The just-ratified DHB NZNO deal includes a commitment for all DHBs to implement the Care Capacity Demand Management (CCDM) system by mid-2021, including filling the staffing gaps highlighted by using acuity data to calculate when nursing needs aren’t matching the care needs of patients. A safe staffing Accord has also just been signed that includes monitoring of DHBs’ progress.

When the DHBs and NZNO management began negotiations last year, only 14 of the 20 DHBs were signed up to implementing the CCDM tools built on the validated acuity software TrendCare. And four of the remaining six – Lakes, Canterbury, Waikato and Counties-Manukau – did not have TrendCare.

But an update from the joint DHB-NZNO Safe Staffing Healthy Workplace (SSHW) Units show that all DHBs are now starting or about to start on the CCDM path (see details below) and with all but one of the DHBs – Waikato – also looking to use TrendCare.

Hilary Graham-Smith, NZNO’s associate professional services manager and a member of the SSHW Unit governance board, welcomed all DHBs coming on board as NZNO had always sought for CCDM to be implemented for all members.

“We want them to have that safe staffing environment right across the board so it was never satisfactory for us that some of our members had that opportunity but a significant portion of others didn’t,” said Graham-Smith.

She said given time DHBs would have come on board as it was the “right thing to do”. “But negotiations and subsequently the Accord has pushed that along a bit more – and that’s a good thing.”

Trust also had to be rebuilt with nurses at DHBs where CCDM had already been introduced and nurses were yet to see DHBs respond by putting more staff on the ward floor.

“If nurses do all that work trying really hard to get their TrendCare data right – and then they see nothing for that – it is no wonder that there’s a complete lack of trust and confidence in the programme and in TrendCare,” said Graham-Smith.  She strongly believed CCDM would deliver but nurses now needed NZNO and the Unit to work with DHBs to ensure boards were transparent and open about what the data analysis was showing about understaffing and when and how they would respond with extra staff.

“That’s what they need to see – the outcomes – and the other thing they desperately need of course is to see that they are working in a safe environment and able to give the kind of care they want to give.”

DHBs spokesman Jim Green said he was no apologist that CCDM had not been consistently introduced across all the DHBs which had led to the implementation deadline being set for 2021 to allow time for the late-starting DHBs to catch-up.

“However, I don’t see that we (the other DHBs) won’t be making progress much, much faster – with greater degrees of progress already at many DHBs.”

CCDM requires nurses to input patient acuity data for 12 months to ensure accurate trend data is available to calculate the FTE staffing to meet patient need – so it can take up to three years to fully implement.

Both Green and Graham-Smith believed that the additional money and resources being put into CCDM through the ratified deal would accelerate the process.

“Others who haven’t yet begun – or only just begun – have got a much bigger journey to make within that time frame but what the package has done has given them the ability to increase the implementation resource and obviously NZNO will get in right behind that and support that right alongside the SSHW Unit,” said Graham-Smith.

Post-quake Canterbury and Counties-Manukau on board, Waikato going different path

Mary Gordon, executive director of nursing for Canterbury DHB, has confirmed that the DHB would be working with the SSHW unit to implement CCDM and was putting together a business case for purchasing an ‘appropriate acuity tool’ (understood to be TrendCare).

She said she very proud of how Canterbury nurses had coped with the disruptions the health service has faced since the 2010-11 quakes – particularly the population growth being well above any forecasted predictions.

“We are now seeing  the impact of this growth on our environment both in terms of service capacity  across our primary, community and hospital services but also in our constrained  physical environment,” said Gordon. She said the impact had been “unrelenting” especially for staff on its Christchurch,  Hillmorton and The Princess Margaret sites “however nurses and their colleagues continue to provide high quality care to patients”.   Gordon added that she and her fellow Canterbury directors of nursing were committed to engaging with staff on ongoing staffing improvements and development of the nursing workforce, including dedicated education units that had increased the number of nursing students able to be trained.

Another late sign-up to a CCDM agreement was Counties Manukau with Head Nurse Jenny Parr saying it signed in late July and it had recently developed a business case for purchasing TrendCare.

She said Counties Manukau had for a number of years, been using the principles of CCDM using an alternative acuity assessment tool.  “Once approved, TrendCare will provide an opportunity to benchmark with other DHBs by using the same tool.”  Parr said while implementation had not taken full effect it did have a full-established CCDM Council and co-ordinator to provide assistance with implementing the core components of the CCDM programme.

Waikato DHB deputy Chief Nurse Deborah Nelson said it signed up to CCDM about 18 months ago and was “well on the way to rolling it out” to ensure safe staffing levels on its wards but using another acuity tool called Assignment Workload Manager, which measured skills and numbers in each ward.  “The MECA does not stipulate that TrendCare is required, we believe our acuity tool meets the requirements of CCDM.”

She said it would be working with NZNO and nurses to ensure there were enough people to deliver patient care in its hospitals. “We are actively working on recruitment strategies which include enticing New Zealand nurses back home from across the globe, increasing NETP intake spread across the year and investigating more active employment of enrolled nurses as they graduate.”


CCDM DHBs (at various stages of implementation)

  • Bay of Plenty
  • Northland
  • MidCentral
  • Nelson
  • Tairawhiti
  • Taranaki
  • Southern
  • Waitemata
  • Hutt Valley
  • Whanganui
  • South Canterbury
  • Auckland
  • Hawke’s Bay
  • Capital & Coast

Have validated patient acuity software and starting to implement CCDM

  • Wairarapa
  • West Coast  (starting when shift to new hospital)

Implementing validated patient acuity software

  • Lakes

Developed business case for validated patient acuity software

  • Canterbury
  • Counties Manukau

Progressing validation of another patient acuity system

  • Waikato


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