Annual Report 2008-09

TURNING SCIENCE INTO HEALTH Contents

Year at a Glance 2 Chairman and CEO Report 6 Board of Directors 8 Organisational Structure 10 Acute Operations 14 Nursing and Ambulatory Care 20 Research 23 Teaching and Training 28 Chief Medical Ofﬁcer 30 Support Services 34 – Infrastructure and Commercial 34 – Human Resources 36 – Strategy, Quality and Service Redesign 38 – Fundraising 39 Our Supporters 40 Senior Staff 42 Awards and Scholarships 44 Financials 46 Our Clinical Services 47 Mandatory Reporting 50 Statement of Priorities 53 Disclosure Index 57

Additional Copies VISION OVERVIEW Please call Austin Health Corporate Austin Health will be renowned for Austin Health is the major provider Communications on 03 9496 5222 excellence and outstanding leadership in of tertiary health services, health health care, research and education. professional education and research We welcome your feedback in the north-east of Melbourne. Austin Please submit online VALUES Health is world-renowned for its at www.austin.org.au/publications Integrity – We exercise honesty, candour research and specialist work in cancer, Design and Production and sincerity. liver transplantation, spinal cord injuries, Fragile Design neurology, endocrinology, mental health Accountability – We are transparent, and rehabilitation. Principal Photography responsible and answerable. Parallax Photography Austin Health comprises Austin Hospital, Respect – We treat others with dignity, Heidelberg Repatriation Hospital and consideration, equality Royal Talbot Rehabilitation Centre. and value. During 2008-09, Austin Health’s 6,402 Excellence – We continually staff treated a record 89,668 in-patients Cover: At the forefront of medical technology, strive for excellence. and 155,538 out-patients. Dr Mark Goodwin, radiologist and Mr Paul Hubbard, radiographer review images obtained during an interventional procedure in Austin Hospital’s new angiography suite.

i VISION OVERVIEW Austin Health will be renowned for Austin Health is the major provider excellence and outstanding leadership in of tertiary health services, health health care, research and education. professional education and research in the north-east of Melbourne. Austin VALUES Health is world-renowned for its Integrity – We exercise honesty, candour research and specialist work in cancer, To provide our patients with the best treatments and sincerity. liver transplantation, spinal cord injuries, available, we have created a culture where excellence neurology, endocrinology, mental health Accountability – We are transparent, in medical research is highly valued and the training and rehabilitation. responsible and answerable. of tomorrow’s clinicians is woven into the Austin Health comprises Austin Hospital, organisation’s ﬁbre. Respect – We treat others with dignity, Heidelberg Repatriation Hospital and consideration, equality Royal Talbot Rehabilitation Centre. This report features some of our most proliﬁc and and value. During 2008-09, Austin Health’s 6,402 respected researchers. Their work, and the work of Excellence – We continually staff treated a record 89,668 in-patients their colleagues, translates to new treatments and strive for excellence. and 155,538 out-patients. innovations, delivered by highly skilled staff. And that means our patients get well soon.

Austin Health : 2008-09 ANNUAL REPORT 1 Year at a Glance

TOTAL NUMBER OF PATIENTS ADMITTED END OF YEAR FINANCIAL RESULTS TO AUSTIN HEALTH FACILITIES

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The number of patients admitted climbed to 89,668 The underlying operating result for 2008-09 was this year – the eighth consecutive year of growth and a $242,000. This ﬁgure was inﬂated by a major donation �� 37 ��per cent increase since 2000-01. of $4.2 million to fund medical research. The 3.7 per cent growth in the number of in-patients treated was due primarily to the number of surgical procedures undertaken at The Surgery Centre.

TOTAL NUMBER OF PEOPLE WHO PRESENTED TO PERCENTAGE OF EMERGENCY PATIENTS WHO WERE THE EMERGENCY DEPARTMENT FOR TREATMENT ADMITTED TO A WARD BED WITHIN EIGHT HOURS

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Emergency Department attendances continued Emergency Department patients admitted to an to increase sharply this year, with 8.2 per cent or in-patient ward bed within eight hours increased 4,659 more�� attendances than the previous year. This slightly compared to the previous�� year, despite constitutes a 47 per cent increase in activity since the increased numbers of patient presentations. This new hospital opened in 2005. This increase was partly result�� was due to improved patient ﬂow systems �� driven by heat-related presentations in summer and within the Emergency Department. the swine ﬂu pandemic during May and June.

2 Austin Health : 2008-09 ANNUAL REPORT PERCENTAGE OF TIME AMBULANCES WERE TOTAL NUMBER OF PATIENTS WAITING DIVERTED TO OTHER HOSPITALS FOR ELECTIVE SURGERY AT YEAR’S END

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Despite the continued growth in patients presenting to The total waiting list for elective surgery decreased the Emergency Department, Austin Health was again by 22 per cent due to the performance of over able ��to achieve the Department of Human Services 5,000 procedures at The Surgery Centre. This was benchmark of being on bypass less than three per achieved despite a 15 per cent increase in numbers of cent of the total time in each quarter. Austin Health patients added�� to the waiting list. �� is continuing to work closely with the Metropolitan Ambulance Service and surrounding hospitals to minimise time spent on bypass.

AVERAGE LENGTH OF STAY FOR ACUTE PATIENTS PERCENTAGE OF PATIENTS WHOSE ELECTIVE (EXCLUDING SAME DAY PATIENTS) SURGERY WAS POSTPONED BY THE HOSPITAL

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The average length of stay of non-same day patients There was a signiﬁcant reduction in the number of remained constant compared to the previous year, patients whose elective surgery was postponed by despite the increasing average acuity of patients the hospital ��this year. This was greatly assisted by �� admitted. Lengths of stay at Austin Health include the quarantining of elective surgery patients at The long-stay spinal and liver transplant patients. Surgery Centre from the pressures of delivering ��emergency care. ��

Austin Health : 2008-09 ANNUAL REPORT 3 Epilepsy research at Austin Health includes research teams from The University of Melbourne and the Brain Research Institute working together to better understand the causes and treatment of epilepsy. The Epilepsy Research Centre conducts internationally recognised research into the genetics of epilepsy; imaging techniques looking at both the structure of the brain and how it works; and the surgical treatment and psychological aspects of epilepsy. This research is integrated into world-leading patient care that draws on the expertise of neurologists, neurosurgeons, neuropsychologists, radiologists, nuclear medicine specialists, psychiatrists, nurses, EEG technicians, neurophysiologists and researchers.

All in the mind – unlocking the mystery of epilepsy

> Laureate Professor Samuel Berkovic AM

Australia leads the world in research Most seizures are brief, and a recovery “By researching and understanding into the genetics of epilepsy, and Austin period of up to a day is common. For the genes that cause epilepsy, and there Health’s Professor Samuel Berkovic, a person with regular seizures, the are several, we can improve therapies clinical neurologist, is at the forefront. condition has a devastating effect on and treatments for our patients,” said His genetic research has led to advances their confidence and quality of life. Prof Berkovic. in patient care, as well as the adoption Leading an expert team in the Prof Berkovic’s motivation for his of new concepts in understanding and Comprehensive Epilepsy Program at research is driven by his intrigue with researching the condition. Austin Health, Prof Berkovic’s discovery the brain as an electrical organ. His first “An epileptic seizure is a disruption in of the first epilepsy gene was a major job, at the Austin Hospital as a neurology the communication between the brain’s breakthrough. The discovery led to a intern in 1978, brought him under the nerve cells, which is via little electrical series of others, and proved that many influence of the founder of the neurology and chemical signals,” he said. “During a types of epilepsy are genetic or the result unit, Dr Peter Bladin. Dr Bladin’s passion seizure there is an uncontrolled burst of of inherited changes in ion channels in for epilepsy inspired the young doctor, abnormal electrical activity that could be the brain. His research has contributed whose prodigious work ethic has brought likened to a brain storm.” to a great increase in the knowledge him international acclaim for about the inheritance of the condition his achievements. and its fundamental causes. Now as a senior clinical neurologist and Because of his work, more accurate Laureate Professor in the Department of diagnosis, treatment and counselling is Medicine at The University of Melbourne, now available to people with epilepsy, students of the highest calibre travel who number around one or two per cent from across the world to work with his of the population. team of first-rate neurologists. Epilepsy patients too travel to the Austin Hospital from all over the southern hemisphere, so the students are exposed to the most acute and complex epilepsy patients.

4 Austin Health : 2008-09 ANNUAL REPORT All in the mind – unlocking the mystery of epilepsy

> Laureate Professor Samuel Berkovic AM

The team’s genetic research contributes “The research environment has Pictured above: Laureate Prof Samuel Berkovic AM in the Department of Medicine, to knowledge that is fundamental come a long way in twenty years,” The University of Melbourne at Austin to the biology of epilepsy and in he said. “The revolution in genetic Health’s genetics laboratory, John Damiano, understanding how and why a ‘brain technology and knowledge, exemplified research assistant, Dr Kheng Seang, storm’ or a seizure develops. The by the Human Genome Project, has neurology registrar and Dr Todor Arsov, senior research fellow. electrical activity in a patient’s brain is allowed unprecedented insights into recorded by an electroencephalogram human disease. (EEG). The EEG recording shows Prof Samuel Berkovic is director of the For people with epilepsy, I believe we rhythmical electrical activity, often called Comprehensive Epilepsy Program at are working towards a far greater brain waves. The brain waves may be Austin Health, Director of the Epilepsy understanding that will give our normal or show abnormalities in certain Research Centre and Scientific Director patients more confidence and control regions. For researchers, the challenge of the Brain Research Institute. over the lives.” lies in understanding the cause of the He holds a personal Chair in the brain’s activity. Department of Medicine, Austin Health at The University of Melbourne and is Compared to his experience as a young an adjunct Chair in the Department of doctor at Austin Hospital, Prof Berkovic Neurology and Neurosurgery at is excited about the technology that is McGill University, Montreal, Canada. now available for genetic studies. He is the author of over 300 peer- reviewed papers, and is on the advisory board of Brain and the editorial board of Epileptic Disorders. Prof Berkovic’s most notable recognition was his election to the Royal Society in 2007. Others include: Member of the Order of Australia, 2005; Research Medal for Scientific Research in Human Health, The Royal Society of Victoria, 2006; Distinguished Scientist Award, Austin Hear Prof Berkovic speaking to Prof Jeffrey Zajac and Repatriation Medical Centre, 2002 about epilepsy at www.austin.org.au/podcasts

Austin Health : 2008-09 ANNUAL REPORT 5 Chairman and CEO Report Mr Tim Daly AM, Chairman of the Board of Directors and Dr Brendan Murphy, Chief Executive Ofﬁcer

It was a productive and The Board approved new, The number of hospital in-patients eventful year at Austin five-year clinical service and strategic increased by 3.7 per cent, representing plans. These key documents were an additional 3,197 patients over last Health. We treated the endorsed and will guide our complex year. This can be attributed to the largest number of patients task of providing clinical services additional elective surgery performed in our 127-year history; that range from community-based at The Surgery Centre at Heidelberg demonstrated strong secondary care through to highly Repatriation Hospital, as well as patient care and quality complex state-wide and national a number of initiatives that improved clinical performance; services. The Board reaffirmed the patient flow throughout the need to strongly support the crucial health service. performed research that leadership role of our major state-wide Austin Health performed 30 per cent rated on the world-scale; services, such as the liver transplant, more surgery than in the previous recruited and retained spinal and ventilatory support services. financial year, highlighting the success talented, committed staff; Our focus on research was reaffirmed of the elective surgery centre model, and, pleasingly, met our as a cornerstone of Austin Health which provides a balance between the financial targets with a through the establishment of the Austin competing demands of emergency and modest operating surplus. LifeSciences Office for Research. The elective surgery. The Surgery Centre Office provides a vital single point of strategy has been recognised as an contact for all campus research activity exemplar of the elective surgery service for our hospital-based researchers, model favoured by the National Health the research institutes based at Austin and Hospital Reform Commission. Health, and our university partners. It However, there remains work to be also serves to promote the impressive done to address procedures in high and extensive research profile to external demand by the community, such as stakeholders. The Office for Research joint replacement surgery. will be enabled through an endowment of $4.2 million from the senior salaried medical staff trust fund.

6 Austin Health : 2008-09 ANNUAL REPORT The ongoing development and upgrades On February 7, bushfires caused We close by offering our gratitude to the of Austin Health’s facilities continued, massive destruction of life and property, staff, volunteers and Board of Directors with major building works underway. We dangerously close to Melbourne. We are of Royal Talbot Rehabilitation Centre, welcome the significant developments proud that Austin Hospital’s Emergency Heidelberg Repatriation Hospital and at Heidelberg Repatriation Hospital. Department (ED) coped with the crisis Austin Hospital. It is their dedication, Construction started on the Health and with skill and efficiency. Professionals hard work and focus that were behind Rehabilitation Centre, which will combine from the mental health service are the successful performance of 2008-09. the full range of subacute services under still involved in the reconstruction Finally, In accordance with the Financial a single roof. Construction will soon effort. The Austin Health community Management Act 1994, we are pleased start on the new Centre for Trauma- was saddened to learn that one of to present the following report of Related Mental Health, where specialist its most outstanding and long-term operations for Austin Health for the treatment for post-traumatic stress staff members, Prof Rob Pierce, died year ending 30 June 2009. disorders will be provided. At the Austin defending his home from the fires at Hospital, the new child care centre and St Andrews. Many other Austin Health the Bio-Resources Research Centre staff lost homes and property. both near completion. The emergence of the contagious The establishment of the Olivia Newton- H1N1 influenza flu centered on John Cancer and Wellness Centre Melbourne, and generated a massive Mr Tim Daly AM remains Austin Health’s highest priority increase in presentations to the ED. Chairman capital investment. The existing facilities A highly-skilled team from our Infectious for the large and growing cancer Diseases and Emergency Departments programs are unsatisfactory. We are displayed tremendous leadership in indebted to Olivia and the fundraising managing the crisis as it unfolded. appeal executive, led by Mr Terry This year saw significant change in Campbell AO and Mr Andrew Hagger, the health service senior executive roles. for their commitment to fundraising for Dr Brendan Murphy We farewelled Mr John Richardson, the project. We continue to work with Chief Executive Officer Mr Chris O’Gorman and Dr Mark governments to realise the additional Garwood and thank them for their 25 August 2009 funding that is required to establish this collective years of service. We were vital facility. joined by Ms Fiona Webster, executive The 3KZ Building was demolished to director of Strategy, Quality and make way for the Austin Neuroscience Service Redesign; Dr John Ferguson Facility. Following substantial as chief medical officer; and investment from both State and Mr Luke Mulkearns, executive Federal Governments, The University director Human Resources. of Melbourne, the Mental Health Directors Mr Robert Webster and Research Institute (MHRI) and a number Ms Joe Manton both completed their of philanthropic bodies, construction statutory terms at the end of June. of this facility is now underway. The The Board of Directors thanks building will accommodate the Florey Ms Manton for her contribution over Neurosciences Institutes, The University the last nine years, and Mr Webster of Melbourne, Austin Health and the for his contribution since he joined the MHRI. Such substantial investment Austin and Repatriation Medical Centre shows a great commitment to Planning Committee in February 1995. strengthening Melbourne’s reputation as a world centre for biomedical and We extend our thanks to the Hon Daniel neuroscience research, and continued Andrews MLA, Minister for Health and acknowledgement of this site as a the Department of Human Services for leading research precinct. their ongoing support.

Austin Health : 2008-09 ANNUAL REPORT 7 Board of Directors

Austin Health’s Board of and is Vice Chair of the Board of community and government boards Directors consists of nine Melbourne Citymission. Joanna lectures in the Australian Capital Territory and in workplace law for the Law Faculty’s Queensland, including the Dental Directors, appointed by postgraduate program at Monash Board of Queensland. Her past the Victorian government. University and is a member of the executive roles include Executive The Board leads the Advisory Panel for the Monash University Director, Mercy Health Care Australia strategic direction Law Faculty Master of Laws coursework and Deputy Executive Director, Corporate program specialising in Workplace and and Communications, Australian for the management, Heritage Commission. administration and control Employment Law. of Austin Health, its funds Ms Suzanne Evans Mr Stephen Kerr and its facilities. Directors BEc, Dip Ed FCPA FAICD BA BSW Dip Crim. GAICD are elected for a term of up Suzanne was appointed to the Board Stephen was appointed to the Board in on 1 July 2008 and is a member of the 2006 and chairs the Primary Care and to three years and may be Audit Committee and the Community Population Health Advisory Committee re-elected to serve for up to Advisory Committee. and is a member of the Clinical Safety nine years. and Quality Committee. Suzanne has a background in Finance and Economics and has broad Stephen is a Director of Atkinson Kerr Mr Tim Daly AM B.Bus, CPA, FAICD management experience in corporate and Associates who specialise in planning Tim was appointed Chairman of the governance, accountancy and in the and review of Indigenous health and Board in 2003. He is a member of the public service. Most recently she community services. Past employment Finance and Audit Committees and was General Manager Customer and includes Lecturer in Welfare Studies at chairs the Remuneration Committee. Community Relations for Western Water. Monash Gippsland, General Manager of the Victorian Correctional Health Service Tim has 38 years’ experience in public She is a current Director of the North and Senior Executive in the Department sector management, including in health East Water Corporation, a member of the of Human Services. He has been Chair services policy and planning, and in a Osteopaths Registration Board, she sits of North Richmond Community Health range of other government functions. on the Australian Osteopath Council’s Limited for the past three years. He was Chief General Manager of the Accreditation Committee and was an former Health Department of Victoria inaugural member of the Customer Ms Joe Manton from 1988 to 1992 and subsequently held Consultative Committee for the Medical GDWA, Fellow Williamson Community senior executive appointments in the Practitioners Registration Board. Leadership Program, Accredited Departments of Justice and Finance. Access Consultant Ms Barbara Hingston Joe is a member of the Community Tim was Chairman of the Board of the BA(Admin), BSW GAICD, AASW Advisory Committee and the Primary Metropolitan Ambulance Service from Barbara joined the Board in 2005. Care and Population Health Advisory May 2000 to June 2008. She brings a wealth of experience in Committee. She has had an extensive public sector management and non- For his services to the Victorian health career in health and community services. government corporate governance, care system, Tim was awarded an Order Joe is a Director of Access Audits policy development, health service of the Medal of Australia in 2009. issues and planning and community Australia, providing disability access advice, publications and consultancy Ms Joanna Betteridge BA, LLM, representation. She is the Chair of the services to the government, community GAICD, Acc M LEADR Community Advisory Committee and a and corporate sectors. She is also Joanna joined the Board in 2003 and is member of the Clinical Safety and the Director of the Institute of Access a member of the Audit Committee, the Quality Committee. Training Australia and a Member of the Clinical Safety and Quality Committee For the past 10 years Barbara has Australian Institute of Building Surveyors. and the Remuneration Committee. worked in public and community health Joe is also a Committee Member of the Joanna practices as a lawyer in the in the management and delivery of Association of Consultants in Access employment and occupational health services addressing family violence, Australia and the Convenor of the and safety areas of law. Prior to starting sexual assault and other trauma. She Victorian Access Consultants Network. her own law practice and consulting continues to be involved in the evaluation business in July 2004, she was a partner of public policy practice in these ﬁelds. Joe has been instrumental in at Maddocks lawyers. She is a current Board member of establishing and developing a range ‘headspace’ - National Youth Mental of community services as well as the Joanna is also an accredited mediator. Health Foundation. Barbara has also evaluation and review of services, She is a graduate member of the served on the Board of Mackillop Family programs and processes within a variety Australian Institute of Company Directors Services Victoria 2003-2006 and other of organisations. She regularly presents

8 Austin Health : 2008-09 ANNUAL REPORT on disability access improvement Women’s Centre Trust and sits as a Mr Robert Webster issues, develops disability action plans Trust member. DBA, FCPA, FRICS, FAPI, MAICD and is highly experienced in facilitating Robert chairs the Audit Committee Josie is also an independent member community engagement. and is a member of the Finance and of the Audit Committee for the Victorian Resources Committee. A Fellow of both Ms Josie Rizza Department of Treasury and Finance. the Australian Property Institute and BEc , CA, Grad Dip Applied Finance and Investment, GAICD Professor David Scott MB BS MD the Royal Institution of Chartered MS FRACS Surveyors, Robert is program leader Josie joined the Board of Austin Health in David joined the Board in 2005 and of property postgraduate studies at 2005. She chairs the Finance Committee was RACS Executive Director, Head RMIT University’s School of Property, and is a member of the Audit Committee of Vascular and Transplant Surgery at Construction and Project Management. and the Remuneration Committee. Monash Medical Centre and Professor He is also Senior Vice-President of the Josie has expertise in ﬁnance, and Chair of Monash University Victorian branch of the RSL. accounting, corporate governance and Department of Surgery. risk management. Josie is a Chartered David chairs the Clinical Safety and Accountant and previously had a senior Quality Committee and is a member role in a large multi-national, public of the Finance Committee. company providing tax planning advice. Josie has served on the Victorian Eye David previously served on the board and Ear Hospital Board and chaired of Victorian Ministerial Council on the Audit and Finance and Investment Medical Workforce Management and Management Committees. Medical Training Review Panel for the Commonwealth Department of Health Josie is currently the Treasurer for and and Ageing. a director of Tweddle Child and Family Health Services. In that capacity she David also chaired the RACS International Pictured below: (L-R) Prof David Scott, chairs the Finance and Risk Management Humanitarian Surgical Aid Program Ms Josie Rizza, Ms Joanna Betteridge, Ms Suzanne Evans, Dr Brendan Murphy, Committee. Josie is also the Chair of and was medical director for East Timor Ms Barbara Hingston, Mr Robert Webster the Finance, Governance and Audit AusAid Specialist Surgical Program. Mr Stephen Kerr, seated Ms Joe Manton Committee for The Queen Victoria and Mr Tim Daly.

