Health Innovation Awards

The judges for the 2020 Health Innovation Awards were:

• Jenny Black: Nelson Marlborough District Health Board (NMDHB) Chair
• Dr Brigid Forrest: Nelson Marlborough District Health Board member
• Shelley Shea: Models of Care clinical co-lead, and Clinical Nurse Specialist Cancer Care Coordination

Hear what Jenny Black, NMDHB Chair had to say about this year's entries

Judges' comments 

All the judges commented on the diversity of the entries and the high calibre of the material being presented. It made their decisions extremely difficult. They were impressed with the ideas, innovation and the overall commitment to finding a better way.

“Our community is so much better off because of these dedicated people. The staff who find the time to write it all up and are committed to quality improvement are absolutely amazing,” says Board Chair, Jenny Black.

Board member and judge, Dr Brigid Forrest commended all the entrants and acknowledged the tremendous effort taken to drive quality improvement changes across the region.

“What great staff we have. They are prepared to think differently, see a problem and own it - observe a situation and think about it,” she says.

“They can take a paper or an idea from a conference or journal, or trip somewhere and develop or extrapolate it - and all this on top of their day-to-day work commitments.”

Nelson Marlborough Health Chief Executive Peter Bramley paid also tribute to everyone involved in the projects.

“I would also like to acknowledge the fact that the people behind these projects are busy and often stretched in their daily jobs, yet when they notice something that could be improved, they are curious enough to ask questions and then work on a solution,” he says.

“We applaud them all for their innovation and commitment to improving the patient experience.”

The Darcy Christopher Trust

Flight Lieutenant Darcy Christopher and his wife Frances spent half their lives in the top half of the South Island, predominantly in Golden Bay. Darcy Chirstopher worked as a training instructor for the RNZAF at Harewood, Christchurch, during the war.  He had twice been hospitalised after dramatic rescues, both on the Dunedin coast, the first due to being injured in a rock fall, the second when his RNZAF biplane crashed off St Clair beach.

In his will, Darcy Christopher created the Darcy Christopher Trust to allocate his estate to a number of public and community organisations; Nelson Marlborough Health is one of the recipients. The Care Foundation has distributed funds from the Trust to a number of health related causes.

The Darcy Christopher Award is the HIA's top excellence award. Recipients receive a trophy and $3000. This award has been made possible by funds from the Darcy Christopher Trust, distributed through The Care Foundation.

The recipient of the 2020 Darcy Christopher Award is the 'Equally Well' project team (listed under the 'Growing a Seedling' category) comprising Helen Lynch, Jocy Wood, Rebecca Lukey, and Jen Hassloch.

About the winning project:

People with mental illness are especially vulnerable in terms of physical health. The Equally Well cardiometabolic monitoring initiative has increased the visibility of these concerns and has prompted coordinated intervention to improve quality of life for this group. This is a great step toward decreasing the disparities between mental and physical illness.

A screening tool has been implemented in the Nelson region and the scope will be expanded to capture people on all antipsychotics and also on methadone, which is a medication that has a side effect of interfering with cardiac function: QT-segment. At the moment, this group are not receiving cardiometabolic monitoring (and subsequent intervention) which increases their vulnerability and continues the health disparity for those with mental health and addiction concerns.

Prize money will go toward creating a mobile screening kit which would enable screening in Motueka, Golden Bay and the wider Nelson region.

Hear what Jen Hassloch (from the 'Equally Well' project team) had to say about winning the Darcy Christopher Award in this video. 

He Tāngata/The People - teamwork with consumer engagement

Where consumers are part of a diverse team and co-design is used to find a solution

Category winner: Community pharmacists improving healthcare for a vulnerable population (Megan Peters, Deidre Magee, Rebecca Lukey, AS (consumer))

People prescribed opioid substitution treatment or OST are a vulnerable population who experience significant inequities in terms of access to healthcare, and ongoing monitoring and management of physical and mental health. Community pharmacists are working with tāngata whaiora to overcome barriers to health equity. 

Pharmacists are supporting local providers and consumers through medication review, education, and awareness; and increasing consumers’ engagement and empowerment with other health providers. Pharmacists are also making changes within the health system by addressing disparities in accessing blood tests and ECGs to improve the healthcare provided to our community.

