Department of Human Services

Meeting Patient Needs

Department of Human Services

Primary & Acute Health – Systems Integration

The Strategic Integration of HARP& Hospital Demand Management Projects

Alison HarleAustin and Repatriation

Medical Centre

Allison HarleAllison Harle

Demand Management CoordinatorDemand Management Coordinator

Austin & Repatriation Medical CentreAustin & Repatriation Medical Centre

The Strategic Integration The Strategic Integration

of HDM & HARP of HDM & HARP

at the A&RMCat the A&RMC

Presentation OverviewPresentation Overview

Background to HDMBackground to HDM HDM at the A&RMCHDM at the A&RMC Outcomes & Key Lessons Outcomes & Key Lessons Development of HARPDevelopment of HARP Integration of HDM and HARPIntegration of HDM and HARP Future ChallengesFuture Challenges

HDM BackgroundHDM Background

Unacceptable numbers of bypass, 12 hour waits, displacement of Unacceptable numbers of bypass, 12 hour waits, displacement of elective surgery etc.elective surgery etc.

Pressure and stress in work forcePressure and stress in work force Shortage of aged care beds, with patients backing up in acute bedsShortage of aged care beds, with patients backing up in acute beds Workforce issues, shortage of nurses, especially critical care and Workforce issues, shortage of nurses, especially critical care and

emergency nursesemergency nurses HDM – development of short to medium term projects targeted at HDM – development of short to medium term projects targeted at

predictable areas of demandpredictable areas of demand

A&RMC HDM InitiativesA&RMC HDM Initiatives Short to Medium TermShort to Medium Term Aged & Chronic - Care Coordinators, Residential Care Placement Team, Chronic Aged & Chronic - Care Coordinators, Residential Care Placement Team, Chronic Disease, Functional Maintenance Program, Disease, Functional Maintenance Program, Continence Continence Emergency Department – Aged Care Team, Short Stay Observation Unit, Emergency Department – Aged Care Team, Short Stay Observation Unit, Multidisciplinary Triage, Multidisciplinary Triage, Medical Assessment and Planning Unit Medical Assessment and Planning Unit Substitution – Ambulatory Care, Medi-hotel, Spinal Admission Prevention, Substitution – Ambulatory Care, Medi-hotel, Spinal Admission Prevention, Rehabilitation in the Home Rehabilitation in the Home Medium to Long TermMedium to Long TermClinical LeadershipClinical LeadershipHospital Primary Care LiaisonHospital Primary Care Liaison

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Key to SuccessKey to Success

Program Governance Program Governance Dedicated Demand Management CoordinatorDedicated Demand Management Coordinator Constant Analysis of Data and Performance Constant Analysis of Data and Performance Program DirectionProgram Direction Project StructureProject Structure Change Management Change Management Combination of Short and Medium to Long Term ProjectsCombination of Short and Medium to Long Term Projects

Clinical LeadershipClinical Leadership Hospital Primary Care Liaison Hospital Primary Care Liaison

Development of HARPDevelopment of HARP

Community ConsultationCommunity Consultation Areas of DemandAreas of Demand Analysis of DataAnalysis of Data ExpectationsExpectations TimeframeTimeframe ImplementationImplementation

Integration of HDM & HARPIntegration of HDM & HARP

Where is the connection?Where is the connection?Build on the strengths and lessons from HDMBuild on the strengths and lessons from HDM Program Governance Program Governance Dedicated CoordinatorDedicated Coordinator Constant Analysis of Data and Performance Constant Analysis of Data and Performance Program Direction Program Direction Project StructureProject Structure

HARP Projects HARP Projects

Chronic Disease Unit (CCF & COAD)Chronic Disease Unit (CCF & COAD)

Improving Diabetes Care Improving Diabetes Care

Community Link Rapid Response ServiceCommunity Link Rapid Response Service

IssuesIssues Project SupportProject Support Stakeholder ExpectationsStakeholder Expectations Budget ProcessBudget Process RecruitmentRecruitment Maintaining Motivation Maintaining Motivation Integration & SustainabilityIntegration & Sustainability

