Hesse Rural Health 2012-2013 Annual Report

hesseRuralhealth

19th annualreport

2012 - 2013

Caring for Rural Communities

HESSE RURAL HEALTH8 Gosney Street Winchelsea 3241

(03) 5267 [email protected]

www.hesseruralhealth.org.au

Winchelsea HospitalChelsea Lodge HostelHesse Lodge Nursing HomeWerruna Dementia Unit8 Gosney StreetWinchelsea 3241

Bannockburn Primary Care2 Pope Street

Bannockburn 3331

MoriacCommunity Health

806 Hendy Main RoadMoriac 3240

Winchelsea Community Health12 Gosney StreetWinchelsea 3241

Beeac Community Health

Lang StreetBeeac 3251

LeighCommunity Health

Ferrars StreetRokewood 3330

Winchelsea Hospital Hesse Lodge Chelsea Lodge Werruna Winchelsea ADASS

Winchelsea Beeac Bannockburn Leigh Moriac Community Health Community Health Primary Care Community Health Community Health


8 Gosney StreetWinchelsea 3241(03) 5267 [email protected]

Winchelsea Adult Day Activity53 Hesse StreetWinchelsea 3241

Hesse Rural Health Service was formed in 1994 from the

amalgamation of Beeac and District Hospital, Leigh Community Care Centre and the Winchelsea and District Hospital.

Minister for Health: Hon. David Davis MPAuditors: Auditor General Victoria

Bankers: Bendigo Winchelsea & District Community BankSolicitors: Birdsey Dedman Bartlett

Since then Hesse has developed

into a key integrated rural healthcare

service within the three local

government areas of Surfcoast,

Colac Otway and Golden Plains.

A broad range of services include: Aged, Community and Residential, Acute Hospital, Urgent Care, Community Health, Health Promotion, Allied Health, Adult Day Activity, Occasional Childcare, Home Nursing and Palliative Care.

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OPERATIONS REPORTOrganisational Report page 2Board of Directors 4Organisational Structure 5Corporate and Clinical Governance 6Key Events 7A New Generation of Nursing in Aged Care 8The Business of Aged Care 9Introducing the Rural Nurse Practitioner 10Wellness Growing from Partnerships 11Letting Nursing Care Come to You 12It’s Whatever You Want it to Be 13Keeping Childcare in the Picture 15Leading in an Era of Change 16Keeping the Beeac Community Healthy 17Big Bucks Growing from Small Ones 18Promoting a Knowledge Environment 19Integrated Services in Action 21New Directions in Diabetes 22Hesse Holds the 2012 Melbourne Cup 23The Great Outdoors 24Supporters of Hesse 25Performance 26Statement of Priorities 28Compliance 30Services 76

Operations Report pages 1 - 32Quality Report pages 33 - 40Finance Report pages 41 - 76LE

GEND

Hesse Rural Health 19th Annual Report 2012 - 2013 2

Organisat ional Report

In 2008 we formulated an ambitious and comprehensive five year Strategic Plan. It covered 11 broad areas that included: establishing partnerships, participating in research, embedding the use of information technology, undertaking structural development, generating increased resources, ensuring workforce sustainability, service planning for integrated care, developing a dedicated child care service and increasing our brand awareness through an increased rural profile.

It is now time to evaluate the results and reset plans for the future. While some areas of the plan are still evolving, others were realised beyond initial expectations.

Werruna, our specialist residential dementia environment, continues to attract a steady stream of visitors both from within Australia and overseas. These have included Dr. Jane Melton, Director of Social Inclusion at 2Gether NHS Foundation Trust in the United Kingdom and Sue Pieters-Hawke, Co-Chair of the Federal Minister’s Dementia Advisory Group in association with Alzheimer’s Australia.

Hesse’s reputation for dementia care has grown from conference presentations, recognition in newsprint such as The Age and Weekly Times and publication in professional journals and books including Designing Outdoor Spaces for People with Dementia. Our work has also enabled us to commence research opportunities in conjunction with Deakin and LaTrobe Universities. This has all occurred in a year where the impact of dementia was fully recognised following its listing as the ninth National Health Priority Area.

The knowledge we have gained from paying close attention to the Aged Care Funding Instrument (ACFI) continues to be of great financial benefit to our organisation. It has additionally resulted in the opportunity for Hesse to host a Barwon South West regional project to improve the knowledge and application of ACFI in four Public Sector Residential Aged Care services. Stage one project findings were presented at the Looking Forward regional forum, and the project has now been extended until June 2014 with an expanded range of participating agencies and significant interest from other regions.

The direct care residential staff roster has seen major change during the year. One important outcome has been improved opportunities for clinical communication, and

education and training, which in turn will allow a smoother transition to the new National Health Standards.

Although we are moving towards greater use of information technology we have been unable to fully meet external expectations to participate in the establishment of electronic patient records and telehealth. Adequate network bandwidth has not been available to support these software platforms and has required the establishment of a wide area network tower on critical health service landspace. Unfortunately the use of IT has not delivered the expected cost savings from our regional IT alliance and instead costs continue to spiral. This is of grave concern to the Board in a period of tight budget constraint.

These increased costs are compounded in the immediate landscape due to the withdrawal of Commonwealth funds both through direct hospital grants and cut-backs applied to aged care funding. The implementation of the Commonwealth Living Longer Living Better aged reforms will see greater consumer choice through alternative cost structures and increase administrative hours. The impact of this is largely unknown.

The organisation operated to a pre-depreciation surplus of $354,428. This position was achieved with the full provision of services to meet our service plan and Statement of Priorities commitments as a small rural health service.

On a pleasing note, accreditation continues to be maintained following successful outcomes to the 2013 Aged Care Standards Agency unscheduled visit and 2012

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Our Mission StatementThe continued development of an integrated health and wellbeing service to the Hesse rural

community in a financially responsible and environmentally sustainable manner.

Australian Council on Healthcare Standards periodic survey. There was a small increase in HACC funding for increased occupational therapy in the Grampians region and high level dementia planned activity groups. A thorough review of HACC district nursing has increased statistical outputs and exceeded targets.

The Board take seriously their role in future planning. Attempts have been made to secure additional landspace and enable the service to develop to its full potential in a rural town designated for population growth. Unfortunately, Hesse’s attempt to achieve a dedicated long-day childcare facility for the Winchelsea community was unsuccessful following application to the Regional Development Australia Fund.

After a long nursing career, Lyn Batson has retired from her short term role as Director of Nursing. Janelle Hodgson has been appointed, and we welcome Janelle’s experience in acute and aged care in both rural and regional settings.

The Ladies Auxiliary continues to demonstrate whole hearted support for the health service and yield astounding financial results, in particular through their ‘Op Shop’ enterprise. We are grateful for the commitment of all

our volunteers in a year where we have provided more recognition and structure to their efforts.

There have been a number of changes around the Board table. Michelle Heagney unfortunately relinquished her Board position, having been elected as a councillor to the City of Greater Geelong. However we gained two new members, Hannah Cameron and David Dillon, whose professional skills are proving to be of value to Board deliberations.

At a recent Better Boards Conference, the Board Members and Management were reminded of the outcomes that can come from an effective team and that everyone within the organisation has a part to play.

The achievement of our strategic outcomes has been the result of hard work and is a credit to all: Board, Management and all sections of Staff.

John CarrPresident

Peter BirkettChief Executive


Board of Directors

PartnershipsResearch

Information TechnologyTeamwork

Structural DevelopmentResources

Workforce SustainabilityIntegrated Care

Service PlanningRural Profile

Noel StinchcombeFinancial Resources & Audit

Michelle HeagneyBSc, MBA, MAICDFinancial Resources & Audit to November 2012

Paul BentonDCR(R)(UK), GDMUFinancial Resources & Audit

Hannah CameronBA, LL.MQuality & Ethics

Rod HansonFinancial Resources & Audit, Medical

Donald LangQuality & Ethics

David DillonCPAFinancial Resources& Audit

David KellySenior Vice President:Quality & Ethics

John CarrPresident:Financial Resources & Audit, Medical

Keith LeighTreasurer:Financial Resources & Audit

BOARD OF DIRECTORS

CHIEF EXECUTIVE OFFICER

DIRECTOR OF NURSING

PRIMARY CARE MANAGER

CORPORATE SERVICES MANAGER

5

Peter Birkett MBA, BCom, RM, RN,

ACHSE, MAICD

Janelle HodgsonRN, FACN

Andrea Dunlop MHlthSc,

GDipHlthSc,BAppSc, (OT),

ACHSE, MIAMA

Annie Coles BNurs, DipCommServ(Childcare),

GDipNurs(Fam&ChildHealth),GDipMid

Organisat ional Structure

FinanceQuality & Ethics

Acute & Urgent Care Dementia Services Residential Aged Care Palliative CareRespite Services

Adult Day ActivityDieteticsAged Care PackagesPalliative CarePhysiotherapyDiabetes EducationRefugee Health

Occasional Child CareHealth PromotionHome & Community NursingHospital in the HomePodiatryOccupational TherapyDomicilary Midwifery

Human ResourcesBusiness ComplianceCommunity LiaisonProject DevelopmentConsumer ParticipationAdministration

Lynette Batson Director of Nursing

to September 2012

Kam BentonCommunity Health Manager

to April 2013


Corporate and Clinical GovernanceHesse Rural Health Board of Directors provides oversight to ensure the effective and efficient running of theorganisation. Through their guidance and leadership the Board of Directors strive to improve performance

through strategy formulation and policy making, forward planning, regulatory compliance, effective risk management, and the delivery of safe quality health care.

