2013 14 qa final v01i

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He Arotake o ā Mātou Mahi

2013/14 Quality Account

November 2014

Quality, safety and experience of care Health and equity for all populations Best value for health system resources

2013/14 QA FINAL v1.0

Table of Contents

Opening Statements ............................................................................................................... 1 Our Commitment to Quality and Service Improvement ................................................................ 1 Providing Feedback

Executive Summary ................................................................................................................ 2

Background ................................................................................................................................ 4

1.0 Introduction ................................................................................................................ 5 Our Quality Improvement Framework ........................................................................................... 5

2.0 Our Performance in Review ................................................................................ 7 What is this About? ......................................................................................................................... 7 What Were Our Priorities for 2013/14 ........................................................................................... 7

2.1 Our Focus on Patients and Consumers .............................................................. 10 What is this about? .......................................................................................................................10 Feedback and Experiences of Care ...............................................................................................10 Reducing the Risk of Harm ............................................................................................................13 What is our focus for improvements in 2014/15? ........................................................................18

2.2 Our Focus on Services .............................................................................................. 19 What is this about? .......................................................................................................................19 Which services and why? ..............................................................................................................19

2.2.1 Child and youth health services ..................................................................................... 21 What did we want to achieve? .....................................................................................................21 How well did we do? .....................................................................................................................21 What is our focus for improvements in 2014/15? ........................................................................28

2.2.2 Primary health care services ........................................................................................... 29 What did we want to achieve? .....................................................................................................29 How well did we do? .....................................................................................................................29 What is our focus for improvements in 2014/15? ........................................................................36

2.2.3 Mental health and addiction services ............................................................................ 37 What did we want to achieve? .....................................................................................................37 How well did we do? .....................................................................................................................37 What is our focus for improvements in 2014/15? ........................................................................42

2.2.4 Health of older people .................................................................................................... 43 What did we want to achieve? .....................................................................................................43 How well did we do? .....................................................................................................................43 What is our focus for improvements in 2014/15? ........................................................................47

3.0 Celebrating our Partners .................................................................................... 48

Quality in context – some basic statistics about us 50


2013/14 QA FINAL v1.0 Page 1

Opening Statements

Our Commitment to Quality and Service Improvement

From the Chair and Chief Executive, MidCentral District Health Board

Everyone in our community experiences health care services in one way or another throughout

their life. As a publicly funded health and disability service, we are committed to ensuring that

that experience is as good as it can be.

This quality account is one way that we have to not only show how well we’re doing, but also

to show that we don’t always get it right. Our commitment to making improvements in the

quality of care that we provide to our community is without question – we rely on you, together

with our staff, to help us get it right.

Phil Sunderland, Chair

Murray Georgel, Chief Executive

From the Chair and Chief Executive, Central Primary Health Organisation

We are pleased to have partnered with MidCentral DHB in presenting our second combined

account of our progress in the quality of care we provide and some of things we are going to

do to continuously improve the experience of care for our patients, so that the right care is

delivered at the right time and place.

Bruce Stewart (Dr), Chair

Chiquita Hansen, Chief Executive

From the Chief Medical Officer, MidCentral DHB and Co-Chairs - Clinical Board, Central Primary Health Organisation

Across our district we have thousands of people with health care knowledge, skills and

dedication who arrive at work every day committed to providing the right care for the people

they see. This quality account highlights some areas where we do very well and other areas

where we plan to make improvements.

Ken Clark (Dr), Chief Medical Officer, MidCentral DHB

Dave Ayling (Dr) and Delamy Keall (Dr), Co-Chairs, Clinical Board, Central PHO

WE WANT YOUR FEEDBACK

We welcome your feedback on this, our second, Quality Account. We have a brief survey to help us with this if you would like to use it, at https://www.surveymonkey.com/s/mdhbourperformance. Otherwise, you can email your feedback to us at this address: [email protected]. Your feedback will be used to help us develop our future Quality Accounts. We appreciate your thoughts and comments.

https://www.surveymonkey.com/s/mdhbourperformance



Executive Summary

We, MidCentral District Health Board (MDHB) and our primary health organisation - Central PHO, are pleased to present our second snapshot account of the quality of services we provide. This publication highlights some of the key results of our performance, as well as profiles just some of the service improvements we have undertaken in the 2013/14 year. We hope that this review of our performance provides you with some information that supports your confidence and trust in the quality and safety of services we deliver. Our efforts to improve our services in response to your feedback and experiences of care are also highlighted. More of our financial and non-financial results for the year can be found in our respective Annual Reports, and a lot more information is also available on our respective websites www.midcentraldhb.govt.nz and www.centralpho.org.nz . We could not possibly encompass all that we would like you to know about. We have focused on some key performance measures of quality and safety together with highlighting some of the feedback and experiences of care by our patients and consumers of our hospital, community health and primary care services. We have also focused on four priority service areas – Child and youth health, Primary health care, Mental health and addictions, and, Health of older people because of their district wide functions and impact; where we have made improvements in access, responsiveness and timeliness of the services we provide as well as specific improvements in services for people with certain health conditions. Quality improvement is about measuring how well we are doing against what is expected then working together on ideas to get better results. Building on “The New Zealand Triple Aim”, we have developed our Quality Improvement Framework as a way to approach our quality and service improvement programmes, focusing on four interconnected elements: being consumer and community focused, getting it right, being willing and able to learn, and, being up to the job. The following table summarises our key priorities for improvements against the goals of the Triple Aim and our Quality Improvement Framework. In reviewing our performance for the year, this Quality Account highlights our achievements and what we need to improve in these areas.

Improved quality, safety and experience of care

Improved health and equity for all populations

Best value for public system resources

Being consumer and community focused

Increased consumer involvement

Better experiences of care

Independence enabled

Increased access to services

Reduced waiting times

Better integration and coordination of services

Resilient community

Getting it right

Reduced risk of harm

Better management of long term health conditions

Reduced unplanned, acute events

Reduced disparities in health status

Reduced avoidable hospitalisations and mortality

Better alignment of resources

Being willing and able to learn

Reduced variation in health care practices

Knowledgeable and skilled workforce

Collaborative partnerships with health and social service providers

Better use of information

Improved system performance

Being up to the job

Protected healthy environments

High performing teams

Fit for purpose services and facilities

Responsive health and disability services

Sound investment and financial management

http://www.midcentraldhb.govt.nz/

http://www.centralpho.org.nz/



Some of the performance improvements and achievements over the year include:

We implemented a range of things to improve information and our communications with our patients and consumers

We strengthened our quality improvement processes to support a reduction of falls in hospital that result in harm, surgical safety, and health care associated infections. Our results for most of the national quality and safety markers and outcome indicators compare favourably with the national average

We had fewer serious adverse events this year, and our system for reporting and reviewing adverse events is now the same across the hospital, community and primary health care setting

Our newborn enrolment programme was introduced in October 2013 and ended the year with 97.5% of newborns enrolled in services

We have increased our rates from 70% to 95% of eight month old infants being immunised on time and reduced the gaps in the results for different ethnicity groups

Fewer children aged 0 – 4 years were admitted to hospital with ambulatory sensitive conditions

More personal health services were delivered to young people in the Horowhenua and Otaki district

Heart and diabetes checks for eligible PHO enrolled adults increased by 31.6%

Support to quit smoking increased from 67% to 81.3% of 17,878 people – proportionately higher results were seen this year for Māori and Pacific people

General practice teams provided 1,895 Enhanced Care Plus packages of care to people with complex long term conditions

Clinical Networks are now well established, driving integrated ways of working and more collaborative clinical pathways have been introduced to guide evidence based practice and referral pathways

More staff across the sector participated in professional education and training and workforce development programmes

A single point of entry access pathway has been established between the Community Probation Service and the Non Government Organisation providers of alcohol and drug services to reduce waiting times for non urgent referrals

Our target access rates for people being seen by specialist mental health and addiction services were achieved for all age group and 80% of people with a non urgent referral to our mental health service were seen within three weeks

Services for pregnant women, mothers and their infants, family and whānau were strengthened to improve access and response to women experiencing perinatal mental health issues

The number of older patients discharged from hospital who received a Package of Temporary Support to assist them with their home-based recovery following an acute admission to hospital increased from 242 in 2011/12 to 573 by the end of June 2014

There was a significant increase in the number of older people taking up options for respite and day care services

The proportion of people aged 75 years or older who have an unplanned (acute) readmission to hospital has been consistently lower (better) than the national rate.

Our thanks go to all, including a number of consumer representatives, who have contributed to this Quality Account and for their commitment to improving the quality and safety of services provided to our community by a vast number of staff and range of health care providers throughout our district. Finally, we would welcome any feedback you may wish to provide on our Quality Account. Details of how best to do so are included on the earlier page with our Opening Statements.



Background

Who are we – MidCentral District Health Board and Central PHO

MidCentral District Health Board (MDHB), a Crown entity, is one of 20 District Health Boards in New Zealand that plans, manages, provides and purchases publicly-funded health services for the population of our district. This includes contracting for the provision of primary care services, hospital services, public health services, aged care services, and health services provided by non-government organisations and other providers including Māori health providers.

Important roles in delivering health and disability services are undertaken by public health units, primary health organisations and general practices, radiology and laboratory services, non-government organisations, hospitals and a range of health professionals including doctors, nurses, physiotherapists, social workers, dieticians, technicians, community pharmacists and the like.

The provision of primary health care services is managed on the DHB’s behalf through the Central Primary Health Organisation (PHO) – an organisation funded by us to support the provision of essential primary health care services through general practitioners (GPs) and general practice teams to people who are enrolled with the PHO. The aim is to ensure GP services are better linked with other primary health services to ensure a seamless continuum of care, in particular to better manage long term conditions, and to support better links with our hospital (MidCentral Health), specialists and associated services.

Our commitment to advancing the health and wellbeing of Māori in our district is formally recognised in a Memorandum of Understanding with Manawhenua Hauora – a consortium of the four Iwi in our district: Ngāti Kahungungu, Ngāti Raukawa, Rangitaane and Muaūpoko. For more details about who we are and what we do refer to our websites at www.midcentraldhb.govt.nz and www.centralpho.org.nz

Who are you – a profile of our population

Our district covers the Otaki ward of the Kapiti Coast district, the territorial local authority districts of Horowhenua, Palmerston North City, Manawatu and Tararua located across the mid-lower North Island.

The latest Census undertaken in 2013 shows our district has a usually resident population of 162,564 people; slightly more females (52%) than males, about 35% are under the age of 25 years, 48% aged between 25 and 64 years, and 17% are aged 65 and over. Our population tends to be similar to the national average, but with a higher proportion of older people.

We have a higher proportion of Māori (around 17%) and a lower proportion of Pacific people (3.5%) in comparison to the national average (14% and 7% respectively), with a growing proportion of Asian people living here (about 6%). There is proportionately more Māori living in the Otaki, Horowhenua and Tararua districts, than there is in the Palmerston North and Manawatu districts.

We have a slightly higher proportion of people in the more deprived sections of our population when compared to the national average.


http://www.centralpho.org.nz/



1.0 Introduction

1.1 What quality means to us There are many definitions of quality, both in health care and in relation to other areas of work. A working definition of quality guides us in our understanding of the services we deliver and helps us to design and shape the interventions and measures aimed at improving outcomes for the individuals and communities we serve. New Zealand has adopted a three-pronged approach to quality improvement – the New Zealand Triple Aim – that we are using as a foundation for our work. It has three dimensions:



Best value for public health system resources.

The New Zealand Triple Aim, as illustrated, shows that health care improvement is focused not only on individuals (patients, consumers), but also the populations we serve and the broader public health system. We use these three dimensions as goals that we work toward in planning, delivering and improving the health and disability services in our district.

1.2 Our Quality Improvement Framework Quality improvement is about measuring how well we are doing against what is expected, then working together on ideas to get better results. Building on the NZ Triple Aim, we have developed our Quality Improvement Framework as a way to approach our quality improvement programmes, focusing on four interconnected elements: being consumer and community focused, getting it right, being willing and able to learn, and, being up to the job. This is illustrated in the following figure.

