Australasian Ambulance Winter 2019 CAA Awards Winners announced August 2019

CAA Awards for Excellence: Innovative projects and research for out-of-hospital care in Australia and New Zealand 2 CAA MAGAZINE

Australasian Ambulance – Awards edition 2019

The CAA Awards for Excellence have been updated to capture all the facets 3 – 10 Patient Care of the outstanding projects and research Patient Experience improvement or innovation undertaken by our member services. Technology This year we have five new categories 11 – 16 Innovation or capability each with sub categories to properly capture the phase of the work submitted. Staff Development Full details are available on CAA’s website. 17 – 19 Education improvement or innovation CAA appreciates the dedication, generosity and independence of our 2019 judges. Clinical Thank you to Professor Peter Cameron, 20 – 21 Innovation or capability Professor Vivienne Tippett, Tony Blaber and Steve Irving. Their impressive Leadership credentials can be viewed under Awards 22 – 26 Management practice and operational improvement and innovation for Excellence at www.caa.net.au

We hope you will take the opportunity to Produced by: Australasian Ambulance Winter 2019 CAA Awards learn more about the nominations in the The Council of Ambulance Authorities Winners announced August 2019 CAA Awards for Excellence: Innovative projects and research for out-of-hospital care in Australia and New Zealand magazine and join us in Perth, Western c/PO BOX 714 Wellington New Zealand Cover: Editors: Chris Hornsey, Helen Conlin Australia, to celebrate the individual Artwork created by Jordan Lovegrove, www.caa.net.au July/August 2019 Ngarrindjeri of Dreamtime Creative, achievements of our 2019 nominees. for the SAAS Reconciliation Action Disclaimer: Plan (RAP). This document has been prepared to promote and David Watersanz_print ad_final.pdf 1 24/01/2019 10:28:14 inform discussion. All images reproduced with the Chief Executive, CAA permission of relevant ambulance services.

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PATIENT CARE PROMPT: Providing Best Care

Dr Paul Jennings, Clinical Manager Barwon Background South West Region, Ambulance Victoria The pilot was Phase 1 – Developed & Progressing conceived by Senior Team Manager In 2018, Ambulance Victoria (AV) attended Peter McCormick, more than 60,000 mental health related who observed presentations representing more than 10 the potentially per cent of its workload. inappropriate Many of these patients require little transport of patients medical intervention and could benefit with mental health from a comprehensive mental health and / or social issues assessment. to an emergency department, due to To improve patient care, AV launched the the inability to access Pre-hospital Response Of Mental health more appropriate and Paramedic Team (PROMPT) pilot services. in the Barwon district, where in 2018, ambulances responded to 5,360 mental Ambulance crews PROMPT team health related cases – approximately 15 are also detained cases a day. at the ED as these • 2 people with significant medical patients are generally assigned low acuity concerns were taken to ED. Incoming The PROMPT team – an AV advanced life triage categories. AV published literature referral completed by PROMPT team support paramedic and a Barwon Health supports Barwon district observations and full assessment completed by BH (BH) senior mental health clinician – that a large proportion of mental Mental Health respond in an unmarked sedan to patients health patients receive little medical • 1 person was transported to ED experiencing low acuity social or mental intervention. health issues. as there was no available bed at a The PROMPT team can provide mental mental health facility but required It is hoped the specialised response health patients access to the most admission under mental health act. will safely and efficiently support appropriate timely care by providing The ambulance was released quickly, patients in the community with patient a detailed physical examination, with the PROMPT team supporting referral, where appropriate, and reduce specialised mental health assessment and handover to ED staff. unnecessary transport to an Emergency facilitate appropriate referrals to ensure The early results are encouraging and Department (ED). outstanding health care. the number of referrals is expected to Aim The team is equipped with emergency increase with the continuation of the pilot. The pilot aims to provide the most response and communication equipment appropriate care for patients experiencing and respond via AV’s existing call taking Evaluation low acuity mental health issues. and dispatch procedures for cases meeting The pilot will be evaluated using both the inclusion criteria. quantitative and qualitative methods. The key objectives are to: During the three month pilot (09/05/2019 The ‘proof of concept’ project will result • Reduce overall ‘case unit time’ by to 28/07/2019), the team will operate in a published manuscript describing referring a greater proportion of from 1 pm – 11 pm five days a week the model, experience and evaluation patients to community services (Thursday – Monday). findings. enabling them to safely remain at While there are several similar models home, or be admitted directly to a Implementation operating nationally and internationally, mental health facility At the time this submission was prepared this pilot differs in that it has a cohort of • Reduce unnecessary transport and the for the CAA Awards for Excellence, the patients with low acuity social and mental possible associated anxiety, discomfort pilot had operated successfully for seven health issues and discreet attendance for and frustration experienced in the ED shifts with: treatment in an unmarked car. • Improve community access to specialist • 3 people assessed at home by the If the pilot is deemed successful, AV mental health clinicians for assessment, PROMPT team were able to remain in intends to implement a larger scale treatment and referral the community with current support project, incorporating a number of plans targeted catchments in Victoria, both • Reduce time between mental health regional and urban. issue, assessment and access to • 1 person admitted to a mental health services. inpatient facility directly 4 CAA MAGAZINE

PATIENT CARE Isobel’s story

Emily Wynch, Clinical Quality Improvement an illness or injury, but can make all the • Patient experiences can be Manager, Wellington Free Ambulance difference to whether patients feel that uncomfortable to hear they have been looked after properly. Paul Fake, Executive Director, Quality • Staff can feel challenged and Improvement and Innovation, Wellington The importance of a patient’s experience threatened by patient experiences Free Ambulance is recognised nationally in the Ministry • Our public image may be affected by of Health New Zealand Health Strategy Phase 3 – Project Implemented, patient stories and we have to consider (2016) and the Health Quality & Ongoing Commitment this impact Safety Commission Triple Aim (2011). Isobel’s story is a simple, honest account Internationally, a fourth dimension of • A gentle, humble and non-judgemental of her experience as a patient in which improved provider experience has been approach is needed towards our she talks about what she was thinking and recognised, reinforcing the health and patients and our staff. feeling when the ambulance came. wellbeing of the healthcare workforce Our vision is to be a patient focused is also a critical factor in improving At the heart of Isobel’s experience was her organisation actively seeking the views of the health of individual patients and overwhelming anxiety of leaving home our staff and patients and engaging them populations. without an overnight bag. in shaping and developing services whilst consistently providing high The animated video about quality care. 63-year old Isobel, who called 111 for help with Evaluation her breathing, highlighted the disparity between Isobel’s story has become what ambulance services a metaphor at Wellington believe to be important Free Ambulance for “what and what people like Isobel matters to the patient” say really matters. and a raft of initiatives to improve the patient Isobel’s story was a turning experience. point for Wellington Free Ambulance, signifying that Telling stories will become patient satisfaction does “the way we do things not always equate to a around here” along with good patient experience. plans for staff and patient focus groups, quality It marked a cultural shift improvement initiatives from “doing to” patients, and patient co-design to “working with” patients projects. and become the platform for the Stories for Change By embracing the strategy designed to importance of everyone’s In 2015, Wellington Free Ambulance elevate the voice of both patients and story and in doing so recognising the transitioned from a patient satisfaction staff to improve the quality of care. difference between satisfaction and survey, which generated a 95 per cent experience, all ambulance services can Aim satisfaction rating, to a patient experience start to: survey. Change in the provision of care by • Accept that what is operationally or ambulance services can only occur when However, comments returned with clinically best for the patient, is not leaders value, listen and truly hear the surveys showed that high patient always what matters to patients honest voices and experiences of their satisfaction scores were misleading. Most • Seek out stories, the good and the bad, staff and patients. patients and their whānau, family and care givers say they are “satisfied” on and use them to drive improvements Ensuring these voices are embedded will the survey, but their hand written stories in all aspects of care provision, service give patients and staff a central role in all sometimes described a less than ideal design, improvement and governance aspects of care provision, service design, experience. processes improvement and governance processes. Patient experience is positively associated • Use ambulance sector conferences Background with self-rated and objectively measured and forums to focus on the patient and health outcomes including technical staff experience as well as clinical skills, Patient experience is the term used to quality-of-care delivery and adverse treatments and clinical outcomes. describe those aspects of healthcare that events. But Wellington Free Ambulance do not relate directly to the treatment of realised that: Win ter 2019 5

PATIENT CARE GoodSAM & AED Registration

Mike Ray, Acting Manager Emergency Co-Responder Programs, Ambulance Victoria Phase 2 – Evidence Based Project Early, effective bystander CPR and public access defibrillation are strongly associated with increased rates of survival from Out-of-Hospital Cardiac Arrest (OHCA). AV’s GoodSAM First Responders Ambulance Victoria (AV) partnered patients’ short and long term outcomes, Initial GoodSAM responders were with UK company GoodSAM to adopt particularly in rural areas where recruited from AV’s operational workforce smartphone technology to alert nearby ambulance response times are longer. during the pilot phase. The program was community responders to suspected extended to AV corporate staff, registered cardiac arrests. Patients defibrillated by a member of health professionals, and first aid qualified the public are significantly more likely to Using the smartphone app, AV alerts members from partner organisations in survive to hospital discharge than those the three nearest registered responders May 2018. attended by EMS first responders or to suspected cardiac arrest following paramedics: 64 per cent vs 33 per cent a Triple Zero (000) call, provides them Evaluation vs 26 per cent respectively in Victoria with the location of the patient and the 2017/18. The number of GoodSAM registrations nearest available Automated External increased steadily over the evaluation Defibrillators (AEDs). The closest available Methodology period, from 527 to 1,926 and have now ambulance is simultaneously dispatched reached more than 4,000. and, in some parts of Victoria, the fire AV’s GoodSAM program was rolled out in brigade is co-dispatched. January 2018. The rate of alert acceptance by responders varied according to time of day, with 26 The current AV AED registry has been per cent accepting during business hours, Aim updated with the introduction of 30.4 per cent during the evening and 11.2 The aims of the GoodSAM and AED GoodSAM which has seen more than per cent from midnight to 8am. Registration Programs are to: 5,000 AEDs registered across the state with 2,921 in public access areas. The proportion of OHCA patients • Alert registered community first surviving when a GoodSAM responder responders equipped with an AED (if Six Advanced Medical Priority Dispatch attended was almost four times higher available) to cardiac arrest patients System (AMPDS) event types are used to than GoodSAM eligible events where no generate GoodSAM alerts, with events • Minimise the time ot effective CPR and responder was present (41.2 per cent vs automatically screened for inappropriate defibrillation in OHCA 11.3 per cent). locations or scene safety issues. • Provide registered AED locations to Community responders agree to a code of Scope GoodSAM users conduct pertaining to safety, patient care Responders have been alerted to 544 • Increase bystander Public Access and privacy and can be deregistered if events during the evaluation period Defibrillation (PAD) in the community they do not comply. with the survival rate where there was a • Improve survival from OHCA. GoodSAM responder was much greater Implementation than for all GoodSAM eligible cardiac Background A detailed implementation plan was arrests. developed to incorporate evaluation, More than 6,500 Victorians experience an This highlights the huge potential survival communications and engagement along OHCA every year. gains if every cardiac arrest patient with extensive stakeholder consultation received a GoodSAM response. The community’s role in the chain of and risk assessment for responders. The survival is vital. Without a bystander mental health and wellbeing of GoodSAM The number of GoodSAM responders performing CPR and using an AED before responders is at the forefront of the need to significantly increase to provide an ambulance arrives, the chance of program. a meaningful impact to OHCA survival, survival reduces by 10% for every minute with the program planned to expand to It is estimated there are up to 15,000 of delay. all first-aid qualified adult Victorians from unregistered defibrillators across Victoria. July 2019. GoodSAM works to improve time to CPR Since calling on the public to help find the and defibrillation by alerting trained missing AEDs, five have been registered Further research is planned into the responders. Reducing time to CPR and with AV and GoodSAM every day. motivations and experiences of GoodSAM defibrillation has a significant impact on responders. 6 CAA MAGAZINE

