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Volume 8, Issue 2 – April 2016

Clinician Connect

C Shipway, J Sherwood, K Hennessy at the ACI Cultural Competency Forum. See the report for more.

Feature Editorial

by Dr Sean Kelly, Clinical Director, ACI Intensive Care Coordination and Monitoring Unit

Dr Sean Kelly

A service rather than unit based approach to providing Intensive Care in NSW

The Agency for Clinical Innovation (ACI) and the Intensive Care Services Network (ICSN) are partnering with Local Health Districts (LHDs) to implement the NSW Adult Level 4 Intensive Care (IC) service model in fourteen of the State's hospitals. Developed by NSW IC clinicians, the model provides recommended standards for standalone ICs in those rural, regional and metropolitan NSW hospitals. Central to the service model is that NSW residents, where safe and feasible should have access to IC services close to where they live.

Smaller, lower level ICs provide an important function, supporting the critical needs of NSW hospitals and communities and accounting for approximately 25% of NSW IC activity. The capabilities of these units determine the acuity of patients that can be safely cared for, the complexity of surgery and procedures that can be undertaken and the number patients requiring transfer to higher level facilities. While the sickest patients requiring complex subspecialty care are best treated in higher level ICUs in major cities, many patients can with the appropriate support be safely managed in Level 4 ICUs, enabling care to be provided closer to where they, their family and friends live and improving the experience of patients and their families. Importantly, supporting and maintaining IC capability in smaller hospitals promotes maintenance of staff skills and improves support for a greater range of clinical activities in these hospitals. A minimum level of critical care capability is mandatory in remote hospitals to manage the inevitable emergencies and support and maintain clinical activity.

However, currently there is significant variation in how smaller ICs in NSW provide care. There are varying governance models in place and difficulties in coordinating escalation and transfer of care to higher level units. Variations in clinical practices also exist. Benchmarking of outcomes and costs is problematic. These issues are difficult to address in a meaningful and sustainable way at a local unit or even LHD level and clinicians from these units often times find it difficult to travel to Sydney to seek advice and lobby for improvements.

Supported by ACI, an ICSN working group was established to develop a service model framework for Level 4 ICUs to clarify the role, function and configuration of these units. The working group identified that major structural change was required in NSW to address many of the challenges these units face. The working group was one of the most productive and enthusiastic that I have been involved with and had broad representation from clinicians from all level of IC across the State together with representation from other NSW agencies.

The consensus and evidence based standards include: recommendations for leadership and governance, care planning and coordination, standards for procedures and protocols, education training and supervision, workforce and evaluating patient quality, safety and experience.

A pivotal recommendation is that functional networking relationships be fostered between lower level IC and higher Level 5/6 units in the same LHD or region. With networking facilitated by rotation of medical and nursing staff, daily phone or telehealth contact and shared performance evaluation forums. The specific networking arrangements will vary but the central focus is fostering a closer working relationship and a shared responsibility for looking after patients requiring IC in an LHD or region.

The ACI is providing considerable support, expertise and experience to the ICSN service model team to ensure that implementation is a success and importantly sustainable. Support includes training of local LHD staff in change management, with the skills acquired transferable to future projects. The ACI is also providing assistance with engaging local clinicians and their executive to support the implementation process, liaising with other NSW health agencies to secure funding models that support implementation and ensure appropriate performance metrics are in place.

ICSN has collaborated with the Ministry of Health in the development of the new NSW role delineation guidelines which aligns and complements the Level 4 service model.

What will success look like? A better patient and family experience will result with IC staff feeling supported to provide safe, quality care to their community. Rational use of IC resources will be evident with the potential for patients where possible to be cared for close to where they live. The service model will ensure avoidance of unnecessary transfers of patients to higher-level centres. Closer relationships will ensue between Level 4 and higher level ICUs in a "service" rather than "unit" approach to IC delivery. Capability will be enhanced to track outcomes that are important to care providers, administrators and above all patients.

From my perspective, ACI has been pivotal in providing a forum and mechanism for ICSN clinicians to identify and work up solutions for improving IC service delivery in NSW. Importantly, support and resources have been put in place to implement these solutions. Implementation of a number of the service model recommendations will not be possible at unit or LHD level, and will require a statewide "system" approach informed and lead by clinicians and supported by key health agencies.

