monashhealth...englishenglish arabic the purpose of this monash health quality of care report is to...

MonashHealth

Report 2014-15Quality of Care

Delivering exceptional care, outstanding outcomes

Monash Health Quality of Care Report 2014-15Monash Health Quality of Care Report 2014-15 32

50Continuity of care

05About Monash Health

08Report of the Chair of the Board and Chief Executive

62Feedback and distribution

10Partnering with consumers

22Quality and safety

Contents

We are right here with you throughout your journey of care

Monash Health Quality of Care Report 2014-154

About usMonash Health is proud to provide integrated health care to one quarter of Melbourne’s population.

We uniquely provide health care across the entire life-span from newborns and children, to adults, the elderly, their families and carers.

We improve the health of our community through: • Prevention •Early intervention •Community-based treatment and rehabilitation •Highly specialised surgical and medical diagnosis, treatment and monitoring services •Hospital and community-based mental health services •Comprehensive sub-acute and aged care programs •Palliative care •Research •Education

Our visionExceptional care, outstanding outcomes.

Our purposeTo deliver quality, patient-centred health care and services that meet the needs of our diverse community.

Our valuesWe remain firmly committed to our iCare values of: • Integrity • Compassion • Accountability • Respect • Excellence

About us

Our care at a glance

3.1 millionTotal episodes of careMore than 3.1 million episodes of care provided across the community.

206,602Emergency presentationsMore than 206,602 people came to our three emergency departments for treatment.

238,851Hospital admissionsMore than 238,851 people admitted to our hospitals.

45,759Surgical operationsMore than 45,759 operations performed.

1,186,825Outpatient servicesMore than 1,186,825 occasions of service provided by our outpatient services.

9,489BabiesThere were 9,489 babies delivered.

257,180Mental healthMore than 257,180 client contacts.

36,453Paediatric admissionsMore than 36,453 admissions of children under age 19 to our children’s wards and neonatal units.

51,476Ambulance arrivalsMore than 51,476 ambulance arrivals handled by our emergency departments.

We provide exceptional care across the entire life-span from newborns to the elderly

HOSPITALS

MONASH HEALTH COMMUNITY

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COMMUNITY FOREWORD

English

Chinese

Quality of Care Report text for translation

English Arabic The purpose of this Monash Health Quality of Care Report is to inform consumers, carers and our community about our quality and safety performance and what we are doing to improve our services.

Chinese Croatian Monash Health

Svrha ovog Izvješća organizacije Monash Health o kvaliteti zdravstvene skrbi je informirati korisnike, skrbnike i našu zajednicu o kvaliteti i sigurnosti davanja usluga i što činimo da unaprijedimo naše usluge.

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Ο σκοπός της Αναφοράς Ποιοτικού Ελέγχου Φροντίδας του Monash Health είναι να εμημερώνει τους χρήστες υπηρεσιών υγείας, φροντιστές και πολίτες της περιοχής μας για το επίπεδο της παρεχόμενης ποιότητας και ασφάλειας καθώς και τις ενέργειες που καταβάλλονται για τη βελτίωση των υπηρεσιών μας.

Khmer Russian

Организация Monash Health подготовила этот отчет о качестве обслуживания и ухода, чтобы проинформировать наших клиентов и тех, кто ухаживает за больными и инвалидами, о качестве, безопасности и совершенствовании наших услуг.

Serbian Somali Овај Извештај о квалитету здравствене неге организације Monash Health има за циљ да информише кориснике, неговатеље и нашу заједницу о квалитету и безбедности давања услуга и шта радимо да унапредимо наше услуге.

Ujeedada Warbixintan Daryeelka Tayada Monash Health waa in la wargeliyo isticmaalayaasha, daryeelayaasha iyo bulshadeena wax ku saabsan waxqabadka ammaanka iyo tayadeena, waxaan sameynayno si aan u hagaajino adeegeena.

Spanish Turkish El objetivo de este Informe sobre la Calidad de los Servicios de Atención prestados por Monash Health es comunicar a nuestros clientes, cuidadores y comunidad sobre la calidad y seguridad de nuestros servicios y nuestros planes para mejorarlos.

Monash Sağlık Kalitesi Bakım Raporunun amacı, kalite ve güvenlik performansımız hakkında tüketicilere, bakıcılara ve toplumumuza haber vermek ve hizmetlerimizi geliştirmek için neler yaptığımızı bilgilendirmektir.

Italian Vietnamese Lo scopo di questo Rapporto sulla Valutazione dei Servizi prestati da Monash Health è di informare ai nostri clienti, badanti e la nostra comunità riguardo la qualità e sicurezza dei nostri servizi e i nostri piani di miglioramento di questi servizi.

Mục đích của bản tường trình thành quả chất lượng chăm sóc của Dịch Vụ Y Tế Monash là để thông tin cho bệnh nhân, người chăm sóc người bệnh và cộng đồng chúng ta về hiệu năng an toàn và phẩm chất phục vụ của chúng tôi; đồng thời thông báo những gì chúng tôi sẽ làm để cải thiện các dịch vụ này.

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Community foreword

We are committed to delivering culturally appropriate care for our community


Report of the Chair of the Board and Chief Executive

Proudly committed to delivering excellent outcomes for our community

REPORT OF THE CHAIR OF THE BOARD AND CHIEF EXECUTIVE

This report provides an insight for our patients, their families and the general community into our activities, achievements and the improvements we have made in partnership with our consumers, to provide safe and effective patient-centred care.

We are proud to be a patient-centred organisation. Being accountable and able to measure our results of patient-centred care is vital to all of our consumers. Monash Health – which is on a path of continual improvement - strives for exceptional care and outstanding outcomes in everything we do.

Monash Health is the largest provid-er of healthcare in Victoria employing more than 15,000 staff undertaking more than 220,000 hospital admissions per year.

We apply our key strategic objective to ‘put our patients first’ to every element of our care and aim to ensure that every patient receives the best possible care when they come to Monash Health.

We have experienced a record year of service delivery, caring for more Victorians than ever before.

We also prepared for and achieved successful accreditation for both the Australian Commission on Safety and Quality in Health Care’s National Safety and Quality Health Service Standards and National Mental Health Standards. This is a tremendous achievement.

We thank our consumer advisors, patients, families, carers and our wonderful staff for their dedication to the process over the past 12 months and for their commitment and passion to improve the quality of care we provide our patients. They were instrumental in Monash Health’s success in the National Standards accreditation journey.

Safety of patients and staff is our number one priority. We have consciously created an environment where safety is the underlying philosophy that underpins our organisational culture. It is also central to our strategic focus to always put our patients first.

Part of providing the safest care is ensuring our iCARE values of integrity, compassion, accountability, respect and excellence are at the core of everything we do.

Ensuring all our systems and practices continuously improve, and implementing beneficial staff health and wellbeing initiatives, are crucial priorities for us.

During 2014 we entered a partnership with the Institute of Healthcare Improvement (IHI), to assist us with our patient-centred care focus. A total of 170 senior clinicians and leaders participated in extensive workshops to accelerate improvements to the patient experience and patient safety.

Teams have been formed on key projects including improving mortality and sepsis rates, and creating the capacity to make our services even more accessible.

Our commitment to research and translating that to real improvements for patients was strengthened in early 2015 with Monash Partners recognised as an Advanced Health and Research Centre – one of only four in Australia.

Monash Partners – our research collaboration with Monash University, Alfred Health, the Hudson Institute and other health and research organisations - was judged by international experts as being among the world’s best for using medical research to improve patient care. This is a proud achievement that forms a foundation for even greater discoveries in the future.

To ensure our services are patient and family-central we engage with consumers on many levels in our planning and service initiatives. Our Community Advisory Committee provides valuable guidance and consumer focus on the way we provide our services.

Thank you to our staff, patients, partner organisations and our community in helping us achieve our vision of exceptional care, outstanding outcomes.

BarbaraYeoh Chair,BoardofDirectors

ShellyParkChiefExecutive

It is with great pleasure that we present Monash Health’s annual Quality of Care Report for 2014-15, which gives our valued community comprehensive details of our performance against standards established by the Department of Health and Human Services.


Involving our consumers, carers and community is essential to ensure we provide optimal, effective and the very best quality care. We are proud of our partnership with patients and consumers as consumer participation is fundamental to our culture and strategic process.

How do we partner with our patients and consumers so you receive the best possible care?

Governancestructuresfacilitatepartnerships

Met

Policiesandproceduresforpartneringwithconsumers

Met

Orientationandtrainingforconsumers

Met

Consultingconsumersonpatientinformation

Met

Consumerspartnerindesigningthewaycareisdelivered

Met

Trainingforworkforceonvalueofandwaystofacilitateconsumerparticipation

Metwithmerit

Informingconsumersaboutsafetyandqualityperformance

Met

Consumersparticipateinsafetyandqualityperformance,actionandimprovement

Met

Consumersevaluatepatientfeedbackforimprovement

Met

Partnering with ConsumersThe National Safety and Quality Health Service Standards, developed by the Australian Commission for Safety and Quality in Health Care, are designed to provide a nationally consistent standard of care for consumers attending any health service organisation across Australia.

In July 2014, Monash Health’s commitment and achievements in consumer participation were recognised through successfully meeting all the requirements of National Standard 2, Partnering with Consumers during accreditation.

How can you Have a Say at Monash Health?Consumers are invited to have a say in a number of ways - by providing feedback, becoming a consumer advisor or working as a volunteer. Monash Health’s Have a Say program was formally launched in March 2015.

Early indicators point to a successful program with the recruitment of 12 consumer advisors in three months. This has seen our consumer advisor register grow to over 100 consumer advisors. Other benefits have included invitations to present the program at community group meetings giving us reach into our diverse community

Through these partnerships we are able to ensure: • the interests of patients and consumers are included in our strategic objectives. •services are responsive to the needs of both individuals and the community. •patient-centred care is at the core of care delivery and planning. • we are accountable to the community we serve.

Thank you to our Community Advisory

Committee which helps enhance

our services


How we ensure we partner with consumers in all aspects of their careConsumer, Carer and Community Participation FrameworkWe continue to increase recruitment of consumer advisors with 115 consumer advisors now part of the our Consumer Advisor Register. Consumer advisors are members of over 60 committees, panels and working groups across the organisation and have strengthened consumer partnerships through their involvement.

Community Participation Plan

The Monash Health Community Participation Plan provides an organisational framework and documents Monash Health wide consumer participation activity, including the “business as usual” and future planning.

Community Advisory Committee

The Community Advisory Committee (CAC) is an advisory committee of the Monash Health Board of Directors, chaired by a consumer. Members of the CAC are involved in a number of committees and reviews, nationally, state-wide and across Monash Health.

Through its annual workplan, the CAC has focussed in three areas: cultural diversity, mental health and medication safety. This approach, based on organisational importance and community need, will ensure the consumer perspective is embedded in improving quality and safety in health service delivery.

How we involve our consumers in the co-design of our services and facilities At Monash Health co-design provides the opportunity for patients, family, carers, the community and staff to:

• identify needs and expectations

• influence how care and services are provided

• inform design and improvement.

Monash Health’s co-design activity operates at all levels from organisation-wide projects, capital planning and infrastructure development and service model reviews to local level improvement activities, wherever the design or redesign of care and services across the organisation takes place. Current co-design activity across Monash Health includes the Monash Children’s Hospital development; a review of how care and services are delivered by Monash Health Community, which involved looking at specialist clinics and information for clients and the community on aged care reforms.

Patients and their families are involved in the design of the new Monash Children’s Hospital


Our consumers play a crucial role in in telling us what we are doing well and where we could improve our services even further.

Monash Health is committed to learning from consumer experiences to improve the quality and safety of our care.

Complaints are reviewed, analysed and themed by issue to help inform improvement.

Monash Health aims to close complaints within 30 days: from July 2014 to June 2015 we achieved this target for 93 per cent of cases.

What you told us “Waiting time… waiting time… always waiting time.”

Consumer feedback informed us that people were waiting far too long in the emergency departments across Monash Health.

What we didIn response, an innovative patient management model to reduce Emergency Department waiting times of patients was implemented in 2014. The number of complaints regarding waiting in our Emergency Departments has fallen dramatically.

What you told us“My follow-up appointment has been organised in three months’ time, this is too long!”

Consumers told us about long waiting times for an outpatient appointment to be scheduled and delays when attending the outpatient clinic.

What we didA project is underway which involves a major overhaul of the Outpatient appointment and scheduling system. Staff, with consumer advisor input, are working hard to ensure improvement over the next 12 months.

Monash Health farewells longstanding volunteerDr Beverley Castleman, a long-standing volunteer on the Monash Health Human Research Ethics Committee stepped down from the position of lay representative at the end 2014.

Dr Castleman was involved with the Human Research Ethics Committee since 1996. A social scientist, Dr Castleman’s commitment to the welfare of research participants and to enhancing Monash Health’s reputation as leader in clinical research was unsurpassed.

She has been a mentor and a wonderful source of knowledge for researchers, clinicians and members of the Human Research Ethics Committee at Monash Health. Monash Health greatly appreciates Dr Castleman’s contribution.

“BeingaconsumeradvisoratMonashHealthin2015meansIhaveanopportunitytoinfluencethefuturehealthcareofMonashHealthconsumers.”

