HOSPITAL ADVISORY COMMITTEE MEETING · 2018-11-08 · 1. Welcome and Apologies Mrs Katie O’Connor, Chair, welcomed members to the Southland District Health Board (DHB) Hospital

HOSPITAL ADVISORY COMMITTEE MEETING

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

Invercargill, at 2.00pm

11 November 2009

“Quality and Humanity in Health”

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

SDHB HAC Meeting – 11 November 2009 Agenda

HOSPITAL ADVISORY COMMITTEE MEETING

Wednesday, 11 November 2009

2.00pm Board Room, Old Nurses Home, Southland Hospital, Invercargill

AGENDA

Sections Pages

Welcome, Introduction and Apologies

1 Interests Registers

Members’ Interests Register 3

Management and Staff Interests Register 4

2 Confirmation of Minutes

Hospital Advisory Committee Meeting held 7 October 2009 5

Matters Arising from the Minutes

3 Review of Action Sheet 13

4 Chief Operating Officer’s Report 15

5 Director of Nursing and Midwifery Update 79

6 Financial Report 93

7 Acronyms 105

SDHB HAC Meeting – 11 November 2009 Agenda

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

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

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

General Subject Reason for passing this resolution

Grounds for passing the resolution

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

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

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

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

Regional Procurement

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




Medical Officers Unit Report





Value for Money Dashboard





SDHB HAC Meeting – 11 November 2009 Members’ Interests Register

SOUTHLAND DISTRICT HEALTH BOARD (SDHB)

HOSPITAL ADVISORY COMMITTEE (HAC)

MEMBERS’ INTERESTS REGISTER

SDHB HAC Members

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

Sch 4)

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

Kaye Crowther • Employee of WHK Cook Adam (Internal Auditors)

• Trustee of Plunket Foundation

• Chairperson of the Management Committee for the car seat rental scheme for Plunket Southland

• Trustee of Wakatipu Plunket Charitable Trust

• Corresponding member for health and family affairs, National Council of Women

Susie Johnstone • Deputy Chair Otago District Health Board

• Deputy Chair Tourism New Zealand

• Council Member Otago Polytechnic

• Principal Shand Thomson Ltd (and associated entities)

• Accountant Clutha Community Health Company Ltd

• Accountant Clutha Health Incorporated

• Associated with Chair Clutha Community Health Company Ltd

• Shand Thomson Nominees Ltd; Shand Thomson Nominees 2005 Ltd; Abacus STO1 Ltd, Abacus STO2 Ltd, Abacus STO3 Ltd, Abacus STO4 Ltd

• Director and Shareholder, Lyddon Investments Ltd

• Director and Shareholder, Johnstone Afforestation Ltd

• Spouse – Accountant Wyndham Rest Home Incorporated

• Spouse – Accountant Tuapeka Community Health Co Ltd

• Spouse – Accountant Tuapeka Health Incorporated

• Spouse – Accountant West Otago Health Ltd

• Spouse – Accountant Roxburgh and Districts Medical Services Trust Board Fiona McArthur

• Theme and event work, HQNZ Ltd

• Event work, Focus NZ (part of Grand Pacific Tours)

• Working group member for Queenstown Plunket Rooms

• Trustee and Board Member, Disabilities Resource Centre, Queenstown

• Ex Officio Board Member of the Central Otago Kindergarten

• Volunteer for Wakatipu Victim Support

• Wine House and Kitchen Ltd

• High Plains Wine Ltd

Katie O’Connor • Chair, Tui Motu: Independent Catholic Magazine Limited

• Guidance Counsellor, St Peter’s College

Tahu Potiki • Chairman, Te Runanga o Otakou

• Director Arataki Associates

• Board Member, Otago DHB Tim Ward • Partner, BDO Spicers Invercargill, Chartered Accountants

Dot Wilson

• Member of National Executive Committee, Disabled Persons’ Assembly (DPA)

• Secretary of DPA Southland

• President of Workbridge Council

• DPA representative on Workbridge Council

• District Advisor on the Personal Advocacy Trust

• Workplace Support Chaplain

• Parent to Parent Southland

SDHB HAC Meeting – 11 November 2009 Members’ Interests Register

SDHB HAC Meeting – 7 October 2009 Management and Staff Interests Register

SOUTHLAND DISTRICT HEALTH BOARD (SDHB)

HOSPITAL ADVISORY COMMITTEE (HAC)

MANAGEMENT AND STAFF INTERESTS REGISTER

HAC Management Member

General Notice of Interest

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

Brian Rousseau • Director of South Island Shared Services Agency Limited (SISSAL)

• Trustee of New Zealand Institute of Rural Health (NZIRH)

• CEO of Southland and Otago DHBs

• Trustee of Southern Health Welfare trust

Pim Allen • Member of the Governing Council of the Southland Medical Foundation

• Trustee of Gilmour Trust

• Information Strategy Advisory Committee (HISAC) Representative

Lexie O’Shea • Trustee, Gilmour Trust

• Regional Deputy CEO of Southland and Otago DHBs

Karyn Penno • Officer of Southland and Otago DHBs

Leanne Samuel • Trustee of Southern Health Welfare Trust

• Member of Community Trust of Southland (CTOS), Health Scholarships Panel

• Member of Southern Institute of Technology Nursing Board of Studies

• Officer of Southland and Otago DHBs

• Member of the Southland Medical Foundation (Inc)

Bron Anderson • Nil

Southland DHB HAC Meeting Minutes – 07 October 2009

Minutes of the Southland District Health Board Hospital Advisory Committee meeting, held on Wednesday, 07 October 2009, in the Southland DHB Board Room, Old Nurses’ Home, Southland Hospital, Invercargill, commencing at 11.05am.

Present: Mrs Katie O’Connor (Chair, Hospital Advisory Committee) Mrs Kaye Crowther Ms Fiona McArthur Mr Paul Menzies Mr Tahu Potiki Ms Dot Wilson In Attendance: Mrs Lexie O’Shea (Chief Operating Officer/Regional Deputy Chief

Executive Officer) Dr Pim Allen (Chief Medical Officer, Southland DHB) Mrs Leanne Samuel (Regional Chief Nursing and Midwifery Officer - via

video conference) Mrs Bron Anderson (Senior Business Analyst, Southland DHB) Miss Jo Harvey (Communications Officer, Southland DHB) Miss Natasha Nicolson (Senior Administrative Officer, Southland DHB)

Apologies: Mrs Susie Johnstone (HAC Member) Mr Tim Ward (HAC Member)

1. Welcome and Apologies

Mrs Katie O’Connor, Chair, welcomed members to the Southland District Health Board (DHB) Hospital Advisory Committee (HAC) meeting. Apologies were noted from Mrs Susie Johnstone and Mr Tim Ward. An apology for lateness was noted from Mrs Kaye Crowther. It was moved: “That the apologies be accepted”

Moved: Mr P Menzies Seconded: Mr T Potiki

Carried

2. Members’ Interests Register

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

3. Confirmation of Minutes

The minutes of the 09 September 2009 HAC meeting were attached to the agenda. It was resolved:

“That the minutes of the HAC meeting, held on 09 September 2009 be confirmed.”

Moved: Mr P Menzies Seconded: Ms D Wilson

Carried


4. Matters Arising from the Minutes

There were no matters arising from the minutes that were not covered in the agenda.

5. Review of Action Sheet

Clinical Governance – Due to uncertainty following the ‘Horn report’, it was agreed that action point 20 be removed from the action sheet. The Chief Medical Officer advised on the likely change as a result of the Horn report. It was noted that reporting would continue in relation to general clinical governance. The Chief Operating Officer/Regional Deputy Chief Executive Officer, (COO/RDCEO), Mrs Lexie O’Shea outlined the clinical KPIs where reporting would continue. Elective volumes achievement of total elective volumes – The COO/RDCEO advised that the wider organisation had received cake and a card thanking them for their efforts during the past year, from the HAC Committee and Senior Management Team (SMT).

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

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

• In overall contract performance for the month, acute volume was 10% above plan and elective volume 4% above plan, despite the acute demand on areas such as maternity, orthopaedics and paediatrics. This acute activity has put pressure on beds.

• Lakes District Hospital had seen more emergency department (ED) attendances than planned but Southland Hospital was tracking to planned volumes after the first two months.

• Outpatient attendances overall are on track but there has been some under delivery against first specialist appointments. The key outliers are explained within the department reports.

• The volume comparison summary in relation to main inpatient throughput and the KPIs were included for the Committee’s information.

• Discussion was held regarding the Did Not Attend (DNA) numbers being lower for the month of August 2009. The COO/RDCEO noted that many factors contributed to the DNAs and she advised that it was too early to ascertain whether the e-texting was having an impact on the DNA rate, but noted that the organisation would be very interested to see the findings of the pilot when it came to a close. The COO/RDCEO advised that the areas with high DNA rates were being targeted.

• The pleasing trend with staff turnover and sick leave was noted.

• The COO/RDCEO referred to the Provider Arm DAP Project Dashboard 2009/10 on page 25 of the agenda. In response to a query the COO/RDCEO advised that the new born hearing implementation was a new national initiative that was being rolled out throughout the country. The CMO outlined the importance of the initiative.

Medical Division Report – In discussion the following key points were noted:

• Reporting on contract performance is by exception where variance is over or under 10%.

• Recruitment has commenced due to the resignation of a geriatrician.

• A wide ranging discussion was held on the significant increase in numbers attending Lakes District Hospital (LDH), emergency department (ED) and the possible reasons for this. It


was noted that approximately 70% of attendances were local residents. Southland Hospital ED attendance is tracking to plan.

• Discussion was held on the increased number of occupational therapy (OT) referrals. Mr Potiki queried the issues associated with this.

• Discussion was held on the availability of OTs and equipment. Ms Wilson highlighted the importance of optimising the patient journey and ensuring the needs of all patients including disabled are met.

• In response to a query regarding the volume variance for general medicine (refer to page 28 of the agenda), the COO/RDCEO advised that there was a change to the funding through the price volume schedule (PVS). Management was currently working on getting the volumes correct for each individual specialty. It was noted that this is an accounting issue and does not impact on patients.

• The Board Chairman noted the significant waiting time in the ultrasound area. The COO/RDCEO advised on the areas impacting this e.g. volume of referral, change to the secondary care maternity ultrasounds and the availability of the facility.

Mental Health Services – In discussion the following key points were noted:

• In response to a query the COO/RDCEO advised that the team had been requested by the Health and Disability Commissioner (HDC) to review the memorandum of understanding by 30 November 2009. The potential risk is that the HDC deadline may not be met.

• In response to a query by the HAC Chair, the COO/RDCEO advised the contract the Provider Arm has with the Ministry of Health (MoH) relating to Mental Health promotion. She advised that Public Health South also has a contract with the MoH and the MoU ensures both areas are aware of their area of responsibility. This may transfer to the PHOs in the future.

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

• The Elective Service Performance Indicators (ESPIs) are green overall. The areas of concern over the past three months have been highlighted and these continue to be of concern.

• The department has been challenged with the anaesthetic levels and bed capacity.

• Planning continues with the regional plastics service. Otago DHB has employed a second plastic surgeon and Otago and Southland volumes will be shared. Where appropriate some cases will continue to be referred to Christchurch. Outpatient clinics and theatre sessions will be carried out in Southland and Otago.

• In response to a query by Mrs Crowther, the COO/RDCEO advised on the difficulties being encountered with the electronic mapping in the outpatients area and noted the resource required to address this. She advised that overall the results were better than expected, but the individual mapping needs to be corrected.

The COO/RDCEO tabled the theatre dashboard (appendix 1). She advised that the dashboard was an updated version through to the end of August 2009 and the dashboard reflects the challenges with first case start performance that occurred due to bed availability.

• In response to a query, the Regional Chief Nursing and Midwifery Officer (RCNMO), Mrs Leanne Samuel, advised on the strategy with training programmes in the perioperative area. She advised on the ongoing challenges in this area and noted the reliance on constant recruitment of new graduates with an aging workforce.


• The Board Chairman noted the continued improvement outlined in the report. Discussion was held on the challenges around waiting times.

• Discussion was held on the managing of beds and the tight schedule was highlighted. Following a query discussion was held and the COO/RDCEO advised that patients are advised prior to their surgery that if an acute case presents, their surgery could be postponed. She advised only a small number of case are delayed and she acknowledged it was disappointing when delays were experienced.

• The HAC Chair acknowledged the standard of the Theatre dashboard. Women’s and Children’s Division – The following key points were noted:

• The staff shortage in Obstetrics and Gynaecology continues.

• Junior doctor vacancies were noted. Human Resources (HR) Update: In response to a query by Ms McArthur, in relation to Senior Medical Officers (SMOs), the COO/RDCEO advised on the regional recruitment process, which is a work in progress. Information Group Update - The COO/RDCEO advised that one of the key enablers around regional clinical services was linkages electronically between Southland and Otago to allow multi-disciplinary team meetings. The video conference links at present are acceptable but investigations into a better bandwidth to reduce delays and enable expansion of use are being explored. Discussion was held on the linkage with more remote rural communities. Quality and Risk Dashboard – in discussion the following key points were noted:

• The COO/RDCEO highlighted that there were a number of quality projects that are linked to risk management that have been high priority. Regional sign off on this was now imminent.

• The COO/RDCEO advised that the accreditation and certification team are on campus during the period 5/9 October 2009. This will set the agenda for quality for the next three years. The standards for certification and accreditation are being monitored against Australasian standards which is new to most DHBs throughout the country. Certification takes place annually and the accreditation period varies between one and three years.

7. Chief Medical Officer’s (CMO) Update

The Chief Medical Officer (CMO), Dr Pim Allen, spoke to her report and in discussion the following key points were noted:

• Mr Tulloch was unable to attend because he was attending an award ceremony receiving an award from the University of Otago. He would address the HAC committee at their meeting on 11 November 2009 on clinical governance and the involvement of clinicians in partnership and leadership roles. Dr Allen advised it was the surgical division who saw the vision for sharing the partnership model with management.

• Dr Allen advised that Southland DHB has received a small amount of funding for a part time research officer for one year from the Southland Medical Foundation. This would assist in raising the profile of the hospital and facilities making it attractive to SMOs both nationally and internationally. She outlined the positive aspects of Southland Hospital staff and the province and noted that research would enhance the profile of the hospital. She highlighted the importance and advantages of research and noted Southland’s stable population was conducive to research work. Dr Allen acknowledged the ongoing research being undertaken in the Nursing department.


• The HAC Chair congratulated the CMO on her new appointment. Dr Allen advised on her new role in the UK. The HAC Chair thanked her for her contribution to Southland DHB.

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

The Regional Chief Nursing and Midwifery Officer (RCNMO), Mrs Leanne Samuel, spoke to her report and the following key points were noted:

• Occupancy remained high over the month of August 2009.

• Budget results for nursing FTEs are noted in the financial report for the Committee’s information.

• The hours per bed day are reported in the key performance indicators (KPIs).

• A high number of patient watches has necessitated one to one observation in the clinical areas.

• A new dashboard has been developed for Otago and Southland reflecting nursing activity across the region. The RCNMO requested feedback on the draft dashboard. The Committee provided positive feedback on the dashboard.

9. Financial Report

The Senior Business Analyst (SBA), Mrs Bron Anderson, spoke to her report and in discussion the following key points were noted:

• August 2009 resulted in an operating deficit of $597k, which is an unfavourable variance to plan.

• The year-to-date (YTD) position is still within plan.

• The key movement from the favourable variance in July 2009 is within the salary costs.

• The SBA highlighted the key variances outlined in the financial report noting she had indicated where trends had begun to develop. At the end of September 2009 the SBA would provide a forecast to year end.

• The revenue items of note were highlighted with a key area being the mental health wash-up. The funder arm is claiming the money back for funded positions that have not been filled, resulting in an unfavourable variance of $140k.

• Accident Compensation Corporation (ACC) revenue is a key component of the provider arm result. The areas impacting this are, Assessment Treatment and Rehabilitation (AT&R) and Imaging.

• Monthly salary costs YTD are within budget, but there was significant movement within the month.

• The movements in medical salaries relates mainly to senior medical staff undertaking additional duties to fill vacancies. This generates an FTE which sits against overtime. The SBA noted that the budget had not allowed for this as costs in the main are against outsourced costs. It was within junior doctors contracts to pick up additional duties and, accordingly, that has been accounted for in the budget.


• The SBA highlighted the need to look at the outsourced costs in relation to the salary costs with the medical staffing because the complement is across both. The combined costs are currently within budget.

• The SBA highlighted the movement within the nursing salaries noting the YTD result was now unfavourable against budget. She noted the reason for the variance outlined in her financial report on page 85 of the agenda.

• The budget for allied health was above the fiscal position, along with the FTEs. The SBA noted the reasons outlined in her report on page 85 of the agenda.

• Management Administration is within target in both FTEs and the financial plan. The Minister’s FTE cap was noted and the SBA advised that the MoH looks at the cap across the whole DHB.

• Outsourced costs are within budget however the SBA noted that there was a significant amount of money being spent in outsourced costs, predominantly within the medical area.

• Clinical supplies are $36k unfavourable against plan for the month of August 2009. The SBA noted that the variance is patient and volume driven.

• Infrastructure and non-clinical supplies is where the majority of savings targets have been factored. The unfavourable variance is being driven by that line.

• The SBA noted the capital commitments as at August 2009. She highlighted that the budget was tight and noted the team had worked well to manage to the budget.

• A wide ranging discussion was held in relation to the costs related to nursing salaries. The SBA highlighted some of the one-off costs in this area and the Board Chairman advised that an amount of this was demand driven.

In response to a query by Mr Potiki, the COO/RDCEO advised on the challenges with the management/administration cap, noting the inability to resource projects that could lead to a reduction in costs across the organisation. It was moved:

“That the committee receives the management and financial reports”.

Moved: Ms F McArthur Seconded: Ms D Wilson

Carried

10. Information Section

The press releases were noted.

11. General Business

The HAC Chair advised the need for the Terms of Reference to include the numbers required for a quorum. She requested that the COO/RDCEO review the document and advise the Committee. The HAC Chair raised the possibility of changing the commencement time for the HAC meeting and discussion was held. Mr Potiki suggested that the matter be discussed at the Iwi Governance Committee meeting as the decision would impact on that group and a decision could be made following that.


