- Evaluation Report 2019

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Acknowledgements

The ACI Rural Health Network would like to acknowledge the following people who helped plan

and deliver the Rural Innovations Changing Healthcare (RICH) Forum 2019:

Jenny Preece Rural Health Network Manager, ACI

Emily Saurman Research Fellow, Broken Hill University Department of Rural Health, FWLHD

Lauren Weller NSW Rural Health Research Alliance, MNCLHD

Annie Nichols Physiotherapist, Temora MLHD

Bronwyn Cosh Acute Health Service Manager, Moree HNELHD

Victoria Lovecchio Integrated Care Change Manager, Orange WNSWLHD

Nicola Daye Telehealth, ACI

Donna Parkes Telehealth, ACI

David Cross Physiotherapist, Gilgandra, WNSWLHD

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Executive Summary

The RICH Forum is an annual virtual forum designed to connect healthcare professionals and

consumers. The forum offers professional development opportunities, networking opportunities and

access to innovative projects for the interdisciplinary rural health workforce across NSW and

interstate. The forum focuses on sharing innovative practices across NSW via face to face

presentations, videoconferencing, Pexip, social media and live streaming technologies to eliminate

costs associated with travel and time lost from work.

The 2019 RICH Forum focused on Resilience of Rural Communities in response to the series of

bush fires and ravages of drought experienced by rural communities over the course of summer

2019.

The forum was attended by 144 delegates from varying sectors and disciplines including

Multipurpose Service staff, NSW Ambulance, medicine, allied health, nursing, Primary Health

Networks, University academics and researchers and consumers. Individuals were able to attend

sessions of relevance and earn continuing professional development (CPD) hours which contribute

to national registration purposes without being absent from their workplace for the whole day, as is

the case with conventional forums.

eHealth NSW has worked continually with ACI over the last six years to develop a choice of

reliable options for both NSW Health employees and external organisations to access and attend

the forum. Options now include face-to-face via traditional videoconferencing, live streaming (both

internally and externally) and linking from individual computers using the Pexip Virtual Meeting

Room platform. Table 1 outlines the technologies used and how many participants used each

technology to attend the forum.

Table 1: Technologies used to attend the forum per eHealth NSW Login Portal

Technology Number of

participants

Videoconference sites 22

Pexip via desktop 33

Live streaming – internal to NSW Health 37% 53

Live streaming – external organisations via YouTube Conference Channel

25%

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eHealth NSW and the ACI Telehealth team provided support during the event to trouble shoot and

fix connectivity issues quickly throughout the day. Question and Answer (Q&A) sessions were

facilitated after each presentation using Pexip Chatroom and SMS messaging to enable audiences

to interact. Due to the Federal election, Government was in caretaker mode so social media

(Twitter) was not able to be utilised.

Attendance on the day was captured via the eHealth NSW login portal with average participation

67 minutes. Forty of the 144 attendees completed a SurveyMonkey evaluation survey following the

forum. A summary of responses is included in this report. The responses will enable refinements

for future forums to ensure they remain relevant and meet the needs of the LHDs and broader rural

health workforce.

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Contents

Acknowledgements .......................................................................................................................... i

Executive summary .......................................................................................................................... ii

Contents ......................................................................................................................................... iii

About the program .......................................................................................................................... 4

Evaluation ....................................................................................................................................... 7

Take home messages ............................................................................................................ 8

Suggested Improvements ...................................................................................................... 8

Future Topics ......................................................................................................................... 9

Appendices ................................................................................................................................... 10

RICH Program 2019 .............................................................................................................. 10

Oral Presentations ................................................................................................................ 12

ePoster Presentations ........................................................................................................... 14

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About the program

The theme Resilience of Rural Communities was inspired by the resilience and fortitude displayed by

the returned service men and women in the Invictus Games late 2018, using sport to overcome

physical and mental disabilities as a result of defence duties. Summer 2019 had also seen the

heartbreak caused by a series of bushfires and the ongoing drought, where communities had

displayed courage and unity in helping each other overcome hardship and adversity.

