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Auckland District Health Board
Board Meeting
Wednesday 4 May 2011
2:00pm
A+ Trust Room Clinical Education Centre
Level 5 Auckland City Hospital
Grafton
Hei Oranga Tika Mo Te Iti Me Te Rahi Healthy Communities, Quality Healthcare
1
KARAKIA
1
2
Karakia E te Kaihanga e te Wahingaro E mihi ana mo te ha o to koutou oranga Kia kotahi ai o matou whakaaro i roto i te tu waatea. Kia U ai matou ki te pono me te tika I runga i to ingoa tapu Kia haumie kia huie Taiki eee.
Creator and Spirit of life. To the ancient realms of the Creator Thank you for the life we each breathe to help us be of one mind As we seek to be of service to those in need. Give us the courage to do what is right and help us to always be aware Of the need to be fair and transparent in all we do. We ask this in the name of Creation and the Living Earth. Well Being to All.
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4
2
ATTENDANCE AND APOLOGIES
5
6
Auckland District Health Board
Board Member Attendance Schedule 2011
NAME JAN FEB MAR APR MAY JUNE JULY AUG SEPT OCT NOV
Dr Lester Levy (Chair)
Jo Agnew
Peter Aitken
Judith Bassett
Susan Buckland
Chris Chambers
Rob Cooper # # #
Lee Mathias (Deputy Chair)
Robyn Northey
Gwen Tepania-Palmer
Ian Ward
* attended part of the meeting only # leave of absence
7
8
3
CONFLICTS OF INTEREST
9
10
Conf l ic ts o f In terest Quick Reference Guide Under the NZ Public Health and Disability Act Board members must disclose all interests, and the full nature of the interest, as soon as practicable after the relevant facts come to his or her knowledge. An “interest” can include, but is not limited to:
Being a party to, or deriving a financial benefit from, a transaction. Having a financial interest in another party to a transaction. Being a director, member, official, partner or trustee of another party to a transaction or a
person who will or may derive a financial benefit from it. Being the parent, child, spouse or partner of another person or party who will or may derive a
financial benefit from the transaction. Being otherwise directly or indirectly interested in the transaction.
If the interest is so remote or insignificant that it cannot reasonably be regarded as likely to influence the Board member in carrying out duties under the Act then he or she may not be “interested in the transaction”. The Board should generally make this decision, not the individual concerned. Gifts and offers of hospitality or sponsorship could be perceived as influencing your activities as a Board member and are unlikely to be appropriate in any circumstances.
When a disclosure is made the Board member concerned must not take part in any deliberation or decision of the Board relating to the transaction, or be included in any quorum or decision, or sign any documents related to the transaction.
The disclosure must be recorded in the minutes of the next meeting and entered into the interests register.
The member can take part in deliberations (but not any decision) of the Board in relation to the transaction if the majority of other members of the Board permit the member to do so.
If this occurs, the minutes of the meeting must record the permission given and the majority’s reasons for doing so, along with what the member said during any deliberation of the Board relating to the transaction concerned.
IMPORTANT If in doubt – declare. Ensure the full nature of the interest is disclosed, not just the existence of the interest. This sheet provides summary information only - refer to clause 36, schedule 3 of the New Zealand Public Health and Disability Act 2000 and the Crown Entities Act 2004 for further information (available at www.legisaltion.govt.nz) and “Managing Conflicts of Interest – Guidance for Public Entities” (www.oag.govt.nz ).
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Date: 27/04/2011
3.0 Board Interests Schedule.doc Page 1 of 5
ADHB BOARD INTERESTS REGISTER
NAME OF BOARD
MEMBER ORGANISATION ROLE FINANCIAL
INTEREST NATURE OF INTEREST DATE OF LATEST
DISCLOSURE
Lester LEVY (Chair) 1. University of Auckland Business School
2. New Zealand Leadership Institute
3. Health Benefits Limited
4. Tonkin & Taylor
5. Waitemata District Health Board
Professor of Leadership Chief Executive Deputy Chair Independent Chairman Chairman
1 February 2011
Jo AGNEW 1. Senior Lecturer Nursing, Auckland University
2. Casual Staff Nurse ADHB
Salary
Salary
21 April 2010
Peter AITKEN 1. Pharmacist
2. Pharmacy Care Systems Ltd
Pharmacy Locum
Shareholder/Director, Consultant
Hourly Fee
Medical Centre development and pharmacy lease
10 December 2010
Judith BASSETT 1. Nil 9 December 2010
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Date: 27/04/2011
R
NAME OF BOARD
MEMBER ORGANISATION OLE FINANCIAL
INTEREST NATURE OF INTEREST DATE OF LATEST
DISCLOSURE
Susan BUCKLAND 1. Writing, editing and public relations services
2. Medical Council of NZ
3. Occupational Therapy Board
Self-employed
Professional Conduct Committee member
Professional Conduct Committee member
Fees
Hourly fee
Hourly fee
Writer, editor and public relations services
Lay member of PCC set up to hear complaints brought to Medical Council and to determine outcomes
Lay member of PCC to assess complaints and determine outcomes
7 August 2009
Dr Chris CHAMBERS 1. Employee, Auckland District Health Board
2. Wife employed by Starship Trauma Service
3. Clinical Senior Lecturer in Anaesthesia Auckland Clinical School
4. Associate, Epsom Anaesthetic Group
5. Member, ASMS
6. Shareholder, Ormiston Surgical
20 April 2011
3.0 Board Interests Schedule.doc Page 2 of 5
14
Date: 27/04/2011
R
NAME OF BOARD
MEMBER ORGANISATION OLE FINANCIAL
INTEREST NATURE OF INTEREST DATE OF LATEST
DISCLOSURE
Rob COOPER 1. Ngati Hine Health Trust
2. James Henare Research Centre, University of Auckland
3. Whanau Ora Governance Group
4. National Health Board
5. Waitemata District Health Board
Chief Executive
Board Member
Chair
Member
Member
Salary
No fee
Fee (to Ngati Hine Health Trust)
Fee (to Ngati Hine Health Trust)
Fee (to Ngati Hine Health Trust)
Management of a Health, Disabilities, Social & Education Services Trust
Advisory
Assists in the development of Government’s Whanau Ora policy
25 February 2011
3.0 Board Interests Schedule.doc Page 3 of 5
15
Date: 27/04/2011
R
NAME OF BOARD
MEMBER ORGANISATION OLE FINANCIAL
INTEREST NATURE OF INTEREST DATE OF LATEST
DISCLOSURE
Lee MATHIAS 1. Lee Mathias Limited
2. Iris Limited
3. Midwifery and Maternity Providers Organisation Limited
4. Pictor Limited
5. John Seabrook Holdings Limited
6. AuPairlink Limited
7. NZ Council of Midwifes
Managing Director
Director
Director
Shareholder, Director
Director
Governance Advisor
Council member
Fee
Fee
Fee paid to Lee Mathias Limited
Fee
No fee
Fee
Fee
Shareholder, director, independent directorships and healthcare services consulting
Director, company provides services to people with multiple physical disabilities especially
cerebral Palsy
Provider of business and professional services to
midwives and other maternity services providers
Biotech start-up focussing on diagnostic products
Estate of late husband
Provider of early childhood
education services contracted to the MoE.
Statutory Authority
1 February 2011
Robyn NORTHEY 1. Self employed Contractor
2. Hope Foundation
3. Northern Region Ethics Committee
Project management, service review, planning etc.
Board member
Member
Fee
Nil
Fee
Some clients are contractors to ADHB
Research and Education into Aging in NZ, Deliver Seminars and awards scholarships
16 December 2010
3.0 Board Interests Schedule.doc Page 4 of 5
16
Date: 27/04/2011
3.0 Board Interests Schedule.doc Page 5 of 5
R
NAME OF BOARD
MEMBER ORGANISATION OLE FINANCIAL
INTEREST NATURE OF INTEREST DATE OF LATEST
DISCLOSURE
Gwen TEPANIA-PALMER
1. Waitemata District Health Board
2. Manaia PHO
3. Ngati Hine Health Trust
4. Awanmarangi Waonangi
5. Te TAitokerau Whanau Ora
Board member
Board member
Chair
Committee member
Committee member
Fee
Fee paid to NHHT
Fee
2 February 2011
Ian WARD 1. Chair, Advisory Board, Healthvision Limited
2. Principal/Director C -4 Consulting Limited
Fee
Tender to National Shared Services
3 February 2010
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4
CONFIRMATION OF MINUTES
- WEDNESDAY 6 APRIL 2011
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Auckland District Health Board
M i n u t e s
MEETING DETAILS
Time and Date 2:00 pm, Wednesday, 6 April 2011
Venue A+ Trust Room, Clinical Education Centre, Level 5, Auckland City Hospital, Grafton
1 KARAKIA
The Chair declared the meeting open at 2:08pm. Naida Glavish led the meeting with the karakia.