By implementing and building on focused improvement activities in these four areas, we aim to progressively move toward achieving the goals and outcomes for our population, and giving effect to the six outcome domains of our Māori responsiveness framework – Te Anga Whāiti:

Te Kāwai Māori – Being Māori Te Hā O Te Māramatanga – Good Environment

Ngā Painga Pūmau – Good Services that Fit People

Te Pai Oranga – Wellness and Illness

Te Pū Arataki Whaihua – Leadership and Participation

Te Mana Rangatira – Having a Full and Enjoyable Life

The New Zealand Triple Aim



MidCentral District Health Board Quality Improvement Framework

What we are wanting to achieve – our intermediate outcomes



Best value for public system resources


Increased consumer involvement

Better experiences of care

Independence enabled

Increased access to services

Reduced waiting times

Better integration and coordination of services

Resilient community

Getting it right

Reduced risk of harm

Better management of long term health conditions

Reduced unplanned, acute events

Reduced disparities in health status

Reduced avoidable hospitalisations and mortality

Better alignment of resources


Reduced variation in health care practices

Knowledgeable and skilled workforce

Collaborative partnerships with health and social service providers

Better use of information

Improved system performance

Being up to the job

Protected healthy environments

High performing teams

Fit for purpose services and facilities

Responsive health and disability services

Sound investment and financial management



2.0 Our Performance in Review

What is this About? This publication of our second Quality Account for the MidCentral District Health Board (MDHB) region is borne out of a desire to provide meaningful and transparent information to the people of our district about the quality and safety of services we provided and on the progress we made with our planned improvements over the July 2013 to June 2014 year. This review of our non-financial performance sits alongside our more formal Annual Report, which includes our Statement of Service Performance and Financial Performance. This account offers us the opportunity to provide more detail than we can in our Annual Report and to show the importance of quality services being at the centre of what we do and that the health of our population improves. This review of our performance highlights some of what we have achieved against what we had planned, some of the successes, what we have learned and what we plan to do to further improve our services across our district. Additional information about our performance, including the results of the national Health Targets, can be found on our website at www.midcentraldhb.govt.nz as well as at www.health.govt.nz/new-zealand-health-system/my-dhb/midcentral-dhb. MidCentral DHB and the Central Primary Health Organisation (CPHO) have worked in partnership to bring together information that spans the primary health care, community and hospital-based services that you come into contact with during your interaction with our health and disability support services. This Quality Account does not cover all aspects of quality and safety in health care but focuses on a few that are high priorities for all of us. Section 2 in this Review of Our Performance is about our focus on patients and consumers and the importance of receiving feedback, learning from feedback and making improvements. This section also has a focus on reducing the risk of harm from serious adverse events and provides our results for the national Quality Safety Markers for the year as part of the Open for Better Care programme. Section 3 focuses on key services and includes some key results and information on our performance improvement activities in relation to Child and Youth Health, Primary Health Care Services, Mental Health and Addiction Services and Health of Older People. In reviewing our performance in these service areas, we have included a number of performance measures to illustrate our progress toward our goals, linked to the things that are important to improving the quality, safety and experiences of care, improving health and equity for our population, and, delivering best value for public health system resources.

What Were Our Priorities for 2013/14 Every year we develop an Annual Plan that is underpinned by legislative requirements and direction from Government, and in response to the assessed health needs of our community and priorities for improvement – all within the funds that are available. The Annual Plan identifies the actions required to deliver improved services against the range of national, regional and local priorities for 2013/14, covering:


http://www.health.govt.nz/new-zealand-health-system/my-dhb/midcentral-dhb

http://www.health.govt.nz/new-zealand-health-system/my-dhb/midcentral-dhb



• Building clinical integration of services across the whole system • Strengthening primary care development and networks • Improving clinical effectiveness and quality of services • Better managing unplanned, urgent care together with shorter stays in the Emergency Department • Shorter waiting times for surgery, cancer and cardiac services • Increasing immunisation coverage for children • Earlier identification of health risk and improved management of long term conditions, in particular

cardiovascular disease and diabetes • Promoting successful quit attempts for people who smoke tobacco • Supporting coordinated wrap around services for older people • Increasing access to specialist child and youth mental health and addiction services • Promoting whānau ora centred services • Providing value for money with efficient service delivery models and investment in future service

developments and infrastructure. In our first Quality Account for the 2012/13 year, we identified a number of focus areas for improvement in the 2013/14 year in addition to those that were identified in each specific service area. These included:

Strengthening quality improvement and safety practices across the district by taking steps to ensure services work more closely together, providing more opportunities to receive feedback from patients, ensuring that adverse events continue to be reported according to the national policy and that improvements continue to be made

Quality improvement in endoscopy services by reducing waiting time to at least 50% of people with an accepted referral for a colonoscopy being seen within the national thresholds, increasing specialist nursing services and introducing a rating scale that includes patient feedback. This will improve the process for patients then being able to access other services in a more timely way by being able to have the essential investigations completed on time

Maternity Quality and Safety programme by improving communication and teamwork across the district, looking at options for a primary birthing unit in Palmerston North, streamlining referrals to maternal mental health services and ensuring all women can access quality antenatal services across the district

Implementing the national Well Child / Tamariki Ora quality improvement framework, with a range of key performance indicators focused on screening and referral for vision and hearing deficits, learning and development issues, oral health status and coverage of 4 year old children having health checks

Surgical site infection programme. Reducing infections following knee and hip joint replacement surgery as a result of implementing national protocols for these procedures

Implementing the national medication safety programme and increasing partnerships with community pharmacists in delivering primary health care services.

These activities are aimed at making a difference to the services received and experienced by our patients and consumers, and our community more broadly, as well as contributing toward a stronger health system. In reviewing our performance for the year, the next sections of this Quality Account highlight our achievements and what we need to improve in these areas to achieve our goals and outcomes for our population.

Additional information about our performance over the 2013/14 year can be found in our Annual Report, at www.midcentraldhb.govt.nz/Publications.

http://www.midcentraldhb.govt.nz/Publications



Some examples of feedback from patients and consumers

Staying in hospital is traumatic, patients become invisible and become part of a conveyor belt, I understand the problem but that doesn’t make it easier.

Think of patients/carers as customers and put yourself in their shoes in thinking about how you can improve your service

My experience overall was great thanks

Try to improve communication between staff so patients don’t have to repeat themselves and explain their problems over and over again

I felt safe and well monitored in caring and capable nursing care throughout my stay

The lady on reception needs to smile and talk to patients

The staff could acknowledge your arrival rather than ignoring you

Too many nursing staff forget to come back to you when they agree to follow something up

The consultation notes sent to me were concise and an accurate record of what we spoke about

All staff in the ward contributed to my wellness, all need to be aware of how their friendly remarks helped me

It seems to me that I had little communication with the consultant including immediately after the procedure

The PHO dietician is fantastic. The technical advice she gives me is always clearly explained, she has take the time to understand me and food issues and while doing so she has not been scornful of my bad habits, but has helped and encouraged me to

find solutions which sit comfortably with me

I am seriously concerned about the lack of GPs in the Palmerston North area. I have rung many medical centres in the region and as I am not registered they are refusing to see me.

Dealing with this general practice is a health issue all on its own…where no one appears accountable, the patient, meaning me, is left stressed, upset and anxious

My feet are a continual problem – the PHO podiatrist has stopped them from getting any worse!!!

Most important thing patients need when ill is to feel staff are there for you and you feel safe

My general practice team are great. I’m really liking the Enhanced Care Plus programme – I have learnt so much about me and how to live well with my diabetes



2.1 Our Focus on Patients and Consumers

What is this about?

Evidence shows that patient safety improves when patients are involved and have more control in their own care. Understanding patients’ needs is crucial to good service delivery so that they drive the care delivered rather than the other way around. By listening to, and involving patients, we can find out what really matters and improve the experience of health care. This is about a partnership and ‘doing with’ rather than ‘doing for’ or ‘to’. Patient and family-centred care means that:

People are listened to and treated with dignity and respect

Health care providers communicate in a way that is meaningful for the patient/consumer and ensures that full and unbiased information is shared fully with the patient/consumer

Patients and their families are full partners and decision-makers in their own care as well as the design of the health care system, in partnership with the health care team.

We are committed to upholding the Code of Health and Disability Services Consumers’ Rights and to implementing all reasonable actions to ensure that we do. The Code of Rights establishes the rights of consumers, and the obligations and duties of providers to comply with the Code, see www.hdc.org.nz/the-act--code/the-code-of-rights This section focuses attention on how well we’re doing with involving our patients in the care we provide and responding to the feedback and concerns that you tell us about. It is also about bringing the safety of health care services that we deliver into focus through reporting what we do and how well we’ve done to reduce the risk of harm.

Feedback and Experiences of Care Brian and Tracey’s story

Brian arrived at the hospital for planned surgery following several weeks of testing to ensure he was fit for surgery. He was cleared for surgery at pre admission clinic. At the point of going to Operating Theatre, he was in his gown and was about to have the needle in his arm, when he was told he was unfit for surgery and needed more tests. Brian was also insulin dependent which had taken time and effort to manage having to be nil by mouth overnight. This resulted in confusion and distress given how close Brian had got to having surgery and left them unsure about what happened next.

This could have been avoided with improved communication between and within hospital services, with the general practitioner and with Brian and Tracey.

http://www.hdc.org.nz/the-act--code/the-code-of-rights

http://www.hdc.org.nz/the-act--code/the-code-of-rights



83.0%

84.0%

85.0%

86.0%

87.0%

88.0%

89.0%

90.0%

2009/10 2010/11 2011/12 2012/13 2013/14

Percentage of patients who rated their overall satisfaction with the services they received as

"good" or "very good"

Overall satisfaction Target

Key Messages

Communication is vital between patient/family, hospital services and primary health care practitioners to ensure everyone is on the same page

Take time to explain o Verbal communication - include family members especially when the patient has a hearing impairment o When giving written medical reports ensure the results are explained and that the patient understands o Patients and their family members are people, not numbers o When ongoing monitoring is required, ensure the patient is aware of the pathway and plan of care.

Our hospital-based patient survey

During the 2013/14 year, there were 2,121 responses to our survey of patients’ experiences of care and satisfaction with the services they received from our hospital services; a response rate of between 49% and 52% each month. A randomly selected sample of patients provided feedback in this survey using a 5-point rating scale against a set of standard statements. Some patients also took the opportunity to provide additional comments (see some examples of feedback from patients and consumers on page 8).

The majority (81%) of the respondents were between 25 and 84 years of age. Of the total 1,004 inpatient respondents, 84% were discharged from medical or surgical services. Of the total

1,117 respondents to the outpatient survey 61% were seen in surgical clinics. This graph shows fairly consistent results at around 88% of patients rating their level of overall satisfaction with the services they received as good or very good.

We use these survey results and feedback to inform quality improvement initiatives, such as better information and coordination of services provided to patients, supporting better discharge planning, managing outpatient appointments and waiting times, better communication pathways and improvements to the hospital environment.

What did we improve? Brian and Tracey’s story and feedback from patients responding to our survey provides useful information that highlight common issues in large, complex systems where communication, planning and coordinating arrangements, managing unexpected events and keeping focused on the individual’s needs is challenging at times. We don’t always get it right….


Patient Status at a Glance Boards are being installed above most hospital beds to show the patient’s requirements such as mobility, dietary needs, daily goals, discharge plans, special needs etc. There is also space for patients or family to note questions they may have.

Patient/Visitor information for the acute inpatient wards has been updated using feedback from staff and patients. This information is now being piloted in two wards prior to being finalised and implemented in other wards. The information includes visiting hours, smoking cessation support, spiritual support, meal times, uniform images to assist identifying the nursing role, as well as the Code of Health and Disability Services Consumers’ Rights.

Enhancing Visual Communication is a training course designed to help people learn basic visual communication and sign language skills. This course runs over an eight week period with 36 hospital staff having attended this course so far.



Shift handovers are now occurring at the bedside in several wards instead of being held in the nursing station. Each patient’s progress and plan of care on the ward is handed over directly to the incoming shift nurse by the outgoing shift nurse who cared for that patient, with the patient participating if they wish. All wards will be implementing this process over the coming months.

A Consumer Advisory Panel has been established to ensure that consumer perspectives are considered in the development of our longer term Master Health Services Plan and business case for reconfiguring our hospital. The panel has nine members, each of whom has established links with health or social services or advocacy networks such as mental health, older persons, palliative care, Māori, refugees and migrants.

A review of how we engage with and seek feedback from patients, families and others was completed. Findings from a review of our complaints and compliments system have now been implemented and include improved updates on progress with responses provided in managing complaints as well as a revised programme for the provision of communication and customer service education and training sessions for staff.

We received feedback from a family regarding lack of communication and information about the process for sedation of their child who required an investigation to be completed. There is an information brochure available for such circumstances, however, it was not used outside the Child Health Service; it has now been made more widely available.

Getting it right

Hospital-based and community pharmacists are vital members of the health care team. They help to ensure that patients and consumers are prescribed and take the right medicines they need for the right purpose at the right time, and that patients and consumers have the right information about the safe use of medicines. Key to this is having on time access to the most up-to-date information about what doctors are prescribing and what is being dispensed to patients across hospital and community settings.

All medical staff and pharmacists throughout the district have access to ‘Clinisafe’, a common database of laboratory tests and dispensed medicines. This shows what medicine has been dispensed by community pharmacies. Authorised access to this information helps doctors and pharmacists manage medicines better.

In early 2014, we commenced a project to assess the feasibility and usefulness of community-based pharmacists having access to our new Clinical Portal at the hospital. The project outcome will enable designated pharmacists access to a single, secure web-based system that brings together multiple hospital information systems for a patient when they see them at their pharmacy.

While it is too early yet to evaluate this project, initial feedback from the participating pharmacists confirms that the most useful aspect is being able to check hospital discharge summaries where any changes to prescribed medicines is documented to verify or clarify what has changed for the patient. Accessing the Clinical Portal has reduced their need to contact the hospital specialists or general practice, and has helped to ensure the patients get the right medicines, that they are used properly and that there is less waste with unused medicines being dispensed.

Being up to the job

New education sessions commenced early in 2014 that are relevant to feedback received from patients - for example around staff attitudes and communication. These sessions will assist in improving our levels of patient/consumer satisfaction with the services they receive. All staff are eligible to attend these new programmes, which are:

Deliver Excellence in Customer Service - The aim of this programme is to provide staff with strategies for dealing with patients/ consumers in a variety of situations, facilitate positive change in relationships with internal and external customers and improve levels of consumer satisfaction. Reference is made to the DHB’s Shared Approach to Work Principles, Complaints Policy and the Code of Health and Disability Services Consumers’ Rights.

