Darling Downs Hospital and Health Service Hospital and Health Service Annual Report 2016-17

Open data The Darling Downs Hospital and Health Service is committed to the Government’s open data strategy. The following additional information has been published on the government’s open data website to form part of our 2016-17 annual report: • consultancy expenditure • overseas travel expenditure • results against the Queensland Language Services Policy

This information is published at: www.qld.gov.au/data

Version control First published September 2017 ISSN 2202-445X (Print) ISSN 2202-736X (Online)

Public availability statement Copies of this publication can be obtained at: http://www.health.qld.gov.au/darlingdowns/pdf/ddhhs-annualreport.pdf or by contacting: The Office of the Chief Executive Darling Downs Hospital and Health Service Jofre Level 1 Baillie Henderson Hospital PO Box 405 Qld 4350 [email protected] Phone (07) 4699 8412

Copyright © Darling Downs Hospital and Health Service 2017

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Attribution Content from this annual report should be attributed as: Darling Downs Hospital and Health Service Annual Report 2016-17

Interpreter service statement Darling Downs Hospital and Health Service is committed to providing accessible services to Queenslanders from all culturally and linguistically diverse backgrounds. If you have difficulty in understanding the annual report, you can contact us on (07) 4699 8412 and we will arrange an interpreter to effectively communicate the report to you.

B DDHHS Annual Report 2016-2017 Letter of compliance

The Honourable Cameron Dick MP Minister for Health Minister for Ambulance Services GPO Box 48 QLD 4000

Dear Minister

I am pleased to submit for presentation to the Parliament the Annual Report 2016–2017 and financial statements for the Darling Downs Hospital and Health Service. I certify that this Annual Report complies with: • the prescribed requirements of the Financial Accountability Act 2009 and the Financial and Performance Management Standard 2009, and • the detailed requirements set out in the Annual report requirements for agencies. A checklist outlining the annual reporting requirements can be found at page 84 of this annual report.

Yours sincerely

Mr Mike Horan AM Chair Darling Downs Hospital and Health Board 06/09/2017

DDHHS Annual Report 2016-2017 i Contents

Letter of compliance i Board Chair report 2 Chief Executive report 3 Overview 4 Our role 4 Our region 4 Our community 4 Our facilities 5 Our services 6 Education and research 6 Our vision, purpose and objectives 6 Our strategic direction 7 Our strategic risks and opportunities 8 Our priorities 9 Our governance 10 Our Board 10 Board meetings 15 Board committees 15 Board and committee meeting attendance 16 Board engagement with our community 17 Our Executives 20 Our organisation 25 Executive committees 27 Risk and compliance management 28 Internal audit 28 External scrutiny 28 Disclosures of confidential information in the public interest 29 Information systems and recordkeeping 29 Our performance 30 This year’s milestones 30 Performance highlights 2016-17 34 Our service standards 35 Our achievements this year against standards 36 Our performance indicators 43 Strategic objectives 43 Glossary of terms 78 Compliance checklist 84 Annual Financial Statements 86

ii DDHHS Annual Report 2016-2017 Acknowledgement of Traditional Owners The DDHHS respectfully acknowledges the Traditional Owners, both past and present, of the region we serve. The DDHHS has a commitment to reducing inequalities in health outcomes for Aboriginal and Torres Strait Islander people in line with Australian and State Government policies including the Closing the Gap initiative.

DDHHS Annual Report 2016-2017 1 Board Chair report

It is with great pleasure that I present the care room at Cherbourg, and announcement of the fifth annual report of the Darling Downs Kingaroy Hospital redevelopment. Hospital and Health Service (DDHHS). The Making Tracks initiative continued in 2016-17 with the implementation of a range of projects designed It has been an incredible year with staff to close the health gap for Indigenous Australians. working consistently to provide first-class The DDHHS held a National Close the Gap Day Expo care for patients and consumers amid the in March 2017 to provide an opportunity to share increased demand for our services. learnings and experiences to break down barriers and promote culturally safe health care. For the second year in a row, we have achieved an Telehealth consultations across the DDHHS saw almost-zero waitlist for specialist outpatients in all an increase in use of 36 percent. These services categories of clinical urgency. This has been a steady link patients with a specialist via videoconference focus for several years and our clinical and support resulting in fewer patients travelling to receive teams have continued to provide timely patient care. specialist care. This increase shows our commitment to health innovation and making it as easy as possible This success has seen the majority of patients for the whole community to access our services. receiving their outpatient appointments, elective surgery, endoscopy and dental treatments This year we farewelled former Board member within clinically appropriate timeframes whilst Corinne Butler and welcomed University of Southern maintaining a balanced financial budget. This has Queensland (USQ) Professor Julie Cotter, a respected been an ongoing achievement over the past few academic with a wealth of experience in business years and one that the Board is very proud of. and governance. Her USQ colleague Dr Ruth Terwijn, a registered nurse, was reappointed for another term I am also pleased to report that the BreastScreen on the Board. Queensland Toowoomba Service had a record-breaking year screening 19,037 women. A significant milestone The Board continues to focus on the importance of was also reached in January with the 350,000th screen genuine community engagement. I thank all the Board since the service started almost 25 years ago. The members for their governance and advocacy. Meetings mobile screening service is on the western run this are held regularly in both Toowoomba and rural year, bringing state-of-the-art mammogram technology facilities and include opportunities to hear directly to women in rural and remote areas. from community leaders and representatives from local organisations about their needs and issues. None of this could be accomplished without the hard work and dedication of all our staff who achieved I would like to congratulate Health Service Chief all targets while maintaining high safety and quality Executive, Dr Peter Gillies, and his executive team on standards and all within budget during a time of providing exceptional leadership and excellence in increased growth in demand. rural and regional healthcare. We look forward to the next financial year and working with you to deliver Improving infrastructure to support healthcare health and wellbeing for our community. delivery has also been a priority, with several key projects in progress and the completion of some important new assets. This included finalisation of the $50.6 million Backlog Maintenance and Remediation Program, a second CT scanner, MRI, and emergency department expansion at Toowoomba Hospital, Baillie Mr Mike Horan AM Henderson Hospital Laundry upgrade, new palliative Board Chair

2 DDHHS Annual Report 2016-2017 Chief Executive report

It has been another outstanding year for This saw 1,501 constructive messages from staff, the DDHHS as we continue to provide providing a real-time overview of the health service. Our plan is to repeat this survey on a biennial basis. excellence in rural and regional healthcare. As part of our commitment to improving our The achievements outlined in this Annual Report organisational culture we were very pleased to show the dedication, commitment and hard work of commence a partnership with the Cognitive Institute our 5,000 clinical and non-clinical staff across the to become a Safety and Reliability Improvement health service. One of the achievements that I am Programme (SRIP) partner. We are the eighth health particularly proud of this year is the efficiency of our service in the world, and the first regional service, emergency departments with patients treated and to be invited to become a SRIP partner and join a discharged, or admitted within 4 hours despite a 3 select group of international healthcare organisations percent increase in emergency presentations. who have committed to this 3 to 5 year safety and reliability culture improvement programme. As a health service, one of our key focuses is providing care as close to patients’ homes as possible and this The development of staff is a key priority and this year year saw the establishment of a renal dialysis unit at saw significant work in the area of clinical education the Dalby Hospital. We have been working on this for a with the development of new education packages number of years and it has required extensive support in Medical Services, Allied Health, Medical Imaging from the Toowoomba renal unit and comprehensive and Sterilisation Services. The DDHHS’s Queensland training for the Dalby Hospital nurses and doctors. We Rural Generalist Program (QRGP) was awarded the have also commenced tele-chemotherapy services at Premier’s Award for Excellence in the Leadership Dalby Hospital and plan to extend this service to other category in December 2016. This is an outstanding rural hospitals in the future. These initiatives reduce achievement for a program that celebrated ten years the need for patients to travel to Toowoomba for their of operation in 2017. This year we farewelled Dr Denis treatment and further reinforce our commitment to Lennox who retired from the position of Executive enhancing accessibility of services across our facilities. Director Rural and Remote Medical Support after 40 years of service. Dr Lennox was announced as the With an increase in demand for our services, this recipient of the AMA Excellence in Healthcare Award year saw a significant investment in the development in May 2017 for his four decades of commitment to of a strategy and planning function to examine rural health care, a fitting tribute to a stellar career. health service planning, clinical redesign and telehealth services. With funding assistance from I am looking forward to the future as we continue to the Department of Health, we are leading two major provide outstanding care across the DDHHS region. innovation projects in diabetes and mental health. These exciting projects focus on health literacy and will see the direction of our organisation enhanced by technology and innovation. We know our staff are our most important resource and this year saw the undertaking of a comprehensive employee culture survey. Overall, we performed Dr Peter Gillies slightly above average for public hospitals, with MBChB, MBA, FRACMA, GAICD opportunities identified for improvements. The Health Service Chief Executive survey also included an opportunity for all employees to communicate directly via a “message in a bottle”.

DDHHS Annual Report 2016-2017 3 Overview

The Darling Downs Hospital and Health Our region Service (DDHHS) is the major provider The DDHHS region is a large and diverse geographic of public hospital and health services in area covering approximately 90,000 square kilometres. the Toowoomba, Western Downs, South The area covers the local government areas of the Burnett, and Southern Toowoomba Regional Council, Western Downs Regional Downs regions. Council, Southern Downs Regional Council, South Burnett Regional Council, Goondiwindi Regional Council, Cherbourg Aboriginal Shire Council and the Our role community of in the Banana Shire Council. The DDHHS was established as an independent Our community statutory authority on 1 July 2012 under the Hospital and Health Boards Act 2011. The DDHHS is governed The region has a population of approximately by the Darling Downs Hospital and Health Board (the 280,000 people, which is expected to reach Board), which is accountable to the local community 300,000 in five years - an increase of 1.2 percent and the Queensland Minister for Health and Minister annually. Aboriginal and Torres Strait Islander for Ambulance Services. Australians make up 4.9 percent of the population compared to 4.0 percent across the State. The DDHHS is one of sixteen Hospital and Health Services that together with the system manager Healthcare challenges for the region’s population make up the entity known as Queensland Health. include health issues associated with ageing, The Hospital and Health Services are the principle obesity, diabetes and low socioeconomic status. providers of public hospital and health services for the Within the DDHHS region: community within a defined geographical area. The • 30.9 percent of the population are in the lowest system manager or Department of Health is responsible quintile for socioeconomic disadvantage for the overall management of the Queensland public • 32 percent of the population are obese health system including Statewide planning and • 17.5 percent of the population are aged 65 years performance monitoring of all Hospital and Health or older Services. A formal Service Agreement is in place between the Department of Health and the DDHHS The leading causes of burden of disease in the DDHHS that identifies the services the DDHHS will provide, are cancer, cardiovascular disease, mental health funding arrangements for those services, and targets disorders and neurological disorders. and performance indicators to ensure expected health The size of the region and the need for some patients deliverables and outcomes are achieved. to travel significant distances to receive specialist To support the services that we provide, the healthcare continues to contribute to the numbers of DDHHS also has service level agreements in place claims administered by the DDHHS through the Patient with a range of private health providers for highly Travel Subsidy Scheme (PTSS). specialised services and at times patients may require Despite these challenges, the DDHHS is well placed transportation to Brisbane for specialist services to provide the necessary public hospital and only provided at tertiary facilities. The DDHHS is also healthcare services to ensure all residents have a provider of specialist services to residents from access to timely, equitable and efficient healthcare surrounding areas, including the South West Hospital that meet their needs. and Health Service, northern New South Wales and the Lockyer Valley regions. DDHHS continues to be one of the largest employers in the region, employing more than 5,000 people in full time, part time and casual positions. In 2016-17 the DDHHS had a funded budget of more than $700 million.

4 DDHHS Annual Report 2016-2017 Our facilities Legend Hospital

Outpatient Clinic

Multipurpose Health Service

Aged Care Facility

1 Taroom 10 Image reference number

12 Proston Murgon 2 13 14 Wondai Cherbourg Nanango 15 3 16 Miles 5 Kingaroy 4 Chinchilla 6 Dalby Glenmorgan 7 Tara

8 Meandarra Oakey Baillie Henderson Hospital 9 Mt Lofty 10 Moonie Toowoomba 11 Millmerran 17 Warwick 18 19 Inglewood

20 Goondiwindi Stanthorpe 21

22 Texas

1 2 3 4 5 6 7 8

9 10 11 12 13 14 15 16

17 18 19 20 21 22

DDHHS Annual Report 2016-2017 5  Our vision – to deliver excellence in rural and regional healthcare.

• BreastScreen Queensland Our services • Aboriginal and Torres Strait Islander health programs The DDHHS is the major provider of public hospital • Child and maternal health services and healthcare services in the Darling Downs region. • Public health. A Service Agreement is negotiated annually with the Department of Health and is publicly available at: https://publications.qld.gov.au/dataset/darling- Education and research downs-hhs-service-agreements The DDHHS is committed to partnering with the The DDHHS provides these services from 31 tertiary education sector to deliver undergraduate facilities across the region, which includes one and post-graduate teaching programs in medicine, large regional referral hospital, one extended nursing and allied health, and has strong inpatient mental health service, three medium partnerships with the University of Queensland (UQ), sized regional hub hospitals, twelve rural hospitals, University of Southern Queensland (USQ), Griffith three multipurpose health services (MPHS), five University and several other academic institutions. community outpatient clinics and six residential aged care facilities (RACF) (see map). Our vision, purpose and From these facilities the DDHHS provides a comprehensive range of specialist inpatient and objectives outpatient services including: As outlined in the DDHHS Strategic Plan 2016 – 2020, • Medicine and a range of medical subspecialties the DDHHS’s vision, purpose and objectives describe • Surgery and a range of surgical subspecialties and support our direction and how we will achieve • Cancer services the Government’s objectives for the community which • Cardiac medicine include strengthening the public health system, • Emergency medicine creating jobs, building a diverse economy, delivering quality frontline services, protecting the environment • Obstetrics and gynaecology and building safe, caring and connected communities. • Paediatrics • Palliative care • Rehabilitation • Emergency and trauma Our vision • Mental health and addiction medicine • Medical imaging To deliver excellence in rural and • Allied health. regional healthcare. Health services delivered in the community include: • Oral health • Infectious diseases Our purpose • Sexual health • Community rehabilitation Delivering quality healthcare in • Residential aged care, aged care assessment partnership with our communities. and home care services

6 DDHHS Annual Report 2016-2017 | Overview Our strategic direction

The DDHHS is committed to delivering quality frontline services and outcomes that strengthen the public health system and align with Commonwealth and State Government healthcare priorities. The DDHHS Strategic Plan 2016-2020 has six key strategic objectives which focus our efforts on delivering quality healthcare for our community and five values that guide how we work and support us to achieve our goals.

Our Strategic Objectives Our Values

Caring Deliver quality evidence-based healthcare for our We deliver care, we care for each other and we care patients and clients about the service we provide.

Doing the right thing Engage, communicate and collaborate with our We respect the people we serve and we do our best. partners and communities to ensure we provide We treat each other respectfully and we respect the integrated, patient-centred care law and standards. Openness to learning and change Demonstrate a commitment to learning, research, We continually review practice and the services innovation and education in rural and regional we provide. We encourage continued learning and healthcare innovation, and we promote professional currency. Ensure sustainable resources through attentive Being safe, effective and efficient financial and asset administration We measure and own our performance and use this Plan and maintain clear and focused processes information to inform ways to improve our services to facilitate effective corporate and clinical and business practices. We manage public resources governance effectively, efficiently and economically. Being open and transparent Value, develop and engage our workforce to promote We keep our patients, staff, stakeholders and professional and personal wellbeing, and to ensure community informed. We understand the importance dedicated delivery of services of engagement and inclusiveness in the delivery of

Our vision: To deliverOur excellence vision:rural in To regional and healthcare quality healthcare.

Overview | DDHHS Annual Report 2016-2017 7 The DDHHS is currently developing and implementing Our strategic risks and a number of workforce strategies to promote and opportunities embed a values-based culture throughout the health service based on the survey results. Significant challenges for the DDHHS include increasing service demands due to an ageing Infrastructure population, increased incidence of chronic The service has a large number of aged buildings disease, rising healthcare costs and heightened and facilities that are expensive to maintain community expectations around the care that or adapt to changing models of care, modern they receive. However the DDHHS also operates standards and meet compliance requirements. in an environment with significant opportunity. In 2016 -17 the DDHHS completed a four year Healthcare in Australia is amongst the best in the $50.6 million Backlog Maintenance Remediation world (OECD indicators 2015) and improvements Program across the region to address some of the in integration of care, clinical innovation, most urgent maintenance requirements, however workforce growth, professional development and significant capital investment is still required strengthening of healthcare partnerships provide to upgrade or replace a number of buildings or for exciting areas of focus for the future. facilities to provide contemporary clinical care.

The most significant challenges facing the DDHHS in Key opportunities for the DDHHS to address these delivering healthcare service in our region include: challenges include: • Continually improving our models of care and Capacity expanding the use of emerging home-based Hospitalisation rates are increasing for many health health technologies to ensure patient-centred conditions, and are likely to continue to rise over service and improved outcomes the next 20 years. While much of the future pressure • Strengthening our relationships with healthcare on the healthcare system will come from an ageing partners, consumers and the community population, there are also other causes, in particular including the Darling Downs West Moreton the impact of chronic diseases. Current infrastructure Primary Health Network (DDWM PHN) and and resources are unlikely to be able to meet the community-controlled Aboriginal and Torres increasing service demands and health needs of our Strait Islander health services residents over the coming years. A key strategy for • The ability to maintain and improve a positive the DDHHS to meet this challenge is to partner with workplace culture to build resilience in the midst community primary care organisations to provide of large change programs and changing work new models of connected care and contribute to the environments arising from infrastructure and IT State healthcare priority of ‘Being a Good Partner’ developments (My Health, Queensland’s Future: Advancing Health • Implementation of integrated electronic Medical 2016). Even with these improvements, a continued Records (ieMR) to replace the existing paper- commitment by both Federal and State governments based patient records. An ieMR will make it is required to continue addressing this challenge. easier to share vital health information across Changing workforce landscape care providers improving quality of care and safety for patients An ageing workforce and remoteness of locations are constant challenges for the DDHHS when • The $62 million redevelopment for Kingaroy recruiting and retaining highly qualified staff to Hospital announced in June 2017 and scheduled deliver services to meet service demand. Creating for commencement in late 2018 will significantly a positive workplace culture increases staff improve patient care and services provided in the retention rates. In 2016-17 the DDHHS completed South Burnett region. Additionally $3 million was a comprehensive Culture Check-Up Survey as the also announced for development of a business case basis for understanding how our workplace culture to determine future needs for Toowoomba Hospital. can be improved.

8 DDHHS Annual Report 2016-2017 | Overview • Ensuring continued safety and quality across Our priorities all services In 2016-17 the DDHHS has undertaken or commenced »» Continuing to achieve the annual ISO:9001 a number of strategic initiatives to ensure that we are accreditation in the best possible position to manage our future »» Continuing the implementation of the SAFE challenges and support the Government in achieving audits its objectives for the community. • Delivering infrastructure improvements including: Our strategic priorities this year included: »» Installation of air conditioning at Stanthorpe • Building on our commitment to Closing the Hospital Gap through targeted initiatives to improve »» Major electrical upgrades for Toowoomba Indigenous health outcomes in our region Hospital, Baillie Henderson Hospital and • Recruiting to key Nurse Navigator positions that Dalby Hospital will provide end-to-end care and coordination by »» A new kitchen for Toowoomba Hospital highly experienced nurses across the patient’s »» Refurbishment of Warwick Hospital kitchen entire healthcare journey »» Expansion of the Toowoomba Hospital • Increasing the number of graduate nurse and Emergency Department to provide more midwifery positions from 48 to 85 positions treatment spaces • Increasing telehealth service provision, »» A new Magnetic Resonance Imaging (MRI) particularly services that support patients in the service at Toowoomba Hospital community and home-based care situations »» Expansion of the Computerised Tomography • Implementing the Diabetes Model of Care Project (CT) scanner service at Toowoomba Hospital in partnership with Clinical Excellence Division, Queensland Ambulance Service (QAS), DDWM »» Repairs to the helipad at Toowoomba Hospital PHN and general practitioners. The first patient »» Completion of the $50.6 million Backlog referrals for the program were received in Maintenance Remediation Program (four year February 2017. Clients in the program will have program) access to appropriate, evidence-based clinical »» Completion of the primary healthcare hub and care to assist them in managing their diabetes in, staff accommodation at Miles Hospital or as close as possible to their own community. • Partnering with St Andrew’s Toowoomba Hospital This will improve health literacy and self- to provide innovative robotic-assisted surgery management to achieve better health outcomes for patients with complex head and neck cancers for clients to ensure regional patients can access services • Supporting staff education and training through a closer to home. number of initiatives including: »» Development of the Queensland Rural Generalist Leader Program, to develop the leadership skills of rural and remote doctors across Queensland »» Launch of the Management Development Program developing leaders in all streams throughout the DDHHS through a comprehensive twelve week program. • Completing a comprehensive Culture Check-Up Survey in February 2017 which will enable the organisation to build a values-based culture and engage the workforce to improve service delivery

Overview | DDHHS Annual Report 2016-2017 9 Our governance

Our Board The Darling Downs Hospital and Health Board (the Board) is comprised of nine non-executive members who are appointed by the Governor in Council on the recommendation of the Minister for Health and Minister for Ambulance Services, in accordance with the Hospital and Health Boards Act 2011. The Board sets the strategic direction for the health service and is accountable for its performance in delivering quality health outcomes to meet the needs of the community it serves.

Mr Mike Horan AM Chair, Darling Downs Hospital and Health Board Mike was the Member for Toowoomba South in the Queensland Parliament from 1991 to 2012. During his political career Mike served as the leader of the National Party, leader of the Opposition, Shadow Attorney-General and Shadow Minister for Police, Health, and Primary Industries respectively. Mike regards his time as Minister for Health (1996-1998) as a highlight of his political career. Mike has considerable experience in the development and construction of small and large health facilities. More than 100 health construction projects varying from rural hospitals to major metropolitan hospitals occurred under his health ministry. During his time as Health Minister, the Surgery on Time System was established, a ten year Mental Health Plan introduced, and targets for breast screening and children’s immunisation were set and achieved. Mike was the general manager of The Royal Agricultural Society of Queensland (Toowoomba Showgrounds) from 1978 to 1991 and was a driving force in the sale of the old inner city Toowoomba Showgrounds and the development of the new Toowoomba Showgrounds on a 98 hectare site. Mike has also served as secretary of the Darling Downs sub-chamber of Agricultural Societies, a number of Breed Societies, Downs Harness Racing and Toowoomba Greyhound Racing Club. In June 2013 Mike was awarded a Member of the Order (AM) in the General Division of the Order of Australia for significant service to the Parliament of Queensland and to the community of the Darling Downs. Mike was appointed as Chair of the Darling Downs Hospital and Health Board in May 2012 and was the inaugural Chair of the Queensland Hospital and Health Board Chairs’ Forum. Mike is also the Chair of the Executive Committee. Mike is currently Board Chair of Downs Rugby Ltd, covering rugby union from Gatton to St George, a board member of the Toowoomba Police Citizens Youth Club and a board member of the Toowoomba Hospital Foundation. Mike is a great believer in working with the community to achieve results.

