Finalists for the 2006 Health Innovation Awards
Attention News Editors: The finalists include entries from Auckland, Gisborne, Hamilton, Tauranga, Rotorua, Palmerston North, Wellington, Christchurch, the West Coast, Dunedin and Southland.
Auckland
Beverage Guidelines a first in child obesity programme
In a New Zealand first, guidelines are helping reduce the almost six kilograms of sugar the average kiwi child drinks each year.
One in three New Zealand children is overweight or obese and more than a quarter of an average child’s daily sugar intake comes directly from what they drink.
Formulated for schools, the Beverage Guidelines use a ‘traffic light’ system that shows the healthiest drinks schools can stock for their students.
Beverages from the green category are a healthier choice, offering some nutritional value and containing fewer kilojoules than ‘amber’ or ‘red’ drinks.
‘Red’ beverages -- such as full-fat milk drinks and sweetened fizzy drinks -- have limited nutritional value.
The guidelines encourage schools to replace ‘red’ beverages with amber or green category drinks.
Waitemata District Health Board developed the guidelines and the National Heart Foundation of New Zealand reviewed them.
Thirteen Waitemata secondary schools and one primary school took part in the project in 2005. More schools are expected to take part in the scheme.
The Beverage Guidelines are part of a comprehensive approach the DHB is taking to tackle New Zealand’s childhood obesity epidemic.
A second project – the Wellbeing in Schools programme is addressing physical activity and other nutritional factors.
Contact: Bryony Hilless 09 486 1491
Email:
Improved acute medical and surgical assessment
A streamlined admission process at Auckland City Hospital is providing improved care for patients, reducing delays and saving inpatient beds.
The changes at the hospital are attracting interest within New Zealand and overseas.
When inpatient services at Greenlane and National Woman’s Hospital closed there was an increase in patients presenting acutely to the new Auckland City Hospital.
They developed an Admission and Planning Unit to improve an admission process that at times was cumbersome, inefficient and involved the double handling of patients.
The 45-bed unit, run by Inpatient Services, provides rapid assessment, investigation and treatment. Patients are admitted if necessary, discharged if not. Next to the Emergency Department, the unit accepts medical and surgical acute admissions.
Patients who have already been seen by their GPs or an accident and emergency clinic and do not require emergency treatment are sent directly to the unit after a triage assessment in the Emergency Department.
This prevents double handling in the Emergency Department and saves nursing and medical time. Taking the load off the Emergency Department has also prevented “corridor medicine”. Almost half the patients admitted to the unit are discharged within 36 hours, and 18,000 bed days were saved in one year.
Although similar units operate in Australasia and the United Kingdom, most are for medical patients only and do not allow direct access from the community. The Auckland unit is now recognised as the Australasian benchmark. Numerous visitors from Australia, the UK and New Zealand have visited the unit, hoping to develop similar facilities at their hospitals.
Contact: Dr John Henley 09 379 7440
email:
Cornerstone – general practice accreditation programme
A quality improvement programme is setting the standard for patient care in every general practice in New Zealand.
Cornerstone, developed by the Royal New Zealand College of General Practitioners (RNZCGP), helps practice teams work together to identify improvements, plan changes and take action to improve their practice.
Practice teams start their own quality improvement regime by assessing themselves against Aiming for Excellence - the RNZCGP Standards for General Practice Care. These were developed through a wide multidisciplinary group, and cover the quality needs of the three key stakeholders: patients, professionals and practices.
Following the practice's own improvement processes, teams of independent assessors with GP, practice nurse and practice manager experience provide an independent review. They explore their findings and further opportunities with the whole practice team.
By December 2005, 55 of the estimated 950 general practices around New Zealand had received Cornerstone accreditation and a further 245 were undergoing their own initial reviews.
Contact: John Wellingham 09 486 8920
email:
On TRACC -Transcultural and intersectoral care centre
Refugee children with problems are now benefiting from an integrated transcultural service in Auckland.
The centre brings together relevant agencies to provide a coordinated and culturally appropriate service for children with severe behaviours, mental health or care and protection needs.
