From the CEO Welcome to the Spring edition of Connect. Although it is officially Spring, we are still experiencing big numbers of presentations and admissions, putting pressure on all front-line staff. I want to thank all of you for such a sterling effort and for the fact that our 6 hour EC target has still been maintained despite the pressures. Our 20,000 Days campaign’s importance is highlighted in these figures. We absolutely must change our strategy to reflect the importance of primary and community care in helping to prevent avoidable admissions and to care for more patients where they should be treated. Hospital is not the best place to treat many patients and we have to make changes so that we can not only survive, we can also thrive. This means partnerships with primary care, patients and their whanaau and our communities. We must no longer think in silos but about how what we are doing links with primary care. This is where whaanau Ora and such thinking has such an important part to play in how we embrace our future and the pressures that await us. It’s not just about being more efficient but about changing how we think about our patients and how we partner with them. Research shows that if a patient has 3 or more co-morbidities that the cost of caring for them rises exponentially. We need to think about the best way of empowering that patient to take better care of themselves and to also be able to access the care they need where they need it, in the community A couple of weeks ago saw the first big step towards our patients being able to access the care the need in their own community with the launch of our first
Locality Clinical Partnership (LCP) in Franklin. LCPs are about working with our colleagues in primary care to deliver more healthcare closer to patients’ homes. Franklin LCP has been created in partnership with primary and community carers in Franklin and has a slant towards the needs of the community, many of whom are older in terms of the services that will be offered. So many people in our community now have say diabetes that if we do not get a good handle on the treatment of this epidemic, we will be overwhelmed in the future by increased hospital demand. One way of doing this is by having an ‘informed’ patient. Diabetes UK reckons that 80% of treatments can be wasted if the patient does not fully understand what the treatments are for and what we are attempting to achieve. Each of us has a part to play in creating the informed patient – and this applies to any chronic condition. On a very positive note I would like to mention the success of the APAC Conference held in Auckland recently and co-hosted by Ko Awatea with the prestigious Institute for Healthcare Improvement from Boston. The meeting drew over 900 healthcare professionals from 16 countries and delegates heard from such luminaries as Dr Don Berwick, Sir Muir Gray and Maureen Bisognano, CEO of IHI. Feedback I have had has been overwhelmingly positive and I know that patient safety and experience will be lifted several notches because of the conference. Thanks also to all the CM Health staff who attended. Best Wishes, Geraint A Martin, CEO, CM Health
Counties Manukau District Health Board has a new name and new logo - but rest assured we will still provide the same excellent services and care our patients have come to expect. It’s been a challenging process. Firstly our brand and values needed to be aligned with our commitment to the Triple Aim of keeping people well, improving patient experience, and affordability. Secondly it needed to define who we are and what we stand for. Our strategic objective is to become the best health care system in Australasia by 2015 and to achieve a balance between excellence and sustainability. The realignment of our brand reflects this journey and our surroundings, our history of Maaori settlement and our aspirations. Blue: The blue colour reflects the waters which bound our district and relates to the special significance of the Waikato river to Tainui Maaori. Wings: Fan shape reflects a birds open wings. Wings reflect freedom from illness and flight to a new future. Partnership: The interwoven wings establish the importance of partnership – wings are interdependent and must work together to function properly, this reflects our focus on integrated services and working closely with our partners and communities. Weaving pattern: Lines when crossed, reference Maaori weaving and have strong architectural cues. The three lines at the tip represent the three main cultures of Counties Manukau district - Maaori / Polynesian; Asian /Indian; and European. Manukau: The full name of the Manukau harbour is “Te Maanukanuka o Hoturoa” meaning, “the compelling paddling of Hoturoa” recognising the anticipation experienced as the Tainui canoe was paddled into the Manukau Harbour for the first time, and a possible reason as to why it was carried across the Tamaki isthmus to the Waitemata Harbour.
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Meet the board In each issue of Connect we will profile board members so that you can get to know them better.
Lyn Murphy Lyn Murphy was elected onto the Counties Manukau Health in 2010. Prior to this she was a Member of the Howick Community Board. Lyn originally trained as an Occupational Therapist. She has worked in general and psychiatric hospitals, as well as providing community-based care. She has been active in supporting a healthy community, including membership of CCS, Arthritis Foundation, and Paraplegics Association committees and Advisory Trustee for the Arohaina Trust for the Elderly. Lyn is a senior lecturer in management at the Manukau Institute of Technology. She has qualifications in psychology and management. She is currently completing a PhD in accounting and finance. Her doctorate thesis investigates the costs and benefits of medical research at CM Health . Lyn is active in promoting New Zealand as a good place to do health research. She is a member of the Australian and New Zealand Academy of Management (ANZAM), Health Management SIG and the New Zealand Association of Clinical Research (NZACRes). She is facilitating the development of a New Zealand chapter of the International Society of Pharmaco-economics and Outcomes Research (ISPOR). She is a recipient of the internationally prestigious ISPOR student award.
