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Volume 13, Issue 2 – April 2019

Clinician Connect

Guest editorial

Ming Loh

Responding collaboratively to complex challenges

Ming Loh, Geriatrician, Northern Beaches Hospital
Chair, Leading Better Value Care Hip Fracture

One of my old friends works in venture capital and has evolved into something of a mentor for medical IT startups. I’m often struck by two key aspects to his line of work: an unyielding thirst for cross-discipline expertise and the powerful assumption that ‘someone else out there is doing this better’.

Creating augmentative teams is almost reflexive for startups, as are the skillsets required to integrate and share the expertise. This is particularly telling in the smaller startups that clearly have to be nimble to survive. The success of the project is not determined by the idea – the ideas are universally good by the time the startup is underway – it’s the composition of the team and the infrastructure around team communication and leadership that determines resilience and survival.

Atul Gawande was asked at the Sydney Writer’s Festival a few years ago what was the next step in the evolution of medicine. Without hesitation he spoke of the need for doctors to learn how to work as teams.

The respect for evidence-based medicine was implicit, but the inference was that the next revolution in medicine would be based on the shifts in how we arrange our health workforce.

In many ways our drift towards specialisation has created silos within our practice. Funding flows through departments restricted to single specialties. Allied health staff often have offices far removed from their medical colleagues (sometimes in neglected dark corners of the hospital). Nurses don’t always have line of sight on the consultant of a team. College level collaboration is improving but still remains an underdeveloped arena. Are there missed opportunities here?

This is particularly pertinent in hip fracture surgery where speed is imperative to improve patient outcomes. There are many stages to hip fracture care, each involving a multitude of clinicians. It is often the failure of a single stage that unravels the patient’s disposition. It has been obvious when reviewing hip fracture services through the Leading Better Value Care (LBVC) Hip Fracture project that successful orthogeriatric teams display one universal capability: dynamic interdisciplinary collaboration.

I think the ACI provides that unique platform for clinicians to overcome the suffocation of medical silos. There are few other avenues for a clinician to reach across to like-minded clinicians from parallel disciplines. There are few opportunities for passionate, younger clinicians to reach up through local health district (LHD) structures and influence healthcare at a state level. The Strategic Plan 2019-2022 outlines how the ACI is positioning itself to enable both prospects in the formation of the directorates as well as the ability to scale up proven innovations to large-scale implementation.

There are challenges no doubt. The ACI has always been a broad church committed to inclusivity and projects can be at risk of being too broad to be effective. The implementation of guidelines at state level across multiple LHDs and negotiating different local challenges can be complex. There are responses to these challenges within the strategic plan and commitments that should show clinicians what opportunities for improving patient care can be created by working with the ACI.

We have found many innovations in perioperative medicine led by dedicated heroic clinicians, including nurses, physiotherapists, surgeons, physicians, anaesthetists, who are often ‘doing this better’ unsung and unfound. It has been a real adventure digging up these innovations through the LBVC Hip Fracture project and disseminating these across the LHDs.

I would like to extend sincere thanks to all those who have given their time to participate in the committees, teleconferences and workshops and I invite you to review the hip fracture work as it unfurls over the next year.

Chief Executive comment

Dr Jean-Frédéric Levesque

The future of healthcare, healthier futures

Jean-Frédéric Levesque

The Agency for Clinical Innovation is now in its 10th year of existence. The organisation has grown from the work of various clinical networks and now produces a wide range of resources that support better healthcare for patients through the production of clinical guides and models, through healthcare redesign and co-design, and through the design, implementation and evaluation of innovations across NSW. Ahead of this important milestone, the ACI has revised its strategic plan, recognising the need to both support clinical innovations and be innovative in doing so.

I’m pleased and excited to share with you the ACI's new Strategic Plan 2019-2022. In developing this plan, we sought input from internal and external stakeholders, interviewed similar organisations from around the world, and assessed and evaluated the ACI’s unique role and work to date. This plan articulates the ACI’s vision, purpose and commitment to addressing complex challenges. We are committing to strategic directions that will enable the innovations we introduce to be:

  • person-centred and focused on the needs of patients in all aspects of their health
  • clinically-led, as clinicians working in hospitals are best placed to lead changes that affect their work and capacity to deliver care for patients
  • evidence-based to ensure the most appropriate use of resources, using clinical and empirical evidence
  • value-driven for everyone who interacts with the health system.

