· web viewquarter 2 2017-18 table of contents south island work that supports the new zealand...

Quarter 2 2017-18

Table of ContentsSouth Island work that supports the New Zealand Health Strategy 3

Clinical Services 4

Southern Cancer Network 4

Child Health SLA 7

Mental Health and Addiction SLA 8

Health of Older People SLA 10

Palliative Care Workstream 12

Cardiac Services Workstream 13

Elective Services Workstream 15

Major Trauma Workstream 16

Public Health Partnership 17

Stroke Services Workstream 19

Key Enablers 21

Quality and Safety SLA 21

Information Services SLA 23

Workforce Development Hub 25

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South Island Alliance work that supports the New Zealand Health Strategy

3

Value and high performance

Te whāinga hua me te tika o ngā mahi

One teamKotahi te tīma

Smart system

He atamai te whakaraupapa

Closer to home

Ka aro mai ki te kāinga

People-powered

Mā te iwi hei kawe

All New Zealanders Live wellStay wellGet well

The regional youth forensic pathway is being implemented across all South Island DHBs. The pathway helps the smaller DHBs with limited forensic staffing when they need the support of a bigger team which the hub can offer. Using the pathway, smaller DHBs can get advice and discuss cases in order to offer a better service for the clients in their areas.

Pilot of Takarangi (cultural) Competency Framework has commenced on the West Coast.

Report completed identifying key motivations and barriers to participation in cervical screening for Māori communities in the South Island. Recommended changes to services now being considered.

The South Island infographic utilising interRAI assessment data to report on topics including Dementia, Restorative Care, Advance Care Planning has been widely distributed. The information will be used to identify trends and gaps and guide workplanning.

150 people from across the sector attended one of 10 SUDI workshops held late in 2017 to brainstorm and share ideas to prevent SUDI. Facilitator Ann Shaw said ‘It enabled us to acknowledge the excellent work being done, but also to hear a grass roots perspective of what they believe the gaps, barriers and challenges to be and how to address these.’

Implementation of the ECG repository is progressing, starting with Canterbury and Nelson Marlborough. Transmitting of ECGs from St John ambulances to EDs is occurring in Nelson and has been tested for implementation in Christchurch.

KEY AREAS DELIVERABLES

Timeliness of services across the cancer pathway (FCT)

1 Support DHBs to deliver the extended FCT target of ‘At least 90% of patients receive their first treatment within 62 days of being referred with a high suspicion of cancer and a need to be seen within 2 weeks by July 2017’

Q1,2,3,4

2 Support DHBs with undertaking and delivering the FCT Round 2 Funded Projects

Q1,2,3,4

3 Undertake a focused review to understand the ‘Route to Service Access/Diagnosis’ for all South Island cancer patients, with a focus on first presentation through ED

Q2

4 Continue to support the maintenance or improvement of the 31 day Indicator: proportion of patients with a confirmed diagnosis of cancer who receive their first cancer treatment within 31 days (85% target for PP30 31 day indicator)

Q1,2,3,4

5 Development of comparable timely, cancer pathways for the SI Q1,2,3,4

6 Undertake an annual assessment of the Cancer Clinical Priorities, through the South Island/SCN Cancer Clinical Leads Group

Q1

7 Supporting DHBs in preparation for the introduction of a national bowel screening programme - focus on services to support the delivery of additional cancer cases

Q1,2,3,4

8 Support DHBs with the implementation of the Early Lung Cancer Guidance (to be published shortly)

Q1,2,3,4

Service coordination and quality improvement

9 Multi-disciplinary meetings: Complete the rollout of the regionally agreed MDT recommendations and service improvement initiatives started in 2015-16

Q1,2,3,4

10 Multi-disciplinary meetings: Review South Island MDM System against national specification

Q1,2,3,4

11 Multi-disciplinary meetings: Focused work to support findings from MDT meeting review e.g. meeting etiquette, training - MDT Coordinators, Chairs, referral requirements/timelines for radiology/pathology review, MDM resourcing

Q1,2,3,4

12 Multi-disciplinary meetings: prioritisation of cases for discussion at MDMs

Q1,2,3,4

13 Survivorship: Rollout of (national) Supportive Care Framework across the South Island

Q1,2,3,4

14 Survivorship: TBA

15 Support implementation of the National Radiation Oncology Plan

Reducing inequalities

16 Improved collection of ethnicity data across the whole health spectrum

Q1,2

17 Support the rollout of the Maori Cancer Pathways Project across the South Island

Q1,2

18 Review and develop a plan to increase the uptake of cervical screening among Maori communities (Te Waipounamu Maori Leadership Group (TWMLG) Priority area)

Q1,2

19 Support the collaborative regional working of both TWMLG & the SI CCG and integrate as co-partners into the regional plan

Q1,2,3,4

20 Support the rollout and implementation of the Psychosocial and Supportive Care Initiative across the South Island, and assess early findings

Q1,2,3,4

South Island Cancer Intelligence Service

21 Develop a plan to support and implement the NZ Cancer health Information Strategy across the South Island

Q1,2,3,4

22 Produce and further develop a Quarterly Cancer Dashboard to understand progress against cancer standards and targets, and to identify areas for service improvement

Q2,4

23 Develop a regional strategic cancer plan to identify priorities out to 2025.

Q2,4

KEY PROGRESS IN QUARTER 2Timeliness of Services Across the Cancer Pathway (FCT)

1-6 The South Island Operational Leads Group continues to focus on Faster Cancer Treatment as their first priority. Understanding and resolving the barriers that prevent timely access are a key focus for our improvement work including those that are excluded from the target.The impact of inter district flow (IDF) on FCT pathways has been included in FCT dashboard to enable greater visibility of the impact of patients accessing service across DHB boundaries. Clinical staff across the South Island have highlighted the need for greater visibility of patients on the FCT pathway. The South Island DHBs and SCN are working towards establishing an FCT indicator that will be visible on the patient record. The SCN has supported SI DHBs in delivery of the following MOH-funded FCT projects:

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SOUTHERN CANCER NETWORK

Ongoing: Improving the Cancer Pathway for Maori (SI-wide, led by NMDHB) Ongoing: Diagnostics Fast Track Clinics (SDHB) Completed: Pathway Entry, Routes to Diagnosis, part A: Emergency

presentations (SDHB) Ongoing: Pathway Entry, Routes to Diagnosis, part B: all cancers (SI-wide, led by

SDHB) Completed: Melanoma, find the spot Ongoing: Gynaecology High Suspicion of Cancer Referral Pathway (CDHB) Ongoing: Valuing patient’s time in complex cancer: Head and Neck (NMDHB &

CDHB)

7SCN continues to be linked into the SI Clinical Leads Oversight Group to monitor impact of programme implementation on cancer volumes for DHBs as the programme rolls out.

Service Coordination and Quality Improvement9-12 SCN continues its support leading three separate projects within the ‘Supporting

MDM’ portfolio:

1. The adoption of the South Island cancer MDM System (SIMMS). As at the end of Q2 we now have 4 Canterbury MDMs on the new system, one of which was not used in the SDHB system and has therefore been designed and developed from scratch (this involves creation of 3 additional customised proformas for this tumour stream). The South Island wide alignment of proformas and adaptation required for each MDM represents a challenge to our overall timetable for completion. All aspects of our project plan are being reviewed to ensure the delivery of the remaining MDMs on the system by June 2018.Now that the Canterbury MDM coordinators are familiar with the new system we anticipate that adoption of the remaining MDMs will be less demanding of their time with regard to adapting to the new system and processes.

2. SCN continues with the work on the “MDM Gap Analysis” as requested by the Ministry as part of the Cancer Health Information Strategy. This project enables the South Island District Health Boards (DHBs) to measure the gap from the current of SIMMS and identify options to progress towards the future MDM state as per new Ministry guidance released in 2016. We have reviewed the SIMMS against the future state requirements and in particular given consideration to the MDM data items which have be assessed for technical and practical feasibility of inclusion in the MDM system. We have also reviewed the business and system requirements against the SIMMS. It is disappointing to

report that we are unable to achieve one of the deliverables for this work which was to test the flow of staging data from SIMMS to a “central point” at the Ministry/CHIS (contributing to the national collection) as we have been informed that the resource required to do this within the CHIS team is now not available. Unfortunately this also means that we will not be able to provide any reporting back from the “central point” to the local clinical teams. However given the importance of this deliverable we will seek other mechanisms to do this using the SIMMS data base and data warehouses available to us in the South Island. Our report to the Ministry has been delayed by approximately one month, in line with the reporting from the three other regions.

