Melbourne Health Quality of Care Report 2011

1BTTJPO
GPS $BSJOH

"DIJFWJOH UIF
&YUSBPSEJOBSZ

Quality & safety information for our community The Melbourne Health Quality of Care Report is our report to the community, describing the way we measure and monitor the quality of care we provide and what we are doing to improve our services. Contents

2 Welcome 4 Melbourne Health at a glance 6 Improving our services 14 Keeping our patients safe 22 Keeping it professional 28 Keeping our patients at the heart of our healthcare 36 Care in the community

1 Welcome

This Quality of Care Report is our In 2011, we welcomed 71 new opportunity to share highlights from a medical interns to The Royal selection of projects that are underway Melbourne Hospital, 115 nurses as across Melbourne Health to improve part of the Melbourne Health graduate patient services. These highlights nurse program, 23 graduate and include reducing waiting times in our 19 post graduate psychiatric nurses Outpatient clinics, developing ways with NorthWestern Mental Health and to keep patients mobile and adopting 13 Allied Health graduates. We see innovations in surgical techniques. these new recruits striving to become Our staff make incredible efforts leaders in their respective fields. every day to improve outcomes for Through embracing the organisation’s our community. vision – passion for caring and I believe our health care service is achieving the extraordinary – new and among the best in the world. We have existing staff provide care that meets achieved this standard by keeping our the medical, emotional and cultural patients at the heart of our healthcare needs of our community and bring and by involving consumers, carers strength, independence and dignity and the community as active partners to our patients and their families. in our decision making. Once you have read this report, please Our multidisciplinary approach to do not hesitate to let us know how we patient care and culture of person can improve our service and meet the centred care are supported by our needs of our patients. By listening to values of Respect, Caring, Integrity, you, we further make this dynamic Unity and Discovery. As a values health service one that belongs to our driven organisation we have become community. Your suggestions can also an employer of choice, reflected in help us improve this report so that it the number of new staff who joined meets your needs. Melbourne Health throughout We hope you enjoy reading our the year. Quality of Care Report.

Robert Doyle Chairman Melbourne Health

2 This report describes the way we measure and monitor the quality of care we provide and what we are doing to improve our services.

3 Melbourne Health at a glance

We manage beds across acute, sub- acute, outpatient and community settings. We also treat and care for many people from regional and rural Victoria and interstate through a number of specialist services.

The Royal Melbourne Hospital - NorthWestern Mental Health provides North West Dialysis Service is one City Campus, on Grattan Street in a comprehensive, integrated range of of the largest providers of renal Parkville, is an acute tertiary hospital, services to people living with mental replacement therapies in Australia, offering a full range of general and illness in north-western Melbourne. providing care for more than a third of specialist medical and surgical A multidisciplinary workforce Victorian dialysis patients. The central services, as well as being a State Adult provides services from 27 sites, hub is located at The Royal Melbourne Trauma Service. It has 12 operating through four adult Area Mental Hospital - City Campus with links theatres, around 400 overnight beds Health Services (Inner West, Mid to six metropolitan satellite centres and 170 day procedure beds including West, North West and Northern), an (operating 80 dialysis beds and chairs) dialysis, as well as additional beds in aged persons’ mental health program and 23 regional satellite centres the community through our Hospital and a youth mental health service, in the north-western corridor of in the Home service. Orygen Youth Health. Services include Victoria. North West Dialysis Service crisis assessment and treatment, also provides training and technical The Royal Melbourne Hospital - Royal rehabilitation, community-based support for home-based dialysis Park Campus is on Poplar Road, treatment, ongoing case management, and pre-dialysis, and pre-transplant Parkville, near Melbourne Zoo. acute inpatient, residential and support and education. This campus provides specialist sub- specialist services. It also provides acute services, including aged care Our patients are diverse in terms of consultation and education to around and rehabilitation inpatient services, culture, language, age, ethnicity and one million people and a wide range assessment services, a community socio-economic status. For example, of health and welfare organisations. rehabilitation centre, outpatient day at The Royal Melbourne Hospital in Currently, NorthWestern Mental activity programs and clinics, and 2010/11, nearly half of our inpatients Health is funded to operate a total community outreach programs. The (41 per cent) were 65 years old or over. of 517 acute and residential beds. campus also manages about 160 beds More men were inpatients (53,300) across four residential facilities. compared to women (41,942), and half were born outside Australia.

4 There were 32,886 occasions of Melbourne Health catchments and services interpreting service, with 59 per cent provided by our in-house team of interpreters. We have interpreters in Italian, Greek, Arabic, Turkish, Vietnamese, Cantonese and Mandarin, which are the languages Whittlesea most often requested by our patients. Interpreting services are also arranged Hume for other languages and dialects Nillumbik as needed. An Auslan interpreting service is available for people who Melton Moreland Darebin have serious hearing impairments, Moonee Valley Brimbank and during the year, it was used 91 times. H Banyule

Maribrynong RMH Inpatients: Admissions % from Total Melbourne Country of Birth 2010/11 Admissions Wyndham Hobsons Bay Australia 47,649 50% Italy 9,716 10% Greece 5,651 6% England 2,492 3% Lebanon 2,377 3% Legend Turkey 2,076 2% Former Yugoslav 1,754 2% NWDS Republic of NWMH (Adult Area Mental Health Service) Macedonia NWMH (Aged Persons’ Mental Health Service) Vietnam 1,440 2% NWMH (Youth Mental Health Service) New Zealand 1,293 1% NWMH - All programs NWMH Catchment Philippines 1,204 1% H Royal Melbourne Hospital India 1,196 1% RMH Primary Catchment Malta 1,145 1% RMH Secondary Catchment Croatia 982 1%

Iraq 960 1% Data Source: Catchment Populations Egypt 944 1% - Provided by Melbourne Health (04/08/2009) - Population data originally from Service and Workforce Other 14,363 15% Planning, DHS (02/10/2008) Local Government Areas - ABS (2006) Total 95,242 100% Map prepared by: Service and Workforce Planning, Portfolio Services and Strategic Projects Division Department of Human Services.

SEPTEMBER 2009 GDA_1994_VICGRID94

5 Improving our services

During 2010/11 Melbourne Health completed 20 major improvement projects. These projects looked at how we can improve access to our services, make things safer for our patients, visitors and staff, reduce waiting times, and make our services more welcoming and inclusive. International and national collaborations, clinical research trials and embracing innovative ideas from our staff, all mean the quality of healthcare we deliver is equal with the best in the world. Here are a few highlights from our improvement projects last year.

Improving access to emergency general surgery In February 2011, our Department of Specialist General Surgery successfully trialed a change in the model of care for the management of emergency general surgery patients. An on-call consultant provides in- appointment or didn’t respond to house cover between 8am and 6pm, Reducing waiting lists in our repeated attempts to contact them. seven days a week. Outpatients clinics The Outpatients Department This reduction of waiting lists will This consultant is also on call for three received funding from the Department translate into shorter waiting times nights a week, with the remaining four of Health to conduct an audit of for our patients, and we will continue nights covered by another consultant. waiting lists to identify patients who auditing regularly. We are also moving This has provided a more responsive no longer needed an appointment. to a patient-focused booking system, service and greater continuity of care Patients are often referred to a number where patients are notified that an for patients needing urgent surgery of health services for the same appointment is available and are and patients have been able to get condition and may be on a number asked to ring the hospital to confirm home quicker. of hospitals’ waiting lists. If these a suitable time. This means we can Since the introduction of the on-call patients are seen at another hospital, better meet our patients’ needs and consultant, the average length of stay and we are not notified, this prevents ensure that appointment times are for patients in hospital following an us from offering the appointment being used in the most efficient emergency admission dropped from time to someone else. and effective way. 5.8 days to 3.8 days (a reduction of From December 2010 to February 2 days); our 8-hour performance, 2011, we audited the Plastic, moving patients from the Emergency Urology, Neurology, Neurosurgery, Department to a ward within eight Orthopaedics, Dermatology, hours, has improved by nearly Colorectal, Head and Neck, 10 per cent; and we performed just Immunology and Cardiology over half of all emergency general outpatient waiting lists. We were surgery operations during regular able to remove 2904 names because hours (weekdays 7.30am to 5.30pm). they either no longer required an

6 We are constantly looking for ways to improve our services, and in the past year we completed 20 major improvement projects.