Austin Health : 2008-09 ANNUAL REPORT 9 Organisational Structure

AUSTIN HEALTH Mr Tim Daly AM Ms Joanna Betteridge Ms Suzanne Evans Ms Barbara Hingston BOARD Chairman

CHIEF Chair, Division of Medicine EXECUTIVE Professor Jeffery Zajac OFFICER

Chair, Division of Surgery Professor Chris Christophi

Chair, Division of Psychiatry Associate Professor Richard Newton

EXECUTIVE DIRECTORS

Ambulatory and Acute Operations Chief Medical Ofﬁcer Nursing Services Mark Petty Dr John Ferguson Ann Maree Keenan

Clinical Service Units • Medical Education Unit • Mental Health CSU • Medical and Emergency • HMO Services • Sub-Acute CSU • Specialty • Pharmacy • Ambulatory and Continuing • Surgical • Clinical Photography Care • Anaesthesia, Peri-Operative • Health Sciences Library • Nursing Services and Intensive Care • Radiology • Austin Child Care Centre • Cancer, Spinal and • Nuclear Medicine and PET • NCASA (Northern Centre Outpatients • Pathology Against Sexual Assault) • Access and Demand • Community Advisory Committee

10 Austin Health : 2008-09 ANNUAL REPORT Mr Stephen Kerr Ms Joe Manton Ms Josie Rizza Prof David Scott Dr Robert Webster

• Corporate Counsel • Fundraising • Corporate Communications • Board Secretariat, including shared responsibility for Audit with CFO • Austin LifeSciences Ofﬁce for Research

Senior Medical Staff Chair Dr Brendan Murphy, CEO Dr Ian Harley

Strategy, Quality Infrastructure Human Resources Finance and Service Redesign and Commercial Luke Mulkearns Ian Broadway Fiona Webster Michael McDowell

• HR Business Services • Finance • Quality, Safety and Risk • Capital Works • People and Performance • Supply Management • Facilities Maintenance • Employee Relations • Billing • Austin by Redesign • Environmental Services • Work/Life Balance • Audit (shared with CEO) • Clinical Information, Analysis • Stericlean • HR Business Partners and Reporting • Security • OH&S • Veterans Liaison • Car Parking • HR Projects - Kronos • Health Information • Food Services Management • Information Technology • Projects Group • Mail and Transport • Service Planning and • Medichef (CPU) Performance • Board Clinical Safety and Quality Committee • Primary Care and Population Health Advisory Committee

Austin Health : 2008-09 ANNUAL REPORT 11 Clinical research is integral to the provision of best practice cancer care. At Austin Health, research is conducted in conjunction with a number of research organisations, including the Ludwig Institute for Cancer Research and The University of Melbourne. Translational research in the ﬁelds of medical oncology and clinical haematology is world-renowned and radiation oncology, psychology, allied health and nursing continue to investigate ways to improve patients’ quality of life. Currently 113 studies are underway into anti-cancer drugs to destroy or inhibit renal, prostate, melanoma, brain, haematology and solid tumours. Many patients who have reached the end of their conventional treatment are invited to join the trials to access otherwise inaccessible drugs. We are proud to provide them with the best possible care, and with a second chance of hope. The hope for an end to cancer begins with research

> Professor Jonathan Cebon

As a young doctor at the Austin “I see my work as clinician and significantly delay, cancer recurrence Hospital, Jonathan Cebon came under researcher as inseparably intertwined,” in patients after the surgical removal of the mentorship of the late Dr Wally said Prof Cebon. “In order to do the their primary tumour. Moon. Described fondly as a colourful very best for our patients we need to One of the major research programs character, Dr Moon was Medical continually find ways to improve on sponsored by LICR is to try to Superintendent of the Austin when it had treatments and therapies. The only way understand what it is that the immune been the “Hospital for Incurables”. to do this is by research.” system ‘sees’ on cancer cells, so it can Dr Moon was renowned as a In addition, Prof Cebon is deeply aware seek out those cells and destroy them. compassionate, hands-on physician who of the psychological effect of cancer on A number of ‘targets’ on cancer cells pioneered cancer medicine in Australia. those who are touched by the disease, have been identified as a result of this His enthusiasm for high-quality, holistic both patients and their loved ones. With research enabling the team to develop care inspired many young trainee doctors tangible empathy, he instils Dr Moon’s immuno-therapies. to become cancer specialists, including concern for patients’ wellbeing into his The vaccines work on a similar Dr Cebon who went on to become team’s approach to their care. principal to vaccinating children against a Medical Oncologist, Professor of It is recognised in the community that disease. Instead of trying to prevent Medicine and cancer researcher with the cancer is a huge health problem. Of whooping cough, for example, the team prestigious Ludwig Institute for Cancer those who develop the disease, 30 per is training the immune system to attack Research (LICR), which jointly operates cent will die despite their treatment, cancer cells. Following the surgical the Medical Oncology department at which may be a combination of surgery, removal of a patient’s tumour there is Austin Health. radiotherapy and chemotherapy. a risk that some cancer cells escape surgery. With malignant melanoma, “The reality is that current cancer cancer cells can come back within two treatments are not good enough and years or even sooner. we have to do better,” said Prof Cebon. His team of researchers are focussed Data from Prof Cebon’s melanoma on cancer immunology: the interaction vaccine clinical trials points to evidence between cancer and the immune system. that most of the patients who received Prof Cebon is overseeing cancer vaccine the vaccine develop strong immune clinical trials that seek to determine responses against the cancer target whether vaccination can prevent, or molecules. The hope is that

12 Austin Health : 2008-09 ANNUAL REPORT The hope for an end to cancer begins with research

> Professor Jonathan Cebon

this will defend them against the An extremely valuable collaboration Pictured above: Prof Jonathan Cebon, return of cancer. for cancer patients is the Centre for Dr Andrew Weickhardt, Research Fellow Assoc Prof John Mariadason, Head of the PET (Positron-Emission Tomography) “This work is still in the research Oncogenic Transcription Laboratory in at Austin Health. Led by Prof Andrew phase,” cautioned Prof Cebon. “We are the Ludwig Institute for Cancer Research Scott, the Centre provides the means of vaccine laboratory at Austin Hospital. continuing to work, both in the laboratory evaluating tumours in patients with the and in clinical trials, to develop these use of PET scanning on-site. vaccines.” Prof Jonathan Cebon is director of For Prof Cebon, it is not just the Excitingly, a number of discoveries the joint Austin Ludwig Oncology development of the melanoma vaccine made by the joint Austin Health/LICR Unit at Austin Health and heads that deﬁnes his career. It is the nurturing research teams have been licensed the Ludwig Institute for Cancer of a team of clinicians, who care for by GlaxoSmithKline, and are under Research’s Cancer Vaccine Group cancer patients with skill and empathy; development for commercial use in in Australia. talented researchers, who perform the future. leading-edge work; and their supportive He is director of the Cancer Vaccine Collaborative, Australasia, Cancer research and treatment at Austin collaborators that is his greatest reward. Professor of Medicine in the Health is performed by teams of highly- Department of Medicine Austin skilled and experienced specialists in a Health, The University of Melbourne. range of professions. As colleagues, the clinicians and researchers depend on He is author of 128 papers. one another for intellectual input, ideas for stimulation and access to equipment and technologies. Prof Cebon describes Austin Health, LICR and its collaborators as a community. It is by collaborating with other members of the community that his team is able to achieve what would be impossible as individuals.

Hear Prof Cebon speaking to Prof Jeffrey Zajac about cancer at www.austin.org.au/podcasts

Austin Health : 2008-09 ANNUAL REPORT 13 Acute Operations

Austin Health performed 21,000 surgical procedures in 2008-09, an 18 per cent increase over last year. The highly-successful elective surgery model at The Surgery Centre contributed to a surgical waiting list reduction of 22 per cent.

SPECIALTY Assoc Prof George Matalanis pioneered patients presenting at ED and receiving The Departments of a technique to replace a patient’s aorta treatment has been cut by 43 minutes. Cardiology and Cardiac while ensuring continuous blood flow The mean time for treatment is now 73 Surgery have initiated a clinical to the brain. In a 12-hour procedure, minutes, well below the best-practice program to replace narrowed aortic Assoc Prof Matalanis re-routed the target of 90 minutes. A multidisciplinary valves using a new minimally-invasive arteries supplying blood to the patient’s team from ED, Cardiac Catheterisation technique. The procedure can be brain. The arteries were disconnected Laboratory and the Cardiac and Thoracic performed via the transfemoral one at a time, allowing two to provide Ward have continued to seek ways to or transapical approach. The first blood flow, until finally all three were shave off precious minutes. The staff procedure at Austin Health was supplying blood from a bypass machine. have now partnered with Ambulance performed in December via the The technique enabled a quicker recovery Victoria to introduce direct admission to transapical approach and was and eliminated the risks associated the Cardiac Catheterisation Laboratory one of Australia’s first heart valve with traditional deep cooling such as from the ambulance, expected to provide replacements that did not involve the impairment of higher brain function. an even greater reduction in ‘door to open-heart surgery. It involved inserting To share the revolutionary method, the balloon’ times. a new type of pericardial heart valve, surgery was broadcast from Austin The Cardiology Department benefitted constructed from cow tissue, via a Hospital’s operating theatre to a from DHS’ Targeted Equipment small incision between the ribs. The symposium of international surgeons Program funding to upgrade two cardiac procedure was guided via x-rays and in Queensland. ultrasound machines with state-of-the- ultrasound to the aortic valve position. A heart attack (myocardial infarction) is art replacements. Valued at $800,000, the The transfemoral technique follows a medical emergency and the patient high-volume machines offer 3D and 4D a similar principle except the valve is has no time to lose. Blood supply must scanning capability to analyse the health inserted into the heart through a small be restored to the heart urgently with a of a patient’s heart. With 7,000 scans incision in the patient’s leg. The new miniature balloon and a stent. For every carried out annually, staff appreciate the technique eliminates the need for a 15 minutes saved before the blocked advanced ergonomics of the equipment. heart-lung machine and reduces the artery is cleared, there is a seven patient’s recovery time, which makes it Tragically, the highly-esteemed per cent increase in patient survival. suitable for those at very high risk from Prof-Director of Respiratory and Following last year’s pilot program, major cardiac valve surgery. Sleep Medicine, Robert Pierce, died the time lapse between ST segment in Victoria’s bushfires on Saturday 7 elevation myocardial infarction (or STEMI)

14 Austin Health : 2008-09 ANNUAL REPORT Pictured left: Mr Philip Hayward and Associate Prof George Matalanis perform an Australian-ﬁrst form of aortic replacement surgery at Austin Hospital.

February. Prof Pierce’s legacy includes With an innovative model focussed INTENSIVE CARE UNIT the establishment of the Victorian on less complex cases, over 5,000 The year was the busiest experienced by Respiratory Support Service and Institute operations have been performed at the Intensive Care Unit (ICU), which cared for Breathing and Sleep. An outstanding The Surgery Centre since its opening. for over 2,000 critically ill patients. DHS clinician, researcher and mentor, Prof provided funding to open an additional Pierce was a passionate advocate for ANAESTHESIA AND PERIOPERATIVE bed, bringing the number of funded the respiratory and sleep health of Following a $2 million grant from beds to 17. At times of peak activity, ICU indigenous Australians and had taken DHS in November, the Operating Theatre has expanded to full capacity within the sabbatical leave in northern Australia to Suite undertook major refurbishment 20-bed area of pod A and pod B, and deepen his knowledge of these issues. works of two of its 12 theatres. Theatres beyond into the adjacent 10 bed area In the days before his death, Prof Pierce three and four are used for complex of pod C for the first time. Additional received major funding from the Victorian procedures and were decommissioned funding was provided by DHS to purchase Neurotrauma Initiative to research sleep for extensive upgrades. Comprehensive essential equipment including ventilators, strategic planning ensured that the disorders in quadriplegic patients. He will haemofiltration machines, monitors impact on work-flow was minimised. be sadly missed by all at Austin Health, and a video laryngoscope to enable the Works were completed in four months but most acutely by his patients, research additional bed to be opened. students and staff. and met rigorous safety and quality standards before re-opening on 22 April. The medical emergency team responded to over 1,800 calls. The ICU liaison nurse SURGICAL As patient throughput continues to Over 21,000 emergency and elective increase year-on-year, innovative reviewed more than 1,600 patients, operations were performed during the solutions are essential to maximise continued to provide follow-up services year. This is an increase of more than the use of resources and provide the to patients discharged from ICU, and 3,200 operations, or 18 per cent, on 2007- best patient care. Elective surgery was reviewed acutely unwell patients on 08 and was accompanied by a 15 per quarantined at The Surgery Centre the ward. cent increase in the number of patients at Heidelberg Repatriation Hospital The post-graduate critical care nursing from the emergency surgery demands added to the surgical waiting list. Despite program achieved excellent results this at Austin Hospital. Importantly, the this increase in demand, Austin Health year. Several students were honoured relatively controlled environment of the reduced its elective surgery waiting list in the top two per cent of all higher centre offered valuable opportunities for by 783 patients, or 22 per cent, compared education students at RMIT for 2008. This clinical teaching. to the previous year. This was due to the is testament to the graduates’ application, opening of The Surgery Centre in July The implementation of green light but also to the ICU educators and nursing 2008. Its four theatres, endoscopy room, laser treatment for enlarged prostates, staff in providing guidance, education and and flexible cystoscopy room increased or benign prostatic hyperplasia, support throughout the year. capacity for elective-only surgery. commenced at The Surgery Centre in September following a Victorian Elective CANCER SERVICES The Surgery Centre - breakdown of Surgery Funding grant of $179,000. The Cancer Services continued to work with procedures performed state-of-the-art technology replaced an the Olivia Newton-John Cancer and invasive surgical procedure known as Wellness Centre (ONJCWC) project team transurethral resection of the prostate on the design of the new centre. The �� (TURP). The green light laser therapy ONJCWC will be constructed on the site provides a minimally-invasive day of Cancer Services’ existing premises, �� procedure as effective as the traditional Heidelberg House. In preparation for the TURP, with fewer side effects. All of demolition of the old building in 2010, the theatre technicians, nursing staff Day Oncology moved into temporary and three urologists received extensive �� accommodation in the nearby Lance training on the use of the system and Townsend Building. Old wards in the performed more than 60 treatments. Harold Stokes Building were refurbished �� to meet current standards in preparation for receiving the cancer in-patient wards in August 2009.

�� Planning for the ONJCWC programs �� continued. New positions will be �� created, including a manager’s position to develop the wellness and supportive care services. A grant was received from

Austin Health : 2008-09 ANNUAL REPORT �� 15 the John Cummins Memorial Fund to SPINAL OUTPATIENTS fund a new 12-month role to set up a As a state-wide acute and sub-acute Over 155,000 people attended outpatient support group and source appropriate spinal services provider, the Victorian appointments at Austin Hospital and patient information for patients with Spinal Cord Service (VSCS) is in a Heidelberg Repatriation Hospital for brain tumours. unique position to improve the long- a range of services. Currently over term outcomes of people with a spinal 15 per cent of patients fail to attend In collaboration with The University of cord injury. To this end, the VSCS their outpatient appointment. This Melbourne, planning was undertaken to engaged in a joint project with key compromises the efficiency of the service create a new role as Professor-Director patient funding agencies, the Transport and results in other patients waiting of Haematology. Preparation was Accident Commission (TAC) and DHS, as longer for a re-scheduled appointment. undertaken to develop an expanded role well as the subacute provider Caulfield as Director of Palliative Care Services to Hospital, to develop an improved model The department successfully sought lead Austin Health’s inter-professional, of service delivery. funding from DHS to trial then introduce holistic care of patients in the advanced a system using short message stages of a progressive terminal illness. After two years of research the new service (SMS) text messaging to send The new role will support Austin Health’s model will be piloted in August 2009. The appointment reminders to patients’ continued involvement with the North innovative pilot program goes beyond the mobile or home telephones. On Western Palliative Care consortia. current in-patient rehabilitation model to evaluation, the reminders improved address the vocational, psychosocial and attendance by up to 10 per cent, Under the leadership of Medical Director recreational needs of patients to support enabling staff to re-allocate cancelled Assoc Prof Paul Mitchell, the North their transition back into community life. appointments and reduce waiting times Eastern Metropolitan Integrated Cancer It is anticipated that the program will for appointments. Service (NEMICS) continued to facilitate reduce patients’ length of stay in hospital the improvement of the coordination and minimise their re-admissions. EMERGENCY DEPARTMENT of cancer care in the local region. Its Over 60,000 people came to Austin Over the next two years the model will be strategic plan was endorsed and the Hospital’s Emergency Department progressively implemented and evaluated development of multi-disciplinary (ED) for treatment during the year. This by TAC, DHS, Caulfield Hospital and care services continued. To improve represented an increase of eight per cent Austin Health. communications between NEMICS compared with last year and an increase sites, videoconferencing facilities were of 47 per cent since the Austin Hospital established.

16 Austin Health : 2008-09 ANNUAL REPORT ��

��

Tower opened in 2005. ED staff continued Flu-Related Presentations to reﬁne their processes for ensuring �� rapid treatment of non-admitted patients or improved access to care for patients �� requiring admission to the hospital. �� To reduce unnecessary ED presentations for residents of residential care facilities, ��

an outreach program was introduced �� following last year’s successful trial. ED doctors accompany a Hospital in �� The Home (HITH) nurse to attend,

�� assess and treat the patient at their �� care facility, avoiding the need to �� transfer to hospital. If required, patients are sent to ED for acute assessment or admitted to hospital. The program INFECTIOUS DISEASES reviewed 25-30 patients each month Hand Hygiene Australia director, and received positive feedback from Prof Lindsay Grayson, oversaw the �� general practitioners, facility staff, implementation of a world-first national residents and families. hand hygiene program across Australian hospitals. The program aims to halve the The ‘fast track’ X-ray service, a joint rate of antibiotic-resistant ‘superbug’ initiative between ED, Radiology and patient infections. Ambulance Victoria, was introduced to enable timely processing of nursing- Following the May outbreak of the H1N1 home patients requiring non-urgent strain of the influenza virus, or swine flu, X-rays. The new process reduced the the Infectious Diseases Department took need for more than one ambulance, as a leading role in advising hospital and the patient arrived and was transferred government on the treatment and testing home in the same ambulance. of patients. At the peak of community This eliminated waiting for a return concern, an additional 90 patients ambulance, allowing the patient to presented to ED daily. To cope with this return home quickly and avoiding demand, a temporary flu clinic was unnecessary waiting in ED. established at the Banyule Community Health Centre, in a joint initiative To easily access the expertise of the between Banyule Community Health state-wide Victorian Toxicology Service, and Austin Health. Banyule Community the Victorian Poisons Information Health provided the staff to run the clinic Centre (VPIC) relocated from the while the Department provided advice Royal Children’s Hospital to the ED. In about patient management protocols. collaboration with ED, Pharmacy and This clinic enabled Austin Health to divert Clinical Pharmacology and Therapeutics, concerned people with mild flu-like the VPIC is able to provide information symptoms from the ED. to callers about the effects of poisons and where required offer advice about management.