12. Confidential Section

It was moved: “That the Committee move to the Public Excluded Section of the business at 12.45pm.” Moved: Mr P Menzies Seconded: Ms D Wilson Carried The Committee rejoined the Public Section of the meeting at 1.30pm.

13. Meeting Conclusion

The meeting closed at 1.30pm.

14. Confirmation of Minutes

Confirmed __________________________________________ Date ________________ Chairman

August 2008 through August 2009

Executive Dashboard

Southland District Health Board

0

100

200

300

400

500

600

Case VolumeCase Volume Case Volume PY

02468

10121416

Turnover Minutes

Turnaround Minutes per Case, PO to PI KPI

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

100%

Session UtilisationSession Utilisation % with Turnaround

02468

10121416

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

1816

18 1821 20 19

21 2220 20

2325

0

5

10

15

20

25

30

Case Length Variance

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

First Case On-Time Start

% On Time (5 min grace), PI KPI

KPI = 12 mins

KPI = 15 mins

KPI = 80%

KPI = 62%

Case Length Variance (Elective Only)

Turnover Minutes per Case (Patient out to Patient In)

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

Session Utilisation

KPI TrackerGoal Progress Toward Goal

SDHB HAC MEETING – 11 November 2009

HOSPITAL ADVISORY COMMITTEE (HAC) ACTION SHEET

HAC Meeting held on 07 October 2009

Action Point No.

SUBJECT

ACTION REQUIRED

BY

STATUS

EXPECTED COMPLETION

DATE 57-09/09 COO/RDCEO

(Minutes Item 11) Review the Terms of Reference to include the numbers requires for a quorum and advise the Committee.

COO/RDCEO

Completed 11 November 2009

SDHB HAC Meeting – 11 November 2009 Chief Operating Officer’s Report

CHIEF OPERATING OFFICER’S REPORT

HAC Meeting Date: 11 November 2009 Report Prepared By: Lexie O’Shea, Chief Operating Officer Date Prepared: 28 October 2009

Recommendation

That the Committee receives and notes this report.

1. Overall Contract Performance

Total case weight delivery is above budget plan for year-to-date (YTD) September 2009. Acute volume is 16% (380 case weighted discharges (CWD) above plan and elective volume is 4% (36 CWD) below plan YTD September 2009. The key areas of inpatient acute demand are general medicine, general surgery and paediatrics. The emergency department in Lakes District Hospital (LDH) tracks higher than planned with 606 attendances above budget YTD. Southland Hospital attendances are on plan. Outpatient attendances overall are on track with over delivery in follow up appointments YTD balanced against under delivery in some first specialist assessment areas. The key outliers are further explained within the divisional reports. Provider Arm DAP Project Dashboard 2009/10. This is attached as appendix 1.

2. Medical Division Update

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

3. Mental Health Division Update

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

4. Surgical Division Update

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

5. Women and Children’s Update

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

6. Human Resources (HR) Update

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

7. Information Systems (IS) Update

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

8. Quality Improvement Programme Report

The quality dashboard 2008/09 is attached as appendix 8.


9. Incubator Programme

Attached as appendix 9 is the full report prepared by Lexie O’Shea, Regional Deputy Chief Executive Officer, Southland and Otago DHBs and Justine Grieg, Regional Workforce Development Manager.

10. Medical Officers Unit Report

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

11. Procurement Report


12. Risk Report


13. Value for Money Dashboard



1. Volumes – September 2009

COMPARISON SUMMARY OF ACTUAL VOLUMES AGAINST BUDGET

September 2009 Description Monthly

Volume

Budgeted

Volume

Monthly

Volume Variance

Actual YTD

Volume

Budgeted YTD

Volume

YTD Volume

Variance

DAP Annual

Volume 2009/10

2008/09

Actual Volume

Dental Acute 1.52 1.56 (0.04) 5.31 4.67 0.64 18.70 30.57

Dental Elective 15.54 15.99 (0.45) 40.92 47.97 (7.05) 177.66 165.78

Plastics Acute 1.18 2.41 (1.23) 6.84 7.24 (0.39) 28.95 43.84

Plastics Elective 1.53 2.00 (0.47) 3.58 6.00 (2.42) 22.21 26.25

ENT Acute - 2.51 (2.51) 3.84 7.54 (3.70) 30.16 23.54

ENT Elective 33.93 30.08 3.85 88.91 90.24 (1.34) 334.24 329.45

Ophthalmology Acute - 3.23 (3.23) 1.43 9.69 (8.26) 38.78 12.29

Ophthalmology Elective 30.01 29.18 0.83 119.47 87.54 31.93 324.21 375.40

General Surgery Acute 215.35 118.87 96.48 486.78 356.61 130.17 1426.46 1464.51

General Surgery Elective 60.83 94.60 (33.77) 301.31 283.79 17.52 1051.08 1078.30

Gynaecology Acute 21.63 14.17 7.46 46.06 42.52 3.55 170.07 158.70

Gynaecology Elective 13.83 35.25 (21.42) 69.48 105.76 (36.27) 391.69 342.03

Orthopaedics Acute 175.83 150.70 25.12 538.74 452.11 86.63 1808.44 1733.30

Orthopaedics Elective 82.26 84.71 (2.45) 241.06 242.03 (0.97) 1210.15 1015.98

Paediatric Surgical Acute - 0.44 (0.44) - 1.31 (1.31) 5.26 -

Paediatric Surgical Elective 3.54 4.26 (0.73) 11.97 12.79 (0.82) 47.38 48.91

Urology Acute 10.42 9.07 1.35 25.50 27.20 (1.70) 108.79 142.52

Urology Elective 13.31 31.42 (18.11) 59.73 94.26 (34.52) 349.10 341.10

General Medicine Acute 350.76 310.67 40.10 1010.67 932.00 78.67 3728.00 3673.50

General Medicine Elective 12.38 5.97 6.40 26.14 17.92 8.22 66.38 84.88

Paediatric Medicine Acute 88.98 52.04 36.95 229.90 156.11 73.79 624.43 709.64

Paediatric Medicine Elective

1.21 0.86 0.35 3.37 2.59 0.78 9.58 8.43

Specialist Neonates Acute 43.65 45.85 (2.20) 130.92 137.55 (6.63) 550.19 580.29

Maternity Acute 115.38 101.72 13.67 333.48 305.15 28.34 1220.58 1170.34

Maternity Elective 1.56 4.78 (3.22) 3.16 14.33 (11.17) 53.07 46.50

Acute Costweights 1024.71 813.23 211.47 2819.48 2439.70 379.78 9758.81 9743.04

Elective Costweights 269.93 339.10 (69.18) 969.10 1005.21 (36.12) 4036.75 3863.01

Total Costweights 1294.63 1152.34 142.30 3788.57 3444.91 343.66 13795.56 13606.05

Pregnancy and Childbirth 358.60 339.66 18.94 1409.72 1018.99 390.73 4069.58 5151.56

Emergency Department

Attendances

3170.00 3023.33 146.67 9789.00 9070.00 719.00 36280.00 37420.00

Outpatients - Allied Health 907.00 863.33 43.67 2714.00 2590.00 124.00 10360.00 9058.00

Rural Inpatients 167.00 210.00 (43.00) 577.00 644.00 (67.00) 2555.00 1939.00

HOP Lines (DHB Funded) 1401.00 1378.67 22.33 4327.00 4176.80 150.20 16645.98 16535.00

DSS Lines (MoH Funded) 289.00 486.21 (197.21) 727.00 1461.88 (734.88) 5842.54 2794.00

Outpatients - Medical and Surgical

5002.29 5466.74 (464.44) 15433.87 16489.03 (1055.15) 63654.18 56736.00

Public Health 49.00 47.83 1.17 139.00 143.50 (4.50) 574.00 527.00


2. Patient and Quality Key Performance Indicators – September 2009

PATIENT AND QUALITY KEY PERFORMANCE INDICATORS

Emergency Department Triage Times – Categories 1, 2 & 3 DEFINITION: Triage Level 1: The percentage of patients attending the Emergency Department triaged to

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

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

Category 3 who are attended to within 30 minutes.

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

0%

20%

40%

60%

80%

100%

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


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

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

SepYTD


0%

20%

40%

60%

80%

100%





SepYTD


0%

20%

40%

60%

80%

100%





SepYTD


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

previous discharge Divided By Denominator: Total Inpatient Discharges

Acute Readmission Rate 2008/09 vs 2009/10

-

5.00

10.00

15.00

20.00

25.00

30.00

Acute Readmission Rate 09/10 20.45 19.08 22.46 - - - - - - - - - 20.70 20.70

Acute Readmission Rate 08/09 24.02 22.09 26.10 12.48 22.97 19.80 23.64 28.22 17.58 23.27 13.76 24.91 21.49 24.06

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

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

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

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

0%

20%

40%

60%

80%

100%

% Of Complaints Resolved 09/10 71% 69% 87% 0% 0% 0% 0% 0% 0% 0% 0% 0% 77% 77%

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

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


SepYTD

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

Patient Satisfaction

70%

75%

80%

85%

90%

95%

Inpat ient 86.52% 88.99% 88.63% 88.96% 87.95% 85.68% 90.75% 84.69% 88.67%

Out pat ient 89.08% 85.60% 86.51% 90.15% 86.46% 86.09% 87.18% 85.21% 88.35%

Combined 87.80% 87.29% 87.57% 89.56% 87.20% 85.88% 88.97% 84.95% 87.61%

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

Qt r 1-Sep07 Qt r 2-Dec2007 Qt r3-Mar 08 Qt r4-Jun08 Qt r1-Sep08 Qt r2-Dec08 Qt r3- Mar 09 Qt r4- Jun09 Qt r1-Sep09


ADMISSION/DISCHARGE RELATED PERFORMANCE INDICATORS

Inpatient Admissions and Discharges (Includes Mental Health)

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

0

250

500

750

1000

1250

Inpatients 09/10 1087 1104 1111 0 0 0 0 0 0 0 0 0 3302 3302

Inpatients 08/09 1051 1046 1051 966 973 936 992 973 1051 1027 990 953 3148 12009


SepYTD

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

0

100

200

300

400

500

600

700

Day Patients 09/10 660 600 674 0 0 0 0 0 0 0 0 0 1934 1934

Day Patients 08/09 536 585 540 567 577 502 480 508 626 546 599 497 1661 6563


SepYTD

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

0

200

400

600

800

1000

1200

1400

1600

1800

Total 09/10 1747 1704 1785 0 0 0 0 0 0 0 0 0 5236 5236

Total 08/09 1587 1631 1591 1533 1550 1438 1472 1481 1677 1573 1589 1450 4809 18572


SepYTD

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

0

200

400

600

800

1000

1200

1400

1600

1800

Discharges 09/10 1760 1677 1781 0 0 0 0 0 0 0 0 0 5218 5218

Discharges 08/09 1582 1630 1609 1522 1567 1465 1438 1453 1706 1547 1599 1445 4821 18563


SepYTD


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

Unplanned Readmissions by Specialty - September 2009

0

100

200

300

400

500

600

Dis

ch

arg

es

0

5

10

15

20

25

30

Read

mis

sio

ns

Dischar ges 62 59 155 184 42 521 184 57 42

Readmissions 0 0 11 2 0 28 0 0 0

EAR NOSE AND

THROATEYE

GENERAL

SURGERYORTHOPAEDIC UROLOGY

GENERAL

MEDICINEPAEDS GYNAECOLOGY DENTAL

Unplanned Readmissions - YTD September 2009

As a % of Raw Discharges

0.00%

0.50%

1.00%

1.50%

2.00%

2.50%

3.00%

3.50%

4.00%

4.50%

5.00%

Percent age 0.00% 0.00% 3.64% 1.17% 0.93% 4.75% 0.21% 2.47% 0.00%

EAR NOSE AND

THROATEYE

GENERAL

SURGERYORTHOPAEDIC UROLOGY

GENERAL

MEDICINEPAEDS GYNAECOLOGY DENTAL

Trend of Unplanned Readmissions

As a % of Raw Discharges

0.00%

1.00%

2.00%

3.00%

4.00%

5.00%

6.00%

7.00%

8.00%

GENERAL SURGERY ORTHOPAEDIC UROLOGY GENERAL M EDICINE PAEDS GYNAECOLOGY

Perc

en

tag

es

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


OTHER PERFORMANCE INDICATORS

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

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

0.00%

0.10%

0.20%

0.30%

0.40%

0.50%

0.60%

0.70%

0.80%

0.90%

Unplanned Returns % 09/10 0.17% 0.00% 0.06% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.06% 0.06%

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

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

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

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

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

0.0

0.1

0.2

0.3

0.4

0.5

0.6

Acquired Bacteremia Rate 09/10 0.19 0.37 0.18 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.25 0.25

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

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


SepYTD


PROCESS AND EFFICIENCY KEY PERFORMANCE INDICATORS

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

Resourced Bed Inpatient Occupancy Rate 2008/09 vs 2009/10

(Medical, Surgical & ATR Only)

0%

20%

40%

60%

80%

100%

Occupancy By M onth 09/10 90% 90% 91% 0% 0% 0% 0% 0% 0% 0% 0% 0% 90% 90%

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



SepAvg

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

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

Medical & Surgical Inpatients exclude:

Elective day cases for Ophthalmology, Paediatrics and Palliative Care.

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

ALOS 2008/09 vs 2009/2010

0.00

0.50

1.00

1.50

2.00

2.50

3.00

3.50

4.00

ALOS By M onth 09/10 3.23 3.04 3.24 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.17 3.17

ALOS By M onth 08/09 3.66 3.15 3.17 3.26 3.20 3.27 3.00 2.96 2.99 3.45 3.16 3.50 3.31 3.23

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


SepYTD


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

DNA Rate - 2008/09 vs 2009/10

0.00%

2.00%

4.00%

6.00%

8.00%

10.00%

12.00%

DNA Rate 09/10 9.18% 8.86% 7.79% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 0.00% 8.64% 8.64%

DNA Rate 08/09 10.88% 9.78% 9.41% 9.46% 9.03% 9.94% 11.04% 9.63% 9.52% 9.60% 9.41% 8.67% 9.62% 9.96%

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

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

ORGANISATIONAL HEALTH KEY PERFORMANCE INDICATORS

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

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

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

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

Staff Turnover (Voluntary) 08/09 5.0% 3.4% 3.4% 3.1% 2.8% 3.1% 3.1% 2.9% 2.8% 2.7% 2.7% 2.8% 2.2% 3.1%


SepYTD

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

Sick Leave Rate - 2008/09 v 2009/10

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

Sick Leave Rate 09/10 3.3% 2.9% 3.4% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 3.2% 3.2%

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


SepYTD


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

Workplace Injuries - 2008/09 v 2009/10

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Work P lace Injuries 09/10 6.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.9 1.9

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


SepYTD

Cumulative Discharges DEFINITION: Increasing elective discharges. SDHB target 3282

Cumulative Total Discharges

-

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

YTD 2009/10 353 670 953

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

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

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

ED Presentations Staying Less Than 6 Hours

DEFINITION Patients who are admitted, discharged or transferred from the Emergency Department within six hours.

Calculated as ED Presentations Staying Less Than Six Hours divided by Total ED Presentations

Emergency Department Waiting Time

70%

75%

80%

85%

90%

95%

100%

ED Present at ions St aying Less Than 6 Hours 95.94%

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

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


September 2009 Appendix 1

STRATEGIC GOALS:

Creating a high performance culture

Achieving Health Targets

Leadership Development

PROGRESS

PROJECT Behind

On target

Complete

COMMENT

Provider Arm

Achieving IPM convergence

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

Emergency department Information system implementation

� Completed.

Emergency Department waiting time less than 6 hours

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

Clinical Leadership � A clinical leadership programme is underway.

Regional Clinical Services � A project manager role appointed with a start date of early November 2009.

Community Paediatrics � An advanced trainee in Paediatrics has been appointed for the 2010 calendar year to complete many of the duties of a fourth paediatrician to enable the community paediatric service to be further developed but this is a one year position and the provider arm will continue to recruit into the fourth paediatrician role for the 2011 calendar year.

Healthy Eating Healthy Action (HEHA)

implementation

� For the month of November the HEHA team are running a series of seminars, cooking demonstrations and activities for staff with the view to supporting a healthy

and active lifestyle.

Oral Health Business Case � Concept designs for the new fixed facilities have been approved by clinical users. Design consultants have been appointed to progress detailed electrical, mechanical and structural design of early mobile site pads. Mobile unit production remains on schedule. Negotiations for fixed clinic sites continue.

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

Better help for smokers to quit

� The systems (policy, procedures, education) are in place. A focus is on the recording of information within the clinical documentation to enable appropriate coding.

ESPI Compliance � ESPIs remain green.

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

Devolution of secondary to primary

� Initial meeting held between the Provider Arm and PHO leadership team to discuss, further work exploring diagnostic access underway.

Improving Mental Health services

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

New born hearing implementation

� Initial discussion underway with planning and funding.