We are energised by this plan, but the real work lies ahead of us: it’s time to put it into action. It wasn’t our goal to produce a document that gathers ‘digital dust’. We look forward to bringing patients, clinicians and managers together to support innovation, design and implementation in 2019 and beyond. Thanks to those of you who provided feedback to inform our strategic planning.

We look forward to building on our successful model of clinician leadership and the recent streaming of networks into clinical specialties to tackle broader system challenges. Our work is collaborative and we will continue to engage widely, both within and outside of the NSW Health, to make strides towards achieving our vision: to create the future of healthcare, and healthier futures for the people of NSW.

Improving the management of vision impaired and blind patients in NSW

Ophthalmology Network Manager

Work is underway in Bankstown and Fairfield hospitals in South Western Sydney Local Health District to explore ways to provide better care for patients with vision impairment. This project arose from the Ophthalmology Network’s Eyes on the Future forum, in mid 2017, where NSW Health staff feedback identified uncertainties about caring for these patients.

To date, multiple consumer focus groups have been held in conjunction with Vision Australia to collect information to understand the hospital experience of people who are blind or have low vision. Interviews have also been conducted with staff and patients at Bankstown Hospital to understand current practice and potential solutions. Some key issues identified include admission, food service staff knowledge of vision disorders and patient orientation to their wards.

The project team is currently working on solution design, with the goal to co-design a resource with patients and staff which provides a clear guidance to NSW Health staff about the safe inpatient management of vision impaired and blind patients across NSW. Implementation of agreed solutions to start in the latter half of 2019. For further information please contact Sarah-Jane Waller, Ophthalmology Network Manager.

ICU Exit Block Project capability training

Clinical Project Officer

The ICU Exit Block Project, which takes a whole of hospital approach to optimising intensive care capacity, is now in full swing. Site project teams from across NSW converged in Sydney in early February for initial training. Each facility received an introduction to the important aspects of project management, including sponsorship, communication and engaging staff in change.

Following the two-day workshop, the ACI team followed up on-site and provided phone support for each facility to help implement their projects locally.

In March, teams returned to Sydney for two more days of training, which focused on using diagnostic methods to assess and understand the current state of the ICU and hospital facilities.

The ACI, along with the Ministry of Health Whole of Health teams, will continue to provide support to sites for 12 months, including implementation packages, further training, and remote and on-site support. Later in the project, sites will work towards implementing one ICU specific and whole of hospital strategy from the Guiding Principles to Optimise Intensive Care Capacity.

The project will expand at a later date, so additional sites with an interest will have an opportunity to participate. If you are interested, please contact Leesa Hawkins, Clinical Project Officer, Intensive Care NSW via email to Leesa.Hawkins@health.nsw.gov.au

Read more about the ICU Exit Block project


ICU Exit Block Project teams from across NSW come together to share idea. Photo: J Wragg.

Public messaging about scald burns

Manager, Statewide Burn Injury Service Network

Did you know that scald burns account for about half of all patients who are treated at a burn unit in NSW, according the Statewide Burn Injury Service (SBIS) Data Registry?

Scald burns are very commonly associated with beverages such as cups of tea and coffee, and it is children under age five who are most at risk. In 2018 almost 200 children were treated in a NSW burn unit for this type of injury; 87% of whom were under five years old. Many of these patients have permanent scars.

Burn prevention often focuses on education of the general public to prevent small children and others getting burnt from cups of tea and coffee. People should not hold a baby whilst drinking a hot beverage and keep young children away from hot drinks (for instance, by placing cups of hot drink on high surfaces away from the edge and away from easy reach).

The SBIS Burn Prevention Committee is continuing to raise public awareness of this issue and reduce public messaging featuring unsafe behaviours. Recently, the committee submitted a complaint to Ad Standardsregarding an advertisement showing a hot beverage dangerously close to an infant, in addition to other unsafe behaviours.

As a result of the complaint, the company voluntarily withdrew the advertisement featuring the dangerous behaviour.

