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Volume 13, Issue 3 – June 2019

Clinician Connect

Guest editorial

Andrew Weatherall

The story of healthcare includes change

Andrew Weatherall, Co-Head, Department of Anaesthesia
The Children’s Hospital at Westmead

The story of healthcare includes change. There is not a day that goes by in general practices or hospitals across Australia where we don’t try to change things for the better.

Climate change is just the latest change we need to tackle.

There may be some who question whether the Agency for Clinical Innovation should be discussing an ‘environmental issue’. It’s time to forget the notion that climate is solely about the environment. Climate change is about everything.

The World Health Organization estimates that climate change will contribute to an additional 250,000 deaths per year between 2030 and 2050.1 Food production will be impacted and there is plenty of evidence that the economy overall will suffer as our climate fundamentally changes. Communicable diseases will increase, and those from low socioeconomic groups will bear the heaviest load.

If we recognise all of this, then we also acknowledge that responding to climate change requires measures taken by everyone. Governments need to get serious about mitigating carbon dioxide emissions. Businesses need to change how they operate. The health sector, which contributes 7% of Australia’s carbon production each year, also must respond.2

Taking steps towards addressing climate change and reducing our carbon footprint is not as daunting as it may seem. In NSW, there are teams across the state already making efforts.

It starts with simple measures, such as establishing sustainability groups, taking measures to reduce waste and reuse materials, and changing how we use electricity. We must focus on primary and preventive healthcare.

It can get bigger than that though. Health facilities can be designed to be more sustainable and to use their size to demand cleaner energy supplies. We can explore how to reduce procedures or tests that are not proven to be potentially beneficial for patients.

In many ways, sustainable healthcare is simply good healthcare.

The ACI is ideally placed to unearth stories of those across the state already taking steps to make healthcare more sustainable. Groups can share tips and tricks about how to change business as usual to be ‘greener’. For instance, the Perioperative Network is hosting actively sharing ideas and local innovations.

It’s well and truly time for healthcare to produce its next big change.

  1. WHO. COP24 Special report: Health and Climate Change. 2018
  2. Malik A, Lenzen M, McAlister S, McGain F. The carbon footprint of Australian health care. Lancet Planet Health. 2018;2:e27-e35. Doi: 10.1016/S2542-5196(17)30180-8.

Chief Executive comment

Dr Jean-Frédéric Levesque

Fostering sustainable health and healthcare through clinical innovations

Jean-Frédéric Levesque

Sustainability is a health issue, not just an environmental issue. This is the realisation we are increasingly making. We need to live and work in clean environments that support physical and mental health, and as clinicians, we must be aware of how climate change impacts on patient health and care. We now know, from recent studies in Australia, that the healthcare system is actually contributing up to 7% of all greenhouse gas emissions through its activities. Healthcare is a social determinant of health.

This realisation forces us to recognise the vital role clinical innovations can play in promotion and delivery of optimal and sustainable healthcare. From the use of fossil fuels in medical transport and the energy required to run hospitals, to waste management and the use of consumables, the provision of health services has environmental consequences at every stage of delivery. Additionally, technological advances, shifts in consumer behaviour and regulatory requirements make the healthcare sector ripe for disruption and primed for transformation. With these factors in play, it is imperative we consider sustainability when evaluating both healthcare innovations and system transformation.

It is thus timely for the ACI to increasingly focus on sustainability. Last year, the Anaesthetic Perioperative Care Network (APCN) held a workshop to share learnings and experiences around issues of clinical sustainability. A formal community of practice was then established for clinicians to share news, funding opportunities, project challenges and successes. Local Health Districts are also developing sustainability initiatives, with South Eastern Sydney releasing ‘Environmental Sustainability Plan 2019-2021’ this month.

We are also working to promote telehealth and the use of technology, to reduce the need for patients to travel to treatment. These technologies can also be harnessed as part of our clinical engagement and implementation activities.

