A COUNTIES MANUKAU HEALTH PUBLICATION | DECEMBER 2015

In this issue SEE AND TREAT CLINIC LAUNCHED AT MIDDLEMORE

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INTEGRATED CARE – WHY IT MATTERS

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ON YOUR BIKE

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CONTENTS See and Treat Clinic launched at Middlemore

 2

Are you ready?

 2

Living Smokefree

 3

National Diabetes Plan launched at Ko Awatea

 4

Living our values

 4

Integrated care

 5

It’s time to be SunSmart

 7

New food service system

 8

On Your Bike!

 9

The big ward

 9

Five minutes with Fetu Paulo

  10

Have a Merry Eco Christmas

  10

It’s BBQ season

  11

East-West beef salad

  11

Connect+ is proudly produced bi-monthly by the communications team. If you have something to share, or would like to receive a copy, please email communications@middlemore.co.nz

FROM THE CEO As the weather starts to warm up, and with winter now behind us, it’s time to draw breath before the Christmas madness begins. This can be a particularly stressful time of the year, so I encourage you to pace yourself, get in some relaxation time and try not to sweat the small stuff. I’d like to congratulate you on making it through another busy winter. As always the Counties ‘can do’ spirit prevails and time and time again you manage to provide safe, high quality and outstanding care, on top of the pressures and challenges we face. Since the last issue of Connect+ in October, we have continued to meet our health targets and have begun to embed our new values (kind, together, valuing everyone and excellent) in our day to day work. The APAC Forum hosted by Ko Awatea, saw record numbers attending, proving that APAC is one of the best quality improvement conferences in the world. This issue of Connect+ is just a taste of some of your successes, and awesome hard work. We have a lot to be proud of.

Geraint A Martin CEO, CM HEALTH 1  |  CONNECT + DECEMBER 2015

Patient/Whaanau FEEDBACK

Primary Birthing I delivered my baby at Papakura ire staff there Unit and I cannot praise the ent Such a wonderful more, particularly the midwives! do such an amazing experience, the midwives really g and helping me heal job – helping me with breastfeedin utiful and nutritious. postpartum. The meals were bea week if I could!!! Would happily stay there for a

My surgeon and anaest het ist were skillduedre and exce llent. They explained the pr ocewho to me in a very simple way. The nursesident assisted me were awesome. I fe lt conf as I was surr ounded wit h skilled and awesome people during my surger y. ience to be one of I just found the whole exper into hospital full of total excellence. People go I was initially - we fear of the unknown - as people we do not put our lives and trust into er end wondering know and come out the oth out. what all the fuss was ab ressed with your I was TREMENDOUSLY imp and see staff working hospital. I was able to hear y impressed with the in the office, and was hugel y with which staff working style, the efficienc s able to hear how attended to their work. I wa with the utmost care other patients were treated . From my admittance and respect from all staff s treated efficiently until I was discharged I wa t by every single and with the utmost respec I felt I was in good staff member. At all times particular I was totally hands and well treated. In that the staff had impressed with the respect h other. I heard those not only for me but for eac respect and courtesy in responsible positions have was reciprocated by for their staff, and this a respectful and yet staff. Staff members had er while efficiently friendly attitude to each oth doing their work.

A new ‘See and Treat Clinic’, formally known as the Sir William Manchester Suite has been formally opened on the Middlemore site by the Minister of Health Dr Jonathan Coleman. This new clinic enables us to treat suitable patients at their first specialist appointment instead of waiting for up to three months. “Predominantly, it will be skin cancers but we do have a bit of additional capacity over and above in terms of the theatres. We will be using those for local anaesthetic procedures like minor hand surgery,” says Department Head, John Kenealy. Board Chair, Lee Mathias, with Minister of Health, Dr. Jonathan Coleman.

See and Treat Clinic

launched at Middlemore

Skin cancer is quite a common condition and Middlemore surgeons treat between 160 and 190 patients a month under local anaesthesia. The new clinic aims to treat up to 23 patients a day. “Delivering faster quality services is a priority for the Government. We know that prompt treatment is more likely to ensure better outcomes for patients,” says Health Minister Dr Coleman.

