Creating Breathing Spaces
Sue Copas, Anne Purcell, Anna Meredith, Oliver Campbell - watch the video(external link)
‘Breathing Spaces’ is a community-led, place-based, wellbeing strategy occurring in the Tāmaki locality. Auckland DHB has been a key partner in supporting local parents to lead the way in creating new spaces to enhance wellbeing.
The initial idea for ‘breathing spaces’ came from local Tāmaki women who were looking beyond the usual offering of parenting programmes. The aim was to create safe ‘time out’ spaces to share stories and challenges, learn new skills, have fun and explore ways to support whānau wellbeing together.
Breathing spaces grew from local wisdom through community conversations using a co-designed, intentional and values-based process. The values Ako (teaching and learning), Alofa (love) and Acceptance were carefully chosen. Expressed in some of the languages of the community they reflect what people said was most essential to create an environment where safe, high trust relationships could be nurtured.
For the mostly Māori and Pacific women involved, the process enabled them to recognise and grow the wisdom they already had; build great relationships within their community; and feel they have the trust, confidence and resources to support each other when challenges arise.
The success of the innovation is measured by the words and experiences of the women involved, who define the benefits that matter most to them. It’s also evident in the emergence of other ‘breathing spaces’ as the community embraces and shares this way of working to build ‘awesome whānau in the locality.
Ready Stead Eat: Emma Darby, Emma Green and team - watch the video(external link)
Health and Education Working Together: Alison Leversha, Alison Burge and team - watch the video(external link)
A Smokefree Environment in Residential Mental Health: Lindsey Yullie, Jane Galea-Singer and team - watch the video(external link)
Haumaru: Safe Together at Te Whetu Tawera
Peter McColl, Carol Stott, Lee Reeves, Lynne Edmonds, Anne Frew, Sean Chew - watch the video(external link)
Te Whetu Tawera (TWT) is our acute mental health unit, where many admissions are involuntary under the Mental Health Act, and with the assistance of NZ Police. Admissions have been increasing due to population growth, with 18,000 people being expected to use secondary mental health services in 2016.
In 2015/16 there was an unacceptably high number of assaults reported in TWT. Assaults included incidents of physical violence, threatening gestures, property damage and verbal aggression.
Morale was generally low with many of the team and recruitment was also a challenge.
The TWT leadership worked on reducing this number of incidents by identifying intertwined problem areas – safety, employee wellbeing and patient flow. After several stakeholder workshops, the decision was made to implement the ‘Four Steps to Safety programme’ developed in the UK, which focuses on proactive models of care, patient engagement and teamwork.
Reported assaults have reduced by 52 per cent compared with 2015/16. Episodes of seclusion and restraint were also reduced. Nurses now have more confidence in their assessments thanks to some of the tools implemented. Charge Nurses have also experienced a change of workplace culture.
Coordination with community mental health services has also improved, meaning that admissions can be timed better, and individual plans for service users with a history of assault can be developed.
The Young Persons Liver Clinic: Rachael Harry, Helen Evans and team - watch the video(external link)
Hyperacute Stroke Pathway: Dean Kilfoyle, Alan Barber and team - watch the video(external link)
Surgical Safety Checklist: Tracey Lee, Vanessa Beavis and team- watch the video(external link)
Speak Up | Kaua e patu wairua
Arend Merrie, Katie Quinney, Maxine Stead, Elizabeth Jeffs, Luke Sutherland, Anne O'Callaghan, Susan Atherton, Shankara Amurthalingam, Zoe Brownlie, Margaret Cain, Fiona Michel, Julie Helean - watch the video(external link)
The fact that bullying and harassment occur within healthcare workplaces is sadly an acknowledged fact. Evidence also shows that a culture where bullying is allowed to exist ultimately affects patient safety.
In response to this a multi-disciplinary team came together to work on a concept of an open, transparent process to talk about, and speak up against, bullying and harassment. The work included developing policy and collateral. The National Health Integrity line was promoted as an anonymised option for reporting unprofessional behaviour.
In addition a group of ‘Speak Up’ supporters were identified who could act as a sounding board for employees to safely approach with their concerns. A training session for managers was initiated and the concept of team charters was established.
The programme was named Speak Up| Kaua ē patu wairua and was launched on Pink Shirt day, an international anti-bullying event. The day was embraced throughout the organisation with pink posters, t-shirts and decorations galore. A memorandum of understanding was signed with the Royal Australasian College of Surgeons on the same day. A launch day was chosen with the understanding that a single day event should be a catalyst for change not the marker of change itself.
Speak Up has had interest from other health organisations and the project team are proud Auckland DHB is known as an organisation that is taking a stand against bullying and that values people and wants them to work in a safe environment where they can do their life’s best work.
Navigate: Natasha Cherry, Gil Sewell and team- watch the video(external link)
Coders Rare as Hens Teeth: Corey Scott, Kumair Naik and team - watch the video(external link)
Health Science Academies: Tuliana Guthrie, Malcom Andrews - watch the video(external link)
Awhi Ora – supporting wellbeing
Oliver Campbell, Camille Gheerbrant, Dominique Cummins, Sue Copas, Michelle Atkinson, Johnny O'Connell - watch the video(external link)
Tāmaki is a vibrant and multicultural area, but many people face health and social challenges, and high levels of stress.
