MurrumbidgeeLocal Health District

Year in Review2014 - 2015

Murrumbidgee Local Health DistrictWollundry Chambers63-65 Johnston StreetLocked Bag 10Wagga Wagga 2650Telephone: 02 6933 9100www.mlhd.health.nsw.gov.au

November 2015

Table of Contents

Year in Review

P1

P 2 Strategic DirectionsP 3-4 Chair’s ReviewP 4-5 Chief Executive’s ReviewP 6 Our People Our FutureP 7 About UsP 8-9 Our BoardP 10-13 Executive Leadership TeamP 14 Performance SummaryP 15 Key Achievements 2014-2015P 16-17 Strategic Direction 1P 18-20 Strategic Direction 2P 21-22 Strategic Direction 3P 23 Strategic Direction 4P 24-25 Strategic Direction 5P 26-27 Strategic Direction 6P 28-29 Thank YouP 30-32 Quality and SafetyP 33 Service DirectoryP 34 Glossary

Year in Review

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Strategic DirectionsOur organisation’s vision and goals are aligned to those of NSW Health. Our strategic directions support Our People Our Future

Our PurposeThe best health outcomes for people in our rural health District

Our VisionWe will be a quality provider of rural health care, recognising the total health care needs of individuals, patients and communities.

Our ValuesCollaboration – Openness – Respect – Empowerment

Our PrinciplesMurrumbidgee Local Health District is recognised as a leader in providing healthcare in ways that meet the needs of rural communities. We pride ourselves on the following principles:

Quality and safety – right care, right patient in the right setting at the right time

Equity – equal opportunity for all persons to achieve their best health level

Access – available, accessible, acceptable and affordable health services

Sustainability – balancing community needs with maintainable workforce and financial resources

Ownership – empowerment of persons to own their health and actively participate in their health care

Year in Review

P3

Chair’s ReviewI am pleased to present the Year in Review Report of the Murrumbidgee Local Health District for 2014-2015. The Board congratulates Jill Ludford, Chief Executive MLHD and her Executive Leadership Team on the achievements in Murrumbidgee throughout the year. The Board acknowledges the role our committed, skilled and passionate staff have played in ensuring the best health outcomes for people in our area. During the year, I have been delighted to participate in a number of celebrations in which we reward and recognise our staff. These included the Don Kendell Award, the MLHD Nursing and Midwifery Awards and the MLHD Excellence Awards. I congratulate all those nominated for awards: I know the competition is tough as we have such talented staff. Awards such as these acknowledge the great job of the award winners and also recognise our great staff who we can be proud of. Over the year, Jill Ludford and I visited all of our facilities across the district. It has been wonderful to acknowledge staff for the work they do and to recognise the many years of experience shared among them. We also appreciate the opportunity to speak with local Councils and we thank the community for their wonderful support of our facilities.

Gayle Murphy

The Board convened meetings at Hillston, Cootamundra, Lockhart, Narrandera, Coolamon, Temora and Wagga Wagga. We appreciate the opportunity to meet staff and community members and to hear of their experiences first-hand. We have a number of initiatives underway across the district, for which we should all feel proud. We held two Local Health Advisory Committee (LHAC) Forums, providing an opportunity for our LHAC representatives to get together and learn from each other. Forums were held at Deniliquin and Wagga Wagga with a variety of topics covered. We have a number of very strong LHACs across our area, with representation from a variety of sections of the community. They work with the community to keep everyone informed on what is happening in health and we are so grateful for the work they do.Across the District we recognise the good work of our volunteers at many of our facilities. Hospital Auxiliaries raise money to support their communities, while LHACs give freely of their time to keep their communities up to date on aspects of health. We also have volunteers who provide a number of other services, such as support to families when a family member has passed away or they may supply extras to make a patients stay more comfortable. In our aged care facilities, we know volunteers assist with ensuring a homely environment for our residents. We thank all our volunteers who work hard for their local hospital and their local community.I wish to thank the Board Directors for their work over the year. I acknowledge the difficult tasks we have had in improving the financial position of the organisation while maintaining service levels across the district.During the year we opened a new $12 million Multipurpose Service (MPS) at Hillston, a wonderful integrated health facility for the residents of the Carrathool Shire. The MPS model has come into being as a result of changing community needs and changes in the way we deliver healthcare. For smaller communities, such as Hillston, flexible service models have needed to be developed which are more patient-focused, responsive to the community’s needs and offer better integration of services and links with other health care professionals and providers.

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Jill Ludford

Chief Executive’s ReviewMLHD has had a dynamic year focusing on improving health outcomes for people in our rural communities. It has been an honour and pleasure to work with our skilled Board and MLHD staff over the 12 months.We are working in a rapidly changing health and rural health landscape, with Commonwealth health reform underway and moves to adopt a more comprehensive approach to primary health care.All the team at MLHD have focused on improving the quality of care we provide in partnership with other providers and to lift performance with improved system-wide changes. Our staff have worked incredibly hard to improve patient outcomes across our region. Achieving National Standards Accreditation during the year demonstrates our commitment.We also released The Murrumbidgee Action Plan (The MAP) to provide an overarching framework to improve performance and deliver our Strategic Plan. The MAP was developed in partnership with Medicare Locals, clinicians and other key stakeholders and takes a whole-of-system perspective to provide the foundations to support long-term clinical and financial sustainability. We launched Our People Our Future, to boost our commitment for our role in improving health outcomes for patients, clients, residents and the broader communities we serve as well as improve our staff satisfaction.

