The Health Leader – Winter 2017

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THE HEALTH LEADER Vol. 4 No.1 Winter 2017

FOCUS ON BETTER HEALTH SERVICES FOR REGIONAL, REMOTE AND RURAL AUSTRALIA PLUS … #2017Congress: The winds of change – adjust your sails Change management for clinical programs



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CONTENTS THE HEALTH LEADER IS PUBLISHED BY:

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susceptible

vaccinated but susceptible

ON BEHALF OF:

10 The Australasian College of Health Service Management (ACHSM) ABN 41 008 390 734 | ISSN 2203-8760 Suite 301, Level 3, 5-9 Devlin Street, Ryde NSW 2112 PO Box 959, Ryde NSW 1680 T: +61 2 8753 5100 F: +61 2 9816 2255 W: www.achsm.org.au

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Features

GENERAL ENQUIRIES:

NOT PROTECTED 10.0% vax rate

All editorial enquiries should be directed to ACHSM

Evidence to guide better health service planning for rural and remote Australians Change Management for Clinical Programs – Implementation of the eMR Connect Programs across NSW Health Essentials for Remote Managers: A Remote Management Pilot Program Herd Immunity – Why you probably won’t get measles in Australia

Regulars NEWS #2017Congress

Accounts: +61 2 8753 5140 Congress and Events: +61 2 8753 5130 Membership: +61 2 8753 5115 NOT PROTECTED E: healthleader@achsm.org.au Managing Editor: 30.0% vax rateRobin Dosoruth

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PACHSM leading in global push to professionalise Healthcare Management

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New Regional, Rural and Remote Special Interest Group

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OPINION Reflection: A year at Justice Health and Forensic Mental Health Network

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INTERN PROFILES Justin Lyon – NSW Management Intern

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Michaela Ward – NSW Management Intern

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MEMBER PROFILE Karen Bradley FCHSM

© All material in this magazine is copyright and may not be reproduced, in part or in full, by any means, without the written permission of the publisher.

THE ACHSM TEAM NATIONAL OFFICE: Catherine Chaffey Chief Executive Officer E: catherine.chaffey@achsm.org.au

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Promoting Professional Accountability Program now offered in New Zealand

Editor: Trish Riley Advertising Sales: Crowther Blayne Lyndon Smith: +61 7 5553 2800 Design and Layout: Andrew Crabb, Judith Terrill, Michelle Triana Administration: Robin Dosoruth Printed by: Bluestar Web

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IN THE LOOP 29 ACHSM COUNCILS 41 DIRECTORS 42

Richa Apte Membership Adminstrative Officer 83.8% vax rate, similar to E: membership@achsm.org.au Santa Cruz County, CA T: +61 2 8753 5125

AUSTRALIAN CAPITAL TERRITORY BRANCH: Rebecca Byrnes Branch Support Officer E: act@achsm.org.au

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contact with an infected

NEW SOUTH WALES BRANCH: Sharlene Chadwick Executive Officer E: sharlene.chadwick@achsm.org.au T: +61 2 8753 5120 Yaping Liu Librarian E: Library@achsm.org.au T: +61 2 8753 5122 Kathy Maxwell NSW Administration Officer E: hmip.nsw@achsm.org.au T: +61 2 8753 5121 QUEENSLAND BRANCH: Adam Lenihan Branch Manager NOT PROTECTED

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E: adam.lenihan@achsm.org.au T: +61 7 3229 3172 SOUTH AUSTRALIA BRANCH: Lou Williamson Executive Officer E: sa@achsm.org.au VICTORIA BRANCH: Julie Owen Executive Officer E: julie.owen@achsm.org.au T: +61 3 9654 5641 Jennifer Allen Administration Officer E: jennifer.allen@achsm.org.au T: +61 3 9654 4111 WESTERN AUSTRALIA BRANCH:

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Executive Officers E: wa@achsm.org.au

Sylvia Chin Accountant E: accountspayable@achsm.org.au T: +61 2 8753 5141

Jayanthi Mohanakrishnan President E: president@nzihm.org.nz

Robin Dosoruth Marketing & Communications Manager E: robin.dosoruth@achsm.org.au T: +61 2 8753 5151

HONG KONG COLLEGE OF HEALTH SERVICE EXECUTIVES:

Erica Jones National Events Coordinator E: erica.jones@achsm.org.au T: +61 2 8753 5124

Anders Yuen E: yuencm@ha.org.hk T: + 852 25898333

Rex Matthews Finance & IT Manager E: rex.matthews@achsm.org.au T: + 61 2 8753 5140 Alison McCann Executive Assistant to CEO E: alison.mccann@achsm.org.au T: + 61 2 8753 5111 Melissa McLennan Congress and Events Manager E: melissa.mclennan@achsm.org.au T: +61 2 8753 5130 Jack Muranty-Wilkins Marketing and Communications Intern E: jack.muranty-wilkins@achsm.org.au

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FOREWORD

From the President Welcome to the Winter 2017 edition of The Health Leader.

Many members attended the National Rural Health Alliance Conference NRHC in Cairns in April where further connections and plans were made. (See news section) EAST COAST ROADSHOW I had the recent pleasure of meeting with members of the NSW, ACT and Vic State Branch Councils in late March. Queensland BC also invited me to join in a teleconference during their strategic planning day. There is a great level of enthusiasm building around the nations as we identify our key mandate – to grow leaders and build better leadership for health. In Canberra I also met with Indigenous Health Minister Ken Wyatt, advisers in Health Minister Greg Hunt’s office, Shadow Health Minister Catherine King and in Adelaide with SA Health Minister Jack Snelling. All expressed a commitment to the College’s goals and pledged support for our vision to grow our College. I have also participated in meetings in Darwin where we are close to re-establishing a Branch – again, an exciting development.

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want to update you on some important work happening in your College this year and at the same time encourage you to continue in your journey of healthcare leadership and management development. Our health management competency framework endorsed by the Board last year is now being utilised for all our professional development events. You will have noticed that events listed on the ACHSM website at achsm.org.au/events now display domains of practice and skill sets relevant to the content of the presentation. The aim is to assist members in having a clearer understanding of the skills, knowledge and practical learnings they might receive by attending the various educational offerings.

Finally I am also enthusiastic about the upcoming National Congress in Sydney, which is shaping to be even bigger and better than Brisbane and Melbourne. My thanks to all the committees involved in the preparation. Let’s continue to grow our College and advocate for greater investment in development of leadership and management capacity in our health systems and organisations. Dr Neale Fong FCHSM (Hon) President Australasian College of Health Service Management

INTERNATIONAL HOSPITAL FEDERATION HEALTHCARE MANAGEMENT SPECIAL INTEREST GROUP (SIG) In August 2016 I was appointed chair of the SIG that is leading the professionalisation of healthcare management at an international level. ACHSM presented its work on the competency and leadership framework at the IHF World Congress in Durban in November 2016. Following this event many contacts have been made with the College about potential support and collaborations, and more of this exciting news will be shared over the coming months. A workshop held in Washington DC earlier this year also mapped out a three-year work plan for the SIG. (See news section) REGIONAL, RURAL AND REMOTE SIG I am thrilled that Mark Diamond (national board member from South Australia) has taken the lead in establishing this group. The RRRSIG will be looking closely at how the College can better meet the needs of health managers in regional, rural and remote areas.

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NEWS

#2017Congress: Sydney counts down to health leadership’s peak annual event The Hilton Sydney is set to be an outstanding venue for the joint 2017 ACHS/ACHS Asia-Pacific congress.

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ith exceptional facilities for business or leisure, Hilton Sydney is superbly located right in the heart of the city, boasting magnificent views and convenient access to Sydney’s favourite attractions, including Darling Harbour, Sydney Harbour Bridge and Bondi Beach. Scheduled to start on Wednesday 27 September and running over three days, this peak event for health managers will feature quality, experienced speakers from their respective fields. Already, the following speakers have been confirmed: • Helen Bevan, Chief Transformation Officer, Horizons, NHS England • Ita Buttrose, a truly exceptional Australian, a legendary media trailblazer, businesswoman, best-selling author, committed community and welfare contributor and the former 2013 Australian of the Year • Chai Chuah, Director-General of New Zealand Dept of Health • Lesley Dwyer, Chief Executive Medway NHS Foundation Trust • Stan Grant, veteran TV journalist, advocate for the rights of Indigenous Australians • Elizabeth Koff, Secretary, NSW Health • Catherine King MP, Shadow Min for Health and Medicare, Fed Member for Ballarat • Ray Pentecost, Policy Director, Global Green and Healthy Hospitals, Health Care Without Harm • Scott Slotterback, Policy Director, Global Green and Healthy Hospitals, Health Care Without Harm ‘THE WINDS OF CHANGE – ADJUST YOUR SAILS’ The theme for this year’s joint congress is ‘The winds of change – adjust your sails’. Change is inevitable in all sectors these days and the rate of change is rapid. How does healthcare adapt to change, continue to reinvent itself and stay ahead of the wave of changes that it inevitably faces? Looking at the themes of topics throughout the program, in the plenary as well as concurrent session, we get a sense of some of the areas

of focus that thought leaders in health management are already spending time and effort on. Pre-congress workshops early on Wednesday 27 September focus on high reliability, improvement and future-proofing. The plenaries then ramp up the nautical theme with ‘Navigating the stormy seas’, ‘Tackling the winds’, and so on. Already, the tone is set: health care and health management are facing rough seas caused by the rate of transformation – advances in technology, the level of awareness that patients have about their health and the level of care they rightly feel they are entitled to are making waves. This is compounded by the imperative to do more with less and continuously seek to achieve greater efficiencies.

PARTNERSHIPS Once again we have joined forces with the Australian Council on Healthcare Standards (ACHS) to bring you our annual congress. This partnership has proved fruitful and successful over recent congresses and continues to strengthen our reach to health management professionals and organisations that prioritise quality in healthcare delivery. We have also secured support from a number of supporting organisations and exhibitors which we have listed on our website, www. achsm.org.au PERIPHERAL ACTIVITIES As is usually the case around congress time, we will hold our Fellowship examinations in

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the days leading up to the start of this year’s congress. There are also a number of tours being organised on Friday 29 September, information for these is also available on our website. ACCOMMODATION We have organised discounted rates and blocked out rooms for this year’s congress in partnership with In-house Event Solutions. This company will handle your accommodation booking and you can do this online through our website, which will take you to theirs. Due to the congress being held during school holidays and rates in Sydney being generally high around that time, we invite delegates to book their accommodation early to avoid having to pay higher rates. At the time this edition of The Health Leader is going to print, early bird rates for registration will no longer apply. That said, one way to secure cheaper pricing on congress registration is to be a member of ACHSM, which also gives you access to member rates for other professional development events held by our Branches. xyz

TO REGISTER, VISIT ACHSM.ORG.AU/CONGRESS SUPPORTERS: SPONSORS@ACHSM.ORG.AU EXHIBITORS: EXHIBITORS@ACHSM.ORG.AU

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NEWS

Promoting Professional Accountability Program now offered in New Zealand Cognitive Institute—part of the not-for-profit Medical Protection Society—has announced it will begin offering the Promoting Professional Accountability Program (PPA) to New Zealand hospitals and healthcare organisations.

Dr Neale Fong, ACHSM National President

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he program aims to support organisations and healthcare professionals to provide the highest levels of safe and reliable care. The PPA is a comprehensive, evidencebased program that builds on the existing professionalism and commitment of the overwhelming majority of staff, while ensuring the actions of no one individual can undermine a culture of safety and reliability. In a recent announcement to hospital CEOs, directors, executives and stakeholders, Cognitive Institute General Manager, Matthew O’Brien, said the program supports healthcare organisations to build on their quality and reliability improvement initiatives by creating a systemic, positive environment where clinicians can support each other to deliver safe care, and address unprofessional behaviours that impact on safety culture. The decision to offer the program in New Zealand comes in response to continued interest in the Institute’s expertise implementing the program and follows a year of planning and consultation with stakeholders. ‘While this is an internationally recognised program, its success comes from ensuring it is adapted to the local context. During the past year we have been working closely with professional, employment and hospital stakeholders to adapt the program to ensure it respects and responds to New Zealand healthcare,’ Mr O’Brien said. ‘Delivered in partnership with Vanderbilt University, the program is currently being implemented through Australia, Singapore and the United States of America. Multiple empirical studies have demonstrated the effectiveness of the program, or its components.’

ACHSM National President, Dr Neale Fong (seated centre) chaired the International Hospital Federation (IHF) Special Interest Group Healthcare Management in Washington DC in February this year.

ACHSM COMPETENCY FRAMEWORK This work ties in with the rolling out of the College’s Master Health Service Management Competency Framework, which sets out Domains and Skills required for growing and developing health service managers. xyz To know more about our competency framework, visit: achsm.org.au/myskills. Cognitive Institute will be hosting a series of information briefings in Auckland, Christchurch and Wellington during March. More information about the program is also available at: www.cognitiveinstitute.org/PPA For more information about the Promoting Professional Accountability Programme visit: www.cognitiveinstitute.org/PPA or contact Louise Cuskelly on: 0800 777 512 or +61 7 3511 5082

VIC HMIP applications opened 1 July 2017 The Health Management Internship Program (HMIP) offers committed, high-potential Interns the opportunity to develop the skills, capabilities and knowledge required to start a career in managing the challenges and complexities of health service delivery across Victoria.

Applications for the 2018 intake of the VIC Health Management Internship Program opened 1 July 2017.

The Victorian program has gone from strength to strength in recent years, with an increasing number of applicants and management interns being accepted, not to mention placement organisations that recognise the benefit of incorporating these carefully selected candidates into their operations.

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ACHSM leading in global push to professionalise Healthcare Management ACHSM is taking a lead role in an exciting worldwide effort to support the professionalisation of healthcare management at an international level. Authors, Dr Neale Fong, Chair of the IHF Healthcare Management Special Interest Group and ACHSM National President and Donelle Rivett, Secretariat HM-SIG and Manager, Paxon Group

ACHSM was an original member of the International Hospital Federation’s (IHF) Global Consortium for Healthcare Leadership and, after three years of consultations and workshops, launched the Global Leadership Competencies for Healthcare Services Managers Directory in October 2016. ACHSM National President Dr Neale Fong is the Chairman of the IHF Health Management Special Interest Group (HM-SIG) that has been charged with promoting the formal recognition of healthcare management as a profession, supporting the adoption and use of the Global Healthcare Competency Directory and supporting emerging healthcare management associations, particularly in developing and Low Middle Income Countries (LMIC). The HM-SIG was established out of recognition that the efficient and effective use of resources and the quality of healthcare services provided is vastly improved by enhancing the management capacity and competencies of individual leaders and teams. However, healthcare organisations face two key barriers to realising the benefits of professional management. The first is the lack of adequate management preparation in the training of many healthcare leaders and the second is the fact that the role of healthcare manager is not recognised as a profession in all countries. At a recent workshop, jointly hosted by the IHF at the Pan American Health Organisation in Washington DC, USA, consortium members agreed to focus on five priority areas for the HM-SIG to progress for 2017-2019: • Promoting utilisation of Healthcare Management and Leadership Competencies Directory; • Promoting the development of Healthcare Management Associations (regional and/or national); • Sourcing funding for HM-SIG activities;

• Developing collaborative partnerships with academia and education accreditation agencies; and • Developing a research agenda to underpin SIG Objectives. The HM-SIG has established working groups who will develop and implement a work plan to progress these initiatives over the next six months. These groups include members from national health and hospital associations, accreditation agencies, academia and research groups, all of whom have volunteered their time to progress this critical agenda.

