Proposed Implementation Plan Organisational Realignment – Rural Division Director of Medical Services Purpose This document provides an overview of a proposed modification of the organisational structure within Darling Downs Hospital and Health Service (DDHHS) involving: Western Cluster, and Southern Cluster – Rural division This document aims to broadly guide affected staff through the scope and implementation process of the proposed change and outlines possible impacts on employees. The document is intended to: • support consultation in relation to the change and the way the proposed change is implemented; and • invite input into the change and ways in which any adverse impacts of the change can be minimised. Background The Rural division delivers excellence in healthcare, to optimise patient centered outcomes for our community. This is achieved by enabling safe, accessible, sustainable, and evidence-based healthcare by a highly skilled and valued workforce. The Rural division consists of: • seven regional hospitals • nine smaller hospitals • six residential aged care facilities • three Multipurpose health services • three outpatient facilities to provide a range of community based health services The Rural division is organised into three clusters, each led by a Cluster Director of Nursing (CDON), and supported by a Director of Medical Services (DMS) as detailed below: Each CDON reports directly to the Executive Director Rural (EDR) operationally and professionally to the Executive Director of Nursing and Midwifery (EDNMS) and consists of the following positions: Cluster Medical lead-position No of Medical No of direct reports to Superintendents Medical Superintendents South Director of Medical Services, 3 15.12 Burnett South Burnett Southern 5.5 24.31 Director of Medical Services, Western Rural 7.0 14.42 In the current structure, the DMS South Burnett operationally reports to the Director of Nursing (DON), Kingaroy Hospital which is the facility with highest activity within the cluster; and the DMS Rural operationally reports to the EDR. Southern and Western cluster facilities with the highest activity are Warwick Hospital and Dalby Hospital respectively. Page 1 of 11 Department | Last reviewed 01/2019 Contact Rural Division | Phone 07 4699 8303 | Baillie Henderson Hospital Printed copies of this document or part thereof should not be relied upon as a current reference document. ALWAYS refer to the electronic copy for the latest version. The Director of Medical Services, Rural is responsible for the professional leadership of medical staff across the Southern and Western clusters, which includes: • Providing leadership to improve care – reviewing and developing processes, and monitoring emerging issues • Lead clinical governance functions – review of incidents including root cause analysis and open disclosure, morbidity and mortality review, escalating significant concerns, proactively managing patient feedback regarding medical services • Responsible for monitoring compliance, mandatory training processes, and credentialing support to the division’s medical staff • Workforce functions including managing vacancies, recruitment, leave, capacity management, and attending conference/networking events • Providing advice to EDR on workforce planning and other issues • While the role is a clinician manager, the role is predominantly a management role with only a small component as direct patient clinical services (< 0.2 Full-time Equivalent) (FTE) The following concerns and risk areas have been identified as a result of capacity issues: No Area Detail Consequence 1 Leadership Advice and support to leaders often Delays to safely support multiple areas occurs on an adhoc basis due to the geographical range and complex case mix 2 Professional Employee Performance and Disengagement of medical staff development and Development discussions can be compliance delayed and unfocussed 3 Clinical Monitoring and reviews of incidents Delays to develop safety and quality governance and feedback on a responsive basis with CDONs and Patient Safety Officers 4 Program Ability to lead and implement medical Delays to innovate and contemporise development models of care, can be delayed practice 5 Service efficiency Compliance monitoring is reactionary Delays to embed a culture of program and often prioritised through breach risk reporting and leading compliance management 6 Service strategy Ability to foster and engage into Delays to service advancement and research, education and training can access to mastery and doctoral be delayed knowledge 7 Workforce strategy Reactive to resignations and Delays to medical workforce model vacancies due to the geographical redesign, and recruitment advantage range and demands required to through proactive engagement with support complex care social media and other access points It is considered necessary to modify the organisational structure due to the following circumstances: 1. Capacity of the DMS, Rural to ably achieve the role requirements across two clusters; 2. Strive for increased patient safety, clinical support and organisational uniformity. 3. Improve Rural Division medical governance maintaining the strategic direction and establishing transparent and effective accountability mechanisms. Page 2 of 11 Scope of the Proposed Change Option 1 Option 1 will achieve medical governance of the rural division having three DMS positions for the South Burnett, Southern and Western Clusters. The DMS’s will work closely with the respective CDON. The three DMS positions will report operationally to EDR, and professionally to the EDMS. Medical Superintendent, Warwick & Dalby These positions are responsible for the provision of efficient quality medical services to inpatients and outpatients, including the provision of 24-hour emergency coverage on a rostered basis. These positions have a clinical component of 0.3 FTE. The roles are evaluated as Medical Superintendent L18-27 and it is accordingly proposed these two positions (Total of 2.0 FTE) will be abolished. Director of Medical Services, Rural This position is responsible for the professional oversight and leadership of medical staff in the Southern and Western clusters of the Rural division. The role takes portfolio responsibility for functions of clinical governance in the Rural division. While the role is a clinician manager, the role is predominantly a management role with only a small component as direct patient clinical services (< 0.2 FTE). The role is evaluated as L18-27 and it is accordingly proposed this position will be abolished. Director of Medical Services, South Burnett (Proposed 0.8 FTE DMS & Medical Superintendent Kingaroy and 0.2 FTE Clinical) It is proposed to retain this position, and realign operational reporting from the DON, Kingaroy Hospital; to the EDR. This position will work closely with the CDON South Burnett. This will enable implementation of a cluster- based model, and integration of services. It is not proposed, this position will require re-evaluation, therefore will remain as L18-27. Director of Medical Services, Southern (Proposed 0.8 FTE DMS & Medical Superintendent Warwick and 0.2 FTE Clinical) It is proposed to establish this new position, after abolishing the Medical Superintendent, Warwick role. The purpose of the role will be to provide strategic, professional leadership and governance for the medical workforce in the Southern cluster (Warwick, Stanthorpe, Goondiwindi, Inglewood, Texas and Millmerran). The position will be the senior clinician leader responsible for efficient quality medical services to inpatients and outpatients of the Warwick Hospital where the position will be based; and deliver quality clinical services in the areas of inpatient and outpatient care, administration, service planning and teaching to the communities within the Southern cluster. Alignment and leverage is expected from the existing DMS South Burnett position description in the creation of this role; and while the position will require evaluation; it is expected to be at L18- 27 or similar. This position will report operationally to the EDR and professionally to the EDMS. This position will work closely with the CDON Southern. Director of Medical Services, Western (Proposed 0.8 FTE DMS & Medical Superintendent Dalby and 0.2 FTE Clinical) It is proposed to establish this new position, after abolishing the Medical Superintendent, Dalby role. The purpose of the role will be to provide strategic, professional leadership and governance for the medical workforce in the Western cluster (Dalby, Oakey, Tara, Chinchilla, Miles, Taroom and Jandowae). The position will be the senior clinician leader responsible for efficient quality medical services to inpatients and outpatients of the Dalby Hospital where the position will be based; and deliver quality clinical services in the areas of inpatient and outpatient care, administration, service planning and teaching to the communities within the Western cluster. Alignment and leverage is expected from the existing DMS South Burnett position description in the creation of this role; and while the position will require evaluation; it is expected to be at L18-27 or similar. This position will report operationally to the EDR and professionally to the EDMS. This position will work closely with the CDON Western. Senior Medical Officer (SMO) Dalby It is proposed to establish SMO 0.3 FTE position in Dalby to undertake the clinical duties previously aligned with the Medical Superintendent position Dalby; it