Lakes District Health Board provides and funds healthcare services for the 102,000 people who live in the Lakes region of New Zealand. Lakes DHB operates two hospitals within the region—Rotorua and Taupo Hospital—but also provides funding for a range of public health services and activities in the community.

A UNIQUE HOSPITAL CULTURE

The unique nature of the region’s population sets the Lakes DHB apart from other district health boards in the country. Approximately 35 percent of the region is made up of Maori people, which is more than twice the proportion in the total New Zealand population. “Our partnership with the Maori community is very important and it is our vision to achieve health equity through a number of strategic priorities,” Chief Executive Cathy Cooney says.

Donna Mayes, Manager Lean Thinking and the Woman, Child and Family Service Manager says, “Due to the demographic and high number of Maori, we’re one of the most bicultural regions in New Zealand, but also one of the lowest socioeconomic districts. One of the big drivers for all of us that work here is our knowledge of the inequity that exists for the Maori population versus the general New Zealand population. We want to contribute to reducing the gap in that inequity.”

The Rotorua Hospital site was gifted for the provision of health services by one of the Maori sub tribes of the area, Ngati Whakaue, and consequently a significant partnership relationship has emerged between the two groups. The district health board engages Ngati Whakaue when decisions regarding the site are made.

FACILITY DEVELOPMENT

The project comprises the renovation of older infrastructure and construction of new buildings. The process for the upgrade began five years ago when a full district clinical services plan determined that both the Rotorua and Taupo facilities required major redevelopment. Eventually the project turned into an $89 million programme. At the Rotorua Hospital, this meant relocating clinical services to the front of the site to consolidate clinical activity, and moving support functions to the back of the site in areas that will be vacated once the new building is commissioned.

The new building is being constructed for inpatient wards and ambulatory services, such as outpatient services, pharmacy, physical therapy, chemotherapy, etc. The intensive care and coronary care unit will also be moved into this new building. A brand new laboratory building is also being constructed.

Rotorua Hospital is located on an active geothermal site, with steaming mud holes and boiling geysers in the area. Potential earthquakes put backup services at as much risk as mainline services and this threat requires significant seismic protection of buildings.

“What we’ve done is a major upgrade of our infrastructure and facilities, replacing plant and increasing backup so that if a particular service goes down, we have effective back-up systems that activate promptly so safety is assured,” General Manager for Corporate Services Nick Saville-Wood says.

Though the geothermal activity presents unique challenges, it also generates benefits. Water from the geothermal features is used in the hospital for heating and hot water supply. Cooney says, “We’re the only place in New Zealand that has the ability to utilize geothermal power and steam to support our business.”

Well drilling recently commenced at Taupo Hospital, marking the beginning of the end for coal-fired energy at the facility. A $330,000 investment has been made by Lakes DHB to convert its current coal fired boilers for heating and hot water to a clean, green geothermal supply.

INTRODUCING LEAN THINKING

With a project of this magnitude, nearly every avenue of the business has been affected. As a result, Lakes DHB introduced lean thinking within the organization in 2007 to change processes and the way people work. Mayes says, “When we became aware of lean thinking in the healthcare industry, it became an easy choice for us. The lean process is consistent with the values of the organization.”

Lakes DHB’s approach to adopting the principles of lean thinking has been to take a long-term view and focus primarily on increasing lean knowledge and skills amongst staff with the goal of having every staff member focused on creating high value processes for delivering customer service. After applying the 5S: Sort, Set in Order, Shine, Standardize and Sustain process, and completing value stream mapping, a number of positive outcomes have been delivered. For instance, medical patients at Taupo Hospital have been able to go home earlier since the introduction of a visual information board to replace the written referral system to specialist staff such as physiotherapists and specialist nurses.

Mayes says, “What we’ve been doing to date is giving people a basic knowledge of lean and using pockets of it to expand where people were willing to work. Now we need to develop in-depth knowledge throughout a division of the organization so that’s it not just pockets, but the whole system that is applying valued added lean thinking to the work they do every day.”

The DHB has also implemented new computerized radiology technology, as well as WinScribe Digital Dictation that allows clinicians to route speech to text transcription. The board also employed iSOFT to deliver a new patient management system. Cooney says, “It’s all in line with lean thinking, which is reducing waste, adding value into the patient’s experience and a more rapid turnaround for the patient.”

Saville-Wood says, “What we’ve tried to do is with a project of this size with refurbishment and a new build is to help prepare and support the affected teams so we have a department within our project called Staging and Migration. We try and plan to the nth degree exactly what is going to happen with staff so that when they get into the new configuration, they are confident and know exactly how to operate. In this way we reduce clinical risk as much as possible.”

LOOKING FORWARD

“The key part of our future is continuing to grow and develop our people and the quality of service delivered to our community,” Cooney says. “We’re in a sustainable and viable position to offer an appropriate range of services to our community. Meeting the health needs of the people we are here to serve is our big goal,” she adds.