Northland District Health Board
Hospital Advisory Committee
AGENDA
DATE:
Monday 5 October 2015
TIME:
9.00am
VENUE:
St John Ambulance Hall
Kawakawa
1
AGENDA
HAC MEETING
MONDAY 5 OCTOBER 2015
9.00am
Karakia
Apologies
Register of Interests


9.05am
1.0
3
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?
Attendance Register
5
Committee Minutes
6
1.1
1.2
7
13
Confirmation of Minutes 24 August 2015
Matters/Actions Arising
9.15am
2.0
Chair’s Report
14
9.20am
3.0
General Business
15
3.1
3.2
9.45am
10.25am
10.30am
4.0
5.0
Clinical Audit Programme- Presentation: Dr
Jozsef Ekhart, Clinical Audit Manager
Clinical Integration Report
16
System Performance
17
4.1
4.2
18
77
Operational Report
Financial Report
Next Meeting Details
86
Closure
2
HAC INTERESTS REGISTER
Name
SANDERSON Bill
(Chair)
Nature of Interest
Date Updated
 Director - Northland Orthopaedic Ltd
 Shareholder - Kensington Hospital Ltd
 Trustee - Northland Medical Museum Trust
17/11/14
BAIN John









BENNETT Win
 Employee - University of Auckland – Academic Co-ordinator
for Northland DHB site for University School of Medicine
 Employee - Northland DHB
JONES Libby







Former social worker and social work advisor for NDHB
Trustee - Paparoa Medical Society
Contracted social worker - Jigsaw North Family Services
Lead Professional For Children’s Team Whangarei
Clinical Supervisor – Staff member Manaia PHO
Elected trustee - Otamatea High School
“It’s Not OK” Family Violence Campaign Champion
Rodney/Otamatea
 Trustee – Rural Support Trust Northland
 Member – Rural Women NZ
26/1/15
MACAULEY Sally
 Councillor - Far North District Council
 Member - FNDC Chairman Community Development &
Service Committee, FNDC Economic Development Committee
FNDC Delegations: Tourism, Governance The Centre Trust Director
 Visiting Justice – Northland Regional Corrections Facility
 Judicial and Ministerial Justice of the Peace
 Northern Regional Representative – Benefits Review
Committee (WINZ)
 Trustee - Kerikeri International Piano Competition
 Chairman - Bay of Islands Festival of the Arts
 Chair - NZ Lotteries Board – Environment and Heritage
 Chair - NZ Lotteries Board World War I Commemorations
 Member – Make It Happen Te Hiku Community Governance
Group
29/8/14
Councillor - Northland Regional Council
Chairman - Order of St John Whangarei
Member – St John Chapter
Member – St John Northern Region Trust Board
Board Member - Sport Northland
Director - Club 21 Ltd
Director - Noble Imports Ltd.
Director - Banjo Trading Co Ltd
Trustee – Northland Road Safety Trust
14/7/14
2/2/14
Peter Macauley (Husband)
 Partner - Palmer Macauley (Lawyers, Kaikohe)
 Member - St John, Area Chairman, Kaikohe; elected member
Northern Region Trust Board; appointee Priory Chapter
NORMAN Tony
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

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Trustee - Kerikeri International Piano Competition Trust
Partner - Mill Bay Haven, Mangonui (accommodation provider)
Director - healthAlliance
Director - healthAlliance (FPSC) Ltd
3
17/11/14
Name
Nature of Interest
Date Updated
 Member - DHB Shared Services Executive Committee
 Deputy Chair – Waitemata DHB
REID Chris
 GP Kerikeri Medical Centre
 Board member - Northland Faculty Royal New Zealand
College of General Practitioners
 Member – National Advisory Council Royal New Zealand
College of General Practitioners
 Trustee – Russell Medical Trust
 Member Green Cross Health Advisory Committee
ROBERTS Ariana
 Employee – Te Hau Awhiowhio o Otangarei Trust – Hauora
 Steering Group Member – Te Hau Awhiowhio o Otangarei
Whanau Ora collective
 Trustee - Bronchiectasis Foundation
 Clinical advisor – Whatever It Takes Home Based
Rehabilitation Services
4
20/4/15
3/6/15
MEMBER ATTENDANCE - 1 JULY 2015 - 30 JUNE 2016
HAC
Bill Sanderson (Chair)
John Bain
Win Bennett
Greg Gent
Libby Jones
Sally Macauley
Tony Norman
Chris Reid
Ariana Roberts
2015
Jul





x


x
Aug

x







Sept
Oct
Nov
Dec
No meeting held
5
2016
Jan
Feb
Mar
Apr
May
June
1.0
COMMITTEE MINUTES
1.1
1.2
Confirmation of Minutes – Meeting 24 August 2015
Matters/Actions Arising
6
DRAFT MINUTES OF THE MEETING OF THE
HOSPITAL ADVISORY COMMITTEE
NORTHLAND DISTRICT HEALTH BOARD
__________________________________________________
HELD ON MONDAY 24 AUGUST 2015
AT TANGIHUA MEETING ROOM, TOHORA HOUSE,
WHANGAREI HOSPITAL
COMMENCING AT 9.05 AM
PRESENT
Bill Sanderson (Chair)
Win Bennett
Libby Jones
Ariana Roberts
Greg Gent (9.15am)
Sally Macauley
Tony Norman
IN ATTENDANCE
Nick Chamberlain (CEO), Sam Bartrum, Neil Beney, Meng Cheong, Kathryn Leydon, Andrew
Potts, Mike Roberts, Jeanette Wedding, Kim Tito, Michelle Crayton-Brown (notes), Craig
Brown (part), Colin Kitchen (part)
Member of the public
FIRE PROCEDURES
The fire exits were noted
APOLOGIES
Nil
Absent John Bain
CONFLICTS OF INTEREST
The Chair reminded Board members that in keeping with agreed protocol, conflicts of interest
should be declared on a meeting-by-meeting basis as issues arise
1.
COMMITTEE MINUTES
1.1 Confirmation of Minutes
It was moved that the minutes of the meeting held on 13 July 2015 be approved
MOVED Greg Gent
SECONDED Libby Jones
CARRIED
1.2 Matters/Actions Arising

Prostheses
Provision of limbs is entirely on need whether funded by ACC or vote health. Where a
more specialised limb is required, ie for running, there is a more complicated process to
follow, but still no difference in access.
2..
CHAIR’S REPORT
There was no Chair’s report
3.
GENERAL BUSINESS
3.1 Nerve Conduction Studies Update – Andrew Potts, General Manager Clinical
Services
 In Northland nerve conduction studies are provided mainly by Dr Nicole McGrath who
7
triages the referrals with participation from a visiting neurologist from Auckland.
Referrals generally come from orthopaedics with the main reasons for referral being
carpal tunnel, foot drop and nerve damage. About three clinics are held per month,
with five to six appointments each clinic. This keeps pace with demand. Waiting time
is usually one month. The number of clinics is currently in step with the number of
patients triaged.
3.2 Discharge Pharmacist Role presentation: Harriet Sands - Senior Clinical
Pharmacist and Samantha Allen, Discharge Pharmacist
 Based on CMDHB process, seven step process including discharge reconciliation
Current Clinical Pharmacist Service:
 Current role approximately 0.5FTE, focussed on medicine reconciliation as per
national targets.
Initiates medicine reconciliation for approximately 70% of
admissions; ensuring supply of medicines to patients on wards, clinical review and
annotation of charts to ensure safe and legal administration; therapeutic drug
monitoring and medicines information.
 Admission medicine reconciliation picks up an unintended discrepancy (error) rate of
approx 8% = an error for one in every 11 medicines charted at admission.
Why a Pharmacist at discharge?
 NDHB currently has no formal medicines management process at discharge.
 Anecdotal stories from GPs, community pharmacies about poor discharges.
 Incidents involving medicines management at discharge have been noted
 Need to capture error rates at discharge.
 Proposed FTE to run pilot – funding obtained for one year pilot.
The Pilot:
 1 FTE for one year consisting of discharge service plus community liaison service.
 Final data collected will be for ¾ year – no further funding currently for role.
 Majority of patients seen have already had medicines reconciliation at admission –
some medicines discrepancies were noted at discharge.
Results:
 256 patients seen in first six months of data; 173 errors identified and resolved; 202
additional interventions to prevent harm/optimise care.
 40% of medical patients (seen by service) discharging with one or more errors and 7%
discharging with three or more errors – reveals medicine reconciliation at admission is
not enough to prevent all errors.
Two case studies provided
 Benefits of service:
Improved accuracy of medicine information at discharge; reduction in errors; increased
likelihood of funded, uninterrupted supply; improved communication with GP and
community pharmacy; increased patient education regarding medication changes during
admission; increased referral to other discharge services when appropriate
Patient compliment after experiencing service provided
 To the future:
Permanently increasing pharmacist FTE to enable the institution of a systematic process
for medicines management at discharge will:
o improve equity by targeting a subset of patients with the greatest needs or
highest risk of medication related harm
o provide value for money through cost reduction as a result of reduced medication
related harm and re-hospitalisation
o improve the patient experience, health literacy and enable better patient
engagement in self-care and management of chronic illness.
Key issues and discussion points:
 Working closely with district hospital operations managers, as current district hospital
pharmacy services not provided by in-hospital pharmacist.
 Discussion on Discharge Pharmacist having the ability to correct discharge summaries
and the GP record.
 Number of patients seen currently is small.
 Highest risk patients followed up by pharmacist.
 Could follow up with patient or community pharmacy.
8



4.
Increase in FTE would allow more patient to be seen. Medically high risk patients
would be seen first.
GMs Planning, Outcomes, Integrated Care and Health of Older People and Clinical
Support to looking into ongoing funding for this role.
Plan to present project at National Hospital Pharmacists Association meeting.
SYSTEMS PERFORMANCE
4.1 Operational Report
 Acute services and mental health services remain busy with activity levels above
those budgeted.
 Maternity build progressing well.
 Acute surgery volumes at Kaitaia higher than planned.
Overview
Surgical
 Acute surgery, particularly orthopaedics above average. Elective surgery in May/June
returned to normal levels.
 Colonoscopy proceeding well. Number of lists now done in second room. 170 P2
patients now on colonoscopy waiting list (down from 1,000 last October).
 ESPI compliance regained in July. (non-compliant in June).
Medical
 After high levels of acute medical activity through summer and autumn, activity went
down in May and June.
 Four additional beds have been opened on Ward 15, with a further four to be opened
on Ward 15 shortly.
 Progressing with plans for interim acute medical unit from July 2016, using space
vacated by maternity relocation.
 Have now appointed a clinical leader for acute medicine part time from the end of
September. Will become full time early in 2016.
Renal
 In-centre dialysis demand has continued to grow. In process of establishing another
shift in Kaitaia to cope with demand. Will move Far North patients to Kaitaia from BOI,
hope to have in place by November.
 Local rate of live kidney donations increasing due to current nationally funded
initiatives.
Emergency
 Performance on ED LOS 93% for quarter to June, 94% in June. Improvement on
previous quarter. Performance highly correlated with acute medical admissions.
August generally most difficult month.
Outpatients
 ESPI compliance fine.
 Cancer waiting times – national target performance (commencing treatment with 62
days of referral) increased in July to 78%. Particular increase in breast cancer, now
focussing on colorectal.
 Area of worst performance is people who require radiotherapy, more complex care
required. Only 15% of cancer patients covered by this target (mostly referred by GPs
with high suspicion). Focussing on improved pathways for all patients, not just those
covered by the target. Auckland DHB needs to reduce their waiting times for
radiotherapy, and treatment decisions need to be made earlier in the patient’s journey.
 NDHB now have navigator role in place and a cancer tracker. Multiple entry points for
these patients make it a complicated journey for them.
 Maori patient cancer navigator role has made big difference in DNA rates.
 Backlog for follow-up outpatient appointments following patients having colonoscopy.
Third colorecatal surgeon joining us in about two months, should see rapid progress in
reducing outpatient follow-up backlog.
Radiology
 Both new scanners are installed and working well. About to start in-house CT
colonography which will greatly reduce outsourcing costs for radiological
9
investigations.
Lagging performance-wise with MRI waiting time for scans within six weeks – 30-40%.
CT now 90% plus for six weeks waiting time target.
 MoH impressed with way NDHB stepped up when it became obvious that colonoscopy
waiting list had grown.
 Currently have four colonoscopists, ideally need six.
 Next big challenge will be colorectal screening. Projection is two full days per week on
an ongoing basis for colonoscopy when this comes in.
 National programme to train nurses to perform endoscopies, progress slow.
Older People & Clinical Support & Lab
 Activity reflects general hospital activity. Drop off in outpatients contacts, increase in
inpatient contacts.
 9% up for laboratory figures. Some will be genuine activity, some will be unnecessary
tests.
 Additional beds in the Stroke Unit have now opened. Stroke beds have increased by
two beds giving a total of six beds.
 Falls with harm – spike this month. Every fall is investigated with root cause analysis
to see what allowed it to happen. Any issues identified will have steps taken to
remedy.
 Looking closely at use of cot sides on beds, if patients climb over they cause more
harm. Need close observation if cot sides in place.
 Use non-slip socks, falls alarms (attached to patient’s clothing and rings when they
leave bed).
Mental Health
 Indicates level of demand that service continues to face particularly for acute adult
psychiatric admissions. Service IPU leadership team have been meeting fortnightly to
address a 12 point priority plan. Areas being worked on in conjunction with other
significant issues discussed at regional level.
 Safe staffing levels key issue. Staffing levels for this current year have been agreed.
 Continue to see high demand for overtime as a consequence of staff replacement due
to sick leave.
 New leadership structure confirmed and first appointment confirmed. Acute Services IPU manager still to be appointed.
 Model of Care programme underway. Good realisation among staff for the need to
retain and record activities of care to judge staffing levels required. Project Manager
has developed project plan and presented initial data sets.
 Crisis adult and community interface group – reviewing pathways for acute admissions
from community into hospital. Policy and pathway has been developed but hasn’t
been socialised with GP and community based stakeholders
 IPU interface group looking at how main hospital can support work occurring within the
IPU. Number of high and complex needs patients in the acute adult area. Young
s
people in their 30 who are going to need years of care, but not in an acute unit. At
regional level, involved in planning for high and complex needs patients.
 Have reviewed current bed capacity. As of 1 July determination made to cease
admissions of child and youth patients into child and youth pod, which frees up two
beds for acute adults. C&Y pod includes two swing beds which could have served
child & youth or older people, so we effectively gain four beds.
 Mason Clinic forensic unit – major project underway to increase capacity for the
region.
 Safe staffing is a key focus. Approval this year to transfer additional funds into
supporting hiring of full time FTEs into unit.
 Working with Group Manager who will take active in-house management role with
other mental health professionals and consumer advisor and one other staff member
to try and better manage demand for additional staff, particularly in evening, night shift
and weekends.
 C&Y beds transferring back to Auckland. Negotiating payment mechanism with ADHB
to take patients into family unit in Auckland.
 IPU 12 point plan – to be shared with Board. Will show actions and progress against
these.