We also opened a new Renal Dialysis Unit at Wagga Wagga which provides two additional chairs as well as a new Haemodialysis and Peritoneal Dialysis Training Unit for the region. The expansion also includes an additional Isolation Room with ensuite facilities and more parking spaces. Being able to self-dialyse means more family time for a number of the clients using the service.The Wagga Wagga Base Hospital redevelopment project continues with stage two scheduled to be complete in early 2016. It is a very exciting time for everyone to have the acute service building rising above the Wagga Wagga skyline. Being a referral hospital, people across the District will soon have access to more services and more equipment at the new facility.Financially, MLHD achieved well in 2014-2015 and I acknowledge the outstanding work of staff to achieve this. We thank staff for their efforts in ensuring Murrumbidgee has improved its financial situation. Not only have staff endeavoured to reach these important key performance measures, but they have maintained good quality care for patients and, in most cases, care has improved. We still have a long way to go to reach full financial stability, but we appreciate the efforts staff have made to reach the present level in our journey.

Gayle MurphyChair, Murrumbidgee Local Health District

Year in Review

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We are working alongside other providers, including primary health, to better coordinate care for people. Our Chronic Disease: Engaged with all Stakeholders and Services (CHESS) collaboration has been established at two pilot sites with a view to roll out in other areas across the region. CHESS provides home support options for people with chronic illness. With their General Practitioner (GP) at the centre of the care team, clinical and social services are tailored to each individual’s needs. CHESS aims to assist people to better manage their health conditions and avoid hospitalisation.Work has continued with a focus on improving health outcomes for Aboriginal and Torres Islander people with a focus on recovery and community integration for people with chronic mental health conditions. During the year a number of Building Strong Aboriginal Families Workshops were held to build skills in providing support and referrals for young parents with psychosocial, mental health and/or drug and alcohol issues.The Mental Health and Drug and Alcohol Clinical Services Plan was endorsed by the Board during the year. The plan provides direction on delivery of mental health and drug and alcohol services across the region for the next five years.Our infrastructure program continued during the year with work on the $282.1 million redevelopment of Wagga Wagga Base Hospital. The extensive change management program for the new facility is underway as part of the redevelopment. The $12 million redevelopment of Hillston Multipurpose Service was also completed during the year and was opened to a proud community. Information and Communication Technology infrastructure to support our future needs continues across the District. HealtheNet and the Electronic Medical Record (eMR2) program were introduced at a number of sites and staff can now view a summary of a patient’s recent medical history and send discharge summaries electronically.Community engagement remains a priority. Local Health Advisory Committees (LHACS) at 32 sites across the district are actively engaged in service planning, priority setting and improving health literary. The LHACs also advocate for their community and provide valuable feedback for our future directions on behalf of their community. LHACs have a powerful voice in the community in the dissemination of important health messages.I thank all our Hospital Auxiliaries and volunteers for their ongoing contribution and dedication to our facilities. Their enthusiasm in ensuring our patients receive the little extras is selfless and proves our volunteers are as committed to ensuring our community’s good health as our staff.I thank the Board, staff, volunteers, community and consumer representatives for their dedication in improving the health of our population and our patient experience.I look forward to continuing on our journey of being a quality provider of rural health care and recognising the total health care needs of individuals, patients and our communities.

Jill LudfordChief ExecutiveMurrumbidgee Local Health District

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Our People Our FutureOur People Our Future embodies the vision and values of Murrumbidgee Local Health District.Our People Our Future identifies who we are and the community we serve and includes our staff as part of this community. Our People Our Future emphasises that we are here to promote healthy living and the improvement of health outcomes for our patients, clients, residents and the broader communities we serve - in collaboration and partnership with others. The Executive Leadership Team are fully committed to Our People Our Future and look forward to engaging with all on this journey.

The aims of Our People Our Future are to: • Identify those things which are critical to our success as an organisation

• Align measures of performance with the vision and goals of MLHD

• Embed accountability throughout MLHD

• Provide the tools and methods to lift performance across clinical, service and operational dimensions

• Assist and develop leaders through coaching to achieve enhanced levels of performance

• Provide MLHD with the tools to “hardwire” sustainable change over the long term

• Develop an organisation culture which is performance oriented and customer-focused

Our PeopleOur Future

MLHD

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About UsMLHD provides a range of public health services to the Riverina and Murray regions of NSW, Australia.We provide services across a geographic area of approximately 125,561 square kilometres and to around 238,919 residents. People of Aboriginal and Torres Strait Islander heritage make up 4.1 per cent of the population.We employ over 3,500 staff and operate 31 hospitals. We are supported by a number of volunteers.

Our Chief Executive, Jill Ludford, and the Executive Leadership Team work closely with the Board to ensure our services meet the needs of the communities we serve. These services are provided through:

• 2 Base Hospitals

• 8 District Health Services

• 7 Community Hospitals

• 14 Multipurpose Services

• 2 Affiliated Health Organisations

• 13 Community Health Posts

• 1 Brain Injury Rehabilitation Service

Our Local Health Advisory Committees (LHACs) are located at 32 sites across the District. LHACs are a central connection between the local community and health services. LHACs work with facility managers to identify local service needs, ways to improve access to services and to assist in planning and development.

Year in Review

Betty CraggBased in Wagga Wagga, Betty is a Wiradjuri Elder and has extensive experience working with Aboriginal people including youth work. Betty is interested in improving the health of Aboriginal people across the region.

John HardingBased in Wagga Wagga, John has extensive experience in the financial and education industries as well as being a former Councillor and Mayor. John is interested in developing education in the community to help improve health outcomes.

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Our BoardThe MLHD Board consists of 10 members from a range of backgrounds and with local ties to the region. The primary purpose of Local Health Districts and Networks is to promote, protect and maintain the healthof the community and to provide relief to sick and injured people through care and treatmentHealth Services Act 1997 (s9).

The functions of the Board include ensuring (s28):

• Effective clinical and corporate governance

• Efficient, economic and equitable operations

• Strategic planning

• Performance management

• Community and clinician engagement

• Reporting to government and local community

The Board is chaired by Mrs Gayle Murphy.

Gayle MurphyBased in Narrandera, Gayle is a school teacher with more than 30 years’ experience in education, including 15 years as a Principal. Gayle is passionate about improving access to quality healthcare across the region.