Supporting service redevelopment and clinical service planning in Southern LHD

In February, a small planning team from Southern NSW LHD and Rob Wilkins (ACI) developed a series of eight model of care planning workshops in Batemans Bay, Eurobodalla.

The workshops were developed to support the Eurobodalla Health Service redevelopment and ongoing clinical service planning process which aimed to:

  • review population and service utilisation data
  • consider current and future service configurations to meet population need
  • articulate service levels, partnerships and resourcing required to meet these across all clinical service streams.

Hundreds of clinicians, service managers and consumers participated in the workshop series. Subject matter experts from the NSW Ministry of Health and the ACI also participated.

The workshops provided a unique opportunity to discuss, debate and consider innovative ways of working to address future population need. They resulted in documented high-level models of care which will be used to further inform clinical service planning and related workforce requirements moving towards the redevelopment.

The planning team from Southern NSW LHD included Kristi Payten, Manager Health Service Planning, Judith Hallam, Redesign Manager, Lisa Kennedy, General Manager Eurobodalla Health Service. Rob Wilkins provided facilitation services.

Requests to the ACI for assistance with service planning workshops such as these can be made through your chief executive or other senior executive to ACI Chief Executive, Jean-Frederic Levesque.

Participants involved in service planning workshops in Batemans Bay, Eurobodalla.

Scientific activities

Manager, Statewide Burn Injury Service Network

Revised clinical guidelines

The Statewide Burn Injury Service has also released the revised versions of the following guidelines:

These documents have been available for many years and provide useful guidance and management advice for burn patient care.

They have been used by clinicians in metropolitan, rural and remote areas across NSW and have assisted clinicians not only in Australia but also other countries worldwide.


Network Manager, Musculoskeletal Network

2019 Musculoskeletal Network Forum

More than 100 clinicians, managers, researches and consumers attended the annual Musculoskeletal Network Forum, held on 28 February at the Kerry Packer Education Centre in Sydney.

Attendees observed presentations and posters based around the day’s four sessions: innovation, quality, research and system enablers in musculoskeletal health. Presenters from LHDs, the Ministry of Health, the ACI and Australian universities shared knowledge on a range of topics, including:

  • the role of e-solutions to reduce the burden of low back pain (presented by keynote speaker, Associate Professor Paulo Ferreira)
  • recent research in musculoskeletal health, including updates on the World Health Organization Bone and Joint Decade, the Australia and New Zealand Hip Fracture Registry and the Osteoporosis Australia Fracture Liaison Service Audit
  • quality improvement and innovation within LHDs, particularly around LBVC initiatives and acute low back pain
  • LBVC updates, including measurement and patient reported measures.

Congratulations to the presentation award winners:

  • Lyn March Award for Excellence – Katherine Maka and Chrissan Segaram (Westmead Hospital): ‘We’ve Got Your Back’ – Providing Early, Quality, Patient Centred Care
  • Robyn Speerin Award for Patient Centred Care and People's Choice Award for Best Presentation – Victoria Amer (Wollongong Hospital): ‘Getting Healthy’ – Aligning the Osteoarthritis Chronic Care Program with the NSW Get Healthy Service
  • People's Choice Award for Best Poster – Dr Joshua Zadro (Institute of Musculoskeletal Health – Sydney LHD and University of Sydney): Is physiotherapy evidence-based? A systematic review of physiotherapy treatment choices for musculoskeletal conditions.

The event, running since 2011, continues to provide an opportunity to network with colleagues from other sites to exchange support, knowledge and encouragement.


ACI Musculoskeletal Network Team: Sarah Bakonyi (Project Officer), Matthew Jennings (Co-Chair), Robyn Speerin (Emeritus Network Manager), Ian Harris (Co-Chair), Lyn March (Former Co-Chair), Chris Needs (Co-Chair), Julia Thompson (Network Manager), Tim Cooper (Project Officer).


Emeritus Musculoskeletal Network Manager Robyn Speerin presenting the inaugural Robyn Speerin Award to Victoria Amer for patient-centred care.


Network Manager, Palliative Care Network

Reaching out virtually: Two end of life forums

In response to a growing number of requests for targeted education, the ACI Palliative Care Network recently broadcast two virtual forums: a Stroke and End of Life Care webinar in partnership with the ACI Stroke Network and a multi-site forum called Navigating the Language of Dying.