PATIENT CARE Prioritising incidents using ePRF data

Dave Richards, Head of Business Clinical status breakdown for each triage priority for St John incidents Intelligence, St John New Zealand 70% Phase 3 – Project Implemented, Ongoing Commitment 60% The New Zealand ambulance sector’s 50% adoption of electronic patient report 40% forms (ePRF) has meant for the first time that all 1,527 ProQA determinants can be 30% linked to patient acuity at scene. 20% Percentage of patients Percentage The new system means that St John and 10% Wellington Free Ambulance now have a greater number of response priorities that 0% 0 1 2 3 4 better reflect patients’ acuity. Clinical status at scene A working group reviewed 12 months Purple Red 1 Red2 Orange 1 Orange 2 Green 1 Green 2 Grey of data for every determinant in the emergency dispatch software (ProQA) to Implementation • Changed dispatcher training to include develop the new system, including: A model algorithm assigned a priority the new material created • Total incident volumes to each determinant, which was then • Changes in the training environment to • Status of the patient on ambulance manually reviewed, with the main criteria allow dispatchers and call handlers to arrival the status of the patient on ambulance view the changes arrival. A status 0 represents a deceased • Patient destination patient, with a higher status (up to 4) • Changed the audit and review criteria representing a more stable and less critical for dispatchers to ensure that it • Percentage of contacts resolved by allowed for dispatching the ‘most clinical telephone advice patient. Reasons for changes applied as part of the manual review are: appropriate resource’ vs the closest • Patient and public experience. resource • Low or no volume in last 12 months The new priority dispatches with colour skewed the model algorithm in % • Posted additional subject matter coding have reduced the percentage of experts (SMEs) in the communication lights and sirens responses from 46 per • When ‘see & treat’ and ‘hear & advise’ centres to support staff for two weeks cent to 30 per cent. The decrease has success rates were applied, cases were post roll out. also reduced the number of broken meal often downgraded if these could be breaks and increased the availability of successfully managed better with CTA Evaluation ambulances to ensure the highest acuity • Not alerts, police/fire responses and The project has reduced the percentage patients get an ambulance first. unknowns (onset) were standardised to of incidents that are a lights and sirens response from 46 per cent to 30 per cent. The Hear and Advise rates for Clinical the same Orange incidents Telephone Advice (CTA) have also • Determinants were often upgraded if ‘Hear and advise’ rates for CTA that improved as a result of more determinants data showed overwhelming status two, successfully avoid an ED presentation have being appropriate for CTA. even if status 0 and 1 were few. increased from 3.5 per cent to 4 per cent of all EAS incidents. Aim Once the response priorities and dispatch procedures were finalised, the following Reducing the percentage of red incidents The aim of the project was to review the engagement process was implemented: and changing the dispatch system from triage priority using 12 months of ePRF sending the ‘closest resource’ to the and Clinical Hub data with the goal of • Creation of comprehensive documents ‘most appropriate resource’ reduced improving dispatches to ensure highest explaining the reprioritisation process the number of broken staff meal breaks acuity patients get an ambulance first and and outcomes including station posters, and the number of times crews were as fast as possible. documents in bulletins and information dispatched when they were over their 5 ½ for specific areas/agencies This project also aimed to improve the hours of driving and required a rest break. number of low acuity patients going • Teleconferences and district meetings The number of back up responses to to secondary triage and increase the for field operations Orange incidents also dropped from 12.1 percentage managed with clinical • Presentations to Clinical Control per cent to 9.9 per cent, as the most telephone advice and avoiding an ED Centres; including information evenings, appropriate resource is sent first time. presentation. dispatcher scenario sessions, podcasts, online modules and printed material Win ter 2019 7

PATIENT CARE Community Paramedic – Ceduna

Throughout the implementation phase all internal and external stakeholders were engaged. Internal and external stakeholder management has continued throughout the program, with strong relationships a testament to the ongoing success of the CP program in Ceduna.

Evaluation A detailed six-month evaluation of the project was endorsed by the Board and the SAAS Executive Leadership Team. Key achievements include: • Clinical practice guideline and scope of Robert Tolson, Operations Manager, Implementation practice tailored to meet local service Far North & West Coast, SA Ambulance With State Government funding for the delivery needs Service CP program the SAAS Executive supported • Clients are managed by CPs, with follow Phase 3 – Project Implemented, the development of a CP model at Ceduna. up and referrals into and from the Ongoing Commitment By working collaboratively with other primary healthcare system SA Ambulance Service (SAAS) expanded health care professionals, the CP has • Other health care professionals, service its model of Community Paramedicine in a shared responsibility and where providers and general community are 2018 to include Ceduna. appropriate provides medical oversight extremely supportive of the initiative, but may not provide treatment outside the quality and timeliness of the Ceduna was selected following a their scope of practice. service successful trail funded by Federal and State Governments. ICPs were selected on merit enabling • Many providers and community the project to deploy a highly qualified members have written testimonials in The model complements and enhances clinician with a broad scope of practice support of the project and the need to SAAS’ existing service delivery model, able to provide interventions to ensure it continues. reduces demand on other health services significantly benefit patients. and provides tailored solutions for An extensive range of benefits for the vulnerable and remote communities in Stakeholders were identified for the Ceduna community across clinical, social South Australia. program through local health networks. A and educational have also been identified working group comprised key stakeholders from; daily health checks and medication The unique model provides Community to ensure the project remained focused distribution and palliative care support to Paramedics (CP) in remote communities on the needs of the local area. community CPR and AED training, chronic where they can coordinate care options disease management and support of and link people with appropriate support During the project phase SAAS also local social and inclusion services in the in a range of areas including palliative established a Project Governance Board development and delivery of care plans. care, mental health and complex care. (PGB). The Ceduna program has included the Local needs and service delivery gaps Scope addition of two Full Time Equivalent (FTE) were identified while work began on The non-prescriptive and flexible delivery paramedics with Intensive Care Paramedic deployment of fluid and dynamic service model for Community Paramedics has (ICP) authority to practice. They are delivery models, aimed at tailored allowed a truly salutogenic approach to equipped with specialist vehicles and solutions to support outcomes critical to healthcare delivery in this community equipment to effectively treat patients the local community rather than a generic based around strong relationships and where they live; provide preventative or prescriptive representation. trust. health screening and referrals in a The local working groups, chaired by the community setting. While this CP model has been deemed a local Operations Managers for each area, successful service delivery option within The program helps clients avoid serious remain responsible for the establishment regional SA, there is a continuing challenge medical conditions that may require of key measurable outcomes specific to with funding. Service and workforce reform urgent medical attention, in turn reducing the site in addition to the outcomes for across sectors are often challenging and the impact on other health services and the overarching project. with this model the financial benefits do health care providers including hospital not accrue to any one sector. emergency departments. The patient’s health care experience is also improved. 8 CAA MAGAZINE

Community Automated External PATIENT CARE Defibrillator Fund

Michael McDermott, Manager Statewide Services, Ambulance Tasmania Phase 3 – Project Implemented, Ongoing Commitment When someone is having a cardiac arrest access to a defibrillator can save their life. With probability of survival declining 7 – 10 per cent with every minute, it is imperative to have a defibrillator nearby. In 2018, The Tasmanian Government established Ambulance Tasmania’s Community Automated External Defibrillator (AED) Fund to increase the public’s access to AEDs and improve the probability of surviving a cardiac arrest. The Fund will deliver 180 AEDs to not-for- profit organisations, community groups and private individuals in areas where there is traditionally limited or no access. In the first round (2018/19) more than 400 applications were received, with 90 AEDs distributed around the State. A further 90 will be distributed in the 2019/20 round. to hospital, proving that the impact • Location of the AED, taking note also Aim community AEDs can have on survival of the hours of availability and rates is undeniable. However, the expense proximity to other community-held The Tasmanian population (approximately in purchasing an AED is often outside AEDs (in metres) 530,000) is spread across geographically the means of individuals, not-for-profit • The size of the community that the diverse and often isolated locations, with organisations and community groups. This device will service. a significant proportion (approximately is where the Fund can aid. 40 per cent) residing in rural or isolated Successful applicants are required to The Fund was launched in keeping with areas. It is these areas in which a register their device with the AT Early AT’s commitment to implementing the disproportionate number (approximately Access to Defibrillation Program (EADP), Global Resuscitation Alliance’s 10 steps 50 per cent) of out of hospital cardiac which allows them to become visible on to improve survival from OHCA and is arrests (OHCA) occur. the AT AED Locator App. administered by AT with the mandate of The distribution of the population ensuring the devices are placed where Evaluation combined with the incidence of the the need is greatest. It complements majority of cardiac arrests, presents several initiatives to improve the survival Significant planning was undertaken a major challenge in providing timely rate for OHCA including an enhanced to ensure the project’s aims would be responses to cardiac arrest, with the first aid responder program and the achieved. state-wide median response time for use of smartphone technology to notify The Fund has successfully increased Ambulance Tasmania (AT) paramedics to bystanders of nearby cardiac arrests. the density of AEDs in both rural and an OHCA being approximately 10 minutes. suburban locations resulting in a 10 per By introducing 180 AEDs into the Methodology cent increase in the number of AEDs community, and making them visible Applicants for AEDs must address the registered, and started a discussion on the AT AED Locator app, AT aims to following criteria: around AED availability within Tasmania. improve OHCA survival rates. • Type of applicant – not-for-profit, AT hopes that improving awareness of Background private individual or community group the potential for AEDs to save lives and ensuring their availability, will positively • Ability of the applicant to maintain Over the past three years, AT has attended impact on the Tasmanian community and both the device and consumables 2166 OHCAs. Of these incidences, just 111 create a precedent for Australia. had access to a community or public-held • The applicant’s willingness to sign the AED and were treated prior to the arrival AED to Ambulance Tasmania’s Early of AT paramedics. Of the 111, 31 survived Access to Defibrillation program Win ter 2019 9

