The Health Advocate - April 2015

Transcription

Health literacy
Why it should be
everyone’s business
Lean philosophy
Helping organisations
reach ambitious targets
Consultation at
the coalface
Views from Health
Minister Sussan Ley
Improving
healthcare
Getting better value for
money by emphasising
integration and prevention
The official magazine of the Australian Healthcare and Hospitals Association
ISSUE 29 / April 2015
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Contents
Issue 29 / April 2015
In depth
08. Reform of the Federation and health
Opportunities for change
22. Sustainable telehealth
Rethinking the culture and skills required
24. The Australian Cystic Fibrosis Data Registry
More than just descriptive epidemiology
26. Will they understand?
Why health literacy is everyone’s business
30. Palliative care gets a boost
New funding for AHHA’s online training program
32. The view from the starting line
A practical application of critical reflective analysis
20
40. Collaborating for better health
A partnership to benefit Melbourne’s inner north-west
Briefing
11. Consultation at the coalface
Cover image: ‘Medical/Surgical Operative Photography’ by Phalinn Ooi. Image sourced from Flickr (CC BY 2.0: https://flic.kr/p/dnc5ES).
Views from Health Minister Sussan Ley
14. The science behind harm prevention
The origins of improvement science and its relevance to health
17. Promoting change
Process improvement and waste elimination starts from the top
34
18. Getting value for money
An overview of continuous improvement projects
20. Embracing the Lean philosophy
Helping organisations reach ambitious targets
28. Pharmacy in review
Taking a closer look at pharmacy standards
34. Helping people self-manage their diabetes
An overview of new support services
37. Violence against nursing students
Better preparing students for clinical placements
38. The changing face of general practice
38
Working towards an integrated model of primary care
42. The power of partnerships
Vehicles of primary care reform
From the AHHA desk
04. AHHA in the news
07. View from the Chair
12. Chief Executive update
45. Who’s moving
46. Become an AHHA member
47. AHHA Council and supporters
40
AHHA in
the news
Concerns over potential
ABS Census cutbacks
A proposal from the Australian Bureau of
Statistics (ABS) to conduct the Census every
ten years instead of five would come at an
HAVE YOUR SAY...
We would like to hear your opinion
on these or any other healthcare
issues. Send your comments and
article pitches to our media inbox:
[email protected]
Health rationing: how
Australia can learn from
international examples
As governments around Australia grapple
unacceptable cost to healthcare planning.
with health budget challenges, a focus on
AHHA Chief Executive Alison Verhoeven
rationing healthcare is inevitable. Australia
said that while the proposal might help the
already has some well-regarded rationing
ABS fund its planned IT systems upgrade,
processes in place, but we can look to
significant flow-on effects would negatively
international examples to improve current
impact the Australian healthcare system.
rationing practices. A new health policy
“The Census is such an important asset for
issues brief by the AHHA’s Deeble Institute
the health sector that any changes should be
2014 Writing Prize Recipient, Elizabeth
the subject of wide consultation, and should
Martin, urges Australian governments to look
Bariatric surgery in public
hospitals: better access,
better data needed
be aimed at improving the data available to
at international best practice to facilitate
inform policy for a strong, productive and
better healthcare rationing in Australia.
New research shows that while bariatric
surgery, a procedure to treat obesity, is
becoming increasingly common in Australia,
access to public-funded services is limited,
and this may be partly attributed to
increasing numbers of private patients
requiring subsequent revisions/reversals in
public hospitals.
These findings are reported in ‘Quantitative
analysis of bariatric procedure trends 2001-13
in South Australia: implications for equity in
access and public healthcare expenditure’
by Samantha B. Meyer et al, featured in the
latest issue of the Australian Health Review,
the AHHA’s peer-reviewed academic journal.
”Bariatric surgery is one of the fastest
growing forms of surgery conducted in
Australia, and obesity is a leading contributor
to the burden of disease, yet only 10% of
bariatric procedures are undertaken in public
hospitals. Better access to affordable surgery
is undoubtedly needed, as is better data so
that we can understand how such surgery is
being funded and delivered,” said AHHA Chief
Executive, Alison Verhoeven.
4
The Health Advocate • APRIL 2015
healthy Australia,” Ms Verhoeven said.
In particular, the ABS proposal would limit
“To ensure healthcare resources are
used as efficiently as possible, Australian
the country’s understanding of the population
governments need to adopt a more
health needs of Indigenous people and those
consistent, explicit and evidence-informed
living in rural and remote areas. “Less frequent
approach to rationing,” Ms Martin said.
Census data and a reliance on sample-based
“Governments will then be better placed
surveys are of particular concern for these
to decide whether to continue funding
groups that already experience significant
programs, services and treatments or to fund
health inequity compared with other
better value for money programs, services
Australians,” Ms Verhoeven said.
and treatments instead.”
FROM THE A HH A DESK
Research shows gap
in healthcare data
surveillance
With an estimated 175,000 Australians
affected by healthcare-associated infections
(HAI) each year, new research published by
the AHHA supports the introduction of a
national data surveillance program.
says that the research, featured in the
organisation’s peer-reviewed journal,
the Australian Health Review, shows how
the health sector can act to curb rates
Closing the Gap: AHHA
calls for Government
commitment
said millions of Australians would be
While only limited progress in closing the
countries,” Ms Verhoeven said.
impacted if the Government fails to
gap has been reported in the 2015 Close
deliver on its 2013 election commitment
the Gap - Progress and Priorities report, the
to the National Partnership Agreement
AHHA welcomed the report recommendations
(NPA) on Adult Public Dental Services, and
and urges the Government to take action
its support for the Child Dental Benefit
on these. “Aboriginal and Torres Strait
Schedule (CDBS) and the National Oral
Islander peoples experience a significantly
Health Promotion Plan.
higher burden of disease and a reduced
Government must come
clean on dental programs
“When it comes to election promises and
life expectancy in comparison to other
oral health, the Government’s report card
Australians. The Government must commit to
looks extremely disappointing,” Ms Verhoeven
renewed investment in prevention strategies
said. “The $1.3 billion in funding for the NPA
including anti-tobacco and drug and alcohol
has been delayed, a review of the CDBS hasn’t
programs as a priority,” said AHHA Chief
eventuated and the implementation of the
Executive, Alison Verhoeven.
National Oral Health Promotion Plan doesn’t
appear to be on the table.”
Ms Verhoeven said that the May Budget
of infection. “While there a number of
Australian states and territories that employ
HAI surveillance programs, these are not
standardised like we see in many other
“As a result, the use of the data collected
by these disparate surveillance programs
is very limited… By leveraging off existing
Australian and international programs, we can
develop an effective surveillance program
that can detect clusters or outbreaks of HAIs,
identify programs and evaluate prevention
and control measures; ultimately driving
improvement.”
ha
In its pre-budget submission, the AHHA
has called for support for programs that
encourage effective collaboration between
would be an excellent opportunity for
Aboriginal community-controlled services and
the government to demonstrate its
mainstream services that serve to develop
commitment to pre-election promises on
the capacity and resilience of individuals and
dental health. “We recognise the need to
communities. There is particular opportunity
contain health costs and our pre-Budget
through the establishment of Primary Health
submission has highlighted opportunities
Networks to entrench better connectedness
for efficiencies and savings,” Ms Verhoeven
with non-Indigenous health services at the
said. “However, a Budget commitment is
primary level, but also better planning for
required to ensure better oral health in
the healthcare needs and challenges facing
Australia.”
Aboriginal and Torres Strait Islander people.
The Health Advocate • APRIL 2015 5
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VIEW FROM THE CH AIR
paul DUGDALE
Chair of the Australian Healthcare
and Hospitals Association (AHHA)
Rethinking
Federalism
Starting point should be health, not finance
T
he health sector needs both a
health needs of the Australian public
on a healthy population, able to work and
contribute to their full potential.
greater level of certainty on how
The White Paper’s process to Reform the
the increasing pressure on public
Federation repeatedly refers to the issue of
hospitals is going to be funded
vertical fiscal imbalance — the Commonwealth
health promotion efforts to the excellent
and a stronger focus on preventative health.
raising more revenue than required for their
health outcomes enjoyed by most Australians.
In striving toward these goals, the AHHA
responsibilities, and the states and territories
Anti-tobacco policies and initiatives such as
supported the calls made by NSW Premier
having greater service commitments than they
the introduction of seatbelts have had a major
Mike Baird for the Commonwealth Government
have the capacity to fund. This was a point of
impact on the better health outcomes we now
to explain how future hospital funding will be
discussion at the AHHA’s Think Tank on Reform
enjoy. Yet there is little recognition in the
placed on a sustainable footing. This follows the
of the Federation and Health on 16 March 2015
report of the role governments must play in
2013-14 Budget, which saw the Commonwealth
at Old Parliament House, Canberra.
investing in health promotion activities.
Government’s unilateral withdrawal from
It was acknowledged at the event — which
The report recognises the contribution of
With the significant disparity in Indigenous
the long term hospital funding arrangements
brought together over 130 health leaders
health outcomes, rates of obesity on the
that had been mutually agreed between the
from around Australia — that the funding and
increase and excess alcohol consumption
Commonwealth, states and territories.
determination of health priorities are a shared
placing a major burden on the health system,
responsibility across governments. Changes
we must as a nation invest in health promotion
and territories to fund the Commonwealth
cannot be made at one level of government
and primary care. Otherwise the goals of
Government’s budget repair, part of which it
without contemplating the impact this will
increased participation and labour productivity
has said will include drastically cutting funding
have on the other. The so-called vertical
improvements forecast in the IGR will be
to public hospitals through the Commonwealth-
fiscal imbalance is in fact a beneficial result
jeopardised.
state funding agreement by over $50 billion
of the states ceding taxation powers to the
from 2017.
Commonwealth in the act of federation, done
projected growth in Australian government
The Commonwealth cannot expect the states
On the positive side, the IGR states that
The Prime Minister and Treasurer point to the
with the recognition that it can be fairer and
spending on health will broadly keep pace with
Reform of the Tax System and of the Federation
more efficient for the Commonwealth to run
Australia’s growing and ageing population and
as the way to re consider financial relations
the lion’s share of the nation’s taxation regime
will be slower than projected in previous IGRs.
between tiers of government and how critical
and then distribute a goodly share of the
This may already be evident in the reduction
public services like public hospitals could be
proceeds to the states, than for each state to
reported in 2013-14 by the Australian Institute
funded. While reform of our Federation and
run their own tax systems.
of Health and Welfare. It is surprising that the
the tax system are important dialogues that
The AHHA calls on the Government to use the
proposed policies from the Commonwealth
governments need to have between each other,
coming Budget to reinstate appropriate levels
therefore appear to be based on a view that
and with the Australian public, we need action
of funding for public hospitals — funding that
the pace of growth is unsustainable and
on hospital funding now.
recognises the growing demand for hospital
requires drastic measures.
The 2015 Budget, to be released in May,
provides the Commonwealth Government
with an opportunity to undo the damage to
services and the efficiencies that are being
Health must be seen as an investment
achieved as part of national health reforms.
in the future, not a drain on budgets to be
In regards to the need for a stronger
managed to meet short-term electoral goals.
sustainable hospital funding caused by the
focus on preventative health, the recently-
Governments at all levels must work together
2014 Budget. The Government has already
released fourth Intergenerational Report (IGR)
to ensure appropriate funding for public
withdrawn several measures from last year’s
confirmed that participation and productivity
hospitals and primary health — revisiting the
Budget, showing some flexibility in achieving
are cornerstones of a healthy economy into
National Partnership Agreements agreed by all
their financial objectives and meeting the
the future, and both of these are dependent
jurisdictions would be a good starting point.
ha
IN DEPTH
Reform of the
Federation and health
AHHA’s Alison Verhoeven and Linc Thurecht discuss opportunities for change
A
s a contribution to the Reform of
proposals for a focussed set of small ideas
the provision of integrated care and local
the Federation process, on 16 March
to make incremental but meaningful and
community engagement were shared, as
2015 the Australian Healthcare
tangible change.
was the need to avoid a postcode lottery
and Hospitals Association (AHHA)
The challenge of managing chronic disease,
of services.