Communication - A series of three Communication modules which build on each other can be attended separately or as a series. These modules are:



0

5

10

15

20

25

2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 2013/14

Number of Serious Adverse Events, 2006/07 - 2013/14 MidCentral DHB

All DHB Average MidCentral

Part A – Fundamentals of Effective Communication Part B – Communicate Assertively with Confidence Part C – Defuse Challenging Situations

These education sessions are delivered by an external provider specialising in these topics. The sessions have been very well received by staff attending. The external provider has been very impressed with those staff who have attended the sessions and reports that staff genuinely want to improve their communication.

Being willing and able to learn Implementing national medication safety programme

The incident reporting system now provides visibility of any adverse events relating to medication management to pharmacy staff and therefore ensures appropriate reviews and improvements are supported. This system also allows for identification of trends and ongoing wider improvement activities. Strengthening quality improvement processes

The system used for reporting adverse events and feedback from patients has been fully implemented in both the hospital and primary care settings. It is intended that information will be compared and trends identified to ensure ongoing improvements to service delivery. This ensures that adverse events are managed, reviewed and reported in a similar way across all areas. Staff in both settings are now trained to use the same investigation/review process.

Reducing the Risk of Harm

Serious Adverse Events

We reported 17 serious adverse events1 in the 2013/14 year –

four less than in the 2012/13 year, as shown in this graph alongside the average number of serious adverse events reported for all DHBs since 2006/07. The apparent increase in reported serious adverse events over the years reflects steady improvement in consistent reporting; this does not mean the number of serious adverse events has increased, only that more events are being correctly reported and reviewed each year against consistent criteria. Notably the majority of these events were related to falls in hospital.

This year, for the first time, the PHO has reported two serious adverse events. One related to undiagnosed fracture and one missed diagnosis. These events in primary care were investigated and as a result recommendations were made to improve assessment and communication processes.

Of the total events reported by us, nine were falls resulting in a fracture, two less than the previous year. The other eight events involved delayed or missed diagnosis (3 events), retained surgical item, incomplete assessment and two events of apparent suicide by inpatients. The two apparent suicide events, which occurred within a short space of time in our inpatient mental health service in the latter part of the year, were the catalyst for commissioning an independent review of the service (in addition to the internal adverse event investigations). As a result, 44 recommendations for improvement, covering clinical leadership, structure, resourcing, culture and environment were made. Addressing these recommendations is a key feature of the 2014/15 improvement plan and our progress with these will be subsequently included in our next Quality Account.

1 An “adverse event” means an incident which results in harm to a consumer. New Zealand Health and Disability Services - National

Reportable Events Policy, Health Quality and Safety Commission, March 2012.



The three events that related to delayed diagnosis have all been reviewed and changes were made to the levels of supervision by senior medical staff in the Emergency Department together with guidelines and training programmes for junior medical staff in the Emergency Department being strengthened to ensure standard practices are being met. Because the number of falls related events are higher than any other type of adverse events, a key focus for ongoing improvement effort continues to be on reducing the risk of and harm from falls.

Focus on Falls

The Falls Aware Ward programme has now been in place in Ward 25 for over six months. This programme involves widespread promotion and implementation of the 5 essentials of falls prevention: beds are at an appropriate height, call bells are handy, patients wear non slip footwear, bed spaces are clutter free and regular toileting is carried out. These messages are promoted to all staff either working in or visiting the ward, to all patients, visitors and to family. The programme includes banners at entrances to the ward, posters displayed around the hospital and specific information for patients and family.

An early evaluation indicated that while the number of falls had not reduced, the severity of the fall did. Compliance with the "5 Essentials” improved from 38% to 95% in the first three months of the pilot project on the ward. While it is unreasonable to expect to eliminate falls completely, we can endeavour to reduce the impact of preventable falls. The project has been rolled out to other wards, with keen interest also shown by GP practices and aged residential care facilities.

All hospital beds will be replaced over the next three years. The new beds lower much closer to the floor than the current beds and will reduce the risk of injury from falling and in some cases reduce the risk of a fall occurring.

The Patient Status at a Glance Board above most beds includes information on the patient’s mobility, risk of falling and assistance required for moving. This helps staff to recognise an individual’s requirements to reduce the risk of falling in hospital.

A Community Falls Action Group is now well established and has been working on implementing the falls aware programme, partnering in the “April No Falls” campaign and developing community-based falls risk assessment and prevention strategies planned for implementation in the 2014/15 year. The Falls in Older People Pathway was launched at our Falls Workshop held on 31 March 2014. This workshop, attended by 135 health practitioners, marked the beginning of ‘April Falls Week’. As well as the Falls Pathway being launched, the workshop included other topics such as the national Patient Safety Campaign, Assessment of bone health, targeted medication reviews and home environment assessments. Development of the Falls in Older People Pathway was a collaboration between hospital and primary health care professionals with representation from ElderHealth Services, General Practice, Clinical Pharmacy, Physiotherapy and Central PHO Physical Activity Officers. The expected benefits of this pathway are:

Consistent and structured approach to the assessment of falls in older people

Appropriate people being referred for specialist assessment

Appropriate treatment with vitamin D and medications for osteoporosis

Reduction in falls and fractures

Reduction in unnecessary medications.



Quality and Safety Markers 2

Reducing harm from falls

Falls risk assessments for patients aged 75 years and older (aged 55 years and older for Māori and Pacific people) is a process that is carried out when patients are admitted to hospital. This helps to identify the likelihood that a patient could fall and cause injury to themselves and to then put in place individualised care plans to reduce the likelihood and consequences of the patient falling. During the 2013/14 year, a total of 3,917 patients of the 4,606 eligible patients discharged from an inpatient ward had a falls risk assessment completed (85% over the year). Some of the shortfall in our result, when considering the national goal of 90%, was attributed to patients who have a short stay like our day of surgery unit and the medical assessment and planning unit.

Of those patients with a risk score of 2 or more out of 5 (which triggers particular care protocols), a sample of records was examined to determine whether each patient had an individualised care plan in place to address their risk of falling. Of the total 547 records audited over the year, 506 (92.5%) had evidence of a plan being in place; a pleasing result that consistently exceeded the national threshold (90%) each quarter. This gives us, as well as patients, some confidence that we have things in place to minimise the risk of harm from falls occurring while in hospital.

As a result of having the falls risk assessment and planning processes in place, we want to know whether we are having an impact on reducing the incidence of falls that result in a fractured hip. The graph to the left shows that there has been no statistical difference to the number of falls with a fractured hip that occur in hospital – on average about 0.4 each month (or 1.5 per quarter) since July 2010. The rolling 12 month result to June 2014 reduced to 5.0 falls with a fractured hip compared to 7.0 over the 12 months to June 2013.

2 More information about the Quality and Safety Markers as part of the national patient safety campaign Open for Better Care can be

found on the Health Quality and Safety Commission website at Health Quality & Safety Commission | Quality & Safety Markers

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

100%

2012/13 Baseline Qtr 1 Qtr 2 Qtr 3 Qtr 4

2013/14

Percentage of eligible admitted patients who have

had a falls risk assessment

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Threshold

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In hospital falls with fractured neck of femurJuly 2010 - June 2014

Cusum Vlo Vhi

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

100%

2012/13 Baseline Qtr 1 Qtr 2 Qtr 3 Qtr 4

2013/14

Percentage of patients at risk of falling (who had a risk

score of >=2) who had an individualsed care plan in place to address that risk

Result

National

Threshold

http://www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/quality-and-safety-markers/



Reducing perioperative harm

A process measure that commenced this year is the degree to which all three parts of the Surgical Safety Checklist developed by the World Health Organisation (adapted for use in Australasia) is used in operations performed by DHBs. The checklist is a commonsense approach to ensuring the correct surgical procedures are carried out on the correct patient. It requires hospital staff to stop and check what they are doing and why. It involves checking the right people are present and that they all are in agreement about why they are operating. Thinking about what could go wrong, for example checking for allergies to medicines is also part of the checklist. The checklist invites documentation of communications between the entire surgical team before anaesthesia commences, before the surgical procedure commences, and before the patient leaves the operating room.

The current national goal is that all three parts of the surgical safety checklist are used in 90% of the operations. Our results from the audit of documentation for the operations sampled varied each quarter from 87.2% to 92.4%.

Of the 523 records sampled over the year, there was evidence of 472 (90.2%) of the operations having all three parts of the checklist completed.

The two outcome measures for surgical safety refer to the incidence of complications such as deep vein thrombosis (DVT) or pulmonary embolism (PE) and sepsis resulting from an infection. The average incidence rate of DVT/PE over the last four years was 4.23 per 1,000 admissions (range 1.81 to 7.75 per 1,000 admissions in a quarter, or, anywhere between 3 and 11 occurrences in a quarter). For sepsis, the average incidence rate over the last 4 years was 14.63 per 1,000 admissions (range 6.79 – 26.95 per 1,000 admissions in a quarter, or, between 3 and 10 occurrences in a quarter). Although there has been a small increase in the average incidence rate when compared to the previous 4-year period from July 2006, the changes are not statistically significant.

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Incidence Average

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Deep Vein Thrombosis / Pulmonary Embolism

incidence per 1000 admissions

Incidence Average

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85%86%87%88%89%90%91%92%93%94%95%

Qtr 1 Qtr 2 Qtr 3 Qtr 4

2013/14

Percentage of sample operations audited where all

three parts of the Surgical Safety Checklist were completed

Result

National

Threshold



HAND HYGIENE IT’S BLACK & WHITE

Reducing health care associated infections

Hand hygiene plays a vital role in preventing harm to patients. Performing excellent hand hygiene at the right time is the most important measure healthcare staff can take to avoid spreading harmful bacteria and to prevent healthcare associated infections. The World Health Organisation approach identifies the following 5 moments for hand hygiene as being critical to the prevention and control of infections:

1. Directly before patient contact 2. Directly before a procedure 3. Directly after a procedure or body fluid exposure 4. After patient contact 5. After contact with patient surroundings.

Hand hygiene is measured by a standardised process of observing the level of compliance with 2100 hand hygiene moments three times each year, undertaken by specifically trained and certified auditors as part of the Hand Hygiene New Zealand programme.

As seen in the top graph, we have been achieving the national goal of at least 70% compliance with the ‘5 moments’ since November 2012 with the exception of the November 2013 to March 2014 audit period. We identified one area of the hospital that was not performing to standard and after some targeted improvement initiatives being implemented, including increased staff education, training and support with stronger performance feedback loops in place, our results for this last quarter improved and returned to a result of 72% – similar to the national rate of 73% for this period. In terms of outcomes, over the 12 months to April 2014 we had 4 instances of a staphylococcus aureus bloodstream infection – an average rate of 0.16 per 1000 beddays per month, and a cumulative rate of 1.24 per 1000 inpatient beddays over the 25 months to end of April 2014 (no significant changes in these rates since January 2012).

We anticipate maintaining at least this minimum goal, but will be working toward a higher challenging goal of 80% of the observed moments being compliant by the end of June 2015.

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hand hygiene

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Health care associated Staph. Aureus bacteraemia per

1000 inpatient bed days

Cusum Vlo Vhi

We have retained a zero rate of central line associated bacteraemia in our Intensive Care Unit (ICU). Although our reported rates of compliance with procedures for inserting central line catheters were below the national goal of 90% up until the last quarter of the year (94%), we know that the lower rates (averaging 85%) were because we did not get the right information documented on time to meet the audit requirements. We spent some time on improving processes, which shows in the much better results this last quarter.



What is our focus for improvements in 2014/15?

A new national Patient experience survey has been developed and will be implemented from August 2014. The survey is made up of a standard set of 20 questions directed at obtaining perspectives on key things that are important to users of our inpatient services. We will be administering the survey in paper-based form in the first instance. Ultimately, we would like the survey to be completed electronically and administered nationally (with confidential unique identifiers, as it is for other DHBs) but we have some work to do to include these kind of contact details when patients are admitted to hospital. The national survey, which replaces the survey tool we had in place for several years, will continue to provide valuable feedback and assist us with improving our services

While both hospital, community and now primary health care services have developed similar

processes for reporting and reviewing adverse events and feedback from patients/consumers, we will be strengthening our processes to ensure that we share our knowledge and experience and use what we learnt from these events, so that every opportunity is taken to continually improve our services

The community-based falls action group will be exploring exercise programme options that could be

made available for building up strength and balance for a targeted at-risk population as another falls prevention initiative. We will also be rolling out the “falls aware ward” concept to Aged Residential Care facilities, starting with the six Aged Residential Care facilities represented at a recent workshop, but will be open to any interested facility. We are also keen to develop a process whereby people who are attended to by the ambulance service following a fall, and not conveyed to hospital, are followed up with appropriate falls risk assessment and strategies implemented if necessary, coordinated by the person’s primary care team

Increasing our rates of compliance with the 5 moments for hand hygiene toward the higher goal of

80% by June 2015 A disability self audit tool will be implemented in a staged process across health services. This audit

is designed to highlight not only the improvements required relating to physical access, but also staff knowledge, resources, education, patient information and signage.