Prize money will go towards purchasing a 'point of care' blood testing machine that enables community pharmacists to accurately and instantly measure HbA1c or lipid profiles for their OST population. 

Providing this service at the pharmacy, and collaborating with general practices, aligns with our integrated and coordinated care goals, and provides healthcare closer to home.

Entry: Better oral health for all

Families in Nelson’s refugee community are eager to attend their children’s dental appointments but with limited English language, basic oral health messages were not being retained and children were returning with further dental decay. 

To address this problem a card, containing photos and images, with important messages essential for keeping teeth healthy, was created and given to families after their clinic visits.

Schools and early childhood centres, kindergartens and kōhanga reo are being asked to include the resource in their enrolment packs. Health colleagues from around the South Island have also asked to use the resource in their work with former refugees and migrants. 

Entry: DIVAs walking the line: making IV access easier

Witnessing patients endure multiple IV attempts and hearing their personal experience was the catalyst for the formation of a 'difficult IV access (DIVA) team'. Often these patients are frequent users of NMH services, and the most vulnerable and overlooked patients. 

After attending an ultrasound course Kirstie, cardiology RN, began to cannulate difficult veins for radiology patients. From here she developed the idea of a DIVA service to help nurses in the day stay unit to successfully cannulate infusion patients. This service has had a massive impact and positive outcome for an increasing cohort of patients.

Entry: Hauora Direct: taking health to the hood

The Hauora Direct initiative supports the most vulnerable members of our community and connects them with the health services they need. Hauora Direct is an advanced service delivery model that fits with key Nelson Marlborough Health priorities of achieving health equity, innovation in models of care, one team and technology–digital enablement and working across sectors. 

The assessment tool designed by the Te Waka Hauora team covers the three age ranges of pēpē-tamariki (birth-12years), rangatahi (13-18years), pākeke-kaumatua (19yrs+) and is first equity initiative of its type nationwide.

It provides an assessment and intervention on health priorities for individuals and whanau who may otherwise have significant challenges in accessing health services. It also supports them to take up opportunities to improve their health.

Entry: Easy to read

People with a learning disability are at greater risk of experiencing mental health disorders than the population as a whole. 

Not providing information in an accessible format for people with a learning disability was identified as a gap in mental health service delivery. Accessible information pamphlets were therefore developed on mental health disorders. 

'Easy Read' was chosen as the format for presenting information because it increases the number of people with a learning disability who can access information. Consulting with People First New Zealand, the self-advocacy organisation led and directed by people with a learning (intellectual) disability, proved invaluable in ensuring the pamphlets are fully in line with the principles of Easy Read.

Entry: Wāhine - you are worth it! Improving access to cervical screening

A cervical screening outreach service has been implemented to increase cervical screening coverage in Te Tauihu (Nelson Tasman Marlborough) by providing opportunities for priority women who are struggling to get to a general practice for the cervical screening. 

This service is being provided by qualified smear takers who are offering appointments in community centres, health hubs, workplace settings, and homes. There are also various evening clinics for those with commitments during the day.

The service is currently available for priority women who are overdue or have never been screened, and are entitled to a funded smear. The current budget provides cervical screening for as many priority women as possible, as well as achieving the required 80 percent target and promotion of the service.

Healthy Communities - best healthy community focussed project

Where the outcome of the project positively and significantly affects the community.

Category winner: Living fully and free of falls: in the Nelson Marlborough community (Kate West, Deidre Crichton)

The Nelson Marlborough Health In Home Falls Prevention (IHFP) Programme was developed in partnership with ACC to prevent falls in the frail elderly population.
The challenge was to develop a sustainable model of care taking into consideration increased demands on the allied health workforce and aligning the programme with evidence based practice (EBP).

The workforce challenges have been overcome by implementing the Calderdale Framework, a clinically-led workforce development tool to facilitate a 'best for patient, best for system' approach. This enabled a competent and flexible allied health workforce with effective delegation of tasks from a registered health professional to non-registered allied health assistant workforce.