Welcome to the April issue of Clinician Connect

by Nigel Lyons – Agency for Clinical Innovation

It is rewarding to see the work our Networks and teams are doing to support local healthcare innovation and service improvement.

This month Sean Kelly Clinical Director of ACI's Intensive Care Coordination and Monitoring Unit (ICCMU) provides insight into the partnerships and local involvement with healthcare services helping to implement new standards of care for standalone Intensive Care Units in NSW hospitals.

Critically ill patients are the sickest people in the hospital and need timely access to specialist care 24 hours a day. Thanks to the trifecta of evidence-based standards developed by clinicians, the support provided by ACI and active involvement of local leadership, clinicians and managers, the Intensive Care Service Model is being introduced to hospitals across NSW bringing many benefits for critically ill patients, their families and carers.

Introducing change like this in large complex healthcare systems is difficult – and I commend our Intensive Care Services Network and the local healthcare teams working with ACI to help make this happen.

There have been many attempts over the years to introduce innovative new ways of caring for people in and out of hospital. Some have worked, some haven't - but too often they've happened without buy in from either clinicians or managers. There's not always been effective coordination between initiatives and all too often a gulf between good ideas and what is happening on the ground.

We continuously work to address this at ACI by building strong partnerships with care providers, promoting collaboration through our clinician-led Networks, streamlining communication with partners, and sharing best practice through the Innovation Exchange. While networking at a state level can boost the engagement of clinicians, we know it's important not to duplicate efforts and to continue to work actively to engage clinicians, managers and Executive teams at a local level.

I have learned a lot from recent discussions with Local Health District Executives and clinicians and managers of their healthcare services – and it's helping guide our approach at ACI to the design of service improvements that suit the needs of local communities.

I have made no secret of my belief that positive change for patients will only be possible if we bring clinicians, managers and local healthcare services with us. Without this buy-in, changes in practice are difficult to introduce and embed. The greatest chance of success comes when our service improvement initiatives are implemented by front line clinicians and the healthcare services responsible for service delivery.

Support for networking, collaboration and local involvement, implementation and evaluation have long been cornerstones of the ACI approach. Over coming months we are actively working with all our teams to think about different ways we can work now and into the future to remain responsive to local healthcare needs.

Together we can make a real difference and deliver better healthcare and better outcomes for patients across NSW.

Dr Nigel Lyons
Chief Executive, ACI

Aged Health Network Co-Chairs: Bill Thoo and Viki Brummell

Aged Health Network Manager

Glen Pang

9464 4630 | 0407 995 329

Aged Health Network

Welcome to Bill Thoo

The Network is pleased to welcome Bill Thoo as the new Medical Co-Chair of the Aged Health Network. Bill is the Head of Geriatric Medicine at Canterbury Hospital, Sydney Local Health District, and has been an active member of the Network since 2011. Bill has previously been the Secretary of the Australian and New Zealand Society of Geriatric Medicine (NSW). Welcome Bill!

Care of the Confused Hospitalised Older Persons Program (CHOPs)

The CHOPs Program, which was developed by the Network in 2010, aims to improve the care of older people with confusion in hospital. There are currently 13 NSW sites implementing CHOPs.

In addition to the program, the Australian Commission for Safety and Quality in Health Care have developed a suite of strategies to support the care of people with cognitive impairment in hospitals, including:

  • Caring for Cognitive Impairment Campaign to raise awareness of cognitive impairment in hospitals
  • Delirium Clinical Care Standards (currently seeking AHMAC endorsement)
  • National Safety and Quality Health Service (NSQHS) Standards (Version 2) - will be released in July 2017. The new standards incorporate safety and quality of care for people with cognitive impairment.

The ACI and Aged Health Network support the Caring for Cognitive Impairment Campaign. Our CHOPs Program supports hospitals to implement strategies to make a real difference. Visit to show your support for caring for cognitive impairment.

Anaesthesia Perioperative Care Network & Nutrition Network

Network Managers

Co-Chairs: Suzanne Kennewell and Nigel Lyons; Michael Amos and Lilon Bandler

Principles for Preoperative Fasting and new Diet Specifications

Studies have shown that reducing preoperative fasting can lead to better patient outcomes. To address this research, the ACI Nutrition and Anaesthesia Perioperative Care Networks recently established a working party to develop resources for Local Health Districts and Networks to help them implement a strategy to reduce unnecessary preoperative fasting.

