Annual Report 2018/19

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Company Overview

TAS works with the leaders and practitioners who plan, commission and deliver health and social care.

We are a professional services organisation, providing a range of strategic, advisory and programme management services to the health sector. We bring together sector experts with data analysis and health system insights, supporting our customers to make informed decisions and improve service planning and delivery.

In everything we do, we’re focused on achieving our 2020 vision - supporting our partners to deliver the best healthcare for all New Zealanders.

 

 
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Leveraging our Expertise

 

Working across the breadth of the health system gives us a unique perspective. We’re leveraging our collective expertise in the areas we know we can have the greatest impact. These areas include:

  • Growing sector collaboration

  • Data analysis, insights and strategy

  • Efficient, effective programme management

  • Building capability through education and training

  • Trusted, independent advice.

 
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Delivering our Strategic Objectives

 

Through our expertise, we can deliver our strategic objectives:

  • Delivering value to the sector

  • Getting closer to our customers

  • Ensuring our processes deliver a high quality, consistent customer experience

  • Continually building the capability of our TAS people.

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Who we work with

 

The six Central Region District Health Boards (DHBs) are our shareholders. Through our work we partner with New Zealand’s 20 DHBs, the Ministry of Health (MoH) and a wide range of stakeholders across the health and social care sectors including:

  • Government organisations

  • Sector bodies and representatives

  • Iwi

  • Non-government organisations (NGOs)

  • Health workforce and service providers.

  • Aged residential care providers

  • Primary health organisations (PHOs)

  • Unions

  • Professional associations and clinical groups

 
 

Singapore health authorities visited TAS and interRAI Services during March 2019 to learn about how we use the interRAI assessment tool in the healthcare of older people.

- Singaporean Delegation, join Graham Smith, TAS Chief Executive and interRAI staff

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 Key Achievements

We are proud to present key achievements from the past year that
are moving TAS towards realising our 2020 vision.

HIGHLIGHTS OF OUR WORK

TAS is committed to enhancing value for our customers to enable them to deliver the best
healthcare for all New Zealanders. The following highlights profile TAS’ role as a key strategic partner and enabler to the sector achieving its goals.

INCREASE IN MAORI PARTICIPATION IN THE HEALTH WORKFORCE

  • 20 DHB CE commitment to taking tangible actions to increase Māori participation in the health workforce, underpinned by the position statement developed by Te Tumu Whakarae on Māori workforce.

INTEGRATED COMMUNITY PHARMACY SERVICES AGREEMENT (ICPSA)

  • Delivery of the new evergreen Integrated Community Pharmacy Services Agreement (ICPSA) on 1 October 2018, which includes greater ability for DHBs to commission local services to meet population need, address equity and support delivery of the Government’s Pharmacy Action Plan. Includes over 1000 community pharmacies, accounting for around $472 million.

ESTABLISHMENT OF PAY EQUITY UNIT

  • Establishment of the pay equity unit and development of a process to respond to claims covering 87% of the health workforce.

REGIONAL EQUITY FRAMEWORK

  • Development of a regional equity framework for Central Region DHBs.

AGED RESIDENTIAL CARE (ARC) FUNDING MODEL REVIEW

  • Management of the Aged Residential Care (ARC) Funding Model Review sponsored by DHBs and MoH, undertaken by Ernst & Young.

REGIONAL DIGITAL HEALTH SERVICES (RDHS)

  • Set up of the Regional Digital Health Service (RDHS), formerly called Regional Health Informatics Programme (RHIP).

DATA ANALYSIS AND RESEARCH REPORT

  • Data analysis and research report produced by TAS and championed by the Health System Performance-Insights programme (HSP-I) for DHBs to better understand the pressures caused by acute demand (unplanned hospital admissions). Report provided performance insights to help DHBs pinpoint opportunities to improve their acute demand flow.

 ORGANISATION PERFORMANCE

Our key performance results in 2018/19 reflect our continuing work to build a sustainable and high performing organisation

 
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New Investment
Funding increases or investment for new work programmes or projects

 

2018/19

5M

2017/18

3M

 

 
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Customer Satisfaction
Respondents who rated overall satisfaction with TAS services 7+/10
 

 

2018/19

76.2%

2017/18

79%

 

 
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Customer Advocacy
Respondents who are likely to recommend TAS services 8+/10

 

2018/19

56%

2017/18

58%

 

 
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People Engagement

In 2019, we used a new platform for our staff engagement survey. This means the 2019 engagement score was not comparable to the 2018 score, therefore the 2018 score is not provided.

 

Participation rate

2018/19

87%

Participation rate

2017/18

80%

 
 

Engagement Score

2018/19

55%


 
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Chair Report

At TAS we are committed to helping our customers deliver the best healthcare they can for all New Zealanders. At the heart of our role as strategic partner and enabler to the health sector, are the strong partnerships and collaboration we build with our customers.

 

Our conference and meeting venue has enabled these partnerships to thrive. Leaders, clinicians and health professionals regularly come together at Front+Centre to shape ideas that collectively help us progress our country’s health priorities.