How the health system should be funded
brought together over 130 health leaders
both in terms of prevention and the need
to discuss the challenges and opportunities
for integrated patient-centric care, was a
was a key focus of the day’s discussions. The
for change in the way health services are
constant theme. Those with chronic disease
prevailing view of Government that health
provided to all Australians.
are not being served well by the current
spending is out of control was not widely
system according to many commentators,
accepted by participants, and it was noted
debate on the process of reforming the
and the cost burden is large with 36% of
that the Government’s fiscal strategy has been
Federation. This Think Tank provided the
health expenditure being spent on the
to increasingly shift the cost burden to the
opportunity for representatives with a
top four chronic diseases in Australia. The
states and territories and to consumers.
wide range of perspectives to discuss how
more strategic way we have responded to
our health system could be alternatively
communicable diseases was contrasted to
good health policy, not the other way
structured to realise better health outcomes
the current approach to chronic disease.
around”, and that while we do not have
The Prime Minister has called for a mature
for all Australians.
E‑health was also identified as essential in
It was argued that “finance should serve
a “crisis in tax”, there are challenges to
improving how the health system operates,
address, including the need to strengthen
day. But perhaps the threshold issue related to
and in particular, improving quality of care and
the tax base. The distributional impacts
complexity in our current system. This results
patient safety. Information is the critical link
associated with reform of taxation need to
in the many known problems of accountability
on the handover between GPs and community
be at the forefront of any proposed change.
gaps, waste, confusion amongst both consumers
care, primary and acute care and needs
and providers, and a system that does not fully
urgent attention. The importance of nationally
performing well, while many others called
meet the health needs of large sections of our
consistent data collections to improve efficiency
for alternative models of healthcare with the
population.
and accountability was also discussed.
patient at the centre. A view was expressed
Many issues were raised and debated on the
A diverse range of solutions were canvassed,
Regional healthcare planning was seen as
Some characterised the health system as
that to devise the best health system, we
from a call for one big idea to drive reform
crucial in the provision of good healthcare, and
should not start with Federalism. It was also
as a catalyst for positive change, to a call for
localism was proposed in meeting the needs of
argued by some participants that health reform
radical change due to the current complexity
communities as “we live in a community, not
does not need to be linked to tax reform.
providing an excuse for failure. In contrast were
a health system”. Examples of success with
The Hon. Catherine King MP
Shadow Minister for Health
8
The Hon. Sussan Ley MP
Minister for Health
So what role should the Commonwealth play
Senator Richard Di Natale
Greens spokesperson on health
The Prime Minister in his Sir Henry Parkes
in healthcare? National interest considerations
a clear demarcation of responsibilities
relating to quarantine and health system
between levels of government and
Oration last October called for a “measured
regulation were accepted, though for one
other ad‑hoc incremental change is only
debate” and noted that, “What’s needed
speaker, obvious areas for the Commonwealth
patching a system not well designed for the
now is not a final answer but a readiness to
involvement in the health system were “hard
contemporary health needs of Australians.
consider possibilities.”
to find”. The possibility of devolving MBS and
Alternative models of care with the patient
PBS responsibilities to the states and territories
at the centre and with a system of healthcare
is the release of the two Green Papers on
was also canvassed. It was proposed that the
based on a core set of principles could be
Reform of the Federation and Reform of
Commonwealth’s role in health be re-cast to
explored. This suggests that the Reform of
Australia’s Tax System. If these Green Papers
be that of a steward, concerned with strategic
Federation process should not be based on
are to be as visionary as the Prime Minister
issues and ensuring accountability.
legacy institutional arrangements.
has called for, they need to do more than
What to make of all this? With a diverse
With respect to funding of health services,
The next formal step in this reform process
just propose the passing of a set of functions
between levels of government.
range of delegates came a diverse range of
the analysis presented did not suggest
views. There was unanimous agreement on the
that we are in a fiscal crisis, though many
need for change in the way health services are
participants noted that the Commonwealth’s
issues must include the broad engagement
provided. There was also an overall sense that
decision in 2014 not to honour partnership
of all health stakeholders, not just selected
the Commonwealth should devolve the majority
agreement provisions for growth funding of
advocacy or private sector groups. It should
of its health service delivery responsibilities.
hospitals presents an enormous challenge for
build on the work done by the National
the states and territories.
Health and Hospitals Reform Commission,
But if this responsibility should be passed to
states and territories or even lower to provide
The Commonwealth Government’s current
A measured debate around all these
and take into account the very real health
a more focussed regional approach was not
approach to health funding is clearly pushing
needs that are not being met adequately
resolved. The Commonwealth could retain
the growing burden of funding healthcare
within our current institutional and funding
a role as an overarching steward of a new
onto the states, territories and individuals.
arrangements.
system of health service provision. Specific
Any changes to the tax system need to
objectives, responsibilities and powers in this
ensure the long term financial sustainability
doing things, not just a passing of the baton
respect would need to be further explored.
of healthcare providers, and that the
from one level of government to another,
distributional impacts of any increase in
or worse, a palming off of responsibility to
that a simple devolution of health delivery
individual contributions to health care costs
ensure high quality health services for all
responsibilities is not enough. Providing
do not adversely affect the less well‑off.
Australians.
More fundamentally, there was a view
Rosemary Calder AM
Mitchell Institute for Health and Education Policy
Lyndon Seys
Alpine Health
And finally, it should consider new ways of
ha
Barbara Reid
ACT Health
‘The flagpole in central Sydney’s Darling Harbour’ by James Cridland.
Image The
sourced
from Flickr
(CC BY 2.0:•https://flic.kr/p/3sWhGW).
10
Health
Advocate
APRIL 2015
BRIEFING
THE HON. SUSSAN LEY
Minister for Health; Minister for Sport
Australian Government
Consultation
at the coalface
Informing Australia’s health policy of the future
S
ince my appointment as Minister
there on the ground talking to people at
principles to help guide my Medicare
for Health and Minister for Sport,
the coalface.
consultations and deliver constructive
I’ve been travelling the country
talking to a wide variety of
I want to ensure the Government has
a clear understanding of the challenges
health professionals and patients to discuss
currently facing the health system and how
their views and ideas about how best to
we can improve on them for the benefit of
ensure our health system remains world-
health professionals and patients alike.
class for generations to come.
I am a strong believer in the essential
role preventative health plays in keeping
us happy and healthy in our daily lives, as
A key part of this from a Federal
Government perspective includes
protecting Medicare for the long-term.
In the last decade spending on Medicare
proposals:
• protecting Medicare for the long term;
• ensuring bulk billing remains for
vulnerable and concessional patients;
• maintaining high quality care and
treatment for all Australians; and
• ensuring that those who have the
means make a modest contribution
towards the cost of their care.
well as the importance of being able to
has doubled from $10 billion in 2004-
access high-quality care and treatment
05 to $20 billion in 2014-15. Spending is
when we need it.
projected to climb to $35 billion in the
professionals have been positive and have
next decade.
seen many constructive ideas put on the
I also believe the fact we’re living
longer as a result of these ongoing health
Yet, you may not be aware that we
The consultations with health
table for consideration.
advancements should be celebrated,
currently raise only about $10 billion from
rather than seen as a negative burden on
the Medicare Levy — or about half of all
advice and honest feedback during these
the health system.
Medicare spend. This has fallen from about
sessions and I welcome it.
However, as we all understand from
running our own budgets — whether
67% ten years ago.
I consider this a
We also have a
genuine consultation
it’s a small practice, a large hospital or
situation where
the nation’s finances — we also need to
72% of services
ensure we spend wisely to ensure we get
provided to
maximum benefit for patients and health
non-concessional
professionals from our investment.
patients were bulk
This can be a difficult balancing act to
billed last year.
get right, particularly in such an important
There are therefore
public policy area like health that interacts
clearly those with
with the daily lives of all Australians.
the means to
It is certainly something that I come
make a modest
across regularly as a regional member
contribution to the
of parliament representing a third of
cost of their care.
NSW, where health issues vary as widely
Yes, at times there has been some frank
I want to ensure the
Government has a clear
understanding of the
challenges currently
facing the health system
and how we can improve
on them for the benefit
of health professionals
and patients alike.
A modest co-payment is something that
effort on Medicare
reform and therefore
we are listening
carefully to what is
being said and taking
note.
However,
overall I continue
to be impressed
and spurred on
by the general
understanding and
optimism about the need for genuine
as the size of the cities and small rural
has long been proposed by groups such
reform of the way health services are
and remote communities throughout my
as the Australian Medical Association and
funded in this country.
electorate.
even the Labor Party and I will continue to
Rest assured my consultative approach
consult with health professionals about the
as Minister will continue across the broader
Government’s current proposal.
Health and Sport portfolios and I hope to
That’s why I’m determined to deliver on
my promise to be a consultative Minister
for both Health and Sport and get out
As such, I have set the following four
work closely with you in 2015.
ha
CHIEF E XECUTIVE UPDATE
New Primary Health
Networks announced
ALISON VERHOEVEN
Chief Executive
AHHA
T
he announcement by Health Minister
Now is the time for them to get to work and for the
Commonwealth to show health policy leadership
The previous transition from Divisions of
for clients, and exercising leadership in
Ley of the successful bids for the
General Practice to Medicare Locals (MLs)
collaboration with clinicians, consumers and
new Primary Health Networks
was problematic in some areas, and similar
the community, to develop innovative models
(PHNs) on 11 April has provided
difficulties can be expected. It will be
of care which will improve health outcomes
clarity for the organised primary care sector,
important to build on the experience of MLs,
for all Australians. The AHHA looks forward
their staff and clients. But strong support is
and not lose hard-learned lessons. Support
to working closely with them.
now needed from all levels of government and
will be required from the Commonwealth
from professional groups to ensure the PHNs
and state and territory governments, as well
Medicare Local staff and board members
are able to get to work and make a positive
as professional groups, to ensure the new
across Australia over the past 12 months,
contribution to the health system, particularly
organisations are fully effective in a timely
as they faced uncertainty about their
in the commissioning of regional health
manner. Stronger policy leadership on the
employment, must be acknowledged. Every
services based on community needs.
role of primary care is needed from the
day, more than 3,000 Medicare Local staff
With only 11 weeks for PHNs to be fully
Commonwealth in particular — work on the
across the country have continued providing
operational — with new partners, governing
National Primary Care Strategic Framework,
important services to support the health
boards, clinical and community advisory
which has been in limbo for 18 months, must
needs of their clients, many of whom
councils, premises and staff to support
be reactivated.
are amongst the most vulnerable in our
primary health across much larger regions
Despite the disruption of the past 12 months,
The hard work and commitment of
communities. It is unfortunate that some
than in the past — the job will be challenging.
there is significant goodwill amongst all parts
staff have today learned of their loss of
Maintaining patient services, for example in
of the health system and across Australia
employment via news reports in the media.
mental health, must be a priority as transition
to ensure that the new PHNs make a strong
The AHHA applauds the Medicare Local
plans are implemented and organisations are
contribution to a high functioning primary
network and staff for their dedication and
developed.
care sector, maintaining continuing of care
resilience.
Primary Health Network
Applicant (Lead)
State/Territory
Central and Eastern Sydney
Northern Sydney
Western Sydney
Nepean Blue Mountains
South Western Sydney
South Eastern NSW
Hunter New England and Central Coast
North Coast
North West Melbourne
Eastern Melbourne
South Eastern Melbourne
Gippsland
Murray
Grampians and Barwon South West
Brisbane North
Brisbane South
Gold Coast
Darling Downs and West Moreton
Western Queensland
Central Queensland and Sunshine Coast
Northern Queensland
Adelaide
Perth North
Perth South
Country WA
Tasmania
Northern Territory
Australian Capital Territory
EIS Health Limited
Northern Sydney Medicare Local Ltd
Wentwest Limited
Wentworth Healthcare Limited
South Western Sydney Medicare Local Ltd
Coordinare Limited
HNECC Ltd
North Coast Medicare Local (NSW) Ltd
Melbourne Primary Care Network Ltd
Eastern Melbourne Health Network Ltd
South Eastern Melbourne Primary Health Network
Gippsland Medicare Local Ltd
Loddon Mallee Murray Medicare Local Limited
Barwon Medicare Local Pty Ltd
Partners 4 Health Ltd
Metro South Medicare Local Ltd
Primary Care Gold Coast Limited
Darling Downs and West Moreton Primary Health Network
North West Hospital and Health Service
Sunshine Coast Health Network Ltd
Mackay Hospital and Health Service
Northern Adelaide Medicare Local Limited
WA Primary Health Alliance Limited
Tasmania Medicare Local Limited
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12
ha
International Hospital Federation
2015 International Awards
Supporting recognition of excellence, innovations and outstanding
achievements in global healthcare leadership and management.
