BEAUTIFUL MACHINES Waitemata DHB’s 2012 technology buys
WELL DONE WAITEMATA DISTRICT HEALTH BOARD YEARBOOK 2012
24 HOURS OF
EXCELLENCE A DAY IN THE LIFE OF NORTH SHORE HOSPITAL
BUILDING OUR FUTURE: NEW INFRASTRUCTURE ON THE WAY
Our unsun g
HEALTH her oes
A TALE of TWO HOSPITALS
THE HISTORY OF WAITEMATA DHB
INSIDE: BOARD PRIORITIES INSPIRING STORIES OF SUCCESS
â€œGood architecture will both inspire and facilitate innovation.â€? Euan Mac Kellar, Health Care Sector Principal at Jasmax
Well done! // 1
Foreword Dr Dale Bramley, CEO
It has been a remarkable year for Waitemata District Health Board. The 2011/12 financial year has been one of tremendous growth, with the largest expansion of our facilities and services since our DHB first came into existence.
n healthcare, we enjoy a special privilege rare in most sectors – that of being entrusted with the care of people. At Waitemata District Health Board, this is something we strive to keep foremost in our minds as we go about the day-to-day duties of caring for the sick and frail, and promoting health in our communities. Fundamentally, we aim to do our best for our population. Our organisational values and promise statement, Best Care for Everyone, reflect this. The values serve to inspire us to always be the best we can be – to strive to provide the best care possible to each and every person, and their family, who walks through our doors. Looking back, the 2011/12 financial year has been one of tremendous growth for our DHB, with the largest expansion of our facilities and services since our organisation first came into existence. An enormous amount of change has occurred and our staff have worked incredibly hard to meet the ever increasing needs of our growing population. A number of significant milestones have been achieved. These include: • the 25-bed state-of-the-art Lakeview Cardiology Centre housing a coronary care unit, a step-down unit, a cardiology ward and two cardiac catheterisation laboratories • the full commissioning of the 50-bed Assessment & Diagnostic Unit, completing the final component of new emergency care facilities at North Shore Hospital • the commissioning of a new CT scanner at North Shore Hospital. With the first CT scanner of its type in New Zealand, North Shore Hospital is acting as a reference site for other DHBs around the country • expansion of the Rangatira paediatric unit at Waitakere Hospital, with ten additional beds, a new indoor playroom, an outdoor garden area, parent kitchen and negative-pressure isolation room for children with infectious diseases • the opening of four new school dental clinics as part of our facilities modernisation programme for child oral health • new Awhina Health Campus facilities at Waitakere Hospital in association with Unitec, providing greatly enhanced opportunities for learning, innovation and collaboration for staff and students in west Auckland.
In February, we also started construction of the Elective Surgery Centre building on the North Shore Hospital site. The $39 million project’s aspiration is for a highly efficient and cost-effective centre for fast-stream elective surgical services – one that would be New Zealand’s most productive, with results better than those achieved in both private and other public hospitals in the country. Nearly 6000 operations across a range of specialties are expected to be performed annually once the centre opens in July 2013. Along with this growth, we have also excelled in our overall performance, ending 2012 having achieved or exceeded five of the six national health targets – one of only four DHBs in New Zealand (and the only large DHB) to do so. We’ve also added new services for our population, including: • a gestational diabetes service providing assessment and support for women without previously diagnosed diabetes who develop the condition during pregnancy • a long-term oxygen therapy service providing assessment, education, and support for adults and children who require oxygen support in their own homes • an interventional radiology service providing minimally invasive imageguided procedures to diagnose and treat diseases. These achievements are a direct result of the dedication and hard work of the countless people who work for our DHB or for our partner organisations in health. An organisation is always only as a good as its people, and we are fortunate to have so many talented and devoted people on staff. This commemorative yearbook is about celebrating our people and their many positive contributions. Thank you to each and every one of you who have played a part in our DHB’s outstanding success.
Dr Dale Bramley CEO
2 // Well done!
Well done! // 3 BEAUTIFUL MACHINES Waitemata DHB’s 2012 technology buys
WELL DONE WAITEMATA DISTRICT HEALTH BOARD YEARBOOK 2012
24 HOURS OF
EXCELLENCE A DAY IN THE LIFE OF NORTH SHORE HOSPITAL
BUILDING OUR FUTURE: NEW INFRASTRUCTURE ON THE WAY
A TALE of TWO HOSPITALS
HEALTH her oes
THE HISTORY OF WAITEMATA DHB
Foreword: Dr Dale Bramley, CEO
Feature: A full general service hospital is born
Introduction: Hon Tony Ryall, Minister of Health
INSIDE: BOARD PRIORITIES INSPIRING STORIES OF SUCCESS
Cover image: (From left) Dr Jutta Van Den Boom, Haidee Renata, Timoti George in front of our state-of-the-art Lakeview building at North Shore Hospital.
The Waitemata DHB Year Book 2012 is a co-production between Waitemata DHB Communications Department and APN Educational Media. Thanks to all the staff who contributed their personal stories and the advertising sponsors who made this book possible.
Supervising editors Paul Patton & Ashley Campbell Waitemata DHB Communications Department
Advertising/Project manager Julian Andrews
Board priority: What’s the bottom line?
Board priority: New organisational values announced
Making a difference: Around the world
People: New staff on the ward
Feature: Building the future
Advertorial: Creating a healthy future
Unsung hero: Testing time for ICU
Unsung hero: Bringing a personal touch to care Unsung hero: Sleepless nights and busy days no problem for Lyn
Advertorial: Cutting-edge partnership leads the way
People: A nurse practitioner on the team Making a difference: Smiles all round
Board priority: Living within our means -- From trash to treasure – and big savings! -- Reduce, re-use, recycle, and save!
Dionne Christian & Peter Barclay
Designer Jay Tweedie
Editor-in-chief Shane Cummings
Publisher Bronwen Wilkins APN Educational Media
www.apn-ed.co.nz ©2012. All rights reserved. Material content in WELLDONE is protected under the Copyright Act 1994. No material may be reproduced in part or in whole without the written consent from the Copyright holders.
Feature: Beautiful machines
Be in to win a beautiful machine
People: With experience comes wisdom -- Cottage hospital remembered
-- Maternity service evolution -- Sense of community
Advertorial: Accuro Wellness Initiative: Healthy steps ahead
Board priority: Clinical Leadership -- Clinical leadership a developing process -- Moving and handling – a whole new world
-- Challenges, triumphs, and new horizons
Feature: 2012: Our world compared with the rest of the world
People: Smoothing the way for visitors
People: Pat packs a lot in
Unsung hero: Caring for cultural and spiritual needs
Health heroes: Sue Lim Health heroes: Sarah Foley-Wilson and Hannah May
People: Faster than before, better than before… People: Lio Rotor
Board priority: Culture -- Creating a culture of change
People: In the best of hands People: Caring till the end
Board priority: Health of older people -- Living long in Waitemata -- Yvonne shares her passion for her work
-- Staying safe at home
4 // Well done!
Board priority: Moving on out of aged care People: Aftermath of a tragedy
Health heroes: Janice Riegan Health heroes: Rosie MacFarlane Health heroes: Te Ara Totoro
Feature: 30 October: A day in the life of North Shore Hospital
People: You wouldn’t read about it…
Board priority: Elective surgery -- An eye on the big picture
Unsung hero: A spoonful of sugar makes the medicine go down
-- Speeding up elective surgery a team effort -- Parking the ambulance at the top of the cliff
Achievement: Nurses recognised for making a difference Achievement: Michal’s international honour
Achievement: Nathan’s heroic quest for health Achievement: Ordering trial a resounding success
Achievement: Awards and accolades for 2012
People: Courtney’s walked the talk
People: Breaking through the language barrier Making a difference: Feeling a bit light-headed
Board priority: Emergency Care -- Emergency care is transformed
-- Breaking through the barriers -- US method could mean E-ICUs
Patient encounters: Life-changing patient encounters
Making a difference: This job is child’s play Achievement: PAMP site given an upgrade
Health hero: Ruth Noel Health hero: Dr Nathan Atkinson
Board priority: Regional collaboration -- A closer partnership with Unitec
-- Collaboration projects well under way -- Appointment makes history
People: Warm welcome to cold climate People: Red socks and lower beds
Board priority: Bowel screening -- Getting the word out to the community
Patient encounters: Four-legged therapists give a helping paw
People: Our not-so-secret lives... -- Junior Rugby’s creative allrounder -- Amy’s book contains essential stuff
-- Exhibiting photographer -- Blood, sweat, and spray tan -- Never too old to make music
Board priority: Chronic Disease Management -- Have a heart for speedy diagnosis
-- Close-to-home dialysis now a reality
-- A long but worthwhile journey -- Ice provides heartwarming break -- A ballroom champion
-- From grass roots to hi-tech diabetes management
-- Here’s what patients say… -- Dave spreads the word
Patient encounters: Winsome’s powerful message makes an impact
Health heroes: Marja Peters Health heroes: Neville Thompson
Making a difference: A treat for young patients
People: Growing up with Kate People: Dementia care her focus
People: Honoured for a lifetime of healing People: Martin Roberts
Board priority: New models of care -- Aviation throws medicine a lifeline -- Paving the way to better care -- CLAB Zero effort saves lives and money
People: Sir Ray throws a lunchtime punch
Well done! // 5
A full general service hospital is born From small beginnings, a huge amount of community pressure, and political manoeuvring, the Waitemata District Health Board has developed into a modern general service facility. By population, it is the largest DHB in New Zealand, and the historical snippets presented here show how it all began.
Built at a cost of ÂŁ350,000, the North Shore Hospital was officially opened by Prime Minister Walter Nash on July 19, 1958. The hospital had a permanent staff of 59 and the first patients were admitted from 9am on July 28. Back then, the complex was mostly known as the North Shore Obstetric Hospital and comprised 44 maternity beds and six casualty beds. The small casualty department was intended to deal with minor accidents and follow-up treatments. It added significant value to the hospital by also providing immediate emergency treatment to more serious accident cases.
The Auckland Harbour Bridge did not open until 1959, and the casualty department provided initial attention before patients were transferred across the harbour to Auckland or Middlemore hospitals. Limited x-ray services, a blood bank, and laboratory were also available, and there was a physiotherapy department for outpatients referred from other facilities and for antenatal and postnatal exercises.
December 20: First set of mirror-image twins are born â€“ Catherine (12:10am) and Jayne Spencer (12:19am). They were born at full term, weighing 7lb 10oz and 8lb 2oz respectively.
Well done! // 7
Stage one of the current North Shore Hospital is opened.
Waitakere Hospital opens.
Stage two of North Shore Hospital, the current tower block, was completed to the original 70s design. The 11 storeys included nine ward floors, a nine-theatre operating suite, and an ICU, emergency, and outpatient departments. The complex came with full diagnostic facilities and full site-based management for the first time. Local MP George Gair fought hard to stop the facility being mothballed because of a lack of early operational funding, and ironically, became the first surgical patient â€“ something he recalled with satisfaction when he opened the new Intensive Care Unit 13 years later.
Elective Caesareans were first performed in 1989 but emergency Caesareans were performed earlier ... following the shift to the tower block in November 1988. Delivery of Caesarean sections means the unit evolves from a primary facility to a Level 1â€“1.5 facility.
Taharoto Unit opens in what was the former Maternity Unit. The Nurses Amendment Act gives midwives autonomy to take full responsibility for a woman throughout pregnancy and childbirth.
Planning is under way to move and co-locate all maternity services to the first floor, where there is 1063 square metres of unused space. The plan to centralise the services is estimated to cost $1.5m.
Kingsley Mortimer Unit, a psychogeriatric ward, is opened.
Auckland Area Health Board is disestablished and Waitemata Health Crown Enterprise comes into being. Denis Snelgar is the first CEO.
Uniform epaulettes change from red to green.
By now, many midwives have moved out of hospital employment and into community-based midwifery practice.
James Ja-Qi Yan becomes the first boy born at North Shore Hospital in the new millennium. Born at 9:36am, James was an unexpected early arrival for his mother, who was on holiday from China. The first girl, baby Anand, arrived at 10:10am. Seven babies were born at North Shore Hospital on January 1. Twelve-hour shifts begin.
May: Hospital clerks are now working seven days a week and evenings. October: The Special Care Baby unit opens and the Maternity unit becomes a Level 2 facility. The opening of the SCBU means some premature and sick babies no longer need to be transferred over the Harbour Bridge.
Two new primary delivery rooms/beds are opened. Each room provides space where women can give birth as naturally as possible yet still be close to hospital care, if necessary. Soon after, 10 new postnatal rooms are blessed and officially opened. Mothers can now stay longer after giving birth, if needed. North Shore Hospitalâ€™s retail pharmacy turns 10. The pharmacy opened as part of a $250,000 foyer redevelopment and has now issued more than half a million prescriptions.
8 // Well done! 2006
BreastScreen Waitemata Northland introduces leading-edge digital mammography at its Takapuna site. It is the first breast screening clinic in New Zealand to install and implement digital breast screening, with two digital radiography units.
Waitemata DHB wins the Excellence in Quality Improvement category in the Health Innovation Awards. The winning entry was Adult Health Servicesâ€™ Colorectal Cancer Service Improvement project. The project aimed to improve patient certainty and choice, enhance access to services, and limit unnecessary delays. It also produced New Zealandâ€™s first recovery handbook for colorectal cancer patients.
July 19: North Shore Hospital turns 50.
The $48 million Lakeview development is given government approval. The plan includes a 50-bed Assessment and Diagnostic Unit (ADU) and a separate, redesigned Emergency Department. The expansion also includes a new 30-bed ward. The board approves a staged increase in services to be delivered at Waitakere Hospital. This includes expansion of Emergency Department operating hours, followed by the introduction of 24/7 emergency services for children, with the introduction of 24/7 acute medical services for adults to follow.
The opening of a fourth operating theatre at Waitakere Hospital reduces waiting times for elective surgery. The theatre was built as part of the new Waitakere Hospital that opened in 2005, but the space could not be commissioned until further funding was received.
A $9.2 million North Shore Dialysis Centre next to North Shore Hospital is opened by Health Minister Tony Ryall. The development includes a west Auckland presence, with a satellite dialysis unit and clinics at Waitakere Hospital.
Well done! // 9
Introduction Hon Tony Ryall, Minister of Health
Over the past few years, Waitemata DHB has undergone an outstanding turnaround. It is now one of the top-performing DHBs in the country.
ne of the best ways to gauge how well a whole hospital service is performing is the length of stay in an Emergency Department. In order to treat ED patients promptly, the whole hospital service has to work well – from having beds available to admit patients and fast turnaround on diagnostic tests, to quick patient transfers and immediate advice from specialists from other departments. In 2009, North Shore Hospital wasn’t working well. It was the poorest performing DHB, achieving only 61% of its targets. Three years on, it is now right up there with the best in the country – exceeding the 95% ED health target this year. This is a great achievement, and I would like to thank you all for your hard work and commitment to provide your community with better health services. Each year, Waitemata is doing better and better and that’s great for patients. Not only are you providing your current services better, you are also providing more services and trailing new initiatives, such as the bowel screening pilot. This publication showcases your successes over the past year, and I thank you all for your dedication and commitment to improving patient care. I look forward to hearing about your successes over the next 12 months.
Hon Tony Ryall Minister of Health
10 // Well done!
What’s the bottom line? Auxilia Nyangoni, corporate group finance manager, provides some insight into our finances. What was the Waitemata DHB’s budget for 2011/12? In 2011/12, Waitemata DHB had a funding budget of $1.37 billion and a breakeven financial plan (ie, funding was planned to fully offset all costs for providing planned services). Waitemata performed better than planned, generating a surplus of $5 million.
Where did this money come from? The $1.37 billion funding is primarily from the government (Ministry of Health and other Government-owned entities, including other DHBs) and a small portion of other income as shown in the chart below: 2% 1%
The board made it a top-ten priority to “carefully manage our budgets with sound financial planning to make our health dollars work harder and ensure we deliver services within the allocated funding”. Was this achieved? Waitemata DHB achieved this as shown by the financial result delivered for the 2011/12 financial year of a surplus of $5m. Underpinning this top priority is the goal of remaining financially sustainable to ensure health services can be sustained well into the future. This goal is achieved through a culture of financial accountability and discipline underpinned by a business transformation programme that seeks to continuously identify and implement savings initiatives.
5% Ministry of Health Other DHBs for care of their residents by WDHB Clinical Training Agency, ACC and other health funders Other income (interest and patient sourced)
Waitemata used this funding to provide the following health services to the Waitemata population and populations of other DHBs:
2% 0% 2% 2%
Waitemata DHB’s own hospital & community health services Other DHB’s mainly for care of Waitemata DHB residents
Community pharmaceuticals Primary care
7% 53 %
Private hospital Personal health contracts
Mental Health (NGOs, private providers) Community Laboratories Home Support services Rest Homes
What are some of the challenges to achieving this? The key challenges include two conflicting factors in the environment in which DHBs operate, which are: • DHBs operate in a fiscally constrained environment where funding growth is at a slower pace than expenditure growth and DHBs have to compete against international markets for the biggest resource (staff) • the health needs and demand for publicly funded health services are insatiable. Therefore, the challenges for the DHB include: • the need to ensure that cost growth is controlled by implementing smarter ways of delivering quality health services more efficiently, more cost-effectively, and reducing any waste, • the need to carefully plan and implement affordable capital developments that enable us to continue meeting the health service delivery requirements for our population.
How proactive have staff been in regards to managing the budget, ie, coming up with ways to save money? Staff members have actively contributed by implementing the initiatives that have resulted in the DHB achieving business transformation savings of $42.6m in 2010/11 and $22m in 2011/12. Actively managing operational financial performance to the budget set and continuous identification of offset for unfavourable variances has enabled the DHB to perform better than planned.
To read stories about successfully living within our means, go to page 27.
Well done! // 11
New organisational values announced
All of us – individuals and organisations alike – need a compass to point us in the right philosophical direction, which is what our new organisational values aim to do.
sk chief executive Dr Dale Bramley what the purpose of our organisation is and he sums it up by saying it revolves around the following themes: • to prevent, ameliorate and cure ill health • to promote wellness • to relieve suffering of those entrusted to our care. This work needs to be built on a values-based foundation that underpins the entire culture of our organisation and gives each of us a reference point from which to make decisions, especially if the path forward isn’t clear. During the last year, time has been spent talking with staff across the DHB about what you think our new core values should be. Following these discussions, our new values are: • Everyone Matters • With Compassion • Connected • Better, Best, Brilliant.
Emendo (now part of McKesson Corporation) is proud to be a supplier to Waitemata Dhb and is pleased to be part of their inaugural yearbook.
Coupled with our promise statement of Best Care for Everyone, these values are the platform from which we need to do our work. “At the heart of these values, there is a need to reflect on the intrinsic dignity of every human person and the fact that in health we are entrusted and indeed privileged to be able to care for people,” Dale says. “This is a profound responsibility that can be lost in the business of everyday service delivery – our values and purpose help remind us of the importance of what we are doing and why we are doing it.” Our values need to inspire us to seek to be the best we possibly can, always. They remind us that in healthcare, there are many people working together to improve health outcomes, that as a community we must have a deep respect for each other and that we need to work together with our community to achieve our purpose. Right now, nominated ‘champions’ are asking you to identify activities and behaviours related to a specific value and think about ways to integrate them into daily working life.
Enabling better, faster, more convenient care through smart technology For more information call 0800 694 364 or go to gen-i.co.nz Gen-i, a division of Telecom New Zealand Limited
12 // Well done!
MAKING A DIFFERENCE
Making a difference around the world Intrepid and big-hearted Waitemata DHB staff have volunteered their skills across the globe. Here are some of their stories from the last few years.
Lesley Look – Nepal and Ethiopia
Amy Buswell – Rwanda and Uganda Amy volunteered for three months in Rwanda developing and implementing a pilot public health programme in two remote villages and spent another three in Uganda working in a rural health clinic (HIV/AIDS and maternity). “Ask any parent in the world what they want for their children and it’s the same. They want them to be healthy, to get an education, to be happy and have more or better than they had themselves.”
In October, Lesley journeyed to Pokhara, Nepal on her second trip as a team nurse for a Habitat for Humanity Global Village build, helping to build 36 adobe brick and mud houses. Last year, she helped build mud huts in Ethiopia. “The reaction from the home owners at the ribbon-cutting ceremony was priceless. The welcoming ceremony and dinner for over 600 took place in the courtyard of the UNESCO World Heritage Square in Bhaktapur and felt like something out of a movie set, with hundreds of tables set with red tablecloths,” says Lesley.
Well done! // 13
Lynley Davidson – Vietnam Lynley spent 18 months in Vietnam in 2006/7 with Volunteer Service Abroad, and “it was the most incredible experience”, she says. “My assignment was to improve the nursing practice in the Binh Dinh province [20 hospitals, 800 nurses], so I spent a large amount of time teaching the head nurses of the different departments and hospitals.”
Pat Alley – Vietnam Between 2005 and 2008, Pat made three trips to Vietnam to assist in the delivery of a trauma care education programme by NZAID. “We not only taught people trauma care, but most importantly, taught them how to teach the programme so that now it is selfsufficient. It was not an easy task.”
Richard Firth – Christchurch As a member of the New Zealand Red Cross and deputy team leader of the Emergency Response Team, Richard Firth headed to Christchurch in February 2011 after the city was struck by the devastating 6.3 magnitude earthquake. “I was tasked to gather and lead the team to Christchurch. Within 24 hours of the earthquake, my team and I were on our way – not prepared for the mass destruction that we were about to see head on! “I have never encountered, and I suspect never will again, the most amazing sense of community which arose from the destruction of the quake. The kindness, a desire to help one another, met me at every destroyed home I visited. People were truly pulling together despite their fears, personal losses, and hopelessness, which most of these families were experiencing.”
14 // Well done!
New staff on the ward
We employ around 6,500 people in more than 30 different locations, so what’s it like to graduate and land your first job in such a dynamic organisation? We spoke with three people who started work with us during 2012.
Bridget Oliver Speech Language Therapist After a career in travel and time spent as a busy mum raising two children, Bridget, 41, returned to studying five years ago. She wanted a new profession that would enable her to make a difference in people’s lives but one that offered opportunities for professional advancement. Having seen speech and language therapists in action, she opted to complete a fouryear Bachelor of Speech and Language Therapy at Massey University’s Albany Campus before joining us in April. She now works across North Shore Hospital, helping patients with speech and swallowing issues. “There were times during the four-year degree when I thought, ‘what am I doing?’, but joining the workforce and putting the theory into practice has been great. “There’s a lot of learning on the job, which you have to be prepared for. Suddenly, you realise patients are real people who don’t have issues in isolation in the way cases might be written up in textbooks. They come from diverse backgrounds and there are a whole range of factors to consider in their treatment. It’s a steep learning curve but a rewarding one.”
Krystle Prenter Occupational Therapist While she might not have realised it at the time, Krystle, 24, has been heading down her chosen career path since she was a teenager. After working in part-time after-school and summer jobs that involved helping people with special needs, she decided to study occupational therapy at AUT University. In her third and final year of a Bachelor of Health Science, Krystle won a Waitemata DHB scholarship, which paid a chunk of her fees and tuition expenses.
It also meant she was bonded to us for a year. She started working as an acute general medical OT pretty much as soon as her studies finished. “I had to ask for my third day off so I could attend my graduation!” She enjoys the team environment and says, after a year, she is now becoming more confident in dealing with patients. “It takes a wee while to settle in, but gradually, you start to realise you do know what you’re doing and have the knowledge to help patients. I’m still learning every single day because there are always new opportunities to gain more knowledge, but I feel I’m on my way.”
Haidee Renata Mental Health Nurse Because we’re the largest provider of mental health services in New Zealand, new graduates like Haidee are vital to our development. Originally a gym instructor, Haidee, 26, has long been interested in the links between health and mental wellbeing. Her interest in mental health nursing developed out of a desire to care for people and work in a branch of medicine that demands a holistic approach. She graduated from AUT University with a Bachelor in Health Science, majoring in nursing, and joined us early this year under a 10-month internship programme for graduate nurses who want to develop a career in mental health. The programme comprises supported clinical placements in two different working environments – Haidee started work in the North Shore One Community Mental Health Team before moving into Liaison Psychiatry – and she recently completed, through the University of Auckland, a postgraduate certificate in mental health, along with 14 other new graduates working for us. She’s enjoyed the balance between work and study and says her supervisors have been helpful and supportive: “I think the programme definitely sets you up with a great start. You’re a supernumerary nurse for the whole 10 months, so you are able to take your time to adjust taking on only what you can handle.” With her internship drawing to a close, Haidee has accepted a fulltime position at the Acute Mental Health Unit, Taharoto. Her advice to those still studying? “Make the most of your undergraduate years by working hard and building relationships with people you may one day want to work with. You might think you’re just a student and nobody will remember you, but if you make a good impression, they will.”
ELECTIVE SURGERY CENTRE
LAKEVIEW CARDIOLOGY CENTRE
Proud to have spent 2012 helping WDHB enhance care for its community
TAHAROTO MENTAL HEALTH
Building the future Let’s be honest, there have been times in recent years when our hospital sites have looked a little like construction sites, but it’s all aimed at providing the most efficient, contemporary, and comfortable facilities for staff and patients. We talk to some of those companies working on these developments.
John Goldsworthy Construction Manager Buildings + Interiors, Fletcher Construction
e’ve carried out a variety of work for Waitemata DHB on various sites since 2000. Works have consisted of everything from a coat of paint and new flooring to extension works on the podium roof level of the hospital, multiple refurbishment projects within the hospital, to stand-alone new building construction – values ranging from a few hundred dollars up to projects well within the tens of millions!
“Hospital projects are always challenging, and there’s never a dull moment. There’s no chance to get bored as no two projects within a hospital are the same. Every project comes with its own set of complexities with different operational needs and demands that have to be considered when planning the construction programme. “In various projects, we have had to introduce staging and ‘out of hours’ works to allow the facility to function as it must while undergoing a refurbishment, extension, or in some cases, a full change of use. It’s always interesting and satisfying to look back on the projects when complete and reflect on how we actually achieved some of the things we have. Some of the more challenging projects have been within operating theatres, Clinical Support Services, Radiology, ICU and Maternity. “No construction project would be possible in any of these areas without the full cooperation of the hospital staff and facility management, which we have had at all times. There have been some fantastic friendships formed between the construction staff and hospital staff during the years. “One of the greatest challenges that occur on every project within the hospital is accessing the areas outside of the construction zone but which are critical for getting the construction works completed. The classic for this is the drain wastes that always have to go through the floor that is being worked on and run through the ceiling of
North Shore Renal unit
the department below. Over the years, we have had to access ceilings within theatres, inpatient pharmacy, emergency department, radiology, main hospital kitchen etc, which are all critical areas and that all operate 24/7. “The planning and staging around the installation of new drains has to be carefully thought through and even more carefully installed! Given the nature of some of the areas, we have also had to remain flexible within our planning and approach to be able to accommodate change without any notice due to a change or unplanned event within the hospital’s requirements for that particular day. “Service’s isolations have also proven difficult during the years. We have had to carry out many major shutdowns to critical services such as med gasses, power, and water. All take a huge amount of planning and communication. Roger Jackman [engineer from Facilities Management, North Shore Hospital] has worked with us on just about all of the shutdowns we have done, which, if counted, would be within the hundreds. For some of the more major oxygen shut downs, bottled gasses were brought from various different sources, including gas suppliers and loaned from various different hospitals, including other DHBs. “Managing construction noise has always been a challenge as it affects departments above and below and is a necessary for the construction works from demolition stage on refurbishments through to services installations and fit-out.”
Well done! // 17
North Shore Renal unit
“Thinking about the future has involved making spaces adaptable and flexible.”
Euan MacKellar Principal Jasmax (Architects)
e started working with the DHB back in 2008 when we began some of the master planning processes. This has involved taking a ‘big picture’ look at site-wide current and future growth needs. The aim is to provide a framework that will allow for planned and sustainable growth right across the DHB, and ultimately, the Auckland region. “We’ve created quite a sophisticated database that links all data about individual developments with the master plan. Eventually we hope to link multiple databases, like Statistics New Zealand, to allow for rapid scenario testing and updating of the master plans across the whole region. “Thinking about the future has involved making spaces adaptable and flexible. For example, the new renal dialysis unit may one day move, so we want to ensure the building would be suitable for, say, community health services if they moved in. “Budgets are tight, so that’s always a challenge; so is getting to the final design. Everyone is passionate about what they do so it’s often about encouraging people, who are used to doing things in a certain way, to think about new ways of approaching tasks. “But the challenges, well, when you can make a change which is positive from a patient and staff point of view that’s great. Often staff put themselves second, because they are committed to their patients and thinking about them, but if they have a good working environment and feel happy about coming to and being at work, that has a flow-on effect and helps improve patient care. “We want patients to feel welcome and relaxed so the question becomes how do you create that environment in a clinical setting? The spaces we work on need to be functional but inspiring. This involves using lots of natural light, colour, and thinking about who works in the building, who will be treated there, and how we can best meet these needs.”
