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Volume 11, Issue 6 – December 2017

Clinician Connect

Wishing you a safe and festive break, we look forward to working with you again in 2018.

Guest Editorial

Metamorphosis
Roger Wilson, Chief Pathologist, Executive Director Clinical Governance and Quality, NSW Health Pathology

Roger WilsonNSW Health Pathology (NSWHP) was established in 2012, bringing together four pathology networks that had evolved largely independently over the previous fifteen years, and the State’s forensic medicine and analytical science services. It is the largest public pathology service in Australia, with 4,500 staff located in 66 laboratories and more than 200 collection centres across NSW. There are more than 300 pathologists working in NSWHP, many of whom are also physicians in their local hospitals, and are an integral part of our State’s clinical community. Modern pathology is a very complex business that can look simple to those outside, and the challenges in bringing these groups together and establishing a unified direction for a strong and sustainable future should not be underestimated.

Nonetheless, much has been accomplished in these first five years, vindicating the decision to adopt a statewide business model for public pathology in NSW. NSWHP has delivered on its five-year strategic plan and exceeded expectations on the business model. To date it has returned more than $120 million in accumulated savings and avoided costs back to the health system and lowered pathology prices to local health districts. Demand for cost efficiencies will continue but the global trend to a value based care model provides NSWHP with opportunities to demonstrate that it has more to offer than commodities. We will continue to partner with local health districts (LHDs) and other NSW Health agencies to make improvements and help find solutions for some of the many challenges faced in meeting the needs of patients and providing better care.

NSWHP is committed to backing up its considerable technical and clinical capability with matching customer service, and to exploring new and innovative operating models that add value to the system. For example, since commencing in 2013, there are now 551 networked point of care testing (PoCT) devices being managed by NSWHP across 346 locations, mostly in rural and remote areas with no on-site laboratory. Industry tells us that this is the largest managed PoCT network in the world. There are many local stories of avoided or expedited patient transfers and better patient clinical and social outcomes resulting from rapid access to test results provided by these devices, all operating under a robust quality framework.

Multiple laboratory information technology systems and variation in testing methods, report formats, results units and reference ranges inherited on formation of NSWHP are all sources of unwarranted clinical variation with the potential to impact the quality and safety of healthcare as well as its cost. Harmonisation is seldom easy but NSWHP’s clinical streams are all working on these issues and progressively reducing variation. Harmonised alert thresholds for urgent notification of high risk results to clinicians have now been achieved for most common tests, but communication of these results out of hours remains challenging. This is a longstanding clinical handover problem that can only be solved in partnership with LHDs. Coronial inquest reports confirm that this is a problem that needs to be solved as a matter of priority.

More than 80% of patients admitted to NSW public hospitals have pathology tests. Appropriate tests that should be requested but are not, as well as unnecessary testing, are elements of diagnostic error that we are striving to better understand. Analysis of appropriateness of test use is complex, with pathology tests requested for many different reasons at different stages in patient assessment and management. NSWHP is exploring the use of machine learning tools to analyse pathology use data and document current practice, and trying to identify best practice in pathology requests in collaboration with clinical partners. This will not provide all the answers but should significantly expand our knowledge and provide a step in the right direction.

Rapidly advancing disruptive technologies are increasingly challenging traditional ways of doing things in pathology, posing both threats and opportunities. In microbiology, automation and digitalisation of bacteriology workflow offers improved care with faster results, greater accuracy, more consistent quality, full traceability and, if operated at capacity, lower cost. Microbiology images can be reviewed and reported remotely from the specimen workflow offering opportunities for better utilisation of the available specialised workforce. Some question the value of these benefits at the expense of on-site services with simpler access and valuable local relationships with the laboratory staff. We recognise the value held in retaining on-site services, but it is hard to quantify, and it is difficult to please all parties when trying to balance this benefit against its higher cost. Scale is both the friend and the foe of pathology as we seek to manage quality and cost through statewide service delivery while also wanting to be responsive to differing local clinical needs and expectation.

Digitalisation of anatomical pathology images is gradually advancing on routine diagnostic reporting, driving efforts to define quality parameters for its safe use and familiarise pathologists with its risks and limitations. There are challenges ahead but also tantalising opportunities for expedited case referral, second opinions, education, workload balancing and optimal use of sub-speciality expertise. The ability to move images digitally will soon make it feasible to allocate every case to the most appropriate pathologist available irrespective of where the patient enters the NSW Health system. NSWHP is building the information and communication technology infrastructure to support this so that its possibilities can become a reality.

These observations are a tiny sample of what is happening across our small microcosm. There is a lot happening everywhere I look.