10 DDHHS Annual Report 2016-2017 Dr Dennis Campbell PhD, MBA, FCHSM, FAIM, GAICD Deputy Chair, Darling Downs Hospital and Health Board (Toowoomba) Dr Dennis Campbell has been a Chief Executive Officer in both the public and private health sectors, during which he held the positions of Assistant and Acting Regional Director in the Queensland Department of Health as well as CEO at St Vincent’s Hospital, Toowoomba for ten years. He also served as Corporate Director with Legal Aid, Queensland for ten years as well as other Executive positions within the Department of Education and Department of Aboriginal and Islander Advancement. In 2007, he was awarded an Australia Day Achievement Medallion for services to the Australian College of Health Service Executives. In 2008, he was awarded the Gold Medal for Leadership and Achievement in Health Services Management recognising his contribution and professional achievements in shaping healthcare policy at the institutional, state and national levels. He is involved in the college’s mentoring programme and on a number of national committees and is committed to making a contribution to the college and its members. Dennis serves as a member of numerous Boards and Advisory Committees, representing both public and private health sectors, has legal and health qualifications and is involved in organisational health consulting. He is Deputy Chairman of the Board of Heritage Bank, trustee of the Queensland Museum Foundation, and Chairperson of the Management Advisory Committee of the Cobb & Co Museum, Toowoomba. Dennis is Deputy Chair of the Darling Downs Hospital and Health Board, Chair of the Board Finance Committee and a member of the Board Executive and Board Audit and Risk Committees. Ms Cheryl Dalton Board Member, Darling Downs Hospital and Health Board (South Burnett) Ms Cheryl Dalton has extensive governance experience gained in her sixteen years as a local government Councillor in the South Burnett, as well as through a long standing membership on a Department of Natural Resources and Mines Panel. She is currently the Chief Executive of SBcare, a not-for-profit aged and disability service and works closely with and advocates for the community and social service sector. Cheryl has in excess of thirty years business management experience through her family agribusiness ventures where she is active as a Managing Director in a variety of agricultural enterprises and works primarily in the financial and quality assurance aspects of the business. Cheryl’s community involvement has and continues to encompass a wide range of interests including water planning and management, the arts, disability employment, social service and advisory committee roles to government. Cheryl is Chair of the Board Audit and Risk Committee and a member of the Board Finance Committee.

DDHHS Annual Report 2016-2017 11 Dr Ross Hetherington MBBS, DRANZOG, FACCRM, PGDipPallMed, FAICD Board Member, Darling Downs Hospital and Health Board (Southern Downs) Dr Ross Hetherington is a medical practitioner and a Designated Aviation Medical Examiner (DAME). Ross also co-founded the Central Queensland Rural Division of General Practitioners and holds a number of aviation and medical memberships. Ross has extensive experience in rural medicine and has been in private practice as a General Practitioner (GP) in Warwick since 1996. He is a board member of Health Workforce Queensland, which supports the regional, rural and remote health workforce in Queensland. Ross is Board Chair of RHealth and was a foundation member of Regional Health Board, Longreach. He has held previous Directorships with AGPN and the Australian Rural and Remote Workforce Agency Group. Ross is a member of the Aviation Medicine Society of Australia and New Zealand and was a foundation member of the Menopause Society of Australasia. Ross is a member of the Board Executive and Board Safety and Quality Committees.

Ms Marie Pietsch MAICD Board Member, Darling Downs Hospital and Health Board (Southern Downs) Ms Marie Pietsch is heavily involved on local committees and is a keen advocate for the sustainability of rural and remote communities. She has extensive healthcare experience across the Darling Downs region and has held positions on numerous councils and committees, including Chair of the Minister’s Rural Health Advisory Council and Chair of the Southern Downs Health Community Council. Marie has a professional background working in the Darling Downs region and her work on agricultural and health related committees has given her extensive exposure to local community needs. Marie is a member of various health committees including being a member of Inglewood Multipurpose Health Service Management Committee and Chair of the Inglewood Community Advisory Network. Marie’s work in representing health consumers in her region earned her a 2003 Centenary Medal for distinguished service to the community. Marie also received an Australia Day Achievement Medallion for outstanding service to Queensland Health and in 2014 Marie was awarded Citizen of the Year by the Goondiwindi Regional Council for services to the community, especially in health. She is a member of AICD. Marie is a member of the Board Safety and Quality and Board Audit and Risk Committees and is a representative on the Darling Downs Hospital and Health Service Consumer Council.

12 DDHHS Annual Report 2016-2017 | Our governance Ms Trish Leddington-Hill BSc, LLB, GAICD Board Member, Darling Downs Hospital and Health Board (Western Downs) Ms Patricia (Trish) Leddington-Hill worked for more than 10 years with RHealth, a primary healthcare organisation servicing the Darling Downs and South West Queensland. Trish grew up on a rural property near Millmerran, Queensland, and was educated in Millmerran, Toowoomba and Brisbane. She completed a Bachelor of Science and Bachelor of Laws at the University of Queensland (UQ) in 2000. Trish worked in the rural sector in a number of roles, before joining RHealth (then known as Southern Queensland Rural Division of General Practice) in 2002 where she coordinated and managed projects across the areas of allied health, mental health, aged care, quality use of medicines, health promotion and integration. Trish’s work became focused on promoting improvements to the health and community services sectors through partnerships and workforce planning and development. She completed studies in the internationally recognised Partnership Brokering Accreditation Scheme (PBAS) and is an internationally accredited Partnership Broker. Trish is a keen supporter of her local community and is heavily involved in various local committees. Trish is Chair of the Board Safety and Quality Committee.

Ms Megan O’Shannessy RN, MPH, MAICD Board Member, Darling Downs Hospital and Health Board (Western Downs) Ms Megan O’Shannessy is a Registered Nurse and Midwife. She has extensive clinical and leadership experience in rural health as Director of Nursing in Thargomindah (1990–1992), Dirranbandi (1992–1995), St George (1995–2001) and Warwick (2001–2013). She was the District Manager of Southern Downs (2007/2008), leading the transition to the district structure. Megan was council member of the Queensland Nursing Council (2001–2005) and member of the Queensland Health Nursing Interest Based Bargaining Implementation Group in 2006. Megan is the Chief Operations Officer of the Griffith University Rural Health Multidisciplinary Training Program on the Darling Downs with the local not-for-profit organisation, QRME. She continues to practise clinically as a part-time Practice Nurse at the Clifton Co-Operative Health Service. Megan is a Senior Lecturer at the Griffith University Rural Clinical School, holds a Masters in Public Health (JCU) and a Bachelor of Nursing (USQ). Megan is also a member of the Medical Board Queensland. Megan is a member of the Board Finance and Board Audit and Risk Committees.

Our governance | DDHHS Annual Report 2016-2017 13 Dr Ruth Terwijn RN, MNurs (Hons), PhD Board Member, Darling Downs Hospital and Health Board (Toowoomba) Dr Ruth Terwijn is a registered nurse and academic who started her nursing career at St Vincent’s Hospital, Toowoomba. Ruth worked with Family Planning Queensland in clinical, educational and managerial roles. During this time she completed an Advanced Practice Nursing in Sexual and Reproductive Health course and a Master of Nursing (Hons) through University of Southern Queensland (USQ). After many years at Family Planning Queensland, she changed her focus to become a lecturer of nursing at USQ. Her teaching priority during this time was introducing student nurses to the profession of nursing, post graduate rural and remote nursing courses, and part of the team that introduced flexible learning through online nursing courses. She received a Learning and Teaching Award for Excellence in Teaching. Ruth worked closely with nursing students who held a Permanent Humanitarian Visa. In 2015, she completed her PhD with a critical research study of the experiences of English as an additional language (EAL) and international nursing students. Ruth maintains an adjunct lecturer position with the School of Nursing and Midwifery at USQ and continues to publish from her thesis. Ruth is a member of the Board Safety and Quality Committee. Professor Julie Cotter PhD, BCom(Hons), FCPA, CA, GAICD Board Member, Darling Downs Hospital and Health Board (Toowoomba) Professor Julie Cotter is a respected academic with a wealth of experience in business and governance. She is the Director of the Australian Centre for Sustainable Business and Development, a research centre of USQ. Professor Cotter’s areas of expertise include finance, governance and agribusiness and she is a Chartered Accountant and a Fellow of CPA Australia. Professor Cotter is the Chair of the Australian Institute of Company Director’s (AICD) Toowoomba Regional Committee and a member of Australian Agricultural Company’s (AACo) Scientific Advisory Board. Julie previously served as a member of the neighbouring West Moreton Hospital and Health Board between September 2012 and March 2015, where she also chaired the Audit and Risk Committee. Other previous non-executive board roles include Toowoomba and Surat Basin Enterprise (TSBE), a membership-based regional development organisation. Professor Cotter’s roles with the AICD, TSBE and USQ have allowed her to build strong relationships with the Toowoomba and Darling Downs business communities. Professor Cotter has held senior management positions at USQ since 2006, including Head of School and Research Centre Director roles. In these positions she has been responsible for strategic and business management and leadership of large teams. During Julie’s time at USQ she has been a member of many university-wide management boards and committees contributing to strategic and operational management of the University. Julie joined the Darling Downs Hospital and Health Board in May 2017 and is a member of the Board Finance and Board Audit and Risk Committees.

14 DDHHS Annual Report 2016-2017 | Our governance Board meetings Executive Committee The Board Executive Committee focussed on The Board meets monthly, with every second supporting the Board in its role, working with the meeting held in a rural area. The Health Service HSCE to progress strategic issues, setting the Board Chief Executive (HSCE) attends each Board Meeting agenda and ensuring accountability in the delivery as a standing invitee. of health services. During 2016–17 Board meetings were held in During the 2016-17 financial year twelve Executive Warwick, Murgon, Taroom, Stanthorpe and Committee meetings were held. The HSCE attends Cherbourg, as well as in Toowoomba (Toowoomba all Executive Committee meetings. Hospital and Baillie Henderson Hospital). When meeting in the rural areas, the Board takes the Finance Committee opportunity to visit the surrounding hospitals and community health centres, as well as meet with The Board Finance Committee provided assurance staff and key community stakeholders including GPs and assistance to the Board, through oversight of in each of the communities. the DDHHS’s financial position, performance and resource management strategies in accordance with The Board travelled in excess of 30,000 km relevant legislation and regulations. throughout the 90,000 km2 of the DDHHS to attend Board meetings, community engagement events and During the 2016-17 financial year eleven Finance to complete site visits throughout the year. Committee meetings were held. Also attending meetings in advisory capacities were the HSCE and A summary of Board activities for 2016-17 is provided Chief Finance Officer (CFO). on pages 17-19. The chair and members provide a significant Safety and Quality Committee contribution to the community through their The Board Safety and Quality Committee provided participation on the Board. Remuneration leadership and scrutiny of patient safety systems acknowledges this contribution and is detailed on and structures to ensure the delivery of safe and page 121. In addition, total out of pocket expenses effective care. The committee provided assurance paid to the Board during the reporting period was and assistance to the Board on safety, quality and $26,131. These expenses include domestic travel, clinical governance frameworks, and strategies of accommodation costs, motor vehicle allowances the service. and meals. During the 2016-17 financial year meetings were held bi-monthly, with six meetings held in total. Board committees Also attending these meetings in an advisory To support the Board in its functions, the following capacity are the Executive Director Medical committees have been established under the Hospital Services, Executive Director Nursing and Midwifery and Health Boards Act 2011: Services, Executive Director Allied Health and • Executive Committee Director Clinical Governance. • Finance Committee • Safety and Quality Committee • Audit and Risk Committee. Each member’s committee membership is listed in their profiles on pages 10-14.

Our governance | DDHHS Annual Report 2016-2017 15 Audit and Risk Committee Also attending meetings in advisory capacities were the HSCE, CFO, Head Internal Audit, and In 2016-17 the Board Audit and Risk Committee representatives of Queensland Audit Office and the observed the terms of its charter and operated with DDHHS’s external auditor, KPMG. due regard to Queensland Treasury’s Audit Committee Guidelines to provide assurance and assistance to the The committee oversaw: Board on the DDHHS’s: • endorsement of the annual risk-based audit plan • risk, control and compliance frameworks • completion of fieldwork in line with the audit plan • external accountability responsibilities as • the preparation of the Annual Financial Statements prescribed in the Financial Accountability Act including review of the CFO’s assurance 2009, the Auditor-General Act 2009, the Financial statement for the financial year regarding the Accountability Regulation 2009 and the Financial continued efficient and effective operation of and Performance Management Standard 2009. the organisations internal financial controls in line with Section 77(2)(b) of the Financial The committee has an oversight role and does not Accountability Act 2009. replace management’s primary responsibilities for • The approval of the Annual Financial the management of risks including fraud risk, the Statements, together with the consideration of operations of the internal audit and risk management recommendations arising during the audit of the functions, the follow up of internal and external audit financial statements. findings or governance of the DDHHS generally. During the 2016-17 financial year, committee meetings Ms Cheryl Dalton was appointed Chair of the were held bi-monthly, with a total of 5 meetings held. committee in May 2016.

Board and committee meeting attendance

Executive Finance Safety and Board Audit and Risk Committee Committee Quality Name Term Held Attend Held Attend Held Attend Held Attend Held Attend Mike Horan 18.5.12 12 12 12 12 ------Chair 17.5.19 Dennis Campbell 29.6.12 12 11 12 12 11 11 5 5 - - Deputy Chair 17.5.19 29.6.12 Cheryl Dalton 12 10 -- 11 10 5 5 - - 17.5.18 18.5.16 Corinne Butler* 12 2 - - 11 3 5 1 - - 23.9.16 29.6.12 Marie Pietsch 12 11 - - - - 5 5 6 4 17.5.19 Megan 29.6.12 12 11 -- 11 8 5 5 - - O'Shannessy 17.5.18 Ross 29.6.12 12 11 12 11 - - - - 6 2 Hetherington 17.5.19 18.5.16 Ruth Terwijn 12 12 ------6 6 17.5.20 Trish 18.5.13 12 12 ------6 6 Leddington-Hill 17.5.18 18.5.17 Julie Cotter** 12 2 - - 11 0 - - - - 17.5.20 *Corinne Butler resigned from the Board on 23rd September 2016 **Julie Cotter was appointed to the Board on 18th May 2017

16 DDHHS Annual Report 2016-2017 | Our governance Board engagement with our community As part of the Board’s commitment to ensuring that the DDHHS is delivering services that meet the needs of our community, regular staff and community consultation sessions are held as part of each Board meeting. These sessions give the Board the opportunity to meet with key stakeholders in our region to hear about their local needs and issues. In 2016-17 the Board members attended nearly 150 meetings and events travelling over 30,000 kilometres. A summary of events, meetings and consultations undertaken in the past year is provided below.

Meetings and consultations Meetings and consultations Advocacy and Support Centre, Warwick Food Assist Warwick Allora Medical Centre Friends of BUSHkids Warwick Centre Arafmi Queensland Inc Taroom Future Fuel Distributors Aurora Training Institute GP Connections Australian Indigenous Ministries - Cherbourg AIM Church Graham House Community Centre Benedictine Order Community Association Blue Care Aged Care Service Granite Belt Medical Services Blue Care Ny-Ku Byun Elders Village (Aged Care) Griffith University Health Blue Care Warwick Respite Care Guy Street Dental Burnett Inland Economic Development Organisation Headspace Warwick Carers Queensland - Toowoomba Health Workforce Queensland Carramar Consulting HHS Audit Committee Chairs Meeting Cedar Centre HHS Safety & Quality Chairs meeting Centacare Institute of Healthy Communities Australia (IHCA) Cherbourg Health Action Group Investment Review Committee Cherbourg Regional Aboriginal and Islander Community Isolated Childrens, Parents & Citizens Association - Controlled Health Service Taroom/Wandoan Branch Cherbourg State School Stanthorpe Italian Welfare Association Cognitive Institute Jeannie Barton Stanthorpe Community Consultative Committee John and Anne Felton Community Network of Warwick Lady Bjelke-Petersen Community Hospital South Burnett CTC Leukaemia Foundation - Warwick DDWM PHN Lifeline Darling Downs and South West Qld DDHHS and West Moreton Hospital and Health Services Lighthouse Community Centre Board Chairs and DDWM PHN Board Chair Lions Club of Warwick Inc DDHHS Community Healthcare Workshop Long Stay Older Patients Committee DDHHS Consumer Council Mercy Family Services Warwick DDWM PHN Annual General Meeting Miles District Hospital Auxiliary Deloitte Moravian College Dementia Support Group Warwick Murgon Business & Development Association Depression Support Network Toowoomba Murgon Family Medical Centre Director-General, Queensland Health Murgon Hospital Auxiliary Directors Australia National Seniors Association Downs Group Training - The Apprenticeship Company

Our governance | DDHHS Annual Report 2016-2017 17 Meetings and consultations Meetings and consultations Palmerin Street Medical Practice Warwick The Olders Mens Network (TOMNET) Toowoomba Parents and Munchins Play Together - PAMPA The Physiotherapy Centre Patient Safety and Quality Advisory Committee (PSQAC) Together Union Price waterhouse Coopers (PwC) Toowoomba and District Local Medical Association Queensland Ambulance Service Toowoomba and Surat Basin Enterprise Queensland Audit Office Toowoomba Chamber of Commerce Queensland Centre for Mental Health Learning Toowoomba Clubhouse Queensland College of Wine Tourism Toowoomba Hospital Foundation Queensland Fire and Emergency Services South Burnett Toowoomba Suicide Prevention Network Queensland Mental Health Commission University Department of Rural Health Steering Committee Queensland Police Service - Murgon University of Queensland (UQ) Queensland Rural Medical Education (QRME) Limited UQ Faculty of Medicine Richmond Fellowship Queensland UQ Rural Clinical School Rotary Club of Sunrise Warwick UQ Rural Clinical School Advisory Committee Salvation Army Warwick University of Southern Queensland Stanthorpe Soul Pattinson Chemist Villa Carramar South Burnett Community Consultative Committee Wandoan Health Auxiliary Inc South Burnett Physio Warwick Ambulance Service Southern Cross Care Retirement Village Warwick Collective Inc Southern Cross Care Taroom - Leichhardt Villa Warwick District Football Association Southern Downs Dental Clinic Warwick Friendly Society Pharmacy Southern Downs Refugee & Migrant Network Warwick Hospital Southern Downs Suicide Prevention Group Warwick Physioworks St Joseph's School Warwick Police Station St Vincent de Paul Zonta Club of Warwick Stanthorpe & Granite Belt Chamber of Commerce Stanthorpe Border Post Hospital visits Stanthorpe State High School Cherbourg Hospital Stanthorpe State School Inglewood MPHS Sunrise Way Kingaroy Hospital South West Hospital and Health Service Board Chair Miles Hospital TAFE South West Millmerran MPHS Taroom Ambulance Service Murgon Hospital Taroom District Development Association Nanango Hospital Taroom Hardware Stanthorpe Hospital Taroom Home and Community Care (HACC) Taroom Hospital Taroom Newsagency Texas MPHS Taroom Pharmacy The Oaks RACF, Warwick Taroom Shire Cancer & Palliative Care Association Toowoomba Hospital Taroom Shire Landcare Group Inc Warwick Hospital Taroom State School Taroom Senior Citizens

18 DDHHS Annual Report 2016-2017 | Our governance Forums and events Forums and events 2016 Queensland Health Awards for Excellence Thanks Mate - THF Function 2017 Health Consumers QLD Annual Forum Toowoomba Mothers Hospital Book Launch 2nd National Rural and Remote Telehealth Conference Toowoomba Regional Council Civic Reception with Annual Volunteers Christmas Function Governor General CEDA Economic Development Forum USQ Vice-Chancellors Cocktail Function DDHHS Aboriginal and Torres Strait Islander Health Forum USQ 2016 Graduation Ceremony and Luncheon DDHHS Allied Health Showcase USQ Town & Gown Research Evening DDHHS Close the Gap Day - Indigenous Health Expo USQ's 50/25 Anniversary Book Launch DDHHS Community Information Expo (Aged Care/Healthy Living/NDIS) Federal and State Members of Parliament DDHHS Employee Awards - Announcement of nominees Federal Assistant Minister for Health and finalists Federal Minister for Regional Development DDHHS Maternity Services Forum Federal Member for Groom DDHHS Staff Awards Dinner Federal Member for Maranoa DDHHS Staff Length of Service Awards Member for Condamine DDHHS Wellness Program Launch – Baillie Henderson Member for Southern Downs Hospital Member for Toowoomba North DDHHS/DDWM PHN Clinical Engagement Function Member for Toowoomba South Directors of Clinical Governance/Hospital and Health Board Safety and Quality Chairs Forum Minister for Health and Minister for Ambulance Services Disability Action Week Celebration Senator for Queensland, Claire Moore Farewell Afternoon Tea - Dr Dennis Lennox Governor-General visit to Inglewood MPHS Local Councils Guiding Stars 10th Anniversary Banana Shire Council Headspace Toowoomba First Birthday Celebration Cherbourg Aboriginal Shire Council Hospital and Health Service Board Chairs’ and Members Goondiwindi Regional Council Forum South Burnett Regional Council Hospital and Health Service Board Chairs’ Forum Southern Downs Regional Council Integrating Health Services Workshop Toowoomba Regional Council Memorial Service for Volunteer – Shirley Meehan Western Downs Regional Council NAIDOC Week Celebrations National Police Remembrance Day Service National Volunteer Week Luncheon Official opening Dalby Hospital Renal Unit Official opening BreastScreen Queensland Toowoomba facility Pathways for Hospital Avoidance Forum Premier’s Award Function Queensland Clinical Senate Forum: Challenges in Healthcare Queensland Clinical Senate Forum: Our Integration – Beyond Fragmentation Queensland Rural Generalist Leader Program Launch

Our governance | DDHHS Annual Report 2016-2017 19 Our Executives The Health Service Chief Executive (HSCE) is accountable to the Board for all aspects of DDHHS performance, including the overall management of human, material and financial resources and the maintenance of health service and professional performance standards. Reporting to the HSCE, the organisation is led by a team of nine executives that are responsible, for the operational and professional management of their respective divisions to achieve the organisation’s strategic objectives.

Dr Peter Gillies MBChB, MBA, FRACMA, GAICD Dr Peter Gillies was appointed as HSCE in May 2016. Dr Gillies has been with the DDHHS since 2009 when he moved to Toowoomba to take up the role of Director Medical Services. Dr Gillies was appointed as Executive Director of Medical Services in February 2011 and subsequently General Manager Toowoomba Hospital in July 2013. In these roles he provided expert direction in improving patient care and meeting or exceeding clinical targets including timely surgery, outpatient waiting lists, and emergency department access. Dr Gillies is a Fellow of the Royal Australasian College of Medical Administrators and has a Masters of Business Administration from Otago University. He is also a Graduate of the Australian Institute of Company Directors. He has a background in general management, previously working as the general manager of a health software company and as the regional manager for a not-for-profit private hospital group in Auckland, New Zealand. He has been a doctor for nearly 25 years and has worked in South Africa and the United Kingdom (UK) in both hospital and general practice roles prior to immigrating to New Zealand in 1995.

Shirley-Anne Gardiner BBS, BA (Hons), MMgt Ms Shirley-Anne Gardiner has extensive knowledge and leadership experience involving people and health service delivery models within large complex organisations with fifteen years’ experience in senior and operational leadership and management positions. She has been the Executive Director for Toowoomba Hospital since August 2016. In this role Shirley-Anne provides single-point accountability for the Toowoomba Hospital, the DDHHS’s largest hospital and main provider of services within the region. Shirley-Anne has previously held leadership roles including Operations Manager of Palmerston North Hospital (MidCentral Health), a 350- bed regional hospital in New Zealand and also Executive Director, Population Health and Engagement for the Darling Downs South West Queensland Medicare Local. Shirley-Anne holds a Masters in Management (Health Services), Bachelor of Business Studies (Finance) and a Bachelor of Arts (Honours) in Social Anthropology. She has used these skills and experience to improve organisational performance and conduct strategic and operational service planning.