18 // Well done! Awhina North Shore Campus planning
Jasmax has worked or is working on: • The Elective Surgery Centre, which is a $39 million unit dedicated to providing elective surgery to patients. It will perform nearly 6000 operations per year in an environment designed to combine the best of private and public hospital practises. The ESC is due to open in July. • The $9.2 million North Shore Dialysis Unit at North Shore Hospital, which provides in-centre renal dialysis for people with kidney failure. • The multi-storey car park at North Shore Hospital. • Master planning for Awhina’s North Shore Campus. • Upgrading patients lounge in our maternity department.
North Shore Renal unit
Damian Simpson Klein (architects)
s the architects on the Lakeview Cardiology Centre, the most exciting thing about being involved with this development was the completion of the award-winning facility on a premium site with outstanding views! The extension, on the eastern corner of the North Shore Hospital site, overlooks Lake Pupuke, with Rangitoto beyond. The design maximises the potential of this beautiful site and deals sensitively with the urban design considerations of its prominent location. “The design involved the construction of the Lakeview extension, followed by the refurbishment stages, performed with minimum disruption to the functioning hospital. The project ensures that health services provided to the public of Auckland will be much improved and up with the best on both a New Zealand-wide scale and in the world. “The Lakeview development presented several challenges to the design and construction team, the most pivotal being working within an existing operational hospital environment and minimising the disruption to hospital staff, patients, and procedures. “The design and construction team staged the reconstruction of the Emergency Department in five stages to ensure minimal disruption to the clinical services. In 2001, the Emergency Department underwent an upgrade involving the same core team, so there were no illusions as to the difficulty and complexity of this task! The planning and communication systems required between contractor, design team, and hospital staff had to be robust, clear, and well thought out; access for the contractors during construction had to be as concise and as negligible as possible.
Well done! // 19
NDHB Maternity Project
Garth Whittaker Director
Ncounter Group (Project Directors)
“I “The planning and communication systems required between contractor, design team, and hospital staff had to be robust, clear, and well thought out...” “The late change in proposed use for the first floor fit-out from a ward to a cardiology unit was particularly challenging as it was to be built directly above the newly completed Emergency and ADU Departments. To minimise disruption, all structural works components and drainage were installed within the ED ceiling before the occupation of ED. This was made possible by a fast-track design process ensuring that overall completion was in line with the final stage of Lakeview.” • The $8.5 million Lakeview Cardiology Centre houses a coronary care unit, a step-down unit, a cardiology ward, and two cardiac catheterisation laboratories. Around 100 staff work in the 25-bed centre. • Klein also worked on the $3 million expansion of Waitakere Hospital’s Rangitira Paediatric Unit, which opened in June. That project added 10 extra beds, a new indoor playroom, an outdoor garden area, and a negative pressure isolation room for children with infectious diseases. The unit’s expansion will save numerous families from having to travel to Starship Children’s Hospital.
’ve worked with the Waitemata DHB since 2000, initially on Project Orion and then on other projects, including new mental health facilities. From these projects, I developed extensive knowledge of the North Shore, Waitakere and Mason Clinic sites. “Allan Johns has now joined Ncounter Group as a fellow director. Allan was project director for the Auckland DHB redevelopment and has worked with Counties Manukau DHB on their redevelopment during the past six years. Between us, we’ve worked for DHBs – and similar organisations – in New Zealand, Australia, Canada, Asia, and the Pacific. “Ncounter Group provides project advisory services, including strategic master planning, business case development, project briefing, design management, and acts as project directors ensuring the projects are delivered on time, budget, and to fit the intended purpose. Ncounter does not act as construction project managers but works with them to ensure the projects are delivered to agreed standards. “The challenges we face are working with a diverse range of individuals from clinical staff through to construction site workers. One of our roles is to find solutions to often complex problems and to pre-empt what is required to keep the project running to schedule. With the range of people involved on a construction site, together with unpredictable factors such as weather, constant planning is required to maintain the tight construction programmes. “It is a good feeling handing over a completed project and knowing that in a small way we are contributing to better patient care and staff satisfaction and adding value. “Hospitals are by far the most complex building projects, provide challenges not found in other sectors, and attract highly skilled and motivated people. “Other projects with the DHB are currently being investigated and are in the early stages of planning. Ncounter group is acting in an advisory capacity for the DHB on these projects.”
This article has been sponsored by Comprehensive Care/Waitemo PHO
Creating a healthy future T his year, Waitemata DHB saved the lives and health of thousands of people. Here at Comprehensive Care (in association with Waitemata PHO), we’ve been doing some life-saving work of our own. In a New Zealand first, we are helping to develop an electronic decision support tool that will assist in the early diagnosis and management of prostate conditions. It’s an exciting venture and a real advancement in the area of men’s health. Our GASP tool (Giving Asthma Support to Patients) has also gained national and international recognition and has resulted in a significant decrease in hospital admissions and the use of oral steroids. A special study “Space to Breathe” is now assessing children aged two to five living with asthma. It is innovative work, and like everything we do in health, we’re passionate about it. Comprehensive Care through Waitemata PHO provides healthcare services and programmes for over 250,000 people living in urban and rural settings, from Rodney to Devonport to West Auckland.
WPHO Key Contract Position 2011/12
Community Palliative Care
Community Retinal Screening
LTC - Education
CVD Risk Assessments
We understand our people’s health needs and we’re committed to ensuring quality services are delivered through our valued general practice teams. So what else have we achieved in 2012? There’s been a lot. • For our children, we are providing an outreach service and delivering home vaccinations, which has contributed significantly to the achievement of the WDHB health target of 95% coverage for twoyear-olds. • We are supporting New Zealand’s first bowel cancer screening pilot by ensuring that all eligible Waitemata patients are included in the screening. • We are working to prevent heart attacks and strokes by increasing the number of cardiovascular disease checks. • Our diabetes patients are given support and training about how to better manage their condition and more diabetes checks are being done through our general practice teams. • A successful nurse-led model has improved the health and wellbeing of many of our older adult population by identifying early risk and impact and working with other health agencies to reduce avoidable hospital admissions. • We’ve identified and are addressing some of the challenges our general practice teams face and giving them support so they are better able to provide quality care to their patients. Much work lies ahead, but we will continue to rise to the challenges. Comprehensive Care is committed to working with our colleagues to ensure the health and wellbeing of our communities, iwi, hapu-, and wha-nau are the priority as we look towards a healthy future.
Team work triumphs in 2012 Anei ra to matou reo maioha ki a koutou o te Poari Hauora-a-Rohe o Waitemata e piki nei ki enei taumata i roto i a koutou mahi tera kia puta he hua mo nga uri whakaheke. (We acknowledge with gratitude the efforts of Waitemata District Health Board to establish opportunities that enable the well-being for all) Congratulations Waitemata DHB! You’ve exceeded your health targets and continued expanding your facilities and services. Comprehensive Care Ltd, in association with Waitemata PHO and its General Practice Teams, is proud to have contributed to your success this year by working with you to improve our communities’ wellbeing. By liaising closely with GP practices, Comprehensive Care is identifying what our communities need and how we can better manage our population’s long-term conditions to reduce hospital admissions. We are making a real difference through our many health programmes - such as our Before School Checks for children at age four, providing successful quit smoking support services by working with families to create smoke free homes, helping those with diabetes and asthma better manage their conditions and helping to protect our children against harmful infections through vaccinations. We look forward to continuing our partnership with Waitemata DHB in 2013 and to creating vital communities that grow from strength to strength. Visit our website www.comprehensivecare.co.nz to find out more about our programmes or give us a call: (09) 415 1091
Well done! // 21
Testing time for ICU
In 17 years as an ICU nurse, Rupert Murch has never encountered a case like it. To make a difference for this young man, he needed to draw on all his training, experience, and expertise.
ost patients who are admitted to the Intense Care Unit (ICU) won’t stay longer than a few days, but North Shore Hospital’s clinical nurse educator for the ICU Rupert Murch was challenged with a young man whose stay was to be a lot longer: 100 days, in fact. Aged in his 30s, the man was admitted to the ICU with a debilitating muscle-weakening condition which, in just a few days, had seen him lose the ability to move his arms and legs and then began preventing him from breathing. “We didn’t know it at the outset, but it was to take a long, long time to get him right.” Naturally, the patient was frightened, and to further complicate matters, he had pre-existing health conditions that complicated his treatment. It meant not only did staff have to treat the multiple aspects of his physical illness, similar to Guillain-Barre Syndrome, but they also dealt with its impact on the patient’s fragile mental wellbeing. Rupert says for a variety of reasons a decision was made not to move
the patient to a ward but to keep him in the ICU. Rupert was to head the multidisciplinary team that would co-ordinate the care for this most unique of critical care patients. The team involved ICU medical staff, physio and occupational therapists, social workers, mental health professionals, and speech language therapists. It identified innovative solutions, enabling the patient, who was tracheotomised and on a ventilator, to communicate with his family and staff. “This patient’s care was a massive team effort and the challenge was to bring it all together, but everyone put in that work and we achieved an outcome better than we could have hoped for.” Rupert is particularly proud that the patient did not develop a secondary chest infection during his 100-day stay on the ICU, which represented a colossal effort from all his carers. Clinical nurse specialist Peter Groom nominated Rupert for a Health Heroes award, saying he fought for funding to enable ongoing care and rehabilitation and showed that “effort, commitment, and drive” can change patients’ outcomes. “He showed the importance of patient focus and forgetting the ‘likely’ outcome, he brought out the best in the whole ICU/HDU team.” Trained in England, Rupert was originally an estimator for a builders’ merchant but swapped to nursing because he wanted a career that was about helping people rather than making money. He has never looked back and says cases like the one described above demonstrate why he became a nurse: “I love being able to make a difference in people’s lives. It’s so rewarding, but this was a real team effort. When people work together like this, it reminds you of what we are capable of.” The patient was discharged to a rehabilitation facility, where he continues to make further progress – much to the team’s delight.
This patient’s care was a massive team effort and the challenge was to bring it all together, but everyone put in that work and we achieved an outcome better than we could have hoped for
22 // Well done!
Bringing a personal touch to care
Rab Burtun, diabetes nurse specialist at Waitakere Hospital, knows what living with the condition is like because he’s been a Type 1 diabetic for 30 years.
ab Burtun suspected he had diabetes when he was in the early years of his nursing training at Salford, England He did a test, and when it came back positive, he consulted a specialist. Despite his medical knowledge, he says he reacted the same way as do most patients who are given the diagnosis. He questioned the test results, got angry, and went into denial. Then he realised he could find the silver lining, become a diabetes nurse specialist, and help others who must deal with the illness. Some 30 years later, Rab, now 50, has been with us for eight years, bringing with him specialist knowledge, education, and experience gathered during 2½ decades of caring for those with diabetes and managing his own diabetes. He was nominated for a Health Hero award by colleague/team leader Jenne Pomfret, who describes Rab as an inspiration. “As a colleague, he is an inspiration and is always available for discussion around difficult issues connected to our client base. He is willing to share his time and his knowledge with the team. He gives 110% to his patients, who also regard him as a special individual.” Rab says adapting his approach to help each patient is important as is being open and honest about his own challenges. He particularly enjoys working with those who are having difficulties coming to terms with the diagnosis of diabetes and the fact they must take insulin. “There are many myths about insulin. Some people feel as if they have failed and are being punished and others believe they will become addicted to it.” He has devised a brightly coloured, concise, and highly visual flow chart help explain diabetes and the importance and benefits of controlling diabetes to prevent complications. This chart also helps patients understand why they need to take insulin and also the benefits of taking insulin. He uses this chart to explain the UKPDS (United Kingdom Prospective Diabetes Study), which is one of the biggest landmark studies done in diabetes. Rab’s chart is now in use all over New Zealand because he travels the country talking to primary healthcare providers about ways to convince people with diabetes to take their insulin. He says the thank-you letters, cards, and emails he receives, coupled with the fact he sees people with diabetes learning to manage and better live with the condition, are ample rewards.
Sleepless nights and busy days no problem for Lyn When she was a mum with young children, night shifts suited nurse Lyn Anderson to a tee. Thirty-one years later, she is still wide awake and brightening up the wee hours of the night and early morning.
esource nurse Lyn Anderson may have just finished an eight-hour night shift, but she’s still smiling when we catch up with her to talk about being an unsung DHB hero. Having returned home and breakfasted, she’s been out in the fields of her Coatesville property feeding the multitude of animals – many of them rare breeds – she and husband Rex care for. As a resource nurse, Lyn works on a rostered basis to cover areas of the hospital where, for whatever reasons, there are staff shortfalls. She works four nights a week and can find herself anywhere from the Special Care Baby Unit to the Emergency Department or one of the geriatric wards. Bureau services manager Marianne Lemmens, who nominated Lyn for a Health Hero award, says she is often assigned to the most needy and busiest areas of North Shore Hospital and sets about her work without grumbles or groans. “She has always been our ‘go to’ nurse and often saves the day for us, as she is able to and has worked in most areas of North Shore. She is a wonderful patient advocate and gives the very essence of tender loving care.”
“It keeps me on my toes! You have to stop and think about what you’re doing because you are rarely in the same place for two nights in a row” Lyn says she tries to go about her work quietly, causing as little disruption to patients as possible because while they may need monitoring during the night, they also need as much sleep as they can get. She also enjoys the variety. “It keeps me on my toes! You have to stop and think about what you’re doing because you are rarely in the same place for two nights in a row.” Lyn also credits her patients for keeping her on her toes. “The basic reason I have been able to continue what is busy, and at times, quite stressful work is because I am sure that, in some small way, I am able to help most people I am assigned to care for. This is because I am constantly inspired by the way most people cope with the worrying and usually painful time of being in hospital. I think people are amazing.” Lyn will soon reduce her working hours to three nights a week and retirement may be on the horizon, although she admits to being reluctant to giving up the job she wanted to do since she was a small girl. For the moment, she and Rex are reducing the number of animals they have, which, during the years, has included Belted Galloway Island cattle, Highland cattle, Ponui Island donkeys, Gotland Pelt sheep, Kunekune pigs, Indian runner ducks, and Houdan and Polish chickens.
This article has been sponsored by Stryker Corporation.
Cutting edge partnership leads the way Stryker is one of the world’s leading medical technology companies and Waitemata DHB is one of their most important Australasian research centres. Thanks to a partnership with Waitemata DHB’s Orthopaedic Service, Stryker has been able to achieve significant technological breakthroughs.
hen Waitemata DHB established its Orthopaedics Service back in the early 2000s, the DHB wanted to create a centre for excellence characterised by innovative models of care, quality service delivery, collaborative partnerships, and clinician engagement and leadership at all levels. In short, the DHB aimed to provide the best care possible for orthopaedic patients, particularly as its catchment grew to become New Zealand’s largest for orthopaedics. Waitemata DHB’s orthopaedics team now performs around 1100 hip and knee transplants per year – both elective and acute – which equals an average of three per day. This means there is little margin for error or delay. Early on, Stryker sought to support the team not just by supplying the many instruments and implants needed for these procedures but by offering the highest quality and most comprehensive technical back-up, education, and training available. Nearly a decade on, Stryker staff members work onsite and alongside the nurses and surgeons at North Shore and Waitakere hospitals. It has led to a unique relationship with a focus on achieving the most consistent, highest quality patient outcomes. In the words of Orthopaedic Charge Nurse Chris Cavalier:“The technical support is fantastic. We can get on with looking after the patients while Stryker looks after all the equipment and technical issues.” Matt Carter, who trained in the UK as an Operating Department Practitioner, is Stryker’s onsite representative. For the past 14 months, Matt has worked with the DHB’s surgical teams to ensure they have the right tools to do their work in theatre – and if for any reason they do not, the equipment they require will be promptly and efficiently delivered wherever it is needed. He works alongside the DHB’s surgical teams answering any technical questions that may arise and helping to troubleshoot if needed. That’s essential when you have – like Stryker does – up to 15 different systems on the shelves
at any one time. Given this volume of equipment, Stryker provides a computerised inventory system that is constantly keeping them abreast of what needs to be replenished and restocked. In addition, Stryker conducts a twice-yearly manual stocktake. Equally critical, Matt is involved in professional development. He believes this is probably one of the most satisfying aspects of his work. “I think the best thing for me is working on professional development. There are a lot of new graduates starting out in the profession or orthopaedic professionals returning to work after taking a break for whatever reasons. “Technology changes constantly; there are often far-reaching advances meaning ongoing education and training is vital. The Orthopaedics Service is such a dynamic department where there is always a lot going on. To be able to offer the team intensive training sessions – we’ve had a couple of all-day or two-day courses recently – is great. “I enjoy the teaching, and it’s especially satisfying to go into theatre and see the nurses putting into action what we’ve been speaking about. The ability to be able to provide ongoing training is one of the most enjoyable and valuable aspects of my job.” By being onsite, Matt can see what does and doesn’t work for the DHB’s orthopaedics staff. For example, he set up a trolley system where, instead of taking up shelf space, Stryker instruments and implants were stored on accessible and mobile trolleys. “Then I saw a nurse rush out of theatre and virtually do a 360° spin around the trolleys trying to find something, so I realised straight away that a clear visual aid, like a map to each trolley, was needed for quick reference. I was able to devise and introduce one within a very short space of time.” What’s also impressed Matt – and indeed, Stryker as a whole – is the DHB’s willingness to pioneer new techniques which, aligning with Stryker’s philosophy, will help people to lead more active and more satisfying lives.
“Technology changes constantly; there are often far-reaching advances meaning ongoing education and training is vital”
This article has been sponsored by Stryker Corporation.
One of the most significant trials involving Stryker currently taking place is the Triathlon Custom Fit Knee trial, which features ShapeMatch Technology. Hugh Griffin, Stryker’s New Zealand area manager for orthopaedics, says the DHB has become a focal site for research and development trials. “The department is very important to Stryker as a place where, with the support and approval of the staff and various bodies, we trial instruments, implants, and surgical techniques as we prepare to bring them to market. “It is a very, very good research centre, and this has benefits for the DHB, its staff, and most importantly, its patients, who have access to some of the most up-to-date equipment and procedures. I would go as far as to say that it is one of the most important orthopaedic research centres in Australasia.” One of the most significant trials involving Stryker currently taking place is the Triathlon Custom Fit Knee trial, which features ShapeMatch Technology. This technology allows surgeons, like Mr Matt Walker, Waitemata DHB’s Clinical Director of Orthopaedic Surgery, to size and position an implant based upon each individual’s unique anatomy. The ShapeMatch process begins with the aid of an MRI (magnetic resonance imaging) taken of the patient’s knee before surgery is scheduled. Proprietary software then utilises the MRI images to create a three-dimensional knee model. With this pre-surgical modelling completed, the surgeon reviews the specifications based on the ShapeMatch Technology. A Triathlon Custom Fit Knee with ShapeMatch Technology replacement allows surgeons to perform knee procedures with customised guides that are designed to provide a fit more closely matching individual anatomy. With this innovative technology, a surgeon can position the implants to help restore the kinematics of a patient’s knee. “ShapeMatch has been used for sometime in the United States, but there hasn’t been a qualitative and quantitative study done, so we are taking part in a controlled trial to see what benefits it provides to patients,” says Matt Walker.
“You have to have scientific proof that a technique is going to make a discernible difference before it becomes accepted by the mainstream. We’re a young department and happy to look at innovative techniques and technology.” Matt Walker agrees that Stryker is working with the DHB to make its Orthopaedic Service one of the best in the world. “Every process is different, and to have the technical back-up that Stryker provides in the theatre at the time of an operation is very valuable should any questions arise. It is also a great help to nursing staff putting the equipment together because there is so much involved in a knee or hip replacement.” Stryker will also work closely with Waitemata DHB as it moves ever nearer to the opening of the Elective Surgery Centre (ESC). Naturally, Stryker is excited by the concept and they are keen to ensure the ESC meets the expectations of all involved.
About Stryker developed out of The Orthopaedic Frame Company, which was formed on 20 February 1941 by Dr Homer Stryker, a Kalamazoo, Michiganbased orthopaedist. He developed the Turning Frame, a mobile hospital bed that allowed for repositioning of injured patients while providing necessary body immobility; the Cast Cutter, a cast cutting apparatus that removed cast material without damaging underlying tissues; and the walking heel, among others. In 1964, the company restructured and changed its name to Stryker Corporation.
26 // Well done!
A nurse practitioner on the team
fter four years of intensive part-time study, Sue Osborne is now one of only two adult urology nurse practitioners in New Zealand. At the time she began studying, she was “a nurse specialist, and the urology department at Waitemata DHB had a vacancy for a nurse practitioner”, she said. Sue belongs to a group of just over 100 nurse practitioners in New Zealand. Members of this group have completed a clinical master’s degree and an advanced education and training programme in a specific area of clinical practice. “We are able to work autonomously. We don’t have to work under a doctor and we can prescribe medication.” To reach the nurse practitioner standard, Sue required more than a master’s degree. “You have to go before a panel in Wellington with a lot of experiential learning behind you and to be able to demonstrate that. For me, the master’s programme I completed through Massey University was a key component of that, but it isn’t enough on its own.” Sue says her level of proficiency now is the result of support from the urology team within Waitemata, which she said was “visionary” because of the wider requirements now being placed on supporting healthcare professionals. “Health professionals have to be innovative about the way we offer care to patients now because of all the time frames the Government makes us work under. It’s not all about what doctors can do now. It’s about how advanced nurses can contribute to quality of care and the assessment and treatment of patients in a timely manner.”
Smiles all round
Six-year-old Emma Hall was bursting with excitement last month when she took possession of a PlayStation 3, on behalf of Waitakere Hospital’s Rangatira Ward.
he donation from the Te Atatu Lions Club was presented by club president Neville Jonas (left) and community services chair Chris Johnstone (right). Emma, a Rangatira patient, told them her older brother was very good at PlayStation and had taught her how to use it, so she wanted to be the first patient to play with this one. Neville said the money for the PlayStation 3 came from the club’s charity account. “If you buy sausages from us at our sausage sizzles outside The Warehouse at Westgate or Mitre 10 Mega on Lincoln Rd, you have contributed.”
Well done! // 27
Board priority: Living within our means It has been one of our top-ten priorities this year to carefully manage our budgets to make our health dollars work harder and ensure we deliver services within the allocated funding. We look at some of the ways we have achieved this.
From trash to treasure – and big savings!
Genealogy and furniture recycling might not appear to have much in common, but Jan Main’s passion for family history may have helped us to save big bucks.
an Main doesn’t like waste, so when she joined the Waitemata DHB 12 years ago as relocations manager, it distressed her to see good-quality used furniture heading offsite. “In the early days of my job, I saw so much going to waste. It was really horrible.” Describing herself as “a bit of a hoarder”, she says one should never underestimate the value of the old and preloved. A member of the family that gave west Auckland’s Bethells Beach its name, Jan has spent much time researching her forebears and appreciates the value of old diaries, documents, and photographs to shed light on their lives. In a roundabout way, this interest prompted her to think about how to make better use of the filing cabinets, workstations, desks, wall brackets, under-desk drawers, shelving units, chairs, beds and bedside tables, and whiteboards that would otherwise be discarded when hospital departments relocate. Jan recalls one service moving out of a Waitakere building and being told to dump its furniture; six months later, a new project team needed furniture. What had been discarded would have been perfect, so she hit upon a smart idea to store serviceable surplus furniture in a disused area of the old North Shore Hospital site. The next step was to put the word out that rather than buying new furniture when departments hired staff, relocated, or set up new services, they should come to her first. Jan’s simple but brilliant idea to recycle furniture saved the hospital $74,000 in 2011/12, and she reckons she is on target to save even more money this year. Since appearing in the June edition of Healthlines, Jan says demand for her furniture has soared. She says she is now known as the recycling lady wherever she goes in the hospital.
Reduce, re-use, recycle, and save! S
ustainability officer Kelly Taylor has been at the forefront of initiatives designed to make us a more environmentally friendly organisation. One of the positive spin-offs is the cost savings some of these have lead to. They include: • Recycling: we have saved almost $50,000 since implementing recycling at the beginning of last year. Our recycling rates are continuing to increase and our recent waste audit found that we are doing a good job of separating waste with less than 10% contamination in our container recycling bins and virtually no contamination in our paper recycling bins. • Recycling in patient and visitor areas was implemented at Waitakere Hospital in August and the Waitakere Surgical Unit has undertaken a recycling trial in theatres – both initiatives will be rolled out to North Shore. • Worm Farm: two domestic-sized worm farms have been installed at 15 Shea Tce to take the staff’s food waste on level 2. This is a demonstration project to show staff what they can do at home. The approximate payback period is four to five years. After this time, it will provide ongoing cost savings. • Energy Audit: last year, we had a level 2 energy audit undertaken that identified around $130,000 of annual savings. About half of the initiatives identified have been implemented to date. • Accreditation: this time last year, we were awarded Bronze EnviroMark Certification for North Shore and Waitakere Hospital sites. This is a major milestone and achievement; we are now working towards Silver. But Kelly is quick to point out that sustainability is not just about reducing our environmental impact; it’s also about economics and efficiency. If a scheme doesn’t work effectively for staff and patients, it won’t go ahead. “Sustainability is about doing things more smartly, being more efficient, but also improving life for people. The spin-offs have to be positive for staff and patients.” One initiative specifically for staff has been the Staff Travel Plan. A staff travel survey found 92% of us have used the staff shuttle, which runs between Waitakere and North Shore hospitals. This is undoubtedly reducing our carbon footprint.
28 // Well done!
Beautiful machines The sky is the limit when it comes to buying modern medical equipment, and each year, hospital officials are faced with a daunting array of options to choose from. Here, we highlight some of these amazing pieces of technology.
his year was no exception, and up to the end of October, Waitemata DHB had spent over $4.1 million on hospital technology, and it hasn’t even been a really big year! Last year’s purchases included the new
Lakeview CT scanner, which cost $2.4 million alone. Some of the substantial buys this year include ultrasound equipment worth over $200,000, patient monitoring equipment worth $490,000, and four dental stations worth $60,000 each.
Patient monitoring & cabling NSH $480,965.06
Washer disinfector 88-5 turbo & accessories $123,849
Zonare ultrasound system and machines $242,480
Sonosite portable ultrasound $77,924.60
Aisys care station with accessories $65,000
General x-ray dr $330,000
Philips monitor system, wall channel, monitor charger $121,783.60
Eizo rx320-k dual with meddc580 $89,495
Sonosite portable ultrasound $70,418.10
Chairs, bedside lockers & misc furniture-oral health $64,951.50
Radiolucent imaging top & table $103,950
6 x Carescape B850 patient monitors $490,000
Endoscopy pendants & liom devices $69,620
Volkswagen Crafter 35 custom van for the Wilson centre $90,581.01
Orthostar II mobile extension table $80,754
Telemetry project network, CCU , wireless $68,925.80
Aplio 400 ultrasound system for diabetes in pregnancy $203,828.04 Image intensifier $171,495
4x drivable dental units with standard equipment $238,180 Colposcope 150 FC $53,841
Well done! // 29
A selection of machines in use at Waitemata DHB
35x intra Planmeca wall mount $52,740
M71412+23 electric 4-section bed, IV poles & access $39,472
Safety sides â€“ bed access $47,700
Cattani k200 $38,222.73
Integrated power console, motor & attachments $47,390 PCA pumps Cadd Solis $40,965
Hand-held Massimo pulse oximeter $34,411 Twin channel gasstroscope $34,000
Colonovideoscope pediatric $33,720.46 Mydriattic retinal camera trcnw8 nikon d700 $30,900 Combioven 12;20 oes $30,700 Heartstart xl & defibrillator & monitor $28,246.66
Low volume iv infusion pump, pole & power supp - b.bruan perusor space $26,320 Alaris gp plus volumetric pumpÂ $25,000 Wheelchairs, leg rests, cushions & accessories $24,225 Misc furn-chairs, lay-z-boys, tables & desks
$23,888 Als simulator nt global 2005 AS $23,612.80 Eizo rx220 dual with meddc5800 $22,398 Video conferencing unit for 44 Taharoto Rd $22,285
30 // Well done!