Peter,ConsumerAdvisor

“Havingbeenaconsumeradvisorfor10yearsIhaveseenmanychanges. Iamheartenedtoknowthatin2015MonashHealthrespectsandvaluesthecontributionthatallconsumeradvisorsgive. Thisisevidentbythesupportandrecognition,especiallyateventssuchasthe’HaveaSay‘forum.Idofeelthatconsumersarebeingheardandrespected,andmakingadifferencetoMonashHealth.Itisrefreshingtothinkthatconsumersarenowacceptedasmember/representativeinkeyareasofhealthserviceswithinMonashHealth. Especiallywhenchangeisbeingmadewithinthesystem,forexampletheMonashChildren’sHospital.”Judy,ConsumerAdvisor

What does it mean to be a consumer advisor at Monash Health in 2015?

Your feedback is crucial

What you told us“You need to have healthier food options for children. Café should also be open later with meals for parents to buy for themselves.”

Consumers told us about their issues with food availability and options.

What we didMonash Medical Centre is trialling fresh fruit juice machines in designated patient seating areas, including the Intensive Care Unit (ICU). The cafe at the Monash Medical Centre has implemented extended café trading hours and a traffic light system of food labelling has been introduced across our cafes to support healthier food choices. Vending machine content is also being reviewed to include more healthy choice options.

Waiting Rudeness/lackofrespect

2013-14

2014-15

Poorcare Poorcommunication

Top issues for complaint

We listened and acted

Thank you to all our dedicated volunteers


What you told us“No communication, the doctor said they would be back to see me and explain my treatment before they went home. Two hours later I’m telling staff why I am there and what is supposed to be happening…”

Communication is a common theme in patient, family and carer feedback.

What we didLots of initiatives are underway looking at improving communication including staff workshops on communication strategies and conducting consumer experience surveys explaining information. Results show this work has been effective in improving communication. Good communication ranks second only to good care in the leading reasons for a compliment. The chart shows the importance of communication.

Monash Health patient informationWe are committed to providing our patients and their loved ones with relevant, accessible, timely and appropriate information. And, again, our consumers have been central to continuous improvement as all patient information developed now involves consumer review.

The procedure Creating Information/Materials for Patients and Consumers, an organisation-wide approach implemented in 2013 in line with National Standard 2 Partnering with Consumers, has had a significant impact on the quality and consistency of written patient information.

The volume of information submitted for review continues to grow as awareness of the value of providing high-quality information increases among staff.

Departments including Pharmacy, Nephrology and Monash Women’s have taken a whole-of-department approach to ensure information is reviewed by consumers and published according to the procedure.

The increase in skills of authors in writing information according to easy English principles has led to improved quality of information being received for review. Staff regularly access the range of self-help tools made available to support the procedure.

Current patient informationNumber submitted for review: 202 Currently in review: 48 Complete to print: 154

How we communicate information to our culturally and linguistically diverse community In 2014-15 Monash Health Language Services translated 53 documents including letters to patients, discharge summaries, patient information and brochures into 28 of the most common community languages.

The patient Rights and Responsibilities brochure is now available in 15 languages.

Helping you make informed decisions

Supportive care planning – Mental HealthA Treatment and Recovery Plan clearly describes the way forward for a consumer and the treating team. Treatment and recovery plans are reviewed and updated to reflect changing circumstances of the consumer. Each consumer and their family or carer is involved in the development of a plan and consumers are encouraged to sign their individual plan, however, many decline.

The Advance Statement is another important aspect of the person’s treatment and recovery as it

Goodcare

4%

44%

52%

Goodcommunication

Positiveattitudetoaquery

Top reasons for compliments

informs the treatment team of a consumer’s preferences in relation to treatment in the event that the consumer is admitted.

The Advance Statement is a new concept under the new Mental Health Act 2014 and the majority of consumers do not have an Advance Statement as yet. Clinicians invite and assist consumers to develop their own Advance Statement.

To make sure that clinicians are equipped to assist consumers with their Advance Statements, education is provided online.

Providing care for individual needs – self reported surveysHaving the client identify if they are having difficulty taking part in day-to-day activities, coping with feelings and interacting with others is important in identifying individualised care and support for clients, their families or carers.

The Behavioural and Symptom Identification Scale (Basis 32) self-reported survey is currently being completed by 41 per cent of consumers.

How do we inform our community of our quality and safety performance?•Patient information and data boards

Thanks to feedback from consumers, we now have simplified ward and unit quality boards that clearly highlight quality and safety information relevant to the clinical area, the services provided, who to contact and how consumers can be involved in patient safety.

Quality boards are on display in our wards. Making quality and safety information available to our consumers ensures that we are accountable for our quality and safety performance.

It was recognised that the National Quality and Safety Health Service Standards can be difficult for patients to understand. So in addition to consumer and community messaging around the National Standards and how they relate to consumers and the community, a review of the boards aimed at consumers was undertaken in February 2015.

The review looked at the information available and if it matched the information patients and carers felt was valuable or required.


Victorian Healthcare Experience Survey

The Victorian Healthcare Experience Survey (VHES) is a state-wide survey of people’s public healthcare experiences.

The VHES allows a wide range of people to provide feedback on their experiences. Questionnaires are available for adults and children who are inpatients or emergency

Improving patient experience – thematic analysisAt Monash Health a thematic analysis of patient experience data is undertaken to combine all available information that can increase knowledge of patient experience at a site and program level.

Results from qualitative and quantitative patient experience data, are collated, analysed

Overallexperience

Adultinpatient

Adultemergency

Paediatricinpatient

Paediatricemergency

Q1 Q2 Q3 Q1 Q2 Q3 Q1 Q2 Q3 Q1 Q2 Q3 Q1 Q2 Q3

86% 88% 86% 91% 89% 89% 81% 86% 82% 89% 89% 92% 87% 88% 87%

*Please note that Quarter 4 (Q4) data was not available at date of publication.

identifying themes for positive performance and opportunities for improvement. A Monash Health site/program-based approach to action planning is applied allowing for more efficient, effective action planning to improve patient experience and ensure site/program strategies complement organisation-wide strategies. The themed opportunities for improvement provide a recommended focus for sites and programs to improve their patients’ experiences.

department attendees, including carers and parents. VHES results are reported quarterly from 1 July to 30 June.

Quarter 1, 2 and 3 results* for the percentage of Monash Health patients who rated their overall experience as either ‘very good’ or ‘good’.

Examples of improvements in response to thematic analysis include:

•Adding discharge-related checklists to the electronic medical record.

•Reviewing Emergency Department signage.

•Structured times for medical ward rounds.

•Comprehensive review of ward based information.

MonashHealthaimstominimisetheuseofrestrictiveinterventions,includingseclusioninitsmentalhealthservices. Seclusionisusedtoprotecttheimmediatesafetyofanacutelyunwellpersonorothers.

TheDepartmentofHealthandHumanServiceshasatargetrateforseclusionof15orlessseclusionsper1000beddays.

MonashHealthhasmaintainedanaveragerateoflessthan8seclusionsper1000beddaysfor2014-15.

Minimising the use of seclusion for our patients with mental health illness

Patient Experience Questionnaire We measure patient experience, expectations and confidence using our six question patient experience survey. The questionnaire is conducted across all inpatient areas on a six-monthly basis.

Comments received while conducting the questionnaire are recorded, relayed to staff, themed and analysed and used with other patient experience data to formulate improvement actions.

Asking our patients about their experience

Consumers tell us:

“I cannot fault the care I have received. The staff are very caring and overall the care that my family and I have received has been exceptional.”

“Everyone we have come into contact with has been amazing.”

“I would like a more definite time on when I am going home.”

“My biggest concern when I got here was pain and that was taken care of and managed very well.”

“Car parking is an issue.”

Percentage of patients across Monash Health who rate:

1. Communication between doctors, nurses and other hospital staff about their treatment as good to excellent

2. How well information about their treatment was explained to them as good to excellent

3. The way staff involved them in decisions about their care as good to excellent

4. How well their pain has been managed as good to excellent

5. How well the care received matched their expectations as met to greatly exceeded

6. They would be likely to definitely recommend the hospital to a relative or friend.

Q2 Q3

2013-14

2014-15

Q4 Q5 Q6

Patient experience questionnaire results

96%91% 91% 90% 91% 90% 93% 91% 93%

95%

Q1

91% 92%


Celebrating life after a transplantThe Nephrology Department celebrated World Kidney Day with a special event for patients and families.

The event Let’s celebrate life and World Kidney Day included a presentation from long-term patient Twanny Farrugia who shared his inspiring story of life after his transplant.

“In October 1971 I was fortunate to have a kidney transplant. That was 43 years ago and at the time I was one of the youngest patients to receive a transplant at 18 years of age,” Twanny said.

“After my transplant I got myself a new life - energy that I never had before, no longer feeling sick and cold and a lovely skin colour,” he said.

Twanny wasted no time in living life to the full after his transplant - travelling with family and full-time work as a loss and grief counsellor and educator in the allied health industry. He retired four years ago after 15 years managing his own business.

Many patients attending the event have received a transplant, hope to have one or face dialysis. Hearing Twanny’s remarkable story gave many hope and encouragement.

Patient journeys

Transplant recipient, Twanny, shares his story of hope with

other transplant patients


“I look forward to every Wednesday because that is the day for my guiding work and I like to assist people as they arrive at the hospital.

It keeps you active and people appreciate the help you give them. They are just so grateful for the service.

I think the Guide Service is wonderful. It’s very worthwhile to me and it helps the patients and visitors.”

Clarice Coleman Volunteer, 20 years, Monash Medical Centre

Learning Management SystemMonash Health implemented a Learning Management System (LMS) in February 2014. This has provided a ‘one-stop-shop for staff learning’, where staff are able to sign up for mandated, required or professional development modules, complete training and print out records of their attendance. New courses are being added to the system which provides a centralised way in which administrators and trainers alike can provide information and updates on learning opportunities. Our consumers also have access to training opportunities both face-to-face and online. Consumers bring a richness to our education programs through their involvement in the development and delivery of staff training.

Partnering with consumers A revised Partnering with Consumers training package was implemented in February 2014 with more than 450 staff completing the training. The package was modified to incorporate what Partnering with Consumers means in practice at all levels of the organisation and also includes helpful hints and information about consumer participation.

Patient centred care education

Co-designed with consumers the Monash Health Patient Centred Care education program began in late 2012 as part of an organisational requirement to provide an education package to the workforce on the principles and practices of patient centred care. It was agreed that embedding an organisation-wide patient-centred culture would require a major program all employees would be required to attend.

To date, 110 staff, including senior leaders have been trained to deliver the program and 10,247 employees have attended a workshop, including new medical, nursing and allied health staff during multidisciplinary orientation.

Educating staff to support our consumers and carers

Through the Pulsar research project education was provided to 86 of 164 identified Monash Health mental health staff in the first quarter of 2015. This was delivered by a consumer educator in partnership with a clinical educator and consisted of two days of personal recovery focus care. The remaining staff will receive this training in the first quarter of 2016 through the research plan.

This training has also been offered to 11 local GPs, registrars and their staff.

506 of 803 mental health staff have completed Patient Centred Care training co-facilitated with a family/carer consultant.

Art in support of mental healthCommunity group A Path to Follow, founded by Kirstie Edwards, presented a cheque to Lidor Arbel, director at Monash Health’s Early in Life Mental Health Services (ELMHS) in November 2014.

Kirstie ran three fundraising events, including an art exhibition and auction at The Breslin Gallery, titled ‘Inside your head’, to celebrate the role art can play in mental health.

Through these events Kirstie raised $8,500 to fund a sensory space at ELMHS for young people with mental health issues.

A Path to Follow was inspired by Kirstie’s personal and professional experiences with mental illness. Kirstie’s work acknowledges the power of art and its potential in supporting youth to connect with their own psychological experiences.

“The creative process can help people resolve issues while developing and managing their behaviour, feelings and stress levels, and improve self-esteem and self-awareness,” she said.

Personal reflectionsHannah Dee is an author of two books about her journey through mental illness - Death didn’t want me…Now I’ve Got Life and Cracks in my reflection. She is also an advocate for mental health, using her experience to inform others by public speaking for Mind Australia.

Hannah joined the Monash Health Mental Health Consumer and Carer Advisory Group which works with consumers and carers in quality improvement and quality and safety discussions within the Mental Health program.

Hannah has been selected to be part of the Mental Health Tribunal Consumer and Carer Group and has returned to study as a counsellor with the Australian College Applied Psychology.

With support readily available from staff of the Consumer and Carer Relations Directorate and fellow Mental Health Consumer and Carer Advisory Group members, Hannah is able to live a full and fulfilling life and help others by sharing her firsthand experience of living with a mental illness.

Hannah is passionate about helping to lift the stigma of mental health issues. She also wants others to know that recovery is possible and that there is life after your diagnosis.

Building capacity to work together


A lifetime of achievement - Minister for Health Volunteer AwardsElsie Ferguson has devoted more than 30 years to volunteer for Monash Health, Monash Medical Centre and its predecessor, the Queen Victoria Medical Centre. Prior to this, Elsie served on various Mount Waverley primary and secondary school parent committees.

