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Volume 12, Issue 6 – December 2018

Clinician Connect

ACI Christmas shutdown 24 Dec 2018 - 4 Jan 2019

Chair Comment

Brian McCaughan

Brian McCaughan, Chair, ACI Board

When the Greater Metropolitan Transition Taskforce started in 2001, the concept of peer networks to drive change was still a new one. The value of these networks became evident when it expanded to become the Greater Metropolitan Clinical Taskforce a few years later. These organisations formed the basis of the ACI, which saw the inclusion of a broader range of networks, institutes and taskforces with increased reach across the state.

The new structure that Jean-Frederic introduced this year will enable the ACI to take the next step beyond the existing successful model of clinical networks, institutes and taskforces. It reflects the growing importance of cross-disciplinary collaboration within and beyond the NSW health system, and will encourage participation not only with local health districts (LHDs), specialty health networks and the other pillars, but from other sectors such as primary care, research and non-government organisations.

We know that healthcare activity does not happen in isolation. For example, an acute cardiac care episode is influenced by nutrition and activity, and connected to rehabilitation and follow-up care. We know that there are significant number of factors that affect a person’s health, that are outside the direct scope of our care (the so-called social determinants of health). The ACI’s new structure provides opportunity to work across disciplines and lead system-wide approaches to innovation and improvement resulting in new initiatives that focus on patient-centred care.

We have come a long way since 2001, but there are still many challenges. I have said before that I am impressed by the passion and commitment of not only our talented ACI staff, but also the dedicated clinicians, consumers and managers throughout the NSW health system who contribute so generously of their time and energy. That remains true.

I would like to acknowledge some extraordinary people who have been a valuable part of the ACI for many years. The ACI Board acknowledged their individual contributions at a farewell award ceremony this month. We wish them all the best as they move on to retirement or other opportunities:

  • Cecily Barrack
  • Lynne Brodie
  • Daniel Comerford
  • Frances Monypenny
  • Chris Shipway
  • Robyn Speerin.

I would like to take this opportunity to thank everyone who has been involved in the work of the ACI in 2018 and I look forward to continuing to see the ACI support change, drive improvements and champion evidence-based innovation for all people across NSW.

Back: Brian McCaughan, Frances Monypenny, Chris Shipway, Robyn Speerin. Front: Cecily Barrack, Daniel Comerford, Lynne Brodie

Chief Executive Comment

Jean-Frédéric Levesque

Dr Jean-Frédéric Levesque

As 2018 draws to an end, it is a good time to reflect on the significant change that the ACI has seen this year. Earlier in the year, we reviewed our organisational structure to realign networks, institutes and taskforces into clinical streams and add new functions to our redesign, implementation, evaluation and communications teams. The purpose of this change was to improve clinical engagement and clinical innovation to provide better services to the people of NSW. The new structure promotes greater collaboration across networks and encourages our staff to work closely to address broader system challenges.

Our structure is comprised around two clinical directorates that focus on the activities of networks, institutes and taskforces, and two system transformation directorates. The ACI is also supported by a finance and corporate team. The names deliberately encourage attention to the role of each directorate.

Clinical directorates

  • CATALYST - Care Across the Lifecycle and Society
    In chemistry, a catalyst is a substance that causes a reaction without itself being affected. In a similar way, networks in this directorate have a role in creating the conditions for change in a complex environment, just as a catalyst would. These networks have a strong focus on complex system problems where many stakeholders are involved, including chronic disease management, provision of care in rural areas and where care is provided across sectors beyond the hospital. CATALYST teams particularly support better integration of care for patients.
  • PRISM - Preserving and Restoring Interventions in Surgery and Medicine
    A prism modifies and expands the trajectory of light. In a similar way, the networks in PRISM have a crucial role in changing the health trajectory of patients requiring surgery, critical or urgent interventions and rehabilitation, so that their outcomes are expanded following this intervention. These networks expand the perspective and focus on care that is person-centred; looking after the entire person throughout, and beyond, their hospital journey.