With strong existing relationships with New Zealand and Hong Kong, ACHSM is a unique position to support to growth and development of the healthcare management profession in the South East Asia and Oceania areas. xyz

Further information on the HM-SIG is available at www.ihf-fih.org

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NEWS

New Regional, Rural and Remote Special Interest Group In December 2016, the ACHSM Board resolved to establish its third special interest group – this time focusing on the issues relevant for members and prospective members working in regional, rural and remote Australia.

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hrough its Strategic Plan (2016-18) the Board is committed to three key goals: 1. Develop and support health leaders and managers. 2. Promote the profession of health and community leadership and management. 3. Ensure a sustainable and vibrant College for the future. The Regional, Rural and Remote Special Interest Group (RRRSIG) has been asked by the Board to identify and progress activities that are intended to fulfil these goals for College members and prospective members who work in regional, rural and remote areas. Membership to the RRRSIG is open to all members working in regional, rural and remote Australia. To register your interest please email your details to RRRSIG@achsm.org.au. We are also keen to hear from you about what you think the issues are for managers and leaders in country areas and how best the College can support you in your professional development and affiliation with the ACHSM network. Please feel free to submit any ideas to RRRSIG@achsm.org.au and we will get back in touch with you directly. Alternatively, please feel free to contact a member of the RRRSIG Working Group listed below. We will develop an action plan based on the feedback received. This web page will be the place to access information on progress we make. We look forward to your participation in enhancing the work the College does to support current and prospective members working in country areas. ELIGIBILITY FOR MEMBERSHIP To be eligible for membership to the RRRSIG you need to: • Work in a location that meets the regional, rural and remote SLA classifications defined by the Australian Institute of Health and Welfare (Rural, Remote and Metropolitan Areas Classification 2004).

• Be a current financial member of the ACHSM in any membership category. BENEFITS OF MEMBERSHIP 1. Access to the ACHSM RRRSIG webpage, including updates on rural issues and College developments and initiatives that are of particular interest to country members. 2. Access to the RRRSIG Working Group to provide ideas for service improvement to College members in regional, rural and remote locations. 3. Ability to volunteer to support particular developments in your state/territory in conjunction with State Branch Council’s. 4. Access to core business College membership services including Networking, Fellowship, Continuing Professional Development and Mentoring Programs. 5. An opportunity for you to contribute your skills to the work of the RRRSIG. The RRRSIG Working Group is keen to hear from you – particularly about what skills you can bring to the group and how you wish to be involved in doing this. xyz

WORKING GROUP CONTACTS: Mark Diamond FCHSM SA Branch Councillor, Board Director ACHSM mark@diamondconsult.com.au 0428 817 090 Dominic Sandilands FCHSM Executive Director, North and West Remote Health dominic.sandilands@nwrh.com.au 0428 984 098 Dr Scott Davis AFCHSM, Senior Director Greater Northern Australia Regional Training scott.davis68@bigpond.com 0410 477 166 Liza Tomlinson AFCHSM, Service Group Director, Townsville Hospital and Health Service Queensland Health Liza.Tomlinson@health.qld.com.au 0438 178 813 Daniel Mahony AFCHSM, WA Branch Councillor, Board Director ACHSM daniel.mahony1@my.nd.edu.au 0423 636 419

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Hea


Healthspace Australian owned and operated, Healthspace supplies fully integrated modular clinical storage and supply management solutions to healthcare facilities.

Healthspace provide a complete flexible, ISO based solution, incorporating all the components required to efficiently store stock in compliance with Infection Control (AS4187), OH&S and hospital accreditation guidelines. Healthspace also distribute ‘RN+ FALLWatch II’ - a digital wireless falls prevention system. We provide a consultancy service and work with our clients to deliver a customised solution which is seamless, holistic and flexible, not limited to but including the following services:  Strategic review  Process review and optimisation  Project management  Training and Education  Organisational design and development  Inventory review  Compliance review  Commitment to continuing to add value through developing long-term consultation Our Health Planners are experienced practicing clinicians with strong knowledge and understanding of the commercial and operational risks and challenges faced by our clients.

Healthspace implements processes and systems that are dynamic and proven in the health industry.

CONTACT DETAILS: 1300 654 327 | Email: sales@healthspace.com.au www.healthspace.com.au

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FEATURE

Change Management for Clinical Programs – Implementation of the eMR Connect Program across NSW Health In this interview Bianca Jordaan, Change and Adoption Manager for the eMR Connect Program at eHealth NSW talks about the approach to Change Management being used to implement and optimise use of the electronic medical records (eMR), including electronic medication management (eMeds), across NSW Health.

Bianca Jordaan, the Change and Adoption Manager for the eMR Connect Program at eHealth NSW.

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hat is eMR Connects’ overarching approach to change management? For us, change is all about helping people to understand what the eMR will mean for them and to feel supported and equipped to use it – and use it well. To help local teams manage this change, we focus on four key things: • Demystifying change management with the help of our Change Management Framework, which also has tools and templates that project teams can adapt for their own needs; • Providing coaching to the local change managers; • Driving continuous learning and improvement based on what we observe across all sites; and • Ensuring there is budget allocated for change resources at both the state and hospital level.

understanding how they affect the eMR. So, BAU is everyone’s business. WHAT IS THE LEVEL OF ‘CHANGE FATIGUE’ ON THE FRONTLINE OF HEALTHCARE, AND HOW ARE WE DEALING WITH THIS? There is a degree of ‘change fatigue’ but more encouragingly, we’re now at a point in rolling out eHealth technologies where end users can start seeing the rewards. We’re giving clinicians electronic tools they can use to support patient care, not just capture data. We’re also learning to support clinicians better through the critical point of going live; while this can be a difficult period, we’re now hearing positive feedback after an eMR implementation. I actually think we’re reaching a point of ‘change hunger’.

Bianca Jordaan, Change and Adoption Manager MR Connect Program at eHealth NSW

WHAT ARE SOME WAYS IN WHICH EHEALTH NSW IS ENABLING THE SUSTAINABLE AND SEAMLESS TRANSITION OF EHEALTH PROGRAMS TO ‘BUSINESS AS USUAL’ (BAU)? This is a big focus for us. We’re working hard to get the right connections between project teams and BAU teams, including up-skilling the BAU teams to support a seamless transition. The day of going live is just the beginning. It’s good to see more Local Health District (LHD) project teams looking past the go live period and continuing to be engaged to ensure the new practices are being applied and, where needed, providing extra support and training. As the eMR is reaching critical mass, people are also beginning to understand that few clinical changes can be considered without

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When people start using the eMR in day-to-day practice, they want more functionality, they want better functionality and they expect it to work like the systems they use in their personal lives. So, we’re getting to an exciting time. HOW HARD, AND THEREFORE IMPORTANT IS IT TO EMBED DIGITAL LITERACY IN THIS APPROACH? I’d first make a distinction between computer literacy and digital literacy. Back when the first eMRs were rolled out, many frontline staff would not have used a computer on a daily basis. The evolution of smart devices has

changed this, along with generational change in our workforce. Now with more than 140 hospitals and over 330 community facilities using the eMR, computer literacy levels are higher and are also supported as needed in the workplace. I think digital literacy is the challenge now. When we ask a user what they’d like the system to do for them, they talk about their needs based on their current way of working – that is, filling in forms. With the new technologies, we need to move beyond this realm of thinking, and look to their

needs based on their future way of working. Just like someone in the 1950s who had to go to a bank branch to withdraw or deposit money wouldn’t have been able to envisage moving money around the world at any time of the day from the comfort of a chair using their phone – and that same phone being pocket-sized, wireless and a camera. In the same way, our challenge is to envisage where eHealth may take clinical care in the next 40 years – we need to start thinking differently about the eMR and what it might do. HOW ARE ELITERACY INITIATIVES BEING TARGETED TOWARDS ALL STAKEHOLDERS IN THE HEALTH SYSTEM, INCLUDING PATIENTS, FAMILIES AND CARERS? When the eMR is rolled out at sites, engagement with patients, families and carers is an important element of our communication plans – we need to ensure people are comfortable with how and why their personal clinical information is being captured. Anecdotally, the on-site teams tell us that patients ‘get it’, and are very accepting of computers on wheels or other devices being used at the bedside. Our stakeholders live and work in a digital world. When I said our clinicians are starting to expect the eMR to work like the systems they use in their personal lives, the same goes for our patients and their families and carers. We need to be continually closing the gap to meet those expectations. Certainly, the eHealth Strategy for NSW Health 2016-2026 is drawing together all the elements and striving to address that. xyz

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legionella and hospital water systems There is building concern and hype around Legionella bacteria lately ever since a series of illness and deaths have occurred over the last few years in Australian Hospitals. That is because hospital water systems provide ideal growing conditions for bacterial growth often exacerbated by the facilities design, functionality and operational usage. Legionella is naturally found in potable water so its presence cannot be eliminated, however there are measures the can help manage the risks. The presence of Legionella in a hospitals water system is the only predictive factor for someone contracting Legionnaires disease and a hospital’s water pipe network is an ideal reservoir for Legionella growth. When water circulation does not regularly reach the distal outlet points of a plumbing system and circulating water remain at temperatures between 25-40°C, the risk is high for naturally occurring legionella bacteria to grow. Expensive and hazardous chemical and thermal intervention can assist in cleansing the pipes of bacteria however it may be more beneficial to increase monitoring and surveillance of the plumbing systems to help prevent and manage its growth. Dr Whiley, an Environmental microbiologist from Flinders University indicates that “Given the bacteria is common in potable water, an alternative is to assume the pathogen’s presence and focus on the management of appropriate control measures and protecting high-risk populations.” ¹ Water movement and preventing stagnation Regular water movement, both hot and cold supply lines around the distribution system is critical in managing microbial growth risks. However often the functionality of the living facility doesn’t allow for good, regular flow of water and manual intervention is prescribed. To prevent stagnation and biofilm growth Enhealth recommends all fixtures be purged within 7 days if unused. However without effective fixture usage monitoring it is very difficult to comply and can be a huge waste of time and water. Risks can be enhanced due to water efficiency regulations and low flow tapware slowing water circulation and increasing the ability of biofilms to adhere to surfaces. Add to this, hot water supply lines circulating below

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60°C and cold water lines above 20°C and the bacteria have the perfect environment to flourish. A health care facilities design and functionality needs greater consideration of risks associated to waterbourne nosocomical infections. It is common practice to design in more tap and shower outlets than needed leading to low flow areas and potential dead legs. A room’s change in functionality may impact water flow usage patterns. All outlets need to be used regularly, otherwise water within the distribution pipes and associated storage tanks become stagnant, and support the growth and proliferation of Legionella bacteria.

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what can be done? Point of use TMV’s should be installed to reduce scalding risks and minimise warm water dead legs Water distribution throughout facility at high and low temperatures greater than 60°C for hot water distribution and less than 20°C for cold water distribution Increase of water velocities and flow within the pipes for improved water movement All pipework should be lagged and wherever possible, cold pipes separated from heat sources Regular monitoring of the water distribution system. Legionella site positivity and control measures need to be routinely monitored for the life of the system Regular flushing of outlets, or purging immediately prior to use – without generating aerosols Point of use filtration ¹ 2017, Whiley www.agedcareguide.com.au/talking-aged-care/calls-to-manage-legionella-to-protect-an-ageing-population

1300 369 273 (AUS) | www.enware.com.au | info@enware.com.au

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FEATURE

Evidence to guide better health service planning for rural and remote Australians Times have changed significantly since the Royal Flying Doctor Service (RFDS) began providing health services to Australians in remote and rural areas in 1928. Like other healthcare organisations, the RFDS has had to respond to a changing safety and quality environment, and ensure that the delivery of our services are appropriate, and designed based on current and comprehensive information about the needs of the people we serve.

Lauren Gale, Director of Policy & Programs, Royal Flying Doctor Service

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ealthcare services driven by information The Australian Safety and Quality Framework for Health Care describes a vision and actions to achieve safe and high quality care for all Australians, and specifies three core principles; this includes that healthcare services are driven by information. The Framework applies in all parts of the Australian healthcare system, for use in primary, community, and acute services. In 2015, the RFDS formed a Research and Policy Unit. The unit’s role is to gather evidence about, and present the disparities in health outcomes and access to services in remote and rural areas, and recommend solutions to address these disparities. We: • Voice and respond to the health outcome and clinical service needs of country Australians, informed by our own and other sourced evidence; • Ensure the fulfilment of the Australian Safety and Quality Framework for Health Care principal of being driven by information; and • Make publicly available RFDS service data, much of which would not otherwise be available, as well as clinical research findings to contribute to public policy and clinical practice improvements. The RFDS has now published three data-driven, public policy research reports with a fourth soon to be released. The remainder of this article provides a summary of the findings of each of these reports. ORAL HEALTH The RFDS recognised the strong link between oral health and other illnesses that the RFDS responds to in emergency situations. For example, cardiovascular disease and respiratory illness are two of the most common reasons for an RFDS aeromedical retrieval: oral disease, particularly when left untreated, is associated

with cardiovascular diseases, respiratory illnesses, and other chronic conditions.

• There are three times as many dentists in cities than in country areas.

Over recent years, the RFDS has established outreach dental services throughout remote and rural Australia, providing almost 10,000 occasions of service in 2015/16 however, unmet need persists. This was demonstrated in our research paper Filling the Gap: Disparities in Oral Health Access and Outcomes, which found that: • Childhood cavities are 55% higher in remote area children; • The number of filled teeth in remote area children is double that of those in major cities; • One third (37 per cent) of remote area residents have untreated tooth decay (A quarter (23 per cent) is experienced in major cities); • Only four in ten (45 per cent) adults in remote areas visited a dentist in a year (six in ten (63 per cent) in major cities); • One in three (33 per cent) remote area residents had a tooth extraction in a year (only one in ten (12 per cent) people in major cities); and

The demonstration of these disparities in dental outcomes and service access enabled an evidence-based case to be put to policy-makers for the expansion of services. On 1 April 2017, the RFDS commenced delivery of a national, Commonwealth-funded dental services program to build on services already being provided and enable access to dental services for more remote and rural Australians. INJURY One in five RFDS aeromedical retrievals are in response to an accident or injury. Consequently, we wanted to know more about the reasons impacting this activity trend and how these rates could be minimised. The report Responding to Injuries in Rural and Remote Australia found that: • Two thirds of injured patients requiring an RFDS aeromedical retrieval were males; • More than one in four injured patients and RFDS aeromedical retrieval were Indigenous;

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as Indigenous males to require an RFDS aeromedical retrieval; • The average age at which an Indigenous Australian underwent an RFDS aeromedical retrieval was 30–34 years; • Children aged 0-4 years were the group of Indigenous patients most likely to require an RFDS aeromedical retrieval; and • Indigenous Australians were most likely to require an aeromedical retrieval for an injury, diseases of the circulatory system (e.g. heart attack or stroke), or diseases of the respiratory system (e.g. influenza, pneumonia).

2015/16 Snapshot (Across a 7 million square km service footprint, flyring over 26 millions kms annually) DAILY AVERAGE Total patient contracts

ANNUALLY

775

282,788

Patient transports

247

90,411

(37,252 aero: 53,159 road)

Primary health care clinics

39

14,172

Telehealth consultations

170

62,372

Dental episodes of care

27

9,845

Primary air evacuation

67 aircraft

Inter hospital air transport 23 aero-medical bases

Non-emergency patient road transport

Primary health care clinics

93 non-emergency road transport vehicles

GP/Nurse telehealth

13 road transport bases

• People living in remote and rural areas are twice as likely to die from, or be hospitalised for an injury, than people living in major cities; • The injury death rate for residents of remote Australia is 1.8 times the injury death rate of residents of major cities; and • Injury hospitalisation rates for residents of very remote areas are 2.2 times higher than for residents of major cities. Importantly, this research found that across every measure, rates of intentional and unintentional injury and associated death are higher in country Australia than in major cities.