A selection of machines in use at Waitemata DHB
Cots – H7 CT cot & CM mattress $21,540
DCA 200 machine for WTK & NSH $15,398.68
North Shore Hospital phone system $20,235.56
Video conferencing system HDx6000 with 50” plasma screen $14,650
Armblock machine – with accessories $18,936.75
Medical air – mixers/blenders/ cylinders/piping $14,160
Audioscan Verifit real ear/hearing aid analyser $18,188.13
Misc furniture – chairs, couches, bedside cabinets $14,066
Diathermy generator $17,000
5 Avalon fetal monitors (FM20/30) & accessories Price: $60,906.10
Cattani K200 $15,401.13
Viking hoist XL2040003 max 300k/armrest & slings $12,654.84 AV equipment linking SIM Centre to Waitakere $12,275 35x Intra Mlanmeca wall mount $11,720 Regulator – suction $11,414 Alaris volumetric pump $10,000.00
WIN! WIN! WIN! WIN! WIN! WIN! Well done! // 31 WIN! WIN! WIN! WIN! WIN! WIN! W TO ENTER Email your name, address, and phone number to: email@example.com Include the prizes you want to win in the email subject line: ‘HP printer’, ‘iPhone’, or ‘Finepix’. You may include one, two, or all three prizes in your email.
BE IN TO
WIN! a beautiful machine
CONDITIONS • This competition is only open to Waitemata DHB staff. • Prizes drawn randomly. • Competition closes 31 December 2012.
HP Envy 110 Printer – the ideal wireless home office companion
Fujifilm Finepix Z90 giftpack
Printing photos has never been easier with the HP Envy 110 e-all-in-one printer (valued at $399). This new wireless, web-connected printer has technology that allows you to email photos and documents from your tablet or smartphone directly to the printer from wherever you are. With its sleek design and high-resolution touch screen, it is the perfect complement for the home.
– quality pics for the dedicated photographer
Apple iPhone 4S 16GB handset – upgrade to the best Courtesy of Vodafone, you could win an unlocked black Apple iPhone 4S 16GB handset (for use on any network). Everything you see and do on iPhone 4S looks amazing. That’s because the Retina display’s pixel density is so high, your eye is unable to distinguish individual pixels. The unlocked iPhone includes all the features of iPhone but without a wireless contract commitment.
Thanks to OfficeMax, we’re giving away a Limited Edition Fujifilm Finepix Z90 giftpack, which contains a pink digital camera, colour matched 2GB SD card, 2GB USB drive, and carry case. Housing an innovative 3-inch wide LCD touch screen, a 14.2 megapixel sensor, a 5x Fujinon optical zoom, 720p HD movie and 1080p image capture, and a YouTube/Facebook easy web-upload facility, the FinePix Z90 is the perfect camera for a fashion-conscious photographer who is looking for a combination of quality and style.
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32 // Well done!
With experience comes wisdom
Three of our longest-serving staff members, each with more than 25 years of service, reflect on the changes they have seen at Waitemata DHB over the past few decades.
Cottage hospital remembered
Glenis Cameron started at North Shore Hospital back in 1986 when the hospital itself was still very much a work in progress.
t that time she, her husband, and young family lived on the ambulance station on Shea Tce and watched the hospital being built. “It was very much a cottage hospital when I started in the social work department as a secretary,” she says. But it wasn’t long before Glenis’s skills were recognised and she became heavily involved in the early development of North Shore Hospital’s mental health services when ward 12 (Kingsley Mortimer) was opened. “They asked me to set the service up for them, and I became its secretary.” The department eventually evolved and split, and Glenis then moved to Marinoto Child and Youth Mental Health and Maternal Mental Health Services. These days, Glenis is an admin officer in Breast Screen on Pupuke Road and still very happy to be part of the great hospital culture she’s enjoyed for many years. “When I started, you would go down to the canteen at lunch time and you would know everybody. I used to park my car outside my office when I first started here, that’s how small it was. You really did know everybody.”
Maternity service evolution
Maternity services have changed substantially since midwife manager Helen Ngatai came to the DHB nearly 30 years ago, but she still recalls those early days with fondness.
or Helen, major changes involved the move out of Taharoto, where mental health services are now located, to doing full Caesareans, and then, for midwives themselves, a major shift as they became more community-based. Overall, she says, the hospital just got busier and more wards were occupied. It was a big contrast to the days when she first started in the tower block where not all the wards were occupied. “When I started work in the tower block in Ward 5, it was only half full. “In 1994, we set up case-loading midwives – the KYM team. Know Your Midwife started on both sites with four midwives at North Shore Hospital and four at Waitakere. That built quickly to teams of 12 on both sites.” Helen has seen several restructures over her time, but compared with the early days, something she remembers most is the feeling of community that the hospital had. “It was easy to get to know a lot of people because it was all so much smaller.” Helen was located at North Shore Hospital for 22 years and has now been at Waitakere Hospital for five years.
Well done! // 33
Sense of community Marja Peters remembers the strong sense of community spirit at North Shore in the 1980s and says that same spirit lives on at Waitakere.
arja came to North Shore in 1984, and back then, “it was just a small hospital, pretty much like Waitekere Hospital is now”. At that time, the services were very limited, but “it’s really grown rapidly since then”, Marja says. She moved from nursing in Auckland Hospital’s neuro surgery department to the Emergency Department at North Shore. “Everything was really new to me, and I immediately loved it. I just loved the team work and the unexpectedness of it.” The people she came across through that time still mean a lot to her. “Some people you never forget because they just grab you and you always remember those moments.” She also recalls the feeling of community spirit on the shore, which was “very, very strong”, and how some other hospitals took an attitude towards them because they were so near Lake Pupuke “and they thought we were just here to have a holiday”. Over the years, Marja says she has also seen a “huge change” in management style, and “I do think it is all moving in the right direction now because I think we are heading into some really positive times for patients”. Marja moved to Waitakere Hospital in 2004 to start set-up of the Emergency Department, where she is now charge nurse. She loves being there because the feeling of community is very much like it was at North Shore in the early days.
This article has been sponsored by Accuro Health Insurance.
Accuro Wellness Initiative: Healthy steps ahead Bruce Morrison
While walking the halls of North Shore or Waitekere hospitals, you may notice a peculiar sight. One in every four staff members will be snatching glances at the pedometer on their belts or clipped to their pocket. Why? Because the competition is on to see who has taken the most steps each day in the Accuro Wellness Initiative.
ore than 1,700 staff members – in 425 teams of four – are taking part in the initiative. A handful of Accuro Health Insurance staff (the major sponsor of the initiative) are also participating. As this yearbook was being written, the initiative was in full swing, with the teams logging their progress through a website developed by Azion Wellness. As those who have logged in to record their progress will know, the website plots a journey on a course chosen by the team captain, and along the way, participants’ online avatars will receive encouragement from some familiar faces. Sam Bartrum, general manager human resources, is one of the driving forces behind the initiative, and he reached out to the DHB’s long-term partner Accuro Health Insurance to gain support for the project. “Accuro has been a partner with the DHB for a long time [as the Health Service Welfare Society, or HSWS]. We asked them if they were prepared to partner with the DHB to promote a wellness initiative. The whole idea of this 10,000 step programme is not only to get general activity and physical fitness up, but also to stay in touch with staff through the
programme and have some fun,” Sam said. So why is Accuro involved in a DHB wellness project? “We have a strong ethos for illness prevention and being fit and healthy, not just because it means less claims on people’s insurance policies but because we think it is the right thing to do. This initiative from Sam and the Waitemata DHB human resources team coincided with us wanting to form a closer relationship with DHB staff,” said Accuro CEO Bruce Morrison. Both Sam and Bruce are very pleased with staff involvement in the initiative, which was budgeted to have a limit of 1,500 participants. However, the uptake far exceeded expectations, and 51 new teams were added. Sam and Bruce are leading by example. Both have strapped on pedometers, striving for 10,000 steps every day and logging their progress through the website. “I love the website Azion has created. I was on it the morning the initiative started, and I know I’ll get bullied by my team mates if I don’t contribute my share,” Bruce said.“The way Azion has set it up, with the ability to design avatars and choosing courses, you can get more involved. It’s a lot different to just putting on a
pedometer. There is something to think about every day. There will be encouragement each day.” On the day he was interviewed for this yearbook, Sam said his team was ranked 61st but that there was fierce competition close to home. “Another team in human resources is led by my Group HR manager, and she is on this real physical fitness bent at the moment. She’s into triathlons, cycling, and running, and she always reminds me of how many steps her team has completed and how far they are around the course. Sometimes, that little bit of competitiveness is quite good,” Sam said. Challenges like this often transcend the finish line. Bruce’s previous experience in a similar project involving Accuro staff has left a lasting impact. “It was very successful and changed a lot of habits, including my own. I now wear a pedometer every day, even when not involved in a challenge like the Accuro Wellness Initiative. It’s amazing the difference between walking up stairs instead taking the lift every day.” Sam, too, was involved in running a wellness initiative when he worked at Counties Manukau DHB, which produced very positive results, and he is looking forward to running this initiative again in the future. “It’s definitely something I’d like to do again. I was very pleased with the uptake this year, and I think this will hopefully become a yearly event for us. I’d like to keep the partnership with Accuro going, and maybe even broaden it out further. For instance, we could talk to places like Auckland City Council, and hopefully have an Auckland City/ Waitemata DHB challenge. Getting another big organisation involved could be a lot of fun.”
About Accuro Health Insurance began as Hospital Service Welfare Society (HSWS) in 1971. In 1989, HSWS changed its name to Health Service Welfare Society as an acknowledgement of the changing structure of the public health system (when area health boards replaced hospital boards). In 2007, HSWS changed its name again, this time to Accuro Health Insurance, in order to extend its offer of providing comprehensive cover at a competitive price to members of the public. In Latin, Accuro means “taking care”. Accuro is a 100% not-for-profit membership organisation.
Accuro Health Insurance congratulates everyone at the Waitemata District Health Board for the major success you’ve had this year in exceeding national health targets for the first time. It’s a great result for you and your community.
Accuro offers a special discount for
Why choose Accuro? We understand what it’s like to have people depend on you in times of need. Accuro Health Insurance is a not-for-profit member organisation that has been providing outstanding medical insurance to New Zealanders for more than 40 years.
Special discount for Waitemata DHB employees We are pleased to be able to support Waitemata DHB employees by offering a special 5% discount on our SmartCare and SmartCare+ plans. You’ll also qualify
You may know us as HSWS. In 2007, we changed our name to Accuro Health Insurance. Accuro is Latin for ‘taking care’, and that’s what we do − take care of our members by offering low premiums, comprehensive cover and personal service.
for an additional 3% discount if you choose to pay your premiums by direct debit. Plus you’ll get one month free if you pay annually. Please get in touch for an obligation free quote or just to find out more about our services.
0800 222 876 www.facebook.com/Accurohealthinsurance
36 // Well done!
Board priority: Clinical Leadership Our clinical leaders inspire us to make good decisions regarding clinical care. Under their leadership, our clinical teams are transforming patients’ lives, exceeding targets, and pursuing innovations.
Clinical leadership a developing process
For orthopaedic surgeon John Cullen, the development of good clinical leadership is an organic process and the definitions of it may vary, but as he sees it, the process is well under way at the Waitemata DHB.
e says the board and senior administration are very keen for clinical engagement to expand, and in line with this commitment, senior clinicians have been given a place on various board committees. “This allows them to have a voice at a higher level than just within their own service departments,” he says. Some of the newer health professionals see the move as a very positive step, but for people like John, the new approach has something of an ancient ring. “In the old days, the clinicians had a much greater say in what went on. I think there was a period there where they got pushed aside a little bit. It was a time where management felt that it was their job to decide how things were going to develop, and as they held the purse strings then, I suppose it gave them more authority to do that.” Now there’s been a shift back to clinical engagement, and from John’s perspective “and in public service generally”, a lot of things need to occur. “Many of those things will need to be clinician-driven because we understand the way things work, on the shop floor.” He also stresses that clinical engagement is a two-way process and its success depends on a willingness on both sides to make it work. “Healthcare in New Zealand is rapidly
running out of money. The reason for that is that medicine is becoming more expensive and the reason for that is that patients’ expectations are greater and doctors’ expectations are greater. “The big challenge in the next few years will be in reducing healthcare costs per individual to allow us to provide more services for the population in general. There’s a whole lot of rethinking needed about how we spend the dollar.” In his own field of surgery, John believes there are many ways to reduce the cost of individual operations to do more for the same dollar spend. “I think we’re at the stage now where we have to ask ourselves as clinicians how we can reduce costs with the management of the patient within and out of the operating theatre.” He says an example of that would be in the use of different levels of consumables or implants. “Now one has to realise that if we could use an alternative implant that is cheaper, it may be uncomfortable for the clinician because they have to change the technique or process they do … but if we can change in that way, it will allow us to treat more people. “We’re the ones who spend the money. We need to be aware that in the mix of patient management we have to reduce costs as well.” For John, the bottom line is that both clinicians and management work more closely together because “there is still a big divide there with clinicians feeling that management is the enemy because they won’t allow them to do the things they want to do. “The message is that we’re actually all in this together and we should all be working together to resolve these things.”
Waitakere pilot shows the way
rom my perspective, the most dramatic demonstration of clinical leadership has been shown in the Waitakere elective surgical pilot, where the individual surgeons and anaesthetists took it upon themselves to develop and run the service,” John says. Government health reports last year showed Waitemata DHB already performing above expected elective surgery access rates. Chief executive Dr Dale Bramley says that for the past two years the DHB has taken 25% of all new elective surgical capacity delivered in New Zealand – a remarkable achievement.
Moving and handling – a whole new world
Ask most Kiwis about matters involved with moving and handling and you’re likely to end up in a discussion about what happened when they last shifted house.
alk to Anne McMahon at North Shore Hospital about the subject, however, and your eyes will open to a whole new world – because in healthcare, there are some serious issues to be faced. In the healthcare world, the problem of moving and handling is not only big, but it’s getting bigger as patients get heavier. “It’s a big subject because it touches every area of the healthcare business,” Anne says “Everything from selecting call cars so that district nurses don’t injure their backs by lifting heavy equipment in and out of car boots to protecting the spinal injury patient who gets moved wrongly and ends up paralysed. “It covers a wide spectrum, but particularly in healthcare, it affects patient safety, patient care, and patient outcomes.” For seven years, Anne has been involved in coordinating moving and handling for Waitemata DHB. “One of the problems we have in New Zealand is that we’re one of the few western countries that doesn’t have any legislation around this. In Europe, the UK, Australia, and the US, there is specific legislation. “The knock-on effect from that is that you then have Ministry of Health directives, ring-fenced funding, and you have real leverage to put it in as core business.” She says the only thing that would stand up in a court of law would be the New Zealand moving and handling
Well done! // 37 guidelines, which were revised and republished in March this year. Anne was one of the co-authors. “They were launched at New Zealand’s first moving and handling conference, held in the Aotea Centre in March. There is also a Moving and Handling Association of New Zealand (MHANZ), which crosses the boundaries of workers in health, social, disability, and education sectors.” Anne is currently the national chairperson for MHANZ. She says the subject itself is not only wide, but when it comes to dealing with buying equipment, the problem of procurement affects hospitals throughout New Zealand. Her next step is the development of a national training programme to help to develop common standards of national care. “It’s complex because it varies with every profession and in every level of that profession. At the moment, we have 20 different DHBs doing it 20 different ways. By taking a standardised national approach, the cost savings would be huge.” The systems developed at Waitemata DHB are the only ones to have undergone academic scrutiny and are regarded to have a national expert running them. Anne is also working to introduce a postgraduate qualification in moving and handling into New Zealand, through AUT University. She says overseas there are several qualifications available with Loughborough University taking it to PhD level. “In New Zealand, moving and handling is seen as an intervention to look after staff. But it’s actually an entire science,” she says. “Something as simple as moving someone out of bed can have all sorts of implications for them. The way someone is moved affects their dignity and their prognosis. It can be a matter of life and death.”
Challenges, triumphs, and new horizons
Pat Alley’s passion for being involved with and developing top surgical services has never waned since the day he arrived at North Shore Hospital in 1984.
e doesn’t mind admitting that he’s seen a lot during his time with the organisation, and when asked to elaborate on some of the good things that have happened over the last year, the conversation immediately turns
to his ‘children’. As director of clinical training, Pat’s main focus is on first-year house surgeons, who he lovingly refers to as children “because they are to me”. “They come here for their first job full of enthusiasm after six years of quite difficult study at a medical school. Some of them, because they’ve just graduated, think they’ve made it, but here I am after 45 years, and I’m still learning stuff.” Over the last year, the hospital has taken in 51 first-year house surgeons, its biggest ever cohort of new surgical talent. “Everyone said you’ll never do it because they can’t do this and they can’t do that or they can’t do something else. “Well, half of them want to come back. That says a huge amount about the culture of the organisation.” North Shore Hospital is also responsible for a significant amount of undergraduate teaching and, until now, the arrangement between the University of Auckland and the DHB has been relatively one-sided, Pat says. “There hasn’t been a lot of resource invested by the university in this place but that’s going to change. It used to be very operational but now
it’s operational and strategic. That’s a big plus and things will go ahead.” He says another big bonus for the hospital this year has been the arrival of one of New Zealand’s “premiere” medical educators, Dale Sheehan, from Christchurch. Dale has taken 12 months sabbatical leave from Canterbury University following the loss of her home in the Christchurch earthquake. She started work with the Waitemata DHB in October. “I see her very much as an architect, not a builder. She’s going to be hugely beneficial for us.” On the wider issues affecting the region, Pat says there are good things happening across the Auckland region. He says there always have been issues between DHBs … “it’s been a bit like children writing in an exam – don’t want you to see what I’m writing! But that’s changing. “I think there’s some really good people operating in the development of, the northern regional training hub.” The hub came into official existence in September 2011 and is responsible for the coordination of postgraduate training and education throughout the northern region. Turning to the wider picture and the development of good clinical leadership, Pat believes our success in this area has a lot to do with the way we see ourselves as New Zealanders and New Zealanders aren’t always good at recognising success, he says. “Good clinicians need to be in an environment where they are applauded and they need to hear it from management. “We’ve got to recognise the good people and the good leaders in our organisation.”
It all boils down to coherence
n Pat’s view, health carers need to listen more to professionals sitting on the fringe of the health system, people such as demographers and sociologists, to develop a wider picture of the future. But he claims the final success will be defined by the comprehension of a single word – coherence. Pat says his views on the subject come down to a “phenomenon of being older”, but he’s quick to point out that while one word might distinguish a difference, it doesn’t imply a single solution for everyone. “We must run a cohesive service. By that, I mean that the education must fit the training, the quality programme, the clinical practice, and the fiscal management of the DHB. It has to fit the overall enterprise of healthcare in New Zealand, so it has to relate to all the other DHBs around New Zealand.”
38 // Well done!
2012: Our world
compared to the rest of the world Hospital life is a world of its own, but in this slightly tongue-in-cheek review, we take a potted look at some of the events in our year and compare them to events around the world. Some instances may make you think that there is a whole new world out there, but others make you grateful for the world we’ve already got.
January 2012 Work continues on a $3.2 million upgrade of the Rangatira paediatric unit at Waitakere Hospital. The redevelopment includes a new negative pressure isolation room built for infectious patients to help control the spread of diseases like measles and chicken pox. It will also add 10 extra beds, a new indoor playroom, an outdoor garden area, and a new parent kitchen. We spend $480,000 on monitoring and cabling at North Shore
Hospital, with a further $330,000 in general x-ray. Meanwhile… elsewhere around the world: A bomb explodes in Damascus killing 25 people and injuring dozens more, including several children. There are calls to withdraw Arab League monitors because the Syrian Government continues to crack down on its opponents. The cruise ship Costa Concordia hits a rock and capsizes near the island of Giglio off the coast of Italy.
February 2012 Preparations are under way to move BreastScreen Waitemata Northland’s mobile screening unit off to Kaukapakapa and Helensville. Publicity is under way, and women are being encouraged to take advantage of the service, which is free to those aged 45 to 69 every two years. Free digital mammograms are also available at BreastScreen Waitemata Northland’s fixed clinic at Waitakere Hospital. The clinic is open six days a week, including Saturday mornings and late nights Monday and Wednesday. Meanwhile… elsewhere around the world: The World Health Organisation (WHO), with support from a charity, continues a five-year breast cancer cost-effectiveness study in 10 low and middle-income countries. The results are expected to provide evidence for developing adequate breast cancer policies in less-developed countries. Russia and China veto an effort by the United Nations Security Council to end the violence in Syria.
Well done! // 39 March 2012 Christine Green planted freesia bulbs at the Devonport Library to help promote World Kidney Day and to publicly thank her daughter Lisa for donating the kidney that saved her mother’s life. “It was an easy choice. I didn’t want to lose my mum,” said Lisa, who made the donation in September 2009. Lisa now visits North Shore Hospital’s renal service annually for a check-up. Christine had known she had polycystic kidney disease (PKD) for 35 years, but it wasn’t until 2007 that her health took a turn for the worse and her kidney function dropped to just 8%. Meanwhile… elsewhere around the world: Lady Gaga announces dates for the European leg of her Born This Way Ball tour. Several tornadoes and severe thunderstorms hit 17 US states, causing at least 27 deaths and injuring hundreds.
June 2012 Bowel Cancer Awareness Week and Waitemata DHB’s highly successful bowel screening pilot is in full swing, offering free testing for all eligible Waitemata residents aged 50 to 74. The aim is to detect early signs of the disease, which kills more than 1200 New Zealanders every year. Waitakere MP Paula Bennett officially re-opens a bigger, better children’s ward at Waitakere Hospital after a major refit. Meanwhile… elsewhere around the world: Maria Sharapova and Rafael Nadal win the French Open, and a massive wildfire covers 60 square miles in Colorado.
April 2012 Dr Penny Andrew, a leading expert in health law and safety, arrives to lead Waitemata DHB’s ongoing delivery of high-quality patient care. As clinical leader for quality, she is tasked to continue the DHB’s systems and processes and to enhance the patient experience. In addition to her medical degree, Penny is also a qualified lawyer. She was a New Zealand Harkness fellow in healthcare policy and practice. Her research projects looked at measuring, improving, and reporting physician performance, and the role of compensation in medical error disclosure. Meanwhile… elsewhere around the world: North Korea prepares to launch a ballistic missile, and large earthquakes send tremors through India, Malaysia, Singapore, and Thailand.
July 2012 May 2012 Ministry of Health results show that Waitemata DHB has achieved four of six health targets, including for the first time for the whole quarter, shorter stays in emergency departments. Waitemata also has the distinction of being the only DHB to be placed in the top nine (out of 20 DHBs) across all health targets for the quarter. Chief executive Dr Dale Bramley said the results augur well for the DHB’s goal of being one of the best-performing DHBs in the country. Meanwhile… elsewhere around the world: US President Obama declares his support for gay marriage. The US Census Bureau declares that white births are no longer the majority, and New Zealand triplets die in a mall fire in Qatar.
A historic milestone is reached with 95% of all twoyear-olds in the district now fully immunised. The achievement means the DHB has now attained the immunisation national health target set down by the Ministry of Health, making Waitemata one of the first large DHBs in the country to reach the target. CEO Dr Dale Bramley notes that while most diseases are now less common in New Zealand, problems can still flare up. “We saw this last year with the measles outbreak across the Auckland region, and this year, it is whooping cough, with the number of cases in the region five times the level reported in January to May last year,” he said. Meanwhile… elsewhere around the world: The Summer Olympics open in London. Scientists confirm the discovery of the elusive Higs Bosun or ‘God’ particle, and the lights go out in India as power supply fails to than 350 million people. And then! The world starts dancing “Gangnam Style” as a Korean rapper’s crazy moves become a major YouTube hit with over 600 million views.
40 // Well done! September 2012
August 2012 A report released by the Ministry of Health reveals that people living in the Waitemata district have the lowest cancer death rates in the country. It shows that Waitemata, Capital & Coast, Nelson Marlborough, and Canterbury have death rates from cancer that were significantly lower than the national average, but Waitemata had the lowest cancer death rates of all 21 DHBs in New Zealand. The findings indicate a continuing trend. Waitemata also had the lowest cancer death rates of all 21 DHBs between 2006 and 2008. Meanwhile… elsewhere in the universe: A plutonium-powered rover named Curiosity successfully lands on Mars after experiencing “seven minutes of hell” and sends back pictures of some ideal holiday destinations. Another YouTube hit, Gotye’s “Somebody That I Used To Know”, which features New Zealand singer Kimbra, notches up over 300 million views.
November 2012 The University of Auckland appoints Professor Martin Connolly as the first assistant dean of the Waitemata Clinical Campus. Martin has been Freemasons’ Professor of Geriatric Medicine at the University of Auckland and a geriatrician at Waitemata DHB since 2006. The Minister of Health gives the green light to the $25 million, 46-bed redevelopment of the DHB’s mental health service. Meanwhile… elsewhere around the world: The death toll in the US attributed to “superstorm” Hurricane Sandy – the largest Atlantic hurricane in recorded history – reaches 90 as millions of people in northeastern USA deal with power outages, petrol shortages, and sparse public transport. Damage from the storm is estimated to reach US$50 billion. The New York City Marathon is cancelled because of the devastation. Astronomers detect what appears to be light from the first stars in the universe, based on data from high-energy radiation, indicating that stars were present at least as early as 500 million years after the “big bang”. Irish thoroughbred Green Moon wins the 2012 Melbourne Cup. Incumbent president Barack Obama wins the US presidential election over Republican challenger Mitt Romney.
Waitemata DHB announces an equipment amnesty. By population size, Waitemata is the country’s largest DHB and can lose well over $100,000 dollars worth of crutches each year as people store them away after use and forget to return them. The move is part of continuing money-saving initiatives to make already tight budgets spread as far as possible. Meanwhile… elsewhere around the world: West Nile disease continues to claim lives in Texas, with 1113 cases to date and 40 deaths. More US embassies are attacked because of a YouTube film that insults the prophet Mohammad and causes riots worldwide.
October 2012 A brand new state-of-the-art dental clinic opens in Albany. The Albany Community Dental Clinic located at Albany Junior High School is the first of four new school dental clinics planned in Waitemata DHB’s 2012/13 financial year. It is the eighth to open as part of the DHB’s dental facilities modernisation programme. Three more clinics in Glen Eden, Westgate, and Birkenhead will follow over coming months. The board announces the development of a new $3.6 million 18-station renal facility that will allow for up to 72 dialysis patients per day. It will be based on the North Shore and marks the start of the second phase of a programme that started with the opening of the $9.2 million North Shore Dialysis Centre last year. Meanwhile… elsewhere around the world: A contaminated steroid drug is blamed for a meningitis outbreak in the US – 13,000 people are exposed – and the US unemployment rate drops to its lowest point since 2009. Six Italian scientists and an ex-government official are convicted of multiple manslaughter and sentenced to six years in prison over the 2009 L’Aquila earthquake after prosecutors accuse them of being “falsely reassuring” before the event. Two celebrities fall from grace: overwhelming circumstantial evidence of doping casts doubt over cyclist Lance Armstrong’s Tour De France victories and a criminal investigation of the late UK TV presenter Jimmy Savile is launched after 200 potential sexual abuse victims come forward.
Well done! // 41
HEALTH BUSINESS: Karen Magorian (left) and Laura Panlilio have backgrounds in insurance and ACC, so both are experienced in case management and problem solving.
Smoothing the way for visitors Laura Panlilio knows some of the anxieties the patients she deals with every day are feeling.
have been a non-resident before, and I know the challenges. If you need medical attention, you are going to have to pay,” she says. “As well as worrying about your health, you’re worrying about that.” Laura and Karen Magorian, nurses with backgrounds in insurance and ACC, are Waitemata DHB’s new non-resident support advisors. It’s their job to find out if a visitor is eligible for publicly funded healthcare and, if not, how they are going to pay. The job calls for empathy, diplomacy and a real knack for problem solving. Karen relates one case where a student with a severe dental infection came to ED with her Kiwi boyfriend. They didn’t know if the student was covered by health insurance and were worried about paying. “She was in so much pain I thought she was going to pass out,” says Karen. “We talked it through and I said, ‘For the sake of this amount of money, I really suggest she needs to be seen, and you can pay it off if you need to.’” While they were deciding, they contacted the student’s university and found out she was
covered by health insurance. “The boyfriend later sent a note of thanks, saying they really appreciated my help.” By dealing directly with insurance companies – rather than expecting patients to claim and then pay Waitemata DHB – Laura and Karen can remove a lot of anxiety. But not everyone has insurance, and then their help is even more important. “You are treading a fine line sometimes between what the clinician wants to do and what the patient wants to do – which is to go home, because they are considering the cost,” says Karen. Laura relates another case of a Fijian woman who got sick while visiting her family. “The consultants and registrars were planning their care, but I was talking with them saying, ‘This patient is not eligible, is there anything else we can do?’” She kept talking to the family about what was happening, what it would cost, what their options were. “They knew what to expect.” The woman has now returned home, and her children in New Zealand and Australia have already paid $10,000 off her bill.
What it costs Emergency Department visit
Waitemata DHB provides emergency treatment without asking about eligibility. All patients have 12 months to pay their bill, or up to three years with approval. Treating non-resident patients costs Waitemata DHB $6 million a year.
