Director Operations / General Manager Meeting …...Strongly Disagree (1) Disa gree (2) Neither...
Transcript of Director Operations / General Manager Meeting …...Strongly Disagree (1) Disa gree (2) Neither...
Director Operations / General Manager Meeting
Introduction
Dr Nigel Lyons Chief Executive ACI
..to facilitate quality health
care …
Aligned with ACI’s purpose and values..
..the outcomes of which will exceed the
expectations of our partners,
patients & community..
...leading to our vision
Core values: Collaboration Openness Respect Professionalism Innovation
Our processes
Our clinicians, patients, health care partners and the community
We will be valued as the leader in the health system for designing, evaluating and supporting implementation of innovative models of patient care
Purpose: We will work with clinicians, consumers and partners to design and drive evidence based innovation to ensure appropriate, effective and sustainable patient centred health care
The go to place for clinician and consumer led reform
Operational Excellence
Ensure collaboration & alignment of key priorities across the organisation
Develop high quality systems & processes that are
continuously improved
..we will invest in our clinicians, consumers and staff to effectively
use our resources..
Our resources
Effective partner in implementation
Better health outcomes for all
Innovative Health Care
Develop a rigorous approach to all aspects of innovation
Create an environment and capability for innovation
Effective Partnerships
Work in collaboration with partners
Understand needs, establish and align strategic priorities
Our financial stewardship
Prioritise and maximise our use
of resources
Our clinicians, consumers and staff Promote our
clinicians, consumers & networks to lead the clinical reform
process
Develop an ACI team with clear
roles for our people
Create a vibrant & stimulating
environment with a shared direction
Invest in our people to
develop skills & expertise
Strengthen involvement & communication
ACI Connect Forums - Partnership Evaluation
To what extent do you agree or disagree with the following statements?
Strongly Disagree
(1)
Disagree (2)
Neither agree nor disagree
(3)
Agree (4)
Strongly Agree
(5)
Rating average (total
5)
Rating average
May 2013
ACI understands the priority areas where they can assist us 0 0 4 8 3 3.9 3.6
ACI is very responsive to our needs 0 0 5 9 1 3.7 3.7
ACI has put in place relevant actions to address our priority needs
0 0 2 11 2 4.0 3.6
ACI management are very accessible (to who?) 0 0 2 11 2 4 4
ACI communicates well with our senior management 0 0 4 8 3 3.9 3.8
ACI communicates well with our senior clinicians 0 1 11 2 1 3.2 3.0
ACI has helped us to more effectively implement improved models of care
0 1 3 10 0 3.6 3.8
ACI is a good partner to work with to improve healthcare 0 0 2 10 3 4.1 4.1
I would recommend to my colleagues the work of ACI in designing innovative models of patient care
0 0 3 7 5 4.1 4.1
I would recommend to my colleagues the work of ACI in implementing innovative models of patient care
0 0 4 5 6 4.1 4.1
Feedback from LHDs to date
▲ Streamline correspondence to LHDs/SHNs from the ACI
▲ Portal – communication tool to improve knowledge about ACI activities in LHDs/SHNs
Add Web link to the Portal
Sharing Information - Feedback
▲ Regular Visits to LHDs/SHNs by ACI Directors ▲ ACI Network Executive and Working Group
Members – list distributed March 2014 ▲ Development of: on-line search option
http://www.aci.health.nsw.gov.au/networks/membership/
LHD/SHN – ACI Partnerships Regular meetings
At last ACI Connect Forum request that an ACI Director be ‘allocated’ as the main contact for an LHD/SHN.
