Minister of Health Announces Funding Under the Elective Services
Productivity and Workforce Programme – Round One
1. A total of $6.921 million in 2010/11 and $1.868 million in 2011/12 has been awarded to 13 District Health Boards, covering 30 projects addressing significant productivity initiatives to support increases in elective surgery.
2. The projects were selected by an Evaluation Panel including key representation from the health sector outside the National Health Board, and endorsed by the Programme’s sector-led Steering Group.
3. The projects cover a range of areas from operational and management efficiencies, to redesigned patient pathways and to revised peri-operative techniques.
4. Eight DHBs have been funded to implement The Productive Operating
Theatre programme, in which the management and infrastructure processes intrinsic to the running of each operating theatre are optimised, enabling fewer cancellations and greater cost efficiencies. Six of these have commenced the Programme, and the remaining DHBs will commence within the next months.
5. Ten DHBs will undertake the redesign of their pre-admission procedures, enabling a focus on care and discharge planning, more efficient use of specialist clinical (anaesthetist) time, and greater patient engagement in the process. These redesigned pre-admission processes may focus upon one or a selection of services, but the contractual commitment is to roll them out across all the DHB’s elective services.
6. Two DHBs will work together in the development of Enhanced Recovery
After Surgery pilots, in which up-skilled nursing staff will support the patient through treatment with a focus upon post-operative planning and care which enables easier discharge for the patient, in keeping with patient safety standards.
7. Key Performance Indicators have been proposed by the sector and accepted by the Evaluators, which will maintain a focus upon long-term, sustainable improvements in productivity, contributing significantly to
DHBs’ efforts to reach the Government’s growth target of an average of
4000 surgical discharges per year.
8. DHB experience will be shared within the sector, to encourage the widest possible capture of the benefits of the projects.

Contacts: Elective Services Productivity and Workforce Programme
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Title
The Productive Operating Theatre (TPOT) .
The TPOT programme examines and refines operating theatre processes and assumptions, relationships and structures to improve throughput and eliminate organizational blockages.
Pre-admission Process Redesign . These redesigns enable trained staff (usually but not necessarily nurses) to undertake basic preoperative assessment according to standards set by anesthetists and other senior medical staff, and to undertake the necessary admission and discharge planning. This frees up senior medical officer time, increases patient commitment and so significantly reduces day-of-surgery cancellations.
Theatre productivity . Parallel to TPOT, this project looks at patterns of usage in Greenlane
Surgical Unit’s theatres to identify and rectify systemic causes of under-utilization from DHB average The aim is to identify more effective scheduling and usage to maximize that productivity.
Contacts
Justin Kennedy-Good jkgood@adhb.govt.nz
Justin Kennedy-Good jkgood@adhb.govt.nz
Justin Kennedy-Good jkgood@adhb.govt.nz
The Productive Operating Theatre
Pre-admission
Bronwyn Anstis
Bronwyn.anstis@bopdhb.govt.nz
Lisa Skeet-Smith
Lisa.skeet-smith@bopdhb.govt.nz
delayed
Gill Cossey cosseyg@middlemore.co.nz
Gill Cossey cosseyg@middlemore.co.nz
Pre-admission
Investigating and resolving systemic causes of booking cancellations at all points of the patient pathway. This project looks at the system issues affecting patient commitment (ie, not just those characteristics unique to CMDHB) at an individual case level to identify and implement improved systems and patient interface protocols.
Enhanced Recovery After Surgery (ERAS)
ERAS deploys specifically trained nurses to act on a ‘case management’ basis especially with known complex cases, to plan recovery and discharge requirements and oversee their implementation. A key outcome is to minimize further interventions or readmissions at the 30-
Gill Cossey cosseyg@middlemore.co.nz

