Proposed Implementation Plan Organisational Realignment – Rural Division Director of Medical Services

Purpose This document provides an overview of a proposed modification of the organisational structure within Hospital and Health Service (DDHHS) involving: Western Cluster, and Southern Cluster – Rural division

This document aims to broadly guide affected staff through the scope and implementation process of the proposed change and outlines possible impacts on employees. The document is intended to: • support consultation in relation to the change and the way the proposed change is implemented; and • invite input into the change and ways in which any adverse impacts of the change can be minimised.

Background The Rural division delivers excellence in healthcare, to optimise patient centered outcomes for our community. This is achieved by enabling safe, accessible, sustainable, and evidence-based healthcare by a highly skilled and valued workforce. The Rural division consists of: • seven regional hospitals • nine smaller hospitals • six residential aged care facilities • three Multipurpose health services • three outpatient facilities to provide a range of community based health services

The Rural division is organised into three clusters, each led by a Cluster Director of Nursing (CDON), and supported by a Director of Medical Services (DMS) as detailed below: Each CDON reports directly to the Executive Director Rural (EDR) operationally and professionally to the Executive Director of Nursing and Midwifery (EDNMS) and consists of the following positions:

Cluster Medical lead-position No of Medical No of direct reports to Superintendents Medical Superintendents South Director of Medical Services, 3 15.12 Burnett South Burnett Southern 5.5 24.31 Director of Medical Services, Western Rural 7.0 14.42

In the current structure, the DMS South Burnett operationally reports to the Director of Nursing (DON), Kingaroy Hospital which is the facility with highest activity within the cluster; and the DMS Rural operationally reports to the EDR. Southern and Western cluster facilities with the highest activity are Warwick Hospital and Dalby Hospital respectively.

Page 1 of 11 Department | Last reviewed 01/2019 Contact Rural Division | Phone 07 4699 8303 | Baillie Henderson Hospital Printed copies of this document or part thereof should not be relied upon as a current reference document. ALWAYS refer to the electronic copy for the latest version.

The Director of Medical Services, Rural is responsible for the professional leadership of medical staff across the Southern and Western clusters, which includes: • Providing leadership to improve care – reviewing and developing processes, and monitoring emerging issues • Lead clinical governance functions – review of incidents including root cause analysis and open disclosure, morbidity and mortality review, escalating significant concerns, proactively managing patient feedback regarding medical services • Responsible for monitoring compliance, mandatory training processes, and credentialing support to the division’s medical staff • Workforce functions including managing vacancies, recruitment, leave, capacity management, and attending conference/networking events • Providing advice to EDR on workforce planning and other issues • While the role is a clinician manager, the role is predominantly a management role with only a small component as direct patient clinical services (< 0.2 Full-time Equivalent) (FTE)

The following concerns and risk areas have been identified as a result of capacity issues:

No Area Detail Consequence 1 Leadership Advice and support to leaders often Delays to safely support multiple areas occurs on an adhoc basis due to the geographical range and complex case mix 2 Professional Employee Performance and Disengagement of medical staff development and Development discussions can be compliance delayed and unfocussed 3 Clinical Monitoring and reviews of incidents Delays to develop safety and quality governance and feedback on a responsive basis with CDONs and Patient Safety Officers 4 Program Ability to lead and implement medical Delays to innovate and contemporise development models of care, can be delayed practice 5 Service efficiency Compliance monitoring is reactionary Delays to embed a culture of program and often prioritised through breach risk reporting and leading compliance management 6 Service strategy Ability to foster and engage into Delays to service advancement and research, education and training can access to mastery and doctoral be delayed knowledge 7 Workforce strategy Reactive to resignations and Delays to medical workforce model vacancies due to the geographical redesign, and recruitment advantage range and demands required to through proactive engagement with support complex care social media and other access points

It is considered necessary to modify the organisational structure due to the following circumstances: 1. Capacity of the DMS, Rural to ably achieve the role requirements across two clusters; 2. Strive for increased patient safety, clinical support and organisational uniformity. 3. Improve Rural Division medical governance maintaining the strategic direction and establishing transparent and effective accountability mechanisms.