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healthAlliance staff ‘Live below the Line’ We had a ball cooking Could you live on $2.25 a day? That’s exactly vegetarian food for each what healthAlliance’s Information Services other,” Christina said. Training team did recently. On the team’s delicious The team of six took part in the Live below the ‘a la carte’ menu was: Line charity challenge from September 24-28th, dahl, potato curry, raising more than $1000 for the P3 Foundation, parata, roti, fried rice and which empowers young people to take a stand porridge with water for against extreme poverty in the Asia Pacific breakfast. region. P3 Foundation’s Team member, Christina Duthil, said it was a mission is to provide young people with the challenge to get by living on a tiny budget. opportunity to be active volunteers in tackling “We really missed the variety of food and extreme poverty. You find out more about them coffee! Resisting all the yummy food in our at www.p3foundation.org. ■ pantry was excruciating. We can’t even begin to imagine how unbearable it must be for people that can’t afford food to watch other people eat what they want. We just feel very blessed to be able to have whatever food we like.” The team pooled resources as much as possible and shared basic foods like oats and rice over the week-long challenge. “Buying the food for only $11.25 for 5 days got us creative with our menu and made us realise how hard it is to live on such a small Back Row: Najla Hassou, Christina Duthil, Jayasree Vijayakumar, budget and how much we waste. Elaine Lorimer. Front Row: Jane Shand, Avneet Sharma
A new service model for community pharmacy Significant and far reaching changes are included in the new Community Pharmacy Services Agreement which took effect from 1 July 2012. District Health Boards (DHBs) have been working with pharmacy representatives for some time on a new service model for community pharmacy. The aim of the new model is to strengthen the Pharmacist’s role in the modern health environment, and use their clinical skills and expertise as part of a multi-disciplinary health team to provide a high quality patient-centred service. The fundamental change in the model is a shift away from payment for each item dispensed to a system which incentivises the provision of clinical pharmacy services for patients. The new model was developed against the backdrop of increasing dispensing fees and a tight economic climate. In particular dispensing via weekly close control has been increasing at an
unsustainable rate. The Long Term Conditions Service has been introduced to help the five percent of New Zealanders with multiple long term conditions who have difficulty managing their medicines. Patients who don’t adhere to their treatment regime don’t get the best health benefit from the medicines prescribed for them. This is a particular area where pharmacists can help by synchronising and reconciling medicines and working closely with patients to identify barriers to compliance with medicines. Some pharmacists are already providing these services – the new model will encourage all pharmacists to do so, working with GPs and other prescribers to assist patients with their medicines. In the new service model, core dispensing services remain the same for the majority of people who receive pharmaceuticals. ■
Franklin Locality Clinical Partnership Applauded for national significance The launch of the Franklin Locality Clinical Partnership (LCP) is a landmark change for primary and secondary care throughout New Zealand, according to National MP for Hunua Paul Hutchison. The Franklin LCP, the first of four LCPs to be introduced in Counties Manukau, was launched in Pukekohe in September. “It’s taken quite some time to get [the integration of primary and secondary care] firmly and squarely on the agenda, but we have here… This is truly a landmark opportunity in New Zealand,” Dr Hutchison told the assembled guests. Counties Manukau Health (CM Health) has divided Counties Manukau district into four localities to improve the way healthcare is organised and delivered. LCPs, which partner CM Health alongside our other colleagues in the health sector (particularly Primary Health Organisations and GPs/family doctors) will be developed for each of the four localities. The Franklin LCP, a joint venture led by CM Health and ProCare, encompasses a network of health services providers and the Franklin community with the fundamental purpose of providing excellent health services for the people of Franklin. Dr Hutchison congratulated the founding members of the new partnership, which includes all of Franklin’s general practices (Waiuku Health Plus Medical Centre, Pukekohe Family Health Care, Pukekohe Medical Services, Seddon Street Medical Centre and Tuakau Health) and ProCare’s Franklin locality team alongside CM Health. LCPs are about working with CM Health’s colleagues in primary care to deliver more healthcare services closer to patients’ homes. For patients, this will reduce the inconvenience and expense of visiting Middlemore Hospital while enabling CM Health to shift demand for some services away from the hospital into the community, where some patients can be better looked after. In Franklin, the initial emphasis is on improving the experiences and health outcomes for patients, particularly in the areas of aged care, palliative care, COPD, CVD and diabetes. “People don’t say ‘I live in Counties Manukau DHB, they say, I live in Pukekohe.’ They relate to their community, so let’s build our services around the communities our patients relate to,” said CEO Geraint Martin at the Franklin LCP launch. “We need to work differently in different places, where the people are – not the lines on a map. “We’re beginning to describe the future of healthcare in New Zealand,” he said. “It sounds bold and dramatic, but it really is. Franklin is a
fantastic laboratory for what needs to happen in the rest of New Zealand.” ProCare CEO Ron Hooton said the new partnership has enabled greater understanding for all involved of the challenges each other faces. “We’re 110% committed to making this work,” he said. “There really is one ultimate measure of success for me: that there’ll be no more emails telling me that Middlemore Hospital is full and can’t take our patients.” Franklin was the first of four LCPs to be launched in Counties Manukau, with East (including Howick, Beachlands/Maraetai, Clevedon and Kawakawa/Orere), Otara/Mangere (including Northern Papatoetoe) and Manukau (including Southern Papatoetoe, Manurewa, Takanini and Papakura) to follow in the coming months. Geoff Smith, who has extensive involvement in the Franklin community and works at ProCare, has
Dr Paul Hutchinson at the Franklin LCP launch
been seconded as the General Manager of the Franklin Clinical Partnership. More information is available at www.cmhdb. org.nz. ■
Dennis Pickup Award Each year the Faculty of Medical and Health Sciences honours the best of our clinical teachers in the form of the Dennis Pickup Clinical Teaching Awards. These are made to clinical teachers who are judged by staff and students to have made an outstanding contribution to medicine, nursing or pharmacy by virtue of their qualities as role models and their contribution to the relationship between the health professions and the Faculty of Medical & Health Sciences. Our second 2012 Dennis Pickup Award recipient from the School of Medicine is Dr Paul Jarrett a Dermatologist at Counties Manukau Health. Paul Jarrett has only been at Middlemore for three years but already his contribution to the academic mission of the South Auckland Clinical School is outstanding. Paul has worked tirelessly to develop teaching in dermatology not only at Middlemore but also across the city. Currently he is working towards redesigning the dermatology contribution to Phase 2 formal learning. He has also mentored cohorted 5th years at Middlemore as part of a pastoral care programme. He is a regular examiner and contributor to the clinical methods programme. He has also volunteered to serve on the Faculty elective supervising committee. He is also a member and contributor to the Medical Education Research Group at the South
Auckland Clinical School (SACS). In addition Paul has enrolled in a Doctorate of Medicine MD programme and is collaboratively working across departments and across Universities to investigate the role of Vitamin D in Psoriasis. He has supervised a student in a dermatology research project and is a vital part of the postgraduate research group at SACS. Paul’s contribution as a ‘clinical academic’ outside of the normal full-time university model is a truly outstanding contribution to the work of SACS. In addition to the above contribution to the academic environment at SACS Paul is a highly respected clinician. He is fully deserving of a Dennis Pickup Clinical Educator Award. ■
Award recipient Paul Jarrett (right) with Mr Dennis Pickup at the ceremony.
