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Volume 9, Issue 2 – April 2017

Clinician Connect

Central Coast Group and the Aboriginal Respiratory Care Learning Map

Feature Editorial

Randall Greenberg, ICU Director, Dubbo Hospital

Randall Greenberg

I have been the director of the Dubbo Intensive Care Unit (ICU) for approximately 10 years. In that time, I've seen several key changes occur, including 24-hour cover of an intensivist on call, as well as 24 hour cover for junior medical officers on site.

Dubbo ICU is a level 4 unit as defined in New South Wales Role Delineation of Clinical Services 20161. Recently, there have been discussions around Dubbo’s Intensive care progressing to a level 5 unit, to meet the needs of the projected needs of the community In mid-2015, the Intensive Care and Coordination Monitoring Unit (ICCMU) from the NSW Agency for Clinical Innovation (ACI) published the Intensive Care Service Model: NSW Level 4 Adult Intensive Care Units2 guideline, which provided a service model for level 4 adult intensive care units in NSW.

The service model was a springboard for a statewide ICU review project led by the ACI. With the support of the hospital and Local Health District (LHD) Executive, Dubbo ICU became part of this project.

The first part of the project was to do a self-assessment to see where there were gaps in our standards. The self-assessment was done not only by intensive care staff, but also other clinical staff, as well as the hospital’s Executive team. This assessment revealed a number of gaps between what we were providing, and the standard of care expected, and made us realise that we had some work to do to get up to the standard expected of a level 4 unit before we could progress to a level 5 unit.

The ACI funded a project officer to assist with this project at a local level, as well as providing support with data collection and analysis.

One of the first actions to come out of the service model was to fully transition to a ‘closed collaborative’ ICU model. In a ‘closed collaborative intensive care model”, unit-level medical governance and leadership are in place, including a designated Intensive Care Director. The intensive care team, led by an intensivist/specialist, has the primary responsibility for patient management, with collaborative input by inpatient teams. A closed intensive care model has been associated with a reduction in hospital and ICU mortality rates2.

We had been trying to implement this model for some time, with some internal resistance from senior clinicians. We were able to implement this model by communicating the meaning of a ‘closed’ unit – physicians are not excluded from management or decision making, but the intensivist manages the admissions and discharges, and co-ordinates care. This message had previously been communicated, but the ACI documenting this as the best practice Intensive care model, with the message being reinforced by senior ICU clinicians visiting the hospital to emphasize that this is the contemporary, evidence based model, was very powerful.

After several meetings with clinical and executive staff of the hospital, the top five areas were chosen for which to focus:

  1. Data
  2. Policies and procedures
  3. Site governance
  4. Nursing education
  5. Multi-disciplinary ward rounds

With the help of the ACI team, and backing of the local hospital executive, we set up a monthly ICU Executive Management Committee consisting of Hospital Executive, Directors of Medical Services, Nursing Executive and the ICU Director and Nursing Unit Manager (NUM). This has been a key feature enabling the project to maintain momentum. An ICU Leadership Group (ICU Director, NUM, Educator) feeds into the Management Committee.

One of the most successful outcomes from this project has been the implementation of multi-disciplinary wards rounds in the ICU. These occur at 09:00am every week day. The participants are the Nurse Unit Manager, Intensivist, Registrar, Junior Medical Officer (JMO), and importantly the bedside nurse, speech pathologist, dietician, pharmacist, physiotherapist and social worker. The rounds ideally last approximately 20 minutes and are structured around a checklist – FASTHUG RAMS. (Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head up, Ulcer prophylaxis, Glucose, Respiratory, Antibiotics, Mobilisation, Social Situation). The key to the success of these rounds has been preparation before the rounds to have the information on hand, and importantly having a ‘driver’ of the round, usually the senior nurse, to keep it ‘short and sharp’. I had underestimated the benefits of sharing information with the whole team every morning in a structured way. It had previously been communicated in a piecemeal manner, with the obvious risks of fragmentation of information and care planning.

The ACI team has helped us helped with collating data. Much of the data required (ventilator hours etc.) is available through hospital systems. However, it has been a challenge to extract the data and importantly verify its accuracy. The ACI team had have expertise with these issues and were able to help us to identify and implement practical strategies to deal with this.

There has also been much work done on nursing education and policies and procedures, once again with the assistance of the ACI teams.

