Statement of Compliance
HON JIM MCGINTY MLA MINISTER FOR HEALTH
In accordance with Section 61 of the Financial Management Act 2006, I hereby submit for your information and presentation to Parliament, the Report of the Metropolitan Health Service for the year ended 30 June 2007.
This report has been prepared in accordance with the provisions of the Financial Management Act 2006.
Dr Neale Fong DIRECTOR GENERAL OF HEALTH Accountable Authority for The Minister For Health in his Capacity As the Deemed Board of Metropolitan Public Hospitals
27th September 2007
Statement of Compliance
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Contents STATEMENT OF COMPLIANCE ...... 1 CONTENTS ...... 2 EXECUTIVE SUMMARY...... 6 YOUR HEALTH SYSTEM ...... 8 Address and Location...... 8 Our purpose...... 11 Our vision ...... 11 Service Framework ...... 12 Services provided ...... 13 Compliance reports...... 15 Statement of compliance with public sector standards ...... 16 Accountable authority ...... 17 Pecuniary interests ...... 17 Senior officers...... 17 Management structure ...... 19 KEY PERFORMANCE INDICATORS CERTIFICATION STATEMENT ...... 25 KEY PERFORMANCE INDICATORS AUDIT OPINION ...... 26 KEY PERFORMANCE INDICATORS ...... 28 Introduction ...... 28 Consumer Price Index Deflator Series ...... 29 Outcome 1: Restoration of patients’ health, safe delivery of newborns and support for patients and families during terminal illness...... 30 1-00 (new indicator): Proportion of public patients discharged to home after admitted hospital treatment ...... 31 1-01 (200): Elective surgery waiting times ...... 32 1-02 (204): Rate of unplanned hospital readmissions within 28 days to the same hospital for a related condition ...... 33 1-03 (205): Rate of unplanned hospital readmissions within 28 days to the same hospital for a mental health condition ...... 34 1-04 (206): Rate of post-operative pulmonary embolism ...... 35 1-05 (208): Survival rates for sentinel conditions ...... 36 1-06 (new indicator): Proportion of live births with an APGAR score of 3 or lower, five minutes
after delivery...... 38 Contents 1-07 (201): Proportion of emergency department patients seen within recommended times ..39 1-08 (new indicator): Percentage of admitted patients transferred to an inpatient ward within 8 hours of emergency department arrival ...... 40 S1-00 (220): Average cost per casemix adjusted separation for teaching hospitals ...... 41 S1-01 (221): Average cost per casemix adjusted separation for non-teaching hospitals ...... 42 S1-02 (PathWest): Average cost per occasion of service for PathWest functions performed at, or managed by, the QEII site of PathWest ...... 43 S2-00 (229): Average cost per bedday in an authorised mental health unit ...... 44 S2-01 (230): Average cost per bedday in older persons’ mental health inpatient units...... 45 S3-00 (new indicator): Average cost per Hospital in the Home patient day ...... 46 S5-00 (222): Average cost per emergency department presentation for Metropolitan Health Service hospitals ...... 47 S6-00 (223): Average cost per doctor-attended episode in an outpatient clinic for Metropolitan Health Service hospitals ...... 48 S6-01 (224): Average cost per non-admitted occasion of service for Metropolitan Health Service hospitals (excludes emergency occasions and doctor attended outpatients occasions) ...... 49 Outcome 2: Improved health of the people of Western Australia by reducing the incidence of preventable disease, specified injury, disability and premature death ...... 50
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2-00 (R101): Loss of life from premature death due to identifiable causes of preventable disease (breast and cervical cancer) ...... 51 2-01 (103): Rate of hospitalisation for gastroenteritis in children (0-4 years)...... 52 2-02 (104): Rate of hospitalisation for respiratory conditions...... 53 2-03 (105): Rate of childhood dental screening...... 55 2-04 (106): Dental health status of target clientele ...... 56 2-05 (212): Access to dental treatment services for eligible people ...... 57 2-06 (213): Average waiting times for dental services...... 58 S8-00 (110): Cost per capita of population health units...... 59 S8-01 (new indicator): Average cost per breast screening ...... 60 S10-00 (111): Average cost of service for school dental care ...... 61 S10-01 (231): Average cost of completed courses of adult dental care...... 62 Outcome 3: Enhanced wellbeing and environment of those with chronic illness or disability 63 3-00 (301): Percent of contacts with community-based public mental health non-admitted services within seven and fourteen days post discharge from inpatient units...... 64 S12-00 (311): Average cost per completed Aged Care Assessment Team (ACAT) assessment...65 S12-01 (310): Average cost per care awaiting placement (CAP) day ...... 66 S13-00 (303): Average cost per person receiving care from public community-based mental health services ...... 67 S16-00 (new indicator): Average cost per client in a chronic disease management program ...68 SIGNIFICANT ISSUES AND TRENDS ...... 69 Overview ...... 69 Major Achievements 2006-07...... 70 Healthy workforce ...... 70 Healthy hospitals, health services and infrastructure ...... 72 Healthy communities...... 77 Healthy partnerships ...... 79 Healthy resources...... 81 Healthy leadership...... 82 Priorities for 2007-08...... 83 OPERATIONS...... 87 Advertising ...... 87 Corruption prevention ...... 88 Disability access and inclusion plan...... 89 Employee profile...... 93 Equity and diversity ...... 94 Contents Industrial relations ...... 96 Internal audit controls ...... 97 Major capital works...... 98 Pricing policy ...... 98 Recordkeeping...... 99 Recruitment ...... 100 Staff development ...... 102 Substantive equality...... 104 Sustainability ...... 104 Workers’ compensation and rehabilitation ...... 105 FINANCIAL STATEMENTS CERTIFICATION STATEMENT ...... 106 FINANCIAL STATEMENTS AUDIT OPINION ...... 107 FINANCIAL STATEMENTS ...... 109 APPENDICES ...... 141 Appendix 1: Abbreviations ...... 141
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Illustrations
Figure 1: Proportion of public patients discharged to home after admitted hospital treatment .....31 Figure 2: Rate of acute myocardial infarction survival...... 36 Figure 3: Rate of stroke survival ...... 37 Figure 4: Rate of fractured neck of femur survival ...... 37 Figure 5: Rate of hospitalisation per 1,000 for gastroenteritis in children 0-4 years ...... 52 Figure 6: Rate of hospitalisation per 1,000 for bronchiolitis in 0-4 years ...... 54 Figure 7: Rate of hospitalisation per 1,000 for acute bronchitis in 0-4 years ...... 54 Figure 8: Rate of hospitalisation per 1,000 for croup in 0-4 years ...... 54
Table 1: Senior officers...... 17 Table 2: Service activities in relation to the components of the outcome ...... 28 Table 3: Consumer price index figures for the financial and calendar years ...... 29 Table 4: Key Performance Indicators for Outcome 1 by reporting entity ...... 30 Table 5: People remaining on the elective surgery wait list as at 30 June 2007...... 32 Table 6: People remaining on the elective surgery wait list as at 30 June 2006...... 32 Table 7: Rate of unplanned hospital readmissions within 28 days to the same hospital for a related condition ...... 33 Table 8: Rate of unplanned hospital readmissions within 28 days to the same hospital for a mental health condition...... 34 Table 9: Post-operative pulmonary embolism rate ...... 35 Table 10: Proportion of live births with an APGAR score of 3 or lower, five minutes after delivery .38 Table 11: Proportion of emergency department patients seen within recommended times...... 39 Table 12: Average cost per casemix adjusted separation for teaching hospitals ...... 41 Table 13: Average cost per casemix adjusted separation for non-teaching hospitals...... 42 Table 14: Average cost per occasion of service for PathWest functions performed at, or managed by, the QEII site of PathWest ...... 43 Table 15: Average cost per bedday in an authorised mental health unit ...... 44 Table 16: Average cost per bedday in older persons’ mental health inpatient units ...... 45 Table 17: Average cost per Hospital in the Home patient day...... 46 Table 18: Average cost per emergency department presentation for Metropolitan Health Service hospitals...... 47 Table 19: Average cost per doctor attended outpatient episode for Metropolitan Health Service
hospitals...... 48 Contents Table 20: Average cost per non-admitted occasion of service for Metropolitan Health Service hospitals (excludes emergency occasions and doctor attended outpatients occasions)...... 49 Table 21: Key Performance Indicators for Outcome 2 by reporting entity...... 50 Table 22: Person years of life lost from breast and cervical cancer ...... 51 Table 23: Rate of hospitalisation per 1,000 for acute asthma (all ages) ...... 53 Table 24: Rate of dental screening of pre-primary school children...... 55 Table 25: Rate of dental screening of primary school children...... 55 Table 26: Rate of dental screening of secondary school children ...... 55 Table 27: Rate of children free of dental caries when recalled ...... 55 Table 28: Average number of decayed, missing or filled teeth for school children ...... 56 Table 29: Average number of decayed, missing or filled teeth for adults ...... 56 Table 30: Access to dental treatment services for eligible people...... 57 Table 31: Rate of completed dental care ...... 57 Table 32: Average waiting times for dental treatment ...... 58 Table 33: Cost per capita of Population Health Units ...... 59 Table 34: Average cost per breast screening ...... 60 Table 35: Average cost of service for school dental care...... 61 Table 36: Average cost of completed courses of adult dental care...... 62 Table 37: Key Performance Indicators for Outcome 3 by reporting entity...... 63
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Table 38: Percent of contacts with community-based public mental health non-admitted services within seven and fourteen days post discharge from public mental health inpatient units .....64 Table 39: Average cost per completed ACAT assessment...... 65 Table 40: Average cost per CAP day...... 66 Table 41: Average cost per person with a mental illness under community care...... 67 Table 42: Average cost per client in a chronic disease management program...... 68 Table 43: Advertising expenditure for 2006-07...... 87 Table 44: Total Metropolitan Health Service FTE by category ...... 93 Table 45: Internal Audits completed in 2006-07 ...... 97 Table 46: Workers’ compensation claims...... 105
Contents
This Report is available in alternative formats upon request from a person with a disability
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Executive summary The Department of Health (DOH) continued its broad-based program of health reform throughout 2006-07 as part of its agenda to deliver a healthy WA. The Department’s commitment to ensure that high-quality, safe and accessible health care is available to all Western Australians remains firm. The strategic and operational planning framework, Strategic Directions 2005 – 2010, continues to inform the work undertaken by the Department of Health.
The Metropolitan Health Service (MHS) continues to ensure access to quality care through its tertiary, secondary and primary care providers. Demand for hospital and other health services continued to rise in 2006-07 and MHS has taken an integrated and proactive stance in addressing these challenges, with admirable results.
MHS is well positioned for continued reform efforts. Throughout 2006-07 significant progress was made in all MHS and DOH priority areas, which include: healthy workforce; healthy hospitals, health services and infrastructure; healthy partnerships; healthy communities; healthy resources; and healthy leadership. Healthy Workforce In 2006-07 workforce improvements have been delivered in terms of the Work Life Balance Policy, Aboriginal Employment Strategy, redesign of models of care and service delivery, and the inaugural Achieving Excellence in WA Health Conference. The WA Health ‘Have Your Say’ 2006 Employee Survey was conducted, the results of which are driving positive changes across the system. Staff have benefited directly from leadership development initiatives and a wide range of skill-enhancing training and professional development courses have been undertaken. All of these initiatives help to create a leading environment in which to work and deliver excellent services to the Western Australian community. Healthy Hospitals, Health Services and Infrastructure The reform agenda continues to move the focus of patient care closer to home, while at the same time ensuring our hospitals are world-class environments. In 2006-07 Health Networks continued to develop articulating models of care that rely less on tertiary care and promote primary and ambulatory care. Two surgi-centres were established to increase the flow of high volume surgical cases and the Ambulatory Surgery Initiative (ASI) was expanded to significantly improve waiting times for elective surgery – despite increasing demands and a growing and ageing population. Construction of the new Rockingham Kwinana District Hospital commenced, and the new Geraldton Regional Resource Centre was opened. Healthy Partnerships Strong relationships and partnerships continue to be cultivated and formalised in the delivery of innovative, cost-effective and high-quality health care services for the whole community. In 2006-07 the Department of Health continued to work closely with a number of independent institutes, non- government agencies, consumers, private providers, health professionals and other government agencies. The Department launched several healthy lifestyle initiatives. DOH also established performance agreements that clarify the performance of the Department and its progress in reform.
Healthy Communities Executive Summary Health promotion, illness prevention, early detection of disease and access to affordable community-based healthcare services are vital to the delivery a health service that is sustainable in the long-term. During 2006-07 a number of strategies have been developed and implemented to serve that end, including the Australian Better Health Initiative (ABHI), Indigenous Healthy Lifestyle Program, obesity prevention and health promotion programs, drug and alcohol campaigns and a patient first initiative developed by the Office of Safety and Quality.
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Healthy Resources DOH continues to develop and promote healthy resources as part of its reform agenda. We again, successfully managed within our allocated budget in 2006-07. These resources support the wider initiatives and efforts of the Department and in 2006-07 included the formation of an aged care assessment team with a training framework and best practice manual. DOH has also been involved with pivotal legislation changes and reviews that will help to more effectively address contemporary health-related issues. DOH also introduced a variety of training, education and service delivery models with accompanying resources which have been adopted by the Metropolitan Health Service. Healthy Leadership Increasing leadership capacity and effectiveness is central to delivering the goals outlined in the WA Strategic Intent 2005-2010. In 2006-07 the DOH continued to make vital progress in identifying, nurturing and promoting strong leadership at all levels within health care services by establishing the Institute for Healthy Leadership. The ‘Leading 100’ and ‘Vital Leadership’ programs support additional professional development opportunities available to all staff. In the last year we have made progress in understanding, valuing and enhancing diverse leadership styles that help staff to perform more effectively for the benefit of the WA community. Conclusion The 2006-07 annual report details the progress being made by the MHS and DOH. What this report cannot do is adequately celebrate the people who have contributed in a myriad of ways to health reform for the benefit of all Western Australians. I would like to take this opportunity to commend all staff within the MHS for their dedication to creating a better and more sustainable health service. In 2007-08 the DOH and MHS will continue, with firm resolve, to focus on delivering services to the community as a world-class health service.
Dr Neale Fong Director General of Health
27th September 2007 Executive Summary
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Your Health System Address and Location North Metropolitan Area Health Service North Metropolitan Area Health Service Women’s and Newborn Health Service Sir Charles Gairdner Hospital King Edward Memorial Hospital for Women Hospital Avenue, NEDLANDS WA 6009 374 Bagot Road SUBIACO WA 6904 Postal address Postal address Locked Bag 2012, NEDLANDS WA 6009 PO Box 134, SUBIACO WA 6904 Phone: (08) 9346 3333 Phone: (08) 9340 2222 Fax: (08) 9346 3759 Fax: (08) 9388 1780 Internet: www.nmahs.health.wa.gov.au Internet: www.wnhs.health.wa.gov.au
NMAHS Sir Charles Gairdner Group (including WA Cervical Cancer Prevention Program Osborne Park Hospital Program) 2nd Floor, Eastpoint Plaza Sir Charles Gairdner Hospital (as above) 233 Adelaide Terrace, PERTH WA 6000 Internet: http://www.scgh.health.wa.gov.au Phone: (08) 9323 6788 or 13 15 56 Email: [email protected] Fax: (08) 9323 6711
Osborne Park Hospital Program Osborne Place, STIRLING WA 6021 Mother and Baby Unit Phone: (08) 9346 8000 11 Loretto St, SUBIACO WA 6008 Fax: (08) 9346 8431 Postal address Internet: www.oph.health.wa.gov.au PO Box 134, SUBIACO WA 6904 Email: [email protected] Phone: (08) 9340 1799 1800 422 588 [outside metro area] NMAHS Ambulatory Care Fax: (08) 9340 1790 Sir Charles Gairdner Hospital (as above) Internet: www.wnhs.health.wa.gov.au Phone: (08) 9346 3333 Fax: (08) 9346 3853 Sexual Assault Resource Centre Internet: http://www.scgh.health.wa.gov.au PO Box 842, SUBIACO WA 6904 Email: [email protected] Phone: (08) 9340 1820 Fax: (08) 9381 5426 NMAHS Area Mental Health Service 24 hour crisis line: (08) 9340 1828 Moore House, Graylands Campus SARC Counselling Line: (08) 9340 1899 or Brockway Rd, MOUNT CLAREMONT WA 6010 Freecall: 1800 199 888 Postal address Internet: www.wnhs.health.wa.gov.au Private Bag 1, CLAREMONT WA 6910 Phone: (08) 9347 6933 Fax: (08) 9347 6949 BreastScreen WA Email: [email protected] 9th Floor, Eastpoint Plaza 233 Adelaide Terrace, PERTH WA 6000 Swan Kalamunda Health Service Phone: (08) 9323 6700 Eveline Road, MIDDLE SWAN WA 6056 Fax: (08) 9323 6799 Postal address Internet: www.breastscreen.health.wa.gov.au PO Box 195, MIDLAND WA 6936 Phone: (08) 9347 5400
Fax: (08) 9347 5410 Your Health System Internet: http://www.nmahs.health.wa.gov.au/ Email: [email protected]
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Address and Locations (continued) South Metropolitan Area Health Service South Metropolitan Area Health Service Rockingham-Kwinana District Hospital Executive Offices Elanora Drive, COOLOONGUP WA 6168 Level 3 South Block, Royal Perth Hospital Postal address Wellington Street, PERTH WA 6001 PO Box 2033, ROCKINGHAM WA 6967 Postal address Phone: (08) 9592 0600 GPO Box X2213, PERTH WA 6847 Fax: (08) 9592 0619 Phone: (08) 9224 3604 Royal Perth Hospital Fax: (08) 9224 3444 Wellington Street, PERTH WA 6001 Internet: www.smahs.health.wa.gov.au Postal address Armadale/Kelmscott Memorial Hospital GPO Box X2213, PERTH WA 6847 3056 Albany Highway, ARMADALE WA 6112 Phone: (08) 9224 2244 Postal Address Fax: (08) 9224 3511 PO Box 460, ARMADALE WA 6992 Internet: www.rph.wa.gov.au Phone: (08) 9391 2000 Email: [email protected] Fax: (08) 9391 2129 Royal Perth Hospital: Shenton Park Campus Internet: www.ahs.health.wa.gov.au 6 Selby Street, SHENTON PARK WA 6008 Bentley Hospital Phone: (08) 9382 7171 33 Mills Street, BENTLEY WA 6102 Fax: (08) 9382 7351 Postal address Rottnest Island Nursing Post PO Box 158, BENTLEY WA 6982 Rottnest Island, WA 6161 Phone: (08) 9334 3666 Phone: (08) 9292 5030 Fax: (08) 9356 1632 Fax: (08) 9292 5121 Internet: www.health.wa.gov.au/bhs Email: [email protected] South Metropolitan Mental Health Service Postal address Fremantle Hospital PO Box 480, FREMANTLE WA 6959 Alma Street, FREMANTLE WA 6160 Phone: (08) 9431 3333 Postal address Fax: (08) 9431 3579 or (08) 9431 3457 PO Box 480, FREMANTLE WA 6959 Phone: (08) 9431 3333 South Metropolitan Population Health Fax: (08) 9431 2921 Public Health Unit Internet: www.fhhs.health.wa.gov.au Level 2, 7 Pakenham Street Email: [email protected] FREMANTLE WA 6160 PO Box 546, FREMANTLE WA 6959 Kaleeya Hospital Phone: (08) 9431 0200 Corner Staton Road and Wolsely Road Fax: (08) 9431 0222 EAST FREMANTLE WA 6158 Phone: (08) 9319 0300 Fax: (08) 9319 1958
Murray District Hospital (see separate Peel Health Service annual report for operational information) McKay Street, PINJARRA WA 6208 Postal address PO Box 243, PINJARRA WA 6208 Phone: (08) 9531 7222 Your Health System Fax: (08) 9531 7241
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Address and Locations (continued) Child and Adolescent Health Service PathWest Laboratory Medicine WA Princess Margaret Hospital for Children J Block, QEII Medical Centre Roberts Road, SUBIACO WA 6008 Hospital Avenue, NEDLANDS WA 6009 Phone: (08) 9340 8222 Postal address Fax: (08) 9340 7000 Locked Bag 2009, NEDLANDS WA 6909 Internet: www.cahs.health.wa.gov.au Phone: (08) 9346 3000 Fax: (08) 9381 7594 Child and Community Health Division Email: [email protected] WASON Building Internet: www.pathwest.com.au 151 Wellington St, PERTH WA 6000
Phone: (08) 9224 1625 PathWest Laboratory Medicine WA RPH Fax: (08) 9224 1612 North Block, Royal Perth Hospital Internet: www.cahs.health.wa.gov.au Wellington Street, PERTH WA 6000 Postal address Dental Health Services GPO Box X2213, PERTH WA 6847 43 Mt Henry Road, COMO WA 6152 Phone: (08) 9224 2422 Postal Address Fax: (08) 9224 3466 Locked Bag 15, Bentley Delivery Centre PERTH WA 6983 PathWest Laboratory Medicine WA KEMH Phone: (08) 9313 0555 King Edward Memorial Hospital for Women Fax: (08) 9313 1302 Bagot Road, SUBIACO WA 6008 TTY: (08) 9313 2085 Postal address Internet: www.dental.wa.gov.au PO Box 134, SUBIACO WA 6904 Phone: (08) 9340 2712 Fax: (08) 9340 2714 PathWest Laboratory Medicine WA PMH Princess Margaret Hospital for Children Roberts Road, SUBIACO WA 6008 Phone: (08) 9340 8271 Fax: (08) 9340 8117
PathWest Laboratory Medicine WA FHHS Fremantle Hospital and Health Services Alma Street, FREMANTLE WA 6160 Postal address PO Box 480, FREMANTLE WA 6959 Phone: (08) 9431 2744 Fax: (08) 9431 2520
Twenty-five PathWest Laboratory Medicine WA branch laboratories and 45 collection points are located throughout the State. Of these, six branch laboratories and twenty- eight collection points are located within the
wider metropolitan area. Your Health System
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Our purpose Our purpose is to ensure healthier, longer and better lives for all Western Australians.
Our vision
Our vision is to improve and protect the health of Western Australians by providing a safe, high quality, accountable and sustainable health care system. We recognise that this care is achieved through an integrated approach to all the components of our health system. These components include workforce, hospitals and infrastructure, partnerships, communities, resources and leadership. We also recognise that the Department of Health must work with a vast number of groups if it is to achieve the vision of a world-class health system.
Your Health System
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Service Framework Better Planning: Better Futures In September 2006, the State Government of Western Australia released Better Planning: Better Futures – A Framework for the Strategic Management of the Western Australian Public Sector.
The framework states that the Western Australian public sector seeks to provide the best opportunities for current and future generations to live better, longer and healthier lives. Its vision is to promote a creative, sustainable and economically successful state that embraces the diversity of its people and values its rich natural resources.
Broad, high-level government goals are supported at agency level by more specific desired outcomes. The whole of health delivers services to achieve these desired outcomes, which ultimately contribute to meeting the higher-level government goals. WA Health principally contributes to the West Australian Government’s Goals 1 and 4.