ARE YOU

READY? Judith Couch is a community midwife at Pukekohe Primary Birthing Unit. She shares Melissa’s pregnancy story and shows how important it is to find a midwife early on. Melissa rang me to tell me she was pregnant at six weeks. She had a very special IVF pregnancy – against all odds she was carrying identical twins. At 13 weeks we noticed a growth discrepancy between the two babies. This can be caused by a condition known as twin-to-twin transfusion, where one baby gets more blood than the other. This condition puts both babies at risk and requires very close monitoring and regular scanning. It was an anxious time for Melissa and her husband and family.

Straight away, I liaised with Middlemore Hospital’s Obstetric team and between Melissa, myself and the Middlemore team we established a plan of care. I reassured Melissa that she could contact me at any time with questions and for reassurance. We expected an early birth and I prepared Melissa for all possibilities – especially time in neonatal care. We made a flexible birth

plan hoping for the best, and preparing for the possibility of a caesarean section. With consistent care and a healthy lifestyle, Melissa’s pregnancy progressed well. Melissa’s positivity, faith in herself and a clear plan allowed the best possible outcome and at 36 weeks and three days, Melissa went into spontaneous labour. Melissa and her husband welcomed two beautiful healthy boys, born by normal birth. The cords were cut by her husband, Lane, with a precious ponamu knife that has been used in their community with many births. Early pregnancy engagement made it possible to be referred to the appropriate services in a timely manner to ensure the best possible care and a beautiful, normal birth experience. Melissa and Lane felt prepared for every possibility and very positive about their entire journey. It was an honour and privilege to walk alongside Melissa and support this wonderful outcome. When this story was written the boys were two weeks old, at home, up to birth weight, fully breast feeding and thriving. COUNTIES MANUKAU HEALTH  | 2 

Living

Smokefree Tony Ormsby, was born and raised in Mangere and is passionate about working in the community. Tony works as a Smokefree Advisor in the Quit Bus team. He shares his story of quitting smoking. I decided to quit when I was 30. I had been smoking for 16 years. It was a family thing – my parents smoked, my grandparents smoked and my great grandfather was a heavy smoker. It was an easy habit to pick up and it was very hard to stop. Four years ago, I made the choice to stop smoking. I was motivated by my kids because I didn’t ever want them to start smoking and get sick one day. I’ve seen a lot of that in my family, people getting sick with different types of cancers. They were all heavy smokers so I know that was a factor in their ill health. I’ve been smokefree for four years now and it’s awesome. I’m blessed to be in a position where I can help the community. Being a Smokefree Advisor on the Quit Bus allows me to help others and I’m really fortunate – I love what I do and I love being smokefree. When someone comes to us wanting to quit we encourage the whole whaanau to get on board. All it takes is one individual stepping out and asking for help. Once we had 16 referrals through one person. Word spread from one household and it grew from there. We ended up pretty much signing two household because everyone was thinking about quitting. People often tell me that their family is their biggest motivation for quitting, especially if they’ve lost parents to cancer. They say they’ve been to too many funerals. The second biggest reason would be financial, that they aren’t able to afford it, but that addiction has a hold over them. We get a lot of that. 3  |  CONNECT + DECEMBER 2015

WANT HELP WITH

QUITTING

?

Call 0800 569 568 The Quit Bus provides support with quitting smoking by text, telephone and through faceto-face counselling. Nicotine Replacement Therapy (NRT) helps sooth cravings. You can get NRT through patches, gum, lozenges and it is only $5 if you have a Quit Card. Follow us on Facebook to find out where the Quit Bus will be:   Smokefree Counties Manukau 2025

One of my clients was a smoker for 60 years, he’s 82 now and he gave up last year. We supported him to give quitting a good go and to cut out the excuses. We maintained dayto-day contact until he was Smokefree for three months. He’s now coming up to a year of being smokefree.

My kids are proud of me quitting. They go to school and they tell their friends and teachers “My Dad helps people stop smoking, he was a smoker and we’re really happy to see that he’s helping people.”

National Diabetes Plan

launched at Ko Awatea Health Minister Jonathan Coleman has launched a five year plan to deal with diabetes. The Minister says the plan provides a clear roadmap to tackle one of the country’s greatest health challenges.