20 DDHHS Annual Report 2016-2017 | Our governance Greg Neilson RN, FACMHN Mr Greg Neilson has over 25 years’ experience in senior nursing and management positions in the DDHHS, Division of Mental Health, Alcohol and Other Drugs. Hospital trained in general and psychiatric nursing, he completed additional post-basic qualifications in gerontic nursing, advanced psychiatric nursing and community mental health. He has a Bachelor Health Science (Nursing) and Masters Degrees in Nursing, Mental Health Nursing and Advanced Practice Nursing. He also has additional postgraduate qualifications in forensic mental health nursing and child and adolescent mental health nursing. Greg also has a Masters Degree in Health Service Management from the University of New England and Graduate Certificate in Health Economics from Monash University. He is a Fellow of the Australian College of Mental Health Nurses and is Chair of the College’s Credentialing Committee. Greg has been the Executive Director Mental Health since June 2016. In this role Greg is accountable for executive leadership over the DDHHS mental health, and alcohol and other drugs services, which includes acute and extended inpatient and ambulatory services. Dr Martin Byrne BAppSc MBBS FRACGP FARGP FACRRM FRACMA MHM DRANZCOG GAICD Dr Byrne has approximately 20 years’ experience as a rural GP throughout Queensland and joined the DDHHS in 2013 as the Director, Clinical Governance. He was Medical Superintendent at Mitchell Hospital for five years, before commencing as Director of Medical Services in Roma and the Executive Director Medical Services for South West Queensland. Dr Byrne is currently acting as both the Executive Director, Medical Services and Executive Director Rural. In these roles Dr Byrne is responsible for providing professional leadership for medical services across the DDHHS and single point accountability for the Rural Services Division and Residential Aged Care Facilities.

Our governance | DDHHS Annual Report 2016-2017 21 Dr Hwee Sin Chong MBChB, MHM, MIPH, FRACMA, GAICD Dr Hwee Sin Chong first commenced in Toowoomba as the Deputy Director of Medical Services in 2011, bringing with her several years of experience in medical management across a range of roles in the public and private health sector. She is a Fellow of the Royal Australasian College of Medical Administrators, and has a Master of Health Management and Master of International Public Health from the University of NSW. Dr Chong graduated from Otago University, working for several years in New Zealand before immigrating to Australia. Dr Chong commenced as Executive Director Medical Services in September 2014 and commenced acting in the role of Executive Director, Rural and Remote Medical Support in July 2016. In this role Dr Chong is responsible for professional leadership and the development of strategies to enhance the delivery of rural and remote medical workforce services, both within the DDHHS and across the State.

Annette Scott BPhty, GCert Mngt, GAICD Ms Annette Scott commenced her career in health as a physiotherapist. After spending her earlier career as a private practitioner in solo practice in Central Queensland, she joined the Queensland public health system where she subsequently fulfilled a number of roles including direct delivery of clinical services as a senior clinician, and non-clinical roles including project management and quality coordination. In more recent years, she has focused her career on health service management and has extensive experience in managing multidisciplinary health services across a range of settings including acute inpatient, outpatient, community and rural outreach. Her most notable achievements include the implementation of a number of successful telehealth-enabled clinical services across the southern region of Queensland including the award-winning Telehealth Preadmission Clinic at the Toowoomba Hospital. In addition she was responsible for implementing a range of innovative Health Practitioner workforce redesign initiatives that attracted national and statewide attention for their ability to impact positively on patient flow and increase efficiency of health service delivery. In her role as Executive Director Allied Health, Annette is the operational lead for the allied health workforce within the Toowoomba Hospital and the rural communities of the Darling Downs and South Burnett, as well as the professional lead for the Health Practitioner workforce across the DDHHS. She also manages a range of Commonwealth funded programs including the Aged Care Assessment Service and the BreastScreen Queensland Toowoomba service.

22 DDHHS Annual Report 2016-2017 | Our governance Karen Abbott RN RM Ms Karen Abbott completed her Registered Nurse training at Royal Brisbane Hospital and her Midwifery training at Redcliffe Hospital. Karen later completed a Bachelor of Health Science (Nursing). Karen's career took her to the rural health environment for the remainder of her career, including as Director of Nursing/Facility Manager at Taroom Hospital for 17 years followed by Director of Nursing/Facility Manager at Gatton Hospital, in the Lockyer Valley. Karen was the Cluster Operations Manager for the Western Cluster in the Division of Rural Health within the DDHHS for three years prior to taking up the Executive Director of Nursing and Midwifery in August 2016. In this role Karen provides professional leadership over the DDHHS’s nursing and midwifery services.

Jane Ranger BBus (Acc), CPA Ms Jane Ranger was appointed to the Chief Finance Officer role in August 2016. In this role, Jane provides single-point accountability for the Finance Division and ensures the prudent financial management of the DDHHS. Prior to being appointed to this role Jane was the Senior Finance Manager for the Toowoomba Hospital. In this role she was responsible for the oversight and sound financial management of the Toowoomba Hospital and Baillie Henderson Hospital. Jane has also held roles as the Group Company Accountant for McNab Construction Group and spent five years as the State Commercial Manager, Queensland, Northern Territory and New South Wales for Healthscope, the second largest private healthcare provider in Australia. Originally from the UK, Jane immigrated to Australia in 1989. Ms Ranger has worked at a senior level in the banking, hospitality, public transport, manufacturing and building industries. She completed her Bachelor of Business, as dux of her class at Griffith University, Gold Coast in 1999 and attained CPA status in 2002.

Our governance | DDHHS Annual Report 2016-2017 23 Dr Paul Clayton BSc (Hons), PhD, DipBus, MAIB Dr Paul Clayton joined the DDHHS and came to work in the health sector in early 2016 after more than 20 years in project management and technical services delivery in the environment sector. Paul has a technical foundation in the aquatic sciences but has worked in senior management and major project oversight roles for the past decade. With a career that includes direct experience in research, government, and the private sector, Paul brings to the DDHHS a professionally- balanced and practical approach to corporate governance, project management, strategic oversight and business planning. Paul was appointed to the Executive Director Infrastructure role in October 2016. In this role, Paul provides executive leadership over the Infrastructure Division and ensures the coordinated delivery of DDHHS infrastructure and maintenance projects. Prior to joining the DDHHS Executive team, Paul contributed in a strategic planning role and coordinated the production of the updated DDHHS Strategic Plan 2016-2020, as well as progressing arrangements for coordinated infrastructure and asset management across the health service. Before joining the DDHHS, Paul was General Manager for a local division of an international consultancy and contractor company working with clients on infrastructure projects for the resources, urban development, and the agricultural sectors, and for all three tiers of government in Australia. Paul has held a number of senior management roles with oversight of multidisciplinary teams and with responsibility for complex project deliverables and project budgets. Corinne Butler Ms Corinne Butler held senior human resource management roles within the former Toowoomba and Darling Downs Health Service District and Darling Downs West Moreton Health Service District from 2007 to 2011. Corinne is the owner of Tweak HR, a local business that helps other local businesses improve their productivity and profitability. She is the founder of the Women of Warwick and Business Network of Warwick, as well as the Chair of Destination Southern Downs. Corinne was also the Vice President of the Queensland Rural, Regional and Remote Women’s Network, whose purpose is to connect rural, regional and remote women, business, and industry, and was the State President of the Australian Human Resources Institute (AHRI) for two terms. Corinne was appointed to the Darling Downs Hospital and Health Board in May 2016 before successfully being appointed as the Executive Director Workforce in September 2016. In the role of Executive Director Workforce, Corinne provides executive leadership over DDHHS workforce services to support employee engagement, safety and effective workforce planning. Corinne has worked in management and consultancy roles across a range of industries and is skilled at facilitating productivity and profitability through good people management.

24 DDHHS Annual Report 2016-2017 | Our governance Our organisation Professional Divisions Four professional divisions lead the DDHHS in Our divisions promoting clinical service improvement, consumer satisfaction, clinician engagement, clinical The organisation is divided into eleven divisions that governance, professional and clinical standards and work in partnership to deliver health services to our clinical workforce planning and education. communities. The divisions are grouped into clinical, professional and support roles with each division Medical Services having specific responsibilities and accountabilities The division provides professional leadership for for the effective performance of the organisation. medical staff and services across the DDHHS and Clinical Divisions has responsibility for the medical workforce, medical education, clinical governance, health information There are three clinical divisions that lead the delivery services, pastoral care, and public health teams. of high quality, safe, and evidence-based patient care across the DDHHS: Rural and Remote Medical Support Toowoomba Hospital The division provides professional leadership for rural and remote medical support through • The largest of the clinical divisions, it operates Queensland Country Practice (QCP) including the main regional hospital for the DDHHS which relieving services, service and workforce design and has nearly 300 beds medical education pathways which are all delivered • The division has four clinical services groups: on a Statewide basis. »» Surgical »» Medical Allied Health »» Ambulatory Care and Support Services The division provides professional and operational »» Women’s, Children’s and Emergency leadership for Allied Health professionals and services Department Services across the DDHHS, including workforce planning • Oral Health Services for the DDHHS is also and development, clinical education, research and operationally aligned to this division. standards. This division also includes the DDHHS Research Unit, Aged Care Assessment Team and Mental Health Services BreastScreen Queensland Toowoomba Service. • The division provides a comprehensive range of child and youth, adult and older persons, and Nursing and Midwifery Services acute inpatient services at Toowoomba Hospital. It The division provides professional leadership for also provides a range of community mental health nursing and midwifery services (including workforce services in Toowoomba and a range of rural centres planning, education and standards) across the DDHHS. • Mental Health services for consumers who require extended treatment and rehabilitation are provided Support Divisions at the Baillie Henderson Hospital, Toowoomba The support divisions work in collaboration with the • The division is also responsible for the DDHHS’s clinical and professional divisions in supporting the Alcohol and Other Drugs Service. provision of high quality, evidence-based, and safe patient care. Rural Health Services • The division operates 15 hospitals, three multi- Finance purpose health services (MPHSs), five outpatient The division supports the health service in ensuring clinics and six residential aged care facilities resources are balanced, sustainable, and efficient. (RACFs) Finance provides DDHHS-wide support functions • The division is managed via a cluster model with comprising Financial Control, Management three geographic clusters (Southern, Western Accounting and Commercial Management which are and South Burnett) and a cluster for residential designed to optimise quality healthcare through aged care services. compliant and efficient business processes.

Our governance | DDHHS Annual Report 2016-2017 25  Members of the DDHHS Executive prepare to cook a barbeque lunch for the workgroup returning highest participation in the Culture Check-up staff survey.

Infrastructure embedding a values-based culture; planning, recruiting The division supports the organisation to plan for, and and retaining an appropriately skilled workforce; deliver key infrastructure and maintenance programs developing, educating and training the workforce; across the health service to meet the organisation’s engaging employees to improve the service; and strategic objective of optimising asset use. This division promoting employee health and wellbeing. manages the Building Engineering and Maintenance Office of the Chief Executive Services, Information and Communication Technology and the Facility Services portfolios. The division supports the organisation through corporate governance (including Board secretariat, Workforce risk and compliance management, and policy The division supports the organisation to deliver on the development), corporate and health service key priority of ensuring a dedicated trained workforce. planning, strategic projects and telehealth service delivery, and media and communications services. Workforce is responsible for supporting managers in

26 DDHHS Annual Report 2016-2017 | Our governance Committee Structure 2017

Darling Downs Hospital and Health Board

Board Audit and Risk Board Safety and Quality Board Executive Committee Board Finance Committee Committee Committee

Health Service Chief Executive

Executive Management Executive Audit and Executive Safety and Executive Innovation Clinical Council Committee Risk Committee Quality Committee Meeting

DDHHS Consultative Forum

Consumer Council

Executive committees Executive Audit and Risk Committee Provides oversight over the DDHHS’s risk, compliance The DDHHS Executive Committees support the Board and audit functions to ensure that the DDHHS’s risks and Executive team to fulfil their responsibilities and opportunities are managed effectively to enable and assist in facilitating effective governance, the delivery of safe and efficient health services. management oversight, collective decision making, and ensuring each Division is working in collaboration Executive Safety and Quality Committee to achieve the strategic objectives of the organisation. Provides oversight over the DDHHS’s safety, quality The committees are as follows: and clinical governance to ensure the delivery of optimal patient care and outcomes. Executive Management Committee Provides oversight over the implementation of Executive Innovation Meeting strategic initiatives, operational management and Provides oversight over the DDHHS’s strategy and resourcing of the DDHHS to ensure the delivery of innovation agenda and drives initiatives based on quality, safe and effective services for our community. global horizon scanning and evidence-based research.

Our governance | DDHHS Annual Report 2016-2017 27 Board Audit and Risk Committee and Executive Audit Risk and compliance and Risk Committees. management The Head of Internal Audit directs the unit’s activities, provides a framework for it to operate effectively and The DDHHS is committed to effectively managing risk reports on Internal Audit activities to the Audit and in alignment with best practice and through a practical Risk Committees of both the Board and the Executive. approach that carefully plans for and prioritises risks, Internal Audit work is carried out using a co-source and balances the costs and benefits of action. model of both in-house resources and external The DDHHS Risk Management Framework uses an contracted auditors that are engaged through a integrated risk management approach to describe transparent procurement process. Internal Audit also how risks are identified, managed and monitored works independently of, but collaboratively with, the within the DDHHS. external financial auditors. The progression towards a fully integrated Compliance Management framework continued in 2016-17 with External scrutiny further development of the compliance management system that will continue to provide assurance that DDHHS operations are subject to regular scrutiny from the organisation is meeting its various obligations. external State oversight bodies such as the Auditor- General, Ombudsmen, Coroner, Queensland Audit Risk Management and Compliance Management Office, and Crime and Corruption Commission. reports are submitted to the Audit and Risk Committees of both the Board and Executive. Coronial findings During 2016-17 findings were handed down in relation Internal audit to one inquest involving DDHHS services. The inquest DDHHS’s Internal Audit function operates under relates to the death of a patient at Toowoomba a Board approved charter in accordance with the Hospital in 2015 from complications following elective requirements of the Financial and Performance surgery to treat diagnosed high-grade synchronous Management Standard 2009. These practices are caecal and rectal tumours. consistent with relevant audit and ethical standards The inquest examined the adequacy of the as laid out in the Institute of Internal Auditors multidisciplinary team approach to the patient’s care International Professional Practices Framework. The and the appropriateness of surgical decision making Internal Audit Charter gives due regard to Queensland and postoperative care. The inquest traversed complex Treasury’s Audit Committee Guidelines. evidence regarding post-operative fluid management The role of Internal Audit is to conduct independent of patients. The inquest found the surgical decision assessment and evaluation of the effectiveness and making to have been appropriate in the circumstances. efficiency of organisational systems, processes and One recommendation was handed down for controls, thereby providing assurance and value to the the DDHHS to examine and formally report on Board and Management. Internal Audit is independent of communication issues that arose within the Surgical management, reporting functionally to the Board Audit Oncology Multidisciplinary Team leading to the and Risk Committee and administratively to the HSCE. surgeon not being aware of the existence of the Internal Audit works in accordance with annual and findings of a CT scan. This scan may have altered the strategic audit plans that are approved by the Board. surgeon’s approach to the surgery and as such was The plans are developed using a risk-based approach considered a significant missed opportunity to have that considers both strategic and operational risks. optimised the patient’s care. The DDHHS has accepted The 2016-17 Internal Audit plan, approved by the this recommendation and the issue will be examined Board, included 11 audits covering topics such as and a formal report prepared. capital works, clinical coding, telehealth, clinical and The DDHHS was encouraged to continue improving its non-clinical records management, triage processes, management of inter-team requests for patient review employee performance management and compliance and the importance of good clinical documentation management. The implementation of recommendations was reiterated. arising from audits is monitored and reported to the

28 DDHHS Annual Report 2016-2017 | Our governance Queensland Audit Office Information systems and During 2016-17 DDHHS participated in the following external audits: recordkeeping • Queensland Audit Office - Organisational Structure The Public Records Act 2002, Information Standard and Accountability Review 40: Recordkeeping (IS4)) and Information Standard »» DDHHS is still awaiting the findings from this 31: Retention and Disposal of Public Records (IS31) audit provides overarching governance for recordkeeping • Crime and Corruption Commission (CCC) - practices within the DDHHS. Recruitment and Selection Audit Training is available to all staff regarding the making »» DDHHS was included in a multi-agency audit by and keeping of public records in all formats at the CCC. Findings were released in June 2017. orientation, local inductions and through the DDHHS It was recommended that DDHHS requires Health Information Services team. improvement in relation to the procedure for The DDHHS is continuing to work towards internal complaint management and complaint implementing an electronic document records assessment and categorisation processes. management system in the 2016-17 financial year to DDHHS has reviewed these findings and will be assist in the ongoing management of its records. progressing improvement initiatives during the second Extensive work has been undertaken in 2016-17 in half of the 2017 calendar year. relation to clinical record-keeping audits to ensure that information is readily accessible and record- Disclosures of confidential keeping is consistent across the DDHHS. Regular processes have also been established with our information in the public records storage partners, Grace Records Management, to increase the functionality of scanning options. interest Utilising scanning options, within the bounds of In accordance with Section 160 of the Hospital and Information Standards, has enabled efficiencies to be Health Boards Act 2011 the disclosure of confidential gained for Right to Information/Information Privacy information is permitted if the Chief Executive of (RTI/IP) requests, information transfer and electronic the service believes, on reasonable grounds, the storage opportunities. disclosure is in the public interest and the Chief Security Risk Assessments have been conducted Executive has, in writing, authorised the disclosure. to determine a baseline for systems compliance The table below summarises the relevant disclosures against Records Management standards and this made in the 2016-17 reporting period: has contributed to the streamlining of workflows whilst ensuring National Privacy Principles are Date disclosure Nature of Purpose met. Importantly, it has heightened awareness of authorised confidential for which cybersecurity and the need to protect DDHHS records information confidential from cyber-attacks. disclosed information disclosed A longer term body of work reached fruition, with GP access to The Viewer enabling ready delivery of clinical 29 August 2016 Threat of harm To warn the information to our GP partners in the community. This to Queensland staff member in Health staff question of the milestone event supports continuity of care through member threat secure access to current information. 09 January 2017 Interactions To alert between a Queensland classified Corrective inpatient and a Services (QCS) visitor regarding to the observed attempts at interactions. secreting contraband into the facility.

Our governance | DDHHS Annual Report 2016-2017 29 This year’s milestones

Toowoomba Community Care Unit celebrates its first birthday

Board Chair praises outstanding work Bumper of Warwick Hospital crowds enjoy operational NAIDOC week services team celebrations Construction commences on the new Toowoomba Hospital kitchen

JULY AUGUST SEPTEMBER OCTOBER

New BreastScreen Queensland Toowoomba premises opened by Chief Health Officer

Toowoomba Hospital Guiding 2016Stars celebrate 10 years

30 DDHHS Annual Report 2016-2017 | Our performance Transition Care Toowoomba Program (TCP) Hospital celebrates 10 CT service year milestone expanded

OCTOBER NOVEMBER DECEMBER

Murgon Hospital goes solar

The DDHHS’s Queensland Rural Generalist Pathway wins the Premier’s Award in the 2016Leadership category

Our performance | DDHHS Annual Report 2016-2017 31 This year’s milestones

New Dalby Hospital Renal Service opens Refurbished primary healthcare hub and new staff accommodation completed at Miles Hospital. Indigenous Health Expo held

2016 DDHHS Employee Awards

JANUARY FEBRUARY MARCH APRIL

RiskMan launched

Speech pathologist wins 2017Statewide speech pathology award Allied Health Showcase winners DDHHS wide announced culture check- up survey undertaken

32 DDHHS Annual Report 2016-2017 | Our performance New palliative care room at Cherbourg Hospital officially opened

Toowoomba Hospital MRI service sees its first patient

Renal services DDHHS boosted at Community Toowoomba Information Hospital with new Expo held inpatient renal beds

APRIL MAY JUNE

Launch of DDHHS Staff $3.14 million Wellness expansion of Program Toowoomba Hospital Central Sterilising Patient able to attend Department underway funeral thanks to use of telehealth services at Toowoomba 2017Hospital

Dr EAF McDonald Nursing Home Congratulation awarded first prize Dr Lennox – in the Inter-Nursing recipient of the DDHHS Length Home Challenge at AMA Excellence in of Service Toowoomba Royal Show Healthcare Award Awards

Our performance | DDHHS Annual Report 2016-2017 33 Our performance

This financial year the DDHHS continued its high performance against a range of targets and key performance indicators set by the Department of Health. Across the DDHHS there was an overall increase in activity, although a few areas including birthing experienced a decrease in the number of services when compared to the previous financial year. Performance highlights 2016-17

People admitted to 82,054 Breastscreens 19,037 hospital admissions, screens, 5,957 more 7% increase 1,272 more 8% increase than 2015-161 than 2015-16

People Babies born presenting to 159,723 2,949 babies emergency presentations, 5% born, 162 departments 4,598 more decrease fewer than 3% increase than 2015-16 2015-16

Outpatient Telehealth occasions of 261,712 consultations 7,090 service attendances, 36% consults, 15,274 more 1,962 more 6% increase than 2015-16 increase than 2015-16

Emergency surgery Endoscopies 5,720 3,618 procedures, Toowoomba surgeries, 3% increase 160 more Hospital 185 more procedures 5% increase surgeries than 2015-16 than 2015-16

Elective surgery Specialist outpatient waiting list – 100% waiting list – almost Oral health waiting of all patients treated 100% of all patients list – third consecutive Gastrointestinal within clinically seen within clinically year that 100% of all endoscopies – almost recommended recommended patient’s waiting had 100% of patients timeframes, timeframes, waited less than two treated in time. maintained now for maintained now for years for treatment. the past three and a the past two years. half years.

34 DDHHS Annual Report 2016-2017 Toowoomba Hospital installed a state-of-the-art MRI, with the first patient seen on 23 May 2017

Our service standards The DDHHS is responsible for providing public hospital and healthcare services which includes a range of medical, surgical, emergency, obstetrics, paediatrics, specialist outpatient clinics, mental health, critical care and clinical support services for people within the Darling Downs region. The DDHHS delivered these services in line with the 2016-17 Service Delivery Statements (SDS) and Service Agreement with the Department of Health. Some of the DDHHS’s key priorities for 2016-17 published in the SDS were:

Key priority area: Status as at 30 June 2017 Progressing works towards the establishment of a state- of-the-art MRI service and second CT (Computerised Installation completed and services operational Tomography) Scanner at Toowoomba Hospital Construction of a seventh operating theatre at the Project commenced in late 2016-17 with completion expected Toowoomba Hospital in 2017-18 Expansion of the Emergency Department at the Completed and services operational Toowoomba Hospital Continuing to implement the Government’s policies for Roll out of four year nurse navigator program commenced nursing, focusing on safety, quality and patient centred in 2015-16, with additional positions recruited to in 2016-17. care. Final recruitment to program to occur in early 2017-18.

The Service Agreement between DDHHS and the Department of Health identifies the health services the DDHHS provides, funding arrangements for those services, and defined performance indicators and targets to ensure outputs and outcomes are achieved. The DDHHS reports against national targets as set in the National Partnership Agreement on Improving Public Hospital Services and documented in the SDS and Service Agreement.

DDHHS Annual Report 2016-2017 35 Our achievements this year against standards Emergency department access

2016-17 Actual Service standards Notes 2016-17 Target Performance Emergency Length of Stay Percentage of emergency department attendees who depart within 4 2 >80% 86% hours of their arrival in the emergency department Percentage of patients attending emergency departments seen within recommended timeframes: Category 1 (within 2 minutes) 2 100% 95% Category 2 (within 10 minutes) 2 80% 83% Category 3 (within 30 minutes) 2 75% 68% Category 4 (within 60 minutes) 2 70% 79% Category 5 (within 120 minutes) 2 70% 94% Median wait time for treatment in emergency departments (minutes) 2 20 14 Patient Off Stretcher Time (POST) Percentage of patients transferred from Queensland Ambulance 2,3 90% 89% Service (QAS) into the Emergency Department in 30 minutes

Emergency Department (ED) presentations increased by three percent in 2016-17 compared to last year4. This increase in demand placed pressure on our EDs particularly in locations where there is limited physical capacity to treat patients. Despite the increase in the number of presentations, facilities across the service achieved the target, or a result close to the target for the majority of ED performance indicators. Specific areas for improvement are outlined below, however performance against these measures was close to target or comparable with State averages: • 95 percent of Category 1 patients were seen in time, this was lower than both the State average of 99 percent and the SDS target of 100 percent • 68 percent of Category 3 patients were seen in time. This was better than the State average for this category at 62 percent although below the SDS target of 75 percent • 89 percent of patients were transferred from a QAS ambulance to the ED treatment area in less than thirty minutes (POST) almost reaching the State and SDS target of 90 percent.

