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Volume 8, Issue 4 – August 2016

Clinician Connect

Sam Sangster, Maggie Haertsch, NSW Health Minister Jillian Skinner, Tara Dimopoulos-Bick and Chris Puplick. Photo: AHI. See the report for more.

Feature Editorial

by Associate Professor David Storey, Clinical Advisor, Clinical Excellence Commission, Director Surgical Education Sydney Local Health District, Director of Training for the Sydney South West Surgical Skills Network, and Associate Professor, Surgery Central Clinical School, Sydney University

David Storey

Delegation and Escalation (Clinical Excellence Commission)

In November 2008 the Special Commission of Enquiry into Acute Care Services in NSW Public Hospitals ('the Garling Report') was published with a chapter 13 dedicated to supervision of junior clinical staff. Recommendation 47 was specifically related to surgical services and included the suggestion that NSW Health undertake a review of, and examine the improvement options for the supervision of registrars undertaking surgery, including but not limited to:

  1. Whether it is appropriate, and if so how, to separate by facility or operating list or otherwise planned surgery from emergency and urgent unplanned surgery
  2. Whether any change in workplace rostering or practices is necessary to maximise supervision of surgeons in training and minimise risk to patient care from surgery being conducted after hours without supervisors present
  3. Developing systems for monitoring the extent of and adequacy of supervision being undertaken by registrars. (Garling, 2008)

Supervision of clinical care has a number of elements which include the education, training, mentoring and support of clinicians, the managerial aspects including resources and performance management and the delegation and escalation of clinical care. The Clinical Excellence Commission has been working with many different organisations and people to improve delegation and escalation of clinical care. These aspects of patient care are crucial – delegation (who is asked to carry out the care and whether they have the knowledge and skills to safely complete the allocated tasks) and escalation (what should happen if the less experienced clinician needs help, or the patient deteriorates, and what should be considered a safe and appropriate response). These processes are equally important in the process of training clinicians.

The documentation of these important elements of care is variable. In medical care especially, the decisions about delegation, and the expectations about (and the responses to) escalation are often matters considered to be between the senior and junior clinician and possibly the postgraduate educational body, ignoring the institution's responsibility under its clinical governance imperatives.

Very little data about supervision is currently captured in institutionally based systems. For example, supervision of surgical cases is not uniformly captured in NSW operation reports. This information should be able to be used to improve processes of training and safety. This is not to suggest that operating theatres are especially problematic areas for delegation and escalation – it is just that the operating theatres are clearly defined precincts.

Root cause analysis where clinical supervision was described as a contributing system issue in the CEC data base during the period 2011-2013*

Emergency: 38, Surgery: 36, Medicine: 17, Cardiology/Cardiothoracic 16, Other: 16, ICI/HDU: 12, Aged care/Rehab/Palliative: 9, Renal/Dialysis: 7, Cancer Care/Oncology: 6, Neurology/Spinal: 5, Respiratory: 5

*Not all RCAs in 2013 were included as they had not yet been submitted and/or classified

Supervision of surgical cases is also not uniformly captured in NSW operation reports. This information should be able to be used to improve processes of training and safety. This is not to suggest that operating theatres are especially problematic areas for delegation and escalation – it is just that the operating theatres are clearly defined precincts.

To capture this information so it can be examined for areas of improvement, a section related to supervision has been added to the operation report in SurgiNet as a trial. The CEC has partnered with SESLHD to trial the changes. For the trial period, there have been two sections addedto the current Medical Staff component of the operation report. The first is a case supervision category which has a number of options for the operating surgeon to select, closely resembling the General Surgeons Australia and Australian Orthopaedic Association logbook categories. There is an additional field that can be selected if the supervisor or case mentor is called into a procedure to assist or to take over. The options are:

S0. No trainee present

S1. Procedure mostly performed by trainee, surgeon mentor scrubbed

S2. Procedure mostly performed by trainee, surgeon mentor in room unscrubbed or in Suite

S3. Procedure performed by trainee, surgeon mentor available if required

S4. Procedure performed by surgeon mentor, trainee assisting

S5. Procedure performed by senior registrar/fellow, trainee assisting

S6. Surgeon mentor called in during procedure (escalation)

The second addition includes the option of selecting a case mentor if this is different from the case consultant. The new section in SurgiNet is being trialled across SESLHD until August. As lessons are learned from the pilot, any required changes will be made in preparation for a wider rollout. If this trial is successful other procedural and non-procedural areas may follow.

Report systems are also being developed to extract this data in formats useful to individual trainees, department heads and institutions. The benefits of reporting this data include provision of data to Surgical Departments for review of trainee progress against an agreed matrix of expected delegation, a log for trainee cases and the ability to measure variation.

Welcome to the August issue of Clinician Connect

by Nigel Lyons – Agency for Clinical Innovation

Welcome to the August issue of the Clinician Connect newsletter. As we move into the second half of 2016, we remain focussed on our work, collaborating with clinicians, consumers, managers and the system itself to deliver real improvement initiatives to patients of the NSW health system.

We recently partnered with the Clinical Excellence Commission (CEC) to host our regular LHD Connect Forum, which saw senior representatives from Local Health Districts (LHDs) and Specialty Health Networks (SHNs) come together to discuss topics such as partnerships and collaboration, enhancing capability for service improvements, and using data to drive change. The Forum was a great opportunity for the ACI and CEC to present current work, with a focus on our approach to addressing unwarranted clinical variation, while also allowing plenty of opportunity for LHD representatives to feed back on the ways in which our organisations work together currently, and how we can further improve our support.

