HOSPITAL ADVISORY COMMITTEE MEETING · Welcome, Introduction and Apologies Interests Registers 1...

HOSPITAL ADVISORY COMMITTEE MEETING

To be held in the Board Room, Old Nurses Home, Southland Hospital,

Invercargill, at 2.00pm

10 February 2010

“Quality and Humanity in Health”

Remember to Visit Our Website at www.sdhb.govt.nz

SDHB HAC Meeting – 10 February 2010 Agenda

HOSPITAL ADVISORY COMMITTEE MEETING

Wednesday, 10 February 2010 2.00pm

Board Room, Old Nurses Home, Southland Hospital, Invercargill.

AGENDA

Sections

Welcome, Introduction and Apologies

Interests Registers 1

Members’ Interests Register

Management and Staff Interests Register

Confirmation of Minutes 2

Hospital Advisory Committee Meeting held 9 December 2009

Matters Arising from the Minutes

Review of Action Sheet 3

Chief Operating Officer’s Report 4

Director of Nursing and Midwifery Update 5

Financial Report 6

SDHB HAC Meeting – 10 February 2010 Agenda

Resolution That the HAC moves into committee to consider the following agenda items:

- Risk Report - Regional Procurement - Medical Officers Unit Report - Value for Money Dashboard

The general subject of each matter is to be considered while the public is excluded. The reason and the specific grounds under Section 32, Schedule 3 of the NZ Public Health and Disability Act (2000) for the passing of this resolution are as follows:

General Subject Reason for passing this resolution

Grounds for passing the resolution

Risk Report Clause 32(a) – to allow the public to be excluded where it is necessary to prevent the disclosure of information that could be withheld under the Official Information Act.

• Where it is necessary to protect the privacy of natural persons, including deceased natural persons – section 9(2)(a)

• Where it is necessary to enable Southland District Health Board to carry on without prejudice or disadvantage, negotiations – section 9(2)(j)

• Where it is necessary to maintain legal professional privilege – section 9(2)(I)

Regional Procurement

Clause 32(a) – to allow the public to be excluded where it is necessary to prevent the disclosure of information that could be withheld under the Official Information Act.




Medical Officers Unit Report





Value for Money Dashboard





SDHB HAC Meeting – 10 February 2010 Members’ Interests Register

SOUTHLAND DISTRICT HEALTH BOARD (SDHB) HOSPITAL ADVISORY COMMITTEE (HAC)

MEMBERS’ INTERESTS REGISTER

SDHB HAC Members

General Notice of Interest (for example, Shareholder, Director, Officer or Trustee) in other entities (S36(3),

Sch 4) Paul Menzies • Daughter – Staff member, Provider Arm, Southland DHB

Kaye Crowther • Employee of WHK Cook Adam (Internal Auditors) • Trustee of Plunket Foundation • Chairperson of the Management Committee for the car seat rental scheme

for Plunket Southland • Trustee of Wakatipu Plunket Charitable Trust • Corresponding member for health and family affairs, National Council of Women

Susie Johnstone • Deputy Chair Otago District Health Board • Council Member Otago Polytechnic • Principal Shand Thomson Ltd (and associated entities) • Accountant Clutha Community Health Company Ltd • Accountant Clutha Health Incorporated • Associated with Chair Clutha Community Health Company Ltd • Shand Thomson Nominees Ltd; Shand Thomson Nominees 2005 Ltd;

Abacus STO1 Ltd, Abacus STO2 Ltd, Abacus STO3 Ltd, Abacus STO4 Ltd • Director and Shareholder, Lyddon Investments Ltd • Director and Shareholder, Johnstone Afforestation Ltd • Spouse – Accountant Wyndham Rest Home Incorporated • Spouse – Accountant Tuapeka Community Health Co Ltd • Spouse – Accountant Tuapeka Health Incorporated • Spouse – Accountant West Otago Health Ltd • Spouse – Accountant Roxburgh and Districts Medical Services Trust Board

Fiona McArthur

• Theme and event work, HQNZ Ltd • Event work, Focus NZ (part of Grand Pacific Tours) • Working group member for Queenstown Plunket Rooms • Trustee and Board Member, Disabilities Resource Centre,

Queenstown • Ex Officio Board Member of the Central Otago Kindergarten • Volunteer for Wakatipu Victim Support

Katie O’Connor • Chair, Tui Motu: Independent Catholic Magazine Limited • Guidance Counsellor, St Peter’s College

Tahu Potiki • Chairman, Te Runanga o Otakou • Councillor, Bioethics Council • Director Arataki Associates • Board Member, Otago DHB

Dot Wilson

• Member of National Executive Committee, Disabled Persons’ Assembly (DPA) • Secretary of DPA Southland • President of Workbridge Council • DPA representative on Workbridge Council • District Advisor on the Personal Advocacy Trust • Workplace Support Chaplain

Tim Ward • Partner in BDO Invercargill Partnership

SDHB HAC Meeting – 10 February 2010 Management and Staff Interests Register

SOUTHLAND DISTRICT HEALTH BOARD (SDHB) HOSPITAL ADVISORY COMMITTEE (HAC)

MANAGEMENT AND STAFF INTERESTS REGISTER HAC Management Member

General Notice of Interest

(for example, Shareholder, Director, Officer or Trustee) in other entities (S36(3), Sch 3)

Brian Rousseau • Director of South Island Shared Services Agency Limited (SISSAL) • Trustee of New Zealand Institute of Rural Health (NZIRH) • CEO of Southland and Otago DHBs • Trustee of Southern Health Welfare trust

Lexie O’Shea • Trustee, Gilmour Trust

• Regional Deputy CEO of Southland and Otago DHBs

Karyn Penno • Officer of Southland and Otago DHBs

Leanne Samuel • Trustee of Southern Health Welfare Trust

• Member of Community Trust of Southland, (CTOS), Murihiku Health Committee

• Member, Southern Institute of Technology, Nursing Board of Studies

• Officer of Otago DHB

• Member of the Southland Medical Foundation( Inc)

Bron Anderson • Nil

Southland DHB HAC Meeting Minutes – 09 December 2009

Minutes of the Southland District Health Board Hospital Advisory Committee meeting, held on Wednesday, 09 December 2009, in the Southland DHB Board Room, Old Nurses’ Home, Southland Hospital, Invercargill, commencing at 2.04pm.

Present: Mrs Katie O’Connor (Chair, Hospital Advisory Committee) Mrs Kaye Crowther Mrs Susie Johnstone Ms Fiona McArthur Mr Paul Menzies Mr Tim Ward Ms Dot Wilson In Attendance: Mrs Lexie O’Shea (Chief Operating Officer/Regional Deputy Chief Executive Officer) Mrs Bron Anderson (Senior Business Analyst, Southland DHB) Mrs Leanne Samuel (Regional Chief Nursing and Midwifery Officer) Mr Ian Winwood (Medical Divisional Manager, Southland DHB) Miss Jo Harvey (Communications Officer, Southland DHB) Miss Natasha Nicolson (Senior Administrative Officer, Southland DHB)

Apologies: Mr Tahu Potiki (HAC Member) Mr Brian Rousseau (Regional Chief Executive Officer)

1. Welcome and Apologies

Apologies were received from HAC member, Mr Tahu Potiki and Mr Brian Rousseau, the Regional Chief Executive Officer (RCEO). Apologies for lateness were received from HAC members, Mrs Susie Johnstone and Mr Paul Menzies and the Chief Operating Officer/Regional Deputy Chief Executive Officer, (COO/RDCEO), Mrs Lexie O’Shea. The Chair requested that the apologies be moved later in the meeting to ensure an accurate resolution was passed.

2. Members’ Interests Register

There were no changes to the Interests Register. The Chair reminded members of their responsibility to declare any conflicts of interest throughout the course of the meeting.

3. Confirmation of Minutes

The minutes of the 11 November 2009 HAC meeting were attached to the agenda. It was resolved:

“That the minutes of the HAC meeting, held on 11 November 2009 be confirmed.”

Moved: Mr T Ward Seconded: Ms F McArthur

Carried

4. Matters Arising from the Minutes

Members confirmed they had received the updated Terms of Reference via email.


In response to a query from the Chair, Mrs Leanne Samuel, Regional Chief Nursing and Midwifery Officer (RCNMO), advised that the Allied Health Manager’s position had been advertised and that the professional leader portion of the role which is 0.1 Full Time Employee (FTE) is being withheld until 2010. She also advised she was working with the Chair of the Professional Advisors around this. In response to a query from the Chair, Mrs Bron Anderson, Senior Business Analyst (SBA) advised that there had been no additional information regarding the proposed co-payment for physiotherapy with ACC since the November 2009 Hospital Advisory Committee (HAC) meeting.

5. Review of Action Sheet

The RCNMO advised that all actions were complete and that updates and information requested were included in each divisional report. Mrs Susie Johnstone joined the meeting at 2.08pm

6. Regional Chief Nursing and Midwifery Officer’s (RCNMO) Update

The RCNMO, Mrs Leanne Samuel, spoke to her report and the following key points were noted:

• Occupancy for November 2009 remained high for Southland Hospital in most clinical areas.

• The RCNMO advised that the nursing budget information was included in the SBA’s report. There is some information in the clinical practice areas regarding recruitment to senior nursing roles. Productive ward opportunities were being explored with the Ministry of Health considering an award in Southland but it was unclear which area at this stage.

• Discussion was held at the November 2009 HAC meeting regarding birthing data for the

prior three years. The data was included for members’ information.

• The KPIs relating to Nursing performance indicators and the Nursing and Midwifery dashboard were highlighted.

Mrs Lexie O’Shea joined the meeting at 2.11pm.

• In response to a query from the Chair the RCNMO provided an update for members on the

productive ward opportunities, noting that the philosophy was around efficiency and lean methodology. Other initiatives included optimising the Patient Journey, and the productive ward.

• The Chair suggested that the Committee receive a presentation on this in the future. The

RCNMO undertook to do this if the initiative was adopted and she outlined reasons why it may not. She advised that further analysis was required.

• In response to a query from Mrs Johnstone, the RCNMO advised that the coordinator

nursing roles were part time roles with the equivalent of 2.4 FTE to cover 80 beds. The RCNMO advised the positions are in the budget.

Mr Paul Menzies joined the meeting at 2.16pm. • Mrs Johnstone advised that birthing numbers had gone up although the length of stay had

remained the same which was positive.

• In response to a query from Mr Tim Ward the RCNMO provided an update on the rural birthing units.

• Mr Ward queried the spike in August in the table on page 91 of the agenda relating to Total

Nursing Salaries actual/FTE, but the cost remained the same. The RCNMO advised that


this spike was aligned to a spike in the sick leave. The Senior Business Analyst (SBA), Mrs Bron Anderson, advised that she would like to revisit the figures and report back to the HAC in February 2010.

• Mrs Crowther raised a concern around the high number of people that were choosing not to

birth at Lakes District. A wide ranging discussion took place in relation to this. The Chairman advised that Queenstown did not have the population to support to support an Obstetric and Gynaecology (O&G) Specialist. The RCNMO advised there was a good number of Midwives in the area and home birthing numbers were good. The COO/RDCEO advised that it should be raised with Planning and Funding as they would be able to give a more informed response to the query at the Community and Public Health Advisory Committee (CPHAC). A wide ranging discussion was held on this issue.

7. Chief Operating Officer’s/Regional Deputy Chief Executive Officer’s Report

The COO/RDCEO, spoke to her report and in discussion the following key points were noted:

• Increased acute volume (16% above plan) is putting significant pressure on the organisation particularly beds and elective surgery. The key areas of acute demand are general medicine, general surgery and orthopaedics in particular.

• Emergency Department (ED) attendances continued to track higher than plan at LHD whilst

Southland Hospital was in line with plan.

• The Provider Arm dashboard was included for the members’ information and included the District Annual Plan (DAP) projects for the 2009/10 year.

• The COO/RDCEO advised that the first mobile dental unit has arrived on site. In response

to a query from Ms Wilson the COO/RDCEO advised that the unit does not have a ramp. In discussion it was noted that the design was a national one and the issue of accessibility was being dealt with at a national level.

• Occupancy for October 2009 was at 93% and the COO/RDCEO stressed that occupancy

level puts enormous pressure on the organisation.

• In response to a query from the Chair, the COO/RDCEO advised that instead of focussing on electives this year, the organisation is having a short break over the Christmas/New Year period and staff will be released on leave for a set period of time. The Chair queried what impact this would have considering the demand for acutes in recent months. The COO/RDCEO advised that management is relying on previous years’ trends to prepare for the break.

• The Board Chairman expressed concern over the impact the increased number of acutes is

having given that the MoH targets are based on elective throughput and increased productivity.

• Mrs Johnstone queried the definition of acutes and why the increase in acutes continues.

The COO/RDCEO provided an update, noting that management was analysing this looking at solutions including working with primary care to insure patient don’t get admitted. She advised that in comparison to Taranaki DHB and Lakes DHB, Southland DHB was significantly lower for acute throughput with a similar population. Mrs Johnstone asked for the comparative data to be included in future agendas for members’ information.

Medical Division Report – In discussion the following key points were noted: The COO/RDCEO highlighted the report on LDH and noted the recommendations. She acknowledged the work being undertaken in relation to the Hospital Capacity Review but noted the need to mitigate the risk at LDH that has been identified now.

• The COO/RDCEO provided an overview on the discussion paper on options for LDH.


• In response to a query by Ms Fiona McArthur, the COO/RDCEO clarified that the accident

and stabilising unit at LDH had become known as an ED over time and she provided a background on the unit and what had happened over time.

• The Board Chair queried where the funding for the additional staff would come from. The

COO/RDCEO advised that management was expecting a tax rebate from the capital charge which would contribute to the 300k that is the estimated cost to the DHB.

• In response to a query from the Chair the COO/RDCEO advised she could not give a

precise number or statistic but she highlighted that there is a large number of people presenting at ED who are very low triage.

• The COO/RDCEO advised that all options in the report had been costed and she advised

the reasons for choosing the option recommended.

• Concern was expressed that the temporary system put in place may cause issues later on. The COO/RDCEO advised that management was awaiting the Cranleigh Report that would identify the model of care that is suitable for all the rural combined hospitals across the Otago/Southland regions. The report would go out for consultation.

• It was noted that ED attendances had increased from 700 to potentially over 7000 in a

seven year period.

• The Medical Division Manager, Mr Winwood described the challenges that have arisen and elaborated on the discussions that have commenced around the issue with GPs in the Queenstown area. He noted the report had stimulated discussion and he outlined some of the proposals that have been discussed.

• In response to a query by Mrs Johnstone, the COO/RDCEO confirmed 24 hour after hours

care was available, but it was very expensive. Ms McArthur noted that the answering service at the medical centre in Queenstown was very informative regarding the costs involved for call outs after hours. She noted the minimum charge for an after hours call out was $200.00.

• The COO/RDCEO advised that the risk related to having insufficient staff to manage the

volume of people presenting at the ED. She advised the pressure on staff to manage the volume of work. In response to a query by Mrs Johnstone, the COO/RDCEO advised that staff did advise those presenting of their options, e.g. seeing a GP.

• Mrs Johnstone and the Chair noted the need for a promotion advising the need to keep ED

for emergency only and to have a notice in the ED. The COO/RDCEO advised that there were no signs, but she outlined the verbal advice given to those presenting by staff. Mr Winwood advised that some of the options identified in the options paper were cost neutral, but the options would take time to implement. The risks were discussed.

• A wide-ranging discussion was held regarding possible solutions for the issue and potential

risks.

• The RCNMO advised the need for the community to change its thinking about primary care and accessing GPs.

• The COO/RDCEO noted the clinical input into the recommendation.


It was moved: “That the Committee recommends to the Southland District Health Board that additional staffing into Lakes District Hospital is supported while an alternative model of care is developed and implemented.”

Moved: Mrs O’Connor Seconded: Ms Wilson

Carried

• Mrs Johnstone stressed the need to know the costings for all options.

• Mrs Johnstone highlighted her concerns at the cost of the recommendation given the Board’s financial position. Mr Menzies also noted his concerns, noting there was no end date. The Chair advised the Hospital Capacity Review would provide some answers. It was unfortunate that discussion on that could not have been held prior to the paper being presented.

• The Chair acknowledged the Medical Divisional Manager and thanked him for his input.

• The impact of visitors to the area was highlighted by the Medical Divisional Manager.

Mr Winwood left the meeting at 3.30pm Mental Health Services – The COO/RDCEO took the report as read and the following key point was noted:

• A training day with the NGOs was held in Southland with Otago and Southland participating.

Surgical Division Update – In discussion the following key points were noted:

• The executive theatre compass dashboard had been received late and the Chair requested that it be tabled at the Board meeting on 10 December 2009.

• In response to a query from Mrs Johnstone regarding the theatre sessions that did not go

ahead in November 2009 due to lack of Anaesthetists, the COO/RDCEO advised that where there was sufficient time surgeons held additional clinics or arrangements were made for staff to take leave. The COO/RDCEO advised that holding additional clinics increased the numbers on the treatment lists.

• The COO/RDCEO highlighted the impact of the staff shortage in O&G.

• The COO/RDCEO highlighted the upward trend in urology with the return of a locum

Urologist.

• ESPIs were green overall. Ear Nose and Throat (ENT) have slipped into amber category and orthopaedics was in danger of moving into amber.

• The one page update on the e-texing pilot and the Did Not Attends (DNAs) was highlighted

by the COO/RDCEO. She advised there were challenges that needed to be looked at and further discussion was held.

Women’s and Children’s Division – In discussion the following key points were noted:

• In response to a query the COO/RDCEO advised the difference between a dental hygienist and a dental therapist. She advised that a therapist treats patients and a hygienist is a mix of treatment, education, promotion and prevention. The COO/RDCEO noted the challenges with the current emphasis on outputs.


• The COO/RDCEO advised that the hospital playroom underwent a review from the Education Review Officer (ERO) and a very good report was received.

The Chair requested that a letter of congratulations on behalf of the HAC be written to the team responsible for the hospital playroom. Human Resources (HR) Update – in discussion the following key points were noted:

• In response to a query raised at the November 2009 HAC meeting the COO/RDCEO advised that the payroll change that the organisation proposed was at no extra cost, but would allow more functionality around the information held in the payroll system.

• An HR management series pilot programme was running within the organisation which has

received excellent feedback from staff. This programme supports new managers around current policies, leave management, recruitment practice, occupational health and safety and performance management.

• The organisation has received feedback from two funders regarding the Incubator

programme. The COO/RDCEO advised that they have considered the programme very positively for the 2010 year.

• In relation to employment relations, the COO/RDCEO advised that there had been some

withdrawal of labour activity within the hospital over the last few weeks. Contingency planning was in place and the team responsible coped well.

• In response to a query by the Chair around workforce, the COO/RDCEO provided an

update on the workshops held in the community.

• In response to a query, the COO/RDCEO advised that the vacancies for senior doctors should be shown within the HR report as zero as it is included in the Medical Officers’ Unit instead. She also advised that work progressing to enable the regional recruitment team to pick up the permanent recruitment positions.

Information Group Update – In discussion the following key points were noted:

• The iPM system upgrade has been completed.

• IT has undergone a recent restructure which will better align roles within the team to the number of clinical systems and with a view to having a team available to work with the business intelligence tool.

• Two vendors for video conferencing have been short listed, one of which has been on site

and presented their product for the selection panel to make sure it meets the needs of the senior medical staff.

Quality and Risk Dashboard – in discussion the following key points were noted: The organisation has received its certification report with a very small number of corrective actions from that report. Plans will now be put in place to make the corrections over the next six to twelve months. The COO/RDCEO advised on some of the areas where corrections are required. The MoH is yet to advise how long certification is for. The accreditation report has not yet been received. Community Oral Health Service – Education Leases – in discussion the following key points were noted:

• The report was tabled for members’ information (appendix 1)

• Due to the length of the lease, a recommendation is to go to the Board from HAC for approval of the lease.


• The COO/RDCEO advised on the actions required and she noted that the terms of the

lease cannot be amended or negotiated. • In response to a query from the Board Chairman, the COO/RDCEO advised that the lease

had been reviewed by the legal team who are managing the national process and that it has been endorsed by DHBNZ.

• It was noted that the lease was a peppercorn rental at $1.00 per year.

It was moved: “That the committee recommends to the Board that the lease (attached to the report tabled at the meeting) and attached to the minutes as appendix 1 is approved for use with the schools set out in Table 1 of the report”.

Moved: Mrs Johnstone Seconded: Mr Menzies

Carried

• Ms Wilson noted that there would not only have to be pads put down for the mobile units but also paths adjoining to them to make them accessible.

It was moved: “That the committee receives the management reports”.

Moved: Ms F McArthur Second: Mrs S Johnstone

Carried It was moved: “That the apologies be accepted”

Moved: Mrs K Crowther Seconded: Mrs D Wilson

Carried

8. Financial Report

The Senior Business Analyst (SBA), Mrs Bron Anderson, spoke to the forecast. In discussion the following key points were noted:

• The forecast reflects the current trends and includes the MECA settlements as per the budget.

• The November 2009 provider arm accounts are currently being finalised and the result is

not as favourable as predicted. • The forecast for Locum cover will change. Predominantly this will be across Anaesthetics

and Obstetrics and Gynaecology (O&G) which is a theme throughout the report but impacts on the dollars.

• The Nursing result is above budget parameters and is driven by FTEs. The MECA allows a

settlement for some current staff which is an allowance over and above the current terms and this is yet to be factored into the forecast. The SBA advised that it is included in the DAP.

• Leave liability adjustments over the Christmas break must be accommodated. In response

to a query, the SBA advised that what is in the forecast currently is current trends. The


Christmas leave has not been reflected in the forecast at the current time. The SBA advised that getting closer to year end she will do an increased amount of work on a line by line basis.

• The decisions made at the current meeting in relation to LDH and the capital charge

adjustment were not factored into the forecast.

• The SBA highlighted a depreciation error that had been found.

• In response to a query from Mr Ward regarding phasing and the variance in the deficit from month to month, the SBA advised management pushes electives when resources are available. When there are significant numbers of acutes then staff time is focused on those. The COO/RDCEO advised that this year has had a very high acute throughput and the SBA advised that this was reflected in the clinical supplies line which is driven by patient volumes. The impact of leave liability was discussed.

• In response to a query from Mrs Johnstone the SBA advised on what divisions are not

included in clinical groups. She estimated that would be approximately 20% of personnel. Mrs Johnstone queried why the FTEs in the clinical groups are under budget year-to-date, but in the financial report they are over budget. She requested that an explanation be included in the February 2010 HAC agenda.

It was moved:

“That the committee receives the financial report”.

Moved: Mrs S Johnstone Seconded: Ms F McArthur

Carried

9. General Business

There were no matters of general business.

10. Confidential Section

It was moved: “That the Committee move to the Public Excluded Section of the business at 4.00pm.” Moved: Mr P Menzies Seconded: Mrs S Johnstone Carried The Committee rejoined the Public Section of the meeting at 4.30pm.

11. Meeting Conclusion

The meeting closed at 4.30pm.

12. Confirmation of Minutes

Confirmed __________________________________________ Date ________________ Chairman

SDHB HAC MEETING – February 2009

HOSPITAL ADVISORY COMMITTEE (HAC) ACTION SHEET

HAC Meeting held on 09 December 2009

Action Point No.

SUBJECT

ACTION REQUIRED

BY

STATUS

EXPECTED COMPLETION

DATE 63-09/12 Presentation on lean

implementation. (Minute Item 7)

The Committee is to receive a presentation on productive ward opportunities and lean methodology if the initiative is adopted.

