Health Matters December 2011

The Victorian Healthcare Association Issue 3 [DECEMBER 2011] www.vha.org.au

Austin nursing initiative

Latrobe wins VHA Award

Bendigo podiatry model

Hamilton’s digital operating theatre

Aboriginal dental health

Kyabram midwife care

The member snapshot issue

HEALTH MATTERSVictorian Healthcare AssociationISSuE 3 [ DECEMBER 2011 ] www.vha.org.au

2 The Victorian Healthcare Association Issue 3 [DECEMBER 2011] www.vha.org.au

The VHA would like to thank member agencies and supporters for supplying many of the photos included in this edition. This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced by any process without prior permission from The Victorian Healthcare Association and inquiries concerning reproduction and rights should be addressed to the editor. © The Victorian Healthcare Association Ltd 2011.

The Victorian Healthcare Association (VHA) is the major peak body representing the interests of the public healthcare sector in Victoria.Our members are public hospitals, rural and regional health services, community health services and aged care facilities. Established since 1938, the VHA promotes the improvement of health outcomes for all Victorians, from the perspective of its members.

This issue…

For editorial content please contact:SARA ByERSMedia and Communications Officer

The Victorian Healthcare AssociationLevel 6, 136 Exhibition StreetMelbourne, Victoria 3000 Australia

Telephone: +61 3 9094 7777Facsimile: +61 3 9094 7788Email: [email protected]

3 CHAIRMAN’S MESSAGE Celebrating public healthcare innovation

4 CHIEF EXECUTIVE’S MESSAGE Impact of reforms will be felt in 2012

5 VHA ANNUAL CONFERENCE Collaboration: the Key to Better Health 2011

6 VHA AWARD WINNER Latrobe mobile wound care

7 VHA AWARD FINALIST Health screening team a success

8 VHA AWARD FINALIST Gippsland Lakes training program

9 VHA AWARD FINALIST Bendigo podiatry diabetes model

10 VHA AWARD FINALIST Health plan for Melbourne’s west

VHA RESEARCH & POLICY 2011 the year in review

11 VHA AWARD FINALIST Intake model lifts participation rate

12 VHA AWARD FINALIST Austin health assistant nurses: a Victorian first

13 HESSE RURAL HEALTH Design promotes wellness for people with dementia

14 KYABRAM DISTRICT HEALTH SERVICE Families celebrate midwife care

15 DOUTTA GALLA COMMUNITY HEALTH City health service for homeless people

16 NORTHERN HEALTH Multicultural model for advance care planning

17 HAMILTON BASE HOSPITAL Digital operating theatre installed

18 MONASHLINK COMMUNITY HEALTH SERVICE Integrated treatment for disordered eating

19 BASS COAST REGIONAL HEALTH Pastoral service for people of all faiths

20 WEST VIC GP DIVISION Advice line cuts after hours calls to GP’s

21 PORTLAND DISTRICT HEALTH Aboriginal dental health campaign

22 ORBOST REGIONAL HEALTH Integrated home care program

21 PORTLAND DISTRICT HEALTH Aboriginal dental health campaign

14

13 HESSE RURAL HEALTHDesign promotes wellness for people with dementia

KYABRAM DISTRICT HEALTH SERVICE Families celebrate midwife care

This publication is printed using eco-clean print processes. Vegetable based inks and recyclable materials are used where possible. Printed by GEON Brunswick – ISO9001 / ISO14001 & AS/NZS 4801

3The Victorian Healthcare Association Issue 3 [DECEMBER 2011] www.vha.org.au

Celebrating public healthcare innovation

Chairman’s Message

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This edition of Health Matters provides a snapshot of the exciting innovations happening within the Victorian public healthcare sector.

The initiatives profiled in this issue cover a breadth of service models from wound care to dementia care, from workforce innovation to spiritual guidance, and from birthing services to dealing with death.

The VHA believes that the capacity for innovation within our healthcare system is directly related to Victoria’s devolved model of governance. This model is based on local agencies making local decisions, allowing innovators to present their ideas directly to organisational leaders and ultimately to those who endorse strategic decisions – the board.

The VHA is proud to represent the governing bodies of our members and delighted to celebrate some of their achievements for 2011. Just as our members strive to innovate, the VHA seeks

to be an innovative and creative peak body for its members by providing thought leadership and strong support for the public healthcare sector.

After many years advocating for a long-term Victorian healthcare plan, the VHA has now been recognised by the minister for Health, David Davis, as being influential in the government’s commitment to developing such a plan.

The VHA acknowledges the work of minister Davis on the Victorian Health Priorities Framework 2012-2022 and thanks him for being available to VHA members through his attendance at our 2011 forums.

in 2012, the VHA will continue to develop the Population Health Approaches to Planning (PHAP) project to build the capacity of our membership. members will have access to a learning module to help them identify the important population health issues that should be reflected within their service strategies.

A new partnership with the Australian College of Health Service management and a Latrobe University research team will identify the managerial competencies of middle to senior level healthcare managers. This research, due for completion in 2013, will help member agencies to inform their own management strategies.

Another research collaboration with the University of melbourne, starting early next year, will test various approaches to quality and safety at the governance level, and their correlation (if any) to clinical outcomes. This is a major research investment, made possible through financial support from the Victorian managed insurance Agency.

i would like to take this opportunity to congratulate winners and finalists in the 2011 Victorian Public Healthcare Awards. i wish all our members, sponsors and supporters a wonderful festive season and encourage you to celebrate the many individual, team and industry-wide healthcare innovations achieved throughout Victoria this year.

Prepared by Anthony Graham and Trevor CarrChairman Anthony Graham and minister for Health David Davis at the 2011 VHA rural Health

Conference.


Over the coming 12 months we will all, in some way, start to experience the impact of various health reform activities at federal and state levels.

At the federal level, the VHA will closely monitor the first steps of the independent Hospital Pricing Authority, the national Health Performance Authority, medicare Locals, and the introduction of personally-controlled electronic health records (PCEHrs).

There is some apprehension over federal reform among VHA members, based largely on Victoria’s recent experience of activity-based funding (ABF) models.

While ABF can deliver the desired technical efficiencies – that is, outputs achieved from designated resources – experience has shown that ABF can result in strategies that simply seek to maximise activity in order to maximise reward. This means that although agencies are conducting significant activity, the system is not actually being reformed to meet future demand.

This is a major concern. Our healthcare system is already too reliant on bed-based solutions. The introduction of a new funding model that rewards bed-based activity will create a wider chasm between political intent and system change. As a consequence, solutions that do not require a hospital bed will not receive the funding they desperately need.

The methodology that will be used to determine the ‘efficient price’ for ABF is also of concern to the VHA. The State

Government will continue as the major funder of this price, yet the Federal Government is promoting an ‘uncapped’ first year of ABF. This raises the spectre of politics versus genuine reform – clearly Victoria cannot afford to fund uncapped bed-based activity within our public hospitals.

Put simply, you can only spend a dollar once, and given tightening economic conditions this formula seems destined to reduce rather than enhance investment in primary healthcare.

The VHA supports transparent access to performance data. nonetheless, the VHA is concerned that we do not have access to consistent data collection or interpretation across Australia, and the media in general tends to report performance outcomes in a sensationalist way. This, in turn, influences public opinion.

While Australia faces many future health challenges, we enjoy a life expectancy that is the envy of many developed countries. in addition, the relative balance between private and public service provision within Australia’s healthcare system is quite unusual. This mix must be considered when implementing any health reform activities.

With this in mind, the implications of performance criteria that further encourage people to choose a public health service over a co-payment must be considered carefully before being implemented. The VHA is concerned that the four-hour waiting time KPi in emergency departments will exacerbate GP-type presentations that are already clogging our emergency departments. While the VHA supports moves to increase after hours GP access, it remains unclear how successful this KPi will be.

Over the coming year, medicare Locals will commence their activities. The VHA generally supports the creation of these new organisations, but is concerned that the enablers to success are missing.

Quite apart from the obvious complications and responsibilities of starting a new company structure, the VHA believes that the fundamental role of medicare Locals

remains unclear. While they are intended to address service gaps in local communities, there is no accord between medicare Locals and the Federal Government. As a result, the options for overcoming any issues identified through population health analysis will depend on political decisions.