7 Reducing waiting times Average number of ultrasound procedures in the Emergency Department performed per business day

The Royal Melbourne Hospital’s 2009/2010 2010/2011 Emergency Department is a busy place. In March 2011, more than 70.0 5000 visits were made to the 65.0 department by sick and injured

Victorians. It was the busiest month 60.0 ever recorded and staff predict they will receive more than 60,000 55.0 presentations in 2011. To keep up with the growing 50.0 demand for its services, our 45.0 Emergency Department has been Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun working to make sure patients are seen and either admitted to a hospital Sounding out ways to save time Nurses leading early detection bed or discharged as quickly as Ultrasound scans are performed in a Bladder tumours are the second most possible, while continuing to provide wide range of diagnostic applications common urological cancer and can be high standards of care. Several to visualise internal organs, muscles easily treated if they are caught while initiatives have been introduced: and tendons without the use of still superficial, that is, before they > ‘Ambulance transfer cubicles’ are ionising radiation. invade the bladder muscle. However opened during our busiest times, there is a 70 per cent lifetime risk that With growing demand for ultrasound making it quicker for ambulance these tumours will recur, so patients scans each year, we have been able to officers to drop off patients, need to be followed up with regular reduce our waiting lists by increasing reducing the time it takes by bladder scans (cystoscopies) to detect the number of scans performed each 15 minutes. This improves care early, and easily treat, any recurrences day. A booking confirmation process to both the individual and the of their cancer. Due to the high means nearly all our patients attend community by getting ambulances volume of cystoscopies required, their scheduled appointment, with back out on the road in the it has been a challenge to keep up fewer than 5 per cent missing their shortest possible time. with demand. confirmed appointment time. > The department’s model of care In response, we established the Other improvement initiatives have has been revised and a new team nurse-led non-muscle invasive bladder contributed to a 9.6 per cent increase structure was introduced during cancer service. Specially trained in the average number of ultrasounds the last 12 months. nurses perform the surveillance performed per day in 2010/11 when cystoscopies, and coordinate patients > To aid communication with the compared to the previous year. with superficial bladder cancer. wards, the Emergency Department We wanted to make sure patients has adjusted its electronic medical received their cystoscopy on time, so records to show when patients are recurrences were detected early when ready for transfer and incorporated easily treatable and therefore avoid the ‘Admission Orders’ into these radical surgery. notes. This has improved the completion of records and means all electronic notes are compiled in one location.

8 A pilot service completed in February We introduced a new report that is 2010 showed that all cystoscopy now given to patients following their patients were seen on schedule and procedure. It provides details on the the waiting list was 100 per cent on procedure and the findings, and is “It’s good to have target. Feedback from patients and useful for patients to take back to information about staff was also positive. This service their general practitioner. has improved continuity of care, our procedure.” We also found that only 79 per cent of follow up and quality of service. our inpatients were having a complete Colonoscopy patient. bowel preparation, meaning they Changing to meet our often needed a repeat colonoscopy patients’ needs procedure. A nurse-initiated bowel We redesigned our Colonoscopy preparation on our inpatient wards Service after we spoke to patients meant patients could start their bowel When we surveyed our patients and discovered that while they were preparation earlier, increasing the following these improvements, they pleased with the service, there was likelihood of a successful procedure. said they were: “very happy with the more we could be doing to improve Now 85 per cent of our inpatients service”; “wouldn’t change a thing”; their experience. Our patients wanted have a successful bowel preparation. “lovely staff” and “perfectly satisfied”. better communication, particularly We are also now triaging all new Responses to a secondary follow-up that “it would be very useful if referrals so that relevant medical survey in June this year included patients received a copy information is known at the patients’ comments that: “it’s good to have a of the procedure report”. first outpatient appointment, making copy of the report”, “it’s a great service”. it easier to plan appropriate treatment or care as soon as possible.

9 Patients at the heart of our > Improved multidisciplinary Cardiology Service communication and discharge planning by using a discharge Last year we looked at ways we planning stamp and whiteboard “I was wonderfully could improve the timeliness of so that the team, patients and care and discharge for patients who satisfi ed with the family were clear about planned have had a heart attack and needed care that I received. investigations and likely a stent procedure, where a device is discharge date I stayed in hospital put into the blocked blood vessel to for the right amount keep it open. We aimed to reduce > Follow-up phone calls with the time it took for patients to the patient to discuss medication of time and I had have their procedure and ensure management and check that enough information that investigations such as GP, outpatient and cardiac to manage once echocardiograms did not rehabilitation referrals had delay discharge. been arranged. I got home.” We also wanted to make sure our These strategies have reduced the Mrs C – a cardiac patient. patients received the necessary amount of time patients need to multidisciplinary care while in spend in hospital, from an average hospital and that they received the stay of six to just over four days. right level of education, information The Cardiology Service has also kept A key member of the project team and follow-up services so patients felt readmission rates down, and received was a former patient, Paul Baden, able to manage on their own once positive patient and staff feedback. who commented that one of the they left hospital. significant outcomes for this project was gathering information that could Timeliness of care was seen as Improving our cancer day be of value for the new Victorian important and the Cardiology treatment centre Comprehensive Cancer Centre. Service wanted to improve access for Demand for chemotherapy services The Centre is being built in Parkville emergency and elective cardiology is rising, so it is essential for day opposite The Royal Melbourne patients, including country patients treatment centres to be as efficient as Hospital - City Campus and will requiring inter-hospital transfer. possible while providing exceptional incorporate some of our cancer The following improvements have quality of care for patients. During services, as well as re-house the been made to address these aims: 2010/11, we collaborated with the Peter MacCallum Cancer Centre and Peter MacCallum Cancer Centre to other partners. Mr Baden hopes this > A waiting list that prioritised reduce patient waiting times, improve project will influence the planning patients according to their communication with our patients, and of the new day treatment units at condition and medical procedure to make our waiting and clinical areas the Victorian Comprehensive Cancer > Guidelines which outlined more patient and visitor friendly. Centre, making them the best in a patient’s essential care We anticipate a new booking system, the State. requirements during their consumer information packs, and hospital stay and in preparation changes to some ward processes will for discharge decrease the time patients have to wait before their appointment. Fresh paint and new treatment chairs have improved patient comfort, and the remodelling of the nurses’ station has made the space a more pleasant place to work.

10 “It has been wonderful to be a part of the 5 West Day Centre Improvement Project group and to see the commitment for change in a positive way from everyone, especially after spending many days in there as a patient.” Paul Baden.

11 Intensive care in mental health – a success story There are six Intensive Care Areas throughout NorthWestern Mental Health. These specialist areas look after the most unwell and high-risk Victorians who need our care. Consumers and carers who use the service, and staff who work in this area, all wanted the same thing: an increased level of responsiveness to consumers treated within Intensive Care Areas, standardised practice guidelines, and improved access. Staff now conduct daily medical reviews of all consumers admitted to an Intensive Care Area, with a second opinion sought for those with a length of stay beyond 10 days. Working with the consumer and their carer, Mrs Zammit and Dr Miller. staff now prepare a collaborative care plan for every consumer. Finally, benchmarked and standardised practice guidelines now provide Virtually pain-free surgery “Until now, patients requiring the consistent and high quality delivery In a Victorian first, specialist removal of one or both adrenal glands of service. endocrine surgeon Dr Julie Miller would be required to submit to a removed a tumour of the adrenal larger procedure, with access to the The project to improve the access to adrenal glands from the front of the and level of service in the Intensive gland using a virtually painless, minimally invasive procedure, called body through the abdominal cavity,” Care Areas has been extremely explained Dr Miller. successful. We have increased Posterior Retroperitoneoscopic consumer satisfaction, improved Adrenalectomy, or PRA. The older technique is a bigger adherence to practice guidelines, The PRA procedure was so successful operation, causes more discomfort reduced the wait for an Intensive that the patient, Doris Zammit from and involves a longer recovery. With Care Area bed, and reduced the Broadmeadows, spent only one night the new approach from the back, amount of time consumers need to in hospital and was well enough to more than half of patients require no stay in our Mental Health Intensive go home the next morning. She prescription pain medication once Care Areas. needed no pain medication other they leave the recovery room. than a single paracetemol tablet to “With PRA, the route to an adrenal relieve minor discomfort. tumour is more direct, and because The operation took only 80 minutes there are no organs in the way, the risk and Mrs Zammit’s adrenal tumour, of injuring other organs is eliminated, just above her left kidney, was reached making it a safer operation as well. by a direct route through three tiny Cosmetically, there’s only minor incisions on her back, just below scarring,” she said. her ribcage.

12 Life saving collaboration

Professor Mitchell with David Baker and his family.

David Baker, a school teacher from He urgently needed specialist Thanks to the quick response of the Croydon, made a miraculous recovery treatment from the neurointervention Box Hill Hospital stroke team and after suffering a life threatening team at The Royal Melbourne the expertise of The Royal Melbourne stroke, leaving hospital without Hospital. His wife was warned Hospital neurointervention team, any permanent disability just four he would probably be in hospital Mr Baker made a complete recovery days later. for a long time and would need from what could have otherwise rehabilitation before he could been a fatal stroke. His life was saved thanks to the rapid go home. response and coordinated efforts from doctors at Box Hill and The Royal Mr Baker was then rushed by Melbourne hospitals, which saw ambulance across Melbourne to Mr Baker access one of the best stroke The Royal Melbourne Hospital services in Victoria. where Professor Peter Mitchell and Associate Professor Bernard Yan The stroke team at Box Hill Hospital immediately took him to the hospital’s realised that although Mr Baker had neurovascular angiography suite. arrived within the time window for ‘clot busting’ medication, his stroke Using a special retrieval device, they was so severe that the clot in his removed a 3cm long blood clot from brain could not be cleared by the the cerebral artery behind Mr Baker’s standard treatment alone. right eye. They also discovered a narrowing in the carotid artery in his neck, and put in a stent to keep it open.