Provider Arm DAP Project Dashboard 2009/10

SDHB HAC Meeting – 11 November 2009 Medical Division Update

MEDICAL DIVISION UPDATE

HAC Meeting Date: 11 November 2009 Report prepared by: Ian Winwood, Divisional Manager Dr Alasdair Millar, Divisional Director Jenny Hanson, Director of Nursing

Date Prepared: 27 October 2009

1. Service Summary

Allied Health Services

• the recruitment process for a replacement allied health manager has been restarted. The previous advertised position combined the allied health manager with the newly created allied professional leader position, under the clinical governance framework. This proved unsuccessful and therefore the previous allied health manager position will be advertised separately

• occupational therapy waiting list has decreased to approximately 12 months for routine referrals. The service is considering how the access criteria will be tightened to manage patients within the available resource and consideration is being given to providing temporary staff to bring the current list back to an acceptable waiting time. The majority of referrals come from district nursing and the Needs Assessment Service Coordination (NASC) team, accounting for over 53%. The next largest source is from inpatient activity with approximately 27% and the rest made up of general practice and other hospitals. The service is now fully staffed after having gone through a period in early 2009 where there were staff shortages

• the Accident Compensation Corporation (ACC) Endorsed Provider Network (EPN) contract for physiotherapy services will be terminated following recent changes announced by ACC. We have applied for an interim contract under the new structure, which will see a decrease in ACC revenue. SDHB intends to charge a patient co-payment and planning is underway to implement

• ACC made public their intention to terminate the falls prevention programme from the year end 2009; this will impact on revenue for physiotherapy. Anticipated loss in revenue is $20,000 for the remainder of the financial year

Assessment Treatment and Rehabilitation Unit

• the unavailability of house officers at the beginning of September 2009 has impacted on outpatient clinic volumes for September 2009 with only 50% being delivered. Year to date the service has delivered 39% of the volume target and there are 9 patients who have waited more than 4 months This volume target is further at risk with the resignation of one geriatrician from January 2010

• nursing overtime remains high which has led to the service being 4 FTE over budget for hospital aides, reflecting the number of watches required for patients with psycho-geriatric and other mental health symptom needs. These have been monitored daily and adjusted as required


• the number of patients seen within triage target time for triage 3 is lower than expected. This reflects a problem with timely entering of data onto the new Emergency Department Information System (EDIS), which has extended the time from presentation until the


patient is seen. The divisional director is working with medical staff to improve the data entry by inpatient medical teams

Lakes District Hospital

• emergency department had 549 presentations in September 2009; this is an increase of 84 more than September 2008. YTD attendance total 1898. Two major factors have been identified for the high volumes presenting in July and August 2009 which are the better than usual ski season with high visitor numbers leading to more trauma and the impact of influenza H1N1. The graph below demonstrates a similar trend to the previous year with the spring seasonal decrease, but the higher overall rate of presentations continue

Total Attendances to Lakes ED

0

100

200

300

400

500

600

700

800

Total 08/09 490 546 465 419 478 504 583 504 462 502 408 452 1501 5813

Total 09/10 680 669 549 1898 1898

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

Medical Imaging

• the screening recalls for mammograms are to be referred by General Practitioners (GPs) as from October 2009. This change will bring the service in line with the practice followed in other centres. We have provided lists to each GP identifying the screening patients that we have on the database in order for this handover to run smoothly

Pharmacy

• Hospital exceptional circumstances (HEC) medicine usage is currently being closely monitored to ensure that all applications meet the basic criteria of being cost effective. Recent applications have demonstrated the difficulty in controlling this budget – high cost items which have a clear cost advantage to fund the medication


2. Quality Initiatives

Assessment, Treatment and Rehabilitation

• the “slippery sam” trial has been completed. A slippery sam is a mat under the patient to decrease friction and facilitate moving the patient in the bed. Staff are looking forward to the provision of these for each bed. The total planned cost is approximately $1,200, which is being finalised through procurement. This is an unbudgeted item but cost will be managed within the minor purchases budget

Medical Imaging

• following the IANZ audit corrective actions and recommendations were made. These are in the process of being corrected and all but one have been cleared by IANZ. We are working on the remaining corrective action, but this recommendation is for an increase in staff and this is difficult within the current financial constraints of the organisation


3. Contract performance

HAC Group Actual YTD

Volume Budgeted YTD

Volume

YTD Volume Variance

% of YTD Budget Reached

Mitigation Comments

Inpatients

General Medicine Inpatient

1036.81 949.92 86.89 9.15% Monitor Increased demand during the winter months

Outpatients

Cardiology Outpatient 376.00 391.50 (15.50) (3.96%)

Dermatology Outpatient

146.00 249.75 (103.75) (41.54%) Increase clinic numbers

Reduced clinics with loss of 1 doctor

Diabetes Outpatient 29.00 129.60 (100.60) (77.62%) Adjust volumes Change in counting general medicine

Endocrinology Outpatient

- 19.44 (19.44) (100.00%) Correct coding This is due to a coding problem, with volumes coded to the wrong speciality

Gastroenterology Outpatient

165.00 186.30 (21.30) (11.43%) Monitor Extended leave for 1 doctor. The service is expected to be on plan for year end.

General Medicine Outpatient

207.00 232.20 (25.20) (10.85%) Adjust volumes Change in method of

counting general medicine

Infectious Diseases Outpatient

- 15.12 (15.12) (100.00%) Review coding and correct

Coding error

Neurology Outpatients 207.00 185.49 21.51 11.60% Extra clinics held to cover leave planned leave

Renal Medicine Outpatients

108.00 129.60 (21.60) (16.67%) Extra clinics planned for October

Respiratory Outpatients

124.00 218.70 (94.70) (43.30%) Additional clinics to be held as planned within budget

Decreased clinics due to junior doctor shortage

Rheumatology Outpatients

214.00 167.40 46.60 27.84% Increased demand


Lakes ED 1807.00 1200.00 607.00 50.58% Review staffing. Consider primary care options

Increased demand from skiing and H1N1

Southland ED 7982.00 7870.00 112 1.42%


Medical Imaging Waiting Times Department This month Last month Target MRI Urgent same day same day same day

semi urgent 2 to 3 weeks 2 to 3 weeks 2 to 3 weeks

routine outpatient

6 weeks 7 weeks 6 to 8 weeks

CT urgent ASAP (within 24

hours) ASAP (within 24 hours)

Same day

Semi urgent 1 to 2 weeks (OP)

2 weeks (OP) 2 to 3 weeks

routine outpatient

6 to 7 weeks 4 to 5 weeks 6 to 8 weeks

Ultrasound all ultrasounds 24 to 26 weeks 22 to 24 weeks 8 weeks

X-Ray appointments

routine 8 weeks 12 weeks 8 weeks

intravenous urograms


barium procedures


Mammography Urgent 1 to 3 weeks 1 to 2 weeks 1 week

semi-urgent 2 to 4 weeks 2 to 4 weeks 2 to 4 weeks

recall patients 8 weeks 8 weeks 4 weeks

Nuclear Medicine

urgent 2 days to 2 weeks

2 days to 2 weeks 2 days to 2 weeks

semi urgent 4 weeks 4 weeks 4 weeks

routine outpatient

4 weeks 4 weeks 4 to 6 weeks

4. Financial performance

Annual

Actual Budget Variance Actual Budget Actual Budget VarianceBudget

$'000 $'000 $'000 FTE FTE $'000 $'000 $'000 $'000

449 403 46 Revenue 1,312 1,210 102 4,839

(1,973) (1,910) (63) 284.17 283.79 Less Personnel Costs (5,997) (5,725) (272) (23,596)

(254) (277) 23 Less Outsourced Costs (615) (878) 263 (2,983)

(505) (498) (7) Less Clinical Supplies (1,566) (1,526) (40) (6,054)

(187) (175) (12) Less Infrastructure & Other Costs (558) (536) (22) (2,122)

(2,470) (2,457) (13) 284.17 283.79 Net Surplus/(Deficit) (7,424) (7,455) 31 (29,916)

Year to DateMonth

Annual

Actual Budget Variance Actual Budget Variance Budget

FTE FTE FTE FTE FTE FTE FTE

23.40 20.76 (2.64) Medical Personnel 23.80 20.09 (3.71) 22.09

139.63 138.31 (1.32) Nursing Personnel 140.65 138.31 (2.34) 138.31

85.26 86.74 1.48 Allied Health Personnel 86.00 86.74 0.74 86.74

35.88 37.98 2.10 Management & Admin Personnel 35.71 37.98 2.27 37.98

284.17 283.79 (0.38) Total Personnel 286.16 283.12 (3.04) 285.12

Month Year to Date


The medical division is reporting an unfavourable variance of $13k for September 2009. Revenue is $46k favourable in September 2009, mainly due to Accident Compensation Corporation (ACC) income in the medical imaging and rehabilitation areas and non-residents income. Expenditure overall is $59k unfavourable in September 2009, the main reasons for the variances include:

• personnel is $63k unfavourable in September 2009. Medical is $91k unfavourable due to the additional hours that have been worked by doctors. Allied is $31k favourable reflected by the 1.48 FTE under budget. Nursing is $13k unfavourable which mainly relates to overtime and parental leave. Management and administration is $10k favourable

• outsourced services costs are $23k favourable in September 2009. This variance relates to senior medical outsourcing

• clinical supplies is $7k unfavourable in September 2009. Contributing to this result is pharmaceuticals $13k favourable and treatment disposables $19k unfavourable. The treatment and disposables unfavourable variance mainly relates to blood components $11k unfavourable and patient consumable $10k unfavourable

• infrastructure and other costs $12k unfavourable in September 2009. This variance relates to IT system and telecommunication charges and pharmacy stock adjustments

5. Risks and Mitigation

Risk Mitigation the resignation of one Geriatrician creates a potential risk to service delivery in the Assessment, Treatment and Rehabilitation unit.

The medical division has commenced active recruitment

increased volume in ED presentations particularly at Lakes District Hospital create potential clinical risk

Explore directing appropriate patients to primary care

changes signalled by ACC to the falls prevention contract and the Endorsed Provider Network contract for physiotherapy may decrease revenue. There is also a review of the high technology imaging contract and changes are likely, which may also decrease revenue

A patient co-payment is to be implemented for the ACC physiotherapy patients and volumes will be monitored

Southland DHB HAC Meeting – 11 November 2009 Mental Health Division update

MENTAL HEALTH SERVICES UPDATE

HAC Meeting Date: 11 November 2009 Report Prepared By: Louise Travers, Divisional Manager

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


Recommendation


1. Service Summary

• provider arm mental health services and Future Directions mental health network members are working collaboratively to co ordinate events and activities for Mental Health Awareness Week, 05 – 11 October 2009. This year’s theme is “Winning Ways to Wellbeing”

• training and workforce development activity has been considerable. This has included four members of Child, Adolescent and Family Service attending a mentoring day for leadership run by the Werry Centre and a large number of staff participating in a Cognitive Behavioural Therapy workshop

• the Mental Health Day Activity Centres weekend service celebrated its 10th birthday this month

• the Director of Nursing attended the TheMHS annual conference in Perth, Australia, as did Te Korowai Hou Ora’s team manager who delivered a presentation called “Te Hononga” (connecting for the greater wellbeing)

• a Memorandum of Understanding was signed off between Pacific Island Advisory and Cultural Trust Incorporated and Mental Health Services on 01 October 2009

• the Mental Health Service section on the Southland DHB intranet has been revamped with the aim of improving internal knowledge and access to information by staff

• Knowing the Peoples Planning (KPP) reporting for the first quarter of 2009 – 2010 reporting year shows an excellent result of 97.5% of people with up-to-date crisis prevention / resiliency plans


Accreditation / Certification audit from QHNZ Surveyors

• the service participated in the Quality Heath New Zealand survey for certification and accreditation. The survey team noted the service had made significant gains and progress since the last survey visit. In particular they noted the excellent work of Te Korowai Hou Ora and the Future Directions Network

Systems and Information Improvements

• full Programme for Integration for Mental Health Data (PRIMHD) compliance was achieved, ongoing maintenance and development of local and national systems and processes ensures continuing high degrees of data validity and quality

• Drug and Alcohol Specialist Service is investigating a replacement for its electronic methadone prescription printing system to provide better reporting and links with other DHB systems

• seclusion reporting via Patient Management System (iPM) is now aligned with local clinical processes and national manual reporting of events


Workforce Development • staff participated in a two-day introduction to cognitive behavioural therapy workshop Orientation for New Staff

• this project is reviewing and updating the mental health orientation process to provide a generic and consistent process across all teams

Future Directions Network Representative Group

• the Future Directions Network Representative Group (NRG) met late September 2009. A range of issues and initiatives were discussed including workforce development, preparations for the Invercargill open forum in October and ongoing work on the first future directions strategic plan

� Southland non government organisations (NGO) forum met late September 2009. These forums continue to attract a diverse range of NGOs including new members. The September forum included a quality development workshop titled “Effectively managing incidents and complaints”

� Southland mental health’s events calendar continues to be updated and distributed to the sector each month and is also included on the Future Directions website - www.futuredirections.org.nz

3. Contract Performance

Mental Health Promotion

• the provider arm mental health service has a contract with the Ministry of Health for mental health promotion. A stocktake of activity against this contract has commenced

4. Financial Performance – September 2009

Annual

Actual Budget Variance Actual Budget Actual Budget Variance Budget

$' 000 $' 000 $' 000 FTE FTE $' 000 $' 000 $' 000 $' 000

1,682 1,721 (39) Revenue 5,057 5,163 (106) 20,651

(1,150) (1,261) 111 164.47 177.17 Less Personnel Costs (3,395) (3,788) 393 (15,139)

(17) (21) 4 Less Outsourced Costs (175) (63) (112) (254)

(12) (12) 0 Less Clinical Supplies (32) (38) 5 (149)

(106) (120) 14 Less Infrastructure & Other Costs (303) (365) 63 (1,435)

396 306 90 Net Surplus (Deficit) before Overheads 1,151 908 243 3,673

(240) (266) 26 Overhead Allocation (857) (798) (59) (3,191)

156 40 116 Direct Net Surplus / (Deficit) 294 110 184 482

Month Year to Date

Annual



10.45 12.76 2.31 Medical Personnel 10.01 12.76 2.75 12.76



0.00 0.00 0.00 Support Personnel 0.00 0.00 0.00 0.00

26.17 27.86 1.69 Management & Admin Personnel 26.62 27.86 1.24 27.86

164.47 177.17 12.70 Total Personnel 164.51 177.17 12.66 177.17

Month Year to Date

Mental health services had an operating surplus of $156k for September 2009 against a budgeted surplus of $40k. This produced a favourable variance to budget of $116k with a favourable YTD variance to budget of $184k. These figures are after the overhead calculation for September 2009 has been applied.

FTEs for September 2009 are under budget by 12.7.


The revenue variance is $39k under budget for September 2009. The wash-up back to funder arm for September 2009 is $73k. October accounts will see a correct of an internal revenue error of $100k hence the anomaly with the September YTD variance being lighter than the September YTD wash up of $213k.

Expenses show an unfavourable variance of $129k for the month, YTD expenses are tracking at $349k under budget.

• salaries are under budget by $111k for the month, with a YTD budget under by $393k. This is reflected with the 12.7 FTE variance to budget

• outsourced expenses show a $4k favourable variance from budget for the month, with a YTD unfavourable variance of $112k being mostly locum cover for the senior medical officer vacancies in mental health

• infrastructure and non-clinical supplies show a favourable variance of $14k for the month, with a YTD favourable variance of $63k

5. Emerging issues / risks / mitigation

Emerging risks for the mental health division are:

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

Monitoring by divisional leadership team

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

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

Potential gap in clinical service delivery for older people

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

SDHB HAC Meeting – 11 November 2009

Surgical Division Update

SURGICAL DIVISION UPDATE HAC Meeting Date: 11 November 2009 Report Prepared By: Peter Bramley, Divisional Manager David Tulloch, Divisional Director Helen McKenzie, Director of Nursing Date Prepared: 28 October 2009

Recommendation


1. Service Summary

• elective service performance indicators (ESPI’s) were green in August 2009 (appendix 4c)

• orthopaedics is now complaint again from an ESPI perspective – though continues to be at risk for both first specialist assessments (FSA) and long wait surgical procedures

• elective services delivered 255 case weighted discharges (CW) for September 2009. The monthly target was behind plan by 72 CWD, and is now behind by 34 CWD YTD (appendix 4b)

• a shortage of anaesthetic resource has affected the delivery of elective surgery. Forty-eight theatre sessions in the September 09 did not go ahead due to the lack of anaesthetic consultants.

• planning is almost complete towards implementing a regional plastics service for Southland and Otago, with the regional service beginning in November

• planning towards a regional ENT service will begin in November 2009

• performance by department (appendix 4a)

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


• the e-texting trial has concluded. The focus of this initiative is to try and reduce the number of patients that fail to attend their outpatient appointments (DNAs). The results of this trial are currently being analysed

• the patient focussed booking trial is also continuing for a number of specialities. From the trial is scheduled to finish at the end of October 2009

• a project plan has been developed for the implementation of the recommendations from the review of our referral processes. This project begins in November 2009

• a customer service programme for our clinical administration staff continues to be rolled out across the team

• satellite patient records for ophthalmology and ear nose throat (ENT) are to be amalgamated back into the main medical record, reducing the possibility of errors in the patient journey

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

• a review of the patient pathway through the fracture clinic has begun




• Southland Hospital is 1 orthopaedic joint ahead of its YTD planned delivery for September 2009. With respect to cataracts Southland Hospital is 3 ahead of its planned delivery YTD

• key areas of variance with outpatient delivery –

HAC Group Actual

YTD Volume

Budgeted YTD Volume

YTD Volume Variance


Comments

Breast Outpatients 293.00 145.80 147.20 100.96% The need dictates volume delivered

General Surgery Outpatients 856.00 1120.50 (264.50) (23.61%) Arrival of 4th general surgeon will facilitate delivery of outpatient clinics

Ophthalmology Outpatients 1359.00 1080.00 279.00 25.83% Monitor performance of the eye service

Orthopaedics Outpatients 2097.00 1240.00 857.00 69.11% High acute demand impacts outpatient volume

Plastics (Non Dental) Outpatients

19.00 149.58 (130.58) (87.30%) Regional plastic service to be started in November

• the theatre compass project continues to drive improvement in theatre performance (dashboard appendix 4e). First case start performance was impacted adversely in the first three months of the financial year due to bed availability and anaesthetic shortage. A project around improving the variance in actual to expected surgical case length for procedures has been started, with a view to reducing overruns, and provide more effective booking of surgical lists

4. Financial Performance

Annual


$' 000 $' 000 $' 000 FTE FTE $' 000 $' 000 $' 000 $' 000

200 101 99 Revenue 402 303 99 1,215

(1,383) (1,422) 39 220.34 220.71 Less Personnel Costs (4,422) (4,296) (126) (17,374)

(189) (253) 64 Less Outsourced Costs (532) (761) 229 (3,279)

(593) (609) 16 Less Clinical Supplies (1,940) (1,868) (72) (7,411)

(115) (114) (1) Less Infrastructure & Other Costs (352) (348) (4) (1,379)

(2,080) (2,297) 217 Net Surplus / (Deficit) (6,844) (6,970) 126 (28,228)

Month Year to Date

Annual






10.77 10.89 0.12 Support Personnel 10.59 10.89 0.30 10.89

50.33 49.64 (0.69) Management & admin Personnel 50.46 49.64 (0.82) 49.67

220.34 220.71 0.37 TOTAL PERSONNEL 224.49 220.71 (3.78) 220.74

Month Year to Date



The surgical division is reporting a favourable variance of $217k for September 2009 ($64k unfavourable August 2009). Revenue is $99k favourable, due mainly to non resident income $69k favourable and Accident Compensation Corporation (ACC) income $31k favourable. Expenditure overall is $118k favourable in September 2009 ($54k unfavourable August 2009) and the main reasons for the variance are:

• overall medical personnel and medical outsourced costs are $74k favourable in September 2009. The nursing unfavourable variance relates mainly to parental leave

• clinical supplies are $16k favourable against budget in the month. The main September 2009 variances are, hip and knee prostheses $26k favourable, ambulance $12k favourable, air ambulance $8k favourable, staples and accessories $10k favourable, grafts $10k unfavourable, patient consumables $19k unfavourable and screws, nails and plates $11k unfavourable


Key risks for the surgical division are around clinical staff resourcing.

