HEALTH MATTERS Victorian Healthcare Association ISSUE 2
[
SEPTEMBER 2012
] www.vha.org.au
Future proofing our health system
greener health services adapting to climate change innovating for social inclusion
The Victorian Healthcare Association Issue 2 [SEPTEMBER 2012] www.vha.org.au
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New benchmark in sustainable design
CHAIRMAN’S MESSAGE Boards need training in complex policy arena CHIEF EXECUTIVE’S MESSAGE We must continue taking steps towards change GREENER HEALTH SERVICES Measuring environmental performance in health GREENER HEALTH SERVICES Healing environment sets new benchmark in design GREENER HEALTH SERVICES Health buildings designed for a sustainable future ADAPTING TO CLIMATE CHANGE Health sector must put its own house in order ADAPTING TO CLIMATE CHANGE Climate policy has overlooked health ADAPTING TO CLIMATE CHANGE Reframing climate change can bring health benefits LEADERSHIP DEVELOPMENT Rapid change drives need for innovation AGED CARE REFORM Moving in the direction of better aged care INNOVATING FOR SOCIAL INCLUSION A life-changing hub for homeless people INNOVATING FOR SOCIAL INCLUSION Intensive service model tackles homeless cycle
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Acting on climate change
For editorial content please contact: SARA BYERS Media and Communications Officer The Victorian Healthcare Association Level 6, 136 Exhibition Street Melbourne, Victoria 3000 Australia Telephone: +61 3 9094 7777 Facsimile: +61 3 9094 7788 Email: vha@vha.org.au www.vha.org.au The VHA would like to thank member agencies and supporters for supplying many of the photos included in this edition. This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior permission from The Victorian Healthcare Association and inquiries concerning reproduction and rights should be addressed to the editor. © The Victorian Healthcare Association Ltd 2011.
The Victorian Healthcare Association (VHA) is the major peak body representing the interests of the public healthcare sector in Victoria. Our members are public hospitals, rural and regional health services, community health services and aged care facilities. Established since 1938, the VHA promotes the improvement of health outcomes for all Victorians, from the perspective of its members.
This publication is printed using eco-clean print processes. Vegetable based inks and recyclable materials are used where possible. Printed by GEON Brunswick – ISO9001 / ISO14001 & AS/NZS 4801
Chairman’s Message
Boards need training in complex policy arena
ANTHONY GRAHAM VHA CHAIRMAN
relationships between those agencies and Medicare Locals, which may impact on their models of service delivery.
Health service boards and their executive teams face a policy environment that is characterised by change on almost all fronts. This change is impacting the predictability of service strategy, organisational capacity, and the compliance and accountability regime within which we operate.
In this context, it is no wonder directors are feeling a little besieged. The Australian Commission for Safety and Quality in Health Care is working on a set of 10 indicators against which clinical outcomes will be measured. Victoria’s Metropolitan Health Plan and Rural and Regional Health Plan suggest that the structural features of our current system must change over the next 10 years. To add further complexity, we also have a Federal Opposition whose policy position is significantly different to that of the government and its reform package, which could have significant implications after next year’s federal election.
In this context, it is no wonder directors are feeling a little besieged. The results of the Victorian Healthcare Association’s 2012 board self-assessment survey indicate that directors want to increase their understanding of population health planning, clinical governance and the current policy environment, and recognise the need to become more financially literate and better able to set and monitor organisational performance. With that in mind, our annual policy conference will shed some light on how service providers might set future strategic directions and operational priorities in a sustainable way. The program will help to develop an understanding of how leaders within our sector can implement change for the future benefit, health and wellbeing of the Victorian community.
Let us reflect for a moment on today’s policy context … The Independent Hospital Pricing Authority has set a price point for future funding arrangements between the Commonwealth and the states. The national weighted activity unit will determine the Commonwealth’s contribution to state-run hospital systems from 2014-15. This creates new accountability structures between federal and state jurisdictions and, by extension, between each local health network and their respective state government. Further, the definition of a hospital service from 2014-15 will make new models of care eligible for funding. At the same time, all local health networks and Medicare Locals will be subject to a new set of standard output measures created by the National Health Performance Authority. Medicare Locals will be required to undertake an analysis of the population health needs of their communities of interest. In addition, the funding relationships of agencies receiving commonwealth funding will become
The Victorian Healthcare Association Issue 2 [SEPTEMBER 2012] www.vha.org.au
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Chief Executive’s Message
We must continue taking steps towards change
TREVOR CARR VHA CHIEF EXECUTIVE
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The vision of the Victorian Healthcare Association (VHA) is to optimise health outcomes for all Victorians. In order to truly deliver on this vision, several wrinkles need to be ironed out of the health system. The necessary change can be managed incrementally, providing there is alignment between our political leadership, bureaucratic leadership, and health service leadership. As a thought-leading organisation, the VHA must ensure that the often opposing forces for change do not cause a retreat to the safety of inertia – simply doing more of the same. Our current tough fiscal environment exacerbates this challenge.
Strong and effective thought leadership, made possible by comprehensive member engagement, allows the VHA to enhance the decision-making processes of policy makers who develop our public healthcare system.
The VHA must ensure that the often opposing forces for change do not cause a retreat to the safety of inertia. The outcome we seek is a healthcare system with: •
a priority focus on person-centred care
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government policy that consistently reflects the physical, social and environmental aspects of personal health status
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service planning derived from population-based health analysis
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a contemporary health workforce structured to meet the changing care needs of Victorians
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flexible funding models that allow innovative approaches to addressing local health needs
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stronger governance models for local leadership
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public awareness of the view of health service agencies
The principles that guide the VHA’s approach to achieving our vision include: •
technology plays an important role in enabling health service models to change – with advances in pharmacology, information capture and interpretation, and surgical instruments must come changes in workforce design
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social determinants, which impact individual and whole population health outcomes, are integral to the design of a public healthcare system
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long-term planning and ongoing policy iteration enable system change and improvement of individual and population health outcomes
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local governance of health services enables tailored strategies that best meet the healthcare needs of individual communities
The Victorian Health Priorities Framework (VHPF) 2012-2022 provides a reasonable alignment to this vision. The ‘how’ will be detailed in the yet-to-be-released Health Capital and Resources Plan. At a time when health service leaders have broadly endorsed the direction of the VHPF we are experiencing increasing fiscal pressure that could scuttle the honest discussion required to achieve system change.