Mental health

Dentistry

3 mobile dentistry vehicles

1 mobile eye care vehicle

Health promotion and wellbeing

Research and Policy

1,385 staff – (Health, Aviation, Fundraising, Administration)

For example: • Road fatalities: Although more than two thirds of Australia’s population live in major cities, more than half of road fatalities occur on rural and remote roads; • Workplace injury: Injury fatality rates for agricultural workers are nine times higher than any other industry; • Poisoning: Death rates from poisoning are 3.5 times higher in remote areas compared to major cities; and • Assault deaths: Australians in remote areas are 3.8 times more likely to die from an injury caused by assault than in major cities. The RFDS has urgently recommended that a new National Injury Prevention Strategy needs to be developed by Australian governments, with targeted interventions for rural and remote Australians as a priority group, along with Indigenous Australians and males aged 20 – 29. The RFDS, in partnership with other service providers, is also considering appropriate local-level initiatives. INDIGENOUS A third of RFDS primary healthcare services, and more than one-quarter of RFDS aeromedical retrievals – roughly 19 every day – are provided to Indigenous Australians. The research paper Providing Aeromedical Care to Remote Indigenous Communities analyses the demand and reason for these aeromedical retrievals of Indigenous Australians by the RFDS from remote and very remote areas of Australia. An analysis of these aeromedical retrievals found that: • Indigenous females were 1.2 times as likely

These top three reasons for an RFDS aeromedical retrieval of an Indigenous Australian, are each, to a large extent, preventable. This evidence supports that timely and culturally appropriate access to healthcare, including primary healthcare and chronic disease management, for Indigenous Australians in remote and rural areas is critical. The RFDS will continue to work in partnership with communities, other service delivery organisations and policymakers to ensure this. MENTAL HEALTH The RFDS is called on to provide an aeromedical retrieval to respond to patients with a mental health related crisis at least 16 times a week – totalling more than 2,500 in the last three years. The next research paper to be published by the RFDS, Mental Health in Remote and Rural Communities, further analyses these aeromedical retrievals as well as other nonemergency mental health services provided by the RFDS, and assesses the factors exacerbating poor mental health in communities we serve. CONCLUSION In conclusion, what is clear in the findings of each of these reports is that there is not the same access to comprehensive health services in remote and rural Australia as in other areas of Australia – there is a significant disparity, and as a consequence there persists critical inequities in the health outcomes of country Australians. The RFDS will continue to build the evidence base on the existence of these disparities and identify the best way to overcome them. In particular it is hoped that making RFDS data available, much of it for the first time, will also further inform efforts by all levels of government and other service delivery organisations to make decisions on where resources are best directed. xyz

All RFDS research reports can be found at: https://www.flyingdoctor.org.au/ what-we-do/research/

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ADVERTORIAL

Day and Short Stay Hospitals Changing Market, Changing Software, Are You Changing?

The traditional model of monolithic hospitals with lots of departments, lots of staff and lots of problems, is changing. Observation of the European and American hospital market shows big changes occurring. The new hospital economy is evolving into hospital ecosystems with not only the traditional provider relationships of pharmacy, radiology, etc., but new relationships with highly specialised ‘day hospitals’. The monolithic hospital is becoming a smaller central hospital, surrounded by satellite hospitals that are specialist ‘day and short stay’ hospitals.

The new smaller general hospital is focusing on: • Emergency services – the emergency room assesses and triages patients to the appropriate satellite “specialist hospital” for expert attention • Intensive Care Units to stabilise and provide extended critical care • Long stay to provide patients non-critical care While the satellite specialist ‘day and short stay’ hospital focuses on a single speciality, or limited related range of specialities, they do it very well and very efficiently. This approach has evolved from lessons learnt in corporate models where strategies focus on core competencies and encourage the development of inter-corporate relationships to deliver complete outcomes. The GP and Dental market has been on the corporatisation road for many years, led by the likes of ‘Primary Health’. Specialists and day hospitals have been slow to get on board. Australia has seen some moves in this direction with the specialist group ‘Vision Eye Institute Limited’ leading the way by first publicly listing in December 2004. Following Vision’s success various specialist groups have consolidated under corporate umbrellas; however few have successfully gone to public listing. Specialist day hospital numbers have been growing, however they have focused on noncritical patient care and generally not been an integral partner of a core hospital ecosystem.

The specialities include: • • • • • •

Ophthalmology Gastroenterology & Endoscopy Oral and Maxillofacial Cosmetic Surgery Orthopaedic Plastic, Reconstructive Surgery

The first evidence of the evolution in Australia towards hospital ecosystems is demonstrated by Australia’s first heart hospital, the ‘Victorian Heart Hospital’, a landmark facility and the first of its kind in Australia. The ‘Victorian Heart Hospital’ will be a satellite specialist facility to the Monash Health hospital in Clayton Melbourne. We can expect to see many more specialist hospitals to appear as general hospitals themselves start to redefine and focus on core competencies and commit to human

ACHSM_TheHealthLeader_Winter_Text.indd 16

factor reengineering to improve compliance to clinical pathways, standards and protocols. This changing world has started to capture the interest of software vendors. Leading specialist software vendors like ‘HealthTrack Medical Systems’ are already releasing products and features to support these new models of care. Current ‘day and short stay hospital’ software has been segmented into the low end and the high end, with very few middle tier, value for money software systems available. Small, private day hospitals have been content to focus on billing systems to invoice Health Funds and DVA for bed charges, theatre, prostheses, and other items, while managing patients has been left to traditional GP systems for scheduling, referrals management, patient data, etc. The new era of advanced middle tier systems like HealthTrack Medical Systems deliver fully integrated functionality including in-hospital billing (IHC), patient management, admission and discharge summaries, scheduling, document management and full electronic medical records (EMR). The Managing Director of HealthTrack, Mark Ballam said “we are committed to delivering quality systems that will save time and money through fast accurate reporting while meeting statutory reporting requirements”. HealthTrack is an integrated ‘Clinical Information System’ delivering clinical and administration management for specialists, hospital departments and day hospitals. Australian built and owned, it is in use by the country’s largest and most prestigious clinics, while also servicing small, innovative and forward-thinking practices. Designed to integrate, automate, and streamline daily operations, focuses on productivity and profitability for both doctors and staff.

The HealthTrack hospital features include: • • • • • • • • • • • • • •

Patient management Inventory management Scheduling/Diary Billing/Invoicing (for private patients and corporate) In-hospital Claims (IHC) with Online Eligibility Checks Document Management Prescribing /Electronic Medications Module including Medication Clinical Decision Support Online Pathology and Radiology Management Admissions/discharge Statutory reporting including PHDB, HCP, State reporting Quality Management using automated questionnaires before and after the episode of care (Admission/Discharge) HL7 compliant – bi-directional DICOM compliant including DICOM Modality Worklist Integrates with most devices, catheterisation labs and theatres

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Day / Short Stay Hospitals by HealthTrack Medical Systems

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Patient Bookings Patient Admission Information (Questionnaire System)

Scheduling

Clinical Software

Accounting

Admissions Clinical

that exceeds expectations! Scheduling

Patients

Doctors

Day Hospitals Hospital departments and Specialist practices

Practice Management

Theatre

Operation / Clinical Reporting

Post-Op/ Recovery

Statutory Reporting

Doctor Billing Online Billing to Medicare, HF, DVA for ... Bulk Bill, Verifications, In-patient Claims, Patient Claims

Discharge

Hospital Billing Online Billing to Medicare, HF, DVA for ... Bed, Theatre, prostheses, plus other

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Patient Bookings

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FEATURE

Herd Immunity – Why you probably won’t get measles in Australia You may have heard about herd immunity (when I was in high school we actually had a science project dedicated to it), but there’s a good chance that you have never really had it explained.

Gideon Meyerowitz-Katz, second year HMIP Intern in New South Wales.

vaccinated

susceptible

vaccinated but susceptible

infected

contact with an infected person

H

erd immunity is a public health term that is one of the most important parts of the theory behind vaccination. It basically means the point at which there are enough people immune to infection to prevent people who are not immune from getting infected. It’s the reason that we don’t have to vaccinate every person to stop everyone from getting measles.

NOT PROTECTED

NOT PROTECTED

NOT PROTECTED

NOT PROTECTED

NOT PROTECTED

10.0% vax rate

30.0% vax rate

50.0% vax rate

58.5% vax rate, similar to Okanagan County, WA

68.9% vax rate, similar to Thurston County, WA

NOT PROTECTED

PROTECTED

NOT PROTECTED

PROTECTED

PROTECTED

74.4% vax rate, similar to Island County, WA

83.8% vax rate, similar to Santa Cruz County, CA

86.0% vax rate, similar to Los Angeles County, CA

90.0% vax rate, similar to Orange County, CA

99.7% vax rate, similar to Gadsden County, FL

50.0%

A lot of herd immunity is about maths. ATTACK RATES, REPRODUCTION NUMBERS AND SCARY MATHS As well as being one of my favourite public health terms, attack rate is a key part of herd immunity. It is a measure of the proportion of people who are infected by a disease in the population. Say there is a measles outbreak in a school of 100 kids. If 10 of those kids get measles, the attack rate is 10/100=10 per cent. It’s a pretty simple metric to see how many people are infected in a population by a specific disease. Along with the attack rate we can calculate a Reproduction Rate for the disease we are looking at, commonly called Ro. This reproduction rate is simply the number of individuals that are infected by each person who contracts the disease. The higher the number, the more people get infected. As shown in Infographic 2, measles has a very high reproduction rate, at 12-18 people infected. Mumps is much lower at 4-7 people. On average, each person who has measles will infect about three times as many new people as each person with mumps. HERD IMMUNITY Most diseases are infectious for a week or so, although it varies greatly. Imagine you catch measles. You are infectious for a couple of days whilst only feeling minor symptoms (cough, runny nose).

Infographic 1: Rates of infection of a certain disease, relative to the percentage of the population vaccinated.

Herd Immunity Thresholds for Selected Vaccine-Preventable Diseases Immunisation Levels Disease

Ro

Herd Immunity

1999 19-35 Months

1997-1998 Pre-School

Diphtheria

6-7

85%*

83%*

9%

Measles

12-18

83-94%

92%

96%

Mumps

4-7

75-86%

92%

97%

Polio

5-7

80-66%

90%

97%

Rubella

6-7

83-85%

92%

97%

Smallpox

5-7

80-85%

*4 doses. + Modified from Epid Rev 1993;15: 265-302, AmJ Prev Med 2001: 20 (45): 88-153,MMWR 2000; 49 (SS-9); 27-38 Infographic 2.

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You then come down with a nasty fever, and after seeing the doctor stay at home for the rest of your infectious period. In this example, you’ve limited your contact with uninfected people by staying at home once you realised you were sick. Even so, you’re still likely to have infected a significant number of people whilst you were wandering around, blissfully unaware. But what if these people were vaccinated? If the vast majority of people you ran into on the street were already immune to catching measles, you might only pass on the disease to one person before going home. If they were all vaccinated, the outbreak of measles would stop with you. This leads us to the Effective Reproduction Rate (called R). This is the rate at which a disease will spread given the percentage of a population that is already immune. It’s just the reproduction rate multiplied by the percentage of the population susceptible to the disease; if the Ro for measles is 18, and half of the population is immune, then R is 18x.5=9. In this population, each infected person will only pass on measles to 9 people, rather than 18. This is how we calculate herd immunity. For a disease to be considered stable, each person can only on average infect 1 or fewer other people. In other words, R has to be less than or equal to 1. For measles, Ro is 18. Therefore, 18x%=1, or 1/18=%. This means that the percentage of people who need to be vaccinated to prevent the spread of measles in a population has to be higher than 1–1/18, or 95 per cent. This is how herd immunity works. It’s a simple mathematical function; if enough people are immune to a disease, it cannot spread beyond the initial infected person and dies out. WHY DO PEOPLE STILL GET SICK? The first objection you’ll always hear when talking about herd immunity is “people aren’t cows”. This is naive. The second, less naive objection is “people do still catch measles, mumps, German measles, love of the dance, typhoid, etc! That means herd immunity can’t work!. Basically, if everyone’s vaccinated (and vaccines work), then how can anyone get sick? Firstly, herd immunity is a simple mathematical function. The immunity can be conferred either through vaccination or just natural immunity; most diseases peter out without vaccination around the 90 per cent infected mark, simply

WHY DOES MY CHOICE MATTER TO OTHERS?

It matters because of the concept of “herd immunity”. Here’s how it works: Not immunized but still healthy

Immunized and healthy

Not immunized sick and contagious

When no one is immunized

...disease spreads through the population

When some of the population is immunized...

...disease spreads through some of the population

When most of the population is immunized...

...spread of the disease is constrained

Infographic 3: A visual representation of the need for vaccinations and resulting herd immunity.

because enough people become immune. The second reason is simple; vaccination rates are often just not high enough to fully prevent diseases, particularly overseas. Some countries have had disease ‘eliminated’, which means that there is no reservoir of disease in the country, but many haven’t reached this point. Most of the disease outbreaks you see are people getting sick overseas and bringing it back to a vulnerable community who don’t have sufficiently high vaccination rates. WHY IT MATTERS Herd immunity is important for one reason; not everyone can get vaccinated. For example, people who are undergoing chemotherapy for cancer have compromised immune systems and can get very sick if they receive certain vaccines.

Some of them have socio-economic issues with attending the doctor. Some think that vaccines are a secret government plot to make us into docile sheep. Whatever the reason, these communities lower the rates of protection, and end up putting us all at risk. Which is unfortunate, because when people don’t get their vaccines, the most vulnerable are the first to suffer. So protect the babies, old people and chemo patients and get your vaccines. You’re probably due for a booster right now. xyz

But if enough people are vaccinated, they will be protected anyway. Australia has some of the best vaccination rates in the world, with most areas topping 95 per cent for the recommended vaccines. We have incredibly low rates of vaccinepreventable disease because of this. But there are some communities who, for a number of reasons, have lower vaccination rates.

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FEATURE

Essentials for Remote Managers: A Remote Management Pilot Program Health services are dependent upon managers effectively performing their management duties for staff to effectively deliver services that lead to positive health outcomes.

Recently, a focus on leadership and effective management practices in rural and remote health identified the need to support leadership at all organisational levels to improve the sustainability of the health system. This project report describes the experiences and key findings from the evaluation of a remote management pilot program designed and implemented as a professional development short course. The program aimed to meet an identified gap in the professional development needs of remote managers and intended to sharpen and broaden managers’ existing expertise about clinical governance, leadership and management, while increasing their capabilities and effectiveness within remote health services. Health services are dependent upon operational managers effectively performing their management duties so that service delivery leads to positive health outcomes for clients and the wider community. Identifying the need for educational support of remote area nurse managers, Wakerman and Davey1 reported ‘inadequate preparation of operational managers, associated with inadequate recognition of health service management as a health discipline and related continuing professional development and accreditation requirements’. Similarly, Onnis2 suggested that managers were the key to sustainable remote health workforces, emphasising the importance of training and support as clinicians transition into manager roles. In fact, several authors have described the need for more education and support for managers in rural and remote regions3-8. In the series ‘Back from the Edge’, Lenthall, Wakerman, Opie, Dollard, Dunn, Knight et al.4,6 reported a strong and consistent theme throughout the literature, of poor management practices, which positively correlated with increased occupational stress. This, in turn, influenced service delivery through increased

% of participants

Marcia Hakendorf, Leigh-ann Onnis and Mark Diamond

Figure 1: Participants’ perceptions of their level of understanding and capability (pre-module survey) (n=6)

workloads, high turnover, burnout and poor retention1,4-6,9. Therefore, robust clinical governance systems and processes are essential for ensuring that management practices address current issues1,4-6,9. The impetus for CRANAplus to invest in a remote management program was recognising that organisational management has a strong influence on performance management, engagement, retention, and the delivery of safe, competent, quality care5,8,10. Furthermore, there has been no specific short course (to date) that is contextualised and reflective of the challenges operational managers experience in remote and isolated areas. The National Rural and Remote Health Reform Strategy Report11 recommended, as a priority, the need to support leadership at all organisational levels to ensure sustainability of the health system

and responsiveness to the health needs of consumers now and into the future. Similarly, the recent CRANAplus National Standards and Credentialing Project Report12 recommended ‘improvements in all areas of clinical governance within remote and isolated health services’. Thus, robust clinical governance systems and leadership are essential for remote services to flourish. The Remote Management Pilot Program (RMPP) was designed as a professional development short course. RMPP supports managers in implementing tangible projects specific to their workplace need; grounded in the elements of clinical governance, and change management. The RMPP intends to sharpen and broaden managers’ existing expertise about clinical governance, leadership and management, while increasing their capabilities and effectiveness within remote health services.

