Health Matters December 2012

The Victorian Healthcare Association Issue 3 [December 2012] www.vha.org.au 1

HEALTH MATTERSVictorian Healthcare AssociationISSuE 3 [ DEcEMbER 2012 ] www.vha.org.au

Slow start to eHealth records

new population health websitepalliative care: the case for reforma message from the state health secretary

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 Manager

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 Looking back while we move forward

4 CHIEF EXECUTIVE’S MESSAGE Opportunities for mutual learning with China

5 eHEALTH Electronic health records: uptake is far below target

6 POPULATION HEALTH PLANNING VHA launches population health planning website

7 DEPARTMENT OF HEALTH Victoria must innovate and embrace change

8 HEALTHCARE CONSUMER MOVEMENT Consumer participation in healthcare reform

9 PALLIATIVE CARE REFORM Palliative care needs national leadership

10 VHA AwARD wINNER Diabetes patients prefer community health setting

11 VHA AwARD FINALISTS Northern Health cuts diabetes waiting list

12 VHA AwARD FINALISTS Teaching patients to quit smoking before surgery

13 Allied health increased without extra funding

14 2012 VICTORIAN PUbLIC HEALTH AwARDS

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

6 VHA launches population health planning website

12 Teaching patients to quit smoking before surgery


Looking back whilewe move forward

Chairman’s Message

This year, the VHA turned 74 and I am struck by the changes that have occurred during those years.

Back in 1938, we were called the Victorian Hospitals Association. In a recent spring clean of the VHA office, several documents from those early years were uncovered, including annual reports all the way back to our first year of operation in 1938-1939.

In those days, the VHA was primarily a buying agency for Victoria’s public hospitals. In 1946, items purchased on behalf of members included 2526 yards of mosquito netting, 2724 egg cups, 162-and-a-half books of blotting paper, 344 gallons of olive oil, 439 tins of lemon butter, 106 flagons of ether soap, and 24 bottles of opium tincture!

By 1980, the emphasis had shifted and the chairman of the day reported a need for the VHA to strengthen its role as spokesman for public hospitals particularly “when political and public interest in health care and its cost effectiveness is increasing”.

More than 30 years later, our name and purpose have changed, and our membership has been transformed to encompass the full range of public health providers in Victoria.

In fact, at this year’s AGM, members voted unanimously to extend our membership eligibility to encompass any public or not-for-profit health provider, including Medicare Locals and private not-for-profit hospitals. This change further reinforces the VHA’s role as the pre-eminent voice of public healthcare in Victoria, and enhances our ability to influence the health system and public policy.

As part of that mission, the VHA advocates the importance of effective strategy to our members. In the interests of practising what we preach, the Board recently held its annual strategic planning day. The day was a valuable opportunity for the Board to examine the status of the company, revisit our vision and mission, and set some clear strategic goals for the next three years. Our task now is to translate these discussions into a strategic plan, which will guide the direction and activities of the VHA until 2016.

My sense of optimism for our future seems to reflect the feelings of my earliest predecessor as chairman, Leslie Jenner, who noted in 1940 that “a splendid feeling has been developed during the year, and we trust that this will continue and develop”.

On behalf of the Board, and everybody at the VHA, I wish you all a merry Christmas and a very happy New Year.

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…our membership has been transformed to encompass the full range of public health providers in Victoria.

Historic annual reports were uncovered during a recent spring clean.

4 The Victorian Healthcare Association Issue 3 [December 2012] www.vha.org.au

Opportunities for mutual learning with china

Chief Executive’s

Message

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I recently had the good fortune of participating in the Victorian Premier’s Super Trade Mission to China. My participation was aimed at better understanding China’s health and aged care systems, and looking at how Victoria can engage with our Chinese counterparts for mutual benefit.It was the largest ever trade mission from Australia, and with good reason – China is one of the world’s largest and fastest-growing economies, and Victoria’s most significant trading partner.

from the moment you set foot in China, it is clear that this country is going places. Beijing International Airport is the world’s second busiest, serving over 77 million passengers each year. Melbourne Airport sees just 28 million.

Our 1000-kilometre journey from Beijing to Nanjing took just three-and-a-half hours by high-speed rail, compared to the 11-hour train trip from Melbourne to Sydney. We also visited Shanghai – one of the world’s largest cities, with a population the size of Australia’s and almost 40 per cent population growth since 2000.

Healthcare in China has been advancing rapidly too. Just 60 years ago, western medicine was almost unknown across large swathes of the country. Traditional medicine dominated, and healthcare was centrally managed with a focus on combatting diseases like cholera and typhoid.

In 2012, China is confronted by many of the same healthcare challenges we face here in Victoria: rapid ageing of the population, increasing rates of chronic disease, and spiralling demand for health services.

The Chinese government’s willingness to pilot new models of care, such as out-of-hospital care, will see it rapidly developing new approaches from which we can learn. The sheer scale of China’s population will offer research opportunities in areas like aged care, with almost 200 million Chinese people aged over 60. Wound care and dementia care are two fields that may offer mutual learning opportunities, particularly if common outcome indicators can be agreed and measured.