42 // Well done!
Pat packs a lot in Earlier this year, Pat Klouwens retired after 61 years as a nurse. She wanted to learn to play the piano, travel, and spend more time with the grandchildren, so have her retirement dreams come true?
miss the job, I miss the staff, and I miss the patients, but I’ve never been busier!” Pat Klouwens laughs as she updates us on what has happened since she retired in April. She’s spent a large chunk of time helping her daughter, Katherine, renovate a house, and thanks to a night school course in furniture upholstery she went to years ago, she was able to revamp the dining room chairs for the new home. But old habits are hard to break. Pat, who started her nursing training in 1951 and worked in Auckland and Tokoroa hospitals, has now also volunteered for ROMAC (The Rotary Oceania Aid for Children project), which provides medical treatment for children from developing countries who need life-saving
and/or dignity-restoring surgery that is not accessible to them in their home countries. The children come to New Zealand and Australia for surgery that will change their lives and open the doors to new opportunities. So far, ROMAC has treated more than 300 children from Bangladesh, Cambodia, China, Fiji, Indonesia, Iraq, Iran, Kiribati, Malaysia, Nauru, Nepal, Pakistan, Papua New Guinea, Philippines, Russia, Sri Lanka, Timor Leste, Solomon Islands, Tonga, Vanuatu, and Vietnam. As a volunteer, she acts as a nurse advocate. Pat helps families negotiate our hospital system by ensuring they know what is happening – for example, they understand what tests are being done and why – and generally getting
them settled in. Having worked from ward and theatre nursing to midwifery and district nursing, Pat is well qualified to understand the workings of various hospital departments. But early next year, she will fulfil one retirement goal when she travels to Kathmandu, India, Sri Lanka, and Borneo. Her son, Jonathan, daughter-in-law, Kathryn, and their three children will join her in Borneo to visit the Kota Kinabalu orang-utan sanctuary. “I never had any desire to go to India, but one day, I picked up a brochure and liked what I saw. I thought, ‘I’m going to be 80 soon, so if I don’t go now, I wonder if I’ll be able to do more travelling because of the cost of the insurance!” We wish Pat all the best on her travels.
Well done! // 43
Caring for cultural and spiritual needs
As a taurawhiri (cultural advisor) with Whitiki Maurea Community Mental Health Services, Tame Ahu draws on his pastoral experiences as an Anglican Ma-ori priest to minister to those in need of cultural support and spiritual guidance, but he admits there are challenges.
ame remembers a day when had he just completed a karakia (prayer) at Waiatarau Mental Health Unit when he was approached by a clinical nurse specialist to facilitate a gathering of almost 30 people. It involved families and CYPS; emotions were running high. By using cultural protocol and tikanga, the two families participated in hongi and handshakes. Karakia followed by waiata (song), preceded mihimihi (speeches) and whanaungatanga (introduction). The most important aspects of this hui were to keep all present culturally safe, considering the highly charged emotions between families at the meeting, which was attended by CYPS.
“Tangata whaiora instantly warm to his status as a kaumatua (older person), allowing the engagement to be therapeutic. Once calm and feelings are heard and respected, it allows for effective communication, assessment and care planning” In his work as a taurawhiri (cultural advisor) with Whitiki Maurea Community Mental Health Services, Tame sees it as vital to consider a persons’ physical, mental, family, and spiritual health. While clinicians focus on mental health, he works on healing the spiritual dimension. “Every situation is different and every individual has different needs.” Roberta Kaio, now at the Counties Manukau DHB, nominated Tame for a Health Hero award, describing him as an inspiration to tangata whaiora (clients) and staff alike. She says his cultural interventions can calm down situations where tangata whaiora are distressed or where risk and safety issues are high. “Tangata whaiora instantly warm to his status as a kaumatua (older person), allowing the engagement to be therapeutic. Once calm and feelings are heard and respected, it allows for effective communication, assessment and care planning.” Tame says he simply enjoys helping people, and if he can make a difference in their lives, that’s all the reward he needs for doing his work. He tries to take care of staff spiritual needs, too, saying working in the mental health field has its challenges and staff also need karakia (prayers) and uplifting words of reassurance and hope.
44 // Well done!
Health Hero: Sue Lim
ue Lim is service manager, Asian Health Support Services. Sue is an extraordinary woman who is passionate about promoting the development of Asian health support services in Waitemata and also the wider Auckland region. I really admire her enthusiasm and drive – these qualities and her kind nature have always impressed me, as well as the broad network of people she encounters daily in her job. Sue has an ability to turn ideas into actions and her “can do” attitude is infectious – she inspires people around her to also think, ‘Yes, this is possible, it can be done.’ Sue reminds clinical staff of how important it is for us to grow our understanding of other cultures, her focus being Asian cultures in particular. Sue is a woman who dedicates a huge amount of energy and enthusiasm to her work, and the team around her cannot speak highly enough of her.
I enjoy her sense of humour, and her warm, humble, and approachable manner means that people both come to Sue for tips and advice, as well as to freely offer their support to the projects she is taking forward.
Health Heroes: Sarah Foley-Wilson and Hannah May
arah Foley-Wilson’s and Hannah May’s positions as Oral Health Pre-School Programme coordinators at the Auckland Regional Dental Service were created to improve access to oral health services, reduce inequalities, and improve overall oral health for pre-schoolers.
Sue is one of the ‘treasures’ we have at Waitemata DHB! Nominated by Margaret Mitchell-Lowe, service clinical director, Child and Adolescent Mental Health Services.
They were also charged with increasing pre-school enrolment and examinations and promoting positive health outcomes. So Hannah and Sarah were given the task of planning and implementing programmes that would target these high-risk pre-school children within the WDHB area. Both have enthusiastically embraced this programme, formulating ideas that have led to positive outcomes and increased enrolments – a 10% growth in enrolments in the first year and 14% in 2011/12. The biggest impact has been in Ma-ori and Pacific enrolments, with 15–20% growth each year. They have developed wonderful working relationships with other Well Child providers, which has enabled them to be welcomed into language nests and childcare centres to enrol these children. More recently, they have started a successful programme of maternity visits, talking to new mums and promoting early enrolment. Their warm and caring personalities, lovely smiles, and their great enthusiasm are paving the way for a brighter oral health future for many children in our area. Nominated by Belinda Tafua, manager, Auckland Regional Dental Service.
Well done! // 45
Lio Rotor PEOPLE
Faster than before, better than before… Brian Jeffreys is no stranger to North Shore Hospital’s day stay haematology ward.
Catholic chaplain Qualifications: Doctorate Canon Law, 1998, Licentiate Canon Law, 1996, Pontifical University of St Thomas Aquinas; MA, theology, 1989, San Carlos School of Theology; BA, philosophy, 1983, St Louis University Based: North Shore Hospital Time at Waitemata DHB: Three years
bout seven years ago he was diagnosed with multiple myeloma (a form of blood cancer) and received a course of intravenous (IV) chemotherapy while preparing for a stem cell transplant. It could take half a day at a time. Now he’s back for further treatment and has noticed a real change. A new drug, Velcade, has been approved by Pharmac, and North Shore Hospital is giving it a new way. Rather than being attached to an intravenous drip, Brian gets a simple subcutaneous injection. This cuts his treatment time from at least two hours to, at most, one hour (and sometimes as little as 10-20 minutes). Brian is impressed: “It’s much better,” he says simply. Not only is it much quicker for patients, it’s also hugely more efficient for the DHB. The ward is treating 21 myeloma patients, and giving Velcade subcutaneously is saving more than 20 bed hours a week. “It really frees up the beds for other patients,” says haematologist Dr Ross Henderson. The change happened last October, after haematologist Dr David Simpson read a Lancet paper outlining the new method and suggested it was worth trying.
FREEING RESOURCES: Associate clinical charge nurse Susie Moncur and haematologist Ross Henderson say the new way of giving Velcade has freed up more than 20 bed hours a week. North Shore became the first haematology department in New Zealand to do so. Now, says associate clinical charge nurse Susie Moncur, all patients on Velcade are getting it by injection rather than a drip. “Some patients wanted to keep having it IV, but they quickly changed to the injection,” she says. One or two who had a skin reaction changed back to IV – but then quickly changed back to the injection again. “ They would rather put up with a relatively minor skin reaction and get the benefit of much quicker treatment,” she says.
Why did you choose to work in this field? The position opened when I was on vacation in New Zealand. Bishop Patrick Dunn asked if I was interested. I took it as a sign and an opportunity for a new ministry. What does your job involve? Chaplains offer a non-judgmental listening ear, extending spiritual, pastoral and emotional support. We take turns being on call 24/7 and rotate presiding over Sunday morning services. We also supervise and train volunteer chaplaincy assistants. We participate in many DHB activities, like blessings and openings of new facilities. As the Catholic chaplain, I help to bring the sacraments to Catholic patients. What do you love about it? I meet people of different cultures and backgrounds. They generously allow me to share in their lives at the time they feel most vulnerable. What are the challenging bits? It is challenging when people expect chaplains to have all the answers. We do not, but we are willing to grapple with them. Hopefully, we discover the answer together. What would you say to people thinking of training in your field? It is a ministry, not just a job – rewarding but it can be stressful. We are but instruments; God is the one in charge.
QUICKER ALL ROUND: Nurse Mandy Carn-Bennett gives Brian Jeffreys his chemotherapy by injection – which cuts the time he needs to be in hospital by half.
A bit about Lio My favourite meal-break escape is… a good pasta meal. Coffee is very important. Apart from prayer, chaplains run on coffee! When I was five I wanted to be… a priest and a world traveller. If I wasn’t a hospital chaplain, I’d be… a lawyer. If I could live anywhere in the world… it would be here! My ultimate Sunday would involve… I work on Sundays, but on days off, I like reading and taking long walks.
46 // Well done!
Board priority: Culture Our culture is more than our ability to meet key performance indicators. We are caring and passionate, and every day, we have positive impacts on people’s lives – physically, emotionally, and spiritually. By banding together, using teamwork and compassion in our daily lives, we are making a difference. Read on to discover a few of the people and projects that are changing our culture for the better.
Creating a culture of change Chairman - Dr Lester Levy
Earlier this year, CEO Dr Dale Bramley referred to an “upward trajectory” in outcomes directly affecting patient care within Waitemata DHB and urged all staff to continue on a trending and already positive path.
t was a reference to some statistics that clearly reflected the existence of a new culture within the organisation that was now producing some satisfying outcomes. In April, Director - General of Health, Dr Kevin Woods, noted how “impressed” he was with discussions he’d had with staff, and the next day the Minister of Health, Tony Ryall, arrived to personally congratulate the DHB on reaching the national health targets. The board was particularly praised for achieving shorter stays in emergency departments. Board chairman Dr Lester Levy said the value of the gains made so far should not be underestimated because it wasn’t so very long ago that Waitemata DHB was in the news for all the wrong reasons. “When I was appointed chairman of Waitemata District Health Board nearly three years ago, it did not take me long to realise that a critical part of my role was to restore the reputation of North Shore Hospital,” he said. Back then, the North Shore Hospital Emergency Department was underperforming and had received a damning Health and Disability Commissioner report. There was also significant disquiet in west Auckland as a decade-long commitment to deliver a 24/7 emergency department service at Waitakere Hospital had totally failed – the emergency department was only open from 8am to 6pm. There’s been a substantial change. “Not only do we have the newest and most modern emergency department in the country at North Shore Hospital, we also have delivered on the 24/7 commitment at Waitakere Hospital,” Dr Levy said.
CEO - Dr Dale Bramley
“We have dramatically turned around the performance of our emergency departments against the six-hour target, from 61% three years ago to 95% last month.” Developing the right culture in any organisation can sometimes be a difficult thing because people generally don’t like moving out of their comfort zones or can’t easily see why what once worked before isn’t good enough now. Change management specialists the world over recognise that when it comes to deeply altering the culture of an organisation managers must be prepared to put themselves on the spot. That’s now happening at Waitemata DHB. Professor Richard Bohmer of the Harvard University School of Business will be advising Waitemata DHB (and Auckland DHB) as part of ongoing work to ensure good patient care and to directly consult with Dr Bramley over the next two years. Another significant management step this year came with the appointment of Dr Penny Andrew as the new clinical leader for quality. Her brief is to further improve the DHB’s systems and processes. Penny is a qualified medical practitioner and lawyer. She was senior associate with law firm Buddle Finlay, where she acted for a wide range of health sector clients and was a senior advisor to the Health Quality and Safety Commission before coming to Waitemata DHB. She now works closely with the hospital’s chief quality advisor, Professor Ron Paterson. Previous statistics revealed that radical changes needed to be made. That’s not only happening from the top down but there’s a growing body of irrefutable evidence to show it’s happening at the coal face, too.
“We have dramatically turned around the performance of our emergency departments against the six-hour target...”
Well done! // 47
In the best of hands
Caring till the end
Two very different patient care experiences this year clearly reflect the kind of cultural change taking place at the coal face of the organisation. Changing life paths
he first involved the birth of Riley Kiff. For his mother, Beks, a former ICU nurse in ICU, Riley’s birth was a life-changing event in both a personal and professional way. Beks gave birth to Riley by caesarean at Waitakere Hospital when he was two weeks overdue and obstructed. It was an experience that brought her close to death. She was on the phone to her best friend after the 10am operation as she nursed her new baby when suddenly “there was all this blood coming out”. She was haemorrhaging uncontrollably. Worst of all, Beks knew what was going on and what the next step might be. “I’ve looked after someone in ICU who had a hysterectomy after childbirth. She ended up having CPR and was brain-damaged.” Obstetrician Bindu Soysa assured her that everything would be done to avoid a hysterectomy but in the end that was not possible. She woke up at 2am the next morning in North Shore Hospital after losing five litres
of blood and the realisation that Riley would be last child she’d ever be able to bear. But it was the care she received afterwards that made all the difference. Bindu and anaesthetist James Woodfine were “fabulous”, she says. “They made me feel like I was in the very best hands.” The experience had a profound effect on Beks, who began retraining as a midwife in July. What she also realised was the importance of patient care and how to show it. “We always say to patients ‘just relax, just relax’. How are you supposed to relax if you can’t breathe properly?” She says she now metaphorically puts herself in the patient’s bed and knows the boost patients get from having confident health professionals around them.
he second experience comes from the other end of the scale and shows how patients facing the certainty of their final hours don’t necessarily expect their agony to be prolonged. For health professionals working in this area the problem is in knowing what the patient wants… especially when some of their charges have moved beyond the point of easy or even possible communication. Intensive care nurse Peter Groom has become strongly involved in advance care planning and receives training that gives health professionals skills to have those “difficult conversations” with patients while they can. One patient he met earlier this year had been admitted to intensive care several times in a few months. “I spoke to him to find out what he wanted, and it wasn’t to come to hospital. But the nursing home was terrified he was going to pass away, and so they kept ringing the ambulance.” What the patient wanted was to accept all the therapy the rest home had to offer and that was enough. “Once the patient recorded his wishes in his advance care plan, everyone was relieved” says Peter. It’s about creating a culture where patients are made to feel comfortable and they have respect to the last.
48 // Well done!
Board priority: Health of older people During 2011/12, we aimed to improve ways of providing care for our older population by streamlining services, developing one point of entry to all specialist treatments such as stroke, dementia, and delirium (with a coordinated approach to discharge planning), and creating a results-driven outreach programme.
Living long in Waitemata If Waitemata DHB was a country, we would have the highest life expectancy in the world.
t 75, David Christian (pictured) is still going strong. He cycles nearly every day, goes dancing two or three times a week, and recently qualified as an ESOL (English for speakers of other languages) teacher. He now helps elderly Chinese immigrants – “we can relate to one another” – to learn English as they spend their twilight years in a new country. But in many respects, David, a Hillcrest resident, is not unusual. You see, people in our catchment area, which includes west Auckland, the North Shore, and Rodney, can expect to live almost 16 years longer than the global average of 67. Latest available figures show we have the highest life expectancy in New Zealand at 83.7 years. “But I intend to push on a lot longer than that – probably into my 90s,” says David. Early screening for chronic illnesses, community-based education, and treatment programmes and new models of care such as speeding up access to tests and elective surgery are credited with keeping Waitemata residents healthier for longer. Sue Skipper, operations manager Older Adults and Home Health Service, said
given our rising life expectancy rate, it’s no surprise to find that the number of residents aged over 85 is growing rapidly. She said they often need extra care and attention: “People are living longer and our staff have been incredibly successful in helping people ‘age in place’.” Sue has around 400 staff working throughout the DHB, both hospital and community-based, including registered nurses, who ensure the one point of entry scheme is working well. She estimates that each month, the Older Adults and Home Health Service receives about 900 referrals – mostly from outside the organisation. Nurses carefully check each referral to determine the most appropriate follow-up. The biggest change in this system has been its integration with the mental health team, which is important because many older people have complex health needs and there are growing rates of dementia among elderly people. Sue said in years to come, the biggest challenge for her team will be meeting the needs of elderly people living with dementia. “This is going to be a huge area of development in gerontology and we need to
start thinking now about and planning for the best ways to manage dementia. We need to ensure there is better integration between primacy care and secondary health services as well as non-government organisations working in the field.”
Yvonne shares her passion for her work
Yvonne Verner joined us in July in a newly developing position as dementia nurse specialist.
t is clear from the way she speaks about her work that Yvonne is an advocate for those with dementia and is determined to involve them as much as possible in decisions about their treatment and care. “Often, people with dementia are
Well done! // 49
Staying safe at home
A Waitemata DHB pilot programme aims to keep older people from being readmitted to hospital soon after discharge.
argaret Batey (pictured) is no stranger to hospital care; during the years, she’s had more than 20 admissions to hospital. This year, Margaret, 74, became one of those taking part in a pilot programme aimed at keeping older folks from being readmitted to hospital within 28 days of discharge. The Integrated Transition of Care project involves non-surgical patients in North Shore and Waitakere hospitals who are Māori and Pacific people aged over 55 and all other ethnicities aged over 65. The aim is to identify early signs of deterioration
treated like children because of behavioural similarities. The big difference is that people with dementia have had a full lifetime to learn and gain knowledge, to adapt and find coping strategies, whereas children have not.” Working with departments across the DHB including inpatient, community, and primary care settings, she provides a consultation and shared care service for clinicians managing patients with cognitive decline who have complex issues. “When someone is having difficulties making decisions around what to do next or the best approach to manage a situation, they can come to me for advice and support.” Yvonne is already involved in a range of projects that focus on the care and treatment
and take appropriate measures, if required, to prevent readmission to hospital. It is a multidisciplinary effort involving nurses, doctors, and allied health staff in our hospitals and community, working closely with the primary care sector. Margaret, who lives with painful arthritis, was admitted to Waitakere Hospital for five days in March. During a regular outpatient visit, her doctor discovered dangerous blood clots. As part of the Integrated Transition of Care project, a pharmacist visited Margaret in hospital to explain warfarin, which she had been newly prescribed, how to take it, its side effects, and to reassure her it was safe to take with her other medications. When she returned home, she received two telephone calls from the Hospital Discharge Support Service (HDSS) nurses within three days of discharge, making sure she was okay, was taking the prescribed medications, wasn’t in too much pain, was drinking and eating
for older adults. One of these initiatives is the delirium project. Delirium is usually a temporary and acute condition caused by multiple factors, such as an infection, and can be easily mistaken for dementia. As part of the Residential Aged Care Integration Programme (RACIP), Yvonne is helping to develop resources and education for families, carers, and staff who care for people with dementia. She will also have input into the RACIP team’s future care guides, which provide reference points for 18 common conditions often encountered when caring for older people in residential care. “This is exactly where I want to be, and what I want to be doing,” Yvonne says. “It really is my dream job because of the chance
enough, and even if she and her husband were coping well. “I said to my husband, ‘it’s a really excellent service’, especially as a lot of people my age are on their own – they haven’t got a husband,” says Margaret. “It makes you feel as though somebody cares.” In our DHB, 12% of all patients who are discharged from hospital are readmitted within 28 days, but small interventions – like those being trialled in the Integrated Transition of Care project – may help to keep them well and at home. Cutting those readmissions by 25% could save us significant amounts of money – possibly hundreds of thousands of dollars – which could then be spent in other areas of patient care. Project manager Karen Holland said since it began last December, around 1800 calls have been made to discharged patients. Karen said feedback from patients indicates they find it helpful to discuss their health concerns and appreciate the chance to recheck they’ve understood their discharge instructions, particularly their medication regime. “They know it’s a health professional phoning them and that makes a difference,” she said. “We specifically chose experienced district nurses to make the calls because they’re used to working with patients making that transition between hospital and home.” Karen said the project has found a large number of older patients don’t have a high enough fluid intake, which can impact on their recovery and raise the chance of readmission because they’re at risk of dehydration, urinary tract infections, and constipation. The project entered a 12-month pilot phase that runs until March 2013, with evaluation and findings to be presented to the Waitemata DHB board in June.
to be a voice for people with dementia in the development of services for them and to promote knowledge and support for the people working with them. “My aim for the service is to work in partnership with other team members to create the best outcomes, using a person centred approach, for these people and those caring for them. “I am enjoying developing my role and working with a dedicated team of people here at the DHB. I think Waitemata is a very progressive DHB with processes already put in place to deal with ongoing service development to address the needs created by increasing dementia rates within the population.”
50 // Well done!
Moving on out of aged care
Most older people who move into a residential aged care facility will see out their final years there, but could some become well enough to go home?
urse practitioner, older adults, Janet Parker has long been thinking about whether some of the people she meets in residential aged care could be supported to live in their own home. “A lot of them tell me they would be happier at home,” she said, “but people seem to think that if you’ve been to hospital and you don’t make enough progress to go home, then there is no other option but to go into care. “I think we need to encourage a cultural change in that some people can move from hospital to an aged care residential facility, where they can have further rehabilitation, recover, and go home.” So, with funding from the Ted and Molly Carr Endowment Programme, the now defunct North Shore Hospital Foundation, and Guardian Trust, Janet and a team of health professionals set up a unique study to see if some older people could, with a little help, return home. She has been sharing with other staff the results of the study, which has run throughout this year. As the name suggests, ‘Rehabilitation in Aged Residential Care: Supporting older adults to transition home after debilitating illness’ (also known as the Ted and Molly Carr Returning Home Pathway) worked with older people who were admitted to hospital but did not, despite treatment and rehabilitation, make enough progress to go home. For those in this situation, the pathway has long been from hospital to residential aged care. However, Janet and the multidisciplinary team were convinced there were some who could make enough gains to return to their homes if further rehabilitation could be done in the facility they wound up in. A trial of an outreach model of rehabilitation was set up for 12 patients discharged to aged care. Rehabilitation plans were devised for each participant who then worked with a multidisciplinary team, including occupational therapists and physiotherapists from the ward who visited them on a regular basis in their aged care facility. The aim was to support them to gain enough independence to safely transition home. All 12 were paired with a ‘champion’ – a residential aged care facility staff member – to encourage them to stay motivated, do their exercises, and follow other advice. Of the participants, four left the trial early for various reasons, two gained enough function to go out independently with family and friends, two could have returned home but chose not to, and a further four participants made enough progress to return home. As well as improving the quality of life for older adults, Janet said the trial showed institutional care costs to the health system can be reduced. Rehabilitation for the 12 participants cost a total of $30,547. For the participants who returned home, the cost of home care support for the first year is $63,250. Had they stayed in aged care, the cost for the first year would have been $275,633. “It shows older adults can be supported to transition home from residential aged care after recovering from a debilitating illness,” she says. “Investment return is enormous in terms of quality of life and money compared to permanent placement.” Janet will write up and publish her findings and hopes she can find money for a larger-scale randomised control trial which compares the progress of those who have rehabilitation with those who don’t. It’s a unique example of innovative thinking and the ways in which we care for older adults can be improved.
Aftermath of a tragedy Dealing with injury and death is part of a nurse’s or doctor’s job. But what happens when it becomes part of your holiday? That was what two Waitakerebased nurses were confronted with in January. Close friends Jacqui O’Connor and Annette Tempest were among the first on the scene of the Carterton balloon tragedy, in which 11 people died. They were five days into a camping holiday with their families when, at 7:30am, a flaming hot air balloon fell from the sky. “It was surreal,” says Jacqui.
not always a good thing. But they will not easily forget the experience of being part of a tragedy. “When we got back to the kids I thought we’d just step back into holiday mode, and we tried to do that because we had the kids,” says Jacqui. “But we just kept going back.” Annette says she’s never had difficulty separating her work and private lives. But this is different. “The Saturday just gone was a week
Jacqui O’Connor (left) and Annette Tempest
“Immediately we sprinted to the campground office to get help. I was screaming ‘Fire! Fire! Help! Help!’” “Immediately we sprinted to the campground office to get help. I was screaming ‘Fire! Fire! Help! Help!’ Once the police were alerted, they jumped in the car and raced towards the crash site talking to each other about what they might find, and how to deal with it. Jacqui is a child and family nurse and Annette is a public health nurse, so this was outside their normal clinical experience. But they worked through the possibilities: head injury, broken bones, burns, CPR. In the event, there was little they could do. Once the ambulances began arriving, they decided to leave, knowing that more people are
on and I relived the whole thing.” Jacqui describes being “hyper alert”, knowing that tragedies don’t happen just to other people and looking for signs of another one. “I was at the beach the other day and someone was screaming out just in fun, and I looked to see what was happening.” Both are confident about how they responded to the unfolding tragedy. But they are also surprised at how they have felt afterwards, and may access EAP counselling to talk it through. “At the end of the day, we are just human,” says Jacqui. “And it’s not an everyday event.”
NEW COLLEGE OF HEALTH
In 2013, Massey University is launching a new College of Health. With a strong focus on prevention, we are looking at doing things differently. We are bringing together a wide range of health experts with a focus on MĂ¤ori health, public health, maintaining wellness and the development of a high-quality health workforce. We are delighted to be working with Waitemata District Health Board in creating a healthier new New Zealand.
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52 // Well done!
30 October: A day in the life of North Shore Hospital 0000hrs: Night shift nurses, who work from 2245 to 0700hrs, are on duty. Throughout the night, they will undertake tasks such as checking temperatures, IV fluid levels and blood pressure, and administering medication, as patients often need round-the-clock monitoring.
0100hrs: The Emergency Department (ED), with 34 beds, is full,
as is the neighbouring Assessment & Diagnostic Unit, where there are 50 beds. In the 2011/12 year, there were 118,232 attendances at an ED by Waitemata residents, which equals 21.5% of the population. Of these, 104,708 were to North Shore or Waitakere hospital Emergency Departments.
0200hrs: Security guards are keeping a watchful eye over the hospital buildings and grounds.
0300hrs: Radiology staff are called to the ED for a mobile chest x-ray. The Radiology Department is staffed around the clock. Staff members carried out 180,573 radiology procedures in our hospitals in 2011/12.
0400hrs: Or 0424hrs to be more precise – the first baby of the day, a
boy, is born. In 2011/12, 6584 babies were born at our hospitals, which is nearly 11% of the country’s total births of 61,031.
0500hrs: A morning supervisor is on his/her way to open the kitchen at 0530hrs.
0600hrs: Preparations begin for breakfast, which is served from
0720-0830hrs. Each day, approximately 1850 meals are produced at North Shore Hospital for inpatients, Meals on Wheels, the Wilson Centre, and Mason Clinic. The breakfast menu includes porridge, cornflakes, toast, stewed fruit, and a selection of spreads.
0700hrs: Night shift staff finish; day shift staff begin their day. 0800hrs: Surgical teams are preparing for theatre. The first operation at North Shore Hospital – a thyroidectomy – takes place at 0812hrs, while across at Waitakere Hospital, arthroscopy knee surgery has been under way since 0810hrs. In 2011/12, 15,891 elective surgeries were performed for Waitemata residents, which was more than 10% of total national elective discharges for the year. There were 12,843 acute surgical discharges from our facilities.
Well done! // 53
1500hrs: Laboratories at North Shore and Waitakere hospitals are
both busy. Peak times are mornings and early to mid-afternoon. Each day, the North Shore Hospital lab will process around 1000 samples; over at Waitakere, about 400 samples will be dealt with. An urgent sample can be processed in 20–30 minutes.
1600hrs: Hospital Discharge Support Service makes its final calls of
the day, having started at 0800hrs. These nurses are working on the Going Home: Integrated Transition of Care project which aims to find ways to reduce the number of times older adults are re-admitted to hospital.
1700hrs: Dinner service is under way. It includes a choice of two
main dishes and two vegetables with a carbohydrate like mash/whole potato, rice, etc, and a dessert.
1800hrs: North Shore Hospital’s outpatients’ pharmacy closes. 1900hrs: Staff who are working 0700hrs to 1900hrs in wards such
as Maternity and ICU finish work. At 1930hrs, the last patients for the day leave the North Shore Dialysis Centre. While the centre shuts at 7:30pm on Tuesdays, Thursdays, and Saturdays, it is open till midnight on Mondays, Wednesdays, and Fridays.
