HEALTH MATTERS Victorian Healthcare Association ISSUE 1
[
MAY 2012
] www.vha.org.au
Focus on healthcare governance board development population health planning performance benchmarking eHealth
The Victorian Healthcare Association Issue 1 [MAY 2012] www.vha.org.au
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This issue… 3 4 5 6 7 8 9 10 11 12 13 14 15
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POPULATION HEALTH PLANNING Putting the ‘social’ into health policy
CHAIRMAN’S MESSAGE Director development is a high priority CHIEF EXECUTIVE’S MESSAGE A new consumer focus in healthcare
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Singapore learns from RDNS model
PALLIATIVE CARE OUTCOMES COLLABORATION National benchmarking program a world first GOVERNANCE Board development Survey is a vital link to strategic planning POPULATION HEALTH PLANNING Putting the ‘social’ into health policy
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eHEALTH Barwon Health leads national MedView trial
POPULATION HEALTH PLANNING Health lies in wealth CLINICAL LEADERSHIP Royal District Nursing Service governance Singapore learns from RDNS model of care eHEALTH Northern Health’s clinical patient folder a success eHEALTH Barwon Health leads national MedView trial HEALTH SUPER/FIRST STATE SUPER Insights from a merger VICTORIAN HEALTHCARE ASSOCIATION The year so far...
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
Director development is a high priority
ANTHONY GRAHAM VHA CHAIRMAN
Information on health system context was the highest director development need identified in the 2012 ACHG board self-assessment survey.
The Victorian Healthcare Association (VHA) and the Australian Centre for Healthcare Governance (ACHG) have undertaken extensive work with our member health service boards over the past two years. During that time, directors have shown a consistent appetite for professional development in three fundamental areas of their governance role: •
building confidence in the processes applied by the board to clinical governance
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improving the board’s understanding of their community’s healthcare needs, and how best to serve them
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managing the important relationship between the board and the CEO
The VHA has proposed multi-faceted director development that would require State Government support and include: •
self-directed online learning packages, similar to those developed by the State Services Authority
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the opportunity for several directors from each board to undertake the Australian Institute of Company Directors course
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funding for a series of round table events, allowing board and committee chairs to learn from each other
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a facilitated discussion at least once every two years, enabling boards to challenge the processes they apply to the conduct of their business and the creation of their service strategy, and to further develop these processes
The Victorian Health Priorities Framework 2012-2022 demonstrates Minister Davis’ unequivocal support for the governance architecture that is unique to Victoria’s public health services. It is now essential that the government invests in a contemporary, systematic and robust approach to fostering the ongoing development of the boards that perform this important governance role across our health sector.
“Information on health system context was the highest director development need identified in the 2012 ACHG board selfassessment survey.”
The VHA has communicated these training needs to the Minister for Health, David Davis, and has encouraged government investment in the ongoing development of the boards appointed to govern our health services. It is evident that board members’ professional development needs vary according to their previous board experience, familiarity with the health sector and grasp of key governance areas. Training must be flexible to accommodate the varied skill mix within boards, while meeting a general need for periodic updates on the changing health environment, to enable informed strategic planning.
The Victorian Healthcare Association Issue 1 [MAY 2012] www.vha.org.au
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TREVOR CARR VHA CHIEF EXECUTIVE
Chief Executive’s Message
“Victorian health services currently operate at, or better than, the nationallyefficient price for hospital services. DTF must acknowledge this reality, and identify a funding approach to address the service gaps experienced by consumers and clinicians.”
A new consumer focus in healthcare The story of Willie the doorman from the Four Seasons Hotel is a frequently-quoted case study in customer service. Willie’s actions in flying between cities to return a guest’s briefcase demonstrate the company culture of taking independent action to deliver a better consumer experience. With Canberra describing current health reforms as the most significant since the introdution of Medicare, we must ask how these reforms will shift the focus of public healthcare onto consumers. The federal reform approach to funding is best described as output (not outcome) based. Output-driven reward mechanisms discourage independent actions that would improve the consumer experience and result in the more efficient use of resources. Some service gaps are inevitable in a maze of healthcare providers that rarely share a common point of information connection. Only the most talented consumer can understand how to navigate such a system and overcome its gaps. Output-based funding leaves many clinicians powerless to remedy gaps in the system, because service providers who do not receive specific funding streams have no incentive to stretch their resources to find solutions. The Victorian Department of Treasury and Finance (DTF) has for many years maintained a position that all government departments are capable of ever-improving efficiency. This approach has resulted in ‘efficiency’ or ‘productivity’ dividends being imposed on health services. Victorian health services currently operate at, or better than, the nationallyefficient price for hospital services. DTF must acknowledge this reality, and identify a funding approach to address the service gaps experienced by consumers and clinicians. This is the essential next step in the outcome-based evolution of our
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The Victorian Healthcare Association Issue 1 [MAY 2012] www.vha.org.au
healthcare system for the benefit of consumers. It will require confidence that an outcome-based approach will create economic benefits not provided by the current output model. In the federal reform context, Medicare Locals are responsible for improving the coordination of care for consumers with multiple chronic comorbidities. Since much of our system of healthcare falls outside the influence of Medicare Locals, their capacity to find a ‘coordination panacea’ will be limited. In this hypothesis, each state (as ‘system designer’) will be left to continue their historical role of funding market failure within the Australian health economy. In his foreword to The Victorian Health Priorities Framework 2012 – 2022, Health Minister David Davis acknowledges that “the health system needs more support to improve management of … longterm chronic conditions” and “we have invested too little in preventing and better managing these conditions”. The VHA encourages those who influence health funding decisions to move away from an efficiency return to government, and towards an economic return to the health status of Victorians. This can be achieved by redirecting a portion of the funds returned through efficiency dividends to new flexible funding strategies that will address service gaps and improve the consumer experience. This edition of Health Matters examines trends in clinical governance, population health and eHealth, which have the potential to deliver real improvements for healthcare consumers.