The August Guest Editorial comes from Associate Professor David Story in his role as Clinical Advisor at the CEC. His piece discusses supervision of registrars undertaking surgery, the difficulty in recording this important information, and a trial being undertaken to test the new SurgiNet section of the eMR dedicated to improving this record.

It is fantastic to see the many collaborations being undertaken between the ACI and other like-minded organisations to improve the way care is provided in NSW. In this issue, you can learn more about the partnerships we have developed with the Australian Commission on Safety and Quality in Health Care (ACSQHC) on dementia and delirium, and with the Arts Health Institute (AHI) on bringing the innovative Music & Memory program to NSW Health facilities.

There is also a lot of work being undertaken to build the capability of frontline staff in the LHDs, empowering them to make innovative changes at a local level, such as our Surgery Redesign School and Patient Reported Measures workshops, which are featured in this issue.

Our annual Rural Innovations Changing Healthcare (RICH) Forum once again showed the advantages of using modern technology in the way we share knowledge and lessons learned across the system, as rural and regional teams from across the state showcased their local improvement projects to other facilities.

Our commitment to making the ACI a culturally competent organisation continues, with celebrations for NAIDOC Week 2016 including events such as a traditional Indigenous 'bush tucker' lunch session, followed by daily screenings of documentaries on Aboriginal history and culture. Our Respiratory Network has also undertaken a project to develop a series of culturally appropriate respiratory education resources for the Aboriginal community with great success, which you can read more about in in the Respiratory Network Update.

We are committed to continually working with all aspects of the system to develop innovative, best practice models that will provide better care for people in NSW.

Dr Nigel Lyons
Chief Executive, ACI

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

Aged Health Network Manager

Care of Confused Hospitalised Older Persons Forum

The Aged Health Network hosted the 2nd Care of Confused Hospitalised Older Persons (CHOPs) Forum on 24 July at the ACI offices, with CHOPs project leads and teams in attendance.

Attendees at CHOPs forum. Photo: S. van de Scheur

The forum was held in collaboration with the Australian Commission on Safety and Quality in Health Care (ACSQHC) Caring for Cognitive Impairment campaign. It showcased the achievements of the NSW Hospitals who have implemented the CHOPs program, highlighted linkages between CHOPs and the new Comprehensive Care Standard as part of the draft version 2 of the National Safety and Quality Health Service (NSQHS) Standards, and discussed strategies to sustain the CHOPs program in to the future.

The Network would like to extend sincere thanks to Cath Bateman, whose secondment to ACI for the CHOPs project was completed on 30 June. Cath returns to her substantive role as Dementia Delirium CNC at Southern NSW LHD and Program Coordinator - Dementia Delirium Volunteers Project.

Allies in Dementia Care

The Allied Health Subgroup and Alzheimer's Australia (AA) have produced two guides to highlight the many ways that allied health professionals (AHPs) can contribute to the everyday lives of people living with dementia, their carers and families.

The consumer guide Allied health professionals and you: a guide for people living with dementia and their carers empowers people living with dementia and their carers to partner with allied health professionals to live life to the fullest.

The health professionals' guide Better health for people living with dementia: a guide on the role of allied health professionals provides information and ideas for doctors, nurses and allied health professionals about a range of evidence-based health interventions that can support people living with dementia and their carers.

Thank you to Atosha Clancy who has completed her secondment with the ACI to undertake the Allies in Dementia Care project.

Left to right: Jamie Hallen, Elaine Todd, Glen Pang, Atosha Clancy and Michelle Frawley.

The steering committee included: Elaine Todd, Joan Jackman, Jenny Henderson Kate Swaffer (Consumer Dementia Research Network, Alzheimer's Australia) Jamie Hallen, Jacqueline Wesson, Michelle Frawley, Viki Brummell (Allied Health Subgroup, Aged Health Network)

These resources will be launched in conjunction with Alzheimer's Australia during Dementia Awareness Week in September at Parliament House Canberra.

Aged Health Collaborative Forum

The 4th Aged Health Collaborative Forum will be held on 14 October 2016 at the Westmead Education Centre, Sydney.

The Forum aims to foster collaboration in aged health across the NSW Ministry of Health and the Pillars. Partners in the collaborative include:

  • Aged Care Unit, Integrated Care Branch, NSW Ministry of Health (MoH)
  • Older People's Mental Health Policy Unit (Mental Health and Drug & Alcohol Office), MoH
  • Whole of Health Program, System Relationship Branch, MoH
  • Nursing and Midwifery Office, MoH
  • Clinical Ethics and Policy, Office of the Chief Health Officer, MoH
  • Agency for Clinical Innovation (ACI)
  • Clinical Excellence Commission (CEC)
  • Health Education and Training Institute (HETI)

The theme of this year's forum is Collaboration for good care.

APAC conference

Why should you attend APAC Forum 2016?

This year, for the first time, Asia Pacific’s premier healthcare conference will convene in Sydney, 12-14 September 2016. The APAC Forum is one of the largest health improvement conferences in the world and it’s hailed as the best.

