The COMMUNITY...focus of OUR ENDEAVOURS. Quality. ...the measure of OUR CARE QUALITY OF CARE REPORT WEST WIMMERA HEALTH SERVICE

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1 The COMMUNITY...focus of OUR ENDEAVOURS Quality...the measure of OUR CARE QUALITY OF CARE REPORT WEST WIMMERA HEALTH SERVICE

2 OUR VISION To establish a health service without peer through the pursuit of excellence and by opening the doors to innovation and technology. OUR MISSION West Wimmera Health Service is committed to the delivery of health, welfare and disability services which are compassionate, responsive, accessible and accountable to individual and community needs, which result in quality outcomes for the people of the West and South Wimmera, and Southern Mallee. OUR VALUES > Strong Leadership and Management > A Safe Environment > A Culture of Continuing Improvement > Effective Management of the Environment > Responsive Partnerships with Our Consumers About this Report This Quality of Care Report was prepared in accordance with the guidelines of the Department of Human Services and with advice from consumers, Community Advisory Committees and a diverse representation of staff, volunteers and consultants. Dimensions of Quality & Safety The increase in the number of measures of Quality & Safety included in this Report is a direct result of consumer interest and are listed in full in the Index (IBC). We have included a Glossary of Terms & Abbreviations and an Index on page 49 to assist readers to navigate this Report. This Report and our Annual Report can be accessed on our Website and the internal Intranet. Hard copies are available at each of our sites or by request via or mail. corporate@wwhs.net.au The Resource Centre West Wimmera Health Service P.O. Box 231 Nhill Victoria 3418 AUSTRALIA Copyright West Wimmera Health Service September 2009 Acknowledgements Design & Production Motiv Design Co-ordination DMR Associates Pty Ltd, Nhill Photography Robert Geh, Michael Mullan (p13, 40), WWHS (p39) Lawyers DLA Phillips Fox, Russell Kennedy Pty Ltd, Stewart & Lipshut Auditors Victorian Auditor General s Offi ce Internal Auditor Deloitte Growth Solutions Pty Ltd Architects Brown Falconer Banker Commonwealth Bank Contents Welcome to West Wimmera Health Service WWHS A Unique Rural Health Service The Quality of Care Report and Our Communities WWHS Services Our Communities... and their Participation with the Service Cultural Diversity Community Needs Analysis Patient Opinion Managing your Health a team approach Increased Visiting Medical Practitioner Services Black Saturday Confirming Safety & Quality... Across Our Service Accreditation Credentialing & Scope of Practice Infection Control Medication Management Pressure Wound Monitoring Falls Monitoring Compliments & Complaints Dental Care Clinical Governance Managing Quality Risk Management We Keep On Caring For You Admission & Discharge Planning Improving our Aged Care Services Improved Lifestyle for Type 1 Diabetics The Road from Dependence to Independence Roseanne A Powerful Story Early Intervention Supporting People with a Disability Health Promotion Education Trainees Josh s Story Learning An Opportunity Online Learning Index and Glossary IBC

3 QUALITY OF CARE REPORT 2008/ WELCOME... TO WEST WIMMERA HEALTH SERVICE BELOW: (Right to left) Dr. Shoaib Munawar, Tristar Medical Group, consults with young Cory Koop and his mother Kathy. WWHS Is: > An integrated health service offering an exceptional choice of health care. > A Public Health Service incorporated under the Victorian Health Services Act 1988 and funded by the State and Commonwealth Government. WWHS Encompasses: > 6 Communities > 17,000 square kilometres WWHS Provides: > Acute Care for patients in hospital > Specialist Surgery > Residential Care for the Aged > Allied & Community Health > Programs to promote better health > Disability Services > Supported Employment Options > Community Aged Care WWHS Has: > 4 Hospitals > 5 Nursing Homes > 5 Hostels > 1 Disability Service > 52 Acute Beds > 77 Nursing Home places > 46 Hostel places > 546 Staff > 50 Individual Volunteers > Volunteer Groups WWHS This Year: > Treated 1,879 patients in our hospitals > Allied and Community Health provided 66,633 services > Had a $26M Budget > With a $599,000 Operating Surplus > Achieved $425,000 Total Net Surplus > Raised $254,105 for equipment and furnishings > Provided residential accommodation for 191 people

4 2 WEST WIMMERA HEALTH SERVICE WEST WIMMERA HEALTH SERVICE A UNIQUE RURAL HEALTH SERVICE How do you, as a consumer, expect to be informed about the standard of healthcare provided at West Wimmera Health Service? Easy. The West Wimmera Health Service Quality of Care Report tells you! This report is published to enlighten you, personally about the range, extent and Quality of the service we deliver. This differs from the Annual Report which focuses on explaining services we offer, the projects undertaken for the year and the financial viability of the organisation. Quality comprises six key aspects > Safety of health care > Effectiveness of health care > Appropriateness of care > Acceptability of care > Access to services > Efficiency of service provision The Quality of Care Report comprehensively describes the systems, processes and achievements of West Wimmera Health Service which are focused on quality outcomes. All six key aspects of quality are incorporated to ensure that the Service does offer the highest level of healthcare. This Report addresses West Wimmera s exceptional programs and specialities, offering a transparent account of the Service which includes frank commentary on aspects of our operations that we readily acknowledge can still be improved. Healthcare is never static. Better Practice models are continually being developed and as a Service committed to continuous improvement in all facets of our undertakings we will continue to strive for perfection. Our endeavour to continually review our processes ensures that best practice standards of care can be intertwined in our clinical pathways and risk processes. West Wimmera Health Service is a unique rural health service as it offers a diverse complement of healthcare options covering acute, aged, community, primary care and disability, a very holistic and multidisciplinary approach to the delivery of healthcare. Risk Management is interlinked with Quality and a crucial component in managing the inherent risks that are associated with providing health services across a multi-campus organisation over a large geographical area of North West Victoria. We believe it is important to take the opportunity to guarantee all care West Wimmera provides is safe, effective, appropriate, acceptable, accessible and efficient for the communities which we are entrusted to serve. It is also important that as consumers you can make an informed choice about the healthcare services you desire. We trust this Report will assure you that if you wisely choose to utilise the services of West Wimmera you will be provided with the quality and standard of healthcare you seek. It is with pride and a strong conviction to perfect quality that we present the West Wimmera Health Service Quality of Care Report Mr Ron Ismay President Mr John N. Smith PSM Chief Executive Officer

5 QUALITY OF CARE REPORT 2008/ ABOVE: (Left to right) Chief Executive Officer John Smith PSM and President Ron Ismay Your leaders committed to quality!

6 4 WEST WIMMERA HEALTH SERVICE THE QUALITY OF CARE REPORT AND OUR COMMUNITIES Our communities know who we are but they want to know more about what we do! Our health services are the mainstay of the six communities and four Local Government areas for whom we deliver quality care. Our 4 Hospitals, 5 Nursing Homes, 5 Hostels, 1 Community Health Centre, 1 Disability Service and Community and Allied Health Services are located in the North West of Victoria across 17,000 sq km. Our communities want to know what we do A recommendation from the 6 Community Forums conducted across the Service this year was that people wanted to know more about our services. What did we do? We made a concerted effort to publish articles in local newspapers. 5 articles published in January escalated to 51 in June. They were wide ranging in their content from introducing new staff, new services, to the results of physical activity challenges and in this Report we have reported on a much wider range of quality and safety activities and included more about our services. Our Quality of Care Report will be delivered across our vast rural area The Report will be published as a magazine and distributed with the Weekly Advertiser, a free newspaper delivered across the Wimmera. It will reach over 5000 homes in 13 towns, placed in waiting rooms and mailed to Doctors, Dentists and Allied Health Professionals. It will also be readily available at our sites and on the internet and released with our Annual Report at the Annual General Meeting on Friday 27 November and its release will be advertised on local radio during the week of delivery extra copies of the Report will be printed for distribution throughout the year. Our Report has changed We have changed the format this year in response to consumer and adjudicator comments that the newspaper sized publication of previous years was too large to handle. Is this the best way to distribute our Report? We think so! Everyone in our communities will have the opportunity to read our story and it is an affordable way for us to reach every corner of our catchment area. We will again have a competition for Reader Response to a questionnaire in the Weekly Advertiser. Radio advertisements will encourage people to enter. Last year there were 64 responses to this initiative, 19 more than the previous year. This year people will be able to leave their entry at our campuses as well as posting them. How do we know our community read the Quality of Care Report last year? Because we had 800 extra copies of the Quality of Care Report printed which were quickly snapped up. We then had to make photocopies to fulfil requests during the year. We also had more community response about its content than in previous years. Reader Response Comments about the 2008 Care Report from readers and adjudicators were varied and certainly helped in the preparation of this Report. Common themes were Great read, Very informative, Easy to understand, I would like to read more about services, Interesting but a bit large, Too awkward to read, Why do you do this as well as your Annual Report?, The photographs made it interesting, Photographs were better than last year, A lot of Graphs, More detail for Falls. Our community and consumers made a valuable contribution to this Report We are indebted to the people who volunteered to read the draft Report during its preparation and suggested improvements, to those who wrote articles, prepared statistics and edited copy. Community Advisory Committees, volunteers, community members, staff and managers from all sites, Executive Directors, Doctors, Dentist and our Internal Auditor all provided valuable information and practical advice for the publication in this Report. A special thank you to Roseanne, Lois and Josh for allowing us to share your stories with our readers.

7 QUALITY OF CARE REPORT 2008/ WWHS SERVICES Aged Care Residential Hostels & Nursing Homes Home & Community Aged Care Clinical Services Acute Services Admission and Discharge Clinic Dental Diagnostic Dental Prosthetic Dialysis Domiciliary Midwifery Ear Nose and Throat Surgery Gastroenterology General Medical Care Specialist Medical Care General and Specialist Surgery Laparoscopic Surgery Maternity Shared Care Clinic Medical Services Nursing Traineeships Obstetrics and Gynaecology Ophthalmic Surgery Oral Surgery Orthopaedic Surgery Palliative Care Pathology Pharmacy Post Acute Care Primary Care Casualty Psychiatry Reconstructive Surgery Regional Discharge Planning Strategy Allied and Community Support Services Aged Care Assessment Services Ante/Post Natal Classes Asthma Education and Counselling Cancer Council of Victoria - Cancer Awareness Cardiac Rehabilitation Carer Support Community Health Nursing Continence Education Diabetes Education Dietetics District Nursing Drought Centre Drug and Alcohol Exercise Groups Exercise Physiology Farm Safety Education Fitness Assessments Guys & Gals School Program Gym/Weights Program Hairdressing Health & Fitness Centre Health Education and Promotion Hearing Screening Home and Community Care Hospital in the Home Hospital to Home Kindergarten Screenings - Podiatry, Speech Pathology Living with Cancer Program Lowan Rural Health Network Massage Therapy Maternal and Child Health Meals on Wheels Myotherapy National Diabetes Services Nutrition Education Occupational Therapy Optometry Orthodontic Referral Pap Smear Tests Physiotherapy Planned Activity Groups (Day Centres) Podiatry Puberty Biz Sexuality Education to Grade 6 Children and Parents Radiology Secret Men s Business Group for older men Social Work Welfare and Counselling Service Speech Pathology Work Experience Disability Services Advocacy Assistant Training Australians Working Together Community Access Employment Program Food Preparation and Sales Future for Young Adults Living Skills Supported Employment Therapy Programs Vocational Training Regional Services To: Allambi Elderly Peoples Home, Dimboola Avonlea Hostel Nhill Dunmunkle Health Service Edenhope Hospital Goroke P-12 College Hopetoun Hospital Jeparit Primary School Kaniva College Kindergartens - Nhill, Jeparit, Kaniva, Rainbow, Goroke Lutheran Primary School, Nhill Natimuk Primary School Nhill College Rainbow College Rainbow Primary School Rural Northwest Health St Patrick s Primary School, Nhill Woomelang Bush Nursing Centre Service Support Education Engineering and Maintenance Health Information Management Hotel Services Library and Resource Services Traineeships Volunteers Work Experience Work Placements Nursing Homes - Hostels - Accommodation Nhill Iona Digby Harris Home, for 26 frail aged, dementia and psychogeriatric residents. Kaniva Archie Gray Nursing Home, Nursing Home for 11 residents. Kaniva Cottages, 10 two bedroom units for low care Hostel residents. Jeparit Nursing Home for 10 residents. Hostel for 5 residents. Rainbow Bowhaven Hostel for 10 residents. Weeah Nursing Home for 10 frail aged residents. Natimuk Natimuk Nursing Home, for 20 residents. Allan W Lockwood Special Care Hostel dedicated care for 11 residents with dementia. Trescowthick House Hostel for 10 frail aged residents. Community Programs Hospital To Home (H2H) H2H is a service available for patients who have a short term need which cannot be met through regular community service provision. This program supports patients in the transition from hospital to home. Patients must live in municipalities associated with West Wimmera Health Service. Hospital in the Home (HITH) HITH is the provision of hospital care in the comfort of the person s own home. Patients are regarded as hospital inpatients and remain under the care of their treating doctor in the hospital. National Respite for Carers (NRCP) Provides time out for carers of people with dementia. This program offers carers the opportunity to maintain their own interests, while fulfi lling the demanding role of carer. Community Aged Care Packages (CACPs) These packages offer comprehensive assistance to the elderly to support them in their homes, thus delaying entry into a hostel or nursing home for as long as possible. The carer is also able to manage for longer with the support provided. Post Acute Care (PAC) Provides community-based services such as community nursing and personal care. Home and Community Care Program (HACC) This program provides care in home and community settings to frail older adults, younger people with disabilities and their carers. Promoting independence to these groups thus avoiding premature or inappropriate admission to long term residential aged care.