The Victorian Healthcare Association Issue 2 [SEPTEMBER 2012] www.vha.org.au
In the absence of a policy that details how we implement the VHPF, industry leaders, bureaucrats and politicians are left to work in a policy void – “nice framework, but how do we get there?” This void is increasing the ongoing tension between treasury officials (who need to count the return on investment) and industry representatives (who need to work within a strategic model that enables flexible supply to productively meet the ebb and flow of fluctuating demand cycles). VHA members consistently express a desire to start implementing the change required to achieve the VHPF’s goals. The VHA acknowledges that it is a 10-year plan, but encourages government to ensure that momentum and support for change is not lost through unnecessary delay. Investment in pilot projects that explore creative new approaches to funding and service delivery must be supported through the 2013-14 Victorian Budget. Projects that are consistent with the objectives of the forthcoming Health Capital and Resources Plan will encourage confidence within the sector that the Victorian Health Priorities Framework can deliver better health outcomes for Victorians.
Greener Health Services
The Global Green and Healthy Hospitals Network has just been launched in Australia by Health Care Without Harm (HCWH) – an international coalition of hospitals, community groups, trade unions, environmental and religious groups. The network is a virtual community where hospitals and healthcare organisations can chart their progress against measurable environmental outputs, and find solutions for shared challenges. It promotes 10 interconnected goals: 1. Leadership: prioritise environmental health 2. Chemicals: substitute harmful chemicals with safer alternatives 3. Waste: reduce, treat and safely dispose of waste 4. Energy: implement energy efficiency and clean, renewable energy generation 5. Water: reduce hospital water consumption and supply potable water 6. Transportation: improve transportation strategies for patients and staff 7. Food: purchase and serve sustainably grown, healthy food 8. Pharmaceuticals: safely manage and dispose of pharmaceuticals 9. Buildings: support green and healthy hospital design and construction 10. Purchasing: buy safer and more sustainable products and materials Hospitals that make a commitment to implementing at least two of these goals, while improving their environmental performance year-by-year, automatically join the network at no cost. HCWH is also running First Do No Harm, a global campaign for ecologically sustainable alternatives to healthcare practices that pollute the environment and contribute to disease. For example, the incineration of medical waste is a major source of dangerous air pollutants such as dioxin and mercury, and the use of hazardous chemicals indoors may contribute to high rates of asthma among healthcare workers.
Measuring environmental performance in health The massive scale of the healthcare sector around the globe means that unhealthy practices — such as poor waste management, toxic chemical use, unhealthy food choices, and polluting technologies — have a significant impact on human health and the environment. HCWH believes the sector’s massive buying power, and mission-driven interest in preventing disease, mean that it can also play a leading role in shifting the health economy towards sustainable, safer products and practices. For example, HCWH and the World Health Organization are campaigning to virtually eliminate mercury-based medical devices over the next decade. Mercury is a potent neurotoxin that can harm the brain, spinal cord, kidneys and liver, and is a significant contributor of pollution in the environment. PVC (vinyl plastic) also creates health risks, including dioxin pollution and patient exposure to hazardous chemicals like phthalate DEHP, which leaches from vinyl medical devices.
PVC is the most commonly used plastic in medical devices, and is used in IV bags, disposable gloves, hospital curtains and flooring. Many health care facilities around the world are switching to safer, cost-effective medical devices that do not contain vinyl plastic or phthalates. HCWH is also helping hospitals to use safer cleaning products and less toxic disinfection methods, and to adopt integrated pest management and fragrance-free policies to improve indoor air quality and promote health. HCWH does not accept financial support from manufacturers or endorse specific products. Groups do not have to pay to join the Global Green and Healthy Hospitals Network or HCWH. For more information visit www.noharm.org or www.greenhospitals.net
FURTHER READING Our Uncashed Dividend: The Health Benefits of Climate Action This briefing paper was jointly launched by the Climate and Health Alliance (CAHA) and the Climate Institute last month. It asserts that reducing emissions could save billions of dollars from healthcare budgets, and save thousands of Australian lives every year. caha.org.au/wp-content/uploads/2010/ 11OurUncashedDividend_CAHAandTCI _August2012.pdf A Comprehensive Environmental Health Agenda for Hospitals and Health Systems Around the World Hospitals that commit to implementing at least two of this agenda’s goals, while improving their environmental performance year-by-year, receive free membership with the Global Green and Healthy Hospitals Network. www.greenhospitals.net/wp-content/ uploads/2011/10/Global-Green-andHealthy-Hospitals-Agenda.pdf
The Critical Decade: Climate Change and Health This Australian Government Climate Commission report outlines how climate change impacts health and wellbeing, and how risks must be managed. It asserts that Australia, and other countries, must take urgent action to slow human-induced climate change. climatecommission.gov.au/report/thecritical-decade-climate-change-and-health Conveying the Human Implications of Climate Change: A Climate Change Communication Primer for Public Health Professionals This new resource from the US Center for Climate Change Communication promotes discussion among health professionals of the health effects of climate change. It provides strategies for communicating the links between climate threats and community health. www.climatechangecommunication.org
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Greener Health Services
The design of Melbourne’s new Royal Children’s Hospital (RCH) recognises the inextricable link between the health of our environment and people’s emotional, physical and psychological health. Central to the hospital’s sustainable design is social responsibility – the creation of a healing environment alongside the reduction of resource consumption. RCH aims to cut greenhouse gas emissions by 45 per cent through a combination of tri-generation, bio-mass heating, solar thermal panels, energy efficient lighting and water conservation. Tri-generation uses gas-fired engines to create electricity that is up to seven times cleaner than coal-fired power station energy. Heat that is a by-product of the hospital’s tri-generation plant is used in its heating, cooling and hot water systems. “We wanted this to be the greenest hospital in Victoria, and possibly Australia – and it is – and we’re very proud of that,” Deputy Chief Executive Officer John Stanway says. “We believe that with sustainability comes economic benefit, comes healing, come a whole host of things that will benefit us as a hospital and the community we serve.
Healing environment sets new benchmark in design “We are the benchmark for hospitals around the world now. We’re getting visitors from all around the world, who want to see what we’ve done here in Melbourne, Victoria.” Stage 1 of the $1.1 billion hospital was opened by Her Majesty the Queen last October, with Stage 2 works continuing until the end of 2014. Sustainable design principles are reflected in the longevity of the 200,000sqm building, which has an expansion strategy providing for an additional 50,000sqm. RCH won the Sustainable Design and Interior Design categories at the 2012 Design and Health International Academy Awards, and was named Best International Health Project over 40,000sqm. It won three top awards at the 2012 Australian Institute of Architects (AIA) Victorian Architecture Awards – including the Victorian Architecture Medal, the Melbourne Prize, and the William Wardell Award for Public Architecture. RCH was also highly commended for its use of art in the patient environment. “Very early in the design phase, we looked at the worldwide research on how the environment can help the healing process, and we built that into the design of the hospital,” Mr Stanway says.