Implementing the mental health service review recommendations and service improvement plan

Continuing to implement priorities of the Open for Better Care campaign, in particular relating to the

focus areas for medication safety



2.2 Our Focus on Services

What is this about? We are looking at improving health service delivery for our community, in particular for population groups that have higher health needs, use a range of health and disability services or who are at risk of developing illnesses or longer term health conditions. We want to focus on care that is delivered across all settings and not just in the hospital or at your doctor’s rooms. The four services/populations that are highlighted in the following pages are a high priority for us and for those who use our services. The Government has also identified these four areas, among others, as high priorities when setting direction and funding for us. We have made many improvements and more are planned, but there are many more things that could still be done. We will highlight where we have done well, where we still have work to do, what that work is, when that work is planned and how you can contribute.

Which services and why?

1 Child and youth health services This is about improving the health and safety of our future generations. We need to bring all health services that support children and their families closer together and make sure we get the best possible outcomes for our children. This includes making sure children, adolescents and their families can have their say about the services we provide now and what they see as the best options for coming years. We are working on reducing rates of avoidable hospitalisations, ensuring all eligible children are offered the health checks to which they are entitled, increasing immunisation rates and ensuring newborn babies are registered with health providers. Our Child and Youth Health programme of work is led by a strong clinical network with representatives from health, education, police, social sector agencies and non-Government organisations. By working together we can support better coordination and integration of services for children and youth.

2 Primary health care services This is about your health provider that you go to first in the community and may be your doctor, nurse, pharmacist, plunket nurse etc. We want to make sure that more services are provided closer to where you live and work. This means more health services need to be grouped together in one place to make it easier for you to use these services. It is also about more services being provided to people who have long term health problems like diabetes and respiratory disease so that they don’t need to go to hospital as often. We also want to make sure that hospital staff and health providers in the community work closely together sharing information to better understand your health needs.



3 Mental health and addiction services This is a local priority particularly in respect of services for youth. About 3% of our population is known to have serious mental illness and about 20% of our population will be affected by mental health issues. Mental health and addiction services are not always in the right place at the right time or delivered in the way that suits the consumer, or their whānau/family. We are aiming to build on the range of services available in the community to improve access. This will help the services to be more responsive and better coordinated when working across the health, social and justice sectors. We also aim to involve consumers more in our service developments as well as build the capability of our collective workforce to address service gaps. We will be using the Ministry of Health’s Mental Health Service Development Plan “Rising to the Challenge” (2012-2017) as a guide to addressing service gaps and improving performance over the next five years.

4 Health of older people As the community ages, it is critical people are encouraged to live well and keep active as a deterrent to many of the diseases that can be associated with old age. There is no cure for cognitive impairment, dementias and frailty. Maintaining good health and having access to a wide range of primary care and social supports will defer the impact of many diseases and enable people to “age well”. The focus for us is to enable timely access to general practice team support and continue to develop a range of community supports that can address the needs of older people, ensuring they are able to live at home safely. Seventy percent of older people who receive community services have a cognitive impairment or dementia. Therefore dementia services have been specifically prioritised to ensure carer, whānau and family are able to continue in their life roles for as long as possible. The older person’s clinical network is the platform for initiating and engaging workgroups to progress areas of focus, which will include advance care planning, promoting safe environments for people with dementia living at home and supporting active and healthy aging in our community.



2.2.1 Child and youth health services

What did we want to achieve?

Rolling out the ‘health home’ newborn enrolment programme to ensure children are offered the services to which they are entitled

Promoting and supporting the use of clinical pathways for children and checking that these are making a difference

Reducing the numbers of children who are admitted to hospital for certain conditions by diagnosing and treating them earlier and closer to home

Extending the community-based child health team to increase the range of services available to families in the community

Advancing components of the Government’s Children’s Action Plan

Aligning our quality activities to the new national Well Child / Tamariki Ora Quality Improvement Framework

How well did we do? Newborn enrolment programme performed well since it commenced in October 2013, with 97.5% of

newborns enrolled

On time immunisation rates for eight month old infants exceeded expectations for all ethnicity groups

Fewer 0 – 4 year old children were admitted to hospital with conditions that are preventable or amenable to earlier interventions by primary health care services

Children’s Team established for the Horowhenua and Otaki district to advance services for vulnerable children

More personal health services delivered to young people in Horowhenua and Otaki and better access to sexual health services across the district

Collaborative plan established with Māori health providers and other Well Child providers to focus improvements on the Well Child Tamariki Ora Improvement programme

Four additional Collaborative Clinical Pathways were published focused on children with behavioural issues, complemented by six child health patient pathways developed by consumer representatives

Progressed priorities of the Maternity Quality and Safety programme as part of the Regional Women’s Health Service with Whanganui District Health Board

The pilot community pharmacy service for paediatric gastroenteritis was so successful that it has been extended for another three years



General Practices

and PHO National

Immunisation

Register

(NIR)

Well Child /

Tamariki Ora

(WCTO) service

providers Child &

Adolescent Oral

Health Services

(CAOHS)

Universal

Newborn Hearing

Screening Early

Intervention

Programme

(UNHSP)


Increasing enrolment of children in health services

Before the Newborn enrolment programme commenced in October 2013, we found that:

Up to 28% of babies were being discharged from

Maternity services with no GP

The Well Child referral system was not working well

Lead Maternity Carers were having trouble placing

some newborns with GPs

We were falling short of the six-week milestone

immunisation targets

The Universal Newborn Hearing Screening Early

Intervention Programme was having trouble

accessing referrals and the information they required

for early screening

We had good data but it was fragmented and

nobody had the whole picture

The worried well navigated the system without

assistance while the at-risk population often got lost

Many families were not aware of their child’s health entitlements.

Since then:

1,537 newborn enrolment forms have been received since the start of the programme, leading to 97.5% of newborns being enrolled

All children have been enrolled with the National Immunisation Register

822 (52%) babies had their GP details updated on the enrolment register because they either didn’t have a GP and the family has since been placed with a GP, or, the information coming from maternity services or Lead Maternity Carer was incorrect

Only five children recorded as not having a GP

Only 57 children recorded as not being enrolled with a Well Child provider. Of these, 45 were born elsewhere and moved into our district, seven were unable to be contacted after having never received a newborn enrolment form and five chose not to use a Well Child provider.

The aim of the programme is to ensure that every baby born in our district is connected to key health services to which they are entitled. It is designed to encourage and support early enrolment and engagement of families following their baby’s birth with the following services:

A General practice team

A Well Child/Tamariki Ora service provider

The National Immunisation Register

The Child and Adolescent Oral Health Services

The Universal Newborn Hearing Screening and Early Intervention Programme.

Benefits so far: Fewer children

without a GP

Fewer children without a Well Child provider

A single point of contact for Midwives having problems placing a child with a GP

A single point of contact for parents and caregivers who have questions about the services they are entitled to

Well Child providers notified earlier of parents wanting their children to access their service

Immunisation rates exceeding national targets

The Universal Newborn Hearing Screening Early Intervention Programme getting more timely and complete information on referrals

One form and contact point for all services involved

Information on the Hospital Patient Administration System is being updated especially around up-to-date addresses and GP

Better able to follow up at-risk children using the

“alternative contact” details supplied on the form.



Universal newborn hearing screening and early intervention programme

Screening for hearing loss is strongly recommended for all newborn babies

Research tells us that if we find out a baby has a hearing loss early we can begin interventions and improve a child's ability to develop language and to learn and develop social skills. Current information suggests that Māori and Pacific babies and children are more likely to have a hearing loss than other

babies and children in New Zealand.

Proportion of newborns who had hearing screening completed within one month of birth

The newborn enrolment programme has assisted with ensuring every newborn is offered a hearing screening within one month of birth. Over the year there was a 6% increase in the number of families with newborns offered screening. Of the 2,149 babies, 77.7% had a hearing screening completed – an increase compared to the previous year (60.5% / 1,218 in 2012/13), with results each quarter at around 80% of newborns screened up until last quarter. The number of families declining screening decreased from 24 in the 2011/12 year to 11 in 2013/14. Of the 1,662 newborns screened, around 6% (96) required targeted follow up by specialist services. Fluctuations in the numbers of screenings able to be completed each quarter were attributable to the availability of audiology screening staff and the time taken to recruit to positions. Also, recent changes to protocols and guidelines for the national programme have resulted in delays to fully resourcing the service with staffing and equipment. This is being addressed in the 2014/15 year so that audiology services can prioritise infants and children, including those referred from the Before School Check programme.

Getting it right

Of the 2,201 eligible infants over the 2013/14 year, 2,094 (95.1%) had had their primary course of immunisation (six weeks, three months and five months) on time. Particularly pleasing was that the target rate had been exceeded for each ethnicity group of eligible infants. We are already achieving the new national goal, which increases to 95% by December 2014.

Increasing on time immunisations

The immunisation service focuses on all children from birth ensuring they have both access to and opportunity for immunisation. We have increased our immunisation rates from 70% to 95% and reduced the gaps between the results for different ethnicity groups.

By using complete and accurate data and sharing that information with all those involved with the immunisation programme, the immunisation team is able to ensure that families have the right information about the programme and the need for on time vaccinations. The team offers flexibility in the choice of options available to have their infant immunised – whether at home, at clinics, by their general practice team, their chosen well child provider or the nurses with the outreach immunisation team.

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Screening Completed Screening Not Completed



Being up to the job Increasing access to health services Personal health services for young people in the Horowhenua district

The intersectoral ‘Life to the Max’ social sector trial that has been underway in Levin for about three years now was the genesis for additional investment in personal health services for young people in the Horowhenua and Otaki districts. Increased General Practitioner and Registered Nurse time focused on young people together with an alcohol and drug clinician added to the pool of available health services, including the youth workers and School based health services. The additional health resources are under the umbrella organisation of the Youth One Stop Shop (YOSS) so they can benefit by their oversight, training and support while retaining their focus on the needs of young people in the Horowhenua.

Sexual Health Services

Rates of laboratory-confirmed chlamydia and gonorrhoea per 100,000 population* in the 15 – 24 year old age groups – MidCentral DHB and NZ

What’s the problem?

New data processing methods were introduced in 2013. While Nucleic acid amplification tests (NAAT) has been the standard method for testing for chlamydia some years, it was recently introduced for testing for gonorrhea – the influence of introducing NAAT testing must be considered when comparing trends over time.

The reported rates of chlamydia and gonorrhea increased in 2013 in MidCentral’s 15 – 19 year old age group but continued to decrease in the 20 – 24 year old age group. Although the rates of gonorrhoea were considerably lower than the national rates for those tested in the 15 – 24 years of age group, for chlamydia the rates were higher. Chlamydia is most commonly diagnosed in females aged 15–19 years and in males aged 20–24 years.

Chlamydia MidCentral New Zealand

2011 2012 2013 2013

15-19 yrs 3270 3113 3152 3080

20-24 yrs 3295 3029 2700 2981

Gonorrhoea MidCentral New Zealand

2011 2012 2013 2013

15-19 yrs 270 146 190 358

20-24 yrs 320 183 83 277

Source: ESR June 2014 - Sexually Transmitted Infections in New Zealand Annual Surveillance Report, 2013

* Population = Statistics New Zealand mid-year population estimates

Making services more accessible and easier

New initiatives by our Sexual Health Service are making testing easier and more accessible for clients. A change in the way testing is conducted for gonorrhoea and chlamydia means that sexual health testing is now far less invasive. The service continues to offer tests for HIV, hepatitis B and syphilis.

Two new clinics are now available for clients wishing to get a check up. Express clinics are being made available for those who have no symptoms but are after a ‘peace of mind’ check-up, or those who struggle to find time to get to the clinic.

Nurse-led walk-in clinics are provided both for convenience, and for people who have symptoms and need to be seen urgently. Sexual Health Clinical Nurse Specialist Kate Allen said: “These new initiatives are great news for our clients. Sexual health is an important issue, so anything that makes it easier

for people to visit us and get checked is a great thing. The fact that the tests are now less invasive makes it more comfortable for clients wishing to get tested.” The service is free for all age groups. The service is located in the Community Health Village on the Palmerston North Hospital grounds. Outreach clinics are also held in Levin and Dannevirke.



Connecting with young people

Excerpts from “Ghost Talk, Late Love, Wet Eyes and Going Down with the Ship: A Non-randomised, Uncontrolled Trial” (Keynote address to the 2013 APAC Forum), and, “Making Sense of Medicine”.

Authored by Dr Glenn Colquhoun – Horowhenua Youth Worker, GP, poet and children’s writer. Used with his permission.

“Currently I am employed by two different organizations

under two different contracts with wildly differing pay scales

but in reality I do one job. I see young people. My bosses are

flexible and long-suffering. We have clinics in the

community and in two of the three high schools where the

best of the old model can be retained but I am free to leave

the clinic each week also and follow up young people who

need more time to talk or a ride to the hospital or who need

to know that they are worth a big person checking on how

they are doing. I get to help out on a local alternative

education program for students who have been excluded

from main stream schools and I get to run a creative writing

group for those who share a similar wound. I can see young

people individually or in groups. I can see them for two

minutes, ten minutes, thirty minutes or an hour. I can bake

with them, carve bone with them, eat burgers with them and

watch movies. I can knock on their doors and explain again

what they are bound to have forgotten the first time round. I

am poorer but richer. Some joy has returned to medicine for

me.”