The VHA is also concerned that the move towards PCEHrs appears underdeveloped. There is no doubt that technology is one of the greatest enablers to quality healthcare and system innovation. However, the introduction of PCEHrs lacks broad support from healthcare providers and the community. in addition, the most disadvantaged people in our society are the least likely to be engaged in this initiative.

PCEHrs require active input from individuals and practitioners but neither of these parties is obliged to participate. The potential result is that practitioners will place little faith in the information stored within these records, defeating the purpose of information management reforms. This will undermine efforts to improve health service delivery through a coordinated approach for people with multiple chronic illnesses or complex conditions.

The first phase of implementing the Victorian Health Priorities Framework 2012-2022 will begin next year. During my time as Chief Executive of the VHA, the lack of a long-term statewide health plan has been a glaring omission from Victoria’s healthcare system. i am very pleased that this process is now underway to guide the activities of our health system and improve the transparency of government decision-making.

The VHA accepts that through this planning framework, baby steps will need to be taken in the early years as we position for more fundamental reform later on. nonetheless, the VHA expects significant policy and budgetary announcements – supported by ministerial commitment – arising from this plan in 2012. When taken, these steps should be applauded by the public healthcare sector, because the reforms expressed in the rhetoric of the Victorian Health Priorities Framework 2012-2022 have been sought by our industry for many years.

Impact of reforms will be felt in 2012

Chief Executive’s

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Collaboration: The Key to Better Health 2011

VHA Annual

Conference

JENNIFER GALE VHA Director and Kyneton and District Health Services CEO

“i’ve enjoyed the focus on consumers – hearing some consumer voices and some examples of how consumers have been involved in their care planning. i think that’s significant because we’ve never really heard it before.”

BILL PARSONS Goulburn Valley Health Director

“it’s been a big learning curve for me, not coming from a health background. it’s been very, very interesting. i’ve only been on the board of Goulburn Valley Health for three months so it’s been really good becoming more familiar with the health system.”

BARRY SMITHGoulburn Valley Health Director

“The networking is sensational. i found Associate Professor Bill Silvester from the Austin’s respecting Patient Choices program a highlight. i think we can pursue that as a board at Goulburn Valley Health. Apparently we have a system in place but it’s not as extensive as the one Bill was talking about. i think that’s a real opportunity to make people feel comfortable about end-of-life decisions.”

GRAEME WELSH Albury-Wodonga Health Director

“it’s been really well run and you’ve had some really interesting speakers. i particularly liked Professor michael Georgeff (who spoke about enabling collaboration through technology). He raised some enormous challenges and opportunities for the VHA as an operation. You’ve got to work out how to tackle today’s older demographic, otherwise all that good work will have no effect for at least 20 years (when today’s under 50’s have aged). most people who are currently over 50 are still not computer literate.”

NANCY HOGANVHA Director and Peninsula Health Vice Chair

“Professor nilmini Wickramasinghe and Professor michael Georgeff both gave very interesting and stimulating viewpoints. i am inspired because i’m joining the VHA board at a great time. i think the VHA has got a terrific future.”

GREG PULLENVHA Director and Northern Health CEO

“i particularly enjoyed the presentation by Associate Professor Bill Silvester from Austin Health. i thought he was the sort of clinician that we would all like to have looking after ourselves and our relatives. i thought he was very empathetic.”

VERONICA SNOOK Whitehorse Community Health Service Director

i really enjoyed Andrew Way’s session on creating collaboration in academic clinic services. That really gave a concrete example of where the future’s going in a more strategic sense. it raised questions for me about how to get community agencies involved. So often, healthcare research and development happens at hospitals and the community is somehow separate, as another tier in the system. my take-away is putting that on the agenda from a community health service point of view.”

JACqUI TARRANT Nurse Business Manager Thomas Hogan Aged Care, Kyneton and District Health Services

“i’ve never been to a VHA conference before. Seeing everyone together discussing things is great and i think collaboration is so important. it’s all about improving our healthcare delivery to clients. i’ve met a lot of rural and regional members here and i’ve just met someone from the metro area. it’s great to meet a lot of different people, just to see how it all works.”

The VHA asked delegates to comment on our program


VHA Award

Winner

Latrobe Community Health Service has won the 2011 Victorian Healthcare Association Award for its mobile wound care (MWC) service.

Official sponsor HardyGroup international presented the award at the VHA’s annual policy conference Collaboration: the Key to Better Health in September. The award recognises an outstanding collaboration that uses a new approach to health service delivery.

mWC is a web-based service with a regional wound consultant as the central reference point for clients in Home and Community Care, district nursing services and public residential aged care services.

The regional wound consultant, marianne Cullen, has remote access to client files so she can provide expert wound management advice to local generalist practitioners, such as community nurses.

“This reduces the time spent travelling, allowing marianne to prioritise on-site

reviews and spend more time with clients and supporting staff,” Latrobe’s Executive Director Ambulatory Care nicole Steers explains.

“This is a terrific example of how technology can help people in regional areas. it means that clients can access expertise that would otherwise be unavailable to them.”

mWC is a joint initiative of Latrobe Community Health Service, the Victorian Department of Health, monash University’s Department of rural and indigenous Health and 17 Gippsland-based healthcare agencies.

Participating agencies include large regional hospitals, community health services, district nursing services, public residential aged care facilities and small rural bush nursing centres across 42,538 square kilometres.

During a 12-month pilot of the model 12,775 assessments were performed on 824 clients, who presented with 1227 wounds.

Assessments, including photos of wounds over time, were shared between the regional wound consultant and local generalist practitioners using software provided by HSAGlobal and hosted by Fujitsu.

“mWC was a unique opportunity for Gippsland health services to participate in a collaborative research project using technology to positively impact health outcomes of clients across the region, including those in isolated communities,” ms Steers says.

“it also highlighted the potential for Gippsland healthcare providers to be at the forefront of innovation in wound management research.”

The Department of Health has funded mWC for a further 12 months.

“This is a terrific example of how technology can help people in regional areas. It means that clients can access expertise that would otherwise be unavailable to them.”

Latrobe mobile wound care

From left: Hardy Group CEO Frank Tracey congratulates Latrobe Community Health Service’s

Executive Director Ambulatory Care nicole Steers, regional Wound Consultant marianne Cullen

and Project Officer Leonie riddle.


A physical health screening team has improved access to primary healthcare for people with severe mental illness in north-east Melbourne.

The Alliance Health Screening Team was a joint initiative of Banyule Community Health Service (BCHS), Austin Health and local psychiatric disability and rehabilitation support service neami Limited.

The team collected data from 177 mental health consumers over a six-month period last year. The consumers were aged between 18 and 68, with a mean age of 42, and comprised 96 men and 81 women. Half were jointly case-managed by neami and Austin Health’s community mental health services, while half were neami consumers.

The Alliance Health Screening Team identified participants’ physical and emotional health needs and helped them to access:

• integratedsupportfrommultipleagencies

• avenuesforaddressingtheirownphysicaland emotional health concerns

• localprimaryhealthcareservices

• priorityservicesthroughVictorianDepartment of Health Community Priority Tools (2009)

The data was used to create sustainable new referral pathways. in 2009, only eight Austin Health/neami consumers were referred to BCHS. This increased to 59 referrals through the Alliance Health Screening Team in 2010.

The team received no additional funding for the screening project.

Although routine screening stopped upon completion of the project last year, referrals to BCHS remained high in the first half of this year with 26 dental, seven counselling, two dietetics and two physiotherapy referrals.

“The relationships that were developed as a result of the project have continued to grow and become systemically embedded,” Service integration Project Officer Jane Howie says.

“The Alliance Screening Team has impacted positively on consumer experience and organisational capacity, in turn supporting improved health outcomes for people with a severe mental illness.