10

Would like to develop longer term strategy. Not just increase in beds. Have people
kept as well as possible at community level with a different way of supporting them
than current. PHOs have done a good to coordinate more community level services.
ACTION: Request for update on reason for reduction in LOS in Mid North/Kaikohe
District Hospitals
 BOI up 25% on bed days. Recently had busiest two weeks ever recorded.
 Operating theatres at Kaitaia now both operable, 40% up on same period last year for
number of cases and wanting to do more. Working closely with Whangarei Hospital
and meeting with CFO to increase surgery volumes at Kaitaia.
 General surgeons will rotate from Whangarei, probably one per week.
Paediatric
 Good end of year result financially. Bed utilisation in June was 107%, July will be the
same. Lot of respiratory illness coming in. 7.5% on actual targets.
 SCBU 66% utilisation level for month.
Maternal
 1,500 births for the year.
 Northland has one of highest teenage pregnancy rates in the country.
School-based, Community & Oral Health
 Adolescents can be dealt with by both private dentists and adolescent dental
providers. Having discussions on keeping them in our services from 12-18 years.
 Screening programme for family violence working really well within the hospital. Have
to screen everyone over 16 years who comes into hospital.
Public Health
 Having to refresh rheumatic fever plan. Ministry holding workshop to release
evaluation of throat swabbing programme in NZ and whether it has been effective or
not.
4.2 Financial Report taken as read
The Chief Financial Officer spoke to the financial report for 30 June 2015 which was taken as
read:
 July provider arm significantly overspent.
 Audit has progressed well. Expecting the forecast result of a minor surplus will be
confirmed by auditors.
 Significant pressure on ED, medical services and mental health in July leading to
increased pressure in diagnostics.
 Unless activity levels off this will be more challenging year than last.
 Underspend in community mental health and other community contracts has helped
balance the overspend.
 Risk pools in place.
 Some funds available this year to invest upstream, ie re-engineering general practice.
 Savings initiatives/targets required annually. Each service has to identify areas for
savings. General discussion on necessity and ability to identify and make savings.
Clinical services and clinical engagement is a huge area requiring change.
It was moved that the Operational and Financial Reports be received
MOVED Tony Norman SECONDED Chris Reid
CARRIED
The HAC Chair acknowledged Greg Gent’s input into the HAC committee as this was his final
meeting.
5.
NEXT MEETING DETAILS
The next meeting will be held at 9.00am, Monday 5 October 2015, at the St John Ambulance
Hall, Kawakawa
11
There being no further business the meeting closed at 10.55am
Confirmed that these minutes constitute a true and correct record of the proceedings
of the meeting.
________________________
CHAIR
DATE
12
TIONS ARISING FROM THE MEETING OF THE NORTHLAND DHB
FROM THE MINUTES OF NORTHLAND
TING ONACTIONS
TUESDAY 2ARISING
AUGUST 2004
DHB
HOSPITAL ADVISORY COMMITTEE MEETING
MONDAY 24 AUGUST 2015
1.
ACTION
Update on reason for reduction in LOS in Kaikohe/Mid
North
BY
GM Mental Health &
Addiction Services
WHEN
October
2015
GMs Planning,
Outcomes, Integrated
Care and Health of
Older People and
Clinical Support
October
2015
Verbal update to meeting
2.
Ongoing funding for the Discharge Pharmacist role to be
investigated.
Verbal report to meeting
13
2.0
CHAIR’S REPORT
14
3.0
GENERAL BUSINESS
3.1
3.2
Clinical Audit Programme - Presentation: Dr Jozsef Ekhart, Clinical Audit Manager
Clinical Integration Report
15
Clinical Integration Report for HAC Meeting to be held on 5 October 2015
Dr Win Bennett, GP Liaison
This report updates progress on a number of activities you have been informed of in
previous reports.
1. Transfer of care (TOC) documents (previously discharge summaries). These
are essential documents that accompany patients and are sent to their GP on
discharge from hospital. They have in the past been the subject of critical
comment from GPs. We have been working on three processes to improve
their usefulness.
a) With junior house staff to improve the content by providing
education sessions, guidelines and audit tools. We have focussed
on eliminating jargon and abbreviations and making the
information relevant and clear for patients and GPs. Anecdotal
feedback from GPs has been positive and we are currently
auditing the content of 100 consecutive TOC documents.
b) Junior staff have taken responsibility for timeliness of the
document and we have developed a report for House officers
that alerts them to TOC documents that are not completed.
We are also providing a monthly report of performance by ward.
c) We have reformatted the form so that the advice to the patient and
advice to the GP are at the top of the form.
2. The Aspire system and electronic clinic letters.
Clinic letters are now
delivered electronically to GPs practice management systems. In recent
weeks we have added the following documents to
the process –
operation notes, clinical reports and management
notes, (such as
multidisciplinary team meeting reports), copies of referral letters to other
secondary and tertiary hospitals). In addition we have started a project with
the aim of having 95% of these documents
delivered to GPs within five
days of the event.
3. Clinical Pathways. The decision has been taken by the DHB and PHOs to
introduce and adapt Clinical Pathways from Canterbury.
The aim is to
provide clinicians with a step by step process to help standardise care and
remove unnecessary variance. This provides an opportunity to improve
patient safety and help reduce waste in DHB and practice systems.
The pathways will need adaption to Northland environment and a Clinical
Editor has been appointed to coordinate this task. The next tasks are to
establish a project team and clinical governance.
16
4.0
SYSTEM PERFORMANCE
4.1
4.2
Operational Report
Financial Report
17
Report to the
Hospital Advisory Committee
Reporting Period: July 2015
For the meeting held 5 October 2015
18
Executive Summary
Overview
An influenza vaccination rate of 71% of staff was achieved compared with 58% last year. Inpatient mental health services
continue to experience major capacity and workload pressures. Acute paediatric and adult medical admissions have
increased substantially during the winter period. A draft health food policy has been developed and is being consulted
upon.
Commentaries
Safety and Quality
Health Targets
Service Delivery
Population Health
Status
Financial
Sustainability
Engaged Workforce
A deterioration in performance, particularly with regard to falls with harm, was notable in July.
Good performance was sustained with regard to the elective surgery discharges and smoking
cessation advice targets. Improvement in the faster cancer treatment target was achieved. The ED
length of stay performance deteriorated only slightly despite increasing acute admissions.
Acute medical activity has increased considerably during the winter period. ESPI compliance
(amber) was regained in July and maintained in August.
The proportion of pre-school children enrolled with Northland DHB (or the Hokianga or Ngati Hine
Trusts) has increased.
High acute workload and high staff sickness associated with the winter period are causing
significant financial pressure.
Staff sickness levels have increased as expected over the winter period.
Information to assist with understanding the scorecards:
The scorecards provide a high level status of performance. The indicators are summarised where appropriate for the
organisation and service specific indicators are presented within separate service area sections of the report.
Indicators are usually updated monthly or as soon as information becomes available.
Performance Colours
Performance Indicators
Green indicates achieved
Indicates performance has improved
Light Green indicates just missed achieving target
Indicates no change from previous month
Orange indicates significantly missed target
Indicates performance has deteriorated
Red indicates substantially missed target
Grey indicates no data available
Please refer to Scorecard Definitions for threshold tolerances
Denotes a cell where no data is being collected
Page: 2 of 59
19
Surgical
1.
Overview
Elective and acute activity was only slightly above plan for the month of July. Continued improvement in colonoscopy
waiting times was achieved. The number of falls with harm in July is concerning and is being investigated.
2.
Scorecard
IP Events Coded For Period - 100%
Surgical Scorecard - Whangarei Hospital
Safety and
Quality
Health
Targets
Service
Delivery
Measure
Goal
Month
All
Month
Maori
Month
Non
Maori
YTD
Goal
YTD
Reducing Acute Readmissions to Hospital
5.0 %
6.3 %
6.3 %
6.2 %
5.0 %
6.3 %
Elective Day of Surgery Admission rate DOSA
90 %
95 %
94 %
96 %
90 %
95 %
Hospital Acquired Pressure Injuries
0
3
0
3
0
3
Falls with harm within facility
0
7
2
5
0
7
646
200
446
Improved Access to Elective Surgery – (All
NDHB)
Better help for smokers to quit – Hospital
95 %
98 %
99 %
98 %
95 %
98 %
Inpatient Average Length of Stay (ALOS)
Acute (excludes Day Cases)
3.9
3.7
3.7
3.7
3.9
3.7
Inpatient Average Length of Stay (ALOS)
Elective (excludes Day Cases)
3.1
3.0
3.1
3.0
3.1
3.0
Elective Caseweights to contract
552
557
552
557
Acute Caseweights to contract
538
545
538
545
Patients on the Surgical Booking List given
a commitment to treatment but not treated
within four months
1.00 %
0.50 %
Theatre cancellations by Hospital
2.0 %
3.2 %
2.0 %
3.2 %
% Overdue Surveillance colonoscopy
within twelve weeks
65 %
78 %
65 %
78 %
% Urgent Colonoscopy within two weeks
75 %
76 %
75 %
76 %
% Non-Urgent Patients Receiving a
Colonoscopy within 42 days
65 %
22 %
65 %
22 %
Population
Ambulatory sensitive (avoidable) hospital
Health Status admissions by weighted value.
78
YTD Variance to net Result ($000)
Financial
Sustainability YTD Variance to Savings plan ($000)
44
34
78
0
(283)
(46)
FTE employed to budget
Engaged
Workforce
646
Percentage Sick Leave Taken
Total Employees in Excess of 240 hours
356.9
341.3
3.00 %
3.34 %
356.9
341.4
3.00 % 3.34 %
0
81
Page: 3 of 59
20
Accrued Leave
Percentage Annual Leave Taken
11.0 %
10.7 %
11.0 % 10.7 %
Commentaries for Scorecard
Safety and
Quality
Health Targets
Service
Delivery
The poor performance with regard to falls with harm in July is being investigated.
Good performance was maintained against the smoking cessation advice target.
Good performance continued for urgent colonoscopy waiting times and significant improvement was
achieved for non-urgent colonoscopy waiting times in July. The target is expected to be achieved from
September.
Population
Health Status
Medical Staffing: the adverse variance to budget can be categorised into 3 parts: salary variances
($117k favourable), additional duties ($123k adverse) and locum variances ($115k adverse).
Favourable salary variances are observed in areas with vacancies that are filled pending commencement,
such as General Surgery ($109k), ENT ($53k) and Urology ($18k), as well as areas not expecting any
additional appointments, such as Orthopaedics ($54k) and Gynaecology ($17k). Anaesthetics remains
the key area of pressure and has produced a significant adverse performance ($170k).
General Surgery and ENT are covering the substantive gaps with the use of locums to meet service
delivery needs. Expenditure in totality is approximately equal to the favourable variances resulting from
funded vacancies.
Outsourcing: In July there were 18.5 funded Kensington Hospital accommodation lease lists ($70k)
However, 24 were paid for in this period ($82k) creating an adverse variance.
Financial
Sustainability
Eighty six colonoscopy procedures outsourced to Rodney Surgical Centre were paid for in July at a total
cost of $79k. This initiative is unfunded and intended to be in place only until such time as the waiting list
issue in colonoscopy is addressed sufficiently. The current expectation is that use will continue until early
September.
Instruments and equipment: There are a number of emergent cost pressures in Theatres ($43k),
Anaesthetics ($9k) and CSSD ($17k) in July. Many of these are associated with savings schemes that
have been targeted but are yet to come to fruition, including switching suppliers for certain high volume
products when current contracts expire.
Prostheses: Analysis has determined that a high volume of primary joint replacements (49) took place in
July, which has had a direct adverse consequence on the financial performance. Hips ($49k) and Knees
($42k) are the primary causes, while other prostheses costs were slightly favourable to budget ($25k).
Non-resident revenue: Extraordinary levels of receipts were observed in July, primarily due to the billing
of $120k for a single patient.
There are favourable FTE variances in Ward 4 (2.33 FTE, 6.8%), House Officer Relievers (3.00 FTE,
33%) and anaesthetics (2.53 FTE, 14.5%) with the net variance for the service 15.5 FTE (4.3%) below
funded establishment.
Engaged
Workforce
Staff sickness at 3.34% in July is reflective of the overall increase observed since December 2014. A
similar pattern was observed last year and is most likely associated with winter.
The number of staff with leave balances over 240 hours has decreased significantly recently from 98 in
May to 94 in June and 81 in July. Annual leave taken at 10.7% is the highest non-January uptake since
July 2014 but is below the 11% target.
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3.
Strategic Initiatives / Health Services Planning
Agreement has been reached with Waitemata DHB regarding a visiting bariatric surgery service in 2015/16 and
beyond, which will ensure the planned number of operations can be performed.
4.
Emergent Issues and Initiatives Identified
The DHB regained ESPI compliance (amber) in July and remained compliant in August. Plastic surgery and dentistry
remain pressure points given limited operating theatre capacity for these specialties.
5.
Other Highlights
Mr Bill Crisp has commenced employment as a consultant general surgeon with an upper-GI interest. Dr Maxine
Ronald has been appointed as a general surgeon with a breast interest and is expected to commence in April 2016.
Originally from the Bay of Islands, Maxine also has an interest in Maori health development.
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22
Medical
1.
Overview
The general medical service has been very busy with an increase in acute admissions over the winter period.
2.
Scorecard
IP Events Coded For Period - 100%
Medical Scorecard - Whangarei Hospital
Safety and
Quality
Health
Targets
Measure
Goal
Month
All
Month
Maori
Month
Non
Maori
YTD
Goal
YTD
Reducing Acute Readmissions to Hospital
10 %
12 %
14 %
11 %
10 %
12 %
Hospital Acquired Pressure Injuries
0
1
1
0
0
1
Falls with harm within facility
0
3
1
2
0
3
95 %
95 %
93 %
98 %
95 %
95 %
1,805
538
1,267
4.1
3.9
Better help for smokers to quit – Hospital
Inpatient Bed Days
Service
Delivery
Inpatient Average Length of Stay (ALOS)
Acute (excludes Day Cases)
4.1
4.0
Acute Caseweights to contract
427
549
Population
Ambulatory sensitive (avoidable) hospital
Health Status admissions by weighted value.
102
55
4.1
4.0
427
549
48
YTD Variance to net Result ($000)
Financial
Sustainability YTD Variance to Savings plan ($000)
102
0
(64)
(26)
FTE employed to budget
Percentage Sick Leave Taken
Engaged
Workforce
1,805
148.7
161.7
3.00 %
4.31 %
Total Employees in Excess of 240 hours
Accrued Leave
Percentage Annual Leave Taken
11.0 %
9.6 %
148.7
161.7
3.00 % 4.31 %
0
64
11.0 %
9.6 %
Commentaries for Scorecard
Safety and
Quality
Health Targets
Service
Delivery
Acute readmissions remains lower than in previous years though above the 10% target.
Good performance maintained with regard to the smoking cessation advice target.
Acute caseweights was significantly above plan in July. A similar level of activity continued in August.
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Population
Health Status
Salaries: Salary costs are adverse to budget across the General Medical Wards ($33k) for July. This is
driven primarily by the need for bureau nursing and additional HCAs above the funded level. Bed
occupancy in July 2015 was 2.2% higher than in July 2014 and is 4% higher than the average of the last
12 months. This is representative of 3 observed trends: 1) bed occupancy is higher in the winter, 2) bed
occupancy increases year-on-year on average and 3) the number of watches required is increasing.
Financial performance was favourable to budget in CCU ($8k) and ICU ($30k) despite occupancy being
6% and 20% higher than July 2014 respectively.
Financial
Sustainability
Medical Staffing: Medical salary costs can be split into 3 areas: salary variances ($15k favourable),
funded locums ($8k adverse) and unfunded locums ($6k adverse).
The salary variance is for a vacant physician post. Unfunded locum costs are for sporadic deployment of
RMO resource to cover roster gaps.
Pharmaceuticals: pharmaceuticals costs on Ward 16 are 67% higher than the average for the previous
financial year with no specific area of expenditure being solely responsible. This trend will be observed
and analysed accordingly.
Wards 14 and 16 have collectively required around 12.3 additional FTE to funded budget in July 2015.
Ward 14 is currently only funded for 26 beds but have 34 operational. The funding for the additional 8
beds has been approved but will not be transacted until July 2016.
Bed occupancy per calendar day was 2.2% higher than July 2014 and 6% higher than the January – June
2015 average. Acuity and the number of watches required are also a factor in the level of staffing
required.
Engaged
Workforce
Staff sickness at 4.31% is the highest level in over 2 years. 20% of this sick leave is attributable to only 2
individuals both of whom have returned to work so this peak should be non-recurrent. The average for the
last 24 months is 3.1%, just above the 3% target.
The number of staff with leave balances over 240 hours has decreased from 68 in May and June to 64 in
July.
Annual leave taken in July at 9.6% is typical of the lower levels of uptake usually observed in winter.
3.
Strategic Initiatives / Health Services Planning
Planning continues to establish an interim acute medical unit from July 2016.
4.
Emergent Issues and Initiatives Identified
Four additional medical beds are being commissioned from September 2015.
5.
Other Highlights
Dr Lucille Wilkinson commences as the lead acute physician in September 2015. Dr Wilkinson will be leading the
reform of acute medicine and will be meeting with a wide range of stakeholders throughout the district in the first
instance.
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Renal
1.
Overview
Good performance continues in renal services across a range of measures. Demand for in-centre dialysis continues
to grow requiring the commissioning of an additional dialysis shift at Kaitaia Hospital.
2.
Scorecard
IP Events Coded For Period - 100%
Renal Scorecard - Whangarei Hospital
Measure
Goal
Month
All
Month
Maori
Month
Non
Maori
Reducing Acute Readmissions to Hospital
Safety and
Quality
Health
Targets
Service
Delivery
YTD
15 %
18 %
Hospital Acquired Pressure Injuries
0
0
0
0
0
0
Falls with harm within facility
0
0
0
0
0
0
95 %
100 %
100 %
100 %
95 %
100 %
Inpatient Bed Days
100
132
103
29
100
132
Inpatient Average Length of Stay (ALOS)
Acute (excludes Day Cases)
5.0
6.5
6.5
6.5
5.0
6.5
Acute Caseweights to contract
25
29
25
29
Better help for smokers to quit – Hospital
Population
Ambulatory sensitive (avoidable) hospital
Health Status admissions by weighted value.
9
7
2
YTD Variance to net Result ($000)
Financial
Sustainability YTD Variance to Savings plan ($000)
9
0
(39)
(32)
FTE employed to budget
Percentage Sick Leave Taken
Engaged
Workforce
YTD
Goal
62.2
60.3
3.00 %
3.21 %
Total Employees in Excess of 240 hours
Accrued Leave
62.2
3.00 % 3.21 %
0
Percentage Annual Leave Taken
11.0 %
12.1 %
60.3
22
11.0 % 12.1 %
Commentaries for Scorecard
Safety and
Quality
Health Targets
Service
Delivery
Excellent performance continues against the safety and quality indicators.
Outstanding performance was maintained against the smoking cessation advice target.
Acute activity was slightly above plan.
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Population
Health Status
Pharmaceuticals: Approval was sought and granted for a one-off 900mg IV Eculizumab infusion for a
patient prior to a combined liver and renal transplant. The cost for the infusion was $20,058.
Financial
Sustainability
Renal Fluid: The required funding for renal fluid was rebased to reflect the change in treatment modality
observed in renal in the last 2 years. Funding was supplied for 312 home haemodialysis treatments per
month and 1,412 in-centre treatments per month. Treatments in July were 225 and 1,443, creating a net
favourable financial performance. Additionally, the benefits of the cost per unit reduction per the recent
contract negotiation have been built into the 2015/16 operating budget and are $7k ahead of the $12k
year-to-date target.
Un-utilised funded resource in Kaitaia, particularly senior nurse, dietician, technician and admin and
clerical posts have created net favourable variances against funded resource across the service (1.95
FTE, 3.1%). The service is formulating a plan to manage capacity and demand in the context of rising
demand.
Engaged
Workforce
Staff sickness at 3.21% remains above the 3% target for a third month for the first time since July 2014.
The average for 2014/15 was 3.0%.
Annual leave taken at 12.1% in July is above the 11% target.
The number of staff with leave balances of 240 hours or greater has dropped from 24 in May and June to
22 in July.
3.
Strategic Initiatives / Health Services Planning
4.
Emergent Issues and Initiatives Identified
An additional dialysis shift at Kaitaia Hospital is expected to be operational from November 2016.
5.
Other Highlights
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26
Emergency
1.
Overview
The Emergency Department has been busy during July and August with the number of presentations 3% above the
planned level and the number of acute medical admissions at peak levels as expected.
2.
Scorecard
IP Events Coded For Period - 100%
Emergency Scorecard
Health
Targets
Service
Delivery
Measure
Goal
Month
All
Month
Maori
Month
Non
Maori
YTD
Goal
YTD
Shorter Stays in Emergency Departments
(All NDHB)
95 %
93 %
94 %
92 %
95 %
93 %
Better help for smokers to quit – Hospital
95 %
99 %
98 %
100 %
95 %
99 %
Percentage proportion of Triage patients
seen within the recommended time for
their category
75 %
42 %
42 %
42 %
75 %
42 %
Level 4 attendances to Contract –
Discharges
1,392
1,392
Level 4 attendances to Contract –
Admissions (includes ED 3 Hour)
1,518
1,518
YTD Variance to net Result ($000)
Financial
Sustainability YTD Variance to Savings plan ($000)
0
0
FTE employed to budget
Percentage Sick Leave Taken
Engaged
Workforce
(19)
75.6
79.7
3.00 %
3.72 %
Total Employees in Excess of 240 hours
Accrued Leave
75.6
3.00 % 3.72 %
0
Percentage Annual Leave Taken
11.0 %
12.2 %
79.7
27
11.0 % 12.2 %
Commentaries for Scorecard
A slight deterioration in ED length of stay performance was experienced in July as acute pressures
Health Targets approached their winter peak. Very good performance was maintained against the smoking cessation
advice target.
Service
Delivery
Financial
Sustainability
The number of ED attendances was 3% above plan during July and August.
Medical Staffing: An adverse salary variance ($18k) and additional duty variance ($15k) are indicative of
winter pressures in ED.
Salaries: A reported favourable variance to budget ($14k) is in spite of the high volume of ED
presentations and no changes to the funded establishment.
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House officer posts are consistently 2.0 FTE over budget in Emergency Services. The requirement for
registered nurses, including bureau, was 2.5 FTE (7.0%) greater than funded FTE while administrative
and clerical usage was 1.0 FTE (19.2%) greater than funding.
Engaged
Workforce
Staff sickness at 3.72% is the second highest since July 2013 with only last month being higher. The
average for 2014/15 was 2.5%, well below the maximum target of 3%.
Annual leave taken at 12.2% in July is comparable to that taken in July 2014 and a significant increase on
the previous 2 months. This is in spite of high levels of sickness.
The number of staff with leave balances over 240 hours has decreased from a recent peak of 33 in June
to 27 in July.
3.
Strategic Initiatives / Health Services Planning
The planning process for a new emergency department continues.
4.
Emergent Issues and Initiatives Identified
The interim redevelopment scheme for the emergency department has been finalised. It is hoped that the scheme
will be completed before Christmas 2015.
5.
Other Highlights
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28
Outpatients
1.
Overview
Performance against the ESPI target for first specialist assessments remains strong. Performance against the
national 62 day target for cancer treatment improved to 71.1% by July compared with 64.3% in May.
2.
Scorecard
Outpatients Scorecard - Whangarei Hospital
Measure