8 6 WEST WIMMERA HEALTH SERVICE OUR COMMUNITIES... AND THEIR PARTICIPATION WITH THE SERVICE Our communities are changing! The mix of nationalities, religious beliefs, languages, increases in chronic disease and vulnerable groups have significantly changed our once predominately Anglo Saxon communities to an interesting mix of cultures and groups with specific needs, creating greater and different demands on our health services.

9 QUALITY OF CARE REPORT 2008/ PAGE LEFT: Div 1 Nurse, Jisha David explaining the new Bladder Scanning Equipment. to Nhill Hospital patient, Henry Elliott Cultural Diversity The diversity of the people in our communities has greatly enriched our Service and we recognise the depth they add to the development of a changing culture in the community and within this Service. Our culturally diverse and aware workforce recognises that social inclusion, the promotion of equality and the encouragement of community participation is at the core of the services and individual care we provide. To understand the make up of each community, to establish partnerships with specialist agencies and practitioners, to develop staff competencies, to generate a responsive and alert organisation we have produced a Diversity Plan which acknowledges and addresses: > Aboriginal and Torres Strait Islander clients. > Clients from culturally and linguistically diverse backgrounds. > Patients of our hospitals. > Residents utilising our aged care accommodation. > Community clients. > Communication methods such as Picture Boards for clients and patients of a non-english speaking background. > Customs and traditions of culturally and linguistically diverse clients. > Employees. Our Community We researched the Australian Bureau of Statistics, Local Government and consumer data to determine the percentage of our clients who may need extra support to access our services and to establish initiatives to improve their experience with us. What did we do? The data suggests we have an increasing Muslim population so our Dietitians and Catering Department now ensure Halal meals are provided in accordance with religious requirements. 5.2% of our communities were born overseas compared with 22% nationally and we are working to ensure our programs take this into account. Staff recruited from overseas are supported to assimilate into our communities and we assisted to set up successful support groups, increasing satisfaction and retention. Our close partnership with the Wimmera Development Association s Skilled Migration Initiatives are aimed at attracting and retaining skilled migrants to Victoria. In February Physiotherapist, Sreekanth Sreekumar, who graduated and practised as a Physiotherapist in India, arrived in Nhill. Through the Skilled Migration Officer we assisted the family with Visa requirements, accommodation and a seamless transition to life in rural Victoria and recently employed his wife Sini, as a Personal Care Worker. The Diversity Plan also includes a partnership with the Aboriginal Liaison Officer from Wimmera Health Care Group to support staff with understanding the specific needs of Aboriginal and Torres Strait Islanders and what is important to them in terms of health care and how we can work together to achieve positive outcomes. Communication essential for a Quality Service We ensure that a qualified interpreter is available to translate for non-english speaking patients. We also have a list of staff and community members who are willing to act as interpreters in an emergency. The Diversity Awareness Group monitors the effectiveness of the Diversity Plan which is constantly evolving as our population changes. Changes to the Plan and Policies are published in the weekly Newsletter distributed to all staff, Visiting Medical Practitioners and the local community. The outcome of our efforts during 2008/2009 We: > Formed a Diversity Awareness Focus Group. > Accessed data which highlighted that 0.9% of our clients are from a non English speaking background, enabling services to be improved for them. > Adopted the new Diversity Awareness Policy, and reviewed the Interpreter Service Policy. > Distributed updated information on interpreter services, resources, information on other languages and indigenous support and the Grampians Home and Community Care (HACC) Diversity Kit.

10 8 WEST WIMMERA HEALTH SERVICE OUR COMMUNITIES... AND THEIR PARTICIPATION WITH THE SERVICE > Ensured Diversity Awareness is now a standing agenda item at the Clinical Quality and Safety meetings. > Initiated, through the West Vic Division of General Practice, education for Medical Practitioners, recognising and respecting pain and palliative care beliefs. > New patients are now consulted by a Dietitian and Catering staff as cultural needs are identified. > Liaised regularly with DHS, HACC Cultural Diversity Officers about changes to Policy or State direction. What we will do next year? Our objectives for discussion and improvement of the Plan in the coming year are to: > Integrate Disability services into the Plan. > Recruit International staff to the Group. > Seek Community representation to the Group. > Distribute the Plan to the West Wimmera and Hindmarsh Shires to initiate a partnership that will encompass the Councils and local businesses enhancing the recruitment and retention of International staff. > Create a Brochure specifically addressing Diversity Awareness. Our Diversity Awareness Policy Statement Purpose We will ensure people from special needs groups are not disadvantaged because of their cultural, linguistic, religious orientation, financial capacity or physical and intellectual abilities. Principle We will support staff in their provision of services to people from culturally and linguistically diverse backgrounds. We will ensure the provision of language services, interpreting and translating, to overcome any language barrier faced by clients and their carers. Clients from special needs groups will have access to appropriately structured service delivery. Community Needs Analysis We asked for our consumers advice During we embarked upon a Community Needs Analysis and Service Profile Project to review our current service provision and demands to plan for the future. An independent consultant was commissioned to undertake the analysis. The Project based on extensive consultation was the most ambitious and comprehensive process undertaken by the Service since its inception in Six public forums were conducted at Nhill, Rainbow, Jeparit, Natimuk, Kaniva, and Goroke to gauge the views of the wider community. Response forms were distributed at each forum with copies available at each site. Three key questions were fielded at each forum 1. What are the key health issues of your community that we should address? 2. What services do you consider essential for us to deliver? 3. What additional services do you believe should be provided to satisfy future community needs? Discussions were also held with key stakeholders including Department of Human Services, Local Government, Local Service Providers, General Practitioners, Divisions of General Practice, Primary Care Partnerships, Cancer Networks, Specialist Providers, Alliances and Community Groups. Eight issues were identified through the consultation process: > Maintenance of the services already provided. > Needs of an ageing and declining population. > Growing demand for additional services to address changing needs. > Limited availability and access to Regional Services. > Remoteness of catchment area. > Limited transport. > Staff recruitment and retention. > Relationships with other services. The results of the consultations and public opinion formed the central basis for the 53 recommendations made in the Report with six key recommendations highlighted.

11 QUALITY OF CARE REPORT 2008/ What did our Communities ask for? > Maintain all current beds and services. > Increase surgery to maximise utilisation of the Nhill Operating Suite. > Provide maternity services in line with DHS Birthing Services Guidelines. > Relocate the Nhill Ambulance Station from its current location to Nhill Hospital. > Increase number of visits of Allied Health Practitioners to all sites. > Construction of a new low care facility co-located with Kaniva Hospital for people with Dementia. The Board of Governance has adopted the Final Project Report and now awaits endorsement by the Department of Human Services. A complete list of recommendations is detailed in the Report which will be available to the community after DHS approval is received. Once this occurs we will begin implementing the recommendations to ensure our future direction does indeed meet changing needs in what can only be described as changing times. Surgeon, Mr David Bird during surgery assisted by Theatre Nurse RN Div 2 Janine Dahlenburg

12 10 WEST WIMMERA HEALTH SERVICE OUR COMMUNITIES... AND THEIR PARTICIPATION WITH THE SERVICE Patient Opinion An Important Measure of Quality We listen to what patients have to say about their care A broad range of surveys provides us with consumer views about what improvements they deem are needed. The Victorian Patient Satisfaction Monitor (VPSM) This is an independent survey conducted by the Department of Human Services. 97.5% of patients surveyed in the VPSM in 2008/09 were satisfied with the care they received while in hospital, compared with 95.5% of patients in the previous year. Many areas of our care rated highly compared with other Category C hospitals and the statewide average: VPSM Patient Satisfaction with Care % of Patients Satisfied Waiting Time WWHS Feb 2009 WWHS Aug 2008 Time Waiting for Bed Communication between Doctors/Nurses about your treatment Category C Hospitals Statewide Average Cleanliness of room The August 2008 survey also highlighted several areas needing improvement including providing patients with information prior to coming into hospital and better information and explanation of medicines. The February 2009 survey indicated that the changes we made had a positive impact. What we did An increase in Admission Clinic hours resulted in an increase in the number of patients interviewed prior to admission. VPSM Information and Medication % of Patients Satisfied Were you provided with information about your stay before you went to hospital? WWHS Feb 2009 WWHS Aug 2008 Explanation of Medicines Category C Hospitals Statewide Average A computer program was installed which the Pharmacist now uses to provide patients with information about their medications prior to leaving hospital, which assists them to understand the importance of safe and effective administration of their medications when they are at home. Another issue identified related to whether patients received information regarding their Rights and Responsibilities. A specific question about this is now asked in our internal survey. One patient indicated that insufficient information was received with all other patients noting they received appropriate information. As part of the admission process a greater emphasis has been placed on ensuring patients understand their rights and responsibilities, with a detailed explanation in addition to written documentation. The VPSM looking forward DHS has undertaken a review of the VPSM resulting in improvements which will assist hospitals to receive more current robust information. The number of surveys sent to patients will almost double, increasing the number of responses received which will provide more comprehensive information and greater capacity to compare our results with others. Information from the surveys will be available online enabling us to access information monthly rather than six monthly, meaning improvements will occur in a more timely manner.

13 QUALITY OF CARE REPORT 2008/ Pharmacist, Martin Yau using computer program Medprof to prepare a Patient Discharge Medication Profile. Our Satisfaction Survey We ask acute inpatients to complete a short survey prior to discharge. From January to June 2009 a total of 62 responses were received with 97% of patients very pleased with their stay. In response to a question asking patients to identify anything they were dissatisfied with only three negative comments were received; two noting that the air conditioning was too cold and the other asking for a shelf for flowers. Our actions Room temperatures are set at a standard temperature and monitored regularly. All rooms have space available for flowers. Patient views + action = improvement, our ongoing objective. District Nursing client response It is equally important to measure the satisfaction of those we treat in the community. District Nursing services are provided to clients at every site with patients receiving care in the comfort of their own home. In % of client responses to the annual satisfaction survey were happy with District Nursing care. 99% of clients recorded that the nurse discussed and planned their care and 90% thought that the nurse had discussed changes to care - a major improvement on the previous survey where changes or care were only discussed 78% of the time. Satisfaction levels with the care provided by the District Nursing service is extraordinarily high.

14 12 WEST WIMMERA HEALTH SERVICE OUR COMMUNITIES... AND THEIR PARTICIPATION WITH THE SERVICE Managing Your Health the Team Approach We have embarked on the development of a Chronic Disease Model of Care that will provide an effective and efficient approach for self management of chronic diseases such as Diabetes, Asthma or Cardiac Disease in partnership with the sufferer. It is a proactive inclusive model that will address the burden of the disease by teaming with clients to ensure complete understanding and participation in their planning for maximum wellbeing and self management is achieved. In Australia, chronic conditions account for approximately 70% of all health expenditure and are the main cause of death and disability. Statistics from Diabetes Australia highlight that the prevalence of Diabetes has increased by 78% in our Local Government Area, accounting for 4.8% of the population which is higher than the national average. Designing your program with you Our model takes into account evidence from the Victorian Healthcare Association and Chronic Disease self-management experts suggesting that for optimal management of individuals with chronic conditions, there is a need for collaborative partnerships and appropriate pathways to be established with the individual so that self management support will be effective. We are moving from systems based on the acute model of care towards a system that promotes selfmanagement for the patient. Pathways or Plans for Diabetes Management, Mental Health and Cancer are currently being developed with clients and our communities. Increased Visiting Medical Practitioner Service The Goroke Community asked for more General Practitioner visits The request Consultation with the Goroke Community to ascertain thoughts on current services and to determine the future needs of that Community revealed an overwhelming request was for better access to General Practitioners! The outome Our discussions with Tristar Medical Group, the providers of General Practitioner services to Goroke resulted in a trial of more GP visits beginning on 3rd June 2009, improving the previously spasmodic service to a guaranteed service, three sessions per week. It is important to note that West Wimmera Health Service provided financial backing to enable this joint venture to proceed. The Future The success of this venture will be evaluated to establish if there is a demonstrated ongoing need for this arrangement to continue! Black Saturday An excellent example of working with and for the community! Saturday 7th February 2009 was one of Victoria s most tragic days. 173 people dying in wildfires that burned out of control across the State. Our facilities were not directly affected by the fires but the extreme weather conditions required coordinated efforts to protect our patients, residents and the wider community. Rainbow, Jeparit and Natimuk all experienced major power failures from the early morning. Fortunately each of our sites has an emergency generator ensuring power is maintained during power outages and which in most instances maintains air conditioning systems. With temperatures of degrees Celsius and no power to keep their homes cool the risk to vulnerable members of the community, including the very old and very young was extreme. Staff at Rainbow, Jeparit and Natimuk sites arranged for at risk people to be brought into the Service where they were cared for in safety and comfort and provided with food and drink during the day until power was restored throughout the area later in the evening. An excellent example of working with and for the community!

