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

Transcription

1 HOSPITAL AND HEALTH SERVICE REPORT FOR MONTH OF JUNE 2008 TO: FROM: The Hospital Advisory Committee Chief Operating Officer DATE: 25 July 2008 SUBJECT: Hospital & Health Service Report for June 2008 INTRODUCTION This report is for the meeting of the Hospital Advisory Committee to be held on 29 July It covers performance information for the month June 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 4.0 STRATEGIC ISSUES 4.1 Presentation: Cheyne Chalmers, Director of Nursing and Midwifery Clinical Governance Quality Initiatives

3 4.2 Chief Operating Officer s Report Strategic Issues The Hospital and Health Services (HHS) has established our new clinical and corporate governance framework. This includes monthly clinical and corporate governance meetings occurring in the second and fourth week of each month. Both meetings include all of the HHS Directors and the Director of Finance. The Clinical Governance Meeting covers: Patient Flows Patient Safety Product Review/New Intervention Clinical Quality Board Clinical Training Clinical Audit Risk Management Review Migration and Transition to NRH The Corporate Governance Meeting covers: Employee Forums Information Management Education and Research Occupational Health & Safety Workforce Directorate Management Forums Finance and Activity Migration and Transition to NRH The Governance Meetings are supported by Monthly Performance Meetings with each Directorate that covers: Patient Flows Workforce Quality and Safety Clinical Management Risk Management Change and Migration End of Month Financial Result Activity End of Year forecast The reorganisation of the management structure has been completed and three roles within the executive structure of the HHS are currently in the appointment process (Clinical Director of Organisational Development & Patient Safety, Operations Director of Surgery, Anaesthesia and Intensive Care, and Director of Performance and Business Services) Directorate Update Medicine and Cancer: Vacancies remain in nursing positions in the inpatient areas of Cancer Services. Some improvement has been made with nursing recruitment in the last month reducing unresourced beds to nine in the Coronary Care Unit and Internal Medicine (Ward 16). Senior

4 Medical Officer recruitment progressing well for Cardiology, General Medicine, Stroke and Endocrine/Diabetes. A focus on moving inpatient chemotherapy to an outpatient basis has commenced with a working group. This will then be evaluated. Discussions on how the District Oncology Nurses will interface with the Cancer Service and the Community Nursing Teams have commenced and a working group to complete this project has been set up. Unzipping of Cancer Service occurred this month, with a number of issues raised in the planning of external support. Card readers and signage was not in place on go live day which created a number of stressful situations. A number of learning s have been documented from this process to be fed back to the main migration. There are significant issues with outreach clinic costing and capture for Cancer Services. With outreach services delivered in other DHBs we are unable to capture true attendance. Revenue for first specialist assessment ($502.00) and follow up ($289.00) does not cover the expenses incurred for each visit. Without the costs of room charges most patients on average have $ radiology investigations and $ laboratory. This needs urgent attention as all three services operating at a financial loss when providing outreach clinics. The Medical Services Redesign project activity is largely on target, but time frames have slipped by several weeks. Decisions made by HHS management include commitment to 20 Medical Assessment and Planning Unit (MAPU) beds. These decisions include a trade off of 18 inpatient beds in the New Regional Hospital (now 40 beds instead of 58 beds) and a reduction in 10 beds from Kenepuru s Surgical Medical Unit (SMU). The priority is to complete the Consultation document, consultation process and business case. Last month s activity has been to complete the operating principles for the MAPU/Admission Planning Unit (APU) and to commence drafting the consultation document and business case. The SMO s from Internal Medicine met and discussed the redesign including the new roster structure. General support and consensus was achieved from this forum Surgery, Anaesthesia and Intensive Care: Theatre utilisation across both theatre suites is above target at 99% for June 2008 and year-to-date 79% for 20007/08 financial year. Full year average utilization for Wellington theatres was 86% (achieving benchmark target of 85%) and average utilisation at Kenepuru was 57%(target not achieved). While trending upwards, below target Kenepuru utilisation has been exacerbated by the continued delay in overseas Anaesthetists commencing at post. From July 2008 sufficient Anaesthetists will have commenced to resource 100% of theatres and clinical sessions. Work continues with Surgical Services to improve Kenepuru theatre session under-booking and fully resource current session requirements in Kenepuru and plan for increased work in third theatre at Kenepuru. Major patient safety initiatives implementation completed. Includes Operating Theatre (Regional) Universal Safety Protocol Project (Correct Patient, Correct Procedure, Correct Site) launched on 23

