HOSPITAL AND HEALTH SERVICE REPORT FOR MONTH OF DECEMBER SUBJECT: Hospital & Health Service Report for December 2008

Transcription

1 HOSPITAL AND HEALTH SERVICE REPORT FOR MONTH OF DECEMBER 2008 TO: FROM: The Hospital Advisory Committee Chief Operating Officer DATE: 26 January 2009 SUBJECT: Hospital & Health Service Report for December 2008 INTRODUCTION This report is for the meeting of the Hospital Advisory Committee to be held on 4 February It covers performance information for the month December 2008 and other issues to date Recommendation The committee is recommended to note the content of this report. Approved for release Shaun Drummond Ken Whelan Chief Operating Officer Chief Executive

2 4.1 Chief Operating Officer Strategic Issues Activity The HHS internal reporting confirms that we are ahead of plan against Year to Date target for activity. Total CCDHB delivery at the end of December reports 1,769 CWD ahead of target of which 12% relates to IDF activity. Local elective activity is reported as 602 CWD above base line targets. Directorate Updates Non-Clinical Support Services It has been business as usual for the directorate with enhancements to service levels and implementation of process changes. The migration into the new Wellington Regional Hospital building is a big focus for the directorate and to date all support changes and services are ready to move as and when each directorate is programmed to. Additional fixed term employees have been recruited to accommodate the additional service level requirements during the migration. The ageing infrastructure continues to show failings, this month the lifts failed several times. An Otis report on the lifts in the WSB and CSB has been completed and recommends that $1.7m be spent on lift refurbishment over the next three years. This is being reviewed by the Directorate. a) Financials: The Operating result of the directorate for the month was favourable with funding being received from Planning and Funding for some previously unfunded activity surrounding patient travel. Loan Equipment continues to exceed budget but the controls surrounding the issuing and purchasing of services have been implemented and significant cost leakage has been stemmed. Additional depreciation was incurred this month due to three years of Work in Progress amounts not being capitalised. b) Quality: Service Level Agreements are being agreed with the other directorates for all core operational services. Process Documentation has been completed for NCSS core services. Top Cat Auditing tool (cleaning) has been implemented in Radiology and Blood and Cancer. The 5000 helpdesk has been established by Spotless and is being used by the organisation. A satisfaction survey was completed at the Vibe Café with questions surrounding variety, quality and value. Spotless received a 93% overall satisfaction rating from 20 respondents. A satisfaction survey was completed on patient meals with respect to customer service, quality and variety. 69 patients responded and Spotless achieved an overall satisfaction rating of 94%. Buckeye meal ordering system has been successfully introduced in Kenepuru. The system will improve the accuracy of the patient meal ordering. It is anticipated that Buckeye will be rolled out to Wellington Hospital mid February 2009.

3 c) Information Management: The second phase of FMIS II has commenced. A transport booking system has been identified to be operationally suitable for the transport division, currently awaiting HIQ acknowledgement regarding any platform issues. d) Projects: Pyxis continues to roll out successfully, operating procedures and final documentation has received approval from all parties and is ready to be released to all inpatient wards. The 3 MW chiller arrived in the country and will be transported to Wellington in January with its installation anticipated to be completed in February This will alleviate the issue of demand for chilled water exceeding the supply capability. All other projects are on schedule. Community and Clinical Support Directorate a) Emergency Service: Introduction of the 6-Hour Rule has dramatically improved the situation in ED. There has been a significant improvement in patient flow in and out of ED, and staff are learning to be proactive in managing patients and encouraging patient flow. Introduction of two staff nurses at Triage has influenced improved care and monitoring of patients in ED. Fewer patients were cared for in corridors in December, which can be attributed to this measure and the 6-Hour Rule. Nursing staff levels are improving in ED with the majority of shifts now well staffed and skill mix suitable for patient acuity. b) Patient Administration Service: DNA rate: Target 8%. Actual: Kenepuru 10%, Kapiti 8%, Wellington 8%. c) Pharmacy: The contract for outsourcing of compounding to Baxter was approved in December. Transition of compounding has begun and incremental outsourcing will occur over the next five months. Phase 1 of Pyxis Medstation implementation was successfully completed by mid December. There were no serious Pyxis related or supply related problems over the Christmas holidays. d) Radiology: The increase in radiology staffing levels has contributed positively to staff morale. e) Decision Support: Contract monitoring and reporting is continuing to improve. The Team Leader Reporting has added substantial visibility to the process, and has been instrumental in resolving a number of issues. His prior experience in this area also enables him to further educate directors on the nuances of contract monitoring.

