Visits from the West: the ACI Clinician in Residence
Medical Director, Service 3 – Surgical Specialties & Women, Children & Newborn Services, and Consultant Geriatrician
Fiona Stanley Hospital, South Metropolitan Health Service, WA
You may not have heard of The Sustainable Health Review – but I was the clinician on the panel that produced this West Australian review. It proved an opportunity to step back from my day to day clinical work as an orthogeriatrician at Fiona Stanley Hospital (where I am also a Medical Director). The Review published 30 recommendations, and while some are specific to WA, many are generalisable to other systems in Australia and worldwide.
One of the recommendations was around a systemwide approach to innovation, so I was delighted to be invited to work firsthand for a short period with the NSW ACI as the Clinician in Residence. It is so important that we learn from each other what works and what could be improved in different states – after all we are all trying do the best thing for our patients and we can learn quicker together. It proved to be a real opportunity to have some rare thinking time to reflect on what is already going well in WA and where we can learn from NSW. The flip side of that is where NSW could possibly learn from other states…
The pillars in NSW, created after the Garling Report, provide a clear division in responsibilities between the Ministry of Health, as the regulator and quality assurer, and health system improvements delivered by the pillars – of which the ACI is one. The open way all of the teams shared information and expertise allowed me to clearly understand how NSW benefits from this approach.
In WA, we have only had Board devolved governance for four years but our system is not as big as NSW. While the organisation of the functions required for quality improvement and innovation in NSW is shared between various pillars, other states need to assess their own context to identify the approach that would best suit their level of resourcing and alignment with other existing bodies. Ultimately, there may be different possible configurations of pillar organisations to support the health system in various contexts.
The critical challenge in any healthcare system is how to get the ideal balance between central coordination and local innovation. A centralised approach allows the ACI to deliver support for systemwide change – this should allow change to occur more quickly and with greater consistency. Allowing local tailoring of solutions keeps clinicians engaged and solutions adapted to local conditions – but how much localisation is too much? Which bits of any intervention are critical to successful translation and should be 'mandatory' and which can be localised? Leading Better Value Care has some examples of these challenging questions and I look forward to hearing your answers!
I was very excited to hear about the focus on patient reported outcomes. This really should be a game changer in years to come as we really start to learn where we add value to patients. The challenge is always to let go and agree to stop the things that don’t add value to reinvest in areas where we do. This has always proven very difficult to do, but will be an absolute requirement if we really are to deliver high value healthcare within our always limited resources.
I did reflect on one area where WA did the hard yards. The WA Clinical Services Framework led to a significant reconfiguration of services at the time Fiona Stanley Hospital opened. Some of these changes, such as those around high complexity and low volume services, upper gastrointestinal cancer surgery and cardiothoracic surgery, were resisted by some clinicians at the time, however the evidence is growing that this is leading to better patient outcomes. Brave leadership is required at all levels to deliver this sort of reform.
I hope to maintain the relationships I developed so we can continue to improve patient care and truly deliver sustainable healthcare.
Chief Executive comment
The power of collaboration
The success of the ACI is built on the dedication and professionalism of its staff. It goes without saying that all of us share a commitment to achieving ambitious goals aimed at delivering better health outcomes for patients across NSW.
To achieve these goals, we recognise the importance of learning from the best. The clinician in residence program is designed to bring the best brains to the ACI to help us see from a wider perspective and support our broader goals. To paraphrase Sir Isaac Newton, “If I can see further, it is only by standing on the shoulders of others.”
By focusing on concrete projects, we can gather specific, useful advice from leaders on their field.
Hannah Seymour was the first clinician in residence, and her visit validated our hopes for this program. It was a great opportunity to learn both from her clinical expertise as well as from the recent leadership she demonstrated in the sustainability review. It was also an opportunity to create links to other organisations and develop important mutually beneficial relationships.
During her time with us Hannah reflected on our work, shared her insights, meet key people around the NSW health system, and provided reflections about her stay.
Her editorial in this edition of Clinician Connect describes some of these reflections that we are pleased to share.
It was a true privilege to have her at the ACI over the last few months and we hope that this will generate a long-lasting collaboration.