Service
Delivery
Patients waiting longer than four months
for their FSA
Goal
Month
All
0.40 %
0.26 %
YTD Variance to net Result ($000)
Financial
Sustainability YTD Variance to Savings plan ($000)
Month
Non
Maori
YTD
Goal
YTD
0
(92)
(82)
FTE employed to budget
Percentage Sick Leave Taken
Engaged
Workforce
Month
Maori
96.6
102.1
3.00 %
4.61 %
Total Employees in Excess of 240 hours
Accrued Leave
Percentage Annual Leave Taken
11.0 %
8.1 %
96.6
102.1
3.00 % 4.61 %
0
9
11.0 %
8.1 %
Commentaries for Scorecard
Service
Delivery
The DHB remained ESPI compliant (amber) in July.
Salaries: Contracted FTE is 4.6 FTE (4.9%) below funded budget; however deployed FTE is 3.3 FTE
(3.5%) above funded budget. This is responsible for $18k of adverse expenditure to budget in July 2015.
The three key areas affected are Oncology, Medical Outpatients and EENT Dentistry Outpatients.
Oncology activity in July 2015 is comparable to July 2014 but 17% higher than the average for the last 12
months. Medical Outpatient activity is 6% higher in July 2015 than July 2014. ENT outpatient
attendances are around 30% higher in July than the average for the prior year.
Financial
Sustainability
Outsourcing: The 2014/15 year-end wash up of outsourced contracts has generated a number of
adverse variances as previously unexpected invoices have been paid or been identified as outstanding,
most notably in Immunology ($29k) and Pacemaking ($39k).
Depreciation: The purchase of new capital items has increased the depreciation charges in Oncology
and Medical Outpatients, creating adverse variances of $5k and $8k respectively.
Pharmaceuticals: Favourable performance in Oncology ($17k) and adverse performance in Medical
Outpatients ($32k) have determined a net adverse variance position for July 2015.
Medical Outpatients continue to incur expenditure beyond budget in a number of areas, including GI
drugs ($12k) and Immuno/hormone drugs ($13k).
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Oncology (2.4 FTE, 13.4%), Medical Outpatients (1.9 FTE, 8.9%), EENT Clinic (1.9 FTE, 12.4%) and
General Surgery and Gynaecology (2.1 FTE, 13.5%) are the core areas of adverse to budget FTE
deployment. Oncology has an unfunded registrar post. Administrative and clerical roles in Medical
Outpatients, General Surgery and Gynaecology and EENT are pressure points as the budget does not
reflect the costs of covering leave.
Engaged
Workforce
Staff sickness at 4.61% is significantly above the target. It is a reduction on May and June’s peak levels
of sickness but remains a pressure. The average for 2014/15 was 4.5%, 50% higher than the target
maximum.
The number of staff with leave balances of 240 hours or greater has decreased from 12 in May and June
to 9 in July.
Annual leave taken at 8.1 in July was below the 11% target for the 15th time in 17 months, demonstrating
the departments’ reliance on the elective shutdown in December and January to manage leave allocation.
3.
Strategic Initiatives / Health Services Planning
The project to review and reform cancer treatment pathways is focusing on colorectal cancer having achieved
significant improvement in the breast cancer pathway. The DHB’s performance against the national 62 day target
has been favourably impacted by the reforms achieved by the project.
4.
Emergent Issues and Initiatives Identified
Plans are being formulated in conjunction with Auckland DHB to reduce the number of visiting clinics in haematology
following the commencement of a specialist haematologist, Sarah Popular, at Northland DHB from October 2015.
5.
Other Highlights
Dee Telfer has been appointed as the clinical nurse manager for cancer and blood services.
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Radiology
1.
Overview
Good performance continues with regard to CT waiting times. Both new CT scanners are now fully commissioned
and operating successfully.
2.
Scorecard
Radiology Scorecard - Whangarei Hospital
Service
Delivery
Measure
Goal
Month
All
Improving waiting times for diagnostic
services - CT % receiving CT scans within
6 weeks
85 %
Improving waiting times for diagnostic
services - MRI % receiving MRI scans
within 6 weeks
85 %
YTD
Goal
YTD
91 %
85 %
91 %
41 %
85 %
41 %
0
(128)
YTD Variance to net Result ($000)
Financial
Sustainability YTD Variance to Savings plan ($000)
Month
Non
Maori
(12)
FTE employed to budget
Percentage Sick Leave Taken
Engaged
Workforce
Month
Maori
70.6
64.7
3.00 %
2.36 %
Total Employees in Excess of 240 hours
Accrued Leave
70.6
3.00 % 2.36 %
0
Percentage Annual Leave Taken
11.0 %
10.2 %
64.7
19
11.0 % 10.2 %
Commentaries for Scorecard
Service
Delivery
Performance against the national 6 week waiting time targets remains very strong for CT. Gradual
improvement is being made in MR waiting times though achievement of the target is dependent upon the
commissioning of a new scanner.
Outsourcing: Funding for outsourced services was revised for 2015/16 with budget only remaining for
external reporting at $15k per month remaining. Currently the Service has need to contract out a number
of unfunded services including PETCT ($36k), CTC ($28k), MRI (6k), MRI Breast ($8k) and DEXA ($9k).
The requirement for PETCT will remain however there are plans in place to remove or drastically reduce
the other costs through capital purchase of a new MRI scanner and DEXA scanner. The demand for
outsourced CTC will cease from quarter 2 now that in-house capability is being developed.
Financial
Sustainability
Treatment disposables: A number of high cost transactions for purchases of syringes for the new CT
injector have been incurred in July 2015. It is to be determined whether this is an on-going long-term cost
pressure or some on-off expenditure associated with the bedding in of the new equipment.
Instruments and Equipment: This variance has arisen due to the phasing of the MRI replacement
service contract savings not aligning to the deliverables of the project. It is expected that the savings will
be delivered in totality but at a later date than was originally expected when the budget was set.
Medical Staffing: Funding for 3 additional posts was provided from July 2015. These posts are not
currently recruited to and the funding is being used to absorb the impact of the additional duties being
paid to existing staff to meet the shortfall in capacity. Additional reads costs are equivalent to roughly 2
posts' worth of costs ($40k) and hence this has generated a favourable variance of $22k in July 2015.
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Favourable FTE performance for SMOs and student MRTs is moderated by adverse FTE performance for
MRTs, with a net 5.9 FTE of variance against budget for the service (8.3%). 3 new SMO posts have been
funded from July.
Engaged
Workforce
Staff sickness at 2.36% is the 10th time in 11 months that the 3% target has been bettered. The average
level of sickness for 2014/15 was 2.10%.
The number of staff with leave balances of 240 hours or greater decreased from 22 in May and 20 in June
to 19 in July.
Annual leave at 10.2% taken in July was below the 11% target. The average for 2014/15 was 9.4%.
3.
Strategic Initiatives / Health Services Planning
The project to replace the current MRI scanner continues. Following Board approval of the decision to purchase a
Siemens scanner, it is expected that the new scanner will be installed by December 2015.
4.
Emergent Issues and Initiatives Identified
A review of how after hours radiologist cover is provided has commenced.
5.
Other Highlights
CT colonography is now being undertaken at Whangarei Hospital. Initially, images will be reported by local
radiologists and Auckland based radiologists.
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32
Older People, Clinical Support & Lab
1.
Overview
A busy start to the new financial year, with service delivery reflective of activity in acute hospital areas.
2.
Scorecard
Older People, Clinical Support & Lab Scorecard
Measure
Safety and
Quality
Health
Targets
Service
Delivery
Goal
Month
All
Month
Maori
Month
Non
Maori
YTD
Goal
YTD
Falls with harm within facility
0
0
0
0
0
0
Hospital Acquired Pressure Injuries
0
4
0
4
0
4
Better help for smokers to quit – Hospital
95 %
100 %
100 %
100 %
95 %
100 %
Assessment and Rehabilitation Bed Days
583
618
583
618
Inpatient Contacts
2,355
2,549
2,355
2,549
Outpatient Contacts
1,060
1,065
1,060
1,065
Community Contacts
2,483
2,470
2,483
2,470
Retinal Screens
339
412
339
412
Breast Screens
980
1,111
980
1,111
Laboratory Test Orders
109,893
YTD Variance to net Result ($000)
Financial
Sustainability YTD Variance to Savings plan ($000)
FTE employed to budget
Percentage Sick Leave Taken
Engaged
Workforce
0
15
285.3
270.3
285.3
270.3
3.00 %
3.43 %
3.00 %
3.43 %
0
55
11.0 %
8.1 %
Total Employees in Excess of 240 hours
Accrued Leave
Percentage Annual Leave Taken
109,893
11.0 %
8.1 %
Commentaries for Scorecard
Safety and
Quality
Health Targets
Service
Delivery
No falls with harm within facility but four hospital acquired pressure injuries in July. The driver of the
pressure injuries is unclear and increased surveillance has been put in place.
The service exceeded the 95% target in July, with 100% of patients receiving smoking cessation advice.
Health of Older People & Clinical Support
Most annual targets are based on average delivery over the past three years, phased to allow for holiday
periods and seasonal variations. Retinal Screening is based on NDHB internal targets, and Breast
Screening is based on the Ministry of Health contract. No service delivery measures were underdelivered
by greater than 2% against target in July.
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33
Laboratory
July was the first month where a full month of comparable year on year data was available from the
Delphic Laboratory Information System (LIS). July 2015 test orders across all NDHB Laboratory sites
were 6% higher than July 2014 test orders. The availability of reliable year on year will enable the
Laboratory Management Team to start investigating demand management strategies.
For the month of July, the overall financial result was a favourable variance of $15k across Health of
Older People & Clinical Support and Laboratory. Note that the majority of the expenditure budget for both
services is phased 49:51.
Health of Older People & Clinical Support - $16k favourable to budget
Favourable variance in Revenue ($80k - includes $35k ACC, $24k Breast Screening, $9k InterRai) and
Outsourced Salaries ($9k) offsets overspend on Salaries ($54k) and Internal Recharges ($10k)
Financial
Sustainability
$10k of Salaries overspend is offset by releases from Income in Advance, and a further $8k is due to
Savings Lines. Remaining Salaries overspend relates to budget phasing and will correct in the second
half of the year. Internal Recharges overspend is due to higher than budgeted Transport and
Photography recharges.
Laboratory - $1k unfavourable to budget
The service had underspends on Outsourced Supplies ($14k) and Supplies ($14k) for the month of July.
Revenue was $4k favourable due to higher than budgeted Coronial Post Mortem revenue.
Salaries were $34k over budget for the month. Overtime and Callback at regional laboratories accounts
for $10k - this is a highly variable area which is difficult to budget. Approximately $5k can be attributed to
higher than budgeted annual leave costs - annual leave taken is paid at a higher rate than provided for in
the budget template due to the impact of penals, overtime and callback on average hourly rates. A further
$4k of Salaries expenditure relates to Coronial Post Mortem payments and is offset by Revenue received.
Remaining Salaries variance is due to budget phasing.
Engaged
Workforce
3.
As at 21 August 2015, 57 staff had annual leave balances in excess of 240 hours (33 in Health of Older
People & Clinical Support and 24 in Laboratory).
Strategic Initiatives / Health Services Planning
Deliverable / Action
4.
Planned Outcome
Status
Home Based Support Services (HBSS)
Review
On track
On Track
e-Pharmacy
On track
On Track
Safe use of Opioid to Reduce Harm
Actions from learning sessions are underway
On Track
Acute Stroke Unit
On track
On Track
Emergent Issues and Initiatives Identified
An unusual number of physiotherapist resignations were received during the month. Investigation has revealed no
underlying issue, rather a series of coincidences that will unfortunately have an impact on service.
5.
Other Highlights
The flu vaccination programme is coming to a close, with a 71% vaccination rate achieved across NDHB employees
(last year 58%)
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34
Mental Health
1.
Overview
The NDHB Mental Health & Addiction Service (MHAS) continues to experience ongoing high demand and acuity
levels for both community and inpatient services. Occupancy of the Tumanako Inpatient Unit was 101.8% in July,
and the three sub-acute units (Whangarei, Kaikohe and Kaitaia) averaged 84% occupancy. Demand for respite, subacute and the community medications run are also exceeding capacity and has limited ability to reduce the acute
services pressure. A high and disproportionate number of young (18-29 years old) Maori male are users of acute
inpatient beds - 23% of the bed days in 2014 2015.
A 3 year Tumanako Acute Inpatient Transformation Plan (Tumanako Plan) has been created to address the capacity
and demand issues. This ultimately involves converting Tumanako from a 25 bed multi population and pod (child
youth, adults, older adults) model to a solely adult service with 30-35 beds. *See the Tumanako Plan table at end of
this report.
There is continuing high demand for access to the older persons beds in the Acute Inpatient Unit (4 beds) with 85%
occupancy. These older persons are typically high and complex needs, are physically and medically fragile, needing
high staff input to manage combined mental and physical health needs. As part of the Tumanako Plan the aim is to
establish an alternative model of inpatient care for older persons, involving a specialist facility either in the community
through an aged residential care provider or a facility on the Whangarei hospital site. This is being developed in
consultation with the Health of Older Person Services and the aged residential care sector.
The Tumanako consistent service demand places ongoing pressure on the operating budget. The July result for
Mental Health is $153k over budget with the over spend primarily in the Tumanako IPU for nursing and auxiliary
worker salaries. The service is operating to agreed core provisional staffing levels and while it is recruiting permanent
staff to achieve this level is requiring the use of overtime by current staff or calling on community MHAS staff and
bureau staff. As a result overtime costs are high. As part of the Tumanako Plan a mental health nursing and auxiliary
worker improvement project has commenced and which will identify the requisite staffing levels required for safe and
effective service provision.
A formal review of the MHAS management structure commenced in February, with a focus on improving service
performance, patient safety and service quality, financial performance and sustainability. This is now in the
implementation phase, two of four service manager positions have been appointed and Team Leader recruitment is
commencing. All key roles should be established by October.
Other key service development work includes the Tumanako Plan; the inter-sector (NGO, primary care, MHAS) Align
Model of Care project. Te Pou will lead MHAS workforce development planning in 2015. A Let’s Get Real (LGR)
workshop has prioritized action on ‘working with Maori’ and is now being implemented in partnership with Te
Poutokomanawa, the Maori health team. LGR workshops were held on 21 July and 5 August and an Action Plan will
be developed by September.
Later in 2015 MHAS will develop a strategic plan with a long term horizon (3-5 years). This will focus on
implementing the national mental health plan ‘Rising to the Challenge’ and with a clear line of sight to other major
policy directions such as Blueprint 2, the Primary Care strategy and the Northland Health Services Plan 2012-17.
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35
2.
Scorecard
IP Events Coded For Period - 100%
Mental Health Scorecard
Measure
Goal
Month
All
Month
Maori
Month
Non
Maori
YTD
Goal
YTD
Safety and
Quality
Reducing Acute Readmissions to Hospital
13 %
8%
10 %
6%
13 %
8%
Health
Targets
Better help for smokers to quit – Hospital
95 %
88 %
86 %
89 %
95 %
88 %
Inpatient Bed Days – Ward 6
659
791
270
521
659
791
Detox Bed Days - Dargaville
132
150
40
110
132
150
Sub-acute Bed Days (Kaitaia, Kaikohe,
Whangarei)
474
474
334
140
474
474
Inpatient Average Length of Stay (ALOS)
(excludes Day Cases)
24
14
15
14
24
14
0
(153)
Service
Delivery
YTD Variance to net Result ($000)
Financial
Sustainability YTD Variance to Savings plan ($000)
(42)
FTE employed to budget
Percentage Sick Leave Taken
Engaged
Workforce
327.4
312.5
3.00 %
5.14 %
Total Employees in Excess of 240 hours
Accrued Leave
Percentage Annual Leave Taken
11.0 %
9.9 %
327.4
312.5
3.00 % 5.14 %
0
46
11.0 %
9.9 %
Commentaries for Scorecard
Safety and
Quality
Readmissions within 28 days were favourable to target this month at 10%, with six patients readmitted. Four
patients were discharged from Tumanako and readmitted to a medical/surgical/ED ward, one patient from the
sub-acute units was readmitted to Tumanako IPU and one patient was discharged from Tumanako IPU, and
then readmitted to the Unit.
The Tumanako Older People pod was used for 106 bed days (85% occupancy) for five clients over 64 years,
and the other bed days used for under 65 year patients.
Health
Targets
Smoking cessation advice given shows as below target at 88% this month. However, all patients received
smoking cessation advice, and coding has now been updated. 83 patients were admitted to mental health
inpatient beds, including the sub-acute units and detox unit. 54 were current smokers, and one had been smoke
free for less than a month.
The smoking rate was 68%, compared to 20% average smoking rate for the whole hospital.
Service
Delivery
The Tumanako Inpatient Unit remains very busy with occupancy of 101.8% and 110.1% including patients on
leave. A sub group of high and complex needs patients, all with stays in excess of 3 months accounted for 33%
of adult bed capacity in July.
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36
10,000
105%
9,000
100%
8,000
95%
7,000
90%
6,000
85%
5,000
80%
4,000
75%
3,000
70%
2,000
65%
1,000
Month Occupancy
110%
60%
0
Jul
Aug
Sep
Last Year
Oct
Nov
Dec
This Year
Jan
Feb
Mar
Apr
Last Year A ctual YTD
Last Year
This Year
May
Jun
This Year A ctual YTD
Occupancy
Result
YTD Cumulative Volume Days
Mental Health Inpatient Unit - Utilisation & Bed Days 2015-2016
Bed Days
Change
Last Year
This Year
Change
Month
101%
102%
1% ▲
Month
784
789
1% ▲
YTD
101%
102%
1% ▲
YTD
784
789
1% ▲
There were 40 admissions this month and 40 discharges, with an average length of stay of 16.7 days in
Tumanako IPU. 13 admissions (33%) were clients new to the service. The average length of stay in the Service
Delivery Table above is 14 days, which is the average length of stay of the combined inpatient unit, sub-acute
units and detox unit.
M H Inpatient Unit - Discharges and Length of Stay 2015-2016
60
200
180
160
140
40
120
30
100
80
20
60
40
10
Average Length of Stay
Discharge Volume
50
20
0
0
Jul
Aug
Sep
Oct
Nov
Discharges Last Year
Dec
Discharges This Year
Jan
Feb
A LOS Last Year
Discharges
Last Year
This Year
Mar
Apr
May
June
A LOSThis Year
Average Length of Stay
Change
Last Year
This Year
Change
Month
30
40
33% ▲
Month
21
17
19% ▼
YTD
30
40
33% ▲
YTD
21
17
19% ▼
The three sub-acute units, (Whangarei He Manu Pae, Kaitaia Te Kohanga and Kaikohe Tu Kaha), remain busy
with occupancy of 84% and an average length of stay of 9.2 days. The average length of stay in the subacute
units was Far North, Kaitaia – 9 days; Mid North Kaikohe – 10 days, and Whangarei – 9 days.
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37
MH Whg, Mid & Far Nth Subacute Units - Discharges and Length of Stay 2015-2016
60
200
180
160
140
40
120
30
100
80
20
60
Average Length of Stay
Discharge Volume
50
40
10
20
0
0
Jul
Aug
Sep
Oct
Nov
Discharges Last Year
Dec
Jan
Discharges This Year
Feb
Mar
A LOS Last Year
Discharges
Last Year
Apr
May
June
A LOSThis Year
Average Length of Stay
This Year
Change
Last Year
This Year
Change
Month
39
43
10% ▲
Month
11
9
18% ▼
YTD
39
43
10% ▲
YTD
11
9
18% ▼
There were 43 admissions to the three sub-acute units in July, with the table below showing the admission
source. This shows The trend is for the Whangarei service to receive clients direct from the IPU, and for the
Far North and Mid North services to receive more clients from the local community. Optimal sub-acute
performance can reduce the demand for access to inpatient services, and also facilitate better discharge from
the IPU back to the community.
Admitted from
Facility
Far North Sub-acute
Mid North Sub-acute
Whangarei Sub-acute
Total
Tumanako
Sub-acute
2
0
16
18
Other Ward
0
0
0
0
2
0
2
Community
14
7
2
23
There were 43 discharges from the sub-acutes.
Discharged to
Facility
Far North Sub-acute
Mid North Sub-acute
Whangarei Sub-acute
Total
Tumanako
Sub-acute
Other Ward
1
2
3
0
Community
15
12
13
40
Detox Unit
The five bed Detox unit in Dargaville had 10 admissions and 9 discharges, with an average length of stay of
14.6 days. Admissions to the Detox Unit are planned and booked 6 weeks in advance, so if a patient leaves
earlier than expected, the bed is not filled until the date of the next planned admission.
Community Mental Health
The community mental health teams had 9,594 client contacts in July and a further 2,491 care coordination
contacts (with persons or agencies other than the client or whanau, such as WINZ).
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38
12,000
120,000
10,000
100,000
8,000
80,000
6,000
60,000
4,000
40,000
2,000
20,000
0
YTD Cumulative Volume
Month Volume
Community Mental Health Client Contacts 2015-2016
0
Jul
Aug
Last Year
Sep
Oct
Nov
Dec
This Year
Jan
Feb
Mar
Apr
Last Year A ctual YTD
May
Jun
This Year A ctual YTD
Client Contacts
Result
Last Year
This Year
Change
Month
9,117
9,594
5% ▲
YTD
9,117
9,594
5% ▲
Mental Health was unfavourable to budget $153k for July. Major reason for the over spend is Tumanako IPU
and Whangarei Sub-acute overtime costs, being $91k over budget and increased use of respite beds and a
month overspend of $21k. There is an emerging respite use and cost issue for the elderly population whose
needs are not able to be met by the rest home care available in Northland.
Tumanako IPU had 101.8% occupancy in July, with high acuity and demand. This is requiring ongoing
additional nursing and auxiliary staff to ensure patient safety and quality. As part of the Tumanako Plan core
provisional staffing levels have been agreed and recruitment is ongoing to achieve this level. A mental health
nursing and auxiliary worker improvement project has commenced to develop improvement initiatives and
identify requisite staffing levels that will also inform operating budget costs.
Reducing overtime remains a high priority for both inpatient and community services. The high overtime hours
in July were also contributed to by high acuity, and staff gaps, in the community crisis teams.
Mental Health Overtime 2013-2015 in Hours
Financial
Sustainability
3000
2800
2600
2400
2200
2000
1800
1600
1400
1200
1000
800
600
400
200
0
Jul-13 Sep-13 Nov-13 Jan-14 Mar-14 May-14 Jul-14 Sep-14 Nov-14 Jan-15 Mar-15 May-15 Jul-15
Inpatient Unit
Whangarei Crisis
Far Nth Comm
Mid Nth Comm
ICT
Other teams
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39
Mental Health FTEs are 15 FTE favourable to budget for the month, with additional staff budgeted in Tumanako
Inpatient Unit this year, which have not been recruited to yet. Overtime was high, with overtime hours not
forming part of the FTE calculation.
Engaged
Workforce
Annual leave taken at 9.9% is very good for the time of year ie winter season. There are 50 staff with over 240
hours annual leave owing – back down to April level. Managers review staff with over 240 hours annual leave
monthly.
Sick leave remains high at 5.15%, with two staff on long term sick leave in Tumanako. Both are expected to
resign within the next two weeks.
3.
Strategic Initiatives / Health Services Planning
1.
2.
3.
Action Item
Tumanako
Acute Inpatient
Unit (IPU)
Transformation
Plan
Tumanako
Nursing and
MHAW
Improvement
Project
High and
complex needs
patients
Action & Priority (H, M, L)
 Implement three year Action Plan to
convert 25 bed Tumanako IPU from a
multi population (child youth, adult, older
adult) pod model into a solely adult 30-35
bed service.
HIGH
Phase 1. Improve nurse and MHAW daily
ways of working, practice, improve
education and information to support
decision making
Phase 2. Improve services ability to plan
and the capacity to manage demand and
capacity in the future
HIGH
 Meet local HCN needs while regional
HCN capacity is established
 Participate in regional HCN planning
 Monthly comprehensive clinical review
meeting to monitor and clarify access to
appropriate care for identified patients
 Active regional participation in High and
Complex Needs planning project
HIGH
4.
Enhance
Service
Coordination
across the
acute services
continuum