Pictured left: “The bullring” at The Surgery Centre links four theatres, two endoscopy suites, a recovery unit and 12-bed short-stay ward.

Austin Health : 2008-09 ANNUAL REPORT 17 At Austin Health, research into osteoporosis is coordinated through the Endocrine Centre for Excellence, Australia’s largest research and treatment facility in this field. Its outpatient clinic, clinical trials unit, endocrine lab and bone mineral density unit work collaboratively to find solutions for treating diseases of the endocrine system such as osteoporosis, diabetes and thyroid disorders. Research into conditions including diabetic kidney disease, androgen deficiency in men, hyperlipidemia, skeletal growth, obesity and foetal growth is underway. It is home to Australia’s only high-resolution 3D peripheral quantitative computed tomography system, a non-invasive method of measuring bone quality that supports patient care as well as testing the efficacy of new medication in trials.

Osteoporosis – a life’s work to slow the breakdown of bones > Professor Ego Seeman

Clinical investigator, endocrinologist, and “Research is the single most important age of 25 years, the replacement process entertaining raconteur, Professor Ego factor in the proper treatment of our breaks down. While only one per cent less Seeman is internationally renowned as a patients,” he explains. “Teaching, bone is replaced each time old bone is man of science. He became a researcher research and patient care grow within removed, “if you lose one percent of bone for a simple reason: it’s fun each other, none can exist in excellence per year over 40 years, you’ve lost almost without each other.” half your skeleton,” said Prof Seeman. “There is beauty in exploration,” said Prof Seeman, with his trademark Osteoporosis, a condition where the “We have succeeded in extending our ebullience. “I love the scientific method. bones become porous and break easily, lives beyond the age of 50, and it is the It is creative and incredibly exciting.” is one of the world’s most common and loss of female hormone that underlies debilitating diseases. One in three women the decay of bones and predisposes Prof Seeman’s contributions to over 50 will experience osteoporotic women to osteoporosis.” osteoporosis research were recently fractures, as will one out of five men. The recognised by the prestigious Prof Seeman has a number of research disease is, to some extent, preventable. International Osteoporosis Foundation interests, particularly the ways in It can be readily diagnosed and effective Medal of Achievement, an honour of the which the skeleton grows. It is through treatments are available. highest order that he describes simply as studying physiology that leads to drug “very nice”. For Prof Seeman, it is his love Prof Seeman describes a patient’s development, which in turn translates to of science, and of the teaching of science, concomitant loss of independence evidence-based health care. In addition, that inspires him. as terrible. the epidemiology of disease gives him clues as to the causes of disease. “To be in constant pain, to need people to help you, to need a walking stick makes For example his groundbreaking for a difficult life,” he said. “Besides collaboration with The University of the impact on a person’s quality of life, Melbourne’s Professor John Hopper fractures are associated with a reduction of the Australian Twin Registry in survival.” unequivocally demonstrated that cigarette smoking is a causative factor The skeleton is a dynamic organ. Bone of osteoporosis in women. renews itself continually. Old bone is removed along with tiny fractures and is replaced with new bone. But after the

18 Austin Health : 2008-09 ANNUAL REPORT Osteoporosis – a life’s work to slow the breakdown of bones > Professor Ego Seeman

Prof Seeman’s boundless enthusiasm The work is an end in itself, he said. But Pictured above: Prof Ego Seeman and for nurturing the talent of his students in the end, the patient is everything. post-doctorate students Dr Ashild Bjornerem, Dr Ali Ghasem-Zadeh, research fellow, reflects his own experience as a younger “As a doctor, one of the best things I Dr Qingju Wang (obscured) and man, mentored by Austin Health’s late can do for my patients is to give them Dr Xiaofang Wang in the bone mineral Austin Doyle. density scanning lab in the reassurance,” he said. “If I say ‘I can fix Endocrine Centre for Excellence, “At the Austin there has been a long this’, then I have given them another day Heidelberg Repatriation Hospital culture of electrifying debate,” he said. of hope, another day of peace.” “I teach my students, as I was taught, to see science as a verb, not a noun. It is Prof Ego Seeman is an endocrinologist a pathway full of challenges beginning and deputy director of Austin Health’s with defining the right question, defining Endocrine Centre for Excellence; the study able to answer the question, Professor of Medicine, The University seeing the weakness and fallibility of of Melbourne. numbers, being cautious in interpreting He is author of over 200 publications the information, and prepared to give and editor of Advances in up what seemed to be a wonderful idea Osteoporosis, BoneKey, Journal when the research tells you it was not of Bone Mineral Research, Bone, such a good idea. The Austin Hospital’s Osteoporosis International, tradition of belief in disbelief is the Calcification Tissue International. fountain of originality and advancement. A life in research, teaching and patient Winner International Osteoporosis care is a great privilege.” Foundation Medal 2009, American Society Bone Mineral Research 2002 Fred C Bartter Award for Excellence in Clinical Research, Matheson Lecturer University of Melbourne 2004.

Hear Prof Seeman speaking to Prof Jeffrey Zajac about osteoporosis at www.austin.org.au/podcasts

Austin Health : 2008-09 ANNUAL REPORT 19 Nursing and Ambulatory Care

Austin Health’s nursing workforce strategy supports nurses to provide skilled care at the bedside. The multi-tiered approach blends complementary sets of skills that result in better care for patients and more rewarding careers for staff.

Austin Health continued to HEALTH ASSISTANTS (NURSING) and Ambulatory Care recognised that attract skilled nursing staff Following 2008’s feasibility study, these factors add up to increased despite the ongoing shortages comprehensive planning took place to pressure on nurses, and can impact on of nurses in the competitive introduce a pilot program that created their stress levels and job satisfaction. health care market. traineeships for six new roles as health In response, Strategy, Quality and assistants (nursing). Employed in July Over 1,730 equivalent full-time nurses Service Redesign introduced a pilot 2009, the trainees will provide assistance were employed in 2008, comprising program to introduce improvements to nurses with tasks such as feeding 40 per cent of the total Austin Health to nurses’ work practices. The initial patients and attending to their personal workforce. The opening of new services, pilot wards – Mellor Ward at Royal hygiene. As Austin Health’s patients such as the 24-bed Ward 10 and the Talbot Rehabilitation Centre, Ward 8 increasingly have more complex health increased bed capacity in ICU, means West at Austin Hospital and Ward 11 conditions, division 1 and division 2 that the demand for qualified nurses in at Heidelberg Repatriation Hospital – nurses will be able to spend their time all divisions continued unabated. reviewed the tasks that prevent nurses using their advanced clinical skills while from providing bedside care, such as In response, Austin Health continued to being supported in some of the basic looking for information or tools needed develop and refine its nursing workforce care by the health assistants. The health to perform nursing care. strategy to ensure it is sustainable both assistants (nursing) will undertake in terms of its capacity and capability. training at RMIT TAFE, after which they By providing training and introducing will be assigned to wards where they strategies and tools, the project aims are additional members of staff – over to identify and eliminate waste – of and above nurse-patient ratios. The pilot time, energy and resources – quickly will be evaluated after 12 months, and if and efficiently. The standardised, successful, the role may be introduced ward-based improvement program will into additional wards. empower ward staff to redesign their work processes and provide more time CARE BY DESIGN for direct care. Importantly, the project The acuity of in-patients, and the aims to improve staff morale and increased rate of patient turnover, has patients’ experience. contributed to a nursing workload of consistently rising complexity. Nursing

20 Austin Health : 2008-09 ANNUAL REPORT Pictured left: Emergency Department division one nurses: Carli Baldacchino, Eliza Baxter and Chris Gartside

RESIDENTIAL OUTREACH SERVICE decommissioned mental health ward Drummond Building on the Austin Austin Health’s Hospital in the Home on level one of the Flanders Building Hospital site, was redesigned to improve (HITH) service provided hospital-standard that commenced in May. The nursing patient and staff safety. The attractively care to 55 patients each day in the and medical model of care was renovated space includes an innovative comfort of their homes. While HITH developed and a recruitment campaign ‘sensory space’, a safe courtyard and patients must be clinically stable to commenced. Ward 10 is scheduled to isolation room, a recreation room, shared be eligible for the service, increasingly open in August 2009. meals area, single-accommodation acute care was provided with a bedrooms and a medical treatment 43 per cent increase in the number NURSING WORKFORCE STRATEGY room. A similar renovation is underway of patients requiring complex wound Ongoing development opportunities in the state-wide Child In-patient Unit. care and intravenous antibiotics were offered to nurses to extend their clinical skills. With close links to At Heidelberg Repatriation Hospital, HITH nurses joined ED consultants affiliated universities, the provision of the construction of a new, purpose- and aged care services to provide post-graduate education ensured Austin built facility commenced to house acute assessment to 190 patients in Health’s nursing staff is highly skilled. the Veterans Psychiatry Unit and residential aged care facilities. See An education pathway that commences the Victorian Psychological Trauma page 17 for more information. immediately following the graduate Treatment Service. The new building year has fostered a culture of ongoing is expected to open its doors in SUB-ACUTE SERVICES educational achievement, and more than October 2010. A major project for Sub-Acute Services 42 per cent of Austin Health’s nurses In response to Victoria’s devastating was the introduction of an online have a post-graduate qualification. bushfires of Saturday 7 February, system to facilitate improved referral, staff from the Victorian Psychological assessment and waiting list processes. Austin Nursing Qualifications Trauma Treatment Service played a Funded by a $130,000 grant from DHS, leading role in assisting psychological the program was introduced in June. recovery amongst communities It assists clinicians to provide more affected by loss of life and property. productive, patient-focussed care by In recognition of this service, DHS providing timely referrals, referral awarded a two-year contract to VPTTS response, improved transparency and �� for service provision and the training of accountability. In addition, the new health professionals to provide post- system has improved efficiencies by �� trauma psychology services. reducing the duplication of effort and Mental Health completed the planning data entry. and development of an operational model WARD 10 to introduce a unique Medicare-funded clinic for people experiencing post- Funding totalling $5.5 million was traumatic stress disorder but without a received from DHS to open and operate �� source of funding to underwrite the cost a specialist ward to treat a mix of acute �� of psychological or psychiatric services. and sub-acute patients. Located at Heidelberg Repatriation Hospital, Austin Health signed a memorandum Ward 10 will deliver an innovative MENTAL HEALTH of understanding with the Australian solution to the growing demand on Centre for Posttraumatic Mental Health The mental health governance structures medical wards at Austin Hospital, to collaborate on training and education were redeveloped with strong emphasis particularly by the elderly. for mental health workers. on content of care, accountability, patient The new 24-bed service will cater to and carer representation and inclusion. Austin Health participated in feasibility the specific needs of elderly patients The services are now governed by a studies, planning and community who, increasingly, have more complex clinical executive and an operational consultation for the proposed Mental conditions and require longer stays in executive. The committee structures Health Rehabilitation Centre at the hospital. The ward will enable patients have been further strengthened through Heidelberg Repatriation Hospital. The to transfer from the Austin Hospital but the development of safety and $141 million centre was planned to continue to receive acute care treatment quality committees. accommodate secure extended care and from doctors and sub-acute clinicians. medium-secure forensic services but The Child and Adolescent Mental Health its bid was not approved in the Victorian Preparation works included the Services in-patient unit for teenagers, government’s May 2009 budget. $1.5 million refurbishment of an old, housed in the 100-year old Marion

Austin Health : 2008-09 ANNUAL REPORT 21 CRECHE REDEVELOPMENT VOLUNTEER PROGRAM a systematic review to determine the Since 1970, the Austin Child Care Centre Over 600 people generously volunteered risk of incorrect provision of meals for has been located in a slate-roofed their time to provide services that this patient group. An audit showed that brick house built in 1882. Overlooking enhanced the experience of patients some patients were not receiving the Heidelberg Station, the site is undergoing such as providing them with company, correct texture-modified meal to help redevelopment to create a modern, transport, and helping out with them swallow safely. purpose-built centre. Stage one of the administrative support. A dedicated A comprehensive process redesign redevelopment was completed in April manager was appointed in February to ensured that communication between with the opening of two new rooms for oversee the introduction of this valuable speech pathologists, menu monitors and babies. The stage two development of assistance into new areas of hospital. dietitians resulted in patients receiving two new rooms for toddlers is underway correct meals more often. Systematic and due for completion in August 2009. NUTRITION AND DIETETICS WITH risk reduction strategies were introduced Stage three will include the renovation SPEECH PATHOLOGY and resulted in significantly more of the original house for its planned use Approximately 13 per cent of patients patients receiving correct meals. as the centre’s single point of entry and in hospitals have some degree of administrative hub. swallowing impairment. They are at risk COMMUNITY ADVISORY COMMITTEE of choking, and of food and fluid entering The Community Advisory Committee their lungs while they eat. Some require (CAC) developed and endorsed Austin texture-modified food to enable them Health’s community participation to swallow safely. Speech Pathology, plan. Members of the CAC were in collaboration with Nutrition and instrumental in the development of Dietetics and Food Services, undertook Austin Health’s annual Quality of Care Report. A consumer register was established to identify past or present patients and/or relatives or carers interested in sharing their experiences, opinions and ideas for improvement about Austin Health services.

Pictured left: Julie Zagorski, clinical support nurse demonstrates equipment to Carolyn Progue, health assistant (nursing).

Pictured right: Dr Daniela Sartor, research ofﬁcer, and Dr Tony Verberne, research fellow, at work in the Clinical Pharmacology laboratory.

22 Austin Health : 2008-09 ANNUAL REPORT Research Austin Health’s culture of medical, research and teaching excellence combine to offer our patients access to rare advantages. Working in collaboration, our researchers and clinicans develop and test pioneering surgical procedures and newly-created drug therapies with promising results.

The newly established Austin CANCER MEDICINE: JOINT AUSTIN/ bowel and upper gastro-intestinal LifeSciences brings together LUDWIG ONCOLOGY UNIT (GI) cancers. He designed the MAX major institutes to form a Austin Health’s team plays both a study, the largest study ever run by research powerhouse in national and international leadership the Australasian GI Trials Group and Heidelberg, already designated as role in the treatment and research initiated international collaboration a Victorian biotechnology precinct. of cancer. Prof Jonathan Cebon and with the UK. He also initiated other They include hospital and The University Assoc Prof Ian Davis have developed studies in advanced colorectal cancer of Melbourne departments of medicine, approaches for harnessing the immune involving novel combinations of biologic surgery, psychiatry and physiotherapy, system to attack unique targets on agents such as the DUX study (dual the National Stroke Research Institute, cancer cells. These studies have led targeting by cetuximab and erlotinib) Ludwig Institute for Cancer Research, to substantial grant support from the and the Vengeance study (dual targeting Brain Research Institute, Australian NHMRC, Melanoma Research Alliance by bevacizumab and AMG386). He is Centre for Posttraumatic Mental Health, and Victorian Cancer Agency (VCA) for a leading recruiter to multiple clinical Institute for Breathing and Sleep, pioneering work into targets shared trials of novel therapies and co- Epilepsy Research Centre and the with germ cells and stem cells within authored two New England Journal of Parent-Infant Research Institute. The cancer. Assoc Prof Ian Davis has Medicine publications establishing a multidisciplinary alliance consists of pioneered new anti-cancer treatments, survival beneﬁt for cetuximab in k-ras world-class scientiﬁc leaders conducting leading several international clinical wild type chemotherapy refractory research in cancer, neurosciences, trials with drugs that target molecular colorectal cancer. transplantation, heart disease, pathways in kidney cancer and the hypertension, immunology vaccines, immune-stimulating protein interleukin CHRONIC FATIGUE SYNDROME (CFS) endocrinology and sleep disorders. IL-21 in melanoma. These trials Paediatrician Dr Lionel Lubitz and together with his comprehensive exercise physiologist Brett Gordon’s In addition, Austin Health is host to the laboratory research program into work on the role of graduated exercise Nucleus Network, which conducts early cancers of the genito-urinary tract in CFS was published in The Journal phase clinical trials in new medications. have been recognized through research of Paediatrics and Child Health in The following pages include brief fellowships from both the NHMRC and March. Dr Lubitz presented a study on highlights of a sample of research VCA. Dr Niall Tebbutt is an international the effect of CFS on family functioning achievements in 2008-09. leader for the clinical research into at the International CFS meeting in Reno,

Austin Health : 2008-09 ANNUAL REPORT 23 Nevada in March on behalf of Dr Tanya an open-label, non-randomised, demonstrated that in males, androgens Newnham, Dr Sarah Wilson and multi-centre study to optimise image act through the androgen receptor to Prof Ingrid Scheffer. This was the first assessment and evaluate the efficiency regulate multiple pathways that control study to show the serious consequences and safety of BAY94-9172 (ZK 6013443) muscle mass, strength and fatigue on the family of the adolescent with CFS positron emission tomograph for resistance, but that androgens are in terms of family activities, parental detection/exclusion of cerebral not required for peak muscle mass in employment and financial burden. amyloid beta in patients with probable females. The work has implications Alzheimer’s disease compared to for drug therapies used for older CLINICAL PHARMACOLOGY healthy volunteers. people at risk of falls and those with The Department of Clinical Pharmacology chronic disease. and Therapeutics, together with Nucleus DEPARTMENT OF MEDICINE Network, established the Austin Centre The University of Melbourne at ENDOCRINE CENTRE FOR for Clinical Studies, a 16-bed, phase Austin Health EXCELLENCE one, clinical trials unit in February 2008. A team led by Prof George Jerums and In a NHMRC-funded grant, Dr Rachel Since opening, 15 new drugs have been Assoc Prof Richard MacIsaac investigated Davey led a team who questioned the tested. In its drug discovery activities, the usefulness for indigenous Australians mechanism by which male hormones, Clinical Pharmacology also focussed on of a common kidney function test, as androgens, contribute to skeletal growth the identification of novel markers for this group’s rate of kidney failure is over and bone accrual in puberty and in bone the diagnosis and treatment of prostate five times that of the general population. maintenance post-puberty. In a paper cancer and neural regulation of the Assoc Prof MacIsaac led a study of 3,900 published in the November edition of circulation, pancreatic function and type 2 diabetes patients and found that the prestigious American Journal of blood glucose. With The University of earlier, more proactive intervention in the Bone and Mineral Research (JBMR), Melbourne, the department continued treatment of the disease could reduce the team demonstrated that androgens to provide evaluation of drugs submitted the risk of serious complications such act through androgen receptors in for registration with the Australian as visual impairment, nerve function and mineralising osteoblasts to maintain Therapeutic Goods Administration kidney disease. bone by regulating both bone breakdown (TGA) and the New Zealand equivalent, and the coordination of bone matrix Prof Jerums, Assoc Prof MacIsaac and Medsafe. After independently evaluating synthesis and mineralisation. The team Dr Elif Ekinci showed that a diet high in clinical trial results, the department found that this action is most important salt reduced the effectiveness of the two made recommendations to the TGA on during times of bone accrual and high most commonly used drugs to protect the safety and efficacy of 20 drugs, as it rates of bone remodelling. These findings kidney function in patients with type 2 does each year. make a valuable contribution to the body diabetes. Prof Ego Seeman led a team AGED CARE SERVICES of research into male osteoporosis. including Dr Sandy Iuliano that showed that nutrition supplementation made of The department participated in a Likewise funded by NHMRC, Dr Davey led whey protein concentrate and vitamin D number of Alzheimer’s disease a project that provided fuel to the debate reduced the rate of falls among elderly treatment trials. Major projects on the physiological role of calcitonin, people. Dr Cherie Chiang and Prof Jeffrey included: the single blind, placebo- a thyroid hormone that inhibits bone Zajac reported that over 90 per cent of controlled, randomised study in breakdown and is used in some countries patients admitted with a hip fracture mild to moderate Group Alzheimer’s to treat this condition in patients with were vitamin D deficient. Disease patients to assess the safety, osteoporsis. Research findings published tolerability, pharmacokinetics and in the JBMR provided strong evidence for EMERGENCY DEPARTMENT pharmacodynamics of GSK239512, a biological role of the calcitonin reception The Emergency Department (ED) a selective histamine H3 receptor in the regulation of homeostasis in states researchers were involved in over antagonist; ENA713D Exelon® of calcium stress. a dozen publications, many more (rivastigmine) a 24-week, multi-centre, conference presentations and open-label evaluation of compliance Again funded by the NHMRC and posters, and increases in intra and and tolerability of the once-daily published in the international biology inter-institution collaboration. Emphasis 10cm2 patch formulation in patients journal, The FASEB Journal in August, was placed on the evaluation of drugs in with probable Alzheimer’s disease; Dr Helen MacLean led a project that the ED setting with considerable work and a fixed-dose study of SB-742457 identified the mechanisms of anabolic being undertaken by both under and versus placebo when added to existing androgen action in muscle strength. post-graduate research students. donepezil treatment in subjects with The team bred a mutant strain of mice mild to moderate Alzheimer’s in which males had extra fat and reduced One highlight was a randomised disease; CTN Phase IV Prospective muscle development and strength, controlled trial (RCT) demonstrating Research in Memory clinics; and but females were normal. The team that a vapocoolant spray, compared with

