Appendix 3 - 2
MidCentral Hospital & Specialist Services 90-day action plan:Q2 2024/25
A Acute flow
RELEASED UNDER THE OFFICIAL
Relevant plans: Acute Flow Improvement Plan, Health Target Plan
Focus for Q2 24/25
Actions and timeframes
Rationale
Measures of success
Responsibilities
RAG Rating
(1) Acute Flow Standards.
1.1 - Socialise the finalised
Acute Flow Standards with al senior and operational leaders to disseminate and champion the
The Standards set out expectations to
•
Self-assessment audit completed.
Actions are ultimately owned by
achieving of standards. (October).
manage acute flow along the patient
Hospital & Specialist Services’ Group
1.2 - Conduct the
self-assessment audit and formulate the corresponding improvement plan based on the findings, with an initial
journey from the emergency department to
Director of Operations for
emphasis on inpatient standards. (October).
inpatients to discharge, as experienced by
MidCentral.
the patient.
Execution of actions is principal y
(2) Reducing average length
2.1 - Identify interventions to reduce
avoidable hospital admissions (Standard 1.4). (November).
MidCentral’s hospital flows when hospital
•
Reduction in average length of stay.
supported by Hospital Performance
of stay in hospital.
2.2 - Establishment of Multi-Disciplinary Team (MDT)
rapid rounds on acute wards to coordinate the patients' plan for their stay
occupancy is between ~92-95%. Ensuring
•
Reduction in time from ED referral to
team with support from Te Whatu
and expedite the addressing of identified barriers to said plan. (October – November).
occupancy remains in this range requires
ward transfer.
Ora Improvement - Planning,
2.3 - Review whole of
hospital discharge processes for medically optimised patients to meet expectations set out in the national
reducing patients’ length of stay, to the
•
Increase in SSED for admitted patients.
Funding and Outcomes.
Acute Flow Standards (Standard 6.8). (December).
extent appropriate.
Specialist support wil be provided
by Jo Gibbs.
(3) Improving timely
3.1 - Review current
MAPU Model of Care to align with the national Acute Flow Standards (Standard 6.2). (October – November).
Bringing forward MidCentral’s average time
•
Reduction in average time of day
discharge from inpatient
3.2 - Ensure that clinicians are
rounding on patients suitable for discharge first to speed up discharges (unless there are
of day discharge, and increasing the rate of
discharge.
hospital wards.
medical y unstable patients that need to be attended to) (October onward).
weekend discharging, is critical to freeing
•
% discharges before 1000.
3.3 - Create a
discharge lounge to assist in the flow of patients identified for discharge that day (October).
up inpatient beds for patients to ‘flow’ into.
•
Increase in weekend discharge rates.
3.4 - Create opportunities for
Early Allied Health Supported Discharge (December).
•
Utilisation of discharge lounge
3.5 - Continue current
Time Of Day discharging initiatives to enhance patient flow, reduce length of stay, improve patient
satisfaction, increase operational efficiency, and lower per patient costs. (Standard 6.9). (Ongoing)
(4) Improving safe, timely
4.1 - Extend ED
work area out of hours into fracture clinic to enable improved treat and discharge performance. (November –
MidCentral’s overal SSED performance wil
•
# of patients discharged from ED via
management of non-
December).
be hindered in meeting interim target
fast track.
admitted patients.
4.2 - Implement
onboarding procedure for distribution of risk for corridor patients, underpinned by existing My Next Patient and
without focus on treated and discharged
•
Increase in SSED for non-admitted
Over Census procedures. (December)
patient cohort. This is crucial for enhancing
patients.
4.3 - Progress the associated model of care for the completed
Children’s area within the Emergency Department to provide a
patient outcomes, reducing hospital
•
% children seen in 6 hours
safe area of assessment and treatment for identified patients. (November)
congestion, and ensuring efficient use of
healthcare resources.
B Clinical leadership & culture Relevant plan: Culture Improvement Plan
Focus for Q2 24/25
Actions and timeframes
Rationale
Measures of success
Responsibilities
RAG Rating
(5) Setting clear expectations
5.1 - Execute
communications strategy about MidCentral’s values and expectations of staff re how these are embodied via
Embedding values-led behaviour at
•
Increase in staff engagement with
Actions are ultimately owned
about values-led behaviour:
workshops, regular updates, and 1:1 meetings (from November).
MidCentral is foundational to facilitating a
communications products. (eg weekly
by Hospital & Specialist
bringing Te Mauri a Rongo
5.2 - Create a
values-led leadership toolkit for people leaders, which includes practical examples of ‘how to say yes’, and ‘if the
shift in culture – wherein ‘culture’ signifies
newsletters, intranet stories, videos)
Services’ Group Director of
(the Health Charter) to life.
answer is no – how to have that conversation, and why it matters’ (December).
how values are embodied through
•
Staff engagement in workshops (NB:
Operations for MidCentral.
INFORMATION
5.3 - Require al staff to complete a new national
eLearning module on Te Mauri a Rongo (from November).
practices, process, and relationships.
mandatory for people leaders).