Terry Mulder, MP, Member for Polwarth, meets with John Carr, Keith Leigh and Rod Hanson at Hesse’s Winchelsea site.

Directorship Changes

Hannah Cameron joined the Board of Management in 2012 and serves on the Quality and Ethics Sub-Committee. Hannah brings valued experience to the Board through her professional legal background, in the particular fields of corporate management, insurance, medical malpractice, worker’s compensation and personal litigation.

David Dillon was also welcomed to the Board of Management in 2012 and serves on the Finance and Audit Sub-Committee. David is a Certified Practising Accountant, has expertise in commercial law and has previously been employed in the public healthcare sector. David has a strong interest in the economic development of communities, serving on many local government committees.

Michelle Heagney served on the Board of Management and on the Finance and Audit Sub-Committee from 2011 to 2012. Passionate about strengthening communities, she assisted in the pursuit of the Board’s strategic direction to secure long-day childcare for families in the Winchelsea Community. Michelle is now undertaking a role as a Councillor in local government.

Being Involved

Expressions of interest are welcome from professionals and community members who are willing to undertake a Board governance role and who are committed to sustaining local rural health care services.

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Sue Pieters-Hawke, Co-Chair of the Federal Ministers • Dementia Advisory Group and daughter of former First Lady Hazel Hawke visits Werruna

Hesse hosts • ‘Arts and Conversations – Living with Dementia and Memory Loss’, exhibition by regional artists in January

Australian Council on Health Care Standards successful • periodic review; accreditation maintained until 2015

Hesse selected as one of two Barwon South West regional • participants in a wound management research study

Janelle Hodgson appointed as Director of Nursing•

Additional HACC funding to provide day respite services for • people living with dementia

Construction of a Geelong Community Foundation funded • Gazebo for resident enjoyment of Werruna’s outdoor spaces

Werruna outdoor farming environment feature article in • The Age newspaper to promote Designing Outdoor Spaces for People with Dementia, a Hammondcare and University of Stirling publication

International visitation from Dr. Jane Melton, Director • of Social Inclusion 2Gether NHS UK, presenting Social Inclusion and Client Centred Practice

Co-presentation with LaTrobe University to • 15th Alzheimer’s Australia Conference, Hobart 2013, on the international survey results and web based developments for the Gateway for Rural International Initiatives in Dementia (GRIID) consortium

Successful implementation of a new direct care staffing roster • providing additional time for education and quality activities

Hesse’s success and expansion since inception featured at the • National Rural Health Alliance Conference, Adelaide 2013

Successful outcome to the Aged Care Standards Agency • unscheduled visit in January

Hesse undertakes Stage 1 of Department of Health Barwon • South West regional project on Management of Residential Aged Care Business in Public Sector Residential Aged Care

Key EventsHesse hosts • Looking Forward forum with Barwon South West regional Department of Health exploring the efficient application of business rules to optimise Commonwealth Aged Care Funding Instrument (ACFI) entitlement

Recruitment of an additional occupational therapist to further • develop models of meaningful engagement in a dementia environment

Presentation of Werruna’s dementia model to 2012 • Grampians HACC Forum and Alzheimer’s Victoria Leadership Seminar

One of four rural participants in a regional project • implementing the McKellar Guidelines as demonstrated best practice in diabetes management

One of three successful rural agencies, Hesse secured • $37,000 from the Victorian Government’s Department of Health to explore the development of a Nurse Practitioner model suitable for our small rural community

Presentation from Prof. David Edvardsson, University of • Umea and LaTrobe University on ‘Thriving in Residential Aged Care’

Hesse participates in the second Aged Care Graduate Nurse • Program delivered by Monash University and Leading Aged Services Australia (LASA)


Alice Cao may be a long way from her home in rural China, but she says there is something pleasantly

familiar about our local rural community that attracted her when she was deciding where to undertake her graduate nursing year.

Alice is participating in the 2013 Aged Care Graduate Nurse Program (ACGNP) delivered jointly by Leading Aged Services Australia (LASA) and Monash University. The program aims to support and mentor graduate nurses through their transition from student to clinical nurse. This is the second year Hesse has become a host provider, with Registered Nurse (RN) Emma Coverdale successfully completing her graduate year in February.

Throughout her Bachelor of Nursing studies at RMIT Alice says the focus was on a broad range of acute health conditions. In contrast, the ACGNP gives greater attention to age related chronic diseases, complex co-morbidities including diabetes, wound care, cardiovascular disease and dementia.

For Hesse, the program offers an opportunity to attract the next generation of the nursing workforce passionate about aged care. The training offered for RNs to function in the role of host preceptor to support the trainees is also of benefit to the organisation.

Highlights of the program have been the focus on the engagement with families, which Alice can relate to on a personal level as she is so far from her own family. She says that ‘the nurse can play a vital role in ensuring families are well informed and remain involved, which is critical to the quality of life and wellbeing of their loved one.’

Overcoming the communication barrier with English as her second language and having the confidence to talk with doctors have been particular challenges. Alice wishes to lead some change in a more comprehensive, person centred clinical handover process, which will become an area of quality focus for the organisation.

A NewGenerat ion

of Nurs ing inAged Care

9

Aged Care has followed an action learning model. Project Officer Miranda Gretgrix has used a ground-up process to assist four regional PSRACS to make systematic improvement in the application of the ACFI tool.

Along with the Department of Health, Hesse hosted the regional Looking Forward forum in July where CEO Peter Birkett told the audience that while agencies are comfortable discussing care, the notion of money is like the ‘elephant in the room.’ He says, ‘Quality aged care services are not only about expenditure, they are also about revenue. We must be expert in the evaluation and application of the business systems that support the aged care sector. It is an act of balance.’

The success of the Project has lead to an extension into Phase 2, with more agencies involved and the project being replicated in other regions of Victoria.

Ach iev ing an Ac t o f Ba lance

State Public Sector Residential Aged Care Services (PSRACS) play a vital role in providing care

options for people living in small rural communities like Winchelsea. However, delivering a range of health services and programs is a challenging business, and in 2010 Hesse was struggling to generate the income it was entitled to following the implementation of the new Aged Care Funding Instrument (ACFI) business rules.

An incidental meeting with a private aged care provider challenged Hesse to look at things differently. Using a business perspective and embarking on a period of major change the organisation was appropriately rewarded for its efforts. Revenue increased and it was used for much needed improvements such as funding new buses, programs, equipment, education and roster changes.

Our business approach resulted in a grant from the Victorian Government’s Department of Health for Hesse to develop a project to assist other public sector agencies in the Barwon South West Region (BSW) with their implementation of ACFI. The 2012 BSW regional project on Management of Residential Aged Care Business in Public Sector Residential

The Business ofAged Care


Receiving timely and accessible medical care is one of the challenges of living in the country. Research

demonstrates that the more remotely people live, the worse their health outcomes.

In a bid to improve healthcare access for our local community, Hesse Rural Health made a successful application to the Victorian Department of Health Nurse Practitioner Project (VNPP) Open Funding Round. Hesse received $37,000 to support the model development of a Nurse Practitioner (NP) for an integrated rural health service. Hesse was one of three rural projects of the eight selected from across Victoria.

A Nurse Practitioner is a registered nurse who is endorsed to undertake a high level of comprehensive health care assessment and may diagnose, investigate, treat and prescribe medication within a defined scope of practice. It is the highest clinical qualification to which a nurse may attain.

The Small Rural Health Service – Nurse Practitioner Model is aligned to key government health care policies and strategies including the Living Longer Living Better reforms, the Active Service Model of community based care and person focused models of care.

Kam Benton is Hesse’s Nurse Practitioner Project Officer and has recently been appointed as the Nurse Practitioner Candidate, undertaking a Master of Advanced Nursing Practice at the University of Melbourne with the assistance of a scholarship from the Australian College of Nursing. Kam says, ‘The Nurse Practitioner is an ideal adjunct to a small integrated rural health service such as Hesse, where working in collaboration with local GPs can fill gaps in medical services and provide equity in health care.’

Throughout her candidacy Kam is being mentored by Nurse Practitioners in both primary and aged care at Bass Coast Community Health Centre and Northeast Health Wangaratta. The model development for the project is overseen by the Quality Improvement and Ethics Committee to ensure the project remains aligned with organisational objectives.

Introducing

the Rural Nurse

Practitioner

11

Football and Netball Club continue to make meals available at reduced member prices; the Lions Club offers volunteer drivers, and Hesse provides overall program coordination support and other resources.

The program was the brain child of local community member and former Hesse employee Michelle Stocks, who recognised that her own father was becoming isolated at home and missing out on important community life.

Bus to the Hub is just one of the programs that focuses on social connection as a priority area within Hesse’s Health Promotion Plan. Contemporary health promotion practice recognises that good health is not achieved by education alone but relies on overcoming the multitude of other barriers that individuals face at various stages of their life span. To achieve sustainable health change the community health promotion practitioner must look to others for help, and Bus to the Hub does just that.