“I think about patients now outside of work and wonder how

to reach them as though I was stuck on a line in the middle

of a poem. Medicine has entered my imagination. My room

is filling up with toys and models and props that explain the

abstract to more concrete minds. My subconscious is

figuring out what to do next in cases where I am stuck. This

has only ever happened in poetry for me, answers to

problems appearing days later when I thought I had given up

on them. I am stockpiling a shelf full of books to give away

to young people who might find something they can identify

with in a particular story. To be able to hand someone a book

instead of a script for fluoxetine or methylphenidate or

something to help them sleep and say this is a story you

might like seems a great freedom. Many of the young people

I work with have my cellphone number. For years I guarded

it as though it was some sacred barrier that could not be

crossed. I am discovering that it is much more convenient

for my patients to have it. No one has abused it. Texted

consultations are evolving in which patients are more direct

in what they want to say than when they are face to face. In the context of being able to see them face to face later it is a

useful adjunct”

“Families are young people soil. It is not difficult to know this but it can be difficult to know how to get a grasp on the

handle that ensures this and then to know which way to turn it. I have seen many times the whakapapa of an illness a

patient is struggling with in the present begin generations earlier in community upheaval and a loss of resource, language,

belief and mana. Over time it has evolved through various stages: social dislocation, relative poverty, unemployment,

frustration, negative self-esteem, anger, drug and alcohol use, violence, loss of attachment, school failure, abuse,

depression, anxiety, disengagement, loss of hope and criminality. By the time it is only a short way into this journey it

has become a template that is too easily stamped into the young of each succeeding generation.”

Horowhenua Chronicle, 27 August 2014



“My new role is very old medicine. It’s about walking alongside people, being part of their lives, somebody to call if

there’s a problem. It’s a steadying of the ship. Not flash medicine or big medicine, just the pastoral element of being a

doctor. It’s painstaking and it takes a lot of time but I sleep straighter in bed knowing that I can authentically connect

with my patients. For the first time in a long time, I’m practising medicine.”


Reducing avoidable hospitalisations

The rate of hospitalisations for certain conditions that are preventable or avoidable through early intervention from primary health care services (ambulatory sensitive hospitalisations, or ASH) has been steadily reducing since 2011/12 particularly for Māori children. We had a rate of 4,645 hospitalisations per 100,000 total 0-4 year old population (326 actual hospitalisations) – less than the previous year and slightly above the national rate. However for Māori children the rate reduced from 5,576 to 5,505/100,000 population (177 actual hospitalisations).

The ASH conditions with the higher rate of hospitalisations for our children include: dental conditions, upper respiratory or ear, nose and throat infections, gastroenteritis/dehydration, pneumonia, asthma and cellulitis or dermatitis.

We have had some success with initiatives to reduce ASH admissions for children aged 0 – 4 years focused on better management of skin conditions, gastroenteritis and asthma.

The development of six child health patient pathways to complement the CCPs was led by a consumer representative. The patient pathways outline the steps used by health professionals in the diagnosis and management of health conditions. Access to this information is publicly available on the Central PHO website and enables patients and their families/whānau to be better informed about what to expect and have greater confidence

in the care provided to them.

Te Ara Whānau Ora Case Study

A solo mother of five children aged from 4 to 16 years was referred to the service. The two youngest children (aged 4 and 8) had presented to the Emergency Department eight times in the last nine months for chronic asthma related illnesses. The children’s mother required better information to increase her confidence in managing the children’s asthma challenges.

Te Ara Whānau Ora utilises a genogram which highlighted the hereditary and frequent nature of asthma and other illnesses amongst the mother’s wider whānau. The genogram also helped to identify that the mother had two siblings with children who also had chronic asthma. The wider whānau was brought together by the Whānau Ora Navigator to meet with a specialist asthma doctor. This gave them the opportunity to formulate some coping strategies and a plan was designed for when attacks occur. It also provided education on prevention measures and how to provide an environment that would not exacerbate the condition. This whānau was now able to provide a sense of support to each other.

Through the use of the genogram this whānau began to open up and become receptive to some conversations and critical thinking regarding their current situation which helped put things into perspective and seemed achievable. The involvement of the Navigator facilitated and increased whānau involvement and activity around the issues they faced when dealing with their children’s asthma related challenges. This increased knowledge amongst the whānau had a direct impact on:

Strengthening whānau bonds

Increasing the whānau confidence in managing illness

Increasing skills to reduce negative environmental effects on the children’s health

Reducing presentations to the Emergency Department

-

20

40

60

80

100

120

140

160

Standardised Discharge Ratio - Ambulatory Sensitive

Hospitalisations for the Top Six Conditions in 0 - 4 year old Children - MidCentral district. Year to March 2014

Maori

Other



Children’s Team – Horowhenua and Otaki In May 2014, the Minister of Social Development, Paula Bennett announced that the Horowhenua/Otaki district would become one of ten areas across the country to establish a Regional Children’s Team by the end of June 2015. The Horowhenua/Otaki Children’s Team - Tamariki Te Tuatahi is part of the Government’s wider plan to support vulnerable children through implementing the Children’s Action Plan. The Children’s Action Plan is driven locally and supported nationally by a local governance group who are the authors of the plans and responsible for monitoring its progress.

Our Children’s Team was officially launched in early September 2014 after much work in the preceding months with the relevant agencies to establish it; building on the strong foundations provided by the social sector trial and the intersectoral forum provided by the Regional Interagency Network. The Children’s Team is made up of skilled frontline practitioners and professionals with diverse perspectives, experiences and local knowledge, drawn from across government, iwi/Māori, NGOs and community. They are best placed to respond to the unique and often complex set of circumstances and needs, within the unique context of each community. It’s their responsibility to ensure that the very best decisions are taken to address the needs of the child. The Children’s Team will be operating in Foxton, Levin, Otaki and Shannon alongside existing initiatives to support children in the area.

Once a referral for a child is accepted, the trans-disciplinary Children’s Team appoints a Lead Professional with the right skills, experience and background to work with the child and their family/whānau. The Lead Professional brings together all of the different people involved in a child’s life and works with them to develop and then action a single plan for the child.

Maternity Quality and Safety Programme

The MidCentral and Whanganui District Health Boards’ Maternity Quality and Safety Programme (MQSP) 2012 – 2015 provides the building blocks to guide continuous quality improvement of maternity services.

The MQSP programme is being implemented in parallel to the planned regional approach to implementing the Regional Women’s Health Service – a joint service development model between MidCentral and Whanganui District Health Boards (DHBs), which commenced from July 2013.

The Quality and Safety Programme highlights for the 2013/14 year included:

Developing an early pregnancy collaborative clinical pathway using the Map of Medicine tool, based on evidence of good practice, international and national guidelines and patient/client information. The pathway will enable a readily accessible checklist and referral process for the assessment, screening and antenatal care of women once a pregnancy is confirmed. This collaborative pathway will also help to strengthen the relationships between general practice teams and Lead Maternity Carers. The tool is expected to be launched in the latter part of 2014.

Strengthening consumer engagement and participation at the governance level and on local projects – appointing consumers representing rural women and their whānau, teen parents, consumers of childbirth education and primary birthing units and who have links to Iwi/Māori and other networks across the region. The consumer representatives actively contribute to the programme by providing advice, feedback and guidance on service developments and quality improvement projects from their unique perspectives.



Implementing the “5 in 10” promotional campaign to encourage pregnant women to register early with a Lead Maternity Carer (LMC), including “Top 5 in 10” education sessions, promoting public awareness at health expos, back of the bus advertising, and articles in “Let’s Talk About Health” publications.

A key requisite for improving the quality of services is access to reliable, complete, accurate, timely data and information. Both DHBs currently have disparate maternity information systems. A key component of the Quality Maternity Initiative is the implementation of the Maternity Clinical Information System being rolled out across all DHBs. Representatives from the MQSP, including consumers, have actively participated in the change processes required to implement the Maternity Clinical Information System for both DHBs – from reviewing and establishing aligned business processes, staged implementation, system user testing, to reporting and staff training.


Supporting early response systems and delivery of coordinated services, including effective referral pathways to/from the new Children’s Team and primary and secondary health services

Improving on time recall oral health examinations of enrolled preschool and primary school children, particularly focused on Māori and Pacific Island children

Extending access to the “Healthy skin” programme and establishing a full continence service, contributing to a further reduction in rates of avoidable hospitalisations

Strengthening capacity of audiology services to prioritise hearing screening, referral and intervention for infants and children

Developing the Maternal and infant mental health service

Implementing priorities of the Well Child / Tamariki Ora Quality Improvement Framework (reducing overdue oral health examinations, increasing breastfeeding rates and increasing rates of children at a healthy weight)

Improving access to personal health services for young people living in the Tararua district and for students at Otaki College



2.2.2 Primary health care services


Reducing admissions to hospital by diagnosing and treating some conditions earlier, closer to where people live

Bringing hospital and community health and disability services closer together through Collaborative Clinical Pathways and Clinical Networks

Increasing heart health and diabetes checks

Promoting and supporting people to quit smoking

Strengthening team based care in preventing and managing long term conditions

Improving the management of acute care across the district

How well did we do?

The rate of hospitalisations for certain conditions that are preventable or avoidable through early intervention by primary health care services (ambulatory sensitive hospitalisations, or ASH) reduced over the 12 months ending March 2014. We had a rate of 2,040 hospitalisations per 100,000 total population (103% of the national rate). However for Māori the rate increased from 2,640 to 2,701/100,000 population

Several Collaborative Clinical Pathways have been established over the year covering the main ambulatory sensitive conditions for which people in the 45 – 64 year old age group were admitted to hospital

Heart and diabetes checks have increased by 31.6% on the number of eligible enrolled patients over the year. The rate for Māori increased by 42% over the year to 5,691 adults, although the proportion of Māori who have had their risk assessed for cardiovascular disease was lower, at 79.8%, than the other population groups

Support to quit smoking was received by 81.3% of the known 17,878 people who currently smoke – a significant increase over the year from 67.1% of 17,823 people at the end of June 2013. Proportionately higher results were seen this year for Māori and Pacific people

General practice teams provided 1,895 Enhanced Care Plus packages of care to people with complex long term conditions – an 18% increase when compared to the previous year



Being consumer and community focused Percentage of MidCentral population (median projections) enrolled with PHO: 2012/13 2013/14

Total: 89.3% 89.7% Māori: 80.9% 82.7%

Note: to retain consistency, population statistics are based on medium projections as at June each year, 2006 Census base (Statistics New Zealand, updated 2013). Based on 2013 Census usually resident population, the projected population figures for MidCentral district are overestimated by about 8000 people in total

Opening of Te Waiora Health Centre

Access closer to home - Increasing enrolments with primary health services

There was a small increase in the proportion of the total population that were enrolled with Central PHO at the end of June 2014 compared to a year ago – up to 153,282 people, representing just over 94% of MidCentral’s population when based on the 2013 Census usually resident figures. The most significant increase was in the Māori population; another 664 Māori people were enrolled – a 2.5% increase.

Integrated Family Health Centres (IFHCs) are about health professionals from many disciplines, community and hospital working together to provide easy access to coordinated quality care closer to where people live. By aligning services to each community they can be designed to meet the particular needs of that community and address any identified gaps. IFHCs support general practitioners (GPs) to provide team based care to their patients. This is important as our ratio of GPs for the size of our population is at the lower end compared to the rest of New Zealand. Recent general practice patient focus groups identified most participants were happy to see the nurse practitioner or practice nurse as their ‘first port of call‘.

IFHCs are at various stages of development across our district, from being well established (Horowhenua and Tararua), newly established (Palmerston North [Palms], Foxton/Shannon), to progressing (Feilding, Palmerston North [Kauri Health] and Otaki) and another in Palmerston North is under development.

Foxton and the surrounding areas now have a new, purpose built healthcare facility. The Te Waiora Health Centre will be the central hub for integrated health care for the people of Foxton, Foxton Beach, Shannon, Himatangi and other local towns. Te Waiora is a unique partnership between the Central PHO and Te Rununga o Raukawa. Many services will operate out of the centre, providing locals with a single location to access GPs, nurse practitioners, district nurses, nurse specialists, and a variety of other primary health services. Clinicians from Te Waiora will also be available at the Shannon site to continue supporting the local community.

As a community project, consultation with local hapu and community members played an important part in the development of the service. Two of the centre’s rooms are named after prominent community members. The name Te Waiora was gifted by Ngati Raukawa hapu, and acknowledges the protecting, healing and rejuvenating qualities of water, and the importance of water in the

wellbeing of whānau.

76.0% 78.0% 80.0% 82.0% 84.0% 86.0% 88.0% 90.0% 92.0% 94.0% 96.0%

June 2011 June 2012 June 2013 June 2014

Total Maori Non Maori



Getting it right

Increased percentage of the eligible adult population who have had their cardiovascular disease (CVD) risk assessed in the last 5 years

Increasing risk assessments for cardiovascular disease and diabetes

At the end of June 2014, of the 46,538 eligible adults in our district, 40,536 (87.1%) had had a cardiovascular disease risk assessment (CVDRA in the last five years – just 3% short of goal of 90%. A significant improvement was made over the year – a 31.6% increase on the number of eligible enrolled patients who have had their cardiovascular disease risk assessment. The rate for Māori increased by 42% over the year to 5,691 adults, although the proportion of Māori who had their CVDRA was lower, at 79.8%, than the other population groups. Our rate for the total eligible people compared favourably with the national rate (85.1%), but rates for Māori and Pacific were generally lower over the year.