ED presentations 200000

175000

150000

125000

100000 2013-14 2014-15 2015-16 2016-17 Increasing ED presentations trend: 3% increase in 2016-17 over 2015-16

36 DDHHS Annual Report 2016-2017 | Our performance To improve timely access to ED care, the DDHHS has completed or is currently undertaking significant refurbishments or extensions at three facilities to increase capacity to meet demand. When completed the improvements will provide improved patient care facilities and assist in meeting ED targets. These include: • A $3 million refurbishment of the Toowoomba Hospital ED which was completed in June 2017. This refurbishment increased the total number of treatment spaces from 21 to 30 to substantially improve capacity • A $3 million redevelopment of the Warwick Hospital ED is planned to commence in mid-November 2017 and will be completed by mid 2018. The new layout will include two additional treatment bays, a paediatric resuscitation bay, isolation room with ensuite and a mental health assessment room. Five existing examination rooms will be replaced with four assessment bays, one triage bay, one triage or QAS bay and a triage room • Nearly $1 million of improvements to the Kingaroy Hospital ED are planned to be completed in 2017-18 to improve patient flow and safety, as well as provide additional space for consultations and two extra examination bays. The improvements will ensure that Kingaroy Hospital ED continues to maintain a high standard of care whilst the hospital redevelopment is completed.

Specialist outpatient appointments provided in time

2016-17 Actual Service standards Notes 2016-17 Target Performance Percentage of specialist outpatients waiting within clinically recommended times: Category 1 (30 days) 2,5 98% 100% Category 2 (90 days) 2,5 95% 99% Category 3 (365 days) 2,5 95% 100%

The DDHHS maintained this achievement throughout 2016-17 to ensure that patients referred for specialist treatment were seen within clinically appropriate timeframes. Activity also increased with a six percent increase in attendances over the previous year. With 100 percent of category 1 and 3 patients and 99 percent of category 2 patients seen in time, the DDHHS has for two consecutive years ensured that almost all patients are seen in time. The DDHHS performed well above target for this measure and continued to outperform all other health services in the State. As at 30 June 2017, 6,441 patients were on the specialist outpatient waiting list, an increase of 1,631 from 30 June 2016. A total of 261,712 patients attended a specialist outpatient clinic in 2016-17, an increase of six percent over the previous year. Specialist outpatient appointments Total patients waiting for specialist presentations outpatients appointments 300000 8000 250000 6000 200000 150000 4000 100000 2000 50000 0 0 2013-14 2014-15 2015-16 2016-17 2015-16 2016-17 6% increase in specialist outpatient attendances in 2016-17 over 34% increase in patients requiring specialist outpatient appointments the previous year 2015-16.

Our performance | DDHHS Annual Report 2016-2017 37 Elective surgery provided in time 2016-17 Actual Service standards Notes 2016-17 Target Performance Percentage of elective surgery patients treated within clinically recommended times: Category 1 (30 days) 2 98% 100% Category 2 (90 days) 2 95% 100% Category 3 (365 days) 2 95% 100% Median wait time for elective surgery (days) 6 25 48

Elective surgery provided in time Statewide targets measure the percentage of elective surgery patients who receive their treatment within the clinically recommended timeframe for their urgency category. The DDHHS has maintained an excellent result by consistently exceeding targets since December 2013. This result was maintained in 2016-17 with 100 percent of patients treated in time. Achieving this result in conjunction with similar excellent results for surgical specialist outpatient wait times means that patients in the DDHHS are seen by a specialist and receive surgery (if they require surgery) in a clinically appropriate time. The median wait time for surgery in the DDHHS was 48 days, above the target of 25 days. This is as a result of a significant proportion of the people waiting for elective surgery being category 2 and 3 patients that require treatment within 90 or 365 days respectively. The DDHHS treated 6,428 patients for elective surgery in 2016-17. This is an eight percent decrease from the previous year as a significant amount of after-hours elective surgery was undertaken in 2015-16 to reduce the number of patients waiting for surgery. This additional activity was not required in 2016-17 to achieve the targets for elective surgery waiting times and the DDHHS’s focus is now on sustaining elective surgery provided within clinically recommended times. Gastrointestinal endoscopies 2016-17 Actual Service standards Notes 2016-17 Target Performance Percentage treated within the clinically recommended time for their category: Upper and lower gastrointestinal endoscopies treated in time 2 90% 100%

This was the first year that the DDHHS reported on performance against treatment time for gastrointestinal endoscopies as part of the Service Agreement. In 2016-17, 5,720 patients had an endoscopy, which is an increase of three percent over last year, with 100 percent of these patients receiving their procedure within clinically recommended timeframes. This is another outstanding achievement for the DDHHS, once again exceeding Statewide targets and achieving a high standard in healthcare delivery. Endoscopy patients treated 6000 5000 4000 3000 Cases 2000 1000 0 2015-16 2016-17 3% increase in the number of gastrointestinal endoscopies in 2016-17 compared to 2015-16

38 DDHHS Annual Report 2016-2017 | Our performance Safety and quality The DDHHS is dedicated to working towards reducing hospital acquired infection rates. The acceptable rate for healthcare associated Staphylococcus aureus bacteraemia infection is no more than 2 per 10,000 occupied bed days. The DDHHS performed well below this rate at 0.3 per 10,000 occupied bed days for 2016-172. Value for money Under the activity-based funding model, Weighted Activity Units (WAU) provide a common unit of comparison for all clinical activities so that hospital activity can be measured and costed consistently. In 2016-17 the DDHHS delivered 20 percent above the activity target which equated to $27.1 million in Commonwealth additional growth funding above base funding, based on National WAU (NWAU) targets and actuals. The DDHHS’s activity results are as follows: 2016-17 Actual Darling Downs Hospital and Health Service Notes 2016-17 Target Performance Total weighted activity units: 7 Acute Inpatient 47,136 52,010 Outpatients 11,901 10,504 Sub-acute 4,638 6,381 Emergency Department 15,482 17,392 Mental Health 8,680 27,868 Prevention and Primary Care 3,170 3,479 Efficiency measure Average cost per weighted activity unit (WAU) for Activity Based 8 $4,651 $4,579 Funding facilities

DDHHS exceeded 2016- 17 activity targets in almost all categories

Our performance | DDHHS Annual Report 2016-2017 39 Other key performance indicators The following table documents performance against the other key service standards defined in the SDS and Service Agreement with the Department of Health. 2016-17 Actual Service standards Notes 2016-17 Target Performance SDS standards: Mental Health Rate of community follow-up within 1-7 days following 9 >65% 72.8% discharge from an acute mental health inpatient facility Proportion of readmissions to an acute mental health inpatient 9 <12% 12.9% unit within 28 days of discharge Ambulatory mental health service contact duration (hours) 9 >72,612 92,454 Minimum Obligatory Human Resource Information (MOHRI) 2 4,011 4,215 Service Agreement standards: Access to oral health services – percentage of patients waiting less 2 100% 100% than two years Discharged Against Medical Advice (DAMA) 10,11 < 0.8% 1.2% Percentage of complaints resolved in 35 days 12 80% 96.7% Telehealth – number of non-admitted telehealth service events 2 6,247 7,090 Relative Stay Index (average length of stay) 2 1.00 1.02

Highlights or strategies the DDHHS is implementing to improve performance on indicators from the above table include: • Oral Health »» As at 30 June 2017, 100 percent of patients were waiting less than two years for dental treatment. This was the third consecutive year that this result was achieved demonstrating the DDHHS’s continuing commitment to delivering improved oral healthcare for residents in the region »» In 2016-17 the DDHHS exceeded the oral health weighted occasions of service (WOOS) target by three percent. This was still a reduction of 17 percent from 2015-16 activity levels due to significant additional work being undertaken to reduce the number of patients waiting for dental treatment not required in 2016-17 to achieve the target »» Oral health waitlist numbers increased in 2016-17 from 4,036 to 7,917 due to the very high numbers of patients being added to the list each month this year. Despite the increase in waiting list numbers, the forecast for 2017-18 is to maintain zero long waits. This will be achieved by monitoring the waiting list closely and ensuring that all patients are treated within two years. Oral health adult patients treated Patients on oral health waiting list 60000 8000 50000 6000 40000 30000 4000 20000 2000 10000 0 0 2013-14 2014-15 2015-16 2016-17 2014-15 2015-16 2016-17

40 DDHHS Annual Report 2016-2017 | Our performance • Telehealth achieved a 36 percent increase over and above the number of telehealth services delivered in 2015-16. Further detail on this achievement is provided in the following section under Strategic Objective 1 • In 2016-17 the DDHHS exceeded its activity target by 20 percent (based on NWAU); increased staffing to deliver this additional activity is the primary reason for exceeding the MOHRI full-time equivalent (FTE) target by 172 FTE. The opening of an additional ward at Toowoomba Hospital as a winter demand management strategy also contributed to the FTE increase. Despite being over the MOHRI target, the DDHHS delivered a balanced budget at year-end as the additional FTE is funded through growth funding revenue associated with the additional activity. • The DDHHS is undertaking intensive work to reduce Discharge Against Medical Advice (DAMA), particularly for Indigenous DAMA that has a target of 1 percent (the Indigenous DAMA rate in the DDHHS was 3.2 percent as at 31 March 2017). In May 2017, Toowoomba, Cherbourg and Warwick hospitals launched the Discharge With Medical Support strategy to support and monitor patients who discharge without meeting required criteria. This work is being undertaken in conjunction with Making Tracks project activities to reduce DAMA (see following section - Strategic Objective 1 for a complete list of Making Tracks projects) • A key performance indicator for measuring efficiency is the comparison of the average length of stay for identified procedures with the State average results. Overall the DDHHS Relative Stay Index was 1.02 compared to a target of 1.00 in 2016-17. While the DDHHS Relative Stay Index was slightly higher than the State average, the DDHHS achieved significantly lower average length of stays for specific surgical procedures while maintaining high-quality patient care. Length of stay results for laparoscopic cholecystectomy, and hip and knee replacements were 17 to 19 percent shorter than the State average. Focused efforts to improve clinical discharge process for procedure groups with above average length of stay are currently underway for implementation in 2017-18.

Continuing increase in demand The number of admissions to DDHHS facilities continues to grow at a rate much higher than the rate of population growth. In 2016-17 there was an eight percent increase in admissions compared to the previous year. Additionally, there was also a five percent increase in emergency surgeries this financial year. Research has found that poor health status is linked to socioeconomic position. A large proportion (30.6 percent) of our population is considered socioeconomically disadvantaged. Our ageing population, high incidences of chronic disease, along with decreasing rates in private health insurance contribute to a much higher growth in demand for health services over and above population increases alone. To ensure a sustainable service the DDHHS is implementing a number of innovations in keeping with our vision - To deliver excellence in rural and regional healthcare.

Admissions Emergency surgeries 100000 4000

90000 3000

80000 2000

70000 1000

60000 0 2014-15 2015-16 2016-17 2013-14 2014-15 2015-16 2016-17 Eight % increase in admissions in 2016-17 when compared with the Emergency surgery increased 5% in 2016-17 over the previous year previous year 2015-16 2015-16

Our performance | DDHHS Annual Report 2016-2017 41  More than 2940 babies were born in the DDHHS in 2016-17

Explanatory notes: The 2016-17 targets are as published in the 2017-18 SDS. Percentage results are rounded to the nearest whole percentage point. 1. Source: HBCIS/TALONS, excludes outsourced activity and counted as separations 2. Source: System Performance Report (SPR) Darling Downs HHS Performance Report Month 12 as at end of June 2017 3. Service Agreement key performance indicator 4. Source: EDIS and manual count from non EDIS sites. ED presentations include all admitted and non- admitted triage categories, did not wait, transfer presentations, died in ED, admitted and non-admitted return visit all triage categories 5. Statewide target for specialist outpatient appointments within clinically recommended time Category 1 = 98%, Category 2 = 95%, Category 3 = 95% (clinically recommended times are Category 1 = 30 days, Category 2 = 90 days and Category 3 = 365 days) 6. Source: Activity Costing and Evaluation Service (ACES) report developed from SATR 7. SDS breakdown reported in Queensland WAU (QWAU). Actual performance sourced from DSS ABF (New) 10/08/2017 for full year 2016-17. ‘Prevention and Primary Care’ is comprised of BreastScreen and Dental WAUs. 2016-17 Mental Health estimated actuals are higher than the 2016-17 actuals due to the statistical discharge of all long stay patients 8. Reflects 1 July to 31 December 2016 activity based costs and actual activity based funded activity. Total 2016-17 patient level costing not available until 30 September 2017 9. Source: CIMHA – POS Contact Delivery Mode Profile, HBCIS APP2, and Activity and Costing and Evaluation Service (ACES) report developed from Talons 10. DAMA target for Aboriginal and Torres Strait Islander patients is less than or equal to 1 percent and less than or equal to 0.8% for non-Aboriginal and Torres Strait Islander patients 11. Results as at 31 March 2017 from SPR. 30 June 2017 results not available at the time of publishing 12. Source: Prime CI and RiskMan.

42 DDHHS Annual Report 2016-2017 | Our performance Our performance indicators The DDHHS’s Strategic Plan 2016-2020 describes how the health service will provide quality care for the community, and includes our aspirations, strategies and measures of success. The DDHHS carefully monitors its achievements against these targets. Strategic objectives On 1 July 2016, the DDHHS’s new strategic plan came into effect with six new key objectives to replace the four objectives in the previous plan. The new objectives align with the five core directions of Queensland Health’s 10-year strategy for Queensland - My health, Queensland’s future: Advancing health 2026, which was released in May 2016. The strategic objectives are:

1. Deliver quality evidence-based healthcare for our patients and clients

2. Engage, communicate and collaborate with our partners and communities to ensure we provide integrated, patient-centred care

3. Demonstrate a commitment to learning, research, innovation and education in rural and regional healthcare

4. Ensure sustainable resources through attentive financial and asset administration

5. Plan and maintain clear and focused processes to facilitate effective corporate and clinical governance

6. Value, develop and engage our workforce to promote professional and personal wellbeing, and to ensure dedicated delivery of services

The following sections demonstrate our progress in 2016-17 against each of these objectives.

Our performance | DDHHS Annual Report 2016-2017 43  BreastScreen Toowoomba celebrate the 350,000th screen since the service commenced in July 1992.

The AACQA also conducted unannounced assessment Strategic objective 1 contact visits at all residential aged care facilities and all met the standards assessed on the day. Deliver quality evidence-based healthcare for our patients and clients Systematic Approach Facilitates Excellence The DDHHS has for the fifth consecutive year delivered (SAFE) Audit Program more healthcare than contracted under the service The SAFE audit program has been in place agreement with the Department of Health. In 2016-17 throughout the DDHHS since July 2014 and remains we provided 20 percent more activity than contracted one of the highpoints of the DDHHS clinical audit to improve access to health services in the region. program. The program engages management and This included meeting or exceeding targets for front line clinicians in assessing compliance against elective surgery, specialist outpatients, oral health, the NSQHS in Healthcare, the National Standards telehealth and endoscopy services. The strategic for Mental Health Services and Aged Care. SAFE objective to deliver quality evidence-based healthcare audits are conducted monthly and consist of six incorporates these healthcare priorities together theme-based modules which are complemented by with improvements in other program areas including a mini audit. Results are reviewed by all levels of mental health, breast screening and Closing the Gap. management and action plans put in place to address During 2016-17 there were a number of measures any areas falling below the agreed benchmark of 80 for these programs to assess the DDHHS’s overall percent. The SAFE program constantly evolves to performance against this strategic objective. assist in meeting and measuring new strategies.

Accreditation affirms safe and quality care. Prestigious partnership commences with The DDHHS underwent several accreditation Cognitive Institute assessments in 2016-17. This included a periodic review against the National Safety and Quality Health Service Standards (NSQHS), assessment against the National Mental Health Standards and a surveillance audit against the Australian Standard/New Zealand Standard International Standards Organisation (ISO) 9001:2008. The DDHHS achieved ongoing certification, receiving a “met with merit” status against NSQHS Standard In early 2017 the DDHHS entered into a long-term 2.1.1 “Consumers and/or carers are involved in the partnership agreement with The Cognitive Institute to governance of the health service organisation”. The become a Safety and Reliability Improvement Partner. Institute of Healthy Communities Australia conducted The Cognitive Institute is an international provider of the assessments over a two week period in April 2017 healthcare education that is renowned for delivering against all facilities within the DDHHS. targeted training focused on improving patient safety The Australian Aged Care Quality Agency (AACQA) and driving culture change. Partnership with The undertook several audits against the residential Cognitive Institute is prestigious with only seven other aged care facilities within the DDHHS. Two facilities Safety and Reliability Improvement Partners selected underwent full re-accreditation assessments of the four to join its exclusive group of partner healthcare standards and 44 outcomes and both were successful organisations. in gaining accreditation for a further 3 year period.

44 DDHHS Annual Report 2016-2017 | Our performance The Safety and Reliability Partnership will drive a quantum leap in the delivery of safe and reliable healthcare across the DDHHS through its focus on organisational culture, leadership, reliability science and high- performance work practices. Commencing in 2017 the Safety and Reliability Improvement Programme will be delivered over four phases: 1. Needs analysis 2. Leadership development 3. Improvement projects 4. Accountability.

Prevention – Breast cancer screening The BreastScreen Queensland Toowoomba Service (BreastScreen Toowoomba) provides breast cancer screening services to women in Toowoomba and the surrounding regions. On 23rd January 2017, the service celebrated its 350,000th screen since the service opened in July 1992. BreastScreen Toowoomba successfully relocated from the Toowoomba Hospital campus to a new facility in the Toowoomba Central Business District, which was officially opened in August 2016. The new location has been well received by clients with its modern spacious fit-out and free and ample car parking for clients and staff. A mobile service is also available and provides screening to women in rural centres of the DDHHS, as well as women outside the DDHHS (Windorah within the Central West Hospital and Health Service, major centres in South West Hospital and Health Service and Gatton in the West Moreton Hospital and Health Service). The service introduced an online booking system in December 2016 as an innovative tool to improve access to services. Since the introduction of this innovation, 12% of BreastScreen Toowoomba clients have booked their screening appointment online. Digital breast tomosynthesis is the latest advancement in mammography. It creates a three dimensional picture of the breast using x-rays allowing enhanced assessment and diagnostic work-up. In 2016-17 there were a number of technological and equipment improvements made to the BreastScreen Toowoomba equipment including the addition of tomosynthesis capability: • Upgrade of the Siemens mammography machine to tomosynthesis capability at a cost of $75,000 with the funds generously donated by the Toowoomba Hospital Foundation • Installation of new Hologic tomosynthesis mammography machine • 2 new ultrasound machines. The breast screening target for total number of annual screens was exceeded in 2016-17 and represented the highest number of women ever screened since the service commenced 25 years ago. This achievement together with other highlights are summarised in the table below: 2016-17 Actual Key performance indicator Notes 2016-17 Target Performance Total number of breast screens performed: 19,000 19,037 Service highlights: • 10,188 mobile screens • 8,849 Toowoomba static site • 563 indigenous women screened (highest annual achievement since the service began 25 years ago) • 89% women screened have been screened by the service previously and the remaining 11% are new patients to the service • 1,721 out of hours screens (outside Monday to Friday, 8.00am to 5.00pm) conducted by BreastScreen Toowoomba, significantly exceeding the target of 906 out of hours screens • 1,058 of the women screened had further investigations and approximately 123 women were referred for definitive treatment.

Our performance | DDHHS Annual Report 2016-2017 45 Aged Care Cluster highlights Aged Care Assessment Team exceeds national key performance benchmarks The Aged Care Assessment Team (ACAT) undertakes assessment and provides information and support to older people and their carers to obtain a range of Commonwealth funded services. The team provides: • Assessment and care coordination for individuals and carers to enable clients to remain living at home or to enter an aged care residential home • Individual, carers and group education to enhance knowledge and skills for management of people with dementia • Analysis of service needs and gaps to contribute to the development of local and regional aged care community services.

2016-17 Actual Key performance indicator Notes 2016-17 Target Performance National ACAT Key Performance Indicator 1 Referrals issued to action (including self-referrals for comprehensive aged care assessments) are actioned 90% of referrals 98.8% (accepted or rejected) within 3 calendar days of issue National ACAT Key Performance Indicator 2 First clinical intervention of clients for high priority ACAT 90% of referrals 96.4 % referrals (within 2 calendar days) First clinical intervention of clients for medium priority ACAT 90% of referrals 96.9% referrals (within 14 calendar days) First clinical intervention of clients for low priority ACAT 90% of referrals 99.5% referrals (within 36 calendar days)

Community Care and Transition Care Programs The DDHHS cares for nearly 300 people a day in our residential aged care facilities (RACFs) or multipurpose health services (MPHSs). 2016-17 brought about changes to Aged Care and Community Care services with our under 65 clients and Disability Services Queensland clients moving to the National Disability Insurance Scheme (NDIS) at the end of May 2017. Home Care Packages also became mobile at the end of February 2017 enabling clients to choose their own provider.

2016 Transition Care Program 10 year celebration

46 DDHHS Annual Report 2016-2017 | Our performance Other highlights Mental Health Alcohol and Other Drugs • The Transition Care Program celebrated 10 years of Division highlights service in 2016-17. They also received a total of 91 compliments in the year Tackling Regional Adversity through • Residents, families and staff greatly appreciated Integrated Care (TRAIC) Mental Health Alcohol the garden improvements at The Oaks RACF in and Other Drugs Warwick. The garden improvements provide a The DDHHS has successfully received $296,937 of friendly and welcoming environment for residents ongoing annual funding for the TRAIC program. With and staff and are all part of the DDHHS’s efforts to this funding, the DDHHS has appointed a Regional ensure continued accreditation of our services Adversity Integrated Care Clinician (RAICC) in April • The Oakey Hospital and Dr EAF McDonald 2016 who has taken the lead role across the DDHHS to Nursing Home won the open garden for a rural coordinate improved support for frontline emergency hospital or nursing home division as part of the department staff working with people experiencing Toowoomba Regional Council’s Carnival of Flowers suicidal behaviour and feelings. The Suicide Risk in September 2016. The gardens also became Assessment and Management in Emergency the venue for the wedding of two longstanding Departments (SRAM-ED) is a Statewide developed and hospital staff members, with all residents locally run program that aims to provide improved care delighted to be able to celebrate the event for people at risk of suicide. The appointment of the • Mt Lofty Heights Nursing Home’s therapy RAIIC has ensured that the DDHHS TRAIC program has dog, Sammy featured on national television delivered on all performance requirements in 2016-17. demonstrating the benefits to resident care that a pet therapy dog can provide. Unfortunately Sammy Independent Patient Rights Advisers for mental died in May 2017 and a memorial service was held health clients to celebrate the valuable role Sammy had as a The DDHHS recruited two Independent Patient Rights therapy pet Advisers in 2017 to support people in the DDHHS and • Mt Lofty Heights Nursing Home, Dr EAF McDonald South West Hospital and Health Service (SWHHS) Nursing Home (Oakey), Millmerran MPHS and using mental health services. The appointments Milton House RACF (Miles) collectively won the were made in accordance with the Mental Health Act Better Practice Award 2016 from the Australia 2016 and relevant Queensland Health policies with Government Aged Care Quality Agency for their dedicated State funding provided for these positions. entry on Maintaining Mature Mouths using Teledentistry. Maintaining Mature Mouths using Acute Mental Health Unit goes tobacco free Teledentistry is an innovative model of care 2017 saw the Acute Mental Health Unit go tobacco enabling DDHHS RACF residents to have oral free with a no handling of tobacco products policy. checks and dental reviews via a live streaming Extensive consumer education and the use of videoconference appointment with a dentist. The evidenced-based approaches to nicotine replacement integrated approach between DDHHS’ Oral Health therapy are used to support people to stop smoking. Clinic, Telehealth team, four RACF’s, as well as This approach was recently showcased as a leading residents and their families, allows residents to example of enhancing patient care at the Department receive optimal dental care while remaining in of Health’s Clinical Excellence Division Innovation their own surroundings, eliminating the need for Showcase in May 2017. frail residents to be transported to the oral health clinic via ambulance with a nurse escort. Closing the Gap One of the DDHHS’s strategies is to deliver Aboriginal and Torres Strait Islander health and support services in line with Closing the Gap to improve the health outcomes of Aboriginal and Torres Strait Islander people. This commitment aligns with the Queensland Government Making Tracks towards closing the gap in health outcomes for Indigenous Queenslanders by 2033: Policy and accountability framework (2010).

