2013 ANNUAL REPORT - Health Roundtable · 7 The Health Roundtable Limited Annual Report 2013 Key Performance ... This provides senior executives an overall Balanced Scorecard that

2013 ANNUAL REPORT

The Health Roundtable Limited

1 The Health Roundtable Limited Annual Report 2013

The Health Roundtable Limited 40 Port Jackson Road

Terrigal NSW 2260 Australia Tel: (02) 4385 5894 New Zealand (09) 889-2551

Australia Fax: (02) 4384 7078 www.healthroundtable.org

ABN 71 071 387 436

Our Mission Since its inception in 1995 The Health Roundtable Limited has operated as a non-profit collaborative organisation. We exist to: Provide opportunities for health executives to learn how to achieve Best Practice in their

organisations Collect, analyse and publish information comparing organisations and identifying ways to improve

operational practices Promote interstate and international collaboration and networking amongst health organisation

executives

Our Members Membership of The Health Roundtable is open to health services across Australia and New Zealand, subject to approval by the Board of Directors. Each member organisation nominates its most senior operational executive to serve as a Personal Member of the Health Roundtable. Personal Members elect a Board of Directors to provide overall governance. They meet regularly to shape the agenda and review progress. The Board’s Audit & Compliance Committee reviews operational and financial performance on a monthly basis. The Health Roundtable receives no direct government funding. All activities are supported by annual membership dues, subscription fees and corporate sponsorships.

Sharing Information Data provided to The Health Roundtable are freely shared amongst participating members, but are not disclosed to outside organisations. However, general insights and methodologies are openly available to the public through our website: www.healthroundtable.org

The Health Roundtable Honour Code In order to maintain frank discussion in our meetings, all our members agree to abide by The Health Roundtable Honour Code which requires that: No member shall criticise the performance of other member organisations, or use any of the

information to the detriment of a fellow member. No external distribution of data or conclusions based on Health Roundtable analysis is made

without the unanimous consent of those contributing the data.

THE HEALTH ROUNDTABLE

Vs19-10March2014

http://www.healthroundtable.org/

The Health Roundtable Limited Annual Report 2013 2

REVIEW OF OPERATIONS 2013

The Health Roundtable works to help members improve patient care by helping them answer three key questions:

1. Where is our performance below that of our peers? 2. What are the “exemplars performers” doing differently? 3. How can we achieve “good practice” in our health service?

Our members now include over 80 public-sector health services from every state and territory of Australia and all District Health Boards in New Zealand, as well as a leading non-profit private health care group in Victoria. In 2013, we analysed more performance data, hosted more Roundtable meetings and involved more people across Australasia in the search for patient care innovations than ever before in our 18 years of operation. This report provides a snapshot of the key activities, which are recorded in far more detail on our website: www.healthroundtable.org. The key improvement messages from the work conducted in 2013 are highlighted below.

FIVE KEY IMPROVEMENT MESSAGES FOR 2013 1. Improving availability of fully-qualified clinicians

at nights and on weekends can remove the “weekend effect” which has increased the risk of death for patients arriving on weekends by 10% or more. (see page 8)

2. New low-cost cleaning systems are being implemented to reduce the burden of hospital-acquired infections that extend patient stays by over 750,000 days a year. (see page 9)

3. New approaches to manage the large number of “follow-up” patients now surviving breast and prostate cancer can enable the health system to cope with increased demand (see page 10)

4. “Bundles” of activities are increasingly being implemented to improve the reliability of care delivery and patient outcomes in key areas (see page 12)

5. Young clinicians are developing innovative “apps” to solve age-old problems in managing patient care (see page 14)

Report Guide Page

1. Performance analysis

3

2. Identifying exemplars

8

3. Achieving Good Practice

27

4. Directors’ Report

29

5. Financial Statements

39

6. Independent Auditor Report

46


The Health Roundtable collects and analyses a wide range of data provided by its member organisations to identify differences in performance to alert them to potential opportunities for further improvement. The following pages summarise the breadth and depth of the reports available to members to help them identify where their results are below that of their peers. During 2013, The Health Roundtable team of analysts collaborated with staff from member organisations to analyse large amounts of data, including: Over 5.0 million inpatient records representing over 13.9 million bed days. Patients aged 80 or more

represent about 4% of the population, but required 21% of bed days. Approximately 7.7% of patients had an additional hospital-acquired condition during their episode. These patients used 28.8% of all bed days. The total cost of the episodes using the Australian national weighted activity unit value was over $25.8 billion Australian dollars.

Over 5.3 million emergency department presentations, of whom 33% were formally admitted to hospital. Across Australia and New Zealand, 64% of those presenting to ED left within 4 hours and 82% left within 6 hours.

Over 7.5 million Allied Health records detailing approximately 6.0 million hours of professional time to service 360,000 individuals as outpatients and 388,000 individuals as inpatients.

Over 2.4 million contacts made by mental health professionals with their community clients.

Over 2.1 million imaging records from radiology imaging services at 17 health services to gauge the timeliness of services to patients during their hospital stay.

Summary reports from these analyses were provided to the participants in each benchmarking group to enable them to compare results with each other. In addition, over 9,500 customised narrative reports were produced to provide clinicians at each member facility with details of their clinical performance for key patient groupings compared with their peer organisations in The Health Roundtable. All reports are stored in an online library on The Health Roundtable website and are available for downloading by registered staff members of every member organisation. The Health Roundtable takes care to ensure that only administrative data about patients is submitted by member organisations, without disclosure of patient-identifying information.

1. WHERE IS OUR PERFORMANCE BELOW THAT OF OUR PEERS?


Core Activities for All Member Organisations The Health Roundtable provided five core membership services in 2013 for all members to help them identify performance improvement opportunities:

1. Inpatient Care Comparisons 2. Emergency Presentation Comparisons 3. Key Performance Indicator Comparisons 4. In-Hospital Mortality Comparisons 5. CEO-Level Executive Briefing Summaries

Members submitted data on a six-monthly basis. We typically provided analysis within four weeks.


Optional Benchmarking Improvement Groups 2013 In addition to the core services, The Health Roundtable offered a wide selection of optional benchmarking services to:

Identify innovative practices at other health services Get help from exemplar peers to improve services Use the peer network to answer urgent questions

Customised analysis, onsite tailored briefings and ABF Planning Tool In addition to our standard reports, we provide detailed analyses of the data to member organisations on request. These include:

Assistance with operational planning at the clinical unit/department/ facility Assisting clinicians and managers to maximise information from reports Specific comparisons with other organisations “Drill down” analyses to the episode level for specific adverse events

All reports are available to all members! All staff members of each member organisation can view any Optional Improvement Group report for any member organisation, whether or not their organisation is participating in the Group. Our goal is to make the information as open and available as possible. However, the key value of The Health Roundtable is learning from the “exemplars” at the meetings!

University Healthsystem Consortium (UHC) The Health Roundtable is an international member of the University Healthsystem Consortium www.uhc.edu that offers all Health Roundtable member organisations and their staff free access to a huge online library of performance improvement presentations, technology briefings and forecasts regarding the health care practices of major academic medical centres in the USA.

Imaging Improvement Group Clinical Costing Improvement Group Allied Health Improvement Group Nursing Improvement Group Maternity Improvement Group Patient Safety Improvement Group Paediatric and SubAcute Interest Groups

Mental Health Improvement Group Surgical Journey Improvement Group End of Life Care Improvement Group New Zealand Chapter NSW Chapter Global Innovation Group

International Hospital Federation (IHF) The Health Roundtable became an associate member of the IHF in 2013 and is participating in a new global special interest group of academic medical centres comparing practices and solutions. Our aim is to identify innovative practices that can be adapted to Australasia.

http://www.healthroundtable.org





Emergency Presentation Analysis Emergency Data Reports Are produced every six months to provide trend information for each health service compared to its peers on a variety of key indicators, such as: Percentage discharged within 4 hours Hourly presentation patterns Monthly volume trends

2013 Improvements in Meeting the 4 Hour Emergency Target In Australia, health services are focusing on getting patients out of Emergency to home or to a ward within four hours. In New Zealand, the target is six hours.

Member hospitals are reaching the target for increasing numbers of patients. The Emergency Reports provide monthly trend analysis and identify the “exemplars” to contact for further insights. The chart below shows the results by hospital size for 2012/13.


Our Emergency reports have been customised for Australian and New Zealand members to reflect differing definitions. In Australia, the ED component is separated from inpatient stay, whilst in New Zealand it remains a part of the inpatient episode.

Performance on National Emergency Access Targets—2012/2013 Major Teaching Hospitals


Inpatient Care Comparisons Every six months, The Health Roundtable produces a suite of customised inpatient briefing reports to assist in finding opportunities for improvement. Although focused on length of stay, the reports also provide data on readmission, DOSA rates, patient complexity and complications of care.


Relative Stay Index — This index is calculated for each health service, clinical unit and episode to adjust for differences in patient mix, such as age, admission source, discharge destination and comorbidity level. Results are displayed in green if the length of stay is declining and in red if increasing.

DRG B02—Cranial Procedure Differences in Length of Stay

Classification of Hospital-Acquired Diagnoses (CHADx)

The Health Roundtable has adopted the CHADx system to identify episodes with hospital-acquired complications. This new approach replaces our previous complications of care approach. Across all member hospitals 7.7 percent of inpatient episodes in 2012/13 were recorded as having one or more of these codes occur during the episode. However, the recorded rate varies widely amongst hospitals. Some occurrences may be expected in the course of a patient’s disease, whilst others are preventable adverse events. We provide the raw analyses as a screening tool for members to evaluate and learn from each other.