The 12th five-year plan of the People’s republic embraces aged care as an industry of value. Taking a positive approach to an ageing population is an important cultural lesson for Victoria. Our healthcare leaders should strive to achieve a similar culture of celebration around caring for our older community.

China’s approach to developing a sustainable healthcare workforce will also be of interest. With a rapidly

diminishing worker-to-elder population ratio, China has an acute need for workforce innovation. We should observe their adaptations to overcoming workforce shortages with interest.

I believe China’s workforce dilemma presents an opportunity for Australians to assist with curriculum development and management. In particular, our healthcare education providers could establish partnerships for the provision of vocationally-targeted certificate III and IV equivalent training.

As the Chinese economy continues to develop, there will also be opportunities for management advisory services to be provided by Australian healthcare leaders, who are used to working with a more consumer-oriented healthcare system.

The VHA is exploring partnership opportunities with academic facilities to engage in a productive exchange of ideas with our Chinese counterparts. In the New Year, we will gauge our members’ interest in hosting delegations from China.

Please accept my very best wishes for a joyful Christmas and a safe and happy New Year. I look forward to working with you in 2013.

China gave a warm welcome to the VHA, on one occasion declaring it a Victorian Healthcare Association delegation rather than a Victorian Government delegation.


technologically savvy to sign up sooner rather than later. Social media platforms like facebook and Twitter heavily relied on these groups as innovators and early adopters to reach ‘the tipping point’ –when mass culture adopts a trend. Social network theory suggests that greater and quicker wins, in terms of building critical mass, can be gained by targeting groups that are more receptive to change, mobile, and willing to adopt innovation.4

users should be able to perceive a relative advantage to take up an innovation. One reason for the low adoption rate of the uK’s HealthSpace personal electronic health records system was that it was seen as a static repository of health data, rather than a dynamic network that could impact on models of care.5

Australia can take advantage of this learning by emphasising the role of its PCeHr project in improving communication and information sharing between health workers, achieving an integrated model of care, and putting patients at the centre of the health system, in addition to its primary purpose as a health record-keeping system.

References

1 itNews PCeHr targets depend on new medical software, accessed from: http://www.itnews.com.au/News/319599,pcehr-targets-depend-on-new-medical-software.aspx

2 Sydney Morning Herald Slower than predicted start for personal e-health records, accessed from: http://www.smh.com.au/it-pro/government-it/slower-than-predicted-start-for-personal-ehealth-records-20120709-21qw4.html

3 Ayers D, Menachemi N, ramamonjiarivelo Z, Matthews M & Brooks r (2009) Adoption of electronic medical records: the role of network effects, Journal of Product & Brand Management 18(2): 127-135.

4 Suarez f (2005) Network effects revisited: the role of strong ties in technology selection, Academy of Management Journal 48(4): 710-720.

5 Greenhalgh T, Hinder S, Stramer K, Bratan T & russell J (2010) Adoption, non-adoption, and abandonment of a personal health record: case study of HealthSpace British Medical Journal 341: 1-11.

As of October 2012, approximately 13,300 Australians had registered for their Personally Controlled Electronic Health Record (PCEHR)1 – far short of the 500,000 target for registrations by July 2013.

The Department of Health and Ageing maintains that it planned a deliberately slow start to PCeHr and that the slow uptake is a “good thing”2 because fewer consumers will be affected by initial teething problems. Critics say this is just an excuse to buffer the backlash PCeHr has been getting.

The slow uptake does not come as a surprise. Opt-in electronic health record systems don’t have a successful track record because they lack the critical mass of opt-out systems. A system like the PCeHr is subjected to network effects, where “the benefits derived from the adoption of a technology increases as the number of adopters increase”.3

GETTInG PEOPlE TO SIGn uP

Given that Australia has committed to an opt-in PCeHr system, the challenge now is to get people to sign up. The potential benefits of a seamlessly integrated electronic health record system have been widely reported, but as the numbers show, it seems that most Australians aren’t convinced.

THE uSER ExPERIEnCE

Is there anything that the PCeHr project can learn from social networks and online communities to improve the current adoption rate? Successful social networks are all about optimal user experience, and the current PCeHr framework has a lot to learn about usability.

The challenge remains to make PCeHr simple to understand and easy to use. from having to remember random alphanumeric combinations as your electronic user ID, to being directed to different websites and back, the current user experience in registering, accessing, and navigating through the electronic health records system leaves a lot to be desired.

TARGETInG THE RIGHT GROuPS

Although the potential benefits of an effective electronic health record are greatest in the most vulnerable populations, such as the elderly and low socioeconomic groups, they are also often the last people to adopt an innovation due to lack of knowledge, conformity to tradition, and aversion to change.

Successful social networks are all about optimal user experience, and the current PCEHR framework has a lot to learn about usability.

With the funding made available to Medicare Locals and general practitioners, it seems that the federal Government is employing a targeted approach to promote PCeHr in the primary health sector. This aligns with the notion that by choosing to target groups in the health system with direct relationship with the users, better adoption to the technology can be facilitated.

However, this strategy can be extended further by aiming to get the young and

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eHealth Electronic health records:uptake is far below target


Despite significant medical advances and increasing healthcare expenditure, rates of ill-health continue to rise.