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% of participants

managers to complete the RMPP. A partnership with the Australian College of Health Service Management (ACHSM) gave participants access to selective webinars and the ACHSM Mentoring program. Each participant had their own mentor, an ACHSM registered member who was recognised as a rural/remote health leader for a period of six -eight months. ADVISORY GROUP A National Remote Management Program Advisory Group was established with membership consisting of 11 senior management leaders across Australia’s remote sector. The Advisory Group met regularly and provided input to curriculum design, content and the mode of delivery as well as actively supporting implementation and evaluation processes.

Figure 2: Participants’ perceptions of their level of understanding and capability (post-module survey) (n=5)

Figure 3: Participants’ level of satisfaction of the learning materials (n=5)

RMPP achieves this aim through engaging participants in contextualised learning activities. METHOD A staged approach was used for the design, delivery, implementation and evaluation of the RMPP. A one-day pre-CRANAplus

conference workshop attended by 17 remote managers identified the need for a structured program. A preliminary call to attend the RMPP received 33 expressions of interest from remote managers. When registrations opened, 18 registrations were received; however, 11 participants withdrew, due to the impost of travel and accommodation costs, leaving seven

PROGRAM STRUCTURE The RMPP used an action learning approach with the focus being for participants to address a continuous quality improvement (CQI) issue in their workplace. The 12-week program comprised four online modules, a two-day workshop and a formal mentoring program, all of which supported participants in the development, implementation and evaluation of their CQI project. An Instructional Designer developed four online modules: Action Learning, Leadership and Management, Clinical Governance, and Project Management. These four modules were accompanied by an introductory module, which introduced the participants to the program and reflective journal writing. The two-day workshop consisted of workshop-style presentations, group discussions, and group activities. Throughout the RMPP each individual participant was contacted via Skype or telephone to provide added support. On completion of the program, participants entered into a mentorship contract with a rural or remote leader (mentor) within the ACHSM program. For successful completion of the RMPP participants were required to complete the online modules, attend the workshop (mandatory), participate in the ACHSM mentoring program, maintain a reflective journal (summary of learning), and to implement a CQI project in their workplace. PARTICIPANTS Seven managers participated in the RMPP. The majority of managers (71%) had five or more years management experience, with the remainder (29%) having less than two years management experience. According to the Australian Standard Geographical Classification13, participants were working in inner regional, outer regional and remote locations in New South Wales (43%); very remote Western Australia

Australasian College of Health Service Management 21

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FEATURE

ONLINE MODULES There was an 86% response rate to the premodule survey which sought to ascertain participants’ understanding and capability with regard to aspects of action learning, leadership and management, and clinical governance. Participants had a good-to-fair understanding and ability in relation to the topics prior to commencing the modules; although, some participants also rated themselves as poor and very good for some topics (Figure 1). There was a 71% response rate to the postmodule survey which sought to ascertain their level of understanding and capability after completing the online modules; hence, any learning and/or development that had occurred. Questions from the pre-module survey were repeated in the post-module survey to enable comparisons to be drawn for the participants’ learning. Overall, postmodule completion, participants perceived improvements across all topic areas with their understanding and capability reported in the good-to-excellent range (Figure 2). Four themes emerged from the workshop discussion about their online modules: module relevance (e.g. ‘related to practice’), new learning experiences (e.g. ‘This type of learning is different to how I usually learn’), opportunities for improvement (e.g. more time to complete the modules prior to the workshop), and management development needs (e.g. ‘reflective journal very useful’). Finally, comments such as ‘I am a nurse in a manager’s position’ confirmed the importance for this type of program so that managers are comfortable in their role as managers. The higher proportion of positive responses received for ‘at the right level’, ‘clear and concise’, and ‘effective modules’ suggested that the learning materials were appropriate (Figure 3). However, it appears that the content could be more ‘informative and interesting’, with one participant saying, ‘areas such as performance management, conflict resolution, and financial planning could be covered in future.’

Figure 4: Participants’ perception of their level of understanding and capability of Project Management (Pre-module survey) (n=6)

% of participants

FINDINGS The evaluation consisted of a tripartite approach to assess the level of relevancy to the participants learning: 1) online surveys conducted pre and post module completion, 2) workshop questionnaires, and facilitators’ notes and observations; and 3) online survey on completion of program.

% of participants

(29%); very remote South Australia (14%); and outer regional Tasmania (14%).

Figure 5: Participants’ perception of their level of understanding and capability of Project Management (Post-module survey) (n=5)

In summary, the post-module results show that participants rated their level of understanding and capability as good-to-very-good in all areas relating to leadership and management, clinical governance and project management. From an educational perspective the participants’ results showed the online modules were pitched at the right level in meeting their

learning needs. Most participants (80%) agreed that the online learning helped to develop the necessary project management skills. QUALITY IMPROVEMENT PROJECT For project management, their pre-module perceptions revealed that further knowledge and skill development was required across

22 Australasian College of Health Service Management

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% of participants

An evaluation of the overall RMPP was conducted, capturing participants’ understanding and capability using the same criteria as the pre and post module surveys with two additional questions, about leadership style and clinical governance systems in a remote setting. Participants perceived improved competence for leadership and management, leadership style, and implementing clinical governance systems into a remote setting (Figure 6). The participants unanimously agreed that the RMPP was a good investment of their time, satisfactorily met their learning needs, and provided value for money. Furthermore, they would consider a mentor for their future professional development. More than half (60%) strongly agreed that undertaking the RMPP was an effective learning experience. The participants’ feedback suggested additional topics for future programs.

Figure 6: Participants’ perceptions of their level of understanding and capability at the completion of the Program (n=5)

all topics with participants predominately self-rating at poor-to-fair for understanding and capability (Figure 4). An improved understanding of project management, including skills developed was demonstrated through the CQI Project. Positive improvements were evident post-module completion with more participants indicating very good-toexcellent across the specific topic areas. In particular, 80% of the respondents perceived themselves as capable of implementing a project in the workplace, and writing a project report after completing the online modules (Figures 4 and 5). WORKSHOP All seven participants attended the workshop and expressed a high level of satisfaction with the two-day workshop program. Most participants (71%) rated the workshop content as excellent and relevant to their needs as a manager. Approximately half (57%) found the provision of new information excellent in its relevancy to the management aspects of their role. The participants’ confirmed the need for this type of program, with one manager saying, ‘I needed this five years ago, so I could have started the right way’. They described benefits in connecting with other remote managers in this manner, with one saying it was good to know ‘that I am not alone, [we] all have similar issues’, and others suggesting that the positive aspects of the workshop were, ‘Connecting with others’, ‘Understanding that most of us experience similar issues’ and ‘Networking and

sharing’. They described areas where they had improved understanding (e.g. ‘Increased knowledge of change management’), and areas of improved capacity (e.g. ‘I feel more positive, confident on how to approach change’). They found the format effective, saying ‘I think the smaller group was very productive’ and that they ‘found the workshop very helpful. It was more discussion than “telling” which helped me feel more comfortable.’ Finally, participants suggested actions they would implement in the workplace. Actions covered elements of project management, communication skills, and building resilience. In addition, they suggested future workshops include: ‘HR – How to deal with challenging staff’, and ‘HR and managing people.’ MENTORING The ACHSM mentoring program undertook a rigorous process for recruiting and matching mentors and mentees. Most participants (86%) engaged in the mentoring program, which not only consolidated their learning but also provided ongoing personal and professional support. The ACHSM will evaluate the mentoring component of the RMPP; therefore, the evaluation is not included in this report. OVERALL PROGRAM EVALUATION “This course will be very beneficial for a new manager or someone aspiring to go into management. I think it is a good foundation.” (Workshop participant)

DISCUSSION Whilst management programs are available, none are contextualized and reflective of the challenges faced by remote and isolated operational health managers. The program structure and staged approach of the RMPP, together with the CQI approach to evaluation greatly improved the success of the RMPP. The Advisory group’s support, and the partnership between CRANAplus and ACHSM proved to be truly invaluable. The extremely positive feedback from participants is testament that the RMPP was pitched at the right level for both the new and inexperienced managers, as well as managers who had been in their roles for longer periods. The workshop provided opportunities for participants to engage in group discussions and activities to consolidate their learning. This new information, relevant to their manager’s role, enhanced their development, building upon and deepening their understanding of management practices, and the importance of being supportive and supported in their role. Many managers, despite having management roles, view themselves first and foremost as clinicians2,3. The findings from the RMPP suggest that it is possible to positively shift remote managers’ understanding of clinical governance to an organisational management perspective. Hence, where clinicians develop confidence in areas that contribute to more effective health services (e.g. project implementation and evaluation), organisations will experience improvements in performance. The evaluation revealed that the managers who participated in the RMPP found the program improved their knowledge and capability, as well as being a good investment of time and

Australasian College of Health Service Management 23

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FEATURE

value for money. The positive feedback about the RMPP further reinforces the need for such programs for remote managers, particularly where there are time limitations and financial constraints2,5. The RMPP exemplifies the value of customised programs tailored to meet the needs of remote managers. Hence, the success of the RMPP provides a foundation for future training suited to the needs of remote managers. The staged approach, together with the Advisory Group, the facilitators and the partnership between CRANAplus and ACSHM all contributed to the success of the RMPP. Moreover, the Action Learning approach ensured that all participants, not only improved their knowledge in the key areas covered by the online modules, they designed, led, implemented and evaluated a ‘real’ change project in their workplace; thus, demonstrating their new management skills through workplace application. KEY LEARNINGS • The partnership between CRANAplus and the ACSHM was integral to maintaining high quality content and the mentoring component of the program. • A tiered marketing approach that connects both senior health management and

operational managers with the relevant information is necessary to increase participant numbers. • The program’s format (i.e. online and faceto face two-day workshop) was appropriate and should be continued for subsequent program intakes. • The CQI approach enabled the content to be reviewed to include suggestions for improvements for all aspects of the program. LIMITATIONS The findings suggest that the program is suitable as a professional development short course; however, the small sample size limits the extent to which the findings can be generalised. While this is acknowledged, as a pilot the program demonstrated enough positive impetus to support the implementation of this style of professional development program for this context. In addition, the participants were all nonIndigenous managers, mainly from a nursing background; however, there was interest in the initial EOI from Indigenous managers. In the future, ways to engage with Indigenous people in remote manager roles with the RMPP will be examined with the view to improve access to professional development programs

and building management capacity in rural and remote regions for Indigenous people. Finally, a more representative sample of participants from other professions (e.g. allied health) and participants who were ‘newer’ to remote manager roles would provide more understanding about how widely the RMPP meets the development and educational needs of all managers in rural and remote regions. CONCLUSION The positive results reported throughout the pilot confirmed that the objectives and outcomes of the RMPP were met. Hence, CRANAplus’ partnership with ACHSM made this pilot program not only innovative, but has added value to the participants’ ongoing learning. A national focus on the need for adequate preparation and support for remote and isolated managers, together with the initial response to the call for expressions of interest, has highlighted that there is a demand for this type of management program. The RMPP is a small, yet significant, step towards providing remote managers with the education, training and support needed to be effective operational managers in remote and isolated areas. xyz

REFERENCE: 1. Wakerman J, Davey C. Rural and remote health management: ‘the next generation is not going to put up with this..’Asia Pacific Journal of Health Management 2008; 3(1): 13-18. 2. Onnis L. Managers are the key to workforce stability: an HRM approach towards improving retention of health professionals in remote northern Australia. In: Proceedings, 28th Australia and New Zealand Academy of Management (ANZAM) Conference; 3-5 December 2014; University of Technology Sydney. ISBN: 978-0-9875968. 3. Townsend K, Wilkinson A, Bamber G, Allan C. Accidental, unprepared, and unsupported: clinical nurses becoming managers. The International Journal of Human Resource Management 2012; 23(1): 204-220. 4. Lenthall S, Wakerman J, Opie T, Dollard M, Dunn S, Knight S, Rickard G, MacLeod M. Back from the edge: reducing and preventing occupational stress in the remote area nursing workforce. Paper presented at: 11th National Rural Health Conference, Perth WA, 2011. 5. Onnis L, Pryce J. Health professionals working in remote Australia: a review of the literature. Asia Pacific Journal of Human Resources 2016; 54: 32-56.

7. Onnis L. An examination of supportive management practices promoting health workforce stability in remote northern Australia. Australasian psychiatry 2015; 23(6): 679-682. 8. Hunter E, Onnis L, Santhanam-Martin R, Skalicky J, Gynther B, Dyer G. Beasts of burden or organised cooperation: the story of a mental health team in remote, Indigenous Australia. Australasian Psychiatry 2013; 21(6): 572-577. 9. Hegney D, McCarthy A, Rogers-Clark C, Gorman D. Retaining rural and remote area nurses. The Queensland, Australia experience The Journal of Nursing Administration 2002; 32(3): 128-135. 10. Battye KM, McTaggart K. Development of a model for sustainable delivery of outreach allied health services to remote north-west Queensland, Australia. Rural and Remote Health 2003; 3(3): 194-207. 11. Health Workforce Australia (HWA). National Rural and Remote Workforce Innovation and Reform Strategy Adelaide: HWA, 2013. 12. CRANAplus. National Standards and Credentialing Project Report Health Workforce

6. Lenthall S, Wakerman J, Opie T, Dollard M, Dunn S, Knight S, Macleod M, Watson C. What

Australia, National Rural and Remote Workforce Innovation and Reform Strategy, 2013.

stresses remote area nurses? Current knowledge and future action. The Australian Journal

13. Australian Bureau of Statistics (ABS). Australian Statistical Geography Standard (ASGS):

of Rural Health 2009; 17(4): 208-213.

Volume 5 - Remoteness Structure. Canberra: ABS, 2011.