5 June 2008 and ICU Patient at Risk Project Phase 1 (Early Identification and Intervention for Deteriorating Patient) implemented within Internal Medicine in April 2008 and Surgical Services in June Preliminary results report overall base elective performance at the end of June at 244 caseweights behind base contract. This is an improvement of 160 caseweights from the previous month and reflects both activity and coding and data quality changes that have been made. There are some final data quality issues to be completed. The reports are due to be refreshed within the next two weeks. All private work, except for Cardiothoracic, will be completed by the end of July. Further discussions relating to the longer standing agreement that is in place with ENT are required and will take into account the potential impact of the Kenepuru theatre once it is able to be resourced from August 2008 on overall capacity. Cardiothoracic throughput and the growing wait list remains a major area of focus and continues to be under intensive monitoring by the Ministry. The number of patients on the total waiting list including Active Review was 208 at the end of June Of these, 147 have been given certainty a decrease of 18 over the past month, with the number waiting >6 months decreasing from 57 to 35. The National Service Improvement Group, facilitated by the Ministry, has been established and has now met twice, C&C DHB representation includes the Clinical Leader, Cardiothoracic Services, Director of Nursing and Midwifery and a Cardiac Anaesthetist who is also an Intensivist. With regards to elective services, the DHB is now reported as compliant at the DHB level for the past nine months now that the data issues have been resolved. Interim arrangements are in place to support reporting while the Information Management Unit further develops the processes to support this. Areas of Non Compliance at the specialty level as reported for May2008 are as follows: ESPI = Elective Services Performance Indicators o ESPI 2 Gynaecology actions are being identified to address this. There are some ongoing issues with the reporting which is currently being addressed. o o ESPI 3 Cardiothoracic. Urology is now compliant. ESPI 5 Cardiothoracic, General Surgery, Neurosurgery, Orthopaedics and Urology. Cardiothoracic is the subject of ongoing work to address the numbers waiting, although this is reducing, the number of patients to be addressed in the remaining services are small and will be worked through over the next two months. o ESPI 6 Orthopaedics this is an ongoing problem and the result of some process issues in the service which are being addressed.

6 o ESPI 7 relates to ESPI 5 and will be addressed once ESPI 5 is compliant. The DHB is still unable to report through to NNPAC for outpatient activity. This is a significant risk as we will not be able to claim any additional revenue for the scopes that have been completed and has the potential to impact on IDF volumes in the future. Work is now progressing to address this within the required timeframes.

7 Mental Health: The National Mental Health Target is that 90% of people who have been in contact with services for two years or more have a relapsed prevention in place. Our attainment for reporting to the Ministry of Health (MOH) for Quarter 4 is 53%. The Capital & Coast Mental Health Client Pathway is the framework for service provision. It provides treatment planning protocols and risk management processes. This Client pathway is under review and it is being updated to ensure that tangata wahiora/service users are actively involved in planning their relapse prevention. Internal qualitative audits are routinely in place to verify the accuracy of reporting rates. Compliance with the national target is expected to be achieved in Quarter 2 of 2008/09 The Evaluation Framework (including tools) that has been developed within Mental Health Local Services is being piloted. The pilot is evaluating the impact and effectiveness of community based recovery houses. The tool uses intervention logic to determine goals and it measures service performance against identified outcomes. After the pilot the Evaluation Framework will be refined and used routinely as a standard method for evaluating Mental Health Services. The upgrade to the Duress system to align security with the Kenepuru and Wellington campuses is ongoing, with the likely commencement date for the project as February Regional forensic step-down cottage is to finish on target and on time. There is a steering group that is finalising the operational guidelines for the cottage. Planning for the second forensic community step-down facility has started with the Regional DHBs. Client acuity in Tane Mahuta (Central Regional Inpatient Rehabilitation & Extended Care) has increased compared to last month. The Unit has received three new bicycles for client use and staff escorts if required. We are working to put forward a process to ensure safe and effective use of these bikes to encourage healthy lifestyle, sustainable transport option and recreational use for our clients. The Nurse Leader and the Consumer Advisor finalised the seclusion debriefing tool to be used to debrief tangata whaiora/consumers following an episode of seclusion. The data will be presented to the service along with any statistics trends noticed coming through in the debriefing process. The intention is to further reduce the use of seclusion in the Te Korowai Whariki Community and Clinical Support: Occupational Therapy and Community Health Service are participating in a new initiative to improve Maori health outcomes in the community and tailor provision of care to Maori needs. Staff are participating in a marae-based trial to deliver the pulmonary rehab programme and education to community clients on a marae, starting 10 July 2008.