3. The findings from the MDM ‘quality’ review were released in early 2017 and the SCN is undertaking work with SI MDMs to implement the recommendations and actions identified as a result of the findings. Much of this will be incorporated in the SIMMS adoption as described above. Our original plan of holding 2 MDM Coordinator workshops has not been achieved due to the demands of the regional adoption of the SIMMS above. Instead the SCN PM will facilitate a number of VCs over Q3 and Q4 to provide a forum for sharing knowledge, including tumour stream specific education and information, which has been highlighted as being of value by the coordinators.

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A request for feedback was circulated to South Island stakeholders to inform a NZ Regional Cancer Network Collaborative decision on the benefits to endorsing the Supportive Care Framework – He Anga Whakaahuru for adoption nationally. South Island feedback reflected support from stakeholders for an increased understanding and awareness of supportive care, however identified reservations and issues on both the adoption of a single nationally endorsed framework and on He Anga Whakaahuru itself. SCN has provided feedback to inform next steps nationally.

15

The South Island Regional Radiation Oncology Partnership is continuing work focussing on tumour streams where variation is notable, developing recommendations for greater consistency in treatment. The recommendations for the treatment of early stage breast cancer have been finalised and are currently being implemented. The next tumour stream under consideration will be colorectal.

Reducing Inequalities16-19 Te Waipounamu Māori Leadership Group (TWMLG) continues its active leadership

and support of three projects focused on Māori health, two underway across the region to deliver sustainable change and more robust pathways for the Māori community and their whānau who have cancer. The projects are:1. The delivery of a report identifying key motivations and barriers to participation

in cervical screening for Māori communities in the South Island. This project

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used qualitative methodology and involved participation of general public, screeners, service provider management and DHB executive representatives. Key recommendations from the report include improving the visibility of services available for wāhine and their integration across settings. The findings and recommendations from the report are to be discussed at TWMLG with confirmed recommendations disseminated to DHBs for their consideration and implementation.

2. A project with a focus on providing coordinated and joined up services for Māori patients with cancer across the South Island (Project B). The identification of gaps and barriers to care has been the basis for recommendations and development of implementation plan for each of the DHBs. Two DHBs are underway with implementation and two DHBs due to prioritise and finalise their implementation plans by January 2018. Consideration will be given to a regional piece of work to address broader recommendations:

Improving the quality of ethnicity data Ensuring a culturally competent health workforce Improving health literacy for whānau Improving relationships between services and service providers

3. A third South Island wide project being led out of NMDHB has a focus on educating service teams, through a Māori Health Educator approach (Project A). DHB implementation initiatives include training and education for accurate referrals, Māori health provider information on HealthPathways, improving uptake of primary and secondary practitioners onto a cultural education programme.

DHBs have identified local initiatives to improve the collection, storing and output of ethnicity data through Project B. There is also a regional focus on improving ethnicity data from Te Herenga Hauora and a national focus with the release of updated HISO Ethnicity Data Protocols. Te Waipounamu Māori Leadership Group (TWMLG) has developed an Ethnicity data project proposal for consideration which will need to take into account initiatives already underway locally, regionally and nationally. This proposal is being considered for feasibility with a view for undertaking work in 18/19.

20

SCN continues to provide support to the Regional Steering Group for the Psychological and Supportive Care Initiative across the South Island. We await a decision regarding the next phase of the CPSS initiative between DHBs and the Ministry of Health.

South Island Cancer Intelligence Service

21 NZ Cancer Health Information Strategy is yet to be finalised for implementation

22The quarterly FCT dashboard has been strengthened to give greater focus on service improvement and the actions needed to improve performance. Feedback on these changes and other opportunities for improvement will be undertaken in Q3.

23

Preliminary work for the development of a regional strategic cancer plan has focused on participation in the wider South Island Alliance Strategic Planning process through 2017 that has resulted in a Vision Statement, Strategic Goals and Principles. The current strategy ‘refresh’ for the alliance has been confirmed as a restatement of that the current framework (2017-20 Health Services Plan), but is one which goes further into detail, seeking to provide specific guidance to the service level alliances, workstreams and other collaboration groups. Explicitly this guidance is intended to support SCN to review its current work plans with respect to the strategic goals, principles and priority foci, refining and targeting the overall Alliance work plan, initially for the coming 1-2 years. In addition the guidance from the Ministry of Health regarding the priorities for Cancer Services, will provide a foundation for further engagement with the South Island Sector on our own strategic cancer plan.

Tumour Standard Reviews

[from 16- 17 work plan]

The report on the review against the lung tumour standards has been signed off by the DHBs, the Consumer and Maori Leadership and will go to the February SCN Steering Group Meeting.The Gynaecological tumour standards audit has had analysis completed on additional CDHB data points. The working group will consider the findings and any service improvements that have been undertaken during the time taken to complete the review.

CHALLENGESFaster Cancer Treatment

1 Overall, the South Island improved on the 62-day Health Target performance. However, the number of patients on both the 31-day and the 62-day health target has decreased, although there are approximately 20 more cancers registered each quarter in the South Island. Work is ongoing to better understand the number of patients expected to be on the 62-day health target and 31-day policy priority, and better understand the South Island’s performance in this regard comparative to the rest of NZ.Ensuring more patients are able to benefit from the 62-day health target remains a challenge for all DHBs. Additional breach code narratives requested by the MOH are

6

designed to help provide further information and visibility. Understanding and resolving the barriers that prevent timely access are a key focus for our improvement work including those that are excluded from the target.

Multi-Disciplinary Meetings

10

The pilot data extraction to the Ministry of Health and the definition of reports for clinical use, as part of the “Gap Analysis” have been delayed by the Ministry CHIS team not being ready to develop them. Given the importance of providing reporting back to clinicians and managers we will seek to still deliver this for South Island MDMs using our local data repositories and resource.

7


Growing Up Healthy

1Working cross-sectorally to better manage the safety of vulnerable children and reduce family whanau violence. Q4

2Support the SI DHBs to understand and respond to information reported from e-Prosafe Q4

3Work with maternity services to continue to reduce Sudden and Unexpected Death in Infants in the South Island with particular emphasis on Maori and Pacific populations.

Q1,2, 3,4

Young Persons Health

4In partnership with Health Promotion Agency, SI Public Health Partnership and SI Mental Health and Addictions SLA, implement recommendations of SI ED scoping exercise (subject to funding)

Q3

5Support DHBs to implement the Ministry of Health’s Sexual and Reproductive Health Action Plan as it relates to teen pregnancy. Q3

Access to Child Health Services

6aSupport interventions to reduce ambulatory sensitive hospitalisations for skin infections, eczema and dermatitis with an emphasis on at risk children and families, Maori and Pacific 0-5 years.

Q2,3

6bImprove Maori and Pacific engagement with WellChild Tamariki Ora providers to support reduction in ambulatory sensitive hospitalisation rates for skin infections, eczema and dermatitis.

Q2

7Support the South Island Diabetes Working Group to implement their workplan including understanding service delivery to Type 1 Diabetic consumers.

Q3

Regional obesity management programme

8 Develop and implement a childhood healthy weight programme Q4

9Align Childhood Healthy Weight Programme with MOH health target for child health Q4

10Work to reduce the number of dental ambulatory sensitive hospitalisations in 0-4 year olds. Q4

11 Sharing learnings from Healthy Families Christchurch and Invercargill. Q4

12Improve uptake and use of South Island Regional Electronic Growth chart. Q1

Consumer Consultation

13 Develop a SI child/youth/parent/caregiver survey Q3

KEY PROGRESS IN QUARTER 2Growing up Healthy

3

SIAPO undertook SUDI workshops in five SI DHBs between Nov – Dec 2017. Attendance and engagement was mostly positive. No LMCs attended at the SDHB workshops held in Cromwell, Dunedin and Invercargill. Two follow up workshops are being arranged for Feb March in SDHB specifically to engage with LMCs. The workshops informed the SI SUDI Prevention Programme Regional Plan Dec 2017 – June 2018 which has been completed (draft) and submitted to MOH. Consumers will be consulted early in the year.