NSWHP is a very different organisation now than in 2012 and expects to be very different again in another five years. We believe research and innovation must be a core part of our business if we are to continue to improve. What we will look like in five years is not entirely clear, but we have a high level of understanding of where we want to be and what it might look like. We think that focusing on the needs of patients and clinicians to improve services, and building stronger more collaborative local relationships with you and your organisations will help us get there and deliver on our purpose of creating better health and justice systems.

Chief Executive Comment

Jean-Frederic Levesque

Dr Jean-Frédéric Levesque

Engaging clinicians in healthcare system innovation: a three person waltz

Clinicians have long been innovative. Innovation implies the combination of ideas and insights. It is when ideas are supported by evidence that they become more than good ideas. Evidence is central to clinicians’ innovation. The history of development in the fields of medicine and other health sciences is rife with examples of clinicians addressing an issue in the treatment of patients or delivery of care by coming up with new ideas.

However clinicians are not the only ones that have turned their interest and intellect to the purpose of improving care. Managers and people specialising in policy setting are also contributing to the emergence of a modern healthcare system, and have supported the emergence of new technologies and new managerial and planning approaches.

As clinicians, we often hear complaints about the management being disconnected from our imperatives and the reality of the care delivery. As managers and policy-makers, we often hear the frustrations of not being able to influence clinical practice. My personal experience in various healthcare systems suggests that none of these issues are specific to NSW.

Another emerging issue is that patients and their carers now also want an increased voice, not only in the care that they personally receive but also in how care is organised and how resources are invested. Increasingly, we need to conceptualise the engagement of clinicians into health system design and improvement as a process where we bring together three different worlds: planning care, providing care, and receiving care.

For an organisation like the ACI, this is a renewed challenge. The organisation is strong because of:

  • its Networks, all having different histories and different achievements
  • its efforts at structuring approaches to innovation and improvement
  • its efforts in developing capabilities within the system to ensure that we can tackle organisational challenges that individual clinicians may find hard to solve as part of their daily clinical activities without external help
  • its recent efforts at structuring approaches to engage patients in decisions about their care and in the design of innovative solutions.

But this changing environment also forces us to revise the way we engage with clinicians and how we manage more generic improvement roles so that all of this works better together. There is emerging evidence of a science of running networks and of engaging patients, in a way that is better integrated into the core activities of innovation and improvement organisations. I believe that this can help us be more effective in our implementation efforts and help our clinical Networks, Institutes and Taskforces be more effective at engaging and mobilising clinicians to be more effective agents of change.

How do we dance a waltz with three people? That is the question we will aim to answer with you and through your patients’ engagement processes. I encourage you to participate in the consultation process to identify together how we can better engage with clinicians, patients and our own leadership structures. I will personally take the time to meet with many of you and hear directly about how you see this happening. We will also share what we find from our consultations with other organisations, who have similar roles outside of NSW, and from the published literature.

Let’s dance!

Aboriginal Chronic Conditions Network Update

Network Manager

The Aboriginal Chronic Conditions Network (ACCN) formed its executive in October following an expression of interest process from Network members.

Fifteen members form the Executive.

  • Ms Alison Barnes – Registered Nurse
  • Mr Anthony Franks – Aboriginal Chronic Care Officer, Northern NSW Local Health District
  • Mr Bob Davis – Chief Executive Officer, Maari Ma Aboriginal Health Service
  • Dr Fadwa Al-Yaman – Head Indigenous Health, Australian Institute of Health and Welfare
  • Ms Jackie Caton – Aboriginal Health Program Coordinator, South Western Sydney Primary Health Network
  • Dr Kath Keenan – General Practitioner, Redfern Aboriginal Medical Service
  • Ms Kellyann Johnson – Manager Aboriginal Health Northern Sector, Western NSW Local Health District
  • Ms Kim Whiteley – Manager Aboriginal Health Programs, Western NSW Primary Health Network
  • Ms Leeanne Cutmore – Aboriginal Health Worker Toomelah, Hunter New England Local Health District
  • Ms Linda Soars – Director Integration, Partnerships and Enablers, Western Sydney Local Health District
  • Mr Matt West – Podiatrist, Associate Lecturer, University of Newcastle
  • Mr Nathan Jones – Director Aboriginal Health, South Western Sydney Local Health District
  • Dr Scott Winch – Discipline Leader Indigenous Health, University of Wollongong
  • Ms Sharon Trindall – Nurse Manager, Waminda Aboriginal Corporation
  • Ms Vicki Wade – Cultural Leader, Rheumatic Heart Disease Australia

Attendees at the first ACCN Executive Meeting
Attendees at the first ACCN Executive Meeting. Photo: J Bunfield.