The Strong Fabric of Rural Communities

It is well known that as people age and are less active their physical health and also their social and emotional

wellbeing are at risk because of the isolation that may follow. However, an innovative program instigated by the Working With Winchelsea collaboration has made an important difference to the lives of many older people living locally.

The program, colloquially known as Bus to the Hub, offers local people with limited social access or reduced mobility the chance to meet once a week for a meal and a chat at the local footy club.

Hesse Rural Health Community Health Manager Annie Coles has been an active participant in the Working With Winchelsea collaboration and is one of the key coordinators of the Bus to the Hub program. Annie says, ‘Missing out on regular contact with the community can have serious consequences for the health of the older person. In the initial weeks the bus collected five people and there are now up to 24 people regularly attending.’ The success of this initiative is attributable to home grown partnerships. The Bendigo Winchelsea Community Bank provided financial assistance to make the first meal free; the

Wellness Growing FromPartnerships


Working in the rural area has its challenges, rewards and the unexpected, so says Hesse Rural Health

District Nurse Julie Kerry. Following the principles of the Active Service Model, home based nursing services aim to keep clients challenged by acute or chronic health issues living independently. And in so doing the unusual sometimes occurs.

Julie describes once arriving at a house to find the client distressed due to the chooks escaping over the chicken coop and into the immaculately maintained garden. The woman’s recovery could have been compromised without some innovative thinking. So to encourage her to rest her lower leg following a surgical procedure, Julie, no stranger to rural farming life, taught the woman how to clip the chooks’ wings to prevent them from escaping. All in a day’s work for a rural nurse.

Funded through the Home and Community Care (HACC) Program, Hesse offers home nursing services throughout the catchment area seven days per week, operating from offices based in Winchelsea, Rokewood and Bannockburn. In one day our district nursing service can visit up to 30 people and travel more than 400 kilometres; over a year the nurses travel an astounding 144,000 country kilometres.

The nursing services include medication administration, wound management, continence management, personal care, post-acute care, and hospital-in-the-home. Liaison with and referral to other primary care service providers such as GPs is an integral part of the role to ensure clients receive comprehensive holistic care.

A current home nursing client, who receives a fortnightly injection to manage a degenerative condition, describes the service as ‘enabling’, without the disruption that centre based appointments might otherwise bring. However, when asked about the value of the nurses, most clients are unanimous in their response. ‘I would be lost without them.’Lett ing Nurs ing

Care Come

to You

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A bit like a service club, volunteering to make a difference to the community ...

A bit like a neighbourhood house, a place to learn new skills ...

A bit like a rehabilitation centre, restoring good health and promoting independence ...

A bit like a party, everyone talking at once ...

A bit like a respite centre, where families can get a break ...

A bit like a country pub, with freshly cooked meals, friendly faces and very cheap ...

A bit like home, one big family who care …

It’s Whatever You Make It

Difficult to define but highly regarded, Winchelsea ADASS is a HACC funded Planned Activity Group

providing supportive care, activities and socialisation opportunities for frail aged community members.

So how does the ADASS community describe it?

A bit like a social club, where people can meet each other …

A bit like Probus, interesting talks and presentations from community groups …

A bit like a holiday, outings to interesting places …

A bit like a guild, people doing interesting craft activities …

A bit like a concert, with music, singing and sometimes dancing too …

A bit like Senior Citizens Clubs, card games and scrabble ...

I t ’s Whatever YouWant i t to Be


Hesse continues to

strive for the addition

of long-day childcare

in Winchelsea.

15

In a small community such as Rokewood, with a population of only 250 and fewer options for informal care, the value of an occasional child care service takes on great significance. Despite the withdrawal of ‘Take a Break’ funding in 2011, Hesse has continued to support the much needed program through the flexibility offered by their small rural health service funding.

Program Coordinator Karren Smith sees the service not simply as child minding, but as a vital health and wellbeing program for a local community. She says ‘parents must be supported if they are to function effectively in their role, and providing them with a few hours to themselves can be just what they need.’

Along with the current successful facilitated playgroup in Beeac and Occasional Childcare in Rokewood, Hesse is seeking to establish children’s services in Winchelsea. Despite an unsuccessful funding bid to the Regional Development Australia Fund in December 2012, we are striving for the addition of long-day childcare for the Winchelsea community. Hesse will continue to work with business and community leaders to create this important rural initiative.

Promoting the Health ofFamilies and Communities

Every parent understands that as much as they enjoy being with their toddlers, they need some time for

themselves too. Time for shopping, attending appointments, catching up with friends or simply recharging their own batteries. Such is the value of occasional child care.

However, the value of the service is not weighted solely in favour of exhausted parents. The children get to socialise and interact with other children, learn important skills focusing on their own physical, cognitive, social and emotional development, and of course have plenty of fun too.

Rokewood Occasional Childcare operates weekly on a Wednesday during the school term for five hours between 9.30am and 2.30pm, sharing its location with the Golden Plains Shire operated Rokewood Kindergarten. Catering for children aged up to five years, the program is licensed to accommodate a maximum of 15 children. The average attendance is ten and there is currently a waiting list for children aged under three years.

Sand play, painting and playdough are some of the children’s favorite activities. However, this year they have also enjoyed water play, making Easter buns, conducting basic scientific experiments and designing the outdoor train track.

Keeping Chi ldcare in the Picture


People with severe dementia can live well if they are treated with kindness and respect, says Hesse Rural

Health Director of Nursing Janelle Hodgson.

Janelle was appointed to the executive leadership role in October 2012 and brings extensive experience from the residential aged care not-for-profit sector as well as senior management roles in rural health services. She is particularly passionate about delivering quality services and is a firm believer in ensuring the patient is central to their care. ‘Many of the things that we do in health care are unnecessarily worker oriented, but we need to turn that around and instead consider the care we provide from the patient’s perspective.’

In fact, this was one of the reasons she was attracted to work at Hesse. ‘I could see evidence of this philosophy already existing within the organisation, particularly within the Werruna dementia environment, and I wanted to develop this further, through empirical research and other initiatives.’

Janelle sees the dichotomy between dependence and independence, suggesting it is sometimes difficult to create capacity for the older person to do things independently when as nurses we are bound by a duty of care to minimise risk. ‘A safe care environment can be sometimes quite disempowering and disabling in itself. The challenge is to assist with the harder tasks to allow the older person the freedom, independence and energy for the things that define their personhood.’

Among her achievements to date she lists implementing contemporary practices relating to palliative care, improving clinical assessment and communication and establishing a new direct care roster that is equitable and meets industrial obligations. Janelle is also a strong believer in personal and professional development being the key to employee growth. Seeing people create something of value and flourish in their own environment drives her work ethos and provides her the most satisfaction.

Leading in an

Era of Change

17

Community Health Centre on Thursdays, she has attended preventative health screening such as hearing, skin-checkand breast screen programs. In fact she credits the screening program for the early detection and successful treatment of her own breast cancer. ‘If I hadn’t been on that bus four years ago, I may not be here today.’

Beeac Community Health Centre also has plenty to offer the health education and developmental needs of children. As toddlers, Alice’s grandchildren have benefitted from the weekly Facilitated Play Group and have also participated in the Farm Safety and Personal Development program currently delivered by Community Health Nurse Karen O’Loughlin at the Beeac Primary School.

Alice says the Beeac Community Health Nurse is integral to the success of the Centre and is a key source of health related information, making sure everyone in the area is made well aware of the great programs on offer.

Serving the Health Needs of the Community

The small rural farming township of Beeac, some 17km from regional city Colac, has seen distinct periods of

both population growth and decline during its 152 years. With new housing under construction, Beeac is growing once again as younger families identify the township, with its quaint rural feel, as an attractive place to live.

Alice Aisbett, aged 77 years, has lived in Beeac most of her life and understands the important role of social and community connection for personal health and wellbeing. An establishment like the Beeac Community Health Centre, she says, is pivotal to that. Alice is a regular participant at the twice weekly Planned Activity Group, aiming to foster the social, intellectual and physical health of older people. She is a founding member of the Nesters Group, offering support to parents when their children have ‘flown the coop,’ and also occasionally attends the Centre’s weekly shopping trips to Colac.

On the first Saturday of the month she attends the ‘Eat, Meet and Greet’ at the Farmers Arms Hotel, a Hesse supported program aiming to improve social connectedness throughout the broader community. Whilst Alice does not require the services of the Medical Clinic operating from the

Keeping the Beeac Community Healthy


Should you need to get spruced up for a special shindig and are a little short of a buck, there is word around the

traps that the gals at Winch can deck you out.

The Winchelsea Hospital Ladies Auxiliary is harnessing quite a reputation for their ‘Op Shop,’ with people coming from miles around to sift through the wares and grab a bargain. The word is it is ‘THE PLACE’ to go for baby clothes. A formal suit, complete with shirt, tie and shoes (and probably socks and jocks too if you are game!) can set you back less than $20. If you are looking for a special something they will even keep an eye out and give you a call if that elusive item comes in.

