Operational Plan 2014 – 2018 · 2015-08-14 · Bowral & District Hospital Operational Plan 2014 – 2018 Page 1 Foreword The year 2014 will see Bowral & District Hospital celebrate

Bowral & District HospitalA District peer group C1 facility of

South Western Sydney Local Health District

Operational Plan 2014 – 2018

Leading care, healthier communities

Bowral & District Hospital Operational Plan 2014 – 2018

Table of Contents

Foreword ................................................................................................................................................. 1

Executive Summary ................................................................................................................................. 2

Introduction ............................................................................................................................................ 3

Values Framework .................................................................................................................................. 7

Community Profile .................................................................................................................................. 8

Facility Profile .......................................................................................................................................... 9

Bowral & District Hospital: Photo Gallery ............................................................................................... 2

Future Demands .................................................................................................................................... 10

Challenges in Meeting Demands – Current and Future ........................................................................ 11

Priority Service Development Directions .............................................................................................. 12

Corporate Actions ................................................................................................................................. 13

Corporate Action 1: Providing High Quality Health Services ........................................................... 15

Corporate Action 2: Community Partnerships ................................................................................ 21

Corporate Action 3: Seamless Networks ......................................................................................... 24

Corporate Action 5: Research and Innovation................................................................................. 32

Corporate Action 6: Enhancing Assets and Resources .................................................................... 34

Corporate Action 7: Supporting Business ........................................................................................ 37

Corporate Action 8: Efficiency and Sustainability ............................................................................ 39

Implementation .................................................................................................................................... 43

Appendices ............................................................................................................................................ 44

Appendix 1: SWSLHD Guiding Principles ......................................................................................... 44

Appendix 2: Health Snapshot Wingecarribee LGA .......................................................................... 45

Appendix 3: Morbidity and Mortality Data for Wingecarribee LGA ................................................ 48

Appendix 4: Role Delineation Levels for Bowral & District Hospital ............................................... 49

Appendix 5: Flow of Local Catchment Population to hospitals for Inpatient Care – Wingecarribee LGA residents 2011‐12 ................................................................................................ 50

Appendix 6: LGA of Residence of Inpatients of Bowral & District Hospital 2011‐12 ....................... 51

Appendix 7: Core Activity Indicators from the Performance Management Framework ................ 52

Appendix 8: Bowral & District Hospital Workforce Profile 2013 ..................................................... 53

Appendix 9: Inpatient Activity Projections by SRG for 2016/17 ...................................................... 54

Appendix 10: Outpatient Activity (NAPOOS) Projections for 2016/2017 ........................................ 55

Appendix 11: Service Development Directions for Bowral & District Hospital ............................... 56


Page 1

Foreword

The year 2014 will see Bowral & District Hospital celebrate its 125th anniversary. Since first opening

its doors on September 4, 1889, the hospital has served the peoples of the Southern Highlands as a

first class treatment and care facility. From modest beginnings as a small cottage hospital, Bowral &

District Hospital has grown and developed to meet the changing needs of its population whilst

keeping abreast of the complex world of modern health care.

This Operational Plan outlines how the hospital will meet the challenges and demands facing it over

the next five years. Demographic changes and the needs and priorities of the hospital’s partner

agencies within the governing Local Health District, as well as the broader healthcare sector, will be

the main drivers of change.

The main demographic pressures on the hospital will be a continued expansion in population growth

of the Wingecarribee Shire, particularly in those two groups that place the most demand on hospital

services: newborns and the elderly.

As a facility of South Western Sydney Local Health District (SWSLHD), the hospital plays a leading

role in meeting SWSLHD goals and cooperating with SWSLHD programs and these are major drivers

of health planning. Working with the other facilities in the SWSLHD presents Bowral & District

Hospital with both opportunities and challenges and the initiatives in this plan are designed to

exploit those opportunities and meet those challenges.

Although this plan has been written to guide and direct hospital staff over the next five years it is

also a document that the hospital hopes the community will read and embrace. In common with

many small rural facilities, Bowral & District Hospital is recognised as an important community

institution and the local populace takes a keen interest and no small degree of pride in their local

hospital and its work. The staff and management of Bowral & District Hospital are very conscious of

the role the hospital plays in the local community and keeping our local community informed and

engaged is very much an aim of this plan.

The very first requirement in a hospital is that it should do the sick no harm. Florence Nightingale


Page 2

Executive Summary

The Bowral & District Hospital Operational Plan is divided into several sections. The opening sections

provide short descriptions and explanatory statements on the hospital’s values as defined and

promoted by the NSW Ministry of Health.

Community and Facility profiles provide brief descriptions, based on census and hospital

performance data, of the Wingecarribee Shire and the hospital that serves it.

In Future Demands, predicted changes in population, particularly the ageing of the population are

identified and quantified. These predictions are then outlined with the other issues the hospital

faces, both currently and future, under the heading: Challenges.

This is then followed by a section entitled: Corporate Actions, where the plans various initiatives are

projects are listed and detailed. These initiatives and projects are grouped into eight chapters. These

are: ‐

1. Providing High Quality Health Services: ‐ initiatives designed to provide quality health care to the community, the meeting of targets and Key Performance Indicators and the assurance of quality.

2. Community Partnerships: initiatives designed to create, foster and develop relationships with the hospital’s local community: a community that should be engaged with its local hospital, informed about its health care choices and has a voice in service developments.

3. Seamless Networks: initiatives designed to create and improve on links to other services so that people experience health care that is integrated and matched to their needs.

4. Developing our Staff: ‐ initiatives designed to assist the hospital in attracting and retaining the skilled staff required to meet the needs of our patients and the community.

5. Research and Innovation: ‐ initiatives designed to keep the hospital engaged with the ever changing and developing world of modern healthcare.

6. Enhancing Assets and Resources: ‐ initiatives designed to maximise efficiency, maintain equipment and respond to infrastructure needs.

7. Supporting Business: ‐ initiatives designed to keep the hospital at the forefront of rapid changes in information technology and management.

8. Efficiency and Sustainability: ‐ initiatives designed to identify opportunities for improving the hospitals’ effectiveness whilst minimising our impact on the environment.


Page 3

Introduction

In December 2013, three strategic planning documents to guide the future directions of South

Western Sydney Local Health District (SWSLHD) were released:

The Strategic and Healthcare Services Plan ‐ Strategic Priorities in Health Care Delivery to 2021 ‐

which provides the healthcare services development plan for the District for the next ten years

The Corporate Plan 2013 – 2017 ‐ Directions to Better Health ‐ which outlines the actions that

the District will take over the next five years to respond to community and District‐wide needs

and concerns and ensure that targets and strategies articulated in the national, NSW and the

SWSLHD performance agreement are addressed.

Summary of Strategic Directions, a summary of the above two documents.

Together these plans form the basis of aligning all SWSLHD services to achieving the vision of

Leading Care, Healthier Communities. They provide a values framework outlining the CORE values of

Collaboration, Openness, Respect and Empowerment, the foundation stones for building trust with

our local communities. The plans also provide the mission statement articulating our purpose and

outlining how we will work collaboratively, innovatively and equitably to deliver better healthcare

(Appendix 1).

The Bowral & District Hospital Operational Plan 2014 ‐ 2018 provides the framework through which the corporate priorities and actions articulated in the SWSLHD Corporate Plan will be addressed. The Corporate Areas of Action are: ‐ High quality health services

Seamless networks

Research and innovation

Supporting business

Community partnerships

Developing our staff

Enhancing assets and resources

Efficiency and sustainability

The plan outlines the specific strategies that the hospital will take over the next five years to realise

these organisational goals and contribute to the achievement of the SWSLHD vision.


Page 4

Map of South Western Sydney Local Health District


Page 5

Map of the Wingecarribee Shire showing major population centres. The service boundaries of the

Bowral & District Hospital are the same as the Shire’s.


Page 6

Map of Bowral township showing the hospital’s location and sketch map of Bowral & District

Hospital.


Page 7

Values Framework

Appendix 1 outlines the Guiding Principles SWSLHD applies in service delivery.


Page 8

Community Profile

The primary service area for Bowral & District Hospital is contiguous with the boundaries of the

Wingecarribee Shire. The name Wingecarribee comes from the district’s chief geographical feature,

the Wingecarribee River and is derived from an indigenous Dharawal language word which is

thought to refer to either “a flight of birds” of “waters to rest beside.”

The eastern parts of the Shire are bounded by the Illawarra escarpment and Morton National Park,

including important tracts of remnant rainforest and heath. The north of the Shire is characterised

by the rugged eucalypt bushland, gullies and gorges that mark the south‐western boundaries of the

Sydney metropolitan area. To the west, the Shire is bounded by the Wollondilly River and to the

south; Uringalla Creek and its surrounding sandstone plateaus mark the transition from Southern

Highlands to Southern Tablelands.

The pattern of development within the Shire is one of small towns and villages separated and

surrounded by grazing lands, forested reserves and National Parks. Retail and wholesale trade,

manufacturing, health and community services, construction, education and training, recreation and

hospitality are the major sources of employment, with only 5% of the workforce engaged in

agriculture.

Road and rail corridors provide the main transport arteries to the Sydney and Illawarra metropolitan

areas, the road distance between Bowral & District Hospital and its main referral hospital, Liverpool,

being 87 km.

In 2011, the population of Wingecarribee LGA was 46,126 people of whom 802 (1.8%) identified as

either Aboriginal or Torres Strait Islander. The Shire has a lower proportion of young people and a

higher proportion of older people (15% aged 70 years and older) than the rest of NSW. The

population grew by approximately 5% between the 2006 and 2011 Census.

Projected population growth for 2011 to 2021 is 6.2% which is less than the expected NSW rate of

14.0%.

Median household income at the time of the 2011 census was $1,094.00, less than the NSW median

and belying the district’s reputation and self‐promoted commercial and tourist image, as a region

characterised by wealth and affluence.

Life expectancy of 85.4 years for males and 84.8 for females is higher than the NSW averages. The

fertility rate (the average number of babies born to a woman throughout her reproductive life) for

Wingecarribee LGA of 2.17 births is one of the highest in NSW.

In measures of Social Capital, which look at the social relationships within a group or community

such as trust between people and shared codes of behaviour, Wingecarribee residents typically

score higher and rate their attachment to their communities higher, than NSW averages.


Page 9

Facility Profile

Bowral & District Hospital is classified as a District group C1 hospital, meaning it provides services for the local community, treating between 5,000 and 10,000 acute episodes of care per annum. An ‘episode of care’ is defined as: ‐

A period of care in a hospital…for a single type of care such as acute, rehabilitation or palliative care. If a patient begins with acute care and then changes to rehabilitation, this would be two episodes of care.

