Dr Teresa Anderson

Chief Executive

October 2014

Creating an Innovative and Sustainable Healthcare Model

Context

Increasing demand for health care services due to:

– ageing populations

– the increased burden of chronic disease

– continued advances in medical technology (including the rapid expansion of

information systems)

– ever growing community expectations

Health care expenditure of most health systems is growing at a rate greater than

GDP (OECD 2008).

Most countries appear to be grappling with how they can create an innovative and

sustainable health system for the future.

Context

Today’s presentation provides:

An overview of reform occurring within the Australian and New South Wales (NSW)

Public Healthcare Systems, which includes devolution to Local Health Districts, a

smaller and more focused Ministry of Health, increased transparency and funding

reform

An overview of SLHD

Challenges facing health services

What we are doing to address these challenges

Examples of innovations and new models of care

Australian Health Care System

• A mix of public and private sector health services

• A range of funding and regulatory mechanisms. Almost

70% of the total health expenditure in Australia is

funded by government

• Financed through a combination of income tax, a

specific income levy (the Medicare Levy) and private

financing by individuals through private health insurance

(PHI) premiums and out of pocket payments

• 1,340 hospitals, 752 public hospitals accounting for 68%

of hospital beds (57,772) and 588 private hospitals

accounting for about 32% of beds (28,000 private

hospital beds) (2009–10 data)

National Hospital Reform

• National Health and Hospital Agreement (2011)

• National Health and Hospitals Network

• National introduction of Activity Based Funding from 1 July 2012

• National Independent Pricing Authority

- National Efficient Price

- Value for money

- National comparability

- Transparency

- Efficiency

• National Health Performance Authority

• Patient Controlled Electronic Health Record

Health and Hospital Reform

The reforms aimed at achieving:

• better access to services

• improved local accountability and

transparency

• increased clinician engagement

• greater responsiveness to local

communities

• a stronger financial basis for the health

system into the future through

increased Commonwealth funding

• effective and accessible ICT to support

the provision of high quality health

services

Reform of the NSW Health System

• One of the largest, most complex and

significant reforms that has occurred in

the last 25 years in any jurisdiction in

Australia.

• First state to transition to local health

networks

• Transition from large area health

services to smaller Local Health

Networks (now Districts), initially with

Governing Councils (now Boards)

• Governance Review

Major themes of Governance Review

1. Devolution of authority and responsibility to the Local Health Districts

2. Changed role and structure for the Ministry of Health

3. Increased clinical leadership, engagement and support

4. Investment in our people

5. Greater transparency and utility of health information

6. Realising the potential of statewide (shared) services

7. Recognising eHealth as the way of the future

Areas to Districts

Sydney Local Health District

• Established on 1 January 2011

• Located in the centre and inner west of Sydney

• A well-established reputation for excellence in the provision of healthcare services

and for managerial and fiscal responsibility

• Strong and well recognised leadership roles in research and education

• Delivers quaternary, tertiary, acute, primary care and health improvement services,

many of which are recognised internationally and nationally

• Our services are highly complex and many are resource intensive

• Responsible for providing health care to more than 580,000 people

• Characterised by socio-economic diversity, with pockets of both extreme

advantage and extreme disadvantage

Sydney Local Health District

SLHD provides health services 24 hours a day, 7 days per week, 365 days per

year

A long history of providing tertiary and quaternary healthcare services to

patients from other parts of NSW, including the provision of telemedicine and

outreach clinics to rural areas

Over 25% of our inpatient activity is for patients residing in other Sydney LHDs,

8% for NSW patients residing outside Sydney and 3% for interstate and

overseas patients

Each of our hospitals and services are unique with different areas of expertise

and networked to ensure that our patients have access to the services they

need

Our clinicians, support staff and managers are constantly planning and

implementing improvements to achieve our vision of excellence in health care

for all

A typical day

Every day SLHD on average:

• Treats over 5,500 outpatients.

• Provides over 400 case weighted separations in our Eds.

• Receives over 110 ambulances.

• Provides 453 inpatient case weighted separations.

• Has over 1620 patients in its beds.

• Performs more than 140 operations.