Elsie is now in her fourth decade of service to her community. She has helped raise hundreds of thousands of dollars to purchase medical equipment and supported the work and development of the best possible public health service for the community.

Elsie was awarded the lifetime achievement award by the Victorian Minister of Health, the Hon. Jill Hennessy in May 2015.

Making Behaviour Matter – Positive WorkplacesA quality, high performing and motivated workforce is essential to delivering exceptional care and outstanding outcomes for patients, families and carers. The People and Culture team (formerly Human Resources) under newly appointed Head, Mr Bill Kernahan, have been working tirelessly to support positive, inclusive and harmonious working environments.

The People and Culture team have designed and delivered leadership and management training with strong content on creating high performing work environments and dealing with poor behaviour. More than 200 new managers, as well as 100 experienced leaders, have received skills development in areas such as building teams, staff recognition, effective communication, hiring for success, and managing poor behaviour.

Over 1,000 new staff in the past year have participated in a comprehensive induction and orientation process, establishing clear expectations in upholding Monash Health values and healthy workplace behaviour.

The team’s ‘Staff Hotline’ has responded to over 900 inquiries each month from employees seeking advice on a wide range of workplace matters. The Hotline allows helpful and early advice to staff on issues such as managing workplace relationships, established support mechanisms, training opportunities, safety and wellbeing.

We are a high- performing team, delivering the best outcomes for our patients

Monash Health is committed to promote reconciliation and to provide culturally appropriate health services, and improve health outcomes. In line with this commitment, Monash Health has developed and implemented a Reconciliation Action Plan which details work across the organisation in partnership with the Aboriginal community with the guiding principles of Relationships, Respect and Opportunities.

Through this plan, Monash Health also details reporting requirements, including the Improving Care for Aboriginal Patients (ICAP) program funded by the Department of Health and Human Services. The following is a snapshot of what Monash Health has achieved this year in Aboriginal Health.

Working in partnership with our community to promote and achieve cultural awareness.• Monash Health has a regular executive forum with Dandenong and District Aborigines Co-operative Ltd. This includes the Chief Executive Officers, Board Chairs, a consumer advisor and senior staff from both organisations. Service data, Koolin Balit, which is the Victorian strategic direction for Aboriginal health over the next 10 years and the Monash Health Reconciliation Action Plan are the key topics of focus for this executive group.

• The Monash Health Aboriginal Health working group comprising a diverse range of staff meets monthly to implement the Reconciliation Action Plan and associated annual work plan and develop initiatives.

• Priority projects for 2015 are Patient Identification – ‘Asking the Question’ campaign and Aboriginal Staff Support and Retention.

• Monash Health has a number of programs that relate to Koolin Balit. These include:

• Monash Childrens Program and Aboriginal Children’s Health.

• Aboriginal Maternity Service supporting expectant mothers and families.

• Integrated Koori Services supporting people from hospital to community.

• Monash Health Community Home and Community Care – Aboriginal Health Services.

• Aboriginal Health Promotion and Chronic Care (AHPACC) - Aboriginal Health Promotion Plan.

• Monash Health Community Dental Services – new Aboriginal Model of Care developed through the Healthy Koori Teeth Pilot which is a joint initiative between Dental Services and Population Health in the Monash Health Community program.

• Monash Health continues to build relationships with the Aboriginal community, through the Dandenong and Gippsland Aboriginal Controlled Health Organisations and co-operatives and Victorian Aboriginal Controlled Child Care Agency. This was achieved in partnership with our Aboriginal maternity patients and our hospital midwife for Aboriginal women and the Koori maternity services.

• Key events during 2014-2015 where Monash Health partnered with Aboriginal community to recognise and celebrate include:

• NAIDOC week presentation of the movie Utopia with a debrief session and afternoon/morning tea with Aboriginal staff.

• A Close the Gap day morning tea at Monash Medical Centre and at Monash Health Community,

where a video was shown with discussion.

• Reconciliation Week networking opportunity for Aboriginal and non-Aboriginal staff (morning tea) at Monash Medical Centre was held and a cultural event was held in Monash Health Community highlighting what Reconciliation means to Aboriginal people and providing experiential insight to attendees.

Celebrating the achievements and acknowledging the experience and history of our community.• Monash Health’s Health Information Services is in the process of developing and implementing a patient identification education and awareness raising ‘Ask the question’ campaign across hospital sites.

A cultural audit tool has been • developed to identify gaps across Monash Health in areas such as; organisational awareness, communication and relationships, staff cultural awareness and training and partnerships. This was piloted as part of the Aboriginal Employment Plan Implementation project, with varying results and opportunities for improvement identified. A further cultural audit will be rolled out across a number of areas in Monash Health in late 2015.

• Monash Health continues to build a welcoming and engaging environment for the Aboriginal community, patients, families and carers, through artwork, healing spaces and support from our staff through their healthcare journey.

Aboriginal Health


Working with our community to provide better access to health services and increase our Aboriginal workforce.Monash Health has continued to work on initiatives to grow and build capacity for its Aboriginal and non-Aboriginal workforce over the past year. These have included:

• Successful funding application to the Department of Health for the Aboriginal Employment Plan Implementation project in conjunction with Alfred Health. This project led to two frameworks, completed in September 2014, that describe approaches for growing an Aboriginal workforce. The first of these covered traineeships and cadetships and provided information and a plan for using these to recruit and retain Aboriginal employees. The second framework was to implement Cultural Safety Training to the health service to support and create an accessible and equitable environment. The next steps are to continue putting in place the actions described in the frameworks.

• In May 2015 Monash Health was awarded another grant from the Department of Health and Human Services. Monash Health is in the planning stages of utilising this funding to implement cultural safety training.

• Two Aboriginal traineeship roles are being recruited in the corporate services area. The traineeships will run for 12 months and following that the intention is to place the trainees into ongoing positions. Interviews for the positions have commenced. Currently, Monash Health has a trainee working within Monash Health Community.

• Aboriginal Hospital Liaison Officers deliver ongoing education to Monash Health each week.

• A locally-focused training package has been developed for staff induction into the Monash Health Community Population Health team, which all team members complete.

• Monash Health had 22 staff identify as Aboriginal and or Torres Strait Islander.

• Trainee and cadetship opportunities: • 2 Aboriginal trainees • 5 Nursing cadets

Tome,inthecentreofAboriginalcadets,otherMonashHealthstaff,MonashHealthandthegeneralcommunity,thereisthepatient.TheeffectsofhavingprogramsliketheAboriginalCadetshipProgramflowontothepatient,which,afterall,iswhatweareallabout.

TimothyDruce,EmergencyDepartmentNurse,MonashMedicalCentre

Healthy Koori TeethHealthy Koori Teeth is an early intervention pilot project targeting preschool-aged Aboriginal children and primary aged children. The objective of the project was to trial a minimal dental intervention along with health promotion for Aboriginal children and their families.

Participants included: •Early Learning Centre at Doveton College, Doveton •Victorian Aboriginal Child Care Agency (VACCA) facilitated playgroups in Cranbourne and Pakenham •Dandenong and Districts Aborigines Co-operative Ltd (DDACL) facilitated playgroup in Doveton and DDACL facilitated Mums & Bubs group in Doveton To reduce barriers Aboriginal community members experience in accessing our dental service, the project:

•Provided Cultural Safety Training to dental staff. •Promoted dental services for Aboriginal community available in Dandenong, Cranbourne and Melbourne. •Provided information about the Bunurong Health Service travel assistance and booking process to access dental services.

• 2 Midwifery cadets • 1 Physiotherapy cadet • 1 Occupational therapy cadet • 6 Graduate nurses and 1 graduate midwife

• Research and education has progressed with collaborative projects including ’Improving service co-ordination for Aboriginal families‘ with Onemda, Melbourne University, Jean Hailes Centre, Monash Health and Monash University.

The delivery of the project to date has been very successful for those it has reached, with overwhelmingly positive feedback received from parents. One mother whose child participated in the project stated “my son is continuously reinforcing the good dental health messages he learnt from the session, such as drinking tap water and eating less sugary foods”.

Working together to Close the Gap in Aboriginal health


Reconciliation Week

Monash Health has a commitment to recognising significant Aboriginal cultural events. Reconciliation Week recognises the harm perpetrated on Aboriginal people through government policies – more specifically the Stolen Generation. In 2014 -2015 two events were held, the first on Thursday 28 May at Monash Medical Centre which was a networking morning tea for all Monash Health Aboriginal staff and those staff who work in, or have an interest in Aboriginal Health.

“OurvisionforreconciliationisthatimprovinghealthoutcomescanonlybeachievedbyworkinginpartnershipwiththeAboriginalandTorresStraitIslandercommunity,providingopportunitiesandpromotingandbuildingmutualrespect.”

MichelleRavesi,ManagerPopulationHealth,MonashHealth

On Friday 29 May, the event held by Monash Health Community was a cultural celebration – facilitated by Jayden Lillyst, an Aboriginal educator. It was an emotional and poignant learning experience which gave non-indigenous staff a small taste of what the Stolen Generation went through and explained why subsequent generations continue to feel the effects of this to this day. It was a thought provoking experience for all staff who attended and was a step along the road towards reconciliation.

We work to improve health outcomes for all our patients

Monash Health is fortunate to be located in one of Australia’s fastest growing and most culturally-diverse community regions – it’s one of our great strengths. Approximately one third of newly arrived migrants, refugees and humanitarian entrants in Victoria settle in the south-east region annually. People using the service are born in more than 280 different countries and speak more than 100 different languages and dialects, including rare and emerging languages.

Celebrating cultural diversityMonash Health has implemented a Cultural Diversity Plan 2013-2018 which aligns with the organisational Strategic Plan 2013-2018 and is reflective of the diversity and breadth of work that is being undertaken and the objectives to be achieved in the cultural diversity portfolio.

The following are the achievements against the Monash Health Cultural Diversity annual workplan 2014-2015.

We listen to our diverse patients, families, carers and community to improve

Halal Multicultural

2011-12

2012-13

2013-14

21,921

30,543

38,558

3,5414,404

6,520

Growth of Halal and multicultural meals at Monash Health2014-15

7,954

47,011

2014-15 2014-152013-142013-14 2012-132012-13 2011-122011-12


Interpreting ServicesMonash Health provides equitable access to services to people from culturally and linguistically diverse backgrounds, including people with disabilities. Monash Health provides appropriately-trained interpreters to ensure patients understand the information being provided to them.

In 2014-15, Monash Health provided 59,473 occasions of interpreting services across all sites. Monash Health also received 14.6 per cent more requests for interpreter services than the previous financial year. The top languages requested were:

•Dari (8511) •Vietnamese (8152} •Mandarin (7277) •Greek (6272) •Khmer (6012)

Monash Health has observed a marked increase in refugees and asylum seekers accessing health services. Providing interpreter services enables the organisation to ensure responsive and accessible services.

•11,883 confirmed occasions of interpreting services were provided to inpatients.

•47,590 confirmed occasions of interpreting services were provided to outpatients.

•8,172 occasions of telephone interpreting services were provided to all consumers.

•369 occasions of interpreting services were provided to deaf and hard-of-hearing patients by Auslan (sign language) interpreters.

•654 unmet requests which are classified as occasions where an on-site and/or telephone interpreter was not available.

Monash Health Language Services also regularly reviews demand to ensure services continue to meet the needs of the diverse community. As a result of the last review:

•Monash Health has employed additional interpreting staff to support Mandarin, Cantonese, Dari, Farsi, Hazaragi, Greek, Khmer and Vietnamese language speakers.

•Mandarin/Cantonese, Khmer, Vietnamese, Greek, Bosnian, Serbian, Italian, Turkish, Arabic, Dari, Pashto, Burmese, Sinhalese, Hindi languages have recently been added to in-house interpreters in response to emerging population demand.

Cancellation Confirmed

2013-14

2014-15

Latecancellation Phoneinterpreternotused

Unmet

Occasions of interpreting services

6533,598 4,858

52,295

59,473

5,984 7,287

3,088 3,494763

Received: Total interpreter requests received.

Confirmed: Interpreter attended appointment

Cancellation: Interpreter service received more than 24 business hours notice to cancel a request for an interpreter.

Latecancellation: Interpreter service received less than 24 business hours notice to cancel a request for an interpreter.

Unmetrequest:Interpreter service was unable to provide an interpreter, short notice when requesting an interpreter (less than 24 hours), not possible to reschedule or not possible to use telephone interpreting service.

Phoneinterpreterofferednotused:Telephone interpreter is offered, but not taken up.

“ThankgodthatyouareonthelinetohelpexplainwhatthemidwifewantedasIhadnoideauntilyoucameontheline”.Complimenttophoneinterpreter

Totalreceived

65,976

75,765

Our community assists us to improve our health service through co-design •Monash Health Community now has a Consumer Advisory Group that focuses on quality improve-ment and quality and safety issues from a program perspective. The Group first met on 9 June 2015 and has seen a fantastic response from the diverse community to be involved ongoing.•Monash Health Community client contracts have been reviewed by the culturally diverse community, with translation into two community languages expected in the next 12 months.