Key Performance Indicator Analysis Six Monthly Key Performance Indicator Reports bring together information derived from inpatient and emergency data, together with selected clinical and workforce measures that are manually entered by hospital staff. This provides senior executives an overall Balanced Scorecard that provides: Trend information of

performance over time Comparisons with peer

hospitals on each indicator

The KPI Overview enables a quick comparison of the performance of

selected Operational Units at the highest level. Drill-down capability is available to review any Operational Unit or KPI grouping in greater detail. Key Performance Information for Chief Executives, General Managers and Senior Health Care Managers is presented via an online scorecard on The Health Roundtable website (see below). The indicators highlight any unusual services provided by each member and then evaluate performance across five key domains: Efficiency, Emergency, Safety, Surgery and Workforce.


Each reported KPI includes a range of views: current comparison to benchmark trend over time ranked comparison against peers The Executive Summary provides convenient and specific information about opportunities and ‘bright spots’ for busy executives.


Inpatient Mortality Analysis Six monthly mortality analysis is based on a period of data containing over 9 million episodes and around 100 thousand deaths. Extensive reports are provided to members to enable them to identify their trends over time and to drill down to specific areas that have unusually high or low mortality rates.

Our review of 204,000 deaths in 11.3 million emergency admissions indicates a 13% higher risk of dying when a patient is admitted on a Saturday compared to admission on a Tuesday. A special Roundtable meeting is being held in 2014 to examine the causes and solutions for this difference.


The chart above shows mortality trends for one health service compared to peer benchmarks. The chart below shows the same hospital in relation to its own data over 4 years so it can track internal HSMR trends.


Achieving Best Practice in Health Service Cleaning 17 services attended the workshop in Sydney and delegates were treated to a guided tour of the new Royal North Shore Hospital that included a demonstration of microfibre cleaning systems, as well as Automated Guided Vehicles (AVGs), colloquially known as 'robots'. The AVGs deliver meals, linen and can also transport waste.

2. WHAT ARE THE “EXEMPLARS” DOING DIFFERENTLY… IN CLEANING?

HEALTH ROUNDTABLE

100,000 DAY CAMPAIGN

Health Roundtable member hospitals treated 2.3 million patients in 2011/12. Of these, approximately 55,000 experienced a hospital-acquired infection which extended their stay by 2 weeks, requiring an additional 775,000

days of care.

It is estimated that 20-40% of infections are due to environmental factors which can be addressed by improved cleaning

practices.

In 2013, The Health Roundtable launched a campaign to give back to the health services 100,000 bed days through improved cleaning practices. This equates to about half of the days lost due to environmental cleanliness

issues.

Innovation Highlights Microfibre and Steam Cleaning at Monash Health

After successful trials, microfibre and steam technology is being implemented across Monash Health. Costs have been reduced by increasing staff efficiency and reducing the need for chemicals, dry cleaning and water. The reduced manual workload has seen the techniques embraced by staff and the training and credentialing program has improved morale and cleaning outcomes.

Automated Decontamination, NZ

Counties Manukau have applied proven technology from industries like CSL and implemented 'cleanroom standards' in their burns unit using vaporised hydrogen peroxide, which can be used with sensitive electronic equipment and allows consumables to remain in place during the decontamination process. Such is the success, more units have been ordered for high risk areas.


Patients living with cancer 65 delegates including representatives of Medicare locals and the peak consumer body CanSpeak, met in Melbourne in September to improve follow-up management for over 1,000,000 patients surviving cancer in Australia and NZ. The focus was on prostate and breast cancer as these represent around 60% of long term survivors. Cancer services are facing large patient increases from aging populations. Many services have long historical tails of follow-up patients ranging out to 10 or more years. However, there was good agreement from all that cancer centres and oncology specialists would be better focussed on treating new patients and finding alternatives for uncomplicated patient follow-up. Prof Michael Jefford, medical oncologist and Director, Australian Cancer Survivorship Centre; eloquently outlined the tasks ahead to: improve outcomes for survivors, use limited resources efficiently and provide most appropriate care.

2. WHAT ARE EXEMPLARS DOING … IN CANCER SERVICES?

Over 145,000 people are newly diagnosed with cancer every year in Australia and New Zealand. It is estimated that over 1 million people are living who have had a previous diagnosis of cancer. Of these cancer patients, 40% had prostate cancer and 20% had breast cancer. As patients transition from the acute treatment phase, most service models continue to provide follow-up care in the same acute setting. It is time to review whether this is the right approach for the future!

The aims were:

To increase the efficacy and productivity of the oncology workforce in acute facilities

Increase new patient access to oncology services

Reduce variation in follow-up protocols to improve patient outcomes

Identify and evaluate alternative models, including Wellness Centres

Keynote Prof John Emery Principal investigator with the Primary Care Collaborative Cancer Clinical Trials Group (PC4). A key platform is shared care and survivorship in the primary care setting. Research demonstrates no difference in clinical outcomes between patients followed-up in a cancer service or primary care setting.

Olivia Newton John Wellness Centre site tour The Austin Hospital generously invited our 35 delegates to tour their new Wellness Centre. The centre aims to integrate traditional medical care with a range of complementary and supportive therapies, that includes the concept of wellness. Chris Scott (right) centre manger and Churchill Fellow shared her experience of international models of wellness and integrated cancer care.

Dr Ian Roos from CanSpeak

Michael Jefford


Medical workforce planning in an ABF Environment Two one-day Medical Workforce meetings were held in 2014. In July over 90 representatives from health services across Australia and New Zealand came together in Brisbane to discuss the new imperative that health services must live within their activity-based funding budgets. The lack of agreed definitions was recognised as a barrier and The Health Roundtable was requested to prepare a discussion paper and data specification to inform the follow-up meeting. In November, members met again in Melbourne. The focus was on the ED and to test the benchmarking concept delegates shared the results of a one-month analysis of medical staff time and workload across member health services to highlight different approaches to medical staffing concepts.

2. WHAT ARE EXEMPLARS DOING … IN WORKFORCE PLANNING?

How many medical consultants, registrars and junior staff can you afford within the activity funding received? What is the role for minimum staffing levels? How do you allocate ABF revenue to medical departments providing services to the main treating team (such as Pathology, Radiology, Anaesthetics

and ICU)?

The difficulty for most health services is that little is known about the actual time spent by medical staff treating patients. Medical staff have many roles in addition to their clinical work and often have multiple sources of funding. Although substantial progress is being made in reducing overtime costs, much work needs to be done to develop appropriate

staffing models for medical staff.

There are no easy answers, but by sharing insights with colleagues across many health services, member health services are beginning to make

progress. Health Roundtable costing data demonstrated for the typical inpatient episode worth about $5,000, there is approximately $1,000 per standard episode available to fund medical staff.

Keynote Speaker David Farlow, Executive Director of Clinical Services Mackay, presented on Mackay Hospital redesign—aiming for 95% ED clearance rate within one hour, with emphasis on senior doctors at front of all decision making.


Global Innovations Group– Workshop The aim of the Global Innovation Group is to improve health service performance across Australia and New Zealand by sharing common issues and innovative solutions with global health service leaders. The key activities for this meeting were to review progress and share insights on the global innovation projects selected in March 2013.

2. WHAT ARE EXEMPLARS DOING … GLOBALLY?

In August, members of our Global Innovations Group met in Brisbane to review progress on projects to reduce variation in care and to move toward becoming “high performing organisations.” Each participating organisation had identified one or more projects of interest and commenced data collection to identify breaches in their agreed protocols (bundles) of care regarding fractured hips, stroke, heart disease, and/or blood management. Professor Peter Spurgeon discussed ways to increase Medical Engagement. This is a key building block in the effort to create and maintain a high-performing health service. Other experts provided insights on the issues involved in reducing variations of care: Dr Joanne Pink, Chief Medical Officer form the Australian Red Cross; stroke researcher, Prof Chris Levi and Prof Peter Goldswain, a pioneer in orthogeriatrics from WA. Comparative benchmarks from the UK and England are being developed to guide the search for exemplars.

Peter Spurgeon, Director, Institute for Clinical Leadership at Warwick Medical School, UK. The Medical Engagement Scale (MES) has established national norms in the UK with approximately 5000 doctors, all specialities and 60 NHS Trusts of all types. The medical engagement data correlates strongly with a range of independently gathered performance measures. Several Global Innovation members have used the MES to assess the level of medical engagement in their organisations.

Chris Levi is a clinician and researcher. He is Director, Priority Research Centre for Brain and Mental Health, University of Newcastle and Director, Acute Stroke Services, John Hunter Hospital. Chris has made significant contributions to the global research effort to improve the health of people who suffer a stroke. A new model of pre-hospital stroke care designed by the group has demonstrated how to overcome the time barrier to effective stroke treatment in metropolitan areas; lifted treatment rates to international best practice; and saved health care dollars.

One service chose care bundles for fractured NOF to address local problems including delirium. CAM screening increased from <10% to >80%


Innovations Workshop and Awards 2013

The Health Care system has never been under such intense pressure. New technologies, an ageing population and workforce shortages are combining with the global financial crisis to create a

“perfect storm” for health system leaders.

Major improvements in care delivery are urgently needed and The Health Roundtable is dedicated to spreading innovative practices as quickly as

possible.

