Key Achievements in 2018/2019

Emergency Q: The Emergency Q pilot began in September 2018. Emergency Q is a digital information system designed to help patients make informed choices about the most appropriate care for their condition. Emergency Q aims to alleviate demand pressure on the Emergency Department through encouraging eligible patients to attend alternative urgent care providers. Between September 2018 and March 2019, 1689 (20%) eligible patients chose to use Emergency Q and attend a local Accident and Medical clinic for free.

Closer to Home

Co-design approach to new model of care for long-term conditions: In August 2018, CM Health launched a co-design process to inform the development of a new model of care to support people and whaanau/families living with long-term conditions. From this process we learnt about our community members’ and providers’ experiences of delivering and receiving care, and their ideas to inform future models. This process involved approximately 47 hui with over 500 participants.

People Powered

Feedback Central and complaints acknowledgment: Feedback Central has achieved its target of 100% of complaints being acknowledged within 5 working days (our KPI). This represents a significant improvement and is a result of the Feedback Central team standardising the logging and acknowledging process for all complaints, since it was established in June 2018. Timely acknowledgment of complaints is an important part of communicating to the patient and their whaanau that their feedback is important.

Inaugural Maaori and Pacific Allied Health Awards: In April 2019, the Allied Health, Scientific and Technical Professions Awards were celebrated, and the inaugural Pacific and Maaori Health Awards were awarded to the Fanau Ola Social Work team and to Renee Taylor, speech language therapist. The Fanau Ola Social Work Team were acknowledged for the life-changing work that they have been doing with all ethnicities across South Auckland and for raising awareness of the non-governmental organisations out in the community. Renee Taylor was acknowledged for her work to enhance professional practice and contribute to the betterment of Maaori health outcomes in Counties Manukau.

Models of care: A number of additional wards and clinics were opened over the 2018/2019 year, in order to increase capacity and introduce or trial new models of care. These included the new Respiratory Close Observation Unity, which is to provide a higher level of acute care to patients with complex acute respiratory problems; 30 beds that were opened for 4 months in medicine to help accommodate the acute winter workload and allow a pilot of the home-based ward concept; additional maternity beds to increase bed capacity for Women’s Health; and the Maternity Assessment Clinic, which relieved some workload on the Birthing and Assessment Unit.

Value and High Performance

Early Pregnancy Assessment Tool: The Northern Region Early Pregnancy Assessment Tool is a web-form for use in the primary care setting at the first antenatal assessment. The tool aims to reduce inequities and improve maternal and child health outcomes. Our vision is that this is the first of a series of web-forms interacting with cloud-based health information. This project has secured Health Promotions Agency funding, and is a collaboration between the northern primary healthcare organisations and CM Health Primary and Integrated Care.

One Team

Living Smokefree: For those referred to the Living Smokefree service who set a quit date in 2018/2019, the team achieved a 70% quit rate at 4 weeks (Carbon Monoxide validated – smokerlyser test for 4 weeks smoke-free), compared to a national average of 47%. The UK average is 36% using the same 4 week measure.

Value and High Performance

Development and implementation of the CM Health Alcohol Harm Minimisation Programme: This programme focusses on alcohol as a key determinant of population health and wellbeing outcomes, and prioritises prevention and early intervention actions. Key achievements in 2018/2019 include the following.

• Implementing the Alcohol ABC Approach (assessment, brief advice, and referral for counselling) in general practices, Middlemore Hospital Emergency Department, the CM Health Living Smokefree Service, the Plastics inpatient ward, and with social workers in Manurewa. This has involved developing supporting systems, and providing customised training and support for frontline staff to help them have skilled and empathetic conversations with people and whaanau about alcohol use.
• Developing a regional data standard for general practice that defines Alcohol ABC indicators, the data to be collected, and standard terms and codes for data recording and extraction.
• Working with communities, health agencies, and other intersectoral partners, such as the Health Promotion Agency, to localise the national communications campaign focussed on alcohol-free pregnancies; and collaborating on the development of alcohol harm reduction approaches for high-risk youth.