•
Majority % of staff having completed
Execution of actions is
eLearning module on Te Mauri a Rongo.
principal y supported by People
•
Improvement in relevant Ngātahitanga
& Communications’
Pulse Survey scores.
Organisational Culture and
Development Team.
(6) (Re)establishing trust
6.1 - Strengthen channels for
meaningful clinical leadership engagement with RMOs and SMOs to ensure open, two-way
Changing MidCentral’s culture requires
•
Improved RMO and SMO engagement
with medical staff.
communication with leadership, and that information is received in a timely, direct, and appropriate way (from October).
buy-in from the medical workforce.
via strengthened communications
Support wil also be provided by
6.2 - Establish
regular support mechanisms for RMOs and SMOs, including monthly online drop-in peer support groups, regular
MidCentral must demonstrate that it has
channels.
the Chief Clinical Officer, and
topic-specific sessions (eg on dealing with pressure, stress, and burnout), and using external providers for confidential,
heard their concerns, and that it’s taking
•
RMO and SMO participation in peer
Interim Chief Wellbeing Officer.
individual support needs (including profession-specific counselling services) (from October).
action accordingly.
support groups.
6.3 - Establish
regular SMO Clinical Lead meetings to ensure effective communication, coordination, and alignment of goals across
•
RMO and SMO attendance at support
Relevant unions (eg Association
different areas of the organisation. (October onwards).
sessions.
of Salaried Medical Specialists)
6.4 - Ensure al Clinical Leads undertake
regular 1:1 meetings with their respective Clinical Executive to provide a dedicated time for
•
Improvement in relevant Ngātahitanga
wil be engaged throughout.
personalised feedback, professional development, and open communication, al owing both parties to discuss goals,
Pulse Survey scores.
chal enges, and progress in a focused setting. (October onwards)
(7) Building psychological
7.1 - Pilot the
Respect at Work programme to enable staff to resolve interpersonal difficulties and address poor behavior on the
MidCentral needs to build an environment
•
Rollout of Respect at Work programme.
safety across the
ground, in real-time, supported by relevant training (eg active bystander workshops) (September onwards).
where everyone is accountable for their
•
Establishment of resolution pathways.
ACT (1982)
organisation.
7.2 - Implement the
Respect at Work programme progressively across MidCentral. (from December).
behaviour, and were speaking out about
•
Staff utilisation of new resolution
7.3 - Create
new pathways for resolution of grievances and employment-related issues, encouraging issues to be resolved
unacceptable behaviour is actively
pathways.
without escalation (where appropriate), via restorative options, or outside of MidCentral (as necessary)(November).
encouraged.
•
Improvement in relevant Ngātahitanga
Pulse Survey scores.
C Quality & safety Relevant plan: Quality and Safety Improvement Plan
Focus for Q2 24/25
Actions and timeframes
Rationale
Measures of success
Responsibilities
RAG Rating
(8) Understand and identify
8.1 - Complete deep dive review into Te Tahu Hauora | Health Quality Safety Commission
Quality Alert for 30-day mortality rate of
Hospital mortality rates can be useful
•
Mortality rates (both in hospital and
Actions are ultimately owned by
any opportunities for
Status two and three patients who do not wait (DNW) to be seen by a clinician when presenting to the Emergency Department.
indicators of quality of care, but careful
30-day mortality) are within normal
Hospital & Specialist Services’
improvement from
December)
statistical analysis is required to avoid
variation of other district hospitals.
Group Director of Operations for
recognised mortality
8.2 - As part of the aforementioned deep dive review and understand the Mortality Four data identified by
Health RoundTable,
erroneously attributing variation in
MidCentral.
reporting data platforms.
(December).
mortality to differences in health care
when it is due to differences in case mix.
Execution of actions is
principal y supported by the
(9) Agreeing MidCentral’s
9.1 - Conduct a
clinically-led review of MidCentral’s current model of acute care with relevant clinicians, via a facilitated-process
MidCentral’s clinical pathways for acutely
•
Establishment of clear clinical
national Clinical Leadership
current, and future, models of
(October onwards).
il and deteriorating patients are not well
pathways for ED, CCU, HDU, and ICU.
Team.
care for acutely il and
9.2 - Establish
clear clinical pathways for the ED, Coronary Care Unit, Higher Dependency Unit, and Intensive Care Unit, and
defined. Reaching consensus among
•
Agreement of associated
deteriorating patients.
corresponding clinical governance mechanisms (November - December).
clinicians is critical to ensuring safe
responsibilities and processes.
Specialist support wil be
9.3 - In concert with the aforementioned clinical pathways, agree the
purpose of each department/unit, staff
roles and
management of such patients and
•
Increase in appropriate use of units
provided by Dr Andrew Connolly.
responsibilities,
referral processes, and
points of communication within and between teams and services (December).
achieving hospital flow.
(eg having no patients discharged
from direct from ‘higher care’ units).
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