news from the auckland district health board community

NEWS FROM THE AUCKLAND DISTRICT HEALTH BOARD COMMUNITY
JUNE 2004
Palliative care team wins grant from Genesis
Auckland DHB’s Hospital Palliative
Care team has helped to devise an
award-winning, computer-based
system to manage delivery of
palliative care. The system was
developed by ADHB’s Centre for
Best Patient Outcomes and is being
used by several services in
Auckland City Hospital.
Hospice/palliative care is well established in
the community in New Zealand, but specialist
palliative care is often not available in
hospitals, even though that is where fortyone percent of New Zealand deaths occur.
Studies have confirmed perceptions that care
of the dying and their families/whanau in
hospitals is not always optimal.
ADHB’s Hospital Palliative Care team has
worked closely with the ADHB Centre for
Best Patient Outcomes to develop an
electronic model called the Hospital
Palliative Care Clinical Support and
Education Initiative (PICSE). This helps
provide improved care for the dying, as well
as increasing the palliative care knowledge
of other health professionals caring for
patients with incurable illness.
PICSE will smooth transition of care between
hospital and community settings by
anticipating future problems and effectively
communicating palliative plans to others
involved in care. The initiative can link to any
generic hospital central data repository to
utilise patient demographic information,
while at the same time adhering to privacy
requirements.
Specialist palliative care is
often not available in
hospitals, even though that
is where forty-one percent of
New Zealand deaths occur.
Among other functions, the initiative
incorporates an educational and audit tool
which allows evidenced-based guidelines to
be inserted into the clinical record at the
point of patient contact. This means
consistent, standardised advice can be given
about common problems - and the model can
track the advice given and its outcome.
"Our initiative also creates an electronic
clinical discharge letter," explains Hospital
website www.adhb.govt.nz
Hospital Palliative Care team clinical director Dr Anne O’Callaghan (left) pictured with Annie Fogarty of the Centre for Best Patient Outcomes. They have
contributed to the development of an electronic model called the Hospital Palliative Care Clinical Support and Education Initiative (PICSE) that helps
provide improved care for the dying.
Palliative Care team clinical director Dr
Anne O’Callaghan, "by collating all the
previous palliative care plans and hence
automatically compiling a story of the
admission from a palliative care perspective.
There is no need for a delay by dictation and
typing. This letter can by faxed or emailed to
the community health professionals, such as
the GP, district nurses, and hospice. This
method of discharge letter is highly rated by
community teams for its speed and
content."
Having successfully implemented the PISCE
system at ADHB, Anne O’Callaghan, along
with the Centre for Best Patient Outcomes
and colleagues at Auckland University and
at Capital Coast Health, has been awarded
a grant from the Genesis Oncology Trust to
pilot the introduction of this groundbreaking work into a second hospital.
Dr O’Callaghan says, "the Genesis Oncology
Trust PICSE project is highly patient-focused
and will help to look at outcomes for
palliative patients so that we can bring
about a systematic improvement in
standards of care."
ZM treats Starship unit to
free lunch
Thanks to resourceful clinical
charge nurse Anne McDonald and
the generosity of ZM radio station,
the staff at Starship’s Child and
Family Unit got to enjoy a free
lunch of Subway sandwiches,
Magnum ice creams and massages
from Bodyworkz’s Lee Hettig.
Anne won the treat for the Child
and Family team in a ZM radio
competition for a workplace lunch.
From left to right: Ward clerk Alison
Murray, support worker Ula Tagica,
staff nurse Brendon Bates, staff
nurse Darren Grbic enjoying a
massage, massage therapist Lee
Hettig, clinical nurse educator Liz
Burgess, clinical charge nurse Anne
McDonald, paediatric registrar
Vesna Markovich, staff nurse Kim
Wrathall (crouching), receptionist
Barbara Weatherell, Bureau health
assistant Tamilo Ahing, and ZM
ambassador Mark Hewlett.
NOVA / Page 1
News
Children’s therapy
conference runs smoothly
Allied Health manager Phillipa Neads
reports that 140 delegates from
around New Zealand and Australia
gathered at Starship to hear local and
international speakers on the theme
"Choices, Challenges and Changes".
Five members of the children’s therapy team Lynette Mills-Eaton, Michelle Holmes, Turid
Peters, Rebecca Udy and Carolynn Simmons
Carlson - organised the successful three-day
Choices, Challenges and Changes conference,
supported
by
management
and
administration. Staff members chaired
sessions, presented papers, and troubleshot
the myriad of tasks that surface in an event like
this. Staff also picked up colleagues’ clinical
loads to ensure there was cover across the
hospital while the conference was in progress.
Shepherd from the University of Sydney,
whose research into motor control is well
known to occupational therapists and
physiotherapists; and Brownyn Kelly from
the University of Canterbury whose work on
dysphagia (disordered swallowing) was of
great interest to the speech language
therapists present. It was an honour to be
told by Professor Shepherd that the
conference was well run and that she had
both enjoyed it and learned from it.
Children’s therapy conference group with copy of
proceedings. Back: Julie Harrison, Michelle
Holmes, Terry Wackrow, Kate Druett, Phillipa
Neads, Nicole Bostin. Middle: Haeley Mato,
Eileen Smith, Louisa Hill, Fiona Miller, Sarah
Butler, Turid Peters. Front: Rebecca Udy, Lynette
Hing, Antonia Fenwick, Lynette Eaton.
Key note speakers were Professor Roberta
Family Violence Intervention underway at ADHB
Family Violence Intervention coordinator Anthea Raven reports that
large scale training has begun of
clinical, allied health and other ADHB
staff in order to increase identification
of partner and child abuse.
The programme is part of a government
directive mandated by the Ministry of Health
that requires government agencies to
incorporate family violence identification into
their practice. WINZ staff, for example, are
trained in family violence intervention.
Auckland DHB is one of four district health
boards contracted to implement the Family
Violence Intervention Programme - the others
are Lakes, Hawkes Bay and Counties Manukau.
The programme aims to increase the rate of
identification of partner and child abuse
throughout ADHB and to provide safety
intervention for victims. It involves routine
screening of all females over the age of 16
years. Protocols for elder abuse will be
implemented later in the year.
Patients who disclose family violence will be
offered support and referral to ADHB family
violence services for risk assessment and
planning for safety strategies.
The ADHB-wide policy will offer services specific
procedures for conducting routine inquiries
into family violence, for recording disclosures,
managing information confidentially and
providing family violence alerts.
routine inquiry will be provided to all
medical, nursing and allied health staff.
A three-hour programme will be provided to
selected staff from each service on
mentoring family violence intervention.
A four-hour programme on risk and lethality
assessment and safety planning will be
provided to all designated ADHB family
violence support services, such as social
workers, case workers and key workers.
Orientation programmes will be put in place
for all new staff and a refresher course will
be available for current staff.
Family Violence Intervention training
Professional support for ADHB staff
A 30-minute session will be provided to all
ADHB staff on the problem of family violence
and the role of healthcare.
Free counselling services are available for
ADHB staff experiencing family violence:
A four-hour programme on identification and
EAP Confidential Services (09-358 2110) and
Domestic Violence Centre (09-303 3939).
Lucy signs on
the dotted line
for Starship
Lucy Lawless, the Starship
Foundation and Mercury Energy are
hoping that customers will get in
behind a new scheme to help raise
more funds for new equipment at
Starship Children’s Health.
The Xena Warrior Princess star and Starship
Foundation board trustee is the first to sign
up for a Mercury Energy scheme called the
Star Supporters’ Club, that will allow
customers to make regular monthly
donations to the charity regarded as most
worthy by many New Zealanders.
"Giving a little each month will make a huge
difference to the work we can do here," says
Lucy Lawless. "Starship commands a very
special place in our hearts and the Star
Supporters’ Club gives us a way to show how
much we value this national facility."
The scheme enables Mercury customers to
donate from as little as $2 each month through
their bills.