Risk Mitigation A shortage of anaesthetic consultants is limiting elective surgery

Ongoing recruitment

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

Ongoing recruitment

Appendix 4a

1. Performance by Department

This section illustrates the year to date performance of each department to September 2009 and progress towards SDHB meeting the objectives outlined. Dental The dental department at the end of September 2009 is 7 CW behind its plan.

Dental - Cumulative Total Of Elective Costweights

-

20

40

60

80

100

120

140

160

180

200

YTD 2009/10 16 25 41

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

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


Ear Nose and Throat (ENT) The ENT department at the end of September 2009 is 1 CW behind its plan.

ENT - Cumulative Total Of Elective Costweights

-

50

100

150

200

250

300

350

400

YTD 2009/10 31 55 89

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

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


Appendix 4a

Ophthalmology The ophthalmology department at the end of September 2009 is 31 CW ahead of its plan.

Ophthalmology - Cumulative Total Of Elective Costweights

-

50

100

150

200

250

300

350

400

YTD 2009/10 47 89 119

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

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


General Surgery The general surgery department at the end of September 2009 is 17 CW ahead its plan.

General Surgery - Cumulative Total Of Elective Costweights

-

200

400

600

800

1,000

1,200

YTD 2009/10 134 240 301

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

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


Appendix 4a

Gynaecology The gynaecology department at the end of September 2009 is 37 CW behind its plan. A shortage of obstetric and gynaecology consultants is impacting elective delivery.

Gynaecology - Cumulative Total Of Elective Costweights

-

50

100

150

200

250

300

350

400

450

YTD 2009/10 28 56 69

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

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


Orthopaedics The orthopaedic department at the end of September 2009 is 1 CW behind its plan.

Orthopaedics - Cumulative Total Of Elective Costweights

-

200

400

600

800

1,000

1,200

1,400

YTD 2009/10 51 159 241

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

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


Appendix 4a

Paediatric Surgery Paediatric surgery at the end of September 2009 is 1 CW behind its plan.

Paediatric Surgery - Cumulative Total Of Elective Costweights

-

10

20

30

40

50

60

YTD 2009/10 4 8 12

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

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


Urology The urology department at the end of September 2009 is 34 CW behind its plan. Anaesthetic shortage impacted the elective delivery in urology.

Urology - Cumulative Total Of Elective Costweights

-

50

100

150

200

250

300

350

400

YTD 2009/10 24 46 60

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

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


Appendix 4a

Plastics Plastics are procedures carried out by SDHB’s oral-maxillo facial surgeon who also contributes to the dental CW. For the end of September 2009 this specialty is 2 CW behind its plan.

Plastics - Cumulative Total Of Elective Costweights

-

5

10

15

20

25

30

YTD 2009/10 2 2 4

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

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


MoH Elective Services OnlineComparison of surgical services for September 2009

Data Warehouse Refresh Date:

Report Run Date:

28/Oct/2009

28/Oct/2009

1.DHB services thatappropriately acknowledge

and process all patientreferrals within ten working

days.

2.Patients waiting longerthan six months for their

first specialist assessment(FSA).

3.Patients waiting without acommitment to treatment

whose priorities are higherthan the actual treatment

threshold (aTT).

4.Clarity of treatmentstatus.

5.Patients given acommitment to treatmentbut not treated within six

months.

6.Patients in active reviewwho have not received a

clinical assessment withinthe last six months.

7.Patients who have notbeen managed according to

their assigned status andwho should have received

treatment.

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

tools.

Service Name Level Status Imp.Req.

Level Status Imp.Req.







Dental 1 of 1 100.0 % 0 X 0.0 % X 3 0.0 % 0 0 0.0 % 0 15 4.4 % 0 0 0.0 % 0 15 4.4 % 0 32 100.0 % 0 %

Ear, Nose & Throat 1 of 1 100.0 % 0 42 3.3 % -17 9 0.0 % 0 0 0.0 % 0 43 7.2 % -14 0 0.0 % 0 23 3.8 % 0 61 100.0 % 0 %

General Surgery 1 of 1 100.0 % 0 0 0.0 % 0 33 3.6 % 0 0 0.0 % 0 17 1.8 % 0 0 0.0 % 0 16 1.7 % 0 47 100.0 % 0 %

Gynaecology 1 of 1 100.0 % 0 12 1.3 % 0 4 0.0 % 0 0 0.0 % 0 4 0.0 % 0 1 0.0 % 0 3 0.0 % 0 28 100.0 % 0 %

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

Ophthalmology 1 of 1 100.0 % 0 5 0.0 % 0 28 3.6 % 0 0 0.0 % 0 1 0.0 % 0 1 0.0 % 0 0 0.0 % 0 57 100.0 % 0 %

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

Orthopaedics 1 of 1 100.0 % 0 50 1.4 % 0 4 0.0 % 0 0 0.0 % 0 28 5.0 % 0 1 0.0 % 0 28 5.0 % 0 54 100.0 % 0 %

Paediatric Surgery 1 of 1 100.0 % 0 1 0.0 % 0 0 0.0 % 0 0 0.0 % 0 2 0.0 % 0 0 0.0 % 0 2 0.0 % 0 5 100.0 % 0 %

Plastics 1 of 1 100.0 % 0 0 0.0 % 0 10 34.5 % 0 0 0.0 % 0 0 0.0 % 0 0 0.0 % 0 0 0.0 % 0 3 100.0 % 0 %

Urology 1 of 1 100.0 % 0 1 0.0 % 0 11 3.0 % 0 0 0.0 % 0 1 0.0 % 0 0 0.0 % 0 1 0.0 % 0 28 100.0 % 0 %

Total 111 102 0 111 3 88 315

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

DHB Name: Southland

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

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

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

Page 1 of 1Data Warehouse Refresh Date:

Report Run Date:

28/Oct/2009

30/Oct/2009

1.DHB services thatappropriately

acknowledge andprocess all patientreferrals within ten

working days.

2.Patients waitinglonger than six

months for their firstspecialist

assessment (FSA).

3.Patients waitingwithout a

commitment totreatment whose

priorities are higherthan the actual

treatment threshold(aTT).

4.Clarity of treatmentstatus.

5.Patients given acommitment to

treatment but nottreated within six

months.

6.Patients in activereview who have not

received a clinicalassessment withinthe last six months.

7.Patients who havenot been managedaccording to their

assigned status andwho should have

received treatment.

8.The proportion ofpatients treated who

were prioritisedusing nationally

recognisedprocesses or tools.

20080901

Level

26 of26

229

67

0

86

11

76

329

2008

Sep

Status %

100.0%

1.8%

1.9%

0.0%

2.5%

6.3%

2.2%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20081001

Level

26 of26

252

70

0

82

4

67

360

2008

Oct

Status %

100.0%

2.0%

2.0%

0.0%

2.3%

0.0%

1.9%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20081101

Level

26 of26

252

130

0

73

7

59

417

2008

Nov

Status %

100.0%

1.9%

3.5%

0.0%

2.0%

0.0%

1.6%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20081201

Level

26 of26

246

72

0

62

7

55

282

2008

Dec

Status %

100.0%

1.9%

2.0%

0.0%

1.7%

0.0%

1.5%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090101

Level

26 of26

254

44

0

66

7

58

293

2009

Jan

Status %

100.0%

1.9%

1.2%

0.0%

1.8%

0.0%

1.6%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090201

Level

26 of26

256

114

0

77

7

69

309

2009

Feb

Status %

100.0%

2.0%

3.0%

0.0%

2.0%

0.0%

1.8%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090301

Level

26 of26

251

81

0

83

9

72

377

2009

Mar

Status %

100.0%

1.9%

2.1%

0.0%

2.1%

0.0%

1.9%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090401

Level

26 of26

211

85

0

89

10

78

328

2009

Apr

Status %

100.0%

1.6%

2.2%

0.0%

2.3%

4.7%

2.0%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090501

Level

26 of26

180

65

0

103

9

84

377

2009

May

Status %

100.0%

1.3%

1.6%

0.0%

2.6%

0.0%

2.1%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090601

Level

26 of26

146

39

0

104

6

80

290

2009

Jun

Status %

100.0%

1.1%

1.0%

0.0%

2.6%

0.0%

2.0%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090701

Level

26 of26

149

83

0

89

6

75

377

2009

Jul

Status %

100.0%

1.1%

2.0%

0.0%

2.2%

0.0%

1.8%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

20090801

Level

26 of26

140

104

0

86

5

72

332

2009

Aug

Status %

100.0%

1.0%

2.6%

0.0%

2.1%

0.0%

1.8%

100.0%

Imp.Req.

0

0

0

0

0

0

0

0.0%

Target

> 90%

< 2%

< 5%

< 5%

< 5%

< 15%

< 5%

> 90%

DHB Name: Southland

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

Appendix 4d

Number of patients Given Certainty and their Wait time for treatment (Includes Booked patients) at September 2009

(Excludes patients with a staged or planned status) The numbers in Red indicate the number of booked patients

40

20

1334

7

59

1523

92

112

17153438

59

8493

141159

0

50

100

150

200

250

300

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

Months Waiting

No

of

pa

tie

nts

Dental ENT General Surgery Gynaeco logy Ophthalmology Oral M axillo Facial Orthopaedics Paediatric Surgery Urology Total Booked

September 2008 through September 2009

Executive Dashboard

Southland District Health Board

0

100

200

300

400

500

600

Case VolumeCase Volume Case Volume PY

02468

10121416

Turnover Minutes

Turnaround Minutes per Case, PO to PI KPI

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

100%

Session UtilisationSession Utilisation % with Turnaround

02468

10121416

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

1618 18

21 20 1921 22

20 2023

25 23

0

5

10

15

20

25

30

Case Length Variance

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

First Case On-Time Start

% On Time (5 min grace), PI KPI

KPI = 12 mins

KPI = 15 mins

KPI = 80%

KPI = 62%

Case Length Variance (Elective Only)

Turnover Minutes per Case (Patient out to Patient In)

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

Session Utilisation

KPI TrackerGoal Progress Toward Goal


Women and Children Division Update

WOMEN AND CHILDREN DIVISION UPDATE

HAC Meeting Date: 11 November 2009 Report Prepared By: Lynley Irvine, Women and Children’s Division

Dr Ian Shaw, Divisional Director Jenny Humphries, Director of Nursing and Midwifery


Recommendation


1. Service Summary

Obstetrics and Gynaecology Services

• a new obstetric and gynaecology consultant arrived this week for 12 months

• recruitment continues for senior medical staff and several candidates are at the reference and credentialing stage of the process. Candidates are currently presenting themselves for 3-6 months term appointment. No candidates this year have come from within New Zealand for advertised positions

Oral Health Services

• clinical director, Dr Tim Mackay, has been seconded part-time (0.6FTE) to the role of acting chief dental officer for the ministry of health (MoH). Dr Mackay will also be working 0.1FTE for the Otago District Health Board

Well Child Services

• all before schools check (B4SC) staff have been orientated to the department and training has occurred

• the B4SC newsletter has been forwarded to multiple stakeholders with positive feedback to date (appendix 1)


• the children’s ward medication chart audit is underway

• the transfer policy and procedure documents are undergoing final review

• paediatric early warning score (PEWS) lanyards are finalised and will be distributed to all medical staff in children’s ward as well as the emergency department (ED) as a quick reference tool to complete this project

• an electronic database has been created for the children’s ward documentation audit and will be trialled in November 2009

• guidelines have been developed for the use of the whanau room in the Maori health unit. These have been distributed to all relevant services and clearly displayed in the unit



3. Service Highlights

Family Violence

The Southland DHB family violence intervention program (VIP) was audited by the Auckland university of technology (AUT) in June 2009. This independent audit is funded by the Ministry of Health (MoH) and focused on DHBs responsiveness to victims at risk of family violence. There are two sections of the audit, partner abuse intervention and child abuse intervention each having nine domains where a DHB is expected to achieve a minimum target score of 70% in each domain. Over time each audit has shown Southland DHB grow and achieve to meet to benchmark 70% target score in each domain. The first baseline audit results ranged from some domains only achieving 4% to others achieving 76%. This year each domain in both sections achieved above the 70% expected level with four out of nine domains in the partner violence audit achieving 100% and five out of nine domains in the child abuse and neglect section achieving 100%. The overall score of the AUT partner violence audit was 91% and child abuse and neglect audit 90%. These scores reflect the commitment and the growth that the Southland DHB has towards the VIP programme.




HAC Group Actual YTD Volume

Budgeted YTD

Volume

YTD Volume Variance


Mitigation Comments

Women and Children Inpatients

Dental Acute 5.31 4.67 0.64 13.60% Demand driven

Dental Elective 40.92 47.97 (7.05) (14.70%) Additional sessions will be completed when available

Extra theatre sessions this month have seen an improvement in the YTD position

Plastics Elective 3.58 6.00 (2.42) (40.33%) Influenced by acute workload

Gynaecology

Elective

69.48 105.76 (36.27) (34.30%) Impact of staff shortage

Paediatric Medicine Acute

229.90 156.11 73.79 47.27% Demand driven. Reflects H1N1 and seasonal

admissions

Women and Children Outpatients

Emergency Dental Outpatient

398.00 450.00 (52.00) (11.56%) Improved position from last month but generally demand driven

Paediatric Medical Outpatient - New

143.00 162.00 (19.00) (11.73%) Extra clinics when advanced paediatric

trainee begins work in December

On target when new and f up reviewed together

Paediatric Medical Outpatient - FU

678.00 605.88 72.12 11.90%

Gynaecology - New

155.00 189.81 (34.81) (18.34%) Complete review of all patients on the waiting list occurred in September

Stable but affected by staff shortage

Gynaecology - FU 210.00 284.85 (74.85) (26.28%) Stable but affected by staff shortage

Paediatric Surgery Outpatient - New

17.00 35.10 (18.10) (51.57%) Review of patients waiting to be undertaken

Plastics (including Burns and

Maxillofacial) - New [Dental]

115.00 71.82 43.18 60.12% Reflects changes to mapping of procedures

Plastics (including Burns and Maxillofacial - FU

[Dental]

119.00 68.85 50.15 72.84% Reflects changes to mapping of procedures



5. Financial Performance

Annual


$' 000 $' 000 $' 000 FTE FTE $' 000 $' 000 $' 000 $' 000

59 142 (83) Revenue 257 427 (170) 1,709

(1,056) (1,124) 67 164.03 173.62 Less Personnel Costs (3,193) (3,385) 192 (13,645)

(195) (121) (74) Less Outsourced Costs (443) (364) (78) (1,458)

(222) (207) (15) Less Clinical Supplies (638) (634) (5) (2,514)

(241) (234) (6) Less Infrastructure & Other Costs (693) (715) 22 (2,803)

(1,655) (1,544) (111) Direct Net Surplus / (Deficit) (4,711) (4,671) (40) (18,710)

Month Year to Date

Annual




97.02 99.45 2.43 Nursing Personnel 97.99 99.45 1.46 99.45


2.20 2.20 0.00 Support Personnel 2.21 2.20 (0.01) 2.20

23.14 24.27 1.13 Management & admin Personnel 23.42 24.27 0.85 24.27

164.03 173.62 9.59 Total Personnel 164.61 173.62 9.01 173.61

Month Year to Date

The women and children’s division is reporting a year to date (YTD) unfavourable variance of $40k against budget, with a movement of $111k unfavourable in September 2009. FTEs are 9.59 under budget. Revenue is $83k unfavourable for September 2009, YTD is $170k unfavourable. The MoH personal health revenue is $46k less than budget. This relates to timing with the oral health business case. Expenditure is $28k unfavourable for September 2009, YTD is $130k favourable.

• personnel costs are $67k favourable for September 2009, YTD $192k favourable. The FTE is 9.59 FTE under budget

• nursing is $9k favourable for September 2009. FTEs are 2.43 under budget.

• outsourced services are $74k unfavourable for September 2009, YTD $78k unfavourable. This variance relates to locum cover for senior medical officers

• infrastructure and non-clinical supplies are $6k unfavourable for September 2009, YTD $22k favourable

• clinical supplies are $15k unfavourable for September 2009, YTD $5k unfavourable


Risk Mitigation A current shortage of obstetric and gynaecology consultants

Ongoing recruitment

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

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



Well Child Services

B4 School Check Newsletter October 2009

Welcome to the first B4 School Check (B4SC) newsletter for the Southland District Health Board (SDHB) Well Child Service (WCS). Some of you will be familiar with the B4SC and we are pleased to advise that the Well Child Service will be continuing with the delivery of the Before School Check screening for the next 9 months through to June 2010. This newsletter is to provide information about the check in general and to keep you informed of the progress and status of the checks here in Southland. Note: the Ministry of Health is reviewing the B4SC screening programme at the end of this year so our focus presently is on the next 9 months.

The B4SC was introduced by the Ministry of Health in 2008 and has become the eighth core check replacing the preschool Vision/Hearing screening and the five year old New Entrant Health Assessment School check (NEHA).

Components of the B4 School Check

Southland is one of six District Health Boards that have met their B4SC target set by the Ministry of Health. This was achieved through the energy and commitment of a dedicated team of staff within Funding and Planning, the Well Child Service Team, parents and staff at Early Childhood Learning Centres. Over the next 9 months the Well Child Service Team aim to perform at least 900 further B4SC in the Southland DHB region. To achieve this the Well Child Service Team have expanded and service staff and roles are outlined overleaf.

Child Health Questionnaire

SDQ T

Dental

Oral Health

SDQ P

Weight

Height

BMI

PEDS

Health Promotion

Vision & Hearing

The B4SC is a free health check for four year olds. Here in Southland it will be carried out by Public Health Nurses and Vision Hearing Technicians. The check is to promote health and wellbeing in preschool children and identify behavioural, developmental or other health concerns that may adversely affect the child and their ability to learn in their upcoming school environment. The check includes an array of physical, social and emotional assessments as well as an opportunity to offer advice and support to parents/caregivers. Liaison with other health, educational and social professionals relating to the child is also an important part of the check.