Geoff TwomeyBased in Cootamundra, Geoff is an accountant with more than 50 years’ experience in the financial industry. Geoff is interested in the impact that the new Wagga Wagga Rural Referral Hospital will have in the region.

Year in Review

Dr Pankaj BangaBased in Wagga Wagga, Pankaj is an experienced General Practitioner, Anaesthetist and Hospital Administrator. Pankaj is interested in supporting the community in Wagga Wagga to access a range of quality treatment options close to home.

Andrea JordanBased in Griffith, Andrea is an experienced Registered Nurse with specialities in areas including general, psychiatry and aged care. Andrea is interested in bringing the “coalface” perspective to the Board.

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Carl CooperBased in Wagga Wagga, Carl is a local Pharmacist and lecturer in Pharmacy at Charles Sturt University. Carl is interested in the “big picture” and delivering the right services to the right people.

Dr Thomas DouchBased in Young, Tom is an experienced General Practitioner and Anaesthetist. Tom is interested in training and up-skilling of local health professionals to deliver quality health services in rural areas.

David EvansBased in Boorowa, David is an experienced IT project manager, management consultant and local Councillor. David is interested in contributing to the health outcomes of local people and communities.

Paul BraybrooksBased in Cootamundra, Paul is a local Pharmacist, Councillor and former Mayor. Paul is interested in local services for local people.

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Executive Leadership Team (Positions current as at 30 June 2015)

Jill LudfordChief ExecutiveJill was appointed Chief Executive in August 2014. Accountable to the MLHD Board, Jill is responsible for providing safe, equitable, quality healthcare to the people of Murrumbidgee through strategic leadership and sound governance. Under her management, MLHD is implementing enhanced operations, performance, innovation and skills to deliver the best health outcomes for people in our Rural Health District. Jill is an ex-officio member of the MLHD Board.

Brett ThompsonDirector OperationsBrett was appointed Director Operations in May 2015. Brett is accountable for leading, directing and managing the operations of MLHD, across a broad spectrum of health service delivery settings and corporate functions.

Ken Hampson Director Clinical GovernanceIn this role, Ken is responsible for managing the Clinical Governance Unit to lead, coordinate and support clinicians and managers in providing clinical excellence and best practice care within MLHD.

Maurice AhernDirector Finance and PerformanceMaurice is responsible for the leadership and management of financial services and performance reporting including clinical activity and trends. The Directorate also plays a key role in implementing improved procurement practices and revenue generation and collection.

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Dr Wendy Cox Executive Director Medical ServicesWendy is responsible for implementation of sustainable systems and processes for reviewing and improving the quality of medical services, for effective engagement of medical staff in LHD planning and service delivery and maintenance of a sustainable medical workforce within the LHD.

Karen Cairney Executive Director Nursing and Midwifery and HSFACKaren is accountable for the development, monitoring and reporting of all aspects of professional activities to optimise health outcomes provided by nurses and midwives in MLHD. Karen is the Health Services Functional Area Coordinator (HSFAC) responsible for emergency management for MLHD.

Sarah Tobias Director Future Sustainability TaskforceSarah‘s key responsibilities are to engage clinicians and the community in healthcare priorities through the implementation of the Murrumbidgee Future Sustainability Plan to achieve sustained improvements in clinical, service and operational areas.

Robyn Manzie Director Mental Health and Drug and AlcoholRobyn has responsibility for leading, directing and managing mental health and drug and alcohol services across MLHD.

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Catherine Maloney Director Allied HealthCathy is responsible for the professional leadership and strategic direction on the development, effectiveness, efficiency and continuous improvement of Allied Health services and Allied Health professions across MLHD. Cathy is also responsible for strategic and operational aspects of rehabilitation and aged care services.

Colin Cowell Director Workforce ServicesColin is responsible for providing high level advice, strategy and assistance in all areas of human resources, industrial relations, recruitment and selection, performance management, operational risk management (including management and liability), work health, safety and well-being, workers’ compensation and organisational development.

Fiona Renshaw Acting Director Integrated Care and PartnershipsFiona has responsibility for leading, directing and managing implementation of programs relating to key State and National programs and priority areas. These programs include Chronic Care, Child Youth and Family Health, Violence Prevention and Response, Aboriginal Health, BreastScreen, Population Health, Oral Health, Health promotion and the integrated care strategy.

Kevin Lawrence Manager Funding and AnalysisKevin has responsibility for budget development, clinical costing, activity and performance, clinical, performance analysis and systems development.

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Denis Thomas General Manager, Wagga Wagga Base HospitalDenis is accountable for leading service delivery, including a comprehensive range of acute, primary health and community based services, operational matters and performance against key indicators for Wagga Wagga Base Hospital.

Meredith Whittaker Acting General Manager, Griffith Base HospitalMeredith is accountable for leading service delivery, including a comprehensive range of acute, primary health and community based services, operational matters, and performance against key indicators for Griffith Base Hospital.

Rosemary Garthwaite Rural Group Manager, BorderRosemary is accountable for leading service delivery, including a comprehensive range of acute, primary health and community based services, operational matters, and performance against key indicators for the Border Group of Hospitals.

Maria RocheActing Rural Group Manager, RiverinaMaria is accountable for all service delivery, including a comprehensive range of acute, primary health and community based services, operational matters, and performance against key indicators for the Riverina Group of Hospitals.

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Key Achievements 2014 - 2015The MLHD Strategic Plan 2013-2018 outlines the vision for MLHD of providing equitable and quality rural health care for the Murrumbidgee population. In delivering these goals, the Strategic Plan outlines six strategic directions supported by a number of priority actions.The Murrumbidgee Action Plan (The MAP), developed in collaboration with Medicare Locals (now the Murrumbidgee Primary Health Network), provides an overarching framework to guide efforts to improve performance across the Murrumbidgee health system and is based on the vision, associated goals and strategic directions of the Strategic Plan. The MAP strengthens partnerships with other organisations that fund and deliver care for the Murrumbidgee population. This Year in Review summarises progress across MLHD in implementing the Strategic Plan and The MAP. Significant work has been completed across MLHD to achieve the strategic directions. The priority actions as outlined in the Strategic Plan and The MAP aim to position MLHD as a quality provider of rural health care; recognising the total health care needs of individuals, patients and communities.