2. WHAT ARE EXEMPLARS DOING … TO INNOVATE?

In November, the biggest ever Health Roundtable Innovation Workshops and Awards meeting in Brisbane attracted over 150 presentations and 260 attendees to share issues and innovations. The presentations were in in four streams of concurrent "rapid-fire" sessions on: Empowering Our Patients Improving Complex Patient Journeys Reducing Variation in Care Delivering Value Workshop sessions were designed to provide time to share issues and innovations and to create a network of colleagues that will assist each other as you cope with the "perfect storm" that is hitting health systems around the globe. The innovative ideas from these sessions will help make financial performance improvements as well as improve the patient care.

Keynote Speaker: Sam Prince Founder and Chairman of “One Disease at a Time” - a non-profit organisation with a simple but ground breaking vision: to systematically target and eliminate one disease at a time.

Keynote Speaker: Michele Fleischacker

Director, Performance Improvement at Kaiser Permanente, Santa Rosa Kaiser Permanente is renowned for the tight integration of its clinical services. Kaiser Permanente closely coordinates primary, secondary and hospital care; places a strong emphasis on prevention; and extensively uses care pathways and electronic medical records. By doing so, it provides its 8.7 million members and patients with high-quality, cost-effective care. Michele’s address demonstrated how every Kaiser care giver actively takes responsibility for a patient’s health, ensuring that primary health checks are completed as well as health issues treated. The results of this are that Kaiser Permanente members are 30% less likely to die from a heart attack than non members.


INNOVATONS WORKSHOP WINNERS

Health Roundtable President Ron Dunham had the enviable job of presenting special trophies to the four stream winners of the Innovation Awards in November.

The winners of the Delivering Value stream were Andrew Maurice(L), Samuel Chan, (R), from The Prince Charles Hospital Qld pictured left with President Ron Dunham for Improving health service planning and reimbursement through quality coding.

Noelle Bennett:( above) won the Improving Complex Patient Journey stream for Southern DHB NZ for her innovation to reduce radiation-induced skin toxicity: It doesn't need to be that bad!

Katy Boulton (R) won the award for Improving Care Stream for Reducing Presentations to Hospital Emergency Care for Very High Intensity Users at Counties Manukau in New Zealand Middlemore Hospital, Counties Manukau, NZ

Greg Flint of Calvary Mater Newcastle won the Patient Safety Stream with his innovation Clean Hands? Senior managers have demonstrated that visible support from the top down can improve hand hygiene compliance remarkably.

https://origin.library.constantcontact.com/doc204/1102938290114/doc/XEPeLkll65d8bhBt.pdf





https://origin.library.constantcontact.com/doc204/1102938290114/doc/YfLVYo2Edt8c1Nsg.pdf

https://origin.library.constantcontact.com/doc204/1102938290114/doc/YfLVYo2Edt8c1Nsg.pdf

https://origin.library.constantcontact.com/doc204/1102938290114/doc/ThmluCcUEGd7HEE1.pdf

https://origin.library.constantcontact.com/doc204/1102938290114/doc/ThmluCcUEGd7HEE1.pdf


Clinical Costing Improvement Group

Detailed costing records are linked with inpatient activity information, bringing together “Activity-Based Costing” with the emerging “Activity-Based Funding” reforms. The Health Roundtable produces an annual comparative analysis of inpatient costs at the DRG and organisational level highlighting key differences in costs amongst members.

More than 60 people from 20 Health services attended the Casemix and Costing ABF Improvement group in Brisbane on 6 – 8 March 2013. Mr James Downie, Chief Executive, Independent Hospital Pricing Authority, outlined the Commonwealth’s approach to costing and establishing the efficient price for Hospital services. For the first time, the Roundtable presented comparative cost and revenue reports for Emergency Department and Outpatient Services in addition to updated and improved Inpatient services analyses. Liz Lea, Manager Funding Analysis and Clinical Costing, Townsville Hospital and Health Service presented on the ground breaking work in Queensland on developing a career path structure, including a competency framework and skills development program, for Clinical Costing practitioners.

2. WHAT ARE EXEMPLARS DOING … IN CLINICAL COSTING?

Costing Summaries at a glance!

Costing reports highlight the variance in each “cost bucket” to provide a quick guide to the areas requiring deeper analysis and then drill down to individual Diagnostic Groups.

James Downey IHPA


The Imaging Improvement Group met in Sydney in February 2013 to address the topic of “Improving Imaging in the Emergency Department: Helping hospitals to meet their access targets” as well as hearing from James Downie on the implications of ABF for Imaging. Our reports highlight variation in practice regarding time from arrival to first imaging visit for emergency patients and time to report completion for all patients to enable members to identify “exemplars.”

Imaging Improvement Group The Imaging Journey Improvement Group aims to reduce waiting times, reporting delays and unnecessary radiation exposure. Members assist each other by sharing practice insights and innovations to improve the flow of patients through their overall hospital journey. Members provide detailed activity data for each patient encounter for comparative analysis by The Health Roundtable. This information is merged with inpatient episode data to provide a customised imaging report on each of the different modalities to compare waiting times, service times, time to report completion and exposure to multiple radiological examinations.

2. WHAT ARE EXEMPLARS DOING … IN IMAGING?

New Performance Summaries for all modalities at a glance! Help members quickly locate opportunities and bright spots for all their imaging modalities: X-ray, CT, MR, Ultra Sound, Mammography, Nuclear Medicine, Fluoroscopy, Bone Densitometry

Innovation Highlight "Open Access" Approach reduced cost: increased efficiency A radical service reconfiguration at Western Sydney has demonstrated that it is not only possible to improve imaging services but also to reduce costs. At the March Imaging Workshop, delegates were challenged to think outside traditional service models with a presentation on an 'Open Access' service for CT and General Radiology. The backlog of reports is reduced to zero, costs down 40% and patient turnaround completed in one hour!


Maternity Improvement Group This group aims to identify innovative and effective practices for safe maternity care. Many health services are experiencing rapid growth in maternity services with limited resources and facilities to meet demand. The Group reviews operational and clinical data to look for innovative practice differences. The group meets annually to discuss trends, report on innovations and share ideas for improvement.

2. WHAT ARE EXEMPLARS DOING … IN MATERNITY CARE?

In April a joint meeting on improving maternity services was hosted by The Health Roundtable and Women’s Healthcare Australasia. Over 70 attendees at the meeting in Sydney shared information on how they are working to improve services for women and the special topic of reducing the Impact of Post Partum Haemorrhage.

Innovation Highlight Project RED Reducing the Impact of Post Postpartum Haemorrhage

Mater Mothers Hospital in Brisbane developed Project RED - Risks and Expectations Documented! A process of visual red markers and stamps was implemented to serve as cues for clinicians and midwives to complete and review plans for all patients deemed at risk of adverse outcomes. Results to date: 100% compliance, no RCAs required and no clinical incident reports.

Maternity KPI Reports provide detailed information on a

balanced scorecard covering the performance of your health services.

Thought starter presentation Professor David Ellwood, a practicing obstetrician with research interests in adverse pregnancy outcomes, shared a review of the current evidence and controversies.


The June 2013 meeting in Brisbane was focussed on the introduction of ABF in mental health. Health Roundtable specialist costing consultant Chris O'Gorman presented details of revenue, costs and potential profit & loss scenarios for members. James Downie from IPPA was welcomed by members to clarify issues arising from changes to funding models. Innovation presentations were wide ranging. Examples are: a smoking cessation program, Improving discharge planning, Integration with primary care and Focussing on outcome measures to standardise service delivery.

Mental Health Improvement Group This group reviews both inpatient and community mental health data to identify innovative practices. Data are organised for three major client groupings: Child & Adolescent, Adult and Aged (over 65). The Group follows national KPI definitions for Australia and New Zealand to the extent possible and is working collaboratively to develop metrics for community outcomes using HoNOSCA scores.

2. WHAT ARE EXEMPLARS DOING … IN MENTAL HEALTH SERVICES?

Innovation Highlight. From Whiteboard to E-Board: Implementation of an Electronic Patient Journey Board. Improving communication and patient flow at The Prince Charles Hospital


Improving End of Life Care More people are dying in hospitals, yet a recent survey in Australia found that over 70% of people wanted to die at home. Unfortunately, less than 20% achieve that goal. The importance of improving the delivery of ‘end of life‘ care is well recognised by health services. The aim is to identify ways to improve patient care in the last 100 days of life.

The theme for the June 2013 End of Life meeting in Sydney was improving access to appropriate care. Delegates shared strategies for improving quality of life in the final 100 days. A recent survey indicates that over 70% of us would prefer to die at home rather than in hospital. However, less than 20% of people achieve that goal at the end of life.

Innovation Highlight An alternative

to the Liverpool pathway. Helping staff identify dying patients and providing tools to assist in end of life management such as the clinical prompts for care of the dying patient at Counties Manakau

Keynote Speaker - Peter Saul

Dr Peter Saul has been intimately involved in the dying process for over 4,000 patients as an intensivist. Paul shared his insights with the group for improving the way we die. The research has shown people older than 70 have a 30 per cent chance of dying or being severely disabled within a year of a major operation. Futile treatments are demeaning with each case to be considered on its merits and people should not be categorised into groups.

Considerable variation in number of beddays in 6 months before death

2. WHAT ARE EXEMPLARS DOING … TO IMPROVE END OF LIFE CARE?


The September 2013 Nursing meeting in Melbourne focussed on the implications of the Francis report and how outcomes can be improved with nursing leadership. Members heard two very thought provoking presentations. The first was from Cheyne Chalmers, Executive Director Nursing Midwifery and Support Services, Monash Health, Melbourne and the second was from Deb Thoms, Chief Executive, Australian College of Nursing. Members again presented an interesting array of innovations including: the use of companions or specials, intentional rounding, the New Zealand approach of Care Capacity and Demand Management, management of pressure injuries and falls and continence management which was especially relevant in the light of the Francis Report.

