director operations / general manager meeting …...strongly disagree (1) disa gree (2) neither...

Director Operations / General Manager Meeting

Introduction

Dr Nigel Lyons Chief Executive ACI

..to facilitate quality health

care …

Aligned with ACI’s purpose and values..

..the outcomes of which will exceed the

expectations of our partners,

patients & community..

...leading to our vision

Core values: Collaboration Openness Respect Professionalism Innovation

Our processes

Our clinicians, patients, health care partners and the community

We will be valued as the leader in the health system for designing, evaluating and supporting implementation of innovative models of patient care

Purpose: We will work with clinicians, consumers and partners to design and drive evidence based innovation to ensure appropriate, effective and sustainable patient centred health care

The go to place for clinician and consumer led reform

Operational Excellence

Ensure collaboration & alignment of key priorities across the organisation

Develop high quality systems & processes that are

continuously improved

..we will invest in our clinicians, consumers and staff to effectively

use our resources..

Our resources

Effective partner in implementation

Better health outcomes for all

Innovative Health Care

Develop a rigorous approach to all aspects of innovation

Create an environment and capability for innovation

Effective Partnerships

Work in collaboration with partners

Understand needs, establish and align strategic priorities

Our financial stewardship

Prioritise and maximise our use

of resources

Our clinicians, consumers and staff Promote our

clinicians, consumers & networks to lead the clinical reform

process

Develop an ACI team with clear

roles for our people

Create a vibrant & stimulating

environment with a shared direction

Invest in our people to

develop skills & expertise

Strengthen involvement & communication

ACI Connect Forums - Partnership Evaluation

To what extent do you agree or disagree with the following statements?

Strongly Disagree

(1)

Disagree (2)

Neither agree nor disagree

(3)

Agree (4)

Strongly Agree

(5)

Rating average (total

5)

Rating average

May 2013

ACI understands the priority areas where they can assist us 0 0 4 8 3 3.9 3.6

ACI is very responsive to our needs 0 0 5 9 1 3.7 3.7

ACI has put in place relevant actions to address our priority needs

0 0 2 11 2 4.0 3.6

ACI management are very accessible (to who?) 0 0 2 11 2 4 4

ACI communicates well with our senior management 0 0 4 8 3 3.9 3.8

ACI communicates well with our senior clinicians 0 1 11 2 1 3.2 3.0

ACI has helped us to more effectively implement improved models of care

0 1 3 10 0 3.6 3.8

ACI is a good partner to work with to improve healthcare 0 0 2 10 3 4.1 4.1

I would recommend to my colleagues the work of ACI in designing innovative models of patient care

0 0 3 7 5 4.1 4.1

I would recommend to my colleagues the work of ACI in implementing innovative models of patient care

0 0 4 5 6 4.1 4.1

Feedback from LHDs to date

▲ Streamline correspondence to LHDs/SHNs from the ACI

▲ Portal – communication tool to improve knowledge about ACI activities in LHDs/SHNs

Add Web link to the Portal

Sharing Information - Feedback

▲ Regular Visits to LHDs/SHNs by ACI Directors ▲ ACI Network Executive and Working Group

Members – list distributed March 2014 ▲ Development of: on-line search option

http://www.aci.health.nsw.gov.au/networks/membership/




LHD/SHN – ACI Partnerships Regular meetings

At last ACI Connect Forum request that an ACI Director be ‘allocated’ as the main contact for an LHD/SHN.

Key Messages heard Volume of correspondence and activity coming from

Pillars Disconnectedness amongst all that activity Integrated Care is a high priority ACI assisting in building relationships/initiatives with

Medicare Locals Mandatory vs Voluntary uptake of ACI work Acknowledgement & recognition of LHD work especially

when it is adopted by a Pillar Provide context to Ministry decisions (gossip) ACI could consult more widely before providing advice to

the Ministry around funding decisions

Local Assistance/Priorities Assistance identifying clinicians to deliver services

through Telehealth (Far West) Improving transition between child and adult services

(Western Sydney) Reorienting community health to deliver better system

outcomes (Murrumbidgee) Forensic patient flow to LHD and community (JFMH) Access to list of Medicare Local contacts (JFMH) Organ donation (Sydney) Support for the NSW trauma review (ASNSW)

Meetings Positive

▲ ‘Good just to talk’ ▲ Growing understanding of ACI role ▲ Increased understanding of local issues by ACI

Opportunities

▲ Directors find it hard to talk beyond our own portfolios ▲ How do others in the LHD find out what was

discussed? ▲ Directors are still visiting other LHDs regularly as part

of normal work – is this confusing?