4 Data Warehouse: significant advances have been made, with the focus being predominantly on the Theatre data elements. This work will continue through January, along with work on gaining some solid outputs from the system. f) Kenepuru Kapiti Community: Capital Coast Rehab has completed FIM training and will begin data collection in January. All allied health staff have been trained and further nursing training to be undertaken. This will ensure the service can continue to contract with ACC for Non-acute Inpatient Rehabilitation. Capital Support has implemented change of numerous processes following an audit around Supported Independent Living. Training is planned for the team and providers in January. Risks Emergency Service: Triage compliance while the service improved compliance for T3 and T4, overall the service is only meeting the T1 target. This may be associated with the run change for junior medical staff at the beginning of December. Allocation of two nurses to Triage has improved patient care. This has been introduced to increase the safety of patients waiting, to reduce the flow of patients into the clinical treatment area and to enable the sickest patients to receive treatment first and to enable better management of patient flow. Laboratory: the service has seen a continued increase in workload (16.7% for month, 8.1% YTD). Decision Support: Costing: The National Pricing Programme submission has taken longer than anticipated. The external consultant engaged to lead this work continues to be heavily involved in this area, and has identified a number of problems that will need to be worked through prior to embarking on monthly costing taking place. Data Warehouse: Issues have been identified with the Business Objects software purchased for the EDW project, and support out of New Zealand is proving less than ideal. This is being managed internally, and escalated where necessary to ensure resolution. Radiology: Clinical Leader Radiology resigned last day 2 January Position is to be advertised, but in the mean time various tasks have been delegated to the consultant group. Surgical Services a) Surgical Throughput: Despite another challenging month in terms of acute activity indications are that most services remain ahead YTD with delivery of elective volumes. Cardiothoracic - have continued downward trend in cardiac waiting list. As at 16 December the total number on the wait list was 61 pts with 1 waiting greater than 6 months. Expected reduced throughput in January due to leave but have contingency plan in place to address any shortfall in activity.

5 Continued focus to increase utilisation of 3 rd theatre at Kenepuru is underway. Current utilisation of the OR suite is approximately 66%. A plan to reallocate some sessions in line with the overall plan for future use of Kenepuru is underway. Planning was finalised for the Christmas period with a reduction in service planned from 24 th Dec 11 th Jan with full operational capacity expected from the 12 th January. Predictions on activity against budgeted levels indicate that the current over activity position will be maintained through this period. b) Outsourcing: Cardiac surgery the plan is to continue to outsource with a plan to rationalise the range of providers in All patients planned prior to Christmas are now completed. The last wave of patients for Sydney is planned for late February. Contracts for cardiac surgery in the private sector continue. c) WRH planning: The new theatre schedule in draft has been circulated to Clinical Leaders for discussion. There is significant additional capacity allowed for within the schedule. Migration planning is being advanced at a fairly rapid rate. Focus currently on inpatient areas, ICU and ORs. d) Elective Services: Overall Elective services monitoring continues to show a broad compliance against MoH indicators and targets. Issues identified in vascular associated with the implementation of the new scoring tool are being addressed and should not present a long term concern. e) Workforce : Charge Nurse Manager appointments are in place now with all appointments confirmed for Orthopaedics/Urology, General Surgery/ENT and Neurosciences/Stroke. Appointment to Service Leader positions have progressed with General Surg/Vascular and Orthopedics appointed. Awaiting commencement of Ophthalmology / Neurosurgery position. New Graduates 34 new graduates have accepted positions across the directorate. Additional support is being explored to support their transition into the workplace. Expressions of Interest for a 12 month appointment for a Clinical Leader for Surgical Services at Kenepuru is now closed and awaiting return of staff from Christmas leave to finalise position. Mental Health a) Te Korowai-Whāriki: The Whanau Day, held on 6 th December 2008, was a great success with very positive feedback from both clients and family. Staff and clients work very hard to make this day happen and it is pleasing to see that it continues to be well supported by families.