Diabetes expenditure is expected to increase more than 400% during the period 2003-2033, followed by dementia at 364%.1 Some groups and communities are over-represented in these statistics, and consistently experience poorer health than others.

A new approach is needed to improve the overall health of populations and to address

the inequalities between sub-populations. This approach should be based on identifying and addressing the social determinants of health – the conditions that contribute to illness and health inequities.

A population health approach to planning is endorsed by many leading health experts, and provides an evidence-based option for achieving this. It takes into account the environmental, economic, political, social, cultural and behavioural factors that contribute to health and wellbeing.

The Victorian Healthcare Association (VHA) has launched a website featuring a framework for population health planning and a toolbox of resources to promote a common understanding of this approach. The toolbox provides an overview of the basic planning processes involved, through six planning steps and six guiding principles represented in the framework below.

The VHA framework differs from other population health planning frameworks, in that it includes downstream actions (the provision of individual health services). It emphasises the importance of formal leadership structures, and the broad range of capacity-building activities required to

facilitate effective cross-sectoral planning.

Population health planning aims to address the social determinants of health at a population level, often outside the health sector. While the World Health Organization recommends action by national governments, there are also opportunities for communities to act on the social determinants of health at a local level.

Health services have a vital role to play in advocating and partnering for cross-sectoral actions. This approach is consistent with Victoria’s Municipal Public Health Planning framework, ‘environments for Health’. Alongside this stewardship role, health services must also provide equitable access to high-quality health and preventive services.

The VHA has long advocated for population health planning to improve health system design and to work towards better population health outcomes.

References1 Goss J 2008. Projection of Australian health care expenditure by disease, 2003 to 2033. Cat. no. HWe 43. Canberra: AIHW

The VHA population health planning resources are available at www.populationhealth.org.au

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VHA DEfInITIOnThe VHA commissioned Monash university’s Department of Health Social Science to develop a working definition of population health planning, which can be used for area, regional and subregional planning, or by individual agencies:

Population health planning is integrated and collaborative cross-sectoral planning that aims to improve the health and wellbeing of whole populations, reduce inequities among and between specific population groups, and address the needs of the most disadvantaged. effective population health planning requires community, inter-sectoral and whole-of-government engagement, collaboration and action to address the broad range of determinants that shape health and wellbeing.

VHA fRAMEwORk

VHA launches populationhealth planning website

PopulationHealth

Planning


Since my appointment as Secretary, Department of Health in July 2012, I have been fortunate enough to meet a lot of people and develop a picture of the tremendous work undertaken by Victorian health services. The tireless work of staff is supported by facts: in the past couple of years 137,000 more people arrived and were treated in emergency departments, and 120,000 more people were admitted to a hospital bed for treatment. The scale of the challenges facing us, and the collaborative work that needs to be done to meet those challenges, has also become clearer.

Significant demographic, financial, and cultural pressures face our health system. Victoria’s population will grow by over a million by 2023, and the number of people aged over 65 is expected to increase by nearly 50 per cent. This dramatic growth is forecast to bring an increasing prevalence of chronic disease, which is best addressed by managed, multidisciplinary approaches to prevention and coordinated care along evidence-based pathways.

The current economic environment compounds the need for innovation. Victoria recently received billions of dollars less in GST revenue than was anticipated, and slower national economic growth is constraining revenue flows in the state budget. Despite these significant pressures, in 2012 the State Government has injected new operating and capital funding into Victoria’s $13.7 billion health budget.

Victoria must innovateand embrace change

Departmentof Health

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responsibilities between various service providers who share in caring for patients. Consumer Advisory Committees and the introduction of Open Access Board meetings are tremendous steps which will further build the relationships between health services and local communities.

finally, DATA is king in dynamic systems. Analysis of data and its conversion into information products is critical to understanding the health of the system, its past and current performances, and most importantly, in setting the future direction of the system. Comparative benchmarking helps us define the future by understanding the past and what is best practice. The Department of health will develop its approach to informatics and system data, and drive the better use of information in decision-making.

Work in these areas will help us build on innovation already underway. Telehealth is being used, not as a cheaper option to plug a service hole, but as an opportunity to expand services and meet community health care needs. Joint appointments are overcoming workforce shortages, and new models of care are being tested across primary and acute settings. We need also to consider the development of health precincts and planning tools to deliver more efficient and effective care to Victorians.

recognising the imperative to innovate, the government recently established the Health Innovation and reform Council under the stewardship of the Hon rob Knowles. Its brief is essentially to kickstart reform and the debate about reform in the system. The government is also establishing a Commission for Hospital Improvement, which will focus on implementing key improvement initiatives.

Those of us within the Victorian health system are faced with a choice about our future. We can sit back and let the inevitability of change wash over us as passive players in the system, or we can take change in hand and try to nudge the system onto a new growth path. either way, to innovate or fall behind – that is the real choice we face. Only together can we meet the challenges before us.

If we are to improve healthcare outcomes and control costs further, we must look for new ways of doing things. We must innovate and embrace change, as articulated in the Victorian Health Priorities framework. The next step is the conception of the health sector as a ‘system’ – more than an aggregation of individual services.