13 Keeping our patients safe

The intravenous line-associated blood stream infections in ICU are currently above average compared with other Victorian hospitals. Some of the strategies to reduce our infection rates are: > Using Chlorhexidine/Silver coated intravenous lines for all patients > Changing skin preparation practices to meet the Centre for Disease Control and Prevention guidelines > Raising awareness among staff about new practices. Later this year our ICU will be participating in a project with the Australian and New Zealand Intensive Care Society to review how to further reduce bloodstream infections. The Royal Melbourne Hospital participates in the national hand hygiene strategy, and we conduct Preventing infections In order to further reduce our infection hand hygiene audits three times a Monitoring the rates of infections rates, we have recently formed a year. Over the past three years staff in our patients and finding ways to multi-disciplinary orthopaedic team compliance has risen to above reduce those rates is an important to assess the management of patients 70 per cent, which is higher than the part of keeping our patients safe and review how we can improve care. Department of Health’s benchmark of during their hospital stay. The Royal We have been monitoring bloodstream 65 per cent. Since we introduced a new Melbourne Hospital is part of a infections caused by staphylococcus alcohol hand gel, usage has increased statewide program to monitor patients aureus (golden staph) since January by 300 per cent. This result is reflected for infections following surgery, 2010 as part of a national program. in the Victorian patient satisfaction including hip and knee replacement, Our rate has been higher than survey where 57 per cent of consumers and coronary artery bypass surgery. comparable hospitals. By giving indicated that they observed hospital staff cleaning their hands between Last year we performed 377 coronary feedback to treating clinicians, patients all of the time. artery bypass surgery operations, identifying opportunities for with four ‘deep infections’ recorded; improvement and establishing a four were recorded from 186 hip working group to tackle this issue, replacement operations which is we have seen an encouraging drop slightly above the Victorian average. in the number of these infections to Only one ‘deep infection’ was below the national benchmark. recorded from 124 knee replacement We also look at all bloodstream operations, which is below the infections caused by golden staph state average. and all infections in Intensive Care Unit (ICU) patients who have an intravenous line in place.

14 Melbourne Health Overall Hand RMH compared with VICNISS Hygiene Compliance Rate Total Surgical Site Infections following Coronary Artery Bypass Graft Surgery by quarter Compliance Rate DOH Target 80% Risk Index Category 1* RMH SSI Cumulative Rate VICNISS Aggregate Rate 70%

60% 5 4.5 50% 4 3.5 40% 3 30% 2.5 2 20% 1.5 1 10% Rate per 100 procedures .5 0 0 Nov 09 Mar 10 Aug 10 Nov 10 Mar 11 Jun 11 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 08/09 08/09 08/09 08/09 09/10 09/10 09/10 09/10 10/11 10/11 10/11

RMH compared with VICNISS RMH compared with VICNISS Total Surgical Site Infections following Intensive Care Unit Central Line Associated Hip Arthroplasty by quarter Bloodstream Infection rate per 1000 line days

Risk Index Category 1* RMH SSI Cumulative Rate VICNISS Aggregate Rate Target Rate RMH VICNISS

6 5 4.5 5 4 4 3.5 3 3 2.5 2 2 1.5

Rate per 100 procedures 1 1 Rate per 1000 line days 0.5 0 0 2008/09 2009/10 2010/11 Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar Apr-Jun Jul-Sep Oct-Dec Jan-Mar 2008 2009 2009 2009 2009 2010 2010 2010 2010 2011

RMH compared with VICNISS RMH compared with VICNISS Total Surgical Site Infections ‘Deep’ Infection Rate following Coronary following Knee Arthroplasty Artery Bypass Graft Surgery Risk Index Category 1* Risk Index Category 1* RMH VICNISS RMH SSI Cumulative Rate VICNISS Aggregate Rate

2.5 1.4 1.2 2 1.0 1.5 0.8 0.6 1 0.4

0.5 Rate per 100 procedures Rate per 100 procedures 0.2 0 0 2008/09 2009/10 2010/11 2008/09 2009/10 2010/11

* Note: Risk index means that the patients in this group either have a number of pre-existing medical conditions, or the operation lasted longer than average for that particular type of surgery. A risk index category of ‘1’ allows us to compare patients with the same ‘risk index’ or predisposition to surgical site infection with other patients from other hospitals. SSI - Surgical site infection. VICNISS - Victorian Hospital Acquired Infection Surveillance System. DOH - Department of Health. 15 Keeping the hospital We achieved a significant reduction Information about the medication clean and green in the hospital’s energy use when we patients use when they are at home changed the temperature setting on is an important part of any admission A clean hospital is not just a more the major chilling plant that supplies to hospital. The Royal Melbourne pleasant place to recover from illness chilled water to both The Royal Hospital’s Assessment and Planning or injury. Cleanliness plays a vital Melbourne Hospital and the Royal Unit has extended its pharmacist role in reducing the risk of a patient Women’s Hospital. By changing the hours so more patients’ medication developing an infection during their water temperature from 6 degrees history can be collected before they hospital stay. Our external cleaning to 9 degrees Celsius we reduced the are admitted to hospital. This means audit for 2011 showed we successfully amount of energy needed to keep the medication prescribed for them met Department of Health cleaning water cold by 221,643 kilowatt hours during their hospital stay is accurate, standards in all risk categories. Our a year. reducing the risk of errors. monthly internal cleaning audits for July 2010 to June 2011 also satisfied A Waste Management Exhibition was Outpatients Pharmacy has developed Department of Health cleaning held in December 2010, attended by a new ordering service to reduce the standards and benchmarks. more than 1000 staff. The exhibition wait in getting prescriptions filled and promoted awareness on correct waste In January 2011, the Department of to make sure the right medications are disposal and recycling. Health changed the Victorian cleaning going to the right patient. Patients can standards, and we have already We have also participated in Earth keep the prescription at the Pharmacy incorporated them into our daily work Hour for three years, as a fun way to and either call or email to order practice. The standards, which we raise staff and community awareness medications. All orders are processed helped develop, are based on levels about being energy-wise. within three working days. of risk – the greater the risk For patients who cannot come into of a patient acquiring an infection Medication safety the hospital to collect their from the environment, the higher Our Medication Safety Committee medication, we also offer a postage the risk category, and the stricter improves awareness of medication service for many medications. To help the level of compliance. risks and encourages staff to report our regional and rural patients living All hospitals have very large carbon whenever there is an error involving more than 30km from the hospital, footprints, and we have developed a medications, including ‘near-misses’. we can sometimes offer up to three Waste Management and Sustainability This enables us to develop new months’ supply of medication. Our Plan and a ‘Think Green’ Strategy initiatives to make prescribing and staff can also identify which medicines 2011-2015 to help us reduce our dispensing medications safer for all are available on the Pharmaceutical footprint and minimise waste. of our patients. The committee also Benefits Scheme and can be dispensed takes on recommendations from by their local chemist. Last year we installed local energy the Department of Health to make meters in several departments medications safer. Currently, the throughout the hospital to make staff Pharmacy Department is working on aware of the electricity they were making oral chemotherapy safer for using, and to encourage them to turn our outpatients. off lights, computer monitors and other power-hungry appliances when not in use. Melbourne Health medication events 2007/2008 2008/2009 2009/2010 2010/2011 Total events 2238 2507 2257 1525 % of total admissions 2.1 2.7 2.5 1.6

16 Pressure ulcer and wound prevalence monitoring In September 2010, we conducted our wound point prevalence survey as part of a statewide audit. All 900 Melbourne Health inpatients were examined over a two-day period to categorise all wounds, assess the severity of pressure ulcers using the Australian Wound Management Association guidelines, and assess the severity of all skin tears using the STAR (Skin Tear Audit Research) instrument. Each patient’s clinical notes were also reviewed to check wound documentation and the presence of a completed pressure ulcer risk assessment form. The survey revealed that 38 per cent of patients had one or more wounds. The most common wounds were acute wounds (18.9 per cent), pressure ulcers (10.8 per cent) and skin tears (6.6 per cent). Of the pressure ulcer Number of Pressure Ulcer Incidents group, 6.6 per cent were hospital (Hospital Acquired) per 1000 bed days 2010/11 acquired. Although any incidents of hospital acquired pressure 4 ulcers represent an opportunity for 3.5 improvement, this figure compares 3 favourably with other hospitals 2.5 around Australia – the lowest national 2 hospital acquired rate was 6 per cent 1.5 in Western Australia, in 2009. Rate per 1000 bed days 1 Other positive results were 0.5 92.2 per cent of patients had a 0 current pressure ulcer risk assessment Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun completed within six hours of Month admission, and 85 per cent of patients had current wound documentation. We have been able to benchmark our data nationally, identify the prevalence of wounds and find areas for improvement. Since the survey, staff are now more aware of how to identify the risks of a patient developing a pressure ulcer, and how to prevent that from happening.

17 During a WalkRound, staff on one ward raised the issue of having no Clinical Assistant at night to help with patient turns and transportation. The ward also had a shortage of patient trolleys, which were subsequently secured from a ward that was over-supplied.

