PMAANZ Newsletter - June 2024

Sent: Jun 2, 2024, 3:46 PM

Kia ora PMAANZ Members

As the seasons shift, so does the dynamic landscape of general practice in Aotearoa. Welcome to the June 2024 edition of our newsletter! Here’s a glimpse of what awaits you.

Advocacy for General Practice: Our indomitable chair, Mary, has been crisscrossing Aotearoa, advocating fiercely for general practice. From high-level discussions with the health minister to exploring groundbreaking ways to reevaluate the capitation model. Good luck, Mary—this task isn’t for the faint-hearted!

Staff Harmony and Challenges: Sometimes, we wear the hat of a mother, gently coaxing our staff to play nicely in the playpen. Fiona from Mas shares her wisdom on managing staff complaints within our practices. After all, a harmonious team is essential for excellent patient care.

Nymbl: Empowering Our Kaumatua (Elders): ACC introduces Nymbl, a new app designed to assist our cherished kaumatua. Let’s embrace technology to enhance their well-being and independence.

Paramedics in the Fold: Jess from Collaborative Aotearoa sheds light on integrating paramedics into general practice. We’ve recently welcomed a paramedic to our practice, and her positive impact within the first week is remarkable.

Executive Team Updates:

Niomi reminds us of the rich education pathways offered by PMAANZ. Lifelong learning is our compass!
Wendy diligently works on the Biennial Survey and is seeking your valuable input.
Jen and her conference team have curated an electrifying lineup for this year’s conference. Get ready for inspiration and networking!
Karen shares a breathtaking snapshot of a solar flare seen in Rangitikei. Nature’s wonders never cease to amaze.
Wendy in Wellington reflects on the enlightening Roadshow with Gary Smith held in March.

Here at PMAANZ, we firmly believe that the support you’ll receive by connecting with your peers within our organisation is unparalleled.

"Ki te kotahi te kākaho ka whati, ki te kāpuia e kore e whati”

When we stand alone, we are vulnerable, but together, we are unbreakable.

Ngā mihi

Carol Neki |PMAANZ Executive National Secretary

Kia ora koutou katoa

I’m writing this mid-May, so before the Budget announcement on the 30th of May, I can only hope there will be some support for our sector this year, but unfortunately, I suspect we will be disappointed. We will continue highlighting our frustrations around workforce issues and funding and reiterate the lack of understanding of what is happening at the ground level in General Practice and other community health services. We provide as much information as possible as it comes to hand, and when I am allowed to release this, it goes out to our members and is on our FB members-only page and our website news page.

I want to take this opportunity to do a BIG SHOUT OUT to ALL our newest members – welcome, and please reach out to your local branches and any of us on the Exec as well as Carole; we are all here to awhi, guide and share our knowledge with you all. Welcome.

PMAANZ had a booth at the National Rural Health Conference in Takina, Wellington, in April. We had the satisfying chance to engage with our valued members and introduce PMAANZ to various groups present at the event. This gathering was an excellent platform for networking, sharing insights, and expanding our community’s reach.

Here are some meetings I have attended in the last couple of months. This serves as a testament to our organization’s esteemed reputation and influence, as we are honoured to have a place at these influential tables.

GPNZ—General Practice New Zealand is a membership organisation of 80% of the PHOs in NZ. On its Executive Committee, there are PHO and nursing representatives, together with Ngā Matapihi o Te Wairua and PMAANZ.

GPLF - General Practice Leaders Forum: comprised of representatives from:

RNZCGP,
Hauora Taiwhenua Rural Health Network,
GenPro,
GPNZ,
The NZ College of Primary Health Care Nurses (NZCPHCN)
PMAANZ

As a group, we have met with Minister Reti via Zoom to endorse and promote GPNZ’s Sustainability of General Practice report recommendations.