2 ATTENDANCE AND APOLOGIES
Board Members
Dr Lester Levy (Chair) Jo Agnew Peter Aitken Judith Bassett Susan Buckland Dr Chris Chambers Dr Lee Mathias Robyn Northey Gwen Tepania-Palmer Ian Ward
Management in Attendance
Garry Smith – Chief Executive Dr Denis Jury – Chief Planning & Funding Officer Dr Margaret Wilsher – Chief Medical Officer Brent Wiseman - Chief Financial Officer Greg Balla – Director Performance & Innovation Taima Campbell – Executive Director Nursing Naida Glavish – Chief Advisor Tikanga, GM Maori Health Janice Mueller – Director Allied Health Vivienne Rawlings – General Manager Human Resources Ian Bell - Board Administrator
Apologies
Rob Cooper had been granted leave of absence.
3 CONFLICTS OF INTEREST
There were no declarations of conflicts of interest for any item on the agenda.
4 CONFIRMATION OF MINUTES 2 MARCH 2011
Moved Gwen Tepania-Palmer; seconded Jo Agnew
That the minutes of the Auckland District Health Board meeting held on 2 March 2011 be confirmed as a true and correct record.
Carried
5 ACTION POINTS 2 MARCH 2011
The budget 2011 - 2012 would be considered in public exclusion.
21
6 CHAIRMAN’S REPORT
Ministerial permission had been obtained to have joint committees with Waitemata DHB for Community and Public Health Advisory Committee, Disability Support Advisory Committee and Maori Health Gain Advisory Committee. The Chair proposed moving to a six week meeting cycle having 8 Board, Finance and Hospital Advisory Committee meetings and 4 meetings for the Disability Support Advisory Committee, Maori Health Gain Advisory Committee and Pacific Health Advisory Committee. The Chair also allocated Board members as points of accountability to each of the Board’s 10 priorities.
There will be an iPad trial to determine whether the Board can make a full move to electronic Board papers.
7.1 Chief Executive’s Summary
The Annual Plan had been delivered to the National Health Board ahead of time although there were last minute changes to the indicators following new advice. Feedback was expected by the end of April. Work was continuing on the Plan, particularly section 3, reformatting and focusing on measures and numbers.
There had been a valuable meeting with the National Hauora Coalition establishing a point of contact for the relationship.
The failure of the continuous power supply when it underwent its six monthly test caused very short-term disruption to electives and a post event review would be undertaken. There is to be an increase in the frequency of testing.
Regional Shared Services had been established with transfer of staff and the work of Vivienne Rawlings and Brent Wiseman was acknowledged.
The overall forecast to year end was breakeven with planning and actions to deliver the results although there was pressure in the provider arm to achieve the elective target, which affects revenue as well as costs of labour and direct treatment costs.
7.2 Better Sooner More Convenient
There was increased confidence in the Access to Diagnostics Radiology target being met. With the consolidation of PHOs, rather than each PHO having contracts with each DHB, the mechanism to have a single point of contact for each PHO had been developed on the basis of a host DHB, which dealt with transactional issues and contracts, and partner DHBs which participated in strategic directions.
There was increased confidence that the Minor Surgery Skin Lesions target would be met.
Bernard Te Paa (Counties Manukau District Health Board) was responsible for Maori Service Development and it was suggested that he be invited to the CPHAC meeting to talk to the lack of progress around this target.
7.3 Regional Service Planning Progress Summary
The Northern Region’s Health Plan was provided under separate cover and Margaret Wilsher’s leadership was acknowledged as was the strong clinical engagement across the region. The Plan was bold but had been developed in collaboration with clinical managers and had been strongly challenged in workshops, which had been an important process. There was a willingness to focus on the patient and take a big picture view. While the Plan identified areas as requested by the National Health Board other services were not ignored but were business as usual. The budget for the Plan was approximately $1.3m across the region, plus staff time, and governance would be through the Steering Committee with the ultimate point of authority being the Regional Governance Group comprised of Chairs, CEOs and CMOs. There were defined
22
outcomes for the first year.
This plan demonstrated the DHBs ability to work together, however, there was a need to understand more clearly the connections between the Minister of Health’s expectations, the National Health Boards priorities, the Northern Region’s Health Plan and how they informed the individual District Health Boards Annual Plans. The next piece of work would be on an implementation plan and a matrix to work against.
Moved Ian Ward; seconded Susan Buckland
That the ADHB endorses the Northern Region’s Health Plan acknowledging that the budget is yet to be developed.
Carried
7.4 Minister’s Six Health Priorities 2010 - 2011
Work was being undertaken on diabetes with an increase in access through coordinators working at the practice level. In terms of self management, percentages had not changed over two years and there was a risk that as access improved the percentage may in fact decrease. There had been a slight increase in immunisation rates and, with audits of practice records, a further increase was expected and there was more confidence that the target would be met by year end.
9.1 DAP Projects Report
This was an overarching summary. The Tamaki project was being rescoped.
10.1 Finance Committee Recommendations
Crown Health Financing Agency
Moved Lee Mathias; seconded Gwen Tepania-Palmer
That the Auckland District Health Board agrees that the proposed repayment of $10.5m to CHFA due in March 2011, as contained in the District Annual Plan 2010 - 2011, be suspended and that the amount be lodged in an amortisation fund.
Carried
Supply of Standard Catalogue Office Furniture
Moved Robyn Northey; seconded Lee Mathias
That the ADHB approves Gregory Commercial Furniture NZ Ltd (GCF) as the preferred supplier for purchase of all standard catalogue office furniture.
Carried
Direct Negotiations Outsourced Surgical Procedures
Moved Gwen Tepania-Palmer; seconded Ian Ward
That the ADHB grants a dispensation to enter into direct negotiation with MercyAscot, Southern Cross, Gillies Hospital, St Marks Hospital, Laparoscopy Auckland and Auckland City Surgical Services, for the provision of outsourced surgical procedures.
Carried
Auckland Region DHB Electronic Referrals – Phase 1
This had been approved by the Finance Committee however they expressed serious concern at having to provide more funding and also the change of project management part way through the project.
Moved Lee Mathias; seconded Robyn Northey
23
That the ADHB endorses that the Auckland DHB, Counties Manukau DHB and Waitemata DHB Boards approve additional capital funding of $165K to ensure full implementation of the Auckland Regional Electronic Referrals solution. This additional funding is required to cover a forecasted shortfall in the current capital budget of $1,380K. ADHB’s share of the additional capital funding is $55K and it is suggested that this is funded from the IMTS capital budget through substitution of capital funds assigned to projects that have been or will be delayed.
Carried
Duel Energy Linear Accelerator
Moved Ian Ward; seconded Robyn Northey
That the ADHB approves the dispensation from tender and purchase of a linear accelerator from Varian Medical Systems. The estimated price is $2.9m (dependent on US$ exchange rate). $463,000 is budgeted in 2010/11 for the deposit, with the remainder budgeted in 2011/12. A full capital expenditure proposal is still required to be presented to the Board.
Carried
Lease 99 Grafton Road
Moved Lee Mathias; seconded Gwen Tepania-Palmer
That the ADHB approves the Variation of Lease and Rent Review for the property at 99 Grafton Road, Grafton for an initial 6 year period with 2 Rights of Renewal of 3 years each and delegates authority to the Chief Executive Officer to execute the Deed.
Carried
Implementing a Metro Auckland Regional After-Hours Network
Moved Ian Ward; seconded Lee Mathias
That the Finance Committee recommends that the ADHB Board:
1. Approves the issuing of an regional request for proposals (RFP) for the development of the Auckland Regional After-hours Network;
2. Notes that the overall objective of this RFP is to implement an affordable, sustainable, integrated After-hours network for the Auckland region that reflect locality needs;
3. Notes that Counties Manukau District Health Board will manage the RFP process on behalf of the Metro Auckland DHBs;
4. Notes Ministerial support for the RFP approach and timeframes committed to through our District Annual Plan.
Carried
10.2 Finance Report
The surplus for the month was $4.7m and year to date $5.2m which was favourable to budget and provided a base to move forward with an expectation to break even at year end. Pressure points were elective revenue and the costs of labour and direct treatment costs.
11 GENERAL BUSINESS
There were no items of General Business.
24
12 PUBLIC EXCLUSION
Moved Susan Buckland; seconded Jo Agnew
That, in accordance with the provisions of Schedule 3, Clauses 32 and 33, of the New Zealand Public Health and Disability Act 2000, the public be excluded for consideration of Item 12.
The general subject of the matters to be considered while the public is excluded, the reason for passing this resolution in relation to each matter, and the specific grounds under the above clause for the passing of this resolution are as follows:
General subject of each matter to be considered:
Reason for passing this resolution in relation to each matter:
Ground(s) under clause 34 for the passing of this resolution:
12.1 Confidential Board Minutes
2 March 2011 12.2 Shared Services Steering Group Update 12.3 Budget 2011 - 2012
To enable the Board to carry on without prejudice or disadvantage commercial activities and negotiations: Official Information Act 1982 s.9(2)(i) and s.9(2)(j)
That the public conduct of the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under s 9 of the Official Information Act 1982.
Carried
The items discussed in public exclusion were the Confidential Board Minutes 2 March 2011, Shared Services Steering Group Update and the Budget 2011 - 12.
Moved Robyn Northey; seconded Jo Agnew
That the meeting resume in public.