To date, the working party has produced:

  • Key principles for fasting in NSW public hospitals.
  • Two new diet specifications for use in hospitals:
    • Fluids – Preoperative Oral: for patients who are awaiting surgery
    • Fluids – Preoperative Oral Diabetes: for patients with diabetes who are awaiting surgery.
  • Implementation advice in a frequently asked questions document for clinicians and food services staff to support the use of these diet specifications in NSW public hospitals.

The ACI Endocrine Network and Surgical Services Taskforce were also consulted as part of the development process.

These resources will support best practice across the system, but it is important for clinicians to be aware of the changes during local implementation processes, such as the cut off times for ordering a diet (prior to the meal delivery time), to ensure patients receive the appropriate diet at meal times.

All of the above documents are now available on the ACI website:

For more information contact the Nutrition or Anaesthesia Perioperative Care Network Managers.

Chronic Care for Aboriginal People Program

Chronic Care for Aboriginal People Program Manager

1 Deadly Step Program

The ACI is working with local health services to host a series of screening days across NSW as part of a continuing collaborative effort to improve the health of Aboriginal communities.

The 1 Deadly Step program is a nine stage screening initiative developed by the Chronic Care for Aboriginal People team. The program delivers free chronic disease health checks in Aboriginal communities across New South Wales. Community members can be screened for health conditions such as kidney disease, heart disease and diabetes, which combined account for the majority of the Gap in Aboriginal health.

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The 1 Deadly Step model engages local health services to plan a program tailored to local health needs. The collaboration sees experienced teams of staff from Local Health Districts, Primary Health Networks, Aboriginal Medical Services, NSW Country Rugby, and other local partners deliver the program at a community event.

In 2016 the 1 Deadly Step program has been hosted in several communities including Wagga Wagga, Moruya, Coffs Harbour, Armidale and Casino.

A unique part of the 1 Deadly Step program is the use of an iPad app to record and analyse each person’s screening results. The app provides a snapshot of the individual’s combined chronic disease risk, which in turn can be accessed by their GP to develop targeted care plans.

Once a person has participated in nine stages of screening they receive a free 1 Deadly Step jersey.

Like 1 Deadly Step on Facebook for the latest information:

ACI Cultural Competency Forum

On Thursday, 10 March 2016 the ACI hosted a Cultural Competency Forum for all ACI staff. Moving towards being a culturally competent organisation is a key priority for the ACI as we work to improve the health outcomes of Aboriginal, Torres Strait Islander and other minority communities in NSW, with the forum one of many initial steps being taken to better educate ACI staff members in this area.

The forum was held with the support of the National Centre for Cultural Competency (NCCC) at Sydney University. Professor Juanita Sherwood of the Centre facilitated the day with ACI Chronic Care Portfolio Director Chris Shipway, while other Centre staff members were on hand to facilitate group work throughout the course of the forum.

The day was an important time for people working within the ACI to explore what culture means to them, and how they engage and interact with both their own and others’ cultures. Presentations from Juanita and Tim Soutphommasane, Australia’s Race Discrimination Comissioner gave attendees an understanding on the principles of cultural competency, providing a strong base for the workshopping activities which followed. Attendees were broken up in to groups and asked to envision what cultural competence at the ACI looks like in five years’ time, then report back to the whole group. A report will be developed with the outcomes and suggestions from the workshopping sessions.

An audit of current understanding of cultural competence within the ACI was also undertaken via a survey that was collected and will be compared against a future audit following more learning opportunities for ACI staff.

The ACI is pleased to be partnering with the NCCC for an initial period of two years while cultural competency improvement initiatives are undertaken.

For more information on the ACI’s commitment to cultural competence, visit the ACI's page on cultural respect.

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Drug and Alcohol Network Co-Chairs: Tony Gill and Jo Lunn

Drug and Alcohol Network Manager

New Working Parties Established

The ACI Drug and Alcohol (D&A) Network Executive Committee has undertaken an extensive planning process to reach agreement on priority areas of activity for the Network in the coming twelve months.