The executive had its first meeting on 13 November 2017 at the ACI office in Chatswood.  Chris Shipway, Director, Primary Care and Chronic Services, introduced the executive to the ACI, its Networks, Taskforces, Institutes and functions. Jacinta Bunfield from the Centre for Aboriginal Health, Ministry of Health, provided an overview of the Centre’s current priorities, and the Chronic Care for Aboriginal People team provided a snapshot of their projects and collaborations with other ACI Networks. A fruitful discussion started on where to focus priorities, and this will continue over the coming months. The executive was keen to understand the scope of Aboriginal projects across the ACI and those projects that have addressed the disparity of health outcomes for Aboriginal people. The next executive meeting will be in February 2018.

Acute Care Taskforce Update

Network Manager

Medical Assessment Unit forum

The ACI Acute Care Taskforce held its Annual Medical Assessment Unit (MAU) forum on Friday, 27 October 2017. It was an opportunity for MAU staff across NSW to present innovations, network and share experiences and knowledge.

The forum was a great success with more than 100 MAU clinicians and managers representing over 25 NSW hospital MAUs attending. Delegates from Royal Perth Hospital (Western Australia) as well as Metro North Hospital and Health Service (Queensland) also attended the forum.

The program included a range of presentations that highlighted important initiatives undertaken in MAUs across NSW. The forum commenced with Uncle Allen Madden welcoming us to country followed by an ACI update from ACI Chief Executive, Dr Jean-Frederic Levesque.

Richard Yarlett from the NSW Ministry of Health provided an update and future scope on the Patient Flow Portal, including a demonstration of the improved Bed Board functionality and Patient Transport Service bookings. Jo Burdajewicz from the Ministry presented on the revision of the 2013 Hospital in the Home Guideline and emphasized the importance of MAU and hospital in the home collaborative partnerships.

Later sessions moved to a more clinical focus, with MAU clinicians from Wollongong, St George, Campbelltown, Sutherland and Westmead Hospitals presenting on a range of local innovations. Metro North Hospital and Health Service (Queensland) presented on success of using the ACI MAU assessment method to review their local MAU.

Visit the Forum webpage to view the presentations.

The MAU Co-Chairs Nadine Mesite and Grand Pickard’s proposal to reinvigorate the MAU community of practice platform, Basecamp, was unanimously accepted and will enable MAU clinicians to have on ongoing communication, share ideas and innovations.

Overall, the feedback from the day was very positive. Thank you to everyone who presented and participated throughout the day, the energy in the room was uplifting!


Participants MAU forum. Photo: A Temple.

Collaborating with the team from Royal Perth Hospital (WA) and Metro North Hospital and Health Service (Qld). Photo: M Tovo.

Aged Health Network Update

Network Manager

The 5th Aged Health Collaborative Forum

The 5th Aged Health Collaborative Forum was held at Liverpool on Friday 20 October 2017. The forum is an annual event hosted by the NSW Aged Health Collaborative, a network including the ACI, NSW Health (Aged Care Unit, Older People’s Mental Health Policy Unit, Nursing and Midwifery Office, and Whole of Health Program), Health Education and Training Institute, and Clinical Excellence Commission.

The forum aimed to promote innovation and good practice regarding older peoples’ care experiences and outcomes.

Key themes

  • Access, co-ordination, integration and transitions of care
  • Communication, information and education
  • Care processes and care environments
  • Measuring patient experiences and outcomes, and using the feedback

The 2017 Best Rapid Fire video presentation was awarded to Juila Gaudin for Pads vs ‘pull ups’: the importance of maintaining safe mobility.


Participants at the Aged Health Collaborative Forum 2017. Photo: L Hassett.

Care of Confused Hospitalised Older Persons (CHOPs) Update

The CHOPs expert advisory group facilitated the attendance 20 participants at Delirium Masterclass held on 23 October 2017.

The Aged Health Network received positive feedback from attendees who indicated gaining a wealth of knowledge on delirium identification and management. According to one participant ‘the delirium research and information gained that day will help to shape our project’.

CHOPs Site Visit from Eastern Health Victoria

On Tuesday 24 October 2017, a group of clinicians with an interest in cognitive impairment from Eastern Health Victoria attended a site visit at Fairfield Hospital where the project leads, supported by the Hospital Executive provided an overview of the CHOPs work undertaken at Fairfield Hospital. This was followed by a tour of the wards involved in the CHOPs implementation.


