Contents

General Comments:

Specific Comments:

Objective 1: Improve Māori health outcomes (Ditre / Janet is this table in the quarterly regional report?)

Objective 2: Integrate across continuums of care

Objective 3: Improve quality across all regional services

Objective 4: Build the workforce

Objective 5: Improve clinical information systems

Objective 6: Efficiently allocate public health system resources

Work programmes of the regional networks and action groups

Cancer services

Cardiac services

Elective services

Health of Older People

Mental Health and Addictions

Midland Region Trauma system

Midland Stroke Network

Child Health Action Group

Midland Maternity Action Group (MMAG)

Radiology Advisory Group (MRAG)

Midland Smokefree programme

2014/15 MEASURES 11

Note: Thisreport should be read in conjunction with the Midland District Health Boards’ Annual Plans and Māori Health Plans.

1

Overall Status / G / Report Date:20 October 2014
General Comments: /
  • Progress with the Quarter 1 milestones for initiatives in the 2014/15 Regional Servies Plan (RSP) are summarised below. Further detail about the initiatives can be found in Appendix 4 of the 2014/15 RSP. The initiatives are aligned against the region’s six strategic objectives to show how they contribute to the achievement of the region’s strategic outcomes and vision. An assessment of progress is provided using a colour coding of green (on-track), orange (caution), red (in trouble) or blue (completed). Where necessary a comment is provided to support the assessment or to clarify the progress.
  • Importantly, the colour assessments in this report are an indication of progress against agreed actions in the 2014/15 Regional Services Plan (RSP) to strengthen and improve health services. Therefore any conclusions about the quality, safety and effectiveness of health services provided by Midland DHBs cannot be drawn from assessments contained in this report about progress with these actions.
  • This report uses an exception format, providing an explanation when an action that was agreed to be achieved in the quarter is not on track. Data and measures that relate to each area are provided in the back of the report (refer to the Table of Contents for easy access).
  • The progress report begins with initiatives that support the achievement of the six regional objectives but which are not part of the regional networks and action groups. The progress with the initiatives of these regional groups then follows. Alignment of the initiatives with the six regional objectives is provided. It needs to be noted however that the six strategic objectives, while helpful to provide a clear line of sight for the region, they are simply a construct to communicate a purpose. Aligning initiatives against these strategic objectives can create some difficulty for regional networks and action groups. This is due to initiatives in individual work programmes being interdependent on other initiatives and being developed as an integrated ‘whole’ for that service or area. Rearranging these initiatives to fit a regional construct may not fit neatly.
  • The measures section of this report presents the summary KPIs for the regional clinical networks and action groups.
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Specific Comments: /
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Objective 1: Improve Māori health outcomes(Ditre / Janet is this table in the quarterly regional report?)

Performance measures: The list of health indicator priorities and the regional lead and co-lead that are detailed below:
No. / Priority / Potential Measure(s) / Comment
1. / Smoking cessation / Health target (Primary Care) / National MHP Priority / IDP:
90% of patients who smoke and are seen by a health practitioner in primary care, are offered brief advice and support to quit smoking
Well Child / Tamariki Ora Quality Improvement Framework (WCTO QIF):
86% of mothers are smokefree at two weeks post natal (#19)
90% of children live in smokefree homes (age four years) (#20)
2. / Breast and Cervical Screening / National MHP Priority
70% of eligible women have had breast-screening
80% of eligible women have had cervical screening
3. / Immunisation / Health Target / National MHP Priority / IDP / WCTO QIF
90% of eight month olds have their primary course of immunisation at six weeks, three months and five months on time by July 2014 and 95% by December 2014.
4. / Breastfeeding / National MHP Priority / WCTO QIF*
74% of infants are exclusively or fully breastfed at six weeks
63% of infants are exclusively or fully breastfed at three months of age
27% of infants are exclusively or fully breastfed at six months of age.
WCTO QIF
74% of infants are exclusively or fully breastfed at two weeks (#11)
68% of infants are exclusively or fully breastfed at six weeks (discharge from LMC) (#12)
54% of infants are exclusively or fully breastfed at three months of age (#13)
59% of infants are receiving breast milk at six months (exclusively, fully or partially breastfed) (#14)
5. / Cardiovascular Disease / Health Target/ MHP Priority
90% of the eligible Māori population who have had their CVD risk assessed within the past five years (ht)
70% of high-risk Māori patients will receive an angiogram within 3 days of admission. (‘Day of Admission’ being ‘Day 0’)
Over 95% of Māori patients presenting with ACS who undergo coronary angiography have completion of ANZACS QI ACS and Cath/PCI registry data collection within 30 days
Key: Completed / C / On Track / G / Caution / A / In Trouble / R