Photos: John Gollings
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“Parkland, light, art, animals – all sorts of features – make this a really fantastic healing environment.” The hospital features a unique two-level aquarium, a meerkat enclosure, a starfishshaped inpatient unit, and a ‘Main Street’ that forms its social heart. This north-facing, light-filled street also joins the campus-like arrangement of buildings and provides views to surrounding Royal Park.
“We wanted this to be the greenest hospital in Victoria, and possibly Australia – and it is – and we’re very proud of that.” A sculpture known as ‘The Creature’, by Melbourne artist Alexander Knox, occupies a large atrium on the Main Street. Above it hangs ‘Sky Garden’ by young Sydney sculptor Jade Oakley – a series of five colourful mobiles that form a tree-like canopy. The project was a public-private partnership with a consortium of companies, including Bates Smart Architects. Associate Director and Lead Health Planner at Bates Smart, Leanne Guy, explains the design’s holistic approach: “It has been widely acknowledged that the physical
USA hospital delivers major energy savings environment of hospitals can directly impact the patient and their healing. “The design of hospitals has evolved to encompass evidence-based design principles of integrating daylight and views to nature into patient spaces, with other design concepts such as creating a sense of place, reducing ambient noise, integrating information technology, and colour and art into the hospital environment.” Green polka-dot glazed panels provide a camouflage pattern that blends the façade of the RCH inpatient unit into its parkland surroundings. More than 1000 leaf-shaped, coloured glass blades form a unique sun shading device on the western façade, and define the hospital’s main entrances. A Bates Smart Director, and Design Director on the project, Kristen Whittle says: “All these elements work to be both functionally responsive and soft, and intriguing to the eye. “The new RCH has created a significant benchmark for hospital design worldwide where the highest standards of human comfort and sustainable design have combined to create a truly holistic built form solution.”
The designers of America’s greenest hospital achieved a 12 per cent return on investment (ROI) by sticking to the principle of not going overboard to make the building appear ‘supergreen’. Instead of using non-energy-related sustainable design elements that did not increase the ROI, Karlsberger Architects focused on creating a sustainable hospital energy system. Their vision for Dell Children’s Medical Center in Austin, Texas, included a custom-built combined cooling/heating power plant. Hospitals are the second most energyintensive commercial buildings in the US, using twice as much energy as traditional office spaces.1 A custom-built US$18 million power plant at Dell Children’s increased the energy efficiency for primary fuel conversion from 29 per cent (for a typical hospital) to 75 per cent. As a result, the 169 bed hospital was the first to achieve Leadership in Energy and Environmental Design (LEED) platinum status.2 A third bed tower, to be completed next year, will be 22 per cent more efficient than required by code and will also be platinum-certified. Air handling units are enclosed in 15 heat recovery rooms dispersed around the existing hospital, instead of on the roof, to simplify maintenance and extend their life expectancy. These rooms are stacked and sized according to the heating and cooling needs of the department they serve. For example, one stack serves a cardio operating theatre, which has to be heated very quickly following surgery, and another stack serves administrative offices with a fairly constant temperature. This innovation allows for shorter ducts with lower air velocity and noise levels, which are a potential stress on some patients. The fan motors are also smaller, saving on construction and operating costs.
Five heat recovery rooms on the roof enable the floors below to re-use cooled air that escapes from the building during summer. Some sustainable design elements were vetoed from the original building –– for example, interior light shelves were seen as dust collectors and a potential threat to infection control.
Hospitals are the second most energy-intensive commercial buildings in the US, using twice as much energy as traditional office spaces. However, the designers managed to deliver daylight into more than 80 per cent of administrative and nonclinical spaces, and 35 per cent of diagnostic and treatment areas. They stuck to their original goal of 12 per cent ROI and avoided using non-energyrelated sustainable features, such as roofmounted wind turbines, vegetative roofs, waterless urinals, an onsite tertiary water treatment plant, pervious pavement, and recycled plaster board. Operations at Dell Children’s are constantly being refined to improve environmental performance. From 2010 to 2011, the hospital reduced its landfill waste by six per cent and increased its collection of recyclable material by 50 per cent. References 1 United States Department of Energy, Energy Information Agency Commercial Buildings Energy Consumption Survey (http://www.eia. doe.gov/emeu/cbecs/cbecs2003/ detailed_ tables_2003/2003set9/2003pdf/c1.pdf) 2 LEED is an internationally recognised certification system developed by the US Green Building Council in 2000 (http://www.usgbc.org)
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Greener Health Services
Health buildings designed for a sustainable future “In community health, you try to provide reasonably generic rooms where a doctor could run a GP clinic, and a range of other allied health professionals could also work in those spaces.” The redevelopment of Lorne Hospital on the Great Ocean Road required a highly flexible design to cater for seasonal fluctuations in demand. “It goes from being a very quiet, largely older population who need the aged care characteristics of the hospital, then in the middle of the high season there needs to be a substantial emergency department running 24 hours a day,” Mr Chrisp says. “The flexibility in the design was about making sure the hospital was suitable in both of those modes.”
LaTrobe Community Health Service
Community health facilities must have flexible design to accommodate new equipment, technology and changing service models.
Flexibility, forethought and “getting the very early principles right” are crucial elements to designing enduring healthcare buildings, says architect Jim Chrisp.
He says a redevelopment strategy to provide for future expansion is crucial to the design of any new hospital. “You must get the fundamental planning and the flow and functionality of the building right. You want to make sure that every element of the building can grow on its own account without having wider ramifications.
A founding director of Vincent Chrisp Architects, he has been designing hospitals, community health centres and aged care facilities for more than 30 years. Projects include the new LaTrobe Community Health Service in Morwell, which is Victoria’s largest, most modern community health building. He says community health facilities must have flexible design to accommodate new equipment, technology, and changing service models. “A service might be running a program that needs three rooms for eight months. Then government funding for that program might either double or be eliminated,” Mr Chrisp explains. “The design has to be flexible to allow service variations to occur without having to chop up the building and start again. Centre for Health Care Innovation, The Alfred Hospital
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The Victorian Healthcare Association Issue 2 [SEPTEMBER 2012] www.vha.org.au
“You must get the fundamental planning and the flow and functionality of the building right. You want to make sure that every element of the building can grow on its own account without having wider ramifications.”