8 Two additional locums have been recruited for Kenepuru A&M Clinic for the next six months. They will provide contingency coverage for regular overnight doctors and provide services to weekday clinic, as well as relieve Porirua After Hours Medical Centre of one Thursday evening and one weekend duty each week/ High average daily patient presentations for Emergency Services in June, resulted in non-achievement of T2 and T3 targets (71% and 39% respectively). T3 patients pose the greatest risk as they are not receiving care in an acceptable timeframe and therefore are a significant risk of an untoward event. Laboratory workload has continued to increase with an overall 9.8% increase for the year. The table below lists the top ten requestors and the % increase for the 2007/08 year compared with the previous year. The obvious growth is coming from the largest client (Emergency) with nearly a 25% increase. Origin Total % Change WGTN EMERGENCY DEPARTMENT 167, % WGTN INTENSIVE CARE 114, % OTHER - WN LOCAL AREA (NOT HUTT HOSP) 55, % WGTN WARD 1 46, % WGTN OUTPATIENTS 43, % WGTN WARD 31 41, % WGTN WARD 30 38, % WGTN NEUROLOGY 38, % WGTN WARD 29 36, % WGTN PAEDIATRIC MEDICINE: NEO NATAL 34, % Patient Information/Medical Records: process improvements for reducing numbers of missing notes for clinics has resulted in a reduction from an average of 20 to 4 missing files per day. Clinical Coding: o Uncoded discharges remain low with most of the risk out on the wards. Coding Department working with wards to improve this. Achieving KPIS within the department. o Quality improvement of coding is a key focus for the department. An external audit this month showed a diagnosis related group (DRG) error rate of 15%. Acceptable industry figure for DRG change is 5-7%. A remedial training programme is in place and performance improvement targeted for specific coders. Ongoing education of all coders will continue with formal training in Advanced Coding for those eligible. A decision to outsource over 80% of cytotoxics (nutrition already 100% outsourced) has been made dependent on the successful completion of contract negotiations with Baxter. The Pyxis project will commence this month in conjunction with Non-Clinical Support Services.