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Finding refuge for Christchurch’s elderly “By three o’clock on Adversity often brings out Friday afternoon I had all the best in people and when of the approvals. There Christchurch was dealt a were no curtains, beds destructive blow it was coweren’t made and there operation and collaboration were no hand cleansers, that rescued the city’s most paper towels or toilet tissue vulnerable older citizens. dispensers,” Allan says. Workers at Christchurch’s He contractually ‘seized rest homes and private the building’ from the hospitals initially thought they builders and then it was all could cope with the aftermath hands on deck to clean and of the big quake that hit on set up everything ready for Tuesday February 22, 2011. the Christchurch evacuees However, without power, by 8pm on Friday. water and sewage systems Jenni says Auckland’s it was soon evident that three DHBs planned the residents needed to be Allan Sargeant, Co-owner of Ambridge Rose Manor worked with Berta Nicoll, Health of Older together and the goal relocated to somewhere People Programme Manager and Jenni Coles, director Hospital Services to re-home Christchurch earthquake evacuees. was to keep the expected safer that could provide for 60 Christchurch people their needs. to supplying hand gels. together. People throughout New Zealand wanted to Allan knew he would need all the compliance “The psychological risk and stress of being know how they could help Cantabrians and staff approvals off to be completed for these new moved would be significant and we could put members at Counties Manukau Health (CM beds to be available. in good support packages from CM Health . Health ) were keen to do their bit. A planned Ministry of Health sign-off went This would be more efficient if we had people When other regions were asked to provide smoothly, Auckland Council promptly issued a grouped together rather than dotted all around accommodation and support CM Health, Health certificate of public use for the ground floor only the area,” says Berta. of Older People Programme Manager Berta and NZ Fire Service signed off for fire evacuation. A triage team was organised to meet the Nicoll, was asked to coordinate the Auckland arrivals at Whenuapai at 8pm on Friday February region response and put in place plans to assist 25. the residential aged care facilities. “The DHBs had their action teams and facilities “Rest home residents were transferred around were waiting and ready to go,” Berta says. the South Island first, within land transport,” says “We were phoned at 9pm and told people Berta. weren’t coming that night and we could stand Air transport transferred people to more When Jenni Coles needed help to down until the morning.” distant locations such as Nelson and Invercargill accommodate older evacuees from Berta stood the DHB and facility teams down but it became logistically easier to transport Christchurch she knew she could depend and headed home, but at about 10pm she was people to Auckland where there were more on the residential aged care providers in contacted again and was told the plane was vacant beds. CM Health . about to land at Whenuapai. Within a day Berta was co-ordinating the “We have excellent collaborative “I re-started the triage. By this stage staff had Auckland region and by Thursday private relationships with the aged care sector. all gone home and people were getting ready hospitals and rest homes were on stand-by. “We negotiated with Allan to make for bed or quietly unwinding. They all came back There were three new facilities in Auckland, Ambridge Rose Manor available and did it again. and Berta and Jenni Coles knew there was on a handshake. That’s the trust that was “Holding an executive role and being at home potential capacity at Ambridge Rose Manor involved and needed at a time like this,” already didn’t let Jenni off the hook and the Private Hospital and Rest Home in CM Health says Jenni. acting COO was collected by Berta to assist in the region, although the new rooms weren’t Allan says the logistical process was emergency response. completed. amazing and there was great support Allan had his feet up in his office but was Collaboration and a well-established from CM Health and his own team, which immediately back on duty calling staff to return relationship with the CM Health and the included the private hospital’s manager’s to Ambridge Rose Manor. residential sector proved invaluable in the husband and their visitors they had from “I learnt to double check every phone call emergency situation and the Pakuranga facility overseas. that came in to make sure I had the correct was asked if they could help out. When asked if he would do it again – he information,” Berta says. Allan Sargeant co-owner of Ambridge Rose responded with a resounding ‘no’, followed “The original call should have informed us Manor says the building was only a carpeted with a smile and ‘of course we would’. that only half the number expected was on that shell and the finishing fit-out was immediately evening’s flight.” launched, including everything from making beds
Sealed with a handshake
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The Christchurch people started to arrive at Ambridge Rose Manor from 1.30am where the CM Health clinical team and private hospital staff welcomed them and got them settled. Allan says the situation was a changing landscape that altered hour-by-hour and it was planning on the fly. “Until the Christchurch people arrived we didn’t know who they were or what level of care they needed. “Plans then changed minute by minute and people they thought could be settled in one room required a higher level of care and were placed nearer to the nurse’s station. “It worked really well. Some people could walk off – we could give them a cup of tea and settle them in their room. Other people needed more care and support,” says Allan.
Diabetes in pregnancy Lesley MacLennan and Isabella Smart, Clinical Specialist Diabetes Midwives working in the community midwifery service in Woman’s Health presented a poster at the ADIPS (Australasian Diabetes in Pregnancy Society) conference in Australia. The poster shows the development of a multidisciplinary care schedule and pathway for women with diabetes in pregnancy. The poster illustrates the development of a competency framework for specialist diabetes midwives at CM Health and various communication tools devised. It was very well received and we have had requests for further information regarding our developmental processes and communication tools from health professionals doing similar work in Australia.