Palliative Care Outcomes Collaboration
Australia is leading the world in establishing a national system to measure the quality and outcomes of specialist palliative care services. The Palliative Care Outcomes Collaboration (PCOC) is a voluntary program that uses standardised clinical outcomes to benchmark and measure palliative care outcomes across Australia. PCOC Chief Investigator Professor Kathy Eagar says it is a world first. “Governments internationally are grappling with how best to provide care for people with life limiting illnesses, and how best to measure the outcomes and quality of that care. “The PCOC is the first effort internationally to measure the outcomes and quality of specialist palliative care services, and to benchmark services on a national basis through an independent third party.” 1 PCOC was developed six years ago to address a lack of standardised information on palliative care outcomes, identified by the National Palliative Care Strategy.
National benchmarking program a world first These tools enable palliative care agencies to consistently measure and benchmark to improve the quality of their services. Professor Eagar says the tools also provide a common language for communication between health professionals, making palliative care a smoother process for patients, carers and service providers.
“Since PCOC was established, we can demonstrate improvements of 10 per cent in pain and symptom control among our services,”
PCOC can then direct agencies that are not meeting national standards to CareSearch resources that will help improve their performance. “One of the clearest indications that PCOC is working is that clinicians from other specialties, such as chronic pain management, are asking for our help to develop similar programs,” Professor Eagar says. References 1. Eagar K, Watters P, Currow DC, Aoun SM and Yates P (2010), Australian Health Review, 34 (2) CSIRO Publishing.
For more information visit www.pcoc.org.au
PCOC collaborates with two other national palliative care programs: the National Standards Assessment Program (NSAP), and CareSearch. Data collected by PCOC can be used as evidence to show which agencies meet NSAP standards.
It is a collaboration between the University of Wollongong, Flinders University, the University of Western Australia and Queensland University of Technology. PCOC is funded until June 2013 by the Federal Government and is currently used by 117 healthcare agencies. “Since PCOC was established, we can demonstrate improvements of 10 per cent in pain and symptom control among our services,” Professor Eagar says. “It was a new experience for the sector to measure patient outcomes as a routine part of business. “About 80 per cent of all palliative care providers are now members of PCOC, helping to achieve national consistency for the first time.” PCOC runs free skill development workshops around Australia for healthcare agencies to learn about using PCOC clinical assessment tools.
The Victorian Healthcare Association Issue 1 [MAY 2012] www.vha.org.au
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ALISON BROWN CLINICAL GOVERNANCE CONSULTANT
Governance
“There was general agreement across the benchmarked agencies that board meetings were conducted in a way that allowed participation by all members, with opportunities for views and recommendations to be challenged.�
Board development
The value of periodically meeting with staff to review their performance in an organisation has long been accepted. There is now growing recognition that performance review must be formalised at all levels of an organisation, including the board. Health services have followed the corporate trend towards regular and formal board evaluations, as required by the Australian Securities Exchange corporate governance standards (ASX 2007).
The survey process allows organisations to benchmark their results with like organisations. It also enables respondents to benchmark against themselves by comparing their results from year to year. Respondents are offered a scale of weighted responses from strongly agree (5) to strongly disagree (1) to a range of statements, for example:
The roles and responsibilities of the board and individual directors are clearly documented:
Board self-assessments are an important component of formal board evaluations. In recognition of this, the Australian Centre for Healthcare Governance (ACHG) offers a board self-assessment survey to healthcare and community service agencies. The 2012 survey has been completed by 38 organisations within the benchmarking period, including 24 health services, 11 registered community health services and three other agencies. The 2012 survey is still open for agencies to compare their results with the benchmarked data. It includes core governance areas common to all boards, and healthcare-specific questions on clinical governance and population health planning.
Strongly Agree Agree Neither Agree or Disagree Disagree Strongly Disagree
The statements reflect board performance in four key domains: 1. The key roles of the board 2. Board structure 3. Board processes 4. Board decision-making and behaviour ACHG is assessing results from the 2012 benchmarking exercise.
