Dr Simon Towler Chief Medical Officer WA Department of Health

Dr Simon TowlerDr Simon TowlerChief Medical OfficerChief Medical Officer

WA Department of HealthWA Department of Health

Dr Simon TowlerDr Simon TowlerChief Medical OfficerChief Medical Officer

WA Department of HealthWA Department of Health

MAKING THE DATA SPEAK!MAKING THE DATA SPEAK!

Just who is listening?Just who is listening?

MAKING THE DATA SPEAK!MAKING THE DATA SPEAK!

Just who is listening?Just who is listening?

What is your vantage What is your vantage point!point!

What is your vantage What is your vantage point!point!

Safe: avoid preventable injury from care

Effective: services based on scientific knowledge

Patient centered: respectful, responsive care

Timely: reducing waiting and harmful delays

Efficient: avoid waste (equipment, supplies, ideas)

Equitable: no variation due to ethnicity, gender, age, etc

Improving 21st CenturyImproving 21st CenturyHealth systemsHealth systems

Institute of Medicine

London Healthcare“A Framework for Action”

1/ Services focused on individual needs and choices

Provision should, wherever possible, be tailored to the particular needs of each individual.

Patients should feel in control of their care and be able to make informed choices.


2/ Localise where possible, centralise where necessary

Routine healthcare should take place as close to home as possible. More complex care should be centralised to ensure it is carried out by the most skilled professionals with the most cutting edge technology.


3 (a) Truly integrated care and partnership working, maximising the contribution of the entire workforce.

Better communication and co-operation is needed – between urgent and planned care, between health and social care – to stop people from falling through the gaps.


3(b) Truly integrated care and partnership working, maximising the contribution of the entire workforce.

Care should be multidisciplinary bringing together the valuable contributions of practitioners from different disciplines. The NHS should be committed to working in partnership with other organisations, including local government and the voluntary and private sectors.


4/ Prevention is better than cure.

Health improvement, including proactive care for people with long-term conditions, should be embedded in everything the NHS does. Close working with local authority partners is needed to help people stay mentally and physically healthy.


5/ A focus on health inequalities and diversity.

….., the most deprived areas of London, with the greatest health needs, need better access to high-quality healthcare.

London Healthcare

“A Framework for Action”

Partnerships to improve health.

The NHS has often made the mistake of thinking it can change healthcare outcomes on its own. It cannot. The NHS must work with its partners – the London boroughs, the Greater London Authority and the Mayor’s Office, the voluntary and private sectors, and the higher education sector – to implement this Framework.

Different viewpoints of what constitutes these outcomes

• The patient

• Carers and families

• Medical practitioners

• Other health professionals

• Management

• Politicians

Improving 21st CenturyImproving 21st CenturyHealth systemsHealth systems

Health information is being used by all these groups!

It is influencing their ideas about their own healthcare experience!

What is the quality of that information?

What is the depth of their understanding?

How is that information feeding back into the system?

“If governments, the professions and the community really want and expect a “better” health system, then it is time to start asking questions about resource allocation, in a spirit of transparency, with an explicit statement of values, and supported by a systematic and evidence-based framework. The answers have the potential to enhance the sustainability and quality of health care.”

Title: Identifying existing health care services that do not provide value for money

MJA Volume 190 March 2009 Elshaug et al

Health expenditure Health expenditure as % GDPas % GDP

Institute of Medicine0

2

4

6

8

10

12

14

16

18

1966 1976 1986 1996 2006

Australia

Austria

Belgium

Canada

Denmark

Finland

France

Germany

Iceland

Ireland

Japan

Luxembourg

Netherlands

New Zealand

Norway

Portugal

Spain

Sweden

Switzerland

United Kingdom

United States

By 2050

USA > 30

Most other countries 20Financial Times March 25 2009

USA

Australia

Advances in medical technology have brought large

benefits but have also been a major driver of increased

health spending in recent years. In many cases,

increased expenditure on new medical technologies

reflects improved treatment and a significant increase in

the number of people treated.

Productivity Commission Report

• This report identified that advances in medical

technology have been a major driver of the growth

in real health care expenditure and estimated that

the cost of technological change contributed 1.9 per

cent to the annual growth in real health care

expenditure of 5.3 per cent, or 36 per cent of the

annual growth in real health care expenditure from

1992-93 to 2002-03.