Key Messages heard Volume of correspondence and activity coming from
Pillars Disconnectedness amongst all that activity Integrated Care is a high priority ACI assisting in building relationships/initiatives with
Medicare Locals Mandatory vs Voluntary uptake of ACI work Acknowledgement & recognition of LHD work especially
when it is adopted by a Pillar Provide context to Ministry decisions (gossip) ACI could consult more widely before providing advice to
the Ministry around funding decisions
Local Assistance/Priorities Assistance identifying clinicians to deliver services
through Telehealth (Far West) Improving transition between child and adult services
(Western Sydney) Reorienting community health to deliver better system
outcomes (Murrumbidgee) Forensic patient flow to LHD and community (JFMH) Access to list of Medicare Local contacts (JFMH) Organ donation (Sydney) Support for the NSW trauma review (ASNSW)
Meetings Positive
▲ ‘Good just to talk’ ▲ Growing understanding of ACI role ▲ Increased understanding of local issues by ACI
Opportunities
▲ Directors find it hard to talk beyond our own portfolios ▲ How do others in the LHD find out what was
discussed? ▲ Directors are still visiting other LHDs regularly as part
of normal work – is this confusing?
Maeve Eikli Director
EESC
Engagement, Executive Support and
Communications
23 May 2014
Our key functions Support openness and strengthen two way communication
Internal and External Communications
Publications
Reports
Website and Intranet
Briefs and Ministerials
Media relations
Social Media
Events
Clarifying our message
New portal Making it easier to stay updated on ACI and CEC initiatives headlines – link to ACI
and CEC websites
search filters – dates local involvement
contact details
www.eih.health.nsw.gov.au
Check out the Intranet
Media liaison
Social Media
Twitter - @NSWACI plus nine individual accounts
Facebook – Two project specific pages
Vimeo - More than 200 videos posted to date
Yammer – internal use, 116 staff accounts
Consumer engagement
Consumers have a voice in our networks
ACI Consumer Council The ACI Consumer Council advises the Board on community engagement and provides a focus for consumer involvement across all ACI networks. The Chair and six members have qualifications or experience in consumer engagement, communication or research designed to identify the views of the community. For more details on the members of the consumer council, visit the ACI website at: www.aci.health.nsw.gov.au/our-people/consumer-council
Thank you
Acute Care Portfolio Daniel Comerford [email protected] 02 94644602
Acute Care: where we work P
RIM
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SP
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IALI
ST
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LATO
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(C
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AC
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THE ACUTE CARE PORTFOLIO SPANS THE PATIENT JOURNEY
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Acute Care: how we will work
THE PATIENT IS AT THE CENTRE OF OUR
WORK
Specialist Ambulatory
(Chronic Disease)
Primary Care
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Acute Care: what we do Acute Care Taskforce:
▲ Medical In-patient Journey, ● Medical Assessment Units, ● Clinical Management Plans, ● Criteria Led Discharge
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Acute Care: what we do Blood and Marrow Transplant: BMT Quality Services
▲ malignant haematology Model of Care ▲ long term follow up Model of Care ▲ AML Model of Care ▲ Environmental Cleaning
Cardiac: ▲ CHF ▲ Cardiac Reperfusion Program ▲ AMI Clinical Variation ▲ Revision of Chronic Disease Guidelines ▲ National Indigenous Acute Cardiac Care
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Acute Care: what we do Endocrine:
▲ Sub-Cut Insulin Medication Chart ▲ high risk foot services Standards of Care ▲ diabetes Model of Care
Gastroenterology: ▲ EIS Implementation ▲ consumer information / standards of care (with Nutrition network) ▲ Hepatitis Pathways and Model of Care
Nuclear Medicine: ▲ Lutate Patient Pathway
Radiology: ▲ Medical Imagine District Business Unit Model, including
Implementation tool kit
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Acute Care: what we do Renal:
▲ home dialysis, ▲ Supportive Care leading to end of life
Respiratory: ▲ NIV consensus guidelines, ▲ Tracheostomy Care consensus guidelines ▲ Pleural Drains Consensus guidelines, ▲ CF Adult Model of Care ▲ COPD service access and improvement, HiTH Partnerships
Stroke: ▲ Stroke Reperfusion Program, ▲ Stroke Clinical Variation
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Prof. Donald MacLellan Director
Surgery, Anaesthesia and Critical Care
Surgery, Anaesthesia & Critical Care
23 May 2014
Surgery, Anaesthesia & Critical Care Portfolio.