Gillian Sim, B4SC Coordinator, Well Child Services. Phone: 03 214 5773 c/p: 0274 223 699

E-mail: [email protected]

Appendix 1



The Well Child Service Team has undertaken over 770 checks since the program began. As well as promoting the health and well being of children and families through information and advice, the Public Health Nurses undertaking the screening have made around 175 referrals through to other health professionals including GPs, Paediatricians, Special Education Services, Optometrists, Child and Family Services. Health concerns such as growth, vision, hearing, dental, speech, educational, behavioural and family issues have been identified and interventions put in place to enable a good start to their future learning and development.

In several recent cases, preschoolers have had timely intervention stemming from issues identified from the assessment tools used in the programme. The teacher SDQ (Strengths and Difficulties Questionnaire) has proven invaluable in assisting to pin point developmental and behavioural problems – highlighting in some children emotional issues, conduct problems, hyperactivity and peer problems. Parents are finding the feedback invaluable and this information supports the nurse assessments. The information is proving valuable for referrals to other services. It is also creating the opportunity for parents to discuss their childrens development and progress with the preschool educators. Thank you so much for completing these, they are making such a big difference to our assessment and the support we all can provide to these families.

The success of the B4SC programme lies in effective relationships and communication between children/caregivers, the Well Child Service Team, and other professionals. Working together to ensure the best outcomes for our Southern children is our foremost aim. Appraisal of the initial B4SC phases of the programme by both caregivers and professionals has been really appreciated. As the checks progress into the next phase of delivery we will be actively seeking feedback from all involved sectors. Please take the opportunity to complete circulating surveys evaluating the processes around the check. Your evaluation will help to ensure that the program is refined and improved where needed.

Our team is very aware that good communication is the key to addressing any issues as soon as they arise. If you have any problems or comments around the B4SC delivery please make contact using the above details. It may be now or in the future that things come up so just call or email.

Regards B4SC Well Child Service Team

Well Child Service Team Line Manager Women and Children’s Division Lynley Irvine Invercargill Public Health Nurses: Vision & Hearing Technicians: Sharon Ayto Invercargill Clinical Nurse Manager Mary Ineson Invercargill Gillian Sim Invercargill B4SC Coordinator Glenda Greig Invercargill Debbie Jensen Queenstown B4SC Professional Advisor Lyn Sanderson Invercargill Vicki Birch Invercargill Vicki Robertson Invercargill Health Assistant: Trudee Sharp Gore Robynne Hollegien Invercargill Maria Popplewell Gore Kate Stratford Gore Health Assistant B4SC: Eileen Ryan Lumsden Audrey Newsome Invercargill Karen Robbins Te Anau



HUMAN RESOURCES REPORT

SDHB Meeting Date: 11 November 2009 Report Prepared By: Karyn Penno Regional GM Human Resources Date Prepared: 22 October 2009

Recommendation

That the Committee receives and notes this report. Human Resources Information Systems / Payroll Scoping is underway to determine the requirements and costs to utilise the recruitment and some associated modules including electronic filing within Employee Connect. Work has also started on the planned payroll upgrade. The existing Datacom PeopleManager system will be replaced next year with a web-based payroll system, also supplied by Datacom. The Dunedin Hospital Childcare Centre (a bureaued service) will initially be upgraded to provide payroll staff with a good understanding of the system before the planned upgrade for ODHB and SDHB employees in 2010. Recruitment Key activity for the regional recruitment team during September 09 included the following:

• Presentations to groups of hiring mangers assisting the education of the recruitment process including feedback for recent recruitment efforts

• Proposals currently being put together for approvals on the following; Employee Referral Programme, Service Level Agreement for hiring managers, recruitment branding and advertising strategy

• New advertising ordering system has been researched with Adcorp (free system) which will produce a variety of reporting – looking to start this in early October 09

• Focus has been prioritised toward regionalisation of recruitment process, templates, structure and the overall recruitment strategy

Sourcing Channels In response to a query from the committee, we are still collating regional information, however initial indications are that the channels most effectively utilised are as listed below. It is worth noting that the success on placement changes dependent on the level and sector of the position that is vacant. Information is currently being gathered where possible from hiring managers with regard to their experiences of finding quality staff. We are also being provided with tangible information via Adcorp, our advertising agency, on where other healthcare providers find success (websites, agencies, advertising options, etc). The most effective channels, in order of success rating, are:

• Networking (ie referrals)

• Talent pool (from previous applications)

• Web advertising

• Agency

• Print advertising

Southland Otago

Allied 3 9

Support/Management/Corporate/Admin 4 2

Nursing 7 8

New vacancies actively being recruited for

SMO N/A 7

Total 14 26

Allied 7 2


Nursing 33 17

New vacancies from pre-September still actively being recruited

SMO N/A 14.55

Total 42 37.55

Allied 2 7


Nursing 15 27

Vacancies filled in September

SMO N/A 1

Total 22 47

Learning and Development The HR Management Series Pilot Programme commenced in September 09. Both an Otago and Southland programme series are being held from September to November 2009. The target audience for these programmes are clinical/professional and non-clinical managers, leaders and supervisors who have responsibility for the identified HR management practices of health and safety, performance reviews, performance management, leave management and recruitment. SDHB leadership and management development activity included confirmation of the workshop programme scheduled for the end of October 2009 for the senior leadership group. Workforce Development Discussions Draft documents to assist in informing our approach for these local discussions have been prepared, and initial conversations have commenced. SDHB Incubator Programme Key activity for September included:

• Preparation for the delivery of Session 6 on 21 October 2009. This is the last classroom session of the year

• Preparation and development of end of programme evaluation activity

• Co-ordination of student work experience during the month

• Planning of a second site visit for the students to Presbyterian Support Services on 13 October 2009

• Draft article for the Aurora College annual magazine prepared

• Preparation for attendance at a careers forum planned for 21 October 2009

• 2010 planning activity

Employment Relations South Island Clerical MECA Public Service Association (PSA) The PSA held membership meetings during August 2009. The DHBs have been advised the meetings have provided a mandate for industrial action, with the final decision regarding the nature of the action to be determined by the PSA head office. The PSA has requested assistance from the mediation Service, which has been scheduled for 2 October 2009. Service & Food Workers MECA SFWU The parties met again on 17 August 2009 to continue discussions. The union tabled a revised claim; however this remained some significant distance outside the DHB parameters. The union have scheduled membership meetings for late August 2009 through to the first week in September 2009. No further dates have been scheduled for negotiations at this time. The DHBs have not received any advice on the outcome of the membership meetings. Southland DHB Clerical and Administrative CEA New Zealand Nurses Organisation (NZNO) The parties met on 21 September 2009. To ensure consistency with the South Island Clerical MECA negotiations, Southland DHB is using the same advocate as the South Island clerical negotiation team (Kevin McFadgen, the DHBNZ ER Specialist for the South Island). The initial day focused on agreeing the bargaining process document and presentation of the union claims and associated issues. MRT MECA APEX At negotiations in August 2009 the Union presented its claims and the bargaining process document was agreed with assistance from the mediation service. At negotiations in September 2009 the DHBs responded to the union claims and tabled the DHB’s claims. Negotiations are continuing. Southland Managers’ CEA APEX The parties are to scheduled to commence negotiations in October 2009. The HR Dashboard 2009/10 attached as appendix 6a.

September 2009 Appendix 6a

2009-2012 STRATEGIC GOALS:

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

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

3.0 Develop an overarching regional framework for workforce development

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

PROGRESS

KEY PROJECTS / ACTIVITY AREAS

2009/2010

Scoping

Behind

On Track

Completed

COMMENT

1.0 RECRUITMENT

1.1 Implement regional centralized recruitment model

√ DHB alignment ongoing. Project teams formed within the regional recruitment team to ensure progress is continues

1.1.6 Recruitment metrics reported √ Baseline data collection continues. Additional reporting structures being scoped

1.1.8 Implement e-recruitment platform module of human resource information system (HRIS)

√ Employee Connect currently scoping to provide a quote. Priorities now established regarding need

1.2 Establish targeted sourcing strategy √ Sourcing strategy in development in conjunction with hiring managers. Plan structure being formatted

2.0 SAFE AND HEALTHY WORKING ENVIRONMENT

2.1 Why staff work at OSDHBs: Drivers of Engagement

√ Linked with culture project

2.1 Engagement Survey √ Linked with culture project

2.1 Review Exit interview √ Document completed; IT to convert to an electronic document so trialling of the workflow process can commence

2.3 Policy, Procedure Alignment √ Proposed document alignment structure awaiting approval

2.3 HSNO Compliance √ Compliance audit completed, results awaited

3.0 WORKFORCE DEVELOPMENT

3.1.1 Workforce Development Discussions √

3.1.2 Workforce Committee √

3.1.3 Community Engagement √

3.2.1 Incubator Pilot Programme √

3.2.2 Scholarship Programme Not yet commenced

3.2.3 Workforce Information √ Scoping activity as part of HRIS Project

3.4.1 Mgmt and Leadership development √

3.4.2 Clinical Governance √

3.4.3 Regional Framework √

4.0 HUMAN RESOURCES SERVICES

4.2 Complete Regional Policies √ Change Management, Harassment and Leave Management policies currently being worked on and scoped up for consultation

HUMAN RESOURCES INFORMATION SYSTEMS

Implement Employee Connect in SDHB √

Introduce Electronic Filing √ Scoping underway with Employee Connect

Payroll system upgrade √ Childcare Centre due to transfer to ‘DataPay’ (the upgrade version) from November 2009.

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

Human Resources Dashboard 2009/10


Information Group Update

INFORMATION GROUP UPDATE

Report Prepared By: Grant Taylor Regional Chief Information Officer (RCIO) Date Prepared: 26 October 2009

Recommendation

That the committee receives and notes this report.

1. Project Highlights

iPM Upgrade An upgrade of iPM to version 5002 was scheduled for mid to late October 2009. However due to delays in compliance with the Ministry of Health extracts. We are now looking for a new date in November 2009 to complete the upgrade. Once complete, work will begin on a gap analysis between the Otago system and the Southland one and then planning will commence on the new Regional Patient Management System with a rollout scheduled mid in 2010. Gore iPM/iSoft A project plan has been developed to get Gore hospital onto the same patient management system as Southland. The project plan sees the system going live prior to January 2010 and the first phase is to establish connectivity. We are working through costing this and currently this project is still on track. Video Conferencing A need for improved clinical video conferencing for Multi Disciplinary Team meetings as well as improved imaging systems for sharing this information while in these meetings is becoming increasingly necessary. The main driver for this is sharing skills across multiple sites (mainly Dunedin). A review of the requirements has been completed and we are waiting on pricing and how we can secure funding to achieve it. As an interim solution audio conferencing has been put in place. Wireless Infrastructure Work is underway to scope and design the installation of wireless infrastructure in Southland Hospital. This will be an enabler to allow more mobile access and devices. The IS Dashboard 2009/10 is (appendix 7a)


STRATEGIC GOALS:

An IS informed organisation

IS alignment to the clinical needs of the organisation

Efficiency gains through technology

PROGRESS

PROJECT

Behind

On target

Complete

COMMENT

Gore iPM/iSoft � A project plan has been drafted and a Project Manager assigned. Communications are going in and the work is due for completion before January 2010.

E-texting � The trial of e-texting reminders for outpatient appointments has started and will conclude in October 2009.

Domain Migration � Underway and cutting over the shared services HR, P&F, IT and Finance first.

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

Regional Service Desk � Scaling up activity to the Regional Service Desk. This will link to cutting over the Domain.

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

Public Records Act (PRA) Compliance

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

iPM Upgrade � Was scheduled to go to version 5002 in October 2009 however this has been delayed until mid to late November 2009.

Licensing Review � Stock take complete and reviewing the options.

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

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

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

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

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

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

Disaster Recovery and Business Continuity Planning

� Crash kit documentation completed.

RISKS:

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

Information Group Dashboard 2009/10

September 2009 Appendix 8

STRATEGIC GOALS:

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

PROGRESS

PROJECT

Behind

On

target

Complete

COMMENT

Quality Improvement Programme

Accreditation Survey and Certification Audit

�

Timetable progressed and event requirements coordinated.

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

�

Evidence folders being completed for onsite event. All required information completed. Survey early October 2009.

Accreditation Quality Action Plan

� Nil further action required.

Certification Corrective Action Plan (Hospital Services)

�

Certification (Mental Health) �

Clinical Practice Manual – Policy and Procedure updating

� There are currently 19 overdue policies and procedures in the clinical practice manual.

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

Organisation Quality and Risk Framework

� Progressing with the view to have a structure for quality and safety in post by November 2009.

Projects

Sharepoint � Exploration in to the use of Sharepoint as a document management system for

organisation wide policy and procedures etc. Trial of site undertaken in Therapies, progress is being delayed due to IS priorities. Currently on hold.

National Quality Improvement Project – Incident Management

�

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

National Quality Improvement Project’s –Hand Hygiene

� Further baseline auditing to occur to ensure sufficient sample size.

Reportable Events

Review of Reportable Events Panel

� Meeting scheduled to discuss objectives of the panel.

Compliments and Complaints

Review of Complaints Review Committee

� Terms of reference review completed, awaiting review by Senior Management Group.

Resolved complaints for August

� Fifteen complaints were received (August 2009) and of those thirteen resolved (87%) within 20 days.

Five complaints were received in September 2009.

Risk Management (RM)

Risk Management policy and procedure review

� Regional risk management policy consultation completed. To be tabled at the November Board meeting for sign-off. Regional (SDHB/ODHB) procedure out for consultation.

Organisational RM Programme

� The alignment of ODHB risk register for use in Southland testing is completed in preparation for finalisation of the policy and procedure review and role out of the risk management programme.

Quality and Risk Dashboard 2009/10

Appendix 9

SDHB HAC Meeting – 11 November 2009 HR – Workforce Development

SDHB INCUBATOR PROGRAMME

HAC Meeting Date: 11 November 2009 Report Prepared by: Lexie O’Shea, Chief Operating Officer, SDHB

and Regional Deputy Chief Executive Officer Justine Greig, Regional Workforce Development Manager

Date: 23 September 2009 9

Recommendation:

That the Board:

• Notes this request

• Recommends to the Southland DHB approval be given to submit Programme Funding Applications with the Invercargill Licensing Trust, ILT Foundation and the Community Trust of Southland for the 2010 programme

1. Programme Overview

1.1 Background Incubator is an interactive educational and information resource designed to:

• Create interest in health careers from Year 12 and 13 students;

• Provide health information in an engaging and interesting manner that both furthers interest in health careers, as well as increase health literacy of the students, their family and whanau;

• Provide access to health care workers who can act as informants and mentors for those wanting to find out more about health careers or health issues;

• Develop an e-learning tool that is responsive to the educational needs of professional development for staff in the health sector.

This initiative is an effective mechanism for addressing equity in workforce representation while also providing a conduit for directing healthy population information into communities. This innovation generates interest in a strategy of ‘grow your own’ for future workforce recruitment practices.

1.2 History In March 2007, Incubator commenced with a decile 1A college in the Flaxmere community. Incubator provides a co-ordinated programme to establish in-depth information of health. This has been achieved by providing examples of possible career paths within health, in a blended style of engaging modern pedagogy methods and mentoring techniques. This concept is built to the following principles of effective and experiential learning:

� Student connectedness (utilising adults in the classroom); � Mixed Media resources (attention to multiple learning styles with smart media

applications); � Role models delivering experiences (behavioural delivery);

Appendix 9


� Mentoring (maintaining engagement and ongoing support). This programme has introduced health professional role models to students and whanau. It is also an effective conduit of information to students and whanau on matters of healthy population, wellness, primary health and emergency response information. Programme Incubator has continued to develop throughout 2009 with additional schools from regional New Zealand District Health Boards. Currently discussions are being held regarding programme delivery during the 2010 academic year. It is anticipated that during 2010 there will be up to 8 participating DHBs and up to 30 participating secondary schools. 1.3 Achievements of the Programme to date

• High conversion of year 13 students progressing onto tertiary education;

• Work experience throughout the health sector (eg occupational therapy, physiotherapy) for year 13 students;

• 8 schools in Hawke’s Bay and the New Zealand Correspondence School now involved with Incubator;

• Five further DHB’s were contracted in 2008 for the use of Incubator in their respective regions during the 2009 year namely Tairawhiti, Counties Manukau, West Coast, Southland and Northland District Health Boards involving 16 schools;

• Partnerships with Universities are in place to support students in transition (Auckland, Otago and Massey);

• Feedback from schools, parents and whanau endorse the programme;

• DHB employees are voluntarily engaging to participate in Programme Incubator;

• Awards achieved to date include:

TUANZ 2008 Telecommunications Users Association of New Zealand, Education Category Award Winner 2008; HIA 2008 Health Innovations Awards, Innovation of the Year Winners 2008 & Finalists Choice Winner 2008; IPANZ 2009 The Institute of Public Administration of NZ Excellence Awards, Improving Performance Through People Award Winner 2009.

2. SDHB Incubator Programme

2.1 2009 Pilot Programme SDHB submitted Community Funding Applications in late 2008, resulting in funding being secured for a one year pilot programme. The 2009 Pilot Programme is supported by the ILT Foundation, the ILT and the Community Trust of Southland. The Programme Co-ordinator position is funded by the DHB. SDHB’s Incubator Pilot Programme was officially launched on early March 2009 and the participating School is Aurora College.

Appendix 9


Key to the success of this programme is the involvement of our health sector workforce, sharing their first hand knowledge and experience with the students. Approximately 71 employees are currently registered as Mentors for the programme. A Pilot Programme Evaluation Report will be completed and submitted with our 2010 Funding Application Requests. 2.2 2010 Programme Approach Subject to securing the required resources, inclusive of funding, Southland DHB is seeking to run the Incubator Programme across the 2010 academic year with additional Southland Schools. Following our preliminary discussions to date with identified schools, Aurora College, Menzies College, Verdon College and Southland Boys High School have expressed their interest in being part of our 2010 programme.

3. Programme Costs

The programme costs indicated below are based on the programme commencing in January 2010 and concluding in December 2010. 3.1 Programme Services The cost of the Contract for Programme Services with Hawke’s Bay DHB is approximately $60,000.00 (excl GST). The scope of programme services provided by Hawke’s Bay DHB includes:

• The development of the Incubator Programme with identified schools or combined cohorts;

• The provision or programme resources which include session storybooks, card sorts, instruments and CD Roms, website infrastructure and programme support manuals such as Mentor Handbooks;

• Support to develop local capability and capacity to operate the programme in the Southland area and continue to phase in local content;

• As appropriate or required assist in the engagement of additional schools during the 2010 academic year.