Weighted Score of Responses (x/5)
Results from the 2011 benchmarking exercise
All Registered Community Health (n=11)
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The Victorian Healthcare Association Issue 1 [MAY 2012] www.vha.org.au
All Health Services (n=19)
Survey is a vital link in strategic planning
The 2011 survey results indicated that board decision-making and behaviour were the strongest areas of board capability. There was general agreement across the benchmarked agencies that board meetings were conducted in a way that allowed participation by all members, with opportunities for views and recommendations to be challenged.
whole range, but that is what you should strive to achieve.
KEITH OBERIN REDHS BOARD CHAIR
Last year, results from 19 health services and 11 registered community health services showed very little difference between these two groups. Their responses showed that similar issues faced the boards of all health agencies, irrespective of their size or service orientation (see graph).
The area needing most development related to a board’s key role in setting strategic direction and monitoring the strategic plan.
The ACHG board selfassessment survey has been a vital link for Rochester and Elmore District Health Service (REDHS) in the review of its Strategic Plan.
The survey indicated that boards did not always effectively monitor their organisation’s progress towards achieving specific strategic objectives outlined in the strategic plan.
“There was no requirement for us to do a review, however the combination of the board self-evaluation and a new CEO made it a priority for us,” Board Chair Keith Oberin explains.
Developing board capacity to undertake formal CEO evaluations was one of the lowest-scoring areas in the survey.
“Knowing that board members had some concerns about the strategic approach we had in the past meant it was an area we had to concentrate on.
Having the appropriate skill mix and diversity on the board was an obvious concern for many boards, reflected in the low score for this question. This indicates the real challenges that face health sector boards in recruiting board members. Orientation processes were the lowestscoring item of the survey, with respondents indicating the need for a sound orientation process to help new board members understand their role and responsibilities, board processes and the organisation. Alison Brown is a Clinical Governance Consultant with the Australian Centre for Healthcare Governance, which is hosting the Australian Governance and Quality Conference in Melbourne this month. For more information email alison.brown@healthcaregovernance.org.au phone 9094 7721 or visit www.healthcaregovernance.org.au
“We made sure we were inclusive in the review process and we also involved senior staff and middle management of the organisation.” The board has also strengthened KPI’s to evaluate the performance of Chief Executive Officer Matt Sharp, who was acting in the role from February 2011 and formally appointed last May. While the board already recognised the importance of diversity and an appropriate skill mix among its members, Mr Oberin says the ACHG survey strengthened this resolve.
“You need some sort of tool – and we use the skills matrix – to tick as many boxes as you can with nominees. “You also want to be representative of your community. Sometimes that can be difficult if all you’re doing is ticking particular boxes, so it’s a balance between the two.” Mr Oberin has recently undertaken the Australian Institute of Company Directors course and also sits on the board of a regional sports academy. He found the ACHG self-assessment survey, now in its second year, a valuable part of the board self-evaluation process. “It is anonymous and therefore board members can be open and honest, and put forward the areas where they think there are weaknesses or strengths. “The other bonus is that it is benchmarked. Because there are other boards are also evaluating, we can see how we compare across the state,” Mr Oberin says. “In the Company Directors course, critical factor was highlighted that boards need to do a level of evaluation of their performances, both as a group and individually.”
“Knowing that board members had some concerns about the strategic approach we had in the past meant it was an area we had to concentrate on.”
“Since the evaluation we have established a skills matrix and in the most recent board nomination and interview process we used that skills matrix for the first time. “Given the sorts of skills you’d like to have across the board, in some ways it may be unrealistic to try to get the
The Victorian Healthcare Association Issue 1 [MAY 2012] www.vha.org.au
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BARRY SMITH POPULATION HEALTH ANALYST
Population Health Planning
Australia and New Zealand are revamping their health systems, with the stated aims of making them more cost-efficient and sustainable in the face of mounting financial and socio-demographic pressures. Reform pronouncements include reconfiguring the relationships between health providers and consumers to deliver improved services with better health outcomes – while still living within their means, of course. For many in the health sector, this will seem like déjà vu. Yet another generation of policy analysts, advisors and lobbyists are having their moment in the sun, or perhaps more accurately, in the shadows. Change is increasingly being promoted in the absence of transparency and meaningful engagement with stakeholders. Little consideration is given to past lessons, which become the ‘old order’ and are deemed irrelevant. There is general agreement that working to improve healthcare delivery for the benefit of patients and their communities is a commendable aim. However, it is concerning that many of the proposed pathways for change involve throwing the baby out with the bath water. Reforms focus on replacing, rather than building on, past successes and the arrangements that achieved them. New approaches are also presented as
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Putting the ‘social’ into health policy solutions to past problems that grew out of very different social, economic and political circumstances.
The intention of this model to shift more services into primary care and community settings is a laudable goal.
Some disquiet is justified on a number of other fronts, including the realisation that tomorrow’s problems often result from today’s solutions.
However, such policies tend to run aground in the face of the misalignment and tension between primary and secondary care, in respect of their business models and funding arrangements and relationships.
