 656 146 510 656 146

Other Equipment 2,871 51 239 188 51 239 188

Information Technology 3,124 232 260 28 232 260 28

Purchase of softw are 1,460 0 122 122 0 122 122

Motor Vehicles 83 93 7 (86) 93 7 (86)

Total Capital Expenditure 46,859 4,649 3,905 (744) 4,649 3,905 (744)

YTD (Jul-16)

$'000sFull Year

Budget

Month (Jul-16)

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As at July 2016, capital expenditure is $744k above the plan. The majority of the spend has been incurred in our four large facilities capital projects. These are Waitakere ED redevelopment, Community Building 5 refurbishment, final costs on the NSH/ESC Bridge link and Mason Clinic 15 Medium Secure Units. Expenditure is also starting to be incurred on the Waitemata Learning Skills Centre.

5 Financial Position

The financial position as at 31 July 2016 is shown below. This indicates a strong balance sheet, with net worth of $335.969m including $79m in cash and deposits. The favourable equity position to budget was due to the increase in property valuation ($29m) in June 2016 following desktop valuations. The detailed Statement of Financial Position for the DHB Parent is provided as Attachment 3.

6 Cash flow Position Summary of the cash flow statement as at 31 July 2016 is shown below. The detailed Cash flow statement is provided as Attachment 4.

The DHB’s cash position in the HBL sweep as at 31 July 2016 is $51m (Last month $54m).

The DHB also monitors performance in collecting amounts owed by other organisations; the total amount owed to the DHB as at 31 July 2016 was $16.4m (last month balance owed was $14.4m). 73% of this is within the 60 days period (63% of this relates to Ministry of Health and 15% to other DHBs). 27% is over 60 days and the majority of this is in the area most difficult to collect, i.e. non-residents income. An Accounts Receivables report and explanation for amounts overdue for more than 60 days is provided as Attachment 5.

In $'000sOpening

30 Jun-16

Jul-16

Actual

Jul-16

Budget

Jul-16

Variance

Full Year

Budget

Crown Equity 335,969 334,816 307,872 26,944 313,532

Represented by :

Current Assets 137,311 139,087 155,356 (16,269) 132,771

Current Liabilities 268,032 269,746 266,571 (3,175) 262,147

Net Working Capital (130,721) (130,659) (111,215) (19,444) (129,376)

Fixed Assets 748,469 747,306 715,190 32,116 739,011

Term Liabilities 281,779 281,831 296,103 14,272 296,103

Total Employment of Capital 335,969 334,816 307,872 26,944 313,532

Month YTD


Opening cash 0 100,460 0 100,460

Operating 2,068 261 1,807 2,068 261 1,807

Investing (4,649) (3,404) (1,245) (4,649) (3,404) (1,245)

Financing 2,581 0 2,581 2,581 0 2,581

Closing cash 0 0

Closing Cash Balance in HBL Sw eep account 51,051 51,051

Deposits 28,000 28,000

Closing Cash + Deposits 79,051 97,317 (18,266) 79,051 97,317 (18,266)

$'000s

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7 Treasury 7.1 Financing Activity

Term debt drawn and average interest expense and rates are shown in the Tables below.

$276.706m of Crown debt was fully drawn as at 31 July 2016. All loan facilities have been drawn down as at 31 July 2016. The average interest rates on the loan portfolio are provided in the table below:

7.2 Treasury Policy All WDHB debt shall be borrowed on either a fixed interest rate or floating interest rate basis, subject to the requirement that the overall percentage of fixed (fixed/floating master limit) in any time bucket must be in accordance with the following limits:

The fixed rate amount at month-end reporting dates must be within the following maturity bands (percentages calculated on the fixed rate amount at month end):

MonthTerm Debt

($’000s)

CHFA Interest Expense

($’000s)

Jul-16 276,706 887

YTD 276,706 887

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The interest rate repricing risk profile for the WDHB Crown debt is shown in the graph below:

7.3 Financial Covenants

WDHB’s performance against financial covenants (which are currently waived) is summarised below and compliance was achieved.

Financial Covenants Actual Budget Covenant Met

Shareholders’ Funds (=> $70 million) 335 m 308 m Yes

Net Total Debt / (Net Total Debt + SHF) < 65% 48% 51% Yes

ANZ Interest Cover EBITDA / Net Interest (> 1.5:1) 11 11 Yes

CHFA Interest Cover EBITDA / Net Interest (> 2.5:1) 6 7 Yes

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ATTACHMENT 1

Attachment 1


STATEMENT OF FINANCIAL PERFORMANCE BY DHB SERVICE GROUP

MONTH Head Count

($000's) Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual

Provider

Medical Services 1,039 1,000 38 17,448 18,201 753 (16,409) (17,201) 791 (16,409) (17,201) 791 1,964 1,977 13 2,374

Surgical Services 656 632 24 12,475 12,735 260 (11,818) (12,103) 284 (11,818) (12,103) 284 1,083 1,054 (29) 1,278

ESC 18 46 (28) 2,167 2,191 24 (2,150) (2,145) (4) (2,150) (2,145) (4) 88 89 1 114

Child, Women & Family Services 1,051 1,082 (30) 6,672 6,950 279 (5,620) (5,869) 248 (5,620) (5,869) 248 886 933 47 1,180

Mental Health 1,111 1,173 (62) 9,262 9,802 540 (8,151) (8,629) 478 (8,151) (8,629) 478 1,221 1,316 96 1,378

Sub Total - Clinical Services 3,875 3,933 (58) 48,024 49,879 1,856 (44,149) (45,946) 1,798 (44,149) (45,946) 1,798 5,241 5,368 128 6,324

Director of Hospital Services 763 760 3 2,028 1,388 (640) (1,266) (628) (638) (1,266) (628) (638) 241 241

Hospital Operations 324 304 19 6,129 6,117 (12) (5,806) (5,813) 7 (5,806) (5,813) 7 547 536 (11) 1,064

Facilities 52 51 2 2,909 2,563 (346) (2,857) (2,513) (344) (2,857) (2,513) (344) 89 45 (44) 85

Provider Management 64,187 65,007 (820) 3,502 3,695 193 60,684 61,311 (627) 60,684 61,311 (627)

Corporate 1,436 1,753 (316) 9,574 9,699 124 (8,138) (7,946) (192) (8,138) (7,946) (192) 329 372 43 297

Sub Total - Corporate & Support Services 66,762 67,875 (1,113) 24,144 23,463 (681) 42,618 44,412 (1,794) 42,618 44,412 (1,794) 965 1,194 229 1,446

Total Provider 70,637 71,808 (1,171) 72,167 73,342 1,175 (1,530) (1,534) 4 (1,530) (1,534) 4 6,205 6,562 357 7,770

Governance & Funding Administration 1,054 1,081 (27) 1,053 1,081 28 1 0 1 1 0 1 89 96 8 99

Funder Arm

Funder NGOs 40,015 40,183 (168) 39,639 39,808 169 376 375 1 376 375 1

Funder Inter District Flows 23,341 23,341 0 23,341 23,341 (0)

Total Funder Arm 63,355 63,523 (168) 62,979 63,148 169 376 375 1 376 375 1

Consolidated 135,046 136,412 (1,366) 136,199 137,571 1,372 (1,153) (1,159) 6 (1,153) (1,159) 6 6,294 6,658 365 7,869

YEAR TO DATE Full Year

($000's) Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual Budget Variance Budget

Provider

Medical Services 1,039 1,000 38 17,448 18,201 753 (16,409) (17,201) 791 (16,409) (17,201) 791 1,964 1,977 13 (218,746)

Surgical Services 656 632 24 12,475 12,735 260 (11,818) (12,103) 284 (11,818) (12,103) 284 1,083 1,054 (29) (154,205)

ESC 18 46 (28) 2,167 2,191 24 (2,150) (2,145) (4) (2,150) (2,145) (4) 88 89 1 (25,287)

Child, Women & Family Services 1,051 1,082 (30) 6,672 6,950 279 (5,620) (5,869) 248 (5,620) (5,869) 248 886 933 47 (74,966)

Mental Health 1,111 1,173 (62) 9,262 9,802 540 (8,151) (8,629) 478 (8,151) (8,629) 478 1,221 1,316 96 (112,982)

Sub Total - Clinical Services 3,875 3,933 (58) 48,024 49,879 1,856 (44,149) (45,946) 1,798 (44,149) (45,946) 1,798 5,241 5,368 128 (586,186)

Director of Hospital Services 763 760 3 2,028 1,388 (640) (1,266) (628) (638) (1,266) (628) (638) 241 241 (2,543)

Hospital Operations 324 304 19 6,129 6,117 (12) (5,806) (5,813) 7 (5,806) (5,813) 7 547 536 (11) (70,824)

Facilities 52 51 2 2,909 2,563 (346) (2,857) (2,513) (344) (2,857) (2,513) (344) 89 45 (44) (29,745)

Provider Management 64,187 65,007 (820) 3,502 3,695 193 60,684 61,311 (627) 60,684 61,311 (627) 784,049

Corporate 1,436 1,753 (316) 9,574 9,699 124 (8,138) (7,946) (192) (8,138) (7,946) (192) 329 372 43 (94,751)

Sub Total - Corporate & Support Services 66,762 67,875 (1,113) 24,144 23,463 (681) 42,618 44,412 (1,794) 42,618 44,412 (1,794) 965 1,194 229 586,186

Total Provider 70,637 71,808 (1,171) 72,167 73,342 1,175 (1,530) (1,534) 4 (1,530) (1,534) 4 6,205 6,562 357

Governance & Funding Administration 1,054 1,081 (27) 1,053 1,081 28 1 0 1 1 0 1 89 96 8

Funder Arm

Funder NGOs 40,015 40,183 (168) 39,639 39,808 169 376 375 1 376 375 1 4,500

Funder Inter District Flows 23,341 23,341 0 23,341 23,341 (0)

Total Funder Arm 63,355 63,523 (168) 62,979 63,148 169 376 375 1 376 375 1 4,500

Consolidated 135,046 136,412 (1,366) 136,199 137,571 1,372 (1,153) (1,159) 6 (1,153) (1,159) 6 6,294 6,659 365 4,500