Collective Advocacy Group – Advocacy for nursing in Community settings

Hauora Taiwhenua Rural Health Network
GenPro
Access Community Health
Family Planning
Whakarongorau
Nurse Maude
The Home and Community Health Association (HCHA)
GPNZ
Hospice NZ
RNZCGP
Aged Care Association
NZ College of Midwives
Plunket

Primary Care Sector Engagement Group

RNZCGP
Hauora Taiwhenua Rural Health Network
Pharmaceutical Society of New Zealand
GPNZ
The NZ College of Primary Health Care Nurses (NZCPHCN)
Physiotherapy NZ
Te Whata Ora
RNZCUC – College of Urgent Care
Nurse Practitioners NZ
PMAANZ

Collaborative Aotearoa - monthly catchup

We have recently been asked to be part of the Capitation Re-weighting: Technical Advisory Group. This collaboration with Sapere will offer clinical and specialist insights that guide the evolution of primary care services. We are exploring innovative approaches to reevaluate the capitation model and exploring diverse workforce compositions to enhance service delivery. Involved in this group are representatives from:

RNZCGP
Te Whata Ora
Sapere
PHOs
GP
Ngatitoa Iwi
PMAANZ

For now, that’s all from me. Please take care, reach out, and use the wonderful network that is our membership.

Hei konā mai

Mary Morrissey | Chair PMAANZ

March new members:

Raewyn Woolliams - Wellington
Chenoa Walker - Canterbury
Leah Mattsen - Otago
Rebecca Colley - Nelson/Marlborough
Lindsay Hiener - Wellington

April new members:

Shamaine Cook - Wellington
Dina Awarau - Wellington
Stacey Gilbert - Canterbury
Michelle Ormsby - Canterbury

May new members:

Kylie Ballantyne - Wellington
Kathy Symonds - Wellington
Waty Arief-Macher - Wellington
Rowena Cook - National
Hilary Morrish Allen - Waikato
Paul Tuvae - Auckland
Amy de Vries - Otago
Tia Toomata - Auckland
Kylie Cantlon - Waikato
Jacinta Burt - Waikato
Wendy Cartledge - Wellington
Kelly O'Keeffe - Waikato

MAS Healthy Practice | Handling Staff Complaints

Receiving a complaint from a staff member against another member of staff is difficult, especially in a small team. It is important that you follow the correct process that respects everyone involved and that you maintain confidentiality.

Your response should be timely as a delay in responding to issues like this can have a negative impact on a team and its culture.

It is easier to deal with complaints when they are formalised in writing. Remember, if a complaint has been received, the information contained in the complaint may only be disclosed with the complainant’s agreement. In serious circumstances you can act on a complaint without revealing the identity of the complainant.

This can sometimes make it difficult to act on a complaint and find a solution, however, breaching the complainant’s privacy could potentially create further issues. The employee who the complaint is against cannot be part of the investigation process.

If you receive a formal complaint an investigation is required, an example process is outlined below. Each situation is different and therefore the process may need to be different depending on the circumstances. If the allegations are serious, you should take advice before commencing any process.

Example process for dealing with staff complaints

Interview the staff member who has made the complaint. Take notes and confirm with them that they are happy for their name and complaint to be shared with the employee the complaint is against.
Interview any other people who are involved or who have witnessed the alleged incident. Again, take thorough notes.
Review all the information collected and decide if the complaint is justified and if so, what action is required. Remember to thank the complainant and witnesses. If no action is going to be taken advise them of this. If you are proceeding to an employment process, advise them that you are following up their complaint, but you are unable to share specifics.
If you decide the complaint is justified and the actions of the employee are unacceptable, then you need to advise the employee that a complaint has been made against them. Invite them to a meeting in writing. The letter must Include a copy of the complaint, along with all other relevant information you have, and advise the possible disciplinary outcomes if the allegations are substantiated.
The meeting is for the employee to provide their responses to the complaint allegations, prior to you making any decision. Hold the meeting at a venue and time that suits both you and the employee. They should be encouraged to bring a support person or representative, especially if there is the possibility of a disciplinary outcome like a warning. Full meeting minutes should be taken or if agreed the meeting discussion can be recorded.
At the end of the meeting advise the employee when your preliminary decision will be given. You may want to allow a few days to give you the time to fully evaluate their responses and consider any history of similar occurrences, relevant agreement clauses, and practice policies, before making your decision.
Your decision should be given as a proposed outcome to give the employee a final opportunity to respond to this (a few days) before you confirm your decision, or change it based on the final responses you receive from them.

To summarise, the guiding principles when undertaking a disciplinary process are:

investigate the allegations
fully inform the employee of the allegations
give the employee an opportunity to respond to the allegations with representation, and for you to consider their explanations, before giving your proposed decision
allow time for the employee to add to their responses before presenting your final decision.

