annual reportTHE HOBART CLINIC

Looking after the mental health

of Tasmanians for over 30 years

2012

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OR H E A L I N G

The Hobart Clinic

Board Directors

Harry Wilsdon Chairman

Keith Bailey Vice Chairman

Dean Johnson Treasurer

Debra Rigby

Anna Housego

Patrick Carlisle

Dr Michael Davie

Leonie Young

Management

Amanda Quealy Chief Executive Officer

Dr Julian Davis Clinical Director

Alison Garrett Corporate Services Manager

Ellen Waugh Nursing Services Co-ordinator

Kate Savage Therapy Program Co-ordinator

Karen Wheeler Quality & Safety Co-ordinator

Jane Wood Strategic Projects Officer

The Hobart Clinic

31 Chipmans Road Rokeby Tasmania 7019

Phone: (03) 6247 9960 Fax: (03) 6247 6439

Email: info@thehobartclinic.com.au

Website: www.thehobartclinic.com.au

The Hobart Clinic AssociationLooking after the mental health of Tasmanians for over 30 years.

Dr Yvonne Turnier-Shea Clinic Consultant Psychiatrist

Dr David JacksonClinic Medical Officer

Dr Michael Evenhuis Clinic ECT Psychiatrist

Aitken, KarenAmbler, SusanAmicosante, RosemaryAnderson, PaulArmstrong, TracyAston, MatthewBatt, GayeBell, DebraBertoz, CherylBurton, TimothyCannell, GlennCannell, IreneCassidy, MoyaClifford, GeoffCollins, HelenCoutts, JoyDaley, RachelDavey, Merryl

Davies, CeridwenDavies, KarenDecambra, BarbaraDillon, TaeDobson, JenniferFreeman, CherylGoodman, AnnGorrie, RoslynGoss, RoslynGriffiths, MarilynGunn, CarolineHaas, MichaelHall, LindaHalley, JanHarriss, DelinaHillier, JennyHoward, NicoleKilleen, Cathy

Kingston, LesaKirrane, CarlyKnight, JamesLeed, KarenLittle, RussellMagoci, MarilynMason, EmmaMarkham, RabiaMarley, PamelaMollineaux, CarolynMollross, DelusMoore, SharonMurphy, TheresaNaismith, BenNorton, GaillePetrusma, TimPoorter, AneliesePrice, Annette

Pyett, ElizabethRees, CeliaRhodes, LeslieRusson, ChartlotteSauvage, DanielShilo, shiraShott, NormaStewart, NicoleStrudwick, CathyTapp, SelinaTurnbull, KirstieVargas, EmmaWilliams, CheryleWright, SuzanneYong, Sau Chan

The Hobart Clinic Staff

The Hobart Clinic Annual Report 2012 1

contents

A Year in Review 2012 – The Hobart Clinic Association 2

The Hobart Clinic Association Treasurer’s Report 4

Clinical Director’s Report 5

Strategic Projects 8

Therapy Programs 9

2 The Hobart Clinic Annual Report 2012

It gives us great pleasure to present a report on the activities of the Association over the past year.

2012 saw the implementation of the first year of our new strategic plan with a focus on developing a contemporary governance model, building our medical workforce capacity and developing specialist mental health services.

A Year in Review 2012 The Hobart Clinic Association

In December 2011 we launched Tasmania’s first eating disorders program for people over the aged of 18 years. This disease is a hidden epidemic in our community and it is often difficult to recognise and diagnose. Our specialist services have been able to provide a response to the community and support General Practitioners in managing patients with complex needs.

We have always provided specialist treatment and recovery services for people with alcohol and drug addictions and the recruitment of Dr David Jackson (Addiction Medicine Specialist) has enabled us to expand our reach in this area with individually tailored treatment, detox and recovery programs.

Our Clinical Director has continued his commitment to the education of GP’s on mental health issues. The Roadshow earlier this year around the State was well received and concluded with our attendance at AGFEST.

Quality improvement and the safety of patients is always at the forefront of our minds. In June 2012, we underwent a Periodic Review with the Australian Council on Healthcare Standards (ACHS), which is the halfway point of the four year accreditation cycle.

The Periodic Review assessed how The Hobart Clinic complied with the 15 mandatory criteria of EQuIP 5, as well as reviewing the progress and actions from the recommendations that had been made during the Organisation Wide Survey in 2012. In addition to this, we voluntarily opted to have an assessment of compliance with the new National Safety & Quality Health Service Standards (NSQHSS) which come into effect on January 1, 2013.

