April 2014 - Australian Private Hospitals Association

Transcription

Private Hospital
The official
Magazine of The
Australian
Private Hospitals
Association
April 2014
Patient Perspective
Consumer Consultant
Representatives Assist
Hospitals
Secret Shopper
Brisbane Private tests
its admission processes
Robotic Surgery
New technology makes
procedures safer
Partnering
with consumers
How private hospitals are addressing the
new standard of healthcare
Agilia® Intuitive Generation
Volumat® MC Agilia
Injectomat® MC Agilia
Injectomat® TIVA Agilia
Fresenius Kabi Australia Pty Limited, 964 Pacific Highway, Pymble NSW 2073
Customer Service 1300 732 001, ® Registered Trademarks, www.fresenius-kabi.com.au
PFKC 4903 06/11
Private Hospital is published six times a year
(February, April, June, August, October and December)
as a joint undertaking between the Australian Private
Hospitals Association Ltd (ACN 008 623 809) and
Globe Publishing (ACN 116 377 354).
Australian Private Hospitals Association
Diamond Sponsor
Major Sponsors:
AccessID
APHA Office
Level 3, 11 National Circuit, Barton ACT 2600
Postal Address
PO Box 7426, Canberra BC ACT 2610
Phone
(02) 6273 9000 Fax: (02) 6273 7000
Email
[email protected]
Website:
apha.org.au
Globe Publishing:
Suite 3.15, 22-36 Mountain Street,
Ultimo NSW 2007
Postal Address:
PO Box 57, Glebe NSW 2037
Phone:
(02) 8218 3400 Fax: (02) 8218 3488
Website:
globepublishing.com.au
Advertising Enquiries:
David Kettle
Phone:
(02) 8218 3401
Email:
[email protected]
Material in Private Hospital is protected under the
Commonwealth Copyright Act 1968. No material may be
reproduced in part or in whole without the written consent
from the copyright holders (APHA).
Private Hospital welcomes submissions and a diversity
of opinion on hospital-related issues and will publish
views that are not necessarily the policy of the APHA.
All material must be relevant, cogent, submitted to
APHA and accompanied by a stamped self-addressed
envelope, or submitted electronically by emailing
[email protected].
Electronic images must be to print standard – 300 dpi
or higher. Please retain duplicates of all hard copy
text and illustrative materials. APHA does not
accept responsibility for damage to, or loss of,
material submitted.
Neither APHA, Globe Publishing or their servants
and agents accept liability, including liability
for negligence, arising from the information
contained in Private Hospital.
Platinum Associate
Member
Terumo Australia Pty Ltd
Gold Associate
Members
3M Healthcare
ANZ
APHS Pharmacy
B. Braun Australia Pty Ltd
BD
Cardioscan Pty Ltd
Ccentric Group
Cognitive Institute
Coregas Pty Ltd
Health Industry Plan
Holman Webb Lawyers
HPS Pharmacies
Intelog Pty Ltd
Johnson & Johnson Medical
Medline International Two Australia
Pty Ltd
Medtronic Australasia Pty Ltd
Virginia Rigoni Consulting
Associate Members
Australian Health Services Alliance
Atrium Australia Pacific Rim Pty Ltd
Bard Australia Pty Ltd
Department of Veterans’ Affairs
GE Healthcare Australia
H Polesy & Co Pty Ltd
Home Nurses
Meditech Australia Pty Ltd
Metrofire Pty Ltd
Noarlunga Health Services
Norman Disney & Young
Odgers Berndtson
Queensland X-Ray
Regal Health Services
Riviera Health Pty Ltd
Siemens Healthcare
Sunway Medical Centre Berhad
Surgical Specialties Pty Ltd
Suters Architects Pty Ltd
Suva Private Hospital
Transport Accident Commission
Vital Healthcare Property Trust
Willow Pharmaceuticals Pty Ltd
Australian Private Hospitals Association
Chief Executive Officer: Michael Roff
Director, Policy & Research: Lucy Cheetham
Director, Finance & Administration: Ruth McGorman-Mann
Director, Communications & Marketing & Editor: Lisa Ramshaw
Communications Officer: Lyndal Bailey
APHA National Council 2012-2014
Steve Atkins Healthe Care Australia
Henry Barclay Cura Day Hospitals Group
Vincent Borg Epworth HealthCare
Michael Coglin Healthscope
Robert Cooke Healthscope
Alan Cooper Friendly Society Private Hospital
Anne Crouch Eye-Tech Day Surgeries
Andrew Currie Healthscope
Philip Currie Sydney Adventist Hospital
Robert Cusack St Vincent’s Private Hospital
Ray Fairweather St Andrew’s Toowoomba Hospital
Christine Gee Toowong Private Hospital
Alan Kinkade Epworth HealthCare
Craig McNally Ramsay Health Care
Alan Morrison Sportsmed SA Hospital
Moira Munro Perth Clinic
Kathy Nagle Western Hospital
Amanda Quealy Hobart Clinic
Chris Rex Ramsay Health Care
Richard Royle UnitingCare Health
Geoff Sam Healthe Care Australia
Daniel Sims Ramsay Health Care
Denise Thomas Metropolitan Rehabilitation Hospital
A P R I L 2014
Private Hospital 3
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Contents
Committee for change
18
At the coal face
20
Consumer representatives
29
South Pacific Private’s Comsumer
& Carer Advisory Committee
Macquarie University Hospital creates
core team to meet national standards
North Eastern Rehabilitation
Centre consults patients for insight
21
Pindara Magazine
Pindara Private Hospital engages
patients with new publication
22
23
Passing the test
Fake patients test Brisbane Private Hospital to improve admissions
Improving programs
Epworth’s Transitional Living
Centre helps patients return to
independent living
24
Strategies for improvement
Eye-Tech Day Surgeries outlines
patient-centred care
26 28
Top 10 tips
Insight into implementing Standard 2
BraveHearts
The Wesley Hospital offers unique
peer support program
16
24
In focus
Partnering with
Consumers
16 April 2014
In this issue
Regulars
14 06
Editor’s Letter
08
President’s Report
09
As I See It
Greenslopes Private Hospital is offering patients a number of robotic procedures
10
News
Safer heart procedures
35
Since the Last Issue
36
Legal Matters
Hunter Valley Private Hospital reduces vision loss in glaucoma patients with iStent
38
Policy Perspective
34
Back in action
42
Pharmacy Focus
36 Private Hospitals Week
Private Hospitals 33rd National Congress
Highlights caught on camera
29
Robotic GI surgery
Strathfield Private Hospital offers
pioneering surgery
30
32
33
Distal pancreatectomy
St Andrews reduces radiation to patients undergoing heart procedures
Eye implant
New procedure improves outcomes for
patients suffering back and neck problems
46
With Lisa Ramshaw
With Chris Rex
With Michael Roff
From APHA and beyond
With Alison Choy Flannigan
With Lucy Cheetham
With Michael Ryan
On The Ground
Kathy Nagle
A P R I L 2014
Private Hospital 5
Editor’s Letter
Interacting with
patients using
modern tools
Lisa Ramshaw
Director, Communications
& Marketing
Australian Private
Hospitals Association
E: [email protected]
P: 02 6273 9000
M: 0413 971 999
W: apha.org.au
T: @Lisa_Ramshaw
6 Private Hospital
A P R I L 2 014
P
rivate Hospital this month looks
at National Standard 2: Partnering
with Consumers and I’d like to
thank all of the hospitals who have
submitted articles for this edition.
A recent survey undertaken by the Australian
Commission on Safety and Quality in
Healthcare (ACSQHC) shows that many
hospitals struggle with implementation of
National Standard 2. It is heartwarming to
see so many hospitals willing to share their
experiences and journeys of implementation
with others through this magazine. If your
facility is finding it difficult to implement
National Standard 2, I hope you will find some
of the articles in this edition helpful. There are
tips to find consumer consultants, information
on how to do a literature review and even an
example of a ‘mystery patient’ at one private
hospital who assisted in changing procedures
and policies.
National Standard 2 was also the topic
of a session presented at APHA’s recent
National Congress in Brisbane. Dr Nicola
Dunbar from ACSQHC explained the
Commission’s intent with this standard,
Cathy Jones, national quality manager for
Healthscope outlined practical implementation
tips for hospitals and I presented on how
hospitals around the world are using social
media to communicate and partner with
patients and carers. From closed Facebook
groups to Instagramming paediatric heart
surgery, patients are on social media and
expect hospitals to use more of it in their
interactions.
As Ed Bennett from University of Maryland’s
Medical Centre says, “Patients expect more
than we deliver. They trust healthcare
providers and are influenced by our messages.
But they want to interact with us using
modern tools.”
Modern tools helped APHA communicate
during the National Congress too. Our new
congress app was well received and allowed
delegates to follow the conversation on Twitter
through #APHACongress even if they were not
on Twitter. We ran our first competition for
delegates to tweet and share photos. Also, if
you attended the congress, we would love your
feedback on the sessions, the program, the
venue and anything else you’d like to tell us.
The feedback survey is live on the congress
app. If you did not attend congress this year
and want to see what you missed out on,
see pages 14-15.
We relaunched our Private Hospitals
campaign at the National Congress too.
If you are not involved with the campaign
yet, I strongly encourage you to contact
APHA to get involved. We have some great
materials for facilities this year to mark
Private Hospitals Week (19-25 May 2014).
To see some of what we have planned,
see pages 36-37.
I wish you all a happy Private Hospitals
Week! I hope you use the occasion to help
communicate the value your private
hospital provides in your community.
Photography: Chris Canham
Implementing National Standard 2 involves
communicating with patients through a variety
of platforms – including social media
Stop the
Drop
Perioperative hypothermia
is unnecessary.
Normal core body temperature
(normothermia) is 37.0°C (+/- 0.5°C).
If core body temperature drops,
vasoconstriction and shivering are
triggered at particular temperature
thresholds to generate heat.
In addition, if the temperature
becomes elevated/rises, the cooling
mechanisms, vasodilation and
sweating, are also triggered at
threshold levels.1
During anaesthesia, the effects of the
anaesthetic drugs/pharmaceuticals
and the effects of the anaesthesia
coupled with a reduction in
metabolic heat production means
patients are at an increased risk of
hypothermia, which is defined as a
core body temperature below 36°C.
This can be exacerbated by a cold
environment.
1. Sessler DI. Chapter 7 Temperature Regulation and Anesthesia.
ASA Refresher Courses in Anesthesiology. 1993;21:81-93.
Find out more at www.molnlycke.com.au
Mölnlycke Health Care Pty Ltd., Suite 1.01, 10 Tilley Lane, Frenchs Forest NSW 2086,T 02 8977 2144. F 02 8977 2155.
The Mölnlycke Health Care, BARRIER®, and EasyWarm® names and respective logos are registered globally to one
or more of the Mölnlycke Health Care Group of Companies. Copyright (2013).
President’s Report
Making progress
APHA is addressing several issues with the government,
including expanding the role of the private health sector.
President
Australian Private
W: apha.org.au
8 Private Hospital
A P R I L 2 014
T
his year, APHA has identified key
objectives to pursue with the
Coalition and has commenced
meetings with Peter Dutton and
Tony Abbott in recent months to
progress some of these.
While we continue to pursue restoration
of support measures for private health
insurance such as indexation of the rebate
and abolishing the means testing of the
rebate, budgetary pressures in the short
term are potentially going to delay changes
just yet. In consultation with the government
we are focusing on initiatives to expand the
role of the private health sector and growing
private health insurance – some of these
were outlined at our recent APHA Congress.
Changing the perverse incentives which
currently drive public hospitals to seek out
and admit privately insured patients, is also
on our agenda. It is an unsustainable strategy
for public hospitals which have a lack of
beds and long waiting lists; it is
unsustainable for the health funds and it is
driving up the cost of health insurance for
everyone. Ironically, in the end, it will drive
more people back onto the public purse as
more and more of the public see a
devaluation of their health insurance or the
increased premiums drive them out. We will
push for regulatory options in this area, as
well as innovations that will encourage
private patients to go private.
There are many other issues APHA is
currently addressing with government, such
as increasing private hospital representation
on government bodies such as the
Ministerial Advisory Council, the ACSQHC
and the Health Workforce Board.
In the area of workforce and training,
the contribution of the private sector is also
under-recognised. Funds committed to this
area should follow the student/trainee to
the private sector and a greater focus needs
to be given to supporting productivity
improvement and innovation in this area.