FTE's

31 July 2016

Net Result FTE'sDirect Revenue Direct Expenditure Contribution

Direct Revenue Direct Expenditure Contribution Net Result 5.1

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ATTACHMENT 2

WAITEMATA DISTRICT HEALTH BOARDSTATEMENT OF CAPITAL EXPENDITURE

Month Ended 31 July 2016

Spend by Asset Category

ServiceSum of Budget 2016/2017

(including prior year carry

forwards) Sum of Spent YTD June 2017

Balance

(Budget

Remaining)

Child, Women & Family

Clinical Equipment 1,766,009 16,900 1,749,109

Contingency 139,715 - 139,715

Information Technology 57,747 2,130 55,617

Building 7,350 - 7,350

Motor Vehicle 209,953 - 209,953

Other Equipment 71,038 - 71,038

Child, Women & Family Total 2,251,812 19,029 2,232,783

Corporate

Clinical Equipment 45,984 - 45,984

Contingency 1,257,314 - 1,257,314

Information Technology 1,476,954 98,489 1,378,465

Building 4,341,249 189,368 4,151,881

Motor Vehicle 2,000,000 - 2,000,000

Other Equipment 728,967 30,950

Corporate Total 9,850,468 318,807 8,833,644

Decision Support

Contingency 305,000 - 305,000


Building - - -

Decision Support Total 11,630,044 31,386 11,598,658

ESC

Clinical Equipment 297,361 43,199 254,162

Contingency 100,000 - 100,000

Information Technology - - -

Building - - -

ESC Total 397,361 43,199 354,162

Facilities


Contingency 250,000 - 250,000

Information Technology 94,674 - 94,674

Building 61,305,375 3,560,799 57,744,576

Other Equipment - - -

Facilities Total 64,955,514 3,606,474 61,349,041

Hospital Operations


Contingency 300,000 - 300,000


Building 500,255 - 500,255

Motor Vehicle - - -

Other Equipment 473,705 95 473,610

Hospital Operations Total 12,695,292 99,315 12,595,977

Medical & Health of Older People


Contingency 112,335 - 112,335

Information Technology 102,264 3,185 99,080

Building 22,485 - 22,485

Motor Vehicle 276,970 93,275 183,695

Other Equipment 19,720 6,110 13,610

Medical & Health of Older People Total 1,885,930 248,745 1,637,185

Mental Health

Clinical Equipment 24,398 - 24,398

Contingency 72,402 - 72,402


Building 484,936 12,681 472,255

Motor Vehicle 34,408 - 34,408


Mental Health Total 633,860 17,531 616,329

Surgical & Ambulatory


Contingency 290,677 - 290,677


Motor Vehicle 20,000 - 20,000


Surgical & Ambulatory Total 5,870,999 264,808 5,606,191

Grand Total 110,171,280 4,649,295 105,521,985

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ATTACHMENT 3

Attachment 3


STATEMENT OF FINANCIAL POSITION ($'000s)

30/06/2016 30/06/2017

Actual Actual Budget Budget

Crown Equity

103,015 Crown Equity 103,015 103,015 103,015

273,890 Revaluation Reserve 273,890 244,491 244,491

(42,785) Retained Earnings - Prior Years (40,936) (38,474) (38,474)

1,849 Retained Earnings - 2016/17 (1,153) (1,160) 4,500

335,969 334,816 307,872 313,532

Represented by :

Current Assets

81,631 Bank and Short Term Deposits 79,051 99,253 76,668

47,953 Debtors 51,249 48,503 48,503

1,113 Prepayments 2,099 1,000 1,000

6,614 Inventory 6,688 6,600 6,600

Assets Held for Resale

137,311 139,087 155,356 132,771

Current Liabilities

Bank Overdraft

116,440 Creditors 139,521 133,053 133,053

46,645 Provisions and Accruals 704 619 619

78,898 Staff Related Liabilities - Current 103,555 106,850 102,426

26,049 Term Debt - Current Portion 25,966 26,049 26,049

268,032 269,746 266,571 262,147

(130,721) Net Working Capital (130,659) (111,215) (129,376)

Fixed Assets

612,730 Land, Buildings and Plant (net) 611,109 597,800 597,800

3,660 Leasehold Building Works (net) 3,615 3,751 3,751

39,963 Equipment (net) 39,089 44,239 44,239

76 Information Technology (net) 74 3,055 3,055

192 Intangible Software (net) 170 1,006 1,006

2,784 Vehicles (net) 2,697 2,069 2,069

50,975 Work in Progress 52,464 18,271 42,092

710,380 709,217 670,191 694,012

38,089 LT & Investments in Associates 38,089 44,999 44,999

38,089 38,089 44,999 44,999

Term Liabilities

29,825 Staff Related Liabilities- Term 29,824 36,100 36,100

435 Trust and Special Funds 435 10,435 10,435

251,519 Term Debt - External 251,573 249,568 249,568

281,779 281,832 296,103 296,103

335,969 334,816 307,872 313,532

Reporting Date 31 July 2016

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ATTACHMENT 4

WAITEMATA DISTRICT HEALTH BOARD Reporting Date

CASHFLOW STATEMENT ($'000s)

Month YTD


Cash flows from operating activities:

Inflows

Crown 133,291 134,563 (1,272) 133,291 134,563 (1,272)

Interest Received 390 501 (111) 390 501 (111)

Other Revenue 4,849 1,347 3,502 4,849 1,347 3,502

Outflows

Staff 49,188 50,930 1,742 49,188 50,930 1,742

Suppliers 23,879 13,653 (10,226) 23,879 13,653 (10,226)

Other Providers 62,998 62,095 (903) 62,998 62,095 (903)

Capital Charge 0 2,044 2,044 0 2,044 2,044

Interest Paid 6 928 922 6 928 922

GST (net) 391 6,500 6,109 391 6,500 6,109

Net cash from Operations 2,068 261 1,807 2,068 261 1,807

Cash flows from investing activities:

Inflows

Sale of Fixed Assets 0 0 0 0 0 0

Associates 0 0 0 0 0 0

Outflows

Capital Expenditure 4,649 3,404 (1,245) 4,649 3,404 (1,245)

Investments 0 0 0 0 0 0

Net cash from Investing (4,649) (3,404) (1,245) (4,649) (3,404) (1,245)

Cash flows from financing activities:

Inflows

Equity Injections 0 0 0 0 0 0

New Debt 0 0 0 0 0 0

Deposits Recovered 0 0 0 0 0 0

Outflows

Debt Repayments 0 0 0 0 0 0

Funds to Deposit (2,581) 0 2,581 (2,581) 0 2,581

Net cash from Financing 2,581 0 2,581 2,581 0 2,581

Net increase / (decrease) 0 (3,143) 0 (3,143)

Opening cash 0 100,460 0 100,460

Closing cash 0 97,317 0 97,317

Closing Cash Balance in HBL Sweep account 51,051 51,051

31 July 2016

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ATTACHMENT 5

WAITEMATA DISTRICT HEALTH BOARD Reporting Date 31 July 2016

STATEMENT OF ACCOUNTS RECEIVABLES

Ref As % Total Outstanding Current 1 - 30 D 31 - 60 D 61 - 90 D 91 Days + Prior Month

1 ACC 2.6% 432,679.16 255,107.64 153,681.94 11,026.74 2,705.87 10,156.97 750,365.09

2 Accredited Employers 0.0% 1,908.68 522.01 60.00 572.34 510.60 243.73 3,332.49

3 Commercial 2.2% 353,627.49 77,392.32 52,242.10 49,244.76 46,255.50 128,492.81 371,752.80

4 Crown (excluding MoH) 7.1% 1,164,847.60 545,179.38 635,549.90 10,897.48 4,794.09 -31,573.25 1,910,447.40

5 DHBS' 19.8% 3,238,202.49 1,027,507.65 676,688.61 14,348.82 705,454.83 814,202.58 3,347,069.13

6 MOH 47.2% 7,715,452.61 6,536,559.29 881,057.36 0.00 165,302.35 132,533.61 4,526,555.09

7 Non Residents 20.9% 3,411,947.09 235.61 363,634.37 503,641.40 338,217.19 2,206,218.52 3,491,989.43

8 Overseas Govt 0.0% 0.00 0.00 0.00 0.00 0.00 0.00 0.00

9 Patient 0.2% 35,214.27 1,000.00 8,460.18 678.89 90.00 24,985.20 45,596.87

10 Staff 0.0% 1,806.71 0.00 521.61 0.00 -36.30 1,321.40 1,570.96

WDHB Total 7.00% 16,355,686.10 8,443,504 2,771,896 590,410 1,263,294 3,286,582 14,448,679.26

52% 17% 4% 8% 20%

Total Less Nres 12,943,739 8,443,268 2,408,262 86,769 925,077 1,080,363

65% 19% 1% 7% 8%

Total 30+ 2,092,209

16%

1 ACC The total outstanding figure has decreased by half compared to last month.

3 Commercial The $ 129k in the 91 days + relates to a commercial matter to be resolved.

4 Crown The negative balance in 91+ represents unallocated payments which is to be allocated to invoices.

5 DHB's For 91+days overdue: CMDHB $344K OPEX cost from 2013-2014 which is waiting resolution.

ADHB $469K working on checking/approving the Radiology charges

6 MOH 61+ days overdue: $238K comprise of invoices in dispute & waiting for resolution on how to proceed. $59K just waiting

for MOH final payment approval.

7 Non Residents $1,603,734.00 is on a current payment plan. This category of debtors is the most difficult to collect from. Clients who break two

consecutive payments are referred to Dunn and Bradstreet.

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6.1 Minutes of the Hospital Advisory Committee Meeting Held on 10th August 2016

Recommendation:

That the Minutes of the Hospital Advisory Committee meeting held on 10th August 2016 be received.