15 QUALITY OF CARE REPORT 2008/ Dr Rizwan Lotia travels from Nhill to consult at Goroke Community Health Centre three sessions per week. This year we have placed more emphasis on seeking the views of our communities about the future direction of this Service and to plan for the services they will need for the future. We have conducted open forums in six communities, invited community participation in committees and surveyed individuals and groups, leading to a wider representation of the community in establishing the future of West Wimmera Health Service.

16 14 WEST WIMMERA HEALTH SERVICE CONFIRMING SAFETY AND QUALITY... ACROSS OUR SERVICE At West Wimmera Health Service we are all accountable for all matters of quality, safety and the management of risk. A solid structure of people and committees make sure that workable systems are in place to monitor and evaluate these factors in our pursuit of quality in every aspect of this Service. Accreditation and Quality Care What is Accreditation? What does it achieve? It is indisputable that we are committed to providing Quality Care and Accreditation is one method we apply to measure the quality of services we deliver. We submit our programs to external assessment by independent surveyors who review our systems, processes and outcomes against Best Practice and National Standards. Accreditation provides assurance to patients and residents that the care they receive at West Wimmera is safe and of a high quality. It also reinforces to staff that their practices are of an expected standard. What happens when a recommendation is received from an Accreditation survey? Action Plans are put in place to tackle the issues and progress is ultimately reported to the Board and the Accreditation authorities. Next year Accreditation is embedded in our quality and continuous improvement culture. Residential Aged Care, Community Aged Care Packages, National Respite for Carers Program and Disability Services will undergo accreditation surveys. We will also complete and submit an EQuIP selfassessment to the Australian Council on Healthcare Standards. In addition to the full surveys occurring at eight of our Residential Aged Care sites, unannounced support visits will continue to confirm that we are providing quality care to our aged care residents at all times. We will also participate in Stage 2 of the Diagnostic Imaging (X-ray) Accreditation process, due to begin in June All testing challenges offering great rewards!

17 QUALITY OF CARE REPORT 2008/ PAGE LEFT: Dietitian, Jessie Toose assesses Iona Digby Harris Nursing Home resident, Sylvie Donnell Accreditation Achievements 2008/09 All forms of accreditation have resulted in positive outcomes! Type of Accreditation Australian Council on Healthcare Standards (EQuIP) Aged Care Standards and Accreditation Agency (ACCA) Home and Community Care (HACC) Disability Services Accreditation Diagnostic Imaging (X-Ray) Community Aged Care Packages (CACP) and National Respite for Carers Program (NRCP) Outcome > Organisational wide survey conducted in November 2008 Four year accreditation status received. > Extensive achievement for Infection Control and Community Consultation. > Moderate achievement for 41 criteria, including all mandatory criteria. > Some achievement status achieved for 1 criterion. > 19 recommendations for improvement received which are now being dealt with. > Self-assessment, focusing on clinical areas will be submitted in October > Full survey undertaken at Archie Gray Nursing Home, Kaniva 3 year accreditation status, with compliance in all 44 criteria. > Unannounced site visits at each of the following residential aged facilities with full compliance achieved at all sites: > Iona Digby Harris Home, Nhill; Archie Gray Nursing Home Unit, Kaniva; Kaniva Hostel; Jeparit & District Nursing Home; Weeah Lodge Nursing Home, Rainbow; Bowhaven Hostel, Rainbow; Natimuk Nursing Home; Allan W. Lockwood Special Care Hostel, Natimuk; Trescowthick House Hostel, Natimuk > Accreditation kits prepared and submitted in preparation for full surveys at the remaining 8 facilities in August and September > Assessment undertaken in November 2008 measuring District Nursing Service against National Standards > High Achievement for all 25 standards, with a rating of 20/20, an improvement on the previous survey of 14.5/20. > Annual audit undertaken in July 2008 one area of minor non-conformance identified. > Follow up review in January 2008 non-conformance cleared. > Action plan formulated to address all recommendations from July review. > Further review July > From July 2009 all diagnostic imaging practices must be accredited to receive Medicare benefits. > A Self assessment and desktop audit was undertaken in April 2009 assessing our service against a range of national standards. > Full Stage 1 accreditation status valid from May 2009 to 30th June > Accreditation undertaken by the Commonwealth Department of Health & Ageing in September > Full accreditation status achieved for both programs. The final report identified that we provide quality services and complex case management through a holistic approach to care. > 5 recommendations received for CACP, all of which have been actioned. > 6 recommendations received for NRCP, 5 of which have been fully actioned, one remains ongoing. > Next accreditation review due in November 2009.

18 16 WEST WIMMERA HEALTH SERVICE CONFIRMING SAFETY AND QUALITY... ACROSS OUR SERVICE Our Staff are Qualified and have the Expertise to Care for You Clinical Credentialing Our Community and Allied Health staff work with adults and children in a variety of clinical settings: acute, rehabilitation, community, home and it is crucial that they are qualified to provide quality care. In order to ensure that our community receives the best and most appropriate care, all our clinical staff are required to provide evidence of their qualifications, experience, continuing professional development, registration status and membership of colleges and professional associations on appointment and reappointment to West Wimmera Health Service. The following Associations are involved in the credentialing of our workforce: Dietetics Australia, Australian Podiatry Association, Occupational Therapy Australia, Speech Pathology Australia, The Australian Counselling Association, Australian Institute of Welfare and Community Workers. Nursing staff are registered with the Nurses Practitioner Board of Victoria. Medical Practitioners credentialing is undertaken in association with the Medical Practitioners Board of Victoria and the relevant Medical College e.g. the Royal Australian College of General Practitioners, the Royal Australasian College of Surgeons or the Royal Australasian College of Physicians. The Victorian Department of Human Services has defined robust and effective processes for credentialing Medical Staff and defining their scope of clinical practice. Scope of practice describes the type and complexity of clinical work which can be undertaken at the various hospitals that comprise West Wimmera Health Service. It depends on the skills and qualifications of the Medical Practitioner and also on the capacity and facilities of the hospital in which they are working. The Executive Consulting Director of Medical Services oversees these processes across West Wimmera Health Service. Infection Control An effective infection control program is central to providing safe quality care. While not all health care acquired infections can be prevented we make sure they are minimised. Reducing the risk of infection Research shows that monitoring infections can reduce the risk to patients. Therefore we have established systems which enable us to use accurate data for clinicians to promptly plan intervention if needed. The results of intervention to prevent the spread or treatment of known infections provide data to confirm if the response has achieved the intended outcome. Currently very few infections are acquired by patients in our facilities. However data to identify hospital acquired infections is collected and analysed. Results are compared across the State of Victoria with like sized hospitals as part of a compulsory reporting system known as VICNISSand for residential care to the Aged Care Quality Association. Control of Potential Infection Immunisation Protecting our residents, volunteers and staff All staff and volunteers are offered vaccinations to minimise the risk of infection. > Influenza vaccinations are optional, 219 staff took up the offer. This was less than the 229 in > Residents in our Aged Care facilities are also offered influenza vaccines. Staff Influenza Vaccinations 2 Year Comparison No of Vaccinations Nhill Rainbow Kaniva Jeparit Natimuk Goroke WWHS 2008 WWHS 2009 Unlike some other States it is not mandatory in Victoria for staff to participate in the Infl uenza vaccination program funded by the Department.

19 QUALITY OF CARE REPORT 2008/ Christine Dufty Unit Manager, Nhill and Perioperative Nurse, scrubs up in preparation for surgery Swine Flu (H1N1) Swine Flu is a mild form of influenza but very infectious. We distributed the literature supplied by the Department of Human Services widely to increase public awareness and knowledge of the situation. We collaborated with the Hindmarsh Shire to prepare a Pandemic Plan, which, combined with our Business Continuity Plan, ensures we are well organised to cope with the challenges should a major pandemic occur. Hepatitis B Antibody Screening Hepatitis B is a viral disease spread by blood and body fluids. A screening program to monitor staff immunity to Hepatitis B is now in place. Blood is taken to assess the level of protective antibodies after undertaking Hepatitis B immunisation. Staff with low immunity are offered a second course of vaccinations. Staff Hepatitis B Immunisations 2009 Nhill Jeparit Kaniva Rainbow Goroke Natimuk No of Vaccinations Hand Hygiene Hand hygiene encompasses hand washing and the use of Alcohol Based Handrubs. The Victorian Hand Hygiene Program combines education and auditing of hand hygiene practices in Victorian Public Hospitals. We achieved a compliance rating of 76.4% compared with the State average of 71%. Patients and visitors are also encouraged to use the alcohol hand rubs to assist us to maintain a low infection rate. We achieved results above the state average however we are reviewing the reasons for the lower rating (69.4%) in Audit 3 and will work towards a higher rate of compliance. Hand Hygiene Compliance Audit % Compliance / /2009 Audit 1 Audit 2 Audit 3 Victorian State Average

20 18 WEST WIMMERA HEALTH SERVICE CONFIRMING SAFETY AND QUALITY... ACROSS OUR SERVICE Preventing infection in Orthopaedic Surgery Antibiotics are administered to patients just prior to joint surgery to prevent post operative infection. There were no infections following joint surgery this year! Administration of Antibiotics prior to Joint Surgery The four occupational exposures which occurred, all within the Nhill Hospital, were investigated, staff were counselled and education in safe practices reinforced. Single Use Policy Equipment which cannot be correctly re-sterilised must be discarded after use. No. of Patients July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun Waste Management Program All waste is segregated, handled, transported and disposed of in an environmentally friendly and cost efficient manner. Waste, produced by medical procedures such as dressings, surgery and dialysis, must be disposed of by specialist waste management. 2007/ /2009 No. of Major Orthopaedic Cases No. receiving appropriately timed antibiotics Gastroenteritis (Norovirus) Ongoing episodes of gastroenteritis occurred in our catchment area with many patients admitted to hospital. There were no outbreaks of hospital acquired gastroenteritis - testament to our exceptional nursing care and infection control procedures. Instrument Tracking All instruments sterilised in our Central Sterilising Department are tracked allowing us to identify instruments and practitioners if an infection is reported, and instruments which have not been sterilised correctly. Adherence to Standard and Additional Precautions Standard precautions reduce the possibility of transmission of infections between staff and patients and are work practices required for a safe, basic level of infection control. Additional precautions are used for patients known or suspected of having an infection that cannot be controlled with standard precautions alone. Occupational Blood and Body Fluid Exposure Managing how we handle and discard sharps safely reduces the risk of unnecessary exposure to contaminated syringes, needles and scalpel blades. Occupational Exposures Needle-stick injuries are an occupational hazard especially in acute areas where more needles and intravenous devices are used. Occasionally accidents do occur and strict reporting and treatment procedures are in place. We questioned if the increased amount of clinical waste reflected how busy we were. We graphed thexamount of waste in kilograms against the number of occupied bed days and discovered that there was a direct correlation reassuring us that the increases were due to increased business not bad management. In we will increase surveillance of how waste is discarded. Our standpoint on a clean environment eliminating the germs Infection control A clean environment reduces the risk of transferring microbes from equipment and furniture to patients and staff. Our cleaning procedures are clearly documented in the Policies & Protocols Manual. The Victorian Patient Satisfaction Monitor (VPSM), an independent survey of hospital patients, showed high patient satisfaction with our cleanliness, higher than other Category C hospitals and considerably above the state satisfaction level, demonstrating the effectiveness of our cleaning program. The most recent survey for patients admitted between September 2008 and February 2009 revealed 100% satisfaction. VPSM Survey Cleanliness Satisfaction % Satisfaction Cleanliness of Toilets/Showers Cleanliness of Room WWHS Feb 2009 WWHS Aug 2008 Category C Hospitals Statewide Average