• Delivers around 20 babies at Royal Prince Alfred and Canterbury.

• Spends around $3.79 million on health care including:

• $2.37 million on our staff (SLHD has 10,000 employees)

• $1.15 million on goods and services

Overview of SLHD Population

Age group Total % of total

0-4 years 36,321 6.2%

5-9 years 27,148 4.7%

10-14 years 24,209 4.2%

15-19 years 27,943 4.8%

20-24 years 50,525 8.7%

25-29 years 64,330 11.1%

30-34 years 58,070 10.0%

35-39 years 50,621 8.7%

40-44 years 43,603 7.5%

45-49 years 39,431 6.8%

50-54 years 35,041 6.0%

55-59 years 30,254 5.2%

60-64 years 26,643 4.6%

65-69 years 19,831 3.4%

70-74 years 15,959 2.7%

75-79 years 13,279 2.3%

80-84 years 10,146 1.7%

85+ years 8,746 1.5%

Total 582,100 100.0%

Population Projections

New Dwellings

The SLHD catchment encompassed

– 17.5% and 18.5% of all new dwelling constructions in the Sydney region in 2011 and 2012 respectively

– 24% of all new dwelling approvals in the year ending 2012

– In 2012, Green Square (895 new homes) and Rhodes (816 new homes) topped the list of growth locations across the Sydney region

City of Sydney LEP plans for an additional 50,000 new homes (including Glebe Affordable Housing Project) and 52,000 jobs

Canada Bay Council over 10,000 dwellings

Burwood Council over 5,000 additional dwellings

Strathfield Council 4,110 homes

Marrickville Council over 4,000 new homes and 1,100 new jobs

Ashfield Council over 2000 dwellings and 1,400 jobs

Continued development in Green Square and Rhodes; urban consolidation along the Parramatta Road corridor, Breakfast Point, Burwood, Strathfield/Homebush, Redfern/Waterloo, the former Carlton United Brewery site in Broadway and the Harold Park Raceway site in Glebe.

Housing

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HD

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Dwellings owned 56.5% 59.7% 64.1% 59.3% 57.3% 54.2% 59.9% 38.5% 54.6% 66.5%

Dwellings rented 40.1% 36.6% 33.1% 36.5% 40.6% 43.0% 36.5% 58.7% 42.2% 30.1%

Dwellings rented from Housing

NSW

1.5% 2.9% 2.6% 5.8% 4.3% 2.9% 4.0% 11.6% 5.4% 4.4%

Homelessness

• 3,307 homeless people in City of Sydney

• 1,430 homeless people in Strathfield-Burwood-Ashfield

• 910 in Marrickville-Sydenham-Petersham

• 663 in Canterbury

• 319 in Leichhardt

• 171 in Canada Bay

Index of Social Disadvantage

A diverse population

Aboriginal people

Cadigal and Wangal people of the Eora nation

4,875 either Aboriginal or Torres Strait Islander

24% of the Aboriginal population is aged under 15 years and less than 1% is

aged over 65 years

CALD communities

43% of residents speak a language other than English at home

7.7% of the population speak little or no English

Mandarin (28,712 people), Arabic (26,665 people), Greek (24,654 people)

and Cantonese (22,881 people)

34.1% of the SLHD population born in non-English speaking countries, with

20.8% of this grouping residing in Australia for less than five years.

Selected Health and Lifestyle Facts

Estimated 106,960 people with a disability live in SLHD, of whom 23,264 people

require assistance with core activities of daily living

44,960 SLHD people identified themselves unpaid carers

14.9% of SLHD residents aged over 16 smoke

23.9% of SLHD residents aged over 16 years consume more than two standard

drinks a day. Higher than state rate of alcohol-related hospitalisations

46.7% of people in SLHD are overweight or obese

Vaccination rates within the SLHD are low

9.8% of people in SLHD considered themselves to have high or very high

psychological distress,

81.3% of SLHD residents over 16 consider themselves to have excellent, very

good or good health

Challenges

• Meeting the increasing demand for health services on increasingly restricted funding