RCNMO To be actioned if the initiative is adopted.

2010

64-09/12 Total Nursing Salaries actual/FTE. (Minute Item 7)

To revisit the figures for the Total Nursing Salaries actual/FTE.

SBA Completed February 2010

65-09/12 Acute throughput. (Minute Item 7)

Comparative data regarding acute throughput to be included in future agendas for members’ information.

COO/RDCEO Completed February 2010

66-09/12 FTE in financial report. (Minute Item 8)

The SBA is to provide an explanation on why the FTEs are within plan for the clinical groups but not overall.

SBA Completed February 2010

December 2009 Appendix 1

STRATEGIC GOALS:

Creating a high performance culture

Achieving Health Targets

Leadership Development

PROGRESS

PROJECT Behind

On target

Complete

COMMENT

Provider Arm

Achieving IPM convergence

� As per IS report in the Chief Operating Officer’s (COO) report.

Emergency department Information system implementation

� Completed.

Emergency Department waiting time less than 6 hours

� A work group are reviewing current statistics and developing a plan to achieve this target.

Clinical Leadership � A clinical leadership programme is underway.

Regional Clinical Services � The project manager role has been appointed to, and strategy ready for consultation.

Community Paediatrics � An advanced trainee in Paediatrics has been appointed for the 2010 calendar year to complete many of the duties of a fourth paediatrician to enable the community paediatric service to be further developed but this is a one year position and the provider arm will continue to recruit into the fourth paediatrician role permanently.

Healthy Eating Healthy Action (HEHA)

implementation

� Through the month of November and December the HEHA team ran a series of seminars, cooking demonstrations, fruit loyalty cards and activities for staff with

the view to supporting a healthy and active lifestyle.

Oral Health Business Case � The prototype mobile underwent acceptance testing and has been commissioned. Leases and construction licences for the first mobile pads were agreed, and building consent applications lodged. Design work on remaining mobile pads and fixed clinics continued as per plan.

Theatre Efficiency � As per theatre dashboard from Theatre Compass attached to the Surgical division report.

Better help for smokers to quit

� Good progress is being made towards the target, promotion of the project continues and all systems are in place including feedback on progress to service areas being provided monthly.

ESPI Compliance � ESPIs remain green.

Elective Surgical delivery � As reported in the surgical division report.

Devolution of secondary to primary

� Awaiting new Primary Health Organisation (PHO) structure.

Improving Mental Health services

� The service submitted its report of progress against Te Kokiri, The Mental Health and Addiction Action Plan 2006-2015 to Planning and Funding at the end of the 2008/09 year. Reporting against Te Kokiri is an annual reporting requirement.

New born hearing implementation

� Discussion continues with planning and funding, initial planning underway.

Provider Arm DAP Project Dashboard 2009/10

SDHB HAC Meeting – 10 February 2010 Medical Division Update

MEDICAL DIVISION UPDATE

HAC Meeting Date: 10 February 2010 Report prepared by: Ian Winwood, Divisional Manager Dr Alasdair Millar, Divisional Director Jenny Hanson, Director of Nursing Date Prepared: 19 January 2010

1. Service Summary

Allied Health Services • there was a reduction in Accident Compensation Corporation (ACC) referrals for

physiotherapy in the second half of November 2009 which could be related to confusion over the introduction of patient co-payment. 91% of target was achieved

Assessment, Treatment and Rehabilitation Services (AT&R) • the AT&R service experienced an outbreak of norovirus in mid December 2009. Initially

the ward was closed to both visitors and admissions. The ward reopened fully on 6 January 2010. The service managed the outbreak well and no spread occurred outside of the quarantined area

Lakes • recruitment has commenced following the Board approval to temporarily increase

medical officer staffing at Lakes District Hospital through to 30 June 2010. The increase will allow the hospital to better manage the current workload, while the Board explores other options

Medical Imaging • the Christmas period was busier than the previous year with 36 more x-rays performed in

the Christmas week, with 146 in 2008 and 182 in 2009 and was driven by emergency department presentations. The New Year period was similar to the previous year

• the waiting times for mammograms for the out of town recall patients and symptomatic

patients is currently 24 weeks. Options to decrease the wait time have been initiated including extra sessions, which is dependent on the availability of current staff. The increase in waiting time is due to leave taken by the staff.

Medicine • one physician finished a contract early in December 2009, leaving the department one

vacancy. A second physician completes his contract in mid-February 2010. Recruitment continues and has been boosted by the changes in the regional recruitment team to create a recruitment adviser for senior medical staff

• there will be a reduction in service delivery from the medical service from February 2010

with the 2 vacancies for senior positions and also with 4 vacancies out of 7 in the medical registrar group. Contingency planning has commenced, whilst recruitment efforts continue. The shortage in this key group is not specific to Southland DHB, with similar recruitment problems throughout the country


Emergency Department (ED) • the ED had an increased work load over the Christmas period with a number of issues

arising. In particular there was a shortage of inpatient beds, leading to patients remaining in an ED bed for longer periods. The division will be reviewing the number of beds closed during the holiday period, to make recommendations for the 2010 Christmas period

• Dr Adam McLeay, FACEM (Fellowship of the Australasian College of Emergency

Medicine) has commenced bringing the complement of New Zealand vocationally registered specialists up to three. This will allow further enhancement of the planned training role for the emergency department

2. Quality Initiatives

Pharmacy • an audit by Medsafe, a department of the Ministry of Health, will take place late January

2010. Final preparation is underway to ensure all policies and procedures affecting medicine use in the hospital are up to date

Emergency Department • ED has initiated patient focused bedside handovers using Identify, Situation, Background,

Assessment, Request (ISBAR) as a guideline. This is a communication tool to aid the quality of the information given, to ensure that the transfer and understanding of information is complete


3. Contract performance

HAC Group Actual YTD

Volume Budgeted YTD Volume

YTD Volume Variance

% of YTD Budget Reached

Mitigation Comments

General Medicine

Inpatient

2092.68 1898.52 194.16 10.23% Monitor Increased

demand during the winter months. Reduction since November 2009 report

Cardiology Outpatient 652.00 754.00 (102.00) (13.53%) Change in counting for some cardiology to general medicine

Diabetes Outpatient 63.00 249.60 (186.60) (74.76%) Change in counting for some diabetes to

general medicine

Endocrinology Outpatient

- 37.44 (37.44) (100.00%) All counted as general medicine

General Medicine Outpatient

655.00 447.20 207.80 46.47% Change in counting for subspecialties

Infectious Diseases Outpatient

42.00 29.12 12.88 44.23% Increased demand

Neurology Outpatients 406.00 357.24 48.76 13.65% Increased demand

Renal Medicine Outpatients

286.00 249.60 36.40 14.58% Monitor Pre-Christmas extra clinics, to offset gap in January

Respiratory Outpatients 357.00 421.20 (64.20) (15.24%) Increased clinics

Decrease in shortfall since November report

Rheumatology Outpatients

413.00 322.40 90.60 28.10% Monitor Additional clinics pre-Christmas to offset January gap

Lakes ED 3288.00 2400.00 888.00 37.00% Increase staffing. Consider primary care options

Increased demand from skiing and H1N1. Decrease observed since

September 2009

Southland ED 15701.00 15740.00 (39.00) (0.25%)

A review of the mapping for outpatient activity has demonstrated that any patient seen by a general medicine physician should be mapped to that speciality. This has been corrected and is now seen with cardiology and diabetes reporting under budgeted volume and a corresponding over budget in general medicine.


Medical Imaging Waiting Times Department This month Last month Target MRI Urgent same day same day same day semi urgent 2 weeks 1 to 2 weeks 2 to 3 weeks routine

outpatient 4 weeks 6 weeks 6 to 8 weeks

ACC 12 days 13 days 10 days Private 12 days 13 days 10 days CT urgent ASAP (within 24

hours) ASAP (within 24 hours)

Same day

Semi urgent 1 week (OP) 1 to 2 weeks (OP) 2 to 3 weeks routine

outpatient 5 to 6 weeks 5 to 6 weeks 6 to 8 weeks

ACC Within 10 days Within 10 days 10 days Private Within 10 days Within 10 days 10 days Ultrasound all ultrasounds 30 weeks 32 weeks 8 weeks X-Ray appointments

Routine 5 weeks 4 weeks 6 weeks

intravenous urograms

6 weeks 6 weeks 4 to 6 weeks

barium procedures

6 weeks 6 weeks 4 to 6 weeks

Mammography Urgent 1 week 1 week 1 week semi-urgent 2 to 4 weeks 2 to 4 weeks 2 to 4 weeks routine 24 weeks 24 weeks 4 to 6 weeks recall patients 8 weeks for out of

town patients 8 weeks 4 weeks

Nuclear Medicine

urgent * 3 weeks *2 weeks * 2 days to 2 weeks

semi urgent 6 weeks 4 weeks 4 weeks routine

outpatient 6 weeks 4 weeks 4 to 6 weeks

ACC 10 days 10 days 10 days Private 2 weeks 2 weeks 10 days Cardiac 6 months 5 months 2 months

* If there is generator activity then urgent Nuclear Medicine Scans would be performed within 2 days.


4. Financial performance

AnnualActual Budget Variance Actual Budget Actual Budget Variance Budget$'000 $'000 $'000 FTE FTE $'000 $'000 $'000 $'000

349 403 (54) Revenue 2,586 2,420 166 4,839(2,262) (2,171) (91) 290.24 284.77 Less Personnel Costs (12,322) (11,761) (561) (23,614)

(154) (254) 100 Less Outsourced Costs (1,173) (1,663) 490 (2,983)(520) (514) (6) Less Clinical Supplies (3,118) (3,052) (66) (6,054)(185) (180) (5) Less Infrastructure & Other Costs (1,098) (1,070) (28) (2,122)

(2,772) (2,716) (56) 290.24 284.77 Net Surplus/(Deficit) (15,125) (15,126) 1 (29,934)Add Divisional Share of Savings Target 11 213 (202) 426Result After Savings Target Adjustment (15,114) (14,913) (201) (29,508)

Year to DateMonth

AnnualActual Budget Variance Actual Budget Variance BudgetFTE FTE FTE FTE FTE FTE FTE

25.42 21.74 (3.68) Medical Personnel 24.02 20.75 (3.27) 22.09141.40 138.31 (3.09) Nursing Personnel 140.63 138.31 (2.32) 138.31

86.73 86.74 0.01 Allied Health Personnel 86.18 86.74 0.56 86.7436.69 37.98 1.29 Management & Admin Personnel 36.86 37.98 1.12 37.98

290.24 284.77 (5.47) Total Personnel 287.69 283.78 (3.91) 285.12

Month Year to Date

The medical division is reporting an unfavourable variance of $56k for December 2009. Revenue is $54k unfavourable in December 2009, mainly due to low ACC income in rehabilitation and medical imaging. Driven by lower volumes. Expenditure overall is $2k unfavourable in December 2009 and the main reasons for the variances include: • personnel is $91k unfavourable in December 2009. Medical is $58k unfavourable due to

the additional hours that have been worked by doctors. Allied Health is $31k unfavourable due to overtime in medical imaging, pharmacy and mortuary

• outsourced services costs are $100k favourable in December 2009. This variance relates to senior medical outsourcing and is offset above with the over run against salaries

• clinical supplies is $6k unfavourable in December 2009. Contributing to this result is instruments and equipment $14k favourable and treatment disposables $21k unfavourable. The treatment and disposables unfavourable variance mainly relates to protective clothing $5k unfavourable, Intra Venous (IV) supplies $6k unfavourable and patient consumables $5k unfavourable

5. Risks and Mitigation

Risk Mitigation • Anticipated shortage of medical registrars

may lead to service reduction

• Contingency plan for decreased services. Prioritise work to ensure acute demand is met. Collaborate with Otago DHB

Southland DHB HAC Meeting – 10 February 2010 Mental Health Division Update

MENTAL HEALTH SERVICES UPDATE

HAC Meeting Date: 10 February 2010 Report Prepared By: Louise Travers, Divisional Manager

Dr Alfred Dell’Ario, Divisional Director Jane Collins, Director of Nursing

Date Prepared: 20 January 2010

Recommendation

That the Committee receives and notes this report.

1. Service Summary

• Mental Health Services and PACT Southland signed an updated memorandum of understanding in November 2009. To complement this, service level agreements between the two providers have been completed

• Mental Health Services and Nga Kete Matauranga Pounamu Charitable Trust signed a service level agreement in December 2009 which will support the interface between the two providers

• Southland’s Mental Health Service was awarded first place in the Future Directions Mental Health Network quality awards for its work on the Southland story and integrated model of care

• Child and Adolescent Service is now operating under the Choice and Partnership Approach (CAPA) model as from 30 November 2009. This is the final step to implement recommendations of the review of this service that was undertaken in early 2008

• the Werry Centre was a highlight among the education and training offered in November and December 2009


Systems and Information Improvements

• programme for integration for mental health data (PRIMHD) compliance has again been awarded by Ministry of Health, achieving a 99.4% result

• work continues on improving the recording of service activity in our Patient Management System (iPM) and we are currently reviewing activity purposes with a view to increasing local reporting

• Knowing our People Planning (KPP) is moving into a phase of further development of the systems and processes to better inform service planning and delivery

Workforce Development

• the provider arm mental health service met with network non government organisations (NGOs) to collaborate in preparing the Mental Health Services and Future Directions sector wide in-service plan for 2010. Opportunities for exchange of resources and combined approaches with workforce development were integrated into the plan

• career and salary progression (CASP) workshops were held for mental health’s allied health staff

• the Director of Area Mental Health held a well attended session outlining his role in relation to clients under the Mental Health Act


Orientation for New Staff • this project is reviewing and updating the mental health orientation process to provide a generic

and consistent process across all teams. Work continues to progress with a second draft to be distributed in early February, for consultation with the service

Future Directions Network Representative Group � the Southland NGO Forum met on 25 November 2009 which included a quality development

workshop titled “Taking your quality systems to the next level”. This workshop was well attended by the sector with good feedback

� Future Directions Network representative group met in November 2009 and also held a separate workshop to further develop its 2010-2015 Strategic Planning document

3. Contract Performance

• Mental Health Promotion activities continue

4. Financial Performance – December 2009

AnnualActual Budget Variance Actual Budget Actual Budget Variance Budget$' 000 $' 000 $' 000 FTE FTE $' 000 $' 000 $' 000 $' 000

1,653 1,721 (68) Revenue 9,964 10,325 (362) 20,651(1,253) (1,403) 150 166.37 178.24 Less Personnel Costs (6,936) (7,732) 795 (15,239)

(20) (21) 1 Less Outsourced Costs (370) (127) (243) (254)(9) (13) 4 Less Clinical Supplies (62) (75) 13 (149)

(112) (120) 8 Less Infrastructure & Other Costs (633) (726) 93 (1,435)258 164 95 Net Surplus (Deficit) before Overheads 1,962 1,666 296 3,573

(184) (304) 120 Overhead Allocation (1,297) (1,673) 376 (3,500)74 (140) 215 Direct Net Surplus / (Deficit) 665 (7) 672 73

Add Divisional Share of Savings Target 44 37 7 53Result After Savings Target Adjustment 709 30 679 126

Month Year to Date

AnnualActual Budget Variance Actual Budget Variance Budget

FTE FTE FTE FTE FTE FTE FTE

11.66 13.83 2.17 Medical Personnel 10.64 13.84 3.20 13.8475.96 75.53 (0.43) Nursing Personnel 77.07 75.53 (1.54) 75.5352.93 61.02 8.09 Allied Health Personnel 51.31 61.02 9.71 61.02

0.00 0.00 0.00 Support Personnel 0.00 0.00 0.00 0.0025.82 27.86 2.04 Management & Admin Personnel 26.16 27.86 1.70 27.86

166.37 178.24 11.87 Total Personnel 165.18 178.25 13.07 178.25

Month Year to Date

Mental Health Services had an operating surplus of $74k for December 2009 against a budgeted deficit of $140k. This produced a favourable variance to budget of $215k with a favourable year to date (YTD) variance to budget of $672k. These figures are after the overhead calculation for December 2009 has been applied. FTEs for December 2009 are under budget by 11.87. The revenue variance is $68k under budget for December 2009. The wash-up back to funder arm is $71k. YTD wash-up back to funder is $411k. Expenses, including overheads, show a favourable variance of $283k for the month, YTD expenses are tracking $1,034k under budget.


• salaries are under budget by $150k for the month, YTD under budget by $795k. This is reflected in the 11.87 FTE variance to budget for the month and 13.07 FTE YTD

• outsourced expenses show a $1k favourable variance from budget for the month, YTD unfavourable variance of $243k being mostly locum cover for the senior medical staff vacancies

• infrastructure and non-clinical supplies show a favourable variance of $8k for the month, YTD favourable variance of $93k

5. Emerging issues / risks / mitigation

Risk Mitigation Ability to meet access targets may be compromised by not and/or staging appointments to vacancies

Monitoring by divisional leadership team and active recruiting to consultant psychiatrist vacancies

Difficulty in finding accommodation for patients with enduring mental illness is blocking acute inpatient beds

Ongoing discussions with planning and funding and providers locally and regionally to find placements

Potential gap in clinical service delivery for older people

Mental Health and Medical divisions are close to confirming a clear clinical pathway

SDHB HAC Meeting – 10 February 2010 Surgical Division Update

SURGICAL DIVISION UPDATE HAC Meeting Date: 10 February 2010 Report Prepared By: Peter Bramley, Divisional Manager David Tulloch, Divisional Director Helen McKenzie, Director of Nursing Date Prepared: 19 January 2010

Recommendation


1. Service Summary

• Southland District Health Board (SDHB) has an orange status hospital wide for ESPI 2 first specialist appointments (appendix 4c)

• ENT, Gynaecology and Orthopaedics are the three services non-compliant for ESPI 2

• Dental is non-complaint for ESPI 5 (elective procedures waiting longer than 6 months)

• Recovery plans approved by the Ministry of Health are in place for each of the non-complaint services

• elective services delivered 297 case weighted discharges (CWD) for December 2009. The monthly target was ahead of plan by 11 CWD, and is now behind by 2 CWD YTD (appendix 4b)

• overall (acute and elective) the surgical division has delivered 354 CWD more than budget and 447 CWD more than at the same time last year. This highlights the high acute demand in 2009

• performance by speciality (appendix 4a)

• patients certainty wait time for treatment (appendix 4d)


• the patient focussed booking trial is being extended across more specialities

• a project for the implementation of the recommendations from the review of our referral processes has begun

• the project scoped to review our pre-admission pathway to improve the experience of our patients, and to minimise cancellations of elective surgery has begun

• a project to improve the management of acute surgical workload in theatre’s is underway • the theatre compass data continues to drive a focus to improvement in theatre performance.

A project with a view to improving the variance of actual to expected surgical case length for procedures has been started with the anticipated benefits are of reducing overruns and providing more effective booking of surgical lists. A project has also begun to try and improve the utilisation of our acute theatre. Of note:

o the volume of elective cases up by comparison with this time last year (2%) o a 24% increase in acute cases compared to the same period last year o over runs of theatre sessions down from 18% in 2008 to 12% in 2010 o turn around times have increased and first case start performance is poor due to

new staff and high acute demand, this is being addressed


3. Contract Performance

• Southland Hospital is 7 orthopaedic joints behind in its YTD planned delivery for December 2009. With respect to cataracts Southland Hospital is 8 behind in its planned delivery YTD

• key areas of variance with outpatient delivery HAC Group Actual YTD

Volume Budgeted YTD Volume

YTD Volume Variance


Comments

Orthopaedics Outpatients 4152.00 2790.00 1362.00 48.82% High acute demand

Urology Outpatients 859.00 763.36 95.64 12.53% Currently two urologists present

4. Financial Performance

Annual

Actual Budget Variance Actual Budget Actual Budget Variance Budget$' 000 $' 000 $' 000 FTE FTE $' 000 $' 000 $' 000 $' 000

129 101 28 Revenue 979 607 372 1,215 (1,594) (1,617) 23 225.40 220.70 Less Personnel Costs (8,771) (8,773) 2 (17,373)

(345) (254) (91) Less Outsourced Costs (1,600) (1,522) (78) (3,279) (713) (629) (84) Less Clinical Supplies (4,090) (3,736) (354) (7,411) (112) (116) 4 Less Infrastructure & Other Costs (688) (695) 7 (1,379)

(2,635) (2,515) (120) Net Surplus / (Deficit) (14,170) (14,119) (51) (28,227)Add Divisional Share of Savings Target 38 225 (187) 448Result After Savings Target Adjustment (14,132) (13,894) (238) (27,779)

Month Year to Date



14.10 15.80 1.70 Medical Personnel 16.18 15.80 (0.38) 15.80 135.21 134.29 (0.92) Nursing Personnel 137.80 134.29 (3.51) 134.29

7.96 10.09 2.13 Allied Health Personnel 7.91 10.09 2.18 10.09 11.10 10.89 (0.21) Support Personnel 10.72 10.89 0.17 10.89 50.67 49.64 (1.03) Management & admin Personnel 50.52 49.64 (0.88) 49.67

219.04 220.71 1.67 TOTAL PERSONNEL 223.13 220.71 (2.42) 220.74

Month Year to Date

The surgical division is reporting an unfavourable variance of $120k for December 2009 and a year to date (YTD) variance of $51k (0.4%) unfavourable against budget. Revenue is $28k favourable for December 2009 and is $372k favourable YTD against budget. The variance is due mainly to:

• Accident Compensation Corporation (ACC) income is $15k favourable for December 2009 and $180k favourable YTD

• non resident income is $5k favourable for the month and $171k favourable YTD Expenditure overall is $148k unfavourable in December 2009 and is $423k unfavourable YTD against budget. The main reasons for the variance are:


• personnel costs are $23k favourable for the month and $2k favourable YTD • outsourced costs are $91k unfavourable for December 2009 and $78k unfavourable

YTD. • overall medical personnel and medical outsourced costs are $5k unfavourable in

December 2009 and $205k favourable YTD • clinical supplies are $84k unfavourable against budget in the month and $354k

unfavourable YTD, reflecting patient volume – acute and elective work. A significant component of this overspend is patient travel with air ambulance $56k unfavourable for the month, and 119k unfavourable YTD

5. Risks and Mitigation

Key risks for the surgical division continue to be around clinical staff resourcing. Risk Mitigation Non-compliance with MOH ESPI indicators potentially put at risk additional elective surgical funding

Additional first specialist attendance (FSA) clinics and limiting referrals into various services

The retirement of the Ear Nose Throat (ENT) consultant will potentially impact the delivery of ENT clinical services

Ongoing recruitment

A shortage of experienced theatre staff will potentially limit elective service delivery

Ongoing recruitment

SDHB HAC Meeting – 10 February 2010 Performance by Department

1. Performance by Department

This section illustrates the year to date performance of each department to December 2009 and progress towards SDHB meeting the objectives outlined. Dental The dental department at the end of December 2009 is 11 case weight discharges (CWD) behind its plan. Anaesthetic shortage has impacted elective delivery. Additional lists are being allocated to meet the elective target.

Dental - Cumulative Total Of Elective Costweights

-

20

40

60

80

100

120

140

160

180

200

YTD 2009/10 16 25 41 54 62 81

Actual 2008/09 20 34 46 58 78 100 113 128 143 153 159 166

Budget 2009/10 16 32 48 64 80 92 105 121 137 149 165 178

Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay Jun

Ear Nose and Throat (ENT) The ENT department at the end of December 2009 is 30 CWD ahead of its plan.