Maeve Eikli Director

EESC

Engagement, Executive Support and

Communications

23 May 2014

Our key functions Support openness and strengthen two way communication

Internal and External Communications

Publications

Reports

Website and Intranet

Briefs and Ministerials

Media relations

Social Media

Events

Clarifying our message

New portal Making it easier to stay updated on ACI and CEC initiatives headlines – link to ACI

and CEC websites

search filters – dates local involvement

contact details

www.eih.health.nsw.gov.au

Check out the Intranet

Media liaison

Social Media

Twitter - @NSWACI plus nine individual accounts

Facebook – Two project specific pages

Vimeo - More than 200 videos posted to date

Yammer – internal use, 116 staff accounts

Twitter

Facebook

Consumer engagement

Consumers have a voice in our networks

ACI Consumer Council The ACI Consumer Council advises the Board on community engagement and provides a focus for consumer involvement across all ACI networks. The Chair and six members have qualifications or experience in consumer engagement, communication or research designed to identify the views of the community. For more details on the members of the consumer council, visit the ACI website at: www.aci.health.nsw.gov.au/our-people/consumer-council

Thank you

Acute Care Portfolio Daniel Comerford [email protected] 02 94644602

mailto:[email protected]

Acute Care: where we work P

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THE ACUTE CARE PORTFOLIO SPANS THE PATIENT JOURNEY

27

Acute Care: how we will work

THE PATIENT IS AT THE CENTRE OF OUR

WORK

Specialist Ambulatory

(Chronic Disease)

Primary Care

28

Acute Care: what we do Acute Care Taskforce:

▲ Medical In-patient Journey, ● Medical Assessment Units, ● Clinical Management Plans, ● Criteria Led Discharge

29

Acute Care: what we do Blood and Marrow Transplant: BMT Quality Services

▲ malignant haematology Model of Care ▲ long term follow up Model of Care ▲ AML Model of Care ▲ Environmental Cleaning

Cardiac: ▲ CHF ▲ Cardiac Reperfusion Program ▲ AMI Clinical Variation ▲ Revision of Chronic Disease Guidelines ▲ National Indigenous Acute Cardiac Care

30

Acute Care: what we do Endocrine:

▲ Sub-Cut Insulin Medication Chart ▲ high risk foot services Standards of Care ▲ diabetes Model of Care

Gastroenterology: ▲ EIS Implementation ▲ consumer information / standards of care (with Nutrition network) ▲ Hepatitis Pathways and Model of Care

Nuclear Medicine: ▲ Lutate Patient Pathway

Radiology: ▲ Medical Imagine District Business Unit Model, including

Implementation tool kit

31

Acute Care: what we do Renal:

▲ home dialysis, ▲ Supportive Care leading to end of life

Respiratory: ▲ NIV consensus guidelines, ▲ Tracheostomy Care consensus guidelines ▲ Pleural Drains Consensus guidelines, ▲ CF Adult Model of Care ▲ COPD service access and improvement, HiTH Partnerships

Stroke: ▲ Stroke Reperfusion Program, ▲ Stroke Clinical Variation

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Prof. Donald MacLellan Director

Surgery, Anaesthesia and Critical Care

Surgery, Anaesthesia & Critical Care

23 May 2014

Surgery, Anaesthesia & Critical Care Portfolio.

Surgery, Anaesthesia

& Critical Care

Anaesthesia & Peri Operative

Network Burn Injury Service Network

Gynae- Oncology Network

Neurosurgery Network

Ophthalmology Network

Urology Network Surgical

Services Taskforce

Emergency Care Institute.

Institute of Trauma Injury Management

ICCMU

Rural Critical Care and

Critical Care Taskforce

Intensive Care Services Network


& Critical Care







Services Taskforce


Institute of Trauma &

Injury Management

ICCMU



Intensive Care Coordination & Monitoring Unit



& Critical Care







Services Taskforce



Injury Management

ICCMU




Established in 2003 4.2FTE & Clinical Director (0.5) 4 Main Activities:

Utilisation of IC resources Understanding of IC service provision Promotes excellence in standards of care Fosters communication across key groups Runs the Critical Care Resource Management System

ICCMU

Critical Care Resource Management System

Traffic Light system for ICU bed availability

Linked to patient admission databases

Automatic refreshes Local clinician input re

factors impacting: ▲ Bed availability ▲ Patient flow through unit ▲ Staffing resources


Re-established in 2013 Improve the ICU/HDU patient care Liaise with HealthShare for ICCIS

implementation Critical Care Data Registry (linkage) Project

Institute of Trauma & Injury Management

Established in 2002 5.5FTE + Clinical Director (0.5) Main Activities: Collection, analysis & responses to trauma activity & outcome

data Development , implementation & monitoring clinical guidelines Development & implementation of trauma training & education Research across the trauma system Trauma Patient Outcome Evaluation

Emergency Care Institute Established in 2011 5.0 FTE + Clinical Director (0.5) Primary role is to improve outcomes for patients

presenting to Hospital Emergency Departments through coordination, networking and research.