Monash Health works in partnership with community focussed organisations •Monash Health continues its partnership with the City of Greater Dandenong, City of Casey and Cardinia Shire Council to deliver health promotion and health prevention initiatives to the south-east region of Melbourne. Monash Health works in partnership with an equity lens in working with and supporting the most disadvantaged and diverse communities.

•Monash Health continues its partnership with the City of Greater Dandenong, South East Metropolitan Medicare Local (SEMML), City of Casey, Cardinia Shire Council and Women’s Health in the South East focussing on a health literacy taskforce.

This partnership has improved the capacity for community to access and actively engage in health services across the region.

•Monash Health convened a regional Responding to Diversity Network which partners with the Southern Migrant and Refugee Centre, Fronditha and New Hope in the delivery of promotional activities and events.

Monash Health Community provided Lesbian, Gay, Bisexual, Transgender and Intersex (LGBTI) Inclusive Training to staff delivering care to the aged. Collaborating with Transgender Victoria and Gay Lesbian Health Victoria, the session aims to support the development of culturally appropriate services for older LGBTI people.

•Cultural responsiveness and interpreting training was provided to more than 150 Monash Health staff.

•The annual Monash Celebrates included awareness on communication and working in a culturally responsive way with the Centre for Culture, Ethnicity and Health and members from African and Cook Islands backgrounds. The Monash Celebrates event celebrates and congratulates our staff each year with activities across all health service sites.

We work directly with our community to set achievable and sustainable goals •The Monash Health Have a Say initiative was promoted to the John Pandazopoulos Hall of Management Group in May 2015 which has representation from more than 15 culturally and linguistically diverse (CALD) community groups in the south-east region of Melbourne. These presentations will continue in 2015-2016.

•Monash Health Community has implemented a volunteer concierge program at 122 Thomas Street which received the 2015 Minister for Health Volunteer Award (see Supporting our Community story).

•Home support packages, through the review against the National Aged Care Reforms, were developed in consultation with CALD clients, including contracts and budget supporting information.

Supporting our communityThe Monash Health Refugee Health and Wellbeing Volunteering Program was established in 2014, to

provide meaningful social inclusion opportunities for refugees and asylum seekers. The program is based at the Monash Health Community site in Dandenong, and is serviced by 40 men and women from refugee and asylum seeker backgrounds.

Volunteers primarily perform a concierge role within Monash Health Community. However, new and innovative opportunities are constantly evolving based on emerging need, and the interests and skills of the volunteers. Opportunities have included the dialysis patient visitor program, facilitating social sporting programs, and the health champion peer education program.

The Volunteering Program has demonstrated benefits at an organisational and community level. Volunteers contribute about 1000 hours per month, supporting the ongoing functioning of the service. Most importantly, volunteers have indicated a range of personal benefits from their engagement within the program. They have reported that they have met people, practised their English, and developed skills and confidence. Significantly, many volunteers have indicated an increased a sense of purpose from helping other community members in need.

“Asavolunteer,Iwilldoanything,becauseIjustwanttohelppeople…it’slikeacirculation,Icanhelpthem,andtheycanhelpsomeoneelse.”

The Volunteer Program sits within a social determinants framework, recognising that meaningful connection and purpose are integral to the recovery process and sustained health and wellbeing outcomes. Monash Health is grateful to the Refugee Health Volunteer Team for nurturing a welcoming and inclusive culture. Monash Health is extremely proud of the ‘Outstanding Achievement by a Volunteer team’ win at the 2015 Minister for Health Volunteer Awards.


“My life is not only for myself, but also to help others. It gives me a sense of satisfaction helping my fellow brothers and a sense of spiritual uplifting.”Ali – Volunteer Guide Dandenong Hospital

Leadership in ageingMonash Health Community, in partnership with Department of Health and Human Services and Southern Migrant and Refugee Centre, hosted the culturally and linguistically diverse (CALD) Seniors Leadership Forum on Wednesday 25 February 2015 at the Paddy O’Donoghue Centre, Noble Park.

The aim was to recognise the contribution made by group leaders to the wellbeing of seniors in their community. Senior groups play a vital role in supporting people as they age, providing culturally responsive social connection, activities and information. Monash Health Community’s close connection with the various cultural groups ensures ease of access for group members, providing direct links to care as required.

More than 45 people attended the event with 18 culturally-diverse groups represented on the day. A certificate of appreciation was awarded to each leader by Marion Lau, Deputy Chair of Ethnic Communities Council of Victoria, with presentations on changes to aged care and a new educational resource on Elder Abuse.

The event provided an opportunity to consult leaders on issues faced by older members within their communities and the feedback provided initiated the delivery of an additional eight aged care

information sessions to CALD senior groups by the Monash Health Community Population Health’s Diversity Team.

The evaluation highlighted the forum’s success with 100 per cent of attendees indicating the forum was valuable. As a result, the partnership between the Department of Health and Human Services, Regional Diversity Advisory and the Southern Migrant and Refugee Centre is planning to implement an annual forum with leaders of CALD seniors groups.

Focusing on Diversity – Open Board meeting 2014More than 60 community members and staff attended the 2014 Monash Health Open Board Meeting. Monash Health holds an open board meeting annually to provide an opportunity for the wider community to be involved in the key focus areas for the Monash Health Board of Directors.

The annual meeting is dedicated to an important theme that is developed in consultation with our consumers – this year it focussed on healthcare delivery in a diverse community.

Chair of the Board of Directors Ms Barbara Yeoh made the opening address and explored diversity in the context of multicultural

Australia, Victoria and Monash Health’s catchment area. She also discussed the principles of equity, access and quality healthcare and provided an overview of Monash Health’s Cultural Diversity Plan.

“Issues in multicultural health are complex and exist at every level of our health system, community and society,” Ms Yeoh said.

“Monash Health, as Victoria’s largest health service plays an important role in addressing and responding to these challenges and I can assure you that this is an area of long-term focus and commitment for the Board,” she said.

Chief Executive Ms Shelly Park detailed Monash Health’s commitment to patient-centred care and the continuous journey to improve how the organisation can be culturally-responsive and inclusive across all levels.

“Recognising and responding to diversity is particularly pertinent with respect to our commitment to patient-centred care. How we provide care must be shaped around the unique health needs of individuals, families and communities,” Ms Park said.

The discussion generated terrific ideas and feedback from community and staff. The Board takes this information and incorporates it into Monash Health’s service planning and delivery.

We involve the community in our decision-making

Monash Health Quality of Care Report 2014-15 35

Australia Day 2015 awards for dedicated staff and supporters

The exceptional dedication and successes of four members of Monash Health were recognised on the Australia Day 2015 Honours List.

The awards are an acknowledgement of the wonderful work undertaken by these individuals and Monash Health commends them for their dedication and excellence.

It is also a reminder that exceptional work in healthcare extends beyond direct patient care, through to local communities and beyond.

Professor John Funder AO was awarded a Companion of the Order of Australia for significant service to medicine; particularly to cardiovascular endocrinology, as a renowned researcher, author and educator, to the development of academic health science centres, and to mental illness, obesity, and Indigenous eye-health programs.

Professor Peter Ebeling, awarded an Officer of the Order of Australia, is Head of the Department of Medicine in the School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health

Board Chair inducted into Victorian Women’s Honour RollMonash Health Board Chair Barbara Yeoh was recognised for her exemplary commitment to public service, health service governance, the arts and road safety with induction into the Victorian Honour Roll of Women.

The annual awards were announced by Premier Daniel Andrews on 11 March 2015, to highlight achievements and contributions of remarkable Victorian women.

Monash Health Chief Operating Officer Siva Sivarajah congratulated Ms Yeoh on the significant achievement.

“Barbara’s leadership has inspired our Board and Executive to commit to patient-focused care,” Mr Sivarajah said. “This means the patient’s welfare is at the centre of every decision we make.”

Celebrating staff

Sciences, the Director of the Australian Institute of Musculoskeletal Science (AIMSS) and is the Medical Director of Osteoporosis Australia.

Professor Peter Fuller was awarded a Member of the Order of Australia for significant service to medicine as an endocrinologist, through contribution to medical research and professional organisations.

Carolyn Worth was awarded a Member of the Order of Australia for significant service to the community through roles with child protection organisations. She has committed more than 20 years of her life to improving services for those affected by sexual assault. She is the manager of the South Eastern Centre Against Sexual Assault (SECASA) empowering survivors and developing a diverse range of programs to assist in their healing.

Our people are community leaders

Women in Medicine Monash Health’s Women in Medicine program was formally launched by The Hon Jill Hennessy, Minister for Health and Ambulance Services, on 3 June 2015, at Monash Medical Centre. Chief Executive Shelly Park said the initiative was an important step for women at Monash Health. “This is a very proud time for us all when we stand up and acknowledge that we wish to remove any impediments to women advancing in medicine. “The Women in Medicine Program has been developed by an inspiring group of senior women doctors led by Professor Helena Teede and Dr Anjali Dhulia. It is strongly supported by our Executive and Board,” Ms Park said.

Minister for Health and Ambulance Services Jill Hennessey commended Monash Health for the initiative.

“I think it is such a great indicator of Monash Health that a group of people came together, supported by management, to develop this fantastic program,” said Minister Hennessey.

“Providing the opportunity for women to progress their careers in medicine and progress to leadership roles is an issue of fairness. It’s also an issue of economics, enabling women to continue to use their training, skills and experience to benefit our health system. “You should be really proud of developing this program and this is something very special and you are absolutely to be congratulated.”

Dr Anjali Dhulia, Director Medical Services said the initiative is a continuation of the journey to build an inclusive and actively caring organisation and to provide equal opportunity for all staff to feel supported to realise their full potential.

“It aims to build leadership capability by providing opportunities for training, coaching and mentoring for our women doctors and creating a culture of equal opportunity for progression in training and career for all Monash Doctors,” Dr Dhulia said.

We support women to progress their careers


The National Safety and Quality Health Service Standards, developed by the Australian Commission for Safety and Quality in Health Care, are designed to provide a nationally consistent standard of care for consumers attending any health service organisation across Australia.

The National Standards for Mental Health Services are an additional set of measures required of mental health services. These standards apply across the broad range of mental health services, including bed-based services, Indigenous health services, alcohol, tobacco and other drug services, community mental health services and aged care services.

In July 2014 Monash Health underwent inaugural assessment against the National Safety and Quality in Health Service Standards and National Standards for Mental Health Services. Surveyors commended Monash Health staff on their commitment to the organisation and patients noting the ‘team effort’ to ensure the standards were met. Surveyors also noted that the strong patient centred care focus across the organisation and progress made with partnering with consumers and

involvement of consumers across services is well advanced. This was supported by the allocation of ‘met with merit’ ratings across Standard 1 - Our Governance Framework, Standard 2 – Partnering with Consumers, and Standard 3 - Our Blood and Blood Products Management.

Monash Health will be required to undertake annual self-assessments and three yearly external reviews against both sets of standards, in order to continue providing quality health services to our community. To support this commitment, we have introduced informal annual external consultant reviews, helping us to achieve our vision of delivering outstanding outcomes and exceptional care for our patients. The first of these reviews occurred in May 2015.

AuditIn order to provide patients with exceptional care, Monash Health first needs to understand how it’s performing. The organisation has implemented a robust and reputable audit framework to ensure patient safety and quality of care is measured and improvement opportunities are identified.

National Standards for consistent consumer careAudits are conducted at an organisational level and locally within clinical areas. Improvements and action planning, in response to audit results, are recorded in quality and safety plans. Many audits contain questions to the patients to assess understanding of critical information and to capture observations of their care.

Examples of patient questions include: • Do you understand your rights as a patient at Monash Health? • Do you know which nurse is looking after you at the moment? • Did your doctor wash their hands before they last cared for you? • One of our requirements when people come to Monash Health is that we ask if they are Aboriginal or Torres Strait Islander. Has anyone asked you this question?

Audit can be a dry topic, but at Monash Health it is capturing the hearts and minds of executive staff, managers, frontline staff and consumers. Results can be reported in real time which enables staff to act on audit results immediately. Check out the Quality Boards in wards for the latest audit results.

Thank you to all our staff who helped us

achieve accreditation

Clinical governance dictates how staff at Monash Health work together to share accountability for:

• Quality and safety • Improvement and innovation • Risk minimisation

The Monash Health Clinical Governance Framework is made up of four pillars: clinical effectiveness, risk management, patient centred care and effective workforce.

Monash Health reviews committee structures annually to make sure that each committee is ensuring good governance and alignment with the National Standards. Over the past 12 months the following improvements have been made:

• Alignment of meeting agendas to the National Standards

• Introduction of annual reporting by National Standards governing committees to the Board Quality Committee

• Review of all governing committee terms of reference and self-assessment against the elements of good governance to ensure alignment with the National Standards and the Clinical Governance Framework

Performance improvementPerformance of individuals, operational teams and the organisation as a whole are monitored by key performance indicators. The performance improvement strategy implemented at Monash Health incorporates these key performance indicators, enabling identification of performance leaders and their innovative practices.

Risk managementMonash Health has robust and effective systems for identifying, analysing and minimising risks to patients. This includes compliance with relevant legislation, the reporting and investigation of incidents and risks and the implementation of strategies to reduce the occurrence of adverse events and near misses and improve patient safety.