ENT - Cumulative Total Of Elective Costweights

-

50

100

150

200

250

300

350

400

YTD 2009/10 31 55 89 119 170 204

Actual 2008/09 29 50 74 100 133 154 166 190 236 267 301 329

Budget 2009/10 30 60 90 120 150 174 197 227 257 281 311 334



Ophthalmology The ophthalmology department at the end of December 2009 is 60 CWD ahead of its plan.

Ophthalmology - Cumulative Total Of Elective Costweights

-

50

100

150

200

250

300

350

400

YTD 2009/10 47 89 119 166 199 229

Actual 2008/09 9 30 71 111 155 183 208 239 273 301 336 375

Budget 2009/10 29 58 88 117 146 169 191 220 250 272 302 324


General Surgery The general surgery department at the end of December 2009 is 63 CWD ahead its plan.

General Surgery - Cumulative Total Of Elective Costweights

-

200

400

600

800

1,000

1,200

YTD 2009/10 134 240 301 408 495 610

Actual 2008/09 90 181 277 380 478 548 617 694 784 882 991 1,078

Budget 2009/10 95 189 284 378 473 547 620 715 809 883 978 1,051



Gynaecology The gynaecology department at the end of December 2009 is 92 CWD behind its plan. A shortage of obstetric and gynaecology consultants continues to impact elective delivery.

Gynaecology - Cumulative Total Of Elective Costweights

-

50

100

150

200

250

300

350

400

450

YTD 2009/10 28 56 69 83 97 112

Actual 2008/09 14 27 67 91 135 171 200 233 263 291 325 342

Budget 2009/10 35 71 106 141 176 204 231 266 302 329 364 392


Orthopaedics The orthopaedic department at the end of December 2009 is 26 CWD behind its plan. Additional orthopaedic theatre lists are scheduled for January.

Orthopaedics - Cumulative Total Of Elective Costweights

-

200

400

600

800

1,000

1,200

1,400

YTD 2009/10 51 159 241 340 470 519

Actual 2008/09 36 129 216 314 408 490 608 690 793 865 941 1,016

Budget 2009/10 73 157 242 339 448 545 678 774 896 992 1,113 1,210



Paediatric Surgery Paediatric surgery at the end of December 2009 is 4 CWD behind its plan.

Paediatric Surgery - Cumulative Total Of Elective Costweights

-

10

20

30

40

50

60

YTD 2009/10 4 8 12 12 17 21

Actual 2008/09 5 5 10 10 14 22 22 25 31 37 44 49

Budget 2009/10 4 9 13 17 21 25 28 32 36 40 44 47


Urology The urology department at the end of December 2009 is 32 CWD behind its plan. Anaesthetic shortage has impacted the elective delivery in urology.

Urology - Cumulative Total Of Elective Costweights

-

50

100

150

200

250

300

350

400

YTD 2009/10 24 46 60 86 124 150

Actual 2008/09 26 61 99 132 174 192 227 244 272 307 325 341

Budget 2009/10 31 63 94 126 157 182 206 237 269 293 325 349



Plastics Plastics are procedures carried out by SDHB’s oral-maxillo facial surgeon who also contributes to the dental CWD. For the end of December 2009 this specialty is 5 CWD ahead of plan.

Plastics - Cumulative Total Of Elective Costweights

-

5

10

15

20

25

30

YTD 2009/10 2 2 5 7 14 17

Actual 2008/09 1 7 9 10 12 14 14 15 20 22 24 26

Budget 2009/10 2 4 6 8 10 12 13 15 17 19 21 22


MoH Elective Services OnlineComparison of surgical services for November 2009

Data Warehouse Refresh Date:

Report Run Date:

16/Jan/2010

20/Jan/2010

1.DHB services thatappropriately acknowledge

and process all patientreferrals within ten working

days.

2.Patients waiting longerthan six months for their

first specialist assessment(FSA).

3.Patients waiting without acommitment to treatment

whose priorities are higherthan the actual treatment

threshold (aTT).

4.Clarity of treatmentstatus.

5.Patients given acommitment to treatmentbut not treated within six

months.

6.Patients in active reviewwho have not received a

clinical assessment withinthe last six months.

7.Patients who have notbeen managed according to

their assigned status andwho should have received

treatment.

8.The proportion ofpatients treated who wereprioritised using nationallyrecognised processes or

tools.

Service Name Level Status Imp.Req.

Level Status Imp.Req.







Dental 1 of 1 100.0 % 0 X 0.0 % X 1 0.0 % 0 0 0.0 % 0 19 5.7 % -3 1 0.0 % 0 19 5.7 % -3 22 100.0 % 0 %

Ear, Nose & Throat 1 of 1 100.0 % 0 48 4.1 % -25 0 0.0 % 0 0 0.0 % 0 33 5.4 % -3 1 0.0 % 0 24 3.9 % 0 92 100.0 % 0 %

General Surgery 1 of 1 100.0 % 0 2 0.0 % 0 34 3.8 % 0 0 0.0 % 0 15 1.7 % 0 1 0.0 % 0 16 1.8 % 0 66 100.0 % 0 %

Gynaecology 1 of 1 100.0 % 0 72 8.4 % -55 2 0.0 % 0 0 0.0 % 0 5 0.0 % 0 0 0.0 % 0 3 0.0 % 0 21 100.0 % 0 %

Neurosurgery 1 of 1 100.0 % 0 0 X 0 X 0.0 % 0 X 0.0 % 0 X 0.0 % 0 X 0.0 % 0 0 0.0 % 0 X X X

Ophthalmology 1 of 1 100.0 % 0 6 0.0 % 0 2 0.0 % 0 0 0.0 % 0 2 0.0 % 0 3 0.0 % 0 0 0.0 % 0 60 100.0 % 0 %

Oral Maxillo 1 of 1 100.0 % 0 0 0.0 % 0 X 0.0 % 0 X 0.0 % 0 X 0.0 % 0 X 0.0 % 0 0 0.0 % 0 X X X

Orthopaedics 1 of 1 100.0 % 0 92 2.6 % -22 3 0.0 % 0 0 0.0 % 0 17 3.0 % 0 1 0.0 % 0 14 2.5 % 0 51 100.0 % 0 %

Paediatric Surgery 1 of 1 100.0 % 0 3 0.0 % 0 10 13.9 % 0 0 0.0 % 0 5 0.0 % 0 0 0.0 % 0 5 0.0 % 0 10 100.0 % 0 %

Plastics 1 of 1 100.0 % 0 0 0.0 % 0 2 0.0 % 0 0 0.0 % 0 0 0.0 % 0 0 0.0 % 0 0 0.0 % 0 6 100.0 % 0 %

Urology 1 of 1 100.0 % 0 0 0.0 % 0 5 0.0 % 0 0 0.0 % 0 0 0.0 % 0 0 0.0 % 0 0 0.0 % 0 42 100.0 % 0 %

Total 223 59 0 96 7 81 370

This report displays ESPI results for individual surgical services. The ESPI results do not include non-elective patients or elective patients awaiting planned and staged procedures. ESPIs 3, 7 and 8 assess surgical specialties where patients areprioritised using nationally recognised tools - including General Surgery from 01 January 08 and Vascular and Urology from 01 July 08. So, Medical specialties are currently excluded from the ESPI results. Please contact the Ministry of Health's ElectivesTeam if you have any queries on the ESPI definitions (details on electives website). NZHIS's Analytical Services Team can assist with providing variations of this information e.g data for a particular DHB or period (details on the NZHIS website -http://www.nzhis.govt.nz/ ).

DHB Name: Southland

http://www.nzhis.govt.nz/

MoH Elective Services OnlineSummary of Patient Flow Indicator (ESPI) results for each DHB

This report displays overall ESPI results for a DHB over a 12 month period. The ESPI results do not include non-electives or elective patients awaiting planned / staged procedures. ESPIs 3, 7 and 8 assess surgical specialtieswhere patients are prioritised using nationally recognised tools - including General Surgery from 01 January 08 and Vascular and Urology from 01 July 08. So, Medical specialties are currently excluded from the ESPI results.Please contact the Ministry of Health's Electives Team if you have any queries on the ESPI definitions (details on electives website). NZHIS's Analytical Services Team can assist with providing variations of this information e.g datafor a particular DHB or period (details on the NZHIS website - http://www.nzhis.govt.nz/ ).

Page 1 of 1Data Warehouse Refresh Date:

Report Run Date:

16/Jan/2010

20/Jan/2010

1.DHB services thatappropriately

acknowledge andprocess all patientreferrals within ten

working days.

2.Patients waitinglonger than six

months for their firstspecialist

assessment (FSA).

3.Patients waitingwithout a

commitment totreatment whose

priorities are higherthan the actual

treatment threshold(aTT).

4.Clarity of treatmentstatus.

5.Patients given acommitment to

treatment but nottreated within six

months.

6.Patients in activereview who have not

received a clinicalassessment withinthe last six months.

7.Patients who havenot been managedaccording to their

assigned status andwho should have

received treatment.

8.The proportion ofpatients treated who

were prioritisedusing nationally

recognisedprocesses or tools.

20081201

Level

26 of26

246

72

0

62

7

55

282

2008

Dec

Status %

100.0%

1.9%

2.0%

0.0%

1.7%

0.0%

1.5%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090101

Level

26 of26

254

43

0

66

7

58

294

2009

Jan

Status %

100.0%

1.9%

1.2%

0.0%

1.8%

0.0%

1.6%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090201

Level

26 of26

256

111

0

75

7

67

309

2009

Feb

Status %

100.0%

2.0%

2.9%

0.0%

2.0%

0.0%

1.8%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090301

Level

26 of26

251

80

0

81

9

70

378

2009

Mar

Status %

100.0%

1.9%

2.1%

0.0%

2.1%

0.0%

1.8%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090401

Level

26 of26

211

84

0

86

10

75

330

2009

Apr

Status %

100.0%

1.6%

2.2%

0.0%

2.2%

4.7%

1.9%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090501

Level

26 of26

180

64

0

99

9

80

379

2009

May

Status %

100.0%

1.3%

1.6%

0.0%

2.5%

0.0%

2.0%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090601

Level

26 of26

146

38

0

99

5

74

290

2009

Jun

Status %

100.0%

1.1%

0.9%

0.0%

2.5%

0.0%

1.8%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090701

Level

26 of26

149

83

0

84

5

70

378

2009

Jul

Status %

100.0%

1.1%

2.0%

0.0%

2.1%

0.0%

1.7%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090801

Level

26 of26

140

103

0

78

4

64

333

2009

Aug

Status %

100.0%

1.0%

2.5%

0.0%

1.9%

0.0%

1.6%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090901

Level

26 of26

138

101

0

98

2

75

314

2009

Sep

Status %

100.0%

1.0%

2.5%

0.0%

2.4%

0.0%

1.8%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20091001

Level

26 of26

179

58

0

116

7

88

347

2009

Oct

Status %

100.0%

1.3%

1.4%

0.0%

2.9%

0.0%

2.2%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20091101

Level

26 of26

280

59

0

96

7

81

370

2009

Nov

Status %

100.0%

2.0%

1.5%

0.0%

2.4%

0.0%

2.0%

100.0%

Imp.Req.

0

-2

0

0

0

0

0

0.0%

Target

> 90%

< 2%

< 5%

< 5%

< 5%

< 15%

< 5%

> 90%

DHB Name: Southland

http://www.nzhis.govt.nz/

Number of patients Given Certainty and their Wait time for treatment (Includes Booked patients) at December 2009 (Excludes patients with a staged or planned status) The numbers in Red indicate the number of booked patients

39

93

8 12

7 40 1

2 0 11

232

128150

73 74

41 45

19 155 1 8

27

0

50

100

150

200

250

300

350

0 1 2 3 4 5 6 7 8 9 10 11 >=12

Months Waiting

No

of

pat

ien

ts

Dental Endoscopy ENT General Surgery Gynaeco logy Ophthalmo logy Oral M axillo Facial Orthopaedics Paediatric Surgery Plastics Urology Total Booked

December 2008 through December 2009

Executive Dashboard

Southland District Health Board

0

100

200

300

400

500

600

Case VolumeCase Volume Case Volume PY

02468

1012141618

Turnover Minutes

Turnaround Minutes per Case, PO to PI KPI

0%10%20%30%40%50%60%70%80%90%

100%

Session UtilisationSession Utilisation % with Turnaround

02468

10121416

Average Number of Delay Minutes, Patient in the Room (First Case)

21 20 20 21 2220 20

2325

22 2023

21

0

5

10

15

20

25

30

Case Length Variance

0%10%20%30%40%50%60%70%80%

First Case On-Time Start

% On Time (5 min grace), PI KPI

KPI = 12 mins

KPI = 15 mins

KPI = 80%

KPI = 62%

Case Length Variance (Elective Only)

Turnover Minutes per Case (Patient out to Patient In)

% On-Time Start, PI (5 min grace)

Session Utilisation

KPI TrackerGoal Progress Toward Goal

SDHB HAC Meeting – 10 February 2010 Women and Children Division Update

WOMEN AND CHILDREN DIVISION UPDATE

HAC Meeting Date: 10 February 2010 Report Prepared By: Lynley Irvine, Women and Children’s Division Dr Ian Shaw, Divisional Director Jenny Humphries, Director of Nursing and

Midwifery Date Prepared: 19 January 2010

Recommendation


1. Service Summary Commercial Services

• the regionalisation of food services continues with the planned recruitment of a hospitality manager for the Southland site to commence February 2010

• staff accommodation is likely to be fully occupied from end February 2010, including

the doctors residence due to an expected increase in student numbers from Otago university and appointment of new staff

• vehicle fleet optimisation review work is underway and is part of a national initiative

that Southland District Health Board (DHB) has subscribed to

Well Child Services • following a request for proposal (RFP) process with funding and planning, the well

child service has been awarded the contract for school based health services in Southland

• significant progress has been made on data recording of before school checks

(B4SC) results on to the ministry of health (MoH) website and the service is on target to meet the identified volume

Contract target 854 High needs target 304

quarter 1 -

07/09 –10/09 quarter 2 10/09 – 12/09

quarter 1 and 2 07/09 – 12/09

Closed/Complete 33 (4%) 510 (59%) 544 (63%) High Needs 9 (3%) 111 (37%) 120 (40%) Obstetrics and Gynaecology Services

• candidates for permanent consultant posts are still being sourced, recruitment continues with several candidates hoped to commence early in 2010 for contracts of between 3 – 12 months which will ensure some stability in the workforce

• planning is in the final stage of the gynaecology department at Southland hospital

being able to only accept urgent referrals until further notice. Patients currently waiting with routine priorities and some semi urgent cases, as prioritised by the clinical director, may be returned to referrer. Three main factors are impacting on the number of referrals that the gynaecology department at Southland hospital are currently able to accept. These factors are:


- the previous 6 months of fluctuating consultant gynaecology resource levels - the large number of people on the first specialist assessment (FSA) waiting

list - the requirement that patients should wait no longer than six months for a FSA

• a targeted waiting list management system is being implemented to enhance the

efficiency of the gynaecology clinics to ensure that any reduction of service is for a minimal time

• interviews for the vacated role of clinical midwife leader have been undertaken with

expression of interests from both New Zealand and Australia Paediatrics

• a new doctor has commenced in post as an advanced trainee in paediatrics in December 2009. This has already resulted in an improvement in the year to date volumes of paediatric for new and follow up patients

Oral Health Services

• the first oral health mobile unit has arrived and will commence service in early February 2010. Acceptance testing of the mobile, staff training and two days of clinical work has been undertaken along with visits to several schools regarding the location of concrete pads and services for the mobiles


• the children’s ward medication chart audit has resumed now that hospital accreditation survey is complete. A total of 50 medication charts will be retrospectively audited for compliance with drug administration standards (patient identification, documentation of patient’s weight, prescribed drug administration times, and legibility). The audit was initiated due to the recent number of reportable event forms relating to medication errors

• paediatric early warning score (PEWS) cards have been laminated and delivered to

children’s ward for distribution to all medical staff in the children’s ward as well as the emergency department as a quick reference tool to complete the implementation of this process

3. Service Highlights

• very positive feedback has been received from the education review office for the early childhood facility written report. Particular comment was made of the respectful interactions the teacher had with children and the way support is given for them to cope with the procedures they are dealing with in relation to their health needs. The only area of improvement suggested was to undertake evaluation and self-review of how well the teaching programme improves the outcomes for children

• baby friendly hospital status has been achieved for the second time with very positive

comments made verbally regarding the findings and a written report is to follow. Huge commitment was shown from the baby friendly hospital initiative (BFHI) coordinator and the manner in which the assessment is undertaken requires a high standard of knowledge and commitment from all staff involved caring for mother and baby’s, including theatre staff


4. Contract Performance HAC Group Actual

YTD Volume

Budgeted YTD

Volume

YTD Volume Variance


Mitigation Comments

Inpatients

Dental Elective 81.37 92.38 (11.02) (11.92%) Position has improved since last month YTD volume variance still remains static

Plastics Elective 17.47 11.55 5.92 51.28% Very low volume of variance influenced by the Acute workload

Gynaecology Acute 104.85 85.04 19.81 23.30% Demand driven

Gynaecology Elective 111.83 203.68 (91.85) (45.09%) Affected by Staff shortage

Staffing levels Jan 2010 on should

improve variance

Paediatric Surgical Acute - 2.63 (2.63) (100.00%) Small volume of Acute

work usually IDF

Paediatric Surgical Elective

21.32 24.64 (3.32) (13.46%) No elective surgery undertaken in previous month due to anaesthetic availability

Paediatric Medicine Acute 425.06 312.21 112.84 36.14% Demand Driven

Paediatric Medicine Elective

4.03 4.98 (0.95) (19.15%) Very small volumes effectively demand driven for planned ongoing care


HAC Group Actual YTD

Volume

Budgeted YTD

Volume

YTD Volume Variance

% of YTD Budget

Reached

Mitigation Comments

Outpatients

General Dental Outpatient

1374.00 1176.24 197.76 16.81% Medically compromised patients are prioritised over Emergency Dental Outpatients

PVS 2010/11 has revised volumes

Emergency Dental Outpatient

772.00 900.00 (128.00) (14.22%) Medically compromised patients are prioritised over Emergency Dental Outpatients

PVS 2010/11 has revised volumes

Paediatric Medical Outpatient – follow up (FU)

1324.00 1166.88 157.12 13.46% Increased acute workload influenced the follow up required

Gynaecology - New 294.00 365.56 (71.56) (19.58%) Affected by Staff shortage

Staffing levels Jan 2010 have enabled a planned improvement on variance

Gynaecology - FU 387.00 548.60 (161.60) (29.46%) Affected by Staff shortage

Staffing levels Jan 2010 have enabled a planned improvement on variance

Paediatric Surgery Outpatient - New

79.00 67.60 11.40 16.86% Extra outpatient clinics in lieu of surgery greatly improved YTD position

Paediatric Surgery Outpatient - FU

123.00 88.40 34.60 39.14% Extra outpatient clinics in lieu of surgery greatly improved YTD

position

Plastics (including Burns and Maxillofacial) - New [Dental]

206.00 138.32 67.68 48.93% Reflects the changes to mapping procedures. Volume realignment to be

considered.

Plastics (including Burns

and Maxillofacial - FU [Dental]

208.00 132.60 75.40 56.86% Reflects the changes

to mapping procedures. Volume realignment to be considered.


5. Financial Performance

AnnualActual Budget Variance Actual Budget Actual Budget Variance Budget$' 000 $' 000 $' 000 FTE FTE $' 000 $' 000 $' 000 $' 000

100 142 (43) Revenue 593 855 (262) 1,709(1,118) (1,273) 155 164.28 173.61 Less Personnel Costs (6,425) (6,904) 479 (13,647)

(123) (122) (1) Less Outsourced Costs (837) (729) (108) (1,458)(208) (213) 5 Less Clinical Supplies (1,264) (1,267) 3 (2,514)(214) (235) 21 Less Infrastructure & Other Costs (1,335) (1,418) 84 (2,803)

(1,563) (1,700) 137 Direct Net Surplus / (Deficit) (9,268) (9,464) 196 (18,712)Add Divisional Share of Savings Target 31 66 (35) 245Result After Savings Target Adjustment (9,237) (9,398) 161 (18,467)

Month Year to Date



8.98 9.84 0.86 Medical Personnel 9.46 9.84 0.38 9.8499.82 99.45 (0.37) Nursing Personnel 99.52 99.45 (0.07) 99.4530.96 37.85 6.89 Allied Health Personnel 31.09 37.85 6.77 37.85

1.17 2.20 1.03 Support Personnel 1.79 2.20 0.41 2.2023.35 24.27 0.92 Management & admin Personnel 23.61 24.27 0.66 24.27

164.28 173.61 9.33 Total Personnel 165.47 173.61 8.15 173.61

Month Year to Date

The women and children’s division is reporting a year to date (YTD) favourable variance of $196k against budget, with a movement of $137k favourable in December 2009. Full time employees (FTEs) are 9.33 under budget for the month and 8.15 under plan YTD. Revenue is $43k unfavourable for December 2009; YTD is $262k unfavourable. The key variance is against the operational portion of the oral health business case. Expenditure is $180k favourable for December 2009; YTD is $458k favourable.

• personnel costs are $155k favourable for December 2009, YTD $479k favourable. The FTEs are 9.33 under budget for the month

• outsourced services are $1k unfavourable for December 2009, YTD $108k unfavourable. This variance relates to locum cover for senior medical staff

• infrastructure and non-clinical supplies are $21k favourable for December, YTD $84k favourable

• clinical supplies are $5k favourable for December 2009, YTD $3k favourable 6. Risks and Mitigation

Risk Mitigation A current shortage of obstetric and gynaecology consultants

Ongoing recruitment

Predicted vacancies in junior doctor staffing in obstetrics, gynaecology and paediatric services

Ongoing recruitment. However contingency planning will be implemented for O&G as there has been limited response to advertising and very few locums making themselves available

Not achieving FSA and elective surgery targets requirements in obstetrics, gynaecology

Operational plan to be put in place to limit access to the service for routine referrals Clinics restructured to maximise all available appointments Investigate the possibility of extra clinics to manage bag log of patients

SDHB HAC Meeting – 10 February 2010 Human Resources Report

HUMAN RESOURCES REPORT

HAC Meeting Date: 10 February 2010 Report Prepared By: Karyn Penno Regional GM Human Resources Date Prepared: 19 January 2010

Recommendation

That the Committee receives and notes this report. Recruitment Key work for recruitment during December 2009 included the following;

• Healthdownsouth audit now complete by Adcorp, recommendations under review for improvements

• Strategic discussions continue – micro-site for Senior Medical Officer (SMO’s) currently being scoped, networking strategies still under review include SMO specific newsletter / alumni, employee referral programme

• Permanent SMO recruitment handover to regional recruitment in Southland

Southland Otago

Allied 3 7

Support/Management/Corporate/Admin 3 7

Nursing 3 9

New vacancies actively being recruited for SMO 0 1

Total 9 24

Allied 10 3


Nursing 13 18

New vacancies from pre-December still actively being recruited

SMO 0 21

Total 24 45

Allied 2 5


Nursing 16 13

Vacancies filled in December

SMO 0 3

Total 21 29 Learning and Development The HR Management series pilot programme was completed in November 2009. The following modules were delivered:

• SDHB Accident Compensation Corporation (ACC) and case management Performance management Performance development review/appraisal practice

SDHB HAC Meeting – 10 February 2010 Human Resources Report

Now that the pilot programme has concluded, a full evaluation will be undertaken in order to assess the most appropriate way forward. SDHB Incubator Programme Key activity for November and December 2009 included:

• Aurora College staff programme update presentation

• Preparation of the 2009 Incubator pilot programme final programme report

• End of year programme administration

• Preparation and submission of community funding applications for 2010 programme funding, which were subsequently approved

• Planning for 2010 delivery year Employment Relations South Island Clerical Multi Employment Collective Agreement (MECA) Public Service Association (PSA) The parties met with assistance from the mediation service on 2 October 2009. Despite a minor amendment to the union’s position the claim remains unaffordable for the DHBs. A number of notices of industrial action for late November were received, with most of the notices subsequently withdrawn, though a 4-hour total withdrawal of labour on Friday 27 November 2009 went ahead. Southland DHB Clerical and Administrative Collective Employment Agreement (CEA) New Zealand Nurses Organisation (NZNO) Discussions for this document are scheduled to continue in the New Year. Medical Radiology Technologist (MRT) MECA APEX The parties were scheduled to meet on Thursday, 17 December 2009. This date was cancelled by mutual consent because no new information had come to hand that would encourage either party to amend its view. Contingency planning has commenced in the event notice of industrial action is received. No new dates for bargaining have been agreed between the parties. Southland Managers’ CEA APEX The parties met in October 2009 to commence negotiations. Further dates are to be set to continue discussions. Resident Medical Officers MECA New Zealand Resident Doctors Association (NZRDA) Initiation of bargaining has been received from the NZRDA for three separate collectives to cover the three Auckland area DHBs, and a multi-employer collective agreement to cover the remaining 18 DHBs. The current RMO MECA expired 31 December 2009.