The initiative aims initially to raise $200,000 to
purchase a new Mobile Image Intensifier, an
important piece of medical machinery that
allows doctors to obtain detailed x-ray images
during surgery on children. The images give
accurate guidance to surgeons during
operations such as spinal corrections, bone
strengthening, hip reconstructions and other
orthopaedic and general surgical work.
Left to right: Anthea Raven, co-ordinator for ADHB's Family Violence Intervention programme presents Domino midwife Lynn Austerberry with her certificate
of completion while charge midwife Jenny Woodley receives hers from Kay Hyman, general manager National Women's Health and Starship Children’s Health.
NOVA / Page 2
Starship Foundation board trustee, Lucy Lawless,
with Starship surgical patients who have used the
existing Mobile Image Intensifier.
website www.adhb.govt.nz
Perspectives
Altered attitude needed towards disability
The Disability Support Advisory
Committee advises Auckland
District Health Board on the
disability support needs of the
resident population of ADHB.
Committee members have found
that, while physical access to
services for disabled people can be
achieved, it is proving more difficult
to change non-disabled people’s
attitudes to the disabled and to
older people.
At the April meeting of the Disability Support
Advisory Committee (DiSAC), promotion of
attitudinal changes to disability was high on
the agenda. As if to underscore this point,
one of the DiSAC members arriving at Rehab
Plus for the meeting found a non-disabled
ADHB manager (who shall remain nameless)
parking in the mobility space next to him.
"Practical help and more openminded attitudes benefit everybody,
not just older people and people with
disabilities," says Marie Hull-Brown.
With no sign of a mobility card in his car
window, the manager jumped out of his car
and disappeared into the building.
Unfortunately, this is not an uncommon
occurrence around ADHB. Some non-disabled
members of staff are having trouble
understanding that mobility parking is there for
a reason. It’s for people who are disabled.
It’s this kind of dismissive attitude to
disabled people - "They don’t really need this
parking space" - that members of DiSAC
would like to see change.
"Staff’s perceptions of disability can
definitely affect how they communicate with
disabled people", says Debbie Mudgway,
"and how services are offered to us."
One of those perceptions is that disabled
people don’t work. DiSAC members speak for
many disabled people and their families
when they recount the frustration of having
to take off from work, for example, five days
in a month for five different clinical
appointments, rather than attending all the
appointments in one day. Not to mention the
added difficulty of having to overcome the
usual barriers of transport and building
access that regularly confront disabled
people.
patient’s age, she immediately addressed all
her questions to his daughter, even though he
was capable of answering on his own behalf."
Sometimes staff are simply ill-at-ease or
apprehensive around the requirements of
disabled people, such as assistance with
toileting. DiSAC members believe that many
of these problematic attitudes could be
ameliorated if strategies to raise awareness
of disablement were linked to performance
objectives, competency and involvement at
the recruitment centre level.
For example, DiSAC members suggest a pack
containing information about the New
Zealand Disability Strategy could be part of
ADHB’s orientation processes for new staff.
"We don’t want people to feel that we are
forcing things on them," says committee
member Barry De Geest. "We want to work
with people in the services to understand our
needs. A caring healthcare environment is
better for them as well as for us."
Some forward-planning in the area of
appointment schedules would definitely be
appreciated.
Christine Harmsworth of the Parent and Child
Resource Centre says, "Attending an
appointment as a health professional,
supporting a family, is quite a different
experience compared to when I go along as a
parent myself of a disabled child. In the
parent role, as opposed to the
"professional" role, I usually feel invisible.
Staff make eye contact with the clinician, not
with me. Yet, to my mind, we should be
acknowledged as the experts on disability,
because we live with it all the time."
As an advocate for older people, Marie HullBrown confirms that ageist attitudes are
widespread. "The recent experience of a
friend of mine is typical of the assumptions
that healthcare people can make. She
accompanied her 90-year-old father to an
appointment. When the nurse found the
Members of the Disability Support Advisory Committee from left, back row: Board member John
Retimana, Christine Harmsworth, Parent and Family Resource Centre, Marie Hull-Brown of Age
Concern and also the Mental Health Foundation, associate-professor Margaret Horsburgh (Chair),
and Meri Kohi, Te Roopu Waiora. Front row, from left: Barry de Geest Renaissance Consulting, Debbie
Mudgway, Ripple Trust and Tanumafili Toso, PIASS Trust. The committee promotes the participation
in society of disabled people and strategies which maximise their independence. Its advice is
underpinned by an ethos that values diversity and self-determination.
Working in partnership: the Board’s perspective
At a meeting of senior nurses and
midwives, associate professor Dr
Margaret Horsburgh, deputy chair
of the Auckland District Health
Board, spoke about the role of the
Board and its current concerns.
Issues management is a major function of the
Board. In order to manage issues effectively,
communication with stakeholders is critical.
Our stakeholders include the Ministry of
Health, consumers and the staff of this
organisation.
The Board agrees annually with the Minister
of Health on the District Annual Plan (DAP),
which is the basis for our funding and our
accountability to the Ministry.
Monitoring is also very important. The Board
spends a great deal of time monitoring
against the DAP and against risk.
This financial year we have agreed with the
Ministry on a budgeted deficit of around $49
million and have undertaken to break even in
three years time. That’s why the Board is
currently so keenly focused on dollars. We
made an agreement with the Crown, which
we must meet.
The Board of the Auckland District Health
Board doesn’t manage this organisation; it
governs. There’s a big difference between
governance and management. The function
of the Board is to employ the chief executive
of the organisation and to assist him in his
job. One of the ways the Board expresses this
assistance is by setting the organisation’s
mission and strategies. In other words, the
Board oversees The Big Picture, while the
chief executive manages the organisation.
website www.adhb.govt.nz
Four key current messages
Information
The Board can’t monitor against the DAP
effectively unless we have information. We
seek useful data that can be analysed. Data is
critical. When the Board sees figures that tell
us the average length of stay has increased,
productivity is going down and costs are
going up, naturally we are concerned. Since
we’ve got a commitment to deliver on our
District Annual Plan and lower that deficit, it is
alarming to see adverse indicators.
Some staff have said that some key
performance indicators are not accurate. If you
can demonstrate that to be the case, then the
CEO and the senior management team need to
know about it, because the Board relies on
this data in order to monitor performance.
Control hospital spending
"The hospital’s eating primary health care’s
lunch!" says Board chairman Wayne Brown.
District Health Boards are fundamentally
about a population-based approach. If we
don’t control hospital spending, we won’t
have the funds to fulfil our population-based
mandate.
The reason the Board focuses hard on
nursing costs is because their trend will
indicate the movement of other costs. For
example, in February we saw that there was
an overspend on Bureau nurses and Specials
and the transition lounge wasn’t being used
as intended. These are variable costs that it is
possible to control. The Board’s role is to see
those costs are controlled so that we can
direct our health care funds fairly to our
population.
Accountability
Everyone working for ADHB is accountable
for what the organisation is trying to achieve.
Team work
Healthcare is about team work and cooperation among clinicians is a priority. The
Ministry’s focus, through the Primary Health
Care Strategy, is on collaboration.
Margaret Horsburgh and chief executive Garry
Smith. Dr Horsburgh joined the Board of
Auckland District Health in 2000. She trained in
nursing at Green Lane Hospital where she
worked in the cardiothoracic area. She moved
into the sector of education and policy and is
now Associate Professor in the School of
Nursing at the University of Auckland.
NOVA / Page 3
Community
Understanding Muslim health issues in Auckland
Auckland DHB staff participated in
a forum titled Working with Muslim
Communities in New Zealand aimed
at organisations who provide care
to refugees and migrants from
Muslim backgrounds.
Discussion topics at the two-day forum
included the importance of religious identity
to peoples of Islamic faith, the barriers to
integration in New Zealand society facing
Muslim refugee and migrant communities,
models of working in partnership with Muslim
communities, issues facing Muslim youth and
the role of Muslim women in New Zealand.
The Auckland Regional Public Health Service
Refugee Health team and staff from ADHB’s
Community Child Health and Disability
service addressed the forum on working with
the growing Muslim population (around
23,000) in Auckland .