Our performance | DDHHS Annual Report 2016-2017 47 The DDHHS was successful in obtaining $1.79 million »» 68% of community members are able to under the Making Tracks investment strategy 2015- understand the health information given by staff 18 for nine projects to implement evidence-based »» 69% of community members feel comfortable initiatives that will address the health gap. when they have to come to the hospital for Achievements in 2016-17 for each of the projects include: appointments Queensland Health Aboriginal and Torres Strait • The DDHHS Aboriginal and Torres Strait Islander Islander Cultural Capability Framework Health Forum is held quarterly to give Aboriginal • The DDHHS Cultural Capability Action Plan 2017-20 and Torres Strait Islander Health staff an was developed in June 2017 for implementation opportunity to highlight their successes, gain over the period July 2018 to June 2020. The plan knowledge of other programs and projects within consolidates existing cultural capability activities the DDHHS and community organisations, to within DDHHS, as well as introducing a number of network with their peers and community-based innovative projects focused on building Aboriginal staff from services outside of the DDHHS and and Torres Strait Islander workforce and leadership. Aboriginal and Torres Strait Islander community The DDHHS will expand on current models of care members and improve cultural competence of the health • National Aboriginal and Islander Day Observance workforce, including recruitment and retention of Committee (NAIDOC) observance activities were held Aboriginal and Torres Strait Islander people in the first week of July 2016. 23 DDHHS facilities • Ward signs were erected in June 2017 at Toowoomba hosted a NAIDOC event to assist in breaking down Hospital incorporating Aboriginal designs to barriers for Aboriginal and Torres Strait Islander demonstrate cultural recognition and build rapport people accessing DDHHS facilities and celebrating with Aboriginal and Torres Strait Islander people the history, culture and achievements of Aboriginal visiting the Toowoomba Hospital. It is a visual way of and Torres Strait Islander people. indicating that Aboriginal and Torres Strait Islander Indigenous Multi-disciplinary Care Team – people are welcomed by the health service and this Toowoomba Hospital is a safe place for them to be • The team delivered culturally and clinically • The DDHHS held the National Close the Gap Day effective dietetics, pharmacy and podiatry expo in Toowoomba on 16 March 2017 to improve services to Aboriginal and Torres Strait Islander understanding of Indigenous Health with staff. people to improve the early detection, treatment The expo provided an opportunity for DDHHS staff and management of chronic diseases, and to learn about holistic health care and programs reduce the rate of potentially preventable addressing the social determinants of health. One hospitalisations and readmissions for chronic of the aims is to improve the rate of Discharge disease-related conditions. This service is Against Medical Advice (DAMA). High rates of provided to Aboriginal and Torres Strait Islander DAMA show that Aboriginal and Torres Strait people presenting to Toowoomba Hospital with Islander people do not feel culturally safe in our a chronic disease or at risk of chronic disease. facilities. By breaking down barriers, myths about Achievements in 2016-17 include: bad experiences, and the stigma attached to »» Pharmacy - 360 occasions of service including hospitals with Aboriginal and Torres Strait Islander 37 medication reviews and 83 smoking community members, it will enable DDHHS to cessation interventions improve DAMA statistics »» Podiatry - 372 occasions of service including • A cultural audit of 406 DDHHS staff and 121 50 new foot protection program plans community members was completed in 2016-17. »» Dietician - 204 appointments including 33 Results demonstrate that: weight reduction and 32 type 2 diabetes »» 88% of staff had completed the cultural mellitus weight reduction plans. awareness survey »» 54% of staff implement welcome to country and acknowledgement of country at meetings and forums

48 DDHHS Annual Report 2016-2017 | Our performance South Burnett Indigenous Hospital Liaison Service • Achievements in 2016-17 include: • In 2016-17 the rate of Indigenous admissions »» Monthly chronic kidney disease clinics with was 22 percent at Kingaroy Hospital. To ensure renal nurse practitioner and Indigenous health culturally-appropriate services are provided, two care workers Indigenous Liaison Officers see every patient »» Telehealth chronic kidney disease and on admission and are involved in their inpatient haemodialysis clinics and reviews stay and follow up care. This service improves »» Plan for commencement of services from two the patient journey and continuity of care by renal chairs at Cherbourg Hospital implementing comprehensive gender specific »» Increased capacity for self-dialysis at Kingaroy culturally-safe and coordinated case management Hospital from 12 to 18 clients. and referral pathways across all entry and exit points into and out of the Kingaroy Hospital, Cherbourg Young Parent Support Service including liaison with Cherbourg Hospital and • The service delivered comprehensive culturally- community health services. appropriate and responsive community based antenatal, intrapartum, postnatal and early Indigenous Alcohol, Tobacco and Other Drugs parenting care to Aboriginal and Torres Strait (ATODS) Youth Program (Cherbourg) Islander young women to improve infant and child • In 2016-17 the Youth ATODS Program in Cherbourg health outcomes. Achievements include: provided practical support to young Aboriginal » and Torres Strait Islander people at risk of harm » Services provided to 129 clients for antenatal from drug and alcohol use. The program delivers and postnatal services alcohol, tobacco and substance misuse harm »» From 1 January 2017 to 30 June 2017, 92 percent prevention, early intervention and treatment of babies born to mothers attending the service services to reduce the uptake and rates of harm were above the standard 2500g at birth – this caused by alcohol consumption, smoking and is an increase on the previous 6 month’s the use of illicit substances and inhalants by achievement (77 percent). Aboriginal and Torres Strait Islander young people. Outreach Maternal and Infant Health Service Achievements in 2016-17 include: (Boomagam Caring) »» Volatile substance program – 1,077 recorded • Provides comprehensive, culturally-appropriate, occasions of service and responsive community-based antenatal, »» Breakfast program – 2,081 occasions of service postnatal and infant care services to pregnant »» Health Promotion 62 occasions of service Aboriginal and Torres Strait Islander women to »» Counselling 165 occasions of service. reduce mortality in Aboriginal and Torres Strait Islander infants aged 0 to 6 weeks. The service South Burnett Renal Services Expansion is located in Toowoomba and surrounding areas • The objective of the expansion is to increase within a thirty minute radius and provided to access to specialist renal services and delay the pregnant and parenting Aboriginal and Torres onset of end stage renal disease by increasing the Strait Islander women, with a particular emphasis number of dialysis chairs available at Kingaroy towards those under 20 years old. Approximately and Cherbourg Hospitals and implementing a 10.4 percent of births (equivalent to 200 births) nurse practitioner model of care to improve the in Toowoomba Hospital are to Aboriginal and early detection, treatment and management of Torres Strait Islander mothers). Achievements in Aboriginal and Torres Strait Islander people with 2016-17 include: chronic kidney disease. »» 2,269 occasions of service

»» 100% Boomagam Caring Outreach Midwifery

Service clients receiving five or more health

checks over the reporting period

» » 96 clients provided with midwifery care plans for both antenatal and postnatal periods.

Our performance | DDHHS Annual Report 2016-2017 49 Maternal Child and Youth Health Workforce • A 3 month trial of a telepharmacy service commenced Development Program in April 2017. The trial involved a pharmacist • The program delivers high-quality workforce receiving referrals from those rural facilities without training to Maternal, Child and Youth health staff a pharmacist and the provision of inpatient and to improve service delivery for young people’s outpatient medication consultations. A total of transition to adulthood and reduce mortality in 72 patients were seen as part of the trial which Aboriginal and Torres Strait Islander children aged has improved access to medication reviews 0 to 4 years. Workforce development programs and assessment in rural areas demonstrating have been implemented across a range of areas. that telehealth is a viable mode of delivery for The Cunningham Centre Workforce Division enhancing access to pharmacy services in rural oversees the governance of the Queensland areas. The trial is currently being evaluated and Aboriginal and Torres Strait Islander Maternal, considered for full implementation. Child and Youth Health Workforce Development • The Telehealth Emergency Support Unit (TEMSU) Program in collaboration with key stakeholders. nursing model was introduced in December 2016. Acute Mental Health Indigenous Health Liaison This model provides emergency nursing support via • In 2016-17, 571 occasions of service were provided telehealth for DDHHS rural and regional facilities 24 by this service including a range of mental health hours a day, 7 days a week. There were 53 telehealth hospital liaisons, case coordination assistance consultations in total in 2016-17. Development of a to Aboriginal and Torres Strait Islander patients medical model is currently in progress with plans to with mental illness accessing Toowoomba Hospital commence implementation of this model in late 2017 and related services (including their families and • A Pastoral Care Telehealth Outreach service has been carers). provided to DDHHS rural hospitals. This has included the coordination of a video conference for a Buddhist The aim of the service is to: palliative care patient with a Buddhist Nun providing »» Improve the patient journey and continuity of in-service advice to nursing staff and individualised care by implementing comprehensive, culturally support to the patient. The recipients of this session safe and coordinated case management and expressed their gratitude for both the support and referral pathways across the continuum of care advice provided. A patient who was unable to leave and all entry and exit points into and out of Toowoomba Hospital was also able to ‘attend’ her DDHHS hospitals father’s funeral in Windorah (700kms away) through »» Implement strategies to reduce the rate of live streaming of the funeral to an electronic tablet Discharge Against Medical Advice for Aboriginal device at her bedside. These are significant examples and Torres Strait Islander patients accessing the of how our staff care for and support our patients to Toowoomba Hospital. receive a holistic patient care experience. Telehealth highlights Telehealth presentations patients treated In 2016-17 the DDHHS delivered 36 percent more 8000 telehealth services against a target of 20 percent more service events than provided in the previous year. Highlights of this year’s achievements include: 6000 • Telestress testing commenced in April 2017 with Toowoomba Clinical Measurements as a recipient 4000 site and the Royal Brisbane and Women’s Hospital (RBWH) cardiac scientist and cardiac registrar 2000 as the service provider. Since commencement of the service 128 patients have received a stress test under the guidance of the team at the RBWH 0 2013-14 2014-15 2015-16 2016-17 resulting in patients being able to receive the necessary testing that they require closer to home 36% increase in telehealth presentations 2016-17 over the previous year 2015-16

50 DDHHS Annual Report 2016-2017 | Our performance New tele-chemotherapy service commences at Dalby Hospital Dalby Hospital was selected as a pilot site for a new tele-infusion and supportive therapies service to provide chemotherapy services closer to where patients live, reduce patient travel time, and minimise disruption to their family and work routines. The service commenced in November 2016 with patients receiving stage 1 chemotherapy and supportive therapy at Dalby Hospital with assistance from an Oncologist and nurse from Toowoomba Regional Cancer Centre using videoconferencing facilities. Staff at Dalby Hospital were trained at the Toowoomba Regional Cancer Centre prior to the trial commencing. Patient feedback on this new service has been overwhelmingly positive and as a result the service delivery model will be extended to other sites in the DDHHS in the 2017-18 financial year. Patient at Dalby Hospital uses videoconferencing to speak with his oncologist. Nurse Navigator Program The nurse navigator initiative is a four year Hospital in the Nursing Home and Acute government commitment to increase nursing Geriatric Service resources between 2016 and 2019 by funding dedicated nurse navigator positions across the In July 2016-17 the pilot of the nurse navigator State’s Hospital and Health Services. In 2016-17, aged care model (Hospital in the Nursing Home) the DDHHS appointed nine nurse navigators with a commenced with the appointment of a nurse further ten scheduled to be appointed by late 2017. navigator to the Acute Geriatric Service Toowoomba Nurse navigators support and work across system Hospital. Services provided by the Hospital in the boundaries in close partnership with multiple health Nursing Home include: specialists and stakeholders to ensure patients • ‘Virtual admission’ of RACF residents allowing receive appropriate and timely care. Nurse navigators acute care to be provided under a Geriatrician are highly experienced and have an in-depth within their nursing home supported by the understanding of the health system to assist patients nursing practitioner with complex health conditions. The core functions • A telephone triage service providing advice to of the DDHHS Nurse Navigators are shown in the RACFs prior to a potential hospital admission, in diagram below. consultation with the patient’s GP • Organisation of an acute response team to attend

rs the RACF if required following a referral from a GP to ga vi a or RACF N Access e s r logistics u Monitoring • Education and support to RACFs and N and evaluation of care Education/ communication and partnerships with GPs. outcomes health literacy As a result of the pilot there have been decreased presentations to EDs and a reduction in preventable Self Management Patient hospital admissions by improved early management Support Strategy Care path of a deteriorating patient. There has also been a transitions significant reduction in length of stay for readmissions of this patient group. In 2017-18 the service will be Advocacy Referral expanded to include four nurse navigator positions providing services to all aged care facilities in the DDHHS region.

Our performance | DDHHS Annual Report 2016-2017 51  DDHH Board Chair Mr Mike Horan AM speaking at the inaugural DDHHS Community Information Expo.

Birthing Services The function of the Maternity and Birthing Advisory There were five percent fewer babies born in the DDHHS Group is to develop a health service wide Maternity in 2016-17 compared to 2015-16. The decrease was and Birthing Services Plan for 2016-2020. The Plan relatively evenly distributed across the health service will develop a consumer focused model of care with most hospital locations reporting fewer births. promoting consistency of safe practice using a collaborative approach. The plan will address the Babies born in the DDHHS 2016-17 challenges of providing safe maternity and birthing services for a population with an increasing risk Hospital Location Births profile due to health issues. Toowoomba 2,013 Remoteness, culturally appropriate services, Kingaroy 333 workforce, access and infrastructure were issues Warwick 163 identified at the forum to be included in the development of the plan. Dalby 173 Stanthorpe 110 New renal dialysis service opens at Dalby Goondiwindi 97 Hospital Chinchilla 51 Prior to 2017, Dalby Hospital provided intermittent Cherbourg, Miles, Millmerran 9 and limited renal services with one dialysis machine for self-caring haemodialysis patients. Total 2,949 Few patients requiring dialysis met the required Total births since 2014-15 criteria for this service and most patients in the Western Downs requiring haemodialysis needed to 3500 travel to Toowoomba three times a week to receive 3000 their treatment. 2500 In January 2017 the DDHHS commenced a new renal dialysis service at Dalby Hospital by training nursing 2000 staff to deliver haemodialysis to relatively stable 1500 patients three days a week (Monday, Wednesday and Friday). Up to four patients a day can be treated 1000 using both the morning and afternoon sessions. 500 Three new dialysis machines were purchased to 0 support the service. 2014-15 2015-16 2016-17 The Toowoomba Hospital Renal Unit provided initial training for Dalby Hospital nursing staff working in 5% reduction in births in 2016-17 compared to 2015-16 the unit and continues to provide valuable support and education to the Dalby Hospital Renal Unit and Maternity and Birthing Advisory Group regular Telehealth consultations. The Toowoomba The recommendation to form a Maternity and Hospital Renal Educator makes routine visits to Birthing Advisory Group was a key outcome from the Dalby Hospital to support nursing staff. Patients who Maternity Services Forum held on 21 June 2016. The previously spent time travelling for their dialysis DDHHS Executive Management Committee endorsed treatment are now able to spend that time on daily the establishment of the Maternity and Birthing living activities in their local community. Advisory Group in July 2016.

52 DDHHS Annual Report 2016-2017 | Our performance Strategic objective 2 Engage, communicate and collaborate with our partners and communities to ensure we provide integrated, patient-centred care The DDHHS completed a number of actions in 2016-17 to support this strategic objective. The measures of success listed in the DDHHS Strategic Plan 2016-20 include: • We will establish and facilitate an engaged and effective consumer advisory council • We will coordinate meetings and jointly plan with the Darling Downs West Moreton Primary Health Network (DDWM PHN) and community-controlled Aboriginal and Torres Strait Islander health services • We will hold meetings between community groups and the Board at least monthly • We will disseminate information and communicate updates about our activities to inform the community and our partners Included in the Our governance section of this report is an extensive list of community meetings that DDHHS Board members attended in 2016-17, demonstrating the Board’s commitment to this strategic objective. In addition to the Board activities, staff throughout the DDHHS proactively engage with community and consumers on a regular basis. The information below provides a summary of how these actions demonstrate support for this strategic objective this year.

Gail Capewell, Kayleen Wallace and Anne Doyle at the Toowoomba Hospital Closing the Gap Day Health Expo

Our performance | DDHHS Annual Report 2016-2017 53 Consumer and community engagement Consumers The DDHHS has 39 consumer representatives involved in 21 committees across the DDHHS. engaged Consumers have been engaged through various committees and advisory groups: • DDHHS Consumer Council • Toowoomba Hospital Management Committee • Toowoomba Hospital Patient Safety and Quality Committee • Reducing Harm Committee • Toowoomba Hospital Consumer Advisory Committee • Consumer Communication Committee • Consumer Publication Review Group • Maternity and Birthing Advisory Group • Floresco Advisory Group • Domestic and Family Violence Working Group • Human Research and Ethics Committee • Diabetes Model of Care Project Group • NDIS Reference Group • Nurse Navigator working groups • Rural Division Management Committee • Goondiwindi Hospital Indigenous Advisory Working Party • Cherbourg Health Action Group • Stanthorpe Community Consultative Committee • Texas Community Advisory Network • Millmerran MPHS Community Advisory Network • Tara Health Community Consultative Committee Issue-specific consumer engagement has occurred in various models of care, including: • Diabetes model of care • Aged care model of care • Stroke model of care. Consumer • DDHHS & DDWMPHN hosted a collaborative Community Information Expo in Toowoomba in engagement June 2017 with 51 exhibitors activities • Pittsworth Bi-annual Health and Wellness Expo held in April 2017 in collaboration with DDHHS and Toowoomba Regional Council • Closing the Gap – Indigenous Health Expo held in March 2017 • Mental Health consumer and carer advisory forums held in Stanthorpe, Kingaroy and Dalby • A carer volunteer program was established at the acute mental health unit to assist families to connect with relevant support services • Regular communication through the media about our services and how consumers can access these services • Patient information brochures updated • Increased partnerships with DDWM PHN and local governments • Patient discharge surveys conducted by volunteers via an iPad • This year saw the establishment of a Consumer and Community Engagement Officer role in April 2017 • Mental Health staff members invite consumers to participate, in the Statewide Your Experience of Service (YES) survey instrument. Good governance • Health service governance processes and structures have been developed and implemented, including a consumer and community engagement strategy, consumer engagement policy, consumer feedback procedure, consumer publication management procedure, staff tools and resources • These resources guide how we engage and collaborate with our consumers to provide enhanced healthcare services.

54 DDHHS Annual Report 2016-2017 | Our performance Consumer and community engagement Patient experience • A variety of patient experience feedback mechanisms have been implemented and made available to all patients throughout the health service in 2016-17. These mechanisms enable patients, their family and carers to provide feedback on their experience across the health service • Numerous patient experience surveys have been undertaken by units across all areas of the health service • Survey data has been analysed to drive quality improvement. Education and • Staff and consumer representatives have participated in Health Consumers Qld (HCQ) training Training • Staff and consumer representatives attended the HCQ Annual Forum to build awareness and knowledge of engagement activities and programs across the State • Consumer representatives are provided orientation to assist in the function and purpose of their roles. Patient feedback • 3,560 compliments • 1,651 complaints • Ratio of 2:1 of compliments to complaints • 98.4% of complaints acknowledged in 5 calendar days and 96.7% resolved within the state- wide benchmark of 35 days.

DDHHS action in response to complaints The DDHHS takes seriously any complaint about our service including staff conduct. In 2016-17 the majority of complaints were resolved with an acknowledgement of concern or an apology. Some complaints required further action such as a policy or procedure change, staff training or provision of a service such as a second clinical opinion. Of the 1,651 total complaints received, 115 required further action over and above an acknowledgement of concern, or an apology.

DDHHS volunteer Margaret Goodman and consumer representative Dr Jim Madden at the Consumer Engagement morning tea 28 February 2017.