Patient Safety Leadership on every WalkRound so the responses many teams throughout the WalkRounds can be classified into themes. organisation working to keep our After the WalkRound, the team patients safe. Here is their story. In September 2010, Patient Safety decides what the most significant Leadership WalkRounds were Rehabilitation Clinical Nurse issues are and agree with staff the introduced as a way to promote Specialist Bernard Smith is the team’s strategies to address them. safety and learn about any Quality Representative. He audits concerns our staff had. By the end of June 2011, we had patient documentation for accuracy conducted 35 WalkRounds. There in identifying each patient’s risk of The WalkRounds aim to increase were 105 improvement strategies having a fall. It can be difficult to mutual understanding and awareness identified which mainly related stop some patients from falling so of quality and safety issues among to equipment, staffing, the ward Bernard makes sure they have the senior leaders and their staff. It is environment and communication. right equipment in place to prevent a positive way of identifying We have evaluated the effectiveness patients being hurt if they do have a practice improvement initiatives of the WalkRounds and believe the fall. This includes low-low beds that that contribute to better outcomes benefits are so great that we plan to go right down to the ground and for our patients. continue them as part of our ‘every concave mattresses that allow patients The WalkRound team comprises an day’ practice at Melbourne Health. to move in bed without rolling out. executive, a quality and patient safety Quality and Patient Safety Consultant consultant, and the manager of the Falls management – Paula Dimakos collates the audits ward or unit. They ‘walk around’ a team’s perspective and information on patient falls to the ward speaking with staff, asking keep the ward staff informed. “There structured questions about what staff The Quality and Patient Safety team are some easy things anyone can do think potentially compromises patient in the Rehabilitation Service at to prevent a fall, like making sure safety. The same questions are asked The Royal Melbourne Hospital - Royal Park Campus is typical of patients have the right footwear

18 Above: A rehabilitation staff member helps a patient using the “I can’t believe it’s not lifting” technique (featured on pg 20). Above Right: Donald Park with a patient in the bone marrow transplant ward (featured on pg 20).

and use a walking aid at all times if Percentage of Falls by Location (1 July 10 - 30 June 11) they need one. It is also important that Acute Sub-Acute patients talk to their doctor to find out 70% if they are taking any medicines that could increase the risk of a fall.” 60% Statistician Mark Tacey turns the 50% data into a meaningful format for the 40% wards to understand and for staff like Clinical Nurse Educator Raelene 30% Smith to use at her falls-prevention 20% education sessions. “Everyone looks at the data that comes in on any falls 10% that have occurred and the patient 0 documentation audit results. We then Bathroom Bedroom Corridor Lounge/ Dining Campus Other Grounds discuss what we can do to prevent Location any other patients from having a fall. We consider everything from assisting patients to the toilet, reviewing their medication, to reducing clutter in their rooms. Every little bit helps.”

19 Consumer engagement: hoist, nursing and physiotherapy staff Patient Satisfaction Results 2010 sharing the journey developed a technique they called, RMH City Campus “I can’t believe it’s not lifting” RMH Royal Park Campus In July last year, Cancer and Infection (pictured on pg 19). All Victorian hospital campuses Medicine Services at The Royal

Melbourne Hospital established a By making a series of simple 90 Quality and Patient Safety Committee. assessments while the patient is An important voice in this committee still in bed, nursing staff can establish 80 is that of Donald Park who joined in the patient’s current level of function May to represent patients and give and suitability to perform the new 70 the committee their perspective transfer. This simple four-question 60 (pictured on pg 19). assessment allows the rehabilitation nurse to see if their patient has enough 50 Having survived several different energy and commitment to perform types of cancer, he has experienced 40

the transfer. If the patient passes the Score (%) Percentage the ups and downs, the wishes and assessment then the ‘step transfer’ 30 the problems of a patient travelling is performed where staff guide the their ‘cancer journey’, making his 20 patient into position with only one contribution to the service a truly hand on their hip and shoulder. 10 valuable and relevant one. If they do not pass, it indicates 0 Mr Park’s input is adding real and the patient is tired and needs to measurable improvement to the patient Physical Access & Follow up Follow

be hoisted. A decision on how to Consumer Admission Complaints Information Overall Care Discharge & Treatment & Treatment Participation

experience through his participation Environment Management

transfer the patient is made each time General patient in local ward rounds to meet managers

they need to be moved, rather than Related Information and clinicians. He has been asked by replicating what was done on previous nursing staff in our Oncology Unit shifts. Patients and their families A total of 190 patients from The Royal for his input and advice on patient are often not aware the assessment Melbourne Hospital - City Campus education literature prior to publication. is being made; they just see the end and 30 patients from The Royal As we begin to explore ways to improve result – a near independent transfer Melbourne Hospital - Royal Park the care we give to cancer patients from bed to chair and back again. Campus completed the last survey, with low immunity, who need to be and almost 10 per cent in a language kept in isolation, we look forward to The technique is so simple and other than English. Overall the survey Mr Park being on hand to help. effective, it has been incorporated shows patients were very satisfied with into the Melbourne Health training the care they received and found our I can’t believe it’s not lifting program, and every nurse will be staff to be helpful and courteous. trained to use this skill. The 40-bed Rehabilitation Unit at This year we formed a VPSM The Royal Melbourne Hospital - Royal The “I can’t believe it’s not lifting” Working Group to address the areas Park Campus works with patients technique has allowed our patients for improvement identified in the who have a variety of conditions to continue to be rehabilitated and survey including waiting area comfort, from strokes and multiple sclerosis to regain their independence. food quality and quantity, and motor vehicle accident injuries and restfulness of the hospital. amputations, to achieve their highest How we respond to possible level of independence. your feedback Waiting area comfort “It was a bit cold where I had to wait Simple tasks, like getting in and out The Victorian Patient Satisfaction for my procedure.” of bed or a chair is a great challenge Monitor (VPSM) is a survey conducted for many patients. Until recently, twice a year by the Department of An audit of patient waiting areas nursing and physiotherapy staff Health across all Victorian health reviewed the number of chairs in used a method known as the ‘pivot services. The survey is sent to a random each waiting area including how transfer’, but it had injury risks for selection of patients after they leave clean and comfortable they were, the our staff. In finding an alternative hospital and asks about their care temperature of the waiting area and without the indignity of a mechanical experience during their hospital stay. what magazines or other distractions 20 Informed consent for a blood component transfusion means the doctor and patient (or carer) discuss the risks, benefits and alternatives to transfusion. As a result of the discussion, the patient or carer will: > Understand what medical action is recommended and why > Be aware of the risks and benefits associated with the transfusion > Appreciate the risks of receiving, and possible consequences of not receiving, the recommended therapy > Be given an opportunity to ask questions > Give consent for transfusion. The patient information brochure ‘Blood Transfusion, have all your questions been answered?’ is available on all wards in English, and staff were available. As a result, painting, a standard patient rest period on all can download the Arabic, Greek, carpet cleaning, chair upgrades and wards between 1:30 and 2:30pm. Italian, Spanish, Turkish and improved temperature regulation will Ten minutes prior to the rest period Vietnamese versions. be done to make the waiting areas a an announcement is made requesting more pleasant place to be. that visitors leave the ward during Auditing compliance the patient rest period. Staff try to We participate in the Blood Matters Food quality and quantity avoid unnecessary activities, dim clinical audit program run by the “Food was bland and often not hot enough.” the lights and close the curtains to Department of Health and the Australian Red Cross Blood Service. In addition to the VPSM Working create a more restful environment We also carry out our own audits to Group, a team from Food Services and (see pg 31). ensure we comply with best practice Dietetics have begun working together and that we are meeting our targets to improve meal choices and quality Safe use of blood and for informed consent. Between August for patients. Our Nutrition Advisory blood components and December 2010 a small audit was Committee, which is developing Australia has invested heavily in completed following the introduction a Nutrition Policy outlining best ensuring that blood and blood of the informed consent form for practice nutrition care for patients, will products are of exceptional quality. blood component transfusions. The support this group. Last year Food Melbourne Health used the guidelines results were promising, indicating Services prepared and distributed published by the Australian and that staff were happy with using the around 2.5 million meals and passed New Zealand Society for Blood new consent form. A more recent all independent food safety audits. Transfusions to develop our blood audit suggested that compliance had Restfulness of the hospital component transfusion procedure. declined in the early part of 2011, In July 2010, we introduced informed “It was too noisy, I couldn’t get enough rest.” so we are refocusing our efforts in consent for elective blood component this area. This year we reviewed our hospital’s transfusions as part of our ongoing Visiting Hours Policy and introduced commitment to best practice.