Three refugee community health workers
employed by ADHB’s Community Child Health
and Disability Service - Mahad Warsame,
Hasem Slaimankhel and Mayada Sharef were among the organisers of the forum.
Many Muslim refugees and migrants come
from traumatic war-torn backgrounds.
Building trust with these communities is
essential to the work of the refugee
community health workers.
"It can be difficult to reach those who are
isolated in their homes," says Mahad. "It is
our job to reach those people and to help
channel health resources more effectively."
Recommendations from the forum
The forum recognised that in-service
professional development is needed for nonMuslim providers of services in health,
education and social services to families
from Muslim backgrounds.
Community education and partnerships with
Muslim communities should also be pursued
in order to reduce discrimination towards
families from Muslim backgrounds. That
includes educating employers, so that
people from Muslim backgrounds can be
placed in suitable employment.
A database of cross-cultural workers
available to assist families from refugee and
Muslim backgrounds should be implemented
in health, education and social services.
In relation to health, in particular, the Koran
has many teachings which promote health,
such as breastfeeding and dietary
requirements which could be incorporated
into health promotion programmes with
Muslim women and families.
People from Muslim backgrounds need
culturally safe and gender-appropriate
care, for example, the provision of female
birth attendants.
In the area of mental health, a website is
needed to improve local agencies’ awareness
of resources available from mental health
services for refugee and migrant Muslim
Refugee community health workers Mahad Warsame (Somali community), Hasem Slaimankhel
(Afghan community) and Mayada Sharef (Arabic-speaking communities) help develop health
promotion programmes with the community, identify issues for refugee families in accessing child
and family health services and develop collaborative relationships with schools and preschools.
families and to guide appropriate referral.
should be more widely disseminated.
Forum participants also found that acceptance
criteria for mental health services should be
more flexible.
The Refugee and Migrant Service, On TRACC
(Transcultural Care Centre), Refugees as
Survivors, and the refugee community workers in
the Auckland District Health Board, Community
Child Health and Disability team should be
widely promoted as effective models of crosscultural health and social services teams.
In the area of education access to qualified
bilingual personnel is needed to support
refugee and migrant students with special
needs and information about support services
Transcultural care centre a pilot at Greenlane
ADHB is a partner in a new
intersectoral service in central
Auckland for children and young
people from refugee backgrounds
with severe behaviour or mental
health needs.
Called On TRACC, the Transcultural Care
Centre is operated by ADHB’s Kari Centre
(Mental Health service for children and
adolescents) and teams from the Ministry of
Education and the Royal Oak and Grey Lynn
offices in the Department of Child, Youth and
Family Services (CYF).
The service started in October 2003 and will
run as a pilot over a two-year period.
The need for this service was prompted by the
increasing utilisation by refugee and migrant
groups of child and adolescent mental health,
special education and care and protection
services in the Auckland region.
On TRACC aims to provide a specialised onestop shop for refugee and migrant children
with severely problematic behaviours and
mental health needs. On TRACC will give them
access to culturally appropriate therapies and
case management, support programmes at
school and will help families to cope.
The initial caseload of the new joint service is
between twenty-five and thirty children and
teenagers.
On TRACC is located in room 601, Building 14,
Greenlane Clinical Centre.
Soothing skills help clients tolerate distress
Three years ago, Taylor Centre
clinical psychologist Trish Du Villier
and social worker Angus Stephenson
started up a programme called
Dealing with Distress. It helps
people to find beneficial ways of
tolerating psychological discomfort
and nurtures greater awareness,
clarity and acceptance of presentmoment reality.
The Dealing with Distress programme runs at
all four of Mental Health Services’ community
mental health centres. In the last year Trish
and Angus have trained more of their
colleagues in Dealing with Distress skills and
the programme has become part of new
clinical staff’s orientation to Taylor Centre.
Trish Du Villier has also worked with the
inpatient unit psychologist to introduce a
similar programme to Te Whetu
Tawera/Auckland City Acute Mental Health
Unit). This is now running very successfully
NOVA / Page 4
as part of Te Whetu’s day programme.
The Dealing with Distress programme consists
of five sessions run over a two and a half week
period. The sessions, which last for one and
half hours, are more like teaching seminars
than traditional psychotherapy groups.
"We get clients to refer themselves", Trish Du
Villier explains, "and to specifically make the
commitment to attend and to participate by
doing practice at home. The only clients
excluded are those unable to take in
information because of intellectual
impairment, active psychosis, or mania."
Clients learn mindfulness skills
Techniques such as distraction, improving
the moment, and self-soothing, assist clients
to be able to observe a situation or a problem
without getting stuck in it and then to be able
to act more effectively in controlling their
reactions to situations.
People come out of the Dealing with Distress
group with a set of goals to work on and a
coping-with-crisis plan that they have
created for themselves as well as alternative
ways of looking at problem behaviours such
as using alcohol or drugs.
Trish Du Villier emphasises, "There is a much
greater commitment to helping yourself
when you take an active role in devising the
coping plan."
Crisis team staff can draw on the details in
individuals’ coping plans so that they can
coach the client more effectively, should the
client present or call in a distressed state.
Trish and Angus have now trained crisis team
and other community mental health
professionals in Nelson and Blenheim.
"We’ve received very positive feedback from
that," says Trish.
Clients and staff at ADHB’s mental health service
continue to enthusiastically endorse the Dealing
with Distress programme. There have been
close to 200 clients now through the programme
and all groups are generally oversubscribed.
Mental Health Services psychologist Trish Du
Villier and social worker Angus Stephenson about
to facilitate a Dealing with Distress session at one
of ADHB’s community mental health centres.
website www.adhb.govt.nz
Hospital
Japanese surgeons are integral to Auckland transplant team
Standards of transplant surgery are
so high at ADHB, Japanese
surgeons want to work and train at
Auckland City Hospital.
Two Japanese transplant surgeons are integral
to the team at the New Zealand Liver Transplant
Unit based at Auckland City Hospital.
Consultant transplant surgeon Dr Motohiko
Yasutomi started at the unit in December
2001. Dr Yasutomi, now a permanent member
of the team, performs mainly kidney and
pancreas transplants.
Liver Transplant surgical fellow Dr Katsuya
Yamashita took over the position from his
Japanese colleague Dr Yuhji Marui in
November 2003. Dr Yuhji Marui returned to
Japan at the end of 2003 to take up a position
as a consultant in transplant and general
surgery at the Japan Railways Tokai Hospital
in Nagoya. Dr Yamashita plans to be part of
the team for one year.
Dr Yasutomi says he loves the New Zealand
lifestyle and working at Auckland City Hospital.
There are many reasons why Japanese
surgeons want to work and train at ADHB, he
says. "Auckland City Hospital has two
excellent consultant liver transplant
surgeons. The surgeons are great mentors
and offer many different training
opportunities to Japanese surgeons."
Consultant liver transplant surgeon and
director of the New Zealand Liver Transplant
Unit Professor Stephen Munn and consultant
liver transplant surgeon Professor John
McCall are both New Zealanders.
Professor Munn trained in liver transplantation
at the Mayo Clinic in Minnesota and Professor
John McCall trained in liver transplantation at
Kings College Hospital in London, England.
The fact they trained in different countries
means they have different specialist
transplantation techniques to offer.
"We can gain a lot of new and different
knowledge from both of the consultants,"
says Dr Yasutomi. "Also, the working
environment for surgeons at Auckland City
Hospital compared with Japanese hospitals
is much better."
Munn says it is extremely difficult to hire
transplant surgeons to work in New Zealand
because a liver transplant surgeon’s
lifestyle is very onerous. And New Zealand
doesn’t offer a competitive salary by
comparison with other countries such as the
United States, Australia, Canada and the
United Kingdom.
"For a number of years now we haven’t had
much interest in consultant transplant
positions from New Zealanders," says
Professor Munn. "We are lucky to have the
Japanese surgeons here. If they weren’t here
we probably wouldn’t have any new
transplant consultants at all, and they are
great people to work with."
He says surgeons at Auckland City Hospital
have a lot more time to concentrate on
performing top class surgery.