For the calendar year 2013 the hospital’s major performance indicators were as per the table below: ‐

Total Episodes of

Care

Same Day Episodes of

Care

Elective Surgery

Procedures

ED Presentations

Babies Born

8,262 3,437 1,494 17,631 469

Clinical Services

The Hospital provides clinical services in: ‐

Emergency Medicine

General Medicine including Stroke, Cardiac

and Aged Care

General Surgery

Orthopaedic Surgery

Obstetrics

Gynaecology

Paediatrics including Paediatric Outreach

and Child & Adolescent Mental Health

High Dependency Unit (HDU)

Ophthalmology

Equipment Loans

Geriatrics

Anaesthetics including Pre admission Clinic

Cardiac Assessment and Rehabilitation

Mental Health including Day Therapy and

Youth Services

Rehabilitation

Allied Health including Social Work,

Physiotherapy, Speech Pathology, Dietetics,

Occupational Therapy and Specialised Aged

Care

Aboriginal Health Clinic

Palliative Care

Alcohol and Other Drugs services including

Needle Exchange

Pharmacy

Pathology

Radiological Imaging including X‐ray,

Ultrasound and Computed Tomography

(CT)

Satellite Renal Service (single chair)


Page 2

Bowral&DistrictHospital:PhotoGallery

Main Administration Building

Uni of Wollongong: New Student Accommodation

Uni of Wollongong: New Student Accommodation


Page 3

Milton Park Wing: Main Clinical Building

Original Cottage Hospital: Opened 1889

Memorial Gardens


Page 4

125th Anniversary Celebrations

Hospital Coat of Arms and Motto

Aliis Non Nobis

For Others, not for Self


Page 5

Patient Activity and Performance

A snapshot of key indicators over three years at Bowral & District Hospital presents the following

picture of hospital activity: ‐

2010/11 2011/12 2012/13

ED Presentations 18,193 18,038 17,527

Episodes of Care 9,059 8,812 8,580

Births 521 467 450

Theatre Cases 2,780 2,780 2,776

16,500

17,000

17,500

18,000

18,500

19,000

2010/11 2011/12 2012/13

ED Presentations

8,000

8,500

9,000

9,500

2010/11 2011/12 2012/13

Episodes of Care


Page 6

2,000

2,250

2,500

2,750

3,000

2010/11 2011/12 2012/13

Theatre Cases

400.00

450.00

500.00

550.00

2010/11 2011/12 2012/13

Births

On a typical day at Bowral & District Hospital in 2012/13, there were:

24 patients discharged from hospital

48 people assessed in the emergency department

1 baby born

8 operations, including 1 emergency operation

177 outpatient, ambulatory and community based services


Page 7

Workforce

In 2013, 361 people were employed at Bowral & District Hospital. This includes 208 nurses, 32

medical staff and a range of other clinical and non‐clinical staff. The graph below provides a

breakdown of the workforce by employment category.

Recent Achievements

Initiating a management plan to identify patients at risk of falling and measures to prevent such falls

A program targeting the identification and treatment of sepsis

The roll‐out of the Communication with Purpose (ComPurs) program

A system to monitor and maintain staff competencies in a range of important clinical skills

New equipment, e.g. wheelchairs, steamers, stick vacuums, floor polisher, bed mover, microfibre cleaning cloths, beds, intravenous pumps, pressure‐relieving mattresses

New security equipment and cameras

Establishing the Tharawal Clinic and appointing an Aboriginal Liaison Officer to improve access to healthcare for the local Aboriginal community

Implementation of the Hanen Program for pre‐schoolers with language delay

Implementation of specialist aged care service (SpACT)

Centralising the following services in the new Outpatient Clinic: ‐ o Haematology o Podiatry o Respiratory o Rehabilitation

Introduction of linen imprest levels to maintain ward stocks levels

Improved cleaning standards with audits and new equipment

The redesign and refurbishment of the Emergency Department to improve resuscitation and patient treatment resources and improve access to the department

The achievement of National Emergency Admission Target rates that regularly exceed averages for both the LHD and NSW

The initiation of an Executive On‐Call system to provide better managerial support to front‐line clinical staff

A program of transferring moderate and high‐risk pregnancies to Campbelltown whilst Bowral continues to provide ante‐and post‐natal care services: thus ensuring patient safety whilst maintaining important aspects of their care locally

58%

9%

0%

8%

1%

24%

0%

Bowral & District Hospital Workforce Profile, 2013

Nursing

Medical

Imaging

Allied Health &Complementary TherapyPharmacy

General HospitalEmployeesOther


Page 8

The opening of a Monday to Friday, midwife‐managed, antenatal clinic.

Replacement of older equipment in the special care nursery and delivery suite.

The creation of a new paediatric outreach service to provide out‐of‐hospital services to identified children

In cooperation with the Berrima & District Credit Union’s Children’s Foundation, the establishment of a new Paediatric and Adolescent Mental Health position

Supervision and education of paediatric advanced trainees seconded from Sydney Children’s Hospital every six months

Clinical Nurse Educator, Elizabeth Longhurst awarded 2014’s Vocational Service Award by the Rotary Club of Bowral‐Mittagong in recognition of her work in improving patient journeys in the High Dependency Unit.

Financial Year 2013‐2014: 219 orthopaedic joint replacements performed

Surginet (part of the electronic medical record) rolled‐out to Operating Theatres

Refurbishment of Operating Theatres to provide a new patient accepting bay, new storage rooms and improved staff facilities

Partners

Work with Medicare Local on disaster planning and preparedness

Achieving agreed standards for the transport of mentally ill patients with the Police, Ambulance and Mental Health services

Improved transfers to and from our major tertiary referral hospital; Liverpool.

Working with the Community Health Nursing team to prevent hospital admissions and facilitate discharges

Improving multidisciplinary cooperation between the Maternity Unit, Drug and Alcohol and Social Work.

Working with a major donor, the Berrima District Credit Union’s Children’s Foundation to fund and improve paediatric services.

Partnering with Liverpool Hospital on the early return of patients following Percutaneous Coronary Intervention

Construction of a purpose‐built student accommodation facility next to the hospital by the University of Wollongong

United Hospital Auxiliaries of NSW

Volunteers

Community Participation

Education and Teaching

Certificate III Wardsperson Course for Hotel Services staff

Participation in the EdWISE program: a web and video based innovative simulation and e‐learning program for health professionals

Hospital Grand Rounds

Increased engagement by Clinical Nurse Educators (CNEs), hospital wide

Post graduate training opportunities for medical students from the University of Wollongong

Undertaking mock trial fellowship examinations for four paediatric trainees attending from Sydney Children’s Hospital

HDU developed ART /CVC line education

Completion of Privacy Training

Completion of Respecting the Difference training

Research


Page 9

Hospital participation in a variety of external research programs including those focussed on: o Hand hygiene o Infection Control o Sepsis o Anti‐microbial stewardship.


Page 10

Future Demands

Population growth, chronic health problems and ageing will be the major contributors to increased

demand for healthcare services on Bowral & District Hospital through to 2018. Ageing, in particular,

presents a special challenge for this hospital as the proportion of older persons in the Shire, already

greater than the NSW average, continues to grow.

Using NSW Ministry of Health Methodologies to predict future demand for health services, the

following table illustrates those particular services that are expected to experience the greatest

growth in demand over the time‐span of this plan: ‐

% increase in National Weighted Activity

Units through to 2017

Cardiology 18% Gastroenterology 13%

Neurology 25%

Respiratory 21%

Orthopaedics 18%

Ophthalmology 25%

Obstetrics 23%

Using the above referred to methodologies; the Ministry of Health estimates that by 2017, Bowral &

District Hospital will require an additional four day‐only and ten overnight beds.

The extent to which this increased healthcare demand can be provided by Bowral & District Hospital

will depend upon funding availability for the service developments and requisite capacity

enhancements identified within this plan.


Page 11

Challenges in Meeting Demands – Current and Future

The major challenges that will face Bowral & District Hospital over the next five years include: ‐

Continued population growth particularly in elderly persons and newborns o In 2011, 14.5% of the local population was aged 70 years or older. By 2021, it is

expected this will grow to 19.9% o The local fertility rate (i.e. the average number of babies born to a woman

throughout her reproductive life) is 2.17; this is higher than the average NSW rate of 1.91.

o Both newborns and elderly are significant consumers of health resources and meeting this growing demand is a particular focus of many of the actions outlined in this plan

Ageing and outdated building stock o The main clinical building was opened 1961, one ward is housed in a building dating

back to 1933 o Older buildings do not lend themselves to renovation as building standards for

clinical units have changed extensively since the hospital was originally constructed. For example, in 2009, when the hospital renovated its Yeoman Ward to meet today’s standards, the ward had to change from 16 to 8 beds.

o Working within the current building infrastructure places particular demands and creates special issues for staff and patients

Improving access to health services for those who, primarily for socio‐economic disadvantage, age or lack of transport, have difficulty accessing the hospital

o Belying its reputation as an area of significant wealth and affluence, census data indicates that the Wingecarribee Shire, in common with many rural LGA’s, contains significant proportion of low income families and individuals including a high proportion of single‐person‐households

o Lack of public transport represents a real barrier for people trying to access health services.


Page 12

Priority Service Development Directions

Of the range of service development directions identified for Bowral & District Hospital, the highest

priority developments are as follows: ‐

Allied Health – extend the current service provision for Allied Health, particularly physiotherapy,

social work and pharmacy services, from a five‐day‐a‐week model to seven‐days‐a‐week and extend

dietetics from three‐days‐a‐week to a full Monday to Friday service (see 1.3.1 below).

Aged Care and Rehabilitation – Using Outpatient, Day Hospital and Hospital‐in‐the‐Home service

models, expand geriatric, rehabilitation and stroke services. Investigate the possibility of establishing

a nurse specialist led stroke thrombolysis‐service (see 1.1.2, 1.5.5, 2.1.5, 3.2.3, 3.3.4, 3.4.1, 3.4.5,

3.4.6 below).

Cardiovascular ‐ enhance cardiology services through development of a Cardiology‐On‐Call roster;

and continue plans for supporting renal dialysis for self‐dialysing, ambulatory patients in a stable

medical condition (see 1.5., 2.3.3, 2.3.4 below).

Critical Care – Develop a model of care for a high quality, critical care service that includes

streamlining of transfers between the hospital’s two critical care units: Emergency Department and

High Dependency Unit. The model will allow for a seamless transfer of care between the units as

well as fostering an environment of mutual support and resource sharing (see 1.3.1 & 3.2.6 below).

Women’s Health – Evaluate the effectiveness and impact of transferring moderate‐ to high‐risk

patients to Campbelltown for obstetric care with Bowral providing ante‐ and post‐natal care.

Evaluate the effectiveness and impact of managing low risk pregnancies at Bowral under a Midwife‐

GP shared‐care model (see 1.4.7 below).


Page 13

Corporate Actions

The following action plan outlines the key actions and initiatives that Bowral & District Hospital will

be taking over the next five years:

The action plan is structured using the eight areas of corporate action referred to in the

Introduction, namely: ‐

o High quality health services o Seamless networks o Research and innovation o Supporting business o Community partnerships o Developing our staff o Enhancing assets and resources o Efficiency and sustainability

Under each of these eight corporate action areas, specific objectives have been identified as well as

the risks to the hospital of failing to progress the initiatives.

Under each objective, specific strategies have been identified, together with timeframes for

achieving them and the staff tasked with responsibility for the strategy.

KeytoAcronymsThe tables below provide definitions for the acronyms that appear in the Corporate Action tables.

Responsible Managers, Positions and Departments

AH Allied Health

ALO Aboriginal Liaison Officer

CE Chief Executive for the Local Health District

CNC Clinical Nurse Consultant

DCF Director of Corporate and Financial Services

DCSS Director Of Clinical & Support Services (Nursing, Pharmacy, Clinical Information)

Dir ED Medical Director of Emergency Department

ED Emergency Department

GM General Manager of the Bowral & District Hospital

GP General Practitioners

HDU High Dependency Unit

HR Human Resources Manager

LHD Local Health District

Medical Admin Medical Administration Manager

NUM Nurse Unit Manager

PT Physiotherapy

SP Speech Pathology


Page 14

Other Acronyms

ComPurs Communication with Purpose Program

eMR Electronic Medical record

IT Information Technology

KPI Key Performance Indicator

MAX Multidisciplinary Assessment Clinic

NEAT National Emergency Acess Target

NEST National Elective Surgery Target

PVITAL Patient, Vital Signs, Input/Output, Treatment, Admission, Legal ‐ a mnemonic used to guide handover between clinicians

QSA Quality Systems Assessment

SpACT Specialised Aged Care Team


Page 15

Corporate Action 1: Providing High Quality Health Services

The community expects and has a right to receive high quality health care. At an individual level, quality is measured by a range of factors including

excellent patient outcomes, ease of access to health care, timeliness of services, good communication, strong teamwork, a seamless service and respectful

treatment. At a system level it is formally measured by achievement of standards and targets and informally through media reports.