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Scope of the Proposed Change Option 1

Option 1 will achieve medical governance of the rural division having three DMS positions for the South Burnett, Southern and Western Clusters. The DMS’s will work closely with the respective CDON. The three DMS positions will report operationally to EDR, and professionally to the EDMS.

Medical Superintendent, Warwick & Dalby These positions are responsible for the provision of efficient quality medical services to inpatients and outpatients, including the provision of 24-hour emergency coverage on a rostered basis. These positions have a clinical component of 0.3 FTE. The roles are evaluated as Medical Superintendent L18-27 and it is accordingly proposed these two positions (Total of 2.0 FTE) will be abolished.

Director of Medical Services, Rural This position is responsible for the professional oversight and leadership of medical staff in the Southern and Western clusters of the Rural division. The role takes portfolio responsibility for functions of clinical governance in the Rural division. While the role is a clinician manager, the role is predominantly a management role with only a small component as direct patient clinical services (< 0.2 FTE). The role is evaluated as L18-27 and it is accordingly proposed this position will be abolished.

Director of Medical Services, South Burnett (Proposed 0.8 FTE DMS & Medical Superintendent Kingaroy and 0.2 FTE Clinical) It is proposed to retain this position, and realign operational reporting from the DON, Kingaroy Hospital; to the EDR. This position will work closely with the CDON South Burnett. This will enable implementation of a cluster- based model, and integration of services. It is not proposed, this position will require re-evaluation, therefore will remain as L18-27.

Director of Medical Services, Southern (Proposed 0.8 FTE DMS & Medical Superintendent Warwick and 0.2 FTE Clinical) It is proposed to establish this new position, after abolishing the Medical Superintendent, Warwick role. The purpose of the role will be to provide strategic, professional leadership and governance for the medical workforce in the Southern cluster (Warwick, Stanthorpe, , Inglewood, Texas and Millmerran). The position will be the senior clinician leader responsible for efficient quality medical services to inpatients and outpatients of the Warwick Hospital where the position will be based; and deliver quality clinical services in the areas of inpatient and outpatient care, administration, service planning and teaching to the communities within the Southern cluster. Alignment and leverage is expected from the existing DMS South Burnett position description in the creation of this role; and while the position will require evaluation; it is expected to be at L18- 27 or similar. This position will report operationally to the EDR and professionally to the EDMS. This position will work closely with the CDON Southern.

Director of Medical Services, Western (Proposed 0.8 FTE DMS & Medical Superintendent Dalby and 0.2 FTE Clinical) It is proposed to establish this new position, after abolishing the Medical Superintendent, Dalby role. The purpose of the role will be to provide strategic, professional leadership and governance for the medical workforce in the Western cluster (Dalby, Oakey, Tara, Chinchilla, Miles, and ). The position will be the senior clinician leader responsible for efficient quality medical services to inpatients and outpatients of the Dalby Hospital where the position will be based; and deliver quality clinical services in the areas of inpatient and outpatient care, administration, service planning and teaching to the communities within the Western cluster. Alignment and leverage is expected from the existing DMS South Burnett position description in the creation of this role; and while the position will require evaluation; it is expected to be at L18-27 or similar. This position will report operationally to the EDR and professionally to the EDMS. This position will work closely with the CDON Western.

Senior Medical Officer (SMO) Dalby It is proposed to establish SMO 0.3 FTE position in Dalby to undertake the clinical duties previously aligned with the Medical Superintendent position Dalby; it is expected to be at L18-27.

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SMO Warwick It is proposed to establish SMO 0.3 FTE position in Warwick to undertake the clinical duties previously aligned with the Medical Superintendent position Warwick; it is expected to be at L18-27.