24 Austin Health : 2008-09 ANNUAL REPORT Pictured below: Dr Soﬁanos Andrikopoulos reviewing research into the cause of diabetes.

a placebo (water) spray, significantly significant investigation was whether the degeneration post-transplant. With reduced the pain of intravenous hormone erythropoietin could reduce the Liver Transplant Unit at Flinders cannulation. This research won the ‘Best the severity of disability from traumatic Medical Centre, SA, the researchers Paper by a Fellow’ at the Australasian brain injury. Prof Rinaldo Bellomo and retrospectively collected data from College for Emergency Medicine Annual Prof Ian Baldwin led research activities patients with cirrhosis and hepatocellular Scientific Meeting and was published in which produced in excess of 50 journal carcinomas who underwent liver the prestigious British Medical Journal. publications and multiple book chapters resection, determining the long-term ED also completed a second RCT for the year. By this measure, Austin survival, the rate of tumor recurrence and demonstrating that vapocoolant spray Health’s ICU is one of the top five identifying prognostic factors associated has significant advantages over the more research focussed ICUs in the world. with liver resection. traditional subcutaneous lignocaine. LIVER TRANSPLANT UNIT The Liver Transplant Unit undertook INTENSIVE CARE UNIT The Liver Transplant Unit (LTU) is research with other transplant units As the foremost intensive care research actively involved in clinical research around the globe. Research currently unit in Australia, the ICU participated both nationally and internationally. The being undertaken internationally involves in 18 major international and national LTU’s national network includes the studying the safety and efficacy of trials, multiple in-house investigator- NSW Virology Research Lab, studying anti-viral medication to enable patients driven trials, and national and antiviral therapy and the prevention of diagnosed with hepatitis B and C to international collaborations. Published cytomegalovirus (CMV) disease in liver safely receive organ transplants and in the prestigious New England Journal transplant patients. With the Anti-Cancer studying the safety and efficacy of new of Medicine, the NICE-SUGAR Study Council of Australia and the University of anti-rejection medication to improve long Investigators (2009) Intensive versus New South Wales, the LTU looked at the term transplant survival. conventional glucose control in critically incidence of cancer post-transplantation ill patients showed that the practice and identified risk factors for this group of lowering an ICU patient’s blood of patients. With the Royal Victorian Eye sugar levels to normal levels carries and Ear Hospital, the LTU investigated significant risk of death. Another the prevalence of age-related macular

Austin Health : 2008-09 ANNUAL REPORT 25 NEPHROLOGY, ENDOCRINOLOGY NUTRITION AND DIETETICS PHYSIOTHERAPY AND SURGERY Nutrition and Dietetics assessed the The Physiotherapy Department Austin Health played a key role in adequacy of fluid intake in dysphagic collaborated with and participated in providing hope for insulin-resistant patients and identified the factors a number of significant projects. Key type 1 diabetes patients through the affecting fluid intake at three Melbourne projects included a study into the effect National Islet Transplant Program that teaching hospitals. Fifty patients were of lower limb prostheses (traditional vs involved a consortium of Australian assessed. Of these, 46 per cent had a novel) upon the ability of above-knee transplant and diabetes researchers. stroke diagnosis and 24 per cent had amputees to traverse ‘everyday’ terrain. The program used emerging therapies respiratory problems. Seventy-six per The department contributed to a study to take insulin-producing islet cells from cent of patients were malnourished into a three-dimensional analysis of a deceased donor pancreas and injected and the mean oral fluid intake was shoulder girdle movement to understand them through a vein into the patient’s only 42 per cent of estimated fluid factors associated with shoulder pain liver where they begin to produce insulin. requirements. Those on thickened following stroke. Austin Health surgeons had a major fluids, who required assistance with role in donor organ retrieval and Assoc drinking, were bedridden or reliant on SPINAL AND ACQUIRED Prof Frank Ierino and his team provided a wheelchair, met a significantly lower BRAIN INJURY RESEARCH a comprehensive medical screening estimated fluid requirement than those Austin Health researchers were awarded program for potential recipients before independent with drinking or mobility. more than $14 million from $19 million waitlisting them for the procedure. This Strategies to improve fluid intake in in grants available from the Victorian is a collaborative program in Victoria with this high-risk population are being Neurotrauma Initiative for projects to St Vincent’s Institute of Medical Research investigated. The project was funded by improve the quality of life of people and St Vincent’s Health where the early a Deakin University small project grant. with spinal cord injuries (SCI). procedures have been performed and A $4.9 million grant was awarded to plans are underway to perform this the late Prof Robert Pierce to investigate procedure at Austin Hospital. how sleep quality could be improved in people with quadriplegia. Prof Pierce’s student, Dr David Berlowitz, was subsequently appointed lead investigator. Prof Mary Galea was awarded $4.7 million to investigate exercise in SCI patients, including its potential to recover neurological function. Another $4.9 million was awarded to a team led by Prof John Furness from The University of Melbourne that included several Austin Health chief investigators.

Pictured left: Dr Melanie Freeman, cardiology fellow and Prof Louise Burrell, Head – cardiovascular research group, in the cardiovascular research lab.

26 Austin Health : 2008-09 ANNUAL REPORT LUDWIG INSTITUTE FOR CANCER NHMRC EXCELLENCE AWARDS 2008 NATIONAL HEALTH AND RESEARCH AT AUSTIN HEALTH Reinforcing Austin Health’s national MEDICAL RESEARCH COUNCIL Prof Andrew Scott, Director of the importance as a research precinct, GRANT WINNERS 2009 Ludwig Institute for Cancer Research two of its researchers were recognised Prof L Burrell: Vasopressin and (LICR) at Austin Hospital led a team with prestigious NHMRC Excellence heart failure, $551,250 responsible for the development of a Awards, only given to the seven new paradigm in targeting cancer cells, highest-ranking grant and fellowship Prof E Seeman, Dr R Zebaze and the monoclonal antibody (mAb) 806. recipients in Australia. team: Cortical porosity to bone Preclinical investigations and a phase fragility, $596,250 Neurologist Prof Graeme Jackson, one, first-in-man trial at Austin Hospital Prof J Proietto: Understanding how in 2007, determined that mAb806 binds Director and founder of the Brain Research Institute was recognised obesity and abnormal lipids are to a previously unreported epitope of linked, $320,100 the Epidermal Growth Factor Receptor for his work defining the causes of (EGFR) that is only exposed in over- epilepsy and classifying the brain’s Prof G Jerums, Assoc Prof R expressed, mutated or amplified EGFR. developmental abnormalities using MacIsaac and team: eGFR in Over-expression of EGFR occurs in magnetic resonance imaging. indigenous Australians, $926,200 more than 50 per cent of some types of Dr Sofianos Andrikopoulos, head of Prof J Zajac, Dr R Davey and team: cancers. Current therapies that target the Islet Biology Research Group at The Male hormone receptors in bone- EGFR cause side-effects by targeting University of Melbourne Department forming cells, $451,625 EGFR both when it is over-expressed on of Medicine at Austin Health, was recognised for research that suggested cancer cells and when it is present in Dr S Andrikopoulos, Dr B Fam and that a common class of drugs used to usual amounts on normal cells. team: The role of a liver enzyme in treat type 2 diabetes, sulfonylureas, Unlike these reagents, mAb806 has been controlling body weight, $475,125 shown in pre-clinical testing to have no actually accelerate the disease. cross-reactivity with normal tissue, and Assoc Prof I Davis, Prof J Cebon, AUSTIN LIFESCIENCES is the first tumour-specific antibody Assoc Prof W Chen and team: RESEARCH WEEK directed towards a cancer-related Immune targeting of melanoma Researchers from Austin Health and its growth factor receptor. stem cells, $506,250 associated institutions and universities In November one of the LICR participated in the annual Research Prof A Scott, Dr P Ramsland and spin-off companies, Life Science Week celebrations in October. The Austin team: Using the immune system to Pharmaceuticals, licensed mAb806 to LifeSciences Symposium and plenary treat cancers, $543,500 pharmaceutical company Abbott. LICR session were popular events, and 153 Prof D Power: Waste control in at Austin Health continues to be actively researchers displayed their work in the kidney disease, $438,000 involved with Abbott in the ongoing annual poster competition. clinical development of this exciting Dr D Christiansen, Dr P Ramsland, Numerous awards were given for cancer therapy candidate. Dr H Vaughan, Prof M Sandrin and excellence in various fields of research, team: The role of carbohydrates in including allied health, cancer, stroke, transplantation, $541,500 nursing, parent/infant, clinical and general research. The 2008 Distinguished Prof R Bellomo and team: Scientist Award was presented to Erythropoietin in Traumatic Brain endocrinologist and internationally- Injury (EPO-TBI), $1,848,475 recognised expert on osteoporosis Prof Ego Seeman for his contribution to the Austin research community over his career at Austin Health.

Rising talent Dr Cherie Chiang won both awards open to young researchers – the Austin Lifesciences Award for Basic Research and the Young Investigator Award, for her abstract Mineralisation and Bone Resorption are Regulated by the Androgen Receptor in Male Mice.

Austin Health : 2008-09 ANNUAL REPORT 27 Teaching and Training

Austin Health is afﬁliated with The University of Melbourne for medical education. In nursing education, Austin Health is a major clinical school for La Trobe University with strong links to RMIT and Deakin Universities.

THE UNIVERSITY OF In an important new approach to medical MEDICAL EDUCATION UNIT (MEU) MELBOURNE CLINICAL education, the focus of the final year Acknowledged by the Australian SCHOOL AUSTIN HEALTH/ program shifted to a model that provided Council on Healthcare Standards as NORTHERN HEALTH students with skills more closely linking one of the best medical education The Austin Clinical School enrolled them into their following internship units in Australia, the MEU provides 100 high-performing fourth year year. To intensify students’ learning innovative education and training to medical students from The University experiences, the number of students meet the needs of our post-graduate of Melbourne, attracted to the school in each group accompanying interns medical staff. for its excellent teaching and modern on patient rounds was halved, exposing clinical facilities. them to greater learning opportunities The MEU in collaboration with the with patients. In addition, the students Clinical Nursing Education Department, An important drawcard for students received training in the typical medical The University of Melbourne and is the school’s reputation. In an emergencies they would expect to La Trobe University, has developed an outstanding result, 2009’s three top- experience as interns, so they graduated inter-professional Clinical Skills Centre scoring students in the final exams better-equipped with the skills required that enables training opportunities in a at The University of Melbourne had by interns. hands-on environment. Equipped with a attended the Austin Clinical School. wet lab, a dry lab and a SimMan Room, It is very pleasing that almost 50 per cent The already abundant opportunities simulated clinical situations enhance of students applied for intern positions within the program included rotations and develop skills and knowledge at Austin Health, representing a high through general medicine, surgical and across all disciplines. percentage of the students eligible to specialty areas of Austin Health. work in Australia. As a measure of the Unit’s success, In 2009, the program was expanded over 30 candidates sat for both the to include vascular surgery for the The Austin Clinical School staff were written and clinical Royal Australasian first time. involved in planning the curriculum College of Physicians (RACP) training development and course content in program and achieved a pass rate of preparation for the implementation of the over 80 per cent. The University of Melbourne’s forthcoming “Melbourne Model”. In 2011, Bachelor of Highlights for the year included Science graduates will commence their the development of a user-friendly post-graduate degrees in medicine. orientation package for junior doctors;

28 Austin Health : 2008-09 ANNUAL REPORT the provision of new simulation The department’s return-to- equipment for skills practice; practice program continued to bring and use of the most effective and unregistered nurses back to the industry innovative education methods such as via an accredited re-registration or simulations, small-group interactive refresher course. Since 2000, 129 learning, and online curricula to suit nurses completed the re-registration different and changing needs. program and 199 nurses completed the refresher program. The 2009 program CLINICAL NURSING EDUCATION enjoyed 94 per cent retention and DEPARTMENT (CNED) targeted clinical areas experiencing Austin Health’s status as an employer of a stafﬁng shortfall. As a result of this choice for nursing graduates continued program, two nurses were employed to into its seventh consecutive year. As a work in the new Ward 10. result of active recruitment campaigns and positive clinical experiences of Austin Health’s undergraduate students, the Graduate Year Program again achieved a 100 per cent ﬁrst-round computer match.

Another measure of the superior calibre of Austin Health’s nursing staff is that those undertaking post-graduate studies increased by 11 per cent over last year. In the 2009 academic year, 93 students enrolled.

The 2009 practice advancement program was expanded to include two additional clinical areas and offer greater development opportunities for the 53 nurse participants. The program continued to inspire and motivate staff to enrol in postgraduate courses and bridge the gap between the Graduate Year Program and enrolment in post-graduate courses. The program has proved a successful retention strategy.

Pictured opposite: Dr Miranda Siemienowicz and Dr Henry Patel practice on SimMan in the Clinical Skills Centre.

Pictured right: Graduate nurses Courtney Green and Susan Pradhanang review patient records.

Austin Health : 2008-09 ANNUAL REPORT 29 Chief Medical Ofﬁcer

In addition to meeting the requirements of junior and senior medical staff, the Chief Medical Ofﬁcer directorate expanded to include Austin Health’s diagnostic services: Radiology; Nuclear Medicine and PET; and Pathology.

Significant changes took A number of innovative programs, Medical Education Unit with the place within the Chief introduced at both national and state extension of inter-professional training Medical Officer (CMO) level, were incorporated in Austin and establishment of a skills centre at directorate during 2008-09. Health’s planning for the future. Key Austin Hospital. In addition, DHS grants The directorate undertook a review of highlights included a clinical placements will fund initiative projects for specific its process for credentialing its medical governance model to oversee the training programs. Austin Health’s staff and defining their scopes of management of undergraduate training affiliations with The Northern clinical practice. The result confirmed placements across the health sector. As Hospital, Bendigo Health, The Epworth, an ongoing robust and comprehensive home to the Victorian Liver Transplant Echuca Regional Health and Wimmera appointment process. A full revision Unit, as well as a significant renal Health Services have expanded to allow of the medical application form was transplantation unit, Austin Health for additional opportunities. Planning is completed, and a review of the formal enthusiastically engaged with the newly in progress with the Victorian Institute appointment processes commenced. To inaugurated Australian Organ and Tissue of Forensic Medicine for Victoria’s first further support medical appointments, and Transplant Authority. forensic pathology internship rotations to the Medical Advisory Committee commence in 2010. As a direct result of government expanded its role as the peak medical initiatives introduced several years ago, a In 2008-09 a number of senior doctors body overseeing medical appointments large increase in the number of Victorian either retired and passed over the mantle and enhanced its advisory role to the medical graduates is due in 2012. The to the next generation or moved on to executive team and Board of Directors. number of new graduates in Victoria will new professional opportunities. Austin Health fully assessed a number increase by 100 per cent over four years, These included Professor Graham of health sector reviews and audits with 690 medical graduates anticipated Burrows; Professor Geoff Donnan; and enacted recommendations for in 2012. Austin Health is expanding Mr Mal Douglas; Ms Jenepher Martin; improvements. The outcomes of both its recruitment to accommodate this Dr Brian Buxton; and Dr Robyn Murray. the Ombudsman’s Report on Alfred increase and planning is underway to Health, and the Garling Review of New provide the graduates with new and South Wales Health were analysed and expanded training opportunities to recommendations were presented to the help foster a strong medical workforce Board of Directors for endorsement. for the next generation. New training programs will be delivered by the

30 Austin Health : 2008-09 ANNUAL REPORT Pictured opposite: Dr Michael Geluk, consultant, Emergency Department, with patient Rebecca Purvis

ACCREDITATION radiologists to view and manipulate PHARMACY In addition to the organisation-wide images on a computer screen to study The opening of The Surgery Centre survey successfully conducted by the areas of interest in detail, without the in July created additional demand Australian Council on Healthcare need for extra x-rays. Patients will for comprehensive clinical pharmacy Standards, Austin Health underwent a benefit from improved accuracy of services. A dedicated pharmacist is variety of accreditation assessments biopsies and fewer mammograms. based within the centre to administer at a teaching and training level. This In conjunction with the new digital pharmacy services to the in-patient unit year a number of surgical specialties machines, three new ultrasounds and the operating suite. practised at Austin Health underwent came online in June. As oral chemotherapy agents become external review. A highlight was the five Following a grant from DHS of more widely available, patients prefer years accreditation for cardiothoracic $4 million, a new cyclotron - a particle to take chemo pills at home rather than surgery, an increase from a single year’s accelerator used to make the positron- visit hospital for an intravenous infusion. accreditation previously. This recognition emitting radioisotopes required for Although more convenient for patients, reflected the efforts of the Cardiac PET scans - came online in August. As the orally-delivered drugs carry the same Surgery Department in promoting the the most sophisticated and advanced risks as parenteral chemotherapy. In teaching and training aspects of this cyclotron in Australia, it is capable response, the Pharmacy Department specialty. Austin Pathology received of accelerating H- ions up to 18MeV developed a protocol and procedure for three years full accreditation as a and D- ions up to 9MeV. Its increased the supply of oral chemotherapy category GX Laboratory, the highest production capacity is projected to for patients. level attainable, with the National allow enough daily production of radio- Association of Testing Authorities. isotopes for the next 15-20 years for The aged care pharmacy team undertook several projects designed to improve FACILITY IMPROVEMENTS both the Centre for PET, and potentially other hospitals in Victoria. Importantly, the care of frail, older people who Ongoing physical upgrades and the it gives the Centre for PET the capability are commonly prescribed multiple installation of new equipment continued to produce a suite of novel PET tracers, medications. To further support safe to meet increasing demand for critical for research activities, which medication use by the elderly, a joint diagnostic services. To improve radiology cannot be accessed elsewhere in Austin Health-Monash University aged services, a Magnetic Resonance Imaging Australia. The Centre for PET research care pharmacist position was formalised. 1.5T unit at Austin Hospital was replaced projects received a boost with the This position will strengthen existing in September. A large new angiography addition of a research-only PET camera, teaching and research links between the suite was completed in April. It includes funded by Bayer Schering Pharma. hospital and the university’s Faculty of a bi-plane angiography unit installed Pharmacy and Pharmaceutical Sciences. in May. This new equipment provides PATHOLOGY sharp, high-resolution images that A redevelopment of the Pathology enable radiologists to see microscopic Department’s facilities commenced, blood vessels in great detail. The system with stage one of its construction features two x-ray machines positioned underway. The facility will house better at 90-degree angles that provide two patient areas and new and enhanced different views simultaneously. testing facilities. Pathology research A Targeted Equipment Program and diagnostics on-site will be possible grant funded the installation of digital with the establishment of a molecular fluoroscopy rooms in the Radiology diagnostics laboratory. The lab will Department at Austin Hospital. The enable Austin Health to undertake digital system delivers advantages the timely, cost-effective diagnostics over analogue systems such as direct of various illnesses. It also opens transmission of data and detailed reports the way for research into the genetic as well as the capacity to store the characteristics of diseases and the ways images electronically on the hospital- in which they respond to pharmacological wide system. treatments and other therapies.

