Western NSW LHD Organisational Structure

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1 Newsletter: 184/2013 Date: 26 th June, 2013 Distribution: All Public Hospital S/B Community & Non S/B Facilities Western NSW LHD Contact: Organiser Zelda Giblett Western NSW LHD Organisational Structure Dear Member, Please find attached the Western NSW Local District revised organisational structure along with correspondence from the WNSWLHD explaining proposed changes. Should you have any queries or concerns regarding this documentation please contact your organiser Zelda Giblett via by close of business on Friday 12 th July 2013 and she will raise your issues with management. Please also indicate if you are prepared to participate in a union specific consultative committee (USCC) meeting regarding your concerns should such a meeting be required to be held. All sub-branches are asked to provide this information to their members for their comment. Yours sincerely Gerard Hayes Secretary - HSU NSW Attach.

2 Organisational Structure 11 June 2013 Introduction The purpose of this paper is to outline modifications to the organisational structure of the Western NSW Local District (District). The District was formed on the 1 January 2011 and is one of the largest rural health districts in NSW. The population is dispersed across 246,676 square kilometres including 23 local government areas. There are 63 Community Centres, 38 inpatient facilities including Multipurpose and District at Mudgee, Cowra and Lachlan Service for Parkes and Forbes. There are three major rural referral hospitals, Orange, Dubbo and Bathurst. Executive Structure The executive structure has been revised to ensure strong leadership is provided to improve health outcomes and develop a robust high performing organisation. There were a couple of critical issues that needed to be addressed: 1. The significant number of direct reports to 2 positions being Director, Operations and Acting Manager, Rural Operations, the number of direct reports was not sustainable for a high performing organisation 2. The need to provide increased support to rural & remote clinical services throughout the District, with the aim of providing care as close to home as possible in a large rural and remote District. The changed Executive Leadership Team (ELT) structure has flattened the previous structure, and enabled a decrease in senior management positions. There has been an increase to the number of positions reporting to the Chief Executive (CE) through allowing the Director, Operations position to be more streamlined. The new positions reporting to the CE include: Director, Integrated Primary Care & Partnerships - Julie Cooper. This position has been renamed and previously reported to Director, Operations and is being escalated to the ELT given the opportunity for Primary Care Reform Director Corporate - Jeff Morrissey. This position has been renamed is being escalated to the ELT given the priority for Corporate to support clinical service delivery Director Workforce & Culture - Sandra Duff. This position has been renamed and is being escalated to the ELT given the urgency to stabilise the workforce, plan future workforce needs and improve the culture of the organisation Director Communication & Engagement - Rebekah Bullock. This position has always reported to the CE, is being renamed and is considered a critical part of the ELT. The Director of Clinical Operations is currently vacant; an international recruitment process is underway. Reporting to the Director, Operations will be: General Manager, Northern Sector (Rural ) General Manager, Southern Sector (Rural ) General Manager, Dubbo Service General Manager, Orange Service General Manager, Bathurst Service Director, Mental General Manager, Imaging Manager, Organisational Performance Western NSW, Living Well Together