SMO Kingaroy It is proposed to establish SMO 0.2 FTE position in Kingaroy to undertake the clinical duties previously aligned with the Medical Superintendent position Kingaroy; it is expected to be at L18-27.

Summary • Retain the DMS South Burnett position (L18-27) and realign role to operationally report to EDR. Professional reporting continues to the EDMS. • Abolish the DMS Rural; Medical Superintendent, Warwick; and Medical Superintendent, Dalby positions. • Create DMS Southern (L18-27) and DMS Western (L18-27) positions each reporting operationally to EDR, and both professionally reporting to the EDMS. Create SMO Dalby (0.3 FTE), SMO Warwick (0.3 FTE) and SMO Kingaroy (0.2 FTE).

Establishment change:

Position Current Proposed

Medical Superintendent, Warwick 1.00 FTE Abolish

Medical Superintendent, Dalby 1.00 FTE Abolish

Director of Medical Services, Rural 1.00 FTE Abolish

Director of Medical Services, South Burnett 1.00 FTE Retain & realign

Director of Medical Services, Southern - 1.00 FTE

Director of Medical Services, Western - 1.00 FTE

Senior Medical Officer, Dalby - 0.3 FTE

Senior Medical Officer, Warwick - 0.3 FTE

Senior Medical Officer, Kingaroy - 0.2 FTE

Option 2 Option 2 will achieve medical governance of the rural division having three DMS positions for the South Burnett, Southern and Western Clusters. The DMS’s will work closely with the respective CDON. The three DMS positions will report operationally to EDR, and professionally to the EDMS. One of the appointed DMS will have oversight for the Rural Division.

Medical Superintendent, Warwick & Dalby These positions are responsible for the provision of efficient quality medical services to inpatients and outpatients, including the provision of 24-hour emergency coverage on a rostered basis. These positions have a clinical component of 0.3 FTE. The roles are evaluated as L18-27 and it is accordingly proposed these two positions (Total of 2.0 FTE) will be abolished.

Director of Medical Services, Rural This position is responsible for the professional oversight and leadership of medical staff in the Southern and Western clusters of the Rural division. The role takes portfolio responsibility for functions of clinical governance in the Rural division. While the role is a clinician manager, the role is predominantly a management role with Page 4 of 11

only a small component as direct patient clinical services (< 0.2 FTE). The role is evaluated as L18-27 and it is accordingly proposed this position will be abolished, however 0.2 FTE will merge with the DMS either South Burnett, Southern or Western, within the existing level of L18-27.

Director of Medical Services, South Burnett (Proposed 0.8 FTE DMS & Medical Superintendent Kingaroy and 0.2 FTE Clinical or 0.2 FTE Rural oversight) It is proposed to retain this position, and realign operational reporting from the DON, Kingaroy Hospital; to the EDR. This position will work closely with the CDON South Burnett. This will enable implementation of a cluster- based model, and integration of services. It is not proposed this position will require re-evaluation, therefore will remain as L18-27.

Director of Medical Services, Southern (Proposed 0.8 FTE DMS & Medical Superintendent Warwick and 0.2 FTE Clinical or 0.2 FTE Rural oversight) It is proposed to establish this new position, after abolishing the Medical Superintendent, Warwick role. The purpose of the role will be to provide strategic, professional leadership and governance for the medical workforce in the Southern cluster (Warwick, Stanthorpe, Goondiwindi, Inglewood, Texas and Millmerran). The position will be the senior clinician leader responsible for efficient quality medical services to inpatients and outpatients of the Warwick Hospital where the position will be based; and deliver quality clinical services in the areas of inpatient and outpatient care, administration, service planning and teaching to the communities within the cluster. Alignment and leverage is expected from the existing DMS South Burnett position description in the creation of this role; and while the position will require evaluation; it is expected to be an L18-27 level or similar. This position will report operationally to the EDR and professionally to the EDMS. This position will work closely with the CDON Southern.