Delegates from Eastern Health Victoria visiting Fairfield Hospital for CHOPs site tour. Photo: M Webb-St Mart.

Emergency Care Institute Update

Manager

New Directions for Nurse Delegated Emergency Care

Following nearly four years of program development, enhancement and statewide implementation, the Nurse Delegated Emergency Care (NDEC) model has reached a state of sustainability.

The Emergency Care Institute (ECI) adapted the NDEC model from one developed and implemented in Walcha in the Hunter New England Local Health District. The ECI began supporting the implementation of the adapted model in rural emergency departments in NSW in 2013.

NDEC is supported by comprehensive web-based resources to assist with the clinical, education and project management aspects of implementation. The model is further validated and supported with the publication of two key documents on the NSW Health Policy Distribution System:

This year the ECI facilitated three NDEC outreach education sessions, targeting registered nurses and nurse educators to build capacity to deliver further NDEC education locally.

There are now 21 NDEC sites across the state; 10 of which are ‘live’. To date, 132 people have completed the online NDEC education modules.

NDEC is now a mature model operating self-sufficiently within local health districts. As a result, from 2018 the ECI be scaling back its day to day involvement in order to focus on other priorities across emergency care.

The ECI will maintain responsibility for all the NDEC resources. It will also maintain a process for reviewing applications from new sites seeking to implement the model, and will be available to respond to queries.


Dr Anne Walton, ECI Advanced Trainee demonstrating an eye assessment technique at the NDEC education session in Dorrigo. Photo: N Goryl.

Dr Anne Walton, ECI Advanced Trainee demonstrating the cobalt light on an ophthalmoscope at the NDEC education session in Dorrigo. Photo: N Goryl.

Health Outcomes Team Update

Patient Reported Measures Information Technology Update

The Health Outcomes team has been collaborating with eHealth NSW to complete the procurement and detailed design of the future Patient Reported Measures (PRMs) information technology system. The future PRMs system will be integrated with clinical systems (electronic medical records and general practice systems) with single sign on access. It will have patient and clinician portals for survey administration and access to PRM results.

A final step in the process to select a future PRMs system has been the evaluation of two shortlisted PRMs systems, including usability testing, technical assessment and user experience assessment. These two prototype systems were presented to a representative group at a workshop on 25 September 2017. The group, consisting of clinicians, service managers and a consumer representative who are familiar with current PRMs systems, reviewed them against the vision for the new PRMs information solution.

The detailed design and evaluation has now been completed. The ACI will commence the customisation and implementation planning when contract negotiations are finalised. The implementation will occur in three phases. In phase 1, current users of the Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs) reporting systems will be migrated to the new PRMs system. This phase will include support for Leading Better Value Care reporting system, which will be integrated at a later stage.

If you have any questions regarding the PRMs system, please contact Elizabeth Hanley, PRMs Project Officer, email: elizabeth.hanley@health.nsw.gov.au phone: +61 2 9464 4724.

Intellectual Disability Network Update

Network Manager

Sydney Local Health District supports Say Less, Show More

Sydney Local Health District generously funded the next adaptation of the Intellectual Disability Health Network’s successful tool and training package called Say Less, Show More.

The original version was developed in the emergency department of the Children’s Hospital Westmead in 2015-16. It was a collaborative effort in co-design involving colleagues from health, disability services, ACI and parents and their children.

Ryde Hospital and partners have since adapted the resource for adults and extended it to include perioperative and imaging visuals, alongside the original taking blood, examination and dental visuals.

In October Sydney Local Health District committed funds and support to develop its own version suited to their local needs.

View the Say Less, Show More webpage

The Say Less, Show More resources support the Essentials framework to build capacity in delivering health services for people with intellectual disability.


Teresa Anderson, Jason Cheng, Jacqueline Small and Lilly Wicks at the funding announcement (SLHD). Photo: D Kaldelis.

Intensive Care NSW Network Update

Program Manager

Kelly Cridland

+61 2 9464 4691

kelly.cridland@health.nsw.gov.au

Intensive Care NSW

The Changing Landscape of Intensive Care Forum, held on Friday 3 November 2017, was the first opportunity for all 14 sites involved in the Level 4 Intensive Care Service Model Project to:

  • meet and network with each other
  • participate in interactive sessions
  • plan how to support and drive quality improvement and sustain change
  • celebrate the amazing success that they have achieved to date.