The process included:

  • consideration of current research and evidence
  • identification of gaps and opportunities in the current response to drugs and alcohol
  • consideration of the aims and objectives of the ACI
  • consultation with Network members.

The review identified three initial key priority areas:

  1. A connected system
    Facilitating greater communication and connectivity between D&A services across NSW and improving access to evidence-based, peer reviewed resources.
  2. Being leaders in innovation
    Promoting and supporting innovation in D&A models of care and service delivery. This includes both stimulating new activity in the field and profiling innovations already happening across the system.
  3. Supporting a strong partnership with Primary Health Networks
    Strengthening the continuum of care through improved collaboration and integration between specialist D&A services and NSW Primary Health Networks.

Three working parties have been established to support each of these priorities. Joining a working party is a unique opportunity for people to collaborate across the D&A sector and be part of a redesign process to improve healthcare in NSW. There was a very strong response to the EOI process (now closed) and we wish to thank all those who have put their name forward.

SAVE THE DATE: ACI Drug and Alcohol Innovation Forum

The Network is pleased to announce the inaugural ACI Drug and Alcohol Innovation Forum to be held on 11 August 2016 at the Kirribilli Club in Lavendar Bay.

The event will profile the ground breaking work already happening across the D&A sector in NSW and provide an opportunity for people to have a say into the activities the Network will support into the future.

Save the date and look out for more details to come!

ICHOM Update

by Rob Wilkins, ICHOM Alliance Lead

Earlier this year, I was fortunate enough to attend the Value-Based Health Care course delivered by the Institute for Strategy and Competitiveness at Harvard Business School. The course was followed by a six week placement at the International Consortium for Health Outcomes Measurement (ICHOM). ICHOM is a small non-profit organisation about a 10 minute walk across the Charles River from Harvard Business School. It aims to “transform health care systems worldwide by measuring and reporting patient outcomes in a standardised way.” In short, ICHOM’s work is to take forward the strategic agenda outlined in the course. The placement and the course marked an opportunity to begin to grasp some of the foundational concepts in value-based healthcare and to better understand what these look can look like implemented in the real healthcare world.

The Value Based Health Care Course is based on the 2006 seminal text written by Porter and Teisberg called Redefining Health Care: Creating Value-Based Competition on Results. The book has a bold aim: to unite all participants in a common purpose. This purpose is to shift from “zero-sum” competitiveness where gains in the system come at the expense of others and costs merely shift, to a value-based competiveness approach: where all participants benefit by competing on results that matter most to patients. Value in health care is measured across the full cycle of care, from monitoring and prevention to treatment and ongoing disease management. Porter and Teisberg conceptualise value as the patient health outcome achieved per dollar of cost expended. They argue that physicians should compete on a local, national and global level to be the best at addressing a particular set of medical conditions. In order for this to begin, medical conditions need to be defined by standard sets of outcome measures: a common measuring framework across the globe. So what can this look like on the ground? That’s where ICHOM fits in. ICHOM’s work is to organise global teams of physician leaders, outcomes researchers and patient advocates to define Standard Sets of outcomes for a medical condition, and then drive adoption to enable health care providers globally to compare, learn and improve. Defining the Standard Sets requires a staged process whereby physicians and patients discuss, vote and ultimately agree on minimum outcome measures that matter most to patients. Patient Reported Outcomes Measures (PROMS) are the largest component of all ICHOM sets. Although in its formative stage of development according to ICHOM, PROMS should be taken as seriously as any other medical instrument such as a thermometer or an MRI. These sets are then disseminated widely and supported for uptake in the clinical setting.

The methodological challenges for implementing these sets are many. In response, ICHOM offers targeted project management support and is working to build a network of providers who can offer their expertise and support to each other. Challenges include clinician buy-in, building localised program governance arrangements, refining workflow, assessing IT platforms, and measuring and analysing data.

However, there are already examples of how this work can scale. I went to Michigan to sit in on the Michigan Urological Surgery Improvement Collaborative (MUSIC). The Collaborative enables clinicians to submit data to a clinical registry maintained by the MUSIC Coordinating Centre and to come together at tri-annual consortium-wide meetings to discuss data, review risk-adjusted measures of processes of care and patient outcomes, and to identify their own improvement strategies–all speaking a similar language, using the same outcome measures. The goal for all of this work is a reformed system, where clinicians readily compare their risk-adjusted benchmarks on outcomes to improve their practice, reduce costs and achieve better health outcomes for patients.