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Minutes of the meeting of the Waitemata District Health Board

Hospital Advisory Committee


held at Waitemata District Health Board Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 2.25pm

PART I – Items considered in public meeting COMMITTEE MEMBERS PRESENT

James Le Fevre (Committee Chair) Lester Levy (Board Chairman) Max Abbott Kylie Clegg Sandra Coney (Committee Deputy Chair) Tony Norman Morris Pita Christine Rankin (until 3.00pm) Allison Roe Gwen Tepania-Palmer Susanna Galea (co-opted member) Willem Landman (co-opted member) Donna Riddell (co-opted member) David Ryan (co-opted member)

ALSO PRESENT Dale Bramley (Chief Executive Officer) Andrew Brant (Chief Medical Officer)

Cath Cronin (Director of Hospital Services) Fiona McCarthy (Director of Human Resources) Emma Farmer (HOD Midwifery, Child, Women and Family Services) Stephanie Doe (Acting General Manager, Child, Women and Family) Jeremy Skipworth (Clinical Director, Forensic Services) Joanne Brown (Funding and Development Manager-Hospitals) David Price (Director of Patient Experience) (from 2.44pm) Helen Wihongi (Acting Chief Advisor Tikanga) Michelle Sunderland (General Manager, Surgical and Ambulatory Services) Mark Watson (General Manager, Elective Surgery Centre) David Grayson (Acting Chief of Surgery) Peta Molloy (Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item.)

APOLOGIES An apology was received and accepted from Warren Flaunty and for

early departure from Christine Rankin.

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WELCOME The Committee Chair welcomed those present and congratulated David

Ryan on being awarded the Hospital Pharmacy Performer of the Year. DISCLOSURE OF INTERESTS There were no additions or amendments to the interests register. There were no declarations of interest relating to the open section of the agenda. 1. AGENDA ORDER AND TIMING

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

2. COMMITTEE MINUTES

2.1 Confirmation of the Minutes of the Hospital Advisory Committee Meeting held on 29th June 2016 (agenda pages 6-13) Resolution (Moved Tony Norman/Seconded Gwen Tepania-Palmer) That the minutes of the meeting of the Hospital Advisory Committee held on 29th June 2016 be approved. Carried Actions Arising (agenda page 14) No issues were raised.

3. ITEMS FOR CONSIDERATION AND RECOMMENDATION TO THE BOARD

3.1 Auckland and Waitemata DHB Joint DNA Strategy and ‘Roadmap’ of Actions (agenda pages 15-60)

Karen Bartholomew (Public Health Physician), Aroha Haggie (Manager, Maori Health Gain Team) and Debbie Lynch (Quality Improvement Manager) were present for this item. Karen Bartholomew summarised the report noting that Manawa Ora (the Auckland DHB and Waitemata DHB Maori Health Gain Advisory Committees meeting) endorsed the strategy at its July 2016 meeting and the Auckland DHB Hospital Advisory Committee endorsed the strategy at its August 2016 meeting. She noted that the report has been presented in three sections: the development of the framework, stocktaking analysis (including a comprehensive look across services) and a suite of nine recommendations. The report also includes information on the transition process and details current activities on achieving results.

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Matters covered in discussion and responses to questions included:

That the strategy is very important given the high rate of Maori and Pacific DNAs.

Morris Pita acknowledged the work undertaken to prepare the strategy noting that the feedback from Manawa Ora was incorporated.

Recommendation four was noted with regard to patients in the northern Rodney area and difficulty attending appointments. The recommendation details potential ways to provide alternative delivery approaches including consideration of care closer to home.

That consent is not requested for contact by phone, but is for contact via email. Contact by phone to confirm appointments has been the current practice to date and the most reliable means of contacting patients.

Karen Bartholomew noted that the outcomes of the Strategy will be reported to and monitored by Manawa Ora. Resolution (Moved Gwen Tepania-Palmer/Seconded Morris Pita)

That the Committee endorse the Auckland and Waitemata District Health Boards joint DNA Strategy and roadmap of actions.

Carried

4. PROVIDER ARM PERFORMANCE REPORT 4.1 Provider Arm Performance Report – June 2016 (agenda pages 61-117)

Cath Cronin (Director of Hospital Services) introduced the report. Matters that she highlighted or updated included:

That the targets had been met and this achievement was acknowledged.

That the budget allocated was being worked through, the challenge to breakeven was noted.

James Le Fevre noted the scorecard for all services and the positive results. Cath Cronin further noted the reduced response time for complaints and that this was due to a reduction in the complexity of phone calls and complaints being responded to immediately by phone, however, more complex matters take time to investigate and respond to. Human Resources

Fiona McCarthy (Director Human Resources) was present for this section of the report. Matters highlighted or updated included:

Noting the executive summary overview and in particular that positive movement has been made in reducing overtime, with a focussed effort within the mental health area. The Committee Chair acknowledged the focus within the mental health area and suggested a similar approach be applied to other services, with a report back to the Committee.

That with regard to sick leave, significant work is being doing in a number of areas to more closely analyse sick leave against other trends.

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Medicine and Health of Older Peoples Services

Debbie Eastwood (General Manager, Medicine and Health of Older Peoples Services) Shirley Ross (Head of Division Nursing) and Jo Grounsell (Acting Head of Department, Allied Health) presented this section of the report. Matters highlighted or updated included:

Acknowledgement of the achievement of all endoscopy waiting time targets, a very pleasing achievement.

That the new Emergency Department at Waitakere Hospital is scheduled to open mid-August. The support of everyone for the Emergency Department development and opening was acknowledged.

That the physio therapy group is the area of recruitment concern for Allied Health and a campaign to recruit has been set in place. It is a nationwide issue and strategies and ideas on how to improve recruitment are being looked at.

Child, Women and Family Services

Dr Peter van de Weijer (Head of Department Medical), Stephanie Doe (Acting General Manager Child, Women and Family Services) and Emma Farmer (Head of Department Midwifery presented this section of the report.

Peter van de Weijer introduced the report noting that key issues for the service are dental arrears and midwifery vacancies as detailed in the report. He noted that there have been major strides forward in addressing both of these issues. Matters covered in discussion and responses to questions included:

The Committee Chair acknowledged and congratulated the Obstetric and Gynaecology Service on gaining reaccreditation for a period of four years from The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Sandra Coney noted that she had received communication regarding the disestablishment of two family coordinator potions at Wilson Home. Cath Cronin noted that the positions disestablished are not employed by the DHB and that she and Sandra Coney would arrange to talk directly following the meeting.

Kylie Clegg acknowledged the reduction of gateway referrals for children waiting for an assessment.

In response to a question about oral health enrolment numbers at 1 year of age being below target, it was noted that non-attendance is being looked at particularly for Maori and Pacific. Stephanie Doe noted that she had visited South Auckland to look at the work being done in that district. Work is being undertaken to link up all services from birth.

Mental Health and Addiction Services

Murray Patton (Clinical Director, Mental Health) and Alex Craig (Acting General Manager Mental Health) were present for this section of the report.

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Matters covered in discussion and responses to questions included:

That the new Substance Addiction Bill is still with the Select Committee, however, there is work underway to progress the model that this legislation will cover. The Ministry of Health is also hosting workshops.

In response to concern about the number of assaults that occurred (in both of the DHB inpatient units) and were reported to the Committee, it was noted that there was no particular reason for the increase and that such an increase does occur from time-to-time.

Surgical and Ambulatory Services and Elective Surgery Centre

Michelle Sunderland (General Manager, Surgical and Ambulatory Services) and Michael Rodgers (Chief of Surgery) presented this section of the report. Matters highlighted and responses to questions included:

That the relocation of ORCA (orthopaedic review clinic patients) to the pre-operative area in the theatre suite has now been achieved, this will mean shorter waiting times for review by orthopaedic staff.

That the commencement of both the Surgical and Ambulatory Services and the Elective Surgery Centre opening 15 additional inpatient beds on the Cullen Ward will be positive for surgical services.

The complaint response time of four days was acknowledged and also queried. It was subsequently confirmed later in the meeting that the Service had achieved a four day complaint response time.

Provider Arm Support Services

Robert Paine (Chief Financial Officer and Head of Corporate Services) introduced this section of the report. The Committee Chair acknowledged both the work and communication of the team who dealt exceptionally well with the recent diesel spill. Resolution (Moved Willem Landman/Seconded Gwen Tepania-Palmer) That the report be received. Carried

5. CORPORATE REPORTS

5.1 Clinical Leaders’ Report (agenda pages 81-89) Dr Andrew Brant (Chief Medical Officer), Dr Jocelyn Peach (Director of Nursing and Midwifery) and Tamzin Brott (Director of Allied Health) presented this report. Andrew Brant noted that Dr Jonathan Christensen would soon be stepping down from his role as Head of Division of Medicine and Health of Older People. Andrew Brant acknowledged the work of Dr Christensen, noting that he had done an outstanding job with the division growing enormously during his time and the

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positive change Dr Christensen had led. Dr Christensen will be looking at other opportunities around education with a key focus being his recent appointment as the President of the College of Physicians. The Committee acknowledged Dr Christiansen and his work. Jocelyn Peach summarised the nursing and midwifery and the emergency planning systems section of the report. Matters highlighted included:

That the new graduate programme continues. Maori and Pacific recruitment is an area of key focus.

That the inpatient clinical areas have completed the Patient and Whanau Clinical Care Standards audit. Key results are detailed in the report (page 119).

That with regard to emergency planning systems and national tsunami exercise is scheduled to take place over three days.

Tamzin Brott summarised the allied health, scientific and technical staff section of the report. She noted the appointment of Susan Peters to the Head of Division Allied Health, Child Women and Family. The positive work from clinicians hearing and responding to patient feedback was also noted. Max Abbott acknowledged the volunteer stroke scheme and the volunteer appreciation event recently held. It was noted that it is an annual event and warmly received by all. Resolution (Moved Sandra Coney/Seconded Gwen Tepania-Palmer) That the report be received. Carried

5.2 Human Resources (agenda pages 90-97) Fiona McCarthy (Director Human Resources) introduced this report. In response to a question about the co-design approach noted in the strategic alignment section of the report, Fiona McCarthy noted that there were a number of areas of co-design in the report. An example given was in relation to the recruitment process for nursing graduates in that there is engagement not just with service users but also candidates to identify what would be seen as useful.

Resolution (Moved Willem Landman/Seconded Gwen Tepania-Palmer) That the report be received. Carried

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7. RESOLUTION TO EXCLUDE THE PUBLIC (agenda page 98) Resolution (Moved Gwen Tepania-Palmer/Seconded Willem Landman)






1. Confirmation of Public Excluded Minutes – Hospital Advisory Committee Meeting of 29/06/16




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

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


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

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

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


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

Negotiations

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


Carried

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The open session of the meeting concluded at 3.30pm. SIGNED AS A CORRECT RECORD OF THE WAITEMATA DISTRICT HEALTH BOARD HOSPITAL ADVISORY COMMITTEE MEETING OF 10 AUGUST 2016 COMMITTEE CHAIR

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6.2 Auckland DHB and Waitemata DHB Community and Public Health Advisory Committees Meeting 31 August 2016

Recommendation:

That the draft minutes of the Community and Public Health Advisory Committee meeting held on 31 August 2016 be received.