6 The registered nurse vacancies continue to impact on the operations of the units. Work on recruitment and retention strategies continues to be priority. The contractors have begun work on the new Duress system and the project is on target for completion early 2009 Two senior staff presented the E diary initiative in the quality competition in December They were highly commended for their presentation by CCDHB executive management. Client numbers and acuity have remained high and the units continue to operate over numbers increasing the use of watch, overtime and casual pool hours. b) General Adult Mental Health Service (GAMHS): It was positive that the acute services approached Christmas with ample capacity in Te Whare o Matairangi and the community facilities. This meant that although the public holidays after Christmas were busy there was sufficient capacity to absorb admissions comfortably. The second half of this year has seen much better doctor coverage in GAMHS. This has been largely brought about by the use of locums, having a full complement of medical staff greatly assists in crisis response, turnover of referrals and keeping waiting lists down. Unfortunately, the costs of locums are far greater than the budgeted FTEs and with a negative variance to budget. The Clinical Leader and Operations Manager will continue with their objective to recruit permanent doctors to the service. The Te Whare o Matairangi redevelopment plans are progressing well with a well engaged stakeholders group and the recently formed smaller users group. The architects have been well briefed with the stakeholders wish list, taking into account available revenue. The timeframes are tight but achievable for work to begin within this financial year. c) Specialty Mental Health Service: Much of the focus this month has been on decision-making for the proposed Child & Adolescent MHS reconfiguration. A number of meetings were held with teams, team leaders, and individuals to discuss the intended changes, due for implementation by March Women s & Children s a) Migration Planning and Readiness: The main focus for the Directorate for the month has been preparing for the moves into the new hospital. The Women s Clinics move is on track to take place on 30 th January 2009 with the first patients scheduled to be seen in the new facility on Monday 2 nd February. The move date for Te Mahoe unit (formerly level J unit) has been deferred to 13 th February because remedial work required to be completed pre-occupation of the unit has not been completed. The women s inpatient move is scheduled to occur on 10 th February, Delivery Suite and the Neonatal Intensive Care Unit on 12 th February. Work in the areas is not complete and therefore the final decision on whether the move will occur as planned is yet to be made.

7 b) Elective Services: Both paediatric surgery and gynaecology are compliant with MOH indicators and targets for elective services. Both services are achieving elective through put according to contracted volumes. Due to theatre access issues gynaecology has had to outsource surgery to achieve contract through put. c) Neonatal Intensive Care Unit (NICU): The NICU continues to be busy with occupancy averaging approximately 36 cots. There has been significant improvement in capturing all activity going through the unit, as well as in contract monitoring reporting and as a result the unit is now showing significantly above contracted level of activity in both local and IDF work volumes. We plan to have staff available for beds in the new hospital which will represent 90% occupancy of the total 40 cots. d) Workforce Planning and Management: Work force plan is progressing very slowly still awaiting payroll changes to cost centres and account codes which is necessary to gain an accurate impression of actual versus establishment FTE Recruitment to SMO vacancies continue in both Women s and Children s services. Key vacancies still exist in Developmental Paediatrics, Gynaecology Oncology and Maternal Fetal Medicine Midwifery vacancies continue to improve but full staffing still remains to be achieved Recruitment to the nursing vacancies in NICU and children s ward continues. Medicine, Cancer & Palliative Care Services a) Directorate: Migration preparation for the Clinical Measurement Unit has been completed with final sign off 5 th January. CMU successfully moved from 5 th January and opened for clinical service delivery from 12 th January Preparation for Inpatient and Renal Services moves continues during December /January. 100% (nine) service plans for Medicine and Cancer have been completed for the 0809 FY. Analysis of cost drivers and progress of financial recovery plan continues for the Directorate. Progressing Price Volume Schedule (PVS) and Capex planning for 09/10 financial year; this is expected to be concluded in late January Activity: Non case weight data quality is improving however mapping for some PVS lines remains an issue for the first 6 months Working with DSU to correct mapping and coding issues identified to date. Financial Recovery Plan progressed and monitored. b) Migration to WRH: CMU commenced their move to the WRH on 5 th January Clinical services commenced on the 12 January The move progressed without major incident and all minor issues have been actioned and/or are in process of being resolved. All of the team leaders, service leaders and clinical leaders have contributed outstandingly to the smooth migration for these five teams including Respiratory, Neurology, Cardiology and Cardiothoracic services and Vascular diagnostic services. The Inpatient project is progressing to target. The teams continue to focus on the implementation of the work that is required to achieve safe migration.