Carried
NEXT MEETING
The meeting closed at 3:48 pm
The next scheduled meeting is : 2:00pm, Wednesday 4 May 2011 A+ Trust Room Clinical Education Centre Level 5, Auckland City Hospital Grafton
CONFIRMED CHAIR: DATE:
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26
5
ACTION POINTS
- WEDNESDAY 6 APRIL 2011
27
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Board Action Points from the meeting on Wednesday 6 April 2011
Item Detail Designated Action
7.2 Bernard Te Paa responsible for Maori service development to be invited to CPHAC Denis Jury Attended 7.4 The draft Annual Plan sent to Wellington to be distributed to Board Garry Smith
Ian Bell Actioned
29
30
6
CHAIRMAN’S REPORT
6.1 Report 6.2 Chairman's Recommendations
31
32
6.1 Report
33
34
6.2 Chairman's Recommendations
35
36
ADHB Board Author: Ian Bell (8077) Subject: Starship Foundation Recommendation
That the Auckland District Health Board appoints Susan Buckland as the ADHB representative on the Starship Foundation.
Background
The ADHB has, under the Starship Foundation Deed of Trust, the Chair or his/her nominee appointed as a member on the Starship Foundation Board of Trustees. Susan Buckland has represented the previous Board and I propose that she continue to represent our Board.
37
ADHB Board Author: Ian Bell (8077) Subject: A+ Charitable Trust Recommendation
Nil.
Background
The Deed of Trust of the A+ Charitable Trust provides that the Chair of ADHB is a Trustee ex officio or his/her nominee. The Chair, Lester Levy will represent ADHB on the A+ Trust.
38
7
CHIEF EXECUTIVE’S REPORT
7.1 Chief Executive’s Summary
7.2 Minister’s Six Health Priorities 2009/10
39
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7 .1 Chief Execut ive ’s Summary
41
42
Chief Execut ive Of f icer ’s Summary Traffic Light Comment Mitigation
Goal 1 Lift the Health of the People of Auckland Annual Plan and District Annual Plan Green Deadlines met, awaiting feedback Implementation Plan being developed
particularly FTE#s and Savings / Productivity requirements. Ensuring measurable deliverables on all objectives.
Better Sooner More Convenient Green Two day workshop for GAIHN has increased confidence.
Clear accountability of delivering 2010/11 DAP. Looking forward simplified focus on Acute Demand, Child Health, embedding locality approach and linking to Integrated Family Health Centres.
Goal 2 Improve Performance Elective Surgery Orange Plan is in place to deliver required result. Daily / weekly monitoring required over the
remaining months of the year.
ESPI Compliance Green ESPI 2 (outpatient) at 31 March 2011 was 462. This is the lowest position since June 2010 and prior to that January 2009. ESPI 5 (surgery) at 31 March 2011 was 413. This is the lowest position since December 2009.
Patients waiting over 12 months 31 March 2011. Of the 51 patients waiting over 12 months 20 have booking date 6 removed for (medical or other) reasons 4 neurosurgery cases cleared for
outsourcing. 13 awaiting review 8 patients not booked.
National and Regional Services / Centres of Excellence
Green Increased focus following board discussion to drive improved service configuration.
Priority and resource applied to gain traction.
Staff Engagement Orange Understanding requirements and priorities.
‘Vital Signs’ sessions during May.
43
Goal 3 Live Within Our Means healthAlliance Green Formation well advanced.
2nd Tier Management appointed. Johan Vendrig successful in attaining GM IS Role.
Form Information Management role to complement new regional structure.
Financial Results and Budget Orange While the forecast overall is producing the required result, cost line variances are unacceptable.
Strong intervention in FTE management. Clinical review of direct treatment costs. Embedding productivity gains and ‘banking’ them. Reviewing models of care.
Employment Relations Orange Close support to National Agreements currently in discussion.
Proactive engagement.
44
7 .2 Min is ter ’s S ix Heal th Pr ior i t ies 2009 /10
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46
Project: Primary Objective: That at least 95% of patients will be admitted, discharged or transferred from Auckland Emergency Departments within 6 hours
Date of Delivery: 30 June 2011
Project Risks / Comments:Performance to achieve Shorter Stays in ED for both Adults and Children’s services continues to demonstrate
improvement . Overall performance for month of February was 86%. This has further improved in March ( 1
March to 25 March) to 94.2% of patients admitted, discharged or transferred within 6 hours.
Acute Patient Flow, Actual vs Target, July 2009 - Dec 2011
0%
20%
40%
60%
80%
100%Ju
l-200
9
Aug
-200
9
Sep
-200
9
Oct
-200
9
Nov
-200
9
Dec
-200
9
Jan-
2010
Feb
-201
0
Mar
-201
0
Apr
-201
0
May
-201
0
Jun-
2010
Jul-2
010
Aug
-201
0
Sep
-201
0
Oct
-201
0
Nov
-201
0
Dec
-201
0
Jan-
2011
Feb
-201
1
Mar
-201
1
Apr
-201
1
May
-201
1
Jun-
2011
Actual Goal MOH Target
47
Adult Acute Patient Flow, Actual vs Target, July 2009 - June 2011
0%
20%
40%
60%
80%
100%
Jul-2
009
Aug
-200
9
Sep
-200
9
Oct
-200
9
Nov
-200
9
Dec
-200
9
Jan-
2010
Feb
-201
0
Mar
-201
0
Apr
-201
0
May
-201
0
Jun-
2010
Jul-2
010
Aug
-201
0
Sep
-201
0
Oct
-201
0
Nov
-201
0
Dec
-201
0
Jan-
2011
Feb
-201
1
Mar
-201
1
Apr
-201
1
May
-201
1
Jun-
2011
Actual Goal MOH Target
Project: Adult Acute Patient FlowPrimary Objective: That at least 95% of patients will be admitted, discharged or transferred from Auckland Adult Emergency Department
within 6 hoursDate of Delivery: 30 June 2011Clinical Leads: Nurse Director Margaret Dotchin , Dr Tim ParkeProject Sponsor: Nurse Director Margaret DotchinSteering Group: Nurse Director Margaret Dotchin, General Manager Ngaire Buchanan,Dr Tim Parke, Dr Art Nahill, Dr Wayne Jones, Dr Andrew Old, Nurse Advisor Mark Entwistle.
Improvements to date:Streamlined AED processes and measurement and manage the challenge of
growing demandReviewed Medical / Nursing requirements for AED and approved business case for
resource increase to match increased workload.Charge nurse patient flow coordinator introducedImproved access to Radiology Streamlined documentation required for safe transfer Improved triage processes.Managing bed block with additional resources58 Additional beds opened 2009‐2010 Winter Ward 31 General Medicine 10 additional beds August – October 2010Managing bed block & reducing the time patients wait through improved processes
and teamworkDaily Rapid Rounds introduced in General Medicine (Feb 2010) and
Orthopaedics
(July 2010)Nurse Facilitated Discharging in General Medicine (April 2010)Improved Bed Management Communication via Estimated Discharge Dates, CMS
upgrades, improved visual management, more efficient bed management meetings,
earlier time of day discharging.Daily breech review meetings to understand root causes and implement short term
solutions.Immediate actions to improve performance:1.
Increased engagement of Senior Leadership Team to support improvement
activities and reduce road blocks to improvement.Increase communication and engagement of Clinical Directors, SMO’s, RMO’s Increase communication and engagement of Charge Nurses and RN’s after hours
to further reduce wait times for patient transfer from Emergency
DepartmentEngage with SMO’s, RMO’s and nurses one to one, by CD, Nurse Advisor
or Level 2 clinical leader where resistance to required behaviour is
demonstrated.Valuing patient time poster campaign
2.
Establish ED short stay unitImplement APU flex beds Improve measurement of Ready to Go patients in EDComplete recruitment of remaining ED resource to improve weekend
coverageSupport General Medicine by diversion of patients to subspecialtiesImplement general surgery acute flow team initiatives to improve
response timeCMO to attend Orthopaedic SMO meeting to increase engagement.Relocate bed manager to ED after hours Implement ED discharge nurse on weekendHands on support of ED flow Charge Nurse to reduce roadblocks to
timely review and transfer of patientsCommence physiotherapy facilitated discharge in Orthopaedics.Establish discharge co‐ordination responsibility in Gen Med ward nursing team.Further increase timely overnight transfers from ED to inpatient
wards once bed
allocated.3.
Five day rapid improvement event planned for April to focus on improvement of
process from decision to admit to patient transfer complete.Improve elective scheduling.
Project Risks / Comments:Significant improvement noted in March with 95% of patient discharged or transferred from ED within 6 hours. A 5‐day Rapid Improvement event is planned for 11‐15 April to identify and implement further solutions from decision to
admit to leaving ED. Further work is also underway on weekend resourcing to meet variable demand, establishment of Short Stay Unit,
understanding triggers and escalation process to accommodate increasing admissions to APU and manage bed block in
winter months.