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OPINION

Reflection: A Year at Justice Health and Forensic Mental Health Network “It is under the greatest adversity that there exists the greatest potential for doing good, both for oneself and others”. Dalai Lama

Jess Harris, a 2nd year HMIP Intern

E

ntering a prison for the first time is a somewhat nerve-wracking experience. The countless men and women in green tracksuits, the shouting that comes from the prison yards and the loud creaks that come from the prison guards ‘cracking’ open a cell. My year at Justice Health & Forensic Mental Health Network (JH&FMHN) has been an unforgettable and rewarding experience in ways that I didn’t expect. Prior to joining the ACHSM Health Management Intern Program, I completed a Bachelor Degree in Socio-Legal Studies at Sydney University. With a strong interest in sociology, law and health, I came to the decision that Justice Health & Forensic Mental Health Network (JH&FMHN) was the perfect organisation for my first year placement. During my first few weeks at JH&FMHN, whilst struggling to understand the organisation and the patient cohort, I was privileged enough to hear our former CE Julie Babineau speak about why the work that we do is so important. She pointed out that many of our patients have grown up without the same opportunities that we have had; without guidance, without an education and without knowing right from wrong, which is why this experience impacts their health, resilience and their decision making. Crime statistics show that intergenerational incarceration is a significant issue, as 45 per cent of our juvenile offenders have a parent in custody and 30 per cent of the adult custodial cohort are received out of home care before the age of 16. Hearing Ms Babineau speak was a profound moment for me, and really changed the way I thought of our patient cohort from that point on. Throughout the year, I have had the privilege

Jessica and her colleagues at the annual Patient Experience Week held at JH&FMHN

of working with many teams on a range of projects. I had the opportunity to spend time with the Forensic Mental Health team and our patients on a Your Experience of Service survey and the Family and Carer Experience Survey. Walking into the Silverwater Correctional Complex to interview the patients, I was faced with the stark reality of the experience and plight of our patients. Each patient had a unique story to tell and varying backgrounds, each yearning for an ear to listen. It was confronting to hear. Hearing the patients’ stories first hand was an enlightening and enriching experience that provided me with the passion to do my part to make their experience with the health services better.

under in the correctional settings, and the positive work that they are achieving despite these constraints.

For my next placement, I worked with the Clinical and Corporate Governance Unit. In November 2016, JH&FMHN went through the onsite accreditation survey and this was a wonderful opportunity to learn about all aspects of the organisation, particularly in relation to safe and quality service provision. Accompanying the surveyors to the onsite surveys across the State was extremely beneficial in terms of understanding the constraints the sites are often working

At the beginning of the year I walked into the Long Bay Cafeteria a nervous wreck unsure of what direction I should look, how I should act and whether it was acceptable to talk to the inmate chefs. Eleven months later, I can say that JH&FMHN feels like home to me. I have developed on a personal and professional level with the support and guidance from all my colleagues. I cannot thank JH&FMHN enough for this opportunity. xyz

Throughout the year I have been afforded unparalleled learning experiences including attending the ACI Patient Experience Week Symposium, the Forensic Mental Health Forum, Redesign Leaders Network Days, Aboriginal Closing the Gap celebrations, the ACHSM Congress and the JH&FMHN Leadership and Change Forum. I have also facilitated a number of events including the Redesign Leaders Network Day at JH&FMHN, an ACHSM Professional Development Day at JH&FMHN and have assisted with the Network’s Patient Experience Week event.

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INTERN PROFILE

Justin Lyon NSW Management Intern J

ustin is a second-year management intern, placed at NSW Health Pathology in Newcastle for both years of the program. His first rotation is in Finance and, over the course of the Health Management Intern Program (HMIP), Justin will have the opportunity to work through a number of other areas of the organisation including Workforce and Corporate Strategy and Support. Before joining the HMIP, Justin worked for a number of years as a Senior Consultant at KPMG in Sydney, with a client base mainly in banking and financial services. During his time in consulting, he contributed to engagements across change management, compliance, process improvement and data analytics. He has a Bachelor of Economics and a Bachelor of Commerce, both from the University of NSW. Throughout the HMIP, Justin will also be completing a Master of Health Administration through La Trobe University. Justin applied to join the program to gain exposure to the NSW health system, and to develop a better understanding of how

health care is delivered across the state. He is particularly interested in health economics, and the potential applications of analytics, including identifying opportunities for performance improvement. He is interested in pursuing a career in health management in regional NSW, and is looking forward to contributing to the continuous improvement of the quality of health care in the state, and the efficiency of how it is provided. Outside of work, Justin supports Liverpool FC and is a member of the Newcastle Jets. He also contributes to the production of the FIFA series of video games, with responsibility for maintaining the database of A-League players. In this role, he updates the skills and abilities (and haircuts!) of the players based on their match day performances, with the changes rolled out to Playstations and Xboxes across the globe every week. Unfortunately, his passion for football doesn’t translate to his own ability on the pitch – he retired aged 12 and is still tormented by a humiliating run of form in Under 6’s when his club lost every game of the season. xyz

Justin Lyon, Management Intern

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INTERN PROFILE

Michaela Ward NSW Management Intern M

y name is Michaela Ward and I am a second year ACHSM Health Management Intern (NSW), currently placed at the Agency for Clinical Innovation (ACI). I hold a Bachelor of Business from the University of Technology, where I majored in Human Resource Management, and sub-majored in Business Law and Marketing.

The Program particularly appealed to me, as it allowed me to combine my interest of healthcare with my area of study, without having a clinical background. As I am uncertain of my ultimate career path, I saw the Program as the perfect opportunity to obtain new and varied skills across a number of different areas that I would probably never have considered without exposure through the Program.

Whilst attending University, I worked parttime on the switchboard of The Sutherland Hospital, where I developed a strong interest for the health system. Upon completion of my Degree, I progressed to administrative roles, and most recently worked for the Access, Redesign and Clinical Services team at South Eastern Sydney Local Health District. This gave me an appreciation for the various career opportunities available in the health care setting, both clinical and non-clinical.

I am currently working within the Surgery, Anaesthesia and Critical Care portfolio, where I am already involved in projects being completed by the Surgical Services Taskforce and the NSW Institute of Trauma and Injury Management. Having commenced in this placement only two weeks ago, I am amazed by the responsibility I have been given, and for the numerous opportunities that have already been made available to me.

In this position I worked with a number of previous ACHSM Health Management Interns, and realised the great opportunities the Health Management Internship Program (HMIP) had to offer. It was encouraging to work with past interns, who were making a positive difference to the health system, and whose careers had advanced significantly. This was a great motivator for me to apply for the HMIP.

My main goal for the Program is to gain as much knowledge as possible, and to participate in the countless opportunities that will heighten my ability to become a successful Health Service Manager. I am also looking forward to enhancing the skills learnt in my work placement component through the completion of a Masters of Health Administration. xyz

Michaela Ward, Management Intern

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MEMBER PROFILE

Karen Bradley FCHSM Chief Nurse and Midwifery Officer, Department of Health Western Australia

INTRODUCTION AND BRIEF BACKGROUND I was appointed to the role of Chief Nurse and Midwifery Officer in Western Australia in 2014 and am responsible for advising on the strategic, professional and workforce direction for nursing and midwifery across the public health sector in WA. I enjoy working at the strategic level of a large and complex organisation, optimising the contribution of nurses and midwives in meeting our health system’s vision of delivering a safe, high quality, sustainable health system for all Western Australians. BACKGROUND OF PROFESSIONAL HISTORY I have worked in the health industry for over 30 years commencing as a student nurse in 1986, graduating with a Bachelor of Science (Nursing) from Edith Cowan University. After completing my graduate year at Sir Charles Gairdner Hospital in Perth and then working and traveling in the UK, Europe and Africa, I came home to a nursing position with St John of God Hospital in Subiaco, Perth where I progressed my career over a very rewarding 13 year association. I took every opportunity during this time to develop new skills which led me on a diverse pathway including experience in the clinical setting, education, health informatics, health service management, strategic and operational planning, social outreach and workforce development. In 2004 I was appointed to the Health Reform Taskforce with the Department of Health in WA, working with a team on the implementation of recommendations from a major review of the public health service undertaken by Professor Michael Reid. This return to the public system led me on to undertake positions as Executive Director of Nursing and Chief Operating Officer with the WA Country Health Service and more recently Area Director of Nursing with the South Metropolitan Health Service.

I have pursued more formal development opportunities throughout my career with a Master of Leadership from the University of Notre Dame Australia, as a Graduate member of the Australian Institute of Company Directors and hold a number of Adjunct Associate Professor positions with Schools of Nursing and Midwifery in WA. OUTLINE OF YOUR INVOLVEMENT WITH ACHSM I have a strong commitment to leadership development as an essential enabler to improving health service delivery and ultimately, the provision of safe, effective and compassionate care to our patients, their carers and our community. I joined the ACHSM as a way to connect with other health service leaders and continue to invest in my professional development. I became a member of the ACHSM State Branch Council in WA in 2014 where I feel I can make a contribution to the development of others and facilitate the engagement of health service leaders across the state. Our council members work well together to facilitate an annual program of education and leadership development events. In 2016 I achieved Fellowship status with the college which I found to be a very rewarding and challenging experience and helped to consolidate my health system knowledge and experience particularly through the group study process and exam preparation. OUTLINE OF FUTURE GOALS/ENDEAVOURS RELATING TO YOUR HEALTH MANAGEMENT CAREER AND YOUR INVOLVEMENT WITH THE COLLEGE Whilst I didn’t necessarily have a career plan, I have taken every opportunity to try something new, develop my relationships and networks and enjoyed the challenge of working on change, improvement and reform projects.

Karen Bradley FCHSM, Chief Nurse and Midwifery Officer, Department of Health Western Australia

Mentors, both formal and informal have also played a significant role in my leadership development journey. My future career goals relate to using my skills and experience in health care, leadership and management to influence system improvement and performance with a focus on developing positive and engaging workplace organisational cultures that enable people to thrive. I have just been re-elected to a second term on the State Branch Council and keen to continue encouraging health service leaders from a diversity of backgrounds to engage in professional and leadership development activities. I am keen to ‘pay it forward’ and provide mentorship and career support to new and emerging leaders throughout my networks. xyz

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IN THE LOOP

Victoria SEPTEMBER September was a busy month for the Victorian branch with the 2016 members’ dinner and our monthly breakfast forum. The Members’ Dinner was held on the 5th of September at The Rydges Hotel in Melbourne to a full house. ACHSM CEO Catherine Chaffey gave a presentation on the highlights of the College over the previous 12 months, and outlined the new initiatives and priorities for the year ahead. In addition to this, we were fortunate to have Dr Stephen Duckett speak on the challenges of clinical governance, a topic of prominent interest in the Victorian health sector. Members in attendance thoroughly enjoyed the presentations and the opportunity to meet our CEO, Victorian Branch Council, and other members of the College, as well as our invited guests. The members’ dinner was followed by the monthly breakfast forum on the 9th of September, where we welcomed Mr Paul Plsek, an internationally recognised advisor on creativity, innovation, leadership and the management of change in complex systems based in the USA. The forum was well attended and thoroughly enjoyed. OCTOBER The Victorian Branch general meeting was held on the 10th of October, with items on the agenda including the Victorian State Branch Council President’s annual report, the Victorian State Branch Council treasurer’s annual report and the announcement of new Victorian State Branch Council members. We would like to congratulate Demos Krouskos, Gabrielle Honeywood and Sandra Brown on their election to the Branch Council, and welcome back Wendy Davis (as President), John Turner (as Treasurer), Greg Allen, Mark Garwood, John Rasa, Margaret Way, Sanda Brown and Karen Minne for another term of Branch Council membership. At our breakfast forum on the 14th of October, we welcomed Dr Mark O’Brien, Medical Director of the Cognitive Institute, who spoke on building a strong safety culture in healthcare. The forum was engaging and stimulating for the attendees. NOVEMBER On the 25th of November, the Peter MacCallum Cancer Centre (Peter Mac) generously opened their doors to provide attendees a tour of their facilities. Peter Mac is one of the world’s leading cancer research, education and treatment centres, and is Australia’s only

Dr Margaret Way, Paul Plsek and Wendy Davis

Grant Phelps

Kym Peake

Steven Duckett

Mark O’Brien

Pete Saunders

public hospital dedicated to caring for people affected by cancer. Attendees were given an insight into the state-of-the-art facilities, as well as presentations by a number of guest speakers including Dale Fisher (CEO of Peter Mac), Nicole Tweddle (VCCC Executive Director of Service Development) and Felicity Topp (COO of Peter Mac). The tour was a huge success, and we would like to thank Peter Mac for their generosity in making this opportunity available. DECEMBER On the 1st of December, The Victorian Branch hosted an Emerging Health Managers (EHM) cheese and wine evening. Targeted at EHMs, emerging leaders and emerging influencers considered their needs for 2017, the topic was ‘Getting from A to B: Principles of Strategic Planning and Evaluation’. Speaker Pete Saunders talked through ways of thinking and strategies of working creatively to solve problems in a group, leading to more effective management and leadership. The evening was highly engaging and thoroughly enjoyed by attendees. Our final breakfast forum of 2016 on the 9th of December was extremely successful, with one of our best turnouts for the year. Speaker Kym Peake, Secretary of the Victorian Department of Health and Human Services was thoroughly engaging, discussing her vision for the following year and highlighting key progress and achievements of the DHHS over the course of 2016.

the Victorian Branch. His presentation centred upon ensuring patient safety, and methods which have been shown to work in engaging clinicians in this area. His presentation was highly engaging and thought provoking. HMIP PROGRAM The Victorian Health Management Internship Program (HMIP) continues to strive forward in educating our future health leaders. Following a large influx of applications, interviews for our 2017 program were held in October 2016. Nine of the applicants were successful. The HMIP currently has 15 interns undergoing either the first or second year of their training, who commenced this year’s program in the 2nd week of January. Interns are currently working on placements across a wide variety of organisations in both regional and metropolitan Victoria. We wish them all the best for the year ahead. xyz

MARCH Grant Phelps, Associate Professor of Clinical Leadership at Deakin University Medical School was the speaker at our 17th of March breakfast forum, the first breakfast forum of the year for

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IN THE LOOP

New South Wales EVENTS Health Management Internship Program (HMIP) Orientation - January 2017 We welcome the following into the 1st Year HMIP for 2017: • Chloe Ashton, Mid-North Coast Local Health District • Andrew Bullen, Independent Hospital Pricing Authority • Leo Clayton, NSW Ambulance • James Comerford, Western Sydney Local Health District • Jamie Dallimore, Western Sydney Local Health District • Kylie Dixon, Mid-North Coast Local Health District • Michael Donnolley, Justice Health and Forensic Mental Health Network • Megan Hart, Western Sydney Local Health District • Christian Jansen, Western Sydney Local Health District • Madeline Johns, Agency for Clinical Innovation • Katie Lau, South Eastern Sydney Local Health District • Jack Roach, South Eastern Sydney Local Health District • Lea Sugay, Western Sydney Local Health District • Bertina Wong, Bureau of Health Information • Jessica Youngberry, Western Sydney Local Health District Orientation was conducted in late January with the continuing 2nd years with presentations from some of the NSW Pillar Organisations – ABF Taskforce, ACI, BHI and HETI. Former Interns also shared their experiences of the Program and their career progression since they graduated. The current Interns also participated in a session ‘Complex Systems and Change Leadership’ with Dr Sean O’Connor from University of Sydney. EMERGING HEALTH LEADERS COMMITTEE (EHL) - JANUARY 2017 We also welcome the new members of the EHL Committee Taryn Medcalfe (Chair); Christopher Horn; Sara McKay and Cassandra Walton. Jamie Dallimore is the HMIP Intern representative on this Committee. They are undertaking a significant body of work with a range of events currently being planned, the first in May 2017. This is a key strategic focus for NSW and we hope to further strengthen the offerings in this space during the year.

NSW HMIP 1st Years

Dr Sean O’Connor

Ros O’Sullivan - BHI, Susan Dunn - ABF, Kate Lloyd - ACI,Annette Solam - HETI

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a focus on resilience in leadership. Associate Professor Stephen Kent, Head of School from La Trobe University was also in attendance to present the graduands with their certificates. The Kevin Dodd Oration was delivered by Adjunct Associate Professor John Rasa, Director ACHSM Board. John spoke about authentic leadership and attributes and skills for future challenges in the health landscape with an emphasis on technology and data. His oration was motivating and provided a platform for these emerging health managers to launch their careers. Audrey Lazaris, who is currently, Project Manager, NHS UK, Health and Justice, responded on behalf of the graduands.