“it is already apparent that the benefits of the Alliance Health Screening Team will continue into the future.”

research indicates that mental illness significantly increases a person’s risk of physical illness, and this co-morbidity can impact on their diagnosis and prognosis.1 Consequently, people with severe mental illness have a life expectancy 20–25 years below the general population.2

A report released this year by the ministerial Advisory Committee on mental Health, Improving the physical health of people with severe mental illness, recommends a collaborative service model similar to the one implemented by the Alliance Health Screening Team.3

“The team’s commitment to increasing sector-wide understanding of the physical and emotional health needs of mental health consumers, and strengthening relationships between agencies, will support the continual growth of community-based mental healthcare,” ms Howie says.

References

1 Coglan, r. Lawrence, D. Holman, D. & Jablensky, A. (2001). Duty to Care. Physical illness in people with mental illness. Department of Public Health and Department of Psychiatry and Behavioural Science. The University of Western Australia, 2001

2Prince, m., Patel, V., Saxena, S., maj, m., maselko, J., Phillips, m., et al. (2007). no health without mental health. The Lancet, 370(9590), 859-877.

3ministerial Advisory Committee for mental Health (2011) Improving the physical health of people with severe mental illness.

VHA Award

Finalist

Health screening team a success

Season’s GreetingsThank you for your continued support throughout 2011. We wish all our members a happy and healthy festive season and a prosperous New Year. From the Board of Directors, the Chief Executive and staff at the Victorian Healthcare Association.

“The Alliance Screening Team has impacted positively on consumer experience and organisational capacity, in turn supporting improved health outcomes for people with a severe mental illness.”


Gippsland Lakes Community Health (GLCH) has more than doubled its recruitment rate for Home and Community Care (HACC) staff, through a Home Care Traineeship designed to combat ongoing recruitment and retention problems.

The traineeship program has resulted in 123 new appointments over the past five years, compared with fewer than 10 appointments per year prior to its introduction.

Since full-time traineeships were introduced, 85 per cent of graduates have gained ongoing employment at GLCH, which is the major East Gippsland provider of HACC, Veterans Home Care and federal/state funded packages.

GLCH has above-average populations of aged, veteran and Aboriginal and Torres Strait islander residents. it has low population density of 2.1 people/square kilometre and 100 home-based care staff caring for 1600 clients.

Director Aged Care Leah mcFadzean says GLCH is facing increasing health workforce challenges.

“The populations we service are impacted by rurality, remoteness, a limited labour market, high competition for skilled workers, and a small and sparsely located pool from which to draw,” ms mcFadzean says.

Other barriers to attracting and retaining a skilled workforce for home-based services include: a Department of Health funding requirement to employ minimum certificate iii qualified staff; current staff with long service leave and retirement pending; and an ever-shrinking labour market.

“retention over the longer term is something we still struggle to define appropriately. However, 51 per cent of the current home care workforce came via the traineeship program,” ms mcFadzean says.

Clients of the Home Care Traineeship program include the frail, the aged, people with a disability, their carers and families.

Partners in the program include:

• theserviceprovider(GLCH)

• thetrainingprovider(EastGippslandTAFE)

• theapprenticeshipagency(VictorianEmployer’s Chamber of Commerce and industry - VECCi)

• localjobnetworkagencies

• trainees

• fundingagencies(HACCandEastGippsland Shire Council)

Up to 25 candidates undertake a 12-month level iii certificate course, which includes paid work and study.

GLCH offers job interviews to all graduates, outlining suitable career pathways and how

their skills may be transferable within the health sector.

Significantly, of those who left the program, many have undertaken further study or work in the health sector – including two in nursing, six in disability services, one in residential care, one in allied health and two in service coordination.

Trainees have reported increased self-esteem and many say the program has given them career opportunites and job satisfaction they did not expect.

ms mcFadzean says the success of trainees within the aged care unit has led to traineeships within other areas of GLCH, such as corporate services, allied and Koori health.

VHA Award

Finalist

Gippsland Lakes training program

“Trainees have reported increased self-esteem and many say the program has given them career opportunites and job satisfaction they did not expect.”

Gippsland Lakes Community Health has designed a new early intervention model to address service gaps for developmentally vulnerable preschool children.

The Active Lorikeets model includes home programs, preschool skills groups at four locations, referrals for further intervention and resources for kinder teachers on how to support the children.

Parents, carers and their children are invited to attend weekly sessions with an Active Lorikeets preschool skills group.

reports based on Brigance Screens are used to help the families and early childhood practitioners develop the childrens’ school readiness.

Allied Health Assistant Danielle Clifford says the model will improve local speech and occupational therapy services and may reduce waiting lists for allied health services over the next two years.

“From this model we have been able to prioritise the children most in need of allied health services,” ms Clifford says.

“To build the confidence of parents, caregivers and kindergarten teachers we have structured the sessions to demonstrate where their child should be performing in readiness for school.

“Using low-cost objects and easily accessible resources, we have developed activities that parents can replicate at home to assist in their child’s development.”

Early intervention for preschoolers


Bendigo Health has developed a podiatry diabetes model (PDM) to improve services for people with diabetes living in the Loddon Mallee region.

People with diabetes are at risk of developing severe foot problems, which can lead to ulceration and lower limb amputation. There are about 3,400 diabetes-related foot amputations each year in Australia.

The PDm ensures people are treated by the most appropriate podiatry service according to their risk of future foot morbidity, which is rated on a scale of 0–6 using the University of Texas Diabetic Foot risk Classification System.

Bendigo Health has 8.6 full-time podiatrists employed through multiple sources of federal and state funding. For much of the previous 20 years there has been a lack of coordinated service planning, inconsistent clinical practice and insufficient agreed pathways for patients at various stages of diabetes-related foot problems.

The PDm was developed by Bendigo Health and Bendigo Community Health Services without additional resourcing. it has also been adopted by local GPs and private podiatrists.

A detailed statistical evaluation of the model was presented at the 2011 Australasian Podiatry Conference and the 6th international Symposium on the Diabetic Foot, and will be published in the next edition of the Australian Health review.

The evaluation was conducted by La Trobe rural Health School Senior Lecturer Byron Perrin, Bendigo Health Chief Podiatrist marcus Gardner, Bendigo Community Health Services Senior Podiatrist Susan Kennett and podiatrists michael Fanning and Jodie Cornelius.

They conducted a three-month prospective clinical audit of diabetes-related podiatry consultations at Bendigo Health and Bendigo Community Health Services following the introduction of

the PDm. During that time, 576 clients attended 919 consultations, including:

• 634communityconsultations

• 226sub-acuteconsultations

• 59acuteconsultations

The evaluation found that PDm patients were seen by the most appropriate podiatric service according to their risk of developing future diabetes-related foot problems, which are associated with extended hospital admissions, high recurrence rates and reduced quality of life.

Future research will investigate whether the PDm actually reduces the incidence of diabetes-related foot complications.

“One of our main goals is to prevent amputations and we hope that implementing this model will help achieve this,” mr Gardner says.

“Evaluation of the model shows we are ensuring that people with diabetes receive the most appropriate podiatry treatment available, and highlights the importance of collaboration with other health service providers.”

VHA Award

Finalist

Bendigo podiatry diabetes model

“One of our main goals is to prevent amputations and we hope that implementing this model will help achieve this.”

Bendigo Health Chief Podiatrist marcus Gardner treats Daryl Twyerould.


VHA Award

Finalist

Health plan for Melbourne’s west

Rapid growth, an ageing population, and increasing rates of chronic and complex disease have prompted the development of a Better Health Plan for the West (BHP4W) in Melbourne.

BHP4W is an agreed set of priorities for health service delivery across the local government areas of Brimbank, Hobsons Bay, Hume, maribyrnong, melton, moonee Valley, moorabool and Wyndham.

The plan was formally launched in October and will be implemented over the coming decade by 22 partners across acute health, community health, Divisions of General Practice and local government settings.

The Australian Bureau of Statistics names Wyndham and melton as the two fastest-growing regions in Australia. in 2010, the combined population of these adjoining regions increased by 20,000 compared with a 14,000 increase in the traditionally high-growth Gold Coast-Tweed regions.

The extra 20,000 people in Wyndham and melton equates to an annual demand for 150 additional nurses, 28 new doctors and nine more dentists in those two local government areas.

ABS figures suggest melbourne’s west will maintain its rapid growth for at least the next decade.