Murray Thompson undertook a charity bike ride from Wagga Wagga to Nowra to raise awareness of depression.

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Strategic Direction 1:Providing healthcare in ways that meet the needs of rural communities.

Key Achievements 2014 - 2015Exciting work progressed in 2014 - 2015 to support our rural hospitals, including linking our small hospitals into specialist services at the Base Hospitals and developing new models of care.• Supported by the NSW Agency for Clinical Innovation, MLHD has implemented a system of care for

patients with a suspected Acute Coronary Syndrome, a group of conditions due to reduced blood flow to the heart. When a heart attack happens, the heart muscle does not receive enough blood and oxygen and some of the heart muscle begins to die. In many cases, a blood clot is completely blocking an artery in the heart. If the artery can be opened quickly there will be less damage to the heart, which is why it is important to confirm this type of heart attack, known as ST elevation myocardial infarction or STEMI, as soon as possible.

• MLHD clinicians are working collaboratively to deliver increased access to medical advice and cardiac therapy across our region. The District has developed a supportive framework to provide expert advice to staff working at small hospitals on patients who self-present. Staff transmit a 12 lead ECG to the MLHD ECG reading service, where Wagga Wagga Cardiologists provide instant expert interpretation. A doctor from the reading service provides rapid interpretation of the ECGs and clinical advice on ongoing management to local clinicians.

• The Enhanced Scope of Practice (ESOP) Nursing model of care provides additional education to nurses in rural Emergency Departments to enable treatment of triage category 4 and 5 patients in their local facilities using clinical pathways. There are now 28 accredited ESOP nurses across the District, with a further 26 currently undergoing training. The learning modules are available through HETI Online and the program was a finalist at the 2014 NSW Health Awards.

• Three Occupational Therapists have been sponsored by the NSW Health Education and Training Institute (HETI) to undertake accredited training in Lymphoedema Management. This is the first stage of a two-step project that will enhance the accessibility of Lymphoedema management services across the District.

• A project to centralise MLHD Elective Surgical Waiting List Management was accepted into the 2015 Clinical Healthcare Redesign Program. This will allow proactive management of the waitlists at all facilities across the district.

• MLHD also formed collaborative partnerships with the three Medicare Locals in our region to provide a mechanism for joint planning, community engagement and service integration. In diabetes, the NSW Agency for Clinical Innovation Diabetes model of care Self-Assessment Tool was trialled at Wagga Wagga and Griffith. The tool is designed to assess current services for diabetes management assessing the key elements of the model of care. Work on a collaborative early intervention model of care for patients with Diabetes is continuing with the Murrumbidgee Primary Health Network.

• A new model of care has been implemented at the Mental Health Sub-Acute / Recovery Unit. This provides short-term, intensive care and support to prevent the risk of further deterioration of mental wellbeing.

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The Mental Health Recovery Unit has developed a new model of care with consumers leading their own recovery journey.

The Enhanced Scope of Practice (ESOP) Nursing Model of Care was a finalist in the 2014 NSW Health Awards. Summa Stephens and Penelope Patterson attended the awards and presented the project.

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Strategic Direction 2:Building a skilled and sustainable workforce.

Key Achievements 2014 - 2015Health care in our region is delivered by our committed and motivated staff. The quality of care that patients receive depends on our staff. Staff who are committed to their hospital and feel valued in their roles are more likely to work collaboratively in a team and show empathy and compassion.

Employee Survey

• The NSW Public Sector Commission 2014 People Matter survey measured employees’ well being, engagement, adoption of organisational values and perception of workplace practices. MLHD performed well compared to other health sector employers and, while proud of the results, there remains room for improvement.

Organisational Development

• The MLHD District Leaders Forum is a multidisciplinary forum designed to provide leadership, direction and support as well as work as a collaborative resource for the development and effective management of senior leaders within the District. The forum is a meeting for all levels of management to engage in open discussion and provide a voice for ideas and innovation, often including experts, guest speakers and specialist staff.

• The 2014 Clinical Leadership Program participants graduated with certificates presented at the April Board Meeting. Participants worked on a variety of quality improvement projects such as reducing the wait for mental health consumers, creating pathways for forensic paediatric services, deteriorating patient management, improving uptake of the Out of Home Care Comprehensive Health Assessment and improving patient safety for outpatient procedures.

• MLHD is also participating in the Clinical Excellence Commission (CEC) Executive Clinical Leadership Program, with one staff member commencing in the 2015 intake.

• Allied Health Advisor roles have been established to provide leadership, professional advice and support for various disciplines in line with MLHD strategic directions. In addition, the Allied Health Future Leaders Forum has been established to develop early career leaders, providing opportunities for dynamic dialogue with senior managers and to harness new ideas for health service delivery. The Allied Health Governance Framework has been developed to assist Allied Health professional networks across MLHD, providing a mechanism for implementation of the HETI Clinical Supervision and Support Program.

Safety Health and Wellbeing

• The MLHD Safety Health and Wellbeing Strategic Plan recognises the safety, health and wellbeing of staff is integral to the achievement of our primary role in providing the best outcomes for our communities. The basis for enhancing safety, health and well-being performance involves a strong safety culture driven by an understanding and acceptance that the responsibility for safety health and well being rests with everyone within MLHD.

• The MLHD BeSafe safety culture program was launched and works to create positive attitudes and behaviours around workplace safety. BeSafe provides the opportunity to promote to staff that their safety is our highest priority in conjunction with instilling positive safety behavioural change at MLHD.