If you have any questions about staff complaints, you can email our MAS HealthyPractice team at business@mas.co.nz or call us on 0800 800 627.

Fiona Mines | HealthyPractice Adviser, MAS

This article is of a general nature and is not a substitute for professional and individually tailored business or legal advice. © Medical Assurance Society New Zealand Limited 2024.

ACC app helps older patients maintain balance

Intro: Nymbl, a free app provided by ACC, can help your older patients improve and maintain their balance, helping them stay independent and enjoy the life they want to lead.

Has your practice ever treated an older patient for a fracture and then found them back in your consult room just a few months later? Or worse, found out their mobility has now reduced to such an extent they need constant care in a rest home?

This will be a familiar story to many of you, and, unfortunately, it is likely to become even more common over the coming years.

New Zealand has an aging population – projections suggest we might see people over 85 doubles in the next 15 years.

This will have major ramifications – both for your practice and the wider health system. We know our strength and balance decline as we age, increasing our risk of suffering serious injury from falling over.

Falls account for nearly 40 percent of all ACC injury claims, and 22 percent are in the over-65 age group.

Every year, one in three people over 65 injure themselves in a fall, rising to one in two once they reach 80.

Many of these fall’s result in serious injury, such as a hip fracture, hospitalisation or even death.

But there is a way to tackle this growing problem and help your older patients maintain their independence.

Next time your practice sees an older patient, introduce them to Nymbl. It is a training app designed to help older adults test, maintain, and improve their balance.

Nymbl is fun, easy to use and free – it is fully funded by ACC.

It uses dual tasking, combining simple body movements with easy brain games, like trivia, to challenge both the brain and body.

Nymbl can be a great complement to community strength-and-balance classes, allowing your patients to work on their balance from the comfort of their own homes. To improve their strength and balance and reduce their risk of falling, they only need to use Nymbl a few times a week, and each exercise takes about 10 minutes.

Engaging regularly in strength-and-balance programmes is proven to reduce fall and fracture risk by 20 to 40 percent, while Nymbl has been shown to increase strength and balance by around 30 percent.

Penny Wilson knows the difference Nymbl can make.

Ten years ago, she fractured her cheekbone in a nasty fall. History nearly repeated more recently when she enjoyed a day out with her family and felt herself falling again.

“I had that same sickening feeling – I’m going to hit the ground, and I can’t stop,” the 81-year-old says.

Luckily, Penny had been regularly doing her Nymbl exercises.

Near to hitting the ground and without conscious thought, Penny’s leg came back up under her body. Her upper body arched backward, and suddenly, she was standing upright and walking forward.

“None of the bystanders could believe it. They all thought I was going to fall flat on my face,” she says.

Penny says the change in outcome could only be attributed to her work with Nymbl.

“They say you must do the trivia and body movements simultaneously because it’s automatic. That’s exactly what happened – I self-corrected without knowing it.”

ACC Injury Prevention Leader James Whitaker says Nymbl has a crucial role in improving the balance of older New Zealanders.

“Most falls are preventable – we want to dispel the idea that falling over is part of the ageing process,” he says.

“Falls can have a significant impact on a person’s quality of life, so we want to do all we can to prevent them from happening in the first place.

“We want to help New Zealanders stay on their feet, enjoying their independence and leading the life they want to live.”

As a health professional, you play a key role in maintaining the well-being of older adults. Nymbl can be a valuable tool for you to share with your patients to help them stay independent well into their later years.

It’s a free and easy way to connect your patients at risk of falls with an intervention.

Let them know they can access Nymbl on their smartphone or tablet by searching ‘Nymbl training’ in the Apple App or Google Play stores.

Head to the ACC website to learn more: https://www.acc.co.nz/preventing-injury/trips-falls/preventing-falls-for-over-65s.

Thank you to everyone who has already completed the PMAANZ Biennial Survey. If you haven’t had a chance yet, I really encourage you to. The more results we get, the richer the data and information will be that we can provide to our members.

My next project for the Executive is to review the budget and make recommendations to the committee for the next year and beyond. PMAANZ continues to grow its membership base, and we want to ensure that we are using your membership fees to provide services and information that you value and that benefits you. The survey is a useful tool to gain feedback from members and assist the Executive with this. We also invite you to contact any of the Executive committee members if you have further feedback or ideas.