21 QUALITY OF CARE REPORT 2008/ Joanne McCartney, Supervisor General Services, conducting a cleaning audit using the accurate Palm Pilot software program. The result will be submitted to DHS. Our cleaning passes the test Internal audits conducted by WWHS The Department of Human Services require all acute public health services to conduct cleaning audits and submit the results to DHS. A minimum standard of 85% must be achieved. 413 internal cleaning audits were conducted throughout the year in our Hospitals and Residential Care facilities. The graph below shows the number of internal audits undertaken at each WWHS location throughout the year and the percentage of compliance. Internal Cleaning Audits 2 Year Comparison % Score WWHS Overall Nhill Kaniva Rainbow Jeparit 2007/ /09 DHS Benchmark Results for all sites were generally above 90% providing further proof that the standard of cleanliness throughout the organisation is excellent. A problem was identified at Rainbow, Weeah Lodge Nursing Home and Bowhaven Hostel, with a compliance result of only 83.9%. Extra cleaning was immediately undertaken to bring the facilities up to standard and daily task sheets were updated. An audit conducted a week later revealed a compliance rate of 90%. External audits conducted by Department of Human Services In 2008/09 each site achieved results greater than the 85% benchmark, with the average across the Service of 96.1%, an improvement on the 95% achieved the previous year. 2008/2009 External Cleaning Audit Hospital Score Location What we will do next year Nhill Kaniva Jeparit Rainbow WWHS 2008/09 WWHS 2007/08 DHS reporting requirements for auditing cleaning standards will change. DHS will not require the results of internal cleaning audit results to be submitted, and Health Services must participate in three audits by a qualified Victorian Cleaning Standards Auditor, compared with only one each year previously.

22 20 WEST WIMMERA HEALTH SERVICE CONFIRMING SAFETY AND QUALITY... ACROSS OUR SERVICE The most common error this year was a drug not given to a patient or resident or given but not signed on the medication chart. A culture of no blame ensures staff are comfortable to report an error and patients can be effectively monitored to prevent unfavourable outcomes. Medication Incidents are presented to the Clinical Quality & Safety Committee which includes doctors, nurses, pharmacist and managers. The Committee analyses the incidents and instigates actions to prevent the incident recurring in the future. A National Standard Medication Chart, endorsed by the Australian Commission on Safety and Quality in Health Care, is used to enhance the way medications are prescribed ensuring awareness of how and when medications are to be administered. Importantly, the Service has not had a Sentinel Event associated with a medication incident in seven years. Sentinel events are relatively infrequent, clear-cut events that occur independently of a patient s condition resulting in unnecessary or serious outcomes for patients. Incidents, classified as high, very high or extreme risk undergo an exhaustive, multidisciplinary team investigation to establish the cause. Medication Incidents Medications must be safe Safe administration of medications to patients and residents is essential to safe care. Medication Incidents 3 Year Comparison Ommitted Dose Wrong Dose Wrong Drug Wrong Patient Our significant improvement is the reduction of the number of medications not administered (omitted doses), which has fallen by 36% over the past two years. Staff maintained a high level of competency for medication management; with an average of 95.5% staff compliance over the last three years. Aged Care medication reviews A Consultant Pharmacist regularly reviews medications prescribed for Aged Care Residents to ensure they have a valid medical reason for taking that particular drug, that the dose is appropriate and the resident has not experienced side effects. As a result of these reviews it was recommended that 24 medications be ceased, no new medications be added and 19 adjustments to dosages be made. The number of errors in administration of medications has steadily decreased over the last three years and the number of staff compliant with annual medication competency remains above 95%. ABOVE: Rainbow Hospital patient, Viola Keller takes a break from her knitting to discuss her daily medication with Div 1 Nurse Janine Harberger.

23 QUALITY OF CARE REPORT 2008/ Pressure Wound Monitoring and Prevention We have a stringent program in place to monitor potential pressure ulcers. What is a Pressure Ulcer? A pressure ulcer is a wound caused by pressure resulting in the damage of underlying tissue and is an internationally recognised patient safety problem which is largely preventable. The severity of Pressure Ulcers is classified according to the depth of injury to the tissue. Stage 1 Persistent skin redness. Stage 2 Partial thickness skin loss superficial abrasion, blister or crater. Stage 3 Full thickness skin loss crater involving surrounding tissue. Stage 4 Full thickness skin loss involving destruction of tissue and muscle. Pressure Ulcers 2 Year Comparison Stage 1 Stage Stage 3 Stage 4 Unfortunately, despite our very best efforts, a number of patients and residents developed pressure ulcers, the vast majority (88%) being of a minor nature (stage 1 and 2) which were detected early and were treated before becoming complicated. The number of stage 3 and 4 pressure ulcers has increased in the last 12 months. We have responded to this increase by reassessing the specific needs of residents: nutritional supplements to aid wound healing, varied positional changes to relieve pressure, better fitting footwear and pressure relieving appliances to assist in wound healing. Our care team, nurses, doctors, dieticians, physiotherapists and personal care workers consider individual needs and set a plan of care to prevent or minimise skin integrity problems. In some instances, patients or residents are transferred into our care from other facilities with pressure ulcers already present. Developing a stage 4 pressure ulcer is very significant as the patient may need an extended stay in hospital to heal the wound which causes severe pain. 9.98% of residents were reported with pressure ulcers compared with 10.06% across the Grampians and the State average of 12.68%. We will work more closely with our neighbouring hospitals to ensure that when patients are transferred into our care, they do so with an active management plan in place to address pressure wounds. ABOVE: Cindy Bone Div 1 Nurse applies a pressure bandage for Nhill Hospital patient Kath Shurdington.

24 22 WEST WIMMERA HEALTH SERVICE CONFIRMING SAFETY AND QUALITY... ACROSS OUR SERVICE Falls Monitoring and Prevention Are you at risk of falling? Falls prevention, a key to patient safety is primarily achieved through regular and timely assessments of patients and residents. We have drastically reduced the number of falls and their consequences by research and: > Sensor mats alert staff when a resident is unsafe. > Hip protectors which reduce the impact of a fall for elderly residents. > Beds that can be lowered to floor height reducing the consequences of falling. > Care teams consider ways to prevent falls by examining the whole patient and their needs. Each fall is investigated to assess its cause; slippery floor, did the patient/resident have the correct footwear, did medication affect balance, providing information to prevent further falls. There is a fine line between total prevention of falling and the desire for independence. The mobility of each person is carefully assessed on admission and regularly monitored throughout their stay. Unfortunately falls do occur but most only require first aid. On one occasion, a patient did break a leg and needed to be transferred to a Regional Hospital. While uncommon, it is upsetting and often lengthens the stay in hospital. A thorough investigation is undertaken to determine factors that may have contributed to the fall and whether changes need to occur. In this case after thorough investigation no changes to care, assessments, or protocols were required. WWHS Number of Falls 2008/ / / Number of Falls Falls have reduced by 40% since ! We have three qualified podiatrists involved in the care of our elderly residents who are also available for outpatient appointments for all ages. Their involvement and treatment is another example of how our health service proactively manages falls and falls prevention. Footcare Advice for the Older Person Falls among the elderly living at home are frequent and linked to poor foot function and to foot pain in particular. As you get on in years you are more likely to have bunions, toe deformities, numbness and poor toe strength and you are much more likely to suffer multiple falls. Older people who ignore their feet do so at their peril. Some dismiss foot pain and foot problems as symptoms of ageing that just have to be accepted. In fact, people with these problems need to seek treatment (Australian Podiatry Council Newsletter).

25 QUALITY OF CARE REPORT 2008/ PAGE LEFT: Podiatrist Erin Moorhead, who was a WWHS Bursary Student while studying for her Degree, discusses the importance of foot care and the correct shoes in preventing falls with patient Pauline Mellington. Learning from Your Comments We appreciate your comments about our services. Consumer views are valuable and reinforce the belief we are providing a user friendly high standard of service. The Patient Rights and Responsibility Brochures distributed to all patients and available at all sites encourage consumers to express their views. Compliments We received 124 compliments expressing sincere gratitude for the wonderful care and services available which is extremely rewarding. We do appreciate the compliments received and find them very reassuring. Compliments 2008/2009 Number of Compliments Acute Aged Community Food Area Complimented Other WWHS Complaints 3 Year Comparison Work Experience Complaints There were three main service areas for which complaints were received Engineering and Maintenance, Food and Clinical Care. Engineering & Maintenance Two areas of concern were emphasised. Extreme weather conditions during the summer of 2009 impacted on the performance of the airconditioning at one site on one occasion. As a result 10 complaints were lodged - almost half of all the maintenance complaints received for the year. Interim cooling measures were put in place and the problem was rectified within 24 hours. The other issue related to the quality of Television reception in our Nursing Homes. The fall in clarity was caused by the state wide transfer from analogue to digital signals. The problem was solved without further inconvenience. Food Implementation of a new menu resulted in considerable comment from patients and residents about meal quality, taste, texture and variety during the trial period when patient and resident opinion was actively sought. Modifications ensure the title of dishes accurately reflect the ingredients used making it easier for those on special diets to make a better choice. Clinical There were no continuing trends associated with clinical complaints but rather individual complaints which varied from acute, aged and community care services. Number of Complaints Clinical Care Maintenance Food Other 2008/ / /2007 Area of Complaint Serious clinical care complaints are often dealt with via a face to face meeting. Of the complaints received the most concerning related to communication between Clinical Practitioners. Education on the need for professionalism in all communication was intensified. Management meets with Clinical Practitioners to ensure that effective methods of communication arepractised. One complaint made to the Aged Care Complaints Investigation Scheme related to the quality of care provided to a resident of a Nursing Home. Staff were confident the care provided was more than adequate with the transparency of the investigation process proving that our systems and care were ideal. The resident and relatives were reassured and accepted that all care provided was of the highest standard.

26 24 WEST WIMMERA HEALTH SERVICE CONFIRMING SAFETY AND QUALITY... ACROSS OUR SERVICE Our complaints process > Is based on the Best Practice Guidelines of the Health Services Commissioner. > Predominately complaints are proactively managed by the Director of Nursing at each campus to ensure a positive relationship with the complainant is the outcome. > A de-identified summary of all complaints and compliments is submitted to the Performance Review Committee. > The designated Complaints Officer meets with consumers to discuss any matters of concern. Compliments and Complaints are always an opportunity to review current business practices and trends as we make every effort to improve our services. Security Incidents Security is about minimising financial loss as well as about the safety of patients/residents and staff. Security Incidents New policies for Locking Buildings and Key Security have been approved. Duress alarms now alert staff appropriately and improved picture clarity of security cameras ensures better monitoring of people moving in and out of buildings. At Natimuk Nursing Home, outside lighting, door locks and lock down procedures have improved as a result of an intruder on the grounds and following close consultation with Victoria Police, no further instances have occured. The risk of leaving buildings unlocked is an ongoing issue and we are working to find a solution such as automatic door locks. The Security Key and Lock Management Policy has also been reviewed. For security reasons a number of areas are locked and we are examining how best to allow access for emergency services such as Ambulance Victoria. We are consulting with the Ambulance Service, our insurer VMIA and the Department of Human Services to establish safe access practises for all personnel and achieve total observance of our Security Regulations. No security related incident has resulted in an adverse outcome during 2008/ Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Security incidents have continued at the same level as previous years. The upsurge in May was predominantly associated with misplaced keys and unlocked doors. Security related incidents, represented only 3% of 1831 incidents recorded. A security review was commissioned to establish potential security gaps with the Final Report highlighting several areas for improvement. An Action Plan was developed and improvements have begun. Dental Care The Nhill Hospital Dental Clinic provides much sought after dental services to public and private patients. Demand has continued to increase. Indicators of Quality Care Emergency dental care provided with retreatment required within 28 days Teeth retreated within 6 months of initial restoration Unplanned return within 7 days after tooth extraction WWHS Grampians Region State Average 0.00% 4.4% 5.1% 3.5% 3.5% 4.6% 0.00% 2.6% 1.1% The indicators of quality care highlight our care is well above the Grampians and State averages, as the table above indicates. The Department of Human Services target that 80% of Emergency patients should be treated within 24 hours is met % of emergency patients were treated with the remaining patients promptly referred to other Clinics.