11
2233
48
Project: Children’s Acute Patient FlowPrimary Objective: That at least 95% of patients will be admitted, discharged or transferred from Auckland Children’s Emergency
Department within 6 hoursDate of Delivery: 30 June 2011Clinical Lead: Richard AickinProject Sponsor: Ngaire BuchananSteering Group: Ngaire Buchanan, Richard Aickin, Michael Shepherd, Janet Campbell, Stuart Dalziel
Improvements to date:Business Case to develop CED Nurse Practitioners –2x Nurse
Specialist (in training for NP) appointed in January
Improved Measurement systems to better identify clinical
short stay patients
Development of weekly dashboard reporting for CED to
better track performance
Daily reviews to identify specific reasons for delays on a
case‐by‐case basis and to communicate findings with
relevant teams
Weekly communications of performance to ward levelDevelopment of ‘full hospital plan’
to improve
responsiveness when indicators of ‘bed block’
developing
Enhancement of electronic tracking systems for acute
patient flow – going live in March
Immediate Actions to Lift PerformanceOpening of 4 additional beds Increase use of transition lounge to improve bed availabilityAdditional CNA to assist wards receiving patients to stop
delays on patient transfer.
Two nurse specialists to immediately take case load in CEDGreater Starship CD engagement, Enhance communications
to Charge nurses
Longer term projectsLean Six Sigma Green Belt projects in progress:
a) Patient Transfers from CED to a ward where a bed
is availableb) Bed turnaround time in ward 24B ‐
time to
discharge from Doctor’s clearancec) Inter‐hospital Paediatric transfersd) Estimated Discharge Date accuracy in Paediatric
Orthopaedics:
Project Risks / Comments: While the March performance of 93% was
short of the target, the
result represented a further improvement over prior months and 6% over the same month last
year. There were some 12 days at 95% or better which comfortably surpassed the performance
of all prior months. The improving results continue to reflect a
number of activities and projects
within Starship. Of particular note in March was: Increased Management focus and engagement.
Daily review of all 6 hour breaches with feedback
and improvement actions being taken in the
relevant areas. Heightened staff awareness brought about by Valuing our Patients Time Campaign
which publishes results on a weekly basis. The importance meeting the 6 hour target and results
achieved have been on the agenda at meetings throughout Starship. Implementation of an
Electronic Whiteboard in CED. This has resulted in a greater level of transparency as to where
patients are in their CED journey to enable prioritisation of patients that may breach the 6 hour
time. The transfer time from CED to ward (relative to the 1 hour
recommendation) made a
significant improvement with the mean falling by 34% over February’s results. All wards are now
using the Estimated Dates of Discharge
.
Children's Acute Patient Flow, Actual vs Target, July 2009 - June 2011
0%
20%
40%
60%
80%
100%
Jul-2
009
Aug
-200
9
Sep
-200
9
Oct
-200
9
Nov
-200
9
Dec
-200
9
Jan-
2010
Feb
-201
0
Mar
-201
0
Apr
-201
0
May
-201
0
Jun-
2010
Jul-2
010
Aug
-201
0
Sep
-201
0
Oct
-201
0
Nov
-201
0
Dec
-201
0
Jan-
2011
Feb
-201
1
Mar
-201
1
Apr
-201
1
May
-201
1
Jun-
2011
Actual Goal MOH Target
49
Project: Improved access to elective surgeryPrimary Objective: Increase ADHB Elective Surgical Discharges from 9,425 to 11149Date of Delivery: 30 June 2011Clinical Lead: Vanessa Beavis, Ian CivilProject Sponsor: Peter LowrySteering Group: Ngaire Buchanan, Dr Vanessa Beavis, Margaret Dotchin, Fionnagh Dougan, Ian Civil.
Risks / Comments: (Amber)At approximately 7,500 discharges ADHB is on target per the work-out plan sent to the Ministry in February 2011 and is 93% of the annual phased plan against which we will be reported for the 3rd quarter.The Forecast to 30 June 2011 is still to meet the elective health target of 11,149 discharges.
Planned activities:
1. Operationalising 2 new OR at Greenlane Surgical Centre
during April. Official opening 27th
April2. Other internal includes additional ophthalmology lists at
GSU in the last quarter and “longer days”
at ACH & GSU.3. Outsourcing across a range of specialties, 4. Activity is targetting high volume, low complexity
volumes.5. We are also reviewing some relevant data issues e.g.
•review of patient discharge data for electives coded as
acutes and •surgical discharges allocated to a medical specialty and
not therefore not counted as an elective discharge and•coding practices for short cases which are inconsistent
across different theatre settings.
Contributors to Elective Health Target
-
2 , 0 0 0
4 , 0 0 0
6 , 0 0 0
8 , 0 0 0
10 , 0 0 0
12 , 0 0 0
Jul-10 Aug-10 Sep-10 Oct -10 Nov-10 Dec-10 Jan-11 Feb-11 Mar-11 Apr-11 May-11 Jun-11
Production July to March Base Production April to June Greenlane Other Internal Ini
he a l t h t a r ge t
11, 14 9 di sc ha r ge s
50
Project: Shorter waits for Radiation TherapyPrimary Objective: That 100% of eligible patients requiring radiation treatment will commence treatment within 4 weeks by 31
December 2011 Date of Delivery: 31 December 2010 (4 weeks)Clinical Lead: Andrew MacannProject Sponsor: Fionnagh DouganSteering Group: Fionnagh Dougan, Andrew Macann, Margaret White,
Robyn Dunningham
Radiation Oncology Wait times – March 2011In March 100% of eligible patients were treated within the
4 week target timeline.
Further improvements in progress to sustain delivery:•
Pantak replacement is planned from early May to
July 2011
•
Replacement of MV6: Decommissioning commences
mid‐July until late November 2011. Evening shifts will
be reinstated during this period to mitigate lost
capacity
•
Introduction of HDR for Gynaecological patients
is
scheduled for May 2011.
•
A
public/private Model of care
has been developed
to enable our clinicians to treat public patients at
ARO. Effective from March 2011 and progressing
well.
•
Breast hypo‐fractionation implemented: Emerging
clinical evidence supports the use of reduced
fractions in a higher % of breast patients. This has
reduced treatment time and freed up capacity on the
linear accelerators.
•
Introduction of new technology: The introduction of
V‐Mat prostate treatment has the potential to
reduce treatment times by 50% when fully
implemented. This is now in progress.
•
Aria project: A project is underway to develop a full
electronic record within the LINAC machine’s
operating system.
•
A weekly capacity modelling tool
has been
developed and is now being used for future LINAC
capacity planning, improved forecasting capability
and management of workload.
•
An “Operational team”
has been established whose
key accountability is to measure KPI’s to prioritise the
waitlist and analyse performance on a weekly basis.
•
A daily Waitlist report
enables daily monitoring and
immediate remedial action if required.
Risks / Comments: The service is 100% compliant to the 4 week target for Quarter 3.Key risks which may impact capacity to deliver to the target:•MV6 Linear Accelerator replacement – the service expects some loss of capacity during the period
of decommissioning and replacement July – November 2011. •Sustained demand – the service on average is receiving 5 more referrals pw as compared to the
same period last year. •RT staff vacancies and skill mix – pending resignations will impact staffing ratios during May –and
flexi shifts cannot operate.•The implementation of HDR treatment within an existing bunker may reduce capacity.•Introduction of new technology transiently reduces capacity e.g.
V‐Mat, IMRT, HDR Gynae
treatment, QA testing of new technology.
Radiation Therapy - % patients commencing treatment w ithin 4 weeks of FSA, Actual vs Target, July 2010 - Dec 2011
0%
20%
40%
60%
80%
100%
120%
Jul-2
010
Aug
-201
0
Sep
-201
0
Oct
-201
0
Nov
-201
0
Dec
-201
0
Jan-
2011
Feb
-201
1
Mar
-201
1
Apr
-201
1
May
-201
1
Jun-
2011
Jul-2
011
Aug
-201
1
Sep
-201
1
Oct
-201
1
Nov
-201
1
Dec
-201
1
Actual Goal MOH Target
51
Better help for smokers -% of hospitalised smokers provided advice and help to quit, Actual vs Target, July 2010 - Dec 2011
0%10%20%30%40%50%60%70%80%90%
100%
Jul-2
010
Aug
-201
0
Sep
-201
0
Oct
-201
0
Nov
-201
0
Dec
-201
0
Jan-
2011
Feb
-201
1
Mar
-201
1
Apr
-201
1
May
-201
1
Jun-
2011
Jul-2
011
Aug
-201
1
Sep
-201
1
Oct
-201
1
Nov
-201
1
Dec
-201
1
Actual Goal MOH Target
Project: Better help for smokers to quit
Primary Objective : % of hospitalised smokers provided advice and help to quit
Date of Delivery: 90% by 1/07/2011, 95% by 1/07/2012
Clinical Lead: Stephen Child
Project Sponsor: Taima Campbell
Steering Group: Di Roud, Anna Schofield, Pam Hewlett, Stephen Child, George Laking, Jim Kriechbaum, Paul Bohmer, Arun Kulkarni, Michelle Stevens,
Kristen Nicol, Bernadette Rehman, Paul Birch, Anne‐Marie Pickering, Victoria Child, Jan Marshall
Improvements to date:•
Direct follow up with wards/services underperforming in
ward audits.
•
ABC Training and coaching of staff in AED & APU.•
ABC chart reminders placed all in AED & APU folders•
Better Help for Smokers to Quit included in Releasing Time
to Care KPIs.
•
New intake of House Officers on 28th February trained on
documentation of ABC.