Streamlined processes for migration and
employment of overseas trained health
professionals and international graduates,
is an item on the agenda with the relevant
government departments, given that our
biggest challenge remains the future of our
nursing workforce.
Finally, the health minister has
committed to removing unnecessary red
tape for clinicians in prescribing, processing
and claiming for PBS medicines as a result
of the chemotherapy funding review.
New funding from 1 January 2014 provides
$152.66 per infusion. This is a good start and
we await further positive announcements in
this area.
Photography: Cliff Kent
Chris Rex
As I See It with Michael Roff
20 years
Recently I passed the milestone of 20 years of service
with APHA, having commenced in 1994 before being
appointed CEO in 2000.
Michael Roff
Chief Executive Officer
Australian Private
P: 02 6273 9000
W: apha.org.au
T: @MAVR_1
O
ccasions like this tend to lead to
reflection and I recall that when
speaking at conferences, Russell
Schneider, the former CEO of
the Health Insurance Association
was always introduced as “the longest serving
health lobbyist in Australia.” I think Russell’s
tenure was 17 years!
I have also been thinking about what has
happened since 1994.
Despite what has appeared to be a long
period of political turmoil, there have only been
three changes of government at a federal level
(1996, 2007 and 2013) indicating the relative
stability of our political system.
There has been a bit more turnover in
individual personnel with eight people filling
the role of minister for health, with one of these
going on to become prime minister (Tony
Abbott).There have also been 11 shadow health
ministers, one of whom went on to become
prime minister (Julia Gillard) and one who
became treasurer (Joe Hockey). So it would
appear that the traditional view that the health
portfolio is a kiss of death for future political
ambition no longer rings true.
There have also been nine APHA presidents,
all of whom have brought a different emphasis
and style to the role but all have been absolutely
focussed on achieving the best outcomes for the
industry as a whole, regardless of the particular
segment they came from.
In addition, there have been quite a few staff
in the APHA national office in the past 20 years,
many of whom have gone on to bigger and
better things. I would like to pay tribute to all
staff, past and present for their dedication and
commitment to providing the highest level of
service to the association. It has been a pleasure
to lead you and I thank you all for your
contributions.
I have also been thinking about why it is I
have been here for so long. First and foremost I
believe in the private hospitals sector and the
vital role it plays within Australia’s health care
system. I consider it an honour to represent the
sector and am grateful for the opportunity to do
so over an extended period.
More broadly, health as an issue directly
touches the lives of every single person in the
country. It always rates as the number one or two
issue in determining votes at elections.
In fact, the most recent True Issues analysis by
JWS Research found 83% of Australians listed
“hospitals and healthcare” as the most important
issue with “the economy and finances” a distant
second at 66%. Quite simply, the work we do at
APHA matters.
Working at the intersection of policy and
politics representing a key component of the
healthcare sector is complex and challenging. It
is also enormously satisfying.
So when summing up why I have been with
APHA for 20 years I suppose the best way to
encapsulate it is,“Time flies when you are having
fun”.
A P R I L 2014
Private Hospital 9
news
Health Minister affirms private
sector’s role in healthcare
Minister for Health Peter Dutton
In his opening address to the
APHA 33rd National Congress,
Minister for Health Peter Dutton
affirmed the importance of the
private hospital sector.
“The sector makes a major
contribution to health and
wellbeing of this country –
providing Australians with more
choice in the type of health care
they can access while at the
same time taking pressure off the
public system, particularly public
hospitals and emergency care.
“Our world-class health system
is as good as it is because it
relies on a combination of private
and public services. And like
business, government can no
longer just rely on increased
funding for increased patient
outcomes.
“We need to be stripping costs,
regulatory burden and
bureaucratic nonsense from the
process. We want to ensure
patient safety and government
can do that by helping to reduce
the red tape industry that has
been created in your sector under
the guise of workplace health and
safety, duplicative reporting
requirements and the like.”
He went on to stress the
importance of productivity in
meeting future health challenges.
“I believe significant
productivity gains in healthcare
can – and must – come - not only
through improved public sector
efficiency - but also through bold
new ideas from the private sector.
“The private sector generally
has a key role to play to ensure
the required productivity gains
are realised, including through
expanded services, innovation
and technology and training.”
Delegates were heartened to hear
the Minister say:
“I believe there is capacity to use
private hospitals better to improve
patient outcomes.
We need to look at roles for you
that aren’t just about service
delivery – as important as that is,
you also can play an important
role in meeting other challenges
– including supporting an
appropriately trained and located
health workforce, improving
patient safety and quality, and
delivering the best outcomes for
patients.”
Fresenius Kabi sets up $47 million pharmaceutical manufacturing centre
Construction is set to begin on a
state of the art Australian
pharmaceutical manufacturing
facility that will deliver lifesaving
infusion therapies, irrigation
solutions, IV generic drugs and
compounded oncology products
to public and private hospital
patients Australia-wide.
The facility will be built on a
40,000-square metre site by
Fresenius Kabi Australia, one of
the major pharmaceutical and
medical device providers to
hospitals in the country. The new
site will create 120 jobs after
entering full operation.
10 Private Hospital
A P R I L 2 014
Fresenius Kabi’s Managing Director Zita Peach marks the start
of construction
Marking the start of
construction, Zita Peach,
managing director of Fresenius
Kabi Australia & New Zealand
and executive vice president
South Asia Pacific said, “The site
will markedly change the
landscape for IV products and
oncology delivery in Australia. Up
until now there has been limited
choice for hospitals when it comes
to choosing products that are
manufactured locally. This site will
see products being manufactured
that have easy handling, drug
compatibility, sterility and
environmental characteristics.
The new centre is being built with
the help of a grant from the
Victorian state government and set
for completion in 2015. The facility
will have the capability to operate
24 hours a day, which will ensure
hospital demand is met with
consistent, guaranteed supply, in
turn minimising the strain on
Australian hospitals.
Queensland medical board
announced
Christine Gee
Queensland Health Minister
Lawrence Springborg has
announced the new Queensland
medical board. Congratulations
to Christine Gee, Chief Executive
Officer of Toowong Private
Hospital, who has been
appointed to the board.
Other members of the board
include: Associate Professor
Susan Young from the University
of Queensland School of Nursing
and Midwifery as the chair; and
Dr Mark Waters, a Visiting Medical
Officer from the Cherbourg
Hospital as deputy. Doctors
Cameron Bardsley, Victoria Brazil,
William Coman, Christine Foley,
David Morgan and Josephine
Sundin have also been
appointed, along with barristers
David Kent and Gregory McGuire
and Associate Professor
Elenor Milligan.
1800RESPECT
1800RESPECT is a free
national government-funded
service which provides access
to training materials, information, screening tools, and other
practical tools and information
to help front-line workers (e.g.
nurses and midwives) better
respond to domestic/family
violence and sexual assault in
the course of their work.
For further information, visit
www.1800respect.org.au.
Revised Guidelines, Codes of Conduct and Policies
The Australian Health
Practitioner Regulation Agency
and associated National Boards
has released a suite of
documents that came into effect
from 17 March 2014. These
documents are: revised Good
Medical Practice: a code of
conduct for doctors in Australia;
revised Guidelines for
advertising regulated health
services; revised Guidelines
for mandatory notifications,
and a new Social media
policy.
All the documents other than
Good Medical Practice are
common across all the
professions that are regulated
through the National Registration
and Accreditation Scheme.
Each health practitioner board
has approved the guidelines
and social media policy.
At the time of going to press
it is understood that, following
outcries from the profession,
the Australian Medical Board
has given an undertaking that
it will change the wording of
guidelines relating to unsolicited
online testimonials.
Further information relevant to
medical practitioners about the
new guidelines is available on
medicalboard.gov.au.
Information specific to other
professions can be obtained
from websites of the relevant
boards.
Platinum Award for Bethesda
Hospital’s Safety
Melody Miles, occupational safety and health manager
Bethesda Hospital received the
WorkSafe Plan Platinum Certificate
of Achievement from Worksafe WA
Commissioner Lex McCulloch at a
presentation in February.
Bethesda Hospital is the only
WA hospital to receive a Platinum
Award from Worksafe WA in this
area for the past six years.
Yasmin Naglazas, hospital chief
executive officer, said, “The
WorkSafe Award demonstrates
our commitment to creating a safe
work environment, and it is an
outstanding achievement for our
Occupational Safety and Health
committee as well as our
management and staff to be
externally recognised for our
practices at the highest level.”
To achieve a Platinum WorkSafe
Plan Award organisations have to
demonstrate a rating of 90% or
more in every element of the
WorkSafe Plan in the areas of
Management Commitment,
Planning, Consultation, Hazard
Management and Training and
Supervision as well as an annual
reduction in either the incidence
rate or frequency rate of lost
time injury.
Melody Miles, occupational
safety and health manager at
Bethesda Hospital, said,
“Achieving Platinum level is a
challenging task, particularly for
hospitals, given the nature of the
work we do. It takes an ongoing
commitment by everyone to keep
our injuries at a low rate, with our
ultimate goal being to achieve
and maintain a rate of zero
injuries.”
A P R I L 2014
Private Hospital 11
news
St George recognised as a ‘Centre
of Excellence’ for bariatric surgery
Sheryl Kelly
after surgery
St George Private Hospital is the
first and only hospital in Australia
to be accredited as a Centre of
Excellence for bariatric surgery
– as recognised by The
American Society for Metabolic
and Bariatric Surgery (ASMBS).
Executive Treasurer of Obesity
Surgery Society ANZ, Dr Ken Loi,
said the hospital accreditation
process, spearheaded by GIT
Nursing Unit Manager Gayle
Finn, was a major coup for the
hospital.
“St George was one of the
first hospitals to carry out gastric
sleeve surgery and gastric
bypasses in Australia and this
award is formal international
recognition of safe and
exceptional healthcare
for patients.”
Dr Loi said, “Obesity surgery
continues to be one of the fastest
growing areas of medicine in
Australia, and obese patients have
two or three times greater chance
of dying at a young age (under 60).
Patients who are otherwise
unable to afford surgery, are now
offered a new option by tapping
into their super to pay for their
surgery.
Patient Sheryl Kelly who once
weighed 150kg and is now just
74kg says she accessed her
superannuation on
compassionate grounds, with a
letter from her specialists
documenting her diabetes, blood
pressure and arthritis sent to the
Department of Human Services.
relevant players in preparation
for the IPO.
The government has
pre-existing authority to proceed
with this sale through the
Medibank Private Sale Act 2006.
This act places a limit on
individual ownership of 15 per
cent.
Lazard, Herbert Smith
Freehills, Ernst and Young and
the Australian Government
Solicitor delivered a report to the
government on the potential sale
of Medibank in February 2014.
This scoping study found no
evidence that premiums would
increase as a result of the sale of
Medibank.
The study found that
Medibank operates in a
well-regulated, competitive
private health insurance market
with 34 competing funds, and
that there is no market failure in
the health insurance market.
Medibank undergoes privatisation
Minister for Finance, Senator the
Hon Mathias Cormann,
announced the sale of Medibank
Private (Medibank) in March. An
initial public offering (IPO) will
proceed in 2014/15, subject to
market conditions. The precise
timing and structure of the IPO
are yet to be determined.
To facilitate the privatisation,
the government has appointed
three new Medibank board
members: David Fagan, a
banking and major projects
lawyer at Clayton Utz; Linda
Nicholls AO, a corporate adviser
and director of a number of
leading companies including
KDR, Sigma Pharmaceutical
Group and Fairfax Media; and
Christine Riley, a director of CSL,
Transurban, Energy Australia and
Baker IDI and a deputy chair of
Care Australia.
The government will appoint
joint lead managers and other
Professor John Turnidge to lead national surveillance program
The Australian Commission on
Safety and Quality in Health Care
(the Commission) has announced
the appointment of Professor John
Turnidge as a senior medical
advisor to lead work on a national
surveillance program for
antimicrobial resistance (AMR)
12 Private Hospital
A P R I L 2 014
and antibiotic usage (AU).
Under the 2013/14 Australian
federal budget, the Commission
has been funded to coordinate
national action to prevent and
contain antimicrobial resistance
through enhanced surveillance
systems. AMR is a critical health issue,
with the World Health Organisation
calling for urgent action. In
Australia, some resistant bacterial
pathogens that were primarily the
concern of hospitals are now seen
with increasing frequency in the
community.