The hospital will develop and deliver quality services. Through clinical governance and corporate structures and systems, quality will be monitored and

measured. The hospital will ensure that the strategies implemented enable quality health care to be fostered and strengthened.

Quality health care not only relates to the health care of people who are sick but also preventing health problems from occurring. There is considerable

evidence that intervention in the early years protects children against poor longer term outcomes and that health promotion strategies will prevent

premature death, reduce ill health and prevent further disability.

Bowral & District Hospital Objectives

1.1 Develop staff communication skills in working with patients, family and service providers

1.2 Ensure patients, carers, visitors, community and service providers are treated with dignity, respect and in an ethical manner

1.3 Improve the quality and safety of health services

1.4 Improve the patient experience

1.5 Implement early intervention and health promotion and illness prevention strategies

Note: The column labelled Links to CPS indicates which strategy of the SWSLHD Corporate Plan the Actions relate to


Page 16

Actions Responsible Manager

Completed by

Links to CPS

1.1 Develop staff communication skills in working with patients, family and service providers

1.1.1 Implement the Communication with Purpose (ComPurs) program to improve communication between staff and patients. Specific areas to target: ‐

Clinical handovers

Discharge summaries to GPs

Facility to facility referrals and handovers

GM

DCSS

Dec 2015 1.1.1

The risk of not achieving this objective is: a failure to engage with and include patients, families and service providers in the hospital’s care activities.

1.2 Ensure patients, carers, visitors, community and service providers are treated with dignity, respect and in an ethical manner

1.2.1 Ensure all staff complete Respecting the Difference: Aboriginal Cultural Training with the aim of delivering respectful, responsive and culturally sensitive services to our local Aboriginal community.

GM

HR

June 2015 1.2.1

1.2.2 Develop a local strategy for implementing the NSW Advance Planning for Quality Care at End of Life Strategic and Implementation Framework. Local strategies will include: ‐

Identification of key stakeholders and support networks

Staff training and education

Quality audits of performance

Evaluation

DCSS Oct 2016 1.2.2

The risk of not achieving this objective is: alienating our target populations particularly those most at risk from discrimination


Page 17


Completed by

Links to CPS

1.3 Improve the quality and safety of health services

1.3.1 Expand Allied Health service cover by moving from a five‐day‐a‐week model to a seven‐day‐a‐week‐model

by: ‐

Identifying the need and preparing a report on the limitations of the current model Develop a model of service provision highlighting both the changes and the goals to be achieved Prepare a business case incorporating a cost‐benefits analysis for submission to the LHD Roll‐out the new model with appropriate audit and data collection tools Evaluate the new model and prepare a report for the CE.

AH Feb 2015 (needs analysis)

June 2015 (service model)

Oct 2015 (business case)

July 2016 (roll‐out)

July 2017 (evaluation report)

1.3.7

1.3.2 Meet National Patient Safety and Quality Standards by achieving accreditation against the following programs:

National Standards Plus Five

Quality Systems Assessment (QSA)

Numerical Audit Accreditation schemes.

GM

DCSS

Quality Manager

Ongoing, audits

undertaken at regular intervals

1.3.1

1.3.3 Implement Infection Control strategies for: ‐

Hand Hygiene (e.g. audits, staff training and compliance reports)

Hospital Associated Bloodstream Infections (e.g. incident monitoring and mandatory reporting)

Antimicrobial Stewardship (e.g. policy development and clinical governance via local Drug Committee)

DCSS

Infection Control

Annually 1.3.3

1.3.4 Improve security arrangements via the Security Improvement Tool Audit DCF Annually 1.3.1

1.3.5 Implement the Clinical Excellence Commission’s: ‐

Between the Flags program for staff to recognise and respond to signs of clinical deterioration

Sepsis Pathway for the recognition and management of sepsis

Chest Pain Pathway for the management of patients presenting with chest pain

DCSS June 2014 1.3.4


Page 18


Completed by

Links to CPS

1.3.6 Meet and maintain targets for: ‐

Whole of Hospital (incl NEAT)

NEST

Unplanned readmissions

Unplanned representations

Incident monitoring

GM

DCSS

Annually 1.3.7

1.3.7 Expand the current scope of the hospital’s Morbidity and Mortality Reviews Quality Manager Oct 2014 1.3.2

1.3.8 Develop an initiative based upon the Central Coast Local Health District’s “Top 5” program, aiming to partner patients with dementia and their carers in their own care planning.

DCSS

CNC Aged Care

Dec 2014 1.3.4

1.3.9 Develop opportunities to implement the FOLKs program to ensure prioritisation of care via the use of Orthopaedic Wait List Management Plans

GM

PT

Dec 2014 1.3.4

1.3.10 Undertake Disaster planning and training to prepare staff for the possibility of hospital involvement in a disaster

DCSS

GM

Dec 2016 1.3.7

1.3.11 Ensure that the CORE values are embedded into the organisation:

Promotion at staff meetings

Poster and promotional displays

GM Dec 2014

The risk of not achieving this objective is: losing the community’s confidence regarding the quality of their local health service

1.4 Improve the patient experience

1.4.1 Improve the local Aboriginal community’s access to health service by: ‐

Promoting the work of the Aboriginal Liaison Officer

Promoting the Tharawal Clinic

Ensuring staff complete the Respecting the Difference: Aboriginal Cultural Training

Organising Closing the Gap initiatives such as the hospital’s recent cultural awareness day

GM Dec 2014 1.4.4

1.4.2 Implement the Nine Principles of Timely Patient Care program to: ‐

Improve the timeliness of referrals and transfers of care

Improve multidisciplinary care planning

Improve resource allocation

DCSS GM

Project Lead

April 2016 1.4.1

1.4.3 Evaluate the MAX (multidisciplinary assessment) Clinic AH Dec 2014 1.4.1

1.4.4 Decrease patient falls rate by improving the identification of at‐risk patients and evaluating the effectiveness of the Hourly Rounding initiative

DCSS Dec 2015 1.4.2


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Completed by

Links to CPS

1.4.5 Implement Essentials of Care program initiatives such as: ‐

Review of nursing care plans in the Maternity Unit.

Ways of Working project

Intentional Rounding

Ward redesign in the Emergency Department

Healing Hands project

Review of care plans in the High Dependency Unit

Criteria led discharge of children with diagnosis of asthma

DCSS Annually 1.4.2

1.4.6 Implement the Clinical Excellence Commission’s Patient Care Challenge to refocus the organisation on the patient by: ‐

Supporting and evaluating the established Orthogeriatric Rounds

Supporting and evaluating the established Gynaecology Clinics

Supporting the Aboriginal health programs (see above 1.4.1)

Evaluation of the SpACT model

DCSS

GM

AH

July 2016 1.4.4

1.4.7 Prepare an evaluation report on Bowral & District Hospital’s practise of transferring moderate and high‐risk pregnancies to Campbelltown with ante‐ and post‐natal care being provided at Bowral. A focus for this evaluation is the impact of transfers on patients and the ability of the hospitals to offer seamless transitions from one facility to the other.

DCSS

GM

Quality Manager

June 2016 1.4.3.

1.4.8 Improve management of post operative pain via the Orthopaedic Pain Project DCSS

Pharmacy

May 2015 1.4.3

1.4.8 Review of haematology services utilisation and effectiveness GM June 2015 1.4.3

1.4.9 Implementation of the facility action plan in response to the patient survey Quality Manager

DCSS

June 2015 1.4.3

The risk of not achieving this objective is: Patients who feel alienated from their health service or who view contact with the health service negatively

1.5 Implement early intervention and health promotion and illness prevention strategies

1.5.1 Continued development and evaluation of the Stepping On project AH Jan 2015 1.5.4

1.5.2 Continued development and evaluation of the School Preparedness Program SP Annually 1.5.6

1.5.3 Implementation and evaluation of the Paediatric Outreach (mental health) position DCSS Aug 2015 1.5.11

1.5.4 Expand the pulmonary rehabilitation and cardiac assessment programs to assist in preventing hospital admissions and readmissions

DCSS

PT

Annually 1.5.11


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1.5.5 Review of the current chronic care program delivery in conjunction with Medicare Local to ensure the most effective use of limited resources

PT

GM

June 2015 1.5.11

1.5.6 Review the location and the service provision at the needle exchange machine GM Mar 2015 1.5.9

The risk of not achieving this objective is: Poorer health outcomes for individuals and increased demand on hospital services


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Corporate Action 2: Community Partnerships

Communities have a significant role to play in the operation of health services ‐ in service planning, in service provision through volunteering, in health

research through participation in clinical trials and other forms of research, in working as businesses or local agencies with health services to meet patient

needs or to provide support services, and in building physical capacity through donations and philanthropy. Different approaches will need to be developed

to ensure that all members and sections of the community, including private business, can contribute.

Integral to service development and delivery will be partnerships with patients, clients, carers and the community. Services will need to draw on the

expertise, experience and diversity of community members and communities to ensure that health responses are appropriate to local needs. In particular

greater effort will need to be given to ensuring that communities who experience greatest disadvantage are consulted and involved in planning and

development of services and programs that are tailored to meet their needs.

Health literacy plays a key role in building effective partnerships with the community. The hospital will need to ensure that the opportunities created

through new social and information media are adapted so that the community and patients receive information in a way that is easily understood and

enables them to make informed choices. Services will also need to consider and accept formal feedback from patients, services and the community when

evaluating the effectiveness of services and programs.


2.1 Engage and involve stakeholders in planning, service development and delivery

2.2 Raise the profile of the District locally through timely and accurate information

2.3 Empower individuals and local communities to make informed health choices


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2.1 Engage and involve stakeholders in planning, service development and delivery

2.1.1 Strengthen and build on partnerships with the Tharawal Clinic via initiatives listed in 1.4.1 above. GM July 2018 2.1.8

2.1.2 Continue to support and promote the work of the local branches of the United Hospital Auxiliaries of NSW by: ‐

Providing meeting and support services

A hospital liaison to attend meetings and provide information and feedback

Hosting annual events and publicly demonstrating the hospital’s appreciation of the Auxiliaries’ work

Liaising with the Auxiliaries and obtaining their support for appropriate initiatives and purchases

DCSS Annually 2.1.6

2.1.3 Continue to support and promote the work of the hospital volunteers and Pastoral Care Workers by: ‐

Promoting and recruiting to the services

Providing meeting and support services

Hosting annual events and publicly demonstrating the hospital’s appreciation of the volunteers work

DCSS Annually 2.1.6

2.1.4 Liaise with the Wingecarribee Shire Council regarding the installation, use and management of outdoor exercise equipment

PT Dec 2018 2.1.1

2.1.5 Aged Care CNC and Occupational Therapy services to work with the local Men’s Shed Groups on promotion of Men’s Health

Aged Care CNC

OT

April 2016 2.1.3

2.1.6 Continue to work with the Berrima and District Credit Union’s Children’s Foundation on the recently started Paediatric and Adolescent Mental Health Nurse. Evaluate the new service and provide feedback to the donors

GM

DCSS

May 2015 2.1.2

2.1.7 Engage the community in the hospital’s quasquicentennial celebrations via: ‐

Organising and promoting a schedule of events

Inviting community participation in events

Promoting events and historical markers via media releases

GM Dec 2014 2.1.9

2.1.8 Ensure community participation in service planning by engaging with the local Clinical Council, inviting community participants to appropriate forums and ensuring plans and developments are communicated to the public.

GM Annually 2.1.1

2.1.9 Cooperate with university partners in planning student placements and programs DCSS

GM

July 2015 2.1.2

2.1.10 Continue to promote the hospital’s Assistant in Nursing course with local High Schools DCSS Annually 2.1.5

The risk of not achieving this objective is: alienation of the hospital’s community from service planning and delivery


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2.2 Raise the profile of the District locally through timely and accurate information

2.2.1 Continue to promote and fund the hospital’s annual Centenary Scholarship DCSS Annually 2.2.1

2.2.2 Regular media releases via the LHD Media Unit, to highlight service developments, new initiatives and major achievements.