3 Manager, Patient Flow Manager, Planning Chief Information Officer To ensure the ELT becomes a high functioning team and the organisation delivers on our strategy, the main responsibility of all Executive Divisions is to support the delivery of clinical operations in a customer / provider partnership. This means that all Divisions should regularly test out priorities of the services within clinical operations and align their priorities to ensure that the relationship is delivering value. New Sector Structure Over the past 18 months, a number of proposals have been developed to improve the level of support and leadership for the Rural across the District. Unfortunately due to the changes in Chief Executive, none of these options were fully implemented, the operational managers and clinical leaders supporting these services have provided good leadership and support in difficult circumstances that have stretched on for a long period of time. To remedy this issue, the two geographic Sectors have been developed to provide robust support and leadership to rural & remote which comprise community health services, district and community hospitals and multi-purpose services. Each Sector will have a General Manager, this role includes responsibility for: Operational implementation of the strategic direction Service delivery spanning from primary health care to inpatient acute services Quality and safety care Performance management of the Sector Financial management Activity management Developing a culture based on the CORE Values and general staff management Communication and engagement of all stakeholders An important role of this position will be the management of relationships with the community, other Agencies and providers, between Sectors and with Clinical Networks. The boundaries of the 2 Rural Sectors have been based on established patient flows whilst attempting to ensure roles are of a manageable size, the Service groupings are: Northern Sector: Goodooga, Lightning Ridge, Collarenebri, Brewarrina, Bourke, Coonamble, Cobar, Nyngan, Gulargambone, Baradine, Coonabarabran, Warren, Trangie, Gilgandra, Narromine, Dunedoo, Coolah, Peak Hill, Walgett and Wellington. Southern Sector: Tullamore, Gulgong, Mudgee, Rylstone, Condobolin, Tottenham, Trundle, Parkes, Forbes, Cudal, Molong, Eugowra, Canowindra, Grenfell, Cowra, Blayney and Oberon. Acting Arrangements for the 2 Sector General Manager Roles will be: Joy Adams will act in the Northern Sector, General Manager s role Sharon McKay will act in the Southern Sector, General Manager s role These positions will commence recruitment in August It is expected that the Northern Sector General Manager s role will be jointly held by the District Director, Nursing & Midwifery to provide an operational focus for this role. CORE Values: Collaboration, Openness, Respect & Empowerment Page 2

4 These roles will be a leadership and support role for the many rural health services. The Service Manager roles in this are critical to better define expectations, provide support and develop capabilities. Service Manager s responsibilities The following information is provided in support of integrated local health services where all staff are managed through the Service Manager who is accountable for the improving health outcomes of the community: Service Managers in rural communities need to have operational responsibility for all aspects of their local service delivery as they are perceived to have this accountability by the local community. Service Managers can make decisions about budget expenditure and increasing expenditure on community health if they have the budget and operational accountability. Service Managers who may have focused mainly on the inpatient component of their service delivery can develop a more wholistic view of health service delivery when held accountable for all aspects of health care in their local community. Support for General Manager & Service Manager Roles Clinical service managers require timely and accurate clinical and business information and support to allow managers and clinical leaders to function effectively. This should include quality, financial and human resources support and needs to be done within current resources which may mean that a full FTE is not allocated to each service and may need to be shared: A Quality Manager will be allocated to each Base Hospital / Sector. How this works will need to be continually reviewed as Clinical Networks evolve and take on greater accountability for clinical quality. Accreditation processes should be reviewed and the interface between Networks and Sectors defined. Medical administration support will be provided by the DMS for each Base Hospital / Mental, the District DMS will provide support to the 2 Rural Sectors in addition to providing leadership and support to other DMS s. A Business manager will be allocated to each Base Hospital / Sector. A Human resources consultant will be allocated to each Base Hospital / Sector, although may not be a dedicated full FTE Administrative support for the Sector GM will be required, this position can also provide administrative support to the Sector services for whole of Sector issues. Clinical Networking Clinical Networks will be developed for a number of clinical conditions and/or population groups, they will not generally deliver clinical services and will provide strategic direction, professional support and guidance around clinical standards. There needs to be a clear indication of which staff are operationally accountable to Network leaders and which staff are operationally accountable to HSM / GM s with a clinical accountability to network leaders. A number of principles will be further developed: 1. The more isolated a health service is, the more likely it will be that local staff are locally managed, with clinical and policy accountabilities to the relevant Clinical Networks. 2. The roles and functions and responsibilities (financial, human resource and service delivery) of the Network, Cluster and local managers need to be clearly defined. 3. The face of the health service in the local community needs to be clearly identified to avoid confusing community members as the first priority this should be the Service Manager or Sector General Manager. CORE Values: Collaboration, Openness, Respect & Empowerment Page 3