Young Persons Health

4

The consultation process with the SI DHBs has been completed following the limited release of the final South Island Youth Alcohol Emergency Department Presentations’ Scoping Project Report from Dr Paul Quigley. The report is to be released following consultation with the SI Emergency Department Alcohol Scoping Project – Youth Steering Committee. Communications advisor will be engaged to support the messages that will go out with the report.

Regional Obesity Management Programme

12

SI regional electronic growth chartEnhancements to e-growth charts have been made. The original project scope was to provide anthropometrics for infants, children and young adults within secondary care. The intent is now to provide access to primary care so they can at least see the data and have the option of entering data. The advantages of having primary care professionals using the system directly include:

there is no transcribing required (from referral letters to secondary care) lessening the potential for errors

it will be known who did the measurement. the link with the Raising Healthy Kids Ministry of Health Target. Data entry and

viewing within Primary Care would strengthen the referral and management of these children.

It provides a view of key patient information which results in both improved population data and availability of information across the five South Island District Health Boards capturing patients who access healthcare across the SI DHBs.

Discussions with IS SLA are underway.

13

Fabio the Frog project – as a result of receiving $10,000 from the Triple P 2017 – 2018 underspend the Paediatric Toolkit pilot can be undertaken. This program will be used at Christchurch Hospital excluding ED and Mental Health to measure the opinions of children and compare this with the experience of their families. Fabio the Frog is a character used within the innovative app, designed to help engage patients as young as four in the process. The pilot outcomes will inform a proposed SI roll out. This pilot is begin undertaken with HQSC.

8STATUS KEY: Not Started Critical Caution On target Complete

CHILD HEALTH SLA

MENTAL HEALTH & ADDICTIONS SLA


Alcohol and other drug services

1aAdvice provided to the implementation of a South Island withdrawal management plan including the new Substance Addiction Legislation (SAL)

Q1,2,3,4

1b Support the identification of Māori and Pacific population concerns Q2,4

1c Workforce Development needs identified and supported Q2,4

Youth Forensic 2Youth Hub and Spoke model evaluation and reporting to determine effectiveness of plan.

Q2,4

Workforce

3aContinue the engagement started with the South Island Mental Health and Addiction Workforce Development plan in 2016/2017

Q1,2,3,4

3bContinue to maintain and strengthen the Education and Training group.

Q1,2,3,4

3cEstablish and support the South Island Mental Health and Addiction Workforce Planning Work group

Q1,2,3,4

People with high & complex needs

4aIntellectual disability and mental health: support development of workforce for patients with Intellectual Disability and mental health issues

Q4

4bForensic Services: A gap analysis of the barriers to the transition between inpatient forensic services to community based services

Q2,4

People with low prevalence disorders

5Develop a plan to support the physical health of people with low prevalence disorders

Q4

Adult forensic services

6Prison screening data provided (Prison screening occurs within agreed timeframes with 80% of prisoners referred seen within 7 days of receipt of referral)

Suicide prevention planning and actions

7aFormation of working group/expert panel to provide advice and strategic planning

Q1,2,3,4

7bMāori and Pacific concerns are addressed as part of the work of the expert panel

Q2,4

KEY PROGRESS IN QUARTER 2New Substance Addiction Legislation - Substance Addiction Compulsory Assessment and Treatment Act (SACAT)

1A regional advisory group of key stakeholders continues to work closely with MoH and Matua Raki on the requirements of the new legislation

Youth Forensic

2

The second regional youth forensic day was held in Dunedin on 29 November to report on the progress and success of the youth forensic model. The regional youth forensic pathway is being implemented across all South Island DHBs however it remains a live document. The pathway helps the smaller DHBs with limited forensic staffing when they need the support of a bigger team which the hub can offer. Using the pathway, smaller DHBs can get advice and discuss cases in order to offer a better service for the clients in their areas. A Christchurch Youth Forensic Team (YFT) planning session has allocated staff to be the key contact for each of the other DHB teams. District youth forensic team staff now have an identified person as their first point of contact for advice or information.The Regional MDT monthly meeting has been established by VC to discuss cases with Consultant, Psychologist, Pukenga Atawhai and other clinicians from the Canterbury team.

People with high & complex needs

4bSteve Bayne of SDHB has joined the SLA and will act as the expert lead on the working group. Terms of Reference have been agreed. Invitations have been sent to nominated members.

People with low prevalence disorders

5

Equally Well is the approach MHASLA have agreed to take to supporting the physical health of people with low prevalence disorders. MHASLA met with the national Strategic Policy Advisor for Equally Well. MHA GM rep on MHASLA has taken a proposal to the MHA GM forum

Suicide Prevention

7

DHBs include suicide prevention in their annual plans. Dr Evan Mason (SDHB) has joined the SLA and has agreed to lead a further piece of work commencing with a discussion with DHB Suicide Prevention Co-ordinators.MHASLA has also been in touch with GMs Maori (Te Herenga Hauora) about informing this work. Te Herenga Hauora have agreed to offer a date to discuss the item in the new year.


MONITORING / BUSINESS AS USUAL ACTIVITYAdult Forensic Services

677% of prisoners referred in SDHB were seen within 7 days of receipt of referral65% (Aug), 92% (Sept) and 95% (Oct) of prisoners referred in CDHB were seen within 14 days of receipt of referral.

CHALLENGESWorkforce

3

This item remains as flagged in the 17/18 Q2 report. The SI MHA Workforce Development Plan has been drafted and includes 50+ actions on developing new “whole of systems” regional strategies and activities to build capacity and capability in:

1. Leadership

2. Cultural Fluency

3. Models of Care

4. Integration between Primary, Community/NGO and DHB/Specialist Workforces

5. Inter-service and Across Service Collaboration

6. Recruitment, Retention and Scope of Practice

7. Education & Training

8. Addiction Specific Workforce

9. Family Safety and Wellbeing:

The plan reflects the strategies that will need to be developed in line with the new national Health Workforce NZ plan. Workforce Development resource will be required to pursue this new work. This resource was previously provided by the Health Workforce NZ Regional Workforce Development Lead role provided via Te Pou, the national workforce centre. HWNZ has disestablished the role. MHASLA have met with HWNZ to emphasise the need to resource the new plan and MHASLA Chair has written to HWNZ, Te Pou and the other workforce centres highlighting this requirement.



Strengthening dementia pathways

1aEnsure people with dementia and their families and whānau are valued partners in an integrated health and social support system that supports wellbeing and have control over their circumstances

Q2,4

1bProvide DHBs with on-going support and overview so that DHBs identify and strengthen components of dementia care pathways within the parameters of the New Zealand Framework for Dementia Care

Q2,4

1cSupport interventions which seek to minimise disparities between Māori and non-Māori in relation to the timely assessment and diagnosis of dementia and subsequent care planning

Q2,4

1dSupport South Island DHB’s with the implementation of the South Island Dementia Model of Care

Q2,4

2Improve the quality and consistency of dementia education and support programmes in operation to support family/whanau carers (e.g., Living Well with Dementia) and people living with dementia.

Q2,4

3Continue to expand Walking in Another’s Shoes programme to foster Person Centred Dementia Care across the health continuum including different levels of staff and management

Q1,4

4

Promote the concept of ‘Think delirium’ across South Island DHBs with regard to delirium prevention.Encourage the development of delirium pathways in all South Island DHBs to assist in the prevention, assessment and management of delirium across the care continuum and create consistencies in care.

Q1,2,3,4

interRAI

5aPromote South Island health professions to use the information from comprehensive clinical assessment (interRAI) proactively in plan of care and in service planning/ development.