IHF EXCELLENCE AWARDS
IHF/DR KWANG TAE KIM GRAND AWARD
Categories
Eligibility
• Leadership and Management in Healthcare
• Quality and Safety and Patient-Centered Care
• Corporate Social Responsibility
• AHHA membership
• Demonstrated fields of excellence and achievements
with proven results at health system or facility level in
several areas such as:
Eligibility
•
•
•
•
• AHHA membership
• Demonstrated excellence and achievement at facility
or unit level through an activity with proven results
quality and patient safety
corporate social responsibility
innovations in service delivery at affordable costs
healthcare leadership and management practices
Award trophy and prizes
Award trophy and prizes
Winners:
Winner:
• US$2,500 to cover travel and accommodation to
attend the 39th World Hospital Congress in Chicago
in October 2015
• 2 complimentary Congress registrations
• International exposure through IHF publications
and healthcare media network
Runners-up:
• US$5,000 to cover travel and accommodation to
attend the 39th World Hospital Congress in Chicago
in October 2015
• International exposure through IHF publications and
healthcare media network
Runners-up:
• 1 complimentary Congress registration/category
ENQUIRIES
ENTRY SUBMISSION
Sheila Anazonwu
IHF Partnerships and Project Manager
Submissions are online-only. To submit, go to:
https://congress.ihf-fih.org/awards_login
Email: [email protected]
Submission deadline: 12 June 2015
Winners announced: 7 August 2015
Tel: +41 (0)22 850 9422
Note for Asian countries: If you are considering entering the IHF
International Awards, you may also want to enter the HMA Asian Hospital
Management Awards. Please visit http://hospitalmanagementasia.com/
http://www.worldhospitalcongress.org/en/abstracts-awards
The science
behind harm
prevention in
healthcare
Ms Bernie Harrison of Peloton Health Care
Improvement Consulting writes about the origins
of improvement science and its relevance to
Australia’s health system in 2015
‘Clean colors’ by Zdenko Zivkovic. Image sourced
14
The(CC
Health
• APRIL
from Flickr
BY 2.0:Advocate
https://flic.kr/p/cw2Y95).
2015
IN DEPTH
T
here has been an increasing
‘pointy end’ of healthcare that they are best
care is that the analytical part of the brain is
focus, both in Australia and
placed to give a proper diagnostic of process
left to do the problem solving and deal with
internationally, on the design or
failure and begin to find a solution.
the more difficult cases. While we never want
redesign of healthcare services to
Through the Clinical Practice Improvement
health professionals to lose the ability to deal
prevent harm. This represents a shift away
Short Course, delivered in partnership
with novel situations, the vast majority of
from simply reporting or counting harm and,
with the AHHA, participants are invited to
patient presentations are predictable.
instead, going a little further ‘upstream’.
do just this; to identify an existing issue in
For instance, 10 years ago we saw the
their workplace and undertake small cycle
development of ‘fast tracking’ through
industries or sectors — such as in aviation,
testing of a process change within their work
emergency departments in hospitals for
nuclear and mass transit systems — that have
environment. This allows health professionals
patients who have lower triage scores. This
developed high-reliability through tackling
to discover any possible flow-on effects in the
allowed these patients, many of whom just
issues or systematic errors at their root
system before widespread implementation
needed an x-ray, to get a quick referral to a
cause.
of change.
fracture clinic or physiotherapist instead of
It is an approach used successfully by other
When looking at human factors for
This testing is an essential step because
waiting for hours to be seen.
example, it is important to examine what
when changes are implemented before
While this has now become standard
the brain does well and what it does poorly,
ever being tested — as they often are in
practice for most emergency departments,
then implementing safeguards and creating
healthcare — we fail
more efficient systems. This is the crux of
to ask the important
improvement science: to design and redesign
question: when is the
systems to improve efficiency and, where
change going to work
possible, reduce or remove the chance
and when is it going
of error.
to fail?
it was very
To improve the efficiency
or safety of treatment in
health services in Australia,
we need to ensure that the
micro-system design or
redesign is inherently local.
innovative at the
time and came
with its own set
of challenges
and flow-on
effects. We had
Its history stems back to the work of
Using improvement
W. Edwards Deming and Joseph M. Juran,
science in this way helps
who worked to improve large scale
to overcome a criticism
manufacturing processes in America in
of the healthcare sector
the 1940s. They believed that the people
that is often made by other industries that
the emergency department, then you also
who work on the frontline — within the
we are far too reliant on the flawed human
had to be able to fast track them through the
system — are the ones with the profound
memory.
radiology suite, pathology clinic and plaster
or fundamental knowledge key to process
The problem with health professionals
to learn that if
you fast track a
patient through
clinic etc.
This shows the tremendous difference that
improvement and waste elimination.
providing non-standardised care which results
This principle is the main essence of
in widespread variation in practice is that you
improvement science can make, creating a
improvement science today.
can’t guarantee an outcome. Not only is there
more efficient model that both eliminates
To improve the efficiency or safety of
variation between facilities, but there is also
waste, reduces harm and improves the
treatment in health services in Australia,
variation within facilities, with the possibility
patient experience.
we need to ensure that the micro-system
of clinicians varying their approach day to day.
design or redesign is inherently local.
This standardisation of procedures is often
Good clinicians often make it their business
to understand and improve the multiple and
met with suspicion from medical professionals
complex processes within the healthcare
to prevent harm in the operating theatre
because they value and aspire to clinical
system because, ultimately, it helps save
or making sure patients don’t go home
autonomy, and warn of the dangers that can
money, reduce harm and increase patient
without their medication, it’s essential to
come from ‘cookbook medicine’. However, this
satisfaction. And that’s a goal that we can all
include health professionals involved in the
need not be the case.
aspire to.
This means that, whether it’s working
microsystem; it’s what the nurse does, it’s
ha
The idea of mass customisation — the
what the pharmacist does, and it’s what the
80/20 rule — is particularly applicable to
doctor does.
healthcare, in that 80% of patients with
Bernie Harrison is the founder of Peloton
common presenting conditions like heart
Health Care Improvement Consulting and
out by senior managers, executives or
attacks, asthma, appendicitis and pneumonia
is currently providing short courses on
bureaucrats in isolation from the health
can be treated on a protocol, while the other
Clinical Practice Improvement and Root
professionals who provide the care, write
20% require customised treatment because of
Cause Analysis in partnership with the
the scripts and administer the medication.
their co-morbidities.
AHHA. For more information, visit the
It is not a process that can be carried
It is because health professionals are at the
The advantage of systematising routine
AHHA website: www.ahha.asn.au
16
BRIEFING
CHRISTINE ILETT
Clinical Nurse Consultant
Wide Bay Hospital and Health Service
Promoting
change
Why a culture of process improvement and
waste elimination needs to start at the top
T
he Wide Bay Hospital and Health
Lean training run by LEI Group Australia in
to come out of the training, with many positive
Service (HHS) includes three major
partnership with the AHHA.
overlaps and flow-on effects trickling through
hospitals — Bundaberg, Hervey
We are excited at the potential that will
the organisation. We are all eager to see
come from the course, which includes a
the results, which shows the importance of
rural hospitals, with each serving the distinct
group of about 50 of our employees across
having senior management setting the tone
needs of their respective communities and
three groups currently undertaking Yellow
and letting that culture spread down to the
responding to unique sets of challenges.
Belt training, and a further 12 employees
staff on the ground. Part of empowering
undertaking the more in-depth Green Belt
employees is giving them the tools and
waste elimination, it is important to have an
training. The Yellow Belt training will provide
techniques necessary to be leaders within
organisation-wide culture where staff at our
staff members with an overview of the basic
the workplace; that’s one of the reasons that
various facilities can help drive performance,
Lean principles and tools to support the
this Lean training is being undertaken. We are
Bay and Maryborough — and eight
When considering process improvement and
ensuring that the patient journey is as
smooth and timely as possible. The Wide Bay
HHS fortunately has a senior management
team that understands this, having fostered an
organisational culture that is conducive to change.
However, the culture hasn’t been created
overnight; it has followed a period over the
last few years where we have done some
really hard yards to lift performance. In doing
so, we have built an environment receptive
to the philosophy of Lean thinking, with a
staff that understands the importance of
continuously striving to improve.
We have now developed a strategic plan to
guide the organisation through the next three
years, providing clear direction and strong
foundations needed to achieve our goals.
Part of this plan involved the development
of five pledges, to which we will align all of
our future organisational activities, programs
and decisions. These include: 1) delivering
a sustainable, patient-centred quality health
service; 2) engaging with our community and
Yellow Belt Group 1. Image
courtesy of Wide Bay HHS.
partners; 3) developing and empowering our
workforce; 4) encouraging innovation and
Green Belt participants both in identifying
confident that it is the right way to continue to
excellence; 5) delivering value for money.
Lean opportunities and implementing major
drive improvement across our facilities and their
projects within Wide Bay HHS facilities.
varying caseloads, ultimately helping Wide Bay
With these foundations in place, it is an
opportune time for our staff to undertake the
I am sure there will be a variety of projects
HHS better meet the challenges of the future.
ha
BRIEFING
Getting value for money
LEI Group Australia’s Business Manager Margaret Ledwith reviews
the value of healthcare continuous improvement projects
‘Piggy Bank with Change’ by Jacob Edward. Image sourced from Flickr
(CC
2.0: Health
https://flic.kr/p/oqcAWm)
18 BYThe
Advocate / •www.seniorplanning.org.
APRIL 2015
H
ow confident are you that
continuous improvement initiatives in diverse
is predominantly written for and by those
any healthcare continuous
areas of an organisation, each with different
engaged in re-imbursement policy making
improvement initiatives that
measures of benefit, can also be challenging.
(an overly narrow focus by health economists
you have been involved in, are
The massive ongoing development and
planning, or are considering undertaking,
adoption of services derived from the
actually represent value for money?
collation and analysis of healthcare data
that has been described by others as ‘the
addiction to adoption’).
The underdevelopped linkages
— such as electronic healthcare records,
between health economics and continuous
as it may call to mind ‘no brainer’ projects which
e-prescribing, clinical decision support
improvement is something that needs to be
simultaneously saved money and improved
systems, knowledge management systems and
addressed to provide meaningful evidence
quality. Continuous improvement approaches,
the products that will result from increasingly
to help decision-makers to achieve optimal
such as the Lean management philosophy,
sophisticated linkage and interrogation of
returns from their continuous improvement
are increasingly used in healthcare precisely
multiple healthcare datasets — mean that
investments. There are a number of specific
because they are frequently credited with
the next decade and beyond is likely to be
areas in which increasing the use of health
benefiting patients, improving staff morale
characterised by further significant change
economic tools and techniques can make
and enhancing the financial performance of
in how healthcare processes are designed
significant contributions.
service providers.
and implemented.
For some, this question may be easy to address
At the heart of healthcare continuous
Often however, it can be difficult to
Change on this scale involves potential risks
improvement approaches, such as Lean,
even complete the initial step of clearly
as well as benefits for healthcare organisations.
is the placement of patient needs at the
outlining a value for money criterion against
Not all continuous improvement strategies will
centre of every decision in a process, as
which to judge a project. Furthermore,
be successful or will represent value for money.
well as an understanding of value from the
continuous improvement in healthcare is
Some continuous improvement investments
perspective of the patient. Health economic
a broad term that encompasses a range
may result in unintended consequences such
preference elicitation techniques provide a
of types of potential projects, outcomes,
as creating new sources of error, more rapid
means of quantifying the value to patients of
implementation tools and methods. As
and widespread replication and dissemination
continuous improvement outcomes as well as
such, continuous improvement approaches
of individual errors, increased administrative
information of wider potential usefulness than
may comprise a combination of training,
burden on clinical staff and making some
patient satisfaction surveys.
role redesign, reorganisation of workplace
information less accessible. It is therefore
layout and changes in how data is measured
increasingly important that healthcare
techniques, such as cost-benefit, cost-
and communicated. Investing in continuous
organisations have access to high quality,
effectiveness and cost-utility analyses,
improvement may involve releasing staff
context-relevant information about the
provide integrated measures of costs and
time to undertake the mapping of processes,
potential clinical and financial impacts of the
consequences deploying well validated
improving visual controls and implementing
continuous improvement strategies they are
value for money benchmarks. In addition
rapid improvement projects so as to improve
considering.
to addressing questions of value for money
the efficiency with which information, people,
That said, data and analyses relating to the
Full health economic evaluation
through these approaches, budget impact
equipment and medications interact within
value of continuous improvement strategies
analyses can provide additional information
healthcare processes.
are scarce and, when available, are not
relating to questions of affordability.