A mammography room was installed in Heidelberg Repatriation Hospital’s Radiology Department to accommodate a new digital mammogram unit that delivers improved imaging of dense tissue. The upgraded equipment allows

Austin Health : 2008-09 ANNUAL REPORT 31 Type 2 diabetes and its major risk factor, obesity, are becoming increasingly common in the community. There are no easy answers to this dangerous and complex condition. At Austin Health, research into these related disorders is coordinated. Findings are shared between the clinical research in the Endocrine Centre for Excellence; the Metabolic Disorders Centre; basic science into the causes of diabetes and body weight regulation; and applied clinical research from the Weight Control Clinic. Patients of the Clinic have the opportunity to participate in trials testing the efﬁcacy of new medications for diabetes and obesity, and the NHMRC has funded grants into studies on weight regain.

A growing concern – treatment of obesity at Austin Health > Professor Joseph Proietto

The rate of obesity in developed At Austin Health, Prof Joe Proietto, Obesity is widely misunderstood, and countries has been described as a a Professor of Medicine and Prof Proietto’s mission is to demystify ‘global epidemic’ that is set to increase. endocrinologist, is working towards the condition. In 2005, 3.2 million Australians were unlocking the genetic secrets that “I see this as a social justice issue,” obese, but research suggests that underlie this serious and complex he said. “There is no doubt that number will double by around 2025. health problem. He is a scientist and obesity is the last ‘legitimate’ form The condition has important and clinician investigating the genetic and of discrimination in all facets of our sometimes devastating effects on biochemical causes of obesity and society. There is an attitude that obese people. They are at risk of type type 2 diabetes. As well as treating people only have themselves to blame. 2 diabetes, and the bulk of obese patients, Prof Proietto oversees two This lack of sympathy means people people become insulin resistant. phases of research into what drives are not motivated to assist them, even Sleep apnoea is widespread. High people to over-eat. In his laboratory, among the medical profession.” blood pressure and cholesterol too are scientists study molecules and genes to common in obese people. Combined, understand their function. This science Led by Prof Proietto, his team of these factors are major contributors translates into the second phase of researchers are looking at the changes towards stroke and heart attack. research, where his clinical research to the hormones in the blood following unit studies weight, particularly to weight loss. The team found that understand why people regain weight cholecystokinin, a hormone responsible after losing it. for signalling the feeding circuits in the brain and conveying a sense of satiety, “I believe that this is the most critical is barely secreted following weight question in obesity management,” loss. This leads to people eating larger said Prof Proietto. “Most obese people meals, which leads to weight regain. are able to lose weight but hardly any can keep it off. There is a common view that such people are lazy and return to old habits. But this is not consistent with the desires of my patients. They are desperate not to be obese.”

32 Austin Health : 2008-09 ANNUAL REPORT A growing concern – treatment of obesity at Austin Health > Professor Joseph Proietto

Prof Proietto also says that there is clinical research groups, we believe Pictured above: Professor Joseph Proietto growing evidence that genes could that we can improve the lives of many in Austin Health’s Endocrine Centre for Excellence with PhD students be permanently switched off by people living with a range of endocrine Wynne Pong, Nicole Wong and environmental factors. He cites studies and metabolic disorders.” Maria Stathopoulos (obscured). that have shown that malnourished With PhD students and advanced pregnant women are likely to have medical science students working obese children, and studies in rats Prof Joseph Proietto is an in his lab and clinic, Prof Proietto that support the epigenetic features endocrinologist and head of the is proud of his students’ success. of obesity. Weight Control Clinic at Recently, students have come from Austin Health. The clinic’s co-location at Austin France, Austria and Brazil to work on Health offers many advantages to his team. Four of his group’s students He is the inaugural chair of the Sir Prof Proietto’s research, particularly are now working in North America, Edward Dunlop Medical Research the ability to undertake brain imaging the only country to have a more obese Foundation, Professor of Medicine, in functional MRI (magnetic resonance population than Australia, and in the Department of Medicine Austin imaging) and image the brain’s hunger Prof Proietto said it is very rewarding Health, The University of Melbourne. pathways. An example he offers is a to contribute to an international He is author of over 100 articles, project that looks at the ways in which body of work. book chapters and books on obesity ketosis, created when the body is and diabetes. He is an editor and burning fat in the absence of sugar, reviewer of a number of changes the ways in which the brain international scientiﬁc journals. functions when a patient is viewing images of food. Prof Proietto sits on the editorial board of Molecular and Cellular “After 20 years of solid research, we Endocrinology have a better understanding of obesity,” he said. “But we are still learning. With collaboration between basic and

Hear Prof Proietto speaking to Prof Jeffrey Zajac about obesity at www.austin.org.au/podcasts

Austin Health : 2008-09 ANNUAL REPORT 33 Support Services

Beyond Austin Health’s busy wards, clinics and laboratories, are committed staff working to plan and provide the best available health care, both now and for generations to come.

Infrastructure and Commercial

ENVIRONMENTAL SUSTAINABILITY of addressing the requirements of the SECURITY This year Austin Health made a government’s sustainability agenda. Security staff at Austin Health’s three concerted effort towards monitoring sites are on duty 24 hours a day, seven Significant resources were invested and reducing its natural resource days a week. A number of service to compile current data on waste consumption and volume of waste improvements have been introduced, generation and water and energy generated. Improving the organisation’s including: upgrading the closed circuit consumption. The audits formed the environmental performance was surveillance system; introduction of basis of performance benchmarks and identified by Austin Health’s staff as a 24/7 security guard role in Austin highlighted opportunities to develop a priority, and was included in the Hospital’s ED, annual competency better guidelines to increase resource organisation’s new strategic plan. An training programs, emergency response efficiency and recycling initiatives across Environment Committee, chaired by the team procedures and introduction of the Austin Health’s three sites. executive director Human Resources, organisation’s risk management program Mr Luke Mulkearns, was established ENVIRONMENTAL SERVICES to enhance departmental reporting. to work towards the development of a The Environmental Services Department, holistic, organisation-wide approach to FOOD SERVICES responsible for cleaning all of the non- sustainable practices. The Food Services Department introduced clinical areas at Austin Health’s three ChefMax, a food management program sites, exceeded the Victorian healthcare A conservation and waste management that electronically assigns individual cleaning benchmark standard of 85 per officer was appointed in 2008 to meals to patients according to their cent. External auditors reported Austin improve Austin Health’s environmental preferences and dietary requirements. Hospital’s score of 93.6 per cent to DHS, performance. The establishment of The system is integrated with MedTrak, as well as scores of 94.6 per cent and this position aligned the organisational the patient management system which 93 per cent for Heidelberg Repatriation strategy to build a strong and enables efficient updates of patient diet Hospital and Royal Talbot Rehabilitation sustainable future by reducing our changes, admissions, discharges and bed Centre respectively. environmental impact. The role also movements. Further the system enables ensured that the organisation is capable comprehensive cost analysis including meal-based and tray-based reporting.

34 Austin Health : 2008-09 ANNUAL REPORT Pictured left: the Food Services Dept produces meals for 2,500 patients each day.

These advantages provide significant at the site, the refurbishment of a ward INFORMATION TECHNOLOGY benefits for the department’s daily supply in the Flanders Building commenced to SERVICES of a fully-plated meal service to the enable the establishment of the new To support clinical care, Information Royal Women’s Hospital, which also 24-bed Ward 10. Technology Services (ITS) focussed utilises ChefMax to place its order. on increasing medical staff access to A range of infrastructure upgrade Patients enjoy the personalised service patient information. In the Outpatients projects were completed. New efficient provided by Food Services’ menu Department, patients’ referral letters steam absorption chillers replaced monitors, who collect the patient’s meal were scanned into electronic records to outdated chillers at both the Austin orders at the bedside using a Tablet PC ensure that referral information is readily Hospital and Heidelberg Repatriation replacing an old, paper-based process. accessible for clinical staff. The number Hospital to ensure the reliability of chilled of desktop computers in clinical areas Another significant project was the water supply for air conditioning on the was increased by 15 per cent, bringing investment in the technology and serving- respective sites. the total number to 3,500. ware to enable the introduction of the Ongoing upgrades and replacement of fully-plated meal service to in-patients at Disaster planning continued and the electrical works were completed to meet Heidelberg Repatriation Hospital which recovery capabilities for critical IT current standards, including replacement will commence in August 2009. systems were upgraded. The Emergency of the switchboards and uninterrupted Department’s bed management system power supply (UPS) equipment. CAPITAL WORKS was enhanced to include ‘Health Displan’ Continuous power to the Operating The Austin Hospital site continues screens, technology that enables fully Theatre Suite is assured as the UPS was to undergo renewal. Construction streamlined patient flows in a replaced during the refurbishment of progressed on the new Bio-Resources mass-disaster emergency situation. operating theatres three and four. Centre which is on track for completion Also in ED, the printing system was in August 2009. The nearby 3KZ Building, MEDICHEF upgraded to enable staff to print triage, originally a children’s facility that opened labels and in-patient registration Austin Health’s main kitchen, the Central in 1939, was demolished to make way forms on the printer closest to their Production Unit (CPU), continued to for the construction of the new Florey workstation: a time-saving system. produce nutritious food items equivalent Neurosciences Institutes Building. to 3,500 meals per day for patients and Ongoing upgrades of communication The future site of the highly-anticipated customers. In addition to providing the tools continued. Staff email storage Olivia Newton-John Cancer and Wellness patients of Austin Health and the co- capacity was doubled and ITS now Centre is occupied by Heidelberg located Mercy Hospital for Women last supports smart phones, portable House, c1939. The enabling works for year, the CPU has provided a fresh food windows devices and iPhones. the building’s demolition commenced bulk service to Caulfield General Hospital and the first departments relocated in since July. To support this initiative and June 2009 into refurbished sections of attract new clients, this service was levels three and eight of Harold Stokes branded Medichef in January. Building. On level nine of the same building, the upgrade of the infrastructure in decommissioned wards commenced to be followed by refurbishment to accommodate the arrival of the in-patient wards in August 2009.

At Heidelberg Repatriation Hospital, construction of the Health and Rehabilitation Centre commenced. The building, long-awaited by the hospital’s veteran population, experienced construction delays but is on track for completion by mid-2010. The contractor for the Health and Rehabilitation Centre, Kane Constructions, will also undertake the construction of the adjacent new Centre for Trauma-Related Mental Health facility – the future home of Austin Pictured above: Prof Colin Masters, the Hon Gavin Jennings MLC, Prof Samuel Berkovic, the Hon Jenny Macklin MP, Prof Graeme Jackson, Premier John Brumby and Prof Geoffrey Donnan Health’s expert psychiatric service. Also turn the ﬁrst sod at the building site for the future Austin Neuroscience Facility.

Austin Health : 2008-09 ANNUAL REPORT 35 Human Resources

OUR PEOPLE STRATEGY Austin Health again achieved an wellbeing initiatives such as subsidised A departmental restructure of the outstanding result in recruiting 139 nicotine replacement therapies provided Human Resources (HR) team was graduate nurses, 100 hospital medical by the Smoking Cessation Unit, as well undertaken to ensure Austin Health’s officers (HMOs) and 80 interns in 2009. as learning and development initiatives. people strategy focuses on meeting the Coordinated via the Postgraduate expectations of Austin Health’s services Medical Council of Victoria, the new CORPORATE WELLNESS while competing for a highly-skilled graduates’ preferences were matched A healthy and happy workforce is one workforce known for chronic shortages against Austin Health’s selection criteria. likely to attract and retain the best in identified professions. By recruiting those who ranked most talent. This objective was defined in highly against the selection criteria, Austin Health’s new HR strategic plan. A key component of the new model was Austin Health employed professionals In response, the work/life balance the introduction of the ‘business partner’ who are amongst the brightest of their manager position was created to role. As business partners, three HR graduate year with a commitment to support the cultural change required to staff members were integrated into each working at Austin Health. help our people balance the demands of the organisation’s major business of their personal and professional lives. units. Their role is to support the STREAMLINING ADMINISTRATION A number of initiatives encouraging leaders of those units in ensuring that Over the past three years, Austin staff to be active and eat well were their operational goals were achieved Health has taken a lead role in DHS’ also introduced. The Healthy Options in alignment with the organisation’s Human Resources Management Committee promoted walking and strategic people goals. Project to pilot comprehensive payroll cycling challenges and new food outlet and human resources systems. This This new approach to the contractors at Austin Hospital began initiative comprises a key component provision of HR services is focussed on serving healthier meal choices. advancing the values and interests of of the Victorian Government’s state- the organisation and its people, while wide information and communication Notably, Austin Hospital joined delivering its ongoing existing goals technology strategy, HealthSMART. Heidelberg Repatriation Hospital and Royal Talbot Rehabilitation Centre in to the highest standard. While in its The Chris21 human resources system becoming 100% smoke-free on earliest stages of implementation, the entered its third year of operation at 1 July 2009. HR business partners have tailored a Austin Health. A pilot of the Kronos variety of initiatives to assist managers rostering program was introduced and PEOPLE AND PERFORMANCE in making the most of the professional integrated with Chris21 in early 2008. The performance review process capabilities of their staff as they deliver The new systems will replace systems provides valuable recognition of staff’s quality services in a safe and supportive that have been in operation for 20 years. workplace. achievements while enhancing their The Kronos rostering systems understanding of their team’s priorities The function has renewed its transitioned from the pilot to the and goals. People and Performance commitment to Austin Health’s values production phase in February. At year’s provided the training, tools and templates - Integrity, Accountability, Respect and end, 1,100 nursing staff were rostered for managers to conduct staff reviews Excellence – in the belief that in practice, with Kronos. All nursing staff are with a high degree of competency. they will not only sustain but accelerate scheduled to be using the system by A focus on self-awareness is integral a positive workplace culture. In practical the end of 2009. The full benefits of the to our approach in developing leaders terms, the team aims to build the values system will not be realised until it is in at Austin Health. A number of initiatives into a frame of reference to guide the use across the entire division, when all designed to improve the communication ways in which staff relate to one another, functions can be brought into operation. share ideas and work together to get skills, attitudes and self-awareness things done. ADVANTAGES FOR OUR PEOPLE of staff were introduced successfully. Austin Advantage, the in-house salary SAFETY AND HEALTH packaging program managed by HR, Austin Health’s Occupational Health attracted an additional 17.5 per cent of and Safety (OHS) strategy is focussed on staff users to its salary packaging facility preventing injuries from occurring. With during the 2008-09 fringe benefits tax this important goal, the OHS Department period. This brings the total number of provided staff with training and support users to 5,412, approximately 85 per cent to improve their compliance with safe of the eligible workforce. Revenues from working practices. The number of Austin Advantage have been channelled WorkCover claims reported by Austin into programs that directly benefit Austin Health dropped. The department aims Health staff. These included health and

36 Austin Health : 2008-09 ANNUAL REPORT Pictured below: division 1 nurse Jennifer Maffei, liaison nurse Naveeni Natkunarajah, division 2 nurse Diane Gration, nurse practitioner Nick Gaynor, NUM Janice Brown, clinical nurse educator Andrew Motley and clinical nurse consultant Megan Yeomans.

to maintain this trend and reduce the “Backsafe” was introduced to teach managers of targeted areas. The course severity of the claims. Of the claims correct manual handling, correct participants learned how to identify and defined as severe, 54.7 per cent were working posture and back injury manage the early stages of interpersonal caused by incorrect manual handling. prevention. More than 80 per cent of conflict between staff. support services staff completed the A new OHS model was introduced Managers were trained to provide “Backsafe” program. to embed safety awareness across strategies that manage unhealthy conflict the organisation. The new structure The department received funding from and to seek assistance when required. established four OHS committees WorkSafe Victoria’s Return to Work across each of the organisation’s Fund to provide an interpersonal conflict directorships, and replaced a single management training program to organisation-wide committee.

The committee members are made up WorkCover Claims Reported by Austin Health of staff health and safety representatives �� and each committee is chaired by an Austin Health executive director. By �� demonstrating commitment and strong �� leadership on safety issues, the executive �� are empowering their staff to assist in �� increasing safety communication and the identiﬁcation of potential hazards and unsafe work practices. ��

Many of Austin Health’s non-clinical �� support services staff do a great deal of manual work and can be at risk of

injury. A back injury prevention project ��

Austin Health : 2008-09 ANNUAL REPORT 37 Strategy, Quality and Service Redesign

The imperative to maximise The 2008 Quality of Care Report was SCANNED MEDICAL RECORDS the use of all available produced in line with DHS requirements Health Information Services commenced resources in planning and and distributed to 170,000 households the implementation of scanned medical in the Austin Health catchment. records to enable timely, simultaneous delivering health care led to Development of the 2009 report access to medical record information to exciting innovations. commenced and aims to promote broad multiple users across all Austin Health consultation and enhanced consumer sites. Significant planning work was Strategy, Quality and Service Redesign engagement in an exciting new undertaken and a vendor was appointed. (SQSR) was established in September as magazine-style format. The highly-anticipated system is a result of an organisational restructure. expected to go live by the end of 2009. The new directorate brought together PERFORMANCE REPORTING key business functions including: Improving performance is reliant on HealthSMART CLINICAL strategy and service planning; clinical access to good quality, timely data. SYSTEMS PROJECT information management, analysis and During 2009, an external vendor was In February, Austin Health commenced performance reporting; the integration contracted to develop the first stage of planning to implement a new DHS- of quality, safety and risk management; a comprehensive, dashboard-driven sponsored clinical system, Cerner veteran liaison; and service improvement performance reporting system (PRS). Millennium. The program will enable and redesign. The directorate supports The first stage of this project will provide clinicians to electronically prescribe and continuous improvement by providing executive team and senior managers administer medications, order pathology clear strategic direction, access to with an intuitive tool to monitor and radiology tests, view results performance information and service and analyse a range of high-level, and record key patient information improvement. organisation-wide key performance electronically. The system has the indicators. potential to deliver advanced functionality SERVICE PLANNING to enhance patient care and is expected AND PERFORMANCE AUSTIN BY DESIGN to be fully implemented by July 2011, The Austin Health 2009-12 Strategic Austin by Design was funded as part subject to Board approval. Plan was completed following of DHS’ Redesigning Hospital Care consultation with staff, DHS and other program. By employing ‘lean thinking’ VETERAN COMMUNITY key stakeholders. It sets the strategic methodologies to redesign service Veterans’ Liaison provides a single point direction and agenda for Austin Health delivery, outcomes are improved while of contact to veterans and war widows. for the next four years. Its objectives time-wasting activities are reduced. An annual program of commemorative were translated into programs of work The program is being applied to ward services was held at the Heidelberg in the annual Austin Health business operations, ED, and Cardiac Surgery, Repatriation Hospital over the course plan, which provides a strong focus for accompanied by a training program to of the year including ANZAC Day, achieving key priorities across all levels assist staff to develop redesign skills. Remembrance Day and Vietnam of the organisation. Veterans Day. In the nursing context, new ways of Austin Health was honoured with four working are being developed to eliminate Liaison with ex-service organisations awards in the 2008 Victorian Public time lost on activities that divert from continued and the Heidelberg Healthcare Awards. Nine submissions patient care. Two wards introduced Repatriation Veterans Centre, linked demonstrating outstanding practice were the system and gained in measurable to a state-wide network, continued to entered into the 2009 program. efficiency, and planning for a third ward support pension and disability claims. to join the program is underway. In ED, The $2 million Heritage Appeal campaign QUALITY, SAFETY AND the project included Ambulance Victoria continued to raise funds to support RISK MANAGEMENT and DHS to develop a standardised a number of activities that preserve The Quality, Safety and Risk Management process to offload arriving ambulances veterans’ historical link to Heidelberg Unit consists of Quality Systems, into the appropriate area of ED in a Repatriation Hospital. Medico-legal, Risk Management, Patient timely and efficient manner. A review of Representative Office and Respecting the patient pathway for cardiac surgery Patient Choices. These functions were commenced with the aim to streamline consolidated to deliver an integrated access to theatre, intensive care and into quality and risk management function the ward to minimise patient delays and and improve the synergy of activities that potential cancellations of surgery. enhance patient care.