9 Pharmaceutical cancer treatment claiming began this month. An audit of our claim process has been undertaken. This is not completed yet, but demonstrates the work required to improve the reconciliation process Non Clinical Support: Non Clinical Support Services are currently undergoing a senior management restructure and a Technical Services restructure. The restructure allows for a flatter structure and is aligned to the key functions of the division. Non Clinical Support Services needs a change in culture and impose a much more commercial focus within the business. Consultation finished on Friday 13 June 2008 and a final structure was announced on 20 June Advertising (internal and external) commenced 21 June 2008 and the anticipated structure in place on 4 August A good response has been received from the market, with a total submission of applicants being in excess of 160, short listed to around 60. The Operations Manager and Operations Director will be filling in for the gaps where possible. The clinical divisions are being kept informed of the changes via the Charge Nurse Leaders meetings, feedback for the change so far has been positive. The Consolidated Domestic Services RFP has been evaluated and a recommendation for a preferred supplier has been submitted to the Chief Operating Officer for approval to proceed with negotiations. It is anticipated negotiations would be complete by the end of July 2008 and transition of services (outcome based) will take place August 2008 in anticipation for the new contract to be in place September Women s and Children s Health: Our vacancy in Gyane-Oncology continues. We have had further discussions with Canterbury DHB. Canterbury clinicians will support our one remaining clinician on a weekly or fortnightly basis in clinic and have a commitment to providing the surgery either locally or in Canterbury for 1-2 women per month who need surgery unable to be performed by our local surgeon. We currently have an offer of employment with a Gyane-Oncologist in the UK. We have agreement to support with Canterbury DHB with brachytherapy for women with cancer of the cervix as the Canterbury LDR machine is no longer functional. The Ministry of Health review of Maternity services commenced on 21 July The DHB lead contacts with the review Group are John Tait, Clinical Director Women s Health, and Delwyn Hunter, Operations Director Women s and Children s Health. Neonatal continues to be busy. Since the beginning of July 2007 there has been an average of 30 plus babies a month. The Unit is currently resourced for 29. April averaged 39, May 35 and June 39. In June 2008 a couple of days the numbers reached over 40. The acuity has been high with two sets of twins born at 23 weeks, twins born at 24 weeks, twins born at 25 weeks gestation and triplets all in the unit simultaneously. To add to the pressure, most of the babies are local so we can not send them to DHB of domicile when they are ready for secondary level care. We have also had to turn

10 4.2.3 Key Challenges for 2008/09: away a number of out of district cases with the resulting loss in revenue. All avenues of additional nursing support have been investigated, but additional nursing support is difficult to obtain as staff need adequate training to work in an intensive care area Workforce: The recruitment of clinical staff will continue to be a challenge. The impact of the new hospital building programme within Australia is not apparent currently. In the next five years a conservative estimate of the additional inpatients beds that will be opened is 2500, this will have a corresponding increase in the demand for a clinical workforce. Within the current shortfall our most significant challenge is recruiting to our 80 nursing vacancies and the impact this has on keeping inpatient beds resourced NRH Migration: A new governance framework for the migration is now in place and the operational structure is in place for planning at a directorate level. The key challenges will be in keeping a timeframe for any required changes to be implemented prior to a March 2009 move date. Funding that is not currently confirmed in the DAP for information technology implementation has the potential to delay migration Unfunded & Underfunded Services: A conservative estimate of current unfunded services puts this figure at approximately $5m. Paediatric Oncology remains our most significant under funded service with a difference between the price volume schedule and operating costs of approximately $1.3m MECA Settlements: Negotiated settlements and the impact on operating costs is the single largest financial challenge. The current system of assessment of costs for MECA being included in population based funding adversely impacts on DHBs which are net providers of service to other DHBs. This is conservatively estimated as a $5m issue for C&C DHB. This is where the IDF price is not adjusted for the changes in MECA costs and the funding for staff is provided to the DHB of residence and not paid to the DHB providing the service. A component of this is also the calculation of the impact of settlements. A recent change in long service leave provisions has created a $1.6m difference between the funding and the actual impact of the change Systems: Sound information systems are a key priority currently. Internal reporting of financial information, revenue and clinical activity is largely manual and prone to human error. Significant revenue is not received as a result of our inability to record clinical activity. This is further impacted by an inability to match expenditure against the delivery of activity Elective Services: The provider has been unable to deliver on the additional elective volumes. A combination of issues has led to this inability to achieve the activity and in the 20007/08 financial year a significant number of