PATIENT CARE Paramedics TV series

for emergencies, delivering best invited to join online conversations with care, occupational violence and paramedics during and immediately aggression, and workforce diversity after episodes on topics identified for and inclusiveness. education

Background • Earned media. Media opportunities were created with patients and paramedics One of AV’s strategic plan outcomes is developing “partnerships that • Member communications. Weekly make a difference”. A key priority messaging during the screening to help deliver this outcome was targeted 62,902 regional ambulance to strengthen AV’s connection with members, using local patient stories the community, allowing them to be from paramedics to promote the Series part of their ambulance service. and demonstrate the emergency air ambulance response provided in their A proposed television project was community identified as an opportunity to help deliver on this strategic plan • Stakeholder preview event. AV hosted outcome. a cinema launch of the first episode for staff and to thank partners, especially In preparing and planning for hospitals Paramedics, a detailed stakeholder identification and needs analysis • Exclusive staff content. Communications was undertaken, to ensure key delivered weekly via an open employee influencers were appropriately social network group (6,900 members) engaged and informed about the including behind the scenes, ratings, project. media clips and a special weekly ‘TV Guide’ with episode synopses and Stakeholders included the Victorian conversation points for staff community of more than six million, AV staff comprising 5,640 employees • Reinforcing the message. The Ambulance Victoria Strategic with 4,155 operational paramedics and series coincided with the Victorian Communications & Engagement Team Victoria’s hospitals. Government’s major advertising Phase 1 – Developed & Progressing campaign ‘Save Lives: Save 000 for Implementation Emergencies’, which asks the community In 2018, Ambulance Victoria (AV) to use local healthcare services for minor AV was heavily involved in every stage of collaborated with the Nine Network and health issues. WTFN Productions to produce a television the television production, to ensure key series, Paramedics, to showcase AV’s world- stakeholders were appropriately engaged Evaluation and supportive, and that AV’s key project class ambulance operations through the Paramedics showcased the importance of: eyes of paramedics. objectives were met. • Lifting the curtain on AV’s work in the Upon airing, Paramedics recorded weekly AV’s strategy to ensure maximum reach and audience engagement included: community; the challenges and the audience growth both across Victoria and impact paramedics have on the lives of nationally reaching a peak of 1.3 million • 10 x 43 minute episodes. Every episode patients, their families and friends Australians. was reviewed to ensure a positive portrayal of AV, its people and patients • Building a clear and shared Layered communication activities across understanding of key project AV’s website, social media channels and and inclusion of additional messages/ proof points in the narration stakeholders, and ensuring they are public relations activities delivered around engaged to become project supporters Paramedics allowed AV to share messages • Organic digital content. AV’s online and advocates aligned to its strategic priorities. There was channels drove awareness and education an eight per cent increase in social media with episode teasers, in-episode live • Taking a genuine storytelling approach followers with almost 500,000 people tweeting, news stories and dedicated to deliver core strategic messages to the engaging across social media platforms web pages with cast biographies and community via the paramedic workforce throughout the series. curated weekly episode resources, and other staff through face-to-face including links to partner advice/ engagements and other communication Research showed that Victorians who channels. watched the program and engaged with information the series on social media were significantly • ‘Ask a Paramedic’ on Facebook. On the back of this success, another series more understanding of AV’s strategic Community members within the of Paramedics has been commissioned to priorities, including saving ambulances Channel 9 25-54 viewer demographic air in 2019. 10 CAA MAGAZINE

PATIENT CARE Client Support Unit (CSU)

A six month pilot established by a dedicated Client Support Unit (CSU) in May 2018 identified 15 of the most frequent callers, deemed to be the maximum number for effective management by one coordinator. Frequent callers were defined as consumers with 20 or more calls to SAAS over a rolling six month period. Event numbers were collated from the Emergency Operations Centre (EOC) CAD data. In the six months prior to CSU intervention, the 15 consumers accounted for 618 ambulance call outs, were transported 293 times to hospital from their home address, and presented at EDs a total of 398 times. The CSU engaged Clinical Support Unit with 12 of the 15 patients – three patients chose not to engage. Jim Haldane, Operations Manager, Client However, a group of consumers who Support Unit, SA Ambulance Service use the Triple Zero (000) emergency The CSU met with the participants in service significantly more frequently their own homes and organised multi- Phase 3 – Project Implemented, than others. Often the calls relate to disciplinary conferences with health and Ongoing Commitment complex issues and may benefit from an social providers. SA Ambulance Service introduced a Client alternative pathway of care rather than Workplace instructions, procedures, and Support Unit (CSU) in 2018 to identify and clinical treatment. These frequent callers establishment of healthcare networks assist frequent presenters to Triple Zero have a significant impact on ambulance were developed; clients’ health and social (000). The unit sought to partner with resources. reviewed; gaps identified and clients clients to design strategies to better meet Often these patients have long term connected to the most appropriate their individual needs and reduce reliance conditions with acute exacerbation or alternate pathway. The regular contact on ambulance services and Emergency may experience specific episodes of ill also reduced social isolation for some of Departments (EDs). health or difficulty, which may or may not these patients. The highly successful pilot resulted in a be life threatening. They also have unmet reduction of more than 50 per cent of social and clinical needs and do not have Evaluation calls to Triple Zero (000) for this group afterhours access to their regular health At the end of the six months an and provided each patient with more care providers. evaluation, conducted by consultants personalised support. Bentleys, demonstrated that the unit’s Methodology In developing the framework for this work had resulted in significant savings for project, SAAS has also strengthened its Service models from within Australia and both SAAS and SA Health through reduced existing network of care providers to the United Kingdom were identified as reliance on services because clients’ needs enable expanded alternate care pathways best practice examples strategies designed were better met. to deal with the callers seeking some for all patients. The model was assessed as financially assistance form ambulance. The pilot project aimed to reduce the viable, providing a compelling case for an demand for SAAS services (call and A Gap Analysis suggested that SAAS and appropriate patient care model. its consumers would benefit from a single attendance) generated by frequent/ In just three months, presentations to referral pathway and dedicated team complex callers by 30 per cent, with emergency departments had reduced for frequent callers, an agreed definition the goal of also increasing call taker/ by 50 per cent. Calls to 000 reduced, of frequent callers, and dedicated dispatcher and crew availability. along with transports to hospitals, which staff to ensure the timely creation of recorded a 46 per cent drop from 115 to 58. Background management plans and SACAD flag reviews. Research also highlighted the SAAS will investigate how the service South Australia’s 1.72 million residents benefit of strengthened links to other could be adapted for regional patients rely on the Triple Zero (000) service for an providers. through a phone or teleconference emergency response to serious and life medium. threatening conditions. Win ter 2019 11

QAS Electronic Ambulance TECHNOLOGY Report Form Project

Gregory Manning, Program Manager, comprehensive reporting with concise The product was initially piloted by the ICT Programs and Service Management, and accurate handover to emergency QAS Low Acuity Response Units (LARU) Service Planning and Performance, departments. which assisted in identifying and resolving Queensland Ambulance Service residual technology and business process Background issues ahead of the full production rollout. Phase 3 – Project Implemented, Ongoing Commitment In 2015, the QAS ICT Strategy incorporated a focus on digital transformation and Implementation In 2016, the Queensland Ambulance operational mobility to enable its transient A key achievement of the eARF application Service (QAS) began to modernise the workforce to ‘work anywhere, anytime’. was the delivery of a user interface that ageing system and processes used for the is intuitive for all level of users. The A keystone of the strategy was the notation and submission of pre-hospital logical flow of screens allows streamlined provision of Apple iPad devices for every patient care records. navigation and documentation from scene frontline Paramedic, which paved the way details and hazards to patient information, The Electronic Ambulance Report Form for the eARF redevelopment project. (eARF) Redevelopment Project was primary complaints, observations, instigated to develop an application diagnoses, triage management and to meet the needs of the mobile and handover finalisation. expeditious nature of the QAS workforce, Real time integration with the ‘000’ and replace the ageing, cumbersome and emergency dispatch systems was another costly system operating on Panasonic key output. The project is aligned with Toughbooks. industry standards and supports a high The eARF solution was developed in degree of interoperability as well as a local alignment with QAS strategies to build repository of clinical information. Highly technological capability, deliver effective visible alert notifications were also added and efficient ambulance services and for patient allergies. provide quality patient care. Reduction of the administrative downtime required to complete patient care records was the primary goal of the application development, allowing paramedics quicker turnaround in emergency response.