In New Zealand there are qualified healthcare
professionals trained specifically to perform
important investigations for patients such as
x-rays and ultrasounds, says Dr Yasutomi. In
Japan surgeons are often required to perform
these investigations, which eats into
operating time.
Cultural limitations in Japan greatly reduce
the number of cadaveric donor transplants
performed there. Transplantation is
predominantly performed using live related
donors.
Since Auckland City Hospital performs both
cadaveric and live related liver and kidney
transplants, Japanese transplant surgeons
are able to gain more experience here in
both surgical techniques.
Former Liver Transplant surgical fellow Professor
Consultant transplant surgeon Dr Motohiko Yasutomi (left) and liver transplant surgical fellow
Dr Katsuya Yamashita.
Drug-coated stents better at keeping arteries open
Internationally recognised trials at
Auckland DHB have reduced the
number of patients needing
coronary artery bypass surgery in
New Zealand.
In 1994 interventional cardiologist Dr John
Ormiston introduced coronary artery stent
trials to New Zealand at Greenlane and Mercy
Hospitals.
A stent is an expandable metal mesh tube
that is implanted in the artery at the site of
the blockage. Once in place, the stent pushes
against the wall of the artery to keep it open.
Dr Ormiston says that bare metal stents were
a big advance when compared with balloon
dilatation alone. However sometimes with
bare metal stents, the artery re-narrows
when healing tissue grows through the mesh
of the stent.
Trials are now being carried out at the cardiac
investigation unit at Auckland City Hospital
using drug-eluting stents rather than bare
metal stents. Stents coated with either
paclitaxel or sirolimus prevent or reduce the
excessive healing often found with
conventional bare metal stents.
"Most of the drug coated stent trials showed
a big improvement compared with bare metal
stents," says Dr Ormiston "Patients treated
with drug-coated stents have a much lower
chance of re-narrowing."
The drug is only delivered to where it is
needed not the whole body.
Trial co-ordinator Stephanie Simpson
Plaumann recently represented ADHB and
New Zealand at the international drug coated
stent trial investigators’ meeting in Bangkok.
"At the beginning there is a lot of computer
work, setting up databases and meeting trial
patients", says Stephanie, "but the best
thing about the job is building up meaningful
relationships with patients."
Stent trial co-ordinators Hector Gonzalez and Stephanie Simpson Plaumann.
website www.adhb.govt.nz
Another trial co-ordinator, Hector Gonzalez,
"Drug eluting stents are a revolution in
decreasing the number of patients needing
repeat stenting and by-pass surgery," says
interventional cardiologist Dr John Ormiston.
says he enjoys being part of a great team.
"It’s a challenging job and mentally
stimulating, but the best thing about the job
is seeing patients back here with no
complications," says Hector.
NOVA / Page 5
Nursing
Hospital’s GM seeks input and guidance from the "shop floor"
Auckland City Hospital general
manager Dr Nigel Murray met with
senior nurses to share his vision of the
hospital and to hear the nurses’ views.
Nigel Murray sees his task as general
manager as one of ensuring that we have a
vibrant, healthy hospital. His vision is to see
Auckland City Hospital recognised not only
as the best hospital in New Zealand, but the
best hospital in Australasia.
He has met with clinical directors and senior
nurses to seek their input.
"You are the life-blood of the hospital," he
said to a forum of senior nurses, "I would like
your guidance about how we run the place.
Staff have indicated to me that there is a
perceived gap between the "shop floor",
that’s all of those people dealing hands-on
emerged as the hospital beds down into its
new existence.
Occupancy issues
The biggest issue facing Auckland City
Hospital at present is that of throughput.
"I’d like level three managers to know
what’s happening in every service and on
every ward so they know what’s slowing us
down. Is there a delay in X-ray, for example?
If so, I’d like to know that, so we can do
something about it. I expect staff to tell
their managers where there’s a problem.
Because I want to take pressure off of
Auckland City Hospital. That way it will be a
better place to work."
"We’re currently operating way up near 90100 percent", Nigel Murray observes, "which
is why you are feeling the pressure. If we can
get ourselves back down to 85 percent
occupancy, some of that pressure will lift."
Along with operations manager 24 Hour
Centre Ngaire Buchanan, the general manager
has been walking the hospital, talking with
staff, to get an understanding of what’s
causing discharge delays on the wards.
"We do know," he says, "that use of the
transition lounge is a key factor for taking
some of the pressure off the hospital. We
Nigel Murray says, "I’m completely open to suggestions about
managing this hospital in a way that includes clinicians as part of
the decision-making, not just for your individual wards and
services, but for the hospital as a whole."
with patients, and the level tw0 management
scene - the general managers, nurse leaders
and clinical leaders."
Nigel Murray said it was a gap that he wanted
to bridge and asked staff to work with
management to solve issues that have
also found that on Saturdays discharges drop
right down to half the rate. So, something’s
happening in the weekend that’s preventing
discharges."
Nigel Murray says he is passionately focused
on getting systems to work properly.
The blue line shows patient numbers in our hospital oscillating from an all time low on Christmas
day to highs in February and March. Notice how at all times the total number of patients was below
the budgeted number of beds, yet we got into trouble in the week before Christmas with a large
number of elective surgical procedures cancelled (shown in the vertical red bars). The yellow
vertical bars represent the number of outliers which improved after Christmas. This graph and
other data suggest that the surgical cancellations were not related to being under resourced for
bed numbers but that something was wrong with the distribution of those beds, and bed blocking.
Graphs acknowledgement to Ngaire Buchanan/Aaron Cooper.
Primary health care an opportunity for nurses to shine
The Primary Health Care strategy is
a real deliverable for nursing, says
Dr Frances Hughes, chief nurse
advisor, Ministry of Health, in a talk
to senior nurses and midwives
about working across the primary
and secondary sectors.
Shifts in health care are redefining
professional nursing. There is a shift from
nursing interventions linked to medical
treatment to nursing interventions linked to
clinical outcomes. In the past, nurses
followed orders. The emphasis now for
nurses is on being providers of care. We are
moving to a continuum of care approach. In
the primary health sector we need to be
teaching consumers about self-care, while
recognising that many consumers will be very
well informed with information down-loaded
from the Internet. Nurses may play a skilled
advisory role in this kind of context.
Ischaemic heart disease, cerebrovascular
disease, unipolar major depression and
trachea, bronchus and lung cancers are the
four most common diseases being treated in
our healthcare system. They are preventable
and they’re lifestyle-related. Chronic disease
management is an area in which nurses can
play a vital role.
NOVA / Page 6
Integration of disease management across
numerous different teams in both the
primary and secondary sectors is the order of
the day - under the auspices of a guiding
process of best practice clinical guidelines.
Diverse roles for nurses
There are many examples of nursing actions
that we know make a difference to health
gains. Nurse-led smoking cesssation
programmes, screening surveillance, and risk
assessment make a difference. So does
nurse involvement with lifestyle plans for
consumers, with referral and with coordination of agencies. The literature is
telling us that the role of information-broker
is beginning to be strongly represented in
nursing, along with other lead roles.
The challenge for DHBs is to move beyond
the concept and the structure of secondarytertiary-primary silos, to move from vertical
integration to horizontal integration. That
means that most of you who work for the
provider arm need to be available with your
expertise and your knowledge to assist care
continuums in primary healthcare.
Many people think that primary healthcare
will be solved by practice nurses. Wrong.
Primary healthcare is every body’s issue. It’s
a wonderful opportunity for nurses to use
their specialist knowledge. We need to
harness nurses’ expertise so that consumers
can go across organisations and not just up
and down.
The Ministry of Health is continuing to work
with district health boards and other
government agencies around nurse
practitioners. The Minister of Health is very
keen to see barriers to nurse practitioners
overcome, because she sees this role as very
important in terms of delivering on the
Primary Healthcare Strategy in New Zealand.
Funding issues need to be dealt with more
effectively at the top end of DHBs. DHBs need
to have clarity about the results they want.