2000hrs: Visiting hours end and the hospital quietens down, 0900hrs: Outpatient clinics are in full swing. In 2011/12, Waitemata residents made 178,187 attendances at an outpatient clinic. This was 32.4% of the population.
1000hrs: Charges nurses, heads of departments and operations
Managers start the ‘bed balancing’ meeting to get an overview of what beds at North Shore and Waitakere hospitals are available where, predicted discharges and possible arrivals, and whether staff are rostered on where they need to be. The meeting takes approximately 15 minutes. There are 426 adult in-patient beds at North Shore; 84 at Waitakere. These exclude maternity, paediatric, ED/ADU, and ICU/HDU wards.
1100hrs: Medirest Food Service staff are about to start delivering
lunches. This starts at about 1120hrs. It includes a hot option of soup, savoury main dish or vegetarian option or a cold option of sandwich of the day. Sides can be a salad and bread with spreads. Lunch service finishes at about 1300hrs.
Midday: The staff cafeteria, open from 0700 to 1900hrs, hits peak hour with staff coming through for lunch.
1300hrs: The ICU’s six beds are empty while six of the HDU’s eight beds are occupied. Because it is quiet, two staff members have been redeployed to help out on busy wards.
1400hrs: Visiting hours begin for most wards, with the exception of cardiology/CCU, where visitors are welcome from 1100 to 1300hrs, and ICU and HDU, where visiting hours are open.
1430hrs: The ICU team have an in-house training session on the use of therapeutic hypothermia and cooling blankets as an aid to recovery in cardiac arrest patients.
completing the transition from day to night. Meanwhile, the last baby – from a total of 14 for today – is born at North Shore Hospital. It’s a boy!
2030hrs: The evening kitchen supervisor closes the kitchen. 2100hrs: The last operation, acute surgery for an abscess, takes place at North Shore Hospital at 2156hrs.
2200hrs: Night shift doctors receive handovers. These doctors will
be on duty till 0800hrs. Late night shift nurses are 15 minutes into their working night.
54 // Well done!
Board priority: Elective surgery Elective surgery has been one of the success stories at Waitemata DHB in 2012. We have exceeded our elective surgery discharge targets, implemented new strategies and ways of thinking, such as the Shorter Journey initiative, to better meet patient needs, and more significantly, with the new Elective Surgery Centre due to be completed next year, elective surgery is an area in which we will excel for many years to come. Here are the stories behind this success story. The priority for 2011/12 was to increase elective surgery discharges to 14,771, but we exceeded those targets by 1120, bringing the total number of discharges to 15,891.
his means we have successfully reduced elective surgery waiting lists and exceeded the targets set for elective surgery discharges in 2011/12. It results from continuing efforts across our facilities to use operating theatres more efficiently and ensure our patients receive their surgery promptly. Our result is the seventh best nationally and means that more than 10% of the country’s elective surgery during 2011/12 was performed for Waitemata DHB residents. Ask our head of surgery and ambulatory care Dr John Cullen how he feels about those numbers, and he smiles. “It makes all the work we do worthwhile.” But John isn’t about to rest on these laurels; on the contrary, he’s in the midst of planning for one of the biggest changes to elective surgery he has seen in his 40-year career as an orthopaedic surgeon. He will be the inaugural director of the Elective
An eye on the big picture
Surgery Centre (ESC), responsible for the overall leadership of the centre, which will operate as a stand-alone division within our provider arm. Before becoming director, John held the role of clinical sponsor for the ESC project and at this stage, will continue providing clinical sponsor input as part of his new role. John is also head of division, Medical, for Waitemata DHB’s Medical, Surgical, and Ambulatory Services and will retain that position until a replacement is recruited. As director of the $39 million state-of-the-art ESC, which opens in July, he will be responsible for a facility with 40 beds, four operating theatres, and 80 clinicians. Located at North Shore Hospital, the centre
Lynne Butler, Elective Surgery Centre project director, says real progress has been made on the development.
ynne Butler (pictured) produces a piece of paper that shows the 12 different work streams that need to come together to make the ESC a reality*, smiles, and announces a number have been ticked off and thorough progress is being made on the others. Ask her how she’ll feel when it opens in July and her response hints at the energy she is investing. “Excited! We’re aiming for a level of service that’s the same or better than in the private sector, and that’s very achievable,” she says. “When you support clinicians to run clinically led services, it’s all doable.” A former pharmacist who holds an MBA, Lynne also has other expectations. “We are fundamentally changing elective
will be dedicated solely to providing elective surgical procedures and hopes are high that 6000 operations across all specialities will be performed within its first year. Rather than waxing lyrical about the ESC, John is pragmatic about the challenges ahead. Among other things, it will mean new ways of working for our staff, as well as those in the primary health sector that refer patients to us; it will mean introducing new IT systems; it may necessitate changes to staff training and wellestablished protocols like patient meal deliveries may have to be rethought. Based on similar projects developed in the United Kingdom, the ESC is expected to streamline pre- and post-surgical visits. For example, most patients will receive an appointment for their surgery during their consultation. An unused operating theatre at Waitakere Hospital was recommissioned to trial ways to reduce elective surgical care costs. John says this was very successful, with more operations performed and the length of patients’ stay reduced. The next step is to look at how to maintain this momentum in the new ESC. surgery delivery in the public sector, so I hope it inspires more innovation and a culture of trying different things.” As project director, Lynne’s day might involve working with the project manager, doing theatre projections, overseeing budgets, and working with clinicians and the project team on how the ESC will work. But she says it’s not as dry as it sounds. “There’s actually a lot of creativity, especially in problem solving,” she says. The 12 work streams are: 1. Governance 2. Finance 3. Business framework and transition plan 4. Workforce development and orientation 5. Design and build 6. Operational commissioning 7. Procurement 8. Referral and perioperative pathways 9. Productivity models 10. Information technology 11. Communications and change management
Well done! // 55
Speeding up elective surgery a team effort The Elective Surgery Centre has been the catalyst for another new initiative here at Waitemata DHB: the Shorter Journey project.
s the name suggests, the Shorter Journey project is about ensuring patients have shorter waits for surgery, greater certainty around their treatment times, and fewer pre-op hospital visits.
Parking the ambulance at the top of the cliff
ne way to shorten patients’ respective journeys to elective surgery is to involve key support services earlier. That includes the allied health disciplines: social work, physiotherapy, pharmacy, occupational therapy, nutrition, and needs assessment. Physiotherapy professional leader Andrew Jones (pictured) says that work is about parking the ambulance at the top of the cliff,
The Shorter Journey pilot is testing new ways of referring and assessing patients for surgery and is being run with significant help from GPs in primary care. The four-month pilot - which started in September, tests new ways of referring and assessing patients for their surgery. It is being run with significant help from GPs in primary care. Project manager Carol Harris says GPs are key to the pilot because they will collect and submit more information about their patients throughout the four months. “Referrals don’t always have the depth of information needed to help decide whether a patient should be assessed at hospital for surgery or not,” Carol says. “But during the pilot, we’re asking GPs to gather and send more detail, such as
rather than the bottom. “At the moment, we often don’t know about the patient until they are lying in a ward bed post-operatively” he says. That’s clearly flawed because if there are any social or functioning issues that will affect their ability to get home in a timely way, we’re finding out too late in the game. “Right now, if a patient needs help with personal cares or grocery shopping when they get home, that’s all determined on the day they’re discharged. What we want is to have that all set up before the patient comes into hospital so that, post-operatively, we just have to press a button and it all happens. “It’s really about making the surgery a formality rather than a potential crisis point. We want to flag up early any patients needing input.” Changing the way things are done has involved working with the ESC project team and e-referrals to get a Risk Assessment and Prediction Tool (RAPT) and a Malnutrition Screening Tool (MUST) included in the referral GPs complete in primary care. The information these tools capture helps stream patients into risk categories from a functional, social and nutritional point of view. “We can then make a recommendation about whether the patient could be fasttracked through the Elective Surgery Centre or needs to follow a more conventional route”. Information received will also tell staff what
relevant diagnostics, cardiology information, and pre-anaesthetic health information.” She says the extra detail will make it faster and easier to determine a patient’s suitability for a first specialist assessment and surgery. “Clinicians in secondary care will use it to stream patients according to whether they need a single pre-operative visit with minimal tests or a more comprehensive evaluation. And it will help decide whether the patient would benefit from early input from services like physiotherapy or social work to give them the best possible outcome.” The pilot covers patient referrals for three surgery types: hip replacement, knee replacement and hernia repair, and it will be fully evaluated at its conclusion.
allied health input the patient might need before surgery. Patients will be classed as green, amber, or red under RAPT and MUST. “What we’re doing now is working out, for each condition, what input a patient might then need from the different professions” says Andrew. For example, ‘green’ hip replacement patients will need occupational therapy input to make sure their house set-up is optimal for their return home. But will an OT need to physically visit the patient or can the patient simply fill out a form and post it in before surgery? “It’s about making sure the patient gets what they need while we use our staff in the most efficient way we can.” Andrew agrees that the ESC and Shorter Journey project have led to some innovative thinking. “I think it’s great because when you start afresh with the right resources, it gives you the capacity to think differently. John’s [ESC director Dr John Cullen] vocal message has been that we need to do things differently – that’s really given people permission not to just cookie cut. “And it’s having a domino effect on other areas. The physios I’ve talked to who will be working with high-risk patients at North Shore Hospital are already buzzing. It’s giving them the momentum to do things differently in their worlds, too.”
56 // Well done!
Nathan’s heroic quest for health When Nathan Bennison quit smoking earlier this year, he set himself a goal to spend the money he saved on his favourite hobby. Did he succeed?
athan Bennison is on his way to Europe thanks to successfully kicking his 20-year smoking habit. By day, Nathan works as Waitemata DHB’s ACC revenue officer, but outside of work, he’s a keen medieval sword fighter. When he gave up smoking, he pledged to use the savings – which he estimated at about $10,000 a year – to buy a helmet and armour for his hobby of medieval sword fighting. He also wanted to start saving so he could go to a tournament in Europe in 2014. Nathan had the support of our staff smoking cessation service and says he doubts he could have done it without them. Smokefree practitioners Kirsten Westwood and Jenny Saxony provided advice on handling situations where he might be tempted to smoke and discussed different ways to quit. They gave him a prescription for four weeks’ worth of nicotine patches, costing just $3 a week. For a few weeks, Nathan had weekly appointments to talk about the challenges and triumphs of his journey. He says the toughest moments came about a month after he quit and his sense of smell started returning. “You can smell cigarettes 100 metres away!” But he stuck it out and now finds it easy not to smoke because he no longer likes the smell. He describes himself as a reformed smoker who
now urges others to quit and has even referred colleagues to the staff smoking cessation programme. (For more information, see http://staffnet/ smokefree/staffcessation.asp) “I think the difference was that this time I did really want to give up, whereas when I’ve tried before, it was because other people were telling me it was something I should do, but I think I would have probably lost motivation without support and started smoking again.” Nathan’s quest may have been more difficult because he also decided to lose weight around the same time he quit smoking. He received help from his father, who also wanted to shed a few kilos, and has now lost around 35kgs. He wants to lose around another 30kgs and says he is well on his way. Waitemata DHB offers an outpatient smoking cessation service to all general hospital patients who are interested in quitting. Patients can access a comprehensive non-judgmental programme incorporating subsidised nicotine replacement therapy, one-to-one consultations and telephone follow-ups for ongoing support.
Ordering trial a resounding success
A trial that streamlined clinical ordering this year has resulted in substantial savings to the DHB.
he Inventory Replenishment Project was the result of an idea from Waitakere Hospital CCU charge nurse manager Nick Price. A trial on the project was run over three months, and the end result was a saving of more than $90,000. Nick explained that the existing system for ordering clinical supplies was an “ad hoc” affair. Running out of items and borrowing
from another ward, or placing an urgent order, was an everyday event. “In some wards, the ward clerk might be really organised and work out an efficient system, but they are keeping all the information in their head. Then when they leave, it’s not written down anywhere and no one knows how the process works.” As part of the trial, three healthcare assistants took sole charge of ordering for their wards. Setting up that part of the process was “a bit daunting”, but the results proved the hard initial effort was hugely worthwhile, with a $40,000 saving in Wards 7 and 8 on the same period for the previous year. The trial covered three areas – North Shore Hospital’s Wards 2 and 6 (medical), 7 and 8 (surgical), and Waitakere Hospital’s Titirangi, Anawhata, and Wainamu Wards (medical).
Well done! // 57 PATIENT ENCOUNTERS
Four-legged therapists give a helping paw W
hen Chic Hunter walks into Waitakere “She’s amazing,” says Toni. Toni’s got a cat at Hospital’s Muriwai Ward with her golden home, but she’s not rigid in her pet allegiances. retriever Rusty, patients, staff and visitors slow “I did used to have a dog a few years ago.” down and smile. Many of them stop to pat Chic and Rusty, and Cassie and her owner Judy Rusty, who laps it up with quiet enthusiasm. Cowie are volunteers in Outreach Therapy Among them is 79-year-old Victor Colcord, Pets, a joint venture between St John and the who’s had a few strokes and been in hospital for SPCA. It brings animals and their owners several weeks. He’s met Rusty before, and greets into 250 hospitals, resthomes, rehabilitation him like a friend. “It’s a change,” says Victor. units and residential schools from Kerikeri to “It’s nice to see Waihi. That them walking involves 300 “That involves 300 volunteers and around. I see volunteers and enough of 315 animals, including dogs, cats, 315 animals, patients and including rabbits, guinea pigs, birds and even a staff.” dogs, cats, miniature donkey.“ Over at rabbits, guinea North Shore pigs, birds and Hospital’s Ward 2, 72-year-old Toni Smith is even a miniature donkey. introduced to Cassie, another golden retriever, Dogs have been visiting Muriwai Ward for for the first time. Just over a week ago, Toni had eight years, thanks to charge nurse manager a stroke, now she’s walking around, preparing Gerry Fennelly, who encountered the benefits of to go home. Before she does, she gets to spend pet therapy while working in Saudi Arabia. At a few moments with Cassie, patting her, telling first it was informal, with volunteers among the her what a lovely girl she is and smiling a lot. staff – including Gerry – bringing their dogs in
Benefits of pet therapy • Animals aren’t shocked by human ailments, frailties, handicaps and confusion. • They don’t judge people based on appearance. • They can reduce the stress and fears associated with illness or old age. • They help to take patients’ minds off their health issues and reduce boredom. • Interacting with pets can raise patients’ awareness of and interest in the world around them.
to interact with patients. Outreach Therapy Pets formally took over after a couple of years, but it’s a new arrival at North Shore’s Ward 2, where it began earlier this year. The two wards are very different – Muriwai is an assessment, treatment and rehabilitation ward for older people, with many patients
staying several weeks or even months. Ward 2 is a short-term acute ward for stroke and renal patients. So there are some different rules. At Muriwai, the visiting dogs go into patients’ rooms, but at Ward 2 they go only into the day room and the patients come to them. On both wards the patients think their animal visitors are, well, the bee’s knees. “I think it’s marvellous,” says Toni. “They really give a calmness to somebody. They don’t care if you’ve got two heads or one foot or whatever. They don’t judge you.” In Muriwai another patient, Carole Dawson, says the visits help her forget her health issues for a while. “When you are in hospital, you are in another world, you are not in reality. And then, when Rusty comes in, it takes you back to an outside world, a world with animals. It’s a feeling of security. It’s very therapeutic.”
Safety first Not any owner and their pet can be volunteers. First the animals are assessed for a suitable temperament. “All the volunteers attend a half-day workshop, where we assess all the animals,” says St John Outreach Therapy Pets manager Jo Hurford. “With dogs, we also need to know that the owners have them under control.” The volunteers are police checked, and have to ensure that their animals are kept free of fleas and upto-date with all their vaccinations. The animals are not allowed to come in if they or their owners are unwell, and are cleaned before each visit.
CALM AND COLLECTED: Rusty lets Victor Colcord adjust his collar, as they get some fresh air in a courtyard off Waitakere Hospital’s Muriwai Ward.
58 // Well done!
Our not so secret lives ... We asked you to tell us about interesting activities you’re involved in outside of work. Given the selection of answers we received, we can report we’re a very interesting and diverse bunch!
Amy’s book contains essential stuff
Junior Rugby’s creative allrounder Viv Phillips, security admin support at Security Services, Hospital Operations, says: “My family and I arrived in New Zealand six years ago, and initially, we struggled to make new friends. We thought it best to join our local rugby club (Marist North Harbour in Albany) so our son Matthew, then 7, could make new friends. “Last year, I was approached by Matthew’s team manager to volunteer for the Junior Rugby Club committee, so I did. In the last two seasons at the club, I have thoroughly enjoyed working as a volunteer alongside other dedicated parents to enhance the club and social experience for players’ families. “My role evolved into taking photos, creating leaflets, newsletters, event flyers, and match programmes, etc, to inform and engage club members. I was then approached by club management to produce and publish the 2011 club yearbook and I’m doing it again this year. In addition, I’ve also been involved in overhauling the club’s website – I now manage the content and weekly site updates throughout the season – and I’ve become team manager for my son’s team. I’ve also helped out with a touring squad to the NZ Junior Rugby Festival in Taupo. “It’s very satisfying when one’s efforts are recognised by your peers and the wider club. This year, I was rewarded with two club achievement awards: the Most Outstanding Contribution to Junior Club Award and the MNH Rugby Club Founders Cup for the overall Club Award as 2012 Most Valuable Club Member. I was even more proud when my team’s coaches received the Club Coaches of the Year award and our Junior Committee Chairman received the SPORT NZ Volunteer of the Year award for the North Harbour region from 672 nominations! “No words can really express what the involvement as a volunteer has done for my family and me since our arrival in this beautiful country six years ago – and one we now proudly call home. Through my volunteering efforts, I have experienced so much enjoyment, and I am very happy to have found a creative outlet for my interests.”
After raising her own children and listening to some “excellent advice” from her work colleagues over the years, Amy Clark has written a book about all the things she wished she’d known a long time ago. The book is titled Stuff I Wish I Knew – Good Advice for the Early Years, and she says, “It’s full of snippets of good, practical Kiwi advice for raising children under 5”. “Being overwhelmed with the mass of information available on raising children, I ended up reading nothing before our kids were born and relied solely on the generous advice shared by the experienced parents and grandparents in my life,” she said. Waitemata DHB has been her home for the last eight years, and along the way, “my amazing colleagues have shared life with me as I got married, bought our first home, worked through two pregnancies, and am now raising our awesome pre schoolers”. Surrounded by “so many brilliant health professionals”, she amassed loads of great parenting advice. “This shared knowledge, combined with further reading and inspiration from the best parenting gurus in New Zealand, has helped me to really enjoy being a mum,” she says. “When a soon-to-be parent and colleague jokingly asked for some of the best advice I had been given, an idea was planted. How great would it be to have all the best advice to get started raising little people in one easy to read, light-hearted book?” The first draft of the book was written during night shift meal breaks. “Sadly, raising babies can be quite a difficult and isolating time for some people, so this book aims to bring a bit of the knowledge, love, and care from the ‘village’ to you.” The books are $15 (+$1.50 p&p if required) and all profits are being donated to a local church building project – see www.masseyanglican.org.nz for details. You can find more information on the book on Facebook: www.facebook.com/stuffiwishiknew Amy is a staff nurse in the Waitakere Hospital Surgical Unit.
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Azure are proud to provide building services for the Waitemata District Health Board. It has been a pleasure to deliver several successful projects in association with the Facilities and Development team at North Shore and Waitakere Hospitals.
60 // Well done!
Exhibiting photographer David Prentice, Clinical Charge Nurse, Community and Home Detox, says: “I am a keen photographer. On the 11/11/11, I was involved in an international time-lapse photography photo shoot called 1day6cities. Photographers in six cities (London, Shanghai, Sao Paulo, San Francisco, Dubai, and Auckland) took one photo every 30 seconds over a 24-hour period on 11/11/11 to document this special day. “The subsequent time-lapse films are in the process of being shown in the six cities. 1day6cities had its Auckland exhibition in June of this year to coincide with the Auckland Festival of Photography. I helped organise the Auckland exhibition and liaised with the festival director and the event organisers, who are based in London. You can view the films at www.1day6cities.org. The great thing about the films is you can see what is happening simultaneously in the six cities at the same time over the 24hour period.”
Blood, sweat, and spray tan Noof, trainee anaesthetic technician, North Short Hospital, says: “Aside from my work, I am passionate about dancing. Growing up, I was exposed to bellydancing in the Middle East, and once I moved to New Zealand, I dabbled in a number of different dancing styles (hip hop, jazz, tap etc). “However, I found my home away from home at Tempo Dance Studio in Birkenhead, where I am currently a competitive Latin Ballroom dancer. I always put 110% into whatever I choose to do, so this year, I have also helped promote and been involved with Tempo Dance Studio’s first ever calendar. “This is my first year as a competitive dancer, and it’s been a rollercoaster ride. However, I have managed to battle through all the blood, sweat (lots of it), and tears (not to mention staggering amounts of spray tan, glitter, and hairspray). I competed in my first ever National New Zealand Latin Ballroom Competition at Labour Weekend, where the number one world ballroom champions held demonstrations and
Never too old to make music Leanne Huff, ward clerk medical ward 10, says: “My story starts six years ago but also brings me right up to this year. Back then, I was diagnosed with breast cancer, and after surgery, chemotherapy treatment, and lots of different hormone treatment, I decided in among all that that I would really like to learn the violin. “I made enquiries, which came to nothing, but one day, I was at the Devonport New World car park and a young lady approached me for directions to a local street. As we got into conversation, it became apparent that she had come to Devonport to start a private music school! This was my chance to ask her if she would teach me and she didn’t hesitate to take me on. “I have been learning the violin now for three years, have made a CD with her help, and I just love the tuition that she gives me. I’m 64 and by far the oldest pupil that she has!”
Well done! // 61 A long but worthwhile journey On 15 September, Sandra Lepou set off for Portugal with her old school friend Lisbeth. They’d planned and talked about the venture for the last three years. The aim was to walk the Portuguese Way of the Camino – also known as the St James Way. This is a pilgrimage walk from Oporto in Portugal to Santiago de Compostello in Spain, 240km in length. The cathedral in Santiago is where the body of St James is buried and there are many routes throughout Europe all leading to this point. In the summer season, 1000 people a day set off on one of the routes. “On the way, we were guided by little yellow markers, either an arrow or a scallop shell [the symbol of St James],” Sandra explained. “We stayed in very basic communal hostels [albergues] each night. “Even though we did a lot of training, we still found the walk a huge challenge, most days walking between 15 and 25kms.
Ice provides heartwarming break When it comes to taking a work break, clinical training director Pat Alley occasionally enjoys a summer trip into sub-zero temperatures. Just when most of us are heading for the beach, Pat becomes a ship’s doctor for Heritage Expeditions, which takes around 50 intrepid sailors down to the Southern Ocean to experience the joys of Antarctica. Last January, he was part of a group that travelled to the Ross Sea. “The combination of air clarity, geological grandeur, and a long horizon makes for exceptional natural beauty.” He says the beauty of this incredible landscape is only equalled by the historical dimensions of the heroic age of exploration made famous by Scott and Shackleton. “To balance that, for any New Zealander, it is a sobering experience to look at beautiful Mount Erebus and think of the tragedy on 29November, 1979.”
Blisters like we’d had never had before were a constant companion.” The route took them through beautiful countryside, with the terrain changing from cobbled lanes, old Roman roads, dirt tracks, and sometimes, open highways. “The journey took us 11 days, with one day being a rest day. When we reached Santiago, we had such a feeling of achievement and satisfaction. We registered our Camino passports, which had been stamped along the way, and received our certificates.” The next day at a special service in the cathedral, the priest called out the countries of the pilgrims who had completed the Camino. “When he called out ‘two pilgrims from New Zealand’, it was a very special moment,” Sandra recalls. “Walking the Camino was a great personal challenge but also the experience of a lifetime, one that I will never forget.” Sandra is a dental therapist at Birkenhead Primary, Dental Clinic.
A ballroom champion Claire Hague, clerk/receptionist in the Radiology Department, North Shore Hospital, says: “My husband, Ray, and I are both bigger, older people, so we took up ballroom dancing to keep fit. We have been doing it for a few years now, but last year, our teachers encouraged us to enter competitions. We do New Vogue and Classical Sequence dancing, which are set routine dances where everyone does the same steps at the same time, as well as ordinary ballroom. “We did a few local competitions with varying degrees of success. At the end of September, we entered the National Classical Sequence Dancing Competitions, where we achieved a first, two seconds, and two thirds in our various grades. The upshot of this? We are now NZ National Champions in Classical Sequence Dancing, Masters One, Level One, having come first in this grade. We are very proud of ourselves!”
62 // Well done!
Board priority: New models of care Here at Waitemata DHB, we constantly look to our inspirational people for our successes, but we also look further afield at different sectors, experts from other countries, and at different ways of thinking to evolve our models of care. Through the new models of care we are developing, we will ensure our patients receive first-class healthcare and our staff have the opportunity to be the very best in their fields.
I BOARD PRIORITY
Aviation throws medicine a lifeline The aviation industry and healthcare might be poles apart in many respects, but when it comes to developing new models of healthcare, doctors, nurses, and several other healthcare professionals might have something to learn from airline pilots.
CU consultant Ywain Lawrey says the comparison works well to a point but the difference is that if a pilot runs through a pre-flight checklist and something doesn’t add up, the plane stays on the ground. “It doesn’t always work that way in health,” he says, “but it will be interesting to see where things go on this in the next decade.” A new method involves checklists to ensure that certain actions have been taken, and where the administration of drugs or a new technology is concerned, “it basically makes sure that people do what they are supposed to do anyway”. Ywain says the methods being adopted don’t really cost money and usually save money, which makes them very attractive to administrators, but there is a payback of a different kind. The changes being implemented also result in the development of measurable common standards which, if shown to work, can and are being applied in other health board areas. “Pilots use pre-flight checklists with everything they do to make sure they’ve ticked off every single point before they progress. That hasn’t really been a feature of medicine, and it’s always been a bit of a debate as to whether it would be a good fit. “A pilot doesn’t turn up and get asked to fly an 84-year-old plane that’s got one out of four engines working. They get the option to stop if everything isn’t perfect, but in medicine, we work in a more imperfect world.” He happily concedes, however, that lessons can be learned from the checklist process. “Doctors haven’t liked them and, particularly in the past, they have viewed them almost as a threat to their intelligence. But those of us who have been involved where checklists work well don’t view it as such. “It actually does free you up, so you don’t have to worry about the more minute points, and you can get on with worrying about the good stuff. Pulling out a list and making sure you really have done all those things is really a useful aid to memory.” He says the Central line Associated Bacteraemia (CLAB) work, particularly at North Shore, “has been a fantastic success”. “It has turned into a new model of care, which still has some fans and some detractors in medicine, but I think it will grow in the next decade.” New models of healthcare are constantly under review, and extending on from work being done within ICU at Waitemata DHB, have meant: • more information available to the public • a new way of working with other DHBs and sharing standards of good practice, ideas, and successes • a new way of collaborating internally with doctors and teams within the organisation • spreading the results to other wards within the hospitals. The initiative to decrease ocurrences of CLAB began in late 2011 but has been deeply developed throughout 2012. Nationally, it is recognised as the CLAB Zero campaign and involves DHBs throughout New Zealand.
Well done! // 63
Paving the way to better care
The visit of a home-grown and now US-based academic earlier this year helped pave the way for some broader discussions on the development of new models of healthcare.
arvard Business School professor Richard Bohmer spent a week with Waitemata DHB clinical staff and chief executive Dr Dale Bramley. A highlight of his visit was an address he delivered to 80 staff in the 2012 CEO lecture series, covering matters on the future of the New Zealand health system. When it came to developing new standards and improved practices, Professor Bohmer challenged those present to look at top-performing health organisations overseas. He named four “habits” evident in high-performing healthcare organisations. These were: • specification and streaming of clinical decision-making • infrastructure design • measurement and oversight • self study.