3.2 Programme Co-ordinator Position It is proposed that Southland DHB will fund the position of the Programme Co-ordinator at a base salary of up to $22,500.00. This role is critical for the delivery of the Incubator Programme within the Southland Region and has a key emphasis on working with the Hawke's Bay DHB Incubator team, the identified schools and the Southland DHB team. The primary purpose of this position is to facilitate, support and deliver the Incubator Programme within the schools and to maximise the experience and learning for the students and those involved within Southland DHB.

SDHB HAC Meeting 11 November 2009 Nursing Productivity Update

NURSING/MIDWIFERY/ALLIED HEALTH UPDATE

HAC Meeting Date: 11 November 2009 Report Prepared By: Leanne Samuel, Regional Chief Nursing and

Midwifery Officer Date Prepared: 29 October 2009

Recommendation


1. Performance Indicators

• occupancy for September 2009 remains in the main high over the optimal 85%. Maternity occupancy was 89%, the neonatal unit at 155%, children’s ward was 87% occupancy, and the mental health inpatient unit was at 81%. The medical ward was busy at 93% occupied, the surgical ward was 89% and the rehab unit 90%

• Lakes District Hospital (LDH) occupancy remains at 56% for the month for the rural inpatient beds

• budget results with regard nursing full time equivalent (FTE) are covered in the financial report for your information and is more favourable this month

• there was a high number (119) of patient watches for September 2009 that necessitated one-to-one nursing to ensure safety of patients. This equates to an additional FTE of 5.59 in September 2009. The majority of patients necessitating the watches were psycho-geriatric, mental health act or falls/awol patient risks

2. Clinical Practice

• in the process of appointing clinical nurse co-ordinators for after hours medical/surgical - 80 beds following recommendations from the medical ward nursing review

• palliative nurse specialist role (shared position between the Hospice and hospital) recruitment underway

• await the arrival of a new associate charge nurse manager from the UK in the new year for the rehab unit

• medical ward staffing remains a challenge in terms of recruitment

• EQuIP accreditation met with favourable feedback from the survey team and nursing and midwifery staff

• allied health professional advisor role remains unfilled and the Regional Chief Nursing and Midwifery Officer (RCNMO) is meeting with the chair of the allied health advisors as an interim solution until the role can be re-evaluated in the new budget round

• CTA funding for post graduate education opportunities currently open for application across all nursing areas ie includes primary health care

Please find attached the dashboard (appendix 5a) reflecting Otago DHB and Southland DHB nursing/midwifery activity for your information.


SEPTEMBER 2009 NURSING PERFORMANCE INDICATORS

NURSING SALARY AND LEAVE COSTS

Total Nursing Salaries Actual/FTE

-

500

1,000

1,500

2,000

2,500

3,000

3,500

Do

lla

rs (

00

0's

)

450

455

460

465

470

475

480

485

490

FT

E

Dollars 2687 3057 2466 2766 2869 2600 2818 3184 2943 3270 2913 3061 2884

FTE 467.70 469.12 468.04 465.31 468.55 466.97 481.30 478.86 474.79 475.52 469.11 488.09 469.68

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

Nursing Annual Leave

-

10

20

30

40

50

60

70

80

FT

E

Actual 32.55 44.33 29.22 28.32 73.17 45.1 45.86 41.04 32.19 26.42 39.23 39.93 33.94

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

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

Average cost of Nursing Overtime per day

-200400600

8001,0001,2001,4001,6001,8002,0002,200

2,4002,6002,8003,000

Do

lla

rs

Actual / day 2,185 1,371 1,915 1,228 1,502 2,436 2,638 1,442 1,861 2,336 2,776 2,480 2,107

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

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

Nursing Sick Leave

-

5

10

15

20

25

30

FT

E

Actual 16.04 12.48 12 14.44 8.65 10.04 13.19 12.88 15.4 16.71 15.092 25.09 15.76

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

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


MATERNITY SERVICES Service Occupancy

Maternity Services Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 81% 88% 89% 0% 0% 0% 0% 0% 0% 0% 0% 0% 86%

2008/09 95% 92% 95% 79% 79% 80% 81% 73% 76% 82% 79% 81% 93%

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

YTD

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

Maternity Non Clinical vs Clinical Nursing FTE

0

2

4

6

8

10

12

14

16

18

20

FT

E

Total Actual 17.80 19.49 16.93 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 54.22

Product ive 14.39 13.93 14.20 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 14.17

Unproductive 3.41 5.56 2.73 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.90

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

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

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

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

Nursing Hours Per Patient Bed Day

Maternity

-

2

4

6

8

10

Maternity 7.04 6.49 6.73 - - - - - - - - -

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

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

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


MEDICAL SERVICES Service Occupancy

Medical Ward 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 89% 96% 93% 0% 0% 0% 0% 0% 0% 0% 0% 0% 92%

2008/09 98% 95% 93% 90% 92% 90% 88% 95% 99% 92% 94% 98% 96%


YTD


Medical Ward Non Clinical vs Clinical Nursing FTE

0

4

8

12

16

20

24

28

32

36

40

FT

E

Total Actual 35.86 33.84 33.57 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 103.27

Clinical 28.56 29.05 29.74 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 29.12

Non Clinical 7.30 4.79 3.83 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 5.31

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

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

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



Medical Ward

-

1

2

3

4

5

6

Medical 5.11 4.57 4.99 - - - - - - - - -

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

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



SURGICAL SERVICES Service Occupancy

Surgical Ward 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 91% 89% 89% 0% 0% 0% 0% 0% 0% 0% 0% 0% 89%

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


YTD


Surgical Ward Non Clinical vs Clinical Nursing FTE

0

4

8

12

16

20

24

28

32

36

40

44

FT

E

Total Actual 39.06 38.81 37.71 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 115.58

Clinical 31.94 31.62 31.74 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 31.77

Non Clinical 7.12 7.19 5.97 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.76

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

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




Surgical Ward

-

1

2

3

4

5

6

Surgical 4.84 4.85 5.02 - - - - - - - - -

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




CHILDREN’S WARD Service Occupancy

Children's Ward 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 60% 69% 87% 0% 0% 0% 0% 0% 0% 0% 0% 0% 72%

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


YTD


Children's Ward Non Clinical vs Clinical Nursing FTE

0

2

4

6

8

10

12

14

16

FT

E

Total Actual 14.15 15.03 15.06 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 44.24

Clinical 12.66 12.65 12.83 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 12.71

Non Clinical 1.49 2.38 2.23 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.03

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

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

Budget Non Clinical 2.12 2.12 2.12 2.20 2.12 2.59 4.45 2.24 2.21 2.93 2.12 2.21 -



Children's Ward

-

2

4

6

8

10

Childrens 8.78 8.03 6.69 - - - - - - - - -

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

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



REHABILITATION UNIT Service Occupancy

Rehabilitation Unit Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 90% 87% 90% 0% 0% 0% 0% 0% 0% 0% 0% 0% 89%

2008/09 94% 92% 92% 71% 81% 80% 82% 83% 89% 87% 91% 83% 93%


YTD


AT&R Non Clinical vs Clinical Nursing FTE

0

4

8

12

16

20

24

28

32

FT

E

Total Actual 24.00 25.65 24.84 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 74.49

Clinical 19.54 20.37 20.97 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 20.29

Non Clinical 4.46 5.28 3.87 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4.54

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

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




AT & R

-

1

2

3

4

5

AT&R 4.68 4.48 4.56 - - - - - - - - -

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




NEO NATAL UNIT Service Occupancy

Neo Natal Unit Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 111% 139% 155% 0% 0% 0% 0% 0% 0% 0% 0% 0% 135%

2008/09 125% 191% 180% 181% 65% 123% 169% 118% 150% 164% 148% 105% 158%


YTD


Neo Natal Non Clinical vs Clinical Nursing FTE

0123

456789

10

11121314

FT

E

Total Actual 11.66 12.53 12.36 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 36.55

Clinical 8.84 9.56 9.07 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 9.16

Non Clinical 2.82 2.97 3.29 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 3.03

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

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




Neo Natal Unit

-

2

4

6

8

10

Neo Natal 8.97 7.88 6.90 - - - - - - - - -

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




CRITICAL CARE UNIT Service Occupancy

Critical Care Unit Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 61% 61% 62% 0% 0% 0% 0% 0% 0% 0% 0% 0% 61%

2008/09 58% 48% 57% 54% 55% 49% 48% 63% 51% 52% 62% 72% 53%


YTD


Critical Care Non Clinical vs Clinical Nursing FTE

0

2

4

6

8

10

12

14

16

18

FT

E

Total Actual 15.88 17.39 15.51 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 48.78

Clinical 13.77 14.96 13.13 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 13.95

Non Clinical 2.11 2.43 2.38 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 2.31

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

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




Critical Care Unit

-

5

10

15

20

25

Critical Care 23.02 23.46 20.95 - - - - - - - - -

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




MENTAL HEALTH UNIT Service Occupancy

Mental Health Unit Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 67% 78% 81% 0% 0% 0% 0% 0% 0% 0% 0% 0% 75%

2008/09 81% 78% 64% 40% 63% 65% 51% 65% 69% 76% 96% 70% 79%


YTD


Mental Health Unit Non Clinical vs Clinical Nursing FTE

02468

101214161820222426283032

FT

E

Total Actual 23.71 26.21 23.90 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 73.82

Clinical 20.07 20.22 19.79 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 20.03

Non Clinical 3.64 5.99 4.11 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 4.58

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

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




Mental Health Unit

-

2

4

6

8

Mental Health 7.17 6.47 6.25 - - - - - - - - -

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




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

Perioperative Non Clinical vs Clinical Nursing FTE

0

4

8

12

16

20

24

28

32

36

40

44F

TE

Total Actual 40.47 42.94 40.17 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 123.58

Clinical 33.24 35.06 34.67 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 34.32

Non Clinical 7.23 7.88 5.50 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 6.87

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

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



LAKES HOSPITAL Service Occupancy

Lakes Occupancy 2008/09 vs 2009/10

0%

50%

100%

150%

200%

2009/10 67% 65% 56% 0% 0% 0% 0% 0% 0% 0% 0% 0% 63%

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


YTD


STRATEGIC GOALS:

1.0 Nursing and Midwifery Workforce

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

2.0 Nursing and Midwifery Practice/Professional Standards

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

3.0 Nursing and Midwifery Resource Utilisation

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

4.0 Nursing and Midwifery Governance and Leadership

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

PROGRESS

KEY PROJECTS / ACTIVITY AREAS 2009/2010

Scoping

Behind

On Track

Completed

COMMENT

1.0 Workforce development

1.1 NETP and NETP expansion and MFYOP

� Ongoing

1.2 PDRP uptake �

1.3 CTA program access/uptake �

1.4 Nurse Practitioner development program

� Workshops planned for November in Otago and Southland DHB’s

1.5 Access to course conference support �

1.6 Unregulated worker orientation/ education

�

O

�

S

1.7 Management and Leadership

development

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

midwifery

2.0 Nursing and Midwifery Practice

2.1 Clearly demonstrated integration of Evidenced based practice

� Needs ongoing evaluation

2.2 Contemporaneous models of care are delivered and evaluated continuously

� As above

2.3 Quality and HR processes and Policy, Procedure Alignment

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

2.4 Regulatory Compliance

� Compliance Nursing and Midwifery councils of New Zealand re APCs, education programs etc

Nursing and Midwifery Dashboard-Otago DHB and Southland DHB 2009/10

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

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

3.1 Safe Staffing and Healthy Workplace

3.1.1 Patient Forecasting

-how many?

-what type?

-when?

-specific needs?

-required outcomes?

-cost?

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

3.1.2 Matching resources

-how many staff?

-what skill set required?

-where?

-with what resources?

-what is the available budget?

� As above

3.1.3 Resource provision

-Right number of staff?

-Right type?

-Right skill mix?

-Right skills

-Right environment

-Right time?

-Right resources?

� As above

3.1.4 Service Delivery

-Safe

-Effective

-Appropriate

-Timely

-Sustainable

-Flexible

-Responsive

�

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

-Capacity planning tools (prospective)

-Integrated roster and bed management alignment electronically

-Business Intelligence reporting platform-live time

4.0 Nursing and Midwifery Governance and Leadership

4.1 Clinical Governance, clinical

leadership on the ground

�

O

�

S Clinical Governance review and structure in place SDHB

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

Projects/Practice Development Initiatives

Falls �

S

�

O

Early Warning Scores (Otago)/

Ups (Southland)

�

Clinical –Key performance indicators

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

Falls �

S �

O Being rolled out on 6th floor at Dunedin Hospital. Yet to be

scoped for Southland Hospital

Pressure Injuries � Not yet commenced

Health care associated infection

� HAI data captured and reported via infection prevention and control

SDHB HAC Meeting – 11 November 2009 Financial Report

FINANCIAL REPORT

HAC Meeting Date: 11 November 2009 Financial Report as at: 30 September 2009 Report Prepared by: Bron Anderson, Senior Business Analyst Date: 23 October 2009

1. DHB Provider Summary Results

Annual


$' 000 $' 000 $' 000 $' 000 $' 000 $' 000 $' 000

11,478 11,367 112 Revenue 34,126 34,101 26 138,636

(6,980) (7,162) 182 Less Personnel Costs (21,165) (21,535) 369 (86,463)

(4,677) (4,629) (48) Less Other Costs (14,216) (14,149) (68) (56,006)

(178) (424) 246 Net Surplus / (Deficit) (1,255) (1,583) 328 (3,834)

Month Year to Date

Summary Comment:

• September 2009 result is an operating deficit of $178k, this is a favourable variance to plan of $246k

• the YTD position is $328k within plan this position arises from a YTD operating deficit of $1,255k compared against a budgeted deficit of $1,583k

2. Emerging trends

• personal health direct funding related to Oral Health Business Case

• other revenue kiwi saver tax credits (favourable variance)

• Accident Leave and Other Leave within salary groups, in particular nursing

• treatment disposables costs, in particular dressings (related to vac wound care machines), protective clothing (related to H1N1) and patient consumables

• clinical equipment minor purchases (favourable variance)

• oncology pharmaceuticals

• building and plant depreciation

• external storage services

• coal costs

• domestic staff travel (favourable prediction)

• fuel costs (favourable prediction)

• data network & internet fees These emerging trends are embodied in the YTD forecast represented later in this report.


3. Revenue

Annual


$' 000 $' 000 $' 000 $' 000 $' 000 $' 000 $' 000

373 310 63 Accident Insurance 1,045 931 114 3,724

(18) 103 (121) Clinical Training Agency 203 310 (107) 1,238

10,553 10,576 (23) Funder Arm revenue 31,602 31,729 (127) 129,149

53 53 - MOH Disability Support Services 158 159 (1) 637

- 46 (46) MOH Personal Health 20 138 (118) 553

8 19 (11) MOH Public Health 18 58 (39) 231

- 2 (2) Non DHB's - 6 (6) 26

47 26 21 Other DHB's 81 79 2 314

217 120 98 Other Income 431 360 72 1,439

243 105 138 Patient/Consumer Sourced 565 314 251 1,257

2 6 (4) Training Fees & Subsidies 2 17 (15) 68

11,478 11,367 112 Total Revenue 34,126 34,101 26 138,636

Month Year to Date

• Clinical Training Agency (CTA) is unfavourable YTD this is due to gaps being in the rosters and therefore posts not being able to be filled. The monthly variance has also resulted from the release of an over provision being released

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

Monthly

variance

YTD

variance Comment

Fee for Service contracts 9 (6)

Claiming catch up for Special

Dental benefits this month

Mental Health wash up back to

funder arm (73) (214) Positions that remain unfilled

Mental Health internal revenue

error 33 100

Correction will happen in

October 2009

Pharmaceutical contract lines;

PCT & Community (9) (19)

PCT revenue over plan,

Community Pharms under

budget

Various other contracts 17 11 Additional funding for Herceptin

Total (24) (127)

• accident compensation corporation (ACC) revenue is above budget for the month and YTD; areas where this is the case include assessment, treatment and rehabilitation (ATR) and imaging

• the operational portion of the Oral Health Business Case is budgeted under the Ministry of Health personal health line. The project is moving ahead well but a misalignment in the timing of the project costs shows as an unfavourable monthly result $46k

• the favourable outcome against patient/consumer sourced revenue is due to non resident activity being above plan for the month

• under the other income category kiwi saver credits and accommodation rentals are favourable to budget, donations received and interest revenue offset part of this positive variance as these income lines are below plan


4. Salaries

Monthly Salary Total Costs The following table summarises the overall salary position.

Annual


Costs$' 000 $' 000 $' 000 $' 000 $' 000 $' 000 $' 000

Medical (2,066) (2,170) 105 (6,128) (6,482) 354 (25,589)

Nursing (2,884) (2,864) (20) (8,858) (8,678) (180) (35,802)

Allied Health (965) (1,006) 42 (2,936) (3,017) 81 (11,882)

Support (41) (49) 8 (143) (144) 1 (563)

Management/Administration (1,025) (1,073) 48 (3,100) (3,214) 114 (12,628)

Total Salaries (6,980) (7,162) 182 (21,165) (21,535) 369 (86,464)

Month Year to Date

Annual

FTEsActual Budget Variance Actual Budget Variance Budget

Medical 111.37 114.15 2.78 111.90 112.45 0.55 112.25

Nursing 477.70 472.59 (5.11) 484.08 472.59 (11.49) 472.59

Allied Health 185.00 179.88 (5.12) 184.01 179.88 (4.13) 179.88

Support 13.97 13.09 (0.88) 13.80 13.09 (0.71) 13.09

Management/Administration 218.30 223.77 5.47 220.00 223.77 3.77 223.96

Total FTEs 1,006.34 1,003.48 (2.86) 1,013.79 1,001.78 (12.01) 1,001.77

Month Year to Date

YTD costs are $369k under budget. FTEs are over budget by a total of 12.01 YTD. Further explanation for different vocational groups is shown below. Medical Salaries Medical salaries have a favourable variance of $105k for the month and $354k YTD. Please refer to the table below for sub category breakdown within the medical salaries.