“You don’t bury part of the emergency department or the radiology department in the middle of the space, so the only way to expand is by moving someone else out, which generates massive complications and costs.” Vincent Chrisp Architects is currently redesigning a hospital in regional Victoria that became redundant just 15 years after it was built. “Population growth has been so dramatic, due to demographics and regional movement, that in order to make that hospital big enough to meet the next 25 years’ demand, they need to treble some areas,” Mr Chrisp says. “It’s almost impossible to do it in a way that is cost-effective. A problem for hospitals is that you can’t demolish the wing which has the emergency department in it, or take the kitchen offline for two months during building works.” He says the design brief for most modern aged care facilities is to create “a warm, friendly home-like environment” so residents don’t feel like they are living in a clinical space.
Two decades ago, the design of nursing homes wasn’t much different to hospitals, with four-bed wards, shared facilities, and almost no private space for residents. Today, residents have individual rooms with en suite bathrooms where possible. North-facing outdoor areas and friendly interior design elements create a sense of homeliness, while residents are encouraged to personalise their space with furniture and belongings.
A redevelopment strategy to provide for future expansion is crucial to the design of any new hospital. At one facility, Vincent Chrisp Architects built a glass recess next to each door for residents to place memorabilia that would help them find their room. Mr Chrisp says a series of residential wings are usually joined by shared recreation and dining spaces. Each wing may have its own separate lounge rooms and outdoor areas
to foster smaller ‘communities’ within the overall facility. “Building design must match the nursing model. Rather than building large-scale complexes to maximise bed numbers, there is more emphasis on creating a certain feel. “When the design is finished and the residents move in, no-one remembers how the project saved $100,000 by squeezing in more beds.” Vincent Chrisp Architects also designed the $13 million Centre for Health Care Innovation at The Alfred Hospital. A joint venture between Alfred Health, Monash and La Trobe universities, the centre has a network of fully quarantined test beds where medical staff receive training in new clinical technologies. Its simulated teaching facilities include a major operating theatre, a procedures theatre, a casualty department, a four-bed nursing ward, a clinical skills lab, a human factors lab, and advanced mannequins remotely operated from control rooms. Jim Chrisp will speak at the breakfast session of the VHA’s annual policy conference Beyond Survival: Redesigning Healthcare for a Sustainable Futures on Friday October 12.
Lorne Community Hospital
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Adapting to Climate Change
Health sector must put its own house in order Britain’s National Health Service (NHS) has calculated its carbon footprint at more than 18 million tonnes of CO2 per year, which is 25% of the nation’s total public sector emissions.3 A plan to reduce this footprint is supported by 95 per cent of NHS staff4, and will have important health co-benefits. Cutting fossil fuel combustion will reduce global warming gases like CO2 and minimise other pollutants that add to the environmental burden of disease. International associations, such as the International Council of Nurses, the World Federation of Public Health Associations, and the UK-based Climate and Health Council, have already taken strong positions on climate change.
“To honour its commitment to ‘first do no harm’ the health sector has a responsibility to put its own house in order so that its practices, the products it consumes, and the buildings it operates do not harm human health and the environment,” according to the World Health Organization (WHO). “To achieve this, there are basic steps the health sector can take – from improving hospital design to reducing and sustainably managing waste, using safer chemicals, sustainably using resources such as water and energy, and purchasing environmentally-friendly products.”1 WHO and global green group Health Care Without Harm (HCWH) believe climate change will have a potentially devastating impact on human health. Their draft discussion paper Healthy Hospitals, Healthy Planet, Healthy People: Addressing climate change in healthcare settings predicts that temperature shifts will encourage the spread of infectious diseases that are sensitive to temperature and rainfall.
WHO and HCWH believe “it is time for the health sector to respond to the reality of climate change by taking a moral and tangible leadership role in mitigation efforts around the globe, beginning with its own policies and practices … Because its climate impact is so vast, the health sector can play a major role in mitigation efforts around the world.” They say global warming may also lead to higher levels of some air pollutants, increase transmission of diseases through unclean water and food, and compromise agricultural production in the least developed countries. Climate change is expected to have far greater health impacts on vulnerable populations, including the very young, the elderly, and the medically infirm. However, the health sector can help reduce these impacts through better emergency response programs and global research. The sector can also reduce its own significant climate footprint to help mitigate the effects of global warming. The United States healthcare sector spends US$8.5 billion on energy each year.2
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The US organisation Practice Greenhealth has created an Energy Impact Calculator (EIC) enabling hospitals to predict the health impacts of their own energy consumption from fossil fuels. These impacts can include premature deaths, chronic bronchitis, asthma attacks and emergency department visits.5 Based on EPA peer-reviewed data, the EIC predicts the number of incidents, treatment costs, external costs to society, and the likely CO2 permit (carbon tax) cost, so that hospitals can see the health benefits of onsite renewable energy generation. References 1
World Health Organization/Health Care Without Harm Healthy Hospitals, Healthy Planet, Healthy People: Addressing climate change in healthcare settings discussion draft, available at: http://www.who.int/ globalchange/publications/climatefootprint_report.pdf
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Energy Star web site, U.S. Environmental Protection Agency (http://www. energystar.gov/index.cfm?c= healthcare.bus_healthcare, accessed 20 April 2009)
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Saving carbon, improving health: NHS carbon reduction strategy. National Health Service, Sustainable Development Unit, Cambridge, January 2009
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Climate change 2007: synthesis report. Summary for policymakers. Intergovernmental Panel on Climate Change (IPCC-AR-4), p2)
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Energy impact calculator. Practice Greenhealth, http://www.practicegreenhealth.org/tools/eic
Adapting to Climate Change
The Climate and Health Alliance (CAHA) believes Australia’s healthcare sector has largely failed to grasp the health risks posed by climate change. At a recent public hearing on the draft Productivity Commission report Barriers to Effective Climate Change Adaptation, CAHA expressed concern that health impacts were being overlooked. CAHA praised submissions by the National Centre for Epidemiology and Population Health and by the Australian Psychological Society but said: “The fact there is no submission from any health service agencies to this inquiry reflects the lack of understanding within health departments and the health sector more broadly about the risks posed to health from climate change, and the importance of protecting health through national adaptive responses. “There are, in fact, excellent examples of some health services demonstrating leadership in helping communities adapt to climate change, such as the Southern Grampians and Glenelg Primary Care Partnership, and Women’s Health in the North, but too often these initiatives depend on the passion and commitment of individuals. “The lack of engagement with this inquiry and with the issue itself suggest that health professionals and the healthcare sector have largely failed to grasp the risks posed to Australian communities.