This growth – in addition to an ageing population, increasing chronic and complex diseases, diverse demographics and predicted healthcare workforce shortages – has prompted the development of BHP4W.

its main priority areas are mental health, cardiovascular disease, obesity, diabetes and cancer.

Key objectives of the plan include:

• givingconsumersinformationandcapacity to manage their own healthcare

• programsthatrecogniseconsumerviewsabout how and when they want to interact with health services

• lookingbeyondtheroleofindividualpartners to a more holistic view of consumer wellbeing

• workingcooperativelytorecruit,developand share staff across the partnership

• optimisingresourcesthroughgreaterresearch and coordination

• attractingnewresourcesthroughprivateinvestment

• usinge-healthtechnologies to develop new models of care, improve health

literacy and empower consumers

Key actions within the plan include:

• creatingasharedorganisationalaudittool for health literacy

• developinganetworkofhealthliteracycommunity leaders

• combininghealthpromotionresourcestodeliver a regional health literacy program

• researchinghowconsumerscurrentlyaccess and navigate services

• developingnewmodelsofcareformental health, cardiovascular disease, obesity, diabetes and cancer

• increasingcarecoordinationandcontinuity of care between agencies

• developingjointscholarshipsandtrainingincentives

• usingBHP4Wresearchoutcomesforservice system re-design, local planning and advocacy

All 22 partners contributed funding to the plan and participated in stakeholder consultations, service mapping exercises and workshops. Planning of a future governance structure for BHP4W is currently underway.

For further information visit www.wrhc.vic.gov.au

National health reform and the activities of a new Victorian Government were central to the VHA’s research, policy and media activities in 2011.We continued to support the growth of sub-acute, early intervention and primary healthcare models to meet Victoria’s future health needs. We advocated for greater investment in these models through the development of the Victorian Health Priorities Framework 2012-2022.

VHA Chief Executive Trevor Carr was involved in the ministerial Advisory Committee for the development of this priorites framework, demonstrating the VHA’s influence at a state political level. in 2012, we will continue to advocate for our members in this way.

in June, a redeveloped national Health reform Agreement was endorsed at COAG,

with the states clarifying their important role as health system managers. The VHA supports this role and believes system management decisions are best made at a state level, due to the need for a whole-of-government approach to the determinants of health.

Under the reform agenda, the VHA supports the creation of:

• apermanentAustralianCommissionforSafety and Quality in Healthcare

• HealthWorkforceAustralia’sInnovationand reform Strategic Framework

• theAustralianHealthPractitionerregulation Agency’s national registration responsibilities

• theAustralianNationalPreventiveHealthAgency

The VHA held four two-day conferences, including the Australian Governance and

VHA research and policy: 2011 the year in review


The introduction of a simple initial needs identification (INI) form across Western District Health Service has led to 90 per cent of clients completing INI.

Previously, only 20 per cent of WDHS clients completed ini, leaving 80 per cent who potentially had other health needs that were overlooked.

The introduction of a single ini tool across primary care, acute care (discharge planning) and Home and Community Care (HACC) has also reduced service duplication by 30 per cent.

Previous intake methods often required lengthy patient interviews, which delayed access to services by up to four weeks and often resulted in the duplication of professional assessments.

WDHS introduced the Service intake First model so clients could report health needs other than the presenting issue at admission or pre-admission.

The model was developed from a study tour of Canada, where priority is placed on meeting the client’s initial need and other needs are identified after engagement.

Under the model, clients complete a simple needs assessment form after receiving a service. An assessment/referral coordinator follows up with WDHS clinicians for those clients who express other healthcare needs.

The model is giving WDHS clients timely access to services, preventing more acute stages of illness and increasing service efficiency. This has enabled the redirection of resources into new care coordination services.

The following outcomes have been reported:

• 90percentofclientscompletingthesame ini form (previously 20% of clients completed ini)

• a53percentincreaseinreferralstocarecoordination

• a100percentincreaseindischargeplanning referrals to community-based services, other than post acute care

The Australian Council on Health Standards (ACHS) has described the single ini form at WDHS as an “impressive initiative” because clients’ discharge needs are being identified at pre-admission or admission.

The ACHS says linking the discharge team

with the primary and preventative health division of WDHS has enhanced linkages within the health service and with outside agencies.

Service First intake is part of a broader integrated Care model which has seen the co-location of acute, primary care and Home and Community Care staff at WDHS, improving coordination and integration between these divisions and local GPs.

APRIL

INI’S COMPLETED

REFERRALS MADE/INFO PROVIDED

MAY JUNE JULY

0

50

100

150

200

This snapshot of monthly discharge planning

data shows consistent throughput and referral.

VHA Award

Finalist

Intake model lifts participation rate

Quality Conference and our Collaboration: The Key to Better Health conference. materials presented at these conferences were enhanced through the publication of Health matters.

Stage 3 of the VHA’s Population Health Approaches to Planning (PHAP) project involved the pilot of a learning module – Population Health: A Shared Understanding – which will be developed into a formal web-based learning module in 2012.

A PHAP toolbox of ‘how to’ information and resources is currently under development, based on work commissioned by the VHA from monash University’s Department of Social Services. The toolbox aims to build capacity, promote a common PHAP framework for the Victorian health sector, and build on the best-practice activities of VHA member agencies.

The VHA commenced two other research

partnership projects in 2011. The management Competency Assessment Project (mCAP) is a collaborative effort with the Australasian College of Health Service managers (ACHSm) and La Trobe University. it will develop a competency assessment tool for health service managers by 2013.

The Clinical Governance and Quality of Care Project aims to describe and analyse the activities of Victorian public health service boards in relation to hospital performance. The Victorian managed insurance Authority is an investment partner in this University of melbourne research.

The VHA’s research and policy sub- committee was established in 2011 and worked with the research and policy team to identify the following goals for future policy work:

• undertakingprojectactivitiesthatincreaseopportunities for collaboration and partnership, including collaboration with

and between the board, VHA members and other peak organisations

• continuingtodeveloptheacademicrigouralready evident in VHA policy work

• ensuringtherelevanceofboard-endorsed position statements to the VHA membership

• developingaprocessthatlinkspolicyand advocacy issues with member and stakeholder engagement processes

Formal and informal feedback showed that member satisfaction with VHA research and policy activities increased in 2011. This was achieved largely through the organisation’s improved public profile, increased policy output and strong industry leadership. in the coming year we will be working hard to further improve our performance in each of these areas.


2009 HAN pilotin 2008, Austin Health launched a feasibility study asking nurses about their workloads and the option of introducing an ‘assistant’ role for basic patient care tasks like feeding and bathing

Following a positive response from nurses, Austin Health developed the Health Assistant nurse (HAn) role

Staff were reassured that the role would not affect nurse-patient ratios but would reduce the need for the intermittent and often ineffective use of supplementary staff unfamiliar with the ward

Austin Health designed a Certificate iii accredited training program for HAns in conjunction with the royal melbourne institute of Technology (rmiT). A recruitment and selection process was also developed

more than 300 people applied for six positions, indicating a large pool of potential employees.

in July 2009, six HAns were employed part-time while completing the Certificate iii in Health Services Assistance at rmiT

This year, Austin Health expanded the program to all of its acute wards and is now employing 30 HAns across 15 wards.

Austin Health has expanded its successful health assistant nurses (HAN) program to all acute wards and is now employing 30 HAN staff across 15 wards.

HAns care for patients under the supervision of a registered nurse. They take pressure off registered and enrolled nurses by undertaking daily living tasks such as toileting, bed making and feeding.

Austin Health introduced the HAn role to relieve the impact that increasing patient acuity and throughput was having on nursing staff and patients. instead of recruiting more nurses, HAns have been employed to supplement the existing registered nursing staff.

Deputy Director Ambulatory and nursing Services Shane Crowe says the Austin Health model is a first for Victoria.

its introduction required regular and open discussions with the Australian nursing Federation to alleviate union concerns over unregistered staff entering the nursing workforce, and the boundaries and supervision of HAns.

Austin Health conducted a pilot of the HAn model in 2009 (see separate box). An independent evaluation of the pilot by PricewaterhouseCoopers (PwC) found that wards using HAns had a 30 per cent drop in the use of ‘specialling’ hours over the first 12 months, equating to a $90,000 cut in agency staff costs.