“In recent years we’ve made significant progress in saving lives and improving the health of more than a quarter of a million New Zealanders with diabetes,” says Dr Coleman.

Counties Manukau Health Chair Lee Mathias says she’s pleased to see the framework for the range of initiatives under way to prevent and manage one of New Zealand’s greatest health challenges. “Here at Counties Manukau we see first-hand every day the impact of diabetes on our local population,” she says. “We need conservative and collaborative efforts to ensure our people have the right information and support to avoid this lifelong and life-threatening condition, and to manage it well and limit its effects.” Dr Coleman launched the plan with the support of Sir Peter Leitch, a diabetic and an ambassador for Diabetes New Zealand.

Living our

values Thank you to everyone who participated in Embedding our Values week 19-23 October! It was fantastic to see over 800 staff come together to learn how we can embed our values into everyday work, so we can better serve our communities. This week followed months of planning, numerous conversations and over 63,000 post-it notes with ideas and comments shared by staff, patients, family and whaanau. It comprised of facilitated sessions aimed at staff, leaders and clinicians. We had a great turnout, with very positive feedback and look forward to continue embedding our values into our everyday behaviours. Thank you for all your support. It’s been an incredible journey of co-design between all levels of the organisation and our community. PowerPoint presentations from the sessions are now available at the Values page on SouthNET.

If you weren’t able to attend a session and would like one to be run for your team, please contact the Project Manager   Adeline.Cumings@middlemore.co.nz

COUNTIES MANUKAU HEALTH  | 4 

Integrated Care “We were lost,” says Stu Bogun. “We’d been to a few clinics and my cholesterol and diabetes readings were sky high. They said I’d be dead by ANZAC day, yet no one had the time to help us. We hadn’t had positive experiences.” Then Stu’s wife Fehi encouraged him to go to Greenstone Family Clinic as she heard they offered special diabetes / cholesterol treatment. He decided to give it a go and soon found that they offered the special ingredient of ‘time’. “It was all so strange, we had no idea where the clinic was, but we booked an appointment and filled the form,” says Fehi Taufa. “It was the first time anyone has taken the time to explain everything. Then from that day they kept contacting us. They couldn’t be more helpful.” Stu comes to an appointment at the clinic every two weeks. When he first received his cholesterol reading it was 32.5. “I work doing runway repairs at the airport, I was at the point where I didn’t want to go to work. Sleeping all the time. I’d experience sugar highs then just feel really tired with no energy,” he says. “The nurse she was so brave. Brave enough to tell me straight that I need to start looking after myself, how to eat, what food to shop for, how to prepare it. Within two weeks my cholesterol was down to 17.”

Now Stu reports that he enjoys going to work. He is also happy because being in good health will assist him and Fehi in their application to formally adopt a child. “They taught me how to encourage him and care for him with the right food and exercise,” says Fehi. “I nearly lost my husband, if it wasn’t for these guys he wouldn’t have made Christmas. They just had the time to explain. Gave us books and this great plate which shows portion sizes is excellent.” “I was down in the dumps. I had no oomph. This is the first time anyone has taken the time to explain things and work with us. They taught us how to eat better. My cholesterol has more than halved, I’m back to gardening and have just finished off building a deck!” Stu epitomises some of the positive stories that clinicians hear each day through the “at risk” initiative, which is part of Counties Manukau Health’s drive to achieve better integrated care. There are now more than 16,000 people in the district experiencing the positive benefits of integrated care. Counties Manukau’s population is growing, ageing, changing and the demand for our hospital services is rising at a rapid rate. We are seeing an increase in chronic conditions such as diabetes and heart disease.

“For patients, integrated care means your district nurse, your primary care, community care and hospital specialists working together and sharing information to give you the best possible care. That’s got to be an outcome worth achieving for the whole population and the whole system,” Benedict Hefford, Director Primary & Community Services

With a continued focus on integrated care, a number of projects, campaigns and improvement initiatives are taking place across Counties Manukau. CM Health is working to improve processes by redesigning how our services are delivered, this includes realigning and extending the capacity and scope of CM Health community teams and integrating with providers of Home and Community Support Services. Primary Care’s role is expanding with an increasing focus on prevention and early intervention.