System transformation directorates

  • SCOPE - Strategy, Communications, People and Engagement
    A scope can mean the area or type of work that we want to do; or an instrument that allows us to see something that we wouldn’t usually see. The teams in SCOPE are the instrument enabling the ACI work to be focused, shared and used by clinicians throughout the system.
  • STEP - System Transformation, Evaluation and Patient ExperienceA step can signify a move, act, or proceeding toward some end or in the general course of some action. The STEP analogy relates to the role of this directorate in helping networks and pan-organisational projects go through the various stages, or steps, to ensure innovation, design, piloting, implementation, scaling and evaluation across the system. STEP teams support change to happen in collaboration with networks, hospitals and LHDs.

You will have already seen some of the new faces and roles this restructure has introduced. I am pleased to present the new Executive leadership team:

  • Sarah Dalton, Clinical Executive Director, PRISM
  • Tracey Tay, Clinical Executive Director, CATALYST
  • Raj Verma, Executive Director, STEP
  • Karen Perini, Associate Director, SCOPE
  • Nirav Bajoria, Associate Director, Finance and Corporate Affairs.

This new way of working together is reflected in the structure of this newsletter, as we bring together points of commonality rather than a focus on individual networks.

I would like to thank all the ACI staff for their dedication and hard work throughout the year, particularly through times of change.

On behalf of all of us at the ACI, I wish you a restful and enjoyable break over the holiday period. We look forward to working with you in 2018 to continue to improve healthcare across NSW.

Raj Verma, Tracey Tay, Jean-Frédéric Levesque, Karen Perini, Nirav Bajoria, Sarah Dalton

ICU Exit Block

Clinical Project Officer

Intensive care unit (ICU) exit block is a significant problem impacting the care and journey of critically ill patients through the hospital setting. The ICU Exit Block project focuses on a whole of hospital approach to optimising intensive care capacity.

The ACI partnered with four NSW ICUs to test and implement solutions to reduce intensive care exit block. This partnership, together with a literature review, informed the development of the Intensive Care NSW Guiding Principles to Optimise Intensive Care Capacity to assist in the reduction of ICU exit block and improve facility patient flow.

The guiding principles, which incorporate best practice, align with the Whole of Health program and the Ministry of Health patient flow systems framework. They include nine key elements to ensure patients have access to the right care, in the right place, at the right time.

The ACI is offering the opportunity for LHDs to partner in the supported implementation of these principles over a 12-month period. Starting in February 2019, this project will involve the testing and implementation of both local and facility-wide strategies. It will include tailored training, with the opportunity for sites to network with other facilities.

Read more about the ICU Exit Block project

Improving the Rural Patient Journey Initiative

Rural Health Network Manager

The Rural Health Network is partnering with Ambulance NSW and the rural LHDs to undertake a baseline analysis and identify key issues regarding urgent patient travel to a higher level facility as a result of critical trauma or injury.

The Improving the Rural Patient Journey Initiative is about:

  • the experience for people living in country NSW accessing urgent and time critical care in other regional and metropolitan centres
  • improving communication and involvement of carers and families in care planning
  • ensuring continuity of care, sensitive to carer and family rurality when a person returns to their general practitioner and community.

The baseline analysis includes:

  • identification of similar work already underway nationally
  • clinical stakeholder focus groups
  • identification of key issues and strategies introduced to address these in LHDs
  • a patient, carer and family survey through local health advisory consumer councils
  • patient flow mapping, data analysis and identification of hotspots
  • literature review.

The aim of the project is to develop a consistent approach to meeting the clinical and social needs of rural people on admission to, and transfer of care from, larger health facilities.

Qualitative and quantitative data collected will provide the basis for a diagnostic report which will be presented to the Rural Chief Executive Group in March 2019. The report will inform a prioritisation and solution design workshop March 2019 to develop an implementation approach for later in the year.

Nathan Croft, Station Manager, Critical Care Helicopter Paramedic, Orange Helicopter Retrieval Service

Nathan Croft, Station Manager - Critical Care Helicopter Paramedic. Photo: J Preece.