Nursing Improvement Group The purpose of the group is to enable Nursing Leaders to improve patient outcomes and ensure a stable and productive nursing workforce. Participants in the group share the latest confidential comparative reports identifying differences on key workforce and patient safety indicators: Pressure injuries Falls UTIs Nursing turnover Nursing sick leave Group members compare their patient outcomes with staffing levels and workforce practices, as well as compare notes on new initiatives to improve patient care.

2. WHAT ARE EXEMPLARS DOING … IN NURSING CARE?

Debra Thoms Chief Executive Australian College of Nursing

Sir Charles Gairdner Hospital saved $2.5 million after attending the 2012 meeting by improving how they used their nursing companions and specials!

It is possible to have less than 1 fall per 1000 risk adjusted episodes!


Patient Safety Improvement Group The Patient Safety Improvement Group meets annually to compare practices and process indicators. A key objective is to spread innovative practices to quickly reduce adverse events throughout Australia and New Zealand. The Health Roundtable has developed the “Safer Patient Care” checklist of key process indicators that are associated with safer care. Each year, member organisations are requested to assess their performance in comparison to mortality and adverse events. (See next page)

In June, 68 delegates joined the Patient Safety Improvement Group meeting in Sydney to share ways to improve patient care. Raj Behal, from Rush University Hospital, Utah delivered a thoughtful keynote demonstrating how variation in clinical care impacts on quality and costs.

2. WHAT ARE EXEMPLARS DOING … TO IMPROVE PATIENT SAFETY?

Innovation Highlight. Sepsis Kills ! Delegates from Westmead shared how implementation of the CEC pathway has seen over 50% reduction in the time to administration of antibiotics and fluids .


Organisation-wide Initiatives 1. A standardised multi-disciplinary and multi‑department

morbidity and mortality review occurs at least quarterly in clinical areas.

2. Specific programs are in place to reduce Hospital Acquired Infection, with audit and feedback to clinicians on their antibiotic prescribing practice.

3. All fall locations are mapped to provide visual feedback to ward staff on trends in the number and location of falls in their specific clinical areas.

4. A consistent communication tool is in place for all requests for assistance e.g. SBAR, or ISOBAR.

5. All abnormal critical results from medical imaging and pathology are communicated quickly to the treating team and signed off.

6. Auto-expiring orders are used for every urinary catheter. 7. All patients and their carers are explicitly given the opportunity

to be included in the provision of Safe Care e.g. a Daily Plan. 8. Every unit has patient safety goals which are measured, on

visual display and discussed at least weekly. 9. All patients receive, in a language they understand, a

statement encouraging them to speak up if they notice a staff member failing to wash hands prior to providing care.

10. All nursing handovers are conducted at the patient bedside and include the patient and/or carer in the discussion.

Governance Process 1. Patient Safety is the first item on the Executive or Board

agenda at every meeting. 2. There are explicit goals for Mortality Rate Reduction which are

tracked at least quarterly by the Executive or Board. 3. There are explicit goals for Adverse Event Reduction which are

tracked at least quarterly by the Executive or Board. 4. Patient stories relating to clinical incidents are discussed at

least quarterly at Board/Executive meetings. 5. Senior Executives participate in “Patient Safety Walkabouts” at

least monthly.

Specific Initiatives A1. Ventilator Care Bundles are used and audited at least monthly,

including sedative interruption. A2. Central Line Care Bundles are used and audited at least monthly,

including the use of checklists for maximal barrier precautions. A3. A documented clinical pathway for Acute MI is used and audited

at least monthly. B1. All clinical staff are trained to use a physiological “track and

trigger” system with a graded response strategy and an escalation protocol.

C1. Staff audit the level of harm caused by high risk medicines within

your hospital at least monthly e.g. Global Trigger Tool. C2. A process is in place for all patients to prevent harm from

medication errors between community and hospital using “patient‑held medication cards” or electronic communication with primary care providers.

C3. All out-of-range INR results (6 or above) are immediately flagged and audited as they occur.

D1. Monthly review processes are in place to reduce the rate of

surgical site infections through the appropriate use of antibiotics. D2. A Safety Checklist is followed for every operation to improve peri

operative communication and teamwork e.g. the WHO Surgical Safety Checklist.

D3. A pre-operative case conference is conducted for every high complexity patient to identify contingency actions if difficulties arise.

D4. DVT Prophylaxis measures are in place and audited for all surgical patients.

E1. All elements of a goal-directed “sepsis resuscitation bundle” are

completed within 6 hours of presentation for ALL patients with severe sepsis or septic shock.

E2. All elements of a “sepsis management bundle” are completed within 24 hours of presentation for ALL patients with severe sepsis or septic shock

F1. Advanced care directives are completed prior to medical or

surgical intervention for all “at risk” patients. F2. A member of the palliative care team participates in multi

disciplinary team discussions for all patients with advanced disease status prior to invasive procedures.

The Health Roundtable “Safer Patient Care” Checklist

We introduced this Checklist to provide a way to gauge improvement in patient safety processes. We encourage all members to use it as a guide and to provide feedback on other key measures that should be included.


The Surgical Journey Group met on 10-11 October, with 33 health services participating. This was a significant increase in subscribers from the previous period. With the aim of “Reducing Delays to Theatre” we identified that across the top ten procedure groups there were 250,000 hours of delays that could be saved if the grouped achieved the exemplar average time from ED to Theatre. If variation was reduced to the exemplar average level, 60,000 hours of potential savings could be made for elective patients

Surgical Journey Improvement Group Members of the group benchmark performance with peer health services on a variety of key indicators such as: Session utilisation rates Procedure time per case Theatre cancellation rates Return-to-theatre Late starts and Early finishes We also examine key steps in the patient’s journey from pre-admission and ED through to recovery and discharge.

2. WHAT ARE EXEMPLARS DOING …TO REDUCE SURGICAL DELAYS?

6 Principals of Timely Quality Care – The Alfred

Top Voted Innovation Highlight


Allied Health Improvement Group In partnership with the National Allied Health Benchmarking Consortium (NAHBC), The Health Roundtable has been collecting and comparing Allied Health activity data for over 12 years. The data is used to drive change and innovation in staffing and delivery of patient care.

The Allied Health Improvement Group is now benchmarking 45 member facilities around Australia and New Zealand. With a focus of “Supporting the achievement of ED Access Targets” new reports were introduced to benchmark the Allied activity levels in ED and their impact on clinical outcomes. Our annual meeting was held in Melbourne 24-25 October with 72 attendees. Mr James Downie, Executive Director, Independent Hospital Pricing Authority, explained the progress IHPA has made and the future directions.

2. WHAT ARE EXEMPLARS DOING … TO REACH ED ACCESS TARGETS?

A large variation in total time spent with patients was identified across all the hospitals

Innovation Highlight !

Increasing nurse confidence to initiate mobilisation activities


New Zealand Chapter This Chapter meets twice per year to help members improve patient care by identifying differences in performance through comparative data from inpatient, mortality and emergency data sets and by sharing good practice ideas.

All New Zealand District Health Boards are members of the New Zealand Chapter of The Health Roundtable. The Chapter met twice in 2013 in May and November. In May, the NZ Health Quality and Safety Commission and The Health Roundtable together hosted a meeting with DHBs sharing their approaches on reducing harm from falls. There were many excellent innovations all available on the website. At the November meeting Dr Ian Sturgess, the National clinical lead, Intensive Support Team, Urgent and Emergency Care in England was the keynote speaker. He engaged the audience with his vision for improving care, particularly for managing the care for frail elderly patients.

2. WHAT ARE EXEMPLARS DOING … IN NEW ZEALAND?

Assessment Units/ Admitting Specialty

Team – Setting the Standards

• Internal clock setting, floor management + visual display– Time to stream +/_rapid senior assess and treatment

• STAT/RAT Process – Southampton/Nottingham

– Time to medical assess and decision support diagnostics

– Time to Senior Clinical Decision (Consultant)

• 80% of admissions < 3 hrs, last 20% < 12 hrs

– Use of evidence based algorithms – timelines to treatment

– Standardising the clinical decision

– Single piece flow vs batch processing

– Virtual/real Merger with ED Team

Segmentation by LOS – 1 – Short Stay

Short Stay – Requires decision makers

• Locus of control = Internal:

• 25% medical admissions discharged in 12 hrs or less

• Further 40% to be discharged with LOS 2 midnights or less

• Zero LOS and Short Stay (2 days or less) - keep within team

Left shift to zero LOS

• Big impact on within day and day to day variation in demand

– hourly drum beat

• Generalist skills + standardisation (decision making and case

management)

• Senior decision making and diagnostics available 8 a.m. to 10 p.m.

• EDD to the minute/hour!