PwC also found that HAns improved the wellbeing of patients and staff. Patient complaints almost halved on wards with HAns, dropping from 40 to 21, while 84 per cent of nurses surveyed said they were able to focus on providing higher-level clinical care.

PwC noted that HAns provided non-clinical care that might otherwise have taken longer or not occurred at all, including shaving patients, washing their hair, and feeding patients while their meal was still hot.

“When nurses are busy, tasks that have no impact on the patient’s clinical outcomes are the lowest priority,” mr Crowe says.

“However, having makeup applied or whiskers shaved can have a huge impact on patient self-esteem and wellbeing.”

Austin Health is a world leader in cancer, liver transplantation, spinal cord injuries, neurology, endocrinology, mental health and rehabilitation. A record 98,159 inpatients and 170,644 outpatients were trated in 2010-11.

“recruitment and retention of nursing and medical staff is a worldwide issue,” mr Crow says.

“Workforce satisfaction is a major concern for Austin Health and we are committed to being an employer of choice.”

Austin Health assistant nurses: a Victorian first

VHA Award

Finalist

Austin Health team members (front row, left to right) Ann-maree Keenan, rebecca monger, Carolyn

Pogue, Stephanie King (back row left to right) Dermot Fitzgerald, Shane Crowe, CEO Dr Brendan

murphy, Georgina Knuckey, Debbie Hill and Duncan Baulch.


Sometimes we find ourselves in a unique position to challenge the environment in which we work to create a better outcome. Seldom do we accept the challenge and test the status quo with something a little different.

Hesse rural Health Board of management has achieved this and, in so doing, has made an outstanding contribution to rural dementia service delivery in Victoria.

Hesse rural Health Service has actively pursued its vision that local people with advanced dementia should be entitled to live within their familiar rural communities.

responding to local demand – and national and international population health analyses of increasing rates of dementia – and frustrated by greater health inequities for rural people, Hesse has developed the Werruna dementia-specific environment.

Based in Winchelsea, Werruna opened in 2010 after five years of dedicated research, planning, and construction.

The rural residential centre for people with advanced memory loss and confusion is based on the health and social needs of people with dementia. its innovation lies in its simplicity.

The contemporary building design strongly reflects the entitlement of people with dementia to live in high quality environments. it is in keeping with local rural family cultures and retains community integration.

Werruna emphasises the importance of light, space, contrast, acoustics, outdoor accessibility, points of reference (way finding), meaningful lifestyle inclusions, outdoor interactive areas, art and music to enable personal expression, social interaction and wellness.

These concepts have been incorporated in a cost effective manner. Fully researched, developed and coordinated by Hesse, this independent rural project is a unique and highly successful community, business, and health service partnership.

Werruna has attracted interest from public, private, not-for-profit, and peak agencies for dementia care, and is an excellent example that small rural services can create world’s best practice.

This state-of-the-art wellness environment was a top-five finalist in the 2010 national Aged Care Association of Australia (ACAA) Building Awards, and reached the final four in a 2011 Organisational Award from Aged & Community Care Victoria (ACCV).

Werruna was featured in a presentation at the 2010 ‘Coming of Age’: Dementia in the 21st Century Conference in London. As a result, Hesse was invited to present at this year’s Alzheimer’s Disease International Conference in Canada alongside representatives from the UK, ireland, Sweden and France.

Hesse has now been invited to be the Australian representative in a proposed international collaboration on rural dementia service provision.

This article was prepared by Hesse CEO Peter Birkett

Design promotes wellness for people with dementia

HesseRural

Health

“The contemporary building design strongly reflects the entitlement of people with dementia to live in high quality environments.”


The withdrawal of obstetric services from Kyabram’s local GPs in 2009 prompted Kyabram and District Health Service to investigate alternatives in midwifery care.

An extensive review by an independent consultant, with the support of key stakeholders, led to the Community and Hospital midwifery Program (CaHm).

The CaHm Program is a primary model of midwifery care that relies on a core group of midwives to provide all pregnancy, birthing and postnatal care. These core midwives are supported by their hospital-based counterparts.

The CaHm Program is also strongly supported by Goulburn Valley Health. This strong collaborative relationship is a crucial component of the program.

Between January and July, 36 women joined the program, including 17 who have since birthed at Kyabram and 10 who have transferred out of the program and birthed at other hospitals.

Of these, four transfers were voluntary and six were due to the pregnancy becoming medium to high risk.

Chief Executive Officer of the health service, Dr neil Cowen, says the CaHm model has significantly changed the way midwifery is practiced in his rural community.

“Customer satisfaction surveys clearly show that women and their families involved in the CaHm program are very satisfied with the standard of care they receive,” Dr Cowen says.

“it is this type of innovation that will ensure our local community is able to retain such vital health services.”

Families celebrate midwife care

From left: nicole Fahy with Shila, Stephanie Grinter with Chloe, midwifery Coordinator Karen Taylor and Ann Evans with Anthony. Photo courtesy of Bellies & Babies.

Kyabram District

Health Service

Alannah holds baby sister Sienna.


Doutta Galla Community Health will open an innovative specialist primary health service for homeless people in Melbourne’s CBD next year.

Doutta Galla is working with the City of melbourne and other agencies to set up the Central City Community Health Service at the Drill Hall site on the corner of Thierry and Victoria Streets, near Queen Victoria market.

Program manager Brian Sardeson says the centre, due to open in April, will integrate health and welfare services to engage and support homeless people.

“As the lead agency in this development, Doutta Galla recognises that the complex mental and physical health needs of these people are often not addressed through mainstream health and homeless services.”

The City of melbourne funded a feasibility study for the service this year, which found that homeless rates in the city are two to three times higher than the national and state averages.

The study also showed that the homeless population is diverse, not homogenous, and includes women, women with children, young adults, singles, families, the aged, and people with disabilities.

“All these groups require different services and engagement strategies,” mr Sardeson says. “in particular, women have higher

needs for safety and security, and despite there being similar numbers of homeless men and women in melbourne, women do not access services in equal numbers.”

Doutta Galla Community Health has had an active role within melbourne’s homeless and health networks through the development of the CBD Homelessness Health Access Protocol. Doutta Galla has also been involved with implementation and training work by the CBD Health Access Coordination network.

The service model for Central City Community Health Service will include:

• centre-basedservices–integratedandcomprehensive medical, allied health and Doutta Galla counselling services, complemented by specialist co-located services. Volunteers will facilitate referrals to key health providers, such as dental services

• assertiveoutreachservices–providedin partnership with existing CBD homelessness services

• facilitatedreferrals–usingtheHomelessness Health Access Protocol and the priority access policies of Doutta Galla and other agencies

• sectorsupportandeducation – to develop peer support, training and mentoring opportunities

Agencies consulted in the development of the centre include mainstream

health agencies, housing, support and homelessness agencies, peak providers, and mental health services.

mr Sardeson says the royal District nursing Service Homeless Person’s Program, royal Women’s Hospital, St Vincent’s Hospital, Home Ground, Hanover, Wintringham, YoungPeople’s Health Service and the Victorian Council to Homeless Person’s Peer mentoring Program have all expressed interest in supporting the initiative.

These agencies have nominated 12 senior managers to participate in a Senior Leadership Forum to develop strategic directions for the Central City Community Health Service.

“it is potentially an opportunity to integrate some of their services with Doutta Galla Community Health in a more discrete location,” mr Sardeson says.

“Through this frontline primary health service, clients will be able to access a range of health and community professionals from one site. Doutta Galla Community Health is committed to transferring much-needed programs into the CBD and encouraging other agencies to target their resources to this under-serviced catchment area.”

For more information contact: [email protected]

City health service for homeless peopleCongratulations to Doutta Galla Community Health Service2011 Primary Health Service of the year

Doutta GallaCommunity

Health

MeeTING AND OffICe fACILITIeS fOR MeMBeR AGeNCIeS

Comfortable facilities are available for member agencies at our Exhibition Street premises in melbourne’s CBD. These facilities are available to members, without charge, providing you with a base in the CBD for meetings, forums, interviews or catching up on work.