Our performance | DDHHS Annual Report 2016-2017 55  Toowoomba Hospital speech pathologist Madeline Dawson, pictured with patient Mrs Lorna Rickert, won the statewide ‘Leaders in Speech Pathology – new graduate quality improvement award’ for the development of an easy- to-read version of the Australian Charter of Healthcare Rights

Allied Health innovation – Australian Charter of The alternate version of the Charter has been rolled Healthcare Rights out for use across all DDHHS facilities, community The Australian Charter of Healthcare Rights describes services and outreach facilities and is provided the rights of patients, consumers and other people on admission to the health service, in consumer using the healthcare system and was developed by information packs, displayed in waiting rooms and The Healthcare Commission on Safety and Quality at each bedside for patients to read. in Healthcare in 2008. The Charter is provided to all Madeline presented this project at the DDHHS’s consumers on admission or entry into a hospital or Allied Health Showcase in March 2017. This project health service. In January 2017 one of the DDHHS’s was also showcased on local radio and television Speech Pathologists, Madeline Dawson, developed media and Madeline was awarded the Statewide an alternative version of the Australian Charter of “Leaders in Speech Pathology – new graduate Healthcare Rights as the way the current Charter quality improvement award”. This new Charter is written is hard for people with age-related or has also been adopted by Logan Hospital, Mackay acquired communication and/or cognitive difficulties Hospital and Lady Cilento Children’s Hospital. to read. The new version of the Charter presents the information for all consumers in an easily understandable format, whilst reflecting the same Aged Care – Community engagement highlights key patient rights. Patient feedback on the alternate Wondai Hospital and Forest View RACF staff actively version has been overwhelmingly positive. engage with their local community to build close relationships. Activities in 2016-17 included: • Wondai annual fete run by the hospital auxiliary with all members of the community invited to attend. The fete this year was opened by the South “I definitely think Burnett Regional Council Mayor and Councillors, the new version is the DDHHS Board Member (Cheryl Dalton) and the better of the two” Director of Nursing of Wondai • Mutual exchange of invitations with the local childcare centre to shared functions • Providing opportunities for school students and TAFE students to have work experience including ‘a project’ to complete “The writing is a lot bigger, • Inviting the local Kingaroy bike club to visit twice you can see everything to have morning tea with the residents. much more clearly and it’s far easier to read.” (102 year old inpatient, name withheld)

56 DDHHS Annual Report 2016-2017 | Our performance Mental Health Alcohol and Other Drugs Division • Introducing a revised Police Ambulance achievements Intervention Plan (PAIP) to improve interagency The Division continues to support engagement coordination and support to people experiencing and collaboration with consumers, carers and the complex mental health problems in the community. community including: Planning for the future – Toowoomba Hospital • Participating in the Queensland Mental Health Commission’s recent regional consultation days redevelopment consultation regarding the review of the Queensland Mental In August and September of 2016, the DDHHS Health, Drug and Alcohol Strategic Plan 2014-2019. invited both staff and the community for their input This included both a general community workshop regarding future planning and redevelopment and a specific lived experience workshop options being considered for Toowoomba Hospital • Supporting strong family and carer engagement to meet the growing healthcare needs of the through the introduction of a volunteer carer population. The options being considered include: support service in the Adult Acute Inpatient Unit. 1. A staged redevelopment of Toowoomba Hospital As part of this service experienced carers are on 2. A new “greenfield” hospital built at Baillie hand most afternoons during visiting hours to Henderson Hospital provide information and support 3. A hybrid model which would see acute services • The Alcohol and Other Drugs Service ran several provided at Baillie Henderson and subacute community family drug support workshops in service at the Toowoomba Hospital campus. 2017 to help staff better understand supports Community and staff information sessions were required by families and carers of people who use held over two months culminating in a survey on drugs. Family Drug Support education included a the three proposals and the feedback received carers evening session being included in a preliminary business case that • Continuing to facilitate and support a number was submitted to the Queensland Government. of mental health Consumer and Carer Reference The DDHHS has received $3 million in the 2017-18 Groups throughout the region financial year to develop a more detailed business • Engaging an Indigenous Liaison Officer in the case on the options to enable the government Adult Acute Mental Health Unit to support to make a final decision on the best option for consumer and family engagement through the Toowoomba and the Darling Downs region. Making Tracks Program

A volunteer carer support service was introduced in the Adult Acute Inpatient Unit at Toowoomba Hospital

Our performance | DDHHS Annual Report 2016-2017 57 In 2016, the selection process for 2017-18 host sites Strategic objective 3 was conducted and 11 host sites were selected. Positions for 2017-18 are located across eight Demonstrate a commitment to learning, HHSs, and include one or more positions from research, innovation and education in the professions of dietetics, medical imaging, rural and regional healthcare occupational therapy, pharmacy, physiotherapy, podiatry and social work. A range of educational and training activities occurs throughout the DDHHS. Our leading Allied Health HP3 to HP4 Rural Development education centre, the Cunningham Centre, Pathway delivers a wide range of high quality programs The Allied Health, Health Practitioner’s (HP)3 throughout Queensland in areas such as allied to HP4 Rural Development Pathway is a human health, medicine and nursing with experienced resource and workforce development strategy and accredited trainers. Since its establishment, jointly coordinated by the Cunningham Centre and the Centre has been involved in high-quality the Allied Health Profession’s Office of Queensland training, education, research and support of health (AHPOQ). The pathway provides a recruitment personnel in Queensland. strategy for health services and an intensive Cunningham Centre rural and remote support development plan for practitioners that are tailored and education highlights to rural and remote practice requirements. The second participant to successfully complete Allied health rural generalist pathway the pathway finished in September 2016, and The allied health rural generalist pathway is a key two further participants are mid-way through the strategy to progress the sustainability and value pathway, having successfully completed their derived from Queensland’s rural and remote allied annual external evaluations in April 2017. A major health workforce. This initiative provides funded component of the pathway is a suite of learning supernumerary graduate positions for rural or resources. Stage 1 and 2 support modules are remote allied health teams. It aims to support early available online with some stage 3 and 4 also career rural and remote workforce development available online. Although tailored to rural and and to assist teams to implement rural generalist remote services, these online resources are service redesign and development. valuable for allied health practitioners in regional or A key component of the allied health rural generalist metropolitan settings. pathway is a structured education program Telehealth education which supports capability development for rural allied health practice. In 2016-17, an education An online training program was developed and provider was sought to develop and implement launched by the Cunningham Centre in March a two-level program. James Cook University and 2017. The program is designed in three sections: the Queensland University of Technology were service redesign, clinical examples and telehealth successful in this regard, and the Rural Generalist resources. Since the launch, 77 Queensland Health Program (Level 1 program) opened for enrolments staff have accessed the training program. in May 2017. Allied Health Rural Generalist Training Administration of the Telehealth Network and Positions in Queensland Health, as well as other presentation series transitioned to the Cunningham states, will be participating in this program during Centre in late 2016. The network currently has 165 2017-18. It is anticipated that the Graduate Diploma members. There have been four presentations in Rural Practice (Level 2 program) will be offered in 2017 with a total of 50 videoconference sites from early 2018. registered. Topics have included presentations Ten allied health rural generalist training positions on occupational therapy hand therapy, were implemented in rural and remote locations in teleradiography, pharmacy and multidisciplinary 2016, and outcomes of these positions were presented persistent pain management. at an implementation showcase in May 2017.

58 DDHHS Annual Report 2016-2017 | Our performance X-ray operator training and support Allied Health Professional Enhancement In 2016, there were approximately 330 Queensland Program Health staff in rural and remote facilities who were The Allied Health Professional Enhancement Program also licenced X-ray operators. A range of training and (AHPEP) provides regional, rural and remote allied support activities for X-ray operators were provided health professionals and assistants with access to by the Cunningham Centre in collaboration with the individually tailored placement opportunities which Toowoomba Hospital Department of Medical Imaging focus on improving services and health outcomes for during 2016-17. These included: their clients. Placements focus on service improvement • Seven training and assessment workshops which themes including clinical or evidence-based practice, provided professional development opportunities skill development, succession planning, and as well as components of the X-ray operator investigation of a new service delivery model or clinical annual competency assessment. 82 participants education. from seven HHSs attended In 2016-17 a total of 99 placements were completed, • A videoconference in-service series for X-ray including 93 individual, five team and one expert operators. Twelve in-services were well attended clinician visit. A total of 406 placement days were and featured guest speakers covering a range of also completed. 66 percent of participants were from topics relevant to X-ray operator skill development regional areas. Immediately after their placement • Facilitation of the Radiographic Advisor Reference 99 percent of participants who completed the post Group which met quarterly to discuss topics placement survey reported that they intended to relevant to X-ray operator support. make changes or improvements in their workplace or clinical practice. When surveyed 3 months after their A number of new activities were introduced during placement, 96 percent of participants who completed 2016-17 in an effort to meet increasing demand for the survey reported they had implemented changes to X-ray operator training and support from across their practice or service as a result of their placement. Queensland. These new activities were: • An advanced training and assessment Clinical Education and Teaching Access in Rural workshop providing professional development Areas (CETAR) opportunities and annual competency assessment requirements in a condensed format, The Clinical Education and Teaching Access in Rural to more efficiently meet the needs of experienced Areas (CETAR) initiative has been developed to X-ray operators promote allied health pre-entry clinical education capability in rural and remote Queensland. The • A videoconference assessment workshop option purpose of this initiative is to build the number of for X-ray operators who were able to source student supervisors in rural and remote Queensland. training from their local Radiographic Advisor, and needed to access annual competency assessment The target for this initiative is allied health components only professionals in increment positions of HP3.2 and • An initial training course for new X-ray operators, above and in HP4 positions that have not been a which meets the needs of the Queensland Health primary student placement supervisor previously. Education and Training Framework for X-ray CETAR links into existing Cunningham Centre Operators, and is endorsed by Radiation Health. programs such as the AHPEP and Supervision training. This course is delivered in a blended learning CETAR includes the following phases: learning stage, format, with online, videoconference and face- AHPEP placement with an experienced student to-face practical workshops forming part of supervisor, student supervision, reciprocal AHPEP the course. The first cohort of this pilot course placement with the experienced supervisor and concluded in April 2017, and the second pilot critical reflection stage. This initiative is currently cohort commenced in May 2017. Evaluation of supporting three identified rural and remote these two initial cohorts will be used to determine practitioners in the development of supervision- the future delivery strategy for this course. active to gaining experience as a primary supervisor for a pre-entry student. Furthermore, CETAR is being evaluated to inform the way forward and the evaluation results will be available in late 2017.

Our performance | DDHHS Annual Report 2016-2017 59 Allied Health Division highlights • A central, searchable Research Repository for research output from the DDHHS, including Allied Health Showcase publications and conference presentations linked The DDHHS Allied Health 2017 Showcase this year to the Library homepage. This resource is a saw innovations in clinical excellence recognised. valuable, concrete record of successful research DDHHS Senior Physiotherapist, Ciaran Fitzgerald activity in the region presented on the “implementation of day-zero • Creation of secure, central stores for paper- mobilisation for total joint replacements at based and electronic research records to assist Toowoomba Hospital” and was awarded best researchers in meeting national guidelines for the presentation at the showcase. Ciaran presented a retention and disposal of research materials study comparing two groups of patients undergoing • Development of useful resources, including major joint surgery. Patients who mobilised on the guidelines for the completion of the Human day of surgery experienced an 11 percent reduction Research and Ethics Committee preferred research in length of stay, without any adverse outcomes. protocol, and guidelines to assist with completing The results provide support for further investigation local assessment of governance processes for all into this innovative physiotherapy model of care research projects. These documents have been and strategies to be implemented to mobilise more well used by DDHHS staff since their release, and patients on the day of their surgery. the protocol guidelines are now being adapted by Two other awards were presented at the showcase the Mackay Institute of Research and Innovation including the best poster award to Ben Kalinowski for their own use for an evaluation of a four-week preadmission • Development of the Research Publication clinic pharmacist trial, and the innovation award to Submission Procedure in December 2016. This Amanda Williamson from Transition Care presenting procedure describes the processes required for on the neoRehab service delivery model using DDHHS staff submitting a research manuscript telehealth to provide services to people’s homes. for publication where the manuscript is based on research either utilising DDHHS data or conducted Embedding evidence-based research into by staff whilst engaged in their DDHHS role practice • Ongoing reviews of all DDHHS studies listed as The Research Support Team encourages and active and following up with researchers who facilitates active research collaboration and are overdue in submitting research reports and engagement by providing flexible, targeted assistance offered by the Research Support Team. research assistance, support and education for DDHHS staff. Team members provide one-on-one Publications and research projects led by consultation with staff members to review drafts or DDHHS or as a collaborator to provide assistance with study design, protocol • A total of 37 research projects were published in development, ethical matters, or anything research 2016-17 where at least one of the researchers was related. This support is also available to staff from the DDHHS undertaking non-research service evaluations, • 13 research projects were led by DDHHS staff audits and service improvement projects. members this financial year. This includes all Achievements in 2016-17 include: projects where a DDHHS staff member has • Introduction of on-demand group training and been listed as a primary or chief investigator. DDHHS online research education Research leads are responsible for conducting • New fortnightly Research Drop-In sessions held the research, obtaining funding if required and in the Toowoomba Hospital library leading research dissemination • The inaugural 2016 DDHHS Research Awards, • A total of 32 research projects were commenced which included awards for Novice and Advanced within the DDHHS where DDHHS staff member/s Researchers were listed as a research team member collaborating on the project.

60 DDHHS Annual Report 2016-2017 | Our performance DDHHS successfully secures Integrated Care Floresco Toowoomba Innovation Funds for two innovative projects The DDHHS was also successful in receiving funding from ICIF for the Floresco Toowoomba Initiative to Diabetes Model of Care Project provide an innovative mental health service for The DDHHS was successful in receiving funding adults experiencing a moderate or severe mental from the Department of Health’s Integrated Care illness who require integrated care. Innovation Fund (ICIF) for the two year Diabetes ICIF have provided $1.5 million in funding for Model of Care project commencing in 2016-17. The the project. This model is based on the already ICIF contributed approximately $1.69 million and the established Floresco Centre in Ipswich, the first of DDHHS committed a further $150,000 over two years. its kind in Australia, and provides holistic, person- The project has four key components: centred, integrated and cost-effective clinical care • Aboriginal and Torres Strait Islander Care and psychosocial support. Coordination Virtual Team In April 2017, DDHHS signed a service agreement • GP led diabetes care with Aftercare as the key partner in the Floresco • Queensland Ambulance Services (QAS) referral Toowoomba project. The DDHHS Mental Health pathway Alcohol and Other Drugs Division will work in • Home monitoring. partnership with Aftercare to develop an integrated community mental health support service. The Referred clients have access to appropriate service will commence in the 2017-18 financial year. evidence-based clinical care as close as possible to their own community. Through the project, Mental Health Alcohol and Other Drugs Division clients improve their health literacy and self- management to better control diabetes and SMS for Dads achieve improved health outcomes. The project The division is currently participating in an has the following goals: innovative research project in conjunction with the • Services should enable people to take more Queensland Centre for Perinatal and Infant Mental responsibility for their own health and wellbeing Health and the University of Newcastle. The project • People should stay well in their own homes and provides regular information and support updates communities to fathers about growth and development to help • When people need complex care it should be them understand and support their partners and timely and appropriate. new family member.

The Diabetes Model of Care Project in partnership Rural and Remote Medical Support Division with QAS and GPs commenced patient referrals in February 2017. By end of June 2017 after five months Educative framework for Junior Doctors in operation, there were 158 patients referred and Queensland Country Practice (QCP), in collaboration 26 patients discharged from the project. The DDHHS with the Australian College of Rural and Remote achieved 101 percent of the 2016-17 target referrals Medicine (ACRRM), commenced the development required. The project has received excellent of an educative framework for junior doctors consumer and clinician feedback to date. undertaking a prevocational rural generalist medical In June 2017, the DDHHS entered into an agreement placement. Curriculum will be based on the Australian for home monitoring to provide a telehealth solution Curriculum Framework for Junior Doctors (ACFJD) with to 50 patients within the program with complex and three key learning areas in clinical management, high-needs diabetes. These patients will be provided professionalism and community. with home monitoring equipment tailored to their needs. The equipment will monitor daily vital signs and provide telephone support, with alerts and step- up care protocols in place. Patients can take their own vital signs readings and answer questions, which are communicated to a monitoring station for a clinician to review and follow up if necessary.

Our performance | DDHHS Annual Report 2016-2017 61 The Queensland Rural Generalist Leader Program Specialist pathways In collaboration with the Royal Australasian College QCP’s specialist training pathways have worked of Medical Administrators (RACMA), a customised with hospital and health services and medical Leadership for Clinicians Training Program education units to deliver significant training contextualised to the needs of the rural medical opportunities for the specialist medical workforce workforce in Queensland has been developed. The across Queensland, incorporating centralised inaugural cohort commenced in March 2017 with the recruitment, selection and education. aim to increase the supply of suitably qualified medical Achievements in 2016-17 include: leaders working in rural and remote Queensland. 1. Coordinating the Statewide centralised recruitment, selection and allocation for the following specialist Rural Generalist Pathway Jurisdictional Forum vocational training pathways/networks: QCP established a national Rural Generalist »» Basic Physician Training Adult Medicine – 133 Pathway Jurisdictional Forum with the aim of sharing new trainees and 168 current trainees, a total information on State, Territory and Commonwealth of 301 trainees rural generalist endeavours and progressing training, »» Basic Physician Training Paediatric – 50 new practice and research in rural generalist medicine trainees and 84 current trainees, a total of 134 for the benefit of Australian rural communities. trainees Membership comprises representatives from each »» Intensive Care Medicine – 54 new trainees and 91 Australian State and Territory and the Commonwealth current trainees, a total of 145 trainees Department of Health. »» Advanced Training General Medicine – 36 new Rural Junior Doctor Training Innovation Fund trainees and 36 current trainees, a total of 72 QCP has partnered with universities, other HHSs trainees and colleges submitting a bid to secure funding »» Advanced Training General Paediatric –7 new to develop rural intern training terms in a primary trainees care setting. In doing so, QCP will broaden its scope 2. QCP delivered the following educational programs and join up medical education from university right for specialist vocational trainees: though to vocational practice. »» Queensland Internal Medicine Education Program (QIMEP) is a registrar-led fortnightly evening lecture Relief services series for 72 advanced trainees in general medicine Statewide relieving services have provided a total of »» Clinical examination preparation program - 1 2,269 weeks of health professional staffing relief to weekend course and 7 evening lectures with 196 rural and remote communities across the following registrants disciplines: »» Paediatric clinical examination preparation – 1 • Medical – Junior – 1,428 weekend course with 92 registrants • Medical – Senior – 274 »» Intensive Care Unit (ICU) Supervisor of Training • Allied Health – 293 workshop with 20 registrants • BreastScreen – 274 »» Basic Assessment and Support in Intensive Care This equates to 43.6 Full Time Equivalent (FTE) staff (BASIC) were held at Gold Coast and Nambour providing support for rural and remote communities Hospitals with 24 attendees per course. by enabling better access to essential health 3. The inaugural Paediatric Clinical Examination services. Preparation Program (PCEPP) was held in April 2017. PCEPP is designed as an adjunct to hospital- based clinical exam preparation and provides paediatric trainees with practical advice from topic experts for long and short case preparation with some summaries of issues, pitfalls, strategies, and important cases to master 4. The Royal Darwin Hospital was included as an accredited paediatric training facility in the Queensland Basic Paediatric Training Network.

62 DDHHS Annual Report 2016-2017 | Our performance DDHHS Director Rural Generalist Training Dr James Telfer (right) instructs Rural Generalist Pathway (RGP) trainees Dr Marika Goodman and Dr James Boland during the RGP Anaesthetic Introductory Program

Queensland Rural Generalist Program Executive Director Rural and Remote Medical The DDHHS’s Queensland Rural Generalist Program Support retires (QRGP) was awarded the Premier’s Award for After a career spanning 40 years, Dr Denis Lennox Excellence in the Leadership category in December retired as the Executive Director Rural and Remote 2016. The team is responsible for the strategic Medical Support on 30 June 2017. Dr Lennox was direction and operational implementation of rural instrumental in establishing the QRGP and was generalist training in Queensland and celebrates passionate about ensuring that rural Queenslanders 10 years of operation in 2017. A rural generalist is had access to quality healthcare. Dr Lennox was a medical practitioner who provides primary and bestowed a number of prestigious awards by the secondary care to rural communities across hospital medical fraternity in the lead up to his retirement in and general practice settings, including advanced recognition of his outstanding achievements during skills in one or more disciplines. In addition to service his career with Queensland Health. and workforce design, the team is responsible for the recruitment, education, placement and support of junior medical officers aspiring to a rural medical career. In 2017, more than 300 trainees are completing Rural Generalist Training and more than 100 Fellows have completed their training.

Our performance | DDHHS Annual Report 2016-2017 63 Strategic objective 4 Budget allocated Ensure sustainable resources through attentive financial and asset administration The DDHHS achieved a balanced budget for the 2016- 17 financial year. This result was achieved against a background of increased activity over the previous 12 months and sustained high performance in providing safe and efficient care to patients requiring elective surgery, outpatient appointments, oral health services and gastrointestinal endoscopies. Revenue and expenses – FY $ (000) ending 30 June 17 Revenue 726,099 Expenses Toowoomba 37% Labour and employment 497,217 Rural 30% Non-labour 207,899 Mental Health 11% Depreciation, impairment and 20,945 revaluation Other professional and support 19% Total 726,061 Depreciation 3% Net surplus from operations 38 How the funding is spent How we are funded Just over two thirds of expenditure is against labour DDHHS’s total income for the 2016-17 financial year costs, this amounts to 68.48 percent of expenditure was $726 million. This comprises $428.1 from the across clinical and non-clinical support staff. Non- State, $192.3 from Commonwealth, Special Purpose labour expenses such as clinical and non-clinical Grants worth $32.2 million and other revenue supplies, other clinical services (such as pathology, (including self-generated) was $73.4 million. radiology, prosthetics), catering, maintenance and Income $ (000) utilities accounted for 27.6 percent of expenditure. State contribution $428,142 Expenses $ (000) Commonwealth contribution $192,338 Employee expenses $497,217 68.48% Special Purpose Grants $32,200 Supplies and Services $200,409 27.60% Other revenue (including self- $73,419 Grants and subsidies $2,992 0.41% generated Other expenses $4,498 0.63% How the funding was distributed Depreciation and expenses $20,945 2.88% The DDHHS operates a complex group of healthcare Labour costs as a proportion of total expenditure services across a broad and diverse geographical increased from 67.83 percent in 2015-16 to 68.48 area. The table below shows the proportion of the percent in 2016-17, while supplies and services budget spent on operational and support services decreased from 28.32 percent to 27.6 percent for the within the DDHHS. Total expenses for 2016-17 were same period. In terms of absolute dollar value, supplies $726 million averaging $1.98 million dollars a day. and services increased by four percent over the previous year as a result of increased activity rates.

64 DDHHS Annual Report 2016-2017 | Our performance Financial outlook Investment in asset optimisation, asset In the 2017-18 financial year the service will provide maintenance and asset replacement or public healthcare in line with the Service Agreement expansion with the Department of Health. The DDHHS will have a total operating budget of $761.74 million, Health Technology Equipment Replacement an increase of 4.9 percent or $35.64 million from (HTER) 2016-17. The Health Technology Replacement (HTER) Next financial year the DDHHS will continue to program is a Statewide rolling two year program to focus on delivering a balanced budget. This will replace aged and obsolete health technology. The be a challenge in an environment where demand HTER program budget for the 2016-18 program was continues to increase due to rising chronic disease $6,387,825 with an allocation of $1,950,100 in 2016- and an ageing population. The health service 17. Major items replaced as part of the program in will continue to work collaboratively with the 2016-17 included: Department to ensure that we can deliver quality • Ultrasound unit Toowoomba Hospital $103,000 public healthcare to all patients within our region as • Mammography unit BreastScreen Toowoomba efficiently as possible. $154,642 • Cardiac ultrasound Toowoomba Hospital Strengthen and enhance ICT capacity and $279,258 capability • Fixed x-ray Toowoomba Hospital $330,000 The DDHHS is committed to strengthening and • Orthopaedic microscope Toowoomba Hospital enhancing our information and communications $229,252 technology (ICT) capacity and capability. Projects • Colonoscope, light source and processor Miles completed in 2016-17 to improve our ICT services Hospital $80,249. include: Backlog Maintenance Remediation Program Dalby Telecommunication Infrastructure (BMRP) Replacement (TIR) project The DDHHS achieved an excellent result for the At a cost of nearly $420,000, the project involved Backlog Maintenance Remediation Program (BMRP) the construction of communications rooms in four by reducing $50.6 million of backlog maintenance in buildings on the hospital campus (Mental Health, four years and completing 474 projects in total. The Myall, Acute Ward and Nurses Quarters) and was DDHHS BMRP was the third largest program in the completed in June 2017. The project was jointly state, after Metro North and Metro South Hospital funded from DDHHS accrued surplus and eHealth and Health Services. The main achievements of the Queensland funds. BMRP were to provide major plant replacement and Increased technology use within Aged Care building repairs to ensure DDHHS asset capability is maintained for patients and staff into the future. Assessment Team (ACAT) While BMRP was a four year project, 2016-17 was an This project has seen all Toowoomba ACAT exceptionally busy year. Projects with a total value clinicians begin using mobile devices and the of approximately $20 million were completed in Myassessor offline app to complete comprehensive 2016-17 including the following major projects: assessments on the National Screening and • Replacement of main campus and Medical Block Assessment Form (NSAF). These assessments switchboards Toowoomba Hospital are uploaded to the live My Aged Care Portal and • Replacement chillers Emma Webb Building and completed. The use of mobile devices has halved installation of new chillers for main campus the time it takes to complete a comprehensive buildings Toowoomba Hospital assessment, which has greatly assisted the ACAT • Refurbishment of Warwick Hospital kitchen team to deliver efficient services to their clients. • Installation of fire compartments to Medical Block Toowoomba Hospital

Our performance | DDHHS Annual Report 2016-2017 65  Director of Medical Imaging Aiden Cook, MRI team leader Alastair Collett and DDHH Board Deputy Chair Dr Dennis Campbell at the official opening of the Toowoomba Hospital MRI service.