Goal 1: Better Services Enhancing the quality of life and wellbeing of all people throughout Western Australia by providing high quality, accessible services
Goal 4: Regional Development Regional communities that are educated, healthy, safe and supportive
The diagram below shows the relationship between the Government and WA Health’s desired outcomes.
Current Department of Health Outcomes and Services Linked to
WA Government Health Outcomes
Goal 1: Better Services Goal 4: Regional Development
An effective and coordinated public Regional communities that are health service educated, healthy, safe and supportive
DEPARTMENT OF HEALTH STRATEGIC DIRECTIONS Healthy Hospitals, Health Services & Infrastructure Healthy Communities
Outcome 1 Outcome 2 Outcome 3 Restoration of patients’ Improved health of the Enhanced wellbeing and health, safe delivery of people of WA by reducing environment of those newborns and support for the incidence of with chronic illness or patients and families preventable disease, disability
during terminal illness specified injury, disability and premature death
Services
Admitted patient Prevention and promotion Home and community care Specialised mental health Health protection Aged care assessment Your Health System Hospital in the Home Dental health Community mental health Palliative care Residential care Emergency department Residential mental health care Non-admitted patient Chronic illness and continuing Patient transport care support
Drug and Alcohol
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Services provided The Metropolitan Health Service provides an extensive range of health services, many of which are detailed below.
Direct patient services haematology respiratory medicine acute mental health haemophilia respite care adolescent clinic hand surgery rheumatology adult mental health hepatology rural paediatric service aged care assessment education HIV/AIDS same day unit after hours general home care midwifery social work practice home visiting nurse speech pathology ambulatory surgery hyperbaric medicine State adult burns unit antenatal service infection control State spinal unit amputee service infectious diseases stomal therapy anaesthesia intra-ocular surgery team midwifery service antenatal clinic maxillo-facial surgery transcultural psychiatry audiology medical clinic tropical medicine bone marrow mental health ultrasound transplantation neck of femur unit urology burns clinics neonatal follow up vascular surgery cardiothoracic surgery neonatology visiting nursing cardiovascular medicine nephrology Medical support services child and adolescent neurology bio-engineering mental health neurosurgery clinical research and child protection unit newborn hearing education children’s program screening community aids & clinical haematology nuclear medicine equipment clinical immunology obstetrics and imaging clinical investigation midwifery medical technology cleft-lip palate occupational therapy pathology continence services oncology patient information cornea grafting ophthalmology management systems coronary care oral surgery pharmacy cranio-maxillo facial orthopaedics radiology & ultrasound and plastic surgery orthotics and dermatology prosthetics Community services diabetes education paediatric gynaecology Aboriginal health dietetics and nutrition paediatric medicine asthma education ear nose and throat paediatric surgery bed-wetting program eating disorders service paediatric urology child development emergency centre pain management chronic disease and emergency medicine palliative care ambulatory care endocrinology parent education community enuresis and stomal pathology physiotherapy therapy pharmacy diabetes education epilepsy service physiotherapy family and child health family early plastic surgery home care intervention program podiatry migrant health
gastroenterology postnatal infants rehabilitation and living Your Health System general medicine primary health care skills services general surgery psychology youth and sexual health geriatric medicine and radiation oncology Positive Parenting extended care radiology Program geriatric mental health rehabilitation gynaecology renal services/dialysis
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Services provided (continued) PathWest Laboratory Medicine WA Dental Health Services Direct patient services Direct patient services haematology emergency and general dental care clinical immunology Medical support services microbiology and infectious disease dental prosthetic services clinical chemistry anatomical pathology Community services domiciliary dental care for the Medical support services homebound comprehensive pathology services to all aged care oral health program public sector teaching and non-teaching hospitals throughout WA Other support services comprehensive pathology services to corporate services private sector practitioners (both general engineering and maintenance and specialist medical practitioners) in hotel services both metropolitan and rural WA supply specialist pathology services to private oral health promotion patients referred through private pathology practices
Teaching and training
Pathologists and medical scientists are involved in undergraduate and postgraduate teaching and training of clinicians and scientists. In WA, the majority of new pathologists are trained in PathWest Laboratory Medicine WA laboratories.
Research and development PathWest Laboratory Medicine WA undertakes a variety of research and development activities, including specifically funded research projects, support for clinical trials and other hospital and university-based research. The development and evaluation of new tests is a major contribution to maintaining the state-of-the-art health service available to the people of WA. Community services Public health testing services for example microbiological testing of food and water. Other support services PathWest Laboratory Medicine WA operates a manufacturing unit that provides a large repertoire of test reagents for its laboratories (mainly microbiology culture media). This allows timely access to specialised reagents Your Health System and achievement of significant economies.
PathWest Laboratory Medicine WA provides forensic pathology and biology services to the Department of Justice and the WA Police Service.
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Compliance reports
Enabling legislation • Nuclear Waste Storage and The Department of Health is established by Transportation (Prohibition) Act 1999 the Governor under section 35 of the Public • Nurses and Midwives Act 2006 Sector Management Act 1994. The Director • Occupational Therapists Act 2005 General of Health is responsible to the • Optometrists Act 2005 Minister for Health for the efficient and • Osteopaths Act 2005 effective management of the organisation. • Pharmacy Act 1964 The Department of Health supports the • Physiotherapists Act 2005 Minister in the administration of 43 Acts and • Podiatrists Act 2005 98 sets of subsidiary legislation. • Poisons Act 1964 • Psychologists Act 2005 Acts administered • Queen Elizabeth II Medical Centre Act • Alcohol and Drug Authority Act 1974 1966 • Anatomy Act 1930 • Radiation Safety Act 1975 • Animal Resources Authority Act 1981 • Tobacco Products Control Act 2006 • Blood Donation (Limitation of Liability) • University Medical School Teaching Act 1985 Hospitals Act 1955 • Cannabis Control Act 2003 • White Phosphorous Matches Prohibition • Chiropractors Act 2005 Act 1912 • Co-opted Medical and Dental Services for the Northern Portion of the State Act Acts passed during 2006-07 1951 • Nurses and Midwives Act 2006 • Cremation Act 1929 • Medical Radiation Technologists Act 2006 • Dental Act 1939 • Tobacco Products Control Act 2006 • Dental Prosthetists Act 1985 Bills in Parliament at 30 June 2007 • Fluoridation of Public Water Supplies Act • Alcohol and Drug Authority Repeal Bill 1966 2005 • Health Act 1911 • Dental Bill 2005 • Health Legislation Administration Act 1984 • Food Bill 2005 • Health Professionals (Special Events • Human Reproductive Technology Exemption) Act 2000 Amendment Bill 2007 • Health Services (Conciliation and Review) • Medical Practitioners Bill 2005 Act 1995 • Pharmacists Bill 2005 • Health Services (Quality Improvement) • Surrogacy Bill 2006 Act 1994 • Hospital Fund Act 1930 Amalgamation and establishment of Boards • Hospitals and Health Services Act 1927 There were no Boards amalgamated or • Human Reproductive Technology Act 1991 established during 2006-07. • Human Tissue and Transplant Act 1982 Ministerial directives • Medical Act 1894 The Minister for Health did not issue any • Medical Radiation Technologists Act 2006 directives on Metropolitan Health Service • Mental Health Act 1996 operations during 2006-07. • Mental Health (Consequential Provisions) Act 1996 Your Health System
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Statement of compliance with public sector standards In the administration of the Metropolitan Code of Ethics and Code of Conduct Health Service, I have complied with the The Public Sector Code of the Ethics and the Public Sector Standards in Human Resource Metropolitan Health Service Code of Conduct Management, the Western Australian Public are available to all employees via the intranet Sector Code of Ethics and the Metropolitan site and documentation distributions via Health Service Code of Conduct. global e-mailing and during induction and training workshops. New employees are I have put in place procedures designed to required to read and acknowledge the Codes ensure such compliance and have undertaken as part of the induction and orientation appropriate internal processes to satisfy procedures. myself that the statement made above is correct. Compliance with the codes is monitored through analysis of employee grievances and To ensure consistency with the requirements complaints and the identification of relevant of the Public Sector Standards and to subject matter. During 2006-07 PathWest encourage best practice, regular reviews are Laboratory Medicine WA in collaboration with undertaken of relevant policies and the Office of Public Sector Standards procedures. The Metropolitan Health Service’s Commissioner, conducted a staff survey to human resources consultants continually assess the level of knowledge and monitor compliance on a transaction-by- understanding of the ‘Standards’ in the transaction basis, and occasionally external workplace and the results are currently being consultants are requested to undertake reviewed. breach reviews to gain an independent view of our processes. For 2006-07 the Metropolitan Health Service received thirty two complaints alleging non- During 2006-07 the Metropolitan Health compliance with either the Code of Ethics or Service received 25 breach claims for the DOH or PathWest Laboratory Medicine WA recruitment and selection, temporary Codes of Conduct where the complaint was deployment and grievances. All were substantiated and required further resolved or dismissed through internal investigation and/or disciplinary action. processes or following investigation by the Complaints related to failing to carry out Office of the Public Sector Standards duties appropriately, inappropriate use of Commissioner (OPSSC). This information resources and computers, failing to follow includes compliance returns from Dental procedures for leave approval or unauthorised Health Services and PathWest Laboratory absence from the workplace, and disregarding Medicine WA. the rights of colleagues and inappropriate workplace behaviour or safe work practices. There were no reports of substantiated Disciplinary sanctions included reprimands breaches of the Public Sector Standards. and requirement to attend additional education and awareness training. Your Health System
Dr Neale Fong Director General of Health
27th September 2007
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Accountable authority The Director General of Health, Dr Neale Fong, in his capacity as Chief Executive Officer, is the accountable authority for the Metropolitan Health Service. Pecuniary interests Senior officers of the Metropolitan Health Service have declared no pecuniary interests in 2006-07. Senior officers Senior officers for the Metropolitan Health Service and their areas of responsibility are listed below:
Table 1: Senior officers Area of responsibility Title Name North Metropolitan Area Health Service Chief executive David Russell-Weisz Mental Health Executive Director Peter Wynn Owen Finance Executive Director Philip Aylward Nursing Services Executive Director Ros Elmes Medical Services Executive Director Mark Salmon Workforce Executive Director Jon Frame Facilities Management Executive Director Alan Buckley Safety, Quality & Performance Executive Director Beress Brooks Sir Charles Gairdner Group Executive Director Amanda Ling King Edward Memorial Hospital Executive Director Amanda Frazer Swan Kalamunda Group Executive Director Philip Aylward Public Health Executive Director Vacant Capital Projects Director Ian Anderson Clinical Planning Director Liz Macleod Ambulatory Care Program Executive Director Ros Elmes South Metropolitan Area Health Service Chief Executive Peter Flett Royal Perth Hospital Group Executive Director Philip Montgomery Armadale and Bentley Group Executive Director Russell McKenney Fremantle Hospital Group Executive Director Mark Platell Rockingham Peel Group Executive Director Geraldine Carlton Fiona Stanley Hospital Executive Director Brad Sebbes Population Health Executive Director Mandy Seel Mental Health Services Executive Director Elizabeth Moore Integrated Healthcare Area Director Amanda Leigh Outpatient Flow Executive Director Shirley Bowen Medical Services Executive Director Paul Mark Ruth Letts Nursing Services Executive Director Patricia Tibbett Workforce Development Executive Director Suzanne McCavanagh
Safety Quality & Performance Executive Director Patricia O’Farrell Your Health System Planning and Performance Executive Director Scott Lisle Finance Area Chief Finance Officer Ian Male
Metropolitan Health Service Annual Report 2006-07 Page 17 of 142
Senior officers (continued)
Child and Adolescent Health Service Executive Director Robyn Lawrence Nursing and Patient Support Services Executive Director Anne Bourke Medical Services Executive Director Mark Salmon Paediatric Medicine Clinical Care Unit (CCU) Chairman David Forbes Paediatric Medicine Clinical Care Unit (CCU) Nursing Director Ann Stynes Surgical Services CCU Chairman Colin Kikiros Surgical Services CCU Nursing Director Kevin Cropper Psychological Medicine CCU Chairman Jonathan Rampono Psychological Medicine CCU Director Paula Chatfield Child and Adolescent Community Health Executive Director Mark Morrissey PathWest Laboratory Medicine WA Chief Executive Peter Flett Corporate Management PathWest Laboratory Medicine WA Corporate Executive Director Darryl Nicol Management PathWest Laboratory Medicine WA Corporate General Manager David Taylor Management, QEII PathWest Laboratory Medicine WA Corporate Director Frances Brogden Management PathWest Laboratory Medicine WA Corporate General Manager David Miotti Management, Royal Perth Hospital PathWest Laboratory Medicine WA Site Site Director David Smith Management, QEII PathWest Laboratory Medicine WA Site Site Director Frank Christiansen Management, Royal Perth Hospital PathWest Laboratory Medicine WA Site Management, Women’s and Children’s Health Site Director Ashleigh Murch Service PathWest Laboratory Medicine WA Site Site Director David McGechie Management, Fremantle Hospital Dental Health Services A/Director Peter Jarman Your Health System
Metropolitan Health Service Annual Report 2006-07 Page 18 of 142
Management structure Department of Health State Health Executive Forum (June 2007)
Chief Officer Finance Finance
Health Service Director Child and Executive Adolescent Adolescent
Reform Reform Director Executive and Clinical and Clinical Health Policy
Chief Health Officer Service Executive WA Country WA Country
Chief South Dr Neale Fong Officer Service Executive
MinisterHealth for Area Health Metropolitan Hon Jim McGinty MLA Hon Jim Director General of Health Director General of Health
General Director Director Office of the
Health System Support Director Executive
Health Mental Division Director Executive
Your Health System
Chief North North Officer Service Executive Area Health Metropolitan
Metropolitan Health Service Annual Report 2006-07 Page 19 of 142
North Metropolitan Area Health Service (June 2007)
Clinical Director Planning and Development Infrastructure Infrastructure Service Planning * Joint NMAHS, SMAHS and CAHS, * Joint initiatives whole-of-metropolitan
Capital Director Projects
Group Health Executive Executive Director SK Director Mental
Health Executive Chief Executive Chief Executive Dr DJ Russell-Weisz Director Public
Group Edward Executive Executive Director SCG Director King
Executive Director Executive Director
Outpatient Services Unit* Outpatient Services Ambulatory Care Services* Ambulatory Services Services Quality & Executive Executive Executive Performance Performance Director Safety, Director Nursing Director Nursing Director Medical
Your Health System Finance Finance Director Director Director Executive Executive Executive Workforce Workforce Facilities Mgmt
Metropolitan Health Service Annual Report 2006-07 Page 20 of 142
South Metropolitan Area Health Service (June 2007)
and Group Bentley Director Armadale Armadale Executive
Capital Director Infrastructure Infrastructure
Group Coastal Director Executive
Internal Internal Director Projects Director/ Fiona Fiona Stanley Fiona Stanley Stanley Director Executive
RPH
Director Executive Director
Workforce Workforce Development Development
Nursing Nursing Director Dr Peter Flett Chief Executive Chief Executive
Chief Officer Operating
Medical Director
Chief Officer Finance Finance Health Director Population Population
Governance Governance Health Mental Director
Director Counsel and and Your Health System
Director Planning Performance Performance
Director Integrated Healthcare
Metropolitan Health Service Annual Report 2006-07 Page 21 of 142
Child and Adolescent Health Service (June 2007)
and Child Health Adolescent Adolescent Community
CCU Surgical Services
CCU
Medicine Paediatric
Dr Robyn Lawrence Executive Director CCU Medicine Psychological Psychological
and Patient Nursing Nursing Support Services
Medical Services Your Health System
Metropolitan Health Service Annual Report 2006-07 Page 22 of 142
Dental Health Services (June 2007)
Unit Research & Evaluation Services Financial Financial Supply Human Physical Services Resources Resources
Services Corporate A/Director Peter Jarman Dental Services
Community Region Region Region Central Northern Southern Services Information Information Unit Care Aged Dental Your Health System Services Services Disability Education Laboratory Outstations Services & Support Central Clinical
Metropolitan Health Service Annual Report 2006-07 Page 23 of 142
PathWest Laboratory Medicine WA (June 2007)
Site FHHS
Director
Site Director
PMH/KEMH
Site QEII Director
Site RPH Chief Director Director Executive Executive Darryl Nicol Dr Peter Flett
Infra-
General Services Manager structure and Special
General Manager Business Planning
Your Health System
Director Services Regional
Metropolitan Health Service Annual Report 2006-07 Page 24 of 142
Key Performance Indicators Certification Statement
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 25 of 142
Key Performance Indicators Audit Opinion
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 26 of 142
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 27 of 142
Key Performance Indicators Introduction Health is a complex area and is influenced by many factors outside of the provision of health services. Numerous environmental and social factors as well as access to, and use of, other government services have positive or negative effects on the health of the population.
The key performance indicators, outlined in the following pages, address the extent to which the strategies and activities of the Metropolitan Health Service contribute to the broadly stated health outcome, which is, through the delivery of its health services, the improvement of the health of the Western Australian community. This overarching goal is measured by three outcomes:
Outcome 1: Restoration of patients’ health, safe delivery of newborns and support for patients and families during terminal illness. Outcome 2: Improved health of people of Western Australia by reducing the incidence of preventable disease, specified injury, disability and premature death. Outcome 3: Enhanced wellbeing and environment of those with chronic disease or disability.
Different divisions of the Health Services are responsible for specific areas of the three outcomes. The largest proportion of Health Services activity is directed to Outcome 1. To ascertain the overall performance of the health system all four annual reports must be read. All entities contribute to the whole of health performance.
These annual reports are: Metropolitan Health Service Peel Health Service WA Country Health Service Department of Health
Table 2: Service activities in relation to the components of the outcome
Outcome 1 Outcome 2 Outcome 3 Service 1 Admitted patients Service 8 Prevention and Service 11 Home and promotion Community Care Service 2 Specialised mental Service 9 Health protection Service 12 Aged care health Assessment Service 3 Hospital in the Service 10 Dental health Service 13 Community mental Home health Service 4 Palliative care Service 14 Residential care Service 5 Emergency Service 15 Residential mental department health Service 6 Other non-admitted Service 16 Chronic illness and patients continuing care support Service 7 Patient transport Service 17 Drug and Alcohol
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 28 of 142
Consumer Price Index Deflator Series The consumer price index (CPI) figures are derived from the CPI all groups, weighted average of the eight capital cities index numbers. For the financial year series the index is the average of the December and March quarters and uses 2003-04 as the base year in the annual reports. The average of the December and March quarter is used because the full year index series is not available in time for the annual reporting cycle.
The calendar year series uses a similar methodology but is based on the average of the June and September quarters.
The financial year costs for the annual report can be adjusted by applying the following formula. The result will be that financial data is converted to 2003-04 dollars:
Cost_n x (100/Index_n) where n is the financial year or calendar year where appropriate.
Table 3: Consumer price index figures for the financial and calendar years
Calendar year 2002 2003 2004 2005 2006 Index (Base 2003) 97.42 100.00 102.40 105.22 109.39
Financial year 2002-03 2003-04 2004-05 2005-06 2006-07 Index (Base 2003-04) 97.87 100.00 102.48 105.44 108.44
Efficiency Indicator Note All calculations for efficiency indicators include administrative overheads in accordance with relevant Treasurer’s Instructions for annual reporting purposes only. These figures are not to be used for any other comparative purpose.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 29 of 142
Outcome 1: Restoration of patients’ health, safe delivery of newborns and support for patients and families during terminal illness
The achievement of this component of the health objective involves activities which:
Ensure that people have appropriate and timely access to acute care services when they are in need of them so that intervention occurs as early as possible. Timely and appropriate access ensures that the acute illness does not progress or the effects of injury do not progress further than is acceptable, increasing the chance of complete recovery from the illness or injury (for example access to elective surgery). Provide quality diagnostic and treatment services, which ensure the maximum restoration to health after an acute illness or injury. Provide appropriate after-care and rehabilitation to ensure that people’s physical and social functioning is restored as far as possible. Provide appropriate obstetric care during pregnancy and the birth episode to both mother and child.
Table 4: Key Performance Indicators for Outcome 1 by reporting entity
Metropolitan Department of Peel Health WA Country Outcome 1 Health Service Health Service Health Service Restoration of patients’ health 1-00 R1-50 1-00 1-00 1-02 R1-51 1-02 1-02 1-03 1-03 1-03 1-20 Timely access to admitted hospital 1-01 1-01 care 1-08 Provide safe services 1-04 R1-52 1-04 1-05 R1-53 1-05
Safe delivery of newborns 1-06 1-06 Timely emergency care 1-07 1-07
Provide palliative care services R1-54
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 30 of 142
1-00 (new indicator): Proportion of public patients discharged to home after admitted hospital treatment
This indicator reports the proportion of public An important indicator of how well patients patients discharged to home after admitted have been restored to health (as well as hospital treatment. survival rate) is that they are not readmitted to hospital for treatment of the same Rationale condition within a short time of discharge. A direct measure of the extent to which This indicator should be linked with 1-02 for people have been restored to health after an greater insight. acute illness is that they are well enough to be discharged home after hospitalisation. The percentage of people discharged home over Results time provides an indication of how effective The overall percentage of public patients the public system is in restoring people to discharged home was 98.03% and is within health. target. The data contributes to the body of evidence that the probability of being The key performance indicator shows the restored to health, as demonstrated by being percentage of all separations for patients able to be discharged home after admitted to metropolitan hospitals (excluding hospitalisation, is more likely for patients in inter-hospital transfers) that are discharged the younger age groups. In 2006, the home after hospital treatment. proportion under 40 years of age was 98.80%, while 94.30% of those over the age of 80 years were discharged to home.
Figure 1: Proportion of public patients discharged to home after admitted hospital treatment
100% Overall (total) 99% target 98% >98%
97%
96%
95%
94%
93%
92% <40 40-49 50-59 60-69 70-79 80+ Total
2006 98.80% 98.30% 98.41% 98.39% 97.49% 94.30% 98.03%
Data Source Hospital Morbidity Data System.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 31 of 142
1-01 (200): Elective surgery waiting times This indicator reports the waiting times for This reporting rationale conforms with the elective surgery. Institute of Health and Welfare Requirements.
Rationale Target WA Health’s purpose is to ensure healthier, Category 1: 100% within 30 days (no cases) longer and better lives for all Western Category 2: 100% within 90 days Australians. Health services strive to improve Category 3: 100% within 365 days access to and efficiency in the provision of elective surgery as well as a range of other Results services. In recognition of the importance of As at 30 June 2007 there were 153 maintaining good health, a range of initiatives overboundary (over 30 days) Category 1 have been introduced to ensure that West patients. The target was not achieved due to Australians are provided with timely access to a limited number of surgeons, patients not elective surgery. willing to accept surgery dates and
emergency pressures. At the same time last These initiatives have focused on patients year the number of overboundary Category 1 who have waited longer than the clinically was 147. desired time for their surgery, which indicates there is a higher likelihood that their There have been significant improvements in condition will deteriorate or become an the numbers of patients waiting longer than emergency. Timely elective surgery ensures desirable in both category 2 and 3. The that patients have a better chance of being targets were not achieved due to limitations restored to health or to having the quality of as a result of acute demand and limited their life improved. surgeon availability in some disciplines.
Patients who are referred for elective surgery are classified by senior medical staff into one of the following urgency categories based on the likelihood of their condition becoming an emergency if not seen within the recommended time frame.