27 QUALITY OF CARE REPORT 2008/ The waiting list for private patients, public prosthetics and oral surgery all decreased while the waiting list for general dentistry for public patients grew slightly. This problem is expected to decline next year when Dental Clinics reopen at Kaniva and Rainbow Hospitals. Dental Therapy - a new service A Dental Therapist commenced in February 2009 to begin the Child Oral Health Program. The results of a Satisfaction Survey conducted in May for patients treated by the Therapist were extremely positive. Patients and parents strongly agreed they were satisfied with the dental care they received. It was also reassuring that respondents indicated good advice was given about caring for gums and teeth encouraging a positive approach to life long dental hygiene for our young people. Dental Clinical Indicators Waiting times Months / / /07 Public Patients Public Prosthetics Oral Surgery (inpatient extractions) Private Patients Dental Therapist 2007/08 ABOVE: Dental Therapist Christine Petersen discussing dental hygiene with Maydelen Sellens 2008/09

28 26 WEST WIMMERA HEALTH SERVICE CONFIRMING SAFETY AND QUALITY... ACROSS OUR SERVICE Clinical Governance Its Relevance to Quality Above All do no harm! This is an imperative associated with the provision of health care. Unfortunately for patients within Australia this has not always been the case. The 2009 National Health & Hospitals Reform Commission Report noted 12 patients per day die unnecessarily due to errors in care. One in every six patients admitted to hospital experience a preventable adverse event. Stark reminders of our responsibility! The Board of Governance its committees, its role The Board of Governance is responsible for the Quality and Safety ideals of West Wimmera Health Service which are bound by a robust and effective Clinical Governance structure. Corporate Governance embraces Human Resources, Industrial Relations, General Administration and Financial Management; reports of which are referred to the Board through its Committees. The Clinical Quality & Safety Committee made up of medical, nursing, pharmacy and management representatives is the central platform for addressing all issues of clinical safety and quality. The Committee reviews incident reports, near misses, compliments and complaints, infection control and medication issues and is responsible for developing and reviewing clinical policies and protocols. The Medical Staff Association (MSA) provides a forum for Medical Staff to discuss pertinent clinical issues and report their deliberations to the Clinical Quality & Safety Committee. Ensuring safety mitigating the risk Our priority is to ensure the safety of patients by limiting the risk of suffering an adverse event We achieved this by: 1. Policies and Protocols Based on best practice and appropriately referenced. 2. By observing Regulatory Compliance in every way. 3. Safe Infrastructure all campuses are modern, edeveloped, comfortable and adequately equipped. 4. Safe Systems appropriately skilled, expert and credentialed staff are employed to ensure safe care is delivered. 5. Informed Consent is obtained from patients prior to receiving care. Detecting, monitoring and preventing clinical adverse events Limited Adverse Occurrence Screening Program (LAOS) We participate in the Grampians Clinical Risk Management Program conducted by the West Vic Division of General Practice which involves screening medical records to detect possible adverse events. As a result of recommendations received from the LAOS Program we have: > Reviewed the policy and developed a flow chart for correct rehydration of patients in Primary Care Casualty. > Provided education for medical practitioners regarding rehydration of patients. > Reviewed the policy regarding transfer of patients with acute heart conditions. > Reviewed end-of-life treatment options information provided to families. Mandatory Education Training staff to minimise catastrophic events Staff must participate in all elements of mandatory education: > Fire and Emergency training. > Manual Handling / No lift. > Privacy and Confidentiality. > Infection Control. > Food Handling. > Chemical Handling. > Medication Management. We believe improving staff knowledge and skills to be the most effective way of reducing the risk of catastrophic events and improving service quality.

29 QUALITY OF CARE REPORT 2008/ BELOW: Div 2 Nurse Judy Ridgwell campaigned vigorously to raise funds for the purchase of the new ECG Machine for the Nhill Hospital. Patient Keith Dickinson is pictured with Judy benefiting from the new purchase. Continuous Quality Improvement Our stance on Continuous Improvement is to achieve better results by analysis, evaluation and action to improve our services. Continuous Quality Improvement has been achieved by: 1. Improving Infrastructure continued the redevelopment of all facilities to achieve state of the art outcomes. 2. Replaced and upgraded medical and non-medical equipment. In 2008/09 an amount of $917,000 was set aside for this purpose with $587,000 for the maintenance and replacement of vehicles. Maintaining a safe and substantial vehicle fleet is vital for the delivery of our comprehensive community services. 3. Learning from others. The Clinical Quality and Safety Committee reviews internal incidents and near misses and actions strategies to improve care in the future. 4. In 2008/09 we introduced a range of quality improvements: > Introduction of a gastroscopy and colonoscopy clinical pathway based on best practice research. > Streamlined Residential Aged Care admission processes to minimise acute hospital admission. > Medical Practitioners were provided with instant online access to pathology and radiology results. > Increased the use of hip protectors decreasing the risk of pressure ulcers and injury from falls. > The Code Blue Cardiac Arrest section of the Emergency Management Plan was reviewed and amended. > Initiated discussion with Ambulance Victoria personnel to achieve coordinated and timely assistance with emergency patients and the granting of visiting rights to Ambulance Paramedics. 5. Accreditation Achievements are detailed on page Auditing of the Clinical Risk Framework by Internal Auditors Deloittes in May Their article appears on page 29.

30 28 WEST WIMMERA HEALTH SERVICE CONFIRMING SAFETY AND QUALITY... ACROSS OUR SERVICE What is a Quality Outcome? Improving quality and achieving a quality outcome mean different things to different people. We believe we have contributed to improved quality of life for residents, patients and clients by: > Providing 191 residents with residential aged care, allowing them to be cared for in their local communities, close to family and friends. > Treating 1,879 patients in acute hospitals, including 305 dialysis services. > Returned 25 patients to a pain free life after successful total hip and knee replacements. > Restored sight for 106 patients following cataract surgery. > 8 insulin dependent diabetic clients no longer require multiple daily injections after insertion of an Insulin Pump. > 275 community members participated in a physical activity challenge losing a total of 302 kg in weight and increasing their physical activity. Great outcomes. What is in store for the future? In July 2009 the Department of Human Services will produce a guide to assist health services establish an effective Clinical Governance Policy Framework, which we will use to review our policy to ensure it is robust, functional and effective. Actions addressing recommendations arising from internal and external audits will be put in place. The importance and vitality of Corporate and Clinical Governance will never be under estimated. It is the catalyst which drives us to achieve excellence. ABOVE: Dr Irfan Hakeem, checking the progress of patient Terry Witmitz at the Kaniva Hospital.

31 QUALITY OF CARE REPORT 2008/ Our Quality Management The View of Our internal Auditor The strategic aim of any rural health service is to provide the highest quality of care to patients and residents of the health service. The expectation of living within or passing through the catchment area of West Wimmera Health Service is that patients receive the highest quality of care when it s needed. A rural health service like West Wimmera is a complex business which provides a myriad of services ranging across acute care, allied health, residential aged care, community aged care, disability services and district nursing. Some services are funded by the Commonwealth Government. Some are funded by the State Government. Some services are governed by legislation which includes specific minimum standards of care. What frameworks are put in place to ensure these complexities are managed and the strategic quality aims are met? How are these frameworks monitored by the Board of Governance? The Service is required under Victorian state legislation to have a demonstrable and robust risk management framework. This framework is multi dimensional in that it considers the strategic and operational risks at a high level, but also specific risk areas at a departmental level i.e Clinical Care or Occupational Health and Safety. It is through this framework of identifying and mitigating risk that the Board and delegated governance sub-committees manage risks associated with the quality of care. The Clinical Quality and Safety Committee (CQ&S Committee), comprising members of the Board and Executive Management oversee the quality of care at WWHS. The CQ&S Committee is responsible for monitoring and evaluating clinical quality and safety and for ensuring continual improvement is achieved. It reports to the Performance Review Committee which reports to the Board on the overall quality, safety, effectiveness and appropriateness of services offered to the community. WWHS is an accredited agency certified by the Australian Council of Healthcare Standards (ACHS) is committed to the ACHS EQuIP Continuum of Care Standards. Accredited surveyors perform an audit of WWHS against each EQuIP standard. Recommendations are recorded in the audit schedule and in the Risk Register. Accreditation was last carried out in November 2008 and WWHS achieved a maximum of four years accreditation status. Aged care facilities and the level of care provided is also subject to regular external audit by the Department of Health and Ageing. All findings from these external audits are fed into the WWHS continuous improvement frameworks including the Risk Management Framework. Identified sentinel events must be reported to the Department of Human Services. Sentinel events are recorded under the WWHS risk framework and processes associated with its Incident Reporting Protocol. All sentinel events are reviewed by the CQ&S Committee as well as the Board of Governance. Making sure our Clinical Practitioners are qualified A credentialing process for Medical Practitioners is also in place. The credentials of all potential clinical professionals are reviewed and assessed by the Clinical Appointments Credentialing and Review Committee and ratified by the Board of Governance. The scope of clinical practice (privileges) is defined and granted for a specified period of time. Each nurse must maintain current registration with the Nurses Practitioner Board of Victoria prior to practising as a registered nurse. Nurses who have not renewed their registrations with the Board by 31 March annually have their name removed from the Register, pursuant to s. 18(7) Health Professions Registration Act 2005 with substantial penalties to apply if they do not comply. West Wimmera Health Service conducts an annual check to ensure all are registered. Additional qualifications are also registered with the Board. Finally, it is our role as internal auditors to ensure that controls are in place to mitigate the risks of the Health Service. Only recently, we completed a review of all the framework elements detailed above which manage the clinical risks of this complex and diverse health service. I trust that this brief summation gives a clear understanding of the layers of control in place to ensure that clinical care is regularly reviewed, assessed and improved at West Wimmera Health Service. Andrew Sloman Partner, Deloitte Touche Tohmatsu Internal Auditors for West Wimmera Health Service

32 30 WEST WIMMERA HEALTH SERVICE CONFIRMING SAFETY AND QUALITY... ACROSS OUR SERVICE Risk Management No longer a Risky Business Risk Management is an everyday work practice for West Wimmera Health Service. A core value of our organisation is a commitment to a safe environment embracing a direct means to achieve this is through effective risk management. Risks are present in the clinical, non clinical, community and volunteering areas of our organisation. As a health care organisation, it is our responsibility to identify risks step by step, measure their possible impacts and determine methods to eliminate them. How we manage Risk Risk is managed by the Board of Governance and by delegation is the direct responsibility of the Chief Executive Officer, Executives, Managers and Employees and is based on the Australia/New Zealand Standard for Risk Management (AS/NZS 4360:2004). The Audit Committee has the overarching responsibility for monitoring and policy development for this agenda. Outcomes from the Performance Review Committee are reported to the Board which systematically reviews risks. A Risk Register which facilitates a systematic review of risk is maintained to record and monitor risks and how they are addressed. The register is accessible to all staff, who are encouraged to notify potential risks as well as contribute solutions and actions in conjunction with Executive Directors. Incident reporting minimising risks Risks are also identified through the incident reporting protocols. Incidents are documented and reported through a computerised incident reporting database (RiskMan). Incidents are rated according to severity, from Immaterial to Extreme and thoroughly investigated. Actions are put in place to prevent incidents from recurring and minimising their impact in the future. These processes have ensured that there are no Very High or Extreme risks at this time. Next year we will refine our Risk agenda to concentrate on the highest organisation wide risks which will be regularly and more concisely reported to the Board, to address these key areas of organisational exposure. We work with our Insurer, the Victorian Managed Insurance Authority (VMIA), to refine and improve our processes, including the review of our Risk Register and its appropriateness. The Board has undertaken education to equip them to effectively lead the risk management process at the governance level. Cataract Surgery Safe and Effective 615 elective surgical procedures were performed at the Nhill Hospital. Of these 106 were cataract operations - low risk surgery achieving exceptional outcomes for patients. Indicators of the quality of our care illustrate patients having a cataract removal at Nhill Hospital are unlikely to suffer complications. Ophthalmology Indicators of Quality Care Indicators of Quality Care Number of readmissions within 28 days Readmissions within 28 days of cataract surgery due to an infection in the operated eye Percentage of cataract surgery patients having an unplanned overnight stay. Jan- June 2009 Jul- Dec 2008 Jan- June 2008 Jul- Dec % 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 4.65% 3.64% 10.42% Cataract surgery is usually a same day admission. However as many of our patients are elderly and travel a significant distance we advise them to stay at a nearby motel overnight. Our nursing staff visit several times during the night to administer eye drops and to ensure they are not in pain. Patients attend a consultation with their surgeon the next morning to monitor their progress prior to returning home. Patients who have been assessed at the Pre Admission Clinic as needing a higher level of care, are admitted to a hospital bed and remain in hospital overnight. Effective discharge processes and strategies ensure patients receive additional services they may require when they return home resulting in the number of patients requiring an unplanned overnight stay reduced from 10% of all cataract surgery patients in 2007 to nil in the first half of 2009.