The program was developed to showcase resilience, self-care strategies and resources available to

support the rural workforce; many of whom who had been directly impacted or were caring for

family members, neighbours or friends in need. See Appendix 1 for a full copy of the program.

Abstracts were invited which showcase resilience of rural communities in:

Health care, services and processes

Creative recruitment and retention

Self-care for rural health workers

Indigenous and culturally appropriate care

Generalist and flexible workforce models

Professional development and leadership

Geographic isolation

Innovation and support

The criteria for oral presentations and ePosters were:

A resourceful and creative approach

Evidence that resilient approaches have potential to be successfully taken up by other health care settings

Is there a clear take home message?

Quality of written abstract and readability?

Marlee Silva provided the opening keynote address, setting the scene with her presentation ‘Tiddas

4 Tiddas – building resilience through story telling’. Marlee is a published writer, activist and

specialist Indigenous consultant at Cox Inall Ridgeway. Marlee and her sister are co-founders of

Tiddas 4 Tiddas (@tiddas4tiddas) a social media-based movement, developed in the hopes of not

losing the momentum of the 2018 NAIDOC theme 'Because of her we can!'

A second keynote speaker Carly Salmon opened the afternoon sessions with her presentation ‘the

Power of Never Giving Up’. Carly was born with cerebral palsy and talked of the trials and

tribulations of pushing through physical barriers to become a para athlete, representing Australia at

age 14 in Lyon, France, in the World Para Athletics and most recently in Australia at the

Commonwealth Games.

The program (see Appendix 1) also included presentations from Deakin University Victoria,

Breastscreen NSW, Enable NSW, NSW Rural Doctors Network, Primary Health Network and rural

Local Health Districts. Question time (10 minutes) was included at the end of each presentation to

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encourage participation from the audience. This was facilitated using SMS messaging and the Pexip

chatroom. The forum was recorded and individual sessions are available on the ACI website.

https://www.aci.health.nsw.gov.au/resources/rural-health/rural-innovation-changing-healthcare-

forums/rich-2019

Speakers were offered practice sessions prior to the RICH Forum so they were confident with the

technology on the day. Practice sessions involved linking to the host via a videoconference Pexip

Virtual Meeting Room (VMR), ensuring that both audio and camera were working, presenters were

able to share the presentation on the screen and then stop presenting at the end so that the speaker

was visible for Q&A. Photos were taken by Jenny Preece as below.

Figure 1: #RuralHealth Together – Promoting Self-Care for the Rural Health Workforce Angela Kerr, Project Manager, NSW Rural Doctors Network

Figure 2: Virtual Midwifery Huddles – Communication and Support for Isolated Midwives Maria Crilley, NSW Pregnancy and Newborn Services Network, Randwick and Hunter New England LHD

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Figure 3: The Ripple Effect: Digital Intervention Reducing Suicide Stigma in the Australian Farming

Community Alison Kennedy, Research Fellow, Deakin University, Victoria

Figure 4: Leadership – Discovering your Hidden Potential Leanne Casey, Rostering Best Practice Manager, Western NSW LHD

“I was so inspired by the work across rural NSW and impressed by the smooth running of the conference. Please look out for the recorded conference and dip into the work of our resilient and innovative rural colleagues”. ACI Participant

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Evaluation

A total of 44 respondents completed the online evaluation 16% had joined individually via Pexip from their desktop. Almost 40% attendees attended from NSW Health facilities via internal live streaming and 26% attended as External Organisations via external live streaming (made live on the day by eHealth as a Conference Channel using thee You Tube Platform. See Figure 5.

Figure 5: How did you participate in the RICH Forum?

There was a good spread of attendance across all presentations, with the most popular sessions

being the NSW Rural Doctors Network social media campaign promoting self-care #RuralHealth

Together (n=27), Deakin University Victoria’s Ripple Effect: Digital intervention reducing suicide

stigma (n=28) and HARP – Way out west a new way to HIV (N=26). Figure 6.