The local community has been very generous with donations of used clothing, furniture, books, music, manchester, household wares and bric a brac. Entire household estates are frequently donated and the Lions Club have rallied to collect and deliver the goods.

In the selling frenzy the ladies need to keep a careful eye on their own possessions. So keen for a sale, one of the ladies cut the buttons of her colleague’s own cardigan and the brand new ‘Op Shop’ outdoor mat was also accidentally sold for a couple of dollars.

The ‘Op Shop,’ in operation since January 2011, is the major fundraising initiative of the Auxiliary. It has now raised in excess of $160,000 and these funds will be donated to Hesse Rural Health to support the childcare project.

Amazingly, the Auxiliary still manage to find time to support their broader community through the provision of emergency and disaster relief by baking for the recent flood and bushfire appeals.

Big Bucks

Growing from

Smal l Ones

19

30 first year OT students were oriented to the application of occupational therapy within a rural integrated health service.

Working with Deakin, Hesse provided fieldwork support for the Policy for Advocacy unit in the Bachelor of Health Science Program. Students researched an issue for policy and advocacy action of relevance to our small rural environment. The conflicting dependency versus independency promoting models of care in residential and community based programs was identified by the students as an opportunity to consider funding streams that support the social and emotional health of aged residents.

In the wider forum Hesse also continued to impart knowledge at a number of conferences including the 15th Alzheimer’s Australia Conference, Hobart; National Rural Health Alliance, Adelaide; Alzheimer’s Australia Vic., Melbourne and the Grampian’s Region HACC Best Practice Forum, Halls Gap. The presentations showcased Hesse’s expertise in dementia environments, discussed a web based repository on international dementia initiatives and reflected on our successful long term organisational growth as a national example for ‘bright futures in rural health.’

Hesse values ongoing professional learning, and this year created a dedicated learning environment,

engaged speakers, supported student education and shared our expertise with others on the national stage.

The redevelopment of the Winchelsea Community Health gymnasium created a fully equipped Seminar Room that accommodates up to 40 people with audio visual facilities. In addition to a regional Dementia Art Exhibition, the venue has now hosted two international speakers. Dr. Jane Melton from the United Kingdom discussed the importance of social inclusion for health and wellbeing and Professor David Edvardsson from University of Umea, Sweden and LaTrobe University promoted his research on thriving in aged residential care. These speakers formed a part of the Hesse 2013 Seminar Series and introduced intra-regional networking and learning opportunities.

Hesse also continues to partner with Deakin University to support undergraduate clinical learning. The Occupational Wellness and Life Skills (OWLS) program for third and fourth year occupational therapy (OT) students is in its fourth year, and 29 students have now gained valuable knowledge of dementia through clinical placement in Hesse’s specialist residential environment. In addition,

Promoting a Knowledge Environment


Seamless and flexibleservice delivery with

great outcomes...

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for Angelo in his rural environment; unfortunately a scenario all too common in the country area.

Hesse found the solution and was able to provide individualised care that included home support, facilitated shopping and social engagement. He was also referred to our local Planned Activity Group, providing Maria with respite one day per week. Angelo’s progressing memory loss meant service provision was time intensive and required the use of interpreters.

As time passed, the couple’s ability to remain living safely at home decreased and Maria was no longer able to manage alone. Angelo was provided with an admission to Hesse’s acute public hospital until a residential bed was available. Angelo is now well settled in the Werruna dementia specific environment with care being provided by familiar staff who work across the service, assisting him to make his transition to residential care a smooth one. Maria plans to be soon living alongside him in nearby Chelsea Lodge.

Flexibility in our small rural funding model provided the additional resources necessary to overcome the barriers to family focused care. Hesse was able to support both Maria and Angelo with the services that they needed as they aged together in their community.

Navigating the complexity of the service system can be a confusing business for the healthcare consumer.

As a smaller health service with a variety of programs and services and an integrated staffing structure, Hesse is well placed to offer consumers a supported and seamless experience with better health outcomes.

Angelo and Maria in their ageing years were new to the community, possessed little spoken English and were without family support. Angelo was becoming increasingly frail, and whilst at the Senior Citizens Club was invited by the occupational therapist to join an exercise group to maintain his strength and fitness and reduce the risk of falls. Maria had also noticed that Angelo’s increasing memory loss was making living at home difficult.

The community nursing team helped the couple to undertake an Aged Care Assessment. Angelo was assessed to be eligible for a Commonwealth funded Extended Aged Care at Home Dementia package of care (EACH-D) and Maria for a standard Community Aged Care Package (CACP).

To respond to Angelo’s needs Hesse unsuccessfully attempted to upgrade an existing CACP to an EACH-D package with the Commonwealth. Due to the distance involved, other agencies were unwilling to provide services

Integrated Servicesin Action


New Direct ions

in Diabetes

Diabetes is one of Australia’s most challenging health problems and it is the most common chronic condition

affecting the older person. Health outcomes can often be compounded for people living in residential aged care facilities due to impaired mobility, decreased level of independence, fewer social supports and other existing health conditions.

So Hesse Rural Health welcomed the opportunity to participate, along with three other rural aged care facilities in Victoria, in an innovative 2013 research project to better identify and manage the condition.

The McKellar Guidelines for Managing Diabetes in Small Rural Residential Aged Care Facilities Project run jointly by Barwon Health and Deakin University, aims to implement a set of best practice guidelines to improve the management of diabetes for aged residents and to educate nursing staff in their application.

Student nurse Christopher Blackman is the Project Champion for Hesse and is supported by Barwon Health Researcher Nicole Duggan. Chris is excited by what the project can offer our residents. Through his undergraduate studies and work as a personal carer he had observed opportunities for improved routine monitoring of blood sugar levels and identified gaps in the knowledge base of staff. ‘Aside from the opportunity for more detailed education regarding diabetes, we have also been able to develop a number of new risk identification and monitoring tools to incorporate in our usual suite of assessments.’

The program is of benefit to the treating doctors, who can use the screening evidence to form the basis of a diabetes diagnosis. In addition to the nine known Hesse aged residents with diabetes, as a result of the project’s new assessment tools 21 have now been screened and a further two confirmed.

Christopher, who completes his Bachelor of Nursing training at the end of the year, has been so motivated by his involvement in this project that he is now considering developing a career in nursing research.

23

The Cup was accompanied by special guests, including former jockey Bob Skelton and race commentator John Russell, who entertained and engaged residents with anecdotes from their racing days. Bob told of his thrill of winning the 1976 Melbourne Cup on Van Der Hum in one of the wettest conditions in race day history. His story sparked much reminiscence for residents reflecting on their own Cup Day memories.

Residents, staff, families and visitors wore protective gloves to have their photographs taken holding the Cup. But with the ‘special protection forces’ watching closely there was no chance of getting away with the gold.

An Active Environment

The lifestyle program at Hesse allows aged residents to stay active, maintain existing interests and social

networks and remain connected to their community. However, for residents too frail to leave the facility, the community sometimes must come to them.

One of the highlights over the last twelve months was the opportunity for residents to get a close-up glimpse of the one and only Melbourne Cup trophy as it toured the state in the lead-up to the big race day in November. The visit to Winchelsea was chosen in recognition of the 1863 Melbourne Cup Winner, Banker, bred locally by Thomas Austin.

In the dining room, adorned with racing memorabilia and jockey silks lining the walls, the Victorian Racing Club (VRC) representative explained that Thomas Austin of Barwon Park, a founding member of the VRC, was known as the ‘Father of the Turf’ and was part of the committee which decided that 1st August would be declared the birthday ofall horses.’

Hesse Holds the 2012Melbourne Cup


Werruna, Hesse’s dementia-specific environment, continues to spark interest from all corners of the

globe with a constant stream of regional, interstate and international visitors eager to understand the key elements of its success.

Of particular interest has been the outdoor environment following its feature in Designing Outdoor Spaces for People with Dementia, edited by Annie Pollock and Mary Marshall, a joint publication by University of Stirling and Hammondcare. The Age newspaper columnist Denise Gadd described Werruna as having ‘all the hallmarks of a farming community in an idyllic rural setting.’

Thanks to the financial assistance of the Geelong Community Foundation, that outdoor idyllic setting can now be more readily appreciated by residents and families all year round following the construction of a gazebo with seated areas and glass panels offering protection from the elements.

Hesse was honoured to host Sue Pieters-Hawke, daughter of former first lady Hazel Hawke, who contacted Alzheimer’s Australia to request a personalised tour. Pieters-Hawke later told a regional Victorian dementia forum ‘Werruna was among the best dementia care environments she had seen.’

There is also plenty going on inside the ten bed unit, which is in high demand and operates with a waiting list. Residents have participated in Acabellas, a meaningful and engaging singing and music program, experimented with technology through the use of iPods and iPads and rekindled former abilities cooking delicious treats with Deakin University Occupational Therapy students.

Hesse has also been a champion for greater community understanding and awareness of the dementia condition through its January exhibition ‘Memory, Arts and Conversations - Living with Dementia and Memory Loss.’ The display ran for two weeks and featured art works by regional artists all touched in some way by dementia.