5.
MHAS
Strategic and
workforce
development
planning


Submission for approval to establish
additional coordination capacity.
Purpose is to improve the access to, and
the effectiveness and efficiency of IPU,
sub-acute, respite and residential
services.
Describe the coordination role function,
operation and benefits
MHAS Annual Mental Health Plan 201516 has been completed as part of the
NDHB DAP process. Quarterly
reporting of progress will occur under
the 4 key goals: Equity; Early
Intervention; Value for Money;
Integration.
Strategic and workforce development
planning in 2015 will involve a
comprehensive analysis of population
needs, projected demand, be related to
national (Rising to the Challenge)
Action / Progress Update
See below
 Project now commenced with K Thornton
seconded part-time 6 months from Nursing
Directorate.
 Monthly review to monitor and clarify access
to appropriate care for identified patients.
 Currently 7 HCN patients in Tumanako IPU
and ‘bed blocking’.
 Two HCN beds purchased at gated
community facility in Auckland
 Ongoing involvement in regional HCN
service planning, exploring options for
regional minimum secure rehabilitation
service.
 NDHB require access to minimum 5 HCN
beds.
 Approval gained for enhancing coordination
capacity
 Paper developed describing need, purpose,
operation and benefits
 Recruitment into role to start and
commence work by September
 Strategic planning will be ‘across sector’ in
collaboration with NGO and primary care
partners in particular.
 Workforce development planning will be led
by Te Pou, the national MHAS workforce
development agency.
 Maori development will be a service
planning priority, and informed by recent
‘Working with Maori’ planning workshops
run in partnership with Te Poutokomanawa
(Maori health team) and facilitated by Moe
Milne and Te Pou.
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40
regional and local planning, including
the NHSP.
 Planning will guide the future design and
location of MHAS services and will
feature the goal to be part of an
integrated ‘whole of person / health’ and
community based service model. This
will align with international best practice
MHAS services.
4.
Emergent Issues and Initiatives
1.
Action
Item
Safe
Staffing
Levels
Action & Priority (H, M, L)
Mitigation / Opportunities
Progress Update
 Establish provisional safe
staffing levels across roster
 Financial analysis to know
cost, budget and planning
implications
 Recruitment and retention
strategy (immediate, long
term) to achieve and maintain
provisional staff levels
 CCDM project to identify
staffing requirement (mix and
numbers) and inform budget
 Involve staff in Action
Plan, keep staff
informed, listen, support
 Establish, recruit to
achieve provisional staff
levels
 Community RNs
secondment to IPU
 Community RN staff
complete shifts
 All staff work to flexible
roster, per contract
 Accurate JD’s
 Proper orientation
 Establish agreed, $
sustainable staffing
levels via CCDM,
productive series.
 Core provisional staffing
levels set
 Budget impact estimated
for 15-16 year
 Ongoing recruitment to
achieve core levels,
currently 5 FTE gap
 Constrained by staff on
preferred hours roster,
constrains optimal roster
management and drives
use of overtime and
bureau. All on flexible
roster by Sept.
 MH Nursing project
supported by Nursing
Directorate. To establish
requisite staff levels and
mix for safe and effective
service.
 MHAS review of
management structure
finalised, and has CEO
approval.
 Aim to recruit IPU/Sub
Acute service manager by
August, followed by senior
nursing and allied health
leader roles.
 See 1. MH Nursing project
above
 MHAW training
programme under
development via M
Baker/Donna K/Jane S
 MHAW staff commenced
NZQA national certificate
training, supported by N
Holden
HIGH
2.
Leadership
Structure
 Current review of
management structure across
MHAS. Completion July
2015.
 New role of Service Manager
for Tumanako and Sub-acute,
and Clinical Nurse Manager.
HIGH
3.
Model of
nursing
care
2.1 Nursing model of care
 Nursing core role and
functions
 Implement a nursing model
 Explore EN role option
2.2 MHAW role, function
 Identify core role, functions
 Establish leader function
 Assess training needs (L4
national cert, other)
2.3 Diversional Worker role
 Identify core role, function
 Implement IPU part of
MHAS structure change
immediately, appointing
Service Manager and
Clinical Nurse Manager.
 Active Group Manager,
Clinical Director, Nurse
Leader, Consumer
Leader support of IPU
 Nurse leadership group
 CCDM, productive
series, time to care
(50K)
 MHAW training
programme
HIGH
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41
4.
Environmental
modification



Review and plan for sensory
modulation and diversional
resources
Review distribution of
diversional and occupational
therapy staff per ward
Sensory modulation training
for staff
HIGH
5.
Crisis /
community
adult –
inpatient
interface

Review and update
guidelines for ensuring rapid
community clinical care for
all patients discharged from
Tumanako
HIGH
6.
IPU and
hospital
Interface
 IPU patient access to
medical care, including
transfer to hospital
 MHA patients attending ED
 Medical care of MHA
patients in IPU
 Access to phlebotomist
 Access to dietitians
 Access to medical
consultant opinion
 Implement SM staff
training
 Provide access to SM
furniture, equipment
(18K)
 Staff confident, capable
in sensory modulation
approaches
 Staff / patient are selfmanaging
 Effective de-escalation
 Reduced incidents,
restraint and seclusion
 Timely, effective
transition between
community and
inpatients services –
smoother access and
discharge
 Improve
communication, coordination between
community and IPU
services
 Improve co-ordination
between IPU,
community services with
sub-acute and respite
services.
 Develop agreed
operating protocols
between IPU and
hospital
 Establish daily
communications by IPU
with hospital wards
 SM training programme
under development by
Vanessa, to commence
in June.
 Tumanako OT /
Diversional programme
available, operating.
 Furniture and
equipment available,
capex requests made
as needed.
 Timely, effective
transition between CY
community and
inpatients services –
smoother access and
discharge
 Improved coordination
and communication
between CY community
and inpatient services
 Agreement with metro
DHBs and improved
access to CFU beds
where required.
 Access to CFU starship
beds in ADHB in place.
 Briefing being prepared
to CEO re NDHB
formalising access to
regional CY beds at
CFU Starship in ADHB.
 Consultation
commenced with NDHB
Child/Paediatric
services, developing
agreed guidelines for
short stay access to
paediatric beds for
children with nonserious MH needs.
 Clinical pathway
guidelines reviewed for
discharge / transition
from IPU to community
 Now needs
communicating and
embedding with all
teams, staff.
 Proposal developed to
increase specialist
coordination function, to
facilitate better transition
between IPU, subacute,
respite and residential
services
 IPU and hospital
interface meeting held
and action tasks
identified. Requires
follow up for ongoing
action.
 IPU senior nurse now
attending daily hospital
bed coordination
meeting.
HIGH
7.
Child and
Youth
admissions
 Review admissions to
Tumanako policy
 Develop alternatives to IPU
admission options paper
 Confirm protocol with ADHB
for referral access to
Starship CFU
 Develop guidelines for
mental health admissions to
paediatric ward
 Evaluate use and
effectiveness of Child and
Youth Pod
HIGH
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42
8.
High and
complex
needs
patients


 NDHB part of regional
HCN planning
 Purchase 2 x HCN beds
 Develop minimum
secure rehabilitation
beds
Monthly comprehensive
clinical review meeting to
monitor and clarify access to
appropriate care for identified
patients
Active regional participation
in High and Complex Needs
planning project
 Ongoing involvement in
regional HCN service
planning, exploring
options for regional
minimum secure
rehabilitation service.
 Currently NDHB require
access to minimum 5
HCN beds.
HIGH
9.
Bed
capacity
review


Review pre Tumanako
analysis of NDHB acute
mental health bed
requirement for adults
 Review requirements for
acute inpatient beds for older
persons and for child / youth


HIGH
10.
Older Adult
admissions



Review admissions to
Tumanako policy
Options paper for older
adults (OA) with dementia
and physical fragility to be
treated in main hospital, near
geriatric medicine
MEDIUM


11.
12.
Rural
hospital
admissions


Develop guidelines for
mental health admissions to
Dargaville, Kawakawa BOI,
and Kaitaia hospital
MEDIUM

Review pre Tumanako
analysis of acute mental
health adult bed
requirement of NDHB
Population analysis and
forecasting of future
need
Work with HOPS and
Paediatrics to plan older
persons and child /
youth strategy
Timely, effective
transition between OA
community and
inpatients services –
smoother access and
discharge
Improved coordination
and communication
between OA community
and inpatient services.
Collaboration by MHAS
with NDHB HOP
services for service
planning, development,
improvement.
Strengthen local service
responsiveness
Reduce demand on
Acute/IPU services
 Referral to regional
forensic beds
Forensic
Interface



Consultation
commenced with HOP
services (N Beney, A
Davis) re service
planning and
development to better
meet OA needs.

Kaitaia hospital started
identifying opportunities
to increase local
capacity to serve MHAS
clients in hospital.
See 8. Above re HCN
clients.
Monthly forensic review
of high risk patients
ongoing.