We have compelling evidence that future health system demands will present complex financial and ethical challenges, but we see much less evidence to support many of the proposed solutions. This apparent lack of evidence stems largely from our fondness for fast policy development to serve the in-vogue ‘disruptive change’ strategy. In this reactive mode, decisiveness is valued over evidence and the focus on dogma, not data, opens the way for change processes to ignore many of the broad social impacts. This generates decision-making that is more about ritual than rationality, putting us at risk of unintended consequences. A good example is the New Zealand Government’s current obsession with reducing back office or administrative functions, which many clinicians say are essential for them to practise in the safest possible way. One of the most perplexing dilemmas confronting both Australia and New Zealand is how to tackle health inequalities.
The overriding realisation is that the key policy drivers are designed to satisfy financial, rather than social, goals. While there is no question that financial viability is important, it is not a guaranteed outcome of the change process, without some compromise on the scope and quality of services.
“One of the most perplexing dilemmas confronting both Australia and New Zealand is how to tackle health inequalities.” This implies that the balance between the financial and social dimensions of health policy itself requires reconfiguration. How much we emphasise social justice when defining need and allocating future health resources across our populations will indicate what we value most in our societies.
Some indicators show an increasing gap between the indigenous and nonindigenous populations of these countries, which implies that past ways of dealing with this inequity have been ineffective.
In finding satisfactory solutions to these challenges, we need to put the ‘social’ back into health policy and, perhaps, into policy development across the board.
While we frequently talk about the social determinants of health, our health systems’ historical focus on hospitals has always made it difficult to address these welldocumented social factors.
References
Better Sooner More Convenient Health Care in the Community – a key health platform of New Zealand’s National Government – focuses on delivering more preventative and personalised primary care closer to home, with the aim of combining health and social support.1
The Victorian Healthcare Association Issue 1 [MAY 2012] www.vha.org.au
1. New Zealand Ministry of Health, Better Sooner More Convenient Health Care in the Community 2011 http://www.nationalhealthboard.govt.nz/sites/all/files/ BSMC%20ebooklet.pdf
Dr Barry Smith is a Population Health Analyst for the Lakes District Health Board in Rotorua and a contract analyst to the New Zealand Ministry of Health. He will speak on healthcare equity and resource allocation at the Australian Governance and Quality Conference in Melbourne this month.
MARTIN LAVERTY CATHOLIC HEALTH AUSTRALIA CHIEF EXECUTIVE
Population Health Planning
Australian health policy has been slow to respond to growing evidence that social determinants influence health outcomes more than biomedical and behavioural factors, according to Catholic Health Australia (CHA). Chief Executive Martin Laverty says national health policy has “largely ignored” two World Health Organisation (WHO) reports that have invited governments around the world to develop action plans on the social determinants of health. Mr Laverty is co-editor of the book Determining the Future: A Fair Go & Health For All, written by 40 Australian health and social policy experts. It outlines how recommendations from the WHO Commission on the Social Determinants of Health should be adopted by the Council of Australian Governments (COAG) as the next phase of health reform. “It is partly because of Australia’s continued inaction that this book has been written,” Mr Laverty says. “While health policy remains focused on biomedical and behavioural factors it will not achieve the best health outcomes, and will burden future taxpayers with ever escalating health costs. “In addition to traditional health system investment, new investment is needed in social determinants.”1 Professor Fran Baum, who served on the WHO commission for three years, agrees. “Currently, our national efforts to reduce
Health lies in wealth
chronic disease are focused on persuading people to change their lifestyles without reference to the social and economic conditions that give rise to those lifestyles in the first place.” The CHA report Health Lies in Wealth found that the lowest 20 per cent of income earners suffered twice the rate of chronic illness and died, on average, three years earlier than the highest 20 per cent of income earners.2 “We know educational attainment, participation in the workforce, and income levels all influence people’s health outcomes,” Mr Laverty explains. “Yet, in Australia, when we talk about health we immediately think of nurses, doctors, and hospitals.” “We don’t think of vibrant childhoods, good schooling, satisfying work lives and fairness in income. We should, and that’s why welfare, education, and health policy thinking should merge.”3 CHA has called for a Senate Inquiry that would embrace a health-in-all-policies approach to the social determinants of health. “People may disagree on how to deliver health services, but there can be no disagreement that an all-of-government approach is required,” Mr Laverty says. “A Senate Inquiry would be a broad stride in the right direction.” CHA is also calling on the Pacific Islands Forum – a political grouping of 16 independent countries of the Pacific Ocean – to follow the lead of the European Commission in addressing the social determinants of health. “The European Commission has been something of a pioneer in responding to the WHO, so it seems appropriate that the Pacific Islands Forum picks up the ball and runs with it,” Mr Laverty says. CHA advocates that actions outside health policy are needed to achieve a healthier Australia, including: •
better assisting at-risk mothers during pregnancy
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expanding early childhood development in disadvantaged areas
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supporting at-risk kids to complete their schooling
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helping people gain and maintain employment
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providing adequate housing
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supporting people in times of personal crisis
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ensuring mental health services are readily accessible
“The building blocks of good health are best understood by considering the various stages and potential crisis points of a person’s life span,” Mr Laverty explains. “Good health starts in the womb ... It needs positive early childhood experiences. School participation, transition to reliable work, safe and secure housing, access to safe food and sustenance, and sufficient access to income and resources are all necessary building blocks to good health.” “With the exception of pregnancy management and food regulation, each of these policy areas is overseen by agencies located outside the normal boundaries of a health portfolio.”4 References 1. Laverty, M & Callaghan, L, Determining the Future: A Fair Go & Health For All, Catholic Health Australia 2011 2. Brown, L, Nepal, B, Health Lies in Wealth - Health Inequalities Of Australians Of Working Age, NATSEMCatholic Health Australia, September 2010 http://www. cha.org.au/site.php?id=15 3. Laverty, M & Callaghan, L, Determining the Future: A Fair Go & Health For All, Catholic Health Australia 2011 4. Laverty, M & Callaghan, L, Determining the Future: A Fair Go & Health For All, Catholic Health Australia 2011
Martin Laverty is Chief Executive Officer of Catholic Health Australia. He will speak at the Australian Governance and Quality Conference in Melbourne this month. Catholic Health Australia is the nation’s largest network of non-government, not-for-profit health services, with 75 hospitals and 550 aged care providers in its network.