•Safety Walkarounds: are vital in enhancing the safety culture of the organisation. Safety Walkarounds occur once each year within each clinical area across Monash Health and give frontline clinical staff the opportunity to showcase their work environment and the initiatives they have implemented in their work areas. Staff also get the opportunity to discuss with an executive and other senior leaders ‘what keeps them awake at night’.

•Clinical Review Panels: review complex clinical incidents where harm has occurred to patients. A Clinical Review Panel reviews each case and identifies gaps in care, systems and processes and makes recommendations on systems changes and improvements to prevent similar incidents from occurring in the future. Importantly Clinical Review Panels are made up of consumer advisors and senior clinical leaders from nursing, medical and allied health disciplines from different clinical areas.

SafetyThe standard you walk past is the standard you accept. Monash Health aims to create a culture of safety that is free from hierarchy and seeks to ensure staff return home as well as or better than they arrived at work.

To ensure that this happens, we undertake regular safety, risk and policy and procedure audits, review and take swift action following any incidents, and proactively research safety cultures in different industries in order to proactively improve our own practices.

Internal communication channels promote safety awareness and team meetings include a standing agenda item supporting staff to raise safety issues. A safe workplace keeps our staff, patients, carers, families and visitors safe.

Patient-centred care

Patient-centred care at Monash Health is the partnership with patients, families, carers and other consumers to provide exceptional care and achieve outstanding outcomes.

This occurs at all levels of Monash Health and includes informed consent and shared decision making about care, consumer partnership in service planning, consumer partnership in designing care and consumer partnership in service measurement and evaluation.

The Monash Health Community Participation Plan, Community Advisory Committee, Primary Care and Population Health Advisory Committee, Patient Centred Care Steering Committee and various consumer feedback networks ensure the interests of stakeholders are incorporated into the organisational strategic objectives.

Governance

“MonashHealthisfocusedonmakingsureourclinicalgovernancesystemsandprocessesworktoachieveourvisionof‘exceptionalcare,outstandingoutcomes’.”AmandaLing,HeadofStrategy,QualityandPerformance

Leadership for better patient ourtcomesLeadership objectives and responsibilities are clearly defined in the position descriptions of each manager, service director and executive at Monash Health. Individually they are expected to lead innovative initiatives that aim to achieve the strategic objectives of Monash Health.


CredentialingTo support the Monash Health strategic goal of We put our patients first, the organisation must ensure staff are appropriately skilled, trained and credentialed.

The objectives include meeting the requirements of the National Registration for Health Professionals legislation and

Department of Health and Human Services requirements for Credentialing and Scope of Practice for Medical Practitioners in Victorian Health Services.

The Credentialing and Scope of Clinical Practice Policy ensures health professionals we employ are appropriately credentialed and have their scope of practice defined.

Our patients come first in everything we do

In support, we developed a Credentialing and Scope of Practice framework.

The framework provides scope for the different needs of various health professional groups regarding credentialing and scope of practice.

The groups affected are Medical, Allied Health/Health Professionals and Nursing.

We work hard to prevent our patients from getting an infection whilst in our care. Healthcare associated infections (HCAI) are a major and growing issue in the quality and safety of healthcare.

HCAIs have been nominated as a priority area by the Australian Commission on Safety and Quality in Health Care (ACSQHC). Improved healthcare worker hand hygiene is the highest priority area to reduce the risk of healthcare-associated infections.

Monash Health has been involved in the National Hand Hygiene program since the pilot was initiated in 2006. Since then hand hygiene rates have progressively increased. The last audit in 2015 showed an overall compliance rate of 81 per cent. This is above the nation-wide benchmark of 70 per cent.

Monash Health continues to promote hand hygiene, even at these high levels of compliance. It has adopted a strategy to increase auditing by more than 250 per cent using trained auditors at the ward level.

Preventing and controlling healthcare associated infections

We implement measures to prevent healthcare associated infections

MonashHealthcontinuestoraisethebarinrespecttohealthcareworkervaccination.Thisyearthetargetof80percentofhealthcareworkersvaccinatedagainstinfluenzaisbeingdrivenbytheuseofamandatorydeclarationform.Anotherexcitinginitiativeisimprovinginfluenzavaccinationintheentirepatientpopulation.Thisisbeingachievedbyanopportunisticprogramwhereat-riskpatientsareidentifiedonthewardandvaccinatedbeforetheyaredischarged.


A clean hospital plays an important part in maintaining a low-risk environment for acquiring infections. Cleanliness at Monash Health is regularly audited to ensure adherence to Cleaning Standards for Victorian Health Facilities.

Moorabbin Hospital has the first operating theatres in Australia to adopt chemical-free cleaning. It uses microfibre cloths and high-powered steam. This reduces costs, hazards, time, water and waste. It is also highly effective. The team was presented with an Innovation Award for its presentation on chemical-free cleaning at the Urological Society of Australia and New Zealand national conference.

Clean hospitals

We are leaders in chemical-free cleaning

Internal audit of cleaning services

Feb

100%75%50%25%0%

March

Jan

July

April

May

June

Sept

Oct

Nov

Aug

Dec

93.2%

96.01%

95.61%

96.26%

95.33%

95.24%

95.99%

96.13%

94.78%

96.31%

96.45%

96.7%

Each year, staff at Monash Health administer about eight million doses of medicine to patients.

Most patients who are admitted to a hospital will receive at least one medicine during their stay, making medication one of the most common types of treatment provided.

Such a common treatment, makes medication a common source of risk of patient harm.

Monash Health has adopted the slogan Medication safety – every medicine, every time to highlight the importance of checking that patients get the right medicine, in the right way, every time.

Monash Health’s Medication Safety Committee works to improve the prescribing, administration and storage of medications and reduce the risk of medication errors that can lead to patient harm.

Each month the committee reviews medication incidents, with a focus

on the incidents that cause serious harm and those that involve the wrong medicine being administered or a medicine administered to a patient who has had a previous adverse reaction to that medicine.

The aim of reviewing the incidents is to determine how the incidents occurred and identify if there are any strategies that can be implemented to prevent that error happening again. The committee developed a specific investigation tool that is completed for each of our focus incidents and this tool is helping to identify common themes in the incidents.

Some of the strategies which have been implemented to improve medication safety include electronic prescribing in outpatient clinics and for discharge prescriptions, the formation of a subcommittee to focus on medication safety in Mental Health facilities and participation in a national pilot of a new medication chart for prescribing and monitoring patient response to insulin.

The committee continues to host an annual Medication Safety Week, to improve staff awareness of safe medication practices and has also undertaken the 6 Rights of Medication Safety Campaign.

This campaign lists the six things that need to be checked by the doctor before they prescribe a medicine, by the nurse before they administer a medicine and by the pharmacist before they dispense a prescription. They are:

• Right patient • Right medication • Right dose and formulation • Right time • Right route • Right reason

Medication safety

We administer eight million doses of medicine a year

Medication safety dataNumberofseriousmedication-relatedincidentsfor2014-2015=8


Allergies and adverse drug reactions training packageMonash Health has developed a unique training package about medication allergies and adverse drug reactions. The online training is intended for doctors, pharmacists and nurses and aims to increase their understanding of the different types of reactions and improve the way they take a patient allergy and adverse drug reaction history and provide information to patients.

The package outlines what questions to ask a patient about previous reactions, where to look in the health record to obtain additional information and where to record new allergy and adverse drug reaction information. It also provides information about how to prevent unintentional re-exposures and how to manage patients who have serious reactions to penicillin antibiotics when they need antibiotic treatment.

The training consists of some interactive slides for the viewer to read, a short video that shows a pharmacist asking a patient about their previous allergies and adverse reactions and then a quiz. Doctors, nurses and pharmacists are required to complete the package every three years and need to answer all of the quiz questions correctly.

Monash Health is the first health service in Victoria to develop this type of training package. The project was led by a pharmacist, with significant input from doctors, nurses, information technology and additional pharmacists. Other hospitals and organisations have expressed interest in utilising this package, so Monash Health will share this valuable education tool.

Electronic Prescribing systemAn electronic prescribing (eP) system is in the final stages of being implemented in all outpatient clinics, inpatient areas for discharge prescriptions and emergency departments at all Monash Health sites. Key functionality of the eP system includes integration with the pharmacy dispensing system and clinical decision support . The project objectives were to design, implement and evaluate the impact of the eP system on patient safety.

The project was designed to investigate the impact of the eP system on prescribing and dispensing errors before and after implementation. Patient waiting times for prescriptions was also evaluated.

The project demonstrated a significant reduction in prescribing errors by 82 per cent, dispensing errors by 6.2 per cent and average patient prescription waiting times by 14 minutes compared to the handwritten prescription and manual dispensing data entry processes. Clinician experience surveys of the eP system have also been very positive. This project has significant implications for

improved patient safety, legislative compliance and clinician workflow efficiencies.

Overall, the introduction of eP significantly reduced the number of prescriptions with at least one prescribing error from 95 per cent to 13 per cent. The greatest impact was seen in the reduction of error-prone terminology or abbreviations, allergy status incorrect/omitted, route incorrect/omitted, dose incorrect/omitted and strength incorrect/omitted.

The eP system significantly reduced the number of prescriptions with at least one dispensing error from 7 per cent to 0.8 per cent with the greatest impact in the reduction of incorrect instructions on the label and incorrect prescriber or prescription date entered. Patient prescription waiting time was significantly reduced from an average of 27 minutes to 13 minutes.

The project has also led to the introduction of pharmacy services in targeted outpatient clinics in a move away from the pharmacy outpatient ‘waiting room’ system to a more integrated pharmacy service based in the outpatient clinics.

TheePprojectdemonstratedasignificantreductioninprescribingerrorsby82percent,dispensingerrorsby6.2percentandaveragepatientprescriptionwaitingtimesby14minutes.

TheintroductionofePsignificantlyreducedthenumberofprescriptionswithatleastoneprescribingerrorfrom95percentto13percent.

TheePsystemsignificantlyreducedthenumberofprescriptionswithatleastonedispensingerrorfrom7percentto0.8percent.

Patientprescriptionwaitingtimewassignificantlyreducedfromanaverageof27minutesto13minutes.

Monash Health understands that correctly identifying patients and matching them to their intended treatment is central to delivering safe and appropriate healthcare.

However, Patient Identification and Procedure Matching has a unique challenge in the community setting for clients and staff as the comment “but we know them” is often heard from the clients and the staff.

The implementation of the patient identification procedure has challenged what are often established relationships and therefore a different approach has been required.

How do we get buy-in when it comes to changes in practices; the way we have always done things?

Within Monash Health Community, it is sometimes difficult to change ways, especially when a client is familiar to the team, it may appear almost embarrassing to check their identity. However, there is good evidence to routinely asking clients to verify their full name, address and date of birth each time they attend our services.

Thanks to the active involvement of Angela McAvoy, Patient Identification and Procedure Matching consumer advisor, a new perspective was offered to staff – the patient’s view.

Angela works with staff to provide a different perspective and to confirm that patients are unlikely to be offended or feel that their care is

compromised if we let them know why it is important to take each patient through the correct identification process. Once patients know why, they will come to expect it every time.

Caryn Tocker, Manager of Integrated Community Health Team and chair of the Monash Health Community Implementation Group for National Standard 5 agrees.

“Angela has been instrumental in providing a unique consumer perspective to our patient identification advisory committee. It helps to hear of Angela’s experiences and ideas when thinking about how we deliver safe, high quality care for our clients in community,” Ms Tocker said.

Patient identification

Angela helps patients understand the importance of our

patient identification process

Benefits of electronic prescibing


Clinical handover comprises the transfer of responsibility and patient information between individuals or groups. Effective clinical handover is essential to ensuring safe and timely clinical care to our patients.

The Monash Health Clinical Handover Steering Committee has supported significant changes to the way clinical handover is conducted and monitored across Monash Health.

Clinical handover tools have been standardised across the organisation and compliance is monitored using local area audits, organisation-wide point of care audits, observational audits and retrospective review of patient records.

Communication of audit results is achieved by ensuring

multidisciplinary and consumer representation on the steering committee. Broad representation ensures free flow of information back to site and program level and provides opportunity for information to flow in both directions.

While audit data demonstrates ongoing improvements in clinical handover, the transfer of information to patients on discharge was identified as an ongoing challenge.

As a way of addressing this, the Patient Discharge Passport booklet was designed and implemented in the General Medicine Unit at Dandenong Hospital, as a means of giving patients post discharge follow-up information in a user-friendly way.

Clinical handover for even better outcomesThe passport booklet provides written information regarding follow-up appointments, changes to medication and any tests that need to be done and when these are required. Allied Health follow-up is also documented as are important contact numbers.

Evaluation of this project demonstrated improvements in terms of the number of patients aware of:

• Changes to medication (increase of 11 per cent)

• Follow-up appointments with their GP (increase of 40 per cent)

• Tests/examinations needed post discharge (increase of 49 per cent)

The Discharge Passport will now be rolled out more broadly across Monash Health.

We deliver safe and timely care to our patients

Australia has one of the safest blood supplies in the world. The precious resource is generously donated by volunteers.

Monash Health is one of the largest users of blood components in Victoria, transfusing more than 29,800 units (fresh blood components) annually across all major sites including Monash Medical Centre, Dandenong, Casey and Moorabbin Hospitals and the Kingston Centre.