The aims of the forum were to:

  • share local ideas and innovations and to celebrate achievements
  • provide an opportunity for local teams to discuss and provide feedback to colleagues on current work being undertaken
  • promote ongoing change and empowering teams to overcome challenges and barriers (current and future)
  • facilitate professional networking across NSW Level 4 Intensive Care Services
  • continue to build a strong culture of collaboration, transparency and leadership in Intensive Care.

The forum was attended by local executive sponsors, clinical champions and leaders. It included presentations by patients, Susan Pearce (Deputy Secretary System Purchasing and Performance at NSW Health), local health district representatives and ACI staff. The discussion in the room clearly verified the work to date and the commitment to ongoing improvements in the ‘hub of the hospital’.

All participating sites are now formulating and putting into place systems to enact local change. They have continued to push the boundaries to promote safe and effective critical care services close to the home of patients – the centre of our work!

Visit the Level 4 Intensive Care Service Model webpage for more information.


Dr Sean Kelly discusses the changing landscape of ICU. Photo: S Stephens.

Ms Julie Henderson (NUM Griffith ICU) showcasing the establishment of a networked Intensive Care Service across Murrumbidgee LHD and the St Vincent’s SHN.
Photo: S Stephens.

Musculoskeletal Network Update

Network Manager

Acute Low Back Pain Consumer Information Booklet

The Musculoskeletal Network has developed and launched the Consumer information booklet - Best practice care for people with acute low back pain.

This booklet was developed and designed to support the community’s understanding of best practice care in the management of acute low back pain. It aims to provide people and their families with clear and accurate information about the treatment and care they can expect to receive by their healthcare team. It also aims to dispel common myths about the management of acute low back pain.

Included in the booklet is a personalised care planto help people with acute low back pain understand and follow recommendations, set goals and make lifestyle changes to improve the health of their back.

We are using them in ED. The patients really like them as do the doctors!

- Physiotherapist at Royal North Shore Hospital

The Consumer information booklet - Best practice care for people with acute low back pain, complements the clinical Acute Low Back Pain Model of Care.The clinical model of careguides health professionals in providing healthcare that helps people with acute low back pain to improve their lives. Importantly the Acute Low Back Pain Model of Care promotes:

  • more appropriate clinical examination and use of radiological imaging only as necessary, rather than as routine investigation
  • evidence-informed and safe use of analgesia
  • enhanced health education that reflects contemporary treatment and self-management approaches
  • follow-up and review.

Both documents can be accessed and downloaded from the Management of people with acute low back pain webpage on the ACI website.

We also have a number of hard copies that can be provided on request by emailing Julia Thompson Julia.Thompson2@health.nsw.gov.au

Nutrition Network Update

Network Manager

Kate Fletcher

+61 2 9464 4635

kate.fletcher@health.nsw.gov.au

Nutrition Network

Revision of the NSW Health Adult Nasogastric Policy

ACI will be undertaking the revision of the NSW Health Fine Bore Nasogastric Feeding Tubes for Adults Policy (PD2009_019).

The revision will be led by the ACI Nutrition Network with the support of Gastroenterology Network and the Acute Care Taskforce.

The revision process will be supported by a steering committee and working group.

Anyone interested in participating in the revision process please contact the Network Manager.

Enhancing implementation of ‘My Food Choice’ (MFC)

The ACI Nutrition Network is continuing to work with HealthShare NSW to support the implementation of a new food service delivery model in hospitals across NSW.

An online toolkit and video to support clinical services are now available on the HealthShare NSW Food and Patient Support Services intranet page (internal NSW Health only link).

Ophthalmology Network Update

Network Manager

Sarah-Jane Waller

+61 2 9464 4645

SarahJane.Waller@health.nsw.gov.au

Ophthalmology Network

A fond farewell to Ms Julie Heraghty, Ophthalmology Co-Chair

In sad news for the Ophthalmology Network, Julie Hergahty will be stepping down from her position of Co-Chair of the Network effective December 2017.

Julie, as the Chief Executive of the Macular Diseases Foundation Australia, has been an asset for the Network over the last two and a half years. In particular, Julie played a key role in the organisation of the successful Eye Forum held in June 2017 and in providing insight into the role of research and non-government organisations in eye health in Australia.

On behalf of the Ophthalmology Network governing body and the rest of the Network, we acknowledge the role Julie has played in helping to develop and guide the Network and the governing body to its current state and wish her well in her future endeavours.

Community Eye Care Project receives NSW Health award

Following on from winning the WentWest Partnership Award for collaboration at the Western Sydney Local Health District Quality Awards, the Ophthalmology Network’s Community-Eye-Care (C-EYE-C) project has received the 2017 NSW Health Innovation award for Delivering Integrated Care.

The finalists were selected by their peers from over 100 entries across the state.