CLAB Zero effort saves lives and money
North Shore Hospital’s Intensive Care charge nurse manager, Liz Dalby, is quick to respond when the discussion turns to establishing new models of healthcare.
ot only is she passionate about it, she’s also deeply involved in it. She says that over the last year they have firmly embraced a national effort to share information and develop better systems of patient care. “The one that I am involved with is the reduction in central line associated bacteraemia (CLAB), where we’ve relooked at the way we insert our central lines, maintain them, and then, based on the evidence, we move that forward.” It’s a process that has required “some quite radical changes for
“Most organisations leave it to individual clinicians to make these decisions using their own clinical judgement,” he said. “But high-value organisations had moved away from this model and into an ‘engineering’ perspective.” He said another key feature of high-performing healthcare organisations was that “they measure like crazy”, study what they are doing, and examine how they can improve. When it came to specification, “organisational performance is as much a determinant of outcome as individual performance”. “The evidence is now pretty solid that the best-run health systems get better outcomes and the worst-run health systems get worse outcomes. “The more we study it, the more we find that good organisational performance can buttress individual performance. We have to build great systems to ensure they [clinicians] can do the very best they can,” Professor Bohmer said. “The future of health delivery systems will be systems where we have taken much tighter control of the organisational procedures that form the core of clinical medicine.” Professor Bohmer, who qualified in medicine at the University of Auckland, previously worked at North Shore Hospital. people within the organisation”, she says, but it’s also received strong support from staff. “We’ve had good medical buy-in from the intensive care doctors, the infection control doctors, and the nurses.” The process is now being moved into other areas. “It has also affected our procurement process by the way in which we order our packs and how we collate what we needed for a certain procedure. We’ve put in check lists, cleared maintenance criteria against best practice, and have started to audit on a regular basis. Information is then sent to clinical governance and the Ministry of Health.” Liz says there is a chain involved but the system works very well. “Because we have ordered steps, we have timely feedback. Each week, we display how many bacteria-free days we’ve had. “We’re not using it as a stick to beat people with, but we’re presenting it in a celebratory form, and we put up posters as well. We’re letting relatives and visiting clinicians know about what we do, which is probably quite new. “The public don’t normally get to see how good we are at stuff, but now we are starting to display it so when the public walk past the noticeboard, they can read about the work we’re doing.” Another value of the new system, Liz says, is that it gives staff an indication of how quality is measured in a particularly area, and “that’s quite a change, certainly from when I started”, Liz says. “I think the big thing about this project that has been so successful is that we have shared our ideas with other DHBs. We go to combined meetings. We’ve now got a national pack, which has brought down costs from a procurement point of view, which in this day of financial constraint has been very positive.” The importance of what can be achieved in this area can hardly be understated when measured against the possibility of what happens if things go badly wrong. Liz says central line associated bacteraemia, when developed, carries around 40% mortality and a $70,000 bill, “so anything we do to prevent it is not only saving people’s lives, but it is also going to save the organisation money”.
64 // Well done!
Health Hero: Janice Riegen
anice Riegen is an occupational health clinical nurse specialist at Waitakere Hospital. I had the good fortune of being involved in her project – Healthy Workplaces – for the mental health services group, where I saw first-hand the dedication and commitment she has consistently demonstrated in making a healthy difference for Waitemata DHB staff. She speaks so passionately about the correlation between a happy and well workforce and improved patient outcomes, citing research articles and studies to support her statements as if she had learned them all by heart. And heart is what she brings to her job, doing most of her research in her own time,
connecting with experts the world over to garner as much information as her head can cope with, to link into the Workforce Wellbeing networks – nationally and internationally – gathering ideas to fit in with our cultural paradigm. She has adroitly navigated her way through nearly 50 team meetings, identifying strengths and creative ideas – it showcased her stamina and a robust sense of humour! Her compelling mantra is that having staff at the heart of the organisation and prioritising collaborative engagement encourages creativity and innovation in the workplace – completely consistent with the mental health services group’s philosophy of employee-inclusive ‘Lean Thinking’. Nominated by Melanie Boortman, clinical charge nurse.
Health Hero: Rosie MacFarlane
osie Macfarlane, the longest-serving district nurse in the small community health team based at Warkworth, manages a caseload of around 30 patients as far north as Wellsford and Te Hana. She is an IV resource nurse and is a great team member, going out of her way to support students and new staff and to help others every day. Rosie works closely with primary care organisations, including the Coast to Coast GP practice and Māori Health provider Te Ha o te
Oranga o Ngati Whatua. Rosie is a skilled and compassionate nurse who also loves to participate in new initiatives and is one of the first to volunteer, even though her day-to-day caseload keeps her very busy.
Health Hero: Te Ara Totoro
e Ara Totoro is whaea awhina (cultural support) at Mo Wai Te Ora Māori Health. On the morning of 23 May, our colleague Te Ara Totoro carried out CPR intervention upon a whaea (mother/aunty) in our accommodation who had lost consciousness and went into a cardiac arrest. Through prompt action by Te Ara, and social worker Joanne Wilson in support, this visitor (whose partner was in ICU at this time) did not suffer any further complications, and both she and her partner are now discharged. We think this action deserves recognition, although I am sure Te Ara would feel very shy that her name has been forwarded. On another occasion, Te Ara also played a major role in another incident. Even though a whānau member passed away, she continued to provide food parcels (from her personal funds) for whānau who arrived with no food, to help support their unplanned stay at North Shore Hospital, so we would like to acknowledge this deserved recognition. Nominated by the Mo Wai Te Ora Māori Health team.
In the last 12 months, she has been involved in the “Innovative models of wound care services” project, which included a trial of the Silhouette hand-held assessment tool. She arranged meetings to coordinate care with the GP practice and Māori Health provider and completed electronic wound assessment and wound measurement in both the community and in the GP practice. Rosie also participated in the making of an educational DVD on multidisciplinary case review, which coincided with the visit from the US of Dr Ed Wagner, the chronic care guru. Ed also ran a workshop, which Rosie attended. Rosie does all this on top of her day-to-day work as she is committed to learning and to providing the best care for her patients. Nominated by Rowanne Bridge, charge nurse manager, Rodney District Nursing and Continence and Ostomy Service.
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66 // Well done!
You wouldn’t read about it… In 1975 Dr Pam Melding left the United Kingdom, as an anaesthetist, for a few years’ OE.
NEW DIRECTION: Pam Melding isn’t retiring – she’s off to university to study creative writing.
omehow her OE became a permanent move, not least because she was having so much fun. She sailed a yacht from Fiji with one other crew member and a seriously injured skipper. She tramped through New Zealand. She became head of Auckland Hospital’s chronic pain clinic, changed specialities and started in psychiatry. She helped to set up psychogeriatrics at Waitemata DHB, lectured in psychiatry at the University of Auckland, wrote two text books, and became an authority in ECT (electroconvulsive therapy). She gave a speech in Parliament, got a New Year’s honour, and became Waitemata DHB’s associate chief medical officer.
Now, after 37 years’ she is retiring. Well, not really. She’s heading back to university to study creative writing. In 1988 Pam came to North Shore Hospital as a liaison psychiatrist working with the geriatricians. “There was no inpatients unit for older people or adults. There was nothing.” Her only inpatients were at Carrington Hospital. North Shore Hospital was “quite delightful”, she says. “Those were exciting days – that was a small dynamic hospital.” During the early 90s health reforms Pam became our first manager of mental health services for older people. “There was me, a trainee intern, a registrar, a psychologist, a couple of nurses and a social worker.” Carrington Hospital closed and North Shore Hospital opened the Kingsley Mortimer Unit (Ward 12). This year it turns 20. Psychogeriatrics changed dramatically in those 20 years. Before then mentally unwell older adults were largely locked away and over-medicated. “We developed very much a community-based model of treatment, and we brought people into hospital only if we had to,” says Pam. “I think we have made a tremendous difference with older people. That care has greatly improved.” Now it’s time for something completely different. Having discovered a love of writing while writing those text books, Pam wants to explore it further. Maybe, if she writes a novel, it will be about a young doctor who travels around the world, sails a yacht from Fiji, leads a pain clinic, changes specialities, sets up departments and gets all sorts of recognition along the way. Great plot. Ward 12 then and now • North Shore Hospital’s Kingsley Mortimer Unit opened on June 4, 1992. • It had 25 beds and 32 staff. • In 1994 seven beds were transferred to Auckland. • It continues as ward 12 with 17 beds and 45 staff. • Patients stay on average for three to six months.
Well done! // 67
A spoonful of sugar makes the medicine go down Jenny Crawford is a rare breed: she is the only paediatric pharmacist at the Waitemata District Health Board.
enny Crawford likes to say her job isn’t rocket science; it’s more about commonsense and seeing things from an anxious and possibly sleep-deprived parent’s point of view. But what she does is vital to the health and wellbeing of some of our most vulnerable patients. Jenny is the DHB’s only specialist paediatric pharmacist, and she is committed to ensuring medication is prescribed effectively and efficiently to children. That may mean thinking outside the square and finding ways to administer medication when a child simply refuses – or is too small – to take tablets; it may mean ensuring parents and caregivers have syringes to take home so they can dispense precise dosages, and it may mean spending time to show staff and families how best to administer medication.
“You can’t send a parent home and say your child needs 3.8mls of this medicine. After all, how are they meant to measure that accurately? We can’t take things for granted. “We expect a lot from parents, so it makes a great difference to them if we can help them by making their lives easier.” Earlier this year, Jenny’s colleagues, Janet Hanson, Jaye Fuller, Reg Wright, and Anna-Marie Scroggins nominated her for a Health Hero Award. They said she is always open to new ideas and changes and there are no limits to her creativity in supporting children and their families. “Jenny provides holistic, individualised care, recognising when families just need that extra support.” The first pupil from Waitaki Girls High School, in Oamaru, to train as a pharmacist, Jenny worked in New Zealand, London, and Singapore. In 2008, she became our first specialist paediatric pharmacist, and with the expansion of the Rangatira Paediatric Inpatient Unit, is busier than ever. She divides her day between Waitakere and North Shore Hospitals, spending part of each day in the Special Care Baby Units at both. Twice a week, Jenny travels to Takapuna to the Wilson Home Centre for children having intensive rehabilitation or who have come in for respite care. “I enjoy working with children, and I enjoy working with the paediatrics team. There are lots of people doing a lot of hard work and the beauty of paediatrics is that it is a great bunch of people to work with. Everybody works together really well.” With clinical nurse educator Jaye Fuller, Jenny won the overall prize in this year’s Waitemata Health Excellence Awards. See the list of names on page 69.
“We expect a lot from parents, so it makes a great difference to them if we can help them by making their lives easier”
68 // Well done!
Nurses recognised for making a difference D
eciding on this year’s recipients for Waitemata DHB’s nursing recognition awards was a difficult task, says director of nursing Jocelyn Peach. “It’s very, very hard to make a selection because their colleagues describe amazing contributions,” she told those gathered for the awards presentation last month. “Being nominated is, in itself, quite an honour. It’s a significant acknowledgement and the words of your colleagues show the attributes that made them so proud to nominate you.”
WINNING WAYS: (from left) Karen McIntosh, Brian Clarke, Maureen Hanson and Jean Bothwell, as well as Johanna McQuoid (absent) all received awards for their contribution to nursing. The awards coincide with International Nurses Day (marked on Florence Nightingale’s birthday, May 12). The five awards were given for best support person, excellence in clinical practice, innovation and support in a practice setting, most valuable preceptor and services to nursing. The winners were: Brian Clarke, ICU (best support person); Maureen Hansen, orthopaedics, and Storme McGregor, mental health (excellence in clinical practice); Johanna McQuoid, public health (innovation and
primary healthcare (most valuable preceptor); Jean Bothwell, urology (services to nursing). Jocelyn said nurses account for 36% of the Waitemata DHB workforce and midwives 3%. “This is a significant contribution to the health work of this organisation. I think we can be proud of the quality and commitment of these people to make a difference, every day to the health and relief of suffering of our community.”
Michal’s international honour Ask Dr Michal Boyd about when she became interested in caring for older people, and she laughs: “When have I not been interested in gerontology?”
HONOURED: Michal Boyd is one of just 346 nurse practitioners worldwide to be made a fellow of the American Association of Nurse Practitioners.
support in a practice setting); Karen McIntosh,
er first job, after school at the age of 17, was as a caregiver working with older people. “I just really enjoy older people, and I really enjoy the dynamic of caring for them. They have interesting lives, they have interesting problems. You can absolutely be yourself with them – there are no pretences and you can’t fake it. That love of working with older people, and fascination with their health issues, has seen Michal become a fellow of the American Association of Nurse Practitioners. She is one of just 346 nurse practitioners worldwide to do so. It is an honour to be invited to be a fellow as the association starts to recognise and represent nurse practitioners internationally, she says. Michal worked in the United States, and gained her doctorate in nursing, before moving
to New Zealand in 2002. She was Waitemata DHB’s clinical leader for community services for older people from 2006 to 2009. Now she practices at North Shore Hospital’s older adult outreach clinic and is a senior lecturer at Auckland University’s school of nursing and Freemasons’ department of geriatric medicine. She has made a real difference to many older New Zealanders by developing Waitemata DHB’s Residential Aged Care Programme. This slows the rate at which older people go to hospital, through coaching and education for nurses and caregivers. It also coordinates care for high-needs residents. And her research on aged care has influenced government funding. Michal has also helped mentor nurses as they become nurse practitioners. We now have three gerontology nurse practitioners, more than any other DHB. It is, she says, an exciting field to be in. “There’s a lot of potential growth in nursing at the moment, particularly gerontology,” she says. “I also think the team that’s attracted to gerontology nursing is an absolutely phenomenal team.”
Well done! // 69
Awards and accolades for 2012 Several Waitemata DHB staff have received commendations and awards this year, some of which will be used for overseas study and research at home. Here is a breakdown of some of them. Margaret Gadsdon Memorial Endowment This grant is awarded to help DHB staff to gain postgraduate clinical experience that can be directly applied for the benefit of patients. It can be used to help with the cost of attending courses, training to obtain postgraduate clinical qualifications, or course secondments to different health services or agencies to gain extended clinical experience. Recipients: Karen Freymark, Paula Davis, Karen Spray, Fiona Johnston. Karen Spray is putting her funding towards an e-learning programme in the Lee Silverman Voice Therapy Programme. “It’s a speech or therapy programme primarily for patients with Parkinson’s disease,” she says.
A. D. Bronlund Education and Travel Award This award was established to help staff (other than medical staff or those training to become qualified) so they can obtain further education or training, gain experience, skills, or knowledge, or undertake research. Recipient: Karen Freymark Karen says her grant will be used to visit three hospitals in Australia to look at how the FEES (fiberoptic endoscopic evaluation of swallowing) programme is run.
Auckland Medical Research Fund North Shore Hospital’s Microbiology Laboratoray was awarded $139,605 to conduct a two year study on the duration of ESBLPE colonisation. ESBLPE, also sometimes called ESBL, is one of the so-called “super bugs”. Those involved are: Dr Dragana Drinkovic, Dr Hasan Bhally, Dr Susan Taylor, Dr David Holland, Dr Arlo Upton, Dr Simon Brigg, Helen Heffernan, and Dr Lifeng Zhou. Infections due to ESBLPE can be difficult to treat, and it is not known whether humans can ever get rid of it. This study will test for ESBLPE in patients known to be carrying an ESBLPE and will see if it continues to be detected in faeces over an extended time period (two years).
Health Research Council Waitemata DHB as an organisation is listed on three Partnerships for NZ Health Delivery Awards (out of a total of four awards made). Waitemata DHB staff are also involved with these projects.
(from left) David Rogers, managing director of Ascot Radiology – sponsor, Jennie Michel – judge, Prof Ron Paterson – judge, Jaye Fuller – winner, Jenny Crawford – winner, Prof Ed Gane – judge
2012 Health Excellence Awards winners Excellence in Research or Technology
Poster: How’s it going? The Visual Alcohol & Drug Outcome Measure: Making Measurement Meaningful (Susanna Galea & Polly Websdell – Community Alcohol and Drug Service) Oral: Paediatric ‘Paperless’ Clinical Record (Anna-Marie Scroggins and Catherine Wightman – Home Care for Kids)
Excellence in Clinical Care
Poster: Removing a Roadblock to ED Patient Flow: Improving Access to Telemetry Monitoring (Linda Gray, Nick Price and Bret Vykopal) Oral: Evolution of the Fantail: A Novel, Ergonomically-designed Insulin Dose Calculator (Steven Miller & Mandy Wong – Diabetes Service and AUT)
Excellence in Compassionate Patient Support
Poster: Person-Centred Care: The Key to Reducing Restraint (Jean Colbeck – Bupa Care Services) Oral: Rehabilitation in Aged Residential Care: Supporting Older Adults to Transition Home After Debilitating Illness (Janet Parker – Older Adults and Home Health)
Awhina Director’s Prize
Oral: The Inventory Imprest Project: improving the Supply Chain while Saving Money (Maria Landarito and Nick Price – Wards 7 and 8)
Poster: Melting Moments: A Recipe for Infusing the Flavours of Person-Centred Care (Jean Colbeck, Chris Beckett and Marie Hume – Bupa Care Services, Beachhaven Hospital)
Poster: New Directions: Achieving an Holistic Approach to the Assessment and Management of Attention Deficit Hyperactivity Disorder in Childhood (Choon Chieh, Sarah Watson and Kaye Brightley) Oral: Baby Steps: Innovative Building Blocks for Improving Medication Safety for Our Children (Jenny Crawford and Jaye Fuller – Pharmacy and Child Health Service) The full list of winners is here: http://www.awhinahealthcampus.co.nz/Research/ Healthexcellenceawards.aspx
Awhina Contestable Research Grant
This grant is an annual round and exists to stimulate and support original high-quality, investigator-initiated research conducted at or with Waitemata DHB. Major project grants are for a maximum of $15,000, small project grants $6000, and there is a summer studentship grant of $5000. Recipients: Mattias Soop (project grant), Steven Miller (small project grant), summer studentship (still to be announced).
The Genesis Oncology Trust’s mission is to offer hope to those affected by cancer to provide better treatments, better prevention, detection, and hope for a cure. All money donated to the Trust goes directly to fund ground-breaking cancer research. This is possible because Genesis Energy covers all administrative and marketing costs. Recipient: Anna Brown (travel grant) surgical research nurse specialist.
70 // Well done!
Courtney’s walked the talk “If someone had told me when I was 16 that I would be celebrating someone not being arrested for three months, I would’ve said ‘You’re mad’.”
ut Fresh Start clinician Courtney Simpson is celebrating that milestone – and being in a job that she absolutely loves. Courtney is working with CADS Altered High youth team as part of the Government’s Fresh Start programme. Waitemata DHB’s Fresh Start contract started last July, with Courtney based in west Auckland and Sean Weatherburn and Raquel Barbellini based in south Auckland. They work with teenagers whose offending is largely influenced by drugs and alcohol. The client Courtney is excited about is one who really seems to be turning his life around. Like many clients, he comes from a disadvantaged background. He is, says Courtney, “accustomed to daily drug use” and using crime to pay his way. “It’s been quite a long journey with him – except he’s now involved in a full-time course and he hasn’t been arrested in over three months. It’s a huge, huge, huge step,” says Courtney. “He’s not smoking much cannabis; he’s not drinking much anymore. He said ‘I had my first game of league at the weekend – it was so much fun!’” The Fresh Start programme works with offenders aged 11-18. Courtney agrees it’s challenging to think of 12-year-olds involved in burglary, assault, theft, alcohol and drugs.
“If I wasn’t in this job, I wouldn’t want to think it either,” she says. “They should be in bed!” But she genuinely understands where the teenagers are coming from: “Maybe I could’ve easily gone down that path myself.” Like many of her clients, she felt she didn’t fit in at high school, “got in with the wrong crowd” and went off track. “My parents didn’t know what to do with me.” She pulled herself out of it around the age of 16 – but her experience helps her to empathise with, and win the trust of, her clients. “It’s not our job to tell them off,” she says. “If a client wants to get down from drinking four boxes of beer a week to drinking two, we’ll congratulate them when they get to two.” Courtney says the programme, which involves Child Youth and Family, Youth Justice and other agencies, is making a real difference for some teenagers. And she is obviously thrilled to be part of it. “I absolutely love my job. There are times I wake in the morning and think I wish I started at 10, but other than that, I absolutely love it.”
“Like many of her clients, she felt she didn’t fit in at high school, “got in with the wrong crowd” and went off track.”
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72 // Well done! ENCOURAGING CHANGE: Dora Zhao (left) and Stella Song help to explain the importance of breast screening to Mandarin and Koreanspeaking women.
Breaking through the language barrier
Stella Song and Dora Zhao were, like many Asian immigrants, confused by New Zealand’s health system at first.
e didn’t have a GP system in Korea,” says Stella, who came to New Zealand as a teenager with her family. Dora, who arrived as a tertiary student from China 10 years ago, adds, “Whenever you are sick, you just go to the hospital.” Going to the doctor to prevent a disease – rather than deal with an existing problem – is most unusual. Their initial confusion helps to explain why five years ago, only 43% of eligible Asian women in Waitemata DHB turned up for breast screening. Since then Stella and Dora have been part of a successful joint effort by BreastScreen Waitemata Northland and Asian Health Support Services to turn the figure around. Now around 70% of eligible Asian women have had at least one mammogram and return for regular check-ups. A lot of work has gone into increasing the coverage. It has involved advertising in ethnic media, developing brochures and other promotional material in Asian languages and lots of talking to community groups about why screening is important. But undoubtedly part of the success is because Stella, Dora and the rest of the team know just what it’s like to find their
way through a completely different health system, in a language they are just learning. In Stella’s case, for many years she and her brother acted as translators for their parents, who took longer to be comfortable using English. “Now, they can go anywhere they want, but sometimes if they go to hospital, they still need me, just because they think they might miss something.” Being afraid that their English isn’t good enough is a common reason why women don’t want to attend an appointment. So group bookings are arranged for Korean, Mandarin or Cantonese speakers, where a medical interpreter is present. And Stella and Dora are just a phone call away for non-English-speaking women who need help understanding their letters or filling out their eligibility forms. One of the biggest rewards, they say, is realising that their efforts have helped to save lives. “I was going out to a community promotion with the whole team and there was one lady looking for me,” says Dora. “She wanted to give me a present, because she had been diagnosed with a cancer and she had been treated immediately. She was very grateful. It was very lovely.”
“In Stella’s case, for many years she and her brother acted as translators for their parents.”
Feeling a bit light-headed
our Waitemata DHB staff members put their locks on the line this year for the Leukaemia and Blood Cancer NZ’s “Shave for a Cure” fundraising drive. Psychiatric registrar Persy Shroff (left), nurses Denise MacKenzie and Jamie Leighton, and physical activity specialist Sanjeev Karan all turned up at 8am to have their heads shaved for the cause. With the support of colleagues, family and friends – and Jeremy Foster-Moan, manager of Serville’s Barber, Smales Farm – they raised more than $2,300 to help support patients and their families living with blood cancers and related blood conditions.
Well done! // 73
Board priority: Chronic Disease Management Chronic disease management has been a top ten-priority for 2011/12. We wanted to provide a more rigorous system for treating chronic diseases including more efficient assessments for cardiovascular risk, along with better treatment for heart disease and diabetes. These stories show the ways in which we’re meeting those goals and highlight a very special individual.
Dr Jonathan Christiansen
Have a heart for speedy diagnosis Sophisticated CT scanning equipment is making it easier and quicker to find out why a patient may be experiencing acute chest pain.
orth Shore Hospital is the first in New Zealand to routinely evaluate patients with acute chest pain, using a CT scanner which captures images of the heart that can reveal cardiac disease. The state-of-the-art scanner, worth between $1.5 and $2.5 million, was installed as part of the Lakeview Cardiology Centre, which opened 14 months ago at North Shore Hospital. The centre houses a coronary care unit, a step-down unit, a cardiology ward, and two cardiac catheterisation laboratories. The scanner operates daily, scanning around 30 patients each week, including those who are not having a heart attack but experiencing acute chest pain. The scanner, which can scan the entire heart within a single heartbeat, allows doctors to see if the pain is caused by coronary artery disease (CAD). Dr Jonathan Christiansen, HOD Medicine and Health of Older People and consultant cardiologist, says it has revolutionised the way cardiology staff work. “Although managing coronary artery disease is a long-term issue for patients, one of the critical components of care in this condition is rapid, accurate diagnosis and treatment when there is an acute deterioration,” says Jonathan. “The CT scanner allows patients presenting with acute chest pain, in whom the diagnosis is uncertain, to be very accurately assessed in a prompt manner. Patients are either reassured that they do not have significant coronary disease or are moved onto a correct management pathway earlier.” The speed of the multi-slice scanner – it captures 128 to 320 slices of image data each time it rotates around the body – means images are highly detailed. As well as cardiac scans, the machine is used to evaluate other potentially life-threatening conditions such as head injuries, lung clots, abdominal pain, stroke, and complicated bone fractures.
Jonathan says now that there are two labs in use, it ensures that if more invasive treatment is needed for coronary disease – such as a stent – there
Cardiovascular disease accounts for 40% of all death in New Zealand and is particularly problematic in our catchment. It is a board priority to provide better treatment for heart disease.
is reduced waiting times for inpatients and outpatients. “Some of the most difficult aspects of being a patient are waiting for tests and the uncertainty that brings,” he says. “Facilities that reduce waiting time and provide greater diagnostic certainty earlier improve the patient experience of care in our system.” Not surprisingly, Jonathan says he cannot imagine going back to working without this type of technology. He says the entire cardiovascular service is committed to continued innovation and improved care for our residents. “If healthcare staff are happy and enthusiastic in their work, patients will have a better experience. The new facilities are part of a wider culture of commitment to optimal care for our patients – and a recognition that ‘everyone matters’.”
74 // Well done!
Close-to-home dialysis now a reality It is a rare and unique opportunity to set up a new renal service within a DHB, but Waitemata DHB has achieved this during the last three years.
ey planning; passion, commitment, and enthusiasm of staff; collaboration with other departments and regional networking; a concern for culture, recognising that ‘everyone matters’; working with consumer and patient advocate groups (ADKS); and clinical leadership involving a solid partnership between management and clinicians. These are some of the reasons why the new renal service is continuing to develop successfully, says Renal Service operations manager Annette Gohns. In just three years, we have evolved from contracting out renal services – Auckland DHB used to do this for us – to offering a comprehensive 24/7 renal service, which means Waitemata residents now have close-to-home kidney dialysis. Previously, a significant number of patients travelled to Auckland three times a week, for four-to-six-hour dialysis sessions. There are approximately 260 Waitemata residents on dialysis. The Renal Service provides care for patients: • with hypertension • with all forms of acute or chronic kidney disease, including those needing acute and chronic dialysis therapies • needing renal transplant work-up and follow-up. Next year, we will complete phase two of a three-phase plan to ensure we offer our residents the most comprehensive geographically convenient renal service we can possibly provide. Phase two involves the development of a new community dialysis facility (satellite and home therapies) on the North Shore, as well as increasing capacity within existing services. This complements our existing west community satellite facility. This new community facility will allow for up to 72 haemodialysis patients a day, including providing the ability for working patients to dialyse in the evenings. These patients can manage, or partially manage, their own dialysis. It will also include a three-training-room peritoneal dialysis unit and an eight station home haemodialysis unit for the training and ongoing care of home haemodialysis patients.
It is the next step along a path, which began with phase one in 2009, that concentrated on the initial development of the service, and which culminated on 4 July last year with the opening of the $9.2 million North Shore Dialysis Centre next to North Shore Hospital. As it took shape, pre-dialysis, renal transplant work-up and follow-up, and other outpatient services transferred progressively from Auckland DHB to Waitemata DHB. Annette says the scope of planning was critical, involving multiple interfaces with other key services across the DHB and regionally. “You would talk to staff about what we were doing and their eyes would just sparkle because everyone was so excited and enthusiastic about being part of, and being able to contribute to such a unique opportunity.” The interdisciplinary renal team includes nephrologists, registrars, house officers, clincal charge nurses, clinical nurse specialists, nurse educator, a technical educator, nurses, clinical dialysis technicians, administrators, a clinical co-ordinator, dietitians, pharmacists, and social workers numbering up to approximately 80 staff. She says that collaboration was very much in keeping with the board’s new values, which include being ‘connected’. A seamless and integrated approach was needed to achieve the best possible health outcomes for patients and their families. Now fully operational, the natural-light-filled centre – with views across the hospital grounds and splashes of colour throughout – provides in-centre renal dialysis for people with kidney failure. The 770sqm unit includes haemodialysis and peritoneal dialysis services on one level and is open six days per week. Annette says a patient satisfaction survey for the initial 70 patients transferred from Auckland to Waitemata DHB was undertaken in October – three months after the centre opened – to ensure it met expectations and needs. “If there were any issues, we wanted to know sooner rather than later, so we could deal with them smartly rather than letting them linger and become bigger challenges. We were pleased to see the resulting feedback was overwhelmingly positive.”