One of the challenges of practicing in a smaller rural hospital is the lack of support staff. We do not have multiple Staff Specialist Intensivists with clinical support time or nursing staff with time off the floor. We also do not have a data manager.

Thus, the level of support from ACI has been crucial in the success of this project. I can honestly say that this project has been one of the best supported project of the many in which I have been involved over the years.

This project has been replicated in other level 4 sites across the state. I believe the ACI has shown significant foresight by putting resources into smaller sites with minimal support staff whose needs are great, in order to support successful implementation of the model statewide.


  1. NSW Ministry of Health. 2016. New South Wales Role Delineation of Clinical Services 2016
  2. Intensive Care Service Network, Agency for Clinical Innovation. 2015. Intensive Care Service Model: NSW Level 4 Adult Intensive Care Units

Comment by the Chief Executive

by Professor Donald MacLellan – Agency for Clinical Innovation

Professor Donald MacLellan
Acting Chief Executive, ACI
donald.maclellan@health.nsw.gov.au

The ACI and our Clinical Networks, Taskforces and Institutes have been busy working with our partner organisations, clinicians, consumers, and managers to bring about meaningful improvements to the way care is provided to people in NSW.

In this issue, Dr Randall Greenberg, Director of Critical Care at Dubbo Health Service provides a guest editorial on the impacts of the ACI Intensive Care Coordination and Monitoring Unit’s (ICCMU’s) Level 4 Intensive Care program at a local level. This project is significant for the organisation as it sees the effects of dedicated internal collaboration between clinical specialty (ICCMU), implementation, health economics and evaluation, knowledge management, and communications come together with strong partnerships with the Local Health Districts (LHDs) to deliver significant improvements to the intensive care system statewide.

We were pleased to host another Co-Chairs Forum on Monday, 27 March 2017. The forum saw more than 60 ACI staff members and Co-Chairs come together to discuss issues of interest on an organisational level and to share the latest successes of the ACI Clinical Networks, Taskforces and Institutes. For more information on what was covered at the forum, visit the ACI update below.

A number of our staff members have been recognised in various internal, national and international awards recently. Congratulations to Maysaa Daher, who was a finalist in the 2017 Young Woman of the Year Awards and Peter McLeod, who was recognised with an ACI Values and Behaviour Award for exemplary conduct.

There are some changes occurring within the activities of the ACI, with reforms to the ACI’s Surgery Redesign Training Program and to the ACI Chronic Care for Aboriginal Team’s focus moving forward. Visit the appropriate update for more information.

There are also contributions from our partner agencies the Sax Institute and Clinical Excellence Commission (CEC), as well as an update on the statewide collaborative Patient Experience Symposium being hosted by the ACI and CEC in May 2017.

I encourage you to read the issue to learn more about these exciting initiatives.

As a system we are busier than ever, and with continued collaboration and partnerships such as those highlighted in this issue, we can look forward to improved outcomes and experiences for patients across NSW.

ACI update

Values and Behaviours Award

Peter McLeod receiving award from Donald MacLellan

Congratulations to Peter McLeod, ACI Web Services Manager, who was presented with the ACI Award for Values and Behaviours at a recent ACI staff meeting.

Promoting and recognising our shared values though the workplace is important in continuing to create a positive and supportive working environment. The ACI Values and Behaviours Awards provide an opportunity to recognise staff who consistently demonstrate our shared values and behaviours.

Nominations for the award are open to all ACI staff. People working within the organisation are given the opportunity to highlight individuals in recognition of their achievements in the demonstration of the ACI values and behaviours charter each quarter.

Peter was nominated for the award due to his outstanding and consistent collaboration, respect, professionalism, and achievements. Congratulations Peter!

Maysaa Daher – Harvey Norman Young Woman of the Year Award Finalist

Maysaa Daher

Congratulations to Maysaa Daher, Project Officer with the ACI Brain Injury Rehabilitation Directorate (BIRD), who was a finalist in the 2017 Harvey Normal Young Woman of the Year Award.

Maysaa has been working in the field of traumatic brain injury research since completion of a Bachelor's degree in Psychology four years ago. Her particular focus has been on resilience in family members caring for a relative with traumatic brain injury. Maysaa is currently steering the ACI’s Vocational Intervention Program, a statewide return-to-work pilot program for people who have brain injuries. The Vocational Intervention Program is the first program of its kind in NSW. To date, Maysaa has also been the author of six publications and will be presenting findings from her family resilience research at the International Brain Injury Association conference in New Orleans in March 2017.