The Commission’s Chief Executive
Officer, Professor Debora Picone,
said, “Professor Turnidge is
eminently qualified. He has been
involved with many high-profile
societies and committees dealing
with issues of antibiotic resistance
and its management.”
Research reveals how Reliable Excellence in Care accelerates revenue growth
The findings of landmark
research into the impact of
Reliable Excellence in Care on
hospital performance were
revealed at the APHA’s recent
National Congress in Brisbane.
Intelog Healthcare
Performance Group led the
research in partnership with
eminent US not-for-profit
Eisenhower Fellowships. Intelog
coined the phrase Reliable
Excellence in Care to describe
what happens when a hospital
stops relying on individual
heroics in the daily delivery of
care. Instead staff, doctors and
patients collaborate to develop
systems, which ensure that care
is delivered right first time and in
the way patients prefer it. More
than 50 CEOs were amongst
over 100 Australian private
hospital leaders who helped
shape the research results. Key
findings include the fact that
respondents, who said that their
hospitals are actively focused on
Reliable Excellence in Care,
reported a 166% higher 3-year
revenue growth than those who
stated that their organisations
didn’t have this focus.
As well as superior revenue
growth, the majority of those who
stated that their hospital was
actively focussed on Reliable
Excellence in Care reported
other benefits. These included
more patient loyalty, attracting
and retaining leading specialists,
making efficiency gains and
achieving cultural change.
Intelog Healthcare
Performance Group’s MD Bernie
Kelly commented “It’s clear that
Australia still lacks a world-class
case study of Reliable Excellence
in Care. However, some of our
clients’ progress shows they’re
on track to match or possibly
even eclipse the famous US
exemplars. There’s a long way to
go, with the likes of Seattle’s
Virginia Mason having begun
their improvement journey 15
years ago. This is part of the
reason we began this research,
which we believe can help our
private healthcare system to
accelerate its pursuit of Reliable
Excellence in Care.”
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community services choose
HESTA for their super
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e Year’ Product ratings are only one factor to be considered when making a decision. See hesta.com.au/ratings for more information. H.E.S.T. Australia Ltd ABN 66 006 818 695
A P R I L 2014 Private Hospital 13
AFSL No. 235249, the Trustee of Health Employees Superannuation Trust Australia (HESTA) ABN 64 971 749 321. For more information, free call 1800 813 327 or visit hesta.com.au
for a copy of a Product Disclosure Statement which should be considered when making a decision about HESTA products.
APHA National Congress
APHA 33rd
National Congress
The APHA hosted its 33rd National Congress in Brisbane at the Brisbane
Exhibition and Convention Centre from the 23-25 March 2014.
Site Visits
Delegates were taken on tours around Eye-Tech Day
Surgery, St Andrew’s War Memorial Hospital and
Greenslopes Private Hospital.
Welcome
Reception
With the assistance of
networking guru Phillip
Jones, delegates were
encouraged to make
new contacts.
Exhibitors
Exhibitors showcased the latest devices
and information to aid private hospitals.
14 Private Hospital
a p r i l 2 014
Speakers
Delegates listened to an array of speakers including: The Hon Peter
Dutton MP, Professor Jeffrey Braithwaite, and Dr Mark O’Brien on a
range of issues affecting the private hospital sector. Sessions included
a mix of clinical information and leadership skills.
Pre-Dinner Cocktail Party and Gala Dinner
Delegates and invited guests were busy networking at
the cocktail party (sponsored by Baxter) and Gala
Dinner at Brisbane City Hall. The night was filled with
lots of laughter and surprises.
april 2014
Private Hospital 15
In focus Partnering with consumers
Positive improvements
The value of consumer and carer engagement
at South Pacific Private
S
outh Pacific Private’s
Consumer & Carer Advisory
Committee (CACA) has
been running for more than
a decade and is typically
comprised of 10 past client and carer
representatives and two South Pacific
Private staff members.The committee
meets quarterly and suggestions for
ongoing improvements are openly
discussed and logged.
South Pacific Private believes the CACA
committee is invaluable and prides itself
on the impact it has on the integrity and
improvements in the hospital and for
the patients.
Claire Barber, South Pacific Private’s
general manager commented,“Effective
partnerships, consumer experience and
high quality healthcare are of the utmost
importance to South Pacific Private and we
feel privileged to work so closely with our
consumers, carers and healthcare partners.”
The hospital received full accreditation
in the 2013 National Accreditation Survey
and was singled out by the surveyors for
its work with consumers. According to the
surveyors,“There was very strong
evidence throughout the service that a
central tenet of the organisation is
partnering with consumers.”
The value of consumer engagement
The CACA committee has been an
integral part of several key improvements
throughout the hospital in recent
years, including:
1.24 hour alumni support line: This
support line was implemented in May
2013 as a direct response from a CACA
committee member suggestion.This
means the hospital is now able to take
enquiry calls 24/7. Prior to this change,
after hours calls (from 5.30pm onwards)
were channeled to the nurses’ station
and to after hours staff. However this
was a strain on resources and
challenging for the nursing department
whose focus needed to be the inpatients’
care and treatment. Implementing this
support line has helped to ensure the
16 Private Hospital
a p r i l 2 014
nurses are able to focus their care on the
inpatients overnight, and that South
Pacific Private is better able to track and
respond to overnight enquiries.
2.Client rights and responsibilities:
The CACA committee reviewed South
Pacific Private’s client rights and
responsibilities.This resulted in
improved communication throughout
the hospital. Posters on rights and
responsibilities are now clearly
displayed for staff and clients.
3.Development of Changes 2
program resulting from phone
survey: The CACA committee
members conduct an annual survey
with South Pacific Private alumni.This
survey consists of questions around
program content, development,
improvements, customer experience,
aftercare and patient recovery. As a
result of this annual survey, the hospital
developed a Changes 2 program to
meet specific needs outlined in the
survey. Changes 2 is designed as a
treatment booster program, providing
an intensive therapeutic experience to
support clients who may be struggling
in their recovery journey, with further
psycho-education, psychotherapy and
life skill development while reinforcing
the principles of recovery.
“The CACA committee has been an integral part of several
key improvements throughout the hospital in recent years”
4.Pacific Connections: On a quarterly
basis, South Pacific Private designs and
develops two newsletters, Pacific Views
(for healthcare professionals) and
Pacific Connections (for past clients
and alumni).The CACA committee
helped to generate the idea for the
latter as a reflection of annual survey
results and this newsletter has been
shared with alumni since 2011. Each
quarter the newletters cover a variety
of topics that are specific to supporting
clients in their ongoing recovery
journey.
5.Complete revision of the Step
Down program (became
Transitions): The Transitions program
supports clients in their first few weeks
after discharge as they transition back
into their home and work environment.
From personal experience
John McMillan is a longstanding committee
member and has been involved in many of
the improvements and changes over the 20
years South Pacific Private (SPP) has been
operating. He has also gone through
recovery firsthand and brings his
experience to the CACA committee in terms
of perspective, insight and support.
SPP asked Mr McMillan about his
experience with the committee over the
years.
You’ve been involved with South Pacific
Private as a client and as one of our
consumer and carer committee
members; what changes have you been
privy to and do you think are significant?
There have been a number of significant
improvements over the years. The first I
would cite would be the remodel and
refurbishment of SSP. It impacted the
‘flow’ in a really positive way and I believe
the service provided as a result is
fantastic. As a result, there are more
beds; and thus more on offer, which is
great as it supports each individual
experiencing treatment at SPP (regardless
of how far along a person is in their
recovery journey). Some of the biggest
changes I have been privy to is the
addition of more after care programs and
day programs, which is really important in
terms of a person’s recovery post
discharge from SPP.
Finally, and most significantly, the
program has stayed constant, effective
and has great integrity.
You’ve been a key member of our CACA
committee for some time now – what’s
the value in being involved in that
committee from your standpoint?
I am able to share with others, from an
intimate point of view, what is on offer;
from the perspective of what the hospital is
offering now and what the future holds. The
CACA committee offers the layer of support
that allows the vision and strategy of the
hospital to be fulfilled and SPP to continue
to support clients.
This program is an important part of
treatment as it allows clients to address
issues as they arise and helps them to
focus on reinforcing and extending the
skills they learnt during their treatment.
The CACA committee disseminated
feedback from clients in the annual
survey and used it to transform the
program into what is now known as
Transitions.
6.Aftercare planning groups and
lectures developed to improve
client aftercare knowledge and
engagement: Another fundamental
and valuable insight from the CACA
committee was the inclusion of tailored
lectures specific to aftercare and
ongoing recovery.This was to ensure
the hospital is educating and preparing
clients in terms of how they would
manage their own aftercare plans. It is
critical to provide insights to clients in
terms of their next steps post discharge
and these lectures are now an integral
part of the facility’s psycho-educational
lecture content.
The CACA committee provides ongoing
support to the hospital. In addition to the
quarterly meetings, South Pacific Private
also engages with consumers and carers
through a variety of channels, which
include:
• Annual phone survey of past clients
• Suggestions box placed in the hospital
• Client feedback cards available
throughout the hospital and at the
reception area
• All compliments and complaints logged
and addressed on a weekly basis
• Weekly staff (clinical and non-clinical)
and community meeting which
provides the opportunity for current
clients to feedback directly to staff
• Alumni support email address.
By Steve Stokes
april 2014
Private Hospital 17
Patient involvement
Macquarie University Hospital created effective, meaningful
strategies to meet national standards by keeping consumer
participation high on the agenda
I
n meeting the Australian Government’s new national standards,
Macquarie University Hospital
prioritised patient engagement and
staff education to make its ‘partnering
with consumers’ standard an outstanding
success.
Early in 2013, Macquarie University
Hospital set to work on developing a range
of innovative strategies to ensure full
compliance with the Australian
government’s new National Safety and
Quality Health Service (NSQHS) Standards.
The key to achieving these standards, in
particular partnering with consumers, was
developing a diligent project plan and
creating a core team that assisted in its roll
out across all levels of the organisation.
Through a methodical approach and the
harnessing of a number of tools to lift staff
engagement and compliance, Macquarie
University Hospital was able to boast being
one of the first facilities in the country to
roll out all 10 standards.
“Every single standard involves some
kind of patient involvement,” said Sue
Dawson, deputy director of Clinical
Services at Macquarie University Hospital,
who also served as quality manager during
the 12-month compliance process.“With
this in mind, we kept consumer
participation high on the agenda for the
development and implementation of each
standard, always focusing on effective
strategies that would be meaningful for
patients and carers.”
Key initiatives included the
development of a quality board to display
information regarding hospital
performance and quality activities such as
falls and infection rates, as well as activities
that extended to community involvement
outside the hospital.
Informing patients took place through
initiatives such as a patient compendium
that provided information about the
services the hospital offers, and how and
why the national standards were being
implemented in clinical practice. In
addition, the Australian Commission on
18 Private Hospital
a p r i l 2 014
Vial
MUH created a core team to assist in the implementation of Standard 2
Safety and Quality in Healthcare (ACSQHC)
resources, such as patient rights and
responsibilities posters, were displayed in
admission areas in 17 different languages
along with a braille copy.
“We also involved patients in the
review process for hospital-produced
publications,” said Ms Dawson.“This
involved amending the patient feedback
form to allow patients to nominate
themselves as patient reviewers, then
developing a reviewer database, which
was used in developing our patient
compendium and the My Stay booklet.”
The hospital installed small
whiteboards in each patient room that
now capture key staff, medical and patient
information. Nursing staff write their
names on the board at the
commencement of a shift, along with
other information the patient would like –
for example, tests to be conducted during
the shift, the kind of diet they are on, and
when their next pain medication is due.
The whiteboards are also used to identify if
a patient is at risk of falls or pressure areas
by the use of a magnet that uses the ‘Falls
and Pressure Injuries’ standards icons with
the permission of the ACSQHC. Auditors
from the commission noted that they had
not seen this strategy used before.
To engage consumers in early detection
of clinical deterioration, criteria for calling
a clinical review were changed to include
‘any serious concern by a family member’.
And clinical handovers were moved from a
private room to the patient’s bedside – also
involving family members, if present.
By Andrea Lewis
Hospira
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april 2014
© Hospira Pty Ltd 2014 ABN 13 107 058 328 140107HOSP. January 2014
Private Hospital 19
Maureen Hanley
Ken Riding
From a patient’s
perspective
The North Eastern Rehabilitation Centre recruited consultant
consumer representatives to provide patient insights into the hospital
P
atient-centred care is at the
heart of North Eastern Rehabilitation Centre’s (NERC)
healthcare provision with a
staff focus on providing the
best patient experience possible.