Aim Evaluation The project’s key objective was an easy Methodology The eARF Redevelopment Project was to use eARF application, which could QAS established an evaluation panel and successfully rolled out in November 2017 operate from Apple iOS devices anywhere issued an Invitation to Offer (ITO) to the to more than 3500 users. and anytime. Use of a lightweight open market. A board was appointed Key outcomes include the introduction of device allows for quick and accurate alongside the User Reference Group (URG) enhanced test and training environments, recording of clinical observations while, comprising subject matter experts from all higher availability and disaster recovery, simultaneously, receiving incident scene facets of the business. updates in real time. greater scalability and significant cost A Technical Reference Group (TRG) rationalisation; structured reference data The eARF application had to be mobile, coordinated technical design activities has enabled the expansion of quantitative secure, highly engaging, easy to use and to ensure secure integration of mobile reporting. customisable. It also had to accommodate devices, 000 dispatching systems, An external review supported benefits continuous updates on clinical treatments, corporate networks and the cloud based including lower costs, enhanced security be capable of receiving incident messages eARF architecture. from 000 dispatch centres and function and improved training. Regional site champions at each Local in an offline, autonomous mode when Streamlining clinical documentation with Ambulance Service Network (LASN) network coverage was unavailable. concise record handovers has allowed communicated and promoted the project QAS to deliver better healthcare to the Another key objective involved objectives and became focal points Queensland public. implementing defined reference data of knowledge. Training collateral was within the application, reducing freehand developed by the QAS Education Centre Future enhancements will include the narrative data entry to allow QAS to (QASEC). electronic handover of clinical records to deliver better patient care through Queensland Health (QH) and the ability to incorporate patient referrals. 12 CAA MAGAZINE

TECHNOLOGY QAS Commonwealth Games Hub

Monica Farrow, Director Operations, Emergency Management Unit, Queensland Ambulance Service Phase 2 – Evidence Based Project In 2018, the Queensland’s Gold Coast hosted the Commonwealth Games from 4 -15 April 2018. This significant sporting event was attended by more than 4,400 athletes from 71 Commonwealth Games Associations, making it the largest event Australia has hosted this decade. QAS officers at the Gold Coast 2018 Commonwealth Games Hockey event QAS and its service delivery played a critical role in pre-hospital care and • Communicate real-time logistics rostering, provided unparalleled support patient transport with more than 600 staff information from the Workforce to QAS operational staff. Planning Unit to Paramedics and deployed with 111 vehicles to support The simplicity of the solution was also Supervisors individually such as: more than 4,000 operational shifts, across very effective, providing a single point roster updates, logistics including 18 venues. of truth for all operationally-related pick-up locations and accommodation information. The Roster App, event QAS required suitable, integrated online information communications capability to support location information and templates operations during the CG. • Communicate real-time logistics were all located in Teams or linked from information from the Workforce Teams, so that staff only had to access Leveraging Microsoft Office 365 solutions Planning Unit to predefined groups the one solution to obtain the necessary including Teams, SharePoint, SWAY and based on specific criteria, for example: information. Power Apps was a cost effective and Supervisors, individual venue groups, Teams’ notifications with information efficient platform, which introduced a outside of venue groups, Operations were available on special subscriber new and contemporary approach to Centres and Logistics Teams communications during a large-scale event. channels. There were fewer than 10 calls • Conduct remote briefings: daily for assistance to the PSBA ICT Service It was imperative that the new solution briefings for event locations and festival Centre. also supported a QAS vision of ‘Excellence areas where people are not all in one in Ambulance Services’. location Evaluation Aim • The ability for QAS Executive messaging The CG Hub delivered a contemporary, across the organisation integrated solution, at no additional The QAS required an affordable, cost to the QAS, which was accessible scalable solution to support online • Provide a supporting document anywhere, anytime by any device. It communications during the CG, which was repository. enabled secure access for command and available to authorised users anywhere, frontline staff. anytime. Implementation The CG Hub was very favourably received The business requirements were aligned Through a strong collaboration with and has laid the foundation for the with the capabilities of the Microsoft Microsoft, the Queensland Ambulance broader use of similar team environments Office 365 suite, with a number of joint Service (QAS) over a four-month supporting major events and operational workshops undertaken to assess the period developed an effective online and business activities. communications capability supporting the suitability, functionality and practicalities ambulance operational deployment to the of a tailored solution, which had to be The CG Hub was deemed a true success Commonwealth Games (CG) the CG Hub. sufficiently resilient to support operations story during the QAS Lessons Learnt within a mission-critical environment. exercise post the CG. The Hub was used to streamline QAS operations through development of an The fully integrated Hub was designed Following the Games Microsoft conducted integrated electronic solution with the with the active engagement of officers a case study and published a report capability to support the highly mobile within the CG team and relevant areas online: https://bit.ly/2Ri3gH9 at QAS, with Microsoft representatives QAS operational workforce. The officers’ positive experience has providing specialist advice. The solution had to be simple and provided a strong platform for the effective providing a single point of truth The ease of use, streamlined training, broader adoption of this type of capability for all operationally-related information venue focused information, personalised throughout the QAS. and the following capabilities: communication options and access to Win ter 2019 13

Self-service Demand Resourcing TECHNOLOGY for Patient Transfer Service

Dave Richards, Head of Business Resource required to Intelligence, St John New Zealand Current Measure have 90% of PTS done Resources Phase 3 – Project Implemented, by a PTS resource Ongoing Commitment PTS demand done by on duty PTS 66.0% 75.3% In 2018 and 2019, St John’s Patient Transfer Service (PTS) contracts with PTS demand done by on call PTS 11.2% 14.3% District Health Boards (DHBs) were up PTS demand done by EAS 22.8% 10.5% for renewal. As part of the renewal process the PTS resources had to be renegotiated along Urgent transfers within 30 minutes of 69.9% 80.5% with a new pricing model. A new tool agreed time was developed to assist PTS Managers Standard transfers within 90 minutes of evaluate different resourcing levels and 90.1% 93.4% agreed time understand the impact on the service. The tool created demand resource profiles for PTS based on the desired percentage Vehicles 15 22 of demand. It includes a self-service component for managers to select core or On duty tours 1,037 1,256 additional PTS resources, days of the week Simulated results of the current and proposed resources one of the DHBs they operate, start time and duration to match the demand profile. It specifies the incidents to be covered by PTS resources Evaluation percentage of demand covered by each (PTS%). Managers can use the self-service PTS resource type along with indicative costs. PTS DRP demand = NORM.INV(PTS%, tool to determine the best resources that match demand, and then the BI Background Average demand, (UCL demand- Average demand)/3) Team can simulate those resources to St John had new strategic targets for 95 better understand the performance and per cent of PTS jobs resourced by PTS The PTS DRP demand represents the breakdown of work by each resource type. vehicles in Auckland and 80 per cent in number of PTS vehicles required to all other areas to reduce the burden on By using the tool it is expected the ensure that x% (PTS%) of PTS incidents percentage of PTS jobs resourced by PTS Emergency Ambulance Service (EAS) are covered by PTS vehicles. If the PTS% vehicles needed to cater for emergencies. vehicles will improve from 76.5 per cent is increased, then the required number of to 83.0 per cent nationally. The pickup There will always be a requirement for PTS vehicles (y) will increase. performance is also expected to improve EAS vehicles to support patient transfer Once the manager has entered the desired as more transfer jobs are serviced by in rural areas because it is not financially resourcing, the demand covered by core, dedicated PTS resources rather than waiting practical to have dedicated PTS vehicles additional or emergency resources for for emergency vehicles to become available. where there are low volumes of transfers. each hour is calculated and summed to To confirm the new contracts and St John’s understand how much demand overall is Scope internal targets, PTS Managers had to covered by each resource type. Further work is being developed in the demonstrate the requirement and benefit simulation of patient transfer activity Demand covered by Core = NORM. of any extra PTS vehicles. In addition, to including: DIST(Core resource, Average demand, support the financial teams with pricing (UCL demand- Average demand)/3, TRUE) • Wait-and-Load: where a vehicle the contracts, managers needed to have * Average demand clearing at hospital waits if it is known an accurate prediction of what proportion that there will be an imminent booked of PTS jobs would be serviced by the Demand covered by Additional = NORM. call to collect from the same hospital different vehicle types – Core, Additional DIST(Core resource + Additional resource, and Emergency. • Wait-and-Return: where a vehicle drops Average demand, (UCL demand- Average off and waits at the drop-off location Methodology demand)/3, TRUE) * Average demand - to take the same patient back to the Demand covered by Core The tool was developed with starting point customisation by each District Health Demand covered by Emergency = Average • Modifying the dispatch logic to limit Board (DHB) area. demand - Demand covered by Core - overtime by not dispatching vehicles The PTS DRP demand uses the average Demand covered by Additional to PTS jobs if it is estimated that they demand and the Upper Control Limit will incur more than a pre-determined (UCL) demand plus the chosen % of PTS amount of overtime. 14 CAA MAGAZINE

Emergency Services Computer TECHNOLOGY Aided Dispatch Project

Fiona Lieutier, Director Projects, This vision to ensure the safety of the Implementation Ambulance Tasmania, Tasmanian community and emergency The implementation took place across service responders is supported by the Han-Wei Lee, ESCAD Project Manager, eight stages including development of the following project objectives to: Ambulance Tasmania business case, planning, system design, 1. Replace current CAD systems with building, testing and training. Phase 2 – Evidence Based Project an integrated system customised for An integral feature of the project was a The Tasmanian Emergency Services current and future demand set of principles agreed by the Secretaries Computer Aided Dispatch (ESCAD) 2. Provide the ability to safely deliver best of the Department of Health and Human Project is a multi-agency project across possible response to emergency calls Services (DHHS) and the Department the emergency services designed to 3. Facilitate business process of Police and Emergency Management improve the safety of the community improvement to deliver efficiencies and (DPFEM). The principles, also endorsed and emergency service responders by enhanced safety. by the head of each emergency service, implementing a contemporary integrated have been instrumental in ensuring the computer aided dispatch system. Background project was appropriately resourced and The Project links Ambulance Tasmania, In 2013, Tasmania was rocked by maintained a tight scope. the Tasmania Fire Service, the State catastrophic bush-fires. A subsequent Following Ambulance Tasmania’s go-live Emergency Service and Tasmania Police to Commission of Inquiry recommended date on 25 June 2019, all Tasmanian create the ability to provide multi-agency all emergency services work emergency services are operating in a responses to incidents and share critical towards integrated technology and truly integrated CAD environment. information across the services. communications. A key benefit of the new system is At that time the ability to share real time incident ambulance, police information. Innovative components of and the fire service the new system with special application operated on three for Ambulance Tasmania are: separate call taking and dispatch systems • Multi-Agency functionality: this allows varying from in-house each emergency service to view the 30-year-old systems to resources of other emergency services more contemporary on maps within the CAD. It also enables systems, which did not warnings to be shared including have the capability to premises containing toxic substances, integrate beyond an persons likely to be violent and alerts individual service. for medical attention A multi-agency Project • Meal break module: Ambulance team established Tasmania has specific Award provisions in 2015 included a for paramedics’ meal breaks. A module number of Ambulance has been incorporated to assist with Tasmania staff managing meal breaks and fatigue Aim engaged in various senior roles. • Patient Transport Web Booking Service: The aim of the ESCAD Project is to provide The new ESCAD system was installed at A web booking services for hospitals a contemporary call taking and dispatch Tasmania Police in 2017, the Tasmania Fire and other care facilities has been system integrated across Tasmanian Service and State Emergency Service in developed and integrated into the CAD emergency services. 2018 and in Ambulance Tasmania on 25 advance non-emergency transport For Ambulance Tasmania the project is June 2019 bookings to assist in planning. also delivering improved staff outcomes The ESCAD installation has already Outcomes highlight a range of by providing a meal break module. A enabled multi-agency interaction in improvements including incident Patient Transport Web Booking Service both major incidents and day to day response, timely and meaningful (PTWBS) integrated into the CAD also business such as traffic accidents. In the intelligence, increased productivity and enables hospitals and care facilities 2019 Tasmanian bush fires, police and efficiency, inter-agency coordination and to book non-urgent patient transport fire dispatchers were able to create and communication in routine and emergency through a web portal. share incidents between services, issue situations. warnings share mapping information, The Business Transformation aspects vehicle locations and fire alerts. of this project have also been uniquely successful. Win ter 2019 15