Actual Budget Variance Actual Budget Variance Actual Budget Variance Actual Budget Variance

$' 000 $' 000 $' 000 FTES FTES FTES $' 000 $' 000 $' 000 FTES FTES FTES

Ordinary (992) (1,113) 121 83.52 90.14 6.62 (3,018) (3,327) 309 83.24 88.60 5.36

Annual Leave Taken (191) (241) 50 9.26 11.85 2.59 (559) (720) 161 10.41 11.74 1.33

Other Leave (19) - (19) 1.09 - (1.09) (25) - (25) 0.48 - (0.48)

Sick Leave (20) (44) 24 1.45 3.46 2.01 (77) (131) 55 2.10 3.43 1.34

Statutory (incl Time in Lieu) 9 - 9 0.05 - (0.05) 4 - 4 0.69 - (0.69)

Training (incl CME)/ Study Lve (38) (79) 41 2.72 4.57 1.85 (109) (234) 125 2.85 4.54 1.69

Long Service Leave - - - - - - - - - - - -

Back Pays (10) - (10) - - - (27) - (27) - - -

Allowances (370) (388) 18 - - - (1,135) (1,159) 23 - - -

Penal - - - - - - - - - - - -

Base Medical Salaries (1,631) (1,865) 234 98.09 110.02 11.93 (4,946) (5,571) 625 99.77 108.32 8.55

Overtime (196) (49) (147) 13.28 4.13 (9.15) (545) (147) (398) 12.13 4.13 (8.00)

ACC Levy (5) (7) 3 - - - (24) (22) (1) - - -

Meals (11) (9) (2) - - - (32) (29) (4) - - -

Superannuation (47) (64) 17 - - - (146) (189) 44 - - -

Course Fees, Conferences, Study Grants (69) (92) 24 - - - (203) (275) 72 - - -

External Clinical Supervision - - - - - - - - - - - -

Professional Membership Fees and Costs (20) (28) 8 - - - (56) (84) 27 - - -

Recruitment Expenses & Advertising (72) (35) (37) - - - (163) (106) (57) - - -

Relocation (3) (20) 17 - - - (3) (60) 57 - - -

Parental Leave (12) - (12) - - - (12) - (12) - - -

Total Medical Salaries (2,066) (2,170) 105 111.37 114.15 2.78 (6,128) (6,482) 354 111.90 112.45 0.55

Month Month Year to Date Year to Date

The bulk of the above YTD favourable result is in the junior doctor area $235k. FTEs levels for the month are within plan. There is a favourable variance in junior medical staffing of 4.76 FTE and a 1.98 unfavourable FTE variance within the senior staffing section. The FTE calculation includes medical overtime. However a budget was only allocated against the junior doctor area for the additional duties incurred to cover roster gaps. Senior doctors are also undertaking extra shifts, so the bulk of the variance against overtime relates to extra duties by senior doctors. The budget includes a vacancy factor which reduces the salary budget and therefore FTEs but increases the outsourced budget. The 2009/2010 split will be monitored carefully to ensure accurate modelling and potential areas where locum use can be modified. Direct salary cost lines against both the senior and junior areas are favourable to plan; so are allowance payments but overtime costs are unfavourable against plan across all the medical areas, this aligns with the FTEs being above budget. Of note some of the non direct salary items are favourable to budget, including superannuation $17k for the month, $44k YTD, course fees and conference costs $24k monthly variance, $72k YTD, professional membership fees $8k for the month, $27k YTD. Recruitment and relocation are $20k over for the month but rest on budget YTD. In most cases the favourable variances will not continue. The budget is phased on a monthly basis but in terms of expenditure it is managed to the annual budget. Outsourced medical costs must be considered as well when reviewing the medical salary costs. As noted above the way the budget is compiled means that part of the staffing establishment is now allocated against the outsourced line. The budget has tried to reflect the reality of the permanent and locum split. The variance to budget is favourable $151k for the month and $478k YTD when considering the two components of medical costs (salaries and outsourced costs). September 09 reflects high locum/ fee for service charges, $736k but with the modelling of the budget the variance of the two medical cost lines (salaries and outsourced) against that budgeted is better than that reported in past months in previous financial years.


The table below shows the last 15 month trend of medical outsourcing charges, it is pleasing to note that September 09 is the lowest month of expenditure since July 08.

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

Total Outsourced (567) (942) (808) (749) (762) (984) (761) (825) (1,069) (922) (833) (813) (808) (747) (736)

The table below shows the variance in categories between salaries and outsourced.

Month Month Year to Date

Actual Budget Variance Actual Budget Variance Actual Budget Variance

$' 000 $' 000 $' 000 FTES FTES FTES $' 000 $' 000 $' 000

Specialist Medical Officer

- Employees (1,161) (1,195) 34 49.98 47.59 (2.39) (3,549) (3,579) 30

- Outsourced (558) (510) (48) (1,538) (1,533) (5)

(1,719) (1,705) (14) (5,087) (5,112) 25

MO

- Employees (249) (234) (15) 12.97 13.38 0.41 (750) (662) (88)

- Outsourced (10) (94) 84 (38) (328) 290

(259) (328) 69 (788) (990) 202

Total SMO (1,978) (2,033) 55 62.95 60.97 (1.98) (5,875) (6,102) 227

Registrar

- Employees (403) (496) 93 29.57 29.95 0.38 (1,229) (1,514) 285

- Outsourced (61) (25) (36) (360) (76) (284)

(464) (521) 57 (1,589) (1,590) 1

House Officer

- Employees (252) (246) (6) 18.85 23.23 4.38 (600) (727) 127

- Outsourced (107) (152) 45 (358) (481) 123

(359) (398) 39 (958) (1,208) 250

Total RMO (823) (919) 96 111.37 114.15 2.78 (2,547) (2,798) 251 RMO costs are $251k within budget YTD. Total Senior Medical Officer (SMO and Medical Officer) costs sit within plan YTD by $227k. Nursing Salaries Nursing salaries have an unfavourable variance of $20k for the month. YTD the variance is unfavourable by $180k. The following table provides the breakdown of the variance by sub categories:



Ordinary (1,984) (2,082) 98 399.46 400.79 1.33 (6,098) (6,327) 228 398.59 400.79 2.20

Accident Leave (7) - (7) 1.31 - (1.31) (22) - (22) 1.52 - (1.52)

Annual Leave Taken (265) (233) (32) 33.94 34.35 0.41 (784) (709) (75) 37.70 34.35 (3.35)

Other Leave (13) - (13) 2.19 - (2.19) (27) - (27) 1.76 - (1.76)

Sick Leave (85) (59) (26) 15.76 11.22 (4.54) (272) (179) (94) 18.65 11.22 (7.43)

Statutory (incl Time in Lieu) 4 - 4 7.40 7.84 0.44 4 - 4 9.05 7.84 (1.21)

Training (incl CME)/ Study Lve (50) (63) 12 8.55 11.70 3.15 (118) (190) 72 7.83 11.70 3.87

Long Service Leave (4) (4) - 1.07 0.73 (0.34) (32) (11) (20) 0.54 0.73 0.19

Back Pays (6) - (6) - - - (7) - (7) - - -

Allowances (274) (268) (6) - - - (839) (820) (19) 0.00 - (0.00)

Penal - - - - - - - - - - - -

Base Nursing Salaries (2,684) (2,709) 24 469.68 466.63 (3.05) (8,195) (8,236) 40 475.63 466.63 (9.00)

Overtime (63) (50) (13) 8.02 5.96 (2.06) (226) (154) (72) 8.45 5.96 (2.49)

ACC Levy (27) (19) (8) - - - (79) (58) (21) - - -

Superannuation (33) (49) 15 - - - (98) (113) 15 - - -

Course Fees, Conferences, Study Grants (29) (22) (7) - - - (100) (68) (32) - - -

Rural Retention Training (3) - (3) - - - (3) - (3) - - -

Professional Membership Fees and Costs 7 (5) 11 - - - (13) (14) - - - -

Recruitment Expenses & Advertising (2) (3) 1 - - - (12) (9) (3) - - -

Relocation (11) (3) (8) - - - (60) (10) (50) - - -

Parental Leave (38) (5) (32) - - - (49) (16) (33) - - -

Gratuities - - - - - - (21) - (21) - - -

Total Nursing Salaries (2,884) (2,864) (20) 477.70 472.59 (5.11) (8,858) (8,678) (180) 484.08 472.59 (11.49)


FTEs are tracking above YTD budgeted levels 11.49 FTE. Last month there was an additional 24.13 FTEs used in the month of August compared to budget. This month the variance is still


higher than planned but pleasingly a reduction down from last month, the monthly position is 5.11 FTEs unfavourable The increase in FTE relates to;

• the over run of sick leave 4.54 for the month (for the month of August 13.87 over plan)

• a number of patient watches being required for confused patients

• FTEs attributed to accident leave where there is no budget allocation

• FTEs aligned with other leave (e.g. bereavement and jury) where there is no budget allocation

• extra work related with H1N1 activity

• there are some nursing position being filled in mental health but are budgeted as an allied position

• overtime payments are being incurred over and above budget, over runs are happening in the ward areas and perioperative

The FTE variance is primarily driving the unfavourable fiscal variation against plan. However the month also incurred a large outlay for parental leave. YTD there are some non FTE related costs which have imposed an unfavourable result when comparing with the budget, costs include course fees, recruitment and advertising, relocation and gratuities. These costs (apart from gratuities because there is no budget apportioned) should be viewed with an annual budget perspective in mind as the budget phasing is a best approximation. The YTD variance of these is $108k unfavourable. Long service leave entitlements have increased over time as employment agreements have been settled. This is reflective above with the unfavourable fiscal variance due to the increase in provisions. Allied Health FTEs are above budgeted parameters for the month by 5.12 The FTE variance does impact on the monthly result as the following areas are above budget

• 0.48 FTE against accident leave

• 1.18 FTE against other leave

• 1.06 FTE over and above plan within the overtime section The fiscal result however stays within plan for the month and YTD, this misalignment with the FTE variance is because currently there are lower average salaries than that budgeted. A vacancy factor has been maintained within allied health for a number of years, and has been set in the 2009/2010 budget to be 31.51FTE. The vacancy factor has been increased to reflect a present discussion about mental health funding. The current non mental health vacancy factor is 25, which is over budget. When mental health vacancies are accounted for the vacancy factor remains at 15, suggesting the factor may have been set too high. The unfilled positions in mental health will be affecting service delivery.

Other items impacting the YTD fiscal result include

• the difference with the treatment of statutory days accrual between the old payroll system and the new payroll system

• additional leave for those working on call during weekend being actioned this month for the 12 month period ended 30 June 2009

• $31k charge for parental leave incurred during July 09


The table below shows both the financial and FTE status of the different allied groups in the provider arm.




Audiologists - (5) 5 - 1.00 1.00 (1) (16) 15 - 1.00 1.00

Child Therapists (1) - (1) - - - (1) - (1) - - -

Dental Therapists (63) (86) 22 11.33 15.22 3.89 (187) (257) 70 11.72 15.22 3.50

Occupational Therapists (76) (85) 9 14.14 16.00 1.86 (228) (256) 28 14.12 16.00 1.88

Physiotherapists (68) (76) 7 14.04 13.39 (0.65) (218) (227) 9 13.85 13.39 (0.46)

Speech Therapists (8) (12) 4 1.60 2.20 0.60 (26) (37) 11 1.60 2.20 0.60

Therapist Aids/Assistants (84) (89) 5 23.45 24.27 0.82 (240) (267) 26 23.22 24.27 1.05

Other Therapists - (16) 16 - 3.30 3.30 - (49) 49 - 3.30 3.30

Case Managers (48) (76) 28 9.54 14.19 4.65 (143) (228) 85 9.60 14.19 4.59

Community Support Workers (96) (95) (1) 22.07 20.80 (1.27) (285) (284) (1) 21.63 20.80 (0.83)

Cultural Workers (40) (34) (6) 6.72 6.61 (0.11) (110) (102) (8) 6.07 6.61 0.54

Health Education Workers - (14) 14 - 2.40 2.40 - (43) 43 - 2.40 2.40

Health Promotion Officers (5) (6) 1 0.80 1.00 0.20 (13) (18) 5 0.78 1.00 0.22

Psychologists (59) (101) 43 8.26 14.11 5.85 (181) (304) 122 7.69 14.11 6.42

Recreation/Training/Welfare Officers (2) (4) 2 1.00 1.00 0.00 (22) (12) (9) 1.58 1.00 (0.58)

Social Workers (107) (108) 1 19.63 19.51 (0.12) (333) (324) (9) 19.02 19.51 0.49

Trainee Psychologists - (4) 4 - 1.00 1.00 - (13) 13 - 1.00 1.00

Pharmacists (33) (28) (5) 4.69 4.57 (0.12) (90) (85) (5) 4.77 4.57 (0.20)

Pharmacist Interns - (4) 4 - 1.00 1.00 - (12) 12 - 1.00 1.00

Pharmacist Technicians (19) (13) (6) 4.60 3.53 (1.07) (52) (38) (14) 4.59 3.53 (1.06)

MRT's & Sonographers (137) (151) 13 20.46 23.25 2.79 (438) (453) 15 20.82 23.25 2.43

MRT & Sonographer Students (15) (5) (10) 3.28 1.00 (2.28) (41) (16) (26) 3.33 1.00 (2.33)

Paramedics - 105 (105) - (25.51) (25.51) - 316 (316) - (25.51) (25.51)

Technicians (68) (83) 15 13.21 16.01 2.80 (209) (249) 41 13.48 16.01 2.53

Dietitians (13) (14) 1 2.60 2.65 0.05 (49) (41) (8) 2.62 2.65 0.03

Hearing / Vision Testers (9) (9) - 1.96 2.00 0.04 (28) (26) (2) 1.96 2.00 0.04

Scientific Officers & Researchers (2) 15 (18) - (6.00) (6.00) (10) 47 (57) - (6.00) (6.00)

Other Allied Health Staff (11) (7) (3) 1.62 1.38 (0.24) (30) (21) (8) 1.56 1.38 (0.18)

Health Protection Officers - - - - - - (1) - (1) - - -

Total Allied Health Salaries (965) (1,006) 42 185.00 179.88 (5.12) (2,936) (3,017) 81 184.01 179.88 (4.13) Management Administration Monthly and YTD costs and FTEs are within plan. The under run of FTEs against budget explains the favourable fiscal variance along with the no provisioning for expired Multi Employer Collective Agreements (MECAs) One item of note relating to this cost category is the unfavourable variance against allowances of $46k YTD. This variance includes a budget mistake not including all allowance payments against some clinical areas, some acting up allowances have been incurred with no budget attached and some regional roles that now have allowances that were not known during budget preparation time.



Ordinary (841) (905) 65 193.61 195.78 2.17 (2,534) (2,712) 178 196.30 195.78 (0.52)

Accident Leave - - - 0.17 - (0.17) (4) - (4) 0.28 - (0.28)

Annual Leave Taken (84) (92) 8 13.07 17.42 4.35 (247) (276) 30 12.87 17.42 4.55

Other Leave (2) - (2) 0.35 - (0.35) (7) - (7) 0.60 - (0.60)

Sick Leave (29) (40) 10 8.77 8.76 (0.01) (110) (120) 10 7.95 8.76 0.81

Statutory (incl Time in Lieu) - - - 0.33 - (0.33) (2) - (2) 0.48 - (0.48)

Training (incl CME)/ Study Lve (8) (8) - 1.47 1.77 0.30 (19) (24) 5 1.05 1.77 0.72

Long Service Leave (2) - (2) - - - (13) - (13) 0.04 - (0.04)

Back Pays (9) - (9) - - - (20) - (20) - - -

Allowances (22) (2) (20) - - - (53) (7) (46) (0.00) - 0.00

Penal - - - - - - - - - - - -

Base Management Admin Salaries (997) (1,047) 50 218 224 6 (3,009) (3,139) 131 220 224 4

Overtime (2) (4) 2 0.53 0.04 (0.49) (6) (11) 4 0.43 0.04 (0.39)

ACC Levy (6) (7) 1 - - - (25) (22) (4) - - -

FBT - - - - - - (4) - (4) - - -

Meals - - - - - - - - - - - -

Superannuation (9) (8) (1) - - - (27) (24) (3) - - -

Course Fees, Conferences, Study Grants (8) (3) (5) - - - (17) (8) (9) - - -

External Clinical Supervision - - - - - - - - - - - -

Professional Membership Fees and Costs - - - - - - (3) (1) (2) - - -

Recruitment Expenses & Advertising (2) (2) 1 - - - (7) (7) - - - -

Relocation - - - - - - - - - - - -

Parental Leave - (1) 1 - - - - (3) 3 - - -

Total Management Admin Salaries (1,025) (1,073) 48 218.30 223.77 5.47 (3,100) (3,214) 114 220.00 223.77 3.77



The ministry has required that a cap be put on management administration FTE so that there is no growth in this area. The capped level against this group has been maintained for September 09.

5. Expenditure

Outsourced Outsourced costs are within plan $52k for the month and $131k YTD. As noted above in the salary section the medical budget was phased and adjusted for locum use (which in most cases is paid at a premium when compared to salaried staff) therefore the fee for service budget lines have increased compared to last year. This approach has resulted in a favourable variance to plan. Outsourced management administration costs lines have no material variance to report. Outsourced allied reside over for the month and YTD. Extra activity has been undertaken against the therapists, psychologists and social workers lines. Outsourced clinical services are within plan. These costs relate to Southern Blood and Cancer and other outsourced services, for example lithotripsy and MRI scans. Clinical Supplies Total clinical supplies expenditure for the month of September 09 is $1,790k against a budget of $1,749k, a $41k unfavourable variance to plan. The phasing of the budget does impact on the monthly result. This year the clinical supplies budget has been phased on days of the month. Within the reported variance various lines have over and under runs which require some explanation

• a lower than planned hip and knee prostheses costs reside in the month. This variance is driven by volume delivery

• pharmaceutical costs are $9k within the monthly budget position; YTD the actual costs reside $6k over budget, last year the oncology pharmaceutical charges maintained the unfavourable variance to plan, the budget was increased for the 09/10 year but it seems the budget growth has not completely covered off all the actual expenditure being incurred, other areas contributing to the unfavourable variance include critical care and perioperative. The oncology costs also include the medical day stay pharmaceutical charges

• blood products usage for September 09 resulted in a $2k variance within budget. This sits under treatment disposable category, and is driven by patient volumes. YTD the variance is $27k unfavourable against plan

• patient consumable costs (treatment disposables category) are above planned levels for the month. This is activity related and is showing up against the perioperative area

• dressing charges are $27k over YTD (treatment disposables category). This is a cost related to the use of vac wound machines machines which has the benefit of keeping patients out of hospital

• continence and hygiene supplies (treatment disposable area) presents a YTD unfavourable variance of $27k, this variance is driven by patient requirements

• protective clothing costs are well above planned parameters (also treatment disposables area) due to H1N1 activity, $43k over YTD

• patient appliance costs for the month are $9k over; due to an uncommon, therefore unbudgeted, patient appliance $3k and also ostomy charges incurred $6k more than


budgeted. YTD the variance is favourable $17k the key driver is ostomy supplies which relates to the patient demand

• instruments and equipment expenditure is under budget by $1k for September 09 and $106k YTD. YTD there is an under run against clinical depreciation, repairs and maintenance for clinical equipment and also minor purchases for clinical items which cost less than $500. Service contract charges and clinical equipment operating leases are favourable to plan. There is a $3k over run against disposable instruments

• diagnostic supplies and other clinical equipment costs are resting right on budgeted parameters so there is no variance to note

• September month of this financial year has incurred a $13k favourable variance against other clinical and client costs. YTD the variance is unfavourable by $5k. Driving this variance is an over run with ambulance and air ambulance costs but an under run against patient transport & lodgings

The table below shows the past 15 months of expenditure against the total clinical supplies line. Predominately the bulk of this cost category is driven by patient volumes and patient mix.