Effective engagement and
communication with patients is a critical
element for NERC in providing a
transparent healthcare service for not only
the patients but their families and carers,
this empowers patients to have a greater
say in the planning, delivery and evaluation
of care and services whilst being treated at
NERC.
Focusing on their patient-first approach,
the NERC management team recognised
the benefits in partnering consultant
consumer representatives who could
provide insight into the hospital from a
patient’s perspective.
The NERC management team wanted to
ensure they engaged the right mix of
people who had not only the willingness
and capacity to undertake such a voluntary
role, but also had been a past or current
patient of NERC or another rehabilitation
facility.
20 Private Hospital
a p r i l 2 014
NERC is a 46-bed hospital located in the
northern suburbs of Melbourne.The
hospital provides rehabilitation for trauma,
spinal injury, neurological/stroke,
orthopaedic, respiratory, chronic pain
management, neurosurgical and
restorative/reconditioning.
Finding the right person meant utilising a
local network to source potential candidates.
In the end there were five applicants who
undertook the recruitment process of which
two candidates were offered the position
– Ken Riding and Maureen Hanley, both
former patients of NERC.
The role of a consultant consumer
representative incorporates many areas,
including being active members of the
Quality and Marketing Committees, as well
as being required to review any new or
amended publications. Another key focus is
their liaison with current patients.
According to Mr Riding,“The knowledge
I have acquired at NERC has been
enriching and based on feedback from
management, my contributions to the
hospital have been equally beneficial. It is
important to realise that NERC is not a
five-star hotel, but a rehabilitation hospital
– patients are not here for a holiday but for
the fantastic care and services. Getting that
balance right is what we hope to achieve.”
Ms Hanley adds,“Being a consultant
consumer representative is different from
what I expected as I have been quite
involved in operational activities.This has
given me quite the insight into how a
hospital runs. Being a member of the NERC
Quality Committee has been very
interesting, my comments or suggestions
are always well heard and I look forward to
my continued involvement in 2014.”
Suggestions from NERC’s consultant
consumer representatives include:
• Placing additional items on the
breakfast menu
• Raising the height of the garden beds
to better facilitate garden therapy
• Installing Wi-Fi so patients and their
visitors can access free internet
• Provision of larger flat screen TV’s
positioned at a preferred height
for viewing
• Creation of an additional single
room with ensuite
By Simon Keating
Hot off the press
Pindara Private Hospital is engaging consumers with
a new health and lifestyle magazine
P
indara Private Hospital, on the
Gold Coast, has adopted an
innovative approach towards
meeting the requirements of
Standard 2 of the 10 National
Safety and Quality Health Service Standards,
with the creation of Pindara Magazine, a
high quality health and lifestyle consumer
quarterly publication.
Encouraging and supporting proactive
participation and decision-making from
consumers and/or carers to improve the
patient experience and patient health
outcomes is a key criterion of Standard 2,
which broadly requires a hospital to partner
with consumers to improve the safety and
quality of care.
Pindara CEO Trish Hogan said the
magazine was one of a range of the
innovative initiatives her hospital has
introduced to meet these requirements.
Thought to be the first publication of its
type, Pindara Magazine is similar in
concept to an airline’s inflight magazine and
is distributed free to all hospital patients,
visitors, staff, doctors, as well as the general
community.
Robbie Falconer, business development
and marketing manager, said,“The aim is
simple: consult, inform and educate
consumers in order to engage and empower
them to make more informed healthcare
choices.”
Ms Falconer said Pindara Magazine was
part of a communication strategy with
long-term goals to keep the Gold Coast
community up-to-date with current issues,
ensuring communication between the
hospital and our important stakeholder
groups is a two-way process,” she said.
“By creating a better informed and better
educated consumer, over time, we expect
they will be able to make more informed
and more personally relevant healthcare
choices. In other words, the more informed
our consumers become, the more active
“By creating a better educated consumer, over time, we
expect they will be able to make more informed healthcare
choices. In other words, the more informed our consumers
become, the more active they will be in decision-making
that concerns their own or their family’s healthcare”
new treatments, and new and improved
healthcare services and what these mean for
the community.
“We invited article submissions from a
range of contributors, including patients,
visitors, staff and the medical community.
This process ensures the magazine content
is relevant and meaningful while also
they will be in decision-making that
concerns their own or their family’s
healthcare.”
The first issue of Pindara Magazine
went into circulation in February, and
judging by the overwhelmingly positive
feedback received from consumers, the
magazine is really hitting the mark.
Ian McGregor, Robbie Falconer, Ainslee Bauer, Jane McGarry enjoy reading the Pindara Magazine
april 2014
Private Hospital 21
Secret shopper
Brisbane Private Hospital planted a fake patient to test and
improve its admission processes
A
s part of its ongoing quest to
improve customer satisfaction,
Brisbane Private Hospital used
an innovative technique to
gauge what the admission
process is like for patients.
After careful planning, General Manager
Mairi McNeill planted a pretend patient in
the system.The patient was booked in for
an elective surgery, which was later
cancelled at the last minute.
The ‘secret shopper’ went through the
entire process – from consultation with the
surgeon, pre-admission and the admission
process and discharge, and provided a
comprehensive report.
This accurate report made it possible
for the hospital to recognise areas that
could be improved and develop ways to
make the entire process more user friendly.
Ms McNeill said while the pretend
patient had no major complaints or
problems, the hospital was able to use her
comments and suggestions to better its
processes.
“In response to the feedback provided
by our secret shopper, we have
implemented a number of measures to
ensure processes are streamlined and to
improve the overall experience for
patients,” she said.
“For example, we have now introduced
electronic admissions which eliminates
duplication and saves time for the patients
and staff.
“We have also made amendments to our
call centre script to ensure consistent
information dissemination, and improved
processes to ensure patients are fully
informed prior to their admission.
Ms McNeill said design layouts of areas
used by patients were upgraded as well.
“We implemented design changes such
as reconfiguration of the waiting room
layouts to improve our patients’ comfort,”
she said.
“The patient change rooms have also
been modified to include benches for
seating and spaces to hold belongings, and
22 Private Hospital
a p r i l 2 014
“In response to the feedback provided by our secret
shopper, we have implemented a number of measures
to ensure processes are streamlined and to improve the
overall experience for patients”
a buzzer has been installed for patients
who may need to call for assistance.”
Ms McNeill said the findings prompted
the hospital to review the time patients are
asked to arrive prior to their operation.
“We are in the process of doing a
thorough analysis to work out the optimal
time needed to prepare before an
operation and how long the process takes
for a patient to be admitted
administratively and clinically,” she said.
“We are working through the timing
with admission, theatre and day surgery
staff as well as practice managers and
doctors to tailor times to suit patient
needs.”
Ms McNeill said the exercise was
successful and the changes have been well
received by patients and staff.
“Our secret shopper provided
invaluable feedback and it is something we
will replicate in the future.”
By Karla Simpson
Saskia Spijker, medical
imaging technologist
The key to better care
Epworth makes consultation with patients and their families
a priority to raise the standard of care
A
focus on improving rehabilitation programs at Melbourne’s
Epworth HealthCare has
resulted in an increase in team
planning that includes meetings
and briefings with patients, their families
and their important social contacts.
Recognising the devastating effect of
severe illness or traumatic injury on
families and friends as well as the patients,
multidisciplinary care teams go to great
lengths to arrange meetings where
everyone can contribute to plans for the
future care and rehabilitation of the
patient.
For example, at Epworth’s Transitional
Living Centre (TLC) in Thornbury, family
consultations have always played a big role
in developing programs for patients
attending the unique residential program.
TLC was established nearly 25 years ago
for patients with severe brain injury. In that
time, it has created individual patient
programs for more than 400 people –
helping them return to independent and
productive living.
Manager Helen Harrington says TLC’s
success is thanks to dedicated staff and
families, as well as organisations like the
Salvation Army and the Keilor Rotary Club,
who all those years ago, understood the
need to create something different from a
hospital setting for brain-injury patients in
their long road towards independent living.
“Whole communities benefit when
families are supported in their care of an
injured family member. A testament to the
great team work and successful personal
outcomes for residents is that many
volunteer to work with new residents to
share their relearning and recovery
experiences – even years after they
have completed their stay there,”
Ms Harrington added.
There are other areas across the
rehabilitation sites, where patient care teams
are guided by former and current patient
views to help improve the programs they
run. During 2013, a group of breast cancer
patients undergoing rehabilitation at
Epworth Camberwell were integral in
shaping a program that addressed their
physical, psychological and social needs.At
the end of the first eight-week program, the
patient group not only reported an
improved confidence in their physical
activities, but said they found a new and
unexpected enthusiasm to return to their
previous lifestyles because the sense of
isolation that they had experienced earlier
in their illness had diminished.
By Fiona Gerrard and Colleen Coghlan
april 2014
Private Hospital 23
Making patient care a
priority
Eye-Tech focuses on providing patient-centred care in a day hospital setting
E
mpathy is the key to patientcentred care in any healthcare
setting. At Eye-Tech Day
Surgeries we have made
empathy a foundation value.
There are numerous definitions for
patient-centred care.The ACSQHC suggest
that a consumer-centred approach to care
involves:
• treating consumers and/or carers with
dignity and respect
• communicating and sharing
information between consumers and/
or carers and healthcare providers
• encouraging and supporting
participation in decision making
• fostering collaboration with consumers
and/or carers and healthcare
organisations in the planning, design,
delivery and evaluation of health care
Internationally, the term patient-based,
person-centred, relationship-based,
patient-centred or patient and family
centred are interchangeable.
At Eye-Tech, we encourage patients to
be actively involved in their care. We
provide a physical environment that
promotes patient comfort, and employ
staff who are dedicated to meeting the
physical and emotional comforts of our
patients.
How do we achieve this in a day
hospital setting? This is a question often
asked at our Consumer Focus Group
(CFG) meetings. Key factors include: an
organisational culture that encourages
staff to be sensitive to patients’ needs
during their stay; a facility designed to feel
like home; and an emphasis on staff,
patient and family education.
Eye-Tech believes these qualities create
a patient experience that distinguishes it
from other day hospitals.There is a
growing body of research that links
patient experience and perceptions of
care. At Eye-Tech we have devoted
considerable time and effort in applying
strategies for quality improvement,
systems of risk management and incident
reporting, which is essential but does not
measure up without patient-centred care.
Recruitment and retention of high
quality staff are crucial to patient-centred
care, and to keep the high quality staff we
have it is important for us to operate as a
learning organisation. As a result, we have
created a relatively flat structure at the
top; management and staff share
information internally and externally, we
provide educational opportunities, we try
to stimulate new ideas, we work as a team
– even though we are over two sites, and
our communication is open.
Increasingly, patients are faced with
out-of-pocket expenses for their care, so
naturally they are seeking more value for
their money. Hospitals who respond to
their consumers with personalised, high
quality care and service excellence are
poised to thrive in this era. We can
differentiate ourselves by building a
brand around a patient-centred approach
that addresses the increasingly high
expectations of our patients and
families.
By Anne Crouch
Eye-Tech’s strategies
1. Rights and responsibilities
Eye-Tech has implemented a
rights-based patient constitution
and charter. These documents
are on our website, in the patient
booklet and displayed in
reception. We ask each patient
individually if they understand the
charter or if they have any
questions they require answering.
Generally speaking, most people
say they understand and require
no further clarification.
24 Private Hospital
a p r i l 2 014
2. Patient feedback systems
One of the methods we employ at
Eye-Tech is the collection and
reporting of patient feedback. We
use a paper-based system and a
telephone system. Another
method of obtaining feedback is
to capture the patient’s story by
interviewing them on the spot.
We use these stories to begin our
meetings when possible. It is a
very effective motivator for
quality improvement.
3. Consumer Focus Groups
For the past three years we have
organised a Consumer Focus
Group. We only have one meeting
a year, generally in July after all
the statistics and feedback for the
organisations have been collated.
There is a core group of five
participants and we invite at least
another four people who have
been recent patients each year. In
the first meeting, we learned
consumers were not interested in
the CEO or high level
management driving this meeting.
From then on the organisation of
this meeting was delegated to
one of our permanent part-time
registered nurses. The CEO and
the executive manager present a
report on the day and answer
questions during the meeting
only.