Surgery, Anaesthesia
& Critical Care
Anaesthesia & Peri Operative
Network Burn Injury Service Network
Gynae- Oncology Network
Neurosurgery Network
Ophthalmology Network
Urology Network Surgical
Services Taskforce
Emergency Care Institute.
Institute of Trauma Injury Management
ICCMU
Rural Critical Care and
Critical Care Taskforce
Intensive Care Services Network
Surgery, Anaesthesia
& Critical Care
Anaesthesia & Peri Operative
Network Burn Injury Service Network
Gynae- Oncology Network
Neurosurgery Network
Ophthalmology Network
Urology Network Surgical
Services Taskforce
Emergency Care Institute.
Institute of Trauma &
Injury Management
ICCMU
Critical Care Taskforce
Intensive Care Services Network
Intensive Care Coordination & Monitoring Unit
Surgery, Anaesthesia & Critical Care Portfolio.
Surgery, Anaesthesia
& Critical Care
Anaesthesia & Peri Operative
Network Burn Injury Service Network
Gynae- Oncology Network
Neurosurgery Network
Ophthalmology Network
Urology Network Surgical
Services Taskforce
Emergency Care Institute.
Institute of Trauma &
Injury Management
ICCMU
Critical Care Taskforce
Intensive Care Services Network
Surgery, Anaesthesia & Critical Care Portfolio.
Established in 2003 4.2FTE & Clinical Director (0.5) 4 Main Activities:
Utilisation of IC resources Understanding of IC service provision Promotes excellence in standards of care Fosters communication across key groups Runs the Critical Care Resource Management System
ICCMU
Critical Care Resource Management System
Traffic Light system for ICU bed availability
Linked to patient admission databases
Automatic refreshes Local clinician input re
factors impacting: ▲ Bed availability ▲ Patient flow through unit ▲ Staffing resources
Intensive Care Services Network
Re-established in 2013 Improve the ICU/HDU patient care Liaise with HealthShare for ICCIS
implementation Critical Care Data Registry (linkage) Project
Institute of Trauma & Injury Management
Established in 2002 5.5FTE + Clinical Director (0.5) Main Activities: Collection, analysis & responses to trauma activity & outcome
data Development , implementation & monitoring clinical guidelines Development & implementation of trauma training & education Research across the trauma system Trauma Patient Outcome Evaluation
Emergency Care Institute Established in 2011 5.0 FTE + Clinical Director (0.5) Primary role is to improve outcomes for patients
presenting to Hospital Emergency Departments through coordination, networking and research.
Main Activities: Collection, analysis & responses to emergency activity & outcome data Development , implementation & monitoring clinical guidelines Research across the emergency care system Actively working to reduce variation in clinical practice and improve the
provision of emergency care Nurse Delegated Emergency Care project
Severe Burns Injury Network
Core Network - CHW, RNSH and CRGH
Broader network includes rehab facilities, rural and
metropolitan EDs and Trauma services
Ensure best assessment and care for transfer of more
severely injured patients.
Provide care for patient with non-severe burn injuries
Telehealth project
Grafting done for days stay patients
23 30 34 52
134184 213
235
050
100150200250300350
2008-09 2009-10 2010-11 2011-12
Day Stay graftingNo grafting
02468
10121416
2008/09 2009/10 2010/11 2011/12
Average LOS for Burn Units
RNSH
CRGH
CHW
All Acute admissions (by separation)
557 508 506 554
157 214 247288
0
200
400
600
800
1000
2008-09 2009-10 2010-11 2011-12
<24hrs
>24hrs
Surgical Services Taskforce
Established 2004 Chair- Dr Michael McGlynn Peak body advising on all aspects of
surgery Works closely with MoH, CEC & LHDs Fractured Hip project OT Efficiency project
Additional SACC Networks Network Major Project
Anaesthesia Perioperative Care Safe Sedation Phase 2
Gynae-Oncology Referral delays re Gynae-onoclogy patients – diagnostic collaborative project
Ophthalmology Eye Health framework and Service Model for Cataracts and Chronic Eye Disease
Urology Prostate Registry
RCCT Nurse Administered Thromobylsis (NAT) Project
CCT Critical Care Data Registry Project (oversight)
Neurosurgery Adult Neuro observation Chart implementation and education package
Surgery, Anaesthesia
& Critical Care
Anaesthesia & Peri Operative
Network Burn Injury Service Network
Gynae- Oncology Network
Neurosurgery Network
Ophthalmology Network
Urology Network Surgical
Services Taskforce
Emergency Care Institute.