DCSS

GM

Annually 2.2.1

The risk of not achieving this objective is: a community that is not aware of what its hospital is doing or promoting

2.3 Empower individuals and local communities to make informed health choices

2.3.1 Promote the Close the Gap program via media releases, staff education and regular events DCSS

GM

Quality Manager

Annually 2.3.1

2.3.2 Ongoing promotion of falls prevention including the April Falls Month event, to raise awareness of falls risks and minimise falls incidents

DCSS Annually 2.3.1

2.3.3 Increase community awareness of the Complex Care (Cardiac & Respiratory)programs DCSS GM

June 2016 2.3.1

2.3.4 Use the Hearts in the Highlands and Lung Support groups to raise community awareness of the services available for chronic conditions

DCSS

AH

Annually 2.3.2

The risk of not achieving this objective is: A community and individuals less able to make informed decisions about their health care


Page 24

Corporate Action 3: Seamless Networks

The health of individuals and communities is not only dependent on quality of health care and how and where health services and programs are delivered

but also on individual factors including the social and environmental determinants of health such as education, employment and income and food security.

Improving health can as a result be extremely difficult, requiring excellent communication, coordination and collaboration within and across health facilities

and services, with other health providers such as general practitioners, with community services and across levels of government.

Health improvement will require input from medical, nursing, allied health, prevention and other health practitioners across hospitals, community health

centres and primary health care settings. It will also require close collaboration and coordination with other government agencies and community based

services which provide ongoing support to individuals, families and communities.

Health staff and services across the Hospital will work at local and regional levels to plan for future needs, develop services and programs, improve access

and build knowledge about factors which contribute to health and wellbeing which will influence the work of other agencies.

There will also be a focus on building an integrated health care system for local residents and other people using and working with health services. This will

mean that irrespective of where help is sought, the right service can be accessed. Networks will be developed within clinical and service streams to build

skills and expertise. Where required, centres of excellence will be developed to ensure that health care is provided at the most appropriately equipped

facility.


3.1 Actively participate in regional and local forums to build capacity to respond to emerging needs

3.2 Foster coordinated planning and service delivery in health care

3.3 Improve transfer of care and patient access to services

3.4 Strengthen access and support for high needs groups


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3.1 Actively participate in regional and local forums to build capacity to respond to emerging needs

3.1.1 Work with the region’s Primary Health Network to include targeted integration strategies, collaborative planning and community consultation

GM

Quality

Manager

June 2015 3.1.5

3.1.2 Regularly meet with other providers of local hospital and aged care services, to improve communication and cooperation

DCSS Annually 3.1.3

3.1.3 Participate on the Local Disaster Management Committee for collaborative intra‐service disaster planning and preparedness

DCSS Annually 3.1.4

3.1.4 Participation in the local Aboriginal Health Forums and Cluster Meetings ALO Monthly 3.1.3

3.1.5 Engage with and represent Health to the local Highlands Child & Families First Committee and the Wingecarribee Early Childhood Intervention Coordination Forum

SP Annually 3.1.3

3.1.6 Utilise membership of the Local Transport Forum to advocate for the health of the community Quality

Manager

Quarterly 3.1.6

3.1.7 Improve public patient access to bronchoscopy and oncology services through enhanced relationships with the Southern Highlands Private Hospital

GM Dec 2015

3.1.6

The risk of not achieving this objective is: failing to keep abreast of service developments and wasting resources solving issues that other facilities may already have found solutions for

3.2 Foster coordinated planning and service delivery in health care

3.2.1 Engage with Community Health and Primary Health Networks to further develop links (e.g. referral processes) between the hospital and community sectors

DCSS Aug 2018 3.1

3.2.2 Lead and participate in the local Ambulance‐Police‐Health Liaison Committee, foster relationships and improve cooperation between the emergency services.

GM Quarterly 3.2.4

3.2.3 Develop and implement the In Place Ageing Project with a local RACF and the Emergency Department, to ensure appropriate management of nursing home residents who require acute care

NUM ED

Quality Manager

June 2017 3.2.3

3.2.4 Identify chronically ill patients who regularly access health services and using resources such as the Chronic and Complex Care programs and the Emergency Department and develop individualised care plans for them that will assist in managing their conditions and reducing the frequency of hospital presentations

DCSS

Quality Manager

Annually 3.2.1


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3.2.5 Using KPI data on re‐presentations, monitor same and identify trends and occurrences requiring further attention or remedial action

DCSS

Quality Manager

Annually 3.2.4


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3.2.6 Develop a “critical‐care‐hub” model of care that aims to: ‐

Provide seamless transfers between the hospital’s two critical care units, ED & HDU

Improves staff support and resources: medical, nursing and allied health, to both units

Develop systems for mutual support and resource sharing between the units

Streamline and provide for seamless transfers of care between the two units

DCSS

Dir ED

NUM ED

NUM HDU

Dec 2015 3.2.3

3.2.6 Improve collaborative planning and management with theWingecarribee Community Health Service for shared patients


The risk of not achieving this objective is: Avoidable hospital admissions, delayed discharges and increased length‐of‐stays

3.3 Improve transfer of care and patient access to services

3.3.1 Improve the efficiency of handover by the continued development and roll‐out of clinical handover tools such as PVITAL and IT innovations.


3.3.2 Continue to use the National Emergency Admission Targets (NEAT) as a driver for innovation and efficiency in managing Emergency Department presentations and admissions.

DCSS

GM

Annually 3.3.1

3.3.3 Use the recently opened Outpatient Clinics to provide a wider and more detailed range of services, improving community access to services, shortening length of stay and avoiding hospital admissions.

GM Dec 2017 3.3.1

3.3.4 Improve the timeliness & appropriateness of information flow between the facility and other service providers including General Practice and Community Health services

DCSS

GM

June 2015 3.3.1

The risk of not achieving this objective is: poor communication of vital clinical information that can lead errors, mistakes, incidents and increases in patient morbidity and mortality

3.4 Strengthen access and support for high needs groups

3.4.1 Evaluate the clinics provided by the Aged Care CNC, Paediatric Outreach, SpACT and MAX Clinics (multidisciplinary assessment clinics), to demonstrate whether these programs access high needs groups in the community

DCSS

GM

Annually 3.4.6

3.4.2 Improve disabled access to Emergency Department, Radiology & Outpatient Clinic DCF Dec 2015 3.4.6

3.4.3 Improve Indigenous access to health services via the targeted work of the Alcohol & Drug Clinic, Tharawal Clinic and the Aboriginal Liaison Officer

GM

ALO

June 2015 3.4.1


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3.4.6 Develop and Implement initiatives and protocols outlined in the Elder Abuse Policy DCSS

Quality Manager

CNC Aged Care

AH

Dec 2016 3.4.6

3.4.7 Development and evaluate a protocol streamlining services for mental health clients DCSS Dec 2015 3.4.7

3.4.8 Provide opportunities to increase access for young people to understand the employment opportunities in health Quality Manager

Dec 2015 3.4.11

3.4.9 Fund raise for and develop a plan carers facilities as an initiative of the 125 fund raising process GM

Quality Manager

February

2015

3.4.6

The risk of not achieving this objective is: poor care outcomes for high needs groups and avoidable hospital admissions


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Corporate Action 4: Developing Our Staff

Over the next ten years, there will be further development of health services in South West Sydney. Quality health services and care relies on having

sufficient staff with the necessary knowledge and skills to provide effective care and to provide it in the right location.

The hospital will need to attract and retain skilled staff across all health professions and support services. It will also need to ensure that the skills and

knowledge of existing staff are developed and that staff has the capacity and adaptability to adopt new practice, and skills needed to support innovation

and change. The hospital will value its workforce and ensure that staff are encouraged, rewarded and treated fairly and with respect.

Building on the work of the Centre for Education and Workforce Development and existing and developing relationships with local universities and NSW

Technical and Further Education, the hospital will develop the skills and qualifications of the workforce. These relationships will also be important in

developing relationships with potential employees.


4.1 Develop a sustainable workforce that reflects and has the skills required to address community needs

4.2 Create an organisation that people want to work in

4.3 Develop relationships with future employees


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4.1 Develop a sustainable workforce that reflects and has the skills required to address community needs

4.1.1 Ensure that all staff address mandatory training requirements DCSS

GM

DCF

Annually 4.1.11

4.1.2 Identify positions that are difficult to recruit to and develop remedial measures HR

GM

Dec 2018 4.1.1

4.1.3 Explore and develop new opportunities for recruitment and retention GM

HR

Dec 2018 4.1.9

4.1.10

4.1.4 Develop a medical workforce plan for the future GM

DMS

Dec 2016 4.1.10

4.1.5 Participate in targeted Aboriginal Training Programs HR Annually 4.1.3

4.1.6 Develop and implement unit based education plans by the Clinical Nurse Educators DCSS Dec 2015 4.1.2

The risk of not achieving this objective is: chronic staffing shortfalls, an inadequate skill base, and poorer health outcomes for patients.

4.2 Create an organisation that people want to work in

4.2.1 Develop and implement the Your Say action plan to implement the recommendations provided by the Your Say surveys.

DCSS

GM

Annually 4.2.6

4.2.2 Promote and encourage staff vaccination clinics. Infection Control

Annually 4.2.3

4.2.3 Ensure that appropriate professional development opportunities are available for staff by the circulation of relevant material and by providing on‐site education

DCSS

GM

HR

DCF

Annually 4.2.4

The risk of not achieving this objective is: chronic staffing shortfalls, an inadequate skill base and poorer health outcomes for patients.


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4.3 Develop relationships with future employees

4.3.1 Continue to enhance the existing cooperative and collaborative frameworks with the universities of Notre Dame, Western Sydney, Wollongong and New South Wales

DCSS

Annually 4.3.1

4.3.2 Continue to develop and expand the new graduate and undergraduate clinical placement programs for nurses, medicine and allied health students

DCSS

AH

DMS

June 2018 4.3.1

4.3.3 Collaborate with local High Schools in the continued development and expansion of the Assistant in Nursing course DCSS June 2018 4.3.2

The risk of not achieving this objective is: loss of teaching and training opportunities and a failure of the hospital to present itself as a potential employer for new graduates and other skilled individuals.


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Corporate Action 5: Research and Innovation

Health services and practices are constantly evolving and changing with new evidence about better methods to respond to emerging needs and improve

health care. There are also changes led by national and state governments that require flexibility and new ways of working including new partnerships.

The hospital has considerable clinical and research expertise and experience that can be leveraged to support the development of the hospital’s healthcare

services. Clinicians and health services will be encouraged and supported to assume leadership roles and identify where they can contribute to health

improvement. In collaboration with Ministry of Health agencies and other agencies, local services will use new health practice and contribute to new

evidence through innovation and research which leads to better health outcomes for local communities.


5.1 Foster an innovative culture and research capability

5.2 Support innovation and best practice in prevention and clinical settings


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5.1 Foster an innovative culture and research capability Chief Executive

5.1.1 Adopt the LHD research strategy as it relates to the facility. Dec 2018 5.1.1

5.1.2 Promote the use of journal clubs, grand rounds and facility based education sessions to foster a culture of continual learning amongst all staff.