Q1,2,3,4

5bMonitor interRAI reports to identify trends including any trends or differences that may exist between Māori and non- MāoriAnalyse specific areas of the data from all South Islands DHBs

Q1,2,3,4

Advance Care Planning

6Support DHBs to develop ACP system implementation with processes to embed ACP as standard practice for those who will benefit

Q2,4

7ACP L1A and L 2 Training is available in a planned manner for staff in each DHB district in South Island (subject to resources)

Q1,2,3,4

8

Support South Island DHBs to participate and support National Conversations that Count Day (CtC). CtC education (Peer education for the public delivered ‘by the public’) is available in each South Island DHB (as resources are available)

Q1,3

Restorative Model of Care

9

Older people will be supported to set and achieve goals by a co-ordinated and responsive health and disability support service that also enables them to maintain their social connections with community life.

Q2,4

Workforce 10

Work with HWNZ and DHBSS to develop a sustainable mechanism for collecting a minimum workforce data set on the health workforce working in health of older people outside the DHB provider arm by 30 June 2018

Q4

KEY PROGRESS IN QUARTER 2Dementia

1-3

SI Dementia Model of Care document “Dementia is Everybody’s Business’ circulated to DHBs for sharing with their teams across the continuum of care. HOPSLA hosted a SI Dementia video conference meeting with 12 sites across the SI participating. The meeting discussed:

o What we hope to achieve by implementing Dementia is Everybody’s Business- Working together to achieve a shared SI Model of Care

o How each centre might respond to this model locallyLocal areas will feedback at the next meeting to be held in March 2018.

Delirium

4

Building on information gained in the Delirium stocktake completed in August 2017, HOPSLA has developed a draft, concise organisational ‘Self Assessment’ for facility based services to make progress with best practice Delirium Management. DHBs and Palliative Care workstream are providing feedback by 9 February 2018. It is hoped the Self Assessment tool will be ready for use across the SI in the week of World Delirium Day 15 March 2018.

interRAI

5

The SI infographic uses assessment data to report on the HOPSLA workplan areas of Dementia, Restorative, Advance Care Planning and interRAI. It shows a number of items that facilitate observing trends. Some items link well to the HOPSLA workplan, for example: 59% of those assessed show cognitive impairment in line with dementia (CPS =3) but only 26% of those assessed have a diagnosis. 36% have CHESS 3, 4 or 5 (Mod/High level of health instability) but only 5% report having ACP. The report includes falls information at the request of SI DHBs. The report is shared widely in the SI and TAS has agreed to do a DHB specific report using this infographic format for each SI DHB.

Advance Care Planning

6-8Two Briefing papers regarding future regional and local support for ACP implementation have gone to SPaIT and ALT for consideration – HOPSLA is awaiting feedback.

MONITORING / BUSINESS AS USUAL ACTIVITYDementia – Goodfellow Primary Care Dementia Education uptake

2 The rate of uptake is declining across the SI since July 2017. HOPSLA is considering how to continue to support primary care dementia education.


HEALTH OF OLDER PEOPLE SLA


Information technology and services

1a

To inform and influence the development of information systems within the South Island that will deliver a more efficient and safer transfer of patient information between Palliative Care Providers (including Hospice services) across the SI while reducing costs and risk

Q4

1bFollowing the completion and evaluation of the current pilot, support the development and the roll out of Palliative Care interRAI across the South Island

Q3

Hospice and Hospital palliative care services

2a

Use the information from Hospital and Hospice Surveys and the evaluation of palliative care in primary care (PHOs ARC and P&F) to promote regional consistency and access to resources. Inform and influence South Island DHBs so services are aligned to the Resource and Capability Framework for Adult Palliative Care and the work of the National Adult Palliative Care Review

Q4

2bWorking within the National Paediatric Palliative care Guidelines: provide high level guidance within the South Island to those providing Paediatric palliative care

Q4

Primary and community care

3a

Based on the survey findings and best practice, develop and support the model of care that reflects the integration of specialist, secondary and primary care into a seamless palliative care service in the South Island.

Q4

3bPartner with St John to understand how palliative and end of life care is provided and how it can be improved

Q4

3cExplore and understand how Palliative Care is delivered by Maori organisations and other ethnic minority providers

Q3

3dExplore opportunities to provide guidance on the substantive competencies for allied health professionals undertaking education in palliative care in South Island.

Q3

Networking and engagement

4

Through benchmarking against the data collected through VOICES, which includes communication with Consumers and Maori on their experience of End of life; determine what and where improvements are called for and use this information to improve performance in the delivery of palliative care in the South Island

Q4

KEY PROGRESS IN QUARTER 2Primary Care Surveying Palliative care – ARC PHO DHB Planning and Funding

3a

The surveying of Primary Care including ARC, PHOs and DHB Planning and Funding is completed. Reports have been sent to the survey respondents. The next step is to look at the five reports (including SI Hospitals and Hospice reports) and draft a briefing paper guide decision making and further work.

Allied Health – Palliative Care

3d

PCW have engaged with the SI Directors of Allied Health (DAHs) and they have offered their support to the proposed project. PC is provided by allied health professionals in non-specialist settings. It is unknown how much preparation, education and support they receive so a stocktake will be undertaken. The details of who will be involved and who will lead the work is yet to be established. A project lead will hopefully be nominated by the SI DAHs who will look to their DHBs for nominations. PCW will work with SI DAHs and Health Workforce Hub SIA.

VOICES

4

The Voices (Views of Informal Carers’ Evaluation of Services) survey project has received all the required approvals, and the PCW and University of Canterbury are looking forward to start surveying next of kin in early 2018.

CHALLENGES3c Information will be included in VOICES.

4

Due to the complex approval process and challenges with access to data the expected date of completion has been extended. Mitigation – contract extended until March 2019.


PALLIATIVE CARE WORKSTREAM


South Island Model of Care

1aSouth Island Cardiac Model agreed and implemented consistently in the region (within resources available)

Q2,4

1bSI Alliance Leadership Team approves the recommendations of the model of care project group.

Q2

1cRecommendations adopted by the cardiac workstream and specific project groups established

Q2

1d Implementation of change evidenced by audit Q4

2Access to tests: all South Island DHBs recording and storing ECGs on common repository

Q2,4

3aOptimal HealthPathways: STEMI Pathway in conjunction with St John implemented

Q2

3bOptimal HealthPathways: Common Accelerated Chest Pain pathway implemented in South Island hospitals

Q2

3cOptimal HealthPathways: review and audit Acute Chest Pain Pathways in Emergency Departments

Q4

Equity of access 4

Monitor access rates for high risk population groups. Prepare reports at Q2 and Q4 from ANZACS QI data to show intervention rates for Maori, Pacific and Asian people to help identify and address any issues.

Q2,4

Meeting national indicators

5Support South Island DHBs to address any challenges that arise with providing appropriate cardiac care and meeting standardised intervention rates

Q1,2,3,4

6Support South Island DHBs in the continued achievement of national indicators around equity of access

Q1,2,3,4

Heart failure 7Implement locally, regionally and nationally agreed protocols, guidance, processes and systems to ensure optimal management of patients with heart failure (within available resources)

Q4

Workforce training

8Implement recommendations formed in conjunction with National Network (subject to resource constraints)

Q4

Transporting cardiac patients

9Guidelines for transporting cardiac patients agreed in 2013 and updated 2015/16 are consistent for the South Island

Q4

KEY PROGRESS IN QUARTER 2South Island Model of Care

1

The workstream has considered the recommendations of the Sustainable South Island Cardiac Services Consensus Report which was prepared and submitted to the Alliance Leadership Team. The workstream is preparing a plan to address the recommendations in an efficient manner along with other already planned deliverables to improve the model of care.

2

Work on implementing the ECG repository is progressing. A good relationship has been developed with the supplier ahead of implementation in each DHB, starting with Canterbury and Nelson Marlborough. Transmitting of ECGs from St John ambulances to EDs is happening in Nelson and has been tested for implementation in Christchurch as part of the ECG project.

3The Workstream is working alongside St John in agreeing the STEMI pathways with the on call cardiologists at Nelson, Christchurch and Dunedin being regarded as the STEMI coordinators for each of the respective districts.