Future ChallengesFuture Challenges

Model of Care – Consumer Focused, Sustainable, Model of Care – Consumer Focused, Sustainable, IntegratedIntegratedManaging ExpectationsManaging ExpectationsAddressing Organisational WeaknessesAddressing Organisational WeaknessesCreativity & InnovationCreativity & InnovationEvaluationEvaluationMaintaining Flexibility Maintaining Flexibility

Better Communication Between the Hospital & Community Services

Evie SoldatosEastern Health

Collaborating on HARP in the East…..better communication between the hospital and

community sectors

Evie.Soldatos@angliss.org.au

Overview

A bit of Eastern collaboration history…. the baseline

The Role of the Clinical Coordinator HARP & HDM

A system for Eastern collaboration What we’re learning…

Key points…

The reflection on HARP 1

Collaboration Who? How? Structure In what manner? Processes &

principles

What are we learning?

History of Eastern HARP collaboration. 2002 HARP 1 Little coordination of effort across the

Health Service & Community Stakeholders internal and external to the

Health Service affected Minimal involvement of the Primary Care

Sector Less than satisfactory outcomes

A clear need for communication to improve

Picking up the pieces…

De briefing – a good ‘vent’… Identifying the issues, expectations

and common ground as a basis for future planning… Inclusion Information Consultation/Contribution Timing Feedback

What we did about it…

Established a central point of coordination

Systematically identified and connected with stakeholders

Improved flow of communication E-mailing Groups, News Flashes,

Work Groups HARP Forum 28 November 2002

Advancing HARP in 2003 Identifying common concerns,

objectives and shared ownership Establishing trust and building the

relationships Developing and implementing a

system for communication and coordination of effort across sectors

Acknowledging and using what we already have

What is the collaboration structure? A collection of interconnected

across sector reference, working groups and operational forums

a vehicle for considering HARP and it’s implications at strategic, coordination and practice levels, and; supporting HARP action.

An evolving ‘species’

Hospital Demand (HARP) Reference Group

Technical Working Groups

Business Systems, Information Management

Project Steering Groups, Medication Management

Eastern Health Committees

Primary Care & Population Health Advisory Committee

Community Advisory Committee

Cohort Reference Groups

Older Persons & Mental Health

Who are the collaborators?

HARP is a ‘bridge’ between the wider external world… 3 PCPs; a ‘portal’ with a central strategic

and communication role

Key community-based service providers Care Management providers Community Health Services Divisions of General Practice Local Government RDNS

Who are the collaborators?

…and the wider internal world… Acute Services Aged Care Rehabilitation &

Community Health Mental Health Planning and Community

Relations Information, Finance and

Corporate programs

What processes underpin collaboration?

Shared vision and opportunity to participate Guiding Principles A focus on what we CAN rather than can’t

do Shared commitment

People, community, service system A culture of consistent communication

and action Frankness, courage & robust debate in the

context of respectful relationships

Essentially…

Establishing objectives Organising Motivating Developing people Communicating Measurement and analysis

(reflecting)

It’s not easy…

An investment Time, energy, money, systems & tools

Cultural considerations Language, philosophy, models &

perspectives

Recognising skills and specialisation across sector

Politics

What we’re learning….

Collaboration processes require:- planning collective agreement commitment to application and

‘troubleshooting’ robust communication across dimensions time & effort support

IT’S Definitely NOT the easy path….. But it’s certainly the worthwhile one.

The Future…..

Ongoing reflection on and improvement of structure and processes

Moving increasingly toward shared ownership and problem solving of systems issues

Balancing strategic vs operational needs; supporting the system AND the projects

Checking our language and the meanings we derive from it

A place for everyone

So…. Create the environment Relationships ARE important Have the shared vision & objectives, but bite off

chewable chunks; focus on what you CAN agree and do Have Exit as well as Project champions Take a ‘systems’ approach Continuously adjust and improve Encourage the debate; embrace the “tail twisters”

Try to have some fun! Enjoy the journey!

“ If possible, try to find a way to come downstairs that doesn’t involve going bump, bump, bump on the back of your head….”