There is still, however, more work to do, particularly in relation to the development of redevelopment of hospitals and healthcare facilities. The ACI looks forward to working with its partners to design sustainable healthcare pathways and environments that deliver better patient outcomes, a healthier work environment and a reduced environmental footprint.

Congratulations to

Centre for Healthcare Redesign Capability Designer Manager

Clinical Redesign School Graduates

Congratulations to the 36 graduates from the second 2018 (cohort two) of the Graduate Certificate in Clinical Redesign program.

This cohort was a special collaboration between the ACI and NSW Health Pathology to improve pathology services. The graduation ceremony, held at Sydney’s Mint on 10 May, was an opportunity for graduates to share their healthcare improvement projects.

Project teams’ redesign goals included streamlining the receipt and processing of pathology samples, reducing variation in patient identification and developing ways to improve provision of forensic social work support to bereaved families. Other groups from across LHDs delivered a wide range of projects on improving access to surgery, acute mental health care and outpatient clinics.

All teams focussed on improving the patient experience and recognised the importance of investing in staff to improve delivery of high quality, timely care.

Projects were presented at the graduation ceremony with participants awarded testamurs from NSW Health Secretary, Elizabeth Koff, who expressed support for the program and acknowledged the work done by the teams to improve healthcare delivery.

The Graduate Certificate in Clinical Redesign is an award winning, program run by the Agency for Clinical Innovation’s Centre for Healthcare Redesign in partnership with the University of Tasmania. The program aims to give NSW health staff the opportunity to learn and apply skills in project management, improvement and implementation sciences in a comprehensive, challenging and well supported environment.

To date, the program has seen more than 650 improvement leaders developed across a range of metropolitan, rural and state-wide health services from NSW.

For information and posters from the initiatives in this graduation, visit the Innovation Exchange. See the Centre for Healthcare Redesign Graduate Certificate Program for more information about the Clinical Redesign program.


Faculty of Health Science Alumni Award for Professional Achievement

Congratulations to Matt Jennings, the 2019 recipient of Sydney University’s Health Science Alumni Award for Professional Achievement. Matt was recognised for his outstanding leadership in the field of physiotherapy and allied health at both a state and national level. Matt currently co-chairs the ACI Musculoskeletal Network, which has established evidence-based guidelines and models of care that have changed the way common and debilitating musculoskeletal problems are managed in the health system.

Matt has been a strong supporter of new models of clinical supervision and education for students from the University of Sydney and other universities in Australia.


2019 Queen’s Birthday Honours members of ACI Networks

Medal (OAM) in the General Division

  • Dr David Thomas McDonald, for service to medicine as a paediatrician.

Member (OAM) in the General Division

  • Ms Brenda Lesley Booth, for service to community health, particularly her work with stroke survivors.

Members (AM) in the General Division

  • Ms Lindsay Cane, for significant service to community health, particularly in regional areas.
  • Professor Elizabeth Mary Chiarella, for significant service to nurse and midwifery education, and to health care standards.
  • Professor Constance Helen Katelaris, for significant service to medicine in the field of immunology and allergy.

New resources

Centre for Healthcare Redesign Capability Designer Manager

A step-by-step approach to clinical redesign

A new suite of Redesign factsheets to facilitate collaboration, innovation and better healthcare are now available to view online or download.

Used by NSW Health for more than 11 years, Redesign is a structured yet flexible methodology for implementing successful change initiatives through the phases of initiation, diagnostics, solutions, implementation and sustainability. The approach incorporates project management, change management and improvement science.

The 50 new factsheets include key points and tips for driving effective change and service improvement at each stage of the Redesign process including:

  • establishing the case for change
  • facilitating collaboration and involving the right people in your change project
  • setting project governance and scope
  • generating solutions
  • sharing knowledge.

There are also links to additional information, tools and training to support clinicians on the Redesign journey.