Climate policy has overlooked health In May 2009, The Lancet medical journal identified climate change as “the biggest global health threat of the 21st century”. CAHA believes raising awareness among health and medical practitioners is one of the key strategies for protecting human health from climate change impacts, such as: •
more frequent and severe extreme weather events causing injuries, trauma and deaths
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increased air pollution and aeroallergens
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increased temperatures creating a higher risk of food-, vector- and water-borne diseases
The five-day Victorian heatwave of 2009, with temperatures 12-15 degrees above average, saw a 62 per cent increase in mortality from heat-related illness and associated exacerbations of chronic medical conditions. The Victorian Department of Human Services reported that demand for ambulance services increased by 46 per cent. Emergency departments experienced an eight-fold increase in heat-related presentations, a 2.8-fold increase in cardiac arrests, and a three-fold increase in patients dead on arrival. “While there has been an energetic public discussion about the need for a national policy response to climate change for several years, there has been little acknowledgement by any government of the imperative to protect health through climate policy,” CAHA states.
“The Climate Commission has produced a report on climate change and health, but its messages are yet to reach the majority of health professionals. “There are many opportunities for the healthcare sector to respond to climate change in ways that reduce energy use, reduce waste, save money and improve health.
CAHA believes raising awareness among health and medical practitioners is one of the key strategies for protecting human health from climate change impacts. “Healthcare providers should be supported to reduce the environmental footprint of the sector in ways that will protect them from future shocks in terms of energy prices, water shortages and resource shortages. Adaptation measures that create a sustainable and resilient healthcare sector will provide ongoing benefits for the community.” CAHA is a not-for-profit national alliance of health sector representatives that raises awareness about the health risks of climate change and the health benefits of reducing emissions. For more information visit www.caha.org.au
RECOMMENDATIONS TO THE PRODUCTIVITY COMMISSION 1. A national plan for how the health sector will respond to climate change through adaptation and mitigation 2. A national community engagement campaign about the risks from climate change 3. Programs to help health professionals develop more effective adaptive responses
4. A substantial increase in funding for Australian climate and health research 5. More investment in research on climate change communication to translate evidence into policy action 6. Improved disease surveillance, health risk monitoring, early warning systems, emergency response and disaster preparedness
7. Improving community resilience through greater investment in health promotion and disease prevention 8. Evaluation of projected healthcare demand from climate change, including impacts on infrastructure and associated costs 9. Initiatives to ‘green’ the health sector
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MARION CAREY VICHEALTH SENIOR RESEARCH FELLOW, MONASH UNIVERSITY
Adapting to Climate Change
Climate change is a complex problem but appears to many people as lacking immediate impact on their lives. Reconceptualising it as a health issue may allow for both better understanding of the issue and greater scope for changing behaviour. Climate change is often perceived as affecting people far from us in both time and space. And what doctors, psychologists and other health professionals have known for some time is that just providing people with more facts about an issue doesn’t always change their minds or cause them to act in an appropriate manner. In fact, how we say something may be as important as what we say. Health-related behaviour can be determined by a number of factors, including whether people think the problem is serious, feel they’re susceptible to it and are convinced they’re able to take effective action. While denial may result from apathy or self-interest, it may also be a way of actively avoiding something deeply worrying that we feel powerless to change. Cognitive dissonance – the discomfort generated when there’s a discrepancy between beliefs or behaviours – occurs when we are presented with information that’s incompatible with our world views or firm beliefs, and we employ strategies
Reframing climate change can bring health benefits to defend these. Denying the new information may be the easiest way to deal with the conflict. Generating powerful emotions, such as fear or guilt, can create an ‘emotional dissonance’ with people trying to avoid what is upsetting, leading to a different type of denial. So fear-based appeals, if not coupled with solutions, can actually reduce engagement. Our emotions and values are intricately tied up with how we respond to information, and that’s why framing of the issue is so important. Climate change can be seen as an environmental, moral, or economic issue. And it can be also framed as a health problem. One of the benefits of using the health frame is that it makes the issues more tangible – here and now and about people, not polar bears. People are already familiar with health problems and accept their importance. While it can seem a somewhat nebulous concept when spoken of in its own terms, framing climate change in terms of heart disease, asthma, food safety and infectious disease can make it more “real” and personally relevant. Issue frames that emphasise benefits rather than focusing on costs, and tailoring messages as much as possible to particular audiences, will achieve better responses. The health frame offers solutions and a positive vision of the future with multiple benefits. The Climate Commission has recently started using the health frame to communicate about climate change. It has also recognised that health professionals are a source of trusted information for people. In fact, there’s an emerging body of literature pointing to the health benefits of acting on climate change. Policies that reduce greenhouse emissions can result in significant health improvements and contribute to tackling the epidemic of chronic diseases now facing modern societies.
Being less dependent on car use and more physically active – walking or cycling – can benefit people by reducing the risk of obesity, cardiovascular disease and diabetes, and promoting good mental health. Reducing fossil fuel combustion from vehicle use and coal combustion can reduce air pollution, a significant cause of cardiovascular and respiratory disease, and premature death. By designing our cities and transportation systems more efficiently, we can reduce emissions and help prevent a range of health impacts.