MEDIUM
5.
Review and research
underway, paper drafted
re NDHB acute inpatient
bed requirements.
Service requirements,
change and
development options
being identified.
Other Highlights
Maori Health and Mental Health & Addictions have combined resources to fund a new position which will implement
Results Based Accounting for NGO contracts, and bring up to 7 NGO providers onto the DHB JADE system.
Page: 26 of 59
43
District Hospitals
1.
Overview
Total recorded bed days across all inpatients wards were 7.8% down from June, and 5.7% down on the same period
last year. Bay of Islands is bucking this average trend, with a 4.5% increase on last month, and a 19% increase on
last year in recorded general ward bed days.
There were a total of 914 presentations in the two district emergency departments during July, a 3.5% increase on
last month, and a 12% increase on the same period last year.
2.
Scorecard
IP Events Coded For Period - 100%
District Hospitals Scorecard
Safety and
Quality
Health
Targets
Service
Delivery
Measure
Goal
Month
All
Month
Maori
Month
Non
Maori
YTD
Goal
YTD
Reducing Acute Readmissions to Hospital
10 %
7%
6%
8%
10 %
7%
Falls with harm within facility
0
1
0
1
0
1
Hospital Acquired Pressure Injuries
0
0
0
0
0
0
Better help for smokers to quit – Hospital
95 %
99 %
98 %
100 %
95 %
99 %
Inpatient Average Length of Stay (ALOS)
(excludes Day Cases)
3.0
2.7
2.7
2.8
3.0
2.7
Acute Caseweights to contract
270
315
270
315
Elective Caseweights to contract
36
33
36
33
Percentage Attendance rate for all OP
Appointments in District Hospitals
95 %
86 %
95 %
86 %
Percentage Attendance rate for all OP
Appointments in Whangarei Hospital
95 %
91 %
95 %
91 %
Percentage Outpatient Bay of Islands
Domicile Attendances in BOI (Quarterly)
22 %
24 %
22 %
24 %
Percentage Outpatient Dargaville Domicile
Attendances in DRG (Quarterly)
18 %
15 %
18 %
15 %
Percentage Outpatient Kaitaia domicile
attendances in KTA (Quarterly)
55 %
58 %
55 %
58 %
Population
Ambulatory sensitive (avoidable) hospital
Health Status admissions by weighted value.
96
YTD Variance to net Result ($000)
Financial
Sustainability YTD Variance to Savings plan ($000)
44
96
0
FTE employed to budget
Engaged
Workforce
52
Percentage Sick Leave Taken
Total Employees in Excess of 240 hours
Accrued Leave
199.4
197.7
3.00 %
2.53 %
199.4
197.7
3.00 % 2.53 %
0
43
Page: 27 of 59
44
Percentage Annual Leave Taken
11.0 %
11.2 %
11.0 % 11.2 %
Commentaries for Scorecard
Safety and
Quality
Health
Targets
There was one fall with harm in Bay of Islands hospital this month. The incident is being reviewed.
The YTD smoking advice rate of performance remains comfortably above target.
Total recorded bed days across all inpatients wards were 7.8% down from June, and 5.7% down on the
same period last year. Bay of Islands saw a 4.5% increase on last month, and a 19% increase on last
year in recorded general ward bed days.
There were a total of 914 presentations in the two district emergency departments during July, a 3.5%
increase on last month, and a 12% increase on the same period last year.
Kaitaia & Bay of Islands ED Department
Presentations
1200
1000
800
ED Presentation
600
ED Presentation w/ Admission
400
Total ED Events
200
Linear (Total ED Events)
Service
Delivery
Jul-15
Jun-15
May-15
Apr-15
Mar-15
Feb-15
Jan-15
Dec-14
Nov-14
Oct-14
Sep-14
Aug-14
Jul-14
0
The operating theatres at Kaitaia hospital processed a total of 112 surgical cases in July, which reflects a
8.9% decrease on total June 2015 cases, but a 9.8% increase on July 2014 volumes.
Kaitaia Hospital Theatres - Surgical Case Volumes
200
150
100
Total Cases
50
Linear (Total Cases)
0
Page: 28 of 59
45
Kaitaia Hospital Theatres - Surgical Case Volumes
(By Specialty)
200
Plastic Surgery
Anaesthetics
150
Urology
100
Orthopaedic
Ophthalmology
50
General Surgery
0
ENT
Dental Surgery
Telehealth, travelling specialists, and other initiatives are helping to increase the proportion of outpatient
clinics taking place at a patient's local hospital.
Weighted avoidable admissions for July 15 are in line with those recorded in July 14.
Population
Health Status
The three district hospitals are reporting an unfavourable variance to budget for July of approximately
$30k.
Financial
Sustainability It is hoped that the district hospitals can be more frequently utilised in 2015/16 to reduce pressure at
Whangarei Hospital, and to decrease reliance on outsourced surgical services. These initiatives are being
discussed with surgical services.
Engaged
Workforce
3.
Annual leave and sick leave sit within their target range in July. The number of staff with large leave
balances remains in the low 40s.
Strategic Initiatives / Health Services Planning
The initial strategy for medical staffing at Dargaville Hospital from 1 October 2015 was agreed by the board at their
August meeting. At the time of writing a press release and communications plan is being readied for public release.
The clinical head at Kaitaia Hospital continues to implement nurse training to assist in upskilling A&M nurses across
the rural hospitals. This upskilling is expected to enable nurses to enact treatment standing orders (see, treat &
discharge) for presentations of relatively low acuity.
2 weekend scope lists have been completed at Kaitaia Hospital. It is hoped the continuation and eventual expansion
of these sessions will reduce the need for the organisation to outsource sessions.
The Bay of Islands Hospital redevelopment work is increasing in pace.
4.
Emergent Issues and Initiatives Identified
It appears that the long standing physiotherapy vacancy at Kaitaia hospital will be filled in the new year.
At the time of writing discussions continue around finalising the model of care at Dargaville once NDHB takes over
responsibility for medical staffing in the hospital.
5.
Other Highlights
16 Children from New Zealand travelled to the BrandX Cross fit games in Ramona, USA. Seven Northland children
were in this contingent with five of them coming from Kaitaia. Of the seven Northland participants, four gained
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46
honours on the podium.
A number of staff attended the Kaitaia walk/run. In conjunction with Sport Northland Kaitaia Hospital Active
workplace is challenging all Northland District Health Board services to the Hatea Drive loop run/walk on 10
December. The idea is to get as many people active as possible.
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47
Paediatric
1.
Overview
The Paediatric ward and Neonatal ward were extremely busy during July. This placed additional demand on nursing
resource and supplies and in turn had an unfavourable impact on the services variance to budget. More Nursing
Bureau resource was utilised during the month to deal with a higher sick leave rate than expected.
The Newmans Foundation donation money is being spent on equipment for Paediatric Oncology patients in the
Cancer Centre as well as in the community.
The Eczema Nurse specialty service is being revamped with new criteria which will broaden the service scope to
include up to 15 year olds.
2.
Scorecard
IP Events Coded For Period - 100%
Paediatric Scorecard - Whangarei Hospital
Safety and
Quality
Measure
Goal
Month
All
Month
Maori
Month
Non
Maori
YTD
Goal
YTD
Reducing Acute Readmissions to Hospital
5%
11 %
14 %
7%
5%
11 %
0
0
0
0
2.9
3.2
2.5
2.9
Inpatients with LOS > 21 days
Inpatient Average Length of Stay (ALOS)
Acute (excludes Day Cases)
Acute Caseweights to contract
Service
Delivery
159
230
159
230
Number of Discharges from Ward 2
268
268
Number of Discharges from SCBU
18
18
Bed Utilisation for Ward 2
103.3
103.0
Bed Utilisation for SCBU
89.7
90.0
Population
Ambulatory sensitive (avoidable) hospital
Health Status admissions by weighted value.
46
YTD Variance to net Result ($000)
Financial
Sustainability YTD Variance to Savings plan ($000)
FTE employed to budget
Percentage Sick Leave Taken
Engaged
Workforce
96.5
99.3
3.00 %
3.23 %
Total Employees in Excess of 240 hours
Accrued Leave
Percentage Annual Leave Taken
11.0 %
9.1 %
21
25
46
0
(56)
96.5
99.3
3.00 % 3.23 %
0
14
11.0 %
9.1 %
Commentaries for Scorecard
Safety and
Quality
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There were 268 discharges from Ward 2 in July and bed utilisation averaged 103% for the month. The
Neonatal ward (SCBU) had 18 discharges at an average length of stay of 19.3 days and utilisation was
90%. Paediatric caseweights were up on target by 61.5% for the month. More analysis around Trendcare
data is set to take place due to some discrepancies identified in July. The volume and acuity levels for the
day shift showed 29/31 shifts were in excess of time provided as "Clinical in Department."
Service
Delivery
Population
Health Status
Financial
Sustainability
Engaged
Workforce
Child Health services were $56k unfavourable to budget for July. This result was primarily due to high
demand placed on the Paediatric ward by both volume and acuity levels. Vacancies in medical salaries
were covered with locums and additional nursing time was required to meet the demand. Supplies were
overspent as well, for the same reasons.
There were 2,197 hours of annual leave taken in July which was up by 975 hours on the previous month.
Sick leave was down by 50 hours on last month with a total of 782 hours taken. There were 398 hours of
training leave taken which was up by 96 hours from the previous month. There are 23 staff with more than
200 hours owing to them and 12 of these staff also have over 240 hours owing. Leave plans have been
submitted for these staff.
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3.
Strategic Initiatives / Health Services Planning
Work has begun to change the referral criteria for acceptance into the eczema nurse specialist service. Previously
only children under 2 were accepted to be seen. The referral criteria have been extended to see all children up to the
age of 15. Children who have only mild to moderate eczema will be referred back to their GP with information on how
to manage the eczema. Further meetings have been planned to discuss education for practice nurses to support the
eczema management plans in primary health.
4.
Emergent Issues and Initiatives Identified
5.
Other Highlights
With the generous donation from the Newman Foundation we have purchased new equipment to support the
treatment and assessment of children with cancer. The majority of this equipment will be based in the Cancer Centre
with the capacity to utilise the equipment in the community for children with cancer. Some of the donated money is
going to be utilised to brighten the paediatric room in the Cancer Centre to ensure it is less clinical looking and a
bright, well-resourced space to come and see the doctor or nurse. The Play Specialists are currently sourcing
furnishings and resources for the area.
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50
Maternal
1.
Overview
Maternity services continue to plan and coordinate the service in preparation for the move into the new facility which
has now commenced work on the "shell" for the floor above. The service continues to carry vacancies which have not
been filled due to the significant reduction in workload currently experienced. This has meant favourable results in the
services variance to budget - $81k for July. The service has just changed the roster to place a 5th Midwife on the
night shift to offer better coordination between Delivery Suite and the Postnatal ward as well as ensuring patient
safety at night – this will carry through to the new maternity facility. There were 133 babies delivered during July.
2.
Scorecard
IP Events Coded For Period - 100%
Maternal Scorecard - Whangarei Hospital
Measure
Goal
Month
All
Month
Maori
Month
Non
Maori
YTD
Goal
YTD
Safety and
Quality
Reducing Acute Readmissions to Hospital
5%
7%
4%
10 %
5%
7%
Health
Targets
Better help for smokers to quit – Hospital
95 %
97 %
96 %
100 %
95 %
97 %
3.5
3.7
3.3
Inpatient Average Length of Stay (ALOS)
Acute (excludes Day Cases)
Acute Caseweights to contract
Service
Delivery
112
115
112
115
Number of Births in Whangarei Hospital
133
133
Number of Discharges from Post Natal
Ward (Ward 11)
243
243
% Exclusive Breastfeeding Rates at
Hospital Discharge
90 %
100 %
YTD Variance to net Result ($000)
Financial
Sustainability YTD Variance to Savings plan ($000)
FTE employed to budget
Percentage Sick Leave Taken
Engaged
Workforce
3.5
100 %
0
81
59.2
52.5
59.2
52.5
3.00 %
4.29 %
3.00 %
4.29 %
0
7
11.0 %
11.9 %
Total Employees in Excess of 240 hours
Accrued Leave
Percentage Annual Leave Taken
90 %
11.0 %
11.9 %
Commentaries for Scorecard
Safety and
Quality
The Maternity Quality and Safety Annual Plan has been accepted.
Health Targets
Service
Delivery
In July there were 133 births in Whangarei Hospital and for the same period last year there were 113.
Utilisation in Ward 11 was 67% and we have changed the number of beds we have in the unit from 22 to
18 to reflect the model in the new Maternity building. This will result in higher utilisation rates than
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previously comparable.
Financial
Sustainability
Maternity services are favourable to budget by $81k for July and this is primarily due to the vacancies
currently being carried due to a reduction in volume and increase in independent Midwives in the
community. The Midwifery roster is set to now include a 5th Midwife on nights to increase patient safety
as well as offer better coordination across the service after hours.
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Engaged
Workforce
3.
There were 1,558 hours of annual leave taken in July which was up by 539 hours on the previous month.
Sick leave was up by 197 hours on last month with a total of 562 hours taken. There were 155 hours of
training leave taken which was down by 27 hours from the previous month. There are 21 staff with more
than 200 hours owing to them and 11 of these staff have more than 240 hours owing. Leave plans have
been submitted for these staff.
Strategic Initiatives / Health Services Planning
Deliverable / Action
Planned Outcome
Status
Northland SUDI prevention project
Significant reduction in the 5 year rolling number of
SUDI in Northland
On Track
Breastfeeding Community Education
Increase in exclusive breastfeeding rates at 6 weeks
and 6 months
On Track
Clinical Risk Management
Improved maternity care for women of Northland in
response to case reviews.
On Track
Maternity New Build and development of New Purpose built maternity unit ready to move into in 2015
Service Delivery Model
with new Service Delivery Model implemented
On Track
Smoke free
All women are screened at booking and on each
admission to hospital and are offered brief intervention
advice. Reduction in number of smoking mothers in
Northland
On Track
Immunisation
On time immunisations for babies in Northland.
On Track
Flu and Pertussis
Pregnant women are vaccinated against flu and
pertussis
On Track
Timing of Registration with an LMC
Increase in the number of pregnant women booked
with a Lead Maternity Carer by 10 weeks gestation.
On Track
The collaborative project between Maternity and Mental Health Services on the development of the
Maternal/Perinatal Mental Health referral pathway has been completed. The next step will be to add the pathway and
referral form to the Clinical Knowledge Centre and rollout an education programme for the staff.
Development is occurring through the Maori Health Action plan to run a pilot ante natal programme that is Wananga
based. Work has commenced with DHB staff and local Iwi providers to explore what is currently being delivered
within the community and assess where further development would be of benefit to the community.
4.
Emergent Issues and Initiatives Identified
Weekly forums with Maternity staff and management continue to ensure all are kept up to date with progress with the
new Maternity facility.
During July over 95% of the Maternity staff took the opportunity to take a guided tour around the new facility with the
Project Team before the building was locked down while work is done on the second story. The staff were very
enthusiastic and keen to move in.
5.
Other Highlights
The Big Latch On was held at “Te Puawai ora” on July 31st and attracted over seventy mums and babies. This was a
community initiative supported by the DHB, Childbirth Education Classes and the Lactation Team. This year the
theme was ‘returning to work and breastfeeding’
.
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School based, Community and Oral
Health
1.
Overview
The Oral Health Service had another busy month in July. The fixed facilities throughout Northland were very busy
over the two week school holiday period with many families accessing oral health care for all their children and
adolescents. One of our community dentists has resigned and left the service on 31 July. We will be one dentist
down until we can recruit into this position. The position has been advertised.
2.
Scorecard
School based, Community and Oral Health Scorecard
Measure
Goal
Mobile Ear Clinic Contacts (one month
retrospective)
Public Health Nurse Contacts
Service
Delivery
Adult Dental Treatments
Number of Pre-School, Schoolchildren and
Adolescents Receiving an Annual Dental
Examination
Month
All
Month
Non
Maori
YTD
Goal
YTD
364
364
1,809
1,809
225
212
225
212
90 %
92 %
90 %
92 %
Sexual Health Contacts
399
399
Number of Reports of Concern to Child
Youth and Family
35
35
Number of Family Violence Positive
Disclosures
26
26
Newborn Hearing Screening Rates (3
Population
Health Status Months Retrospective)
Preschool Dental Enrolments
85 %
84 %
85 %
84 %
95 %
70 %
95 %
70 %
School Dental Enrolments
118 %
Adolescent Dental Enrolments
85 %
35 %
YTD Variance to net Result ($000)
Financial
Sustainability YTD Variance to Savings plan ($000)
FTE employed to budget
Percentage Sick Leave Taken
Engaged
Workforce
Month
Maori
162.8
147.9
3.00 %
3.96 %
Total Employees in Excess of 240 hours
Accrued Leave
Percentage Annual Leave Taken
11.0 %
8.8 %
118 %
85 %
35 %
0
108
162.8
147.9
3.00 % 3.96 %
0
6
11.0 %
8.9 %
Commentaries for Scorecard
Service
Delivery
The number of children and adolescents seen by dental therapists/hygienists has remained at 10.5 patients per
day on average. We have done some interesting data analysis in the service around the number appointments
required to complete a treatment plan for a child or adolescent. The number of appointments required after an
examination has dropped from 4.0 in 2007 to 1.0-1.5 in 2014.
Reports of Concern numbers are consistent with previous months, as are family violence positive screens. The
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peripheral hospital figures demonstrate an effective screening programme by staff for family violence screens.
In the last quarter (March to June) Whangarei Maternity services have demonstrated effective screening with
97% of patients screened and a 7% disclosure rate. We will be working with ED to improve current screening
rates - 13% screening rate and 0% disclosure rate. The Family Violence team continues to work with staff and
management in targeted NDHB areas to embed screening as a normal part of assessment practice.
Population
Health
Status
The percentage of pre-schoolers enrolled with Northland DHB, Hokianga Health Enterprise Trust and Ngati
Hine Health Trust oral health services has risen slightly this month. All providers are striving for the MoH target
of 85% for this financial year. The enrolment of pre-schoolers continues to be a focus of all providers.
The service is underspent by $108k for July. Additional revenue is $103k favourable and the two main drivers
are monies released from Income in Advance to offset spend in the new Rheumatic Fever Sore Throats
Financial
contract and on Public Health projects. The spend for this work is reflected in the overspend in and Outsourced
Sustainability
services ($68k).
Engaged
Workforce
There were 2,389 hours of annual leave taken in July. There are currently 12 staff with more than 200 hours
annual leave and 4 staff with more than 240 hours. Managers will be talking with these staff about their leave
plans.
There were 1,257 hours of sick leave taken in July - a decrease of 175 hours from June.
3.
Strategic Initiatives / Health Services Planning
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Sexual Health Clinic continues to have improved figures following increased opening hours and offering of long acting
reversible contraception (implants). From September they will also be able to offer HPV vaccination for clients. There
has been an increase in transgender clients in the past month and staff are working on developing a pathway for
those wishing both hormonal and surgical treatment.
4.
Emergent Issues and Initiatives Identified
The dental therapy/hygienist vacancies continue to be a problem as we have not been able to recruit. The service is
looking at forming relationships with some third year undergraduates at Auckland University of Technology (AUT)
who might be interested in working in Northland. The dental therapy workforce is a concern nationally as the average
age of a dental therapist in NZ is 57; in Northland it is 58. By 2020 half (14) of our dental therapists would have
retired. AUT and Otago University produce around 60 graduates per year, however all DHBs currently have
vacancies and are wanting to recruit out of this pool. We have had five AUT undergraduates on placement within the
service for two weeks over June. Management has met with all undergraduates to entice them back to Northland for
fulltime work next year.
5.
Other Highlights
NDHB have a Health Broker, a Lead Professional, a Psychologist and a Paediatrican working alongside the
Children’s Team. 97 children have been referred to The Children’s Team in the past year. Our Lead Professional
currently has a workload of 21 children. The cases are complex and working with the families for sustainable change
is long term.
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Public Health
1.
Overview
Work for the Public Health Unit (PHU) this month has predominantly focused on alcohol harm reduction issues,
particularly around the sale and supply of alcohol. A major highlight was the withdrawal of the application for licence
from the Onerahi outlet and the local body hearings in terms of the development of Local Alcohol Plans (LAP).
The Ministry of Health has also requested the DHB to refresh the current Rheumatic Fever Plan 2013 – 2017 by 20
October this year.
The Public Health Unit has successfully recruited into the vacant 1 FTE Medical Officer of Health role and the Health
Promoting Schools Kura Kaupapa Maori .09FTE position. The successful candidates will start with the team in
November 2015.
2.
Scorecard
Public Health Scorecard
Measure
Goal
Month
All
Month
Maori
Month
Non
Maori
YTD
Goal
YTD
0
0
33.4
28.9
YTD Variance to net Result ($000)
Financial
Sustainability YTD Variance to Savings plan ($000)
FTE employed to budget
Percentage Sick Leave Taken
Engaged
Workforce
33.4
28.9
3.00 %
4.66 %
3.00 % 4.66 %
Total Employees in Excess of 240 hours
Accrued Leave
Percentage Annual Leave Taken
11.0 %
7.9 %
0
1
11.0 %
7.9 %
Commentaries for Scorecard
Population and Public Health:
The service is underspent by $15k for July. The underspends are in Salaries and Supplies.
Financial
Sustainability
Core Public Health:
The Core Public Health underspend of $27k has been accrued to Income in Advance. The main driver is
an underspend in salaries of $26k due to current vacancies.
Population and Public Health:
There was 160 hours of annual leave taken in July. There are two staff with balances of more than 200
hours and one with more than 240 hours. Leave plans have been requested for these staff. There was
136 hours of sick leave taken in July - a decrease of 136 hours from June.
Engaged
Workforce
3.
Core Public Health:
There were a total of 446 hours of annual leave taken in July. There is currently two staff members with
more than 200 hours leave, and none with more than 240 hours. There were a total of 263 hours of sick
leave taken in July - an increase of 67 hours from June.
Strategic Initiatives / Health Services Planning
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The infectious disease notification and investigation process undertaken to identify the source of infection, is currently
being audited to assess internal administrative standards and measure the quality of public health advice which is
offered.
DHB Healthy Food Policy is in its final processes. The policy will include updated food standards, reconfiguration of
vending machines, and a graduated move to removal of fizzy (carbonated) drinks from commercial sale.
Written and oral submissions to the draft Whangarei LAP have been completed by the team; the focus for the
submissions is mainly on limiting further licensing hours and a “presumption of ‘no’” for new licences. As well the Far
North District Council provisional LAP is due to come out in next month, there will be a 30 day appeal period for this.
Onerahi off licence application: A decision was made to appeal the Alcohol Regulatory Licencing Authority (ARLA)
decision, to High Court. However the applicant has now withdrawn his licence application. Multiple hearings (mainly
related to off and on- licence hours) are coming up before District licensing committees.
We are currently appealing the District Licencing Committee (DLC) decision on Countdown Regent hours to ARLA.
4.
Emergent Issues and Initiatives Identified
A couple of small water suppliers (non-Council) showed the presence of E.coli in their reticulated water. The Medical
Officer of Health has issued boil water notice on one supply and further water sample results are awaited from the
second supplier before further action is taken.
Since the removal of the Animal Products Officer (APO) designation under the Animal Products Act, a few years ago,
the individual shellfish team members have had to maintain Technical Expert Assistant status to support the APO
from the Ministry for Primary Industry (MPI) carrying out duties required in the Animal Products (Specifications for
Bivalve Molluscan Shellfish) Notice 2006 (BMS RCS). This past month saw two new officers successfully assessed
by MPI for this purpose.
5.
Other Highlights