In other news… I recently attended the Linda Hutchings training organised for the PMAANZ Waikato branch members. Many thanks to Michelle Meenagh for organising this. It was fantastic training, and for those of you considering going to the masterclass at the conference run by Linda, I highly recommend it. She is an entertaining and knowledgeable trainer who will challenge you and leave you with many ideas of how to be a better leader and communicate clear expectations for your team. One of my takeaways from the day was, “The standard you walk past is the standard you accept.” How many times do we ignore behaviour because we think it is a “one off” or weren’t brave enough to address it at the time. So, my challenge is to address it in the moment, no matter how uncomfortable that conversation might be.

Have a fabulous week and keep smiling.

Wendy Harris | PMAANZ Treasurer

Have you registered yet?

The PMAANZ 24 Conference at the Cordis Hotel, Tamaki Makaurau, from 14th -16th September promises to be an enriching experience for Practice Managers and Administrators.

With a carefully curated program, the conference aims to foster development and leadership skills, particularly through the masterclass led by Linda Hutchings. Her expertise in nurturing current and new leaders is invaluable in today's dynamic healthcare environment. Attendees will also benefit from the diverse range of speakers and workshops designed to provide educational insights and practical tools for professional growth.

The reception day's focus on well-being, privacy, and conflict resolution highlights the conference's commitment to addressing the multifaceted challenges faced by healthcare professionals. This year's Casino Royale-themed dinner adds a touch of excitement and is an event not to be missed.

The dedicated committee, including Iain Watkins, Della-Maree Trask, Jessica Dodds, and Ruth Mansell, is a testament to the collaborative effort behind our conference this year.

Register Here!

Jen Kaponga | PMAANZ Conference Convenor

It has been a slow start to 2024, for the education portfolio. Nevertheless, I have noticed with the plummeting temperatures and early dark nights, a flurry of new education papers to be marked. Huge congratulations to Kylie Wright from Te Rengarenga medical, and Brodee Devonshire and Tracey Reihana from Raukura Hauora o Tainui for achieving their Bronze papers. If you have been thinking about undertaking one of our PMAANZ or UNEP's papers, now is the time. If your workplace cannot support you or you do not have the financial means to take these papers, our scholarship applications are about to go live. Scholarships are an excellent resource for those who desire to continue their education. Keep an eye out for details on our website and social media pages.

As some of you may know, I am the Practice Manager for Third age health, a company that provides care to residential facilities nationwide. I was recommended an excellent book series called Thursday murder club.

'In a peaceful retirement village, four unlikely friends meet up once a week to investigate unsolved murders.

But when a brutal killing takes place on their very doorstep, the Thursday Murder Club find themselves in the middle of their first live case. Elizabeth, Joyce, Ibrahim and Ron might be pushing eighty, but they still have a few tricks up their sleeves.

Can our unorthodox but brilliant gang catch the killer before it's too late?' It is the kind of read where you don't need to concentrate too hard. Plenty of good old British humour. It is perfect to cuddle up in bed with a cuppa and some sneaky chocolates.

Niomi Flemming | PMAANZ Education

Kia ora

Welcome all new members of PMAANZ. We are thrilled to have you on board and hope you enjoy your first edition of the PMAANZ newsletter.

I have noticed that these last few weeks, I am going to work in the dark and coming home in the dark. So winter is coming sooner than I thought. Like most of you, we have been busy with lots more paper war, staff shortages, and COVID has been visiting. But we will get there in the end, at least if winter is near. It’s time for a good book, blanky, and relax.

Weren’t the solar flares amazing? This was from a weeeee settlement called Scott’s Ferry, which overlooks the Rangitikei.

Toni (hubby) and I are heading away with the caravan over the long weekend, which we are really looking forward to. Happy hour at 4 pm, games, reading books, and being tourists. Those who may have a caravan or motorhome will know what I mean.

Since the last newsletter, I have been busy in the garden and frantically crocheting a blanket for my sister-in-law’s birthday. Umm, I don’t think I will get it done by then. But it’s the thought that counts. I haven’t had much time to read, but going away in the caravan, it will happen.

I hope everyone is looking forward to our PMAANZ Conference, I certainly am, there is some amazing speakers coming.

Well, that’s it from me. If any members need help with anything don’t hesitate to contact me any time. I will try and answer as soon as possible.