Figure 6: Harp – Way Out West: A New Way to HIV Jo Lenton, CNC Sexual Health, Far West LHD

There was diverse representation of disciplines in attendance; LHD clinicians, Primary Health

Networks, NSW Ambulance, Universities (Sydney, Charles Sturt, Southern Cross), some

undergraduate students, as well as interstate (Queensland Health, SA and WA Country Health).

Participants commented that presentations were relevant, well presented, pitched at the right level

and that the audiovisual quality was good. Unfortunately the process for sharing videos on screen

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required the presenter to stop presenting to bring up the video, then recommence the presentation

afterwards, which was clumsy. eHealth NSW are working to streamline this process for RICH 2020.

Feedback on the program was overall positive.

Generally well presented and easy viewing and listening

Need a smoother process for showing videos. They didn't transmit on the full screen.

Collaboration and inter-disciplinary work are key to building resilience for staff and clients. There is so much potential for telehealth.

I like being able to attend virtually and pick out the relevant sessions. Sticking to the timetable makes it possible to do this.

Effective and innovative use of technology can provide rural people with relevant & timely care as well as reduce the clinical isolation that comes from geographical isolation.

Really great information presented and very convenient being able to attend from my

office.

“I loved the format. Coming and going allowed me to do quick meetings and then rejoin without

interrupting anyone”.

Take home messages The messages were varied due to the range of presentations. The biggest take home

message was the positive work being done and the power of networking.

Listen to people and be compassionate, open minded.

Improvements, no matter how small make a big difference to those in our

communities.

We are resilient and inventive and this needs to be supported and fostered

Using technology to improve service delivery Ways to promote and support self-care in rural communities. Never give up!

Don't stop looking for ways to be creative and share your work.

Creativity goes a long way to finding regional solutions

Diversity, resilience, breaking down barriers and fears and opening conversations.

Use tough times to learn from and grow.

Use existing resources to connect (people, websites, social media, media - TV or paper, and technology).

“I thought that the take home message was inclusion. Broken Hill did that extremely well”

“Resilience is looking after ourselves – use the resources available and the systems in place”

Suggested improvements Refining the process for showing videos was mentioned numerous times. In previous years, the technology could not support transmission of videos via videoconference due to bandwidth and connectivity capacity. Audiovisual quality control could not be guaranteed and moving images would frequently pixulate or freeze.

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As the technology improves, so does the potential for showing videos via videoconference. RICH 2019 was the first forum to trial videos as part of a presentation. Videos were sent to eHealth who uploaded them when prompted by the presenter. Unfortunately this had not been tested, and for the first presenter - the presentation was still being shared on the full screen and the video only transmitted as a small screen. To rectify this, subsequent presenters were asked to stop sharing their screen before eHealth uploaded the video which enabled the video to be seen on full screen, but then required the presenter to resume sharing their screen and finding the slide they needed to resume the presentation, which was a bit awkward.

There were some issues with individual sites muting and unmuting microphones for the Q&A

sessions and resource limits being reached due to large numbers of guests joining the Virtual

Meeting Room (VMR). All presenters were enabled to join the Forum as a host and all other

attendees joined as guests. This allowed all attendees to be force muted if required and eliminated

any noise disturbance, reducing management burden for ACI and eHealth.

Slido will be used to moderate Q&A sessions for RICH 2020 and live stream attendees will have the

opportunity to ask the presenters questions, with the Slido page integrated into the VMR live stream

so everyone can see it at the same time.

There were many positive comments about the forum. One attendee said:

“Everything about this day was great. I loved how presenters could present from their respective

areas, stretching across NSW. I loved how I didn't have to take two days out of office to travel to get

to partake in this forum. This method of communication is effective, interactive and saves

organisations lots of money.”

Future Topics Attendees were asked to suggest potential themes for future RICH Forums. Suggestions included:

Telehealth – bringing health services to rural and remote regions

Patient Flow – understanding the patient journey to hospital and back again. Specialties can

be a bit ‘ivory tower’ in their particular domain and we sometimes forget that the patient

has to interact / journey through more than just one particular area. How we can work

together better, reduce fragmentation and provide better continuity of care and outcomes

for patients.