The development of a local renal information system was a key innovation towards quality service delivery. This system is used for financial monitoring, day-to-day management of patients, quality/audit, and research. It was achieved through the renal service working collaboratively with Decision Support Group and has been so successful that other DHBs are interested in adopting the same system. Renal Service clinical director Dr Walter Van Der Merwe says: “My team and I are passionate and privileged to provide this new service, which is in high demand and never before existed on the Shore. It’s an important step in providing quality care closer to the local population we serve.” He says Waitemata has an increasing elderly population with a higher incidence of kidney disease, and is experiencing growth in Māori and Pacific populations, who are at higher risk of developing diabetes. Prevention and treatment of kidney disease is very important. The most common cause of end-stage renal disease is diabetes, and unless the patients undergo a kidney transplant, they will be on dialysis for life. The following groups are also at increased risk of kidney disease: • people with a family history of kidney disease • people over the age of 50 • people of Māori and Pacific heritage • people who smoke • people with high blood pressure. So what’s next in the development of our renal services? Phase three, to take place in around 2015, is the provision of vascular surgery and nephrology services. Renal dialysis is a medical process where blood is cleansed of toxins that are normally removed by the kidneys. Kidney malfunction, requiring dialysis, may be temporary but is usually permanent and due to chronic renal failure. What are the two types of renal dialysis? • Peritoneal dialysis uses the abdomen as an artificial kidney and can be performed by patients at home. A special solution is placed in the abdominal cavity to draw out fluid and waste products from the arteries and veins lining this cavity. These products and the special solution are then emptied from the abdomen and discarded. The process can be performed manually or by machine. • Haemodialysis is when a machine acts as an artificial kidney. Blood is pumped through this machine – a haemodialyser – to remove waste, chemicals, and fluid. It can take place in a variety of locations – from a home environment to a dialysis facility.
Well done! // 75
From grass roots to hi-tech diabetes management Rising rates of diabetes mean we must think outside the square to provide better education and treatment.
n the outskirts of North Shore Hospital, there’s a weatherboard house with vegetables growing in the garden. There’s a good smell of tangy limes as you walk into the building, which is the friendly and welcoming home to the North Shore Diabetes Centre. In west Auckland, at Waitakere Hospital, there is a hallway of open doors. The diabetes service at Waitemata DHB began with two enthusiastic clinicians: a physician and a nurse. They worked out of one very small office in the outpatient clinic department, but the service has evolved and is now a much larger multidisciplinary team spanning both North Shore and Waitakere hospitals. The team include six endocrinologists, eight clinical nurse specialists, three diabetes podiatrists, three dieticians, a health psychologist, and a health psychology intern. This growth reflects how the incidence of diabetes has increased during recent years. The diabetes service provides and supports the care of 25,000 people with diabetes in the Waitemata district. To keep abreast of the changing needs of the population, the team has continued to develop their services – from grass roots to high tech. The garden surrounding the North Shore Diabetes Centre is provided by
The Diabetes Project Trust to promote its scheme of community gardens where people in a community can come together and grow vegetables with the support of the trust. This is just one way the service promotes healthy eating. The service also provides one-to-one and group education for both patients and health professionals in hospital and in the wider community. The DAFNE (Dose Adjustment for Normal Eating) programme is a weeklong management programme for people with Type 1 diabetes that has been running successfully for four years. This year, a Type 2 education programme has been piloted. The TIP (Targets, Information, Patterns) Programme, the first of its kind in New Zealand, is for those with Type 2 diabetes who are on insulin. It teaches them to look for patterns in their blood sugar levels based on what they eat and how to moderate their insulin doses. We have also had an increase in one-day education groups. As the incidence of diabetes has grown, so has the complexity of the patients we care for. This year, we have seen increased numbers of diabetes patients receiving dialysis at our DHB, and the numbers of patients in hospital who have diabetes has also increased. The podiatry service has expanded to continue to support the Acute Ulcer Clinic but also to support the development of podiatry services in the inpatient setting.
“As the incidence of diabetes has grown, so has the complexity of the patients we care for.” The diabetes team has increased inpatient nursing support for patient and staff education. This forms part of the Mind the GAP (Glycaemia Awareness Project), which is aimed at improving safe inpatient management. Next year will see the service moving even more into primary care to support GPs and practice nurses to set up nurse-led clinics while continuing to provide specialist community satellite clinics. Clinical nurse specialist Lisa Stevens says, “We are keen to make it as easy as possible for people to access healthcare in a way that is useful to them. Are we making progress? Yes, I think we are, but it’s a long-term process and there isn’t a quick fix. We’re a very dynamic service that is always thinking of how we can do things better.”
76 // Well done!
Winsome’s powerful message makes an impact Winsome Johnston is an inspiration to those living with Type 1 diabetes.
insome Johnston could well be the New Zealander who has lived the longest with Type 1 diabetes. Now 84, she was diagnosed with the condition 78 years ago when she was seven. Waitakere Hospital diabetes nurse Rab Burtun says Winsome is living proof that it’s possible to live long, to live healthy, and to live well with Type 1 diabetes. “I tell Win’s story every day to patients, especially those needing encouragement, because she is so inspiring,” says Rab, himself a Type 1 diabetic. Five years ago, Winsome became the first New Zealander to receive the Diabetes UK Macleod Medal for living successfully with insulin-dependent Type 1 diabetes for more than 70 years. She also received Diabetes New Zealand’s Sir Charles Burns Memorial Award. These awards now take pride of place – alongside photos of her three children, eight grandchildren, and nine great-grandchildren – in the living room of her Titirangi home. Ask Winsome how she has managed to avoid a single complication of diabetes, have three successful pregnancies – one with twins – and live a full and active life, and she credits it to following her doctors’ orders, a healthy diet, and a lifelong love of exercise and physical fitness. Indeed, until recently, she led a senior citizens’ exercise class at the retirement village she calls home. But Winsome’s story is tinged with sadness. When she was 10, her older sister, June, died aged just 16 from complications of Type 1 diabetes. As Winsome points out, it was a very long time ago and diabetes management is now far more sophisticated and successful than it was then. When June died, Winsome had been living with diabetes for three years after being diagnosed by a doctor in Wellington in 1935. She had similar symptoms to June – drinking copious amounts of water, losing weight, and frequent trips to the bathroom – which their mother recognised. She acknowledges being naturally shaken and frightened by June’s death and made a promise to herself never to let it happen to her. Describing herself as very independent, Winsome started injecting her own insulin – back then it was a single daily dose – right from the outset and took responsibility for eating well and exercising. She says the syringe was huge and she had to boil it every morning before she used it. Winsome also had to test her blood sugar levels by adding a urine sample to a special solution heated over a Bunsen burner. Even then, the result only indicated what the level was the day before. After leaving school, she trained to be a nurse, clocking up another first. She was the first person with diabetes to be allowed to undertake nursing
What is the Sir Charles Burns Memorial Award? The Sir Charles Burns Memorial Award is presented to any member of Diabetes New Zealand who has managed their diabetes for a period of 50 years or more through the use of insulin therapy. Sir Charles Burns is generally acknowledged to be the first resident doctor to administer insulin to a patient in a New Zealand hospital. The patient was Isabelle Styche and the year 1923. Sir Charles had a distinguished medical career and was awarded a KBE following a period as vice-president of the Royal Australasian College of Physicians from 1956 to 1958. What is the Macleod Medal? The Macleod Medal is presented by Diabetes UK to people who have lived with insulin-dependent diabetes for 70 years. It is named after Scottish physician and physiologist John James Richard Macleod, who received a Nobel Prize in 1923 for his work in co-discovering insulin. The first Macleod medal was presented in 2006. More than 25 people have been awarded the medal in the UK. training at Wellington Hospital. Her training meant she learned even more about the correct management of her diabetes. She eventually became a midwife. Married to John Herbert at 23, Winsome says no one told her it could be dangerous to fall pregnant. Pregnancy can be challenging for women with diabetes because their blood sugar needs to be kept at a certain level at all times to avoid complications. “They just said I wouldn’t be able to have children, but I didn’t seem to have any trouble at all! I did have caesarean deliveries, though, because they thought that would be safer, especially with the twins.” Now she has five daily insulin injections using pre-loaded insulin pens with super-fine needles and a hand-held glucose meter that can analyse a finger-prick sample of blood in seconds. Winsome says the changes have made life much easier. “Of course, I’ve had times when I’ve thought, ‘why me?’ but it really is just part of my life. I decided that would be a silly attitude to take because it’s really not so bad. I mean there are far worse things in the world. “I’ve met others with diabetes who say they don’t like it and think they probably won’t live very long, but I tell them it is something you have to accept and that the better you deal with it, the easier you make things for yourself.”
“I tell Win’s story every day to patients, especially those needing encouragement, because she is so inspiring.”
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78 // Well done!
MAKING A DIFFERENCE
A treat for young patients Generous donations will put smiles on the faces of young patients at the Rangatira kids’ ward.
he WellKids 2012 fundraising campaign organised by the in-house Communications team began with a party like no other: a teddy bears’ picnic, face painting, a bouncy castle, Cherry the Clown, colouring-in competitions and visits from celebrities including Cookie Bear, Shortland Street stars, and TV3 personalities. There’s more to celebrate given that the campaign has now raised about a quarter of the $150,000 it needs to make the revamped Rangatira children’s ward at Waitakere Hospital a friendlier place for young patients. The money will be used to buy toys such as train sets, puppets, Lego, dolls, and other play equipment, as well as non-essential medical items. While this equipment isn’t vital, it goes along way to making life more pleasant for the estimated 2500 sick children who visit Rangatira each year. A Lord of the Rings Lego mosaic has been one of the most unique donations. The 4sqm mosaic contains 56,000 bricks and was built by
shoppers at LynnMall. For a gold coin donation, 1500 people helped build the mosaic by assembling a small piece of it. “Kids love Lego, so we’re really excited about such a child-friendly piece of artwork for the unit,” says Stephanie Doe, Waitemata DHB’s child health operations manager. “The fact that we also received the community’s gold coin donations is really just the icing on the cake for us. Those contributions will help us to keep enhancing the unit as a really welcoming and magical place for sick children and their families. We’re very grateful for the support LynnMall and the community are giving us during our WellKids 2012 campaign.” Shelley Jenkin, centre manager, is proud to support the Wellkids Campaign 2012 at LynnMall. “The Rangatira Unit at Waitakere Hospital plays an important role in our community and we are so pleased to be able to assist in making this a brighter place for the children.”
“The fact that we also received the community’s gold coin donations is really just the icing on the cake for us.”
This year, the Waitemata DHB has an estimated population of 553,698 people and it is estimated 114,691 are aged between 0 and 14 years. The average length of stay for patients at Rangatira is two days, although some children stay for much longer. The most common illnesses seen in children admitted to Rangatira are asthma and chest infections, skin infections, and vomiting and diarrhoea.
Well done! // 79
Sir Ray throws a lunchtime punch In a packed conference room at North Shore Hospital in late October, a neatly suited and seemingly demure man sits in the front row waiting to be introduced.
here’s a distinct buzz in the air as hospital staff from all echelons gather to hear the words of a graduate of orphanages, foster homes, and a one-time bum from the streets of London. The space is tight, and a few last-minute arrivals politely hover near the doorway, slow to claim a rare spare chair. It was an open invitation, and Sir Ray Avery, former New Zealander of the Year, co-founder of the Department of Pharmacology at the Auckland School of Medicine, entrepreneur, and philanthropist, wouldn’t have it any other way. It was an open invitation because for Sir Ray, the kind of things he deals in can just as easily be thought of by an orderly pushing a gurney as the expensively educated health professional treating the person lying on it. To coin a phrase from his former homeland, he really doesn’t give a toss. What he does care about is making it happen – in a big way. He makes no distinction about who can come up with an idea that might change anything in health and that’s why his address was all about an electronic door that’s open to anyone – The Health Innovation Hub.
“Sir Ray explained that this was his earliest introduction to the Kiwi ‘can do’ attitude and urged everyone present to tap into it.” The Hub is essentially a virtual space where anyone is encouraged to present an idea, have it reviewed, and maybe, get it taken into production. Its purpose and function can’t really be explained in a few lines, but Sir Ray doesn’t work that way. He wasn’t there to recall the words of a prepared statement – in fact, he never works that way. In an interview he gave in 2010, he said he never prepares for interviews or speeches on the basis that it’s disrespectful to his audience. Sir Ray takes the ‘gauge before you engage’ approach so he can consider the best way to deliver his message. On that day, and for that audience, he decided that some levity was required after an interesting but relatively formal introduction. “For a start, I wonder if I could have a show of hands on who’s heard of Ray Avery … just a show of hands, thanks,” he says as he glances around the room. “That’s good – about 1.75 precent.”
And then there was the tale of what happened when he first arrived in New Zealand in 1973, when house prices in Auckland “were doubling overnight”. “I bought a nice house on the side of Mt Eden and it had a rather unfortunate lava flow going through the basement – so I decided I’d dig it out …” To cut a long story short, nothing worked. “Then this old guy came over from across the road” and invited him back to see his own basement. There it was, a perfectly useable space nicely carved out of solid rock. Exactly what Ray wanted. “So I said to him, how’d you do that? And he replied – dynamite.” Amidst roars of laughter from the crowd afterwards, and with other examples to follow, Sir Ray explained that this was his earliest introduction to the Kiwi ‘can do’ attitude and urged everyone present to tap into it. “Who’s heard of Colin Murdoch? Hmm … half a per cent. Every single person in this room has been touched by Colin.” Sir Ray said Colin had a simple gift called observation: “Observation is the key to innovation.” Because of it, New Zealand pharmacist and veterinarian Colin Murdoch invented the disposable hypodermic syringe. “That changed global health forever.” In another example, he cited Peter Beck’s success by launching a rocket into interstellar space. “There’s no other country in the world where you can do that. People want to know where’s it’s gonna land … well, we have no idea where it landed because we’re Kiwis. We don’t give a shit! “And that’s the whole point. We can change things.” In a nutshell, that, too, is what The Health Innovation Hub is all about. Afterwards, in a lunch room not far away, people were adamantly discussing Sir Ray’s address. All agreed it was excellent, and one canteen wit was heard to remark …“Yes, and when he mentioned that bit about intellectual property, I could certainly see Dale’s ears prick up.” For more information check out: innovationhub.co.nz
Sir Ray Avery
80 // Well done!
Board priority: Emergency Care The quality and timeliness of emergency care has long been the xxx of our success or failure in the public eye. In this past, this measure is an area in which we’ve struggled, but with determination, skill, and teamwork, our recent results in emergency care shown that we can be the best in the country. Here are some of the people responsible for our success in this area.
Emergency care is transformed
At midnight on March 31 this year, Waitemata District Health Board achieved a major milestone.
hat was the moment when a former and very much maligned facility finally put a demon to rest. For the first time in its history, the DHB realised the national quarterly Emergency Department goal of having 9% of patients admitted, discharged, or transferred in six hours or less. Around the corridors of the department, there are those who well remember those bad old days, but mostly, it’s not something they want to recall. One health professional who did not want to be named said they recalled the “stories they wrote about us”. For him, the whole thing was “just awful, and I knew we’re all way better than that.” CEO Dr Dale Bramley was effusive in his praise of the event, noting that “the turnaround has been remarkable”. “In June 2009, our performance against this target was among the worst in the country, standing at just 61 per cent. Long waits and patient beds in corridors were a common occurrence at North Shore Hospital. We, rightfully, received severe criticism for this.” Today, a new Emergency Department and Assessment and Diagnostic Unit at North Shore have made a difference, as have initiatives to speed up bed availability and improve patient flow, such as the Short-Stay Ward and discharge lounge for medical and surgical patients at North Shore Hospital. What made the achievement even more remarkable, however, was that it came during a period of considerable growth in demand for emergency services. In 2009, the board’s EDs treated 78,000 people. Last year, the figure was over 100,000.
“What made the achievement even more remarkable, however, was that it came during a period of considerable growth in demand for emergency services.“ In a statement earlier in the year, Dale noted that while the new facilities had helped, it was not possible to conclude that an improvement in facilities alone had created this outcome. He was in no doubt that “the real turnaround” had been driven by staff. “The commitment all of you have shown – from the orderlies and cleaners to the nurses and doctors – has enabled us to achieve this important milestone,” he said. What has happened is an essential and deep-seated change in the culture of the entire organisation. And if letters from patients since are any gauge, the effort made has substantially lifted the public’s perception of both hospitals. The Emergency Department became the focus for change, but as Dale noted, the momentum spread.It started with ED, but because so many
other departments are connected so closely to it, they had to change, too. “It is a reflection of our entire DHB, of all our services working together to assess and treat people quickly. As the first port of call when people are injured and unwell, the experience any ED patient has gives them a very strong impression about how well our hospitals operate,” Dale said.
n December 2011, there were more than 8,000 presentations to Waitemata DHB’s emergency departments. North Shore Hospital saw 157 patients a day and Waitakere saw 105 a day. April-June quarter 2012: 97% ED patients were admitted, transferred, or discharged within six hours! Waitakere Hospital’s emergency department can now train junior doctors after the hospital applied for training accreditation last year. Architectural judges this year named Lakeview “an exceptionally efficient emergency care centre”, adding that it “ensured significant improvement to service delivery and patient satisfaction”.
Well done! // 81
Breaking through the barriers Overcoming the communication barrier in an emergency department could, at least, be essential to a patient’s immediate comfort but might also be crucial to their immediate care.
t’s a problem that intensive care doctor Janet Liang, clinical director of the Intensive Care and High-Dependency Units, believes technology can solve. She has a vision to create an electronic visual aid and a software system that will enable foreign patients presenting in her Emergency Department to communicate with staff more easily. Waitemata DHB’s intensive care and emergency staff often face patients who speak several different languages. But Janet is determined to bridge this barrier, and the first step towards making the idea reality came when she won the Clinicians’ Challenge at the Health Informatics NZ conference in November last year. The win carried a $10,000 reward which, in the 12 months to now, has been put to good use. Janet wants to create an application that can work on something like an iPad because it will be portable and easily moved to the bedside. Her portable language interpreter system would help patients give “yes” or “no” answers to straightforward but crucial questions – and to help with common bedside issues. “This would not and could not take the place of a trained clinical interpreter,” she told the judges. “Instead, it would be designed to get basic clinical information (enough for urgent therapy to begin), communicate simple clinical requests and therapies, and allow the patient to make simple requests or report problems.” If a patient had breathing problems, the doctor could ask: “Are you usually short of breath?”, “Do you get more short of breath when you lie
US method could mean E-ICUs
The future shape of emergency care may take a different turn if a US operational method gains support here.
down?” and other simple questions. They would be translated onscreen and the patient or their relative would answer “yes”, “no”, or “I don’t know” in their own language. The answers would be translated back to English for the doctor. It would have diagrams and videos and would recognise different ways of saying the same thing. Work has begun on turning the idea into reality, but there’s still a long way to go, Janet says. The money she won is going into translating (into six languages) the sentences and questions that will be required. “Sue Lim (Asian Support Services) has been really influential in organising that. She has arranged the translators and the high-quality recording.” She said an experienced graphic artist had prepared simple graphic illustrations to be used in the program when it is finally compiled. “What I am still lacking is an application to put it on an iPad or similar. I am working with the North Shore Hospital Foundation to try to get funding, but at the moment, that is still under discussion. “I am also working with Jo van Schalkwyk. He is a consultant physician at Auckland Hospital and also happens to be rather good at programming.” She said Jo was volunteering his time on the project, but it was now coming together, and at the time of interviewing, she was planning to update her colleagues at the next Health Informatics conference in Rotorua in early November.
mergency doctor Trevor Wisenberg says the day will come when western residents say they want an ICU at Waitakere Hospital. He says a method he saw working at Geisinger Hospital, Pennsylvania, while on paid sabbatical leave from North Shore Hospital, could be the ideal answer – emergency ICU facilities. Outlying hospitals have small ICU units, staffed by specialist ICU nurses. Intensive care doctors visit but are not resident. The sites are connected electronically with the main hospital, where more ICU nurses monitor all the patients via computer. “The patients have the same access to ICU as at the main hospital but which they may otherwise have missed out on in their local hospital.” Trevor believes the model could suit Waitemata DHB’s growing population. “There’s going to come a time when people say, ‘we want an ICU at Waitakere.’ “Are we going to employ intensivists to be there 24/7, or are we going to look into how we can provide access to ICU without necessarily having to spend a fortune?” is the question he believes a future board may need to consider.
82 // Well done!
Denise Hetherington RN L3 PATIENT ENCOUNTERS
Life-changing patient encounters Patients often tell us about the difference we made to their lives, but it’s a two-way street because we regularly encounter people who make us reflect on our own lives and work. You’ve shared some stories about memorable patients with us.
Outpatients, North Shore Hospital “Even after 38 years of nursing, the following scenario reiterated again that just as we have our daily professional and personal angst, our patients do as well. A patient presented for her 14:15 outpatient appointment at 13:40, I noted at that time the Medical registrar had not arrived for the 13:30 clinic. I phoned the doctor (who was involved in resuscitation of a ward patient) and she said she would be down as soon as she could. “I approached the patient explaining her appointment would be delayed; she was upset. “I monitored the situation once the registrar arrived – the first patient was a long consultation – and I had two further discussions with the patient, who said she would give it another 10 minutes and then she would leave. “I saw a consultant walking towards his room, so I quickly approached him to ask if he could possibly review this patient as she was going to leave. He agreed to. I called the patient into the room; she thanked me profusely. Later that afternoon, the clerk said the patient asked her to thank me again and the reason she wanted to go was to pick up her pet dog’s body from the vet as it had been put down that morning. I then understood her way of being that afternoon.”
Meredith Macalincag RN
Community occupational therapist Older Adults and Home Health Services, Waitakere Hospital “I work in community at Waitakere Hospital and encounter a broad range of patients who live in diverse homes, from state houses to mansions. I was born and raised in Zimbabwe, and when I was about 16 years old, my family visited a leper colony, which proved to be a life-changing event for me. “In the 1980s, lepers were ostracised in Zimbabwe, and moved to the outskirts of the capital city, Harare. From far away, looking down into the valley, the leper colony looked quite picturesque, with surrounding mountains and bush. However, once we drove into the valley, the poverty rose up to meet us, the acrid smell of burning wood fires and the bare huts and stray dogs all added to the feeling of neglect. “Then I met Amai Tarisai, one of the residents who had leprosy, a beautiful spirit and a smile that illuminated her dark hut with an inner glow. She had so little, in terms of possessions, yet she was grateful she could still scoot around on a little skateboard, feed, dress, bathe, and toilet herself. She was happy to be alive, and happy with life. I learned that day that it is not a house with things inside, nor a body with all its parts, that makes a person whole. It is their spirit, their inner self, and I would endeavour from then on to never judge a person by their house, or their disability, but to look further, inside.”
“This story is simple but has touched me personally. I took a blood sample from a frail lady using a walker. Her husband asked if he could also have some of the blood in her glucometer so he could check the accuracy of their machine. He was trying to squeeze more blood from his wife’s finger and said, ‘Oh, my hands are shaking’. “The wife responded, ‘I still have that effect on you, and we are now in our 70s.’ The three of us laughed; I smiled for the rest of my shift. This elderly couple approached their situation in a positive manner. The wife did not say anything negative about her hubby’s shaking hands but said something endearing. At work when nothing seems to go right, when tears are about to fall because someone has been unkind, I will turn the negative to positive like this lady.”
Well done! // 83
Child & Family North
South 2 Auckland Regional Dental Service
“Part of our role as public health nurses is delivering the school-based vaccination programme. It’s a big job going into all the intermediates and seeing hundreds of students, but I recall helping a young refugee student. “The family had not been in New Zealand for long and they had a really difficult time before they settled here. We used an interpreter to go through all the information with the parents and get the consent form completed correctly. The paperwork for previous immunisations had been lost, but we were advised by IMAC to go ahead. With a bit of extra effort, we were able to offer this student the vaccine the same as the rest of the class. She was pleased to be included with her classmates and the family really appreciated it. This case reminded me of the importance of tailoring our service to meet the needs of the clients.”
“I was on the dental screening van at a teen parenting unit in south Auckland. Before I went to the screening, I was aware that there would be young girls – 12 years and upwards to 18 years old – with either a baby or pregnant. “It hadn’t really occurred to me that not all of these girls had just had sex with their boyfriends at a party on a Saturday night and ended up pregnant at some point. One of the girls came in with her four-monthold beautiful baby. The girl was 13 years old. She looked older and was mature for her age. She spoke so articulately and was such a caring and loving mother. “Being new to this kind of environment and patient base, I asked, ‘Are you still friends with the father or are you bringing this wee boy up by yourself?’ She said, no, she wasn’t still friends with the father. The father was a 56-year-old relative who was serving a jail sentence for raping her repetitively over quite a long period. The girl was so strong when she spoke of this and really inspired me to get on with life, even if I was having a rough day. You really can’t judge a book by the cover. “Because of the support she is getting from the teen parenting unit, this girl is going to be very successful in whatever she decides to do; she is strong and is a wonderful mother and friend to many. I come to work now, sometimes maybe feeling somewhat frustrated for one reason or another, and I always think of her, and I immediately get over myself. Thinking of her smiling face and knowing people can overcome such awful events makes me happy. “The happiest people don’t have the best of everything, they make the best of everything”.
Public health nurse
Clinical charge nurse Community and Home Detox “I am the charge nurse of Community and Home Detox at Community Alcohol and Drug Services (CADS). In the last 12 months, I’ve worked with a client who was reducing off diazepam. My client is 32 years old, has been using substances from the age of 14, and could not imagine a life without substance use. “Through a series of interventions, I guided my client through a process of entering residential rehab at Odyssey House. My client has been at Odyssey House now for two months, is substancefree, and is experiencing the longest ever period of abstinence from substance use in her life. “The impact that this has had on me is that change is possible when everything seems hopeless. That it is possible for someone to overcome huge obstacles to realise a goal. This experience has inspired me to become a better person and nurse.”
Prof Pat Alley
Head of surgical training “In one of my last clinics at North Shore Hospital, an old lady came to see me with a skin cancer. Review of her birth date showed she was, in fact, 103 years old! I asked her what was the best thing about being such a great age and she thought for a minute and then said, ‘I think the best thing is that I have at last become myself. For many years, I was either the daughter of someone, the wife of a man, or the mother of someone. Now, at last, I have an identity. I am civil to people, but I do not tolerate anything that I do not care for or even mildly upsets me. Surprisingly to me, at least, that view is accepted by my family and friends.’ I immediately thought of the poem “When I am old I shall wear purple” and pondered with a degree of sadness that nobody should have to wait that long to have their mana respected.”
Dupe Bolodeoku-Alofokhai Healthcare assistant
Ward 12 North Shore Hospital “While on duty as a ward assistant doing the usual 15/60 check, I met a patient by his bedroom door who requested me to lock his door and switch off the corridor light. I responded to him that this is against the hospital policy. I further reassured and encouraged the patient back to his bed. “As I walked away, I felt uncomfortable with his action, which provided me with a rationale to return back to his bedroom after few minutes to check on him. I found the patient seated with a table knife pointed toward his neck, and as he sighted me, he was shocked. I called for help immediately and the patient quickly stabbed himself in the stomach and blood began to gush out before help arrived. “All the staff on duty worked well as team, by calling the emergency team, preventing other patients from getting involved, and attending to the patient before the arrival of the emergency team. “Personally, this incident has challenged my decision to take mental health nursing as a career. Professionally, the incident has made me more proactive when caring for patients with similar challenges and has made me more aware of working as a team.”
84 // Well done!
MAKING A DIFFERENCE
This job is child’s play If you’re 30-plus and don’t have children, films like Alvin and the Chipmunks 3 may not top your must-see-movies list.
HEALTHY PLAY: Waitakere Hospital play specialist Tiana Brookes engages in some fun play with six-year-old Tanisha Cherrington, admitted to Waitakere Hospital with a skin infection after an insect bite to her eye.
ut if you’re Waitakere Hospital play specialist Tiana Brookes, sneaking in to watch the latest kids’ movies is all part of the job. “It helps keep me up to speed with what they’re interested in,” she smiles. Knowing what children find fun and relaxing is what makes Tiana so good at reducing their anxiety in hospital. “It’s really about making the child and the family’s hospital experience as stress-free and comfortable as possible,” she says. “Sometimes it’s just about using simple words to explain what’s going on so they more easily understand a medical procedure.” Based in the RangAtira paediatric unit, Tiana creates educational and therapeutic play programmes for Waitakere Hospital’s youngest patients. “We know that play is really important. All kids recognise it and they all do it. It helps them express their feelings, cope with their illness and regain their confidence and independence.” But for seven years, the former early childhood teacher has had to work with kids at their bedside or in a converted waiting area with no natural light. Now that’s all changed. Along with ten new beds and a negative-pressure isolation room, a $3 million refurbishment of the Rangatira unit added a a purpose-built indoor playroom. The brightly coloured room will feature a pint-sized sink for children to wash their hands, lots of natural light thanks to a big window, and plenty of storage. “It also has an oxygen connection so kids on oxygen can come and join in our activities and a hard floor that makes it safe and easy to wheel drip stands,” explains Tiana, who is one of about 65 play specialists in New Zealand. A dedicated baby area has age-specific toys, space for “tummy time” and a built-in mirror so babies can see their own reflections. The room also opens to an outside courtyard. “It is a sunsafe, secure area where the children can get fresh air and feel the sunlight on their skin.” Tiana says the room, which also caters to teenagers,will make a huge difference. “It will be a space that’s fun, safe and inviting for all ages,” she says. And for a play specialist, there’s only one thing better. “It’s seeing a child happy.”
