Celebrating a Magnificent Year for CMDHB

Recently I gave a short presentation on our end of year results for 2011/2012 to the Clinical Management Executive Committee. This week I want to again share our phenomenal success and outline some of our achievements, which can be organised around our Triple Aim – to get value for money, to improve the patient experience and to improve population health.

As you know, it is becoming increasingly important for us to control our costs, even with financial growth in public health funding, given the growth in our population and our ability to provide more services. That said, I’m extremely pleased that we’ve delivered a small surplus against a budget of $1.3 billion in the last year. A key reason for this is Thriving in Difficult Times, our programme to identify ways to improve quality while reducing costs. It has delivered extraordinary dividends, with $38 million saved in the last 24 months. This initiative has captured the imagination of staff and allowed us to save a substantial amount of money by working smarter rather than just cutting budgets. In the coming financial year (2012/2013), we hope to save an additional $20 million through Thriving in Difficult Times 3. We aim to identify savings that equate to around about 1.5% to 2% of our provider arm budget – a level which would match what is being done by the best organisations around the world such as Kaizer Permanente.

Secondly, we’ve seen significant improvements to the patient experience over the past year. These include work to substantially reduce harmful falls and pressure injuries, and eradicate Central Line Associated Bacteraemia (CLAB), an initiative we are leading nationally. I’m thrilled that April and May were CLAB-free at CMDHB and throughout New Zealand. Each case of CLAB we avoid provides a better experience for the patient, saves lives and saves CMDHB $20,000.

We are progressing the Developing Patient and Whaanau Centred Care workstream and looking at ways of engaging patients and staff to help us provide care in a meaningful way. We’re also continuing to improve access to our services and are meeting our target around Six Hours Can Be Ours despite growing demand for ED services. This year we’ve also seen record numbers of surgical elective admissions, improving quality of life for thousands of patients who are no longer waiting for surgery. And for those patients who are waiting, our lists are as short as they’ve ever been. Nobody is now waiting more than six months and work is underway to further reduce that to four months.

Finally, we’re also making inroads into improving the health of our population. We’re developing Locality Clinical Partnerships in four localities throughout Counties Manukau. These will allow clinicians from primary and secondary care to design health services which can be delivered in the community. This work sits alongside some key innovations such as Whaanau Ora and the development of a large Integrated Family Healthcare Centre which will be the hub of a lot of new services. The development of Locality Clinical Partnerships is a major strategic initiative and I believe will become a flagship for CMDHB in the next couple of years.

We’ve also kicked off our 20,000 Days campaign which seeks, through a number of key interventions, to shift demand away from the hospital so that Middlemore can focus on providing high quality secondary care. Although this winter is very busy, we know that the projected growth in admissions and bed days has levelled off as a result of implementing these initiatives. Now we aim to go further and actually begin to reduce these.

Of course, there’s also our immunisations team which has done a superb job challenging the assumption that immunising 65% of patients was the best that could be done in South Auckland. Just like Six Hours Can Be Ours, the team methodically worked through this challenge and saw ways to improve, and for the first time ever, immunisations hit 95% this year. They literally achieved a result that was previously considered unobtainable.

Given these many and varied achievements, I can confidently say we are providing more care which is better, safer and more cost effective than ever before, giving us a very stable platform on which to build over the coming year. That’s not to say it won’t be busy, challenging or difficult, or that we’re currently getting everything right. I’m aware there are still areas, like junior doctors and the development of new roles, which we need to progress. But even as we recognise the challenges ahead, I think it’s important to stop for a moment and reflect not on how much further we have to go but on how far we have come.

None of this would have been achieved without the professionalism and dedication of all CMDHB staff and our primary care partners. You all have a commitment to improving service, determination to go the extra mile and good humour. I’ve worked for 30 years in three countries as a manager in public healthcare and I have to say CMDHB far eclipses any other organisation I’ve been involved with. It really does make me humble to work alongside people of such high calibre and to be CEO of such an organisation. On behalf of the Board but more importantly our patients, I send a huge, heartfelt thank you to you all for the professional service you provide day in, day out. I look forward to taking the journey further in the coming year.

Driver Diagram

This brings me to mention where we are headed next. CMDHB’s Executive Leadership Team has been busy working on Achieving a Balance, aligning the work that we do to our strategic objectives. I want to have one single piece of paper which documents everything we do so that staff can see where they fit and how they’re helping make CMDHB the best healthcare system in Australasia by 2015. With that in mind, please check out this diagram (click on the picture on right) which shows how all our work contributes to our strategic goals. We’ve also got a short paper coming soon which describes what Achieving a Balance is all about. Do take a couple of minutes to identify where you fit in and the role you play in making our aspirations a reality.

Geraint

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Author: Geraint Martin

Geraint Martin was appointed Chief Executive Officer of Counties Manukau DHB in December 2006. It is one of the largest District Health Boards in New Zealand and services a population of half a million. He has significant experience over 30 years in national policy & in managing both primary and secondary care . Previously, he was Director of Health and Social Care Strategy at the Welsh Government .He authored a radical 10 year strategy of reform, including the successful “Saving 1000 lives” Campaign.Until 2004, he was CEO at Kettering General Hospital & had held senior positions in London & Birmingham.He has worked closely with clinicians in improving clinical standards,patient safety,chronic disease management & managing acute care to reduce hospital demand.In NZ, He has promoted clinical quality and leadership as central to improving patientcare. This has led to a significant increases in productivity and access, whilst maintaining financial balance. CMH has completed in 2014 a $500 m capital redevelopment programme, the largest in New Zealand. A central part of this is the establishment of Ko Awatea,the Centre for Innovation and Research which will underpin CMH as one of the the leading health systems in Australasia.In 2008, he chaired the Ministerial Review of Emergency Care in New Zealand, and in 2013 was an member of the Expert Advisory Panel on Health Sector Performance. Geraint has an MSc in Health Policy from Birmingham University .His post-graduate work has focused on health economics and Corporate Strategy . He is adjunct Professor of Healthcare Management at AUT and Victoria University, Wellington Elected in 2006 as a Companion of the Institute of Healthcare Management, previously he was an Associate Fellow at Birmingham University.He is is Chair of the Auckland Philharmonia Orchestra, a member of the Institute of Directors, on the Board of the NZ Institute of Health Management & previously the Board of The NZ Health Quality and Safety Commission.

2 thoughts on “Celebrating a Magnificent Year for CMDHB”

  1. Dear Geraint
    Thank you for your blog and the ‘Achieving a Balance’ framework

    The first Aim of ‘Keeping People Well’ is of considerable interest to General Medicine. Regarding Approaches 2-5 (Literature & Evidence Review, Health Needs Analysis, Intervention, Recommendations), I would like to know who has been working on this so far and how far they have gone with each of these four objectives.

    Many thanks
    Colin Thompson

    1. Hi Colin,
      Thanks for your comment and questions. This piece of work sits with Haidee Davis, our Programme Director for Achieving a Balance. I have asked her to reply to you directly.

      Thanks – Geraint

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