11 volumes were outsourced without corresponding funding. In the 2008/09 financial year approximately $10m of additional elective funding is available if the provider is able to deliver on our base volumes. Any capacity to produce elective volumes over base is impacted by the migration to the NRH in March Current activity predictions are for a 2% reduction in total activity in the Directorate of Surgery, Anaesthesia and Intensive Care. We will be looking at our service planning over the Christmas period to build capacity for this additional funding. 4.3 Chief Medical Officer s Report Risks: HDC Reports: Two HDC reports are soon for release on the HDC website, which may generate adverse media comment: a) Medication Safety : In 2003 a woman with a spinal abscess was initially treated at Hutt Valley Hospital where she was begun on an antibiotic to which she had previously experienced a severe adverse mucocutaneous reaction. This was documented as an adverse reaction in the past and in 2003 to this antibiotic. She was transferred to Wellington Hospital for surgery and the antibiotic continued. She subsequently developed a severe (rare) skin reaction which continued to her death. This was designated a serious event and investigated. There was a subsequent ACC findings of medical error Outcomes and recommendations included: Proactive need for patients to have medic alert bracelets. Improved outcome to document and define the nature of adverse drug reactions (C&C DHB new drug chart assists). Training of documenting drug alerts on the forthcoming Clinical Record. Neither DHB were breached. b) HDC 07977: A 72 year old woman presented to the Emergency Department, Wellington Hospital, on four occasions and was only diagnosed with an aortic aneurysm on the last occasion, shortly before she died. The criticisms were not around diagnostic acumen per se, but related to: Supervision and review by senior ED doctors. Delay in typing a report on an x-ray (public holiday a factor). Failure of discharge summary to be sent to GP (in part an IT issue since rectified) These cumulative issues resulted in a finding of a breach of the HDC code (rather than the provisional opinion finding of Referral to the Director General of Proceedings). C&C DHB did not consider this case as a serious event and strongly contended the first and second issues above Ministry of Health Reviews: a) Deaths on the C&C DHB Cardiothoracic Waiting List (2007 & 2008).

12 There is a Ministry of Health review of these deaths (including national context). The report is due mid August, and will attract media interest. C&C DHB has designated as a serious event and is conducting its own review. It is noted the C&C DHB waiting list is differently structured compared to other New Zealand centres which delay waiting list status until all pre-op requirements are completed. b) Review of C&C DHB Maternity Services: A review of this has been commissioned by the Ministry of Health, but C&C DHB yet to be formally advised Quality: Clinical Quality Board: The June meeting discussed: Written consent (with HDC advice) for medications with risk of significant adverse effects. Implementation of training around the introduction of new defibrillators. Alerts Policy for the new Electronic Health Record. Feedback from ACC Treatment Unit and Ministry of Health regarding C&C DHB patients. The need to fund training to staff around open disclosure and develop a level of expertise to assist difficult disclosures, by developing Critical Incident Leaders. Review of the Patient Satisfaction Survey. The Clinical Quality Board recommends C&C DHB use this tool as a primary indicator for use by services Primary/Secondary Interface Clinical Governance Committee: Again, there was good representation by primary care, community services and HHS. The meeting mostly discussed discharge medication management strategies with practicable improvement for implementation. Formatting discharge medical template. Better use of HHS clinical placement. Improved communication on discharge with community Pharmacists Audit of such processes HHS: Minimal organizational difficulty has been encountered adapting to the new Directorates structure. A Clinical Director of Organisation Development and Improvement (ODI) is yet to be appointed NRH: CMO, DON, Operational Director of ODI and Ruth Heather (HHS Change) visited Auckland City Hospital on 4 July They provided seven key messages in my view: Migration is prime HHS focus from now. Cease relitigating change/locations now. Denote the day(s) of migration - now March Migrate with prime safety focus identify clinical risk early. Use optimal language around migration. Mandatory fora for all senior clinicians/management a must. Provide ownership for departments in their NRH locations.

13 Relationship Management: Wellington School of Medical and Health Sciences: CEO to give graduation oration. CMO on panel to select Professor of Paediatrics. CMO appointed to WSMHS Policy Committee. Joint Relations Committee scheduled. Dean attended Medical Education Training Unit seminar on Integrated Clinical Training Faculty on 15 July 2008, and CD meeting on 16 July 2007

14 Wellington Hospital and Health Foundation: The CEO and CMO are Trustees. Issues discussed at the recent meeting included: The need for decision on relocation or not of the Children s Hospital to Grace Neill (much of WHHF fundraising is around child health).

