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Midcentral DHB Case Study

Safer hospital environment and better patient outcomes

MidCentral DHB provides health services to over 158,000 people – who mostly live in Palmerston North. It receives around $550 million every year to fund its health services. 28,000 people are discharged from hospital and 10,000 people receive operations each year.

MidCentral was one of the first District Health Boards in New Zealand to use TrendCare, starting in 2000. TrendCare measures patient acuity and is the base of all data needed to run Care Capacity Demand Management (CCDM).

Sue Wood, Director of Nursing, says MidCentral has worked with NZNO since the start of their CCDM process.

Staff across the hospital have been involved in developing and changing the way health services are delivered at MidCentral. A hospital-wide group helped in the roll-out of the programme, and staff continue to mentor each other ensuring everyone is using CCDM to its full potential.

“We’ve always been lucky that our data people adoptedit early, 2004,... once other departments started using it(other than nursing) they saw it as a broader, organisational tool rather than it just being a nursing system”.

The power of matching nurses to patients

Sue Wood says the ability to match nurses to patients is the least understood part of the CCDM system.

“Every patient is matched to a nurse. So when you allocate staff in the system, you are allocating a nurse to a patient.”

She says that no other programme does this; the system is sensitive to what the patient actually needs, including their required hours of care.

For her there is immense power in linking the nurse and patient as staff can see what the reasonable workload is at a glance.

All this information builds in the system over time so it can ensure better decision making and build best practice processes – like tracing who was looking after a patient in the instance of an MRSA outbreak.

Managing by facts

CCDM helps nurses make decisions about patient care, based on fact, experience and instinct.

It gives hard evidence on what’s happening in a hospital. Sue says that by using it, “you’re managing by fact more, rather than just ‘I feel’”.

CCDM can help substantiate how someone feels, but if it doesn’t then you can start digging. “If it’s not reflecting how you feel, look at the data and dig down because there’ll be something that’s missing.”

MidCentral has worked alongside other District Health Boards using TrendCare. Sue says that in the National Nursing Workload project in 2001 a ward at Taranaki hospital was overworked and unhappy but it had plenty of staff, so management didn’t know what was causing the problem.

It wasn’t until someone drilled down into the TrendCare data that the real problem was revealed; it wasn’t a lack of staff but simply an issue with staff composition. The ward’s case-mix required more registered nurses than were assigned, and they had care assistants who weren’t being use to full capacity.

Consistency in healthcare

The simplicity of CCDM is that no matter which DHB is using it, they are all have the exact same definitions and are generating the same type of data, allowing health professionals to get on with delivering better services for patients instead of comparing and contrasting the data they each provide.

Sue says when each DHB works with different systems, same terms different definitions, they are talking about apples and bananas and oranges, and it’s hard to get past that.

“Having the one tool meant we were able to start talk about the differences in practices rather than how we were measuring.”

Improved patient care and lower risks

Sue Wood says CCDM is a multi-pronged approach. It isn’t about having more staff; it’s about efficiency and effectiveness – and what the patient needs. If hospitals have old or inefficient systems, they won’t get much benefit from the programme unless they tackle these.

And the benefits are worth the work. Patients become the centre of care delivery, lowering risks for them and for staff.

MidCentral has had strong organisation-wide buy in – it’s capable of delivering a wide range of services and providing a wide range of information.

This means nurses and hospital staff are better informed – they can do risk assessments, patient action plans, as well as monitor activity levels, all in one place.

The future with CCDM

As District Health Boards move into a more digital and mobile environment, Sue believes there is a future for CCDM to become more mobile – much like the e-prescribing tool being trialled at Southern District Health Board. The assessment and care pathways in TrendCare could then be used at the beside more easily.

CCDM already complements Releasing Time to Care (a programme that reduces ‘motion’ and interruptions for nurses, allowing them to spend more time caring for patients) and making it mobile would allow nurses to get on with the business of nursing.

Sue Wood says CCDM is a key hospital management programme.

“In smart hands it creates better work environments and better care practices.”

Key Facts

Staff turnover down

Common language around care

Productivity up