This represents a profound shift in conceptualisation, and requires more thinking about the key characteristics of dynamic systems. I’d like to highlight four key elements of dynamic systems.

We need to debate the PuRPOSE of our health system. I would like to start that debate by positing wellness/wellbeing – the objective of reducing the risk of illness – alongside safety and quality as the system’s overriding focus. This approach allows us to best consider the roles and interface between prevention, treatment in various settings, and models of care, while continuing to emphasise the primacy of safety and quality in the wellness focus of our system.

It is critical to ensure that we understand well the PARAMETERS of the system, and the roles each of us play within it. for example, the role of planning should allow individual health services to better articulate their tasks and enable them to truly ‘think global, act local’, while highlighting more clearly the importance of networks and settings of care in maximising scarce resources. Leadership by boards, including how they collaborate with each other and private providers to share resources and learn from each other, has the potential to transform our health system by encouraging new models of care and driving clinical and service excellence in the system.

The development and maintenance of fEEDbACk lOOPS is another important characteristic of complex systems such as health, as it is the mechanism by which the system learns and evolves. Bolstering clinical engagement will ensure system design and redesign is driven by the practical clinical experience of those who deliver services. Patient experience (real time) also has the potential to shine a light on performance in a way that builds joint


consumer participationin healthcare reform

HealthcareConsumerMovement

Australia has had an organised healthcare consumer movement since the 1970s. My definition of consumers is broader than just people who use healthcare services: it includes consumers as citizens, who have a responsibility to keep governments and nGOs accountable for the provision of services and maintaining wellbeing within the population as a whole.

The Consumers Health forum (CHf) of Australia, established in Canberra in the 1980s, focuses on national issues, overarching health policies, and gaps, inequities or anomalies in service provision between the jurisdictions. However, one criticism of CHf has been that it shapes its priorities to those of the Commonwealth Government, which provides its funding.

Some of the CHf’s member organisations are true consumer groups with a regional or state base, which tend to be funded directly by governments. The best established of these are the Health Consumers’ Council of WA, the Health Consumer Alliance of SA and the Health Care Consumers Association (ACT). Health Consumers Queensland – resourced by the Queensland Government and subject to recent cutbacks – has partnered with the Council of the Aged in that state. Health Consumers NSW has a small secretariat funded by the state government. Neither Tasmania nor the Northern Territory has a health consumer peak body, although the role is partly filled by consumer advisory groups to Medicare Locals.

The one standout in all this is Victoria. While there are well-established consumer advisory processes for most of the state’s acute and community health services, and for Medicare Locals, there isn’t a health consumer peak body. The gap is covered to some extent by the Health Issues Centre and the Chronic Illness Alliance. In recent times, an Australian Patients Association has emerged in Victoria with support from the legal sector, but it mainly advocates for individual entitlements to redress harm from the healthcare system.

There is great potential for consumer health groups to progressively merge with public healthcare organisations. This would address the burden of chronic disease by bringing together a broad coalition of civil society players, including many from outside the health sector who are more influential in the social determinants of health. for example, there are synergies between the Public Health Association of Australia and some elements of the consumer movement. They share a mutual interest in primary healthcare reform to manage chronic conditions in a more cost-effective way and to avoid unnecessary admissions to the acute care sector. One approach being tried in the ACT is the formation of a Canberra Health Alliance, using the well-established Oxford Health Alliance model.

At an international level, several bodies are seeking to improve the effectiveness of consumer participation in health reform, including:

• the People’s Health Movement, which held its third international Peoples Health Assembly in Cape Town this year

• the International Alliance of Patients Organizations, which operates within the confines of the World Health Organization

• Health Technology Assessment International, which involves consumers, academics and others in health technology assessment

Australian consumers can learn from these movements, while those who deliver our health programs can contribute extensive knowledge and experience. Australian aid projects in the Asia Pacific region also present an opportunity to foster new healthcare consumer movements overseas.

We can develop more awareness of these issues through conversations between clinicians, consumers and those who fund health services, especially in the primary care sector. Disappointingly, this did not occur during the recent Australian health reform process, unlike in Canada where reform was driven by the romanov Commission. However, the reforms enacted here may have provided a mechanism to start this conversation – Medicare Locals. They could be the change agents for redesigning our health system to one driven by primary healthcare. Considerable evidence suggests that such a system would produce better population health outcomes in the future.

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Season’s GreetingsThank you for your continued support throughout 2012. 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.


Palliative care needsnational leadership

PalliativeCare Reform

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Over the next 40 years, the number of people aged 85 years and over is expected to increase four-fold.1 At the same time, disease patterns are changing.It is estimated that more than 80 per cent of people will die after a chronic illness, not a sudden event.2 The demand for palliative care in Victoria is growing at 4.6 per cent each year3, yet there are many barriers to our health system providing high quality, seamless palliative care.

Palliative care must be appropriate to people’s needs – delivered at the right time and in the place of their choice. It should be available to all who require it, irrespective of their location, income, age or cultural background.