Productivity Commission Report

1.98%

3.11%

4.50%

2.07%

4.55%

1.51%

3.04%

4.28%

2.79%

0.00%0.50%1.00%1.50%2.00%2.50%3.00%3.50%4.00%4.50%5.00%

WA is the

fastest growing State in

the nation

Population Growth Sept 2005 - Sept 2007*

GP workforce in WA

Itunes.lnk

Case study 1

2005-06 WA Metro GP FWE’s

11% less than the national average

WA Rural GP FWE’s

16% less than the national average

• You can imbed commercial videos or your own video movie in any slide ...

Distribution of General Practice in PerthDistribution of General Practice in Perth

PERTH

ROCKINGHAM

MANDURAH/PEELHH

HH

HH

HH

HH

HH

HH

FREMANTLE

ARMADALE

KELMSCOTT

Pink dots are GP PractisesPink dots are GP Practises

Population growth by SLA to 2016

0

5000

10000

15000

20000

25000

30000

Rockingham

(C)

Sw

an (C)

Cockburn (C

)

Mandurah (C

)

Wanneroo (C

) -S

outh

Wanneroo (C

) -N

orth-East

Arm

adale (C)

Wanneroo (C

) -N

orth-West

Gosnells (C

)

Inner city

Kw

inana (T)

Stirling (C

) - Central

Joondalup (C) -

North

Kalam

unda (S)

Stirling (C

) -C

oastal

Rem

ainder

Top 15 by population

0%

10%

20%

30%

40%

50%

60%

70%

80%

% g

row

th

Growth to 2016

% growth

Note overall metro growth rate is 17%

Population growth to 2016

Rockingham27000 additional people by 2016

30% growth



HHROCKINGHAM

Population growth by SLA to 2016

0

5000

10000

15000

20000

25000

30000

Rockingham

(C)

Sw

an (C)

Cockburn (C

)

Mandurah (C

)

Wanneroo (C

) -S

outh

Wanneroo (C

) -N

orth-East

Arm

adale (C)

Wanneroo (C

) -N

orth-West

Gosnells (C

)

Inner city

Kw

inana (T)

Stirling (C

) - Central

Joondalup (C) -

North

Kalam

unda (S)

Stirling (C

) -C

oastal

Rem

ainder

Top 15 by population

0%

10%

20%

30%

40%

50%

60%

70%

80%

% g

row

th

Growth to 2016

% growth

Note overall metro growth rate is 17%

Population growth to 2016Cockburn

25000 additional people by 2016

30% growth



HHROCKINGHAM

COCKBURN

What are GP’s doing?

BEACH data suggest that in the 12 months 2001–02,

people in Australia spent on average 83 minutes with

a GP per head of population.

This compares with about 56 minutes per head in New

Zealand and about 30 minutes in the United States

during the same period.

What are GP’s doing?

BEACH

The extent to which this affects health outcomes

for the populations is as yet unclear. However,

considering this high use of general practice

care, information about the problems dealt with

and how they are managed by GPs is essential.

Improving health systems

2nd

1st

2nd

Improving health systems

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

2003-04 2004-05 2005-06 2006-07

Year

ED A

tten

danc

es

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

8,000,000

9,000,000

GP A

tten

danc

es

Metro ED WACHS ED GP Attendances

GP attendances

have remained relatively

stable, ED attendance

(metro) growing at 6.2% per annum)

Services per July 2006 - May 100,000 pop

GP Attendances

NSW 3122 913503 35315 100129

VIC 6486 847737 30505 88771

QLD 6441 797695 70608 69215

SA 15989 865701 34315 99613

WA 2396 731812 27213 71454

TAS 2566 819081 10082 83156

ACT 906 674357 7575 72351

NT 2123 452029 12704 34852

Average 5444 841939 38931 86814

GP Services

Rates of ED presentation by area of residence (2004/05)

0 – 150 presentations

per 1000 population

310 - 402 presentations

per 1000 population

Public hospital activity is growing faster than the population

WA: Population Growth

AVERAGE LENGTH of STAYBy AGE GROUP and SEX

SEPARATIONS per 1000 POPULATION

by USUAL RESIDENCE

• Malcolm (1994):

“the overriding problem of hospitals, as organisational entities, is that they

fragment the continuum of care, the delivery of integrated services which

should be inclusive of both hospital as well as community-based care”.

Secondary

Hospitals

Upstream Downstream

SEPARATIONS per 1000 POPULATION by INDIGENOUS STATUS and AGE GROUP

Indigenous Australians as

percentage of all population, by

region

• The major weakness evident in the Western Australian health system is a lack of integration across its component agencies.