In addition to the direct staff and training
always of high quality. Unlike medicines and
Some health economic evaluation techniques
costs generally associated with continuous
medical devices — where purchasing decisions
such as discrete event simulations are natural
improvement projects, there may also
are informed by a significant body of quality
companions to process mapping activities.
be expenditure on external consultants
health economic data (a significant proportion
These can provide detailed modelling that
and mentors or investments in enabling
of which is funded by the manufacturers
inform decisions about complex projects with
technologies. The redesigned processes
and marketers of these products) — there is
potentially significant outcomes.
that result from such investments may have
almost a complete absence of full economic
cost and benefit impacts that span multiple
evaluations of methodologies, such as Lean,
workshops in Canada and Ireland last year
departments, which may also extend beyond
and the overall quality and transferability
focusing on the health economics of continuous
the sponsoring organisation. It can be far
of health information technology economic
improvement and an online Green Belt course on
from straightforward to work out how to take
evaluations has been widely noted as
this topic will be available soon. Hopefully, these
an integrated approach that appropriately
unsatisfactory (though it is improving).
and other initiatives will encourage greater
accounts for the multiple returns to patients,
Furthermore, administrators and clinicians in
use of valuable health economic techniques
staff and healthcare funders from continuous
healthcare organisations have limited skills
in both assessing the performance of previous
improvement investments. Comparing the
and confidence in understanding and applying
continuous improvement projects and informing
relative returns on investment of diverse
health economic evaluation evidence, which
future investment decisions.
Leading Edge Group ran a series of training
ha
Embracing
the Lean
philosophy
From huddle forums to vision boards,
Lean techniques are currently
being implemented to great effect
at the Royal Dental Hospital of
Melboune. The Manager of Surgery
at Dental Health Services Victoria
(DHSV), Wesley Smith, spoke to the
AHHA’s Dominic Lavers about how
recent training has helped put the
organisation on track to meet some
ambitious targets.
20
A
s part of its aim to increase the
number of eligible Victorians it
cares for from 14 to 20% of the
state by 2016, the Royal Dental
Hospital of Melbourne last year undertook a
Lean training course in improving processes
and eliminating waste.
The training, run by LEI Group Australia
in partnership with the AHHA, encouraged
both clinical and non-clinical staff to think
differently about their roles; moving beyond
their particular skills towards new models of
care that consider the whole system.
The hospital has since incorporated Lean
philosophy into its day-to-day activities, with
DHSV Manager of Surgery, Mr Wesley Smith,
saying that staff members have driven
significant change within the organisation.
“We’re creating processes that allow us
to do more with less human effort, space,
capital, and time,” Mr Smith said. “Our goal
is to deliver services that are cost and time
effective and it’s fantastic that our staff
have been achieving a lot more with the
resources we have. We have some of the
best clinicians in the world. And to make
sure that we provide the best service that
we are capable of, we are always working
together to find new ways to improve our
BRIEFING
Mr Smith said that Lean philosophy had
systems and service flow. The beauty of
a huddle forum that the 26 items used in
Lean training is that it equips both our
the sterile surgical setup could be acquired
become a culture within the organisation,
clinical and non-clinical staff with the tools
through one disposable product, rather than
with staff being involved every step of
to take a step back and look at the way their
packed individually and later sterilised.
the way. “We have built up now what we
roles function within the system.”
“We took that idea and developed a
call ‘vision boards’, which communicate
working party, examining what impact
to staff members the status of current
teams begin each day by forming ‘huddle
the change would have on efficiency, cost
Lean projects. This allows them to see
forums’, five minute meetings where each
and waste,” Mr Smith said. “As a result,
the progress made in turning their ideas
staff member is invited to share learning
we have gone from a linen-based service
into everyday practice, as well as letting
and ideas on how to improve services and
to a single-use disposable option, which
them know that the team have turned
patient care.
means that staff members don’t have
their vision into a Lean improvement. The
to prepare all 26 individual items. It is
staff has really engaged with the training
To encourage this kind of thinking,
The huddle forums give staff members
the opportunity to communicate regularly
an example of one simple
with each other about any process or
innovation that has certainly
procedural limitations, look at a particular
reduced our waste and
function through a fine lens and make sure
improved efficiency. As the
any internal work flows are aligned with
items come to the hospital
the most efficient process.
already sterilised, it has
For example, one project looked at the
saved our sterilising team
and we have people
“We’re creating
processes that
allow us to do more
with less human
effort, space,
capital, and time”
talking about it
every day; sharing
with colleagues
when they have
identified a possible
Lean opportunity
or discussing ideas
equipment used in the operating suite
1.5 hours each day, as well
which previously required the Central
as reduced our electricity,
Sterilising Service Department to spend
water and steam usage
about 1.5 hours every day on sterilisation
significantly across the organisation. There
daily rounds with the other departments.
processes. Dental assistants also had
have also been flow-on benefits for other
Ultimately, The Royal Dental Hospital of
to manually select 26 individual items
departments. This idea has actually turned
Melbourne wants to deliver better care for
to prepare for each individual case and
into a more wide-reaching Lean project
patients and achieve our goal of providing
numerous staff were involved in setting
itself, as we seek to identify further
services to 20% of Victorians by 2016,”
up the operating suite.
opportunities to reduce waste and find
Mr Smith said. “With the help of Lean,
more efficient ways of doing things.”
we’re well on our way.”
It was identified by a staff member in
with my surgery
team as we do our
ha
The Health Advocate • Image
APRIL
2015 21
courtesy of DHSV.
IN DEPTH
Yvette Blount
Macquarie University Centre for
the Health Economy
Sustainable
telehealth
Rethinking the culture and skills required
T
echnology is a major driver of
practitioner when compared to their city
with local patients so there’s no time [for
change in many industries such as
counterparts (more than six days compared
telehealth consultations].”
retail, travel and banking. Health
to three days). In some regions the wait
care delivery is no exception.
is four times as long (more than 13 days).1
the skills to operate in a virtual team with
For telehealth to work, clinicians need
Rural patients have similar issues with access
multiple stakeholders. For example, a
public and private hospital information
to specialist services. Telehealth has the
consultation involves the patient, specialist,
systems (including the personally controlled
potential for more equitable access to health
general practitioner, possibly a practice
electronic record), the ability to capture
services by closing this gap.
nurse, as well as someone to set up the
Access to affordable fast broadband,
high resolution photos, video-conferencing
In a recent study by Macquarie
technology and appointment to facilitate
and cloud storage as well as increasingly
University’s Centre for the Health Economy,
the consultation. This in itself can be a
sophisticated smartphone apps are changing
45 registered nurses, general practitioners,
challenge for rural and regional areas, as
the way health care is delivered and how
specialists and allied
patient data is collected and stored.
health professionals were
Patients can use smartphone apps, not
interviewed. The purpose
just to monitor conditions such as blood
of the study was to
pressure or glucose levels, but to obtain a
examine the barriers to
diagnosis.
the sustainable adoption
Eric Topol explains in his book, The
of telehealth from the
Patient Will See You Now: The Future of
perspective of the
Medicine is in Your Hands, how a patient
clinicians. A key theme
who after using an electrocardiogram (ECG)
that emerged was the
app (approved by the U.S. Food and Drug
reluctance of clinicians
Administration) sent him the ECG results
to use technology and/
with the message: “I’m in atrial fib, now
or change their business
what do I do?” In other words, increasingly,
practices.
these apps not only record data — they can
diagnose.
So what do these technologies mean for
some communities
The success of
telehealth in rural and
regional Australia
relies on relationships
between the clinicians
involved in the care of
the patient, in particular,
the general practitioner
and the specialist.
The success of telehealth in rural and
regional Australia relies on relationships
between the clinicians involved in the care
don’t have a general
practitioner who
can assist with the
consultation.
The consultation
also requires
schedules to align
(one clinician may
be running late
for example), the
patient has to show
up, the clinical notes
have to be recorded
and someone has to be accountable for
follow-up.
Telehealth is more than just a video
telehealth and the culture and skills for
of the patient, in particular, the general
conference. Follow-up support to the
stakeholders, particularly clinicians?
practitioner and the specialist.
general practitioner may be required from
The Australasian Telehealth Society
Leaving the issues of funding and business
the specialist via phone or email. There is
defines telehealth as delivering healthcare
models aside (an area that requires further
a role for specialists to work with general
services over distance using information
research), the first hurdle is identifying
practitioners to increase their knowledge
and communication technologies (ICT).
the clinicians who are willing to provide
about specific areas of practice, such as
Increasingly health services can be delivered
telehealth health care services.
diabetes treatment.
using technology wherever the patient
resides.
For example, one rural general practitioner
If telehealth is to be sustainable, it must
noted that some specialists do not always
be both effective (clinically appropriate)
continue their telehealth practices because
and efficient (economically justified).
Australia because rural patients wait, on
“they’ve got appointment books that are
Health data is being captured in various
average, twice as long to see a general
already overflowing… their books are full
health information systems and apps in large
This is important for regional and rural
22
‘Telehealth - Older man and nurse using blood pressure’ by Tunstall. Image sourced from Flickr (CC BY 2.0: https://flic.kr/p/brnWyk).
databases (such as the Personally Controlled
The Macquarie University Centre for the
eHealth Record).
Health Economy has released a white
Clinicians will need skills to be able to
paper, Connected Care: Realising the
Reference:
1. Sheppeard, A. (2014, November 28).
GP waiting times can be double for
access the large volumes of data, make sense
Vision outlining the key issues relating to
of that data and use that data to provide
the Health Economy. Download the paper
rural patients, Australian Rural Doctor.
appropriate health services. At the same
at: http://health-economy.mq.edu.au/
Accessed 9 February, 2015 at:
time, clinicians will need an understanding
research/research_papers_and_journals/
http://www.ruraldr.com.au/news/gp-
of the privacy and security issues associated
white_papers/connected_care_realising_
waiting-times-can-be-double-for-rural-
with using technology.
the_vision.
patients
ha
IN DEPTH
GEOFF SIMS
Director / Principal Consultant
Geoff Sims Consulting
The Australian
Cystic Fibrosis
Data Registry
More than just descriptive epidemiology
T
he Australian Cystic Fibrosis Data
Registry is soon to release its 16th
annual report, detailing data up
until the year 2013.1 Demographic,
clinical, treatment and social characteristics
of over 3,200 people in Australia with cystic
fibrosis (CF) are described annually in some
detail, and clinically relevant data are
returned to the 23 specialist CF treatment
centres that contribute data about their
patients.
Population-level trends map impressive
progress with improving outcomes for people
with CF (see figures 1 and 2). Contributing
factors to improving survival include
early diagnosis via newborn screening,
management in specialist CF care centres,
better antibiotics and a variety of improved
care practices.2 Implications for the nature
of care required for a population that is
changing so rapidly are also signalled by
these trends. Growth of around 5% per year
in the number of adults with CF has placed
increased pressure on adult care centres,
where patient management issues include
a focus on social and family life issues as
well as managing complications — such as
CF-related diabetes and depression — that
had not been as prevalent in younger CF
populations of a generation ago. In response,
one state government has recently announced
additional resources to address the pressures
in its adult CF centres.
Registries can be key contributors to
at international CF conferences, from
such as in nutrition management and the
knowledge about the progression of rare
which findings flow into best practice and
treatment of lung infections, have had direct
diseases. CF registries are credited with
treatment guidelines. In fact, maintenance
origins in registry-based comparative studies
making an important contribution to the
of national registries is acknowledged as a
of outcomes alongside clinical practices at
improvement of patient outcomes.3 Registry
quality management component of recently
centre level. The Australian registry has
data now pervade the CF literature and
published European Standards of Care for
contributed to this international pool of
inform large numbers of presentations
CF.4 Some current measures of best practice,
learning through published research about
24
References:
the contribution of neo-natal screening to
data registry has embraced fledgling eHealth
early diagnosis — which can lead to better
activity since 2006, when first provision
long term outcomes — as well as the effect
was made to upload an entire annual
of temperature on the propensity to acquire
dataset from hospitals that had introduced
lung infections.5,6
an electronic medical record (EMR) for CF
Registry. Baulkham Hills NSW: Cystic Fibrosis
patients. However, hospital data systems
Australia.