Table 5: People remaining on the elective surgery wait list as at 30 June 2007
Category 1 Category 2 Category 3 Median Median Median Cases % waiting time Cases % waiting time Cases % waiting in days in days time in days People remaining within 629 80 2,034 55 5,854 96 boundary 11 73 101 People remaining over 153 20 1,639 45 229 4 boundary
Table 6: People remaining on the elective surgery wait list as at 30 June 2006
Category 1 Category 2 Category 3 Median Median Median Cases % waiting time Cases % waiting time Cases % waiting in days in days time in days People remaining within 604 80 2,274 49 6,331 82 boundary 11 93 133 People remaining over 147 20 2,388 51 1,382 18 boundary Key Performance Indicators
Data Source Patient Electronic Analysis Referral Liaison System.
Metropolitan Health Service Annual Report 2006-07 Page 32 of 142
1-02 (204): Rate of unplanned hospital readmissions within 28 days to the same hospital for a related condition This indicator reports the rate of unplanned Although there are some conditions that may hospital readmissions within 28 days to the require numerous admissions to enable the same hospital for a related condition. best level of care to be given, in most of these cases readmission to hospital would be Rationale planned. A low unplanned readmission rate Good medical and/or surgical intervention suggests that good clinical practice is in together with good discharge planning will operation. decrease the likelihood of unplanned hospital readmissions. An unplanned readmission is an A return to hospital is a readmission only if unplanned return to hospital as an admitted the reason for this admission is the same or is patient for the same or a related condition as related to the condition treated in the the one for which the patient had most previous admission. Only actual separations, recently been discharged. Unplanned not statistical discharges, are included. readmissions necessitate patients spending additional periods of time in hospital as well Results as utilising additional hospital resources. The 2006-07 readmission percentages for all Metropolitan Health Service hospitals were low. These results suggest that good clinical practice and discharge planning are in place.
Table 7: Rate of unplanned hospital readmissions within 28 days to the same hospital for a related condition
2002-03 2003-04 2004-05 2005-06 2006-07 Target Unplanned readmission rate 1.48% 1.62% 1.68% 1.77% 1.58% <2.8%
Data Source Hospital Morbidity Data System.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 33 of 142
1-03 (205): Rate of unplanned hospital readmissions within 28 days to the same hospital for a mental health condition This indicator reports the rate of unplanned Although there are some mental health hospital readmissions within 28 days to the conditions that may require numerous same hospital for a mental health condition. admissions to enable the best level of care to be given, in most of these cases, readmission Rationale to hospital would be planned. A low An unplanned readmission for a patient with a unplanned readmission percentage suggests mental health condition is an unplanned good clinical practice is in operation. return to hospital, as an admitted patient, for the same condition as the one for which the Note patient had most recently been discharged. The numbers of patients who receive inpatient mental health care are very low, While it is inevitable that some patients will hence small numbers of patients who have need to be readmitted to hospital within 28 unplanned readmissions can result in large days, in an unplanned way, a high percentage variations to the annual percentage. of readmissions may indicate that improvements could be made to discharge A return to hospital is a readmission only if planning or to aspects of inpatient therapy the reason for this admission is the same or is protocols. Appropriate therapy, together with related to the condition treated in the good discharge planning will decrease the previous admission. Only actual separations likelihood of unplanned hospital readmissions. not statistical discharges are included. Unplanned readmissions necessitate patients spending additional periods of time in hospital Results as well as utilising additional hospital The 2006-07 readmission percentages for all resources. Metropolitan Health Service hospitals were low resulting in an overall readmission rate of 5.31%. These results suggest that good clinical practice and discharge planning are in place.
Table 8: Rate of unplanned hospital readmissions within 28 days to the same hospital for a mental health condition
2002-03 2003-04 2004-05 2005-06 2006-07 Target Unplanned readmissions rate 3.32% 4.95% 5.74% 5.72% 5.31% <10%
Data Source Hospital Morbidity Data System.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 34 of 142
1-04 (206): Rate of post-operative pulmonary embolism This indicator reports the rate of By monitoring the incidence of post-operative post-operative pulmonary embolism. pulmonary embolism occurring, a hospital can ensure clinical protocols, which minimise such Rationale risks, are in place and are working. Patients post-operatively can develop a blood clot in the deep veins of the leg, which can The monitoring of post-operative travel to the lungs and cause circulatory complications is important in ensuring the problems. This is known as a pulmonary optimum recovery rate for people with acute embolism and is one of the main preventable illness. causes of death in fit people undergoing elective surgery. Target The target for this indicator is few or no cases Hospital staff can take special precautions to of post-operative pulmonary embolism. decrease the risk of this happening. This indicator measures the percentage rate of Results patients who underwent surgery and The rate of post-operative pulmonary subsequently developed pulmonary embolism. embolism in the metropolitan area in 2006 was 0.30%. The low rate of pulmonary emboli suggests that the health services post- operative protocols represent good clinical practice.
Table 9: Post-operative pulmonary embolism rate
2002 2003 2004 2005 2006
Post operative pulmonary embolism rate 0.30% 0.15% 0.31% 0.26% 0.30%
Data Source Hospital Morbidity Data System. Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 35 of 142
1-05 (208): Survival rates for sentinel conditions This indicator reports the survival rates for For each of these conditions – stroke, heart sentinel conditions. attack - also known as acute myocardial
Rationale infarction (AMI), and fractured hip, also The survival rate of patients in hospitals can known as fractured neck of femur (FNOF) - a be affected by many factors. These include good recovery is more likely when there is the diagnosis, the treatment given or early intervention and appropriate care. procedure performed, the age, sex and Additional co-morbid conditions are more condition of each individual patient including likely to increase with age therefore better whether the patient had other (co-morbid) comparisons can be made if comparing age conditions at the time of admission or slices not the whole population. developed complications while in hospital. This indicator measures the performance of The comparison of ‘whole of hospital’ survival hospitals in relation to restoring the health of rates between hospitals may not be people who have had a stroke, AMI, or FNOF, appropriate due to differences in mortality by measuring those who survive the illness associated with different diagnoses and and are discharged well. Some may be procedures. Three ‘sentinel’ conditions, transferred to another hospital for specialist therefore, are reported for which the survival rehabilitation or to a hospital closer to home rates are to be measured by specified age for additional rehabilitation at the end of the groups. acute admission.
Figure 2: Rate of acute myocardial infarction survival
100
) 80
60
40
AMI survival rate (% 20
0 2001 2002 2003 2004 2005 2006 Targets 0-49 years 97.27 97.67 99.56 97.56 97.79 97.92 0-49 = >97% 50-59 = >97% 50-59 years 98.92 97.93 97.85 97.53 96.96 97.21 60-69 = >95% 70-79 = >90% 60-69 years 95.88 93.93 96.86 94.42 96.63 95.57 80+ = >80% 70-79 years 86.26 92.23 88.25 91.91 90.18 95.07
80+ years 81.45 79.18 84.03 83.20 86.12 86.46
Results Survival rate for AMI in 2006 was similar to previous years in most age groups. The rate for 80+ years was higher in 2006 than any of the previously reported years and all are within target range.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 36 of 142
1-05 (208): Survival rates for sentinel conditions (continued)
Figure 3: Rate of stroke survival
100.00
80.00
60.00 40.00
20.00
Stroke survival rate (%) 0.00 2002 2003 2004 2005 2006 Targets 0-49 years 90.44 86.14 94.25 91.35 88.70 0-49 = >90% 50-59 = >85% 50-59 years 92.21 84.25 88.61 90.71 87.98 60-69 = >85% 60-69 years 86.73 91.45 87.41 91.73 92.05 70-79 = >85% 80+ = >75% 70-79 years 82.47 80.56 87.25 84.74 88.62
80+ years 73.89 77.58 75.57 80.13 76.90
Results Survival rates for stroke in 2006 were similar to previous years. The age group 0-49 years was slightly below the target.
Figure 4: Rate of fractured neck of femur survival
100.00
90.00 80.00 70.00
60.00 50.00 40.00
30.00
FNOF survival rate (%) 20.00 10.00
0.00 Targets 2002 2003 2004 2005 2006 70-79 = >95% 80+ = >90% 70-79 years 95.98 96.40 95.85 96.21 97.94 80+ years 92.03 93.01 93.78 92.30 94.15
Results Survival rate for FNOF for 2006 were within the target range.
Data source Hospital Morbidity Data System. Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 37 of 142
1-06 (new indicator): Proportion of live births with an APGAR score of 3 or lower, five minutes after delivery This indicator reports the proportion of live The management of labour in hospitals does births with an APGAR score of 3 or lower, five not usually affect birth weights, but can minutes after delivery. affect the prevalence of low APGAR scores for babies with similar birth weights. Within Rationale birth weight categories therefore, Apgar ‘APGAR score at five minutes’ is an outcome scores may indicate relative performance. indicator of governments’ objective to deliver maternity services that are safe and of high Note quality. The APGAR score is a numerical score Factors other than hospital maternity services that indicates a baby’s condition shortly after can influence Apgar scores within birth weight birth. APGAR scores are based on an categories – for example antenatal care, assessment of the baby’s heart rate, multiple births and socioeconomic factors. breathing, colour, muscle tone and reflex irritability. Results The Metropolitan Health Services hospitals Low APGAR scores (defined as less than 4) are are all within the State target for 3 of the strongly associated with babies’ birth weights birthweight categories. being low.
Table 10: Proportion of live births with an APGAR score of 3 or lower, five minutes after delivery
Birthweight (grams) Proportion of babies Target (State)
0 - 1499 6.57% ≤16.60%
1500 - 1999 0.35% ≤0.70%
2000 - 2499 0.32% ≤0.50%
2500 and over 0.14% ≤0.10%
Data Sources Midwives Notification System Text: Report on Government Services 2007
Note As this is the first year this indicator has been reported, previous years’ comparisons are not available. Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 38 of 142
1-07 (201): Proportion of emergency department patients seen within recommended times This indicator reports the proportion of This indicator measures the percentage emergency department patients seen within of patients in each triage category who recommended times. were seen within the time periods recommended by the Australasian College Rationale for Emergency Medicine (ACEM). When patients first enter an Emergency Department, they are assessed by specially Results trained nursing staff who judge how urgently Factors contributing to triage category 2, 3 treatment should be provided. The aim of the and 4 patients not being seen within process known as triage is to ensure treatment recommended times include: an increase in is given in the appropriate time. This should emergency department attendances driven prevent adverse conditions arising from by a growing metropolitan Perth population; deterioration in the patient’s condition. increased attendances of patients assessed Treatment within recommended times should to have the most urgent triage category 1, 2 assist in the restoration to health either during or 3 conditions; and, lack of available the emergency visit or the admission to general practitioners in the community hospital, which may follow Emergency which increases the demand for emergency Department care. department services.
A patient is allocated a triage code between 1 Strategies to improve the 2006-07 results for and 5, which indicates their urgency. this indicator have been developed and are The triage process and scores are recognised being, or have been implemented. by the College of Emergency Medicine and recommended for prioritising those who present to an Emergency Department. In a busy Emergency Department when several people present at the same time, the service aims for the best outcome for all. Treatment should be within the recommended time of the triage category allocated.
Table 11: Proportion of emergency department patients seen within recommended times
2002-03 2003-04 2004-05 2005-06 2006-07 Target Triage category 1 (immediately) 99.92% 99.87% 99.7% 97.9% 97.8% 100% Triage category 2 (within 10 mins) 72.09% 68.23% 74.3% 74.3% 67.1% 80% Triage category 3 (within 30 mins) 56.81% 59.08% 59.5% 60.6% 52.0% 75% Triage category 4 (within 60 mins) 49.95% 51.53% 53.6% 54.2% 49.7% 70% Triage category 5 (within 2 hours) 68.15% 67.15% 75.3% 77.3% 75.5% 70%
Data Source Emergency Department Data Collection.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 39 of 142
1-08 (new indicator): Percentage of admitted patients transferred to an inpatient ward within 8 hours of emergency department arrival This indicator reports the percentage of Most patients who require a bed will benefit admitted patients transferred to an inpatient from early transfer to the specialist unit, ward within 8 hours of emergency department which can best treat their condition. Patients arrival. may be restored to health more quickly and there may be less adverse incidents when Rationale overcrowding in emergency departments is Emergency departments are specialist limited. multidisciplinary units with expertise in managing acutely unwell patients for the first Target few hours in hospital. Queuing for initial care The target for this indicator is 100% admitted in emergency departments is managed by within 8 hours. triage, which stratifies patients by urgency and ensures the most time-critical cases are Results seen first. Once it has been determined that a In Metropolitan hospitals 61% of people who patient needs admission to a hospital bed the needed admission were admitted within 8 time between admission to a ward depends hours. Rising hospital occupancy rates have usually on the availability of a bed. resulted in this target being missed.
While there may be some delays in transfer to Data source ward beds appropriate care and treatment Emergency Department Data Collection. takes place while in the emergency department.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 40 of 142
S1-00 (220): Average cost per casemix adjusted separation for teaching hospitals This indicator reports the average cost per Hence, the number of separations in a hospital casemix adjusted separation for teaching may be adjusted from the actual raw number hospitals. by a casemix index to reflect the complexity of the services provided. Metropolitan Health Rationale Service hospitals utilise the Australian Refined The use of casemix in hospitals is a recognised National Diagnostic Related Groups (AR-DRGs) methodology for adjusting actual activity data to which cost weights are allocated. A new to reflect the complexity of the service round of case weights was applied in 2006-07. provided against the use of resources. Results In 2006-07 the average cost per casemix adjusted separation for teaching hospitals was $4,862 and slightly over target.
Table 12: Average cost per casemix adjusted separation for teaching hospitals
2002-03 2003-04 2004-05 2005-06 2006-07 Target Actual cost $3,893 $4,034 $4,365 $4,612 $4,862 $4,796 CPI adjusted $3,978 $4,034 $4,259 $4,374 $4,484
Data Sources Hospital Morbidity Data System. Health Service Financial System.
Note Statewide overhead costs have been apportioned to this key performance indicator from 2005-06.
The key performance indicator results include capital user charge. The target was set as part of the Government Budget Statements process, which excludes capital user charge.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 41 of 142
S1-01 (221): Average cost per casemix adjusted separation for non-teaching hospitals This indicator reports the average cost per The use of a casemix index together with casemix adjusted separation for non-teaching expenditure data allows a reasonable hospitals. comparison between hospitals on the efficient use of resources in providing inpatient services. Rationale A new round of case weights was applied in The use of casemix in hospitals is a recognised 2006-07. methodology for adjusting actual activity data to reflect the complexity of service provision Results and the use of resources. Hence the number of In 2006-07 the average cost per casemix separations in a hospital may not necessarily adjusted separation for non-teaching hospitals equal the number of casemix adjusted was $4,040. separations.
The magnitude of the difference will depend on the complexity of the services provided.
Table 13: Average cost per casemix adjusted separation for non-teaching hospitals
2002-03 2003-04 2004-05 2005-06 2006-07 Target
Actual cost $2,775 $2,800 $3,070 $3,445 $4,040 $3,369
CPI adjusted $2,835 $2,800 $2,996 $3,267 $3,725
Data Sources Hospital Morbidity Data System. Health Service Financial System.
Note Statewide overhead costs have been apportioned to this key performance indicator from 2005-06.
The key performance indicator results include capital user charge. The target was set as part of the Government Budget Statements process, which excludes capital user charge. Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 42 of 142
S1-02 (PathWest): Average cost per occasion of service for PathWest functions performed at, or managed by, the QEII site of PathWest On 15 July 2005 PathCentre was abolished. Provides public health services and advice to All operations, assets and liabilities were the Department of Health, any other transferred to the Metropolitan Health department of the State or Commonwealth, Service. After PathCentre was abolished its any local authority and any other person or functions together with those of the body. pathology services of Royal Perth Hospital, Provides forensic science services to the Fremantle Hospital and Health Service and public and private sectors. Women and Children’s Health Service formed Undertakes commercial exploitation of any a single public sector pathology service under research undertaken, or of any intellectual the name of PathWest. property rights.
PathWest currently The efficiency of PathWest can be gauged by Provides pathology services to meet the measuring the average cost of its various requirements of the Department of services. Health, public hospitals, private hospitals, public patients, private patients, medical This indicator reports the average cost per practitioners and any other person or occasion of service for PathWest by service type. body. Provides clinical teaching or research Results facilities or both for pathology services. See table below for results. Acts as reference centre and centre of Average cost per occasion of service is $23.64 excellence for pathology services. and slightly over target of $22.00.
Table 14: Average cost per occasion of service for PathWest functions performed at, or managed by, the QEII site of PathWest
Occasions of Average cost Occasions Average cost Total cost Total cost Service service per occasion of service per occasion 2005-06 2006-07 2005-06 2005-06 2006-07 2006-07
PathWest (QEII site) $16,732,055.09 1,503,475 $11.13 $22,174,406.95 1,637,074 $13.55 Clinical Pathology
PathWest (QEII site) $18,664,541.26 835,174 $22.35 $20,948,171.74 830,893 $25.21 Microbiology
PathWest (QEII site) $20,586,135.59 143,800 $143.16 $24,200,653.08 150,596 $160.70 Tissue Pathology
PathWest Branch $24,446,087.80 1,184,793 $20.63 $26,473,458.35 1,348,817 $19.63 Laboratories
Total $80,428,819.74 3,667,242 $21.93 $93,796,690.13 3,967,380 $23.64
Notes 1. An occasion of service refers to a laboratory test (or group of tests commonly performed as a panel). 2. Branch laboratories are those laboratories administered by the QEII site and situated in metropolitan and rural non-teaching hospitals/health centres. 3. Expenditure directly relating to Royal Perth Hospital, Fremantle Hospital, King Edward Memorial Hospital and Child and Adolescent Health Service has been apportioned across MHS key performance indicators.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 43 of 142
S2-00 (229): Average cost per bedday in an authorised mental health unit This indicator reports the average cost per These are hospitals or hospital wards devoted bedday in an authorised mental health unit. to the treatment and care of patients with psychiatric, mental or behavioural disorders; Rationale that are by law able to admit people as The efficient use of hospital resources can involuntary patients for psychiatric help minimise the overall cost of providing treatment. health care, or mean that more patients can be treated with a similar amount of This indicator measures the average cost per resources. bedday in authorised mental health units and includes: Because of variations in patient Graylands Hospital. characteristics between sites and across time, Bentley Health Service - Mills St Centre. there may be differences in service delivery Alma Street Centre, Fremantle. costs. In order to ensure quality and cost Armadale Adult Mental Health Service. effectiveness, it is important to monitor the Swan Adult Mental Health Centre. unit cost (cost per bedday) of admitted patient care in authorised mental health Results units. In 2006-07 the average cost per bedday in an authorised mental health unit was $915 and was over target.
Table 15: Average cost per bedday in an authorised mental health unit
2003-04 2004-05 2005-06 2006-07 Target
Actual cost $737 $751 $815 $915 $870
CPI adjusted $737 $733 $773 $844
Data Sources Mental Health Information System. Health Services Financial System.
Note Statewide overhead costs have been apportioned to this key performance indicator from 2005-06.
The key performance indicator results include capital user charge. The target was set as part of the Government Budget Statements process, which excludes capital user charge.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 44 of 142
S2-01 (230): Average cost per bedday in older persons’ mental health inpatient units This indicator reports the average cost per or late onset psychiatric disturbance, or a bedday in older persons’ mental health physical condition accompanied by severe inpatient units. psychiatric or behavioural disturbance.
Rationale This indicator measures the average cost per The efficient use of hospital resources can help bedday in older persons mental health minimise the overall cost of providing health inpatient units and includes: care, or mean that more patients can be Armadale Seniors Mental Health Service. treated with a similar amount of resources. Bentley Elderly Mental Health Service. Osborne Park Older Adult Mental Health Because of variations in patient characteristics Unit. between sites and across time, there may be Boronia Inpatient Unit (Swan Mental Health differences in service delivery costs. In order to Service). ensure quality and cost effectiveness, it is Fremantle Seniors Mental Health Services. important to monitor the unit cost (cost per Selby Older Adult Mental Health Service. bedday) of admitted patient care in older adult psychiatric facilities. These are dedicated Results wards or units that provide care for older In 2006-07 the average cost per bedday in older adults with age-related brain impairment due persons mental health inpatient units was $728 to injury or disease with significant behavioural and was over target.
Table 16: Average cost per bedday in older persons’ mental health inpatient units
2003-04 2004-05 2005-06 2006-07 Target
Actual cost $641 $660 $741 $728 $655
CPI adjusted $641 $664 $703 $671
Data Sources Mental Health Information System. Health Services Financial System.
Note Statewide overhead costs have been apportioned to this key performance indicator from 2005-06.
The key performance indicator results include capital user charge. The target was set as part of the Government Budget Statements process, which excludes capital user charge.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 45 of 142
S3-00 (new indicator): Average cost per Hospital in the Home patient day This indicator reports the average cost per This indicator measures the cost per bedday Hospital in the Home (HITH) patient day. of clients in this program.
Rationale Results Hospital in the Home is a recognised method The average cost per Hospital in the Home of providing acute medical care for some patient day was $204 and was over target. patients in their home environment. HITH is a new program and targets may be The medical governance for the patient care better forecast as the program matures. remains with the hospital physician and may be a full episode of care or part of an episode of care.
Table 17: Average cost per Hospital in the Home patient day
2006-07 Target
Actual cost $204 $177
Data Source TOPAS
Note The key performance indicator results include capital user charge. The target was set as part of the Government Budget Statements process, which excludes capital user charge.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 46 of 142
S5-00 (222): Average cost per emergency department presentation for Metropolitan Health Service hospitals This indicator reports the average cost per There may be differences in service delivery emergency department presentation for costs due to variations in patient mix between Metropolitan Health Service hospitals. sites and across time. It is important to monitor the unit cost of this part of the acute Rationale health service that is often the first point of The efficient use of hospital resources can help contact with hospitals for residents of the minimise the overall cost of providing health community. care, or provide for more patients to be treated for the same amount of resources. Results In 2006-07 the average cost per emergency department presentation for Metropolitan health Service hospitals was $390.
Table 18: Average cost per emergency department presentation for Metropolitan Health Service hospitals
2002-03 2003-04 2004-05 2005-06 2006-07 Target Actual cost $302 $324 $348 $369 $390 $382 CPI adjusted $309 $324 $340 $350 $360
Data Sources Mental Health Information System. Health Services Financial System.
Note Statewide overhead costs have been apportioned to this key performance indicator from 2005-06.
The key performance indicator results include capital user charge. The target was set as part of the Government Budget Statements process, which excludes capital user charge.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 47 of 142
S6-00 (223): Average cost per doctor-attended episode in an outpatient clinic for Metropolitan Health Service hospitals This indicator reports the average cost per There may be differences in service delivery doctor attended outpatient episode for costs due to variations in patient Metropolitan Health Service hospitals. characteristics and clinic types between sites and across time. It is important to monitor the Rationale unit cost of this non-admitted component of The effective use of hospital resources can help hospital care in order to ensure overall quality minimise the overall cost of providing health and cost effectiveness. care or can provide for more patients to be treated for the same amount of resources. Results In 2006-07 the average cost per doctor- attended episode in an outpatient clinic for Metropolitan Health Service hospitals was $222.