21 Keeping it professional

Credentialing and We have also improved the Using a fibre optic endoscope, the Scope of Practice credentialing and scope of practice speech pathologist makes a detailed system for our doctors and plan to assessment of a patient’s ability to All doctors, nurses and allied health implement a new on-line database swallow and where the problem staff go through a credentialing process to make recording and tracking their areas are. With this information when they are first employed and as qualifications more efficient. they develop a tailored rehabilitation part of an annual staff review process. program, and teach patients specific Credentialing involves verifying the techniques to better cope with their qualifications, registration, experience More skills means better care condition. The Advanced Endoscopic and ongoing education of each Advanced or extended practice Evaluation of Swallowing is an clinical staff member. roles can improve services and important diagnostic tool that is care experiences for patients. In Scope of practice defines the having a direct impact on patient the Emergency Department, five procedures, actions, and processes quality of life. experienced nurses are enrolled in that a licensed health professional is the Masters of Advanced Nursing allowed to perform. At Melbourne Practice at The University of Clinical Governance Health, all our doctors, nurses and Melbourne. They are also involved in The term ‘clinical governance’ has allied health staff have a scope of a program to develop their leadership, become common-place in modern practice that is defined by their collaboration, and clinical decision- health care services and describes capabilities and qualifications, is making skills. These nurses will then the policies, plans, systems and specific to where they work and have a greater influence on improving accountabilities we have in place to the tasks they are competent the quality of care for Emergency ensure the care our patients receive is and confident to perform. Department patients. safely delivered and meets the highest This year we reviewed how we go standards of care. Our Board of Advanced practice physiotherapists about credentialing and defining the Directors and Executive Management operate six specialist orthopaedic scope of clinical practice for nursing Team, together with all our doctors, and neurosurgery outpatient clinics, and allied health professionals. nurses and allied health professionals, a service previously provided by We have revised the scope of practice share the responsibility of ensuring surgeons. These senior physiotherapists guidelines to include intravenous and our community receives the health assess patients, order investigations, medication administration for division services it needs as quickly and monitor pre- and post-surgical progress 2 registered nurses and created a effectively as possible. and refer patients for services. Detailed new committee which supports the in last year’s Quality of Care report, We have implemented the safe introduction of new roles for these advanced practice physiotherapy Victorian Clinical Governance nurses and allied health staff who services are an accessible, efficient Policy Framework, and reviewed our may have advanced or extended their and flexible way of managing safety and quality program against scope of practice. The committee specific orthopaedic and the elements of the policy. The has developed a framework to define neurosurgery conditions. checklist summarises many of the the characteristics of a nurse or allied activities we have in place to assure health practitioner necessary to Patients with dysphagia, where their our Board of Directors and the execute advanced practice ability to swallow has been affected Department of Health that we roles effectively. by damage to the brain, nerves or meet the policy requirements muscles that control swallowing, (see pg 23). are getting help from advanced practice speech pathologists.

22 The Clinical Governance Strategic Quality and Safety Program Checklist Comply Plan (Quality, Patient Safety and Consumer Liaison) 2010-2013 guides Consumer Participation our quality and safety programs Consumers participate in management committees, risk management activities ✔ and processes and annual and quality improvement programs operational plans. Consumer complaints and feedback processes are managed in a timely way ✔ The four priority areas of our Clinical Consumers participate in developing resources and education materials ✔ Governance Operational Plan match Consumer feedback from regular patient satisfaction surveys informs strategic ✔ and business planning the Victorian Clinical Governance Quality Framework. The consumer experience informs new models of care ✔ Open disclosure between clinicians and consumers is actively practiced ✔ We set 45 quality improvement when things don’t go to plan objectives this year and completed 37. Clinical Effectiveness The eight that were partly completed ✔ have been carried forward to next Quality and safety indicators are used to measure and monitor performance year’s Operational Plan. Strategies to improve quality and safety are implemented when significant issues are flagged ✔ Underlying causes are investigated when serious incidents are reported ✔ In November 2010 we evaluated our Board Clinical Governance and Clinicians are represented on Board and clinical governance and quality committees ✔ Improvement Committee. We have There is a clinical audit program across all specialities ✔ now added consumer representation Issues of quality performance and safety are reported to the Board and ✔ positions that strengthen the ‘patient clinical governance committees voice’, and improved our monthly Quality improvement initiatives are prioritised and managed, and have Executive oversight ✔ quality and safety key performance Research and innovation grants are sought and lessons learned are communicated and published ✔ indicators reports. In addition, 35 Melbourne Health complies with accreditation standards and proactively ✔ targeted quality improvement projects implements improvements were started across all our wards, and Services and clinical practices are benchmarked with similar ‘gold standard’ organisations ✔ we were one of five Victorian hospitals Effective Workforce to participate in a pilot ‘patient safety climate survey’ of our staff. Melbourne Health enacts a just culture, focused on learning and improving rather than blaming ✔ Processes to check credentials, registration and scope of practice for all clinical ✔ We believe it is important to listen disciplines are robust to the experiences and ideas of our Clinical education and competency development for staff is based on research ✔ consumer representatives, and in and best practice evidence March 2011 the Clinical Governance Clinicians receive regular and appropriate supervision ✔ and Improvement Committee held a All staff are orientated to quality and safety systems when entering new areas of work ✔ joint meeting with the Community Advisory Committee, which was Risk Management very productive. All staff are encouraged to report risks, incidents and near misses ✔ There is a mechanism for managing ‘whistle blowers’ ✔ Our clinical governance and quality committees closely monitor our quality There are processes and tools for assessing and investigating incidents ✔ and safety performance indicators. There are mechanisms for actions when clinicians practice outside their scope ✔ of practice or inappropriately These committees focus attention on how well we are performing, and take Periodic reviews of compliance with legislation occur ✔ action to fix areas that start to show Risk management is formalised through organisational and service risk registers that ✔ are regularly reviewed and updated signs of reduced performance. Patient Safety and Leadership WalkRounds are regularly scheduled involving executive, ✔ senior managers and clinicians, and quality and safety officers Quality, risk and safety policies and frameworks are reviewed and updated periodically ✔ Clinical policies, procedures and guidelines are based on best practice evidence ✔ and updated periodically

23 We aim to provide a safe, high quality service to meet the needs and expectations of our patients and consumers.

24 Your feedback matters Accreditation Another recommendation was a The Quality, Patient Safety and Accreditation is a process that all review of the guidelines for case Consumer Liaison Service works health services go through to show management of people experiencing closely with clinical and non-clinical they comply with standards developed first onset psychosis, to ensure it staff to give advice, identify risks by the Australian Council on reflected contemporary practice. and coordinate investigations into Healthcare Standards (ACHS). Their We have since updated the case adverse events. They also coordinate Evaluation and Quality Improvement management manual for early responses to complaints and patient Program (EQuIP) measures us against psychosis, and in February relevant feedback, lead practice improvement 47 criteria to determine how well we staff were trained on the changes in projects and schedule regular audits are performing. The program operates the manual. This updated information to check that certain clinical practices on a four-year cycle, consisting of two was also incorporated into orientation are undertaken effectively and in surveys and two self-assessments. for new clinical staff. a timely way. The structure of the Our most recent survey was the We aim to provide safe, high quality Quality, Patient Safety and Consumer Periodic Review in February care for our patients and consumers, Liaison Service was evaluated, and 2010 (with 15 mandatory criteria and the accreditation process helps us as a result new teams were formed addressed) where we achieved our to ensure that we not only meet but to better support the Clinical best results to date. We are preparing ultimately exceed these expectations. Governance Strategic Plan 2010-2013. for our Organisation Wide Survey Our residential care facilities in November 2011 when we will be (Parkville Hostel, Boyne Russell Health Round Table assessed against all 47 of the criteria. House, Gardenview House and We are a member of a not-for-profit Following the Periodic Review there Cyril Jewell House) and all five aged organisation called the Health Round were 23 recommendations, which persons’ mental health residential Table where we contribute and share we have been working to address, services (Westside Lodge, Merv data and information on various and anticipate that most of them Irvine, McLellan House, Weighbridge aspects of healthcare and patient will be closed once the surveyors and South Stone Lodge) are safety. A number of our staff have have reviewed our actions in the 100 per cent compliant against the been to meetings to compare our Organisation Wide Survey. 44 outcomes of the Commonwealth results with those of similar health Aged Care Standards and organisations across Australia One recommendation was to Accreditation Agency (ACSAA). and New Zealand. Some of the review and scope requirements for Further information about projects include: an electronic policy management system to provide a central, consistent accreditation and the ACHS and > The Deteriorating Patient database for all Melbourne Health ACSAA can be found at their > Access to Healthcare polices. Our new system, iPolicy, websites: www.achs.org.au and will be rolled out across the service www.accreditation.org.au > Long Stay Patient Program in October 2011. > Patient Safety Program.

25 Managing risk No-one sets out to create problems, but when things sometimes go wrong, we respond quickly to investigate incidents and complaints and put strategies in place to prevent such incidents happening again. We regularly monitor areas of risk and apply treatments to reduce their adverse impact. Managing and reducing risk is everyone’s responsibility, and we have dedicated resources and processes to manage potential and real risks associated with providing care in this complex environment. Staff use the ‘RiskMan’ database to report when things went wrong (an adverse event) or when things nearly went wrong (a near miss). They rate the incident according to the degree of harm caused, the level of care required as a result of the incident, and the treatment that the patient, visitor or staff member required. An incident severity rating of 1 is the most serious, and 4 is the least severe. The most serious incidents are reported to the Department of Health and form part of a state-wide report on incident trends in Victorian public hospitals. Last year, staff reported more than 11,000 incidents, including clinical, occupational health and safety and non-clinical issues. Most of these incidents were minor, as 95 per cent had an incident severity rating of 3 or 4. In order to continually improve how risk is managed at Melbourne Health, we undertook a benchmarking exercise with four metropolitan and rural public hospitals. The review resulted in a series of recommendations, which have been incorporated into key risk management documents and processes.