NSW Mentoring Orientation

MENTORING ORIENTATION BREAKFAST JANUARY 2017 There are 46 Mentees participating in the Mentoring Program in NSW this year, with 43 Mentors. Matching of pairs took place during the latter part of last year to enable the commencement of the Program in January. The Branch extends its thanks to Terry Clout, Vice-President and Mentoring Coordinator for his tireless efforts in this growth area for NSW, which has the largest number of participants. NEW BRANCH COUNCILLORS In February, NSW Branch Council endorsed the following Councillors for 2017 for a 3 year term: • Dominic Dawson - Associate Director, Business Intelligence and Efficiency, SESLHD • Godfrey Isouard - Associate Professor, Head of Health Management Programs, UNE • Karen Patterson - Organisational Development and Learning District Manager, SESLHD • Connie Porter - CEO, Port Macquarie Private Hospital, Ramsay Health Care • Rebecca Pinheiro, SESLHD and Natasia Seo, WSLHD are the HMIP Interns on Branch Council for 2017. We would like to thank Dr Wayne Hsueh, Mary Potter Forbes and Dr Anuj Saraogi as the outgoing Councillors for their time and input during the terms of office. BREAKFAST FORUM - THE VALUE-ADD ROLE OF A PMO IN HEALTH CARE DELIVERY FEBRUARY 2017 Mark Shepherd, Director of Programs and Performance and Deputy Chief Executive

Officer South Eastern Sydney Local Health District presented an insightful forum discussing case study examples of how this success has come about and some ‘pit-falls’ to be aware of in establishing a PMO. Project Management Office (PMO) is increasingly becoming a value-add part of health service operations. The SES LHD established a PMO in mid2015 to provide the organisation a new way of addressing a range of organisational opportunities, particularly around efficiency by building in foundations of project management and consistency of methodology and metrics. Mark Shepherd as the Director of this unit has led a range of significant improvements across the organisation and shared his experience, particularly regarding the establishment of the unit; its maturation over the last 18 months; how it adds value and some of the outcomes. Thank you to NAB for providing the venue for our breakfast forums in 2017. HMIP GRADUATION - APRIL 2017 There were 10 Interns graduating from the inaugural Health Management Internship Program at the end of 2016 with all graduands currently employed in the health sector. The Graduation ceremony celebrating the 42nd cohort was held on 6 April 2017 at the Hilton Sydney with over 80 people in attendance.

Each of their addresses are available for reading on the ACHSM website at: https://achsm.org. au/Public/Education/Health_Management_ Internship_Program/HMIP_NSW/Public/ Education_/HMIP_folder/HIMP-NSW.aspx Recipients of the Awards presented for 2016 year: • Mark Shepherd, Deputy Chief Executive and Director of Programs and Performance, South Eastern Sydney Local Health District Placement Organisation of the Year 2016 • Justin Lyons, NSW Pathology - Stan Williams Young Leaders’ Award 2016 – 1st Year Intern • William Hackworth, St Vincent’s Hospital Network - Stan Williams Young Leaders’ Award 2016 – 2nd Year Intern Placement Organisations were closely involved in the recruitment process and ongoing supervision and development of Management Interns. We would like to thank the Placement Organisations who participated in the 2015/16 Program. Thank you to HESTA Superfund and Holman Webb for sponsorship of the event. As part of the Strategic Plan for NSW in providing varied opportunities to our members we ran a Rural Health Manager’s Symposium in Dubbo on 2 June and half-day Workshop Seminars on Ethical Decision Making through June, July and August and a one day Seminar focused on Health Planning in July. xyz

Kate Munnings, Chief Operating Officer, Ramsay Health Care provided the Opening Address with

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IN THE LOOP

Queensland OCTOBER In October, the peak annual 2016 ACHSM/ ACHS joint Asia-Pacific Congress was held at the Sofitel Brisbane Central. With attendance far outstripping all our initial estimates, more than 520 attendees enjoyed hearing our speakers explore the theme of ‘The health leadership challenge: making things happen’. For a full report on 2016 Congress, please see Volume 3, Edition 2 of the Health Leader or go to our website. NOVEMBER Our breakfast forum on the 16th of November in Brisbane was highly successful. We welcomed Dr Jeannette Young, Chief Health Officer and Deputy Director-General, Prevention Division of the Department of Health Queensland, who spoke on the key findings from the Health of Queenslanders 2016 report, including the rapidly growing pressures on the health system and the success of present preventative measures in healthcare. The forum explored ways in which the sector can work with Queenslanders to achieve improved health outcomes among the general population. It was a most enlightening discussion that our attendees greatly enjoyed. DECEMBER The seventh December breakfast forum was very well attended and highly stimulating. Professor Wayne Hall, Director of the Centre for Youth Substance Abuse Research at the University of Queensland, tackled the controversial topic of how to respond to calls to allow the medical use of cannabis. Professor Hall discussed whether we should follow the example of the 21 states in the USA who have legalised medical cannabis, under what conditions the treatment should be dispensed and how to address the issues of cannabis supply. In addition, he pondered how these policy decisions relate to the legalisation of recreational cannabis use by adults in Australia, another controversial current issue. Professor Hall effectively navigated this issue, creating robust discussion and a very successful final breakfast forum for 2016. FEBRUARY On the 23rd of February, the Queensland branch held its first breakfast forum of the year which was very well attended. The topic was Translation Simulation: connecting healthcare simulation with outcomes, and

Dr Jeannette Young

Wayne Hall

Dr Victoria Brazil

Simulation training is a prominent growth area in healthcare, which enables efficient education, assessment, research and integration, translating into better care and management of patients and healthcare facilities as a whole. Kate Copeland

we were privileged to welcome Dr Victoria Brazil, Professor of Emergency Medicine at the Gold Coast Health Service and Director of Simulation in the Faculty of Health Sciences and Medicine at Bond University as out speaker. Dr Brazil utilised case studies to present on how healthcare simulation can be used to improve patient journeys and clinical outcomes in health. Simulation training is a prominent growth area in healthcare, which enables efficient education, assessment, research and integration, translating into better care and management of patients and healthcare facilities as a whole. The forum was very successful and attendees found Dr Brazil’s presentation thoroughly engaging. MARCH At the tender of the Queensland Government Australian Unity is currently undertaking a redevelopment of the Herston Quarter, a part of Queensland’s Herston Health Precinct, located around two kilometres North of the Brisbane CBD. This development aims to transform the area into an integrated and internationally renowned health, ageing and research destination, as well as a ‘wellbeing community’ in which Queenslanders can thrive. Our presenter at the March breakfast forum was Kate Copeland, the Executive Director of Corporate Systems and Infrastructure at Metro North Hospital and Health Service. She was joined by Sam Betros, the Transaction Manager at Projects Queensland. Their presentation discussed the project vision, examined the delivery model and laid out the challenges anticipated during the delivery of the project, as well as painting a picture of the benefits of the project. Their presentation was thoroughly engaging and informative for attendees.

HMIP PROGRAM 2016 was a very successful year for the HMIP Program. We would like to congratulate our eight interns who finished their second year of the program in December 2016. We wish them all the best in their future endeavours. March 2017 saw the running of our first Professional Development Day, delivered by Adjunct Associate Professor Sue Hawes, of Sue Hawes Consulting Pty Ltd. Sue is a registered nurse with more than 35 years’ experience in the healthcare industry as a senior clinician, working in executive, strategic and operational spheres. This has given her a strong understanding of reform agenda, and how small to large-scale transformation change projects contribute to that agenda. Recently, Sue established a bespoke performance improvement program for Children’s Health Queensland HHS, and regularly lectures postgraduate students on project management and performance improvement at Queensland University of Technology. The session aimed to strengthen project management knowledge and skills, and introduce participants to foundation principles of successful project and change management. The interns in attendance found it to be a fantastic learning opportunity. WEBCASTS The Queensland breakfast presentations are all available as a webcast, either live at the time the event is taking place or can be watched at personal convenience via our website. xyz

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IN THE LOOP

South Australia T

he last few months since our last report have been extremely busy, but incredibly productive for the SA Branch. We are committed to continue to provide opportunities for our members and the broader community by providing professional development and networking events that are meaningful and contemporary. Highlights of these events are featured in this SA Branch update. SA BRANCH COUNCIL ELECTIONS Much has happened in the College, including constitutional changes. This will see the opportunity for any branch councillor to put their name forward to a nominations committee when it comes time to elect a board director from the branch along with an increased number of independent board directors. This required all branch council elections being completed by the end of March 2017 to enable sufficient time for the new process to take place. We are delighted that our elections have been completed and we now have a nine-member council comprising the following people – Stuart Schneider (President), Mark Diamond (Vice President), Christine Barber, Heather Baron, Roslyn Chataway, Gary Day, Liana Niutta and Heidi Silverston. We welcome to the council our newly elected member Bronwyn Masters. Bronwyn is General Manager, RDNS SA which is part of the Silver Chain Group.

MENTORING PROGRAM 2017 The program is a developmental partnership through which one person shares knowledge, skills, information and perspective to foster the personal and professional growth of someone else. We all have a need for insight that is outside of our normal life and educational experience. The power of mentoring is that it creates a one-of-a-kind opportunity for collaboration, goal achievement and problemsolving. We are delighted to have established three mentor/mentee teams and look forward to reporting on their progress in the next edition of The Health Leader.

The SA Branch Council would like to extend sincere thanks to the outgoing council members – Linda South (who has been an outstanding honorary treasurer), Amanda Shields and Madhan Balasubramanian. Their contribution to the SA Branch has been commendable and we are indebted to them for their tireless efforts.

EXECUTIVE OFFICER SA BRANCH In December 2016, we officially bid a warm farewell to Adrienne Copley, our Executive Officer for the past seven years, as she announced her retirement from this position. Adrienne has executed this role with distinction over this period of time and her significant contribution is acknowledged. We wish to extend sincere best wishes to her for the future and thank Adrienne for her efforts in handing over the reins to our new Executive Officer.

EXECUTIVE MANAGEMENT DEVELOPMENT PROGRAM The SA Branch is planning to introduce an Executive Development Management Program designed to provide targeted hands-on experience to four motivated employees interested in pursuing a career in healthcare management and administration. They will be offered a two-year opportunity to alternate through difference administrative career fields, gain valuable insight into other SA healthcare sectors and position themselves as future leaders. We look forward to launching the program mid-2017 and the opportunity to foster development opportunities for our emerging and future leaders.

In January 2017, we welcomed Lou Williamson to the role of Executive Officer. Lou has extensive experience across a diverse range of public and private health services as well as the not-for-profit sector. This has been complemented by post-graduate study through Flinders University – Master of Health Service Management (2005). Within government and not-for-profit sectors, key aspects of the various positions that Lou has held have focussed on establishing and maintaining strong community relations. In addition, she has coordinated and provided strategic and operational aspects of clinical client care, resource management, strategic and business planning and project

management. This is evidenced by her contribution to the breast cancer screening program – BreastScreen SA over a 14 year period as General Manager. This role provided the opportunity for her to gain an insight and valuable experience in managing a statewide health service as well as the opportunity to contribute to and have a positive influence at a national level through BreastScreen Australia. Lou demonstrates a commitment to high quality services to clients and demonstrates a passion for quality improvement as evidenced by her appointment to the role of Chairperson of the BreastScreen Australia National Quality Management Committee in 2003, a role she held for nine years. Lou is delighted to be given the opportunity to join ACHSM SA Branch as the Executive Officer and looks forward to making a significant contribution to the College and to engaging with members and the broader College community across SA as well as nationally. Lou can be contacted via our email sa@achsm.org.au. The SA Branch has been focused on planning a variety of meaningful professional development and networking events for 2017. This year five breakfast events and one evening event are planned as well as the mid-year SA Branch conference and pre-conference dinner. Here are some of the highlights from 2016 and 2017. BREAKFAST WITH MARCO BACCANTI – 22 SEP 2016 Marco Baccanti was appointed to the role of Chief Executive, Health Industries South Australia (HealthInSA) organisation that was established in early in 2016 reporting to the Minister of Health (as Minister of Health Industries). Marco explained the mandate of the organisation is to create jobs and secure investment in South Australia. He has analysed

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The SA Branch is committed to continue to provide opportunities for our members and the broader community by providing professional development and networking events that are meaningful and contemporary.

the potential market with the aim of raising awareness globally about Adelaide. The state has decades of experience in manufacturing through providing high-skilled workers and solid supply chains. He said Adelaide is a highly competitive city for doing business in the Asia-Pacific with well-established domestic and international markets, it is politically stable and has free trade agreements with Asian countries. Another reason to invest is that companies with a turnover of less than $20million benefit from a 43.5% cashback from the federal government for research and development with a 38.5% tax offset for other eligible entities. Plus, the SA Health and Biomedical Precinct (North Terrace West in the CBD) is quickly becoming one of the largest health precincts in the southern hemisphere and will advance the national and international reputation for health and biomedical research and innovation. Marco summarised the main areas in which HealthInSA is focusing. PHARMACEUTICAL R&D AND MANUFACTURING AND CLINICAL TRIALS Adelaide features a world-class animal research facility, has one of Australia’s largest and most experienced Phase 1 clinical trials units with a database of more than 13,000 active volunteers and is a ‘one-stop-shop’ offering smooth transition from pre-clinical research to clinical trials. Facilities for phase 2 and phase 3 trials are established along with a full range of local providers for drug manufacturing, clinical, data and bio-analytical services for small and large molecule clinical trials and applied clinical pharmacogenomics (PGx) services. There is no investigational new drug requirement and ethics approval can be obtained in an average of six weeks. MEDTECH MANUFACTURING AND DISTRIBUTION Adelaide has decades of experience in world’sbest-practice manufacturing providing highskilled workers and solid supply chains that are now being successfully applied to medical device manufacturing. The medical device

partnering program provides access to research and development support, academic research and market connections. DIGITAL HEALTH CARE RESEARCH AND DEVELOPMENT Adelaide is set to become the ‘first Gig City’ that will connect business with many of Adelaide’s innovation precincts with extremely fast broadband speeds. The government is investing $4.7million in the program to help attract hi-tech business, entrepreneurs and start-ups with ‘bandwidth heavy’ ideas, products and services to the city. He said the unique demographic mix South Australia has is the ideal location to test digital healthcare solutions across urban, rural and remote communities and to deliver benefits to patients. NEUTRACEUTICALS Marco explained that Australia enjoys a global reputation as a pollution-free, clean and green land, low population density and high-quality standards applied in the cultivation of its agricultural produce. Markets in developed countries are ready to pay premium prices to secure products from natural sources, grown in a clean and green environment like South Australia. The state also possesses a large repository of native flora and fauna that are believed to have health benefits, offering a potential opportunity to provide exclusive food and beverage products with a uniquely Australian flavour. It is planned to establish a dedicated extraction and purification plant in Adelaide for production of pure ingredients and extracts in compliance with the TGA regulatory framework. CHINESE MEDICINE He said that the SA Government welcomes investment from traditional Chinese medicine companies. These companies are an important part of HealthInSA’s mission as the Chinese spend billions in natural products each year. It is important to take advantage of Adelaide’s expertise, including its three universities that have decades of experience in world-leading research in active ingredient extraction, purification and processing.