The poster is the culmination of two years of hard work by the two Diabetes in Pregnancy midwives focused on improving the Diabetes in Pregnancy Service at CM Health. The aim is to enable pregnant women with diabetes to be cared for in a safe, appropriate and efficient manner – remaining with their primary care midwife wherever possible – thus maximising their choice of maternity carer and continuity of care, even when complicated by diabetes. The poster also demonstrates the links between primary and secondary carers in the care of women with diabetes in pregnancy and the communication tools to ensure information flow. To see the full poster, please call Isabella Smart on 021 784 061. ■
“Noeline Whitehead and her clinical team were set up to assess them comprehensively and to settle people into bed,” Jenni says. The last people were being settled at about 5am on Saturday. About 10 people arrived at Ambridge Rose Manor in the early hours of Saturday morning and at about 10.30pm on Saturday another five people arrived Many of the people had prepared to leave Christchurch at 5am on Friday and they didn’t arrive at Ambridge Rose Manor until about 1.30am the following day. As some arrived with nothing other than the clothes they wore and basic clinical information, the clinical team and caregivers assessed the need and provided the care and support. “Every action plan for emergencies says contact the families and they will come in and assist but you can’t contact families in this sort of situation,” Berta says. “Their homes were demolished, they didn’t have phones or power to recharge mobile phones and they were dealing with their own crisis. “They’re thinking in the back of their minds ‘at least my loved one is safe in a residential care facility.’ Physically they just couldn’t get to their relatives.” Berta was pleased to know the planning for similar situations really worked when put into practice. “We were really pleased that we could move quickly to meet this need” says Allan. “When we stopped we felt like we could do anything. It was a great confidence boost.” ■
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Connecting families in times of need First National Real Estate has kicked off a new relationship with the National Burn Centre by donating four new ipads, complete with Internet connections, to assist patients to stay in touch with their family and friends during their prolonged hospital stay for severe burn injuries. Tracey Perrett, National Burn Service Coordinator, says the donation of ipads will allow patients to use First National General Manager Colleen Milne, Chairman Bob Brereton and burn survivor Erik Molving with the new Home Safe Kits and ipads. social media and email to maintain contact with their friends and family during their admission to the photoelectric smoke alarm and a fire blanket. centre. iPads are also currently being trailed First National office and sale representatives in burn centres internationally to provide will give $5 from every Home Safe Kit to the First distraction during stressful procedures. National Foundation, which will then donate the “We are delighted to be able to offer this to full amount to the National Burn Centre. our patients in the National Burn Centre,” Mrs First National’s General Manager Colleen Perrett says. Milne said the partnership was a great way As well as the ipads, First National is gifting to give back to the community and support new home buyers a Home Safe Kit, which the lifesaving work the National Burn Centre includes a 0.9KG ABE fire extinguisher, a does. ■
SuperClinic’s wish list answered Christmas has come early for Manukau SuperClinic after a new ECG machine and autism toys were donated from Middlemore Foundation for Health Innovation sponsors. Donna Neal, Clinic Nurse Manager, was presented with a new ECG machine worth $13,000 from Visy Recycling General Manager Andrew Gleason. Visy’s 350 staff members competed in a six week ‘Biggest Loser’ fundraising challenge and The Pratt Foundation, founded in 1978 by Richard and Jeanne Pratt who own Visy, matched dollar for dollar their fundraising efforts. Siu Havili, 12, had rheumatic fever and a heart valve replacement when she was seven-years-old. This new ECG machine has made her visits faster. Mrs Neal said, in some cases, if a good heart rhythm was not detected on the old ECG machine patients had to make another appointment.
Middlemore’s Woman of the Year Doctor Vanessa Thornton, clinical head of Middlemore Emergency Care, has become a top 30 finalist in the NEXT Woman of the Year 2012 awards. NEXT magazine’s annual Woman of the Year awards ‘acknowledge remarkable women who manage all aspects of their lives while making an outstanding contribution in the following fields: Arts and culture, business, community, education, health and science, and sport’. The Middlemore Foundation for Health Innovation nominated Vanessa, not only because she runs one of the busiest emergency departments in Australasia, but because she is a wife and busy mum-of-three, leads health research and projects and is a great mentor to staff. Winners will be announced at a glamorous gala dinner on Thursday, October 11 at Auckland’s leading venue, The Wharf. ■
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Specialists used toys to diagnose Tresahn Wharerau, 2, with autism earlier this year.
On the other hand, the Twinkle Child Foundation, a student run charity, used its links with some of Auckland’s top schools to run bake sales, stalls and a comedy night at the University of Auckland. Proceeds raised bought toys for Manukau SuperClinic, to be used as a tool to help specialists diagnose autism in children. Louise Porteous, Developmental Paediatrician, explained the toys would be used in play-based assessments to see how patients analyse, problem solve, take directions and seek help. “We find informal assessment with skilled people is equal to more formal assessments,” Louise said. ■
Girl power wins kids’ hearts Communities give back Relationships with two community sponsors were strengthened when Weymouth Cosmopolitan and Sports Club and Red Knights Firefighters Motorcycle Club (Northland) were presented with Certificates of Appreciation. Weymouth Cosmopolitan and Sports Club had just donated $2,000 to Kidz First Children’s Hospital after its annual Kahawai Fishing Tournament on the Firth and Manukau Harbours. Keen anglers come from as far as Whangarei to take part in the fishing competition. This is the 12th year children admitted to Kidz First will benefit from the tournament. Over the last 11 years, proceeds from the event total $18,000 and have been used for much-needed equipment, like hearing aids, eyeglasses, a paediatric bed space and paediatric cot and vital signs monitor. A day after the fishing extravaganza, petrol heads took to Northland roads and revved into the 10th annual Ride for Kids run by the Red Knights International Firefighters Motorcycle Club (Northland). Two hundred riding enthusiasts cruised from Kaiwaka Fire Station to Waipu Fire Station. The event raised $1,500 for children admitted to hospital with burns. The annual rides have raised in excess of $10,000. ■
Most New Zealanders will never have the opportunity to hold an Olympic medal in the palm of their hands. But lucky patients at Kidz First Children’s Hospital held and wore two Olympic bronze medals recently. Rowers Juliette Haigh and Rebecca Scown visited Kidz First after winning bronze medals in the Women’s Coxless Pair event at the London Olympic Games in August. The visit arranged by the Middlemore Foundation for Health Innovation was discussed two days after Juliette and Rebecca won bronze. Six weeks later, when the pair walked into the Kidz First playroom it was hard to tell who was more excited - the patients or Rebecca and Juliette.