• Planning has been isolated from clinical expertise and consequently implementation of plans and recommendations has been difficult

Deloitte Ross Tohmatsu 1991

London Healthcare

“A Framework for Action”

Clinical leadership.

The whole approach of this review has been to develop clinical support for our proposals. But it is easy to support principles for London, harder to support change in the hospital or locale where you work. Many clinicians understandably fear that change will affect their job satisfaction, their autonomy, their clinical reputation. To confront and assuage these fears, NHS London needs to indentify clinical champions to make the case for change.

Case study 2

What is evidence-based medicine is:What is evidence-based medicine is:

“Evidence-based medicine is the integration of best research evidence with clinical expertise and patient values”

- Sackett, et al 2001

Managing Disease

How well do we treat patients?

Between 16 to 50% of RBC transfusions in Australia may be inappropriate

“a failure of contemporary Australian transfusion practices to align with recommended best practice.”

Transfusion Variability in Austria

1,401 THR - patients transfused

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

15 12 13 16 9 3 1 7 2 11 4 6 5 8 14 10

Center No.

Huge inter-hospital variability of RBC transfusion rate for matched pts:16 – 84%

Gombotz H, Rehak P, Shander A, Hofmann A. Blood use in elective surgery: the Austrian benchmark

study. Accepted for publication February 14, 2007 in

Transfusion

AKH Linz Experience - Hip and Knee Replacement

0

10

20

30

40

50

60

70

80

90

100

1

% patients transfused

Baseline (2003)

Evaluation (2003)

Guidelines (2004)

Individual approach (2004-2005)

Plus preop treatment (2005)

Goal

Patient Blood

Management

AllogeneicTransfusion

Gombotz H. et al. Unpublished data.

Problems in Transfusion MedicineThe dramatially growing non-donating but blood using age cohort

The dramatially growing non-donating but blood using age cohort

The less growing donating age segment The less growing donating age segment

• Annual cost of the program• Total estimated annual savings

• Reduced product utilisation• Shorter hospital stays• Less work in transfusion laboratories• Less work in nursing units

• Enhanced patient satisfaction and safety

$1,800,000$14,950,000

Population 11.4 million (2001)

Freedman J, Luke K, Escobar M, et al. Experience of a network of transfusion coordinators for blood conservation(Ontario Transfusion Coordinators [ONTraC]). Transfusion 2007

60

98% 16% 22%0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Tra

nsfu

sio

n R

ate

in

Perc

en

t

1 2 3

Year

Perioperative Transfusion Rate (%) in Total Hip Replacement (Primary & Revision)

Fremantle Kaleeya Hospital

Perc

enta

ge

1989 1996 2002

The Blood Using Age Segment

<40yrs.40-69yrs.>70yrs. total0%

20%

40%

60%

80%1997 - 2006

1997 - 2016

Source: Compiled from WA Tomorrow

U/1,000

<40yrs. 40-69yrs. >70yrs.0

40

80

120

160

200

WA population growth until 2016 Transfused RBCs/1,000

Inhabitants

WA PublicHospitals

Unnecessary transfusion?

$340 per unit

A recent editorial in the New England Journal of Medicine (NEJM) estimated

that over $700 billion is wasted annually in the US health system. [i]

At first glance the statement seems extraordinary. By way of corroboration the

estimate in the NEJM is in line with an earlier estimate from the Health

Research Institute at PricewaterhouseCoopers published in their report, “The

price of excess – Identifying waste in health care spending” in which they

report a figure close to $1.2 trillion per year [ii].

Remarkably, this represents nearly 50% of the annual US expenditure on

healthcare!

[i] NEJM, 1……

[ii] PWC HRI ‘The price of excess”

Waste in healthcare spending

HEALTHPACT – Process

The business of health• Health is not just a “social good”• In Australia it is a business• There has been little work on the

interface between these two ideas• Different models exist• In WA, private operators provide

public health services• Australia is dependent upon

private sector in health.

The business of health

• Providing health care• Supporting policy and economic

review• Logistic development• Fostering innovation in

management• Working with providers on new

service models• Direct patient support• Improving clinician performance

Opportunities – reform is needed

• Enhancing patient and clinician participation

• Collecting and evaluating information

• Effective implementation

• Managing performance

• Adapting to the evidence

Key aims of policy and implementation

DATA is CENTRAL to this PROCESS!!

INFORMATION Management is Even More IMPORTANT

IMPLEMENTATION must be EVALUATED

Working in partnership

Improving health outcomes for WA

THANK YOU for YOUR ATTENTION

Dr Simon Towler Chief Medical Officer WA Department of Health

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