38 Austin Health : 2008-09 ANNUAL REPORT Fundraising

Austin Health’s world- class care is enhanced by the generosity of its donors, corporate partners, supporters and volunteers. Their donations, gifts and bequests enabled the health service to provide extra equipment for patients, improve its facilities, and perform important research. This year, a net result of $1.77 million was raised to help support the work of Austin Health. A further $2.2 million was raised toward the Olivia Newton-John Cancer and Wellness Centre Appeal. Over 3,400 new donors joined the 42,000 donors who respond to Austin Health’s quarterly appeals. Thanks to those who responded to the appeals, more than $100,000 was raised to purchase additional equipment for Cardiac Surgery, Liver Transplant Unit, Aged Care Services and ICU. Special thanks are offered to the individuals who chose to leave bequests of almost $1.7 million. In September, Olivia attended the Pictured above: Olivia and Assoc Prof Paul Once more, Austin Health was Lord Mayor’s Charitable Foundation Mitchell, medical director Cancer Services at thankful for the contributions of the Ball, where the foundation gave an a fundraising event for the Olivia Newton-John Cancer and Wellness Centre Appeal. ‘Friends of Austin Health’ who devoted extraordinary grant of $1.5 million, thousands of hours during the year to their largest donation to date. In addition, raise funds and contributed $198,073. Olivia attended two events with the To preserve the veteran heritage of Myer Community Fund celebrating the Heidelberg Repatriation Hospital, $1 million partnership pledged over four Tattersall’s donated $50,000 towards years. More than $120,000 was raised the Heritage Appeal. from The Good Music Month concert with Olivia and her friends, including The Olivia Newton-John Cancer and Guy Sebastian, Vanessa Amarosi Wellness Centre Appeal continued to and Kate Ceberano. The Appeal gain momentum thanks to the leadership also welcomed a number of new of Terry Campbell (Emeritus Chairman) ambassadors: Dannii Minogue, and new Appeal executive chairman, Sir Cliff Richard, Sigrid Thornton, Andrew Hagger. Olivia met with the Deborah Hutton, Pat Farrar, centre’s project team and was thrilled Tottie Goldsmith, Leeza Gibbons, with the architectural plans. Sue McIntosh, Barbra Ward, Melinda Schneider and John Lazarou.

Austin Health : 2008-09 ANNUAL REPORT 39 Our Supporters

THANK YOU Auxiliaries and Volunteers ONJCWC Appeal Advisory Chocolatier Australia Ivanhoe Austin Health donors have made a President, Friends of Austin Committee Shop significant difference contributing Health, Mrs Beverley Briese Mr Michael Andrew, Chairman CitiPower Pty Commodity Traders Australia P/L to research, patient support and Austin Health Volunteers Auxiliary Australia, KPMG Cue Clothing vital patient equipment across all Friends of Austin Health Mr Chris Butler, Partner, Ernst Diamond Creek Auxiliary and Young Curves areas of Austin Health including Greensborough Auxiliary Mr Peter Court, Managing Department of Veterans Affairs Austin Hospital, Heidelberg Royal Talbot Rehabilitation Director, Streetscope Research DT Digital Repatriation Hospital and Royal Centre Auxiliary Pty Ltd Finity Consulting Talbot Rehabilitation Centre. Templestowe Auxiliary Mr Tim Daly, Chairman, Austin FM Global Volunteer drivers French Island Retreat Pty Ltd One of the major projects Health Board ...with special thanks to more than Ms Michaela Green, Executive Gaia Retreat and Spa supported this year continues 600 volunteers who support Austin Director, Aegis UCMS Group Goldman Sachs JBWere to be the capital appeal for the Health every year Assoc Prof Paul Mitchell, Austin GT Building Developments Olivia Newton-John Cancer and Hallmark Editions Pty Ltd Austin Health Ambassador Health Wellness Centre Appeal. Special Mr Lee Moffit, Lee Moffit Cancer Hoscaf Pty Ltd Mr Denis Walter thanks to all who have supported Centre Interrisk Olivia’s vision to see this centre Olivia Newton-John Cancer and Mr Robert Pradolin, General Ivanhoe Traders Association come to reality – we are getting Wellness Centre Appeal Patron Manager, Australand Landsdale Rose Gardens so close! Olivia Newton-John OBE AO Mr Phillip Scanlan AM, Australian Lend Lease Consul-General, New York Lyall Hotel Thanks to the individual donors, ONJCWCA Ambassadors Mark Morrissey and Associates corporations and community Ms Pat Farrar ONJCWCA Young Professional MBT Advisory Group groups who have supported Austin Ms Leeza Gibbons Michael Kefford Pty Ltd Health by donating, or running Ms Tottie Goldsmith Melanie Beith, Mallesons Middletons Creations Sam Cottell, Clayton Utz events to raise funds. Thanks also Ms Deborah Hutton Moffitt Cancer Centre Andrea Hassett, Deloitte to individuals who have made gifts Mr Eddie McGuire Myer Mrs Sue McIntosh Mark Malinas, Allens Arthur in memory of loved ones. This NAB Ms Dannii Minogue Robinson News International Pty Ltd makes a significant difference to Sir Cliff Richard OBE Rachael Meadows, Allens Arthur Nintendo Australia Pty Ltd our work. Ms Melinda Schneider Robinson Novo Nordisk Pharmaceuticals Jessica O’Hara, Clayton Utz Of course we also thank the many Ms Sigrid Thornton Pty Ltd Ms Barbra Ward Cindy Perryman, Ernst and Young individuals who have made a Oracle CMS Mark Phillips, Ernst and Young Orica bequest to Austin Health – their ONJCWC Appeal Emeritus Parks Victoria lasting legacy goes on to ensure Chairman HRH Heritage Appeal Patron Pleasure State the continued growth of our health Mr Terry Campbell AO, Chairman Major General David McLachlan Powercor Australia Ltd service for future generations. Goldman Sachs JBWere (Ret’d) AO, State President RSL (Vic Branch) Premier Hotels Group ONJCWC Appeal Chairman Preston Motors Group FRIENDS OF Mr Andrew Hagger, EGM HRH Heritage Appeal Committee Qantas Airways Ltd AUSTIN HEALTH Insurance MLC and NAB Wealth Maj Gen David McLachlan AO, Ritchies Stores RSL (Vic Branch) Roche Diagnostics Australia Special acknowledgement for ONJCWC Public Appeal Chairman the work undertaken by the Mr Craig Langdon MP, Member Royal Australian Navy Mr Andrew Demetriou, CEO, for Ivanhoe Sanofi Aventis Friends of Austin Health. This Australian Football League group volunteers many hours Mr Noel Sanderson, Veteran Shine Lawyers Mr Robert Winther, Austin Health to raise funds throughout the ONJCWC Appeal Executive State Theatre Telstra year to purchase much needed Committee Corporate Supporters The Bing Boys equipment for Austin Health. Mr Paul Bonnici, Marketing and 3AW The Leeza Gibbons Memory Creative Strategist ACP Magazines Their dedication is remarkable, Foundation Mr Max Campbell, Director, AIPP and send our special thanks to all, Universal McCann Outlook Financial Services Airmaster Australia Pty Ltd under the leadership of President, Verso Consulting Ms Alisa Camplin, Manager, Multi Alepat Taylor Mrs Beverley Briese OAM. Watergardens Hotel Vendor Management, IBM Allens Arthur Robinson Wyeth Australia Pty Ltd Prof Jonathon Cebon, Director Araluen ACLU Xinnia Café Oncology Unit, Ludwig Institute for Australand Cancer Research Australian Football League Major Donors Dr Colin McLeod, Group Balios Pty Ltd Ms Kaye Ackerman Marketing Manager, Australian Banyule City Council Mrs Lorraine Aitken Football League Barklys Hotel Mrs Edith Aitken Mr Scott Lorson, Media Strategist Beaufort Community Grant Fund Mr and Mrs Armando and Vittoria Dr Brendan Murphy, CEO, Austin Bonds Alessio Health Bradcorp Holdings Pty Ltd Mr and Mrs Ian and Sue Apted Mr Morry Schwartz, Director, Pan Burt and Davies Ms Margot L Atkins Urban Corporation Catherine Manuell Design Mr W H Attwood Charity Greeting Cards Mrs Joan Avent

40 Austin Health : 2008-09 ANNUAL REPORT Mr Keith Bailey Mr Mike O’Meara Estate Oceana Kimpton Order of the White Shrine of Mr and Mrs Carl and Nancy Mr Harry Ronald Orchard Estate John Lambrick Trust Jerusalem Berndt Mr Alfred Osbourne Estate Trust George H Levers Panton Hill Cricket Club Ms Joanna Betteridge Mrs Jill Outen Estate M M Livingstone Pickle Movie Club Mr Ray G Blackbourn Brother John Parker Estate C D Lloyd Trust Pink Party Mr Ross Blair Mr Howard Paul Estate A C MacBean PLC Association Inc. Mr L G Bowes Mr Tom Payne Estate J R G and E MacKenzie Preston War Widows and Widowed Mr Lyle Boxer Mr John A Perry Estate William Macrow Mothers Mr Bernie Brookes Ms Anne Piccirilli Estate Margaret Lillian Merriﬁeld Repat Café Mrs Huong Bui Ms Maria Piccirilli Estate Jacqueline Meulenberg Rosanna Primary School Ms Geraldine Bergmuller Ms Simone Polidatu Estate H Morris Rotary Club of Brighton North Dr Graham Cannon Ms Lorna Price Estate Thomas B Payne Rotary Club of Heidelberg Mr Joseph Carrozzi Mr Michael Psaltis Estate Maria Petrenko Rotary Club of Central Melbourne Mrs Irene Chryssanthou Mrs Clarice M Purcell Estate William Maxwell Potter Rotary Club of North Balwyn Miss Margaret Coles Mr Lyle Regester Estate Annie E Roberts – Rotary River Ride Ms Rita Dametto Mr Christopher Rhodes Estate Simon Rothberg Rotary Club of Williamstown Mr Tony De Santis Mr Ian Robertson W H Russell Trust RSL Altona Sub Branch Mrs Margaret Donazzan Mr Stewart Rogers Estate F E I Smith RSL Bairnsdale Sub Branch Ms Linda Duncombe Mrs Margaret S Ross AM Estate Elizabeth Stephens Women’s Auxiliary Mr Stephen Earp Mrs Tracey Russell Estate Wesleigh Gordon Tabe RSL Epping Sub Branch Mr Reece and Mr Heath Evans Mr Allan Sheridan Estate A L D Taylor RSL Geelong Women’s Auxiliary Mrs F Forte Mr Ralph Smith Estate Flora Louisa Thompson RSL Morwell Women’s Auxiliary Mr Patrick France Mr Michael Stewart Estate H G Turner RSL Noble Park Sub Branch Mrs Betty Frid Mr Bernie Stock Estate Eliza Wallis RSL North Balwyn Sub Branch Mr Armando Giufre Mr Ronald Stone William and Eileen Walsh Trust RSL (Vic Branch) Inc Ms Leeza Gibbons Mr and Mrs John and Maureen Estate Wright C Trust RSL (Vic Branch) Women’s Mrs Lois Goodin Szanto Estate J F Wright Council of Victoria Mr and Mrs T and M Gray Mr W Szykman Estate Henry Herbert Yoffa RSL Greensborough Sub Branchl Ms Michaela Green Mr and Mrs Efthimios and Clubs, Groups and Scrap 4 Cancer Dr Margaret Hartley Chrisoula Traitsis Sovereign Order of St John of Community Events Mr Mick Hayes Mr Lai Trinh Jerusalem Mr Vincent M Holian Ms Mindy Verson Arden Crescent Concert Series TPI Association Ms Irene Hosford Mr John Vlahos Art in Motion Victorian Veterans Counci Mr and Mrs Harold G and Mr Noel Walker Australian Institute of Professional Victorian Orchid Club Margaret J Jarvis Mr Colin Wallace Photography (AIPP) War Widows Guild Mrs Judith Jones Mr Martin Williamson Associazione Padovani nel Mondo Whitefriars College Mrs Dale King Mr Michael Wilm Circolo del Victoria Whittlesea F/C Inc. Social Club Mrs Betsy King Dr Jos M Xipell Banyule/Watsonia RSL Trust WOW Ivanhoe Social Club Mr Tom Kirchner Mr Guo Hua Zhou and Mrs Xiao Bentleigh War Widows and … and numerous other smaller Mrs Irene Kirkpatrick Wen Lu Widowed Mothers Assoc events and individuals who held Mrs Freda Kondarios Billings Long celebrations requesting donations Estates and Bequests Mr Yi Sheng Kuang Blue Illusion in lieu of gifts Estate Ian John Bailey Mrs Dorothy Lewis Body and Soul Expo Estate Dorothy Sadie Barke Trusts and Foundations Mr Joe Liistro Bundoora Contact Community Estate Howard Wesley Berry Collier Charitable Fund Miss Barbara C Lim Centre Inc. Estate H and C Brennen Bene Lord Mayor’s Charitable Mrs Jean Linton Catalina Club of Victoria Estate Louis Berner Foundation Mr Graeme Little Celebrating Women in Estate A L Blannin Myer Community Fund Mrs Audrey Joan Loughnan Photography Estate William Andrew Bon S.T.A.F. Isabella Agnes Pritchard Mr Bernie Lourey Chocolatier Australia Ivanhoe Estate Ethel Mary Davenport The S R Stoneman Foundation Mr Matthew Lowry Doncaster-Templestowe Amateur Estate D T M Davies Tattersall’s George Adams Miss Peggy Luker Swimming Club Estate Thomas Gladstone Dowsley Foundation Dr Hong Thai Luong Eating for a Cause Estate Stanley Peter Egan Walter and Eliza Hall Mrs Iris Manton Garry Tyson Memorial Golf Day Estate Mary Ann Edwards Supplementary Trust Mrs Sheryl McCowan Good Music Month Estate W E and M E Flanagan WCF Thomas Charitable Trust Mrs Thelma May McEachern Heidelberg Theatre Company Inc. Charitable Trust Mrs Amanda McKenzie Hot Rhythm Swing Estate Timothy John Fleming Professor John McKenzie Ivanhoe Traders Association Estate William F Fletcher Ms Annette McWaters Lioness Club of Brown Hill Estate Helen Fookes Ms Ann Middleton OAM and District Estate Arthur William Godfree Ms Susan E Monger Lions Club of Mooroolbark Estate William Samuel Godfree Ms Louise Myer Lions Club of Waverley Estate Grant Bequest Mrs Dianne Newport Lungs in Poor Shape Estate L Henty Mr Tinh Ngo Macedonian Senior Citizens Club Estate Edward Vernon Jones Mrs Di Nicholas Maria SS Della Quercia Divisora Estate Gustave Alexander Junier Mr Bruce Nichols Masonic Masters Group 1989-90 Estate Ernest John Kebby Mrs Merna Olver Northern Football League

Austin Health : 2008-09 ANNUAL REPORT 41 Senior Staff

Executive Team Senior Nursing Staff A Wilcox Mr M Douglas M Wood Head General and Upper Dr Brendan Murphy S Afrasiabi K Young Gastrointestinal Unit Chief Executive Officer J Ahmling M Apostilidis Senior clinical staff Dr J Duggan Michael McDowell R Armstrong Prof P Angus Director Clinical Haematology Redevelopment Infrastructure K Arunasalam Director Gastroenterology and Dr B Fabiny and Commercial K Aspridis Hepatology, Medical Director Director Radiology Ian Broadway L Auriant Liver Transplant Unit Finance J Batten A/Prof G Fabinyi Mr A Auldist Director Neurosurgery Dr Mark Garwood D Baulch Head Paediatric Surgery Unit Chief Medical Officer (to E Bogdan Prof O Farouque November) M Bowkett-Hall Mr C Baker Director Cardiology K Bowler Director Radiology Mr G Fell Dr John Ferguson D Brown Prof S Berkovic Director Vascular Surgery Chief Medical Officer (from J Brown November) Head Comprehensive Epilepsy Mr S Flood L Bujas Program Ann Maree Keenan C Cheshire Head Plastic and Reconstructive Ambulatory and Nursing Services P Connors A Bladen Surgery Manager Occupational Therapy Chris O’Gorman M Conway H Fithall Corporate Development M Cook A/Prof D Bolton Manager Hospital in the Home M Cosgriff (to July) Head Urology Unit Prof A Frauman R DeZilva Fiona Webster A/Prof D Brown Director Clinical Pharmacology, C Denton Director Victorian Spinal Cord Toxicology and Hypertension Strategy, Quality and Service S Dixon Service Services Redesign (from September) W Driver Mark Petty I Edney A/Prof R Buchanan Prof M Galea Acute Operations A Gonzales Head Rheumatology Unit Director Rehabilitation Science Research Centre John Richardson C Holland Mr M Campbell Human Resources (to July) M Hooke Head ENT/Head and Neck Unit K Garrett K Hopkins Director Pharmacy Luke Mulkearns Mr L Castles E Hughes Human Resources Services Head Breast and General Surgery Dr P Gow G Jepsen (from October) Unit Director Endoscopy G Jones Clinical service unit directors G Knuckey Prof J Cebon Prof L Grayson Director Austin Ludwig Oncology Sub-Acute Services S Lorman Director Infectious Diseases and Unit A Szysz A Manley-Grant Microbiology Dr R Weller C McCarthy Prof C Christophi Dr K Gullifer R McFarland Chair Division of Surgery, Prof of Anaesthesia, Perioperative Head Ophthalmology Unit Surgery, Head of HPB/T Unit and Intensive Care N Mitton Dr G Gutteridge D O’Leary (to November) R Monger Dr N Coventry Director Intensive Care Unit A Moulder R Griffiths (from December) Director Child and Adolescent Prof C Hamilton A/Prof L McNicol C Naismith Mental Health Service K Owen Director Radiation Oncology Cancer, Spinal and Outpatients R Interlandi N Crinis Dr I Harley R Gould J Phelan Director Pathology Chair Senior Medical Staff Dr P Mitchell S Pillai S Crowe Association Medical and Emergency K Reid Deputy Director, Ambulatory and A/Prof M Hopwood J Macloy (to December) K Rim Nursing Services Director Veterans’ Psychiatry C Goodyear (from March) L Robb Dr P Crowley Head Brain Disorders Program A/Prof G Thomas J Rogan Director Anatomical Pathology K Skinner Dr M Howard Mental Health Mr R Cunningham J Scott Director Victorian Respiratory L Potter Head Orthopaedic Unit 1 Support Service Prof G Burrows (to December) N Seevanayagam A/Prof H Dewey A/Prof R Newton (from February) J Shoesmith Dr R Lakshmana Head In-patient Stroke Service Chair Division of Psychiatry K Spotswood Director North East Area Mental K Ireland C Doebrich Health Service Specialty Services T Tait Manager Orthotic and Prosthetic L Turner Prof G Jerums K Tan Services Director Endocrinology (to June) Dr J Johns S Har Tan Prof G Donnan Surgical B Vandenberg Prof B Jones Director Neurology (to January) B McDonald (to September) J Vella Director Liver Transplant Unit M Heland (from October) E Wadeson Dr L Doolan Dr E Jones Mr M Douglas (February) H Walters Director Operating Room Deputy Director Cardiology (from Prof C Christophi (from April) A Warland Services April) N Wendel