One of the benefits of using the health frame is that it makes the issues more tangible – here and now and about people, not polar bears. Even increasing the proportion of vegetables and reducing meat consumption in our diets can provide a win for both health and the environment. Such multi-sectoral policies and approaches to daily life also have the capacity to generate considerable economic savings. Health professionals are well-placed to use the health frame for communicating the impact of climate change and illustrating the health benefits mitigation strategies can have. Reframing climate change as a health issue helps people understand what climate change predictions mean for them and their loved ones, as well as to unite people across ideological divides and empower and motivate them to act. This article was originally published by The Conversation at www.theconversation.edu.au
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DR HARRY MAJEWSKI CHIEF EXECUTIVE OFFICER INNER EAST COMMUNITY HEALTH
Leadership Development
Massive change is taking place in the newspaper industry as an obvious response to the dramatic effect of the internet. Healthcare may not be immune from innovations that will also change our sector fundamentally. An article in Forbes Magazine titled ‘Healthcare CEOs guide to avoiding newspaper industry mistakes’ paints a picture of impending disruptive change in the United States health sector: “Like local media executives in the late 90s, healthcare leaders can view the present time period as either the best or worst time to be in their role. The health system leaders who believe it’s the best of times … can reinvent and reinvigorate a lumbering giant, turning it into a dynamic organisation.”1 The UK National Health Service established the NHS Institute for Innovation and Improvement to develop innovation cultures within Britain’s healthcare system. In five years, the institute has developed products in critical clinical areas that could save the NHS £6 billion. The institute says: “In 2012 our work is all about embracing change and being adaptable, flexible and open to new ways of working to meet the demands of delivering healthcare while we emerge as a nation from the economic recession.”2 The key driver for innovation is the need to deliver more and higher quality care, with fewer resources, to clients who
Rapid change drives need for innovation themselves are responding differently from established patterns. In my own organisation – Inner East Community Health Service – the innovation culture is inhibited by government funding models whose unimaginative designs numb creativity. The challenge for us was to step back from the funding agreement and spend time imagining what the future could look like. It sounds easy, but the reality was much more difficult. Our strategic planning sessions often found it hard to imagine a future outside the funding models. We worked with Leadership Victoria’s Williamson Program.3 The brief was to design a leadership development program for our health service that focused on leadership, not management. We are about half-way through presenting this year-long program. The key aims are to develop confidence and understanding within our leadership group and individually. We expect to wear the De Bono ‘green thinking hat’ for creativity more often, perhaps because the more traditional elements that have dominated our work as health service managers can be moved further down the priority list. Many organisations and academics outline best practices for innovation. Often at the centre is the need for leaders to demonstrate behaviours that empower other people to innovate4. This is far more subtle than, for example, developing a web-based information exchange. It is also far more difficult. Some of the challenges include being prepared to let go of some dearly held beliefs so that a longer-term view can be imagined. This applies not only to service delivery organisations but also to funding bodies. The innovation path is most complex for publicly funded community health services because no two services are alike. Further, their role in the health system is unclear, their funding often uncertain, and their outcomes not systematically measured.
The expectation is that community health services deal with health issues that others find difficult to deal with. This scenario creates a reactionary political dimension to the community health system. Because of that environment, some foundations for innovation will need to be built in partnership with government. We need resources to define consistent benchmarks for outcomes, and to create a framework that encourages innovation. If healthcare does experience the disruptive technology revolution predicted in Forbes Magazine, one component is likely to be how information will be used to inform and target client care. One can imagine intelligent IT systems that prompt and manage the relationships between patients, practitioners, activities and data might fundamentally alter the nature of care and treatment. An innovation strategy starts with people being able to imagine the future and then to step backwards towards the present. Surprisingly, it may not be difficult to find real world examples of most of the necessary steps. Our innovation program is available to other groups on request, and consists of a series of eight half-day modules. It will be supported this year by an innovation professional development program for all staff as a service priority. We don’t want to be left behind! References 1 Chase D (2012) Forbes Magazine, 9th February, 2012 http://www.forbes.com/sites/davechase/ 2012/02/09/healthcare-ceos-guide-to-avoidingnewspaper-industry-mistakes/ 2 NHS Institute for Innovation and Improvement http://www.institute.nhs.uk/ 3 Leadership Victoria Williamson Community Leadership Program http://www.leadershipvictoria.org/programs/ williamson-community-leadership-program 4 Xerri M & Brunetto Y (2011) Fostering the innovative behaviour of SME employees: a social capital perspective. Research and Practice in Human Resource Management, 19(2), 43-59
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CHIEF INVESTIGATOR ARC CENTRE OF EXCELLENCE IN POPULATION AGEING RESEARCH
PROFESSOR HAL KENDIG
Aged Care Reform
The Federal Government’s Living Longer. Living Better aged care reform package is a landmark for setting valuable directions for better care. It’s the first such major initiative in more than 25 years – but there’s a long and uncertain road ahead. The reforms outlined in the Living Longer. Living Better report align with important values about what older people (and their carers) want – to stay in their own homes for as long as possible. There’s an emphasis on a fairer, more accountable, and more sustainable financial system. Inconsistencies in existing funding arrangements will be addressed, and consumer protections strengthened. The proposed ‘gateway’ to aged care services and the My Aged Care website have potential to improve transparency and access to services. The favourable reception so far, from consumers and providers alike, reflects sound policy work by the Productivity Commission, attentive consultation by the Minister and Council on the Ageing, and astute political judgements by the minority Gillard Government. But substantial commitments have yet to be achieved. Only baby steps have been outlined in terms of genuinely new public funding, with most foreshadowed increases deferred for years.
Moving in the direction of better aged care New initiatives are to be paid for mainly through increased user charges and tighter means tests, redirection of existing funds, and re-worked funding formulae. There appears to be little risk of a major consumer backlash as, once again, the family home remains sacrosanct. But while the principles and directions are strong, one might well ask “how will this actually happen?” It will probably take the planned 10year timetable to fundamentally reorient the aged care system. And we have to remember that the 10-year implementation that occurred last time we had reform in aged care, from the mid-1980s to mid-1990s, was under one political administration – Labor. And this government’s future – in terms of political control and leadership and economic prospects and funding contexts – is less than clear. The focus on people with dementia recognises their special needs and community concern. We’d hope that comparable resources and sensitivity could also be directed to those with intense and complex needs on the basis of other social, cultural, and health vulnerabilities. COMMUNITY CARE The new Commonwealth Home Support Program promises to better integrate and increase flexibility in providing assistance at home, carer support and respite. The new home care packages will provide more options for higher-level support in the community along with a wider range of flexible consumer-directed care. It’s disappointing that there hasn’t been a more fundamental funding redirection toward community care – although there are cost pressures on the residential care industry. Nor is there much indication that services will be developed and delivered at a more regional level, where they can be better coordinated. That sort of redirecting is going to be a tough nut to crack and it’s going to take a lot of effort.