5  |  CONNECT + DECEMBER 2015

Further development of integrated, interdisciplinary care based around enhanced general practice teams. Locality clinical partnerships have been formed with hospital and primary care clinicians working together to treat patients from within the community. This will continue to evolve.

– why it matters “As more hospital admissions occur due to preventable causes, we need to examine what could be improved in how we deliver our services, says Harry Rea, Professor of Medicine and Clinical Director of Integrated Care at CM Health. “Care of people with several long-term medical conditions becomes complicated, especially for those who face other complicating social and economic factors. Some of the dimensions of good healthcare include access, compassion, continuity, coordination, comprehensiveness and care that are delivered in the context of whaanau and community.” For many of our patients, good care can no longer be delivered by a single part of the system in isolation. Integrated care that coordinates primary, secondary, social and community support is essential for most patients. We have a big challenge on our hands to integrate our services and systems across the health spectrum and empower our healthcare users to keep themselves well and at home – reducing unnecessary trips to hospital. For most people, it is best that their General Practice, supported by a wider community and specialist team is considered the main point of ongoing care.

Harry Rea, Professor of Medicine and Clinical Director of Integrated Care

“The system’s too complex, with patients in and out of hospital, multiple outpatient visits, and possibly 12 clinicians involved. There needs to be a simpler way.”

“There is a growing realisation that only 50% of our patients act on medical advice they are given. This strengthens the argument for integrated, interdisciplinary care delivered in the community,” says Professor Rea. “Adherence is heavily determined by a person’s ‘social determinants of health’ and unless these are assessed and addressed, clinical care and advice is wasted. Changing behaviour to improve adherence requires whaanau and household support.” “There’s a need to better manage long-term conditions, keeping people at home with family and in the community,” says Benedict Hefford, Director of Primary Health and Community Services. “Counties Manukau Health is changing to ensure that our patients get the best care possible and that our resources meet demand.”

Stu and Fehi Bogun with Greenstone Family Clinic nurse leader Devika Dayal.

Each project has a specific goal, but all have the needs of the patient and family/whaanau at its core.

Localities are our vehicle for implementation and ensure a local voice is heard within the planning process.

Integrated Care initiatives also include shared care plans, a greater focus on the role of nurses in primary care, and utilizing telehealth and virtual clinics.

There’s a big focus on patients with chronic illness or long-term conditions – equipping patients and family/whaanau to manage their conditions better with support in community settings.

We will use technology better to ensure those involved in a patients care have access to the right clinical information at the point of care. This will enable community staff to work more closely with general practice and create a smoother patient journey.

COUNTIES MANUKAU HEALTH  |  6 

IT’S TIME TO BE

t r a m SunS When the days start are longer, the sun’s ultraviolet radiation increases which means it can damage our skin, causing sunburn now and could lead to skin cancer. Latest figures from the Ministry of Health show that nearly 500 New Zealanders died from skin cancer in 2012, compared to 308 road deaths that year. Most of these deaths were from melanoma.

In addition, 69,000 New Zealanders are estimated to require treatment for Melanoma and Non Melanoma Skin cancers every year, making skin cancer our most common cancer. Unlike many cancers skin cancer is largely preventable if we consistently use SunSmart steps to protect our skin and eyes from damaging of ultraviolet radiation. We all can protect ourselves UV radiation damage by covering up more of our skin and protecting our eyes with sunglasses so we are SunSmart. It’s important to remember that we can also get burnt on windy, cool or cloudy days over summer and that using some type of sun protection is always a good idea during summer.

7  |  CONNECT + DECEMBER 2015

Being SunSmart means using simple steps:

SLIP

on a collared shirt and into shade,

SLOP

on a broad spectrum sunscreen with a SPF of at least 30,

SLAP

on a broad-brimmed hat, and

WRAP

on close fitting sunglasses.

EW food service system to boost N patient satisfaction Improvements to Middlemore Hospital’s food service system are set to continue over the next couple of months. In September this year Middlemore Hospital, in partnership with Compass NZ, replaced food trolleys with “B-Pod nesting stations” that provide state of the art temperature control to the trays containing each patient meal.