TAS has forged a new direction over the last year, including forming a Services Group and Insights and Analytics Group to optimise how we work across the business.

We’ve created a Centre of Excellence with increased capability across our people, technology and processes - to more effectively take advantage of evolving data analytics. By harnessing our data resources, we have enhanced the value of health insights we provide across our customer base. This puts us in the best position to offer expert advice and services that benefit health and social care in New Zealand.

Perceptions of quality outcomes, customer advocacy, customer satisfaction and the value that TAS provides are fundamental to our reputation and success as an organisation - nationally and globally.

In the last year we enjoyed hosting overseas visitors who had heard about TAS’ work with our health partners and wanted to gain knowledge about our service model and expertise.

One group included Singaporean health authorities who visited during March to learn about how we use the interRAI assessment tool in the healthcare of older people. These visits have expanded the exchange of ideas between TAS and our neighbouring counterparts and are the type of collaboration we aim to continue over the coming year.

To conclude, I’d like to welcome two exceptional new Board members to the table. Sir Paul Collins and Catherine Law are already bringing their wealth of experience to the fore. I’d also like to thank my fellow Board members, Chief Executive Graham Smith, Board Secretary Jane Doherty, the TAS management team and staff for their support over what has been a significant twelve months for TAS.


 
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Chief Executive Report

It’s been a big year for TAS. We’ve developed our operating model to set TAS up to deliver on our future aspirations: to grow the value we deliver, and to build a resilient, agile organisation that’s a great place to work. 

 

A key part of this was embarking on a 2020 programme to invest in our people and culture. We set defined change aims that resulted in a new TAS people strategy, culture strategy, and a refreshed IT security model, architecture and framework.

This past year we have achieved some meaningful results alongside our health sector partners on national and regional work programmes. This includes the delivery of the new evergreen Integrated Community Pharmacy Services Agreement (ICPSA), management of the Aged Residential Care (ARC) Funding Model Review, development of a regional equity framework for Central Region DHBs, and the implementation of a Stroke Clot Retrieval Service, among many other positive initiatives. The case studies throughout this Annual Report show these programmes are creating lasting impact.

As a reflection of our past programme successes, we are pleased the DHB CEs and DHB Executive Governance Group have endorsed our 2019/20 National and Regional Work Plans, enabling our progress for the next 12 months.

Earlier this year, we were honoured to receive double accreditation by Joint Accreditation System of Australia and New Zealand (JASANZ) and Accreditation Audit by International Health Accreditation Organisation (ISQua). ISQua assessed our TAS Certification Audit Programme as exceptional for its processes and systems, noting the strategy and vision are deeply implemented throughout TAS.

In April 2019, we also celebrated two years of Front+Centre, our meeting venue that provides space for health sector stakeholders and external customers to hold important discussions and shape ideas.

In looking forward, I am excited for the many initiatives we have underway at TAS to cement our strong organisational values of Integrity, Professionalism, Courage and Aspiration. To that end, we are evolving our cultural competencies through the establishment of a Māori Strategy Steering Group in partnership with our Māori staff group (Te Roopu Māori o TAS) to develop our Tikanga and Te Reo Māori.

I’d like to thank Murray Bain, our Board Chair, and our dedicated Board members and staff for their commitment to helping our partners deliver the best healthcare for all New Zealanders, now and in future.

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- Speakers and DHB representatives at the national OIA workshop

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 Key Programme Achievements

TAS core services are focused on facilitating key national and regional work programmes on behalf of New Zealand’s DHBs and the MoH. In 2018/19, we worked with our DHB and MoH partners and broader sector stakeholders to deliver key achievements across the following programmes of work.


 
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EMPLOYMENT RELATIONS

  • Established the pay equity unit and developed process to respond to claims covering 87% of the health workforce.

  • Led the DHBs’ response to the MBIE Labour Inspectorate Holidays Act compliance requirements and pay equity claims, in partnership with NZ Council of Trade Unions (CTU) and other health unions.

  • Positive engagement with the 20 DHBs, including development of employment relations (ER) capacity and capability within DHBs through inclusion of ER/HR DHB staff in national MECA bargaining.

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SAFE STAFFING HEALTHY WORKPLACES (SSHW)

  • The CCDM software was constantly improved to enable DHBs to achieve greater traction with their full-time equivalent (FTE) calculations. The development of a roster testing pool provided DHBs with a rigorous method for managing rosters.

  • Operationalised core data set (CDS) with great examples from at least two DHBs on how they operationalised the CDS. One DHB hosted webinars with the developer (Qlik) for the sector, to share their CDS journey and key Care Capacity Demand Management (CCDM) learnings.

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COMMUNITY PHARMACY

  • Delivered the new evergreen Integrated Community Pharmacy Services Agreement (ICPSA) on 1 October 2018, which includes greater ability for DHBs to commission local services to meet population need, address equity and support delivery of the Government’s Pharmacy Action Plan. Includes over 1000 community pharmacies, accounting for around $472 million annually.

  • Established the National Annual Agreement Review process, which aligns with the Primary Care and Age-Related Residential Care annual review processes.