Providing a unique platform to improve the health and wellbeing of our population, the APAC Forum unites global thought leaders, frontline teams, colleagues and contemporaries to inspire every person working in health, stimulate cross-sectorial and multi-disciplinary dialogue, nurture knowledge transfer, design and share best practice, and enable every delegate to become a catalyst for change.

By attending the APAC Forum 2016 you will have access to dozens of high-profile speakers covering keynote presentations, interactive workshops, readymade sessions, intensive sessions, and more. You will hear from local and international presenters, who are pioneering change and making a real difference to the lives of their patients, their organisation, and the health sector.

Keynote speakers

Dr Devi Shetty – Dr Shetty is the founder and director of India’s Narayana Health. He is a cardiac surgeon who has completed over 15,000 surgeries; more than 4,000 of them on children suffering from heart disease. Dr Shetty is described as a healthcare entrepreneur and is credited for “walmart-ising” heart surgery.

Janine Shepherd - Once a champion cross country skier, Janine’s life was irrevocably altered when she was hit by a truck while training for the winter Olympics. Doctors expected that she would not survive her extensive injuries but her fighting spirit saw her not only survive but become a pilot, an aerobatics instructor, successful speaker and best-selling author.

Professor Jonathon Gray - With 20 plus years’ experience and a Master’s in Public Health from Harvard, Jonathon is an expert in healthcare improvement, known for his passion for collaboration and innovation. He is the director of Ko Awatea, the Stevenson Professor of Health Innovation and Improvement at Victoria University of Wellington, a visiting chair to Auckland University of Technology (AUT) and Cardiff University, and is a Fellow at Oxford Centre for Healthcare transformation.

Professor Nicholas Christakis – Nicholas is a sociologist and physician who conducts research in the area of biosocial science, network science, and behaviour genetics. He directs the Human Nature Lab at Yale University and has been named as one of the ‘100 most influential people in the world’.

The ACI and Clinical Excellence Commission (CEC) are proud to be joint Gold Sponsors of this event.

Register now! For more information or to register please visit the APAC Forum website.

Burn Injury Network update

Burn Injury Network Manager

Burn Education sessions

The ACI Burn Injury Network offers a range of educational courses for health professionals working in the burn injury field.

The Minor Burn Management Education Day is designed primarily for nurses who treat minor burn injuries in their practice.

This training event is run once or twice per year in Sydney at one of the three NSW Severe Burn Unit Hospitals; Children's Hospital at Westmead, Royal North Shore Hospital and Concord Repatriation General Hospital.

The training lectures cover the following topics:

  • Burns Assessment
  • Wound management in both adults and paediatrics
  • Factors impacting healing in both adults and paediatrics
  • Pain management
  • Understanding referral processes and local management
  • Biobrane management
  • Patient self-management
  • Scar management/ splinting/ positioning.

Feedback from previous evaluations of the event includes:

Informative – interesting. The presenters all provided great information – shows they know their specialty areas well.

Awesome informative day. Thanks.

The full day course has interactive sessions in the afternoon.

For more information on the Minor Burn Management Education Day course contact Siobhan Connolly, Burn Education and Prevention Manager on

The Burn Rehabilitation Management Course is an annual event held over two days. It is aimed at health professionals who have minimal experience or are just beginning to work with people who have sustained a burn injury, as well as those interested in this area of practice.

Burn Rehabilitation Course lecture.

The course cover the following topics:

  • Burn Rehabilitation overview
  • Pathophysiology of burn injuries
  • Surgical management
  • Pain management
  • Wound management in the rehab setting
  • Psychosocial impact and management
  • Nutrition
  • Burn reconstructive surgery
  • Scar management
  • Exercise
  • Splinting
  • Swallowing and voice.

Feedback from previous course evaluations includes comments such as:

Excellent course overall. I learnt a huge amount and feel a lot more confident about treating burn patients.

The full Burn Rehabilitation Management Course has interactive sessions with burn survivors, which allows attendees the opportunity to pull together all the theory covered over the two days connecting and speaking with someone who has the lived experience of a burn injury.

For more information on the full course contact Anne Darton, Burn Injury Network Manager on

The didactic lectures from two recent burn education sessions were recorded and can now be viewed here.

Clinical Program Design and Implementation update

Specialist Geriatric Outreach program for residential aged care facilities launch

The Specialist Geriatric Outreach (SGO) into Residential Aged Care Facilities (RACF) Project, which sees an integration of services between acute care services, primary care, and residential aged care facilities (RACFs), is being launched across NSW.

The project is a statewide initiative led by the ACI in partnership with NSW Ambulance, Local Health Districts (LHDs), Primary Health Networks (PHNs), and local residential aged care facilities.

Evidence has shown that treating older patients in their place of residence not only improves patient experience and comfort, but can also improve health and wellbeing outcomes.

The SGO program aims to provide the local community with an enhanced patient experience, decreased length of stay for hospital admissions, improved coordination and partnerships throughout the patient journey from residential facilities to the Emergency Department (ED), faster response time for assessments, and appropriate interventions for RACF residents.

The program includes a central point of contact for RACF staff to speak to hospital staff should a resident begin to feel unwell, assessment of the resident at the aged care facility, a care plan to be developed should the resident require any additional care, and a feedback loop with the GPs who regularly visit the resident in the RACF.

For more information on the SGOP, visit the Clinical Innovation Program webpage.