Two HPOs attended Coordinated Incident Management Systems (CIMS 4) training this month provided by the
Northland Regional Council. More training sessions are on offer in September and November for which staff
have made themselves available.
A Drinking Water Assessor contractor commenced with the Drinking Water Assessment Unit to assist with
urgent drinking water scope work.
Following the retirement of the shellfish coordinator and a very experienced Technical Officer from this portfolio
earlier this year, the remaining team members have risen to the challenge and have undertaken two successful
shoreline surveys working closely with the shellfish farmers and the Ministry for Primary Industries (MPI).
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Human Resources and Corporate
Support
1.
Overview
Negotiations continue with the Association of Professional & Executive Employee (APEX) for renewal of the
Physiotherapy, Anaesthetic Technicians and Sonographer collective agreements. Engagement with Engineering,
Printing & Manufacturing Union (EPMU) for the renewal of the Maintenance Collective Agreement remains positive.
APEX has also initiated bargaining for the social workers and dietitians with dates for bargaining scheduled in
September 2015.
Over the past several months the HR toolkit has been revised and updated and is ready for use by all managers and
is available from on the Human Resources page of the Intranet.
The intention of the HR Toolkit remains to provide managers with reference material on HR practice - the Toolkit
equips managers with practical information and knowledge to help them manage HR issues in line with the agreed
HR processes. Processes that include:- Recruitment
- Employment Agreements
- Induction
- Learning and Development
- Employee Wellness
- Performance Appraisal
- Change Management
- Managing Misconduct
- Managing Leave
- Exit and Termination
- Managing Poor Performance
- Remuneration
- Employment Relationship Problems
Improvements to the HR Toolkit include:
• Existing template letters have been updated and additional template letters have been provided to assist
managers deal with common themes not previously provided for.
• Some notable improvements are:
Performance Management - the inclusion of the Supportive Improvement Plan and Performance Management Plan,
and associated development tools. The part of this section devoted to non-nursing staff has also been aligned to be
consistent with the nursing approach to the topic (i.e. use of Supportive Improvement Plan / Performance
Management Plan/ associated template letters).
Change Management section - several new template letters to assist managers across various topics, including
dealing with disciplinary matters.
We continue to deliver the HR Training Modules which deals with themes derived from the actual contents of the
Toolkit and provides practical workplace examples and ensures the consistency of approaches taken by managers.
The DHB has implemented Police Vetting for new employees as required under the Vulnerable Children Act. Police
are responding in a timely manner to all enquiries. The Human Resources Information System (HRIS) has been
updated to capture information required for the 3 yearly re-checking of employees under the Vulnerable Children Act.
The Organisation’s Orientation Booklet for new employees is in the process of being reviewed with the intention of
making it more contemporary and user friendly
A Values Quiz has been developed as an outcome of the recent DHB values and behaviours project. Prospective
employees interested in working for the DHB will be able to access the values quiz on the intranet when applying, and
in doing so able to measure the alignment of the applicant’s values with those of the organisation.
A second retirement seminar titled “is there life after work?” is being held on 30 September 2015. The seminar
focusses on financial planning, personal lifestyle planning and how to prioritise what is important to people. This is
joint initiative between the DHB and our union partners and has arisen due to considerable interest and positive
feedback from the initial retirement seminar in 2014.
2.
Scorecard
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59
Human Resources and Corporate Support Scorecard
Measure
Goal
Month
All
Month
Maori
YTD Variance to net Result ($000)
Financial
Sustainability YTD Variance to Savings plan ($000)
YTD
Goal
YTD
0
(24)
(5,833)
FTE employed to budget
Percentage Sick Leave Taken
Engaged
Workforce
Month
Non
Maori
44.3
46.4
44.3
46.4
3.00 %
3.90 %
3.00 %
3.90 %
0
6
11.0 %
8.6 %
Total Employees in Excess of 240 hours
Accrued Leave
Percentage Annual Leave Taken
11.0 %
8.6 %
Commentaries for Scorecard
Financial
Sustainability
HR and Corporate Support Services were unfavourable for the month of $24,258. This included the
savings line of $5,833 and a gratuity payment.
The Business Manager will continue to monitor and endeavour to negate the overspend in August's
operating costs.
There were 803.3 hours (8.6%) of annual leave taken.
There are currently 6 staff with a leave balance of over 240 hours. This equates to a total of 154.3 hours
above the benchmark of 240 hours.
There was 3.9% sick leave in July (366 hours). The majority of sick leave were in the following services:
Engaged
Workforce
- Telephonists = 106.5 hours
- Library = 24 hours
- Payroll = 101.8 hours
- Human Resources = 67 hours
- RMO Unit = 20.5 hours
- Education & Development = 46.20 hours
There was approved overtime of 32.20 (0.3%) hours in Payroll.
3.
Strategic Initiatives / Health Services Planning
Deliverable / Action
No actions or deliverables have been set for
this service
Planned Outcome
Not Applicable
Status
New
.
4.
Emergent Issues and Initiatives Identified
5.
Other Highlights
From an organizational perspective, the following workforce indicators summarize the employee activity with regards to
FTE and hours for July 2015.
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Staff
Actual
Budget
Difference
FTE – Month (Paid)
2,192
2,121
71
FTE – Month (Accrued FTE)
2,274
2,121
153
FTE – YTD (July 2014- July 2015) (Average)
Previous Month
Hours (June
2015)
1
Actual Hours – Productive
303,551
Actual Hours - Annual leave
27,768
Actual Hours - Sick leave
13,412
Actual Hours – Training
5,113
Actual Hours - Other Leave
2,723
Actual Hours – Overtime
4,081
Actual cost – locums
211,703
2,163
Current Month
Hours (July
2015)
409,085
49,954
18,710
5,679
4,431
5,562
381,547
2,121
% of Total Hours
(July 2015)
42
83.9%
10.2%
3.8%
1.2%
0.9%
1.1%
Staffing Analysis
Sick leave remained static for July 2015 (3.8%) against June 2015 (3.8%). The Sick Leave percentage (3.8 %) is
higher than the July 2014 and 2013 percentages of 3.5% and 3.58% respectively.
The Annual leave taken percentage of 10.20% in July 2015 is a decrease on the July 2014 percentage of 10.6% and
an increase against July 2013 at 9.72%.
1
Productive Hours – Ordinary Hours exclusive of Overtime and Call back
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Leave Balance Accrued > 240 Hours
Total Leave Hours Accrued > 240 Hours
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Leave Hours Accrued > 240 Hours by Number of Staff
Staff Turnover Percentage
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Facilities and Hotel Management
1.
Overview
It has been a good start to the new financial year for both Hotel Management and Facilities. Facilities continues to be
busy with paid car parking and all of the construction projects around the hospital as well as the recent lab move at
BOI hospital. Electricity and gas usage has been a lot higher in July due to the winter season and the new Medical
Gas room that is now operational. Hotel Management has been busy in July, the laundry service and has kept up with
demands of extra electives and the porters and cleaners have been stretched due to office relocations around the
campus.
2.
Scorecard
Facilities and Hotel Management Scorecard - Whangarei Hospital
Measure
YTD
Goal
YTD
1
0
1
99 %
95 %
99 %
95 %
Cleaning Complaints received
0
3
0
3
Laundry and Porter Staff Injuries
0
0
0
0
Estate Services Staff Injuries
0
1
0
1
90 %
92 %
90 %
92 %
Food Complaints received
Cleaning Audits – results All hospitals
Safety and
Quality
BEIMS – Requests Completed
Service
Delivery
Goal
Month
All
0
Month
Maori
Month
Non
Maori
Energy Consumption – All Hospitals Kilowatt (kWh)
700,000 912,271
700,000 912,271
Natural Gas – Whangarei Hospital Gigajoules (GJ)
590,000 838,579
590,000 838,579
Fuel Usage – All Vehicles (petrol and
diesel) - Litres (Ltrs)
43,000
51,875
43,000
51,875
Medical Waste Volumes - Kilograms (Kgs)
6,000
6,328
6,000
6,328
Completed Programmed Maintenance
Jobs for Clinical Engineering
300
448
300
448
Outstanding Programmed Maintenance
Jobs for Clinical Engineering
0
1,744
0
1,744
22,000
30,061
22,000
30,061
550
643
550
643
Spotless Patient Satisfaction Survey – All
Hospital Patient Meals
90 %
95 %
90 %
95 %
Spotless Patient Satisfaction Survey – All
Hospital Cleaning
90 %
99 %
90 %
99 %
Laundry Washes (Wet Kg’s) - Kilograms
(Kgs)
82,000
90,954
82,000
90,954
Laundry Issued Out - Kilograms (Kgs)
80,000
83,990
80,000
83,990
Laundry Re Washes - % of Total Laundry
Washes
3.60 %
2.50 %
3.60 %
2.00 %
0
(104)
Number of Patient Meals (All Sites)
Number of Meals on Wheels (All Sites)
YTD Variance to net Result ($000)
Financial
Sustainability YTD Variance to Savings plan ($000)
0
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FTE employed to budget
Percentage Sick Leave Taken
Engaged
Workforce
77.1
72.9
77.1
72.9
3.00 %
3.67 %
3.00 %
3.67 %
0
14
11.0 %
11.0 %
Total Employees in Excess of 240 hours
Accrued Leave
Percentage Annual Leave Taken
11.0 %
11.0 %
Commentaries for Scorecard
Safety and
Quality
Estate services had one injury and no near misses in July 2015 and Hotel Management had staff with two
old back strains which are being dealt with.
Facilities:
An increase in repair work and smaller projects around the hospital continue to keep the facilities team
busy. The team worked with the Projects Office in preparing the BOI laboratory to move to an alternate
location which was successfully completed in July. Car parking issues are continuing to be sorted,
implementation has been successful but there are still teething issues that are being worked through.
Service
Delivery
Hotel Management:
The facilities maintenance team are currently working through the repair and maintenance list across all
kitchen sites. Three kettle steamers have been ordered for replacement in the Whangarei Kitchen and are
due to arrive at the end of August 15. Patient meals continue to trend upwards for Whangarei and a slight
decrease in doctor’s meals from last month. Bay of Islands Hospital had a considerable increase in
patient meals and meals on wheels in July 15. Dargaville Hospital and Kaitaia Hospital had a decrease in
patient meals but an increase in meals on wheels in July.
The laundry staff were operational for 23 days in July. NDHB is continuing to trial bariatric gowns in Ward
14 and 16, which will most likely be added to the linen stock as there is a high demand for these.
The porter service staff are being encouraged to be aware of the maximum weight of 15kg for soiled linen
bags to avoid porter staff back strains, we have one porter on leave for a non-work related injury with a
broken leg.
Financial
Sustainability
Facilities are unfavourable to budget by $103k for July 2015. Electricity costs have been higher than
expected for July 15.
Hotel Management is unfavourable to budget by $1k for July 2015.
The joint initiative between NDHB and CareerForce to enable all porters the opportunity to obtain a NZ
Qualification for Orderlies is underway with porters working towards completing these qualifications.
Twelve of the fourteen Porter staff involved in this has received their first ten credits of the NZQA orderly
qualification framework.
Engaged
Workforce
ITO opportunity has been presented to the laundry staff to completed NZQA qualifications. They are
waiting for registration papers to allow them to begin.
Negotiations are underway for SFWU. This covers staff across the porter, laundry, food & cleaning
services.
3.
Strategic Initiatives / Health Services Planning
Deliverable / Action
Planned Outcome
Site Master Plan
4.
Status
On Track
Emergent Issues and Initiatives Identified
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5.
Other Highlights
Positive feedback comments below
Internal Customer (NDHB) Food Comments:
Rachel Thompson (CNM Kaitaia Hospital) - compliments to Fiona Gower and Lisa Crewther (cooks in Kaitaia kitchen)
for “their efforts to make a patient feel very special”
External customer - Security service comment from a patient:
“As per our discussion on the phone two days ago I'm following up in writing regarding the recent events while I was
in hospital. Without going into too much detail, I was admitted for psychiatric reasons. I began to feel my
psychological state was beginning to approach an unsafe potential and requested from the nursing station a security
guard. Travis Lamb attended and sat outside my room and we spoke quietly for a number of hours. It is this friendly
conversation, interaction and sense of fast rapport to which I attribute my rapid return to a more healthy state. He is
clearly well suited for the job, in which one must be able to speak to those at risk of committing violent acts to resolve
a situation, rather than responding with force, potential escalation of violence and the unfortunate possible necessity
to involve police. He was very polite, professional, intelligent and seemed genuinely interested in my well-being.
During my entire five day stay at Whangarei Hospital it was Travis who had the most beneficial effect on my recovery,
even compared to the medical staff. Please pass on to him my kindest regards, well-wishes for his personal and
professional future, and a huge thank you for just being himself and doing his job and that being exactly what was
needed at the time. If I get to nominate employee of the month, this is my vote.”
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NDHB Wide Patient Transport
1.
Overview
This is the first HAC report for NDHB Wide Patient Transport. This report will show a summary of the volumes of
patients transported by NDHB and the cost associated. Renal Transport has been down on patient numbers due to
decreased demand and is expected to return to usual levels shortly.
2.
Scorecard
NDHB Wide Patient Transport Scorecard Measure
Goal
Month
All
Number of Fixed Wing Flights in Northland
(excluding ACC)
5
Number of Fixed Wing Flights outside
Northland (excluding ACC)
YTD
Goal
YTD
5
5
5
1
1
1
1
Total Cost (excl GST) of fixed wing flights
21,250
31,105
21,250
31,105
Number of Helicopter Flights in Northland
(excluding ACC)
35
34
35
34
Number of Helicopter Flights Outside
Northland (excluding ACC)
1
0
1
0
Total Cost (excl GST) of Helicopter flights
Service
Delivery
183,000 192,454
Month
Maori
Month
Non
Maori
183,000 192,454
Number of patient transfers using St John
road Ambulance in Northland (excluding
private, hospice and ACC transfers)
230
226
230
226
Number of patient transfers using St John
road Ambulance outside Northland
(excluding private, hospice and ACC
transfers)
10
11
10
11
Total Cost (excl GST) of road ambulance
patient transfers
77,500
79,066
77,500
79,066
Number of renal patients transported by
NDHB
110
106
110
106
Total KM’s travelled by renal transport
drivers
100,377 76,298
100,377 76,298
Total cost of Renal transport service (excl
GST)
122,516 119,746
122,516 119,746
Total cost of National Travel Assistance to
eligible NDHB patients (excl GST)
212,500 201,424
212,500 201,424
YTD Variance to net Result ($000)
0
71
Financial
YTD Variance to Savings plan ($000)
Sustainability
YTD variance to Net Result – Patient
Transport Positive /(Adverse)
0
71,129
FTE employed to budget
Engaged
Workforce
Percentage Sick Leave Taken
Total Employees in Excess of 240 hours
Accrued Leave
22.5
21.4
22.5
21.4
3.00 %
0.35 %
3.00 %
0.35 %
0
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67
Percentage Annual Leave Taken
11.0 %
9.9 %
11.0 %
9.9 %
Commentaries for Scorecard
Financial
Sustainability
Patient Transport is under budget for July 15 due to a decrease in renal patients needing to be
transported.
Engaged
Workforce
Service
Delivery
Current contract negotiations are under way with St John for the road ambulance contract. We propose to
do a further fixed fee contract for 18 months (ending Dec 16) while we trial a scheduled patient transfer
service to reduce costs.
3.
Strategic Initiatives / Health Services Planning
4.
Emergent Issues and Initiatives Identified
Skyline Aviation has taken over from The Life Flight Trust in transporting patients from Kaitaia Hospital to Auckland
hospital as well as the SCBU helicopter flight co-ordination
5.
Other Highlights
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68