Main Activities: Collection, analysis & responses to emergency activity & outcome data Development , implementation & monitoring clinical guidelines Research across the emergency care system Actively working to reduce variation in clinical practice and improve the

provision of emergency care Nurse Delegated Emergency Care project

Severe Burns Injury Network

Core Network - CHW, RNSH and CRGH

Broader network includes rehab facilities, rural and

metropolitan EDs and Trauma services

Ensure best assessment and care for transfer of more

severely injured patients.

Provide care for patient with non-severe burn injuries

Telehealth project

Grafting done for days stay patients

23 30 34 52

134184 213

235

050

100150200250300350

2008-09 2009-10 2010-11 2011-12

Day Stay graftingNo grafting

02468

10121416

2008/09 2009/10 2010/11 2011/12

Average LOS for Burn Units

RNSH

CRGH

CHW

All Acute admissions (by separation)

557 508 506 554

157 214 247288

0

200

400

600

800

1000

2008-09 2009-10 2010-11 2011-12

<24hrs

>24hrs

Surgical Services Taskforce

Established 2004 Chair- Dr Michael McGlynn Peak body advising on all aspects of

surgery Works closely with MoH, CEC & LHDs Fractured Hip project OT Efficiency project

Additional SACC Networks Network Major Project

Anaesthesia Perioperative Care Safe Sedation Phase 2

Gynae-Oncology Referral delays re Gynae-onoclogy patients – diagnostic collaborative project

Ophthalmology Eye Health framework and Service Model for Cataracts and Chronic Eye Disease

Urology Prostate Registry

RCCT Nurse Administered Thromobylsis (NAT) Project

CCT Critical Care Data Registry Project (oversight)

Neurosurgery Adult Neuro observation Chart implementation and education package


& Critical Care







Services Taskforce



Injury Management

ICCMU




Level 4, Sage Building, 67 Albert Ave, Chatswood NSW 2067

PO Box 699 Chatswood NSW 2057

T + 61 2 9464 4604 www.health.nsw.gov.au/gmct/ ABN 89 809 648 636

Professor Donald MacLellan Director of Surgery, Anaesthesia & Critical Care

9464 4604 [email protected]

Chris Shipway Director Primary Care and Chronic Services ACI

May 2014

Primary Health and Chronic Care Initiatives

Past MINISTRY: Health Ones GP Advisory Committee (currently being reconvened)

Clinical Handover Project Chronic Disease Management Program Funded position in GP NSW Working with GPs Guidelines ACI: Pain Plan Presence on some networks

ACI: Current Activities GP Advisory Group Pathways Projects and Evaluation Osteoporosis Project (Murrumbidgee) Chronic Disease Management Program

(Connecting Care)

Home Medical Home Community Hospital

Patient Family

Carer

GP

Council

NGO

RACF

Hospital

Hospital

Specialist

Community Nurse

Allied Health

Aged and Community Care

CHC

Community Pharmacy

Chronic Disease Manager

Practice Nurse

Diabetes Educator

Exercise Physiologist -Patient preference decreases

- Holistic/generalism decreases - Relationship decreases - Integration decreases - Numbers decrease - Multi-morbidity increases - Cost increases

Medical Home*

* Courtesy of Dr Tony Lembke

Chronic Disease Management Program – Connecting Care Model: community-based care coordination and

self-management support for people 16 years + with chronic disease at risk of hospitalisation

LHD / ML relationships variable across NSW ▲ Funding partnership ▲ LHD staff placed in ML ▲ Governance support

Multi morbidity increases with age

Barnett, Mercer, Norbury, Watt, Wyke, Guthrie: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study; Lancet 380:9836, 7-12 July 2012, pp. 37-43

Multi morbidity correlated with socio-economic status

Barnett, Mercer, Norbury, Watt, Wyke, Guthrie: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study; Lancet 380:9836, 7-12 July 2012, pp. 37-43

Avoidable hospitalisations pre and post enrolment

33% reduction P<0.001

ACI: Future Chronic Disease Management GP enabled Pain Clinics Musculo-Skeletal Primary Health Project Palliative Care Framework for Older People with Complex

Health Needs ISBAR Initiative

Local level What form can the messages take?