Australian patient data are being pooled
with data from other national registries
are not yet ready for seamless transfer of
in an important international project at
data to registries, so the real benefits of
Johns Hopkins University. This ‘CFTR2’
eHealth for registry data quality are yet to
project is progressively identifying which
be realised.
of approximately 2,000 known mutations of
The Australian CF registry is managed by
the Cystic Fibrosis Transmembrane Regulator
Cystic Fibrosis Australia, in a long-standing
(CFTR) gene are CF-causing, and describing
collaboration with Directors of specialist CF
their functional characteristics.7
treatment centres. All Australian centres
Research focus on the specific CFTR
contribute. Patient or parental consent
mutations has seen the emergence of
is obtained at centre level and is rarely
mutation-specific therapies. Ivacaftor,
denied. An Advisory Committee of medical
a novel mutation-specific drug recently
specialists, consulting with allied health
approved for funding under the PBS in
professionals, oversees scientific practice.
Australia, is reversing the effect of the
A memorandum of understanding with a
G551D mutation on cell function — good
Sydney hospital’s Ethics Review Committee
news for the 7% of Australians whose CF is
provides for oversight of ethical practice,
caused by at least one mutation of the G551D
including for use of de-identified patient
type. For novel therapies like Ivacaftor,
level data by researchers. Research interest
registry data play a role in clinical trial
is encouraged.
design, in economic evaluation for funding
The 16th Annual Report from the
1. Cystic Fibrosis Australia. (2015). Cystic
Fibrosis in Australia 2013, 16th annual report
from the Australian Cystic Fibrosis Data
2. Bell, S.C.; Bye, P.T.; Cooper, P.J.; et al.
(2011). Cystic Fibrosis in Australia 2009:
results from a data registry. Medical Journal
of Australia. 195(7): 396-400.
3. Schechter, M.S.; Fink, A.K.; Homa, K. & Goss,
C.H. (2014). The Cystic Fibrosis Foundation
Patient Registry as a tool for use in quality
improvement. British Medical Journal
Quality and Safety. 23: i9–i14.
4. Stern, M.; Bertrand, D.P.; Bignamini, E; et
al. (2014). European Cystic Fibrosis Society
Standards of Care: Quality Management in
cystic fibrosis. Journal of Cystic Fibrosis.
13(Supp1): S43-S59.
5. Martin, B.; Schechter, M.S.; Jaffe, A.; et al.
(2012). Comparison of the US and Australian
Cystic Fibrosis Registries: The Impact of
Newborn Screening. Pediatrics. 129(2):
e348-55.
decisions and in post-authorisation safety
Australian CF Data Registry will be
and efficacy studies (PASS and PAES) — just
available from Cystic Fibrosis Australia and
et al. (2011). Effect of Temperature on
beginning in the United States and the
at its website at www.cysticfibrosis.org.
Cystic Fibrosis Lung Disease and Infections:
United Kingdom.
au/data-registry. For international focus,
To serve all of the purposes to which
reports from other national and regional
registry data are applied, an emphasis on
registries can be obtained through the Cystic
high quality, verifiable, data is important.
Fibrosis Data Network website:
In this respect, a relationship with eHealth
http://www.cysticfibrosisdata.org.
6. Collaco, J.M.; McGready, J.; Green, D.M.;
A Replicated Cohort Study. PLoS ONE. 6(11).
Available online at: http://www.plosone.org
7. The Clinical and Functional Translation of
CFTR (2015). Available online at:
ha
is envisaged in a Framework for Australian
http://www.cftr2.org
8. Australian Commission on Safety and Quality
Clinical Quality Registries, developed by
Geoff Sims has managed the Australian CF
the Australian Commission for Safety and
Data Registry for Cystic Fibrosis Australia for
Australian Clinical Quality Registries.
Quality in Health Care and endorsed by
the past 13 years. He is project leader for a
Available at: http://www.safetyandquality.
the Australian Health Ministers’ Advisory
Harmonisation of International CF Registry
gov.au/our-work/information-strategy/
Committee in March 2014.8 The Australian CF
Data project.
clinical-quality-registries
in Health Care. (2014). A Framework for
Will they understand?
Cassie Moore, from Murrumbidgee Medicare Local, tells us
why health literacy is everyone’s business
T
he World Health Organisation
be expensive or complicated. Results
group included the MML’s CEO, executive
defines health literacy as the
are achievable with limited dedicated
directors, appropriate senior managers
cognitive and social skills which
resources.
and operational staff, with leadership
determine the motivation and
from the Manager of Planning and Health
ability of individuals to gain access to,
(MML) is a primary healthcare organisation
understand and use information in ways
covering the large rural and regional
The MML health literacy action plan is
which promote and maintain good health.
area of Southwest NSW. The MML has
nearing completion, with the organisation
Promotion.
been addressing health literacy since
having now undertaken a wide range of
difficulties regarding health literacy. It is
early 2013, pursuing the vision of
initiatives. These include:
a key social determinant of health that is
being recognised as a health literate
impacting on the wellbeing of Australians,
organisation. A key factor in the success
with people experiencing difficulties with
of the organisation’s progress has
health literacy being up to three times
been due to the commitment from its
more likely than those with higher degrees
executives to tackle this issue head on.
More than half of Australians experience
of health literacy to experience poorer
health and live with comorbidity.
The United States has estimated that
As a starting point, the organisation
engaged an accredited local provider to
deliver a series of interactive workshops
inadequate health literacy costs its
for operational staff, senior managers,
economy $106-236 billion annually. It is
executive and board directors, as well as
also known to impact its hospital system,
providing opportunities of other primary
with health illiterate individuals requiring
health providers in the region.
• Development of a consumer friendly
map;
• Reviewing signage both outside and
inside buildings to assist with access;
• Development of an organisation wide
policy;
• New processes for the development
of resources and communication
with consumers, including seeking
consumer feedback;
• Development of an advertising
Following the training sessions, a
campaign and supporting resource to
Health Literacy Steering Group was
empower consumers to take control
with many dimensions, taking actions
formed to develop a plan of action for
and ask questions when they do not
to address illiteracy does not have to
the organisation. Membership of the
understand;
longer hospital stays.
While health literacy is an area
26
The Murrumbidgee Medicare Local
IN DEPTH
• Development of a “while you wait”
language used and consideration of health
This internationally recognised tool
resource to send to patients ahead
literacy principles in any planning and
paints a picture of what a health literate
of their initial appointment; and
implementation moving forward.
organisation looks like and how it
• Development of a health literacy
Another indication from the evaluation
operates. Prior to the development and
toolkit that is available to staff
was that over three quarters of participants
implementation of the health literacy
to support the adoption of health
in the health literacy program have not only
action plan and formation of the steering
literacy principles in their day-to-
modified their service delivery following
group, the MML met very few of these
day work.
participation in the training workshop
indicators. Now, 18 months down the
but they have also observed benefits
track, the MML reflects each of these
from incorporating health literacy
attributes and is proud to hold the status
subtle adjustments to complete reviews
principles in their day-to-day work. These
of a health literate organisation.
in operations. The most important aspect
benefits include patients having a better
The MML will expand this work into the
throughout the implementation process has
understanding of their health; patients
future by providing support to primary
been the ownership that staff have had over
being more engaged and able to focus
healthcare organisations and providers
the changes, not to mention the interest
during consultations; and clients being
to assist them in incorporating health
and commitment to make such changes.
comfortable to ask more questions and
literacy principles in their day-to-day
Following the provision of training
seek clarification. The adoption of health
practice and ongoing engagement and
and the implementation of changes to
literacy principles within the organisation
empowerment of consumers.
procedures, an evaluation was undertaken
has also seen more of a focus on patient-
to measure the impact of the health
centred care and consumer engagement
and is the responsibility of the entire
literacy initiative. The results were
n processes generally.
health sector. It is important to constantly
The changes implemented as a result
of the action plan have ranged from
Health literacy is everyone’s business
A further way that the organisation
ask ourselves ‘…will they understand?’
of managers reported observing changes
has evaluated its achievements in health
Making small changes can make a big
in the service delivery of their teams,
literacy is the use of the ‘10 attributes
difference to the health outcomes of
including greater awareness of the kind of
of a health literate organisation’ tool.
Australians.
overwhelmingly positive. The majority
ha
Pharmacy
in review
Following the Pharmacy Practitioner
Development Committee’s (PPDC)
review of the National Competency
Standards Framework for Pharmacists
in Australia taking place in 2015,
Dominic Lavers shares findings
from some initial background and
consultation work undertaken by the
AHHA earlier in the year.
A
move towards a much more
great feedback that would help guide
the Pharmacy Guild of Australia’s Guild
streamlined, user-friendly and
the review of the framework.
Intern Training Program, Ms Hayley Smilie,
robust competency standards
“We’ve received feedback that the
said the different perspectives offered in
profession wants to see the one set
the consultation environment helped to
has been supported by a number of key
of competency standards that act in
provide a holistic view of the profession.
stakeholders at consultations run by the
a continuum from entry level — from
AHHA in 2015.
university graduation to advanced
different ways in which the competency
practice — rather than have two separate
standards are used,” Ms Smilie said.
framework for pharmacists
The AHHA, commissioned by the PPDC
to help inform its regular review of the
frameworks like we have currently,”
competency standards, is also conducting
Dr Jackson said.
a national survey, a literature review
“There’s also been feedback around
“It’s been great to be able to discuss the
“A number of people have raised that
the competency standards in their current
format are quite unwieldy; they’re large
and an examination of other competency
making sure the descriptors within
and complex. Streamlining them and
frameworks used in Australia and around
the competency frameworks are more
making them more relevant and accessible
the world.
behaviourally based. So, the framework
to the general pharmacist out there would
could perhaps be more focused on the
be really useful.”
While the findings of this national survey
are yet to be released, PPDC Chair Shane
behaviours of the individual as opposed
Dr Jackson said this desire to make the
Jackson said the literature review and
to the tasks that they might undertake.”
framework more user-friendly was valuable
consultations had already provided some
The current National Coordinator of
feedback to come out of the consultations.
28
BRIEFING
‘Pharmacy’ by Army Medicine. Image sourced from Flickr
(CC BY 2.0: https://flic.kr/p/bGVXxD).
practitioners and leaders of the future.”
“There’s no use creating standards if
training and postgraduate level, so it’s
people aren’t aware of them or think that
important for us to not only understand
they don’t apply to them,” Dr Jackson said.
what’s happening in the profession but
by the AHHA has shown that it is essential
also to help drive where it needs to go,”
to engage with the wider professional
Professor Kirkpatrick said.
community to ensure the competency
“Some of the things we’ve talked about
during the consultations are having an
overarching framework and then developing
“For this reason, the competency
Dr Jackson also said the work undertaken
standards are as usable as possible.
implementation or support tools, and
standards need to not only capture what a
“As part of its research, the AHHA has
certainly we’ll be looking at those types
current, competent pharmacist looks like
done some fantastic work in engaging with
of things to help the profession use the
but also have enough flexibility to allow
people whom we haven’t engaged with
competency standards framework better.”
future roles to develop without restriction.
formally before, from individual pharmacists
This is because universities need to be
to non-pharmacy organisations such as
Melbourne’s Monash University, Carl
able to develop curriculums and teaching
doctor, nursing and consumer groups,”
Kirkpatrick, welcomed the opportunity
practices that equip the pharmacists of
Dr Jackson said.
to take part in the consultation, and said it
tomorrow with the skills to undertake those
was important for universities to be involved
future roles. As such, this consultation
helping to inform the review, but it will
in the review of the competency standards.
provides a great opportunity to improve
also help to inform pharmacists about
current competency standards and assist
what the community expects of them in
education providers in producing the
the future.”
Professor of Pharmacy Practice at
“Monash University educates pharmacists
from undergraduate level through to intern
“Not only has this been important in
ha
Palliative care
gets a boost
Yasmin Birchall outlines the benefits of new
funding for the AHHA’s online training program
that can be accessed anywhere, anytime
A
s technology continues to
which focuses on the priority area of
enable broader, more rapid
service delivery improvement in the
training provider Silver Chain Training to
and more flexible access to
palliative care sector, the project
develop the online portal and two new
information and training,
will involve the development of a
palliative care training modules in the first
the AHHA is pleased to announce that
comprehensive online education portal
half of 2015.
it has secured funding to expand its
which will improve palliative care
innovative palliative care training modules
education and training for the health
the new units will be based around the
through technology-enabled modes.
and aged care workforce.