DCSS

Quality Manager

DMS

Annually 5.1.8

5.1.3 Increase staff research capacity through the training and development of staff GM

DCSS

Dec 2018 5.1.2

5.1.4 Use and develop the recently opened Education Centre to promote educational opportunities such as distance learning and virtual classrooms

GM

DCSS

Dec 2017 5.1.2

5.1.5 Investigate the creation of a forum for the purpose of promoting and supporting health research in the local area

GM Dec 2017 5.1.2

The risk of not achieving this objective is: a workplace that is resistant to change and innovation

5.2 Support innovation and best practice in prevention and clinical settings

5.2.1 Promote the Annual Health Awards Night as a means of celebrating the hospital’s many achievements DCSS

GM

DCF

Annually 5.2.1

5.2.2 Ensure that the work of the facility is showcased by contributions to the Essentials of Care showcases, Patricia Lloyd Lucas Award, Health Services Award and the SWSLHD Quality Awards

GM

DCSS

Annually 5.2.1

5.2.3 Provide appropriate time and resources so that participants at conferences, symposiums and other external educational courses, have opportunity to share and distribute new knowledge and innovations

DCSS

GM

DMS

Quality Manager

Annually 5.2.2

5.2.4 Develop the existing Grand Rounds program to give it a multi‐disciplinary focus by expanding the range and specialities of presenters

Medical Admin Dec 2015 5.2.1

5.2.5 Use existing collaborative links with the University of Wollongong and the University of Western Sydney, to expand to explore opportunities for the hospital to participate in appropriate research activities

DCSS

GM

Apr 2017 5.2.6

The risk of not achieving this objective is: Failure to keep up to date, a workplace that is resistant to change and innovation


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Corporate Action 6: Enhancing Assets and Resources

SWSLHD will need to ensure that health service infrastructure has capacity to meet the growing and complex healthcare needs arising from demographic

change. Additional investment will be required in public and private health services to meet this demand.

The hospital will continue to identify and invest in capital infrastructure programs and new technology. Information technology will also require further

development to ensure that communication supports clinical services, health service structures and needs. Improving utilisation and management of

existing resources will also ensure that new and existing resources are efficiently used.

The hospital will also investigate and be open to new opportunities to develop health services for local communities.


6.1 Provide physical capacity to address emerging health needs and population increases

6.2. Respond to changes in the operating environment

6.3 Ensure good stewardship of existing resources


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6.1 Provide physical capacity to address emerging health needs and population increases

6.1.1 Evaluate operation of the recently opened Tharawal Clinic and Outpatients Clinic to assess the utilisation of these resources by their respective target groups and evaluate methods for improving access.

DCF Dec 2015

6.1.10

6.1.2 Develop and implement a Bowral & District Hospital repair & refurbishment. Priorities include: ‐

ED redesign (e.g. paediatric bay, radiology access, drug store)

Reconfiguration of laundry and stores

Accessible public toilets

MPG bathrooms

Renovations of the Old Hospital

Car parks

Front entrance access

Carers’ amenities

Quiet Room

Main Hospital Foyer

Maternity Services

Theatre air‐conditioning

Therapy space for inpatients

Redesign of Central Sterilisation Department

Maintenance of external environment including the garden areas

DCF Dec 2018 6.1.2

6.1.3 Use the recently opened Education Centre as a resource for teaching undergraduates on clinical placement DCSS Dec 2015

6.1.3

6.1.4 Continue to improve the hospital’s signage with particular regard to addressing the recognised difficulties patients and visitors have in navigating around the facility.

DCF Dec 2015

6.1.2

6.1.5 Ensure that resurfacing of verandahs, walkways and paths is undertaken to minimise the risks of slips and falls. DCF Dec 2016 6.1.2

The risk of not achieving this objective is: a hospital that losses the capacity to respond to demand, longer wait‐times, poorer responses and adverse impacts on patients’ health outcomes


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6.2 Respond to changes in the operating environment

6.2.1 Cooperate with the LHD’s environmental scanning and health service forecasts GM Dec 2017 6.2.1

6.2.2 Monitor relevant data streams on population growth, morbidity and mortality trends and hospital performance figures and use the data to inform planning decisions

GM Dec 2017 6.2.2

The risk of not achieving this objective is: Failure to keep up‐to‐date, poorer health outcomes for patients.

6.3 Ensure good stewardship of existing resources

6.3.1 Develop and maintain the Assets Register to maintain a record of the hospital’s physical assets DCF Annually 6.3.1

6.3.2 Liaise with LHD Bio‐Medical and Engineering Departments to develop a schedule of planned maintenance, calibration and replacement

DCF Nov 2015 6.3.1

6.3.3 Undertake regular reviews of the Outstanding Equipment List. DCF Annually 6.3.2

6.3.4 Ensure that there is an ongoing review of equipment priorities , and that the design of units (HDU, SSW, medical records) continues to be able to meet demand

DCF

DCSS

Annually 6.3.2

The risk of not achieving this objective is: waste and deterioration of infrastructure


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Corporate Action 7: Supporting Business

In an environment of rapid change, clinicians and managers require access to appropriate and up‐to‐date information and data to support informed

choices, monitor progress and develop new ways of care. Information management and technology (IM& IT) provides potential for developing efficiencies,

promoting innovation and improving patient care.

A patient‐centred Electronic Medical Record (eMR) informed by privacy considerations will provide a comprehensive view of each patient. All team

members will share access to the EMR, strengthening decision making and improving communication.

The hospital will develop bedside technology and use of applications to promote work practice innovation, and provide specialist support required for such

a system. Business planning capabilities will be developed to ensure that existing and new services are viable from a service and financial perspective


7.1 Develop integrated and appropriate technology to meet the needs of clinicians, managers and patients

7.2 Develop business intelligence and decision support capability


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7.1 Develop integrated and appropriate technology to meet the needs of clinicians, managers and patients

7.1.1 Promote the use of remote medicine technology and evaluate the current remote‐ECG system. DCSS

GM

Dec 2015 7.1.7

7.1.2 Improve systems that allow timely communication with general practitioners DCSS July 2015 7.1.4

7.1.3 Investigate the use of wireless and tablet technology in clinical areas within the facility DCF Sept 2018 7.1.8

7.1.4 Evaluate the nurse call and patient wandering systems. DCF DCSS

Dec 2016 7.1.5

7.1.5 Evaluate the application and use of clinical IT equipment DCF Annually 7.1.1

The risk of not achieving this objective is: failure to keep abreast of changes in technology, failure to use these changes to benefit our patients.

7.2 Develop business intelligence and decision support capability

7.2.1 Utilise the data made available by the Performance and Redesign Unit to guide and direct service planning and innovation.

DCSS Oct 2018 7.2.3

7.2.2 Review the process of data integration between public & private facilities, e.g links to Bowral Medical Imaging and the Southern Highlands Private Hospital: to assess effectiveness and identify areas for improvement.

DCSS

GM

Sept 2018 7.2.4

The risk of not achieving this objective is: Failure to maximise efficiency and effectiveness gains from new technology.


Page 39

Corporate Action 8: Efficiency and Sustainability

Recent changes to funding models created by the National Health and Hospitals Reform Agreement will drive considerable change in how services are

funded, provided, organised and measured. There will be a growing emphasis on monitoring performance and identifying opportunities to improve

efficiency and effectiveness in care and service delivery. All services will need to ensure that the necessary processes and systems are used to drive

improvement.

With a complex health environment, responding to new challenges will also create new risks. Systems will need to be developed to ensure that the risks are

clearly identified and strategies are in place to ensure that these risks are managed. These systems will need to be supported by effective governance.

The threats posed by climate change on the environment and on individuals and communities are increasingly recognised. The hospital will reduce and

manage use of resources so that the impact on the environment is minimised.


8.1 Strengthen the financial sustainability of the District

8.2 Minimise risk

8.3 Contribute to environmental sustainability

8.4 Ensure efficiency of services

8.5 Strengthen governance


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8.1 Strengthen the financial sustainability of the District

8.1.1 Develop and Initiate strategies (e.g. training and recruitment) to achieve coding targets DCSS Annually 8.1.2

8.1.2 Audit local revenue performance to assess efficiency and identify areas for improvement. DCF

DCSS

Annually 8.1.4

8.1.3 Ensure that all managers participate in SMRT training DCF

GM

Dec 2018 8.1.6

8.1.4 Develop an annual facility ABF plan. GM

DCF

Annual 8.1.2

8.1.4 Ensure that the hospital meets the negotiated expenditure and activity targets GM

DCF

Annual 8.1.4

The risk of not achieving this objective is: financial loss and inefficiency.

8.2 Minimise risk

8.2.1 Initiate the LHD’s RISKMAN program to facilitate the identification and management of risks. GM

Local champion

Dec 2015 8.2.1

8.2.2 Participate in internal audit processes prepare appropriate responses to audit recommendations GM

DCSS

DCF

Annually 8.2.2

The risk of not achieving this objective is: adverse outcomes for patients, staff and the service.

8.3 Contribute to environmental sustainability

8.3.1 Implement local sustainability options for the facility by the adoption of the LHD sustainability plan .e.g. Light Bulb Replacement Program and insulation

DCF Sept 2016 8.3.1

8.3.2 Investigate consolidation of rubbish removal and continue regular waste audits so as to maximise appropriate sorting and recycling of waste.

Infection control July 2016 8.3.1

The risk of not achieving this objective is: environmental waste and degradation

8.4 Ensure efficiency of services

8.4.1 Review cooperation with other rehabilitation service providers to improve the movement of patients between services (e.g. Camden, Goulburn)

DCSS Nov 2018 8.4.1

8.4.2 Investigate the provision of on‐call services for operating theatres and explore the cost effectiveness of alternatives.

DCSS Mar 2018 8.4.1


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8.4.3 Review the model of care for transfer and management of patients to Residential Aged Care Facilities DCSS

Aged Care CNC

Dec 2015 8.4.2

8.4.4 Review booking and cancellation procedures for Outpatient Services DCSS

DCF

Dec 2015 8.4.1

The risk of not achieving this objective is: Increased costs, financial loss and inefficiency.

8.5 Strengthen Governance

8.5.1 Work with the South Western Sydney Local Health District Board to ensure the major issues relating to Bowral & District Hospital are considered and addressed

GM

DCSS DCF

Annually 8.5.1

8.5.2 Develop the management and decision making skills of Bowral & District Hospital’s executive staff by attending appropriate educational and developmental opportunities

GM

DCSS DCF

Annually 8.5.2

8.5.3 Provide feedback to service heads and staff on the hospital’s performance against annual targets and key performance indicators

GM

DCSS DCF

Annually 8.5.4

The risk of not achieving this objective is: Failure to seize opportunities to improve governance


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8.6 Work Health & Safety

8.5.1 Evaluate local processes aimed at implementing the NSW Ministry of Health’s policy directive: ‐ Work Health and Safety: Better Practise Procedures

GM

DCSS DCF

Annually 8.6.1

8.5.2 Monitor and evaluate breaches of work, health and safety GM

DCSS DCF

Annually 8.6.2

The risk of not achieving this objective is: Failure to maintain a safe workplace, workplace injuries and associated costs, losses and inefficiencies.

Bowral & District Hospital Corporate Plan 2014 ‐ 2018

Page 43

Implementation

Outline how the plan will be monitored and implemented.

For Bowral & District Hospital this might include wording such as:

This Plan identifies the key strategies that will be implemented in Bowral & District Hospital over the

next five years. Against each key strategy the person(s) responsible for ensuring that the operational

aspects of the strategy are progressed and the completion status have been identified.

The Bowral & District Hospital Management Team will monitor, on a monthly basis, progress against

this Plan. It is expected that all services will contribute to achieving the objectives of the Plan and

will report progress to the Executive. The review process will include consideration of:

The performance reports prepared for the South Western Sydney Local Health District Annual

Strategic Priorities and Performance Agreement with the NSW Ministry.

Local priorities from this Plan for inclusion in the Annual SWSLHD Strategic Priorities and

Performance Agreement for the subsequent financial year

New and emerging NSW Government priorities and whether they are adequately reflected

within this Plan.

Reports on progress against strategies which may not be in the annual performance agreement.

This may include strategies which have a longer timeframe or have been prioritised to respond

to the operating environment.