1

Māori health reporting
Priority Area / Outcome Reported / Progress / Comment
Quality Assurance / Establish Regional Tools to Support Māori Health Gain
Māori Health Gain
Smoke-free Aotearoa by 2025 / Support attainment of Māori Quit Support Indicators in secondary and primary care
Cardiovascular disease / Cardiac
  • Cultural Competency
/ Colours provided as examples only
  • Health Literacy

Stroke
  • Provide support for DHBs local work plans to implement the 2010 Stroke Guidelines.

  • Support the NZ Stroke Foundation to develop a primary stroke prevention education resource kit

  • Ongoing implementation of education programmes for clinicians across the region, inclusive of education resources for Māori health key workers.

  • Discharge planning and post stroke care stocktake completed and plan developed to address gaps and issues

  • Stroke services are accessible and utilised by Māori within the Midland region. Measures collected including audits are broken down to include ethnicity

Māori Health Gain activities led by regional groups-in areas outside the identified five priority areas / Child Health- Child Health Action Group
  • Ongoing monitoring of child and youth initiatives across the region and nationally

  • Key outcome measures are monitored by the Child Health Action Group

  • Well Child/Tamariki Ora Quality Improvement Framework

Cancer Services alignment - Midland Cancer Network
  • Continue to facilitate Midland Māori Health Providers in the Kia ora - E te iwi (May 2015)

  • Explore feasibility to increase the number of DHB whānau ora/ community/ Iwi workers whose contract agreements that include cancer component (April 2015)

  • From FCT wait time data information and/or from regional tumour standards identify any equity issues and implement improvement strategies(June 2015)

Objective 2: Integrate across continuums of care - Please see the progress reports of each regional network and action group

Objective 3: Improve quality across all regional services - Please see the progress reports of each regional network and action group

Objective 4: Build the workforce

Kiri to provide Q1 progress report

Objective 5: Improve clinical information systems

Darren / Katherine to provide a Q1 progress report

The current focus for clinical IS delivery is on the regional deployment of:

  • The ePharmacy hospital dispensing application which is due to go live across the Midland region at each DHB by the end of 2014.
  • Clinical workstation functionality utilising solutions from Orion, Sysmex and other suppliers is a foundation IS enabler across all clinical specialities. The first Midland DHB (Waikato) will be implemented on the solution in the 2013/14 financial year with Lakes DHB deployment in the 2014/15 financial year.
  • A regional clinical data repository as a foundation IS enabler across all clinical specialities. The Sysmex CDR is being established as a component of the clinical workstation solution to support access to clinical information across organisational boundaries.
  • Electronic referral management as a key enabler for improved clinical (and business) practice - implementing referral management workflow within the DHB and supporting intra- and inter-DHB referrals.
  • Further expansion of clinical pathway tools to support improved clinical practice.
  • The Midland Regional Telehealth Strategy through development and implementation of a work programme and supporting IT road map. Core videoconferencing capability is being established in the 2013/14 financial year.
  • The delivery of these initiatives requires ongoing prioritisation of current activities at both a local and regional level to enable appropriate resources to be made available.