The Great

Outdoors

25

Supporters ofHesse

Hesse benefits from a significant amount of community involvement across the catchment. Contributions come in the form of time, goods and

cash from people eager to make a difference and keep our valued services going ahead. Regardless of the type, each is highly valued and represents a clear expression of the community commitment to the organisation.

Financial donations totalled $24,800 for the year, and while this is less than in previous years it is apparent that people are still eager to make a difference wherever they can. Whether it be some spare change in the donation tin at the local chemist, a tax deductible cheque, a bequest or funds directed to the health service in lieu of flowers at a funeral, all such sums benefit the delivery of a quality service.

Donations of gifts and equipment are also highly appreciated and this year have included pedometers, books, craft supplies, plants, artworks and a stereo system.

Hesse has 39 registered volunteers who willingly provide their time to ensure our programs and services are delivered to the highest standards, whether that be volunteering to cook the barbeque for breakfast club, friendly visits to residents, assisting with activities and outings or using musical talents to entertain. With improvements in the coordination of volunteers, the range of possibilities is likely to expand. A new direction will be to train interested volunteers willing to work with people with dementia. This will make an important difference to residents who thrive with interaction.

The number of volunteers swells to 78 if you count in the 39 members of the Ladies Auxiliary, whose dedicated activities are specifically for the purpose of fundraising. The achievements of the Auxiliary, predominantly but not solely including the ‘Op Shop,’ are a superb feat for a group whose membership is ageing. This year the Auxiliary donated $5,000 to support new resident initiatives. In addition, they have now amassed $160,000 for the specific purpose of contributing to a much needed long-day childcare service for Winchelsea.

The Auxiliary have also functioned in the role of a community advisory committee, providing comment and feedback on programs, service initiatives and consumer focussed publications. Such community and consumer participation will expand as Hesse formalises arrangements under the new national health standards.

Last, but by no means least, the Board of Management are tireless in providing their time, expertise and consideration while undertaking the governance function which ensures our organisation is the success that it is.

Aitkin PartnersAllen KBloggs MGeelong Magistrates CourtGeelong CommunityFoundationGregory MHiggins L & FHolmes CHughes THunter MInverleigh Golf ClubJohns G & JJohnson RLake MLang D & JLeigh RMcCallum MMunro CMurfitt LRepertory SocietyRowley DSalmon AWard AWhittaker WWinchelsea Girl GuidesWinchelsea HouseWinchelsea Ladies AuxWinchelsea Lions ClubWinchelsea PharmacyWinchelsea Primary SchoolWitcombe R


Performance

SEPARATIONS 2013 2012 2011 2010 2009Acute 56 43 40 49 13Non-Acute 3 2 2 1 0Same Day 3 1 2 4 0Total Hospital Separations 62 46 44 54 13

WEIS 113 81 64 45 13Aged Care (consolidated) 56 50 38 50 20

PATIENT DAYSAcute 796 496 457 315 116Non-Acute 207 253 358 205 69Same Day 3 1 2 4 0Total Hospital Patient Days 1,006 750 817 524 185

Aged Care (consolidated) 19,417 19,287 19,401 17,633 15,218

ADMITTED PATIENTS

2013 2012 2013 2012 2011 2010 2009Nursing 29.40 26.87 27.09 24.70 23.17 24.23 25.40

Medical Support 0.00 0.00 0.00 0.00 0.00 1.00 1.00

Administration 8.05 9.37 9.35 9.82 9.73 8.21 10.55

Hotel & Allied 33.70 31.10 32.72 28.96 28.19 23.09 21.21

Ancillary (Allied) 0.84 0.93 0.88 1.31 1.48 1.54 1.49

TOTAL 71.99 68.27 70.04 64.79 62.57 58.07 59.65

Hesse has now reached 130 employees, and 78 service and fundraising volunteers. Of these, 83% live inside the service catchment.

70 & over14%

CommunityAge Profile

25 to 4931%

50 to 6927%12 to 24

15%

0 to 1113%

WORKFORCE STATISTICSJune Current Month June Year to Date

2013 2012 2011 2010 2009Emergency MedicalTreatment

216 167 201 248 357

HACC (District Nursing, Allied Health, PAG)

19,567 17,090 16,691 17,183 17,727

Hesse’s aged care bed occupancy remains at 96.75% with an active

waiting list.

NON-ADMITTED PATIENTS

Data from profile.id.com

27

Performance

2013 2012 2011 2010 2009Total Expenses 9,805,155 8,902,974 7,842,599 7,677,823 6,473,141Total Revenue 9,539,908 8,845,720 7,323,706 7,285,532 7,486,944Operating Surplus (deficit) (265,247) (57,254) (518,893) (392,291) 1,013,803Retained Earnings (accumulated losses) 2,918,860 3,184,107 3,241,361 3,760,254 4,152,545Total Assets 14,756,484 14,981,155 15,834,386 15,209,130 15,063,483Total Liabilities 5,350,805 5,310,229 6,106,206 4,962,057 4,424,119Net Assets 9,405,679 9,670,926 9,728,180 10,247,073 10,639,364Total Equity 9,405,679 9,670,926 9,728,180 10,247,073 10,639,364

FINANCIAL SUMMARY(Refer to consolidated Financial Statements for details.)

Mandated IT costs have risen to 5% of the health

service budget.5%

KPI - Quality & Safety Target 2013 ActualsHealth service accreditation Full compliance AchievedResidential aged care accreditation Full compliance AchievedCleaning standards Full compliance AchievedSubmission of data to VICNISS Full compliance AchievedHospital acquired infection surveillance No Outliers AchievedHand Hygiene Program rate 70 79Victorian Patient Satisfaction Monitor: (OCI) 73 Not ApplicableConsumer Participation Indicator 75 Not Applicable

SERVICE PERFORMANCE

Net Operating Result 2013 Actuals TargetBefore Capital & Specific Items $354,428 $252,121Comprehensive Result ($265,247) ($408,383)

Cash Management 2013 Actuals TargetCreditors 12 < 60 daysDebtors 7 < 60 days

FINANCIAL PERFORMANCE REVENUE BY AREA

AdmittedPatients

ResidentialAged Care

Home &Community

Care

PrimaryHealth

Other

5m

4m

3m

2m

1m

0m


Priority Action Deliverable OutcomeDeveloping a system that is responsive to people’s needs.

Explore opportunities to develop strategies that support greater service responsiveness for diverse populations.

Conduct a formal communityconsultation throughout the Hesse Rural Health catchment to facilitate improved community information and expression of consumer need.

Use information gained from community consultation in the development of a Strategic Plan from 2013 – 2017.

Planning and initial community consultation commenced in 2013.

Strategic Plan 2013-2017 development scheduled following completion of community consultations.

Improving every Victorian’s health status and experiences.

Consider new models of care and more coordinated services to respond to the specific needs of people with priority clinical conditions.

Engage with Barwon MedicareLocal to identify new opportunities for service provision for people with chronic disease that do not duplicate primary care services in existence.

Action has been completed through the successful application for funding from Dept. of Health VNPP Open Funding Round 4.11 to support development of Nurse Practitioner Models. Hesse was one of 8 Projects selected across the state.

Hesse will undertake a project to identify an effective and sustainable Nurse Practitioner Model suitable for implementation within an integrated small rural health and aged care context.

Nurse practitioner candidate appointed with a Commonwealth Scholarship from College of Nursing and studies commenced with Melbourne University.

Hesse Rural Health representation on Barwon Medicare Local Aged Reference Group.

Expanding service, workforce and system capacity.

Identify opportunities to address workforce gaps by optimising workforce capability and capacity, and exploring alternative workforce models.

Develop the 2012-2014 Hesse Rural Health Human Resource Plan in line with review of existing HR plan and ensure it meets organisational workforce objectives and is in line with the 2012-2016 Strategic Plan.

Following the 2012 appointment of a Volunteer Coordinator, implement the HRHS Volunteer’s workforce management plan ensuring sustainability of community programs.

Human Resource Plan 2012 - 2014 has been formulated and 53% of items actioned to date.

Volunteer Coordinator appointed July 2012. Opportunities for sustainable community programs being explored.

Statement of PrioritiesThe Statement of Priorities is a key document of accountability between the Department of Health and Hesse Rural Health as asmall rural public health service. This agreement identifies how Hesse has contributed to the achievement of the government’s

seven key priorities in 2012-2013 through the following actions, deliverables and outcomes.

29

Priority Action Deliverable OutcomeIncreasing the system’s financial sustainability and productivity.

Identify opportunities for efficiency and better value service delivery.

Examine and reduce variations in administrative overheads.

To further advance the understanding of the Aged Care Funding Instrument (ACFI) for improved aged care business accountability through hosting of Regional ACFI Project.

Explore a transition of Hesse Rural Health banking from the State Government directed Westpac Higher Yield requirement to a better investment outcome.

Phase 1 of BSW Regional Project on Public Sector Residential Aged Care Business successfully completed with positive outcomes showcased at regional Looking Forward Forum in July 2013. Further funding obtained from the Department of Health to expand project with other BSW PSRACS participants until June 2014. Inter regional networking commenced and common data set proposed across regional projects.

Transferring of funds has now been influenced by improved competition in Hesse’s selected banking options.

Implementing continuous improvements and innovation.