Navigating the Language of Dying explored some of the challenges, benefits and practical strategies to initiating meaningful end of life conversations. Associate Professor Richard Chye, Director Palliative Care at St Vincent’s Hospital Network, opened the session with a patient role play. The conversation was both empathetic and honest, using clear language and avoiding euphemistic terminology.

Kate Munro, End of Life Coordinator from Hunter New England LHD, spoke of the need to ‘connect with compassion’ and highlighted a number of resources to support clinicians to develop their skills in having end of life conversations.

The forum closed with a personal story from Brian Long, the ACI Palliative Care Network Executive Committee consumer representative. Brian spoke about some of the key challenges our health system faces in supporting patients approaching the end of their lives, their families and carers. Brian also provided some valuable insights about building a better system of care.

The technology was again pushed to the limits, with more than 700 clinicians, researchers and consumers registering for the Pexip and livestream broadcasts. Support from the Palliative Care Service Development Officer Network and the Telehealth managers ensured that 75 videoconferencing rooms across NSW were made available.

As demand grows for these kinds of virtual forums, we look forward to working in partnership again to streamline our technologies and to build a platform that reaches as many people as possible, across NSW.


Research Strategy Project Officer

Ivana Goluza Riddell

+61 409 289 642

ivana.goluza@health.nsw.gov.au

Research

ACI Research Grant Scheme 2019: Consultation phase now open

The 2019 round of the ACI Research Grant Scheme is now open.

The purpose of the Research Grant Scheme is to undertake and source relevant, high-quality research that aligns with the ACI mandate, functions, strategic plan and research priorities. Grant funding of $240,000 is available to fund several small to mid-size projects.

This round of funding is focused on supporting translational projects and cross-network projects that span more than one ACI clinical network, taskforce or institute.

Research proposals submitted to the ACI should be multi-method studies, deploying realist evaluation and drawing on disciplines and theories from the clinical and health sciences, and the organisational and social sciences. The research must be conducted in NSW and/or benefit the health of communities in NSW. Projects must be 1.5 years in duration and endorsed by the relevant ACI Clinical Network, Taskforce or Institute.

The consultation process for endorsement of research proposals closes 14 June, and endorsed proposals will be invited to submit a grant application by mid-July. Successful grants will be announced in September.

For more information about application requirements and timeframes, please visit the Research page.

Welcomes and farewells

Stream Manager, Integrated and Aboriginal Care

Regina Osten

+61 2 9464 4637 | 0429 637 131

regina.osten@health.nsw.gov.au

GP Advisory Group Co-Chair update

The General Practitioner Advisory Group (GPAG) farewells Co-Chair Dr Diana O’Halloran AM and welcomes new Co-Chair Dr Walid Jammal.

Dr O’Halloran co-chaired the GPAG for two years, completing her term in October 2018. During this time, she demonstrated outstanding dedication and leadership. She has shown strong commitment to improving patient outcomes and providing equitable access to high quality primary care and through integration of primary, secondary and tertiary healthcare services.

The ACI thanks Dr O’Halloran for her valued contribution as Co-Chair, and is grateful to continue to benefit from her experience and expertise as she continues her GPAG membership.

The GPAG welcomes Dr Walid Jammal as Co-Chair, who was nominated and elected by GPAG members following an expression of interest process.

Dr Jammal has been a GPAG member since 2017 and brings a wealth of knowledge and experience to the role. He has expertise in innovative, team-based, patient-centred models of care and a strong commitment to safety and quality in healthcare.

Dr Jammal joins current Co-Chair Dr Paresh Dawda whose term of office continues until December 2019.


Updates to CATALYST Directorate

The ACI welcomes two familiar faces to the Care Across the Lifecycle and Society (CATALYST) directorate.

Linda Soars returns the ACI as Clinical Associate Director, Acute Care for Children and Older People, and Christen Stubbs transitions from the role of Manager, Audit and Improvement to Network Manager, Emergency Care Institute.

Linda Soars
Linda Soars

Christen Stubbs
Christen Stubbs

Patient Experience Symposium 2019