November/December 2009

2009-2012 STRATEGIC GOALS:

1.0 Establish a recruitment infrastructure that enables and supports delivery of a strategic and proactive approach to recruitment, including improved efficiency, more effective selection outcomes and enhanced budget control

2.0 Cultivate and promote a positive, safe and healthy working environment

3.0 Develop an overarching regional framework for workforce development

4.0 Deliver human resources services that support managers in their management of workforce

PROGRESS

KEY PROJECTS / ACTIVITY AREAS

2009/2010

Scoping

Behind

On Track

Completed

COMMENT

1.0 RECRUITMENT

1.1 Implement regional centralised recruitment model

√ Model implemented. Ongoing education of hiring managers regarding process.

1.1.6 Recruitment metrics reported √ Metrics being collected represent baseline data to establish trends. Human Resources Information System (HRIS) reporting scoping ongoing.

1.1.8 Implement e-recruitment platform module of HRIS

√ Further discussions occurred following presentation of scope. Awaiting further feedback and clarification.

1.2 Establish targeted sourcing strategy √ Specific sourcing strategies for specialised areas being finalised.

2.0 SAFE AND HEALTHY WORKING ENVIRONMENT

2.1 Why staff work at OSDHBs: Drivers of Engagement

√ Linked with culture project.

2.1 Engagement Survey √ Linked with culture project.

2.1 Review Exit interview √ Workflow process being trialled in the Otago and Southland DHBs.

2.3 Policy, Procedure Alignment √ Draft joint Health and Safety policy released for consultation.

Joint mercury policy completed.

2.3 Hazardous Substances and New Organisms Compliance

√ New Zealand Chemistry Industry Council compliance audit report still awaited.

3.0 WORKFORCE DEVELOPMENT

3.1.1 Workforce Development Discussions √ No activity this month, currently on hold.

3.1.2 Workforce Committee √ No activity this month, currently on hold.

3.1.3 Community Engagement √

3.2.1 Incubator Pilot Programme √ Year one pilot programme delivery activity delivered.

3.2.2 Scholarship Programme Not yet commenced, currently on hold.

3.2.3 Workforce Information √ Scoping activity as part of HRIS Project.

3.4.1 Management and Leadership development

√ Deliverable timing under review, may roll over into 2010/11 plan.

3.4.2 Clinical Governance √

3.4.3 Regional Framework √ Deliverable timing under review, may roll over into 2010/11 plan.

4.0 HUMAN RESOURCES SERVICES

4.2 Complete Regional Policies √ Change management, harassment and leave management policies currently being worked on and scoped up for consultation.

Regional annual leave, leave without pay, lump sum payment and indemnity application forms have been agreed and implemented.

HUMAN RESOURCES INFORMATION SYSTEMS

Implement Employee Connect in SDHB √

Introduce Electronic Filing Not yet commenced.

Payroll system upgrade √ Initial conversations held with supplier.

Please note: the numbers in the left hand column correspond to the HR Strategic Plan

Human Resources Dashboard

SDHB HAC Meeting – 10 February 2010 Information Group Update

INFORMATION GROUP UPDATE

HAC Meeting Date: 10 February 2010 Report Prepared By: Grant Taylor, Regional Chief Information Officer (RCIO) Date Prepared: 18 January 2009

Recommendation

That the committee receives and notes this report.

Project Highlights

iPM Upgrade A significant upgrade of iPM to version 5002 was completed 10 November 2009. This upgrade changed workflows and had significant bug fixes. The process of upgrading the system went smoothly and was well managed by the Information Technology (IT) team in general. Documentation on how this was achieved, and build documents of the application servers was generated and will be of use for future upgrades to ensure we continue to implement change to this standard. It was noted post upgrade however that communication and testing could have been more thorough and this was documented also to make future improvements. IT Restructure A restructure of the IT team was completed in December 2009 to better align roles and functions and to better support regionalisation and national strategies. To date input from the organisation and IT team has been constructive and very positive towards what is trying to be achieved. Gore iPM/iSoft (on hold) A project plan has been developed to get Gore hospital onto the same patient management system as Southland. The project plan saw the system going live prior to January 2010 and the first phase is to establish connectivity. We have worked through costing this project but the work to implement is on hold now until questions on funding and the outcome from the Health Capacity Review (HCR) is known. Video Conferencing A need for improved clinical video conferencing for multi disciplinary team meetings as well as improved imaging systems for sharing this information while in these meetings is becoming increasingly necessary. The main driver for this is sharing skills across multiple sites (mainly Dunedin). A review of the requirements has been completed and we are waiting on pricing and how we can secure funding to achieve it. As an interim solution audio conferencing has been put in place. Two vendors have been shortlisted and presented in December 2009 the preferred approach on what they can deliver. Wireless Infrastructure Work is underway to scope and design the installation of wireless infrastructure in Southland Hospital. This will be an enabler to allow more mobile access and devices and implementation is scheduled in the first quarter of 2010.

December 2009

STRATEGIC GOALS:

An Information System (IS) informed organisation

IS alignment to the clinical needs of the organisation.

Efficiency gains through technology.

PROGRESS

PROJECT

Behind

On target

Complete

COMMENT

MOH Extract Compliance � All MOH extract compliance achieved for and 09/10.

iPM Upgrade � The upgrade to iPM version 5002 was successful.

E-texting � The trial of e-texting reminders for outpatient appointments is concluded.

Gore iPM/iSoft � This work is currently on hold and pending the funding and the outcome from the Health Capacity Review (HCR).

E-referrals � Southland is looking at how best to achieve this and is closely reviewing three options.

Regional Service Desk � There can not be a single regional help desk until both SDHB and ODHB are on the same network which is being worked on. Once complete a regional help desk will be set up and operated.

Video Conferencing � A project manager has been assigned and requirements for a vendor agnostic solution sought.

Public Records Act (PRA)

Compliance

� A working group has been formed and a stock take and roadmap are being drafted.

Licensing Review � Stock take complete and reviewing the options.

Server Virtualisation � A roll out plan for servers has been developed and the project has started. We are progressing well with this and will be replicating systems on completion of the Otago Data Centre.

Application Audit � All applications are being audited and assigned to analysts to manage. An audit document has been completed.

Network Audit � Auditing, changing and documenting the configuration of the DHB’s switching environment.

Wireless � Design and scoping underway. Scheduled for early 2010.

Thin Desktop � Decision on technology has been made and a roll out schedule planned.

Vocera � A proof of concept is being investigated for Emergency Department (ED) and surgery out of Otago but with SDHB input. Dependent on the wireless network going in.

Disaster Recovery and Business Continuity Planning

� Crash kit documentation completed.

RISKS:

• The PABX is old and the hardware intermittently has issues.

Information Group Dashboard November and December 2009

December 2009 Appendix 8

STRATEGIC GOALS:

Promotion of a “Quality Culture” within the organisation Maintenance of a Continuous Quality Improvement Programme Risk Management process implementation throughout all levels of the organisation

PROGRESS

PROJECT

Behind

On

target

Complete

COMMENT

Quality Improvement Programme

Accreditation Survey and Certification Audit

�

Organisation wide accreditation survey and certification audit completed 5-9 October 2009. Awaiting notification regarding the length of certification awarded.

Accreditation Programme – Evaluation and Quality Improvement Programme version 4 (EQuIP4)

�

As above, awaiting accreditation survey outcome.

Accreditation Quality Action Plan

� Formal accreditation report received, three years accreditation granted. Draft report outlines recommendations across all criterion.

Certification Corrective Action Plan (Hospital Services)

�

Certification report received, nine corrective actions identified. First reporting on corrective actions due 9 April 2010.

Clinical Practice Manual – Policy and Procedure updating

� There are currently 41 overdue policies and procedures in the clinical practice manual.

Patient Satisfaction Survey � Timely quarterly reporting to Ministry of Health occurring.

Organisation Quality and Risk Framework

� Progressing with the view to have a structure for quality and safety established by early 2010.

Projects

Sharepoint � The Public Records Act project is proposing a new version of Sharepoint for policies and

procedures. Therefore MIDAS will not be progressed until Sharepoint has been fully assessed for its capability and a decision is made.

National Quality Improvement Project – Incident Management

�

SDHB reporting of SAC 1 and SAC 2 events to National Central Repository as they occur.

National Quality Improvement Project’s –Hand Hygiene

� Planning for education roll out to commence February 2010.

Reportable Events

Review of Reportable Events Panel

� Monthly review of reportable events is occurring.

Compliments and Complaints

Complaints Review Committee

� Monthly review of complaints is occurring.

Resolved complaints for December

� Eleven complaints were received in December 2009.

Risk Management (RM)

Risk Management policy and procedure review

� The regional risk management policy has been released in Otago and Southland Regional (SDHB/ODHB) procedure consultation completed and changes being incorporated into document.

Organisational RM Programme

� The alignment of ODHB risk register for use in Southland testing is complete. Divisions are currently assessing service risk issues and entering these into the risk register.

Quality and Risk Dashboard 2009/10

Complaints to HDC involving District Health Boards

Report and Analysis for period 1 January–30 June 2009

Complaints to HDC involving DHBs 1 January–30 June 2009

2

National data for all DHBs/Southland DHB data

1

Introduction

This report provides aggregated DHB data and data specific to individual DHBs. The data reflects only the complaints to HDC involving a DHB — it excludes those complaints made directly to a DHB that are not received by HDC. The report includes: 1. Background on new categories of information. 2. Data on complaints received:

(a) Current period: — how many — whether investigated or not — service type — key words and primary issue.

(b) Comparison over time (trend data): — number of complaints over previous six-monthly periods — % complaints assigned for investigation over previous six-monthly periods.

3. Data on complaints closed: — how many — outcomes — how the matter was resolved. 4. Frequency data:

(a) Current period — number of complaints received per 100,000 discharges.

(b) Comparison over time (trend data): — rate of complaints over previous six-monthly periods.

(c) Ranking — by rate of all complaints — by rate of complaints investigated. 5. Case studies. Please note: Data in this report pertaining to previous six-monthly periods may vary slightly from that quoted in earlier reports. This is a result of improvements in the HDC data system, and updates to MOH discharge data for earlier time periods.

Complaints to HDC involving DHBs 1 January–30 June 2009

2

Background on new categories of information

Since the last report (1 July–31 December 2008), HDC has moved to a new data collection and reporting system. Previously, data about incoming complaints was reported in a way that described each complaint in terms of the Code Right most closely associated with it. The new system introduces two different descriptors for complaints: what they concerned and how they were resolved. Variables we can now report on include:

service type, eg, maternity, mental health

key words and primary issue

manner of resolution, ie, whether investigation or non-investigation. The change in data collection has an important implication for the analysis of complaint numbers over time. In earlier reports we presented data for complaints related to Right 4 (quality of care and treatment). Comparisons of numbers of complaints in this way is of limited use, since Right 4 is only one of a number of categories describing quality of care. The new categories will provide a more useful indication of quality of care. The assignment of a complaint for investigation will in itself generally indicate serious or complex issues related to quality of care. We will be interested in your feedback on the new data categories.


3

National Data for all District Health Boards

Complaints received

In this period, HDC received a total of 229 complaints about care provided by District Health Boards nationally. Manner of resolution As illustrated in the table below, 10 complaints were assigned for investigation and 214 were resolved using other options. Five complaints were outside HDC’s jurisdiction (OJ). These complaints concerned issues such as access to subsidies and funding, privacy and confidentiality, waiting lists and service availability.

Manner of resolution Number of complaints

Investigation 10

Non-investigation 214

Outside jurisdiction 5

Total 229

Service type Complaints to HDC are shown by service type in Table 1 below. Please note: In the new data system a number of new categories have been introduced to capture more detail about the types of complaints. Generic categories (such as medical services and geriatric services, listed below) have now been replaced. As this report comprises data from both the old and new data systems, these two categories are included in this report, but will not occur in the next report.

Table 1

Service subject to complaint Number of complaints

Investigation Other options for resolution

Areas of care:

General Practice 1 6

Home care 1

Public hospital care1 3 39

Rest home care 2

Specialist care2 1 9

Service type:

Accident and Emergency services 2 15

Counselling/therapy 2

Geriatric services 1

Inpatient mental health services 1 20

Laboratory services 1

Maternity services3 20

Medical services 7

Mental health services 28

Complaints to HDC involving DHBs 1 January –30 June 2009

4

Table 1


Investigation Other options for resolution

Methadone/drug & alcohol services 3

Midwifery services4 5

Multiple services5 4

Nursing services 7

Oncology services 2

Other disability services 1

Paediatric services 7

Plastic/reconstructive surgery 1

Radiology services 1 1

Rehabilitation services (after surgery) 1

Surgery — public sector 1 30

Vision care 1

Total 10 214

1. The public hospital care category relates to complaints about the overall level of care, where no providers are

specifically mentioned, or providers are mentioned in a general way. 2. Specialist care refers to a complaint where a specific senior clinician has been named. 3. General Maternity services denotes care provided by any attending staff. 4. Midwifery services refers to the care provided by a specific midwife or midwives. 5. The category ‘multiple’ refers to a complaint where several services are involved.

Patient concerns When making a complaint, patients and their families tend to use key words. The most frequently used key words in complaints to HDC in this period are listed in Table 2.

Table 2

Key word Occurrence in complaints

Attitude/manner 18%

Inadequate treatment 18%

Communication with family 16%

Delay in treatment 14%

Diagnosis 10%

Inadequate information 9%

(continued)


5

Primary issues For each complaint received by HDC that was not investigated, a primary issue was identified. The primary issues are listed in Table 3.

Table 3

Primary issue in non-investigated complaints

Number of complaints

Access and funding 8

Communication 34

Consent/information 12

Disability/other issues 1

Discharge and transfer arrangements 3

Fees and costs 3

Grievance/complaints process 2

Management of facilities 8

Medical records/reports 2

Medication 4

Privacy/confidentiality 1

Professional conduct 7

Treatment 129

Total 214

Manner of resolution of complaints — comparison over time Figure 1 shows the proportion of complaints assigned for formal investigation as a percentage of total complaints received by HDC, over current and previous six-monthly periods. As stated previously, the assignment of complaints for investigation generally indicates serious or complex issues related to quality of care.


6

Figure 1

Jan–Jun 06

Jul–Dec 06

Jan–Jun 07

Jul–Dec 07

Jan–Jun 08

Jul–Dec 08

Jan–Jun 09

Total complaints 209 199 299 216 256 233 229

For investigation 15 13 19 25 21 9 10

% for investigation 7.2 6.5 6.3 11.6 8.2 3.9 4.4

The number of complaints was highest in January–June 2007; however, in this period the percentage of complaints assigned for investigation was lower than in previous periods, indicating a lower incidence of serious and complex issues in complaints. In the period July–December 2007 investigations increased to 11.6% of complaints received, then declined through the following periods: January–June 2008 and July–December 2008 (8.2% and 3.9% respectively) before showing an increase to 4.4% in the current period. The reducing incidence of investigations is likely to reflect HDC processes during complaints assessment, including:

HDC’s commitment to resolve complaints at the lowest level appropriate, reserving investigation for more serious and complex matters;

preliminary advice obtained during complaint assessment indicating that formal investigation is not necessary (this may include evidence of adequate and appropriate DHB response);

identification of complaints that are likely to be resolved by referral to advocacy; and

DHBs’ ability to work with complainant(s) to resolve complaints referred back to them (with report to Commissioner).

Jan–Jun 06

Jul–Dec 06

Jan–Jun 07

Jul–Dec 07

Jan–Jun 08

Jul–Dec 08

Jan–Jun 09

% for investigation 7.2 6.5 6.3 11.6 8.2 3.9 4.4

0

2

4

6

8

10

12

14

% for investigation

All District Health Boards Complaints Received — manner of resolution

(% over time)


7

Complaints closed and outcomes

HDC closed 247 complaints involving DHBs in this period. The outcomes are shown in Table 4. This data is also presented in the graph on page 8 (Figure 2), where the number of complaints for each outcome type is shown as a percentage of all closed complaints. Please note that the percentages are approximated to whole numbers.

Table 4

Outcome Number of complaints

Investigation

Breach 18

No action — s 38(1)1 3

Referred to provider2 1

Resolved at mediation 1

Non-investigation

Referred to Advocacy 24

No action — s 38(1)1 115

Referred to District Inspector 4

Referred to Ministry of Health 5

Referred to Privacy Commissioner 1


Resolved at mediation 1

Resolved by Commissioner 1

Resolved by parties 6

Outside jurisdiction 6

Total 247

1. Complaints closed under this section of the Act may include those where matters do not meet the threshold for a

formal investigation, or where an appropriate outcome can be achieved without it, in a more flexible and timely way. Before a decision is made, information is gathered and carefully assessed, and preliminary expert clinical advice is sought when needed. An education letter may be sent to a provider, highlighting any issues and aspects of care needing review. An apology or other follow-up action is frequently requested. Section 38 is also used to close complaints when no further action is required because careful assessment indicates that there is no apparent breach of the Code, or because matters are already being addressed through other appropriate processes or agencies.

2. In line with their responsibilities under the Code, DHBs have increasingly developed good systems to address complaints in a timely and appropriate way. Where complaints come straight to HDC without being raised with the provider, it may be appropriate to refer them to the provider in the first instance.

In summary, Figure 2 illustrates that

for almost half of all the complaints closed, no action was taken;

one-quarter of complaints were referred back to the provider;

about 10% were referred to Advocacy;

9% were assigned for investigation; and

7% of all complaints resulted in a breach finding.


8

Figure 2

Frequency data

When numbers of complaints to HDC are expressed as a rate per 100,000 discharges, comparisons can be made between DHBs, and within DHBs over time, enabling any trends to be observed. Frequency calculations are made using discharge data provided by the Ministry of Health (provisional as at the date of extraction, 27 July 2009). Please note that the number of total discharges (390,138) excludes same-day discharges from Emergency Departments, and patients attending outpatient units and clinics. Rate of complaints received — current period Table 5 (opposite) shows the number and rate of complaints for (i) complaints formally assigned for investigation, and (ii) all complaints, per 100,000 publicly funded discharges nationally (aggregated data from all DHBs) for this time period. For this period, the rate of investigations by HDC was 3 per 100,000 discharges, and the rate of complaints to HDC was 59 per 100,000 discharges.

7%

1% 1% 1%

9%

46%

2% 2% 1%

24%

1% 1% 2% 2%

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%B

reac

h

No

fu

rth

er a

ctio

n —

s 3

8(1

)

Ref

err

ed t

o p

rovi

der

Re

solv

ed

at

me

dia

tio

n

Ref

err

ed t

o A

dvo

cacy

No

fu

rth

er a

ctio

n —

s 3

8(1

)

Ref

err

ed t

o D

istr

ict

Insp

ecto

r

Ref

erre

d to

Min

istr

y o

f H

ealt

h

Ref

err

ed t

o P

riva

cy C

om

mis

sio

ner

Ref

err

ed t

o p

rovi

der

Re

solv

ed

at

me

dia

tio

n

Res

olv

ed b

y C

om

mis

sio

ner

Res

olv

ed b

y p

arti

es

Ou

tsid

e ju

risd

icti

on

Investigation Non-Investigation

All District Health BoardsOutcome of Complaints (%)


9

Table 5

Manner of resolution


Rates per 100,000

discharges

Complaints for investigation

10 3

All complaints 229 59

Rate of complaints received — comparison over time The graph below (Figure 3) shows the rate of complaints received by HDC per 100,000 discharges, for current and previous six-monthly periods. For all DHBs, the average rate of complaints received was 59 per 100,000 discharges. The rate peaked in January–June 2007 with 76 complaints per 100,000 discharges, and in the following periods fluctuated between 53 and 65 complaints per 100,000 discharges. Figure 3

Ranking The tables on pages 10–11 show the total rate of complaints to HDC (Table 6), and those assigned for investigation (Table 7), per 100,000 discharges for each DHB (ranked, not named1) relative to other DHBs. Each DHB’s ranking on the tables can be identified from its individual report.

1 Individual DHBs have not been named in this report given the small sample size and the short period covered

(six months).

Jan–Jun 06

Jul–Dec 06

Jan–Jun 07

Jul–Dec 07

Jan–Jun 08

Jul–Dec 08

Jan–Jun 09

Rates per 100,000 discharges 55 49 76 53 65 55 59

0

10

20

30

40

50

60

70

80

All District Health BoardsComplaints Received — Rates over time


10

All DHBs were subject to some complaints to HDC — the rate of complaints ranged from 26 complaints per 100,000 discharges to 100 complaints per 100,000 discharges — a four-fold increase in frequency across DHBs. The rate for all DHBs taken together (aggregated data) was 59, and there was an even spread across the range (median 60).

Table 6: Table 6 (continued)

Rate of complaints to HDC per 100,000 discharges


DHB ranking All complaints DHB ranking All complaints

DHB 1 26 DHB 12

64

DHB 2 29 DHB 13

65

DHB 3

34 DHB 14

69

DHB 4

37 DHB 15

72

DHB 5

39 DHB 16

DHB 16

76

DHB 6

45 DHB 17

77

DHB 7

47 DHB 18

85

DHB 8

65

69

50 DHB 19

95

DHB 9

D76HB 9

51 DHB 20

99

DHB 10

55 DHB 21

100

DHB 11

60 All DHBs (aggregated data)

59


11

For investigated complaints (Table 7), the data aggregated from all DHBs showed a rate of 3 per 100,000 discharges, but a much wider range — from 0 to 24 complaints per 100,000 discharges. For 12 DHBs, HDC investigated no complaints. A small number of DHBs were subject to the higher frequencies of complaints.