Table 19: Average cost per doctor attended outpatient episode for Metropolitan Health Service hospitals
2002-03 2003-04 2004-05 2005-06 2006-07 Target Actual cost $160 $164 $184 $196 $222 $198 CPI adjusted $163 $164 $180 $186 $205
Data Sources The Open Patient Accounting System. Health Service Financial System.
Note Statewide overhead costs have been apportioned to this key performance indicator from 2005-06.
The key performance indicator results include capital user charge. The target was set as part of the Government Budget Statements process, which excludes capital user charge.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 48 of 142
S6-01 (224): Average cost per non-admitted occasion of service for Metropolitan Health Service hospitals (excludes emergency occasions and doctor attended outpatients occasions) This indicator reports the average cost per non- It is important to monitor the unit cost of this admitted occasion of service for Metropolitan non-admitted component of hospital care in Health Service hospitals (excludes emergency order to ensure overall quality and cost occasions and doctor attended outpatients effectiveness. occasions). Results Rationale In 2006-07 the average cost per non-admitted The efficient use of hospital resources can help occasion of service for Metropolitan Health minimise the overall cost of providing health Service hospitals (excluding emergency care, or provide for more patients to be occasions and doctor attended outpatients treated for the same amount of resources. occasions) was $221. There may be differences in service delivery costs due to variations in patient The target of $111 was set prior to a change in characteristics and clinic types between sites the activity counting rules and therefore is not and across time. met.
Table 20: Average cost per non-admitted occasion of service for Metropolitan Health Service hospitals (excludes emergency occasions and doctor attended outpatients occasions)
2006-07 Target Actual cost $221 $111
Data Sources Health Services Information System. Health Services Financial Information.
Note The key performance indicator results include capital user charge. The target was set as part of the Government Budget Statements process, which excludes capital user charge.
The counting rules have changed in this key performance indicator therefore cannot be compared with previous years. Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 49 of 142
Outcome 2: Improved health of the people of Western Australia by reducing the incidence of preventable disease, specified injury, disability and premature death The services, or outputs, of all parts of the Department of Health contribute to the above outcome. Achievement of this component of the health objective includes activities that reduce the likelihood of disease or injury and reduce the risk of long-term disability or premature death. Strategies include prevention, early identification and intervention and the monitoring of the incidence of disease in the population to ensure primary health measures are working.
The outputs of the Metropolitan Health Service as well as the other divisions of the Department of Health are contained in the table below. The greatest proportion of outputs provided by the Metropolitan Health Service in this outcome is directed to children. Other health services and the Department of Health, provide more services directed to prevention and surveillance of disease, including those affecting the adult population.
Table 21: Key Performance Indicators for Outcome 2 by reporting entity
Metropolitan Department of Peel Health WA Country Outcome 2 Health Service Health Service Health Service Prevention and promotion 2-00 R2-50 2-01 2-01 activities 2-01 2-02 2-02 2-02 Protection from diseases R2-51
R2-52 Access to dental health services 2-03 R2-53 2-04 2-05 2-06
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 50 of 142
2-00 (R101): Loss of life from premature death due to identifiable causes of preventable disease (breast and cervical cancer) This indicator reports the loss of life from Results premature death due to breast and cervical There has been an overall decrease in the cancer. annual PYLL per 1,000 in the WA population from 1996 to 2005 for both female breast Rationale cancer and cervical cancer. The indicator provides a measure of the impact of two screening programs directed at minimising the number of deaths due to breast and cervical cancer.
Table 22: Person years of life lost from breast and cervical cancer
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Target Breast Cancer 4.4 4.8 3.8 4.4 3.4 3.4 3.9 3.7 3.2 2.9 3.8 Cervical cancer 0.7 0.5 0.6 0.6 0.5 0.5 0.4 0.6 0.4 0.4 0.4
Notes a. Age- standardised PYLLs up to 74 years of age per 1,000 population.
b. The following ICD-10 and 9-CM codes were used to select deaths for conditions known to be largely preventable.
Breast cancer 174.0 to 174.9 C50.0 to C50.9 Cervical cancer 180.0 to 180.9 C53.0 to C53.9
c. Although not all cases of these conditions will be avoidable, it is very difficult to assess what proportion was avoidable without extensive meta-analysis of the literature. The conditions identified above are those for which the Department of Health has screening or health promotion programs; premature deaths from these should be largely preventable
d. Additional deaths registered in years following the year of occurrence may result in slight changes in some data shown in this report compared with previous years. Due to some cases still being before the Coroner’s office, some deaths occurring in 2004 were not registered by the Australian Bureau of Statistics until 2005 and were not included in this analysis. The preliminary nature of the 2004 death data is likely to affect the calculation of PYLLs for conditions, which contribute to the greatest proportion of deaths. Consequently no trend analysis was applied to these data. Non-WA residents who died in WA were included. PYLL calculations were based on three year moving averages.
e. Person Years of Life Lost have been recalculated for all years as the method of calculation has been improved. The new method has resulted in higher PYLL values, but the relative trends over time have remained the same as found by the previous method.
Data Source Mortality Database, Epidemiology Branch, Analysis and Performance Reporting, Department of Health, Western Australia.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 51 of 142
2-01 (103): Rate of hospitalisation for gastroenteritis in children (0-4 years) This indicator reports the rate of The Department of Health is also engaged in hospitalisation for gastroenteritis in children the surveillance of enteric diseases. Some 0-4 years. forms of gastroenteritis for example salmonellosis and shigellosis are notifiable Rationale diseases and infection rates are monitored. Gastroenteritis is a condition for which a high number of patients are treated either in the Note hospital or in the community. It would be This indicator measures hospital separations of expected that hospital admissions for this children living in a given location who may condition would decrease as performance and attend a hospital close to home or in another quality of service in many different health Health Service area. This indicator is not areas improves. necessarily a measure of the performance of the Health Service providing the The rate of children who are admitted to hospitalisation. hospital per 1,000 population for treatment of gastroenteritis may be an indication of Results improved primary care or community health During 2006, hospitalisation rates for strategies - for example, health education. non-Aboriginal children are within target. Programs are delivered to ensure there is an Rates for Aboriginal children are higher than understanding of hygiene within homes to assist last year. and prevent gastroenteritis. It is important to note, however, that other factors such as environmental issues will also have an impact on the prevalence of transmissible diseases like gastroenteritis.
Figure 5: Rate of hospitalisation per 1,000 for gastroenteritis in children 0-4 years
25
20
15
10 Target 5 <10 per 1,000
0 2001 2002 2003 2004 2005 2006
Non aboriginal 12.0 9.6 9.6 9.1 8.3 9.2 Aboriginal 18.0 20.7 16.1 16.7 10.0 17.2
Data Sources Hospital Morbidity Data System. Australian Bureau of Statistics population figures.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 52 of 142
2-02 (104): Rate of hospitalisation for respiratory conditions This indicator reports the rate of The performance of the health service hospitalisation for respiratory conditions. providing the hospitalisation is not being measured. Rationale The rate of children aged 0-4 years who are Target admitted to hospital per 1,000 population for Population Condition Age treatment of respiratory conditions such as per 1,000 acute bronchitis, bronchiolitis and croup and Asthma 0-4 years 10.4 the rate of all persons admitted for the 5-12 years 3.4 treatment of acute asthma may be an 13-18 years 1.2 indication of primary care services or community health strategies for example, 19-34 years 0.8 health education. 35+ years 0.8 Bronchiolitis 0-4 years 10.1 It is important to note, however, that other Bronchitis 0-4 years 0.2 factors may influence the number of people Croup 0-4 years 3.7 hospitalised with these respiratory conditions.
The conditions are ones, which have a high number of patients treated either in hospital or Results of Acute Asthma in the community. It would be expected that In 2006, hospitalisation rates for the non- hospital admissions for the conditions would Aboriginal population are comparable and are decrease as performance and quality of service within target for all age groups. increases in primary or community health. In the Aboriginal population hospitalisation This indicator measures hospital separations of rates are outside targets for all but the 19-34 individuals living in a given location who may years age group. attend a hospital in their own or another Health Service.
Table 23: Rate of hospitalisation per 1,000 for acute asthma (all ages)
2002 2003 2004 2005 2006
Non Non Non Non Non Aboriginal Aboriginal Aboriginal Aboriginal Aboriginal Aboriginal Aboriginal Aboriginal Aboriginal Aboriginal 0-4 years 11.0 18.7 8.7 16.5 9.6 15.6 8.6 22.0 8.3 16.4 5-12 years 3.4 4.6 3.4 6.1 2.7 3.3 3.4 2.9 2.6 4.5 13-18 years 1.2 1.2 1.1 1.5 0.7 1.4 1.0 1.9 0.7 1.4 19-34 years 0.8 1.4 0.8 1.7 0.7 1.1 0.8 2.1 0.6 0.6 35+ years 0.9 6.9 0.7 5.9 0.7 7.3 0.7 4.9 0.6 3.6
Data Sources Hospital Morbidity Data Systems. Australian Bureau of Statistics population figures.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 53 of 142
2-02 (104): Rate of hospitalisation for respiratory conditions (continued) Figure 6: Rate of hospitalisation per 1,000 for bronchiolitis in 0-4 years
60 Results for Bronchiolitis 49.2 50 In 2006, the rate of 40.5 40 37.3 37.6 hospitalisation for bronchiolitis 31.6 increased and was not within 30 target for non-Aboriginal or 20 Aboriginal children. 10.3 9.2 9.6 10.4 Rate per 1,000 10 7.5 0 2002 2003 2004 2005 2006
Non Aboriginal Aboriginal
Figure 7: Rate of hospitalisation per 1,000 for acute bronchitis in 0-4 years
1.4 Results for Acute Bronchitis 1.2 1.1 The rate of hospitalisation in the 1.0 Aboriginal population decreased 0.8 0.8 0.7 but was over target. The non- Aboriginal population were within 0.6 0.4 target.
Rate per 1,000 0.4 0.3 0.2 0.2 0.2 0.2 0.1 0.1 0.0 2002 2003 2004 2005 2006
Non Aboriginal Aboriginal
Figure 8: Rate of hospitalisation per 1,000 for croup in 0-4 years
5.0 4.5 4.5 Results for Croup 4.1 3.9 3.7 The rate of hospitalisation for 4.0 3.5 3.3 croup in both the Aboriginal 2.8 3.0 2.5 and non-Aboriginal population 2.0 2.0 decreased in 2006 and were within target. Rate per 1,000 1.0
0.0 2002 2003 2004 2005 2006
Non Aboriginal Aboriginal
Data Sources Hospital Morbidity Data System. Australian Bureau of Statistics population figures.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 54 of 142
2-03 (105): Rate of childhood dental screening This indicator reports the rate of screening the School Dental Service is an effective means within the school dental program. of delivering disease prevention and health promotion programs. The percentage of pre- Rationale primary and primary school children enrolled Dental screening programs for school children and under care has reduced slightly and is are undertaken to ensure early identification of therefore below target. This has been due to dental problems and, where appropriate, staff shortages, particularly in rural areas. As in provide treatment. The early identification and previous years, the ‘under care’ figures for the management of dental problems improves secondary school group vary from the health outcomes for children. enrolment figures because the older children are expected to take more responsibility for This indicator examines the disease prevention their own care i.e. missed appointments are and health promotion effectiveness of the not followed up by the service. Until such time School Dental Health Service by measuring the as those students make further contact, they enrolment and screening rates for school are not ‘under care’. A number of strategies children that are eligible for the service. It also implemented to increase the participation rate measures the ‘free of active caries’ rate at the of secondary school students have resulted in time of patient recall, because if the an increase participation in 2006-07 to exceed preventive program has been effective, targets. children should have a low level of active caries. Free of Active Caries Rate: The ‘Free of Active Caries on Recall’ rate has remained relatively Results constant even though the average recall Percentage of Children in the School Dental interval has increased from 16.7 months to 17.5 Service: The percentage of school children months over the past five years. The caries free enrolled in and receiving care from the service rate of 66% exceeds the target. remains at a high level and is confirmation that
Table 24: Rate of dental screening of pre-primary school children
2002 2003 2004 2005 2006 Target Enrolled in program 82.6% 84.3% 83.7% 83.3% 82.6% 84.0% Under care 82.6% 84.3% 83.7% 83.3% 82.6% 84.0%
Table 25: Rate of dental screening of primary school children
2002 2003 2004 2005 2006 Target Enrolled in program 85.2% 85.2% 84.7% 84.5% 84.0% 85.0% Under care 85.2% 85.2% 84.7% 84.5% 84.0% 85.0%
Table 26: Rate of dental screening of secondary school children
2002 2003 2004 2005 2006 Target Enrolled in program 82.6% 82.2% 84.4% 80.7% 81.2% 84.0% Under care 58.9% 58.9% 70.0% 58.3% 58.7% 70.0%
Table 27: Rate of children free of dental caries when recalled
2002 2003 2004 2005 2006 Target Children free of active dental 67.2% 67.6% 67.6% 66.7% 66.0% >65.0% caries on recall
Data Source School Dental Health. Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 55 of 142
2-04 (106): Dental health status of target clientele This indicator reports dental health status of The number of DMFT in children has remained target clientele. constant over the past five years and with the excellent dental health status, gains are Rationale relatively difficult to achieve. The Western A major role of the Dental Health Service is to Australian results for 12-year olds was 0.84 and prevent dental disease. To gauge the compares favourably with international effectiveness of the service, the rate of benchmarks. decayed, missing or filled teeth (DMFT) of its target clientele may be measured. International Benchmarks for 12 Year Olds
This indicator reports dental health status of Austria 1.0 (2002) Denmark 0.80 (2005) school children and adults eligible to use the Finland 1.20 (2000) Germany 0.70 (2005) state government Dental Health Service. It Italy 1.1 (2004) Norway 1.5 (2000) measures the effectiveness of the School These data are provided from the WHO Oral Dental Service and the adult dental program by Health Country/Area Profile Program. Data is measuring the 2006-07 rate of DMFT. updated through the Oral Health Collaboration and the protocol is standardised, making data Results comparable. The rate of DMFT per person was measured in two groups: children enrolled and under the The number of DMFT in adults showed a small care of the School Dental Service, and a target decrease in 2006-07. This data fluctuates with group of financially disadvantaged adults aged the dental health status of dental patients 35 to 44 years. Results were compared to presenting in any given year. previous years. Increases/decreases have not been significant over the years and 2006-07 included a reduced number of patients surveyed.
Table 28: Average number of decayed, missing or filled teeth for school children
2001-02 2002-03 2003-04 2004-05 2005-06 2006-07
5 years old (deciduous DMFT) 1.59 1.54 1.45 1.52 1.45 1.57
8 years old 0.34 0.35 0.30 0.31 0.28 0.30
12 years old 0.84 0.93 0.85 0.85 0.85 0.84
15 years old 1.51 1.57 1.61 1.69 1.49 1.67
Table 29: Average number of decayed, missing or filled teeth for adults
2001-02 2002-03 2003-04 2004-05 2005-06 2006-07
Adults 13.8 12.5 12.1 11.5 13.1 12.9
Data Source School Dental Health. Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 56 of 142
2-05 (212): Access to dental treatment services for eligible people The indicator reports the access to dental Results treatment services for eligible people. Eligible persons who access services: Historically only about 20% of eligible persons Rationale access care in government dental facilities. The Dental Health Services provide financially The Government initiative to provide additional disadvantaged people with access to funding to allow long term waiting patients to non-specialist dental treatment services both access dental care has maintained the emergency and non-emergency. percentage of patients assessing services in 2006-07. There has been a shift in the emergency/non emergency ratio over the last five years. As Emergency/non-emergency mix of services: emergency care consumes greater resources There has been a stabilising in the than non-emergency care this shift has had an emergency/non-emergency ratio over the last impact on the agency’s overall volume of care five years. Emergency care consumes greater to eligible people. The continuation of special resources than non-emergency care. The funding to reduce and maintain waiting lists has continuation of special funding to reduce and resulted in an improvement in the ratio with an maintain waiting lists has allowed this stable increase in general rather than emergency situation. dental care.
Table 30: Access to dental treatment services for eligible people
2002-03 2003-04 2004-05 2005-06 2006-07 Target
Eligible people who access 19% 19% 21% 21% 20% 20% Dental Health Services
Table 31: Rate of completed dental care
2002-03 2003-04 2004-05 2005-06 2006-07
Emergency completed courses of care 57% 58% 58% 56% 56%
Non-emergency completed courses of care 43% 42% 42% 44% 44%
Data Source Dental Health Service Records.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 57 of 142
2-06 (213): Average waiting times for dental services This indicator reports the waiting time in Results months for access to non-urgent dental care. The increase in waiting time in 2006-07 compared to 2005-06 is due to staff shortages Rationale and a workforce plan is being developed to The Dental Health Services provide financially address this issue. However, the 2006-07 disadvantaged people with access to non- indicator still remains below the target set by specialist dental treatment services, both Dental Health Services. emergency and non-emergency. Emergency dental care is provided to patients presenting on the day. One of the key measures of the effectiveness of the service is the timeliness in accessing non-emergency services.
Table 32: Average waiting times for dental treatment
2002-03 2003-04 2004-05 2005-06 2006-07 Target
Waiting times (months) for non 12 14 14 12 13 14 urgent dental care
Data Source Dental Health Service Records.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 58 of 142
S8-00 (110): Cost per capita of population health units This indicator reports the cost per capita of Promoting healthy environments. population health units. Prevention and control of communicable diseases. Rationale Injury prevention. Population health considers the health of Promotion of healthy lifestyle to prevent individuals, groups, families and communities illness and disability. by adopting an approach that addresses the Support for self-management of chronic determinants of health. With the aim of disease. improving health, population health works to Prevention and early detection of cancer. integrate all activities of the health sector and link them with broader social and economic Results services and resources. This is based on the In 2006-07 the cost per capita of population growing understanding of the social, cultural health units was $44.87. Included in this and economic factors that contribute to a indicator are the Child and Adolescent Health person’s health status. Servicethat provides a statewide service.
Population health unit supports individuals, families and communities to increase control over and improve their health. These services and programs include: Supporting growth and development, particularly in young children (community health activities).
Table 33: Cost per capita of Population Health Units
2003-04 2004-05 2005-06 2006-07 Target
Actual cost $29.02 $32.36 $34.72 $44.87 $41.42
CPI adjusted $29.02 $31.58 $32.93 $41.38
Data Source Health Service Records.
Note Statewide overhead costs have been apportioned to this key performance indicator from 2005-06.
The key performance indicator results include capital user charge. The target was set as part of the Government Budget Statements process, which excludes capital user charge.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 59 of 142
S8-01 (new indicator): Average cost per breast screening This indicator reports the average cost per Early detection is the key to reducing breast breast screening. cancer morbidity and mortality. Women aged 50 to 65 as well as those with family history Rationale of breast cancer are offered screening. This Breast cancer remains the most common indicator reports the average cost per woman cause of cancer death in women under 65 screened. years. Results In 2006-07 the average cost per breast screening was $103.65.
Table 34: Average cost per breast screening
2006-07 Target
Actual cost $103.65 $98.00
Data Sources BreastScreen WA. Oracle financial system.
Note The key performance indicator results include capital user charge. The target was set as part of the Government Budget Statements process, which excludes capital user charge.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 60 of 142
S10-00 (111): Average cost of service for school dental care This indicator reports the cost per enrolled This indicator measures the average cost of child in the care of the school dental service. providing a single dental service in the school program. Rationale The primary outcome of school dental care is Results the prevention of oral disease and the In 2006-7 the average cost of service for school promotion of good dental health. The dental care was $99.77 and was over target. efficiency of health services may be gauged by Capital user charge increase in 2006-07 was a measuring the average cost of its various contributing factor. services in comparison to previous years’ average costs.
Table 35: Average cost of service for school dental care
2002-03 2003-04 2004-05 2005-06 2006-07 Target
Actual cost $79.86 $85.04 $88.18 $92.63 $99.77 $90.00
CPI adjusted $81.60 $85.04 $86.05 $87.85 $92.00
Data Source School Dental Health Service.
Note Statewide overhead costs have been apportioned to this key performance indicator from 2005-06.
The key performance indicator results include capital user charge. The target was set as part of the Government Budget Statements process, which excludes capital user charge. Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 61 of 142
S10-01 (231): Average cost of completed courses of adult dental care This indicator reports the average cost of The increase in 2006-07 is the result of two completed courses of dental care for adults. factors, an increase in the capital user charge and an increase of 18.7% in the Department of Rationale Veteran Affairs fee schedule. This schedule is The efficiency of health services can be gauged the basis for the fee paid to private practice by measuring the average cost of the various participants in the dental subsidy schemes. services in comparison to previous years’ This increase has meant a decrease in the average costs. number of patients seen, which results in a higher average cost per patient. Results In 2006-07, the average cost of completed courses of adult dental care was $287 and is within target.
Table 36: Average cost of completed courses of adult dental care
2002-03 2003-04 2004-05 2005-06 2006-07 Target
Actual cost $226 $228 $226 $257 $287 $294
CPI adjusted $231 $228 $221 $243 $265
Data Source Dental Health Services Data.
Note Statewide overhead costs have been apportioned to this key performance indicator from 2005-06.
The key performance indicator results include capital user charge. The target was set as part of the Government Budget Statements process, which excludes capital user charge. Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 62 of 142
Outcome 3: Enhanced wellbeing and environment of those with chronic illness or disability
The achievement of this component of the health objective involves provision of services and programs that improve and maintain an optimal quality of life for people with chronic illness or disability. If a client suffers from a chronic illness they have access to services and support through a range of organisations, including non-government organisations, which are managed through the DOH. The effectiveness and efficiency measured for this support is reported by DOH. Chronic illness is also managed by the Metropolitan Health Services by health management teams who assist people to manage their own illness and work to keep people out of hospitals.
The Health Services in general will mainly come into contact with clients with chronic illness when they become acute and require acute care. When this type of care is completed they are returned to the community where they can again receive ongoing (continuing) care through the other agencies and services provided.
To enable people with chronic illness or disability to maintain as much independence in their every day life as their illness permits, services are provided to enable normal patterns of living. Support is provided to people in their own homes for as long as possible but when extra care is required long term placement is found in residential facilities. The intent is to support people in their own home for as long as possible. This involves the provision of clinical and other services which:
Ensure that people experience the minimum of pain and discomfort from their chronic illness or disability. Maintain the optimal level of physical and social functioning. Prevent or slow down the progression of the illness or disability. Make available aids and appliances that maintain, as far as possible, independent living (eg wheelchairs, walking frames). Enable people to live as long as possible in the place of their choice supported by, for example, home care services or home delivery of meals and support families and carers in their roles. Provide access to recreation, education and employment opportunities.
The significant areas of continuing care provided by the Health Services are in the areas of Mental Health Community Care and Aged Care. The Mental Health Community Care consists of multi- disciplinary teams including mental health nurses providing continued and regular contact with clients to prevent or delay the onset of acuity and thereby allow the client to continue to maintain as close to normal lifestyles as possible.