Develop and implement improvement strategies that better support patient flow and the quality and safety of hospital services.

To evaluate patient and resident transfer into our local tertiary referral hospital to ensure all clinical needs are met and are patient centred by December 2012.

Executive Nursing Director seconded to Barwon Health for two weeks in September 2013 to establish improved tertiary referral linkages and networking.

Increasing accountability & transparency.

Implement systems that support streamlined approaches to clinical governance at all levels of the organisation.

Educate all levels of staff on individual responsibilities in risk management through attendance at a whole of staff forum by June 2013.

Commence the use of a care development room to facilitate better involvement with families in the development of care pathways.

Successfully embedded the concept of risk management as part of routine clinical practice. Reviewing and trending risk outcomes within regular work group meetings.

Care Development Room constructed and utilised by clinical staff for family and carer involvement in care planning.

Improving utilisation of e-health and communications technology.

Maximise the use of health ICT infrastructure to better connect a broad range of health care and other health – related workforces.

Work with partners to better connect service providers and deliver appropriate and timely services to rural and regional Victorians.

Embed the use of ICT for specialist services in aged care.

In line with sub-regional planning outcomes, to commence work with Barwon Health to achieve video conferencing as support for emergency presentations requiring stabilisation and transfer by June 2013.

Inadequate band width to support ICT infrastructure in the Hesse catchment area. Deliverable unable to be actioned.

Local GPs supplied with necessary hardware to support video conferencing but stalled due to lack of ICT infrastructure.


Hesse Rural Health Service (HRH) has a statutory obligation to report legislative compliance status on a range of matters.

Board FunctionsThe Directors contribute to the governance of HRH collectively through attendance at meetings. Individual contribution occurs through participation in, or chairmanship of, the various committees of the Board.

The Board has established a number of sub-committees which are also attended by members of the HRH management team. The President is an ex-officio of each committee.

Payment of Board MembersIn accordance with the Health Services Act, Board Members of rural hospitals are not eligible for payment or sitting fees, but may be reimbursed for expenses incurred as a member of the Board.

Pecuniary InterestBoard Members must declare a pecuniary interest in agenda items of Board meetings, where applicable, and retire from the meeting until discussions on the subject are terminated or voting has concluded.

No issues of pecuniary interest were noted.

Conflict of InterestMembers declare a conflict of interest in matters listed for discussion at Board meetings and leave the meeting when the item is under discussion. They do not participate in proceedings or voting. No issues of conflict of interest arose.

EducationGovernance education is available to Board members through external sources.

Corporate Risk ManagementThe Board has policies and procedures in place to ensure that it is compliant with the requirements of Risk Management.

Clinical Risk ManagementAll staff are qualified to undertake their roles. Professional persons are checked each year to ensure they meet the standards of the Australian Health Practitioner Regulation Agency (AHPRA) or other recognised bodies.

Hesse is part of a sub-regional approach to medical credentialing with access to clinical advice through Colac Area Health. Hesse participates in a variety of quality systems ensuring clinical care is subject to continuous review.

FeesAll Fees charged by the service are in accordance with the Hospitals and Charities (Fees) Regulations 1986 and otherwise

determined by the Department of Health and as directed by the Commonwealth Department of Health & Ageing.

Comments and ComplaintsConsumer comments are valued as a guide to the quality of care delivered. Comments and suggestions enable us to gauge the need for improvement as well as reaffirm our worth to the community. Comments and suggestions are welcomed and should be directed to the Chief Executive Officer.

The Health Service Commissioner can be contacted on (03) 8601 5200 or Toll Free 1800 136 066 to assist with unresolved complaints.Formal complaints were five.

Financial Management Act 1994The requirements as listed under the Direction for the Minister for Finance Part 9.1.3 (iv) are available for scrutiny by the Minister, Members of Parliament or consumers on request to the Chief Executive Officer.

Freedom of InformationThree requests for information were received during the year. The Service operates within the guidelines defined within the Freedom of Information Act 1982 and its subsequent amendments.

For access to medical records there is a mandatory application fee of $25.10 that must accompany the written charges for searching, photocopying and postage.

Consumers wishing to access information should make a written request to the Chief Executive Officer, Hesse Rural Health Service, 8 Gosney Street, Winchelsea, Vic 3241.

PrivacyHRH complies with legislation relating to confidentiality and privacy including the Health Services Act 1998 and Health Records Act 2001. Policies ensure that personal health information remains confidential and secure and is accessible under FOI guidelines.

Buildings and MaintenanceHesse Rural Health Service complies with the Building Act 1993, which encompasses the Building Code of Australia, under the guidelines for publicly owned buildings in all redevelopment and maintenance issues and issued by the Minister for Finance in 1994.

Publications and InformationThis Annual Report is distributed widely and is available upon request at Hesse Rural Health Service. A range of brochures and information pamphlets are freely available for consumers and carers.

Compliance

31

Occupational Health & Safety Act 2004Policies and procedures provide guidance for safety in the workplace. Designated workgroups have been established and representatives are elected. No major work accidents were reported during the year.

Employment and Conduct PrinciplesHRH is committed to the principles of merit and equity in the workplace with respect to employment, promotion and opportunity. An employee Code of Conduct guides responsible behaviour in the workplace. Employees have been correctly classified in workforce data collections.

Victorian Industry Participation PolicyHRH is required to report the application of the Victorian Industry Participation Policy against any tenders greater than $1 Million. During 2011-12 no tenders were let or completed with a value greater than $1 Million.

Reporting Compliance IndexThis Report is prepared in accordance with the Financial Management Act and the directions of the Minister for Finance, Part 9, for open disclosure about our Service, our people and our financial management.Competitive NeutralityAll competitive neutrality requirements were met in accordance with Government costing policies for public hospitals.

DETAILS OF INDIVIDUAL CONSULTANCIESConsultant Purpose of

ConsultancyStart Date End Date Total approved

project fee (excluding GST)

Expenditure2012-2013

(excluding GST)

Future expenditure(excluding GST)

Community Childcare Assoc.

Feasibility Study 01.06.12 02.01.13 $20,455 $19,500 Nil

Clark Philips Roster Review 01.11.11 10.08.12 $15,790 $15,790 Nil

In 2012-2013 Hesse Rural Health engaged four consultancies where the total fees payable to the consultants were less than $10,000, with a total expenditure of $7,065 (excluding GST).

John Carr, President30 August 2013




ATTESTATION ON COMPLIANCE WITH AUSTRALIAN / NEW ZEALAND RISK MANAGEMENT STANDARDI, John Carr, certify that Hesse Rural Health Service has risk management processes in place consistent with the Australian/New Zealand Risk Management Standard, and an internal control system in place that enables the executives to understand, manage and satisfactorily control risk exposures. The audit committee verifies this assurance and that the risk profile of the Hesse Rural Health Service has been critically reviewed within the last 12 months.

ATTESTATION ON DATA INTEGRITYI, John Carr, certify that Hesse Rural Health Service has put in place appropriate internal controls and processes to ensure that reported data reasonably reflects actual performance. Hesse Rural Health Service has critically reviewed these controls and processes during the year.

ATTESTATION FOR COMPLIANCE WITH THE MINISTERIAL STANDING DIRECTION 4.5.5.1 - INSURANCEI, John Carr, certify that Hesse Rural Health Service has complied with Ministerial Direction 4.5.5.1 - Insurance.

RESPONSIBLE BODIES DECLARATIONIn accordance with the Financial Management Act 1994, I am pleased to present the Report of Operations for Hesse Rural Health Service for the year ending 30 June 2013.


Hesse is proud of

its reputation and

commitment to quality

service provision.

33

QUALITY REPORTIntroduction page 34Australian Council on Health Care Standards 34Aged Care Standards 34National Healthcare Standards 35Recognising and Responding to Clinical Deterioration 35Palliative Care 35Clinical Handover 35Safe Use of Blood and Blood Products 36Evidence Based Contemporary Care 36Education 36Falls Prevention 36Pressure Injury Prevention 36Safe Medication Management 37Preventing and Controlling Infections 37Restraint 38Unplanned Weight Loss 38Risk Management 38Workforce Satisfaction 38Safe Environment and Staff Wellbeing 39Victorian Patient Satisfaction Monitor 39Consumer, Carer and Community Participation 39Please Tell Us 40


GEND


Australian Council on Health Care StandardsHesse continues to be fully accredited across several quality frameworks.

Australian Council on Healthcare Standards periodic review was held in November 2012, the surveyors endorsing the rating of Marked Achievement across the fifteen clinical, support and corporate criteria. The survey team found ‘much evidence of organisational commitment to delivering high quality, safe and appropriate services to local communities, which are experiencing significant growth,’ also making particular mention of the ‘collaborative and innovative approach used to acquire a building and commence primary care and community health services at Moriac.’

A small number of recommendations were made for improvement, including widespread education of the principles of open disclosure and ensuring patients, carers and residents are all informed about the organisation’s incident management system.

Quality of Care ReportHesse Rural Health is proud of its reputation and commitment to quality service provision. Underpinning this commitment is a firm belief that quality is everyone’s responsibility. Whether the gardener, receptionist, cook, cleaner, nurse or volunteer, everyone has the power to make an impact on the service experienced by our consumers. Understanding that quality means change necessitates the continual identification of ways to improve the care we provide.