Table 7


DHB ranking Complaints assigned for investigation

DHB 1–12 No complaints investigated

DHB 13

2

DHB 14

8

DHB 15 =

9

DHB 15 =

9

DHB 15 =

9

DHB 18

12

DHB 19

15

DHB 20

22

DHB 21

24

All DHBs (aggregated data) 3


12

Learning from complaints — HDC case reports

In the following cases, the complaint raised issues of concern, and action was taken to improve hospital systems and practices. The first three complaints were investigated — the full anonymised report can be found on the HDC website. The last case was resolved without investigation. Case 1: Quality and safety of funded services (07HDC11548) Each DHB has a responsibility to monitor the delivery of services that it funds within its district. This responsibility was highlighted in a case concerning shortcomings of the care provided by a rural hospital in a small town. The complaint concerned a 66-year-old man who suffered worsening shortness of breath, thought to be caused by fibrosing alveolitis or pulmonary fibrosis. When his condition deteriorated he was admitted to a rural hospital where, after a respiratory physician carried out a transbronchial biopsy, he was approved for weekend leave. However, because of breathlessness, he returned to the hospital at 4.15am the next morning. He was seen by the medical officer, diagnosed with a pneumothorax, and maintained on oxygen. An urgent X-ray was not obtained, and no consultation took place with either the clinician providing second on-call back-up cover (an emergency medicine specialist) or a public hospital specialist. An X-ray taken four hours later revealed a significant pneumothorax; draining tubes were inserted and, although the man’s pneumothorax improved, his condition continued to deteriorate. The following day he was airlifted to the public hospital in a main centre. Despite intensive care, he died of respiratory failure. In summary, an unstable patient was being cared for by a weekend on-call team, but there were no formal arrangements for cover from the respiratory physician, nor protocols for after-hours liaison with public hospital specialists. Although staff at the rural hospital were generally aware that they could consult the city hospital specialists, the process for doing so was not clearly outlined to staff. The decision to consult or transfer a patient is a matter of clinical judgement, and medical officers may not necessarily have the skills and/or experience to make such judgements. Adequate systems must be in place for consultation with, and referral to, a higher level of service when the severity or complexity of the condition is beyond the technical and clinical capacity of the local service. The investigation found that the health service company that owned and operated the rural hospital did not provide services with reasonable care and skill, and did not sufficiently facilitate cooperation between its staff and the public hospital specialists to ensure quality of care. In these circumstances, the company breached Rights 4(1) (quality of care) and 4(5) (coordination of care). Given the lack of appropriate arrangements for consulting with specialists, the medical officer was found to have taken reasonable actions to provide appropriate care to the man, and therefore did not breach the Code. Audits on behalf of the DHB did not pick up that there was no appropriate system at the rural hospital for consultation with specialist physicians, even though this was part of the service specification. The DHB agreed to review its audit tool to ensure that it covers the key service specification areas. HDC recommended that the rural hospital develop protocols relating to specialist consultation and referral.


13

Case 2: Support for house officers (08HDC04311) A 2½-year-old child presenting with a moderately severe exacerbation of asthma was assessed and treated at the Emergency Department. His condition stabilised and he was transferred to the paediatric ward. Overnight he experienced increasing respiratory distress and suffered a cardiorespiratory arrest at 4.30am. He was resuscitated and transferred to the Intensive Care Unit, where he suffered three further cardiorespiratory arrests. Later that morning, the boy was airlifted to Starship Hospital, where it was found that he had suffered severe brain damage. Life support was withdrawn, and he died the following day. The paediatric house officer attending the boy overnight did not recognise the severity of the boy’s condition and made an inappropriate decision to downgrade his medication from nebulisers to spacers. He delayed seeking assistance from the on-call paediatrician and, when he did so, omitted to relay key information about the boy’s medication. The house officer was found not to have exercised reasonable care and skill, in breach of Right 4(1) of the Code. Despite providing collegial support and a good orientation programme for junior paediatric doctors, the DHB had placed the house officer in a position where he was working beyond his depth. It was held vicariously liable for the house officer’s breach of the Code. This case highlights the importance of good systems to support junior doctors, especially in specialties (such as paediatrics) where junior medical staff may have limited experience. There should be a safety net of vigilant senior nurses and readily available consultants. The case also emphasises the importance of seeking early assistance, particularly where doctors providing care are inexperienced, and may not recognise the gravity of the situation or their own limitations. Case 3: Care provided by a community health service prior to a patient’s suicide (08HDC08140) A 23-year-old man who had recently ended a two-year relationship with his girlfriend aborted a suicide attempt at the last minute. He then received care from his general practitioner, who prescribed antidepressant medication and referred him to the community mental health team. A week later he was assessed by a CMHT nurse, but he was not referred for a psychiatrist assessment (so no formal diagnosis was made) and a copy of the CMHT report was not sent to the GP. Following an episode of self-harm 10 days later, he was admitted to hospital, where he was again assessed by a CMHT nurse, but the nurse did not complete documentation regarding diagnosis, suicide risk or care plan. The man was discharged home alone the next day and took his own life two days later. The investigation exposed inadequacies in the communication between the CMHT and the GP, and the difficulties for rural DHBs in providing psychiatric review within reasonable time frames. However, the critical inadequacies were in the process of risk assessment and management by the CMHT nurse at the hospital; the failure to objectively assess the man’s level of risk led to a lack of appropriate community supports being sought. The DHB did not provide mental health services with reasonable care and skill, or in a manner consistent with his needs (breaching Rights 4(1) and 4(3)), and failed to ensure cooperation amongst providers (breaching Right 4(5)).

In response to recommendations from its sentinel event review, the DHB made changes to (i) facilitate specialist medical assessments, including urgent assessments following a suicide attempt; (ii) make comprehensive use of electronic patient management systems; (iii) recruit a full-time psychiatric doctor; and (iv) introduce documentation to support referrals (acknowledgement and outcome), assessment and treatment planning, and provide comprehensive and explicit risk assessment and management. HDC asked the DHB to advise it of the results of audits of the use of Risk Assessment documentation, and the new procedures for managing referrals.


14

Case 4: Communication with family during withdrawal of life support (09HDC00849) Following a non-survivable brain bleed, a man was placed on life support in an Emergency Department awaiting the arrival of his family from distant locations. On their arrival, a consultant told the family that life support would be disconnected, and began this procedure in their presence. There were difficulties with the extubation, which distressed the family. The man’s mother wrote to HDC, describing her harrowing experience, and complaining that the consultant was insensitive and showed a lack of respect for her son. The DHB provided a prompt and open response, explaining and commenting on the events, and apologising unreservedly for the lapse by the doctor involved. The DHB noted the need for ongoing staff training in the way traumatic situations are handled, and requested permission to use the comments and experiences recorded in the complaint letter (in an anonymous form) to train clinicians in the future. The complaint raised several important issues: (i) Patients for extubation are generally more appropriately managed in ICU. Removing an ET tube

once ventilatory support is discontinued occurs more often in ICU, and staff have much more experience in withdrawal of life support, and communicating with families. While ED doctors and nurses are generally well trained in handling dying patients and their relatives, extubation is a relatively unfamiliar task for them. In this case the man was kept in ED on life support for some time because his family were travelling by plane to reach the hospital, and there were no beds available in ICU. An alternative option may have been to call ICU staff for assistance.

(ii) The man’s family was not advised what to expect from the extubation procedure. It should be standard practice to warn families what may happen and offer them the option of leaving the room during withdrawal of life support.

In considering the need for policies to prevent a situation like this in the future, DHB clinicians recognised and distinguished between a situation where a patient is expected to wake up and be discharged from ED (or admitted to another ward), and where a tube is to be removed to allow an inevitable death. Although ideally ICU is the appropriate facility, in some circumstances life support withdrawal does need to be managed in ED. DHBs therefore need to ensure appropriate education for ED medical and nursing staff in managing these situations with competence and sensitivity.


15

Data for Southland District Health Board

Complaints received

In this period, HDC received eight complaints about care provided by Southland District Health Board. Manner of resolution One of these complaints was assigned for investigation; this involved the Accident and Emergency service. The remaining seven complaints were handled using other resolution options. Service type Complaints to HDC are shown by service type in Table 1 below.

Table 1


Areas of care:

Specialist care1 1

Physician care 1

Service type:

Inpatient mental health services 1

Maternity services2 1

Mental health services 2

Rehabilitation services 1

Total 7

1. Specialist care refers to complaints where a specific senior clinician has been named. 2. Maternity services denotes general care provided by attending staff.

Patient concerns When making a complaint, patients and their families tend to use key words. The most frequently occurring key words for these complaints to HDC are shown in Table 2.

Table 2

Key words Number of complaints

Attitude/manner 2

Delay in treatment 2

Service availability 2


16

Primary issues A primary issue was identified for each complaint received by HDC. The issues are shown in Table 3.

Table 3

Primary issue in non-investigated complaints


Communication 2

Consent/information 1

Treatment 4

Total 7

Manner of resolution of complaints — comparison over time The graph below (Figure 1) shows the proportion of complaints assigned for formal investigation as a percentage of total complaints received by HDC, over current and previous six-monthly periods. As stated previously, the assignment of complaints for investigation generally indicates serious or complex issues related to quality of care. Figure 1

Jan–Jun 06 Jul–Dec 06 Jan–Jun 07 Jul–Dec 07 Jan–Jun 08 Jul–Dec 08 Jan–Jun 09

For investigation 0 3 0 2 2 0 1

Total complaints 10 6 5 8 10 7 8

% for investigation 0 50 0 25 20 0 12.5

Jan–Jun 06

Jul–Dec 06

Jan–Jun 07

Jul–Dec 07

Jan–Jun 08

Jul–Dec 08

Jan–Jun 09

% for investigation 0 50 0 25 20 0 12.5

0

10

20

30

40

50

60

% for investigation

Southland District Health Board Complaints Received — manner of resolution

(% over time)


17

Complaints were assigned for investigation in four of the seven periods reported.

In the period July–December 2006, three complaints were assigned for investigation; this comprised 50% of the six complaints received. Where a small number of complaints was received, any assigned for investigation comprised a large percentage.

Complaints closed and outcomes

HDC closed nine complaints related to Southland DHB in this period. The outcomes of these complaints are shown in Table 4.

Table 4

Outcome Number of complaints

Investigation

Breach 1


Non-investigation

No action — s 38(1)2 2

Referred to Advocacy 2

Referred to Ministry of Health 2


Total 9

1. In line with their responsibilities under the Code, DHBs have increasingly developed good systems to address

complaints in a timely and appropriate way. Where complaints come straight to HDC without being raised with the provider it may be appropriate to refer them to the provider in the first instance.

2. Complaints closed under this section of the Act may include those where matters do not meet the threshold for a formal investigation, or where an appropriate outcome can be achieved without it, in a more flexible and timely way. Before a decision is made, information is gathered and carefully assessed, and preliminary expert clinical advice is sought when needed. An education letter may be sent to a provider, highlighting any issues and aspects of care needing review. An apology or other follow-up action is frequently requested. Section 38 is also used to close complaints when no further action is required because careful assessment indicates that there is no apparent breach of the Code, or because matters are already being addressed through other appropriate processes or agencies.

This data is also presented in Figure 2 (overleaf), where the number of complaints for each outcome type is shown as a percentage of all closed complaints. Please note that the percentages are approximated to whole numbers. The graph shows that no action was taken on more than one-fifth of complaints.


18

Figure 2

The breach report (07HDC14286) concerned communication between DHBs in relation to the mental health care of an itinerant patient. Southland DHB failed to conduct an adequate assessment of the man, breaching Right 4(1) of the Code, and failed to ensure coordination of care within and between DHBs, resulting in a breach of Right 4(5). Frequency data

Rate of complaints received — current period The table below shows the rate of complaints to HDC per total discharges from Southland DHB (8,109) compared to the rate of complaints per total discharges nationally (390,138), for (i) complaints assigned for investigation, and (ii) all complaints. Please note: the number of total discharges excludes same-day discharges from Emergency Departments, and patients attending outpatient units and clinics.

Table 5

Manner of resolution

Southland DHB National Rate (All DHBs)


Rate per 100,000

discharges

Rate per 100,000

discharges

Complaints for investigation

1 12 3

All complaints 8 99 59

11% 11%

22% 22%

11%

22%

0%

5%

10%

15%

20%

25%

Breach Referred to Provider

Referred to Advocacy

Referred to Ministry of

Health

Referred to Provider

No action —s 38(1)

Investigation Non-investigation

Southland District Health Board (%) Outcomes of Complaints


19

The rate of complaints about Southland DHB was greater than the rate of complaints received nationally (aggregated data from all DHBs), and the rate for investigation was also greater. Please note that Southland DHB is identified on the overall DHB ranking list (pages 10–11) as DHB 20 for All complaints, and DHB 18 for Complaints assigned for investigation. Rate of complaints received — comparison over time The graph below (Figure 3) shows the rate of complaints received by HDC per 100,000 discharges, for current and previous six-monthly periods. For Southland DHB, the rate

fluctuated from 63 to 126 complaints per 100,000 discharges, and

showed less variation in the last three time periods.

Increases in the rate of complaints may reflect a variety of factors, including consumer concern with health care provided, better understanding of health complaints processes, and increased willingness to make complaints.

Figure 3

Jan–Jun 06

Jul–Dec 06

Jan–Jun 07

Jul–Dec 07

Jan–Jun 08

Jul–Dec 08

Jan–Jun 09

Rates per 100,000 discharges 125 78 63 100 126 80 99

0

20

40

60

80

100

120

140

Southland District Health BoardComplaints Received — rates over time

SDHB HAC Meeting – 10 February 2010 Chief Operating Officer’s Report

CHIEF OPERATING OFFICER’S REPORT

HAC Meeting Date: 10 February 2010 Report Prepared By: Lexie O’Shea, Chief Operating Officer Date Prepared: 19 January 2010

Recommendation


1. Overall Contract Performance

Total case weight delivery is above budget plan for year to date (YTD) December 2009. Acute volume is 14% (705 case weighted discharges (CWD)) above plan and elective volume is 1% (17 CWD) below plan YTD October 2009. The key areas of higher inpatient acute demand are general medicine, general surgery, orthopaedics and paediatric medicine. There have been over 1000 (14%) more patients treated in the first six months of this financial year than the previous equivalent six months last financial year. The majority of these are acute patients. The emergency department in Lakes District Hospital (LDH) tracks higher than planned with 888 attendances above budget YTD. Southland Hospital attendances are on plan. Outpatient attendances overall are on track with over delivery in follow up appointments YTD balanced against under delivery in some first specialist assessment areas. The key outliers are further explained within the divisional reports. The Provider Arm DAP Project Dashboard 2009/10. Is attached as appendix 1.

2. Medical Division Update

Attached as appendix 2 is the full report prepared by the leadership team – Medical Division.

3. Mental Health Division Update

Attached as appendix 3 is the full report prepared by the leadership team - Mental Health Division.

4. Surgical Division Update

Attached as appendix 4 is the full report prepared by the leadership team - Surgical Division.

5. Women and Children Update

Attached as appendix 5 is the full report prepared by the leadership team - Women and Children Division.

6. Human Resources (HR) Update

Attached as appendix 6 is the full report prepared by Ms Karyn Penno, Regional, General Manager - HR.

7. Information Systems (IS) Update

Attached as appendix 7 is the full report prepared by Mr Grant Taylor, Regional Chief Information Officer.


8. Quality Improvement Programme Report

The quality dashboard 2009/10 is attached as appendix 8.

9. Medical Officers Unit Report

This report is included in the Public Excluded Business for the reasons outlined in the agenda.

10. Procurement Report


11. Risk Report


12. Value for Money Dashboard



13. Volumes – December 2009

Description Monthly

Volume

Budgeted

Volume

Monthly

Volume

Variance

Actual YTD

Volume

Budgeted YTD

Volume

YTD Volume

Variance

DAP Annual

Volume

2009/10

2008/09

Actual

Volume

Dental Acute 1.13 1.56 (0.43) 7.71 9.35 (1.64) 18.70 30.57

Dental Elective 19.76 12.44 7.32 81.37 92.38 (11.02) 177.66 165.78

Plastics Acute 5.73 2.41 3.32 15.70 14.48 1.22 28.95 43.84

Plastics Elective 3.39 1.55 1.83 17.47 11.55 5.92 22.21 26.25

ENT Acute 2.76 2.51 0.24 8.11 15.08 (6.97) 30.16 23.54

ENT Elective 33.75 23.40 10.35 204.24 173.80 30.44 334.24 329.45

Ophthalmology Acute 2.37 3.23 (0.86) 10.94 19.39 (8.45) 38.78 12.29

Ophthalmology Elective 30.14 22.70 7.44 229.02 168.59 60.43 324.21 375.40

General Surgery Acute 186.76 118.87 67.89 962.18 713.23 248.95 1426.46 1464.51

General Surgery Elective 115.49 73.58 41.92 610.18 546.56 63.62 1051.08 1078.30

Gynaecology Acute 18.55 14.17 4.38 104.85 85.04 19.81 170.07 158.70

Gynaecology Elective 15.07 27.42 (12.35) 111.83 203.68 (91.85) 391.69 342.03

Orthopaedics Acute 154.48 150.70 3.78 1001.87 904.22 97.65 1808.44 1733.30

Orthopaedics Elective 49.12 96.81 (47.69) 519.36 544.57 (25.20) 1210.15 1015.98

Paediatric Surgical Acute - 0.44 (0.44) - 2.63 (2.63) 5.26 -

Paediatric Surgical Elective 4.49 3.32 1.18 21.32 24.64 (3.32) 47.38 48.91

Urology Acute 4.15 9.07 (4.92) 63.23 54.39 8.84 108.79 142.52

Urology Elective 26.33 24.44 1.89 150.06 181.53 (31.47) 349.10 341.10

General Medicine Acute 338.68 310.67 28.01 2048.28 1864.00 184.28 3728.00 3673.50

General Medicine Elective 6.36 4.65 1.71 44.40 34.52 9.88 66.38 84.88

Paediatric Medicine Acute 61.48 52.04 9.45 425.06 312.21 112.84 624.43 709.64

Paediatric Medicine Elective - 0.67 (0.67) 4.03 4.98 (0.95) 9.58 8.43

Specialist Neonates Acute 44.96 45.85 (0.89) 259.98 275.09 (15.11) 550.19 580.29

Maternity Acute 118.58 101.72 16.86 676.49 610.29 66.20 1220.58 1170.34

Maternity Elective 1.18 3.71 (2.53) 4.34 27.60 (23.25) 53.07 46.50

Acute Costweights 939.63 813.23 126.39 5584.40 4879.40 705.00 9758.81 9743.04

Elective Costweights 305.08 294.67 10.41 1997.63 2014.40 (16.77) 4036.75 3863.01

Total Costweights 1244.71 1107.91 136.80 7582.03 6893.80 688.23 13795.56 13606.05

Pregnancy and Childbirth 381.92 339.66 42.26 3273.79 2037.98 1235.81 4069.58 5151.56

Emergency Department

Attendances

3098.00 3023.33 74.67 18989.00 18140.00 849.00 36280.00 37420.00

Outpatients - Allied Health 769.00 863.33 (94.33) 5325.00 5180.00 145.00 10360.00 9058.00

Rural Inpatients 111.00 217.00 (106.00) 1018.00 1288.00 (270.00) 2555.00 1939.00

Mental Health (Capacity) 784.27 788.42 (4.16) 4731.40 4726.05 5.35 8554.55 8571.33

Mental Health (PVC) 35.57 42.87 (7.30) 213.70 257.20 (43.50) 44.70 33.27

HOP Lines (DHB Funded) 1637.00 1399.07 237.93 8896.00 8353.60 542.40 16645.98 16535.00

DSS Lines (MoH Funded) 142.00 487.83 (345.83) 1270.00 2923.75 (1653.75) 5842.54 2794.00

Outpatients - Medical and Surgical 4396.29 4756.47 (360.18) 30695.75 32365.38 (1669.63) 63654.18 56736.00

Public Health 38.00 47.83 (9.83) 255.00 287.00 (32.00) 574.00 527.00

COMPARISON SUMMARY OF ACTUAL VOLUMES AGAINST BUDGET

December 2009

Costweighted Contract Lines


14. Patient and Quality Key Performance Indicators – December 2009

PATIENT AND QUALITY KEY PERFORMANCE INDICATORS Emergency Department Triage Times – Categories 1, 2 & 3 DEFINITION: Triage Level 1: The percentage of patients attending the Emergency Department triaged to

Category 1 who are attended to immediately. Triage Level 2: The percentage of patients attending the Emergency Department triaged to

Category 2 who are attended to within 10 minutes. Triage Level 3: The percentage of patients attending the Emergency Department triaged to

Category 3 who are attended to within 30 minutes.

Emergency Department Triage Level 1 2008/09 v 2009/10

0%

20%

40%

60%

80%

100%

% Emergency Triage Rate 1 09/10 100% 100% 100% 100% 100% 100% 0% 0% 0% 0% 0% 0% 100% 100%


District Annual Plan 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%

Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay JunYTD Dec

YTD


0%

20%

40%

60%

80%

100%





YTD


0%

20%

40%

60%

80%

100%





YTD


Acute Readmissions (Rate per 1,000) DEFINITION: A measure of the rate at which discharged patients are admitted unexpectedly to a hospital within seven days of a previous discharge. Numerator: The number of acute admissions that occur within seven calendar days of a

previous discharge Divided By Denominator: Total Inpatient Discharges

Acute Readmission Rate 2008/09 vs 2009/10

-

5.00

10.00

15.00

20.00

25.00

30.00

Acute Readmission Rate 09/10 20.45 19.08 22.46 17.10 24.35 23.81 - - - - - - 21.22 21.22

Acute Readmission Rate 08/09 24.02 22.09 26.10 12.48 22.97 19.80 23.64 28.22 17.58 23.27 13.76 24.91 21.49 21.33

Target 25.00 25.00 25.00 25.00 25.00 25.00 25.00 25.00 25.00 25.00 25.00 25.00 25.00 25.00

Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay Jun Total YTD

Complaints Resolved Within 30 Days DEFINITION: The number of formal written and verbal complaints resolved, within 30 days of receipt, during the month, expressed as a percentage of total formal complaints received during the month.

Complaints Resolved Within 30 Days - 2008/09 v 2009/10

0%

20%

40%

60%

80%

100%

% Of Complaints Resolved 09/10 71% 69% 87% 80% 57% 71% 0% 0% 0% 0% 0% 0% 72% 72%

% Of Complaints Resolved 08/09 78% 67% 80% 86% 50% 100% 85% 75% 100% 83% 54% 84% 80% 80%

District Annual P lan 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80% 80%


YTD

Patient Satisfaction DEFINITION: Patient Satisfaction surveys implemented by DHBs in accordance with Ministry of Health patient satisfaction survey guidelines.