On TRACC is a collaborative pilot project, funded by the High and Complex Needs Unit - a joint initiative of the Ministries of Health, Education and Child, Youth and Family, to improve outcomes for children and young people with high and complex needs through effective inter-agency service collaboration.
The pilot scheme has developed effective service delivery practices and promotes refugee issues within the government departments working with them. It is also helping to determine the most cohesive way for departments to deliver services to refugee communities.
The lessons learnt from the pilot will contribute to the existing information known regarding the complexities of working effectively with refugee populations and their unique requirements.
An evaluation of the service shows the benefits gained from attendance at the centre include a reduction in the severity of symptoms of trauma and participation and achievement in education, management of youth offending, mental health issues and care and protection needs.
On TRACC is the first scheme developed in New Zealand to provide a comprehensive transcultural and integrated service for refugees. The pilot has helped improve existing service responses in government agencies.
Contact: Peter Shaw 09 307 4949
email:
Advanced Wound Care
Access to specialist care means speedier recovery for patients with painful and debilitating wounds.
Treating serious wounds is costly and recovery can take months, sometimes years. Wound nurse specialist Amanda Palmer is helping to change that.
The Advanced Wound Care Project is a joint initiative between Auckland’s HealthWest primary health organisation (PHO) and Amanda’s Wound Management Consultancy.
If a practice nurse or GP feels that a patient needs specialist assessment or treatment, they call in Amanda. This has a two-fold effect. Not only does the patient receive specialist care but the practice nurses and GPs also have the opportunity to learn.
Amanda provides wound management education, advice and support. Twenty-five practice nurses have studied how to manage complex wounds.
Before the programme was available, patients complained of wounds taking a long time to heal.
With Amanda’s care, the average healing time is now nine weeks and patients are more satisfied with their treatment. They need fewer visits to the doctor, experience better continuity of care and feel more involved in the management of their wounds.
Amanda is now spreading the word across the country. She has helped to develop The Compression Therapy Service Project for ACC-related lower leg wounds. Based on the Wound Care Project, this service has been extended to include other specialist practitioners around the country.
Contact: Amanda Palmer 027 443 2546
email:
Organisational Change Management – Making a Case for Change;
A Clinical Governance Tool
A page on a patient’s electronic medical record allowing nurses to identify patients with potentially high risk medical conditions is improving healthcare for thousands of patients in South Auckland.
About 90-95 percent of medical errors are from faulty processes rather than mistakes by a health professional.
People are quick to point the finger at health professionals and this culture of blame can reduce willingness to report errors or near misses. The opportunity to share lessons learnt is also missed.
A proactive approach to reducing the potential for mistakes helps safeguard high standards of care.
The Triage Template is a page in the patient’s electronic medical record that allows nurses to identify any patients who present with potentially high risk medical conditions such as chest pain, shortness of breath or severe allergic reaction. Relevant findings from examining the patient are recorded for the doctor.
The Triage Template allows an easy audit of the level of care provided for these patients.
The Triage Template was piloted for a month in three of East Tamaki Healthcare’s eight surgeries. After evaluation, the template was modified and rolled out to all East Tamaki Healthcare’s surgeries.
The template was designed by Dr Richard Hulme, Director of Clinical, Quality & Continuing Medical Education at East Tamaki Healthcare.
East Tamaki Healthcare provides care for more than 70,000 patients in South Auckland.
Contact: Dr Richard Hulme 021480111
email:
Gisborne
Ngati and Healthy - Diabetes prevention project
A community health project tailored to the lifestyle of remote East Coast communities is tackling high rates of diabetes among Maori.
Traditional ‘boil ups’ are out and gathering food from the sea and the bush becomes part of an exercise programme in the Ngati and Healthy project. The East Coast Rugby team even act as role models to promote a healthy lifestyle.
Ngati and Healthy is a collaboration between Ngati Porou Hauora, the major health care provider for the largely Ngati Porou communities living north of Gisborne, and the University of Otago’s Edgar National Centre for Diabetes Research.
Of 247 people randomly selected for the project, more than half were at risk of developing diabetes or already had it.
Twenty-two people had diabetes they knew about and a further 11 people were identified as having diabetes. Eleven people had impaired glucose tolerance, and 91 people were insulin resistant.