Launch of the Consumer Enablement Guide

Project Officer, Primary Care Institute

Angela Wicks

+61 2 9464 4638

angela.wicks@health.nsw.gov.au

The ACI Primary Care Institute, in partnership with the Chronic Care Network and the SCOPE directorate, has developed Consumer Enablement: A Clinician's Guide. The guide is a web-based resource for healthcare providers in NSW.

Consumer enablement means the extent to which consumers understand their health conditions and have the confidence, skills, and knowledge to manage their health and wellbeing. People who are more enabled have greater capacity and ability to:

  • access health services
  • obtain, understand and act on health information
  • actively participate in decisions about their healthcare
  • make healthy choices in their life.

The guide brings together concepts, evidence and resources to create awareness, build knowledge, support enablement approaches in clinical practice, and promote an integrated and effective health system for NSW.

Visit the Consumer Enablement web page

Launch event

The launch of Consumer Enablement: A Clinician's Guide was held in Parramatta on 3 December 2018 at a joint event with Western Sydney LHD. The event brought together 250 people in attendance and many more via live stream to hear from international experts and local innovators on health literacy and consumer enablement research, initiatives and experiences.

Highlights

  • A wonderful Welcome to Country by Uncle Graham King
  • The launch of the Western Sydney Health Literacy Hub
  • Keynote addresses from Professor Michael Paasche-Orlow from Boston University School of Medicine and Professor Joanne Protheroe from Keele University School of Primary Care and Health Sciences
  • A consumer’s perspective on what it feels like to be enabled, using a sliding door story, presented by Dr Coralie Wales, President of Chronic Pain Australia and Manager of Community and Consumer Engagement in Western Sydney LHD
  • The launch of the ACI’s new resource, Consumer Enablement: A Clinician's Guide

New chronic pain management clinic for people with a brain injury

Project Manager, Pain and Brain

The chronic pain and brain injury project is funded by icare to develop clinician and consumer resources and to establish a service model for people with chronic pain and moderate-to-severe traumatic brain injury.

Following consultation with clinicians, a new model of care was developed to provide a pain management clinic within the brain injury rehabilitation programs. A pain specialist, physiotherapist and clinical psychologist will provide a pain assessment and pain management plan. The treating brain injury clinicians will be available for consultation and case conferencing. This enables people to receive a care from specialised pain clinicians within the familiar environs of their usual brain injury rehabilitation program and with their usual treating team.

To trial the feasibility and acceptability of the new clinic, during November and December 2018 several pilot clinic days were run across a number of brain injury rehabilitation programs and with Lifetime Care participants.

Redesign is now on My Health Learning

Associate Director, Clinical Innovation Redesign and Consumer Engagement

Are you interested in learning about Redesign and improvement methodologies? Or perhaps it’s time for a refresher on creating a case for change or setting up your project for implementation success?

The Centre for Healthcare Redesign has just published over 50 interactive modules in seven courses, on the Heath Education and Training Institute (HETI) My Health Learning platform. The modules cover project management, Redesign methods and tools, implementation, and spread and sustainability. They reflect a significant component of the content for the Graduate Certificate in Clinical Redesign, however you don’t need to be enrolled in the certificate to engage in the learning.

My Health Learning allows all NSW Health employees the opportunity to self-enrol in the modules that are of interest to you, examine the extensive resources on offer and engage in online learning at your own pace.

Please consider sharing the modules with teams you may be working with in LHDs or specialty health networks that are keen to learn more about improvement or innovation, or are unsure where to start in their improvement journey.

The courses can be found by searching the My Health Learning catalogue using ‘redesign’ or ‘AIM’, or by selecting ‘Nationally Recognised Training’ from the ‘Browse’ menu. The specific modules are under the courses.

The ACI worked closely with eHealth and HETI to make this become a reality and will continue to ensure our offerings meet your needs. If you have any questions about the Accelerated Implementation Methodology or Redesign modules on My Health Learning please contact the Centre for Healthcare Redesign team via ACI-CHR@health.nsw.gov.au.

Telestroke: lifesaving minutes

Stroke Network Manager

Kate Jackson

+61 2 9464 4614

kate.jackson2@health.nsw.gov.au

Stroke Network

Telehealth Network Manager

Donna Parkes

+61 2 6809 8675

donna.parkes@health.nsw.gov.au

Telehealth

Telestroke is the provision of time-critical specialist stroke care to a rural or regional area where specialists are not available on site.