An important part of ensuring that services are provided to those frail aged who need them is assessment by Aged Care Assessment Teams (ACAT). Without equal access to ACAT assessments appropriate services/aged care may not be provided. Where a person has a disability, including a younger person, they will receive support through a number of agencies including Disability Services Commission and the Quadriplegic Centre. The DOH also provides assistance to those with disabilities through the provision of Home and Community Care (HACC) services. The HACC program is administered through the DOH. The effectiveness and efficiency indicators for HACC are reported by DOH. The Health Services will provide acute services to those with disabilities under Outcome 1.
Table 37: Key Performance Indicators for Outcome 3 by reporting entity
Metropolitan Department of Peel Health WA Country Outcome 3 Health Service Health Service Health Service Providing appropriate home care for frail aged R3-50 3-20 R3-51 Providing supports services for those with R3-52 mental illness Providing follow up in community to people 3-00 3-00 3-00 with mental illness Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 63 of 142
3-00 (301): Percent of contacts with community-based public mental health non-admitted services within seven and fourteen days post discharge from inpatient units This indicator reports on clients with a A severe and persistent mental illness refers to principal diagnosis of schizophrenia or bipolar clients who have psychotic disorders that result disorder who had contact with community- in severe and chronic impairment in the based public mental health non-admitted conduct of daily life activities. It includes those services within seven and fourteen days with a diagnosis of schizophrenia or bipolar following discharge from public mental health disorder. inpatient units. The time period of seven days has been Rationale recommended nationally as an indicative A large proportion of people with a severe and measure of follow up with non-admitted persistent psychiatric illness generally have a services for people with a severe and persistent chronic or recurrent type illness that results in mental illness. only partial recovery between acute episodes and a deterioration in functioning that can lead Results to problems in living an independent life. As a In 2006, 57.75% of discharges with a principal result, hospitalisation may be required on one diagnosis of schizophrenia or bipolar disorder or more occasions a year with the need for from public mental health inpatient units ongoing clinical care from community-based resulted in contact with a community-based non-admitted services following discharge. public mental health non-admitted service within seven days of discharge. Approximately These community services provide ongoing 4% of discharges had no contact within the mental health treatment and access to a range year. No contact may indicate that referrals, of rehabilitation and recovery programs that following discharge, were made to the private aim to reduce hospital readmission and sector (eg General Practitioners, Private maximise an individuals independent Psychiatrists, Private Psychologists etc) for functioning and quality of life. which data on contacts is not available.
This type of care for persons who have The findings indicate that the target for 0-7 experienced an acute psychiatric episode days has not been achieved. The percent of requiring hospitalisation is essential after people seen within 8-14 days was 72.69% and discharge to maintain or improve clinical and was under target. functional stability and to reduce the likelihood of an unplanned readmission.
Table 38: Percent of contacts with community-based public mental health non-admitted services within seven and fourteen days post discharge from public mental health inpatient units
Days to first 2003 2004 2005 2006 Target contact
% Cumulative % % Cumulative % % Cumulative % % Cumulative % Cumulative %
0-7 days 57.18 57.18 57.48 57.48 57.50 57.50 57.75 57.75 60
8-14 days 14.89 72.07 16.47 73.95 15.60 73.10 14.93 72.69 75
Data source Mental Health Information System, Information Collection and Management, Department of Health WA.
Note As well as community-based clinical services clients have access to non-clinical support services (refer to Department of Health key performance indicator R3-52). Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 64 of 142
S12-00 (311): Average cost per completed Aged Care Assessment Team (ACAT) assessment This indicator reports the average cost per A range of services are available to people completed ACAT assessment. requiring support to improve or maintain their optimal quality of life. Rationale People within targeted age groups are at risk of This indicator measures the cost per completed experiencing a poorer quality of life because of assessment of providing ACAT assessments. frailty, chronic illness or disability reducing their capacity to manage their activities of Results daily living. In 2006-07 the average cost per completed Aged Care Assessment Team assessment was $528 and was over target.
Table 39: Average cost per completed ACAT assessment
2003-04 2004-05 2005-06 2006-07 Target
Actual cost $368 $343 $385 $528 $384
CPI adjusted $368 $335 $365 $487
Data Source Aged Care Assessment Program WA Evaluation Unit Minimum Data Set Reports, July to December 2006.
Note 1 As the data is based on ACAT team coverage rather than statistical local areas, this indicator does not include ACAT assessment data from Rockingham and Peel. This information is reported in the Peel Health Service annual report.
Note 2 Statewide overhead costs have been apportioned to this key performance indicator from 2005-06.
The key performance indicator results include capital user charge. The target was set as part of the Government Budget Statements process, which excludes capital user charge.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 65 of 142
S12-01 (310): Average cost per care awaiting placement (CAP) day This indicator reports the average cost per CAP In some instances there may be a period of day. waiting before long-term residential care becomes available. Rationale Some people with chronic illness or disability, The Department of Health manages a CAP who are not able to be cared for at home even program to ensure that those who need with regular respite care and Home & residential placement can remain in temporary Community Care service, may need long-term care while awaiting more permanent residential care to ensure that their quality of placement. life is maintained. Results In 2006-07 the average cost per CAP day was $315 and over target.
Table 40: Average cost per CAP day
2002-03 2003-04 2004-05 2005-06 2006-07 Target
Actual cost $273 $311 $319 $354 $315 $260
CPI adjusted $279 $311 $311 $335 $291
Data Source Health Services Records.
Note Statewide overhead costs have been apportioned to this key performance indicator from 2005-06.
The key performance indicator results include capital user charge. The target was set as part of the Government Budget Statements process, which excludes capital user charge.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 66 of 142
S13-00 (303): Average cost per person receiving care from public community-based mental health services This indicator reports the average cost per This indicator gives a measure of the cost person with mental illness under community effectiveness of treatment for public mental care. health patients under community care (non-admitted/ambulatory patients). Rationale The majority of services provided by Results community mental health services are for In 2006-07 the average cost per person people in an acute phase of a mental health receiving care from public community-based problem or who are receiving post-acute care. mental health services was $4,273 and is over target.
Table 41: Average cost per person with a mental illness under community care
2002-03 2003-04 2004-05 2005-06 2006-07 Target
Actual cost $3078 $3115 $3659 $3329 $4,273 $3,814
CPI adjusted $3145 $3115 $3570 $3157 $3,940
Data Source Mental Health Information Systems.
Note Statewide overhead costs have been apportioned to this key performance indicator from 2005-06.
The key performance indicator results include capital user charge. The target was set as part of the Government Budget Statements process, which excludes capital user charge.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 67 of 142
S16-00 (new indicator): Average cost per client in a chronic disease management program This indicator reports the average cost per Results client in a chronic disease management In 2006-07 the average cost per client in a program. chronic disease management program was $2,078. Rationale As the population ages there are more people This is the first time this indicator has been living in the community with chronic disease. reported and the target was under-estimated. Chronic diseases include conditions such as asthma, chronic heart failure, respiratory disease and diabetes. People with these diseases usually require frequent medical care to enable them to keep healthy at home.
Good chronic disease management can help prevent crises and deterioration and enable people living with chronic conditions to attain the best possible quality of life. Chronic disease management teams support those with chronic illness to take an active role in managing their own care. The teams help people to manage their specific conditions and to adopt approaches that prevent the conditions getting worse and reduce the risk of getting further complicating conditions.
Table 42: Average cost per client in a chronic disease management program
2006-07 Target Actual cost $2,078 $750
Data Sources Chronic Disease - Patient Referral Registry. Oracle Financial System.
Note The key performance indicator results include capital user charge. The target was set as part of the Government Budget Statements process, which excludes capital user charge.
Key Performance Indicators
Metropolitan Health Service Annual Report 2006-07 Page 68 of 142
Significant Issues and Trends Overview The year 2006-07 has been another year of The expansion of capacity through the surgi- progress of the broad-based program of centres and ASI has contributed to a health reform for the Western Australian significant improvement to waiting times for health system against the challenge of elective surgery, despite the increasing meeting increased demand for hospital and demand for elective surgery from a growing other health services. and ageing population.
Focus on the delivery of hospital services To further free capacity and release resources continued during the year to ensure that the for the priority areas of emergency demand resources and capacity of the health system management and elective surgery, WA Health are applied to meet demands for emergency is pursuing an expansion of the care awaiting services and access to elective surgery. Two placement (CAP) program and arrangements surgi-centres were established at Kaleeya and for public patients to access private facilities. Osborne Park Hospitals to increase throughput The CAP program provides temporary of surgical cases. The two centres are an accommodation pending permanent integral part of the Metropolitan Health placement in residential aged care facilities Service’s response to the Government’s for elderly patients who are ready for targets for guaranteeing access to elective discharge from a public hospital following an surgery within acceptable waiting times for acute episode of care. Western Australians. Note The Ambulatory Surgery Initiative (ASI) was The Metropolitan Health Service is a large and further expanded during the year. The ASI is a complex entity providing a variety of health care joint initiative with the Commonwealth services. The achievements reported in the following sections contribute to the continued Government that enables low-risk public health benefit experienced by the community and patients on the elective surgery waitlist to may support more than one of the ‘Healthy’ receive treatment as private patients in a outcomes. public hospital at no cost to themselves.
Significant Issues and Trends
Metropolitan Health Service Annual Report 2006-07 Page 69 of 142
Major Achievements 2006-07 Healthy workforce
The Metropolitan Health Service (MHS) Academic staff and medical students from the recognises the importance of a skilled, stable University of Notre Dame Australia and sustainable workforce in delivering commenced at Swan District Hospital (SDH). quality health care services to the people of The Swan-Kalamunda graduate nurse program Western Australia. Providing and promoting a participants are now awarded a tertiary healthy working environment that provides qualification recognised by the University of opportunities for professional and personal Notre Dame as a Graduate Certificate in development while at the same time, Clinical Nursing. This is a first for Australia. supports workforce planning for the future, is a priority for the Area Health Service. South Metropolitan Area Health Service A general medical physician commenced with North Metropolitan Area Health Service the Disease Management Unit covering the During 2006-07 the North Metropolitan Area Royal Perth Hospital (RPH) / Bentley Hospital Health Service (NMAHS) appointed a patient (BH) corridor supported by the Chronic flow nurse director to improve patient access Disease Management Teams. to mental health facilities. Nurse practitioner roles were created at The NMAHS registered training organisation, Fremantle Hospital (FH) in urology / the Education and Development Centre (EDC), continence, and at RPH in wound continued to offer a wide range of nationally management and emergency medicine. recognised training programs. Rockingham–Kwinana District Hospital (RKDH) During the year 2,392 staff completed manual and the FH have introduced joint surgeon handling training and approximately 1,000 appointments in general and orthopaedic staff members completed training in surgery reducing transfers to FH, and enabling managing and preventing workplace transfer of some patients to RKDH. Surgical aggression and violence. outpatient clinics have also been established Sir Charles Gairdner Hospital (SCGH) was at RKDH. recognised for a number of workforce Fremantle Hospital and SMAHS secondary achievements in 2006-07 including: hospitals have created joint appointments in • being a finalist in the 2006 Prime ear, nose and throat surgery, plastic surgery, Minister’s ‘Employer of the Year’ award general surgery and orthopaedic surgery. for employing people with a disability; • research fellow Dr Anne Williams and The Armadale-Kelmscott Memorial Hospital research nurse Susan Slatyer receiving the (AKMH) emergency department was staffed National Institute of Clinical Studies with an additional mental health registrar and ‘Evidence into Action’ prize for their work mental health liaison nurses for two shifts per to improve pain assessment and day, enabling quicker patient assessment and management; and treatment/transfer. Commencing February • being awarded a $2 million National 2007 the mental health inpatient unit has Health and Medical Research Council been staffed with doctors overnight (NHMRC) grant to establish a Centre of facilitating quicker admission of patients from Clinical Research Excellence in the emergency department. Respiratory Medicine to investigate new and improved methods for the early detection, monitoring and treatment of lung disease caused by environmental pollutants. The Centre will also boost research capacity by training medical, scientific, allied health and nursing staff. Significant Issues and Trends
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Healthy workforce (continued) Royal Perth Hospital created two Aboriginal PathWest Laboratory Medicine WA Health Worker roles in cardiac rehabilitation During 2006-07 a workforce planning and renal dialysis to support and improve committee was formed for PathWest communication with Aboriginal patients. Laboratory Medicine WA to oversee the establishment of a vacation employment The hospital also established a health program for medical science students. This is promotions committee to encourage staff to a staff attraction initiative to address the form healthy lifestyle habits. Programs predicted shortage of scientists. include monthly lunchtime walks and Quit campaigns. A PathWest Laboratory Medicine WA workforce strategic plan (2008-2018) project Fremantle Mental Health Service appointed a has also been initiated. senior psychiatric registrar and senior social Dental Health Services worker to compliment the existing emergency Recruitment initiatives have continued to department psychiatric liaison service. attract additional overseas trained dentists.
The RPH emergency department mental An improved criteria progression classification health liaison team has introduced more system has been implemented to attract and psychiatric liaison nurses to support mental retain dentists in the public health system. health observation beds. A new structure for dental clinic assistants has been initiated in consultation with the The Fremantle Mental Health Service has CPSU/CSA Union. The structure is being successfully recruited a significant number of progressively introduced. overseas and interstate mental health professionals in a number of disciplines. The Dental Health Service (DHS) provided bullying and harassment prevention training Child and Adolescent Health Service to all managers and 25 per cent of other staff A coordinator has been appointed to in accordance with its coverage quota for represent the Child and Adolescent Health 2006-07. This program will continue in 2007- Service (CAHS) allied health staff, to promote 08. and encourage collaboration between the
CAHS allied health services and the service’s other departments.
The Princess Margaret Hospital (PMH)
Postgraduate Paediatric Nursing Program has increased to two intakes per year. The program is collaborative with Curtin
University of Technology (Curtin) and articulates to higher degrees in nursing.
Negotiations are underway with Curtin to create a Master of Nursing course (Child and
Adolescent Health).
Nurse Researcher Dr Anne-Sylvie Ramelet was awarded a fellowship for her project ‘Long term health outcomes of critical illness in children at PMH’s intensive care unit: A linked data project’.
Significant Issues and Trends
Metropolitan Health Service Annual Report 2006-07 Page 71 of 142
Healthy hospitals, health services and infrastructure The Metropolitan Health Service (MHS) Planning for the OPH and Swan-Kalamunda provides the greater part of hospital services Health Service (SKHS) redevelopments has including pathology and dental health to the commenced. people of Western Australia and is committed to ensuring that these services are efficient, A 47-hour ward was also commenced at SCGH accessible, innovative and responsive to during 2006-07 to provide for up to 10 community needs, and are of the highest elective surgery patients requiring less than quality. 47 hours hospitalisation.
Funding of $25 million was announced in the During 2006-07 the MHS “Hospital in the 2007-08 State Budget to establish a facility to Home” services provided by both the NMAHS house the WA Institute for Medical Research and SMAHS were further integrated and and other research bodies on the QEII site. expanded to incorporate the “Rehabilitation This funding has been matched by the in the Home” program. In addition, the University of Western Australia (UWA) and a NMAHS and SMAHS have also promoted the commitment from the Commonwealth option of privately referred non-inpatient Government for a further $33 million totalling (PRNI) services that run in parallel with $83 million for this research facility. traditional public outpatient services. PRNI services are outpatient services provided to The expansion of fracture clinic operations at patients in a private capacity, by Swan District Hospital (SDH) has improved participating specialists, at public hospitals. local access to orthopaedic services holding North Metropolitan Area Health Service two orthopaedic clinics per week. In 2006-07 the $5.2 million surgi-initiative commenced at Osborne Park Hospital (OPH), An After Hours General Practitioner (GP) enabling the hospital to undertake additional clinic operated by the Perth and Hills Division surgical procedures including general surgery, of General Practice commenced at the SDH. elective orthopaedic joint replacement, The service increases local access to primary ophthalmology, and ear, nose and throat care and eases pressure on emergency surgery. OPH received the ‘Healthy department staff, enabling them to Resources’ award in the Healthy WA Awards concentrate on patients with more urgent for its pioneering Ambulatory Service conditions. Initiative. The SCGH has commenced development of a The SCGH was highly commended for its Interventional Neuroradiology State Service, patient flow improvements where the which includes the addition of two state-of- reduction in the length of stay has been the-art biplane units and a transcranial recognised by the Health Roundtable as the doppler service to the radiology department best in Australia. The Health Roundtable is a at the hospital. To maintain first class care not-for-profit organisation with voluntary for patients of this service, the high membership which focuses on Best Practice dependency unit has been expanded and comparisons, and identifies ways to improve refurbished, including: operational practice, and national and six new state-of-the-art monitoring international collaborations. systems; an additional isolated treatment room, The draft Site Structure Plan (SSP) for the two storage rooms and a sterilising area; $536 million redevelopment of the QEII a hoist tracking system; and Medical Centre (QEII) was released for public an increase in the number of monitored comment in September 2006. In February beds from five to eleven with another two 2007, the SSP was submitted and adopted in expected to open in the immediate principle by the WA Planning Commission. future. The redevelopment Master Plan will now be finalised. Significant Issues and Trends
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Healthy hospitals, health services and infrastructure (continued) A number of initiatives were funded through Hospital-wide patient flow initiatives to the Mental Health Strategy 2004-2007 to decrease length of stay, decrease access increase access to adult inpatient beds for block and ensure patients are safely people with severe mental illness, including discharged have been implemented by the the addition of 12 adult secure beds and four NMAHS include: observation beds at Graylands Hospital (GH). introduction of a float team to ensure bed spaces are cleaned and patients moved in Hawthorn House, a new community-based a timely manner; mental health facility, provides a supportive extension of a Strategic Winter Allied environment for up to 16 people who no Team cover, to streamline discharge and longer require acute hospital care, and who improve response time to referrals; will acquire vital independent living skills to continuation of the emergency help them prepare for life back in the department discharge coordinator to community. assist patient turnaround; new documentation identifying The new eight-bed Mother and Baby Unit at admissions, staffing shortages, patients in King Edward Memorial Hospital for Women ED and possible discharges; (KEMH) opened in June 2007 and the $1.9 a new staffed patient discharge lounge million upgrade of the antenatal clinic and (including eight transit beds), for patients maternity ward at SDH was completed in who still require medications, transport, December 2006. doctors letters, outpatient appointments or medical certificates; During 2006-07 the coronary care unit and access to up to 15 Care Awaiting cardiovascular ward at SCGH received a new Placement (CAP) beds at Kalamunda $500,000 central patient monitoring system. Hospital; funding for 100 new CAP sub-acute beds A monthly Spinal Care Clinic was established for the NMAHS; and at SCGH to help patients with chronic back an additional six acute assessment unit pain receive faster treatment through beds and nine general beds at SCGH. appropriate referral from a senior South Metropolitan Area Health Service physiotherapist. During the year the hospital During 2006-07, Patient Flow Units were also received funding from the established at RPH and FH to improve bed Commonwealth Department of Health and management, admission and discharge. Ageing to undertake a 12-month Falls
Prevention Project. Royal Perth Hospital and FH introduced:
criteria-led discharges in a number of Planning and design for 15 public and 15 specialties; private beds in the adult inpatient mental allied health weekend discharge services health facility on the Joondalup Health (including CAP and a diversion service Campus has progressed and a construction from emergency departments); and contract will be awarded in the near future. a CAP social work service to reduce Five beds were added to a specialty ward at length-of-stay for CAP patients. SCGH for patients requiring less than 23 hours hospitalisation. Fremantle Hospital established a four-bed
Level 1 neonatal nursery for the management Dedicated beds for Aboriginal patients with of neonates transferred from KEMH. Aboriginal staff and culturally secure programs have been established in the DAO Maternity and obstetric services were inpatient detoxification service and the successfully relocated from Woodside Hospital Cyrenian House residential rehabilitation to Kaleeya Hospital. Kaleeya Hospital won service. the “2006 Statewest Achievement Award for
Excellence in the Workplace”. A smoking ban has been implemented across the QEII campus.
Significant Issues and Trends
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Healthy hospitals, health services and infrastructure (continued) To reduce the number of non-acute patients Royal Perth Hospital and FH emergency occupying beds in tertiary hospitals, RPH departments have: contracted 14 CAP beds and FH contracted 10 introduced a discharge coordinator CAP beds from private residential aged care improved allied health services, facilities. These beds provide temporary promoting diversion from emergency accommodation for aged care patients departments, early identification of awaiting permanent accommodation. patients requiring CAP and complex and at-risk patients; and The Armadale Kelmscott Memorial Hospital improved falls and at-risk screening for (AKMH) Perioperative Department recruited elderly patients, with improved linkages staff to start an afternoon shift four days a to ambulatory services week, reducing transfers to tertiary facilities and on-call hours. Fast tracking for selected emergency presentations was introduced at RKDH Fremantle Hospital commenced a primary emergency department. angioplasty service when the second cardiac catheter theatre was commissioned in The provision of transition care in the SMAHS February 2007 providing best practice was enhanced with the commencement of the management of patients presenting with a Southern Transition Care Service, which heart attack. provides 30 residential places and 20 flexible community packages. Transition care provides A Residential Outreach Assessment Medical therapeutic care in a non-hospital Service trial commenced in January 2007 environment for frail older people at the across the metropolitan area. This service conclusion of their hospital stay, to improve uses the Residential Care Line to prioritise or maintain the older person’s level of clinical response. independence, and assist in arrangements for longer-term care when appropriate. The Cannington satellite renal dialysis unit opened in March 2007, allowing patients from Jacaranda House, a purpose-built facility on RPH’s Shenton Park Campus and other dialysis the AHS campus, was completed in March units to be dialysed in purpose-built 2007 to accommodate the Whitby Falls Hostel surroundings, closer to home. Similar units residents. The AHS has also introduced a will open in Osborne Park and Midland by Saturday morning occupational therapy and early 2008. pharmacy service to improve the timeliness and safety of discharges for surgical patients. As part of the SMAHS review of palliative care at AKMH: RPH has commenced building a 40-bed trauma evaluation of patient satisfaction was and burns ward, and a secure unit for held in the last quarter of 2006-07; prisoners was opened at RPH’s Goderich staff education was provided, including Street outpatient clinic in June 2007. the ‘Programme of Experience in the Palliative Approach’ course; and During 2006-07 RPH created an Elective strategies to evaluate palliative care Surgery Waitlist Taskforce to work with standards were formulated and will be secondary hospitals around the metropolitan implemented in 2007-08. area to reduce waitlist numbers and times. The taskforce comprising surgeons, nurses Capital works are complete for five mental anaesthetists, theatre and clerical staff, health observation beds in the FH emergency ensures that surgical lists are reviewed department. weekly, every opportunity to operate is maximised, and secondary hospitals are used for RPH elective surgery patients.
Significant Issues and Trends
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Healthy hospitals, health services and infrastructure (continued) In March 2006, RPH with the Council of Derbal Yerrigan Health Service and an on- Australia Governments (COAG) established a campus clinic run through Boodjari Yorgas multi-disciplinary Care Coordination Team for Antenatal Clinic for Indigenous women. elderly patients entering the emergency department. The team commences organising An operational plan has been developed and a for the appropriate discharge for patients as site identified for a new adult intermediate soon as they present to hospital, ensuring care facility and acute inpatient facility for support on their arrival home and thereby adults and older people at RKDH. Work is minimising readmission events. underway on a concept plan.