Patient Satisfaction

70%

75%

80%

85%

90%

95%

Inpat ient 88.99% 88.63% 88.96% 87.95% 85.68% 90.75% 84.69% 86.67% 87.44%

Out pat ient 85.60% 86.51% 90.15% 86.46% 86.09% 87.18% 85.21% 88.35% 86.84%

Combined 87.29% 87.57% 89.56% 87.20% 85.88% 88.97% 84.95% 87.61% 87.14%

Dist r ict Annual Plan 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00% 85.00%

Qt r 2-Dec2007 Qt r3-Mar 08 Qt r4-Jun08 Qt r1-Sep08 Qt r2-Dec08 Qt r3- Mar 09 Qt r4- Jun09 Qt r1-Sep09 Qt r2-Dec09


ADMISSION/DISCHARGE RELATED PERFORMANCE INDICATORS Inpatient Admissions and Discharges (Includes Mental Health)

Comparison of Inpatient Admissions - 2008/09 vs 2009/10

0

250

500

750

1000

1250

Inpatients 09/10 1087 1104 1111 1070 1087 1014 0 0 0 0 0 0 6473 6473

Inpatients 08/09 1051 1046 1051 966 973 936 992 973 1051 1027 990 953 6023 12009


YTD

Comparison of Day Patient Admissions - 2008/09 vs 2009/10

0

100

200

300

400

500

600

700

Day Patients 09/10 660 600 674 668 678 672 0 0 0 0 0 0 3952 3952

Day Patients 08/09 536 585 540 567 577 502 480 508 626 546 599 497 3307 6563


YTD

Comparison of Total Admissions - 2008/09 vs 2009/10

0

200

400

600

800

1000

1200

1400

1600

1800

Total 09/10 1747 1704 1785 1738 1765 1686 0 0 0 0 0 0 10425 10425

Total 08/09 1587 1631 1591 1533 1550 1438 1472 1481 1677 1573 1589 1450 9330 18572


YTD

Comparison of Total Discharges - 2008/09 vs 2009/10

0

200

400

600

800

1000

1200

1400

1600

1800

Discharges 09/10 1760 1677 1781 1754 1766 1722 0 0 0 0 0 0 10460 10460

Discharges 08/09 1582 1630 1609 1522 1567 1465 1438 1453 1706 1547 1599 1445 9375 18563


YTD


Readmissions DEFINITION: An unexpected admission for further treatment of the same condition, a related condition, or complication of the condition, for which the patient was previously hospitalised (with 28 days of discharge). Includes day stay patients but excludes patients re-admitted to the Emergency Department only.

Unplanned Readmissions by Specialty - December 2009

0

100

200

300

400

500

600

Dis

char

ges

0

5

10

15

20

25

30

35

Rea

dmis

sion

s

Dischar ges 76 53 203 146 41 500 136 47 56

Readmissions 0 0 6 4 0 31 1 1 0

EAR NOSE AND

THROATEYE

GENERAL

SURGERYORTHOPAEDIC UROLOGY

GENERAL

MEDICINEPAEDS GYNAECOLOGY DENTAL

Unplanned Readmissions by Specialty - YTD December 2009

0

500

1000

1500

2000

2500

3000

3500

Dis

char

ges

0

20

40

60

80

100

120

140

160

180

Rea

dmis

sion

s

Dischar ges 399 426 1104 990 274 3003 931 309 230

Readmissions 0 0 37 14 5 159 5 9 0

EAR NOSE AND

THROATEYE

GENERAL

SURGERYORTHOPAEDIC UROLOGY

GENERAL

MEDICINEPAEDS GYNAECOLOGY DENTAL

Trend of Unplanned ReadmissionsAs a % of Raw Discharges

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

GENERAL SURGERY ORTHOPAEDIC UROLOGY GENERAL M EDICINE PAEDS GYNAECOLOGY

Per

cent

ages

Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 Mar-10 Apr-10 May-10 Jun-10


OTHER PERFORMANCE INDICATORS Returns To Theatre DEFINITION: Unplanned refers to the necessity for a further operation for complication(s) related to a previous operation/procedure in the operating room. Calculated by the number of patients having an unplanned return to the operating room during the same admission.

Unplanned Returns to Theatre - 2008/09 vs 2009/10

0.00%

0.10%

0.20%

0.30%

0.40%

0.50%

0.60%

0.70%

0.80%

0.90%

Unplanned Returns % 09/10 0.17% 0.00% 0.19% 0.18% 0.34% 0.40% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.22% 0.22%

Unplanned Returns % 08/09 0.21% 0.19% 0.39% 0.18% 0.17% 0.00% 0.21% 0.00% 0.37% 0.72% 0.56% 0.82% 0.32% 0.32%

Dist rict Annual Plan 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5% 0.5%

Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay Jun YTD Dec YTD

Hospital Acquired Blood Stream Infections (per 1,000 inpatients) DEFINITION: The number of hospital acquired Staphylococcus Aureus blood-stream infections, occurring 48 hours or more after admission per 1,000 inpatients.

Hospital Acquired Infection Rate - 2008/09 v 2009/10

0.0

0.1

0.2

0.3

0.4

0.5

0.6

Acquired Bacteremia Rate 09/10 0.19 0.37 0.18 0.18 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.15 0.15

Acquired Bacteremia Rate 08/09 0.17 0.00 0.18 0.42 0.21 0.22 0.00 0.00 0.00 0.38 0.18 0.19 0.16 0.16

District Annual P lan 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5 0.5


YTD


PROCESS AND EFFICIENCY KEY PERFORMANCE INDICATORS Resourced Beds Inpatient Occupancy Rate DEFINITION: Inpatient beds in service: The sum of set-up and stated daily beds in service for the month, where a daily bed is one resourced overnight. Nursery beds adjacent to a mother’s bed do not count as an additional bed in service. Cot facilities separate from the mother’s bed count as inpatient beds in service, if staffed and ready for use in the period. Calculated as: Inpatient bed days as a percentage of resourced bed days.

Resourced Bed Inpatient Occupancy Rate 2008/09 vs 2009/10(Medical, Surgical & ATR Only)

0%

20%

40%

60%

80%

100%

120%

Occupancy By M onth 09/10 90% 90% 91% 93% 96% 95% 0% 0% 0% 0% 0% 0% 93% 93%

Occupancy By M onth 08/09 94% 92% 91% 80% 86% 84% 87% 90% 93% 91% 91% 92% 88% 89%



Avg

Casemix Weighted Average Length Of Stay For Medical and Surgical Inpatients Only DEFINITION: Inpatients exclude the following:

Well babies, boarders, Mental Health, Assessment and Rehabilitation services and continuing care.

Medical & Surgical Inpatients exclude:

Elective day cases for Ophthalmology, Paediatrics and Palliative Care.

ALOS Calculated as: Total Inpatient Days Divided By Total Inpatient Discharges (VCWD)

ALOS 2008/09 vs 2009/2010

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

ALOS By M onth 09/10 3.23 3.04 3.24 3.43 3.23 3.11 0.00 0.00 0.00 0.00 0.00 0.00 3.22 3.22

ALOS By M onth 08/09 3.66 3.15 3.17 3.26 3.20 3.27 3.00 2.96 2.99 3.45 3.16 3.50 3.28 3.23

District Annual P lan 3.35 3.35 3.35 3.35 3.35 3.35 3.35 3.35 3.35 3.35 3.35 3.35 3.35 3.35


YTD


Did Not Attends (DNAs) DEFINITION: A rate based measure of the proportion of patients that do not attend their specialist clinic appointment at the scheduled time. Numerator: Number of patient Did Not Attends for specialist clinic appointments Divided By Denominator: Number of scheduled specialist clinic appointments

DNA Rate - 2008/09 vs 2009/10

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

DNA Rate 09/10 9.18% 8.86% 7.79% 10.02% 10.01% 7.48% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 8.86% 8.86%

DNA Rate 08/09 10.88% 9.78% 9.41% 9.46% 9.03% 9.94% 11.04% 9.63% 9.52% 9.60% 9.41% 8.67% 9.62% 9.68%

District Annual P lan 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00% 10.00%

Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay Jun Total YTD

ORGANISATIONAL HEALTH KEY PERFORMANCE INDICATORS Staff Turnover (Voluntary) DEFINITION: The number of Provider Arm employees who cease employment due to voluntary resignation during the period expressed as a percentage of the total headcount of Provider Arm employees at the beginning of the period.

Staff Turnover (Voluntary) - 2008/09 v 2009/10

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

Staff Turnover (Voluntary) 09/10 3.0% 2.5% 1.9% 1.9% 1.6% 1.6% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 2.1% 2.1%

Staff Turnover (Voluntary) 08/09 5.0% 3.4% 3.4% 3.1% 2.8% 3.1% 3.1% 2.9% 2.8% 2.7% 2.7% 2.8% 2.1% 3.1%


YTD

Sick Leave DEFINITION: The total number of paid and unpaid sick leave hours taken by Provider Arm employees during the period, expressed as a percentage of the total of Provider Arm accrued full time equivalent hours.

Sick Leave Rate - 2008/09 v 2009/10

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

Sick Leave Rate 09/10 3.3% 2.9% 3.4% 2.8% 3.0% 2.8% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 3.1% 3.1%

Sick Leave Rate 08/09 3.5% 4.3% 3.2% 3.1% 3.0% 3.4% 1.6% 1.8% 2.7% 1.9% 3.1% 3.8% 2.7% 2.9%


YTD


Workplace Injuries or Illnesses DEFINITION: All occurrences of work related injury or illness resulting in whole days or shifts lost for work by Provider Arm employees during the period, expressed as a percentage of hours worked by all Provider Arm employees.

Workplace Injuries - 2008/09 v 2009/10

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Work P lace Injuries 09/10 6.2 0.0 0.0 12.5 9.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 4.7 4.7

Work P lace Injuries 08/09 0.0 14.7 0.0 6.5 0.0 0.0 0.0 8.8 14.7 6.1 4.9 0.0 4.6 4.6


YTD

Cumulative Elective Surgical Discharges DEFINITION: Increasing elective discharges. SDHB target 3282 patients

Cumulative Total Discharges

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

YTD 2009/10 353 670 953 1,271 1,603 1,929

Actual 2008/09 262 532 854 1,192 1,576 1,841 2,097 2,382 2,707 3,013 3,363 3,584

Budget 2009/10 281 568 854 1,144 1,440 1,674 1,922 2,213 2,513 2,747 3,047 3,282


ED Presentations Staying Less Than 6 Hours DEFINITION Patients who are admitted, discharged or transferred from the Emergency Department within six hours. Calculated as ED Presentations Staying Less Than Six Hours divided by Total ED Presentations

Emergency Department Waiting Time

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

ED Present at ions St aying Less Than 6 Hours 82.74% 82.35%

2009-10 Target 95.00% 95.00% 95.00% 95.00%

Qt r1-Sep09 Qt r2-Dec09 Qt r3- Mar 10 Qt r4- Jun 10

SDHB HAC Meeting – 10 February 2010 Nursing Productivity Update

NURSING/MIDWIFERY/ALLIED HEALTH UPDATE

HAC Meeting Date: 10 February 2010 Report Prepared By: Leanne Samuel, Regional Chief Nursing and

Midwifery Officer Date Prepared: 18 January 2010

Recommendation That the Committee receives and notes this report. 1. Performance Indicators

• occupancy for December 2009 remains in the main high over the optimal 85%. Maternity

occupancy was 78%, the neonatal unit at 129%, children’s ward was 58% occupancy, and the mental health inpatient unit was at 63%. The medical ward was busy at 104% occupied, the surgical ward was 94% and the rehab unit 92%

• Lakes District Hospital (LDH) occupancy was low at 36% for the month for the rural inpatient beds

• budget results with regard nursing full time equivalent (FTE) are covered in the financial report for your information

• there was a higher number (144) of patient watches for December 2009 that necessitated one-to-one nursing to ensure safety of patients. This equates to additional FTE of 6.97 in December 2009. The majority of patients necessitating the watches were psycho-geriatric, mental health act or falls/awol (absent without leave) patient risks

• the planned Christmas reduction in open beds occurred however a norovirus outbreak in the rehab ward caused some delays in actioning the original plan

2. Clinical Practice • new clinical nurse co-ordinators for after hours medical/surgical - 80 beds following

recommendations from the medical ward nursing review have been orientated and have commenced in the roles with very favourable feedback to date. Also recruiting for a clinical midwife manager for maternity

• unfortunately, the new associate charge nurse manager from the UK for the rehabilitation unit has withdrawn and we are back to the recruitment drawing board again

• Clinical Training Agency (CTA) funding for post graduate education opportunities currently open for applications across all nursing areas ie includes primary health care. There is a wait list for access to some programmes

• active planning for a monovalent (H1N1 strain) and the seasonal immunisation (including H1N1 strain) programmes has begun with significant logistics requirements being rapidly planned for given the roll out of the former for frontline personnel will occur in February and the seasonal programme will commence in March 2010

Please find attached the dashboard (appendix 5a) reflecting OSDHBs nursing/midwifery activity for your information.


DECEMBER 2009

NURSING PERFORMANCE INDICATORS NURSING SALARY AND LEAVE COSTS

Total Nursing Salaries Actual/FTE

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

Dol

lars

(00

0's)

450

455

460

465

470

475

480

485

490

FT

E

Dollars 2766 2869 2600 2818 3184 2943 3270 2913 3061 2884 2941 2927 3343

FTE 465.31 468.55 466.97 481.30 478.86 474.79 475.52 469.11 488.09 469.68 470.07 480.05 474.85

Dec-08 Jan-09 Feb-09 M ar-09 Apr-09 M ay-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09

Nursing Annual Leave

-

10

20

30

40

50

60

70

80

FT

E

Actual 28.32 73.17 45.1 45.86 41.04 32.19 26.42 39.23 39.93 33.94 40.83 32.28 34.14

Budgeted 49.71 40.63 40.63 40.63 40.63 40.63 41.35 34.35 34.35 34.35 34.35 34.35 34.35

Dec-08 Jan-09 Feb-09 Mar -09 Apr -09 May-09 Jun-09 Jul -09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09

Average cost of Nursing Overtime per day

-200400600800

1,0001,2001,4001,6001,8002,0002,2002,4002,6002,8003,000

Dol

lars

Actual / day 1,228 1,502 2,436 2,638 1,442 1,861 2,336 2,776 2,480 2,107 1,829 2,473 2,295

Budget / day 1,833 1,833 1,833 1,833 1,833 1,833 1,833 1,673 1,673 1,673 1,673 1,673 1,673

Dec-08 Jan-09 Feb-09 M ar -09 Apr -09 M ay-09 Jun-09 Jul -09 A ug-09 Sep-09 Oct -09 Nov-09 Dec-09

Nursing Sick Leave

-

5

10

15

20

25

30

FT

E

Actual 14.44 8.65 10.04 13.19 12.88 15.4 16.71 15.092 25.09 15.76 12.99 13.24 14.05

Budgeted 11.48 11.48 11.48 11.48 11.48 11.48 11.48 11.22 11.22 11.22 11.22 11.22 11.22

Dec-08 Jan-09 Feb-09 Mar -09 Apr -09 May-09 Jun-09 Jul -09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09


MATERNITY SERVICES Service Occupancy

Maternity Services Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 81% 88% 89% 88% 81% 78% 0% 0% 0% 0% 0% 0% 84%

2008/09 95% 92% 95% 79% 79% 80% 81% 73% 76% 82% 79% 81% 83%

Jul Aug Sep Oct Nov Dec Jan Feb M ar Apr M ay JunAvg YTD

Non Clinical vs. Clinical Nursing FTE (Excludes Health Assistants)

Maternity Non Clinical vs Clinical Nursing FTE

0

2

4

6

8

10

12

14

16

18

20

FT

E

Total Actual 17.80 19.49 16.93 17.74 19.73 18.11 0.00 0.00 0.00 0.00 0.00 0.00 18.30

Productive 14.39 13.93 14.20 15.16 14.36 14.38 0.00 0.00 0.00 0.00 0.00 0.00 14.40

Unproduct ive 3.41 5.56 2.73 2.58 5.37 3.73 0.00 0.00 0.00 0.00 0.00 0.00 3.90

Total Budget 19.09 19.09 19.09 19.13 19.09 19.18 19.31 19.09 19.14 19.18 19.09 19.14 19.14

Budget Productive 16.23 16.23 16.23 16.11 16.23 15.60 13.22 16.07 16.10 15.18 16.23 16.10 15.79

Budget Unproduct ive 2.86 2.86 2.86 3.02 2.86 3.58 6.09 3.02 3.04 4.00 2.86 3.04 3.34

Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09 Jan-10 Feb-10 M ar-10 Apr-10 M ay-10 Jun-10 YTD

Nursing Hours Per Patient Bed Day

Maternity

-

2

4

6

8

10

Maternity 7.04 6.49 6.73 7.01 7.22 7.52 - - - - - -

Benchmark 6.55 6.55 6.55 6.55 6.55 6.55 6.55 6.55 6.55 6.55 6.55 6.55

Bissetts assessed average 8.02 8.02 8.02 8.02 8.02 8.02 8.02 8.02 8.02 8.02 8.02 8.02

Jul 09 Aug 09 Sep 09 Oct 09 Nov 09 Dec 09 Jan 10 Feb 10 Mar 10 Apr 10 May 10 Jun 10


MEDICAL SERVICES Service Occupancy

Medical Ward 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 89% 96% 93% 96% 95% 104% 0% 0% 0% 0% 0% 0% 95%

2008/09 98% 95% 93% 90% 92% 90% 88% 95% 99% 92% 94% 98% 94%



Medical Ward Non Clinical vs Clinical Nursing FTE

0

4

8

12

16

20

24

28

32

36

40

FT

E

Total Actual 35.86 33.84 33.57 34.65 34.91 34.20 0.00 0.00 0.00 0.00 0.00 0.00 34.51

Clinical 28.56 29.05 29.74 29.75 30.01 29.15 0.00 0.00 0.00 0.00 0.00 0.00 29.38

Non Clinical 7.30 4.79 3.83 4.90 4.90 5.05 0.00 0.00 0.00 0.00 0.00 0.00 5.13

Total Budget 37.45 37.45 37.45 37.45 37.45 37.45 37.45 37.45 37.45 37.45 37.45 37.45 37.45

Budget Clinical 31.95 31.95 31.95 31.84 31.95 30.90 26.14 31.60 31.84 29.95 31.95 31.84 31.16

Budget Non Clinical 5.50 5.50 5.50 5.61 5.50 6.55 11.31 5.85 5.61 7.50 5.50 5.61 6.30



Medical Ward

-

1

2

3

4

5

6

Medical 5.11 4.57 4.99 4.66 4.75 4.25 - - - - - -

Benchmark 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40

Bissetts assessed Average 4.53 4.53 4.53 4.53 4.53 4.53 4.53 4.53 4.53 4.53 4.53 4.53



SURGICAL SERVICES Service Occupancy

Surgical Ward 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 91% 89% 89% 91% 95% 94% 0% 0% 0% 0% 0% 0% 91%

2008/09 90% 89% 89% 77% 85% 81% 88% 89% 91% 92% 89% 94% 88%



Surgical Ward Non Clinical vs Clinical Nursing FTE

04

812

1620

2428

3236

4044

FT

E

Total Actual 39.06 38.81 37.71 37.75 39.18 36.56 0.00 0.00 0.00 0.00 0.00 0.00 38.18

Clinical 31.94 31.62 31.74 32.94 32.95 32.16 0.00 0.00 0.00 0.00 0.00 0.00 32.23

Non Clinical 7.12 7.19 5.97 4.81 6.23 4.40 0.00 0.00 0.00 0.00 0.00 0.00 5.95

Total Budget 40.95 40.95 40.95 40.95 40.95 40.95 40.95 40.95 40.95 40.95 40.95 40.95 40.95

Budget Clinical 34.93 34.93 34.93 34.82 34.93 33.79 28.58 34.56 34.82 32.75 34.93 34.82 34.07




Surgical Ward

-

1

2

3

4

5

6

Surgical 4.84 4.85 5.02 4.90 4.72 4.80 - - - - - -

Benchmark 4.70 4.70 4.70 4.70 4.70 4.70 4.70 4.70 4.70 4.70 4.70 4.70




CHILDREN’S WARD Service Occupancy

Children's Ward 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 60% 69% 87% 67% 61% 58% 0% 0% 0% 0% 0% 0% 67%

2008/09 73% 74% 84% 56% 53% 51% 49% 67% 67% 66% 54% 68% 63%



Children's Ward Non Clinical vs Clinical Nursing FTE

0

2

4

6

8

10

12

14

16

FT

E

Total Actual 14.15 15.03 15.06 14.73 15.21 14.95 0.00 0.00 0.00 0.00 0.00 0.00 14.86

Clinical 12.66 12.65 12.83 12.31 12.43 12.36 0.00 0.00 0.00 0.00 0.00 0.00 12.54

Non Clinical 1.49 2.38 2.23 2.42 2.78 2.59 0.00 0.00 0.00 0.00 0.00 0.00 2.32

Total Budget 14.65 14.65 14.65 14.65 14.65 14.65 14.65 14.65 14.65 14.65 14.65 14.65 14.65

Budget Clinical 12.53 12.53 12.53 12.45 12.53 12.06 10.20 12.41 12.44 11.72 12.53 12.44 12.20




Children's Ward

-

2

4

6

8

10

Childrens 8.78 8.03 6.69 8.02 8.95 9.40 - - - - - -

Benchmark 5.93 5.93 5.93 5.93 5.93 5.93 5.93 5.93 5.93 5.93 5.93 5.93

Bissett assessed average 6.54 6.54 6.54 6.54 6.54 6.54 6.54 6.54 6.54 6.54 6.54 6.54



REHABILITATION UNIT Service Occupancy

Rehabilitation Unit Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 90% 87% 90% 93% 97% 92% 0% 0% 0% 0% 0% 0% 92%

2008/09 94% 92% 92% 71% 81% 80% 82% 83% 89% 87% 91% 83% 85%



AT&R Non Clinical vs Clinical Nursing FTE

0

4

8

12

16

20

24

28

32

FT

E

Total Actual 24.00 25.65 24.84 20.80 25.29 25.24 0.00 0.00 0.00 0.00 0.00 0.00 24.30

Clinical 19.54 20.37 20.97 17.06 20.48 20.16 0.00 0.00 0.00 0.00 0.00 0.00 19.76

Non Clinical 4.46 5.28 3.87 3.74 4.81 5.08 0.00 0.00 0.00 0.00 0.00 0.00 4.54

Total Budget 23.75 23.75 23.75 23.75 23.75 23.75 23.75 23.75 23.75 23.75 23.75 23.75 23.75

Budget Clinical 20.27 20.27 20.27 20.16 20.27 19.54 16.53 20.06 20.15 18.97 20.27 20.15 19.74




AT & R

-

1

2

3

4

5

AT&R 4.68 4.48 4.56 3.48 4.02 4.61 - - - - - -

Benchmark 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40 4.40




NEO NATAL UNIT Service Occupancy

Neo Natal Unit Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 111% 139% 155% 105% 104% 129% 0% 0% 0% 0% 0% 0% 124%

2008/09 125% 191% 180% 181% 65% 123% 169% 118% 150% 164% 148% 105% 143%



Neo Natal Non Clinical vs Clinical Nursing FTE

0123456789

1011121314

FT

E

Total Actual 11.66 12.53 12.36 10.56 10.64 11.43 0.00 0.00 0.00 0.00 0.00 0.00 11.53

Clinical 8.84 9.56 9.07 9.00 8.63 8.74 0.00 0.00 0.00 0.00 0.00 0.00 8.97

Non Clinical 2.82 2.97 3.29 1.56 2.01 2.69 0.00 0.00 0.00 0.00 0.00 0.00 2.56

Total Budget 10.75 10.75 10.75 10.75 10.75 10.75 10.75 10.75 10.75 10.75 10.75 10.75 10.75

Budget Clinical 9.19 9.19 9.19 9.12 9.19 8.82 7.46 9.10 9.11 8.58 9.19 9.11 8.94




Neo Natal Unit

-

2

4

6

8

10

12

Neo Natal 8.97 7.88 6.90 9.85 9.48 7.74 - - - - - -

Benchmark 8.00 8.00 8.00 8.00 8.00 8.00 8.00 8.00 8.00 8.00 8.00 8.00




CRITICAL CARE UNIT Service Occupancy

Critical Care Unit Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 61% 61% 62% 45% 73% 59% 0% 0% 0% 0% 0% 0% 60%