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Minutes of the meeting of the Auckland DHB and Waitemata DHB

Community and Public Health Advisory Committees


held at Waitemata DHB Boardroom, Level 1, 15 Shea Terrace, Takapuna, commencing at 2.00pm

Part I - Items considered in Public Meeting COMMITTEE MEMBERS PRESENT:

Gwen Tepania-Palmer (Committee Chair) (ADHB and WDHB Board member) Max Abbott (WDHB Board member) (present from 2.07pm, item 3.1) Jo Agnew (ADHB Board member) Peter Aitken (ADHB Board member) Judith Bassett (ADHB Board member) Sandra Coney (WDHB Board member) Warren Flaunty (Committee Deputy Chair) (WDHB Board member) Lee Mathias (ADHB Board member) Robyn Northey (ADHB Board member) Christine Rankin (WDHB Board member) Allison Roe (WDHB Board member) (from 2.07pm, item 3.1) Elsie Ho (Co-opted member) Tim Jelleyman (Co-opted member)

ALSO PRESENT: Dale Bramley (WDHB Chief Executive Officer) Debbie Holdsworth (ADHB and WDHB, Director Funding) Andrew Old (ADHB, Chief of Strategy/Participation and Improvement) Peta Molloy (WDHB, Board Secretary) (Staff members who attended for a particular item are named at the start of the minute for that item)

PUBLIC AND MEDIA REPRESENTATIVES: Tracy McIntyre, Waitakere Health Link

Wiki Shepherd-Sinclair, Health Link North Elizabeth Buswell, Waitemata PHO

WELCOME: The Committee Chair gave a warm welcome to all those present. She extended personal thanks to all of the DHB staff noting that she had had a very busy week supporting family at North Shore Hospital in Wards 9 and 14. The week provided a good insight about not only the high standard of care but also the consistency of care for patients. To start the Committee meeting, the Committee Chair gave blessings to all the staff for their hard work.

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APOLOGIES:

Resolution (Moved Warren Flaunty/Seconded Christine Rankin) That apologies be received and accepted from Chris Chambers and Rev Featunai Liuaana and for late arrival from Allison Roe. Apologies were also received from Ailsa Claire (Chief Executive, Auckland DHB) and Simon Bowen (Director, Health Outcomes). Carried

DISCLOSURE OF INTERESTS

There were no additions or amendments to the Interests Register. There were no declarations of interests relating to the agenda. 1. AGENDA ORDER AND TIMING

2. COMMITTEE MINUTES 2.1 Confirmation of the Minutes of the Auckland and Waitemata District Health

Boards’ Community and Public Health Advisory Committees Meeting held on 20 July 2016 (pages 7-14) Resolution (Moved Tim Jelleyman/Seconded Robyn Northey) That the Minutes of the Auckland and Waitemata District Health Boards’ Community and Public Health Advisory Committees Meeting held on 20th July 2016 be approved. Carried Matters Arising (page 15) There were no further updates related to the matters arising.

3. STANDARD REPORTS

3.1 Primary Care Update (agenda pages 16-33) Lee Reygate (Portfolio Manager, Mental Health and Addictions), Stuart Jenkins (Clinical Director, Primary Care) and Sonia Varma (Programme Manager Quality Use of Medicines and Pharmacy) were present for this time. Debbie Holdsworth (Director Funding) introduced the item and gave apologies from Tim Wood (Deputy Director and Funding and Development Manager, Primary Care) who was on annual leave.

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Sonia Varma noted that the new Community Pharmacy Waste Management Service was successfully implemented, the service is being provided by International Waste Limited. The following matters relating to the service were highlighted:

That it will reduce incident of accidental poisoning, accidental needle stick injuries and environmental harm by disposal of medicines and household waste.

That the service is free and has been successfully implemented with no disruption to the public. Pharmacists have been supportive.

That the DHB provided collection bins to support pharmacies.

The next steps for the service is a campaign to increase awareness and implementation of DUMP (dispose of unused medicines properly) and encourage the community to dispose of unused waste or backlog.

Later in the meeting Warren Flaunty noted that pharmacies were paying for this service. Debbie Holdsworth clarified the DHBs were previously contracting with individual pharmacies for the disposal of waste however this wasn’t well managed in the past and in some cases was simply going to pharmacies bottom line. We have taken back this money from pharmacies and entered into a single contract with International Waste Limited and a much improved service is in place at a lower cost to DHBs. Debbie Holdsworth highlighted the following matters:

That the Auckland Waitemata Alliance had agreed to joint PHO/DHB funding of the clinical pathways work programme.

That nationally Auckland DHB is third and Waitemata DHB fourth for the national ‘Better Help for Smokers to Quit’ health target. Warren Flaunty noted that the contract between the Ministry of Health and Waitemata DHB had concluded and that people that seek help to quit smoking from a pharmacy want assistance immediately. He hoped that Waitemata DHB would continue to advocate the Ministry of Health to establish a new contract.

That Auckland DHB is first and Waitemata DHB sixth nationally for the national ‘More Heart and Diabetes Checks’ national health target. The Auckland DHB and Waitemata DHB are working with the PHOs to obtain ethnicity reporting.

Diabetes Service Level Alliance Update

Stuart Jenkins introduced this section of the report. Lee Mathias noted that the Auckland DHB Board had received a presentation from an outgoing diabetologist who indicated that the number of newly confirmed diagnosis for type 2 diabetes had plateaued for all but one age group. In response Debbie Holdsworth advised that the purpose of the diabetes service level agreement is to ensure the numbers do not increase. Stuart Jenkins further advised that the Alliance group is undertaking a substantial piece of work focussing on diabetes and diabetes management. In response to a question from Elsie Ho regarding high risk groups such as Pacific and Maori and whether the South East Asian group will also be looked at, Stuart noted that within the service level agreement all high risk groups will be included. The population from the Indian sub-continent is a group that will be focussed on. Debbie Holdsworth noted that work is also being undertaken with particular groups, like the

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Auckland Taxi Association, to assist in improving participation rates and allowing easy access to screening in the first instance. Other matters highlighted in discussion of the diabetes service level agreement included:

That the ‘Good Diabetes Management’ graphs for both Auckland DHB and Waitemata DHB (pages 23 and 24 of the agenda) do not show improvements. Debbie Holdsworth noted that it was a specifically funded target; however, it is now an outcome indicator for the Alliance. It was noted that if a programme is no longer specifically funded it should become business as usual and PHOs should be held accountable to ensure targets are still met.

That advertising on public network buses is considered as an option to raise awareness of health matters.

Sarmila Gray noted that the accuracy of data received from practices is reliant on what is entered into the system.

Dale Bramley noted that a presentation could be arranged for the Committee from regional public health looking at broader determinants. Resolution (Moved Warren Flaunty/Seconded Jo Agnew) That the Committee requests a presentation regarding diabetes and diabetes management. Carried

3.2 Planning, Funding and Outcomes Update Kate Sladden (Funding and Development Manager Health of Older People), Ruth Bijl (Funding and Development Manager Child, Youth and Women’s Health), Aroha Haggie (Manager Maori Health Gain) and Lee Reygate (Portfolio Manager, Mental Health and Addictions) were present for this time. Debbie Holdsworth introduced the report. Health of Older People

Kate Sladden presented this section of the report. Matters highlighted or covered in discussion included:

That the Auckland DHB was selected to be part of a pilot trialling a form of guaranteed hours for the home and community support service workforce. Auckland DHB was selected as it has bulk funding for the case mix.

That the draft Health of Older People Strategy has been released for consultation, closing on 7th September. There has been feedback on the scrutiny of actions where it seems like there is limitation on the development of new models of care. There needs to be age appropriate care for a person who ages and has a disability or mental health condition.

That the falls prevention programme is underway and a Business Case has been submitted to the Board. It was noted that the ‘Otago’ falls prevention programme whilst not financially viable can reduce falls by up to 50 per cent. A

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more sustainable model is being investigated with cost benefits being part of that.

Child, Youth and Women’s Health

Ruth Bijl presented this section of the report. Matters highlighted or covered in discussion included:

That the Rheumatic fever target was not met; dialogue continues with the Ministry of Health on how to improve the target result. Areas of improvement include extending the programme to other groups within the community (particularly pregnant women or women with new babies), continuing to work with primary care whilst increasing community awareness about the programme.

That good progress is being made in the childhood obesity area. Mental Health and Addictions

Lee Reygate presented this section of the report. He noted the Waitemata DHB Stakeholder Network Mental Health and Addiction Strategic Plan 2015-2020.He also noted the Look Up Event, which is focussed on youth wellbeing around alcohol and other drugs; an evaluation of the event is being processed and it is anticipated a presentation will be given to the Committee at its meeting scheduled in October. Maori Health Gain

Aroha Haggie (Manager Maori Health Gain) presented this section of the report. She noted that the Auckland DHB and Waitemata DHB joint DNA Strategy had been endorsed by both Boards. In response to a comment about moving away from the term DNA to a more positive framing of ‘improving attendance’, Karen Bartholomew noted that changing the narrative had been an area of focus when preparing the strategy. Pacific Health Gain

Apologies were received from the Lita Foliaki (Manager Pacific Health Gain). Debbie Holdsworth introduced the report noting that the consultation for the renewing the Pacific Health Action Plan closed on 31 August. Asian, Migrant and Refugee Health Gain

Debbie Holdsworth noted that Asian International Benchmarking report will be presented to the Committee at its meeting scheduled in October. Auckland Regional Public Health Service

Dr Simon Baker (Medical Officer of Health, Auckland Regional Public Health Service) and Andrew Philips (Policy Analyst – Environmental Health, Auckland Regional Public Health Service) were present for this section of the report. Apologies were received from Jane McEntee and Julia Peters (Auckland Regional Public Health Service). Matters highlighted or covered in discussion included:

That the Auckland Council has agreed to progress a review of its Smokefree policy.

