New way of working transforms hospital

By Mary Anne Gill

There’s a huge transformation taking place within Waikato District Health Board (DHB) and while the giant cranes and major building programme at Waikato Hospital are an obvious sign, it’s from within the biggest changes are happening. Health Waikato, Waikato DHB’s provider arm of hospital and health services recognised the need to change the way it did business four years ago when the DHB embarked on a 15-year service and campus redevelopment programme.

Front Row: (L-r) Kathy Jenkin, Ann-Marie Cannaby, Haidee Davis, Lindsay Duncan, Karen Owen, Amber McTainsh, Alan Kuyper, Julie Law, Christopher Baker, Greg Keyte Back Row: (L-r)  Hayley Goodall, Claire Forsythe, Sybil Hau, Katie Holloway, Trina Falconer, Virginia Endres, Darwin Geenty, Paula Lear. Absent:  Ros Morell, Shane Riley, Jenny MacFarlane, Vin Kaur, Anne Koppens

Chief operating officer Jan Adams was keen to see some business disciplines put on the various projects and programmes either already underway or due to start.

“We had people working on multi million dollar projects using all kinds of different methodologies. It wasn’t their fault – as an organisation we didn’t have an official project methodology and here we were embarking on a $500 million service and campus redevelopment,” says Adams.

She established the Programme Management Office (PMO), put Haidee Davis in to manage it and told her she expected it to take control of the service side of the projects and become a centre of excellence.

A big ask but one Davis, a former nurse at Waikato Hospital, took on with gusto.

“I don’t think I really knew quite how it would grow as it has done,” she says.

“From a small team of six managing a few projects, there are now 20 of us managing more than 30 projects.”

As the work increased the organisation adopted a project methodology based on PRINCE2 but adapted for Waikato DHB and renamed the Waikato Way.

It formalises reporting frameworks, establishes project resources, programme and project governance structures and pipeline planning of projects.

The PMO gets stakeholder engagement, provides project advice and assistance to staff that are not experienced project leads and then communicates the change portfolio to the wider organisation.

Projects range from the big ones – service development for the $118 million Meade Clinical Centre and the $48 million Acute Services Building including a new emergency department – to the ones on the wards and in the community, which make nurses and health care workers more productive so they can spend quality time with patients.

The PMO’s work has come to the attention of businesses outside health. Companies like PricewaterhouseCoopers and ABB New Zealand have commented on how impressed they are with the disciplined project work and pipeline modelling.

Waikato DHB chair Graeme Milne, a professional director associated with a number of companies including Synlait, Genesis Power and Farmers Mutual Group, says the PMO is doing great work.

“The systematic approach using Lean principles is just what we in the health system need to make finite resources go that much further. It is very pleasing to see the gains we have made in many of the wards at Waikato Hospital where processes have been simplified resulting in significantly more time spent with patients and less time needing to be spent on other tasks,” says Milne.

Graeme Milne Jan Adams Haidee Davis Jo-Anne Deane Ann-Marie Cannaby

Adams says the organisation cannot continue to work the way it has always done.

“That’s why the PMO focuses on efficiency as it relates to capacity, patient safety, standardisation, process and change management, elective and acute streaming of patients.”

Recent successful completed projects include the cardiac surgery redevelopment, elective short stay unit, a new bed footprint for Waikato Hospital, production planning and a productive wards pilot showcase in wards 2 and 12 now rolled out to other wards.

Releasing Time to Care -The Productive Ward focuses on improving ward processes and environments to help nurses and therapists spend more time on patient care thereby improving safety and efficiency.

It empowers them to look at how processes such as drugs rounds, ward rounds and discharges work, strip out what is stopping those processes from being better and releasing them from activities that prevent them from spending time on direct patient care.

The pilot resulted in an increase of direct care from 30 per cent to 50 per cent. There were one off stock level savings of $4000-$5000 and in the first month laundry cost savings amounted to nearly $2000. Medication events reduced.

“There’s no doubt in my mind that Releasing Time to Care increases time staff have available to help our patients. The focus is not on how staff then use this capacity; rather it’s on the next improvement opportunity. We had a dedicated project team from within the PMO who implemented, planned and gained success,” says Adams.


“The challenges ahead are substantial and we will continue to use the PMO as the project leaders and the lean methodology, a key component of the productive series to become a productive organisation, eliminating waste from the system and bringing transformational change across Health Waikato.”
Ann-Marie Cannaby, the chief nurse and operating officer at The University Hospitals of Coventry and Warwickshire, is currently in the PMO on a four-month secondment with Waikato DHB.

In what Adams understands is the first arrangement of its kind in New Zealand, Waikato DHB and The University Hospitals of Coventry and Warwickshire created an opportunity for their staff to learn and develop from each other.

Renal nurse Jo-Anne Deane was the first to come from Coventry in March last year to help with a review of renal services at Waikato and returned to Hamilton in September as clinical director.

Dr Cannaby arrived in November. She has extensive experience in nursing governance and can advise Waikato on operational efficiencies from a nursing perspective to support the current nursing work streams.

She has been involved in the build of a new hospital at Coventry and Warwick, and the transfer of staff and services from the old hospital to the new one.

“This is valuable experience for the staff at Health Waikato to be exposed to,” says Adams.

The New Zealand health system is a new experience for Cannaby, and the work of the PMO impresses her.

“I have learnt a great deal about how Waikato DHB predicts its activity and some of the modelling that is used to plan activity and will use this experience and understanding when I go back to the UK.

“I also have a better understanding of the New Zealand health system and its organisation. It has been interesting comparing the New Zealand and the UK systems and hearing the conversations and developments to improve the effectiveness of health care.

“From a nursing perspective there are differences in roles and the scope of practice of nurses in the two countries but this again has led to the sharing of practices and better understanding of models which enables individuals to consider the way they deliver care and think about different ways of providing care.”

New Zealand has a very good advanced practice model, which we can learn from in the UK.

“It’s a great opportunity to learn from a different health sector and also bring over expertise where it is needed to support some clinical service areas,” says Adams.

“While we have benefitted from Jo-Anne Deane’s experience, she says some of the things our (renal) unit does is excellent and sees the opportunities for the UK to take the learnings from our experience and do things differently. She has also learnt new skills especially in the finance area which she will take back to Coventry with her.”

Adams describes the relationship as symbiotic.

“One sector learns and gains from the other and vice versa. There is the possibility for Health Waikato staff to have an exchange at Coventry although both organisations would want specific outcomes from the exchange.

L-r: Anna Proverbs, Anne Koppens, Julie Law, Fiona Beaumont, Haidee Davis, Kay Hudson in the new Emergency Department.

“In Ann-Marie’s case she has brought her vast nursing experience at a senior level, knowledge of the productive wards and change processes associated with the new building programme at Coventry, which we are putting to good use here in Waikato.”

Cannaby’s work at Waikato involves reviewing nursing governance – challenging nurses to think about their structure and roles.

“The sabbatical has meant that I have also been able to discuss and share experiences with those leading the productive wards and community series projects originally designed in the UK.”

The secondment at Waikato ends in March and Cannaby hopes to be able to put into practice some of what she has learned in Hamilton.

“What I will say is that the people of the Waikato have every reason to be proud of the work in the PMO and the staff at Waikato DHB. I marvel at what they achieve with what they’ve got,” she says.

Visit the Programme Management Office webpage for more information.

* Mary Anne Gill is communications director at Waikato DHB.