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 WORKFORCE PLANNING AND DEVELOPMENT

  • 20 DHB CE commitment to taking tangible actions to increase Māori participation in the health workforce, underpinned by the position statement developed by Te Tumu Whakarae on Māori workforce.

  • Developed nursing graduate costing model to quantify the costs for DHBs of employing additional nursing graduates as part of the Nursing Accord.

  • Wellbeing project partnership now includes Ministry of Health’s (MoH) Clinical Cluster to ensure a multi-professional approach to wellbeing, along with the Health Sector Relationship Agreement (HSRA).

Members of our workforce planning and development team

Members of our workforce planning and development team

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ELECTRONIC ORAL HEALTH RECORD

  • Completed the planning phase and commenced implementation.

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AIR AMBULANCE

  • Established the DHB Air Ambulance Steering Group and projects to support DHBs and MoH to roll out new contractual arrangements to implement inter-hospital transfers by Air Ambulance.

 
Electronic Oral Health Record dental stakeholders

Electronic Oral Health Record dental stakeholders

 
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HEALTH OF OLDER PEOPLE

  • Managed the Aged Residential Care (ARC) Funding Model Review sponsored by DHBs and MoH, undertaken by Ernst & Young.

  • Managed and allocated the transitional support fund for ARC providers who required temporary support to deal with the negative effects of the allocation methodology used in ARC for the Care and Support Workers’ Pay Equity Settlement.

  • Managed the annual review of the Age-Related Residential Care Agreements and associated work plan.

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ORAL HEALTH

  • Used design thinking to prototype an oral health analytics dashboard with DHB portfolio managers, clinicians, provider and adolescent oral health coordinators. This work is completed with biannual analysis and reporting for the stakeholder to be able to make informed decisions on oral health for adolescent services.

  • Analysed the triannual New Zealand Dental Association fees survey to help DHB customers put forward a successful price increase for 2019/20.

 
interRAI Education & Support and Software Services teams

interRAI Education & Support and Software Services teams

 
 
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interRAI

  • 93% of Registered Nurses in aged residential care are competent to undertake interRAI assessments.

  • 100% of Home Care Assessors are interRAI competent.

  • Programme of education and support updated with new ways of training delivery through accreditation model and tertiary providers.

  • Online training introduced for health professionals who read assessments.


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MENTAL HEALTH AND ADDICTION

  • Facilitated the establishment of a Partnership Group focused on six key issues impacting mental health and addiction Non-Government Organisation (NGO) providers with a national focus.

  • Established a training support fund for support workers in mental health and addiction with a view to having 80% of support workers at level 4 NZQA or equivalent within a two-year time frame.

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REGIONAL SERVICES PLAN (RSP)

  • Development of a regional equity framework for the region.

  • Developed and agreed a single system of care operating model for the region for cancer services.

  • Regional launch of the New Zealand Out of Hospital ST elevation myocardial infarction (STEMI) pathway in March 2019.


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REGIONAL DIGITAL HEALTH SERVICES

  • Set up the Regional Digital Health Service (RDHS), formerly called Regional Health Informatics Programme (RHIP) as a standalone service.

  • RDHS and its Service Delivery Partner (previously located at Capital & Coast DHB) now based under one roof at the TAS office on Cambridge Terrace and renamed Regional Support Team (RST).

  • Preparing for the onboarding of Hawkes Bay and Capital & Coast DHBs in 2019.

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PRIMARY CARE

  • Supported Lead DHB Negotiators with advice on policy, funding, contracting, negotiation and implementation to introduce new subsidies for Community Services Card holders and 13-year olds from 1 December 2018. Held a forum for all DHB Portfolio Managers to support the implementation. Over 90% of general practices are now providing the new subsidies.

  • National DHB CEs approved the extension of the scope of the Primary Care Programme to include Public Health. This has provided an immediate mandate to engage MoH on negotiating the next three-year agreement for public health services.


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HEALTH SYSTEM PERFORMANCE INSIGHTS

  • Data analysis and research report produced by TAS and championed by the Health System Performance-Insights programme (HSP-I) for DHBs to better understand the pressures caused by acute demand (unplanned hospital admissions). Report provided performance insights to help DHBs pinpoint opportunities to improve their acute demand flow.

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AUDIT AND ASSURANCE

  • The equivalent of 65 audits completed within the Central Region.

  • Double accreditation by Joint Accreditation System of Australia and New Zealand (JASANZ) and Accreditation Audit by International Health Accreditation Organisation (ISQua). ISQua assessed TAS Certification Audit Programme as exceptional for its processes and systems, noting the strategy and vision are deeply implemented throughout TAS.


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- TAS Chief Executive Graham Smith and the Audit and Assurance team with ISQua auditors

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 STRATEGIC OBJECTIVE

 
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Delivering Value to the Sector

TAS has a strong focus on continuous improvement to ensure we keep adding value to our customers and the sector. 

 
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Over the last year we’ve been providing value to our customers through four key areas:

 
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We’ve developed our operating model to set TAS up to deliver on our future aspirations to grow the value we deliver, and to build a resilient, agile organisation that’s a great place to work.