The key to this meeting is in the
pre-reading, which is sent out in
advance. We share everything
Clockwise: Second stage recovery; checking patient ID prior to operating theatre; discharge lounge; patient clinical admission
with this group with the exception
of financial data. The members
sign confidentiality statements
and the work books are handed
back at the end of the meeting.
We include things such as quality
and safety statistics, collated
feedback and any booklet,
brochure or piece of paper we
hand out to patients and family in
these work books. This allows
time for a thorough review of the
documents to ensure that
everyone in the group can
understand them. Participants are
encouraged to ring the nurse
organising the meeting if they
require clarification prior to the
meeting. We have made many
changes from the feedback over
the years. There is generally a lot
of work to cover on the day and
this preparation is essential for
the smooth running of the
meeting. Most of the participants
have marked up questions and
have prepared comments for
discussion on the day.
The other key is to ensure you
cover everything you need to
meet the standards in this annual
meeting so that it can be
reported. The consumer’s
perspective is captured in the
meeting minutes and action plan.
These are the tools we table at
every other meeting from
staff to our highest governance
level.
4. User-centred design
We found it important to get
patients and carers involved in
the design from the initial
planning stage.
The consumer group stated
that a quiet environment and
cleanliness were very important
to them. They also indicated the
design should incorporate
positive spaces, interesting
ceilings, a natural colour palate
and open planning.
april 2014
Private Hospital 25
Top 10 tips
Insight into how private hospitals can implement Standard 2
M
any small hospitals recruit a
consultant to help them
implement the 10 National
Safety and Quality in Health
Care (NSQHC) standards,
but a consultant can only do so much. At
some point, the owner or senior management needs to become involved in the
implementation and execution of all 10
standards effectively and appropriately.
Standard 2: Partnering with Consumers
seems to offer more challenges than the
other nine.This is because thinking care is
reasonable and getting good feedback from
an annual survey is not enough. Involvement with consumers progresses across a
continuum of participation, building from a
passive relationship to fully involved
consumer engagement at a management
level. Here are 10 tips to start you on your
way:
1. Don’t be scared of it and don’t
ignore it
This standard seems intimidating because
we don’t really understand what an auditor
is going to look for. Unlike the other
NSQHC standards, especially Standard 3:
Infection Control, there is no definitive list
of things to achieve. Overcome your fear of
Standard 2 by looking at it, and accessing
the Australian Commission on Safety &
Quality in Healthcare (ACSQHC)’s website
for changes. If you choose to ignore this
standard, you will achieve ‘not met’ ratings,
and, have a relatively short time to rectify it.
2. Read the standard
Start by understanding what partnering
means, and then read about examples of
how this is achieved. I recommend looking
at some major leaders in patient centred
care: Planetree and the King’s Fund.Then,
look at some Australian and state resources,
such as the Australian Institute Patient &
Family Centred Care. I would recommend
reading what similar organisations around
26 Private Hospital
a p r i l 2 014
you are doing, and how they are
implementing their partnering with
consumers program.These resources will
give you an idea of how to scope this for
your organisation. It does not matter how
small you are, there are things that can be
done to meet the requirements. Looking at
the ACSQHC’s website now, there are many
toolkits available to suit various clinical
settings.
3. Know your demographic
Define your target population and design a
partnering strategy around them. For
example, Chermside Day Hospital (CDH)
have chosen to recruit and contact their
consumer group via email and the web.The
majority of their maxillofacial consumer
group are young adults dependant on
internet engagement. CDH also present
some scenarios to their Consumer Advisory
Group (CAG), based on their incident
reporting system. Feedback from the CAG
provides insight on how consumers would
resolve a particular issue.
4. Educate, educate, educate
Education is essential. Educate and arm
yourself with references and the
standard. Present to the owner or board
members. Engaging the highest level of
governance is important to achieve the
intent of this standard. I often get
comments like ‘they just want me to take
care of it’ or ‘they don’t want to be
involved’. They need to be. Also, present it
to your staff and teach them about
partnering. You may choose to invite a
consumer to your staff meetings so they
can speak about their experience and
provide advice to your staff members. At
small one theatre facilities this is easy to
do because the staff meetings are very
intimate. You can also educate your
consumers here and discuss topics like
Open Disclosure.
7. Communicate
Share hospital information with your
consumers. Place a noticeboard in your
waiting room or provide a flyer indicating
what changes have occurred at the facility
and seek feedback. Communicate your hand
hygiene rates, the average wait time for
patient procedures, and anything else you
measure.Ask for suggestions from your
consumer group. You may choose to write
and display a ‘Partnering with Consumers’
policy outlining what you intend to do to
partner with your consumers.
8. Follow-up and post op phone calls
This is a great way to harness feedback
from your patients and discuss the
hospital’s performance.To do this, come up
with a couple of things you’d like to
measure. At the end of your post-op phone
calls ask the patients some consumer
related questions, such as ‘We’ve recently
introduced our new booklet, what did you
think of it?’ or tell the consumer what the
organisation has achieved in the last three
months, and ask them if they like this
change and request some feedback.
9. Are you doing anything to change
the facility?
Some facilities change their layout or
services from time to time. Display your
plans, or invite your consumer group to
discuss them with senior staff members.
5. Recruit some interested people
People love to share their experiences.
Chat to a few carers, and ask their
thoughts about recent changes in your
facility. Set up an email address so patients
can be encouraged to communicate their
input at any time. Put the email address on
your discharge advises and website. Give
your consumers the opportunity to
contact you, other than when they are
upset. Make sure you create a consumer
group, complete with terms of reference.
6. Look at your documentation
What do your consumers look at? Are your
forms easy to fill in? Consider a patient
brochure or booklet for them to have
before their procedure.This will help you to
think through the process for your
consumer. It is important to identify what
they need to know. Provide information in
this brochure, for example ‘When not to
come for your procedure’ or information
about the national standards.Ask your
consumer group to review your
documentation. If your facility is very small,
consider contacting an association to help
you. For example, one of my clients has a
predominately Chinese consumer base, so
they presented their documentation to
their local Chinese community support
centre for advice.Another client contacted
a hotel that specialises in care for the first
night post procedure, and asked them to
review their brochure on discharge care.
Think outside the box!
10. Document, document, document
and discuss
Document your discussions and collect
your reviews, regardless of how few they
may be. Discuss all of your findings,
feedback and suggestions at your meetings,
and ensure ‘Consumer Engagement’ appears
as a standing agenda item.
The key is to start somewhere. When
you start involving consumers in your
facility, the inward flow of valuable
information is inevitable. It becomes easier
to integrate consumers once you have
started. It won’t be long until you will be
fostering partnering relationships without
realising it.
By Kelly Brandt, Tick It Business Solutions
april 2014
Private Hospital 27
Wesley cardiac patient Stephen McLean
(left) with BraveHearts volunteer Ian Heap
Peer support
BraveHearts support cardiac patients at The Wesley Hospital
W
hen Ian Heap was
diagnosed with coronary
heart disease and underwent a stent procedure at
Brisbane’s Wesley Hospital
eight years ago, a visit from one of the
hospital’s BraveHearts had an enormous
impact on him – so much so, that Mr Heap
is now a BraveHeart himself.
BraveHearts are volunteers who have
experienced a cardiac event, gone through
The Wesley Hospital’s cardiac rehabilitation
program HeartWise, then received special
training to visit and offer support and
encouragement to cardiac patients in the
hospital’s wards.
The BraveHearts cardiac patient peer
support program began in 1999, and since
then volunteers have made more than
12,000 visits to patients.
“The visit I had from Ron was the
beginning of the healing process for me,”
Mr Heap said.“No matter what people
might say, a cardiac event is a frightening
experience and thoughts like ‘this is the
28 Private Hospital
a p r i l 2 014
end of my life’ run through your head. I
felt very lonely.
“Ron said to me,‘Look, this happened to
me. I understand how you are feeling, but
there is life after this’.Talking to him was a
great benefit to me.”
Mr Heap became a BraveHeart volunteer
about five years ago and visits patients at
The Wesley Hospital one day per week.
“I visit people usually after they have had
their stent procedures, and would normally
see about four patients in a day,” Mr Heap
said.“The first thing is to listen, to gauge how
someone is feeling, if they want to chat or
not.We respect a patient’s privacy and
dignity. I come with a cheery attitude and I
am happy to share my experience, talk about
the lifestyle changes I had to make after
finding out I had heart disease.
“It is very rewarding for me to be
involved as a BraveHeart. Knowing that you
have helped somebody, that’s the first and
foremost thing.”
HeartWise Health Services Clinical
Nurse Manager, Sandy McKellar, said the
BraveHeart volunteers provided an
invaluable peer support service to patients
admitted for a range of acute cardiac
events including bypass and valve surgery
and angioplasty.
“The BraveHearts program is an adjunct
of HeartWise and is designed to meet the
needs of a patient as an individual,” Ms
McKellar said.
“BraveHearts volunteers are in a unique
position to provide understanding and
empathy for patients, their partners and
families because they have been there, they
have gone through it.
“Research has shown that social
isolation and social stresses can have a
negative impact on cardiovascular
outcomes, whereas social support has been
associated with improved quality of life for
cardiac patients.
“Partnering with past HeartWise
participants who can share personal
experiences, provide compassion, support
and motivation to patients enhances our
cardiac services.”
Strathfield on the
cutting edge
Dr David Martin at
Strathfield Private
Hospital
Strathfield is using robotic GI surgery to improve outcomes for patients
P
ioneering surgeons Dr David
Martin and Dr Michael Talbot
from Strathfield Private
Hospital are the first Australian
doctors to perform robotic
upper gastro-intestinal surgery using the
da Vinci robot – with the initial procedures
yielding impressive results.
The robot, which features a 3D-high
definition vision system, has tiny wristed
instruments that bend and rotate further
than the human hand – resulting in tiny
incisions, fast recovery and less blood loss.
“Robotic GI surgery allows the surgeon
to have a significantly greater range of
movement and dexterity when compared
to conventional keyhole surgery,” Dr
Martin said.
“It may be particularly useful for
difficult cancer operations or complex
revision bariatric surgery.
“We’ve performed several procedures
including sleeve operations, gastric
bypasses, hiatus hernia operations and
revision surgery on two patients who have
previously undergone obesity operations.”
Dr Martin says surgical procedures for
obesity are gaining more acceptance as the
health benefits are better understood by
patients and the medical community –
coupled with innovative new technology
and good safety profiles.
“The number of obesity operations
carried out annually has increased from
around 400 procedures 10 years ago, to
13,000 in 2013.”
He said whilst diet and exercise are still
the front line tactics in the war on weight,
when that fails, increasingly surgical
procedures play a role.
“Today, serious side effects of bariatric
surgery occur in less than one per cent of
all bariatric surgeries when performed by
subspecialty upper GI teams.
“And in more advanced cases, not
having surgery can be much riskier.
“For our average obesity patient with a
BMI of 45, (who often has co-existing
conditions such as diabetes), the risk of
dying prematurely through a weightrelated issue or cancer is about three times
higher than someone of a healthy weight.”
He says sleeve surgery and gastric
bypass were also increasingly beneficial
for people with weight-related diabetes.
“Post-surgery, the effects on insulin
have been fast and dramatic – due to the
metabolic effect of the operation. In about
50 per cent of cases people resolve their
diabetes; some people come to hospital on
diabetic medication and leave without it
or else resolve their diabetes in the weeks
and months that follow.”
By Jane Worthington
april 2014
Private Hospital 29
Feature New technology
Robotic surgery
Greenslopes Private Hospital is utilising its well-established robotic surgical
unit to offer patients complex and uncommonly performed procedures
G
reenslopes Private General
Surgeon, Dr Shinn Yeung,
has performed the first
robotic distal pancreatectomy in Australia.
A distal pancreatectomy is performed
in order to resect a tumor in the distal
portion of the pancreas – also known as
the tail. In this procedure, the abnormal
portion of the pancreas is removed –
sometimes with the adjoining spleen, and
the remaining part of the pancreas is
sutured or stapled shut.This operation is
normally performed as an open
procedure, but can be performed
laparoscopically.
Since it is a minimally invasive
procedure performed through a number
of small incisions, robotic distal
pancreatectomy avoids the need for a
large abdominal incision, resulting in less
post-operative discomfort and scarring
and a speedier recovery.
In addition, the da Vinci Si surgical
robot provides surgeons with an
enhanced ability to visualise and safely
operate on the blood vessels surrounding
the pancreas, compared with laparoscopic
or open surgery.This enhanced
visualisation also allows for improved
spleen preservation rates.