Increased transparency in the allocation of the Flexible Funding Pool: The Flexible Funding Pool is a pool of funding distributed under the national Primary Health Organisation Services Agreement, for the purposes of health promotion, services to improve access, care for people with long-term conditions and management services. Over 2018/2019 we have worked to increase the transparency of how this funding is allocated across the district, and have begun to develop a regional framework, which aims to better align priorities and actions to improve equity.

Living Smokefree: In 2018/2019, the Living Smokefree service has received over 5500 referrals. Of these, 70% are Maaori and Pacific, which reflects the equity commitments the service adheres to. The service works across the health system in collaboration with primary care, secondary care, maternity care, mental health, community health and community settings, to engage with whaanau to support them to stop smoking.

People Powered

Workforce reflecting our population: An improved recruitment process for increasing Maaori and Pacific representation in the nursing workforce has been progressed during the 2018/2019 year. The recruitment process used for the last intake of graduate nurses for 2018/2019 (the September 2019 intake) identified that: 100% of all Maaori and Pacific nursing candidates were shortlisted to interview; a mihi whakatau and a creative interview assessment centre were provided; and there was cultural representation across all of the interview panels. Overall, Maaori and Pacific collectively represented 41% of this total graduate intake.

South Auckland Social Wellbeing Board: CM Health is a member (and host) of the South Auckland Social Wellbeing Board. The board is a multi-sector endeavour involving 13 agencies, and is trialling new ways of working to promote child wellbeing and better meet the needs of tamariki and whaanau in South Auckland. The South Auckland Social Wellbeing Board spotlights the social determinants of health and is seeking to reduce siloed ways of working and commissioning across agencies. Over 2018/2019, the board’s activities included exploring innovative ways to reduce the exposure of children to family violence and the impact this can have on life-course outcomes; supporting the ‘Start Well’ initiative, which is testing a new way of supporting young mothers, their babies and wider whaanau from pregnancy through to when the child is age five; and providing innovative support for teachers/kaiako and children in early childhood education settings.

One Team

MRI waitlist reduction: The MRI team has reduced the MRI waiting list from 1734 in April 2019 to 730 by June 2019. Opening the new radiology unit in November 2018 allowed CM Health to co-locate two scanners and work a 2+1 medical radiation technologist staffing model, using three medical radiation technologists between two scanners. As we now have a shared control room and patient preparation area, we have been able to optimise our staffing, with one technologist on each scanner and one ‘floating’ between the, two helping to prepare patients. This freed up two technologists to keep the third MRI unit, which is situated away from the main hospital, open – and this has been our biggest efficiency gain.

Smart System

Urology service Cx Bladder Project: Cx bladder triage testing was introduced to the urology service in October 2018, to investigate people with blood in their urine (haematuria) and help diagnose potential cases of bladder cancer. The testing involves suitable patients visiting a local laboratory to provide a urine sample, which is then forwarded to an external laboratory for analysis. Of the 371 reported tests to 30 June 2019, 207 patients have been able to be discharged to GP care or other clinics with no further investigation required, where they would normally have required a cystoscopy.

Value and High Performance

Every Hour Counts: Over 2018/2019, the Every Hour Counts portfolio was established with the vision of improving patient flow to optimise the quality of care, the experience of care, and the experience of caring, while also improving the efficiency of the system. This covers both acute and ambulatory patient flow, with a number of work programmes in each area. This portfolio of work will support CM Health to deliver a more effective, timely, end-to-end, patient-focused system of care. It also aims to optimise and value the time of staff, by reducing the steps in patient care, in order to get the best out of the highly skilled workforce we have.