International research has found that although up to 90 per cent of people with a life-threatening illness prefer to die at home or in a home-like environment, only 26.5 per cent of people actually do die at home, while 56 per cent die in hospital.4 According to the Department of Health, this figure is consistent with the proportion of Victorians who die in hospital.5

In Victoria, palliative care is not adequately resourced. While there is increasing demand for palliative care in residential aged care (rAC) facilities, it is still funded within ‘general care’. for one VHA member, this creates a huge discrepancy between the cost of an acute palliative care bed (approximately $1300 per day) and the subsidy payment for palliative care in rAC (approximately $163 per day).

Length of stay in rAC is typically short. Almost a quarter of residents die within seven months and half die within 14 months6, so their predominant need is for care, not accommodation. However, current funding inequities mean that older people entering rAC for end-of-life care pay a daily accommodation charge, as opposed to receiving free accommodation in a hospital or palliative care unit.

funding reform is only one way of improving access and availability of choice for palliative care. Cultural change, training and education are also vital to remove the stigma of palliative care being equivalent to ‘terminal’ care. A lack of understanding among communities and health professionals about the benefits of delivering palliative care simultaneously with disease-focused treatment restricts early referral options. early referral leads to better care management and coordination, and has been shown to significantly improve a patient’s quality of life and mood and to improve their survival time.7

The provision of palliative care nationally is not as effective as it should be. Commonwealth Government funding arrangements favour hospital bed-based services, as opposed to palliative care being provided ‘in place’.

from 1 July 2013, hospital-based palliative care services will be funded on an activity basis, and the VHA is concerned that this will limit their ability to meet patient needs. By comparison, home and community-based programs deliver specialised patient-centred medical care, and care coordination, enabled by block-funded grants.

The recent Senate inquiry into palliative care is a timely reminder that national leadership is required to drive reform at a system, provider, and patient level. Many of the inquiry’s final recommendations align with the concerns of the VHA, and we look forward to working with both levels of government to improve palliative care services for the future.

SEnATE RECOMMEnDATIOnS• The Australian Commission on

Safety and Quality in Healthcare considers implementing a national standard linked to accreditation.

• The Australian government considers creating a new funding category for palliative care.

• The costs of providing palliative care in the community sector are factored into overall costing.

• The Independent Hospital Pricing Authority establishes a committee to advise on appropriate costing for services, with an activity-based funding approach.

• Consistent national data collection be introduced specifically for palliative care.

• The government, and the Council of Australian Governments, improve the information provided to palliative care patients, carers and families.

• All governments work together to fund minimum levels of bereavement service provision for all families and carers of people with a terminal illness.

References

1 Productivity Commission (2008) Trends in Aged Care Services: Some implications. Commission research Paper: Canberra.2 Lee M, Heland M, romios P, Naksook C & Silvester W (2003) respecting Patient Choices: Advance Care Planning to Improve Patient Care at Austin Health. Health Issues no 77 pp23-26.3 Victorian Department of Health (2010) Demand modelling – internal report.4 Higginson IJ & Sen-Gupta GJA (2000) Place of care in advanced cancer: a qualitative systematic literature review of patient preferences Journal of Palliative Medicine vol 3 pp287–300.5 Victorian Department of Health (2011) Strengthening palliative care: policy and strategic directions 2011-2015.6 Karmel r, Lloyd J & Anderson P (2008) Movement from hospital to residential aged care. Australian Institute of Health and Welfare: Canberra.7 Temel JS, Greer JA, Muzikansky A, Gallagher er, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl Wf, Billings JA & Lynch, TJ (2010) early palliative care for patients with metastatic non-small-cell lung cancer New England Journal of Medicine vol 363 no 8 pp733–742.


Diabetes patients prefercommunity health setting

VHAAward

Winner

The Integrated Diabetes Education and Assessment Service (IDEAS) run by whitehorse Community Health Service (wCHS) and Eastern Health has won the 2012 Victorian Healthcare Association Award.

This year there were 34 nominations from all over Victoria, with the five finalists invited to present their projects at the VHA’s annual conference Beyond Survival: Redesigning Healthcare for a Sustainable Future.

This year’s award recognised healthcare agencies that have developed a sustainable approach to changing their models of care over the past two years to reflect the needs of their community.

IDeAS combines eastern Health’s acute specialist endocrinology expertise with integrated chronic disease management in a community health setting.

Diabetes patients who would benefit from team-based care are redirected from the eastern Health endocrinology Department to a community health service. The program was piloted at WCHS in 2009, and in 2011

was replicated at community health centres in Knox and Yarra. IDeAS runs half-a-day per week at each location, with the three services holding sessions on different days to increase client access.

Consumer feedback has shown that 92 per cent of clients prefer IDeAS to a hospital outpatient clinic. WCHS plans to expand its sessions next year, while discussions are underway for a fourth community health location and a service for women with gestational diabetes.

Joint IDeAS Managers Janine Scott and Professor Chris Gilfillan praised their teams’ high level of collaboration: “It was a complex and difficult task to gather so many stakeholders together to achieve a productive result for the local community.

“The next step for IDeAS is to conduct further research into the effectiveness of the service model in supporting people to better self-manage their diabetes.”

Strategic Projects Manager Carina Martin said she hoped the award would help IDeAS to gain funding to extend the service to other areas.