Education Training Information Consultation support Community education models Website

Support each othe

ACI Musculoskeletal Models of Care

Osteoarthritis Chronic Care ▲ Conservative care options for hip & knee arthritis ▲ Is surgery really needed? ▲ In any case, learn self-management strategies

Low Back Pain – currently being developed • Early conservative care • Aim to stop the chronic pain cycle

Osteoporotic Refracture Prevention • Identify fragility fractures & treat underlying

cause

Musculoskeletal Initiative for Primary Care Providers Community preferred setting and leadership –

primary care Address osteoporosis, arthritis & back pain at

‘one-stop shop’ Allocated coordinator to support MDT Formal collaboration between PHCO & LHD to:

▲ Ensure executive ‘buy-in’ ▲ Pool resources ▲ Support each other

ACI Model for Palliative & End of Life Care Service Provision Palliative Care Network established Sep ‘12 Over 360 members as of November 2013 Vision: All NSW residents have access to

quality care based on assessed need as they approach and reach the end of their life

A focus on supportive and supported primary care providers including general practitioners

ACI Model for Palliative & End of Life Care Service Provision Emphasis on care as close to home as possible Recognition of gaps in specialist palliative care

services and need to build capacity in primary care Recognition of the need to have earlier end of life

discussions, care planning and advance care planning with patients

Support for shared care and networked service arrangements

Model of Care due in March 2014

NSW Health Integrated Care Strategy defines integrated care as the provision of seamless,

effective and efficient care that responds to all of a person’s health needs, across physical and mental health in partnership with the individual, their carers and family.

It means developing a system of care and support that is based around the needs of the individual, provides the right care at the right time and makes sure dollars go to the most effective way of delivering healthcare for the people of NSW

62

63

Older Person Centred Care Components of the Older Person’s Health Journey

• Initial contact/access • Management & planning • Crisis/acute need

• Specialised health care • Recovery/rehabilitation • Supportive, palliative and end-of-life care

The Framework for Integrated Care for Older People with Complex Health Needs

Develop a shared vision for aged health services in our local community with agreed

goals and measures of success.

65

System Design Principles

System Design Principles Promote clear and transparent multi-sector governance and leadership in every setting

to drive system change.

66


System Design Principles Implement models and services that achieve timely access to care and empower other

services to deliver appropriate care as close to home as possible.

67



Involve older people, their carers and families at every step of their journey and

value their experiences as much as clinical effectiveness.

68



Ensure technology supports integrated service delivery that shares information to

effectively support multi-sector decision making.

69


Implementation Forerunner sites Economic analysis Clinical redesign school and support Partnership with Medicare Locals and

RACFs Evaluation feedback on outcomes

Level 4, Sage Building 67 Albert Avenue, Chatswood NSW 2067

PO Box 699 Chatswood NSW 2057

T + 61 2 9464 4600 F +61 2 9464 4728

www.aci.health.nsw.gov.au ABN 89 809 648 636

Chris Shipway Director PC&CS

Email: [email protected]

Raj Verma Director

Clinical Program Design & Implementation, ACI

Clinical Program Design & Implementation


Implementation

Health Economics and Analysis

Centre for Healthcare Redesign

Research

Clinical Program Design & Implementation –

Implementation



Research

Implementation



Research


ACI Priority Program 2014-15

Chris Shipway Director

Primary Care & Chronic Services 6 May 2014

ACI creates a lot of “product” These products potentially form a “toolkit” Balance between clinical network initiatives

and LHD priorities This exercise will explore how we better

get that balance right

Introduction

At end of the session we will: Have a list of shared implementation

priorities (for consideration in ACI 14/15 Ops Plan). Understand some of the rationale for those

priorities.

Steps 1. Introduction 2. Create an implementation priority list

(small group) 3. Reflect on how your list will could improve

the patient experience/system performance (small group).

4. Feedback

Implementation Priority List Using prepared list - discuss which of

those models/initiatives should be included. You can use the longer list of projects as a

reference. You can suggest other initiatives.

What will change? (Clinical and value-based factors) Better patient experiences?

Improved population health?

Best use of our resources?

Is this what is really important ? Do you

want to change priority list?

Is one model/initiative more likely to succeed? (Contextual factors)

Common priority across multiple LHDs? Already in place in some LHDs? Funding available? Capacity and capability exists in the system Strong leadership

At end of the session we will: Have a list of shared implementation

priorities Understand some of the rationale for those

priorities. Have tested those priorities against

potential patient/system benefits.

Feedback

Daniel Comerford Director Acute Care

ACI Project Implementation

6 May 2014

director operations / general manager meeting …...strongly disagree (1) disa gree (2) neither...

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