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The bigger picture is that the directions of the reforms are sensible but still have the hallmarks of control out of central offices in Canberra. And there’s scant attention to the need for better accommodation options in the community, and for more integration of aged care with healthcare and health promotion. Fundamental change – not incremental program developments – is needed to get aged care focused on what older individuals and their carers really want and where they live. Nonetheless, here are the beginnings of a necessary turn-around toward a fundamental transformation from a fundingdriven, provider-driven system to one that’s driven by what older people themselves need and want. It signifies a move toward how to improve the health and wellbeing of older people, as well as their care. Although we don’t see far ahead on specifics yet, you have to start with the vision, with purposes and principles, and then define the directions. RESIDENTIAL AGED CARE The funds given to residential care in the package are fundamentally band aids for the hole we’re in right now. That’s understandable because it’s very difficult to provide quality care for people with high levels of need, and many residential-care providers are pressured in this regard. But while attending to this short-term crisis, we have to make sure we don’t lock in ongoing support for high-level care only in a residential context. That’s not what older people want, and it’s not necessarily the best way of doing it. It could be a selfperpetuating policy approach. We’re going to have to work hard to enable us to really move with the new system, albeit without abandoning the good providers and the older people in care now. MEANS TESTING The proposed means testing is actually quite gentle at this point. There’s no way
There’s scant attention to the need for better accommodation options in the community, and for more integration of aged care with healthcare and health promotion.
older people will be forced out of their homes in order to pay for residential care or aged care of any kind. That’s not going to happen.
older people without means, rather than to achieve surpluses or reduce taxes.
If these recommendations are fully implemented, older people with the financial means would make sensible and fair contributions in a variety of ways towards the cost, especially the capital cost, of their care.
It’s surprising to see how large the amounts of money dedicated to the aged care workforce are. It makes me wonder how they’d be paid for from savings within existing programs, while maintaining levels and quality of care. Good education and training are essential, of course, but there are risks if central directives lock in work practices that aren’t meeting care needs in the most cost-effective ways.
This is a necessary reform that could enable more resources to be available for those in very high levels of need. And it would limit the financial pressures on the next generation, many of whom do not have the same kind of wealth that some older people have when moving into residential care. So this means-testing and shared funding responsibility is fundamental to refocusing the aged care system to equitably meeting our basic principles. It’s important that we use the co-contributions to improve access to quality accommodation and care for
WORKFORCE
The Productivity Commission’s approach was to adequately fund and require good quality care, leaving providers to work out the best ways ahead within these quality and cost controls. THE FUTURE
fundamentally important analyses and we’ll need real public will and political will to take the next steps. It will be worth it. Expectations for care certainly are increasing for the next generation of older people. And there will be some modest increase of financial capabilities for some, but people’s aspirations about old age when in their 50s and 60s are likely to be very different once in their 80s, frail and very dependent. Everyone wants to feel secure, comfortable and respected in advanced old age. The best way to plan for this is to have good health promotion and economic security in mid-life, and to get the care system right for vulnerable people who are already in their old age. This article was originally published by The Conversation at www.theconversation.edu.au
This is the most encouraging direction we’ve had in aged care for two decades. The government’s response is based on
The Victorian Healthcare Association Issue 2 [SEPTEMBER 2012] www.vha.org.au
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Innovating for Social Inclusion
“I’m linked up with doctors and psychiatrists so I can get my life back on track. I’d be lost without the Living Room, completely lost.” “They listen to you, they don’t push you away, they’re not judgemental.” - Living Room clients
A life-changing hub for homeless people The Living Room health service has helped more than 55,000 homeless and disadvantaged Melburnians take the first steps towards support and recovery in an inclusive, non-judgemental environment. Established by Youth Projects in 2002, The Living Room provides an innovative, holistic model of care for marginalised people in the CBD. It is staffed by community development workers, doctors, nurses and allied health professionals, including a podiatrist, a psychologist, a mental health nurse and a nutritionist. Youth Projects CEO Rod Mackintosh describes it as a positive, inclusive space where people can access support, free medical care and opportunities to be socially engaged members of the community. “The Living Room overcomes prejudices and barriers to ensure the problems of poverty, housing, nutrition, mental health, HIV/AIDS and addiction are supported sensitively and discreetly within the city.
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“It is a life-changing hub of unique services that strengthens, educates and supports Melbourne’s most vulnerable people. “It builds individual capacity, promotes inclusion and contributes to creating a Melbourne that is safe, welcoming, tolerant and sustainable. The service has always worked above and beyond the funding it receives to leave no client alone.” Funded for just 800 clients a year, support was provided to 6,534 clients in 2011. Each week, more than 100 people receive direct services from a team of doctors, nurses, allied health professionals and community development workers. In addition to clinical services, The Living Room offers food and nutrition, shower and laundry facilities, and plays a broader role in service co-ordination, referral and education. “The service has played a vital role in the education of police, city residents, shoppers, workers and traders about injecting drug use, needle and syringe disposal and responses to homelessness in an urban setting,” Mr Mackintosh says.
Nurses are the difference between hope and despair This has reduced public concerns over the street-based nature of homelessness and drug use, which has benefited city residents, traders, workers and education providers. “Concerns around the impact of drug use and alcohol in the city continue to grow, and with them, the demands upon our service to predict and respond to trends in this field. “Our track record in service innovation will ensure any emerging trends and needs are identified and early intervention strategies are developed and implemented.
The Royal District Nursing Service (RDNS) Homeless Persons’ Program was a finalist at the 2012 Melbourne Awards, giving public recognition to the program’s 38 nursing staff. They provide health and social assessments, professional care, counselling, active support, first aid, medication management, and follow-up visits for homeless clients around Melbourne. The RDNS team collaborates with other agencies, including public hospitals, and advocates on behalf of people living in
rooming houses, crisis accommodation, hotels, parks and on the street. “These nurses work quietly and efficiently with people experiencing homelessness, ensuring they do not go without the healthcare that most of us take for granted,” RDNS Chief Executive Stephen Muggleton said. “The staff do a remarkable job with very complex clients in quite tough conditions. For hundreds of people, our nurses are the difference between hope and despair.”
“We continually add new initiatives that are outside our funding to add to the empowerment and connection within clients’ lives, recognising the links between marginalisation, poverty, education, health and housing.” For more information phone 9945 2100 or visit www.youthprojects.org.au/health/programs/living-room
Sam Dennis RN (top) and Kate Maddaford RN with homeless RDNS clients. Photos: Jerry Galea
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Innovating for Social Inclusion
Intensive service model tackles homeless cycle
SUE GRIGG J2SI MANAGER
participation. They will also demonstrate whether a targeted, intensive approach is more cost-effective than reliance on the criminal justice, health and crisis service systems. (At a cost of $4 million, J2SI is a significant investment.)