The Victorian Healthcare Association Issue 1 [MAY 2012] www.vha.org.au
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RO HOGAN RDNS EXECUTIVE GENERAL MANAGER (SERVICE DELIVERY)
Clinical Leadership
Royal District Nursing Service governance Each group gives our people the opportunity to be a clinical nursing leader, with dedicated time and modest resourcing. These clinical nursing leaders are drawn from staff involved in direct patient care.
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disseminate outcomes through an agreed communication process
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promote RDNS clinical best practice through formal presentations or publications
Clinical leaders can be thought of as those who continuously improve care by influencing others. Leadership in this context is not merely a series of skills or tasks, but an attitude that informs behaviour.
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provide clinical leadership in their area of clinical specialty to all staff
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participate in the scheduled review of RDNS clinical policies/procedures
RDNS has found the important functions of these nurse leaders are:
Clinical leadership, sound clinical governance, innovative clinical advances, technology, and service delivery are key drivers for the Royal District Nursing Service (RDNS). RDNS is one of Australia’s largest community-based nursing providers, employing more than 1100 nurses to provide a 24/7 service. Most RDNS staff work alone and remotely in people’s homes, so clinical governance is critical. Healthcare is currently facing many challenges: an ageing population, increasing demand for health services, skilled workforce shortages, chronic disease, and rising costs, to name just a few. In a recent paper, Health Workforce Australia identified a need for innovation and change to meet these increasing challenges, and a strong imperative for different models of care and new workforce practices to accommodate the wider range of treatment possibilities arising from new technologies.1 The paper went on to say that these innovations must give significant regard to patient, client and staff safety, and that all organisations have witnessed significant growth in governance and accountability. To help RDNS respond to healthcare governance issues as we innovate and change, we have harnessed the talent, skills and interests of our staff through Clinical Leadership Groups (CLGs).
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acting as a role model
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collaborating to provide optimum care
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providing information and support
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providing care based on theory and research
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being an advocate for patients and the health care organisation
We have established six CLGs since 2002. Initially, their remit was to ensure a consistent and standardised approach, and to develop evidence-based practices within RDNS. Over time, their role has expanded to include: •
new or updated technology or products, therapies and approaches to care
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questions from RDNS clinical staff and management about client care, including requests for interventions that are outside recommended or standard practice
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issues identified through clinical indicators (eg: client complaints, client incidents and client outcomes) systematic practice issues identified through performance management processes
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use of an evidence-based framework and formal process to investigate and make recommendations for best practice regarding identified clinical issues
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initiate or participate in research projects undertaken within RDNS
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Role expansion has led to a growth in clinical nursing leadership that is focused on continuous improvement through influencing others. Assessing evidence, formulating solutions and applying clinical judgement requires time, according to Cook2 and Scott3. RDNS has invested significantly in CLGs, providing time away from clinical care activities on a regular basis, although each CLG has chosen to use the time differently.
“To help RDNS respond to healthcare governance issues as we innovate and change, we have harnessed the talent, skills and interests of our staff through Clinical Leadership Groups (CLGs).” We also support CLG activities through the RDNS Helen Macpherson Smith Institute of Community Health, widely recognised as a centre of excellence in community health education, research and clinical practice. The CLGs are part and parcel of RDNS governance, and their outputs and benefits can be measured on three levels. Firstly, they respond to clinicians’ concerns, acting as a contact point for reviewing current practices and testing new ideas. CLGs sometimes conduct literature reviews to clarify clinical practices, or as part of a policy review. In cases where relevant literature is lacking, they alert researchers at the RDNS Institute. This has resulted in research that is directly
Singapore learns from RDNS model of care relevant to our clients and, therefore, our staff. Secondly, our clients report that they receive consistent, reliable advice in decisionmaking, care planning and technical support. Focus groups and client surveys have also demonstrated that 82 per cent of clients find our brochures and handouts useful. Finally, our staff acknowledge that they are able to contribute effectively to improving client care. In a 2008 organisational survey, more than 90 per cent of staff noted that RDNS was committed to best practice in our industry, and almost 96 per cent would recommend RDNS to their family and friends. A May 2011 survey confirmed these results, with RDNS nurses noting they are “encouraged to participate in learning and development activities, which enhance professional skills” and are “trusted to make decisions necessary to perform effectively”. Further, the overwhelming majority acknowledged that RDNS policies and procedures helped them to work effectively. Our CLGs are an engine room for innovation and change towards different models of care and new workforce practices. Without them, RDNS would not be able to address healthcare governance nor innovate for the significant healthcare challenges of the future.