Hepatobiliary and pancreatic
operations are complex and uncommonly
performed procedures, and to date there
are few centres around the world where
they are performed robotically.
“We are fortunate at Greenslopes
Private to have a well-established robotic
surgical unit, and can now offer patients
the option of performing these
procedures robotically,” Dr Yeung said.
“We are building on the success of the
last five years with more than 2,000
robotic radical prostatectomies being
performed here at Greenslopes.”
As a major tertiary referral centre with
some of Queensland’s finest surgeons on
campus, Greenslopes is able to offer
30 Private Hospital
A p r i l 2 014
Greenslopes Private Hospital General Surgeon, Dr Shinn Yeung
patients access to very complex surgical
procedures, some of which can now be
performed robotically.
In recent months we have seen other
firsts for robotic surgery performed at
Greenslopes Private Hospital.
Urologist Dr Kate Gray performed
Queensland’s first robotic
sacrocolpopexy. This procedure is
performed to correct prolapse and/or
herniation of the vagina, uterus and
bladder.
In this procedure, mesh is used to
anchor the cervix to the sacral bone
thereby lifting the vagina and bladder into
their normal anatomic positions.
The robotic sacrocolpopexy avoids the
need for a large abdominal incision, and
women undergoing this procedure are
able to experience a less painful recovery
with a significantly quicker return to
normal activities than would be possible
with open surgery.
Gynaecological Oncologist,
Associate Professor Russell Land
recently performed Greenslopes’ first
robotic hysterectomies. Many women
suffer from gynaecologic conditions that
may require a hysterectomy.
Associate Professor Land said that until
now, women facing a hysterectomy have
had the option to have this procedure
done as open surgery or laparoscopically
but now we are able to offer this state of
the art minimally invasive surgical option
using the da Vinci system.
By Frances McChlery
Feature New technique
Improving
diagnosis
World-first study shows MRI technique improves diagnosis
of life-threatening prostate cancer
I
n an international first, a clinical trial at
Brisbane’s Wesley Hospital has shown
that a medical resonance imaging
(MRI) guided technique will significantly improve diagnosis of life-threatening prostate cancer while reducing
over-diagnosis of non-life-threatening cases.
Wesley urologist Dr Les Thompson
detailed key findings of a two-year study
published in the journal European Urology.
The study found that use of multiparametric MRI (mpMRI):
• reduced the number of men needing
prostate biopsies by 51%
• reduced the problem of over-diagnosis
of non-life threatening disease by
about 90%
• had a 92% sensitivity in diagnosing
life-threatening prostate cancer.
(Compared with the current leading
method for prostate cancer diagnosis
- transrectal ultrasound biopsy – which
had a 70% sensitivity in diagnosing
life-threatening prostate cancer)
“This latest mpMRI imaging technique
will reduce over-treatment of men with
non-life-threatening prostate cancer,
avoiding the possible side-effects of
treatment,” Dr Thompson said.
“This is a significant improvement in
terms of accuracy and in reducing
discomfort for patients and spares many
men the burden of multiple prostate
biopsies.”
The clinical trial was conducted by Dr
Thompson in collaboration with Dr Rob
Parkinson, a specialist radiologist from
Wesley Medical Imaging, Professor Jelle
Barentsz, from the Radboud University
Nijmegen Medical Center,The Netherlands
and Dr Morgan Pokorny, a Research
Urological Fellow at Queensland University
of Technology.The trial was supported by
the Wesley Research Institute and the
Thoresen Foundation.
In the study, 223 patients who had
elevated prostate-specific antigen (PSA)
levels underwent two different diagnostic
approaches: a standard transrectal
ultrasound biopsy (TRUSGB) and mpMRI
imaging of their prostates. Only those
patients whose MRI images pointed to
high-risk prostate cancer then underwent
mpMRI-guided biopsy to pinpoint cancer.
TRUSGB had a 70% sensitivity in
diagnosing life-threatening prostate cancer
while mpMRI had a 92% sensitivity in
diagnosing life-threatening prostate cancer.
“TRUSGB uses as many as 12 to 30
needles for biopsy to randomly test cells in
the prostate,” Dr Thompson said.“The
mpMRI-guided biopsy needs only two
needles directed into the suspicious area
that has been identified on the mpMRI
images.”
Wesley Medical Imaging radiologist Dr
Parkinson said that mpMRI used three
parameters when imaging the prostate.
“Diffusion-weighted imaging, one of
these three parameters, assesses
movement of water molecules within
tissues. An imaging map is mathematically
generated from this information, and
prostate cancer is evident as a dark area,”
Dr Parkinson said.
“When biopsies are done under
ultrasound guidance, random core samples
are obtained from all areas of the prostate.
“When biopsies are performed after a
prostate mpMRI, you know where the
tumour is located and thus where to
direct the biopsy needle.”
Wesley Hospital urologist Dr Les Thompson and Wesley Medical Imaging
radiographer Dr Rob Parkinson.
april 2014
Private Hospital 31
Feature New technology
Cardiologist Dr John Hayes in St Andrew’s EP laboratory using MediGuide
Heart guide
St Andrew’s War Memorial Hospital in Brisbane offers ground-breaking
technology for safer heart procedures
S
t Andrew’s War Memorial
Hospital is the first hospital in
the Southern Hemisphere to
acquire ground-breaking
technology that provides a safer
way for patients to undergo heart procedures by dramatically reducing radiation.
St Andrew’s has invested $1 million in the
MediGuide Technology, which will assist
specialists during complex electrophysiology
(EP) procedures to diagnose problems with
the heart’s rhythm (arrhythmias) and to
provide treatment therapies such as ablation
and implant of cardiac resynchronisation
therapy (CRT) devices (pacemakers and
defibrillators).
MediGuide incorporates technology
that is similar to a GPS (global positioning
system) in a car satellite navigation device
or smartphone. During conventional EP procedures,
a continuous series of live X-ray images of
the heart (fluoroscopy) is needed to show
specialists the real-time position of electrode
catheters inside the heart. Using MediGuide,
32 Private Hospital
A p r i l 2 014
only a brief series of recorded fluoroscopic
images is required.
The MediGuide Technology uses
miniature sensors embedded in catheters
and other devices to superimpose a
three-dimensional (3-D) visualisation of these
devices over the prerecorded images to
show the specialist their precise location
inside the patient.
By reducing the time live X-rays are used,
radiation exposure is cut substantially –
overseas experience shows decreases of
up to 90 percent using MediGuide can be
achieved, depending on the type and
duration of a procedure.
St Andrew’s Cardiologist and a Director of
Queensland Cardiovascular Group, Dr John
Hayes, performed the first EP procedures at
St Andrew’s using MediGuide on 28 January,
in the presence of Dr Philipp Sommer,
associate professor at the University of
Leipzig, Germany, who has utilised the
technology in more than 350 cases.
“We are excited that St Andrew’s is the
first hospital not only in Australia, but in the
Asia-Pacific region and the southern
hemisphere, to have this technology,”
Dr Hayes said.
“Rather than using GPS satellites in the
sky we have, in effect, a couple of satellites
in the X-ray equipment using lowfrequency electromagnetic signals to track
miniature sensors in the catheters and
other devices to guide us.
“Reducing radiation exposure to
patients is very important because the
more radiation anybody is exposed to, the
greater the cumulative risk of developing
cancers. Patients with cardiovascular
disease may have to undergo many tests
and procedures that involve radiation in
their lifetimes.”
Deputy Chief Medical Officer for
UnitingCare Health and Director of Medical
Services at St Andrew’s War Memorial
Hospital, Dr Christian Rowan, said the
acquisition of MediGuide demonstrated the
hospital’s commitment to innovation in
healthcare and achieving world-class results
for patients.
Glaucoma
breakthrough
Dr Manning checks Carol Hall’s eye
Group 44 Graduating Group
Australia’s first iStent procedure in progress
Hunter Valley Private Hospital has successfully completed
an Australian-first glaucoma procedure
A
new Australian-first procedure
to help reduce vision loss in
glaucoma patients has been
successfully completed on a
Newcastle woman at a Hunter
Valley hospital.
Carol Hall from Cardiff had a tiny
titanium device called an iStent implanted
into her right eye in a 20-minute procedure
at Hunter Valley Private Hospital (HVPH)
last month.
Glaucoma is a disease often associated
with rising pressure inside the eye that
damages the optic nerve. Nicknamed the
‘sneak thief of sight’, if left untreated it can
cause irreversible blindness.
Consultant surgeon Dr David Manning
said in the past glaucoma sufferers either
had to undergo complicated surgery or
use daily eye drops to help manage this
incurable disease. Dr Manning said the
implant is helping to reduce the need
for either. Research conducted in the
United States shows that 68 per cent
of glaucoma patients who received the
iStent remained medication free at 12
months.
“The iStent basically creates a channel
for fluid to bypass the site of blockage in
the eye and lower the eye pressure
to help prevent further vision loss,”
Dr Manning said.
“The procedure is minimally invasive
and has little risk compared to other major
glaucoma surgeries.”
Ms Hall had her check up with Dr
Manning at his rooms in Charlestown. She
said she was back at bingo and is chuffed at
being the first Australian with an iStent.
According to Glaucoma Australia, one in
10 Australians over 80 will develop
glaucoma. More than 300,000 Australians
have glaucoma, but 50 percent of those
people don’t know they have it. While it is
more common as people age, it can occur at
any age. As our population becomes older,
the proportion of glaucoma patients is
increasing.
HVPH CEO Lance Wheeldon said the
hospital is a leading ophthalmology facility
in Newcastle and the Hunter.
Dr Manning is one of eight eye specialists
that operate at the Shortland hospital. HVPH
was the first hospital in NSW and the
second in the southern hemisphere to use a
$65,000 surgical guidance system to enable
real-time eye tracking ensuring extremely
accurate alignment of a lens.
iStent and iStent inserter
By Craig Eardley
april 2014
Private Hospital 33
Feature New treatment
Change in fate
Australian-first surgery has patient back in action
Dr David Johnson
A
fter almost 10 years of
debilitating neck and back
pain as a result of a farming
accident, Jason Ogden is
pain-free thanks to a multilevel disc replacement - the first of its kind
in Australia.
Mr Ogden, a 42-year-old IT analyst at
the University of the Sunshine Coast, was
just weeks away from having his neck
fused – the traditional treatment for
collapsed or bulging cervical discs that
can leave a patient with permanent pain
and loss of mobility.
Mr Ogden said it wasn’t an option he
was comfortable with but it was a fate he
was willing to accept.
“I was no longer coping with my injury.
I had been in a lot of pain and on a huge
amount of medication for so long and it
just wasn’t working anymore,” he said.
“I was reluctant to have my discs fused
but I felt like I had no other option. I just
couldn’t take the pain any longer.”
Luckily for Mr Ogden, Brisbane Private
Hospital neurosurgeon Dr David Johnson
gave him an alternative.
“It was like serendipity,” said Mr Ogden.
“Just when I had come to terms with
having to have the fusion, Dr Johnson gave
me another option that had just become
available – one that would give me a
better prognosis and take less recovery
time. I jumped on it and now I couldn’t be
happier.”
In an Australian-first, Dr Johnson
performed a multi-level cervical disc
replacement using new artificial discs that
have a unique mobile core.
These new prosthesis preserve the
34 Private Hospital
a p r i l 2 014
natural motion of the neck and their
compact design means multiple implants
can be inserted without over distracting
the neck.
Dr Johnson said this new technology is
showing great promise for better
outcomes in people with multi-level neck
disease when compared to fusion.
“Older style surgery fused the neck,
leaving the patient with ongoing pain and
stiffness, making even the simplest of
tasks like reverse parking, painful and
difficult,” he said.
“These new implants have a mobile
core which mimics a healthy spine and
results in faster recovery times and there
is no loss of cervical movement,
particularly if multiples of segments of the
spine need to be
addressed surgically.”
Dr Johnson said
while other prosthetic
discs had been around
for some time, most
were very bulky and
were still constrained
in the movement they
provided.
“These new devices
are low profile which
is especially good for
older patients who
have collapsed discs, as
there is not a lot of
space to insert them,”
he said.
“The compactness
also allows for
multi-level disc
replacements which is
what we performed
with Jason.
“Thanks to this new
technology, Jason will
regain the mobility of a
healthy spine and be
able to live a life free
of pain from his injury.”
Now seven months
since the surgery, Mr
Ogden said he is back
at work and living a
normal life again.