Immediate Actions to improve performance:A.
Focus on short stay and high volume areas:•
1:1 ABC staff coaching to commence in General Medicine
and General Surgery and AED and APU
•
Negotiation with Women’s Health to identify best options to
improve target performance using funded resources.
B.
Improve engagement with clinical workforce:•
Campaign for a Call to Action to Senior Medical staff to
encourage Registrars and House Officers to routinely assess
smoking with patients and document the ABC.
•
Monthly publication of results of Senior Medical Officer’s
Better Help for Smokers to Quit performance.
•
Details of all Quit Card Providers to be included in monthly
reports to services.
•
Better Help for Smokers to Quit Steering group Terms of
Reference and membership revised.
•
Clinical research strategy under development C.
Data collection systems and processes:•
Meet with Clinical Coding team to review coding practise
and identify areas for improvement.
•
Monthly reports and data analysis to identify areas of
improvement and address areas of underperformance with
services.
•
Electronic Discharge Summary data to be audited for
consistency and accuracy against patient clinical records
Project Risks and CommentsOf the 9221 events coded in March, 1208 (13.1%) of patients were
identified as smokers and
853 (71%) of the smokers were documented as receiving advice to quit. While the number
given brief advice is the highest ever the percentage was lower due to the high number of
events coded in the period. The key areas for improvement remain
the high volume areas of
AED and APU. It has been identified that the “first aid”
–
type cases are currently being missed.
Key staff AED staff are being trained in giving brief advice and
supported with a Quit Smoking
booklet and short letter to handed out to patients on discharge.
The junior doctors are another
key to lifting the target by recording the ABC in the clinical notes and accurately in the
Electronic Discharge Summary. Direct feedback is being given to junior doctors where
documentation is missing during the regular ward audits. National Women’s Health has
instigated a weekly check of ABC documentation and liaising with
the coding team to ensure all
brief advice given is captured. NWH are also monitoring systems and advising clinicians to
record the ABC.
C
AB
52
Project: Cardiac Bypass SurgeryPrimary Objectives: To enable timely access to cardiac bypass surgery the waiting list should be no greater than 80.
To support the national cardiac bypass intervention target, 916 bypass will be completed in 2009/10Date of Delivery: 31 December 2011Clinical Lead: Paget MilsomProject Sponsor: Garry Smith, Fionnagh DouganSteering Group: Marian Hussey, Paget Milsom, Andrew McKee, Peter Ruygrok, Elizabeth Shaw, Pam McCormack, Greg Balla, Gordon Davies
Completed Improvement Activities:
Developed and implemented electronic scheduling system
Initiated pre‐admit process
Developed detailed operational reporting
Set up development production process
Approved business case for CVICU bed capacity
Built capacity planning model for CVICU and Ward 42
Developed patient load planning tool
Initiated daily bed management meeting
Further improvements in progress:
Standard theatre rosterProvide greater weekly standardisation in supply of theatre
resource, to improve planning and co‐ordination. 3 in a row bypass (productive list)
Optimise the theatre schedule by planning a productive list
ECMO – Resource planning processTo improve resource planning and day to day processes to
reduce the impact of high ECMO demand
The Productive Operating Room (NHS Programme)To increase productivity and improve safety in theatre through
better co‐ordination and removal of waste and
frustrations
CVICU/HDU MergeTo increase the overall skill mix so that staff can work in both
units, adding flexibility and reducing cancellations
Enhanced recovery initiativeTo provide a pathway for suitable patients, reducing average LOS
and cancellations
Delay to discharge – ward 42To reduce LOS for patients who are delayed during the discharge
process, reducing theatre cancellations
Delay to discharge CVICUTo reduce LOS for patients who are delayed during the discharge
process, reducing theatre cancellations
Project Risks / Comments:There are 39 patients on the waiting list as at the end of March 2011. YTD throughput is 37 patients less than planned as at end January 2011. Opportunities for additional capacity have been built into the production plan however catch up on the throughput target of 916 is constrained by a shortfall of additions to the waiting list. Work continues on improving the reliability and productivity of the service. The service has currently completed 80 more bypass (through the ACH facility) than last year (19% improvement)
Reduce Cardiac Waiting List, Actual vs Target, Jan 2010 - Dec 2011
0
20
40
60
80
100
120
Jan-
2010
Feb
-201
0
Mar
-201
0
Apr
-201
0
May
-201
0
Jun-
2010
Jul-2
010
Aug
-201
0
Sep
-201
0
Oct
-201
0
Nov
-201
0
Dec
-201
0
Jan-
2011
Feb
-201
1
Mar
-201
1
Apr
-201
1
May
-201
1
Jun-
2011
Jul-2
011
Aug
-201
1
Sep
-201
1
Oct
-201
1
Nov
-201
1
Dec
-201
1
Actual Goal MOH Target
53
Project: Diabetes
Primary Objectives: Increase the percentage of people with diabetes accessing and attending their free annual diabetes get
check
Date of Delivery: 55% June 2011
Clinical Lead: Gayl Humphrey
Project Sponsor: Dr Denis Jury
Steering Group:
Primary Care Clinical Advisory Group, Auckland Diabetes Advisory
Team
Recent and Current activities:
1) Increase awareness project with PHOs driving information share
2) Practise based data (results) feedback
2a) Increase other feedback options
3) Improved understanding of IT linkages in Practice systems
4) Paper from the Auckland Diabetes Advisory Team to CPHAC requesting funding to implement improvements in diabetes care and management that will impact on National Health Targets.
5) Routine reports to clinical advisory leadership meetings
6) CPHAC initiatives for long term conditions quality improvement coordinators and population audit tool beginning to be implemented.
7) Regional shared care pathway work
8) Regional shared target setting and service outcomes
Project Risks / Comments:Q2 shows we are now meeting target for DGC, however this is primarily due to the MOH decreasing the denominator for the expected
number of people
with diabetes. The number of Diabetes Annual Reviews for the Pacific and Indian populations are performing over 20% above target, with reviews for
Maori now also above target under the revised prevalence. However, the performance for the Other group continues to underperform against target
(42% against a target of 58%). In order to improve performance,
the DHB is working with primary care to implement a comprehensive range of activities
to improve DGC numbers and initiate an overall quality improvement framework. One initiative is a contract with the PHO’s (through Auckland PHO) to
employ long term condition quality improvement coordinators to work with all our priority practices to improve get checked performance. The first two
coordinators start in February 2011. Another initiative is the funding of a Population audit tool for each practice to enable them to better interrogate
their practice management system to identify and manage their population with long term conditions. This contract will be signed shortly. [Please note that the activity from Tongan Health Society has been estimated due to their data not being received in time for this report].
Diabetes Annual ChecksTarget vs Actual Mar 2008-Jun2011
0%
10%
20%
30%
40%
50%
60%
70%
Mar
-200
8
Jun-
2008
Sep
-200
8
Dec
-200
8
Mar
-200
9
Jun-
2009
Sep
-200
9
Dec
-200
9
Mar
-201
0
Jun-
2010
Sep
-201
0
Dec
-201
0
Mar
-201
1
Jun-
2011
Actual Goal MOH Target
1
2
3
24
5
6
7
8
2
2
08/09 Prevalence 18.79709/10 Prevalence 21,802
10/11 Prevalence 25,008
reduced to 21,342
54
Project:
Diabetes
Primary Objectives: Increase the percentage of people with diabetes having satisfactory or better diabetes management
Date of Delivery: 79% of people with diabetes will have a HbA1c ≤8%
Clinical Lead: Gayl Humphrey
Project Sponsor: Dr Denis Jury
Steering Group: Primary Care Clinical Advisory Group, Auckland Diabetes Advisory Team
Recent and Current activities:1)
Increase awareness project with PHOs
driving information share
1a) reinforce awareness 2) Practise based data (results) feedback via
various mediums including Health point
2a) increase feedback processes 3) Direct Secondary Service phone support for
GPs
4) Increased community shared clinics with
secondary care
5) Increased SEAsian Nurse Specialist access 6) Widened opportunity for self management to
include greater than 2 year or less
diagnosed people with diabetes
7) Improved culturally appropriate self
management courses
8) Improved understanding of IT linkages in
Practice systems (linking PPP)
9) Auckland Diabetes Advisory Team –
structured
agreed district plan of action
10) Redesign the supported self management to
meet needs of population
11) Developing shared care pathway for Diabetes12) Regional shared care pathway work including
clinical workshop
13)Implementation plan being developed for
diabetes coordinators (quality
improvement roles) and population audit
tools for each practice.
Project Risks / Comments:Q2 of 2010/11 performance continues in the same trend as the previous quarter, and we have only achieved
73% against a target of 84% of people having an HbA1C <8. The
main areas of underperformance are in our
diabetic management of Maori and Pacific populations. As noted in the DGC report, the activities currently
being put in place to improve the DGC targets should impact on management in the long term. Additionally a
new contract is being signed with Te Hononga O Tamaki Me Hoturoa
to provide Diabetes Self Management
Education for the ADHB region. With their focus on providing to
our high needs populations, we look to see
improvement in the self management capacity of our high needs populations with diabetes.