Prize money will go towards:

• Staff development - attendance at the 9th Biennial Australian and NZ Falls Prevention Conference. • providing more ankle weights to the people on the programme 
• printing of the IHFP programme exercise booklet and pamphlet
• networking with other fall prevention coordinators around New Zealand

Highly commended award: Hapū wānanga: A kaupapa Māori pregnancy and parenting programme (Te Waka Hauora - Maori Health and Vulnerable Populations unit)

Hapū wānanga is a kaupapa Māori pregnancy and parenting programme that operates across the Te Tauihu. 

The programme is a partnership programme led by NMH Māori Health and seeks to support wāhine and their whānau having a pēpi, who traditionally are unlikely to engage with mainstream antenatal education. 

Since its launch in 2018 there has been over a 1600 percent increase in Māori engagement in pregnancy and parenting programmes. Many whānau have increased their health literacy and been given access to support services as a result of the programme. 

The programme has a uniquely Māori approach supporting a good start in the first 1,000 days of an infant’s life, and it works. Prize money will support the sharing of information to other DHBs to encourage them to set up their own hapū wānanga programmes.

Entry: Vulnerable populations (VIP) project

Our vulnerable populations are missing out on accessing health services due to barriers such as health literacy, isolation, lack of financial support and navigation.

A community workshop was held to ask about the needs of vulnerable people and then primary health care and community agencies were also consulted. A ‘wellness welcome back pack’ was created for general practice and pharmacy which has received good feedback: “The relief from people has been incredible, they have been able to access health services and gain positive health outcomes”.

For example:

• A young mother was supported through many health needs by reducing her debt at general practice and addressing ongoing medical costs by starting an automatic payment to support her future appointments.
• A grandmother caring for a young school-aged child was so focused on the child’s care she not been attending to her own health needs. She has been able to see her GP and assistance given to pay off debt and care for her own health needs.

Entry: Sit & Bfit

Sit & Bfit provides an opportunity for older people who are either unfit or socially isolated to improve their wellbeing and increase their socialisation. It also provides a close-knit group of friends which contributes positively in all aspects of their lives.

Entry: Community Youth Health Space

Whanake youth’s goal is to raise the quality of care for young people in Nelson and Tasman.

This is achieved by providing youth services, such a professional healthcare, advice, support, and an inspiring place, watched over by knowledgeable, trained professionals who care about how youth are raised.

Nationally only 74 per cent of young people access healthcare annually. The barriers include, lack of transport, money, perceived lack of confidentiality and a ‘can’t be bothered’ attitude. However, through Whanake youth 97 percent of the youth population has been able to access to health and wellbeing services.

Young people are receiving timely access from a trustworthy service and by doing so have increased their health literacy, decreased time away from school and developed a greater connection with health and wellbeing services. Creating safe places for young people has impacted positively on their health thereby reducing the burden on the healthcare system.

Prize money be invested in improving healthcare for and with young people specifically:

• Professional development for health and social services to empower youth-friendly skills and services in the Nelson Tasman region
• Empowering young people to have a voice within local government and the health sector

Top of the South – Integration across the district and the healthcare and support system

Where the team includes staff and consumers from across hospital, primary and community care.

Category winner: Getting "Spotty" for vision (Jacqui Hitchcock, Jill Clendon, Janice Howard, Paula Murray)

As part of the NMH vision screening programme the Welch Allyn Spot Vision Screener, a handheld, portable device designed to help users detect vision issues, was trialled.

The trial was intended to determine if an electronic vision screener would be suitable in a mass screening programme, and to test how easy the equipment was to use, time savings and the comfort of the children being screened.

Preliminary results show the screener is easy to use and more comfortable for children. Parents, teachers and vision hearing screeners appreciate the speed with which testing is completed and the rapid results.

The Spot Vision Screener costs approximately $13,000 per instrument, tests for six different eye conditions compared to the usual one, is more comfortable for children and enables better quality care to children across the region.

Prize money will go toward the purchase of the screeners.