Working together – communities and workforce collaborating to improve access to

healthcare.

Mental Health

Rural and Remote Health – what will the future look like?

Innovations to traverse / facilitate the patient journey

Integrated service delivery

“I listened to the first two presenters on the Forum on my mobile as was driving that day to clients. Later managed to see a few other sections on you tube. Finishing the Forum off this afternoon. I appreciated the ability to drop in and out and the access via you tube so I could listen to all the presenters. I enjoyed the variety of presenters as well.” Narrandera

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APPENDIX 1: RICH Forum 2019 Program

Wednesday, 20 March 2019

9.00 am Introduction, Acknowledgement to Country and Housekeeping Jenny Preece

9.10 am Official Opening Jean-Frederic Levesque, Chief Executive, Agency for Clinical Innovation

9.15 am

Tiddas 4 Tiddas – building resilience through story telling

Marlee Silva, Published Writer, Activist and Specialist Indigenous Consultant at Cox Inall Ridgeway

Sydney

9.45 am Harp – Way Out West: A New Way to HIV

Jo Lenton, CNC Sexual Health, Far West LHD Broken Hill

10.15 am

The Ripple Effect: Digital Intervention Reducing Suicide Stigma in the

Australian Farming Community

Alison Kennedy, Research Fellow, Deakin University, Victoria

Hamilton

Victoria

10.45 am Morning Tea (15 mins)

11.00 am Addressing Funding Gaps for Home Modifications in NSW

Christa Roessler, EnableNSW, HealthShare NSW, Parramatta

11.30 am Breastscreen NSW Aboriginal Engagement Project

Christine Fing, Breastscreen, Greater Western NSW Orange

12.00 pm Leadership – Discovering your Hidden Potential

Leanne Casey, Rostering Best Practice Manager, Western NSW LHD Orange

12.30 pm Lunch (30 mins) – ePosters will be displayed as a slide show

1.00 pm The Power of Never Giving Up

Carly Salmon, Para Athlete, Australian Institute of Sport Canberra

1.30 pm Virtual Midwifery Huddles – Communication and Support for Isolated

Midwives CEC

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Maria Crilley, NSW Pregnancy and Newborn Services Network, Randwick and

Hunter New England LHD

2.00 pm #RuralHealth Together – Promoting Self-Care for the Rural Health Workforce

Angela Kerr, Project Manager, NSW Rural Doctors Network

Hamilton

NSW

2.30 pm

Care Closer to Home – Pain Management in Southern NSW

Philippa Gately, Manager System and Service Integration, COORDINARE,

South Eastern NSW PHN

Moruya /

ACI

Keynote Speakers

Carly Salmon Carly was first involved in Para-Athletics as an eight-year-old living in Wagga Wagga, when her PE teacher saw her potential in sport and encouraged her to take part in local Athletes with Disability competitions. Although she was born with cerebral palsy, she never saw herself as someone with a disability but thrived on the opportunity to compete. In 2012, Carly was internationally classified, which opened new doors. Carly has represented NSW many times as a Para athlete and trains at the NSW Institute of Sport. Carly first represented Australia at age 14 in Lyon, France, in the World Para Athletics. Carly came fifth in the 100m and got a bronze medal in the 200m. Since then she has represented Australia in Doha and London and most recently in Australia at the Commonwealth Games.

Marlee Silva Marlee Silva is a 23 year old Kamilaroi and Dunghutti woman from Sydney. She's a published writer, activist and specialist Indigenous consultant at Cox Inall Ridgeway. She's also the Co-Founder of Tiddas 4 Tiddas (@tiddas4tiddas) a social media-based movement, developed in the hopes of not losing the momentum of the 2018 NAIDOC theme 'Because of her we can!' The page is committed to building the resilience and confidence of Aboriginal and Torres Strait Islander women and girls, through storytelling. With over five and a half thousand followers, the page has reached people all across the country, connecting to everyday women doing amazing things and showing the rest of the nation, they are something we should all be proud of. Marlee has previously worked in the non-profit sector and has extensive experience working with young Indigenous people from metro regions to remote communities.