Welfare Check Dashboard: TECHNOLOGY filling the “care gap”

Methodology The WFA Clinical Quality Improvement Committee, comprising staff from across the service, worked together to identify ways to reduce the care gap. A physical map of the process was created to ascertain what was being done well – including the importance of the checks, and what was not done well – such as having only one person responsible for the welfare checks, with confusing procedures. It was agreed that the KPI of 90 per cent for welfare checks needed to be met – an increase from 50 per cent and the best way to achieve it was a real time welfare check dashboard, an idea proposed by a senior emergency medical dispatcher. The welfare check dashboard is a visual representation of all outstanding incidents Oceana Dave, Emergency Medical Dispatcher and the length of time until the next welfare check is due. The dashboard is a WFA wanted to ensure that at least 90 per Stacey Etheridge, Operational Support dedicated screen in the communications cent of patients waiting for an ambulance Manager, Clinical Communications Centre, centre for all staff to see, and can be received a welfare check by telephone Wellington Free Ambulance displayed on individual computers. within the key performance indicator (KPI) Phase 3 – Project Implemented, time of 35 minutes. Ongoing Commitment Evaluation Wellington Free Ambulance (WFA) is using Background The dashboard has resulted in an increase technology to fill the “care gap” that exists in the KPI from March 2018 to November For most ambulance services around the 2018, when 90 per cent was recorded. between answering a 111 emergency call world, demand for help often outweighs and getting a paramedic to the patient. ambulance resources creating a care gap The process reinforced that staff The reality for WFA is that demand often for patients. involvement in a range of ways is outweighs ambulance resources, and the key to successful change, generating Although emergency call handlers give empowerment and ownership. time spent waiting for the ambulance to instructions over the telephone on how to arrive following the 111 call can cause care for the patient and what to do while WFA has also introduced “Emergency patients to feel vulnerable and anxious. waiting, the stressful situation may mean Caller Location Information” technology A lack of information from the ambulance that instructions can be misunderstood, or to text patients with post-dispatch service when help is delayed represents a forgotten. instructions, estimated time of arrival, and ambulance diversions. very poor experience for patients and the The increased anxiety can also create care gap can mean a patient’s condition difficulties for responding paramedics for It is vital for ambulance services to focus deteriorates as they wait. example, locating the patient’s address if on continuous quality improvement in To fill this gap WFA call handlers shared the patient is distressed. order to provide the best care while meeting demand. the responsibility to monitor and make In May 2018, in an effort to bridge the welfare check calls to patients waiting for gap a dedicated WFA call handler was The live dashboard has improved the an ambulance. However, in March 2018, allocated responsibility for monitoring quality of healthcare delivery, increased less than 50 per cent of these calls were and making welfare check calls to patients patient safety, strengthened the being performed. waiting for an ambulance. interaction between patients and the The WFA Quality Improvement Committee service and improved the care experience This approach resulted in only 50 – 60 per for patients and staff alike. investigated how the gap could be cent of patients receiving a welfare check reduced to improve patient experience in the KPI specified time, representing a WFA embraced technology to develop and clinical outcomes and came up with considerable clinical risk for patients. the dashboard to bridge the care gap, technological innovation – a live welfare which exists for patients everywhere – an check dashboard. opportunity open to all ambulance services. 16 CAA MAGAZINE

TECHNOLOGY Analytics Uplift Project

Craig Howard, Executive Director, Change Impact Transformation & Strategy, 400 individual reports reduced to dashboards Whole organisation is using ‘single source of truth’ for reporting data. As a result, Ambulance Victoria discussion progressed from unhelpful disagreements about data accuracy to useful problem identification and remediation Phase 2 – Evidence Based Project Delays in the order of 2 weeks to 6 months A timely feedback loop is critical in emergency care. Operational managers are able to became next day or real time reporting contemporaneously discuss response performance and clinical care issues With patient demand, complexity of care, Access to more granular data Operational managers now have access to more precise geographical and employee and the quantity and sources of data all level data which allows for more targeted intervention rising, Ambulance Victoria (AV) recognised Automation Improved data quality due to removal of manual handling error the need to improve its reporting Time required to produce scheduled reporting reduced by 90% environment to better support operational managers in driving performance Outcome: technology improvements. • maximising the benefit of data by “Agile” mindset and practices provided the AV data was optimized to generate more disseminating it with a wider audience right framework for iterative, collaborative meaningful insights for better strategic • keeping pace with the analytical and customer focused delivery throughout decision making, to enhance operational industry the project. capabilities, and manage enterprise risks • promoting consistency and trust and compliance mandates. Evaluation • sharing data with health care partners Communication with the operational The changes translate to improved clinical • deploying predictive and prescriptive workforce was a fundamental part of the and operational response performance. analysis to solve complex operational project’s successful implementation. The The project focused on three main areas; and business challenges project has improved the use of reports improving technology, upskilling AV • building the capability to adapt to the to support evidence based decision managers and analysts and delivering challenges of the future. making, initiating a positive shift in value complex predictive and prescriptive perceptions towards data and reporting analytics. Methodology functions. To successfully deliver the transformation, Background The project has improved the use of improvements centred on technology, reports to support evidence based The objective of the Project was to people and service. decisions, initiating a positive shift develop a sustainable end-to-end analytics Technology and data components in perceptions of data and reporting process, starting with understanding provided foundations to enable people functions. the requisite data and finishing with a and services to achieve improvements sustainable change in business operations. AV achieved the goal of ensuring a legacy with a focus on a mature, self service of increased in-house analytical capability Gap analysis of reporting functions capability for all operational management and business knowledge. Feedback from identified a number of operational including individual paramedics. the AV analyst team indicates higher levels reporting and analytics requirements Automation was a key factor in helping of job satisfaction and optimism with could not be delivered and there were improve accuracy, remove manual data analysts’ turnover in the last 18 months issues with sourcing and connecting the handling risk and reduce time delays. at zero. right data to generate meaningful insights. AV aspired to link ambulance and hospital Operational managers found it difficult Scope data at patient level, recognising analysis and time consuming to access information AV now has capability to tackle rapidly of paramedic assessments compared while data and analysis teams were changing business challenges with the along side hospital diagnoses offered rich constrained by siloed structures and revolution in data and analytics. opportunities. Recent agreements with a an outdated operational reporting number of Victorian hospitals and a pilot AV has achieved the goal of ensuring a environment. of two-way data feeds, has generated legacy of increased in-house analytical Known data quality issues limited the meaningful insights. capability and business knowledge. ability to confidently rely on this source to A suite of dashboards and reports to To build on the technology investment inform decision making. support operational managers has created it was essential to develop capability. A a more informed workforce, introducing The project was an ambitious chapter in plan to uplift capability included analysts data collection with more granularity the digital transformation at AV with the working alongside analytics specialists; and providing paramedics with access aim of: providing multiple benefits including to individual performance data. The AV building real world deliverables, uplifting • transforming the analytical landscape workforce also has a better understanding AV analysts’ skills and ensuring IP • providing meaningful and timely of KPIs and how individuals contribute to remained in house post project. insights AV’s overall performance, encouraging • delivering interactive dashboards and Integrating automation with reporting and accountability and ownership of personal analysis analysis processes enabled analysts to performance. invest in rewarding and complex tasks. Win ter 2019 17

Critical Care Paramedic STAFF DEVELOPMENT Leadership Development Program

Methodology • reflect on their professional practise The QAS has • take risks and by being vulnerable and delivered a range of showing courage leadership programs in • step into the planned activities and collaboration with the share experiences Queensland University of Technology Creative • support each other and learn from Industries (QUTCI). each other • ask curious questions Research demonstrates that experiential • follow facilitators lead learning fosters • be boisterous, chat, laugh, joke with more memorable colleagues and facilitators and influential • tell stories facilitators did not expect to learning experiences, hear Queensland Ambulance Service Capability offering perspectives and Development Unit rarely found using more traditional • physically move in the space to engage methodologies. with new colleagues. Phase 3 – Project Implemented, Ongoing Commitment The CCPLP was designed with a Evaluation commitment to activities to engage A fundamental of developing an effective The CCPLP has encouraged CCPs to participants cognitively, physically, socially leadership style is self-awareness – understand the position of influence they and emotionally. This Is achieved through knowing one’s strengths and limitations; hold as clinicians and leaders within QAS group discussion, playful exercises how these play out in different ways, with an important role to mentor and including games, live modelling of best different circumstances and what drive positive cultural change. practice behaviours, peer to peer learning, influence they have on the ability to be a small group interactions based around Positive formal and informal feedback successful leader. practical and theoretical activities, and from participants, clearly illustrates a The Queensland Ambulance Service reflective practice. strong desire from QAS leaders to have (QAS) Critical Care Paramedic Leadership meaningful learning experiences, along Participants use solution focused coaching Program (CCPLP) curriculum has been with the use of innovative tools for scenarios with real situations readily developed specifically for approximately leadership development. identifiable from their lived experience 400 Critical Care Paramedics (CCP). as part of their development within the Participants appreciated the opportunity The CCPLP incorporates highly program. to be exposed to new theories and models participatory sessions on emotional and responded positively to the innovative The learning design process allows intelligence, team building, change approach with feedback comments participants to have direct input into how management, situational leadership, including: the experience assists (or at times does appreciative inquiry, quality improvement not assist) their growth, with their input “This is by far the best professional and organisational culture, to articulate fed into the next iteration of the program. development course I have been on. the expected professional standards and This process ensures the program is Interactive and the presenters were behaviours envisaged for a CCP as an constantly refreshed and connects to absolutely fantastic.” exemplar clinical leader in the QAS. individual and QAS learning needs. “Excellent, informative, more self-aware, Leaders have often traditionally defaulted should be part of the CCP internship. I to a ‘command and control’ style that can Implementation hope they continue to develop this and often conspire against collaboration and The CCLDP is an experiential interactive have follow-up sessions.” can be perpetuated as aspiring leaders program offering space for reflective emulate predecessors. practice to provide an environment for Scope The challenges of delivering high quality participants to challenge their thinking, QAS is committed to the development healthcare requires effective leadership learn from their colleagues, and shift of technical skills, professionalism and through staff and stakeholder engagement perspectives, which in turn triggers new leadership capability in its staff, with and strengthening relationships at all insights and understandings. a growing emphasis on the cognitive levels, emphasising the importance Participants demonstrate a willingness benefits in understanding emotional of self-reflection, evaluation and self- to step into the learning experiences, intelligence. improvement for personal growth and by being prepared to: Since the first program in December development. • share their workplace concerns/ 2017, another five programs have been dilemmas/challenges delivered in 2018 & 2019 with a total of 130 participants. 18 CAA MAGAZINE