They need to develop new models of working
and flexible working arrangements. They
should not forget that regional services like
public health have models of care which can
help us get back to reaching our community.
Nurses will have to get used to not being
"owned" by a particular unit. Nurses are a
resource for the DHB - competent,
autonomous people with specialist expertise
and knowledge. Finally, I can’t emphasise
enough the importance of nurses moving
beyond anecdotes and having some data so
that their work is not invisible. Nurses need
to embrace best practice and evidence.
"In the future we will see increasing numbers
of nurses influencing and planning policy
development," says the Ministry of Health’s
chief nurse advisor Dr Frances Hughes.
website www.adhb.govt.nz
Dialogue
Nurses get involved in question and
answer session
Executive director of nursing and
midwifery Taima Campbell, operations
manager 24 Hour Centre Ngaire
Buchanan and general manager of
Auckland City Hospital Nigel Murray
answer questions from nurses about
"the state of the nation."
Q: We are really understaffed. What are you
doing to attract nursing talent to ADHB?
Taima Campbell: First we wanted to
understand why people are leaving. Clearly,
workload is a big issue. We will attract staff if
we can manage the hospital’s high occupancy
rate and release pressure there. We’ve also
got to look at the staffing templates for
nursing and the assumptions on which these
were based. We intend to make better use of
the resource nursing team and we’re
endeavouring to have another new graduate
intake in September. But our main focus is to
manage the workload so that nurses are able
to provide safe quality patient care.
Q: What’s happening about managing
outliers better?
Nigel Murray: Outlier management is very
important. If we can reduce hospital
occupancy down from 95-100 percent to 85
percent, that will help. Ngaire is also
looking at how beds are allocated in the
first place.
Ngaire Buchanan: We know that the average
length of stay of outliers has increased. I am
working with a nursing group about better
management of outliers. We started by
monitoring where outliers come from. So we
are working hard on this issue right now.
Q: There doesn’t seem to be a review
process for some of the Change Programme
projects that clearly need tweaking.
Nigel Murray: There’s been a fundamental
change in the way the Change Programme
works. The programme used to sponsor
projects and work with the services to
implement them. Now, we own all the change
projects. We - as in the operational people will run our projects, as they come through
the Level two management team (the general
managers and clinical leaders). The Change
Programme now helps projects to be
implemented through facilitation rather than
actually running them. If a project needs
tweaking, it’s our responsibility to see that
that is done.
Q: Is it enough to enter a problem on a risk
report?
Nigel Murray: Noting an issue on a risk
report is not enough. When an issue comes
up, we need to own that issue. That means
bringing it to the attention of your level three
managers so that they can alert general
managers. I need to hear about any
problems through my management team
and it’s up to us to fix it. As long as we make
changes in a disciplined manner through the
management system, we will get it right. But
if we make changes to projects on an
idiosyncratic basis, we will end up in the
mess we were in before, where everything
was done differently. The good thing about
the Change Programme is that it has
standardised systems and processes.
Q: Why aren’t more patients getting Day of
Surgery Admission (DOSA)? Too many are
coming in the night before surgery.
Nigel Murray: The nurse leaders, the
clinical leaders, myself and the general
managers are determined on this point: we
want 100 percent Day of Surgery Admission
(DOSA) - apart from those exempt for good
clinical reasons. Day of Surgery Admission
is vital so that we save that bed day and
ease the workload. We absolutely need the
help of nurses to improve this situation.
Any advice that you can offer to achieve this
will be very much appreciated. I want to
draw a line in the sand and say that
inpatients who have been booked
inappropriately will be subject to
cancellation in preference to Operating
Room Direct Admission (ORDA) - taking into
account, of course, clinical justification.
Q: Is anything more being done for day
surgery?
Nigel Murray: Yes. Building 4 at Greenlane
is being reconfigured as a day surgical unit.
It is scheduled to come on stream in July this
year. I know there is tension about working
over two sites, but there is no way we could
run half a million outpatient appointments
on the Grafton site. It’s not inconsistent
internationally with the move to provide
outpatient and day stay surgery closer to
the populations they serve. Greenlane
Clinical Centre has good parking, good
access and is equidistant from all corners of
the central isthmus.
Primed to
be leaders
Whichever way you look at the
values and attitudes of nurses
and doctors, the differences
between the two groups can be
explained in terms of their
professions, explains Associate
Professor Margaret Horsburgh.
Many studies around the world - and
also at ADHB - have investigated the
way in which different values and
beliefs inform the way in which
doctors and nurses work.
Broadly, nurses profile as collectivists
and doctors as individualists. Nurses
believe that more systemised
integrated approaches to service
delivery are useful and that teambased
systemisation
is
the
appropriate model for clinical
management.
Doctors profiled in these studies
believe in the medical ascendancy
model of care. Research I am involved
in now with first year medical, nursing
and pharmacy students has found
similar profiles. Medical students on
Day One of medical school profile
exactly the same as experienced
doctors: ie as individualists who
believe in a medical ascendancy
model of care.
The emphasis on healthcare as a
collaborative environment has been
mandated by the Ministry of Health
particularly in its Primary Healthcare
Strategy. The research I have
mentioned indicates to me that nurses
are disposed to roles as leaders and
managers, because they understand
how to be team players.
My message to nurses is that they
should recognise their accountability
for this, seek further education and
develop the confidence to express
their leadership skills.
Q: What about patients from out of the ADHB
area?
At the monthly meeting of senior nurses from inpatient services are Dr Nigel Murray, general
manager ACH, clinical nurse specialist Marita Gillespie and operations manager 24 Hour Centre
Ngaire Buchanan.
website www.adhb.govt.nz
Nigel Murray: Under the redistribution of
services in greater Auckland, we should not be
accepting patients from Waitemata and
Counties Manukau. Clinical directors tell me
that every ward round they do, there are at
least two or three patients that could be cared
for at Waitemata. I know these patients come
into our system because that was the tradition
over the last decade or so, but if you’ve got
patients who shouldn’t be in this hospital
because they belong to Waitemata, then tell
us so we can take action. Let’s help
Waitemata, because they want to become a
fully-fledged district general hospital like
Middlemore. And they should. They’ve got
400,000 people living on the North Shore.
Without them becoming that, we will continue
to have a massive pressure on our
organisation.
Research shows that nurses are naturally
collectivist. That means they are ideally
suited for the shift to team-based care that is
the new character of clinical management,
says nursing school professor (and ADHB
deputy chair), Dr Margaret Horsburgh.
NOVA / Page 7
News
Rotary helps parents and toddlers to bond over books
Rotary Club of Auckland has asked
chief executive Garry Smith to
relate its sincere thanks to ADHB
for supporting a reading project
called "Books for Babes" that
encourages parents in low-income
families to read with their small
children.
Books for Babes (B4B) is a health programme
- run as a charitable trust by Auckland Rotary
- that stimulates parent/child relationships
by promoting the value of reading to children
aged two years and under.
Consultants to the trustees are Kaye Lally from
Auckland City Libraries, Elaine Macfarlane
from Plunket and Madeleine Sands, Child
Development team leader at ADHB.
Rotary provides ADHB and Plunket with free
books for families that therapists and public
health nurses identify are in need. These lowincome families receive a total of three books
over 15 months. On completion, the
programme aims to link children and their
parents to the local library.
Some of the parents are unable to read
themselves. The nurse’s advice in these
situations is that looking at the pictures and
making sure the child hears the language is
just as important and helpful as reading.
Books are available in Maori, Samoan,
Mandarin and Tongan, as well as English.
"The small pamphlet giving ideas about
reading to children is very popular with
families," says Madeleine Sands. "One of
our little ones has very limited vision, but
loves his Mum reading to him. The idea of
Books for Babes is to encourage the
parent and child relationship, with the
byproduct of better literacy. It is
very heartening to see what we set
out to do is really happening."
registered with B4B, with some 700 books
delivered in the last 12 months.
"Well done Rotary", says public
health nurse Maureen Thorpe, "for
Books for Babes. I meet with
mothers and their children at a
residential family centre that
supports them to rebuild shattered
lives. The families arrive at the centre
with few possessions. When they get a
B4B book there is great excitement - a
book of their very own with their name
on the back."