Winnie the Pooh Pooh’s Little Instruction Book

Inspired by A. A. Milne

HARP: A Vehicle to Transform Relationships and Practice

Phil CornishBayside Health

HARP: A Vehicle for Change

Building Relationships Between Providers

Better Care Of Older people

The successful HARP project for Bayside Health and its Partners was a multifaceted integrated model Components of the model included;– Identified register, shared electronic health care

record, targeted strategies, extra resources

Headings

Vision/PassionLeveraging Existing RelationshipsEmphasis on Method not ModelBuild on Complementary InitiativesPrinciple on Integration and resource shifting

Vision

No ones believes the current model of health care will be sustainable into the futureIt is a question of when the model changes rather than if

Leading the Vision

There is no doubt the personal involvement of the Bayside CEO Michael Walsh helped generate a lot of supportThe Vision was further refined by the CEO doing a round of sessions with representatives from different agencies across the length of the catchments

Means to an End

Better Care of Older People ( also a Bayside Strategic Direction) saw the project as no end in of itselfIt was a way of promoting alternate care models which emphasised community interventions

Life After HARP

It was important in our view to change the nature of the interaction between the sectorsWe saw more of the leadership coming from the primary care sector in the future as they were closer to the community

Resultant Model

There is a Joint Steering Committee chaired by the Bayside Health CEO

Membership

CEO’s of two community health services2 LGA representatives at a senior level2 other Bayside Health Representatives from The Alfred and CGMCISEPHICJewish CareRDNSGP Division and Bayside Care Options

Leverage Existing Relationships

Would we had to invent the PCP’s?Strong commitment to the PCPPrimary Care Sector had long history of engagement (Primary Care Alliance)

Other Key Players

Strong Involvement from a range of key staff such as CHS CEO’s Bayside Health involvement across a number of areasBayside Health Representative had cross sector interests both in Primary Care sector and other sectors.

Partnership Statement

The development of successful long term strategic relationships, based on mutual trust, world class and sustainable competitive advantage for all partners; relationships which have a further separate and positive impact outside the partnership.Lendrum, T. The Strategic Partnering Handbook McGraw-Hill 3rd Ed.

Developing Own Partnering Statement

The group has developed its own partnering statementOther agreements about personnel and service agreements

Tony’s 12 Steps

Select a PartnerReview Internal r’shipsReview with partner and share infoAnalyse RequirementsEnsure IFOTA1 requirementsCarry out site visits

Select and Review partnering Team MembersReview skills customer/supplierReview UpstreamTechnologyNetwork reviewDevelop implement and review strategy/action planPp145-149, Lendrum, 1998

Method rather than Model

The group produced a description of both a model but more importantly a description of a method which would allow the project to respond to client need as it was identifiedUnitary/integrating model which would be multifaceted

Proposed Model Components

Identified client group of over 70 years multiple admissions or presentationsShared Electronic Health Care RecordSpecialist TeamProvider Resourcing Funds( not brokerage)5 sub-programs24 hour call centre

Resource Shifting to Primary Care Sector

Bayside Health Representatives stated that Acute Health would not benefit from resource allocationThis has lead Bayside to judge internal proposals against this criteria

Build on Complementary Initiatives

There was a strong desire to ensure that multiple initiatives added to the total changes desired rather than doing so independentlySo, we envisaged structures which had common membership I.e. NDHP, Other Electronic Work, PCP Co-ordinated Care

What we said

Through our PCP and this program’s development, we are establishing a structure and model for service collaboration as the basis for implementing not only HARP projects, but also an on-going population health focus for the Bayside Health catchment.HARP Submission

Welcome

Rather grandly welcomed Case managers and others to the future of health care which we had entrusted to them.

At least lets explore the opportunity

Relevant Links

www.baysidehealth.org.au ( Bayside Health)

www.portphillip.vic.gov.au/primary_care_partnerships.html I (ISEPHIC lead PCP)http://www.baysidehealth.org.au/uploads/general/Bayside%20Health%20Strategic%20Plan.pdf ( B’side Health trategic Plan)

Department of Human Services

Primary & Acute Health – Systems Integration

QuestionsDiscussion Time