Monash Health services a diverse population and is committed to providing safe and appropriate transfusion therapy to all patients.

Transfusion clinical governance and practice is overseen by the

multidisciplinary Monash Transfusion Committee (TC) which includes two consumer advisors.

The Transfusion Working Group (TWG), also a multidisciplinary team comprising a transfusion medicine specialist, senior Blood Bank scientist, transfusion registrar and two transfusion nurses, is also an essential part of transfusion governance and service activities. The group meets weekly and there is a focus on quality improvement, such as adverse event and incident evaluation, transfusion policy and procedure development, and audit planning and analysis.

In 2014-2015, regular audits continue to identify areas for practice improvement with results

reported to the TWG and TC. The clinical audit program includes monitoring consent to transfusion, reason for transfusion, clinical appropriateness, storage and transport, documentation of the required safety checks before transfusion, documentation of patient observations such as temperature, pulse and blood pressure and unreported incidents or reactions.

A follow-up audit in 2014 on patient’s’ understanding of the consent process showed a significant improvement in the provision of written information provided to patients from 10- 70 per cent. Ongoing monitoring in this area will continue.

Safe use of blood and blood products

Consumer perspectives “Asa52-year-oldThalassaemiaMajorpatientIhaveexperiencedmanypositivechangestothelevelof treatment duringmylifetime.Thecurrentregimeoftreatmentallowsmetoleadaveryfulfillinglifewherework,familyandhealtharewellbalanced.Iamverygratefultotheenormouseffortfromthemanygenerousblooddonors,aswellastheprofessionalandeffectivesysteminplaceattheMedicalTherapyUnitformymonthlyblood transfusions.

WithoutthishighlevelofserviceprovidedbycentressuchastheMedicalTherapyUnitinAustralia, IfeelthatmyhealthandthatofotherThalassaemiaandSickleCellsuffererswouldbe severelycompromised.

ManythankstoTerriDunstanandtheMedicalTherapyUnitteam fortheopportunitytoexpressmythoughtsinthisareaofmylife.”

Jim,patientandconsumeradvisor

“MysonwasdiagnosedwithSickleCellBetaThalassaemiaattwoyearsold,whilebeingadmittedtoMonashChildren’sHospitalwithsuspectedpneumonia.Thissawhisfirstbloodtransfusion,whichhasnowturnedintoalifetimeoftransfusions.

HeisnowtreatedwithintheMedicalTherapyUnitwerehereceivesabloodtransfusioneverythreeweeks.Atthestartofhistreatmentregime,beingcannulatedwasaheartwrenchingexperienceformyson,myselfandthenursesintheunit.Ittookmorethanayearandhalftoeasehisterrorbutwiththeassistanceofplaytherapywewereallprovidedwithtechniquestosupporttheprocessforall.

Nownearlyfiveyearsin,weknowhereceivestopshelfbloodproductsandismonitoredbyexperiencednursesattheMedicalTherapyUnitandMonashChildren’sHospital.Henowgoesintothetreatmentroomwithoutmypresenceandconverseswiththenurseonhowhepreferstobecannulated.Hehascomealongwayinunderstandingtheprocess,withmypersistenceinexplainingwhyheneedstreatment,thebenefitsofreceivingthebloodtocheckinghisnameanddateofbirthonthetagofeachbloodbag.

Eachpatientinourunithasaspecialnumber,thismonthhisnumberis75.Jaredhasreceived75bagsoflife-savingbloodandheisnearlysevenyearsold.

Thatisalotofpeopletothank.Fromthedonorstoallthevariousmedicalpeoplewhomhandlethebloodallthewaytothenurseswhoadministerit.”

Helen,parentandconsumeradvisor


Monash Health recognises that pressure injuries (also known as pressure ulcers or bedsores) cause significant harm to patients. Patients who are poorly nourished, have impaired mobility and/or reduced sensation are particularly at risk. The prevention of pressure injuries requires clinicians in consultation with the patients and carers, to assess for risk factors, implement a prevention plan, perform on-going skin assessments and monitor data.

As well as regularly reviewing reported incidents, in March more

than 1,000 patients were surveyed to define the prevalence of pressure injuries at Monash Health. Prevalence is the number of patients, expressed as a percentage, who have a pressure injury. The survey also looked at whether the pressure injury was acquired while in Monash Health care or before admission. Conducting the survey also provides a great opportunity to check compliance with the pressure injury prevention procedures and update staff on the latest best practice guidelines.

Preventing and managing pressure injuries As you can see from the graph below the prevalence is decreasing, however, the organisation must remain vigilant in working with patients and staff to keep that number decreasing. The focus in 2015 is to continue to improve engagement with patients in all aspects of prevention including regular rounds by senior nurses checking that expectations are being met.

2003

26.5%

Pressure injury prevalence results

12.0%17.8%

20.8%

7.1%

9.4%

2004 2006 2009 2013 2015

Recognising that a patient’s condition is deteriorating and responding to their needs in an appropriate and timely way is an essential component of safe and high-quality care provided at Monash Health.

Early identification of any worsening in health status, followed by prompt and effective action, can minimise the occurrence of these events, and may improve outcomes and lessen the level of intervention required to stabilise patients whose condition deteriorates.

The Deteriorating Patient Risk Management Committee was established in May 2010 to monitor progress and evaluate Monash Health systems for identification and management of patients who deteriorate or cardiac arrest in hospital. Consisting of clinicians across the spectrum, ranging from Intensive Care Unit outreach nurses to medical executives, the Committee’s initiatives include:

• Target Zero Program: the rate of cardiac arrests has fallen significantly during the Target Zero program. This program was designed to achieve continuous improvement in the quality of care provided in six key areas that were assessed as extreme organisational risks. The key concept of this program was the establishment of achievable improvements (50 per cent improvement each year) in each year of a five-year program. The establishment of ‘half-lives for improvement’ was a key factor in medical engagement.

• Patient Centred Goals of Care Committee: reviews current services, practices, processes and policies to identify and address gaps in the provision of safe and high quality end-of-life care across

the care continuum. The committee has adopted a ‘shared decision making’ and ‘patient centred goals of care’ approach to achieve high quality end of life care.

Chaired by the Chief Medical Officer, the committee has multi-disciplinary membership including a consumer advisor who is a very active and valued member of the committee, providing a consumer voice and perspective on the work undertaken by the committee.

The committee provides governance for the Palliative Care “Promoting Improved Care for the Dying” (PICD) clinical guidelines and the Advance Care Planning Program. A tool that supports a shared decision making approach to promote and support improved communication between patients, families, substitute decision makers and medical staff regarding care and treatment goals has recently been developed by the committee.

Clinical case examples are utilised by the committee to identify and provide advice on actions to address clinical care gaps in achieving safe and high quality care across the care continuum.

• VITALS training (Vigilant Assessment Learning Session): was developed to provide a system for patient evaluation and treatment to improve the early identification and management of the deteriorating patient before a MET (Medical Emergency Team) call is required. The program also encourages the sharing and exchange of ideas between inter-professional disciplines so that all health professional team members can work together optimally on the ward to improve patient care.

Early identification of clinical deterioration

Family-led escalation of care response In 2014 Monash Health proudly introduced a new family-led escalation of care procedure to enable patients, carers and families to raise an urgent escalation of care request. The procedure recognises the important role families and carers have in helping staff detect and quickly react to signs of rapid deterioration in their loved one’s health.

Under the new model, families are encouraged to raise their concerns with staff if they feel:

• a patient is becoming more unwell or behaving differently.

• a patient is not receiving the medical attention they feel is necessary.

• there is some confusion around what needs to be done in a critical situation.

• there is a general concern with what is happening with their care.

In response to an escalation request, the patient’s healthcare team will assess the situation, provide emergency assistance if required, and support the family to relieve any concerns.

Following excellent feedback, the procedure has been implemented at all Monash Health sites. During 2015 Monash Health is reviewing the current systems and working with patients, their families and their carers to further improve this process.


Monash Health continues to strive to reduce the number of patients who fall in hospital. There is increasing evidence to show us that we may need to change the way we do things.

The 6-PACK Falls Prevention Research Project (the 6-PACK project) is the largest Australian trial looking at the effectiveness of traditional falls prevention strategies. The project studied the effectiveness of improving compliance with the implementation of the following six strategies:

• falls alert sign • walking aid within reach • toileting regime • bathroom supervision • low-low beds • bed/chair alarm

The project showed improved compliance with implementing the strategies but no reduction in falls or falls with harm. The presentation of the results is publicly available on the website.

The Monash Health Falls Prevention procedure is similar to 6-PACK Project strategy and in light of these results the Monash Health Falls Committee is reviewing the procedure. As part of this review the committee will look at approaches both internationally and locally that have been successful in reducing falls. For example, it is looking at an interesting piece of research from Western Australia.

The trial, published in the Lancet in April, showed the effectiveness of a simple patient and staff education strategy in reducing falls and harm from falls. The Committee members will review all the evidence and discuss possible options with the Australian Commission on Safety and Quality in Health Care to ensure Monash Health continues to comply with the National Standards.

Volunteer Falls Reduction programDespite significant work, falls remain a real risk for patients in the care of subacute inpatient services. The risk is recognised internationally and innovative, sustainable strategies are encouraged, like the Volunteer Falls Reduction Pilot Program which is based on a model trialled and successfully implemented in another health service. Volunteers are recruited and trained to engage patients, who are assessed as having a high risk of falling, in structured programs of mentally and physically stimulating activity.

Pamela Sloss, through her commitment as a consumer advisor at Monash Health since 2008, is committed to improving community health through preventive mechanisms. Pamela’s interests in healthcare provision include empowering people to make informed and healthier choices, linking environment quality with health outcomes and facilitating the inclusion of community needs and views in the provision of all health care services.

It is from this focus and interest that the Volunteer Falls Reduction Pilot Program was realised. Pamela’s passion and drive, evidenced by her volunteering significant time and financial resources for the project, has helped the project stay on track, meet timelines and aims.

The program has been in place for 12 months, there are 10 community-based volunteers

including a retired Kingston Centre nurse and recently, 10 psychology students joined the volunteer group. Volunteers attend at a variety of times Mondays to Saturdays and engage patients in discussions about their history, interests and families, using iPads, books and newspapers. To date no patient has fallen while spending time with a volunteer.

Preventing falls

“Wearegratefultotheoutstandingandbeyondthecallofdutyspiritdisplayedbyyourclinicalandnon-clinicalstaffinrescuingmymotheraftershefell.AfterreturningfromtheEmergencyDepartmentat3amwewereprovidedwithwarmandpromptcarefromstaff,makingmymotherandourfamilycomfortablewithtoastandacupoftea.Wefeltthatwewerepartofthefamily,eventhoughitwasinthesmallhoursofthemorning.Throughthisincidentwehavedeepenedourtrustandunderstandingoftheserviceyouprovide.”

Agratefulfamilymember,YarramanNursingHome

Dental Health Services Victoria measures and reports on a range of data and provides each public oral health agency with quarterly clinical indicator data at a local, regional and state level.

The reports are used to monitor the quality of clinical services provided by identifying unfavourable trends in retreatments and unplanned returns for different treatment services.

Retreatment or unplanned returns do not necessarily reflect an issue with the dental treatment received. There may have been an issue with a data entry error (ie: patient information or the service provided) or clients may have received preventive dental treatment and then come back for further treatment.

Examples of clinical indicators reported include: • Restorative retreatment within six months (see table below for 2014-15 which shows Monash Health has a lower rate of retreatment than Dental Health Services Victoria) • Repeat emergency care within 28 days • Denture remakes within 12 months • Unplanned return within seven days subsequent to routine extraction.

The data is compared with statewide dental health services to benchmark for ongoing quality improvement.

The Oral Health Clinical Governance group uses these reports as a reference point to compare

performance as well as change and improve areas of clinical practice, staff training or recruitment needs, where required.

Monash Health continuously looks to improve the quality of care provided by clinicians. For example, to improve Restorative Retreatment results staff constantly review new dental products and materials and provide education and training, including hands-on workshops, in order to achieve and deliver quality clinical care.

World Oral Health Day 2015 For Monash Health Dental Services, World Oral Health Day 2015 was an opportunity to address its long

Oral health clinical indicatorswaiting list and to improve the oral health of patients while on the waiting list. Monash Health supports the World Dental Federation’s efforts of improving the oral health of people and promoting awareness of the impact of frequent sugar consumption. In addition to raising awareness and educating patients, the dental services team also screened the patients on the waiting list.

World Oral Health Day proved to be a successful event, with both staff and clients reflecting on the opportunities it provided to support the ongoing oral health care and preventive health messages provided to clients and the community.

Educating our patients on the

importance of prevention

MonashHealth

Statewidehealthservices

6.1% 6.5% 6.5% 6.3%

7%

6%

5%

0%

Restorative retreatment within six months

7.7% 7.8% 7.5% 7.7%

8%

January-March April- June July-September YTD


Monash Health’s five residential facilities provide care to a wide range of residents with complex medical and psychosocial needs, and specialise in Aged Persons Mental Health Services. In August/September 2015 the residential facilities will undergo accreditation with the Australian Aged Care Quality Agency.