PAMP site given an upgrade
A website which is the brainchild of Waitemata DHB’S Quality Use of Medicine pharmacist John Kristiansen is expected to have a revamp completed by Christmas.
he PAMP (www.pamp.co.nz) site was started as a way to stop high rates of hospital admission for Pacific children with asthma but is now a tool for children of all ethnicities. PAMP stands for Pictorial Asthma Medication Plan. John says Pacific children have more asthma and are more likely to end up in hospital because of it. “One reason is the parents didn’t understand the importance of using everyday preventers.” Working with nurses from Waitakere’s West Fono Health Trust, a web-based programme Tom developed that creates individualised posters to remind families what their children are meant to use and when. The posters can be in Samoan, Tongan,
Tuvaluan, or English. The results were significant. Each year, 120 Pacific children in the Waitemata district are admitted to hospital with asthma. In the year after getting their plans, none of the 48 children that received them were admitted to hospital. The proportion of children using preventer inhalers most days more than doubled. “The upgrade to the website included changes based on feedback from users,” John said. “It’s about making it more acceptable, and the more acceptable it is to health professionals, then the more children it will be made available to. It will have a tool that can be more widely used to help support asthma education in children and their families.”
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86 // Well done!
Health Hero: Ruth Noel
uth accepted the role of hand hygiene coordinator for Waitemata DHB in October 2011, in addition to her pre-existing responsibility in the Quality Department. Despite her role being part-time, Ruth has worked tirelessly in raising the standards of the hand hygiene programme at Waitemata DHB. She has worked determinedly, focussing
Health Hero: Dr Nathan Atkinson
r Nathan Atkinson is the gastroenterology registrar at North Shore Hospital. I met Nathan when I was an observer at the hospital three years ago. He had to look after me, a trainee intern, fourth year, and a house officer. We had him stretched in all directions, but he listened to each of us patiently. He stayed behind till midnight to sort out our patients and returned the next day at 8am. Recently, I was on night shift and my buddy
on specific aspects including: • promoting awareness among staff and patients • provided innovative ideas regarding education and culture change • restructuring Waitemata DHB audit tools and implementing a schedule in line with national and international standards • planning and implementing a quality improvement project in ED/ADU • organising stakeholder meetings, WHO hand hygiene activities, and taking a lead role in a very successful hand hygiene seminar.
Her efforts have been praised by many, including Hand Hygiene New Zealand group members. Waitemata DHB hand hygiene compliance has improved significantly since March this year and clearly reflects her dedication, commitment, and effective role modelling. Ruth recently left her role for personal reasons, but we felt she should be recognised. Nominated by Hasan Bhally, Jo Grounsell, Jutta Van Den Boom, David Lang, and Peng Voon.
called in sick. Nathan came in to do the night shift with me, after finishing his regular day at 7pm, and then completed his day duty the next day. He said he had previously done a night shift on his own and did not want any other registrar to go through the same pain. Two weeks later, I was finishing a shift at 8pm but we were one registrar down, so Nathan came in two hours early for his night shift to release me home on time. Nathan is currently the gastroenterology registrar, and he is always approachable and helpful when juniors call him for advice. Nathan shows compassion for each patient as if they are a good old friend. I have seen a staff member, who had Nathan as her doctor while she was in hospital, rush out of the department when she saw
him walking by to thank him. There are so many ways of fulfilling a job description but Nathan does it by putting his students, colleagues, and patients before himself. Nominated by Dr Annika Lam, general medical registrar.
Well done! // 87
Board priority: Regional collaboration Waitemata DHB is not an island in providing of excellent healthcare. Other committed groups, such as our neighbours at Auckland DHB and educational institutions such as The University of Auckland and Unitec, are working with us for the betterment of our patients, staff, and stakeholders. This spirit of collaboration has produced remarkable projects such as the Awhina Health Campus at Waitakere Hospital. While we are strong by ourselves, we are stronger with the help of our regional partners. Here are some examples.
A closer partnership with Unitec A collaboration between Waitemata DHB and Unitec resulted in the opening of the Awhina Waitakere Health Campus at Waitakere Hospital in May this year.
he joint venture has been designed to foster learning opportunities and encourage innovation and collaboration between health practitioners, community agencies, and more than 1000 Unitec health science and social practice students in Waitakere. Unitec and Waitemata DHB each contributed significant funding to refurbish the ground floor of the Snelgar and Health West buildings on the Waitakere Hospital campus. Now a whole floor dedicated to student and staff inter-professional education, simulation, research collaboration, and innovation has been established. Unitec’s executive dean, Faculty of Social and Health Sciences, Wendy Horne, says Waitakere’s Awhina Health Campus is a progressive step for both organisations and signals a strong
commitment to the Waitakere community. “Unitec has a longstanding relationship with Waitemata, but this initiative takes the relationship to a higher level.” The building is already home to the Nursing Simulation Centre, which Unitec nursing students have been using since 2006. It has become a physical and virtual hub that works alongside community organisations to encourage and promote collaboration and develop the future health workforce in west Auckland. Awhina director Dr Janice Chesters says collaborative spaces are at the heart of the health campus. “We want educators, researchers, learners, and others to come together in groups for projects, problem solving and opportunity
The proud Autumn Health Campus team
Dr Janice Chesters, Awhina director identification. The open spaces have been designed to encourage creativity and enable access to local, national, and global resources.” The redevelopment includes a brand new 164-seat multi-purpose space with full audio-visual facilities linked to the simulation lab. It has been developed to house training, conferences, and lectures. The building also features refurbished staff offices and common areas, with vastly improved IT connectivity. Student areas that connect to a wireless network have also been created to provide comfortable learning spaces and rooms to hold practical training and examinations. “The Awhina Health Campus will contribute significantly to Unitec’ and the region’s wider strategy for regeneration, workforce development and community engagement,” says Unitec chief executive, Rick Ede. He says Unitec needed to become more embedded in industry and business “so we can blur the traditional boundaries between education and work. That way, theory and practice are better linked, so our graduates get more meaningful careers and employers get more productive talent. “We believe this investment will generate great value for our students, staff, and community.”
88 // Well done!
Collaboration projects well under way Collaboration and partnerships are becoming the buzz words for DHBs around New Zealand, and the collaboration culture has taken a firm hold at Waitemata DHB.
lready, Auckland and Waitemata are strongly involved in identifying areas where quality improvements can be made to services that help improve outcomes for their respective populations. Collaboration activities are now happening in Ma-ori and Pacific health, planning, and funding, sterile supplies, contact centre, and human resources. In October, the two boards officially announced the creation of a joint Ma-ori research advisor role. Several objectives are proposed for the role,
Questions and answers
A move to better explain and keep staff up to scratch with collaboration changes came with the establishment of a dedicated StaffNet site in April.
he site includes a feature where staff members can anonymously ask questions of the Collaboration Steering Group without being identified. Responses to these questions are being posted into a Q&A section on the site where everyone can view them. This section now has many submissions and covers matters ranging from Māori health to funding, avid planning, and … will this all lead to the creation of a Super City Health Board? On this question, the working group says that “no larger plan for merger of the DHBs exists at this time”. See:http://staffnet/ADHBWDHBCollaboration
but two of the key areas are to ensure a robust Ma-ori perspective in research within the DHBs and that research applications have supportive input from Ma-ori. Human resources has been marked as an area of opportunity and here a planning group has been assigned to find new ways of working and using resources across the two DHBs. Eventually, and after consultation, a project team of managers from both DHBs is expected to develop the best model for operating HR resources in the future.
Collaboration tests established
Five objectives have been developed as tests for determining the value of collaboration projects between Waitemata DHB and Auckland DHB. They are: 1. That activities use resources in the most effective way. 2. That they build capacity and/or capability within the two DHBs. 3. That they ensure that no DHB is disadvantaged as a result of change. 4. The collaboration activities aim to standardise processes and practices in order to facilitate future steps towards merged services (should this be relevant and appropriate). 5. The collaboration activities are outside of (or complementary with) regional and national collaboration activities planned or ongoing by Health Alliance or the National Health Board.
Appointment makes history
The Waitemata DHB and the University of Auckland have made a firm move to strengthen their historical ties with the appointment of the first assistant dean.
rofessor Martin Connolly has been appointed assistant dean of the University of Auckland’s Waitemata campus. Professor Connolly has been a geriatrician at our DHB since 2006, and is also the Freemasons’ professor of geriatric medicine at the university. His new position could be compared to an ambassadorial role between countries and will help to strengthen ties between the university and Waitemata DHB over coming years. “Waitemata DHB is a major clinical teaching site for the Faculty of Medicine,” Professor Connolly explains. Each year, Waitemata takes in about one third of the university’s year four students for intern training, but as is the case almost worldwide, much of their training is not overseen by their previous school of learning. “Therefore, there’s a great need from the point of the students and the delivery of the curriculum, and if nothing else, for liaison between the DHB and the Faculty of Medicine. “My role really is to represent the DHB to the university and the university to the DHB at a middle-to-senior level and also to be there at a coalface level to help things run smoothly day to day.” Chief executive Dr Dale Bramley says research and the tertiary education sector will play an increasing role in healthcare in the future as we seek new and innovative ways to improve the delivery of services to our population.
Well done! // 89
Warm welcome to cold climate Rotha Keorotha feels the cold. The director of nursing from Sihanouk Hospital Center of Hope in Phnom Penh, Cambodia is not used to Auckland springtime temperatures.
n winter in Cambodia it is 16-25 degrees,” she says. “When I come here, I’m freezing.” But for three weeks in September, she endured not just Auckland’s, but also Rotorua’s, temperatures, to learn more about nursing and professional development in New Zealand. Last year, Waitemata DHB nurses Bev Hopper and Raewyn Somers and ED doctor Adrian Kerner were among a team of nine who visited Cambodia to help train the nurses at Sihanouk Hospital, and also to work in a slum clinic. The visit, organised by the Impact Charitable Trust, was very useful in running a three-day nursing assessment practice paper, says Rotha. “Before we qualify as registered nurses, we have to know advanced nursing assessment,” she says. “But we just read the theory, we don’t practise assessment. That’s why, when the team were there, and they go through from the top of the head to the toes, it was very crucial.” Shianouk Hospital Center of Hope is a charitable hospital in the capital city that runs a 24-hour service for the poor and disadvantaged and also
Red socks and lower beds Earlier this year, Ward 2 charge nurse manager Jason Russell became a front person for the regional First Do No Harm campaign.
serves as a training hospital for health professionals. The main problems it sees, says Rotha, are HIV/Aids and diabetes. “It is very, very busy,” she says. Raewyn says her visit last year was a very positive experience and has inspired her to go again this year in December, when Impact is organising another visit. “There was genuine gratitude from the nurses we were working with and from the people we were seeing.” And Bev says helping to educate nurses from a developing country is extremely satisfying. “We are trying to leave a lasting legacy. They need to have that ongoing push for education and improvement.” This year’s visit will take place in the first two weeks of December and the team will deliver a paper on clinical reasoning for nurses at Shianouk Hospital and also run clinics in the provinces and slums. Staff who want to take part should contact Impact Charitable Trust at firstname.lastname@example.org. For more information on Impact Charitable Trust see www.impactcharitabletrust.org
he campaign aims to minimise preventable harm to patients during clinical care. It is estimated that around 13% of patients suffer ‘adverse events’ during care and falls can cost a hospital thousands of dollars annually. “Ward 2 was a high falls area, with patients with strokes and renal issues,” Jason says. “Bringing this number down was a priority for me, my colleagues, our patients, and their families. “We had to take responsibility and be more proactive. I don’t think there is any doubt that this was the right way to go.” Speaking after the first national Do No Harm conference in early November, Jason said things had come a long way since he first appeared in Healthlines in June. One of the speakers at the conference was Shirley Ross from Waitemata DHB, who spoke on the falls campaign for which Jason became one of the poster boys. He says the campaign had received a great response, and some of its notable improvements had been the introduction of special non-slip red socks, which are given to some high-risk fall patients. Other changes have included the introduction of beds that lower completely to the floor, more signs for patients, and magnets on the white boards so carers can easily and quickly identify fall-risk patients.
90 // Well done!
Board priority: Bowel screening We made it a top ten priority in 2011/12 to plan and deliver a bowel screening pilot programme that will have 60% of all eligible residents in our district participating within two years. We look at the work done on the programme so far. Jun Li (left) and Insik Kim
Getting the word out to the community If we want to deliver a bowel screening programme that has 60% of all eligible residents in our district participating within two years, we need a team to tell them all about it.
un Li, Insik Kim, Tom Ruakere, and representatives from Pacific health provider West Fono are on the frontline of our plans to make the Bowel Screening Programme a success. Jun is the Chinese coordinator for the programme, Insik the Korean coordinator, and Tom the Ma-ori care coordinator. They visit groups and individuals within their respective communities to tell them more about the pilot programme, its benefits and why it is important to take part.
Bowel cancer is the second most common cause of cancer death in New Zealand. More than 1200 people in our country die from the disease each year – one of the highest per capita mortality rates in the world. Being aware of early bowel cancer signs can help people beat the disease.
They act as interpreters, and in some cases, will even transport people to Waitakere Hospital, where follow-up colonoscopies are done. When Jun says she loves knowing she is making a difference to people’s lives, Insik nods his head enthusiastically. “Most people in our communities want to take part but some are resistant or worried or say they don’t wish to take part, so we take it on a case-by-case basis and try to find ways to explain the benefits to them,” says Insik. Elizabeth Brown, programme community awareness raising coordinator, says it’s all about getting the word out among all population groups. “Our response from community groups and individuals across Waitemata is very heartening – they are aware of the seriousness of this disease and how to detect possible symptoms,” says Elizabeth. Regular information and resources are being provided to community groups and eligible people through numerous channels as a way to increase participation in the programme. Meanwhile, Georgina Tutengaehe helps staff the call centre, open from 7.30am to 5pm, which fields telephone enquiries about the programme. Georgina says the vast majority of callers are extremely positive about the programme and keen to take part. “They say it should have started a long time ago!” For further information on the Waitemata DHB bowel screening programme, call the Coordination Centre on 0800 924 432 or visit www.bowelscreeningwaitemata.co.nz.
Elizabeth Brown Georgina Tutengaehe
Waitakere Hospital Bowel Screening Pilot’s Endoscopy Unit team
Well done! // 91
Here’s what patients say… If the bowel screening programme is to be rolled out nationwide, we need to know from participants that it’s meeting their needs and what we can do to improve it.
arlier this year, we asked 110 participants who had had a colonoscopy at Waitakere Hospital in June for their comments. They were sent a survey, which had a 71% response rate. Here are some of the comments we received:
“I am grateful for the bowel screening programme as cancer was identified and an early operation planned.” “Thank you for initiating the BSP – the early intervention has probably extended my life.” “The team that treated me were excellent. We are ‘Westies’ and very proud of the service delivered, which was very private, professional, and extremely courteous to me and my wife.” “Thank you for the opportunity to participate. I had absolutely no symptoms of anything untoward, but the colonoscopy revealed multiple polyps. So a great outcome for me.” “Everyone I came across was so kind and understanding and made what was a potentially frightening and certainly an embarrassing situation – I won’t say pleasurable – bearable.” “The staff were so courteous. I actually arrived three weeks to the hour early for my procedure and they fitted me in! I was dreading going through the bowel prep again if they sent me away. Thanks to all staff.” “An interpreter was organised for my father and we were very satisfied.” “The overall friendliness and professionalism of all staff involved in my procedure.” “It was a privilege to have taken part in the BSP.”
Dave spreads the word The first participant in the bowel screening programme tells all his mates to take part.
ave Swale doesn’t know why men are reluctant to go to the doctors. Dave, who’s run his earthworks business, Swales Earthmovers, and lived in Helensville for 32 years, reckons it’s just the way blokes are. But he’s been quick to tell his mates and colleagues about our BowelScreening that may just save their lives. Earlier this year, Dave was the first participant in the bowel screening programme. BowelScreening is being offered to all men and women aged 50 to 74 who live in the Waitemata DHB area and who are eligible for publicly funded healthcare. It’s part of a four-year programme to test whether bowel screening should be introduced throughout New Zealand. Dave sent in his sample within 24 hours of getting his test kit in the mail late last year. He got a negative result a few days later from LabPlus. Dave had never been screened for any kind of cancer, so he felt compelled to complete the test and send in his sample quickly. Although “somewhat surprised” to be the first official participant in the programme, he was naturally delighted with the process and his result. Dave has told others about the test and has this advice for people who get a kit but don’t feel the need to take the test: “If you want to live a long, healthy life, get it done. It will give you peace of mind.” Two of Dave’s uncles and a friend died from cancer, which was part of the reason he got tested. “They were never checked by a doctor or medical centre – they were stubborn old Irishmen.” By the time their illnesses were discovered, it was too late, so Dave is determined to spread the word about the importance of early detection, especially as most bowel cancers are treatable if caught early. Symptoms include: • Bleeding from the bottom (rectal bleeding) without any obvious reason. Or if you have other symptoms such as straining, soreness, lumps, and itchiness. • A persistent change in bowel habit eg, going to the toilet more often or experiencing looser stools for several weeks. • Abdominal pain especially if severe. • Any lumps or mass in your stomach. • Weight loss and tiredness (a symptom of anaemia).
92 // Well done!
Health Hero: Marja Peters
arja Peters is the charge nurse manager at the Waitakere Hospital Emergency Department. It’s not only floor staff who do an amazing job within the DHB, it also takes a great manager to keep a team together to produce
Health Hero: Neville Thompson
eville Thomson is associate administration service manager at Mason Clinic. Neville has made a difference to residents who leave Mason Clinic with new skills and go on to make a positive contribution to society. As a manager at Mason Clinic, Neville is constantly looking at ways to improve the facility’s budget. There is also another side to Neville – he is deeply committed to the
results, meet our targets, and be the best team that there is within Waitemata DHB. Marja is an amazing manager who covers nursing staff as well as clerical for Waitakere Hospital, and goes over and above for her team. Marja is fair, firm, but very much respected within the Emergency Department. Marja works some very long hours and her determination sees our team strive to better our processes and meet our targets on a regular basis.
service and the welfare of patients and staff. There is no limit to his creativity in supporting patients and staff. Neville recognised that residents need meaningful activity during their stay at Mason Clinic and implemented the maintenance of service vehicles. He provided them with an opportunity to learn basic skills that would help when they take their place in the community. Neville also established a laundry system that is cost-effective and involves patients in caring for their own clothing. He also set up the maintenance group for patients to maintain the grounds and swimming pool. He supports patients using personal IT equipment and often takes computers home to work on in the evenings
Marja never seems to stop. If not constantly running backwards and forwards from Waitakere to North Shore for meetings, she’s in her office working hard or out on the floor assisting her staff through the rough and busy patches. She is an awesome lady, manager, and part of our great team. Nominated by Toni Scott, clerical team leader, Emergency Department, Waitakere Hospital.
for those who cannot afford to get their computer repaired. Nothing is ever too much trouble for Neville. I have been extremely humbled by the work Neville has done at Mason Clinic in helping restore patients’ sense of pride and dignity. Nominated by Manjula Sickler.
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94 // Well done! LONG-TERM MENTOR: Many of Kate Thomas’s patients have been calling on her advice and support for several years as they learn to live with their diabetes.
Growing up with Kate “T
hank you for all the time and effort you put into me over the years. Most of all, thank you Kate for never giving up on this ratbag.” This card from one of diabetes nurse educator Kate Thomas’s patients makes Kate smile. “We have a long-term relationship with some of these people,” says Kate. “These people” are patients with diabetes, usually type 1, that’s difficult to control. The diabetes team helps them with monitoring, advice and education on how to control their condition. “My children have grown up with Kate,” says former patient Megan Simpson. “I’ve pretty much grown up with her, diabetes-wise.” Twenty-two years ago, Kate set up Waitakere Hospital’s diabetes team with “a pencil, paper and a phone!” “I didn’t have a dietitian or anybody,” says Kate. “I thought, where do I start?” Now Waitakere boasts a multidisciplinary team that runs daily
diabetes clinics, and also does clinics in Te Atatu, Helensville, Blockhouse Bay and Ranui. Understanding and treatment of diabetes has, like all areas of medicine, changed significantly in those 22 years. “Even blood glucose testing, when I started you had to prick your finger, put the blood on a piece of paper and wait for two minutes and hope for the best,” says Kate. Now, results are available in two seconds. There are different types of insulin, pumps are relatively common, and even gastric bypass and gastric sleeve operations are helping obese people with type 2 diabetes banish the condition. Kate says 22 years ago she liked the idea of a job involving “something that I could develop up”. Having done that, she retired at the end of last month leaving behind her “a really, really good team”. What will she do? Garden, read books, enjoy her new home. She smiles: “I’ve got a job in the hospice shop if I need it!”
“We have a long-term relationship with some of these people” – Kate Thomas, diabetes nurse educator
Dementia care her focus
Marja Steur has been making steady progress towards developing clear clinical pathways for dealing with dementia since she became based at North Shore Hospital’s Awhina Health Campus earlier this year.
ne of her first tasks has been setting up national action groups looking at issues such as information sharing, research, and advocacy to get people with expertise together across the country. Marja is coordinator for the National Dementia Cooperative. The cooperative was set up by people already well involved in the field, but says Marja, a lot of smaller providers feel isolated. “It was felt that we could do more to share what was happening already.” Since taking up her role, Marja has been involved in two regional meetings, one in Rotorua and the other in Wellington. As this yearbook went to press, she was organising one in Christchurch, where she will be moving (for personal reasons) to live in December. “The Ministry of Health wants all DHBs to have clinical pathways for dementia, so the action group is now looking at a national framework for dementia care pathways. That’s made good progress,” she says.
“Another action group is on advocacy. They plan to establish a declaration that would be signed by groups working in this area, stating what we would like to see happen with dementia in this country.” As New Zealand’s population continues to age, dementia care is expected to become a major feature in future geriatric care. According to information published in The Lancet, a dementia case is now being reported worldwide every seven seconds.
Well done! // 95
Honoured for a lifetime of healing When Timoti George smiles, it involves his entire face in an unselfconscious display of happiness.
nd when he talks about Ma-ori mental health, it involves his entire being, as he speaks with passion. “I’m not talking about treatment, I’m talking about healing. Healing is a different focus altogether.” Timoti has spent a lifetime trying to reconnect Ma-ori with their own ways of healing, and now he’s won recognition from the Te Ao Maramatanga Ma-ori Caucus of the College of Mental Health Nurses. He’s one of five recipients of the first Whetu Kanapa Awards, honouring long contributions to Ma-ori wellbeing and mental health nursing. Timoti’s career started in the early 1970s at Oakley Hospital, where he trained as a psychiatric nurse. “Most of the services I’ve worked in, Ma-ori have been over-represented.” The problem, he says, is that Ma-ori have been cut off from their own ways of solving their own problems. He realised that at Oakley. He used to sit and talk te reo with one patient. One day, while talking, the patient emptied several tablets into the ashtray by his seat. Timoti realised the man wasn’t taking his medication, and alerted the charge nurse, who made sure he did. When the patient came back, they began talking in te reo again. “He said, ‘When I first came here, they gave me this medication and it made me see things, it made me feel awful, that’s why I stopped taking it.’ “And then he said ‘Ko te reo toku rongoa’” – which means ‘Talking te reo is my medicine’. “It was talking the language that made him feel good. I realised then that Ma-ori people like him saw things slightly differently.” A few weeks later, the patient was discharged and Timoti didn’t see him again. Timoti has been a psychiatric home visitor and district nurse. He’s managed the national secure unit and the regional forensic psychiatric services. He’s been a clinical manager, a kaiako matua (lead trainer in Ma-ori healing models of practice) and is now service manager of Whitiki Maurea-Ma-ori mental health and addiction. Those 41 years have convinced him that Ma-ori must control their own healing. “We need to start taking ownership ourselves, and start providing those things that will make our people well.” Timoti was honoured to receive a Whetu Kanapa award. “The younger people coming through will see us as an example,” he says. And by building on that example, he hopes they will make their people well. HONOURED: Timoti George is among five Ma-ori mental health professionals to be recognised for their lifetime contribution to Ma-ori wellbeing.
Martin Roberts Clinical coder Qualifications: NHS National Clinical Coding Qualification (UK) 2004 Based: North Shore Hospital Time at Waitemata DHB: More than five years Why did you choose to work in this field? I used to work in the United Kingdom as a clinical records clerk and developed an interest in coding. When an opportunity arose for a trainee coder, I jumped at it. I was soon enrolled on a novice coders’ course and then began work within the coding team. Four years later I sat the national clinical coding qualification. What does your job involve? You identify diagnoses and procedures from patient records and translate these into appropriate codes, so the information can be used in clinical research, funding and planning. You need to understand medical terminology, disease processes, investigations and treatments, clinical record forms and the classification system. What are the challenging bits? Analysing and abstracting the relevant information from the clinical record. Sometimes it can be difficult to read or it can be unclear exactly what a patient was diagnosed with or treated for, so you need to do some research or ask the clinician. Meeting monthly Ministry of Health deadlines can be challenging. What do you love about it? Coding can be a bit like trying to solve a difficult conundrum. I like investigating and analysing records, trying to find solutions. It can also be very satisfying when after a bit of research you find a code which completely encompasses a statement. What would you say to people thinking of training in your field? Clinical coding is highly skilled. It is a great career for someone who has an interest in anatomy/physiology and is meticulous, likes investigating and who’s good at making connections. A bit about Martin... My favourite meal-break escape is… McHugh’s of Cheltenham –
excellent buffet meals in a superb setting. When I was five I wanted to be…a lion tamer! If I wasn’t a clinical coder I’d be…a geologist. With its varied geology and spectacular landscapes, New Zealand would be one of the best places to study! If I could live anywhere in the world it would be…Great Barrier Island. I love its remoteness and the islanders’ independent spirit. My ultimate Sunday would involve…Walking with my wife Lynn and Mollie the dog on Omaha beach, with a picnic and maybe afterwards a pint in the Matakana pub.
96 // Well done!
Closing words Dr Lester Levy, Chairman As we’ve seen from the pages of this publication, 2012 has been an immense year of growth and expansion for Waitemata District Health Board. It is a marked contrast to the organisation I came into when I was first appointed chair in June 2009.
rom the outset, it was apparent that Waitemata had tremendous potential. Our key asset was – and still is – the many dedicated and skilled staff devoted to making a positive difference to the patients and population we serve. But the organisation was being held back by ageing facilities that had not kept up with the times. Poor systems and processes in some instances also hindered our people from doing their jobs well. This manifested itself in a number of longstanding problems, all of which have been well documented publicly. From my early days as chairman, I have been clear that addressing these historical problems will take time, but the potential that was always inherent is now beginning to be revealed, and quite quickly too. The DHB’s historic problem area, the performance of its emergency departments, has now been consigned to the past. A new Emergency Department and Assessment & Diagnostic Unit at North Shore Hospital – coupled with initiatives on to improve patient flow – have meant that Waitemata has consistently exceeded the national health target of having 95% of all emergency department patients admitted, discharged or transferred in six hours or fewer. Furthermore, after being promised for over a decade, a 24/7 Emergency Department has been opened at Waitakere Hospital. Looking towards the future, we enter 2013 with good forward momentum. By the middle of next year, we will have the Elective Surgery Centre up and running. This $39 million facility will enable people in our district to see a specialist and receive treatment more quickly than before. The intent is for a highly efficient and cost-effective centre for faststream elective surgical services – one that would be New Zealand’s most productive, with results better than those achieved in both private and other public hospitals in the country. Once it opens in July, it will perform nearly 6000 operations annually across a range of specialties.
Health services for people with kidney-related conditions are also to receive a boost next year, with the development of a new 18-station community-based dialysis facility. The move is part of a long-term strategy to bring renal services back to Waitemata, enabling the DHB to provide care closer to home for our renal patients. Our facilities modernisation programme is also set to continue in the new year. To date, the programme has already seen a number of our wards for older adults and our paediatric unit in Waitakere Hospital modernised. A number of our buildings were first developed in the 60s and 70s, and the programme is as much about providing a working environment that will enable our people to deliver healthcare effectively and efficiently, as it is about improving the overall experience for patients at our facilities. There remains much to do. Our services and facilities will continue to evolve as we seek to meet the needs of one of the fastest-growing – and ageing – populations in the country. But we enter next year on firm footing. The many dedicated people within our organisation, the investments in our facilities over recent years, and the strong partnerships we have forged with other healthcare providers will stand us in good stead for the future.
Dr Lester Levy Chairman
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