CONfeReNCe fACILITIeS

VHA’s multifunctional facilities can cater for meetings for groups of between two and 50 in both boardroom and theatre-style configurations. Videoconferencing, teleconferencing, whiteboards and AV facilities are available on request.

Fruit, biscuits, water, tea and coffee can be provided for meetings, on request. A list of catering options is also available.

HOT-DeSKS AND MeMBeR LOuNGe

members can access a PC, internet, phone line, printer and reference library to make your working day in the CBD a little more comfortable.

When it’s time to relax, VHA’s member lounge provides comfy chairs, daily papers, espresso coffee, chilled water and fruit.

For more information or to make a booking, please call 03 9094 7777 or email us at [email protected]

Make your membership count


Northern Health has adopted a three-step rule for advance care planning, using the acronym ACP as a device to remember Appoint an Agent, Chat and Communicate, Put it on Paper.

ACP is a process for people to identify how they would like to be cared for should they become unable to participate in their own medical decisions.

Communication occurs between the patient and their substitute decision-maker, their family, friends, clinicians and their priest or spiritual adviser.

Up to one-third of northern Health patients were born overseas, so cultural and religious diversity are major considerations in ACP.

“Communication is encouraged in a way that is appropriate to the decision-making culture, moral and religious beliefs of the patient and their family,” Palliative Care Physician Dr Barbara Hayes says.

“This needs to be an ongoing conversation, which can be refined and revised as circumstances or views change.

“By emphasising the importance of values, we recognise that different patients will use different ethical reasoning when making health care decisions.”

ACP brochures and posters have been

printed in nine languages and northern Health is holding information sessions for English and non-English speaking community groups.

northern Health has also adopted a new approach to CPr based on the findings of Dr Hayes’ recent PhD study Ethical CPr decision-making.1

This qualitative study was co-supervised by northern Health’s Chief medical Officer Associate Professor Kwang Lim.

Senior doctors, junior doctors and nurses were interviewed to identify the ethical elements of making advance decisions about whether hospital patients would receive CPr in the event of a cardiac arrest.

Dr Hayes’ research confirmed that clinical CPr decision-making was inconsistent and lacked a systematic teaching approach. Of the 11 junior and 11 senior doctors she interviewed, only one had received formal teaching about how to discuss CPr with patients and families.

After identifying the ethical elements that confront clinicians, Dr Hayes developed a decision-making algorithm to guide future CPr discussions.

in this, she distinguishes between the technical, medical and ethical aspects of decision-making using four patient groups – two groups that could be expected to survive a CPr attempt and two groups that

might survive a CPr attempt. Each patient group has identified aims for the CPr discussion.

“Teaching this in a systematic way assists junior doctors to identify the clinical information they require before they begin the discussion,” Dr Hayes explains.

“They begin knowing what the specific aims of the discussion are for that patient, and how they might negotiate differences of opinion.“

The approach is being taught to doctors, medical students and nursing staff at northern Health. initial feedback suggests that junior doctors and nursing staff find the approach helpful.

“Outcomes from this approach will be formally evaluated, but early feedback from clinical staff has been positive,” Dr Hayes says.

“in particular, junior medical staff have identified the clinical value of an algorithm that helps them negotiate the technical and ethical aspects of CPr decision-making.”

1 Dr Hayes’ thesis Ethical CPr decision-making was passed in April 2011. Her PhD research was conducted in the Centre for Health and Society at melbourne University’s School of Population Health, co-supervised by northern Health Chief medical Officer Associate Professor Kwang Lim, Associate Professor Lynn Gillam from the Centre for Health and Society, and Professor Colleen Cartwright, Director of the Aged Services Learning and research Collaboration (ASLarC) in Southern Cross University’s Aged Services Unit.

Multicultural model for advance care planning

Northern Health

“Communication is encouraged in a way that is appropriate to the decision-making culture, moral and religious beliefs of the patient and their family.”

Palliative Care Physician Dr Barbara Hayes.


A new eNDOALPHA Operating Room System has equipped Hamilton Base Hospital with high definition digital imagery for laparoscopic and endoscopic surgery.

Olympus Systems integration Consultant Brad mischel says the digital theatre model installed at Hamilton is the first of its kind in Australia. installation required closure of the main operating theatre for two weeks and restricted use of the second theatre for one week.

The installation completes a $600,000 upgrade which began at Hamilton two years ago.

As part of the upgrade, an ergonomic operating room system and video management system have been integrated into the PACS (digital radiology) system and the Trakcare – electronic medical record system.

The first stage of the project provides images for endoscopic and laparoscopic procedures. in future, clinicians will be able to use the state-of-the-art high definition digital imagery and equipment for 45 per cent of the 3,100 operations performed at the hospital each year in gynaecology and urology, ear, nose and throat, general, endoscopic and laparoscopic surgery.

Western District Health Service (WDHS) Acting CEO Pat Turnbull says clinicians have described the new images as ‘stunning’.

“The benefits in terms of ability to diagnose and clearly see the operating site were immediately apparent,” mr Turnbull says.

“This quantum shift in image quality is the equivalent of moving from an analogue to high definition digital TV. The benefit for patients will be improved diagnosis and surgeons will be able to work with greater accuracy, leading to better outcomes and faster recovery times.”

A ceiling-mounted arm centralises all controls for medical and peripheral equipment and displays two monitors for the surgeon to view. The EnDOALPHA system also stores high-definition digital images, reports and video in the patient’s electronic record.

“The ability to stream images live within the health service or to a remote external consultant will significantly enhance our teaching and training capacity,” Surgeon Stephen Clifforth says.

“it will also provide exciting opportunities for referral to external expert consultants for unusual or complex cases.”

Hamilton’s Top of the Town Committee and sponsors contributed more than $215,000 while the Hospital Opportunity Shop Auxiliary donated $35,000. The project was also supported by community donors, WDHS staff and Olympus.

Digital operatingtheatre installed

Hamilton Base

Hospital

From left: Olympus Sales Specialist michael Allwell with Surgeon Stephen Clifforth and Olympus Systems integration Consultant Brad mischel.


MonashLink Community Health Service has developed a Disordered eating Service (DeS) for people with mild to moderate eating disorders and those struggling with obesity, disordered eating and body dissatisfaction.

The DES is an integrated psychology and dietetic program that is client-centred, low-cost and community-based.

monashLink’s Counselling Services manager Carmel Fox says this type of service has not been offered in the Victorian community health sector before.

“The clinical innovation of the DES is that psychologists and dietitians jointly assess clients and provide integrated individual and group treatment in the community health setting,” ms Fox says.

“This is fundamental to the strong clinical outcomes we have achieved.”

The DES offers:

•helpforteenagersandadultswithmildto moderate eating disorders, weight problems, binge eating and body dissatisfaction

•jointpsychological/dieteticassessmentand treatment

•individualevidence-basedtreatmentfor mild to moderate anorexia nervosa, bulimia nervosa, binge eating and disordered eating

•family-basedtreatmentforadolescents

•asustainablenon-dietapproachtoobesity and weight management

•aneight-weekweightmanagementandpositive body image group called no more Diets in conjunction with therapy or as a separate option

ms Fox says the DES has achieved excellent clinical outcomes over the past four years and has provided a tested clinical model that responds to community needs.

Eating disorders result in the highest mortality and suicide rates of any psychiatric diagnosis and 20 per cent of people suffer debilitating, lifelong illness3. research shows that although early intervention achieves better clinical outcomes,1 it is rarely available2.

“Without programs like the monashLink DES, unless individuals can afford private treatment, the window of opportunity for early intervention is lost,” ms Fox says.

research shows that Australian rates of obesity, disordered eating, body dissatisfaction and the associated physical and mental co-morbidities are increasing across all ages and genders4. These are major factors in the burden of disease and a source of substantial community concern5.

Body dissatisfaction resulting in disordered eating can be motivated by the failure to achieve an internalised, socially mediated ‘thin ideal’. This is associated with obesity, increased risk of eating disorders, depression and social stigma6.

increasingly, research supports a non-dieting and integrated physical/mental approach to weight management7,8,9.

“Unfortunately people are rarely able to access such treatment,” ms Fox says.