Best poster award winner: Health needs of recognised seasonal employment (RSE) workers in Marlborough (Lisa Blaker, Simone Zillwood, Hazel Faulkner)

Our audit explored the issues facing recognised seasonal employment (RSE) workers presenting to Wairau Hospital. There are up to 2169 RSE workers in Marlborough each month in the wine industry, with plans to increase numbers. There are no dedicated health services for this population and three issues have been identified; inadequate access to GPs, language barriers and chronic health issues. 

There has been extensive engagement with NMH, the wine industry and government departments to share our findings. We hope to encourage submissions to the national review of the RSE scheme by the Ministry of Immigration, in a collaborative bid to improve the health care of RSE workers.

Prize money will fund further translations of key documents into Bislama, including key phrases to use with Bislama speaking RSE workers.

The money will also fund staff time to develop ways to connect with the RSE community directly and progress greater understanding of their experiences with health services.

Entry: Gestational diabetes: it's all about the follow-up

Gestational diabetes mellitus (GDM) occurs in five percent of all pregnancies. While the majority of women recover from their glucose intolerance once pregnancy is over, GDM puts women at an increased risk for developing Type 2 diabetes later in life.

Postpartum HbA1c screening is recommended to ensure diabetes has resolved and to provide an opportunity for dietary counselling, exercise and weight management to delay or prevent the onset of diabetes.

This project explored the reasons for the poor uptake of the postpartum test and identified three key areas that could be implemented to increase it.

Entry: Reviewed, updated and current

Reviewing and updating policies, procedures and guidelines (PPGs) involves many authors who spend time consulting widely, reviewing relevant legislation and literature. This work, and the author friendly system for processing PPGs, has enabled NMH to achieve 71 percent of PPGs in-date.

The intention of submitting this quality entry is not to win, but celebrate and publicise the work authors have done on updating NMH PPGs.

Entry: Hip Hip Hooray: a brighter future after a hip fracture

The 2019 ANZ Hip Fracture Register annual report shows NMH is leading the average time to surgery across New Zealand ensuring our patients are receiving surgery promptly within best practice guidelines.

It’s been demonstrated that early surgery reduces ill health, hastens recovery, reduces length of stay and returns more people back to their homes. Patients are also less likely to require a transfer to a care facility as now we are discharging patients to their homes 76 percent of the time.

The hip fracture pathway has enhanced the care of adults 50 years and older with low impact fractures. This integrated pathway has cut nearly two days off the average length of stay without increasing the readmission rate. People are going home safely, quickly and in better condition than when they came to us.

A team comprising a geriatrician, pharmacist and nurses ensure the right pain medications and antiemetic’s are prescribed.

Wise and Green is the new gold - Environmental sustainability

Where the project has contributed to reducing emissions, reducing waste and/or creating a movement of changed behaviours for a healthy planet

Category winner: Putting the informed back in to informed consent (older adult risk assessment in cardiology) (Rebecca Eddington)

The Positive Ageing Strategy (2014) is about empowering older people to make well informed choices in regards to their health journey. Interviews with local older patients identified a need for more accurate understanding of risk versus benefit from cardiac surgery or intervention. 

While the Ministry of Health acknowledge that assessing frailty is essential for this population, there has not been a road map to adopt this into practice in New Zealand. 

After extensive research, the Essential Frailty Test has been adopted locally and the aim is for it to be rolled out nationally. Called the ‘Overall Wellbeing Level’, it aids discussion with patients to allow a truly informed decision on their journey forward and also provides an objective measure for heart teams to understand patient risk.

The next phase in implementation locally will examine reversible causes of frailty from the assessment and streamline care and referral. There should also be education and a framework for goals of care discussion, which is an essential part of frailty testing to empower patients to make well informed decisions.

Entry: The DMEK revolution in Nelson Marlborough Health

In 2019, Dr Sacha Moore introduced the relatively new DMEK (Descemet’s membrane endothelial keratoplasty) procedure (partial corneal transplant) for selected patients.

Prior to this, the traditional full corneal transplant was performed, which took longer to recover from, had higher rates of rejection, higher dependence on steroid eye drops and required numerous stitches.

A multidisciplinary collaboration was made, encompassing the managerial, administrative, clinical care and operating theatre teams. The benefits have translated into significant quality of life improvements in our patients and their surrounding community, reflected in their personal stories.