8 Charge Nurse Manager positions for two of the three medical/cancer inpatient wards (5 south, 6 south) have been appointed. An interim CNM has been appointed to 5 North. All these positions attended an orientation and planning program for two day in early January to ensure these new roles are successful. Time lines and KPI's are in place to achieve these objectives. The MAPU business case has been signed off by impacted Directorates and the COO. The MAPU 2 nd phase consultation paper will be released the week of 12 January The draft design for MAPU fit-out of Level 2 has been completed, signed off and approval to proceed to Quantity Surveyor has been actioned by the COO with the NRH team. Work continues on the RMO and SMO model for the Medicine redesign with plans to table with Unions and intent to submit work pattern changes has been flagged with the National MOU Steering Group. c) Blood, Cancer & Palliative Care Services: Operational Management: - Radiation Therapy Wait list: - 1 Patient waited longer than 6 weeks, this was due to capacity constraints within the service. - Clinical commissioning of the 3rd Linac continued and was completed on time and on budget to meet target date of 12 January 09 for first patient treatment. Workforce: - The newly appointed Radiation Oncologist has arrived from South Africa for a one year locum to cover maternity leave. He has extensive Gynae brachytherapy experience which will relieve the pressure on key staff - Prostate brachytherapy service implementation continues. A letter has been sent to feeder DHBs informing them of progress and service availability & access. Nursing resignation in Brachytherapy area has caused some concern as it is a narrow specialty to recruit, and is currently filled by staff rotating from the ambulatory area. - There have been no applicants for Clinical Leader (CL) position for Medical Oncology. Discussions with staff continue. - Ward 1 resignations and annual leave approved will result in tight staffing levels for January and February. Recruitment to vacant positions is continuing including graduate nurses commencing in late January. The ward has been busy, right up to Christmas with high patient acuity. - The Palliative Care registrar business case is with the Clinical Leader for approval and will then be submitted to Planning &Funding. Quality & Safety: - Ambulatory Oncology - all cancer patients previously treated in the Day procedure Unit have returned to the cancer ambulatory service. - Changes to Herceptin and one other chemotherapy protocol will see an increase in chemotherapy administration. Additional funding for Herceptin will be provided from MOH this will need to be carefully monitored to ensure funding covers the costs. - Palliative Care Liverpool care pathway of the dying - progressing funding discussions with P&F to implement this key DAP and Palliative Care plan strategy across acute and hospice services - Extensive discussions are being held on the implementation of the Central Cancer Network (CCN) multidisciplinary management framework. The implementation is supported by the managers of the DHBs, however individual discussions need to be held within each DHB to identify funding for the project.

9 d) Medicine Services: Financial result for month of December: $75k underspent. Revenue: $667,064, Expenditure: ($591,894). Primary area of concern for expenditure continues to be staffing in SMO, RMO and nursing. Improvements have been noted with the reduction of HCA usage however levels remain high with watch and specials being legitimately used and reviewed every 24 hrs. Clinical supplies are unfavourable ($113,324), and Infrastructure and non clinical supplies are ($54,847) unfavourable, the latter largely due to minor equipment purchases this month. Operational Management: - the Renal Service (ward 40) supported seven patients to have transplants in a period of six days (including 4 within 24 hours). A considerable achievement by a committed cross service interdisciplinary team. Workforce: - A review of CCU staffing has been completed with the final report due early Staffing levels in all services remains good. Medical and Renal wards report they are staffed to FTE establishment, but CCU continue to have several vacancies. Recruitment remains positive - RMO rosters are covered for the holiday period, and this has been achieved without the significant additional payments that were required to fill the roster last year. - The Nurse Leader for Medicine and Cancer has resigned with last day scheduled for 9 January Recruitment planned post Christmas in January Consultation Document on the Radiology / Cardiology nursing teams in the interventional suite was released in December. This will be concluded in January. The CNM of the Cardiology Interventional suite has resigned. Recruitment for this role will commence in early January. Quality & Safety: - RN from Ward 17 won the Poster presentation award in the annual Quality Quest - The Gastroenterology service met with the COO and CEO on 19 December and agreed that the service would remain in its current location (and configuration) in the medium to long term. This appears to be an acceptable solution. - 6 hour rule appears to have been bedded down well in all areas, with only several concerns noted by staff (Medical Wards). - An early evaluation of the Discharge Lounge has been completed and this is likely to be repeated on a regular basis. The information will provide useful guidance for the WRH Transit Lounge Risks/Issues: - Recruitment for the EP physician has faltered. This will result in a delay to the service start date of 6-12 months. Action: worldwide recruitment has been reactivated. - Endocrinology awaiting confirmation from NRH team and COO office re collocated office and ambulatory service delivery space/options for Department and team. Action: COO and NRH team are currently considering other potential locations to be advised in late December /January.