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

Drug and Alcohol Network Manager

Drug and Alcohol Innovation Forum 2016
Your Ideas Making a Difference

The ACI Drug and Alcohol Network is pleased to host the Drug and Alcohol Innovation Forum on 11 August at the Kirribilli Club in Lavender Bay.

The Forum is the first forum of its kind in NSW and will showcase innovative and creative solutions to address the diverse and complex needs of people accessing drug and alcohol services. Come along to hear about the inspiring work being done in the field across NSW.

There will also be an opportunity on the day to vote for your favourite potential project, which will be taken forward by the Drug and Alcohol Network and the ACI.

This event will be live streamed for those unable to join in person and can also be followed on Twitter via the hashtag #DAIF16.

To register to attend the event, please visit the online form.

Health Outcomes update

ICHOM Alliance Relationship Lead

Rob Wilkins

9464 4741

Reflections on Health Outcomes approaches here and overseas

The ACI's Health Outcomes Program aims to achieve improved health outcomes for the people of NSW by working with clinicians and consumers to collect and apply clinically meaningful information to the way care is provided.

Left to right: Rob Wilkins, Health Outcomes Program Lead; Andrew Brooks, Co-Chair ACI Urology Network; Suzanne Kennewell, Co-Chair ACI Nutrition in Hospitals Committee, Jo Lunn, Co-Chair ACI Drug and Alcohol Network and Raj Verma, Director Clinical Program Design and Implementation.

Part of this program of work is a strategic partnership with the International Consortium of Health Outcomes Measurement (ICHOM). ICHOM's mission includes defining global Standard Sets of outcome measures for the most relevant medical conditions, as well as driving adoption and reporting of these measures worldwide.

This year's ICHOM Conference was held in London and had a focus on impact and implementation - the "why" and "how" of outcomes measurement.

ACI Network Co-Chairs Suzanne Kennewell, of the ACI Nutrition in Hospitals Committee, Jo Lunn of the Drug and Alcohol Network and Andrew Brooks of the Urology Network participated in the conference. These three ACI networks are all currently engaged in health outcomes-based programs, and the Conference gave the Co-Chairs an opportunity to learn more about the work being done in this area globally. ACI staff members Raj Verma, Director of Clinical Program Design and Implementation, and Rob Wilkins, Health Outcomes Program Lead also joined the Co-Chairs at the Conference.

The following pieces are reflections from the ACI Network Co-Chairs' experience of the Conference.

Suzanne Kennewell, Co-Chair, ACI Nutrition in Hospitals Committee

The 2016 ICHOM Conference explored the concept of 'value' in healthcare, with a repeated theme throughout the conference of:

Value = Outcomes ÷ Cost

The conference focused on the need to use practical steps to weave capturing health outcome measures into routine work within healthcare systems. Some key tips included:

  • Start simple and use a project management approach to implementing outcome measurement
  • IT engagement is critical for success, but can be both challenging and expensive
  • Link health outcome data with eMR wherever possible
  • Hardwire health outcome data capture into day-to-day work

Health managers across the globe understand the challenge of managing ever increasing demand on healthcare with finite resources. Speakers encouraged senior healthcare managers to explore the potential to use health outcome data to better rationalise expenditure of the health dollar through identifying low value versus high value expenditure.

There was also a strong theme around the value of Patient Reported Outcome Measures (PROMs) to capture health outcome data, but only if PROM tools reflect the local population and language. Clinicians reported using PROMs not only to measure outcomes, but to drive therapeutic interventions. PROM data is collected at the beginning and end of treatment, with key attributes also measured between treatments. These 'in-treatment' measures are used to identify current issues for patients and to trigger intervention. Using PROMs to drive therapy resulted in strong patient and clinician engagement, creating obvious 'wins' for all parties. However, speakers noted if PROMs were used as a performance measure, then item reliability, validity and risk to validity (e.g. missing data, poor response rate) needed to be considered.

The development of internationally recognised health outcome measures that focus on outcomes valued by patients supports a patient-centred health care system. NSW Health, with a proactive approach to using health data to improve patient care, is ideally placed to make the most of these opportunities.

Jo Lunn, Co-Chair ACI Drug and Alcohol Network

This opportunity was timely for the Drug and Alcohol Network, with major changes in Patient Reported Outcome Measures (PROMS) occurring in both the alcohol and other drug (AOD) government and non-government sectors. The NSW Ministry of Health has commissioned the development of a clinical outcome and quality indicator framework (the COQI project) that will draw data from drug and alcohol clinical information entered into the NSW eMR systems. The project involves sector consultation, collaboration with information and data branches, a validation study and developing composite measures for future benchmarking.

The non-government AOD sector has been electronically collecting client outcomes for approximately five years to demonstrate positive effects of treatment and/or guide service improvement. These measures are currently being reviewed to ensure that they are in line with client goals and expectations of treatment.

The ICHOM conference allowed for the opportunity to create international contacts and to see what is happening across the world. Despite the timely relevance for the AOD sector of the ICHOM conference, my main reflection was the reinforcement of the key importance of theory behind PROMs.

