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Northland DHB Case Study

Transforming health services – a programme in high-demand

The Northland DHB provides health services to around 160,000 people in Te Tai Tokerau (Northland) living in mostly rural areas. Northland’s population is ageing, presenting unique challenges in the way it provides health services. Each day around 133 in-patients are discharged from their hospitals in Whangarei, Dargaville, Kaitaia and Bay of Islands.

Northland DHB says Care Capacity Demand Management(CCDM) is a transformational programme that has improved hospital culture. Now they can have the right people, in the right place at the right time – ensuring patients get the best possible care.

CCDM has been in place since early 2011. The hospital had been using TrendCare (the programme that measures patient acuity) for around 10 years using various aspects of the system.

Director of Nursing and Midwifery, Margareth Broodkoorn said she had heard about three demonstration sites piloting CCDM, including the innovative work happening at Tauranga Hospital and decided it was the right time to implement it in Northland.

A new way of delivering health services

In choosing CCDM, Margareth says she wasn’t aware of any other programmes that would meet their needs.

While it has taken some time to implement, the key to its success is the support from management, service managers, NZNO and of course staff. Now its benefits are being felt across the entire organisation.

One of the concerns was around the potential need to increase staff. But Margareth says CCDM is not just around increasing full-time employees (FTEs) it’s about working smarter. Using CCDM, staff are able to get an accurate picture of the work they’re doing, to identify who should be doing what, why and when.

For the first time, Northland is now able to accurately calculate how many FTE’s they need instead of relying on a historical process that included estimates around demand.

Margareth says staff are more engaged in the decisionmaking process, meaning they are helping make sustainable long-term decisions about the delivery of health services in Northland.

A programme in high-demand

CCDM is in high demand across the Northland DHB.

From its early beginnings in the paediatrics ward, it has moved into the medical and orthopaedic wards, into a district hospital, an assessment and rehabilitation ward and the discharge lounge. Community nurses are also keen to start using the programme.

Margareth says they’re also talking to doctors about what capacity they have to support wards or areas that are under pressure, or starting to enter into risk areas of orange or red.

A safer environment for patients and staff

Involving allied and medical staff across the hospital means a safer environment for patients and staff.

Margareth says the occupational therapy and physiotherapy teams are all involved.

They all have access to the ‘Hospital at a Glance’ screen that means they can prioritise their workload to help support areas that are dealing with a high number of, or very sick, patients.

This means the entire hospital works more efficiently and effectively, and the right patients are treated at the right time.

Better Care for Patients

Patients at Northland DHB are receiving very different health services compared to two years ago.

Apart from the ability for the DHB to gauge who needs to be doing what, and where, nurses have said they feel more able to complete the care a patient needs than before CCDM was put in place.

Margareth says “They used to spend a lot of time doing other things, and now their tasks are aligned to the right skill level”.

CCDM complements other efficiency programmes

Margareth believes there is a natural synergy between CCDM and programmes including The Productive Operating Theatre (TPOT), and Productive Wards.

The TPOT Co-ordinator works with the Theatre team to agree on indicators for theatre so the entire hospital can see how well Theatre is operating, and include this in planning.

“Over time, theatre staff also hope to develop their own ‘at a glance’ screen to help improve their delivery of health services.”

Better outcomes for staff and patients

There has been a culture shift in the way staff think about practicing. Nurses realise they have fundamental sets of skills they can apply to any area they work in. Auditing processes are also stronger.

In the show case ward Nurses say they are more satisfied, staff turn-over is down, and there is a reduction in the amount of sick leave taken.

Involving staff in CCDM’s development has been crucial because it’s helped change the way they think, and has improved team culture.

The future with CCDM

Margareth sees CCDM only growing stronger in Northland DHB. She believes in the two years since it was implemented there has been substantial culture change at the DHB and staff are more engaged in change management, leading to improved patient outcomes.

“We have organised the environment differently – making sure we have the right people in the right place at the right time.”

Now, we have a better system and tools that can clearly identify where gaps are, and make robust decisions about patient care.

Margareth says CCDM will have a lasting, and positive, impact on delivery of health services at Northland DHB. We still have a way to go in implementing and consolidating the tools of CCDM, but if the improvements and learning’s to date are anything to go by, the future is looking bright.

Key facts

More timely care for patients

Safer environments for patients and staff

Whole organisation focused on efficiency of care