With the bonding achieved by reading, the child
feels loved, develops trust and is ready to learn.
Latest statistics show that over 300 highdeprivation families in Auckland are
Clear reporting aids culture of continuous improvement
The performance improvement
project aims to embed a culture of
continuous improvement at ADHB.
For this to succeed we need sound
measurements, clear reporting and
specific follow-up actions.
Now that most services have migrated to
their new facilities and the change
programme projects have mostly been
handed over to the business, the changes
already made need to be embedded so that
ongoing improvements become a way of life
at ADHB.
"Performance improvement" can be defined as
a process for achieving specific results. These
include describing the desired performance,
identifying gaps between desired and actual
performance, identifying causes of gaps,
selecting interventions to close the gaps and
measuring changes in performance.
The performance improvement project will
ensure that key performance indicators are
aligned to the District Annual Plan, the
Statement of Intent and the organisation’s
operational requirements; and that reports
to managers and leaders clearly show
progress against key performance indicators
and show managers and leaders where they
need to take action to close the gap between
actual and desired performance.
ADHB currently has a wide variety of reports
and report types. The performance
improvement project asks: Are they all
necessary? Do they link to our
organisational goals? Do they facilitate
evidence-based management?
Over the next month, general managers,
service managers, clinical leaders, charge
nurses, team leaders and analysts can
expect to be contacted by the performance
improvement project team. The team is
identifying what reports people currently
receive, what reports they might need and
what training might be required on how to
use information to manage more effectively.
Chief executive Garry Smith and general
manager of quality, safety and
performance improvement Trish Langridge
are co-sponsors of the performance
improvement project.
For any queries or more information, please contact
Project Leader Jo Gilbert (pictured right) on ext 4629.
Review seeks to improve community care
The first job of the community
integration project team is to identify
and understand current community
services run by ADHB. Then the team
will formulate a proposal to define
the project’s scope.
Already the project team has met with
nursing, allied health, community child
health, service managers, nurse leaders,
wards at Auckland City Hospital and women’s
health. Further meetings are planned with
other ADHB community services.
Any ideas with the potential for improvement
will be checked with the relevant community
staff and prioritised. Implementation of
changes and improvements - which are
scheduled to occur later this year - will take
place in consultation with the services
concerned.
Allan Johns, interim general manager
Greenlane Clinical Centre and Janice Mueller,
Allied Health director, are both on the project
steering committee. Janice says, "The
Community Integration project is an
opportunity for community staff to have
input into the future of their services. It is
fantastic to hear how many of you have
already made the project team welcome.
If you have any queries or comments about
the project, please contact Barbara Arundell,
Project Leader, via email or on ext 4422.
From left; Community integration project team
Barbara Arundell, Lesley Wyers, Wendy Turner
and Ana Gluyas.
Research processes and policies to be tidied up
A review of the administration,
funding and policies surrounding
research activity at ADHB is focusing
on research which requires ethics
approval, in particular projects
funded by the Ministry of Health,
external organisations, charitable
trusts or grant funds, non-profit
organisations, or internal projects
funded by surplus research funds.
Lesley Powell and Laurie Pedlar are working
on the project, alongside project sponsors
NOVA / Page 8
Denis Jury, chief planning and funding officer,
and Dr David Sage, chief medical officer.
According to data held by the Research
Development Office, there are over 550
current research projects currently active
within ADHB and 145 employees being
remunerated from research cost centres (RCs).
This number includes senior medical officers,
nurses, co-ordinators and other support staff.
Between $4.5 and $5 million a year is
channelled through known research RCs.
Several significant issues have arisen from an
initial analysis of research practices within
ADHB. These can be classified into four major
themes: administration, financial, policies,
and vision and principles.
Administrative processes and responsibilities
around research are not well defined at
ADHB. Key stakeholders don’t always have
the information needed to manage research
effectively.
The tracking of financial transactions and
management against approved budgets is
inconsistent. Adherence to ADHB policies
varies by service, exposing the
organisation to audit and contractual risk.
Currently, there are no agreed principles to
define
ADHB’s
research
values.
Researchers are uncertain as to what
support they can expect to receive from
ADHB.
Improvements in these areas will benefit all
those undertaking research as well as the
organisation as a whole.
For further information, please contact
Lesley Powell on ext 4432.
website www.adhb.govt.nz
Medical comment
"I’m so grateful not be cancelled this time…"
I heard that comment during April
from a number of people being
wheeled into the operating theatre
for their "planned" surgery. Except
that in their case the planning had
gone wrong and on at least one
occasion their planned surgery had
been cancelled at the last minute
by the hospital.
Until we started strictly accounting for
cancellations this occurred to one
unfortunate patient three times. I am talking
about adult patients admitted on the day of
their surgery who will be phoned the evening
before or that day to be told their operation is
cancelled because of a shortage of beds.
It’s a disheartening process for both patients
and staff and calls into question our overall
efficiency.
In a mixed elective and acute hospital only
the elective component can be completely
controlled. When we run short of the main
resource needed for your stay in hospital your nurse – then the only thing left to reduce
demand on nursing is to cut elective surgery.
And the sub-group of surgical patients most
convenient to cancel is those planned for day
of surgery admission – hopefully people who
are still at home.
This group that is automatically squeezed
out as soon as more compelling demands on
nurses arise, is thus a very sensitive
surrogate marker of overall hospital
efficiency of bed planning. (Another one is
"access block greater than eight hours" in
the emergency department).
The angels in all of this are the bed managers
who do an amazing job of finding 600 adult
beds daily - and nurses to match them. Of
course they can only work with the number of
resourced beds they have been given.
Since we opened Auckland City Hospital last
October analysis of how we use the new
hospital architecture and how many beds
and nurses we resource for it has been
studied in preparation for this winter. Have a
look at the graph which is a bed number plan
(shown in black) superimposed on the dotted
red line showing projected bed numbers
required.
It certainly looks like we will need to maintain
our current level of 640 resourced beds,
including 18 beds flexed above our budgeted
numbers with a flex up to an additional 30
beds in May and 20 more in July. We
anticipate stepping down to the 640 level at
the start of November.
All these projections are based on
averages and on an assumption of efficient
bed use with minimal bed blocking
obstructions. If our sensitive marker of
hospital efficiency – surgery cancellation starts to show up this winter, we know we
are either not using the projected bed
numbers efficiently, or patient numbers
have peaked above the average
projections as occasionally they must.
With our experience of the first six months
of patient throughput at Auckland City
Hospital I am hoping we are giving our bed
managers the right resources for the more
difficult second six months through winter.
Make sure tests are pre-booked if a patient
is being admitted for investigations, and
use the transition lounge before and after
using a ward bed.
The blue line shows last year’s numbers. Actual 2004 numbers are shown in yellow. There is an
assumption here of 90 percent occupancy. In fact this year our average occupancy has been 93
percent, somewhat higher than the ideal 85 percent that in theory produces the most efficiency.
I also hope everyone understands how
important their bit is in speedily fixing
blockages in patient flow – one day it will
be you or your patient who needs that
elective surgery.
Dr David Sage
Chief medical officer
Paediatrics
consultant wins
prestigious
travel fellowship
Vipul Upadhyay, consultant in
Surgical Paediatrics at Starship
Children’s Health, has been
awarded an $18,000 Wilton
Henley Memorial Travelling
Fellowship by the Auckland
Medical Research Foundation.
"This is a fantastic achievement for
Vipul," says Starship general manager
Kay Hyman. "It provides a tremendous
opportunity for Vipul to observe
practice in centres of excellence. We
look forward to his return, the new
ideas that he will bring and how these
may be incorporated in practice at
Starship to improve the care provided
to the children we treat."
Dr Upadhyay’s main interest is
paediatric reconstructive urology. He
says this Fellowship will allow him to
bring back new techniques, technology,
and management practices. He will also
study clinical governance and medical
credentialing at the centres he visits.