In a move to drive better consistency and bring our collective expertise together, we formed the Services Group and Insights and Analytics Group. With our services aligned, we shifted our focus to work smarter, so we can provide more for our customers.

“With our customers at the forefront of our work, we’re not only optimising how we work now but we’re looking to the future; growing new business and developing new services to have greater impact and add benefit back to the health sector” - Graham Smith, TAS Chief Executive


STRATEGIC OBJECTIVE

 

Getting closer to our customers

Partnering with our customers to enable them to reach their goals is at the heart of our business.

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CUSTOMER SATISFACTION

Strong partnerships and collaboration with our customers are the cornerstone of our business, enabling us to help them deliver the best healthcare for all New Zealanders.

Every year we formally measure how well we are delivering against customer expectations through our annual customer satisfaction survey. This year’s survey examined four key areas: perceptions of TAS, customer satisfaction, customer advocacy and our value proposition.

Survey respondents covered District Health Boards, primary care and other health sector organisations in a variety of roles from chief executives and board members to portfolio managers, and operational and clinical staff.


OVERALL SURVEY DEMOGRAPHICS

Response by Organisation

 
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Response by Role

 
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Customer Advocacy

How like is it that you would recommend TAS to a colleague or to another organisation?

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Customer Satisfaction

Overall how satisfied are you with the services you receive from TAS?

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Overall high advocacy (8+/10) has remained similar for 2018/19.

69% of respondents from DHBs outside Central Region rated satisfaction as high (8+) compared with 64% in 2017/18.

 

PERCEPTIONS

Perceptions of TAS remain positive (the trend shows customers agree/strongly agree with positive perception statements).

The highest rated areas are related to professionalism of relationships and quality services/advice.

VALUE ATTRIBUTES

This year our survey explored key areas of value that TAS provides to customers. We tested how important these areas of value were to customers and asked them to rate our performance.

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There is a continued strong correlation between importance and performance. This indicates that the areas where TAS is performing the best are also areas which are most important to our customers.


REFRESHED WEBSITE DESIGNED FOR OUR CUSTOMERS

In February 2019, we launched a refreshed website designed to reflect our TAS 2020 direction and be a more effective communication hub for our customers.

To see where the opportunities lay for making improvements, we interviewed a range of stakeholders at different levels from DHBs, the Ministry of Health, crown agencies, sector groups and TAS staff to understand how customers were using our site and their reasons for visiting.

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FRONT+CENTRE TEAM CELEBRATING SECOND BIRTHDAY MILESTONE

 
Front+Centre team celebrating second birthday milestone

Front+Centre team celebrating second birthday milestone

 

A key part of our work at TAS is supporting and enhancing partnership and collaboration across the sector.

Our meeting and collaboration space, Front+Centre, has transformed the way we achieve this. In April 2019, we celebrated two years of providing a bespoke and neutral space for our health sector stakeholders to join together, hold important discussions and shape ideas. With our high-tech video conferencing, our out of town customers can successfully link into meetings without the need to travel.

Over the last year we’ve continued to build awareness in the Wellington venue market (and beyond) by:

  • Growing our customer base beyond the health sector - on average we hold around four meetings per week from external organisations.

  • Identifying training providers as a new market - Blue Circle Consulting are among other consulting companies who have been complimentary of our space and facilities.

  • Hosting conferences and overseas delegations - the 20 DHBs Employment Relations conference and Singaporean delegation were both successful events and received great feedback.

  • Connecting with some inspiring groups - we hosted a Chamber of Commerce business breakfast with Lucy Revill (Wellington blogger), welcomed PACE, an EA network for after-hours tour, and hosted the Public Relations Institute of New Zealand (PRINZ).

“We especially like the fresh modern look and feel of the rooms; they provide a great environment for learning and discussion” - Blue Circle Consulting

 
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STRATEGIC OBJECTIVE

 

Innovating smart business processes

To enable us to evolve and grow we need to invest in and strengthen the foundations on which TAS operates.

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TRANSFORMING OUR BUSINESS AND THE WAY WE WORK

Over the last year, TAS has been developing its operating model to help us achieve our future aspirations to grow the value we deliver to the sector, and to build a resilient, agile organisation that’s a great place to work.

We started by forming the Services Group and Insights and Analytics Group to optimise how we work across service lines to deliver greater impact where it matters most. Integrating our teams and leveraging areas of shared capability, we shifted our focus and way of working.

With robust and future proofed systems and processes, we’re supporting and enabling the specialisation we need to succeed and become a high-performing organisation - with our customers at the heart of everything we do.


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MIGRATION TO WINDOWS 10

In March 2019, we transitioned our IT environment from Revera to Microsoft Azure, with a major component being the transition of our laptops and desktops to use Windows 10. The pilot was successful in identifying a number of unknown issues which our team were able to resolve ahead of the move. Before the migration, employees who were familiar with Windows 10 were encouraged to be Windows 10 champions to support colleagues during and after the transition.

This was a complex project for our IT team whose detailed planning and preparation paid off. They put in a huge amount of effort, despite the short timeframe, to minimise disruption and ensure all staff were supported during the process. The successful migration was a big step towards an IT infrastructure that is more robust, secure and fit for purpose. It will not only improve the way we manage and access our data, but is also a smarter environment, allowing greater opportunity for collaboration, more capability and better functionality. Ultimately this environment will make it easier to do our work alongside our customers.