As is the regular pattern here at the ACI, there is the pleasure of welcoming new faces to the team as well as the sadness of saying goodbye to valued colleagues. I know though that everyone commits their best during the time they spend with the Agency, and the past few months have demonstrated that again and again.
Earlier this month, I had the pleasure of attending the co-design guide and collaborative culture e-tool launch with the Minister for Mental Health, Bronwyn Taylor MLC. Designed to enhance collaboration in the design and delivery of our mental health services, it also demonstrated the power of collaboration.
To everyone involved, there was a genuine spirit of partnership – between service providers, mental health professionals, consumers and carers – and it is the key element in ensuring that we have mental health services that truly work for those they are intended to help.
New approaches, new ways of thinking, and the ability to learn from experts and consumers alike have empowered us to make a real difference.
Vale Dan Comerford
Daniel Charles Comerford
20 September 1963 – 8 July 2019
Brian McCaughan, Chair, ACI Board
Those of us honoured to be at Dan’s farewell at the Boys’ Chapel, St Aloysius’ College on 17 July 2019, were deeply moved by the heartfelt words of his amazing mother Judy, his wonderful wife Sally and his devoted sons James and Thomas. Their stories complemented the photographic images of Dan’s life dating from childhood and extending through many years. Dan was consistent in his beliefs and ideals and has clearly passed these on to his sons.
I had the pleasure of knowing Dan for over 30 years and working with him in various capacities over the last 15 years. Dan may have had some imperfections (after all he drank Tooheys New and barracked every year for Queensland in the State of Origin) but these were easily overlooked when working with him. Dan loved to be at work but similarly was committed to the community in which he lived and the schools his sons attended. At home he was a masterful handyman and a dedicated gardener.
I loved his passion for health at all levels that he worked. I can only imagine his enthusiasm arriving from the bush in 1982 to begin training as a nurse at St Joseph’s Hospital Auburn (with his mop of red hair to match the suburb’s name). It was at St Joseph’s – or as both Dan and Sally fondly call it, ‘Joeys’ – that they met and were soon married. As a result of the infamous doctors' strike in the early 1980s, they headed off to Concord Hospital where Sally found her great love in the operating theatre and Dan then moved on to his clinical passion in emergency medicine. Dan completed the College of Nursing course in Emergency Care and subsequently held a series of clinical positions in the then Western Sydney Area Health Service before moving into full-time administrative roles.
In senior roles, Dan had the uncanny ability to be loved and respected by the people who worked for him. He was also admired and greatly appreciated by those he worked for. It is no exaggeration that ACI staff made every effort to be employed in the networks under Dan’s control. The people who worked for him loved his sense of humour but most importantly respected and admired his work ethic and the results he achieved.
Dan’s attention to detail was legendary and ‘good enough’ was never acceptable to Dan – it had to be right in all ways. I witnessed this repeatedly in my work with him at the Department of Health from 2005 and then at the ACI where he joined us in 2012. The experience he gained in these positions and his previous experience in the Western Sydney Area Health Service served him well when he returned to the Ministry to head the Leading Better Value Care program. We often sat and discussed what needed to be done and where the priorities should be, and even in his last days he was talking with me about what needed to be done, and how to do it. That was the Dan I knew, always getting things done.
Sally has received many words of condolences since Dan’s death but equally words of praise and appreciation for all of Dan’s work. She recently received a letter from the Stroke Recovery Association highlighting the improvements in stroke care across NSW initiated and implemented by Dan and his team.
During his time at the ACI, Dan had a strong passion for improving both the patient and staff experience across NSW. He was a true flagship for the ACI as he toured the state promoting the appropriate models of care, be it in stroke or cardiac reperfusion, aspects of bone marrow transplantation, quality in stroke care, cystic fibrosis or in investigating clinical variation in the acute care settings. These examples are meant to be only that, as Dan’s influence extended through so much of the work performed at the ACI during those heady days when so much was achieved by the team.
I may be biased but I don’t know anyone who didn’t like and respect Dan.
How do we acknowledge and honour the lifetime achievements and commitment of Daniel Charles Comerford? After discussion with his wife Sally, I am pleased to announce that the ACI will make an annual award – The Daniel Comerford Medal – to a person who has demonstrated extraordinary leadership and commitment to improve health outcomes for the people of NSW.
Dan, your contribution to health in NSW will never be forgotten.