Entry: Whare Ora: warmer healthy homes

The Whare Ora healthy home assessment initiative seeks to reduce Māori and vulnerable population groups Avoidable Hospital Admissions or ASH.

Tamariki, 0-4 years old are targeted as this group is frequently admitted with conditions, such as respiratory illness or asthma, caused by living in cold, damp and unhealthy homes.

After a Whare Ora assessment and everything from heaters to curtains and mould kits are completed the findings from the NMH ASH patient management system were significant; no re-admissions for respiratory or asthma illnesses from the 40 homes for aged 0-14yrs group once discharged home from hospital.

Entry: The hole in the wall: reducing pharmaceutical landfill

An amount of unwanted medication returned from the community and added to landfill is within date and could be reused.

Medical Aide Abroad is charity operating in New Zealand which readily accepted taking our sorted, eligible medication. Staff volunteers, both working and retired health professionals, were enlisted to assist. In the first five months of the project over 10 percent of unwanted, returned medication was forwarded to Medical Aide Abroad for overseas distribution.

Fast, simple, bold - Small changes with big impacts

Where a little idea just grew, quickly. May have had a small team (of one or more), no or minimal additional resources, and made a big difference.

Category winner: Roopu Tāne Kotahi Rau+ (Lewis Boyles, Mamae Elkington, Amanda Inwood)

An opportunity was identified to work with a group of Maori males currently case managed by the mental health service. The tāne are all on major antipsychotic medications, half were homeless, all weighed over 100kg, and all but two smoked.

By engaging with them one day a week for 12 weeks members of the group lost weight, took centimetres off their girth, increased their knowledge in tikanga Maori, increased levels of fitness, raised self-esteem and made a future commitment to a smoking reduction roopu. This was achieved through offering incentives, having consistent staff with the roopu, buy-in from the tāne and commitment and support from wider community organisations.

The goal in 2020 is to do a wāhine version of the tāne roopu – the roopu is likely to be moulded to suit the needs and wants of the wāhine participating in the roopu. There is ongoing discussion with the mental health sector on the effectiveness of this programme and the possibility of implementation in other areas.

Entry: Kōrero mai!

Kōrero Mai badges are being worn throughout Nelson Marlborough Health to show who can speak some te reo Māori. There are no levels of fluency required for the badge, just a willingness to use and continue learning te reo Māori.

With a language comes a culture, and with the increasing use of te reo Māori comes an increase in the understanding of tikanga Māori and te ao Māori. With a better understanding of Māori, the health inequities faced by Māori can be addressed and reduced.

Prize money would be used to buy more badges and to create communications to make the badges more visible in our community.

Entry: Medication training made fun in Disability Support Service (DSS)

Gaps in staff knowledge around the administration of medication were highlighted by increasing medication errors. The project team saw the opportunity to provide a more hands on, practical training that could support staff knowledge and ability.

The team worked with pharmacy and RNs to put together a practical training experience where staff checked in, completed a three-way match and gave medico packed skittles to one another as per medication procedure.

By following the process (which had a few hidden mistakes) staff were able to identify medications, identify mistakes and practice following the procedure.

Staff recognised the importance of the policy and procedure in ensuring correct medications every time.

Entry: ON FORM: Standardisation of the adult elective booking form

Across the surgical services there were there different forms used for adult elective bookings.

The booking form includes: the booking page, informed consent to procedure form, patient health questionnaire, smokefree cessation assessments, multi-drug resistant organisms screening and pre-admission testing. An inter-disciplinary team reviewed the adult booking form and developed a version to be used district-wide for people having elective surgery. A paediatric booking form is still under review.

Entry: Medi-Map: online and on time 

Increasing medication errors, pain points in the current medication administration process and the call from GP’s to move to a more modern system provided the basis for change within the Disability Support Service in Blenheim.

Medi-Map, a cloud based medication management application, provided an opportunity to address these issues with a small scale trial. The key to the project’s success was a willingness from staff to adopt the new technology, learn new skills and work together to implement the new system. There have been a number of anecdotal improvements since the system went ‘live’ in August 2019. However, the journey towards meeting the project aim of 90 percent reduction in medication errors across PDSS, Blenheim continues.