10 Organisational Development and Patient Safety (OD&PS) a) Directorate: The Directorate continues to support Migration planning and pre migration audits. A follow up Clinical Governance Workshop was held in December. The model has been finalised and will be signed off by the HHS Executive in February for implementation in March The role of OD&PS to support Clinical Governance will also be clearly defined as an outcome and will be incorporated within the Directorate s work plan. Planned staff development activities across the organisation have been reviewed for the next six months. All except core training will be reduced from January April 09 to ensure we are able to support the WRH familiarisation training and the release staff to attend this. b) Staffing: Legal Services all vacancies have now been filled. OD Consultant this position has been filled c) Service overview: PDU Preparation of post graduate courses has been completed with this years programme commencing in March. The review of Core Competencies across Nursing has been completed. There are significant deficiencies in the current framework that is in place to support this. Recommendations have been accepted and an implementation plan is currently under development. Changes will be implemented over the next three months Clinical Governance and Patient Safety Unit The Quality Quest was held prior to Christmas. This was once again a successful event with a large number of entries. Certification Action plans have been updated. The Unit has also been supporting the Mental Health Directorate with preparation for Certification survey in February. Risk Management Policy Implementation training has been completed. Further training will be made available on an ongoing basis quarterly. rl solutions (Reportable Events System) good progress has been made with addressing implementation issues and improving data capture and reporting. Organisational Development The OD Consultant commenced in December. Planning has progressed with the Leadership and development programme for The future direction and priorities for the e-learning is currently under development.

11 The development programme for the newly appointed in-patient Charge Nurse Managers of the in patient wards commenced in January. Director Allied Health, Technical and Scientific a) Consumer Value: As Director of Allied Health Technical and Scientific I continue to be involved in Audits for the move/migration to WRH which is a valuable exercise not only to ensure that the AH T&S are involved in the planning where they need to be but to raise the profile of the new Director role. The Director role is now being integrated into daily practice to assist and support service developments and complaint processes. I have been involved advising in one complaint of a professional nature for allied health and have had many calls asking for assistance to ensure that the right people are involved in developing services. b) Clinical Effectiveness Clinical Governance: Continuing to be involved in the HHS development of the governance structure. I have also presented to physiotherapist (with the professional leader for physiotherapy) how do we know we are doing a good job. This presentation was based on a complaint that was systemic as the patient journeyed through our organisation and physiotherapy was a part. We looked what governance structures we have and how they add value to the services we provide to patients. Allied Health Standard: There is no more progress on this. It is unlikely that a decision will be made prior to March if this standard will be reviewed or not. Patient flows 6 hour rule: This has now been implemented and has provided no major issues for Allied Health Technical and Scientific. Clinical Risk Risk register: Any current risks are documented within the Directorates register. Predominantly this in regard to vacancies in different areas. See below Clinical Workforce Emergent issues: There are significant shortages in Occupational Therapy across the HHS, MRT, radiation therapists, Social Workers Professional leaders are working with Operational managers and the HR recruitment office to have targeted sourcing and selection strategies. New Graduates starting in January will provide some relief, however a number of these positions are more senior. The implementation of the Professional, Technical and Allied Health Professionals MECA which has an increased annual leave provision will affect these groups as, for the most part, there is little or no leave back fill

12 provision capacity within the current workforce. Professional leaders are working with Directorates to assist in workforce planning. Implementation for the Professional, Technical and Allied Health Professionals MECA is due to begin in January. It is a complicated MECA and will take many months to fully implements. The Technical Merit Scale and the Allied Health Career and Salary Progression will require the most work from a professional perspective. The work required by payroll to implement this MECA is significant. Key achievements: The first allied health staff form has occurred. Allied health Technical and Scientific Leaders meetings are set up for 2009 Allied health Technical and Scientific Intranet page is set up (awaiting full edit rights before completing information on the site) Migration - No issues Update on initiatives/projects: NZ Allied Health Directors Network a face to face meeting will be held in Auckland on February 5 to determine ongoing network structures and meetings, purpose and value Technical and Scientific teleconference Network begins in January 2009 and I am now on this group. Assistant model for Allied Health Technical and Scientific I meet with Career force late January to discuss the options for us being able to use this programme internally. After this meeting the options will be presented to the HHS clinical governance group for approval to support the development of a model. This project, if approved is likely to be a 2 year plan Director allied health technical and scientific plan draft has gone to all Directorates including Maori and Pacific. Feedback due mid January. Financial result (cc 4751) - within budget Individual Clinical Practice Update Achievements: First month of clinical supervision has occurred and report sent to the Physiotherapy Board (this requires evidence of supervision, clinical practice hours and types of conditions seen, clinical reasoning, professional development, and peer review) Work in progress: R-entering clinical practice is really enjoyable, and gives and added perspective to the role of Director. There have been many comments from staff (positive) about this initiative and staff have been very supportive and welcoming. Chief Medical Officer a) Quality/Governance/Patient Safety: A final report paper synthesizing the Clinical Governance Workshops held in October and November 2008, and defining a new Clinical Governance Framework will be discussed at the Clinical Quality Board Meeting on 29 January 2009.