View and download the new fact sheets to create a framework for your next change project


Manager, Brain Injury Rehabilitation

Information for people recovering after a severe brain injury

The ACI Brain Injury Rehabilitation Network has released a new fact sheet for clinicians to provide to people who have experienced a traumatic (acquired) brain injury and their family and carers.

Co-designed by consumers and clinicians, the information is particularly relevant to those being considered for referral to the network of specialist Brain Injury Rehabilitation Programs (BIRPs) in metropolitan and rural NSW.

Download the Recovering After a Severe Brain Injury fact sheet from the ACI website.

For more information, please visit Brain Injury Rehabilitation Program


Network Manager, Statewide Spinal Cord Injury Service

Launch of online Pressure Injury Toolkit for Spinal Cord Injury and Spina Bifida

The Pressure Injury Toolkit for Spinal Cord Injury and Spina Bifida will support clinical decision-making and encourage an interdisciplinary, consumer-focused approach to pressure injury assessment and management.

The online toolkit, the first of its kind in the world, incorporates practical advice and strategies, red flag identification, lifestyle and psychosocial considerations and key messages based on evidence and best practice guidelines.

Toolkit components include:

  • a multidisciplinary pressure injury pathway
  • assessment tools
  • sample forms
  • consumer resources.

The toolkit aligns with the Clinical Excellence Commission’s Pressure Injury Prevention Project, assisting health professionals to identify patients at risk, identify strategies to assess pressure injuries and factors related to their risk, prevent or delay complications, optimise management of pressure injuries, and enhance quality of life for the patient.

An introductory video explain how community clinicians use the tool kit to help manage pressure injuries in a collaborative manner.

The resource is suitable for both specialist SCI clinicians and those new to SCI.

Please access the toolkit and please share with your colleagues.

Campaigns

Steps to home ladder safety

Did you know ladders are the most dangerous piece of DIY equipment around the home?

Ladders are linked to more deaths and serious injuries than any other product. Falls from just 1-2 metres can cause serious injuries such as broken limbs, spinal cord damage, severe brain injury or even death.

An analysis of five years of statewide data (2010-2014) found 8,496 people were admitted to a NSW hospital as the result of a ladder fall. The average age of people requiring admission was 58 years, with males making up 80% of those injured.

The ACI's Institute of Trauma and Injury Management has created a Steps to Home Ladder Safety web resource and a community awareness program. The program features videos, checklists, and step-by-step instructions on using ladders safely.

Visit Steps to Home Ladder Safety for more information.

Workshops, forums and conferences

Network Manager, Intellectual Disability Network

Transitioning young people with intellectual disability (and mental health comorbidity) to adult health services

Paediatrics, Transition Care and Intellectual Disability Health are three networks within the child and family stream of the CATALYST Directorate.

A priority for these networks was addressing the complex system challenges detailed in the 2019 ACI strategic plan including:

  • care integration at the juncture of hospital, primary, community and social care services
  • creation of new care models for people living with mental and physical comorbidities.

In collaboration with Sydney Children’s Hospital Trapeze, the networks hosted a forum on 11 April, with the aim of developing abroad consultation system, connections across services and sectors as well as showcasing recent transition initiatives.

An expert roundtable discussed transitioning young people with intellectual disability and mental health comorbidity to adult health services.

More than 90 people attended the forum from across health, justice services, community, PHN and GP, education and the disability sector.

Keynote speaker, Evelyn Culcane, leads Transition to Adult Care at the Royal Children’s Hospital (RCH) Melbourne. Ms Culcane presented her work in transition on improving the care of young people with intellectual disability and/or Autism Spectrum Disorder with mental health or behavioural comorbidities.

Anne Funke spoke of her experience as a mother supporting her son through the transition experience, as he moved from paediatric to adult health services. New LHD initiatives to meet the complex needs of young people transitioning to adult services were also presented.