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That in response to a question about the impact of the Government introducing legislation to transfer the decision-making for community water fluoridation from territorial local authorities to District Health Boards and the impact, it was noted that a cost benefit study was undertaken and there is significant positive impacts in introducing fluoridation (it was likened to spending 50 cents for a return value of $5). Further discussion points around the topic of fluoridation included:

- That approximately 96 per cent of the Auckland area is fluoridated. - That following the water issues recently experience in the Hawkes Bay area,

metro-Auckland DHBs are undertaking a review of water. A report will be presented to the Boards detailing each DHBs status and lessons learnt from Hawkes Bay.

- That in response to a question about fluoride not being medication it was noted that the High Court concluded that fluoridation does not constitute medical treatment, on the basis that medical treatment involves direct interference with the body or state of mind of an individual, and does not extend to public health interventions delivered to the inhabitants of a particular locality or the population at large. That the Committee will be provided with information via email on costs associated with fluoridating the Auckland region.

- That there is robust evidence on the benefits of fluoridation.

That the monitoring of dust emissions from unsealed roads was very detailed and took into account when measuring effect of how far back people lived, wind, type of vehicle and the like.

Resolution (Moved Warren Flaunty/Seconded Jo Agnew) That the report be received. Carried

4. GENERAL BUSINESS

There were no items of general business.

The Committee Chair thanked those present for their participation in the meeting. The meeting concluded at 3.24pm. SIGNED AS A CORRECT RECORD OF A MEETING OF THE AUCKLAND AND WAITEMATA DISTRICT HEALTH BOARDS’ COMMUNITY AND PUBLIC HEALTH ADVISORY COMMITTEES HELD ON 31 AUGUST 2016 CHAIR

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7.1 Health and Safety Marker Report – update September 2016

Recommendation:

That the report be received

Prepared by: Fiona McCarthy (Director of Human Resources)

Purpose of report The purpose of this report is to provide an update on progress towards meeting the expectations of the Health and Safety at Work Act 2015, which came into effect on 4 April 2016.

1. Executive Summary

The new Health and Safety and Work Act 2015 came into force on 4 April 2016. The new legislation is the result of work from the health and safety taskforce established in 2012 to evaluate whether the workplace and safety system in New Zealand was fit for purpose, and to recommend practical strategies for reducing the high rate of workplace fatalities and serious injuries by 2020. From taskforce recommendations made in 2013, WorkSafe NZ was established with one goal – to reduce workplace deaths and injuries by 25% by 2020. The most significant changes are as follows:

Move from a relationship between employers and employees to one where a Person Conducting a Business or Undertaking (PCBU) has a primary duty of care for ensuring the health and safety of a worker on or near the business or undertaking.

Provides for personal liability for officers of a PCBU to exercise due diligence in relation to a PCBU’s health and safety obligations.

Provides that suppliers, who supply, install and/or manufacture plant, fixtures, fittings, substances do so to ensure they are fit for purpose and do not post any risk to any person. This includes any calculation, testing, analysing or examining that is required to comply with the Act, as well as guidance on safe use, handling and storage.

Move from hazard management to risk management, which enables a broader view of health and safety

A change from serious harm reporting to notifiable injuries, illnesses and incidents. We are now required to report incidents that could have caused harm but may not have.

Clarification of employee participation, selection and training obligations. A separate set of regulations re to govern health and safety representatives is currently in consultation. The new legislation extends powers of health and safety representatives to provide improvement and compliance notices.

New obligations to set up a Health and Safety Committee if requested.

Additional penalties and fines with officers being exposed to higher remedies than workers. Details on how the DHB complies with the new legislation are outlined in Appendix 1. Aspects, of this work will be part of a number of deep dive audits planned for 2016/17.

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2. Glossary PCBU – person conducting a building or undertaking, and has a primary duty of care to ensure the health and safety of workers. The DHB is the PCBU. Officers - Includes Board Directors and the Senior Management team who make governance decisions that significantly affect the business. Officers have a duty of due diligence to ensure their business complies with its health and safety obligations. Officers may be found guilty of an offence under the Act, in addition to the PCBU. Due Diligence – taking steps to acquire and keep up to date knowledge of health and safety matters; gain an understanding of the business and hazards and risk associated with that business; ensure PCBU has available and uses appropriate resources and processes to manage risk; ensure PCBU has appropriate processes for considering incidents, hazard and risks in a timely way; ensure PCBU implements processes for complying with obligations under the Act; validates the provision and use of resources and processes to comply with obligations under the Act. Workers - Workers have a duty to take reasonable care for their own safety and that their own actions do not adversely affect the safety of others. They need to comply with reasonable health and safety instructions from the PCBU and co-operate with health and safety policies and procedure. Workers are people who work at the DHB and include employees, contractors, sub- contractors or their employees, apprentices, trainees, persons gaining work experience, employees of a labour hire company and volunteers. Other people - People who come to the workplace such as visitors or customers also have duties to comply with health and safety processes. Our patients and visitors are in this group. Notifiable injury or illness – an injury or illness that requires immediate treatment (i.e. amputation, serious burn, serious head injury or burn); admission to hospital; serious infection; medical treatment within 48 hours of exposure. All notifiable injuries or illnesses are to be reported to WorkSafe NZ. A notifiable incident is an incident that is an unplanned or uncontrolled incident in a workplace and that exposes a worker or other person to a serious risk to health and safety. Notifiable incidents include events such as: a spillage or leak of a substance; explosion or fire; escape of gas or steam; falls; electric shocks; structural collapses; in rush of water, gas or mud; interruption of underground ventilation. All notifiable instances are to be reported to WorkSafe NZ. Health and Safety Representative is a person elected to represent the workers in relation to health and safety matters. The representative has specific functions and roles under Schedule 2 of the Act.

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Appendix 1 Progress implementing the Health and Safety at Work Act 2015

Policy The DHB policies have been reviewed and are aligned to the new legislation. Changes and updates to policy will occur over the next few years as new regulations, audits and experimental learnings led to new processes. Significant policy changes will be endorsed by the Board. Worker engagement, participation, and representation

What the Act says

A PCBU must:

Initiate election of health and safety representatives on request of workers.

Agree the work groups that are represented by a health and safety representative.

Consult about matters related to health and safety

Provide information as requested with due consideration to the Privacy Act

Allow a health and safety representative time to discharge their powers under the act

New regulations on worker engagement, participation and representation were introduced in February 2016 and outline the functions, number, training, powers and participation expectations of health and safety representatives.

How do we comply?

We have 260 health and safety representatives throughout the business, most of whom have baseline health and safety representative training, as endorsed by WorkSafe as well as divisional health and safety committees in place to provide ways to participate in local issues. In addition, the annual update of hazards is reviewed by representatives, and representatives participate in the self-assessed 6 monthly departmental health and safety audit. From a recent hazard event review, new expectations on participation in health and safety matters have been introduced, and include ensuring work impact meetings are held for each building project, and that health and safety is a regular item on team meeting agendas. Seven health and safety representatives sit on our health, safety and wellbeing committee. Transition training for representatives has been provided and foundation health and safety training are available on line.

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What is outstanding?

The regional employee participation agreement with Unions is close to agreement – due Oct

Ongoing training needs (as part of the new Worker Engagement, Participation and Representation Regulations) will be assessed as part of a special project lead by Margaret Kamphuis, Group Manager, Occupational Health and Safety – due end Oct

We still need to determine the process for on-site contractors to establish health and safety representatives and discuss health and safety matters together- due Dec

Consequences

There are fines for not having appropriate employee participation processes in place.

Notifiable events

What the Act says

A PCBU must

report on notifiable injury, illness and incidents as soon as possible after being made aware of them.

Secure a site if a notifiable event has occurred.

Keep a record of notifiable events

How do we comply?

We currently have notifiable event reporting and recording processes in place.


There are no outstanding actions

Consequences

There are fines for not notifying workplace injury or illness as soon as possible after being made aware of them.

Health and Safety Committee

What the Act says

A PCBU must:

Put in place a health and safety committee if requested by a worker.

Establish a health and safety committee within two months of this request.

Consult about health and safety matters with the committee.

Allow time for members to attend and carry out functions as a member of the committee.

Provide information to the committee

Within a reasonable time, adopt recommendations made by the committee.

A PCBU can also establish a Health and Safety Committee on its own initiative.

How do we comply?

The DHB has an organisation wide Health, Safety and Wellbeing Committee.


There are no outstanding actions.

Consequences

There are fines for not setting up a Health and Safety Committee if requested, and if a PCBU does not: allow time for members to attend committee meetings/consider matters raised at the committee; or if a PCBU does not implement recommendations from the committee.

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Orientation

What the Act says

Orientation to a workplace is an important part of complying with the duty of care to ensure the provision and maintenance of a workplace that does not give rise to health and safety risks.

How do we comply?

Pre commencement orientation and a “safety first’ video are now in use for orientation, training and general health and safety messaging. A departmental health and safety induction checklist is sent to recruiting managers.


We need to put an Officer orientation programme in place – due Dec. We need to check orientation processes for students and volunteers - Resource to review is being discussed.

Consequences

There are fines and criminal punishments of imprisonment for reckless conduct in respect to duty of care, and fines for failing to comply with risks that expose individuals to death or serious injury/illness.

Risk Management

What the Act says

PCBUs have a duty of care to ensure the health and safety of another person is not put at risk from work carried out as part of the conduct of the business or undertaking. Risks must be eliminated or minimised so that a PCBU can, in so far is reasonably practicable:

Provide a workplace without risk

Provide and maintain safe systems, plant and structures

Ensure the safe handling, storage and use of plants, substances and structures

Provide training or supervise to protect persons from risk

Maintain accommodation so a worker is not exposed to risk

How do we comply?

We have an online hazard management system where hazards are identified and controls recorded. This is complemented by a corporate risk register where service, division and organisation wide health and safety risks are also recorded, controlled and regularly reviewed. Hazards/Risks are reviewed every 12 months by the divisional lead manager and Health and Safety Representatives. W2025 design and works impact meetings are occurring. Processes to monitor and maintain operational compliance are in place, i.e., fire management plan, training, exercises, maintaining clear egress, etc., and are part of a current process improvement review. Entrances ways have signage to indicate they may be slippery when wet. On wet days, additional signage is displayed to alert patients, staff, visitors, contractors to potential slip, trip and fall hazards. This expectation is audited. CCTVs are active in appropriate place on and around our sites.