Scorecard Definitions
Measure
Notes
IP Events Coded for period - 68%
Coding data is used to generate many of the indicators,
including complications of care, Falls, Better help for
smokers to Quit. While the denominator includes all events,
only those coded as having one of the indicators will be
included in the result. The coding pie should be used to
understand how close the results are to being finalized.
Results are being updated as new information becomes
available.
Service and Hospital
The service is defined in 2 ways. Patient events whether
they are Inpatient, Outpatient or Community events, belong
to a Health Service such as Medical, Surgical, Paediatric etc.
In this way any indicators that are patient related are
grouped. Note that some services report specifically for a
hospital. In this way you will find Surgical Discharges for
Whangarei hospital reported in the Surgical Service and
Surgical discharges for Kaitaia reported under the District
hospitals service.
Where the indicators are non-patient related, (for example
indicators in the financial sustainability area), indicators are
reported under the service that manages that area. In this
way costs relating to ICU are reported under Medical for
example even though the Health Service of patients in ICU
may be various.
Timeliness of information
The latest data available is reported. This means that some
data may change after the report is released. Some results
are updated daily and others may be quarterly.
Performance Indicators
Most measures have standard threshold tolerances for
measuring performance and these are displayed below.
Where tolerances differ from the standard, the light green
and orange variances are displayed with the Measure
description. Green always means achieved and red is
always outside the orange indicator tolerance.
Overview
Standard threshold tolerances
Green indicates achieved or better than target
Light Green indicates within 2% variance from target
Orange indicates between 2% and 10% variance from
target
Red means outside the orange indicator tolerance
Safety and
Quality
Cleaning Audits – results All hospitals
NDHB complete monthly cleaning audits with spotless
services. This shows the result of those audits
Cleaning Complaints received
Number of complaints received from patients for cleaning
through the NDHB Safety & Quality complaints process
Elective Day of Surgery Admission rate DOSA
Admissions where Surgery occurs on the day of admission
are counted here. This excludes Day cases and counts
Elective cases only
Estate Services Staff Injuries
Number of staff injuries for NDHB estate services
Falls with harm within facility
Falls are only coded when there is injury involved. The date
of the fall and the 'Service Area' occurrence location code
are used to determine if the fall happened within the DHB
facility. This count should be similar to the 'with injury' figures
in the Incident Reporting system. Recent month figures may
be under-reported if coding is not complete.
Threshold Tolerance
Within 1.0% of target
Between 1.0% and 2.0% of target
Food Complaints received
Number of complaints received from patients for food
through the NDHB Safety & Quality complaints process
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Pressure Injuries are counted using inpatient coding and the
Health Round Table rules. Effective July 2013, hospital
acquired pressure injuries are based on the Condition Onset
Flag. We exclude any patient whose primary diagnosis is a
pressure injury and anyone that is a day case. Recent month
figures may be under-reported if coding is not complete
Hospital Acquired Pressure Injuries
Threshold Tolerance
Within 1.0% of target
Between 1.0% and 2.0% of target
Laundry and Porter Staff Injuries
Number of staff injuries for the NDHB Laundry and porter
services
Reducing Acute Readmissions to Hospital
A readmission is counted when any admission (the original
admission) results in a subsequent acute admission to the
same hospital within 28 days. This follows Health Round
Table rules and counts readmissions regardless of relation to
the original admission. The Original admission is only
flagged for inclusion once 28 days have passed and the %
reflects that.
Better help for smokers to quit – Hospital
Health Target 5 requires that 95% of patients are given
advice and help to quit. Coding data is used to identify ABC
(ABC = Ask, Brief Advice, Cessation Support). Includes
hospitalised smokers only.
Improved Access to Elective Surgery – (All
Health Targets NDHB)
NDHB is required to deliver a certain number of elective
discharges. This includes all admitted patients including day
cases for our population. The cases can be delivered in any
hospital e.g. Auckland.
Shorter Stays in Emergency Departments (All
NDHB)
95 percent of patients admitted, discharged, or transferred
from Whangarei or Kaitaia Emergency Departments, do so
within six hours.
% Exclusive Breastfeeding Rates at Hospital
Discharge
The breastfeeding counts exclude the following records:
% Non-Urgent Patients Receiving a
Colonoscopy within 42 days
P2 Non Urgent Colonoscopies are required to be seen within
42 days of referral.
% Overdue Surveillance colonoscopy within
twelve weeks
Surveillance Colonoscopies are for patients at increased risk
of colorectal cancer. This may be due to a family history or
patients who need to be monitored on a regular basis due to
previous colorectal cancer or polyps found. They are
required to have a colonoscopy which is determined by the
NZGG (New Zealand Guidelines Group) guidelines for
surveillance colonoscopies – in either a 1, 3 or 5 year time
frame.
% Urgent Colonoscopy within two weeks
P1 Urgent Colonoscopies are required to be seen within 14
days of referral.
Threshold Tolerance
Service
Delivery
Within 5.0% of target
Between 5.0% and 10.0% of target
Acute Caseweights to contract
Caseweights can be used to measure the volume of actual
activity against plan. A certain number of Elective
Caseweights are planned to be delivered each year.
Performance is managed to avoid both under and over
delivery. Acute Caseweights are managed in conjunction
with population health needs and initiatives such as ‘better,
sooner, more convenient”.
Adult Dental Treatments
Assessment and Rehabilitation Bed Days
Counts total number of days in a hospital bed.
Bed Utilisation for SCBU
Bed Utilisation is based on the number of patients in a bed
divided by the number of beds available.
Bed Utilisation for Ward 2
Bed Utilisation is based on the number of patients in a bed
divided by the number of beds available.
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BEIMS – Requests Completed
Number of Building maintenance and new work requests
completed by estate services in the month for all hospitals.
Breast Screens
Community Contacts
Completed Programmed Maintenance Jobs
for Clinical Engineering
Number of completed programmed maintenance jobs on
clinical equipment completed by clinical engineering
Detox Bed Days - Dargaville
Beds dedicated to the Detox service for Drug and Alcohol
addiction.
Elective Caseweights to contract
Caseweights can be used to measure the volume of actual
activity against plan. A certain number of Elective
Caseweights are planned to be delivered each year.
Performance is managed to avoid both under and over
delivery. Elective Caseweights are managed in conjunction
with waiting times and demand.
Energy Consumption – All Hospitals - Kilowatt The energy consumption for all hospitals. Kilowatts
(kWh)
Fuel Usage – All Vehicles (petrol and diesel) - The total fuel (petrol & diesel) consumed for all hospitals.
Litres (Ltrs)
Litres
Improving waiting times for diagnostic
services - CT % receiving CT scans within 6
weeks
Improving waiting times for diagnostic services – MRI and
CT 85% of accepted referrals for CT scans, and 75% of
accepted referrals for MRI scans will receive their scan
within than 6 weeks (42 days)
Improving waiting times for diagnostic
services - MRI % receiving MRI scans within
6 weeks
Improving waiting times for diagnostic services – MRI and
CT 85% of accepted referrals for CT scans, and 75% of
accepted referrals for MRI scans will receive their scan
within than 6 weeks (42 days)
Inpatient Average Length of Stay (ALOS)
(excludes Day Cases)
The length of time between all admits and discharges
averaged over all inpatient stays. The time is included in the
calculation, to include part days.
Inpatient Average Length of Stay (ALOS)
Acute (excludes Day Cases)
The length of time between all admits and discharges
averaged over all acute inpatient stays. The time is included
in the calculation, to include part days.
Inpatient Average Length of Stay (ALOS)
Elective (excludes Day Cases)
The length of time between all admits and discharges
averaged over all elective inpatient stays. The time is
included in the calculation, to include part days.
Inpatient Bed Days
Counts total number of days in a hospital bed for all patients.
Will give a similar result to total length of stay, but does not
count part days.
Inpatient Bed Days – Ward 6
Inpatient Contacts
Inpatients with LOS > 21 days
The number of patients who had a length of stay > 21 days.
21 days is considered by the Health Round table to be an
indicator for stranded patients, i.e. those patients that stay in
hospital longer than they need to.
Laboratory Test Orders
Laundry Issued Out - Kilograms (Kgs)
Total dry kilograms of Laundry issued out in the month
Laundry Re Washes - % of Total Laundry
Washes
% of total laundry washes that had to be rewashed due to
not being clean enough.
Laundry Washes (Wet Kg’s) - Kilograms
(Kgs)
Total wet kilograms of Laundry washed in the month
Level 4 attendances to Contract – Admissions Annual plans provide for a certain number of Emergency
(includes ED 3 Hour)
department attendances to occur. Whangarei Emergency
department is a Level 4 Emergency department and Bay of
Islands is level 2 and Kaitaia is level 3
Level 4 attendances to Contract – Discharges Annual plans provide for a certain number of Emergency
department attendances to occur. Whangarei Emergency
department is a Level 4 Emergency department and Bay of
Islands is level 2 and Kaitaia is level 3
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Medical Waste Volumes - Kilograms (Kgs)
The kilograms of medical waste for all hospitals
Mobile Ear Clinic Contacts (one month
retrospective)
Number of individual children receiving assessment and
treatment at the 3 MEC
Natural Gas – Whangarei Hospital Gigajoules (GJ)
The natural gas consumption for all hospitals. Gigajoules
Number of Meals on Wheels (All Sites)
Number of meals on wheels provided for all hospitals by
Spotless services
Number of Births in Whangarei Hospital
Total number of births at Whangarei Hospital, includes
caesarean and vaginal births.
Number of Discharges from Post Natal Ward
(Ward 11)
Count of total number of patients discharged from hospital in
a period. Does not count admissions still in hospital.
Number of Discharges from SCBU
Count of total number of patients discharged from hospital in
a period. Does not count admissions still in hospital.
Number of Discharges from Ward 2
Count of total number of patients discharged from hospital in
a period. Does not count admissions still in hospital.
Number of Fixed Wing Flights in Northland
(excluding ACC)
Number of Fixed Wing Flights in Northland (excluding ACC)
Threshold Tolerance
Within 3.0% of target
Between 3.0% and 5.0% of target
Number of Fixed Wing Flights outside Northland (excluding
ACC)
Number of Fixed Wing Flights outside
Northland (excluding ACC)
Threshold Tolerance
Within 3.0% of target
Between 3.0% and 5.0% of target
Number of Helicopter Flights in Northland (excluding ACC)
Number of Helicopter Flights in Northland
(excluding ACC)
Threshold Tolerance
Within 5.0% of target
Between 5.0% and 10.0% of target
Number of Helicopter Flights Outside Northland (excluding
ACC)
Number of Helicopter Flights Outside
Northland (excluding ACC)
Threshold Tolerance
Within 3.0% of target
Between 3.0% and 5.0% of target
Number of Patient Meals (All Sites)
Number of patient meals provided for all hospitals by
Spotless services
Number of patient transfers using St John
road Ambulance in Northland (excluding
private, hospice and ACC transfers)
Number of patient transfers using St John road Ambulance
in Northland (excluding private, hospice and ACC transfers)
Threshold Tolerance
Within 5.0% of target
Between 5.0% and 10.0% of target
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Number of patient transfers using St John road Ambulance
Number of patient transfers using St John
road Ambulance outside Northland (excluding outside Northland (excluding private, hospice and ACC
transfers)
private, hospice and ACC transfers)
Threshold Tolerance
Within 3.0% of target
Between 3.0% and 5.0% of target
Number of Pre-School, Schoolchildren and
Adolescents Receiving an Annual Dental
Examination
All pre-schoolers, school children and adolescents are
required to receive an annual examination appointment as
per MOH contract
Number of renal patients transported by
NDHB
Number of renal patients transported by NDHB
Threshold Tolerance
Within 5.0% of target
Between 5.0% and 10.0% of target
Outpatient Contacts
Outstanding Programmed Maintenance Jobs
for Clinical Engineering
Number of outstanding programmed maintenance jobs on
clinical equipment completed by clinical engineering.
Patients on the Surgical Booking List given a
commitment to treatment but not treated
within four months
Those patients that have been on the Surgical waiting list for
more than 4 months.
Patients waiting longer than four months for
their FSA
Those patients waiting for a First Specialist appointment that
have been waiting longer than 4 months.
Percentage Attendance rate for all OP
Appointments in District Hospitals
Percentage Attendance rate for all OP
Appointments in Whangarei Hospital
Percentage Outpatient Bay of Islands
Domicile Attendances in BOI (Quarterly)
Of all of the attendances of the people who live in the Bay of
Islands hospital area, how many attendances were carried
out in the Bay of Islands hospital area.
Percentage Outpatient Dargaville Domicile
Attendances in DRG (Quarterly)
Of all of the attendances of the people who live in the
Dargaville Hospital area, how many attendances were
carried out in the Dargaville Hospital area.
Percentage Outpatient Kaitaia domicile
attendances in KTA (Quarterly)
Of all of the attendances of the people who live in the Kaitaia
hospital area, how many attendances were carried out in the
Kaitaia Hospital area.
Percentage proportion of Triage patients seen
within the recommended time for their
category
Public Health Nurse Contacts
Number of 0-18 year olds and their whanau who receive an
assessment, treatment, education, communicable disease
follow-up or clinic visit from a PHN.
Retinal Screens
Sexual Health Contacts
Number of clients who attend sexual health clinics for
assessment, education or treatment
Spotless Patient Satisfaction Survey – All
Hospital Cleaning
Spotless services complete random patient feedback
surveys every month at each hospital for cleaning. This
shows the result of those surveys
Spotless Patient Satisfaction Survey – All
Hospital Patient Meals
Spotless services complete random patient feedback
surveys every month at each hospital for meals. This shows
the result of those surveys
Sub-acute Bed Days (Kaitaia, Kaikohe,
Whangarei)
Comprehensive goal-oriented inpatient care designed for a
patient who has had an acute illness. It is rendered either
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immediately after or instead of acute care hospitalization, to
treat specific active or complex mental health conditions in
the context of the person's underlying long-term condition.
Theatre cancellations by Hospital
Counts planned theatre procedures cancelled by the
hospital. Reasons for cancellation include; Patient unfit;
Equipment failure; lack of time etc.
Total Cost (excl GST) of fixed wing flights
Total Cost (excl GST) of fixed wing flights
Threshold Tolerance
Within 5.0% of target
Between 5.0% and 10.0% of target
Total Cost (excl GST) of Helicopter flights
Total Cost (excl GST) of Helicopter flights
Threshold Tolerance
Within 5.0% of target
Between 5.0% and 10.0% of target
Total Cost (excl GST) of road ambulance patient transfers
Total Cost (excl GST) of road ambulance
patient transfers
Threshold Tolerance
Within 5.0% of target
Between 5.0% and 10.0% of target
Total cost of National Travel Assistance to eligible NDHB
patients (excl GST)
Total cost of National Travel Assistance to
eligible NDHB patients (excl GST)
Threshold Tolerance
Within 5.0% of target
Between 5.0% and 10.0% of target
Total cost of Renal transport service (excl GST)
Total cost of Renal transport service (excl
GST)
Threshold Tolerance
Within 5.0% of target
Between 5.0% and 10.0% of target
Total KM’s travelled by renal transport drivers