A Singaporean delegation has visited Melbourne to learn about the centralised homebased care system run by the Royal District Nursing Service (RDNS). Minister of State Mdm Halimah Yacob was accompanied by Permanent Secretary Mr Chan Heng Kee, Assistant Director Esther Soon and members of the Ministry of Community Development, Youth and Sports. They discussed the RDNS model with Executive General Manager (Service Delivery) Ro Hogan and Customer Service Centre Manager Maureen Wilkinson. Caring for an ageing population, attracting a skilled nursing workforce, and the challenges of multiple-sourced funding were also discussed. Ms Wilkinson said the visitors were impressed by the telephone system that supports the centralised referral and intake process at RDNS, and by the use of technology to communicate important client information to field-based clinicians. “They were very interested in understanding general healthcare service provision in Australia, various funding arrangements, our use of technology, client demographics, nursing recruitment and retention issues, and the RDNS centralised intake and referral model.” A recent leading article in the Singapore
Medical Journal notes that while the elderly comprise seven per cent of the population, they use some 20 per cent of public sector primary care and hospital services.1 Based on these figures and population projections, Singapore is expecting a fourfold increase in the use of health resources by 2030. The article notes that a shortage of aged care services is causing acute hospital beds to become “blocked” because of the difficulty discharging elderly patients to more appropriate settings. Ms Hogan said the Singaporean delegates were interested in learning how to run efficient community-based services and how RDNS connected nurses to clients. She said the Singaporean custom of children looking after their ageing parents and grandparents was becoming more difficult because of their country’s trend towards smaller families. “Some of the issues that our visitors raised actually shed light on our own issues.” It was the second Singaporean delegation to visit RDNS in two years, and Ms Hogan is due to meet ministry officials in Singapore next month. References 1. S L Ling, Singapore Medical Journal, Health Care of the Elderly in Singapore http://www.sma.org.sg/ smj/3910/articles/3910ia1.html
References 1. Health Workforce Australia (2012) Leadership for the Sustainability of the Health System (Part 3: An Environmental Scan) 2. Cook, M (2001) The Renaissance of Clinical Leadership, International Nursing Review, 48. 3. Scott L and Caress AL (2005) Shared Governance and Shared Leadership: Meeting the Challenges of Implementation, Journal of Nursing Management, 13.
Ro Hogan is Executive General Manager (Service Delivery) of the Royal District Nursing Service, Australia’s oldest and largest provider of home nursing and healthcare services.
IT Development Coordinator Kylie Park explains the RDNS nursing system to Singapore delegates Mdm Halimah Yacob, Chan Heng Kee and Esther Soon.
The Victorian Healthcare Association Issue 1 [MAY 2012] www.vha.org.au
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TERRI LETIZIA CHIEF HEALTH INFORMATION MANAGER
eHealth
Northern Health has developed a practical framework of tools and templates for the digitisation of its medical and business records. Known as the clinical patient folder, it is a secure, semi-electronic scanned medical record system that allows clinicians to view and update medical records from any Northern Health campus. It won a Sir Rupert Hamer Records Management Award for the Victorian public sector last year.
Northern Health’s clinical patient folder a success Chief Health Information Manager Terri Letizia said records storage had become a big issue at Northern Health’s four sites, particularly the 429-bed Northern Hospital.
in 2008. This soon developed into a broader digitisation framework that included employee human resources files, financial and corporate correspondence.
Ms Letizia said the Clinical Patient Folder had enabled Northern Health to adapt to treating an increasing number of patients each year.
This framework uses updated PROV specifications and guidelines that comply with Victoria’s Evidence Act 2008, which enables digitised documents to be tendered as evidence in court.
The folder has improved information access across all sites and reduced the risks associated with medical records not being immediately available. “This is particularly beneficial for patients who may receive follow-up care at a Northern Health campus closer to home, or from the comfort of home, as clinicians can access the system remotely,” Ms Letizia said. The folder gives clinicians immediate access to a full medical history in critical situations, and for patients needing care from the emergency department, primary injury clinic, or crisis assessment and treatment teams.