She says the monashLink DES aligns with the principles of community health in that it:

•respondstocommunityneedasdetermined by national prevalence data5 and local demand

•fillsagapinprimaryhealthcareidentifiedin Victorian service mapping

•isaccessibleforpeopleonlowincomes

•isclient-centred

•takesanearlyinterventionapproach to health care

•haseffectiveworkinglinkswithother local services

•collaborateswithinternalservices(alcoholand drug, family violence) and external agencies (monash medical Centre, monash University counselling service)

This article is based on research by monashLink Psychologist Dr Beth Shelton and Team Leader of Healthy Eating, Diabetes and Children & Communities Sheree Smalley.

references

1 Berkman, n.D., Lohr, K.n., & Bulik, C.m (2007). Outcomes of eating disorders: A systematic review of the evidence. international Journal of Eating Disorders, 40, 293-309

2 Commonwealth Department of Health and Aging (2010), Eating Disorders: The Way Forward: An Australian national Framework.

3 Sullivan P.F. mortality in anorexia nervosa (1995). Am J Psychiatry 152:1073-1074.

4 Eating Disorders Foundation of Victoria , (2008), A response to Because mental Health matters a new focus for mental health and wellbeing in Victoria, Consultation paper, (2009), melbourne

5 Hay, P.J., mond, J., Buttner, P., & Darby, A. (2008). Eating Disorder Behaviours are increasing: Findings from two sequential community surveys in South Australia. PLoSOne

6 Paxton, S.J., Eisenberg, mE.,& neumark-Sztainer. D. (2006) Prospective predictors of body dissatisfaction in adolescent girls and boys: a five-year longitudinal study. Developmental Psychology, 42, 888- 889

7 Kausman, Dr. r., (2004), if not Dieting Then What? Allen and Unwin, Australia

8 Horwath, C., (2008), non-dieting approach improves obese women’s health. University of Otago, new Zealand

Fairburn, C.G., & Brownell, K.D (eds) (2002) Eating Disorders and Obesity; A comprehensive handbook. 2nd edition: Guildford Press. new York

• 3 February – Community Health CEOs/GMs meeting jointly held with a special interest group of the Australasian College of Health Service Management, at the VHA.

• 10 February – Meeting for community health managers in integrated agencies at the VHA from 12pm-3pm.

• 15 & 16 March – Rural Health ConferencePolicy experts from across Victoria will give their views on how to improve rural health outcomes at the Novotel Forest Resort, Creswick. Registration includes accommodation and all meals.

2012 Diary

Dates

Integrated treatment for disordered eating

MonashLink Community

Health Service


A new pastoral care model has been jointly developed by Bass Coast Regional Health, the Wonthaggi-Inverloch Interchurch Council and the Healthcare Chaplaincy Council of Victoria Inc (HCCVI).

The model was set up with seed funding from HCCVi — Victoria’s peak body for chaplaincy, pastoral and spiritual care services within the healthcare sector.

Bass Coast is the first regional health facility to receive funding through HCCVi’s regional and rural Development Project. The model could be used for similar programs throughout Victoria.

The three-year pilot program was launched in may and has been embraced by all denominations within Bass Coast Shire.

rather than being based solely on a religious framework, the model provides a broad spiritual outreach service to

consumers at local hospitals and aged care facilities.

Bass Coast agencies first met with HCCVi in 2009 to discuss the possibility of a Chaplain responding to local acute health and aged care needs. This led to the appointment of a pastoral care coordinator, reverend Geoff Campbell, to:

•recruit,trainandsupervisevolunteersfrom local faith groups to provide pastoral care in acute health and aged care facilities

•coordinateandprovideastructuredpastoral care service with a process for referring more complex spiritual issues to relevant faith leaders

•provideregularpastoralvisitsandcoordinate an on-call service for after hours needs

HCCVi is funded by the Department of Health and provides pastoral care services in the context of illness, treatment, suffering, life and death.

CEO reverend Cheryl Holmes says HCCVi supports the spiritual needs of healthcare consumers as an essential part of caring for the whole person.

“in caring for the whole person within a healthcare context, it is important to respond sensitively to a person’s spiritual needs as well as the physical, social and psychological, to enable them to be sustained and nurtured as they deal with challenges they may encounter in this setting,” rev Holmes says.

HCCVi’s Capabilities Framework 2011 states that spirituality “may be experienced in a quest for meaning, purpose, connection, belonging and hope … it can become more conscious at major turning points in life” and that “pastoral care may or may not be explicitly religious depending on a person’s spiritual identity and expressed needs”.

For more information visit www.hccvi.org.au

Put in place effective healthcare •governance frameworks and processes that equally emphasise corporate and clinical governance responsibilitiesAssess board performance and •development needsDevelop processes to monitor and redirect •organisational performanceDevelop a quality and risk management •framework customised to the activities of your organisation

Australian Centre for Healthcare Governance A VictoriAn HeAltHcAre AssociAtion initiAtiVe

For information please contact:

The Australian Centre for Healthcare Governance (ACHG) can help you:

www.healthcaregovernance.org.au

Develop appropriate quality systems •and processes in your organisationFormulate strategy to address the •population health needs of the community being servedConnect and network with peers, •attend knowledge transfer and professional development forumsKeep up-to-date with research and •policy developments

PHone 03 9094 7777Australian centre for Healthcare Governancelevel 6, 136 exhibition street Melbourne

Trevor Carr – chief [email protected] Brown – clinical Governance [email protected]

Bass CoastRegional

Health

Pastoral service for people of all faiths


five community health services are working collaboratively with the West Vic Division of General Practice to operate Westvic After Hours Health Advice (WAHA), a nurse-led telephone triage service linking consumers with after hours GP care.

Health services at Stawell, East Grampians (Ararat), Wimmera (Horsham), East Wimmera (St Arnaud) and Beaufort/Skipton jointly employ a triage nurse who can be based at any one of these sites.

The West Vic GP Division covers 62,500 square kilometres with a population of 80,000. it has only one emergency department staffed by resident medical officers at the Wimmera Health Care Group in Horsham.

This means GPs have to provide visiting medical officer services to the division’s many small rural and regional health services, often travelling considerable distances.

Westvic After Hours Health Advice (WAHA) is the public name for the Westvic After Hours Service (WAHS), set up 10 years ago by the federal Department of Health and Ageing to reduce after hours demand on local GPs.

A WAHA triage nurse takes each caller’s details and uses a set of agreed evidence and symptom-based protocols to assess whether they need nursing advice, a medical appointment, treatment from an on-call GP, medical assessment at a local health service or emergency care.

The model has led to a 60 per cent drop in after hours calls to GPs, and half of all calls to WAHA are being successfully managed by the triage nurse.

“We are unable to estimate how many of these callers would have presented to a health service,” WAHS manager Deidre rennick says.

“However, recent data shows that less than eight per cent of callers were directed to an emergency department via ambulance or to a health service.”

The service is staffed by a dedicated triage

nurse between 6pm and 10.30pm when most calls are received. From 10.30pm to 8.30am, calls are managed by a night supervisor at Stawell regional Health.

Calls to the advice line are documented in a database and sent (with client permission) to relevant GPs and healthcare agencies the following day. Cases requiring immediate medical review are stamped ‘priority’ and the GPs/agencies arrange follow-up appointments.

The service has been extended to palliative care networks in the Grampians, maryborough, Wimmera and Sunraysia districts. WAHA telephone triage nurses have been trained in basic palliative care advice, including trouble shooting devices such as syringe drivers, to help clients stay in their home environment.

Eventide, a residential aged care facility in Stawell, is also using WAHA when access to a division 1 or 2 registered nurse is limited. A WAHA triage nurse can authorise the use of Prn medication and give general healthcare advice over the phone under specific guidelines developed by Eventide.

“This will reduce the after hours burden on nursing staff and carers at Eventide and potentially prevent inappropriate after hours hospital admissions and GP calls,” ms rennick says.

“We hope this service will be extended to other residential aged care facilities in the region.”

Westvic After Hours Health Advice line can be contacted on 1800 641 395.

“This will reduce the after hours burden on nursing staff and carers at Eventide and potentially prevent inappropriate after hours hospital admissions and GP calls.”