Kilahn Manuera, two, was the hugger of the day and took a liking to Juliette and wearing her medal. Cambridge-based Rebecca told sports-mad Kenna Richmond, 10, to follow her sporting dreams and that hard work really does pay off. Juliette said she was blown away by the excited patients and the experience of visiting Kidz First. “Amazing visit thanks, Juliette said. “Gorgeous kids and loved sharing our medals with them! We’d love to come again and bring more rowers too.” Middlemore Foundation and Kidz First patients can see Juliette and Rebecca again at the Kidz First Christmas Party in December. ■
Tyrone Oti, 10, couldn’t believe Juliette let him wear her bronze medal. Juliette couldn’t believe Tyrone made her a paper oar.
Middlemore alumni kicks off
Russell Rawiri, President of the Red Knights International Firefighters Motorcycle Club (Northland), and Sandra Penny from Middlemore Foundation shake a collection bucket for Kidz First.
Middlemore Foundation for Health Innovation is pleased to announce the arrival of Bernie Mackie, who has been tasked with creating an alumnus for past and present Counties Manukau Health and South Auckland Health staff. Bernie is no stranger to Middlemore, as a former nurse and now Middlemore Alumni Coordinator. Alumni members will be kept updated on CM Health projects, news and events. To join please call Bernie at the Foundation on 09 270 8808 or email Bernie. firstname.lastname@example.org. ■
Bernie Mackie is a former Middlemore nurse.
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Health science academies Counties Manukau (CM) Health faces significant challenges for future health service delivery including a global shortage of skilled health professionals and an ageing health workforce. Research literature indicates that having a health workforce that reflects the community it serves leads to improved health outcomes. Currently at CM Health there is significant under-representation of Maaori and Pacific in the clinical workforce. Growing this workforce is a key focus. The Tindall Foundation generously provided $2.25million to CM Health for 2010 - 2013 to develop opportunities for Maaori and Pacific people to enter CM Health’s workforce development pipeline. One of the projects funded by the Tindal Foundation is the Health Science Academies which was established in three secondary schools in 2010: James Cook High School and Tangaroa College partnered with CM Health while Otahuhu College partnered with the Pasifika Medical Association. The schools work collaboratively to equip selected Maaori and Pacific students with the prerequisites for entry into health-related tertiary degree programmes. The first cohort of Year 11 students entered the academies in 2011 with the target of 80% achieving NCEA Level One. 87% achieved this with many receiving merit and excellence endorsements. The health science academies were entered
into the Tomorrow’s Workforce category in this year’s ANZ NZ and Equal Employment Opportunities (EEO) Trust Work and Life awards and won ‘by a country mile’ according to the judges. The entry was then chosen as Supreme Winner. These accolades are a tribute to the vision and hard work put in by all involved. Congratulations to the Future Workforce team for their successful implementation of CM Health’s workforce development vision.
On Tuesday 2 October, there was a Health Science Fair held at the CM Health Ko Awatea centre where high school students had the opportunity to talk with people from various tertiary institutions that offer undergraduate programmes in health and also meet a range of health professionals from CM Health. For more information about the Health Science Academies, you can contact Christine Hanley, Workforce Consultant on 021 226 3293. ■
Northern region CLAB highlights The Northern Region has achieved zero CLAB for the months of April, May and August. In January 2012 the rate of CLAB was 4.53/1000 line days to a rate of 0/1000 line days. This is a very encouraging achievement and the teams to be congratulated on this great result. At the commencement of the project there were at least 4 reported CLAB per month. The Northern Region makes up 44% of the total line days (7760/17666)*100. It should be noted that the Northern Region has worked hard to implement the surveillance definition of CLAB. Implementing the surveillance definition across all DHBs requires active collaboration with microbiologists and Infectious Diseases Physicians. There were a total of 12 CLAB in the implementation months January to March. Since March there have been a total of 3 CLABS over a period of 5 months, at least 12 less patients diagnosed with a CLAB. CONNEC T I PAGE 8
The benefits to the patient are a better experience, reduced number of days in hospital and reduced harm. This was best demonstrated when a patient arrived at Middlemore Hospital from Auckland DHB with a central venous line in place. Prior to this National CLAB reduction programme this central line would have been removed and a new line inserted. However ICU staff noted that both the insertion bundle and maintenance bundle processes had been
followed with the checklists completed by staff at Auckland DHB. The patient kept the existing line and avoided the trauma of having it replaced. “This is really exciting because its shows the positive difference the staff make, most importantly for the patient”. This could not have achieved so much without involvement of the Project and Clinical Leads, the participating Microbiologists and Infectious Diseases Physicians and they are to be congratulated without exception for the focus and collaboration that has helped achieve the outcomes to date. Implementing the surveillance definition across all DHBs requires active collaboration with microbiologists and Infectious Diseases Physicians. There were a total of 12 CLAB in the implementation months January to March. Since March there have been a total of 3 CLABS over a period of 5 months, at least 12 less patients diagnosed with a CLAB. ■
Celebrating a new way of training nurses
From left: MIT student Dong Dela Cruz, Clinical Liaison Nurse Kusum Narayan and student Anj Taylor working within a Dedicated Education Unit at Middlemore Hospital.