Breakfast with Roger Drake (AM) – 8 Dec 2016 At the final professional development and networking event for 2016, we were fortunate to hear from the CEO of Drake Supermarkets, Roger Drake AM. Roger commenced his career in the grocery industry in 1974 when he bought a small supermarket in Adelaide. This business has subsequently grown opportunistically to 62 stores nationwide, 40 of which are in South Australia and employs a total of 5,500 staff. The audience appreciated Roger’s honesty, humour and the opportunity to hear the perspectives from a different industry, to identify the ways in which insights from his success and experience can apply to the health sector. Customer focus is a key value of the Drake family business. ‘My boss is the customer’ is one of Roger’s catch phrases that he ‘preaches’ across his business at all levels to build this culture in line with expected standards of practice. Importantly, there is also a system to reward staff who display evidence of demonstrating these values. The staff are seen as a key resource in the business and are well supported. Roger emphasised the importance of ‘hiring slowly and firing quickly’ to ensure as much as possible that staff are aligned with the culture of the organisation. Having staff who believe and fit in with the culture is more important than the experience or technical skill they may bring to the job which can be learned. When talented staff are identified, they are supported with training and he promotes from within. Succession planning with ‘an understudy who is better than you’ is key to ensuring the business goes on. Roger’s view on leadership is that it is always from the front and never from behind. He leads by being visible and present with staff; ‘management by walking around.’ Roger emphasised the importance of ‘tough love’, that is, telling it how it is and not skirting around the issue when addressing concerns, and directing comments at the issue not the person. Roger spoke of the importance of

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surrounding yourself with smart people who know the right answers. He emphasised that it isn’t necessary for the leader to have all the information, but to have access to people who do. Roger believes that when staff leave an organisation, it usually that they are ‘leaving the leader’ who is not able to adequately lead, support and develop their staff. The Drake Supermarket business prides itself on customer focus, supporting local industry and family values. Roger’s passion for his business and this industry was clearly apparent and can be summed up by his comment ‘if you love what you do, you never have to work a day in your life. BREAKFAST WITH VICKIE KAMINSKI, CHIEF EXECUTIVE, SA HEALTH – 15 FEB 2017 Vickie is a senior health care executive with more than 35 years of experience in the Canadian health care system with a background in nursing. As the president and CEO of Alberta Health Service, Vickie was responsible for an integrated health service with 100,000 employees. Vickie joined SA Health in early 2016 as the Deputy Chief Executive, Transforming Health and in midDecember 2016 was appointed as the Chief Executive, SA Health.

We were delighted to have 78 people attend the SA Branch’s first breakfast event for 2017 with Vickie providing her ‘state of the nation’ address focusing on four major priorities for SA Health. NEW ROYAL ADELAIDE HOSPITAL (NRAH) The aim is clearly to get the hospital open and Vickie described the agreement and resolution recently reached with the partners to move forward. A date for opening has not been released but it is hoped to be before this year’s peak winter season. Vickie showed photos of the nRAH demonstrating the high use of natural light and outdoor spaces (70 internal courtyards) and the importance of ‘way finding’ across large, decentralised areas. Potential fatigue for staff given the scale of the building was highlighted. Significant planning and staff training about the transition is currently underway and tour days for the public will be arranged to reduce the likely influx of presentations on opening.

TRANSFORMING HEALTH (TH) Vickie noted that this term has become synonymous with what is not working rather than what the future state needs to be. The focus of TH is about improving the flow, quality and integration of care across the system. Based on the financial modelling completed, this should lead to improved efficiency and sustainability of the system long term. Key enablers include workforce design to ensure flexibility and working to full scope of practice, leadership training and ensuring patient and family-centered approaches to care. Some of the current key activities include relocation of Repatriation General Hospital services (closing by December 2017), reform of the outpatient system and the ‘care awaiting placement’ initiative. Reconfiguring models of care in various areas such as stroke, ortho-geriatrics and acute coronary syndrome to achieve reduced length of stay is planned. The Jamie Larcombe Centre (the new Veteran’s mental health precinct at Glenside Health Service) is underway and the Modbury Hospital’s ambulatory rehabilitation and pool facility are almost complete. Operating theatre expansion work is underway at Noarlunga Hospital and future sites of SA Ambulance Service stations in the north and west of Adelaide are progressing. 2016/17 BUDGET The current net expenditure budget for SA Health is $5.8 billion; an increase of $235million from the previous year result. Capital expenditure excluding the nRAH is $3.67million. An additional $671million over five years from 2015-16 has been allocated to enable the transformation of the health system. Continued investment in ‘Closing the Gap’ in Aboriginal health outcomes provides $44.4million over four years, investing in programs that have achieved positive outcomes for Indigenous South Australians. Additional funding has been allocated for the replacement of the patient administration system in country hospitals and mental health services in Whyalla.

across eight SA Health sites have been trained and use EPAS on a daily basis. Current assessment for readiness is underway at some country sites and Flinders Medical Centre. Questions from the audience touched on stability of the system by ensuring leadership commitment and succession planning from within SA. Also discussed was the importance of telehealth for country patients and the challenges of gaining attention from public health and health promotion in four-year election cycles when their benefits are generally long term but critical to the sustainability and effectiveness of the system. FUTURE EVENTS IN 2017 We are delighted with the success of our professional development and networking events and look forward to further breakfast sessions in September and October and an evening event in December. Our SA Branch conference will be held on Friday 28 July with the pre-conference dinner held Thursday 27 July. Please visit the event calendar at achsm.org.au/events and click on SA for more information. SPONSORSHIP We are delighted that SA Health will once again be the platinum sponsor for the 2017 SA Branch conference in July 2017 along with the Silver Chain Group who will be the gold sponsor. Our ongoing partnerships with our sponsors Finlaysons Lawyers, HESTA and Spotless means that we are well positioned to continue to provide meaningful professional development, networking opportunities and the ability influence – Better leadership and Healthier communities. We look forward to a very successful 2017 through our partnerships and programs. ACHSM SA Branch is extremely grateful to our sponsors for their ongoing support. xyz

ENTERPRISE PATIENT ADMINISTRATION SYSTEM (EPAS) EPAS went live at The Queen Elizabeth Hospital in July 2016. This is the largest and most complex site in which it has been implemented to date in helpful readiness for roll out at the nRAH. Approximately 11,000 staff and students

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Western Australia ANNUAL LEADERSHIP DINNER Another year, another fantastic annual Leadership Dinner. 160 health executives and leaders came together to listen to the inspiring leadership journeys of our past Premier, Hon Dr Geoff Gallop and his esteemed wife, Dr Ingrid Van Beek. Geoff spoke fondly of his long career in politics, namely as a Premier of the state under a Labor government. He emphasised that one in a position of power and leadership should always strive to have a positive influence and impact. He stressed that a greater priority needs to be given to the role that politics plays for all health leaders in driving change and results. The political dimension is an area that cannot be ignored and leaders need to learn to communicate ideas, be credible and broker relevant political and strategic relationships.

Hon Dr Geoff Gallop and Dr Ingrid Van Beek during a Q&A with dinner guests (left to right)

Dr Van Beek then took us through her long experience in an innovative and controversial area of health in Sydney’s Kings Cross. She is the Founding Director of Australia’s first medically supervised injecting centre and has been Director at the Kirketon Road Centre for nearly 30 years. She reminded us of the fundamentals of health care, and stressed that it should always be available and accessible to all, and that we are in a client-centred industry. Ingrid spoke of the challenges she has faced when negotiating government policies and that these hurdles are all patient-driven and essential in order to provide the best care and outcomes for a highly marginalised group. Dr Stephen Duckett Breakfast Forum The ACHSM WA Branch first met Dr Stephen Duckett in 2014 when he presented a breakfast forum titled ‘The Billion Dollar Efficiency Problem’. Three years later he returned to present another breakfast forum titled ‘Challenges for the Health Economy’. This sold out event of over 100 health executives and leaders was sponsored and hosted by EY. Stephen presented the latest updates from the Grattan Report and lessons from Bacchus Marsh which provided valuable insight into this event, and what we as managers and leaders can do to prevent this ever happening again. As always, the audience found Stephen’s presentation most engaging and enjoyable.

Hon Dr Geoff Gallop, Dr Ingrid Van Beek, Dr Neale Fone (left to right)

KIM JELPHS BREAKFAST FORUM The ACHSM WA Branch was also privileged to have another outstanding speaker present at a sell-out breakfast forum titled ‘Leadership for Safety and Quality – An Uncompromising Commitment’. Presenter Kim Jelphs is a visiting Academic Fellow to the School of Public Health at Curtin University. She currently works as an Organisational Development and Leadership Consultant in the UK.

The forum explored a timeline of development interventions, and shared stories, learning and insights about improving outcomes. There was a focus on what is having the most impact and making a real difference to services, leaders and their teams, at a time when demand and expectations are high, money is tight and return on investment needs to be evidenced. It was thoroughly enjoyed by all in attendance. xyz

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Australian Capital Territory PROFESSIONAL DEVELOPMENT ACTIVITIES Our planned professional development activities for 2016 contained many highlights. The second half of the year continued the trend, with motivating and energetic speakers providing thought-provoking addresses – with some challenging the status quo of the health service manager. At our Annual Members’ Meeting in Air Vice-Marshal Tracy Smart Prof Chris Baggoley with guests at the Annual Members Meeting in August August we were privileged to have the outgoing Chief Medical Officer for the Australian Government, Prof Chris Baggoley, in attendance as our guest speaker. Prof Baggoley was also the principal medical advisor to the Minister and the Department of Health, and was formerly the Chief Executive of the Australian Commission on Safety and Quality in Health Care. Professor Baggoley spoke to us about the expansion of the role that he played in the development of medical services throughout Australia, and in particular about the international networks in which Australia is involved that relate to disease identification and control. He spoke of the highly skilled group of clinicians with which he worked, and about the importance of President Lesley Dickens with the participants in the ACT political debate prior to the ACT election teamwork in high-pressure situations when outbreaks of serious disease in December 2015 after an extensive medical career in the Air Force. are identified. Chris also spoke about a number of international rescue Tracy spoke extensively about the journey that the Joint Health Support and trauma responses that Australia has been involved with, including Service of the ADF had embarked upon over the last decade or so, and the Typhoon Haiyan in the Philippines and the clinical responses to the challenges that were faced by that organisation in meshing together, not Ebola, Zika and MERS outbreaks around the world. just ‘domestic’ health service delivery, but operational support activities to the significant overseas presence that Australia has had during this time. With the ACT election being conducted in late September, Branch Branch Council was really pleased that so many of our Defence colleagues Council organised a very successful evening forum that saw our political could join us for this event and wishes to encourage attendance at future leaders go head-to-head in a debate on all matters ‘health’ in the ACT. activities into 2017, some of which will also address Defence health issues. Each of the main parties were represented in this event: Jeremy Hansen MLA (Liberal); Chris Bourke MLA (ALP); and Indra Esguerra representing PLANNED FUTURE ACTIVITIES the Greens. This debate was facilitated by Michael Moore, former ACT Following the election of the new Branch Council in August, one of the Independent Health Minister and currently CEO of the Australian Public more important tasks was to commence planning the PD activities for Health Association. This debate proved somewhat controversial in that 2017. The first cab off the rank was the breakfast forum on 20 Feb, where the subject matter for the debate shifted from health matters to the Prof Imogen Mitchell, Dean of the Medical School at the Australian highly topical ‘train’ on several occasions, but once the participants National University spoke on what is impacting and influencing current focused on the job at hand a number of issues associated with the medical education, and what is going to shape the future. health portfolio were pursued with vigour and candour. Topics ranged from hospital bed availability, additional stand-alone emergency facilities, mental health and public health matters and health prevention We are sure that the events calendar for this coming year will be most interesting and appealing to a wide range of our membership, and Council activities. Our final Professional Development session for 2016 saw Air encourages all of our members to come along and participate and enjoy Vice-Marshal Tracy Smart join us. AVM Smart was appointed to the some hospitality and fellowship with your colleagues. xyz positions of Commander Joint Health and Surgeon General of the ADF

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Tasmania In December, the Tasmanian Branch hosted an end of year function in Hobart. This was well attended by around 30 people, including both College members and non-members. While this was a fun and relaxing way to cap off a busy year, it was also an excellent opportunity to engage with colleagues and vision how the College may best serve our members into the future. This question (how we can best serve our members) has been a major focus for State Branch Council during the first months of 2017 and has led to the development of a renewed professional development schedule.

In June, in another first, the College hosted an event in partnership with the University of Tasmania’s Health Services Innovation Tasmania. This event provided clinicians and managers with the skills to implement improvement projects by exploring the important role of a project sponsor. This was an excellent session with an engaged audience. It was inspiring to see the number of attendees who have ideas and visions for their respective services. This session was a good example of how the College can support skill development to the benefit of the community in collaboration with other organisations.

The State Branch Council is committed to building on the 2016 events program to offer new opportunities in addition to the existing benefits of College membership. A major consideration has been designing events which are going to be useful and meaningful for our Tasmanian members, but which will also be appealing to the wider community and help to attract new members.

Planning is also well underway for the Tasmanian Health Conference in September. The ACHSM is part of the organising Committee which means that College members can access reduced member registration rates. This year’s theme is #OneTeam: Working together to keep Tasmanians out of hospital. A full program is expected to be released soon, so please keep watching the website for further details: www.tasmanianhealthconference.org.au.

One initiative to fall out of this work is the introduction of the ‘Cuppa with the Chief’ networking sessions in Tasmania. The ‘Cuppa with the Chief’ has been based on the success of the format in other College Branches. From the initial response, we expect this to also be very popular in Tasmania. The first of these events was held in July and featured Kathryn Berry, Chief Executive Officer of Calvary Health Care Tasmania. By restricting attendance numbers, it allowed exclusive access to Kathryn to discuss a range of topics in an informal setting. This type of event provides an amazing opportunity to gain insights and receive some practical suggestions for navigating a career in health management. A highlight from this session was Kathryn’s advice for women aspiring to advance into senior leadership roles.

One of the best things about our College is the ability to provide members with an opportunity to engage with senior leaders in the health sector as well as providing the skills and knowledge to succeed in their careers. This has been a key objective of our first activities held in 2017, and will continue to be a focus moving forward. As always, the State Branch Council is interested in hearing from members, feel free to email tas@achsm.org.au with any feedback or questions. xyz

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New Zealand FELLOWS FOR NEW ZEALAND NZIHM is excited to support six candidates for the Fellowship examinations in 2017. Our Fellowship coordinators Jagpal Benipal and Angela Francis are gearing to actively support them through this process with jointly conducted, regular learning sessions. BRANCH ACTIVITIES The theme for the Branch Seminars this year is ‘Accountability in Leadership’. Prof Kevin Lowe is a recognised leader in the field of leadership; his work on leadership and cross-cultural management has been cited more than seven thousand times. At the Auckland Branch Seminar on 14 March 2017, he spoke on ‘Life stream: Exploring Your Leadership from the Inside Out’. A particular emphasis was placed on the role of ethical assumptions on leadership and decision-making.

a Registered Nurse at Whanganui DHB and finding herself returning as Chief Executive. This was a thoughtful and engaging session with Julie passing on her reflections and moments of learning at key points of her career. Julie recommended three books for all Health Managers, Group Process for Health Professions by Edward E Sampson, Good to Great by James C Collins and the One Page Project Manager by Clark A Campbell and Mick Campbell. Her presentation was greatly enjoyed by all who attended. OTHER NEWS NZIHM has an MOU with Health Informatics New Zealand (HiNZ) and we collaborate on events of mutual interest to our members. Each year we encourage our members to attend the HiNZ Conference, and NZIHM has an exhibition booth at their event. NZIHM is proud to support HiNZ bid to host MEDINFO 2021 in Auckland, New Zealand. xyz

These assumptions typically come from a life stream of experiences, both favorable and unfavorable, that are often deeply and viscerally held but poorly articulated. The session employed a combination of micro lectures, audience participation, and small group investigations of ethical dilemmas to illuminate our theories in use. The attendees benefitted by a greater awareness of how their life stream impacts the practice of leadership. Attendees were challenged to use that enhanced awareness to more fully engage co-workers, negotiate winwin outcomes, and more fully develop the capacity for leadership in themselves and others. 2017 saw the revival of the Wellington Branch and their first Seminar kicked off on Thursday 23 March 2017. We were privileged to hear Julie Patterson, CEO Whanganui District Health Board, who spoke about her leadership journey. Julie has had a varied career, starting as

Professor Kevin Lowe

Attendees at the Auckland Branch Seminar

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Hong Kong HONG KONG COLLEGE REPORT The Hong Kong College of Health Service Executives (HKCHSE) successfully launched the 2016/17 Fellowship Program in September, 2016 with 16 program candidates enrolled. The Fellowship Program is scheduled to be completed by July 2017, and the Hong Kong Fellowship Conferment Ceremony will be held at the Hong Kong College 2017 Annual Conference cum Annual General Meeting on 22nd July, 2017 in the Cordis Hotel of Mongkok, Hong Kong. In October 2016, a Hong Kong delegation attended the Joint ACHSM/ACHS Congress in Brisbane, Australia. The Hong Kong delegates enjoyed the opportunity to meet with overseas colleagues and members of ACHSM. We also treasured the chance to learn from the overseas experience on making things happen in health management. The HK delegates did not go unnoticed at the Congress in light of our impressive dress for the theme of the Congress Dinner on “Halloween Howling”.