Get Checked patients w ith HBA1C<8Actual vs Target Mar2008 - Jun 2011
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Mar
-200
8
Jun-
2008
Sep
-200
8
Dec
-200
8
Mar
-200
9
Jun-
2009
Sep
-200
9
Dec
-200
9
Mar
-201
0
Jun-
2010
Sep
-201
0
Dec
-201
0
Mar
-201
1
Jun-
2011
Actual Goal MOH Target
12
3 4
5
6
7
81a
2a
9
1011
1213
55
Project:
Cardiovascular Risk Assessment
Primary Objectives: Increase the percentage of our eligible population who have had their CVD risk, assessed in the last five years
Date of Delivery: Overall goal is to have 80% of eligible population CVD risk assessed every five years.
Clinical Lead: Gayl Humphrey
Project Sponsor: Dr Denis Jury
Steering Group:
Primary Care Clinical Advisory Team Recent and Current activities:
1) Support the uptake of an electronic CVD tool
2) Training and information system support for
electronic tool
3) IT help line for GPs for risk assessment tool
4) Increase the cumulative incentive payments
for achieving both good assessment and good
management together
5) Review and reshape incentives to link with PPP
targets
6) Enhance links to Green Rx and maximise
primary care uptake
7) Continue to work in various workplaces to
enhance CVD risk assessment for men
8) Link in with research looking at ways to
optimise Pacific males participation in health self
management
9) Work regionally to have similar focus on
incentive goals
Project Risks / Comments:The Q2 CVD data from the MOH shows that we have now meet this target (79.4% against a target of 79%).
Individual targets for each ethnicity have also been meet.
We continue to support primary care in CVD screening and management through funding the license of the
Predict tool and an incentive based contract, which we will be reviewing in the coming months to ensure that
incentives are properly aligned.
Cardiovascular Risk Screening - Actual vs Target Sept 2008-Jun 2011
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Sep
-200
8
Dec
-200
8
Mar
-200
9
Jun-
2009
Sep
-200
9
Dec
-200
9
Mar
-201
0
Jun-
2010
Sep
-201
0
Dec
-201
0
Mar
-201
1
Jun-
2011
Actual Goal MOH Target
12
3
45
67
8
9
56
Project: Increased Immunisation
Primary goal: That 85% of two‐year olds will be fully immunised by July 2010, 91% by July 2011
and 95% by July 2012
Date of Delivery: 1 July 2010, 1 July 2011 and 1 July 2012
Clinical Lead: Richard Aickin
Project Sponsor: Richard Aickin
Steering Group: Richard Aickin, Carol Stott, Aroha Haggie, Hilda Faasalele, Ruth Bijl, Alison Leversha, IMAC, Auckland PHO, Public Health, Plunket,
Commissioner for Children Office, Ministry of Health
Current activities
1.
Practice level reporting available2.
Primary care Immunisation Co‐
ordinators funded ‐
ongoing3.
ADHB Immunisation Strategy approved4.
Funding application made to Starship
Foundation to fund social marketing
programme5.
Data cleansing project in primary care
approved and funded6.
Scoping project for multi‐agency
engagement in promoting
immunisation to high needs families7.
Data cleansing and practice nurse
education project by NIR team and
Immunisation Coordinators in all
practices begins with final results
expected by June 2011.8.
Letters sent to all parents who are
noted on the NIR as having declined
immunisation for their child to check
that this is correct.
Project Risks / Comments:Coverage for Quarter 3, 2010/11 (2 years olds full immunised all
ethnicities) is 88% (regional target 90%, ADHB target 91%). Maori coverage at 18
months increased by 4% in February. The data quality and practice nurse education project targeting systems issues is well underway with so far 2426
missing doses entered manually on the NIR including 214 children
who will turn 2 in the next 3 months. In addition, all children turning 2 in the next 3
months who are currently overdue for a scheduled immunisation are being automatically referred to the Outreach Service for follow up and as of 1
April 63 children had been referred. ‘Courtesy’
letters to check ‘decline’
status on the NIR have been sent 554 parents to check that they
had
intended to decline immunisation. Of 95 responses received so far 31% did not intend to decline immunisation and these children
will be followed up.
Together, it is expected that these initiatives will result in at least a 2‐3% increase in coverage by 30 June 2011.
Percentage of two year olds immunisedActual vs Target Sept 2007-Jun 2011
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Sep
-200
7
Dec
-200
7
Mar
-200
8
Jun-
2008
Sep
-200
8
Dec
-200
8
Mar
-200
9
Jun-
2009
Sep
-200
9
Dec
-200
9
Mar
-201
0
Jun-
2010
Sep
-201
0
Dec
-201
0
Mar
-201
1
Jun-
2011
Actual Goal MOH Target
2
3
4 5 7
68
1
57
58
8
LIFT THE HEALTH OF PEOPLE IN
AUCKLAND CITY
8.1 Committee Recommendations
59
60
8.1 Commit tee Recommendat ions Community and Public Health Advisory Committee Recommendations Maori Health Advisory Committee Recommendations Pacific Health Advisory Committee Recommendations Disabled Support Advisory Committee Recommendations
61
62
9
PERFORMANCE IMPROVEMENT
9.1 DAP Projects Report
63
64
Agenda Item
BRIEFING PAPER TO THE BOARD Date: 4 May 2011 To: Auckland District Health Board – Board Meeting Subject: District Annual Plan Progress Report The attached report shows the progress of the 107 improvement activities ADHB committed to in our 2010/11 District Annual Plan. For over half of these activities we are currently implementing the developed solution or have completed the activity and are monitoring to ensure a sustained solution. We have been pleased with the significant change in performance for the acute flow (ED 6hr target) project. While we are behind schedule for 19 of the activities the sponsors have appropriate plans going forward to mitigate the risk for 10 of these. The nine activities listed as exceptions in this report, mainly due to being behind schedule, are the activities that the sponsor believes still have potential risk associated with them and significant management focus is still required to ensure delivery of the activities objective.
65
66
Goal Level Summary
Goal: 1 Lift the Health of the people in Auckland City
Legend: Red - , Orange - , Green -
Group Pack Report Group/Committee: Board
DAP Projects - total projects: 107
Goal
Num
ber
Started
Current Phase On Time On BudgetExpected Outcome
Finished
Post Implementation Benefits
PlanDo/
Check Act Cancelled
Green
Orange
Red
Green
Orange
Red
Green
Orange
Red
Green
Orange
Red
Define
Measure
Analyse
Improve
Control
1 Lift the Health of the people in Auckland City 40 40 11 9 3 13 3 0 34 3 2 38 0 1 37 1 1 1 1 0 0
2 Performance improvement 56 56 7 6 6 29 4 0 40 11 1 49 2 1 48 3 1 4 4 0 0
3 Live within our means 11 10 1 1 3 1 3 0 8 2 0 10 0 0 10 0 0 1 1 0 0
Total # 107 106 19 16 12 43 10 0 82 16 3 97 2 2 95 4 2 6 6 0 0
Total % 100% 99% 18% 15% 11% 40% 9% 0% 77% 15% 3% 91% 2% 2% 89% 4% 2% 6% 6% 0% 0%
Exceptions
Project Coverage PhaseOn Time
On Budget
Expected Outcome Sponsor Review Committee
Develop Care Pathways for people with Long Term Conditions
National Define The original pathways have been incorporated into the BSMC plan and the Diabetes pathway is included in the regional health plan. The 5 pathways under development will meet the DAP target.
CPHAC
Increase access and capacity to community diabetic eye screening
National Analyse Loads of activity happening. Good progress on volumes etc. ,Need to keep aware of the timelines and the implications of them being delayed.
CPHAC
Māori Service Development Regional Define Merger activity to date has been complex and time consuming. Progress has been made although slow. A project framework is under consideration. Additional activty is planned to ensure the project gets back on track.
CPHAC
Palliative Care Redesign ADHB Analyse Delays - clarity around the way forward expected from steering group meeting scheduled for the end of March.
CPHAC
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67
Goal: 2 Performance improvement
Legend: Red - , Orange - , Green -
Goal: 3 Live within our means
There are no projects that have been marked as an exception
Exceptions
Project Coverage PhaseOn Time
On Budget
Expected Outcome Sponsor Review Committee
Better help for smokers to quit
National Improve A range of improvement strategies are in the process of being implemented with the assistance of the new steering group. Results remain unsatisfactory due to the high volumes of short stay patients to whom advice is not being routinely offered or documented. Confirmation of funding for Smokefree services for the 11/12 year has not been confirmed. Funding expires 30 June.
HAC
Skin Lesions Regional Improve Project is now back on track. Contracting arrangements are currently being finalised and transition plan from ADHB provider to GP's is being developed.
CPHAC
Pharmaceuticals Regional Measure Original benefits idetified may not be delivered although work is underway to forcast benefits likely for the end of the financial year.