Burn Injury Network Manager
Revised clinical guidelines on escharotomy for burn patients
Deep dermal and full thickness burns develop a rigid and inelastic tissue termed ‘eschar’. In deep circumferential or near circumferential burns of limbs or chest, as oedema forms the inelastic eschar can cause a build-up of pressure and act like a tourniquet. This pressure can lead to significant complications such as respiratory compromise and loss of tissue perfusion requiring a surgical procedure known as an escharotomy. An escharotomy is performed by making an incision through the eschar to release the pressure.
The guidelines cover the procedure and management of eschar in burn patients.
Urology/Gynaecological Oncology Network Manager
Gynaecological cancer: A guide to clinical practice in NSW
The ACI has recently revised and updated the Gynaecological Oncology Clinical Practice Guidelines, which were originally published in 2004. The guidelines were widely used as a resource in the initial planning for management of women gynaecological cancer, with treatment decisions reviewed by the Gynaecological Cancer Multidisciplinary Team.
The revised guidelines are intended for clinicians to use prior to referral for multidisciplinary management.
Mental Health Network Manager
New mental health resources
Building Collaborative Cultures of Care within NSW Mental Health Services
Collaborative cultures are trauma-informed, person-centred and recovery-oriented, and are focused on maximising self-determination for people with lived experience of mental health issues.
This resource supports the development of collaborative cultures in NSW mental health units. It provides principles, strategies, practical examples and resources to strengthen therapeutic partnerships between clinicians, practitioners, managers and people with lived experience of mental health issues and caring, families and kinship groups.
A Guide to Build Co‑design Capability
This resource is designed to support local health districts and health networks partner with people with lived experience of a mental health condition to make healthcare improvements using co-design processes.
Acting Rehabilitation Network Manager
New rehabilitation resources
Principles to Support Rehabilitation Care
The Principles to Support Rehabilitation Care was launched on Friday 26 July to an audience of over 100 people (in person and online). The document is a guide for the establishment of new rehabilitation services and for the development of existing rehabilitation services.
The document defines the goals and aspirations for rehabilitation and provides a valuable resource for health professionals and the broader community. The principles document provides a framework, developed from expert opinion, literature review and consultation with clinicians and consumers, that represents a theoretical understanding of rehabilitation as a coherent complex intervention. It explains rehabilitation using program theory and a logic model which highlights the elements that underpin effective rehabilitation.
Rehabilitation consumer information
The Rehabilitation Network Education and Professional Development Working Party has developed a brochure for consumers about rehabilitation. The brochure, Rehabilitation: What It Is and What to Expect, provides information for people receiving rehabilitation care, including who might be involved in rehabilitation, settings where care might be provided, and what to expect.
Paediatric Portal launch
The ACI has developed a Paediatric Portal, an online resource connecting health professionals to the most up-to-date clinical guidelines, tools and fact sheets from renowned paediatric and child health organisations.
The Paediatric Portal supports clinicians working on the frontline of acute and ongoing community care, by collating resources on 28 paediatric and child health topics ranging from adolescent health and child protection to trauma and mental health. Content has been curated by subject matter experts and features material from leading paediatric institutions including the Sydney Children’s Hospital Network, Children’s Health Queensland and the Royal Children’s Hospital Melbourne.
The portal was conceived by the ACI’s Paediatric Network, a group of paediatricians, nurses and health professionals driving improvements in the experience and delivery of health for young people in NSW.
Pain Management Network Manager
Quick steps through opioid management
This online tool outlines a balanced approach to safer opioid prescription as part of multimodal pain management. In this tool, you will find recommendations and resources for the management of people with chronic non-cancer pain at each stage of prescribing – whether you are considering, starting, continuing at or below 60mg oMEDD, continuing above 60mg oMEDD or reducing opioids.
Workshops, forums and conferences
Project Officer, Primary Care Institute
Consumer Enablement Spotlight Series
The ACI Primary Care Institute and the Patient Experience and Consumer Engagement team held the first Consumer Enablement Spotlight Series on 11 June 2019.
The Spotlight Series webinars aim to shine a light on different consumer enablement interventions or approaches. They are free to attend and open to anyone with an interest in learning about consumer enablement approaches, including clinicians, managers, consumers, carers and students.