VHA Chief executive Trevor Carr congratulated the winners for providing “joined-up” healthcare within existing resource constraints. He said IDeAS recognised current and future financial pressures, and the benefits of working in partnership.

“In the face of state and national health reform, increasing financial pressures, the mounting impact of climate and demographic change, the health system and health agencies must be prepared to manage change,” Mr Carr said.

“Sustainable approaches to care necessitate a rethinking of service delivery, redesigning healthcare services around the long-term needs of the population.”

frank Tracey, CeO of award sponsor Hardy Group International, said “the vital role of leadership and of developing robust networks in such approaches cannot be understated.”

Mr Tracey presented the winner’s award and congratulated the other 2012 finalists – Peninsula Health, Northern Health, Gippsland Lakes Community Health, and east Wimmera Health Service.

from left: VHA Chairman Anthony Graham, Hardy Group International Principal Kevin Hardy, eastern Health’s Prof Chris Gilfillan, Janine Scott and Carina Martin from Whitehorse Community Health Service, HGI Chief executive Officer frank Tracey and VHA Chief executive Trevor Carr.


IDEAS CASE STuDy

‘bob’ is 54 and has schizophrenia and diabetes. when diagnosed, he had poor blood glucose control and an HbA1c of 14.5 per cent.

His GP referred him to IDeAS, via the eastern Health endocrinology outpatients unit. Initial assessment by WCHS identified the possibilities of type 1 diabetes or late onset autoimmune diabetes, which was supported by his family history.

Blood tests clarified the diagnosis and Bob commenced insulin. Bob had several consultations and regular phone reviews with a diabetes educator to adjust his insulin dose, improve his self-management and prevent hypoglycaemia.

After two months, Bob’s Hba1 was 7.5 per cent. He now confidently self-monitors his blood glucose levels and administers insulin.

A dietician provided healthy eating education, so that Bob now understands the effect of food on his blood glucose levels. He also receives meals on wheels to balance his diet.

Northern Health cutsdiabetes waiting list

VHAAward

Finalists

northern Health has achieved a 93 per cent reduction in its waiting list for outpatient diabetes services by redesigning its intake processes.The six-month project, Building Capacity from Within, was a finalist in the 2012 VHA Awards. Its objectives were to:

• test the effectiveness of a central access team in decreasing waiting times for clients

• increase client engagement with the service and reduce ‘did not attend’ rates

• improve consumers’ understanding of the service and ensure their experience was positive.

At the start of the project, there were 327 outpatients on the waiting list for Northern Health diabetes services. Some were waiting up to 347 days for care, with a median waiting time of 72 days.

At the end of the project, there were 22 patients on the waiting list and a median waiting time of just four days.

There was also a 13 per cent drop in the ‘did not attend’ rate for new patients, and the number of vacant appointments in clinicians’ schedules dropped by a third.

Previously, all diabetes patients were wait-listed to see an endocrinologist first, causing lengthy delays. At the end of the project, 42 per cent of patients needing

referral were cared for by other suitability qualified health professionals.

Building Capacity from Within used a Lean Six Sigma methodology to identify silos in service capacity, where some areas were being over-utilised and others under-utilised. This allowed Northern Health to identify vacant appointments and reduce waste in the system.

The introduction of a Biogrid database provided patients and GPs with real time care – another important change to the outpatient model. The total cost of staffing the project was $17,000.

“The health care sector is consistently being asked to do more within current resources while improving the client’s quality of care. I believe this project highlights this is an achievable goal,” said Director – Ambulatory Care Access, Cherie Hunter.

“for a relatively modest investment, we have achieved significant changes to waiting times, improved targeting of clinical care, increased effectiveness of resource use and positive consumer feedback.”

The Northern Health intake model has been presented to the Hume Whittlesea Primary Care Partnership. Its ‘Improving Coordination of Diabetes Care’ working group is adapting the model to standardise the referral and triage processes for the region’s ambulatory, acute, and community health sectors.

East Wimmera central intake systemPreviously, access was largely based on a ‘first come, first served’ approach.

The new intake system requires acute care, aged care, and community health services to work collaboratively for the benefit of consumers. It has been introduced using existing staff resources.

Consumers are evaluating the new intake system, and data collected will assist long-term planning and the future development of services.

‘Cultivating healthy communities’ is the new slogan for East wimmera Health Service, reflecting a change in focus from reactive, acute care to wellness and empowering the community. eWHS has introduced a central intake system for consumers needing to access community health services. The project was a finalist in the 2012 VHA Awards.

It involves each consumer being contacted by a community health nurse for initial

needs identification (INI) and referral to an appropriate community health service.

from 7 November 2011 to 7 february this year, 203 consumers made initial contact with eWHS community health services. Of these, 172 received same day INI, while 31 were unable to be contacted and took an average of 1.8 days to complete INI.

The community health nurse has become a central access point, empowering consumers to take control of their health and navigate the healthcare system.


Smoking kills 20,000 people in Australia and new Zealand each year – more deaths than if the Titanic sank in the Tasman Sea every month.This startling statistic was presented by Dr Ashley Webb from Peninsula Health’s Department of Anaesthesia to delegates at the VHA’s annual conference.