42 Austin Health : 2008-09 ANNUAL REPORT Dr F Kerr A/Prof A Scott J Evans J McLeod Director Emergency Medicine Head Centre for PET, Program Manager Strategic and Business Project Director Mr S Knight Director Ludwig Institute for Planning/Quality (to November) A Moorhouse Head Thoracic Surgery Unit Cancer Research H Fithall Manager Medical Physics D Leahy T Shevchenko Manager Ambulatory and J Moorfoot Manager Social Work, Manager Hospital Primary Care Continuing Care Director Quality, Safety and Risk Interpreters and Transcultural Liaison Unit A Germech Management Services, Aboriginal Health Dr C Smith Financial Controller B Morton Prof R Macdonell Medical Director Pathology K Gogel Manager Supply Director Neurology Prof A Street Manager Employee Relations J Neill AM Mahoney Director La Trobe/ C Goodyear Director Supply and Contracts Manager Clinical Austin Health Clinical Manager Access and Demand (to School of Nursing M Noa Nursing Education February) Manager Security (from A/Prof George Matalanis J Sweeney Dr H Grusauskas November) Manager Speech Pathology Director Cardiac Surgery Director Medical Education P Oppy A/Prof C McDonald Dr R Vaughan J Heselev Director Information Technology Acting Director of Respiratory and Director Endoscopy Director Corporate (to October) Sleep Medicine (from February) Mr R Westh Communications (from March) K O’Sullivan Mr I Pilmer A/Director Orthopaedic Surgery K Hider Manager Access and Demand Acting Head Colorectal General Mr P Wilde Community Advisory Committee (from February) Surgery Head Spinal Surgery Service D Hill Dr S Panagiotopoulos Dr C Meehan Dr R Woodruff Human Resources Business Manager Office for Research Head Dermatology Head Palliative Care Partner Ambulatory and Nursing G Reeves Prof J Milgrom A/Prof M Woodward Services Manager Stericlean Director Clinical and Health Head Aged Care Services S Hillman L Roberton Psychology Prof J Zajac Director Fundraising Patient Representative C Nall Chair Division of Medicine, C Hirst R Sedgwick Director Physiotherapy Prof of Medicine, Director of Corporate Counsel Manager Cleaning and Waste A/Prof R O’Brien Endocrinology (from July 2009) H Hussein Services Clinical Dean School Senior support staff Manager Occupational Health A Smith of Medicine R Anderson and Safety Manager Work/Life Balance L Owen Manager Central Production Unit K Jenkins C Smith Manager North East J Begley Manager Health Information Manager Food Services Post Acute Care Management Manager Transport and Couriers A Whitby R Paino Services D Kelleher Director Pastoral Care Aged and Residential Care Co- J Clark Director Service Planning and ordinator Performance J Wilkinson Manager Human Resources Director Facilities Maintenance A/Prof N Paoletti Business Services A Lafferty R Winther Head Consultation/Liaison R Condon Human Resources Business Veteran Liaison Officer Psychiatry Director Austin By Design Partner Acute Operations A Wright L Pearce D Cosentino I Leong Manager Learning and Manager Nutrition and Dietetics Manager Austin Child Director Capital Works and Infrastructure Organisation Development P Moore Care Centre (to March) Head – Adolescent Gynaecology G Cozaris A Macleod and Family Planning Unit Director Information Technology Director Clinical Governance (to Prof R Pierce (from October) January) Director of Respiratory P Davey K McCarthy and Sleep Medicine (to February) Director Clinical Information, Manager Northern Centre Prof D Power Analysis and Reporting Against Sexual Assault Director Nephrology J Davis S McConchie Mr J Robin Manager Research Ethics Manager Hospital Medical Officer Services Head Orthopaedic Unit 2 D Edwards Prof C Rowe Clinical Photography R McGlynn Manager Security (to December) Director Nuclear Medicine and M Ellis Centre for PET Board Secretariat L McKay A/Manager Corporate Mr M Rutherford D Ellks Communications (to March) Head Oral Maxillofacial Surgery Change Manager Sym.Fin.e A/Prof M Saling A McLean Director Clinical Neuropsychology Manager Health Sciences Library

Austin Health : 2008-09 ANNUAL REPORT 43 Awards and Scholarships

AWARDS Dr Sheila Patel Professor Graeme Jackson Medical Education Unit awards 2008 Austhos Travelling Fellowship National Health and Medical Research Council (NHMRC) Excellence Award 2008 Dr Nancy Sadka Dr Philip Peyton Best Resident as Mentor sanofi aventis Prize for Clinical Research in Rosemary Moore, David Berlowitz, Vascular Medicine Linda Denehy, Ken Sharpe, Dr Mandy Lau Bruce Jackson, Christine McDonald Best Registrar as Mentor Shauna Poole Allied Health Research Award Thoracic Society of Australia and Dr Andrew Nunn New Zealand/Boehringer-Ingelheim Prize Best Senior Medical Staff as Mentor Catherine Said National Stroke Research Institute Prize for Assoc Professor Richard Newton Dr Prahlad Ho Stroke Research Margaret Tobin Award 2009 Best Resident in Teaching Professor Ego Seeman Mr Phuong Phan Dr Ali Aminazad 2008 AHMRF Distinguished Scientist Award Gait CCRE Clinical Research Training Best Registrar in Teaching Fellowship Dr Mark Newton International Nurses Day awards Professor Ego Seeman Best Senior Medical Staff in Teaching Eleanor Hughes International Osteoporosis Foundation Dr Yan Chow Clinical Leadership Award Medal of Achievement 2009 Best Resident as Supervisor Christina Hornby-Waring Dr Yisha Tong Dr Ada Cheung Care and Compassion Award - Graduate Chinese Ultrasound Doctor Association Best Registrar as Supervisor Nurse Year (CUDA) Outstanding Contribution Award Assoc Professor Gwynne Thomas Lorelle Martin Dr Qingju Wang Best Senior Medical Staff as Supervisor Clinical Excellence Award International Bone Mineral Society Young Investigator Award 2009 Assoc Prof Bill Silvester Kallie Yammouni Best Intern Education presenter Clinical Excellence Award – Graduate Nicole Wong Nurse Year Pincus Taft Young Investigator Award 2008 Assoc Prof Russell Buchanan Best HMO Education presenter FJ O’Rourke Fellowships Tania Quirk Mayfield Education Academic Excellence Dr Stephen Warrilow Rebecca Monger and Georgina Knuckey Award for Diabetes Education 2008 Most outstanding overall contribution to Emily Moor education and training External non-medical awards Dr Jenny Than Spirit of Anzac Award Tim Daly Most outstanding contribution to the Physiotherapy Veterans Team Member of the Order of Australia 2009 Medical Education Unit Sharon Hillman External awards Dr Jason Trubiano Fellow of Fundraising Institute of Australia Dr Sofianos Andrikopoulos Intern of the Year (FFIA) National Health and Medical Research Dorothy Lewis Dr Kacey Williams Council (NHMRC) Excellence Award 2008 Darebin Australia Day Award 2009 Intern of the Year – runner-up Dr Siddhartha Deb Rhonda Martinez DS Nelson Trainee Prize, March 2009 Research Week awards Winner, Chapter 1 (Vic) Cadbury Fundraiser Ian Baldwin Claudia Doebrich Volunteer of the Year Nursing Research Award Ian Brand Prize 2008 Allen Bailes Dr Luke Burchill Professor Geoffrey Donnan Banyule Community Volunteer of the Year AHMRF Young Investigator Award Bethlehem Griffiths Research Foundation (BGRF) medal 2008 Dr Patrick Carney AHMRF Young Investigator Award Dr Elif Ekinci 2008-2009- NHMRC Post-Graduate Dr Cherie Chiang Medical Fellowship for research into Salt, Austin Lifesciences Award for Basic Hypertension and Microalbuminuria in Research patients with Type 2 Diabetes AHMRF Young Investigator Award Pfizer CVL Grant 2007-2009: to support Dr Adee Davidson MD/PhD into Salt, Hypertension and sanofi aventis Prize for Cancer Research Microalbuminuria in patients with Type 2 Jennifer Ericksen Diabetes Parent-Infant Research Institute Early Ipsen International Travel Grant, Years Award September 2008 Dr Leighton Kearney Ludwig Institute Scholarship

44 Austin Health : 2008-09 ANNUAL REPORT SCHOLARSHIPS Dr Bryan Wai Dr Ali Al-Fiadh Heart Foundation/ National Health and National Heart Foundation/National Health Medical Research Council Postgraduate and Medical Research Council scholarship Research Scholarship 2009, for his Pfizer Australia Cardiovascular Lipid research project Echocardiographic Grant 2009 Predictors of Cardiovascular Outcomes and Their Progression in Diabetes Mellitus Esther Chan CardioVascular Lipid Travel Grant 2008 Ian Scott PhD scholarship from Australian CardioVascular Lipid Research Grant 2009 Rotary Health, to investigate the for his research project Novel genetic management of acute agitation in the markers of cardiac disease in patients Emergency Department (ED) setting. with diabetes Kok Fei Chan Cardiac Society of Australia and New Australian Government Endeavour Zealand Travelling Fellowship 2009 for his International Postgraduate Research project Progression of Cardiac Structural Scholarship and Functional Parameters in Type 2 The University of Melbourne International Diabetes Mellitus Research Scholarship Dr Andrew Weickhardt Dr Emma Frankling and Dr Robyn Stargatt 2008 NHMRC Scholarship Australian Rotary Health Research Grant Roche Haematology Oncology Targeted Dr Melanie Freeman Therapy Scholarship 2009. Heart Foundation Postgraduate Research Scholarship 2009 Dr Darren Hiu Kwong Lee Jacquot Research Entry Scholarship 2009 Dr Leighton Kearney Heart Foundation Postgraduate Research Scholarship, including an additional award for being the Heart Foundation’s top ranked clinical scholar 2009-10 Pfizer Australia Cardiovascular Lipid Research Grant Elizabeth Mackey Post-graduate Nursing Scholarship Tracy Sheldrick QUOTA South Pacific Area Scholarship 2008 Royal Talbot Rehabilitation Centre Health Professionals Scholarship 2009 Department of Human Services (DHS) Improving care for older people and people with complex needs scholarship 2009

Pictured right: Dr Andrew Weickhardt NHMRC Scholarship winner 2008.

Austin Health : 2008-09 ANNUAL REPORT 45 Financials

The underlying operating result for gained by the improved budget time to provide an improved service to 2008-09 is a small surplus of $242,000. accountability processes introduced departmental managers and budget Pleasingly, this figure approximates the over recent years. holders, and to initiate numerous budgeted breakeven target. For a year business improvement projects. Austin Health’s longer term objective greatly influenced by a difficult funding is to improve its financial result The Department’s contact with the environment and significantly higher to provide the necessary funds to public has improved, with highlights staffing costs, in particular those replace equipment and keep up with including the on-going success of the related to medical staffing, it is a technological advancements. This will Private Patient Initiative, improved commendable result. require even greater budget rigour contract management and the work Austin Health reported its operating to ensure that limited resources are undertaken to improve the collection of result as a surplus of $4.521 million. allocated in a manner that maximises patient admission information. Planning It is important to note that this figure overall performance. is underway to introduce similar is the result of a major donation of efficiencies through the implementation The Finance Department continued to $4.2 million to fund medical research of a state-of-the-art patient billing build on previous years’ improvements. through Austin LifeSciences. system, and improved operations of The effort made to improve the quality the supply and procurement functions. That Austin Health achieved its budget of the core budgetary and financial target while treating record patient reporting processes are beginning to numbers was due largely to efficiencies reap rewards. This has freed up staff

2005 2006 2007 2008 2009 Financial Summary $000 $000 $000 $000 $000 Total Revenue 443,646 474,953 507,829 550,319 608,637

Total Expenses 448,353 474,002 504,011 550,247 604,116

Operating Surplus/ (Deﬁcit) before capital and speciﬁc items (4,707) 951 3,818 72 4,521

Capital and Speciﬁc Items (11,557) (4,991) (15,832) (10,018) 11,856

Operating Surplus/ (Deﬁcit) (16,264) (4,040) (12,014) (9,946) 16,377

Accummulated Deﬁcit (63,064) (65,732) (78,501) (88,034) (74,824)

Total Assets 673,660 683,512 715,487 766,238 1,190,514

Total Liabilities 141,934 142,649 152,161 177,711 197,252

Net Assets 531,726 178,255 563,326 588,527 993,262

Total Equity 531,726 178,255 563,326 588,527 993,262

Average Collection Days In-patient Accommodation Fees Outstanding Total Total 2009 2008 Under 30 Days 31-60 Days 61-90 Days Over 90 Days 30/6/09 30/6/08 Revenue Indicators Days Days $000 $000 $000 $000 $000 $000 Private 69 51 892 524 185 333 1,934 3,379

TAC 123 93 177 81 74 164 496 1,119

VWA 62 223 160 49 67 427 703 676

Other Compensable 249 95 113 72 68 262 515 397

Psychiatric 49 67 39 8 4 15 66 76

Residental Aged Care 7 5 13 11 - - 24 14

Total 56 55 1,394 745 398 1,201 3,738 5,661

46 Austin Health : 2008-09 ANNUAL REPORT Our Clinical Services

STATEWIDE SERVICES CANCER SERVICES MEDICAL AND EMERGENCY Australian Centre for Ballarat Austin Radiation Oncology Centre After Hours GP Clinic Post-traumatic Mental Health Cancer Clinical Trials Clinical Pharmacology, Therapeutics and Child and Adolescent Mental Health Cancer Immunology Hypertension Services Cannulation and Apheresis Service Dermatology Ventilation Weaning Unit Clinical Haematology Emergency Medicine Victorian Liver Transplant Unit Day Oncology/Chemotherapy Endocrinology Victorian Respiratory Support Service Familial Cancer Clinic/Clinical Genetics General Medicine Victorian Spinal Cord Service Service Infection Control Victorian Toxicology Service Medical Oncology Infectious Diseases Acquired Brain Injury Unit Palliative Care Medical Assessment and Planning Unit Radiation Oncology Nephrology AGED CARE Lymphoedema Service Paediatric Medicine Aged Care Podiatry Aged Care Assessment Service CARDIOTHORACIC SERVICES Renal Dialysis Aged Care Co-ordination Teams Angiography Rheumatology Aged Care Volunteer Program Cardiac Catheterisation Laboratory Short Stay Observation Unit Community Link Rapid Response Service Cardiac Rehabilitation Toxicology Community Rehabilitation Centre Cardiac Surgery Continence Service Cardiology MENTAL HEALTH Darley House Coronary Care Adult Psychiatry Medical and Cognitive Research Unit Echocardiography Brain Disorders Program Memory Service Hypertension Secure Extended Care North East Dementia Innovations Respiratory and Sleep Medicine Clinical and Health Psychology Demonstration Pilot Respiratory Function Laboratory Community Mental Health Services Northern Region Extended Aged Care at Sleep Disorders Unit General Hospital Psychiatry Home Program Thoracic Surgery Drug Dependence Clinic Planned Activity Group Tracheostomy Review and Management Eating and Mood Disorder Program Wound Clinic Service Mother and Baby Unit Older Veterans’ Psychiatry Program ALLIED HEALTH DIAGNOSTIC SERVICES Veteran’s Psychiatry Nutrition and Dietetics Anatomical Pathology Occupational Therapy Centre for Positron Emission Tomography NEUROSCIENCES AND Physiotherapy Chemical Pathology VASCULAR SURGERY Social Work Clinical Pathology Clinical Neuropsychology Speech Pathology Haematology Comprehensive Epilepsy Program SUB-ACUTE AND Laboratory Medicine Epilepsy Unit AMBULATORY SERVICES Magnetic Resonance Imaging Neurodiagnostics Acquired Brain Injury Unit Microbiology Neuroimmunology Day Treatment Centre Nuclear Medicine Neurology Hospital in the Home Radiology Neurosurgery Ophthalmology Medi-Hotel GASTROENTEROLOGY, SURGICAL Neurological Rehabilitation Services Orthoptics AND TRANSPLANTATION Stroke Care Unit North Eastern Post Acute Care Breast Surgery Northern Centre Against Sexual Assault Vascular Laboratory Colorectal Surgery Vascular Surgery Orthotics and Prosthetics Endoscopy Outpatients Gastroenterology PHARMACY Rehabilitation General Surgery SPECIALIST SURGICAL AND SPINAL Rehabilitation in the Home Gynaecological Surgery Audiology Staff Medical Services Liver Transplantation Dental Services Paediatric Surgery ANAESTHETIC, PERIOPERATIVE AND Ear Nose Throat/Head and Neck Surgery Renal Transplantation INTENSIVE CARE Oral and Maxillofacial Surgery Upper Gastrointestinal Surgery Anaesthesia Orthopaedic Surgery Urology Day Care Unit Plastic and Reconstructive Surgery Day Surgery Spinal Surgery Intensive Care Unit Operating Room Services Pain Services Perioperative Services

Austin Health : 2008-09 ANNUAL REPORT 47 Austin Health’s Infectious Diseases Department conducts research into infection control, public health, microbiology and clinical medicine as well as providing expertise in the care of patients with infectious diseases. The Department has close links with Austin Health’s Departments of Microbiology and Infection Control, and the three groups work collaboratively to provide the best in patient treatment. The Department leads Australian research into the epidemiology of the Bairnsdale Ulcer and currently holds an NHMRC grant to study the epidemiology and virology of the H1N1 (swine ﬂu) virus in its Australian epicentre, Melbourne.

Desire to help drives doctor-detective > Professor Lindsay Grayson

As part-physician and part-investigator, Without investigation and treatment, Prof Lindsay Grayson specialises in such patients are likely to die. Identifying diagnosing and treating infections caused the patient’s illness and ﬁnding innovative by bacteria, viruses and parasites. These solutions to multiple problems makes bugs can attack any organ and often the work challenging. Yet the results are make patients acutely unwell, showing usually dramatic. Following treatment, symptoms with which their treating the patient returns home as healthy and general practitioners may not be familiar. well as they were before their infection.

“At the Austin Hospital, our department Research is vital to the success treats few chronic infectious diseases. of treating infectious diseases. At Often our patients are acutely unwell and Austin Health, research is focussed are admitted in an emergency,” said on controlling antibiotic resistance Prof Grayson. “Our role is to diagnose and ﬁnding solutions to resistance complex, often antibiotic-resistant mechanisms in the laboratory. Prof bugs and urgently implement steps to Grayson said that his team’s challenge eradicate them.” lies in translating current knowledge about antibiotic-resistant superbugs into practical interventions that help clinical practice.

It is through educating health care workers about his team’s research ﬁndings that Prof Grayson has found his greatest career rewards. At Austin Health, his team measured hand hygiene practices by conducting multiple observational sessions of staff in clinical practice.

48 Austin Health : 2008-09 ANNUAL REPORT Desire to help drives doctor-detective > Professor Lindsay Grayson

“Hand hygiene is the single most “It is exciting that the Infectious Diseases Pictured above: Prof Lindsay Grayson with important strategy in reducing hospital- rotation attracts competition by young Wei Gao, infection control research scientist in Austin Health’s microbiology lab. acquired infections,” said Prof Grayson. doctors,” he said. “Our residents are some of the busiest in the hospital, and He led the development of the DeBug™ we have great expectations of them. Program at Austin Health, a hand Prof Lindsay Grayson is director They are enthused about enquiring into hygiene compliance initiative using an of the Infectious Diseases and diseases and finding solutions to them.” alcohol-based hand rub. Its success led Microbiology at Austin Health; to the introduction of the program into all It is the challenge of developing better Professor of Medicine, The University hospitals state-wide. The national roll- ways of approaching infection control of Melbourne and Honorary Professor out is now underway. and finding innovative solutions that in the Department of Epidemiology keeps Prof Grayson excited about and Preventive Medicine, Monash Prof Grayson is building on the gains coming to work. University. made through the program. Currently, his team is finetuning the optimal ways “Encouragingly, the Austin has a very He is author of over 95 articles and in which to educate the different craft open culture,” he said. is a Member on the editorial board groups within health care on facets of of Clinical Infectious Diseases and “We address issues and declare them dealing with superbugs, and the infection also Antimicrobial Agents and openly. That allows us the freedom to control procedures that are necessary to Chemotherapy, Washington DC USA. deal with them openly. At Austin Health control them. we identify systematic problems and His knowledge, and that of his team, find systematic solutions. That quality is is highly sought after by his students what makes us the key leading research – medical undergraduates, interns hospital in Australia.” and HMOs.