Have you been watching our social pages - lots of content has been posted about our conference sponsors and speakers! We would really appreciate you sharing among your networks on your socials if you are happy to 'like and share'.

We have two webinars coming up in June that you might like to register for:

Q&A session with Mary Morrissey - on 12 June
Cyber Security webinar - one 27 June

Information and links to register for these are on our events page. Click here.

Wellington Branch Update

On March 11th, we welcomed Australian Practice Management expert (“guru”) Gary Smith to Wellington for the first of four roadshows around the country. The event was well attended, and the participants soaked up his one-liners, humour, and wealth of knowledge and experience that he generously shared. Many of us look forward to the book he and Colleen have just finalised. Days like this reinvigorate and refresh our sense of passion for the complicated role that we have. They also reinforce the benefits of networking and knowing that we are not alone – someone in the room always has some wisdom to share.

We appreciated PHO, Tu Ora Compass Health’s support in hosting us in one of their conference rooms.

Also, if you attended the Roadshow earlier this year, Gary Smith has sent us the link for you to purchase his book.

Principles of Healthcare Practice Management: Your Handbook: Gary Smith

Our most recent event was a three-hour Te Reo pronunciation workshop on Friday, May 24th. Krissi from Kūwaha gave us many insights and a useful tool to help with the pronunciation of Te Reo. While only a small group attended, everyone found it beneficial.

There has been some movement in Practice Management around the region, so if Wellington members know of any new managers in their neighbouring practices, please let me know. It would be great to reach out to them.

On a non-PM note, a lot is happening in Wellington, including live theatre, gin festivals, and high-performing local sports teams playing live in front of good crowds, to name but a few. It is great to feel a bit of the buzz coming back to the city (though I am sure the city will feel the impact of all the public sector redundancies). We’ve had some pretty amazing autumn days, so if you need a mini break, maybe consider the “coolest capital.”

Regards

Wellington Branch Chair/Co-ordinator: Wendy Slight

Bronze Sponsor: Tū Ora Compass Health

The PMAANZ Practice Manager Specialist of the Year Award recognises and rewards a practice manager for their contribution to the profession of Practice Management.

The last 2-3 years have been unprecedented as managers have navigated the pandemic and various weather events to get the team and the practice through difficult times.

If you know of a skilled and knowledgeable practice manager who is also a great leader, nominate them now for the 2024 PMAANZ Practice Manager of the Year Awards. there is no better way to acknowledge them for their skills and dedication!

Nominate Now!

2024 Scholarships are now OPEN!

We are excited to announce that our scholarships that will be available this year are:

1 x Knowledge and Skills Framework Bronze Paper
1 x Knowledge and Skills Framework Silver paper
1 x UNE Partnerships Scholarship of $3,450.00 sponsored by General Practice New Zealand.

Applications are requested from current financial Registered Members and Practice Membership members of PMAANZ.

Go to our website and get all of the information you will need along with the application forms which will need to be emailed to education@pmaanz.org.nz by 18 August 2024.

Click the link to find all the information and forms.

Welcome to the 2024 Practice Managers and Administrators Association of New Zealand biennial survey. This survey provides the Association with important information to assist the Executive with strategic planning and provides you with information to benchmark your remuneration alongside practices of a similar profile.

We believe this is an invaluable tool in identifying current levels of remuneration as well as potential disparity.

As this is the eleventh survey, we have conducted we now have empirical data which enables us to better understand the changes that have occurred in the health sector.

Please feel free to share our Survey among your networks as we would love to have as many responses as possible. We look forward to sharing the results with our members later this year.

Click on the link to complete the survey

NZ Doctor Read / Newsletters and Publications

We are always adding to the page of NZ Doctor articles, click the link.

We also have publications that might be of interest to you, click the link.

To read our Partner newsletters which might be of interest, click the link.

Collaborative Aotearoa | Paramedics in General Practice: Extended care teams that enable timely access to same day

The role of paramedics is evolving beyond ambulance response, with an increasing number of paramedics now working in general practice settings. This shift is driven by the need to provide same-day access for patients to primary care services and the ongoing workforce challenges general practices face.

Traditionally, paramedics have been associated with ambulance services, providing critical care in urgent situations in the community. However, their extensive training and clinical skills make them well-suited for broader responsibilities in primary healthcare. In general practice, paramedics can take on a variety of roles, including conducting home visits (including end-of-life), triaging patients (both in person and over the phone), and supporting and delivering acute care clinics. Their scope is extensive and very complimentary to the other primary care team members.