Working with or accessing any health service I am often struck by the similar sense of organised chaos. There are always too many clients/patients/consumers (whichever term you like to use), too much paperwork and/or complicated admin processes to comply with, commonly a background of potential change coming through, such as the looming date of a funding submission, threat of budget cuts or yet another restructure (all of which will result in the demand for us to do things differently) and not to mention the 'joys' that office politics can often bring. That is before we even start the medical/psychological interventions we specialise in.

With all of these distractions it is no wonder that we can lose sight of why we are at work in the first place. Obviously we need to earn a living but the point of our employment is the health and well-being of the people; our clients. It can also be easy to forget that we can enter our clients lives at incredibly traumatic or life changing moments and that they too will bring their own fears, hopes and expectations in relation to the outcomes of the interventions we provide.

The ICHOM conference strongly reinforced the advantage of PROMs.

It thankfully is not yet another distraction or paperwork requirement but is a key process that can help remind us that we are working to improve our clients' health and well-being in a meaningful way by:

  1. actively identifying what the client values in terms of their health care and recovery
  2. reflecting on which client groups respond well to our treatments and which do not. This allows us to ask and explore the very important question of why and either continue doing what we are doing because it works, or design new interventions, while targeting the resources to where they are most needed.

Andrew Brooks, Co-Chair ACI Urology Network

Seeking value and measuring quality in the delivery of health care would seem obvious. Despite this, most of our current systems do not do this well and confound the determination of value. Systems such as audits, professional education measures or financial data held by funders at best provide a misty clue as to quality. The use of length of stay data as a surrogate for quality of care is one such example. In an era of increasing health costs, funders and patients are looking for value. This can be estimated by relating outcomes to cost but needs appropriate data systems to provide accurate measurement.

Traditional measures of health delivery have relied on 'process data'. This system acknowledged activity only and was frequently used as a funding model. Models such as 'activity based funding' currently used by NSW Health are an example. Activity funding itself encourages activity with no recognition of the quality of the outcome. The information systems built into this model were thus focused on activity data and are not readily adaptable to other systems.

Outcome data is being adopted as the way forward to measure quality of care and obtain value in delivery. A poor outcome frequently increases the cost of an episode of care three to four times. Measurement and improvement of outcomes over time would contribute to cost reduction. Outcomes include not only clinical outcomes but patient reported outcomes (PROMS). These outcomes measure another parameter, namely quality of life, after an episode of treatment. This is a measure of the appropriateness of treatment in parameters other than the narrow clinical one often used by the treating team. However, we need different data collection systems to provide the relevant information.

The NSW Cancer Institute, with funding from Movember, is participating in a programme to collect outcome data on the treatment of all cases of prostate cancer over a defined period. In addition to clinical data they will collect patient reported outcome data (PROMS). This is an extension of the concept of clinical data recognising that what a clinician may define as an outcome may not reflect the quality of life that a patient would desire. The discussions around quality of life in regard to continence and potency and the variable clinical behaviour of prostate cancer make this aspect very relevant.

The ICHOM data set for prostate cancer outcomes is almost identical to that used for the NSW Prostate cancer outcomes registry and provided NSW Health with an excellent measure of outcomes in NSW public hospitals.

Implementation of a system provides many challenges. We will need data sets that are relevant, compact and readily collectable. We will need IT systems such as tablets to facilitate clinician and patient input in PROMs. We need the support of the professional groups and funders in data collection and implementation of quality improvement programmes. We need governance systems and controls around data access, research and publication of the data.

Welcome to the new world of outcome measures.

Intellectual Disability Network update Co-Chairs: Les White and Maria Heaton

Intellectual Disability Network Manager

Korean Delegation for People with Disability

Lee Seong Gyu, Chairman of Korea Foundation for Persons with Disabilities, and other delegates visited Australia in May 2016. Tracey Szanto, Manager of the ACI Intellectual Disability Network, had the opportunity to speak with delegates about the purpose and activities of the Network in NSW. The delegates were particularly interested in the structure of the Network and the supports for inclusive health services for people with intellectual disability across the lifespan.

Delegates from the Korea Foundation for Persons with Disabilities, Ministry of Health staff and ACI Intellectual Disability Health Network Manager Tracey Szanto.

Nuclear Medicine Network update Co-Chairs: Barry Elison and Elizabeth Bailey

Nuclear Medicine Network Manager

Nuclear Medicine Forum

The ACI held a Nuclear Medicine Forum at North Shore Private Hospital on 23 May. Clinicians and Managers involved in Nuclear Medicine service provision were invited to attend the event.

Session one opened with an overview of the current and future direction of Nuclear Medicine presented by Paul Roach and Dale Bailey. This was followed by updates on workforce issues, with each profession represented. The session concluded with a presentation on equipment by Peter Troy from the Business Assets and Services Branch of the NSW Ministry of Health.

Session two explored the topic of dementia, beginning with a moving story from the wife of a person with dementia who discussed the challenges that occurred as a result of her husband receiving such a delayed diagnosis. Geriatrician Peter Veitch and Nuclear Medicine Physician Edward Hsiao of Royal North Shore Hospital gave comprehensive descriptions of the issues involved in diagnosis and treatment options for people with dementia. They also explored new imaging options using Positron Emission Tomography – Magnetic Resonance Imaging (PET-MRI) to give a diagnosis up to 20 years earlier.

In Session three, Radiation Oncologist Andrew Kneebone joined Edward Hsiao to discuss the combination of diagnosis and treatment known as Theranostics for Prostate Cancer patients.