Objective 6: Efficiently allocate public health system resources

Please see the progress reports of each regional network and action group

Work programmes of regional networks and action groups

Overall summary
National Initiatives / Progress / Progress
Cancer / Mental Health and Addictions
Cardiac / Stroke
Electives / Trauma
Health of Older People
Regional Initiatives / Progress / Progress
Child Health / Radiology
Maternity / Smokefree
Regional Objectives:
Initiatives are specifically aimed at achieving this objective
Initiativesmay achieve this objective but as an indirect consequence

Work programmes of regional networks and action groups

National Initiatives

Cancer Services Midland Cancer Network: Clinical Director, Dr Humphrey Pullon; Manager, Jan Smith

Key highlights
Risks for noting
What we did in Quarter 1, in addition to what we said we would do.
Regional Objective / Progress / Comment
1 / 2 / 3 / 4 / 5 / 6
Midland Māori cancer improvement plan / Colours provided as examples only
Primary - secondary pathway tools – prioritise pathway development & include equity reminders
Faster Cancer Treatment – using data / information to identify and address inequity & improve services
Shorter waits for cancer treatment - sustain performance targets for radiotherapy and chemotherapy
Improve medical oncology services - continue to implement Midland Medical Oncology Service Plan
Improve radiation oncology services – Waikato/Bay of Plenty service change transition project
Faster Cancer Treatment Health Target and wait time indicator
Regional tumour standard reviews - regional DHB stocktake and gap analysis against national standards
Improve Midland lung cancer services - Implement regional recommendations
Improve Midland gynae-oncology services
Improve the functionality and coverage of multidisciplinary meetings (MDM). Develop MDM databases
Improve waiting times and quality of endoscopy/colonoscopy services
Support the cancer nurse coordinator initiative (CNCI)
National lung cancer work programme

Cardiac Services Midland Cardiac Clinical Network Chair: Dr Gerry Devlin, Cardiologist, Waikato DHB

Key highlights
Risks for noting
What we did in Quarter 1, in addition to what we said we would do.
Regional Objective / Progress / Comment
1 / 2 / 3 / 4 / 5 / 6
Integrated Care Management - CVD Pathway development / Colours provided as examples only
Integrated Care Management -Primary Risk Factor Management
Integrated Care Management -Secondary Risk Factor Management
Integrated Care Management - Regional Cardiac e-referral mechanisms
Integrated Care Management – Heart Failure
Integrated Care Management – Cardiac Rehabilitation (in a scoping phase)
Ischaemic Heart Disease - Regionally agreed guidelines, protocols, processes and systems.
Ischaemic Heart Disease - Angiograms and Percutaneous Revascularisation
Ischaemic Heart Disease - Revascularisation - Cardiac Surgery
Strategic Midland Region Cardiac Regional Service Plan
Strategic Midland Region Cardiac Regional Service Plan – Health Literacy
Strategic Midland Region Cardiac Regional Service Plan – Workforce
Strategic Midland Region Cardiac Regional Service Plan – Cultural Competency e-learning programme

Elective Services Clinical Chair: Dr Martin Thomas, Chief Medical Officer, Lakes DHB

Key highlights
Risks for noting
What we did in Quarter 1, in addition to what we said we would do.
Regional Objective / Progress / Comment
1 / 2 / 3 / 4 / 5 / 6
Produce Maps of Medicine for Chronic Pain – one per annum / Colours provided as examples only
Complete demand analysis to inform Chronic Pain Map of Medicine pathways
Development of a Regional collaboration between external Chronic Pain agencies
Create sustainable workforce development plans for regional roles
Produce Maps of Medicine for ENT – one per annum
Develop network for ENT services
Continuation and development of additional regional sharing of patients to non-tertiary care facilities outside of their domiciled DHB
Reduction in appropriate low complexity acute cases being transferred to Waikato DHB
Expansion of sub-regional arrangements allowing sharing of lower complexity patient regionally

Health of Older People Clinical Chair: Dr Phil Wood, Geriatrician,Waikato DHB

Key highlights /
  • The Dementia Assessment and management Pathways were implemented on the Map of Medicine ( MoM)web site. There has been excellent feedback on these pathways resulting in more refinement of these tools. These pathways have been one of the highest polling pathways in the MoM.
  • Education resources for the roll out orf the Pathways have been developed withmore to come.
  • A Qilkview dashboard of data has been developed and is being refined through consultation with Hop experts from the Region.
  • Work is continuing on how to access and utilise the InterRAi data.