This webinar event focused on shared decision making and was attended by more than 200 people from across NSW and beyond, via videoconference, teleconference, live stream and Skype. There were seven short presentations over the course of the morning where speakers from the ACI, Clinical Excellence Commission, The Sydney University and Laval University in Canada shared their research and experiences using shared decision making in practice.
The presentation slides from the day are available on the consumer enablement webpage under Consumer Enablement Resources.
Acting Rehabilitation Network Manager
Rehabilitation Network annual education forum
The Rehabilitation Network hosted its annual education forum on Friday 26 July at the Kirribilli Club. Over 100 people attended the event – 90 people in person and more than 25 via livestream. The forum started with guest speaker Louisa Hope sharing her story of the Lindt Café siege and her subsequent hospital admission, rehabilitation and recovery.
The forum also included an update of the Rehabilitation Network activities over the past 12 months, the latest on the Paediatric Rehabilitation Model of Care, and the launch of the new Principles to Support Rehabilitation Care. There were numerous presentations from NSW clinicians on rehabilitation projects and research, covering topic such as measuring person-centred rehabilitation experience; increasing intensity of practice; enriched environments; rehabilitation screening; telehealth; exercise-based physiotherapy in aged care; sharing knowledge and skills; post-stroke sexual rehabilitation; supporting adolescent and young adult health outcomes; assessments for transgender clients; and assessing unmet rehabilitation needs with a novel telerehabilitation service.
A number of posters were also available to view during the day. Feedback from those who attended was extremely positive and thanks goes to the Education and Professional Development Working Party for their assistance with organising the event.
Renal Network Manager
Renal Network planning day
A Renal Network planning day was held 20 June 2019 to explore work themes initially suggested by responses to a survey to members. The last forum had been held in 2015.
Michael Noel, Co-Chair of the Renal Supportive Care Committee, Supportive and Palliative Care Physician at Nepean, gave an account of the committee’s work. His heartfelt call to treat a patient’s suffering rather than just their symptoms was well received.
Kate Lloyd, Stream Manager, Chronic and Long Term Care, ACI briefed the 69 participants on the prioritisation approach the ACI encourages for networks to consider when deciding on their workplan.
The outgoing Chair of the Renal Executive, Paul Snelling, Nephrologist at Royal Prince Alfred, gave a history of and rationale for the Renal Network from 1999 to today.
He then spoke about the End Stage Kidney Disease Projections group overseen by the Ministry of Health with input from several rounds of stakeholder consultation. The objective is to deliver projections to inform renal service and capital planning at the state and local levels over the next 10-15 years.
Annie Hutton, Renal Network Manager, took participants through the most popular topics that survey results had revealed and the facilitator, Rob Wilkins, Palliative Care Network Manager, drew out a number of other topics from the group.
Smaller groups then teased out the top five pieces of work including preliminary stakeholders and methods:
- Equity of access – for at risk patient groups
- Care close to home
- Service delivery, capacity and resource audit
- Networked approach and haring multidisciplinary team models of care
- Research and evidence base.
Once the Renal Executive Committee is re-convened, the work will be prioritised and working groups formed. Thank you to all who participated.
Project Officer, PRMs
Implementation planning workshop: Patient reported measures
In June, over 150 stakeholders including patient reported measures (PRMs) program leads, executives, site teams, primary care and consumers gathered in Sydney or on livestream for an implementation planning workshop and the first live demonstration of the new online PRMs platform – Health Outcomes Patient Experience (HOPE).
Facilitated by Raj Verma, Executive Director, System Transformation Evaluation and Patient Experience, ACI, the workshop premiered the functionality of HOPE and the multi-phased implementation plan.
- Phase one: launch of the stand-alone platform.
- Phase two: integration with patient administration systems and electronic medical records
- Phase three: integration with primary care clinical software.
eHealth NSW also flagged the early planning for next phases which includes identification of new cohorts and settings.
Presentations and expert panels also explored the scope and role of public health registries, PRM workflows, eHealth, integrated care PRMs and Leading Better Value Care cohorts and a roadshow of tranche 1 models and how they use PRMs. A highlight was the consumer panel who discussed the importance on focusing on ‘what matters to me’.
An evaluation of the planning day highlighted an enthusiasm for continued discussion and collaboration in the planning and implementation and the value of including consumer participation and local site experiences with PRMs.