Cardiovascular risk assessment campaign after-hours clinics during 2013/14:

After hours clinic days

Location Number of patients

Number of clinics

Saturdays Palmerston North 68 1

Tararua 23 1

Weekday

after-hours

Shannon 12 1

Levin 252 5

Tararua 20 2

Feilding 32 1

PN 124 5

Otaki 116 3

Total 647 19

The Central PHO campaign team worked on a number of strategies aimed at increasing the number of people who had their cardiovascular disease risk assessed. The team used data to drive and inform performance, installing a “dashboard” to trigger the completion of screening activities, and provided current data weekly to practices relating to eligible patients and performance. In addition, Clinical leaders provided specific peer support and mentoring for members of the General Practice Teams.

In acknowledging time as a critical success factor, Central PHO employed casual Registered Nurses to work within general practices supporting the development of systems and processes to ensure they could sustain completion of risk assessments.

Practices were also supported through the provision of after-hours clinics staffed by the Central PHO who undertook the cardiovascular disease risk assessments on behalf of the patient’s General Practice Team.

Being up to the job

Increasing support for managing long term conditions

Central PHO and Arthritis NZ work in partnership to provide self-management programmes for people with long term conditions

The Chronic Disease Self-Management Programme known as the “Living a Healthy Life Programme” is a group self-management workshop run over two and a half hours, once a week, for six weeks, in community settings. Workshops are facilitated by two trained leaders. Each course has 8-15 participants and people with different chronic health problems attend together.



Compared to last year, many more people with diabetes attended the “Living a Healthy Life” programme, followed by people with arthritis, cardiovascular disease and long term respiratory conditions.

The subjects covered include: 1. techniques to deal with problems such as frustration,

fatigue, pain and isolation 2. appropriate exercise for maintaining and improving

strength, flexibility and endurance 3. appropriate use of medications 4. communicating effectively with family, friends and

health professionals 5. nutrition 6. decision-making 7. how to evaluate new treatments.

It is the process by which the programme is taught that makes it effective. Classes are highly participative, where mutual support and success build the participants’ confidence in their ability to manage their health and maintain active and fulfilling lives.

Over the year there were 108 participants who completed the courses - 27% were Māori or Pacific people, and 30% were male. Three of the courses were specifically designed for Māori, Pacific people and men; there were 27 participants in these courses, with an 85% completion rate.

The post course evaluations provided by the participants show positive results:

• 83% increase in the number who felt confident about their ability to cope with their condition

95% increase in the number who felt confident that on most days of the week they will do at least one activity to improve health

94% increase in the number who were confident that they had a good understanding of when and why to take their medications

73% increase in the number who believed that they can do daily activities

87% increase in the number who felt that they were actively involved in life

94% increase in the number who responded that they knew where to go for further support and information.

John’s story: “I have attended a six week course called ‘Living a Healthy Life with Long Term Conditions’ and found it very uplifting. It has shown me different ways to look at my condition in a positive and purposeful way. Before I was casual in my approach to my health problems but now I have a deeper appreciation and better perspective of what my condition is all about. Through talking and sharing experiences with my fellow attendees has raised my awareness and understanding of my condition and has helped me awaken from my silent state. I did not do what I should have done and that was being pro-active. The information gained has given me the push to deal with the complexities of a person’s long term illness. I recommend this course to anyone with a similar diagnosis and care givers alike as the benefits are more positive than negative”



Supporting people to quit smoking

This graph shows that of the PHO enrolled population aged 15 years and older, who were seen by a health practitioner in primary care, 81.3% of 17,878 people were offered brief advice, and support to quit smoking – a significant increase over the year from 67.1% of 17,823 people at the end of June 2013. Proportionately higher results were seen this year for Māori and Pacific people than for the other ethnicity groups – as shown in the table below.

12 months to June 2014

Advised Seen Percent

Māori 4199 4937 85.1%

Pacific 399 478 83.5%

Asian 202 279 72.4%

Other 9741 12056 80.8%

TOTAL 14541 17878 81.3%

The ABC pathway…

Ask

Brief advice

Cessation support

Over the last few years, we have invested in a community-based collective to support the reduction in smoking prevalence across our district.

Te Ohu Auahi Mutunga (TOAM) is a collective comprising Iwi and Māori Health Providers with invited partner Central Primary Health Organisation. Māori and non-Māori services are working together to provide a seamless and inclusive district-wide smoking cessation service across the district using Kaupapa Māori practices, in particular the Te Ara Whānau Ora process with whānau and Māori.

Initially TOAM focused on services for Māori, Pacific Island peoples and pregnant women who smoked, with other ethnicities being referred to available services eg. QuitLine. Following an initial low and slow uptake of the service and since including all ethnicities, there has been a growth in referrals from 1,041 in 2012 (averaging 86 per month) to 1,680 in 2014 to date (210 referrals per month).

TOAM has worked to attract and encourage general practice referrals by providing ‘ABC’ calls on behalf of some practices, situating Mātanga (specialist practitioners / quit smoking coaches) in practices and clinics to provide smokers with additional opportunities for assistance. The Mātanga GP Liaison position increased exposure to and knowledge of the potential and capabilities of TOAM, as well as improving systems and access for practices and referrers.

Joint activities with the DHB have also benefitted the service through the provision of education and resource packs, including nicotine replacement therapies, targeted to particular groups of people who smoke as well as for other frontline health professionals, midwives, pharmacies and the Emergency department.

A more recent development has been the appointment of a lead Midwife as part of the Whakahau Ora project, to strengthen relationships with Lead Maternity Carers and their collective support for helping pregnant women stop smoking, together with their whānau and family.

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20.0%

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40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Jul-

Sep

2011

Oct

-Dec

201

1

Jan-

Mar

201

2

Apr

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201

2

Jul-

Sep

2012

Oct

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201

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201

3

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4

Quarter

Percentage of Central PHO enrolled population aged 15+ years who smoke, and seen by a health practitioner in General Practice

offered brief advice and support to quit smoking.

July 2011 - June 2014

MidCentral DHB All DHBs Target




Ambulatory sensitive hospitalisation (ASH) rate per 100,000 population (age standardised), aged 0 – 74 years (expressed as a percentage of the national rate)

Reducing avoidable hospitalisations

The rate of hospitalisations for certain conditions that are preventable or avoidable through early intervention by primary health care services (ambulatory sensitive hospitalisations, or ASH) reduced over the 12 months ending March 2014. We had a rate of 2,040 hospitalisations per 100,000 total population (103% of the national rate compared to 106% in the 2012/13 year). However for Māori the rate increased from 2,640 to 2,701/100,000 population, although this rate was less than the average (2,936) for the previous three years. Our rate for Māori is better than the national rate for Māori, but when compared to the rate for all ethnicities it was 137% of the national rate of 1971/100,000 population. The ASH conditions with the higher rate of hospitalisations for Māori include pneumonia, dental conditions, cellulitis, asthma and upper respiratory or ear, nose and throat infections

Implementation of the long term conditions programme and the Collaborative Clinical Pathways that focus on diabetes care, and better managing heart and respiratory conditions in particular will have a positive impact on reducing the hospitalisation rates for adults.

Collaborative Clinical Pathways (CCPs) are computer-based maps used in primary health care and hospital services as a guide to the best treatment options and check of best practice for patients at each stage of their care.

Forty-eight CCPs using the Map of Medicine tool have been developed so far. Each pathway development is led by primary and hospital clinicians and involves wide consultation. The consumer representative on the CCP executive has developed a number of patient pathways alongside the CCPs (see side box).

By using these common pathways of care we can ensure that practitioners are kept up-to-date with evidence-based care and patients can expect effective, appropriate treatment and an efficient referral process.

Clinical Networks

Clinical Networks provide leadership for health service developments, quality improvement and innovation throughout our district. They bring health professionals from secondary and primary health care services, Non Government Organisations, Māori/Iwi, patients, consumers, carers and social services together to collaborate on improving the performance of the health care system.

Each of the seven Clinical Networks has a work programme that connects our local and regional service developments, quality improvements and delivery of priority initiatives.

60%

70%

80%

90%

100%

110%

120%

130%

140%

150%

160%

2010/11 2011/12 2012/13 Yr to Mar 2014

Maori Other Total

Introducing the Patient Pathways

The patient pathways align exactly with

the collaborative clinical pathways

available to all health professionals

across the MidCentral district

They enable patients and their

families/whānau to understand the

steps used in the diagnosis and

management of their health conditions

Access to this information will enable

patients and their families/whānau to be better informed about what to

expect and to have greater

confidence in the care provided

Six child health patient pathways have

recently been published – they are

publicly available on the Central PHO

website as follows:

→ www.centralpho.org.nz

→ ‘Collaborative Clinical Pathways’

→’Patient Information’



We have 7 Clinical Networks:

Child Health Tamariki Ora

Health of Older People

Mental Health and Addictions

Urgent and acute care

Long term conditions

Cancer

Palliative care

Currently there are close to 200 people contributing to the Clinical Networks. The Network groups held a number of community forums throughout the year, which provided valuable opportunities to hear directly from our consumers about what’s been working well and not so well.

Some of the projects led by the Clinical Networks include:

Investigating and developing primary options for acute care, which will be carried over into the 2014/15 for implementing preferred options

Establishing a centralised after-hours service in the Horowhenua, giving more certainty around the ‘where and when’ of access to local after-hours general practice services

Increasing the level of health literacy of Highbury community members so that they may, in turn, support and up-skill their whānau

Supporting the use of dermascopes (for detection and diagnosis of skin lesions and cancers) within general practice as part of the collaborative clinical pathway

Exploring how to better ensure seamless nursing care is provided across primary and secondary services to those with cancer (and their families)

Developing a quality palliative care framework for the district, with key indicators and priorities that are person and service centred

Enhancing patient care for renal patients; developing better support and resources for general practice teams to identify and care for patients with chronic kidney disease, including referral pathway

Developing general practice as the centre of care for pre-diabetes patients, including education and research initiatives with Massey University.

Being up to the job

Transformational leadership

Transformational Leadership is central to achieving the goal of transforming health care services in the district. The ‘In Good Hands: Transforming Clinical Governance in New Zealand’ Task Group (2009) report identified that health care that has “competent, diffuse, transformational, shared leadership is safe, effective, resource efficient and economical.”

The Transformational Leadership Programme is a professional development opportunity for primary and secondary health care providers. The six day programme develops understanding of the transformational leaders’ role, identifies personal leadership style, develops skills to lead and manage change and improvement. It blends theory and experiential learning to enable staff to apply the knowledge and skills in their workplace with access to coaches for support and advice.

“I have learnt that I work with a diverse group of people and now have some excellent tools to work within a team

environment and how important leading the team is”

“Importance of communicating, sharing goals, vision, to motivate, encourage others’ participation”



Twelve programmes have been delivered to over 240 participants and twenty past participants have been mentored into coaching roles. The partnership approach to Adaptive Change Projects undertaken as a programme requirement promotes primary and secondary collaboration. Examples of these Adaptive Change Projects include:

integrated care for people with heart failure living in a rural area

establishment of a dietetic service for overweight pregnant women

improving co-ordination of chronic care management with a local Iwi clinic

professional supervision: a regional approach

management of needle-stick accidents in acute hospital

self-managing whānau households who make lifestyle changes that will improve diabetes management

prevention of readmission to hospital for over 65’s

nurse-led health assessments in addictions

Kia tapatahi, kia kōtahi rā: Māori building support groups for Māori.


Meeting the 90% health targets for heart and diabetes checks and supporting people to quit smoking

Increasing uptake of Enhanced Care Plus and self-management support programmes

Supporting the development of more Integrated Family Health Centres

Increasing uptake of Collaborative Clinical Pathways by general practice teams

Implementing Clinical Networks’ service and quality improvement initiatives

Decreasing the number of Emergency Department presentations and ambulatory sensitive hospitalisations through developing primary options for acute care

Developing more joined up information management capability and supporting better access to information for consumers



2.2.3 Mental health and addiction services

What did we want to achieve? Developing our plans in response to the national “Rising to the Challenge” service development plan

Increasing the participation and involvement of consumers and making better use of feedback from consumers

Establishing an integrated, evidence-based supported employment service model, in collaboration with Whaiora Trust Employment and Vocational Service

Improving the range and quality of perinatal and infant mental health services available to pregnant women, mothers and babies

Extending the Choice and Partnership Approach model

How well did we do?