15 4.4 Director of Nursing and Midwifery s Report: Emergent Issues: Team Nursing Model of care progressing phase 5 to be implemented August, most wards now using new model. Health Care Assistant programme negotiation with Union continues. Financial analysis of nonclinical support delivery should confirm savings to be put to HCA patient care costs. New Hospital Tier 4 Nursing Hospital Leadership Model to be decided by new Director Roles. Generic role descriptions completed. Libraries amalgamation CEO s of both organisations finalising contract. Once signed, the HR process and move will commence for staff involved. Nursing and Midwifery vacancies continue to be an issue with some beds closed. The vacancy rate for June is not available due to the change in Director roles and responsibilities. Director of Nursing Primary position appointed - Vicky Noble starts 4 August Infant death at Kenepuru Maternity involving an independent midwife using C&C DHB premises. Resultant Ministerial and internal reviews in progress Financials The DONM and Quality budgets are in positive position of approx $120k for year end. CTA post graduate nursing 2008 contract signed off with additional $400k unbudgeted and secured revenue Contract Achievement/Productivity: Post Graduate CTA Nursing Programmes Planning for 2009 programmes underway and contract for PG programmes signed. CTA processes are cumbersome and time consuming Library amalgamation Contract near completion with legal currently Massey Professional Development Agreement Contract work continues Whitireia Professional Development Agreement The contract will be sent for sign off shortly Risks Reduced Clinical Care- Bed closures due to reduced staffing mitigations include: Urgent meetings with Directors and Nurse Leaders regarding bed closures. HCA s being recruited into nursing vacancies process being developed. Model of care implementation. Patient at Risk Service (ICU Outreach) commenced in April. Comprehensive communication strategy to advise the organisation of actions being taken to resolve staffing shortages. Recruitment strategy - working with recruitment unit on recruitment strategies including overseas nurses and a large mid year intake of New Graduates.

16 4.4.5 HHS Taskforce Team to support winter workload management in place with further recruits needed. Permanent Pool (Health Care Assistants and RN s) and Return to Nursing Programmes continue Financial- Implementation of the Nursing & Midwifery MECA is a risk to the organisation due to the unbudgeted increases. Mitigations include the increase of leave provisions in the NHPPD budget model, increases removed at last budget round, however the costs are now identified Potential Clinical Safety- Provision of core competency training (CPR) for the organisation at risk due to staffing shortages and the inability to release staff to provide the training. Mitigations include a review of the current delivery model. Project person appointed and recommendations due end of July Organisational Restructure- there is a risk to the change programme delivery timeframes Public confidence- Media reports of infant death at Kenepuru maternity involving an independent midwife using C&C DHB facilities Patient Services Co-ordination Unit: Significant recruitment activity within PSCU. PSCU Manager confirmed. Charge Nurse Manager interviews underway Nurse Entry to Practice Programme: The Nursing Council has verbally confirmed that we have achieved audit and therefore the programme will retain its accreditation for a period of up to two years. There are 11 nurses employed onto the September NETP intake. Recruitment is underway for the January cohort Paediatrics: Acting Charge Nurse Manager in Ward 18. Nurses from Ward 18 attending Chemotherapy training in Christchurch July and August 2 two courses with further work occurring regarding oncology education to up-skill staff for planned oncology return to tertiary status in October. This will be done in conjunction with Christchurch Mental Health: Significant organisational changes with the RRAIU and PPS coming under Te Korowai Whariki. Acuity remains high with most units over their numbers for occupancy as reflected in NHPPD for watches, overtime and casual pool usage. Ongoing shortage of RN s. Investigation into alleged unprofessional conduct by three nurses from the forensic inpatient service underway. There has been an increase in medication errors this month CSS: Safe Staffing Meeting now established in ED. The introduction of the electronic reporting of Reportable Events has led to a dramatic reduction of reports being processed. Nurse Practitioner framework working with Service Manager and NP candidate to introduce a framework into A&M Clinic so candidate can begin her advanced clinical practice and start focusing purely on her NP candidate role. Clinical Leader offering up a number of challenges working through and keeping people on track is time consuming. 33 respondents to the NP survey of staff. Communication and Teamwork project near completion involved with analysis and report development.