Director of Medical Services, Western (Proposed 0.8 FTE DMS & Medical Superintendent Dalby and 0.2 FTE Clinical or 0.2 FTE Rural oversight) It is proposed to establish this new position, after abolishing the Medical Superintendent, Dalby role. The purpose of the role will be to provide strategic, professional leadership and governance for the medical workforce in the Western cluster (Dalby, Oakey, Tara, Chinchilla, Miles, Taroom and Jandowae). The position will be the senior clinician leader responsible for efficient quality medical services to inpatients and outpatients of the Dalby Hospital where the position will be based; and deliver quality clinical services in the areas of inpatient and outpatient care, administration, service planning and teaching to the communities within the cluster. Alignment and leverage is expected from the existing DMS South Burnett position description in the creation of this role; and while the position will require evaluation; it is expected to be an L18-27 level or similar. This position will report operationally to the EDR and professionally to the EDMS. This position will work closely with the CDON Western.

Senior Medical Officer (SMO) Dalby It is proposed to establish SMO 0.3 FTE position in Dalby to undertake the clinical duties previously aligned with the Medical Superintendent position Dalby; it is expected to be at L18-27.

Senior Medical Officer Warwick It is proposed to establish SMO 0.3 FTE position in Warwick to undertake the clinical duties previously aligned with the Medical Superintendent position Warwick; it is expected to be at L18-27.

Senior Medical Officer Kingaroy It is proposed to establish SMO 0.2 FTE position in Kingaroy to undertake the clinical duties previously aligned with the Medical Superintendent position Kingaroy; it is expected to be at L18-27.

Summary • Enhance DMS South Burnett position (L18-27) to include oversight of Cluster Director of Medical Service positions and realign role to operationally report to EDR. Professional reporting continues to the Executive Director Medical Services (EDMS). • Abolish the DMS Rural position. • Abolish the Medical Superintendent, Warwick and Medical Superintendent, Dalby positions. • Create DMS Southern (L18-27) and DMS Western (L18-27) positions, each operationally reporting to EDR and professionally reporting to the EDMS. • Create SMO Dalby (0.3 FTE), SMO Warwick (0.3 FTE) and SMO Kingaroy (0.2 FTE) • One of the appointed DMS will have oversight for the Rural Division. Page 5 of 11

Establishment change:

Position Current Proposed

Medical Superintendent, Warwick 1.00 FTE Abolish

Medical Superintendent, Dalby 1.00 FTE Abolish

Director of Medical Services, Rural 1.00 FTE Abolish

Director of Medical Services, South Burnett 1.00 FTE Retain & realign

Director of Medical Services, Southern - 1.00 FTE

Director of Medical Services, Western - 1.00 FTE

Senior Medical Officer, Dalby - 0.3 FTE

Senior Medical Officer, Warwick - 0.3 FTE

Senior Medical Officer, Kingaroy - 0.2 FTE

Director of Medical Services, Rural (to be allocated across 1 of the 3 clusters) 0.2 FTE

Benefits and Enhanced Service Delivery 1. Align with a cluster-based model of medical leadership and governance to empower connections with local workforce. 2. Increased local innovation and accountability, by empowering solutions and decision-making relevant to district issues. 3. Strengthen the rapport with the district, by being an accessible, collaborative leader in the community. 4. Travel time and distances are significantly reduced with a cluster-based model. 5. Clinician engagement is respected by being focused, enduring, proactive, and readily accessible. 6. Improved workplace culture that enhances patient care and staff satisfaction. 7. Medical workforce is proactively managed, through engaged and connected leadership with capacity to access contemporary methods to attract new clinicians, retain through investing in timely performance and professional development discussions; and offer professional growth opportunities through encouraging succession plans. 8. Attraction for clinicians seeking a challenging variety of medical administration combined with clinical duties. 9. Staff are supported and focused on continually improving results and increasing access to the community. 10. Continued innovation and effective leadership is attainable with the number of direct reports. 11. Performance and excellence Medical advice to CDONs and Directors of Nursing

This proposal is consistent with the Government’s Employment Security Policy.