• Being more efficient and effective with the resources that we have

• Developing and evaluating innovative and sustainable models of care

• Establishing robust clinical and corporate governance structures including effective

enterprise risk management

• Ensuring our workforce has the skills and competencies to effectively drive and

implement new models of care

• Ensuring clinicians are adequately equipped to provide quality health services that

meet the communities needs in this changing environment

Challenges

• Establishing effective relationships with a multitude of stakeholders including the

community, the Ministry, central agencies, NGOs and private organisations

• Ensuring that senior executives and managers are adequately equipped and have

the competencies to effectively manage and lead these new organisations

• Ensuring robust and transparent reporting, analytics and decision support tools

• Facilitating increased clinician and community input into decision making and

strategic planning

• Adapting to new technology and genetics - genomics

• Getting the balance right between prevention, acute care and chronic disease

management

Our Focus To keep the patient, their family

and carer(s) at the centre of the

care we provide and to ensure

their emotional support, their

physical comfort and the

coordination and delivery of their

care is of the highest possible

standard.

What are we doing?

Our Vision Excellence in healthcare for all

What are we doing?

Ambulatory Care and Hospital Alternatives

Increasing investment in integrated care in the community – hospital in the home,

Sydney District Nursing, community mental health

Increasing investment in Ambulatory Care/Work with medicare local (GPs and

other primary care providers)

Health Pathways (60 pathways in 2013/14) – data system linking with GPs and

other primary care providers

What are we doing?

Increasing Hospital Efficiency

- using data analytics (QLIKview/STARS)

Systematically addressing Clinical Variation

Continuing to improve hospital efficiency e.g. NEAT /Whole of system programs

Ensuring clinical quality and safety standards are of the very highest

Supporting technology and data and eMR interconnectivity

Supporting upgrades in Imaging/Diagnostics – ensuring all equipment can

interface with the eMR – ECG carts; haemodynamic equipment

What are we doing?

Planning and Strategy Development with other government and

nongovernment agencies

– Child Health and Youth Health Inter-sectoral Plans

– Homelessness Strategy

– Whole of District Health Improvement Plan

– Community and Private Health Partnerships

– Lifehouse

– Charles Perkins/USydney

Underpinning this is the need for ICT connectivity with other organisations

What are we doing?

Strategic Direction

• Focusing on the outcomes we want to achieve

• Setting clear direction and articulating a compelling vision for

our organisations/departments/clinical services

• Being innovative and encouraging, planning and implementing

strategies that result in service improvements

• Being responsive to community needs

• Developing strategic relationships that will enhance our health

services and magnify our outcomes

• Being performance driven

• Using lessons learnt from other Districts/health services

• Buying in expertise where required

What are we doing?

Organisational capabilities

• Building and maintaining an effective and dynamic team

• Effectively managing our relationships – internally and externally

• Promoting effective information and communication management

• Being credible with clinicians and managers- listening and using evidence

• Creating a culture of enquiry and enthusiasm

• Developing a learning organisation

• Managing organisational change and ensure business and clinical continuity

What are we doing?

Organisational effectiveness

• Developing corporate and clinical governance structures that support the effective

operation of our Districts and their services

• Developing and utilising sound business judgement and effective business skills-

ensuring our staff know how to write compelling business cases

• Developing robust enterprise risk management systems and processes

What are we doing?

Financial performance

• Ensuring all staff understand their and their District’s budgets!

• Managing finances and having appropriate financial controls (come in on budget!)

• Ensuring we have the capacity to adapt to new funding regimes

• Effectively managing and being responsible for resources

• Developing new and more efficient models of care

• Analysing and monitoring trends

• Enhancing our financial literacy and quantitative problem solving skills

• Engaging clinicians and other team members in financial management

• Reducing clinical variation

What are we doing?

Effective relationships with internal and external stakeholders

• Developing effective relationships with the community, patients and their families

and the public (and the media)

• Supporting the skill and knowledge development of our clients, team members,

partner organisations

• Developing and maintaining effective partnerships within the District, MoH, Pillars

and other Districts

• Developing strategic partnerships with other organisations including Private Allied

Health, Specialists, Medicare Locals, NGOs, other human services and private

companies

• Developing effective governance arrangements with partner organisations for shared

projects eg FACS

• Developing best practice contract management

What are we doing?