MONITORING / BUSINESS AS USUAL ACTIVITYMeeting national indicators

5/6

ANZACS QI data regarding access is included below. Note: that the region exceeded the target for form completion in August and September but there was a significant decline in October. This was caused by Canterbury experiencing a shortage of House Officers during this period resulting in fewer forms being completed.

Workstream members are concerned about the accuracy of cardiac intervention data so have not included it in this report. This issue is something that will be addressed as part of planned work on the South Island Cardiac Model of Care, along with the availability and accuracy of cardiac surgery data, to give a clearer view of cardiac services in the region.

8The region maintains regular links with the National Network through the Alliance and contributes to national initiatives.


CARDIAC SERVICES WORKSTREAM

CHALLENGESImplementation of key deliverables

Confirmation and implementation of several deliverables are partly dependent on the completion and adoption of the workstream’s plan for the SI. There have been delays in agreeing the report recommendations and subsequently preparing the plan.

In the case of pathways for instance, progress has been delayed until St John documentation has been completed. Adequate processes are in place but need to be formalised. The ECG project continues to move steady but very slowly subject to personnel resource being assigned to the work.



Improve equity of access to elective services

1aImprove equity of access, system quality and practice in selected elective service areas through the establishment of project, team and methodology

Q1,2,3,4

1b

Identify baseline for Māori access (current and evidence) in selected priority areas Including access to primary care, and referrals into services.When collecting health data, this will be recorded separately by Māori & non Māori

Q1,2,3,4

1cCollate and share innovations in the selected service areas via best practice documents and use of HealthPathways

Q1,2,3,4

2Support South Island DHB management of regional electives volumes including the longer term approach to electives across the South Island that maximises resources

Q1,2,3,4

Bariatric surgery 3Support management of South Island Bariatric Surgery Service by CDHB with the introduction of an independent Chair

Q4

Plastic Surgery 4Implement agreed process to access Plastic surgery for post bariatric patients

Q2,4

Vascular Services

5Implement the nationally agreed Vascular Services model of care in the South Island

Q2,4

Eye Health Services

6a Develop sustainable Model(s) of Eye Health Care for the South Island Q2

6b Complete model(s) of care and agree implementation process Q3

6cRecommend a transition pathway, including resource implications, to achieve the desired model(s).

Q4

Maxillofacial Services

7 Agree a sustainable South Island plan for Maxillofacial Services Q1,3

Otolaryngology 8 Agree a sustainable South Island plan for ENT Services Q1,3

Orthopaedic Services

9 Agree a sustainable South Island plan for Orthopaedic Services Q1,3

Colonoscopy / bowel screening

10Support South Island DHBs to meet Colonoscopy Waiting Times Indicators

Q2,4

11South Island planning to support Bowel Screening Regional Centre development and implementation and Tranche 2 & 3 rollout schedule

Q1,2,3,4

Urology 12 Consistent Urology follow-up and surveillance processes Q4

KEY PROGRESS IN QUARTER 2Improve Equity of Access to Elective Services

1

Projects with a system & equity of access focus (including electives, ethnicity data & Māori access, information sharing), are in place for:

• Eyes • Colonoscopy, Bowel Screening• Cardiac• ENT/ORL• Vascular• Telehealth Strategy

Projects are overseen by, and reported to, a joint group comprising GMs Planning & Funding, Hospital GMs and Chief Medical Officers.

Plastics

4Equitable access to post bariatric Plastic surgery still being discussed, as Plastics services facing strong demand and introducing new service is challenging

Vascular Services

5Vascular service model: draft MOH agreement received to implement SI model; endorsed by oversight group

Eye Health6 Model of care in development, focus on Glaucoma

Colonoscopy/Bowel Screening

10South Island DHBs performing well and consistently meeting (or close to meeting) colonoscopy waiting time indicators; Clinical Leads group continues to meet 6 weekly

11

South Island planning is occurring, supported by clinical leadership group and SI BSRC being formed within SDHB. SDHB planning is the most advanced; NMDHB, CDHB have submitted draft business case information, and SCDHB are to submit by end February 2018. Rollout order was delayed for CDHB, SCDHB by MOH at the end of end 2017.

MONITORING / BUSINESS AS USUAL ACTIVITYBariatric Surgery

3

Bariatric Surgery: CDHB manage the service with support of revamped Multi-Disciplinary Selection Committee after discontinuation of Steering Group. The service continues to be overseen by, and reported to, joint group comprising GMs Planning & Funding, Hospital GMs and Chief Medical Officers.


ELECTIVE SERVICES WORKSTREAM


South Island Major Trauma Plan

1South Island Major Trauma regional plan is reviewed and updated: South Island region focuses on implementation of local and regional trauma systems

Q2,4

NZ Major Trauma Minimum Dataset

2a

South Island data collection and input into national major trauma registry no more than 30 days after patient discharge.Achievement of quality improvement markers as defined by the National Major Trauma Clinical Network

Q1,2,3,4

2bSouth Island ethnicity and rurality data by site is known including patient outcomes

Q1,2,3,4

Clinical leadership

3Responsibilities identified and assigned for Clinical lead and coordinator roles in each DHB

Q1

4 Trauma committees established in each DHB Q2

5Clinical leaders agree to and follow guidelines and inter-hospital transfer processes

Q1,2,3,4

Destination policies

6Implement Regional Destination Policies in collaboration with DHBs, Ambulance and Air Transport providers

Q2

KEY PROGRESS IN QUARTER 2Regional plan

1The Workstream plans are being followed to comply with local and regional processes. Strong links are maintained with the National Network.

Trauma Committees4 All but one DHB have active Trauma Committees.

Transfer and destination policies

5/6The workstream is working closely with St John to agree, confirm and formally implement the most efficient transfer and destination polices for the region. The work is progressing, but implementation is now likely to begin in Q3.

MONITORING / BUSINESS AS USUAL ACTIVITYNZ Major Trauma Minimum Dataset

2aThe South Island is contributing information to the national minimum dataset under the national agreement.

Clinical Lead and Trauma Nurse Coordinators

3CLs and TNCs in each District are working on data collection and trauma initiatives within the limits of the resources allocated. See note regarding the lack of administration support under ‘risks.”

CHALLENGESData Collection and Registry

2

The SI workstream is preparing a set of common data fields to capture further information on all admitted trauma patients. There is no consistency to what is recorded and it is limited by the personnel hours available. Most DHBs require administration support for the collection and entry of data for major and non-major cases. This point will be raised further when consideration is given to renewing the agreement with Midland or similar.


MAJOR TRAUMA WORKSTREAM


Collective Impact

1 Governance: Establishing an engaged cross-sector Public Health SLA Q4

2 Governance: South Island Public Health Strategic Framework developed and agreed Q4

3 Population health reporting: Initial South Island Population Health Report complete Q4

4 PHU infrastructure: Enhanced leadership alignment of the South Island Public Health Partnership/three Public Health Units

Q1,2,3,4

5 PHU infrastructure: strengthened operational alignment of the South Island Public Health Partnership/three Public Health Units

Q1,2,3,4

6 Evaluation: Evaluation of the South Island Public Health Partnership’s evolution and the SLA’s development

Q1,2,3,4

7 Communications: Positive profile and support of the PH SLAs work Q1,2,3,4

Māori

8 Promotion of key messages on South Island priority public health issues as they pertain to Māori by Te Herenga Hauora

Q1,2,3,4

9 Selection of a priority public health issue for Māori for a collaborative approach Q1

Environmental sustainability

10Comprehensive current data to inform next steps, including gap analysis and identification of potential useful and cost-saving measures for DHBs to consider

Q3

11

Promote awareness of the policy/position statement once South Island DHB Boards endorse. Utilise DHB Boards endorsement of sustainability to promote awareness and action in DHBs.

Q3,4

Health in all Policies

12

Promote awareness of the position statements once the South Island District Health Boards have endorsed them:

Water fluoridation Air Quality Warm Homes Sugar sweetened beverages Environmental Sustainability

Q2,3,4

13 Undertake new regional approaches/ initiatives to promote healthy eating and active lifestyles as identified in 20116/17.