”Our IT infrastructure being on Azure Public Cloud platform affords us a more secure environment for our data and opens up new functionality for how we work together” - Graham Smith, TAS Chief Executive


STRATEGIC OBJECTIVE

 

Growing our people

We’re committed to growing innovative, trusted, expert advisors who love what they do and make a difference.

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BUILDING OUR CULTURE

2018-2019 has been an important year for growing TAS people and culture. We built on the earlier role-modelling we’d done of our TAS values (aspiration, integrity, courage and professionalism) and moved into how we approach our work. We then embarked on a 2020 programme to invest in our people and personal growth.

 
Celebrating our great team culture

Celebrating our great team culture

Getting those steps in with Move it March

Getting those steps in with Move it March

 
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Our change aims were:

  • New leadership framework and ways of working

  • Leadership for our Services Group

  • Operating model for Data and Analytics service

  • Learning Management System

  • IT roadmap

  • Capability mapping

  • People and culture strategies

  • Quick win initiatives

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What we achieved:

  • TAS People Strategy developed

  • TAS Culture Strategy developed

  • New leadership framework and ways of working developed

  • IT Security model, architecture and framework refreshed

  • New purpose, direction and operation model for Services Group and Data and Analytics service developed and teams set up

  • IT roadmap finalised

HEALTH, SAFETY AND WELLNESS

Our health, safety and wellness (HSW) committee, made up of representatives from each business unit, meet regularly to foster and monitor positive health and safety practices in the organisation.

A monthly report on HSW activities, issues and incidents is presented to the TAS Board so that it can ensure TAS is meeting its obligations under the Health and Safety at Work Act.

 
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Key achievements over the past year included:

  • New HSW intranet hub to host information on upcoming initiatives, wellbeing, fire safety, workstation assessments, EAP, the HSW Committee and First Aid/Floor Warden representatives.

  • Launch of monthly ‘Wellness Wednesday’ initiative kicking off with fresh fruit for three months, followed by subsidised chair massage to reduce stress and boost energy.

  • First Aid course run on site for staff.

  • Proactive health initiatives such as free flu vaccinations.

  • Ergonomic workstation set ups and assessments.

  • Events organised to encourage staff engagement and collaboration - such as Move it March (10,000 step challenge) and Pink Shirt Day anti-bullying quiz and staff morning tea.

 

- Colleagues in our Tory Street office coming together on Pink Shirt for anti-bullying

 
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DHBs’ Employment Relations Strategy

Over the past year TAS has been leading development of a five-year ‘20 DHBs Employment Relations Strategy’ (ER Strategy).

“With complex health challenges and no overarching ER strategy providing context and direction, how do we know our employment arrangements enable DHBs to meet these environmental and operational challenges as they deliver health care for their communities,” reflected Peter Brown, TAS Director of Employment Relations.

 
Participants at the Employment Relations (ER) strategy session - 2019 ER Conference

Participants at the Employment Relations (ER) strategy session - 2019 ER Conference

 

SHAPING THE STRATEGY

To develop the strategy, TAS on behalf of DHBs held a number of consultation workshops nationally, with each workshop engaging the voices of both clinical and non-clinical employees, and union representatives. The workshops focused on the overarching objective that future employment arrangements need to deliver across the health sector and the challenges facing the sector in New Zealand.

Stephen Cummings, Victoria University of Wellington’s

Professor of Strategy and Innovation was brought in as an expert advisor to support the workshops, and team, to develop the strategy.

Stephen focused on using the ‘Growth Options Heatmap’ to help sort and prioritise feedback from the workshops. The heatmap is a unique approach to the use and interpretation of the traditional SWOT analysis and enabled the identification of five key strategic intents. Stephen’s book, Strategy Builder (Wiley, 2015) was a relevant source of information on the most effective way to develop and visualise a strategy.

The Balanced Scorecard approach was then used to develop operational strategies, goals and measures, across innovation and learning, customer, financial and internal business perspectives.

THE ENVIRONMENTAL CHALLENGES

Any ER strategy needs to enable future proofed employment arrangements to address our workforce and health operating environment challenges.

Examples of these changes and challenges include:

  • the increasing complexity and expectations of the medical treatments available to diagnose and treat each patient

  • the use of artificial intelligence, robotics, automation and advanced digital and cognitive technologies disrupting health care delivery models

  • the increased use of trans disciplinary teams in the delivery of patient care

  • the continuing pressure on the funding available for health care.


“We enjoyed a high level of enthusiastic engagement with unions and health sector practitioners who all provided a realistic picture of the challenges facing DHBs and their views on strengths in the sector.”

Peter Brown, TAS Programme Director of Employment Relations


ALIGNMENT OF WORKFORCE PRINCIPLES AND ER STRATEGIC INTENTIONS

It was important that the ER Strategy Development team closely engaged with the Ministry of Health Workforce Strategy Group, in order to align the strategy, goals and measures across both strategies.