There was support to continue to hold an ACI Nuclear Medicine Forum annually. This event provides an opportunity for multidisciplinary teams to come together to discover what is on the horizon for this specialty, particularly as it relates to many different conditions and rapidly changing technologies.

Farewell – for now

Longstanding Nuclear Medicine and Medical Imaging Network Manager Annie Hutton has accepted a twelve month secondment with the Clinical Excellence Commission as Project Manager for a clinical decision support tool called OrderRight.

The tool will assist referring clinicians to select the most appropriate modality in Radiology to diagnose or treat their patients, and will be tested at two pilot sites in Liverpool and Royal North Shore Hospitals.

There is a great opportunity to involve the many ACI Networks, Taskforces and Institutes which refer into Radiology in this work.

We look forward to welcoming Annie back in a year's time with a wealth of new knowledge and experiences.

Nutrition Network update Co-Chairs: Suzanne Kennewell, Nigel Lyons, Kelli Ward and Janet Bell

Nutrition Network Manager

Peter Talbot – Dietitians Association of Australia Award of Merit

Peter Talbot.

Congratulations to Peter Talbot, Manager Nutrition and Dietetics at Westmead Hospital, who received an Award of Merit at the Dietitians Association of Australia National Conference in May 2016.

Peter was nominated for the award for his significant contribution to nutrition care in NSW. This includes his role as Co-Chair of the ACI Home Enteral Nutrition (HEN) Executive Committee (2006-2015), his ongoing advocacy for people needing HEN, and for promoting the importance of nutrition as a critical part of patient care.

The ACI and the Nutrition Network commend Peter on his award.

Gastrostomy Care Workshop – Dietitians Association of Australia Conference

Tanya Hazlewood and Gayathri Jegendran.

The ACI Nutrition Network collaborated with dietitians from the Alfred Hospital in Melbourne to host a workshop on gastrostomy care at the Dietitians Association of Australia National Conference in May 2016.

Gayathri Jegendran, Senior Dietitian at Liverpool Hospital, and Tanya Hazlewood, Nutrition Network Manager, represented the ACI. The workshop, titled A Dietitians guide to gastrostomy tubes and devices: more than PEGS! was well attended, with more than 70 delegates participating.

Presentations and practical sessions covered the different types of gastrostomy tubes and devices, insertion and removal methods, routine assessment and basic troubleshooting.

Content for the workshop was based on the A Clinicians Guide: Caring for people with gastrostomy tubes and devices document.

Patient Experience and Consumer Engagement update

NSW Music and Memory Pilot launched

On 5 July the Health Minister Jillian Skinner launched the NSW Music & Memory pilot at the Art Gallery of NSW.

Chris Puplick, Maggie Haertsch, NSW Health Minister Jillian Skinner, Tara Dimopoulos-Bick and Sam Sangster. Photo: AHI

The event officially commenced the NSW Music & Memory pilot and opened a training day which brought together all the successful pilot site participants and Music & Memory program experts for a day of knowledge sharing and learning. Participants were introduced to the program, developed implementation plans for their sites and a received a hands-on introduction to the equipment and resources that will be used throughout the pilot.

Minister Skinner also launched the NSW Health and the Arts Framework and the Arts Information Exchange, hosted by ACI's Innovation Exchange website.

NSW Health Minister Jillian Skinner speaks at the Music & Memory Training Day 5 July 2016. Photo: AHI

The Music and Memory pilot program is a joint initiative of the ACI and the Arts Health Institute (AHI), and was a winner of the NSW Health in the Arts start-up grant in November 2015. Following the awarding of the grant, which funded two sites, the NSW Government funded an additional 19 sites to bring the program to 21 health facilities across metropolitan, rural and regional NSW.

"I was blown away after watching the presentation for the Music & Memory program. I've seen videos of patients with dementia who were totally withdrawn, become energised, getting up and dancing and singing. These results are fantastic," said the Minister at the event.

"I'm thrilled that after the initial grant we provided, we were able to fund 21 locations for this remarkable program."

Music & Memory is an accredited program that uses individual, personalised playlists on iPods to help improve the lives of people accessing healthcare.

It is a scalable, systematic and sustainable initiative from the USA which was initially designed to assist people with dementia. Due to the growing evidence of the importance and impact that music has on mood and recovery, the program was expanded to include people experiencing depression and feelings of isolation.

Music is profoundly linked to personal memories and our brains are hardwired to connect music with long-term memory. Uncovering music with deep personal meaning helps to bring joy and comfort to those with dementia, mental illness, chronic illness or those who are suffering from loneliness or isolation.

More information on the pilot is available on the NSW Health and the Arts Information Exchange at

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Patient Reported Measures update

Patient Reported Measures Program Manager

PRMs Capability Workshop comes to the ACI

Discussions held at the PRMs Capability Workshop. Photo: M. Tinsley.

The Patient Reported Measures (PRMs) program is a key enabler of and a priority within the NSW Health Integrated Care Strategy. The strategy will engage healthcare professionals with PRMs to enable their patients with chronic and complex conditions to provide direct, timely feedback about their health related outcomes. This process will enhance communication, involve patients in decisions about their care, and drive improvement and integration of health care across NSW.