Q1,2,3,4

14Identify and undertake regional approaches/initiatives re alcohol harm reduction, including contributing a regional population health perspective to the Alcohol Harm Reduction ED Project.

Q1,2,3,4

Rheumatic Fever 15Ongoing monitoring and collective South Island public health response to results

Q1,2,3,4

KEY PROGRESS IN QUARTER 2Collective Impact

1

The co-design approach to establishing “a form of” a SI Public Health SLA was completed. This involved workshops in October and December.

Cross-sector agreement was reached to establish the SI Hauora Alliance at the December workshop. The Hauora Alliance will initially focus on exploring way of working collectively on key South Island hauora issues relating to the first 1,000 days. Leaders from the Ministry of Education, Te Putahitanga o Te Waipounamu Whanau Ora Commissioning Agency and the NGO sector agreed to form the initial steering group, alongside members of the SI PHP workstream. Stakeholder and project groups have also been nominated.

2 A draft South Island Public Health Strategic Framework was developed.

3A background paper, Population health reports for South Island District Health Boards, was developed and discussed by the PHP at the November meeting. .

4 , 5

A snapshot /stocktake of South Island PHU team structures and workforce FTE was initiated

A working group was nominated to identify a sustainable after hours/on call strategy that facilitates the safe delivery of consistent high quality health protection services in the South Island.

A draft shared annual planning template for SI PHUs was developed.

Health in All Policies

2b

The SI PHP presented to and met with the Joint Group of SI DHB GMs Planning and Funding, Chief Operating Officers and Chief Medical Officers in September 2017. The presentation focused on public health approach and opportunities re health promoting DHBs .This was well received and followed by positive discussion.

A Healthy Eating and Active Lifestyles working group was nominated to articulate and promote a SI Health in all Policies approach to healthy eating and active lifestyles, with responsibilities across the system highlighted. This initiative will be connected

with and to the work of the Child Health SLA.


PUBLIC HEALTH PARTNERSHIP

MONITORING / BUSINESS AS USUAL ACTIVITYPublic Health Network

The regional public health network continues to develop via the workgroups and analysts’ network. These groups include the Workforce Development Group, the Alcohol Working Group and the Environmental Sustainability Working Group.

The Programme Facilitator attended the National Public Health Clinical Network meeting in November and continues to have regular telephone meetings with the National Coordinator of the Network.

Six-weekly co-coordination korero/meetings continued with Te Herenga Hauora / South Island DHB Maori Health Managers.

CHALLENGESHealth in all policies

New, unanticipated DHB priorities have reduced analyst capacity to develop South Island position statements.

There is wide variation in the priority that individual DHBs appear to be according environmental sustainability.

Lack of dedicated alcohol harm reduction coordinators and the need for wide DHB engagement impedes DHB development of alcohol harm reduction strategies and the ability to deliver on the alcohol position statements.



Organisation of Stroke services

1a

People with stroke admitted to hospital are treated in a stroke unit and/or in the setting of an organised stroke service (see PP20 for definitions of a stroke unit and organised stroke services).Support interventions which seek to minimise disparities between Maori and non-Maori

Q1,2,3,4

1bEnsure that existing acute stroke pathway information that is available to primary care is consistent across the South Island.

Q4

Thrombolysis

2aAll people with stroke have access to a quality assured thrombolysis service (24/7)

Q1,2,3,4

2bSouth Island regional centres collaborate with local ambulance services to ensure pre-notification to hospital services

Q2,4

2cA telestroke service for SI DHBs will be scoped for embedding in the South Island within available resources

Q2,4

Regional inter-arterial clot retrieval service

3A regional Intra-arterial clot retrieval service based in CDHB to be scoped for the South Island

Q2,4

Rehabilitation and community stroke services

4a

All eligible people with stroke receive early active rehabilitation services and equitable access to community stroke services (as defined by the National Stroke Network), supported by an interdisciplinary stroke team

Q1,2,3,4

4b

Work collaboratively with Stroke Foundation and Ministry of Health in order to Integrate Primary care at every opportunity including:

– Education– identifying prevention

Review Workstream membership and include primary care professionals

Q1,2,3,4

Workforce

5aDevelop a regional workforce plan that supports the delivery and achievement of high quality stroke care provision

Q2,4

5bCDHB and SIAPO will provide standardised thrombolysis education across the South Island regional centres via videoconference using a hub and spoke model

Q2,4

5cAll members of the interdisciplinary stroke team participate in ongoing education, training (a minimum of 8 hours stroke specific education per year (minimum standard) and service improvement programmes.

Q2,4

Information technology and analysis

6aIdentify actions that the region will take to support improved information management

6bIdentify trends in delivery of acute stroke services, thrombolysis, and rehabilitation services to detect disparity between Maori and non-Maori to inform improved service delivery

KEY PROGRESS IN QUARTER 2Thrombolysis

2Thrombolysis is not consistently available at each main centre in the South Island. Telestroke is being scoped for the region as part of the South Island Acute Stroke Service plan scoping project

Regional intra-arterial clot retrieval service

3

The South Island Acute Stroke Service plan scoping aims to identify sustainable development in order to progress organised stroke services, SI telestroke service and SI regional intra-arterial clot retrieval service in a timely manner.The plan has been written by an expert group from the SI DHBs, CCDHB and St John at the request of SI GMs Planning & Funding, Hospital GMs and Chief Medical Officers at their 4 September 2017 meeting.

The plan describes the parallel streams of work that will create the building blocks for a SI acute stroke service, as a subset of an organised stroke service:

a. Robust triage to identify appropriate patientsb. Assessment

Acute Stroke Telehealth rollout, out of hours initially, led from CDHB, with NMDHB preferring to continue to link to CCDHB

Implementation of the Australasian Stroke Guidelinesc. Treatment

Thrombolysis available at designated stroke hospitalsd. Clot Retrieval available at CDHB, with a streamlined referral pathway from across

the SI (except NMDHB who will continue to link with CCDHB).e. Transport

Acute stroke destination policy implementation, to1. Transport acute stroke patients from the community directly to the most

appropriate stroke hospital and 2. Transport eligible patients with a large vessel occlusion from stroke

hospitals to clot retrieval centre (CDHB) in line with the agreed pathway.The expert group has provided some advice about each DHB’s current capability but a more formal assessment is needed to establish what each DHB would need to do to fully achieve the work plan (and therefore the funding required). There are a number of critical dependencies and the whole plan may be impacted if any of the parts are not available or commitments not fulfilled in agreed timeframes. A mandate is being sought so that work can commence at the earliest opportunity in a staged and sustainable manner.

MONITORING / BUSINESS AS USUAL ACTIVITYStroke Measures

1,2,4Measures are reviewed each quarter and are included below with no significant trends noted. Service gaps relating to no Lead Stroke Nurse in SDHB & NMDHB are noted, and action is being progressed to address this.