The more than 70,000 employees across our 20 DHBs account for the majority of the health expense budget. It was important to develop a pragmatic ER Strategy that recognised this and enabled achievement of our overall workforce objectives and created long-term benefits for our health operations and workforce.

THE ROAD AHEAD

The Employment Relations Strategy 2019-2024 has been signed off by all 20 DHBs. This signals their commitment to:

Develop employment arrangements across the sector which will enable effective teams to do their best work to deliver Pae Ora for our communities.

In practice, this means DHBs will:

  • Seek to think and act as one ‒ managing and delivering services, thinking and acting as one organisation and one system.

  • Tackle pay disparity ‒ lessen the gap between low and high paid staff and address pay equity.

  • Support our staff to do meaningful work ‒ leaders within DHBs commit to developing our people and ensuring the work environment supports our people to thrive.

  • Support mutual agility and innovation ‒ employment arrangements support our people to be agile and innovative in how they deliver services.

  • Be financially sustainable ‒ recognise our agreements need to be financially sustainable.


“We are confident the commitment of the DBS to the implementation of this strategy will enable employment arrangements across DHBs, which support continuously improving healthcare for all New Zealanders.”

Peter Brown, TAS Director of Employment Relations

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Taking action on acute demand pressures in DHBs

DHBs are facing increasingly complex challenges. Over the last year, TAS has been focused on addressing one of these key challenges - acute demand. The pressures caused by acute demand, a term used to refer to any unplanned admission to hospital are likely to increase, posing a significant threat to our health system.

 
Members of the Insights and Analytics Group and corporate communications.

Members of the Insights and Analytics Group and corporate communications.

 

TAS interviewed a range of DHB leaders to determine their perspectives on acute demand and the impact it has on the health system. These interviews raised several themes which TAS subsequently explored in data.

In June 2019, TAS produced the report Addressing Acute Demand Pressures, championed by the Health System Performance-Insights (HSP-I) programme, to provide a collective narrative for acute demand. The data insights in the report aim to provide a better understanding of the factors affecting acute demand pressures on the public health system.

DHBs reported in their interviews with TAS the increasing Emergency Department volumes and increasing pressure on resources. These reported challenges were reinforced by TAS data analysis, which proved that the numbers of acute admissions to hospital are growing faster than the rate of population growth.

Due to the different characteristics of each DHB, they are faced with different pressures and opportunities to address acute demand. TAS identified how DHBs are currently responding and the opportunities to improve management of acutely unwell people. TAS’ insights show that almost one in three of all hospital admissions is considered potentially avoidable bydelivering more planned care in the community.

The health insights gained from the report will benefit all DHBs, despite their differences. With increased clarity and understanding, the DHBs are better positioned to work together, and from a new perspective, to overcome these challenges and ultimately affect positive change in our communities.


“High quality relationships led to a trusted partnership that has produced some actionable insights for individual health systems and across NZ. I am confident that this baseline work will be used to derive further insights from the comprehensive data set that TAS has access to. I am delighted with the quality of work that we were able to deliver together.”

DR Andy Phillips, Chair of Health System Performance Insights Programme Governance Group, Hawke’s Bay DHB


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TAS audit success put us on the map

In March 2019, TAS was audited for the first time by the International Society for Quality in Health Care, receiving Accreditation for the TAS Certification Audit Programme.

 
TAS Chief Executive and Audit and Assurance team with ISQua auditors

TAS Chief Executive and Audit and Assurance team with ISQua auditors

 

Three auditors from Australia, France and Malaysia visited the TAS Wellington Office to assess our Audit processes along with our overall governance, IT, Finance, HR, Risk Management, Quality Management and strategic planning processes. We were assessed against eight organisational standards and received positive feedback particularly on our processes and systems.

The auditors also commented that our strategy and vision are deeply implemented throughout the organisation and were obvious during conversations with a range of people interviewed, including students, employees, the CE, Board Chair and external contractors.

The ISQua accreditation is a testament not only to the hard work of our certification audit team in their preparation for the audit, but also to their efforts to further demonstrate our credibility, and position TAS as trusted advisors in the sector.

The accreditation shows the integrity and quality of our services, ensuring our customers always have faith that we are delivering value in everything we do.


“I have been a surveyor (auditor) for ISQua for 7 years and I have never seen a company that performed so exceptionally well and was so well prepared as TAS was, which was even more remarkable given that this was the first time ISQua have audited TAS and the standards were unknown to TAS.”

Lead Auditor


Regional Services Programme benefitting patients and communities

It has been a significant year for the regional health programmes TAS has helped lead.

 
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As part of the Regional Services Plan, we’ve built strong and collaborative relationships with programme partners across diverse areas like cardiac care, sudden unexplained death in infants (SUDI), and stroke intervention.

We’re also proud to have worked alongside the Central Region Service Planning Forum (CRSPF) on an Equity Framework, designed to achieve health equity for all New Zealanders.

“The Central DHBs’ regional programmes reach all pockets of our communities, from caregivers and babies through to those needing lifesaving therapy,” said Tricia Sloan, General Manager, TAS Services Group.