Using an ehealth supported platform, a stroke physician can talk to patients and family and provide a time-critical assessment diagnosis and treatment plan, so where possible, treatment and care can be provided locally.

On 1 November the telestroke usage case was presented and demonstrated live at the eHealth and HealthShare expo. Dr Bill O’Brien (Stroke Director, Central Coast LHD) demonstrated how the technology works, using Sype for Business to review advanced imaging, assess the patient and provide specialist hyperacute stroke advice.

The current project is a partnership between the ACI, eHealth and three LHDs. The project has already shown promising outcomes for patients at the rural sites involved and we are planning a statewide approach.

Watch a video and find out more about the Telestroke project

Trauma Data Report

Acting Manager, Institute of Trauma and Injury Management

The Institute of Trauma and Injury Management (ITIM) annual data report, Major Trauma in NSW: 2016-17. A Report from the NSW Trauma Registry, has been finalised and is now available on the ITIM website.

Report highlights

  • There were 3961 major trauma patient admissions
  • The average age was 52
  • Males were 2.5 times more likely to be injured than females
  • The case fatality rate for Injury Severity Score >12 was 10.2%
  • Females had a higher case fatality rate (13.2%) compared to males (9%)
  • Falls accounted for 44.2% of all major traumas, exceeding transport incidents (37.6%)
  • Pedestrian traumas had a significantly higher case fatality rate (17%) than all other forms of road trauma.

Say Less Show More for adults with intellectual disability

Network Manager

Say Less Show More (SLSM) is an initiative seeking to provide additional support to people with intellectual disability, using a series of simple photo stories (visuals) that illustrate what will happen during a visit to the doctor.

The SLSM visuals for adults were featured at an Intellectual Disability Symposium at Ryde Hospital in October 2018. The event showcased the work Ryde Hospital has been doing over the past 18 months to smooth the patient journey for people with intellectual disabilities who come in for an operation.

The original resource was developed at Children’s Hospital Westmead, then the visuals were updated by Ryde Hospital in partnership with consumers, Lifestart, the Benevolent Society and the ACI Intellectual Disability Health Network. This work was led by Leah Whitton, Nurse Unit Manager Intensive Care Unit at Ryde Hospital, and Brian Bonham, Director of Nursing, and has also involved doctors, nurses, allied health staff, community groups and carers.

The symposium highlighted the difference planning and good communication about a person and their needs can make to their overall hospital experience and their journey home. Theatre staff spoke about their experiences using resources like SLSM.

Say Less Show More is on the ACI website and includes training on how to use the visuals, and tips about how to make the resources meet local needs.

Awards

Congratulations to the Centre for Healthcare Redesign

On 22 November the Graduate Certificate (Clinical Redesign) program won the national education award for sustainable healthcare from a competitive field of 13 finalists at Bond University. The Sustainable Healthcare Award recognises pioneers who have developed educational offerings that promote best practice in high value health care. Specifically it recognises evidence-based programs that deliver improved healthcare outcomes, using resources efficiently to ensure this work can continue into the future without accumulating adverse consequences for society or individuals. Senior Bond academics, Gold Coast Hospital executives, Professor Jeffrey Braithwaite, Professor Brian Dolan, various consultancy companies, nationally recognised health service improvement experts and senior medical and nursing staff were present on the night.

The program received high praise on the evening with panel members particularly impressed by the work integrated nature of the program and unique partnership between ACI and the University of Tasmania. With a current research project underway to evaluate the impact of the Graduate Certificate (Clinical Redesign) course on student learning, and patient and organisational outcomes, the evidence of sustainable benefit included in award submission was well received.

