Laureen Hines – CARU Queensland Health

Moira Goodwin – Silver Chain

Rebecca Bell – Blue Care

The Road To The

Horizon

The Road To The Horizon Growth outstripping supply

Major health care reform

HHS are statutory authorities

National and state funding reform

National targets (NEAT and NEST)

New Beginnings

New Beginnings Need to:

Work smarter, not harder

Look at redesign and reform practice

Partner to deliver innovative models of care Department –The Blueprint for better healthcare in

Queensland Four principal themes:

• Health services focused on patients and people. • Empowering the community and our health workforce. • Providing Queenslanders with value in health services. • Investing, innovating and planning for the future.

Light On The Horizon

Light On The Horizon Hospital In The Home (HITH)

provides care in a patient’s permanent or temporary residence

acute conditions requiring clinical governance,

monitoring and/or input otherwise require treatment in the traditional inpatient hospital bed.

focused exclusively on acute admitted care substitution.

HITH has been identified as an opportunity to

Support patients with greater choice in their care,

improve access to health services,

equal or better patient care outcomes,

improve efficiencies in service delivery.

To underline the importance the state budget allocated $28 million (over four years).

Mode of delivery is via Public Private Partnerships

Horizon Scan

Horizon Scan Consult with interstate colleagues

Consult with MDT stakeholder group Clinical HHS

Departmental

Property

Contestability

Two stage procurement process (geographical diversity, ability to deliver, DRG, scalability and quality)

Contract development (Safety and Quality and governance included)

View of Success

View of Success

Blue Care – Metro South and Townsville

Silver Chain – Metro North and Sunshine Coast

The Silver Chain Group comprises of Silver Chain in Western Australia, New South Wales and Queensland and Royal District Nursing Service (RDNS) in South Australia. Together, we are one of the largest in-home health and care providers in Australia.

Silver Chain and our partners RSL Care and Telstra Health will support patients to plan their care and recovery, providing the patient with the option to receive their health care needs, as appropriate, in their own home.

The Silver Chain led team is professionally trained to deliver to our patients quality services and coordination of their care requirements.

Silver Chain Hospital in the Home HITH PPP QLD

Presented by Moira Goodwin Silver Chain State Manager, Queensland March, 2014

Blue Care NFP operating for more than 60

years

Leading service provider in residential aged care, community care and retirement living

Operates more than 260 centres in 80 communities across Queensland and northern New South Wales

Hospital in the Home partnering with Medibank Health Solutions

Design example

QLD PPP Joint HITH Governance

QLD State HITH

Joint Governance Committee

HHS HITH

Joint Governance Committee

HHS HITH Committee

HHS HITH Working Groups

Provider Board

Executive Governance Committee

Provider Clinical Management

Committee and Medical and Quality

Safety Committee

HHS Board

Executive Governance Committee

Learnings Adjustment Advice Action

Contestability PPP contract implementation

Consider PPP contract management logistics

Contract management relationship building between key Queensland Health and provider to collaboratively implement contract focussing on service sustainability. Ongoing governance and support required - provides platform for escalation of issues.

Clarify HITH need

Understand HHS view of their HITH access problem

Localise HITH model effectiveness to the HHS and to each of the referring Hospitals. Collaborative approach.

Engagement with HHS

Consider PPP impact and workflow changes to implement PPP HITH model

HHS and provider alignment of continuous workflows with collaboration to co-design incorporation of PPP as a component of HHS service delivery

Learnings Adjustment Advice Action

Leadership commitment to PPP contract implementation

Clarification of HHS goals to utilise HITH Tier 1 PPP funding

Collectively agree on implementation communication and joint communication messages to commit to effective uptake of available funding. Change management implementation

Increasing choice in options for acute care delivery.

Multi mode engagement, communication and marketing strategy.

Localise strategy to each hospital to increase acceptance of accessible and responsive options for safe care delivery via HITH model.

Engagement with HHS for HITH design.

Design value target problem DRGs and co-design protocols and pathways.

DRGs simple and complex where appropriate. Clinical Review Committee advice and agreement on protocols and pathways.

Learnings Adjustment Advice Action

Cultural shift enabling acceptance of PPP

Repeated communication from HHS/hospital executive to all levels regarding PPP.

Collaborative working between existing service staff and new service staff. Shared understanding of ownership and changes required. Medical safety and quality.

Messages to be communicated to all involved

Communication and relationships are key. Gain understanding of local processes as starting point

Work with key champions to enable local discussions and trust. Ensure processes are agreed on and clearly understood and regularly reviewed.

Local PPP governance oversight

Relevant representatives to reach process agreement early to enhance referrals.

Messages to be shared through a variety of communication and education options with clear referral processes and minimum documentation.

Learnings

Adjustment Advice Action

Gain trust from referring medical officers and nurses

Understand the requirements of potential referring doctors and nurses

Simplify referral processes Minimum referral documentation Flexibility in medical oversight: provide medical oversight and allow retention of medical oversight Flexibility around DRGs – patient safety first approach

True hospital substitution

Provision of 24 hour acute care

Acute care nursing Flexible 24 hour customer centre Web-based interactive real time care plan forum, includes clinical photography. Mobile devices Video conferencing Medication and diagnostics

Learnings

Adjustment Advice Action

Workforce design alignment to local HITH model requirements

Workforce learning and development processes and competency achievement shared with HHS.

Collaborate with HHS to build confidence in skills, knowledge and capacity to deliver agreed referred care requirements.

Introducing options of Medical Governance.

Direct engagement with HHS referring doctors to confirm governance requirements.

Localise medical governance options including internal HHS Medical Governance and co-design an option VMO HHS credentialed Medical Governance.

Evaluate value of safe and quality PPP HITH service.

Consider evaluation capability requirements at EOI stage.

Multi internal coordination of data linkages to produce reports and complete formative and substantive evaluation.

Learnings

Adjustment Advice Action

Information management system design alignment to HHS

Early identification and analysis of patient information management systems and potential IT interface issues

Work with key IT and system analysts to establish dual IT required modifications and enhancements to enable effective planning for HITH implementation

Collaborative approach to documentation development

Documentation design to meet requirements of all parties.

Identify key contributors to documentation development – policy, access, clinical, safety, pt. information, etc. Streamline referral pathway and minimise duplicate information handling.

Learnings Adjustment Advice Action

Quality and safety

PPP HITH provision should align with hospital quality and safety standards.

Clinical incidents are reported to a risk management system. Clinical risk management plans focus on patient journey from admission to discharge. Clinical review committee Antibiotics/antimicrobial stewardship. Utilisation of Q-ADDS. Reporting against quality performance indicators within PPP contract drives quality of HITH service delivery, eg. pt satisfaction.

Bright Future

Bright Future

HITH Activity 1st Feb-21 Jan

Hospital Health Staff

Questions?