Advice line cuts after hours calls to GPs

West VicGP Division

Senior Triage nurse Clare maher provides after hours advice.


Portland District Health and Winda-Mara Aboriginal Corporation have launched Deadly Teeth, a campaign promoting oral health in local Koorie communities.

Three colourful, culturally appropriate tip cards have been reproduced from acrylic paintings by indigenous artist Dan Joseph featuring an indigenous ‘wellbeing fella’ collecting bush foods, drinking stream water and brushing his teeth.

The artwork was inspired by children, families, elders and indigenous health workers who attended art workshops at Winda-mara – a health and cultural service for the Gunditjmara people living in the Heywood and Hamilton district.

“The links between the Gunditjmara people and their land, community and spirit are fundamental to their health,” Winda-mara CEO michael Bell says.

“Paying recognition and consideration to these connections is vital to all local health promotion initiatives. The Deadly Teeth health promotion initiative aims to generate messages that are stimulating, enjoyable and effective.”

The cards were launched during nAiDOC week and distributed to five western Victorian health services plus Dental Health Services Victoria. They have since been distributed to health services elsewhere in Victoria, new South Wales, Western Australia and the northern Territory.

indigenous Australian children have dental decay rates two to five times higher than non-indigenous children. Three years ago, Winda-mara worked with Portland District Health and Dental Health Services Victoria to pilot the Smiles4miles program at three indigenous playgroups.

Program workers realised there were no culturally appropriate oral health promotion

tools for indigenous communities, prompting the Deadly Teeth campaign.

“Dental decay is largely preventable but often goes untreated, resulting in it being the highest preventable hospital admission among children in Victoria,” mr Bell says.

“inadequate access to culturally appropriate oral health information and services limits the ability of families to care for their children’s overall health needs.

“The earlier the health messages can be introduced the more likely the success. Good oral health habits can never be started too early.”

Deadly Teeth was a collaborative project between the Health Promotion Team at Portland District Health, Dental Health Services Victoria, staff and community members at Winda-mara Aboriginal Corporation, indigenous artist Dan Joseph and graphic designer Damon Yuill.

Winda-mara Aboriginal Corporation CEO michael

Bell and Health Practice manager Janice Huggers.

Central Gippsland Health Service has employed three young Aboriginal people in a training program aimed at creating pathways for Aboriginal health workers and improving Aboriginal health outcomes.Kayla Kennedy Hill, rhiannon munro and Kimberley Pepper are completing the 18-month program, which combines practical work with online study to achieve a Certificate iV in Allied Health Assistance.

They will also do rotations in physiotherapy, occupational therapy, speech therapy, social health, dietetics and podiatry at Central Gippsland Health Service.

The program started this year and all members of the first intake group are now employed in ongoing positions at the health service. Their success prompted the initiation of an all-Aboriginal intake group during nAiDOC Week in July.

Chief Executive Officer Dr Frank Evans says the allied health traineeships are part of a long-term workforce strategy at East Gippsland.

“Data shows that local people trained in their home area are more likely to remain in the local workforce,” Dr Evans, an accredited coordinator with the Australian institute of Flexible Learning, says.

“The health service is working towards a self-sufficient allied health workforce supply within seven years.”

The health service matched a $75,000 grant from the Department of Health’s Closing the Health Gap in Victoria program to run the Aboriginal allied health traineeships program.

Portland District Health

Aboriginal dentalhealth campaign


Home based care (HBC) staff at Orbost Regional Health are enjoying an expanded scope of practice that allows them to liaise with allied health staff, report consumer risks and activate care reviews.

Care plans are prepared by allied health staff and kept in the consumer’s home to be regularly updated by HBC staff.

Director Community Services Peter Quin says this helps consumers to comply with their home-based falls management plans.

He says HBC staff have also gained a better understanding of allied health workers, their assessments and their expectations of home care.

“This is the first time we have developed a formal relationship between allied health and home-based care staff.”

The trial was run with HACC funding and enabled HBC staff to:

• motivateconsumerstodiscusstheirfallsrisk and undertake a risk management strategy

• supportconsumerstocomplywithahome-based falls management plan prescribed by the physiotherapist

• monitorandreporttoanagreedhealthprofessional on consumer progress in achieving the goals in their care plan

“Being a small multi-purpose service we are fortunate to have GPs, district nurses, allied health and HBC staff under one roof, which helps greatly with the provision of integrated home care,” mr Quin says.

“We knew HBC staff often had the best rapport with our HACC clients. informally, our GPs and allied health staff knew that our district nurse and HBC worker could obtain a commitment from our HACC clients, who are often stridently independent, to undertake the necessary assessments and recommended home-based strategies.”

Department of Health funding for communication with GPs under the Plan, Do, Study, Act program meant local GPs were already focused on the care planning process.

“This meant our allied health and district nursing staff already had a good system of

communication for contributing to GP care plans for HACC consumers.”

Evaluation of the trial will ask:

•Wasithelpfulfortheconsumer?

• Didtheconsumerthinkitenabledthemto adapt to strategies more readily?

•Wastheconsumercomfortabletalkingto the personal care attendant about progress and barriers?

• DidthePCAthinktheleveloftheirinputwas beneficial to the consumer?

• DidtheGPandalliedhealthstafffindhigher levels of compliance with their home-based falls management plan?

“These questions about impact are still being answered but we already know our HBC staff can now activate timely reviews,” mr Quin says.

“Allied health staff have found that involving HBC staff helps their rehabilitation aims and changes behaviour in HACC clients. Our HBC workers feel they’ve been given permission to do what they always wanted to anyway.”

Integrated homecare programCongratulations Orbost Regional Health 2011 Rural Health Service of the year

Orbost Regional

Health

The Orbost regional Health team. Personal carer Leanne Scott with Frank Shanahan.


Nurse, alfresco bruncher and member since 1988.

healthsuper.com.au 1800 331 719Health Super is a division of the First State Superannuation Scheme ABN 53 226 460 365 of which FSS Trustee Corporation ABN 11 118 202 672 AFSL 293340 is the Trustee.

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hes5132_200x133_Rosie.indd 1 22/08/11 11:52 AM

The Australian Centre for Healthcare Governance (ACHG) aims to support further development of the governance and quality of health services delivered to Australians through the public sector.

This ACHG conference will explore contemporary themes in facilitating strong, integrated governance systems in health services: primary health and community services in the context of current health reform; issues of board structure and evaluation; leadership; clinical governance; research; multiple accreditation standards; strategy; tools; and processes to support effective governance will be addressed.

For Health and Community Services

24–25 MAY

2012HILTON ON THE PARK

MELBOURNE

REGISTER ONLINE NOW AT

WWW.HEALTHCAREGOVERNANCE.ORG.AU

AUSTRALIAN GOVERNANCEAND QUALITY CONFERNCE

The Victorian Public Healthcare Awards recognise innovative and effective healthcare leadership across the state.

The VHA congratulates winners and those who were highly commended in the 7th annual awards, presented by the Victorian Government on November 16.

This year, VHA member agencies won every category in the Victorian Premier’s Health Service of the Year Awards:

Winner Doutta Galla Community Health Service

Highly commended Knox Community Health Service

Highly commended Western District Health Service

Winner Orbost Regional Health

Highly commended Alexandra District Hospital

Highly commended Hesse Rural Health Service

Winner Barwon Health

Highly commended Bairnsdale Regional Health Service

Highly commended Latrobe Regional Hospital

Winner Alfred Health

Highly commended Austin Health

Highly commended St Vincent’s

ViCToRiAN PuBLiC HeALTHCARe AWARDS

PRimARy HeAltH SeRviCe Of tHe yeAR

RuRAl HeAltH SeRviCe Of tHe yeAR

ReGiOnAl HeAltH SeRviCe Of tHe yeAR

metROPOlitAn HeAltH SeRviCe Of tHe yeAR

THE VHA 2012 RuRAL HEALTH CONFERENCE will be held on 15 & 16 March at the Novotel Forest Resort, Creswick. Policy experts will present on building the capacity of rural communities to improve health outcomes. Registration includes accommodation and all meals. For details visit www.vha.org.au

Documents

Health Matters December 2011