What’s next? I propose to start by having some open discussions in the ACI about some of the key messages and approaches advocated for in Redefining Healthcare. Let’s ask ourselves: In what ways are these messages, our messages? Let’s think about how we are already using health outcomes data to drive better patient care. And let’s consider how we may want to participate with the many Australian and international partners already working towards a system of value-based healthcare.

Intellectual Disability Network Co-Chairs: Ms Maria Heaton and Prof. Les White

Intellectual Disability Manager

Tracey Szanto

9464-4632 | 0408 365 528

Intellectual Disability

Congratulations Les White

Intellectual Disability Network Co-Chair Professor Les White AM will retire from the position of inaugural NSW Chief Paediatrician this month. A retirement dinner to honour his longstanding career was held at Dalton House on 17 March, which brought together many of his colleagues past and present, including from Network.

Les has been the Network’s Co-Chair along with Maria Heaton since the Network was formed in 2011. Although Les will remain as Co-Chair, the Network will be looking to train a third Co-Chair in preparation for Les moving into other roles as his retirement continues.

The Network benefits immensely from Les’ leadership and communication skills, as well as his understanding of how the layers of the health system interconnect.

Les did not train in intellectual disability. As a Paediatrician, he has worked as an Oncologist and researcher before moving into health services management. He was Executive Director of Sydney Children’s Hospital for 16 years, UNSW academic lead for six years and President of Children’s Healthcare Australasia for more than five years. He also currently serves on 10 Boards.

What he brings to the role as Co-Chair is an interest in health services and health outcomes improvement, a commitment to equity and support of vulnerable populations, as well as a belief in the importance of engaging clinicians and patients in the process. He works tirelessly to that end and will see the launch of Building Capacity in NSW Health Services for people with Intellectual Disability: The Essentials, the final component of a comprehensive ID Resource Pack, before he retires from the role as Network Co-Chair.

Congratulations Les on a wonderful career, we look forward to continuing to work with you to improve care for people with intellectual disability in NSW.

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Institute of Trauma and Injury Management

New Innovation Working Group

The ACI Institute of Trauma and Injury Management (ITIM) is seeking members for the newly created Innovation Working Group.

The working group has been established to provide the ITIM Executive Committee with clinical subject matter expertise on feasibility, desirability, execution and implementation of innovative projects and where appropriate, to assist in communication of ITIM initiatives to the trauma community.

Who should join?

NSW clinicians with a background in the pre-hospital, retrieval, emergency, trauma, surgical, intensive care and critical care sectors that can fulfil one of the following roles:

  • Medical/Surgical Fellow
  • Medical/Surgical Registrar
  • Clinical Nurse Consultant
  • Clinical Nurse Specialist
  • Paramedic (P5 [ICP] and Above)
  • Retrieval Nurse.

Expressions of Interest are now open until close of business 15 April 2016.

For more information and the terms of reference go to the Innovation Working Group website or contact

Ophthalmology Network Co-Chairs: Michael Hennessy, Ross Ferrier and Julie Heraghty

Ophthalmology Network Manager

The eyes have it – validation for the vision defect stroke tool

The Vision Stroke Defects tool is a joint project between the Network’s Orthoptic Standing Committee and the Stroke Network. The project aims to develop a screening tool which can be used by non-eye care practitioners to assist in the identification of pre‐existing and recently acquired vision problems in patients who have recently had a stroke. The need for such a tool has been previously identified, with many patients failing to have eye conditions detected and therefore managed during the early stages of their recovery.

Validation of the screening tool was required prior to the introduction of the tool into Stroke Units in NSW hospitals. A total of 100 hundred patients, along with stroke unit clinical staff, were recruited from Hornsby Ku‐ring‐gai and Manly Hospitals in conjunction with the University of Sydney and the University of Technology, Sydney.

The report concludes that the vision screening tool is suitable for its intended purpose and identifies pre‐existing and newly acquired visual problems in patients with a diagnosis of stroke. The report further highlights that when coupled with an educational package, the use of this tool could potentially reduce over‐referral of patients (50% during validation) to ophthalmological services, ultimately reducing outpatient demand.