Integrating paramedics into general practice brings numerous benefits. For patients, this means quicker access to healthcare professionals who can address a range of medical needs. It also has a huge professional benefit for the paramedic workforce, enabling them to have an alternative career path to ambulance services. The life span of a paramedic is often short due to the nature of ambulance service work. If we can extend their career in healthcare by providing alternative employment options, this has benefits sector wide.

For general practices, the presence of paramedics helps distribute the workload more evenly, allowing GPs to focus on complex cases and longer consultations. This collaborative approach enhances the overall efficiency of the practice, ensuring that patients receive the right care at the right time.

Several general practices internationally and in Aotearoa have already seen positive outcomes from integrating paramedics into their teams. For instance, a practice I visited a couple of months ago in Taranaki reported a significant reduction in urgent care and emergency department visits after employing extended-care paramedics to manage patients with same-day acute needs. Patients expressed high satisfaction levels, appreciating the prompt and personalised care they received.

To maximise the effectiveness of paramedics in general practice, ongoing training and collaboration are essential. Collaborative Aotearoa established a working group to drive a collective approach to introducing this extended workforce into general practice. The working group is compiling a set of standing order templates that practices in Aotearoa can adjust and adopt. We have also created a toolkit that explains everything from their scope of practice to insurance requirements, clinical supervision, and job descriptions.

This resource is available through Collaborative Aotearoa member PHOs or the Collaborative directly.

Integrating paramedics into general practice is a promising development in the primary healthcare landscape. It reflects a broader trend toward multidisciplinary teams and patient-centered care elements that have always been at the heart of the Healthcare Home model of care. As more practices embrace this model, the benefits to patients and the healthcare system are becoming increasingly evident.

Paramedics and Extended Care Paramedics, in general practice, represent a valuable asset in enhancing the quality and accessibility of care. By leveraging their skills and expertise, general practices can provide more comprehensive and efficient services, ultimately leading to better health outcomes for whānau.

Jess Morgan-French

Books / Movies / Shows - recommended by our members

Mary's Show Reviews

The Gentlemen - Netflix

The Gentlemen is an action-comedy television series created by Guy Ritchie for Netflix.

Edward Horniman unexpectedly inherited an estate of 6000 hectares and the title of Duke of Halstead at the reading of the last will and testament of his deceased father. He learns that the land has become part of a weed-growing empire run by Susie Glass. He must navigate a world of eclectic and dangerous characters with nefarious agendas, while also trying to protect his home and stay alive.

Bodkin - Netflix

Bodkin is an Irish dark comedy thriller television series on Netflix. Gilbert Power, an American podcaster looking to discover his Irish roots, travels to Bodkin, an Irish coastal town, to investigate a cold case involving three people who disappeared. He is joined by Dublin-born Dubheasa "Dove" Maloney, an investigative journalist in London who is sent on assignment after the death of her source, a government whistleblower.

Mary's Book Reviews

Alex Lake - Ready or Not

Alice and Tom Sark seem to have it all – a wonderful marriage, a gorgeous baby, a beautiful home. And now Alice, a journalist, starts investigating a story which could make her career – a serial killer in their town.

Very quickly though, the murder case takes its toll. Alice and Tom begin fighting all the time. Their baby daughter just won’t stop crying. And sometimes it feels almost as if they’re being followed…

The killer has found a new family to target. And the clock is ticking for Alice and Tom to stop their worlds being destroyed forever.

Alex Kava - Compulsion

FBI Special Agent Maggie O'Dell is just starting a vacation when she gets a call from her friend, psychologist Dr Gwen Patterson. One of Gwen's patients, Joan Begley, is missing. At first Maggie dismisses Gwen's concern. But when the body of a woman is discovered in an abandoned rock quarry in Connecticut, Maggie heads to the small town on 'unofficial' business. Soon the shocking news surfaces that more bodies have been discovered, and Maggie is drawn into a case that confounds both local law enforcement and a seasoned criminal profiler like herself. But where is Joan Begley? Is she in fact the woman discovered buried in the quarry?

Or is she the unwilling guest of a killer obsessed with possessing an unimaginable prize from his victims?