Risks for noting /
  • None Identified

What we did in Quarter 1, in addition to what we said we would do.
Regional Objective / Progress / Comment
1 / 2 / 3 / 4 / 5 / 6
Improving services for people with dementia / The Dementia pathways have been implemented on the Map of Medicine. Education resources: A Pathway training document has been completed. An information card for primary Care is about to be tested in Tairawhiti. Road shows to high light the Dementia pathways to Primary Care have commenced.
Delirium service development / The Delirium Sub Group has been given the green light to set up and a Chair has been appointed by the HOP Chair. A Terms of Reference has been established for the Group. A large amount of work has been completed within Waikato DHB which will form the basis of the new Groups work.
Wrap around services (rapid response and discharge management) / A Qilkview dashboard gas been developed during the last part of the 2013/24 year and the first quarter of the 2014/15 year. Recently an experienced Data Analyst has started with HealthShare and in consulation with the HOP group and in particular with the Chair a comprehensive data reporting plan is under development. Specific effort is being put into interrogating the InterRAi data to provide a picture of what is going on across the region.
Improving services between hospital specialist services and aged residential care / The HOP group includes representative from Aged residential care and Home Based Support Service providers. This provides the opportunity for excellent share learning exchanges.

Mental Health and Addictions Chair: Professor Graham Mellsop, Midland MH&A Clinical Governance

Key highlights /
  • The MH&A Clinical Workstation project Steering Group has been meeting monthly since August to progress the regional clinical pathway agreements. Significant alignment across all five DHBs with only minor points of difference identified.
  • Preliminary reports from the National MH&A Workforce Stocktake being presented at all of the regional Network meetings. 76% of Midland providers completed the workforce stocktake survey.

Risks for noting /
  • Nil

What we did in Quarter 1, in addition to what we said we would do. /
  • HISO New Codes training to each of the Midland DHB NGO providers
  • Back room and facilitation support provided to the Inpatient, Opioid Substitution Clinical Networks and to the Advanced Co-existing Disorders Practitioners workshop.
  • Participated in the National Shared Services MH&A Leadership quarterly meeting
  • Presented the MH&A Workplan to various for a
  • Facilitated a ‘live’ view of the West Coast MH&A Solution for the Clinical Workstation Steering Group

Regional Objective / Progress / Comment
1 / 2 / 3 / 4 / 5 / 6
Improve access to all age ranges / See below
Improve strategic alliances / Regional Networks continue to meet quarterly. At the August Consumer and Addictions Network meeting the Mental Health Commission attended to seek feedback on key questions.
Several papers submitted to the GMS P&F and Maori Health during the quarter.
Eating Disorders Inpatient Care / Supra-regional (Midland & Northern) project commenced with work progressing in the Model of Care. Midland is strongly represented at a clinical and funding level. Project timelines will not be met due to the amount of work that needs to be done around costings. Extension requested from the MoH.
High and Complex Needs / Stocktake format developed and circulated to Clinical Directors for completion. Agreed at Clinical Goveranance level that once a regional definition has been developed the remainder of the work will be locally driven.
Forensic Inpatient Care / Still awaiting the MoH release of the Forensic Guidelines.
Youth Forensic Implementation / All funding and model of care fully implemented.
Perinatal / Maternal Mental Health & Addiction / Perinatal Infant Phase II report completed and distributed widely. One off funding received to support consistent model of care development across the region. Dr Denise Guy workshops scheduled for Nov-Dec and will be offered in each DHB.
MH&A regional data management / Midland Clinical Workstation Project commenced. Steering Group formed and clinical pathway work being progressed. Solid alignment of all 5 DHBs with the regional Service Provision Frameworks developed so far.
Mapping document support provided to NGOs who were struggling to get these completed.
Regional Workforce Planning / Trauma Informed Care workshops held in all 5 DHB areas. Evaluation report completed and recommendations to be progressed by Clinical Governance and regional Portfolio Managers.
Maori MH&A 2 day Summit completed in the quarter. Evaluation Report completed and distributed widely.

Midland Region Trauma System Clinical Chair: Dr Grant Christey, Trauma Specialist, Waikato DHB

Key highlights
Risks for noting
What we did in Quarter 1, in addition to what we said we would do.
Regional Objective / Progress / Comment
1 / 2 / 3 / 4 / 5 / 6
Trauma Quality Improvement Programme (TQIP) - IT platform / Colours provided as examples only
Community of Research/Learning
IS Support for MRTS

Midland Stroke Network Clinical Chair: Dr Peter Wright, Neurologist, Waikato DHB