Media release from Waitemata DHB

Waitemata District Health Board today responded to the Health and Disability Commissioner's report into North Shore Hospital as an opportunity to further improve patient care.

The report concluded that Emergency Care Centre (ECC) overcrowding and staff shortages were major factors in unsatisfactory care received by five elderly patients during the winter of 2007.

Acting Board chair, Professor Max Abbott, said: "The Board takes the report's findings and recommendations seriously. Since the events described two years ago the Board has addressed a number of the concerns raised and is making further changes to enhance hospital care."

Professor Abbott said that since 2007 nursing staffing has greatly increased, 62 extra beds have been added and significant changes made to bed management and patient flow through the hospital.

Chief executive officer Dave Davies said: "We have apologised unreservedly to the patients and families who were identified in the report and who received care that was not as good as they could have expected and we met with several of them at the time.

"We are committed to providing excellent care to patients and families who come to North Shore Hospital and treating people with respect."

Specific steps taken by the Waitemata DHB to tackle many of the issues the commissioner raises include:

Beds & Overcrowding
o Since 2007 the WDHB has added 62 new beds across its two hospital sites and added an eight-bed High Dependency Unit to North Shore Hospital.
o An additional 27-bed medical ward is planned for 2010.
o Work has started on a complete reform of acute and emergency care processes to be completed by 2011 with the recently approved $48m Lakeview extension to North Shore Hospital. This will play a major role in reconfiguring the current ECC in to a 50-bed Assessment and Diagnostic Unit (ADU) and a separate redesigned Emergency Department. The new development will also include a new 30 bed ward. This will further alleviate Emergency Department overcrowding, increase bed numbers and improve patient flow through the hospital.
o WDHB is supporting GPs to provide care in the community and is working closely with GPs to increase their opening hours and reduce co-payments.

Staffing
o Nursing vacancies in key areas including ECC have reduced through good recruitment and retention strategies.
o The previously vacant position of emergency medicine clinical director has been filled and he has full authority over all ED activity.
o A health workforce strategy is being developed to help make Waitemata DHB an employer of choice.
o A senior nurse development programme is in place to assist the key frontline roles.

Clinical governance
o The clinical governance structure is being reformed. This will clarify clinical lead roles and responsibilities, with a focus on management, accountability, quality and safety at every level. This new structure, which includes an ECC Governance Committee, will be in place within the next few weeks.
o A chief operating officer, a new post, to oversee operations across all our hospital services, has been appointed.

Efficiency
o Several new initiatives are improving work processes so that nurses have more time to care for patients. This includes the 'Releasing time to Care' project on Ward 11 and the 'Optimising the Patient Journey' project in ECC.
o More health care assistants have been employed to support the nurses and assist patients. This allows nurses more time to provide the more complex patient care.

Discharges
o In 2008 three discharge planners were appointed in the ECC. They ensure that each patient with complex care needs receives careful discharge planning.

Cleaning
o The ward manager and cleaning supervisor have increased their cleaning audits. Extra cleaning hours have been implemented.

Communication
o Staff have worked to implement processes for improved communication with inpatients and their families. Emphasis is on regular updates with patients and families, explaining the care plan and providing clear information about who is caring for them. Communication acknowledges privacy and cultural sensitivity and makes provision for family meetings as needed.

Mr Davies added: "Although we have made many quality improvements we recognise we are not perfect, and still have much to do in a system that is under a lot of pressure.

"This winter and next is going to be tough for us until our Lakeview extension opens in 2011. But we believe the changes we are making will have a positive impact and are a step in the right direction.

"Sixty-two extra beds have been added, staffing has increased, inpatient wards now share the burden of overcrowding to prevent the ECC becoming overwhelmed. Improved bed management systems and increased duty manager support is assisting the workload of ECC nursing staff.

"We are working hard to implement all the Commissioner's recommendations and are committed to improving our service to the public. We can assure patients that their safety is paramount and we know from feedback that many patients benefit from the care they receive from our staff."