STROKE SERVICES WORKSTREAM

South Island Stroke National Service Measures Q1 2017-18

80% of all stroke patients to be cared for in organised stroke unit DHB Hospital Numerator Denominator (all

stokes – bleeds, clots & unspecified)

Percent cared for in organised stroke service

SDHB Dunedin 0 16 57 0Invercargill 0 2 47 0Dunstan 0 2 11 0Oamaru 0 1 7 0

CDHB Christchurch 204 30 209 85.36Ashburton 0 5 12 0

WCDHB Grey Base 14 1 13 100

NMDHB Nelson 2 19 0Blenheim 3 6 0

SCDHB Timaru 22 2 21 95.65

8 % of acute ischaemic stroke patients thrombolysedDHB Hospital Numerator Denominator

(excludes bleeds)

Percentage thrombolysed

SDHB Dunedin 4 57 7%Invercargill 1 47 2%Dunstan 0 11 0%Oamaru 0 7 0%

CDHB Christchurch 19 209 9.1%Ashburton 0 12 0

WCDHB Grey Base 2 13 15.4%

NMDHB Nelson 19 0Blenheim 6 0

SCDHB Timaru 3 21 14.3%

Proportion of those transferred to rehab- who are transferred within 7 days of acute stroke admission National measure - target 80%DHB Hospital Numerator Denominator Percentage seen

within 7 days

SDHB Dunedin 16 73 22%Invercargill 9 49 18%Dunstan 13 0%Oamaru 8 0%

CDHB Christchurch 50 239 20.9%Ashburton 5 21 23.8%

WCDHB Grey Base 2 14 14.3%

NMDHB Nelson 2 21 9.52%Blenheim 3 9 33.33%

SCDHB Timaru 16 73 22%

Proportion of those referred to community rehab who are seen face to face within 7 days of inpatient discharge. National measure - target 80%DHB Hospital Numerator Denominator Percentage seen

within 7 days

SDHB Dunedin 0 0 0Invercargill 0 0 0Dunstan 0 0 0Oamaru 0 0 0

CDHB Christchurch 4 85 4.7%Ashburton 0 0 0

WCDHB Grey Base 4 7 57%

NMDHB Nelson 0 0Blenheim 0 0

SCDHB Timaru 8 9 89%



Serious and adverse events

1 DHBs understand the National Reportable Events policy Q3

2Regional agreement on application of the new reportable events policy

Q4

3 Build regional capability in investigators of SAEs Q4

HQSC Projects4 Regional approach to HQSC Deteriorating Patient programme agreed Q4

5 Collaboration on HQSC Pressure Injury Prevention Programme Q4

Regional policies 6 Identify policies that could be regional policies Q4

Safety 1st

7a Regional South Island DHB Safety 1st reports Q4

7b Support ongoing development and review of Safety 1st Q4

7c Support the Safety 1st Control Group Q4

Tikanga 8 A stocktake of Tikanga in the South Island DHBs Q4

Regional quality improvement

9Explore regional approached to share learnings of improving quality of care

Q4

KEY PROGRESS IN QUARTER 2Reportable Events2 Each DHB has procedures and templates in place already. HQSC has not yet offered

national templates for the new national policy but are working on non-specific examples. The work on regional agreement on the application of the new national reportable events policy commenced with the request to share templates. Quality Managers reviewed the templates in use and discussed the development of regional templates at the Patient Safety Group (Quality Managers). The templates are many and varied and systems become more complex drilling down through processes and procedures. CDHB have demonstrated the quality improvement planning intranet site and serious adverse events (SAE) processes and documents to the other SI DHBs. A blend of approaches is used in reviews and review levels and processes are determined by committees in the divisions. It was determined that the work should await the new HQSC training and associated DHB local training.CDHB/WCDHB commence SAE training in Feb 18. The other SI DHBs are keen to learn from the training. It was agreed that the way forward is to observe how the training goes in Feb and look to have it spread to other DHBs using method-training or a train-

the-trainer approach.

Regional capability in investigators of SAEs

3

HQSC will be addressing regional training on investigating serious adverse events. CDHB have advertised for a nurse consultant to co-ordinate reviews. This role may evolve into the team manager as more roles are added to cover all divisions. CDHB Quality Team would follow-up on recommendations emerging from reviews. Other DHBs are considering similar centralised systems.SCDHB have two Quality Improvement Advisors who work as part of the Quality and Risk Department Team. The team members each hold a specialist portfolio of quality leadership through which they support the DHB to plan for quality initiatives, facilitate committees established to address identified areas of priority, facilitate investigations into SAEs including documenting learnings and supporting the sharing of these across the DHB.NMDHB have four Quality Improvement Advisors who have completed the training, three of whom sit on ELT, one a senior manager. Two more are undertaking training at present - both work in Clinical Governance. A further two are about to start, one in strategy and one a pharmacist

Deteriorating Patient Project

4

The latest version of the Deteriorating Patient Project (DPP) will have two process measures and two outcome measures. The HQSC Predicted Risk of Death study will also look at the trajectory of patients who are included in the DPP. NMDHB is the ED pilot site for the early warning score part of this project. Work on the Deteriorating Patient is developing and links with Advance Care Planning (ACP) are being investigated. NMDHB are also advertising for FTE for a Learning and Development role to work with DHB groups on discharge. CDHB switched over to the NZ Early Warning Scores on 19 Sept. A presentation was provided to the SLA on the DPP in CDHB, incorporating the NZ Early warning Score (NZEWS). There were also 170 attendees at three CDHB workshops. Models were developed using a large observations dataset. The system developed includes InterRAI as part of the nursing assessment.The SDHB Deteriorating Patient system has been refreshed in preparation for the implementation of the full national programme. The Delirium package is also being implemented by SDHB.


QUALITY & SAFETY SLA

Pressure Injury Prevention

5

As a pilot site, SDHB continue to keep the region informed of the progress of the project by providing updates at the Quality and Safety SLA meetings and the South Island Patient Safety group meetings. The SDHB work is going well with the HQSC/SDHB shared learning project written up and on the HQSC website.Work is underway on consistency of scoring on the Pressure Injury Project. Detail on improvement will emerge from this work. Further funding is being offered by ACC, with whom CDHB are discussing a contract.

Safety1st

7

The Project Manager has completed the report on regional supports and reports. The SIA Coordinator has met with the Quality Managers to discuss future regional supports for Safety1st. The Project Manager will provide more information on the challenges anticipated in the coming years, crossover/intersections between agencies using Safety1st and how regional reporting can be developed. A regional approach to which all DHBs can sign up will be required.

Tikanga

8The Quality Managers have been canvassed for information on such activity in their DHB. Brief responses have been received from all but SDHB



Strategic Plan 1Complete review and refresh of the South Island Information Services Strategic Plan Q2

eMedicines Programme

2

ePrescribing and Administration (ePA): West Coast DHB ePrescribing and Administration project complete Deliverable removed from 2017/18 workplan due budget & resource constraints. Carried over to subsequent year for delivery.

18/19

3

ePrescribing and Administration (ePA): Nelson Marlborough DHB ePrescribing and Administration project complete for Wairau campus Deliverable removed from 2017/18 workplan due budget & resource constraints. Carried over to subsequent year for delivery.

18/19

4ePharmacy Management (ePM): Implementation of ePharmacy completed across DHBs Q4

eReferrals Programme

5Stage 3: Complete South Canterbury DHB eTriage implementation Delivery timeframe amended from Q3 to Q1/2 2018/19 18/19

6Stage 3: Complete Southern DHB eTriage implementationDelivery timeframe amended from Q3 to Q1/2 2018/19 18/19

7Stage 3: Complete Nelson Marlborough DHB eTriage implementation Delivery timeframe amended from Q3 to Q1/2 2018/19

18/19

South Island Patient Information Care System (SIPICS)

8Canterbury DHB: Complete the progressive implementation of SI PICS into other Canterbury DHB sites Q4

9Nelson Marlborough DHB: Project go-live for Nelson Marlborough DHB Q3

10South Canterbury DHB: Prepare for SI PICS implementation including the development of the implementation business case and initiation of project planning

Q4

11West Coast DHB: Prepare for SI PICS implementation including the development of the implementation business case and initiation of project planning

Q4

12Southern DHB: Commence development of the implementation business case for SI PICS Q4

ED information solution

13 Identify the preferred South Island solution Q2

14 Progress business case/implementation planning Q4

Regional Service Provider Index

15 Identify the preferred South Island solution Q1


17 Commence a phased roll-out Q4

eOrdering of Radiology tests


19Implementation of eOrdering Radiology tests completed for Nelson Marlborough, South Canterbury, West Coast DHBs Q4

20Confirm integration requirements of Southern DHB RIS platform into Regional éClair Clinical data repository Q4

Mental health

21Identify and confirm the preferred South Island approach for delivering the required mental health functionality Q4


23Support SCDHB, WCDHB, NMDHB and SDHB to progress a paper-lite strategy for transitioning paper mental health records into the electronic health record

Q4

Alerts and warnings

24Identify the preferred South Island solution Delivery timeframe amended from Q2 to Q4 due to resource constraints Q4


Clinical workflow 26Scope, agree and commence the implementation of the processes and structures to enable the SI DHBs to create, configure and manage automated clinical workflow