More people accessed specialist mental health and addiction services over the year - 5,997 of the estimated 170,430 population (3.5%). The number of Māori people, particularly adults, being seen by the service was disproportionately higher at 5.1% than for non Māori (3.2%) although rates are affected by smaller numbers

There were two serious adverse events of apparent suicide in quick succession by patients in our mental health inpatient unit. These prompted an independent external review of the service, which culminated in 44 recommendations for improvement covering clinical and operational leadership, structure, resourcing, culture and environment

Services for pregnant women, mothers and their infants and family / whānau were strengthened with better service and agency linkages, establishing pre-birth plans, and developing options to improve the response to the acute perinatal needs of women, their infants and family and whānau

Seventy people participated in the Mahi Tu Maia programme established between Oranga Hinengaro (specialist Māori Mental Health Service) and the Whaiora Trust Employment and Vocational service to support people with mental illness into employment

A single point of entry access pathway has been established between the Community Probation Service and four Non Government Organisation providers of alcohol and drug services for offenders

By the end of June 2014, shared care programmes had been established with primary health practitioners for 662 people who had a mental illness or addiction




Increasing access rates

We achieved our target access rates expected for our total population over the year with 5,977 (3.5%) people seen by specialist Mental Health and Addiction services. This was a 4% increase on the total volume for the 2012/13 year. 29% (1,735) of the total people seen in 2013/14 were aged up to 19 years. Although smaller in number, the estimated Māori population seen by the services, at 5.0% (1,659), was disproportionately higher than for the non-Māori population (3.2%), particularly in the adult age group, as can be seen in the graph at left.

Over the year, the Choice and Partnership Approach (CAPA) model has been implemented across all specialist services provided by MidCentral Health. This model strengthens the partnering relationship between the referred client, their family or whānau and the clinician at point of entry to the service. It engages clients and their family more actively in determining an agreed view around the reasons for referral, collaborating on decisions around the preferred service options available and better matching treatment needs and available skills.

This approach has been well received by clients and their family, providing positive feedback about their experience (see side bar at left).

The benefits of systematic adoption of the CAPA model are not only from a service user’s point of view, but also for the system. It helps to better manage demand and capacity issues, reduce waiting periods and non attendance rates, establish clear working goals with clients and their family, and clinicians with appropriate clinical skills are better utilised.

Goal: By the end of June 2015, 80% of new client referrals for non urgent mental health or addiction services are seen within 3 weeks, and 95% within 8 weeks

Reducing waiting times for non-urgent referrals

Specialist mental health services are meeting the targets for 80% of non urgent referrals being seen within three weeks and 95% within eight weeks. Improvements are being made toward the target for people being seen within eight weeks following a non urgent referral to alcohol and drug services – including services provided by non government organisations (NGOs), but the goal of 80% being seen within three weeks continues to be a challenge.

The NGO sector has made several improvements to address their waiting times in response to the increasing demand for services. A key change in the latter part of the 2013/14 year was the development of a new way of managing the increasing number of referrals from the Probation Service, which had a significant influence on the wait times.

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0-19 years 20-64 years 65+ years All ages

Percentage of MidCentral population seen on average

per annum, by age and ethnicity groups. 2012/13 - 2013/14

2012/13

2013/14

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

100%

12 mths to March 2013




Alcohol & Other Drug Services (NGOs and

Specialist)

Specialist Mental Health Services

<3 weeks

<8 weeks

“For the first time, my family has been

taken seriously”

“It just amazes me the effort that has gone into my recovery” “It has taken awhile, but perseverance from all involved has brought about a good end.”



E-therapy is becoming more widely used as one of the options for treating mild to moderate depression. Beating the Blues® is available as an effective and evidence-based treatment for depression and/or anxiety in primary care. Free access to the online cognitive behavioural therapy programme is managed by GPs, with accredited trainers offering training to practices in their area.

Seven out of 10 people who have used Beating the Blues® have been able to overcome their depression. Talk to your doctor if you think Beating the Blues® could be helpful for you. Your doctor can introduce you to the programme.

Single point of entry service for offenders with alcohol and/or drug issues referred by the Community probation Service:

There were 124 referrals made to the service over the two months since being commissioned: 78.2% (97) were males and 55.6% (69) of the total were Māori.

Consistent with one of the Government’s priorities to address “Drivers of crime”, the DHB, Community Probation Service and NGOs collaborated on redesigning the referral and treatment pathway amongst the Alcohol and Other Drug (AOD) service providers to establish a ‘single point of entry access pathway’. This means that people with AOD problems who offend can be referred by the Community Probation Service to one place, triaged and then referred to the most appropriate service without undue delay. Not only will this improve access, but also be more responsive, reduce waiting times for clients and reduce reoffending. It also means better use can be made of the available capacity amongst the contracted providers with the required skills for this client group.

Getting it right

Perinatal infant and maternal mental health (acute service)

A key project has been the development of the perinatal and maternal mental health service to strengthen the capacity of services to respond to the needs of pregnant women and mothers in the 12-month postnatal period. This first phase of the development has been focused on acute services, particularly for women who experience, or have a history of, serious mental illness. The local community-based maternal mental health service will be supplemented by additional options for women, their infants and their family or whānau who need more urgent and higher levels of assessment, treatment and support to keep mother and baby safe while offering better access to opportunities for early intervention and recovery.

A Clinical Nurse Specialist role has been established for the Mental Health Service that is dedicated to maternal mental health services. This specialist position has a key consultation and liaison role with a range of services including work with other agencies involved in the care and support of the women and their families. Over the next year, the services will be further strengthened with additional clinical resources to support the next phase in service improvements, building on the guidelines for Healthy Beginnings.

Collaborative Clinical Pathway for the Management of Depression

Mental health is an important component of primary health care. About 90% of people with a mild to moderate mental illness such as depression, anxiety and addictions are treated in a primary health care setting.

The “Management of Depression in Adults” collaborative clinical pathway was published in April 2014 to better equip primary health practitioners – and clients – with a standardised tool to identify and assess people presenting with common mental disorders such as depression. This pathway aligns to evidence-based practice guidelines for the management of depression, providing in summary:

Accurate assessment of depression and risks to ensure appropriate management and referral

Immediate access to two screening tools

Guidance on when to refer for specialist secondary care input

Information about programmes available for clients.

Our consumer representative is in the process of developing a patient pathway to complement this clinical pathway.



Responsive services for Māori

Nga Kaitohutohu, our Māori Mental Health and Addiction Advisory Group, led the development of a service improvement plan following an evaluation of mental health and addiction services provided by generic Non Government Organisations. The evaluation considered two priorities from the Rising to the Challenge Service Development Plan – service effectiveness for Māori and working together to address disparities for Māori.

Overall, the evaluation found that non Māori service providers were making good progress in delivering culturally appropriate services aimed at improving Māori mental health status. However, there were four areas that needed further attention: governance, workforce development, whānau ora based service models and forging links with local Iwi. Each of these is being addressed with the providers through the service improvement plan being overseen by Nga Kaitohutohu.

Being up to the job

Relapse prevention plans

Relapse prevention plans are developed between clinicians and clients (and their significant others wherever possible) to document early warning signs of a relapse, what they can do for themselves and what services can do to support them.

The above graph shows around 90% of adult clients with a long term mental illness or addiction have up-to-date relapse prevention plans in place and for young people around 87% (rates fluctuate with small numbers) – not consistently achieving the goal of 95%. The variation is more often attributed to a lag in documentation when the audit occurs rather than there not being a plan in place. The future focus is changing to transition planning with young people in the transfer of care from specialist services to their nominated primary health care practitioner. We are well on the way to having these systems and processes in place before formally commencing in the year ahead.

Collaborating with partners

Co-Existing Shared Care programme

Primary care has a pivotal role in delivering services to clients with a mental illness or addiction. The Co-Existing Shared Care programme offers clients with an enduring mental illness and/or addiction issue, often coupled with at least one chronic physical condition, better access to General Practice Team (GPT) care. The General Practice Team is supported by liaison clinicians from specialist services as required.

The participating General Practice Teams:

address the mental health or addiction and physical needs of clients on the programme

provide regular consultations and active follow up if required, including a recall system

ensure the client has had at least one comprehensive health assessment each year and is linked to the Enhanced Care Plus support programme if necessary

attend specific training and education opportunities provided

There has been a significant increase in the number of people accessing 29 of the 35 Central PHO practices involved in the programme. At the end of June 2014, there were 662 clients on the programme:

272 clients of the specialist Mental Health Service fully discharged to primary care

222 clients of the Alcohol and Drug service and 168 clients with a mental illness were participating in the transitional phase, where there is shared clinical responsibility between the General Practice Team and specialist secondary Mental Health and Addiction Service.

On average, each client had 11 free consultations with their General Practice Team over the year.

0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%

100.0%

Q2 Q4 Q2 Q4 Q2 Q4

2011/12 2012/13 2013/14

Proportion of people with a long term mental illness who have an up to date relapse

prevention plan

Adult Child&Youth Target



Evidence Based Supported Employment Service Oranga Hinengaro – the specialist kaupapa Māori mental health service – has been working with Whaiora Trust Employment and Vocational service on implementing the Mahi Tu Maia programme to support people with mental illness into employment. Currently there are 70 people participating in the programme.

Committing to shared goals and service improvement

An independent external review of our mental health service was carried out following the apparent self-inflicted deaths of two inpatients in the latter part of the 2013/14 year. Forty-four recommendations were made for improvements to the service. The external review was commissioned to ensure that any underlying issues in relation to the structure, resourcing, or culture of the service be identified and addressed. A root cause analysis review of each serious adverse event was also undertaken. These were carried out internally using staff that are trained in the root cause analysis methodology. The implementation of the recommendations from these reviews has been incorporated into the work programme for 2014/15.

Rising to the Challenge: The Service Development Plan for Mental Health and Addiction Services, 2012 – 2017

The Plan provides further impetus to increase consistency in access, service quality and outcomes for people who use mental health and addictions services. Such services are provided by a range of organisations across the MidCentral district. These include primary, secondary, Non Government Organisation (NGO) and community based organisations. Improved linkages are emerging with other government agencies where intersectoral collaboration contributes to efficient and effective outcomes.

Fifty five stakeholders involved in the Mental Health and Addictions (MHA) sector met in August 2013 to address the goals and desired results outlined in Rising to the Challenge – the Government’s 5-year service development plan for the mental health and addictions sector. Key themes identified include:

using current resources more effectively

building infrastructure for improved integration between specialist services, primary care and community based support groups

enhancing access to client-centred mental health and addiction services for youth, adults, older people, Māori, Pacific, refugee/immigrants and people with disabilities.

The Forum also noted the importance of supporting and strengthening our workforce capacity and capability to achieve the goals and meet future growth in demand. The Mental Health and Addictions Network guides and oversees implementation of the annual work plan for the priority service developments relating to the goals of Rising to the Challenge.

“I have been able to work on my CV and Mahi Tu Maia are helping me to

focus on what I want to do. I have been on a course in Wellington”

“They were helpful in finding me interim employment and I now have a full time job”




The Community workforce survey identified:

256 support workers – 75% were female

80% were NZ European

15.3% were Māori

Average length of employment was 4.2 years

28% were engaged in supervision

Connected Workforce

Ensuring the workforce of Non Government Organisations (NGOs) has the knowledge, skills and support needed to deliver effective, efficient and sustainable services for service users in our community requires a strategic focus in four key areas:

Leadership Development

Sector Development

Workforce Development

Organisation Development.

The ‘Connected Workforce’ strategic work plan guides us toward achieving that goal. Work has been undertaken to understand the roles, long-term impact and ongoing career development needs of the registered health

professionals who are employed in the NGO workforce.

Twenty-seven training workshops in total were coordinated by the NGO sector. These training workshops encompassed topics such as “Let’s get real” Values and Attitudes, Working with Refugees, Eating Disorders, Working with Youth, Co-Existing Problems, Working with Pacifika, and, Challenging Stigma.

Workforce development training was undertaken by 328 people within the NGO and primary sector and training was also provided to 23 service users for the Wellness and Recovery Programme, which was well received.

The NGO and Primary Connected Workforce Leadership group has created a shared workforce development plan with specialist mental health and addiction services.


Mental Health Service Development Plan: We are committed to implementing the recommendations of the external review undertaken and sustaining the service improvements that address crucial patient safety and service delivery issues in the first instance, as well as achieving a longer term overall systemic change

Ongoing implementation of the ‘Rising to the Challenge’ priorities within our Clinical Network work programme and Māori Mental Health and Addiction Advisory group programme

Continuing to address waiting times for people with a non urgent referral to alcohol and drug services, particularly supporting the NGOs with service improvements to achieve the goal of 80% of those referrals being seen within three weeks

Integrating the Choice and Partnership Approach (CAPA) model and establishing systems and processes that support a single point of entry approach to improve access across all secondary specialist services

Further developing the capacity of maternal mental health services to better respond to the needs of pregnant women, mothers, infants and their family and whānau

Continuing to strengthen workforce capability across the sector

Improving integrated health care delivery options, including earlier brief interventions for young people and seamless transition care planning between services



2.2.4 Health of older people


Widen access to community supports including home-based support to streamline planning for appropriate hospital discharge

Establishment of a Fracture Liaison Service

Aged Residential Care facilities are supported to reduce unnecessary admissions to the Emergency Department or inpatient hospital beds

Elder Abuse Guidelines are promoted to key stakeholders and implemented through the DHB family violence programme and the Older Persons District Group

The National Dementia Care Framework is supported and developed locally across primary and secondary care

How well did we do?