The introduction of the “B-Pod” means that hot food is consistently delivered hot and cold food is consistently delivered cold. Serving foods at their ideal temperature increases the taste and look of foods, which naturally increases the likelihood of a patient enjoying their meals and consuming the energy and nutrients they need.

A further food service innovation will be introduced to Middlemore over the next eight weeks a new integrated meal ordering system will links patients’ dietary needs with their menu options. Electronic tablets will be used by ward food service assistants to discuss with patients their meal options while completing their order electronically in most of the acute wards. The ability to talk through the menu options with someone who then enters those choices into the tablets makes it far easier for each patient to select foods that are suitable for them and also to their personal tastes. Inaccuracies in meal trays are also significantly reduced. Compass NZ introduced a new food service model into CM Health in July 2015. The new menu has a broader range of dishes including traditional meals like roast beef, as well as more modern but popular dishes like butter chicken.

stopbeforeyoustart.co.nz COUNTIES MANUKAU HEALTH  | 8 

On your

BIKE! Sixteen buttocks will go on the line when the eight Motley Crew mountain bikers take on a gruelling ride to raise funds for Kidz First Children’s Hospital. Specialist anaesthetist, Graham Morton says all eight are enthusiastic, but far from seasoned riders. Dr Graham Morton and his band of cycling superheroes are taking on ‘The Pioneer’ cycling event. The event is a seven day ride, beginning in Christchurch on 31 January and finishing a week later in Queenstown.

SHOW YOUR SUPPORT Visit fundraiseonline. co.nz/middlemoredoctors. Everyone who makes a donation will go into a draw to win a Raleigh bike. The course crosses some of New Zealand’s most scenic trails and at 546 kilometres and 15,057 metres of climbing, it’ll certainly be a challenge.

“There are going to be some tired muscles, sore bodies and affronted eyes. The sight of us in lycra is not going to be pleasant. But if we can raise money for Kidz First along the way, it will be worth it.”

The teams of two feature anaesthesia and pain medicine clinical head Mark grumpy moleman Moores and otorhinolaryngology specialist Andrew flash Gordan in team one.

THE BIG WARD

With obesity figures rapidly rising, New Zealand is fast becoming the most obese nation in the world. The Big Ward explores the challenges faced by both the patients and the medical staff who care for them, while addressing the wider issues that this spiraling pandemic has created.

Specialist anaesthetist, Craig the natural Birch and Chris black sheep Smit make up team two. Their rivals in team three are orthopaedic consultant Wes EPO boy Bevan and specialist anaesthetists Andrew gadgetman Wong. Simeon the chosen one Eaton and Graham Jabba Morton make up the last team.

The Big Ward is a new local series that follows the emotional and inspiring journeys of six morbidly obese Kiwis. Set in the Manukau SuperClinic and community, each patient must put in the effort to lose weight in order to qualify for potentially life-saving bariatric surgery, more commonly known as stomach stapling. As they are forced to change their eating habits and start exercising, will they have the strength and determination to reach their goal weight for surgery? This 10 part series is proudly funded by NZ on Air and TVNZ. It will air in 2016.

9  |  CONNECT + DECEMBER 2015

y r r e M Have a

Eco Christmas Christmas potentially impacts on the environment in three main ways:

WASTE, PRESENTS AND FOOD. Enjoying Christmas with a clear conscience may actually make preparations easier.

Five minutes with

Fetu Paulo

HERE ARE THREE TIPS TO ENJOY A MERRY ECO CHRISTMAS:  

After the special day, much of the packaging is not recyclable and extra waste is destined to end up in landfill. Avoiding glossy and metallic wrapping paper helps, as does avoiding the use of ribbons and bows.

At Counties Manukau Health we invest in our staff to provide excellent services. We spoke to Fetu Paulo, who is a First Security guard based at Kidz First foyer. Fetu shared with us her love for her Samoan culture and some great tips on staying active during summer. Tell us a bit about yourself My name is Fetu Paulo, I am 37 years old and I am a mother of two. I moved to New Zealand from Samoa in 2004 to look after my father.