“Our framework aims to ensure that we comply with all of our statutory obligations with respect to the retention and storage of records,” Ms Letizia said. Space previously occupied by large storage cabinets full of paper records at the Northern Hospital has been converted to a transit lounge, where patients are cared for by nurses while their discharge medications and transport are arranged. “The need for electronic storage of business and clinical information will only increase. One day we may just remove paper altogether!”
Northern Health began scanning all medical records completed by doctors and clinicians
VHA submission on electronic health records The Victorian Healthcare Association made a recent submission on the Commonwealth Government paper Personally Controlled Electronic Health Record (PCEHR) System: Proposals for Regulations and Rules.
likely that an opt-in system will fail because there is no obligation to participate. An opt-out system would ensure greater buy-in from consumers and practitioners.
The VHA supports the general premise of introducing PCEHR into the health system.
Many details about the PCEHR system remain unclear, although the scheme is due to go live on 1 July 2012.
VHA members were concerned about the capacity of smaller, particularly rural, health services to deliver the PCEHR system and the VHA is satisfied that the Independent Advisory Council takes this into account. However, there are broader concerns. It is
Claims that a PCEHR will benefit the elderly, people with chronic and complex conditions, and Aboriginal and Torres Strait Islanders may be unfounded, as these people may be least likely to opt-in.
Section 5.2(d)(i) states that “to lessen or prevent a serious threat to an individual’s life, health or safety … a treating healthcare provider may assert to the System Operator that access to the consumer’s PCEHR is required”.
12 The Victorian Healthcare Association Issue 1 [MAY 2012] www.vha.org.au
Clarification is needed as to what constitutes a ‘serious threat’. The circumstances in which a consumer’s privacy settings can be overridden must be clearly explained to them. Also needed is clarification of the System Operator’s role in allowing or denying access to a record in the case of ‘serious threat’. If the only requirement is for the healthcare provider to ‘assert’ need, this raises security concerns. If the claim is illegitimate, a security breach has already occurred, and penalties should apply to prevent misuse. The VHA supports the involvement of diverse stakeholder groups in the future development and monitoring of the PCEHR system.
eHealth
Barwon Health is the primary trial site for a national eHealth initiative to share medications records across the acute, aged care and community healthcare sectors. The MedView trial, led by Fred IT Group, will provide learning and direction for the Commonwealth Government’s eHealth reform program. Barwon Health’s Geelong Hospital is the only hospital participating in the trial, which also involves doctors and pharmacists from Melbourne’s inner east, throughout Tasmania and Brisbane South. With patient consent, the MedView trial gives authorised healthcare providers access to the combined records of their patients’ prescribed and dispensed medications. The medications records of these patients are stored securely in a repository, allowing participating healthcare professionals to view them through their existing desktop software. Fred IT Group Chief Executive Officer, Paul Naismith, said this would give them a clearer picture of a patient’s medications history, regardless of how many doctors or pharmacies they visited.
Barwon Health leads national MedView trial Mr Naismith said there was potential to improve workflow and efficiency for pharmacists, without changing the way patients filled their prescriptions.
Consent to upload and view patient data is held at each organisation the patient attends, and all access can be logged and audited.
“The project means that, for the first time, locals within selected national trial regions will benefit from the connection of healthcare providers across community, hospital and aged care settings.
At Geelong Hospital, MedView has been integrated with BOSSnet – which stores medical and pathology records, and doctors’ prescribing information – and with the Merlin pharmacy dispensing system.
“Patients can be confident that participating members of their care team are more informed about their medications. This is particularly valuable for pharmacists in helping to monitor medications compliance and watch for potential adverse drug interactions.” The trial relies on wider eHealth infrastructure, including Medicare’s Health Identifier Service and eRx Script Exchange – a national electronic prescription exchange that enables data to be securely shared with the MedView repository. MedView is fully integrated with clinical desktop systems, so that participating pharmacies, doctors and aged care facilities can review a patient’s medications history via their existing patient management system.
Pharmacist Leonie Abbott has been implementing MedView at Geelong Hospital since last December. “This is something quite different. It integrates potentially numerous electronic systems into the one repository. “It’s also quite different to a medications list, which needs to be manually updated. It is an integrated record of events as they have happened to the patient. “It is an easy way for doctors within our hospital to see what we have dispensed, whereas previously they couldn’t access our pharmacy records. “It’s very early days but I can see huge benefits in terms of time saving and efficiency, and it does improve communication between acute settings and the community, which is beneficial 24 hours a day.”
The Victorian Healthcare Association Issue 1 [MAY 2012] www.vha.org.au
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Health Super First State Super
Insights from a merger
MICHAEL DWYER FIRST STATE SUPER CHIEF EXECUTIVE OFFICER
Both super funds had to ask why they wanted a merger and what was the motivating principle. For the boards, it was about their responsibility to their members’ future. The merger had its beginnings in a close and trusted working relationship between the funds so that management, and later the boards, could consider the benefits of a merger to their members.
The merger of Melbourne-based Health Super and Sydney-based First State Super is one of the most complex ever attempted in the Australian superannuation sector. Under close examination, it is really an enormous change management project, or rather, a collection of about 25 interdependent and stand-alone projects which needed to be scoped, managed and overseen to culminate in a successful merger.