Guidelines for a Palliative Approach to
The three-year project will result in a
expand on AHHA’s
online information training portal aimed
four highly successful
at frontline palliative care workers,
online palliative
predominantly those working with older
care training
persons in the community setting.
modules which have
attracted over 17,000
Aged Care in
The project will expand
on AHHA’s four highly
successful online
palliative care training
modules which have
attracted over 17,000
registrations across
Australia.
the Community
Setting (COMPAC
Guidelines).
The content
will be mapped
to nationally
Australia face considerable resource
registrations across
pressures when delivering their services,
Australia. A new
the AHHA’s new project will create
information portal
opportunities for free education and
will be developed
training which will provide the workforce
to host interactive,
with a cost-effective opportunity to
engaging professional development
endorsed for continuing professional
acquire further skills in the delivery of
activities and links to best-practice
development credit with professional
evidence-based palliative care.
resources to support improved services
bodies.
Under the Australian Government’s
National Palliative Care Projects funding,
30
Similarly to the first four modules,
The project will
comprehensive, innovative and accessible
While healthcare providers across
The AHHA has partnered with registered
and client experiences across the palliative
care sector.
recognised
competencies
to support
formal training
outcomes, and
The new modules and information
portal will draw upon contemporary
IN DEPTH
online education software to allow for
numerous benefits. The strengths of online
streamlined, accessible internet-based
learning have been widely documented and
animation adds richness to the learner
training on the Moodle platform. Moodle is
include:
experience;
open-source software used by thousands
of organisations globally. It is stable,
accessible via mobile devices and multiple
operating systems. It provides excellent
reporting functionality, is highly flexible,
and can scale to accommodate very high
numbers of accounts without decreased
performance. Learners will be able to
access support from a dedicated team
around the clock if required.
At a course level, contemporary
instructional design principles will
be applied to ensure appeal, ease of
use, engagement, optimum knowledge
retention and learning outcomes, and
mobility of content delivery across devices
and operating systems.
At a time when many organisations are
challenged by reduced training budgets,
the palliative care online information and
training portal will promote increased
efficiency in healthcare and deliver
• More cost-effective than traditional
• The use of video, audio, imagery and
• Learners can test out or skim over
in-person delivery — no cost to access
materials already mastered and
the portal or complete the training
concentrate efforts in mastering areas
modules;
containing new information; and
• Module completion can be scheduled
• Self-marking assessments provide
around work commitments rather than
learners with immediate feedback
impinging on work time;
on their progress.
• No travel time and associated costs
to attend training;
In addition to providing valuable learning
opportunities for health professionals,
• Consistency of content delivery;
the palliative care online training modules
• Self-paced, with no time limits for
offer a particular opportunity for service
completion;
• No specialised equipment required
other than a computer with internet
access;
• Flexibility to join discussions in the
bulletin board threaded discussion
areas at any time;
• Ability to engage with other
participants or facilitators remotely;
providers to easily and at low cost embed
the free training in internal activities for
related staff and volunteers by utilising
the portal’s content in professional
development or induction.
To find out more about the first four
modules in the free, online training,
visit www.palliativecareonline.com.au or
contact Project Manager Yasmin Birchall at
[email protected]
ha
Image courtesy of Dominic Lavers.
IN DEPTH
SINGITHI CHANDRASIRI
Medical Management Registrar &
RACMA Candidate
The view from
the starting line
A practical application of critical reflective analysis
T
he conceptual and theoretical
on a statement I made. The interruption was
inevitably formulate an external response,
aspects of critical reflection, and
sudden, vehement, and rather blunt. Not only
and a point at which critical reflection can
subsequent recommendations for
did it contribute very little to the subject
equip us with the tools to actively choose
incorporating it into adult education
under discussion, it was also in complete
which direction that response will take.
curricula and competency frameworks, are
abundant in modern medical management.
opposition to what I had said.
In undertaking a critical reflective analysis
It is at these precise moments that we —
especially trainees of medical management
But why do we need critical reflection and
of such a situation, one must first identify
— need to actively challenge our reactive
how do we translate its theory into a practical
the initial reactions and assumptions that
assumptions and put into practice learned
means of managing doctors and of managing
will provide the baseline for analysis.
emotional intelligence principles. We need
organisations?
In this case, where the recipient of such
to develop self and emotive awareness. Only
commentary is likely to have been caught
then can we restrain impulsivity and cultivate
enables us, as medical managers, ‘to embrace
off guard and left feeling rather persecuted,
patience and humility in trying to explore
subjective understandings of reality as a
the immediate reflexive internal response
alternative ways of behaving so that we can
basis for thinking more critically about the
would be to adopt a
impact of our assumptions, values and actions
defensive standpoint.
on others... (and thereby) helping us to
The instant thought
develop more collaborative and responsive
process, in all
ways of managing organisations.’1 Adopting
likelihood, would
such an approach is said to provide ‘a
oscillate between
means to improve our clinical practice, a
feeling self-righteous
means to change and challenge dominant
indignation about
power relations and structures and a means
having been unjustly
to create possibilities to enable practice
criticised; a sense of
in organisational contexts that are not
immediate threat to
conducive to clinical practice.’2
one’s ego and pride, as
It has been argued that critical reflection
While the benefits of critical reflective
thinking are well documented, current
literature proves far more elusive as to
well as anxiety about
fear of failure.
Like other young
minimise personal
While the benefits
of critical reflective
thinking are well
documented, current
literature proves far more
elusive as to objectives
which can be translated
into everyday practice,
and how young doctors
who are new to the field
can implement such an
approach in a way that is
relatable and of benefit
to them.
and professional
damage.
Several years
ago, at an intern
teaching session,
I was advised to
‘develop thick
skin as a doctor.’
Adopting a
similar mentality
as a registered
practitioner,
and applying the
principles of critical
reflective thinking,
objectives which can be translated into
and inexperienced
everyday practice, and how young doctors
trainees, I was
who are new to the field can implement
no different. My
such an approach in a way that is relatable
mind conjured up a
and of benefit to them. My own personal
multitude of reasons
experience provides one such perspective
as to why this individual deserved some form
such as those described above. My own
that may be of help to others.
of counter-attack to put them in their place;
experience has shown that actively pursuing
to be told exactly what was on my mind — in
critical reflection can help restrain self-
no uncertain terms.
imposed projections of criticism as the
At the start of my career as a
medical management trainee, during a
multidisciplinary meeting, an employee —
At times such as this, one must take a step
have enabled
me to change
my perspective
for situations
catastrophic events that we so often assume
who had been a health service provider for a
back, for this is, indeed, a crucial moment;
them to be. In doing so, it ensures that we
great many years — openly contradicted me
a moment when our internal reaction will
have the capacity to modify our reactions
32
and behaviour in more constructive and
practice of critical reflection as medical
contextually appropriate ways.
management trainees. Whether we are
There are likely to be a myriad of situations
still at the start, or well progressed in our
and events in our future careers as medical
medical management journey, maintaining
leaders where we may be criticised or
a reflective approach to our work and our
humbled, albeit unjustly with inaccurate
colleagues allows us to respond from a
claims. But taking ill-conceived measures to
range of emotional, communication and
preserve a sense of pride and sustain the ego
intellectual styles in order to react in a
in the eyes of other colleagues at the expense
collaborative and constructive manner.
of damaging inter-professional relationships
Above all, it ensures that we remain
would be counter-intuitive to the practice
adaptive to change which is, after all, the
of emotional intelligence principles and the
sentiment that should underpin our very
greater goal of becoming an inspirational
practice as future medical leaders.
ha
leader and manger. Through continued
practical application of critical reflection,
we are better equipped to redefine social
interactions as power-neutral exchanges,
References:
1. Cunliffe, A. (2004). On Becoming a
rather than attempts to challenge or maintain
Critically Reflexive Practitioner. Journal
hierarchies — social and/or organisational.2
of Management Education. 28(4): 407-426
Practising these principles, and making
2. Morley, C. (2007). Engaging practitioners
an attempt to restrain impulsivity, helps us
with critical reflection: issues and
to grow as leaders and health professionals;
dilemmas. Reflective Practice. 8(1): 61-74.
to show respect for other people’s points of
view, adopt non-confrontational language
to diffuse tense situations and modify
our responses in a more constructive and
contextually appropriate manner — even in
3. Brookfield, S. D. (1987). Developing
critical thinkers: Challenging adults to
explore alternative ways of thinking and
acting. San Fancisco: Jossey-Bass.
the face of blunt inaccurate opposition. While
‘asking critical questions about our previously
accepted values, ideas and behaviours can
be anxiety-producing… (it is only) as we
abandon assumptions that had been inhibiting
our development, we experience a sense of
liberation.’3
Having now actively practised the art
of critical reflective analysis of responses
to a variety of incidents, I have a newfound appreciation for the conceptual and
theoretical aspects of why we need to
continuously engage in and develop the
Helping people
self-manage
their diabetes
Diabetes Australia provides an overview
of new support services currently available
34
Image courtesy of Diabetes Australia.
BRIEFING
W
ith the ever-growing
136 588), which, in addition to ordering
to have a screening test for type 2
prevalence of diabetes,
NDSS products, can be used to get advice
diabetes are also distributed.
a complex chronic health
from health professionals and to find
Efforts to further expand diabetes
condition that requires
out more about local NDSS and other
management resources were marked by
close monitoring and potentially significant
health services. A further feature of the
the release of a new range of resources
lifestyle adjustments, all people in
scheme is the provision of information
in December 2014, launched by the Hon.
Australia diagnosed with diabetes should
about healthy eating programs, physical
Peter Dutton, former Minister for Health.
be registered on the National Diabetes
activity programs, as well as group support
These resources have been developed to
Services Scheme (NDSS). This helps ensure
programs – such as support for those newly
assist Aboriginal and Torres Strait Islander
that they have access to the wide range of
diagnosed with diabetes,
support services available to assist them,
peer support for people
their families and their carers to learn
with type 1 diabetes
about managing life with diabetes.
or young people with
Currently, more than 1.2 million
diabetes. The scheme
Australians have registered on the NDSS.
also directs the creation
This number is growing by around 100,000
and distribution of fact
people every year, which is equivalent to
sheets, brochures and
275 people each day. Generally providing
other information about
services and programs free of charge,
diabetes, as well as
the NDSS helps people self-manage their
information about various
diabetes as well as access to affordable
health professionals
products, such as subsidised blood
who can assist in the
glucose testing strips; subsidised urine
self-management of the
testing strips; free insulin syringes and
condition.
peoples; older
Currently, more than
1.2 million Australians
have registered on the
NDSS. This number
is growing by around
100,000 people every
year, which is equivalent
to 275 people each day.
Generally providing
services and programs
free of charge, the
NDSS helps people
self-manage their
diabetes while also
giving them access to
affordable products.
people with
diabetes;
women with
diabetes who
are planning
a pregnancy,
or who are
pregnant; and
people with
diabetes from
culturally and
linguistically
diverse
communities.
The resources
pen needles (for people using insulin
To help increase
or an approved non-insulin injectable
literacy and autonomy
medication); and subsidised insulin pump
around diabetes self-
consumables (for people with type 1
management, greater
diabetes and gestational diabetes). Such
awareness of gestational
products can be obtained through NDSS
diabetes is required.
Agents and NDSS Access Points (e.g.
Gestational diabetes is
community pharmacies), which can be
associated with higher than normal blood
Resources/. To request a hard copy please
found online using the NDSS Online Services
glucose levels during pregnancy, and thus
contact the NDSS Infoline on 1300 136 588.
Directory at osd.ndss.com.au. All products
an increased risk of developing type 2
can be ordered by phone, mail, fax, email
diabetes for both the pregnant woman and
or online and can be delivered directly
her child. As part of the NDSS, a National
to the person with diabetes. Postage of
Gestational Diabetes Register (NGDR)
An initiative of the Australian Government, the
NDSS products is free. Further information
has been established to assist women
NDSS is administered by Diabetes Australia
on how to order products is available
diagnosed with gestational diabetes, and
and delivered through state and territory
from http://ndss.com.au/en/About-NDSS/
their families, to understand how to take
diabetes organisations. Further input and
Product-and-Supply/.
steps to reduce the risk of developing type
support is provided from two key national
2 diabetes in the future. Registrants of the
health professional organisations dedicated
subsidised diabetes management
NGDR are notified by the NDSS to visit their
to diabetes in Australia: the Australian
products, another key service included
GP for a glucose tolerance test once their
Diabetes Society and the Australian
in the scheme is the NDSS Infoline (1300
baby is born, and annual reminder letters
Diabetes Educators Association.