The Ophthalmic Standing Committee met in March to plan a wider trial and eventual state wide roll out.

For more information, contact the Network Manager.

Pain Management Network Co-Chairs: Michael Nicholas and Philip Siddall

Pain Management Network Manager

New resources to celebrate second anniversary of innovative pain website

On 25 March 2014, the Agency for Clinical Innovation (ACI) Pain Management Network launched an innovative new website in response to the NSW Health Pain Plan 2012 - 2016. Two years later, the Chronic Pain website has had more than 360,000 visits and continues to provide a wealth of information and support for clinicians and consumers managing chronic pain.

Affecting one in five people, chronic pain is pain that persists for more than three months and doesn’t go away. It interferes with people’s lives, work and relationships. Many people with chronic pain feel isolated and alone, and that others don’t understand their experiences. Learning different strategies to manage pain is an important part of an integrated approach to living with chronic pain.

To celebrate the second anniversary of the launch, two new sections have been added to the website. Quicksteps is a decision making tool which can help General Practitioners (GPs) to work with their patients to create tailored, individual care plans by providing a framework of care depending on the responses given. It considers factors such as history and current condition, psychological distress, self-management, medications, physical activity, sleep and nutrition. Once a GP and patient have worked together to answer the questionnaire, free online resources are suggested to address each area of need and a GP plan template provided to aid continuing management of chronic pain.

Following extensive consultation, new resources for people in different languages have also been added to the website. A toolkit for pain management and a five minute video have been translated and are now available in Arabic, Vietnamese, Mandarin, Cantonese and Greek languages.

Learn more about how we are working together to make a difference or visit the ACI Chronic Pain website.

Connecting Pain into Primary Care using telehealth

Accessing specialist care such as pain clinics can be a challenge for people living in rural and remote areas. In order to address this challenge, the Pain Management Network partnered with the ACI Telehealth Officer to develop and trial a model with the goal of assisting pain clinics in NSW adopt capabilities

The two pilot sites were based at Orange Hospital and the Sydney Children’s Hospital Westmead. The pilot provided telehealth consultations in patients’ homes and primary care settings (e.g. general practitioner (GP) practices and private allied health practices).

A Chronic Pain Telehealth toolkit was developed which outlines all aspects of the telehealth model and provides clinicians and service managers with checklists, patient consent, patient information sheet, and a patient evaluation sheet template. The toolkit supplements the hands-on implementation support provided by the ACI.

The Network engaged Healthdirect Australia to provide the technology for the service, known as videocall©. Videocall© provides is readily accessible desktop video conferencing to clinicians and patients. Results from the trial suggest that telehealth is a feasible alternative delivery model for chronic pain clinics for both patients and clinicians. Over the six month period:

  • 32 sessions were conducted across both sites with an average of 50 minutes of contact time per session.
  • Of these, 26 were successful to the point that they were rated as good as a face to face session by the clinicians and the patients, with 83% achieving the desired clinical outcome and 100% of patients reporting that they would continue using the telehealth service.
  • Benefits were delivered to the patient, staff, service, to primary care and the system as a whole. Over 9000 kilometres in travel was saved and cancellations were reduced.
  • Referring clinicians were more likely to refer a second patient following a successful telehealth intervention.

The service has now been expanded to Greenwich Hospital and St Vincent’s Hospital with a further six sites planned for implementation in the future. Capability for use of iphones and ipads will also roll out shortly, with compatibility for Android devices already available.

The full evaluation report can be found on the ACI website.

For further details about telehealth in NSW contact Julia Martinovich, Telehealth Implementation Officer on email or telephone 02 9464 4622.

For more information on Pain Management contact the Manager.

Renal Network Co-Chairs: Jane Milz and Paul Snelling

Renal Network Manager

2016 Renal Network Forum

The Renal Network hosted a Renal Network Forum in Sydney on 16 March 2016. The event was attended by 58 clinicians, consumers and managers from across rural and metropolitan Local Health Districts (LHDs), the Sydney Children’s Hospital Network and the NSW Ministry of Health.

The purpose of the event was to identify several key objectives and strategies for the Renal Network and to update members on ACI’s role in assisting the Renal Network. To kick things off, attendees heard from Daniel Comerford, Director, Acute Care about the various ways the members can further engage with the ACI, as well as key items from the ACI Strategic Plan 2015-2018.