In 2007, RPH established the Safety and The Armadale Mental Health Service (AMHS) Quality Investment for Reform (SQuIRe) opened an eight-bed rehabilitation unit, clinical practice program. This aims to: increasing the Service’s mental health beds to improve staff excellence and efficiency 41. The AMHS also opened a new community and reduce adverse and sentinel events; facility in Gosnells. provide incentives for safe health care; and The Fremantle Mental Health Service has ensure the presence of clinical established a brief intervention clinic to governance and safety management provide short-term multi-disciplinary systems intervention and treatment, timely access and appropriate referral to primary care by The Safety and Quality Investment in Reform community agencies. (SQuIRE) program is a clinical governance initiative adopted by WA Health, and RPH is The AHS created a team of discharge care currently undertaking three SQuIRe projects coordinators in the emergency department, on evidence-based care processes, medication inpatient medical, surgical and short-stay safety and infection control practices. The wards to address possible causes for re- Bentley Mental Health Service has admission. implemented two SQuIRe projects for falls Child and Adolescent Health Service management and medication reconciliation. Completion of a Delphi study to prioritise
nursing research at PMH identified ‘strategies Redevelopment of the RKDH has begun, with to reduce medication incidents’ and ‘improve Stage 1 due for completion in 2009. The pain assessment and management in children’ redevelopment will include a new high as the most important aspects. This has led dependency unit, geriatric evaluation and to the establishment of a paediatric pain rehabilitation services, chemotherapy, renal research program and, together with SQuIRe, dialysis, mental health in-patient beds, research on medication incident reporting and consulting suites and a child-care centre. compliance with medication guidelines.
Eight Chronic Disease Management Teams Botox injections for Cerebral Palsy patients (CDMTs) are operational across the commenced in January 2007, following the metropolitan area. The SMAHS has construction and commissioning of a commissioned a ninth CDMT in Mandurah. procedure room in the theatre suites. Implementation of a communication strategy has contributed to an increase in referrals. During 2006-07 the “Joanna Sewell Adolescent
Oncology Wing” was opened and the Kaleeya Hospital and FH created a routine paediatric oncology ward was refurbished. screening service for new mothers to identify This has provided separate adolescent and and treat women at risk of developing post- paediatric areas for patients, and provided natal depression. adolescents with facilities appropriate to
their needs. The Armadale Health Service (AHS) improved antenatal services for indigenous women with a new community antenatal clinic run through Significant Issues and Trends
Metropolitan Health Service Annual Report 2006-07 Page 75 of 142
Healthy hospitals, health services and infrastructure (continued) A Respiratory Liaison Nurse was appointed to distributing a computer application to provide coordinated care and follow-up for manage the laboratory medicine quality patients requiring ventilation support, home system which will control the oxygen and interventions for sleep disorders. documentation to the required This new position provides a single point of accreditation standards as well as meet contact for families of these patients, and internal audit, management and other coordinates a range of therapists and quality functions. specialists providing care to these children. A request for a proposal for the replacement In 2006-07, ambulatory care programs were (and standardisation) of major analytical established, including “Hospital in the equipment and acquisition of specimen Home”. This initiative enables children to be handling automation has been completed. cared for in their own homes instead of in Once installed, this equipment will result in hospital and children are visited up to three reagent savings in the order of $1.9 million times a day for medical treatments. per annum.
Dental Health Services In addition, the cardiac catherisation During the year the new Joondalup Dental laboratory facilities were upgraded assisting Clinic opened in September and the the diagnosis of congenital cardiac conditions construction of the new Kununurra clinic was in children and there was a planned increase completed. New dental therapy centres have in mental health support to both general and been opened in the suburbs of Baldivis, Butler specialised paediatric areas. and Tapping.
Statewide education and training services were developed in relation to the eating disorders program, increasing clinical services to meet clinical demand and best practice guidelines.
PathWest Laboratory Medicine WA During 2006-07 PathWest Laboratory Medicine WA staff have actively contributed to the business planning process for new laboratories at QEII and the proposed Fiona Stanley Health Campus (FSHC).
Ten additional registrar positions were created to address the shortage of pathologists across the health system.
During the year Pathwest Laboratory Medicine WA has implemented a number of information technology initiatives to improve services including: commencing the roll out of the main laboratory information system, “Ultra”, to non-metropolitan branch laboratories with the pilot site at the Northam Hospital laboratory becoming operational; developing a computerised electronic order system for laboratory medicine to be piloted in September 2007; and
Significant Issues and Trends
Metropolitan Health Service Annual Report 2006-07 Page 76 of 142
Healthy communities The Metropolitan Health Service provides a Specific initiatives included: number of health promotion and protection a partnership with the Town of Kwinana services that focus on both individuals and on to increase local government investment communities, and inform the public about in physical activity and tobacco cessation prevention of illness and injury, about healthy initiatives; lifestyles and about the self management of consultation with Diabetes WA, the chronic disease. Services include screening Canning Division of General Practice and programs, health advisory and support Aboriginal community-controlled health services, community based services and services to develop a customised diabetes immunisation programs, and are both direct self-management program and associated as well as contracted services. resources; participation in the Maddington Kenwick North Metropolitan Area Health Service Sustainable Communities Partnership BreastScreen WA provided extended-hours providing multiple chronic disease clinics in areas of high demand and reminder prevention activities; and calls for appointments, thereby minimising collaboration with the City of Gosnells the number of missed appointments. Breast and Canning Division of General Practice screening services were also provided to to develop an Active Communities Christmas Island, with a small number of Strategic Plan. women referred for further investigations. Educational talks and promotional material Child and Adolescent Health Service were provided to all women on the island Ear, nose and throat surgeon Mr Shyan aged over 40 years. It is expected that two- Vijayasearan established a aero-digestive yearly visits will continue. clinic for the multidisciplinary management of children with complex airway and feeding A new mental health emergency response problems. service commenced for the NMAHS and SMAHS. The service includes Community- The Human Papiloma Virus (HPV) based Emergency Response Teams and a immunisation program was implemented. The Mental Health Emergency Response Line current uptake is 65 per cent, exceeding the (MHERL). During 2006-07 MHERL received target of 60 per cent. approximately 3,700 calls and made about 1,400 outbound calls a month to consumers, A liaison nurse for refugee health was clinicians and other services. appointed to coordinate the hospital-to- community services for children of refugee South Metropolitan Area Health Service families, including screening and follow up The SMAHS delivered priority health management. Refugee health is a relatively promotion programs targeting risk factors for new service and is an area of growth. chronic disease: smoking, nutrition, alcohol and physical activity. Community mental health liaison nursing
positions were established for Princess The RPH Residential Care Line service Margaret Hospital. In partnership with the provided education for residential aged care “Hospital in the Home” program, these staff. Education has included basic life positions provide dedicated community support and clinical updates of various mental health nursing to the diabetes service medical and nursing topics. and paediatric rehabilitation services.
Kaleeya Hospital introduced a home-visiting PathWest Laboratory Medicine WA midwifery service that provides excellent PathWest Laboratory Medicine WA opened support to more than 100 new mothers and three new Eligible Collection Centres at their babies each month, following their Kelmscott, Southern River and Carnarvon. discharge from hospital.
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Healthy communities (continued)
Dental Health Services
Approximately 241,000 school children are enrolled in the school dental program across the State. These children continue to access free oral health treatment.
Government funding of $1 million to address waiting lists resulted in approximately 2,300 patients receiving general dental care. The average wait time has been maintained at approximately 12.5 months.
Significant Issues and Trends
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Healthy partnerships The Metropolitan Health Service recognises Parents’ and ‘Children of Parents with Mental the importance of partnerships with other Illness (COPMI)’ established an inpatient health service providers in ensuring access to playgroup for parents with children under five quality health care as well as supporting years old. medical and health research and developing and sharing infrastructure investment. The A Peel and Rockingham-Kwinana COPMI Area Health Service is committed to co- steering group was formed with non- operation with these organisations including government agencies, community health the Commonwealth and other State services and other departments. Several government agencies, local government, non- training forums were organised and additional government organisations, academic staff recruited. institutions and private health care providers, community groups, and with consumers and The Peel and Rockingham-Kwinana Mental carers and their representative bodies and Health Service worked with the Department stakeholders. of Education and Training, the City of Rockingham and SMAHS community health North Metropolitan Area Health Service services to survey five and six-year-old A partnership is being developed between students from 17 schools for the Australian KEMH and Kaleeya Hospital to support the Early Development Index. The results led to model of obstetric care being provided at an outline of the need for universal early- Kaleeya and to ensure the long-term viability years services from local government. of the service. The Rockingham-Kwinana Child and The KEMH women’s “Hospital in the Home” Adolescent Mental Health Service program commenced in partnership with implemented a dialectical behaviour therapy Silver Chain Nursing Association. program that includes individual therapy with the young person and a group program with South Metropolitan Area Health Service parents. Evaluation and associated research Royal Perth Hospital and Curtin University is being undertaken in partnership with (Curtin) began the Curtin/RPH Partnership Murdoch University. Undergraduate Program, enabling nursing students to undertake around 1,000 hours of Child and Adolescent Health Service clinical placements at RPH over the seven The Child and Adolescent Health Service has semesters of their degree. This will lead to maintained its strong relationship with the consistency in training and create a more School of Nursing and Midwifery (SONM) at welcoming work environment. Curtin to promote nursing opportunities at CAHS. RKDH has linked with KEMH to provide clinicians for on-call services for A hospital liaison general practitioner was paediatric/neonatal care. appointed to improve the interface and communication between Princess Margaret Fremantle Hospital was recognised at the Hospital and general practitioners. inaugural Healthy WA Awards with: • the hospital’s allied health management The Child and Adolescent Mental Health winning a Healthy Leadership award; Service (CAMHS) has collaborated with the • nephrology receiving a commendation for Department of Education and Training to its work in live kidney donor transplants; create an education liaison teacher role, and based in the CAMHS clinic to improve the • physiotherapy nominated for the Healthy liaison networks between schools and CAMHS. Workforce category for improving clinical placements for physiotherapy students across the metropolitan area.
The Armadale Mental Health Service in conjunction with ‘Parents Empowering Significant Issues and Trends
Metropolitan Health Service Annual Report 2006-07 Page 79 of 142
Healthy partnerships (continued) The Rural and Remote Diabetes Program is Dental Health Services identifying children and adolescents with A trial to allow the sharing of patient-level Type 2 diabetes in rural and remote information has been run with a large new communities and implementing treatment dental practice. The sharing of information programs that can be delivered to the facilitates more efficient patient treatment children while they remain within their and continuity of care benefiting both the communities. This program is being funded in patient and the practice. An implementation conjunction with the Unity of the First People plan to distribute the system across the State of Australia. A clinical nurse consultant has is being developed. been appointed to coordinate this program. A trial to allow Dental Health Service A collaboration between Paediatric Nursing reception officers to access patient eligibility Education and the West Coast College of TAFE information directly from Centrelink has been has been successful in a tender process to successful. This system will be implemented provide a Post Registration Paediatric Nursing Statewide as it greatly simplifies patient program for Enrolled Nurses. enrolment and saves patients having to attend a Centrelink office to obtain evidence of their A Memorandum of Understanding has been level of benefit. implemented with the Disability Services Commission to improve access for mutual clients, streamline communication and improve referral pathways. PathWest Laboratory Medicine WA During 2006-07 partnership agreements have been established with a number of academic and research bodies and include: • an agreement with Curtin to establish a formal vacation employment program as part of the clinical practice component of the medical science course; • an agreement with UWA for the re- establishment of a School of Laboratory Medicine; and • the appointment of a Professor of Laboratory Medicine within the Medical Faculty to be jointly funded by UWA and PathWest Laboratory Medicine WA to ensure an adequate training facility to
address a predicted shortage of pathologists in WA.
Significant Issues and Trends
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Healthy resources It is a key priority for the Metropolitan Health The Peel and Rockingham Kwinana Health Service is to provide its health care services Service completed an Australian Council of in a sustainable, equitable, efficient and Healthcare Standards (ACHS) organisation- accountable manner, delivering the best wide survey in March 2007, achieving full health outcome possible, in a safe working accreditation status. RPH achieved full environment. The Area Health Service has accreditation in an organisation-wide survey adopted sound financial and resource in August 2006. management practices along with approved The Fremantle Hospital social work building and equipment, and health reform department secured Commonwealth projects to meet this objective. government funding to increase staff numbers North Metropolitan Area Health Service to improve complex case management for the During 2006-07 the implementation of the Aged Care Assessment Team (ACAT). Statewide Obstetric Support Unit has PathWest Laboratory Medicine WA continued including: Investigation of a fee for service model for • the development of educational material PathWest Laboratory Medicine WA services on perinatal depressive and anxiety provided to teaching hospitals has disorders; commenced with an expected implementation • the establishment of an educational of notional billing next financial year and a telehealth program to rural WA; and project has commenced to extend the Royal • the development of the obstetric College of Pathologists ‘national emergencies ‘In Time’ program benchmarking in pathology costs’ program to
all major PathWest Laboratory Medicine WA The Sir Charles Gairdner Hospital pharmacy sites. department began to dispense drugs listed on the Pharmaceutical Benefits Scheme.
South Metropolitan Area Health Service The Armadale Health Service developed a mental health education package for general practitioners with a corresponding model of service delivery.
RKDH introduced the Picture Archive
Communication System (PACS) into medical imaging. This has reduced the reporting time of patient diagnosis and enabled timely referral and review by a clinician in a tertiary hospital, without the need to transfer the patient.
In April 2007, RPH established the ‘Ruth Reid Clinical Skills Education Centre’ that will educate 1,800 clinical staff from all disciplines onsite.
Metropolitan Health Service Annual Report 2006-07 Page 81 of 142 Significant Issues and Trends
Healthy leadership Establishing an environment that develops restructured with the appointment of a and provides strong leadership at all levels clinical director and operations manager. across the Metropolitan Health Service is vital Child and Adolescent Health Service to the delivery of quality and accessible During 2006-07 Princess Margaret Hospital health care in the metropolitan area, (PMH) commenced support for a Bachelor of especially in this period of health system Science (Nursing) Honours student in a reform. In developing strong leadership, the collaborative program with the School of health service focuses on identifying potential Nursing and Midwifery at Curtin, supervising leaders and providing access to leadership the student during nursing practicums. There development programs. is a commitment between the two
organisations to support two additional places An important leadership event in 2006-07 was commencing in July 2007. The hospital is also the ‘Have Your Say’ 2006 employee survey. assisting the development of Aboriginal Results and feedback were presented to MHS Health Workers by delivering a child health staff and improvement activities identified. module for Marr Mooditj College. North Metropolitan Area Health Service The SCGH Associate Professor Lynn Oldham To increase the enrolled nurse (EN) workforce was recognised for her research into palliative and expand the scope of EN practice, three, care, and pain education and management highly-successful competency programs have programs, named top research nurse at the been implemented at PMH: 2007 WA Nursing and Midwifery Excellence EN Comprehensive Medication Awards. Competency Course; EN Paediatric Medication Administration Professor Judith Finn was appointed the Module; and Inaugural Chair in Nursing Research at SCGH EN IV Medication Administration and the University of WA. This position will Competency Course. advocate evidence-based clinical practice, and promote and lead acute care nursing A visiting professor of child and adolescent research at SCGH. psychiatry was also secured. PathWest Laboratory Medicine WA Implementation of the Statewide obstetric Five PathWest Laboratory Medicine WA staff support unit continued, including: members were accepted into the “Leading the development and piloting of a 100” program in 2006-07. Staff from across program for assessing overseas-trained PathWest Laboratory Medicine WA attended doctors’ obstetrics skills; and workshops to develop mission, vision and the development and piloting of a values statements which have been ratified mentoring program for general by the Executive and promoted across the practitioner obstetricians service. South Metropolitan Area Health Service SMAHS staff members took part in the Forty-five medical and 28 scientific staff Department of Health’s Leading 100 and Vital members attended conferences and other Leadership programs in 2007 and a number of professional meetings overseas. Seventy- staff members presented papers at seven medical and 97 scientific staff members international and national conferences. attended conferences and other professional meetings interstate. These activities were Royal Perth Hospital (RPH) mental health principally funded from external sources or services have been restructured to become from research or special purpose accounts. the Department of Psychiatry providing a clear governance and management structure The inventors of Hepascore, Dr Ric Rossi with a clinical director, operations manager PathWest Laboratory Medicine WA and and senior nurse. Associate Professor Gary Jeffrey, Dr Leon Adams and Mr Max Bulsara from UWA, were During 2006-07 the Peel and Rockingham- the winners of the Research Organisation Kwinana Mental Health Service was category of the “Inventor of the Year” award. Significant Issues and Trends
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Priorities for 2007-08 WA Health’s Strategic Directions 2005-10 development reviews. Strategies to provide the framework for strategic and increase the representation of Aboriginal operational planning for the health system, of and Torres Strait Islander people in the which the Metropolitan Health Service (MHS) health professionals’ workforce will also forms a significant part. The strategic intent be undertaken in 2007-08 is to continue to apply the Service delivery roles: new and expanded recommendations and principles of the Health roles for health service delivery will be Reform Committee to deliver a ‘Healthy WA’. developed. Work roles will need to develop, respond and adapt to the The strategic directions being followed to changing models of care resulting from deliver this intent are: clinical and infrastructure reform and - Healthy Workforce; from current and future workforce - Healthy Hospitals, Health Services and strategies. Examples include the Infrastructure; expansion of the nurse practitioner model - Healthy Partnerships; and nursing hours per patient day model, - Healthy Communities; and the development of new and - Healthy Resources; and emerging clinical roles in the delivery of - Healthy Leadership. patient-centred care Workforce satisfaction: strategies will be Priorities for 2007-08 for each of these implemented to address priority strategic directions are detailed below. workforce satisfaction issues, including work-life balance, improved leadership Healthy Workforce and management, development of a WA Health will find itself under increasing problem-solving culture, safer work pressure to retain, renew and reform the environments and common values for the workforce as the median age rises and the MHS constituent bodies. workforce depletes due to accelerating retirement rates. Healthy Hospitals, Health Services and Infrastructure WA Health’s response is to anticipate the The Metropolitan Health Service aims to changes occurring in the workforce and improve access to, and efficiency in, hospitals position itself as an employer of choice. The and health care services, based on defined Healthy Workforce Strategic Framework 2006- population needs. Achieving this aim means 16 was developed to provide the basis for all progressing WA Health’s hospital building and future health workforce planning and strategy infrastructure redevelopment program over deployment. the next 13 years. This will enable better alignment and integration between facilities, MHS workforce priorities for 2007-08 are: clinical services and health networks. Family friendly initiatives: the DOH’s Achieving service and care targets Work Life Balance, Creating Family To ensure that the focus remains on Friendly Workplace initiatives, will be delivering services to the community during implemented and action will be taken to this time of rapid transition, Department of create family friendly workplaces Health targets for service performance have including implementing the DOH’s Child been established. Care Strategy
Workforce planning: targets have been The MHS is to increase numbers of patients established to improve workforce treated under the ‘Hospital in the Home’ and attraction and retention. Targets include ‘Rehabilitation in the Home’ programs. achieving a 10 per cent reduction in lost
time injuries and ensuring that 80 per cent of employees undergo performance Significant Issues and Trends Metropolitan Health Service Annual Report 2006-07 Page 83 of 142
Priorities for 2007-08 (continued) Ensuring infrastructure developments are Improving non-inpatient services delivered on time and within budget A new reporting framework is being established to more accurately measure Implementation of the DOH’s approved waiting time for outpatient appointments. capital works program will be progressed Access targets have been set to reduce the during 2007-08, including the following major time between referral and first appointment, metropolitan developments: determined by the patient’s clinical urgency. detailed planning for the new Fiona
Stanley Hospital will be well advanced; Initiatives will be implemented to reduce construction will commence on the waiting times for patients attending expansion of Joondalup Health Campus; outpatient clinics. These include better and scheduling, timelier triaging, and audit and redevelopment of Rockingham-Kwinana review to ensure patients are seen in the District Hospital will continue most appropriate place in a timely manner. Focusing on safety and quality Healthy partnerships WA Health and the MHS are progressing the The Metropolitan Health Service shares the Western Australian Strategic Plan for Safety Department of Health’s intent is to create and Quality in Health Care 2003-2008, and in stronger partnerships with other government 2007-08 will commence planning for the next agencies, non-government organisations, five-year strategy covering the period 2009- consumers, community groups, private 2013. The focus on safety and quality will be providers, health professionals and the maintained through implementation of the Commonwealth Government all of whom have Safety and Quality Investment in Reform an interest and stake in the future of the WA (SQuIRe). health system.
The Clinical Practice Improvement program Key priorities for 2007-08 include: under SQuIRe aims to promote evidence- Improving primary care in partnership based practice where there is a demonstrated with General Practice through relationship with improved patient outcomes. implementing the Western Australian
Directions for Primary Care 2007-2021. Eight priority areas will be the focus for Implementing integrated models of care 2007-08: developed by the DOH’s Health Networks falls prevention which include MHS personnel. Models of treatment of acute myocardial infarction care define directions for service delivery (heart attack) within individual clinical streams, and are prevention of venous thrombo-embolism informed by expert clinicians and prevention of pressure ulcers consumer input. accurate medication reconciliation Integrating Home and Community Care prevention of surgical site infection providers and non-government prevention of central line associated organisations into new models of care. blood stream infection The development of new models of care appropriate hand hygiene by the DOH’s health networks recognises
that the challenges of improving the Specific initiatives under the Clinical health system’s response to disease are Governance Framework for 2007-08 include shared with partner organisations, whose supporting the ‘Patient First’ Program, contribution, expertise and resources upgrading the Western Australian incident must be included in broad-based service reporting and management system, planning. developing a state policy framework for Clinical Handover and supporting implementation of the Western Australian ‘Credentialing and Defining the Scope of Clinical Practice’ policy. Significant Issues and Trends
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Priorities for 2007-08 (continued) Increasing consumer participation in care Targeting illicit drug use: the ‘Drug planning and delivery. The ‘Patient First’ Aware’ public health campaign will focus program will continue to be implemented, on amphetamines as a priority and, in involving participation by WACHS District combination with community action and Health Advisory Councils and Community school drug education, aim to maintain Advisory Councils. the downward trend of illicit drug use The State Health Research Advisory Improving community-based Aboriginal Council promotes the translation of health services: a partnership approach research results into health and industry involving Area Health Services and outcomes. The focus in 2007-08 will be on Aboriginal community controlled Health working with health networks to achieve Services will be taken to deliver better outcomes through the integration preventative programs to reduce the of research outcomes into health care incidence of chronic diseases as well as to service delivery. improve self management Healthy communities Healthy resources WA Health’s intention is to focus on improving A key rationale for reform in WA public health lifestyles, working on the prevention of ill system, including the Metropolitan Health health and the implementation of a long- Service is the need to deliver a sustainable, term, integrated health promotion program. equitable and accountable health care service This will be done in collaboration with to all Western Australians. government and non-government agencies, general practitioners and community groups. The WA Health’s intention is to provide Priority will be given to community-based sustainable resourcing and world-class management of chronic and long-term management of health budgets. conditions and improving access to services in Accountability measures for health system the community. resourcing and performance will be transparent and reported to the community in Key priorities for WA Health and MHS in 2007- order to reinforce this accountability. 08 include: Focusing on health promotion and disease State-wide and MHS priorities for 2007-08 prevention: through promotion of good include: health, wellbeing and healthier lifestyles disciplined budget management will - particularly good diet, physical activity, continue to be applied to ensure that the smoking cessation, healthy weight and MHS delivers its services and meets cost low-risk alcohol consumption. The and demand pressures within approved priorities and approaches outlined in the budget parameters. Improved budget WA Health Promotion Strategic management will be assisted by the Framework 2007-11 will be implemented progressive implementation of the Delivering effective screening programs: Resource Allocation Model; goals are to achieve 70 per cent screening progress the Information and rate of the target population for breast Communications Technology Strategy; and cancer every two years; and ensuring 90 development of a long-term asset per cent of children are fully immunised management planning system to inform at 12 and 24 months asset reconfiguration in the WA Health by Obesity: the prevention of obesity and enabling the integration of asset planning overweight among children and adults is a processes with strategic and operational priority area for the purchasing of health planning decisions. This discipline will promotion programs and campaigns from focus on strategically significant asset non-government agencies stocks under the responsibility of Area Chief Executives. Significant Issues and Trends
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Priorities for 2007-08 (continued) Healthy leadership Healthy leadership is a vital factor that will take the Metropolitan Health Service into the future. The intention is to continue to develop the leadership capacity and capability in the MHS, and to identify and promote strong leadership at every level within health care services.