17 4.4.6 NRH Medical: Nurse Leader, Operations Managers and HR Nursing Recruitment working closely with all teams on recruitment. Targeted recruitment of nurse from Philippines is underway in Medical Services Group. Wards and units who take a large cohort (5-8) of Graduate Nurses can appoint a senior staff nurse as a Clinical Coach specifically to support Graduate nurses and their preceptors. Model working well in Wards 16 & 17. Ongoing staffing issues in Ward 1 and ongoing issues with nursing standards. CNE appointed to WBCC to support staff. CCU retention and recruitment impacted by ongoing CNM performance issues. CNM has now resigned Patient Observation Policy to be rolled out in July The policy is in response to evidence of inadequate documentation of baseline patient observations. The policy may be elevated to Tier 1. PEG insertions will have pre assessment and post insertion follow up by CNS, Gastro. Ward 17 CNE has implemented a programme of fast track training of the High Dependency Bay. The CNM ICU has offered support to this programme and will be meeting with the CNE to progress this Falls reduction strategy benchmarking with other centres. Falls data base for Medical Directorate in process of development. This will provide more in-depth analysis and focussed actions for falls reduction Theatre, Surgical & ICU: Model of Care(MOC) preparation work in Surgical Assessment and Theatres. ICU MOC underway. SMU has a lack of senior nursing support currently with 2 senior nurses resignations. CNM resignation provides opportunity to assess leadership needs across SMU and Ward 5. Migration Clinical Safety Steering Committee now established and attended by Nurse Leader Strategic representing Nursing. Appropriate levels of staffing for NRH being investigated via agreement and implementation of benchmarks that support clinical and non-clinical staff. 1. Press Ganey consultant to all Quality Leaders. Survey lists top ten priority issues with main issues for inpatients and outpatients being discharge and wait time respectively. 2. Patient safety officer role being recruited to Planning & Funding Primary, secondary clinical governance meetings occurred with membership from PHO s and HHS. Terms of reference reviewed, CEO to sign off. Issues identified to progress - Integrated IT - Discharge Summary - Medication Safety - Funding flexibility for primary and secondary care - Admission avoidance Change

18 Model of Care: Nurse and Midwife Leaders are leading the change regarding the nursing and midwifery Model of Care. - Phase Five Implementation commences August. Phase 1 evaluated. - Evaluation group developing indicators to measure the outcomes of the new model. - Issues with non clinical support particularly the reliability and cost of the cleaning service HCA Education: All clinical areas have now completed training for their permanent HCA s in the 2 day initial programme and are now accessing Challenging Incident training. A pilot programme for the initial roll out of the HCANZQA (National qualification) aims to start in July. Adaptation of work career force work books continue Tier 4 Nursing Hospital Leadership Model: Consultation closed with final decision on hold until Director roles appointed. It is envisaged the six main Charge Nurse Manager positions will be in place by July Inpatient Hospital Project: Sponsorship of the project now transferred to DONM. Project scoping underway. Workshop with key stakeholders held 28 th April Projects Crèche: Application to Ministry of Education for project funding completed. Preparation of business case for crèche development, and Ministry of Education capex grant expected to be completed by October Defib Project: New defibs have been distributed in clinical areas following training Core Competency: Project person reviewing core competency process for nurses with report imminent Libraries Amalgamation: CEO s from both organisations meeting shortly to resolve contract. HR process about to commence for staff involved Patient At Risk Team: Commencement of reference/advisory reference group with organisation wide representation Maori/Pacific Cultural support framework for New Graduate and post graduate Maori and Pacific nurses progressing with the Maori Health Unit Intersectoral & DHB Linkages Further work regarding safe staffing will occur via the Mini Joint Action Committee shortly to be convened. This group will look at escalation and other Ward Risk Assessment documents for when nurses consider staffing to be unsafe. The DONM and CMO Lower North Island regional meetings continue, regional approaches to best practice clinical care being explored at a workshop held recently. Work commenced on standardized early warning scoring tool.

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