Her commitment to people with disability extends beyond her work. Maysaa has volunteered with the Police Citizens Youth Clubs as a soccer coach for adults and children with disabilities and with Best Buddies Australia as a mentor/friend for people with intellectual and developmental disabilities.

Congratulations on this prestigious nomination Maysaa!

Co-Chairs Forum

The ACI hosted a Co-Chairs Forum on Monday, 27 March 2017 at the Chatswood Concourse. The forum saw more than 60 ACI staff members and Co-Chairs come together to discuss issues of interest on an organisational level and to share the latest successes of the ACI Clinical Networks, Taskforces and Institutes.

A big focus for this forum was the Leading Better Value Care (LBVC) Program being implemented across LHDs in NSW. The LBVC Program supports the NSW health system to improve patient outcomes and experiences, and delivers a more efficient, value rather than volume based service. The LBVC Program consists of three key areas, of which one, ‘Better Value Healthcare’, is supported by the ACI and Clinical Excellence Commission. The Better Value Healthcare initiative will see LHDs implement eight clinical priority projects to improve patient outcomes, with ACI responsible for supporting implementation of seven of the priorities from musculoskeletal, diabetes, renal, and unwarranted clinical variation (chronic heart failure and chronic obstructive pulmonary disease) streams. The CEC are supporting the falls prevention stream. The ACI Executive Sponsors for this project (Directors of Acute Care, Primary Care and Chronic Services, and Clinical Program Design and Implementation) spoke to the forum about the ACI’s approach to the LBVC project and how we aim to support LHDs to successfully make improvements in their services over the course of the 2017-18 year.

The Forum was also an opportunity to share some of the recent successes of ACI Clinical Networks, Taskforces and Institutes. Frances Monypenny, Network Manager of the ACI State Spinal Cord Injury Service (SSIS) presented on the Model of Care for Prevention and Integrated Management of Pressure Injuries in People with Spinal Cord Injury and Spina Bifida, while Michael Dinh, Clinical Director of the ACI Institute of Trauma and Injury Management (ITIM) presented on data process and reports, lesson learned and the move towards outcomes. Joyce van Akkeren and Coralie Wales also presented on the new look ACI Consumer Council.

A partnership agreement between the ACI’s Brain Injury Rehabilitation Program and iCare Lifetime Care was also ratified at the Forum, with Don Ferguson and Suzanne Lulham from iCare Lifetime Care signing off the agreement with Chris Shipway, Director of Primary Care and Chronic Services at the ACI.

Blood and Marrow Transplant Network update Co-Chairs: John Kwan, Elizabeth Newman

Manager, Blood and Marrow Transplant Network

Environmental Cleaning Project

The ACI Blood and Marrow Transplant (BMT) Network recognises that hospital cleanliness serves many purposes. The release of the NSW Environmental Cleaning Policy (PD2012_061) in 2012 provided the initial motivation for the Network’s Environmental Cleaning Project, having highlighted BMT units as extreme risk functional areas and recommending a 90% Acceptable Quality Limit (AQL) for environmental cleanliness.

Since the introduction of the policy, a yearly audit has been undertaken to benchmark compliance levels of BMT units. Previous results to date have included the following.

  • September 2013: None of the 15 BMT units achieved the recommended 90% AQL.
  • May 2014: Five of 15 units exceeding the 90% AQL and an additional three achieving scores above 88%.
  • August 2014: Results ranged from 86-100%, with 10 of 15 facilities exceeding the 90% AQL.
  • August 2015 (one unit completing audit in March): Results ranged from 81-100% with two units achieving 100%, and eight achieving 95%.
2016 audit results

To enable continual meaningful benchmarking against previous results, another round of audits across the 15 BMT facilities took place in December 2016. Results included the following.

  • Three units achieved 99%.
  • An additional five units achieved above 95%.
  • Three units fell below the 90% AQL, ranging from 70% - 89%.
  • Seven units either maintained or improved their score from the previous round of audits in August 2015.
Patient experience

Feedback from 460 BMT patients across 12 sites has been collected over a two year period. The data revealed that 98% (451) patients felt that their environment was clean and safe all or most of the time.