13 There is increasing momentum on safer medications management. The Pyxis dispensing system is now in eight wards. Discharge education management remains a focus of the Primary/Secondary Governance Interface Committee. New prescription guidelines are promulgated to RMOs. A Medicines Safety Week is planned following the migration in May 2009 b) Senior Medical Officers (SMOs): A Senior Medical Office (to compliment the Junior Doctors Office (RMO Unit) is being established by Human Resources to better support SMOs and their Directorates, as a one-stop shop for information and assistance. There were recent interviews for a Primary Care Liaison Medical position reporting through Planning and Funding. c) External Relations: The Regional Directors of Nursing and Chief Medical Officers continue to meet every second month. The Director of Clinical Training, Chief Resident and Chief Medical Officer met with the Joint RMO/SMO Commissions. C&C DHB also presented a written submission focused on SMO retention/recruitment. The Chief Medical Officer attended the Future Visioning workshop of the Medical Workforce Group held on 10 December Sale of Liquor Action Review. Dr Paul Quigley (Emergency Department) and Chief Medical Officer were invited to meet with Sir Geoffrey Palmer and officials. Emergency Department data on intoxification and injury were presented. It was emphasized that alcohol would merit Class B Controlled Drug status if reviewed under the Misuse of Drug Act Scheduling Criteria. Clearly the Law Commission is seeking data on medical and psychological alcohol related morbidity from DHB. Director of Nursing & Midwifery a) Emergent Issues: In summary December exceeded bed capacity at the beginning of the month but slowed down towards the end. The mood of staff over the Christmas period was positive. The preparation for the Clinical Measurement Unit and Womens/Childrens move is progressing well. 1. New WRH Nursing Leadership roles implemented at directorate level. Charge Nurse Managers (CNM) working through inpatient processes and changes required for WRH. 2. Nurse Practitioner facilitation project- good progress has been made with the extension of the work until the end of December. From this there will be a process to identify where NPs could contribute in CCDHB, and how to grow and develop them. 3. Bed Management- new processes started December Considerable work continues to meet 6 hour ED LOS target, this includes active engagement with the ward nursing staff, medical staff, duty managers and the unions. 4. Crèche project continues. Awaiting funding application results. There has been between children of staff utilizing the school holiday programme for Christmas school holidays.

14 5. 72 New Graduate Nurses starting in the General Hospital in January, 10 nurses in Mental Health and 8 Midwives in Womens. 6. Pyxis medication station roll out almost complete at Wellington site. 7. Clinical Governance meeting to design the HHS model moving forward continues, implementation plan being developed for early 2009 roll out. 8. Primary/secondary interface group- process now developed to log complaints/issues/events via an internet based electronic complaints submission form, to be discussed at next meeting. This submission form could be designed to meet both the needs of patients and primary health providers. Need to work with Communication team on this initiative. 9. Director of Nursing and Midwifery Office Review those staff reporting to ADON are under review to ensure the increased numbers of graduate nurses for the NETP, HCA training and developing the NETP into a post graduate qualification are able to be supported. 10. Nursing Council decision that Surgical Assistant RNs are working outside their RN Scope of Practice, working through implications of this. 11. The Team Nursing and Midwifery Questionnaire results are being collated. This survey forms the base line of how the Team Nursing Model is progressing and will assist in the identification of issues. 12. Nursing Library amalgamation with the Otago School of Medicine and move is planned for February. b) National Involvement: 1. Summary of Serious and Sentinel events for sent to Ministry of Health as per QIC directive. 2. Preparation of CCDHB to participate in the National Hand Hygiene project in March 2009 commencing early January.