“By taking a whole of system approach to eliminating inequities and improving quality, safety and experience of care across the region, the benefits are far-reaching.”

SUDI PREVENTION - MAKING SUDDEN UNEXPECTED DEATH IN INFANTS HISTORY

Preventing SUDI through safe sleeping practices and smokefree whānau is a key regional priority and one close to people’s hearts.

TAS Child Wellness, Planning and Improvement Managers Jessica Sandbrook and Katie Kennedy have been leading collaboration with the Central Region DHBs on developing and implementing local SUDI prevention plans that empower whānau to protect their pepi from SUDI, and meet Ministry of Health requirements.

This' year’s achievements have included support for DHB portfolio managers and local safe sleep coordinators on programme initiation and development. Regional connections have been strengthened through monthly online hui for DHB safe sleep coordinators. Katie and Jessica have collaborated with Hapai te Hauora on National Safe Sleep guidelines and SUDI prevention needs assessments.


“The two key modifiable risk factors that impact on SUDI are smoking during pregnancy and bedsharing”

Jessica Sandbrook, TAS Child Wellness, Planning and Improvement Manager


TAS has supported DHBs who have existing SUDI prevention programmes, and also worked alongside Hutt Valley DHB to set up and outwork their new safe sleep device service, Moe Ora. This service is directly connected to the hapu mama stop smoking service - a clever approach to support whānau to protect pepi from SUDI.

A highlight for TAS was the regional SUDI prevention wānanga hosted at Napier’s Pukemokimoki Marae to support workforce development for kaimahi.

“The two key modifiable risk factors that impact on SUDI are smoking during pregnancy and bedsharing,” says Jessica Sandbrook.

“The goal of the SUDI prevention programme is to address these factors in a mana enhancing way, utilising a safe sleep solution designed by Māori for Māori. The respect and value given to a wahakura woven from harakeke is valuable for the pepi that will sleep safely in one tonight, and for their wider whānau to see the DHB’s value and investment in a kaupapa Māori solution.”

 
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“The hui was designed to support collaboration with health workers across the region and identify ways to support whānau to act on the knowledge that separate sleep surfaces are safest for baby and ‘smoke-free’ is best for pregnant women, babies and whānau.”

The hui was grounded in a Māori worldview, provided as a wānanga, and held on Pukemokimoki Marae. Participants learned about the history of wahakura - New Zealand’s first indigenous response to reduce the inequity of SUDI for Māori whānau - from its creator Dr David Tipene-Leach.

“The National SUDI Prevention Coordination Service (NSPCS) were pleased to attend this well organised and facilitated hui. It offered the team an opportunity to meet face to face with and hear directly from those at the coal-face and to answer their conerns and queries directly,” said Fay Selby Law, National SUDI Prevention Programme General Manager.


“Those in attendance were personnel from a wide range of health and community organisations within the Central Region, who each have a stake in providing SUDI prevention messaging through their specific work programme. There were opportunities to hear from well-known SUDI prevention advocates and workshops to discuss and learn from one another.”

Fay Selby Law, National SUDI Prevention Programme General Manager


STEMI - NEW INITIATIVE ENABLING QUICKER ACCESS TO LIFE SAVING TREATMENT

Every day in New Zealand, five people will suffer the most life-threatening form of heart attack (myocaridal infarction), and approximately 20% will die.

To minimise these statistics, TAS was proud to facilitate conversations between clinical leads on introducing a new out-of-hospital treatment pathway for cardiac patients in the Central Region.

Known as STEMI (ST elevation myocardial infarction), this new pathway enables paramedics to give a clot busting drug to patients in the community and then transport those patients directly to the most appropriate hospital.

The pathway was launched initially by DHBs in the Central Region and is a collaborative treatment method developed by St John, the Ministry of Health and the Cardiac Network. TAS managed the complexities of in-depth discussions between partners, enabling the pathway to move forward.

“The result is a crucial reduction in the time it takes to receive lifesaving treatment. A quicker journey to hospital means the loss of heart muscle is minimised, enabling patients to potentially go back to work two weeks later, rather than months after their heart attack,” says Jeanine Corke, TAS Planning and Improvement Manager.

Craig Johnston said the ability to have STEMI patients assessed in the community by St John paramedics will “decrease transfer waiting times to Wellington Hospital, preserve cardiac function and improve outcomes for patients across the region”.

Any initiative involving emergency healthcare relies on the expertise, composure and care of the paramedics, nurses and doctors delivering this lifesaving treatment around the clock. The impact on clinical teams is significant and Capital Coast DHB and St John’s role in providing this 24/7 service has been fundamental to its success.

Around 350 patients each year could benefit from the pathway, resulting in improved long term survival and the delivery of equitable healthcare to all New Zealanders, particularly those living in rural and remote areas.

“This is a crucial step in achieving regional equity which is one of the fundamental goals of the Cardiac Network and represents a lot of hard work from all involved. We still have more work to do. The current pathway only benefits those patients who call 111 and we will be looking to extend the pathway for those patients who attend emergency departments of non-PCI capable hospitals this year,” said Nick Fisher, Clinical Lead Central Cardiac Network and Head of Department Cardiology, Nelson Marlborough DHB.