The Quality and Ethics Sub-Committee of the Board of Management plays a key clinical governance role to set our quality framework and ensure our activities are monitored and evaluated. While we strive to meet the expectations and standards set by external accreditation agencies, the ultimate judge of our services are the consumers themselves. From 2013 we embark on another challenge to embrace the new National Health Standards set by the Australian Commission on Safety and Quality in Healthcare.

This 2012-2013 Quality of Care Report provides an overview of a number of quality initiatives, projects currently underway and the ways in which their outcomes will improve our service for our community.

It is with great pleasure that I recommend this report to you.

Aged Care StandardsIn January the Residential Aged Care Standards Agency conducted an unscheduled visit to Hesse Lodge, Chelsea Lodge and Werruna. A successful outcome was achieved along with some pleasing comments about the organisation’s commitment to person centred care, and the ‘relaxed atmosphere in the dementia environment with a focus on activities of meaningful engagement.’

Recommended areas of improvement included procedures for maintaining an accessible and current resident list in the case of evacuation, changes to the electrical tag and testing schedule, clinical audit and care planning schedules.

190 MealsPreparedAn Average

Day at Hesse

1 Urgent & 2Acute Patients

Cared For

55 Residents &19 District NursingClients Cared For

976 KmTravelled

57 PrimaryCare Contacts

Made

Donald Lang, ChairpersonQuality and Ethics Sub-Committee

35

Palliative CarePatients and residents in the end stages of life deserve quality, respectful and dignified care. The use of the evidenced based Liverpool Care Pathway to promote positive end of life care increased from 60 to 70% of all palliative episodes. Assessment tools from the Palliative Care Outcomes Collaboration (PCOC) have been implemented. The number of residents with Advanced Care Plans rose to 90% following staff training in the Respecting Patient Choices Advanced Care Planning Program. Six staff have also been trained as Palliative Link Nurses to promote best practice palliative care and share information with colleagues.

Clinical HandoverTo enable effective 24 hour care, clinical information transfer is critical. In addition to the implementation of ISBAR (Identify, Situation, Background, Assessment, Recommendation) as a guide for priority information exchange, changes to the shift times have allowed for a more generous handover timeframe.

National Healthcare StandardsWith new National Healthcare Standards introduced in January 2013, the standard remains high for retaining accreditation in small rural hospitals. Hesse has opted for assessment against five more than the mandatory 10 National Safety and Quality Healthcare Standards using the EQUiP National Program. A number of new initiatives are already underway to ensure compliance to the National Quality Standards. These include: Recognising and Responding to Clinical Deterioration, Palliative Care, Clinical Handover and the Safe Use of Blood and Blood Products.

Recognising and Responding to Clinical DeteriorationConsiderable efforts have been directed to the development of new guidelines for responding to clinical deterioration. In preparation, a number of nursing staff across the organisation have attended training in Comprehensive Health Assessment of the Older Adult.

The employment of a Nurse Practitioner Candidate to work within the rural aged and primary care setting together with participation in the Regional and Isolated Practice Endorsed Registered Nurse (RIPERN) Project are both initiatives aiming to improve acute nursing skills and responsiveness to clinical change.

UnplannedWeightLoss

StaffInjuries

MedicationErrors

FeedbackReceived

StaffTraining

FallIncidents

Use ofRestraint

TotalIncidents

PressureUlcers

At a Glance


Safe Use of Blood and Blood ProductsHesse participates in the ‘Blood Matters Program,’ undertaking an annual audit and ensuring staff education regarding the safe administration of blood and blood products is aligned with current guidelines. In 2012-13 one blood transfusion was undertaken. The appropriate consent was obtained and there was no adverse reaction.

Evidence Based Contemporary CareParticipation in on the ground research is an excellent way for staff to engage with contemporary clinical best practice. Hesse is actively participating in the McKellar Guidelines project for Managing Diabetes in Small Rural Residential Aged Care Facilities (see also p. 22). In addition, through the Wounds West Project, direct care staff have received specialist consultancy, education and in-service in contemporary wound assessment and treatments.

Education A concerted effort has been made to ensure our staff have access to a variety of ways to improve their knowledge and skills. The introduction of an additional one hour of double staffing through shift length changes in the residential areas has allowed greater focus on professional education and training. Online learning topics have included clinical care, safe food handling, preventing elder abuse, open disclosure, person centred care, hand hygiene, fire and evacuation and manual handling. Recording systems have also been improved and now more effectively capture all internal and externally conducted education. There were 556 recorded occasions of training in 2012-2013.

Falls PreventionOlder people are at a higher risk of falling, and this can have serious health consequences. Falls risk screening is conducted at the time of admission. This allows appropriate strategies to be put into place to help prevent injuries from occurring. The number of overall falls reduced from 139 to 136 during the year. Two resident falls resulted in a fracture. Improvements have included audits of staff falls awareness, review of risk assessment tools, increased use of protective clothing and provision of floor level beds.

Pressure Injury PreventionPressure injuries occur when an area of skin is damaged from prolonged periods of unrelieved pressure. They are largely preventable due to the range of contemporary strategies available to health professionals and patients. Pressure injuries are graded in terms of Stages 1 to 4. Hesse had four instances of the least serious Stage 1 pressure injuries, an improvement from the six Stage 2 wounds last year.

Fall Locations

66%

10%

7.5%

7.5%1.5%

7.5%

Bedroom

Lounge / Dining

Bathroom

Grounds

Off Site

Other

37

Preventing and Controlling InfectionsEffective infection control is essential to support good clinical care. A registered nurse is allocated the portfolio to manage the infection control program at Hesse which includes high standards of hygiene, immunisation, education and environmental cleaning. A total of 48 infections were recorded in 2012-2013, a reduction from the prior year. An overarching infection prevention risk management program contains a comprehensive set of actions and performance measures to prevent and reduce infection rates. Strategies AchievementsHand Hygiene Compliance 79.1%Influenza Vaccination Program - Residents

91%

Influenza Vaccination Program - Staff

40%

External Cleaning Audit Report 98%Aged Care Infection Control Audit 94%LGA Food Premises Audit Compliant

Safe Medication Management The safe administration of medications is crucial for quality health care and any inaccuracies in dispensing or recording are closely monitored. A Medication Advisory Committee involving clinical staff, GPs and pharmacists plays an oversight role.

While the 59 reported errors are an increase from 22 recorded last year, they are related to improved awareness about reporting requirements and the implementation of the electronic Riskman incident management program. Accurate reporting leads to better outcomes.

The National Inpatient Medication Chart has been implemented for acute inpatients and Hesse is participating in the Resident Medication Management Reviews and Quality Use of Medications Program. The community nursing program has implemented guidelines and consent for the safe use of narcotic analgesia for people being treated at home.

Hesse is required to report to the Department of Health the number of high care residents prescribed nine or more medications. On average there were five residents in this category and this is consistent with the state average (4.45) for similar facilities.

Eye UTI Chest Other

Infections

21

17

10

0

5

10

15

20

25


RestraintHesse Rural Health considers restraint free options to ensure resident and patient safety at all times. Restraint is closely monitored and minimised. A comprehensive patient assessment, care planning and consent process is followed to ensure Commonwealth guidelines and mandated reporting requirements are met.

Family consent was provided for the use of a restraint device on one occasion during the year. This was identified, after careful consideration, as the least restrictive option for ensuring safe mobilisation. In the previous year there were two occasions of restraint.

Unplanned Weight LossAs older people are vulnerable to weight loss, which may be a catalyst for further deterioration, resident weight is closely monitored. In the case of trends of greater than three kilograms lost over three months, care pathways are implemented. This involves dietitian review and meal plan development. Eight residents were reviewed as a result of these pathways.

Risk ManagementHesse applies a risk management framework that complies with Australian Standard for Risk Management AS/NZS IS0 31000:2009 and is overseen by the Board of Management Quality and Ethics Sub-Committee. The organisational risk register captures key risks using a consequence and likelihood descriptors to predict impact. Incident and near miss reporting accounted for 353 incidents recorded using the Riskman electronic management system and staff are now proficient in its application.

Workforce SatisfactionHesse participates in the State Services Authority People Matter Survey which collects employee perceptions of the public sector values and principles applied at their workplace, including commitment and job satisfaction. The response rate for the 2013 survey was 22% with satisfaction levels noted in all areas across the domains.

09/10 10/11 11/12 12/13

Total Incidents

353

0

100

50

200

150

300

250

400

350

Safe Environment and Staff WellbeingProviding a safe environment is a priority focus for the organisation. An Occupational Health and Safety (OHS) committee with designated work group representatives meet second monthly to discuss relevant personal workplace safety and environmental issues. The staff health program is a key element outlined by the annual OHS Action Plan and included free Worksafe sponsored Employee Health Checks, bulk billed medical care, subsidised allied health consultations, Quit smoking programs and an employee assistance program for psychological support. Reported staff injuries reduced for the second consecutive year from ten to nine. Mandatory smart lift and fire and emergency training also ensure staff remain alert to safety issues.