Hospitals are busy places and when you are a nursing student doing your clinical experience you can simply feel in the way. Manukau Institute of Technology Bachelor of Nursing graduate Anj Taylor says she felt like a wallflower at times during her student days. “At handover it was like ‘who wants the student?’ It wasn’t negativity. You could see the nurses were exhausted and they felt the student wasn’t going to facilitate making their job easier. They felt like being with a student was a chore.” Luckily for Anj she became one of the first MIT students to do her clinical experience in a Dedicated Education Unit (DEU) at Middlemore Hospital. In a DEU students work shifts alongside registered nurses, but the environment and staff are dedicated to teaching and learning. The
student is not an add-on, but an integral part of patient care. In 2009 MIT and Counties Manukau Health worked together to trial two pilot DEUs in wards six and 24 of Middlemore Hospital. It has been a successful pilot. There are now nine DEUs within CM Health , consisting of seven inpatient wards, two in mental health and one recently set up for aged care at Howick Baptist Hospital. This week [Sep 5] a celebration was held at Middlemore Hospital, with past and current students, hospital and MIT staff attending to mark the success of the DEU model, which has become embedded in clinical education. Anj, who is now a registered nurse and helps teach students within a DEU, says she can’t imagine working in a different environment.
“I think the Dedicated Education Unit really breaks down barriers. It’s a fantastic philosophy and way of going forward. There is no way of failing. You’ve got all these people there to help you.” The staff and students within a DEU are supported by a Clinical Liaison Nurse (appointed by the hospital) and an Academic Liaison Nurse (appointed by MIT). Clinical Nurse Liaison Rhonda Thorn says there is no doubt the DEU environment is best for students. “We didn’t have DEUs when I came through MIT. I didn’t have a bad experience, but I knew there were some things missing. Now I’m able to help the students move through their study with confidence.” Rhonda says a focus is to introduce students to other disciplines within the hospital, including pharmacy, physiotherapy, occupational therapy, speech therapy and social work. This prepares students for the collaborative skills they need to give patients the very best care. One of the most eye-opening experiences for students is spending time with the hospital’s bed managers, Rhonda says. This helps them understand exactly what a patient goes through before they are admitted to a ward. MIT Dean of Nursing and Health Studies Willem Fourie says MIT and CM Health have presented to the Nursing Council about the success of the DEUs and have also published a how-to guide for other DHBs and tertiary institutions. The project has received support and funding from Ako Aotearoa, the National Centre for Tertiary Teaching Excellence. Director Peter Coolbear says it has been highly successful and the model could be used by other vocational training disciplines. ■
October is breast cancer action month October is Breast Cancer Action Month, and the perfect time for health professionals to promote the benefits of breast screening to their patients. Mammograms can find very small cancers before a lump can be felt and women who are aged 45 to 69 should be encouraged to join the BreastScreen Aotearoa (BSA) programme, New Zealand’s free national breast screening programme that checks women for signs of early breast cancer. Women aged between 45 and 69 who are not already part of BreastScreen Aotearoa can register to enrol on-line by going to www. breastscreen.govt.nz, or ringing the freephone number 0800 270 200. Primary care practices can refer women who have consented to be on
the programme electronically (Medtech practices only) or by fax or phone. As there will be increased publicity around breast cancer during October, GPs may be approached more often by women who have concerns about their breast health. As the breast screening programme is for asymptomatic women only, women with symptoms should be referred to the South Auckland Breast Clinic (fax 277 1646) and women with a strong family history of breast cancer can be referred to the CMDHB Mammography Unit (fax 277 1644). BreastScreen Counties Manukau has recently developed a Birthday card to send to women who are turning 45 to encourage them to enrol in the programme. Primary care practices wishing
to send these Birthday cards to women, or wanting to identify women who are not enrolled or who are overdue for the breast screening programme can contact Roshina Singh (ph 250 8070). Roshina can arrange a data match with the BreastScreen Counties Manukau (BSCM) data base, discuss the birthday card project and assist with other projects to increase participation in the BSA programme. If you would like further information about the BSA programme or you would like someone to talk to your practice or a group of your colleagues about the screening programme or breast cancer, please contact Roshina or ring the freephone number 0800 270 200. ■ CONNEC T I PAGE 9
Shared health information briefing Counties Manukau Health staff have had an opportunity to hear first-hand about improvements to the way personal health information will be shared electronically. By the end of 2014 the Government’s aim is for all New Zealanders and the health professionals caring for them to have electronic access to their core health information. The Ministry of Health’s National Health IT Board (NHITB) held a briefing for DHB staff and providers in Auckland in August, and NHITB Director Graeme Osborne was pleased with people’s engagement with the issues. “This is going to be a significant part of health care delivery in the future so I was glad of the opportunity to talk to DHB clinicians and staff, and some of their providers, about the progress being made. “Improved electronic sharing of health information will ensure that everyone involved in a person’s care will have access to the most accurate and complete information possible. That means health professionals have a fuller picture before making decisions, and result in better, safer care.” The Chief Executive of Counties Manukau Health, Geraint Martin, says that this is one of his priorities in terms of improving patient care and the patient experience. “I am aware of patients who have not understood clearly
what their medication is for and that is such a waste. If we are all talking together and sharing the same information the chances of this happening are much reduced,” he said. The DHB briefing was part of a series of public and community seminars held around New Zealand to discuss shared health information. These follow on from a series of community Future of Health workshops run in 2010, and the NHITB says there will be further opportunities for public feedback and discussion.