Next steps

A BMT Environmental Cleaning Forum will take place on Friday, 16 June 2017. This forum aims to bring together stakeholders from the Clinical Excellence Commission (CEC), clinical governance, nurses, cleaners, and others to discuss their experiences and share improvement practices.

The ACI BMT Network is committed to supporting ongoing external environment cleaning audits, with the next round of audits planned for 2018.

Burn Injury Network update Co-Chairs: John Harvey, Diane Elfleet

Burn Injury Network Manager

Churchill Fellowship

Congratulations to Stephanie Wicks, Physiotherapist - Burn Unit, at the Children’s Hospital at Westmead, who was awarded the Dr Lena Elizabeth McEwan and Dame Joyce Daws Churchill Fellowship to investigate strategies used in burns units to optimise therapy for regional patients.

Stephanie is planning to travel from July to September this year, visiting a range of specialist burns centres in the USA including Galveston, Texas, Sacramento and Boston. She also hopes to visit a specialised rehabilitation facility in Toulon, France, and present at the European Burns Association ASM in Barcelona, Spain. While the focus of her travel is to investigate strategies to improve our management of rural and regional patients, it is also an important opportunity to learn specialist skills from international clinical experts who may become important mentors and associates in the future.

“My aim is to learn strategies from leading paediatric therapists who treat very severe burns and come back with world class strategies that I can apply in my practice,” said Stephanie.

“Many of the patients I see at Westmead Children’s Hospital come from rural areas and travel considerable distances for specialised treatment, which adds significant emotional and financial burden and trauma.

“It is an ordeal for the children and parents, and I want to find ways to improve the scar management regime and make the process easier for families already going through an extremely difficult time.

“Being a Churchill Fellow is an extraordinary opportunity to challenge myself and to make changes that assist my patients return to their lives with hope and potential for the future. “I cannot think of another group that brings such a diverse group of passionate people together and I am immensely proud to be considered amongst them.”

We congratulate Stephanie and wish her a safe and successful trip. We look forward to hearing and learning about fellowship in the future.

Stephanie Wicks at the Children’s Hospital at Westmead Burn Unit

Stephanie Wicks at the Children’s Hospital at Westmead Burn Unit

Chronic Care for Aboriginal People update

Manager, Chronic Care for Aboriginal People

New Directions for the Chronic Care for Aboriginal People Program

Key statewide initiatives aimed at improving outcomes for Aboriginal people are embedded within the strategies of Local Health Districts (LHD) and Specialty Health Networks (SHN) across NSW.

This has created the opportunity for the ACI Chronic Care for Aboriginal People (CCAP) team to explore new initiatives to improve health outcomes for Aboriginal people living with chronic conditions.

Site visits were undertaken in collaboration with Directors and Managers of Aboriginal Health to identify key chronic condition health priorities for Aboriginal people. Participants included Aboriginal Health, Integrated Care, Aboriginal Medical Services and Primary Health Networks.

Discussion focused on:

  • identifying local Aboriginal chronic condition priorities
  • the capacity and capability of the CCAP team to work collaboratively with LHDs and SHNs in addressing priorities.

More than 80 priorities were identified from the 18 site visits. These were grouped by thematic analysis into the following categories.

  1. Transfer of Care
  2. Chronic Conditions Management
  3. Workforce
  4. Access
  5. Promotion and Prevention
  6. Data
  7. Integrated Care
  8. Health Literacy
  9. Mental Health

A New Directions Workshop was held on Tuesday 14 March to present key findings to staff who participated in the consultations. Participants in the room and watching via live web cast were able to vote on priority topics for the CCAP team to potentially implement in partnership with LHDs and SHNs.

The top four priority topics are:

  1. Integrating Care – Aboriginal Health is everyone’s business
  2. Transfer of Care – Continuum/Pathways of care post discharge
  3. Access – better linkages with primary care
  4. Improving Health Literacy.

The first meeting of the CCAP Working Party was held on 15 March, with discussions around the New Directions Workshop the main agenda item. The Working Group has one representative from each LHD and SHN, and is a key advisory group for the CCAP Team.

The CCAP team will work closely with nominated representatives to transition the identified priorities into new initiatives over the coming 12 months.

Chronic Care for Aboriginal People Forum – Abstracts open!

Abstracts are now open for the CCAP Forum to be held at the Kirribilli Club, Lavender Bay Tuesday, 20 June 2017. For more information visit the event page.

