Southern DHB Strategic Services Plan
Presentation for the Strategic Partnership Group
9 February 2016
Overview of presentation
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Scope
Assumptions
Project exclusions
Approach for Stages One and Two of the project
Challenges to be addressed
Staged deliverables
Stage 1: Describing the challenge
Deliverable: Strategic Services Plan for Southern DHB
Timeframe: 15 February 2016 - 5 April 2016 (2 months)
Stage 2: Developing potential solutions
Deliverable: Detailed Service Plan for hospital services in Dunedin
Timeframe: 18 April 2016 – 17 June 2016 (2 months)
Stage 3: Assessing the options
Deliverable: Strategic Assessment
Timeframe: 16 May – 17 June 2016 (1 month)
Stage 4: Refining the preferred option
Deliverable: Detailed Services Plan for hospital services in Dunedin
(optional)
Timeframe: April 2016 – March 2017
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In scope
In scope
• An assessment of the impact of best practice primary care in line with the international
trend towards delivering care closer to where service users
• An assessment of the existing list of hospital services including ongoing clinical
viability/ risks and whether/the extent to which (or manner whereby) services are
potentially regionalised or re-focussed
• An assessment of the future University teaching requirements along with an
expression of their projected facility needs.
Assumptions
• Re-lifing the clinical services building for clinical purposes is not a potential option
• Project governance will be able to come to a common view
• Staff across SDHB will be available to engage with the project team
• Southern DHB will be able to offer clinical leadership and internal challenge
• Otago University staff will be available to engage with the project team
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In scope…
Assumptions continued:
• All services can be reviewed without constraint
• The deliverables will align with the Southern Strategic Health Plan
• Data any other relevant information (e.g. financials/facilities) will be made available
within reasonable timeframes
• Information on all relevant DHB and regional activity will be available to the project
team.
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Out of scope
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Service change processes
Architectural services
Financial modelling
A full asset age and condition report for existing facilities
An assessment on the feasibility of refurbishing existing facilities.
An assessment of the feasible expansion zones on current DHB-owned land
National funding models including the rural and tertiary adjusters
The development of an Indicative Business Case or Detailed Business Case under
the Treasury’s BBC model
Issues relating to improving culture and/or clinical teamwork
Secretariat duties for the Strategic Partnership Group and Steering Group
Stage One - Strategic Services Plan
The Strategic Services Plan will build on previous work and take a whole of system view
across the district to define the current and future challenges and pose potential solutions.
This plan sets the scene and leads into the second deliverable.
The plan will include the following (as specified in the contract):
• Organisation overview
• Demographics, population and catchment profile
• Organisational strategic goals, priorities and actions
• Key policy and service directions
• Current infrastructure profile
• Current services, current capacity and throughput
• Patient journey and service challenges
• Performance comparisons and forecast activity
• Future demand and proposed management strategies
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Approach for Stage One
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Broad and high quality stakeholder engagement
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In-depth document review (strategies, policy and service directions…)
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Description of current infrastructure profile
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Historical, current and projected service activity (demographic data, comparative
trends and levels of service delivery, forecasts under alternative assumptions,
benchmarking and comparison of quality measures)
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Identification of alternative appropriate service delivery targets and intervention rates
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Stage Two – Detailed Services Plan
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In stage two the focus shifts to hospital services in Dunedin. It will include a number of
components of the Strategic Services Plan, but specific to Dunedin hospital
services only.
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Additional components to be included in this deliverable include:
 alternative future service models
 scenarios of future growth and demand management options
 scenarios of future capacity requirements including facility sizing
 detailed current workforce profile and future requirements
 current and future service costs and affordability
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Approach for Stage Two
Quantitative analysis
• Develop and test a template to engage with clinicians at the level of individual services
• The template will include both historical, current, and projected service level data,
including
 Service activity metrics
 Ideally if available, an overview of historical, current, and projected staffing
 Using the projections, identify ranges for future service volumes, costs, staffing,
and beds (where relevant).
Workshop series
• Use the service level data packs as a platform for working with clinical staff to develop
a range of options for future service models and demand management options.
• Workshops will use patient profiles and their journeys
• Purpose of workshops:
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Provoke debate with radical assumptions about services.