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New in September 2016 A hazard and security risk assessment tool is being piloted in Community and inpatient Mental Health settings. Asbestos surveys are underway.


Regular on site campus audit criteria is being developed – draft due end September. Confirmation of investigation methodology – due Dec

Consequences

There are fines and punishments of imprisonment for reckless conduct in respect to duty of care, and fines for failing to comply with risks that expose individuals to death or serious injury/illness.

Contractors (Facilities, Health Alliance and Information Technology)

What the Act says

The PCBU, as well as ensuring the health and safety of its employees (workers), is also required to ensure the health and safety of other workers, as well as ensuring that plant, fixtures and fittings are without risks to health and safety to any person. There are new asbestos regulations that require a change in how PCBU’s currently manage and remove asbestos.

How do we comply?

Selection of Contractors: The DHB has moved to a process of selecting a panel of preferred contractors who can tender for DHB construction and refurbishment work as it arises. Each main contractor has to first qualify to be a part of the panel by satisfactorily completing contractor health and safety questionnaire which allows the organisation to demonstrate their performance against 12 health and safety criteria. Maintenance contractors do not have a preferred supplier arrangement in place as yet but contracts are in place and current for main contractors. Supplier Contracts and RFP processes: DHB contracts provide a standardised health and safety statement for minor or individual contracts. This clause will be confirmed that it satisfies the Act. Health Alliance procurement processes: Documentation is not adequate for the new Act. Orientation: Construction contractor induction is in place and completed prior to gaining access to the relevant site. Site access: All building contractors must report to Facilities before commencing their work and all Health Alliance (hA) staff (IT) will report to security. In addition,

New projects must be agreed and coordinated with Facilities prior to commencing

New contractors must complete induction prior to starting work

A contractor carrying out an agreed task e.g. for call out does not need to report to Facilities prior – they do need to report to area supervisor prior to and post work.

All contractors must have a WDHB photo ID which will only be issued

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after completing induction)

All healthAlliance staff and contractors are required to have the hA issued photo id on them at all times and visible. Usually if they are based on a particular site on a regular basis (i.e. not just visiting) then we will request a security access card with photo ID for that staff member from the site. Facilities: Once inducted contractors working for Facilities are issued with a Waitemata DHB ID card with a photo. Proof of identification (passport/ drivers licence) is require to obtain this ID. The duration of the ID card can be set to cover the estimated time of the project. On the job: Toolbox meetings occur on a scheduled basis. There is active management and collaboration with architects and designers to meet design expectations and requirements. Work impact meetings to assess risk occur regularly and ensure contractor health and safety plans are implemented. All Project managers, including the 2025 team are Site Safe certified. Regular meeting with construction contractors are occurring. Asbestos: Asbestos register in place but the register is not complete and needs to be updated in line with new regulations. This work is now underway via the WDHB Asbestos Management Group. Incidents and Accidents: Reporting of incidents and accidents follow the DHB process. Contractors experiencing any accident or incident are required to notify the DHB, investigate and report back any findings. On site audits: Regular external audits are conducted for construction site work. Project managers also undertake audits of their projects. Maintenance work review and sign off: For IT project work related to moves and new fit-outs, the desktop team work closely with the Waitemata DHB PM who reviews and signs-off that the work is complete. Building project health and safety management and sign off: A performance review is done mid-way through each major building project. Health and Safety design sign off and pre occupation processes are complete. The building sign off process follow the relevant policy. Post Implementation Reviews (PIRs): PIRs are done for each facility build project and results provided to the contractor selection panel.


Selection of contractors: The DHB is moving to the same preferred supplier process for maintenance contractors as noted above for large construction contractors. This process will be in place by June 2017. WDHB maintenance team requires contractors to provide suitable prequalification material by a certain date. If not met the contractor will be removed from the approved contractor list. Health Alliance processes: The DHB is working with Health Alliance about site orientation, safety and procurement processes Orientation: Induction material is being reviewed. On the job: A pre start safety meeting process is in development for all build projects, as well as ensuring work impact meetings occur regularly during the project. Safety in design guidance is in development. Asbestos: To review asbestos management plan in line with new regulations. Accidents and Incidents: Facilities intend to adopt an ICAM concept of investigation that will identify why things went wrong and what actions are

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required to ensure compliance and keep workers safe. All of evidence gained through incident reviews, audits and investigations is saved as confirmation of active management by the DHB in its role as the PCBU. Evidence folders and process will be discussed during audit training. Maintenance work review and sign off: The DHB is currently sharing learning from ADHB on a task planning and sign off process for maintenance work, ensuring competent review and management oversight. Building project health and safety management and sign off: Complete implementation of project sign off documentation. Meetings: Put in place regular meetings will maintenance contractors

Consequences


Hazardous substances

What the Act says

A PCBU has a primary duty of care to provide for staff use, handling and storage of substances. The DHB is also required to comply with the Hazardous Substances and New Organisms Act 1996 which requires the DHB to prevent and manage adverse effects of hazardous substances and new organisms.

How do we comply?

The DHB has focused on the 33 areas with high volume use of hazardous substances, with over 315 substances identified and added to the online register of substances available on StaffNet. A new and comprehensive HSNO policy has also been developed and published on the intranet, with a strong focus on roles and responsibilities. The Intranet HSNO site now contains hot links to information covering:

Policy document

Full HSNO database of all hazardous substances identified, including constituents, product state, UN number, CAS number, identified hazards, exposure limits, HSNO class and PPE specific to each substance. It is worth noting that, on average, we are identifying an additional 15 new chemicals per month, which are then added to the database.

Master Material Safety Data Sheets (MSDS) repository

Wastewater Disposal Guidelines

Training resources, including introductory PowerPoint

List of all Approved Handlers and their locations

Emergency response requirements

Specific spill kit contents list

Managers responsibilities

Key contacts for staff Approved handler training has been delivered for high risk areas. Work has also concluded with healthAlliance, to ensure that Material Safety data Sheets are supplied for all new chemicals being procured.

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We have another estimated 350 areas to review but a comprehensive audit

of the 33 high risk areas is underway.

The business case for the construction of a Hazardous Substances Store for

Waitakere Hospital is now being reviewed, as quoted costs were far higher

than were expected. Facilities are carrying out a full review of costs and

revised quotes are being sought. The construction of this store will greatly

reduce the risk associated with the bulk storage and disposal of hazardous

substances at Waitakere Hospital.

Consequences

There are fines and punishments of imprisonment for reckless conduct in

respect to duty of care, and fines for failing to comply with risks that expose

individuals to death or serious injury/illness. It is worth noting that hazardous

substances are covered under three sets of national legislation, as well as

local bylaws (Health and Safety at Work Act 2015, Hazardous Substances and

New Organisms (HSNO) Act 1996, Resource Management Act 1991 and

Auckland Council’s ‘Water Supply and Wastewater Bylaw’), under all of which

fines can be payable.

Health of workers

What the Act says

A PCBU must ensure that the health of workers and conditions of the workplace are monitored for the purpose of preventing injury or illness. The PCBU must, as far as is reasonably practicable, maintain accommodation so that the worker is not exposed to risks to health and safety.

How do we comply?

The DHB has pre-employment screening in place but a number of staff still commence work pending their results. Planning is underway to put a process in place to ensure that staff cannot start until the health screening process is complete, results known, vaccinations or other actions are complete and the potential employee is fit for work or an offer is withdrawn if they are not fit to work. We undertake occupational health monitoring via our Occupational Physician health clinics and have now extended this to monitoring exposure to noisy areas (facilities), hazardous substances, laser care, and other risk areas. Monitoring for exposure for radiation (Radiology, Cardiac Catheter Lab) occurs externally. We provide free influenza and other vaccinations. A stocktake of issues with workplace heating, ventilation and cooling was completed in May 2015 and is being implemented in priority order. Areas with friable asbestos require additional security clearance to gain access. Containers for sharps, hazardous materials and substances are provided on each site.

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Staff are provided with personal protective equipment (PPE) to wear. PPE requirements are outlined in various policies including the hazardous substances register, use of lasers, gloves, etc. Infection control processes are in place to manage any disease outbreaks and exposure. Installation of signage close to potential slip, trip and fall hazards has occurred and cleaner are asked to regularly monitor wet areas. Regular communication on hazards is issued.


Complete implementation of pre-employment screening – due Oct Health monitoring programmes should be in place across all relevant risk areas. An audit on use of PPE will be planned as part of the health monitoring programme to validate the application of various policies and risk controls – due June 2018. Audit criteria for review of ward and communal area is in development – due end Sept

Consequences


Equipment and Maintenance

What the Act says

A PCBU must provide and maintain a work environment that is without risk to health and safety.

How do we comply?

Equipment that is broken is escalated for capital replacement as relevant. A register of capital assets is in place and being added to, to ensure that equipment is budgeted for replacement according to the life span of that equipment. All bio-medical equipment is maintained by the Bio-Engineering team A fast track process is in place to approve maintenance triggered for health and safety reasons. New for September A Board approved funding pool for major H&S purchases has been accrued for activation by the CFO as relevant.


Alert systems for community workers are currently in an RFP process.

Consequences


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Training

What the Act says

A PCBU must provide any information, training, instruction and supervision necessary to protect all persons from risks to health and safety arising from work carried out by the DHB.

How do we comply?

Orientation training is provided to staff pre commencement and within the first four weeks of their employment. Health and Safety representatives are provided with two days of training (Four half day modules) by the Occupational Health and Safety Service covering an introduction to health and safety management, hazard and emergency management, accidents and occupational rehabilitation, safe working procedure, health and wellbeing and the new legislation. All staff are required to complete the annual health and safety update online. Training is provided on departmental specific instances such as moving and handling in patient areas, crisis intervention in areas where aggressive clients may be experienced, calming and restraint in mental health services, laser care in theatre, handling sharps by infection prevention and control. As already noted, approved handler training is in place for hazardous substances. Training is provided on how to access our incident management, risk register and hazard register systems. Training for notifiable events is complete. Emergency Response Training occurs regularly

Fire Response and Evacuation Training occurs for all new staff and annually online and face to face in key areas

Fire Evacuation Training occurs across all DHB areas six monthly which means each week there are activities in order to cover all areas

Warden Training occurs on all sites annually for all wardens and deputy wardens. This is for all areas so requires multiple sessions annually

Duty Nurse Manager training occurs for all new staff and three times a year

Incident Management Team training occurs quarterly

Key staff are required to attend Health CIMS2 training – which is available monthly and is done as a regional programme with the other DHBs. This is open to all health settings including PHO’s Accident and Medical centres and Residential Aged Care key staff

Key staff attend CIMS4 training quarterly

The DHB runs particular Health CIMS4 training with a provide provider twice a year for key areas that have identified a need.