Dr Ian Sturgess


The 2013 meeting of the NSW Chapter took place in Sydney in November. The Meeting focus – “Closing the Gap with Victoria” included a teleconference linkup with Professor David Ashbridge, Chief Executive Officer at Barwon Health who spoke about the innovations at Barwon Health and the strategies they have in place for meeting Health Roundtable and ABF objectives. The meeting also featured a Key Note Presentation from Michele Fleischacker, Director of Performance Improvement for the Santa Rosa Kaiser Permanente Medical Centre about getting better results from your performance Improvement program. Members presented a range of innovations (to be found on the HRT website under the NSW Chapter section) including: Rapid Improvement Event – achieving 1 Hour to Bed. See

outcomes so far graph below Emergency Department to a General Acute Ward Bed within

60 minutes or less from the time of bed request. Strategies to achieve 71% NEAT by December 2013 Improving care of the elderly medical patient in the

Emergency Department Antibiotic Stewardship - reducing usage of broad-spectrum

Abs, increase use of narrow-spectrum Abs, improve appropriateness of prescribing, shorten duration of antibiotic use including early change from IV to oral and reduce cost of Abs

Develop an integrated model of care for COPD patients that will reduce ED presentations and/or admissions

NSW Chapter The current intense focus on Activity Based Funding across Australia and particularly in NSW, prompted establishment of the NSW Chapter in 2012 to improve everyone’s readiness for the new system. The Terms of Reference for the NSW Chapter have incorporated ideas proven to work with our New Zealand, Victorian and Queensland Chapters. The key focus of the NSW Chapter will be "Improving Readiness for Activity Based Funding”.

2. WHAT ARE EXEMPLARS DOING IN NEW SOUTH WALES?


The Health Roundtable Training Development Programs One of the key issues facing health services is how to train expert clinicians to become good managers. In many cases, talented clinicians move into new managerial roles with little guidance on organisational practices, team leadership, project management, accounting, budgeting or staff development. The Health Roundtable has developed several ways to address those needs. The programs are:

LEAN Healthcare

Identifying and Rescuing Long-stay ‘Stranded’ Patients

Staff Climate Surveys

Operational Planning Models and Training

Improving Medical Documentation

Improving Budgetary and Planning processes

LEAN Healthcare Improvement Programs We began using Lean Thinking techniques for healthcare in 2007 to provide project management skills to people selected to implement major improvement initiatives. Lean Thinking techniques are now being used in hospitals throughout the world to reduce waste while improving patient care. In 2013 we continued our Lean Healthcare program with in-house training programs to improve the journey of oncology patients; to improve clinical documentation and to improve budget processes. In partnership with Roche Pty Ltd, we have also delivered Lean Healthcare programs to 10 medical oncology services throughout Australia.

3. HOW CAN WE ACHIEVE “GOOD PRACTICE?”


The “Stranded Patient” Program—Helping save 158,000 bed days When this program began in 2009, patients in hospital for three weeks or more represented 2.4% of episodes (excluding Mental Health and Dialysis), but accounted for about 29% of bed days. Since then, the focus on long-stay patients has reduced the number of long-stay bed days by 158,000 to 26% of overall bed days. The percentage of patients having a long-stay episode has decreased by 15%. The bed day savings have allowed hospitals to increase the number of patients treated by 12% even though total bed days increased by only 4% over the five year period.

3. HOW CAN WE ACHIEVE “GOOD PRACTICE?”

Staff Climate Improvement Surveys The impact of ‘culture’ on the ability to implement and sustain an innovation is one of the most commonly cited “lessons learnt” reported by members at our workshops. Functional teamwork and staff engagement are essential to innovation. It is useful to have an clear understanding of the staff climate in a ward, division or hospital in order to develop innovation strategies for areas requiring major adjustments. We have designed this survey as a low-cost and effective alternative to commercial surveys. The goal is to identify practical opportunities for improvement in the areas of: Safety and Working Conditions; Teamwork; Job Satisfaction and Perceptions of Management.

Year 20082009 20102011 20122013 Change

Episodes 3,067,586 3,309,967 3,425,614 +12%

Eps >=21 days 72,829 71,538 69,383 -3,446

Percent Eps >21Days 2.4% 2.2% 2.0% -15%

BedDays 10,145,288 10,520,950 10,601,672 +4%

BedDays >=21 2,899,230 2,829,818 2,740,706 -158,524

Percent BD >=21Days 29% 27% 26% -10%

Overall Data

Source: 101 Health Roundtable member facilities with continuous data from July 2008 to June 2013. Excludes Mental Health and Dialysis episodes.


THE HEALTH ROUNDTABLE LIMITED ABN 71 071 387 436

DIRECTORS’ FINANCIAL REPORT FOR 2013

Your directors submit the financial accounts of the Company for the calendar year ending 31 December 2013

Directors

Members of the Board of Directors as of 25 February 2014 were:

David Dean serves as General Manager and Board Secretary of The Health Roundtable.

Principal Activities The principal activities of the Company during the financial year were to:

provide opportunities for health executives to learn how to achieve best practice in their organisations

collect, analyse and publish information comparing organisations and identifying ways to improve operational practices

promote interstate and international collaboration and networking among health organisation executives

The Health Roundtable focuses on sharing innovations in patient care amongst its members, so that they can treat additional patients and continue to improve the quality of patient care.

Operating Results The Health Roundtable continued to operate on a sound financial basis in 2013, with income exceeding expenses. The organisation had 83 member health services during the year with 143 facilities providing data for comparative analysis.

The organisation recorded a surplus of $107,470 for the financial year, representing 2.5% of income. The accumulated surplus increased to $712,870 as of the end of the financial year. The Health Roundtable makes no provision for income tax, as the company is exempt from income taxation as a not-for-profit charitable organisation.

Almost all expenses are matched against member subscription revenue under an outsourcing contract with Chappell Dean Pty Limited. Administration and discretionary expenses are offset against corporate sponsorship and interest earnings.

The overall financial strategy of the Board is to build a surplus to cover monthly fluctuations in income and expense. As at December 2013, the surplus represents about 8 weeks of running costs for the organisation.

Ron Dunham - President Frank Daly - Vice President Andrew Way - Treasurer John O'Donnell - Director Jane Holden- Director Margot Mains - Director

David Ashbridge - Director Phillip Balmer - Director Max Alexander—Director Shelly Park—Director Kim Hill—Director

4. DIRECTORS’ REPORT



Under the Constitution, Associate Individual and Organisational Membership can be offered to a wide range of organisations and individuals, subject to approval of the Board of Directors. Associate Membership status provides the opportunity to participate in selected activities as authorised by the Board of Directors. There are no Organisational Associate Members at this time. The individual Associate Members of The Health Roundtable as of the date of this report are:

Bill Kricker Jennifer Williams Colin MacArthur Linda Sorrell Michael Walsh Karen Roach Pat Martin Kathryn Cook Kaye Challinger Adrian Nowitzke Kerry Stubbs Andrew Bernard Michael Szwarcbord Mary Bonner David Dean

Annual General Meeting 2013 The Annual General Meeting held 22nd March was to review 2012 activities and share key financial and patient safety opportunities. The workshop looked at how to leverage our membership in the UHC. For the last 15 years, The Health Roundtable has been an international affiliate of the University Health System Consortium, a group of over 100 academic medical centres primarily in the USA, including Mayo Clinic, Cleveland Clinic, Rush University Medical Centre and other prestigious institutions. The UHC provides a huge range of services to its members, which our members in Australia and New Zealand can access via their website. The Workshop provided an

executive-level overview of the breadth of information available. Keynote Presentations by Irene Thompson and Rick Lofgren, key executives of the University Healthsystem Consortium in the USA. We were also joined by Daniel Ray, Director of Informatics, Birmingham UK and other international benchmarking partners from our new Global Innovation Group.

Daniel Ray

Ric Lofgren UHC

Irene Thompsons UHC

Membership 2013 The Constitution of The Health Roundtable delineates separate roles for Organisational and Personal members. Health service providers are eligible for Organisational Membership. Personal Membership is offered to a senior executive within each Organisational Member. Voting rights on issues affecting the operation of The Health Roundtable are vested in Personal Members only. During 2013 there were a multitude of organisational realignments and executive personnel changes. We added Cabrini Healthcare, Child and Adolescent Health (WA), Murrumbidgee LHD and Mid-North Coast LHD and farewelled Peter MacCallum, Western District, Liverpool and Wide Bay, maintaining a total of 83 members in the organisation. Organisational and Personal Members of The Health Roundtable as of February 2014 are listed next page