26 Getting to the bottom of a problem - root cause analysis

When something particularly severe Step 3 The Risk and Patient Safety Step 7 A Risk Reduction Action goes wrong, Root Cause Analysis Manager oversees the setting up Plan is developed to address the (RCA) helps us work out why and of an RCA team which includes RCA recommendations. what we can do to stop it from appropriately qualified and Step 8 Improvement initiatives are happening again. This review process representative staff, patients or implemented to help prevent or is a critical feature of our safety and consumers to capture all perspectives reduce the possibility of the event quality management system. on the problem. from occurring again. The root There are eight key steps to the Step 4 An RCA investigation is cause analysis report is also sent to RCA process: completed using the Department the Department of Health, so it can of Health’s RCA methodology, tools monitor any trends in critical events Step 1 Once an event has been and resources. across all public hospitals and allow identified, the Risk and Patient Safety hospitals to share what they have Manager carries out a brief review to Step 5 The RCA team provides a learned to benefit patients. identify its extent, seriousness and report detailing the event, the problem circumstances. identified, the causes and effects and recommendations for improvement to Step 2 Melbourne Health’s Executive minimise the possibility of a similar Director of Clinical Governance and event happening in the future. Medical Services commissions a Root Cause Analysis (RCA) investigation. Step 6 The RCA findings are presented to senior management of the area where the incident occurred.

27 Keeping our patients at the heart of our healthcare

Consumer feedback We aim to resolve all complaints During 2010/11, we received more within 30 days, and this year, than 1100 suggestions, complaints achieved this for about 90 per cent and compliments; an increase of about of all complaints. This is a significant 15 per cent on the previous year. achievement, and demonstrates our willingness to assist patients and We encourage our consumers to their families. It also means that more comment on the care and services consumers are receiving information we provide, and we see these and answers to the queries they comments as opportunities for review have brought to our attention. and improvement. Considerable effort goes into ensuring that consumers are We have revised the way our heard, that issues are addressed, and consumers can give us feedback, that steps are taken to embed new with input from our Community and better ways of doing things. Advisory Committee. New user- friendly brochures and postcards The main areas of concern raised by will make it easier for patients and consumers included communication consumers to ‘talk’ to us. with clinicians and access to services, which represent challenging issues This year we have also implemented for all large health services. the Victorian Health Incident Management System (VHIMS). We are using this feedback to inform Part of this system is designed to planned customer service training capture, manage and report on for our staff, and to assist with consumer feedback data. It means improvements, such as the 8-hour that information will be readily Access Improvement Project. This available for reporting against a project aims to have patients who defined Department of Health dataset. need to be admitted to hospital in a The dataset includes a categorisation bed within eight hours of their arrival of complaints and the degree and at the Emergency Department. nature of complaint resolution.

28 29 Consumer, carer and STANDARD 1 Melbourne Health’s commitment to consumer community participation The organisation demonstrates a commitment participation is reflected in: to consumer, carer and community participation - Melbourne Health Strategic Plan 2010-2015 Patients, carers and clients offer a appropriate to its diverse communities. - Melbourne Health Consumer, Carer and Community unique insight into their experiences, Participation Policy expectations and needs. We have - Melbourne Health Community Participation Plan 2010-13 found working with consumers, - Melbourne Health Clinical Governance Quality, carers and the community rewarding Patient Safety and Consumer Liaison Plan 2010-11 and effective. - NorthWestern Mental Health Strategic Service Directions Plan For the past decade, our Community STANDARD 2 North West Dialysis Service uses mechanisms to Advisory Committee has been Consumers, and, where appropriate, carers are empower patients to get involved in their own care instrumental in our planning, service involved in informed decision-making about their including training and support for home-based treatment, care and wellbeing at all stages and dialysis, brochures available in other languages, delivery and policy development. with appropriate support. patient newsletters to ensure accessible information about healthcare and treatment and information Consumer, carer and community packages for new patients. participation is formally incorporated STANDARD 3 Consumers are involved in the development of into our Strategic Plan and Consumers, and, where appropriate, carers are new, and the review of existing patient information. Business Plans. provided with evidence-based, accessible information Melbourne Health is reviewing its patient information to support key decision-making along the continuum system, which will incorporate the Checklist for of care. assessing written consumer health information. While the Community Advisory This includes a review of patient rights and Committee is advisory in its capacity, responsibilities information. members have a ‘hands on’ role STANDARD 4 Consumers, carers and community members when it comes to quality and safety Consumers, carers and community members are participate across all levels of the health care active participants in the planning, improvement, system. Here are some examples of their activities. This includes participation and evaluation of services and programs on an involvement during the reporting period: in Root Cause Analysis reviews. ongoing basis. - Strategic planning including the development of an educational strategy for staff, consumers One of the key roles of the committee and volunteers has been to develop and monitor a - Membership on key quality committees - Review of consumer feedback and complaints Community Participation Plan, which management system outlines our approach to consumer - The review of Melbourne Health rights and and community involvement across responsibilities brochures including ward audits the organisation. The Plan, which is and interviews with patients - Development of this Quality of Care Report reported annually to the Department of Health, focuses on increasing STANDARD 5 Consumers are provided with the opportunity for The organisation actively contributes to building training and professional development in the form of organisational capacity for consumers, the capacity of consumers, carers and community orientation, conference and workshop attendances members to participate fully and effectively. and training for specific projects. Health Issues carers and the community to become Centre facilitated a one-day training session at active partners in decision-making at Melbourne Health titled How to get what I need from health services. Community members felt the all levels of Melbourne Health. session provided them with the foundation to identify roles and rights as a consumer of a health service. Doing it with us not for us Health services must report to the Department of Health on achievements according to participation indicators set out in the Department ‘Doing it with us not for us’ policy. Our commitment to working with consumers, carers and community members is demonstrated as follows:

30 Community Advisory Committee member, Diana Frew.

Health promotion Extended visiting hours A patient can ask for one or two We have developed a Health support patient care visitors to have a key role in their care. These designated visitors may help Promotion policy, framework and After feedback and extensive during mealtimes, or be present when action plan and established an consultation with patients, visitors the doctor visits if the patient would advisory committee to coordinate and staff, The Royal Melbourne like them to. These visitors may also projects that improve the health Hospital’s visiting hours have been arrange to stay with a patient outside and wellbeing of patients, staff and extended. The new policy better normal visiting hours in consultation our community. The committee is supports family participation in care, with the Nurse in Charge. “We aimed reviewing our smoke free policy to which has been shown to improve to provide flexible yet practical visiting better support staff and patients recovery, decrease anxiety or stress, arrangements for the patient and to quit smoking. They will also increase family satisfaction, and everyone involved in their care – be focusing on strengthening improve communication between and I think the new visiting hours partnerships with our community patients, families and staff. partners to support patients as they policy strikes the right balance,” Visiting Hours Working Group’s leave the hospital. Ms Frew said. consumer representative Diana Frew A brochure explaining the new said that listening to the views of visiting hours has been translated into patients, families and staff was vital in the six main languages used by our determining the new visiting hours. patients and their visitors and families. “We recognised that families provide support and comfort to the patient when they often feel at their most vulnerable. Their views and feedback helped us shape a patient-centred policy,” Ms Frew said.

31 Respecting our community The presentations educated staff about The AHLO works directly with the Melbourne Health reports to the the burden of disease for Aboriginal families, assisting them to access Department of Health on the key communities, highlighted the and navigate the health service result areas 1 to 4 of the Improving importance of asking patients whether and ensure they are supported and Care for Aboriginal and Torres Strait they identified as Aboriginal or Torres linked into services on discharge. Islander Patients (ICAP) program. Strait Islander, introduced the concept The assistance can be as practical as of cultural safety and explained the organising accommodation and meals, Key Result Area 1: Establish and AHLO role. In partnership with as well as educating staff on patients’ maintain relationships with Aboriginal Western Health, we have supported cultural needs or understanding of communities and services. a cultural awareness training session their health issues. The AHLO has We have developed a key with international medical graduates worked to build relationships with relationship with the Wurundjeri on Aboriginal health. Evaluations of local Aboriginal Controlled Health Tribe Land Compensation and education programs have indicated Organisations and support workers Cultural Heritage Council, who have increased awareness of issues to improve access pathways and provided advice on improving access, and resources. discharge planning. These include: creating a welcoming environment As part of National Reconciliation > Aboriginal Home and Community and have assisted with collaborative Week, three sessions were held on Care access workers cultural events and celebrations culturally safe practice in Aboriginal > Victorian Aboriginal which included a traditional smoking and Torres Strait Islander health. Health Service ceremony and an Aboriginal More than 50 staff attended these art exhibition. informative and interactive workshops. > Aboriginal Community Elders Services. A plaque acknowledging the Key Result Areas 3 & 4: Set up and Traditional Owners of the land on maintain service planning and evaluation Number of Aboriginal and which The Royal Melbourne Hospital processes that ensure the cultural needs Torres Strait Islanders discharged stands is displayed in the Emergency of Aboriginal people are addressed when from Melbourne Health Department’s waiting room. Brass referrals and service needs are being plaques have also been commissioned considered, particularly in regard to 600 to be displayed at The Royal discharge planning. Melbourne Hospital - City Campus 500 main entrance and also at The Royal Establish referral arrangements to support all hospital staff to make effective primary Melbourne Hospital - Royal 400 Park Campus. care referrals and seek the involvement of Aboriginal workers and agencies. Key Result Area 2: Provide or 300 coordinate cross-cultural training for In 2007/08, a metropolitan ICAP hospital staff. Involvement of Aboriginal Project Officer was based at The Royal 200 people in planning, implementation Melbourne Hospital and undertook and evaluation. staff awareness training. In September 100 2009 we employed our first Aboriginal More than 110 nursing, allied Hospital Liaison Officer. Aboriginal 0 health and administration staff Hospital Liaison Officers can make a 2008/09 2009/10 2010/11 have attended presentations by the significant contribution to increasing Aboriginal Hospital Liaison Officer Aboriginal people’s willingness (AHLO) and the Cultural Diversity to come to hospital and identify Coordinator over the past year. themselves as Aboriginal.