Renal Network Co-Chairs Paul Snelling and Jane Milz presented an overview of the Network. Jane provided a detailed background about the history and evolution of the Network prior to it being incorporated as part of the ACI, while Paul outlined the recent restructuring of the Network, which aimed to better align Network priorities with the strategic direction of ACI going forward.

The morning session was dominated by project presentations including:

  • Mark Brown presented the Renal Supportive Care Project which provided a brief background to the project on providing a co-ordinated approach to the management of patients with End-stage Kidney Disease (ESKD) for whom dialysis is not the most appropriate management pathway and for those who continue to have a poor quality of life despite dialysis, funding allocation and the current implementation model across NSW
  • Mary Ann Nicdao presented the Home Haemodialysis App which was developed at a local level by the Western Sydney Renal Service
  • Paul Snelling presented several projects outlining the need for a process in clinical research
  • Sallie Newell presented the Health Economics & Evaluation at the ACI framework which included a snapshot of evaluation methods and highlighted the various tools and resources available through ACI website
  • Lisa Bardy and her team from the Ministry of Health presented the Clinical Services Planning Methodology review that is currently being developed and consulted with the renal group of stakeholders for feedback.

The afternoon session included a workshop facilitated by Paul and Renal Network Manager Rama Machiraju. The workshop focused on brainstorming and a voting session for work under the two new streams in the restructured Network, Service Delivery and Innovation & Redesign. A session summary will be prepared using the inputs from the day to develop a workplan for the Network.

Farewell Jane Milz

The ACI Renal Network would like to thank Jane Milz, Co-Chair of the Network, who is stepping down from the role she has held since 2013. Jane has also served as Co-Chair of Dialysis Working Group since Dec 2011, and has been a leading force in developing the Network and its work in improving care for renal patients in the NSW health system. Jane has been an active contributor in the restructure of the Network in the past few months as we look at how we can work more efficiently to provide improvements in renal care.

Jane is also retiring from her role as Manager Renal Services, MNCLHD & NNSWLHD and is looking forward to a well-earned break. Congratulations on a wonderful career Jane, we wish you all the best in your future endeavours.

Rural Health Network Co-Chairs: Richard Cheney and Patrick Frances

Rural Health Network Manager

Rural Innovations Changing Healthcare Forum

On Tuesday, 15 March more than 210 people attended the 3rd annual Rural Innovations Changing Healthcare (RICH) Forum.

RICH is a 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.

The RICH 2016 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, Medicare Locals, residential aged care providers, 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.

Presentations addressed the overall theme of ‘Patients, Families, Communities - Partners for better outcomes’, and came from clinicians and managers across five LHDs and one PHN. Two moving consumer patient experience stories kicked off the day on the right note and highlighted the importance of health services developing innovative new ways of delivering care in such a complex and challenging setting. The RICH Forum uses a combination of face-to-face, tweeting via the #RICH2016 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. The presentations from the 2016 RICH Forum are available to view on the website.

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Transition Care Network Co-Chairs: Sue Towns and Mae Rafraf

Transition Care Network Manager

Lynne Brodie

9464 4617 | 0414 015 115

Transition Care Network

Westmead Transition Orientation Tour

Western Sydney Local Health District’s (WSLHD) patient and carer experience team, in collaboration with the Children’s Hospital at Westmead and Agency for Clinical Innovation Transition Care Team, held their inaugural transition orientation tour of Westmead Hospital on 10 February 2016.

The tour was targeted at carers of young people who are unable to self-manage, transitioning from paediatric to adult health care at Westmead. Staff from outpatient services, pharmacy, emergency, radiology, dental services and physiotherapy departments were on hand to answer a variety of questions.

WSLHD Patient and Carer Experience Officer Wendy Cain acknowledged that transition can be daunting time for patients and carers and it is hoped that the tour will help them to feel more comfortable and better able to navigate the hospital when they leave paediatric services.

Referrals for 2015

A total of 463 young people were referred to our Transition Care Coordinators in 2015, a 55% increase on the previous year. The increase largely reflects the change in referrals to ACI from Trapeze, the chronic care and transition service of the SCHN. The majority of referrals (75%) come from SCHN and John Hunter Children’s Hospital, with the remainder from a sources such as The NSW Department of Education, Ageing, Disability and Home Care, paediatric units throughout NSW and self-referrals from young people and their families/carers. A full report is available on the Transition Network page.