Best Practice

• Evaluating what we do – have our new models of care delivered us the

benefits that we anticipated

• Developing effective measures and monitor outcomes of our services/

programs

• Participating in and supporting research on our services and practices

• Participating in and supporting research on new models of care

What are we doing?

• Investment in Research and Education

• Sydney Research Hub

• Collaborative establishment of the Charles Perkins Clinical Research Facility

• New Mental Health and Lifehouse Research roles

• Institute for Academic Surgery

• Sydney Health Care Partners

Investment in Innovation and new models of care

– Performance Monitoring Systems, Improvement and Innovation Unit

– Investment in analytics- STARS

– Innovations Steering Committee

– Innovation Symposium

– The Pitch

The Pitch video

Clinicians

and

managers

Ministry

SLHD

CEC

ACI

Data Mining & Analytics

Other

States

Ambulance

Service

Other

Districts

The holy grail: access to timely, accurate data

Limitations of Current System

Labour intensive

Limited data able to be reviewed

Unable to respond to different needs of different departments

No real time access to data

Limitations of Current System

Labour intensive

Limited data able to be reviewed

Unable to respond to different needs of different departments

No real time access to data

Why STARS?

We can’t manage what we can’t analyse/monitor

Managing processes in real time

Efficient insight into data

Combines and manages multiple sources of data

Data Source Collections

Incidents related to:

•Falls

•Medication

•Pressure Ulcers

Data Collections:

•Non Admitted Patient Data

Data Collections:

•Admitted Patient Data

•Emergency Department Feeder Systems:

•Pathology

•Imaging

•Pharmacy

•Prosthesis

•Blood

•Operating Theatre

Data Extracts:

•Overdue Patients (Weekly)

•Financial Class (3 times a Day)

•NEAT (Daily)

•Orders and Results

Standalone Clinical

Databases

What does STARS offer clinicians & managers?

A tool to help:

– increase our collective knowledge about our services

– identify clinical variation / reduce unwarranted clinical

variation

– strengthen / implement ‘best-practice’ models of care, &

monitor outcomes

– improve clinical outcomes

– drive efficiencies

– link clinical databases

– identify cost savings

– support research to improve

clinical practice

What does STARS offer clinicians?

Real time access to a huge amount of data

User driven and flexible design

Link to clinical databases

District led

Specialty / Clinician driven

-78.24

What are we doing?

Examples of innovations and new models of care

Orthopaedic Re-fracture Program

Living Well, Living Longer

Enhanced Recovery After Surgery

Sydney District Nursing and Hospital in the Home

Population Health Observatory

Health Equity Development Unit

Organ donation

Organ Donation for Transplantation

Access to organ donation for transplantation is essential to ensure that the

best outcomes are achieved for people with end stage disease such as

kidney, liver, heart, lung or pancreas failure or for people receiving tissue

donation (bone, corneas or skin) to improve the quality of their lives.

Australia’s organ donation for transplantation system does not meet the

nation’s present demand for organ transplantation and is unlikely to meet its

future needs without significant change.

Organ donation for transplantation in Australia: The gap between Australia and world-leading countries.

Global ranking of deceased donors per million 2013

1 35.1 dpmp

2 – 3 30 - 35 dpmp

4 - 7 25 – 29.9 dpmp

8 - 10 23 – 24.9 dpmp

11 - 14 20 – 22.9 dpmp

15 – 19 17 – 19.9 dpmp

Additional Australians who could receive a

transplant every year*

1100

800

500

400

200

100

20 16.9 dpmp 0

Source: INTERNATIONAL REGISTRY IN ORGAN DONATION AND TRANSPLANTATION. International rankings for 2013 based on deceased organ donors per million of population. Prepared by ShareLife Australia, July 2014. www.sharelife.org.au * 2.7 transplants per donor

Australia

Italy, Norway, UK, Czech R

Estonia, Austria, Slovenia

Belgium, Portugal, France, United States

Croatia, Malta

Spain

Ireland, Uruguay, Belarus,

Finland, Latvia

Australia: Increase only marginally ahead of population

growth and a disturbing decline in the last 16 months.