On 3 June 2016, the ACI PRM team held a Capability Development Workshop for clinicians, managers and administration staff wanting to implement PRMs. The program aims to support local teams (within both tertiary and primary care) as they consider how PRMs might provide benefit in their specific practice setting and how successful implementation and integration can be achieved.

The workshop was a major milestone in the team's progression towards providing capability development to clinicians. The program addresses the evidence for, and value of, implementing PRMs in clinical settings and also addresses many practical considerations related to engaging patients and implementing PRMs both for patient care and for assessing quality outcomes.

One of the aims of the day was to get direct feedback from the clinicians that will be accessing the training and implementing the program on the front line. A General Practitioner (GP) who attended the program and who is implementing PRMs stated that they are changing their approach to patients from "What's the matter with you? to "What matters to you? Letting the patient have the voice".

Overall the day was positively received by attendees, who viewed the event not only as informative, but also as a great networking opportunity between other sites, and with the ACI PRM team.

The program will enable GPs and primary healthcare providers to find indicators and objective measures that will demonstrate how we are making a difference over time and that this has been a weakness, they are very excited to learn how they can use PRMs in their super clinic.

Clinician, Chronic Disease Management Forum, November 2015

For further information please contact the Manager.

Respiratory Network update Co-Chairs: Claudia Dobler and Sheree Smith

Respiratory Network Manager

Aboriginal Consumer Resources for better Respiratory Care

A statewide need for culturally appropriate consumer resources for respiratory disease education was identified as a priority by participants at the ACI Improving Aboriginal Respiratory Health Forum in 2013.

To address this need, the Respiratory Network consulted with Directors and Managers of Aboriginal Health Services to assess the cultural appropriateness of a set of existing Indigenous Respiratory Outreach Care program resources that were developed for use in Queensland Aboriginal and Torres Strait communities. Based on their advice, a formal evaluation of the Queensland resources was undertaken with Aboriginal community members, Aboriginal Health Workers, Aboriginal Health Service Managers and clinicians who provide respiratory care to Aboriginal people in NSW.

The evaluation showed that the images within the resources did not appropriately depict the diversity of Aboriginal people in NSW and their home, work and recreational environments.

Under the guidance of an Aboriginal Advisory Group, and with permission from organisations involved in the creation of the original resources, significant changes have been made to the images within the resources to make them culturally appropriate for use in NSW.

The set of the Aboriginal consumer resources includes:

  1. Flip charts to support discussions between health care providers and consumers:
    • Asthma in Children
    • Asthma in Adults
    • Chronic Lung Sickness (Bronchiectasis)
    • COPD
    • Pneumonia
    • Lung Cancer
  2. Action Plan for COPD to support patients to recognise flare ups, start early self-management therapy and get the right help.
  3. Talking Story Boards to raise awareness of lung problems and where to get help.
    • Smokes make your lungs sick.
    • Does asthma control you?

A series of workshops are planned to further support this work over the next year.

The new ACI Respiratory Care Aboriginal Consumer Resources are available for download.

There is a limited number of hard copy resource sets available via an online order process.

For further information, please contact the Manager.

Rural Health Network 'Grass Roots' update Co-Chairs: Richard Cheney and Patrick Frances

Rural Health Network Manager

Living Well in Multipurpose Services Principles of Care

Multipurpose Services (MPSs) are unique health care facilities that provide a combination of health services including 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. There are currently 60 MPS in operation across rural NSW with more in the planning stage.

The ACI Rural Health Network MPS Reference Group has developed a Principles of Care document to support staff in providing individualised care for people living in Residential Aged Care sections of an MPS.

The Principles are underpinned by the Commonwealth Aged Care Standards as an evidence base; to improve the quality of life for older people who reside in an MPS as people living in their 'home', not as patients in hospital.

Baselines for the Principles are:

  • Homelike environment
  • Role of the person on their own care (resident-centred)
  • Cognitive Impairment
  • Hydration and Nutrition
  • Leisure activities and Lifestyle.

The Principles of Care are accompanied by a Living Well in MPS Toolkit which consists of:

  • A Principles of Care document, which identifies eight key principles designed to improve the quality of life and wellbeing of residents living in MPS residential aged care facilities
  • A Self-Assessment Checklist, designed to help MPS's identify their current strengths and weaknesses in relation to the eight key principles and prioritise areas they wish to improve
  • A Resource Guide of evidence-based resources and strategies which MPS's can implement to foster improvements in relation to the eight key principles
  • An Evaluation Package which will be implemented by participating MPS's in order to determine how well the Living Well in MPS Collaborative achieves its overall aims.

The draft document is now available for review and comment until 5 August 2016. Contribute to the review of the document here.

Expressions of interest will be sought in September for MPS sites to join a Collaborative which will see ACI supported implementation of the Principles of Care during 2017.

2016 NSW Rural Health and Research Congress
'The Rural Health Vision: Translate, integrate and innovate!'

The Health Education and Training Institute (HETI), Northern NSW Local Health District and Congress partners are pleased to announce the 2016 NSW Rural Health and Research Congress which will be held in the beautiful coastal location of Tweed Heads from 9 - 11 November 2016. The Congress will involve three days of inspiring keynote speakers, innovative researchers and a diverse offering of concurrent sessions and poster presentations not to mention networking with colleagues whilst overlooking the magnificent Tweed River.