H B D H B
H B D H B
H u t t D H B
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L a k e s D H B
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S o u t h e r n ( I n v)
S o u t h e r n ( I n v)
T a ir a w h it i day-post-discharge point.
Pre-admission
The Productive Operating Theatre
The Productive Operating Theatre
Pre-admission
Pre-admission
Pre-admission
Designing and implementing a patient-focused bookings system. Building upon some earlier analysis into patient experience among Maori or rural populations, the DHB will design and implement a booking system from access to FSA through to admission which is responsive to individual patient requirements. Key measures include a redesign of how clinics are organized and staff resources deployed to ensure the best usage of resources.
Julie Ball
Julie.ball@hawkesbaydhb.govt.nz
Kath Johnson
Katherine.johnson@hawkesbaydhb.gov
t.nz
Kay McDonald
Kay.McDonald@huttvalleydhb.org.nz
Regan Spillane
Regan.spillane@huttvalleydhb.org.nz
Greg Vandergoot,
Greg.Vandergoot@lakesdhb.govt.nz
Martin Thomas
Martin.thomas@lakesdhb.govt.nz
Jane James
Jane.james@lakesdhb.govt.nz
Shirley-Anne Gardiner shirleyanne.gardiner@midcentraldhb.go
vt.nz
Shirley-Anne Gardiner shirleyanne.gardiner@midcentraldhb.go
vt.nz
Pre-admission
The Productive Operating Theatre
The Productive Operating Theatre
Lynley Irvine
Lynley.irvine@southerndhb.govt.nz
Judith Kissell
Judith.kissell@southerndhb.govt.nz
Lynley Irvine
Lynley.irvine@southerndhb.govt.nz
Sharon Turner
Sharon.turner@southerndhb.govt.nz
Angela Freschini, Clinical
Lead
Angela.Freschini@tdh.org.nz
Sue Macpherson, Project
Lead
Sue.Macpherson@tdh.org.nz

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Demonstration site: pre-admission.
Waikato will provide support to other DHBs implementing preadmission process redesign.
Demonstration Site : Capacity Management.
Waikato is implementing a comprehensive capacity-management system (based on a model from Air NZ). The NHB is keen to encourage similar approaches (without specifically endorsing the particular model at this point) and Waikato will make resources available for demonstration purposes
Elective care complex case management.
Upskilled nurses will be allocated specific complex cases (ie, those who pre-admission assessment identifies as needing greater focus) and will plan their individual pathways according to senior medical officer assessments, resource availability and patient circumstances.
Debi Whitham
Debi.whitham@waikatodhb.govt.nz
Mark Spittal mark.spittal@waikatodhb.health.nz
Debi Whitham
Debi.whitham@waikatodhb.govt.nz
Debi Whitham
Debi.whitham@waikatodhb.govt.nz
Pre-admission
The Productive Operating Theatre
New models of care . This project extends to other services the lessons learned from a pilot of a new approach in managing simpler versus more complex hip joint cases.
Debbie Holdsworth
Debbie.holdsworth@waitematadhb.g
ovt.nz
Dr Andrew Love
Andrew.love@waitematadhb.govt.nz
Debbie Holdsworth
Debbie.holdsworth@waitematadhb.g
ovt.nz
Dr Matthias Soop
Mattias.soop@waitematadhb.govt.nz
Debbie Holdsworth
Debbie.holdsworth@waitematadhb.g
ovt.nz
Enhanced Recovery After Surgery
Shoulder Soft Tissue Reconstruction – cost savings in operating technique. This pilot trials whether in some cases more traditional surgical techniques are more effective (in outcome and cost terms) than the deployment of modern technology for its own sake.
Day-stay surgery for laparoscopic cholecystectomies. This pilot will conduct such procedures on a ‘day-stay’ basis. Evaluation will consider applicability to other procedures.
Managing acute demand to enable more elective discharges . Acute demand proves to be statistically predictable. This pilot trials a series of protocols to be able to deliver key resources to elective surgery efficiently, through longer-term planning.
Debbie Holdsworth
Debbie.holdsworth@waitematadhb.g
ovt.nz
Debbie Holdsworth
Debbie.holdsworth@waitematadhb.g
ovt.nz
The Productive Operating Theatre
Pre-admission
Judith Bothma
Judith.bothma@wdhb.org.nz
Jan Denman
Jan.denman@wdhb.org.nz