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Effects on employees ▪ ‘directly affected’ means: the role will be abolished or reduced in size of FTEs. ▪ ‘indirectly affected’ means: the unit or department the employee is in may report to a new Manager.

Effects on Employees Option 1 Option 2 Number of directly affected employees 3 3 Number of indirectly affected employees 1 1

Organisational Structure Change The current and proposed organisational structures and reporting lines are detailed in Attachments 1, 2 and 3. Any changes to the organisational structures and reporting lines resultant from this proposed organisation realignment may require a review of the Hospital and Health Service Human Resource Sub-Delegations Manual and the Financial Delegations Manual. Such documents may be amended to align with any newly adopted governance structures and reporting lines implemented at the conclusion of this organisation realignment process.

It may also be necessary to review and amend the Integrated Workforce Management (IWFM) organisation structure and workflow of forms in myHR in order to align such systems with any newly adopted governance structures and reporting lines implemented at the conclusion of this organisation realignment process.

Appropriate steps will be taken to in such regard as necessary.

The role description for the DMS cluster-based model will be similar to the DMS South Burnett role description. Clarification around the pre-requisite qualifications will flow from the consultation phase with an expectation that the following Fellowships will be eligible for the role: • Fellowship of Australian College of Rural and Remote Medicine (FACRRM) with any advanced skill • Fellowship of the Royal Australian College of General Practitioners (FRACGP) with or without FARGP (Fellowship in Advanced Rural General Practice) with any advanced skill • Highly Desirable – Fellowship of the Australasian College of Medical Administrators (FRACMA) or commitment to obtain FRACMA or associate FRACMA (aFRACMA).

Supporting Staff through Change Darling Downs Health (DDH) values and respects its staff and the contribution they make to the health of our community. For employees generally, the supports will include: • Detail about the decision and impacts as soon as possible in the process; • Access to Employee Assistance Program (EAP) including face-to-face counselling and other strategies; • Line manager support; and • Team-based support where required.

Minimising the Effects of the Change DDH wants to avoid or minimise any possible adverse effects of the proposed change on existing employees. Input of employees in implementing the changes can help minimise the impacts.

Steps for Consultation on Implementation 1) Proposal about restructure agreed to proceed to consultation. 2) Documentation provided to employees advising a proposal has been made on restructure. 3) Documentation provided to relevant union/s advising a proposal has been made on restructure. Page 7 of 11

4) Documentation tabled at DDHHS Consultative Forum. 5) Individual meetings with affected employees where requested. 6) Period of consultation with employees and unions in relation to proposal and implementation. 7) Feedback received in relation to proposal and implementation considered. 8) Consultation finalised and decision and implementation plan determined and commenced.

Timeline for implementing change

Date/s Action Responsible Officer

03/05/ 2019 Documentation provided to employees articulating proposal and Executive Director advising of commencement of consultation. Rural 03/05/ 2019 Documentation provided to relevant union/s articulating proposal Executive Director and advising of commencement of consultation. Rural 17/05/2019 Documentation tabled at DDHHS Consultative Forum. Executive Director Workforce 03/05/2019 Individual meetings with affected employees, if requested. Executive Director Rural 03/06/2019 Consultation/feedback period closes. Executive Director Rural August Decision made and announced to affected staff and stakeholders. Executive Director 2019 Rural

Providing Feedback Stakeholders are invited to provide feedback by 3 June 2019 about the proposed change and implementation process. Feedback may be provided by mail or email to:

Internal Mail: Executive Director Rural, Jofre Building, Baillie Henderson Hospital External Mail: Executive Director Rural, PO Box 405, QLD 4350 Email: [email protected]

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ATTACHMENT ONE – Current Organisational Structure