“It’s been a long time since I’ve been
able to move around freely and live my life
without pain,” he said.
“I could feel the results immediately
after the surgery and now, seven months
later, I am feeling great and back into my
normal day to day activities.
“The pain from the original injury is
gone altogether now. It is almost like I
never had the injury to begin with.
“I could not be more pleased with the
outcome and hope this will help others
take the leap if this is an option for them
to be pain free as well.Thank you from the
bottom of my heart to Dr Johnston and his
entire team, I am so happy.”
By Karla Simpson
Since the last issue
Moving forward
APHA is building relationships and providing guidance
APHA and CHA Meet with Health
Workforce Principals Committee
On 13 February, 12 months collaboration
between APHA and Catholic Health Australia
(CHA) through the Not For Profit and Private
Sector Workforce Committee bore fruit in an
opportunity for Michael Roff and Martin Laverty
to meet with the Health Workforce Principals
Committee (HWPC).The HWPC brings together
senior bureaucrats from the federal government
and all states and territories. In his concluding
remarks, Dr Pradeep Philip, chair of the
committee identified the opportunity for the
sector to continue to build a relationship with
the committee around the development of a
shared narrative about workforce. APHA and
CHA were also encouraged to continue building
relationships with each of the jurisdictions
represented.
APHA Discussions on Performance
Reporting With NHPA
The most recent upload of data to the My
Hospitals website on 17 March saw a significant
number of private hospitals reporting on
performance indicators.What is under discussion
now is how private hospitals might participate in
other National Health Performance Agency
(NHPA) reports were this data analysed on a
comparative basis. NHPA’s public sector reporting
program includes multi-stage consultation and
data changing processes and it remains to be seen
how equivalent processes might be established in
the private sector. One proposal under
consideration is that the private sector might be
invited to participate in a ‘shadow report’, ie
production of an unpublished report in order to
test the process. Further consideration of this
matter and the complex issues involved is being
led by the APHA Safety and Quality Taskforce.
Reports already produced by NHPA on the public
hospital sector are available from its website
nhpa.gov.au.
AIHW Private Hospital Statistics
Advisory Committee
AIHW has established a committee to provide
guidance to it on the production of a report
dedicated to the private hospital sector. APHA
has welcomed this development while
cautioning that the limitations of existing data
collections must be recognised and development
of new reports must involve extensive consultation with the sector. APHA is represented by
Meke Kamps, Manager Data and Research.
Representing APHA
Christine Gee, CEO of Toowong Private Hospital
has accepted an invitation to represent APHA in
discussions with the Department of Veterans
Affairs on Pay for Performance.
Mark Stephens (Chesterville Day Hospital)
and Dr Daniel Heredia (Hollywood Private) have
accepted appointment to ACHS working parties
on internal medicine and anaesthesia
respectively.
Kay Bonello (La Trobe Private Hospital) is
representing APHA on the International
Classification of Diseases Technical Group
committee while Scott Williams (North Eastern
Community Hospital) has taken on the role of
representation on the Diagnosis Related Group
Technical Group. Both Committees are
convened by the Australian Consortium for
Classification Development.
Council Meeting
The APHA Council met during the Congress and
welcomed Alan Morrison, Sportsmed SA
Hospital and Vincent Borg, Epworth Health Care
to the Council.The Council listened to a
presentation from Bernie Harrison, Executive
Director Hospital Performance, National Health
Performance Authority and received a briefing
from Lisa Ramshaw, Director, Communications
and Marketing on the relaunch of the Valuing
Private Hospitals campaign (see page 42).
APHA Quarterly PHIAC Update –
December 2013
The Private Health Insurance Administration
Council (PHIAC) released its quarterly statistics
for the December quarter of 2013 on 17
February 2014.
The APHA has now completed its detailed
analysis for this quarter which is available on
the members area of the APHA website.
Should you require further information
please contact Meke Kamps at APHA on
(02) 6273 9000.
APRIL 2014
Private Hospital 35
Private Hospitals Week
Choose what’s
best for you
Show your community how valuable your private hospital really
is and get involved with Private Hospitals Week 2014
T
he Australian Private Hospitals
Association (APHA) was proud to
launch the new look to the Private
Hospital campaign at the APHA
National Congress in March.
The successful ‘We Do So Much More’
campaign has run for the past three years and
has helped raise awareness of the contribution
private hospitals make in caring for Australians
and supporting the Australian health system.
Public perception of Australia’s private
healthcare system has improved and there is a
marked increase in the understanding of
services offered in private hospitals. After three
years, APHA decided that it was time to change
the messaging and to refresh the brand.
The APHA Communications and Marketing
Taskforce met at the end of last year to discuss
what they needed from the campaign; from this
the following aims were decided:
• Promote the benefits of choice
• Establish a clear identity/brand of private
hospitals
• Distinguish the offering between
private and public hospitals
• Change behaviour – Is this what’s
best for me or my family?
From this discussion,‘Choose What’s
Best for You’ was developed, which
creates a strong differential and emotional
attachment to private hospitals.
APHA will be sending campaign
material, including X-frame banners,
posters, brochures, fact cards, balloons
and stickers to hospitals for Private
Hospitals Week, which will be held on
the 19-25 May 2014.
APHA encourages hospitals to invite
their local community into their hospitals
for morning teas, information sessions
and tours of their facility.
If you are a member hospital of
APHA and would like to be involved,
please contact Lyndal Bailey on
[email protected].
40% of patients
are treated in private hospitals
about private hospitals
Almost
half
of all heart
procedures
privatehospitals.org.au
36 Private Hospital
a p r i l 2 014
performed occur in private
and day hospitals
More than half
of all surgeries
in Australia
are performed in private hospitals
Care and support throughout your recovery
choose what’s best for you
Private hospitals are a vital part of Australia’s
health care system. Every day we save lives
and improve the quality of life for our patients.
Timely treatment for you and your loved ones
Peace of mind for you and your loved ones
Care and support when you need it
APRIL 2014
Private Hospital 37
Legal Matters
Consumer
privacy
What do changes to the Privacy Act mean for
private hospitals?
Partner
Holman Webb, Lawyers
Health, aged care & life
sciences
E: alison.choyflannigan
@holmanwebb.com.au
P: 02 9390 8338
T
he Privacy Act 1988 (Commonwealth)
(Privacy Act), which applies to
Commonwealth government agencies
and private sector organisations, has
been recently amended by the Privacy
Amendment (Enhancing Privacy Protection) Act
2012 (Cth) (Privacy Amendment Act).The
Privacy Amendment Act commenced on 12
March 2014.
The amended Privacy Act continues to
operate concurrently with related state and
territory laws. Penalties for privacy breaches
have increased for some offences to up to
$340K for individuals and $1.7 million for body
corporates.
Australian Privacy Principles
The Privacy Amendment Act replaces the
Information Privacy Principles and the National
Privacy Principles (NPPs) with the Australian
Privacy Principles (APPs). In summary they are:
APP 1 – open and transparent management
of personal information
APP 2 – anonymity and pseudonymity
APP 3 – collection of solicited personal
information
APP 4 – dealing with unsolicited personal
information
APP 5 – notification of the collection
of personal information
APP 6 – use or disclosure of personal
information
APP 7 – direct marketing
APP 8 – cross-border disclosure of personal
information
APP 9 – adoption, use or disclosure
of government related identifiers
APP 10 – quality of personal information
APP 11 – security of personal information
APP 12 – access to personal information
APP 13 – correction of personal information
38 Private Hospital
a p r i l 2 014
All private hospital operators must review
and revise their privacy policies if they have not
done so already.
Consumer engagement and direct
marketing
All businesses are usually involved in consumer
engagement and direct marketing to some
extent, hospitals included. Hospitals may involve
consumers/patients in patient feedback forms,
hospital websites and forums, community
engagement meetings, discussions with
consumer advocacy and interest groups,
recruitment for research projects and/or clinical
trials, fundraising, health awareness programs
and/or marketing for hospital services.
However, hospitals are in a unique situation
because their consumers are usually patients
and hospitals collect personal information in
the course of providing health services. Person
information collected to provide or in providing
a health service is “health information” and
health information is “sensitive information”.
Special rules apply to “sensitive information”.
As it is difficult for a hospital operator to
categorise which information was collected in
providing a health service and information
which was not, it would be prudent to operate
on the basis that all of the personal information
a hospital operator holds in relation to patients
is “sensitive information”.
Sensitive information (including health
information)
APP 7.4 requires that an organisation may use or
disclose sensitive information about an
individual for the purpose of direct marketing if
the individual has consented to the use or
disclose of the information for that purpose.
Therefore, if you wish to contact past or
current patients for consumer engagement or
direct marketing you should obtain their
Photography: Sue Ferris
Alison Choy
Flannigan
consent to use their information for that
purpose. For the avoidance of doubt, we
distinguish:
• “consumer engagement”; from
• communications with patients which is
required for their healthcare. Use of
information for healthcare is a “primary
purpose” of collection and is permitted.
Consent can be express or implied, written
or oral, however, express consent is preferable.
Consent can also be “opt in” or “opt out”,
however, if you proceed with the “opt out”
model, say in your admission forms, it will be
appropriate in limited circumstances and:
• the opt out option must be clearly and
prominently presented;
• you must provide to the individual
information about the proposed collection,
use and disclosure and the option to opt out;
• you must provide to the individual
information on the implications of not opting
out;
• the opt out option must be freely available
and not bundled with other purposes;
• it must be easy for the individual to exercise
the opt out option;
• the consequences of opting out are not
serious; and
• an individual who opts out at a later time, will,
as far as practicable, be placed in the position
as if they had opted out earlier.
Non-sensitive information
If you have collected personal information that is
not sensitive information (that is, not health
information) – for example information about
non-patient information, then that information
may be used in direct marketing.
• if the information was collected directly from
the individual; and
• the individual would reasonably expect the
organisation to use or disclose the information
for that purpose; and
• the organisation provides a simple means by
which the individual may request not to
receive direct marking communications from
the organisation; and
• the individual has not made such a request to
the organisation.
If you have collected personal information
which is not sensitive information and all of the
following conditions are met, that information
may be used in direct marketing:
• the information was collected direct from the
individual but the individual would not expect
you to use that information for direct
marketing or you collected that information
from a third party (such as marketing list); and
• either the individual has consented to that use
or it is impracticable to obtain consent; and
• the organisation provides a simple means by
which the individual may easily request not to
receive direct marking communications from
the organisation; and
• in each direct marketing communication with
the individual the organisation indicates a
prominent statement that the individual may
request to opt out or the organisation
otherwise draws the individuals attention to
the fact that the individual may make such a
request; and
• the individual has not made such a request.
Note, however, other laws may also apply, for
example, in relation to the “do not call register.”
Reports and anonymity
When using information for consumer
engagement it is preferable to use de-identified
data in any resulting reports if possible. Also,
consumers should be given an option to
provide consumer feedback on an anonymous
basis or by using a pseudonym.
In publishing results concerning regulated
health professionals (such as medical
practitioners and nurses) remember to comply
with the Medical Board of Australia Guidelines
for Advertising of Regulated Health Services,
including the Social Media Policy which
commenced on 17 March 2014.
The Australian Privacy Principle Guidelines
are available on oaic.gov.au.
This article is provided for general
information purposes only and should not be
relied upon as legal advice.
APRIL 2014
Private Hospital 39
Policy Perspective
Prescription for
medication safety
Electronic prescribing systems could ensure safety and
quality of care for patients as they move into and out of
acute care settings.
Lucy Cheetham
Director, Policy & Research
Australian Private
P: 02 6273 9000
W: apha.org.au
T: @LucyCheetham1
40 Private Hospital
a p r i l 2 014
E
lectronic prescribing systems could
ensure safety and quality of care for
patients as they move into and out
of acute care settings.
Medication issues account for
about 2-3% of hospital admissions every year.
These result in hospital stays that are either
avoidable altogether, or longer than they need
have been.This rate has been stubbornly
consistent over three decades resulting in an
annual cost of $1.2 billion. A literature review of
the research on medication safety completed for
the Australian Commission on Safety and Quality
in Health Care in August 2013 makes timely
reading as we prepare to begin the final year of
the Sixth Community Pharmacy Agreement.
Patients are at particularly high risk of
medication related misadventure as they move
in and out of acute care settings. High risk
groups include:
• Chemotherapy patients
• Palliative care patients
• Hospital in the home patients
• Aged care residents
• People with multiple conditions
An estimated 20% to 30% of admissions for
people over the age of 65 – up to 1.1 million
admissions – are medication related.