The programme’s strength is its focus on the community as well as the individual. Health indicators such as blood pressure, weight and waist measurements are monitored, but the programme also includes nutrition and exercise programmes that suit the East Coast Maori lifestyle.
Researchers are also trying to make healthy foods such as wholegrain bread easier for people to access.
The Ngati and Healthy project is taking place in coastal communities with a population of approximately 6000. It will run for two years.
Contact: Terry Ehau 06 8646 803
email:
Hamilton
Design and implementation of CostPro, an activity based costing system and patient data warehouse
A New Zealand-developed system for costing health services is helping district health boards save thousands of dollars.
CostPro also provides the Ministry of Health with the data to determine accurate figures about health costs.
Costing and Business Solutions, a specialised consulting firm that develops and implements systems for health care organisations, developed CostPro.
Accurate costing is vital to the Ministry of Health, DHBs, clinicians and managers as budgets are constantly being juggled to ensure health dollars are spent wisely.
The CostPro system spans an entire organisation to provide accurate cost information of the business right down to an individual patient’s stay.
Seven DHBs have adopted CostPro over the last three years. In many cases, it has replaced an American system that was more expensive, not user friendly and slower.
Hospitals are reporting cost savings and identifying revenue opportunities of about $100,000 to $300,000 a year.
Reports are also easier to extract from CostPro and are produced in less time than under the old system.
CostPro also provides the Ministry of Health with detailed patient costing data for the determination of national prices.
Analysts use the system extensively to report on patient treatment patterns, length of stay analysis, profitability of contracts and department productivity.
Contact: Ross Wilson 021 527 007
email:
Rotorua
Options for Patient Treatment
Patients in Rotorua are enjoying hospital treatment at home.
The Options for Patient Treatment (OPT) scheme provides free services to patients. It was developed by the Rotorua General Practice Group to improve patient access to healthcare and to plug some gaps in the services previously provided.
The range of patient conditions being treated at home is expanding and includes cellulitis, deep vein thrombosis and elderly people who have had falls.
Patients are referred from general practice, from the Emergency Department, or from the hospital through early discharge. They receive clinically and culturally appropriate home assessment and treatment.
Pacific people and Maori, who are often reluctant to go to hospital seeing it as a place to die rather than a place to get better, really appreciate this option.
Rotorua Hospital is also saving bed space for urgent patients and the Emergency Department can refer patients who would not be admitted as emergencies but are unable to cope at home.
The OPT scheme also means people in rest homes can be cared for without having to go into hospital and ACC is benefiting from reduced costs of patient care.
Rotorua General Practice Group is a health management organisation that works in partnership with family doctors and their practices. The partnership includes 16 urban practices and one rural practice, and involves 64 GPs and 63 practice nurses.
Contact: Fiona Thomson 07 349 3563
email:
Tauranga
Patient driven outcomes in joint replacement surgery – immediate and long-term analysis
Orthopaedic patients are partners in their own assessment process in the Bay of Plenty.
In a New Zealand first, the Bay of Plenty District Health Board is using a system set up by a group of local orthopaedic surgeons to help prioritise the treatment process for patients.
The Tauranga Orthopaedic Research Society Inc (TORSI) was created by the eight orthopaedic surgeons in Tauranga to study the outcomes of their orthopaedic surgeries.
Patients assessed by an orthopaedic surgeon as needing hip or knee joint replacement surgery complete scientific assessment forms.
These internationally recognized scoring tools record their health and wellbeing, the level of their joint pain and stiffness, and their ability to perform tasks of daily living with their affected joints.
By completing the surveys before and after their surgery, the patient’s subjective outcome is measured and added to the clinical assessment made by the surgeons.
This recognizes that the most important assessment of the result of joint replacement surgery is how the patient feels about it.
To date, almost 1500 patients have been scored, including more than 600 DHB patients who have been prioritized for treatment.
The orthopaedic surgeons also use the scoring system for the long-term follow up of their joint replacement patients. This allows long-term surveillance of patients over the lifetime of their artificial joint. The system used is unmatched by any other in New Zealand.