The C-Eye-C project was established in recognition that existing services will not meet the needs of NSW’s ageing population. This is demonstrated by the waiting lists for access to public hospital ophthalmology clinic services. The model of shared care between hospital and community eye health providers is set up to ensure patients receive the right care in the right time and place. In the model, an optometrists reviews the person with an ophthalmologist co-ordinating care.

Initial results have revealed a high level of satisfaction reported from both patients and the staff involved at the two trial sites. A 47% ‘no hospital follow up’ resulting in a seven week reduction in wait lists for the busy ophthalmology outpatient department. A model of care that can be replicated in other NSW public ophthalmology outpatient clinics is currently under development based on this project.

For further information


L-R Joe Nazarian (optometrist), Clinical A/Prof Andrew White (Westmead ophthalmologist), Baxter Health representative, Belinda Ford (CEYEC Service Coordinator and PhD candidate), Margaret Nguyen (optometrist), Jackie van der Hout (Ophthalmology Administration manager)

Palliative Care Network Update

Network Manager

Planning for Palliative and End of Life Care – a statewide improvement journey

Earlier this year the ACI and the Clinical Excellence Commission offered a series of tailored workshops to all local health districts and specialty health networks to help use the Palliative and End of Life Care: A Blueprint for Improvement (the Blueprint). The Blueprint is a flexible online guide for health services to meet the needs of people approaching and reaching the end of their life, their families and carers. It’s based on over 1200 consultations, research-based evidence and rounds of critical feedback from members the ACI Palliative Care Network. It emphasises the need for an integrated approach to care and is designed to meet local health districts (LHDs) and services where they are at in their improvement journeys.

The events aimed to help develop and refine local plans for improving care to those approaching the end of their lives, their families and carers.

Sixteen events were planned across the state. Formats varied and included hypotheticals, strategic and operational planning forums and targeted workshops. There were common issues many are focussing on such as:

  • advance care planning
  • bereavement
  • predictive tools for identification of end of life
  • clarifying roles of specialist palliative care providers locally
  • building the confidence and capability of everyone else.

As the workshop series comes to an end, a number of key planning reflections come to mind. First and foremost, that everyone is on a unique improvement journey and that no single tool or person can significantly improve our systems of care on their own. Our work ahead lies in building an inclusive, networked approach to improvement; one that values everyone’s unique roles and contributions and that works towards a shared vision that is always centred around the patient, family and carer.

Read more about the Blueprint

Patient Experience and Consumer Engagement Update

Manager

Tara Dimopoulos-Bick

+61 2 9464 4684

aci-peace@health.nsw.gov.au

PEACE

What is Experience-Based Co-Design?

In experience-based co-design the people who use and deliver health services are engaged to share their experiences and design improvements together.

There are three important features of experience-based co-design: experience, co and design.

  1. Experience highlights that we need to gather real stories from people to understand what is going well and what would be better.
  2. Co means that consumers, families and staff are working together from start to finish with equal say, decision making and responsibility.
  3. Design clarifies that we are identifying the why, what and how to make things better in partnership with consumers, families and staff.

We have been using experience-based co-design to bring people together to improve health services. We have supported six projects in different health settings across NSW in 2016-17. We have put together the following infographic which shows the five stages of the experience-based co-design quality improvement approach.

Primary Care and Chronic Services Update

Program Manager

Regina Osten

+61 2 9464 4637

regina.osten@health.nsw.gov.au

Rehabilitation for Chronic Conditions Framework

The Rehabilitation for Chronic Conditions Framework was released in October 2017 and has been distributed to all local health districts and relevant agencies.

Chronic conditions are responsible for nearly 80% of the total burden of disease and injury in NSW, bringing challenges and complexities to the health sector.

The Framework has been developed to support a uniform approach to rehabilitation within the context of chronic conditions. It does not promote replacement of disease-specific rehabilitation services.

Clinicians and managers (particularly sub-acute services), rural and community-based services, primary care providers and care coordinators can all have a role in reducing the impact of chronic conditions, particularly on people who are:

  • ageing with more than one chronic condition
  • at risk of being diagnosed with a chronic condition
  • unable to access disease-specific rehabilitation services.

The Framework includes the latest evidence on therapeutic exercise and behaviour change methods, and provides details on core components and enablers of chronic condition rehabilitation. Strategies can be embedded in other already established systems of care, particularly chronic disease management programs.

Broadly, rehabilitation for chronic conditions aims to restore and maintain an optimal level of one’s functional ability, increase quality of life and reduce hospital admissions.