STAFF DEVELOPMENT Peer Support Dog

Angela Ewing, Director Wellbeing and Following Bruce’s Support Services, Ambulance Victoria acceptance as part of the peer program, AV Phase 3 – Project Implemented, personnel reported an Ongoing Commitment increased willingness to Ambulance Victoria (AV) is committed access Peer Support. to improving paramedics’ mental health Evaluation of the and wellbeing. In keeping with that effectiveness of the commitment, AV introduced a support pilot program employed dog trial as an integrated part of its staff both quantitative and wellbeing programs. qualitative data. The aim of the Program was to: An evaluation survey was • Increase uptake of peer support and all rolled out to all staff, even Wellbeing and Support Services if they had not been in contact with Bruce and • Decrease stigma surrounding help- Ken during the pilot. seeking behaviour In total, 832 AV staff • Improve staff satisfaction regarding participated in the survey AV’s commitment to improving staff including 22.5 per cent mental health and wellbeing from rural Victoria. • Reduce occupational stress. Overwhelmingly positive Background results were received Paramedic Emily Apolito with Bruce with 96.5 per cent One of the key impediments identified for reporting they had staff seeking help for mental health issues Implementation experienced a great deal was a perceived stigma associated with Expressions of interest were sought from of comfort during Bruce’s visits and 79 per accessing such services. active peer support staff with canines. cent “agreed or strongly agreed” that the AV sought to break down this barrier Dogs were required to undergo veterinary Program helped to lessen mental health by promoting conversations about the checks, specialised assessment and stigma. suitability tests. importance of proactively managing “From the moment that he arrived I felt mental health at all levels of the Six peer support responders applied with much happier and content. It is amazing organisation and actively encouraging staff seven dogs for one position. how simple the touch of a “non-judging” to access available services as required. animal really can make the difference to Bruce and his handler Ken were selected, mental health and wellbeing.” Methodology and after specialised training, Bruce commenced work initially for two hours “That week, myself and my partner had A volunteer therapy dog engaged by a a day from Monday to Friday across the done a few ‘big’ jobs and I was feeling regional Canadian ambulance service metropolitan region only. quite emotional and physically drained. It triggered the idea for the program. was wonderful to be able to meet Bruce His visits included a mix of ambulance A small team investigated options and as he instantly put a smile on our faces branches, corporate sites and approved conducted an extensive review of risks and my mood had completely changed. hospital bays booked two weeks in and issues including state and federal This was especially evident in the next advance. This was to ensure maximum compliance with animal welfare legislation job that we attended as I didn’t feel as access to staff and to counter any issues and codes of practice, OH&S, insurance, emotionally drained and was able to for staff such as phobias or allergies. biosecurity concerns and industrial engage and connect better with the The pilot received between 30 -40 visit implications. next patient (something which is very requests a day. important to me).” The project team also consulted relevant state government bodies, landlords, Evaluation The success of the trial has resulted in the participating hospitals, unions, AV’s Over the trial period, Bruce and Ken program being expanded across the state workforce, Board and committees. made 260 visits and 2,895 contacts, many with three dogs and handlers in active service on a part time basis until the The team developed protocols to manage involving multiple staff. Some 77 per cent program reaches full capacity with up to issues including phobias and allergies of visits were proactive and 22 per cent 12 dogs and handlers. alongside processes for interacting with were requested. staff who did not want to engage with a dog. Win ter 2019 19

STAFF DEVELOPMENT Wellbeing Workshop

Tricia Mawson, Manager, Learning & Development, NSW Ambulance Phase 3 – Project Implemented, Ongoing Commitment The NSW Ambulance Wellbeing Workshop is a dedicated program providing comprehensive wellbeing education specifically developed for paramedics, control centre staff and volunteers. The program is delivered with face-to-face training over three days: Day 1 – Well at work – Provides staff the The Wellbeing Workshop Team tools for mental health resilience and physical health and wellbeing Methodology Evaluation Day 2 – Safe at work – Provides tools to Providing access for shift working The program was launched in March 2018. make hazardous manual handling safer paramedics and 000 call takers across Since implementation outcomes include: NSW, while maintaining 24/7 service Day 3 – Protected at work – Provides • More than 65 staff had made contact delivery, poses a significant challenge in tools to prevent and manage occupational to discuss personal health goals maintaining duty rosters. violence. • an increase in the number of staff The Wellbeing Workshop primarily focuses registered for the Fitness Passport Aim on three business cases, each backed by Program The program’s overarching aims are: the latest research. • data gathered through online Brief Well at Work • to develop all NSW Ambulance staff to Health Checks will determine regions be positive and resilient, engaged and Mind fit has been developed in with high risk factors so intervention empowered by their work partnership with research organisations strategies can be put in place such as UNSW, Black Dog Institute and • to develop all NSW Ambulance staff Beyond Blue, feedback from staff and a • an increase in the amount of to find meaning and accomplishment Wellbeing and Resilience Summit (2016) occupational violence incidents through what they do, have strong survey. reported relationships both at work and home and utilise practical tools to embed Body Fit is based on the Fit for Duty • a decrease in the number of wellbeing in the culture at NSW research study in partnership with Charles occupational violence incidents that Ambulance Sturt University (CSU). Healthier, fitter have led to workers’ compensation paramedics are more physiologically claims and time off work • to improve skills, knowledge and resilient. capabilities in wellbeing and to address • an increase in paramedics staging prior key organisational risks associated with Safe at Work to entering a scene working in an emergency service. Paramedics work in uncontrolled and • more than 75 per cent of participants unpredictable environments with periods believe that the training is relevant, Background of sedentary activity interspersed with they feel more confident in decision One in three staff in first responder bouts of high physical strain in highly making and that they will be supported organisations experience high or very high charged emergency settings. by NSW Ambulance psychological distress – higher than one in Other risk factors for musculoskeletal • positive feedback with 82 per cent eight for all Australian adults; more than injury include erratic shifts over long of respondents stating they feel one in 2.5 report having had a diagnosed hours. The combination of shift work ‘confident’ or ‘much more confident’ mental health condition compared to one and heavy physically demanding tasks in their ability to be well, safe and in five of all Australian adults. contribute to high levels of fatigue, which protected at work The health status of NSW Ambulance have been linked to increased injury risk. • an increase in the number of staff that employees is similar, and in some cases Protected at Work have tailored self-care plan. worse, with increased incidence of employees who are overweight, obese Protected at Work occupational violence The workshop will be expanded in and have low levels of physical activity. prevention training has been instrumental 2019/20 to include regional workshops. Inactivity also contributes to a high in leading cultural change for prioritising number of paramedics with body stress, of paramedic safety. costing millions of dollars annually. 20 CAA MAGAZINE

A state-wide, multi-agency model CLINICAL for High Performance CPR

Matt Rose, Resuscitation Officer, After decades of resuscitation research, Performing hands-on charging Ambulance Victoria high-quality CPR has emerged as a critical and analysing the ECG rhythm in factor for survivability. The American manual mode, combined with a well- Phase 3 – Project Implemented, Heart Association (AHA) guidelines, choreographed, ‘pit-crew’ approach Ongoing Commitment International Liaison Committee on to the rhythm analysis and responder More than 30,000 Out of Hospital Cardiac Resuscitation (ILCOR) guidelines and the rotation can significantly decrease CPR Arrests occur across Australia and New Australian and New Zealand Committee interruption. Zealand annually and typically less than on Resuscitation (ANZCOR) guidelines 10 per cent survive, with similar rates of repeatedly emphasise the importance Implementation mortality globally. of high-quality CPR with minimal A Resuscitation Officer was appointed interruptions as the basis for optimal When effective cardiopulmonary in 2018 as part of the Research and resuscitation. resuscitation (CPR) and defibrillation Evaluation Team, to lead the development are provided quickly, the chance and implementation of the model, of successful resuscitation greatly In 2017-2018, 37% of patients in Victoria who had a bystander and introduce systems to support increases. witnessed, shockable OHCA survived to hospital discharge. data collection and the debriefing model. A ground-breaking 10 step Early CPR performance data from a random selection of cases program to improve out pre and post the implementation of the HP CPR model shows: New cardiac arrest guidelines were approved and a HP CPR of hospital cardiac arrest CPR performance pre-HP CPR: education package was developed (OHCA) developed by Seattle’s Average compression depth: 4.9cm (47% in target range) combining eLearning modules, Resuscitation Academy and Average compression rate: 118/min (42% in target range) approved by Emergency Medical Chest compression fraction: 82% didactic teaching and simulation- Service (EMS) leaders comprising Average pre-shock pause: 11.3 seconds based training. These initiatives the Global Resuscitation Alliance were supported by interactive CPR performance post-HP CPR: (GRA), has the potential to improve Workplace groups to answer Average compression depth: 6.1cm (89% in target range) survival by up to 50 per cent. staff questions and share success Average compression rate: 117/min (58% in target range) stories, and an intranet page While Ambulance Victoria (AV) is Chest compression fraction: 94% housing updated guidelines, committed to adopting each step, Average pre-shock pause: 2.4 seconds instructional videos another other two programs were identified as The figures show a significant improvement in the time that new resources. the most significant for patient patients are receiving compressions within the recommended AV also collaborated with the survival in Victoria: depth and rate ranges. MFB and CFA to incorporate HP • Begin high-performance CPR CPR for first responders; and the (HP CPR) with ongoing training and Methodology university sector to provide training and quality improvement An AV CPR Feedback Pads Trial in 2017, resources linked to accredited paramedic • Measure professional resuscitation which analysed approximately 80 undergraduate programs. Now, University using the defibrillator recording. resuscitation attempts, revealed that students on clinical placement are trained adequate compression depth and rate and practised in AVs HP CPR model. The overall aim of the project was to were achieved only 50 per cent of the The Resuscitation Officer worked with improve the resuscitation skills of EMS in time; the average pre-shock pause was Victoria, particularly chest compression leaders in resuscitation improvement in 16 seconds; and an adequate chest what is believed to be the first joint effort fraction, rate and depth and in the long compression fraction was only achieved to improve OCHA in Australia and New term improve the rate of OHCA survival in 65 per cent of the time. Victoria. Zealand. Consistent interruptions greater than five HP CPR became expected practice from Developing and implementing a seconds can reduce a patient’s chance 11 February, 2019. model for AV and external Emergency of survival by up to 18 per cent. While Medical Responder (EMR) partners, pauses are necessary for ECG rhythm the Metropolitan Fire Brigade (MFB) analysis, specifically pre-shock pauses Evaluation and Country Fire Authority (CFA), was a prior to defibrillation, extended pauses It is anticipated that the real-time significant undertaking given Victoria’s can decrease the chance of survival. audio-visual feedback provided through population and the size of the combined CPR feedback pads during resuscitation workforce. A retrospective analysis of over 14,500 attempts, combined with ongoing training OHCA in Victoria showed: semi-automatic in HP CPR and structured debriefing will While Ambulance Victoria is a regional rhythm analysis removed human result in the delivery of high-quality CPR leader in OHCA outcomes, there is performance variability and led to quicker and improved patient outcomes. considerable variation across geographical initial time to defibrillation but resulted regions and agencies. in reduced incidence of event patient survival and survival to hospital discharge. Win ter 2019 21