2008/09 58% 48% 57% 54% 55% 49% 48% 63% 51% 52% 62% 72% 56%



Critical Care Non Clinical vs Clinical Nursing FTE

0

2

4

6

8

10

12

14

16

18

FT

E

Total Actual 15.88 17.39 15.51 15.39 16.29 15.92 0.00 0.00 0.00 0.00 0.00 0.00 16.06

Clinical 13.77 14.96 13.13 11.87 13.40 13.55 0.00 0.00 0.00 0.00 0.00 0.00 13.45

Non Clinical 2.11 2.43 2.38 3.52 2.89 2.37 0.00 0.00 0.00 0.00 0.00 0.00 2.62

Total Budget 15.15 15.15 15.15 15.15 15.15 15.15 15.15 15.15 15.15 15.15 15.15 15.15 15.15

Budget Clinical 12.95 12.95 12.95 12.87 12.95 12.47 10.56 12.82 12.86 12.11 12.95 12.86 12.61




Critical Care Unit

-

5

10

15

20

25

30

Critical Care 23.02 23.46 20.95 25.04 17.54 21.83 - - - - - -

Benchmark 12.00 12.00 12.00 12.00 12.00 12.00 12.00 12.00 12.00 12.00 12.00 12.00




MENTAL HEALTH UNIT Service Occupancy

Mental Health Unit Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 67% 78% 81% 65% 75% 63% 0% 0% 0% 0% 0% 0% 71%

2008/09 81% 78% 64% 40% 63% 65% 51% 65% 69% 76% 96% 70% 68%



Mental Health Unit Non Clinical vs Clinical Nursing FTE

02468

101214161820222426283032

FT

E

Total Actual 23.71 26.21 23.90 24.41 23.88 23.53 0.00 0.00 0.00 0.00 0.00 0.00 24.27

Clinical 20.07 20.22 19.79 18.56 20.44 20.00 0.00 0.00 0.00 0.00 0.00 0.00 19.85

Non Clinical 3.64 5.99 4.11 5.85 3.44 3.53 0.00 0.00 0.00 0.00 0.00 0.00 4.43

Total Budget 25.45 25.45 25.45 25.45 25.45 25.45 25.45 25.45 25.45 25.45 25.45 25.45 25.45

Budget Clinical 21.78 21.78 21.78 21.59 21.78 20.90 17.65 21.58 21.58 20.33 21.78 21.58 21.18




Mental Health Unit

-

2

4

6

8

10

Mental Health 7.17 6.47 6.25 7.07 6.80 7.84 - - - - - -

Benchmark 7.01 7.01 7.01 7.01 7.01 7.01 7.01 7.01 7.01 7.01 7.01 7.01




PERIOPERATIVE SERVICES (NON WARD) Non Clinical vs. Clinical Nursing FTE (Excludes Health Assistants)

Perioperative Non Clinical vs Clinical Nursing FTE

0

48

12

1620

2428

32

3640

44F

TE

Total Actual 40.47 42.94 40.17 39.79 40.32 41.05 0.00 0.00 0.00 0.00 0.00 0.00 40.79

Clinical 33.24 35.06 34.67 34.41 33.36 34.50 0.00 0.00 0.00 0.00 0.00 0.00 34.21

Non Clinical 7.23 7.88 5.50 5.38 6.96 6.55 0.00 0.00 0.00 0.00 0.00 0.00 6.58

Total Budget 39.80 39.80 39.80 39.80 39.80 39.80 39.80 39.80 39.80 39.80 39.80 39.80 39.80

Budget Clinical 34.03 34.03 34.03 33.82 34.03 32.78 27.74 33.70 33.81 31.84 34.03 33.81 33.14



LAKES HOSPITAL Service Occupancy

Lakes Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 67% 65% 56% 63% 45% 36% 0% 0% 0% 0% 0% 0% 55%

2008/09 53% 46% 60% 51% 55% 34% 53% 60% 56% 57% 54% 49% 52%


December 2009

STRATEGIC GOALS:

1.0 Nursing and Midwifery Workforce

High performing nursing and midwifery workforce able to effectively contributes to meeting the health needs of the community.

2.0 Nursing and Midwifery Practice/Professional Standards

Professional excellence and safety in Nursing and Midwifery practice delivering optimal frontline care and maximising the potential of the nursing workforce.

3.0 Nursing and Midwifery Resource Utilisation

Effectively deployed, managed and supported Nursing and Midwifery Resource able to meet the service needs.

4.0 Nursing and Midwifery Governance and Leadership

Clinical governance and leadership roles and responsibilities are upheld professionally and within the wider organisations structures and functions within the multidisciplinary and management teams.

PROGRESS

KEY PROJECTS / ACTIVITY AREAS 2009/2010

Scoping

Behind

On Track

Completed

COMMENT

1.0 Workforce development

1.1 NETP and NETP expansion and MFYOP

� Ongoing new cohorts start in February

1.2 PDRP uptake �

1.3 CTA program access/uptake �

Waiting list for access to programmes on both sites

1.4 Nurse Practitioner development program

�

Workshops planned in Otago and Southland DHBs went very well increasing interest in NP roles

1.5 Access to course conference support � Exploring Clinical Nurse specialist course conference support for Otago

1.6 Unregulated worker orientation/ education

�

O

�

S

1.7 Management and Leadership development for Senior nurses

� Aligns to HR program and possibly CTA funding for nursing and

midwifery. Ideally a local programme for the region to be sourced in 2010 or 2011

2.0 Nursing and Midwifery Practice

2.1 Clearly demonstrated integration of Evidenced based practice

� Needs ongoing evaluation

2.2 Contemporaneous models of care are delivered and evaluated continuously

� As above recent independent reviews held in gastroenterology (Otago) and medical ward (Southland). Recommendations to be actioned

2.3 Quality and HR processes and Policy, Procedure Alignment

� Recruitment and retention strategies aligned, gaps identified, and approval processes complied with

2.4 Regulatory Compliance

� Compliance Nursing and Midwifery Councils of New Zealand re APCs, education programmes etc

3.0 Nursing and Midwifery Resource Utilisation – this is in the context of production, planning, value for money

initiatives, models of care development, clinical leadership, expert opinion, audit, culture, organisational systems/relationships, District Annual Plan delivery

3.1 Safe Staffing and Healthy Workplace

3.1.1 Patient Forecasting

-how many?

-what type?

-when?

-specific needs?

-required outcomes?

-cost?

� Project briefing and scoping yet to be undertaken, nor project management resource identified. Aligns to national SSHW demonstration site pilot work due for completion in April 2010

Nursing and Midwifery Dashboard-OSDHBs

3.1.2 Matching resources

-how many staff?

-what skill set required?

-where?

-with what resources?

-what is the available budget?

� As above

3.1.3 Resource provision

-Right number of staff?

-Right type?

-Right skill mix?

-Right skills

-Right environment

-Right time?

-Right resources?

� As above

3.1.4 Service Delivery

-Safe

-Effective

-Appropriate

-Timely

-Sustainable

-Flexible

-Responsive

�

Establishing targeted tool kit sourcing strategy for senior nurses use on a shift by shift basis

-Capacity planning tools (prospective)

-Integrated roster and bed management alignment electronically

-Business Intelligence reporting platform-live time

4.0 Nursing and Midwifery Governance and Leadership

4.1 Clinical Governance, clinical

leadership on the ground

�

O

�

S Clinical Governance review and structure in place SDHB

Putting the patient first, OPJ, value for money related projects for ODHB

Projects/Practice Development Initiatives

Falls �

S

�

O

Falls material from Otago to be shared with Southland key groups in Feb 1010

Early Warning Scores (Otago)/

Ups (Southland)

� Evaluations of both sites progress underway

Clinical –Key performance indicators

Failure to rescue � EWS (Otago) UPS (Southland) project being audited for improved rescue rates

Falls �

S �

O Being rolled out on a number of floors at Dunedin Hospital. Yet

to be scoped for Southland Hospital

Pressure Injuries � Not yet commenced

Health care associated infection

� HAI data captured and reported via infection prevention and control

SDHB HAC Meeting – 10 February 2010 Financial Report

FINANCIAL REPORT

HAC Meeting Date: 10 February 2010 Financial Report as at: 31 December 2009 Report Prepared by: Bron Anderson, Senior Business Analyst Date: 25 January 2010

1. DHB Provider Summary Results

Annual

Actual Budget Variance Actual Budget Variance Budget$' 000 $' 000 $' 000 $' 000 $' 000 $' 000 $' 000

11,239 11,367 (128) Revenue 68,270 68,201 69 138,636

(7,651) (7,958) 307 Less Personnel Costs (42,558) (43,732) 1,174 (86,463) (4,697) (4,725) 29 Less Other Costs (28,777) (28,149) (628) (56,006)

(1,109) (1,316) 207 Net Surplus / (Deficit) (3,065) (3,679) 615 (3,834)

Month Year to Date

Summary Comment:

• December 2009 result is an operating deficit of $1,109k, this is a favourable variance against plan by $207k

• the YTD position is $615k within plan this position arises from a YTD operating deficit

of $3,065k compared against a budgeted deficit of $3,679k

2. Continuing Trends

Favourable

• personal health funding for 12 months herceptin • other revenue kiwi saver tax credits • clinical equipment minor purchases • domestic staff travel • fuel costs

Unfavourable

• personal health direct funding related to Oral Health Business Case, behind plan • accident leave and other leave within salary groups, in particular nursing • treatment disposables costs, in particular dressings (related to vac wound care

machines), protective clothing (related to H1N1) and patient consumables • external storage services • coal costs • oncology pharmaceuticals • data network and internet fees


3. Revenue

AnnualActual Budget Variance Actual Budget Variance Budget$' 000 $' 000 $' 000 $' 000 $' 000 $' 000 $' 000

212 310 (98) Accident Insurance 2,068 1,862 206 3,724

56 103 (47) Clinical Training Agency 430 619 (190) 1,238

10,546 10,577 (31) Funder Arm revenue 63,099 63,458 (359) 129,149

54 53 1 MOH Disability Support Services 322 318 4 637

56 46 10 MOH Personal Health 162 276 (115) 553

18 19 (1) MOH Public Health 56 115 (59) 231

- 2 (2) Non DHB's - 13 (13) 26

23 26 (3) Other DHB's 132 157 (25) 314

155 120 35 Other Income 1,110 719 390 1,439

103 105 (1) Patient/Consumer Sourced 866 629 237 1,257 16 6 10 Training Fees & Subsidies 25 34 (9) 68

11,239 11,367 (128) Total Revenue 68,270 68,201 69 138,636

Month Year to Date

• Clinical Training Agency (CTA) is unfavourable against budget YTD this is due to training posts not being able to be filled

• Internal Revenue The following variances exist within the internal revenue line

ContractsMonthly Variance

YTD Variance Comment

Fee For Service contracts (10) (3)

Dental Contracts over plan, Aged care behind plan

Mental Health wash up back to funder arm (71) (410) Positions that remain unfilled

Pharmaceutical Lines; PCT & Community 37 (27)

PCT revenue over plan, Community Pharms under budget

Various other contracts 13 81

B4 Schools check, Additional herceptin funding, one contract now delivered in primary care, PPE, Health promotions

Total (31) (359)

• accident compensation corporation (ACC) revenue is below budget for the month but $206k greater than plan YTD; areas above YTD plan include assessment, treatment and rehabilitation (ATR) and imaging

• the operational portion of the Oral Health Business Case is budgeted under the Ministry of Health personal health line. The project is moving ahead well but a misalignment in the timing of the project costs shows as an unfavourable monthly result and yearly result, however we are now collecting revenue for 12 month herceptin costs the revenue associated sits under this budget line hence the favourable position for December 09

• the favourable YTD outcome against patient/consumer sourced revenue is due to non resident activity being above plan


• under the other income category kiwi saver credits and accommodation rentals are favourable to budget, donations received and interest revenue offset part of this positive variance as these income lines are below plan

4. Salaries

Monthly Salary Total Costs The following table summarises the overall salary position. Annual

Actual Budget Variance Actual Budget Variance Budget

Costs$' 000 $' 000 $' 000 $' 000 $' 000 $' 000 $' 000

Medical (1,902) (2,245) 342 (11,742) (12,965) 1,223 (25,589) Nursing (3,343) (3,478) 135 (18,069) (17,993) (75) (35,802) Allied Health (1,152) (1,063) (89) (6,074) (6,052) (22) (11,882) Support (151) (50) (101) (395) (287) (108) (563) Management/Administration (1,103) (1,123) 20 (6,278) (6,434) 156 (12,628)

Total Salaries (7,651) (7,958) 307 (42,558) (43,732) 1,174 (86,463)

Month Year to Date

Annual

FTEsActual Budget Variance Actual Budget Variance Budget

Medical 108.12 108.86 0.74 109.36 112.23 2.87 112.25 Nursing 483.77 472.59 (11.18) 483.60 472.59 (11.01) 472.59 Allied Health 190.37 179.88 (10.49) 186.17 179.88 (6.29) 179.88 Support 20.16 13.09 (7.07) 14.73 13.09 (1.64) 13.09 Management/Administration 219.06 223.78 4.72 220.75 223.77 3.02 223.96

Total FTEs 1,021.48 998.20 (23.28) 1,014.61 1,001.56 (13.05) 1,001.77

Month Year to Date

YTD costs are $1,174k under budget. FTEs are over budget by a total of 13.05 YTD. Further explanation for different vocational groups is shown below. Medical Salaries Medical salaries have a favourable variance of $342k for the month and $1,223k YTD. Key reason for this favourable result include

• lower FTE against plan • high annual leave taken therefore a reduction in leave liability • non direct salary items are very favourable against plan

Please refer to the table below for sub category breakdown within the medical salaries.


Actual Budget Variance Actual Budget Variance Actual Budget Variance$' 000 $' 000 $' 000 FTES FTES FTES $' 000 $' 000 $' 000

Ordinary (1,079) (1,007) (72) 86.85 75.24 (11.61) (5,959) (6,426) 467 Accident Leave - - - - - - - - - Annual Leave Taken (128) (252) 124 9.25 11.23 1.98 (1,021) (1,445) 424 Other Leave (2) - (2) 0.10 - (0.10) (25) - (25) Sick Leave (3) (47) 44 0.83 3.48 2.65 (117) (265) 149 Statutory (incl Time in Lieu) (46) (131) 86 0.95 10.32 9.37 (62) (195) 134 Training (incl CME)/ Study Lve (13) (83) 70 2.07 4.57 2.50 (194) (471) 277 Long Service Leave - - - - - - - - - Back Pays (13) - (13) - - - (47) - (47) Allowances (352) (409) 56 - - - (2,287) (2,324) 36 Penal (13) (4) (9) - - - (17) (6) (11) Base Medical Salaries (1,649) (1,933) 284 100.05 104.84 4.79 (9,729) (11,132) 1,404

Overtime (90) (50) (41) 8.07 4.02 (4.05) (885) (292) (593) ACC Levy (10) (8) (2) - - - (46) (45) (2) Meals (11) (10) (1) - - - (68) (59) (9) Superannuation (52) (67) 15 - - - (292) (382) 90 Course Fees, Conferences, Study Grants (38) (94) 56 - - - (381) (554) 173 External Clinical Supervision - - - - - - (1) - (1) Professional Membership Fees and Costs (8) (28) 21 - - - (91) (168) 77 Recruitment Expenses & Advertising (44) (35) (8) - - - (241) (213) (29) Relocation - (20) 20 - - - 11 (120) 131 Parental Leave - - - - - - (18) - (18)

Total Medical Salaries (1,902) (2,245) 342 108.12 108.86 0.74 (11,742) (12,965) 1,223

Month Month Year to Date

The bulk of the above YTD favourable result is in the junior doctor area $898k. Overall FTEs levels are within plan for the month. However there is an unfavourable variance in junior medical staffing of 0.64 FTE but a 1.38 favourable FTE variance within the senior staffing section. The FTE calculation includes medical overtime. However a budget was only allocated against the junior doctor area for the additional duties incurred to cover roster gaps. Senior doctors are also undertaking extra shifts, so the bulk of the variance against overtime relates to extra duties by senior doctor. The budget includes a vacancy factor which reduces the salary budget and therefore FTEs but increases the outsourced budget. December month saw a higher establishment represented in the outsourcing line compared to that in the salary line than what had been the prediction for the previous months. This budget modelling was related to the change over of the junior doctor runs. The 2009/2010 split is monitored carefully to ensure accurate modelling and potential areas where locum use can be modified. Junior doctor staffing for the holiday period was well aligned with the senior staffing leave. Direct salary cost lines against both the senior and junior areas are favourable to plan; allowance and overtime costs are unfavourable against plan across both medical areas, this aligns with the FTEs being above budget. Of note some of the non direct salary items are favourable to budget

• superannuation $15k for the month, $90k YTD • course fees and conference $56k monthly variance, $173k YTD • professional membership fees $21k for the month, $77k YTD • recruitment and relocation are $12k for the month, $102k YTD

Outsourced medical costs must be considered as well when reviewing the medical salary costs. As noted above the way the budget is compiled means that part of the staffing establishment is now allocated against the outsourced line. The budget has tried to reflect the reality of the permanent and locum split. The variance to budget is favourable $404k for the month and $910k YTD when considering the two components of medical costs (salaries and outsourced costs).


December 09 reflects high locum/ fee for service charges, $816k but with the modelling of the budget the variance of the two medical cost lines (salaries and outsourced) against that budgeted is better than that reported in past months in previous financial years. The table below shows the 18 month trend of medical outsourcing charges, December chargers are lower than those incurred during November.

Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09

Total Medical Outsourced (567) (942) (808) (749) (762) (984) (761) (825) (1,069) (922) (833) (813) (808) (747) (736) (828) (1,259) (816)

The table below shows the variance in categories between salaries and outsourced.


Specialist Medical Officer - Employees (1,065) (1,254) 189 46.77 47.54 0.77 (6,778) (7,172) 394 - Outsourced (536) (511) (25) (3,332) (3,066) (266)

(1,601) (1,765) 164 (10,110) (10,238) 128 MO - Employees (252) (263) 11 13.76 14.37 0.61 (1,472) (1,403) (69) - Outsourced (7) (70) 63 (111) (561) 450

(259) (333) 74 (1,583) (1,964) 381 Total SMO (1,860) (2,098) 238 60.53 61.91 1.38 (11,693) (12,202) 509 Registrar - Employees (310) (471) 161 24.22 24.77 0.55 (2,308) (2,926) 618 - Outsourced (200) (127) (73) (965) (304) (661)

(510) (598) 88 (3,273) (3,230) (43)

House Officer - Employees (276) (256) (20) 23.37 22.18 (1.19) (1,184) (1,464) 280 - Outsourced (79) (177) 98 (798) (962) 164

(355) (433) 78 (1,982) (2,426) 444 Total RMO (865) (1,031) 166 108.12 108.86 0.74 (5,255) (5,656) 401


RMO costs are $401k within budget YTD. Total Senior Medical Officer (SMO and Medical Officer) costs sit within plan YTD by $509k. Nursing Salaries Nursing salaries have a favourable variance of $135k for the month. YTD the variance is unfavourable by $75k. The following table provides the breakdown of the variance by sub categories:



Ordinary (1,898) (2,058) 159 407.58 379.79 (27.79) (11,970) (12,502) 532 Accident Leave (6) - (6) 1.21 - (1.21) (52) - (52) Annual Leave Taken (288) (273) (14) 34.14 34.35 0.21 (1,614) (1,453) (161) Other Leave (12) - (12) 2.45 - (2.45) (54) - (54) Sick Leave (59) (61) 1 14.05 11.22 (2.83) (459) (357) (102) Statutory (incl Time in Lieu) (314) (218) (97) 7.40 28.84 21.44 (430) (326) (103) Training (incl CME)/ Study Lve (14) (65) 51 7.29 11.70 4.41 (259) (381) 122 Long Service Leave (7) (4) (4) 0.73 0.73 0.00 (56) (23) (33) Back Pays (237) (292) 55 - - - (246) (292) 46 Allowances (225) (272) 47 - - - (1,612) (1,633) 20 Penal (119) (72) (47) - - - (156) (108) (48) Base Nursing Salaries (3,179) (3,315) 133 474.85 466.63 (8.22) (16,908) (17,075) 167

Overtime (71) (52) (19) 8.92 5.96 (2.96) (428) (308) (120) ACC Levy (31) (21) (10) - - - (166) (118) (48) Superannuation (37) (50) 13 - - - (200) (260) 60 Course Fees, Conferences, Study Grants (8) (23) 15 - - - (149) (136) (13) Rural Retention Training - - - - - - (3) - (3) Professional Membership Fees and Costs (8) (5) (3) - - - (26) (27) 1 Recruitment Expenses & Advertising (5) (3) (2) - - - (33) (18) (15) Relocation - (3) 3 - - - (65) (20) (44) Parental Leave - (6) 6 - - - (62) (33) (30) Gratuities - - - - - - (21) - (21) Grievance Settlements - - - - - - (8) - (8) Total Nursing Salaries (3,343) (3,478) 135 483.77 472.59 (11.18) (18,069) (17,993) (75)


FTEs are tracking above YTD budgeted levels 11.01 FTE. This month 11.18 FTEs have been used higher than budget. The over run in FTE relates to;

• the over run of sick leave 2.83 for the month, 4.82 YTD • a number of patient watches being required for confused patients • FTEs attributed to accident leave where there is no budget allocation, 1.21 FTE for the

month and 1.67 FTE YTD • FTEs aligned with other leave (e.g. bereavement and jury) where there is no budget

allocation, 2.45 FTE for December 09 and 1.82 YTD • extra work related with H1N1 activity • there are some nursing positions being filled in mental health but are budgeted as an

allied position approx 2 FTE • overtime payments are being incurred over and above budget, over runs are

happening in the ward areas and perioperative The FTE overrun (11.01 FTE YTD) should be causing a larger YTD unfavourable fiscal variance than exists, however this is not the case as those currently employed have a lower average salary than that budgeted and also the additional allowance payment due in December was lower than budgeted. So other items driving the unfavourable budget variance include some non FTE related costs. These costs include

• course fees YTD unfavourable against plan $12k • recruitment and advertising YTD unfavourable against plan $15k • relocation YTD unfavourable against budget $44k • gratuities YTD position is $21k unfavourable against plan

The above costs (apart from gratuities because there is no budget apportioned) should be viewed with an annual budget perspective in mind as the budget phasing is a best approximation. Parental leave costs are over running budget expectation, the budget is set on historical data but in reality this often does not align, the fiscal position is $30k above plan YTD


Long service leave entitlements have increased over time as employment agreements have been settled. This is reflective above with the unfavourable fiscal variance due to these entitlement changes. Allied Health FTEs are above budgeted parameters for the month by 10.49 The FTE variance is impacting on the monthly result as the following areas are above budget

• 0.33 FTE against accident leave • 0.67 FTE against other leave • 1.56 FTE over and above plan within the overtime section • 7.93 FTE over in base salaries (3 Biomedical technicians are now classified here as

now an in house service, the offset in costs sits in the maintenance outsourced line) The FTE position is contributing to an unfavourable fiscal result however it is not as bad as it potentially could be as the current staff are being paid on lower average salary than budgeted. Along with the lower than average salaries some non direct salary items are tracking behind plan which is maintaining a lower than expected fiscal blow out, line items include superannuation, course and conference fees, professional membership fees, recruitment and relocation costs. A vacancy factor has been maintained within allied health for a number of years, and has been set in the 2009/2010 budget to be 31.51FTE. The current non mental health vacancy factor is 25, which is over budget. When mental health vacancies are accounted for the vacancy factor remains at around 15, suggesting the factor may have been set too high. The unfilled positions in mental health will be affecting service delivery.