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Propose services and volumes where demand could be shifted from the main Dunedin Hospital campus to
other settings.
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Identify the constraints presented by current facilities.
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Identify the levels of investment needed to reuse existing facilities.
Approach for Stage Two continued
Workshops continued
This stage will involve several workshops to review and challenge data, to develop
options and to further consider options
Facility impact analysis – translating services to space
Demonstrate the impact of the service model scenarios in terms of events, bed day
implications and service location, over a period of time.
What it won’t be:
• Translating the volume forecast into a schedule of accommodation and translating that
schedule into a master site plan is out of scope.
• Modelling of the DHB financials
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Specific challenges to be addressed
Risk:
Insufficient engagement with core stakeholders:
• Core stakeholders may underestimate the imposition of the project on
themselves
• Senior clinicians will need to lead the engagement and challenge options – there
is a risk this leadership and challenge will not occur
Effect:
The model of care may not be subjected to sufficient challenge. This, in turn, would lead
to gaps in the analysis, and an inadequate option set.
Management strategy:
There is a dedicated contact for Southern DHB solely tasked with this project.
Use existing clinical groups, provide a variety of ways to engage, in terms of locations,
timings, and modes (e.g. individual, small group, large group).
If the existing clinical groups don’t provide the leadership and challenge, look to bring in
(possibly external) clinical champions
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Likelihood:
Medium - high
Impact:
High
Challenges…
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Risk:
Stakeholders may have different expectations regarding future directions. This
may arise as the BBC framework requires that issues are looked at with fresh
eyes.
Effect:
Stakeholders may not buy into the final service options leading to opposition and
difficult relationships which could make implementation difficult. Risk of creating difficult
political situation.
Management strategy:
All service options must be feasible with thorough stakeholder input. We will ensure we
highlight this message in discussions with stakeholders.
Likelihood:
Medium
Impact:
High
Challenges…
Risk:
There may not be alignment between the Southern Partnership Group and the
Steering Group.
Effect:
This could create issues with developing the options and meeting the timeframes.
Management strategy:
The Terms of Reference are clear on the respective roles of the groups. Regular and
ongoing communications between the project team (MoH, DHB, Sapere) and project
sponsors will highlight any divergence of views and appropriate strategies put in place.
Likelihood:
Low – medium
Impact:
Medium - high
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Challenges….
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Risk:
There may not be alignment between the Project Governance, Ministry of
Health and Southern DHB.
Effect:
This could impact on timeframes.
Management strategy:
The Southern Partnership Group is accountable to the Ministers of Health and
Finance. Differences of perspective will need to be resolved via discussions
between the parties involved.
Likelihood:
Medium
Impact:
High
Challenges…
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Risk
There is significant activity underway with the Implementation of the Southern
Strategic Health Plan to develop a coherent and integrated system of care. Much
of this activity is pertinent to the redevelopment of the Dunedin hospital and
there is a risk that the option set this project is tasked with will pre-empt the
outputs of the Southern Strategic Health Plan implementation.
Effect:
Misalignment of respective outputs, expectations and resulting confusion and
disengagement from stakeholders.
Management strategy:
Deep and ongoing engagement with key stakeholders and in particular the Southern
Alliance.
Likelihood:
Medium
Impact:
Medium
Challenges….
Risk:
The complexity of the governance and management structures for the
development and the importance of ensuring contributing partners are
supportive of decisions and approvals, could detrimentally impact on lead
times for decision making. Time delays will not be acceptable.
Effect:
Delays to the project will impact on future stages in the BBC process and ultimately
the hospital development
Management strategy:
The DHB has available committed appropriate resource and expertise.
The Ministry has available committed appropriate resource and expertise.
The Ministry has efficient process to facilitate promote authorisations and approvals
where it has delegated authority or budget.
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Likelihood:
Medium
Impact:
Medium - high
Challenges…
Risk:
The complex nature of the project and the requisite extensive stakeholder
engagement will make meeting the timeframes particularly challenging
Effect:
The options are not as comprehensive or innovative as they could be
Management strategy:
Assign the right mix of capacity and skill to the project
Frequently share and challenge the options as they are developed
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Likelihood:
Medium
Impact:
High