33 QUALITY OF CARE REPORT 2008/ Consent A Must Obtaining consent from patients prior to a surgical operation, procedure or treatment is a legal requirement. Medical Practitioners must explain procedures and treatments so that patients understand the procedure and the expected outcome. A consent form is completed by the Medical Practitioner and signed by the patient after the explanation and an understanding of what is to transpire is evident. We have clear Policies and Protocols to guide clinicians through this process. Despite this, on 5 occasions, documentation was incorrect or absent when a patient was admitted to hospital percent of all surgical cases. The anomalies were detected before the procedure took place resulting in an explanation being provided and consent obtained. Surgeons were contacted, the issue was discussed and our protocol reinforced. At all times patients are kept informed of the irregularity and what was being done to rectify it. We have adopted the World Health Organisation Surgical Safety Checklist, which has been endorsed by the Royal Australian College of Surgeons and Victorian Surgical Consultative Council. It is designed to reduce adverse events in the operating theatre by applying a routine set of questions before, during and after the procedure and includes questions relating to consent. During , no operative procedures occurred without the correct consent. That is the way it should be! ABOVE: Theatre Nurse Lisa Newcombe checking the Consent Form prior to surgery.

34 32 WEST WIMMERA HEALTH SERVICE CONFIRMING SAFETY AND QUALITY... ACROSS OUR SERVICE Medical Records A Vital Ingredient in the Delivery of Quality Care The Medical Record provides health professionals with information about the past medical history of patients and residents assisting them to make accurate decisions about treatment. Australian Standard for Health Records (AS ) and the professional standards of health information professionals ensure medical records are comprehensive, accurate and complete. The Health Information Act 2001 and Freedom of Information Act 1982 stipulate patients have the right to access a copy of their medical record. The Health Information Act also protects privacy of information with a patient s consent required before any information can be released or shared. Duplicate Unit Record Numbers To ensure that comprehensive patient information is readily available it is important medical records are complete and that only one record exists for each patient. The number of duplicate records is monitored monthly and this year only 5 duplicate numbers were identified. They were immediately rectified by merging the information into one record. Locating Medical Records Medical records must be readily available in an emergency admission to hospital or attendance at our Primary Care Casualty area. Records can be physically located in a variety of places including the Physiotherapy Department, Consulting Suite or with the Admission and Discharge Coordinator so we must know where they are at all times. We track their location electronically with a target of 95% accuracy. Accuracy of File Tracking Percentage Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Dec-08 Jan-09 Feb-09 Mar-09 Apr-09 May-09 Jun-09 Accuracy 08/09 Target 08/09 (95%) Average financial year 98% of records were able to be located immediately. In April 2009 problems were identified with records recorded as being in one location but were actually elsewhere. Staff were alerted to the problem and education provided with subsequent improvement resulting. New isoft Patient and Client Management System (PCMS) Patient and Client management systems are used to support all functions associated with their administrative management. 10 hospitals in the Grampians Region, including West Wimmera Health Service, have commenced the implementation of a new patient management software system, incorporating admissions, discharges, transfers, diagnoses and procedures. The isoft Patient and Client Management System (PCMS) was chosen by DHS with the goal of all Victorian public health care services using standardised computer technology. The System will enhance care delivery through efficient bed management and decreased errors when completing admissions, discharges and transfers, and provide for continuity of patient care by supporting an integrated workflow between hospital inpatients and outpatients.

35 QUALITY OF CARE REPORT 2008/ Manual Handling Compliance Staff safety is a paramount concern particularly when related to manual handling. Our efforts in combating manual handling injuries over the past three years have realised an 80% reduction which is directly attributable to staff education including enhanced access to online computer based learning and practical demonstrations. Manual Handling Incidents as a Percentage of all OHS Incidents Percentage Hosp 1 Hosp 2 Hosp 3 Hosp 4 Hosp 5 Hosp 6 Hosp 7 Hosp 8 WWHS The Service has also benchmarked its Manual Handling incidents with nine other healthcare organisations in the Grampians Region. Data was collected for the period January 2009 to June Results showed that our performance was mid way between other healthcare services, and 24% better than the worst performing service in the region. (West Wimmera Health Service organisation 112 in the graph below). In our WorkCover premium was 33% higher than the industry standard. It has reduced significantly to be 21% better than industry average. A 54% turnaround a great effort. We will further reduce our WorkCover premium from $229,000 in to $170,000 for We are proud to reduce the number of manual handling incidents but believe that one incident is too many and therefore continually strive to improve this performance. With education and investment in new and improved equipment to assist with the movement of heavy objects, we are well placed to achieve our goals. Comparison of Manual Handling Incidents to Education Compliance Grampians Regional OH&S Incidents January-June 2009 No. of Incidents / / / / Compliance Percentage Incident Level % Assault & Aggression Manual Handling Occupational Exposure Slips, Trips & Falls Security Hospital Code Strains Other Education Of the 10 sprains and strains experienced in , only one resulted in a claim to the Services insurer which still remains active.

36 34 WEST WIMMERA HEALTH SERVICE CONFIRMING SAFETY AND QUALITY... ACROSS OUR SERVICE Right Side Right Procedure Recognising the increasing trend in Victoria of procedures involving the wrong patient or body part we take great care to ensure this does not happen at West Wimmera Health Service. We have adopted and implemented the Victorian Surgical Consultative Council Guidelines addressing correct patient, correct side and correct site surgery protocols. At many points of the clinical journey, patient information regarding the type, side and site of the surgery is verified using a detailed checking list before admission to hospital, at admission, before leaving the ward, upon arrival at the operating theatre and in the theatre itself. 100% of patients had their details verified by nursing staff on entering the Operating Theatre. If there was a discrepancy it would immediately be discussed with the surgeon, nursing staff and patient. In the Operating Theatre the surgical team confirms the operation with the conscious patient before the anaesthetic is administered. The side and site of the body to be operated on is clearly marked with a permanent marker. Discrepancies have occurred but they have been revealed, and addressed before the operation has commenced. In no patient had incorrect surgery. Patient Aggression and Inappropriate Behaviour Patients, Residents and Community visitors will on occasion exhibit physical or verbal abuse and aggression toward staff and other patients or residents. The number of incidents has remained relatively static over the past three years. Our Service includes a Dementia Specific Hostel and a Pyschogeriatric Residential Care Unit so we anticipate that incidents of aggression may occur, with 76% of incidents of aggression occurring in our Residential Aged Care settings. A task for will be to increase education for staff by specialists from the aged care and psychiatric industry to assist in dealing with aggression and difficult behaviours. How do we deal with behavioural problems? > Individual care planning and case conferencing occurs with all appropriate health care practitioners to map the care required to prevent, minimise or eradicate aggression and inappropriate behaviour. > In response to these issues, the Service has conducted in-service and external education sessions for 41 staff, specifically dealing with difficult behaviour, dementia care and counselling. > Our goal is to keep improving, as we have in the second half of when the number of incidents experienced within the Service reduced by 44%. > The commencement of regular visits by a Geriatrician and a Psychiatric Nurse in September 2009 will be a major move in improving performance. This we believe is a very positive record in addressing a very difficult subject. Incidents of patient Aggression and Inappropriate Behaviour No. of Incidents Blood Your safety Patients receive Blood or Blood Products in two distinct scenarios - a life saving situation or following elective surgery. It is carefully considered and patients or family discuss why the transfusion is necessary so that an informed decision can be made whether or not to receive the transfusion. Specific protocols are followed and our procedure is reviewed every two years or when changes are made to State or National guidelines. Careful observation of the patient following specific guidelines detects any problems that may arise from the transfusion. There has been no instance of a patient receiving the wrong type of blood or a significant adverse event associated with transfusion. Performance in this area is a Key Indicator of care reported to the Performance Review Committee.

37 QUALITY OF CARE REPORT 2008/ Bullying and Harassment We have a legal obligation under the Occupational Health and Safety Act 2004 to provide a workplace that is safe and free from discrimination, bullying and harassment. We are committed to ensuring we meet that obligation! Alleged incidents are investigated promptly and impartially. Our Policies underpin our commitment to ensuring that this Service is regarded as the employer of choice with a reputation as a safe and enjoyable workplace. 19 incidents were reported, investigated and resolved by mediation with no complaint substantiated. To reinforce our stance on this matter, workshops and counselling sessions were conducted by the Executive Director, Industrial Relations. 96% of staff participated in these sessions or in self directed learning about workplace bullying and harassment. Further education will take place next year. We have also implemented a zero tolerance policy regarding aggressive or violent behaviour by clients towards staff. Clients or visitors who display aggressive or violent behaviour are advised that future visits to the Service may be jeopardised if unacceptable behaviour continues. Staff are encouraged to report any breaches of this policy. Bullying and Harassment Staff to Staff No. of Incidents Fire Detection Systems False Fire Alarms An effective fire detection system is a key component in the safety of residents, patients and staff. An early warning system - the difference between life and death for those we care for and employ. Our facilities all have fire detection systems to alert staff and the Country Fire Authority (CFA) should a fire occur. False fire alarms occur for many reasons; dust, moisture, steam and even overcooked toast. Sometimes the reason for the false alarm is less apparent and demands investigation of the electronics of the systems. False alarms increased by 65% between and % of these were at Kaniva Hospital and Nursing Home - a core reason being obsolete and aged fire detection systems. The graph illustrates false fire alarms for the last three years. False Fire Alarms No. of Incidents Jul Aug Sep Oct During we: Nov Dec Jan > Successfully applied to DHS to upgrade fire detection infrastructure at Kaniva. Work to upgrade the system including integration of the nurse call system will occur in the second half of > Increased preventative maintenance programs ensuring smoke detectors remain dust free. > Rainbow and Jeparit Hospitals under eave detectors removed in accordance with Building Code of Australia stipulations. > Replaced the fire detection panel at Rainbow Hospital due to a power surge in April > Upgraded cabling and fire detection software at Nhill Hospital to ensure fire panels operate correctly and efficiently. > Hosted visits by the CFA to our sites for members to refresh their knowledge about layout and the location of fire fighting equipment. New regulations for regular checking of fire sprinkler systems are to be introduced. Engineering Staff will be trained to enable these checks to be part of the regular preventative maintenance program ensuring the system is functioning correctly at all times. Feb Mar Apr May Jun

38 36 WEST WIMMERA HEALTH SERVICE WE KEEP ON CARING FOR YOU ABOVE: Rainbow Hospital patient John Clarke returning home on the due day after successful discharge planning, is escorted to the car by his wife Fayisse and RN Div 2 Nurse Hannah Wedding. Admission and Discharge Planning The time we spend with our patients to plan for their admission and effective discharge from our health service back to their home is of utmost importance to their recovery and satisfaction with their ongoing care. All patients booked for elective surgery attend a Pre-Admission Clinic prior to admission to hospital.

39 QUALITY OF CARE REPORT 2008/ What happens at the Pre Admission Clinic? > The procedure is clearly explained and advice given about realistic expectations for recovery, proposed date of discharge and arrangements which will be made for this. Patients have the opportunity to ask questions and they receive an information kit containing pamphlets and brochures to refer to later. > Health screenings such as electrocardiography (ECG), blood glucose levels, temperature, pulse and blood pressure are completed. > Current medications are reviewed and advice provided should they need to be stopped prior to surgery. > Plans are made for rehabilitation after the surgery, which may include: > Physiotherapy pre and post operative exercises > Occupational Therapy equipment to increase independence in hospital and at home after discharge > Speech Pathology assists if swallowing difficulties are evident > Dietetics advice on appropriate diets pre and post operation > Community Health & Counselling assist with social issues that may impact on the patient s lifestyle dependent children or spouses. > Diabetes Educator monitors and recommends appropriate treatment for diabetic patients. > Pathology tests are explained and scheduled. > A reminder to cancel any community services patients are currently receiving. > A tour of the Hospital is offered for patients not familiar with the facility. We plan your discharge from hospital Planning for a smooth discharge begins at the Pre-admission Clinic for elective patients or on admission for all unplanned admissions. Our discharge plan ensures that patients are discharged with appropriate services in place to assist their recovery. We find the best community services for your recovery. All funding and care options are explored so our patients receive the community based services they require to recuperate. What Accreditation Surveyors say about our Admission and Discharge Planning ACHS Accreditation EQuIP 4 Survey November 2008 Planning for discharge begins prior to admission for elective surgery. The admission and discharge coordinator completes risk assessments to ensure that obstacles to discharge are managed proactively. Audits of discharge showed that 100% of patients receive discharge information. Community based services include a wide range of allied health and community nursing programs, with a clear focus on supporting clients to maintain and manage their health in the community setting. Continuity of care is a major focus of WWHS. Providing acute, community and aged care services, the Service is in a sound position to offer services that meet the needs of their communities and the dedication and commitment of staff is obvious. Sound systems exist for assessment, care planning and discharge. Ongoing care following discharge is well managed by the District Nurses and Community Options Packages (CACPs). Allied Health professionals consult many patients in an outpatient capacity for ongoing rehabilitation maintenance. These include: > Post Acute Care (PAC) - a range of communitybased services designed specifically on individual needs. The most common services provided are District Nursing, Home Help and Handyman arranged for the recuperative period. > Hospital In The Home (HITH) - hospital care in the comfort of your own home. Patients are regarded as hospital inpatients and remain under the care of their treating Medical Practitioner. > Hospital To Home (H2H) - short term community services to assist with recuperation following an acute hospital admission. > Aged Care Assessments (ACAS) - independent teams assess frail older people and their carers to identify the kind of care which best meets their needs. ACAS teams conduct comprehensive assessments for those needing community services or aged care residential placement.