Total KM’s travelled by renal transport drivers
Threshold Tolerance
Within 5.0% of target
Between 5.0% and 10.0% of target
Adolescent Dental Enrolments
Population
Health Status
Ambulatory sensitive (avoidable) hospital
admissions by weighted value.
Counts those admissions that may be able to be better
treated in the community. Patients who need services that
can be provided in community settings receive them there
rather than at hospitals.
New-born Hearing Screening Rates (3
Months Retrospective)
Percentage of all new born babies who receive their new
born hearing screen within 3 months of birth. Includes total
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eligible population not just consented population
Number of Family Violence Positive
Disclosures
Number of people who disclose to staff following routine
screening that they have suffered family violence in its many
forms
Number of Reports of Concern to Child Youth
and Family
Number of reports of concern from NDHB staff to Child
Youth and Family e.g. concern of physical, sexual, emotional
abuse, neglect, family violence.
Preschool Dental Enrolments
School Dental Enrolments
YTD Variance to net Result ($000)
% variance of Actual Net Result (Revenue less Expenditure)
to Plan
YTD variance to Net Result – Patient
Transport Positive /(Adverse)
YTD variance to Net Result – Patient Transport
/(Adverse)
Positive
Threshold Tolerance
Financial
Sustainability
Within 5.0% of target
Between 5.0% and 10.0% of target
YTD Variance to Savings plan ($000)
This is the total savings determined for each service, by
financial year, and incurred YTD against annual budget.
Total savings will vary for each service. The target objective
is for each service to align its actual costs to the savings
objective on a monthly basis concluding with the
achievement of the total savings plan at financial year end.
FTE employed to budget
Measures the number of staff by converting the paid ordinary
hours of full time, part-time and casual staff into FTEs. The
conversion is assumed on the standard paid ordinary hours
of 40hours per week for all groups. All ordinary hours
worked over 40 i.e. overtime, call hours and extra paid hours
are excluded. The maximum worked FTE for an employee is
1 FTE. All annual, sick and other paid leave types are
included, with the exception of annual leave paid out on
termination.
Percentage Annual Leave Taken
Annual Leave taken as a percentage of Total Hours. This is
calculated using the following formula: annual leave hours *
100 / base hours. The benchmark for this across all services
is between 11%, anything under should be flagged as amber
or red depending on the variance
Percentage Sick Leave Taken
Sick Leave taken as a percentage of Total Hours. This is
calculated using the following formula: sick leave hours *
100 / base hours. The benchmark for this across all services
is between 0% to 3%, anything over the 3% should be
flagged as red
Total Employees in Excess of 240 hours
Accrued Leave
This is the total headcount of employees that have accrued
leave > 240 hours. Any service operating with zero or
minimal headcount over 240 hours is in the clear. We will
need to determine the levels of clearance for this.
Engaged
Workforce
Page: 58 of 59
75
Page: 59 of 59
76
FINANCIAL REPORT TO THE HOSPITAL ADVISORY COMMITTEE
FOR AUGUST 2015
Author: Meng Cheong, CFO
OPERATING RESULT
Month ($000)
Budget
Actual
Variance
Budget
Actual
Variance
102
9
(92)
(356)
(1,244)
(888)
DHB Owned Services
1.
YTD ($000)
Result for the Month
Summary
The financial result for the month is an operating surplus of $9k against a budgeted surplus
of $102k, an unfavourable variance of $92k. The year to date financial result is an operating
deficit of $1,244k against a budgeted deficit of $356k, an unfavourable variance of $888k.
Revenue
The month’s revenue was $665k favourable to budget. Year to date revenue is favourable to
budget by $878k.
Expenditure
Expenditure excluding capital charge was $662k unfavourable to budget for the month and
is $1,575k unfavourable year to date.
Personnel costs were $225k unfavourable to budget for the month and $215k unfavourable
to budget year to date.
Overall outsourced services were favourable to budget for the month by $123k and
overspent year to date by $378k. Outsourced salaries are favourable in the month by $43k
and unfavourable year to date by $133k. Outsourced supplies are favourable for the month
by $80k and unfavourable year to date by $245k.
Clinical supplies were unfavourable to budget in the month by $239k and are unfavourable
year to date by $432k. Infrastructure & non-clinical supplies excluding capital charge were
unfavourable to budget in the month by $321k and unfavourable year to date by $549k.
77
Provider Contract Volumes (Caseweights)
Summary of Volume Variance Analysis
Annual
Volume
Contract Measure
Total Caseweights Acute
YTD Volume
Bud
Act
Var Var %
Bud
Act
Var
Var %
19,793
1,649
1,856
206.6 12.5%
3,299
3,749
449.9
13.6%
7,347
612
615
2.8
0.5%
1,225
1,235
10.9
0.9%
27,140
2,262
2,471
209.4
9.3%
4,523
4,984
460.8
10.2%
Total Caseweights Elective
Total
Month Volume
Staffing Full Time Equivalents (whole of DHB)
Staffing Full Time Equivalents Accrued
Medical
Nursing
Allied Health
Support
Mgmt/Admin
Total
(FTEs)
Jun
Jul
Aug
Mth Mth
Bud Var
274
301
272
286
1,047 1,000 1,024
Var to
Jun
14
2
971 (52)
24
496
491
491
505
15
5
95
95
96
97
1
(1)
393
388
390
375 (14)
4
2,305 2,274 2,272 2,236 (37)
33
FTEs are reported as accrued FTEs, which include annual leave accrued but does not include annual leave taken.
78
79
Caseweights Acute
Jul
Aug
Sep
Month Budget
1,649
1,649
Month Actual
1,893
1,856
243
207
15%
13%
YTD Budget
1,649
3,299
YTD Actual
1,893
3,749
243
450
Month Variance
Month Variance %
YTD Variance
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
1,649
1,649
1,649
1,649
1,649
1,649
1,649
1,649
1,649
1,649
4,948
6,598
8,247
9,896
11,546
13,195
14,845
16,494
18,143
19,793
80
Caseweights Elective
Jul
Aug
Sep
Month Budget
612
612
Month Actual
620
615
8
3
Month Variance %
1%
0%
YTD Budget
612
1,225
YTD Actual
620
1,235
Month Variance
YTD Variance
YTD Variance %
8
11
1%
1%
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
612
612
612
612
612
612
612
612
612
612
1,837
2,449
3,061
3,674
4,286
4,898
5,510
6,123
6,735
7,347
81
Caseweights Acute, Caseweights Elective
Jul
Aug
Sep
Month Budget
2,262
2,262
Month Actual
2,513
2,471
Month Variance
251
209
11%
9%
YTD Budget
2,262
4,523
YTD Actual
2,513
4,984
251
461
11%
10%
Month Variance %
YTD Variance
YTD Variance %
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
2,262
2,262
2,262
2,262
2,262
2,262
2,262
2,262
2,262
2,262
6,785
9,047
11,308
13,570
15,832
18,093
20,355
22,617
24,878
27,140
82
83
Northland District Health Board Hospital Services & Governance
REVENUE STATEMENT
For the Month and Year-to-Date ended :
31-Aug-15
CURRENT MONTH
Hospital Services & Governance
Page 1
ACTUAL
$(000)
BUDGET
$(000)
YEAR TO DATE
VAR
$(000)
VAR
%
ACTUAL
$(000)
BUDGET
$(000)
ANNUAL
VAR
$(000)
VAR
%
BUDGET
$(000)
Operating Income
MOH Non-Devolved Contracts (provider arm
side contracts)
1,357
1,007
351
34.8%
2,336
2,013
322
16.0%
12,241
Other Government (not MoH or other DHBs)
667
428
240
56.0%
1,145
856
289
33.8%
5,134
Non-Government & Crown Agency Sourced
416
521
(104)
20.0%
1,026
1,078
(51)
4.8%
6,209
97
91
6
6.3%
211
182
30
16.2%
1,090
Internal Revenue (DHB Fund to DHB Provider)
24,216
24,043
173
0.7%
48,374
48,085
289
0.6%
288,511
Total Operating Income
26,754
26,089
665
2.5%
53,092
52,214
878
1.7%
313,185
InterProvider Revenue (Other DHBs)
Cost of Services
Personnel Costs
17,053
16,827
(225)
1.3%
34,401
34,185
(215)
0.6%
202,422
Outsourced Services
1,772
1,895
123
6.5%
4,184
3,806
(378)
9.9%
22,940
Clinical supplies
3,839
3,599
(239)
6.6%
7,675
7,242
(432)
6.0%
43,350
Infrastructure & Non-clinical supplies
3,255
2,934
(321)
10.9%
6,423
5,874
(549)
9.4%
35,700
25,918
25,256
(662)
2.6%
52,683
51,107
(1,575)
3.1%
304,413
Operating Surplus /(Deficit)
836
833
3
0.4%
409
1,106
(697)
63.0%
8,772
Capital Charge
827
731
(96)
13.1%
1,653
1,462
(191)
13.1%
8,772
9
102
(92)
91.0%
(1,244)
(356)
(888)
249.4%
0
Total Cost of Services
Surplus/(Deficit)
84
Northland District Health Board Hospital Services
REVENUE STATEMENT
Page 1
For the Month and Year-to-Date ended : 31-Aug-15
ACTUAL
$(000)
CURRENT MONTH
BUDGET
VAR
$(000)
$(000)
VAR
%
ACTUAL
$(000)
YEAR TO DATE
BUDGET
VAR
$(000)
$(000)
VAR
%
ANNUAL
BUDGET
$(000)
Operating Income
MOH Non-Devolved Contracts (provider arm
side contracts)
1,357
1,007
Other Government (not MoH or other DHBs)
667
Non-Government & Crown Agency Sourced
416
351
34.8%
2,336
428
240
56.0%
1,145
521
(104)
20.0%
1,026
2,013
322
16.0%
12,241
856
289
33.8%
5,134
1,078
(51)
4.8%
6,209
InterProvider
Revenue
DHBs)
Internal
Revenue
(DHB(Other
Fund to
DHB
Provider)
97
91
6
6.3%
211
182
30
16.2%
1,090
23,888
23,715
173
0.7%
47,719
47,430
289
0.6%
284,579
Total Operating Income
26,426
25,761
665
2.6%
52,437
51,558
878
1.7%
309,253
Cost of Services
Personnel Costs
Outsourced Services
Clinical supplies
Infrastructure & Non-clinical supplies
16,949
1,703
3,863
3,132
16,752
1,836
3,539
2,809
(197)
133
(325)
(323)
1.2%
7.2%
9.2%
11.5%
34,195
4,054
7,679
6,195
34,034
3,687
7,121
5,623
(162)
(366)
(558)
(572)
0.5%
9.9%
7.8%
10.2%
201,494
22,214
42,608
34,164
Total Cost of Services
25,647
24,935
(712)
2.9%
52,123
50,465
(1,658)
3.3%
300,481
Operating Surplus /(Deficit)
779
826
(47)
5.7%
313
1,093
(780)
71.4%
8,772
Capital Charge
827
731
(96)
13.1%
1,653
1,462
(191)
13.1%
8,772
Surplus/(Deficit)
(48)
95
(143)
150.0%
(1,340)
(369)
(971)
263.1%
0
85
5.0
NEXT MEETING DETAILS
The next meeting will commence 9am on Monday 16 November 2015 in the Tangihua Meeting Room, Tohora House,
Whangarei Hospital.
.
.
86
NORTHLAND DISTRICT HEALTH BOARD
GLOSSARY OF ACRONYMS
October 2014
Acronym
Meaning
A&D
A&E
A&M
AAU
ACP
A&C
ACA
ACC
ADON
ADHD
ALOS
AMI
AOD
AP
AR
ARRC
ARC
ASH Rates
ASMS
BAU
BOI
BSMC
BSC
BSI
CABG
CAPD
CATT
CBA
CCP
CCU
CEA
CEO
CFA
CGB
CHC
CHS
CIPP
CMO
CME
COPD
CPAC
CPSOG
CPHAC
CPR
CSC
CSU
CT
CVD
CWD
DAO
Alcohol and Drug
Accident and Emergency Department
Accident & Medical Centre
Acute Assessment Unit (part of child health services)
Advanced Care Planning
Audit & Compliance
Access Criteria for First Assessment
Accident Compensation Corporation
Assistant Director of Nursing
Attention Deficit and Hyperactivity Disorder
Average Length Of Stay
Acute Myocardial Infarction
Alcohol and Other Drugs
Annual Plan
Active Review
Age Related Residential Care
Aged Residential Care
Ambulatory Sensitive Hospitalisation Rates
Association of Salaried Medical Specialists
Business As Usual
Bay of Islands
“Better Sooner More Convenient”
Balanced Scorecard
Blood Stream Infections
Coronary Artery Bypass Graft
Chronic Ambulatory Peritoneal Dialysis
Crisis Assessment Treatment Team
Cost Benefit Analysis
Contribution to Cost Pressures
Coronary Care Unit
Collective Employment Agreement
Chief Executive Officer
Crown Funding Agreement
Clinical Governance Board
Child Health Centre
Community Health Services
Community Injury Prevention Programme
Chief Medical Officer
Continuing Medical Education
Chronic Obstructive Pulmonary Disease
Clinical Priority Assessment Criteria
Clinical Pharmacy Services Operational Group
Community and Public Health Advisory Committee
Cardio pulmonary resuscitation
Community Services Card
Central Sterilising Unit
Computerised Tomography
Cardiovascular Disease
Caseweighted Discharge
Duly Authorised Officer
87
Acronym
Meaning
DHB
DHBSS
DIAS
DiSAC
DN
DNA
DOA
DONM
DRG
DSAC
DSS
EAP
ECG
ED
EENT
EEO
ELT
ENT
EOI
ERA
ESS
ESPI
FAQ
FBT
FFT
FRS
FSA
FST
FTE
GETS
GDB
GM
GMS
GSE
hA
HAC
HBSS
HDC
HRT
HEHA
HHC
HIN
HNA
HOD
HOP
HPO
HPV
HQSC
HWNZ
IANZ
IAT
ICU
ICT
IDF
IEA
IFHC
District Health Board
District Health Board Shared Services
Disability Information Advisory Service
Disability Support Advisory Committee
District Nurse
Did not attend
Dead on arrival
Director of Nursing and Midwifery
Diagnostic Related Group
Doctors for Sexual Abuse Care
Disability Support Services
Employee Assistance Programme
Electrocardiogram
Emergency Department
Eyes, Ears, Nose and Throat
Equal Employment Opportunity
Executive Leadership Team
Ear Nose and Throat
Expressions of Interest
Employment Relations Act
Elective Services Statistics
Elective Services Performance Indicators
Frequently Asked Questions
Fringe Benefit Tax
Future Funding Track
Financial Reporting Standard
First Specialist Assessment
Financial Sustainable Threshold
Full time equivalent
Government Electronic Tender Service
General Dental Benefit
General Manager
General Medical Services Benefit
Government Special Education
healthAlliance
Hospital Advisory Committee
Home Based Support Services
Health and Disability Commissioner
Health Round Table
Healthy Eating Health Action
Home Health Care
Health Information Network
Health Needs Analysis
Head of Department
Health of Older People
Health Protection Officer
Human Papillomavirus
Health Quality & Safety Commission
Health Workforce New Zealand
International Accreditation New Zealand
Income and Asset Testing
Intensive Care Unit
Intensive Care Team (Mental Health)
Inter District Flows
Individual Employment Agreement
Integrated Family Health Centre
88
Acronym
Meaning
IIA
InterRAI
IR
IS
ISSP
IT
JV
KPI
LMC
LOS
LTC
MDO
MECA
MERAS
MF (score)
MHGC
MHIPU
MI
MIF
MMR
MoH
MOH
MOSS
MOU
MPDS
MRI
MRT
MSD
MVS
NASC
NDHB
NEST
NGO
NHB
NHI
NHSP
NHSS
NIF
NIR
NRA
Income in Advance
International Research and Assessment Instruments
Industrial Relations
Information Systems / Information Services
Information Systems Strategic Planning
Information Technology
Joint Venture
Key Performance Indicator
Lead Maternity Carer
Length of stay
Long Term Conditions
Maori Development Organisations
Multi Employer Collective Agreement
Midwifery Employee Representation & Advisory Services
Missing Filled (score) (dental services)
Maori Health Gains Council
Mental Health Inpatient Unit
Myocardial infarction
Monitoring and Intervention Framework
Measles-mumps-rubella
Ministry of Health
Medical Officer of Health
Medical Officer Special Scale
Memorandum of Understanding
Maori Provider Development Scheme
Magnetic Resonance Imaging
Medical Radiation Technologist
Ministry of Social Development
Meningococcal Vaccine Strategy
Needs Assessment and Service Co-ordination
Northland District Health Board
Northland Emergency Services Trust
Non-Government Organisation
National Health Board
National Health Index
Northland Health Services Plan
National Health Supply Service
Northland Intersectoral Forum
National Immunisation Register
Northern Region Alliance (formerly NDSA Northern DHB Support
Agency)
Northern Region Health Plan
Northern Regional Training Hub
National Travel Assistance
New Zealand Blood Service
New Zealand College of Midwives
New Zealand Health Strategy
New Zealand Medical Council
New Zealand Nurses’ Organisation
Obstetrics and Gynaecology
Official Information Act
Operational Management Group
Outpatient
Otorhinolaryngology (=ENT)
Occupational Safety and Health
Occupational Therapy (sometimes also Operating Theatre)
NRHP
NRTH
NTA
NZBS
NZCOM
NZHS
NZMC
NZNO
O&G
OIA
OMG
OP
ORL
OSH
OT
89
Acronym
Meaning
PACU
PBFF
PCO
PDRP
PGY
PHO
PHN
PHU
PN
POID
POPN
PQ
PSA
PSAAP
PUC
QID
RBA
RDA
RFF
RFP
RG
RICF
RMO
RWL
SAT
SAU
SBL
SCBU
SCOPE
Post Anaesthetic Care Unit
Population Based Funding Formula
Primary Care Organisation
Professional Development Recognition Programme
Post Graduate Year
Primary Health Organisation
Public Health Nurse
Public Health Unit
Practice Nurse
Planning, Outcomes, Integrated Care & District Hospitals
Primary Options Programme Northland
Parliamentary Questions
Public Service Association
PHO Service Agreement Amendment Protocol
Purchase Unit Cost
Quality & Improvement Directorate
Results Based Accountability
Resident Doctors’ Association
Regional Funding Forum
Request for Proposal
Referral Guidelines
Reducing Inequalities Contingency Funding
Resident Medical Officer
Residual Waiting List
Self Assessment Tool
Surgical Admission Unit
Surgical Booking List
Special Care Baby Unit
Service Coordination – Primary Care Navigation for Older People in
their Environment
School Dental Service
Senior House Officer
Service to Improve Access
Speech Language Therapy
Senior Medical Officer
Statement of Intent
Service Planning and New Intervention Assessment
Shared Support Services Group
Single Transferable Voting
Sudden Unexplained Death in Infancy
Technical Advisory Services
Territorial Local Authorities
Terms of Reference
Treaty of Waitangi
Te Puni Kokiri
The Productive Operating Theatre
Te Runanga O Te Rarawa
Whanau End smoking Regional whanau Ora Challenge
World Health Organisation
Whanau Integration Innovation & Engagement Fund
Whanau Ora Collective
Year-to-date
SDS
SHO
SIA
SLT
SMO
SOI
SPNIA
SSSG
STV
SUDI
TAS
TLA
TOR
TOW
TPK
TPOT
TROTR
WERO
WHO
WIIE
WOC
YTD
Any additions/amendments, please contact Kathryn Leydon on 430 4100 Ext 60640, or
e-mail kathryn.leydon@northlanddhb.org.nz
90