In addition to providing access to
are available
online at http://
www.ndss.com.
au/en/AboutNDSS/NEWS/
Launch-of-NDSSha
‘Nursing practice CEP 05’ by University of the Fraser Valley.
Image The
sourced
from Flickr
(CC BY 2.0:•https://flic.kr/p/hJACYz).
36
Health
Advocate
APRIL 2015
BRIEFING
BRIEFING
MARTIN HOPKINS
PhD Candidate and Lecturer
Murdoch University
Violence against
nursing students
The need to better prepare our future nurses to
manage the challenges of clinical placements
when it comes to treating aggressive patients
A
s a former emergency
profession. This is a real shame because it
though, there are lots of courses available
department nurse, I’ve worked
shows we have students who are leaving
to post-graduate staff and that tends to be
in some very busy clinical
before they’ve even begun their career.
on an individual facility basis.
Some of the reported incidents have
One of the issues is that there is no
aggression and violence on a daily basis.
been considerable, and have the potential
directive from any nursing bodies about
I’ve since become passionate about A) how
to cause life-threatening injuries; we
how to address this problem, and there is
to prevent it and B) how we can deal with
had people who were bitten, slapped,
no benchmark or gold standard that says
it as nurses.
kicked and punched. One of our third year
what we should be aiming for.
environments and encountered
Moving into the world of academia as
a lecturer, I was curious as to whether
students were exposed to the same levels
students even had an attempted stabbing
As part of this study, we have realised
that we can’t really prevent a lot of the
on them.
I don’t think students consciously think
aggression and violence because it’s
of aggression and
they’ll face
manifested through so many different
violence as registered
aggression
mechanisms. But, what we can do is better
and violence
prepare our students to deal with it and
when they
build some resilience in them to cope with
begin their
these situations.
nurses. I realised that
there was actually
nothing reported from
Australia about nursing
students, and very
little globally as well.
As a result, I
interviewed 150
students undertaking
clinical placements in
Perth hospitals — the
results were surprising.
While I expected
a level of aggression
The impact that aggression
and violence is having
on students is really
significant, to the point
where we have had
students say that they have
considered leaving the
profession. This is a real
shame because it shows
we have students who are
leaving before they’ve even
begun their career.
and violence to be
nursing
Here at Murdoch University, we’ve
education.
implemented an education strategy and
While it’s
had some very positive results. What I
unwritten
have done is integrate aggression and
that nurses
violence education into the undergraduate
are subjected
curriculum, scaffolding it through the three
to aggression
year training. This is because what the first
and violence,
year students require in their first semester
no one has
is very different to what the third year
really looked
students require in their last semester, and
at whether
we structure the curriculum accordingly.
nursing
Through these kinds of activities, we can
experienced by our nursing students,
students are. Therefore, there is nothing in
help prepare students for the personal,
I didn’t expect it to be so high. More
the undergraduate program to address it.
emotional and psychological impacts that
importantly — and what is more concerning
There may be ad hoc education looking at
nursing can have on individuals entering
— is the impact it is having on them.
aggression and violence in certain places,
the profession. As my research has shown,
but there is certainly nothing across the
aggressive incidents — even if not physical
is having on students is really significant,
board to say that this problem exists and
— can have a considerable and negative
to the point where we have had students
how it can be addressed. In terms of post-
impact on nursing students. That is
say that they have considered leaving the
registration and clinical environments,
definitely something we need to rectify.
The impact that aggression and violence
ha
Dr Bob Walker with patients. Image
courtesy of Tasmania Medicare Local.
M
any general practitioners across
advice. Such a model can be particularly
professionals can learn from each other and
Tasmania have embraced the
important in rural areas where access to
work to enhance health care delivery.”
idea of integrated care and,
allied health and other service providers can
together with Tasmania Medicare
present challenges and transport to regional
conference rooms and operating theatres,
centres may not always be an option.
practice manager Mandy White said the large
Local (TML), have been working closely with
other health providers to improve patient
The Lindisfarne Clinic’s practice principal
With consulting rooms, treatment rooms,
scale to which the Lindisfarne Clinic can
outcomes. While integration can take many
Dr Bob Walker said the face of general
offer rooms to allied health practitioners
forms, one model — such as that used by
practice was changing “for the better”
has significantly enhanced the delivery of
the state’s Lindisfarne Clinic near Hobart —
with the inclusion of
allows people to see a variety of providers
these allied health
in the same location, thereby reducing the
services. “Our clinic has
need for multiple referrals and assessments.
been purpose-designed
The clinic has extended allied health
for GPs of the future,”
primary health care services to
“Our clinic has
been purposedesigned for GPs
of the future”
the local community. “Co-located
general practitioners conduct
their individual practices at the
clinic but enjoy the economies of
scale with shared administration,
services available at the site to include
Dr Walker said. “The
access to a lactation consultant and sleep
opportunity to meet,
technician. The clinic now covers a broad
discuss and share experiences
range of services, from psychology and
onsite is invaluable, both in formal education
speech pathology to sleep consultancy,
sessions as well as informally in the staff
more integrated care and other new ways of
physiotherapy and feeding and lactation
room where nurses, doctors and allied health
working can be challenging, several practices
38
practice nursing support, leave
and after hours care,” Ms White said.
While accessing resources to implement
BRIEFING
The
changing
face of
general
practice
How Tasmania Medicare Local
is working towards an integrated
model of primary care
in Tasmania have been able to do this
“A portion of the funds has also been used
their family. “It is also a partnership with
effectively. For example, the Patrick Street
towards improving the clinic’s telehealth
allied health and other health professionals to
Clinic at Ulverstone received a $500,000
communication and e-health initiatives,”
provide a connected and collaborative service
Primary Care Infrastructure Grant in 2011
Dr Djakic said. “Video conferences between
where the GP is at the centre of their care,” Ms
from the then Department of Health and
a patient and a GP, in particular, are a great
Brain said. “We see the aim of care in general
Ageing to expand its practice. The funding,
alternative to face-to-face consultation
practice is to increase patients’ knowledge,
which was matched by an investment by
which can be conducted without devaluing
encourage independence and enhance self-
the clinic, has been used to support the
the clinical experience. “This system will
management for improved health outcomes.”
provision of a range of allied health and
enable us to continue coordinating and
other services. These include physiotherapy,
providing comprehensive, whole-patient
Tasmania Medicare Local supports general
gym, pilates, Australian Hearing’s visiting
medical care with a focus on convenience
practices and other primary healthcare
audiology service, nutrition and dietetics,
and accessibility.”
psychologist, care coordination, and health
Another way general practices are providing
ha
providers focused on connecting care.
It does this through programs including
education and group education programs;
integrated care is through the employment
care coordination, Australian Primary Care
all of which operate onsite.
of a practice nurse. Patrick Street Clinic
Collaboratives, and eHealth, such as securing
Dr Emil Djakic says the practice welcomed
nurse manager Sharon Brain said integrated
messaging and electronic discharge initiatives.
the improved access to specialists and better
care for practice nurses meant responding
It has also been successful in its application
health outcomes that the new resources
to a patient’s health needs and working in
to become the Primary Health Network for
and infrastructure were expected to deliver.
partnership with them, their carers and
Tasmania from 1 July 2015.
IN DEPTH
CHRIS CARTER
Chief Executive Officer
Inner North West Melbourne ML
Collaborating for
better health
A partnership to benefit Melbourne’s inner north-west
A
cross Australia, chronic and
complex care needs are straining
providers in our region.
Recognised principles of partnering and
our healthcare resources. Data
information have informed the development
from the Australian Institute
and ongoing management of the collaborative.
The goals of the first two years have been
achieved and there is good progress towards
the longer-term goals.
A key purpose of the collaborative is
of Health and Welfare shows that chronic
The collaborative commenced with the
to improve the patient journey, creating
conditions increase with age and can
development of a strategic directions
smoother transitions through a better-
be characterised by complex causality,
document that clearly articulates the shared
coordinated system. This is being achieved
multiple risk factors, long latency periods,
goals and purpose of the partnership and
directly through work at the project level
a prolonged course of illness and functional
commitment of resources to develop and
and indirectly through changes in policy,
impairment or disability. Care that is poorly
implement flagship projects as a focus for
culture and routine practice in partner
integrated and uncoordinated is ineffective
working together. The initial four projects
organisations. The following broad areas
and costly. If we continue delivering
included diabetes pathways and systems,
of achievement are being pursued.
care in this way, hospital admissions for
chronic kidney disease service coordination,
the treatment of chronic conditions will
improving ICT interfaces and eHealth, and
settings: Through the collaborative, new
increase to unsustainable levels. Clients
lower back pain clinics. A fifth project on
primary care pathways are being developed
will continue to receive disjointed services
advanced care planning was recently endorsed
for patients with chronic disease. The back
and they will not be empowered to manage
by the Chief Executive Group and work is
pain project includes specialist triage at the
their own health.
underway on scoping this project.
Royal Melbourne Hospital from orthopaedic
In July 2012, cohealth, Inner North West
The framework articulates our common
Encouraging healthcare in community
and neurology wait lists and referral into
Melbourne Medicare Local (INWMML),
goals and includes the following indicators
community-based back pain treatment clinics,
Melbourne Health and Merri Community
of success.
thereby reducing time to treatment and
Health Services formed an innovative
partnership to improve care in Melbourne’s
inner north-west. These four partners each
play a unique role within the healthcare
system in the catchment and all made a
commitment to work together to trial and
then mainstream different service delivery
models to improve the coordination of care
for patients.
A formal collaborative framework outlines
our shared commitment to improve patient
Within two years:
• Two collaborative projects/programs
at the Royal Melbourne Hospital
areas;
reduced;
• Annual Collaborative Forums
established;
• Shared understanding of the population
and health needs documented;
• Strategic Plan for the region developed
a common goal of patients receiving the
• Shared Evaluation Framework
the right setting. All four partners share a
commitment to jointly plan and redesign
healthcare, particularly across the acute/
primary interface, so that we can better
meet the needs of patients and healthcare
40
• New to follow up outpatient ratio
implemented to address priority
care, outcomes and pathways and to support
right type of care, at the right time, in
Within five years:
developed to measure the
effectiveness of collaboration; and
• Scope and develop an agreed position
• Collaborative presentations on
integrated service models delivered;
• Collaborative research projects
established to provide academic focus
to priority area projects/programs;
• Two collaborative projects are
mainstreamed in priority areas;
• Joint research grants awarded; and
• Mechanism for collecting and analysing
on a region based Electronic Medical
client feedback on their journey
Record.
through the system established.
Healthcare on the move.
Image courtesy of INWMML.
providing care closer to patient’s homes.
Enhancing workforce collaboration:
the collaborative is not a separately funded,
Improving quality of healthcare: Service
Cross-system care coordination strategies are
one-off ‘project’ of the partner organisations:
quality to patients is being enhanced through
improving communication and data sharing
rather, it represents an ongoing commitment by
the development and use of quality guidelines,
between GPs, health services and community
four key health organisations in one geographic
service directories and clinical pathways.
healthcare providers. This collaboration is
catchment to improve the design and delivery
For example, the chronic kidney disease
building wider professional communication and
of healthcare across the care continuum.
project has developed a screening tool for
networks. Whilst engagement of managers and
use in community health settings and the
clinicians in the collaborative has increased
leadership and commitment, and the
diabetes project is piloting GP practice-level
understanding amongst the partners of each
evaluation to date indicates that there is
quality improvement strategies including
other’s role in the care continuum, additional
strong support for the partnership amongst
data mining and providing multi-disciplinary
plans are being developed for shared training
stakeholders. Evidence is emerging that the
care in partnership with hospital clinicians.
and leadership opportunities to facilitate this
collaborative is contributing to the cultural
In addition, 21 diabetes clinical pages have
alignment.
change required to provide better coordinated
been developed as part of the HealthPathways
Improving system connections: A joint
The collaborative has required significant
care to patients and to better manage
program and an annual consumer diabetes
commitment to increasing the take-up of
our resources. We hope that collaborative
forum has commenced.
the Person Controlled E Health Record
leadership across the care system is recognised
(PCEHR) across the catchment is resulting
as essential for improved outcomes within the
Work is progressing innovative models of
in improved transfer of information across
Australian healthcare system, and that work
primary care that deliver evidence-based
the acute and primary care sector. For
such as this is supported and expanded.
practice supported by hospital specialists.
example, cohealth GPs are using the PCEHR
Models that support inter-sectoral and
with their patients and a chronic disease
cross-profession knowledge sharing can
project based from the Royal Melbourne
Inner North West Melbourne Medicare Local
improve coordination of services for patients
Hospital will be focused on increasing
is part of a consortium that will constitute
living with, or at risk of, chronic healthcare
meaningful use of the PCEHR through increased
the North West Melbourne Primary Health
conditions.
uploads of health summaries. The work of
Network from 1 July 2015.