40 38 WEST WIMMERA HEALTH SERVICE WE KEEP ON CARING FOR YOU BELOW: Dr Rob Grenfell visits Shirley Argent, a resident of Allan W Lockwood Special Care Hostel, Natimuk Improving Our Aged Care Services The Need A Geriatrician and Psychogeriatric Nursing Services We identified a gap in the Continuum Care of the Aged Residents with complex care needs or requiring expert attention have to endure a lengthy waiting time to attend a Geriatrician visiting the region or make a three hour trip for an appointment in a regional centre - neither was palatable in our mind! This is how we responded! Our Chief Executive Officer pursued the services of a Geriatrician and was successful in attracting Dr. Rosie Shea a Ballarat Geriatrician to visit monthly beginning in September Dr. Shea will: > Assess and assist with the management of Geriatric Evaluation and Management ( GEM ) patients who require a longer hospital stay. A multi disciplinary team work with patients to ensure every element of their care is considered. The care will now be supervised by Dr Shea and managed by the patient s General Practitioner. > Consult with residents in our aged care facilities and people still living at home to assist them manage their care when it becomes complex, a benefit for them and a great support for the medical practitioners responsible for their ongoing care. > Provide residents and their families with access to this previously denied speciality and remove the difficulties associated with the tyranny of distance. We have also been fortunate to obtain the service of a Psychogeriatric Nurse who will develop and evaluate care plans for residents in our Psychogeriatric and Dementia Residential Accommodation. This commitment will include staff training to ensure their skills are of the highest level. The outcome A new service a great achievement in improving the care for this vulnerable section of our community.

41 QUALITY OF CARE REPORT 2008/ BELOW: Lesley Robinson, Diabetes Educator and initiator of the insulin Pump Program, in her office at Nhill conducting a follow up consultation with a client in Stawell using the Medilink Videoconferencing Unit Lifestyle for Type 1 Diabetics A Revelation The Insulin Pump Clinic has been operating for 12 months. It was established to provide education and ongoing support for clients with Type 1 Diabetes wishing to use an insulin pump to improve the control and management of their condition. Continuous Control + Constant Management = reduced risk of the complications of diabetes such as blindness, kidney failure, amputation, heart attack and stroke. Looking after Type 1 Diabetes and maintaining a normal blood glucose level is a constant juggle of insulin, food and exercise. The insulin pump makes achieving this an easier proposition and reduces the need for multiple insulin injections. So far 8 clients are using insulin pumps and all have reported an improvement in the control of their diabetes and importantly their quality of life. A new client is introduced to this innovative program every 6-8 weeks. One client who began insulin pump therapy before her pregnancy recently delivered a healthy baby girl - an absolute achievement! We have improved ongoing support for clients by using the Medilink Videoconferencing Unit for follow up support and education after the therapy has commenced using new technology to overcome the barrier of distance experienced by many of our clients. The Medilink Unit has 2 cameras enabling us to view the client and the insulin pump much more clearly and provide more accurate advice than a normal videoconference unit. We will establish a continuous glucose monitoring service by purchasing a Continuous Glucose Monitoring System to further improve ongoing support for clients in the lifelong management of their diabetes. Clients who are having difficulty controlling their diabetes will wear the monitor for 3-6 days. It will record blood glucose levels every 5 minutes and when the data is downloaded it will reveal comprehensive information about blood glucose patterns and where problem areas are, making it much easier for the client and the doctor to adjust treatment to improve management of the disease.

42 40 WEST WIMMERA HEALTH SERVICE WE KEEP ON CARING FOR YOU Patient Stories The road from dependence to independence the story of Lois I struggled with poor vision for most of my adult life. I enjoyed reading and watching television, albeit with specially magnified glasses, activities which became impossible when a rapid deterioration in my sight occurred. I was referred to the Visiting Ophthalmology Specialist at Nhill Hospital, who recommended cataract surgery. I then attended the Admission and Discharge Clinic The Coordinator was most understanding and she answered my questions, set out a detailed itinerary of my stay and the recovery process and recommended I book into a nearby motel with my family for the night following surgery. After the surgery I awoke with a patch on my eye. The staff were all very kind and helpful. An appointment was made with the Specialist for the following morning and as suggested I booked into a nearby motel with my husband and daughter. We were amazed to discover that the ongoing care included nursing staff visiting me at the motel during the evening to monitor my progress and administer eye drops. They were very caring and reassuring. I felt safe. I can see! In the morning when the patch was removed I could see! The first thing I noticed were the lines on my face, and I saw my daughters face for the first time in years. I can again enjoy watching the football on television. I am less dependent on my daughter and I am thankful I can now see my grandchildren. My family and I are very grateful to West Wimmera Health Service. The hospital is excellent and the quality of care and attention of staff exceptional. I was a little apprehensive after the operation but it was marvellous to have qualified staff call on me and monitor how I was progressing. I will now return to have the cataract removed from my other eye. My husband has also been diagnosed with cataracts and has no hesitation following my footsteps.

43 QUALITY OF CARE REPORT 2008/ Roseanne A powerful story History Roseanne was involved in a car accident in Queensland over three years ago. The resultant physical and psychological trauma dramatically altered her lifestyle. She lives with constant back pain and restricted mobility, day to day activities and personal care are difficult and medication for pain management causes problems. Although he has health problems of his own, Roseanne s husband is a great support. Considering her future expectations, Roseanne would just like to be comfortable, have a little more independence, and most of all regain her self esteem. Before she arrived in Jeparit Roseanne had been pushed from one health care worker to another with little or no communication between them. When the Jeparit doctor referred her to a West Wimmera Health Service Counsellor she had few expectations. To her immense surprise this time her journey through the system, beginning with her doctor visit and referral to the Counsellor was smooth. The team of health professionals, including her doctor, consult with each other to plan each step of her rehabilitation. The Counsellor s weekly visits maintain constant communication and any needs are addressed immediately. Roseanne s steps to recovery > Roseanne consulted with the Doctor at Jeparit Hospital. > Doctor referred Roseanne to West Wimmera Health Service Counsellor. > Assessment by Counsellor. > Comprehensive plan set for continuum of care, in conjunction with GP. Strategy Client difficulty or need > consults Counsellor > recommended to West Wimmera Health Service Allied Health Practitioners > strategy for care > action > future plan. Actions > Diet lack of appetite Dietitian small meals and more often, quality of meals, food and medications, weight management. > Personal Care Occupational Therapist shower chair and other aids. > Personal Care affect of medication on hair arranged for hairdresser to visit. > Mobility Occupational Therapist pick up stick, blocks fitted to raise height of armchairs. > Back and leg pain Physiotherapist and Massage Therapist exercise regime agreed. There have been enormous improvements in Roseanne s daily life but there are challenges ahead. However Roseanne believes that with the support of her team of healthcare workers she will achieve some normality in her life. Future Plan To restore quality of life by providing stimulus and reassurance, continuing rehabilitation and working towards a quality outcome. Patient Satisfaction Roseanne can t speak highly enough of the care and support she has received. She is most grateful for the teamwork, which is the basis for her improvement, her inclusion in making decisions and the assistance given to her all of which has resulted in her positive outlook for the future. No longer is she a ball being bounced everywhere with no plan for the future. She has regained dignity, is grateful for the care she receives and is again able to respect and enjoy the values her life offers. We now look forward to Roseanne s return to full participation in community life. PAGE LEFT: Ophthalmologist Mark Chehade performing cataract surgery at Nhill Hospital

44 42 WEST WIMMERA HEALTH SERVICE WE KEEP ON CARING FOR YOU We Understand Our Communities and Which Groups Need Special Support Early intervention vulnerable children and families The importance of the early childhood prevention and early intervention programs is based on the premise that the first few years of a child s development are crucial in setting the foundation for lifelong learning, behaviour and health outcomes. Working With Our Young Families Our Maternal and Child Health nurse works closely with young families to ensure that parents are supported and infants and children receive the best care possible. Let s Make Tracks In March 2009, our Allied health team also embarked on the development and implementation of an early intervention program titled Let s Make Tracks. A multi-disciplinary team of professionals, inclusive of Counselling, Dietetics, Occupational Therapy, Physiotherapy, Podiatry, and Speech Pathology screened all kindergarten children across the Hindmarsh, West Wimmera and Yarriambiack Shires. An evaluation of the program is currently in place, with preliminary data suggesting that at least 20% of children screened were referred for further testing or therapy. ABOVE: Sarah White and baby son Riley visit the Maternal and Child Health Nurse Mandy Stephan.

45 QUALITY OF CARE REPORT 2008/ Supporting people with a disability Cooinda Disability Service focuses on ensuring people with a disability are supported to achieve their individual goals and dreams. Identifying how the Service can most effectively support our clients is a continually evolving process. Clients accessing Day Programs at Cooinda have Individual Support Plans developed. We work with each client to identify a variety of activities they wish to participate in which provide skill development for potential career paths, social interaction, increased health status, learning activities of daily living and importantly includes choices which the individual finds fulfilling and rewarding. Community integration is a primary focus for clients and outings ranging from grocery shopping, lunch in cafés, accessing recreation centres to participating in local community events creating involvement which assists with improving their communication skills, self-confidence and life skills in general. Through Cooinda we offer supported employment in our Enterprise Services - Oliver s Café, Oliver s Kiosk, the Duck Breeding Shed and Snappy Seconds quality clothing and collectibles. Supported employment enables people to gain training which can assist them to enter the workplace as an independent employee. Working in our Enterprise Services brings our clients into the community and has given them immeasurable satisfaction and confidence to participate in community events and social activities. They are a valued part of our community. ABOVE: Client Gary Allison, a dedicated gardener fertilising the vegetables in the market garden at Cooinda.

46 44 WEST WIMMERA HEALTH SERVICE WE KEEP ON CARING FOR YOU The Healthy Workplace Challenge Among our most successful Health Promotion activities is the Healthy Workplace Challenge organised by our Community Health Nurses. The Challenge involved 6 towns, 20 businesses and 275 participants. The main aim of the Challenge was to increase the awareness of the benefit of incorporating physical activity into our lifestyles. It was remarkable to witness that over the six locations there was a total weight loss of 301.9kg. An evaluation of the Challenge revealed that participants were satisfied with the Challenge and felt it had contributed to improved health status. Health Promotion the Process for People to Increase Control Over, and to Improve, Their Health The Community and Allied Health Professionals provide: Community Nursing, Counselling, Diabetes Education, Dietetics, Occupational Therapy, Physiotherapy, Podiatry, Speech Pathology and Welfare Work. Staff work together in a multidisciplinary environment to provide an holistic approach to the management of health. These professionals work in the Hospitals, Nursing Homes, Hostels, in the community and in homes. As well as clinical care, they also conduct Health Promotion activities. What is Health Promotion? The Ottawa Charter (1986) defines health promotion as: the process of enabling people to increase control over, and to improve, their health. To reach a state of complete physical, mental and social wellbeing, an individual or group must be able to identify and to realise aspirations, to satisfy needs, and to change or cope with the environment. Health is, therefore, seen as a resource for everyday life, not the objective of living. Health is a positive concept emphasising social and personal resources, as well as physical capacities. Therefore, health promotion is not just the responsibility of the health sector, but goes beyond healthy lifestyles to wellbeing. Healthy Workplace Challenge Evaluation Did you notice any benefits? Percentage Category % YES 87 NO 13 Do you think others should attend a program? Rating Category % ABOVE: Jeparit Strutting Strollers gathering for their regular walk. (L-R) Lauren Badua with son Marcel in stroller, Teresa Smith, Nicole Schneider (Community Health Nurse, Lowan Rural Health Network), Nicole Schumann with her children Alex and Crystal in stroller and big sister Kierra standing alongside.