Q4

KEY PROGRESS IN QUARTER 2eMedicines

2/3/4

ePrescribing and administration (MedChart): The Southern instance of MedChart (Southern DHB & South Canterbury DHB) was successfully migrated to NZULM in early November 2017 by SDHB. The technical execution piece resulted in a 2hr 48 minute outage to the organisation with the post hand back to the organisation and majority of the re-charting was completed within 5 hours.A couple of minor Incident Reports were logged that seem to be related to the prescriber’s translation of the Offline Chart into NZULM which is a clinician responsibility and is an identified risk of these types of exercises (7% chance of error in any transcription). A lessons learned report will be completed.ePharmacy: Focus on the South Island eMedicines programme has shifted to resolving end of life ePharmacy solution for the SI DHBs. The South Island is working actively with DXC, the vendor for the ePharmacy solution, to identify a transition plan from the current Windose application to ePharmacy with transition plan to incorporate an extension to the current support model for those DHBs on the Windose application. Preferred option being progressed is the tactical implementation of two ePharmacy environments to support the current two instances of Medchart. The timeframe for this deliverable has been rebased and included in the 2018/19 IS SLA workplan.

eReferrals

5,6,7Stage 3: eTriage multi-DHB functionality development has been completed and will be deployed in upcoming HCS releases. A phased approach to delivering multi-DHB functionality to SI DHBs will occur.


INFORMATION SERVICES SLA

NMH have re-baselined the eTriage implementation, deciding to complete SI PICS implementation ahead of eTriage. Planning is underway with SCDHB, SDHB and CDHB Project Leads to ensure they have all support required for their eTriage implementations. Delivery timeframes have been amended with project closure now scheduled for 2018/19.

Stage 3 Part 2 Create eRequests within the hospital: Will deliver electronic requests inter and intra hospital as well as out to community, private and ACC providers.Business Case development being progressed. Business Analysts currently developing the requirements document, completing the gap analysis to support a recommended development path forward. Impact Mapping workshop was held in Christchurch on 28th November 2017 with attendees from CDHB, NMDHB, and SDHB. Further workshops are planned for January in SDHB, WCDHB and a follow up one in CDHB. Outputs from the workshops will inform the Business Case.

South Island Patient Information Care System (SI PICS)

9Software delivery for the full outpatient/inpatient functionality for Nelson Marlborough Health has been delivered. User acceptance testing has commenced. Nelson Marlborough Health remain on target for go-live of SI PICS across the Nelson and Wairau sites.

Regional Service Provider Index (RSPI)

15-17

The South Island completed due diligence for a South Island Regional Service Provider Index with IBM and MKM/Nextgate. As part of this process a detailed review was undertaken with the MoH to better understand the suitability of the standard or advance IBM software available through the existing national HPI. The IS SLA approved the recommended option of creating extensions to the MOH’s HPI system and facilitating the integration of an initial six key regional applications to the RSPI with other applications to be integrated in following phases.

Current focus of activity has been centred on project initiation tasks (project initiation document, communications strategy, and schedule), engagement with the MoH to agree a programme MoU, and requirements gathering for the six key applications, liaison with MoH staff, and the creation of the solution design. Next steps included the completion of requirements gathering for the interfaces required with the SI core systems to be completed. Detailed Business Case to be delivered within the next six months.

eOrdering of Radiology tests

18-19

Hospital Radiology tests: Due diligence completed. IS SLA have confirmed the approach for radiology ordering across the SI hospitals. Negotiations are currently underway for a Radiology Hospital Order licencing framework.

ERMS - eDelivery Radiology Project: Electronic delivery of ERMS generated Radiology referrals to the regional instance of Comrad has been completed for CDHB, SCDHB, WCDHB and NMH. eDelivery removes the fax delivery and manual entry of over 4500 Radiology requests each month. Pacific Radiology integration design workshop held, planning underway.Southern DHB don’t currently utilise the Regional instance of Comrad, alternative eDelivery solution being investigated by SDHB.

MONITORING / BUSINESS AS USUAL ACTIVITYHealth Connect South

South Island Alliance Orion Health Strategic Partnership: Contract negotiations are underway with Orion Health to formalise the South Island Alliance Strategic Partnership with Orion Health.HCS Reliability: Independent review into improving the reliability of the HCS production environment has been completed by Theta. Report to be tabled with the IS SLA for consideration and prioritisation of recommendations.

CHALLENGESeMedicines

2-3

ePrescribing and administration (MedChart):The WCDHB ePrescribing and Administration implementation business case has been declined due to budget constraints in the 2017/18 financial year. The deliverable has been rebased and included in the 2018/19 IS SLA workplanIt has been agreed that NMH will defer the implementation of MedChart until the ePharmacy instance has been implemented and the NMH SI PICS implementation has been completed. The deliverable has been rebased and will be included in the 2018/19 IS SLA workplan.



Workforce planning

1Health workforce data and intelligence is collected to support planning

Q1,2,3,4

2The pipeline for health workforce is aligned with health workforce need

Q1,2,3,4

3Kaiāwhina workforce: Allied Health Assistants (AHAs) working across the South Island health system have access to appropriate NZQA level 3 training

Q1,2,3,4

4Kaiāwhina workforce: the Careerforce NZQA Level 4 Health and Wellbeing qualification is included in the AHA development framework

Q4

5Kaiāwhina workforce: Allied Health Assistants (AHAs): An effective delegation model is in place for services where Calderdale Framework (CF) has been implemented

Q4

6An effective skill sharing model is in place for services where Calderdale Framework has been implemented Q4

7Ensure sustainability of workforce redesign model (CF)across South Island Q4

8Inter-disciplinary: A coordinated clinical simulation network for the South Island is established Q4

9Inter-disciplinary: South Island teams participate in the Health Care Challenge Q2

10Allied Health Scientific & Technical: regional clinical/professional leadership frameworks are implemented for smaller Allied Health & Scientific & Technical professions

Q4

11Medicine - new graduates: community based attachments (CBAs)are in place to meet requirements of new Medical Council curriculum

Q3

12Medicine - new graduates: support the DHBs to integrate the increased number of PGY1s (NZ citizens and permanent residents) into the workforce

Q2

13Nursing - new graduates: support the employment & orientation of new graduate nurses Q4

14 Midwifery: clinical leadership is further developed Q4

Priority (vulnerable) workforces

15Sonography: support for the training of Sonographers to meet the identified South Island need Q4

16Rural Health Medicine: the opportunity of a South Island rural health medicine clinical placement programme is explored to support vocational training

Q4

17 Imaging workforce is fit for purpose Q4

Workforce diversity

18 Improved employee ethnicity data collected by South Island DHBs Q4

19Increased Māori DHB clinical workforce, working towards reflecting the South Island population Q4

20Establish a framework for Cultural Competence Education which ensures it is embedded into practice for the non-Māori workforce. Q4

Workforce enablers

21Lippincott Clinical Procedures: the South Island and Midland Regions are working in partnership to develop designing a national framework for the management of Lippincott New Zealand instance

Q4

22Elearning platform: work with Ko Awatea to establish a single platform for NZ

Q2,3,4

23Elearning packages: an increased number of eLearning packages are available to the South Island health workforce which can be shared nationally

Q1,2

KEY PROGRESS IN QUARTER 2Māori Workforce

20Pilot of Takarangi (cultural) Competency Framework has commenced on the West Coast.

eLearning

22

The National GMs HR are the lead sponsors for exploring the creation of a national eLearning platform. A national workshop was held on 20 November with reps from all DHBs and the Ministry of Health. The outcomes from the workshop will inform a paper with recommendations for consideration by the national clinical leadership groups (DoNs, DAHs, CMOs) and GMs HR/P&C.

Nurse PrescribingA South Island regional approach to nurse prescribing has been agreed. This is a new piece of work. A workplan has been developed which includes the development of a policy and framework for implementation across the sector.

MONITORING / BUSINESS AS USUAL ACTIVITYKaiawhina workforce

3Ongoing regional support and coordination required, however some AHA related activity has been passed back to local DHBs as becomes imbedded in BAU.


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