Dr Webb has developed Peninsula Health’s Stop Before the Op program, which helps patients to quit smoking before elective surgery. The program was a finalist in the 2012 VHA Awards.

“Innovative approaches are required to ensure that smokers having elective surgery are systematically informed of the risks of smoking and surgery, and are given support to stop,” Dr Webb explained.

“Stop Before the Op is a cost-effective, sustainable model that engages surgeons, anaesthetists and other perioperative clinicians through clinician education and training.”

In his 2012 study, Smoking cessation strategies at public hospital pre-admission clinics in Victoria, NSW and the ACT, Dr Webb surveyed 29 Victorian public hospitals and found that none had a systems approach to smoking cessation.

Another recent survey of 177 smokers on the elective surgical waiting list at Peninsula Health found that most were not opposed to perioperative quit support, but few had actually received it.

Teaching patients to quitsmoking before surgery

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Physicians’ advice to quit was uncommon but when given, it doubled a patient’s chance of quitting while on the waiting list.

“Knowledge of smoking risks as they relate to surgery was low, with only one-third of participants knowing of the increased risks of wound infection, slower healing, anaesthetic complications or postoperative pain,” Dr Webb said.

“Despite this, many patients attempted to quit while waiting for surgery, usually without any additional support, and most relapsed or achieved only brief abstinence prior to surgery.”

Since 1944, more than 300 studies have shown smoking significantly increases a patient’s risk of surgical complications.1 Despite this, Victorian surgeons are not routinely advising quitting before an operation.2,3

even temporary abstinence from smoking improves surgical outcomes4. Surgery offers a ‘teachable moment’ for behaviour change that may enable patients to stop smoking permanently.5

“Given the large numbers of smokers having elective surgery, seizing this teachable moment by supporting quitting before surgery could reduce in-hospital morbidity and mortality, as well as provide a significant public health benefit to Victorians,” Dr Webb said.

Peninsula Health trialled this approach through Stop Before the Op between August 2011 and January 2012, mailing 650 quit packs to smokers on its elective surgery waiting list.

The response indicated:

• 83 referrals (12.8 per cent) were returned to Quit Victoria for follow-up

• 1.8 per cent of elective surgery smokers used Quitline in the previous year, and this increased to 10 per cent after the program

• Before the program, 40.9 per cent of pre-operative quitting was clinically significant (ie: the patient managed to quit for at least one month before surgery). This increased to 77.8 per cent after the program.


Allied health workers at Gippsland lakes Community Health (GlCH) have increased their output by 75 per cent over the past two years, with no extra funding.

By strategically developing its allied health assistant (AHA) workforce, GLCH delivered 1400 allied health hours in 2011-12, compared with 800 hours in 2009-10.

Some waitlists were reduced by more than half. for example, the speech pathology waitlist dropped from 33.3 days to 13.5 days, while the occupational therapy list went from 30.1 to 8.3 days.

AHAs work under the direction of allied health professionals (AHPs) such as physiotherapists, podiatrists, dieticians, exercise physiologists, occupational therapists and speech pathologists.

The GLCH allied health workforce has operated as a private-public service since 2009, supporting the development of AHP roles and creating new AHA positions.

Increasing the scope of practice for AHAs has alleviated pressure on its AHPs, enabling them to see high priority patients more quickly. It has also led to higher

levels of job satisfaction among AHAs.

GLCH has a higher proportion of families experiencing social and economic barriers to accessing services than the national average. Ten per cent of its clients are Aboriginal or Torres Strait Islander.

“There is an inequitable distribution of health professionals rurally, and we face unique regional challenges such as the lack of private service providers,” executive Manager, Community Health Services, Angela ellis, said.

“Through successful utilisation of our AHA workforce, GLCH is now at the forefront of expanding services supported by AHAs. Our programs continue to be evidence-informed and well-planned to meet the unique health needs of a remote service area.”

In 2010-11 the Victorian Health Department developed a Supervision and Delegation framework for Allied Health Assistants to enhance AHA roles across health and community services.

GLCH’s new AHA model was presented at the launch of the Victorian framework, and its manager is a statewide mento for its implementation.

from left: allied health assistant Tracey Dear and physiotherapist Angela ellis with client Denise Bull.

Due to the success of Stop Before the Op, Peninsula Health includes a quit pack in the routine brochure pack that is mailed to all patients on its surgical waiting list.

References

1 Khullar D & Maa J (2012) ‘The Impact of Smoking on Surgical Outcomes: A Collective review’ Journal of American College of Surgeons.

2 Myles PS, Iacono GA, Hunt JO, fletcher H, Morris J, McIlroy D & fritschi L (2002) ‘risk of respiratory complications and wound infection in patients undergoing ambulatory surgery: smokers versus nonsmokers’ Anesthesiology, vol97 no4 pp842-7.

3 Webb A (2012) ‘Smoking and surgery: time to clear the air’ in r riley (ed.) Australasian Anaesthesia 2011, ANZCA Melbourne pp 115-24

4 Myers K, Hajek P, Hinds C & Mcrobbie H (2011) ‘Stopping Smoking Shortly Before Surgery and Postoperative Complications: A Systematic review and Meta-analysis’ Arch Intern Med, vol171 no11 pp983-9.