Graeme Osborne has led discussion at the seminars, supported by representatives from the National Clinical Information Leadership Group (NICLG) and the NHITB consumer panel. Public seminars have now been held in New Plymouth, Invercargill, Auckland and Nelson. There have also been seminars for specific groups – students and Maori, Pacific and Asian populations, and for DHBs/health sector. Emerging themes from shared health information seminars Ernie Newman, Chair of the NHITB’s Consumer Panel, says people using health and disability services will benefit greatly from
these improvements. ‘It means that clinicians caring for us will, with our consent, have access to all of our core health information over the course of our health journey,’ he says. “We will also be able to access our own records and take a greater role in managing our own health and wellness.” There was widespread support for the concept of electronic sharing of health information. Ernie Newman says issues which will need to be resolved to ensure public confidence include: • questions about security and confidentiality, and who will have access to information • the possibility of some information being ‘sealed’ to protect privacy and further restrict who can view it • questions about how long data will be stored • concern about other services gaining access to personal information • issues raised by particular community groups – eg Pacifica peoples seeking assurances about citizenship databases and Asian families concerned about access to an elder’s health status within the family. More information about the seminars and a list of Frequently Asked Questions (FAQs) can be found at: http://www.health.govt.nz/ yourhealth-topics/health-care-services/sharingyour-health-information. ■
National melanoma summit Health professionals with an interest in melanoma will gather in Wellington for the third National Melanoma Summit on 5 April 2013. With the theme ‘Connecting melanoma expertise in New Zealand’ the Summit will provide a unique and important opportunity for those working in all areas of melanoma control to hear about recent developments, identify priorities for action and work more closely to reduce melanoma’s incidence and impact. New Zealand has one of the highest rates of melanoma incidence in the world. In addition to hearing from internationally recognised melanoma experts, the Summit will include workshops on prevention, diagnosis, clinical management and research. One-day courses on common skin lesions and dermatoscopy will be offered on 4 and 6 April.
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Speakers The Summit programme features New Zealand experts, including overseas speakers who trained here and are now recognised internationally for their contribution to melanoma control: They include: • Professor David Elder, Professor of Pathology and Laboratory Medicine at the Hospital of the University of Pennsylvania and in the Department of Pathology and Laboratory Medicine at the university, who will speak about melanoma diagnosis and staging criteria. • Professor John Hawk, Emeritus Professor and recent Head of the Photobiology Unit, St John’s Institute of Dermatology, King’s College, London, who will talk about current trends in incidence and strategies for prevention of melanoma. • Dr Mary Jane Sneyd, medical epidemiologist
and Senior Research Fellow, Hugh Adam Cancer Epidemiology Unit, University of Otago, Dunedin, who will speak about how melanoma epidemiology in New Zealand differs from that of other countries and how these differences can give clues about melanoma risk factors. She will also discuss her development of a New Zealand-specific tool to assess an individual’s risk of developing melanoma. MelNet is sponsoring early bird registration, valued at $276, for five delegates working in the area of melanoma control. Successful applications will be chosen on the basis of merit and need. To register for the Summit, apply for sponsorship, or for more information, visit http://www.melanoma.org.nz/MelNet/News/ Melanoma-Summit-2013/ ■
World Honorary residency breastfeeding week World breastfeeding week was held again this year as for the past 20 years from August 1-7. The theme for this year was “Understanding the past - Planning the future” and this year also celebrates 10 years of WHO/UNICEF’s Global Strategy for infant and young child feeding. The Global Strategy has identified a clear need for optimal infant feeding practices in reducing malnutrition as well as poverty. It is based on a human rights approach and calls for the development of comprehensive national policies on infant and young child feeding. It provides guidance on how to protect, promote and support exclusive breastfeeding for first six months, and continued breastfeeding for two years or beyond together with adequate, appropriate and indigenous complementary feeding starting from the age of six months. ILCA (International Lactation Consultants Association) believe the strategy serves as their roadmap in developing a framework for action to protect, promote and support breastfeeding, hence their logo for this years World Breastfeeding Week theme, The Road to Lifelong Health Begins with Breastfeeding. The Lactation team at Middlemore chose to use the “Road to Lifelong Health Begins with Breastfeeding” as the theme for display posters in Maternity ward and ALBU. The Big Latch was held on Friday 3 August 2012. There were seven sites that Mothers and babies could attend within the CM Health area, and a total of 101 babies were counted toward the new national record of 1571(up from1564 last year). Lactation Midwife/Nurse Specialists from our team at Middlemore attended at Manurewa and Pukekohe to show our support. Globally there were a total of 626 locations across 23 countries and 8862 breastfeeding children counted for “The Big Latch”. Thanks to all those in CM Health area that are helping mothers and families to make their journey successful. References; http://worldbreastfeedingweek.org/ http://www.womens-health.org.nz ■
Five New Zealanders awarded Honorary Residency of the Cook Islands for outstanding service over many years in the arena of health to the people. Photo taken at the Queens Representatives House: Left to right: Liz Iro (Sec Health), Dr Bob Eason (Physician CM Health ), Dr John Veale, Lady and Sir Frederick Goodwin (Queens Rep), Andrew MacDiarmid (Orthopaedic Surgeon, Tauranga), Dr Mike Webber.