“TAS has organised the work programme and managed most of the project streams within the work programme.”

Craig Johnston, Midcentral DHB General Manager Strategy, Planning and Performance


CENTRAL REGION EQUITY FRAMEWORK - ESTABLISHING EQUITY FOR ALL

Over the past year, TAS has supported Central Region DHBs to strengthen the equity focus in the Regional Services Plan. A major piece of that work has been the development of a Central Region Equity Framework. The Framework, informed by the Ministry of Health’s ‘Equity of Health Care for Māori’ has been designed to provide guidance to the Central Region Service Planning Forum on strengthening their commissioning role to achieve equity.

Central Region DHB Chief Executives have agreed that the implementation approach for the Framework includes regional activity focused on strengthening equity in the Regional Services Plan, local activity building the capacity and capability of staff in each DHB, as well as local activities that would be captured in the DHBs’ Annual Plans.

People who are poor, have chronic conditions/disease, live with disabilities, live rurally and are of different ethnicities will have poorer health, greater exposure to health risks and poorer access to health services. In New Zealand, the differences between Māori and non-Māori are the most persistent and compelling equity issues in health. Achieving equity for Māori is a priority, as health gaps across the life-course is significant for Māori.

While the Equity Framework takes a very broad approach, the companion Treaty of Waitangi DHB obligations document under development will provide guidance to the Central Region DHBs on what they need to do meet their Treaty of Waitangi obligations, as well as achieve equity for Māori.

 
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STROKE CLOT RETRIEVAL SERVICE - REDUCING THE LONG-TERM IMPACT OF STROKE ON PATIENTS

Stroke is the second most common cause of death and adult disability in New Zealand and worldwide. Nationally, around 8,500 people had a stroke in 2015/16 and about 50,000 lived with the consequences of stroke.

Launched in the Central Region in April 2019, the Regional Stroke Clot Retrieval Service is a highly specialised treatment, involving removal of a blood clot in the brain when ‘clot-busting’ drugs cannot dissolve the clot.

“It has a high success rate, significantly improving the likelihood of a patient walking out of hospital the next day versus a long process of rehabilitation and recovery or potential permanent disability,” said Stephanie Calder, TAS Director, Regional Services Programme.

To get the Regional Stroke Clot Retrieval Service over the line, TAS helped support the introduction of the Service within the six Central Region DHBs, along with bordering DHBs in Nelson-Marlborough and Taranaki.

Early intervention with endovascular clot retrieval (ECR) is the most effective treatment available to reduce the debilitating impact of strokes, and improve survival rates.

“The implementation of a regional ECR service will help to reduce current inequities in achieving best patient outcomes, reducing overall post-stroke disability.”

The service applies to patients presenting to one of the participating emergency departments (Hastings, Hutt, Masterton, Nelson, Taranaki Base, Wairau, Wellington, or Whanganui hospitals). There is strong evidence that clot retrieval, as a procedure, directly prevents avoidable costs in acute medical care, neurosurgical procedures, rehabilitation for stroke patients, as well as aged residential care.


“The implementation of a regional ECR service will help to reduce current inequities in achieving best patient outcomes, reducing overall post-stroke disability.”

Stephanie Calder, TAS Director, Regional Services Programme


First Review of Aged Residential Care Funding Model in 20 years

New Zealand’s aged residential care sector has transformed since the government’s funding model for residential care was put in place over 20 years ago.

 
Members of the Cross-Sector Steering Review Group

Members of the Cross-Sector Steering Review Group

 

While the aged population is growing steadily, the characteristics of people going into aged residential care have changed. People are going into care much later, at an average age of 85, and a high number have complex needs involving long-term conditions and disability related dependencies, requiring specialist or around the clock 24/7 care.

“The funding model for aged residential care must be fit for purpose and financially sustainable long-term to cope with the changing nature of the sector, so facilities can continue to provide effective, quality services,” said Chris Fleming, lead District Health Board Chief Executive for the Health of Older People, and Chief Executive of Southern District Health Board.

SIGNIFICANT ENGAGEMENT AND ANALYSIS OVER EIGHTEEN MONTHS

On behalf of the 20 DHBs and the Ministry of Health, TAS commissioned Ernst & Young to undertake a comprehensive review of the funding model, to see if it was keeping pace with the changes in the sector and would support future requirements. The focus was purely on the funding model ‒ the amount of funding was not considered in the Review.

Advice as the Review progressed was provided by a cross-sector steering group including representatives of aged care providers, consumers and unions as well as DHBs and the Ministry of Health. The steering group was co-chaired by Chris Fleming, and Keriana Brooking, Deputy-Director General, Health System Improvement and Innovation, Ministry of Health.

“At TAS, we were privileged to manage the Review, working closely with Ernst & Young and the cross-sector steering group,” said Jon Shapleski, TAS Programme Director, Health of Older People.


“The Review was a great example of partnership and collaboration across the entire aged care sector. It took eighteen months and involved extensive engagement with a wide range of people - from providers to residents to consumers.”

Jon Shapleski, TAS Programme Director, Health of Older People


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