5 4. The site Service Manager or General Manager will have accountability for the safety and security of all staff working on-site and will need to be fully informed of issues, staff movements and service delivery decisions in order to properly co-ordinate the activities of the health service across a site or Sector. 5. Given that Clinical Networks will evolve at different rates, any structure needs to be flexible enough to accommodate the changing accountabilities between operational management and network leadership for individual staff and clinical performance. 6. Structures will need to recognise the different business of community-based, emergency, inpatient, and aged care residential services within the one location. The complexity and staff support roles of community-based services needs to be recognized both by Network and Sector managers and adequate infrastructure established or maintained. Principles for patient flow and partnership accountability It is critical that organisational structures and geographic lines on a map do not impede best practice clinical service delivery and patient flow, any clinical staff or managers that do not act with patient best interest in mind and the CORE Values will be held accountable. To ensure that this patient flow improves, it is critical that Sector General Managers, Base Hospital General Managers and Director, Mental form a close partnership to: Remove all barriers to the flow of patients in both escalating care and ensuring that as soon as possible, patients are transferred as close to home as possible for the remainder of their care Ensure strong relationships are developed at all levels within the management and clinical leadership structure and issues can be resolved without needing intervention from the Director, Operations or Chief Executive. Ensure organisational structures do not impede staff providing a clinical service or professional support across boundaries. This should apply in particular to outreach clinicians and regional roles including CNC s if there has been a relationship established over a number of years, this should continue. There has been a trend develop when a workforce shortage occurs in a team, the first thing to be impacted is outreach or rural support, this needs to be reversed, outreach services are to become the priority and only reduced when all efforts to realign services have been exhausted. Ensure that a consistent, partnership approach is visible with Local Councils, MP s and other government agencies, any issues need to be respectfully resolved within the CORE values of the organisation. CORE Values: Collaboration, Openness, Respect & Empowerment Page 4

6 DRAFT FOR CONSULTATION Organisational Chart Directorate: Chief Executive Chief Executive Reports to: Board Board Audit Chief Executive Scott McLachlan Executive Office Support Director Operations Vacant Director Integrated Primary Care & Partnerships Julie Cooper Director Population Thérèse Jones Director Corporate Jeff Morrissey Director Finance Geoff Hanson Director Workforce & Culture Sandra Duff Director Communication & Engagement Rebekah Bullock Director Clinical Governance Di Wykes Director Nursing & Midwifery Joy Adams Director Medical Clayton Spencer Director Allied Richard Cheney -Bathurst -Dubbo -Orange -Northern Sector -Southern Sector -Mental -Patient Flow -Information Technology -Medical Imaging -Organisational Performance Improvement -Clinical Redesign -Planning - Oral - Rural Service Development & Coordination - ACAT & Aged Care - Aboriginal - Specialist Outreach (MSOAP) - HACC - DVA Community - Partnerships & Integrated Chronic Care - Children, Families & Young People - Ethics & Research Governance - Epidemiology Research & Evaluation - Immunisation - HIV/AIDS & Related Programs - Promotion - Environmental - Communicable Diseases - Maintenance - Asset - Purchasing & Supply - Biomedical - PPP - Fleet - Corporate Records -Property - Contracts -Security - Environmental / Fire - Capital Works - Energy - Accounting - Revenue Strategy - Financial Accounting - Human Resources - Recruitment - Workplace Culture - Workforce Systems - Industrial Relations - Risk - Education & Training - Employee Assistance Program - Corporate communication - Public Relations - Media engagement - Community Engagement - Ministerial Liaison - Intranet and Internet development - Volunteers - Fundraising - Patient Safety - Clinical Risk - Quality - Accreditation - Complaints - Practice Improvement - Patient Experience - Nursing Policy and Practice - Nursing Initiatives - Emergency Unit - Nursing Transition Program - Infection Control - Maternity - Medical Administration - Appointments / MAADAC - DMS Leadership - Clinical Network Leadership - Allied Workforce strategy - ACI Rural strategy - Sub Acute Service Development - Multicultural Policies & - Disability Policies and - Cancer - Policy & Guidelines - Allied Advisors - Pharmacy Version 4 24 Jun 2013 Clinical Networking Strategy will be developed in coming months and an Executive member will take the lead on each network.