The residential facilities continue to participate in quarterly Department of Health and Human Services state-wide benchmarking and perform consistently well in key areas of quality care provision including: • Pressure injuries • Falls • Use of physical restraint • Use of multiple medications (more than nine) • More than 3kg weight loss per month

The Rehabilitation and Aged Care program continues to monitor clinical risk regularly. Preventing resident falls continues to be a focus with some sustained decrease achieved across the service in 2014-15. Examples of quality improvement activities to reduce falls in our residential facilities have included:

• implementation of a resident-centred approach to clinical handover in Eastwood Hostel.

• access to hydrotherapy to improve the residents’ physical condition and reduce falls.

Ensuring residents remain well-nourished is an important component of care for the elderly. One indicator of an individual’s nutrition status is weight loss over

time and this is monitored regularly. All residents have access to specialist care by dietitian and speech pathology services, to promote optimum nutrition and hydration outcomes for residents.

Residents often have complex medical conditions requiring a number of medications to manage various issues. The facilities continue to work with residents’ GPs, consultant psychiatrist and pharmacy to consolidate and reduce medications where appropriate. The number of medications prescribed is monitored as ‘9+ medications’.

Data for each of the residential aged care services by site is represented in the following graphs.

Residential aged care services

100%

75%

50%

25%

YarramanNursingHome

Pressure ulcers

Use of physical restraint

Multiple medication use

Weight loss during the quarter

MooraleighHostel

ChestnutGardensAgedCareHomeAGEastwoodHostel AllambeeNursingHome

2013-2014 2014-2015

100%

75%

50%

25%

2013-2014 2014-2015

0%

100%

75%

50%

25%

2013-2014 2014-2015

0%

100%

75%

50%

25%

2013-2014 2014-2015

100%

75%

50%

25%

2013-2014 2014-2015

0%

0%0%

Percentageofresidents





Quality improvement activities

In 2014-15, improvements have been made to support residents to provide greater choice in meal selection and the dining experience. In addition residents in Eastwood Hostel enjoy a high tea twice a week which will also be offered to the other facilities.

With a focus on improving communication and the resident/patient experience, Eastwood Hostel, Biala and Unit 3 at Dandenong Hospital implemented quality improvement activities aiming to reduce falls and medication errors, improve communication and the inclusion of the resident/patient in their care. The results of both projects indicated improved resident/patient satisfaction and improved identification of clinical risk. While the Biala and Unit 3 evaluations are in progress, Eastwood Hostel reported a reduction in falls and medication errors on completion of the project.

In January 2015, Unit 3 Aged Acute Mental Health Inpatient Unit and Allambee Aged Mental Health Residential Unit commenced the trial of a model of care under the Safe Wards Project in collaboration with the Department of Health and Human Services. The project aimed to reduce the number of aggressive incidents within a ward environment by recognising early

warning signs and utilising engagement strategies and deescalation proving a safe environment for all. The objectives of this model are to:

• improve communication between staff and patients and provide a safe environment for all by reducing the number of aggressive incidents which occur in any ward.

• identify flash points which lead to restrictive interventions and

We strive to improve our aged care residents’

physical condition

“MywifeandIwouldliketopassonourdeepestappreciationforallofthegreatworkdonebyMonashHealthstafftoourhelpoursonfindhisfeetagain.

Iwouldliketopassonaverybigthankyoutothedoctors,physiotherapists,occupationaltherapyandnursingstaffwhoworkedtirelesslytogiveusbackourson.

Hewouldnothavereachedthestagethathewouldbecominghomewithoutthetirelesssupportofthephysiotherapystaff,occupationaltherapists,socialworkerswhosupportedusthroughtheearlyandmoststressfuldays.Tothenursingstaffwhowerealwayswillingtolistentoourconcernsandalerttoourneeds.Tothewardclerksfortheirsupportaroundtransportarrangementsandotherday-to-daysupport.AndtothemealstaffwhobroughtthemealsandcupsofMiloalwayswithasmile.

Noamountofpraisewillbesufficientforthesededicatedpeople.Thanksonceagain.”

Parents.KingstonCentre

decrease the need for restrictive practices embedding this change in the ward culture.

Champions for each of the interventions were identified and staff allocated to assist in the imple-mentation on the ward. Strategies related to each of the interventions such as community groups, safe wards and discharge messages have been put in place for each area.


Access and Discharge PracticesHeart Hospital announcementAustralia’s first dedicated heart hospital will be built at the Monash University site in Clayton.

The $120 million stand-alone hospital will treat tens of thousands more heart patients and will replace MonashHeart’s current cardiac unit, which is already the busiest in Victoria.

Monash Health Chief Executive Shelly Park said having a world-class purpose-built centre would mean more patients treated at Clayton.

“This will help us take cardiac care to new heights for the people of Melbourne and Victoria,” Ms Park said.

Heart disease is Australia’s biggest killer, and MonashHeart Director Professor Ian Meredith said Victoria would require several hundred new cardiac beds over the next decade, and a specialist heart hospital would complement other hospitals.

“We need a centre for leadership, research and administration, policy development and training — not simply for service delivery,” Prof Meredith said. “We are doing a number of world-first clinical trials and our reputation globally is probably bigger than it is domestically,” he said.

Casey Hospital celebrates 10 yearsIn October 2014 staff participated in 10-year anniversary celebrations at Casey Hospital.

The Berwick Leader dedicated an edition to the wonderful milestone and shared stories of how the hospital has touched the lives of hundreds of thousands of patients, staff and volunteers in the past decade.

The level of care Casey Hospital has achieved is impressive and every staff member who has contributed to this hospital over the past ten years should be congratulated.

Casey Hospital is home to a wonderful team of people delivering the highest levels of care to the Casey community.

Continuity of Care

Georgia, one of our leukaemia patients, enjoys the new adolescent youth aged clinic at the Monash Children’s Hospital Cancer Centre

Patient journey

New skills for dental nursesA dual qualification in Certificate IV in Oral Health Promotion and Radiography is being offered to Monash Health dental nurses.

Presented by Monash Health Dental Services, the qualification allows nurses to expand and develop their skills across these areas.

“I believe in giving people opportunities to grow in their roles and was humbled to have the opportunity to facilitate this training. There were numerous assessments tasks but they should be proud and celebrate that they have worked hard in pursuit of their goal”, Practice Manager, Monash Health Dental Services Julie Papaxanthou said.

Cancer Centre launches youth clinicTheMonashChildren’sCancerCentrelauncheditsfirstadolescentyouthaged(AYA)clinic.

TheAYAclinicistheonlyspacewhichprovidesadolescentpatientstheopportunitytoreceivetreatmentintheirownenvironment.

PlaytherapistLizVirgosaid:“Wearehopingthatbygivingadolescentstheirownspace,wecangivethemavoice.Theclinicprovidesanareathatpromotestheirgrowingindependenceandmaturity.”

Leukaemiapatient,Georgia,13,enjoysthenewAYAclinicasitensuresadolencentyouthreceivetreatmentinanage-appropriateenvironment.


Partnerships

Monash Children’s sod turning On Tuesday 15 July 2014 Monash Children’s Hospital celebrated the turning of the first sod to commemorate the beginning of building works on the new hospital site.

Chief Executive Shelly Park, Board Chair Barbara Yeoh, and Monash Health staff, including the executive management team and Monash Children’s Hospital staff, were thrilled to welcome the Honourable Dr Denis Napthine MP, then Premier of Victoria, the Honourable David Davis MP, then Minister for Health and Ageing and the Honourable Mary Wooldridge MP, Minister for Mental Health, Community Services, Disability Services and Reform to the event.

This exciting development means that the Monash Children’s Hospital will be one of only two dedicated tertiary paediatric facilities for Victorian children and their families.

Lady Marigold Southey AC, Founding Patron of the Monash Children’s Hospital and former

Lieutenant-Governor of Victoria was the guest of honour. She was delighted to meet some current Monash Children’s Hospital patients who made their way from the wards with their families to join in the celebration.

The project builder, Lend Lease, was also represented as well as architects Silver Thomas Hanley. Project partners the Starlight Foundation, Ronald McDonald House, Kidsafe, Hoyts, Radio Lollipop and Healesville Sanctuary, and the many generous philanthropic supporters, terrific volunteers and auxiliaries were also there to show their fantastic support at the beginning of this exciting phase of the project.

“Major capital projects such as these require our leaders to be visionary; to see into the needs of the community in the future and to have the courage to make things happen.

As I’m sure we can all feel, this is the start of something special for our children, Monash Children’s Hospital and Monash Health,” Ms Park said.

Streamlined approach for drug and alcohol supportDrug and alcohol services across south-east Melbourne have been streamlined under an exciting new initiative. The announcement was made to community members at the Punthill Apartments in Dandenong on 7 September 2014, demonstrating the unified approach of localised resources and experiences.

The service, called secada, began on 1 September and will streamline a number of existing services in drug and alcohol recovery, servicing the areas of Berwick, Cockatoo, Cranbourne, Dandenong, Koo Wee Rup, Narre Warren, Pakenham and Springvale.

A single point of contact for intake and screening will be delivered by experienced intake clinicians in Dandenong and all current clients have been transitioned into the new system without disruption to their treatment and care.

Secada is designed to be easier to navigate for clients, offering a ‘no wrong door’ approach to ensure all

We are building better healthcare for our youngest patients

callers are connected to necessary supports as quickly as possible. As part of the arrangement, intake and assessment, counselling, care and recovery, and non-residential withdrawal services will all be provided through this single service.

South Eastern Melbourne Medicare Local (SEMML) is the lead agency for the consortium, which also includes Odyssey House Vic, TaskForce, Windana, Youth Support and Advocacy Service and Monash Health. It is the first time the agencies have pooled their resources and experience to provide this service in the region.

The Monash Health Mental Health team should be congratulated for their involvement in this exciting initiative. It is another wonderful example of strengthening community relationships and working towards the vision of exceptional care and outstanding outcomes for patients in the region.

Launch of doctors’ mental health and wellbeing strategyThe MonashCare Doctors’ Mental Health and Wellbeing Strategy, was launched at a special event on 22 October 2014 by Mr Jeff Kennett, with a keynote presentation from Dr Steve Ellen, a psychiatrist with an interest in trauma, emergency psychiatry, teaching and research who is often heard on radio stations 774ABC and 3RRR.

The basis of this initiative comes from the National Mental Health Survey of Doctors and Medical Students conducted by beyondblue which found that:

• Doctors reported substantially higher rates of psychological distress and attempted suicide compared to both the Australian population and other Australian professionals.

• Young doctors and female doctors appeared to have higher levels of general and specific mental health problems and reported greater work stress.

• The general work experience for Australian doctors is stressful and demanding.

Stigmatising attitudes regarding the performance of doctors with mental health conditions persist.

• Monash Health is aware that the work experience of doctors and medical students can be stressful and demanding, and seeking help through such periods can be difficult.

The MonashCare Doctors’ Health and Wellbeing Strategy is a framework to raise awareness, reduce workplace stress and create avenues to encourage doctors to seek help early by creating a workplace that is encouraging and caring so that no Monash Doctor has to struggle in silence.

Short film festival Reel Health returnsThe Reel Health International Short Film Festival returned in 2014 with a dedicated screening event on 22 October 2014 at the Capitol Theatre in Swanston Street, Melbourne.

The festival surprised many people in 2013, with the quality of production and the variety of

subjects covered proving to be very impressive.

This year showcased a wide array of magnificent films from across the world that inspire, touch and challenge audiences. Highlights included a creative short piece from China that explores the concept of kindness in adversity and how that affects the human mind, inspiring stories of local community groups and their effect on local health, as well as a couple of animation films that manage to tackle difficult subjects with a sense of subtlety or even humour.

Optimising cancer careA comprehensive project lead by the Paediatric Integrated Cancer Service (PICS) focusing on the care of children with cancer, fever and neutropenia has been underway since 2013.

The project - involving doctors and nurses from the Monash Health Children’s Cancer Centre, Monash Medical Centre Emergency Department and Infectious Disease team in partnership with consumers, families and carers - has led to significant changes in care and service delivery around Victoria.

In late 2014, major revisions were made to the paediatric fever and neutropenia guideline (endorsed by the Victorian Paediatric Network) which led to the introduction of patient/family ‘alert’ cards. These changes have been accompanied by an extensive education campaign, which included the development of an online learning module.

As a result, there has been significant improvement in the treatment of fever and neutropenia in Victorian Emergency Departments. Children are reviewed more quickly and antibiotics administered within the recommended 60 minutes which has led to a reduction in the length of stay in Emergency Departments.

Work is continuing towards the target ensuring all children with fever and neutropenia are administered within the recommended timeframe. This will be achieved by ongoing education and information provision to consumers, families and carers and staff in the Emergency Departments.


Hands on Health experienceSecondary students from schools in the Greater Dandenong area have been exposed to opportunities within the health care profession through the program Hands on Health.

The week-long experiential program at Dandenong Hospital is designed to open students’ minds to the potential of tertiary education in health care professions, with the ultimate objective of providing a workforce of the future to meet the needs of marginalised communities around Dandenong.

A total of 20 students undertook the two programs delivered in June, with another 50 students participating in further programs in late 2014.

Students were issued with a uniform and stethoscope that identifies them as Hands on Health participants.