Victoria Personal Member

Alfred Health Andrew Way

Austin Health Brendan Murphy

Ballarat Health Services Andrew Rowe

Barwon Health David Ashbridge

Bendigo Health John Mulder

Cabrini Health Michael Walsh

Eastern Health Alan Lilly

Goulburn Valley Health Dale Fraser

Melbourne Health Gareth Goodier

Mercy Public Hospitals Linda Mellors

Monash Health Shelly Park

North East Health Margaret Bennett

Northern Health Janet Compton

Royal Children's Hospital Christine Kilpatrick

Royal Women's Hospital Susan Matthews

South West healthcare1 John Krygger

St Vincent’s Health Chris Doidge

West Gippsland Healthcare Dan Weeks

Western Health Alex Cockram

South Australia Personal Member

Central Adelaide David Panter

Northern Adelaide Margot Mains

Southern Adelaide Belinda Moyes

Womens&Childrens Health Adelaide(1) Phil Robinson

Tasmania Personal Member

Tasmanian Health Org (South) Jane Holden

Australian Capital Territory Personal Member

Calvary ACT Ray Dennis

Canberra Hospital Ian Thompson

Northern Territory Personal Member

NT Acute Health Veronica Snook

New Zealand Personal Member

Auckland DHB Fionnagh Dougan

Bay of Plenty DHB Phil Cammish

Canterbury DHB Nigel Millar

Capital and Coast DHB Debbie Chin

Counties Manukau DHB Phillip Balmer

Hawkes Bay DHB Warrick Frater

Hutt Valley DHB2 Graham Dyer

Lakes DHB Ron Dunham

Mid Central DHB Murray Georgel

Nelson Marlborough DHB Chris Fleming

Northland DHB Nick Chamberlain

South Canterbury DHB Nigel Trainor

Southern DHB Lexie O'Shea

Tairawhiti DHB Jim Green

Taranaki DHB Rosemary Clements

Waikato DHB Jan Adams

Wairarapa DHB Graham Dyer

Waitemata DHB Dale Bramley

Whanganui DHB Julie Patterson

Queensland Personal Member

Cairns &Hinterland HHS Julie Hartley-Jones

Children’s Health Queensland Peter Steer

Central Queensland HHS Rod Boddice

Darling Downs HHS Peter Bristow

Gold Coast HHS1 Ron Calvert

Mackay HHS Kerry McGovern

Mater Health Service, Brisbane John O'Donnell

Metro North HHS

Caboolture Caroline Weaver

Redcliffe Hospital Donna O'Sullivan

Royal Brisbane&Women’s Lesley Fleming

The Prince Charles Stephen Ayre

Metro South HHS

Logan Brett Bricknell

Princess Alexandra Julieanne Graham

QE II Jubilee Mike Kerin

Redland Rosalind Crawford

Metro South Addictions &Mental Health(1) David Crompton

Sunshine Coast HHS Kevin Hegarty

Townsville Hospital HHS Kieran Keyes

West Moreton HHS Lesley Dwyer

New South Wales Personal Member

Calvary Mater Newcastle Greg Flint

Central Coast LHD Matt Hanrahan

Illawarra Shoalhaven LHD Sue Browbank

John Hunter Hospital Michael DiRienzo

Mid North Coast LHD Kathleen Ryan

Murrumbidgee LHD Jill Ludford

Nepean Blue Mountains LHD Kevin Hedge

Royal North Shore & Ryde Sue Shilbury

South East Sydney LHD

St George & Sutherland Cath Whitehurst

Prince of Wales Network Jon Roberts

St Vincent’s Hospital Brett Gardiner

Southern NSW LHD Max Alexander

Western NSW LHD Lynne Weir

Western Sydney LHD Kim Hill

Western Australia Personal Member

Child&Adolescent Health Service Philip Aylward

South Metro AHS

Armadale Hospital Chris Bone

Fremantle Hospital David Blythe

Royal Perth Hospital Frank Daly

Rockingham General Hospital Geraldine Carlton

North Metro AHS Robyn Lawrence

Fiona Stanley (1) Brad Sebbes

(1) New members from first quarter 2014


External Linkages The Health Roundtable maintained its international affiliate membership in the University

Healthsystem Consortium, a collaborative group of over 100 academic medical centres in the USA. This affiliation has provided valuable methodological assistance and insights to the organisation and its members across Australia and New Zealand. Health Roundtable staff also liaise regularly with staff of the Australian Commission on Safety and Quality in Health Care and the Health Quality and Safety Commission in New Zealand. In February 2013, The Health Roundtable joined the International Hospital Federation. The role of the IHF is to help international hospitals work towards improving the level of the services they deliver to the population regardless of that population’s ability to pay.


2013 Review of Board Policies During 2013, The Health Roundtable Board reviewed its policies, particularly in regard to the disclosure of performance information using Health Roundtable benchmarks. In recognition of the increasing need for information by government and the public, The Health Roundtable now encourages members to release their own results on key indicators publicly including: Hospital Standardised Mortality Rate (HSMR) and trends Relative Length of Stay (RSI) and trends National Emergency Access Target (NEAT) Performance and trends Each member organisation is authorised to release its own results, but not those of other individual members, in keeping with our Honour Code. However, the release of information may also include a reference to the overall performance trends within the group.

2013 Research Collaboration The Health Roundtable inpatient episode data base is one of the largest non-governmental collections of hospital operational activity in the world, adding over 4.5 million records per year for over 130 hospital facilities across Australia and New Zealand. Data are available from 1996 to 2013 for 15 of the member organisations and for at least five years for over 100 facilities. The database has a wealth of diagnosis, procedure and demographic data linked to hospital stays and provides a mechanism to track episodes of the same patient over time for many member organisations. Extracts from the database are available to researchers who agree to abide by the conditions set out in the academic research policy: In 2013 requests for data were approved for: - Estimating the incidence and prevalence of inpatient gout in Australia over the last 5 years. - Analysing the robustness of hospital mortality data using random sampling techniques

Extract from Board Policy #07 with illustration of permitted


Progress on Our Business Model Since its creation in 1995, The Health Roundtable has operated as a virtual organisation by outsourcing all of its operations and financial risks to Chappell Dean Pty Limited, which provides the staff, facilities and data systems to carry out all the activities approved by the Board of Directors and its members. In 2012, the Board conducted an extensive consultation with members to review other business models, such as hiring staff to provide these services, or using a variety of contractors instead of a single management contract. The Board determined that the current outsourcing model remains the most appropriate structure so long as the provider of services continues to meet our expectations. The Audit & Compliance Committee of the Board reviews the member evaluations from every meeting and works with Chappell Dean to identify opportunities for improvement. Meeting evaluations routinely show high levels of satisfaction with ratings above 4.0 on a 5 point scale. Specific meeting results are posted in the Governance section of The Health Roundtable website and are available to all members for review. The outsourcing contract with Chappell Dean is negotiated on a rolling basis a year in advance to allow time for service development by the contractor and/or time for the Board to find alternative providers if necessary. Services to be offered to members in calendar year 2014 were approved by the Board in 2012. In October 2013, the Board renewed Chappell Dean’s contract to provide services for calendar year 2015. The Health Roundtable contract with Chappell Dean requires pricing of services to be offered on a per-member per-service basis, with the contractor expanding or reducing staffing as our needs change. The range of services and the prices negotiated for them have remained very stable over several years and the growth of revenue has been largely the result of increased numbers of members and increased participation in optional activities. The main change negotiated for 2015 is the movement from six-monthly processing to quarterly processing of activity data for all members to match our governmental reporting processes. The cost per processing cycle will be reduced from $4,000 to $3,000, raising the total cost for the year from $8,000 for two cycles of processing to $12,000 for four cycles of processing. One of the key issues facing The Health Roundtable and Chappell Dean is the planned retirement of Dr David Dean as the General Manager of the organisation in 2015. David is seconded by Chappell Dean to serve as General Manager of The Health Roundtable and has held that position since the organisation was formed in 1995. The management contract requires any change in General Manager proposed by Chappell Dean to be approved by the Board. If a suitable appointee cannot be found within 90 days, the Board may terminate the overall Chappell Dean contract and find other providers of services. The Board and Chappell Dean are working together to identify an acceptable replacement to take on the role of General Manager in 2015. As of January 2014, Chappell Dean has established a senior management team of five people to take on increasing responsibilities to support the General Manager and the Board: Bernie Mullin, Wojciech Korczynski, Paul White, Kate Tynan and Aman Dayal. The Board will have multiple opportunities to take stock of the management skills available within Chappell Dean during 2014 and will work closely with David to identify a suitable replacement in 2015. Chappell Dean plans to continue to offer services to The Health Roundtable for 2016 and future years, with David Dean continuing as Managing Director of that organisation.




The Health Roundtable is a virtual organisation without bricks and mortar or staff. The Board of Directors has negotiated a contract with an external management firm, Chappell Dean Pty Limited, to manage the operations of the organisation. Chappell Dean provides a network of employees and independent contractors to help you improve the effectiveness and efficiency of patient care. Under the contract, Dr David Dean is seconded to serve as General Manager. During the year, Chappell Dean provided the following team members to support the operations of The Health Roundtable:

Chappell Dean Independent Contractors

Michael Hart, Health Data Consultant

Peter Reeves, Operational Consultant

Pieter Walker, Operational Consultant

Nicholas Smeaton, Website Designer

Bill Kricker, Operational Consultant

Bindy Steuart, Report Preparation

Bernie Mullin, Medical Consultant

Michael Blatchford, Lean Facilitator

Chris O’Gorman, Operational Consultant

Marion Dixon, Operational Consultant

Ian Tebbutt, Database Architect

Wojciech Korczynski, Consultant

Rohan Cattell, Operational Consultant

Matt Stewart, Project Manager

Brian Dolan, Clinical Consultant

Paul Long, Consultant

Raj Behal, Patient Safety Consultant

Chappell Dean Employees

Margaret Dean, Accounts Manager

Aman Dayal, Systems Developer

Margaret Colville, Data Analyst

Nick Mitchell, Systems Analyst

Christine Eko, Systems Analyst

Kate Tynan, Innovations Manager

Siavash Adibi, Systems Analyst

Mariette Reefman, Intern

Paul White, Operational Manager

Leon Ma Systems Analyst

Jason Li Systems Analyst

Kavitha George, Systems Analyst

Rebecca Tian, Analyst

Lisa Brady, Systems Analyst

The Health Roundtable Team


In 2013, The Health Roundtable enjoyed the support of the organisations listed below. The Health Roundtable welcomes sponsor organisations to participate in its activities to learn more about the issues facing health services, provided that no perceived conflict of interest is identified by any member, and that sponsors abide by the Honour Code. Funds received from sponsorship are used to defray administrative expenses and to fund awards for innovative practices amongst members.

Roche Products Pty Limited (Australia) is part of the International F. Hoffmann-La Roche Group worldwide . Roche has grown from a small drug laboratory into one of the world's leading research-based healthcare companies and is known for many innovative contributions to medicine. Arranged in two operative divisions, our global mission today and tomorrow is to create exceptional added value in healthcare. These two units are:

Pharmaceuticals and Diagnostics.