• Replacement of the main switchboard at Dalby • Baillie Henderson Hospital Laundry upgrade Hospital including batch washer and ironer purchased and • Replacement of the electrical submains at Baillie installed in 2016-17 at a total cost of $1.2 million Henderson Hospital • Refurbishment of main staff station area in • Installation of air-conditioning to Stanthorpe Goondiwindi Hospital to provide improved Hospital patient privacy, staff safety and administration • Installation of fire compartments to Stanthorpe facilities at an approximate cost of $170,000 and Hospital completed in April 2017. • Installation of air-conditioning at Dalby Hospital • Upgrade of the Acute Mental Health Unit • Demolition or removal of empty buildings Toowoomba Hospital courtyard security at a cost no longer cost effective to maintain or repair of approximately $240,000 completed in June throughout the DDHHS (including Residence 5 2017. The refurbishment included replacement and Gowrie Hall at Baillie Henderson Hospital, of existing fencing and roofing in the courtyard Farr Home Kingaroy Hospital, Community Health areas to improve patient safety and amenity. The building Murgon and Community Health buildings new fencing is less institutional in appearance Nanango Hospital) while still ensuring patient safety. • Repair and refurbishment of heritage-listed The DDHHS has continued to reinvest accrued buildings at Baillie Henderson Hospital surplus funding this year to provide vital clinical • Repair of Kingaroy Hospital roads infrastructure and equipment. Projects completed • Refurbishment of Fountain House 2 on the in 2016-17 include: Toowoomba Hospital campus • Cherbourg Hospital – An area was refurbished within • Refurbishment of 8 bathroom ensuites at Kingaroy the hospital to create a new palliative care room Hospital at a cost of $150,000 to deliver more comfortable • Internal painting of Kingaroy Hospital. facilities for patients and families at difficult time when loved ones are receiving end-of-life care. The Capital works new room was officially opened on 30 June 2017 The DDHHS invests its annual $3.5M minor capital • Miles Hospital – allocation provided through the State Budget on »» Primary health hub completed in February equipment and infrastructure prioritised to support 2017: An existing building on the Miles the continuous delivery of clinical services. Key Hospital campus was extensively refurbished clinical equipment purchases in 2016-17 included to accommodate primary health hub services a new theatre table, theatre pendants, telemetry including a general practice equipment and scopes. »» Staff accommodation completed in March Minor infrastructure projects completed in 2016-17 2017: new purpose built facility including eight included: modern self-contained units, communal areas • Tara Hospital ambulance bay and ramp - and car parking completed in April 2017 at a cost of $205,000 to »» The combined value of both projects was $2.6 provide a covered ramp to the hospital with the million. The completed projects have provided appropriate gradient and safety railings Miles Hospital with infrastructure that will make it easier to attract clinical staff to this rural location.

66 DDHHS Annual Report 2016-2017 | Our performance • A second CT Scanner was installed at Toowoomba The five bed facility enables seriously ill patients Hospital in September 2016. The $2.75 million who need dialysis to have their treatment on project included replacement of the existing CT the ward, rather than being transported through Scanner nearing the end of its functional life the hospital to the Renal Unit which is set up with a new machine and installation of a second for ambulatory patients. Stages 2 and 3 of the machine to provide additional capacity for medical project will involve refurbishment of the Renal imaging services. The scanning capacity of the Unit to improve patient and staff flow and increase new scanners is 500 slices a rotation providing a capacity, and refurbishment of a small building co- significant improvement on the existing machine located next to the Hospital for an outpatient renal installed in 2006 that only had 64 slice capacity self-care and training centre. • The commissioning of new sterilisers at Toowoomba Hospital Central Sterilising Department (CSD) neared State funded infrastructure projects completion at the end of the financial year with final Medical imaging services for all patients within the completion of this stage expected in August 2017. DDHHS region were enhanced with the installation of The next stage of the project will follow in 2017-18 the first magnetic resonance imaging (MRI) service with the refurbishment of CSD to provide a dedicated at Toowoomba Hospital. The medical imaging reverse osmosis plant to meet the requirements department welcomed their first MRI patient in May of a new Australian Standard (AS4187), as well as 2017. The $9.55 million State Government funded improve throughput for future increased theatre project included $1.85 million to relocate the capacity. Total cost of both Stage 1 and Stage 2 CSD BreastScreen Toowoomba service to a new purpose- works is estimated to be $3,410,000 built offsite premises which enabled the new MRI • The first stage of a three stage $4 million expansion service to be installed adjacent to the existing medical of renal services at Toowoomba Hospital was imaging department. The BreastScreen relocation was completed in April 2017. At a cost of approximately completed in July 2016. The new MRI service increases $750,000, stage 1 consisted of refurbishing access to public hospital services for patients in the an existing ward area to provide a five bed region with this service previously only available at haemodialysis facility in the Toowoomba Hospital’s private facilities in Toowoomba. Medical Unit Two (MU2).

New switchboard for the third electricity feed at Toowoomba Hospital

Our performance | DDHHS Annual Report 2016-2017 67 The new service means that inpatients at Toowoomba The list below is a summary of the valued support Hospital no longer need to travel offsite for an MRI provided to the DDHHS by our partners in 2016-17: and provides medical imaging staff at Toowoomba • The Toowoomba Hospital Foundation supported Hospital with valuable clinical experience using the Toowoomba Hospital and our staff by providing latest technology. funding projects and equipment with a total value The $3 million expansion of the Toowoomba if $668,410. Major items included construction of Emergency Department (ED) was completed June a carpark for day visitors and staff, mammography 2017. The refurbishment involved the extension of equipment, urology equipment, an ICU ventilator, the ED area to provide additional patient treatment support for Patient Flow Manager software, areas, clinical storage and staff support spaces. The disinfection unit and blood testing equipment expansion has increased the number of treatment • The Miles Hospital Auxiliary provided $116,781 in spaces from 21 to 30 to help facilitate an increase donations for equipment and furnishings for Miles in patient throughput and assist in alleviating some Hospital including patient monitors, installation of the capacity issues being experienced by the costs for information technology improvements, ED due to increasing demand. The scope of the tables, chairs and blinds for consultation and project included building an extension to create conference rooms additional storage and staff amenity facilities, internal • The Kingaroy Hospital Auxiliary donated a monitor refurbishment (including reconfiguration of ED), and a for endoscopy procedures at a total cost of $30, 184 dedicated paediatric treatment room. • The Lions Club Nanango donated a $3,600 patient The new kitchen project for Toowoomba Hospital monitor (pulse oximeter) to Kingaroy Hospital at a cost of $9,760,000 commenced on 30 August • Murgon Hospital Auxiliary provided $18,169 to 2016. The project will provide a new kitchen to upgrade blinds in palliative care and to provide serve the Toowoomba Hospital campus for the privacy frosting to the palliative care room. The preparation of patient meals. Key areas of design funds also provided for items to improve the in the new kitchen include preparation areas, Emergency Department storage capacity cool rooms and freezers, dishwashing and plating • Tara Hospital Auxiliary donated $9,840 for areas, and office and staff amenities. The project is improvements to the staff quarters and patient expected to be complete by late 2017. equipment including a tympanometer In June 2017 the Minister for Health and Ambulance • Incapacitated Service Men and Women provided Services announced the Kingaroy Hospital Oaks Nursing Home in Warwick with a donation redevelopment with a total value of $62 million. The of $5,000 redevelopment will increase the range of services • The Goondiwindi Hospital Auxiliary donated and improve the hospital’s role as a hub for trauma, $3,710 for over-bed tables paediatric, obstetric, rehabilitation and mental • The Millmerran Hospital Auxiliary and Lions health services. It will also enable the delivery of Club donated a monitor valued at $2,903, The contemporary and future models of care for the Millmerran Hospital Auxiliary and Hot Rods Inc entire community into the future. Planning for the donated a sofa bed valued at $2,110, and the development will commence in 2017-18. Millmerran Hospital Auxiliary donated a trailer and sprayer at a cost of $650 Our generous supporters • The Dalby Hospital Auxiliary donated $5,425 for Our local hospitals are an important part of each a telehealth-chemotherapy trolley, two palliative community and we are big-heartedly supported by the care mattresses and two televisions with headsets Toowoomba Hospital Foundation, local auxiliaries, for the renal unit service clubs, other groups and individuals through • The Jandowae Lions Club donated to Jandowae fundraising efforts and other generous donations. Hospital a mobility aid at a cost of $1,995 • Individual donations were also made to Stanthorpe Hospital, Dr EAF McDonald Nursing Home, Oaks Nursing Home and Miles Hospital with a total value of $18,713.

68 DDHHS Annual Report 2016-2017 | Our performance The Darling Downs Public Health Unit has continued Strategic objective 5 to develop and refine these plans for each of the DDHHS facilities. In line with the plans, water samples Plan and maintain clear and focused are taken quarterly from each facility and Legionella processes to facilitate effective detections notified to the Department of Health. A corporate and clinical governance report about the results of testing is also submitted to the Department each quarter. A number of initiatives were undertaken in 2016- 17 to support this strategic objective including If Legionella is detected a range of remedial actions implementation of improved reporting systems, are implemented to minimise the risk to staff and implementation of a sustainable energy project and patients as determined by the facility’s water risk actions to support legislative and policy changes and management team. Remedial actions may include, but requirements. are not limited to, replacing fittings, flushing water lines to improve chlorine levels, pasteurising hot Establishment of dedicated Strategy and water systems, plumbing upgrades and minimising Planning Team set to boost health service the exposure of at risk patients. All DDHHS facilities planning and service redesign have been working to eliminate dead legs in plumbing systems and improve hot/warm water systems to A key strategic objective for the DDHHS is to establish reduce the risk from Legionella. redesign and innovation capability, and support staff with the implementation of service and clinical redesign Portable chlorinators have been purchased to assist with initiatives across the organisation. The DDHHS Strategy Legionella remediation and prevention programs in areas and Planning team was established in April 2017 to help where facilities have low chlorine levels in incoming fulfil this goal. Strategy and Planning is a small, diverse water. The implementation of the water risk management team of project and service planning officers led locally plan ensures quality and consistency in our processes by a Director. Under the governance of the Health through compliance with appropriate standards and with Service Chief Executive and Executive Management legislative and regulatory requirements. Committee (EMC), the Strategy and Planning team New Health Service Directive for Emergency evaluates the feasibility of projects and engages the broader workforce in developing and implementing Management innovative ideas. The team also leads larger health The DDHHS is committed to implementing the service wide, strategic projects and supports the principles of the Queensland Health Disaster and organisation through the management of corporate Emergency Incident Training Framework published performance planning and reporting. in June 2016. The Framework is an overarching guide to the requirements and considerations of capability The Strategy and Planning team will undertake development; through training, exercises and comprehensive health service planning activities in lessons management, and is supported by Health 2017-18, which will enable the DDHHS to proactively Service Directive 003:2017 Disasters and Emergency respond to emerging health needs and issues, ensure Incidents which came into effect January 2017. our future service developments are in line with health data evidence, and include engagement with our staff The Health Service Directive mandates such things as: and community in the health service planning process. • the establishment of an emergency management committee Public Health - Water Risk Management Plans • ensuring the DDHHS is represented on district and to Control Legionella local disaster management groups On 1 February 2017, amendments to the Public Health • record keeping for appointments Act 2005 commenced which required public sector • roles and responsibilities are understood hospitals and aged care facilities to develop and • collaboration with external entities. implement water risk management plans to control The DDHHS has developed a training program to meet Legionella in their water distribution systems. the requirements of the new training framework and is progressively training all relevant staff that manage and are involved in emergency incident management.

Our performance | DDHHS Annual Report 2016-2017 69  The DDHHS Board inspects solar panels at Murgon Hospital with Murgon Hospital staff and community members

Patient Travel Subsidy Scheme (PTSS) Murgon Hospital goes solar improvement initiatives implemented Ergon Energy supplied and installed one hundred The DDHHS completed a Patient Travel Subsidy Scheme and eight 280-watt solar panels on the Murgon Service Improvement report in March 2016 identifying Hospital roof in October 2016. Murgon Hospital is 16 key recommendations to improve PTSS processes now running partly on solar power as part of an including centralisation, governance of appeals and Ergon Energy initiative. approvals, completion of forms and identification of Ergon will maintain and monitor the panels to telehealth and information technology options. assess the feasibility of implementing similar A significant amount of work has been done to systems at other hospitals in the DDHHS with complete 10 of the report’s recommendations and comparable energy usage. The solar panels are work continues on completing the remaining six of estimated to reduce the hospital’s monthly energy the 16 recommendations. As a result of the review bill by approximately 23 percent, a saving of around the District Travel Officer position has now taken on $10,000 per year. The panels generate more power a DDHHS-wide focus and acts as the central point than what the hospital alone can use enabling the of accountability for all PTSS-related queries. This extra power to contribute to the grid system. change has greatly increased the efficiency and effectiveness of PTSS processing and the overall Allied Health Division takes on operational and service within the DDHHS. professional focus A key initiative identified to improve management The Division of Allied Health was realigned in of PTSS is the purchase of a software solution 2016-17 to include operational management for the management, processing and reporting of of allied health services. In October 2016 the patient travel claims, which will enhance efficiency Division established the Allied Health Workforce and improve PTSS services to our patients. Development Officer – Data and Informatics Implementation of this system will occur in the 2016- position to use data and informatics to promote 17 financial year. greater flexibility and allocation of resources which has resulted in: In 2016-17 the DDHHS spent $7.7 million on PTSS (not • An 88% reduction in long waits for Allied Health including aeronautical retrieval services). outpatient services PTSS Annual Expenditure • Increases in all outpatient occasions of service including a 70% increase for telehealth consults 8000000 and a 6% increase in face to face consults. 7000000 • An 8 % increase in inpatient events 6000000 5000000 Implementation of the Mental Health Act 2016 4000000 The new Mental Health Act 2016 came into effect on 3000000 the 5 March 2017. The DDHHS undertook extensive consultation, education and administrative 2000000 preparation for this change. This included 1000000 outreach support to general EDs regarding new 0 responsibilities under the Public Health Act 2005. 2013-14 2014-15 2015-16 2016-17 There was a 4 percent increase in PTSS in 2016-17 over 2015-16

70 DDHHS Annual Report 2016-2017 | Our performance Risk management Compliance management framework In 2016, DDHHS was one of three hospital and A Compliance Management Framework comprising health services selected to participate as a pilot site of a policy, procedure and guide to Compliance for the Queensland Integrated Safety Information Management System was implemented in November Program (QISIP) to replace the aged clinical 2016. The primary objective of the Compliance incident, consumer feedback and staff incident Management System is to support and guide the management systems (PRIME CI, PRIME CF and behaviour of all those working for or on behalf of IMS.net) with RiskMan. The software solution also the DDHHS to ensure compliance with relevant replaces the Risk Management system (QHRisk). legislative and regulatory obligations, government On 13 February 2017, DDHHS became the first policies, directives, and standards. hospital and health service in Queensland to commence using the RiskMan software. DDHHS staff Rollout of Qlikview dashboards – improving expertise in trouble-shooting and problem-solving timely access to data significantly enhanced the implementation process Qlikview is a web based graphical reporting system making it easier for other hospital and health providing clinical and administrative managers services to follow. with current information on performance in With the implementation of the software, there has areas such as ED and elective surgery. The first been a need to review internal processes. The most dashboards became available in February 2017 significant change is the recording of workplace health and development is set to continue to produce and safety events and their management directly into more reports in consultation with users. Qlikview the software system rather than through a paper- is consistent with our strategy to support timely based system. The new system also has the capability access to accurate data to facilitate and support to accept staff feedback in the form of compliments decision making. and suggestions for managers to review.

DDHHS was the first HHS in the state to start using RiskMan software

Our performance | DDHHS Annual Report 2016-2017 71  The DDHHS Staff Wellness Program was officially launched by HSCE Dr Peter Gillies on 24 May 2017

Strategic objective 6 Sterilisation Services – The Main Game The Cunningham Centre commenced delivery of Value, develop and engage our the updated version of the nationally recognised Certificate III in Sterilisation Services course under workforce to promote professional the Australian Qualification Training Framework in and personal wellbeing, and to ensure February 2017. The qualification contributes to the dedicated delivery of services development of knowledge and skills required to comply with the Australia/New Zealand Standards Management Development Program (4187:2014 and 4815:2006). The goal of the The Workforce Division commenced the Management training, known as ‘The Main Game’ is to encourage Development Program in February 2017 using sterilisation workers to focus on each stage, in every existing staffing resources within the DHHHS to phase of reprocessing, to ensure that the sterilised develop, facilitate and present. The objectives of device legitimately meets the release criteria 100% of the program are to provide managers with training the time. This improves patient safety by decreasing that is focussed on building their confidence and the risk of complication from a hospital acquired competence to perform organisational functions in infection. 37 students enrolled in the pilot cohort in line with DDHHS expectations. 2016-17, and as at 30 June 2017, total enrolments had raised $74,200 in revenue. As at 30 June there were: • 12 graduates Participants provided very positive feedback from the pilot cohort about the quality of the online training • 26 enrolled in the program component and the impact it has on their learning. • 38 service improvement projects including one Students reported that the course really helped them initiative to be implemented as a DDHHS strategic to apply their learning in the workplace. project (Review of Community Health services) A survey undertaken to measure the success of the program demonstrates that 100% of participants and mentors would recommend the program to their peers and staff reporting to them. The average rating given by participants on the quality of the presentations is 8.8 out of 10.

72 DDHHS Annual Report 2016-2017 | Our performance University Department of Rural Health (UDRH), The program takes a holistic view of health with focus Southern Queensland Rural Health on mental health, physical health, emotional health In April 2017 the DDHHS, led by the Executive Directors and financial health. The program is coordinated for Allied Health, Rural and Remote Medical Support and through the Work Health and Safety Unit and was Nursing and Midwifery, in collaboration with South West launched in May 2017 at health services across the Hospital and Health Service, University of Queensland region. Staff are kept informed through the DDHHS and University of Southern Queensland were successful intranet page, screensavers, Staff Connect, Facebook in a bid for Commonwealth funding to establish a group and their local Wellness Champions. University Department of Rural Health (UDRH) in The program will be implemented over a three year Southern Queensland. Known as ‘Southern Queensland period and had an initial allocation of $185,000 for Rural Health’, the department will host students from 2016-17. Actions to date include: the professions of allied health (Exercise Physiology, • Majority of high sugar content drinks removed Nutrition and Dietetics, Occupational Therapy, from vending machines across the DDHHS Pharmacy, Physiotherapy, Social Work and Speech (the Toowoomba Hospital Foundation kindly Pathology), nursing and midwifery. Work continues on participated in making these change at the establishment of the centre in 2017-18. Toowoomba and Baillie Henderson hospitals as well as Directors of Nursing at locations where Allied Health Initiatives vending machines were located). Clinical education placements across a range of • Morning and afternoon teas and lunches professions including Nutrition and Dietetics, provided at launches have a healthy focus Occupational Therapy, Physiotherapy, Podiatry, Psychology, Social Work and Speech Pathology were Embed a values–based culture provided during 2016-17. Allied Health Clinical Education In early February 2017, the DDHHS engaged Best Support Officers, Clinical Educators and Clinical Practice Australia, an organisation that specialises Supervisors supported these placements to achieve: in improving culture in the health sector, to deliver • 6,445 clinical placement days a comprehensive workplace culture survey. All staff • 11,935 hours of student clinical activity had access to the survey in an electronic or paper (represented approximately 7% of overall allied based format. Of the 5,229 surveys distributed, health service delivery ) 52% or 2,738 DDHHS staff responded. • high levels of student satisfaction with quality The survey results included very detailed of clinical education and level of professional benchmarking data comparing the DDHHS with preparedness (as per clinical placement evaluations) public and private healthcare organisations across An audit of the compliance of the Division of Allied Health Australia and New Zealand. Overall the DDHHS with the Allied Health Professions Office of Queensland performed slightly above the average for public (AHPOQ) Allied Health Assistant Framework was hospitals but there are many opportunities for us undertaken from January to June 2017. Recommendations to improve our organisational culture, recognising from this audit regarding various changes to DDHHS the broader Queensland Public Service values. The processes will be implemented in 2017-18. DDHHS Executive team are all highly motivated to improve the culture across the organisation and, DDHHS Staff Wellness Program Launched assisted by the Workforce Capability, Culture and May 2017 Engagement Team, are ensuring that all work units develop action plans to improve the workplace Healthcare facilities play an important role in culture in their areas and have access to relevant promoting the health and wellbeing of patients, staff training and support to achieve this goal. The and visitors. The DDHHS was successful in obtaining results of the survey also guided the DDHHS Board funding under the Queensland Health ‘healthier and Executive in the development of a new set of drinks at healthcare facilities’ initiative for the DDHHS values to be launched in 2017-18. A repeat survey Staff Wellness Program. The DDHHS Staff Wellness will be undertaken in February 2019 to measure any Program supports staff members to incorporate change in the DDHHS’s culture response. healthy choices into daily living as well as identifying opportunities for regular movement and exercise.

Our performance | DDHHS Annual Report 2016-2017 73 Clinical to non- clinical ratio 2:1

Occupational status % Casual 8.84 Temporary 19.69 Permanent 71.46

Target Gender % 4,011 5,363 Female 79 Headcount Male 21

4215.48 7.35% MOHRI FTE Separation rate Average age *MOHRI – minimum obligatory human resource information

Planning for and retaining a skilled workforce The DDHHS’s Strategic Workforce Plan 2016-2020 is In 2016-17 DDHHS had a retention rate of 88 percent for a key tool that helps the DDHHS to identify the key permanent staff with a separation rate of 7.35 percent risks, objectives and goals that affect our workforce or 307 resignations. These figures remain comparable and was updated for 2017. Key to this plan is the with the previous two years, indicating a stable DDHHS values and embedding a workforce culture workforce ratio. that commits to these values and the highest standards of ethical behaviour. With an increasing The DDHHS welcomed 140 new permanent employees demand on aged care services in our region, to the service in 2016-17. All new staff completed an pressure on health expenditure, as well as State orientation and induction training package via the and Federal healthcare reforms, the DDHHS work DDHHS’s online training platform Darling Downs environment will continue to change. The workforce Learning Online (DD-LOL). The training package plan develops an understanding of these changes provides a comprehensive overview of the DDHHS, and the adaptation that will need to be undertaken our values and performance expectations and by the DDHHS to continue to improve performance, development opportunities for our staff. productivity and healthcare delivery. The DDHHS paid $57,000 to two employees in termination benefits in 2016-17. No early retirement or retrenchment packages were paid during this period.

74 DDHHS Annual Report 2016-2017 | Our performance Registered nurse Jessica Boyes (centre), Toowoomba Hospital, Registered nurse Rosie Beutel (centre), pictured with Mt Lofty receives her Preceptor of the Year award. Also pictured are (l to r) Heights Nursing Home Director of Nursing Cindy Pitt, and EDNMS Helen Towler, EDNMS Karen Abbott, Karen Gordon and Megan Minasi Karen Abbott, also received a Preceptor of the Year award Educating and training our workforce To support our staff in complying with their The DD-LOL team deliver training courses for staff obligations under the Public Sector Ethics Act 1994 induction, work health and safety, cultural practice, staff are required to complete an ethics and fraud ethics, patient centred care and other role specific awareness training package annually through the training to support our workforce. In 2016-17 the DD-LOL platform. DD-LOL contributed to: Division of Nursing and Midwifery highlights • workplace culture initiatives by producing the “Introduction to Performance Appraisal and The Division of Nursing and Midwifery had an Development” and “Workplace Bullying and exceptionally busy year rolling out a number of Harassment” packages online. initiatives in 2016-17. Highlights included: • the effort to reduce medication errors by • The workforce and workload management system providing access to the Intellilearn resources for TrendCare and patient management system Patient Medication Safety and assisting with reporting Flow Manager were installed across all DDHHS facilities to support effective capacity demand • the reduction in financial penalties incurred management in the delivery of patient centred care through poor management of pressure injuries by facilitating the development of the “Pressure • International Nurses Day held in May 2017 was Injury Prevention and Management package”. refreshed with a Health Hub concept held at Toowoomba Hospital in liaison with Queensland • Learning initiatives with the creation of 46 Nurses and Midwives Union. Across the rural courses divisions, the day was celebrated with many Ethics training local events including barbecues, morning and afternoon teas. This special day’s events were The DDHHS is committed to ensuring the highest very well received by all staff level of ethical behaviour through all areas of the • Two preceptor awards were implemented this health service. As a public service agency, the year – one for rural and one for Toowoomba Code of Conduct for the Queensland Public Service Hospital and Mental Health. Award recipients is applicable to all employees of the DDHHS. All were Jessica Boyes and Rosie Beutel employees are expected to uphold the Code by committing to and demonstrating the intent and • The application of the Business Planning spirit of its principles and values. Framework (BPF) is now embedded in all facilities across the DDHHS. Ratio compliance of 99 We strongly support and encourage the reporting percent has been achieved across legislated of Public Interest Disclosures. All employees have units within DDHHS. Statewide BPF General and a responsibility to disclose suspected wrongdoing Midwifery audits across selected units were and to ensure any disclosure is in accordance with undertaken with confidence and presented to a DDHHS ethical culture. Statewide Health Round Table.