During their week at Dandenong Hospital they are mentored by Monash University medical students and work alongside Monash Health practitioners.

Clinical site administrator, Gina van de Berg said students gained practical experience in CPR, hand hygiene, taking blood, plastering and orthopaedics.

“They learn how to give an injection, how to use an EpiPen auto-injector and how a stethoscope is used. Familiarisation with blood pressure monitors and thermometers is a highlight of the program, and these are linked with checking patients’ vital signs,” Ms van de Berg said.

Speech pathology applicationsBen Smith, a speech pathologist working in rehabilitation at Kingston Centre, designed, created and released two iPad apps.

Ben has a particular interest in looking at appropriate ways to use technology to treat communication disabilities.

The apps he designed were created to assist speech pathologists treat clients with speech difficulties.

One app is a Pacing Board, a tool to help individuals slow down their rate of speech to articulate more clearly. This can be used specifically for patients with stroke, head injury, stuttering or progressive conditions like Parkinson’s Disease where speech can be characterised by short rushes of speech and variable speech rates.

The second app is called Fluency Calc, which helps clinicians record and assess stuttering behaviours in adults and children.

Congratulations to Ben for continuing to develop healthcare with innovative initiatives.

Responding to consumers’ needs

We partner with our community

High-tech box reduces breast cancer surgeryNew technology is helping reduce the number of surgeries women with breast cancer are subjected to at Moorabbin Hospital

Every year, an estimated one in five women who have tumours removed are forced to undergo further surgery because all the cancer has not been taken out.

But doctors at Moorabbin Hospital have found a way to halve the number of repeat surgeries by using technology that allows surgeons to X-ray and analyse the tumour they have cut out immediately.

Monash Health director of breast services and surgeon Dr Jane Fox said that in breast conservation surgery, they took out the tumour with a rim of normal tissue, leaving the majority of breast behind.

Normally, the tumour is taken to the radiology department where it is X-rayed before the images are taken back to the theatre for analysis.

Even at Moorabbin Hospital, where radiology is beside the operating theatre, the process takes 20 minutes.

But the new machine, dubbed the “pizza oven” by theatre staff, sits in the operating theatre allowing every single tumour to be X-rayed in real time.

Once the tumour is removed, it is placed in the “oven”, which X-rays it and instantly produces an image, which shows the tumour’s borders so the surgeons know if they have removed enough.

Dr Fox said it had led to a 50 per cent reduction in repeat surgeries at the hospital, which performs about 400 breast cancer operations each year.

“It gives us instant visual feedback about what we have taken out and tells us if we still need to remove a little bit more,” Dr Fox said.

“There is no doubt it saves time and gets more patients through the operating theatre and it also reduces the chance of the woman needing a second operation and that’s not just because we X-ray it, there is something about the instant X-ray and immediate feedback to operating surgeons that improves outcomes.”

It also leads to better cosmetic outcomes for women undergoing the surgery.

The hospital was the first in Victoria to have the machine after it was loaned to the hospital by the manufacturer, Faxitron. It has since been purchased.

We are saving more women from breast

cancer surgery


Wellness and recovery centre opens at Dandenong HospitalThe relocation of the Monash Health Wellness and Recovery Centre (WRC) from Monash Medical Centre to Dandenong Hospital was made official with the opening of a refurbished four-bed unit on Monday 8 December.

A dedicated team of staff and supporters were on hand to launch the facility, which offers a supportive and positive environment for patients with eating disorders.

The facility has purpose-built spaces for relaxation and a dining room for meal support therapy. The service is part of West 4 and takes the ward’s total bed number to 40.

Professor David Clarke, Monash Health’s Mental Health Program Medical Director, said the unit addressed many of the issues and concerns identified with the previous site, and stood to be a wonderful addition for Monash Health and patients.

The collaboration between the mental health program, general medicine and the West 4 nursing team should be commended as an example of partnerships for better service.

Patients presenting with serious eating disorders are some of the most vulnerable, and this unit is a positive environment to aid their recovery.

Surgery a birthday giftIt was a gift that arrived just in time for Onaisah Hasina’s first birthday, and one she will benefit from for the rest of her life.

The Noble Park toddler spent her first day at home after rare and radical surgery to recorrect the shape of her skull at Monash Children’s Hospital.

The seven bones in a baby’s skull

usually don’t fuse until the age of two, to allow the brain to grow.

But the coronal suture, the joint running between the skull bones across the top of the head ear to ear, had fused before Onaisah was three months old. It was causing the right side of her forehead to be flattened, the eye socket to be lifted and the nose to shift.

Parents Hasina Shakirahmat and Abdul Hakin, who left their home in Myanmar two years ago to seek peace in Australia, were told surgical treatment for craniosynostosis involved removing part of the skull to rearrange it into the correct shape.

We help dialysis patients live

their lives

They agreed with doctors that by correcting the congenital abnormality early, it would reduce the trauma for Onaisah.

“When she grows up and says, ‘Why, Mummy, do I look like this?’ it will be very hard,” Ms Shakirahmat said. “What will my answer be if I don’t do this for her now?”

But there were other reasons for the surgery. Monash Children’s director Professor Nick Freezer said the cranial deformity would soon cause pressure on the brain and lead to intellectual disability.

In a complex four-hour surgery, neuro and plastic surgeons removed the front portion of her skull, reconfigured it into different pieces and put them back together to form a more rounded forehead.

“I hope she has a good and happy future with no more surgery,” Ms Shakirahmat said.

The Big Red Kidney BusFollowing the launch of the world-first holiday mobile dialysis unit on the 2014 World Kidney Day, patients are enjoying being able to travel away from home for holidays without missing critical treatment.

A number of patients have experienced their first holiday in years.

By going online, patients can see where the bus is travelling to and book a place when they see a holiday destination which appeals. Patients then arrange their own holiday near the bus.

The bus, a partnership between Monash Health, the Victorian Department of Health and Human Services, Ventura Bus Lines and Kidney Health Australia, travels around Victoria stopping for six weeks at a time.


Twins saved by MonashThe Monash Women’s team performed Australian-first foetal surgery to save the lives of identical twins Mila and Mika Lichtenstein while they were still in the womb.

A global search to find a treatment for a rare condition led to an experimental procedure that bought the girls an vital extra month in the womb. The procedure, carried out three times, involved multiple injections through mum Simone Lichtenstein’s abdomen into the womb and into tiny blood vessels in the babies stomachs.

A scan at 23 weeks gestation had revealed the girls, who shared a placenta, had a dangerously unequal blood count. The Monash Women’s Foetal Diagnostic Unit found they had the rare Twin Anemia Polycythemia Sequence (TAPS), in which one foetus is starved of blood while the other gets too much.

Of the 175 identical twin pregnancies in Victoria each year, only about eight will develop mild forms of TAPS, requiring no treatment. But Dr Andrew Edwards said that was not so in the case of Simone and Dov Lichtenstein’s twins.

Without treatment, Mika, whose blood was thick from too many red blood cells, risked stroke and spontaneous limb amputation. And Mila’s low blood count left her facing heart failure, as she fought to get oxygen around the body.

Eventually it was decided that the best bet was a transfusion of blood to Mila and in a first exchanging Mika’s blood for saline.

“It had been put up as a theoretical procedure, and been done in a few centres around the world only,” Dr Edwards said.

Ms Lichtenstein said opting for the experimental procedure had been a labour of love for her children and for others who one day may be saved by refining the procedure.

“I thought, if this is what I have to do to see these babies, I’ll do anything,” she said.

The procedures bought the twins an extra month inside the womb, dramatically reducing the risks of long-term disability.

The twins were born 11 weeks early, but healthy. Ms Lichtenstein said she expected to be treated to breakfast in bed on Mother’s Day, followed by cuddles in bed with the twins, daughter Lily, 5, and son Lior, 3. “Our family is complete. I can’t imagine life without them,” she said.

Patient journeys

We helped save Simone’s twin girls


Each year the Premier of Victoria awards health services for outstanding service.

Some of the highlights of our submissions that showcase outstanding staff activities that demonstrate leadership and excellence in the provision of health services to our community include:

Advanced Practice Continence and Women’s Health Physiotherapy service commencesThe introduction of a safe and effective Advanced Practice Continence and Women’s Health Physiotherapy service has improved accessibility and timeliness of care for patients referred to the Monash Health Urogynaecology Clinic with pelvic floor dysfunction.

The advanced practice physiotherapists can now see patients who meet certain criteria prior to their specialist urogynaecological appointment. The model enables the physiotherapist to independently manage patient care where indicated. This has allowed patients to be seen by the most appropriate professional, reducing the number of specialist medical appointments required and streamlining the patient’s journey to best meet their healthcare needs.

This has ensured patients with pelvic floor dysfunction have timely access to practical clinical care with appropriate patients waiting less than one month for an appointment in the Advanced Practice Continence and Women’s Health Physiotherapy clinic.

The clinic is co-located with the urogynaecology specialist clinic, ensuring seamless access to both medical and physiotherapy services and greater collaboration between professions. Streamlining the patient journey in this way has resulted in patients requiring fewer appointments and improved utilisation of resources.

Patient satisfaction levels with the service are extremely high, with 98 per cent of patients being either ‘very satisfied’ or ‘satisfied’ with their experience of being cared for by the advanced practice physiotherapists.

The Advanced Practice Continence and Women’s Health service at Monash Health is providing an innovative way to meet the future challenges of an ageing population and rising health care costs.

Healthcare awards

We are innovative

Monash Children’s Hospital expanding paediatric telehealthMonash Children’s Hospital is one of the lead agencies for the State Wide Paediatric Telehealth project. The expansion of the service across rural and regional Victoria aims to reduce unnecessary travel time and cost for patients/carers and staff, and to support rural and regional specialists to diagnose and manage paediatric patients.

Telehealth saves patients the financial burden of travel and time. The service is appreciated by patients and early data suggests that paediatric developmental medicine intake clinics conducted via telehealth have significantly lower failed to attend rates than face-to-face clinics. The patient satisfaction survey also collected

information from patients on the practical benefits of telehealth. Patients reported a saving in travel costs ranging from $10 to $250. Close to 60 per cent of respondents indicated they had saved anywhere from $61 to $250 in income by attending a telehealth appointment rather than attending a face-to-face appointment in the hospital.

While telehealth is still in its infancy, this project is providing evidence that sustainable, appropriate telehealth is appreciated by patients and it appears to provide unanticipated benefits with respect to fail to attend rates.

Leading the way in telehealth


Feedback and consultationThe Monash Health Quality of Care Report is developed by the Monash Health Innovation and Quality Unit in conjunction with Monash Health consumer advisors and our staff. .

Feedback on our previous report was sought from consumers of our health services and diverse community and our staff.

FEEDBACK AND DISTRIBUTION

Help us to improve Tell us what you thinkWe welcome your feedback about the value and relevance of this report and all aspects of the services we provide. Please contact us:

Monash Innovation and Quality Monash Health Locked Bag 29 Clayton South Victoria 3169

t: 03 9594 4019 w: www.monashhealth.org

DistributionHard copies of our Quality of Care Report are provided to local government and service providers within Monash Health’s catchment, the Community Advisory Committee (CAC), Board of Directors and upon request.

The report is also available on the Monash Health website www.monashhealth.org so that it can be accessed by the wider community.

We are always interested in hearing from consumers, carers and community members who might want to join the Monash Health Consumer Advisor Register or become a member of a Monash Health committee, including site-based Consumer Advisory Groups or the Community Advisory Committee (CAC). Being a member of the Consumer Advisor Register creates opportunities for individuals interested in quality and safety, patient experience or health issues to participate in our health service. If you are interested in becoming a consumer advisor at Monash Health, please contact [email protected] or phone 03 9594 6230.

Are you interested in bringing a community perspective to decisions that are made within your local health service?

Feedback and distribution

Monash Health – Corporate Office 246 Clayton Road, Clayton t: 03 9594 6666 e: [email protected] www.monashhealth.org

Casey Hospital 62-70 Kangan Drive Berwick t: 03 9594 6666

Cranbourne Integrated Care Centre 140-154 Sladen Street Cranbourne t: 03 9594 6666

Dandenong Hospital 135 David Street Dandenong t: 03 9594 6666

Monash Medical Centre 246 Clayton Road Clayton t: 03 9594 6666

Moorabbin Hospital 823-865 Centre Road East Bentleigh t: 03 9594 6666

Kingston Centre Cnr Kingston and Warrigal Roads Cheltenham t: 03 9594 6666

Monash Health Community

Berwick 28 Parkhill Drive Berwick t: 03 8768 5100

Cockatoo 7–17 McBride Street Cockatoo t: 03 5968 7000

Cranbourne 140-154 Sladen Street Cranbourne t: 03 5990 6789

Dandenong 122 Thomas Street Dandenong t: 03 8792 8100

Pakenham Cnr Deveney Street and Princes Highway Pakenham t: 03 5941 0500

Springvale 55 Buckingham Avenue Springvale t: 03 8558 9000

FEEDBACK AND DISTRIBUTION

Monash Health Quality of Care Report 2014-1566MonashHealth

Monash Health Corporate Office

246 Clayton Road, Clayton t 03 9594 6666e [email protected] w www.monashhealth.org

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