New for September Board and Senior Management training on health, safety and wellbeing is due November.

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The training framework for security is currently being reviewed and due for completion in Oct 2016. (was August). A DHB wide training framework is being developed to enable officers and workers to increase awareness and knowledge of health and safety systems and processes – due Nov.

Consequences


Audits

What the Act says

An Officer of a PCBU must verify the provision and use of resources and processes put in place by the DHB.

How do we comply?

Since early 2015 we have completed a number of readiness audits to access compliance with the new health and safety legislation and to assess new or different resources needed. Going forward the Northern region has agreed to undertake two audits during 2015-2017 which includes community workers and contractor management. Regular external audits of contractor sites are in place. A governance audit has just been completed with five corrective actions.


New for September An audit programme for 16/17 will be tabled by Internal audit and includes deep dive audits on Investigation processes and feedback loops, contractor management, community safety, governance assurance, efficacy of works to improve our three top accident types, environmental controls.

Consequences


Reporting

What the Act says

An Officer of a PCBU must ensure they acquire and keep up to date on health and safety matters.

How do we comply?

Monthly reports on health and safety matters are provided to the Board meeting and the Audit and Finance Committee meeting. In time reporting will incorporate feedback from the organisational health, safety and wellbeing committee.


As a result of the resource review, the DHB will revise its leading indicators and revise the Board committee reporting formats.

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The DHB will update the Board reporting format later in 2016.

Consequences


Resources

What the Act says

An Officer of a PCBU must verify the provision and use of resources and processes put in place by the DHB.

How do we comply?

A resource review was completed last year. Recommended actions were tabled to the Board in August. On review of the report we have already implemented the following new resource:

0.4 training FTE to an existing Health and Safety adviser role

Hazardous substances co-coordinator (1 FTE)

Health monitoring nurse specialist (1FTE fixed term for two years)

Investigator / auditor (1FTE)

Health and Safety advisor (1FTE) so we can spread training across the advisory team and allow advisors to have service portfolios for in service outreach, advice, training and assistance

And the following are due to be recruited

Analyst and reporting specialist (1FTE)


Complete recommendations from the resource review- first progress report due February 2017.

Consequences


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7.2 Waitemata 2025 Update

Recommendation:

That the report be received. Prepared by: Annette Gohns (Senior Project Manager, Waitemata 2025) and Lynne Abercrombie (Senior

Project Manager Interims Projects, Waitemata 2025) Reviewed by: Cath Cronin (Director of Hospital Services) and Robert Paine (Chief Financial Officer and Head of

Corporate Services; Co-Sponsors, Waitemata 2025)

Glossary ADCU - Assessment, Diagnostic and Cardiac Unit CIC - Capital Investment Committee DHB - District Health Board CIC - Capital Investment Committee CEO - Chief Executive Officer CFO - Chief Financial Officer ED - Emergency Department ESC - Elective Surgery Centre F&D - Facilities and Development MoH - Ministry of Health NSH - North Shore Hospital SMP - Site Master Plan SSW - Short Stay Ward WTH - Waitakere Hospital


This paper provides an update on the Waitemata 2025 facility development works that has been established to support clinical development – people, services, facilities at Waitemata District Health Board (DHB). It provides an update on major projects subject to Ministerial Approval and also provides an update on interim projects that are reported more fully by Facilities and Development. This report is submitted for information only.

2. Strategic Alignment

Community, whanau and patient centred model of care

Facility upgrades and new builds consider patient needs and design supports and enhances agreed models of care

Service integration and/or consolidation

Facility upgrades/new builds can provide an opportunity to co-locate like services – achieving better service integration

Evidence informed decision making and practice

Facility design incorporates the Waitemata DHB ‘Ideal Ward’ and ‘Core Design Principles’ that are evidence-based and have been approved by the Waitemata DHB Institute for Innovation and Improvement. All builds comply with current healthcare facility design standards.

Outward focus and flexible, service orientation

Future-proofing is considered in all new builds and generic design features are incorporated to provide future flexibility

Operational and financial sustainability

Investment in new facilities and replacement of not fit for purpose facilities allows Waitemata DHB to manage future demand and remain operationally sustainable

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3. Introduction/Background

The development of clinical facilities, for both the interim and long-term, is collectively known as Waitemata 2025. Waitemata 2025 is being driven from the output from the Health Services Plan, the Site Master Plan, the need to replace not fit for purpose facilities and the requirement to provide sufficient inpatient beds and clinic capacity until larger facility build programmes are realised.

4. Ministerial Business Cases

4.1 Elective capacity and Inpatient Beds project The case for addressing short term needs for inpatient beds, theatre and endoscopy capacity has now been termed the Elective Capacity and Inpatient Beds (ECIB) project. On 4 August the DHB received approval from the Minister of Finance and Minister of Health for this project to proceed as a single stage business case (SSBC). The approval is subject to submission of the long list and short options to the Capital Investment Committee for their review and direction. On 23 September the strategic assessment for this business case and submission of the initial long list and short list options were endorsed by the W2025 Special Committee of the Board. These were expected to be submitted to MoH for the CIC meeting on 1 September. However, submission was delayed to the CIC meeting in order to allow for endorsement of the strategic assessment by the Regional Capital Group (RCG) In the meantime work is continuing in further developing the options that will be informing the business case. 4.2 Replacement for not fit for purpose wards The Point of Entry documents are being developed for submission to the Capital Investment Committee. In the meantime background work is being undertaken such as functional design briefs, models of care and accommodation schedules that would inform any future design for replacement wards.

5. Progress/Achievements/Activity

5.1 Elective Capacity & Inpatient Beds budget and expenditure Note budget expenditure report is indicative for August month period. Actual costs will be available

approximately 20 September.

Expenditure to date $000

Approved Funding

Internal Costs W2025 F&D

External Costs Total Expenditure

Balance -variance

$1,584

$168

$236

$763

$1167

$417

5.2 Replacement wards budget and expenditure Note budget expenditure report is indicative for August month period. Actual costs will be available approximately 20 September.

Expenditure to date $000

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Approved funding

Internal costs External costs Total expenditure

Balance

W2025 F&D -variance

$500

$171

$18

*$72

$261

$230

*Cost reduction due to reallocation of external costs to correct project

5.3 Governance Regular W2025 Project Control Group (PCG) meetings are held six weekly. The PCG members will make decisions within the delegated authority of their appointed roles and escalate key decisions to the CEO and or the W2025 Board Special Committee. Responsibilities for the ministerial business cases, replacement and not fit for purpose wards, and the Elective capacity and inpatient Beds project are coming under Dr Andrew Brant, Chief Medical Officer. 5.4 W2025 Interim Projects Highlights (reported in detail in the Facilities and Development report) NSH Sky Bridge The design for the Pedestrian crossings has been approved. The pricing is under review before instruction. Interim measures have been put in place to meet safety legislative requirements. Planning continues for the gas main repair. The expected timeframe is yet to be confirmed. NSH Short Stay Ward (SSW) & Diagnostic Breast Service (DBS) A review of scope for the NSH SSW is currently being progressed as information regarding the feasibility of proposed work came to light during investigation of the options for development. The review process is complete. Feasibilities are being investigated with an options paper to be completed by November 2016. A hold has been placed on the design process until this is completed. The Diagnostic Breast Services scope of works remains unchanged with the aim of undertaking the work following completion of Community Building 5 subject to the options paper for SSW. NSH Antenatal and Cardiology Clinics Relocation This project progressed to completion of preliminary design in December 2015 and was then put on hold awaiting future direction and possible changes to project scope. NSH Community Building 5 An exception report was submitted in July. Formal notification of the outcomes from this report is required before revising the programme, scope and costs. The current indicative ‘go live’ date is March 2017. NSH Surgical Pathology Offices Relocation The programme ‘go live‘ date has been pushed back due to impact of delayed works for the relocation of the service that currently occupies the space. The indicative ‘go live’ date is November 2016. NSH Pupuke Building Services Relocation (CYF Mental Health and Child Health Services) Interim arrangements to relocate services from Pupuke building is now the priority of this project. A W2025 Operational Project Manager has been assigned. Options for relocation have been identified and the first staff relocated recently. The remaining options will be presented to the Steering Group shortly. Planning continues to identify medium term solutions for the service. WTH ED New Build

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First patients were received as planned on Wednesday 17 August 2016. The models of care and facility are operating as expected. A post opening review will be conducted in 3 months. WTH ED Refurbishment Following the opening of the new ED the project team moved immediately into a multiphase refurbishment of the existing footprint. This work is proceeding well and due for completion in April 2017. WTH Additional Beds – Wainamu and Muruwai Wards Construction design is complete however the project has had a scope change involving relocation of cardiology beds. A revised business case will be presented to the Board in September and if approved work is scheduled to begin in October 2016. SCBU WTH & NSH This project is for extension of the SCBU at WTH and reconfiguration of the SCBU at NSH. The WTH works will be completed first. Concept design for WTH SCBU has been signed off and progress is well underway with the concept design for NSH SCBU. A business case is expected to be presented to the Board in late 2016. WTH CT Scanner Progress on concept design development is underway. Clarity of service development has enabled progress on development of the business case due to be presented to the Board in November 2016.

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7.3 Mason Clinic Remedial Works - Update

Recommendation

That the report be received.