Clinical Innovation Program

Clinical Innovation Program Implementation Manager

Chris Ball

9464 4656 | 0408 627 228

chris.ball@health.nsw.gov.au

Clinical Innovation Program

New Content

The ACI’s Clinical Innovation Program (CIP) was developed to assist the spread of innovation that is designed and delivered by clinicians, managers, consumers and carers to enable efficient and effective health care to our patients and consumers across the NSW Health system.

The CIP website houses models of care or ways of working that are developed by teams of local health providers in NSW; those who identify a need for change and address the need by designing and implementing these models or ways of working.

Recently the ACI partnered with teams from the Coffs Harbour Health Campus and Northern Sydney Local Health District to deliver case studies of successful innovative implementation. These are case studies based on “real” examples of local practices, developed and implemented to improve experiences and outcomes for consumers and communities.

  1. Enhanced Management Orthopaedic Surgery –This case study describes the successful implementation of a program at Coffs Harbour Health Campus that has improved outcomes for people having joint replacement surgery
  2. Home Oxygen Discharge –This case study documents the successful implementation of new processes in the Northern Sydney LHD, which have improved the access and use of short term oxygen therapy for patients discharged from hospitals within the district.

Both case studies are now available to access on the ACI website. Providers across the state are encouraged to read, consider, and identify local opportunities for change and improvement. They not only share the story of these local innovations, but also provide a starting point for other sites and individuals who would like to focus on similar issues. They should be used in conjunction with the ACI Implementation guide.

Have an example of local innovation that you would like to showcase, or interested in further information? Please contact Chris Ball, Implementation Manager, chris.ball@health.nsw.gov.au.

Institute of Trauma and Injury Management update Chair: Michael Dinh

NSW Trauma System: 25 years since Trauma Bypass was introduced

On Sunday, 29 March 1992, the pre-hospital component of the State Trauma Plan was activated in Sydney through the introduction of NSW Ambulance Pre-hospital Trauma Triage Protocol (Protocol 4). The aim was to minimise inter-hospital transfers and to enable more patients to be delivered by ambulance to the hospital most appropriate for their treatment needs. The introduction of Protocol 4 resulted in patients with serious injury being transported directly to a major trauma service hospital, even if it meant bypassing a closer local hospital.

When it was first introduced, the Sydney Morning Herald hailed it as giving “high hopes” for saving the lives of trauma patients. A year later, then NSW Minister for Health Ron Phillips told parliament that since the plan had begun, the number of preventable deaths resulting from serious trauma had dropped from 12.5 percent to less than five percent.

29 March 2017 marked 25 years since Protocol 4 (which is now referred to as the T1 Protocol) was introduced. The establishment of this protocol marked the beginning of an important step in saving the lives of people who had experienced major trauma. The NSW trauma system has since evolved into a mature system built on clinician engagement and continual innovation, with outcomes comparable to other leading trauma systems across Australia and the globe. While there is more work to be done in continuing to improve efficiency and outcomes in the system, it is great to look back and reflect on how far we have come, and to recognise the important work that everyone involved in this system undertakes on a daily basis.

Sydney Morning Herald (SMH) article on the proposed protocol in 1992.
Sydney Morning Herald (SMH) article on the proposed protocol in 1992.

Patient Experience and Consumer Engagement update

Music and Memory Pilot

In June 2016, the ACI partnered with the Arts Health Institute (AHI) to deliver a Music 4 Health pilot program in NSW. The pilot saw 21 sites across ten LHDs supported to implement the official Music & Memory® program for one year until July 2017.

Pilot implementation

The AHI is the sole licensee of Music & Memory® in Australia, and supported sites to implement Music & Memory® through:

  • provision of iPod starter kit and iTunes card
  • access to monthly webinars and a community of practice
  • online and telephone support
  • a site visit.

Implementation of the Music 4 Health pilot is nearing completion, with very positive responses to the program from the patients, carers and staff who have participated in the program.

Following the completion of the Music 4 Health pilot in July 2017, LHDs will have the option to continue to work with AHI to run the program in their services.

Evaluation

The ACI is undertaking a limited evaluation of the Music 4 Health pilot. The evaluation will explore the process of implementing Music & Memory® in NSW Health facilities, and the impact of the program on patient, family and staff experiences of care. Results will be available to LHDs once the evaluation is complete.

Patient Experience Symposium 2017

Program now available!