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AUSTRALIA

LeadingPerformanceat35dpmp

Kidney Waiting List

How is this possible?

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Is this possible?

Kidney waiting list

dialysis

Organ Donation for Transplantation

Sydney Local Health District (SLHD) is committed to being an Australian

leader in organ donation to support the world leading transplantation

services that are provided by Royal Prince Alfred Hospital (RPA).

Yet it is clear that significant progress will need to be made to achieve

this goal.

Organ utilisation rate 2009 to 30 June 2014

99% 99%96%

97%

98% 93%

50%

55%

60%

65%

70%

75%

80%

85%

90%

95%

100%

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2009 2010 2011 2012 2013 2014 YTD

Organ Utilisation Rate in NSW

(not including Islets)

Total Retrievals

Total Transplants

Organ Utilisation Rate

RPA

Has the only liver transplant unit and the largest kidney transplant unit in

NSW.

LHD clinicians have played an active role at a State and National level in the

development of strategies to support best practice in organ donation for

transplantation.

Is an international leader in liver and kidney transplantation.

Has been a pioneer in the fields of kidney and liver transplantation since

1967.

Performed 71 liver transplants and 81 kidney transplants in 2012/13.

Works closely with other transplantation units at Westmead (kidney and

pancreas), Prince of Wales (kidney), and St Vincents (heart and lung) and is a

key member of the NSW Donatelife network.

NSW Organ and Tissue Donation Service

Request Rates

89%

64%100%

100%

83%

100%

75%

100%

75%

93%

82%

50%

88%

75%

100%82%

94%

100%

93%

88%

88%

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

Royal Prince Alfred

Royal North Shore

R

S

T

Total NSW Hospitals

Request Rate - 2013 Full Year

NSW Organ and Tissue Donation Service

Consent Rates

38%

29%

100%

75%

40%50%

100%

75%

67%

36%56%

0%

62%

78%47%

50%94%

55%31%

64%

58%

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

Royal Prince Alfred

Royal North Shore

R

S

T

Total NSW Hospitals

Consent Rate - 2013 Full Year

NSW Organ and Tissue Donation Service

Donation Rates

33%

18%

100%

75%0%

0%

50%

63%

25%

20%45%

0%38%

42%

40%

35%

88%

73%

21%

44%

44%

A

B

C

D

E

F

G

H

I

J

K

L

M

N

O

Royal Prince Alfred

Royal North Shore

R

S

T

Total NSW Hospitals

Donation Rate - 2013 Full Year

Leading practice in the Organ Donation for

Transplantation process

Identified in the areas of:

System governance and infrastructure

Hospital Education Activities

Communication strategies

Audit and Quality Improvement

Detection

Brain death Diagnosis

Donor Viability

Donor Maintenance

Organ viability

Family approach

Organ recovery

Organ allocation

Transplantation

Organ transplant feedback

Donor family follow-up

Strategies

A dedicated Organ Donation for Transplantation Unit

A Director of the Organ Donation for Transplantation Unit -a clinical

academic who will provide leadership in the development of best practice

organ donation within RPA.

The re-establishment of the Organ Donation for Transplantation Steering

Committee

24/7 coverage

Support for data collection, development of educational resources and audit.

Whole of Hospital approach

Review of the education

Enhanced audit and review RPA/SLHD practices for identifying potential

donors and our practices for obtaining consent.

Where to from here

Although the District recognises

that the targets it has set itself are

ambitious, the working party

believes that they are achievable

with the implementation of the

District’s Organ Donation for

Transplantation Plan.

The strategies contained in the

SLHD Organ Donation for

Transplantation Plan will enhance

its ability to be an Australian leader

in organ donation to support the

world leading transplantation

services that are provided by

Royal Prince Alfred Hospital.

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%

RPA Organ Donation Rates Trajectory

Actual Request Rate (%)

Forecast Request Rate (%)

Actual Consent rate (%)

Forecast Consent rate (%)

Actual Donation Rate (%)

Forecast Donation Rate (%)