Progress on strategies within this Plan will be used to inform the South Western Sydney Local Health

District Annual Report and reporting to the NSW Ministry of Health


Page 44

Appendices

Appendix 1: SWSLHD Guiding Principles

The Principles which guide how services are managed and developed into the future are:

1. All residents have equity in access to health care services. People who are disadvantaged will be provided with assistance to access services where necessary.

2. Health services across the District will be of high quality.

3. Patients, communities, staff and service providers will be treated with courtesy, dignity and respect.

4. Health care will be patient and family centred and responsive to the needs of individuals,

families and communities.

5. Individuals and communities will be actively engaged in health care and programs. They will be provided with information and supported to make informed choices about their health. Autonomy in decision making will be respected.

6. Population health programs and strategies will be developed with communities and other

agencies to improve the health of local communities. Strategies will be multifaceted to increase effectiveness and sustainability.

7. Services will be provided as close to home as possible and integrated across hospitals,

community and primary health settings. Networks to centres of excellence and tertiary services will increase access to expertise when required and support timely care.

8. Teamwork will occur within all health services, and involves patients, community members and

service partners. New partnerships and opportunities to improve health and health care will be explored and developed.

9. The workforce is valued and will be consulted and included in the development and implementation of initiatives. Personal and professional development opportunities will be provided to enable staff to meet ongoing changes in the health system.

10. Services will be provided in a safe and healthy environment.

11. New models of care, health care practices and technology based on evidence will be used to

ensure that patients and communities receive the best and most appropriate service available. Innovation and research will be encouraged to ensure safe and appropriate interventions.

12. Services will be provided in an efficient and cost effective manner and will be evaluated and

remodelled as required.

13. Environmental sustainability will be fundamental to the design and delivery of clinical and non‐clinical services and infrastructure.


Page 45

Appendix 2: Health Snapshot Wingecarribee LGA

Wingecarribee is one of seven local government areas (LGA) covered by the South Western Sydney

Local Health District (SWSLHD). It is a fringe, medium LGA under the Australian Classification of Local

Governments covering an area of 2,689 square kilometres with a population density of 17 persons

per square kilometre.

Population Demographics

In 2011 there were 46,126 residents, projected to rise to 49,134 by 2021, i.e. 6.5% growth

19.2% are ≤14 years and 14.5% ≥ 70 years of age. By 2021 the proportion of children and older

people will be 17% and 19.9% respectively. The fertility ratei is 2.17 ( NSW rate 1.91)

8.6% of residents speak a language other than English at home (NSW 27.5%), the most

common being Italian (0.6%), German (0.4%), Greek (0.4%) and Spanish (0.2%)

802 residents (1.8%) identify as being Aboriginal people or Torres Strait Islanders (NSW 2.5%)

‐10%

0%

10%

20%

30%

40%

50%

60%

70%

0‐14 15‐44 45‐69 70‐84 85+

% Growth

Age Group

Population Increase 2011 ‐ 2021

Wingecarribee SWSLHD NSW

0%10%20%30%40%50%60%70%80%90%

100%

Age Structure of LGA Populations 2011

0‐14 15 ‐ 44 45 ‐ 69 70 ‐ 84 85+


Page 46

It is ranked the 120th most disadvantaged of 152 LGAs in NSW (SEIFA 2011). The most

disadvantaged suburbs are Welby and Wingello

There are 620 (3.2%) social housing dwellings NSW (NSW 5.0%) ii. 80 people are homeless

41.8% have only completed their education to year 10 or below (NSW 37.1%)

The unemployment rate is 4.2% (NSW 5.9%)

1.8% use only public transport (NSW 11.7%)

19.7% of private dwellings have no internet connection (NSW 20.1%)

81.1% (NSW 72.4%) of residents feel safe walking down their street after dark

82.4% (NSW 73.4) would feel sad to leave their neighbourhood

Health Behaviours of Adults

23.0% of adults consume 2+ standard drinks a day (NSW 30.4%)

58.9% consume the recommended daily amounts of fruit (NSW 56.6%) and 20.9% consume

the recommended daily amounts of vegetables (NSW 10.0%)

47.9% engage in adequate physical activity (NSW 55.2%)

37.2% are overweight (NSW 33.4%) and 27.9% are obese (NSW 19.6%)

14.8 % of adult residents smoke (NSW 17%) The Prevalence Ratio for women who smoke

during pregnancy is 143 (NSW 100)

78% of women have their first antenatal visit before 14 weeks gestation (NSW 79.3%)

The cervical screening rate for women aged 20‐69 years is 62% (NSW 57.3%) xvi. The rate of

breast screening is 75.5% (NSW 76.3%)

Health Status

80.4% of adult residents rated their health as excellent, very good or good (NSW 80.2%).

7.7% indicated high or very high levels of psychological distress (NSW 11.1%)

Compared to NSW (100), Wingecarribee has lower rates of death that are from

- all causes (94.0)

- potentially avoidable (76.1)

- from preventable causes (77.7)

- amenable to health care (80.5)

- smoking attributable (93.2)

- high body mass attributable (75.8)

The rate of deaths that are alcohol attributable is 100.3 (NSW 100)

Compared to NSW (100), Wingecarribee has lower rates of hospitalisations that are from

- all causes (94.9)

- diabetes related (78.1)

- from falls‐related injury (69.4)

- coronary heart disease related (83.8)

- COPD related (78.9)

- alcohol attributable (85.9)

- smoking attributable (96.4)

- high body mass index attributable (96.3)

The rate of hospitalisations that are potentially preventable is 105.3 (NSW 100),

The prevalence of Diabetes is 4.9% (NSW 5.5%)

Hepatitis B notifications are 5.8/100,000 people (NSW 37.6/100,000). Hepatitis C

notifications are 43.7/100,000 people (NSW 57.2 /100,000)


Page 47


Page 48

Appendix 3: Morbidity and Mortality Data for Wingecarribee LGA

Source: Data derived from Centre for Epidemiology and Evidence. Health Statistics New South Wales. Sydney: NSW

Ministry of Health. Available at: www.healthstats.nsw.gov.au. Accessed (10/10/2013).

Indicator Wingecarribee SWSLHD

Deaths from all causes 2005‐2007, Standardised Mortality Ratio (SMR) 93.9 100.8

Life expectancy at birth and by gender 2002‐2006Males: 80.6

Females: 85.4

Males: 78.7

Females: 83.5

Hospitalisations 2009‐10 to 2010‐11, smoothed number of separations per year

(smoothed estimate of Standardised Separation Ratio ‐ seSSR)18,560 (94.9) 284,213

Potentially preventable hospitalisations 2009‐10 2010‐11 smoothed number of

hospitalisations per year (seSSR)1,527 (109.1) 20,431 (n.a.)

Alcohol attributable hospitalisations, 2009‐10 to 2010‐11, smoothed number of

hospitalisations per year, (seSSR)29 (87.5) 4,792 (n.a.)

Smoking attributable hospitalisations, 2009‐10 to 2010‐11, smoothed number of

hospitalisations per year (seSSR)340 (93.4) 4,692 (n.a)

High body mass index attributable hospitalisations, smoothed number of separations

per year 2009‐10 to 2010‐11 (seSSR)317 (101.7) 4,218 (n.a)

Coronary heart disease hospitalisations 2009‐10 to 2010‐11 smoothed number of

hospitalisations per year (seSSR)354 (83.8) 4,806 (n.a)

COPD Hospitalisations, persons aged over 65, 2008‐09 to 2009‐10, smoothed number of

separations per year (seSSR)108 (82.5) 1,533 (n.a.)

Diabetes hospitalisations, 2009‐10 to 2010‐11, smoothed number of separations per

year (seSSR)117 (78.1) 2,293 (n.a.)

Fall‐related injury overnight hospitalisations, persons aged 65 years and over, 2008‐

2009 to 2009‐2010 combined, smoothed number of hospitalisations per year (seSSR)169 (66.1) 2,659 (n.a.)

Potentially avoidable deaths, persons aged under 75 years, 2006 to 2007 combined,

smoothed number of deaths per year,smoothed Standarised Mortality Ratio (sSMR)65 (78.8) 1,115 (n.a)

Deaths from preventable causes, persons aged under 75 years, 2006 to 2007 combined

(sSMR)39 (81.3) 668 (n.a.)

Potentially avoidable deaths from causes amenable to health care, persons aged under

75 years, 2006 to 2007 combined, smoothed number of deaths per year (sSMR)30 (88.1) 449 (n.a.)

High body mass index attributable deaths by LGA 2006 2007, (sSMR) 18 (75.8) 261 (n.a)

Alcohol attributable deaths, smoothed estimate of standardised mortality ratios per

year, 2006 ‐ 2007 (sSMR)9 (100.3) 123 (n.a.)

Smoking attributable deaths, smoothed estimate of standardised mortality ratios per

year, 2006 ‐ 2007 (sSMR)40 (93.2) 504 (n.a.)

Number of people with diabetes ‐ NDSS Registrations (% of 2011 population) 2,124 (4.8%) 53,438 (6.1%)

All cancers, count and age standardised incidence rates per 100,000 2004 ‐ 2008 1,524 (522.0) 16,609 (450.1)

All cancers, count and age standardised mortality rates per 100,000 2004 ‐ 2008 461 (152.6) 6,347 (178.7)


Page 49

Appendix 4: Role Delineation Levels for Bowral & District Hospital

Service Delineation

Level Service

Delineation Level

Pathology 3 Orthopaedics 3

Pharmacy 2 Plastic Surgery NPS

Diagnostic Imaging 3 Urology NPS

Nuclear Medicine 3 Vascular Surgery NPS

Anaesthetics 2 Maternity 3

Intensive Care 3 Neonatology 2

Operating Suite 3 Paediatric Medicine 3

Coronary Care 2 Paediatric Surgery 2

Emergency 3 Family & Child Health 3

General Medicine 3 Adolescents 3

Cardiology 3 Adult Mental health (Inpatient) 1

Dermatology 3 Adult Mental Health (Community) 4

Endocrinology 3

Child Adolescent Mental Health (Inpatient) NPS

Gastroenterology 3

Child Adolescent Mental Health (Community) 3

Haematology 3

Older Adult Mental Health (Inpatients) NPS

HIV/AIDS 2

Older Adult Mental Health (Community) 2

Immunology 3 Child Protection Services 1

Infectious Diseases 3 Drug & Alcohol Services 4

Oncology ‐ Medical 3 Geriatrics 3

Neurology 3 Health Promotion 6

Oncology ‐ Radiation 4 Palliative Care 3

Renal Medicine 3 Rehabilitation 3

Respiratory 3 Sexual Assault Services 3

Rheumatology 3 Aboriginal Health 5

General Surgery 3 Community Health ‐ General 5

Burns 3 Community Nursing 5

Cardiothoracic Surgery NPS Genetics 1

Day Surgery 3 Multicultural Health 3

Ear, Nose & Throat NPS Oral Health 5

Gynaecology 3 Sexual Health Services 1

Neurosurgery NPS Women's Health 4

Ophthalmology 1

Note “NPS” refers to where there is no planned service or a limited service. In addition, some services listed above are provided by other facilities including SWSLHD Community Health Services, Drug Health Services and Mental Health Services.