Assessment against the NSQHSS prior to them becoming a mandatory requirement of accreditation was seen as an opportunity to perform a gap analysis, and also to further our knowledge and understanding of the new requirements. Of the ten NSQHSS only eight are applicable

Amanda Quealy Harry Wilsdon

The Hobart Clinic Annual Report 2012 3

to The Hobart Clinic. Each standard is made up of a series of actions, all of which must be assessed as being ‘satisfactorily met’ before compliance with the standard can be awarded.

At the completion of the survey, The Hobart Clinic was awarded a Marked Achievement for 13 mandatory EQuIP5 criteria and an Excellent Achievement for the two remaining mandatory criteria; Risk Management and Continuous Quality Improvement. All recommendations were signed-off as complete and on-going accreditation for the next two years was awarded.

Continuing our commitment to the development of a contemporary corporate governance model, we engaged an experienced consultant, Mr John Mero, Principal of Vision, Method, Outcome. Following an extensive consultation process and work with the Board a new model of organisational membership was developed.

The new Constitution was endorsed by a members special general meeting in June 2012 and to date; three organisations have joined as founding members of the new model – Colony 47, Rural Alive and Well and Flourish. The new arrangements underpin the Clinic’s strategic direction and provide us with an improved opportunity to connect with the community and other organisations in the mental health sector.

We have seen some changes in our nursing team and were delighted to welcome Ellen Waugh as our new Nursing Services Co-ordinator. Ellen has brought a new level of energy to the nursing team and already made a big impact in developing improved processes for patient care and nursing practice. Thanks goes to our nursing team in continuing their commitment to high quality patient care.

Administration and Services staff have again been the quiet achievers, often behind the scenes delivering support services to patients and staff. Paul Anderson, Maintenance Officer was awarded Employee of the Year 2012 for his work in maintaining our beautiful gardens and keeping the building up to scratch.

Late in 2011 Leonie Young, former CEO of the national depression initiative, Beyond Blue, joined our Board bringing a wealth of knowledge and experience in mental health. A number of directors are retiring this year, Dr Michael Davie, Dr Keith Bailey and Anna Housego. We thank them for their contribution and commitment to delivering the mission of the organisation.

We look forward to another year of working to deliver the highest quality of best mental health services in the State.

Harry Wilsdon Chairman

Amanda Quealy Chief Executive Officer

Back row L-R: Dean Johnson, Patrick Carlisle, Keith Bailey.Front row L-R: Leonie Young, Michael Davie, Harry Wilsdon, Anna Housego (Debra Rigby absent)

4 The Hobart Clinic Annual Report 2012

I present to the members of The Hobart Clinic Association the Treasurer’s Report for the twelve month period ending on the 30th June 2012.

I have examined the audited financial statements as presented by Deloitte Touche Tohmatsu and agree that they represent the financial performance for the period, and financial position of the Association at the end of that period.

Like many organisations over the past financial year we have had a difficult year and The Hobart

The Hobart Clinic Association Treasurer’s Report

Clinic has been challenged to navigate through the highs and lows of business, made worse by the current economic climate. The Financial Report reveals that as a result of operations for the period there was a deficit for the year, resulting in a decrease in retained members’ equity.

It’s fair to say that in first half of the year we had a significant reduction in income as a result of lack of medical capacity and our ability to meet community demand. The Board made a number of bold decisions one of which was to employ some of its own medical personnel to supplement existing private practitioners. As a result, the second half of the year has seen an upward trend in income to pre 2011 levels and in some months exceeded our expectations.

Management also progessed a strong marketing campaign and education of General Practitioners to demonstrate our capabilities and re-establish vital relationships.

As a not-for-profit organisation we are eligible to apply for and receive government funding. Our contract with the Commonwealth Respite Centre has enabled the delivery of family support services, providing an alternative source of income to our core funding base of private health insurance. We have also been successful in obtaining funding for a registrar position effective from January 2013 which will assist in increasing medical

capacity. We will continue to pursue diversifying our funding base as a progressive risk management strategy and to enable service diversification

Apart from occupancy as one of our main drivers in income, we measure our effectiveness on the average length of stay and rates of new referrals. I am pleased to advise that average length of stay has decreased and our new referral rate has increased. Both these indicators show healthy trends within the business.

Expenses were well managed throughout the year and were in line with or below budget. Expenses were consistent with the previous year, with the exception of an increase in marketing as referred to above.