Recruitment and retention

• Recruitment marketing has been enhanced with the commencement of digital recruitment advertising campaigns for hard-to-fill positions. Channels such as social media (Facebook) and professional networking (LinkedIn) are now being utilised. The MLHD careers website has been refreshed, to better promote hard-to-fill positions, capture expressions of interest and provide more targeted and helpful web content.

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Murrumbidgee Local Health District has made an improvement to the Aboriginal workforce in the 2014 calendar year increasing the number of Aboriginal people employed from 1.45% to 1.62% against a target of 2.6%. An Aboriginal Employment Action Plan 2015-2016 has been developed in an effort to improve the number of Aboriginal employees within the workforce.

Specific recruitment initiatives achieved include:

• Fifty-one new graduate Registered Nurses (RNS) commenced in February with more than half being students from local Universities.

• Through the NSW Newly Graduated RN program, MLHD was able to offer 61 positions in 2014, 17 of which were at smaller rural sites. The number of graduates choosing MLHD as first preference has increased.

• The Rural Metropolitan Graduate RN Rotations Program enables graduates to rotate between a rural and metropolitan graduate placement. Rotations are underway at Wagga Wagga/Westmead, Leeton/Wollongong and Griffith/Blacktown.

• In 2014, 11 MLHD staff were offered Postgraduate Midwifery Scholarships at Wagga Wagga, Griffith, Leeton, Deniliquin and Tumut. Postgraduate education opportunities delivered by the Australian College of Nursing have been sponsored by the Ministry of Health and offered to Registered and Enrolled Nurses in MLHD areas of need.

• In partnership with the Nursing and Midwifery Office (NAMO), MLHD participates in the Rural Undergraduate GrowYourOwn (RUGs) initiative. RUGs promotes sustainability of the Nursing and Midwifery workforce by supporting students enrolled in courses that lead to registration as a nurse or a midwife coupled with the pairing of the students with rural facilities. Urana Multipurpose Service has been the first site to participate in this initiative.

• In partnership with TAFE NSW Riverina Institute, five scholarships were provided in 2014-2015 to MLHD residents to complete the Enrolled Nursing qualification.

• Wagga Wagga had 90 Junior Medical Officers on Post graduate placement and had over 50 medical student placements from the University of NSW and Notre Dame University.

• MLHD has approved a remote supervision model for Visiting Medical Officers (VMOs). This enables MLHD to recruit less experienced VMOs and provide them with the support of experienced clinicians. This provides the District with additional avenues to recruit to more remote facilities.

• The Allied Health Assistant (AHA) Program continues to be implemented to meet service needs and assist Allied Health Professionals with therapeutic and program-related activities. AHA training is delivered in partnership with Riverina Institute of TAFE.

• MLHD and Charles Sturt University established a Nutrition and Dietetics Clinical Placement Unit at Wagga Wagga Base Hospital.

• MLHD has partnerships with several medical training institutions to provide high quality training to Medical Officers. This includes the University of NSW Rural Clinical School, located on the Wagga Wagga Base Hospital campus, which provides 4-6 year medical students with simulated learning opportunities and access to the hospital environment. MLHD also partners with GP practices in Wagga Wagga, Gundagai and Cootamundra as part of the Post graduate GP training program to provide interns with exposure to the GP practice setting. Through the Rural Vocational Training Scheme, MLHD also provides advanced training for GPs in obstetrics and anaesthetics in order to increase the GP Proceduralist workforce.

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Tumut Hospital’s Graduate Nurses enjoyed their placements, Lorraine O’Sullivan, Acting Facility Manager (left) and Narelle McKenzie, Nurse Manager (right) worked with Amanda McLennan and Kellie O’Connell during their placements.

The YourSay Employee Survey was held in early 2015 and YourSay champions, such as Batlow ladies Melissa Cooper and Kathie McKenzie, encouraged staff to participate.

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Strategic Direction 3:Improving clincian and community engagement.

Key Achievements 2014 - 2015Murrumbidgee Local Health District recognises organisations with more engaged clinicians and staff achieve better outcomes and experiences for patients. New frameworks to involve our clinicians in strategic planning and decision-making are supporting change, organisational performance and innovation.

Clinician engagement

Activities to enhance engagement with clinicians included:

• The Wagga Wagga Base Hospital Clinical Council was re-established with excellent representation from senior Medical Officers. The establishment of Clinical Leads to support the medical clinical governance structure commenced, with the appointment of the Clinical Lead Obstetrics and Gynaecology.

• Delivery of Cultural Considerations Cultural Awareness Training, to further motivate Health staff to build positive and meaningful relationships with Aboriginal and Torres Strait Islander people who may be clients, visitors or Aboriginal staff, and to improve their confidence in establishing appropriate and sustainable connections.

• The 2014 Annual Patient Safety Forum for Clinicians was convened to promote patient safety and medico-legal matters. The forum provided an opportunity to consider patient safety issues arising throughout the year, in line with the National Standards Accreditation Program.

• The Community Health Leaders Forum focused on the growing need to integrate services. With an ageing population and a growing number of people living with a chronic and complex health condition, needs have changed and the demands on the health system increasing. The motivation for focusing attention on the need to integrate services has been to ensure MLHD is progressing towards a position to respond to the challenges the health system is facing.

Community engagement

In addition to the work undertaken by Local Councils, Hospital Auxiliaries, Volunteers and Local Health Advisory Committees, activities to consult and engage with communities and stakeholders included:

• The Community Engagement Communication Strategy has been developed to provide a guide to improving the level of communication with consumers to drive the implementation of safety and quality systems and improve the quality of health care in MLHD. The Strategy aligns with National Safety and Quality Health Service Standard 2 – Partnering with Consumers, to create a health service responsive to patient, carer and consumer input and needs.