You are invited
Long term conditions workshop Date: 28th November 2012 Time: 12.00 – 2.00pm (please bring your lunch) Location: Ko Awatea Lecture Theatre – Middlemore Hospital Long-term conditions account for 70-78% of all morbidity and mortality in New Zealand and consume a similar proportion of all healthcare spending. New models of care are required to move from acute reactive care to planned, proactive care with improved health outcomes and patient experience. Workshop 101: An introduction to Patient SelfManagement This is a 2 hour session which introduces some key concepts and resources for improving chronic care. These include self-management support, health literacy and some practical tools for person-centred care planning. This is ideally suited for health professional continuing education sessions for medical, nursing, allied health or interprofessional forums within or across DHBs, PHOs, general practice and community health organisations. Workshop outcomes • Know how patient self-management can improve the management of long-term conditions. • Understand how patient self-management supports integrated care practise models. • Be familiar with Health Navigator’s resources – the website and self-management toolkit.
• Have been introduced to the Long Term Conditions Network –how it connects and informs health professionals and consumers across New Zealand. • Know about the importance of personcentred care in improving adherence and health outcomes. Please RSVP to Yasmien Khan by e-mail (Yasmien.Khan@middlemore.co.nz) by the 14th of November with your name and the organisation you work for. If you have any questions about this workshop please contact Rochelle Bastion via Rochelle.Bastion@middlemore.co.nz Facilitator The facilitator is Dr Janine Bycroft (Clinical Director) MBChB, Dip Obs, Dip Paeds, MPH (Hons), FRNZCGP Janine is the Founder and Clinical Director for Health Navigator NZ. She is also a GP, Flinders Trainer, GP Liaison for Auckland District Health Board, Researcher and Self-Management Clinical Advisor for several DHBs and PHOs. Her areas of interest include self-management support, quality improvement, chronic care, e-health, health literacy and the integration of primary and secondary care. She is the primary care clinical lead for the National Shared Care Plan Programme and a member of the Cardiac Care Strategic Advisory group for the Heart Foundation. ■
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National depression initiative The National Depression Initiative’s advertising campaign began in 2006 and achieved a high level of awareness of depression amongst the public. The campaign has continued to evolve and now offers several resources you might find useful to help support patients through their treatment.
Using JK’s experience as a discussion point Depression can be challenging to discuss and treat when patients are reluctant to even acknowledge the issue. The John Kirwan advertisements have created a discussion point when talking to patients about the illness. Some doctors have reported patients explaining they have the “full JK”. This has reportedly made it quicker for doctors to get to a point of diagnosis with their patients. Depression.org.nz as an information resource The depression.org.nz website offers people further information and covers several areas: • Warning signs and symptoms • Contributing factors • Treatment options • Managing depression • Advice for family and friends The site also contains video stories of several people’s experience of recovering from depression. Many people find it comforting and informative to hear from others who have been through a similar experience. JK’s story is also told through the original series of TV commercials. The Journal online programme A key component of the latest campaign is The Journal. Designed to teach people self- management skills for mild depression, it also follows much of the process used in a clinical environment. Given the challenges of educating patients on all the techniques within a consultation timeframe, The Journal can assist by allowing the education to take place between consults, freeing up time to focus on discussing progress with their patients. The Journal is made up of six lessons that
cover the key evidence-based, self-help skills: • Positive thinking • Healthier lifestyle • Problem solving The lessons are structured in a fixed sequence that is designed to build up the skills in much the same way they would be during consultations. This has the added benefit of guaranteeing all your patients will follow the same process. Each lesson features engaging videos of JK and leading mental health professionals explaining the theory behind each skill. To help them implement what they’ve learnt JK assigns practical, realworld tasks for them to complete between online sessions. Every step of the way they are supported by automated reminders and live services from the depression helpline. Whilst the structure of the programme is fixed there are several ways it can be customised to reflect each user’s individual situation: In the healthier lifestyle lesson the user may select from one of four physiological health areas; diet, exercise, sleep or relaxation. Talking with a patient about which to choose gives you an opportunity to align their learning with parallel treatment for other health issues. Within the 3 three problem solving lessons the user has the ability to select one particular issue they face to work through to a resolution, in order to learn the process. Again, discussing what they might focus on beforehand may help them overcome issues you have identified during consults. To protect the safety of people using The Journal they are asked to self-assess the severity of their symptoms (using the PHQ9 questionnaire) at the beginning, middle and end of the programme. In cases where their condition appears to deteriorate all users receive prompts to contact their doctor or the depression helpline for assistance. These messages will help patients understand when they need to reconnect with you. Throughout the programme their activity is
recorded, in order to reflect it back to them and build a sense of achievement. This summary, at the end of the Journal, is an ideal way for patient’s to share their activity (and their selfassessed symptoms) during the programme. It appears the Journal’s strong link to the advertising campaign is also adding an unexpected benefit. Whilst it was designed as a self-directed intervention, surveys of users indicated that 30% of them discussed or involved a friend or family member in their activities. Getting support from someone was also cited as a key way to improve completion of the full programme. This desire, or willingness, for help presents an opportunity to offer patients followup contact from practice staff. Since launching in June 2010, over 30,000 people have actively used The Journal. It has yet to be clinically trialled, but results from user’s self-assessments indicate an improvement in their condition can be associated with its usage. Dr Lyndy Matthews, from The Royal Australian and New Zealand College of Psychiatrists, says “If people are able to use a programme such as The Journal, it shows that although an individual may be suffering moderate depression, the techniques used in The Journal are practical, manageable and effective," and that it may be time for GPs to consider prescribing it to patients. The Lowdown for teenage patients The Lowdown was created to meet the different attitudinal and media habits of teenagers. Like the main campaign, its objective is to raise awareness of the illness and promote help seeking.
The key difference is that The Lowdown uses youth celebrities to help normalise the problem and introduced text-based services for the first time in New Zealand. In a clinical environment The Lowdown may help doctors approach the issue of depression with younger patients. The Lowdown campaign is active in secondary schools, so patients may already be familiar with its messages and services. ■
Counties Manukau Health staff publication