On his return to New Zealand he will
deliver a public lecture and write a report
for the Medical Foundation on his trip.
Vipul Upadhyay in his Starship office in May
before departing on a study trip that takes in
the USA, UK, Germany, Finland and India.
Junior doctors get their own medical advisor
Auckland DHB has appointed Dr
Stephen Child as the medical
advisor for RMO issues. This new
role supporting junior doctors
parallels the role Dr David Sage
plays in support of senior medical
staff.
ADHB employs 487 junior doctors, who are
traditionally known as "Resident Medical
Officers". The "resident" description comes
from the days when these doctors worked 24
hours shifts and essentially lived at the hospital.
Junior doctors work in apprenticeship style
training, on three to six-monthly rotations in
various departments, to gain experience and
learn the techniques and skills of independent
clinical practice. They are entitled to free meals
while working and full reimbursements of
training and work related expenses.
website www.adhb.govt.nz
Junior doctors carry the responsibility for
clinical care and although they are fully
supported by senior and other clinical staff, it
is still a demanding time for this employee
group as they climb a steep learning curve.
They work hard, averaging a 15 hour shift
every sixth day, during a work week of 54-58
hours. On-call periods can be stressful.
Recent surveys have shown a pager
frequency ranging from every two-18 minutes
during a six-12 hour shift.
Over the past fifteen years, New Zealand
public hospitals have struggled to develop an
appropriate management structure for this
employee group. They have mostly been
viewed as a loose sub-set of senior medical
staff. For a variety of reasons, similarities
between senior and junior doctors are
diminishing and it has become necessary to
develop an appropriate management and
representative structure for this group of
employees. Accordingly, Dr Stephen Child
has been named medical advisor for RMO
issues.
ADHB has recently increased its investment
in the RMO Support Unit which manages the
complex administrative processes of junior
doctors,
rotating
throughout
the
organisation. Processing leave, dealing with
hundreds of claim forms each day and
making numerous phone calls to replace
doctors who call in sick are part of the daily
routine of the RMO Support Unit staff.
Leave and parking continue to be problems for
junior doctors and the organisation, however,
these issues are currently being addressed.
Dr Child welcomes any comments regarding
junior doctor management or issues at ADHB
Contact him on extension 2216.
Steve Child believes it is important to
foster a better understanding of the life of
a junior doctor. He hopes for improved cooperation and sharing of problems among
the various employee groups represented
in this organisation.
NOVA / Page 9
People
Lesley Maclennan
What are the essential qualities for
your job?
What advice would you give
someone who wanted your job?
What would you do if you won a
million dollars?
The ability to balance the clinical with the
management role and being able to focus on
what is really important.
Keep some clinical input to the role.
Not tell anyone!
What are your favourite CDs at the
moment?
In stressful situations how do you
cope?
Love and Theft by Bob Dylan and Almost Blue
by Elvis Costello and the Attractions.
Have some contact with a patient to bring it
all back into focus.
What is your favourite childhood
memory?
What’s your favourite pastime?
What is one of the funniest
moments at work?
As a community midwife in the East End of
Glasgow. I can’t pick between the tale of the
breast milk scones or the pet python at the
home birth story.
What was the last book you read?
Dead Air by Iain Banks.
Walks with friends up the hill to find the
source of the burn that ran in front of our
house. We never did find it.
Walking my dog.
Favourite movie?
American Werewolf in London.
Lesley Maclennan is a charge midwife at
National Women’s Health High Risk Clinics.
She has been with ADHB for nine years.
Claire Wilson
What are the essential qualities for
your job?
What is the best advice you have
been given in life?
You need to have technical stills as well as
being creative, and having attention to detail.
Going that little bit further to make sure
things are 100%. The ability to communicate
at all levels.
Standing for the Truth is more important than
Life itself.
Favourite thing about your job?
Managing to achieve something you never
thought you could. "A new day is a door to
new opportunities."
Who do you admire? Why?
My husband, because he puts up with me!
What was your very first job?
School days – shop assistant at a clothing store.
What advice would you give
someone who wanted to do your job?
Always be willing to learn something new and
further your skills in the latest internet
innovations. With technology changing at a
rapid pace, you have to keep ahead. There is
always a way to make things work, you just
have to work out what it is . . .
What makes you laugh?
My son Ronan.
Least favourite thing about your
job?
Getting sign off from so many different areas
of the organisation before anything is
approved can take a long time!
Describe yourself in five words.
Creative, God-focused, patient and loving.
Favourite movie?
The last one I can remember that I enjoyed
was Tomb Raider
Claire Wilson is a web publisher and
developer in the IS department. She has
been with ADHB since November last year.
Gloria Smith retires after 28 years of service
General paediatrics charge nurse
Libby Barraclough reports that Gloria
Smith has retired from nursing after
contributing to the health of
thousands of children and families
during almost three decades of
service to ADHB and its predecessors.
Gloria now plans to have a well-deserved
rest but cannot see herself stopping work
altogether. She is interested in attending
night classes in psychology and history.
and Starship Children’s Health will be missed
team members she has worked alongside.
tremendously. Her commitment to family-
Gloria’s contribution to both Wards 25A/B
has positively impacted on the nurses, and
We would like to take this opportunity to
thank Gloria for her huge contribution and
commitment to the organisation and wish her
a healthy and happy retirement.
centred care has been outstanding. Gloria
has also served as a great role model, which
Gloria Smith started her nursing career at
Auckland Hospital in 1975 where she worked
in ward 6B before moving "down the hill" (a
fond term for Princess Mary Children’s
Hospital) a couple of years later.
Twenty-six years later Gloria is still
enthusiastic about caring for children and
their families. After working in ward 22B,
Special Room and Ward 29 in Princess Mary,
Gloria moved to the new Starship Children’s
Hospital and has been working in Ward
25A/B (General Paediatrics) since.
Gloria has seen many changes over the years
in paediatrics. She says that the move to
using angiocaths from "butterflies" had
huge advantages; and the joy of pumps
rather than free running intravenous fluids.
The advent of nasal cannula for the
administration of oxygen meant doing away
with nursing children in oxygen tents, which
were misty and damp. She says
nasogastrically rehydrating children with
gastroenteritis is far more effective than
being restrained with fluffy restraints, with
an IV and nothing by mouth.
NOVA / Page 10
Staff nurse Gloria Smith (centre) surrounded by colleagues from general paediatrics Ward 25A/B wishing her a happy retirement.
website www.adhb.govt.nz
News
Voyage promotes friendship and understanding
Melissa Lelo is a health promotion
advisor for the Auckland Regional
Public Health Service working in
the area of alcohol and youth. She
describes the experience of sailing
round the world on the 16th Ship for
World Youth Programme 2004.
The purpose of the Ship for World Youth
Programme is to promote friendship and
mutual understanding among the youth of
Japan and other countries.
I was one of 12 chosen to represent New
Zealand among 260 other young people aged
18-30 from 13 other countries, who set sail
from Yokohama in Japan on the Nippon Maru.
Our voyage of 43 days took in Singapore,
India (Mumbai), Tanzania (Dar es Salaam)
and Seychelles (Victoria).
There were many highlights and definitely
some eye-opening experiences. From the
Goodbye pager.
Hello Trekkie
communicator
American nurses and doctors are
getting the chance to emulate Star
Trek and talk to colleagues via a lapel
communicator, reports BBC Online.
US firm Vocera has created a wireless voice
communicator just like they use in Star Trek:
The Next Generation. Vocera is focusing on
healthcare to help provide bedside patient care
and replace pager type calls. Pagers can lead to
people leaving endless numbers of messages
for each other but never actually speaking.
The Vocera communicator is proving popular
in hospitals to make it easier for nurses to
find and get advice from doctors. Similar to
the TV series, all you do to contact someone
is press the talk button on the lapel badge,
say their name, and you will be put through.
The Vocera communications system channels
voice calls via a wi-fi network to recognise
who someone is trying to reach and then to
connect them.
Servers do the job of decoding speech to
recognise names, find out if the person is
available and then a portion of the wireless
network is reserved so the people can speak
to each other.