• The “Stand Up! Stand Out” Mental Health Consumer Forum was held in Cootamundra in May with over 80 people attending. The Forum was intended for people of all ages who have, or feel they might have, a mental health condition to learn how they might better support themselves and take ownership of their recovery. Family, carers, friends or people who have an interest in mental health were also invited. The day included a presentations from the NSW Deputy Mental Health Commissioner, consumers and an expert panel that responded to questions raised by consumers.

• The MLHD Facebook page has enabled MLHD to build brand awareness, share information in a timely and customised manner and become more connected with local communities. As at June 2015, the page has been “liked” by over 800 people.

• National Volunteer Week was celebrated in May by congratulating 90 Tai Chi, Community Exercise and Aqua Fitness leaders for their hard work and commitment to preventing falls. Almost 800 people now take part in 118 Tai Chi and community exercise classes weekly across the District, nearly two per cent of the target population.

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Volunteers at Young Health Service were presented with certificates of appreciation in recognition of the tireless work of volunteers in local facilities.

Hillston staff members Teagan Manners and Payal Chaudhair learn the new electronic medical records system.

Lockhart staff member Emily Turner works with local GP and Visiting Medical Officer, Dr Ken Mackey, to learn more about the recently installed electronic medical records system.

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Strategic Direction 4:Expanding innovative use of information technology.

Key Achievements 2014 - 2015

The use of new and up-to-date technology in improving patient care is always evolving.

• Information and Communication Technology (ICT) Infrastructure to support MLHD for the future continues. The rollout of site infrastructure for wireless / WiFi connectivity has also progressed and all sites live on eMR are fully wireless as well. This has allowed for mobility of devices, such as computer-on-wheels and tablets/laptops, within these sites.

• Telehealth capacity within MLHD is being enhanced with strong management and clinician engagement. This will enable telehealth consultations and enhanced communications to occur more widely across MLHD. The introduction of the new Pexip IT tool and further use of cameras will enable communication, consultation and referral for patients to be enhanced. Pexip allows for seamless integration of Telehealth support between the patient and clinician. This means any previous barriers of hardware and software integration has been reduced. Installation has commenced at key sites.

• Funding has been received to enhance the Hospital in the Home Program for provision of in-home devices to enable monitoring of blood pressure, weight, lung capacity and other measures. Funding has also been received to enhance Community Health, providing tablets or laptops for clinicians to use in the home and on the road, providing full mobility and ease of access to up-to-date clinical information.

• Utilisation of video conferencing for provision of psychiatry clinics in community settings has increased, enabling greater access to services in these settings.

• Nursing and Midwifery Rural and Remote Grand Rounds are conducted monthly using video conferencing. Eight to ten sites participate in each session.

• The ‘Business Intelligence’ Clinical and Business Analytics reporting tool has been developed to provide suitable data to support decision-making. Presentations and workshops have been held with Wagga Wagga and Griffith Base Hospital’s management and clinicians. Organisation-wide rollout continues.

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Strategic Direction 5:Fostering effective partnerships.

Key Achievements 2014 - 2015Murrumbidgee Local Health District recognises the opportunities for collaboration and partnership with the three Medicare Locals within the geographical footprint:

• Hume Medicare Local (HML)

• Loddon Mallee Murray Medicare Local (LMMML)

• Murrumbidgee Medicare Local (MML)

Some partnership highlights included:

• MLHD and MML have signed a Murrumbidgee Health Partnership Agreement. The Partnership Agreement is designed to improve the health of our communities and ensure patients can access primary health care services that are effectively coordinated and integrated with hospital services. The partnership is dedicated to joint planning, defining common goals and focus areas and empowering clinicians, staff and consumers. The partnership will be driven by a shared values statement and defined by joint working practices. Some joint projects include:

• Implementation of the ACI “Building Partnerships” initiative to improve the care of residents/recipients of aged care services in the early detection and subsequent management of acute decline.

• Implementation of the ACI Musculoskeletal Primary Health Care Initiative, to provide a ‘one-stop’ program of care within primary care settings, for people with musculoskeletal needs such as knee and hip issues.

MLHD has other partnership arrangements including:

• The Physiotherapy Service Collaboration with HML and Back on Track Physiotherapy is under implementation at Finley, Urana Jerilderie and Berrigan.

• The Integrated Women’s Health Strategic Plan for Wagga Wagga and Surrounding Districts 2014 - 2017 was launched by the Wagga Wagga Women’s Health Centre. The plan was developed through a consultative process with key stakeholders, including MLHD, MML, Wagga Wagga City Council and the Department of Family and Community Services.

• Under the auspice of LMMML, the Barham, Cohuna and Kerang Health Services continued implementation of an Integrated After Hours GP Model across their communities. The model has been both accessible and effective in alleviating workload pressure on local GPs through collaborative models and telephone triage services.

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From 1 July 2015, the three MLs were transformed into Primary Health Networks (PHNs) as per Commonwealth policy, with the Murrumbidgee PHN a key partner for MLHD.

Cancer Institute NSW

• A new mobile breast screening unit was delivered to the region as part of a NSW Government investment to upgrade the existing BreastScreen NSW fleet with state-of-the-art vehicles and screening technology. The new van supports early detection by bringing potentially lifesaving cancer screening to women without the need to travel long distances to larger towns and cities.

NSW Agency for Clinical Innovation (ACI)

• The Fractured Neck of Femur Model of Care is in place at Wagga Wagga Base Hospital.

Mental Health and Drug and Alcohol Alliance

• A Collaborative Partnership Forum, with a broad range of service providers, was held to develop a Murrumbidgee Mental Health and Drug and Alcohol (MHDA) Alliance/Memorandum of Understanding (MOU). The agreement will facilitate progression of agreed strategies under the NSW Mental Health Commission’s Living Well Strategic Plan and the MLHD MHDA Clinical Services Plan. There is a high level of commitment from agencies, and broad agreement reached on principles for working together, with the patient at the centre of care. The Alliance MOU has been signed by all partners, with representation across government, community managed organisations and the Murrumbidgee Medicare Local (now Primary Health Network).