  • Amelia Giles: Course Coordinator: Centre for Healthcare Redesign, Clinical Innovation, Redesign and Consumer Engagement, ACI
  • Dr Pieter Van Dam: Coordinator Professional Honours (Clinical Redesign) School of Medicine College of Health and Medicine, University of Tasmania
  • Professor Ben Canny: Head, School of Medicine, Dean of Medicine, College of Health and Medicine, University of Tasmania
  • Bronwyn Paton: Course Manager, Centre for Healthcare Redesign, Clinical Innovation, Redesign and Consumer Engagement, Agency for Clinical Innovation
  • Raj Verma: Executive Director, System Transformation Evaluation and Patient Experience, ACI
  • Lea Kirkwood: Associate Director, Clinical Innovation Redesign and Consumer Engagement
  • Tricia Cummins, Capability Design Manager, Centre for Healthcare Redesign, Clinical Innovation, Redesign and Consumer Engagement, ACI
  • Gabrielle Gonzalez: Administration Officer, Clinical Innovation Redesign and Consumer Engagement, ACI
  • Absent -  Dr Phoebe Griffin: Lecturer in Health Services Improvement, Unit Coordinator, School of Medicine, University of Tasmania

Congratulations Tish Lancaster

The ACI would like to congratulate Tish Lancaster on receiving the Distinguished Merit Award from the International Society of Nurses in Cancer Care. It’s awarded every two years in recognition of an outstanding member who has contributed to the international advancement of the science and art of cancer nursing.

Tish is an active member of the ACI’s Gynaecological Oncology Network as well as the Gynaecological Oncology Nurses and Allied Health Group.

Tish has had a long and distinguished career as both a cancer nurse, specifically in the field of gynaecological oncology. She has worked as a cancer nurse for over 30 years in both clinical and management positions. For the past 20 years, she has worked as the Clinical Nurse Consultant for Gynaecological Oncology at Westmead Hospital in Sydney.


Prof Patsy Yates, President of the International Society of Nurses in Cancer Care and Tish Lancaster, Clinical Nurse Consultant - Gynaecological Oncology, Westmead Hospital

Tish has participated in policy development both nationally and internationally and has given evidence at two Australian Senate Inquiries into cancer-related services. Tish is the co-editor of the Australian Journal of Cancer Nursing and a member of the Cancer Forum journal editorial board. She has published in the cancer nursing literature, authored four book chapters and is the co-editor of the Australian textbook Gynaecological Cancer Care: A Guide to Practice. Tish is a Fellow of the Australian College of Nursing and in 2012 was named Westmead Hospital’s Nurse of the Year.


Congratulations Jenny McKenzie

The ACI would like to congratulate Jenny McKenzie, Nurse Practitioner Palliative Care, Murrumbidgee LHD, on winning the Staff Member of the Year Award at the 2018 NSW Health Awards.

Jenny is a founding member of the Palliative Care Network Executive Committee. Over the past six years, Jenny has significantly contributed to the development of our key messages, educational forums and resources including our Blueprint for Improvement.

Read more about her award. Thanks Jenny for all you've done for palliative care. You’re an inspiration to work with.

Scientific activities

Acting Manager, Institute of Trauma and Injury Management

ITIM research projects

Institute of Trauma and Injury Management (ITIM) research and data teams, in collaboration with clinicians across the NSW Trauma system, have completed a study on external benchmarking of trauma services in NSW. Data obtained from NSW Trauma Registry, of patients with moderate to severe injury from 2012 to 2016, identified variability in risk-adjusted outcomes across different services. The study is published in the Journal of Injury and a poster was also presented in the Trauma 2018 Conference in Perth.

Additionally, a study has been undertaken that examines the rate of injury and deaths in construction zones across the Pacific Highway. The study identified a higher ratio of injury at times when construction zones were active. This study was presented at the Australasian Road Safety Conference in Sydney.

ITIM’s Data Officer, Hardeep Singh, delivered two presentations at the Nursing Quality Improvement and Data Management Forum at the Trauma 2018 Conference. The topics covered were practical tips on data governance, secure handling of data during use, transmission and maintaining data confidentiality, and various tools on Data and Geo Analytics. Hardeep also represented ITIM on the Australian Trauma Registry working group meeting while in Perth.

Hardeep Singh and Pooria Sarrami with the ITIM poster presentation at the Trauma 2018 Conference in Perth, October 2018. Photo: M Dinh


Manager, Statewide Burn Injury Service Network

Burn care showcase

The ACI Statewide Burn Injury Network showcased work in burn care at Australian and New Zealand Burn Association (ANZBA) annual scientific meeting in October.