EDR EDMS

Professionally manages: - DMS Rural A/Executive Support - DMS South Burnett Officer

DMS Rural DON South Burnett DON Southern DON Western

DON Kingaroy Professionally manages: - Operationally DON Dalby - Medical Superintendent, Warwick manages DMS South DON Murgon - Medical Superintendent, Stanthorpe Burnett - Operationally DON Warwick DON Oakey - Medical Superintendent, Inglewood manages Med - Medical Superintendent, Texas Super DON Stanthorpe DON Tara - Medical Superintendent, Goondiwindi - Medical Superintendent, Millmerran DON Cherbourg DON Inglewood DON Chinchilla - Medical Superintendent, Dalby DMS South Burnett - Operationally - Medical Superintendent, Oakey manages Med DON Texas DON Miles - Medical Superintendent, Tara Professionally manages: Super - Med Super Murgon - Medical Superintendent, Chinchilla DON Goondiwindi DON Taroom - Medical Superintendent, Miles - Med Super Cherbourg DON Nanango - Med Super Nanango - Medical Superintendent, Taroom - Operationally DON Millmerran DON Jandowae - Medical Superintendent, Jandowae manages Med Super

DMS South Burnett works closely with DON South Burnett

Page 9 of 11 Department | Last reviewed 01/2019 Contact Rural Division | Phone 07 4699 8303 | Baillie Henderson Hospital Printed copies of this document or part thereof should not be relied upon as a current reference document. ALWAYS refer to the electronic copy for the latest version.

ATTACHMENT TWO – Proposed Organisational Structure: Option 1

EDMS Executive Director Rural

Professionally manages: - DMS South Burnett Executive Support Officer - DMS Southern - DMS Western

DMS South Burnett DON South Burnett DMS Southern DON Southern DMS Western DON Western

DON Dalby DON Warwick DON Oakey DON Kingaroy Operationally manages DON Stanthorpe Operationally manages Warwick Hospital Medical Dalby Hospital Medical DON Tara Operationally manages DON Murgon Officers DON Inglewood Officers Kingaroy Hospital Medical DON Chinchilla Officers DON Cherbourg Professionally manages: DON Texas Professionally manages: - Med Super Stanthorpe - Med Super Oakey DON Miles Professionally manages: DON Nanango - Med Super Goondiwindi DON Goondiwindi - Med Super Tara - Med Super Nanango - Med Super Inglewood - Med Super Chinchilla DON Taroom - Med Super Cherbourg - Med Super Texas DON Millmerran - Med Super Miles - Med Super Murgon - Med Super Millmerran - Med Super Taroom DON Jandowae - Med Super Jandowae

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ATTACHMENT THREE – Proposed Organisational Structure: Option 2

Executive Director Rural EDMS

Professionally manages: - DMS Rural Executive Support Officer

DMS Rural DMS South Burnett DON South Burnett DMS Southern DON Southern DMS Western DON Western

0.2FTE Either added to DMS South Burnett, DMS Southern or DMS Western DON Dalby DON Warwick DON Oakey DON Stanthorpe DON Kingaroy Operationally manages Operationally manages Dalby Hospital Medical DON Tara Operationally manages Warwick Hospital Medical DON Inglewood DON Murgon Officers Kingaroy Hospital Medical Officers Professionally DON Chinchilla Officers DON Texas manages: DON Cherbourg Professionally manages: Professionally manages: - DMS South Burnett - Med Super Oakey DON Miles Professionally manages: - Med Super Stanthorpe DON Goondiwindi DON Nanango - Med Super Tara - DMS Southern - Med Super Nanango - Med Super Goondiwindi - DMS Western - Med Super Chinchilla DON Taroom - Med Super Cherbourg - Med Super Inglewood DON Millmerran - Med Super Miles - Med Super Murgon - Med Super Texas - Med Super Taroom DON Jandowae - Med Super Millmerran - Med Super Jandowae

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