A new mobile breast screening unit was delivered to the area during the year.

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Strategic Direction 6:Providing infrastructure and systems to support clinical services.

Key Achievements 2014 - 2015Murrumbidgee Local Health District has planned for appropriate infrastructure for its facilities and developed meaningful and usable systems and processes that support service delivery.

Infrastructure planning

• Multipurpose Service Statements were completed for Adelong-Batlow, Berrigan, Boorowa, Coolamon, Gundagai, Jerilderie, Junee and Urana. Service Statements provide an opportunity to review service needs and highlight issues.

• The MLHD Asset Strategic Plan 2015 - 2016 – 2025 - 2026 has been reviewed and endorsed by the MLHD Board. The plan provides the long-term approach for managing the District’s land, buildings, infrastructure, plant and equipment to support implementation of health care priorities and initiatives within the Strategic Plan. The plan includes planning, acquisition, maintenance and asset disposal.

• NSW Health has provided over $400 Million in capital funding for the redevelopment of 64 facilities across the State to increase service quality and efficiency, with the flexibility to expand into the future. The program has great diversity and includes small primary care and outpatient health services to larger acute and aged care services. The MPS Stage 5 program involves assessment for recurrent Commonwealth MPS funding, and NSW Government capital funding. Barham, Tocumwal, Murrumburrah-Harden and Holbrook will be converted to the MPS model and two existing MPSs have been identified as requiring capital upgrades, at Culcairn and Tumbarumba.

Systems Improvements

• A number of sites have implemented the Improving Access to Primary Care in Rural and Remote Areas Initiative. This initiative recognises many patients in small rural and remote towns have limited access to primary health care services that in response to a lack of private practices, many rural and remote public hospitals have employed medical officers to make traditional GP services available. The initiative provides for exemptions under s19(2) of the Health Insurance Act 1973 to allow exempted eligible sites to claim against the Medicare Benefits Schedule (MBS) for non-admitted, non-referred professional services (including nursing, midwifery, allied and dental services) provided in emergency departments and outpatient clinics.

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The Hillston Multipurpose Service was opened in May 2015 by The Hon Sarah Mitchell, MLC and The Hon Adrian Piccoli, Member for Murray.

Representatives at Tocumwal discuss the planned Tocumwal Multipurpose Service.

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Thank you Murrumbidgee Local Health District is grateful for the generosity of volunteers across the district who give their time to support patients, their families and staff. In particular there are United Hospital Auxiliaries across most of the facilities. The Hospital Auxiliaries work quietly behind the scenes to improve the experience for patients while they are in hospital by fundraising to provide additional equipment and services that make patients more comfortable.The Hospital Auxiliaries go above and beyond, selflessly devoting themselves to those who need it most, the sick and vulnerable.The Local Health Advisory Committees (LHACs) also volunteer their time to work as advocates and be the voice within their local community. By meeting regularly, the LHACs work as the link between the local health service and their local community raising issues and providing localised feedback.Across all MLHD facilities there are a number of other volunteers who donate their time to visit patients and assist in tasks in the local hospital.Thank you to all volunteers who provide services across all MLHD facilities.

Donations

Through the generosity of the community, MLHD has been able to enhance patient care through numerous donations to the health service.These donations come from individuals, businesses and organisations throughout our community. Some have been supporters for many years.

Barham Health Service is supported by Local Health Advisory Committee members and United Hospital Auxiliary members.

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Local Health Advisory Committee Members at Young meet with a local patient.

Volunteers at Wagga Wagga Base Hospital prepare the trolley service.

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Our Quality and SafetyMurrumbidgee Local Health District’s commitment to safe, high quality care continued throughout 2014-2015. This is achieved by working together with clinicians and other agencies to provide the best possible care. These achievements reflect the way all staff and volunteers work together to improve the care of patients across every facility within the District.

Achievements during 2014-2015 include:

Accreditation of Health Services

All MLHD facilities achieved Accreditation by the The National Safety and Quality Health Service Standards (National Standards) were developed by the Australian Commission on Safety and Quality in Health Care to drive the implementation of safe and quality systems, as well as improve the quality of health care in Australia in 2014-2015. The 10 National Standards provide a nationally consistent benchmark for the level of care consumers can expect from health service organisations. The Standards protect the public from harm and improve the quality of health care provided.During 2014 all MLHD hospitals, mental health and dental units prepared for the first accreditation process. Three separate teams of surveyors each spent a week in the District examining facilities against the Standards. Positive comments were made by the surveying teams for areas that achieved the Standards.The survey team observed areas including governance; partnering with consumers; infection control; medication management; correct identification; handover of care to the next shift, and referral to other specialists and back to a patient’s GP giving blood transfusion products safely; reducing pressure injuries; being able to respond to medical emergencies quickly and appropriately; and making sure our patients don’t fall and injure themselves. The surveyors examined all MLHD systems and processes, making sure there is a consumer focus on patient safety, good quality care; and that the medical care practised is the best practice available. In the summations, the Survey Coordinator indicated that the survey teams believed MLHD had a safe health service.Preventing Patient Deterioration

During 2014-2015, a particular focus has been placed on recognising and responding to a patient whose condition clinically deteriorates. MLHD has worked with staff and the Clinical Excellence Commission (CEC) to continue to implement the Between the Flags program. This program is based on the premise of the Surf Life Saving principle that if people swim between the flags, there is a greater chance of being helped if needed. The life guards are on duty, the same as hospital staff are on duty to care for patients and their loved ones.Murrumbidgee Local Health District has implemented charts that record all patient vital signs. Should these vital signs begin to fall, a notification is triggered for staff to act by either seeking further help, notifying a doctor or monitoring a patient more closely.The program provides concise information to ensure our staff can identify early warning signs of deterioration, use simple assessment tools and implement simple treatments.