The ACI and Clinical Excellence Commission, along with event partners the Health Education and Training Institute, Bureau of Health Information, Cancer Institute NSW, eHealth NSW, Mental Health Branch and Health and Social Policy Branch of the NSW Ministry of Health, and Health Consumers NSW, are pleased to host the 2017 NSW Patient Experience Symposium, to be held at the Masonic Centre, Sydney, from the 2 - 3 May 2017.

Now in its third year, the Patient Experience Symposium brings together NSW Health staff, researchers, and consumers to share and showcase innovative work and initiatives aimed at improving patient experience.

The theme of the 2017 Symposium is “Communication and Connecting People”. Keynote speakers include Jason A. Wolf, President, The Beryl Institute, USA, which organises the international Patient Experience Week, and Tim Blake, Engaged Patient and Carer, Managing Director, Semantic Consulting, with more to be announced.

The program is now available on the Symposium website.

Follow the event hashtag on Twitter at #PEXS2017 for key updates and learnings over the two days.

Patient experience symposium

Primary Care and Chronic Services

Program Manager

Regina Osten

9464 4637

regina.osten@health.nsw.gov.au

Shared Decision Making Masterclass: Making Health Decisions Together

The ACI Chronic Care Network has sponsored the development of a Consumer Enablement Framework in 2017.

Enablement is about people having the confidence, skills, information and knowledge to play a central role in the management of their health conditions and life.

The Framework will provide healthcare professionals with approaches, tools and resources to create an organisational culture and environment that supports and optimises enablement.

Shared decision making is a key approach to facilitating and optimising consumer enablement. An exciting opportunity exists to bring clinicians and consumers together to participate in a Shared Decision Making Masterclass: Making Health Decisions Together with renowned leaders Tammy Hoffmann, Professor of Clinical Epidemiology, and Lyndal Trevena, Professor of Primary Health Care.

Shared decision making promotes the right of consumers to be fully informed and involved in making decisions about their healthcare.

It is a decision making process that incorporates evidence based practice and person-centred care by discussing health care options, the benefits and risks, and considering the consumers values, preferences and life circumstances.

The full day Masterclass is an opportunity to build skills in applying shared decision making in clinical practice.

Places are limited. We encourage doctors, nurses, allied health professionals, health managers and consumers to register on the event page.

For more information contact Tara Dimopoulos-Bick tara.dimopoulosbick@health.nsw.gov.au

Respiratory Network update Co-Chairs: Sheree Smith, Jimmy Chien

Respiratory Network Manager

Aboriginal Respiratory Care Workshops

The first ACI Aboriginal Respiratory Care Workshops were held at the Central Coast and Wagga Wagga in March, with a further four workshops scheduled for Ballina, Wollongong, Dubbo and Sydney shortly.

The workshops primarily target Aboriginal Health Workers and clinical staff working with Aboriginal adults and children in Aboriginal health services within both community controlled organisations and local health districts.

The workshops are small group interactive learning forums that draw on Aboriginal perspectives and learning techniques, based on the eight Aboriginal ways of learning method.

Participants have an opportunity to understand and explore culturally appropriate ways to screen, assess, teach. and support self-management of common lung problems that affect Aboriginal children and adults in their community including :

  • asthma
  • chronic obstructive pulmonary disease (COPD)
  • pneumonia
  • bronchiectasis.

The Respiratory Network has partnered with the Aboriginal Health and Medical Research Council, Chronic Care for Aboriginal People team and managers from the 17 Aboriginal health services to co–design the workshops to ensure they are relevant for their workforce needs and support local service development priorities.

Central Coast Group and the Aboriginal Respiratory Care Learning Map
Central Coast Group and the Aboriginal Respiratory Care Learning Map

Building airways and alveoli
Building airways and alveoli

Rural Health Network update Co-Chairs: Richard Cheney, Patrick Frances

Rural Health Manager

Living Well in Multipurpose Services Collaborative

Multipurpose Services (MPSs) are unique health care facilities that provide a combination of health services, including acute care, sub-acute care (including respite and palliative care), emergency, allied health, primary health, and residential aged care to meet the needs of small rural communities.

The Living Well in MPS Collaborative has been designed to support staff in providing care for residents of MPS; not as patients in hospital, but as people living in their home. Twenty five MPSs have joined the 2017 Collaborative to undertake small scale improvements to enhance quality of life and the homelike environment for residents. These improvements will be achieved by sites leveraging off each other’s learnings through a series of three Learning Sets and Action Periods to achieve a greater collective level of enhancement.