Executive Fitness Management (EFM) management of on-site health and wellness programs at hospitals includes the provision of equipment and coaches for supervised fitness programs, management, marketing, reporting, administration, event management and insurance at zero cost to your hospital. In fact, some of the larger hospitals make a

margin on EFM's membership fees and generate significant revenue from the program.

The Pavilion Health group of companies offers an unprecedented depth of ability and experience to the health industry. As an Australian based organisation, our experience is well-founded in ICD-10-AM, AR-DRG and Australian Coding Standards. Specialties are: Health informatics and information management, Health industry revenue cycle management, Clinical coding, counting and costing, including audit and organisational change management.

Pfizer Australia is a leading provider of pharmaceutical medicines and animal health products. We also provide a range of over-the-counter and infant nutrition products. For more than 70 years, Pfizer Australia has partnered with government and healthcare providers to expand access to our medicines and vaccines to provide better quality health care.

3M is a diversified technology company serving customers and communities with innovative products. 3M Health Care provides innovative solutions to hospitals and the health industry via the following 3 divisions: 3M Health Information Systems 3M Infection Prevention Division's 3M's Critical and Chronic Care Solutions Division

Novartis is caring and curing. We are committed to research and development and since 2007 Novartis has invested 20% of its net pharmaceutical sales globally in R&D – in Australia we invest around $AUD 30 million annually. Our dedication to research drives innovation and we have one of the strongest pipelines in the industry. In Australia, the Novartis Group comprises of – Pharmaceuticals, Alcon, Sandoz, Consumer Health, Animal Health and Vaccines & Diagnostics.

Activity BarCoding (ABC) replaces paper diaries and data entry typing tasks with a portable barcode reader that instantly records the barcode label of the patient you are seeing plus codes for your key activities with the patient, as you deliver your service. The system is widely used in Allied Health settings and helps to count services more accurately in an Activity Based Funding environment.

Ashurst is a national law firm that is a recognised leader in health, aged care and retirement living. Awareness of the unique commercial, political and regulatory drivers underpinning the environment in which this sector operates is a key strength of ours. We help our clients mitigate risk, achieve their commercial outcomes and plan appropriately

for change.



Director’s and Auditor’s Indemnification During the 2013 accounting period, The Health Roundtable paid premiums to insure itself and each of the Directors and Officers of the company against liabilities for costs and expenses incurred by them in defending any actual or alleged breach of duty, breach of trust, neglect, error, misleading statement, omission, breach of warranty or authority claimed against them while acting in their individual or collective capacities. The total amount paid for the insurance in 2013 was $2,454.

Meetings of Directors During the 2013 calendar year, the Board of Directors met in person or by teleconference on 22 February, 22 March, 11 July, 7 August, 4 October and 8 November and voted by email on special resolutions as needed.

Meetings of the Audit & Compliance Committee The Board’s Audit & Compliance Committee has responsibility for reviewing the organisation's Risk Register, for reviewing the performance of the organisation and has delegated authority from the Board for disbursement of funds. This committee includes two external members with extensive financial expertise, Ross Cooke and Colin Holland. The committee met on 27 September and reviewed status reports and approved expenditures through email resolutions on a monthly basis during the year. Ross Cooke, Chartered Accountant has extensive experience in strategic, financial and operational consulting in the health and aged care sectors. Ross has substantial operational experience in healthcare organisations and has undertaken several due diligence investigations covering operational, financial and strategic considerations in the health and aged care sectors for debt providers and equity investors. Ross regularly provides strategic advice to organisations on legislative, political and competitive environment issues.

Colin Holland, holds a Bachelor of Business, Master of Business Administration and a Graduate Diploma in CSP. He is a Fellow of CPA Australia and a member of Company Secretaries Australia (ACIS). Colin joined the health sector in 2008 as Executive Director Finance and Logistics, Melbourne Health. He brings a wealth of experience that includes five years as Chief Financial Officer and Company Secretary for National Leisure & Gaming Limited and Select Harvests Limited; 13 years in a variety of senior financial and commercial positions within South Pacific Tyres; and three years as Divisional Financial Controller for the automotive division of Nylex Limited.

Board Expenses Board expenses for 2013 were $6,676 for reimbursement for travel and accommodation expenses to attend Board meetings and hold consultations with members.

Directors Benefits’ No director has received or become entitled to receive, during or since the financial year, a benefit because of a contract made by the company with: a director, a firm of which a director is a member or an entity in which a director has a substantial financial interest.

Proceedings on behalf of the company No person has applied for leave of Court to bring proceedings on behalf of the company or intervene in any proceedings to which the company is a party for the purpose of taking responsibility on behalf of the company for all or any part of those proceedings. The company was not a party to any such proceedings during the year.



David Dean, Company Secretary April 2006, Elected General Manager of The Health Roundtable Limited, serving in that capacity since its inception in 1996. David is also Managing Director of Chappell Dean Pty Limited, which provides services to The Health Roundtable

AUDIT AND COMPLIANCE COMMITTEE

Andrew Way, Chair from April 2013 Ron Dunham July 2012—Current David Ashbridge Nov 2012—Current Margot Mains Nov 2012—Current

External Members of the Audit and Compliance Committee The Board expresses its appreciation to its external members serving on the Board’s Audit and Compliance Committee for their

input to the governance of The Health Roundtable during 2013:

Colin Holland, Chief Financial Officer, Melbourne Health.

Ross Cooke, Director of Paxton Partners. November 2013, Resigned

DIRECTOR RESIGNATIONS 2013

Mary Bonner, Chief Executive Capital and Coast DHB March 2012, Casual vacancy appointment August 2013, Resigned

Andrew Bernard, Director of Operations, Prince of Wales South East Sydney LHD April 2009, Elected . Re-elected March 2012 Oct 2011, Treasurer March 2013, Retired from Board and Audit Committee

David Alcorn, Executive Director Royal Brisbane & Women’s Hospital, Qld March 2011, Elected July 2012, President Feb 2013, Resigned

OFFICERS

Ron Dunham, Chief Executive, Lakes DHB New Zealand Feb 2012, Casual vacancy appointment March 2012, Elected Feb 2013, Elected President

Frank Daly, Executive Director Royal Perth, WA July 2012, Casual vacancy appointment March 2013, Elected March 2013, Elected Vice President

Andrew Way Director Chief Executive Alfred Health, Vic Feb 2012, Casual vacancy appointment March 2012, Elected March 2013 Elected Treasurer

DIRECTORS

David Ashbridge, Chief Executive Barwon Health, Vic July 2012, Casual vacancy appointment March 2013, Elected

Phillip Balmer, Chief Operating Officer, Bay of Plenty DHB, NZ July 2012, Casual vacancy appointment March 2013, Elected

Margot Mains, Chief Executive Northern Adelaide LHN, SA Feb 2012, Casual vacancy appointment March 2012, Elected

John O’Donnell, Chief Executive Mater Health Services Brisbane, Qld March 2008, Elected March 2008—April 2009, President March 2010, Re-elected Director

Shelly Park, Chief Executive Monash Health, Vic March 2013, Elected

Max Alexander, Chief Executive Southern NSW LHD March 2013, Elected

Jane Holden, Chief Executive Tasmanian Health Organisation, South March 2013, Elected

Kim Hill Executive Medical Director Western Sydney LHD, NSW August 2013 Casual vacancy appointment

4. DIRECTORS’ REPORT – OFFICERS AND DIRECTORS 2013

2013 President of The Health Roundtable Ron Dunham


This Annual Report of the Directors of The Health Roundtable Limited is signed in accordance with a resolution of the Board of Directors

Ron Dunham, Director and President 28 February 2014

Andrew Way, Director and Treasurer 28 February 2014

I, David Dean, General Manager of The Health Roundtable Limited, declare that in my opinion:

1. The financial records of The Health Roundtable Limited for the financial year have been properly maintained.

2. The financial statement and the notes for the financial year comply with the accounting standards;

3. The financial statements and notes for the financial year give a true and fair view; and

4. Any other matters that are prescribed by the regulations for the purposes of this paragraph in relation to the financial statements and the notes for the financial year are satisfied.

David Dean. General Manager

Date: 26 February 2014

The Health Roundtable 40 Port Jackson Road Terrigal NSW 2260 Tel: (02) 4385 5894 Fax: (02) 4384 7078 www.healthroundtable.org ABN 71 071 387 436


After Balance Events Since the close of the financial year in December 2013, no matters or circumstances have arisen which may significantly affect the operations of the Company, the results of those operations, or the state of affairs of the Company in subsequent financial years.