Many more older people received packages of temporary support to assist with their home-based recovery following their discharge from an acute admission to hospital

There was a significant increase in the number of older people taking up options for respite and day care services

Corrective actions resulting from aged residential care certification audits have reduced significantly

The proportion of people aged 75 years or older who have an unplanned (acute) readmission to hospital has been consistently lower (better) than the national rate

More support has been provided to Aged Residential Care service providers to enable service improvements through the use of comprehensive clinical assessments, and increased levels of training and peer support

A local dementia care framework has been developed and better information has been made available to support people living with dementia




Increasing access to community support

Figure 1: Enjoying a day of stimulating activities at the Marion Kennedy

Centre

Day care service options extended from being delivered in one central location to communities in all four local authority areas across the district. Not surprisingly then, the number of older people accessing day services increased from 232 to 269 clients over 2013/14. On average, clients attended day services for 37 days, but it ranged from one day to 204 days. Day services are delivered by a variety of providers including aged residential care facilities, the Alzheimer’s Society and the Adult Day Care Centre.

Packages of Temporary Support (PoTS) are designed to better support older inpatients with their discharge and transfer of care from hospital. Based on assessed need, home-based services are available to ensure older patients are supported in their recovery with safe and appropriate clinical care, disability equipment needs and social supports. These enable the patient to return to their optimum level of independent functioning as soon as possible and to reduce the potential for a readmission to hospital. The number of patients discharged from hospital who received a PoTS increased from 242 in 2011/12 to 573 by the end of June 2014.

In September 2013, the Older Persons District Group introduced a Respite Case Manager role to improve access for older people and their carers to respite and day centre services. The role was twofold. Along with being a central contact for whānau and carers to obtain information and better link people with services, it was tasked with improving utilisation of respite beds across the district. There are currently four dedicated beds in Levin, Palmerston North and Dannevirke in addition to respite care services accessed separately by individuals or their carers. Since this position started, utilisation of the dedicated respite beds has increased dramatically from 19% to over 65% each month up until a drop off in May and June (total utilisation for the year was 53.4%). Key findings from this new initiative are:

complaints and concerns about access to respite services have reduced to only one over the nine months

increased liaison activities with a range of key stakeholders to promote the benefits of respite and day centre support

resolution of barriers to access has been made easier

referral process reviewed to enable earlier engagement with potential clients for planned respite care and/or access respite care prior to crisis

identifying opportunities and gaps in provision of respite care for clients with dementia.

0

100

200

300

400

500

600

700

2011/12 2012/13 2013/14

Number of inpatients aged 65+ years discharged with Packages of Temporary Support

2297

963

6839

Number of days spent at day care facilities by

clients aged 65+ years, 2013/14

Rest Homes

Adult Day Care

Alzheimers Society



9.0%

9.5%

10.0%

10.5%

11.0%

2009 2010 2011 2012 2013 12mths to June

2014

Standardised Rate of Acute Readmissions to Hospital - Aged 75+ years. 2009 - 2013

MidCentral National

Getting it right

Reducing unnecessary admissions

Aged Residential Care facilities are supported to reduce unnecessary admissions to the Emergency Department or inpatient beds

About 6.4% of our population aged 65+ years are cared for in one of the 36 aged residential care facilities. Just over 4% (1563) of the total attendances at the Emergency Department by people living in our district in 2013/14 were by individuals receiving care from an aged residential care facility (similar to the number over the previous year). One of the key issues that caused delays in the diagnosis, treatment and the transfer of care of some patients was not having complete, up to date information readily available to the service provider. In many instances the individuals could not reliably convey that information themselves. Sometimes this meant that patients were admitted to hospital or stayed longer than necessary.

The “Pink Envelope” is a service improvement initiative designed to improve the

clinical handover of patients between aged residential care facilities and the hospital. It was developed and implemented as a collaborative between MidCentral Health staff and Aged Residential Care Managers and Clinical Leaders. It contains key information like medication charts, nursing care summaries, and other important documentation including any enduring power of attorney arrangements for example. In the longer term, it is envisaged that this information become available electronically, but in the meantime, the “pink envelope” has helped to ensure a smoother handover of care between providers that benefits the individual.

Reducing hospital readmissions

When considering the proportion of people aged 75 years or older who have an unplanned (acute) readmission to hospital, MidCentral’s standardised rates have been consistently lower (better) than the national rate since 2009, as shown in this graph. For the 12 months to June 2014, 504 of the 5,774 patients who were discharged from hospital were readmitted within 28 days (a raw rate of 8.7% of the discharges). When these figures are applied to the national average across a number of variables, then our rate was 10.1% (national rate was 10.6%) for this period.

Being up to the job

Better use of information and strengthening the capacity of service providers

Two hundred and seventy people attended a symposium on Elder Abuse Guidelines and all 36 Aged Residential Care facilities accessed their Elder Abuse training for staff through local services such as Age Concern organisations. The two Age Concern organisations across our district lead the promotion of the guidelines through their networks with our local health services. Clinicians and managers participate in the annual Elder Abuse Awareness campaigns alongside training for the sector to continually support the changing carer environment.

Figure 2: Acute readmissions, aged 75+ years



Aged Care providers have been steadily implementing the Long Term Care Facility (LTCF) comprehensive clinical assessment tool over the past 12 months with more aged care staff being trained in the use of the tool. Central to the learnings for the nurses working in aged residential care facilities is the support and leadership they are given to ensure they are up to the job. Recently launched, we now provide additional expert resource to support these nurses via peer support meetings. These peer meetings consolidate learning, re-visit coding queries and have a strong focus on robust, quality outputs from the resident assessment process and tool. Four Needs Assessment and Service Coordination (NASC) staff have been trained in the LTCF tool as well, bringing a total of six DHB staff supporting the Aged Residential Care providers with their implementation of the LTCF comprehensive clinical assessment tool. These staff complement and assist the national trainers with the training rollout provided to Aged Care staff.


Building capability with knowledge and skill

Being willing to learn from others has supported aged residential care providers to learn from each other when it comes to undergoing audits for certification. Provider engagement forums held four times per year provide a discussion and learning opportunity on where the issues were for providers and to identify possible solutions for these particular types of issues as well as opportunities for service improvement.

Corrective actions resulting from aged residential care audits have reduced significantly from 11.5 in 2012 to 3.5 in the first half of the 2013/14 year. Since 2012/13, a total of 13 audits across ten different aged residential care providers have resulted in one or zero corrective actions, seven of these audits from five facilities resulted in perfect scores.

Sector engagement for resources to better support those people living with dementia in our communities will continue to be a strong focus in the 2014/15 year but was underway this year. Development of the local Dementia Care Framework was completed, based on the national framework.

Ensuring older folk have access to local information in easy to read formats specific to dementia will give better ‘at hand’ knowledge to people and their families. The recently released information booklet “People Experiencing Mild Cognitive Impairment or Dementia” was written for the person directly affected by this health concern and can also be used as a guide for family and whānau to understand the help and support available as they care for their loved one.

Twenty two participants enrolled for the eight month training programme, Walking in Another’s Shoes that commenced in May. This programme is designed to help caregivers understand what it’s like to live with dementia. The training provides care staff with new skills and a greater understanding of the pivotal role they play in the move towards more person-centred care for people with dementia. “Walking in Another's Shoes teaches caregivers to view challenging behaviour in those with cognitive impairment and dementia as a communication of unmet needs. It is a model of care that will help caregivers and registered nurses working in the sector have a more positive view of the condition and the care provided” says the DHB’s Portfolio Manager for Health of Older People.

Walk a mile in my shoes

see what I see hear what I hear

feel what I feel, THEN maybe you’ll understand

why I do what I do, ‘til then don’t judge me

(Anon)




Advance Care Planning into primary care services with a stronger focus on connectedness

Integrating and supporting Aged Residential Care providers to improve medicines management and further reduce corrective actions in this area

Improving dementia environments for those living at home

Reducing stigma associated with dementia

Supporting non specialist palliative care nursing workforce with education and training

Developing short term community-based supports, linked to the Recovery at Home service, to enable older clients to remain at home while receiving clinical interventions for acute ill health, thereby reducing likelihood of Emergency Department attendances and hospital admissions

The Fracture Liaison Service was unable to be established during 2013/14 as expected, however it is anticipated this will be achieved over the 2014/15 year. This is about developing prevention plans for individuals and groups who are at risk of fracture, particularly hip fracture, and will involve both primary and secondary care services



3.0 Celebrating our Partners

Since 2004 we have hosted an annual “Health Awards” sponsored event to recognise and celebrate the achievements and innovations in health and disability services being delivered by a range of providers across our district. In October 2013, we had scores of entries for the Awards covering nine categories that showcased excellence, innovation, energy and commitment to delivering the very best in health care. These individuals, groups and organisations are invaluable partners in our health system and we are privileged to celebrate their successes with them. The applicants for the 2013 Health Awards are listed below with the Award winners highlighted in italics.

Supreme Award – Excellence in Innovation and Integration in Health Care

MidCentral Immunisation Team

Improving Health of Older People in Horowhenua - Warwick Dunn, Nicola Turner and Sylvia Meijer

Total Healthcare (PN) Ltd

Tararua Hauora Services

U-Kinetics - Universal College of Learning (UCOL)

Combined Health Conditions and Cancer Psychology Services - Massey University

Collaborative Clinical Pathways Programme

Paediatric Gastroenteritis Assessment and Management Service from Community Pharmacies - MidCentral Community Pharmacy Group

Best Use of Integrated Technology in Health Care Award

Quality and Clinical Risk Team - MidCentral DHB

IT Project Group - Arohanui Hospice

Short Term Loan Equipment Management System (STEMS) - Enable New Zealand


Supportlinks, Social Work Department

Collaborative Clinical Pathways Programme

Excellence in Health Service Quality Improvement Award

Total Health Care General Practice Team

Housing Outreach Clinics - Enable New Zealand Professional Advisory Team

Clinical Dietetic Service - Spotless Facility Services (NZ) Ltd

Quality and Clinical Risk Team - MidCentral DHB

Excellence in Optimising the Health Status of Priority Populations Award

Renal/Palliative Care Interface Group - MidCentral Health and Arohanui Hospice

Trish Chaplin and the Palmerston North Women's Health Collective Inc.

Best Care (Whakapai Hauora) Charitable Trust GP Immunisation Programme

MidCentral Immunisation Team

Children's Eczema Service - Child Health Community Team

Whānau Triathlon - Sport Manawatu



Te Kawei Whakaheke Steering Group - Heart Foundation

U-Kinetics - Universal College of Learning (UCOL)

Reducing Skin Infections Pilot Project - Public Health Service, MidCentral Health

Excellence in Intersectoral Collaboration to Improve Health and Social Outcomes Award

Renal/Palliative Care Interface Group - MidCentral Health and Arohanui Hospice

Community Wellbeing Executive - Life to the Max and Horowhenua District Council

Tararua Hauora Services

Whānau Triathlon - Sport Manawatu

Behaviour Issues in Children Collaborative Working Group for Map of Medicine - Collaborative Clinical Pathways, MidCentral DHB

Waitangi Day Children's Eczema Project - MidCentral Community Pharmacy Group, Clinical Nurse Specialists (PHO) and Child Health Community (HCD)


Synthetic Cannabis Community Taskforce 2013

Connected Workforce Te Hononga Kaimahi Group - Journeys to Wellbeing

MKC Club Feilding - Manchester House Social Services and Alzheimers Society Manawatu

Supportlinks, Social Work Department

Excellence in Health Care Advocacy Award

Consumer and Family Advisor's Team, Mental Health Services

Healthy Schools Award

"Catch Me If You Can" Sports Initiative - Russell Street School

Our Place - Te whare Manaaki' - Pahiatua School

Waiopehu College

All applicants’ entries are included in the People’s Choice and the Judges Choice Awards. With the help of our sponsors, October 2014 will mark a decade of these Health Awards recognising our partners in excellence of continued achievement in health care across the district.

2013 Health Awards



Quality in Context – some basic statistics about us

Between July 2013 and June 2014, in our district,

on average eevveerryy ddaayy there were….

2 people being admitted to the

Coronary Care Unit

4 adults being referred to the

Green Prescription programme

5 newborn babies having a

hearing screening test

6 babies being born at the

hospital

6 infants being immunised

6 children having a B4 School

health check

24 young people being seen at

the Youth One Stop Shop

24 people having an MRI scan

24 adolescents being seen by

DHB funded dental services

27 people having an operation

at Palmerston North Hospital

46 people seeing community

mental health teams

71 people in contact with Allied

Health Services

104 people being discharged from

hospital care

111 people attending the

Emergency Department

115 people being seen by the

‘long term conditions’ team

156 people being seen by the

District Nursing service

180 ACC consultations with

primary health practitioners

231

unused medicines being

returned

522 people attending an

outpatient appointment

1,249

people receiving aged

residential care services

1,822 people consulting their

general practice team

2,200

people receiving home-based

support services

5,430 laboratory tests being done in

the community

7,769 medicines being dispensed in

the community

…being delivered by…

38 general practices

60+ non-government

organisations

35

aged residential care

facilities

32 community pharmacies

22 dental practices

8

optometry practices

6 Iwi/Māori providers

3 Integrated family health

centres

2

community radiology

services

1 public hospital

1 primary health organisation

1

laboratory


2013/14 QA FINAL v1.0

www.midcentraldhb.govt.nz

Documents

2013 14 qa final v01i