Institute of Trauma &
Injury Management
ICCMU
Critical Care Taskforce
Intensive Care Services Network
Surgery, Anaesthesia & Critical Care Portfolio.
Level 4, Sage Building, 67 Albert Ave, Chatswood NSW 2067
PO Box 699 Chatswood NSW 2057
T + 61 2 9464 4604 www.health.nsw.gov.au/gmct/ ABN 89 809 648 636
Professor Donald MacLellan Director of Surgery, Anaesthesia & Critical Care
9464 4604 [email protected]
Chris Shipway Director Primary Care and Chronic Services ACI
May 2014
Primary Health and Chronic Care Initiatives
Past MINISTRY: Health Ones GP Advisory Committee (currently being reconvened)
Clinical Handover Project Chronic Disease Management Program Funded position in GP NSW Working with GPs Guidelines ACI: Pain Plan Presence on some networks
ACI: Current Activities GP Advisory Group Pathways Projects and Evaluation Osteoporosis Project (Murrumbidgee) Chronic Disease Management Program
(Connecting Care)
Home Medical Home Community Hospital
Patient Family
Carer
GP
Council
NGO
RACF
Hospital
Hospital
Specialist
Community Nurse
Allied Health
Aged and Community Care
CHC
Community Pharmacy
Chronic Disease Manager
Practice Nurse
Diabetes Educator
Exercise Physiologist -Patient preference decreases
- Holistic/generalism decreases - Relationship decreases - Integration decreases - Numbers decrease - Multi-morbidity increases - Cost increases
Medical Home*
* Courtesy of Dr Tony Lembke
Chronic Disease Management Program – Connecting Care Model: community-based care coordination and
self-management support for people 16 years + with chronic disease at risk of hospitalisation
LHD / ML relationships variable across NSW ▲ Funding partnership ▲ LHD staff placed in ML ▲ Governance support
Multi morbidity increases with age
Barnett, Mercer, Norbury, Watt, Wyke, Guthrie: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study; Lancet 380:9836, 7-12 July 2012, pp. 37-43
Multi morbidity correlated with socio-economic status
Barnett, Mercer, Norbury, Watt, Wyke, Guthrie: Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study; Lancet 380:9836, 7-12 July 2012, pp. 37-43
Avoidable hospitalisations pre and post enrolment
33% reduction P<0.001
ACI: Future Chronic Disease Management GP enabled Pain Clinics Musculo-Skeletal Primary Health Project Palliative Care Framework for Older People with Complex
Health Needs ISBAR Initiative
Local level What form can the messages take?
Education Training Information Consultation support Community education models Website
Support each othe
ACI Musculoskeletal Models of Care
Osteoarthritis Chronic Care ▲ Conservative care options for hip & knee arthritis ▲ Is surgery really needed? ▲ In any case, learn self-management strategies
Low Back Pain – currently being developed • Early conservative care • Aim to stop the chronic pain cycle
Osteoporotic Refracture Prevention • Identify fragility fractures & treat underlying
cause
Musculoskeletal Initiative for Primary Care Providers Community preferred setting and leadership –
primary care Address osteoporosis, arthritis & back pain at
‘one-stop shop’ Allocated coordinator to support MDT Formal collaboration between PHCO & LHD to:
▲ Ensure executive ‘buy-in’ ▲ Pool resources ▲ Support each other
ACI Model for Palliative & End of Life Care Service Provision Palliative Care Network established Sep ‘12 Over 360 members as of November 2013 Vision: All NSW residents have access to
quality care based on assessed need as they approach and reach the end of their life
A focus on supportive and supported primary care providers including general practitioners
ACI Model for Palliative & End of Life Care Service Provision Emphasis on care as close to home as possible Recognition of gaps in specialist palliative care
services and need to build capacity in primary care Recognition of the need to have earlier end of life
discussions, care planning and advance care planning with patients
Support for shared care and networked service arrangements
Model of Care due in March 2014
NSW Health Integrated Care Strategy defines integrated care as the provision of seamless,
effective and efficient care that responds to all of a person’s health needs, across physical and mental health in partnership with the individual, their carers and family.