I would like to thank the Board for their ongoing support and dedication in reviewing the monthly financials, budgets and capital expenditure. The Board are committed to the strategic plan that will ensure a surplus is consistently returned in the coming financial years to facilitate new service developments and ensure the continued delivery of quality mental health care to the Tasmanian Community.

Dean Johnson Treasurer

Dean Johnson

The Hobart Clinic Annual Report 2012 5

Clinical Director’s Report

Since last year when several new initiatives were detailed in the Annual report, a process of consolidation and evaluation of Clinic activities has occurred. The Clinic also has undergone a periodic review for Accreditation by the Australian Council on Healthcare Standards and this review, although very time consuming in terms of preparation, has proved most beneficial with an excellent report received.

As expected the appointment of Dr Turnier-Shea as the Clinic Consultant Psychiatrist has enhanced our ability to respond to requests for admission and our Addiction Program with Drs David Jackson and Nicolle Ait Khelifa continues to expand and provide a valuable service to patients Statewide.

The work of our Consultant Psychiatrists in the management of anxiety, depressive and psychotic disorders continues but we are able to offer an enhanced capacity to respond to depressive disorders with the successful establishment of the Electro-Convulsive Therapy Program in conjunction with Hobart Day Surgery. We are most grateful to Hobart Day Surgery for acting in partnership with us and especially to Fiona Svamvur, Director of Nursing of Hobart Day Surgery who has greatly assisted in establishing a service. Dr Michael Evenhuis has been appointed to staff and he has been responsible for administration of Electro-Convulsive Therapy to our patients.

Inpatient Unit

The Clinic’s 27 bed inpatient unit continues to provide a valuable service to the Tasmanian community Statewide. Our cohort of Consultant Psychiatrists provide specialised and evidence based therapy to both high and low prevalence psychiatric disorders. The Consultant team has been

joined by Dr Laurence Herst, a very experienced Tasmanian Senior Psychiatrist who assists Dr Turnier-Shea in the inpatient unit and will be reviewing patients in the Day Program.

We were sorry to see Clinical Nurse Manager Kathryn Gregory resign for personal reasons and we wish her every success in her future career. The Clinic restructured the Clinical Nurse Manager position and the new Nursing Services Coordinator is Ellen Waugh who with her husband and family moved to Tasmania during the year. Ellen has proved to be most enthusiastic and through her experience and hard work helped the Clinic in the accreditation process and is involved in improving and developing the services we offer.

During the year we put out to tender our pharmacy services and the successful tender was awarded to South Arm Pharmacy. As a result we have developed a Pharmacy and Drug Subcommittee, which is a subcommittee of the existing Clinical Executive Committee. The pharmacy not only provides medications to our patients but is assisting in education of patients, staff and assisting the psychiatrist in the prescribing of medication. We will soon change our drug charts and the method of prescribing for our Consultant Psychiatrists to reduce the possibility of medication errors and reduce the paperwork that is imposed upon inpatient staff.

Dr Julian Davis Clinical Director

6 The Hobart Clinic Annual Report 2012

Day Patient Program

Kate Savage continues to lead a successful Day Program for the Clinic. She has been joined by a cohort of psychologists and trainee psychologists from the University of Tasmania in delivering Eating Disorders Programs, Anxiety and Depressive Programs and Addictive Programs. In addition, Ms Savage has developed a Dialectical Behaviour Therapy Program for persons with Borderline Personality Disorder.

The Day Program will expand further in the coming year and significant new ventures are being planned at this point in time.

The content of the therapy program is constantly under revision and further changes are expected to more adequately meet the needs of inpatient. The Day Program groups help provide a seamless transition from inpatient stay to meeting the needs of those who have been discharged.

Education Initiatives

Members of the Clinic including the Chief Executive have engaged in teaching sessions for GP’s around the State particularly in the areas of Eating Disorders and Drug Addiction. Seminars have been conducted in Hobart, Launceston, Ulverstone for GP’s and Mental Health Professionals in these areas and the Clinical Director has also been involved in teaching at the Royal College of General

Practitioners. Dr Davie from the Clinic continues to teach medical students and we also continue to teach registrars for the Royal Australian and New Zealand College of Psychiatry.

The Hobart Clinic Case Conference has proved to be most successful and we’ve had a variety of speakers this year including Professor Fiona Judd and Dr Louise Newman.

The Hobart Clinic Annual Report 2012 7

Ellen Waugh Nursing Services Co-ordinator

Kate Savage Therapy Program Co-ordinator

The Clinic wishes to thank the Mental Health Professionals Network for their assistance in setting up these education sessions.