CPHAC
Starship 6 hour project
National Improve While the March performance of 93% was short of the target, the result represented a further improvement over prior months and 6% over the same month last year. There were some 12 days at 95% or better which comfortably surpassed the performance of all prior months. The improving results continue to reflect a number of activities and projects within Starship. Of particular note in March was: Increased Management focus and engagement. Daily review of all 6 hour breaches with feedback and improvement actions being taken in the relevant areas. Heightened staff awareness brought about by Valuing our Patients Time Campaign which publishes results on a weekly basis. The importance meeting the 6 hour target and results achieved have been on the agenda at meetings throughout Starship. Implementation of an Electronic Whiteboard in CED. This has resulted in a greater level of transparency as to where patients are in their CED journey to enable prioritisation of patients that may breach the 6 hour time. The transfer time from CED to ward (relative to the 1 hour recommendation) made a significant improvement with the mean falling by 34% over February’s results. All wards are now using the Estimated Dates of Discharge.
HAC
Tamaki P2HC project
Regional Analyse A revised programme design and costings has been developed and agreed to by the SLT subject to funding. Funding for training for eligible Maori trainees has been transfered from He Kamaka Oranga to offset some of the cost
BOARD
Exceptions
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68
10
LIVE WITHIN OUR MEANS
10.1 Finance Committee Recommendations
10.2 Finance Report
69
70
10.1 F inance Commit tee Recommendat ions
71
72
ADHB Board Author: Ian Bell (8077) Subject: Fluoroscopy Room Radiology Recommendation
That the Auckland District Health Board approves the budget based business case for the replacement of fluoroscopy equipment with associated installation costs at a cost of $1m subject to tender for the equipment.
Background This will be discussed by the Finance Committee at their meeting on 3 May 2011.
73
ADHB Board Author: Ian Bell (8077) Subject: Replace 2 Angiography/DSA Rooms Recommendation
That the Auckland District Health Board approves the budget based business case for the replacement of a bi-plane and single plane DSA/Angiography equipment with associated installation costs and approves the purchase of pendants for carrying anaesthetic gases as specified by Anaesthetic clinical staff, subject to tender for the equipment, with the project not to exceed $3.5m.
Background This will be discussed by the Finance Committee at their meeting on 3 May 2011.
74
ADHB Board Author: Ian Bell (8077) Subject: Clinical Records Scanning Solution Recommendation That the Auckland District Health Board approves the purchase and implementation of the 3M Health Information Systems (3M) solution for a clinical record scanning system at a capital cost of $3,259,722 and ongoing annual operating costs of $180,000 subject to a further budget of $1.3m being found through reprioritisation of the capital budget. Background This will be discussed by the Finance Committee at their meeting on 3 May 2011.
75
76
10.2 F inance Repor t
77
78
Auckland District Health Board
Board Financial Report
March 2011
79
Performance Graphs by Month & YTD
‐10
‐8
‐6
‐4
‐2
0
2
4
6
8
10
12
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
$ Millions
Net Results
Net Results for 09/10 Act Net Results for 10/11 Bud Net Results for 10/11 Act
‐14
‐12
‐10
‐8
‐6
‐4
‐2
0
2
4
6
8
Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun
$ Millions
Cumulative Net Results
Cumulative Net Results for 09/10 Act Cumulative Net Results for 10/11 Bud Cumulative Net Results for 10/11 Act
80
Auckland District Health BoardSummary ResultMonth of Mar-11
$000s Month Month Month YTD YTD YTDA B Var A B Var
IncomePBF - AKL Population 80,124 79,701 423 F 721,022 717,311 3,711 F
Inter District Inflows 52,626 47,891 4,736 F 453,496 431,016 22,481 F
132,750 127,592 5,158 F 1,174,518 1,148,326 26,192 F
MOH Sub-contracts 9,931 7,515 2,416 F 67,456 67,019 437 F
Other Patient Care 5,055 2,670 2,385 F 28,590 24,207 4,382 F
Services & Products 4,443 4,548 105 U
67 U 482 U
145 F 718 F
153 U
,323 F
228 U
549 U 3,021 U122 U 1,371 F
10 U 306 U
151 U 29 U
313 U 585 U
766 U 2,799 U
3,602 U 15,243 U
227 U 2,672 U
6,249 U 17,206 U
54 U 1,100 F
64 F
183 U
(80) 281 U
116 51 U 989 F
10,778 U 35,283 U
455 U 472 U
(2,536) (2,656) (1,569)
40,306 40,173 133 F
CTA 1,618 1,685 14,480 14,961
Trust & Donation Income 572 428 4,606 3,888
Financial Income 1,375 830 545 F 6,979 3,775 3,205 F
Other Income 414 567 4,987 4,762 225 F
156,159 145,836 10 1,341,922 1,307,111 34,811 F
ExpenditureEmployee Costs Medical 20,174 20,554 380 F 175,325 175,097
Nursing 20,653 20,104 179,788 176,767 Technical 10,836 10,714 90,326 91,697
Hotel Services 843 833 7,507 7,200
Administration 8,366 8,215 70,004 69,975
Other 3,816 3,503 31,831 31,247
Total Employee Costs 64,689 63,923 554,781 551,982
Direct Treatment Costs 21,735 18,133 172,852 157,609
Indirect Treatment Costs 3,508 3,280 32,061 29,388
Funder Payments 45,715 39,465 372,277 355,070
Inter District Outflows 8,426 8,372 74,251 75,351
Prop, Equip. & Transport 3,867 3,931 36,174 37,199 1,025 F
Maintenance 107 133 26 F 1,383 1,200
Building Compliance 0 0 0 F 0 0 0 F
Loss on Sale of Fixed Assets 1 82 F 293 12
Administration Costs 2, 2,065 17,023 18,012
Total Operating Expenditure 150,083 139,304 1,261,108 1,225,826
Operating Contribution 6,077 6,532 80,814 81,285
Depreciation 4,215 4,422 207 F 38,637 40,448 1,810 F
Finance Costs 1,514 1,714 199 F 13,739 15,100 1,361 F
Capital Charge 2,883 3,051 168 F 25,744 27,307 1,563 F
Total Non Operating Costs 8,612 9,187 575 F 78,120 82,855 4,734 F
Net Surplus / (Deficit) 120 F 2,693 4,262 F
81
Auckland District Health BoardStatement of Financial PositionAs at Mar 2011
Mar-11 Mar-11 Feb-11 Jun-10Actual Budget Actual Actual$ 000s $ 000s $ 000s $ 000s
Crown EquityOpening Balance 569,409 569,304 569,409 566,089 Equity Injections/(Repayments) 1,144 3,044 1,144 3,320 Closing Balance 570,553 572,348 570,553 569,409
Revaluation reserveOpening BalanceRevaluation AdjustmentsClosing Balance 353,537 381,278 353,537 353,538
Retained EarningsOpening Balance (468,367) (468,437) (468,367) (468,645)Surplus/(Deficit) Current YearClosing Balance
Total Crown Equity 458,418 483,618 460,953 454,578
Represented by:Fixed AssetsLand 181,497 201,337 181,497 181,497 Buildings 573,241 583,301 574,862 586,094 Clinical, Other Equipment & Motor Vehicles 81,373 121,848 81,207 79,856 Work in Progress 32,938 28,168 29,745 23,166 Total Fixed Assets 869,048 934,654 867,311 870,612
Derivative Financial Instruments 4,772 4,399 5,321 7,061
InvestmentsAssociated Company Investments 95 386 95 470 Trust Deposits 6,326 8,000 6,326 10,078 Total Investments 6,421 8,386 6,421 10,547
Current AssetsCash & Short Term Deposits 80,787 36,195 77,246 56,815 Trust Deposits 15,679 11,508 15,564 11,747 Debtors 30,181 24,435 19,132 25,691 Accrued Income 25,538 26,591 32,567 31,221 Prepayments 3,454 2,320 3,912 2,245 Inventor
353,538 381,278 353,538 381,278 (0) - (0) (27,740)
2,693 (1,571) 5,229 279 (465,673) (470,008) (463,138) (468,367)
y 12,202 12,106 12,286 11,220 Total Current Assets 167,842 113,155 160,706 138,938
Current LiabilitiesBorrowings 25,640 25,787 26,086 75,027 Trade & Other Creditors, Provisions 226,004 218,318 222,646 222,910 Income Received in Advance 27,939 18,647 24,523 20,087 Taxes Payable 23,128 19,153 18,640 18,040 Funds Held in Trust 1,086 1,108 1,088 1,067 Total Current Liabilities 303,796 283,012 292,984 337,132
Working Capital (135,954) (169,856) (132,278) (198,193)
Non Current LiabilitiesBorrowings 263,086 273,086 263,078 213,014 Employee Entitlements 22,782 20,880 22,744 22,435
Total Non Current Liabilities 285,868 293,965 285,822 235,449
NET ASSETS 458,418 483,618 460,952 454,578
82
Statement of Cashflows for the Year ended 30 June 2011
Actual Budget Variance Actual Budget VarianceOperationsRevenue Received 154,894 143,732 11,162 1,344,751 1,314,312 30,439Payments (145,944) (135,839) (10,105) (1,291,445) (1,267,838) (23,607)
Net Operating Cashflows 8,950 7,893 1,057 53,306 46,474 6,832
InvestingIncome 660 370 290 5,287 3,327 1,960
Capital Sale of Assets 0 1 (1) 17 12 5Purchase Fixed Assets (5,951) (6,460) 509 (37,684) (58,146) 20,462
Net Investing Cashflows (5,291) (6,089) 798 (32,380) (54,807) 22,427
Financing Equity Injections 0 1,014 (1,014) 1,145 3,043 (1,898)New Loans 0 0 0 70,000 91,000 (21,000)Loans Repaid 0 0 0 0 375 (375)Equity Repayment 0 0 0 0 0 0Loans Repaid 0 0 0 (70,000) (70,000) 0
Net Financing Cashflows 0 1,014 (1,014) 1,145 24,418 (23,273)
Total Net Cashflows 3,659 2,818 841 22,071 16,085 5,986
Opening Cash 48,441 43,296 5,145 30,029 30,029 0Closing Cash 52,100 46,114 5,986 52,100 46,114 5,986
Mar-11 Year to Date
83
Financial Commentary for March 2011 Financial Performance The result for March was a favourable variance with a deficit of $(2.5)m compared to a budgeted deficit of $(2.6)m. The result year to date is a surplus of $2.7m compared to a budgeted deficit of $(1.5)m, a favourable variance to budget of $4.3m.