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Wagga Wagga Base Hospital staff participated in Sepsis Awareness Week.

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Preventing and Controlling Healthcare Associated Infections

Our Duty – Your Entitlement

Healthcare Associated Infections (HAIs) may occur following treatment in a health facility. Fortunately many of these infections are preventable. Murrumbidgee Local Health District’s duty of care is to keep infection rates low and maintain excellent hygiene practices for the safety of patients and staff.

Murrumbidgee Local Health District does this by having in place an Infection Prevention Program to protect patients from contracting a HAI by:

• Making sure that staff hands are cleaned before and after touching a patient

• Monitoring infections and using antibiotics wisely

• Ensuring the environment is clean

• Cleaning and sterilising all medical devices and instruments

• Delivering safe practices for all invasive treatments and procedures

• Providing staff, patients and visitors with infection prevention education

MLHD provides all patients, visitors, carers and families with information on how to reduce the chance of infection when visiting a facility.

Complaints, Compliments and Patient Stories

Murrumbidgee Local Health District takes all complaints seriously and learns from complaints where customer expectations are not met. With permission from complainants, MLHD uses the experience to provide valuable feedback to staff from the patient’s perspective. Posters are located at every service advising how to lodge feedback.

When I encountered the

quality of the theatre personnel, I knew I was in the

best of hands.

No-one likes to have to spend the night in hospital

but you guys made it all the more better.

Their manner and professionalism was outstanding.

Without this help he would not be able to remain at home in my care.

We are so lucky to have such great staff in the hospital system and I am grateful for all their work - it wouldn't

be easy sometimes.

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The ED was extremely busy,

but the staff were terrific.

Would you really do that for me?

I am so impressed with the care that

he (and me the mummy) received during our stay.

I visited Wagga Wagga Base Hospital emergency department today and just wanted to commend the staff on their

fabulous work.

Staff and Board meetings begin with a patient story or a patient journey to remind everyone of MLHD’s vision and purpose.

Partnering with consumers in their own care

National Standard Two is Partnering with Consumers and this has been a key focus area that all staff have embraced enthusiastically. Health care is a changing environment and MLHD delivers services to various communities, therefore it is vital that MLHD makes decisions with the patient as the focus. This involves MLHD communicating and understanding patient and consumer needs better by listening and providing advice in a manner that is easy to understand to help make informed choices. Murrumbidgee Local Health District is working to improve consumer engagement across the district by implementing projects, such as assisting in end of life matters, by working with consumers and their families to make decisions, document goals and preferences and help be part of the care in accordance with the patient’s wishes.Murrumbidgee Local Health District has implemented the state-wide sepsis program that provides clinicians guidance on appropriate use of antibiotics and fluid therapy within strict time frames. MLHD has had excellent results in managing these patients. The below graph indicates results for the medium time for administration of first dose antibiotics for the MLHD facilities.

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Griffith LHAC members Margaret King and Yvonne Turnell review the oncology ward refurbishment at Griffith Base Hospital with staff members Margaret Gandy and Jenny Bell

The Sister Alison Bush Mobile Simulation Centre (HETI) visited the region throughout the year providing training and education to staff across the district.

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Year in Review

The Holbrook Local Health Advisory Committee meet regularly to advocate for their community.

Young Health Service staff Catrina Richens (Social Worker) and Wendy Fisher (Child and Family Health Nurse) prepare for a Grandparents Workshop to help grandparents update their knowledge on family health.

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Year in Review

The redevelopment of the new hospital at Wagga Wagga continued throughout the year with the Acute Services Building due to open in 2016.

The MLHD Board met at the new Hillston Multipurpose Service for the June 2015 meeting

The Emerikus Land Foundation generously donated a “cuddle cot” to the maternity ward at Wagga Wagga Base Hospital.

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Abbreviations and GlossaryAHA - Allied Health AssistantCNA – Comprehensive Needs AssessmentCHESS - Chronic/Complex Healthcare: Engaged with all Stakeholders and ServicesCOAG - Council of Australian GovernmentsCHSP - Commonwealth Home Support ProgramCORE Values - Collaboration – Openness – Respect – Empowerment District – Murrumbidgee Local Health DistrictECG – electrocardiogram (a test that checks for problems with the electrical activity of the heart)EEO – Equal Employment OpportunityeMR – electronic Medical RecordsEN – Enrolled NurseGIPA – Government Information Public Access Act authorises and encourages the proactive release of information by NSW public sector agenciesGP – General Practitioner (doctor)Healthenet – The eHealth NSW program that connects health information spread across a vast number of different locations systemsHETI - Health Education Training InstituteHSFAC - Health Services Functional Area Coordinator ICT – Information Communications TechnologyLHAC – Local Health Advisory CommitteeLMMML – Loddon Mallee Murray Medical LocalThe MAP – The Murrumbidgee Action PlanMFaCS - Murrumbidgee District Family and Community ServicesMHDA – Mental Health Drug & AlcoholMIA – Murrumbidgee Irrigation AreaMLHD – Murrumbidgee Local Health DistrictMPHN – Murrumbidgee Primary Health NetworkMPS – Multipurpose ServiceRAS - My Aged Care Regional Assessment ServiceNAMO - Nursing and Midwifery OfficeNGO – Non Government OrganisationOur People our Future – cultural change program promoting accountability for all staffPEXip – software associated with telehealth allows for seamless integration of Telehealth support between the patient and clinicianPHN – Primary Health NetworkQSA - Quality Systems AssessmentRN – Registered NurseRUGs - Rural Undergraduate GrowYourOwn program, targets undergraduate nursing or midwifery students and links these students to a rural health facility in close proximity to the their local preferenceTelehealth - the delivery of health-related services and information via telecommunications technologies such as phone or secure video conferenceUNSW – University of New South Wales

Year in Review