Vincent Ponzio from the Ministry of Health detailed how is the Ministry is funding new initiatives to assist people with mental illness and intellectual disability, the funding of Sydney Children’s Hospital (Westmead) as a tertiary hub to build capability across the health system.

View the presentations from this event

Another expanded expert roundtable will be convened in late 2019.


Network Manager, Rehabilitation Network

Focus on quality improvement in rehabilitation

The ACI Rehabilitation Network has been busy over the past six months hosting workshops on a number of key areas for quality improvement including stroke rehabilitation, unwarranted clinical variation and amputee care.

In December 2018, a workshop was held to review information gathered via the National Stroke Audit – Rehabilitation Services 2018.

The workshop included:

  • presentations from the Stroke Foundation on national and state audit data
  • discussions led by the ACI Implementation Team on creating a case for change and considerations for planning implementation
  • knowledge sharing from high performing NSW rehabilitation services teams
  • discussions and planning around local services.

In February, more than 50 clinicians, managers and executives gathered in Mascot to examine unwarranted clinical variation in rehabilitation care, focusing on stroke, reconditioning and hip fracture.

Presentations were delivered by the ACI, Ministry of Health and Australasian Rehabilitation Outcomes Centre.

The ACI Implementation Team led discussions on:

  • timeliness of referral to rehabilitation from acute care
  • timeliness of transfer to inpatient rehabilitation
  • length of stay
  • delays with discharge from inpatient rehabilitation.

Delegates from Hornsby Ku-ring-gai Hospital shared findings from the Inpatient Rehabilitation Length of Stay project, detailing steps, processes, actions, learnings and outcomes.

The following month, 80 clinicians and managers from amputee services across NSW convened in Chatswood for Care of the Person following Amputation - Minimum Standards of Care implementation workshop.

The workshop recapped the development and components of the Standards, and reviewed the use of the Standards in NSW amputee care services.

Attendees workshopped implementation of the Standards: barriers and enablers, special considerations, how to ‘plan, assess, operationalise’, project planning, change management processes and next steps.

Stroke rehabilitation workshop. Photo: Justine Watkins.


Stream Manager, Trauma, Pain and Rehabilitation

Pain Society conference highlights pain management initiatives in vulnerable populations

The Australian Pain Society held its 39th Annual Scientific Conference on the Gold Coast in April. In line with the International Association for the Study of Pain’s (IASP) 2019 Global Year Against Pain in the Most Vulnerable Populations, presentations included topics relating to pain management in remote and regional populations, CALD communities and the socially disadvantaged.

The ACI Pain Management Network was recognised for leadership in implementing a state pain plan that delivered outcomes across Australia, particularly the work done in primary care and vulnerable communities. Jenni Johnson, Trauma, Pain and Rehabilitation Stream Manager, spoke about Pain management: a wicked problem for vulnerable communities. The presentation showcased recent improvements in accessing specialist care using telehealth, capacity building and training of non-health staff to deliver pain programs in CALD communities.

The electronic Persistent Pain Outcome Collaboration (ePPOC), a national data registry and quality improvement system initiated by the ACI with seed funding from the Ministry, was recognised for improving the quality of service delivery nationally. The ACI Pain Network has played a critical role in promoting and coordinating implementation of ePPOC in NSW, and participates in annual workshops to review service delivery challenges such as reducing opioid prescription and improving quality of life.

Visit the Pain Management Network for more information.


Network Manager, Diabetes and Endocrine Network

Leading Better Value Care – inpatient management of diabetes workshop

In April, more than 70 clinicians and program leads from LHDs and SHNs attended a workshop for the Leading Better Value Care (LBVC) inpatient management of diabetes mellitus initiative.

Participants shared their LBVC experiences during the workshop, with eight clinicians delivering presentations on initiatives around the four statewide diabetes priority areas:

  • diabetes identification and screening at hospital presentation
  • best practice insulin management, including implementing and using capability building resources such as Thinksulin, eLearning and Qstream
  • access to specialist care and diabetes education
  • ensuring continued quality care from hospital to home for both patients and healthcare providers.