ACCESS 3 Research Study

The NSW Youth Health Access Survey is a research project from the University of Sydney which aims to find out more about how young people aged 12 to 24 access health services in NSW. The report has important implications for improving the transition of marginalised young people and the ACI Transition Network Manager is a member of one of the research groups. Funded by the Office of Kids and Families, NSW Health, the ACCESS 3 research study will describe the experiences of young people accessing and navigating the health system in NSW. The study examines the barriers and facilitators to accessing health care for marginalised young people in NSW.

The study will focus on young people aged 12-24 living in NSW who are:

  • Aboriginal and/or Torres Strait Islander
  • living in rural/remote areas
  • homeless or at risk of homelessness
  • refugee or vulnerable migrants
  • identifying as gender or sexuality diverse.

Research findings will be presented to key stakeholders from policy and practice to help translate the findings into policy-relevant recommendations. or to share the survey with relevant young people, visit the website: NSW Youth Health Access Survey.

Fourth International Oesophageal Atresia Conference

SAVE THE DATE! The Sydney Children's Hospitals Network will host the 4th International Oesophageal Atresia Conference in Sydney on 15 – 16 September 2016.

The aim of the forum is to improve the standard of care of these complex patients, who often have problems with severe reflux, feeding difficulties, failure to thrive, gastrostomy feeds, dysphagia due to recurrent strictures, chronic lung disease and tracheomalacia. The international consensus guidelines will be presented to an international audience including more than 300 gastroenterologists, pulmonologists, ENT specialists, surgeons, dieticians, speech pathologists and parent support groups for the first time.

Don't miss out, learn more and register at

Get Involved. Make a Difference

There are many ways to get involved with ACI. You can join a network, access resources, attend an event, improve your skills, use your experience, stay informed, learn share connect with the Innovation Exchange, or work with us to improve healthcare. All of these opportunities are advertised on the ACI's Get Involved website.

There are numerous benefits to being involved with ACI.

Access Resources: Help for GPs – New pain management resources

Use the new Quicksteps tool to guide you in your chronic pain consults.

Dr Hester Wilson discusses how she uses the Pain Website in her General Practice to manage her chronic pain patients. Watch the film below, then click through to listen to clips to help with introducing exercise and psychological therapies, and how to approach your chronic pain patients with the idea of reducing opioids.

Improve your skills: Centre for Healthcare Redesign

The ACI Centre for Healthcare Redesign (CHR) provides a statewide diploma program for health professionals to improve clinical processes and deliver better patient journeys.

Using proven Redesign methodology this course teaches frontline staff how to identify the root causes of issues impacting the patient journey and then develop and implement sustainable change processes to improve the way health care is delivered.

Participants of the CHR Diploma program complete a workplace project as part of the course and on completion have the opportunity to gain an accredited Diploma of Project Management qualification.

View last years' graduation and the Maitland hospital VIP project on the film below.

Aboriginal Cultural Competency and Safety Working Party

The ACI hosted a cultural competency forum for all ACI staff on Thursday, 10 March 2016. For more information, see the update.

Upcoming events

Stroke Reducing Unwarranted Clinical Variation Forum


11th Annual Critical Care Conference in the Vineyards

Please visit our Events Calendar for program details and information on how to register.

APAC Forum

The APAC Forum is coming to Sydney!

This year, for the first time, Asia Pacific's premier healthcare conference will convene in Sydney over the three days of 12-14 September 2016. As one of the largest health improvement conferences in the world it is set to attract the biggest delegation of change-makers APAC Forum and Australia has ever seen.

Bringing together some 2,000 health professionals, the APAC Forum will appeal to anyone with an interest in the health sector that has the aptitude and desire to create change; it attracts change-makers who are leaders, policy makers, patients, consumers, carers, doctors, nurses, allied health and quality improvement specialists.

The Agency for Clinical Innovation and the Clinical Excellence Commission are joint Gold Sponsors of this year's APAC Forum.

Early bird tickets available now!

Discounted early bird registrations are available now. Please visit the APAC Forum website for detailed conference costs, program information, and to register.