Vocera says the communicator is ideal for
workplaces where staff move around a lot,
are spread around large campuses or across
several buildings. The battery-powered
gadget can either be clipped to a lapel or
worn on a lanyard around the neck.
welcome ceremonies and receptions on
board and in each port of call to visiting
various institutions, meeting with local youth
and getting a demonstration of the different
cultures, it was a totally amazing trip.
We participated in seminars and discussions
on common subjects from global viewpoints
as well as activities on board. These included
seminars on United Nations, mental health,
environmental issues and IT. There were also
club activities ranging from Japanese culture
to martial arts and music. Voluntary activities
like Egyptian and Latin dance, world beauty
club (very popular) and learning the haka and
poi were also part of the programme.
We kiwis played an important role in
organising the two sports days that were
held. Also, our leadership skills came
through when we facilitated many issuefocused workshops/discussion groups on
topics such as alcohol and drugs, poverty,
justice, social issues, sexual health, and the
environment.
One of the highlights would have to be the
New Zealand national presentation. We
started with a powhiri and waiata, did a hip
hop dance to the local flavours of Aotearoa,
sang our national anthem ‘gospel style’ and
performed a powerful haka - all to video
scenes in the background of our beautiful
country and kiwi icons. It was a huge
success! We were superstars with everyone
wanting a photo with us. We were a very
popular delegation indeed!
This experience has helped broaden my
perspectives on the world. Among all the fun
and laughter there were also serious
moments and times of reflection on one’s life.
I made many friends from across the globe. I
will treasure my time on board the Ship for
World Youth for the rest of my life.
Health promotion advisor Melissa Lelo for
the Auckland Regional Public Health Service
was chosen to represent New Zealand on a
World Youth Programme voyage.
Allied Health disciplines join forces in two new teams
Speech language therapists,
occupational
therapists
and
physiotherapists,
who
were
previously managed in separate
discipline-specific teams, have
combined together in two new
Allied Health interdisciplinary
teams for adult patients.
Following a review of hospital-based Allied
Health services by Allied Health director
Janice Mueller, it was decided that a new
structure was needed in which Allied Health
colleagues worked more closely together to
support a patient-centred model of care.
Allied Health at Auckland City Hospital now
comprises two interdisciplinary teams:
Medical, Older People’s Health and
Neuroservices, led by Lesley Thornley and
Surgical, Cardiac, Ambulatory, led by Dawn
Birrell. The teams are currently in short
term accommodation until the new Allied
Health Department base is completed on
level 4 of the Support Building towards the
end of 2004.
Allied Health staff, from left, physiotherapist Gerard Smith, speech language therapist Anna Miles and
occupational therapist Cherie McCaw at a lunch to mark the change from single discipline Allied Health
teams at Auckland City Hospital to two teams combining staff from three Allied Health disciplines.
Crossword
ACROSS
7
8
10
11
12
13
17
18
22
23
24
25
Resistant to infection (6)
Modernise (6)
Historic Auckland
mansion (7)
Decided on (5)
Hideous (4)
Young adults (5)
Effervescent (5)
Tear down completely (4)
Principal (5)
Deep rut (anag) (7)
Inventor's protection
Regulator customer
DOWN
1
Free from (7)
2
Import illegally (7)
3
Recognised (5)
4
Assign to a post (7)
5
Fry briefly (5)
6
Toss call (5)
9
Bygone New Zealand
department store (9)
14
He sang 'I was born in
Te Awamutu,..."
15
Electric cell (7)
16
Muffles (7)
19
Ranges (5)
20
Short simple song (5)
21
Of the ear, hearing (5)
A replica communicator as worn in Star Trek
the Next Generation.
website www.adhb.govt.nz
NOVA / Page 11
Notice board
Access to ADHB email just got easier
As a result of our email system
upgrade in February this year, a
new email service called Outlook
Web Access (OWA) is available to
ADHB staff.
OWA enables staff to access email via the
Intranet on any network-connected PC within
ADHB.
There is no need to create an email profile on
the PC, which was previously required.
Currently this service is available internally
on the ADHB Intranet. The next stage is to
enable access to OWA from outside the
organisation. This means that staff will be
able to access their ADHB email from home
PCs, internet cafés or even international
hotel rooms. The IS department is currently
testing and running security checks on the
new system and hopes to have it operational
at the end of June.
TRAVEL
Welcome back to the
BTI New Zealand travel column.
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Letter to the Editor
From General Medicine clinical
director Dr David Spriggs:
Communications manager Megan Richards
replies:
I write requesting support for the re-opening of
the stairwell in the Support Building at
Auckland City Hospital. This stair is the easiest,
quickest and healthiest way to move between
floors. Many of us work on various levels in the
support building. Waiting for one of the two
lifts to arrive (the other two being closed) is
wasteful and irritating. Not only that, but I am
not convinced of the safety of the present
arrangements in the event of an evacuation.
The closing of the main stairwell in the
support building is a legislative
requirement under the Health and Safety
Act. The stairwell, which has been handed
over to the construction company for the
duration of the work, is used by
contractors to bring in very large items that
won’t fit in the construction lifts, and ADHB
has an obligation to make sure staff and
visitors are not put at risk. Building
programme staff say considerable thought
was given to the best way to manage the
daily business of the hospital in the
context of a long term building contract.
The closure of the main stairwell was
acknowledged to be a real inconvenience
for staff, but a necessary one.
Unfortunately, the two other staircases in
the support building cannot be opened to
staff and public because of the security
risk. A swipe card system was considered,
but because of the nature of the
construction programme this was not a
physical possibility. At the moment, two
lifts are designated construction lifts - but
there are six lifts available to staff.
I have attempted to get an explanation of the
current state of affairs. The closure of the
stairwell, I am told, is to improve the security on
those floors that are being renovated. I would
suggest that doors to those floors are locked
and the stairwell is reopened. This is,
apparently, unacceptable. I am assured that the
closure is not due the asbestos in the ceilings.
I would encourage staff who are adversely
affected by the closure to speak to their
manager or myself and register their
frustration at what can only be seen as a lack
of appreciation of the already busy working
lives we lead. A speedy resolution to this is
surely possible.
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Sun up in Samoa this winter!
Competition Question
What is the award winning Palliative Care Computer Based System called?
Send your answers to the Communications Department, Level 8, Building 13, Greenlane
Clinical Centre by 5pm June 15 to go into the draw to WIN a $50 travel voucher.
Conditions: Valid for travel taken before 31 December 2004
Valid on Package, Cruise and Special Event Holidays only.
Further conditions apply and are available on request.
To view our full range of holiday packages and travel services, visit
www.travelonline.co.nz
Or call Travel Online 09 920 6000
The winner of the May competition is: Daisy Ganjia, Team Secretary, Community Child
Health and Disability Service.
Crossword Answers
Contacting NOVA
NOVA is the official newsletter of the
Auckland District Health Board. It is
published by the Auckland District Health
Board Communications Department, Building
13, Level 8, Gate 4, Greenlane Clinical Centre.
the month of publication, i.e. June 1 for the
July issue. Please send copy in Microsoft
Word and photographs as a jpg file.
If you want to contribute a story please
contact our Editor, Debra Daley on 849 6703
or via email [email protected]
Any other queries please contact Rachael
Parkin on 630 9750
Editorial Assistant: Rachael Louise Parkin
Make sure your digital camera is set on
"fine" or "high" resolution when you are
taking a photograph that is intended for
publication; otherwise the jpg file will have to
be reproduced in very small format to
maintain acceptable resolution in print.
Copy deadline is the first of the month before
Articles should be a maximum of 300 words.
Executive Editor: Brenda Saunders
Editor: Debra Daley
NOVA / Page 12
Each month one letter to the editor will win
a $30 Borders voucher – so get writing...
Send
Letters
to
the
[email protected]
Editor
to
We welcome Letters to the Editor. Just make
sure your letter is no more than 200 words.
Letters may be edited. They must be signed and
contact details given – no noms de plume or
fictitious names – and must not be defamatory.
website www.adhb.govt.nz