Further Developments

The Clinic is most pleased to report that the Commonwealth Government has awarded initial funding to the Clinic for a period of three years for the establishment of a registrar position. This position will be run in conjunction with the Royal Australian and New Zealand College of Psychiatrists and also with the Royal Hobart Hospital. Registrars will work during the year both at the Royal Hobart Hospital and at The Hobart Clinic and this experience will provide great experience for psychiatrists in seeing the spectrum of psychiatric disorders and the differing presentations and management in both public and

private settings. The Clinic wishes to thank the Specialist Outreach Program of the Commonwealth for awarding funding to us and we look forward to providing an excellent training experience for psychiatric registrars in their quest to become Consultant Psychiatrists.

In conclusion, it is most pleasing to be part of a Clinic that is dynamic and innovative. Our Patient Satisfaction Survey shows that the vast majority of our patients are pleased with their inpatient stay and we will continue to respond as quickly and effectively as possible to general practitioners to assist them in the management of their patients. It is heartening that our dedicated staff have responded well to changes made during the year. We hope that all those who utilise the Clinic will continue to benefit from our improvements and strategies.

8 The Hobart Clinic Annual Report 2012

Strategic Projects

In 2011 the clinic set down its strategic direction for the next three years including specific objectives to be a well managed organization and to ensure good governance and a high functioning Board.

The past twelve months have seen those objectives come to fruition with significant changes to the Clinic’s governance arrangements.

Under the guidance of the Governance Advisory Committee, two specific projects were led by Jane Wood, Strategic Projects Officer to adopt best practice governance and to ensure stable and effective leadership that will underpin the achievement of Clinic objectives and sustain the organisation through shifting economic challenges.

The first of these projects examined the composition of the Board and particularly the balance of skills, experience and independence of the Board appropriate to the business and direction of the Clinic. An important part of this process was to look at how similar organisations had structured their Boards, the ASX principle of governance and ACHS standards. It soon became clear that, in order to meet best practice, our Board needed to have an appropriate mix of skills and expertise and independence of directors (ie; no financial business relationship with the organisation which could or could be perceived to impede their

decision making). Additionally, there would need to a mechanism for both election and appointment to the Board that would achieve this.

Updates to the Constitution to support the changes were endorsed by members in late 2011 and the process of transition has commenced.

The focus over the coming 12 months will be to continue to implement the new Board arrangements and to establish a process of Board evaluation.

The second major project was a review of the Association Membership Model as referred to by the Chairman and CEO in their report. Following on from the membership model review is to be the creation of a ‘Friends of the Clinic’for those individuals who would like to be involved in the Clinic community and who can support the work of the Clinic. This will be further developed in 2013.

Jane Wood Strategic Projects Officer

The Hobart Clinic Annual Report 2012 9

Therapy Program Goals

To support and empower individuals in their recovery journey and to specifically:

1. Improve individual functional capability in all areas of daily living

2. Educate patients about mental illness and management to enable greater self awareness and the ability to prevent relapse

3. Teach preventative and early intervention skills and stress management techniques

4. Assist patients to develop, set and achieve their own aims in life

Inpatient ProgramsOur inpatient services provide a safe and nurturing environment where patients receive support, medical and nursing care and therapy sessions. Inpatient programs consist of group therapy, individual support and counselling and a range of complementary activities such as exercise, art and relaxation.

Inpatient programs include:

• AlcoholandDrug

• Mooddisorders

• AnxietyandDepression

• Olderpersonsmentalhealth

• Communitytranistion

Outpatient ProgramsOur outpatient programs provide both continuity of care for inpatients to participate in a recovery and psychosocial rehabilitation program post hospital and community support to intervene at the earliest possible time to prevent deterioration or hospitalisation.

Outpatient programs include:

• AlcoholandDrugProgram

• Individualandgrouptherapy

• MoodManagement

• AnxietyManagement

• WellnessandSupportGroup

• DialecticalBehaviourTherapy

• MemoryClinic

• MemoryEnhancement Program

• EatingDisordersAssessmentand Group Therapy

The Hobart Clinic Association • ABN 47 009 543 828 • Trading as The Hobart Clinic. A hospital accredited by the Australian Council on Health Care Standards.

The Hobart Clinic

31 Chipmans Road

Rokeby Tasmania 7019

Phone: (03) 6247 9960

Fax: (03) 6247 6439

info@thehobartclinic.com.au

www.thehobartclinic.com.au

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