Other items impacting the YTD fiscal result include

• additional leave for those working on call during weekend being actioned this year for the 12 month period ended 30 June 2009

• $33k charge for parental leave incurred during July 09 and $2k during October 09 The table below shows both the financial and FTE status of the different allied groups in the provider arm.


Month Month Year to DateActual Budget Variance Actual Budget Variance Actual Budget Variance$' 000 $' 000 $' 000 FTES FTES FTES $' 000 $' 000 $' 000

Audiologists - (6) 6 - 1.00 1.00 (1) (33) 32 Child Therapists - - - - - - (2) - (2) Dental Therapists (64) (89) 25 11.72 15.22 3.50 (380) (513) 133 Occupational Therapists (66) (90) 24 14.84 16.00 1.16 (446) (513) 68 Physiotherapists (88) (80) (8) 14.40 13.39 (1.01) (442) (458) 16 Speech Therapists (9) (13) 4 1.44 2.20 0.76 (48) (74) 26 Therapist Aids/Assistants (88) (94) 6 23.59 24.27 0.68 (483) (535) 52 Other Therapists - (17) 17 - 3.30 3.30 - (98) 98 Case Managers (62) (80) 18 10.90 14.19 3.29 (317) (458) 141 Community Support Workers (90) (100) 10 19.54 20.80 1.26 (565) (569) 4 Cultural Workers (39) (36) (4) 6.34 6.61 0.27 (223) (205) (18) Health Education Workers - (15) 15 - 2.40 2.40 - (87) 87 Health Promotion Officers (7) (6) - 0.79 1.00 0.21 (24) (37) 13 Psychologists (101) (107) 6 11.03 14.11 3.08 (433) (609) 175 Recreation/Training/Welfare Officers (7) (4) (3) 1.75 1.00 (0.75) (42) (24) (18) Social Workers (127) (113) (14) 19.30 19.51 0.21 (675) (648) (27) Trainee Psychologists - (5) 5 - 1.00 1.00 - (27) 27 Pharmacists (40) (30) (10) 4.58 4.57 (0.01) (186) (171) (15) Pharmacist Interns (3) (4) 1 0.50 1.00 0.50 (3) (25) 21 Pharmacist Technicians (18) (13) (5) 4.19 3.53 (0.66) (101) (76) (25) MRT's & Sonographers (166) (161) (4) 19.69 23.25 3.56 (903) (917) 14 MRT & Sonographer Students (21) (6) (16) 3.68 1.00 (2.68) (93) (32) (61) Paramedics - 108 (108) - (25.51) (25.51) - 639 (639) Technicians (116) (87) (29) 15.84 16.01 0.17 (479) (500) 21 Dietitians (15) (14) (1) 2.64 2.65 0.01 (94) (81) (13) Hearing / Vision Testers (9) (9) - 1.97 2.00 0.03 (55) (53) (3) Scientific Officers & Researchers (1) 16 (17) - (6.00) (6.00) (17) 93 (110) Other Allied Health Staff (14) (7) (7) 1.64 1.38 (0.26) (61) (43) (18) Health Protection Officers - - - - - - (1) - (1)

Total Allied Health Salaries (1,152) (1,063) (89) 190.37 179.88 (10.49) (6,074) (6,052) (22) Support The annual support budget for the provider arm has resided around $500k for many years which represents approximately 13.00 FTE. From December building and property services are now an in house service. The majority of the salary costs related to this service reside in this cost category. The monthly variance is $101k over plan due to this fact. The offset of this cost over run sits against the outsourced maintenance line. Management Administration YTD costs and FTEs are within plan. The under run of FTEs against budget explains the favourable fiscal variance along with the no provisioning for expired Multi Employer Collective Agreements (MECAs) One item of note relating to this cost category includes the YTD unfavourable variance against allowances of $98k. This variance includes a budget mistake where all allowance payments against some clinical areas have not been budgeted for, some acting up allowances have been incurred with no budget attached and some regional roles that now have allowances that were not known during budget preparation time.



Ordinary (832) (853) 21 190.32 176.04 (14.28) (5,040) (5,286) 246 Accident Leave (9) - (9) 1.57 - (1.57) (14) - (14) Annual Leave Taken (88) (97) 9 13.47 17.42 3.95 (503) (554) 50 Other Leave (1) - (1) 0.35 - (0.35) (11) - (11) Sick Leave (20) (42) 21 5.73 8.76 3.03 (166) (239) 73 Statutory (incl Time in Lieu) (86) (95) 9 6.72 19.75 13.03 (131) (142) 11 Training (incl CME)/ Study Lve 1 (8) 9 0.18 1.77 1.59 (27) (48) 21 Long Service Leave - - - 0.24 - (0.24) (11) - (11) Back Pays (14) - (14) - - - (82) - (82) Allowances (20) (3) (17) - - - (114) (16) (98) Penal (5) - (5) - - - (7) - (7) Base Management Admin Salaries (1,074) (1,098) 23 219 224 5 (6,106) (6,285) 178

Overtime (2) (4) 2 0.48 0.04 (0.44) (14) (22) 8 ACC Levy (10) (8) (3) - - - (52) (44) (8) FBT - - - - - - (14) - (14) Meals - - - - - - (1) - (1) Superannuation (10) (8) (2) - - - (56) (48) (9) Course Fees, Conferences, Study Grants (2) (3) - - - - (23) (15) (7) External Clinical Supervision - - - - - - (1) - (1) Professional Membership Fees and Costs - - - - - - (2) (1) (1) Recruitment Expenses & Advertising - (2) 2 - - - (9) (14) 5 Relocation (1) - (1) - - - (1) - (1) Parental Leave - (1) 1 - - - - (6) 6

Total Management Admin Salaries (1,103) (1,123) 20 219.06 223.78 4.72 (6,278) (6,434) 156


The ministry has required that a cap be put on management administration FTE so that there is no growth in this area. The capped level against this group has been maintained for YTD December 09.


5. FTEs

The table below shows where the budget is allocated for the various FTE groups.

Year to Date AnnualDivision Staff Group Actual Budget Variance Budget

FTES FTES FTES FTESMedical Division Allied Health Personnel 86.18 86.74 0.56 86.74

Management & admin Personnel 36.86 37.98 1.12 37.98 Medical Personnel 24.02 20.75 (3.27) 22.09 Nursing Personnel 140.63 138.31 (2.32) 138.31

Medical Division Total 287.70 283.78 (3.92) 285.12 Surgical Division Allied Health Personnel 8.27 10.09 1.82 10.09

Management & admin Personnel 50.18 49.64 (0.54) 49.67 Medical Personnel 15.58 15.80 0.22 15.80 Nursing Personnel 138.45 134.29 (4.16) 134.29 Support Personnel 10.83 10.89 0.06 10.89

Surgical Division Total 223.31 220.71 (2.60) 220.74 Mental Health Division Allied Health Personnel 51.31 61.02 9.71 61.02

Management & admin Personnel 26.16 27.86 1.70 27.86 Medical Personnel 10.64 13.84 3.20 13.84 Nursing Personnel 77.07 75.53 (1.54) 75.53

Mental Health Division Total 165.18 178.25 13.07 178.25 Women & Children Division Allied Health Personnel 31.09 37.85 6.77 37.85

Management & admin Personnel 23.61 24.27 0.66 24.27 Medical Personnel 9.46 9.84 0.38 9.84 Nursing Personnel 99.52 99.45 (0.07) 99.45 Support Personnel 1.79 2.20 0.41 2.20

Women & Children Division Total 165.47 173.61 8.15 173.61 Chief Operations Officer Shared Allied Health Personnel - - - -

Management & admin Personnel 16.13 16.98 0.86 16.98 Medical Personnel 0.71 1.00 0.29 1.00 Nursing Personnel 1.60 - (1.60) -

Chief Operations Officer Shared Total 18.44 17.98 (0.46) 17.98 Corporate - Director of Nursing Allied Health Personnel 0.98 1.01 0.03 1.01

Management & admin Personnel 3.01 2.84 (0.17) 2.86 Medical Personnel 0.80 0.80 (0.00) 0.80 Nursing Personnel 25.04 24.63 (0.41) 24.63

Corporate - Director of Nursing Total 29.84 29.28 (0.56) 29.30 Corporate - Finance, Supply, Maintenance Allied Health Personnel - - - -

Management & admin Personnel 18.73 20.45 1.73 20.45 Medical Personnel - - - - Nursing Personnel 0.02 - (0.02) - Support Personnel 2.11 1.00 (1.11) 1.00

Corporate - Finance, Supply, Maintenance Total 20.85 21.45 0.60 21.45 Corporate - Human Resources Allied Health Personnel - - - -

Management & admin Personnel 11.41 11.92 0.51 11.92 Medical Personnel - - - - Nursing Personnel 1.14 1.10 (0.04) 1.10 Support Personnel - - - -

Corporate - Human Resources Total 12.55 13.02 0.47 13.02 Corporate - Information Systems Allied Health Personnel 0.58 0.66 0.08 0.66

Management & admin Personnel 27.70 28.02 0.33 28.03 Nursing Personnel 0.03 - (0.03) -

Corporate - Information Systems Total 28.31 28.68 0.37 28.69 Corporate Allied Health Personnel 7.76 (17.49) (25.25) (17.49)

Management & admin Personnel 6.97 3.81 (3.16) 3.94 Medical Personnel 48.15 50.20 2.05 48.87 Nursing Personnel 0.09 (0.72) (0.81) (0.72) Support Personnel - (1.00) (1.00) (1.00)

Corporate Total 62.96 34.80 (28.17) 33.60 Grand Total 1,014.61 1,001.56 (13.05) 1,001.77

6. Expenditure

Outsourced Outsourced costs are within plan $50k for the month but $394k YTD. As noted above in the salary section the medical budget was phased and adjusted for locum use (which in most cases is paid at a premium when compared to salaried staff) therefore the fee for service budget lines have increased compared to last year. This approach has resulted in a favourable variance to plan in the medical outsourced cost category.


Outsourced management administration costs lines have no material variance to report. Outsourced allied reside over for the month and YTD. Extra cost has been incurred against the therapists, psychologists and social workers lines; there is a partial offset against the allied salary line. Outsourced clinical services are over plan. These costs relate to Southern Blood and Cancer and other outsourced services, for example lithotripsy and MRI scans. The over run this month and YTD relates to the outsourcing of some ACC activity. Clinical Supplies Total clinical supplies expenditure for the month of December 09 is $1,955k against a budget of $1,803k, a $151k unfavourable variance against plan. YTD this variance is $605k outside budget parameters. The phasing of the budget does impact on the monthly result if activity slowed down for the holiday period. This year the clinical supplies budget has been phased on days of the month. Within the reported variance various lines have over and under runs; which require some explanation.


Line Item Monthly Variance YTD Variance CommentBlood Products 7 (41) Patient VolumesContinence & Hygiene supplies (7) (56) Patient RequirementsDrapes (9) (33) Change in practice

Dressings (9) (51)VAC wound care machines; benefit of keeping patients out of hospital

Protective Clothing (20) (82) H1N1IV Fluids & Supplies (14) (27) Patient volumesMedical Gases (3) (28) Patient VolumesSutures (23) (28) Patient VolumesStaples & Accessories (1) (13) Patient MixSyringe, Needle and Sharpe Bins (6) (28) Patient VolumesTubes, drainage & suction (2) (18)Customised Procedure packs (3) (15)

Patient Consumables (20) (149)

Activity related, some of the variance is offset below against Operating Leases

Other (19) (46)Total Treatment Disposables (130) (614)

Sterilising Consumables (10) (19) Activity relatedOther (3) (6)Total Diagnostic Supplies & Other clinical equipment (13) (25)

Clinical Equipment -Minor Purchases 9 57 Expenditure is being closely monitoredClinical Equipment - Repairs & maintenance 3 (28) Budget over run in PerioperativeClinical Equipment - Depreciation 16 84 Timing of expenditure

Clinical Equipment - Operating Leases 8 43In part a change in coding therefore offset is against patient consumables

Clinical Equipment - Service Contracts 2 21 Over budgetingOther 5 11Total Instruments & Equipment 43 188

Ostomy Supplies 14 65 Patient demandOther 3 (3)Total Patient Appliances 17 62

Total Implant and Prosthesis 32 89 Volume delivery

Total Pharmaceuticals (59) (155)

Patient mix, Oncology which includes medical day stay has the highest variance

Total Other Clinical & Client Costs (41) (149) Air ambulance & ambulance

Total Clinical supplies (151) (603)


The table below shows the past 18 months of expenditure against the total clinical supplies line. Predominately the bulk of this cost category is driven by patient volumes and patient mix.

Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Jul-09 Aug-09 Sep-09 Oct-09 Nov-09 Dec-09

Total Clinical Supplies (1,688) (1,497) (1,731) (1,835) (1,600) (1,767) (1,684) (1,629) (1,911) (2,024) (1,964) (2,178) (1,847) (1,837) (1,790) (1,893) (1,991) (1,955)

Infrastructure and Non Clinical Supplies Total infrastructure and non clinical supplies costs were $1,576k for the month compared to a budget of $1,707k therefore generating a favourable variance to plan of $130k for December 09. YTD the variance compared to budget is unfavourable by $371k Hotel service costs are $13k over budget for the month and $116k YTD. YTD the items driving this variation include laundry charges. Part of the higher cost against budget is related to volume (including activity related to H1N1) but also there has been an associated cost with lost property. There also exists an unfavourable variance against patient meals $31k YTD, this is related to the variable portion of the contract, more meals than planned. $17k relates to food and groceries costs. There is also an over run against orderlies outsourced $28k; cleaning charges offset some of the YTD variance by sitting $13k under budget. Facilities costs are $66k within budget for the month and $334k YTD. Within this cost section the following comments support this variance

• maintenance expenditure resides within plan by $81k for the month and $35k YTD. This favourable variance needs to be offset with the salaries now sitting under the support category as this service is no longer outsourced

• the budget for electricity and coal expenditure needs to be looked at on an YTD basis as the phasing of the budget is creating artificial variances during the first half of the year. There has been an increase in the price of coal, the prediction is that the variance will be approximately $30k higher than budget.

• waste removal charges are $11k outside the YTD budget • building and plant depreciation is on plan for the month, the YTD position represents

an earlier error that was discovered in October that relates to the revaluation of some assets last year

• external storage charges reside $23k over YTD, this variance relates to last financial year some charges were missed during the year end accrual process.

Transport costs are within budget for the month and YTD. YTD the staff travel expense line is maintaining this positive variance along with fuel charges being under plan. Information systems and telecommunication costs are within plan for the month and YTD. Depreciation charges, IT leases and hardware minor purchases, software maintenance are favourable to budget but are offset with an over run against bureau and outsourcing fees ($14k), and direct telecommunication charges ($62k). Interest and financing costs are below plan by $345k YTD. This variance is driven by the capital charge cost being under budget by $363k. Total professional fees and expenses rest within YTD budget allocation by $66k. YTD all line items have been managed to planned parameters apart from insurance and affiliation fees. Total other operating expense includes the one liner of savings. This saving initiative is on top of the vacancy factors included in the salary lines. Each area in the hospital has been tasked with contributing to this savings initiative in various ways.


7. Forecast

The following table shows a high level forecast predicting that the final fiscal result will be worse than plan by $426k. This forecast assumes the same trends that are being currently experienced along with the assumptions relating to employment agreements as per the financial recovery plan. In terms of categories the forecast reflect the in housing of the building and property service.

YTD YTD YTD Forecast Annual budget VarianceActual Budget variance Jun-10 Jun-10 Jun-10$' 000 $' 000 $' 000 $' 000 $' 000 $' 000

Revenue 68,270 68,201 69 138,914 138,636 278

Less Personnel CostsMedical (11,741) (12,965) 1,224 (23,806) (25,589) 1,783 Nursing (18,069) (17,993) (76) (35,966) (35,802) (164) Allied (6,074) (6,052) (22) (12,240) (11,882) (358) Support (395) (287) (108) (1,301) (562) (739) Management / Admin (6,278) (6,434) 156 (12,567) (12,628) 61

(42,557) (43,731) 1,174 (85,880) (86,463) 583

Less Other CostsOutsourced Cost - Medical (5,193) (4,893) (300) (10,386) (9,897) (489) Outsourced Cost - Other (2,076) (1,982) (94) (4,159) (3,963) (196) Clinical Supplies (11,314) (10,709) (605) (22,777) (21,294) (1,483) Infrastructure Costs (10,194) (10,565) 371 (19,972) (20,853) 881

(28,777) (28,149) (628) (57,294) (56,007) (1,287)

Net Surplus / (Deficit) (3,064) (3,679) 615 (4,260) (3,834) (426)

8. Capital Commitments

TOTAL Core IS IS project BuildingsClinical & Other

Oral Health

Annual Budget 6,557 823 377 600 2,600 2,157

Carried Forward 2008/09 (Including those approved and ordered but not paid for)

1,840 461 583 65 731 -

Total Capital Available 8,397 1,284 960 665 3,331 2,157

Purchased YTD December 09 1,903 603 91 223 909 77 Donated Assets 12 12 WIP 84 81 3 Committed 698 166 224 - 191 117

Remaining Capital 5,700$ 516$ 564$ 442$ 2,218$ 1,960$

Significant purchases December 09 $'000Oxygen Concentrators 22$ 22

TOTAL 22$ -$ -$ -$ 22$ -$

Capital Budget as at December 09 ($'000)

The capital budget has to be managed within agreed parameters. Capital affordability will continue to be an issue in this financial year.


Statement of Financial Performance

Current Month Year to Date Annual

Part 2: DHB provider Actual Budget Variance Variance Actual Budget Variance Variance Budget

$(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

Part 2.1: Statement of Financial PerformanceREVENUEMinistry of Health MoH - Personal Health 56 46 10 F 21% 162 276 (115) U (41%) 553 MoH - Mental Health - - 0 F n/m - - 0 F n/m - MoH - Public Health 18 19 (1) U (6%) 56 115 (59) U (51%) 231 MoH - Disability Support Services 54 53 1 F 1% 322 318 4 F 1% 637 Clinical Training Agency 56 103 (47) U (46%) 430 619 (190) U (31%) 1,238 Internal - DHB Funder to DHB Provider 10,546 10,577 (31) U 0% 63,099 63,458 (359) U (1%) 129,149Ministry of Health Total 10,730 10,798 (68) U (1%) 64,069 64,788 (718) U (1%) 131,808Other Government Other DHB's 23 26 (3) U (12%) 132 157 (25) U (16%) 314 Training Fees and Subsidies 16 6 10 F 180% 25 34 (9) U (26%) 68 Accident Insurance 212 310 (98) U (32%) 2,068 1,862 206 F 11% 3,724 Other Government - 2 (2) U (100%) - 13 (13) U (100%) 26Other Government Total 251 344 (93) U (27%) 2,225 2,066 159 F 8% 4,132

Government and Crown Agency Total 10,981 11,142 (162) U (1%) 66,295 66,854 (559) U (1%) 135,940

Other Revenue Patient / Consumer Sourced 103 105 (1) U (1%) 866 629 237 F 38% 1,257 Other Income 155 120 35 F 29% 1,110 719 390 F 54% 1,439Other Revenue Total 258 225 34 F 15% 1,976 1,348 628 F 47% 2,696REVENUE TOTAL 11,239 11,367 (128) U (1%) 68,270 68,201 69 F 0% 138,636

EXPENSESPersonnel Expenses Medical Personnel (1,902) (2,245) 342 F 15% (11,742) (12,965) 1,223 F 9% (25,589) Nursing Personnel (3,343) (3,478) 135 F 4% (18,069) (17,993) (75) U (0%) (35,802) Allied Health Personnel (1,152) (1,063) (89) U (8%) (6,074) (6,052) (22) U (0%) (11,882) Support Services Personnel (151) (50) (101) U (202%) (395) (287) (108) U (38%) (563) Management / Admin Personnel (1,103) (1,123) 20 F 2% (6,278) (6,434) 156 F 2% (12,628)Personnel Costs Total (7,651) (7,958) 307 F 4% (42,558) (43,732) 1,174 F 3% (86,463)

Outsourced Expenses Medical Personnel (816) (885) 69 F 8% (5,193) (4,893) (300) U (6%) (9,897) Allied Health Personnel (20) (13) (7) U (57%) (119) (77) (41) U (54%) (154) Support Personnel (5) - (5) U n/m (9) - (9) U n/m - Management / Administration Personnel - (2) 2 F 87% (5) (11) 6 F 54% (22) Outsourced Clinical Services (301) (291) (10) U (3%) (1,802) (1,745) (58) U (3%) (3,487) Outsourced Corporate / Governance Services (23) (25) 1 F 6% (141) (149) 9 F 6% (298)Outsourced Services Total (1,165) (1,215) 50 F 4% (7,269) (6,875) (394) U (6%) (13,860)

Clinical Supplies Treatment Disposables (675) (546) (130) U (24%) (3,868) (3,254) (614) U (19%) (6,438) Diagnostic Supplies & Other Clinical Supplies (37) (24) (13) U (56%) (169) (144) (25) U (18%) (277) Instruments & Equipment (327) (369) 42 F 11% (1,989) (2,177) 187 F 9% (4,394) Patient Appliances (42) (60) 18 F 29% (291) (353) 62 F 18% (699) Implants & Prosthesis (147) (179) 32 F 18% (978) (1,068) 89 F 8% (2,114) Pharmaceuticals (581) (521) (60) U (11%) (3,250) (3,095) (155) U (5%) (6,146) Other Clinical Supplies (145) (104) (41) U (39%) (768) (618) (149) U (24%) (1,227)Clinical Supplies Total (1,955) (1,803) (151) U (8%) (11,314) (10,709) (605) U (6%) (21,295)

Infrastructure & Non Clinical Expenses Hotel Services, Laundry & Cleaning (385) (372) (13) U (3%) (2,324) (2,208) (116) U (5%) (4,379) Facilities (420) (487) 67 F 14% (2,959) (3,293) 334 F 10% (6,271) Transport (74) (114) 40 F 35% (516) (680) 164 F 24% (1,355) IT Systems & Telecommunications (223) (257) 34 F 13% (1,426) (1,523) 96 F 6% (3,066) Interest & Financing Charges (301) (375) 74 F 20% (1,906) (2,250) 345 F 15% (4,566) Professional Fees & Expenses (41) (47) 6 F 12% (210) (276) 66 F 24% (548) Other Operating Expenses (133) (56) (77) U (138%) (853) (334) (519) U (155%) (666)Infrastructure & Non-Clinical Supplies Total (1,576) (1,707) 130 F 8% (10,194) (10,565) 371 F 4% (20,852)Total Expenses (12,348) (12,683) 335 F 3% (71,335) (71,881) 546 F 1% (142,470)

Net Surplus/ (Deficit) (1,109) (1,316) 207 F 16% (3,065) (3,679) 615 F 17% (3,834)

HOSPITAL ADVISORY COMMITTEE MEETING · Welcome, Introduction and Apologies Interests Registers 1...

Documents

Transcript of HOSPITAL ADVISORY COMMITTEE MEETING · Welcome, Introduction and Apologies Interests Registers 1...