Using a co-design approach, which brought together local people, GPs, NGOs and health professionals, the people of Tāmaki identified ‘stress’ as one of the biggest issues they face. In response to this, Awhi Ora was created – a preventative, early intervention approach integrating NGO support as a core part of primary care, to support mental health and wellbeing.
In an initial prototype phase, NGOs and GPs learned new ways of interacting with each other, and the people using the service. An action learning group met fortnightly, to refine the service design, with a strong focus on removing access barriers. For example, contracts linking NGOs to DHBs were changed to enable people without a mental health diagnosis to access the service. Another example of person-centred service design is the changes made to the language of the service to address the stigma attached to the phrases such as ‘mental health’. The group allowed collaborative, trusting relationships to develop between service users, community leaders, GPs and NGOs.
The voice of the person using the service remains at the heart of the growth and development of Awhi Ora. The stories gathered from people who have used the service provide credible evidence of success.
Awhi Ora is now connected with over 20 practices and has recently up scaled to connect with social sector and education providers. More importantly the service is receiving more self-introductions, indicating that the value of the service is being advocated across communities.
Ready Steady Eat: Emma Darby, Emma Green and team - watch the video(external link)
Meeting the Oral Health Needs of our Most Vulnerable Children: Collette Muir, Allie Fyfe - watch the video(external link)
Enhanced School Based Health Services: David Bloore, Renee Berry and team - watch the video(external link)
Improving Care for Older People
Judith Catherwood, Anna McRae, Jane Lees, Tim Denison, Samantha Abbott, Elizabeth Waiari, Sandy Ash, Janet Horrell, Joanne Michaels-Mulder, Maree Todd, Raewyn Osbaldiston, Lorraine Thompson-Aramoana, Angela Minto, Charlotte Lay, Lalit Kalra, Jim Kriechbaum, Jennie Montague - watch the video(external link)
In 2013/14, an analysis of hospital use showed that patients over the age of 75 are more likely to be admitted, stay in hospital longer, and use more than 1/3 of all hospital bed days. The demand for older people’s health services is growing, with the Auckland DHB region expecting a population increase of 30% across the next 20 years, half of whom will be aged over 65.
In response, the Community and Long Term Conditions directorate set out to improve patient care. By providing quality, patient-centred, self-directed care as close to home as possible for these patients, aiming to reduce hospital demand, and support a more sustainable health system.
New models of care were introduced after collaborative workshops with directorate experts. Clinicians now respond to community or aged care referrals by assessing patients at their place of residence instead of admitting them. A full-time gerontology nurse specialist has now been introduced to support older patients presenting to ED.
A seven day rapid response service means that individual patients have more options for an earlier or more supported transition home from hospital. The early supported discharge service provides intensive rehabilitation at home as an alternative to inpatient rehabilitation. An interim care pathway offers short-term admission into a residential care facility, with an individualised care programme.
Since the programme began, patients over 75 years old have spent fewer days in hospital. Thanks to these new approaches to providing care closer to home, older adults are estimated to be spending 3000 to 4000 fewer days in hospital each year. Further improvements are underway to develop a fully inclusive Frailty Service.
Improving the Care of the Cellulitis Patient – a pathways approach: Rupert Handy, Bret Vykopal and team - watch the video(external link)
Decreased Non Adherence in Haemodialysis Dependent Patients: Jason Wei, Tim Denison and team - watch the video(external link)
Incident Management in the Surgical Directorate: Katie Quinney, Arend Merrie and team- watch the video(external link)
Prophylactic Oral Dextrose Gel for Newborn Babies at Risk of Neonatal Hypoglycaemia
Joanne Hegarty, Jane Harding, Gregory Gamble, Caroline Crowther, Richard Edlin, Jane Alsweiler - watch the video(external link)
Low blood sugar level (hypoglycaemia) is common soon after birth, with 30% of all babies born at risk, and hypoglycaemia developing in half of these at-risk babies.
Babies who develop hypoglycaemia are at risk of neurodevelopmental impairment, including developmental delay and poor school performance. Despite clinical guidelines recommending that prophylactic measures should be taken in babies at risk, there currently are no effective strategies for preventing hypoglycaemia.
Oral dextrose gel is effective for treating neonatal hypoglycaemia, but it was unknown if this could be used to prevent babies developing it.
This was the first trial to demonstrate an effective strategy to reduce the incidence of neonatal hypoglycaemia, which could therefore help reduce NICU admissions and neurodevelopmental impairment.
We conducted a multicenter, randomised controlled trial of prophylactic oral dextrose gel in babies at-risk of developing neonatal hypoglycaemia to determine an effective dose to reduce the incidence of this condition.
416 at-risk babies were randomised to receive either a standard (200mg/kg) or high (400mg/kg) dose of dextrose gel or placebo, either once or followed by three more doses before feeds. We found that 200 mg/kg of 40% dextrose gel was the most effective dose. Overall, dextrose gel reduced the incidence of hypoglycaemia by over a third, and may also reduce NICU admission.
This research has the potential to improve outcomes for many babies, both in New Zealand and overseas. If long term outcomes are also improved (study in progress), this simple and inexpensive intervention could become the standard of care for up to 30% of all babies born.
The EPPI Trial: Katie Groom, Lesley McCowan and team - watch the video(external link)
Impact of a National Time Target on ED Length of Stay on Patient Outcomes: Peter Jones, Susan Wells and team- watch the video(external link)
Katie Quinney, Director of Nursing Surgical Directorate
The CoRe Team