Improving local service coordination:
ha
BRIEFING
Helen Keleher
Adjunct Professor, School of Public
Health and Preventive Medicine
Monash University
The power of
partnerships
Vehicles for primary care reform
M
any ideas have been put forward
about how to reform the primary
care sector, as governments seek
to reduce expenditure and shift
costs to individual consumers. Debate has
been polarised around co-payments at the
level of individual consultations, but broader
systems thinking is needed for cost savings to
bite. Systems-thinking requires investment in
infrastructure at local and regional levels to
enable health providers to be involved in the
building of solutions to systemic problems.
We might think of doctors, psychologists,
physiotherapists, or speech and occupational
therapists as one-on-one health professionals
working by and large in isolation from each
which have been developed by partnerships
of health professionals in conjunction with
Medicare Locals. Many of the new Primary
Health Networks will have opportunities to
build on these initiatives.
There is much to be gained, not just across
the primary care sector and the broader health
system but intersectorally if more attention
were paid to partnerships. This is because
collaborative action can bring about reforms.
As organisations and individuals learn about
each other, they also learn what resources
are available, what skills are held in which
agencies, and what those agencies are funded
to do. Collaborative advantage is what happens
when a partnership finds:
fests — health providers don’t have time to sit
around chatting. Partnerships are successful
when people have a business approach
to achievement and a constant sense of
momentum. To work in this way, they need
support to develop quality evidence briefs,
to maintain the rhythm of the partnership,
develop a business case, redesign and
redevelop the delivery of care, implement
strategies and have their progress evaluated.
However, health providers don’t have the
luxury of doing the hard yards required to
actually do the implementation, and that is
where Primary Health Networks will have a
vital role.
Partnerships require backbone support by
other, and certainly in isolation from other
• synergies;
an organisation dedicated to coordinating
sectors. But in primary care, evidence is
• how best partnering organisations can
the work processes of the partnerships and
emerging that supporting these health
work together to drive the delivery of
the collaborators involved in the initiatives.
professionals to collaborate and work with
outcomes; and
Medicare Locals/Primary Health Networks
other sectors through partnerships on
• that each organization, through the
are these kinds of organisations. An exemplar
specific projects can produce dividends.
collaboration, is able to achieve its
is The Peninsula Model for Primary Health
Collaborative ways of working increase the
own objectives better than it could by
Planning for which the Frankston-Mornington
impact of individuals and organisations
working in isolation.
Peninsula Medicare Local is the backbone.
with multiple advantages.
Health professionals are very well aware
of what doesn’t work well in the systems
they work with, but rarely are they given
opportunities to develop new approaches.
Secure messaging and electronic referral
systems, streamlining the myriad of Advance
Care Planning tools and working with the
local aged care sector to increase their use,
increasing cancer screening rates across a
local population, using telehealth to link GPs
with Residential Aged Care Facilities to reduce
presentations to Emergency Departments,
reducing the burden of alcohol and drug abuse,
or the prevention of violence against women
and children — these are all programs of work
42
This means, for example, that a Local
Hospital Network working alongside health
providers, and local governments, nongovernment organisations, government
departments and local citizens, can use
partnerships and collaboratives to increase
their own impact, while working more
broadly on outcomes that impact on their
own business.
It is difficult to show causal relationships
between partnerships and outcomes, so
it is critical that partnerships work from a
strong evidence base, and use a program
logic approach to service development
and when appropriate, a theory of change.
Partnerships working on reform are not talk-
This collaborative model demonstrates the
value and advantages that can result from
collaborative action. The support provided by
backbone infrastructure keeps people around
the table, ensures that effort is maintained,
and that momentum is constantly moving
towards desired outcomes.
As Primary Health Networks evolve, they
will have a common purpose: to strengthen
the capacity of organisations to improve both
individual and population health, and reduce
health risks. There is significant potential
for reforms to be implemented at local and
regional levels through the expertise and
energy for better ways of working that a
collaborative provides.
ha
‘_MG_2726’ by Danijel James. Image sourced
from Flickr
(CC BY 2.0:
https://flic.kr/p/ppZoNe).
The Health
Advocate
• APRIL
2015 43
:
w
o
n
R
E
REGIST sn.au/events
a
hha.
www.a
Root Cause Analysis Workshop
If you are a frontline clinician or clinician manager, join this one-day
workshop and develop your skills in measuring patient harm and
undertaking clinical investigations of sentinel events.
The workshop will give participants an understanding of root cause
analysis methodology and provide them with a prevention strategy
framework for avoiding or managing events that may lead to patient harm.
Participants will be invited to engage in reflective discussion throughout
the workshop and will together conduct an audit using one of the patient
harm detection methods.
The workshop – also suitable for patient safety officers, quality
improvement officers and clinical risk managers – is presented by the
Australian Healthcare and Hospitals Association in collaboration with
Peloton Health Care Improvement Consulting.
44
Short course dates
Sydney
7 May 2015, Novotel Sydney Central
Melbourne
13 May 2015, Mantra Southbank
Brisbane
17 June 2015, Novotel Brisbane
Limited places available.
Contact us
T: (02) 6162 0780
Who’s moving
Readers of The Health Advocate can track who is on the move in the hospital
and health sector, courtesy of healthcare executive search firm, Ccentric
T
erry Welch has moved to
Australia from his position as Vice-President
Leon Berkovich has recently joined
Maryborough District Health
and Dean at the University of Manchester
Southern Sun Healthcare as their new Chief
Service as Chief Executive Officer,
as well as Director of the Manchester
Executive Officer. He was previously the
previously as Chief Executive
Academic Health Science Network.
Chief Operating Officer for GE Healthcare.
Officer at Yarrawonga District Health
Service.
Matt Kropman has moved from his
role at Director Junior Medical Workforce
Martin Bean, who has been the ViceChancellor of The Open University in the
Shane Thomas, Associate Professor
with Northern Health and has accepted
United Kingdom since 2009, has returned
and Executive Director of International
the position of Director Medical Workforce
to Australia to take up the position of
Academic Engagement at Monash University,
with Alfred Health.
Vice-Chancellor and President of RMIT.
Elizabeth Forbat, a Reader in Cancer
is moving to South Australia to become the
Tim Daniel has moved to Greenslopes
new Pro-Vice-Chancellor (International) at
Private Hospital as Chief Executive Officer.
and Palliative Care at the University
the University of Adelaide.
Previously he was Chief Executive Officer
of Stirling, is moving to Australia to
at Westmead Private Hospital.
become Professor of Palliative Care at the
Rebecca Graham has been promoted
within SA Country Health Local Health
Anton Peleg has become the new
Australian Catholic University and Calvary
Health Care ACT.
Network. Previously Executive Director of
Professor-Director of Infectious Diseases
Mental Health, she is taking on the position
at Alfred Health. He was previously the
of Chief Executive Officer.
Associate Professor of Infectious Diseases
Health division of the North Metro Area
and Microbiology at Alfred Health and
Health Service in Western Australia to take
Monash University.
up a position as Chief Psychiatrist in South
Andre Nel has moved to Western Health
as Executive Director Medical Services.
Dr Nel was previously in a similar role at
Bendigo Health.
Ian Jacobs has just started in the roles
Lexie Spehr, Executive Director and
Director of Nursing at Redcliffe Hospital,
Aaron Groves is moving from the Mental
Australia.
Tarun Bastiampillai has recently
has taken on the position of Executive
accepted the position of Director Mental
of Vice-Chancellor and President of the
Director of Nursing and Midwifery at Metro
Health Strategy with South Australia
University of New South Wales. He moved to
North Hospital and Health Service.
Health.
Helen Palmer has recently moved from
Capital Day Surgery to the position of
Perioperative Services Manager with Calvary
Health Care Riverina.
Kerryn Dillon has moved from a role as
Director of Broadreach Employee Relations
to take up a role as General Manager
People and Culture with TLC Aged Care.
Christine Bessell will shortly leave
her role as Executive Director Medical
Services at the Royal Women’s Hospital
in Melbourne to take up the position of
Executive Director Medical Services at the
Royal Victorian Eye and Ear Hospital.
ha
If you know anyone in the hospital and health
sector who’s moving, please send details to the
Ccentric Group: [email protected]
Become an
AHHA member
Help make a difference to health policy, share innovative ideas
and get support on issues that matter to you – join the AHHA
T
In partnership with the LEI
he Australian
the AHHA, you will gain access
and workshops; and helps
Healthcare and
to AHHA’s knowledge and
policymakers, researchers and
Group, the AHHA also provides
Hospitals Association
expertise through a range of
practitioners connect when
training in ‘Lean’ healthcare
(AHHA) is an
research and business services.
they need expert advice.
which delivers direct savings to
The AHHA’s JustHealth
the service provider and better
independent national peak
The Deeble Institute for
body advocating for universal
Health Policy Research was
Consultants is a consultancy
outcomes for customers and
and equitable access to high
established by the AHHA to
service exclusively dedicated to
patients.
quality healthcare in Australia.
bring together policy makers,
supporting Australian healthcare
practitioners and researchers
organisations. Drawing on
developments across these
engagement and experience
to inform the development of
the AHHA’s comprehensive
various health research, policy
with the acute, primary and
health policy.
knowledge of the health sector,
and training spheres, the AHHA
community health sectors, the
In joint collaboration with
JustHealth Consultants provides
publishes its own peer-reviewed
AHHA is an authoritative voice
our university partners and
expert skills and knowledge in
journal (Australian Health
providing: strong advocacy
health service members, the
areas including: corporate and
Review), as well as this health
before Ministers and senior
Institute: undertakes rigorous,
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Advocate).
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To learn more about these and
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Briefs; conducts conferences,
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other benefits of membership,
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visit www.ahha.asn.au
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By becoming a member of
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Making connections across the health sector
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experience knowledge expertise * understanding
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The Health Advocate
• APRIL
2015
Phone: 02 6162 0780
Fax: 02 6162 0779
Email: [email protected]
Post: PO Box 78 | Deakin West ACT 2600
Location: Unit 8, 2 Phipps Close | Deakin ACT 2600
AHHA Council
and supporters
Who we are, what we do, and where you
can go to find out more information
AHHA Board
Mr Andrew Harvey
Ms Emily Longstaff
The AHHA Board has overall
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including the strategic direction
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Membership enquiries
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Contact details
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publication of the AHR are:
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Membership.
ISSN 2200-8632
The Improvement Challenge
How local health performance information creates opportunities to improve rural and
remote health outcomes | 24 May 2015
This is a workshop designed to help rural and remote health
service managers, clinicians, consumers and researchers
make better use of data to improve patient experiences and
outcomes.
The workshop will focus on data and evidence available to
Local Health/Hospital Networks and to the new Primary
Health Networks that are due to begin operations on 1 July
2015. The workshop will also explore both international and
Australian experiences with performance measurement
and will equip participants with a greater understanding
of the local health data available to them and how it may
be best used for improving health service and healthcare
performance.
Participants will have the opportunity to identify data they
need, even data that may not yet be available, and to have
a conversation with key government and non-government
agencies about the practical support they need to measure
48
and improve health service performance and the health and
wellbeing of the people within their region.
Speakers will include Alison Verhoeven, Chief Executive of the
Australian Healthcare and Hospitals Association, Diane Watson,
Chief Executive of the National Health Performance
Authority, a senior officer from the Federal Department
of Health, and health care managers and researchers
experienced in rural and remote healthcare delivery.
The Improvement Challenge is hosted by the Australian
Healthcare and Hospitals Association and the National Health
Performance Authority ahead of the National Rurul Health
Alliance’s 13th National Rural Health Conference (24-27 May,
Darwin Convention Centre, NT).
For more information, or to register, visit www.ahha.asn.au
or contact the AHHA at [email protected] or on
02 6162 0780.

The Health Advocate - April 2015

Transcription

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