The interactive sessions focused on knowledge sharing to enhance clinician capability, as well as ways to improve patient-reported measures.

Presentations and storyboards are available on the LBVC Hub


Network Manager, Intellectual Disability Network

Intellectual Disability Health Network Annual Forum

More than 120 people attended the Intellectual Disability Health Network’s annual forum on 5 April.

Delegates came from across NSW and included staff from health, education, corrective services, disability sector, community sector, PHNs, GPs and carers. It was a great opportunity to network with colleagues from within health and across sectors.

MC Richard Habelrih, inspired everyone with his stories on working with school students to promote diversity and inclusion as well as his own life experiences.

The program also included sessions on:

  • innovative practice in dental anaesthetics
  • health and the National Disability Insurance Scheme interface
  • the intellectual disability (ID) health and mental health teams and models
  • translational research activity such as the FaceMatch project
  • community of practice start-ups.

View forum presentations

Tracey Szanto (ACI); David Dossetor (SCHN); Vince Ponzio (Children & Young People Mental Health); Robert Leitner (SESLHD); Jodie Caruana (Schoollink)

Tracey Szanto (ACI); David Dossetor (SCHN); Vince Ponzio (Children & Young People Mental Health); Robert Leitner (SESLHD); Jodie Caruana (Schoollink). Photo: Mary Crum.


Network Manager, Statewide Spinal Cord Injury Service

Spinal Cord Injury Network forum: Improving transitions to community living and person-centred care

An expert stakeholder forum on improving transitions to community living and person-centred care for people with spinal cord injury (SCI) was held on 15 May at Royal Rehab in Sydney. The forum was attended by 26 stakeholders including consumers, representatives from Federal and State Government as well as community organisations and icare.

The aim of the forum was to develop innovative solutions on improving:

  • communication and streamlining of process between service providers
  • equitable and timely access to services
  • consistency of quality of service provision
  • transparency.

The forum presented an opportunity to raise awareness of existing initiatives across different sectors and solution-focussed approaches to address areas of need. Discussions focussed on seamless transition to community from hospital and person-centred care.

Delegates workshopped collaborative solutions in the following areas.

  • strengthening person-centred delivery
  • person-centred care with multiple systems
  • person-centred care where there are changing housing needs.

The outputs from the forum will help develop collaborative pathways to share learnings, and create partnerships that generate outcomes for people with spinal cord injury in NSW regardless of their location, age or funding source.


Professor John Corrigan to address National Brain Injury Conference

Brain Injury Australia, in partnership with the Melbourne Disability Institute, will hold the seventh National Brain Injury Conference on 28-29 October 2019 at the University of Melbourne.

The conference is a premier learning and development event on the disability calendar. The program includes presentations and panel discussions with consumers, clinicians, researchers and service providers on the topics of rehabilitation, recovery and adaptation to brain injury.

John Corrigan, Emeritus Professor, Department of Physical Medicine and Rehabilitation at Ohio State University will deliver this year’s international keynote address, and participate in panel discussions on domestic violence and brain injury, concussion and ‘mild’ traumatic brain injury.

Professor Corrigan is Editor-in-Chief of the prestigious, Journal of Head and Trauma Rehabilitation and is also the Director of the Ohio Valley Center for Brain Injury Prevention and Rehabilitation. Since 1997 Professor Corrigan has led the Ohio Regional Traumatic Brain Injury Model System program (TBIMS). The program aims to improve the lives of people who have experienced traumatic brain injury (as well as their families and communities) by creating and disseminating new knowledge about the course, treatment and outcomes relating to their condition.

The ACI encourages interested parties to put forward an abstract or register for the conference.

Visit the conference website for more information, or contact Interpoint Events, on 1300 789 845 or info@interpoint.com.au