The result year to date, is driven by higher revenue of $34.8m compared with higher expenditure of $(30.6)m. This was the result of:-
a) Favourable Base Revenue $26.2m is driven by higher base contract variations,
which are primarily for additional Herceptin funding $6.4m, PHO realignment funding $13.6m, Oral Health funding $1.2m and a provision for FY11 IDF wash up’s $3.0m.
b) Higher MoH Subcontract revenue $0.4m, is driven by higher SCI funding $3.4m, Mental Health (Eating Disorder) funding and other MoH Subcontract revenue $7.3m, lower Herceptin funding (now in base revenue above) $(6.2)m and lower Additional Elective revenue $(4.1)m as a result of lower year to date volume delivery than budgeted.
c) Higher volumes of non resident activity $3.5m. d) Higher levels of inter DHB side contracts $2.2m to meet additional PHO costs. e) The timing of donations $0.7m. f) Higher interest received on term deposits $2.0m.
g) A realised gain on Interest Rate Swap Instruments $1.2m.
Year to date expenditure was higher than budgeted by $(30.6)m. The unfavourable variance in employee costs of $(2.8)m was driven by vacancies
and annual leave taken in Mental Health $2.7m, Adult Health $1.8m, Operations $2.1m and Cancer $0.9m, and increased employee costs in Child Health ($3.1)m, Cardiac $(1.8)m, Operating Theatres $(2.0)m, Ambulatory $(0.9)m, driven by increased volume and complexity. In addition, provision has been made for potential MECA settlements $(1.8)m and long service and gratuity payments $(0.9)m.
Direct Treatment costs are $(15.2)m unfavourable to budget in the following services – Adult Health $(1.6)m, Child Health $(4.5)m, Cardiac Services $(5.5)m, OR & Anaesthesia $(2.3)m, Laboratories $(2.8)m, Imaging $(1.7)m and Ambulatory $(0.6)m. The increase is due to increases in Drugs $(0.8)m driven by high usage in immunology and paediatric oncology, Chemicals & Media $(1.9)m driven by higher test volumes and higher reagent prices, Clinical Supplies & Implants $(7.8)m driven by higher volumes in OR & A, Cardiac and Child Health and Outsourcing $(6.0)m primarily to cover operational vacancies, manage cardiac waiting lists and increase elective volumes. There were also various initiatives that have not delivered the treatment cost savings to the planned levels. Further analysis is also provided within the Hospital Advisory Committee agenda.
Funder Payments (excluding IDF Outflows) are over budget $(17.2)m due to
increased PHO costs following a process of realigning PHO’s $(16.3)m. Additional IDF revenue is being received to cover this additional expenditure. There are also unfavourable variances in Laboratory costs following revised contracts with LTA and DML $(1.8)m, costs arising from settlement of prior year’s pharmaceutical claims $(0.7)m and additional Mental Health (Eating Disorder) expenditure $(1.0)m for which additional revenue has been received as described above.
Inter District Outflows are favourable to budget $1.1m driven by the finalisation of
the FY 2010 outflows provision.
84
Indirect Treatment Costs are $(2.7)m unfavourable primarily due to the provisioning for doubtful non resident debts in relation to the increased non resident revenue described above ($2.1)m and the higher cost of sales for retail pharmacies for which additional revenue has been received $(0.4)m.
Property costs are favourable to budget $1.0m driven by lower utilities, lower property
and vehicle maintenance costs and lower computer maintenance costs.
Administration Costs are lower than budget $1.0m due to lower consulting fees for improvement projects $0.9m.
Loss on Sale of Fixed Assets is higher than budget $(0.3)m following review of the
fixed asset register.
Depreciation is lower than budget $1.9m driven by lower levels of capital expenditure.
Finance Costs are lower than budget $1.4m driven by lower than planned interest
rates and CHFA loans not having to be drawn down.
The Capital Charge is lower than budget $1.6m driven by the revaluation of Land & Buildings downwards at balance date.
Financial Position
The opening balance of fixed assets was $(39.5)m below budget principally due to the
downward revaluation of land & buildings $(27.8) m as at 30 June 2010 and FY10 full year capital spending being $(28.7) m lower than forecast.
YTD Capital spending is $32.9m, under budget by $(20.8) m. Baseline and Facilities
projects are behind budget by $(10.3) m driven by slower spending on the Greenlane Surgical Unit $(6.0) m, Oral Heath Clinics $(2.8) m and a reduction in spending through reprioritisation $(4.8) m. Information Systems projects are behind budget by $(10.5) m driven by the pace at which business cases are completed, approved and implemented.
At month end there is an unused overdraft facility of $44.1m.
85
86
1υ
GENERAL BUSINESS
87
88
12
PUBLIC EXCLUSION
89
90
AUCKLAND DISTRICT HEALTH BOARD
RESOLUTION TO EXCLUDE THE PUBLIC
FROM A MEETING OF THE BOARD
Clauses 32 and 33, Schedule 3, New Zealand Public Health and Disability Act 2000 (“ Act”)
That, in accordance with the provisions of Schedule 3, Clauses 32 and 33, of the New Zealand Public Health and Disability Act 2000, the public be excluded for consideration of Item 12. The general subject of the matters to be considered while the public is excluded, the reason for passing this resolution in relation to each matter, and the specific grounds under the above clause for the passing of this resolution are as follows: General subject of each matter to be considered:
Reason for passing this resolution in relation to each matter:
Ground(s) under clause 34 for the passing of this resolution:
12.1 Confidential Board Minutes
6 April 2011 12.2 Governance Committee Structure and Meeting Cycle 12.3 Committee Structure Quality, Risk and Audit Committee 12.4 Appointment to the Audit and Finance Committee 12.5 Northern Region Shared Services Organisation
To enable the Board to carry on without prejudice or disadvantage commercial activities and negotiations: Official Information Act 1982 s.9(2)(i) and s.9(2)(j)
That the public conduct of the relevant part of the meeting would be likely to result in the disclosure of information for which good reason for withholding would exist under s 9 of the Official Information Act 1982.
91
ADHB Board
A g e n d a
MEETING DETAILS
Time and Date 2:00pm, Wednesday, 4 May 2011
Venue A+ Trust Room, Clinical Education Centre, Level 5, Auckland City Hospital, Grafton
Members Dr Lester Levy (Chair), Jo Agnew, Peter Aitken, Judith Bassett, Susan Buckland, Dr Chris Chambers, Rob Cooper, Dr Lee Mathias, Robyn Northey, Gwen Tepania-Palmer, Ian Ward.
Apologies Rob Cooper (Leave of Absence)
In Attendance Garry Smith, Dr Denis Jury, Dr Margaret Wilsher, Brent Wiseman, Greg Balla, Taima Campbell, Naida Glavish, Paul Green, Janice Mueller, Vivienne Rawlings, Ian Bell.
Item Page No
1 2m to 2:02pm
Karakia 001
2 3m to 2:05pm
Attendance and Apologies 005
3 2m to 2:07pm
Conflicts of Interest 009
4 5m to 2:12pm
Confirmation of Minutes Wednesday 6 April 2011 019
5 3m to 2:15
Action Points Wednesday 6 April 2011 027
6
5m 5m to 2:25pm
Chairman’s Report
6.1 Report 6.2 Chairman’s Recommendations
031
7
10m 15m to 2:50pm
Chief Executive’s Report
7.1 Chief Executive’s Summary 7.2 Minister’s Six Health Priorities 2009/10
039
8
5m to 2:55pm
Lift the Health of People in Auckland City
8.1 Committee Recommendations
059
9
5m to 3:00pm
Performance Improvement
9.1 DAP Projects Report
063
ADHB Board
A g e n d a
Item Page No
10
5m 10m to 3:15pm
Live Within Our Means
10.1 Finance Committee Recommendations 10.2 Finance Report
069
11
5m to 3:20pm
General Business 087
11
1h 10m to 4:30pm
PUBLIC EXCLUSION 089
NEXT MEETING
Time and Date: 2:00pm, Wednesday, 1 June 2011
Venue: A+ Trust Room, Clinical Education Centre, Level 5, Auckland City Hospital, Grafton
Hei Oranga Tika Mo Te Iti Me Te Rahi Healthy Communities, Quality Healthcare