47 QUALITY OF CARE REPORT 2008/ Nhill College Guys Group Another extremely successful program was the Nhill College Guys Group targeting males aged years focusing on Mental Health, Physical Activity and Healthy Eating, improving self-esteem and body image through discussion around issues including identity, bullying, belonging, qualities, strengths and emotional intelligence. An Occupational Therapist, Dietitian, Community Health Nurse teamed with a Senior Constable from the Victorian Police and the Student Wellbeing Manager from the Department of Human Services Grampians Region to deliver this program. A total of 27 students completed the program of a 1 hour weekly session throughout the duration of a term with 24 evaluations received indicating the success of the program. Our Assessment Has your self esteem improved? Category % Yes 96 No 4 How much has your self esteem improved? Category % A little 28 More than a little but not a lot 44 A lot 24 None 4 Do you think you can maintain these changes? Category % Yes 60 No 4 Don t Know 8 Maybe 16 No Response 12 Do you think others should attend a program? Category % Yes 68 No 0 Maybe 32 We will evaluate the responses to decide if we will continue with the program or if changes are needed. Health Screenings at Agricultural Shows Lowan Community Health Nurses attended agricultural shows at Rainbow, Jeparit and Nhill to conduct health screenings. Obvious, Valuable Assessments Total Male Female Venue Rainbow Jeparit Nhill 208 blood pressure screenings were conducted, utilising the Stroke Foundation Know Your Numbers program. 197 Blood Sugar Levels tests were also performed. 55 participants were referred to their doctor with elevated blood pressure. An increase in elevated blood pressure may be related to the impact of the current drought conditions as many males said that rain would reduce their BP! Health Promotion planning for West Wimmera Health Service acknowledges that the most effective Health Promotion Plans are developed in partnership with other groups. Therefore, we have committed to planning for the next three years in conjunction with the Wimmera Primary Care Partnership, and Local Government Councils. The Priority Areas determined for the Wimmera Region are Social Connectedness and Physical Activity, and we will divert our health promotion resources to these areas.

48 46 WEST WIMMERA HEALTH SERVICE WE KEEP ON CARING FOR YOU WWHS Health and Fitness Centre In December 2008, the Service took over the management of the Nhill Gymnasium from Nhill College, and is operating as the WWHS Health and Fitness Centre. Membership numbers have increased from 12 in January to 418 in June and our Physiotherapists, Exercise Physiologists and Fitness Instructors have commenced health and fitness programs. WWHS Health and Fitness Centre Patronage 500 No. of Patrons Jan Feb Mar Apr May Jun The Health and Fitness Centre will work toward achieving better health outcomes by utilizing a holistic and individual approach. The Centre will be fundamental to the Physical Activity component of the Health Promotion Plan. Partnerships The Lowan Rural Health Network supports Health Promotion in the Hindmarsh and West Wimmera Shires. Community Health Nurses, an Exercise Physiologist and Social Worker provide activities addressing chronic diseases such as cardiovascular disease, diabetes management and mental health. We have a strong relationship with Wimmera Primary Care Partnership which has members from organisations across the region working together to enhance health promotion and chronic disease pathways. Conclusion A comprehensive team of allied and community health care professionals work as an interdisciplinary team to improve quality of life for patients, enhance recovery time and assist clients to remain at home for longer. Future directions ABOVE: Sharon Bone (right), member of WWHS Health & Fitness Centre receives some good advice from Exercise Physiologist Tracey Bell (left). PAGE RIGHT: Josh Rintoule, Trainee Administration Clerk (front), Cassy Moar, Assistant Accountant (centre), and Richard Lane, Accounts Payable Officer (at rear) during training for the new PayGlobal Human Resource Self Service (HRSS) payroll system. > We will work with the community, local government and industry to complete the Health Promotion Plan focusing on Physical Activity and Social Connectedness. > The opening of a Community Hub will increase access to mental and physical health services.

49 QUALITY OF CARE REPORT 2008/ EDUCATION ONE OF THE KEYS TO OUR QUALITY SERVICES WWHS Trainees We employ over 500 people and regularly offer traineeships in a variety of disciplines including nursing, personal caring, medical records, finance and administration. A traineeship provides the trainee an opportunity to decide whether they have a long term future in a particular field while providing them with valuable experience in the world of work. The financial cost is relatively small but we do not consider trainees to be a source of inexpensive labour, rather an opportunity to gain and retain qualified future employees who will remain with the Service in the medium to long term which indeed has been the case for the majority of our trainees. Trainees are fully oriented into the Service and are gradually entrusted with increasing levels of responsibility as they take on new skills and knowledge. Traineeships provide assurance that newly qualified employees are already aware of the Service s safety and quality requirements reducing the likelihood of workplace accidents and impaired service quality at the beginning of their full time employment. Our trainees are often local young adults allowing them to remain in their rural community amongst family and friends as further support to that provided by West Wimmera. Josh s Story With an interest in accounting subjects at school, I chose my career path. The Year 12 Coordinator mentioned a Traineeship in Finance and Administration was being offered by West Wimmera Health Service. I was looking for something to fill in my gap year before going to University so following discussion with my parents, I applied for the position and proceeded through the interview process. I was fortunate to gain the 18 month Traineeship and planned to complete the course in just 12 months and go on to University. My role includes Payroll and Reception duties and I appreciated the opportunity to spend time in the Accounts Payable discipline. My days are busy, and I enjoy the variety of positions and the challenges they bring, there is no chance of boredom! The staff are always very supportive and encouraging, enabling me to gain confidence in what I do. My traineeship allocates four hours weekly to complete my Work Book, but sometimes this is difficult because of my rostered positions. I enjoy my job and now should I be given the opportunity to stay on at West Wimmera Health Service, I would and continue studying part time, eventually becoming a qualified accountant.

50 48 WEST WIMMERA HEALTH SERVICE EDUCATION ONE OF THE KEYS TO OUR QUALITY SERVICES Learning An Opportunity The versatility of our staff and their commitment to continual learning is at the heart of the quality of our care and the emphasis on continual improvement in our programs, and in fact every facet of the Service, which is beneficial in the following ways: > Trainees graduating from their Traineeships to become permanent members of the West Wimmera Health Service team. > A General Services worker graduating as a Division 2 Nurse. > General Services staff graduating as Personal Care Workers. > Division 2 Nurses studying to become Division 1 Nurses. > Division 2 Nurses undertaking training to have the qualifications to work in the Dialysis Unit. > Division 1 Nurses undertaking management training and study. > Board Members undertaking Australian Institute of Company Directors Courses. > Occupational Health and Safety courses being undertaken. All this as well as participating in West Wimmera Health Service mandatory education modules, department specific upgrades and training, elearning, clinical research and the multitude of further education organised by the Education Co-ordinator and external course providers. Mandatory education includes a significant focus on Infection Control education to ensure all staff gain an understanding of Infection Control principles ranging from hand hygiene, special cleaning, isolation, protective clothing to the special requirements of patients to minimise infection. Never has this Service experienced such a thirst for further education and importantly never has there been such a need to be at the cutting edge of learning. Online Learning A new and exciting development in the way our employees learn was unveiled this year. All staff within West Wimmera Health Service can now access a myriad of education modules using the technology of the internet. Online learning is a different experience from learning in the classroom with a teacher and has the benefit that it can be undertaken at the students pace in their own time. Our staff have continued to embrace online learning since its launch in January 2009 over 190 individual education sessions have been completed. 85 different staff have participated and we expect this number to increase over the next 12 months as awareness of its availability grows. Each workplace has a number of computers available for online education and it is also available for home access. Participants receive a certificate of achievement upon successful completion of the course and the information is recorded in their personnel record. 100% of the eighty five staff who have participated have passed their courses. Online learning is very effective, cost effective to provide and very accessible. E3 Learning 2009 E3 Learning Participants by month Jan Feb Mar Apr May Jun Basic Life Support Manual Handling Elder Abuse Office Ergonomics IV Cannulation

51 GLOSSARY & INDEX Admission The process whereby a patient enters the organisation for an episode of care. Best Practice Measuring results against the best performance of other groups. Catchment Geographical area for which West Wimmera Health Service is responsible for providing health services. CFA Country Fire Authority DHS Department of Human Services Discharge Process whereby care is completed and the patient/client leaves the organisation. GP General Practitioner (Doctor) IBC / IFC Inside back/front cover Medical Record Compilation of a patient/client medical treatment history Needlestick Injury Skin is accidentally punctured by a used needle. Outcome The result of a service provided. Patient/Client/Consumer A person for whom this Service accepts the responsibility of care. Standard Level of performance to be achieved. The Service West Wimmera Health Service VICNISS Hospital Acquired Infection Association VPSM Victorian Patient Satisfaction Monitor WWHS West Wimmera Health Service Aboriginal Accreditation Acute beds Admission & Discharge , 40 Adverse Events Aged Care Assessments Aged Care Standards & Accreditation Agency Aggression Allied & Community Health AS/NZS 4360: Audit Committee Australian Council on Healthcare Standards Black Saturday Blood Blood & Body Fluids Board of Governance Bullying Cataract Surgery , 40 Chief Executive Officer Chronic Disease Cleaning Audits Client stories , 41 Clinical Governance Clinical Quality & Safety Committee... 26, 29 Clinical Risk Framework Community Advisory Committees Community Aged Care Packages , 15 Complaints Compliments Consent Continuous Improvement Contributors Cooinda Counselling Credentialing Cultural Diversity Dental Care Dental Therapy Diabetes Educator , 39 Diagnostic Imaging Dietitian Dimensions of Quality Accreditation Credentialing & Scope of Practice Infection Control , 17,19 Medication Management Pressure Wound Monitoring Falls Monitoring Compliments & Complaints , 24 Security Dental Care , 25 Clinical Governance , 27, 28 Managing Quality Risk Management Safe Cataract Surgery Consent Medical Record Management Manual Handling Right Side Right Procedure Managing Patient Aggression Blood - Your Safety Bullying & Harassment Fire Detection Disability Services , 43 District Nursing Diversity Focus Group Diversity Plan Early intervention Education , 48 Engineering & Maintenance EQuIP Falls Fire alarms Gastroenteritis Geriatrician Goroke Guys Program H1N1 Influenza Hand Hygiene Health & Fitness Centre Health Promotion Hepatitis B Home & Community Care , 7,19 Hospital in the Home Hospital to the Home Hospitals Incident Reporting Infection Control Influenza Vaccinations Insulin Pump Clinic Internal Auditor Report Interpreter Service isoft Jeparit Kaniva Manual Handling Maternal & Child Health Maternity Services Medical Records Medical services Medication Medications Medilink Mission IFC Natimuk National Respite for Carers Needlestick injury Nhill Nhill College , 46 Nursing Homes Occupational Therapy Online Learning Operating Suite Ophthalmology Ottawa Charter Patient Management Software Performance Review Committee Pharmacy Physiotherapy Podiatry Post Acute Care , 37 Pre Admission President Pressure Wounds Rainbow Reader response Right side Right procedure Risk Management ,29,30 Satisfaction Survey Security Services Skilled migration Speech Pathologist Standard Precautions Swine Flu Torres Strait Islanders Trainees Type 1 Diabetes Values IFC VICNISS Victorian Managed Insurance Authority Victorian Patient Satisfaction Monitor Videoconferencing Vision IFC Vulnerable groups Waste Management Weekly Advertiser WorkCover Workplace Challenge WWHS Health & Fitness Centre Please use, re-use & recycle.

52 About this Report West Wimmera Health Service is a complex organisation. We are care givers, we are business managers, we are forward planners, we are employers, we are stimulators of the local economy. It is an extensive list of activities and responsibilities and every single endeavour represented is directed towards people the people of the diverse communities in North West Wimmera. NHILL Nelson Street Nhill Victoria 3418 T (03) F (03) KANIVA 7 Farmers Street Kaniva Victoria 3419 T (03) F (03) COOINDA Queen Street Nhill Victoria 3418 T (03) F (03) NATIMUK 6 Schurmann Street Natimuk Victoria 3409 T (03) F (03) Rainbow NSW GOROKE Natimuk Road Goroke Victoria 3412 T (03) F (03) JEPARIT 2 Charles Street Jeparit Victoria 3423 T (03) F (03) RAINBOW 2 Swinbourne Avenue Rainbow Victoria 3424 T (03) F (03) corporate@wwhs.net.au SOUTH AUSTRALIA Jeparit Nhill Kaniva Goroke Natimuk Horsham Ararat Ballarat Melbourne