Key consideration has been given to inclusiveness and accessibility to services for Aboriginal people, culturally and linguistically diverse and rural communities, and those with a lived experience of mental illness, so they too can benefit from this intervention model.

To assist with implementation, an online assessment tool is being developed to facilitate measurement of current chronic conditions rehabilitation services or programs against the needs of local communities. The tool will be able to identify local strengths, opportunities and actions to inform quality improvement activities, with links to a range of relevant resources.

A copy of the Framework and other resources can be downloaded from the ACI Chronic Care Resources webpage.

Rehabilitation Network Update

Network Manager

Claire O’Connor

+61 2 9464 4639

claire.oconnor@health.nsw.gov.au

Rehabilitation Network

In memoriam: Dr Garry Pearce

Garry PearceThe ACI Rehabilitation Network mourns the loss of our dear friend and colleague Dr Garry Pearce who passed away on Friday 18 August 2017 after a brief period of serious illness. 2017 marked Garry’s fourth year of involvement with the Rehabilitation Network, as both executive member and more recently network Co-Chair.

Garry joined the ACI Rehabilitation Network Executive Committee in early 2014, taking on the role of medical Co-Chair in 2015. During his time as Co-Chair, Garry had a strong focus on revising and updating the Rehabilitation Model of Care, and represented the Network on the ACI Unwarranted Clinical Variation Taskforce. His advice and guidance on other clinical projects was always measured and relevant. He was a passionate advocate and always endeavoured to champion the importance of rehabilitation and its role in the wider health system.

In addition to his substantial contribution at ACI, Garry was President of the Australasian Faculty of Rehabilitation Medicine (AFRM) from 2006 to 2008. He was responsible for designing the original AFRM logo, in burgundy and silver featuring the Southern Cross within three circles representing impairment, disability and handicap.

It was through his efforts in compiling several successful grant proposals that an Australian Minimum Data Set for Rehabilitation Medicine was developed. This paved the way for the establishment of the Australasian Rehabilitation Outcomes Centre (AROC). Together with his colleague A/Prof Ben Marosszeky, Garry was instrumental in developing AROC in 2002, encouraging all rehabilitation clinicians to become AROC members and participate in national outcome benchmarking. Due in no small part to his never flagging enthusiasm, AROC has now grown to include almost all Australian inpatient rehabilitation units, all New Zealand inpatient rehabilitation units, and a growing number of ambulatory rehabilitation services as members.

Garry was a great mentor in our professional network, a personal friend to many. Garry achieved great things patiently and quietly, and was content to do this together with and through other people. Many of us have worked side by side with Garry over the time he was involved in ACI as well as in his capacity as a rehabilitation physician and the recent months simply have not allowed time to adjust to the reality and sense of loss we feel. Garry has been not just a colleague but an endearing member of our extended professional family, an extraordinary person, and a truly great loss to our profession and the community.

As in the rest of his life, Garry bore the difficulties of his last illness with patience and fortitude. His compassionate gentle nature, good humour and strategic vision will be sadly missed. He will be remembered as a modest man, determined and patient, a quiet achiever.

From all at ACI, we extend our deepest sympathies to Toni Pearce and the rest of Garry’s family at this difficult time.

Rural Health Network Update

Network Manager

ACI Excellence and Innovation in Rural Health Award winner

The winner of the 2017 ACI Excellence and Innovation in Rural Health Award is District medication safety system for rural facilities with no on-site pharmacist from Hunter New England Local Health District (HNELHD). This project was led by Kirstin Berry, Medication Safety and Quality Manager, HNELHD.

District medication safety system for rural facilities with no on-site pharmacist

At the Rural Health Network Executive meeting on 27 September 2017, one of the topics tabled for discussion was that many small rural sites have no on-site pharmacists, and in the current climate of antimicrobial stewardship, this is impacting on accreditation in terms of safety and quality – and here we have found a solution.

How the system works

The District Medication Safety System is an audit tool which sits on the HNELHD intranet. Teams in small facilities can use it to measure their compliance with LHD pharmacy guidelines and National Safety and Quality Healthcare Standards (NSQHS) accreditation. An action plan is automatically generated to create a pathway to remedy any medication issues e.g. out of date stock, medication reconciliation, check out procedures for restricted medications, chart audits, etc.

This project includes staff awareness training and capacity building to generate more empowerment for these isolated staff to use the audit tool and mobilise the action plan.

The district medication safety system is embedded as common practice, is transferable to other LHDs and represents a much needed remedy for a vast number of small rural facilities.