The Health Roundtable Limited

ABN 71 071 387 436

Financial Statements

For the year ended 31 December 2013

Ronald Smith & Co

Suite 101, 10 Edgeworth David Avenue

HORNSBY NSW 2077

Phone: 02 9477 1650 Fax: 02 9477 6649

Table of Contents

Detailed Operating Results

Balance Sheet

Statement of Cash Flows

Notes to the Financial Statements

Directors' Declaration

Independent Auditor Report

5. FINANCIAL STATEMENTS



The Health Roundtable Limited ABN 71 071 387 436

Detailed Operating Results


2013 2012

$ $

Income

Subscription fees income 3,927,129 3,575,235

Delegate registration fees 258,617 203,284

Interest received 106,065 120,687

Special project income 126,705 30,665

License & Sponsorship income 112,500 47,500

Membership fees 16,400 16,500

Total Income 4,547,416 3,993,871

Expenses

Subscription program expenses 3,767,128 3,408,265

Hotel and Venue costs 268,544 202,599

Management & Office expenses 160,000 163,500

Special project costs 141,705 30,665

International Membership costs 18,257 17,725

Innovation Awards 69,864 32,273

Insurance 2,580 2,454

Board Expenses 6,676 5,274

Audit fees (Note 8) 2,810 3,041

Bank Fees and Charges 2,039 1,737

Filing Fees 343 627

Total Expenses 4,439,946 3,868,160

Surplus from Ordinary Activities 107,470 125,711

The accompanying notes form part of these financial statements




Balance Sheet As At 31 December 2013

Note 2013 2012

$ $

Current Assets

Cash assets 3 3,040,793 2,108,930

Receivables 4 1,371,201 1,018,655

Total Current Assets 4,411,994 3,127,585

Non-Current Assets

Other 5 1,035 1,035

Total Non-Current Assets 1,035 1,035

Total Assets 4,413,029 3,128,620

Current Liabilities

Payables 6 276,822 44,350

Current Tax Liabilities (GST) 103,556 39,436

Prepaid Subscriptions 7 3,319,780 2,439,435

Total Current Liabilities 3,700,158 2,523,221

Total Liabilities 3,700,158 2,523,221

Net Assets 712,871 605,399

Equity

Retained surplus 712,871 605,399

Total Equity 712,871 605,399

The accompanying notes form part of these financial statements




Note 1. Reconciliation of Cash

For the purposes of the statement of cash flows, cash includes cash on hand, in banks and investments in term deposits.

Cash at the end of the year as shown in the statement of cash flows is reconciled to the related items in the balance sheet as follows:

Note 2. Reconciliation of Net Cash Provided By/Used in Operating Activities to Net Profit

2013 2012

$ $

Corporate Cheque Account 12,352 338,829

Online Saver Account 1,170,419 436,247

Term Deposits 1,858,022 1,333,855

Total 3,040,793 2,108,930

2013 2012

$ $

Operating surplus 107,470 125,711

Changes in assets and liabilities net of effects of purchases and disposals of controlled entities:

(Increase) decrease in trade debtors (352,546) 19,424

Increase (decrease) in trade creditors and accruals 267,972 8,850

Increase (decrease) in other creditors 844,845 296,470

Increase (decrease) in taxes (GST) 64,121 48,988

Net cash provided by operating activities 931,863 499,443

Statement of Cash Flows For the year ended 31 December 2013

2013 2012

Cash Flow from Operating Activities $ $

Receipts from members and sponsors 4,088,805 3,892,608

Payments to Suppliers (3,263,007) (3,513,852)

Interest received 106,065 120,687

Net cash provided by operating activities (note 2) 931,863 499,443

Net increase in cash held 931,863 499,443

Cash at the beginning of the year 2,108,930 1,609,488

Cash at the end of the year (note 1) 3,040,793 2,108,930


Note 1. Summary of Significant Accounting Policies

The directors have prepared the financial statements on the basis that the company is a non-reporting entity because there are no users dependent on general purpose financial statements. The financial statements are therefore special purpose financial statements that have been prepared in order to meet the needs of the members.

The financial statements have been prepared in accordance with the significant accounting policies disclosed below, which the directors have determined are appropriate to meet the needs of the members. Such accounting policies are consistent with the previous period unless stated otherwise.

The financial statements have been prepared on an accruals basis and are based on historical costs unless otherwise stated in the notes. The accounting policies that have been adopted in the preparation of the statements are as follows:

(a) Cash and Cash Equivalents

Cash and cash equivalents include cash on hand, deposits held at call with banks and term deposits with original maturities of twelve months or less. Bank overdrafts are not used.

(b) Revenue and Other Income

Revenue is measured at the value of the consideration received or receivable after taking into account any trade discounts and volume rebates allowed. For this purpose, deferred consideration is not discounted to present values when recognising revenue.

Interest revenue is recognised when received.

Revenue recognised related to the provision of services is determined with reference to the stage of completion of the transaction at the reporting date and where outcome of the contract can be estimated reliably. Stage of completion is determined with reference to the services performed to date as a percentage of total anticipated services to be performed. Where the outcome cannot be estimated reliably, revenue is recognised only to the extent that related expenditure is recoverable.

All revenue is stated net of the amount of goods and services tax (GST).

(c) Goods and Services Tax (GST)

Revenues, expenses and assets are recognised net of the amount of GST, except where the amount of GST incurred is not recoverable from the Tax Office. In these circumstances, the GST is recognised as part of the cost of acquisition of the asset or as part of an item of the expense. Receivables and payables in the balance sheet are shown inclusive of GST.

Cash flows are presented in the cash flow statement on a gross basis, which are disclosed as operating cash flows.

(d) Trade and Other Payables

Trade and other payables represent the liability outstanding at the end of the reporting period for goods and services received by the company during the reporting period, which remain unpaid. The balance is recognised as a current liability with the amounts normally paid within 30 days of recognition of the liability.

The Health Roundtable Limited ABN 71 071 387 436 Notes to the Financial Statements





The Health Roundtable Limited ABN 71 071 387 436 Notes to the Financial Statements


Note 5: Other Assets: Non Current

Establishment expenses 1,035 1,035

Less: accumulated amortisation

1,035 1,035

Note 4: Receivables: Current

Trade debtors. Member subscriptions billed but unpaid

1,371,201 1,018,655

1,371,201 1,018,655

Note 6: Payables

Trade creditors 276,822 8,850

Other creditors: Innovation Prizes 35,500

276,822 44,350

Note 7: Other Liabilities

Advance commitments for subscriptions in following year

3,319,780 2,439,435

3,319,780 2,439,435

Note 8: Auditors' Remuneration

Remuneration of the auditor of the company for: Auditing or reviewing the financial report

2,810 3,041

Other services

2,810 3,041

2013 2012

Note 2: Revenue $ $

Operating Activities

Sales Revenue 4,438,715 3,872,099

Interest Revenue 106,065 120,687

Other income (late fees) 2,636 1,085

4,547,416 3,993,871

Note 3: Cash assets

Bank accounts:

Corporate Cheque Account 12,352 338,829

Online Saver Account 1,170,419 436,247

Term Deposits 1,858,022 1,333,855

3,040,793 2,108,930



Directors’ Declaration

The directors have determined that the company is not a reporting entity and that this special purpose financial report should be prepared in accordance with the accounting policies prescribed in Note 1 to the financial statements.

The Directors of the company declare that:

1. The financial statements and notes present fairly the company's financial position as at 31 December 2013 and its performance for the year ended on that date in accordance with the accounting policies described in Note 1 to the financial statements;

2. In the directors' opinion, there are reasonable grounds to believe that the company will be able to pay its debts as and when they become due and payable.

This declaration is made in accordance with a resolution of the Board of Directors.

Ron Dunham

Director

Andrew Way

Director

28 February 2014



We have audited the accompanying financial report, being a special purpose financial report, of The Health Roundtable Limited (the company), which comprises the Directors' Declaration, Balance Sheet, Income Statement, notes comprising a summary of significant accounting policies and other explanatory notes, for the year ended 31 December 2013.

Directors' Responsibility for the Financial Report

The directors of the company are responsible for the preparation of the financial report and have determined that the basis of preparation described in Note 1 to the financial report is appropriate to meet the financial reporting requirements of the company's constitution and is appropriate to meet the needs of the members. The directors’ responsibility also includes such internal control as the directors determine is necessary to enable the preparation of a financial report that is free from material misstatement, whether due to fraud or error.

Auditor's Responsibility

Our responsibility is to express an opinion on the financial report based on our audit. We have conducted our audit in accordance with Australian Auditing Standards. Those Standards require that we comply with relevant ethical requirements relating to audit engagements and plan and perform the audit to obtain reasonable assurance whether the financial report is free from material misstatement.

An audit involves performing procedures to obtain audit evidence about the amounts and disclosures in the financial report. The procedures selected depend on the auditor’s judgement, including the assessment of the risks of material misstatement of the financial report, whether due to fraud or error. In making those risk assessments, the auditor considers internal control relevant to the entity’s preparation of the financial report that gives a true and fair view, in order to design audit procedures that are appropriate in the circumstances, but not for the purpose of expressing an opinion on the effectiveness of the entity’s internal control. An audit also includes evaluating the appropriateness of accounting policies used and the reasonableness of accounting estimates made by the directors, as well as evaluating the overall presentation of the financial report.

We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our audit opinion.

Independence

In conducting our audit, we have complied with the independence requirements of Australian professional ethical pronouncements.

Auditor's Opinion

In our opinion, the financial report presents fairly, in all material respects, the financial position of The Health Roundtable Limited as at 31 December 2013 and of its financial performance for the year then ended in accordance with the accounting policies described in Note 1 to the financial statements.

Basis of Accounting

Without modifying our opinion, we draw attention to Note 1 to the financial report, which describes the basis of accounting. The financial report has been prepared for the purpose of fulfilling the directors' financial reporting responsibilities under the company's constitution. As a result, the financial report may not be suitable for another purpose.

Ronald Hamilton Smith, Chartered Accountant, Ronald Smith & Co 101/10 Edgeworth David Ave, Hornsby NSW Date: 28 February 2014

6. INDEPENDENT AUDITOR REPORT


Documents

2013 ANNUAL REPORT - Health Roundtable · 7 The Health Roundtable Limited Annual Report 2013 Key Performance ... This provides senior executives an overall Balanced Scorecard that