5 Shi Y & Warner DO (2010) ‘Surgery as a teachable moment for smoking cessation’ Anesthesiology vol112 no1 pp102-7.

This article is based on information provided by Dr Ashley Webb, Department of Anaesthesia, Peninsula Health.

Allied health increasedwithout extra funding


VICTOrIAN PuBLIC HeALTHCAre AWArDSThe Victorian Public Healthcare Awards, in their eighth year, recognised innovation and excellence in the delivery of public health services.

Hosted by the State Government, all four Victorian Health Service of the Year Awards went to VHA member agencies.

PRIMARy HEAlTH SERVICE Of THE yEARSunRAySIA COMMunITy HEAlTH SERVICES

SCHS services the Mildura district in north-west Victoria, with a population of 50,000. More than 50 services are provided from five sites, with an operating budget of over $11 million. In the past year, SCHS provided almost 7,500 hours of allied health services, over 15,500 in-home meals, and more than 6,500 hours of palliative care. More than 7,000 clients received public dental services, and 940 aged care assessments were performed. SCHS is also addressing emerging community needs, through the provision of a refugee health nurse, counselling for survivors of torture and trauma, and flood recovery counselling.

METROPOlITAn HEAlTH SERVICE Of THE yEARAuSTIn HEAlTH

One of Victoria’s largest healthcare providers, Austin Health employs 8,038 people at the Austin Hospital, Heidelberg repatriation Hospital, and the royal Talbot rehabilitation Centre north-east of Melbourne. Austin Health has 980 beds across acute, subacute, and mental health, with a 2011–12 annual operating budget of $702 million. In the same year, 100,765 inpatients and 185,526 outpatients were treated, while the emergency department was the busiest in Victoria, with 70,325 presentations. Austin Health is an internationally recognised leader in clinical teaching, affiliated with eight universities. It is Victoria’s largest training provider for specialist physicians and surgeons. In 2011–12, Austin Health established Australia’s first nurse endoscopist program, training nursing staff to perform ultrasound-guided PICC line insertion. Statewide services include the Victorian Spinal Cord Service, Victorian Liver Transplant unit, veterans mental health services, Acquired Brain Injury unit, and the Victorian respiratory Support Service.


VICTOrIAN PuBLIC HeALTHCAre AWArDSThe Victorian Public Healthcare Awards, in their eighth year, recognised innovation and excellence in the delivery of public health services.

Hosted by the State Government, all four Victorian Health Service of the Year Awards went to VHA member agencies.

RuRAl HEAlTH SERVICE Of THE yEARORbOST REGIOnAl HEAlTH

A multipurpose service in far-east Gippsland, OrH has won this award for the second consecutive year. Created 14 years ago, the service now has an annual budget of $13 million and is the largest employer in the sub-region, with 189 staff. OrH has 50 beds and delivers 63 programs.

A community-needs survey and relevant population health data, including trend data from medical clinic files, guides service planning at OrH. Staff develop goal-based care plans to provide person-centred care, ensuring that clients understand their condition, how to self-manage, and how to access education and support groups.

REGIOnAl HEAlTH SERVICE Of THE yEARwESTERn DISTRICT HEAlTH SERVICE

In 2011–12, WDHS had a total budget of $63.3 million, an effective full-time staff of 555, treated 7,562 inpatients with an average stay of 2.88 days, 54,951 occasions of non-admitted patient service, and 7,221 emergency presentations. Clinical placements were also provided for 300 nursing undergraduates, 17 allied health students and nine medical students. Covering Hamilton, Coleraine and Penshurst in western Victoria, WDHS is undertaking a $35 million capital development program, including the new $26.5 million Coleraine District Health Service. WDHS volunteers also won a 2012 Minister for Health Volunteer Award for outstanding team achievement in a regional health service. The award-winning National Centre for farmer Health (NCfH) continues as a centre of excellence, with 66 students from four states having completed the centre’s agricultural health and medicine subject, which is the only one of its kind in Australia.

Rosie. Nurse, pâtissier and member since 1988.

Health 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.

We’re giving Rosie con� dence she can relax when she’s � nished work.

Find out more on how we’re helping Rosie at healthsuper.com.au/Rosie

Visit fi rststatesuper.com.au or healthsuper.com.au

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Australian centre for Healthcare Governance

2013 COnfEREnCEThursday 16th & friday 17th May 2013This conference will focus on strategic decision-making to meet future community needs, through organisational strategies and area-based planning. we will look beyond the health sector to promote cross-sectoral partnerships that are built on strong leadership and good governance.

Victoria’s devolved governance model enables boards to bring a local perspective to strategic decisions.

Rising demand for health services will place increasing pressure on boards to develop sustainable strategies to address the population health needs of their communities. This conference will give boards and directors the necessary skills and tools to monitor the effectiveness of their health service.

The Australian Centre for Healthcare Governance (ACHG) is the research and consulting arm of the Victorian Healthcare Association (VHA), the peak body representing the Victorian public healthcare sector.

www.healthcaregovernance.org.au

Documents

Health Matters December 2012