For further information on this audit tool please contact Kirstin Berry, Medication Safety and Quality Manager, Hunter New England Local Health District, phone +61 2 4985 5834, kirstin.berry@hnehealth.nsw.gov.au

About the Award

Each year, the Rural Health Network Executive attend the annual NSW Rural Health and Research Congress and award the ACI Excellence and Innovation in Rural Health peak award. The award includes up to $2,000 to be used by the project team, at the discretion of the organisation, to add value to the project and contribute to sustainability.

All concurrent sessions are judged and ranked according to the following criteria:

  • innovation, creativity and originality
  • effective partnerships
  • relevance and sustainability
  • transferability and system-wide potential value.

Surgical Services Taskforce Update

Manager

NSQIP NSW Collaborative Meeting

On 26 October, NSW National Surgical Quality Improvement Program (NSQIP) hospitals came together to share their experiences of the program, profile clinical improvement projects and discuss the future of NSQIP in NSW.

NSQIP is sponsored by the ACI’s Surgical Services Taskforce and uses clinical data collected by surgical clinical reviewers to assess hospital performance and drive quality improvement initiatives.

The Collaborative reflected on lessons learned at the American College of Surgeons Quality and Safety Conference in July 2017. The conference is attended by delegates from many of the 750 NSQIP hospitals and it is a forum for sharing quality improvement initiatives. Visit the conference website to view the presentations

The Collaborative also welcomed new participants from Sydney Children’s Hospitals Network and Prince of Wales Hospital, who have recently joined NSW NSQIP.

Established NSW NSQIP hospitals provided updates on their local quality improvement projects, and an overview of the NSW NSQIP data.

  • Dr Tony Shakeshaft and Kate Scanlon presented their work on reducing urinary tract infections at Nepean Hospital.
  • Dr Bruce Hodge and Robyn Austin’s spoke about the colorectal surgical site infections (SSI) project at Port Macquarie Hospital.
  • Ming Zeng presented on the SSI reduction project in gastrointestinal surgery at Westmead Hospital.
  • Ashma Dawadi presented on the reducing SSI at Coffs Harbour Hospital.

An ongoing comparison of administrative data sets and NSQIP data collections was also discussed, along with potential use of NSQIP data for a National Emergency Laparotomy Audit and the role of NSQIP in morbidity and mortality meetings.

NSQIP is also trialling a patient reported outcomes module and NSW is investigating options for participation in the beta version of the module.


NSW NSQIP Collaborative members at the NSQIP Collaborative Conference New York, July 2017. Photo: G Meredith.

Transition Care Network Update

Network Manager

Transition Care and the new Centre for Adolescent and Young Adult Health at Westmead

Louise Charlton is the ACI Transition Care Co-ordinator, based at Westmead Hospital. She works to smooth the transition of young people with chronic health conditions to adult health services. For patients transitioning from The Children’s Hospital at Westmead this means working closely with Trapeze. Trapeze concentrates on preparation for transitioning from the paediatric side.

On 30 November 2017, Louise spoke to key clinicians, managers, service providers and consumers as part of the detailed design phase for the new Centre for Adolescent and Young Adult Health.

She described her involvement with young people from thirteen years of age until twenty-five, to support ongoing engagement and understanding of their health needs, the systems and people to support them and the interplay of other factors like housing and employment which impact health. She spoke of how a whole person approach to healthcare is supported by physical space and how this space can create a sense of belonging for adolescents and young people.

Louise and her colleagues from Trapeze are already working closely together but expect the model of care will undergo further development when they move into the new centre in 2019.


Transition Care and the new Centre for Adolescent and Young Adult Health at Westmead. L-R: Louise Charlton, Jane Ho, Mary-Clare Waugh, Michael Kohn.

2018 Patient Experience Symposium

The 2018 Patient Experience Symposium (PExS 2018) will be held at the Hilton Hotel Sydney on Monday 9 and Tuesday 10 April 2018.

PExS 2018 will showcase expert evidence, local and international examples, and consumer stories. It will also be an opportunity for consumers and health staff to share local innovations which have improved patient experience and outcomes.

PExS 2018 is a joint collaboration between the ACI, Clinical Excellence Commission, Health Education and Training Institute, Bureau of Health Information, Cancer Institute NSW, eHealth NSW, the Ministry of Health’s Mental Health Branch and Health and Social Policy Branch.

Registrations now open

Registration rates per person for two days

  • Early bird - $280 until 23rd February
  • Standard - $330 after 23rd February

Put the dates in your diary now and don’t miss out in joining us at this key annual event! We look forward to two days of inspiring keynote speakers, innovative workshops and a diverse offering of presentations.