Page 50

Appendix 5: Flow of Local Catchment Population to hospitals for Inpatient Care – Wingecarribee LGA residents 2011‐12

Cardiology 433 86% 22 4% 5 1% 8 2% 3 1% 1 0% 2 0% 2 0% 30 6% 504

Interventional Cardiology 29 18% 99 63% 2 1% 7 4% 0% 4 3% 0% 0% 17 11% 158

Dermatology 16 89% 0% 0% 1 6% 0% 1 6% 0% 0% 0 0% 18

Endocrinology 33 61% 4 7% 3 6% 1 2% 1 2% 0% 3 6% 0% 9 17% 54

Gastroenterology 730 86% 29 3% 14 2% 13 2% 5 1% 7 1% 12 1% 1 0% 35 4% 845

Diagnostic GI Endoscopy 367 84% 3 1% 19 4% 13 3% 1 0% 4 1% 2 0% 4 1% 27 6% 436

Haematology 78 65% 11 9% 1 1% 2 2% 5 4% 10 8% 2 2% 0% 11 9% 120

Immunology & Infections 82 81% 2 2% 0% 8 8% 1 1% 0% 2 2% 3 3% 6 6% 101

Oncology 39 43% 4 4% 6 7% 3 3% 2 2% 4 4% 21 23% 0% 12 13% 91

Neurology 386 75% 18 4% 14 3% 3 1% 3 1% 7 1% 9 2% 27 5% 72 14% 512

Renal Medicine 50 57% 8 9% 12 14% 8 9% 0% 2 2% 5 6% 0% 2 2% 87

Respiratory Medicine 661 91% 12 2% 8 1% 7 1% 5 1% 1 0% 5 1% 4 1% 24 3% 723

Rheumatology 29 76% 1 3% 0% 1 3% 0% 0% 0% 0% 7 18% 38

Pain Management 41 84% 0% 1 2% 0% 0% 2 4% 0% 0% 5 10% 49

Non Subspecia l ty Med 431 80% 9 2% 17 3% 5 1% 5 1% 12 2% 10 2% 2 0% 49 9% 538

Breast Surgery 31 76% 3 7% 1 2% 1 2% 1 2% 0% 0% 0% 4 10% 41

Cardiothoracic Surg 1 4% 19 79% 0% 0% 0% 1 4% 0% 0% 3 13% 24

Colorecta l Surgery 137 82% 2 1% 10 6% 4 2% 0% 4 2% 1 1% 1 1% 10 6% 168

Upper GIT Surgery 153 76% 7 3% 3 1% 12 6% 5 2% 2 1% 1 0% 1 0% 19 9% 202

Neurosurgery 54 36% 43 28% 0% 2 1% 6 4% 5 3% 3 2% 0% 39 26% 152

Dentis try 0% 2 11% 6 32% 0% 0% 0% 3 16% 1 5% 8 42% 19

ENT & Head and Neck 115 49% 19 8% 26 11% 8 3% 20 9% 3 1% 8 3% 4 2% 36 15% 235

Orthopaedics 476 73% 49 7% 19 3% 5 1% 9 1% 5 1% 3 0% 0% 89 14% 655

Ophthalmology 160 69% 3 1% 8 3% 1 0% 0% 0% 2 1% 1 0% 58 25% 232

Plastic and Recon Surg 129 69% 16 9% 3 2% 1 1% 2 1% 12 6% 0% 8 4% 24 13% 187

Urology 132 40% 28 8% 104 31% 18 5% 2 1% 4 1% 11 3% 3 1% 32 10% 331

Vascular Surgery 33 29% 33 29% 1 1% 5 4% 23 20% 2 2% 5 4% 2 2% 13 11% 115

Non Subspecia l ty Surg 617 81% 39 5% 25 3% 7 1% 6 1% 12 2% 8 1% 1 0% 51 7% 765

Transplantation 0% 0% 0% 0% 0% 1 100% 0% 0% 0 0% 1

Extens ive Burns 0% 0% 0% 0% 0% 0% 0% 1 33% 3 89% 3

Tracheostomy 0% 8 50% 1 6% 1 6% 0% 1 6% 2 13% 0% 3 19% 16

Gynaecology 199 78% 9 4% 6 2% 0% 3 1% 15 6% 1 0% 1 0% 22 9% 255

Obstetrics 426 81% 10 2% 54 10% 0% 19 4% 1 0% 0% 0% 16 3% 526

Qual i fied Neonate 63 64% 2 2% 29 30% 0% 3 3% 0% 0% 0% 1 1% 98

Perinatology 0% 9 45% 0% 0% 0% 1 5% 1 5% 0% 9 45% 20

Drug and Alcohol 92 70% 2 2% 9 7% 0% 1 1% 0% 0% 2 2% 27 21% 131

Psychiatry ‐ Acute 113 40% 1 0% 112 40% 2 1% 1 0% 1 0% 2 1% 13 5% 51 18% 283

Psychiatry ‐ Non Acute 0% 0% 0% 0% 0% 0% 0% 0% 14 100% 14

Rehabi l i tation 9 13% 28 41% 0% 0% 0% 0% 0% 3 4% 32 46% 69

Psychogeriatric Care 0% 0% 0% 0% 0% 0% 0% 0% 4 100% 4

Pal l ia tive Care 2 13% 1 6% 0% 0% 0% 0% 0% 1 6% 13 81% 16

Maintenance 29 78% 2 5% 0% 0% 0% 0% 0% 0% 6 16% 37

Unal located 1 20% 0% 0% 1 20% 0% 0% 0% 0% 3 60% 5

Total 6,377 72% 557 6% 519 6% 148 2% 132 1% 125 1% 124 1% 86 1% 895 10% 8,878

% of

Total

Total Pub

Hosp

% of

Total

Sydney

Childrens

% of

Total Concord

% of

Total

Other

HospitalRPAService Related Group Bowral

% of

Total Liverpool

% of

Total

Campbell

town

% of

Total

St Vincents

Public

% of

Total

Wollon

gong

% of

Total


Page 51

Appendix 6: LGA of Residence of Inpatients of Bowral & District Hospital 2011‐12

Cardiology 433 81% 59 11% 2 0% 3 1% 3 1% 2 0% 0% 35 7% 537

Interventiona l Cardiology 29 88% 3 9% 0% 0% 0% 0% 0% 1 3% 33

Dermatology 16 70% 5 22% 0% 0% 0% 0% 0% 2 9% 23

Endocrinology 33 85% 3 8% 0% 0% 0% 0% 0% 3 8% 39

Gastroenterology 730 80% 132 14% 6 1% 1 0% 1 0% 1 0% 6 1% 39 4% 916

Diagnosti c GI Endoscopy 367 73% 108 21% 6 1% 7 1% 1 0% 2 0% 1 0% 11 2% 503

Haematology 78 95% 4 5% 0% 0% 0% 0% 0% 0 0% 82

Immunology & Infections 82 77% 9 8% 12 11% 1 1% 0% 0% 0% 3 3% 107

Oncology 39 95% 2 5% 0% 0% 0% 0% 0% 0 0% 41

Neurology 386 85% 40 9% 1 0% 2 0% 0% 1 0% 1 0% 21 5% 452

Renal Medicine 50 83% 7 12% 0% 0% 0% 0% 0% 3 5% 60

Respiratory Medicine 661 83% 100 13% 2 0% 2 0% 0% 0% 0% 30 4% 795

Rheumatology 29 63% 5 11% 12 26% 0% 0% 0% 0% 0 0% 46

Pain Management 41 85% 4 8% 0% 1 2% 0% 0% 0% 2 4% 48

Non Subspecia l ty Med 431 79% 71 13% 6 1% 4 1% 0% 1 0% 1 0% 29 5% 543

Breast Surgery 31 66% 10 21% 4 9% 0% 0% 0% 1 2% 1 2% 47

Cardiothoracic Surg 1 100% 0% 0% 0% 0% 0% 0% 0 0% 1

Colorecta l Surgery 137 67% 57 28% 7 3% 1 0% 0% 0% 1 0% 3 1% 206

Upper GIT Surgery 153 74% 37 18% 2 1% 1 0% 2 1% 0% 0% 11 5% 206

Neurosurgery 54 75% 8 11% 2 3% 2 3% 0% 1 1% 1 1% 4 6% 72

ENT & Head and Neck 115 80% 20 14% 1 1% 1 1% 1 1% 0% 0% 6 4% 144

Orthopaedics 476 61% 97 13% 49 6% 35 5% 15 2% 18 2% 11 1% 74 10% 775

Ophthalmology 160 63% 45 18% 31 12% 2 1% 10 4% 0% 3 1% 5 2% 256

Plastic and Recon Surg 129 79% 24 15% 3 2% 1 1% 0% 0% 1 1% 5 3% 163

Urology 132 77% 28 16% 4 2% 3 2% 0% 1 1% 0% 4 2% 172

Vascular Surgery 33 80% 6 15% 0% 0% 0% 0% 1 2% 1 2% 41

Non Subspecia l ty Surg 617 77% 113 14% 13 2% 6 1% 2 0% 5 1% 2 0% 39 5% 797

Extens ive Burns 0% 0% 0% 0% 0% 0% 0% 1 100% 1

Gynaecology 199 70% 41 14% 24 8% 5 2% 3 1% 1 0% 3 1% 8 3% 284

Obstetri cs 426 70% 145 24% 18 3% 5 1% 3 0% 2 0% 2 0% 11 2% 612

Qual i fied Neonate 63 73% 15 17% 5 6% 0% 3 3% 0% 0% 0 0% 86

Drug and Alcohol 92 86% 8 7% 0% 0% 0% 0% 1 1% 6 6% 107

Psychiatry ‐ Acute 113 82% 6 4% 1 1% 2 1% 0% 1 1% 0% 15 11% 138

Rehabi l i tation 9 64% 4 29% 1 7% 0% 0% 0% 0% 0 0% 14

Pal l ia tive Care 2 100% 0% 0% 0% 0% 0% 0% 0 0% 2

Maintenance 29 83% 3 9% 1 3% 0% 0% 2 6% 0% 0 0% 35

Unal located 1 50% 0% 0% 0% 0% 0% 0% 1 50% 2

Total 6,377 76% 1,219 15% 213 3% 85 1% 44 1% 38 0% 36 0% 374 4% 8,386

Total

Hospital

% of

Total

Shoal

haven

% of

Total

Upper

Lachlan

% of

Total

Campbell

town

% of

Total Camden

% of

Total Other LGAs

% of

Total

Goulburn

MulwareeService Related Group

Winge

carribee

% of

Total Wollondilly

% of

Total


Page 52

Appendix 7: Core Activity Indicators from the Performance Management Framework

Indicators 2010/11 2011/12 2012/13

Emergency Department

ED Admissions 5,218 4,927 4,748

ED Admissions to Ward 2,891 2,881 3,072

ED Attendance Triage 1 ‐ Immediately life threatening 66 48 56

ED Attendance Triage 2 ‐ Immenently life‐threatening 695 435 537

ED Attendance Triage 3 ‐ Potentially life‐threatening 2,940 2,355 2,022

ED Attendance Triage 4 ‐ Potentially serious 1,436 1,903 1,898

ED Attendance Triage 5 ‐ Less urgent 81 186 235

ED Attendances 18,193 18,038 17,527

ED Available Beds 10 10 10

ED Emergency Access performance (EAP) 78.5% 80.8% 86.8%

ED National Emergency Access Target (NEAT) 72.7% 72.6% 76.7%

ED Transfer of Care (ToC) 86.7% 87.5%

ED Triage 1 (% seen ≤ 2 mins, immediately life threatening) 100.0% 100.0% 100.0%

ED Triage 2 (% seen ≤ 10 mins, immenently life‐threatening) 77.6% 92.4% 94.8%

ED Triage 3 (% seen ≤30 mins, potentially life‐threatening) 70.0% 79.7% 75.6%

ED Triage 4 (% seen ≤60 mins, potentially serious) 74.2% 80.5% 76.4%

ED Triage 5 (% seen ≤120 mins, less urgent) 93.2% 93.1% 91.4%

Separations

Separations Total 9,059 8,812 8,580

Separations Planned 2,361 2,531 2,531

Separations Unplanned 6,698 6,281 6,049

Separations Overnight 4,937 4,856 4,770

Separations Same Day 4,122 3,956 3,810

Acute Inpatient Activity

Acute Separations Total 9,016 8,762 8,531

Acute Overnight BedDays 17,954 17,705 16,750

Acute Separations Overnight 4,894 4,808 4,721

Acute Separations Same Day 4,122 3,954 3,810

ALOS Overnight

Average Length of Stay Overnight 3.74 3.78 3.61

Average Available Beds

Average Available Beds 86.2 93.5 93.8

Overnight Bed Days

Overnight Bed Days 18,471 18,352 17,199

Non‐acute Inpatient Activity

Non Acute Separations Total 50 49

Non Acute Separations Overnight 48 49

Non Acute Separations Same Day 2 0

Births

Births 521 467 450

Surgery

Theatre Cases ‐ Elective 2,157 2,195 2,251

Theatre Cases ‐ Emergency 623 585 525

Theatre Cases ‐ Total 2,780 2,780 2,776

National Elective Surgery Targets (NEST)