It means developing a system of care and support that is based around the needs of the individual, provides the right care at the right time and makes sure dollars go to the most effective way of delivering healthcare for the people of NSW
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Older Person Centred Care Components of the Older Person’s Health Journey
• Initial contact/access • Management & planning • Crisis/acute need
• Specialised health care • Recovery/rehabilitation • Supportive, palliative and end-of-life care
The Framework for Integrated Care for Older People with Complex Health Needs
Develop a shared vision for aged health services in our local community with agreed
goals and measures of success.
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System Design Principles
System Design Principles Promote clear and transparent multi-sector governance and leadership in every setting
to drive system change.
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System Design Principles
System Design Principles Implement models and services that achieve timely access to care and empower other
services to deliver appropriate care as close to home as possible.
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System Design Principles
System Design Principles
Involve older people, their carers and families at every step of their journey and
value their experiences as much as clinical effectiveness.
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System Design Principles
System Design Principles
Ensure technology supports integrated service delivery that shares information to
effectively support multi-sector decision making.
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System Design Principles
Implementation Forerunner sites Economic analysis Clinical redesign school and support Partnership with Medicare Locals and
RACFs Evaluation feedback on outcomes
Level 4, Sage Building 67 Albert Avenue, Chatswood NSW 2067
PO Box 699 Chatswood NSW 2057
T + 61 2 9464 4600 F +61 2 9464 4728
www.aci.health.nsw.gov.au ABN 89 809 648 636
Chris Shipway Director PC&CS
Email: [email protected]
Raj Verma Director
Clinical Program Design & Implementation, ACI
Clinical Program Design & Implementation
Clinical Program Design & Implementation
Implementation
Health Economics and Analysis
Centre for Healthcare Redesign
Research
Clinical Program Design & Implementation –
Implementation
Health Economics and Analysis
Centre for Healthcare Redesign
Research
Implementation
Health Economics and Analysis
Centre for Healthcare Redesign
Research
Clinical Program Design & Implementation
Implementation
Health Economics and Analysis
Centre for Healthcare Redesign
Research
Clinical Program Design & Implementation
ACI Priority Program 2014-15
Chris Shipway Director
Primary Care & Chronic Services 6 May 2014
ACI creates a lot of “product” These products potentially form a “toolkit” Balance between clinical network initiatives
and LHD priorities This exercise will explore how we better
get that balance right
Introduction
At end of the session we will: Have a list of shared implementation
priorities (for consideration in ACI 14/15 Ops Plan). Understand some of the rationale for those
priorities.
Steps 1. Introduction 2. Create an implementation priority list
(small group) 3. Reflect on how your list will could improve
the patient experience/system performance (small group).
4. Feedback
Implementation Priority List Using prepared list - discuss which of
those models/initiatives should be included. You can use the longer list of projects as a
reference. You can suggest other initiatives.
What will change? (Clinical and value-based factors) Better patient experiences?
Improved population health?
Best use of our resources?
Is this what is really important ? Do you
want to change priority list?
Is one model/initiative more likely to succeed? (Contextual factors)
Common priority across multiple LHDs? Already in place in some LHDs? Funding available? Capacity and capability exists in the system Strong leadership
At end of the session we will: Have a list of shared implementation
priorities Understand some of the rationale for those
priorities. Have tested those priorities against
potential patient/system benefits.
Feedback
Daniel Comerford Director Acute Care
ACI Project Implementation
6 May 2014