I like that The people here are nice, I find that the staff are very friendly and I love that CM Health is multicultural. I live in Otahuhu and it reminds me so much of Samoa! It is comforting to see a lot of Samoan people as well as other Pacific cultures in the area. I also enjoy the fact that my workplace is near my home.

I stay healthy by Walking, cutting out bad foods and making sure fruits and vegetables are part of my diet every day.

My favourite new organisational value is Kindness. Kindness is doing good for another person. Helping or supporting them in any way. That is what I like about my job, I try my best to help people and it makes me happy.

WASTE:

PRESENTS:

Local is best and presents that are not buried under several layers of packaging.

FOOD:

Look for NZ-made products, find out where they come from and what the ingredients are.

Christmas o c E t s e b r u o Share y a d r aw t o in d e c la p e b d tip an ired gift! p s in o c e n a win The top tip will be chosen on Friday 18 December and the winner announced the following week. Send your tip to Debbie.wilson@middlemore.co.nz This competition is only available to CM Health employees.

COUNTIES MANUKAU HEALTH  | 10 

It’s BBQ

SEASON

The secret to a successful and stress-free Kiwi barbecue is all in the preparation. The night before, boil your potatoes, cook your rice or pasta for your salads, cook the beans for the bean salad and make the marinades. If you don’t have time for this, you can always get out the can opener and open a can of beans or use a supermarket marinade. Often Kiwi barbecues have too much meat. When deciding on the menu you only need one meat, but if you have guests you may wish to have one red meat and one white meat such as chicken. Remember, one serving of meat is the size of the palm of your hand.

Serve plenty of vegetables and aim for lots of colour – zucchinis, capsicums, tomatoes and eggplants are all great on the barbecue. Try threading vegetables onto a skewer as this makes them easier to handle and they look great when ready to serve. Fresh corn on the cob is also a real winner – just boil the cob first and finish on the barbecue.

TIPS FOR A GREAT KIWI BBQ:

2

SERVES

Here’s a great recipe for the left-overs

East-West Beef Salad INGREDIENTS

FOR THE DRESSING

200g lean rump steak

1 to 2 cloves garlic, chopped

Mixed salad leaves

1 tsp finely chopped lemon grass

Cucumber chunks Sliced cooked green beans 1/4 avocado sliced thinly Basil leaves

ƒƒ Marinades containing sugar burn quickly and you’ll be surprised how delicious your favourite marinade can be without it ƒƒ Homemade hamburgers with lean mince and crunchy vegetables are quick and easy

EASY RECIPE IDEAS: Marinate chicken overnight in lemon juice, olive oil, pepper and fresh herbs from the garden. Fish makes a delicious alternative to red meat. Try cooking fish in foil – it’s quick and there is no cleaning up afterwards. Or serve fresh fish fillets on pieces of French bread with lettuce. Squeeze a fresh orange and a clove of garlic over steak and leaving to sit overnight in the fridge.

11  |  CONNECT + DECEMBER 2015

1 tbsp fish sauce 2 tbsp fresh lime juice 2 tbsp water 1/4 tsp salt 1/2 tsp chilli powder or minced red chilli

ƒƒ The key to good tender steak is letting it rest after cooking ƒƒ Pre-cooking sausages will help to get rid of some of the extra fat

1 tsp sugar

Cherry tomatoes

2 to 3 tbsp chopped coriander 1 chopped spring onion

STEPS 1. Trim any fat from the steak and cut into 2cm strips. 2. Prepare the salad ingredients, making two salads in shallow bowls.

3. To make the East West Coriander Dressing, finely chop the garlic and thinly sliced lemon grass in a food processor or blender. Add the remaining dressing ingredients and process until coriander and spring onion leaves are chopped.

4. Arrange slices on the individual salads and drizzle

over extra dressing. Serve with crusty bread or with bowls of Basmati rice.

Note: Replace rump with sirloin, rib eye or fillet steak if desired. Although avocados are high in fat, it is heart friendly monounsaturated fat. Thanks to Diabetes NZ for these great tips and recipes. Please visit diabetes.org.nz for more delicious recipes and tips for healthy eating.