Entry: Hair to stay

A distressing side-effect for women undergoing chemotherapy treatment for breast cancer is the loss of their hair. In December 2017 the New Zealand Breast Cancer Foundation funded a pilot study at NMH using scalp cooling therapy in a chemotherapy clinic within the public health setting.

The theory behind scalp cooling is to reduce the amount of blood flow to the hair follicles, and therefore reduce the chemotherapy reaching the fast dividing cells involved in hair growth. Scalp cooling therapy to reduce hair loss has been used internationally for decades.

Twelve women chose to participate in the pilot and appreciated maintaining their hair and their self-esteem and confidence. Since the pilot study Nelson Hospital has continued to offer scalp cooling, with plans to extend this to Wairau Hospital Wairau oncology patients.

The Nelson team has become a resource for other DHBs in the country who are interested or wanting to know how scalp cooling may work in their areas.

Growing a seedling - Best use of an improvement framework such as the Nelson Marlborough Health Improvement Process

Where an improvement framework is applied, such as the Model for Improvement, Lean, or Kaizen Continuous Improvement.

HIA overall winner - Darcy Christopher Award: Equally Well: Improving cardiometabolic screening and quality of life for clients on Clozapine (Helen Lynch, Jocy Wood, Rebecca Lukey, Jen Hassloch)

People with mental illness are especially vulnerable in terms of physical health. The Equally Well cardiometabolic monitoring initiative has increased the visibility of these concerns and has prompted coordinated intervention to improve quality of life for this group. This is a great step toward decreasing the disparities between mental and physical illness.

A screening tool has been implemented in the Nelson region and the scope will be expanded to capture people on all antipsychotics and also on methadone, which is a medication that has a side effect of interfering with cardiac function: QT-segment. At the moment, this group are not receiving cardiometabolic monitoring (and subsequent intervention) which increases their vulnerability and continues the health disparity for those with mental health and addiction concerns.

Prize money will go toward creating a mobile screening kit which would enable screening in Motueka, Golden Bay and the wider Nelson region.

Category winner: Improving access to child and adolescent mental health services (Emma Williams)

Some referrals to the Child, Adolescent Mental Health Service were being placed on hold for over two weeks with multiple clinicians involved in decision making.
The service collaborated with a number of community agencies and asked for feedback on where they felt the barriers were to accessing the service.

A number of adaptations to the referral form were made to give clearer information to enable a clinical decision to be made quicker. This change, together with a significant change in the internal process saw a significant reduction of referrals being placed on hold and thereby improving the wait time for first face-to-face appointments. This project highlighted the need for further communication with the CAMHS 0-18 age range.

Prize money will be used to support the service to increase capacity to deliver evidence based interventions and increase the number of clinicians trained in these.

Entry: Trusted Transfer of Care for mental health and addiction in-patients

Transfer of Care (discharge) checklist for in-patients was Nelson Marlborough Health’s contribution to a national five-year mental health and addiction (MHA) quality improvement programme, hosted by the Health Quality & Safety Commission.

A lot of work went into designing a checklist that meant Tāngata whaiora (people) and their whānau could trust that they could get on with their wellness journey once out of hospital.

The Transfer of Care checklist follows a logical layout, it includes the needs of all relevant parties, and most importantly, it is started on admission. It has meant a big change of mind-set for everyone involved.

Entry: Improving GuardrailsTM: Is your IV Medication dose safe?

Nelson Marlborough Health  IV pumps have a drug error reduction software called GuardrailsTM which gives limits for safe administration of all IV medications and fluids.

The guardrails dataset or library was found to be significantly out-of-date leading to increased risk of patients experiencing medication errors and harm. A multidisciplinary approach, partnered with expert advice and support from the IV pump supplier company, achieved a significant update of the guardrails dataset, along with clinical staff training and increased awareness of the importance of using guardrails in daily practice.

During this work staff at Nelson Marlborough Health have moved from a culture of frustration to one of collaboration and synergy.

The 2020 entry categories are based on the Health for Tomorrow Strategy diagram (p12).

View the posters made for each entry.