Network clinicians, researchers and ACI staff presented over 40 papers during the four day meeting, SCAR WARS, which was held in Brisbane in October 2018. The event was attended by over 300 delegates from across our region, Europe and North America.

Siobhan Connolly, Burn Prevention and Education Manager, ACI gave three presentations and was awarded the best ‘Prevention’ ePoster. Claire Toose, Burn Physiotherapist Children’s Hospital at Westmead, was awarded best ‘Care’ ePoster, for her work on developing paediatric burn specific online physiotherapy exercises. Anne Darton, Burn Network Manager, co-authored seven papers and presented two: Beyond Burns Online Hub – A Co Design Approach and The Shared Value of Consumer Engagement, as well as participating in a panel debate on the role of the doctor in the burn clinic.

The ACI Burn data registry contributed data to many of the papers delivered by the clinicians and researchers.

Siobhan Connolly award presentation


Acting Clinical Associate Director, Acute Care for Children and Older People

Transition at the Australian Adolescent Conference

The topic of transition was well represented at the Australian Association for Adolescent Health conference held on the Gold Coast 7-9 November. The ACI Transition Network joined with Sydney Children’s Hospitals Network Trapeze service to host a 90 minute symposium showcasing transition initiatives across Australia and New Zealand.

To set the context of the session, Mae Rafraf, ACI Transition Support Worker, joined 13 year old Charlotte Newey to provide their unique perspectives on a young person preparing for transition.


Mae Rafraf presenting

Angie Myles, Transition Coordinator, gave an overview of initiatives in the northern region and Transition Coordinator Silvana Techera presented a poster titled Growing with Every Hurdle – the Changing Challenges of Transition, developed in collaboration with Trapeze. Jane Ho, Staff Specialist with Trapeze and Lynne Brodie, ACI Transition Network Manager presented a paper on implementing evidenced based transition principles.

The conference was the largest to date with 365 delegates from a broad range of youth-related services, including young people who facilitated a youth forum on day one and participated actively throughout the conference. Key messages from young people included:

  • nothing about me without me
  • include us up front, not as an afterthought – especially when designing technology to help us
  • technology should be an enabler and should never replace the personal relationship with clinicians.

Welcomes and Farewells

Farewell A/Prof John Harvey, Burn Network

We would like to say farewell and thank you to A/Prof John Harvey who has stepped down from his position of Burn Network Co-Chair leading into his retirement. John has been involved in the Burn network since its beginning and has twice held the position of Co-Chair. He has made a significant contribution to the lives of burn injured children and adults through his many years of work with the network. His leadership has supported and guided improvements in the delivery of burn care across NSW.


Rehabilitation Network Manager

Louise Sellars started maternity leave in October and we congratulate her and her husband on the newest addition to their family. Justine Watkins will continue as the acting Network Manager.


Justine Watkins


Louise Sellars


Inaugural Transition Care Network Manager retires

From 2004-2018, Lynne Brodie held the position of Transition Care Network Manager at the ACI. In this role she has supported the transition of adolescents with chronic and complex conditions from paediatric to adult care. An important part of this role was her management of a small team of transition coordinators working across NSW.

Since the network’s inception, Prof Kate Steinbeck worked closely with Lynne as a member of the network’s executive group and a dedicated advocate.

Current network Co-Chairs, Clinical A/Prof Sue Towns and Mae Rafraf, value Lynne as a skilled problem-solver who is always responsive to emerging needs and opportunities. Sue says, ‘under Lynne’s guidance, transition care in NSW became a statewide initiative with collaborative research and innovative programs in so many areas’.

Lynne and team members recently presented their work, alongside Trapeze, at the Youth Health Conference in Queensland. Lynne is recognised internationally as a leader in the field.

Network members and ACI colleagues wish Lynne well in her retirement and thank her for her dedication in helping young people remain engaged in their healthcare as they enter adulthood and enter the adult health system.

Lynne and her colleagues enjoying morning tea