Rural Innovations Changing Healthcare Forum 2016

The Rural Innovations Changing Healthcare (RICH) Forum is an annual 'virtual' forum using Telehealth, live webstreaming and social media technologies to connect 18 rural health sites across NSW for a day showcasing health innovations and clinical and workforce redesign projects which improve patient care.

200 delegates registered to attend RICH 2016 and 170 Certificates of Attendance were issued for Continuing Professional Development purposes, with no travel, accommodation or registration fees required. RICH also allowed participants to schedule work commitments around sessions of relevance and actively participate in discussions in real time via social media.

In 2016, Western Australia Health, South Australia Country Health, and Health Workforce Queensland staff joined the RICH Forum via live webstreaming, spreading the key learnings of the forum nationally. The value of social media in promoting the event and sharing lessons learned in real time was enjoyed by all participants, and over the course of the day there were 222 tweets generated and 185,754 impressions which contributed to numerous conversations following the #RICH2016 hashtag.

The overwhelming increase in attendees accessing live webstreaming for RICH 2016 may well influence webstreaming as the preferred mode for future RICH Forum planning. This would establish the annual RICH Forum as a fully 'virtual' and cost neutral event, yet still with interactive capacity to reach clinicians statewide and interstate.

All presentations, a video recording of the day and the RICH Evaluation Report are now available.

Sax Institute update

PHRP: Making Innovative use of cohort data

The third issue of Public Health Research & Practice for 2016 is now available, with the issue focusing on the innovative use of cohort data to address emerging public health issues and inform health services planning and policy.

Public Health Research & Practice (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.

The guest editor for Issue 3 (2016) is Julie Byles, the Director of the Australian Longitudinal Study on Women's Health (ALSWH), from the University of Newcastle, NSW. The ALSWH, which celebrates its 20th anniversary this year, has provided invaluable data about women's health across the lifespan and informed federal and state government policies.

Cohort-themed articles in the issue include an 'In practice' paper on how the Study of Environment on Aboriginal Resilience and Child Health (SEARCH) has developed into a long-term platform for closing the gap. A perspective by Graham Colditz from Washington University describes how the US Nurses' Health Study, which marks its 40th anniversary this year, has set the standard for contemporary cohort studies. Another perspective highlights the potential for the Sax Institute's 45 and Up Study, a cohort of more than 250,000 people in NSW, Australia, to inform health planners on integration and coordination of services.

Two other research papers suggest that hospital emergency departments and intensive care units are prime settings for adopting strategies to improve public health. One paper confirms smoking is more prevalent among patients in emergency departments than in the general population; the other describes how NSW has the opportunity to establish public health surveillance within intensive care units, which can help to protect the population from dangerous pathogens.

The Sax Institute anticipates the journal's focus on innovation and perspectives from policy and practice will support policy makers, program agencies and practitioners in making decisions that are informed by evidence.

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 on Twitter at @phrpjournal.

Surgery Redesign School update Co-Chairs: Richard Cheney and Patrick Frances

Rural Health Network Manager

Surgery Redesign Training Program

Participants of the 7th Surgery Redesign Training Program. Photo: E. Rawstron.

The ACI Surgery Anaesthesia and Critical Care Portfolio (SACC), in conjunction with the Ministry of Health, recently held its 7th Surgery Redesign Training Program.

The five day face to face course focuses on the development of foundational project management, change management and clinical redesign skills.

In response to feedback from previous years, a presentation day in November has been added to the program to provide an opportunity for participants to feedback on project progress and next steps to other participants and invited guests.

The Program aims to equip front line clinical and managerial staff from NSW surgical services to identify issues impacting on their service, then develop and implement sustainable change to improve the way care is delivered, using proven redesign methodology.

The benefits of this five day course include:

  • Rapid immersion in Accelerated Implementation Methodology (AIM)
  • Opportunity to achieve improvements in patient experience and theatre KPIs
  • Empowers clinicians and managers with tools to address problems using existing resources
  • Engages surgeons, anaesthetists and managers in improving operating theatre efficiency
  • Promotes mixed-discipline learning, collaboration and problem solving
  • Statewide networking across NSW surgical services.

The importance of patient and consumer engagement is also demonstrated to participants throughout the course structure, with participants introduced to practical methods to meaningfully engage with consumers, carers and families.

The focus for the 2016 program was Operating Theatre Efficiency, with 22 participants from across nine Local Health Districts, all with operating theatre efficiency projects, taking part. Topics included reducing surgical cancellations, improving turnover time and increasing operating theatre utilisation.

Participants had the opportunity to apply the learning to their workplace project during the face to face days, and completed key elements of their project plan with the support of staff from the SACC and Centre for Healthcare Redesign teams at the ACI as well as the team from the Ministry of Health.

The Program was evaluated daily and the feedback was extremely positive. Examples of feedback include "Very informative", "The ACI/CHR team have been great!" and "Really enjoyed the mix of group work and activities."

Participants will receive ongoing support from the ACI, MoH and their LHD Redesign Leader.

For more information, visit the Surgery Redesign Training Program webpage.

Aboriginal Cultural Competency and Safety Working Party

The ACI celebrated NAIDOC Week 2016 from 3 – 9 July. Events included a morning tea with some Indigenous bush tucker from Aboriginal catering company Kallico, as well as daily lunchtime screenings of documentaries offering our staff members learning opportunities about Aboriginal history and culture.

Upcoming events

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