Victorian Patient Satisfaction MonitorOf the 34 patients treated and discharged at Hesse between July and December 2012 ten have provided feedback to the Department of Health regarding their experience of their hospital stay via the Victorian Patient Satisfaction Monitor (VPSM). While insufficient patient admissions allowed a valid overall care index rating, especially high performance scores were obtained for ‘personal safety’, ‘cleanliness of rooms’, ‘privacy of rooms’, ‘courtesy of nurses’ and ‘responsiveness of nurses’.

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09/10 10/11 11/12 12/13

Aged Care Occupancy96.75%

0

20

40

60

80

100

Consumer, Carer and Community ParticipationCaring for Rural Communities is Hesse’s vision for ensuring our programs are relevant to the needs of consumers, carers and the public we service. We welcome and actively listen to feedback from patients, carers, visitors, staff and the broader community about the services we offer and the ways they may be improved. We received 107 items of feedback during the year.

Satisfaction rates recorded by users of primary care and domiciliary post natal services yielded a pleasing 95.8% and 97.1% overall service satisfaction rate from 70 and 10 returned surveys respectively.

The Victorian Government’s Doing it With Us and Not For Us consumer participation policy provides a framework to ensure we are actively involving consumers in all aspects of the care pathway. Partnering with Consumers is also a key element of the new National Health Standards, and Hesse will be increasing the avenues available to our consumers to participate in their health service experience to meet these national expectations. Community consultations will also inform our renewed strategic planning process in late 2013.


Please Tell UsWe hope you found the Quality of Care Report relevant and informative. We would be pleased to hear your feedback and suggestions regarding the report or the services of Hesse Rural Health.

You may direct your responses to: The Chief Executive Officer, Hesse Rural Health, 8 Gosney St. Winchelsea, VIC 3241 or submit them via our website:www.hesseruralhealth.org.au

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FINANCE REPORTVAGO Report page 42Disclosure Index 44Declaration 46Comprehensive Operating Statement 47Balance Sheet 48Statement of Changes in Equity 49Cash Flow Statement 50Note 1: Statement of Significant Accounting Policies 51Note 2: Revenue 62Note 2a: Analysis of Revenue by Source 63Note 2b: Patient and Resident Fees 63Note 2c: Net Gain/(Loss) on Disposal of Non-Current Assets 63Note 3: Expenses 64Note 3a: Analysis of Expenses by Source 65Note 4: Depreciation 65Note 5: Cash and Cash Equivalents 65Note 6: Receivables 66Note 7: Investments and Other Financial Assets 66Note 8: Investments Accounted for Using the Equity Method 66Note 9: Property, Plant & Equipment 67Note 10: Payables 67Note 11: Employee Provisions 67Note 12: Other Liabilities 68Note 13: Equity and Reserves 68Note 14: Reconciliation of Net Result for the Year to Net 68 Cash Inflow from Operating Activities Note 15: Financial Instruments 69Note 16: Commitments for Expenditure 72Note 17: Contingent Assets & Contingent Liabilities 72Note 18: Operating Segments 72Note 19: Jointly Controlled Operations and Assets 73Note 20a: Responsible Person Disclosures 73Note 20b: Executive Officer Disclosures 74Note 21: Remuneration of Auditors 74Note 22: Controlled Entities 74Note 23: Events Occuring After the Balance Sheet Date 74


GEND


Disclosure Index

MINISTERIAL DIRECTIONSReport of Operations - FRD Guidance

Charter and Purpose

LEGISLATION REQUIREMENT PAGEFRD 22C Manner of Establishment and the Relevant Ministers Inside Cover

FRD 22C Objectives, Functions, Powers and Duties 6

FRD 22C Nature and Range of Services Provided Inside Cover & 76

LEGISLATIONLEGISLATION PAGEFreedom of Information Act 1982 30

Victorian Industry Participation Policy Act 2003 31

Building Act 1993 30

Financial Management Act 1994 30

FINANCIAL STATEMENTS - FRD GUIDANCEFinancial Statements Required Under Part 7 of the FMA

LEGISLATION REQUIREMENT PAGESD 4.2(a) Statement of Changes in Equity 49

SD 4.2(b) Comprehensive Operating Statement 47

SD 4.2(b) Balance Sheet 48

SD 4.2(b) Cash Flow Statement 50

Other Requirements Under Standing Directions 4.2SD 4.2(a) Compliance with Australian Acounting Standards & Other Authoritative

Pronouncements51

SD 4.2(c) Accountable Officer’s Declaration 46

SD 4.2(c) Compliance with Ministerial Directions 51

SD4.2(d) Rounding of Amounts 59

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The Annual Report of Hesse Rural Health Service is prepared in accordance with all relevant Victorian legislation. This index has been prepared to facilitate identification of the

Department’s compliance with statutory disclosure requirements.

FINANCIAL AND OTHER INFORMATIONLEGISLATION REQUIREMENT PAGEFRD 10 Disclosure Index 44FRD 11 Disclosure of Ex-Gratia Payments naFRD 15B Executive Officer Disclosures 46FRD 21B Responsible Person and Executive Officer Disclosures 73 & 74FRD 22C Application and Operation of Freedom of Information Act 1982 30FRD 22C Compliance With Building and Maintenance Provisions of Building Act 1993 30FRD 22C Details of Consultancies Over $10,000 31FRD 22C Details of Consultancies Under $10,000 31FRD 22C Major Changes or Factors Affecting Performance 2 & 3FRD 22C Occupational Health & Safety 31FRD 22C Operational and Budgetary Objectives and Performance Against Objectives 2 & 27FRD 22C Significant Changes in Financial Position During the Year 2 & 27FRD 22C Statement of Availability of Other Information 30FRD 22C Statement on National Competition Policy 31FRD 22C Subsequent Events naFRD 22C Summary of the Financial Results for the Year 27FRD 22C Workforce Data Disclosures Including a Statement on the Application of

Employment and Conduct Principles26 & 31

FRD 25A Victorian Industry Participation Policy Disclosures 31SD 4.2(j) Sign-off Requirements 31SD 3.4.13 Attestation on Data Integrity 31SD 4.5.5.1 Attestation on Data Insurance 31SD 4.5.5 Attestation on Compliance with Australia / New Zealand Risk Management

Standard31

MANAGEMENT AND STRUCTURELEGISLATION REQUIREMENT PAGEFRD 22C Organisational Structure 5

Hesse Rural Health 19th Annual Report 2012 - 2013 72 Hesse Rural Health 19th Annual Report 2012 - 2013 72

75

The achievement of our strategic outcomes is a credit to all: Board, Management and all sections of Staff.


Our Services

Acute CareAged Care Packages Breakfast ClubChildren at PlayCommunity NursingDementia CareDiabetes EducationDieteticsDistrict NursingExercise GroupsFarm Safety ProgramHealth PromotionHIPPY & Play ProgramHospital in the HomeImmunisation ProgramMaternal & Child HealthMen’s GroupMen’s Shed ProgramNesters Group

No Fall Exercise ProgramOccasional CareOccupational TherapyPalliative CarePersonal DevelopmentPhysiotherapyPlanned Activity Groups PodiatryPost-Acute CarePost-Natal CarePre-School Health Refugee HealthResidential Aged Care RespiteSub-Acute CareUrgent CareVolunteeringWalking GroupsWell Women’s Clinic

Contemporary and relevant health services thoughout the lifespan

Winchelsea HospitalChelsea Lodge HostelHesse Lodge Nursing HomeWerruna Dementia Unit8 Gosney StreetWinchelsea 3241

Bannockburn Primary Care2 Pope Street

Bannockburn 3331

MoriacCommunity Health

806 Hendy Main RoadMoriac 3240

Winchelsea Community Health12 Gosney StreetWinchelsea 3241

Beeac Community Health

Lang StreetBeeac 3251

LeighCommunity Health

Ferrars StreetRokewood 3330

Winchelsea Hospital Hesse Lodge Chelsea Lodge Werruna Winchelsea ADASS

Winchelsea Beeac Bannockburn Leigh Moriac Community Health Community Health Primary Care Community Health Community Health


8 Gosney StreetWinchelsea 3241(03) 5267 [email protected]

Winchelsea Adult Day Activity53 Hesse StreetWinchelsea 3241

Hesse Rural Health Service was formed in 1994 from the

amalgamation of Beeac and District Hospital, Leigh Community Care Centre and the Winchelsea and District Hospital.

Minister for Health: Hon. David Davis MPAuditors: Auditor General Victoria

Bankers: Bendigo Winchelsea & District Community BankSolicitors: Birdsey Dedman Bartlett

Since then Hesse has developed

into a key integrated rural healthcare

service within the three local

government areas of Surfcoast,

Colac Otway and Golden Plains.

A broad range of services include: Aged, Community and Residential, Acute Hospital, Urgent Care, Community Health, Health Promotion, Allied Health, Adult Day Activity, Occasional Childcare, Home Nursing and Palliative Care.

hesseRuralhealth

19th annualreport

2012 - 2013


HESSE RURAL HEALTH8 Gosney Street Winchelsea 3241

(03) 5267 [email protected]

www.hesseruralhealth.org.au

Hesse Rural Health 2012-2013 Annual Report

Documents

Transcript of Hesse Rural Health 2012-2013 Annual Report