Revolutionising cardiac arrest CLINICAL outcomes in WA

Associate Professor Paul Bailey, 12 month average OHCA survivors Western Australia Medical Director, St John Ambulance 200 Western Australia 180 Phase 3 – Project Implemented, Ongoing Commitment 160

Western Australia’s Out of Hospital 140 Cardiac Arrest (OHCA) outcomes have steadily improved across the last decade 120 but St John Western Australia was determined to do better. 100 Sudden cardiac arrest continues as a 80 significant issue in the state, with five people a day treated throughout Western 60 Australia. Of those, just over two a week survive to hospital discharge. 40 The project to improve survival rates began 20 in late 2016 with the aim of achieving an 0 additional five survivors a year, consistently, 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 for the following five years. Changes in OHCA outcomes: tracks the rolling 12 month total of OHCA survivors to hospital The introduction of a state-wide high discharge from 2009 - 2019. Utstein survival increased from 29.6% in 2017 to 37.9% in 2018 performance CPR model known as IMPACT sought to: improve the recognition and changes in population, case mix, and ** Ongoing IMPACT CPR training dispatch of OHCA cases in the State all aspects of the chain of survival. St is being delivered to the volunteer Operations Centre; Increase the number John’s internal audit data was used to workforce. of community based automated external understand and track progress of the defibrillators (AED); implement an app quality improvement initiatives. Evaluation based community response to OHCA; and Project outcomes: continue to focus on community first aid Methodology • Time to identify the need for CPR training and bystander response to OHCA. 1. State Operations Centre dropped from 48 seconds in 2017 to However, Implementation of all the Activity in the State Operations Centre 44 seconds in 2018 necessary elements to improve OHCA was identified as pivotal to OHCA outcomes was a problem. outcomes • Bystander CPR rates from 72 per cent in 2017 to 80 per cent in 2018 St John’s attendance at the Seattle A focus on call taker efficiency in Resuscitation Academy in 2017 and identifying OHCA; the need for CPR • In 2017, there were 1834 known AEDs the CPR University in Phoenix in 2018 and a prompt to perform chest in WA – only 206 were available 24/7; confirmed there was work to be done compressions. in 2018 the number increased to 2834 at all levels of response to OHCA – from ** OHCA linguistics were studied and AEDs with 422 available 24/7 community first aid training through to learnings put into operation - The increase in AED numbers was choice of destination hospital for a patient facilitated in part by grants 2. Community based AEDs with return of spontaneous circulation. Community based AEDs were • In 2018, 40 survivors received a shock There was also an appreciation of the recognised as pivotal to OHCA from bystanders – up from 17 in 2017 rewards available to systems that adopt a outcomes • OHCA survivors to hospital discharge relentless focus on getting the basics right Aim to increase the number of increased from 113 in 2017 to 173 in for expert first responders, along with community based AEDs available; 2018. insights into the achievements of other increase the number of AEDs available services around the world. 24/7; and improve location information Scope Motivated to further improve outcomes, via the First Responder App. St John is confident it has conclusively proven St John looked to Australia’s oldest OHCA 3. High Performance CPR it is possible to have a large step increase in registry, based in WA and maintained by OHCA survivor numbers based on a rational A new high performance model of CPR PRECRU at Curtin University. approach to doing the basics well. was developed: “IMPACT CPR”. Using the data, St John sought to IMPACT CPR training was delivered St John will continue to push the limits understand the key contributing factors to to 750 paramedics, 150 ambulance and pursue OHCA outcome improvement patient survival taking into consideration officers and 300 transport officers in Western Australia. 22 CAA MAGAZINE

LEADERSHIP Better Together

Methodology • Innovation in the way AV works AV undertook a detailed with operational staff. Community stakeholder analysis with engagement has been integrated the objective of testing new with a significant operational review methods of engagement and restructure which is devolving and setting a baseline for accountability for community community knowledge. engagement to local paramedic Area The primary, secondary and Managers, Senior Team Managers and tertiary analysis confirmed: Team Managers, supported by new community engagement support roles Victorian community and training Ambulance Victoria Strategic Characteristics: Victoria • Regional community forums. In Communications & Engagement Team has a diverse population of 6.1 million 2018/19 these forums focused on and one of Australia’s fastest growing AV’s five key regional communities Phase 2 – Evidence Based Project communities. The ageing population is and one disability forum. In year 2, Ambulance Victoria (AV) is implementing reflected in a third of patients aged 75 further forums will engage regional a new model for community engagement years or older, along with growing and communities, groups with diverse based on shared leadership and more complex health needs. Melbourne interests and the mental health sector accountability. accounts for 4.7 million people. A further 1.4 million live in rural and regional • Online forum. bettertogether. The fundamental shift in our communities with more limited health ambulance.vic.gov.au provides 24/7 communication and engagement care and telecommunication access access for people to engage. AV now approaches extends to the way AV plans challenges. A third of Victorians were born can respond openly and transparently and manages its business, giving the overseas and 20 per cent have a disability, to positive and negative feedback community a greater say and participation driving diverse access and engagement • Social media in their ambulance service: we can’t save needs. lives and achieve better health outcomes • Test electronic direct mail (eDM) with by doing it along. AV staff including paramedics and AV Members and stakeholders. volunteers AV developed a new Community and Scope Stakeholder Engagement Framework Characteristics: Of 5,640 staff, 4,155 with the aim of creating a baseline for members are operational paramedics with Phase One of the project has community knowledge and understanding a role in community work. While their demonstrated the value of embedding with key activities including a series of engagement skills need development, a new model of communication and regional community forums, an online they have pride in their community community engagement. Future activity forum, and operational managers engagement and it’s important the new will include: involvement in the development of a model is developed with their input and • Strengthening and reviewing data, detailed stakeholder database. doesn’t criticise past efforts. insights and findings to inform community and stakeholder Background Community Advisory Committee, Board and Government engagement One of AV’s strategic plan outcomes is • Reporting back to the community to develop partnerships that make a Characteristics: These stakeholders want on findings, implementing new difference and Better Together is a key transparent reporting on full diversity and engagement approaches enabler for: inclusion approaches and demonstrated links to business and community health • Supporting the operational workforce • Working with communities to develop outcomes. to develop local community and local emergency health care solutions stakeholder engagement plans, that • Collaborating with our partners to Implementation address local needs as part of an improve health outcomes The model represented a fundamental enterprise-wide strategic direction shift in the way AV plans and manages its • Sharing knowledge, experience and business with a commitment to greater • Building the capacity of operational data. community and stakeholder engagement. staff to deliver local community and stakeholder engagement plans through In developing Phase One, AV sought to The Framework was developed through a the provision of tools, resources and demonstrate its commitment to shared series of focus groups and workshops to training. leadership and accountability with the incorporate: community by seeking their input and • Continual improvement based on data insight to co-design communication and • Visual storytelling and insights via staff and community engagement approaches. feedback. Win ter 2019 23

LEADERSHIP Protected at Work

Wendy Last, Occupational Violence Methodology Prevention Officer, NSW Ambulance The Occupational Violence Bonnie Stanyer, A/Occupational Violence Prevention Strategic Advisory Protection Officer, NSW Ambulance group was developed with a wide cross-section Phase 3 – Project Implemented, of metropolitan, regional Ongoing Commitment corporate and operational A series of reports has established that staff along with NSW Ministry paramedics are one of the highest at risk of Health representatives and groups for occupational violence. Industrial bodies. For NSW Ambulance two significant Two occupational violence reports reinforced the need for stronger prevent officers were measures to prevent and manage appointed; a consistent new occupational violence: a 2016 internal term for reporting incidents Occupational Violence Prevention was introduced to ensure Strategic Advisory Group (OVPSAG) consistency in reporting and An internal Occupational Violence report and the 2017 findings of a NSW accurate capture of data; and Prevention intranet page was developed Parliamentary Inquiry into Violence a set of words agreed to clearly identify to explain the new program and reaffirm Against Emergency Services Personnel. the meaning of occupational violence. support from the Chief Executive and The reports, which confirmed the risk A working group was established for staff Executive team in prioritising safety. of violence, also identified contributing consultation including metropolitan, A Dynamic Risk Assessment Poster was factors including mental health, drug and regional corporate, operational and distributed to all stations. The poster alcohol abuse, shift work and a lack of industrial bodies to assist in the urges paramedics to consider: Risks, security. preparation of easy-to-use flowcharts to record occupational violence incidents Equipment, Assess, Discuss (READ). Historically there had been an acceptance involving paramedics and duty operations that “violence was just a part of the managers. Evaluation job” for operational frontline staff and Following implementation of the Data analysis enabled the development that reporting was thought to be under- occupational violence prevention of tailor-made training and a review reported. initiatives, analysis has shown a 46 per of existing protocols for managing cent increase in the reporting of incidents. Data from the NSW Ambulance Incident challenging behaviours to ensure best However, the data also revealed a drop in Information Management System (IIMS) practice to mitigate risk for patients and assaults resulting in injuries, time off and showed a stable increase in occupational paramedics. violence incidents over the five years workers compensation claims. 2011-2016. Implementation IIMS data also shows an increase in the The two reports delivered more than The Protected at Work: Best Practice reporting of “notification only” incidents 50 recommendations including the Occupational Violence Prevention Program which did not result in an event. This appointment of two occupational violence incorporates a range of initiatives. indicates “zero tolerance” is becoming prevention officers to oversee the more common, as opposed to the implementation of a tailored Occupational The occupational violence prevention previous acceptance of “violence is just a Violence Prevention Strategy which training includes de-escalation skills, part of the job”. included: understanding aggressive behaviours, conducting a dynamic risk assessment There has been a 20 per cent increase in • Conflict resolution using the READ principle (Risks, staging incidents linked to occupational Equipment, Assess, Discuss) and violence or aggression and a 30 per cent • Dynamic risk assessment skills and decrease in directly related workers principles self-defence manoeuvres to protect paramedics. compensation claims. • Understanding aggression, self defence To date, 93 per cent of participants manoeuvres NSW Ambulance Chief Executive and the Health Minister made a joint public feel the new training is suited to their • Building paramedic awareness about statement to support the safety of work: 74 per cent agreed the training occupational violence prevention paramedics, reiterating they would be would provide them with better tools initiatives supported that if, after a risk assessment, to deal with violent incidents and 83 they decided against entering a dangerous per cent would be more likely to report • Public messaging/Reporting systems to occupational violence and near misses. enable effective, efficient monitoring of scene; their safety was the priority. incidents. 24 CAA MAGAZINE