Both boards had stakeholders from similar organisations, which created a common understanding of their respective stakeholders’ needs. They also had very similar governance structures. These factors enabled them to reach a nonbinding heads of agreement very quickly. There was a natural vision created by the merger, which was: “To create the best value fund with focus on the health and community services, education and training and public sectors; our differentiator being our expertise in financial advice.” Under the merger governance structure of the Unite Steering Committee, 23
separate working groups were established. Communication was a key to keeping focus. It was not simply about communication frequency, but the orderly, timely and transparent release of considered content wherever possible. Although this is a long-term journey, we have focused on delivering change quickly to avoid staff developing ‘change fatigue’. Cultural acceptance of the new order has been embedded within the organisation. Celebrating milestones and recognising efforts along the way have helped this process of acceptance. It wasn’t ever going to be good news for all but we have remained sensitive to those losing their jobs, while giving due recognition to staff who have progressed the critical pieces of work during the merger. Michael Dwyer will speak at the Australian Governance and Quality Conference in Melbourne this month. He will address themes from John Kotter’s book Our Iceberg is Melting, about recognising the need for change, then leading and managing that change.
We’re giving Rosie confidence she can relax when she’s finished work.
HES5158_VHA_R
Rosie. Nurse, pâtissier and member since 1988.
Find out more on how we’re helping Rosie at healthsuper.com.au/Rosie 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.
14 The Victorian Healthcare Association Issue 1 [MAY 2012] www.vha.org.au
Victorian Healthcare Association
The year so far…
Research and policy update The 2012 Rural Health Conference was a great opportunity for the VHA to engage with our rural members. Publications launched at the conference include Directions 2012, the Oral Health Position Paper, the Rural Emergency Services Position Paper and Community Health Services: A major platform for realising the goals of health reform. Directions 2012 examines the six key themes underpinning the VHA’s vision of optimal health outcomes for all Victorians – funding reform, governance, information management, population health, service reform and workforce reform. The Oral Health Position Paper recognises the important role that oral health plays in overall health, and asserts that dental care must be accessible and affordable for all Victorians. The VHA advocates increased public funding for holistic and preventative dental care, including an intern year for the oral health workforce, incentives to attract oral health practitioners to rural areas, and the integration of oral health into tertiary courses, such as nursing, medicine and allied health. Ultimately, the VHA would like to see a phased and targeted introduction of universal dental health services that focus on prevention, education and early intervention. The Rural Emergency Services Position Paper addresses the obstacles to providing localised emergency services, including funding complexity, increasing costs, workforce shortages and skills upkeep. Key recommendations include a public information strategy, funding for the true costs of delivering services, especially transfer costs, and greater scope of practice for the rural health workforce. Community Health Services – A major platform for realising the goals of health reform is a flyer developed with member community health services, reaffirming their role in state and national health reform. This flyer will be sent to governments,
policy makers, departmental and parliamentary secretaries, primary care partnerships, Medicare Locals and other relevant decision-makers.
Population health approaches to planning project update
In 2012, the VHA has also made a submission on activity-based funding (to the Independent Hospital Pricing Authority) and on the Regionally Tailored Primary Health Care Initiatives through Medicare Locals Fund.
Stages 1 & 2 of the PHAP project investigated the disparate approaches to health service planning across Victoria, the lack of shared understanding about population health, and strategies for improvement.
The VHA has also written submissions on the Ten Year Roadmap for Mental Health, the Personally Controlled Electronic Health Record: Proposals for Regulations and Rules, and the Senate Inquiry into Palliative Care in Australia. The VHA remains involved in research partnerships, such as the Management Competency Assessment Project with La Trobe University and the Australian College of Health Service Managers, which is developing a competency assessment tool for health service managers. The Clinical Governance and Quality of Care Project with the University of Melbourne will describe and analyse the activities of Victorian public health service boards in relation to hospital performance. Work also continues on the VHA’s Population Health Approaches to Planning project, with a toolbox and online learning module currently under development. These publications, submissions and projects are the foundations of the VHA’s advocacy role in influencing public health policy and contemporary healthcare systems.
The VHA commissioned Monash University’s Department of Health Social Sciences to develop definitions, a glossary of relevant terms, a planning framework, and content for a toolkit. Stage 3 objectives include: •
improving the understanding of the definition, purpose, roles and responsibilities of PHAP among VHA members and stakeholders
•
increasing member and stakeholder capacity to participate in population health planning
•
developing recommendations for the VHA to advocate for greater government investment in population health planning
Recent project activities include: •
piloting an online learning module with VHA member agencies, including CEO’s, board members, managers, clinicians and staff
•
revising the population health planning framework and toolkit
Funding is being sought for the roll-out and development of these resources into web-based tools.
The Victorian Healthcare Association Issue 1 [MAY 2012] www.vha.org.au
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UR O Y K ! M A R E N D A R soon CALion openoirngg.au
t vha. istra Reg t www. a
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
Proudly sponsored by Health Super The Hardy Group Intersystems