Key priorities for 2007-08 include: focus on the development of future and emerging leaders; continue to develop leadership capacity and capability in the MHS; and implement a comprehensive leadership development program.
The Institute for Healthy Leadership will be established in 2007-08 to lead the delivery of the Healthy Leadership Strategic Framework. New strategies focused on performance development and succession planning will enhance and build upon those leadership development programs already conducted by the Department of Health and in which the Metropolitan Health Service participates.
The participation of clinicians in health system improvement will be encouraged with the aim that 10% of all clinicians employed in WA Health actively participate in health network activity. Significant Issues and Trends
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Operations Advertising In accordance with section 175ZE of the Electoral Act 1907, the MHS incurred the following expenditure on advertising agencies, market research, polling, direct mail and media advertising. Total expenditure for MHS in 2006-07 was $1,933,491.
Table 43: Advertising expenditure for 2006-07
Summary of Advertising Amount ($) Advertising Agencies 50,686 Media Advertising Organisations 1,882,805 Polling Nil Market Research Organisations Nil Direct Mail Organisations Nil
Advertising Agencies Amount ($) Beilby Corporation Pty Ltd 1,410 Brandconnect Australia 6,000 Concept Audio Visual 455 Concept Media 4,512 Health Communication Network Limited 2,009 Healthstaff Recruitment 36,300 Total 50,686
Media Advertising Organisations Amount ($) 303 Advertising Pty Ltd 210 AMA Services (WA) Pty Ltd 9,900 Community Newspaper Group Limited 3,379 Marketforce Express 346,951 Marketforce Productions 1,273,206 Media Decisions WA 200,400 Sensis Pty Ltd 9,353
The West Australian 11,166 Operations University of Western Australia 6,884 Churches of Christ in Western Australia Inc. 80 City of Mandurah 1,488 Concept Media 4,512 Cypress Print 1,607 Examiner Newspapers (WA) 231 Fast Track Media 3,065 Lasso Kip Pty Ltd 1,297 Ludford Associates Limited 900 Medical Forum Magazine 1,863 Osborne Park Agricultural Society Inc 300 Pelican Graphics Pty Ltd 473
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Advertising (continued)
Record Newspaper 800 Rural Press Regional Media (WA) Pty Limited 182 Seek Limited 2,275 The Fence Post Newspaper Inc 30 The Fremantle Book 500 The Uniting Church in Australia Property Trust (WA) 280 Aust College of Physical Scientists & Engineers in Medicine 1,473 Total 1,882,805
Corruption prevention Government agencies are required to Approval was given for the establishment specifically consider the risk of corruption and of a Fraud and Corruption Control misconduct by staff, and to report on risk Committee to consider system-wide reduction strategies in place within the initiatives, monitor and review fraud and agency. Within WA Health, the existence of corruption risk assessments and monitor an effective accountability mechanism is fraud prevention development. The fundamental to good corporate governance. committee will have representatives from This year the Corporate Governance all areas of WA Health. Directorate carried out a total of 121 The Corporate Governance Directorate investigations of alleged misconduct. commenced an education awareness program, with a number of presentations Strategies introduced across WA Health in already having been made to the 2006-07 assisting in preventing corruption Department of Health, North Metropolitan include: Area Health Service, Child and Adolescent A Fraud and Corruption Control Plan was Health Service and WA Country Health established, to set an appropriate Service. These will continue next year, strategic framework that defines and will also include South Metropolitan management and staff responsibilities and Area Health Service. Presentations were to ensure the implementation of robust developed in consultation with practices for the effective detection, appropriate external oversight agencies investigation and prevention of fraud and such as the Corruption and Crime corruption of any description associated Commission and the Office of the Public with WA Health. Sector Standards Commissioner. Operations
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Disability access and inclusion plan The Disability Services Act 1993 was During 2006-07, the Metropolitan Health introduced to ensure that people with Service provided a range of programs and disabilities have the same opportunities as initiatives to meet Disability Access and other West Australians. A 2004 amendment to Inclusion Plan key outcomes, as detailed the Act required the Department of Health to below. fully develop and implement a Disability Outcome 1: People with disability have the Access and Inclusion Plan (DAIP). During 2006- same opportunities as other people to access 07, the Metropolitan Health Service provided the services of, and events organised by, the a range of programs and initiatives to meet relevant public authority. disability access outcomes. • Reception counters at Sir Charles In line with the Act, WA Health submitted Gairdner Hospital (SCGH) were made DAIPs to the Disability Service Commission universally accessible in respiratory from the following health entities: medicine, the day hospital, occupational Sir Charles Gairdner Hospital health and safety, cardiology and the Royal Perth Hospital cancer centre. Universally accessible Fremantle Hospital toilets were installed in the interventional King Edward Memorial Hospital neuro-radiology suite and the cancer Princess Margaret Hospital centre. Department of Health (a collective DAIP • King Edward Memorial Hospital (KEMH) incorporating all health areas other than continued to provide a Telephone teaching hospitals) Typewriter (TTY) phone in the front foyer and a portable TTY phone that can be An extensive Statewide consultation process wheeled to the bedside. was conducted to inform the WA Health • KEMH’s occupational therapy team DAIPS. The process included: continued to provide functional analysis of previous Disability Service assessment, home visits and Plans, DAIPs, subsequent review reports education/advice on home modifications and other relevant DOH documents and to ensure the safety of patients with a strategies; disability following discharge. investigation of contemporary trends and • The Swan Kalamunda Health Service good practice in access and inclusion; (SKHS) completed a carers survey to consultation with the Disability Services determine satisfaction levels regarding Commission; and access to services and information, consultation with the community and participation in decision-making and staff. involvement in care planning. Results
indicated a high level of satisfaction Operations The Metropolitan Health Service participated across a broad range of access to service in an advertising campaign developed for points. Statewide and local newspapers and radio, • Signage, parking and building access was advising the community that the WA Health reviewed at all 41 mental health service was progressing the development of its DAIP sites in the north metropolitan region. to address the barriers that people with • All points of access at Osborne Park disabilities and their families experience in Hospital (OPH) were reviewed and accessing WA Health functions, facilities and recommendations incorporated into the services, and inviting feedback from the Disability Access and Inclusion Plan. community. • SMAHS disability advisory committees audited several key areas of hospital services, and actioned both long-term and smaller, project-specific disability access plans.
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Disability access and inclusion plan (continued) • Key upgrades to SMAHS services included: • Accredited consultants completed steps replaced with ramps in the RPH detailed disability access audits across car park and at Armadale Kelmscott OPH, with recommendations prioritised Memorial Hospital’s Mead Centre across the site. Rockingham-Kwinana District Hospital • Two new fire doors, linked to automatic installed new seating near a bus stop fire release, were installed OPH’s Ward 4, toilets were re-designed to meet with improved lever-style door handles Disability Standards at Fremantle more appropriate operating action for Hospital people with a disability. Accessible toilet • The Child and Adolescent Health Service door locks were also installed. (CAHS) commenced implementation of a • New buildings and renovations at SMAHS Disability Access and Inclusion Plan (DAIP) hospitals comply with disability standards. providing ongoing review of access to Disability advisory committees have Princess Margaret Hospital’s (PMH) conducted reviews of several areas to services and events. assess current buildings for disability • People with disabilities, their families and access. carers took part in community • Fremantle Hospital has replaced swing consultation to identify where service doors with automatic doors in its ‘T Block’ access requires improvement at PMH. building, installed Braille signs in toilets, • The provision of appropriate access to and installed a wheelchair-friendly water PMH buildings and facilities was reviewed fountain. and updated in 2006-07. • An audit for the Royal Perth Hospital Goderich Street Outpatient Clinic and a Outcome 2: People with disabilities have the redesign of its spaces was completed. same opportunities as other people to access Clinic patients can use a shuttle service the buildings and other facilities of the that runs between the clinic, the relevant public authority. hospital’s main entrance and the main • Plans are complete for another bariatric carpark. universally accessible toilet in Ward G41 • The cashier desk at RPH’s Shenton Park of SCGH and for another universally Campus and Bentley Hospital’s ‘D Block’ accessible counter with the reception reception areas have been re-designed to area on the first floor of ‘G Block’. allow for wheelchair access. • The new Mother and Baby Unit and Sexual • Armadale Hospital has built rest stations Assault Referral Centre at KEMH have between the main building and the fully accessible facilities, including pharmacy department. treatment rooms, consulting rooms and toilets. • As part of the refurbishment of oncology Ward 3B at PMH, wheelchair access was Operations • The new premises for Mediation and Legal improved to the nurses’ station, Support Services at KEMH has a purpose- outpatient reception desk area, and toilet built reception area, designed to ensure and bathroom facilities. that customers in a wheelchair can have face-to-face interaction with staff. • Ramp access was provided to the PMH Friendship Room and a public telephone • A wheelchair-height doorbell has been in the outpatient area was adapted to installed at KEMH’s Centenary Clinic and a ensure improved wheelchair access. designated wheelchair space created in the waiting room. An accessible reception • The Dental Health Services undertake desk was been added to the Maternal regular reviews to ensure access to Fetal Assesment Unit. buildings and facilities. This year, toilets and bathrooms were upgraded to allow • The KEMH Hensman Road staff carpark, wheelchair access at the Mt Henry clinic which includes one ACROD bay, is being and a new access ramp was installed at made available to KEMH customers. the Rangeway Centre. • Better hearing bed disks were purchased
and distributed to inpatient areas at the SKHS.
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Disability access and inclusion plan (continued) • Refurbishment of the PMH Hay St information on all services was also building, and design and creation of the included on the mental health website. Children’s Rehabilitation unit is complete, • OPH installed larger televisions with including: improved sound quality in wards assisting provision of adequate doorway and vision and hearing disability patients. room space for wheelchair access • All OPH publications include a caption slip-resistant floor surface offering versions in alternative formats on continuous accessible paths of travel request. Patients requesting information designation of ACROD parking bays in alternative formats can receive it in a purpose-built wheelchair training area large font document, spoken word • PathWest Laboratory Medicine WA cassette or disk, in Braille, or they can provides a clearly-marked parking bay and receive help from an interpreter. TTY self-opening doors at the QEII reception machines are also available. area allowing easy access for frail and • Braille signs were installed in the lift at disabled patients. Kaleeya Hospital, and in the toilets in Fremantle Hospital’s ‘B Block’. Outcome 3: People with disabilities receive information from the relevant public • The PMH publications committee is well authority in a format that will enable them to informed as to disability access standards access the information as readily as other and considers these when reviewing and people are able to access it. approving hospital publications. • Emergency department and observation • The PMH guidebook which includes wards at SCGH were reviewed for data information to assist people with transfer points to maximise the use of disability to access hospital services is portable TTY services. being reviewed. • A review of access to SCGH’s day hospital • The PMH intranet site has been reviewed. reception counter was completed All new designs meet the disability access assessing the needs of hearing impaired standards set by the Office of e- visitors and staff. Government and these measures will be integral to the updating of the PMH • KEMH undertook a recruitment campaign Internet site during 2007-08. for its Community Advisory Council. A revision of the application process • The Dental Health Services also make ensured applicants could respond to the published material available in alternative criteria verbally as well as in writing. formats, such as Braille, CD-ROM, audio compact disc and large print. TTY is also • KEMH’s occupational therapy team available. continues to develop resources for gynaecology and obstetrics patients with Outcome 4: People with disabilities receive a disability. the same level and quality of service from the Operations • BreastScreen WA (BSWA) recently updated staff of the relevant public authority as other their brochure entitled – ‘Women With people receive from that authority. Disabilities, Information on Access’. BSWA • The SKHS held regular presentations for has also presented screening information staff on working with people with a to women with a hearing impairment. disability conducted by a training officer • The SKHS has improved material relating from the Disability Services Commission. to rights and responsibilities, patient • OPH Community Advisory Council and the information and consumer feedback, to OPH DAIP Reference Group both include a promote the use of the national relay community representative with a mobility service to meet the needs of customers disability. with hearing and speech impairments. • Bentley Hospital conducted surveys to • All common information provided to determine staff awareness of disability consumers within mental health services issues and identify gaps. The hospital was reviewed and recommendations developed a staff information package made. Comprehensive, easy-to-use and training sessions to raise awareness in this area.
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Disability access and inclusion plan (continued) • KEMH reviewed and conducted disability mechanisms are in place to allow people awareness sessions for staff. with disabilities to participate without • PMH is committed to providing ongoing impediment. disability awareness/training sessions to Outcome 6: People with disabilities have the staff through the Education and same opportunities as other people to Development Centre. Workshops offered participate in any public consultation by the include Makaton Key Word Signing, relevant public authority. facilitated by CAHS speech pathologists. • The SCGH Community Advisory Council Outcome 5: People with disabilities have the includes a consumer with a disability. same opportunities as other people to make • KEMH appointed a dedicated project complaints to the relevant public authority. officer to develop its DAIP. Community • The SCGH complaints process offers agencies providing services to people with alternative response mechanisms, should disabilities were asked to provide a complainant have difficulty with the feedback on how the hospital could written component. For example, audio- improve its services. tapes can be produced for patients with • Consumer representatives with disabilities vision impairment. are also members of the SKHS Community • The KEMH Customer Service Unit (CSU) Advisory Council. has reviewed its complaint process in • Mental health service consumer advisory relation to services provided to people groups also include members with with disabilities. If a complainant has disabilities. Representatives from the difficulties with the written component of NMAHS Mental Health Service participated the process, the person can attend a in a whole-of-health community meeting with senior staff to resolve the consultation for development of the 2007- complaint. 2010 DAIP plan. • At SKHS, a range of brochures in various • Two consumer representatives with a formats is readily available to the public disability are members of the OPH DAIP explaining internal and external avenues reference group and provide a link to for complaints. This is to accommodate community disability groups. communication difficulties that may be • All patients are able to apply to become experienced by people with disabilities. members of SMAHS Community Advisory • OPH advertised widely for community Councils, which represent patients. feedback on the six disability outcomes, • PMH’s Community Advisory Committee in conjunction with the Department of helped facilitate three consumer Health’s DAIP reference group. Feedback consultation events to review current was incorporated into the services and plan for Western Australia’s Operations OPH/Department of Health DAIP new children’s hospital. PMH encouraged Implementation Plan. and facilitated community engagement in • OPH complaint mechanisms include the above projects with particular complaints being regularly reviewed by emphasis on people with disabilities and the hospital’s Community Advisory their families who are often long-term Council. consumers of hospital services. • The PMH Customer Service unit continues • To assist in the development of the CAHS to support consumers with disabilities, DAIP, information was sought from over their families and carers, to ensure the 80 consumer groups providing services complaint process is accessible. This and support for people with disabilities includes the use of interpreters, and their carers. communication aids and linking to external services. • The Dental Health Services have redesigned complaint procedures to meet the needs of clients who are unable to make written complaints. Grievance
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Employee profile Agencies are required to report a summary of the number of employees by category, in comparison with the preceding financial year. The table below shows the average number of full-time equivalent employees for the Metropolitan Health Service year-to-date June 2007, by category. Table 44: Total Metropolitan Health Service FTE by category
Category Definition 2005-06 2006-07 Includes all clerical-based occupations together with patient- Admin & clerical 3,376 3,313 facing (ward) clerical support staff. Includes FTE associated with the following occupational categories: administration and clerical, medical support, hotel Agency 160 270 services, site services, medical salaried (excludes visiting medical practitioners) and medical sessional. Dental Assisting Includes dental clinic assistants. 253 253 Includes catering, cleaning, stores/supply laundry and Hotel services 2,406 2,357 transport occupations. Includes all salary-based medical occupations including interns, Medical salaried 2,048 2,230 registrars and specialist medical practitioners. Includes specialist medical practitioners that are engaged on a Medical sessional 244 255 sessional basis. Includes all Allied Health and scientific/technical related Medical support 3,539 3,871 occupations. Includes all clerical-based occupations together with patient- Nursing 7,092 7,542 facing (ward) clerical support staff. Includes workers that are engaged on a ‘contract-for-service’ Nursing agency 148 162 basis. Does not include workers employed by NurseWest. Site services Includes engineering, garden and security-based occupations. 355 375 Captures Aboriginal and ethnic health worker related Other categories 42 40 occupations. Total 19,663 20,668
Data includes NMAHS, SMAHS,CAHS, PathWest Laboratory Medicine WA & Dental Health Service Data includes Peel Health Service as numbers cannot be easily extracted from SMAHS
Data excludes the Drug and Alcohol Authority Operations
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Equity and diversity The Metropolitan Health Service (MHS) bullying and harassment in the workplace to including the State-wide Dental health Service maintain awareness of processes and and PathWest Laboratory Medicine WA serves employee rights across the metropolitan area. an increasingly diverse community, and therefore has an ongoing commitment to Recruitment and selection policies, improving equity and diversity in its procedures and forms for all areas under the workforce, in accordance with the Equal MHS are reviewed regularly to ensure that no Opportunity Act 1984 and the Public Sector discriminatory language or practices exist, Standards for Human Resource Management. and that the forms comply with public sector standards. Job description forms are reviewed The Minister for Health and the Director to eliminate potentially discriminating General have supported and established the criteria, are written in plain English and State Health Advisory Committee on Work Life include gender-neutral language, and where Balance and the WA Health Equity and necessary, the management of equity and Diversity Working Group. Through these diversity policy. committees, whole-of-health equity and diversity policies will be issued to promote Recruitment and selection training provided implementation of diversity management across the MHS encompasses EEO/diversity strategies to achieve ‘vibrant and positive principles are available to all staff via workplaces’ and to retain and attract a corporate staff development opportunities. workforce to meet future demands. Wherever possible, interview panel members are appointed to reflect the diversity of the The WA Health Equity and Diversity Group group for which they are recruiting. with representatives of the area health services recently developed the DOH Equity In 2006-07 all Metropolitan Health Service and Diversity Plan 2007 - 2009 providing a staff were surveyed to gather important strategic framework for equity and diversity information on the diversity of our workforce. outcomes specific to the public health sector. CAHS has established a Reconciliation Working The plan has been approved by the Director Party to identify and address issues to General, issued to all health services and improve service delivery and the employment submitted to the Director of Equal of Indigenous people. Opportunity in Public Employment, Office of Equal Employment Opportunity. North Metropolitan Area Health Service The North Metropolitan Area Health Service The Health Equity and Diversity Plan aligns (NMAHS) supports its workforce with with WA Health’s Strategic and Operational entitlements, practices and facilities that are plans which provide targets for workforce family friendly and meet the needs of work- Operations participation and distribution objectives. life balance. These include: a vacation care program for children aged Policies issued in 2006-07 included those on 5-15 and a before and after-school care work-life balance, workplace breastfeeding program at SCGH; and and prevention of bullying in the workplace. access by KEMH staff to in-house childcare and the vacation care program Please see Appendix 1 of the Department of for school-aged children at PMH. Health 2006-07 Annual Report for the Equity and Diversity - Workforce Participation and Workforce SCGH Nursing Managers are trialling initiatives Distribution achievements in 2006-07. that include: a relief pool to offer more flexible start The MHS, the Dental Health Service and and finish times; PathWest Laboratory Medicine WA introduce allowing individual wards to negotiate Equal Employment Opportunity (EEO) and flexible start and finish times; diversity policies and principles to new introduction of fixed night-shifts; employees at staff inductions. Sessions are routinely conducted on the prevention of
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Equity and diversity (continued) allowing nurses to be employed to ward redevelopment planning committees to areas for as little as one day per week; ensure child-care issues as well as other gradual return to work from maternity workforce matters are considered. Planning leave; for the Rockingham-Kwinana District Hospital casual shifts during maternity leave; and redevelopment includes childcare facilities, return to nursing/support refresher and Royal Perth Hospital continues to offer programs after extended family leave. vacation care to staff members’ school-aged children. The KEMH Neonatal Unit is supporting: purchased leave; SMAHS has a number of positions that working from home (in certain specifically target diversity groups. In circumstances); partnership with the AMA, Indigenous school- increased maternity leave; based traineeships are in place throughout personal leave; the health service. changing hours to part-time and casual work; and Other examples of equal employment early finish of shift for child care/school principles being adopted include: reasons. the Bentley Hospital where two people with learning difficulties have been South Metropolitan Area Health Service employed in Patient Support Services; A SMAHS priority in 2006-07 was to educate the support and availability of part-time, staff to reduce workforce harassment and job-share and flexible working bullying. Face-to face training was offered arrangements, policies and practices to and an e-learning package ‘The Bullying is all staff; and Banned’ was developed. Training aimed to the introduction of a Disability Services raise staff awareness including steps that can Commission video to their orientation be taken if they experience or witness program for new Armadale Health Service bullying or harassment. Managers can also employees. attend courses to help them identify and deal with bullying. Child and Adolescent Health Service The Child and Adolescent Health Service In late 2006, 26 new grievance and contact (CAHS) is committed to supporting its officers were recruited and trained across workforce with practices and facilities that SMAHS to provide a network of skilled people are family friendly and meet work life to support staff with discrimination, balance needs. harassment or bullying issues. Training was
conducted by the Equal Opportunity The CAHS is represented on the State Health Operations Commission at Royal Perth Hospital (RPH) and Advisory Committee on Work Life Balance. Fremantle Hospital. Through this committee the CAHS has promoted to its workforce, various The SMAHS has membership of the State publications to inform staff and encourage Health Advisory Committee on Work Life managers to find solutions to balance Balance Creating Family Friendly Workplace, operational needs with staff requirements. and the RPH and Armadale Health Service are participating in a pilot of pre and post-exit Princess Margaret Hospital provides in-house interviews aimed at assessing how nurses can childcare for children aged up to five years of be retained using work-life balance age and vacation care for school-aged strategies. children.
In support of the State Government’s Nurse managers are improving flexible commitment that child-care facilities being rostering to allow staff to transport children incorporated into infrastructure to and from school, to provide care and redevelopments, the SMAHS Workforce support to other family members and to Director is a member of a number of facility attend special and/or cultural events.