Our performance | DDHHS Annual Report 2016-2017 75  Finalists in the DDHHS Employee Awards Caring category Vicki Stenhouse, Lee Jenson, Katrina Mackenzie, Corey Keable (winner), and Tania Hydes

• From July 2016, 85 graduate nurses and midwives Work health and safety were recruited to the Nursing and Midwifery The DDHHS is committed to providing a Graduate Program across Toowoomba Hospital, healthy and safe work environment through Mental Health and the Rural Division facilities the implementation of a robust governance including three aged care facilities. framework and continued improvements to our These graduates have undertaken a revitalised safety management system. Our major focus areas theoretical and critical skills and judgement include safety management, injury management, supported practice program. This new program safety training and staff wellness with a priority model has been presented at a state level and on meeting legislative and policy requirements to received very positive feedback from the applicants, create a safe workplace for all staff. unit and facilities and from Statewide peers In 2016-17 the DDHHS continued to perform well • On 11 May 2017 the DDHHS held a workshop for against key work health and safety indicators as all DDHHS community and primary care providers outlined below. to review current practice models and identify strategies to inform future practice models Key performance State DDHHS to promote alignment with the DDHHS vision indicators: target Result and strategic objectives. The initial planning (%) (%) outcomes from this workshop will be developed Current hours lost 0.33 0.27 in 2017-18 for future implementation (WorkCover hours) vs • The Office of the Chief Nursing and Midwifery occupied FTE Officer (OCNMO) facilitated a workshop to Average return to work 21.37 16.08 coordinate a Professional Practice Model with direct care nursing and midwifery staff from across the New work health and safety initiatives underway DDHHS. The outcome of the workshop will progress this year include: the development of a DDHHS Nursing and Midwifery • A task analysis project being undertaken Services Professional Practice Model to include inherent job requirements such • The quarterly DDHHS Nursing and Midwifery Senior as physical/sensory/psychosocial and Nursing Forums continued in 2016-17 to provide environmental demands within all DDHHS role professional development of senior nursing and descriptions midwifery staff and sharing of innovative quality • Modification of Occupational Violence training activities and models of care. The OCNMO have to include a component for management in aged attended these meetings on a regular basis to care residences provide updates on statewide and national issues • Planning for the introduction of body worn • Miles Hospital participated in an innovative cameras by DDHHS security officers telehealth mentoring program for child health nurses in rural and remote locations. Mentoring is well-known as a valuable support tool and involves an experienced clinician partnering with an inexperienced clinician to assist them in their professional development. Traditionally, participants meet face to face but developments in technology have prompted the introduction of tele-mentoring.

76 DDHHS Annual Report 2016-2017 | Our performance 2016 Annual DDHHS Employee Awards Inaugural Volunteer Awards (supported by the The 2016 Annual DDHHS Employee Awards were Toowoomba Hospital Foundation) held in January as a celebration of individuals • Quiet Achiever Award: David Wait, volunteer with and teams who “go the extra mile” in their Health Information Services at Toowoomba Hospital work. There were 127 nominations received in 11 • Commitment Award: The Texas Hospital Auxiliary categories, including new categories to recognise Inaugural Research Awards researchers and volunteers. The employee awards • Novice Researcher: Margot Tannock, Clinical program recognises employees for excellence in Pharmacist and CHARM Team Leader, demonstrating our values, delivering our purpose, Toowoomba Hospital and striving towards our vision. The 2016 awards • Advanced Researcher: Peter Gilbar, Pharmacist saw two new categories: Consultant, Toowoomba Hospital • Senior and Junior Researcher awards to encourage the development of a research Length-of-service awards culture across the DDHHS and recognise the important contribution our staff make to The DDHHS acknowledged 83 of our longest contemporary evidence serving staff members whose service totals more than 2,866 years between them at a • Volunteers of the Year Awards, supported by the special awards presentation in June 2017. One Toowoomba Hospital Foundation to recognise the staff member had achieved an incredible 60 wonderful efforts of volunteers right across the years of service and three had five decades of hospital and health service. service recognised. Staff who had also achieved The winners in each of the categories were: milestones of 45, 40, 35 and 30 years of service • Caring: Corey Keable, Assistant Business were also honoured at the awards ceremony. Manager for the Southern Cluster, Rural and Aged Care Division Queensland Health Workforce Diversity and • Doing the right thing: Wendy Friend, Human Inclusiveness Strategy initiatives – DDHHS Research Ethics Committee Coordinator, Medical implementation plan Services Division The DDHHS is committed to diversity in the work • Openness to learning and change: Damien place and is proud that 63 percent of our senior Teakle, Clinical Nurse at the Community Care Unit management positions are occupied by women. in Toowoomba, Mental Health Division In late 2016-17 the Queensland Health Workforce • Being Safe, Effective and Efficient: Lynn Boundy, Diversity and Inclusion Strategy 2017-22 was Nursing Director Clinical Governance for Rural circulated to hospital and health services in and Aged Care, Medical Services Division preparation for its implementation at the local • Being open and transparent: Hayley Farry, Senior level in the 2017-18 financial year. The DDHHS’s Learning Consultant with the DD-LOL team, implementation plan includes setting up a group of Workforce Division colleagues, practitioners and sources of knowledge • DDHHS Purpose: Dr James Beit, Director of (also known as a ‘community of practice’) to share Anaesthetics, Toowoomba Hospital knowledge and develop learning content. This group will work together with Workforce Planning to • DDHHS Vision: Cecil Brown, Senior Health Worker formulate the DDHHS’s local Diversity and Inclusion for Healthy Hearing, Cherbourg Health Service, Action Plan. The Queensland Public Service has Rural Health and Aged Care Division identified Aboriginal and Torres Strait Islander peoples, people with a disability, non-English speaking backgrounds and gender equity as areas in need of critical attention.

Our performance | DDHHS Annual Report 2016-2017 77 Glossary of terms

Term Meaning Accessible healthcare is characterised by the ability of people to obtain appropriate Accessible healthcare at the right place and right time, irrespective of income, cultural background or geography. Accreditation is independent recognition that an organisation, service, program or activity Accreditation meets the requirements of defined criteria or standards. A management tool with the potential to enhance public accountability and drive technical efficiency in the delivery of health services by: • capturing consistent and detailed information on hospital sector activity and accurately measuring the costs of delivery Activity Based Funding • creating an explicit relationship between funds allocated and services provided (ABF) • strengthening management’s focus on outputs, outcomes and quality • encouraging clinicians and managers to identify variations in costs and practices so they can be managed at a local level in the context of improving efficiency and effectiveness • providing mechanisms to reward good practice and support quality initiatives. Acute Having a short and relatively severe course. Care in which the clinical intent or treatment goal is to: • manage labour (obstetric) • cure illness or provide definitive treatment of injury • perform surgery Acute care • relieve symptoms of illness or injury (excluding palliative care) • reduce severity of an illness or injury • protect against exacerbation and/or complication of an illness and/or injury that could threaten life or normal function • perform diagnostic or therapeutic procedures. Is generally a recognised hospital that provides acute care and excludes dental and Acute hospital psychiatric hospitals. The process whereby a hospital accepts responsibility for a patient’s care and/or treatment. It follows a clinical decision, based on specified criteria, that a patient requires same-day or Admission overnight care or treatment, which can occur in hospital and/ or in the patient’s home (for hospital-in-the-home patients). Aftercare is a non-profit organisation and Australia's longest serving mental health Aftercare organisation, supporting people with mental health issues to lead fulfilling, independent lives. Aged Care Assessment ACAT provides comprehensive assessments for the needs of frail older people and facilitates Team (ACAT) access to available care services appropriate to their needs. Professional staff who meet mandatory qualifications and regulatory requirements in the following areas: audiology; clinical measurement sciences; dietetics and nutrition; Allied Health staff exercise physiology; medical imaging; nuclear medicine technology; occupational therapy; (Health Practitioners) orthoptics; pharmacy; physiotherapy; podiatry; prosthetics and orthotics; psychology; radiation therapy; sonography; speech pathology and social work. Care provided to patients who are not admitted to the hospital, such as patients of Ambulatory emergency departments, outpatient clinics and community based (non-hospital) healthcare services. Antenatal care constitutes screening for health, psychosocial and socioeconomic conditions likely to increase the possibility of specific adverse pregnancy outcomes, providing Antenatal therapeutic interventions known to be effective; and educating pregnant women about planning for safe birth, emergencies during pregnancy and how to deal with them (WHO, 2011).

78 DDHHS Annual Report 2016-2017 Term Meaning A State Government program providing capital expenditure and maintenance funding to Backlog Maintenance address high priority and critical operational maintenance, life cycle replacements and Remediation Program upgrades. Block funding is typically applied for small public hospitals where there is an absence of economies of scale that mean some hospitals would not be financially viable under Activity Block funding Based Funding (ABF), and for community based services not within the scope of Activity Based Funding. A breast screen is an x-ray of the breast that can detect small changes in breast tissue before they can be felt by a woman or her doctor. A breast screen is for women who do not have Breast screen any signs or symptoms of breast cancer. It is usually done every two years for women in the targeted age range. A tool for nursing and midwifery workload management to assist in determining appropriate Business Planning nursing and midwifery staff and skill mix levels to meet service requirements and evaluate Framework (BPF) the performance of the nursing and midwifery services. Chronic disease: Diseases which have one or more of the following characteristics: (1) is permanent, leaves residual disability; (2) is caused by non-reversible pathological Chronic disease alteration; (3) requires special training of the individual for rehabilitation, and/or may be expected to require a long period of supervision, observation or care. A framework by which health organisations are accountable for continuously improving the Clinical governance quality of their services and safeguarding high standards of care by creating an environment in which excellence in clinical care will flourish. Professional activity undertaken by health professionals to investigate patient symptoms Clinical practice and prevent and/or manage illness, together with associated professional activities for patient care. Clinical process redesign is concerned with improving patient journeys by making them Clinical redesign simpler and better coordinated. The redesign process is patient focused, led by clinical staff, systematic and methodical and quick with tight timeframes. A government strategy that aims to reduce disadvantage among Aboriginal and Torres Strait Closing the Gap Islander people with respect to life expectancy, child mortality, access to early childhood education, educational achievement, and employment outcomes A Community Care Unit (CCU) is a residential facility for adult mental health consumers who Community Care Unit are in recovery but require additional support and life skills rehabilitation to successfully transition to independent community living. Community health provides a range of services to people closer to their home. Some of these services include children's therapy services, pregnancy and postnatal care, rehabilitation Community health and intervention services, and programs that focus on the long-term management of chronic disease. Computerised CT is diagnostic imaging technique which uses Xrays that are rotated around a patient to tomography (CT) demonstrate the anatomy and structure of the organs and tissues. Consumer Advisory Formal advisory body to provide advice to the DDHHS and to act as a bridge between health Council consumers and the health service. The Department of Health is responsible for the overall management of the public sector Department of Health health system in Queensland, and works in partnership with Hospital and Health Services to ensure the public health system delivers high quality hospital and other health services. Time elapsed for each patient from presentation to the emergency department to start of Emergency department services by the treating clinician. It is calculated by deducting the date and time the patient waiting time presents from the date and time of the service event. Endoscopy Internal examination of either the upper or lower gastro intestinal tract.

DDHHS Annual Report 2016-2017 79 Term Meaning Environmental Health programs are related to human health issues that are affected by the Environmental Health physical, chemical, biological and social factors that are present in the environment. Full-time equivalent Refers to full-time equivalent staff currently working in a position. (FTE) Governance is aimed at achieving organisational goals and objectives, and can be described as the set of responsibilities and practices, policies and procedures used to provide Governance strategic direction, ensure objectives are achieved, manage risks, and use resources responsibly and with accountability. A general practitioner is a registered medical practitioner who is qualified and competent for GP (General general practice in Australia. General practitioners operate predominantly through private Practitioner) medical practices. Commonly called kidney dialysis or simply dialysis, is a process of purifying the blood of a Haemodialysis person whose kidneys are not working normally. The Commonwealth funded HACC Program provides services which support frail older Home and Community people and their carers, who live in the community and whose capacity for independent Care (HACC) living are at risk of premature or inappropriate admission to long term residential care. Healthcare facility established under Commonwealth, state or territory legislation as a Hospital hospital or a free-standing day-procedure unit and authorised to provide treatment and/or care to patients. Hospital and Health The Hospital and Health Boards are made up of a mix of members with expert skills and Board knowledge relevant to managing a complex healthcare organisation. Hospital and Health Hospital and Health Service (HHS) is a separate legal entity established by Queensland Service Government to deliver public hospital services. A patient who is admitted to a hospital or health service for treatment that requires at least Inpatient one overnight stay. Internal auditing is an independent, objective assurance and consulting activity designed to add value and improve an organisation's operations. It helps an organisation accomplish Internal audit its objectives by bringing a systematic, disciplined approach to evaluate and improve the effectiveness of risk management, control, and governance processes. A medical practitioner in the first postgraduate year, learning further medical practice under Interns supervision. Key performance Key performance indicators are metrics used to help a business define and measure indicators progress towards achieving its objectives or critical success factors. A form of atypical pneumonia found naturally in fresh water that can contaminate hot water Legionella tanks and air conditioning plant. A ‘long wait’ elective surgery patient is one who has waited longer than the clinically recommended time for their surgery, according to the clinical urgency category assigned. Long wait That is, more than 30 days for an urgent (category 1) operation, more than 90 days for a semi-urgent (category 2) operation and more than 365 days for a routine (category 3) operation. Magnetic resonance A medical imaging technique to form pictures of the anatomy and the physiological imaging (MRI) processes of the body Mammography is specialized medical imaging that uses a low-dose x-ray system to see Mammography inside the breasts. A person who is registered with the Medical Board of Australia to practice medicine in Medical practitioner Australia, including general and specialist practitioners.

80 DDHHS Annual Report 2016-2017 | Glossary of terms Term Meaning Minimum Obligatory MOHRI is a whole of Government methodology for producing an Occupied Full Time Human Resource Equivalent (FTE) and headcount value sourced from the Queensland Health payroll system Information (MOHRI) data for reporting and monitoring. Model of care and models of service delivery broadly defines the way that clinical and non- Models of care clinical services will be delivered. Health professionals employed by a public health service who work together to provide Multidisciplinary team treatment and care for patients. They include nurses, doctors, allied health and other health professionals. Provide a flexible and integrated approach to health and aged care service delivery for small Multipurpose Health rural communities. They are funded through pooling of funds from Hospital and Health Service (MPHS) Services (HHS) and the Australian Government Department of Health and Ageing. My Aged Care A website established by the Australian Government to help navigate the aged care system The National Safety and Quality Health Service (NSQHS) Standards were developed by the Australian Commission on Safety and Quality in Healthcare (the Commission) in consultation National Safety and and collaboration with jurisdictions, technical experts and a wide range of other Quality Healthcare organisations and individuals, including health professionals and patients. The primary Standards (NSQHS) aims of the NSQHS Standards are to protect the public from harm and to improve the quality of care provided by health service organisations. National Screening Form designed to collect information for the screening and assessment processes conducted Assessment Form under My Aged Care The National Standards for Mental Health Services (NSMHS) were first introduced in 1996 National Standards for to assist in the development and implementation of appropriate practices and guide Mental Health Services continuous quality improvement in mental health services. Demonstration of the delivery of (NSMHS) services against these standards ensures that consumers, carers and the community can be confident of what to expect from mental health services. Occasion of service Any examination, consultation, treatment or other service provided to a patient Is the occupancy of a bed or bed alternative by an admitted patient as measured at midnight Occupied bed days of each day, for any period of up to 24 hours prior to that midnight. Oncology The study and treatment of cancer and malignant tumours. Consultation, assessment, review, treatment and management of conditions relating to eye Opthalmology disorders and vision, and services associated with surgery to the eye. Consultation, diagnosis, treatment and follow-up of patients suffering diseases and Orthopaedics disorders of the musculoskeletal system and connective tissue. Non-admitted health service provided or accessed by an individual at a hospital or health Outpatient service facility. Provides examination, consultation, treatment or other service to non-admitted non- Outpatient clinic emergency patients in a speciality unit or under an organisational arrangement administered by a hospital. Services delivered to sites outside of the service’s base to meet or complement local service Outreach needs. Own Source Revenue (OSR) is revenue generated by the agency, generally through the sale of Own source revenue goods and services. Examples of OSR include revenue generated through privately insured inpatients, private outpatients, and Medicare ineligible patients (e.g. overseas visitors). Palliative care is an approach that improves quality of life of patients and their families facing the problems associated with life threatening illness, through the prevention of Palliative care suffering by means of early identification and assessment and treatment of pain and other problems, physical, psychological and spiritual.

Glossary of terms | DDHHS Annual Report 2016-2017 81 Term Meaning Pastoral Care Services exist within a holistic approach to health, to enable patients, families Pastoral care and staff to respond to spiritual and emotional needs, and to the experiences of life and death, illness and injury, in the context of a faith or belief system. The Patient Travel Subsidy Scheme (PTSS) provides assistance to patients, and in some Patient Travel Subsidy cases their carers, to enable them to access specialist medical services that are not Scheme (PTSS) available locally. A measure that provides an ‘indication’ of progress towards achieving the organisation’s Performance indicator objectives. Usually has targets that define the level of performance expected against the performance indicator. Primary healthcare services include health promotion and disease prevention, acute Primary healthcare episodic care not requiring hospitalisation, continuing care of chronic diseases, education and advocacy. Primary Health Networks (PHNs) replaced Medicare Locals from July 1 2015. PHNs are established with the key objectives of: • increasing the efficiency and effectiveness of medical services for patients, particularly those at risk of poor health outcomes; and Primary Health Network • improving coordination of care to ensure patients receive the right care in the right place at the right time. PHNs work directly with general practitioners, other primary healthcare providers, secondary care providers and hospitals to ensure improved outcomes for patients. Prosthetic An artificial replacement for part of the body. Public hospitals offer free diagnostic services, treatment, care and inpatient accommodation Public hospital to Medicare eligible patients. Patients who elect to be treated as a private patient in a public hospital, and patients who are not Medicare eligible are charged for the cost of treatment. A public patient is one who elects to be treated as a public patient, so cannot choose the Public patient doctor who treats them, or is receiving treatment in a private hospital under a contract arrangement with a public hospital or health authority. Queensland Weighted QWAU is a standardised unit to measure healthcare services (activities) within the Activity Unit (QWAU) Queensland Activity Based Funding (ABF) model. An individual registered under national law to practice without supervision in the nursing Registered nurse (RN) profession as a nurse, other than as a student. Renal dialysis Renal dialysis is a medical process of filtering the blood with a machine outside of the body. Risk The effect of uncertainty on the achievement of an organisation’s objectives. A process of systematically identifying hazards, assessing and controlling risks, and Risk management monitoring and reviewing activities to make sure that risks are effectively managed. Safety and Reliability Improvement Partners are an exclusive group of healthcare Safety and Reliability organisations, led by the Cognitive Institute, committed to a quantum leap in the delivery of Improvement Partners safer and reliable healthcare. SAFE (Systematic A DDHHS program to measure performance against the clinical standards to improve safety Approach Facilitates and quality. Excellence) Medical care provided by a specialist or facility upon referral by a primary care physician. It Secondary healthcare includes services provided by hospitals and specialist medical practices The process by which an episode of care for an admitted patient ceases. A separation may Separation be formal or statistical. Service Delivery Service Delivery Statements provide budgeted financial and non-financial information for Statement (SDS) the Budget year; https://www.treasury.qld.gov.au/resource/service-delivery-statements/

82 DDHHS Annual Report 2016-2017 | Glossary of terms Term Meaning Statutory bodies/ A non-departmental government body, established under an Act of Parliament. authorities Sub-acute Sub-acute care focuses on continuation of care and optimisation of health and functionality. A health system that provides infrastructure, such as workforce, facilities and equipment, Sustainable health and is innovative and responsive to emerging needs, for example, research and monitoring system within available resources. Moveable arm system to provide medical gas and electrical service and facilitate equipment Theatre pendant management in an operating theatre Delivery of health-related services and information via telecommunication technologies, including: • live, audio and/or video inter-active links for clinical consultations and educational purposes Telehealth • store-and-forward Telehealth, including digital images, video, audio and clinical (stored) on a client computer, then transmitted securely (forwarded) to a clinic at another location where they are studied by relevant specialists • Telehealth services and equipment to monitor people’s health in their home. Triage category Urgency of a patient’s need for medical and nursing care. Ultrasound imaging allows an inside view of soft tissues and body cavities without the use of Ultrasound invasive techniques. Ultra-sound waves can be bounced off tissues by using special devices. The echoes are then converted into a picture called a sonogram. A medical practitioner who is employed as an independent contractor or an employee to Visiting Medical Officer provide services on a part time, sessional basis. Weighted activity unit A single standard unit used to measure all activity consistently. (WAU)

Glossary of terms | DDHHS Annual Report 2016-2017 83 Compliance checklist

Annual report Summary of Requirement Basis for requirement reference • A letter of compliance from the Letter of accountable officer or statutory body to ARRs – section 7 i compliance the relevant Minister

• Table of contents ARRs – section 9.1 1

• Glossary ARRs – section 9.1 78-83

• Public availability ARRs – section 9.2 Inside cover

Accessibility Queensland Government Language • Interpreter service statement Services Policy Inside cover ARRs – section 9.3 Copyright Act 1968 • Copyright notice Inside cover ARRs – section 9.4 QGEA – Information licensing • Information licensing Inside cover ARRs – section 9.5

• Introductory Information ARRs – section 10.1 2-4

General • Agency role and main functions ARRs – section 10.2 4-6 information

• Operating environment ARRs – section 10.3 4-9, 25-27

• Government objectives for the ARRs – section 11.1 6 community • Other whole-of-government plans/ ARRs – section 11.2 47-51 Non-financial specific initiatives performance • Agency objectives and performance ARRs – section 11.3 7-9, 34-77 indicators • Agency service areas and service ARRs – section 11.4 34-77 standards Financial • Summary of financial performance ARRs – section 12.1 64-65 performance

• Organisational structure ARRs – section 13.1 25-26

• Executive management ARRs – section 13.2 10-14, 20-24 Governance – • Government bodies (statutory bodies management ARRs – section 13.3 Not applicable and other entities) and structure Public Sector Ethics Act 1994 • Public Sector Ethics Act 1994 75 ARRs – section 13.4

• Queensland public service values ARRs – section 13.5 73

84 DDHHS Annual Report 2016-2017 • Risk management ARRs – section 14.1 28, 71

• Audit committee ARRs – section 14.2 16 Governance – risk management • Internal Audit ARRs – section 14.3 28 and accountability • External Scrutiny ARRs – section 14.4 28

• Information systems and recordkeeping ARRs – section 14.5 29

• Workforce planning, and performance ARRs – section 15.1 58-63, 72-77 Governance – human Directive No.11/12 Early Retirement, • Early retirement, redundancy and resources Redundancy and Retrenchment 74 retrenchment ARRs – section 15.2 • Statement advising publication of ARRs – section 16 Inside cover information

• Consultancies ARRs – section 33.1 Inside cover Open Data • Overseas travel ARRs – section 33.2 Inside cover

• Queensland Language Services Policy ARRs – section 33.3 Inside cover

FAA – section 62 • Certification of financial statements FPMS – sections 42, 43 and 50 131 Financial ARRs – section 17.1 statements FAA – section 62 • Independent Auditors Report FPMS – section 50 132 ARRs – section 17.2

FAA Financial Accountability Act 2009 FPMS Financial and Performance Management Standard 2009 ARRs Annual report requirements for Queensland Government agencies QGEA Queensland Government Enterprise Architecture

DDHHS Annual Report 2016-2017 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 DDHHS Annual Report 2016-2017 DDHHS Annual Report 2016-2017 137 Darling Downs Hospital and Health Service 2016–2017 Annual Report www.health.qld.gov.au/darlingdowns/