32 A symbol of healing and hope

In March 2011, representatives of the Wurundjeri people performed the first traditional smoking ceremony at The Royal Melbourne Hospital - Royal Park Campus to conclude celebrations for the launch of the Melbourne Health Respecting our Community Action Plan. The ceremony symbolically helped heal the suffering of the past as the men, painted in ceremonial ochre, used eucalyptus smoke to cleanse the land and call the spirits to peace. It was a powerful reminder to everyone present that without open ears, open eyes, an open mind, and most importantly an open heart, we can sometimes do more harm than good. As the men took the smoking embers out across the campus, guests were invited to write messages of hope and healing, and tie them to a flowering gum. This non-traditional act was the idea of a Community Advisory Committee member, who wanted a way to express her hope for the future, and give others the opportunity to do the same. The smoking ceremony was an important way to strengthen the hospital’s relationship with the Wurundjeri Tribe Land Compensation and Cultural Heritage Council and connect with the broader Aboriginal community. Many staff commented afterwards that they had never seen a smoking ceremony before and felt privileged to have been a witness and learn more about Aboriginal culture and history.

33 Cultural Responsiveness The Plan is a way of bringing greater As part of the Plan’s launch, activities Framework focus to the work we have already were held to celebrate and raise done to create a safer and more awareness among staff and patients. Melbourne Health was required to supportive environment for all of our These included staff learning the submit a Cultural Responsiveness people, including patients, visitors, basics of Auslan at workshops, African Plan in November 2010 and report on staff and volunteers. drumming sessions for rehabilitation progress towards achieving three patients and performances by the of the six standards. It will also provide direction and Italian women’s choir, La Voce Della guidance for future initiatives. Standard 1: A whole of organisation Luna. For the third consecutive approach to cultural responsiveness The key objectives of the Respecting year, staff participated in A Taste is demonstrated. Our Community Action Plan are: of Harmony as part of Cultural Awareness Week, gathering together The Melbourne Health Respecting our 1. To better understand and care to share their national dishes, Community Action Plan 2011-2013 for our diverse clients was launched in March 2011 by the favourite recipes and culinary 2. To support and engage our Minister for Health, the Honourable specialities. The final event of the diverse workforce David Davis. The Plan provides Respecting our Community Action a coordinated organisation-wide 3. To create and maintain an accessible Plan launch was a traditional smoking approach to improving the care we and welcoming organisation ceremony on the grounds of The provide to people from culturally and Royal Melbourne Hospital - Royal 4. To strengthen our community linguistically diverse backgrounds, Park Campus – the first of its kind partnerships Aboriginal and Torres Strait Islander in the recorded history of the site people and people with a disability. 5. To consult broadly for better (see pg 33). decision making 6. To demonstrate leadership in diversity.

34 Asha and Muluka volunteer at The Royal Melbourne Hospital - City Campus on the volunteer desk, escorting patients to clinics and departments around the hospital.

People speaking 82 community Standard 5: Culturally and linguistically languages other than English attend diverse (CALD) consumer, carer and The Royal Melbourne Hospital – community members are involved in 78 per cent required an interpreter in the planning, improvement and review one of our top seven language groups: of programs and services on an Standard 3: Accredited interpreters are Italian, Greek, Arabic, Vietnamese, ongoing basis. provided to patients who require one. Turkish, Cantonese and Mandarin. We have a Respecting our Community In 2010/11, 15,260 people admitted As well as medical letters and reports Action Plan implementation group were identified as requiring an for individual patients, the ‘Please representing key areas of Melbourne interpreter; 19,343 outpatients were Tell Us What You Think, Health, which includes two members of identified as requiring an interpreter, Compliments, Suggestions and the Community Advisory Committee. and about 8 per cent of Emergency Complaints’ brochure was translated Department presentations (4582 to the seven most frequently requested Quarterly progress reports presentations) required an interpreter. languages. The visiting hours are provided to the Executive We provided 32,886 occasions of brochure was translated into the top Management Team and the interpreting service across The six languages, reaching nearly three Community Advisory Committee, Royal Melbourne Hospital, and quarters of our consumers who speak and both groups will approve the 59 per cent of them were provided a language other than English. annual implementation plan. by in-house staff.

35 Care in the community

Working with General Sharing the care for breast In association with the National Practitioners cancer survivors Breast and Ovarian Cancer Centre we developed our model of care, forms Our GP liaison unit works closely Breast cancer survival rates have and templates, and recruited GPs with general practitioners (GPs) to improved dramatically over the last and patients to the project. Between improve patient communication and 20 years, but the number of women September 2010 and March 2011 we care between the hospital and home. diagnosed with the disease has also recruited about 370 patients. GPs can access up-to-date information increased. There is a growing group 24 hours a day via our website. Our of women who are breast cancer We are now evaluating this project, GP liaison team is also available by survivors needing long term medical and plan to introduce this as our new phone or email to answer any queries care and support. model of care. We expect the results GPs may have about our services. will show that the shared care model Traditionally follow-up care was provides convenient high quality care Our GP liaison also promotes given in hospital or in the specialist’s for all our patients, and gives us the collaboration with other services. rooms, which was inconvenient for the ability to see a greater number of new For example, The Royal Melbourne patients and may not have provided patients in our Breast Service. Hospital hosted a GP education the best holistic care. It also meant a event called ‘Diabetes Dramas’. huge number of patients were coming The event was a collaboration between to the hospital, limiting the number our diabetes education department, of new patients who could be seen. the Diabetes Alliance Group, four Shared care between the hospital and General Practice Divisions and two a patient’s general practitioner was Primary Care Partnerships. a potential solution to this problem. GP placements for junior doctors are The National Breast and Ovarian now available at The Royal Melbourne Cancer Centre recognised the need Hospital. The Prevocational General to develop and implement a shared Practice Placements Program care model. The joint Breast Service (PGPPP) started in 2010, allowing at The Royal Melbourne Hospital and junior doctors to rotate to a general Royal Women’s Hospital was selected practice placement in the community in early 2010 to be one of the four for 10 to 12 weeks. This placement pilot sites for the National Breast and allows junior doctors to experience Ovarian Cancer Centre Shared Care the primary care setting first hand Pilot Project. and recognise the importance of developing and improving communication channels between the hospital and general practice.

36 37 Opposite page left: Ballarat link nurse Judy Parry with one of her home dialysis patients.

Right: Wodonga link nurse Jenny Galea with a home dialysis patient.

Integrated Hepatitis C Service There is also an element of support The service is also well supported In February 2011, the newly for the needs of rural and regional by an advisory group, made up of a created Melbourne Health Integrated patients and any shared care number of key stakeholders including Hepatitis C Service began a unique arrangements that are already in place community and Department of Health shared care model between the with rural agencies. representatives, who provide guidance on the direction of the service and the Victorian Infectious Diseases Service, The Integrated Hepatitis C Service is needs of the target client group. based at The Royal Melbourne coordinated by a hepatology clinical Hospital, and high case load nurse consultant, whose role is central primary care services. to the design, implementation and Home Dialysis The service, funded by the evaluation of the program and the The North West Dialysis Service Department of Health, provides delivery of coordinated hepatitis C Home Dialysis Service coordinates comprehensive support and treatment management and care. Using a support system to 160 patients for priority client and patient groups outreach and coordinated shared across metropolitan and regional living with hepatitis C who have care programs, the service delivers Victoria. The Home Dialysis Service been identified as previously being dedicated sessional clinic time team offers a unique model meeting poorly served by existing hospital within primary health services. the needs of people with chronic based services. This includes: people There is a strong focus on linking kidney disease across Victoria. who inject drugs; people from the primary health services with the All staff are skilled in all treatment culturally and linguistically diverse hospital system and ensuring access options and rotate through all care backgrounds; those who are homeless to physician-initiated treatment areas in the home support system, or at risk of homelessness; people who for hepatitis C in the community, including pre-dialysis education identify as Aboriginal or Torres Strait with ongoing nursing support and for patients. Islander and youth. management for the duration of the treatment process.