Prepared by: Nigel Ellis (General Manager Facilities and Development) Endorsed by: Robert Paine (Chief Financial Officer and Head of Corporate Services)

Glossary

DHB – District Health Board MoH – Ministry of Health

1. Executive Summary This paper provides an update on the status of the Mason Clinic facilities programmes.

2. Discussion

Facilities The following main facilities related initiatives are underway at Mason Clinic: a) The construction of the new 15 bed inpatient facility is underway, with no significant issues to

report. The facility will be commissioned in June /July 2017, and immediately be available as a decanting facility for the new villa remediation (Tanekaha).

b) Immediate repair programme. The immediate works have been identified and the necessary design and contract specifications are being finalised ready for immediate remedial works as planned.

c) An all of government review of the whole campus, including Unitec land, has been commissioned by MBIE, and is underway, with initial meetings having been held. It is expected that this review will conclude by the end of October 2016.

d) Tanekaha Remediation. A project team has been formed to progress the development of a single stage business case by December. The business case will follow better business case process and be submitted to the CIC for approval. An Investment Logic Mapping (ILM) and options evaluation process has been initiated with meetings to occur on 13th September. The Chief Financial Officer is the sponsor of this Business Case.

e) A proposal for the Project Control Group and special committee to maintain oversight of the Mason Clinic Campus Remediation is being prepared. The project oversight structure will be submitted to the next board meeting. The project sponsor is the Chief Financial Officer

f) Remainder of the Mason Clinic redevelopment. The terms of reference and high level requirement brief is being prepared for approval prior to initiating development of the program business case for master planning review of Mason Clinic Campus. These will be agreed by the project control group prior to submission to the board. The project sponsor is the Chief Financial Officer

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7.4 SkyBridge Project - Pedestrian Access Issues Report

Recommendation

That the report be received.

Prepared by: Nigel Ellis (General Manager, Facilities & Development)

Endorsed by: Robert Paine (Chief Financial Officer and Head of Corporate Services)

Glossary

ESC - Elective Surgery Centre

1. Background At its meeting on 10th August, the Board requested a report on the Sky Bridge project pedestrian access issues that had been identified. The attached report was also submitted to and received by the Auckland DHB and Waitemata DHB Disability Support Advisory Committees at its meeting on 24th August 2016.


The Sky Bridge project was implemented to assist in meeting the demand for additional beds at the North Shore Hospital site by connecting the Tower block to the Elective Surgery Centre (ESC). The design commenced in May 2015 and the ESC Bridge was opened on 21 June 2016. A number of issues have been identified that impact on pedestrian access around the new Sky Bridge. This paper outlines what has been put in place to correct these issues. This will also improve the process for inclusion of the Disability Advisor’s input in new projects and buildings.

3. Issues Identified The following issues were identified: Issue A: Advice from Disability Advisor was not reflected in design/ built environment.

Issue B: Visibility around column on the corner of the Car Park.

Issue C: Accessibility between column and kerb edge/road adjacent the ESC Management Suite. These are discussed in detail in the attached paper.

4. Conclusion Following the identification of these issues, actions have been completed to rectify them. A better process for engagement with the Disability Advisor has also been identified.

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Waitemata DHB

Sky Bridge Project

Pedestrian Access Issues Report

3 August 2016

Prepared &

recommended:

Endorsed by: Endorsed by: Approved by:

H. Padharia M. Knight J. Cauvain N. Ellis

F&D Project Manager F&D Senior PM F&D Project Director F&D General

Manager

Date: 03.08.16 Date: 03.08.16

04.08.16 05.08.2016

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1. Purpose

The purpose of this report is to provide the background and actions being planned to

correct pedestrian flow issues identified upon completion of the Sky Bridge project.

To highlight the involvement within a typical construction project.

2. Project Overview

The Sky Bridge project was implemented to assist in meeting the demand for additional beds at

the North Shore Hospital site by connecting the Tower block to the Elective Surgery Centre

(ESC).

The design commenced in May 2015 and the ESC Bridge was opened on 21st June 2016.

During the design stages (Preliminary, Developed and Detailed design), User Group consultation

was undertaken with representatives from the following teams:

Hospital Operation

Facilities

Traffic and Parking

Security

Emergency Response

Fire

ESC Charge Nurse Manager

Moving and Handling

Disability Advisor Occupational Health & Safety

3. Design & Pedestrian/ Vehicle Issues

The ESC Bridge design evolved over three key stages (Preliminary / Developed / Detailed)

involving User Group Consultation and sign-off at the end of each design stage by specific

WDHB stakeholders.

In relation to the pedestrian and vehicle flow the following design consultants were engaged:

A specialist transportation engineering company (Flow Transportation Specialists Ltd).

Civil Engineers (Woods Consulting Engineers Ltd)

Architect (Jasmax Ltd)

4. Issue A: Advice from Disability Advisor was not reflected in design/ built environment.

Background: As part of Developed Design sign off Waitemata DHB’s Disability Advisor on behalf

of Disability Support Advisory Committee (DSAC) was consulted at each design stage. In

Developed design the Disability Advisor advised, “That the design should make sure there are

no impacts on access once the kerbs have been built”.

Issue: Even though these comments were considered the comments were not reflected in the

design and therefore the final built environment.

Recommendation: WDHB DHB Disability Advisor reviews plans at design stage with consultant

team and attends Safety in Design meeting with consultant team to highlight and mitigate any

issues.

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5. Issue B: Visibility around column B on the corner of the Car Park (ref: sketch page 5).

Background: During the developed design Flow suggested that Column B should be removed. As

construction has begun, repositioning the column was no longer an option. Therefore, the

advice was to:

Change the intersection “Give Way” markings to “Stop” and mark the limit line at the

intersection edge (previously 1-2 metres up on the link road).

Install a convex mirror opposite the column to assist pedestrians to see vehicles

travelling east to west and potentially turning into the link road.

Issue: Visibility around column B on the corner of the Car Park.

Recommendation: The road markings were changed as part of the construction works. The

convex mirror requirement has been superseded as part of proposed remedial works (see

recommendations relating to Issue C and figure 3 – page 7).

6. Issue C: Accessibility between column A and kerb edge/ road adjacent the ESC Management

suite (ref: sketch page 5)

Background to issue: In the design stage Flow Transportation Specialists suggested that Column

A should be moved. This column is as close to the ESC Management suite as possible.

Therefore, the advice from Flow and Woods was to:

Change the kerb adjacent the column A to a dropped kerb to 2m both sides and

replicate the same kerbing opposite (on the car park side). This is the current

situation.

Flow’s specific advice which the current design is based on was:

Having the kerb ramp either side of the column will ensure pedestrians from either

direction can easily cross the road (or use the road) to get past the column.

Given that most pedestrians will be travelling past the proposed crossing a gentler

ramp grade of 1:20 is a good idea, and we agree that the kerb ramps should be the

same size on both sides of the road, directly opposite each other.

The visibility from the proposed location is sufficient given the distance from the

intersection and the low speeds of vehicles on the road.

The minimum width of a pram crossing is generally 1.5m. The lowered landing either

side of the column could be reduced from 2m to 1.5m.

Tactile pavers should be installed on the both sides of the crossing as per RTS14

Guidelines for facilities for blind and vision impaired pedestrians. These will also more

clearly define it as a crossing point to both pedestrians and drivers.

Sufficient crossfall is needed on the landing to ensure it does not pool with water

when it rains. Max cross fall is 2%.

Current issue: The gap between Column A and the kerb/ road edge is narrow. Pedestrians may

need to travel on the road to get past the column. Following opening of the ESC Bridge on 21st

June 2016 the pedestrian crossing and access issues became apparent. Obviously this is not

acceptable and proposed alternatives have been discussed with WDHB Disability Advisor (see

recommendation below).

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Recommendation: Flow Transportation Specialists have provided a post contract solution to

resolve issue. The following were consulted:

Group Manager, Occupational Health & Safety

Disability Advisor

Operations Manager, Traffic

Project Manager (Delivery) from Beca

Project Manager, Facilities

Transportation Engineer, Flow Transportation Specialists

Civil Engineer, Woods

Following consultation a proposed scheme (See figure 3 – page 7) was approved by the above

team on 27th July 2016 with the following recommendations:

1. Relocating the current crossing away from the column A adjacent the ESC

Management suite. The crossing is to be raised and line marked as a ‘zebra’ crossing

in red (see photo 3 – page 8).

2. A fence be installed to both corners of the link road to direct pedestrians to the new

crossing and avoid the ‘blind spot’ created by the column on the corner of the car

park.

3. Provide an additional crossing further up the link road closer to the car park

entry/exit. The crossing is to be raised and line marked as a ‘zebra’ crossing in red.

4. Closed of the footpath between the two crossing to prevent pedestrians attempting to

continue and walk past the narrow section of the footpath next to the column

adjacent the ESC Management suite.

5. Providing signage to warn pedestrians of the hazards.

6. Adequate lighting around the crossings.

The above scheme is currently being detailed and priced.

In the interim, the following temporary measures are being carried out mitigate some of the

issues whilst the procurement of the contractor is underway:

Fence to both corners of the link road to direct pedestrians to the crossing.

Signage to pre-warn pedestrians of the narrow section next to the column.

It is expected to complete the temporary and final solution as quickly as possible as follows:

1. Temporary works complete by Friday 5th August 2016 ( picture 4 on page1)

2. Completion of final solution by proposed by end August 2016.

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Figure 1: As-built Design and Construction Layout

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Photograph 1: Current Pedestrian Crossing (Column A to left/ Column B to right)

Photograph 2: Column B at Car Park Corner

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Figure 2: Proposed Alterations To Address Pedestrian Issues below ESC Bridge

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Photo 3: Proposed Red & White Pedestrian Crossing

Photo 4 – Temporary work done

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8 Resolution to Exclude the Public

Resolution:






1. Minutes of the Meeting of the Board with Public Excluded 10/08/16





2. Minutes of the Hospital Advisory Committee with Public Excluded 10/08/16





3. Minutes of the Audit and Finance Committee with Public Excluded 31/08/16



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


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4. Minutes of the Waitemata 2025 Special Committee of the Board with Public Excluded 23/08/16





5. Business Intelligence Tool



Confidence The disclosure of information would not be in the public interest because of the greater need to protect information which if made available:

i) would disclose a trade secret; or ii) would be likely to unreasonably

prejudice the commercial position of any person who supplied, or who is the subject of, such information.

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


Legal Professional Privilege The disclosure of information would not be in the public interest because of the greater need to maintain legal professional privilege. [Official Information Act 1982 S.9 (2) (h)]

6. Additional Medical Beds




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7. Amendment to Precision Driven Health Agreement





8. Transactional Banking and Treasury Services




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




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



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



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BOARD MEETING - Waitemata District Health Board€¦ · 1.15pm 4.1 Waitemata DHB owned and operated...

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