Delegates at the joint ACHSM/ACHS Congress

The HKCHSE also conducted a strategic planning workshop at the Hong Kong Disney Resort Hotel on 8th November, 2016. We were honored to have Professor Geoffrey LIEU to serve as the facilitator for this important retreat of the College. College financial management, engagement of stakeholders, organisational development and succession planning, partnership and fellowship program were the five critical issues identified during the workshop. All College Council Members found it a productive and enjoyable experience. In November, the HK College organised a hospitals study tour to Singapore where executive meetings and discussions on Singapore’s healthcare financing and delivery, as well as the challenges in the care of elderly were held. Visits to the Alexandra Hospital, the Agency for Integrated Care, Ng Teng Fong General Hospital and National University Hospital, Singapore also occurred. There were more than 20 College Fellows that participated in the hospital study tours and most of them found the overseas hospital visits to be inspiring and a thought-provoking journey. The Hong Kong College 2017 Members’ Night was held successfully on 17th March, 2017 with more than 100 College members gathered in the Royal Plaza Hotel, Kowloon. A good evening was had by all. xyz

An evening of fun at the Halloween Howling Congress dinner

Participants at the Singapore hospitals study tour

Participants at the Singapore hospitals study tour

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COUNCILS

ACHSM Councils The list of Branch Councillors published hereunder was accurate as at mid June 2017. ACT Paul Dyer Jennie Gordon

AFCHSM AFCHSM

Stephen Sant Tania Dufty

AFCHSM AFCHSM

Tony Gill

AFCHSM

Glenys Wilkinson

AFCHSM

Marina Buchanan-Grey FCHSM

Branch Councillors Robert Curtis Lesley Dickens

President Registrar/ Membership Relations Treasurer Professional Development Coordinator Professional Development Coordinator Communications/ Branch Promotion (Non-Council Member) Branch Fellowship Mentee Coordinator

AFCHSM AFCHSM

NEW SOUTH WALES Paul Preob rajensky FCHSM President Terry Clout FCHSM Vice-President Dr Christine Dennis AFCHSM Treasurer Adj A/Prof Dominic Dawson FCHSM Immediate Past President Branch Councillors A/Prof Godfrey Isouard FCHSM Karen Patterson FCHSM Connie Porter AFCHSM Rebecca Pinheiro MCHSM (Management Intern) Natasia Seo MCHSM (Management Intern) QUEENSLAND Mark Avery Kate Copeland Mick Davis Dominic Sandilands Duncan McConnell

FCHSM FCHSM FCHSM FCHSM AFCHSM

Branch Councillors Maj Wayne David Bullock FCHSM Dr Dennis Campbell FCHSM Dr Frances Cunningham FCHSM Prof Anneke Fitzgerald FCHSM Gwenda Freeman FCHSM Richard Olley FCHSM Jeff Parker FCHSM Glynda Summers FCHSM Graham Hyde FCHSM SOUTH AUSTRALIA Stuart Schneider Mark Diamond

FCHSM FCHSM

Branch Councillors Gary Day Brownwyn Masters Chris Barber Heather Baron Roslyn Chataway Liana Niutta Amanda Shields Heidi Silverston

FCHSM AFCHSM AFCHSM AFCHSM AFCHSM AFCHSM AFCHSM AFCHSM

President Vice-President Treasurer Secretary Assistant Secretary/ Membership Registrar

Chair (Hon)

President Vice-President and National Board Director

TASMANIA Amanda Quealy Julie Crowe John Kirwan Julie Tate Jonathan Bugg

AFCHSM President AFCHSM Vice-President AFCHSM Immediate Past President FCHSM Treasurer/Board Director AFCHSM Secretary/Registrar

Branch Councillors A/Prof Leonard Crocombe FCHSM Anne-Marie Stranger FCHSM Phil Edmondson AFCHSM Lauren Parr AFCHSM Jonathan Bugg MCHSM VICTORIA Wendy Davis John Turner

FCHSM FCHSM

Karen Minne

FCHSM

Branch Councillors Greg Allen Briana Baass Dr Mark Garwood Adj A/Prof John Rasa Demos Krouskos Adam Stormont Sandra Brown

FCHSM FCHSM FCHSM FCHSM AFCHSM AFCHSM MCHSM

WESTERN AUSTRALIA Neale Fong FCHSM Peter Mott Andrew Tome

FCHSM AFCHSM

Branch Councillors Dianne Bianchini Karen Bradley Learne Durrington Kim Gibson Trenton Greive Chris Hanna Elizabeth Rohwedder Frank Daly Daniel Mahony Suzanne Robinson

FCHSM FCHSM FCHSM FCHSM FCHSM FCHSM FCHSM AFCHSM AFCHSM AFCHSM

Secretary/Registrar

President Treasurer/Immediate Past President Registrar

HKCHSE Dr LIU Shao Haei Ms CHIANG Sau Chu Mr. Anders YUEN Mr Leo LUI Dr MA Hok Cheung Dr Fowie NG Dr Steve CHAN

FCHSM FCHSM FCHSM FCHSM FCHSM FCHSM FCHSM

President/Board Invitee Vice President Honorary Secretary Honorary Treasurer Immediate Past President Academic Convenor Publication Convenor

Council Members Ms Pearl CHAN FCHSM Ms Liza CHEUNG FCHSM Dr Flora KO FCHSM Dr Gladys KWAN FCHSM Mr Stephen LEUNG FCHSM Dr Arthur SHAM FCHSM Ms Ivy TANG FCHSM Dr Canissa YUEN Yin Fun FCHSM

(Hon) President/ National President Vice-President Treasurer

NZIHM Jayanthi Mohanakrishnan FCHSM President Catherine Cooney FCHSM Treasurer Branch Councillors Jagpal Benipal Jennifer Coles Prof Jackie Cumming Wendy McEwan Karen Osborn John McManus

FCHSM FCHSM FCHSM FCHSM FCHSM MCHSM

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DIRECTORS

Neale Fong

Godfrey Isouard

Graham Hyde

DR NEALE FONG FCHSM (HON) MBBS DIPCS MTS MBA FAICD President Appointed to the Board in 2011 and elected President in 2016. Dr Fong has more than 25 years’ experience in medical, health care and aged care delivery and leadership roles. He is currently Chairman of Bethesda Hospital and Professor of Healthcare Leadership at Curtin University. He was Director General of the WA Department of Health and Chief Executive Officer of St John of God Health Care Subiaco. He currently consults through Australis Health Advisory to a number of key health clients in Australia. He holds Bachelor Degrees in Medicine and Surgery, a Masters in Theological Studies and a Masters in Business Administration.

Mark Avery

Mark Diamond

President and Immediate Past President and retired from QBC in 2001. He was re-elected to QBC in May 2013 and was elected President again. Graham was appointed Executive Officer Gosford District Hospital (Woy Woy) Medical/Rehabilitation Unit in 1974. In 1979 he was appointed Chief Executive Officer Brunswick Byron Area Health Service. In 1991 he was appointed as District Manager of Bayside Health Service District, one of the Districts in the former Brisbane South. Graham retired from public health services in 2001 and established a Consultancy business in specialising in Quality Management Systems, Health Service Management, Strategic Planning, Organisation Development and Financial Accounting services.

ASSOCIATE PROFESSOR GODFREY ISOUARD FCHSM BSC MHA PHD AFAIM Vice President Appointed to the Board in 2009. Godfrey Isouard is Associate Professor of health Management at the University of New England. He has a medical science and public health background, and before moving to academia held senior clinical and health service executive positions. He is currently chair of the National ACHSM Education Committee, Foundation Member of the Editorial Advisory Board for the Asia Pacific Journal of Health Management, and Past President of ACHSM NSW Branch and the Society for Health Administration Programs in Education. His research interests focus on leadership, evaluation and review of organisational performance, the health management workforce, and quality and safety improvement.

MARK AVERY FCHSM BHA MBUS(RES) FAIM FAICD Branch Councillor Director Appointed to the Board in 2016. Mark Avery is an academic and the Program Director for Health Services Management at the Griffith University. His research and consultancy interest areas include leadership and management in health services; patient safety and quality care; community information in health services. Mark has over 30 years’ experience in senior leadership, management and corporate roles in both the public and private health care sectors in Australia and the United Kingdom. His career and experience has been at senior executive, chief executive, consultant, board director levels in hospitals, community health and regulation. Mark has been a member of the College for some 40 years and in that time has been member of three State and Territory Branches.

GRAHAM HYDE FCHSM (HON) FIPA FAIM FRSH AFAAQHC PHF MASQ Treasurer Graham is currently Queensland Branch President. He joined ACHSM in 1974 and has represented the NSW Branch College on the NSW Health Department Fire Advisory Committee the Education and Seminar Committee. He was elected to Queensland Branch Council in 1991. He served as Registrar,

MARK DIAMOND FCHSM BA (BCAE - LATROBE UNIVERSITY) BSW (UNIVERSITY OF MELBOURNE) Branch Councillor Director Appointed to the Board in 2009. Mark has more than 25 years’ management experience in the health and community services industry in three Australian states. He has worked in both metropolitan and rural environments and has been involved in the implementation of significant reforms in the mental health

Angela Magarry

Daniel Mahony

sector in South Australia. He now provides management consulting services to the health and community service industry and is sought after for his expertise in providing strategic and operational support to government, nongovernment and private sector organisations. Mark first joined the College in 1997, is currently the Vice President SA Branch (since 2010) and was appointed to the former Junior Vice President position of the Board in 2012. MS ANGELA MAGARRY FCHSM BHA MPS Branch Councillor Director Angela Magarry is an experienced healthcare CEO who has extensive experience in both government and non-government sectors mainly in strategic policy and government relations roles, nationally and internationally. She is currently CEO of the Committee of Presidents of Medical Colleges. In 2011 Angela received an Australia Award for excellence in higher education reform. Angela holds a BHA, MPS and is a Fellow of ACHSM. Angela is on the ACT Branch. MR DANIEL MAHONY B. PHYSIO G.DIPHSM AFCHSM APAM MAICD Additional Director Daniel is currently Chairman of Future Health Leaders, ACHSM WA Branch Councillor and Chair of the Australian Physiotherapy Association (APA) National Rural Group. Daniel has a passion for rural and remote health and is a past Board Member of Services for Australian Rural and Remote Allied Health (SARRAH). As a Senior Physiotherapist in rural Western Australia, Daniel aims to promote and support the next generation of health leaders and managers into the future. MS JAYANTHI MOHANAKRISHNAN FCHSM President NZIHM Jayanthi has a wealth of private and public healthcare experience gained during 25 years in a number of senior management roles in India and New Zealand. Jayanthi’s expertise lies in having a vision and getting everybody on board, set clear expectations and work efficiently towards a common goal. Jayanthi

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Jayanthi Mohanakrishnan

John Rasa

has built a reputation as someone with high integrity, strong professionalism, and passion, that is committed to high quality outcomes in all her endeavours. Her strong technical abilities, focus and drive play an important role in supporting the DHB. Jayanthi is on a number of Regional and National Committee’s as the Health Board representative on health service design. ADJUNCT ASSOCIATE PROFESSOR JOHN RASA FCHSM BA MHP FAIM MAICD FAHRI Additional Director Appointed to the Board in 2009. John is Chief Executive Officer of Networking Health Victoria (NHV) and was involved in the development of Medicare Locals and subsequently the PHNs in Victoria. John is still Executive Director of the Australian Centre for Leadership Development and continues to be involved in health management leadership programs. John has been National President of ACHSM for the past four years and is also the Chair of the Victorian Chronic Disease Prevention Alliance. He has served as President of the Victorian Branch of the College and as Chief Examiner for the College’s Fellowship program. John is also currently on the Board of the Latrobe Regional Hospital. DR TIM SMYTH MB BS LLB MBA Additional Director Tim joined the Board in August 2014 as a Board appointed independent director. He is well known in the health sector having had a range of senior executive roles across hospitals, health services and the NSW Ministry of Health. Tim is a Special Counsel in corporate and commercial law with Holman Webb lawyers, Chair of the Western NSW Primary Health Network and a management consultant.

Tim Smyth

Julie Tate

MS JULIE TATE FCHSM FIR MBUS GRADDIPHSM GRADDIPED DIPDIAGRAD MAICD Branch Councillor Director Appointed to the Board in 2015. Julie has recently commenced in the position of Operations Manager Medical Imaging Services for the Tasmanian Health Service Southern Region following five years with the Department of Health and Human Services Tasmania as Manager Clinical Support and Cancer Services Development. Julie has extensive health management experience gained during 27 years in a number of senior management roles in Victoria and Tasmania. Some of her special interests include process redesign, workforce planning and community participation in health. Julie has been a member of the College since 1995 and has served on Stage Branch Council in both Victoria and Tasmania. She has previous Board experience as a Board Director for the Cooperative Research Centre for Biomedical Imaging Development and she is a current Board Director for MS Tasmania. MR JOHN TURNER FCHSM JP GRAD DIP H SC (ADMIN) CERT BUS Branch Councillor Director John retired in January after 19 years as Chief Executive of Bentleigh Bayside Community Health which is based in metropolitan Melbourne’s southern suburbs for the past seventeen years. The service provides a wide range of services across two municipalities. He has worked in healthcare administration in both South Australia and Victoria for fifty years in city and rural hospitals, community health services and specialist medical institutions. His involvement in community health dates back to 1974 when the Federal Government commenced funding community health. A member of the College since 1969 and Immediate Past President of the Victorian State Branch, John has also been convenor of the Community Health CEO Special Interest Group for eleven years and a member of the Education & Seminar Committee. John was awarded Life Membership of the College in 2015.

John Turner

Liu Shao Haei

Invitee DR LIU SHAO HAEI PRESIDENT - HONG KONG COLLEGE OF HEALTH SERVICE EXECUTIVES He was the Medical Superintendent of Tuen Mun Hospital from 1990-1992 and commissioned the regional hospital. In 19931995, he was the Hospitals Chief Executive of Ruttonjee Hospital to implement new management initiatives. During the SARS epidemic, he was a member of the Head Office outbreak team and was involved in infection control, data administration and dissemination of information. In 2008, he coordinated the Hospital Authority rescue operations to Sichuan Earthquake and the leader of the Initial Assessment Team. Dr Liu is also the in-charge and Advisor of the Corporate Clinical Psychology Service in Hospital Authority Head Office. He is now the Chief Manager of Infection, Emergency and Contingency Department. His portfolio includes coordination of various specialist services such as Accident & Emergency Service, Intensive Care Service, Trauma Centres, Isolation Facilities, Major Incident Control Centre, Toxicology and Critical Incident Psychology Service. xyz

Australasian College of Health Service Management 43

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