Learning Set 1 (LS1) familiarized the MPS sites to the Collaboratives objectives through a series of seminars relating to the principles of care for living well in an MPS and change management. The sites were also introduced to the Plan-Do-Study-Act (PDSA) Portal, which was created to help execution of ideas and tracking of progress.

LS1’s aim was to maximise networking potential among the MPS teams, as well as to enhance the relationship between the ACI and participating sites. The teams returned to their MPSs inspired, motivated and resourced to implement their PDSA concepts with staff.

During the action periods, sites are receiving weekly phone calls to track their progress and trouble shoot implementation barriers and change resistance. Sites will also create monthly reports to display their development and challenges in preparation for Learning Set 2 in May.

So far, 126 PDSAs are now sitting on the portal – from social profiles to podiatry care plans, “it appears the MPS world is our oyster!” It is great to see teams now venturing into their other prioritised areas such as multidisciplinary services and keeping residents informed and involved.

View the Living Well in MPS Collaborative Toolkit

Rural Innovations Changing Healthcare Forum (RICH) 2017

The ACI Rural Health Network was pleased to host the 4th annual Rural Innovations Changing Healthcare (RICH) Forum on Friday, 31 March 2017.

RICH is an annual virtually delivered conference hosted by the Network which showcases innovative new models of care being used in rural settings, and demonstrates new ways to collaborate across physical and technological boundaries to improve care across rural NSW. There is no registration fee, no travel and no time lost from work.

The RICH 2017 Forum saw healthcare professionals and consumers from non-government organisations, Local Health Districts (LHDs), Primary Health Networks (PHNs), general and private practitioners, pillar agencies, Aboriginal Medical Services, Residential Aged Care Facilities, NSW Ambulance, Royal Flying Doctor Service, University Departments of Rural Health, the Department of Education, rural patients and undergraduate students come together for a unique knowledge-sharing opportunity.

The theme of RICH 2017 was Connecting the disconnect. Presenters showcased rural innovations with demonstrated outcomes in:

  • closing the gap
  • integrating care
  • outreach using telehealth
  • inter-sectorial collaboration
  • transfer of care; admission, discharge and referral pathways
  • public / private relationships
  • harnessing technologies to bridge gaps in service delivery, access, geographic isolation, affordability and continuity of care.

The RICH Forum uses a combination of face-to-face, tweeting via the #RICH2017 hashtag, video-conferencing and live streaming technology to link rural and regional satellite groups to the host hub at the ACI offices in Sydney. Attendees are encouraged to ‘pop in’ for sessions of relevance without the need to be absent from the workplace for the whole day, as is the case with conventional forums.

Jenny Preece at RICH 2017
Jenny Preece at RICH 2017

Surgical Services Taskforce update Co-Chair: Arthur Richardson

Manager, Surgical Services

Big Changes to Surgery School in 2017

The ACI’s Surgery Redesign Training Program is being overhauled in 2017, following an in-depth review which included valuable participant feedback. The five day face-to-face program, aimed at developing the foundation skills of project management, change management, process improvement and clinical redesign, will now be broken down into separate one and two day sessions across the year. This will enable busy clinicians, nurses and managers who might otherwise not be able to take part to attend the training.

Each session can now be taken as a one-off or in succession, and are pitched at both introductory and advanced levels to ensure all participants receive training appropriate to their experience and ability to influence. The new one-day-courses have been rebranded as Sprint LABS (Learning and Building for Surgery).

The course is aimed at both individuals and project teams, particularly those with a proposed surgical project they would like to develop and implement; ideally one which can be completed in three to six months. Participants are exposed to state-based approaches in their specialty, and have the opportunity to hear from clinical leaders and experts, as well as learn from other health staff in the program.

Three individual one day courses will now be available at introductory and advanced levels – Project Management Planning, Diagnostics, and Planning and Solutions. The two day Accelerating Implementation Methodology (AIM) course will continue to be delivered twice per year, giving participants a practical guide to effectively manage change by overcoming personal and cultural barriers. The first Introduction to Project Management Planning one day course will be held on Wednesday, 12 July 2017.

The courses are delivered by the Centre for Healthcare Redesign in partnership with the Surgical Services Taskforce and the Ministry of Health. If you would like more information about any of the above courses or would like to apply for the course in July, please register your interest.