38 With an ageing, medically complex The entire Home Dialysis Service team and culturally diverse population, assisted with training a frail elderly the team adapts to individual patient rural patient and her carer. Training and carer’s learning needs. Following methods were adapted to circumvent a major review of home services to challenging problems, but patience determine how North West Dialysis and persistence was rewarded. This Service could improve the experience team effort has rescued this person of home dialysis for patients and from the distressing option for her carers, staff rewrote the training and her carer of moving to an aged program manuals and materials to care facility. Many other such patient simplify the learning process. They success stories are testament to the enlisted the assistance of a Renal team’s dedication and approach. Social Worker for an interview survey of home patients, which led to a range of improvements, including the implementation of an out-of-hours telephone support service. The service also now has two Regional Link Nurses. These home dialysis service nurses are based in Ballarat and Wodonga. The Department of Health has now adopted this successful Home Dialysis Service as a model for future Victorian renal care.

39 Mildura’s kidney transplant outreach clinic Kidney transplantation is well recognised as offering improved survival and quality of life for people with end-stage kidney disease. In 2010, The Royal Melbourne Hospital performed 138 kidney transplants, more than double our transplant rate of five years ago and representing more than 60 per cent of Victoria’s kidney transplants. However, our transplantation rate for patients in regional and rural areas was lower than for metropolitan patients. The key barriers to transplant for rural and regional patients included: > A lack of active promotion regarding new opportunities for transplantation in the regional The Mildura Kidney Transplant Outreach Clinic team. setting > The tyranny of distance, including time, financial and Identified needs included: social constraints P.A.R.T.Y. prevents > Transport youth trauma > Limited access to expert Over the last five years, The Royal education and counselling for > Interpreter service Melbourne Hospital has admitted some remote groups, especially > Aboriginal liaison officer more than 5000 patients aged those who are culturally and between 15-25 years. Of these, linguistically diverse. > Social worker 30 per cent sustained life-threatening One solution has been the Outreach > HARP nurse (The Hospital injuries with long-term consequences. Clinic at Mildura to take care of the Admission Risk Program - The most common causes of these people in surrounding communities. Partnerships in Health is a service injuries were road trauma, assaults, for people with chronic and fights, and falls. Drugs, alcohol, or a Belinda Bennett, a kidney transplant complex medical conditions who combination of both were involved in coordinator, volunteered to frequently present or are at risk of 35 per cent of the trauma cases where coordinate the pilot clinic and engage presenting to hospital and require the patient suffered serious and life- appropriate staff at both Melbourne intensive service coordination). threatening injuries. and Ramsay Health. She worked with the physicians and regional staff to In only one day, the outreach team To try and reduce the number of develop a patient list for the clinic and of six provided a comprehensive young Victorians seriously injuring ensured that all potential needs of the service to 16 transplant candidates, themselves, the Trauma Service joined patients attending were considered two potential live donors and the Prevent Alcohol and Risk-Related and planned for in advance to enable reviewed two people for vascular Trauma in Youth (P.A.R.T.Y.) program. the best possible outcomes. access. Many of these patients would Originally developed in Canada in not have been able to make the 6 hour the 1980s, this in-hospital trauma trip to Melbourne and so would not prevention program is aimed at have had access to transplantation. senior school students (15-18 years)

40 More than half the students who have gone through the program said that thanks to participating in the P.A.R.T.Y. program, they would think twice about their behaviour.

and young offenders (18-25 years). Taking care of families early intervention in, mental health It gives them first-hand experience ‘Parents are central to the lives of children problems among children and young of the possible traumatic and often and have great capacity to influence people, and increases the range of preventable consequences of risky their growth and development from the support and quality of care provided behaviour. They spend a day following very first moments of life. Parents with a to those with a mental illness. a patient’s journey from what happens mental illness may at times need extra ‘Our Time’ facilitated playgroup at the scene of an accident, to the support to manage the daily challenges of The ‘Our Time’ playgroup started in Emergency Department, the Intensive family life. Families that are vulnerable April 2010 in Preston after an audit in Care Unit, the trauma wards, and marginalised due to mental illness 2008 identified a growing and unmet rehabilitation and beyond. have fewer opportunities to participate need for parents with a mental illness in community activities and children and We have been involved in the who had preschool-aged children. parents in these families are more likely P.A.R.T.Y. program since February It is a joint initiative of the Northern to experience an increased range of risks this year, and so far more than 300 Area Mental Health Service (NAMHS), and poorer outcomes.’ (Families where a students from 12 schools across Anglicare and Kildonan Child and parent has a mental illness: Victorian Melbourne have taken part. This Family Services. glimpse into the world of the trauma Government Department of Human patient will ultimately help young Services, Melbourne, Victoria 2007.) The playgroup aims to enhance parent-child attachment, promote people to recognise risks and make Timely identification and appropriate child development and provide a safe safer choices. referral to support services can environment where parenting issues, significantly reduce the impact a More than half the students who including those related to the impact parent’s mental illness may have have gone through the program said of mental illness, can be explored. on their children. The Families of that thanks to participating in the At the moment, four families are Parents with a Mental Illness Strategy P.A.R.T.Y. program, they would think attending the weekly sessions which encourages family-focused practice. twice about their behaviour. run during the school term. It promotes the prevention of, and

41 Three facilitators run the playgroup: an adult mental health clinician (NAMHS), a ParentZone worker (Anglicare) and a parent consumer peer leader. The combination of these areas of expertise spanning mental health, children’s development needs and particularly the lived experience of the parent peer leader has been very successful in engaging parents and their children. We are now evaluating the effectiveness of this unique model. Keeping parents in touch with their children during an acute inpatient stay The development of a new recovery- focused model of care within the Northern Psychiatric Unit has given us the opportunity to focus on one aspect of family sensitive practice – the impact of hospitalisation on the parent-child relationship. A staff survey showed that while they were aware of the potential impact of separating children from parents when their parent needed to go to hospital, staff were less confident about the best practice approaches to supporting children and parents to minimise trauma and promote resilience. The Keeping In Touch With Your Children menu is a way to reduce the trauma of disruption to the parent-child relationship, and stigma associated with parental mental illness. It also maintains and promotes family resilience and well-being. It conveys critical messages about recovery and well-being and is a tool to encourage conversations between staff, consumers and their families about this area that is often affected by stigma and fear. The menu is Research shows that through We are now developing available for any inpatient unit across maintaining healthy attachment and practice guidelines, staff training, NorthWestern Mental Health, and parent-child relationships, promotion implementation and evaluation staff can download it and print it as an of connection and alleviating concerns to support this initiative. A4 size bedroom menu or poster for during periods of separation, the display in public areas. impact of mental illness on children and young carers can be minimised.

42 Please cut here cut Please Melbourne Health

✁ Quality of Care Report 2011

Tell us what you think Thank you for reading our Quality of Care Report. To help us improve this report, we would appreciate if you would take a moment to complete this feedback form. Please tick the answer that best represents your response.

What did you think of the information in this report? Poor Excellent 1 2 3 4 5

What did you think of the presentation of this report? Poor Excellent 1 2 3 4 5

Do you think the report was: Too short About right Too long

Do you think the report was: Easy to understand Difficult to understand

Please indicate the areas you would like more information to be included in future reports: Information about Melbourne Health services Yes No Information about what Melbourne Health does when someone has a complaint Yes No Information about what we do when something goes wrong Yes No Information about how we improve our services Yes No Information about how many people die and why Yes No Information about our plans for the future Yes No Information about how we keep you safe in hospital Yes No Information about new innovations Yes No Other:

General Comments:

Thank you for your feedback.

Please return this survey to: Quality, Patient Safety and Consumer Liaison Unit Level 8, The Royal Melbourne Hospital, Parkville 3050 If you have any compliments, complaints or suggestions about your experience at Melbourne Health, please contact our Consumer Liaison Unit on 9342 7806 or email: [email protected]

This report describes the way we The group also used guidelines This year, we will distribute the measure and monitor the quality from the Department of Health report across our services to of care we provide and what we to make sure all mandatory areas ensure as many people as possible are doing to improve our services. were reported on, as well as can read and comment on it. We It is a snapshot of our work in incorporating comments will be running advertisements 2010/11, including our quality from the Department about in the local papers, letting people and safety initiatives, new services, previous reports. know the report is available on community liaison and special our website, or to contact us Last year a letter was mailed to a projects as well as what’s planned if they would like a hard copy random selection of 2000 people for the future. posted out to them. We will also who were patients in the past year provide a form on the website for A working party of community informing them the report was giving feedback, or you can use representatives, medical, nursing available on our website, or to the feedback form provided in and allied health staff from across contact us if they would like this report. the organisation developed this a copy posted to them. year’s report. This working party We welcome your comments The report was also available used feedback from people who about this year’s report. By sharing to patients and families in received last year’s report, input your thoughts, you will help us our Outpatients clinics, at from our Community Advisory make sure this report and our Pre-admission, in the Emergency Committee and staff to shape its services best meet your needs. Department, hospital cafeteria, content and look. and other patient waiting areas. It was also accessible from our website: www.mh.org.au

Melbourne Health Quality of Care Report 2010/11 Production: Melbourne Health Public Affairs Design: Ckaos Photography: Mark Munro, Melbourne Health Medical Illustration Department 1BTTJPO
GPS $BSJOH

"DIJFWJOH UIF
&YUSBPSEJOBSZ

Postal Address: c/o The Royal Melbourne Hospital Victoria 3050 Phone: 61 3 9342 7000 www.mh.org.au [email protected]