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ORAL PRESENTATIONS

The Ripple Effect: Digital Intervention Reducing Suicide Stigma in the Australian Farming Community Alison Kennedy, Research Fellow, Deakin University Victoria Australian Farmers demonstrate toughness and self-reliance rather than displaying emotional vulnerability and are known to avoid seeking help increasing risk of mental health issues and exposure to suicide. Suicide stigma is common leading to isolation, weakness, shame and a sense of rejection. The Ripple Effect is an innovative digital intervention where participants share experiences, learn from peers and build knowledge and skills to assist them through challenges using smart phones, iPads or the home computer. Personal digital stories, SMART goal setting and digital postcard messaging provides links to resource supports tailored to the participant’s location and experience. Addressing Funding Gaps for Home Modifications in NSW Christa Roessler and Jemma Burns, Clinical Advisors Enable NSW In response to gaps in funding for home modifications being identified by LHDs, Enable NSW has partnered with the NSW Ministry of Health to introduce a new home modification funding program. The Safe and Supported at Home (SASH) initiative commenced in October 2018 as a stand-alone program, with guidelines and referral forms being developed to streamline eligibility, clinical and technical information. There has been a high level of uptake, particularly in regional areas. Breastscreen NSW Aboriginal Engagement Project Christine Fing, Aboriginal Engagement Officer, Breastscreen Greater Western NSW

This project targets Aboriginal women aged from 40 years for breast screening (both first time and return screeners). In partnership with the Western NSW LHD Aboriginal Health Leadership Team and the Bila Muuji Aboriginal Health Service (a combination of the WNSW Aboriginal Community Controlled Health Services), Breastscreen has established yarning circles preceding the screening session around the importance of screening and mammograms at fixed sites and in mobile units. Three hundred and seventy women have attended yarning circles across 23 sites, with 238 women screened – 97 being first-time screened.

Leadership – Discovering your Hidden Potential Leanne Casey, Rostering Best Practice Manager, Western NSW LHD In preparation for a senior nursing position to be vacated for long service leave and retirement, Western NSW LHD developed a program to explore and grow potential leaders. The program consists of learning modules, three month rotations into the position and mentorship. Staff were identified who were keen to participate in leadership opportunities, some of whom who were not previously known to have an interest in senior roles because of the unknown fear and commitment to a position unfamiliar to them. This staggered program involves self-directed learning, online learning, mentorship and guidance allowing opportunity to grow expertise and skills. Harp – Way Out West: A New Way to HIV Jo Lenton, CNC Sexual Health, Far West LHD In 2015, Far West LHD identified an existing event, the Australian Drag Performance – the Broken Heel Festival, which attracts a priority population at risk of HIV. Point of care testing was trialled at the festivals, and since then the model has evolved to incorporate health promotion and urine screening for sexually transmitted infections. Participation has grown from 22 tests in 2015 to 41 tests in 2016 and 2017. Opportunistic use of point of care testing in a non-clinical setting is reaching a priority group in regional NSW.

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Virtual Midwifery Huddles – Communication and Support for Isolated Midwives Maria Crilley, Hunter New England LHD The Every Baby Every Time (EBET) project has been implemented across Hunter New England LHD to support rural midwives in rural settings without midwifery colleagues on site, providing second opinions when making clinical assessments, including those requiring foetal heart rate monitoring. Using clinical telehealth videoconferencing as a communication tool, virtual meeting rooms with virtual huddles were piloted and rolled out across the LHD, significantly improving professional support, working relationships and enabling timely consultations to improve safety and quality of care for rural women and their babies.