Hear Prof Grayson speaking to Prof Jeffrey Zajac about infectious diseases at www.austin.org.au/podcasts

Austin Health : 2008-09 ANNUAL REPORT 49 Mandatory Reporting

By Government Gazette Notice dated ATTESTATION ON DATA ACCURACY Procedures are available on the Austin 1 July 2000 the Governor in Council, I, Brendan Murphy certify that Austin Health website (www.austin.org.au) on the recommendation of the Minister Health has put in place appropriate or can be obtained from the Protected for Health, established Austin and internal controls and processes to ensure Disclosure Officer, on 03 9496 5370 or by Repatriation Medical Centre as a body that the Department of Human Services writing to Austin Health, PO Box 5555, corporate, being a metropolitan health is provided with data that reflects actual Heidelberg, Vic, 3084. service, pursuant to the provisions performance. Austin Health has critically of the Health Services Act 1988. The reviewed these controls and processes VICTORIAN INDUSTRY organisation changed its name to Austin during the year. PARTICIPATION POLICY ACT 2003 Health in 2003. Pursuant to amendments Austin Health let no contracts of in 2004 to the Health Services Act, $3 million or over in 2008-09 and Austin Health was designated a public therefore no VIPP disclosure is required. health service and appears as such in Schedule 5 of that Act. Dr Brendan Murphy BUILDING ACT 1993 Chief Executive Officer During the financial year it has been ATTESTATION ON COMPLIANCE WITH Heidelberg Austin Health’s practice to obtain AUSTRALIAN/NEW ZEALAND RISK 25 August 2009 building permits for new projects MANAGEMENT STANDARD and certificates of occupancy or I, Brendan Murphy certify that Austin EX-GRATIA PAYMENTS certificates of final inspection for Health has risk management processes Austin Health made no ex-gratia all completed projects. in place consistent with the Australian payments for the year ending Registered building practitioners / New Zealand Risk Management 30 June 2009. Standard (4360:2004) and an internal have been engaged for all new control system is in place that enables FREEDOM OF INFORMATION building projects. APPLICATIONS 2008-09 the executive to understand, manage In order to ensure Austin Health’s and satisfactorily control risk exposures. Requests Received 782 buildings are maintained in a safe and The Board Audit Committee verifies this serviceable condition, routine inspections assurance and that the Austin Health Fully Granted 619 and ongoing maintenance programs Risk Register has been critically reviewed Partially 23 were undertaken. Where required, within the last 12 months. Austin Health implemented Denied 0 Austin Health is committed to the recommendations arising from those ongoing evaluation and development of Other inspections through a program of rectification and maintenance works. our new Risk Management Framework. - Withdrawn 27 - No documents 32 NATIONAL COMPETITION POLICY In progress 81 Austin Health continues to comply with the National Competition Policy. In Dr Brendan Murphy All applications were processed in addition, the Victorian Government’s Chief Executive Officer accordance with the provisions of the competitive neutrality pricing principals Heidelberg Freedom of Information Act 1982, for all relevant business activities have 25 August 2009 which provides a legally enforceable been applied by Austin Health. right of access to information held by CONSULTANCIES ENGAGED government agencies. Austin Health DURING 2008-09 reports on these requests to the Victorian 1. In excess of $100,000 per consultancy Department of Justice annually. There were no consultancies in 2008-09 greater than $100,000 WHISTLEBLOWERS’ PROTECTION ACT 2001 2. Less than $100,000 per consultancy There were 19 consultancies engaged Austin Health has procedures in place at a total cost of $392,229 to facilitate the making of disclosures, to investigates disclosures and to protect persons making disclosures. During 2008-09, one disclosure of improper conduct or detrimental action by Austin Health or its employees was made.

50 Austin Health : 2008-09 ANNUAL REPORT Mandatory Reporting

AVAILABILITY OF ADDITIONAL WORK FORCE DATA INFORMATION In 2008-09, workforce data reporting In compliance with the requirements of requirements changed from reporting the Standing Directions of the Minister YTD numbers to reporting staffing for Finance, details in respect of the numbers in the month of June 2009. If items listed below have been retained the same reporting method was applied by Austin Health and are available to in 2007-08, the current month head the relevant Ministers, Members of count number would have been 6,198. Parliament and the public on request (subject to the freedom of information June current June current June month head requirements, if applicable): Labour Category (2008-09) month FTE YTD FTE count a. A statement of pecuniary interest has Nursing Services 1,987.52 1,928.36 2,637 been completed. b. Details of shares held by senior Administration and Clerical 758.60 732.37 932 officers as nominee or held Medical Support 631.94 619.08 738 beneficially. c. Details of publications produced by the Hotel and Allied Services 635.50 647.61 747 department about the activities of the Medical Officers 146.99 136.23 155 entity and where they can be obtained. d. Details of changes in prices, fees, Hospital Medical Officers 364.45 333.15 369 charges, rates and levies charged by the entity. Sessional Medical Officers 101.33 85.93 312 e. Details of any major external reviews Ancillary Support Services 410.89 395.61 512 carried out on the entity. f. Details of major research and Total 5,037.21 4,878.35 6,402 development activities undertaken by the entity that are not otherwise covered either in the Report of Operations or in a document that contains the financial report and Report of Operations. g. Details of overseas visits undertaken including a summary of the objectives and outcomes of each visit. h. Details of major promotional, public relations and marketing activities undertaken by the entity to develop community awareness of the entity and its services. i. Details of assessments and measures undertaken to improve the occupational health and safety of employees. j. General statement on industrial relations within the entity and details of time lost through industrial accidents and disputes, which is not otherwise detailed in the Report of Operations. k. A list of major committees sponsored by the entity, the purposes of each committee and the extent to which the purposes have been achieved.

Austin Health : 2008-09 ANNUAL REPORT 51 Mandatory Reporting

AUSTIN HEALTH ACTIVITY DATA 2008-09 Admitted Patients 2006-07 2007-08 2008-09

Discharges

Acute (including rehabilitation) 83,185 83,726 86,840

Mental Health 940 920 889

Aged and palliative care 1,003 1,024 1,167

Total Separations 85,128 85,670 88,896

Total WIES (Weighted Inlier Equivalent Separations) 59,022 61,430 64,754

Total bed days (accrued) 301,964 307,945 306,692

Available Beds (at June 30)

Acute (including rehabilitation) 678 684 718

Mental Health 138 137 131

Aged and palliative care 58 59 77

Other 60 60 60

Total Available Beds 934 940 986

Intensive Care Beds 17 17 17

Non-Admitted Patients

Victorian Ambulance Classiﬁcation System (VACS) – No. of Weighted Attendances 102,364 97,387 98,678

Allied Health Occasions of Service 79,974 80,389 79,228

Elective Surgery Performance

Elective surgery – removals from waiting list 7,243 7,623 10,321

Category 1 patients waiting less than 30 days 100% 100% 100%

Category 2 patients waiting less than 90 days 50% 38% 62%

Category 3 patients waiting less than 365 days 82% 83% 88%

Emergency Department Performance

Emergency Department presentations 53,501 56,887 61,546

Category 1 patients receiving immediate attention 100% 100% 100%

Emergency patients admitted to an in-patient bed within 8 hours 63% 67% 70%

Percentage of operating time on hospital bypass 2% 2% 2%

Non-admitted emergency patients with a length of stay of less than 4 hours 67% 71% 72%

No. of patients with an emergency department length of stay greater than 24 hours 5 0 0

52 Austin Health : 2008-09 ANNUAL REPORT Statement of Priorities

A ‘statement of priorities’ is the key accountability agreement between Austin Health and the Minister for Health. The following documents Austin Health’s delivery of, or substantial progress towards, the key shared objectives of ﬁnancial viability, improved access and quality of service provision and is consistent with sections 65ZFA and 65ZFB of the Health Services Act 1988.

Part A: Strategic and planning priorities STRATEGIC PRIORITIES FOR 2008 – 09

STRATEGIC PRIORITY DELIVERABLES DUE DATE ACHIEVEMENT

1. Strategic service plan In consultation with DHS complete the November 2008 Achieved Austin Health strategic service plan for the next 5-10 years

2. Planning for Mental Health Completion of the feasibility study and approved November 2008 Achieved rehabilitation facility business case within agreed timeframe for submission to ERC

3. Site master planning across Continue master planning across three sites June 2009 Site survey of all the three sites infrastructure services commenced

4. Review Austin Health’s Review and develop new strategic plan June 2009 Achieved strategic plan 2009-2011

5. Continue to provide better Meet DHS access and performance targets June 2009 See section B for access to emergency and performance data elective surgery Improve outpatient access and referral management Outpatient improvements made

6. Improve Austin Health Meet statement of priorities ﬁnancial targets June 2009 Achieved - see section cash position B for performance data Ensure sufﬁcient capital funds are available to meet Achieved proposed equipment and infrastructure works

7. Complete, with capital Independent documentation of defects and other October 2008 Issues identiﬁed and management branch, an issues documented, with plans for rectiﬁcation prior to planning for resolution independent audit of the full disengagement of MPV progressed Austin Hospital tower redevelopment

8. Implement the Metropolitan Central Production Unit kitchen operating to June 2009 Achieved Food Services Strategy planned capacity

9. Human Resources restructure Implement new HR delivery model in response to June 2009 Achieved external review and new leadership

10. Redesigning Hospital Participate in the Redesigning Hospital Care Program June 2009 All achieved Care program Complete the redesign capability building process Establish new team and projects including productive ward project implemented

11. Infrastructure and Utilities Continue to update and improve the reliability of key June 2009 Site survey of all infrastructure and utilities infrastructure services commenced

Austin Health : 2008-09 ANNUAL REPORT 53 Statement of Priorities

PLANNING PRIORITIES FOR 2008-09

DELIVERABLES ACHIEVEMENT DELIVERABLES ACHIEVEMENT

1. Completion of the Austin Health strategic Achieved 18. Participate in Department of Human Services Achieved service plan (DHS) Medical Equipment Replacement Program 2. Continue to develop master plans for the Site survey of all three Austin Health sites infrastructure 19. Develop with programs and capital Achieved services management branches a strategy to address commenced the issues arising from the conditions survey of Mellor Ward at Royal Talbot Rehabilitation 3. Significantly increase elective surgery Achieved Centre throughput in The Surgery Centre and refine the new elective surgery model of care 20. Update asset management plan for buildings Capital plan and equipment updated 4. Implement a revised health service redesign Achieved program 21. Continued expansion of the client base for Expansion Central Production Unit continuing 5. Completion of the feasibility study and Achieved business case for the Heidelberg Repatriation 22. Continued planning and redevelopment of Completed. Hospital medium-security forensic mental radiology department facilities including Under health centre development, mental health angiography suite, Emergency Department construction. service plan and model of care computerised tomography (CT) and ultrasound suite and Heidelberg Repatriation 6. Completion of final design documentation for Achieved Hospital radiology redevelopment the veterans mental health redevelopment for tender in early 2009 23. Strategies to support and sustain improving Achieved care for older people across the whole of 7. Complete planning and design documentation Achieved health service for stage one of the Olivia Newton-John Cancer and Wellness Centre 24. Continue to update and improve the reliability On track with of key utilities and infrastructure good progress 8. Continue to develop cancer services as part of On target the North Eastern Integrated Cancer Service 25. Continue to plan for infrastructure Stage one and according to the Cancer Action Plan improvements for Department of Medicine redevelopment 2008-2011 laboratories approved and proceeding 9. Implementation of the work plan and Achieved review program as an organisation-wide 26. Continue to implement the credentialing and In progress performance management program defining the scope of clinical practice policy for medical practitioners 10. Workforce planning including workforce On target redesign, succession planning, employee assistance program and return to work MAJOR CAPITAL DEVELOPMENTS support DELIVERABLES ACHIEVEMENT 11. Addressing the key issues raised in the 2008 Achieved and employee opinion survey ongoing 1. Construction of Health and Rehabilitation Constuction Centre development including hydrotherapy delayed. 12. Continuing to plan for an electronic medical Achieved pool and rehabilitation gym due for Due for records by commencing the implementation completion in early 2009 completion in planning study for HealthSMART clinicals in first half of 2010 early 2009 and developing the final business case for document scanning 2. Continuation of Bio-Resources Facility On target construction due for completion in August 13. Build on the integrated risk management On target 2009 system incorporating business continuity management and code brown disaster 3. Finalise plans and commence construction Achieved planning of Florey Neurosciences Institute, including decant 14. Continue to identify and make service Achieved improvements to enhance flow through all 4. Documentation and tender for stage one of Achieved areas of the hospital including outpatients Olivia Newton-John Cancer and Wellness Centre

15. Implement new cardiac model of care Achieved 5. Commence Austin Child Care Centre Achieved redevelopment 16. Complete clinical review of liver services Achieved 6. Complete refurbishment of CAMHS Achieved 17. Implement recommendation of renal clinical Implementation adolescent unit and reinstate full clinical service review commenced operations and service functions

54 Austin Health : 2008-09 ANNUAL REPORT Statement of Priorities

Part B: Performance priorities FINANCIAL PERFORMANCE Operating Result 2008-09 Actual ($M) 2008-09 Target ($M) Annual operating result 4.5 0

Cash management/liquidity 2008-09 Actual 2008-09 Target Creditors (days) 45 < 60

Debtors (days) 45 < 60

Net movement in cash balance ($M) 1 - 14.9

SERVICE PERFORMANCE WIESS activity performance 2008-09 Actual 2008-09 Target WIES performance to target (%) 98 98 to 102

Elective surgery 2008-09 Actual 2008-09 Target Elective surgery admissions 10,321 9,510

Critical care 2008-09 Actual 2008-09 Target ICU minimum operating capacity – Austin Hospital 17 16

Quality and safety 2008-09 Actual 2008-09 Benchmark Accreditation status (%) Full Full

Cleaning standards (%) 94 85

Submission of data to VICNISS (%) 100 since April 2009 100

VICNISS Infection Surveillance Indicators No Outlier No Outlier

Participation in the Hand Hygiene Program Yes Yes

Mental Health 2008-09 Actual 2008-09 Target 28 day readmission rate (%) 13 14

Access performance 2008-09 Actual 2008-09 Benchmark Operating time on hospital bypass (%) 2 3

Emergency patients admitted to an in-patient bed within 8 hours (%) 70 80

Non-admitted emergency patients with length of stay of less than 4 hours (%) 72 80

No. of patients with length of stay in the emergency department greater than 24 hours 0 0

Triage Category 1 emergency patients seen immediately (%) 100 100

Triage Category 2 emergency patients seen within 10 minutes (%) 94 80

Triage Category 3 emergency patients seen within 30 minutes (%) 79 75

Elective surgery 2008-09 Actual 2008-09 Benchmark Category 1 elective patients admitted within 30 days (%) 100 100

Category 2 elective patients waiting less than 90 days (as at 30 June 2009) (%) 44 100

Category 3 elective patients waiting less than 365 days (as at 30 June 2009) (%) 83 100

No. of patients on the elective surgery waiting list 2,786 3,160

Number of Hospital Initiated Postponements (HiPs) per 100 scheduled admissions 8.6 8

Austin Health : 2008-09 ANNUAL REPORT 55 Statement of Priorities

Part C: Activity and Funding ACTIVITY AND FUNDING TYPE 2008-09 2008-09 2008-09 2008-09 Weighted Inlier Equivalent Activity Activity Activity Activity Separations (WIES) Achievement Target Non-acute Ambulatory Achievement Target WIES Public 49,070 49,907 SACS – Non DVA 15,280 14,850

WIES Private 10,348 9,111 Post Acute Care 1,542 1,600

WIES Renal 1,769 1,804 Transition Care (Non DVA) – Bedday 6,042 6,873

Total WIES (Public, Private and Renal) 61,187 60,822 Transition Care (Non DVA) – Homeday 6,271 9,125

WIES DVA 2,542 2,697 SACS – DVA 294 698

WIES TAC 1,025 924 Post Acute Care – DVA 1,086 1,100

WIES TOTAL 64,754 64,443 Aged Care

Acute Non in-patient Aged Care Assessment Service 1,836 1,764 VACS – Allied Health 52,704 51,472 Other Aged Care – –

VACS – Variable 96,333 97,714 Residential Aged Care 21,848 21,696

VACS - Other – –

Radiotherapy – WAUs Public 46,912 46,858

VACS Allied Health – DVA 25,017 23,334

VACS Variable – DVA 2,345 3,211

Radiotherapy – WAUs DVA 1,926 1,392

Non-acute In-patient CRAFT 728 737

Rehab Spinal 6,456 3,449

Rehab L1 (non DVA) 4,811 6,855

Rehab L2 (non DVA) 423 482

GEM (non DVA) 15,315 11,872

Palliative Care – In-patient 4,855 5,500

Rehab 1 – DVA 48 84

Rehab 2 – DVA 1,070 844

Rehab Other – –

GEM – DVA 2,165 2,199

Palliative Care – DVA 790 988

56 Austin Health : 2008-09 ANNUAL REPORT Disclosure Index

The annual report of Austin Health is prepared in accordance with all relevant Victorian legislation. This index has been prepared to facilitate identiﬁcation of the Department’s compliance with statutory disclosure requirements.

MINISTERIAL DIRECTIONS

Report of Operations Charter and purpose FRD 22B Manner of establishment and the relevant Ministers 7, 50 FRD 22B Objectives, functions, powers and duties i FRD 22B Nature and range of services provided 47

Management and structure FRD 22B Organisational structure 10-11

Financial and other information FRD 10 Disclosure index 57 FRD 11 Disclosure of ex-gratia payments 50 FRD 21A Responsible person and executive officer disclosures 7, FS 50-51 FRD 22B Application and operation of Freedom of Information Act 1982 50 FRD 22B Application and operation of Whistleblowers Protection Act 2001 50 FRD 22B Compliance with building and maintenance provisions of Building Act 1993 50 FRD 22B Details of consultancies over $100,000 50 FRD 22B Details of consultancies under $100,000 50 FRD 22B Major changes or factors affecting performance 6-7 FRD 22B Occupational health and safety 36-37 FRD 22B Operational and budgetary objectives and performance against objectives 46, 52, 53-56 FRD 22B Significant changes in financial position during the year 46 FRD 22B Statement of availability of other information 51 FRD 22B Statement of merit and equity n/a FRD 22B Statement on National Competition Policy 50 FRD 22B Subsequent events FS 50 FRD 22B Summary of the financial results for the year 46 FRD 22B Workforce Data Disclosures 51 FRD 25 Victorian Industry Participation Policy disclosures 50 SD 4.2(j) Report of Operations, Responsible Body Declaration 7-9 SD 4.5.5 Attestation on Compliance with Australian/New Zealand Risk Management Standard 50

Financial Statements Financial statements required under Part 7 of the FMA SD 4.2(a) Compliance with Australian accounting standards and other authoritative pronouncements FS 6 SD 4.2(b) Operating Statement FS 1 SD 4.2(b) Balance Sheet FS 2 SD 4.2(b) Statement of Changes in Equity FS 3 SD 4.2(b) Cash Flow Statement FS 4 SD 4.2(c) Accountable ofﬁcer’s declaration FS (i) SD 4.2(c) Compliance with Ministerial Directions FS 6 SD 4.2(d) Rounding of amounts FS 6

Legislation Freedom of Information Act 1982 50 Whistleblowers Protection Act 2001 50 Victorian Industry Participation Policy Act 2003 50 Building Act 1993 50 Financial Management Act 1994 FS 6

57 AUSTIN HOSPITAL 145 Studley Road PO Box 5555 Heidelberg Victoria Australia 3084

T 03 9496 5000 F 03 9496 4779 www.austin.org.au

HEIDELBERG REPATRIATION HOSPITAL 300 Waterdale Road PO Box 5444 Heidelberg West Victoria Australia 3081

T 03 9496 5000 F 03 9496 2541

ROYAL TALBOT REHABILITATION CENTRE 1 Yarra Boulevard Kew Victoria Australia 3101

T 03 9490 7500 F 03 9490 7501