Safe Surgery Patient Safety Markers: CM Health leads the country in auditing the Safe Surgery Patient Safety Markers of briefings, checking, timeout, sign out and debriefing at the end of the theatre lists. CM Health achieved 14,151 audited moments, with a 97% average of good team engagement within the 2018/2019 financial year.

Every $ Counts: The Every $ Counts portfolio supports CM Health’s financial objective to return to a sustainable financial position. In 2018/2019, a number of projects were consolidated under Every $ Counts, with a total savings of $8.7million.

Hand hygiene: In the latest national hand hygiene report to June 2019, CM Health has the second highest levels of ‘moments’ (the key moments when health-care workers should perform hand hygiene) recorded nationally; and one of the best compliance rates for large district health boards (DHBs), with a compliance rate result of 87.7% against a national rate of 85.1%. All major groupings of health care workers met the 80% compliance rate in the latest audit results.

Falls in hospital: CM Health has consistently met the target for the percentage of older patients assessed for risk of falling and having an individualised care plan that addresses this risk. Risk assessment and care planning has led to a consistently low number of in-hospital falls leading to hip fractures sustained at CM Health since October 2015.

Fundamentals of Care: The Fundamentals of Care programme was introduced by CM Health in October 2017 to measure standards of care against nine fundamental elements of care at Middlemore Hospital and the Manukau Elective Surgery Centre. The programme aims to ensure the consistent, safe, and high-quality delivery of the fundamental aspects of care, for all patients, by all health professionals. Fundamentals of Care has steadily built in significance for our nursing teams and, in March 2019, CM Health completed our third cycle of the programme’s review. The overall organisational result was 82.2%; the lowest achieved standard was ‘Clinical Monitoring and Management’ with 75.3%, and the highest ‘Respect, Privacy and Dignity’, which scored 87.0%.

People Powered

Retinal Screening Clinic: A new walk-in Retinal Screening Clinic has been established alongside the High Risk Diabetes in Pregnancy Clinic has been established. This clinic has captured several women who have significant retinal disease, some requiring urgent laser treatment to save their sight.

Closing the gender pay gap: Gender pay equity is a fundamental issue of fairness at work. It is also one of the government’s priorities to close gender pay gaps in the public service. In 2018/2019, CM Health undertook analysis to understand the gender pay gap for our employees. This analysis identified that in some cases women were paid less than men for performing jobs in the same job band. CM Health is committed to correcting this and during 2018/2019 a gender pay gap correction was applied to eligible IEA women within bands 5 to 8 (approximately 150 employees). CM Health will work with the sector to address gender pay gaps for other groups over 2019/2020 and 2020/2021.

Spend Five to Save Lives – Surgical Safety Checklist: In 2018/2019, CM Health successfully embedded start-of-list briefings (called huddles) throughout all theatres as part of the safe surgery campaign. For each of these huddles, the full surgical team meet for a few minutes before the start of the surgical list to introduce themselves and discuss each patient on the list and any other relevant issues for the day. The huddles are improving teamwork, camaraderie, patient safety and efficiency.

One Team

Newly registered CM Health nurse practitioners: Four nurses have gained nurse practitioner registration over 2018/2019, reflecting the culmination of many years of hard work and focus, and bringing the total number of nurse practitioners working at CM Health to 18. The four newly registered nurse practitioners are now providing their expertise in our neonatal unit and mental health, ophthalmology and diabetes services.

Regional approach to using data for primary care quality improvement: Under the Regional Data Sharing Framework, a number of key health outcome indicators have been agreed across the DHBs and primary health organisations in Auckland. Using Health Safe, quarterly uploads of this data are occurring, and the information can be used for service quality improvement and planning.

The Medinz Primary Care Communications Platform: The Medinz platform has now been implemented across the district. Medinz provides a single place for all primary care staff, including GPs, pharmacists and staff in urgent care clinics, to receive communications from DHBs, community laboratories, regional public health units and primary health organisations. This supports consistent and timely communication across the whole primary care sector.

Smart System