Clinical Excellence Commission

NSW Paediatric Patient Safety Committee Meeting

The first meeting of the revised Paediatric Safety and Quality Committee Meeting, chaired by Matthew O’Meara, Acting Chief Paediatrician of NSW, and Jonny Taitz, Director Paediatric Patient Safety, was held in the Deerrubin Room at the ACI on Wednesday, 8 March 2017.

This meeting has been held at the CEC since 2014; in late 2016 a decision was made to change the structure of the meetings to be more action focused. Meetings will now be held quarterly, with the overall aim to improve the safety and quality of paediatric care across public health facilities throughout NSW. The CEC Paediatric Safety and Quality Committee has been established to provide high-level advice and networking opportunities for the paediatric quality and safety portfolio within CEC, as well as for all programs/portfolios within CEC that have a paediatric component. This includes the identification and analysis of risks and opportunities and the sharing of key information relevant to the CEC’s operational and communication strategies.


Committee members

Thirty clinicians and managers from multidisciplinary health teams across LHDs were chosen to represent their organisations and all undertook to report back to their local stakeholders. This first meeting reviewed systems and processes around morbidity and mortality (M&M) meetings across public health services in NSW with the aim to provide more standardisation around the meetings, clear governance and reporting lines and better communication around recommendations.

To set the context, three guest speakers provided short presentations on different aspects of M&M meetings.

David Storey Clinical Advisor for Patient Safety at the CEC provided background on the history of Quality and Safety and M&M Meetings, Bronwyn Shumack, Project Director for ims+ at the CEC spoke on obtaining data from the new ims+ and Patsi Michalson, Medico-Legal Manager for the Sydney Children’s Hospitals Network presented challenges and barriers to setting up a standardised M&M process.

Four different topics were then discussed by small working groups facilitated by ACI Network Manager Rob Wilkins.

  • Challenges and solutions and business rules for M&M committees (who ,when, agenda)
  • Data- what is required (e.g. IIMS, RCA, HIE )
  • Cases – what should be included (e.g. complaints, RCAs, deaths, stories)
  • Learnings and reporting – links (e.g. to pillars, local governance, paediatric safety and quality committees, and then feeding back to clinicians on the floor)

ACI representatives Sarah Dalton and Lynne Brodie will distribute information from the committee to ACI staff as it becomes available. A newsletter that provides updates on paediatric safety prepared by the CEC will also be circulated. These reports are on the CEC Paediatric watch page.


Working group facilitated by Rob Wilkins

Sax Institute

Knowledge translation: evidence into action

Transferring evidence into the policy making process is the focus of the latest issue of Public Health Research & Practice (PHRP), which includes a special interview with former Federal Health Minister Nicola Roxon on getting evidence into public health policy.

The guest editors for Issue 1 (2017) are Associate Professor Andrew Milat, Director, Evidence and Evaluation at NSW Ministry of Health, and Professor Don Nutbeam, PHRP Editor-in-Chief. Themed articles include an ‘in practice’ paper that describes the experiences of The Australian Prevention Partnership Centre, one of Australia’s NHMRC Partnership Centres for Better Health, in delivering coproduced partnership research. In a perspective article, researchers explore how secondments can be used between government and research organisations as a tool to increase knowledge translation. Other papers discuss a procedure for embedding stakeholder engagement in the development of simulation models; a long-term approach to evidence generation and knowledge translation in NSW; frameworks for translating research evidence into policy and practice; and the aims and achievements of the World Health Organisation partnership, the Alliance for Health Policy and Systems Research.

In a special interview with PHRP, Nicola Roxon gives an insider view about how evidence is used in policy decisions in a highly politicised environment with many competing demands.

Non-themed articles in the issue discuss best practice for communicating about public health hazards where the risk is low but public concern is high; and reasons behind opposition to water fluoridation in regional NSW.

PHRP is Australia’s first online-only open access peer-reviewed public health journal, published by the Sax Institute with a strong focus on the connection between research, policy and practice.

You can subscribe to receive quarterly e-alerts when the journal is published, make suggestions about themes or topics for future issues, submit papers and follow us on Twitter @phrpjournal.

Aboriginal Cultural Competency and Safety Working Party

The ACI Chronic Care for Aboriginal People (CCAP) Team have identified new priorities for their work moving forward. Read the CCAP update for more information