Journey to Social Inclusion (J2SI) is a Sacred Heart Mission program aimed at demonstrating how a well-resourced and intensive service intervention model can break the cycle of long-term homelessness. The three-year service delivery phase of the pilot has delivered: •
intensive case management (1 worker: 4 clients) to 40 long-term homeless people
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a structured therapeutic response to the underlying trauma that is both a cause and a consequence of homelessness
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a skills development component to enable reconnection with the broader community
J2SI works in close partnership with the Office of Housing, the Mental Illness Fellowship of Victoria, and Alfred Psychiatry. Importantly, it is being comprehensively evaluated by RMIT University (social evaluation) and the Melbourne Institute of Applied Economic and Social Research at Melbourne University (economic evaluation). The universities are conducting a fouryear randomised control trial, involving six-monthly surveys of the 40 clients receiving J2SI services and 40 other eligible people who were randomly allocated to a control group. These surveys compare changes in health, housing, and social and economic
RMIT University is evaluating the systems and processes that underpin delivery of the service model, and how these impact on client outcomes. While overall outcomes to date are positive, there have been successes and challenges along the way. J2SI has maintained relationships with almost all 40 people who started in 2009 – a remarkable achievement given that long-term homeless people are highly transient, often have enduring mental illnesses, and are commonly caught up in a cycle of substance abuse. Their previous life experience was one of broken relationships and an understandable resistance to services. J2SI started from this reality. As such, significant effort was invested in building and maintaining these relationships. This took patience, persistence, flexibility and creativity. The casework team had to work through some very challenging behaviour without falling into the trap of withdrawing services as punishment. Initially, it meant finding people at meals programs, health services, or local rooming houses and consistently demonstrating that we were prepared to hang in for the long haul. It required listening to people’s stories, and following through with what we said we would do. It also meant adapting our practice to an individual’s journey over three years, rather than requiring them to adapt to us. The casework team has maintained contact with participants when they are interstate, in hospital, in prison, or just unavailable. In many instances, this was one of the program’s most important achievements. J2SI participants have been banned from services all their lives. By not withdrawing
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services, J2SI has challenged their expectations and moved beyond their difficult behaviour. The program has also modelled respectful and trusting relationships over a three-year period, which has allowed participants to trial new strategies for engaging with the world. The relationships formed have demonstrated that there is no such thing as a service-resistant client when there is an opportunity to realise trust. Preliminary data from the 24-month outcomes evaluation indicates that 85 per cent of J2SI participants are in stable longterm housing. Significantly, most tenancies have been maintained for more than 18 months, which has required collaboration, flexibility, and problem-solving from J2SI staff and from housing managers.
J2SI has taken responsibility for participants in a way that most services cannot. The Mental Illness Fellowship of Victoria colocates a full-time employment consultant with J2SI. As a result, almost half our participants have engaged in employment or training, including five people with ongoing employment and six who have completed certificate-level courses. Most J2SI participants continue to struggle with substance abuse. Work has been undertaken in this area, but changing lifetime patterns of addiction presents ongoing challenges. Connecting with the mainstream community has proved challenging, as many participants remain engaged with the homeless subculture. Employment outcomes during the final stages of the program are an opportunity to strengthen their connections to the mainstream. As the service delivery phase of the program draws to a close, it is important that Sacred Heart Mission reflects on what we have learned.
The casework team had to work through some very challenging behaviour without falling into the trap of withdrawing services as punishment.
Working with the range of services necessary to meet the needs of long-term homeless people is a well-documented challenge. The resources available to J2SI have made a difference in several ways:
•
•
J2SI facilitated collaboration between multiple support services, ensuring a consistent service response. Our casework team developed a detailed understanding of individual needs, issues and behaviours over a sustained period, and appropriately shared this knowledge with other services. This meant the service system brought coherence and consistency to their stressful lives, rather than fragmentation and conflicting demands. J2SI could gather participants’ files and reports from multiple agencies. We identifyied and addressed gaps in information that was contradictory or outdated, helping us to build a coherent and detailed story about each person. We built an integrated narrative, rather than a series of time-related, problembased snapshots. J2SI has been effective in service coordination because we sit outside the
Sacred Heart remains committed to its original aim of helping participants re-engage with the mainstream community. Our partnership with the Mental Illness Fellowship of Victoria has been a key factor in meeting this challenge. Almost every J2SI participant experienced extreme trauma in their childhood, which has been compounded by a lifetime of disadvantage, poverty and homelessness. The impact of this trauma cannot be overstated. J2SI has demonstrated the importance of a therapeutic, traumainformed service in facilitating positive client outcomes.
Sacred Heart Mission and its philanthropic partners have invested significantly in J2SI, a high-profile and very expensive program. Closely managing these resources was a high priority. A robust governance framework included a steering group to monitor overall progress, a reference group to address practice challenges in service delivery, and a reference group to oversee the evaluation and address methodological challenges. In short, J2SI has taken responsibility for participants in a way that most services cannot, and this was another important factor in successful client outcomes. The J2SI pilot has been a rich source of information about delivering services to long-term homeless people with complex needs. Sacred Heart Mission is acutely aware of the importance of documenting and disseminating this information. For more information visit www.sacredheartmission.org
Rosie. Nurse, pâtissier and member since 1988.
We’re giving Rosie confidence she can relax when she’s finished work. ROSIE AAR 0812
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specialist/clinical service system, with a very broad focus across the specialist mental health, drug and alcohol, employment, recreation and legal systems. Training and vital secondary consultation partnerships with specialist providers like Regen Drug and Alcohol Services and The Lighthouse Foundation have made this possible. Our capacity to be responsible for the full range of presenting issues has been a key factor in successful client outcomes.
Find out more on how we’re helping Rosie at healthsuper.com.au/Rosie Visit firststatesuper.com.au or healthsuper.com.au
Health Super is a division of the First State Superannuation Scheme ABN 53 226 460 365 of which FSS Trustee Corporation ABN 11 118 202 672 AFSL 293340 is the Trustee.
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11 & 12 October 2012 Hilton on the Park, Melbourne This two-day conference will explore how to create a sustainable healthcare system in an environment of dynamic change. The health system and healthcare agencies must adapt to state and national health reforms, mounting financial pressures, and the impacts of climate and demographic change. Redesign is essential to create robust processes that move beyond simply surviving year-to-year, towards achieving a sustainable future. Conference sessions will examine how healthcare services can use funding, infrastructure, workforce, information management and research to achieve the best health outcomes for consumers in the shifting healthcare landscape. Who should attend? Board members, CEOs, managers and practitioners of health, primary health and community service organisations, academics, policy professionals, peak bodies, government officials and consultants. Enquiries Phone: 03 9094 7777 Email: vha@vha.org.au