Importantly, this review also identifies key
interventions to address these problems.
Medication reconciliation for patients on
admission to hospital is identified as essential in
ensuring that medication charts are an accurate
and comprehensive record of both therapies
and allergies. Research has shown that without
routine intervention, as many as one in two
patients will have a medication chart that is
incomplete. Allergies are often poorly
documented unless pharmacists review charts.
Procedural and documentation errors within
hospital settings can be reduced by use of
electronic prescribing systems. More importantly,
these systems provide crucial efficiencies that
free up pharmacists’ time to attend to the
prevention of clinical errors, which it is estimated
arise in 2.5% of medicine orders.
Ideally electronic prescribing systems need to
incorporate substantial clinical decision support.
Implementation also needs to be accompanied by
staff training. Currently, however, electronic
prescribing systems are not permitted in private
hospitals, beyond a strictly limited number of sites
involved in a long running government trial.
As was mentioned in APHA’s submission to the
recent review of the Personally Controlled
Electronic Health Record System, electronic
recording of medication and allergy records
should be prioritised. These initiatives would
provide safe and effective clinical handover and
the reduction of medication error and related
adverse events.
The APHA will be calling on the federal
government to ensure that future funding
arrangements for the PBS and associated programs
takes heed of these findings and recognises the
crucial role of hospital based pharmacists in
ensuring safety and quality of care for patients as
they move into and out of acute care settings.
Professor Libby Roughead, Dr Susan Semple, Ms Ellie
Rosen Feld, Literature Review: Medication Safety in
Australia, Australian Commission of Safety and Quality in
Health Care, August 2013. http://www.safetyandquality.
gov.au/wp-content/uploads/2014/02/Literature-ReviewMedication-Safety-in-Australia-2013.pdf
You eTG complete me.
Concise, independent and evidence-based recommendations for patient
management. eTG complete features the latest versions of over 3000
Therapeutic Guidelines topics, including the current endorsed therapeutic
guidelines on antibiotic usage.1
Available for use via intranet, individual workstations and mobile devices.
1
Australian Commission on Safety and Quality in Health Care (September 2011).
National Safety and Quality Health Service Standards, ACSQHC, Sydney.
www.tg.org.au
Pharmacy Focus
Dispensary
automation
Can a sound business case be made for pharmacy
robotic dispensing units?
Michael Ryan
Director, PharmConsult
PharmConsult is Australasia’s
leading hospital pharmacy
consultancy advising hospitals
on the operational, financial,
professional, service, risk and
legislative issues associated
with hospital pharmacy
services.
P: 03 9813 0580
W: pharmconsult.com.au
42 Private Hospital
a p r i l 2 014
T
he answer quite simply is, yes. As
with most complex analyses, the
ability to arrive at a positive business
case depends on the criteria against
which automated dispensing
machines (ADMs) or as they are also known,
pharmacy robotic dispensing units or robotic
dispensing, are assessed.
Background
In an earlier article in the December 2013
edition of Private Hospital, the benefits of
ADMs were described. A reasonable next step
is to produce a business case for pharmacybased robotic dispensing.
Evidence from a number of UK hospitals
over the last 10 years has shown that the
introduction of pharmacy robotic dispensing
has resulted in fewer dispensing errors, faster
dispensing requiring fewer staff, less expired
stock and reduced stock holdings. But can
these benefits justify the large capital
investment required for robotic dispensing?
In their November 2010 review of robotic
dispensing, Deloitte made the point that to
make a business case for robotic dispensing,
savings must exceed both the equipment and
other associated and ongoing costs.1
They also highlighted that although the
financial benefits and process efficiencies can
be quantified in terms of inventory, turnover
and staff savings, there is also a need to assign
measurement to risk minimisation, space
utilisation and staff morale. In addition, to
quantify the capital cost of the robots, other
costs including enabling work, infrastructure,
interfaces, hardware, project management,
overtime and contingency plans need to be
considered.
Quantification of benefits
The following measures of benefits resulting
from ADM implementation are drawn from
a number of primary and secondary sources
including:
• a report on the impact of robotic
dispensing in a hospital pharmacy
department published by the King’s
College Hospital (KCH);2
• the Deloitte paper entitled
Robotic dispensing. Automation
in pharmacy; and
• a review conducted for the Australian
Commission on Safety & Quality in
Healthcare in June 2013 entitled
Automated Dispensing Systems and
published as part of its Evidence Briefings
on Interventions to Improve Medication
Safety. 3
Cost savings
The main areas for savings in costs
associated with the implementation of
robotic dispensing in pharmacy include:
a) reduction in pharmacy dispensary staff:
KCH reduced pharmacy dispensary staff
expenditure by 51%, i.e. reduced costs
from £262,278 to £134,068 pa over 12
months;
b) reduction in stock holding: KCH reduced
stock holding by £534,000 as a one-off
saving [for reference, the value of drugs
issued by KCH Pharmacy in the year of the
analysis was approx. £28.3million (or
$A53.2m)];
c) reduction in expired stock: KCH reduced
expired stock from 0.5% of the value of drug
issues to 0.3% (with actual savings in the
order £100,000 pa in the first three years).
In addition, through automation of the
picking process, a number of UK hospitals
have reduced employment costs by shifting
the skill mix towards lower paid staff without
increasing error rates, whilst enabling
reductions in overtime and the use of agency
staff despite increases in dispensing activity.
Reduction in dispensing errors
Observational studies following
implementation of ADMs in UK hospital
pharmacies have shown significant decreases
in dispensing error rates from 0.64% to
0.28%4 in one study and from 1.2% to 0.6%
and 2.7% to 1.0% in another multisite study.5
KCH observed a reduction from an average of
12.85 reported errors per day to 4.52 reported
errors per day. In contrast, other studies have
found non-significant reductions in
dispensing errors following implementation
of ADMs.6
Increasing dispensing efficiency
A number of improvements in the dispensing
process have been reported including:
a) at KCH – reducing the waiting time for
patients for discharge medication by 27
minutes (from 131 minutes to 104 minutes)
and for outpatients by an average of 15
mins (49 minutes to 34 minutes);
b) reducing the average time to dispense
a prescription from 8.44 minutes to
5.377 minutes.
Although there are reports of nonsignificant reductions in the time taken to
dispense medications, the majority of studies
show that dispensing robots reduce both
dispensing and patient waiting time.
Other factors
Additional benefits found by KCH in their
post ADM-implementation analysis,
included:
a) t he release of pharmacists, no longer
involved in routine supply processes,
to support direct patient care;
b) the implementation of original pack
dispensing (i.e. the dispensing, on
admission, of an original pack with full
administration directions so that it is
ready to take home at discharge without
the need for another supply to be
made);
c) less occupied drug storage space and
increased storage capacity in the order
of 23% compared to traditional storage
methods; and
d) improvements in staff morale after
ADM implementation, through the
creation of a calmer environment with
less staff movement in the dispensary,
which, in turn, may improve the
concentration of staff and reduce errors.
Conclusion
In summary, costs include the ADM,
infrastructure and installation costs,
interfaces, project management and
allowance for overtime. Savings include
reduction in stock holding (one-off), staffing
costs, drug expiry and out-of-hours recalls.
The ROI figure must also incorporate the
harder to quantify benefits. When
considered together these benefits outweigh
the costs and create a business case
supporting pharmacy robotics in busy
pharmacy departments.
1 D
eloitte. Robotic dispensing.
Automation in pharmacy,
November 2010. Available at
deloitte.com
2 Brinklow N. A report assessing
the impact of an automated
dispensing system (ADS) at
King’s college Hospital NHS
Trust. Available at media.dh.gov.
uk
3 Australian Commission on Safety
& Quality in Healthcare. Evidence
briefings on interventions to
improve medication safety:
automated dispensing systems.
Issue 2, June 2013. Available at
aihi.unsw.edu.au
4 James KL, Barlow D, Bithell A, et
al. The impact of automation on
workload and dispensing errors in
a hospital pharmacy. Int J Pharm
Pract 2013;21(2):92-104.
5 Franklin BD, O’Grady K, Voncina
L, et al. An evaluation of two
automated dispensing machines
in UK hospital pharmacy. Int J
Pharm Pract 2008;16(1):47-53.
6 Temple J, Ludwig B.
Implementation and evaluation of
carousel dispensing technology
in a university medical center
pharmacy. Am J Health Syst
Pharm 2010;67(10):821-9.
7 Study conducted by The Next
Level for Willach Australia Pty Ltd
(unpublished), 2013.
acy.com (accessed 2 Jan 2014).
APRIL 2014
Private Hospital 43
News Industry Update
Industry update
From the healthcare and hospital industry
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email: [email protected].
44 Private Hospital
a p r i l 2 014
In the Western World the prevalence of cancer is
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drug treatments available evolving and growing.
Preparing, transporting and administering cytotoxic
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Hospira is committed to protecting patients,
caregivers and the environment from exposure to
hazardous medications. The reconstitution and
infusion delivery of anti-neoplastic drugs within the
oncology setting is complex and Hospira has
developed a Total Closed Oncology Solution,
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Hospira provides pharmacy with one of the
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eTG complete
eTG complete is TGL’s core product, which
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clinical topics, relevant PBS, pregnancy and
breastfeeding information and links to key references.
Importantly for hospitals, eTG complete includes the
current endorsed therapeutic guidelines on antibiotic
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in Health Care [September 2011] National Safety and
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eTG complete is available in a range of convenient
formats – online access, online download, CD, and
intranet access for hospitals. Multi-user licences, ideal
for a practice or clinic, are also available. For online
subscribers, eTG complete is now optimised for
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APRIL 2014
Private Hospital 45
On the Ground
Kathy Nagle
CEO/ DON, Western Hospital
Where do you work, what is your role
and how long have you been there?
I am employed at Western Hospital and I have
the joint position of Chief Executive Officer /
Director of Nursing. I am also the CEO of
Western Sports Ortho and GP Practice and
Western Facilities Management Service – a
company designed to assist in the management
of other facilities.
I have been in this position for 10 years
under the current ownership and 14 years prior
to this when managed as a community hospital.
I am a councillor representing small “for
profit” hospitals for APHA. I am also chairman
for the SA State Advisory Committee for the
Australian Council on Healthcare Standards
(ACHS) and work as a surveyor for ACHS.
What is involved in your role
as an ACHS surveyor?
I feel privileged to be an ACHS surveyor which
satisfies and drives my passion for quality
improvement. My role as a surveyor for the
ACHS entails committing to the understanding
and philosophy of the national standards set by
the Safety and Quality in Healthcare
Commission and representing the ACHS in
measuring an organisation’s performance
against these standards and those of the EQuIP
National Program. I feel I act as an ambassador
for the ACHS when surveying other facilities and
I hope I impart meaningful feedback and
education to support staff in their endeavours
towards continuous quality improvement.
Did being a surveyor help your
hospital meet the National Safety
and Quality Health Service
(NSQHS) Standards?
The national standards are different from the
EQuIP accreditation model which is outcomesfocused. I feel my role as a volunteer surveyor
has assisted both the hospitals I survey and my
46 Private Hospital
a p r i l 2 014
own hospital in identifying the common
challenges faced by all hospitals in their
attempts to comply with the national
standards. I feel I can empathise and assist
other organisations in navigating their way
through the standards due to being at the
coalface in implementing these standards at
my own organisation. As a working surveyor,
I am able to draw on my own hospital’s
challenges and achievements and share these
experiences and those of others to benefit
not only my hospital but also those I survey.
What would be your tip for
helping facilities meet the NSQHS’
Standard 2: Partnering with
consumers?
My tip would be to use a gap analysis
exercise to identify the criteria that you
believe are not being met. Use the
monitoring tool which is available on the
Commission website. Consider actions that
will meet several criteria. Define and identify
exactly who your consumers are (this is half
the battle) and work your way through each
criteria remembering always to evaluate
as you go.
You sit on the Communication
and Marketing Taskforce for
APHA, which has just launched
its re-branded Private Hospitals
campaign. Can the campaign
help facilities meet Standard
2: Partnering with consumers?
I believe that the campaign will assist
hospitals in educating all consumers about
the standard and its importance in providing
healthcare in Australian hospitals. I hope it
will be a platform for consumers to engage
with hospitals and healthcare facilities whilst
assisting these facilities to improve by being
active participants in decision-making.
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creating better environments

April 2014 - Australian Private Hospitals Association

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