NEST 1 (% within 30 days) 100.0% 100.0% 100.0%

NEST 2 (% within 90 days) 99.1% 100.0% 99.5%

NEST 3 (% within 365 days) 100.0% 98.2% 99.9%

National Weighted Activity Units (NWAU) 1

Acute 5,933

ED 1,783

Mental Health 39

Non Admitted 1,435

Sub Acute 71

Non‐admitted Patient Occasions of Service

NAPOOS 2 46,209 55,400 64,620

1. An NWAU i s a measure of activi ty expressed as a common unit, aga inst which the Nationa l Efficiency Price (NEP) i s paid. It

i s a point of relativi ty for pricing of hospita l services , which are weighted for cl inica l complexity. The ‘average’ hospi ta l

service i s worth one NWAU. More intens ive and expens ive activi ties are worth multiple NWAUs, and s impler and less

expens ive activi ties are worth fractions of an NWAU.NWAU not ava i lable for 2010/11 and 2011/12

'2. NAPOOS exclude Private Referred Non Inpatient (PRENIP)

'3. Data sourced December 2013


Page 53

Appendix 8: Bowral & District Hospital Workforce Profile 2013

Headcount (Number) of

Employees % of Employees

Nursing 208 58%

Medical 32 9%

Imaging 1 0.3%

Allied Health & Complementary Therapy 27 7%

Pharmacy 5 1%

General Hospital Employees 88 24%

Other 0 0%

Total 361 100%

Source: SWSLHD Workforce Profi le, April 2013

Bowral Hospital

Employment Category


Page 54

Appendix 9: Inpatient Activity Projections by SRG for 2016/17

Seps

I/P Beds

@

B'mark2

Seps B'days

I/P Beds

@ 85%

B'mark3

Seps

Beds @

B'mark Seps B'days

Beds @

B'mark

NWAUs

V13

11 Cardiology 24 0.1 390 1,382 4.5 306 27 0.1 449 1,917 6.2 362 18%

12 Interventional Cardiology 0.0 35 203 0.7 52 0 0.0 29 211 0.7 50 ‐3%

13 Dermatology 8 0.0 16 37 0.1 15 8 0.0 16 56 0.2 16 5%

14 Endocrinology 0.0 40 221 0.7 46 0.0 36 213 0.7 43 ‐8%

15 Gastroenterology 296 1.0 264 888 2.9 290 326 1.1 313 1,198 3.9 326 13%

16 Diagnostic GI Endoscopy 462 1.5 40 126 0.4 183 508 1.7 44 175 0.6 197 8%

17 Haematology 75 0.3 21 85 0.3 38 61 0.2 21 124 0.4 42 9%

18 Immunology and Infections 19 0.1 58 151 0.5 41 13 0.0 60 150 0.5 37 ‐8%

19 Oncology 3 0.0 50 272 0.9 61 12 0.0 79 589 1.9 112 85%

21 Neurology 85 0.3 185 1,000 3.2 208 79 0.3 208 1,175 3.8 259 25%

22 Renal Medicine 1 0.0 32 164 0.5 36 6 0.0 38 227 0.7 47 32%

24 Respiratory Medicine 29 0.1 475 2,224 7.2 465 28 0.1 535 2,901 9.3 565 21%

25 Rheumatology 17 0.1 22 85 0.3 22 18 0.1 24 160 0.5 30 39%

26 Pain Management 0.0 8 34 0.1 6 2 0.0 15 63 0.2 7 22%

27 Non Subspecia l ty Medicine 32 0.1 311 1,845 5.9 370 45 0.1 374 2,400 7.7 468 27%

41 Breast Surgery 13 0.0 22 71 0.2 48 18 0.1 26 85 0.3 54 14%

42 Cardiothoracic Surgery 0.0 1 15 0.0 3 0.0 0 4 0.0 2

43 Colorecta l Surgery 158 0.5 47 184 0.6 207 186 0.6 55 390 1.3 235 13%

44 Upper GIT Surgery 17 0.1 96 276 0.9 146 15 0.0 129 450 1.5 195 34%

46 Neurosurgery 4 0.0 65 317 1.0 61 8 0.0 69 399 1.3 80 31%

47 Dentis try 0.0 0.0 16 0.1 0 0 0.0 9

48 ENT & Head and Neck 19 0.1 76 140 0.5 42 20 0.1 109 217 0.7 61 46%

49 Orthopaedics 233 0.8 406 2,211 7.1 1,253 267 0.9 475 2,717 8.8 1,483 18%

50 Ophthalmology 242 0.8 10 37 0.1 147 299 1.0 12 48 0.2 184 25%

51 Plastic and Reconstructive Surgery 120 0.4 23 83 0.3 103 157 0.5 27 95 0.3 125 22%

52 Urology 40 0.1 17 53 0.2 26 45 0.1 24 77 0.2 33 28%

53 Vascular Surgery 2 0.0 31 248 0.8 64 4 0.0 35 253 0.8 70 10%

54 Non Subspecia l ty Surgery 114 0.4 350 882 2.8 409 125 0.4 354 1,057 3.4 447 9%

62 Extens ive Burns 0.0 1 10 0.0 1 0.0 1 9 0.0 1 3%

71 Gynaecology 158 0.5 87 200 0.6 193 157 0.5 89 230 0.7 195 1%

72 Obstetrics 56 0.2 562 1,689 5.4 613 62 0.2 661 2,051 6.6 756 23%

73 Qual i fied Neonate 3 0.0 88 361 1.2 78 5 0.0 119 561 1.8 105 35%

81 Drug and Alcohol 4 0.0 50 129 0.4 25 8 0.0 64 213 0.7 39 53%

82 Psychiatry ‐ Acute 1 0.0 39 217 0.7 63 1 0.0 39 217 0.7 63 0%

99 Unal located 1 0.0 5 43 0.1 16 1 0.0 5 43 0.1 16 0%

Total Acute SRGs 2,236 7 3,923 15,883 51 5,637 2,526 8 4,535 20,673 67 6,715 19%

84 Rehabi l i tation 0.0 10 123 0.4 N/A 0.0 37 673 2.0 N/A

86 Pal l ia tive Care 0.0 4 20 0.1 N/A 0.0 24 286 0.9 N/A

87 Maintenance 0.0 34 377 1.1 N/A 0.0 74 1,549 4.7 N/A

Total Sub and Non Acute SRGs 0 0 48 520 2 0 0 135 2,507 8

Total All SRGs 2,236 7 3,971 16,403 53 5,637 2,526 8 4,670 23,180 74 6,715 19%

2011‐12 average available beds4

4 64

Estimated additional beds in 2017 above 2012 level at benchmark occupancy levels 4 10

1 excludes chemotherapy, renal dia lys i s , unqual i fied neonates

2 benchmarked at 120% occupancy for 250 days p.a.

3 benchmarked at 85% occupancy for 365 days p.a. for acute care and 90% occupancy for 365 days p.a. for sub and non acute care

4 excludes emergency department, renal dia lys i s , bass inets , del ivery sui te, des ignated mental hea lth beds

Service Related Group1

2010‐11 2016‐17

% ∆ in

NWAUs

Day Only Overnight

Total

NWAUs

V13

Day Only Overnight


Page 55

Appendix 10: Outpatient Activity (NAPOOS) Projections for 2016/2017

Clinical Services

2011/12 Equiv

Non Admitted

Patients Occasions

of Service 2017 projections

2011/12 Privately

Referred Non‐

Inpatients 2017 projections

2017 projections

(NAPOOS & PRNIP) % Growth

Aged Care & Rehab 10,825 13,953 0 0 13,953 28.9%

Allied Health 5,627 7,253 0 0 7,253 28.9%

Cardiovascular 3,255 3,356 0 0 3,356 3.1%

Critical Care 12,690 13,566 1 1 13,567 6.9%

Paediatrics 1,938 1,997 0 0 1,997 3.1%

Womens Health 5,428 5,384 0 0 5,384 ‐0.8%

Facility Services 1,742 1,858 0 0 1,858 6.6%

Pathology 12,952 13,813 46 49 13,862 6.7%

Bowral Total 54,457 61,181 47 50 61,231 12.3%Data Sourced Dec 2012, excludes Mental Heal th and i s cons i s tent with that in the SWSLHD Strategic & Healthcare Services Plan . Variance between data in this

table and the SWSLHD Performance Management Framework (data sourced Dec 2013) i s due to exclus ion of PRNIP data , ongoing auditing and service

real ignment.


Page 56

Appendix 11: Service Development Directions for Bowral & District Hospital

Extract from SWSLHD Strategic & Healthcare Services Plan

Allied Health ‐ provide extended hour social work and physiotherapy services for emergency and

specific inpatient caseloads 7 days per week

Aged Care and Rehabilitation ‐ enhance geriatric, rehabilitation and stroke services, including

expansion of multidisciplinary day hospital/outpatient/home based therapy service and

establishment of a nurse specialist led stroke thrombolysis service

Cancer ‐ develop a Cancer Care Centre providing haematology and cancer genetics, in conjunction

with private hospital services, and ultimately a Wellness Centre to enhance survivorship

Cardiovascular ‐ enhance cardiology services through development of a Cardiology on call roster;

and continue on site renal dialysis for self‐dialysing, ambulatory patients in a stable medical

condition

Complex Care and Internal Medicine ‐ develop peri‐operative medicine for people with multiple

medical co‐morbidities admitted under surgical teams; expand medical inpatient and ambulatory

care capacity and service provision in chronic care, including ambulatory infusion services; and

establish an Infectious Diseases Service, including consultation, Hospital in the Home and chronic

care clinics

Critical Care ‐ expand ED services and physical capacity; establish a Medical Assessment Unit/Acute

Assessment Unit (MAU/AAU) adjacent to ED, including associated MAU/AAU clinics; and create a

Critical Care “Hub” to allow for higher acuity admissions to the HDU with ED medical support close

by 24/7

Drug Health ‐ continue provision of hospital consult liaison and counselling and provide for the

Needle & Syringe Program (NSP) via Automatic Dispensing Machines or over‐the counter dispensing

and sharps disposal bins.

Laboratory ‐ Investigate expansion of Pathology to meet demand and changing service models

Medical Imaging ‐ Investigate expansion of Imaging to meet demand and changing service models

Paediatrics and Neonatology ‐ explore feasibility of providing paediatric ENT services; and expand

medical inpatient and ambulatory medical capacity

Surgical Specialties ‐ increase surgical short stay capacity and consider need for modest expansion of

operating theatre capacity; and expanded orthopaedic surgery provision; and explore options for

ENT and urology service development for local public patients in partnership with the private

hospital

Evaluate Women’s Health ‐ deliver midwifery led / GP led shared care service for women with low

risk pregnancies (and their babies), with transfer to Campbelltown Hospital for moderate and high

risk obstetrics care; and continue antenatal and post natal care at Bowral

Bowral & District Hospital97 - 103 Bowral Street

Bowral NSW 2576Tel. (612) 4861 0200Fax. (612) 4861 4511

www.swslhd.nsw.gov.au

© South Western Sydney Local Health District

ISBN 978 1 74079 172 4

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Operational Plan 2014 – 2018 · 2015-08-14 · Bowral & District Hospital Operational Plan 2014 – 2018 Page 1 Foreword The year 2014 will see Bowral & District Hospital celebrate