#RuralHealth Together – Promoting Self-Care for the Rural Health Workforce Angela Kerr, Project Manager, NSW Rural Doctors Network The impact of drought on health workforce capability has been significant and there is a need to promote self-care and resilience. #RuralHealth Together provides self-care information and access to tailored support using digital mechanisms and social media campaigns via twitter and Facebook; posting videos and messages of support from clinicians, politicians and rural advocates. In addition, the Rural Doctors Network aggregates service support information that is disseminated through the #RuralHealth Together website, maximising expertise and resource availability of specialist services and allowing rural health workers to channel their energies into service delivery.

Care Closer to Home – Pain Management in Southern NSW Philippa Gately, Manager System and Service Integration, COORDINARE, South Eastern NSW Primary Health Network Southern NSW has opioid prescribing rates 6-7 times the national average and high rates of Emergency Department presentations to related to pain. Access to specialist pain care in limited and located up to 500km away. Through a partnership between the ACI, SENSW PHN, St Vincent’s Pain Service and Southern NSW LHD, a telehealth service was established to manage people with severe chronic pain, as well training and funding local allied health providers to run group programs for mild to moderate chronic pain. Over the last two years, 186 telehealth patients have saved an average of 830 driving hours over 66,000km. More than 50% of patients participating in the group allied health programs made clinically significant improvements in pain, depression and stress.

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ePOSTER PRESENTATIONS

A rolling slideshow over the lunch break

Tai Chi Raising Rural Health Workforce Resilience Anne Smart, CNC Women’s Health, Western NSW LHD In a bid to respond to the need for stress management, self-awareness and self-care, a six-week Tai Chi course for health workers was commenced in October 2018. Fifty-four participants attended the course once per week. The outcomes included mindful moving meditation, strengthening resilience and emotional intelligence and raising energy and wellbeing. The Tai Chi sessions have recommenced in 2019 and are ongoing.

Forbes High School Wellness Hub Brenda Hurst, Women’s Health Nurse, Western NSW LHD Forbes has a small regional high school of 380 students, with 29% students identifying as Aboriginal. There are embedded barriers for students in accessing health services and addressing emerging psychosocial needs. Cross-sector partnerships were established to commence a wellness hub in a safe youth friendly space as a one-stop shop for health. On average, there are 400 appointments per term with students accessing multiple service providers at no cost to Western NSW LHD.

Integration of Art and Signage with MPS Redevelopments Fiona Ostini, Change Manager, Western NSW LHD Redevelopment projects at Coolah, Molong and Rylstone Multipurpose Services (MPS) sites has integrated funding from the LHD, including Aboriginal artwork and signage into Health Infrastructure funded redesign. Art in health improves the patient, staff and carer experience in health services by providing more vibrant treatment spaces with a less clinical feel and social inclusion which generates perceptions of improved care quality. The health facility gains a distinctive identity and leaves a positive legacy that goes beyond healthcare, enhancing resilience of rural communities and culturally appropriate care.

Partnerships and Shared Pharmacist Positions Andrew Johnson, Pharmacy Academic, Broken Hill University, Department of Rural Health Despite the fact that there are more pharmacy students entering study, there is still a scarcity of rural pharmacists. As part of its pharmacist succession planning, the Outback Pharmacies Group has partnered with the Far West LHD, Maari Ma Aboriginal Corporation, Southern Cross Care Broken Hill and the Broken Hill University, Department of Rural Health, to create shared intern/pharmacist positions and student placements which offer exposure and experience on rotation between the organisations. As a result, 15 interns have been recruited since 2012, with 12 registering as pharmacists and eight remaining in Broken Hill.

Staff Stories – the other half of the equation using emotional touchpoints to effect cultural change. Janet Masters and Eureka van der Merwe, CNS2, Safety Culture Coordinator and Essentials of Care Program, Far West LHD Far West Local Health District (FWLHD) has used patient stories collected via Appreciative Inquiry

(AI) and Emotional Touchpoints (ET) to engage the Board, Senior Executive and staff as a catalyst for

change within the past two years. Staff stories have revealed many positive experiences and

highlighted areas for improvement. Stories from patients, staff and carers are the substance of

person-centred care, are a valued practice in FWLHD and have been used to effect a culture of high

performing teams across the District.