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

Total Clinic Supplies (1,688) (1,497) (1,731) (1,835) (1,600) (1,767) (1,684) (1,629) (1,911) (2,024) (1,964) (2,178) (1,847) (1,837) (1,790)

Infrastructure and Non Clinical Supplies Total infrastructure and non clinical supplies costs were $1,828k for the month compared to a budget of $1,769k therefore generating an unfavourable variance to plan of $59k for September 09. Hotel service costs are $19k over budget for the month and $60k YTD. YTD the items driving this variation include laundry charges. Part of the higher cost against budget is related to volume (including activity related to H1N1) but also there has been an associated cost with lost property. Also there is an unfavourable variance against patient meals $15k this is related to the variable portion of the contract, more meals than planned. A $6k over run of budget relates to food and groceries costs. There is also an over run against orderlies outsourced, cleaning charges offset some of the YTD variance by sitting $5k under budget. Facilities costs are $4k within budget for the month and $45k YTD. Within this cost section, maintenance expenditure resides over plan by $26k for the month and $26k YTD. The adverse monthly result is driven by the upgrading of some of the staff accommodation. The budget for electricity and coal expenditure needs to be looked at on an YTD basis as the phasing of the budget is creating artificial variances during this period of the year. There has been an increase in the price of coal over and above the budget allocation; the prediction is that the variance will be approximately $30k higher than budget. Waste removal charges are $11k outside the monthly budget and $19k YTD over budget. Building and plant depreciation is above plan for the month the budget setting does not marry up with the last part of the expenditure in the 2008/2009 financial year hence this variance exists. External storage charges reside $19k over YTD, this variance relates to last financial year some charges were missed during the year end accrual process. Transport costs are within budget for the month and YTD. YTD the staff travel expense line is maintaining this positive variance along with fuel charges being under plan. Information systems and telecommunication costs are over plan for the month but within budget YTD. Depreciation charges are favourable to budget but are offset with an over run against bureau & outsourcing fees ($9k), software maintenance fees ($10k) and direct telecommunication charges ($48k). Interest and financing costs are below plan by $39k YTD. This variance is driven by the capital charge cost being under budget by $39k.


Total professional fees and expenses rest within YTD budget allocation by $46k. YTD all line items have been managed to planned parameters apart from insurance. Total other operating expense includes the one liner of savings. This saving initiative is on top of the vacancy factors included in the salary lines. Each area in the hospital has been tasked with contributing to this savings initiative in various ways.

6. Forecast

The first quarter of the financial year has past therefore it is possible to start predicting a year end position given that some trends are emerging. The following table shows a high level forecast predicting that the final fiscal result will be better than plan by $665k This forecast assumes the same trends as are being currently experienced.

YTD YTD YTD Forecast Annual budget Variance

Actual Budget variance Jun-10 Jun-10 Jun-10

$' 000 $' 000 $' 000 $' 000 $' 000 $' 000

Revenue 34,126 34,101 26 138,635 138,636 (1)

Less Personnel Costs

Medical (6,128) (6,482) 354 (24,661) (25,589) 928

Nursing (8,858) (8,678) (180) (35,662) (35,802) 140

Allied (2,936) (3,017) 81 (12,034) (11,882) (152)

Support (143) (144) 1 (584) (563) (21)

Management / Admin (3,100) (3,214) 114 (12,400) (12,628) 228

(21,165) (21,535) 370 (85,341) (86,464) 1,123

Less Other Costs

Outsourced Cost - Medical (2,291) (2,417) 126 (9,364) (9,897) 533

Outsourced Cost - Other (986) (992) 6 (3,940) (3,963) 23

Clinical Supplies (5,474) (5,352) (122) (21,600) (21,295) (305)

Infrastructure Costs (5,465) (5,388) (77) (21,560) (20,852) (708)

(14,216) (14,149) (67) (56,464) (56,007) (457)

Net Surplus / (Deficit) (1,255) (1,584) 329 (3,170) (3,835) 665


7. Capital Commitments

TOTAL Core IS IS project BuildingsClinical

& OtherOral Health

Annual Budget 6,557 823 377 600 2,600 2,157

Carried Forward 2008/09 (Including

those approved and ordered but not paid

for)

1,840 461 583 65 731

Total Capital Available 8,397 1,284 960 665 3,331 2,157

Purchased YTD September 09 1,520 595 91 181 576 77

Donated Assets 12 12

WIP 84 81 3

Committed 1,149 166 224 641 117

Remaining Capital to carry forward 5,633$ 524$ 564$ 484$ 2,101$ 1,960$

Capital Budget as at September 09 ($'000)

The capital budget has to be managed within agreed parameters. Capital affordability will continue to be an issue in this financial year.


8. Statement of Financial Performance

Current Month Year to Date Annual

Part 2: DHB provider Actual Budget Variance Variance Actual Budget Variance Variance Budget

$(000) $(000) $(000) % $(000) $(000) $(000) % $(000)

Part 2.1: Statement of Financial Performance

REVENUE

MoH - Personal Health - 46 (46) U (100%) 20 138 (118) U (85%) 553

MoH - Public Health 8 19 (11) U (56%) 18 58 (39) U (68%) 231

MoH - Disability Support Services 53 53 0 F (1%) 158 159 (1) U (1%) 637

Clinical Training Agency (18) 103 (121) U (117%) 203 310 (107) U (34%) 1,238

Internal - DHB Funder to DHB Provider 10,553 10,576 (23) U 0% 31,602 31,729 (127) U 0% 129,149

Ministry of Health Total 10,596 10,798 (202) U (2%) 32,002 32,394 (391) U (1%) 131,808

Other Government

Other DHB's 47 26 21 F 81% 81 79 2 F 3% 314

Training Fees and Subsidies 2 6 (4) U (62%) 2 17 (15) U (87%) 68

Accident Insurance 373 310 63 F 20% 1,045 931 114 F 12% 3,724

Other Government - 2 (2) U (100%) - 6 (6) U (100%) 26

Other Government Total 422 344 78 F 23% 1,128 1,033 95 F 9% 4,132

Government and Crown Agency Total 11,018 11,142 (124) U (1%) 33,130 33,427 (296) U (1%) 135,940

Other Revenue

Patient / Consumer Sourced 198 105 93 F 89% 449 314 134 F 43% 1,257

Other Income 262 120 142 F 119% 548 360 188 F 52% 1,439

Other Revenue Total 460 225 236 F 105% 996 674 322 F 48% 2,696

REVENUE TOTAL 11,478 11,367 112 F 1% 34,126 34,101 26 F 0% 138,636

EXPENSES

Personnel Expenses

Medical Personnel (2,066) (2,170) 105 F 5% (6,128) (6,482) 354 F 5% (25,589)

Nursing Personnel (2,884) (2,864) (20) U (1%) (8,858) (8,678) (180) U (2%) (35,802)

Allied Health Personnel (965) (1,006) 42 F 4% (2,936) (3,017) 81 F 3% (11,882)

Support Services Personnel (41) (49) 8 F 16% (143) (144) 1 F (0%) (563)

Management / Admin Personnel (1,025) (1,073) 48 F 4% (3,100) (3,214) 114 F 4% (12,628)

Personnel Costs Total (6,980) (7,162) 182 F 3% (21,165) (21,535) 369 F 2% (86,463)

Outsourced Expenses

Medical Personnel (736) (781) 45 F 6% (2,291) (2,417) 126 F 5% (9,897)

Allied Health Personnel (19) (13) (6) U (44%) (52) (39) (14) U (35%) (154)

Management / Administration Personnel - (2) 2 F 100% - (6) 6 F 100% (22)

Outsourced Clinical Services (279) (290) 11 F 4% (863) (872) 9 F 1% (3,487)

Outsourced Corporate / Governance Services (25) (25) - 1% (70) (75) 4 F 6% (298)

Outsourced Services Total (1,059) (1,111) 52 F 5% (3,277) (3,409) 131 F 4% (13,860)

Clinical Supplies

Treatment Disposables (591) (530) (61) U (11%) (1,897) (1,632) (265) U (16%) (6,438)

Diagnostic Supplies & Other Clinical Supplies (22) (24) 2 F 8% (70) (72) 2 F 3% (277)

Instruments & Equipment (356) (358) 1 F (0%) (974) (1,080) 106 F 10% (4,394)

Patient Appliances (67) (58) (9) U (16%) (160) (176) 17 F 9% (699)

Implants & Prosthesis (171) (174) 3 F 2% (506) (535) 29 F 5% (2,114)

Pharmaceuticals (495) (505) 9 F 2% (1,553) (1,548) (6) U (0%) (6,146)

Other Clinical Supplies (88) (101) 13 F 13% (315) (309) (5) U (2%) (1,227)

Clinical Supplies Total (1,790) (1,749) (41) U (2%) (5,474) (5,352) (122) U (2%) (21,295)

Infrastructure & Non Clinical Expenses

Hotel Services, Laundry & Cleaning (379) (360) (19) U (5%) (1,164) (1,104) (60) U (5%) (4,379)

Facilities (574) (578) 4 F 1% (1,705) (1,750) 45 F 3% (6,271)

Transport (91) (112) 21 F 19% (271) (340) 69 F 20% (1,355)

IT Systems & Telecommunications (274) (251) (23) U (9%) (744) (756) 13 F 2% (3,066)

Interest & Financing Charges (357) (369) 11 F 3% (1,093) (1,132) 39 F 3% (4,566)

Professional Fees & Expenses (17) (45) 28 F 62% (92) (138) 46 F 34% (548)

Other Operating Expenses (135) (55) (80) U (145%) (396) (167) (229) U (137%) (666)

Infrastructure & Non-Clinical Supplies Total (1,828) (1,769) (59) U (3%) (5,465) (5,388) (77) U (1%) (20,852)

Total Expenses (11,657) (11,791) 134 F 1% (35,381) (35,683) 302 F 1% (142,470)

Net Surplus/ (Deficit) (178) (424) 246 F 58% (1,255) (1,583) 328 F 21% (3,834)

Part 2.1 A: Supplementary Information to Statement of Financial Performance

Depreciation - Clinical Equipment (180) (194) 14 F 7% (539) (578) 39 F 7% (2,402)

Depreciation - Non Res Buildings & Plant (211) (198) (13) U (7%) (633) (594) (39) U (7%) (2,394)

Depreciation - Motor Vehicles (1) - (1) U n/m (2) - (2) U n/m -

Depreciation - Information Technology (92) (104) 12 F 12% (256) (306) 50 F 16% (1,279)

Depreciation - Other Equipment (17) (16) (1) U (9%) (52) (48) (4) U (9%) (192)

Total Depreciation (502) (512) 10 F 2% (1,482) (1,526) 44 F 3% (6,267)

Interest Costs from CHFA (242) (242) - (0%) (743) (742) (1) U (0%) (2,692)

Capital Charge (114) (125) 11 F 9% (346) (385) 39 F 10% (1,856)

Press Releases are available on SDHB website

Website at www.sdhb.govt.nz

GLOSSARY OF ACRONYMS

A & D Alcohol and Drug ACC Accident Compensation Corporation

ADM Acute Demand Management ADON Associate Director of Nursing

ALOS Average Length of Stay

AOD Alcohol and Other Drug

APEX Association of Professional and Executive Employees

ASMS Association Salaried Medical Specialists AT&R Assessment, Treatment and Rehabilitation

aTT Actual Treatment Threshold AWUNZ Amalgamated Workers Union New Zealand

BCP Business Continuity Plan

CAFS Children, Adolescent and Family Services

CAPEX Capital Expenditure

CAT Computer Axial Tomograthy CCP Clinical Career Pathway

CCU Coronary Care Unit CD Clinical Director

CDS Child Development Service

CEA Collective Employment Agreement CEO Chief Executive Officer

CFA Crown Funding Agreement; Crown Funding Agency CFO Chief Financial Officer

CHS Community Health Services

CI Cataract Initiative

CIO Chief Information Officer

CIS Clinical Information System CL Clinical Leader

CME Continuing Medical Education CMO Chief Medical Officer

CNC Clinical Nurse Co-ordinator

CNL Clinical Nurse Leader and Care Needs Level

CNS Clinical Nurse Specialist

CCN Clinical Charge Nurse COO Chief Operating Officer

COT Certainty of Treatment CPAP Continuous Positive Airway Pressure

CPHAC Community and Public Health Advisory Committee

CQI Continuous Quality Improvement

CSF Critical Success Factors

CTA Clinical Training Agency CW Case Weights

CWD Case Weighted Discharges DAP District Annual Plan

DHB District Health Board

DHBNZ District Health Board New Zealand

DNA Did Not Attend

DRP Disaster Recovery Plan

DSAC Disability Support Advisory Committee DSS Disability Support Services

DSU Day Surgery Unit EAP Employment Assistance Programme

ED Emergency Department

EDIS Emergency Department Information System

EEO Equal Employment Opportunity

EMT Executive Management Team EN Enrolled Nurse

ENT Ear, Nose and Throat ESPI Elective Service Performance Indicators

eTXT Telecom’s computer to cell phone text messaging service

EXEC Executive Management Team

EQuIP4 Evaluation and quality improvement programme version 4

FACEM Fellowship of the Australasian College of Emergency Medicine FF&E Furniture, Fixtures and Equipment

FSA First Specialist Assessment FTE Full Time Equivalent

FU Follow-up visit

GM General Manager GP General Practitioner

H&S Health and Safety HAC Hospital Advisory Committee

HBL Health Benefits Limited

HHS Hospital and Health Service

HISNZ Health Information Strategy for New Zealand

HO House Officer HOT House of Travel

HPCAA Health Practitioners Competency Assurance Act HR Human Resources

HRIS Human Resources Information Systems

HWIP Health Workforce Information Project

IAA Immigration Advisors Association

IANZ International Accreditation New Zealand ICM International Confederation of Midwives

ICT Information and Communications Technology ICU Intensive Care Unit

IDF Inter District Flows

IEA Individual Employment Agreement

IP Inpatient - Internet Protocol and Intellectual Property

IPA Independent Practitioners Association IS Information Systems

ISAC Information Systems Advisory Committee ISSP Information Systems Strategic Plan

IS Information Systems

IT Information Technology

JV Joint Venture

K Thousand KPI Key Performance Indicators

LAN Local Area Network

LDH Lakes District Hospital

LMC Lead Maternity Carer

MECA Multi-Employer Collective Agreement

MERAS Midwifery Employee Representation and Advisory Service MH Mental Health

MHINC Mental Health Information Collection MHSOP Mental Health Services for Older People

MIMS MIMS

MO Medical Officer

MOH Ministry of Health

MOSS Medical Officer of Specialist Scale MRI Magnetic Resonance Imaging

MRSA Methicillin Resistant Staphylococcus Aureas (a “superbug”) MRT Medical Radiation Technologist

MVS Meningococcal Vaccine Strategy

NASC Needs Assessment and Service Co-ordination

NBS National Booking System

NCAMP National Collections Annual Maintenance Project NETP Nursing Entry to Practice

NRG Network Representative Group NGO Non Government Organisation

NHI National Health Index

NHPPD Nursing Hours Per Patient Day NICU Neonatal Intensive Care Unit

NIR National Immunisation Register NMDS National Minimum Data Set

NNPAC National Non-Admitted Patients Collection

NRG Network Representative Group

NZ New Zealand

NZHIS New Zealand Health Information Service NZNO New Zealand Nurses Organisation

O&D Organisation and Development NZREX New Zealand Registration Examination

O&G Obstetrics and Gynaecology

ODHB Otago District Health Board

OP Outpatient

P&F Planning and Funding PACS Picture Archiving and Communication System (digital x-rays)

PBFF Population Based Funding Formula PC Personal Computer

PD Position Description

PH Public Health or Personal Health

PHNCW Personal Health Non Cost Weighted

PHO Primary Health Organisation PRIMHD Programme for Integration for Mental Health Data Project

PSA Public Service Association PTR Professional Technical Related

QHNZ Quality Health New Zealand

QIC Quality Improvement Committee

RDA Resident Doctors Association

RFI Request for Information RFP Request for Proposal

RHMU Residual Health Management Unit

RIS Radiology Information System

RMO Resident Medical Officer

RN Registered Nurse

SBVS School Based Vaccination System SCL Southern Community Laboratory

SDHB Southland District Health Board SISSAL South Island Shared Service Agency Limited

SLA Service Level Agreement

SLH South Link Health

SMHET Southland Mental Health Emergency Team

SLT Speech Language Therapist SMO Senior Medical Officer

SMT Senior Management Team SOI Statement of Intent

SS Sterile Supply

SWFU Service and Food Workers Union

TC Thin Client

UK United Kingdom WAN Wide Area Network

WAP Workforce Action Plan WINZ Work and Income New Zealand

YTD Year to Date

Documents

HOSPITAL ADVISORY COMMITTEE MEETING · 2018-11-08 · 1. Welcome and Apologies Mrs Katie O’Connor, Chair, welcomed members to the Southland District Health Board (DHB) Hospital