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Equity and diversity (continued) PathWest Laboratory Medicine WA Dental Health Services The PathWest Laboratory Medicine WA Code Dental Health Services employment programs of Conduct is provided to all staff at induction and practices aim to achieve diversity and in addition to EEO policy information. The quality of employment opportunity for the Code provides details on the values and four EEO groups for the majority of positions. behaviours that encompass three major principles: justice, respect for persons and The work life balance policy has been responsible care. distributed to all employees and DHS has promoted work practices to meet operational One of the priorities of the PathWest requirements and the needs of employees. Laboratory Medicine WA operational plan for 2006-07 was to educate staff to reduce workforce harassment and bullying. Management and staff from all PathWest Laboratory Medicine WA sites have been participating in training accordingly.
PathWest Laboratory Medicine WA trained 18 new grievance/contract officers to expand the network of skilled staff available to support staff who may encounter situations of discrimination, harassment or bullying. This training was conducted by the Equal Opportunity Commission at the PathWest Laboratory Medicine WA QEII site and was attended by staff from across metropolitan and regional sites.
Industrial relations Operations
.Please see the Department of Health Annual Report 2006-07.
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Internal audit controls The Corporate Governance Directorate WA Health has an overarching Audit (Internal Audit) has the role of accountability Committee that considers matters of strategic adviser and independent appraiser, reporting importance and system-wide issues. This directly to the Director General. Audits committee is informed by a number of sub- undertaken were generally planned audits, committees, which consider operational however on occasion management initiated issues as they relate to specific areas. Sub- audits or Corporate Governance Directorate committees have been established for the initiated audits were also carried out. Audits North Metropolitan Area Health Service were of a compliance, performance or (including the Child and Adolescent Health information system nature. The audits were Service), the South Metropolitan Area Health conducted to assist senior management in Service, the WA Country Health Service, the achieving sound managerial control. External Department of Health and Health Corporate consultants were utilised to complete some Network. audits.
Table 45: Internal Audits completed in 2006-07 Audit Area audited Accounts Payable, Supply & Finance Health Corporate Network Accounts Receivable Health Corporate Network Asset Governance Health Corporate Network Audit Log Integrity WA Health Clinical Governance North Metropolitan Area Health Service; Child & Adolescent Health Service; South Metropolitan Area Health Service; WA Country Health Service Control Review Drug & Alcohol Office; WA Country Health Service (x 2) CPOE Project Review South Metropolitan Area Health Service Email Management & Admin Department of Health Employment Services Health Corporate Network Financial Returns Volunteer Organisations with the Metropolitan Health Service FMA Compliance Drug & Alcohol Office Follow-up Review Dept of Health & Aging (Office of Aboriginal & Torres Strait Islander Health) FSCP & Annual Report Preparation Plan Health Corporate Network, Metropolitan Health Services; WA Country Health Service
Governance Review Department of Health Operations IM & ICT Governance Department of Health I-Procurement Health Corporate Network Nursing Hours Per Patient Day North Metropolitan Area Health Service, Department of Health, WA Country Health Service Occupational Safety & Health North Metropolitan Area Health Service Patient Handover Procedures North Metropolitan Area Health Service, Child & Adolescent Health Service; South Metropolitan Area Health Service PATS Processing WA Country Health Service Purchasing & Accounts Payable South Metropolitan Area Health Service Remuneration/Billing Department of Health Review of Audit Log North Metropolitan Area Health Service; South Metropolitan Area Health Service; WA Country Health Service Risk Management Department of Health; North Metropolitan Area Health Service; Child & Adolescent Health Service; South Metropolitan Area Health Service; WA Country Health Service
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Major capital works Please see the Department of Health Annual Report 2006-07. Pricing policy The majority of WA Health's services are These fees are incorporated into the Hospital provided free of charge. Some classes of (Service Charges) Regulations 1984 and the patients are charged fees — for example, Hospital (Service Charges for Compensable patients who have elected to be treated as Patients) Determination 2002. private patients, or compensable patients (i.e. patients for whom a third party is Dental Health Services utilises fees based on covering the costs, such as patients covered the Australian Government Department of by worker's compensation or third party motor Veterans’ Affairs Schedule of fees, with vehicle insurance). Where fees are charged, patients charged: the prices are based on legislation, 50% of the treatment fee if holder of a government policy, or on a cost-recovery Health Care Card or Pensioner Concession basis. Card 25% of the treatment fee if holder of one of Health Finance sets a schedule of fees each the above cards and in receipt of a near year to cover patients for whom fees apply. full pension or benefit from Centrelink or the Commonwealth Government Department of Veterans' Affairs Operations
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Recordkeeping WA Health has continued to progress the Each SMAHS hospital has its own training Recordkeeping Plan. During 2006-07 the State program for medical records staff, with new Records Commission approved the WA staff receiving between one and six weeks’ Health’s Records Retention and Disposal comprehensive, one-on-one training. A review Schedule. of individual training programs for recordkeeping staff is planned for 2007-08. All new employees in the Metropolitan Health Service are informed of their obligations in PathWest Laboratory Medicine WA is regard to recordkeeping through the induction evaluating and updating the Record Keeping programs. Plan and Retention and Disposal Schedule appropriate to each site. Following is a brief summary of the types of recordkeeping plans and policies adopted by All PathWest Laboratory Medicine WA the Metropolitan Health Service. laboratory records are maintained to NATA accreditation standards – many having longer Health Corporate Network is seeking to retention periods than required by the State improve document management across the Records Office. health system with the trialling two alternative document management systems To ensure compliance with the State Records (DMSs). The North Metropolitan Area Health Act 2000, Dental Health Service conducts an Service (NMAHS) is continuing to utilise its ongoing review of the processes controlling existing document management processes. the opening, classification, security, filing, However should the HCN DMS trials prove distribution, retention and disposal of successful, the NMAHS will consider records. All recordkeeping system users are implementation of an alternative system. made aware of their responsibilities under the Act, and new employees are made aware of Bentley Hospital has implemented the Medical their recordkeeping roles and responsibilities. Record Information Tracking System (MeRITS), which has improved the timeliness of retrieving medical records by recording the movement of each record, every time the record moves between departments and wards.
Operations
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Recruitment The current economic environment of near accreditation is an international staff full employment continues to be a challenge attraction and retention initiative. and the Metropolitan Health Service continues Osborne Park Hospital facilitated movement to develop new retention and attraction of consultant staff across campuses on a strategies and review current options for mutually agreed basis in the speciality areas improvement. of rehabilitation of the aged, elective
surgery, and women’s and newborn health. Recruitment difficulties continue to occur Medical recruitment at SCGH introduced an particularly in clinical areas such as nursing, improved interview process for overseas medical, patient support services and allied trained junior doctors, resulting in improved health staff. Strategies have included a focus quality of recruits. on international staff recruitment especially for areas of particular clinical need, and has South Metropolitan Area Health Service targeted the recruitment of doctors, medical Negotiations have been under-way with HCN technologists and nurses from the United to monitor the Service Agreement and Kingdom. develop performance indicators. Feedback has been provided to HCN against the service The Health Corporate Network now provides agreement, and action plans put in place to Employment Services across the MHS under improve deficiencies. Service Agreements. These services include During 2006-07, SMAHS Human Resources (HR) recruitment and appointment, payroll and HR staff have worked to standardise all work reporting. Positions are advertised through practices in relation to the standards. A on-line systems, the HCN and health service comprehensive set of SMAHS HR policies and websites, newspapers, industry specific and procedures has been developed and professional journals with an increasing disseminated. emphasis on website advertising. The introduction of the Working With The MHS uses a number of initiatives to Children (Criminal Record Checking) Act 2004 attract staff. These include employment required SMAHS to review all positions to information sessions and morning teas used to identify ‘child related work’ so that invite prospective nurses to find out more recruitment to these positions adheres to about the hospitals prior to applying for a Government strategy. position. All hospitals took part in the annual Nursing Training is also provided to staff involved in Expo in an effort to attract high school and recruitment and selection and advice is university students to this career path, and provided to managers on staff planning and hospitals have strengthened relationships with Operations attraction strategies. Training topics include particular universities in an effort to create a Public Sector Standards, relevant legislation, smoother transition from university to organisational policy, recruitment, selection graduate placements. This includes RPH’s new and appointment procedures, child protection relationship with Curtin University’s School of issues, behavioural interviewing methods and Nursing, which will see many student nurses the appeals process. do all their university practicum placements at the one hospital (hopefully increasing their Following is a brief summary of the types of chances of applying for graduate positions) recruitment plans, polices and programs and Fremantle Hospital’s continuing provided by the Metropolitan Health Service. relationship with both nursing and medical students from the University of Notre Dame North Metropolitan Area Health Service Australia. Recruitment strategies included additional promotion of the health service as a preferred employer. In particular, Sir Charles Gairdner Hospital (SCGH) is applying for Magnet Accreditation Status. The “Magnet”
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Recruitment (continued) Hospitals such as Armadale Kelmscott A recruitment campaign for anaesthesiologists Memorial Hospital and RPH have analysed was also successfully completed. workforce trends and interviewed resigning staff in an effort to improve workplace A bi-monthly recruitment, selection and morale and retention. RPH has focused on appointment half-day workshop at CAHS is encouraging enrolled nurses to upgrade their well attended by staff involved in skills to become registered nurses. recruitment. The course is designed to ensure appointment of the most suitable staff. The South Metropolitan Mental Health Services program covers human resource management, established a Workforce Working Party that public sector standards, relevant legislation, aims to deal with current issues affecting the hospital policy, child protection issues, existing workforce, to improve workforce behavioural interviewing, documentation and development processes, and to ensure the appeals process. Regular advice is appropriate resources are in place to available to management and staff. implement the Mental Health Strategy 2004- 2007, and for future developments in mental PathWest Laboratory Medicine WA health services. In early 2007, PathWest Laboratory Medicine WA partnered with Curtin University of Child and Adolescent Health Service Technology to offer a student vacation Recruitment priorities fluctuate at the Child employment program, which will provide paid and Adolescent Health Service and PMH. work placements during university breaks for However, there is a constant demand for high-potential second and third-year nurses in specialty areas including paediatric students. Eight students were recruited to intensive care, theatre, oncology and participate. The program is seen as a first emergency. A recruitment priority for step in developing positive relationships with anaesthesiologists was also identified. future employees.
PMH established a Recruitment and Retention Ten new pathology registrar training-positions Steering Committee, incorporating were created in January 2007 to address the subcommittees on recruitment and retention. shortage of pathologists. The recruitment subcommittee adopted various initiatives, such as advertising through Dental Health Services community newspapers, ‘Seek Limited’ and Dental Health Services continues to professional publications, and conducted experience significant difficulties in recruiting employment information sessions. dentists to rural and remote locations and in attracting and retaining experienced dentists The information sessions included a Post for other locations.
Graduate Paediatric Information Session in Operations November 2006, a Post Registration Education Initiatives to overcome this situation include: for Enrolled Nurses-Paediatrics Information an improved pay and conditions package Session in April 2007, and an Employment for dentists and the introduction of an Information Open Day for Registered and enhanced criteria progression policy; Enrolled Nurses in May 2007. targeted advertising to United Kingdom dentists who are registrable in Western Following the Post Graduate Paediatric Australia; and Program Information session, 14 graduates ongoing implementation of the Public were recruited with several on the waiting list Sector Dental Workforce Scheme, for the next program. Three enrolled nurses targeted at overseas qualified dentists to were recruited. work in rural locations.
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Staff development In striving for excellence in health care, the campuses, ongoing development included Metropolitan Health Service is committed to postgraduate courses (in collaboration with developing the skills and expertise of staff universities), clinical short courses, corporate through training and continuous professional programs, computer skills, e-learning, development. Staff development facilitates managing aggression in the workplace, mental personal growth, confidence and competence health programs, clinical programs and of staff through planned learning experiences modules, graduate enrolled nurse and in formal and informal settings. registered nurse study days and nursing midwifery programs. Following is a brief summary of the types of staff development programs provided by the Staff development highlights during the year Metropolitan Health Service. included: Armadale Kelmscott Memorial Hospital’s North Metropolitan Area Health Service staff development program receiving an North Metropolitan Area Health Service Extensive Achievement rating during its (NMAHS) education and development accreditation through the Australian programs aim to provide integrated learning Council of Healthcare Standards. through education and change interventions, The Ruth Reid Clinical Skills Education and the support of best practice in Centre was launched at Royal Perth leadership. The NMAHS Education and Hospital providing a purpose-built Development Centre (EDC) continues to offer learning area and efficient delivery of a range of nationally recognised programs. mandatory competency training for
clinical areas, and management of During 2006-07, the EDC issued 106 staff with aggression training. national statements of attainment for 190 The Bentley Health Service has trained units of competency. In addition 61 staff 257 mental health staff in ‘Dialectical completed 656 units of competence to Behaviour Therapy. graduate with full qualifications ranging from Fremantle Hospital launched a new ‘grand Certificate II Health Support Services (Client round’ for surgical nurses. Patient Support) and Certificate IV in Training & Assessment to Diploma of Business Child and Adolescent Health Service and Advanced Diploma of Business The Department of Paediatric Nursing Management. Education at Princess Margaret Hospital for Children offers a service to nursing staff Approximately 2,400 staff completed focusing on education, clinical support and mandatory training in Manual Handling and professional development. The programs and about 1,000 staff completed training in courses range from study days, short-courses, Operations managing and preventing Workplace and graduate and postgraduate certificate Aggression and Violence. programs. The department provides opportunities for nurses at all levels for The Women’s and Newborn Health Service professional development and further Corporate Training Group amalgamated with education that articulates with further EDC, providing the opportunity for shared degrees through Curtin University of resources and improved access to training for Technology. staff. Major developments during 2006-07 include South Metropolitan Area Health Service education to enable enrolled nurses to expand Staff development departments across the their scope of practice. These educational South Metropolitan Area Health Service programs include the development and (SMAHS) carried out formal and informal implementation of the Medication learning experiences for staff in the areas of Competency Course, the Paediatric personal growth, confidence and competence. Medication Module and the IV Competency The departments were involved in the Course for enrolled nurses. induction of new staff, their occupational training and career development. Across the
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Staff development (continued) CAHS is very proud to have established and Women’s and Children’s Health Service. The maintained a collegial relationship with TNA survey identified non-clinical training Nursing Education at Sir Charles Gairdner priorities for 2007-08. The survey form Hospital in the development and facilitation comprised sections covering organisational, of these programs. This collaboration has also management and leadership skills, personal included the development of the Medication development, human resources, WCHS policy Competency and Paediatric Medication and procedures, information technology, Competencies being developed as disability awareness, emergency comprehensive program and education preparedness, and occupational safety and packages to enable educators to conduct the health. These priorities form the basis for course. These resources are available at no 2007 training and education programs. cost via NurseLink. A research project has been conducted to assess the job satisfaction Through the Office of the Chief Nursing of enrolled nurses in relation to their Officer, the Department of Health has expanded scope of practice. provided PMH with funding to realise strategies to minimise workplace violence and PMH has been successful in a joint tender aggression against nurses, and to provide with the West Coast College of TAFE to annual mandatory training for nurses. Part of develop and conduct a Post Registration the funds allocated have been used to fund a Paediatric Nursing Course for Enrolled Nurses full-time SRN Level 3 Nurse Educator position commencing in June 2007. PMH has for four months with possible extension to developed a strong relationship with the help realise these strategies. Nurses Board of WA and Office of the Chief Nursing Officer in the facilitation and Postgraduate Medical Education coordinates development of the Shared Health Interactive two hours of paid, protected teaching time a Practice project. week in the emergency department for all residents. Ad-hoc education sessions target The Women’s and Children’s Health Service registrars, but all medical staff are invited to Graduate Nurse Program is in a transition attend. Sessions have included topics on period as a result of changes in the health writing of grants, communication skills, service structure, and will become a PMH medico-legal issues and refugee health. Graduate Nurse Program. PathWest Laboratory Medicine WA During 200-07 PathWest Laboratory Medicine The Education Development Centre PMH- WA staff participated in the Leading 100 KEMH (former Corporate Staff Development) program and the Vital Leadership programs is now part of the Education and Development run by the Department of Health. Centre (EDC) of the North Metropolitan Area Operations Health Service. The role of the EDC relates to Staff members receive job related training in the non-clinical training and development PathWest Laboratory Medicine WA protocols needs of all staff. Its aim is to deliver training when they join the organisation and ongoing and development activities that are useful, training is provided as required. When new relevant and timely for PMH/KEMH staff. processes and procedures are introduced all staff receive appropriate training. A key goal in 2007 is to promote the increased education services now available with the Staff members attend further educational linking of Child and Adolescent Health Service courses relevant to their particular discipline (CAHS) and NMAHS Education Development and position, and are encouraged to continue Centres. Courses are now offered in training their professional development. and assessment, performance management, Occupational safety training is provided for preventing workplace bullying and various new safety representatives with updates for information technology topics. current representatives as required.
In 2006, a Training Needs Analysis (TNA) survey was implemented across the then
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Staff development (continued) Selection and interview skills training are Dental Health Services provided for staff in non-discriminatory It is the policy of Dental Health Services to processes. implement appropriate staff development programs to ensure staff are aware of current The consolidation of pathology services has public health (and relevant dental and given the organisation the opportunity to medical) practices and techniques. make better use of shared academic resources, and the contribution to scientific In 2006-07 appropriate introductory and forums and meetings has resulted in a number advanced training was provided for of awards and presentations to staff. occupational safety and health staff PathWest Laboratory Medicine WA frequently representatives. Training to deal with provides presenters for national and aggression in clients has been provided to international conferences and events. School Dental Service staff. In addition, clinical and administrative training was PathWest Laboratory Medicine WA provided provided to metropolitan and country School training for staff through programs to address Dental Service staff. Patient Management identified developmental needs. Training System training was provided for supervisors, programs included “New Supervisor” training reception and dental laboratory staff, and for newly appointed supervisors, Conflict support was provided to clinical staff to Management, Bullying Awareness Training, attend continuing education courses not “Get in Training” and “Train the Trainer” available in-house. programs to provide staff with skills to train colleagues in small groups.
Substantive equality Please see the Department of Health Annual Report 2006-07.
Sustainability Please see the Department of Health Annual Report 2006-07.
Operations
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Workers’ compensation and rehabilitation The Metropolitan Health Service is committed Health promotion programs on stress to establishing a vibrant and positive management, healthy diet, safe and workplace culture. A large part of delivering responsible drinking, infectious diseases this commitment is ensuring the safety and vaccination, heart disease, hand care, health of all employees. fatigue reduction and ergonomics Aggression management programs The Metropolitan Health Service endeavours Increased manual handling training for to ensure a safe and healthy workplace by nursing and hotel services staff, a review maintaining active Occupational Safety and of manual handling equipment and Health (OSH) programs throughout its areas of increased mechanical lifting aids responsibility. Development of staff training needs Table 46: Workers’ compensation claims analysis surveys. Employee category Claims PathWest Laboratory Medicine WA sites are Nursing Services/Dental Care equipped with needle stick injury packs. 327 Assistants Chem Alert II is also in operation to provide Administration and Clerical 52 on-line information for all chemicals on site. Medical Support 56 The Dental Health Services (DHS) injury management team has continues to assist Hotel Services 182 injured employees with medical management, Maintenance 14 to ensure a safe return to work. An Medical (salaried) 4 occupational physician and therapist have Total 635 also assessed DHS workplaces, and identified suitable programs and workshops to reduce Notes: strain at work with posture and exercise 1. “Administration and clerical” includes advice for employees. administration staff and executives, ward clerks, receptionists and clerical staff. Employee rehabilitation 2. “Medical support” includes physiotherapists, speech Injury management systems were updated pathologists, medical imaging technologists, pharmacists, occupational therapists, dieticians and and implemented in compliance with the social workers. amended legislation. Injury management 3. “Hotel services” includes cleaners, caterers and teams work together to assist an injured patient service assistants. worker return to work as soon as medically Occupational injury and illness prevention appropriate with suitable meaningful duties Across the MHS, hazard and incident data is within medical restrictions. Regular monitored and reported to identify risk areas monitoring in liaison with the injured worker’s medical practitioner, manager and and formulate prevention strategies. Other Operations occupational safety and health programs the insurer ensures appropriate interventions include: are facilitated as required. Risk management programs The NMAHS initiated links with external Staff infection control screening and occupational medical practitioners and immunisation programs nearby functional rehabilitation services to Pre-employment health assessments complement existing in-house injury Worksite and workstation assessments management services, providing a Contractor safety programs comprehensive, timely and effective Provision of information, education and consultancy service with a positive impact on training for staff, OSH representatives, injury management outcomes. managers and supervisors Injury management programs An Injury Management Coordinator position OSH input into facilities planning and was created in SMAHS. Vocational retraining procurement of equipment programs for injured staff unable to resume Area Health Service OSH policies pre-accident duties include transferable skills Increased number of OSH representatives assessment, retraining in suitable duties and job search facilitation.
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Financial Statements Certification Statement
Financial Statements
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Financial Statements Audit Opinion Financial Statements
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Appendices Appendix 1: Abbreviations
ABHI Australian Better Health Initiative ACAT Aged Care Assessment Team ACEM Australian College for Emergency Medicine AHS Area Health Service AIDS Acquired Immunodeficiency Syndrome AMI Acute Myocardial Infarction AR-DRGs Australian Refined National Diagnostic Related Groups ASI Ambulatory Surgery Initiative BSWA BreastScreen WA CAHS Child and Adolescent Health Service CAMHS Child and Adolescent Mental Health Service CAP Care Awaiting Placement CCU Clinical Care Unit CDMTs Chronic Disease Management Teams COAG Council of Australian Governments COPMI Children of Parents with Mental Illness CPI Consumer Price Index DAIP Disability Access and Inclusion Plan DAO Drug and Alcohol Office DHS Dental Health Service DOH Department of Health DMFT Decayed, Missing or Filled Teeth DMS Document Management Systems ED Emergency Department EDC Education and Development Centre EEO Equal Employment Opportunity EN Enrolled Nurse FH Fremantle Hospital FMA Financial Management Act FNOF Fractured Neck of Femur FTE Full Time Equivalent GP General Practitioner HACC Home and Community Care Appendices HITH Hospital in the Home HIV Human Immunodeficiency Virus HPV Human Papiloma Virus ICT Information Communications Technology IM Information Management KEMH King Edward Memorial Hospital MeRITS Medical Record Information Tracking System MHERL Mental Health Emergency Response Line MHS Metropolitan Health Service NMAHS North Metropolitan Area Health Service OPH Osborne Park Hospital OPSSC Office of the Public Sector standards Commissioner OSH Occupational Safety & Health PATS Patient Assisted Travel Scheme
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Abbreviations (continued) PMH Princess Margaret Hospital PRNI Privately Referred Non-Inpatient PYLL Person Years of Life Lost RKDH Rockingham/Kwinana District Hospital RPH Royal Perth Hospital SCGH Sir Charles Gairdner Hospital SKHS Swan Kalamunda Health Service SMAHS South Metropolitan Area Health Service SONM School of Nursing and Midwifery SSP Site Structure Plan SRN Senior Registered Nurse SQuRIE Safety and Quality Investment in Reform TNA Training Needs Analysis TOPAS The Open Patient Administration System TTY Teletypewriter UWA University of WA WCHS Women’s and Children’s Health Service
Appendices
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