Since the event, a new online forum for the PRMs Program leads has launched on the Leading Better Value Care Hub. The forum will accommodate new resources and discussion threads and provide an online environment for sharing patient stories, wins and challenges during the implementation of HOPE.
Urology / Gynaecological Oncology Network Manager
Gynaecological Oncology Network congratulates Shannon Philp
The ACI Gynaecological Oncology Network would like to congratulate Shannon Philp, Gynaecological Oncology Nurse Practitioner, Chris O’Brien Lifehouse, on being awarded the Jeannie Ferris Award by Cancer Australia for her work with women with gynaecological cancers. The award recognises outstanding contribution to improving outcomes for women with gynaecological cancers.
Shannon has nearly 25 years of experience in gynaecological oncology. She is a member of the Cancer Nursing Research Unit, a consortium of Sydney Nursing School and the Sydney Local Health District, and on the Executive Committee of the NSW ACI Gynae-oncology Nurses’ Group. Shannon holds a Master of Nursing (Nurse Practitioner) and Graduate Certificates in Cancer Nursing and Women’s Health Nursing. Shannon has research interests in many aspects relating to the care of women with gynaecological cancers, particularly patient satisfaction and experience, quality of life and fast track surgical care, and women’s experience of gestational trophoblastic disease, and publishes in peer-reviewed journals. She runs a nurse practitioner clinic which provides a comprehensive service to women with a low risk of cancer recurrence, post-operative patients and women with gestational trophoblastic disease.
Shannon is also a Lecturer and Course Coordinator of Cancer and Haematology Nursing at Sydney Nursing School, The University of Sydney.
(L-R) Dr Helen Zorbas AO, Nicole Livingstone OAM, Shannon Philp and Jeremy Ferris.
Welcomes and farewells
Acting Rehabilitation Network Manager
Rehabilitation Network Medical Co-Chair
This month we say farewell to our Rehabilitation Network Medical Co-Chair Dr Kath McCarthy.
Dr Kath McCarthy has been a member of the Rehabilitation Network Executive since May 2013, and the Rehabilitation Network Medical Co-Chair since October 2017.
Sandra Lever, Nursing Co-Chair, kindly shares some words from working with Dr McCarthy.
‘On Wednesday 24 July, Dr Kath McCarthy attended her last Rehabilitation Network Executive meeting following her resignation as the Rehabilitation Network Medical Co-Chair.
Kath took up the position as Medical Co-Chair following the sad and untimely passing of Dr Garry Peace in 2017 and added her expertise to the good work that was in progress. Kath has been a member of the Rehabilitation Network and Executive since its formation and has been involved in many of the Network initiatives, including the recent Principles to Support Rehabilitation Care. Kath was a powerhouse in the development of this document. Her reminders that the inpatient period is short in relation to the person’s whole life and her experience in the community, really raised the quality of the work that was achieved.
Kath has also contributed her expertise by providing comment on many a document that passed the way of the Rehabilitation Network, as well as assisting with setting strategic priorities and guiding activities of the Network.
Following a very busy working life, Kath is finally retiring to enjoy other aspects of her life, such as travelling. Kath has been a fabulous team player and she lives and breathes person-centredness.
We all wish Kath well and will miss her compassion, enthusiasm and keen intellect in working to continue the improvement of rehabilitation care across NSW.’
We now warmly welcome our new Rehabilitation Network Medical Co-Chair, Dr John Estell.
John is a Consultant Physician in Rehabilitation Medicine. He also holds a Masters in Sports Medicine. As the Director of Rehabilitation Services at St George Hospital, a tertiary level, teaching hospital in Sydney, he also practices in private rehabilitation medicine with appointments to six local private hospitals.
John is a rehabilitation physician with an extensive experience in stroke rehabilitation, trauma rehabilitation and able-bodied and disabled sports medicine. He has a particular interest in spasticity management.
He has research interests in epidemiology of rehabilitation medicine, costs and outcomes of Rehabilitation, costs and outcomes of spasticity management, epidemiology of sports injuries, rehabilitation services and provision.
John has been an active member of the Rehabilitation Network since its creation, and part of the Data Outcomes and Measurement Working Party, as well as the Executive, for many years.