LEADERSHIP Growing Leaders Program

Michelle Murphy ASM, Clinical Support Aim • Develop a ‘tool box’ of tips/tricks that Officer, Ambulance Victoria The key purpose was to deliver an they can utilise Phase 2 – Evidence Based Project accessible, low cost, adaptive style • Know how to ‘flex’ their preferred leadership program to support the growth style for the individual they’re Building leadership capabilities of frontline and development of our junior leaders. communicating with and the situation operational staff is often expensive, • Activity – practice the different styles in resource intensive and logistically AV seeks to deliver on a strategic objective groups (create/develop scenarios). complicated. that AV is “a great place to work and volunteer” through a range of initiatives, Module 3 – Complex Environments Ambulance Victoria (AV) identified including a culture of continual learning • Understand the Swiss Cheese & leadership development aspirations in and development. a large cohort of junior managers and Parmesan Cheese Model – theory developed a unique leadership program Traditional training methods across the • Consider human factors and bring a that was in-expensive, flexible and able organisation were labour & resource curious mind to the management of to be rolled out in geographically disperse intensive, transactionally focused on complex situations. locations. policies & procedures and costly when outsourced or staff were required to be Module 4 – Building Teams The Growing Leaders Program provided backfilled to participate. This program • How does diversity and inclusion link to participants with the skills and tools to focused on the non-technical leadership performance? lead with clear purpose and set clear capabilities, utilising skill and expertise • Consider the impact of ‘Group Think’ in objectives, and enable their teams to from experts within the organisation. organisations deliver excellent patient centred care. • Activity – Team Mapping; Build The 10 month program on the information from DISC included five key to consider who’s in your team, components; where are your gaps? 1. Personal Leadership • How do you go about creating 2. Directing, Coaching and a team that is diverse and Mentoring inclusive? 3. Complex Environments Module 5 – Continuous 4. Building Teams Improvement 5. Continuous Improvement. • Understanding data and what it really means As a result of the program our leaders were more • Consider what needs to occur confident in: to create a ‘Learning Team’ • Flexing their own • Activity – Planning for Success; leadership styles Choose 1 thing you want to achieve – develop a plan including • Communicating in different situations Methodology specific measurable outcomes. to get results Five modules, delivered to 28 participants, • Understanding their own leadership were designed to facilitate discussions Participants indicated their confidence, style & how to get the best out of their about elements of individual behaviour, knowledge, skill level and their perceived teams. team behaviour, culture and performance importance of each of the topics focused motivations. towards leadership on a five-point Likert Our leaders also increased their scale before and after the program. understanding and knowledge of: Module 1 – Personal Leadership • The impact of ‘Group Think’ • Understand their own behavioural Scope preferences and styles using DISC • How greater diversity and inclusion The Growing Leaders Program has improves performance • Identify their own blind spots transformed the way AV supports and • The difference between Directing, • Be aware that others have different develops front-line operational leaders. Coaching and Mentoring as leadership behavioural preferences and how they can flex to meet others. This type of program could be rolled styles out across regional areas and provide a • How to measure success. Module 2 – Directing, Coaching and local opportunity for adaptive leadership Mentoring development for all front-line leaders across • Understand the key differences the organisation. The style of program between each style of communication would complement any centralised more formalised education program. Win ter 2019 25

LEADERSHIP SAAS Reconciliation Action Plan (RAP)

Implementation The project began in 2016 with a committee of 12 staff members recruited from across the workforce, including operational and non-operational, career and volunteer, Aboriginal and non- Aboriginal staff, in both the metropolitan and country regions. During development of the RAP, the committee participated in Aboriginal community events to inform their path and lead the organisation to effectively work with Aboriginal communities, build Sandy Mantell, Senior Coordinator, Clinical • Identifying opportunities to support relationships and an understanding of Service Improvements – RAP Chair, SA existing health services meet the health Aboriginal culture, history and spirituality. Ambulance Service needs of local Aboriginal communities. A major challenge was acknowledging that Aboriginal Australians do not identify Phase 3 – Project Implemented, Aim Ongoing Commitment English as their first language along with RAP is a framework designed to contribute staff acceptance of the RAP due to a SA Ambulance Service (SAAS) embarked to reconciliation and improve the health range of personal values, believes and on the Reconciliation Action Plan (RAP) and wellbeing of Aboriginal and Torres experiences. to engage with Aboriginal and Torres Strait Islander communities. Strait Islander (ATSI) peoples, increase The official launch in May 2018 was their current rate of employment in Following the Reconciliation Australia RAP professionally filmed to create a 20 minute its workforce and deliver equality of guidelines, the SAAS RAP identified three video, which has been incorporated into healthcare thereby making a positive main areas to address: training sessions to ensure the same information and key messages are seen contribution to Closing the Gap. 1. Introduce all staff to the purpose of the and heard by all staff. Staff must also RAP A range of initiatives highlighted within complete a one hour Aboriginal cultural the SAAS first Reconciliation Action Plan 2. Educate all staff in the history, culture awareness e-learning package. (RAP) include: and spirituality of Aboriginal and Torres Strait Islander peoples • Provision of cultural training programs Evaluation for staff 3. Engage and empower staff to seek out Paramedics now perform regular health opportunities that have a direct impact checks and oversee distribution of • Opportunities for staff to engage with on improving Aboriginal people’s medications for clients from surrounding Aboriginal and Torres Strait Islander health outcomes. communities of Yalata, Oak Valley and communities by participating in locally other APY communities. based cultural events Background Aboriginal artwork commissioned • Building key performance indicators Health is a holistic term for Aboriginal to adorn the livery of community into performance reviews to encourage people encompassing their physical and paramedics’ vehicles in Ceduna where staff to contribute to reconciliation mental health, employment, education 22.4 per cent of the community identify as and living standards. • Reward and recognise silent achievers Aboriginal and Torres Strait Islander, has who contribute to reconciliation For them, hospitals may be seen as a place been a successful initiative to build trust with negative connotations associated with a universal language. • Using culturally appropriate artwork to with suffering and death; when English promote commitment to reconciliation The strength of the relationships, is not their first language, they are often respect and trust developed has enabled • Cultural mentoring network for existing reluctant to engage in conversations that paramedics to provide early interventions, Aboriginal staff reflect negative health outcomes; their hospital avoidance and follow up checks spiritual and cultural beliefs can conflict • Implementing employment pathways with clients who visit the Aboriginal with western medicine. such as traineeships specifically for Drug and Alcohol Council (ADAC) clinic. Aboriginal peoples Ambulance services have the opportunity Paramedics are empowering clients to to break those barriers and engage in look after their healthcare. • Implementing a recruitment and respectful relationships and build trust as retention strategy through the broader Community paramedics’ work in Ceduna they travel into communities. SA Health Aboriginal Workforce is an excellent example of a RAP actively Implementation Group. contributing to better healthcare outcomes for Aboriginal communities. 26 CAA MAGAZINE

LEADERSHIP Real time reporting and alerts

Jeannette Perez Mawyin, Business Intelligence Manager – Commercial, Community & Communications, St John New Zealand Phase 3 – Project Implemented, Ongoing Commitment For St John New Zealand making decisions that improve patient outcomes and crew welfare are an integral feature of the service’s vital role. Real time data is no longer an extra but a necessity for managers to do their job well. St John uses daily dashboards that monitor and support managers in their decision making by displaying real time statistics on key parts of operations. In addition, thresholds and alerts were developed to supplement the real time dashboards, alerting managers to when they are likely needed to intervene. Example of real time reports showing EAS incidents demand and 111 call volumes for the day, a comparison between actual and estimated as well as service level agreements achieved. Aim retrieval from the Computer-Aided Initially alerts were triggered for staff The aim of this project is to assist Dispatch (CAD) system as required without welfare, vehicles with significantly higher operations managers understand service affecting the production environment. time at hospital and low acuity patients performance measured against key waiting more than an undesired length of Replicated data had to be stored outside performance indicators (KPIs) using real time without being called back. time information. the St John Emergency Ambulance Communication Centre (EACC) production The following alert thresholds are being The project tools provide situational environment to interact in real time with developed: awareness and shows demand and other databases ensuring these did not • Significantly higher workload than pending allocations as well as current suffer any drop of performance. and estimated demand. Managers also expected In 2018, thresholds and alerts were receive an alert when they likely need • Low performance for a period to intervene to maintain a good service developed so managers received an alert allowing them to make quick decisions. when data identified an incident which • Call answering SLA significantly below demanded their attention. target Real time reports provide information related to call answering, incidents Methodology • No vehicles available for a large area. waiting for vehicle dispatch, response performance as well as time spent at A text limitation of 160 characters and Evaluation consideration of managers’ welfare, treatment centre. Based on thresholds it There were 7,435 alerts sent to DOMs, meant alerts were developed and will trigger a performance alert or staff TMs, Peer Support Leaders and clinical activated to go out Monday-Friday 0800- welfare check. control members between 20 June 2018 1800 based on the selected criteria: and 31 April 2019. Managers reported Background a. Actionable – support immediate positive feedback on crew welfare Prior to 2017, information received by decision-making alerts and benefits of having real time District Operation Managers (DOMs) and b. Informative – contain enough reports during disasters and large-scale Territory Managers (TMs) was delayed information to allow a quick decision emergencies. by a day. Reports were received around Prompt an action Future development includes using 8:00 am and dashboard data contained machine learning to predict incidents information up to midnight. While the Prompt viewing real time reports likely to require a helicopter response, analytics allowed managers to understand for more information allowing the air desk to review as a and learn from each day’s events, it c. Frequency – alerts should not be priority as well as perform sentiment was too late to act on information ignored and manager welfare should analysis on real time tweets to support immediately. be considered communication teams to better track The challenge for St John was having d. Repetition – a trigger should only conversations related to St John. the infrastructure able to support data create a single alert in a period. YOUR PARTNER IN RESUSCITATION

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